GASTROINTESTINAL

Question 1

The foregut extends from the ….. to the ….. at the level of ….. and ….. ?

Answer 1

The foregut extends from the oesophagus to the duodenum at the level of the pancreatic duct and common bile duct insertion (Ampulla of Vater)

Question 2

The midgut extends from the …. …. to the ….. …. of the …. …..

Answer 2

The midgut extends from the lower duodenum to the proximal 2/3rds of the transverse colon

Question 3

The hindgut extends from the ….. …. of the …. … to the … …. …. …. …

Answer 3

The hindgut extends from the distal 1/3rd of the transverse colon to the anal canal above the pectinate line

Question 4

Name a ventral wall defect due to:
1) Rostral fold closure
2) Lateral fold closure (x2)
3) Caudal fold closure

Answer 4

1) Ectopia cordis
2) Gastroschisis, Omphalocoele
3) Bladder exstrophy

Question 5

Describe the location of the herniation of abdominal wall contents in:
1) Gastroschisis?
2) Omphalocele?

Answer 5

1) Gastroschisis - paraumbilical herniation of the abdominal wall contents through abdominal wall defect
2) Herniation of abdominal wall contents through the umbilicus

Question 6

Between gastroschisis and omphalocoele, which is covered by peritoneum and amnion and which isn’t?

Answer 6

Gastroschisis - covered by peritoneum and amnion VS
Omphalocele - uncovered by either peritoneum or amnion

Question 7

Gastroschisis has good or bad prognosis?

Answer 7

Good prognosis (since not associated with chromosomal abnormalities)

Question 8

Is omphalocoele associated with chromosomal abnormalities?

Answer 8

Yes

Question 9

Which chromosomal abnormalities are associated with Omphalocoele?

Answer 9

Trisomies 13 and 18
Beckwith-Wiedemann syndrome

Question 10

Why do congenital umbilical hernias happen embryologically speaking?

Answer 10

Due to failure of the umbilical ring to close after physiologic herniation of midgut, covered by skin

Question 11

Give 2 associations with congenital umbilical hernias |(2 other conditions)

Answer 11

1. Down’s syndrome
2. Congenital hypothyroidism

Question 12

List 3 different types of tracheosophageal anomalies
(Also which is most common?)

Answer 12

1. Pure oesophageal atresia
2. Pure tracheo-oesophageal fistula (H-type)
3. Oesophageal atresia with tracheo-oesophageal fistula (Most common)

Question 13

How will each type of oesophageal anomaly make the stomach look on CXR?

Answer 13

1. Pure oesophageal atresia (gasless stomach)
2. Pure tracheo-oesophageal fistula (prominent gastric bubble)
3. Oesophageal atresia with distal TEF (prominent gastric bubble)

Note in normal anatomy there is a small gastric bubble on CXR

Question 14

What is a useful clinical test indicative of oesophageal atresia with tracheo-oesophageal fistula?

Answer 14

Failure to pass an NG into the stomach

Question 15

CXR sign in duodenal atresia?

Answer 15

“Double bubble sign”

Question 16

Outline the arterial supply to the foregut, midgut and hindgut

Answer 16

Abdominal aorta —- coeliac axis then SMA then IMA
Coeliac axis supplies the foregut, SMA supplies the midgut, IMA supplies the hindgut

Question 17

What CXR sign is shown in jejunal and ileal atresia?

Answer 17

Triple bubble sign

Question 18

Duodenal atresia is associated with which other condition?

Answer 18

Down’s syndrome

Question 19

Jejunal and ileal atresia is associated with which 2 other conditions?

Answer 19

Cystic fibrosis
Gastroschisis

Question 20

Jejunal and ileal atresia may be caused by what maternal behaviours during pregnancy?

Answer 20

Tobacco smoking
Cocaine use (vasoconstrictive effect)

Question 21

Hypertrophic pyloric stenosis presents with what electrolyte / acid-base disturbance?

Answer 21

Hypokalaemic, hyperchloraemic metabolic alkalosis

Question 21

Hypertrophic pyloric stenosis more common in F or M?

Answer 21

M (often firstborn males)

Question 22

What imaging investigation can be used to identify hypertrophic pyloric stenosis and what would it find?

Answer 22

U/s - thickened and lengthened pylorus

Question 23

What is the management of hypertrophic pyloric stenosis?

Answer 23

Pyloromyotomy (surgical incision of pyloric muscles)

Question 24

Hypertrophic pyloric stenosis is associated with exposure to which drug?

Answer 24

Macrolide

Question 25

Pancreas is derived from foregut, midgut or hindgut?

Answer 25

Pancreas is derived from the foregut

Question 26

Embryologically with regards the pancreas, the .... ..... ... contributes to the uncinate process. Both ... and ... ... contribute to .... ... and main .... ......

Answer 26

Embryologically with regards the pancreas, the ventral bud contributes to the uncinate process. Both the ventral and dorsal buds contribute to the pancreatic head and the main pancreatic duct

Question 27

How does annular pancreas occur, and how does it present? Name another condition it is associated with

Answer 27

The ventral bud rotates abnormally forming a ring of pancreatic tissue which encircles the 2nd part of the duodenum which causes duodenal narrowing - presenting as vomiting Associated with Down's syndrome

Question 28

How does pancreas divisum present embryologically and how might it present?

Answer 28

Failure of ventral and dorsal buds of pancreas to fuse at 7 weeks of development Mostly asymptomatic, but may cause chronic abdominal pain and / or pancreatitis

Question 29

Describe the arterial supply of the pancreas

Answer 29

Abdominal aorta - coeliac trunk - splenic artery

Question 30

List the retroperitoneal structures

Answer 30

SADPUCKER Suprarenal (adrenal glands) Aorta and IVC Duodenum (D2-D4) Pancreas (except tail) Ureters Colon (descending and ascending) Kidneys E (oesophagus) Rectum (partially)

Question 31

Pg 368 labelling of GI ligaments

Answer 31

See page 368

Question 32

What structure(s) are contained within the falciform ligament?

Answer 32

Ligamentum teres hepatis (derivative of foetal umbilical vein), patent paraumbilical veins

Question 33

What structure(s) are contained within the hepatoduodenal ligament?

Answer 33

Portal triad: proper hepatic artery, portal vein, common bile duct

Question 34

What structure(s) are contained within the hepatogastric ligament?

Answer 34

Gastric vessels

Question 35

What structure(s) are contained within the gastrocolic ligament?

Answer 35

Gastroepiploic arteries

Question 36

What structure(s) are contained within the gastrosplenic ligament?

Answer 36

Short gastrics, left gastroepiploic vessels

Question 37

What structure(s) are contained within the splenorenal ligament?

Answer 37

Splenic artery and vein, tail of pancreas

Question 38

Out of the following GI ligaments match them to whether they are ventral or dorsal mesentery derivatives: 1. Hepatoduodenal ligament 2. Hepatogastric ligament 3. Gastrocolic ligament 4. Gastrosplenic ligament 5. Splenorenal ligament 6. Falciform ligament

Answer 38

1. Hepatoduodenal ligament - ventral mesentery 2. Hepatogastric ligament - ventral mesentery 3. Gastrocolic ligament - dorsal mesentery 4. Gastrosplenic ligament - dorsal mesentery 5. Splenorenal ligament - dorsal mesentery 6. Falciform ligament - ventral mesentery