Gi: Anatomy/embryo/histo

Front 1

For parietal peritoneum, pain is usually well localized except for the diaphragm... what nerve roots innervate it and to where is pain referred?

Back 1

C3,C4, C5 (keeps the diaphargm alive)
irritation referred to dermatomes over the shoulder

Front 2

What is the portal triad?

Back 2

portal vein, hepatic artery, bile duct contained in the hepatoduodenal ligament

Front 3

What is housed in the lateral umbilical fold?

Back 3

inferior epigastric vessels

Front 4

What is 15 cm long and attaches from the upper left to the lower right quadrants?

Back 4

root of THE mesentery

Front 5

What is the most common congenital anomaly of the small intestine?

Back 5

Meckel's (ileal) Diverticulum (remember rule of two's)

Front 6

Most reabsorption of water in the GI tract occurs where?

Back 6

ascending colon

Front 7

What part of the embryological gut becomes pharynx to ~1/2 the duodenum (and some accessory structures)?

Back 7

foregut

Front 8

What part of the embryological gut becomes duodenum to transverse colon (~2/3)?

Back 8

midgut

Front 9

What part of the embryological gut becomes distal transverse colon to rectum?

Back 9

hindgut

Front 10

What blood vessels supply foregut structures?

Back 10

celiac trunk

Front 11

What BV's supply midgut structures?

Back 11

superior mesenteric artery

Front 12

What BV's supply hindgut structures?

Back 12

Inferior mesenteric structures

Front 13

Fetus had failure of lateral body folds to fuse leading to extrusion of abdominal contents through the abdominal folds. Diagnosis?

Back 13

Gastroschisis

Front 14

Neonate born w/ persistence of herniation of abdominal contents into the umbilical cord. Diagnosis?

Back 14

Omphalocele

Front 15

2 week-old presents w/ nonbilious projectile vomiting. You find a palpable "olive" mass in the epigastric region. Diagnosis?

Back 15

congenital pyloric stenosis

Front 16

What embryological abnormality can cause duodenal narrowing (anomaly not w/in duodenum itself)?

Back 16

annular pancreas (encircling the pandreas)

Front 17

What is the normal relationships of the contents of the portal triad?

Back 17

Posterior (Pahsterior if your Thomas)- Portal vein
Right: bile duct
Left: Hepatic proper artery

Front 18

What is Ant and Post to the omental (epiploic) foramen (of Winslow)?

Back 18

Anterior is portal triad of the hepatoduodenal ligament
Posterior is the IVC

Front 19

Round ligament of the liver used to be.... ? .... now housed in... ?

Back 19

LEFT umbilical vein
falciform ligament

Front 20

The gastrocolic ligament connects what to what and houses what?

Back 20

It's a part of the greater omentum
Connects Greater curvature of stomach to the transverse colon
houses the gastroepiploic vessels

Front 21

The gastrosplenic ligament connects what to what and houses what?

Back 21

Separates the left greater and lesser sacs
Connects greater curvature of stomach to spleen
Houses short gastric vessels

Front 22

What is the parasympathetic innervation to the foregut, midgut, and hindgut?

Back 22

Vagus: foregut, midgut
Pelvic: hindgut

Front 23

Borders of Hasselbach's triangle?
What type of hernia occurs here?

Back 23

Inferior epigastric vessels, lateral border of rectus abdominus, and inguinal ligament
DIRECT inguinal hernia (only external spermatic fascia)
.. usually in older men

Front 24

What are the only GI submucosal glands? What part of the gut are they located in?

Back 24

brunner's glands
duodenum

Front 25

What landmarks form the pelvic inlet (aka linea terminalis)?

Back 25

Pectin pubis, arcuate line, and sacral promontory

Front 26

What horizontal plane lies halfway b/w the jugular notch and pubic symphysis?

Back 26

transplyoric plane (around body of L1)... passes through pyloric sphincter

Front 27

What four planes delineate the 9 regions of the abdominal cavity?

Back 27

Horizontals: subcostal, transtubercular
Verticals: R and L midclavicular planes to midinguinal points)

Front 28

The superficial inguinal ring opens b/w what to bony landmarks?

