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198 Cards in this Set

  • Front
  • Back
retroperitoneal structures
duodenum (2nd, 3rd, 4th parts)
descending colon
asscending colon
kidney and ureters
pancrease (except tail)
Aorta
IVC
adrenal glands
rectum
derivative of fetal umbilical vein
falciform ligament (connect liver to anterior abdominal wall)
connects greater and less omental sacs
hepatoduodenal ligament
ligament that contains portal triad
hepatoduodenal ligament
ligament that contain splenic artery and vein
splenorenal
three gastric ligaments that contain: gastric, gastroepiploic, and short gastric arteries respectively
gastric arteries - gastrohepatic
gastroepiploic - gastrocolic
short gastrics - gastrosplenic
separates the mucosa and the submucosa
muscularis mucosa
where are meissner's and aurbach's plexi found respectively
meissner's plexus - submucosa
auerbach's plexus - muscularis externa
frequencies of basal electric rhythm (slow waves) of: stomach, duodenum, ileum
stomach - 3 waves/min
duodenum - 12 waves/min
ileum - 9 waves/min
where are brunner's glands of the submucosa found
duodenum
this section has the largest number of goblet cells in the small intestine
jejunum
this section contain only crypts and no villi
colon
muscle of esophagus
upper 1/3 - striated muscle
middle 1/3 - striated and smooth
lower 1/3 - smooth muscle
where does the celiac trunk, superior, and inferior mesenteric branch off respectively(vertebral level)
celiac - T12
superior - L1
inferior - L3
where is the bifurcation of the aorta in terms of vertebral level
L4
does the superior mesenteric branch of above or below renal arteries
above
structures associated with the embryonic foregut
stomach to proximal duodenum; liver, gallbladder, pancreas, spleen
structures associated with embryonic midgut
distal duodenum to proximal 2/3 of transverse colon
structure associated with embryonic hindgut
distal 1/3 of transverse colon to upper portion of the rectum
three branches of celiac trunk
common hepatic
splenic
left gastric
4 collateral circulations if abdominal aorta is blocked
1. internal thoracic (subclavian) - superior/inferior epigastric
2. superior pancreaticoduodenal (celiac) - inferior pancreaticoduodenal (SMA)
3. middle colic (SMA) - left colic (IMA)
4. superior rectal (IMA) - middle rectal (Internal Iliac)
3 portosystemic anastomoses, clinical signs along with veins involved
1. esophageal varices (left gastric - esophageal)
2. caput medusa (paraumbilical - superficial and inferior epigastric)
3. internal hemorrhoids (superior rectal - middle and inferior rectal)
**these are all VEINS
formed where hindgut meets ectoderm
pectinate line
what is found above the pectinate line
internal hemorroids
adenocarcinoma
arterial supply from superior rectal artery (IMA)
venous drainage to inferior mesenteric vein (portal system)
what is found below the pectinate line
external hemorrhoids
squamous cell carcinoma
arterial supply from inferior rectal artery (pudendal artery)
drainage to inferior rectal vein (IVC)
what type of hemorrhoids are painful
external hemorrhoids, inffervated by inferior rectal nerve (branch of pudendal nerve)
what makes up the common bile duct
cystic duct from gallbladder + common hepatic duct (joining of left and right hepatic ducts)
tumors in the head of the pancreas can obstruct what
common bile duct
what two things make of the ampulla of vater
pancreatic duct
common bile duct
femoral region organization from lateral to medial
NAVEL: (venous near the penis)
nerve, artery, vein, empty, lymphatics
what does the femoral sheath contain, and where is it located
located below inguinal ligament
contains femoral vein, artery, and canal (deep inguinal lymph nodes), but NOT femoral nerve
what does the femoral triangle contain
femoral vein, artery, and nerve
what fascia makes up the inguinal ligament
external oblique
what is the landmark of a direct vs. indirect hernia
inferior epigastric vessels
medial side - direct
lateral side - indirect
most common diaphragmatic hernia (abdominal structures enter the thorax)
sliding hiatal hernia
differentiate sliding vs. paraesophageal hernia
sliding - GE junction is displaced
paraesophageal - GE junction is normal, cardia moves into the thorax
this type of hernia goes through the internal (deep) inguinal ring, external (superficial) inguinal ring, and into the scrotum
indirect inguinal hernia
occurs in infants due to failure of processus vaginalis to close (can form hydrocele)
indirect inguinal hernia
