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21 Cards in this Set

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Muscles of mastication (a complex process involving alternating elevation, depression, forward movement and backward movement of the lower jaw.
Digastric and Mylohoid - depress the jaw when chewing

Medial pterygoid - helps to elevate the lower jaw during chewing.

Temporalis - helps in the backward movement of the lower jaw when chewing.

Lateral pterygoid - moves the lower jaw forward when chewing
Anuular pancreas
Results from abnormal rotation of the ventral pancreatic bud around the 2nd part of the duodenum --> projectile vomiting in infants.

Notes: Both pancreatic buds form from 2nd part of the duodenum. Normal rotation is around the Rt. side of the embryonic duodenum (Ventral pancreatic bud rotates to fuse with the dorsal pancreatic bud).
Annular panc. results from the ventral pancreatic bud dividng and rotating around both the Rt. and left sides of the 2nd part of the duodenum, thus encircling it.
Gall bladder stones
1. Bilirubin pigment stones --> Pt with sickle cell anemia. Also seen in hepatic cirrhosis & liver fluke infestation.
(Bilirubin stones are sp. associated with excessive bilirubin production in hemolytic anemias)
2. Mixed stones (Cholesterol & Calcium bilirubinate) - Most common Gallstones. "garden variety"
RFs: Obesity, middle-age, F predominance.
Retropharyngeal space
Its the fascial plane btw the Buccopharyngeal fascia and the prevertebral fascia.

Bucopharyngeal fascia = posterior lamina of the pretracheal fascia

Prevertebral fascia - covers the prevertebral muscles.

This fascial plane (retropharyngeal space) extends from the neck into the thorax and allows the spread of infections btw these regions.
Ligaments in GI
Hepatoduodenal ligament - contains Proper hepatic a. and its branches, Common bile duct and its branches and the Portal vein.
- the hepatoduodenal ligament is the portion of the lesser omentum that connects the liver to the first part of the duodenum.

2. Falciform ligament - a mesentery that connects the liver to the anterior abodminal wall. Within its free edge is found the Round ligament of the liver (ligamentum teres hepatis) - the adult remnant of the umbilical vein.

3. Gastrocolic ligament - portion of the greater omentum btw the greater curvature of the stomach and the transverse colon. The Gastroepiploic artereies lie within the gastrocolic ligament along the greater curvature of the stomach.

4. Gastrohepatic ligament - portion of the lesser omentum btw the liver and the lesser curvature of the stomach. R and L gastric arteries are in here.

5. Splenorenal ligament - the mesentery that connects the spleen to the posterior abdominal wall. Contains the splenic a. and the splenic v.
What structures lie in the free edge of the lesser omentum?
Common bile duct, Hepatic a. and the portal vein.

(neither the cystic duct nor the hepatic vein lie in the free edge of the lesser omentum)
Reye's syndrome
Fatty liver, hypoglycemia and coma.
Increased serum ammonia levels

- can be due to salicylate exposrue
- or an inherited mitochondrial abnormality
Postgastrectomy (Gastric bypass surgery)
Postgastrectomy sxs: Nausea, diarrhea, sweating, palpitations and flushing soon after eating a meal.

Thus, pt should eat more frequent smaller meals that are high in Fat (slow absorption)

Together these sxs are called the DUmping syndrome.
- b/c all or part of the stomach is removed, the ingested meal will be delivered to the small intestine more quickly than normal.
The increased osmotic load of the SI Results in:
1) increased motility thru reflex mechanisms --> diarrhea
2) Blood vol contraciton and the assoc. release of vasoactive peptides such as Bradykinin/VIP --> hypotension and tachycardia.
Plummer-Vinson Syndrome
Characterized by Atrophic glossitis, esophageal webs (cause dysphagia) and iron-deficiency anemia.

- high risk for developing sq. cell carcinoma of the esophagus.
Gangrenous small intestine
Several foot long loop of SI with a dark red-to-brown, edematous appearance. The lesion ends abruptly on both the distal and proximal edges.

Due to ISCHEMIC BOWEL DISEAE (arterial thrombosis, emboli arterial occlusion, venous thrombosis, or mechanical strangulation of vessels in twisted bowel loops.
NEC (necrotizing enterocolitis)
Common in premature, low birth wt, formula fed babies.
- intestineal Ischemia
- microbial agents --> sepsis
- poor GI immune response (Gangrene of the terminal ileum & ascending colon)
Zenker's diverticulum
false diverticulum formed at the junction of the pharynx and esophagus in the posterior hypopharyngeal wall.

- Zenker's is associted with Dysphagia, regurgitation.
Diarrhea, wt loss and epigastric discomfort. Biopys reveals Hyperplasia of superficial mucosal cells with scant gastric glands. As a consequence, pt is losing what in excessive amts from his digestive tract?
Protein!

Classic Menetrier's disease presentation = protein losing gastroenteropathy. Increased mucus production in Menetrier's --> proteins losses.
- may also cause hypoalbuminemia and peripheral edema.
- associated with atrophy of pariteal cells --> thus decreased acid production
Halothane toxicity
Idiosyncratic hepatic failure. Pts may experience hepatitis with focal to massive hepatic necrosis.
Elevated AST and ALT reveal that heptacellular death has occurred since hepatocytes release these enzymes as they lyse.
Coagulative necrosis
Occurs due to the denaturation of proteins, a process usually assoc. with Irreversible ischemic injury. Clinical conditions typically assoc. with Coag necrosis are myocardial, renal and splenic infarctions.
Steady, severe pain in the righ hypochondrium. Nausea. Temp of 102. Imaging shows obstruction of the cystic duct. Treatment?
ACUTE Cholecystitis - assoc. with gallstones in more than 90% of cases. Stone becomes impacted in the cystic duct and inflammation develops behind the obstruction. THe acute attack is often precipitated by a large fatty meal.
Lab findings include elevated wbc, serum bilirubin.

Rx: IV alimentation, analgesics and antibiotics as well as witholding oral feedings.

Mepridine is the narcotic of choice - since its least likely to cause spasm of the spinchter of Oddi. It is thus preferred over morphine, oxycodone and propoxyphene.
Naproxen (NSAID) is too mild of an analgesic to help this pt.
Alk phos
Alakaline phosphate is primarily located within the cells of the bile ducts and biliary tree. Thus, an elevation of this enzyme indicates pathology within the biliary tree (i.e stones within bile ducts, cancers in the biliary tree, or other destructive processes causing damage in the biliary tree).
Pt presents with troubling heartburn, and difficulty swallowing. Esophageal motility studies demonstrate a near absence of smooth muscle peristalsis and LES tone. No mass lesions or esophageal dilation. What other findings would also present?
Thick skin! - Scleroderma

Near complete absence of muscle tone and peristalsis is characteristic involvemnt of the esophagus with scleroderma.
Massively dilated colon
1. Ulcerative colitis - megacolon

2. Hirshsprug's disease - megacolon proximal to the agonglionic segment of the colon (due to failure o fneural crest cell migration)

3. Chagas disease - Megacolon and Mega Esophagus and a dilated heart.
Liver cancers
1. Hepatocellular carcinoma - Hep B infection in dvlping countries. Or Hemochromatosis in developed countries. Many etiologies.

2. OCP use --> liver adenoma

3. Metastases to the liver.
Eg: Angiosarcome - aggressive tumor that arises in the blood vessels. Causes Multinodular with patches of normal parenchyma in the liver.
Direct bilirubin
CONJUGATED bilirubin