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73 Cards in this Set

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(3) branches of the celiac trunk
Left Gastric A

Splenic A

Common Hepatic A
(2) branches of the Common Hepatic Artery that supply the stomach
Right Gastric A

Gastroduodenal A
trace the Gastroduodenal Artery to the spleen
GDA -> R. Gastroepiploic A ->
L. Gastoepoploic A -> spleen

(Gastroepiploic AA supply blood to Greater curvature of stomach - can also be called Gastro-omenal AA)
Name the Veins that you would see varices in w/ portal HTN
(3 sets)
Esophageal:
Left gastric -> Azygos

External hemorrhoids:
Superior -> Inferior rectal

Caput Medusae:
Paraumbilical -> Inferior Epigastric
what does the Submucosa portion of the GI contain and control?
Submucosa:

meiSSner's plexus

control:
Secretions, blood flow and absorption
what does the Muscularis portion of the GI contain and control?
Muscularis:

Myenteric Auerbach's plexus

control: Motility
what is the immunoglobulin of the gut?
IgA
Definiton:

Secrete alkaline mucous to neutralize acid contents entering the duodenum from the stomach
Brunner's glands
what is the name of the structure where the hindgut meets the ectoderm in development?

why is it significant?
Pectinate line

Above line: Internal hemorrhoids

Below line: External
Innervation, blood supply and pain level to Internal Hemorrhoids
Nerves: Visceral innervation

Blood: Superior rectal A

Pain: none
Innervation, blood supply and pain level to:
External Hemorrhoids
Nerves: Somatic innervation

Blood: Inferior rectal (Pudendal branch)

pain: Painful
what are the objects from lateral to medial in the Femoral Triangle?
NAVEL:
Nerve
Artery
Vein
(Empty)
Lymphatics
what are the top, medial and lateral edges of the Femoral triangle?
Top: Inguinal ligament

Medial: Adductor Longus m

Lateral: Sartorius m
What is Hasselbach's triangle made of?
Lateral: Inferior Epigastric A

Medial: Rectus Abdominis

Bottom: Inguinal ligament
best landmark to determine of the inguinal hernia is Direct or Indirect
Inferior Epigastric artery
[MDs don't LIe]

Medial to artery = Direct

Lateral to artery = Indirect
why is the Indirect hernia more common in infants?
failure of Processus Vaginalis to close
what is the primary cause of Achalasia?

secondary?
Primary:
Failure of LES to relax due to loss of Auerbach's plexus

Secondary:
Chagas Dz
Dx:

"Olive" mass in epigastric region and projectile vomiting at 2 weeks of age
Pyloric stenosis
Dx:

Infecton of GI causing PAS-positive macros in intestinal lamina propria and mesenteric nodes
Whipple's Dz

(T. Whippelii)
Definition:

epithelial tumor arising from precursor cells of the enamel origin
Ameloblastoma
MC Salivary gland tumor
Pleomorphic Adenoma
Dx:

newborn w/ copious salivation assoc w/ choking, coughing and cyanosis on attempts at eating
Tracheoesophageal fistula
Definiton:

Acute gastritis in assoc w/ severe burns
Curling Ulcer
Definiton:

Acute gastritis in assoc w/ brain injury
Cushing ulcer
Definition:

focal damage to the gastric mucosa w acute inflammation, necrosis and hemorrhage
Acute (erosive) Gastritis
Dx:

Autoimmune dz, pernicious Anemia, Achlorhydria

where in stomach?
Chronic (nonerosive) Gastritis Type A (3 As)

(Fundal)
MC form of Chronic Gastritis

where in stomach?
Type B:
H. Pylori-assoc Gastritis
[B = Bug]

(Antrum)
Dx:

Pain greater w/ meals

Ulcer cause?
Gastric

[Gastric = Greater w/ meals]

Cause:
low mucosal protection vs. acid
(H.pylori and NSAIDs)
Dx:

Pain Decreases w/ meals

Ulcer cause?
Duodenal ulcer

[Duodenal = Dec w/ meal]

Cause: H.pylori
MC type of stomach cancer

(2) Extra-GI sites of involvement
Adenocarcinoma

extra sites:

Virchow node,

Krukenberg tumor - signet-ring cells in bilateral Ovary
Definition:

Stomach cancer that is diffusely infiltrative (thickened, rigid appearance)
Linitis Plastica
Definition:

extreme enlargement of gastric rugae and possible loss of plasma proteins from altered mucosa
Menetrier Dz

(giant hypertrophic gastritis)

[MENE large Rugae]
Dx:

colon inflammation w/ crypt abscesses and pseudopolyps
Ulcerative colitis
Definition:

twisting of portion of bowel around its mesentary
Volvulus
remnant of Embryonic Vitelline duct
Meckel's Diverticulum
Dx:

inc serotonin, cutaneous flushing, diarrhea, bronchospasm, valvular lesions of right heart, RLQ mass
Carcinoid tumor