this type of hernia is covered by all 3 layers of spermatic fascia
indirect inguinal hernia
this type of hernia is only covered by external spermatic fascia
direct inguinal hernia
this hernia protrudes through the inguinal triangle (Hesselbach's), bulges directly through abdominal wall, and goes through external (superficial) inguinal ring only
direct inguinal hernia
protrudes below inguinal ligament through femoral canal and lateral to pubic tuberacle
femoral hernia
this type of hernia is more common in women
femoral
leading cause of bowel incarceration in women
femoral hernia
what makes up the inguinal (Hesselbach's) triangle
inferior epigastric artery
lateral border of rectus abdominis
inguinal ligament
hormone secreted by antrum of stomach that increases gastric H secretion and growth of gastric mucosa
gastrin
what two amino acids are potent stimulators of gastrin
tryptophan
phenylalanine
hormone secreted by duodenum and jejunum that increases pancreatic secretions and gallbladder contraction
cholecystokinin
hormone secreted by duodenum that increases pancreatic bicarb secretion and bile secretion, and decreases gastric acid secretion
secretin
what is the job of bicarb in the GI tract
to neutralize gastric acid and allow pancreatic enzymes to function
this inhibitory hormone is found in both pancreatic islet cells and GI mucosa
somatostatin
what hormone allows an oral glucose load to be use more rapidly than an IV one
GIP
non alpha, non Beta islet cell pancreatic tumor associated with copious diarrhea
VIPoma
this parasympathetic ganglia hormone causes intestinal water and electrolyte secretion along with relaxation of smooth muscle and sphincters
VIP
this hormone is associated with migrating motor complexes
motilin
when is motilin increased
fasting state
produced by parietal cells of the stomach and is used to bind Vitamin B12
intrinsic factor
what three things regulate increased gastric acid secretion
histamine
ACh
gastrin
hormone associated with increased bicarb secretion
secretin
secreted by chief cells of the stomach
pepsin
three salivary glands
which ones are the most mucinous and most serous
parotid (most serous)
submandibular
sublingual (most mucinous)
*serous on the sides, mucinous in the middle
what stimulates salivary secretion
sympathetic (T1-T3): superior cervical ganglion
parasympathetic: facial and glossopharyngeal nerve
differentiate low and high flow rate of salivary secretion
low rate - hypotonic because more time to reabsorb Na and Cl
high rate - isotonic
what nerve runs through the parotid gland and can become damaged during surgery
CN VII
function of salivary secretion (4)
1. a-amylase to begin starch digestion
2. bicarb to neutralize oral bacterial acids
3. mucins to lubricate food
4. growth factors to promote epithelial renewal
how does gastrin increase acid secretion
directly on parietal cells via CCKB
but MOSTLY indirectly through ECL cells leading to histamine release which bind to H2 receptor
most important mechanism for gastric acid release
ECL cells releasing histamine to be H2 receptor on parietal cells
three different types of receptors that cause gastric acid secretion
what are their respective secondary messenger systems
M3 receptor (ACh) - IP3
CCKB receptor (gastrin) - IP3
H2 receptor (histamine) - cAMP
what does omeprazole block
H/K pump on gastric parietal cells
glands that secrete alkaline mucus to neutralize acid contents entering the duodenum
*the only GI submucosal glands
brunner's glands
what activates trypsin
enterokinase/enteropeptidase, enzyme secreted from duodenal mucosa
hypertrophy of brunner's glands is seen in what
peptic ulcer disease of the duodenum
the rate-limiting step of carbohydrate digestion, produces monosaccharides from oligo and disaccharides
oligosaccharide hydrolases (brush border enzymes)
what transports all carbohydrates to the blood from enterocytes
GLUT-2
facilitates fructose diffusion
GLUT-5
where are iron, folate, and B12 absorbed respectively
Iron (Fe 2+ only) - duodenum
folate - jejunum
B12 - ileum (requires intrinsic factor)
unencapsulated lymphoid tissue found in the lamina propria and submucosa of small intestine, contains specialized M cells
peyer's patches
what do B cells in the germinal centers of Peyer's patches differentiate into
IgA-secretory plasma cells
the only significant mechanism for cholesterol excretion
bile salt excretion
needed for both digestion of triglycerides and micelle formation (absorption of lipids)
bile salts
what is direct bilirubin conjugated with
