First Aid Step 1 - Gastroenterology - Anatomy, Physiology, Embryology

Front 1

What is the source of gastrin?

Back 1

G cells (antrum of the stomach)

Front 2

What is the action of gastrin?

Back 2

Inc gastric H+ secretion, inc growth of gastric mucosa, inc gastric motility

Front 3

How is gastrin regulated?

Back 3

Inc by stomach distention/alkalinization, amino acids, peptides, vagal stimulation. Dec by stomach pH <1.5

Front 4

What disease has increased gastrin?

Back 4

Zollinger-Ellison syndrome

Front 5

What medication can cause increased gastrin?

Back 5

Chronic PPI use (proton pump inhibitors).

Front 6

What amino acids are potent stimulators of gastrin production?

Back 6

Phenylalanine and tryptophan

Front 7

What is the source of Cholecystokinin?

Back 7

I cells (duodenum, jejunum)

Front 8

What is the action of Cholecystokinin?

Back 8

Increases pancreatic secretion, galbladder contraction, and spincter of Oddi relaxation. Decreases gastric emptying

Front 9

How is Cholecystokinin regulated?

Back 9

Increased by fatty acids and amino acids

Front 10

How does Cholecystokinin cause pancreatic secretions to increase?

Back 10

Acts on neural muscarinic pathways

Front 11

What is the source of secretin?

Back 11

S cells (duodenum)

Front 12

What is the action of secretin?

Back 12

Increases pancreatic bicarbonate (HCO3-) and bile secretion.

Decreases gastric acid secretion.

Front 13

What regulates secretin levels?

Back 13

Increased by acid and fatty acids in the lumen of duodenum

Front 14

How does secretin help to allow pancreatic enzymes to function?

Back 14

It increase bicarb, which neutrolizes gastric acid in the duodenum, allowing pancreatic enzymes to function

Front 15

What is the source of somatostatin in the GI tract?

Back 15

D cells (pancreatic islets, GI mucosa)

Front 16

What is the action of somatostatin in the GI tract?

Back 16

Decreases gastric acid and pepsinogen secretion, decreases pancreatic and small intestine fluid secretion, decreases gallbladder contraction, and decreases insulin and glucagon release

Front 17

How is somatostatin regulated in the GI tract?

Back 17

Increased by acid and decreased by vagal stimulation

Front 18

What type of hormone is somatostatin (stimulatory or inhibitory?)

Back 18

Inhibitory

Front 19

What is the effect of somatostatin on growth hormone?

Back 19

Inhibits growth hormone (inhibits digestion and absorption of substances needed for growth)

Front 20

What is the source of glucose-dependent insulinotropic peptide?

Back 20

K cells (duodenum, jejunum)

Front 21

What are the actions of glucose-dependent insulinotropic peptide?

Back 21

Exocrine: decreases gastric H+ secretion.

Endocrine: increases insulin release

Front 22

How is glucose-dependent insulinotropic peptide regulated?

Back 22

Increased by fatty acids, aminoacids, and oral glucose

Front 23

Why is an oral glucose load used more rapidly than the equivalent by IV?

Back 23

GIP (Glucose-dependent insulinotropic peptide) secretion

Front 24

What is the source of VIP (vasoactive intestinal polypeptide)?

Back 24

Parasympathetic ganglia in sphincters, gallbladder, and small intestine

Front 25

What is the action of VIP?

Back 25

increase intestinal water and electrolyte secretion, increases relaxation of intestinal smooth muscle and sphincters.

Front 26

What regulates VIP levels?

Back 26

Increased by distention and vagal stimulation.

Decreased by adrenergenic input

Front 27

What is a VIPoma and what are the symptoms?

Back 27

VIPoma = non-alpha, non-beta islet cell pancreatic tumor that secretes VIP.

Symptoms: copious watery diarrhea, hypokalemia, achlorhydria

Front 28

What is the action of nitric oxide in the GI tract?

Back 28

Inc smooth muscle relaxation, including lower esophageal sphincter

Front 29

What is a potential cause of achalasia wrt GI tract hormones?

