Usmle Step 1 Gi

Front 1

achalasia

Back 1

-a/w scleroderma
-decrease in VIP
-nocturnal regurg of food
-dysphagia for solids and liquids
-chest pain and heart burn, hiccups, nocturnal cough, difficulty belching

Front 2

Tx for achalasia?

Back 2

pneumatic dilation, esophagomyotomy, long acting nitrates, Calcium channel blockers, botulinum toxin injection

Front 3

gold standard diagnosis for GERD?

Back 3

24-48 hr PH monitoring

Front 4

Esophageal varices

Back 4

-painless bleeding of submucosal veins in lower 1/3 of esophagus
-L. gastric vein, portal HTN

Front 5

Esophagitis

Back 5

a/w reflux, infection (HSV-1, CMV, Candida), or chemical ingestion

Front 6

Plummer-Vinson syndrome

Back 6

traid of: Dysphagia, Glossitis, Iron deficiency anemia

Front 7

Barrett's esophagus

Back 7

replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium

Front 8

risk factors for esophageal cancer?

Back 8

ABCDEF
Alchohol/Achalasia
Barrett's esophagus
Cigarettes
Diverticuli
Esophageal web, esophagitis
Familial

Front 9

Where does squamous cell carcinoma present vs Adenocarcinoma in esophagus?

Back 9

Squamous cell--upper and middle
Adenocarcinoma--lower 1/3

Front 10

Where does celiac's dz present?

Back 10

proximal small bowel

Front 11

What is celiac's dz a/w?

Back 11

dermatatis herpatiformi (vesicular lesions on elbow)

Front 12

Tropical sprue

Back 12

probably infection; responds to antibiotics. Similar to celiac sprue, but can affect entire small bowel

Front 13

Whipple's disease

Back 13

-tropheryma whippeli (can't culture, gram (+);
-PAS positive (stains with glycoprotein) in intestinal lamina propria
-mesenteric nodules
-Arthlagias, cardiac and neurologic symptoms are common
-commin in older men

"andy Whipple becomes and old man who has a big heart but is slightly crazy bc he lives in the PASt when his medical school years were good.

Front 14

disaccharidase deficiency

Back 14

-MC= lactase defieciency--> milk intolerance. Normal-appearing villi.
-Since lactase is located at tips of intestinal villi, self-limited lactase deficiency can occur following injury (viral diarrhea)
-

Front 15

What kind of diarrhea is disaccharidase deficiency?

Back 15

osmotic diarrhea

Front 16

PH of stool in disaccharidase deficiency?

Back 16

Low, acid stool

Front 17

mechaninsm of disaccharidase deficiency

Back 17

-lactose--> glucose and galactose
-Goes to colon and anearobic bacteria eat it

Front 18

Pancreatic insufficiency

Back 18

-Due to cystic fibrosis, obstructing cancer, and chronic pancreatitis
-Causes malabsorption of fat and fat-soluble vitamins (A, D, E, K)

Front 19

Abeta-lipoprotinemia

Back 19

-decrease synthesis of apo B --> inability to generate chylomicrons --> decreased secretion of cholesterol, VLDL into blood stream --> fat accumulation in enterocyte. Present in early childhood with malabsorption and neurologic manifestations

Front 20

Celiacs have antibodies to what?

Back 20

gliadin and tissue transglutaminase

Front 21

Celiacs dz primarily affects what area?

Back 21

jejunum

Front 22

What is the screening test for celiacs?

Back 22

serum levels of tissue transglutaminase antibodies

Front 23

causes of acute gastritis?

Back 23

stress, NSAIDs (decrease PGE2 --> decrease mucosa production), alcohol, uremia, burns (Curlings ulcer) and brain injury (Cushing's ulcer)

-"Burned by the curling iron, always cushion the brain"

Front 24

describe the difference between cushings and curling's ulcer

Back 24

Curlings: decrease plasma volume --> sloughing of gastric mucosa

cushings: increased vagal stimulation --> Increased Ach --> increased H+ production

Front 25

Type A chronic gastritis

Back 25

-nonerosive, fundus/body
-Autimmune disorder characterized by Autoantibodies to parietal cells
-pernicious Anemia
-Achlorhydira
-a/w other autoimmune disorders

Front 26

Type B chronic gastritis

Back 26

-MC
-H. Pylori infection (burrown through mucus)
-increased risk of MALT lymphoma

"Bacterium affects the Antrum"

Front 27

Menetrier's dz

Back 27

-Gastric hypertrophy with protein loss, parietal cell atrophy and increase mucous cells. Precancerous.
-Rugae of stomach are so hypertrophied that they look like brain gyri
-Mostly males

Front 28

What type of cancer is stomach cancer usually?