glucuronic acid to make water soluble via glucuronyl transferase
what happens to conjugated bilirubin once excreted into bile
gut bacteria transform to urobilinogen - most is excreted into feces, some excreted into urine as urobilin, and some is taken back to the liver
most common parotid gland tumor; painless, moveable mass
pleomorphic adenoma
benign parotid gland tumor, heterotopic salivary gland tissue trapped in a lymph node, surrounded by lymphatic tissue
Warthin's tumor
most common malignant salivary gland tumor (usually in parotid)
mucoepidermoid carcinoma
failure of relaxation of lower esophageal sphincter (LES) due to loss of myenteric (Auerbach's) plexus
achalasia
Bird's beak on barium swallow
achalasia
what can secondary achalasia arise from
Chaga's disease
associated with increased risk of esophageal squamous cell carcinoma
achalasia
common presents as heartburn, regurgitation, nocturnal coughing, and dyspnea
GERD
organisms associated with esophagitis
HSV-1
CMV
Candida
transmural esophageal rupture due to violent retching
boerhaave syndrome
mucosal lacerations at the GE junction associated with alcoholics and bulimics
Mallory-Weiss syndrome
plummer-vinson syndrome triad
1. dysphagia (esophageal web)
2. glossitis
3. iron deficiency anemia
glandular metaplasia in the epithelium of the distal esophagus due to GERD, associated with esophagitis, ulcers, and increased risk of adenocarcinoma
Barrett's esophagus
where is squamous cell carcinoma and adenocarcinoma of the esophagus found respectively
SCC - upper 1/3
adenocarcinoma - lower 1/3
what is the most common type of esophageal cancer worldwide vs. United States
worldwide - SCC
U.S. - adenocarcinoma
malabsorption syndrome
sprue (tropical or celiac)
whipple's disease
disaccharidase deficiency
abetalipoproteinemia
pancreatic insufficiency
infectious sprue that is similar to celiac sprue, however can affect entire small bowel
tropical sprue
PAS-positive macrophages in intestinal lamina propria, arthralgias, cardiac, and neurologic symptoms are common
whipple's disease
autoantibodies to gluten, proximal small bowel primarily
celiac sprue
presents in childhood with malabsorption and neurologic manifestations, inability to generate chylomicrons
abetalipoproteinemia
causes pancreatic insufficiency
CF
obstructing cancer
chronic pancreatitis
associated with antibodies to gliadin and tissue transglutaminase, blunting of villi, decreased mucosal absorption that primarily affect jejunum
celiac sprue
associated with dermatitis herpetiformis and increased risk of T-cell lymphoma
celiac sprue
causes of acute gastritis (erosive)
stress
NSAIDs
alcohol
uremia
burns (Curling's ulcer)
brain injury (Cushing's ulcer)
Curling's ulcer
decreased plasma volume leads to sloughing of gastric mucosa
Cushing's ulcer
increased vagal stimulation leads to increased ACh causing increased gastric acid production
causes of chronic gastritis (nonerosive)
autoimmune to parietal cells (pernicious anemia)
H. pylori infection
where is type A and B chronic gastritis found respectively
type A - gastric body
type B - antrum
gastric hypertrophy with protein loss, parietal cell atrophy, and increased mucous cells
menetrier's disease
linitis plastica
adenocarcinoma of the stomach that is diffusely infiltrative with thickened appearance, leather bottle
virchow's node
involvement of left supraclavicular node by metastasis from stomach
bilateral metastasis to ovaries from stomach carcinoma, abundant mucus and signit ring cells
Krukenberg's tumor
causes of adenocarcinoma of stomach
nitrosamines (smoked foods)
achlorhydria
chronic gastritis
potential complications of peptic ulcers
bleeding
penetration into pancreas
perforation
obstruction
differentiate gastric and duodenal ulcers
gastric - pain greater with meals, H. pylori in 70%, chronic NSAID use, due to decreased mucosal protection
duodenal - pain decreases with meals, H. pylori almost 100%, due to increased gastric acid secretion, hypertrophy of Brunner's glands
IBD associated with: skip lesions, rectal sparing, transmural inflammation, creeping fat, noncaseating granulomas, and fistulas
Crohn's disease
IBD associated with: continuous lesions, always with rectal involvement, mucosal and submucosal inflammation only, pseudopolyps, bloody diarrhea
ulcerative colitis
extraintestinal manifestations of Crohn's disease
migratory polyarthritis
erythema nodosum
ankylosing spondylitis
uveitis
recurrent abdominal pain associated with pain improving with defecation, change in stool frequency and appearance.
