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67 Cards in this Set

  • Front
  • Back

Baby vomits milk when fed and has a gastric air bubble.

What kind of fistula is present?
Blind esophagus with lower segment of esophagus attached to trachea

After a stressful life event, 30yo man has diarrhea and blood per rectum; intestinal biopsy shows transmural inflammation.


Young man presents with mental deteriation and tremors. He has brown pigmentation in a ring around the periphery of his cornea and altered LFT's? Dx and Rx?
Dx: Wilsons
Rx: Penicillamine

20yo male presents with idiopathic hyperbilirubinemia: What is the most common cause?
Gilberts disease

55yo male with chronic GERD presents with esophageal CA.

What is his most likely histologic subtype?

Female presents with alternating bouts of painful diarrhea and constipation. Colonoscopy is nL

Irratable bowel

What are the four collateral arterial anastamoses available to compensate for a blocked abdominal aorta?
1. internal thoracic/mammary (subclavian) --> superior gastric (internal thoracic) --> inferior epigastric
2. superior pancreaticoduodenal (celiac trunk) --> inferior pancreaticoduodenal (SMA)
3. Middle colic (SMA) --> left colic (IMA)
4. Superior rectal (IMA) --> middle rectal (internal iliac)

Five portal-systemic anastomoses:
1. left gastric --> azygous (esophageal varices)
2. superior --> inferior rectal (external hemorrhoids)
3. paraumbilical --> inferior epigastric (caput medusae at navel)
4. retroperitoneal --> renal
5. retroperitoneal --> paravertebral
6.splenic v (drains into portal vein) --> L renal v. (drains into IVC)

Varices of gut, butt, and caput are commonly seen with portal hypertension.

MOW: layers to get to kidney?
Latissimus dorsi
serratus posterior inferior
tranversus abdominus
quadratus lumborus
psoas m.

What are the seven retroperitoneal structures?
1. duodenum (2nd,3rd,4th)
2. descending colon
3. ascending colon
4. kidney and ureters
5. pancreas (except tail)
6. aorta
7. IVC

Embryologically what artery is associated with the foregut and what structures are supplied?
Celiac a: stomach to proximal duodenum; liver, gallbladder, pancreas

Embryologically what artery is associated with the midgut and what stuctures are supplied?
SMA: distal duodenum to proximal 2/3 of transverse colon.

Embryologically what artery is associated with the hindgut and what structures are supplied?
Hindgut: IMA - distal 1/3 transverse colon to upper portion of rectum

HY: What are the three branches of the celiac trunk?
Left gastric
common hepatic

HY: What are the two strong anastomoses that exist around the stomach?

What is one weak anastomosis
1. L and R gastroepiploic
2. L and R gastrics

Weak anastomoses: short gastrics (if splenic artery is blocked they can't handle it)

What two arteries supply the proximal greater curvature of the stomach?
1. short gastrics (supplies proximal greater curvature above the splenic a)

2. left gastroepiploic a (supplies the proximal greater curavature below the splenic a)

What artery supplies the distal greater curvature of the stomach?
Right gastroepiploic a

What artery supplies the proximal lesser curvature of the stomach?
Left gastric

What do the gastroepiploic nodes drain?
Drain the greater curvature of the stomach

What do the subpyloric nodes drain?
Drain the distal stomach, pancreas, and duodenum

What do the inferior mesenteric nodes drain?
Descending colon - anular colon CA

What do the interial iliac nodes drain?
Drain bladder and male external genitalia

What doe the superifical inguinal nodes drain?
Drain rectum, vagina, and perineum

Compare varicosities from the inferior rectal vein and superior:
Inferior: produce external hemorrhoids

Superior: produce internal

What are the layers of the gut wall from inside to outside?
1. Mucosa: epithelium (absorption), lamina propria (support), muscularis mucosa (motility)
2. Submucosa: submucosal nerve plexus
3. Muscularis externa: includes Myenteric nerve plexus (Auerbach's)
4. Serosa/adventitia
Importance and function of:

Falciform ligament?
Connects liver to anterior abdominal wall.