Back 28

-adenocarcinoma
-early aggressive local spread and node/liver mets (supraclavicular node)

Front 29

What is adenocarcinoma of the stomach a/w?

Back 29

nitrosamines (smoked foods), achlorhydria, chronic gastritis type A blood.

Front 30

features of adenocarcinoma of the stomach?

Back 30

-Signet ring cells
-acanthosis nigricans
-linitis plastica (diffusely infiltrative, thickened rigid appearance "leather bottle)

Front 31

MC location for adenocarcinoma of the stomach?

Back 31

lesser curvature

Front 32

Virchow's node

Back 32

involvement of left supraclavicular node by mets from stomach

Front 33

Krukenberg's tumor

Back 33

bilateral mets to ovaries. Abundant mucus, signet ring cells

Front 34

Sister Mary Joseph's nodules

Back 34

subcutaneous periumbilical metastasis

Front 35

gastric uclers

Back 35

-pain if Greater with meals (weight loss)
-often older pts
-H. pylori if 70%
-NSAIDs
-due to decrease mucosal protection

Front 36

MCC of duoenal ulcers?

Back 36

-almost 100% h. pylori
-

Front 37

Zollinger-Ellison syndrome

Back 37

increase gastric acid secretion causes duodenal ulcers

Front 38

Hypertrophy of Brunner's glands?

Back 38

-Cause of duodenal ulcers. Decrease mucosal protection

Front 39

What do the ulcers look like in the duodenum?

Back 39

clean, punched out margins unlike the raised margins of carcinoma.

Front 40

Complications of duodenal ulcer?

Back 40

-bleeding, penetration into pancrease, perofration, and obstruction

Front 41

Presentation of Duodenal ulcer?

Back 41

-pain Decreases with meal (weight gain)
-black tarry stool (acid works on hemaglobin to make hematin = black pigment)
-can present as shoulder pain do flat plate

Front 42

What does ischemic colitis of the splenic flexure present as vs Small bowel?

Back 42

-ischemia of splenic flexure= specific pain and bloody stool
-small bowel= entire abdomen + bloody diarrhea
-pain after eating --> weight loss

Front 43

extraintestinal manifestations of chrons?

Back 43

Migratory polyarthritis, eythrma nodosum, ankylosing spondylitis, uveitis, immunologic disorders

Front 44

extraintestinal manifestations of Ulcative colitis?

Back 44

pyoderma gangrenosum, primary sclerosing cholangitis

Front 45

treatment of chrons?

Back 45

Corticosteroids, infliximab

"Inflict the Crohn with steroids"

Front 46

treatment of Ulcerative colitis?

Back 46

ASA preparations (sulfasalazine), ifliximab, colectomy

Front 47

IBS

Back 47

Recurrent abdominal pain a/w >2 of the following:
1) Pain improves with defecation
2) Change in stool frequency
3) Change in appearance of stool

No structual abnormalities. May present with diarrhea, constipation, or alternating. Tx symptoms

Front 48

MCC of appendicitis in children?

Back 48

-mumps or adenovirus
-Lymphoid tissue in appendix. -Hyperplasia of lymphoid tissue in appenix

Front 49

MCC of appendicitis in adults?

Back 49

stool impaction= produces ischemia and e. coli gets in

Front 50

MC indication for abdominal surgery in children?

Back 50

appendicitis

Front 51

False diverticula

Back 51

-most common
-lack or have an attenuated muscularis externa
-only mucosa and submucosa outpouch (vs true which has all three)

Front 52

MC place for a false diverticula?

Back 52

where vasa recta perforate muscularix externa

Front 53

What causes diverticulosis?

Back 53

increased intraluminal pressure and focal weakness in colonic wall. A/w low fiber diets.

Front 54

Symptoms of diverticulosis?

Back 54

often aymptomatic or a/w vague discomfort and/or painless rectal bleeding

Front 55

MC place for diverticulosis?