Back 28

Pubic tubercle and Pubic symphysis

Front 29

What ligament is important in femoral hernias?
Why?

Back 29

lacunar ligament
It is an extension of the inguinal. its sharp free edge cuts into the femoral triangle which enlarges w/ a femoral hernia.... also its lateral-posterior extension runs along the pectineal line (as the pectineal ligament) and can constrict the hernia tooooooo

Front 30

What abdominal muscle forms the cremaster muscle and half o the conjoint tendon?

Back 30

internal oblique

Front 31

What muscle is housed w/in the rectus sheath, attaches to the pubic crest, and tenses the linea alba?

Back 31

pyramidalis

Front 32

If you stab a man in the anterolateral abdominal wall... what layers will be pierced in order?

Back 32

Skin, superficial subcut tissue (camper's), deep membranous (scarpa's) fascia, external oblique investing fascia and muscle, internal oblique fascia and muscle, transverse abdominal fascia and muscle, transversalis fascia, extraperitoneal fat, and parietal peritoneum.... boom

Front 33

What abdominal layer is continuous w/ the fascia lata and the deep layer of the superficial perineal fascia (penis and scrotum included)?

Back 33

scarpa's fascia

Front 34

What abdominal layer is continuous w/ superficial fatty layers of the thorax, thigh, and perineum?

Back 34

camper's fascia

Front 35

What two muscles for the conjoint tendon?

Back 35

internal oblique and transversus abdominus

Front 36

When suturing below the umbilicus, what layer do you want to include for its strength?

Back 36

scarpa's fascia

Front 37

What potential space is a possible site for fluid leakage and accumulation (eg urine from a ruptured urethra)

Back 37

space b/w scarpa's fascia and deep fascia of external abdominal oblique (and rectus abdominus)

Front 38

What important abdominal layer change is located halfway b/w the umbilicus and pubic symphysis?

Back 38

arcuate line (posterior rectus sheath below this point only has transversalis fascia)

Front 39

What three major arteries run in the superficial fascial layer of the abdominal wall?

Back 39

superficial circumflex iliac, superficial epigastric, and external pudendal artery (w/ superficial and deep branch)

Front 40

What three major veins run in the superficial fascial layer of the abdominal wall?

Back 40

THORACOEPIGASTRICs (think blocked IVC or SVC), lateral thoracics, and superfical epigastric

Front 41

What are the sensory dermatomes around the xiphoid region, umbilical region, and inguinal fold?

Back 41

xiphoid: T7
umbilical: T10
Inguinal fold: L1
Reminder: T4 = nipple region

Front 42

What nerves supply the rectus abdominus, skin muscles, and parietal peritoneum of the anterior abdominal wall?

Back 42

cutaneous branches of the ventral rami (intercostal nerves)

Front 43

Nerve root for iliohypogastric?

Back 43

L1 (sometimes +T12)

Front 44

What nerve (& its root) enters the inguinal canal and supplies the groin and scrotum/labium majus?

Back 44

ilioinguinal (L1)

Front 45

What nerve exits the inguinal canal through the superficial ring and innervates the cremaster/cutaneous to labium majus?

Back 45

genital branch of genitofemoral (L1-2)

Front 46

What nerve supplies the cutaneous femoral triangle area?

Back 46

femoral branch of genitofemoral nerve (L1-2)

Front 47

Superior superfical to umbilicus. where does lymph drain?

Back 47

anterior axillary and sternal nodes

Front 48

Inferior superficial to umbilicus. where does the lymph drain?

Back 48

superficial inguinal nodes

Front 49

deep lymphatic drainage of abdomen goes where?

Back 49

deep abdominal nodes

Front 50

three places abdominal hernias can occur?

Back 50

umbilical (infants and adults, women) linea alba/epigastric (men), and linea semilunaris

Front 51

What are the boundaries of the inguinal canal?

Back 51

floor: inguinal & lacunar ligs.
roof: int. abd. oblique
Ant wall: Ext. abd. oblique
Post wall: transversalic fascia and conjoint tendon

Front 52

What forms the deep inguinal ring?

