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USMLE Step 1 Random Facts > GI > Flashcards

Flashcards in GI Deck (91):
1

what structure contains the ligamentum teres hepatis?

falciform ligament

2

what structure contains the portal triad?

hepatoduodenal ligament

3

what is the portal triad?

hepatic artery, portal vein, common bile duct

4

what structure connects the greater and lesser omentum sacs?

hepatoduodenal ligament

5

what structure contains the gastric arteries?

gastrohepatic ligament (liver to LESSER CURVATURE of stomach) - cut during surgery to access lesser sac

6

what structure contains the gastroepiploic arteries?

gastrocolic ligament (GREATER CURVATURE and transverse colon) - part of GREATER omentum

7

what structure contains short gastric and left gastroepiploic vessels?

gastrosplenic ligament (GREATER curvature + spleen)

8

what structure separates the greater and lesser sacs on the right?

gastrohepatic

9

what structure separates the greater and lesser sacs on the left?

gastrosplenic

10

what structure contains the splenic artery and vein, and tail of the pancreas?

splenorenal

11

ulcers can extend to?

submucosa

12

erosions can extend to?

mucosa only (epithelium, lamina propria, muscularis mucosa)

13

this part of the pancreas is formed from the VENTRAL bud alone

uncinate process

14

pancreas derived from?

foregut

15

ventral pancreatic buds form?

inferior/posterior part of head
main pancreatic duct of Wirsung
uncinate process

16

dorsal pancreatic buds form?

body
tail
isthmus
accessory pancreatic duct
MOST of head

17

third part of duodenum trapped b/w?

aorta and SMA

18

only duodenal part not retroperitoneal?

1st

19

2nd part of duod in ass w/?

head of pancreas (ampulla of Vater)

20

3rd part of duod in ass w/?

uncinate process of pancreas
SMA/SMV

21

RF for increased incidence of cholangiocarcinoma

primary sclerosing cholangitis
infection w/ Clonorchis sinenus
ulcerative colitis

22

carcinoid synd produces what?

high levels of serotonin

23

when is carcinoid synd not seen?

if limited to GI tract (bc serotonin undergoes first-pass metab in liver)

24

sympt of carcinoid synd

recurrent diarrhea, cutaneous flushing, asthmatic wheezing, right-sided valvular disease

25

dx/tx of carcinoid synd

**increased 5-HIAA (metabolite of serotonin) in urine
niacin deficiency
tx = octreotide (somatostatin analog)

26

window period in Hep B?

when HbsAg is (-), AND HbsAb (-), but HbcAb (+)

27

virchow's node involves the

left supraclavicular node (mets from stomach)

28

sister mary joseph nodule involves

subcut periumbilical metastasis

29

what PUD causes pain w/ eating?

gastric ulcer

30

what PUD causes relief w/ eating?

duodenal ulcer

31

bleeding from what artery w/ ruptured gastric ulcer on lesser curvature?

left gastric artery

32

bleeding from what artery w/ ulcer on posterior wall of duodenum?

gastroduodenal artery

33

most common stomach cancer

adenocarcinoma

34

ligaments cut when removing spleen

gastrosplenic + splenorenal ligaments

35

arterial supply/venous drainage above pectinate line (proximal)?

A: superior rectal artery (branch of IMA)
V: superior rectal vein --> inferior mesenteric vein --> portal system

36

hemorrhoid/cancer seen above pectinate line?

internal hemorrhoid - NOT painful (bc visceral innerv)

adenocarcinoma

37

arterial supply/venous drainage below pectinate line (distal)?

A: inferior rectal artery (branch of internal pudendal artery)
V: inferior rectal v. --> internal pudendal v. --> internal iliac v. --> IVC

38

hemorrhoid/cancer seen below pectinate line?

external hemorrhoid - painful! (bc somatic innerv - inferior rectal branch of pudendal n.)

squamous cell carcinoma

39

autoimmune gastritis located in what part of stomach?

fundus/body

40

H.pylori chronic gastritis located in what part of stomach?

antrum

41

Mallory bodies typically seen w/?

alcoholic hepatitis

42

triad of Budd-Chiari synd

hepatomegaly
ascites
abdominal pain

43

cholelithiasis is

gallstones

44

cholecystitis is

inflamm/infection of GB

45

cholangitis is

inflamm/infection of biliary tree

46

choledocholithiasis is

gallstones in bile ducts

47

area of colon most suscept to infarction?

