Anatomy Exam 5: Gastrointestinal Tract 1 & 2

Front 1

The abdominal esophagus is the distal portion of the esophagus below the _______________

What is it innervated by?

Back 1

esophageal hiatus of the diaphram


anterior & posterior vagal trunks from the esophageal plexus of nerves

Front 2

What are the primary functions of the upper & lower esophageal sphincter?

Back 2

upper- prevents entrance of air during respiration
(^located at pharyngoesophageal junction)

lower- guards against gastroesophageal reflux
(^located at esophageal hiatus of diaphram)

Front 3

Obj.
Describe the 3 esophageal constrictions

Back 3

1. cervical constriction
-upper esophageal sphincter

2. thoracic constriction
-arch of aorta & left main bronchus

3. diaphragmatic constriction
-lower esophageal spincter

Front 4

Clincially, esophageal constrictions are important for:

Back 4

-passing an instrument through esophaus & into stomach
-interpreting radigraphs of patients w/ dysphagia
-swallowed foreign objects
-caustic fluids cause strictures

Front 5

Obj.
What does achalasia cause & why might it occur?

Back 5

causes: failure of lower esophageal sphincter to relax, leading to dysphagia, regurgitation, chest pain & bird-beak appearance on radiograph

due to: absence of ganglion cells w/i wall of esophagus

Front 6

Obj
A hiatal hernia is a predisposing factor for longitudinal tears in the distal esophagus & gastroesophageal junction. What may this tearing lead to?

Back 6

Upper GI bleeding (10% of cases), presenting as hematemesis

Front 7

What else may result in longitudinal tearing of the esophagus, known as Mallory-Weiss tears?

Back 7

severe retching or vomiting due to acute alcohol intoxication

Front 8

T/F
The stomach may vary in its position depending on patients posture and body type

Back 8

TRUE

Front 9

What are the 4 main parts of the stomach?

Back 9

1. cardia
2. fundus
3. body
4. pyloric
(subdivided into antrum & canal, whose junction is indicated by the angular incisure)
*also note, lesser (facing liver) and greater (inferior/left) curvature

Front 10

The pyloric region has a thickened ring of circular smooth muscle , the ________________, which controls passage of chyme into the duodenum under ___________ nerve control

Back 10

pyloric sphincter


vagus nerve (parasympathetic) control

Front 11

Obj
Congenital hypertrophic pyloric stenosis is marked by what symptom?

Back 11

hypertrophy of the pyloric sphincter, inhibiting gastric emptying w/ non-bile stained, severe "projectile" vomiting, presenting as 4-8 wks in infants
(secondary dilatation of stomach)

Front 12

The _______ attaches the stomach from the lesser curvature to the liver.
The _______ attaches the greater curvature to the posterior body wall, spleen, & diaphragm & also migrates to wall off inflamation

Back 12

less omentum

greater omentum

Front 13

Of the 2 main types of hiatal hernias ________________ does NOT result in regurgitation of gastric contents (& is less common) & ____________ DOES and may lead to Barrett's esophagues

Back 13

parasophageal hiatal hernia (does NOT)

sliding hiatal herna (DOES)

Front 14

Obj.
If medical treatment of gastric ulcers is unsuccessful _____________may be performed.
In some instances this procedure must be accompanied by _________________ to allow gastric emptying (since sphincter cant relax)

Back 14

vagotomy= surgical section of the vagus nerve


drainage procedure (ie pyloroplasty)

Front 15

obj
Duodenal ulcers may cause fatal ________ from the ______________ artery.

Back 15

hemorrahage

gastroduodenal branch of the celiac artery

*may result in peritonitis (superiorly) or pancreatitis (inferiorly)

Front 16

obj
Describe the development of gallstone ileus

Back 16

-an inflamed gallbladder may adhere to superior duodenum & pass gallstone into it through a cholecystenteric fistula
-a gallstone entering this way may obstruct the ileocecal valve, producing gallstone ileus

Front 17

Obj
What may hepatopancreatic ampulla obstruction be caused by?
what may it lead to?

