CHAPTER: GI (Embryo, Anatomy, Phys) Flashcards Preview

LCK STEP > CHAPTER: GI (Embryo, Anatomy, Phys) > Flashcards

Flashcards in CHAPTER: GI (Embryo, Anatomy, Phys) Deck (42):
1

Structures in the hepatoduodenal lig

Portal triad
1. Hepatic art (going)
2. Portal vein (going)
3. Common bile duct (coming)
Pringle = clamp all 3 to buy time to find liver bleeder

2

Structures contain in the gastrocolic // splenorenal ligaments

Gastrocolic = greater curve stomach to transverse colon
Contains L + R gastro-epiploic arteries
Spleno-renal ligament connects spleen to post ab wall
1. Splenic A + V
2. Tail of pancreas (aka what isn't retro)

3

What are 2 ways you can get into the lesser sac?

Lesser sac (post) and the greater sac (ant) are created by the ligaments
On L: gastrosplenic
On R: gastrohepatic
1. Cut through the gastrohepatic to get in
2. Foramen of Winslow = natural opening between liver, hepatoduo lig, and duodenum

4

Name the 4 layers of the gut wall in order and the structures within them

MSMS
Mucosa 1. epi 2. LP (CT) 3. muscularis mucosa
*Erosions only through mucosa*
Submucosa w/ Meissners to secrete fluids
*Ulcers extend into subM*
Muscularis externa - inner circ, Myenteric for motility, outer long
4th:
1. Intraperitoneal organs = serosa
2. Retro = adventitia

5

Fastest section of the GI tract

Duodenum > ileum > stomach

6

Histo for duodenum + what absorbed here

IRON
Villi + MV
Brunner - make bicarb
Crypts of L = regen

7

Histo jejunum + what absorbed here

FAT + FOLATE
Plicae circulares ↑↑SA
Lacteals
Crypts of L

8

Histo ileum + what absorbed here

B12, IF, BILE ACIDS
Peyers patches
↑est # goblet cells
Crypts L, plicae

9

Difference in histo between stomach and colon

Both simple columnar
Stomach: gastric pits (acid) + glands (mucous)
Colon: crypts of goblet cells only

10

Only BV off aorta that runs in front of the IVC

Gonadal

11

What are connects the sup + inf mesenteric arteries

Marginal artery
@ L flexure
If you have to ligate IMA, this is how the colon with get colateral from SMA

12

What condition would cause the SMA to compress the duodenum between it and the aorta causing post prandial pain?

Malnutrition -> lose fat around the SMA
Duodenum between SMA (top) and aorta (bottom)

13

BS, sympa, and para to foregut, midgut, and hindgut

Fore: celiac
Mid: SMA
Both sympa = greater + lesser splanchnic n; para = vagus
Hind: IMA. lumbar splanchnic, pelvic n (para)

14

Trace the common hepatic artery's branches as it comes out of SMA

Proper hepatic
1. Into liver via hepato-duo lig (portal triad)
2. R gastric art (lesser curve)
Gastroduo art
1. R gastroepip (greater curve, L coming from splenic)
2. Ant pancreaticoduodenal
3. Post-sup pancreaticoduodenal

15

What are the 3 veins that varices are trying to get access to for shunting

GOAL = direct drain into IVC
Esophagus - back up into L gastric so get into azygos
Caput medusae - open paraumbilical veins into small epigastric veins
Anorectal varices - back up into sup rectal to get into middle inf rectal

16

A/LN/V and cancer above the pectinate line

A: sup rectal (IMA)
V: sup rectal -> IMV -> portal
LN: int iliac
Adenocarcinoma (GI tract)

17

A/N/V/LN and cancer below the pectinate line

A: inf rectal (int pudendal) - ↓BS post causes anal fissure
V: inf rectal -> internal iliac -> IVC (↑bioavail for drugs)
LN: superficial inguinal
N: pudendal nerve = somatic innervation = painful hemroid
SCC (HPV)

18

What do Ito cells? What organ?

