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last min GI anatomy
| Question | Answer |
|---|---|
| falciform ligament | runs from liver to umbilicus |
| falciform ligment contents | ligamentum teres - the umbilical vein remannt |
| hepatoduodenal ligament | segment of lesser omentum, runs from the porta hepatis (liver) to duodenum |
| hepatoduodenal ligament contents | portal triad - proper hepatic artery, portal vein, and CBD |
| may be ompressed between thumb and index placed in omental foramen to control bleeding | hepatoduodenal ligament |
| connects greater and lesser sacs | hepatoduodenal ligament |
| gastrohepatic ligament | also part of lesser omentum. Connects medial liver to stomach |
| gastrohepatic ligament contents | gastric vessels |
| separates right greater and lesser sacs | gastrohepatic |
| may be cut during surgery to access lesser sac | gastrohepatic |
| gastrosplenic ligament | part of greater omentum. connects greater curvature of stomach to splenic hilum |
| contains the short gastrics | gastrosplenic |
| separates left greater and lesser sacs | gastrosplenic |
| splenorenal | spleen to posterior abdominal wall |
| contains splenic artery and vein | splenorenal |
| gastrocolic | contains gastroepiploid arteries |
| gastrocolic connection | greater curvature and transferse colon - part of greater omentum |
| foregut | celiac artery. Bracnhes: left gastric, common hepatic, and splenic |
| includes liver/gallbladder and pacnreas (via branches of the common heaptic artery) | foregut |
| stomach receives arterial blood from: common hepatic (via right gastroepiploic), splenic, and left gastric | foregut |
| stomach connected to splenic by? | short gastrics and left gastroepiploic |
| stomach connected to common hepatic by? | right gastroepipolic |
| pain in right upper quadrant radiating to right shoulder region | irritation of liver on phrenic nerve |
| liver stroma consists of? | reticular fibers type 3 collagen |
| liver borders | stomach on left, gallbladder and small intestine blelow, diaphrgam above, kidney and pacnreas behind/below |
| left lobe contains the? | falfiorm ligament and the ligamentum teres 9remnant of left umbilical vein) |
| stellate ito cells | store lipid soluble vitamins (vit A) and fat. Secrete extracellular matrix components -> hepatic fibrosis in cirrhosis |
| kupffer cells | monocyte/macrophage cells. First line against infection or toxins |
| endothelial cells of liver | fenestrated and lack basement memebrane -> maximal exposure of hepatocytes to portal blood |
| zone 1 | portal triad. highly oxygenated, carries out processes needing oxygen (beta oxidation of FA,ccholesterol synthesis, gluconeogenesis) |
| zone 3 | poorly oxygenated, P450, lycolysis, lipogenesis |
| centrilobular necrosis | zone 3 |
| periportal fibrosis | zone 1 |
| affected first by viral hepatitis | zone 1 |
| affected by ischemia, alcoholic hepatitis, toxic injury | zone 3 (ventral vein) |
| flow of blood | to central vein (zone 3) |
| flow of bile | to portal triad (zone 1) |
| contraction of taenia coli? | causes haustra. Colonic mucosa. It is not continuous, but broken up into bands |
| distal colon supplied by? | IMA via left colic, sigmoid, superior rectal arteries |
| proximal colon supplied by? | SMA via middle colic, right colic, and ileocolic arterise |
| ileum blood supply | branches of the SMA and drains into the portal venous system |
| ileum histo? | short vili and smaller or absent plicae circularis, peyer's patches in lamina propria |
| peyerls patches in GI infection? | become hyperplastic -> can cause intussusception |
| ileostomy | bypasses the hindgut by creating a hole in the abdominal wall that drains ileum |
| jejunum | abdundant plicae circularis, long thing vili to maximize absorption |
| jejunum supply? | brainches of superior mesentaric artery and drains in to the portal venous system |
| first part of duodenum | first 2 cm are intraperitoneal, rest are retro; overlies the common bile duct and gastroduodenal artery. The hepato duodenal ligament and greater omentum attach here |
| 95% duodenal ulcers in superior part of duodenum | clinical correlate |
| descending 2nd part duodenum | received common bile duct and main pancreatic duct at vater |
| 3rd part of duodenum | L3, anterior to IVC and aorta, posterior to SMA |
| which portion can be crushed against the spine with blunt abdominal trauma | horizontal portion of duodenum (3) |