Back 17

-obstruction may be caused by gallstones becoming lodged or tumors forming w/i the narrow hepatopancreatic ampulla

-may lead to bile flow backing up into pancreatic duct causing bile pancreatitis/gallstone pancreatitis

Front 18

Obj
What is superior mesenteric artery syndrome?

Back 18

-The inferior 3rd of the duodenum passes btwn the superior mesenteric artery & aorta where it becomes compressed & completely obstructed

*surgical emergency

Front 19

Obj
Differentiate btwn characteristics of upper GI and lower GI bleeding

Back 19

Upper- typically produces vomiting of blood (hematemesis) and/or black tarry stool (melena)

Lower- bright red rectal bleeding (hematochezia)

*ligament of Treitz is the junction point btwn upper & lower GI

Front 20

The ______________, where the small intestine transitions from retriperitoneal to intraperitoneal is a frequent site for peritoneal folds & _________

Back 20

duodenojejunal junction

paraduodenal fossae (recesses)

Front 21

Obj
A loop of small intestine may become entrapped w/i a paraduodenal fossae as a _________________ & have to be surgically freed
During surgery what artery & vein are at risk of damage?

Back 21

paraduodenal /internal hernia



inferior mesenteric artery & vein

Front 22

How are the jejunum & ileum distinguished by blood supply?

Back 22

jejunum- has FEW arterial arcades & LONG vasa recta in mesentary w/ LITTLE fat

ileum- has MANY arterial arcades & SHORT vasa recta in mesentary laden (LOT) w/ fat

Front 23

How does the mucosa of the ileum & jejunum differ?

Back 23

ilueum is smooth & jejunum has plicae circulares "feathery" appearance

Front 24

obj
What is an ileal (Meckel's) diverticulum?

Back 24

it is a remnant of the embryonic vitelline duct (yolk stalk), contains all layers of intestinal wall= true diverticulum (may contain ectopic gastric or pancreatic tissue)

*most common congenital anomaly of small intestine

Front 25

An ileal diverticulum usually follows the rule of 2's, what is the rule of 2s?

Back 25

rule of 2s:
-it occurs in 2% pop
-is symptomatic in 2% of ppl w/ it
-is symptomatic in first 2 yrs of life
-is 2 in long
-is located w/i 2 ft of ileocecal junction

Front 26

What may be caused be an ileal diverticulum?

Back 26

-painless hemorrhage
-intestinal obstruction
-inflammation (diverticulitis)
-perforation
-pain mimicking appendicitis
-lower GI bleeding (hematochezia)
^ most common cause in children

Front 27

obj
What are appendicitis signs and symptoms?

Back 27

-vague central periumbilical pain that later becomes sharp, localized, right lower quadrant pain at McBurnery's point
-vomiting typically follows pain
-positive obturator or psoas signs

Front 28

Differentiate btwn obturator & psoas sign

Back 28

Obturator sign:
-pain on passive medial rotation of flexed R thigh
= inflamed pelvic appendix
-appendix in contact w/ fascia over obturator internus muscle

Psoas (iliopsoas) sign:
- pain against resisted flexion of R thigh (passive extension)
=inflamed retrocecal appendix
-appendix in contact w/ fascia over ilipsoas muscle

Front 29

Where is McBurney's point located?

Back 29

at a point 1/3 the distance on a line connecting the right ASIS & umbulicus

Front 30

obj.
What is cecal volvulus?

Back 30

Twisting of the cecum on itself, causes obstruction & compromises blood supply (strangulation)

^predisposable due to mobile ascending colon

Front 31

obj.
Differentiate btwn the 2 major inflammatory bowel diseases; ulcerative colitis and Crohn’s disease

Back 31

ulcerative colitis:
-begins in distal rectum & spreads into colon
-does NOT involve small intestine
-characterized by continuous inflammatory lesions involving mucosa & submucosa only

Crohn's disease
-involves terminal ileum & colon
-characterized by inflammatory lesions of ALL layers of bowel wall (transmural lesions)
-discontinuous "skip" lesions
-causes malnutrition
-intestinal obstruction & fistulas may occur
*both cause abdominal pain, bloody diarrhea, fever & predispose to cancer

Front 32

Obj.
Sigmoid volvulus is made more likely by a (short/long) sigmoid mesocolon.

