GI: 334 - 336

Question 1

What defines the foregut?

Answer 1

Pharynx to duodenum

Question 2

What defines the midgut?

Answer 2

Duodenum to proximal 2/3 of transverse colon

Question 3

What defines the hindgut?

Answer 3

Distal 1/3 of transverse colon to anal canal above the pectinate line

Question 4

What 3 things that lead to developmental defects of the anterior abdominal wall and what are their associated defects?

Answer 4

1. Failure of rostral fold close - sternal defects
2. Failure of lateral folds to close - omphalocele, gastroschisis
3. Failure of caudal folds to close - bladder exstrophy

Question 5

What is duodenal atresia due to?

Answer 5

Failure to recanalize

Question 6

What is duodenal atresia associated with?

Answer 6

Trisomy 21

Question 7

What causes jejunal, ileal, colonic atresia?

Answer 7

Vascular accident

Question 8

Explain the two important steps in midgut development.

Answer 8

1. Week 6: Midgut herniates through umbilical ring

2. Week 10: Returns to abdominal cavity and rotates around SMA

Question 9

What is gastroschisis?

Answer 9

Extrusion of abdominal contents through abdominal folds, not covered by peritoneum

Question 10

What is omphalocele?

Answer 10

Persistence of herniation of abdominal contents into umbilical cord, covered by peritoneum

Question 11

How does TE fistula typically present?

Answer 11

Drooling, choking, and vomiting with first feeding

Question 12

What would you see on CXR with a TE fistula?

Answer 12

Air in the stomach

Question 13

What is a clinical test for TE fistula?

Answer 13

Failure to pass nasogastric tube into stomach

Question 14

What causes cyanosis in TE fistula?

Answer 14

Laryngospasms which work to avoid reflux-related aspiration

Question 15

What causes congenital pyloric stenosis?

Answer 15

Hypertrophy (of the pylorus)

Question 16

How does congenital pyloric stenosis present?

Answer 16

Palpable “olive” mass in epigastric region and nonbilious projectile vomiting at 2-6 weeks

Question 17

What is the treatment for congenital pyloric stenosis?

Answer 17

Surgical incision

Question 18

How common is congenital pyloric stenosis?

Answer 18

1/600 live births

Question 19

Congenital pyloric stenosis is more common in what subset of patients?

Answer 19

Firstborn males

Question 20

What are the different embryological precursors to the pancreas?

Answer 20

Pancreas comes from the foregut

Ventral pancreatic buds - form pancreatic head, main pancreatic duct, uncinate process

Dorsal bud - forms body, tail, isthmus, accessory pancreatic duct

Question 21

What are two developmental defects that can occur with the pancreas?

Answer 21

1. Annular pancreas

2. Pancreas divisum

Question 22

What happens in an annular pancreas?

Answer 22

Ventral pancreatic bud abnormally encircles 2nd part of the duodenum, forms a ring of pancreatic tissue that may cause duodenal narrowing

Question 23

What happens in pancreas divisum?

Answer 23

Ventral and dorsal parts fail to fuse at 8 weeks

Question 24

What does the spleen vs. its blood supply arise from embryologically?

Answer 24

Spleen - mesentery of the stomach (mesodermal)

Blood supply - from the foregut (celiac artery)

Question 25

What can injury to retroperitoneal structures lead to?

Answer 25

Blood or gas accumulation in retroperitoneal spaces

Question 26

What are the retroperitoneal structures?

Answer 26

Mnemonic: SAD PUCKER Suprarenal (adrenal) glands Aorta and IVC Duodenum (2nd through 4th parts) ``` Pancreas (except tail) Ureters Colon (descending and ascending) Kidneys Esophagus (lower 2/3) Rectum (partially) ```

Question 27

What are 6 important GI ligaments?

Answer 27

1. Falciform 2. Hepatoduodenal 3. Gastrohepatic 4. Gastrocolic 5. Gastrosplenic 6. Splenorenal

Question 28

What does the falciform ligament connect?

Answer 28

Liver to the anterior abdominal wall

Question 29

What is contained within the falciform ligament?

Answer 29

Ligamentum teres hepatis (derivative of fetal umbilical vein)

Question 30

What does the hepatoduodenal ligament connect?

Answer 30

Liver to duodenum

Question 31

What does the hepatoduodenal ligament contain?

Answer 31

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

Question 32

What does the gastrohepatic ligament connect?

Answer 32

Liver to less curvature of the stomach

Question 33

What does the gastrohepatic ligament contain?

Answer 33

Gastric arteries

Question 34

What does the gastrocolic ligament connect?

Answer 34

Greater curvature of stomach and transverse colon

Question 35

What does the gastrocolic ligament contain?

Answer 35

Gastroepiploic arteries

Question 36

What does the gastrosplenic ligament connect?

Answer 36

Greater curvature of stomach and spleen

Question 37

What does the gastrosplenic ligament contain?

Answer 37

Short gastrics, left gastroepiploic vessels

Question 38

What does the splenorenal ligament connect?

Answer 38

Spleen to posterior abdominal wall

Question 39

What does the splenorenal ligament contain?

Answer 39

Splenic artery and vein, tail of pancreas

Question 40

Which ligament separates the greater and lesser sacs on the right and why is this important?

Answer 40

Gastrohepatic - may be cut during surgery to access the lesser sac

Question 41

What is the Pringle maneuver?

Answer 41

Ligament may be compressed between thumb and index finger placed in omental foramen to control bleeding

Question 42

What separates the greater and lesser sacs on the left?

Answer 42

Gastrosplenic

Question 43

Which ligament is part of the greater omentum?

Answer 43

Gastrocolic ligament