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274 Cards in this Set
- Front
- Back
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derivative of L umbilical vein
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Ligmentum teres (falciform lig.)
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3 structures contained in the hepatoduodenal lig.
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hepatic artery
portal vein common bile duct |
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which ligament contains the short gastric arteries
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gastrosplenic lig.
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which ligament contains the gastroepiploic arteries
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gastrocolic lig.
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which ligament contains the gastric arteries
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gastrohepatic lig.
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which layer of the gut wall contains Meissner's plexus
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submucosa
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function of Meissner's plexus
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secretions
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which layer of the gut wall contains Auerbach's myenteric plexus
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muscularis externa
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function of Meissner's plexus
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motility of gut
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what epithelium makes up the esophagus
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nonkeratinized stratified squamous epithelium
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mucosal features that help increase absorptive surface area of the intestines
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villi and microvilli
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location of Peyer's patches
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ileum
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portion of the intestines with the most goblet cells
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jejunum
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portion of the GI tract that has crypts but NO villi
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colon
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muscles distribution found in the upper/middle/lower third of the esophagus
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upper 1/3: striated
middle 1/3: mixed striated/smooth lower 1/3: smooth |
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vertebral level of celiac trunk
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T12
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vertebral level of SMA
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L1
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vertebral level of renal arteries
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L1/L2
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vertebral level of gonadal arteries
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L2
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vertebral level of IMA
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L3
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vertebral level of bifurcation of abdominal aorta
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L4
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vertebral level of root of IVC
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L5
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parasympathetic innervation to foregut structures
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vagus nerve
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sympathetic innervation to foregut structures
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celiac ganglion, greater splanchnic
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parasympathetic innervation to midgut structures
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vagus nerve
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sympathetic innervation to midgut structures
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SMA ganglion, lesser splanchnic
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parasympathetic innervation to hindgut structures
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pelvic splanchnics
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sympathetic innervation to hindgut structures
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IMA ganglion, least splanchnic
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anatomical transition area from foregut to midgut
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ampulla vater (1st/2nd portion of duodenum)
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anatomical transition area from midgut to hindgut
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splenic flecture (transverse colon)
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3 branches of celiac trunk
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common hepatic
L gastric splenic |
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blood supply to lesser curvature
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L and R gastrics
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blood supply to greater curvature
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L and R gastroepiploics
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3 branches of common hepatic artery
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gastroduodenal
R gastric hepatic proper |
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anastomoses between celiac and SMA
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pancreaticoduodenal arteries
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main artery to body of stomach
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splenic
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origin of short gastric arteries
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splenic artery
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main artery to antrum of stomach
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gastroduodenal
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origin of cystic artery
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R hepatic
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origin of R and L hepatic arteries
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hepatic proper artery
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anastomoses between SMA and IMA
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middle and left colic arteries
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3 sites of portocaval anastomoses
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L gastric vein <-> esophageal veins
paraumbilical veins <-> epigastric veins superior rectal vein <-> middle/inferior rectal vein |
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anastomoses affected in esophageal varices
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L gastric vein <-> esophageal veins
