EXAM #1: UPPER GI ANATOMY Flashcards Preview

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Flashcards in EXAM #1: UPPER GI ANATOMY Deck (50)
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1
Q
What are the four layers of the GI tube?
A
1) Mucosa
2) Submucosa
3) Muscularis externa/ propria
4) Serosa
2
Q
What are the four layers of the mucosa?
A
- Epithelium is in contact with chyme
- Basal lamina
- Lamina propria
- Muscularis mucosae
3
Q
What are the two layers of the muscularis externa/ propria?
A
- Inner circular
- Outer longitudinal
4
Q
Where in the mucosa are lymphatics, nerves, blood vessels, and glands located?
A
Lamina propria
5
Q
In what two segments of the GI tube are glands in the submucosa?
A
Esophagus
Duodenum
6
Q
What are the two plexus of the GI tube?
A
- Submucosal--inner
- Myenteric--outer
7
Q
What is the eponym for the Submucosal plexus?
A
Meissner's plexus
8
Q
What is the eponym for the Myenteric plexus?
A
Auerbach's plexus
9
Q
What is the function of the submucosal plexus?
A
Ion and fluid movement
10
Q
What is the function of Meissner's plexus?
A
Motility
11
Q
What is the normal type of epithelium in the esophagus? Stomach? Describe their appearance.
A
Esophagus= Nonkeratinized stratified squamous epithelium (pale)

Stomach= Non-ciliated simple columnar epithelium with goblet cells(red/ tongue-like)
12
Q
What is the name of the transition between the epithelium of the esophagus and stomach?
A
Z-line
13
Q
What is Barrett's esophagus?
A
Metaplasia in the distal esophagus with simple columnar epithelium with goblet cells in response to GERD
14
Q
How is Barret's Esophagus diagnosed?
A
ALCAIN BLUE staining
- Goblet cells in esophagus will produce mucous
- alcain blue stains mucous
15
Q
What cancer are patients with Barett's Esophagus at risk for?
A
Adenocarcinoma
16
Q
What third of the esophagus is most likely to harbor an adenocarcinoma?
A
Distal 1/3
17
Q
What third of the esophagus is most likely to harbor a squamous cell carcinoma (SCC)?
A
Middle 1/3
18
Q
What patient populations are at risk for stratified squamous cell carcinoma?
A
Males
African Americans
Smokers
Drinkers
19
Q
What type of esophageal cancer is most likely to cause hoarseness? Why?
A
SCC

*****Middle 1/3 of the esophagus is in close proximity to the recurrent laryngeal nerve of the vagus (innervates the larynx) ******
20
Q
Generally, how is SCC staged?
A
The deeper the penetration of the esophageal walls, the higher the stage

****Stage 4 has completely penetrated****
21
Q
What histologic characteristic of the esophagus lends it to metastasis?
A
Lack of a serosa to contain the cancer
22
Q
What are the four anatomic esophageal constrictions?
A
1) Upper Esophageal Sphincter
2) Aortic arch crosses the esophagus
3) Left Bronchus
4) Esophageal hiatus
23
Q
How do the clinical constrictions of the esophagus differ from the anatomic?
A
Only 3x

--> Aortic arch and left bonchus are combined
24
Q
What vertebral level is the esophageal hiatus located at?
A
T10
25
Q
What is the clinical consideration that you need to keep in mind about the constrictions of the esophagus?
A
Be weary of constrictions on endoscopy i.e. don't force and penetrate the wall of the esophagus
26
Q
What is pill esophagitis?
A
Difficulty swallowing pills in the elderly leading to inflammation of the esophagus
27
Q
Where is there an anatomic weakness in the esophagus prone to developing a diverticula?
A
Inferior border of the pharynx, specifically between the oblique thyropharyngeus and cricopharyngeus
28
Q
What is the eponym for the triangle between the thyropharyngeus and cricopharyngeus?
A
Killian's Triangle
29
Q
What is the eponym for the diverticula that develops at Killian's Triangle?
A
Zenker's Diverticulum
30
Q
What is the main symptom of a Zenker's Diverticulum?
A
Halitosis
31
Q
Where would you ligate the inferior thyroid artery when performing a thyroidectomy?
A
Above/ distal to the esophageal branch of the inferior thyroid artery
32
Q
What does cirrhosis/ portal hypertension lead to in the esophagus?
A
Esophageal varices
33
Q
What is achalasia?
A
- Inhibitory neurons of Meissner's plexus have been destroyed
- Normally relaxes the Lower Esophageal Sphincter

-->Abnormally contracted LES leading to proximal esophageal dilation
34
Q
Describe the lymphatic vessels of the esophagus. How does this differ from the colon?
A
Lymph flow moves LONGITUDINALLY i.e. the length of the esophagus in the SUBMUCOSA

****Colon lymph flow is RADIAL
35
Q
What are the clinical implications of the direction of lymph flow in the esophagus?
A
Metastatic cells can travel cranially or caudally
36
Q
Where does metastasis travel more commonly in the superior esophagus?
A
Cranially into the cervical lymph nodes
37
Q
Where does metastasis travel more commonly in the inferior esophagus?
A
Caudally into the celiac trunk
38
Q
What is a chylothroax? What causes a chylothorax?
A
Damage to the throacic duct during esophageal surgery spills lymph into the throacic cavity
39
Q
What type of glands are in the pyloric area of the stomach?
A
Gastrin secreting G-cells
40
Q
What is the function of Gastrin?
A
Increases the secretion of HCl from parietal cells
41
Q
What is the surgical procedure that can be done for refractory PUD?
A
Surgical excision of the pylorus to decrease the number of gastrin secreting G-cells
42
Q
Where are most ulcers found in the stomach?
A
Lesser curvature proximal to the angular notch
43
Q
What is the angular notch?
A
Interface between the body of the stomach and the pylorus
44
Q
What is Zollinger-Ellison Syndrome?
A
Tumor of gastrin producing cells, a Gastrinoma
45
Q
What is the most common location for a Gastrinoma?
A
Gastrinoma Triangle, which is defined as:
1) Junction of cystic and common hepatic duct
2) Junction of neck and body of pancreas
3) Junction between 2nd and 3rd part of the duodenum
46
Q
What are the contents of the Gastrinoma Triangle?
A
Pancreas
Duodenum
47
Q
What gross change of the stomach is seen in Zollinger-Ellison Syndrome?
A
Prominent rugae due to increased parietal cell mass
48
Q
Review the arterial supply of the stomach.
A
N/A
49
Q
What are the six major arteries the supply the stomach?
A
1) Right gastric
2) Left gastric
3) R. gastro-omental
4) L. gastro-omental
5) Gastroduodenal
6) Splenic
50
Q
What arterial variation do you need to be weary of in a gastrectomy?
A
Left hepatic artery can branch from the left gastric artery--impairing blood supply to the left lobe of the liver.