Back 29

Loss of Nitric Oxide secretion is implicated in inc lower esophageal tone of achalasia

Front 30

What is the source of motilin in the GI tract?

Back 30

Small intestine

Front 31

What is the action of motilin in GI tract?

Back 31

Produces migrating motor complexes (MMCs)

Front 32

What regulates motilin levels in GI tract?

Back 32

Increased in fasting state

Front 33

What drug is used to stimulate intestinal peristalsis in GI tract?

Back 33

Motilin receptor agonists (ex: erythromycin)

Front 34

What is the source of intrinsic factor?

Back 34

Parietal cells (stomach)

Front 35

What is the action of intrinsic factor?

Back 35

Vitamin B12-binding protein (required for B12 uptake in terminal ileum)

Front 36

What happens when autoimmune disease destroys parietal cells?

Back 36

Chronic gastritis and pernicious anemia

Front 37

What is the source of gastric acid in GI tract?

Back 37

Parietal cells (stomach)

Front 38

What is the action of gastric acid?

Back 38

Decreases stomach pH

Front 39

What regulates gastric acid levels?

Back 39

Increased by histamine, ACh, gastrin.

Decreased by somatostatin, GIP, prostaglandin, secretin

Front 40

What is a gastrinoma?

Back 40

Gastrin-secreting tumor that causes continuous high levels of acid secretion and ulcers

Front 41

What is the source of pepsin?

Back 41

Chief cells (stomach)

Front 42

What is the action of pepsin in GI tract?

Back 42

Protein digestin

Front 43

What regulates pepsin levels?

Back 43

Increased by vagal stimulation, local acid

Front 44

What converts inactive pepsinogen to pepsin?

Back 44

H+

Front 45

What is the source of bicarbonate (HCO3-) in GI tract?

Back 45

Mucosal cells (stomach, duodenum, salivary glands, pancreas) and Brunner's glands (duodenum)

Front 46

What is the action of bicarb in GI tract?

Back 46

Neutralizes acid

Front 47

What regulates bicarb levels in GI tract?

Back 47

Increased by pancreatic and biliary secretion with secretin

Front 48

Where is bicarb found on cells in GI tract?

Back 48

It is trapped in the mucosa that covers the gastric epithelium

Front 49

What glands secrete saliva?

Back 49

Parotid, submandibular, and sublingual galnds via sympathetic and parasympathetic activity

Front 50

What are the components of saliva and what are their actions?

Back 50

Amylase digests starch, bicarb neutralizes bacterial acids, mucins lubricate food.

Front 51

Is saliva normally hypo, iso, or hypertonic?

Back 51

Hypotonic because of absorption but more isotonic with higher flow rates (less time for absorption)

Front 52

How does atropine affect vagal stimulation of parietal cells and G cells?

Back 52

Atropine blocks vagal stimulation of parietal cells.

Vagal stimulation of G cells is unaffected, as a different transmitter (GRP) is used, not ACh

Front 53

How does gastrin increase acid secretion?

Back 53

Primarily through its effects on ECL cells (leading to histamine release) rather than directly through its affects on parietal cells

Front 54

Where are Brunner's glands located?

Back 54

Duodenal submucosa

Front 55

What is the action of Brunners glands?

Back 55

Secrete alkaline mucus

Front 56

When do you see Brunner's gland hyperplasia?

Back 56

Peptic ulcer disease

Front 57

Are pancreatic secretions hypo, iso, or hypertonic?

Back 57

Isotonic

Front 58

How do low flow and high flow affected pancreatic secretions?

Back 58

Low flow -> high Cl-

High flow -> high HCO3-

Front 59

What is the role of alpha-amylase?

Back 59

Starch digestion

Front 60

Is alpha-amylase secreted in the active or passive form?

Back 60

Active form

Front 61

What are the roles of lipase, phospholipase A, and colipase?

Back 61

Fat digestion

Front 62

What is the role of proteases?

Back 62

Protein digestion

Front 63

What are the proteases?

Back 63

Trypsin, chymotrypsin, elastase, carboxypeptidases.