| ascending 4th part - | ligament of treitz |
| brunner's glands | duodenal submucosa 0- secrete Hco3 |
| supply of 1and 2 of duodenum | superior pancreaticoduodenal artery (branch of gastroduodenal artery from the common hepatic artery) |
| distal parts of duodenum supply? | inferior pancreaticoduodenal artery - branch of the SMA |
| hypertrophy of brunner's glands? | peptic ulcer disease |
| villi of small intestine consist of? | enterocytes- absorb nutrients; goblet cells -secrete mucus; enteroendocrine cells: regulate digestion |
| base of villi of small intestin | crypts - contain paneth cells and undifferentiated cells |
| paneth cells | secrete lysozyme, antimicrobial products (defensins), and immunomodulatory factors -> mucosal defense |
| plicae circularis | folds of mucosa and submucosa that increase SA |
| fundus of stomach | above GE junction |
| cardia | closest to the GE junction |
| pyloric stenosis | non-bilious vomitng, young male infant |
| gastric rugae | large longitudinal folds of mucosa |
| hypertrophied gastric rugae | menetrier's disease (hyperplasia of gastric mucosal cells) |
| menetrier's disease | protein loss, parietal cell atrophy, increase mucous cells. Precancerous. |
| decreased plasma protein levesl | Menetrier's disease; childhood form assiceated with CMV infection; increased gastric cancer risk |
| similar to celiac sprue but can affect entire small bowel | tropical sprue |
| whipple's disease | foamy macrophages arthralgias, cardiac, CNS problems, diarrhea, generalized lymphadenopathy, increased skin pigmentation, fever, oculomastictory myohrthmia |
| celiac sprue affects which area? | distal duodenum, proximal jejunum - folic acid |
| hlA DQ2 | celiac sprue- present gliadin to Th cell |
| osmotic diarrhea | lactase deficiency |
| lactose tolerance test | positive if glucose rises <20 produces symptoms with giving lactose |
| abetalipoproteinemia | decreased synthesis of apo B -> inability to generate chlomicrons -> decreased secretion of cholesterol, VLDL into bloodstream -> fat accumulation in enterocytes. |
| presentation of abetalipoproteinemia | early childhood with malabsorptio and neuro defects |
| population affected with Whipple's | older men |
| pancreatic insufficiency causes | cystic fibrosis, obstructing cancer, chronic pancreatitis |
| increased neutral fat in stool | pancreatic insufficiency |
| acanthocytes | abeta lipoproteinemia, liver disease |
| congenital pyloric stenossi | nonbilious projectile vomiting at 2 weeks |
| duodenal atresia | bilious vomiting within 38 hours of birth |
| chronic adult form | chronic pyloric ulceration -> scar tissue obstructin/constricting pyloris |
| cyanosis, choking, and vomiting with feeding, air bubble in stomach on CXR, polyhydramnios, failure to pass NG tube into stomach, pneumonitis | TE fistula |
| rostral fold closure failure in abdominal wall | sternal defects |
| lateral fold closure defect | omphalocele, gastroschesis |
| caudal fold closure | bladder exstrophy |
| failure to recanalize (trisomy 21) | duodenal atresia |
| jejunal, ileal, colonic atresia | due to vascular accident (apple peel atresia) |
| 6th week midgut development | midgut herniates through umbilical ring |
| 10th week midgut development | returns to abdominal cavity and rotates around SMA (counterclockwise 270) |
| extrusion of abdominal cavities NOT covered by peritoneum, increased AFP | gastroschesis |
| persistence of herniation of abdominal contents into umbilical cord covered by peritoneum | omphalocele |
| pancreas derivation | endoderm derived from foregut |
| formation of pancreas? | dorsal and ventral pancreatic buds contribute to the pancreatic head and main pancreatic duct |
| uncinate process of pancreas? | ventral bud alone |
| dorsal pancreatic bud | becomes everything else- body, tail, isthmus, accessory pancreatic duct |
| annular pancreas | ventral pancreatic bud abnormally encircles 2nd part of duodenum; forms a ring of pancreatic tissue that may cause duodenal narrowing |
| pancreas divisum | ventral and dorsal parts fail to fuse at 8 weeks |
| esophageal hiatal hernia | newborns present with frequent projectile vomiting when the infant is laid on its back after feeding |
| heart sounds heard on rigth side of chest, respiratory distress, bowel in lung fields on chest x-ray | left posterolateral congenital diaphgramatic hernia |