Back 55

sigmoid colon

Front 56

Diverticulitis

Back 56

-inflammation of diverticula
-may perforate--> peritonitis, abcess formation or bowel stenosis.
-Give antibiotics

Front 57

symptoms of diverticulitis

Back 57

-LLQ pain, fever, leukocytosis
-bright red bleeding
-"left sided appendicitis"

Front 58

pneumaturia

Back 58

-caused by diverticulitits
-colovesicle fistula (fistula with bladder)

Front 59

Zenker's diverticulum

Back 59

-False diverticulum
-herniation of mucosal tissue at junction of pharynx and esophagus.
-symptoms: halitosis, dysphagia, obstruction

Front 60

Where does meckel's diverticulum arise from?

Back 60

-vitelline duct or yolk stalk

Front 61

What may be contained in a meckel's diverticulum?

Back 61

-ectopic acid--secreting gastric mucosa and/or pancreatic tissue

Front 62

MC congenital anomaly of the GI tract?

Back 62

meckel's diverticulum

Front 63

What can meckel's diverticulum cause?

Back 63

PAINLESS bleeding, intrussusception, volvulus or obstruction near the terminal ileum.

Front 64

omphalomesenteric cyst

Back 64

-cystic dilation of vitelline duct
-feces coming out of umbilicus
-connects midgut with the yolk sac

Front 65

intussusception

Back 65

-can comprimise blood supply
-usually in kids (adenovirus)
-Abdominal emergency in early childhood
-coil spring appearance on barium enema on ultrasound

Front 66

Volvulus

Back 66

-twisting of portion of bowel around its mesentery; can lead to obstruction and infarction
-may occur at cecum and sigmoid colon, where ther is redundant mesentery
-usually in elderly

Front 67

What is Hirschsprungs dz due to?

Back 67

-failure of neural crest migration (lose Auerbach's and Meissner's plexuses)
-lose sympathetic neuons
-problem in RET signalling pathway

Front 68

Symptoms of Hirschsprungs dz?

Back 68

-no bowel movement, chronic constipation early in life
-abdominal pain, small stools
-no stool on examining finger, no stool in rectal vault
-failure to pass meconium
-dilated portion of colon proximal to the aganglionic segment (dilated megacolon)

Front 69

What bug can cause Hirschsprungs dz?

Back 69

Chaga's dz (trypanosoma cruzi)

Front 70

MC place for Hirschsprungs dz?

Back 70

-distal sigmoid colon and rectum

Front 71

duodenal atresia

Back 71

-Causes early bilious vomiting with proximal stomach distention (double bubble) due to failure of recanalization of small bowel.
-a/w down syndrome

Front 72

Meconium ileus

Back 72

in cystic fibrosis, meconium plug obstructs intestine, preventing stool passage at birth

Front 73

Necrotizing enterocolitis

Back 73

-Necrosis of intestinal mucosa and possible perforation.
-Colon is usually involved, but can involve entire GI tract
-In neonates, MC in premies
-blood in stool, biliary distention, air in bowel

Front 74

Angiodysplasia

Back 74

-Tortuous dilation of vessels--> bleeding
-most often found in cecum, terminal ileum and ascending colon
-MC in older pts
-confirmed by angiography

Front 75

What makes a polyp more malignant?

Back 75

the more villous it is

VILLous = VILLainOUS

Front 76

MC non-neoplastic polyp in colon?

Back 76

Hyperplastic (>50 % found in rectosigmoid colon

Front 77

Juvenile polyposis syndrome

Back 77

-if just one = not pre-cancerious
-if mutlople increase risk for adenocarcinoma

Front 78

Puetz-Jeghers syndrome

Back 78

-AD
-multiple nonmaligant hamartomas
throughout GI tract
-hyperpigmented mouth, lips, hands, and genitalia
-increase risk of CRC and other malignancies

Front 79

Familial adenomatous polyposis (FAP)

Back 79

-AD mutation of APC gene (uncontrolled cell proliferation) on chromosome 5q
-Two-hit hypothesis. 100% progress to CRC
-Thousands of polypsl pancolonic, always involves the rectum

Front 80

Gardner's syndrome

Back 80

FAP + osseus and soft tissue tumors, retinal hyperplasia

"The FAMILY GARDNER was a SOFT man with nice EYEs, and had BONEY hands

Front 81

Turcot's syndrome

Back 81

AR, FAP + malignant CNS tumor

"Turcot = Turban"

Front 82

Hereditary nonpolyposis colerectal cancer (HNPCC/Lynch syndrome)

Back 82

AD mutation of DNA mismatch repair genes (80% progress to CRC)
-proximal colon is always involved

Front 83

Risk factors to CRC?

