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90 Cards in this Set
- Front
- Back
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Retroperitoneal structures
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SADPUCKR
Suprarenal glands Aorta/IVC Duodenum Pancreas Ureters Colon, ascending and descending Kidney Rectum |
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Falciform ligament
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Liver --> anterior abdomen
Contains ligamentum teres Derived from fetal umbilical vein |
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Hepatoduodenal ligament
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Liver --> duodenum
Contains portal triad (hepatic a., portal v., common bile duct) Compress b/t thumb and finger in the epiploic foramen of Winslow |
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Gastrohepatic ligament
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Liver --> lesser curvature
Contains gastric arteries Cut during surgery when trying to access lesser sac |
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Meissner's plexus
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Submucosal
Regulate secretions |
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Auerbach's plexus
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Myenteric (muscularis externa)
Regulates motility |
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Layers of GIT
Inside --> outside |
Mucosa (epithelium, lamina propria, muscularis mucosa)
Submucosa Muscularis externa (circular) Muscularis externa (longitudinal) Serosa |
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Highest frequency slow waves in GIT
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duodenum
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Slowest frequency slow waves in the GIT
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stomach
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Foregut structures, artery, and nerve
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Stomach to proximal duodenum, liver, gallbladder, pancreas
The spleen is not a foregut organ, but is supplied by celiac artery too Vagus innervation |
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Midgut structures, artery, nerve
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distal duodenum to transverse colon
SMA Vagus innervation |
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Hindgut structures, artery, nerve
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end of transverse colon to rectum
SPLENIC FLEXURE is a watershed region b/t SMA and IMA IMA pelvic innervation |
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SMA syndrome
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partial obstruction w/bilious vomiting due to transverse duodenum trapped b/t SMA and aorta
Seen in rapid weight loss, lordosis, bed rest |
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3 sites of anastomoses in GIT
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1. Esophagus (varices)
2. Umbilicus (caput medusae) 3. Rectum (internal hemorrhoids) |
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Where can a portocaval shunt be placed to relieve portal HTN?
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B/t splenic and left renal veins
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Arterial supplies above and below pectinate line
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Above: superior rectal a. (branch of IMA)
Below: inferior rectal a. (branch of internal pudendal a.) |
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Why do external hemorrhoids hurt?
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b/c of pudendal nerve (somatic) innervation (internal hemorrhoids = visceral innervation; no pain)
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What zone of liver is most affected by viral hepatitis?
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Zone 1
portal triad area |
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What zone of liver is most affected by hypoxia, EtOH hepatitis, and contains p450
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Zone 3
central vein area (--> hepatic vein, systemic circulation) |
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What is unique about the basal surface of hepatocytes (face the sinusoids)?
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No BM and fenestrated
allow plasma macromolecules to pass through perisinusoidal space (of Disse) |
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Borders of the femoral triangle
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Sartorius muscle
Adductor longus muscle Inguinal ligament |
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In men and women, which does the inguinal canal contain?
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Men: spermatic cord and cremasteric muscle
Women: round ligament In both, transmits the inguinal nerve |
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Indirect hernia
Where? Why? |
Deep inguinal ring AND superficial inguinal ring, lateral to inferior epigastric a.
Into scrotum, covered by all 3 spermatic fascial layers Failure of processus vaginal to close (male infants) |
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Direct hernia
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Abdominal wall protrusion then through the superficial inguinal ring, medial to inferior epigastric a.
Covered by external spermatic fascia ONLY Old men bulge that decreases w/reclining |
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What fascial layer defect is known as the deep/internal inguinal ring?
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Transversalis fascia
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What layer defect is known as the external/superficial inguinal ring?
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External oblique
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Hernia that protrudes below inguinal ligament through femoral canal
What is a complication? |
Femoral hernia
Women---leading cause of bowel incarceration!!! |
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Hernia where GE junction is displaced
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Sliding (very common)
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Hernia where GE junction is normal, and just cardia moves into thorax
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Paraesophageal
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Where are Peyers patches found
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lamina propria and submucosa of ILEUM
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Gland that secretes the most serous saliva?