Back 52

evagination of transversalis fascia

Front 53

What happens to the external iliac vessels once they pass underneath the inguinal ligament?

Back 53

become femoral

Front 54

What are the contents of the inguinal canal?

Back 54

male: spermatic cord w/ cremaster muscle, ilioinguinal n, genital branch of genitofemoral n.
Female: same nerves + round ligament of the uterus

Front 55

before entering the inguinal canal, the ilioinguinal nerve passes down in b/w what two muscles?

Back 55

transversus abdominus and internal oblique

Front 56

What guides the descent of the testes?

Back 56

The gubernaculum

Front 57

What is the title of the film that portrays twin boys separated at conception that work their ways through dark separate paths guided by the big G who eventually meet in the end of the film where they live happily ever after?

Back 57

Descent of the Testes.... directed by gubernaculum.... starring Larry and Roger Balls.

Front 58

What is cryptorchidism?

Back 58

undescended testes, associated w/ prematurity... higher incidence of testicular cancer

Front 59

What is a hematocele?

Back 59

blood in the tunica vaginalis (due to injury of spermatic vessels)

Front 60

What forms the round ligaments of the ovaries and uterus?

Back 60

the gubernaculum

Front 61

What is the appendix of the testis a remnant of? The appendix of the epididymis?

Back 61

Testis: paramesonephric duct
Epididymis: detached efferent duct

Front 62

What are the contents of the spermatic cord (internal to internal spermatic fascia)?

Back 62

artery of ductus deferens, testicular artery (w/ autonomic nerves), ductus deferens, pampiniform plexus of veins, and lymphatics

Front 63

Hernia below the inguinal ligament?

Back 63

femoral (more common in women)

Front 64

What structure is usually weak in direct inguinal hernias?

Back 64

conjoint tendon

Front 65

What hernia occurs often due to incomplete closure of process vaginalis?

Back 65

indirect hernia

Front 66

The abdominal esophagus and parts of the stomach move into the thorax through the esophageal hiatus. What is it?

Back 66

sliding hiatal hernia

Front 67

The fundus (usually only this) moves into the thorax next to the esophageal hiatus. What is it?

Back 67

paraesophageal hernia

Front 68

Which is sensitive to heat, touch, cold, laceration, and pain is well localized; nerve fibers to the parietal peritoneum or visceral peritoneum?

Back 68

parietal (visceral is poorly localized pain and insensitive... what a bastard. primarily stimulated by stretching and chemical irritation)

Front 69

The root of the mesentery crosses what important structures?

Back 69

ascending and horizontal duodenum
abdominal aorta
IVC
R ureter, psoas major, and testicular/ovarian vessels

Front 70

What is the rule of twos on diverticulum?

Back 70

2% of population
2 ft. from ileocecal junction
2 inches long
It is the remnant of the omphaolomesenteric (vitelline) duct

Front 71

Where should the spleen sit in relation to the rib cage?

Back 71

Posterior wall of LUQ, protected by ribs 9-11. Should NOT be palpable inferior to the costal margin

Front 72

What part of the pancreas is intraperitoneal?

Back 72

tail

Front 73

The abdominal aorta terminates (divides) at what vertebral level?

Back 73

L4 (T12-L4)

Front 74

What forms the aortic hiatus?

Back 74

Left and Right crus of diaphragm

Front 75

At what vertebral levels are the unpaired branches of the abd. aorta?

Back 75

celiac trunk: T12,L1
SMA: L1
IMA: L3
Median sacral: L4

Front 76

Where can blood drain to superiorly and inferiorly from the esophagus?

Back 76

superiorly to azygous system
inferiorly to portal system

Front 77

What part of the GI tract has no goblet cells?

Back 77

stomach

Front 78

Carcinoids arise from what type of cell?

Back 78

enterochromaffin cells

Front 79

What part of the alimentary canal has no muscularis mucosae?

Back 79

oral cavity

Front 80

Cremasteric reflex: what are the afferent and efferent nerves?

Back 80

afferent: iliohypogastric
efferent: genital branch of genitofemoral nerve