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127 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Order of abdominal layers
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skin, superficial fascia, camper's fascia, external oblique, internal oblique, transversus abdominis, transversalis fascia, peritoneum
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Arcuate line
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above arcuate line: skin, fat, external aponeurosis, internal aponeurosis, rectus abdominus, internal again, transversus aponeurosis
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below arcuate line: skin, fat, external, internal, and transversus aponeurosis, rectus abdominus,
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Retroperitoneal structures
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Duodenum (2nd, 3rd, 4th parts), descending/ascending colon, kidney, ureters, pancreas (except tail), aorta, IVC
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Hepatoduodenal ligament contents and what does it connect?
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Contents: hepatic artery, common bile duct, portal vein
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Connects: greater and lesser sacs
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Lesser omentum is composed of...
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hepatoduodenal and gastrohepatic ligaments
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Gastrohepatic ligament contents and it's importance
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Contents: gastric arteries
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Doesn't contain vital vessels, so it can be cut to access the lesser sac, which is where the pancreas sits
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Gastrocolic ligament contents
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gastroepiploic arteries
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Gastrosplenic ligament contents and what does it connect?
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Contents: short gastric arteries
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Connects left lesser and greater sacs and can be cut to gain access to left lesser sac
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Layers of gut wall
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Mucosa: epithelium, lamina propria, muscularis mucosa -> Submucosa: contains Meissner's plexus -> Muscularis externa: internal circular muscle, myenteric plexus, external longitudinal muscle -> serosa/adventitia
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Waves of stomach
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3 waves/min
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Waves of duodenum
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12 waves/min
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Waves of ileum
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8-9 waves/min
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GI area w/ 3 muscularis externa layers
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stomach: oblique, circular, longitudinal
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Plicae circulares found in...
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jejunum. also in proximal ileum, but they're small
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Peyer's patches are found in...
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ileum
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Cells at the base of villi
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Paneth cells: secrete lyoszyme, antimicrobial defensins. Stem cells: renew mucosa by migrating up to the tips of the villi
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Taeniae coli
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found only in the colon, are NON continuous bands of longitudinal muscle surrounding the colon
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Function of Meissner's plexus
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regulates local secretions, blood flow, and absoprtion
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Innervation of foregut and midgut
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Vagus nerve
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Innervation of hindgut
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Pelvic nerve
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Internal thoracic anastomoses with...
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superior epigastric, which anastamoses with...
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inferior epigastric
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Superior pancreaticoduodenal anastamoses with...
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inferior pancreaticoduodenal off the SMA
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Middle colic off the SMA anastamoses with...
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the left colic off the IMA
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The superior rectal off the IMA anastamoses with...
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the middle rectal off the internal iliac
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Umbilicus varices due to...
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anastomosis between paraumbilical vein and superficial (off external iliac)/inferior (off external iliac) epigastric veins
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Rectal varices
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due to anastomoses between superior rectal and inferior/middle rectal veins
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Retroperitoneal varices
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due to anastomoses between retroperitoneal lumbar veins and colic veins
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Blood supply of anus above pectinate
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Arterial: superior rectal artery off the IMA
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Venous: superior rectal vein, which drains into the IMV, which drains into the portal system
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Blood supply of the anus below the pectinate line
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Arterial: inferior rectal artery off the internal pudendal
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Venous: inferior rectal vein, which drains into the internal pudendal, which drains into the internal iliac, which drains into systemic circulation
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Cancer above pectinate
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adenocarcinoma (because it's technically still mucosa)
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Cancer below pectinate
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squamous cell carcinoma (because it's now surface ectoderm)
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hepatic lobule
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hexagonal w/ central vein in middle
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Which Zone in the hepatic acinus is affected first by viral hepatitis
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Zone 1 because it has the highest O2 tension
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Which zone in the hepatic acinus is first affected by ischemia
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Zone 3, because it has the lowest O2 tension
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Contents of Zone 3
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P-450 system, where alcoholic hepatitis, ischemia, and toxic injury occur first
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Which side of hepatocyte faces the bile canaliculi
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apical
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Union of the common bile duct and the pancreatic duct
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Ampulla of vater
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Processes found in Zone 3
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detox, glycolysis, lipogenesis (all of these are O2 independent)
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Femoral sheath doesn't contain...