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anastomoses affected in caput medusa
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paraumbilical veins <-> epigastric veins
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anastomoses affected in internal hemorrhoids
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superior rectal veins <-> middle/inferior rectal veins
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anatomical line that separates internal/external hemorrhoids
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pectinate line
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cancer common above the pectinate line
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adenocarcinoma
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cancer common below the pectinate line
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squamous cell carcinoma
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which hemorrhoids are painful
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external hemorrhoids
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what forms the common bile duct
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cystic and common hepatic ducts
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2 ducts that combine to drain into the ampulla vater
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common bile and pancreatic duct
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orientation of vessels in the femoral region going lateral to medial
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Nerve
Artery Vein Lymphatics ("NAVeL") |
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what forms the superficial inguinal ring
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aponeurosis of external oblique
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what forms the deep inguinal ring
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transversalis fascia
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what forms the floor of the inguinal canal
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inguinal ligament
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bony attachments of inguinal ligament
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ASIS to pubic tubercle
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what forms the conjoint tendon
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internal oblique and transversus abdominus
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abdominal layer continuous with the cremasteric fascia
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internal oblique
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abdominal layer continuous with the external spermatic fascia
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external oblique
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abdominal layer continuous with the internal spermatic fascia
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transversalis fascia
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what lies between protrusion sites for indirect vs. direct hernias
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inferior epigastric vessels
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what hernias enter the deep inguinal ring
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indirect
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MOST common type of hernia overall
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indirect
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hernia more common in women than men
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femoral hernia
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most common side of indirect hernia
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right
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what hernias protrude through Hesselbach's triangle
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direct
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boundaries of Hesselbach's triangle
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inguinal ligament
rectus abdominus inferior epigastric vessels |
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boundaries of femoral triangle
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inguinal ligament
sartorius adductor longus |
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difference between sliding and paraesophageal hernias
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sliding: gastroesophageal junction is displaced; "hourglass stomach" on xray
paraesophageal: GE junction is norma; cardia herniates into thorax |
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which hernia protrudes into the scrotum
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indirect
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fluid fills up in the precessus vaginalis
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hydrocele
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how do the protrusions on indirect vs. direct hernias relate to the location of inferior epigastric arteries
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direct hernias: protrude MEDIAL to inferior epigastric arteries
indirect hernias: protrude LATERAL to inferior epigastric arteries ("MDs dont LIe") |
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which hernia causes bowel incarceration
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femoral hernia
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which hernia protrudes below the inguinal ligament
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femoral
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what cells and where in the stomach is gastrin secreted
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secreted by G cells in the antrum
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what cells and where is CCK secreted
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secreted by I cells in the duodenum and jejunum
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what cells and where is secretin secreted
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secreted by S cells in the duodenum
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what cells and where is somatostatin secreted in the GI tract
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secreted by D cells in the GI mucosa
(*also secreted by D cells in the pancreas) |
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what cells and where is GIP secreted
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secreted K cells in the duodenum and jejunum
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hormone secreted in Zollinger Ellison syndrome
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gastrin
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functions of CCK
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increase pancreatic secretions
increase gallbladder contractions decrease gastric emptying relaxes sphincter of oddi |
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functions of secretin
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increase pancreatic HCO3 secretion
decrease gastric acid secretion increase bile secretion |
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functions of gastrin
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increase gastric H+ secretion
