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144 Cards in this Set

  • Front
  • Back
Derivative of fetal umbilical vein?
Falciform ligament
- connects liver to anterior abdominal wall
Which ligament connects the greater and lesser sacs and contains the portal triad?
Hepatoduodenal ligament
The gastrosplenic ligament contains what vessels?
Short gastrics
- also separates left greater and lesser sacs
- connects greater curvature of stomach to spleen
Gastrosplenic ligament separates the L greater and lesser sacs. Which ligament separates the R side?
(contains gastric arteries)
Ligament that contains the gastroepiploic arteries?
Areas of the small intestine that have plicae circulares?
Jejunum and proximal ileum
Areas of the small intestine that have crypts of Lieberkuhn?
All of the small intestine
Area of the small intestine that have Brunner's glands?
Submucosa of duodenum
Area of the small intestine with the most goblet cells?
Parasympathetic innervation of foregut, midgut, and hindgut?
Foregut and midgut: vagus nerve
Hindgut: pelvic
3 branches of celiac trunk?
Common hepatic, splenic, and L gastric
4 collateral circulations of GI system?
1.Internal thoracic/mammary (subclavian) w/ superior epigastric (internal thoracic) w/ inferior epigastric (external iliac)
2. Superior pancreaticoduodenal (celiac trunk) w/ inferior pancreaticoduodenal (SMA)
3. Middle colic (SMA) w/ left colic (IMA)
4. Superior rectal (IMA) w/ middle rectal (internal iliac)
Innervation of external hemorrhoids?
Inferior rectal nerve (branch of pudendal) - somatic innervation
- compare with internal hemorrhoids (visceral innervation)
Blood supply above vs below pectinate line?
Above: superior rectal artery (IMA)
Below: inferior rectal artery (from internal pudendal artery)
Esophageal anastomosis?
Left gastric (portal) and esophageal (systemic)
Umbilicus anastomosis?
Paraumbilical (portal) with superficial and inferior epigastric (systemic)
Rectal anastomosis?
Superior rectal (portal) with middle and inferior rectal (systemic)
Femoral triangle vs femoral sheath?
Femoral triangle contains femoral vein, artery, and nerve. Femoral SHEATH (fascial tube 3-4cm below inguinal ligament) contains femoral vein, artery, and canal (deep inguinal lymph nodes) but NOT nerve.
Order of fascias/muscles on lateral abdominal wall?
Parietal peritoneum, transversalis fascia, transversus abdominis, internal oblique, external oblique
What are the median and medial umbilical ligaments remnants of?
Median: remnant of urachus
Medial: remnants of umbilical arteries
Where do congenital diaphragmatic hernias (Bochdalek hernia) usually occur?
Left posterolateral.

Due to defective development of pleuroperitoneal membrane.
Sliding vs paraesophageal hernia?
Sliding: GE junction is displaced upward (get "hourglass stomach")

Paraesophageal: cardia of stomach moves into the thorax but GE junction is normal

Both are types of hiatal hernias.
Leading cause of bowel incarceration (especially in women)?
Femoral hernia. Occur below the inguinal ligament, through femoral canal.
Borders of Hesselbach's triangle?
Inferior epigastric artery
Rectus abdominis
Inguinal ligament
Division between direct and indirect inguinal hernias?
Inferior epigastric artery/vessels.