Front 64

How are proteases secreted?

Back 64

Proenzymes also known as zymogens

Front 65

What is the role of trypsinogen?

Back 65

Converted to active enzyme trypsin which activates other proenzymes and creates more trypsinogen (positive feedback loop)

Front 66

What converts trypsinogen to trypsin?

Back 66

Enterokinase/enteropeptidase (an enzyme secreted from duodenal mucosa)

Front 67

What is the action of salivary amylase and how does it do it?

Back 67

Starch digestion. Hydrolyzes alpha-1,3 linkages to yield disaccharides (maltose and alpha-limit dextrins)

Front 68

Where is the concentration of pancreatic amylase the highest?

Back 68

Duodenal lumen

Front 69

What does pancreatic amylase do?

Back 69

Hydrolyzes starch to oligosaccharides and disaccharides

Front 70

Where are oligosaccharide hyrolases located?

Back 70

A brunch border of intestine

Front 71

What is the rale limiting step in carbohydrate digestion?

Back 71

Oligosaccharide hydrolases

Front 72

What do oligosaccharide hydrolases produce?

Back 72

Monosaccharides from oligo- and disaccharides

Front 73

Which type of sugars can be absorbed by enterocytes?

Back 73

Only monosaccharides (glucose, galactose, and fructose)

Front 74

How are sugars taken up by enterocytes?

Back 74

Glucose and galactose are taken up by the SGLT1 (Na+ dependent).

Fructose is taken up by facilitated diffusion by GLUT-5.

All are transported by GLUT-2.

Front 75

What is the D-xylose absorption test?

Back 75

Distinguishes GI mucosal damage from other cauess of malabsorption

Front 76

How/where is Iron absorbed?

Back 76

As Fe2+ in duodenum

Front 77

Where is folate absorbed?

Back 77

Jejunum

Front 78

Where/how is B12 absorbed?

Back 78

In terminal ileum alone with bile acids; requires intrinsic factor

Front 79

What are Peyer's patches? Where are they found? What type of cells do they contain?

Back 79

Unencapsulated lymphoid tissue found in the lamina propria and submucosa of ileum.

Contain specialized M cells that take up antigen

Front 80

What happens to B cells in Peyer's patches?

Back 80

B cells stimulated in germinal centers of Peyer's patches differentiate into IgA-secreting plasma cells, which ultimately reside in lamina propria.

Front 81

What is the path of IgA in the GI mucosa and what is its role in GI mucosa?

Back 81

Made form B cells in Peyer's patches.

IgA receives a protective secretory component and is then transported across the epithelium to the gut to deal with intraluminal antigen

Front 82

What makes up bile?

Back 82

Composed of bile salts (Bile acids conjugated to glycine or taurine, making them water soluble), phospholipids, cholesterol, bilirubin, water, and ions.

Front 83

What is the rate limiting step of bile formation?

Back 83

Cholesterol 7alpha-hydroxylase catalyzes the rate limiting step.

Front 84

What are the 3 main functions of bile?

Back 84

1. Digestion and absorption of lipids and fat-soluble vitamins
2. Cholesterol excretion (body's only means of eliminating cholesterol)
3. Antimicrobial activity (via membrane disruption)

Front 85

What is the body's only means of eliminating cholesterol?

Back 85

Bile

Front 86

What metabolic pathway makes bilirubin?

Back 86

Heme metabolism

Front 87

How is bilirubin removed from the body?

Back 87

1. From blood by the liver
2. Conjugated with glucuronate
3. Excreted in bile

Front 88

What is Direct Bilirubin?

Back 88

Conjugated with glucuronic acid. Water soluble

Front 89

What is Indirect bilirubin?

Back 89

Unconjugated. Water insoluble

Front 90

What constitutes the foregut?

Back 90

Pharynx to duodenum

Front 91

What constitutes the midgut?

Back 91

Duodenum to transverse colon

Front 92

What constitues the hindgut?

Back 92

Distal transverse colon to rectum

Front 93

What disorder results form failure of rostal fold closure of anterior abdominal wall?

