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last min GI anatomy

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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