Anatomy - Git

Front 1

Circular muscle fibers in the gastroesophageal junction are under ___ and ___ ocontrol

Back 1

Hormonal

Vagal

Front 2

The esophageal varices anastomose between ___ and ___ circulations

Back 2

Portal (portal vein)

Caval (azygos vein to SVC)

Front 3

What can happen if the esophageal varices are under an increase of pressure?

Back 3

They could rupture, leading to massive bleeding and vomitting of blood

Front 4

What is barrett's esophagus?

Back 4

Its when the lining of the esophageal is replaced by tissue similar to that of the stomach (intestinal metaplasia)

This is pre-cancerous but a small number of people develop a relatively rare but often deadly type of esophageal cancer (adenocarinoma).

Associated with gastroesophageal reflux dis. GERD

Front 5

What is Achalasia?

Back 5

Loss of ability of the esophagus to propel food from the mouth to the stomach.

Valve mechanism at the lower end of the esophagus fails to relax to allow the food into the stomach.

Front 6

"Megaesophagus-dilation of esophagus beginning at upper 1/3 eventually involving entire length"

^is a characteristic of what disease?

Back 6

Achalasia

Front 7

Lack or paucity of ganglion cells in Auerbach's plexus is an example of what disease

Back 7

Achalasia

Front 8

T/F: Hepatoduodenal ligament supported the duodenum and stomach

Back 8

False. It supports the duodenum only

Front 9

What are rugae?

Back 9

Gastric folds/ridges

Front 10

Gastric mucosa?

Back 10

Gastric pits that lead to gastric glands in the lamina propria

Front 11

What is a common effect of pyloric stenosis?

Back 11

Projectile vomitting

Front 12

What organs do the stomach bed consist of?

Back 12

Stomach bed:
1. pancreas-body/tail
2. left kidney
3. spleen
4. diaphragm
5. left suprarenal gland
6. transverse mesocolon
7. omental bursa
(lesser sac)

Front 13

Acid Peptic disease is more common in which part of the stomach?

Back 13

Pyloric part towards the lesser curvature

Front 14

what kind of pain does chronic ulcer mainly present as?

Back 14

epigastric pain

Front 15

A gastric perforation can adversely affec which organ?

Back 15

The one directly under neath it, the pancreas.

Front 16

Which artery can be damaged by a gastric perforation?

Back 16

Splenic Artery

Front 17

First part of the duodenum relationships

Back 17

LV1, gall bladder (could pass gall stone into the duodenum through a fistula).

gastroduodenal artery passes posteriorly (could be affected by a posterior perforation of a duodenal ulcer)

Front 18

Which part of the duodenum is most commonly affected by an ulcer?

Back 18

First part. Duodenal cap or ampulla

Front 19

Anterior duodenal perforation can result in what?

Back 19

Peritonitis

Front 20

Second part of duodenum relationships

Back 20

LV1-LV3

Transverse colon, anteriorly, comon bile duct and major pancreatic duct, posteriorly.

Front 21

Third part of duodenum relationships

Back 21

LV3

Superior mesenteric artery and vein pass anterior

Front 22

Fourt part of duodenum relationships

Back 22

LV2-LV3

Joints the jejenum, attaches the ligament of treitz at junction.

Front 23

T/F: The lining of the duodenal cap (ampulla) contains plicae circulares

Back 23

False. The internal feature of the ampulla is smooth lining.

Front 24

What are plicae circulares?

Back 24

Circular folds or valves of kerkring

Front 25

What is so special about the major duodenal papilla?

Back 25

It demarcates the junction of embryonic foregut and midgut.

It also contains opening of hepatopancreatic ampulla (the structure formed by pancreatic duct and common bile duct)

Front 26

True or False: Jejunum is longer than the ileum.

Back 26

False. 8 vs 12 feet

Front 27

True or Fale: Ileum has a bigger diameter than the jejunum

Back 27

False.

Front 28

True or False: Jejunum has larger plicae circulares

Back 28

True

Front 29

T/F: The ileum has more vasculature and is darker

Back 29

False

Front 30

This part of the small intestine is known to have lesser fat in the mesentery and have "windows"

Back 30

Jejunum

Front 31

This part of the small intestin is known to have fewer arterial arcades and longer vasa rectae

Back 31

Jejunum

Front 32

This part of the small intestine has more mesenteric fat

Back 32

Ileum

Front 33

This part of the small intestine has more arcades

Back 33

Ileum

Front 34

This part of the small intestine has shorter vasa rectae

Back 34

Ileum

Front 35

This part of the small intestine is where meckel's diverticulum happens

Back 35

Ileum

Front 36

This part of the small intestine has peyer's patches

Back 36

Ileum

Front 37

The walls of the jejunum have what that contributes to their feathery appearance?

