Gi - 1

Front 1

What organs are retroperitoneal?

Back 1

Retroperitoneal:
2, 3, 4th parts of duodenum
Ascending and descending colon
Kidneys and ureters
Aorta and IVC
Pancreas other than the tail

Front 2

What ligament connects the liver to the abdominal wall? What is this a derivative of?

Back 2

Falciform ligament: liver to abd wall
- remnant of umbilical vein

Front 3

What ligament connects the greater and lesser sacs? What is contained within the ligament?

Back 3

Hepatoduodenal ligament connects the greater and lesser sacs and contains the portal triad: hepatic artery, portal vein and common bile duct

Front 4

What ligament contains the gastroepiploic arteries?

Back 4

Gastrocolic ligament (b/w greater curvature and transverse colo) contains gastroepiploic arteries.

Front 5

At which part of the digestive tract is seen nonkeratinized, stratified squamous epithelium?

Back 5

Non-keratinized stratified squamous epithelium = esophagus

Front 6

Where in the GI system are Brunner's glands?

Which part has Peyer's patches?

Where are each located within the GI wall?

Back 6

Brunner's glands = duodenum (submucosa)

Peyer's patches - ileum (lamina propria, submucosa)

Front 7

What type of muscle is seen in the esophagus?

Back 7

Esophagus:
upper 1/3 = striated
middle 1/3 = mixed
lower 1/3 = smooth

Front 8

What are the blood supplies and innervation to the GI system?

Back 8

Foregut - Stomach to proximal duodenum including liver, gallbladder, pancreas and spleen = Celiac

Midgut - distal duodenum through proximal 2/3 of colon = SMA

Hindgut - Distal 1/3 of transverse colon to rectum = IMA

Hint 8

Foregut and midgut - Vagus

Hindgut - pelvic

Front 9

Blood supply to the stomach:

Back 9

Celiac and branches:
Greater curvature: L and R gastroepiploic
Lesser curvature: L and R gastric

Front 10

What branches come off the celiac artery?

Back 10

Celiac trunk divides into
1. L gastric
2. Splenic
3. Common hepatic which quickly divides into:
a. R gastric
b. Hepatic proper
c. Gastroduodenal

Front 11

What two shunts can be introduced to lower portal HTN?

Back 11

1. Splenic to L renal

2. Portal vein (drains into liver) to IVC

Front 12

What anastamosis is indicated by each of the following?
- Caput medusae

Back 12

Caput medusae: Paraumbilical <--->superficial and inf epigastric

Front 13

What anastamosis is indicated by each of the following?
- Esophageal varices

Back 13

Esophageal varices: L gastric <--> esophageal

Front 14

What anastamosis is indicated by each of the following?
- Internal hemorrhoids

Back 14

Internal hemorrhoids: sup rectal <-->middle and inf rectal

Front 15

What diff types of cancer affect above/below the pectinate line?

What blood supply and drainage?

Back 15

Above - adenocarcinoma

Below - squamous cell carcinoma

Hint 15

Above: Sup rectal artery (IMA) and superior rectal vein (IMV)

Below: Inferior rectal artery (internal pudendal branch) and inf rectal vein (internal pudendal vein)

Front 16

What are the different zones of the liver and how does this determine what each is affected by?

Back 16

Zone 1: periportal (richest O2 supply) - first affected by viral hepatitis

Zone 2: intermediate

Zone 3: pericentral vein zone - affected by ischemia first, contains p450, most sensitive to toxic injury and alcoholic hep

Front 17

What is the role of Kupffer cells? Ito cells?

Back 17

Kupffer cells - macrophages

Ito (hepatic stellate cells) - store vit A and activate to produce collagen and fibrosis during injury

Front 18

Describe the path bile takes from the liver to the duodenum.

Back 18

Bile is collected in the liver in the bile duct. Bile ducts coalesce into R and L hepatic ducts which form the common hepatic duct. These connect with the cystic duct (from the gallbladder) to form the common bile duct. The common bile duct connects with the pancreatic duct and opens onto the duodenum through the Ampulla of Vater which is surrounded by the Sphincter of Oddi.

Front 19

What is in the femoral triangle?

What makes up the bounds of this area?

Back 19

Femoral triangle is NAVEL - nerve, artery, vein, empty space, lymphatics (from lateral to medial)

Hint 19

Superiorly: inguinal ligament
Medially: Adductor longus muscle
Laterally: Sartorius

Front 20

What runs in the inguinal canal?

Back 20

Inguinal canal: spermatic cord and cremasteric muscle

Front 21

What are the two types of diaphragmatic hernias and which is more common?

Back 21

Diaphragmatic hernias: sliding (hourglass) > paraesophageal (cardia in thorax)

Front 22

Where will an indirect hernia appear and why does this happen?

What covers an indirect hernia?

Back 22

Indirect hernia: through internal inguinal ring and into scrotum due to failure of processus vaginalis to close.

Hint 22

Indirect hernias are covered by all three layers of spermatic fascia.

Front 23

Where do direct hernias course and what covers them?

Back 23

Direct hernias (med to inf epigastric vessels) course through external inguinal ligament and are covered by external spermatic fascia.

Front 24

What is the leading cause of bowel incarceration in women?

Back 24

Femoral hernias are the leading cause of bowel incarceration in women.

Front 25

What is Hesselbach's triangle?

Back 25

Hesselbach's triangle: site of direct hernia protrusion
Medially: rectus abdominus
Laterally: inf epigastric vessels
Inferiorly: inguinal ligament