Back 93

Sternal defects

Front 94

What 2 disorders result from failure of lateral fold closure of anterior abdominal wall?

Back 94

Omphalocele, gastroschisis

Front 95

What disorder results form failure of caudal fold closure of anterior abdominal wall?

Back 95

Bladder extrophy

Front 96

What is duodenal atresia and what patients is it most common in?

Back 96

Failure to recanalize.

Seen commonly in trisomy 21

Front 97

What causes jejunal, ileal, and colonic atresia?

Back 97

Due to vascular accident (apple peel atresia)

Front 98

What are the 2 main steps in midgut development and when do they happen?

Back 98

1. 6th week: midgut herniates through umbilical ring.
2. 10th week: return to abdominal cavity + rotates around SMA

Front 99

What are the types of pathology that can be seen with failure of GI tract development?

Back 99

Malrotation of midgut, omphalocele, intestinal atresia or stenosis, volvulus

Front 100

Compare gastroschiss and omphalocele

Back 100

Gastroschisis:
-extrusion of abdominal contents through abdominal folds.
-NOT covered by peritoneum.

Omphalocele:
-Persistence of herniation of abdominal contents into umbilical cord
-COVERED by peritoneum

Front 101

What is the most common trachoesophageal anomaly?

Back 101

Esophgeal atresia with distal tracheoesophagel fistula (85%)

Front 102

What are the signs of tracheoesphageal fistula?

Back 102

-Drooling, choking, vomiting with first feed.
-TEF allows air to enter stomach, which is visible on CXR.
-Cyanosis is secondary to laryngospasm (to avoid reflux-related aspiration).

Front 103

What clinical test can be used to diagnose TEF?

Back 103

Failure to pass NG tube into stomach

Front 104

What is an H-type TEF?

Back 104

Fistula alone (no atresia).

Front 105

What will CXR show in pure esophageal atresia?

Back 105

CXR will show gasless abdomen

Front 106

What is congenital pyloric stenosis? What will see on PE? What are symptoms?

Back 106

Hypertrophy of pylorus causes obstruction.

PE: palpable "olive" mass in epigastric region and nonbilious projectile vomiting at ~2 weeks of age.

Front 107

What is the treatment for pyloric stenosis?

Back 107

Surgery

Front 108

How common is pyloric stenosis and who is it more common in?

Back 108

1/600 live births.

More common in first born males

Front 109

What is the pancreas derived from and how does it happen?

Back 109

Foregut.

-Ventral pancreatic buds contribute to the pancreatic head and main pancreatic duct.
-The uncinate process is formed by the ventral bud alone.
-The dorsal pancreatic bud becomes everything else (body, tail, isthmus, and accessory pancreatic duct)

Front 110

What is an annular pancreas?

Back 110

Ventral pancreatic bud abnormally encircles 2nd part of duodenum; forms a ring of pancreatic tissue that may cause duodenal narrowing

Front 111

What is pancreas divisum?

Back 111

Ventral and dorsal parts fail to fuse at 8 weeks

Front 112

What is the spleen derived from?

Back 112

Arises in mesentery of stomach (therefore is mesodermal) but is supplied by foregut (celiac artery)

Front 113

What does the term retroperitoneal mean? Why are they important?

Back 113

GI strcutres that lack mesentery (as well as non-GI structures).

Injury to retroperitoneal structures can cause blood or gas accumulation in retroperitoneal space.

Front 114

What are the retroperitoneal structures?

Back 114

SAD PUCKER:
Suprarenal (adrenal) glands
Aorta and IVC
Duodenum (2nd and 3rd parts)

Pancreas (except tail)
Ureters
Colon (descending and ascending)
Kidneys
Esophagus (lower 2/3)
Rectum (lower 2/3)

Front 115

What does the falciform ligament connect?

Back 115

Liver to anterior abdominal wall

Front 116

What structures are contained in the falciform ligament?

Back 116

Ligamentum teres hepatis

Front 117

What is the ligamentum teres hepatis a derivative of?

Back 117

Fetal umbilical vein

Front 118

What is the falciform ligament a derivative of?