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the femoral nerve
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Cremasteric fascia is derived from
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internal oblique fascia
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Internal spermatic fascia is derived from
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tranversalis fascia
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external spermatic fascia is derived from
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external oblique
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Tunica vaginalis is derived from
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peritoneum
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Most common diaphragmatic hernia
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sliding hiatal hernia, where GE junction herniates into thorax
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Indirect inguinal hernia goes through which inguinal rings and is covered by which fascia
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Passes through deep and superficial inguinal rings
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Covered by 3 layers of fascia (internal, cremasteric, and external) because it passes through each of those as it goes through inguinal canal
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Direct inguinal hernia goes through which inguinal rings and is covered by which fascia
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Passes though superficial inguinal rings only
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Covered only by internal spermatic fascia because it doesn't pass through inguinal canal
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Hernia that's more common in women
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Femoral hernia
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Which hernia is found below the inguinal ligament
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Femoral hernia
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Only GI hormone to be released after eating amino acids
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GIP
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G cells are found where in the stomach?
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Antrum
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which 2 amino acids stimulate gastrin secretion
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phenylalanine and tryptophan
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Pepsin is secreted by...and does...
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Chief cells in body of stomach
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breaks down proteins
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GIP secreted by what cells?
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K cells of the duodenum and jejunum
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VIP release stimulated by...
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parasympathetic input from ganglia
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Function of motilin
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produces migrating motor complexes (MMCs), which are increased in fasting states
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Ghrelin
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increases before meals and decreases after meals (hormone of HUNGER)
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lost following gastric bypass surgery
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What hormone is associated w/ hyperphagia in Prader-Willi syndrome
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Ghrelin
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Enkephalin effect on GI
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constrict sphincters, decrease GI secretions
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this is why opiates are effective against diarrhea
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Gastrin-releasing peptide (GRP)
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released by vagus nerve onto G-cells, leading to gastrin release.
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this is why anti-ACh drugs don't decrease Gastrin levels
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Gastrin main mechanism
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acts on ECL cells, leading to an increase in histamine, and histamine then leads to an increase in gastric acid secretion
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Pleomorphic adenoma
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most common benign tumor of major and minor salivary glands (parotid most common). Painless, movable
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May transform into malignant tumor -> facial nerve involvement is a sign of malignancy
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Warthin's tumor
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Benign parotid gland tumor
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heterotopic salivary gland tissue trapped in a lymph node
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Mucoepidermoid carcinoma
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most common malignant salivary tumor, MC in parotid gland
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Low flow rate vs. high flow rate of salivary secretions
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Low flow rate: the ductal cells are able to reabsorb more NaCl, meaning the secretion will be hypotonic
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High flow rate: the ductal cells can't reabsorb fast enough, meaning the secretion will be closer to isotonic
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Nerve that runs through the parotid gland
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CN VII
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Alkaline tide
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When you eat, more HCl needs to be pumped into the stomach, which means more Cl needs to be taken up by the parietal cells. Therefore, more HCO3- must be pumped out of the parietal cells and into circulation
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Interstitial cells of Cajal
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GI pacemaker cells that regulate gastric motility
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What tonicity of gastric fluid has highest emptying rate?
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isotonic
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Low flow rate vs. high flow rate of pancreatic secretions
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Low flow rate: mostly Cl-
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High flow rate: mostly HCO3-
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What's the rate limiting step of carb digestion?
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Oligosaccharide hydrolases, which break down di- and oligosaccharides into monosaccharides
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SGLT1
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absorb glucose and galactose in intestines with the help of Na+
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Bile acids are conjugated to which amino acids to turn them into bile salts?
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glycine and taurine
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Where is Ca2+ reabsorbed in the small intestines?
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Duodenum
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Adenoid cystic carcinoma
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tumor of minor salivary glands, has perineural invasion
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Uptake of amino acids in intestines
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Mono-AA: Na+ based carriers
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Di- and Tri-AA: use H+-dependent cotransport that is faster than Mono-AA transport
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Tropical sprue affects which part of the small bowel?
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the entire small bowel!
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Self-limited lactase deficiency
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can occur after a viral diarrhea
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HLA associated w/ Celiac
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DQ2, DQ8
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Curling's ulcer
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due to burns, which decreases plasma volume and leads to sloughing of gastric mucosa
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Cushing's ulcer
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due to brain damage. Leads to increased vagal stimulation, which increases ACh and leads to increased H+ secretion
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Type A chronic gastritis
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autoimmune disorder of fundus/body w/ autoantibodies against parietal cells
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pernicious anemia, achlorhydria, increased risk of adenocarcinoma
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Type B chronic gastritis
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More common than Type A, affects antrum, caused by H. pylori
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increased risk of MALT lymphoma
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Childhood form of Menetrier's disease is associated with...