increase gastric motility |
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functions of GIP
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decrease gastric H+ secretion
increase insulin release |
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functions of VIP
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increase intestinal water/electrolyte secretions
relaxation of intestinal GI tract |
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loss of nitric oxide secretion causing increased lower esophageal tone
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achalasia
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what cells secrete instrinsic factor
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parietal cells
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function of instrinsic factor
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binds B12 to promote absorption in ileum
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autoimmue destruction of parietal cells in what condition
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chronic gastritis
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what cells secrete gastric acid
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parietal cells
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what hormones increase the release gastric acid
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histamine, ACh, and gastrin
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what cells secrete pepsin
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chief cells
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function of pepsin
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protein digestion
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which saliva secretion are completely serous
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parotid secretions
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which saliva secretion are completely mucinous
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submandibular/sublingual
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digestive hormone in saliva
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alpha-amylase (ptyalin)
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function of ptyalin
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starch digestion in mouth
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during normal saliva secretion rates, is the saliva hypotonic, isotonic, or hypertonic
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hypotonic
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during period of excessive saliva secretion, is the saliva hypotonic, isotonic, or hypertonic
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isotonic (not enough time for adequate NaCl reabsorption)
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gastrin activates which cells to release histamine which ultimately will increase gastric acid release
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enterochromaffin-like cells (ECL cells)
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special glands in duodenum that secrete alkaline mucus
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Brunner's glands
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enzyme that activates trypsinogen
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enterokinase
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glucose and galactose are taken up in the intestine by what transporters
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SGLT1
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fructose is taken up in the intestine by what transporters
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GLUT-5
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where is iron absorbed
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duodenum
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where is folate absorbed
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jejunum
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where is B12 absorbed
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ileum
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2 things required for B12 absorption
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intrinsic factor (from parietal cells in stomach)
R factor (from salivary secretions via parotid gland) |
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special M cells in the Peyer's patches helps form plasma cells made of what immunoglobulin
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IgA
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main functions of bile
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digestion of triglycerides and excretion of cholesterol
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where is bile made and where is it stored
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made in gallbladder and stored in liver
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which bilirubin is water soluble
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direct
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where is bilirubin conjugated
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liver
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in what form is bilirubin excreted in the urine
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excreted as urobilin
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how is bilirubin formed
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lysis of RBCs and breakdown of heme
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in what form is bilirubin excreted in the feces
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stercobilin
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in what form does bilirubin exist in the gut
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urobilinogen
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enzyme that conjugates bilirubin
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glucuronyl transferase
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MOST common cause of high blood levels of indirect bilirubin
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hemolysis
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achalasia is characterized by damage to which plexus
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Auerbach's myenteric plexus
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"bird's beak" on barium swallow
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achalasia
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secondary achalasia is linked to what infection
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Chagas disease
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autoimmune syndrome linked to achalasia
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scleroderma (CREST)
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patient presents complaining of sternal pain that doesn't radiate to the back or exremities; pain is worse when lying down; he suffers from nocturnal cough and dyspnea; antacids temporarily relieve his symptoms
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GERD
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DOC for esophageal varices
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octreotide