Back 118

Ventral mesentery

Front 119

What does the hepatoduodenal ligament connect?

Back 119

Liver to duodenum. Also connects the greater and lesser sacs

Front 120

What structures are contained in the hepatoduodenal ligament?

Back 120

The portal triad: hepatic artery, portal vein, common bile duct

Front 121

What structures make up the portal triad?

Back 121

Hepatic artery, portal vein, common bile duct

Front 122

What is the Pringle maneuver?

Back 122

The hepatoduodenal ligament may be compressed between the thumb and index finger placed in omental foramen to control bleeding

Front 123

What does the gastrohepatic ligament connect?

Back 123

Liver to lesser curvature of the stomach

Front 124

What structures are contained in the gastrohepatic ligament?

Back 124

Gastric arteries

Front 125

What does the gastrohepatic ligament separate?

Back 125

The greater and lesser sacs on the right (may be cut during surgery to access the lesser sac)

Front 126

What does the gastrocolic ligament connect?

Back 126

Greater curvature and transverse colon.

Front 127

What structures are contained in the gastrocolic ligament?

Back 127

Short gastrics, L gastroepiploic vessels

Front 128

What does the gastrosplenic ligament separate?

Back 128

Greater and lesser sacs on the left

Front 129

What does the splenorenal ligament connect?

Back 129

Spleen to posterior abdominal wall

Front 130

What does the splenorenal ligament contain?

Back 130

Splenic artery and vein, as well as the tail of the pancreas

Front 131

What are the 4 layers of the gut wall from inside to outside?

Back 131

MSMS: mucosa, submucosa, muscularis externa, serosa/adventitia

Front 132

What are the layers of the mucosa and what are their functions?

Back 132

Epithelium (absorption), lamina propria (support), muscularis mucosa (motility)

Front 133

What nerve plexus is in the submucosa?

Back 133

Submucosal nerve plexus (Meissner's)

Front 134

What nerve plexus is in the muscularis externa?

Back 134

Myenteric nerve plexus (Auerbach's)

Front 135

When do you call the outermost layer of the gut wall serosa vs adventitia?

Back 135

Serosa when intraperitoneal, adventitia when retroperitoneal

Front 136

Where can ulcers extend to in the gut wall? What about erosions?

Back 136

Ulcers can extend into the submucosa, inner, or outer muscular layer whereas erosions are in the mucosa only

Front 137

What are the frequencies of basal electrical rhythm (slow waves) in the sotmach, duodenum, and ileum?

Back 137

Stomach: 3 waves/min.
Duodenum: 12 waves/min.
Ileum: 8-9 waves/min

Front 138

What is the histology of the esophagus?

Back 138

Nonkeratinized stratified squamous epithelium

Front 139

What is the histology of the stomach?

Back 139

Gastric glands

Front 140

What is the histology of the duodenum?

Back 140

Villi and microvilli increase absorptive surface. Brunner's glands (submucosa) and crypts of Lieberkuhn

Front 141

What is the histology of the jejunum?

Back 141

Plicae circulares and crypts of Lieberkuhn

Front 142

What is the histology of the Ileum?

Back 142

Peyer's patches (lamina propria, submucosa), plicae circulares (proximal ileum), and crypts of Lieberkuhn.

Front 143

Where is the largest number of goblet cells in the GI tract?

Back 143

Small intestine

Front 144

What is the histology of the colon?

Back 144

Crypts but no villi. Numerous goblet cells

Front 145

What direction do aortic arteries supplying the GI structures branch?

Back 145

Anteriorly

Front 146

What direction do aortic arteries supplying the non-GI structures branch?

Back 146

Laterally

Front 147

Whas is SMA (superior mesenteric artery) syndrome?

Back 147

Transverse portion (3rd segment) of the duodenum is entrapped between the SMA and aorta, causing intestinal obstruction

Front 148

At what level do the celiac trunk, SMA, L renal artery, inferior mesenteric artery, and bifurcation of the abdominal aorta branch off?