IBS
may present with diarrhea, constipation, or alternating with no structural abnormalities present
IBS
differentiate cause of appendicitis in kids vs. adults
kids - lymphoid hyperplasia after viral infection
adults - obstruction by fecalith
differentiate true vs. false diverticulum
true - all 3 gut wall layer outpouch
false - only mucosa and submucosa outpouch
most common location for diverticulum
sigmoid colon
many diverticula most commonly in sigmoid colon, caused by increased intraluminal pressure associated with low-fiber diets
diverticulosis
inflammation of diverticula classically causing LLQ pain, fever, leukocytosis
diverticulitis
often asymptomatic or associated with vague discomfort and painless rectal bleeding
diverticulosis
false diverticulum that is a herniation of mucosal tissue at junction of pharynx and esophagus
zenker's diverticulum
true diverticulum that is a persistence of the vitelline duct or yolk stalk, may contain ectopic gastric mucosa or pancreatic tissue
meckel's diverticulum
most common congenital anomaly of the GI tract
meckel's diverticulum
what can cause intussusception in children
usually idopathic, however may be viral (adenovirus)
where does volvulus usually occur
cecum and sigmoid colon because there is redundant mesentery
congenital megacolon characterized by lack of ganglion cells/enteric nervous plexuses in segment
hirschsprung's disease
due to failure of neural crest cell migration and associated with down syndrome
hirschsprung's disease
double bubble, causes early bilious vomiting, associated with down syndrome
duodenal atresia
seen in CF, meconium plug obstructs intestine preventing stool passage at birth
meconium ileus
necrosis of intestinal mucosa, usually in the colon, associated with preemie babies
necrotizing enterocolitis
reduction in intestinal blood flow causing ischemia (ischemic colitis) typically occur where
splenic flexure
bleeding due to tortuous dilation of vessels most often found in cecum
angiodysplasia
most common non-neoplastic poly in colon
hyperplastic
mostly sporadic lesions in children < 5 year of age, if single there is no malignant potential
juvenile
autosomal dominant syndrome featuring multiple nonmalignant hamartomas throughout GI tract along with hyperpigmented mouth and lips
peutz-jeghers
is peutz-jeghers syndrome associated with increased risk of colorectal cancer
yes, however the polyps themselves are nonmalignant
autosomal dominant mutation of APC gene on chromosome 5q, 100% progress to colorectal cancer
familial adenomas polyposis
FAP + osseous and soft tissue tumors, retinal hyperplasia
gardner's syndrome
FAP + malignant CNS tumor
turcot's syndrome
autosomal dominant mutation of DNA mismatch repair genes, proximal colon is always involved
hereditary nonpolyposis colorectal cancer
associated with iron deficiency anemia in older males, apple core lesions on barium enema, CEA tumor maker
colorectal cancer
what determines if carcinoid syndrome is observed or not
location - confined to GI system, no carcinoid syndrome is observed since liver metabolizes 5-HT; If metastases (usually to liver) then carcinoid syndrome is observed
classic symptoms of carcinoid syndrome
wheezing
right-sided heart murmurs
diarrhea
flushing
tumor of neuro-endorcrine cells that are usually located in appendix, ileum, and rectum
carcinoid tumor
causes of micronodular (< 3 mm nodules) in liver
alcohol
hematchromatosis
wilson's disease
causes of macronodular liver nodules
postinfectious or drug-induced hepatitis
*associated with increased risk of hepatocellular carcinoma
effects of liver cell failure
coma
terrible breath (fetor hepaticus)
spider nevi
gynecomastia
jaundice
testicular atrophy
asterixis
anemia
differentiate ALT > AST, AST > ALT
ALT > AST - viral hepatitis
AST > ALT - alcholic hepatitis
increased levels of alkaline phosphatase (ALP)
obstructive liver disease (hepatocellular carcinoma), bone disease, bile duct disease
associated with decreased ceruloplasmin
Wilson's disease
associated with increased lipase
acute pancreatitis
*chronic pancreatitis has no enzyme elevations
two associated with elevated serum amylase
acute pancreatitis
mumps
childhood hepatoencephalopathy due to child taking salicylates for viral infection
Reye's syndrome
hepatoencephalopathy associated with decreased B-oxidation by reversible inhibition of mitochondrial enzymes leading to microvesicular fatty change