Indirect: lateral
Direct: medial
What kind of hernia do people with ascites, obesity, black newborns, or pregnant people get?
Umbilical. Can lead to incarceration in adults, or often spontaneously close <2 yo in kids.
What type of hernia occurs in an area weakened by previous surgery?
Ventral hernia
Which nerve can be damaged during parotid surgery?
- runs through parotid gland
Stimulation of salivary gland secretion?
Sympathetics (T1-T3, superior cervical ganglion) and parasympathetics (facial, glossopharyngeal nerves)
Prostaglandins, somatostatin, and histamine work through what mechanism on gastric parietal cells?
ACh and gastrin work through what mechanism on parietal cells?
Gq --> IP3/Ca
What is the effect of atropine on parietal cells?
It blocks direct vagal stimulation of parietal cells (M3 receptors) but NOT stimulation of G cells (where GRP transmitter is used).
Hypertrophy of what is seen in peptic ulcer disease?
Brunner's glands (duodenal submucosa)
Carbohydrate absorption transporters?
SGLT1: Glu/gal
GLUT-5: fructose
GLUT-2: transports all monosaccharides to blood
Cells in Peyer's patches that take up antigen?
M cells. Present it to B cells in germinal centers, which then differentiate into IgA secreting plasma cells (in lamina propria).
Common benign tumor of the salivary gland?
Pleomorphic adenoma
- more common F, painless, moveable
Common malignant tumor of the salivary gland?
Mucoepidermoid carcinoma
- often in parotid gland
- CN VII involvement is a sign of malignancy
Causes of macroglossia?
Myxedema, Down syndrome, Acromegaly, Amyloidosis, MEN IIb/III
What is Warthin's tumor?
Benign salivary gland tumor
- heterotopic salivary gland tissue trapped in a lymph node, surrounded by lymphatic tissue
What area of the bowel does celiac sprue affect?
Primarily the proximal small bowel
Findings in Whipple's disease?
Tropheryma whippelii (gm positive, PAS positive)
- macs in intestinal lamina propria & mesenteric nodes
- arthralgia, cardiac, neuro symptoms, fever, steatorrhea, lymphad, inc skin pigment
- older men
"ABCDEF" risk factors for esophageal cancer?
Alcohol/Achalasia, Barrett's, Cigarettes, Diverticula (Zenker's), Esophageal Web (Plummer-Vinson)/Esophagitis, Familial
Tests of pancreatic insufficiency?
Secretin stimulation test, trypsin levels, Bentiromide test (cleaved by chymotrypsin to PABA --> urine)
Striated muscle vs smooth muscle causes of dysphagia?
Upper (striated muscle): dermatomyositis, MG, stroke
Lower (smooth muscle): systemic sclerosis, CREST, achalasia
Nerve plexus lost in achalasia?
Myenteric (Auerbach's) plexus (in esophageal body) --> failure of relaxation of LES
3 infectious causes of esophagitis?
HSV-1, CMV, and Candida
What are Mallory-Weiss tears heavily associated with?
Hiatal hernia
- tears: mucosal lacerations caused by severe vomiting
What can Boerhaave syndrome cause and what is the physical exam finding?
Can cause pneumomediastinum.
- hear Hamman's crunch on auscultation
Pain with gastric vs duodenal ulcers?
Gastric: Pain is Greater with meals
Duodenal: Pain Decreases with meals
Complications of duodenal ulcers?
Bleeding (gastroduodenal artery), penetration into pancreas, perforation, obstruction
Cause of gastric vs duodenal ulcer?
Gastric: decreased mucosal protection against gastric acid
Duodenal: increased gastric acid secretion OR decreased mucosal protection
Malignancy risk with celiac sprue?
T-cell lymphoma
Dermatologic findings associated with gastric cancer?
Acanthosis nigricans, sign of Leser-Trelat
Associations/causes of gastric cancer?
Chronic gastritis (H. pylori), achlorhydria, type A blood, dietary nitrosamines (smoked foods)
Findings with Menetrier's disease?
Gastric hypertrophy, protein loss, parietal cell atrophy, increased mucous cells
Causes of acute erosive gastritis?
NSAIDs, stress, alcohol, uremia, burns (Curling's ulcer), brain injury (Cushing's ulcer), Anisakis (worm)
Types of chronic (non-erosive) gastritis?
Type A (fundus/body): Autoimmune, Abs against parietal cells, pernicious anemia, achlorhydria