Back 83

IDB, streptococcus bovis, tobacco use, large villous adenomas, juvanile polyposis syndrome, Peutz-Jeghers syndrome, decreased fiber intake (decreased ability to get rid of lithcolic acid)

Front 84

Presentation of distal vs proximal colon in CRC

Back 84

Distal (L)-obstruction, colicky pain, hematochezia (smaller diameter, forms anular polyp bc theres not enough room.

Proximal colon (R)- dull pain, iron deficiency anemia, fatigue (bleeds, bigger diameter, better chance of forming a polyp)

Front 85

Apple core lesion seen on barium enema x-ray?

Back 85

colorectal cancer

Front 86

Villous adenoma

Back 86

-sessile. Looks like villous surface of small intestine. Have increase Malignant potential
-Mucus coating of the stool

Front 87

most common place for carcinoid tumor?

Back 87

small intestine

Front 88

EM of carcinoid tumor?

Back 88

dense core bodies

Front 89

Symptoms of carcinoid tumor?

Back 89

wheezing, right-sided heart murmurs, diarrhea, flushing

Front 90

Serum markers of viral hepatitis?

Back 90

ALT> AST

(ALT means diffuse liver necrosis)

Front 91

Serum markers of alcoholic hepatitis?

Back 91

AST>ALT also GGT
"wASTed"

could also be fatty change. Increased AST means mitochondria are uncoupled

Front 92

MI Serum markers from liver?

Back 92

AST

Front 93

Obstructive liver dz

Back 93

increased gamma glutamyl transferase and increased Alkaline phosphatase

Front 94

best tests for liver severity?

Back 94

-albumin levels and PT (these are made in the liver so if there is a severe problem they will be low)

Front 95

Mechanism of Reye's syndrome

Back 95

asprin metabolites decreases beta oxidation by reversible inhibition of mitochondrial enzyme.

Front 96

Findings in Reye's syndome?

Back 96

-mitochondrial abnormalities, fatty liver (microvesicular fatty change), hypoglycemia, coma
-a/w viral infections (VZV and influenza B)

Front 97

Hepatic steatosis?

Back 97

short-term change with moderate alcohol intake. Macrovesicular fatty change that may be reversible with alcohol cessation

Front 98

Alcoholic hepatitis

Back 98

-Requires sustained, long-term consumption.
-swollen and necrotic hepatocytes with neutrophilic inflitration.
-Mallory bodies (intracytoplasmic eosinophils

Front 99

alcoholic cirrhosis

Back 99

-irreversible
-micronodular
-irregular and shrunken liver
-"honail" appearance
-sclerosis around central vein

Front 100

risk factors for hepatocellular carcinoma/hepatoma

Back 100

-Hep B and Hep C
-Wilson's dz
-hemochromatosis
-alpha1-antitrypsin deficiency
-alcoholic cirrhosis
-carcinogens (aflatoxin in peanuts)

Front 101

important serum marker for hepatocellular carcinoma?

Back 101

-alpha-fetoprotein

Front 102

Findings in hepatocellular carcinoma?

Back 102

jaundice, tender hepatomegaly, ascites, polycythemia, and hypoglycemia

Front 103

Nutmeg liver

Back 103

-back-up of blood into liver.
-Commonly caused by right sides heart failure and Budd-Chiari syndrome.
-liver appears mottled like nutmeg
-centrilobular congestion and necrosis can result in cardiac cirrhosis

Front 104

Budd-Chiari syndrome

Back 104

occlusion of IVE or hepatic veins with centrilobular congestion and necrosis, leading to congestive liver disease (hepatomegaly, ascites, abdominal pain and eventual liver failure)
-varices, visible abdominal and back veins
-Absent JVD

Front 105

what is Budd-Chiari syndrome a/w?

Back 105

polycythemia vera, pregnancy and hepatocellular carcinoma

Front 106

alpha-1 antitrypsin in hepatic carcinoma?

