GI

Question 1

gastroschisis

Answer 1

extrusion of abdominal contents through abdominal folds; no covering
failure of the fusion of lateral folds during transverse folding
right of the umbilical cord
gastRoschsis–Right

prematurity and vasoconstritive agents (cocaine)

Question 2

exstrophy of bladder

Answer 2

caudal fold closure, anterior abdominal wall.

Question 3

midgut development

Answer 3

6th week–herniation through umbilical ring
10th week-return to cavity, rotation around SMA
270 degrees.

Question 4

midgut volvulus/malrotation

Answer 4

green puke, failure of midgut to complete 270 degrees into peritoneal cavity
C loop must be on right side (small intestine, cranial limb) and the caudal limb (large intestine to the left).
caudal limb rotates addition 180 degrees inside, cecum returning last
formation of Ladd bands–malrotation

Question 5

duodenal atresia

Answer 5

double bubble sign 
polyhydroaminos 
low intestinal reabsorption of amniotic fluid .
failed recanalization of duodenal lumen
annular pancreas (Ladd bands)
trisomy 21. 
bilious vomiting.

Question 6

H type fistula

Answer 6

still some connection, not as severe. gasless abdomen

Question 7

EA with distal TEF

Answer 7

most common. blind end esophagus (esophageal atresia). drooling, choking, and vomiting with first feeding. air enters the stomach. cyanosis
failure to pass NG tube into stomach

Question 8

Pyloric stenosis

Answer 8

marked hypertrophy and hyperplasia of 2 muscular layers of pylorus
palpable “olive” mass in epigastric region
nonbilious projectile vomiting.
hypokalemic hypochloremic metabolic alkalosis.
male first born
correct dehydration first
pyloromyotomy
hungry vomiter

Question 9

Annular pancreas

Answer 9

ventral pancreatic bud abnormally encircles 2nd part of duodenum
may cause duodenal narrowing

Question 10

Hirschprung’s disease

Answer 10

absence of ganglion cells in the distal bowel.
failure of differentiation and migration of neural crest cells
neurocristopathy
functional bowel obstruction with dilation of proximal bowel.
failure to pass meconium, constipation, abdominal distension
RET gene
increase risk with down syndrome
Hirschsprung is a giant spring that has SPRUNG in the colon.

Question 11

imperforate anus

Answer 11

urorectal septum fails to completely separate hindgut
VACTRAL
(tet, ASD, VSD)
(esophageal atresia, duodenal atresia, Hirschprung)
(VCUR, Renal Agenesis)
Vertebral

Question 12

Falciform ligament

Answer 12

liver to anterior abdominal wall

fetal umbilical vein–ligament teres hepatis

ventral mesentary

Question 13

hepatoduodenal ligament

Answer 13

liver to duodenum
borders the omental foramen, which connectrs greater and lesser sacs
portal triad:
proper hepatic artery
portal vein 
common bile duct

Question 14

gastrohepatic ligament

Answer 14

liver to lesser curvature of stomach
gastric arteries
separates greater and lesser sacs on the right. cut to access lesser sac

Question 15

gastrocolic ligament

Answer 15

greater curvature to transverse colon
gastroepiploci arteries
part of greater omentum
loose connective tissue
free fold of visceral peritoneum clinically important in that it adheres to sites of inflammation limiting damage to abdominal cavity.

Question 16

gastrosplenic ligament

Answer 16

greater curvature and spleen
short gastrics, left gastroepiploic vessels
seperates greater and lesser sacs on the left

Question 17

splenorenal

Answer 17

spleen to posterior abdominal wall
splenic artery and vein
tail or pancreas

Question 18

iluem histology

Answer 18

peyer patches (lymphoid aggregates in lamina propria, submucosa) plicae circulares (proximal ileum), crypts of Leiberkuhn
largest # of goblet cells in small intestine

Question 19

blood supply/innervation to foregut

Answer 19

Celiac artery, vagus nerve, T12/L1.

pharynx (vagus) and lower esophagus (celiac) to proximal duodenum. liver, gallbladder, pancreas, and spleen

Question 20

branches of celiac trunk

Answer 20

splenic artery
left gastric artery–esophageal aa
common hepatic artery

Question 21

portal-systemic anastomosis

Answer 21

1)esophageal veins into left gastric veins (portal) or superiorly into azygous system (esophageal) (caval)
2) umbilicus–caput madusae, paraumbilical and epigastric veins of the anterior abdominal wall
3)rectum–anorectal varices. superior rectal (caval)from middle and inferior rectal (portal)
varices of gut, butt, and caput portal hypertension

Question 22

stomach blood supply

Answer 22

left gastric (from ciliac... has esophageal branch..portal/caval anastomosis)
right gastric (from proper hepatic-->celiac) 
short gastric (-->splenic-->celiac)
left and right gastroomental(splenic-->celiac and gastroduodenal-->common hepatic-->celiac)