(MC place = Appendix)
Definition:

dilation of the colon due to the absence of ganglion cells

underlying cause?
Hirschsprungs Dz

(colon SPRUNG open)

cause: failure of neural crest cells to migrate
Dx:

trisomy 21 patient w/ chronic constipation early in life
Hirschsprungs Dz
MC place for ischemic bowel due to being poorly vascularized regions
(2)
Splenic flexure

Rectosigmoid junction
Dx:

Unexplained lower bowel bleeding
Angiodysplasia
Dx:

inflammation of the colon w/ flask-shaped ulcers
Amebic colitis

(E. Histolytica infection)
Dx:

barrium swallow has "apple core" lesion in lower GI
Colorectal cancer
which polyp is benign?

which is most malignant?
Benign: Tubular Adenoma


most malignant: Villous Adenoma
Dx:

polyps of the colon and small intestines and melanotic accumulations in the mouth, lips, hands and genitals
Peutz-Jegher syndrome
Dx:

adenomatous polyps w/ osteomas and soft tissue tumors
Gardner syndrome
Dx:

adenomatous polyps w/ tumors of the CNS
Turcot syndrome
Causes of Micronodular Cirrhosis
(3)
Metabolic insult:

Wilsons Dz;

Alcohol;

Hemochromatosis
what type of shunt may releive portal HTN?

connecting what vessels?
Portacaval shunt:

between Splenic vein and Lt Renal vein
Another name for AST in lab
SGOT
Dx:

swollen, necrotic hepatocytes, PMN infiltrates, intracytoplasmic eosinophilic inclusions, fatty change, sclerosis around central vein
Alcoholic Hepatitis
Definition:

intracytoplasmic eosinophilic inclusions

what are they seen in?
Mallory bodies

in: Alcoholic hepatitis
Dx:

high unconjugated bilirubin w/o hemolysis, decreased UDP-glucuronyl transferase, stress induced, no sx
Gilbert's syndrome
Dx:

high unconjugated bilirubin w/o hemolysis, absent UDP-glucuronyl transferase, jaundice, kernicterus, CNS damage
Crigler-Najjar syndrome
Dx:

Increased Conjugated bilirubin, brown to black discoloration of liver
Dubin-Johnson syndrome
Dx:

hypergammaglobinemia and anti-smooth muscle Ab
Autoimmune Hepatitis
Dx:

severe obstructive jaundice, itching, hypercholesterolemia, xanthomas
Primary Biliary cirrhosis

(Anti-mitochondrial Ab)
Definition:

extrahepatic biliary obstruction causing increased pressure in intrahepatic ducts leading to injury and fibrosis; Inc Alk phos, Inc conjugated bilirubin
Secondary Biliary Cirrhosis
Dx:

tender hepatomegaly, ascites, polycythemia, hypoglycemia

what is elevated in serum?
Hepatocellular CA

(elevated alpha-fetoprotein)
Definition:

Inadequate hepatic copper excretion and failure of copper to enter circulation, leading to copper accumulation in organs
Wilson's Dz

(Auto Resessive)
Dx:

asterixis, parkinsonian sx, cirrhosis, low ceruloplasmin, dementia
Wilson's Dz

ABCD:
Asterixis
Basal ganglia sx
Copper accumulation/low Ceru.
Dementia
Dx:

occlusion of IVC or hepatic veins w/ centrilobular congestion and necrosis; assoc w/ polycythemia, abd CA, or complication of pregnancy
Budd-Chiari syndrome
Hyperbilirubinemia type, urine bilirubin and urine urobilinogen changes for:

Hepatocellular jaundice
Conjugated/Unconjugated

Inc Urine Bilirubin

nml/Dec Urobilinogen
Hyperbilirubinemia type, urine bilirubin and urine urobilinogen changes for:

Obstructive jaundice
Conjugated

Inc Urine Bilirubin

Dec Urobilinogen
Hyperbilirubinemia type, urine bilirubin and urine urobilinogen changes for:

Hemolytic jaundice
Unconjugated

Absent urine Bilirubin

Inc Urobilinogen
Dx:

hepatoencephalopathy in young children w/ virus who are given aspirin
Reye's syndrome
what is chronic calcifying pancreatitis assoc with?
alcoholism
what is chronic obstructive pancreatitis assoc with?
Gallstones
Cause of Cholangiocarcinoma
Liver fluke
(C.sinensis)
Dx:

"Strawberry gallbladder"
Cholesterolosis
what causes the GB to become enlarged and distended?
Tumors (not stones)
(3) changes in the pancreas w/ Acute Pancreatitis
Hemorrhagic Fat Necrosis

Calcium soaps (leading to HypoC)

Pseudocysts
Dx:

abdominal pain radiating to back, migratory thrombophlebitis, obstructive jaundice w/ palpable GB
Pancreatic Adenocarcinoma
Dx:

malabsorption problem w/ positive D-xylose test

what CA can it lead to?
Celiac Sprue


leads to: T-cell lymphoma