Back 106

-decreased
-can be seen as PAS (period acid-schiff) positive globules

Front 107

Gilbert's syndrome

Back 107

-mildly decreased UDP-glucuronyl transferase or decrease bilirubin uptake.
-asymptomatic. Elevated unconjugated bilirubin w/o overt hemolysis

Front 108

What is wilson's disease characterized by?

Back 108

-Asterixis
-Basal ganglia degeneration (parkinsonian)
-Ceruloplasmin, Cirrhosis, Corneal deposits (Kayser-Fleischer rings), Copper accumulation, Carcinoma, Choreiform movements
-Dementia
-Hemolytic anemia
-Renal dz (fanconi's syndrome)

Front 109

Tx for wilson's dz

Back 109

Penicillamine (copper chelator), zinc (inhibits copper reabsorption in intestine), ammonium tetrthiomolydate (amonium competes for copper reabsorption in bowel, increase excretion in urine)

Front 110

Pathology behind wilson's dz?

Back 110

-failure of copper to enter circulation as ceruloplasm (binding protein for copper)
-increased unbound copper in blood
-toxic effects

Front 111

gold standard diagnosis for wilson's dz?

Back 111

liver biopsy for copper

Front 112

Hemochromatosis

Back 112

-iron deposition.
-classic triad= Cirrhosis, Diabetes mellitus, and skin pigmentation --> bronze diabetes
-CHF, increased risk of hepatocellular carcinoma
-May be AR or due to chronic infusion therapy (high ferritin, iron and decreased TIBC= increased transferrin saturation)

Front 113

serum marker in Primary biliary Cirrhosis

Back 113

-increased serum mitochondrial antibodies
-a/w other autoimmune conditions

Front 114

serum marker for primary sclerosing cholangitis

Back 114

Hypergammaglobuinemia (IgM). Associated with ulcerative colitis. Can lead to secondary biliary cirrhosis

Front 115

Cholesterol stones

Back 115

-MC, radiolucent with 10-20% opaque due to calcifications
-obesity, Crohn's dz, cysitc fibrosis, advanced age, clofibrate, estrogens, multiparity, rapid weight loss and native american

"The Fat Old Native American Chron, who had Many Babies and was on Estrogen meds refused to eat Cholesterol and only ate Fiber so she had Rapid Weight Loss"

Front 116

Pigment stone

Back 116

-radioopaque
-seen in pts with chronic hemolysis, alcoholic cirrhosis, advanced age and biliary infection
-jet black stones.

Front 117

Cholestasis

Back 117

-Stone in common bile duct -deep green colored liver.
-Bile is blocked, which has conj bilirubin in it and is backed up into the liver.
-conj bilirubin will eventually reflux into the sinusoids, and leads to bilirubin in the urine and light color stools, with NO urobilinogen in the urine. The yellow urine is due to water soluble conj bilirubin in the urine.
-Alk phos and gamma glutamyl transferase are elevated What is the mech for getting rid of cholesterol? Bile. So, you reflux cholesterol, bilirubin and bile salts (they are all recycled).
-No hypercholesterolemia b/c it is recycled.
-bile salts deposit in the skin, leading to itching.

Front 118

Hemosiderosis

Back 118

ACQUIRED Fe overload – from alcohol.

Front 119

MCC’s hepatocellular carcinoma

Back 119

pigment cirrhosis: hemochromatosis; hepatitis B and C.

Front 120

pt with underlying cirrhosis, and is stable. But suddenly the pt begins to lose wt and ascites is getting worse. Do a peritoneal tap and it is hemorrhagic. Dx?

Back 120

hepatocellular carcinoma (get alpha feto protein)

Front 121

MCC small bowel obstruction?

Back 121

adhesion from previous surgery if no surgery than indirect inguinal hernia.

Front 122

25 y/o female, RUQ crampy pain, fever, point tenderness, neutrophilic leukocytosis, stones revealed on ultrasound. CBC showed a mild normocytic anemia and a corrected reticulocyte ct of 8%. Splenomegaly on PE and family hx of splenectomy. Dx?

Back 122

Congenital spherocytosis; b/c she has been hemolyzing RBC’s all her life, she puts a lot of bilirubin into conj bilirubin and therefore has supersaturated bile with bilirubin, and forms Ca bilirubinate stones that are jet black. Seen with ultrasound.

Front 123

screening test of choice for stones?