It contains the ligamentum teres
Importance and function of:

Hepatoduodenal ligament
Connects: liver to duodenum

Contains: portal triad (hepatic artery, portal vein, common bile duct) and the cystic a. (a branch of the R hepatic)

Special: may be compressed between compressed between thumb and index finger and placed in epiploic foramen (of Winslow) to control bleeding
Importance and function of:

Gastrohepatic ligment?
Connects: liver to lesser curvature of stomach

Contains: gastric arteries

Special: separates R greater peritoneal sac and lesser peritonal sac. May be cut during surgery to gain access to lesser sac (ie to get to pancreas)
Importance and function of:

Gastrocolic ligament?
Connects: Greater curvature and transverse colon

Contains: Gastroepiploic arteries

Special: part of greater omentum
Importance and function of:

Connects: spleen to posterior abdominal wall

Contains: splenic artery and vein

Importance and function of:

Gastrosplenic ligaments
Connects: greater curvature and spleen

Contains: nothing

Special: separates lower greater and lesser sacs

What is the importance of the foramen of Winslow?
It is the connection between the greater and lesser sacs and is bounded by common bile duct, duodenum, and stomach. Thus dz of the large bowel can spread to the stomach and duodenum via this pathway and pancreatitis can cause inflammation of the large bowel; cholecytitis can cause gastroparesis due to inflammation

Describe the sinusoids of the liver:
They are irregular "capillaries" with fenestrated endothelium (pores 100-200nm in diameter). They have no basement membrane.

This allows macromolecules of plamsa full access to basal surface of hepatocytes through perisinusoidal space (space of disse)

What is the pectonate line?
A line in the rectum formed where the hindgut meets the ectoderm.

What is above the pectonate line? Art, Vein, Nerv
Above: internal hemorrhoids, adenocarcinoma.

Arterial supply from superior retal artery (branch of IMA).

Venous drainage is to superior rectal vein --> inferior mesenteric vein --> portal system.

Innvervation: visceral (so internal hemorrhoids are not painful)

What is below the pectonate line? Art, Venous, Nerv
External hemorroids, squamous cell carcinoma.

Arterial supply from inferior rectal artery (branch of internal pudendal artery)

Venous drainage to inferior rectal vein --> internal pudendal vein --> internal iliac vein --> IVC

Innervation is somatic so external hemorrhoids are painful.

What is in the femoral triangle?
Femoral vein, artery, and nerve.

What is contained in the femoral sheath?
Femoral sheath is a fascial tube 3-4cm below the inguinal ligament.

It contains the femoral vein, artery, and canal (deep inguinal lymph nodes), but NOT THE FEMORAL NERVE!!!!

Where does an indirect hernia protrude through?
Internal inguinal ring

Where does a direct hernia protrude through?
Abdominal wall

What are the layers of the abdomen that lead into the inguinal canal:
Parietal peritoneum
Transversalis fascia
Deep inguinal ring
Tranversus abdominis
Internal oblique
External oblique
Inguinal ligament

Diaphragmatic hernia
Abdominal structures enter the thorax; may occur in infants as a result of defective development of pleuroperitoneal membrane.

Most commonly a hiatal hernia, in which stomach herniates upward through the esophageal hiatus of the diaphram.

MCC of Hiatal hernia: sliding of the GE junction upward

Indirect inguinal hernia
Goes through the INternal (deep) inguinal ring, external (superficial) inguinal ring, and INto the scrotum.
Enters the internal inguinal ring lateral to inferior epigastric artery.
Occurs in INfants oweing to failure of processus vaginalis to close. (more common in males)

What hernia is covered by three layers of spermatic fascia? What are the three layers?
INdirect hernia: (from outside in:) external spermatic fascia, cremasteric muscle and fascia, internal spermatic fascia.

Direct inguinal hernia?
Protrudes through the inguinal (Hesselsbach) triangle.
Bulges directly through abdominal wall medial to inferior epigastric artery.
Goes through the external (superficial) inguinal ring only.
Covered by transversalis fascia.
Usually in older men.

What fascia covers a direct inguinal ring?