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which class of drugs can cause corrosive esophagitis
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bisphosponates
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mucosal lacerations at the GE junction secondary to vomiting in alcoholics and bulimics
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Mallory-Weiss syndrome
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transmural esophageal rupture due to violent retching
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Boerhaave syndrome
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clinical triad of Plummer-Vinson syndrome
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dysphagia
glossitis iron deficiency anemia |
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glandular metaplasia in the esophagus
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Barrett's esophagus
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risk factors for Barrett's esophagus
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GERD and smoking
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major complication of Barrett's esophagus
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increases risk for esophageal cancer
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MOST common esophageal cancer in the US
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adenocarcinoma (lower 1/3)
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MOST common esophageal cancer worldwide
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squamous cell carcinoma (upper and middle 1/3)
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patient presents with acute onset of diarrhea; it's noted that the stool floats in the water; patient also has general weakness and some weight loss; labs reveal PAS-positive macrophages in the intestinal mucosa
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Whipple's disease
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DOC for Whipple's disease
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penicillin (tetracycline if allergic)
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autoantibodies against gliadin and endomysium
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celiac disease (celiac sprue)
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treatment for celiac disease
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remove gluten from diet
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child presents with chronic, fatty diarrhea with weakness, weight loss, and a chronic mucus-producing cough; serology is negative; no enzyme deficiencies are found; no organisms are found; what's the most likely cause
|
chronic pancreatitis secondary to cystic fibrosis
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dermatitis herpetiformis is linked to what condition
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celiac disease
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celiac disease is linked to what cancer
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T-cell lymphoma
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2 pathologic ulcers seen in acute gastritis
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Curling's ulcer: sloughing off of mucosa secondary to burns
Cushin's ulcer: secondary to brain injury |
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causes of acute gastritis
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stress
NSAIDs alcohol uremia burns brain injury |
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main cause of chronic gastritis
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H. pylori
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autoantibodies against parietal cells of the stomach
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autoimmune chronic gastritis
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2 unique symptoms to differentiate autoimmune chronic gastritis from H. pylori gastritis
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autoimmune gastritis will have pernicious anemia and achlorhydria
(*parietal cells are unable to secrete intrinsic factor or gastric acid anymore) |
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cancer associated with H. pylori
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MALT lymphoma
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disease characterized by gastric hypertrophy with protein loss, parietal cell atrophy, and increased mucous cells; the rugae of the stomach are hypertrophied and appear as brain gyri
|
Menetrier's disease
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MOST common type of stomach cancer
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adenocarcinoma
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foods containing what are linked to stomach cancer
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nitrosamines (smoked meats)
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morphologic cell in stomach cancers
|
signet ring cells
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unique stomach cancer that metastasizes to ovaries
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Krunkenberg's tumor
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nodule that's palpable when stomach cancer metastasizes to umbilical region
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Sister Mary Joseph's nodule
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nodule that's palpable when stomach cancer metastasizes to thorax
|
Virchow's node (L supraclavicular node)
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in which ulcer does the pain INCREASE after meals
|
gastric ulcers
(*pain decreases after meals in duodenal ulcers) |
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which ulcers are associated with weight gain
|
duodenal ulcers
(*gastric ulcers are linked to weight loss) |
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is PUD precancerous
|
NO
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Is Crohn's or UC associated with skip lesions and rectal sparing
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Crohn's
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Is Crohn's or UC associated with transmural inflammation
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Crohn's
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Is Crohn's or UC associated with "string sign" on barium swallow
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Crohn's
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Is Crohn's or UC associated with linear ulcers, fissures, and fistulas
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Crohn's
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Is Crohn's or UC associated with noncaseating granulomas
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Crohn's
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Is Crohn's or UC associated with migratory polyarthritis, erythema nodosum, ankylosing spondylitis, uveitis
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Crohn's
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Is Crohn's or UC treated with corticosteroids
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Crohn's
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Is Crohn's or UC associated with creeping fat