Back 37

1) large and numerous plicae circulares

2) Villi

Compared to the smooth surface of the DISTAL ileum

Front 38

What is meckel's diverticulum?

Back 38

Remnant of vitelline duct (the proximal part of the yolk stalk)

May appear in various stages of regression: short finger-like projection, fibrous cord, remain patent creating an umbilico-intestinal fistula, may contain a sinus or cyst.

Front 39

Whats the difference between diverticulum vs. diverticulosis?

Back 39

A diverticulum contains all layers of the intestinal wall

Front 40

What are the rule of 2's (for meckel's diverticulum)?

Back 40

1) present in ~2-3% of infants
2) ~1-2 inches long
3) appears ~2-3 feet proximal to ileocecal junction
4) mucosal lining is similar to that of the ileum, but may contain islands of 2 types of tissues: (gastric or pancreatic mucosa)

5) 2 clinical manifestations: intestinal obstruction or GI bleed

Front 41

This manisfestion is characteristic of what:

"intestinal obstruction or GI bleeding; could also mimic appendicitis presenting as periumbilical pain which localizes to right lower quadrant"

Back 41

Meckel's Diverticulum

Front 42

What are some complications of meckel's diverticulum?

Back 42

Ulcerations
Inflammation
Torsion +/- strangulation
Intussusception (telescoping)
Herniation

Front 43

What is another name for regional enteritis?

Back 43

Crohn's disease

Front 44

What are some of the ways to tell if you have crohn's disease

Back 44

Chronic inflammation that affects terminal ileum and possibly colon

segments that are affected are separated by "normal" segments (skip lesions)

Increased cancer risk

Front 45

What bands meet at the root of the appendix?

Back 45

Taeniae coli

Front 46

What is the usefulness of the taeniae coli?

Back 46

It is used to locate the appendix

Front 47

How come the Vermiform appendix doesn't have any tenia coli?

Back 47

It has its own complete muscle layers (inner and outer longitudinal)

Front 48

Is the vermiform appendix always located in the same position?

Back 48

No

Retrocecal is most common
Retro colic
Subcecal
Pelvic

Front 49

What are some symptoms of appendicitis?

Back 49

1) Anorexia
2) Nausea
3) Vomitting

Front 50

What is appendicitis?

Back 50

opening of v. appendix into the cecum is blocked by build-up of thick mucus, hardened stool (fecalith) or enlarged lymphoid tissues

poorly localized diffused pain initially, moves to right inguinal area due to involvement of parietal peritoneum (presents with rebound tenderness)

Front 51

What is psoas sign?

Back 51

Pain on passive extension of the right thigh.

Front 52

What is the anatomic basis for the psoas sign?

Back 52

inflamed retrocecal appendix in contact with fascia over the psoas muscle (overstretched during the extension maneuver)

Front 53

What is obturator sign?

Back 53

Pain on passive internal rotation of the flexed thigh.


Examiner moves lower leg laterally while applying resistance to the lateral side of the knee resulting in internal rotation of the femur.

Front 54

What is the anatomic basis for the obturator sign?

Back 54

Inflamed appendix int he pelvis is in contact with the fascia over the obturator internus muscle. Which is stretched by this maneauver. Remember, obturator internus actually is involved in external rotation, thus, when we internally rotate we are going to stretch it.

Front 55

What are some characterisitics of diverticulosis?

Back 55

Outpouchings of intestinal wall in the colon

Pouches do no contain layer of intestinal wall

Often asymptomatic but can includ mild cramps, bloating, and constipation

Complicaions: bleeding, infections, perforations, or tears or blockages

Front 56

Hirschsprung's disease is also known as ____

Back 56

Congenital Megacolon

Front 57

This disease is characterized as the most common cause of neonatal obstruction of the colon

Back 57

Hirschsprungs (congenital megacolon)

Front 58

This disease mostly affects the rectum and sigmoid colon

Back 58

Hirschsprungs (congenital megacolon)

Front 59

How is hirschsprun'gs disease presented?

Back 59

As abdominal enerlagement, constipation in neonates, and unable to pass meconium at birth

Front 60

What is the disease that has this characteristic:

Portion of colon is dilated due to absence of autonomic ganglia (parasympathetic) in the intestinal wall distal

Back 60

hirschsprung's

Front 61

Why is there an absence of ganglia for hirschsprungs disease?

Back 61

The cells were arrrested during migration of neural crest cells

Front 62

Why is there dilation in the colon for hirschsprungs?

Back 62

Due to failure of peristalisis in the aganglionic segment