Back 123

Ultrasound

Front 124

Screening test of choice for anything in the pancreas

Back 124

CT

Front 125

What can be seen on x-ray if stone obstructs ileocecal valve?

Back 125

air in the biliary tree

Front 126

Cholecystitis

Back 126

-Inflammation of gallbladder. -Usually from gallstones; rarely ischemia or infections
-increase alkaline phosphatase if bile duct becomes involved

Front 127

Causes of acute pancreatitis?

Back 127

-Gallstones
-Ethanolol
-Trauma
-Steroids
-Mumps
-Autoimmune
-Scorpion string
-Hypercalcemia/Hyperlipidemia
-ERCP
-Drugs (sulfa drugs)

"GET SMASHED"

Front 128

clinical presentation of acute pancreatitis?

Back 128

-epigastric abdominal pain radiating to back
-anorexia
-nausea

Front 129

labs in acute pancreatitis?

Back 129

elevated amylase lipase

Front 130

MCC of acute pancreatitis?

Back 130

alcohol

Front 131

2nd MCC of acute pancreatitis?

Back 131

stone caught in accessory ducts of the pancreas

Front 132

Pancreatic pseudocyst

Back 132

-Hx of acute pancreatitis
-a lot of fluid accumulates around an inflamed pancreas and forms a false capsule and has a potential to rupture (not good to have amylase in peritoneal cavity).

Front 133

MCC of pancreatic cancer in the head of the pancreas? 2nd MCC?

Back 133

MCC = smoker, 2nd MCC = chronic pancreatitis, painless jaundice (mainly conjugated bilirubin), light colored stools, palpable GB (Courvoisier’s sign).

Front 134

Sentinel sign

Back 134

Duodenum next to inflammed pancreas stops peristalsing (Whenever the bowel lacks peristalsis, will see air accumulate and will get distension)

Front 135

Chronic pancreatitis?

Back 135

-can lead to pancreatic insufficiency --> steatorrhea, fat -soluble vitamin deficiency
-Chronic calcifying pancreatitis is stongly associated with alcoholism, increase risk of pancreatic cancer

Front 136

Where are tumors more common in the pancreas?

Back 136

pancreatic head

Front 137

PPl at risk for pancreatic adenocarcinoma?

Back 137

Jewish and African-American males

Front 138

tumor markers for pancreatic adenocarcinoma?

Back 138

CEA and CA-19-9 tumor markers

Front 139

how does pancreatic adenocarcinoma present?

Back 139

1) abdominal pain radiating to back
2) weight loss (due to malabsoprtion and anorexia)
3) Migratory thrombophlebitis (redness and tenderness on palpation of extremities (trousseau's syndrome)
4) Obstructive jaundice with palpable gallbladder (Courvoisier's sign)

Front 140

I-hyperchylomicronemia labs

Back 140

-increased chylomicrons
-elevated TG, Cholesterol

Front 141

pathophysiology of I-hyperchylomicronemia

Back 141

-lipoprotein lipase deficiency or altered apolipoprotein C-II.
-Causes pancreatitits, hepatosplenomegaly, and eruptive/pruritic xanthomas (no increased risk for atherosclerosis)

"hyperCYLomicronemia causes the pancreas to CRY"

Front 142

IIa-familial hypercholesterolemia labs

Back 142

increased LDL, increased Cholesterol

Front 143

IIa-familial hypercholesterolemia pathophys

Back 143

AD, adsent LDL receptors, Causes accelerated atherosclerosis, tendon (achilles) xanthomas, and corneal arcus

"Achilles LoveD cholesterol so he turned yellow and got athersclerosis"

Front 144

IV-hypertriglyceridemia labs

Back 144

increased VLDL, increased TG

Front 145

IV-hypertriglyceridemia pathophys

Back 145

-hepatic overproduction of VLDL
-causes pancreatitis

"the liver TRIs too hard to produce VLDL"

Front 146

the left gastro-omental artery branches off of what artery?

Back 146

-splenic
-supplies greater curvature of stomach

Front 147

the right gastro-omental artery branches off of what artery?

Back 147

Gastroduodenal artery

Front 148

Gastroduodenal artery branches off of what?

Back 148

common Hepatic artery

Front 149

Right gastric artery branches off of what artery?

Back 149

proper hepatic

Front 150

The left gastric artery branches off of what artery?

Back 150

Celiac trunk