Back 148

Celiac trunk T12
SMA L1
L renal artery L1
Inferior mesenteric L3
Bifurcation L4

Front 149

What artery supplies the foregut? What is its parasympathetic innervation and at what vertebral level does it sit?

Back 149

Celiac artery
vagus nerve
T12/L1

Front 150

What artery supplies the midgut? What is its parasympathetic innervation and at what vertebral level does it sit?

Back 150

SMA
vagus nerve
L1

Front 151

What artery supplies the hindgut? What is its parasympathetic innervation and at what vertebral level does it sit?

Back 151

IMA
pelvic nerve
L3

Front 152

What structures are contained in the foregut?

Back 152

Stomach to proximal duodenum, liver, GB, pancreas, spleen (mesoderm)

Front 153

What structures are contained in the midgut?

Back 153

Distal duodenum to proximal 2/3 of transverse colon

Front 154

What structures are contained in the hindgut?

Back 154

Distal 1/3 of transverse colon to upper portion of rectum

Front 155

What is the watershed area of the hindgut?

Back 155

Splenic flexure

Front 156

What are the branches of the celiac trunk?

Back 156

common hepatic
splenic
L gastric (these are the main blood supply of the stomach)

Front 157

Do the short gastrics have good anastomoses if the spleic artery is blocked?

Back 157

Nonkeratinized stratified squamous epithelium

Front 158

Where are there strong anastamoses in the stomach blood supply?

Back 158

L and R gastroepiploics, L and R gastrics

Front 159

What are the 4 collateral circulations in the GI blood supply if the the branches off the abdominal aorta are blocked?

Back 159

1. Superior epigastric (internal thoracic/mammary) <-> inferior epigastric (external iliac)

2. Superior pancreaticoduodenal (celiac trunk) <-> inferior pancreaticoduodenal (SMA)

3. Middle colic (SMA) <-> L colic (IMA)

4. Superior rectal (IMA) <-> middle and inferior rectal (internal iliac)

Front 160

What is the clinical sign of portosystemic anastamosis at the esophagus and what is the portal <-> systemic anastamosis?

Back 160

Esophageal varices. Left gastric <-> esophageal

Front 161

What is the clinical sign of portosystemic anastamosis at the umbilicus and what is the portal <-> systemic anastamosis?

Back 161

Caput medusae. Paraumbilical <-> superficial and inferior epigastric below the umbilicus, adn superior epigastric and lateral thoracic above the umbilicus.

Front 162

What is the clinical sign of portosystemic anastamosis at the rectum and what is the portal <-> systemic anastamosis?

Back 162

Internal hemorrhoids. Superior rectal <-> middle and inferior rectal

Front 163

What varices are often seen in pts with portal hypertension?

Back 163

gut (esophageal), butt (hemorrhoids), caput (medusae)

Front 164

How can you treat portal-systemic antastamoses in patients with portal hypertension?

Back 164

TIPS (transjugular intrahepatic portosystemic shunt) between the portal vein and hepatic vein percutaneously relieves portal hypertension by shunting blood to the systemic circulation

Front 165

What is the pectinate (dentate) line?

Back 165

Formed where the endoderm (hindgut) meets the ectoderm

Front 166

What is the pathology above the pectinate line?

Back 166

Internal hemorrhoids, adenocarcinoma

Front 167

What is the arterial blood supply to above the pectinate line?

Back 167

Superior rectal artery (branch of IMA)

Front 168

What is the venous drainage for above the pectinate line?

Back 168

To the superior rectal vein -> inferior mesenteric vein -> portal system

Front 169

Compare internal and external hemorrhoids

Back 169

Internal are above the pectinate line; external are below. Internal receives visceral innervation and are NOT painful. External receives somatic innervation (inferior branch of pudendal nerve) and ARE painful

Front 170

Where does lymph drain to from above and below the pectinate line?

Back 170

Above: deep nodes. Below: superficial inguinal nodes

Front 171

What is the pathology below the pectinate line?

Back 171

External hemorrhoids, squamous cell carcinoma

Front 172

What is the arterial blood supply to below the pectinate line?