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Crohn's
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Is Crohn's or UC associated with rectal involvement
|
UC
|
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Is Crohn's or UC associated with pseudopolyps
|
UC
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Is Crohn's or UC associated with "lead pipe" appearance on imaging
|
UC
|
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Is Crohn's or UC associated with crypt abscesses without granulomas
|
UC
|
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Is Crohn's or UC associated with toxic megacolon
|
UC
|
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Is Crohn's or UC associated with always bloody diarrhea
|
UC
|
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Is Crohn's or UC associated with pyoderma gangrenosum and primary sclerosing cholangitis
|
UC
|
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Is Crohn's or UC treated with sulfasalazine
|
UC
|
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initial pain of appendicitis
|
periumbilical
|
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where is McBurney's point
|
1/3 the distance from iliac crest to umbilicus
|
|
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CE tests to check for appendicitis
|
rebound tenderness
Rosving's sign Psoas test Obturator test |
|
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CE test to check for cholecystitis
|
Murphys sign
|
|
|
4 main risk factors for cholecystitis
|
Female
Forty years old Fat Fertile (premenopause) |
|
|
MOST common location for diverticulitis pain
|
LLQ
|
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single blind pouch protruding from the GI tract and communicates with lumen of gut; MOST common in sigmoid colon
|
diverticulum
|
|
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characterized by many diverticula secondary to low-fiber diets usually in the sigmoid colon
|
diverticulosis
|
|
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known as "left-sided appendicitis"
|
diverticulitis (sigmoid colon)
|
|
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a "false" diverticulum at the junction of pharynx and esophagus
|
Zenker's diverticulum
|
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a "true" diverticulum usually occuring near the ileocecal valve
|
Meckel's diverticulum
|
|
|
persistence of the vitelline duct or yolk stalk
|
Meckel's diverticulum
|
|
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what are the five "2's" of Meckel's diverticulum
|
2 inches long
2 feet from the IC valve 2% of the population (MOST common congenital anomaly of GI tract) 2 years old 2 different epithelial types (gastric and pancreatic) |
|
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age group associated with intussusception and volvulus
|
children: intussusception
adults: volvulus |
|
|
2 common location of a volvulus
|
cecum and sigmoid colon
|
|
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virus linked to intussusecption
|
adenovirus
|
|
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Hirschsprung's disease is linked to damage to what plexus
|
lack of BOTH Auerbach's myenteric AND Meissner's plexuses
|
|
|
embryologic cause of Hirschsprung's disease
|
failure of neural crest cells to migrate
|
|
|
increased risk for Hirschsprung's in what genetic disease
|
Down syndrome
|
|
|
newborn starts vomiting soon after birth; "double-bubble" sign is seen on imaging
|
Duodenal atresia
|
|
|
failure to pass meconium without vomiting in newborn is suggestive of what
|
Hirschsprungs
|
|
|
meconium ileus is associated with what disease
|
cystic fibrosis
|
|
|
MOST common site of ischemic colitis
|
splenic flexure
|
|
|
tortuous dilation of vessels near IC valve or ascending colon
|
angiodysplasia
|
|
|
which polyps are usually malignant
|
villous polyps
|
|
|
MOST common GI polyp
|
hyperplastic
|
|
|
child presents for a routine physical; during the PE, it's noted that the child has spots of hyperpigmentation in his mouth, and on his hands, lips, and genitalia; his mother says this same condition is seen in his father and paternal grandmother; based on the presumptive diagnosis, how will the GI tract be involved in this disease
|
nonmalignant hamartomas throughout the GI tract
(*Peutz-Jeghers syndrome) |
|
|
gene and chromosome linked to Familial Adenomatous Polyposis (FAP)
|
APC gene on chromosome 5q
|
|
|
syndrome characterized by retinal hyperplasia and soft tissue tumors combined with FAP
|
Gardner's syndrome
|
|
|
syndrome characterized by FAP along with malignant CNS tumors
|
Turcot's syndrome
|
|
|
autosomal dominant mutation of DNA mismatch repair genes
|
hereditary nonpolyposis colorectal cancer (HNPCC)
(aka Lynch syndrome) |
|
|
"apple-core" lesions seen on barium enema along with CEA marker
|
colorectal cancer
|
|
|
MOST common tumor of the appendix
|
carcinoid tumor
|
|
|
hormone secreted by carcinoid tumors
|
serotonin
|
|
|
metabolite found in urine in someone with carcinoid tumor
|
5-HIAA
|
|
|
symptoms of cirrhosis/portal HTN
|
esophageal varices
hematemesis PUD melena hepatosplenomegaly caput medusa ascites hemorrhoids scleral icterus systemic jaundice fetor hepaticus spider nevi gynecomastia testicular atrophy asterixis increased bleeding anemia ankle edema |
|
|
serum marker to check for alcohol use
|
GGT
|
|
|
serum enzymes increased in pancreatitis
|
amylase and lipase
|
|
|
ALT > AST suggests what
|
viral hepatitis
|
|
|
AST > ALT suggests what
|
alcoholic hepatitis
|
|
|
marker suggestive of bile duct disease/obstruction
|
alkaline phosphatase
|
|
|
fatal childhood hepatoencephalopathy
|
Reye's syndrome
|
|
|
2 viruses linked to Reye's syndrome
|
VZV and influenza B
|
|
|
drug linked to Reye's syndrome
|
aspirin
|
|
|
morphologic feature of alcoholic hepatitis
|
Mallory bodies
|
|
|
tumor marker of hepatocellular carcinoma
|
increased AFP
|
|
|
risk factors for hepatocellular carcinoma
|
hepatitis B/C
Wilson's disease Hemochromatosis alpha-1-antitrypsin deficiency alcoholic cirrhosis carcinogens (aflatoxins) |
|
|
condition characterized by thromboembolisms occluding the hepatic veins
|
Budd-Chiari syndrome
|
|
|
explain physiologic jaundice in the newborn
|
at birth, the newborn is deficient in UDP-glucuronyl transferase so bilirubin cant be conjugated and excreted thus it builds up in the infant
|
|
|
complication of prolonged physiologic jaundice in the newborn
|
kernicterus
|
|
|
a college student has noticed a yellowing of his skins before big tests throughout his first 2 years of school; it goes away soon after the test passes so he had never had medical attention for this; what underlying condition is most likely
|
Gilbert's syndrome
|
|
|
form of hyperbilirubinemia characterized by decreased bilirubin uptake
|
Gilbert's syndrome
|
|
|
form of hyperbiliribuinemia characterized by mildly decreased UDP-glucuronyl transferase
|
Gilbert's syndrome
|
|
|
child is noted to have physiologic jaundice for a month after birth; he begins to develop symptoms of kernicterus; phototherapy has no effect on his condition; doctors inform the parents there is no treatment for this condition and the child dies within the next year
|
Crigler-Najjar syndrome
|
|
|
hyperbilirubinemia characterized by completely absent UDP-glucuronyl transferase
|
Crigler-Najjar syndrome
|
|
|
Of the 3 hereditary hyperbilirubinemias (Gilbert's, Crigler-Najjar, and Dubin-Johnson), which ones are direct and which ones are indirect