Liver
Store vit A
Produce ECM

19

Which zone liver affected by metabolic toxins

3
This is where p450 is - activates the drugs therefore ↑est risk damage

20

Zone for alcoholic vs viral hepatitis

1 - viral
3 - alcoholic (p450)

21

Zone for yellow fever

2
Yellow fever = flavi (+ssRNA)
Back pain
Jaundice
Bloody stool
Aedes mosquito, live atten vaccine

22

Role of Kupffer

Liver macrophages
Breakdown RBCs to make BR

23

Structures in the femoral triangle vs sheath

NAVL
Triangle = N, A, V
Sheath = A, V, deep inguinal LN in femoral canal
Go medial for central venous access

24

What is the double duct sign

Stone obstructs ampulla vater
See the main and accessory pancreatic ducts dialted

25

3 parts Hesselbach triangle

Rectus ab
Inf epigastric vessels
Inguinal ligament
Why direct hernias are medial to inf epi vessels (vs indirect lateral)

26

What hernia gives you
Hourglass stomach
Fundus stomach into thorax
Entire stomach into thorax

Sliding hiatal
Paraesophageal
Hiatal

27

Where are K cells - what do they excrete?

D +J
GIP = incretin
↑insulin release
↓gastric acid (stop digesting, we've got it down here)
INCRETIN EFFECT is why you get so much more insulin with PO > IV glucose loads

28

Symptoms of a VIPoma

VIP stim parasympa (M3) @ sphincters, GB, SI - rest, digest (also how macrolides stim GI motility)
Watery diarrhea
HypoK
Achlorhydria

29

Fxn secretin

↑bicarb from pancreas to make SI more basic for enzymes to work

30

Where does CCK vs secretin work in the pancreas?

CCK @ acinar cells - ↑secretions
Secretin @ ductal cells - ↑bicarb

31

Enzyme for protein digestion

Pepsin from chief cells in stomach
Acid in stomach activates - therefore protein digestion starts in stomach

32

2 ways vagus ↑acid secretion

ACh @ parietal cells
GRP = gastrin releasing peptide @ G cells (duo) -> gastrin into circulation to bind parietal and #1 ECL cells (release H)

33

3 phases of acid secretion

1. Cephalic = small, thought, taste - vagus
2. Gastric = stomach distension - gastrin
3. Intestinal ↓acid via YY peptide from ECL cells

34

SI BB enzymes that activate trypsin

Enterokinase
Enteropeptidase

35

What 2 AAs do bile acids get conj to making them H2O sol?

Glycine or taurine

36

What enzyme is the rate lim step of bile acid synthesis

Cholesterol 7alpha hydrox

37

2 SI receptors that absorb monosacc

SGLT1 - glucose + galactose
Na co-trans (use the Na gradient)
GLUT 5 - facilitated diffusion fructose

38

Enzyme that converts UCBR into CBR in the liver to make H2O sol

UDP glucuronosyl transferase
Gut bacteria convert CBR -> urobili
Stercobilin - feces
Urobilin - urine

39

Which fold failures cause omphalocele + gastroschisis vs bladder exstrophy

O/G - lateral fold closure defect
Bladder out - caudal fold closure defect

40

Cause jejunal and ileal atresia

Disrupt mesenteric vessels -> ischemic necrosis
Triple bubble or apple peel
Vs duodenal atresia = fail recanalize
Double bubble

41

Exposure to macrolide ↑risk what

Hypertrophic pyloric stenosis
1st born males too
Olive mass 2-6 wks after bith
PROJECTILE vomiting

42

Fore vs mid vs hind gut derivatives

Fore - mouth -> duodenum (celiac art)
Mid - duodenum -> prox 2/3 transverse (SMA)
Herniates through umbilical ring to grow
Hind - to above the pectinate (IMA)