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67 Cards in this Set
- Front
- Back
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GI-FA
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
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GI
After a stressful life event, 30yo man has diarrhea and blood per rectum; intestinal biopsy shows transmural inflammation. Dx? |
Crohns
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GI
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 |
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GI
20yo male presents with idiopathic hyperbilirubinemia: What is the most common cause? |
Gilberts disease
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GI
55yo male with chronic GERD presents with esophageal CA. What is his most likely histologic subtype? |
Adenocarcinoma
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GI
Female presents with alternating bouts of painful diarrhea and constipation. Colonoscopy is nL Dx? |
Irratable bowel
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GI
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) |
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GI
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. |
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GI
MOW: layers to get to kidney? |
Latissimus dorsi
serratus posterior inferior tranversus abdominus quadratus lumborus psoas m. kidney |
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GI
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 |
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GI
Embryologically what artery is associated with the foregut and what structures are supplied? |
Celiac a: stomach to proximal duodenum; liver, gallbladder, pancreas
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GI
Embryologically what artery is associated with the midgut and what stuctures are supplied? |
SMA: distal duodenum to proximal 2/3 of transverse colon.
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GI
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
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GI
HY: What are the three branches of the celiac trunk? |
Left gastric
splenic common hepatic |
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GI
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) |
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GI
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) |
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GI
What artery supplies the distal greater curvature of the stomach? |
Right gastroepiploic a
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GI
What artery supplies the proximal lesser curvature of the stomach? |
Left gastric
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GI
What do the gastroepiploic nodes drain? |
Drain the greater curvature of the stomach
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GI
What do the subpyloric nodes drain? |
Drain the distal stomach, pancreas, and duodenum
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GI
What do the inferior mesenteric nodes drain? |
Descending colon - anular colon CA
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GI
What do the interial iliac nodes drain? |
Drain bladder and male external genitalia
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GI
What doe the superifical inguinal nodes drain? |
Drain rectum, vagina, and perineum
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GI
Compare varicosities from the inferior rectal vein and superior: |
Inferior: produce external hemorrhoids
Superior: produce internal |
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GI-HY HY HY
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 |
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GI
Importance and function of: Falciform ligament? |
Connects liver to anterior abdominal wall.
It contains the ligamentum teres |
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GI
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 |
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GI
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) |
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GI
Importance and function of: Gastrocolic ligament? |
Connects: Greater curvature and transverse colon
Contains: Gastroepiploic arteries Special: part of greater omentum |
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GI
Importance and function of: Splenorenal |
Connects: spleen to posterior abdominal wall
Contains: splenic artery and vein Special: |
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GI
Importance and function of: Gastrosplenic ligaments |
Connects: greater curvature and spleen
Contains: nothing Special: separates lower greater and lesser sacs |
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GI
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
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GI
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) |
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GI
What is the pectonate line? |
A line in the rectum formed where the hindgut meets the ectoderm.
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GI
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) |
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GI
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. |
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GI
What is in the femoral triangle? |
Femoral vein, artery, and nerve.
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GI
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!!!! |
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GI
Where does an indirect hernia protrude through? |
Internal inguinal ring
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GI
Where does a direct hernia protrude through? |
Abdominal wall
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GI
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 |
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GI
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 |
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GI
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) |
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GI
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.
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GI
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. |
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GI
What fascia covers a direct inguinal ring? |
Transversalis
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GI
Who is most likely to get a direct inguinal hernia? |
Older men
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GI
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 |
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GI
In terms of salivary glands, which gland produces the most serous saliva and which produces the most mucinous? |
Parotid: serous
Sublingual: mucinous |
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GI
What happens to alpha salivary amylase once it hit the stomach? |
It is inactivated by low pH
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GI
3 components of saliva? |
alpha amylase: carb digestion
bicarb: neutralize bacterial acids, maintian dental health mucis (glycoproteins) that lubricate food |
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GI
Describe a femoral hernia: |
Protrudes through femoral canal below and lateral to pubic tubercle
More common in women |
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GI
what type of hernia is the leading cause of bowel incarceration? |
Femoral hernia
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GI
What is in Hesselbach's triangle? |
Hesselbach's triangle:
inferior epigastric artery lateral border of rectus abdominis inguinal ligament |
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GI
What sympathetics and parasympathetics go into stimulating salivary secretion? |
Sympathetics: T1-T3 superior cervical ganglion)
Parasympathetic: facial, glossopharyngeal nerves |
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GI/LIVER
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 |
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GI/LIVER
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 |
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GI/LIVER
Source, action, regulation of: Pepsin |
Source: chief cells
Action: protein digestion Regulation: increased by vagal stimulation, local acid Notes: inactive pepsinogen --> pepsin by H+ |
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GI/LIVER
Source, action, regulation of: HCO3- |
Source: mucosal cells in stomach and duodenum
Action: neutralizes acid and prevents autodigestion Regulation: increased by secretin |
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GI/LIVER
Source, action, regulation of: Gastrin |
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 |
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GI/LIVER
Source, action, regulation of: Cholecystokinin |
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 |
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GI/LIVER
Source, action, regulation of: Secretin |
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 |
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GI/LIVER
Source, action, regulation of: Somatostatin |
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 |
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GI/LIVER
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 |
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GI/LIVER
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. |
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GI/LIVER
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. |
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GI
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 |