|
direct hyperbilirubinemias: Dubin-Johnson
indirect hyperbilirubinemias: Gilbert's and Crigler-Najjar |
|
|
disease characterized by inadequate hepatic excretion of copper
|
Wilson's disease
|
|
|
5 areas of the body where copper accumulates in Wilson's disease
|
liver, brain, cornea, kidneys, joints
|
|
|
symptoms of Wilson's disease
|
asterixis
parkinsonisms kayser-fleischer rings choreiform movements dementia hemolytic anemia |
|
|
DOC for Wilson disease
|
penicillamine
|
|
|
labs reveal decreased ceruloplasmin
|
Wilson's disease
|
|
|
mode of inheritance of Wilson's disease
|
autosomal recessive
|
|
|
clinical triad of hemochromatosis
|
cirrhosis
diabetes skin pigmentation |
|
|
unique symptom of hemorchromatosis seen only in men
|
erectile dysfunction
|
|
|
DOC for hemochromatosis
|
deforoxamine
|
|
|
HLA allele associated with hemochromatosis
|
HLA-A3
|
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lab values in hemochromatosis
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increased ferritin
increased iron increased transferrin saturation decreased TIBC |
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mode of inheritance of hereditary hemochromatosis
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autosomal recessive
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"onions-skinning" fibrosis of the bile ducts
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Primary Sclerosing Cholangitis
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bile duct shows alternating strictures and dilations with "beading" of both intra and extrahepatic bile ducts
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Primary Sclerosing Cholangitis
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antimitochondrial antibodies
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primary biliary cirrhosis
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ascending cholangitis usually occurs along with what other biliary tract disease
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secondary biliary cirrhosis
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2 types of gallstones
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cholesterol stones and pigment stones
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which gallstone is linked to hemolysis
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pigment stones
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which gallstone is linked to CF, Crohn's disease, obesity, and estrogen therapy
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cholesterol stones
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which gallstones appear radiolucent? what about radiopaque?
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cholesterol stones- radiolucent
pigment stones- radiopaque |
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pathogenesis of acute pancreatitis
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autodigestion of the pancreas by pancreatic enzymes
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3 common causes of acute pancreatitis
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gallstones
ethanol autoimmune |
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MOST common part of the pancreas to develop cancer
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the head of the pancreas
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tumor marker unique for pancreatic cancer
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CA-19-9
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patient presents complaining of abdominal pain that radiates to the back; he has lost 10 lbs in the last 6 months; PE reveals redness and tenderness on palpation of extremities, jaundice, and a palpable gallbladder
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pancreatic cancer
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which cancer has the highest fatality rate
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pancreatic (99% fatality rate)
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is pancreatic cancer linked to alcohol? what about smoking?
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pancreatic cancer is NOT linked to alcohol but is linked to smoking
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RUQ pain radiating to the R shoulder; pain is worse on inspiration
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acute cholecystitis
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MOA of cimetidine
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H2 blocker
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H2 blocker that is a potent inhibitor of P-450
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cimetidine
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MOA of omeprazole and lansoprazole
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irreversibly inhibits H+/K+ ATPase in the parietal cells of the stomach (PPI)
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DOC for traveler's diarrhea
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bismuth
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DOC for healing ulcers
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sucralfate
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1st line therapy for H. pylori infection
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Omerazole + Amoxicillin + Clarithromycin
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alternative treatment for H. pylori infection or if patient is resistant to 1st line therapy
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Omeprazole + Bismuth + Levofloxacin + Metronidazole
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DOC for prevention of NSAID-induced ulcers
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Misoprostol (PGE1 analog)
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off-label uses of Misoprostol
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induce labor and maintain a patent DA
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these 2 drugs block M1 receptors on ECL cells (decreasing histamine secretion) and M3 receptors on parietal cells (decreasing H+ secretion)
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Pirenzepine and Propantheline
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most common SE of aluminum hydroxide
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constipation
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most common SE of magnesium hydroxide
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diarrhea
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active ingredient in TUMS
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calcium carbonate
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anti-emetic used during chemo
|
ondansetron
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DOC for diabetic and post-surgical gastroparesis
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Metoclopramide
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MOA of metoclopramide
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D2 antagonist
|
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what structure courses between the internal and external iliac arteries
|
ureter
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