What does sigmoid volvulus result in?

Back 32

long

-results in obstruction & infarction

*90% of colon volvulus cases involve sigmoid colon

Front 33

obj.
Differentiate btwn diverticulosis and diverticulitis

Back 33

diverticulosis:
-sigmoid colon prone to develop outpocketings of it's own wall
-often asymptomatic, can cause cramping, continuous low abdominal discomfort, bloating, constipation, diarrhea
-present in 50% ppl over 60yr

Diverticulitis:
-infected/inflamed diverticula
-may cause bleeding (intermittent or massive hemorrhage (rare), obstruction, or perforate
-fistula may form btwn colon & adjacent organs

Front 34

If an infected diverticula perforates, what may result?

Back 34

an absecess may form of infection may spread to produce generalized peritonitis

Front 35

Obj.
What is Hirschsprung disease (congenital megacolon) and how does it present?

Back 35

-portion of colon is dilated (megacolon) due to failure of peristalsis resulting from absence of autonomic ganglic w/i intestinal wall, distal to dilated segment
-absent ganglia due to arrest in migration of embryonic neural crest cells

-presents as denlargement & constipation in neonate

*most common cause of neonatal obstruction of colon
*10% of cases are in down syndrome children

Front 36

The liver occupies most of the right __________, upper __________ & extends into the left __________+

Back 36

right hypochondrium
upper epigastrium
left hypochondrium

Front 37

Important ligaments of the liver:
______ contains to ligamentum teres hepatis & paraumbilical veins
____________ outlines bare area of liver & is continuous & triangular ligaments
__________ composed of hepatogastric & hepatoduodenal ligaments

Back 37

falciform ligament

coronary ligament

lesser omentum

*also note R & L triangular ligaments

Front 38

Important functions of the liver (5):

Back 38

1. carb metabolism
2. protein metabolism (produces blood clotting factors)
3. lipid metabolism
4. bile production
5. detoxification

Front 39

obj
The livers attempts to detoxify may be overwhelmed in chronic alcoholism resulting in _____________

This condition may also result from what?

Back 39

cirrhosis (fibrosis of the liver)


-viral inflammation (hep B & C), obstruction of bile drainage, etc

Front 40

Unlike the rest of the body, in which venous drainage passes directly toward the sup or inf vena cava, venous drainage from the abdominal gastrointestinal system & spleen goes where?

Back 40

enters the hepatic portal vein for transport to the liver

Front 41

obj
What impairments to portal venous blood flow may result in portal hypertension?

Back 41

Impairments:
-prehepatic (portal vein thrombosis)
-intrahepatic (cirrhosis)
-posthepatic (R-sided heart failure or Budd Chiari syndrome

Front 42

What is Budd-Chiari syndrome?

Back 42

hepatic vein thrombosis, prevents drainage of blood from liver into the inferior vena cava via hepatic veins

Front 43

Obj
Portal hypertension complications and treatment

Back 43

complications:
-esophageal varices (at gastroesophageal junction)--> fatal hemorrhage
-caput medusae (subcutaneous veins radiate out from umbilicus, secondary to paraumbilical veins)
-hemorrhoids (at anorectal junction)

treatment:
-portosystemic (portocaval) shunt btwn portal vein & inferior vena cava
-splenorenal shunt btwn splenic vein & left renal vein

Front 44

Venous drainage of GI to liver also provides a pathway for what?

Back 44

metastasis of cancer from GI into liver

Front 45

The gallbladder recieves blood from cystic artery, which arises from the R hepatic artery within the cystohepatic triangle, what is this triangle formed by?

Back 45

-common hepatic duct
-cystic duct
-visceral surface of liver

Front 46

If the cystic artery or right hepatic artery is cut during cholecystectomy, how may a surgeon control bleeding?