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Parotid
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Gland that secretes the most mucinous saliva?
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sublingual
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Where are Brunner's glands located and what do they do
When would you see hypertrophy of these glands? |
Secrete alkaline mucus to neutralize acid into crypts of Leiberkuhn
DUODENAL submucosa (the only GI submucosal glands) Hypertrophy in peptic ulcer disease |
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"left-sided appendicitis" and bright red stools
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diverticulitis (a complication of diverticulosis)
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What systemic disease might small bowel diverticula suggest?
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Sclerosis
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True diverticulum
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3 gut wall layers (mucosa, submucosa, and muscular layer) outpouch
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False, "pseudo", diverticulum
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only mucosa and submucosa outpouch, usually near a vessel (vasa recta) of the sigmoid colon
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Zencker's diverticulum
Where? What Sx? |
false diverticulum
junction of pharynx and esophagus --> halitosis, dysphagia, obstruction |
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Persistence of vitelline duct, or yolk stalk
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Meckel's diverticulum
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What is the rule of "five 2's" of Meckels diverticulum?
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2 inches long
2 feet from iliocecal valve, in the ileum 2% of population 2 y/o presentation 2 types of tissues- ectopic H+ secreting gastric mucosa, and pancreatic tissue |
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Omphalomesenteric cyst
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cystic dilation of vitelline duct due to persistence of vitelline duct
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Causes of bowel obstruction
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#1- Adhesions
#2- Indirect inguinal hernia Chrone's Duodenal atresia |
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What part of bowels does Hirschprung's affect?
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Rectum
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Necrosis of intestional mucosa, usually colon but can be anywhere
Who is most at risk and how do they present? |
nectrotizing enterocolitis
preemies w/dusky looking skin |
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What is the main clinical diff. b/t adenomatous and villous polyps of the large intestine?
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Adenomatous polyps are benign, and don't need to be removed
Villous adenomas are large w/high cancer risk and should be removed |
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Where does ischemic colitis usually occur?
What is the most common cause? |
Splenic flexure
SMA atherosclerosis |
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What do villous adenomas secrete?
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Protein rich, K+ rich fluid
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Left and ride sided colon cancer presentations
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Left side: obstruction. Change in stool caliber, cramping, abdominal pain, N/V
Right side: bleeding. Iron-def. anemia, pallor, fatigue They both present anorexia, weight loss, and malaise |
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What is a guaiac test?
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Hb or Mb reacts w/peroxidase and oxidation creates a color change
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Dx of colon cancer...
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Apple core barium scan
CEA (+) |
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Sequence of events in FAP that leads to cancer:
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1. APC tumor suppressor gene (chrom. 5) mutation
2. K-RAS mutation leads to unregulated growth of polyp 3. Malignant transformation w/p53 and DCC gene mutation |
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APC w/brain involvement
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Turcot's syndrome
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APC w/osseous and soft tissue tumors, retinal hyperplasia
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Gardner's syndrome
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Hamartomoutous colon AND SMALL INTESTINE polyps, hyperpigmented mucosal surfaces and hands
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Putz-Jeghers syndrome
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Serotonin syndrome
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Rapid onset tachycardia, hyperthermia, HTN, sweating, miosis, myoclonus, and hyperreflexia
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Small intestine tumor of endocrine cells that appear as "dense core bodies' on EM
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carcinoid tumor
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Testing peritoneal fluid for ascites of liver of peritoneal fluid
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Serum albumin/fluid albumin
>1.1 is liver ascites (transudate) <1.1 is exudate |
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What are the effects of hyperestrinism in liver cirrhosis
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gynecomastia
spinder telangioectasias testicular atrophy palmar erythema |
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What are the Sx of encephalopathy in cirrhosis?