Question 23

SMA

Answer 23

vagus parasympathetics, L1
distal duodenum to proximal 2/3 of transverse colon
midgut
–>inferior pancreaticoduodenal artery (anastamosis with sup pancreaticoduodenal aa–>gastroduodenal–>from common hepatic–> celiac)
–>ileocolic and appendicular
–>right and middle colic
–>marginal artery

Question 24

diverticulitis

Answer 24

high internal pressure pockets with fecal matter in sigmoid colon

Question 25

pectinate line

Answer 25

above--internal hemmorhoids, superior rectal artery (IMA), portal drainage (superior rectal-->inferior mesenteric-->portal), visceral innervation(pelvics), not painful, internal iliac lymph nodes below--external hemmorrhoids, fissures, squamous cell carcinoma arterial supply--inferior rectal from internal pudendal venous--inferior rectal-->internal pudendal-->internal iliac-->common iliac-->IVC innervation--inferior rectal branch of pudendal nerve (somatic) painful, superficial inguinal nodes

Question 26

femoral region organizatoin

Answer 26

NAVEL nerve artery vein empty lymphatics lateral to medial to find your navel femoral triangle-- vein, artery, and nerve sheath--vein, artery, canal (but no nerve)

Question 27

layers of spermatic cord from abdomen

Answer 27

external spermatic fascia (external oblique) cremasteric muscle and fascia (internal oblique) internal spermatic fascia (transversalis fascia)

Question 28

indirect vs direct hernia

Answer 28

deep inguinal ring--indirect, into the scrotum, infants, failure of processus vaginalis to close, covered by all 3 levels of fascia direct-through hesselbach triangles. through abdominal wall, medial to inferior epigastric artery goes through external/superficial ring, covered by external spermatic fascia. MEDIAL. MDs don't LIe medial direct lateral indirect

Question 29

borders of hesselbach triangle

Answer 29

Inferior epigastric vessels lateral border of rectus abdominis inguinal ligament

Question 30

peyer patches

Answer 30

unencapsulated lymphoid tissue found in lamina propria and submucosa of ileum contain specialized M cells that sample and present antigens to immune cells B cells in germinal centers of Peyer patches IgA secreting plasma cells, reside in lamina propria

Question 31

Bilirubin

Answer 31

heme oxygenase heme-->biliverdin unconjugated--liver, indirect, water insoluble conjugated--bile, conjugated with glucuronic acid, more soluble Gilbert syndrome---bilirubin to bilirubin diglucuronide problem, less than 20% conjugated.. (could be hemolysis) increases in conjugated--liver specific disease

Question 32

perforation of duodenal ulcer

Answer 32

referred pain to the shoulder via phrenic nerve

Question 33

hemorrhage ulcer complication

Answer 33

posterior gastric/duodenal gastric ulcer on less curvature--- bleeding from less gastric artery posterior duodenum--bleeding from gastroduodenal artery

Question 34

newborn jaundice

Answer 34

underdeveloped livers are not capable of appropriately processing bilirubin, phototherapy, zz-ee

Question 35

severe newborn jaundice

Answer 35

mother Rh-, baby is Rh+. antibodies from mother cross the placental barrier and lyse RBCs of fetus. mother processes excess bilirubin for kid before birth RhoGAM to develop antibody to Rh antigen

Question 36

Meckel diverticulum

Answer 36

persistance of vitelline (omphalomesenteric) duct secretion of gastric mucosa and/or pancreatic tissue most common congenital anomaly of GI tract 2's 2 inches long 2 feel from ileocecal valce 2% of population first 2 years of life 2 types of epithelia painless rectal bleeding or melena most patients are aysmptomatic

Question 37

FAP

Answer 37

autosomal dominant of APC tumor suppressor on 5q 100% progress to CRC unless resection. wnt signal, take away apc complex (polyubinquinates B-catenin), now B-catenin is stable, b-catenin goes to nucleus, transcription factor made. latent signal

Question 38

Lynch syndrome

Answer 38

hereditary nonpolyposis colorectal cancer autosomal dominant mismatch repair genes--20x rate mutation, introduced during replication microsatellite instability proximal colon always involved endometrial, ovarian, and skin cancers, 3 relatives with lynch syndrome-associated cancers across 2 generaltions, 1 of whom is diagnoses before age 50. MLH1/MSH2

Question 39

hemochromatosis

Answer 39

chronic transfusion therapy increase ferritin, increase iron, decrease TIBC, increase transferrin saturation. HFE gene phlebotomy or chelation therapy

Question 40

Omphalocele

Answer 40

abdominal contents into umbilical cord (epithelium). sealed by peritoneum. has covering omphaloCELE--SEALed by peritoneum persistance of midgut herniation bowel and liver in amnion more associated abnromalities than gastroschesis