Back 46

Pringle maneuver-
surgeon may pass index finger through omental foramen & pinch hepoduodenal ligament btwn thumb & index finger

Front 47

Obj
Gallstones (cholelithiasis) may possibly cause what complications?

Back 47

if it obstructs bile flow, bile will be absorbed into blood, causing:
-yellowing of skin, sclera, & mucous membranes (jaundice icterus)

Front 48

If the gallbladder becomes inflamed (cholecystitis), pain may be referred from the diaphram to ____________ via the __________nerve

Back 48

right shoulder
phrenic nerve

Front 49

________________, may develop at the junction of the neck of gallbladder & cystic duct when gallstones become impacted at the _____________

Back 49

Hartman's pouch (an abnormal sacculation)

hepatopancreatic ampulla

Front 50

What is an endoscopic retrograde cholangiopancreatography (ERCP)?

Back 50

-insertion of a cannula through the major duodenal papilla & hepatopancreatic ampulla for injection of radiographic contrast medium

Front 51

Obj
Differentiate btwn acute and chronic pancreatitis

Back 51

acute pancreatitis:
-ranges from mild & self-limiting to life threatening
-damage is REVERSIBLE
-presents w/ abdominal, epigatsric pain radiating to back, nausea, vomiting, fever
-commonly caused by alcoholism or gallstone bile flow obstruction

chronic pancreatitis:
-PERMANENT & progressive damage
-diminished exocrine & encodrine function
-may lead to chronic pain, weight-loss, diabetes mellitus, pancreatic cancer, pseudocyts
-may result from recurrent acute pancreatitis, autoimmune disorders, toxins, obstructions of pancreatic ducts, idiopathic
-genetic causes in children
*25 yr mortality is 50%

Front 52

Pancreatitis frequently results in development of a ________________

Back 52

pancreatic pseudocyst- an encapsulated (fibrous-walled) collection of pancreatic enzyme-rich fluid w/i pancreas
-most common location in in omental bursa (lesser sac)

Front 53

What are some of the possible complications of pancreatic pseudocysts?

Back 53

-compression or perforation of adjacent structures
-hemorrhage
-infection
-peritonitis
-pleural effusion

Front 54

Obj,
Pancreatic cancer (of pancreatic head) commonly leads to what?
What is the first sign of this?

Back 54

obstruction of bile duct


painless jaundice is first sign, however overall pain is the most common symptom, usually severe pain radiating to mid or lower back*

Front 55

T/F
Spleen is part of the digestive system

Back 55

FALSE

-however does share blood supply w/ GI

Front 56

Where is the spleen located?

What are its functions?

Back 56

location:
-intraperitoneal
-deep to L lower ribs 9-11
-long axis parallel to rib 10

function:
-antibody formation
-disposal of deteriorating RBCs & platelets
-stores blood

Front 57

The spleen is supplied by the _________________

it is drained by __________________, which joins to superior mesenteric vein to form the ______________

Back 57

splenic artery (branch of celiac trunk)

splenic vein
portal vein

*the inferior mesenteric vein usually drains into the splenic veins

Front 58

Obj
Common splenic pathologies-

Back 58

-splenic artery may aneurysm during 3rd trimester
^rupture may cause fatal hemorrhage

-splenomegaly from hypertension of hemolytic anemia

Front 59

The ________ is the most commonly ruptured abdominal organ w/ life threatening hemmorrhage

What are some common causes of rupture?

Back 59

spleen


causes:
-blunt trauma to abdomen
-lacerated in L lower rib fracture

Front 60

Splenectomy may be required to remove a ruptured spleen. What structure, that enters the splenorenal ligament may be injured during this procedure?

Back 60

tail of the pancreas

*one or more accessory spleens may also be present

Front 61

During splenic needle biopsy, the relationship of the spleen to the costodiaphragmatic recess (which descends to 10th rib at midaxillary line) is important to remember, to avoid what?

Back 61

entering the pleural cavity which would cause pleuritis

Front 62

Splenic pain would be referred to the _________ via the ___________nerve

Back 62

left shoulder
phrenic nerve