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Mental status changes
Flapping asterixis Coma |
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There are two types of shunts used in cirrhosis, one decreases risk of encephalopathy and one relieves portal HTN
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1. transjugular intrahepatic portosystemic shunt (TIPS)
2. portacaval shunt b/t splenic vein and left renal vein |
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Marker of p450 induction
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GGT
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Microvesicular fatty change
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Reye's syndrome
Also see encephalopathy and increased transaminases |
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Macrovesicular fatty change
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hepatic steatosis (reversible) due to alcoholic liver disease
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What liver disease would you see very low transaminases, hyperammonemia?
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Fulminant liver failure
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Risk factors for hepatocellular carcinoma
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HepB/C
Wilson's disease Hemochromatosis AAT deficiency Alcoholic cirrhosis Carcinogens (aflatoxins) |
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Marker for hepatocellular carcinoma
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alpha-FP
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Budd-Chiari and RSHF cause this liver appearance
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Nutmeg liver (congestion); decreased outflow
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Occlusion of IVC or hepatic veins, leading to congestive liver failure WITHOUT JVD
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Budd-Chiari
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"red cytoplasmic granules" in liver on PAS stain
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AAT deficiency, misfolded gene that accumulates in children w/cirrhosis
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Difference in cell infiltration of alcoholic and viral hepatitis
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Alcoholic- neutrophils
Viral- lymphs |
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Gilbert's syndrome
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decreased UDP-glucoronyl transferase
Benign |
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Crigler-Najjar type I
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Absent UDP-glucoronyl transferase
Kernicterus |
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How do you treat Crigler-Najjar type II
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Phenobarbital
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Dubin-Johnson syndrome
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Conjugated bilirubin accumulation due to defective liver exretion
Benign, but grossly black liver **Epi metabolites in hepatocytes |
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Jaundice in newborns due to inflammatory destruction of bile ducts
Need a liver transplant |
Extrahepatic biliary atresia
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What causes micronodular cirrhosis?
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Alcohol and hemochromatosis
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Bronze diabetes and skin pigmentations
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Hemochromatosis
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Inflammation and fibrosis of bile ducts --> strictures and dilations w/beading on ERCP
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Primary sclerosing cholangitis
assc. w/UC, and can lead to secondary biliary cirhhosis |
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Primary vs. secondary biliary cirrhosis (location)
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Primary: intrahepatic, AI disorder (serum anti-mitochondrial ABs). Assc. w/scleroderma
Secondary: extrahepatic biliary obstruction (PSC, CF) Both have increased ALP, pruritis, jaundice, hepatosplnomegaly, xanthalesma |
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the 4 F's of cholesterol stones
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Fat
Female Fertile Forty |
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Ascending cholangitis
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Bacterial inflammation of bile duct
Increased ALP |
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Causes of acute pancreatitis
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Gallstones
EtOH Trauma (in kids, seatbelt injury) Steroids Mumps AI disease Scorpion sting Hypercalcemia/hyperlipidemia Sulfa drugs |
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Gold standard Dx acute pancreatitis
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Contrast CT
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Enzymatic fat necrosis
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Unique to acute pancreatitis
Lipase released by pancreas degrades TGs --> FA (saponification), then Ca++ calcifies it into chalky substance (dystrophic calcification) |
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Chronic pancreatitis
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Pancreatic insufficiency --> malabsorption and DM
"chain of lakes" on ERCP from dilations of pancreatic ducts If calcifying chronic pancreatitis, strong assc. w/alcoholism |
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Marker for pancreatic adenocarcinoma
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CA-19-9
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Pancreas disease presents in what way?
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Pain radiating to back, weight loss, obstructive jaundice
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"C-sign" of pancreas in adenocarcinoma
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Where pancreatic head indents teh duodenum
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Whipple's procedure
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pancreaoduodenalectomy
take out 1/2 stomach, 1/2 duodenum, and whole pancreas |
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What compound is used to test brush border enzymes independent of pancreatic function?
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D-xylolose; b/c it is already a monosaccharide and doesn't depend on amylase from pancreas for absorption
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