Type B (antrum): H. pylori, most common
Side effect of Infliximab (Ab to TNF-alpha)?
Respiratory infection (including reactivation of latent TB)
2 uses of misoprostol (PGE-1 analog) besides for peptic ulcers?
1. Maintenance of patent ductus arteriosus
2. Induce labor
Drug interactions of metoclopramide?
Digoxin and diabetic agents
Sulfasalazine mechanism and uses?
Sulfapyridine (antibacterial) and 5-aminosalicylic acid (anti-inflammatory)
- activated by colonic bacteria
- used for UC and CD
M1 and M3 blockers and use?
Pirenzepine, propantheline
- used for peptic ulcers (but rarely)
- block M1 on ECL cells and M3 on parietal cells
Side effects of overuse of aluminum hydroxide (antacid)?
Constipation, hypophosphatemia, proximal muscle weakness, osteodystrophy, seizures
Side effects of overuse of magnesium hydroxide (antacid)?
Diarrhea (also works as osmotic laxative), hyporeflexia, hypotension, cardiac arrest
Are PPIs reversible or irreversible?
Which H2 blockers decrease renal excretion of creatinine?
Cimetidine and Ranitidine
What is Courvoisier's sign?
Palpable gallbladder.
Seen in obstructive jaundice (pancreatic adenocarcinoma) and cholangiocarcinoma.
What is the "C sign" seen in?
Carcinoma of the head of the pancreas --> indents duodenum and forms "C" shape
Risks of gallbladder adenocarcinoma?
Cholelithiasis and porcelain gallbladder (dystrophic calcification)
Black vs brown gallstones?
Black: seen in chronic hemolysis
Brown: seen with biliary infection
- both are pigmented and radiopaque
Ultrasound can diagnose gallstones in what location?
US can only see stones still in the gallbladder, not in the common bile duct (need to use HIDA radionuc scan)
What is the Grey-Turner sign?
Flank hemorrhage (seen in retroperitoneal injury)
What is Cullen's sign?
Periumbilical hemorrhage (seen with necrotic pancreatitis)
Complications of acute pancreatitis?
DIC, ARDS, diffuse fat necrosis, hypocalcemia (FA soap deposits), pseudocyst formation, hemorrhage, infection, necrosis, multiorgan failure
Causes of acute pancreatitis?
Gallstone, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, Hyperlipidemia/hypertriglyceridemia, ERCP, Drugs (sulfa)
Differences in iron location between primary and secondary hemochromatosis?
Primary: more parenchymal Fe
Secondary: more in Kupffer cells (macs)
Lab values in hemochromatosis?
High ferritin, high iron, Low TIBC, high transferrin saturation
Risks for cholangiocarcinoma?
PSC, Clonorchis sinensis, thorotrast (thorium dioxide), choledochal cyst, Caroli disease
"Onion skin" bile duct fibrosis?
Primary sclerosing cholangitis (PSC)
- "beading" of intra and extra hepatic bile ducts on ERCP
Special findings in PBC?
- granulomas and lymphocytic infiltrate
- F > M
- pruritis BEFORE jaundice
- Kayser-Fleischer rings
Appearance of alpha-1 antitrypsin deficiency on histology?
PAS-positive red cytoplasmic granules/globules in liver
Where does copper accumulate in Wilson's disease?
Liver, brain, cornea, kidneys, and joints
Findings in Wilson's disease?
Asterixis, Basal ganglia degeneration (PD sx, hemiballismus), Cirrhosis, Corneal deposits (Descemet's membrane), Copper accum, Carcinoma, Dec ceruloplasmin, Dementia, Dyskinesia, Dysarthria, Hemolytic anemia
Two types of Crigler-Najjar syndrome?
Type 1: absent UDP-glucuronyl transferase
Type 2: less severe, responds to phenobarbital (inc liver enzyme synthesis)
Dubin-Johnson vs Rotor syndrome?
Both involve defective excretion of conjugated bilirubin.
Rotor is LESS severe.
Dubin-Johnson: grossly black liver
Post-viral hepatoencephalopathy with microvesicular steatosis, mitochondrial abnormalities, and hypoglycemia?
Reye's syndrome
- often follows VZV or influenza B infection
Key histo finding of hepatocellular carcinoma?
Bile in neoplastic cell
What do Mallory bodies look like and what are they seen with?
Intracytoplasmic eosinophilic inclusions. Seen in alcoholic hepatitis.
Findings in alcoholic cirrhosis?
Micronodular shrunken liver ("hobnail" appearance). Sclerosis around central vein (zone III). Manifestations of chronic liver disease.
EM finding of carcinoid tumor?
Dense core bodies.
Series of gene mutations in APC pathway of colon cancer?
Loss of APC gene --> K-ras mutation --> loss of p53 (& DCC)
- chromosomal instability pathway accounts for 85% of colon cancer
Micronodular vs macronodular regeneration: which has greater HCC risk?
MACRO. Seen with significant hepatic necrosis (postinfectious or drug-induced hepatitis)
- Micronodular: seen with metabolic insult (alcohol, hemochromatosis, Wilson's disease)
Physical exam findings in appendicitis?
Psoas sign, Blumberg's (rebound tenderness), and Rovsing's sign
Locations of volvulus?
Cecum in young people
Sigmoid colon in older
Most commonly involved area in necrotizing enterocolitis?
Mucosa of colon but can involve entire GI tract
Common location of ischemic colitis?
Splenic flexure (watershed area) and distal colon
Tubular vs villous polyps?
Tubular: often stalked
Villous: often sessile, more likely to be malignant
Most common non-neoplastic polyp in colon?
- 50% in rectosigmoid colon
- "sawtooth" appearance
Peutz Jeghers syndrome?
Aut dom, multiple nonmalignant hamartomas throughout GI tract (esp sml intestine)
- hyperpigmented mouth, lips, hands, genitalia
- inc risk CRC and other visceral malignancies
Presentation of R vs L colon cancer?
L: obstruction, colicky pain, hematochezia
R: dull pain, iron deficiency anemia, fatigue
Gardner's and Turcot's syndrome?
Gardner's = FAP + osseous and soft tissue tumors, retinal hyperplasia (aut dom)

Turcot's = FAP + malignant CNS tumor (astrocytoma, medulloblastoma) (aut recess)
Level that testicular/ovarian arteries exit aorta?
Structures supplied by celiac artery?
Stomach to proximal duodenum
Spleen (mesoderm origin)
Histology of colon?
Crypts but no villi
Location of 2 nerve plexuses?
Submucosal nerve plexus (Meissner's): in submucosa