Reye's syndrome
associated with macrovesicular fatty change
hepatic steatosis
differentiate micro/macrovesicular fatty change
microvesicular - aspirin in child with fever
macrovesicular - alcohol
associated with swollen and necrotic hepatocytes with neutrophilic infiltration, mallory bodies are also present (intracytoplasmic eosinophilis inclusions)
alcoholic hepatitis
micronodular irregular shrunken liver with sclerosis around central vein
alcoholic cirrhosis
most common primary malignant tumor of the liver in adults, increased incidence with HBV, HCV, Wilson's, hemochromatosis, a1-antitrypsin deficiency, alcohol, aflatoxin
hepatocellular carcinoma
tumor associated with increased a-FP
hepatocellular carcinoma
cause of nutmeg liver
backup of blood into liver - Right sided heart failure, Budd-Chiari syndrome
occlusion of IVC or hepatic veins with centrilobular congestion and necrosis
Budd-Chiari syndrome
causes of Budd-Chiari syndrome
hypercoagulable state
polycythemia rubra vera
pregnancy
misfolded gene product protein accumulates in hepatocellular endoplasmic reticulum, PAS-positive globules in liver
a1-antitrypsin deficiency
associated with panacinar emphysema due to decreased elastic tissue in lungs along with liver liver
a1-antitrypsin deficiency
immature UDP-glucuronyl transferase leading to unconjugated hyperbilirubinemia
neonatal jaundice
what does phototherapy due to neonatal jaundice
converts UCB to water-soluble form (conjugated)
differntiate urine bilirubin and urine urobilinogen found in: obstructive and hemolytic
obstructive - increased conjugated bilirubin in blood leading to increased urine bilirubin and decreased urine urobilinogen
hemolytic - increased unconjugated bilirubin in blood leading to absent urine bilirubin and increased urine urobilinogen
mildly decreased UDP-glucuronyl transferase or decreased biliurbin uptake leading to elevated unconjugated bilirubin, but no clinical consequences
Gilbert's syndrome
absent UDP-glucuronyl transferase leading to elevated unconjugated bilirubin; however patients die within a few years
Crigler-Najjar syndrome
what is the treatment for type II Crigler-Najjar syndrome
phenobarbital because it's less severe and this drug increases liver enzyme synthesis
associated with conjugated hyperbilirubinemia due to defective liver excretion, causes grossly black liver
dubin-johnson syndrome
like dubin-johnson syndrome but milder and does not cause black liver
rotor's syndrome
inadequate hepatic copper excretion and failure of copper to enter circulation
Wilson's disease
treatment of Wilson's disease
penicillamine
where does copper accumulate in Wilson's disease
liver, brain, cornea, kidneys, joints
associated with asterixis, basal ganglia degeneration, cirrhosis, choreiform movements, dementia
Wilson's disesae
classic triad or hemochromatosis
micronodular cirrhosis
dibetis mellitus
skin pigmentation
associated with increased ferritin, iron, and transferrin saturation, with decreased TIBC
hemochromatosis
secondary biliary cirrhosis
extrahepatic biliary obstruction (gallstone, biliary stricture, chronic pancreatitis, carcinoma of the pancreatic head)
autoimmune reaction associated with increased serum mitochondrial antibodies
primary biliary cirrhosis
bile duct fibrosis leading to alternating beading of intra and extrahepatic bile ducts
primary sclerosing cholangitis
presentation of biliary tract diseases
pruritis, jaundice, dark urine, light stools, hepatosplenomegaly
associated with increased conjugated bilirubin, increased cholesterol, and increased alkaline phosphatase
biliary tract diseases
biliary tract disease associated with ulcerative colitis
primary sclerosing cholangitis
presentation of cholangitis
jaundice
fever
RUQ pain (positive murphy's sign - inspiratory arrest on deep palpation)
in what type of patient would biliary colic not present with pain
diabetic
potential problems associated with pancreatitis
DIC, ARDS, diffuse fat necrosis, hypocalcemia, pseudocyst formation
associative causes of pancreatic adenocarcinoma
cigarettes
chronic pancreatitis (not alcohol)
presentation of pancreatic adenocarcinoma (4)
1. abdominal pain radiating to back
2. weight loss
3. migratory thrombophlebitis
4. obstructive jaundice with palpable gallbladder