| angioddysplasia | 20% of all GI bleeds; most common in ascending colon, terminal ileum, or cecum; elderly |
| increased risk in development of angiodysplasia in pateints with? | ESRD, vWD |
| cecum has the largest diameter thus develops? | greatest wall tension |
| absent meissner's 9submucosal) and auerbach's (myenteric) plexus | hirschsprung |
| occurs with ulcerative colitis, C.diff colitis, Chagas disease | toxic megacolon (nonosbrtuctive colonic dilatiation + systemic toxicity) |
| infection of trypanosoma cruzie lead to? | loss of ganglia -> toxic megacolon |
| how does C. diff toxin work? | Exotoxin A = inflammatory response; Exotoxin B. destroys epithelial cytoskeleton |
| polyps in small intestine, hamartomatous polyps, mucocutaneous hyperpigmentation | Peutz jeghers |
| increased risk of colon, pacnreas, breast, lung, ovarian, uterine, and testicular cacner with? | Peutz jeghers |
| juvenile polyposis | child <5; rectum polyps, rectal bleeding |
| sawtooth appearance, hematochezia | colonic polyp |
| 90% are nonneoplastic | colonic polyps |
| most common nonneoplastic polyp | hyperplastic polyp |
| often asymptomatic; lower GI bleed, partial obstruction, secretory diarrhea | polyp symptoms |
| precancerous polyps, | adenomatous polyps. VILlous = villanous bad |
| macrocephaly, intestinal hamartomatous polyps, benign skin tumors, hemangiomas, lipomas | Cowden syndrome PTEN tumor suppressor gene |
| not at increased risk for GI malignancy | Cowden syndrome and Bannayan ruvalcaba riley syndrom |
| cronkite canada syndrome | hamartomatous polyp syndrome that is not hereditary and develops after age 50. LATE AGE OF ONSET, polyps throughout GI |
| inflammation of esophageal myenteric plexus | achalasia |
| increased risk of esophageal squamous cell cancer | achalasia, alcohol, cigarretes, esophgeal web |
| cant swallow solids AND liquids | achalasia, MG, stroke, CREST syndrome |
| cant swallow solids | obstruction, esophgeal web, cancer |
| secondary causes of achalasia | chagas, diabetic neruopathy, esogephal CA, infiltrateive disorders such as maglinancy, amyloidosis, sarcoidosis |
| dilated veins in submucosa of distal esophagus and proximal stomach | esophageal varices |
| tx of esophageal varices | beta blockers |
| retinal hyperplasia, which cancer? | Gardner's syndrome = FAP + osseous and soft tissue tumors, retinal hyperplasia |
| turcot's syndrome | FAP + CNS tumor |
| Proximal colon involvement | HNPCC |
| DNA mismatch repair gene colon cancer | HNPCC |
| cancer area risks | rectosigmoid > ascending > descending |
| ascending colon cnacer presentation | exophytic mass, iron deficiecny, weight loss |
| descending resentation | infiltrating mass, partial obstruction, colicky pain, hematochezia |
| dense core bodies on EM | carcinoid tumor |
| biopsy contraindicated because of risk of hemorrhage | cavernous hemangioma |
| benign liver tumor, soft blue compressible masses | cavernous hemangioma |
| increased incidence with hep B, C, WIlson's hemochromatosis, alpha 1 antitrypsin def, cirrhosis, aflatoxin from aspergillus | HCC |
| increased AFP, jaundice, tender hepatomegaly, ascites, polycythemia, hypoglycemia | HCC |
| may lead to budd chiari syndrome | HCC |
| hypercoagulable state, PCV, pregnancy, HCC | budd chiari syndrome |
| visible abdominal and back veins, no JVD, hepatomegaly, ascites, abdominal pain, varices | budd chiari |
| budd chiari | occulsion of IVC or hepatic veins with centrilobular congestion and necrosis (zone 3 - central vei |
| misfolded gene product protein aggregates in where for alpha antitrypsin def? | hepatocellular ER |
| PAS positive globules in liver | alpha 1 antitrypsin def |
| panacinar emphysema cause | alpha antitrypsin defciency |
| what genetic inheretince is alpha 1 antitrypsin def? | codominant trait |
| omphalomesenteric cyst | cystic dilation of vitelline duct |
| what can meckel's cause? | melena, RLQ pain, intussuceuption, vovlulus or obstruction near terminal ileum |
| currant jelly stools | intussusception |
| where does intussusception commonly occur? | ileocecal junction |
| where does vovulus occur? | cecum and sigmoid colon, where redudnat mesentery happens |
| hemorrhagic ulcer locations? | gastric, duodeal (psoterior) |
| perforation ulcer | duodeal (anterior) |
Created by:
ilovemusic007
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