Who is most likely to get a direct inguinal hernia?
Older men

Compare the locations of the direction and indirect hernias to the inferior epigastric artery.
MD's don't LIe

Medial to inferior epi a = Direct

Lateral to inferior epi a = indirect

In terms of salivary glands, which gland produces the most serous saliva and which produces the most mucinous?
Parotid: serous

Sublingual: mucinous

What happens to alpha salivary amylase once it hit the stomach?
It is inactivated by low pH

3 components of saliva?
alpha amylase: carb digestion
bicarb: neutralize bacterial acids, maintian dental health
mucis (glycoproteins) that lubricate food

Describe a femoral hernia:
Protrudes through femoral canal below and lateral to pubic tubercle

More common in women

what type of hernia is the leading cause of bowel incarceration?
Femoral hernia

What is in Hesselbach's triangle?
Hesselbach's triangle:
inferior epigastric artery
lateral border of rectus abdominis
inguinal ligament

What sympathetics and parasympathetics go into stimulating salivary secretion?
Sympathetics: T1-T3 superior cervical ganglion)

Parasympathetic: facial, glossopharyngeal nerves
Source, action, regulation of:

Intrinsic factor
Source: parietal cells in stomach

Action: Vit B12 binding protein (required for B12 uptake in terminal ileum)

Regulation: none

Notes: autoimmune destruction of parietal cells --> chronic gastritis and pernicious anemia
Source, action, regulation of:

Gastric acid
Source: Parietal cells

Action: decrease stomach pH

Regulation: increased by histamine, ACh, gastrin
Decreased by somatostatin, GIP, prostaglandin, secretin
Source, action, regulation of:

Source: chief cells

Action: protein digestion

Regulation: increased by vagal stimulation, local acid

Notes: inactive pepsinogen --> pepsin by H+
Source, action, regulation of:

Source: mucosal cells in stomach and duodenum

Action: neutralizes acid and prevents autodigestion

Regulation: increased by secretin
Source, action, regulation of:

Source: G cells in the antrum of the stomach

Action: increase H+ secretion, increase growth of gastric mucosa, increase gastric motility

Regulation: increased by stomach distention, amino acids, peptides, and vagal stimulation

Decreased by stomach and a pH<1.5

Notes: INCREASED in zollinger-ellison syndrome
Phenylalanine and tryptophan are potent stimulators
Source, action, regulation of:

Source: I cells in duodenum and jejunum

Action: increase pancreatic secretion, increase gallbladder contraction, decrease gastric emptying

Regulation: decreased by secretin and stomach pH <1.5
Increased by fatty acids, amino acids

Notes: in cholelithiasis, pain worsens after fatty food ingestion due to ingestion due to increased CCK
Source, action, regulation of:

Source: S cells in duodenum

Action: Increased pancreatic HCO3 secretion, gastric acid secretion

Regulation: increased by acid, fatty acid in lumen of duodenum

Notes: increase in HCO3 neutralizes gastric acid in duodenum, allowing pancreatic enzymes to function
Source, action, regulation of:

Source: D cells, pancreatic islets, GI mucosa

Action: decreased gastric acid and pepsingen secretion, decreased pancreatic and small intestine fluid secretion, decreased gallbladder contraction, decreased insulin and glucagon release

Regulation: increased by acid and decreased by vagal stimulation

Notes: inhibitory hormone, antigrowth hormone effect (digestion and absorption of substances needed for growth)

Used to treat VIPomas
Source, action, regulation of:

Gastric inhibitory peptide (CIP)
Source: K cells in duodenum and jejunum

Action: exocrine: decrease gastric H secretion; endocrine: increase insulin release

Regulation: increased by fatty acids, amino acids, and glucose

Notes: an oral glucose load is used more rapidly than the equivalent given by IV
Source, action, regulation of:

Vasoactive intestinal polypeptide
Source: Parasympathetic ganglia in sphincters, gallbladder, small intestine

Action: increases intestinal water and electrolyte secretion
Increases relaxation of intestinal smooth muscle and sphincters.

Regulation: increased by distension and vagal stimulation
Decreased by adrenergic input

Notes: VIPoma: non-alpha, non-beta islet cell pancreatic tumor that secretes VIP causing copious diarrhea.
Source, action, regulation of:

Nitric oxide
Source: n/a

Action: increase smooth muscle relaxation, including lower esophageal sphincter

Regulation: n/a

Notes: loss of NO secretion is implicated in increase of lower esophageal tone of achalasia.

Describe carbohydrate absorption
Carb absorption

Only monosaccharides (glucose, galactose, fructose) are absorbed by enterocytes.

Glucose and galactose are taken up by SGLT1 (Na dependant). Fructose is taken up by facilitated diffusion by GLUT-5
All are transported to blood by GLUT-2