Back 172

Inferior rectal artery (branch of internal pudendal artery)

Front 173

What is the venous drainage from below the pectinate line?

Back 173

Inferior rectal vein -> internal pudendal vein -> internal iliac vein -> IVC

Front 174

What does the apical surface of hepatocytes face?

Back 174

Bile canaliculi

Front 175

What does the basolateral surface of hepatocytes face?

Back 175

Sinusoids

Front 176

What are the 3 zones of the liver?

Back 176

Zone I: periportal zone. Zone II: intermediate zone. Zone III: Pericentral vein (centrilobular) zone

Front 177

Which zone of the liver is first affected by viral hepatitis?

Back 177

Zone I

Front 178

Which zone of the liver is first affected by ischemia?

Back 178

Zone III

Front 179

Which zone of the liver contains the P-450 system?

Back 179

Zone III

Front 180

Which zone of the liver is most sensitive to toxic injury?

Back 180

Zone III

Front 181

Which zone is the site of alcoholic hepatitis?

Back 181

Zone III

Front 182

What can happen when gallstones reach the common channel at the ampulla of Vater?

Back 182

They can block both the bile and pancreatic ducts

Front 183

What can happen when tumors arise at the head of the pancreas (near the duodenum)?

Back 183

They can cause obstruction of the common bile duct

Front 184

What is the organization of the vessel/structures in the femoral region?

Back 184

Lateral to medial: Nerve-Artery-Vein-Empty space-Lymphatics (you go from lateral to medial to find your NAVEL)

Front 185

What is contained in the femoral triangle?

Back 185

Femoral vein, artery, and nerve

Front 186

What is the femoral sheath and what does it contain?

Back 186

Fascial tube 3-4cm below the inguinal ligament. Contains the femoral vein, artery, and canal (deep inguinal LN) but NOT the femoral nerve

Front 187

What is a hernia?

Back 187

Protrusion of peritoneum through an opening, usually at a site of weakness

Front 188

What is a diaphragmatic hernia?

Back 188

Abdominal structures enter the thorax

Front 189

How can diaphragmatic hernias happen in infants?

Back 189

As a result of defective development of pleuroperitoneal membrane

Front 190

What type of diaphragmatic hernia is most common?

Back 190

Hiatal hernia (stomach herniates upward through the esophageal hiatus of the diaphragm. Of these, sliding hiatal hernia is more common than paraesophagel hernias.

Front 191

What is the difference between sliding and paraesophageal hiatal hernias?

Back 191

Sliding: GE junction is displaced upwards, leading to "hourglass stomach".

Paraesophageal: GE junction is normal and the fundus protrudes into the thorax

Front 192

What is an indirect inguinal hernia?

Back 192

Goes through the INternal (deep) inguinal ring, external (superficial) inguinal ring, and INto the scrotum. It follows the path of the descent of the testes and is covered by all 3 layeres of spermatic fascia

Front 193

Where does an indirect hernia enter the internal inguinal ring?

Back 193

Lateral to the inferior epigastric artery

Front 194

How does an indirect hernia occur in infants?

Back 194

Failure of processus vaginalis to close (can form hydrocele)

Front 195

What sex is indirect inguinal hernias more common?

Back 195

Males

Front 196

What is a direct inguinal hernia?

Back 196

Protrudes through the inguinal (Hesselbach's) triangle. Goes through the external (superficial) inguinal ring only. It is covered by external spermatic fascia

Front 197

Where do direct hernias bulge through the abdominal wall?

Back 197

Medial to the inferior epigastric artery.

Front 198

Who do direct hernais most commonly occur in?

Back 198

Older men

Front 199

What is a femoral hernia?

Back 199

Protrudes below inguinal ligament through femoral canal below and lateral to pubic tubercle.

Front 200

What is the leading cause of bowel incarceration?

Back 200

Femoral hernia

Front 201

Who are femoral hernias more common in?

Back 201

Females

Front 202

What are the borders that make up Hesselbach's triangle?

Back 202

Inferior epigastric vessels, lateral border of rectus abdominis, and inguinal ligament