Myenteric nerve plexus (Auerbach's): in muscularis externa
What does the pectinate line divide?
Hindgut and ectoderm
Venous drainage of external hemorrhoids (below pectinate line)?
Inferior rectal vein
--> internal pudendal vein
--> internal iliac vein
--> IVC
Portal HTN affecting the anastomosis between the paraumbilical (portal) and superficial and inferior epigastric (systemic) arteries causes what?
Caput medusae (at the umbilicus)
What does the femoral sheath contain?
Femoral artery
Femoral vein
Canal (deep inguinal lymph nodes)

Does NOT contain femoral nerve
What forms the boundaries of the femoral triangle?
Inguinal ligament (top)
Sartorius (lateral)
Adductor longus (medial)
Origin of cremasteric muscle and fascia?
Internal oblique aponeurosis
Site of protrusion of direct vs indirect hernia?
Indirect: internal (deep) inguinal ring

Direct: abdominal wall (inguinal/Hesselbach's triangle)
Which hernias go through internal inguinal ring? External inguinal ring?
Only indirect goes through internal inguinal ring.

Both direct and indirect go through external inguinal ring.
Where does a femoral hernia travel through?
Through femoral canal

- below and lateral to pubic tubercle
5 components of saliva?
1. Alpha-amylase (ptyalin)
2. HCO3
3. Mucins (glycoproteins)
4. Antibacterial products
5. Growth factors (for epithelial renewal)
Neurotransmitter released when vagus nerve innervates G cells and significance?

- CANNOT be blocked by atropine
Strongest effect of gastrin is on what cells?
Strongest effect is on ECL cells (leading to histamine release) which has a greater influence on gastric acid secretion than gastrin's direct effect on parietal cells.
Which of the pancreatic enzymes is secreted in its active form?
Alpha amylase
Mechanism of absorption of glucose vs fructose?
Glucose: SGLT1 (Na+ dependent)

Fructose: GLUT5 (facilitated diffusion)
Salivary vs pancreatic amylase?
Salivary: hydrolyzes alpha-1,4 linkages to yield disaccharides (maltose and alpha-limit dextrins)

Pancreatic: hydrolyzes starch to oligo and disaccharides
Tropical vs celiac sprue?
Both are malabsorption syndromes.

Tropical sprue is similar to celiac but affects the entire small bowel and responds to antibiotics.
Complications of duodenal ulcers?
Bleeding (gastroduodenal artery)
Penetration into pancreas
Where can PAS-positive macrophages be found in Whipple's disease?
Intestinal lamina propria and mesenteric nodes
Cause of appendicitis in kids vs adults?
Kids: lymphoid hyperplasia after viral infection

Adults: obstruction, fecalith
How does pneumaturia result from diverticulitis?
Results from formation of a colovesical fistula (fistula with bladder)
Zenker's diverticulum occurs at what junction?
Junction between the pharynx and esophagus
Bowel layers with inflammation in UC?
Mucosal and submucosal only
Histology of UC?
Crypt abscesses and ulcers
NO granulomas
Common locations of angiodysplasia?
Terminal ileum
Ascending colon
"Double bubble" sign?
Duodenal atresia.
Reproductive AE of sulfasalazine?
Reversible oligospermia
Ocular effect of muscarinic antagonists?
Difficulty focusing/accommodating
What electrolyte abnormality can all antacids cause?
Which 2 drugs decrease renal excretion of creatinine?
Cimetidine and Ranitidine
Muscarinic receptor on ECL cell? Parietal cell?
ECL cells: M1 receptor

Parietal cells: M3 receptor

Both are cAMP mediated.
Associations of cholesterol stones?
Crohn's disease
Advanced age
Rapid weight loss
Native American
Gross appearance of alcoholic cirrhosis?
Micronodular, shrunken, "hobnail" appearance
Sclerosis around central vein
Source of motilin?
Small intestine
Source of VIP and its actions?
Parasympathetic ganglia in sphincters, gallbladder, and small intestine.

Increases intestinal water/electrolyte secretion.
Increases relaxation of intestinal smooth muscle and sphincters.
Potent amino acid stimulators of gastrin secretion?
Phenylalanine and tryptophan
Regulation of somatostatin secretion?
Increased by acid.

Decreased by vagal stimulation.
2 actions of GIP?
Exocrine: decreases gastric H+ secretion

Endocrine: increases insulin release
Regulation of VIP secretion?
Increased by distention and vagal stimulation

Decreased by adrenergic input
In what state is motilin secretion increased?
Fasting state