watershed area of splenic flexure

48

hereditary hyperbilirubinemia responding to phenobarbitol

Crigler-Najjar type II
Gilbert synd

bc increases liver enzyme synth

49

hereditary hyperbilirubinemia w/ black liver

Dubin-Johnson synd

50

air seen in GB and biliary tree a sign of?

cholecystenteric fistula leading to gallstone ileus (stone stuck in ileocecal valve)

51

level of celiac trunk

T12

52

level of SMA

L1

53

level of LEFT renal artery

L1

54

level of IMA

L3

55

level of bifurcation of aorta

L4

56

receives blood from both SMA + IMA

splenic flexure (watershed area)
first affected in hypotension

57

the 4 anastomoses + origins

sup epigastric (internal thoracic/mammary) inf epigastric (external iliac)

sup pancreaticoduod (celiac) inf pancreaticoduod (SMA)

middle colic (SMA) inf colic (IMA)

sup rectal (IMA) middle + inf rectal (internal iliac)

58

3 portal systemic shunts

forms varices!
1) left gastric v. esophageal v.
2) paraumbilical v. superficial and inf epigastric v. (BELOW umbilicus), sup epigastric and lateral thoracic v. (ABOVE umbilicus)
3) sup rectal middle + inf rectal

59

rectal drainage above + below pectinate line

above: sup rectal v. --> IMV --> portal system

below: inf rectal v. --> internal pudendal v. --> internal iliac v. --> IVC

60

zone I of liver

affected 1st by viral hepatitis

61

zone III of liver

pericentral vein zone
-affected 1st by ischemia (bc farthest from O2 blood)
-contains P450 system
-most sensitive to toxic inj (acetaminophen OD, alc tox)
-site of alcoholic hepatitis

62

blood flows from

zone 1 --> 3

63

bile flows from

zone 3 --> 1

64

tumor of pancreatic head blocks

common bile duct ONLY

65

diaphragmatic hernia in infants can be due to

defective dev't of pleuroperitoneal membrane

66

potent gastrin stimulators

phenylalanine
tryptophan
Calcium

67

bile acids conjugated to what substances?

glycine or taurine

68

rate-limiting enzyme in bile prod

cholesterol 7alpha-hydroxylase

69

bilirubin conjugated to what to make soluble?

glucuronic acid

70

tx of esoph varices

vasopressin

71

duodenal ulcer perforation usually in

anterior > posterior

72

rectal SPARING

Crohn's!

73

continuous lesions w/ RECTUM ALWAYS involved

UC

74

unique ass w/ Crohn's (vs. UC)

migratory polyarthritis
erythema nodosum
kidney stones
strictures

75

unique ass w/ UC (vs. Crohn's)

pyoderma gangrenosum (tissue necrosis causing deep ulcers)
primary sclerosing cholangitis
toxic megacolon

76

colorectal cancer presenting w/ Fe-def anemia is located where

ascending

77

tx for ulcer hemorrhages

somatostatin (octreotide) - bc decreases splanchnic blood flow

78

microvesicular fatty change

Reye's synd

79

macrovesicular fatty change

hepatic steatosis (mod alc intake)

80

why is AST >> ALT in alcoholic hep?

bc B6 def decreases ALT

81

centrilobular congestion + necrosis

halogenated inhalation anesthetics injury
nutmeg liver
Budd-Chiari

82

cirrhosis w/ PAS positive globules in liver

alpha1-antitrypsin def

83

tx for physiological neonatal jaundice?

phototherapy (converts UCB to water soluble form)

84

tx of PBC

ursodiol

85

black pigment stones

ass w/ hemolysis
radiopaque (white)

86

brown pigment stones

ass w/ infection
radiolucent (black)

87

air in biliary tree ass w/

cholecystenteric fistula in SI (b/w GB and SI)
gallstone ileus (stone obstructing ileocecal valve)

88

positive Murphy's sign usually in

cholecystitis

89

charcot's triad of cholangitis? Reynold's pentad?

triad - jaundice, fever, RUQ pain
pentad - triad + hyPOtension, altered mental status

90

pancreatic pseudocyst = complic of what? and lined by?

acute pancreatitis
lined by granulation tissue

91

signs of pancreatic cancer

-abd pain radiating to back
-wt loss
-Trousseau's sign (migratory thrombophlebitis)
-Courvoisier's sign (palpable, NONTENDER [aka painLESS] GB w/ obstructive jaundice)