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CMV
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Cancer associated w/ type A blood
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Stomach adenocarcinoma
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Small bowel obstruction causes
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Descending order: adhesions, indirect inguinal hernia, intussuception, volvulus
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Extraintestinal manifestations of Crohn's disease
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Migratory polyarthritis, erythema nodosum, ankylosing spondylitis, uveitis
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Crohn's tx
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corticosteroids, infliximab
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Colonic manifestations of Ulcerative colitis
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Toxic megacolon, colorectal carcinoma
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Extraintestinal manifestations of Ulcerative colitis
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Pyoderma gangrenosum, primary sclerosing cholangitis
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Tx of Ulcerative colitis
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sulfasalazine, infliximab
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Pathophysiology behind where diverticuli occur
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occur where vasa recta perforate muscularis externa, because this is the weakest point in the wall
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Tx for diverticulosis
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high fiber diet
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Pneumaturia
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think diverticulitis. caused by a fistula which has formed between the colon and the bladder
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Viral cause of intussusception in children
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adenovirus
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Most common site of volvulus in children and elderly
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children: cecum
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elderly: sigmoid
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Etiology of duodenal atresia
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failure of recanalization of small bowel
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Difference in pain between ischemic colitis and small bowel infarct
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Ischemic colitis: localized pain after eating
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Small bowel infarct: generalized, diffuse pain
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Angiodysplasia
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tortuous dilation of vessels that can bleed. MC in cecum, terminal ileum, and ascending colon
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Associated w/ vWF, calcified AS
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Acute colonic pseudoobstruction (Ogilvie's syndrome)
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non-obstructive gross dilation of cecum most commonly associated w/ chronic narcotics, spinal anesthesia, trauma, sepsis
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Mucoid diarrhea w/ cauliflower polyp
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villous adenoma
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Gardner's syndrome
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FAP + osseous and soft tissue tumors + retinal hyperplasia
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Site involvement of FAP vs. HNPCC
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FAP: pancolonic, but always involves rectum
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HNPCC: proximal colon is always involved
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COX-2 relationship w/ CRC
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COX-2 overexpression has been associated w/ CRC
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Thus, taking NSAIDs has been shown to decrease adenomas and possibly CRC
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Reye's syndrome MOA
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aspirin metabolites decrease beta-oxidation by reversible inhibition of mitochondrial enzymes, leading to mitochondrial abnormalities and microvesicular fatty liver change
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Alcoholic hepatitis biopsy
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swollen and necrotic hepatocytes w/ neutrophilic infiltration and mallory bodies
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3 carcinomas that spread by hematogenous ways
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hepatocellular carcinoma, renal cell carcinoma, follicular carcinoma of the thyroid
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Cavernous hemangioma
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most common benign tumor of the liver
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Budd-chiari etiologies
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polycythemia vera, pregnancy, HCC
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Neonatal jaundice MOA
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at birth, UDP-glucuronyl transferase is immature
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Hemolytic jaundice labs
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Unconjugated hyperbilirubinemia, absent urine bilirubin, increased urine urobilinogen
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Obstructive jaundice labs
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Conjugated bilirubinemia, increased urine bilirubin, absent urine urobilinogen
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Viral hepatitis jaundice labs
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Mixed hyperbilirubinemia, increased urine bilirubin, increased urine urobilinogen
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Treatment of Crigler-Najjar type II
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phenobarbital, because it increases liver enzyme synthesis
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Treatment of iron overload
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deferoxamine
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lymphocytic infiltration + granulomas of biliary tract
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Primary biliary cirrhosis
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Concentric "onion skinning" of bile duct with alternating strictures and dilation
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primary sclerosing cholangitis
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affects intra- and extrahepatic bile ducts, associated w/ hypergammaglobulinemia
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7alpha hydroxylase
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turns cholesterol into bile acids
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deficiency leads to gallstone formation
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S/E of cimetidine
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can cross BBB and lead to confusion, dizziness, headaches, decreases renal excretion of creatinine
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Triple therapy for H. pylori
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Metronidazole, Amoxicillin, Tetracycline, Bismuth, can also use PPI
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Misoprostal mechanism for stomach
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PGE1 analog that increases secretion of gastric mucous barrier
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Antimuscarinics used in PUD
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Pirenzepine and propantheline
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Aluminum hydroxide S/E
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constipation and hypophosphatemia leads to proximal muscle weakness, osteodystrophy
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Magnesium hydroxide S/E
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diarrhea, hyporeflexia, cardiac arrest
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Calcium carbonate S/E
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hypercalcemia, rebound increase in acid
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S/E of all antacids
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hypokalemia
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Sulfasalazine S/E
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sulfa allergy, reversible oligospermia
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Metoclopramide use and S/E
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Use: reverse gastroparesis, anti-emetic
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S/E: parkinsonism, contraindicated n small bowel obstruction
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