GI, Topnotch Flashcards by CM L

Vertebral level: Umbilicus

IVD of L3-L4

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Vertebral level: Subcostal plane

10th rib, L3

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Iliac tubercle

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Central regions of the anterior abdomen (3)

1) Epigastric 2) Periumbilical 3) Hypogastric/pelvic

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Lateral regions of the anterior abdomen

1) Hypochondriac 2) Lumbar 3) Inguinal

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Dermatomal level: Apex of supraclavicular fossa

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Dermatomal level: Acromioclavicular joint

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Dermatomal level: Radial side of antecubital fossa

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Dermatomal level: Dorsal surface of proximal phalanx of thumb

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Dermatomal level: Dorsal surface of proximal phalanx of middle finger

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Dermatomal level: Dorsal surface of proximal phalanx of little finger

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Dermatomal level: Ulnar side of antecubital fossa

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Dermatomal level: Apex of axilla

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Dermatomal level: Nipple/4th ICS MCL

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Dermatomal level: Midway between nipple and xiphisternum MCL

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Dermatomal level: Xiphisternum

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Dermatomal level: 1/4 between xiphisternum and umbilicus MCL

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Dermatomal level: 1/2 between xiphisternum and umbilicus, MCL

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Dermatomal level: Umbilicus MCL

T10

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Dermatomal level: Midpoint of inguinal ligament

T12

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Dermatomal level: Anteromedial thigh

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Dermatomal level: Medial femoral condyle

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Dermatomal level: Medial malleolus

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Dermatomal level: Dorsum of foot

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Dermatomal level: Lateral heel

Dermatomal level: Popliteal fossa

Dermatomal level: Ischial tuberosity

Dermatomal level: Perianal area 1 cm lateral to mucocutaneous junction

S4-5

Most superficial abdominal muscle

External oblique

External oblique: Direction of fibers

Obliquely downward and medially

Immediately deep to the external oblique

Internal onlique

Internal oblique: Direction of fibers

Obliquely upward and medially

Components of conjoint tendon

Aponeurotic fivers of 1) Internal oblique 2) Transversus abdominis

Muscle whose aponeurosis splits to form the rectus sheath

Internal oblique

Innermost abdominal muscle

Transversus abdominis

Muscle on either side of line alba

Rectus abdominis

Lateral borders of rectus abdominis

Linea semilunaris

Crescentic border on the posterior wall of the abdomen midway between the umbilicus and pubic crest

Arcuate line

Characteristic arrangement of fibers above arcuate line

Internal oblique aponeurosis splits to form rectus sheath (present posterior layer)

Characteristic arrangement of fibers below arcuate line

Internal oblique aponeurosis is superficial to the rectus sheath (absent posterior layer) and transversalis fascia is directly below the rectus abdominis muscle

Contents of rectus sheath (4)

1) Rectus abdominis 2) Pyramidalis 3) Superior and inferior epigastric vessels 4) Lower 5 intercostal and subcostal vessels and nerves

Boundaries of foramen of Winslow: Anterior

Hepatoduodenal ligament

Boundaries of foramen of Winslow: Posterior

IVC

Boundaries of foramen of Winslow: Superior

Caudate lobe of liver

Boundaries of foramen of Winslow: Inferior

Superior part of duodenum

Extensions of visceral peritoneum (3)

1) Mesentery 2) Ligaments 3) Omentum

Layers: Mesentery

Layers: Ligaments

Supports hollow viscous to body wall for neurovascular communication

Mesentery

Connects viscera to each other or to the body wall

Ligaments

Connects the stomach with other viscera

Omentum

Layers: Greater omentum

Abdominal policeman

Greater omentum

3 parts of greater omentum

1) Gastrophrenic 2) Gastrosplenic 3) Gastrocolic

Layers: Lesser omentum

Greater omentum connects

Greater curvature and proximal duodenum to transverse colon

Lesser omentum connects

Lesser curvature to fissure for ligamentum venosum and porta hepatic of liver

Hepatoduodenal ligament: Posterior

Portal vein

Hepatoduodenal ligament: Anterior to the right

CBD

Hepatoduodenal ligament: Anterior to the left

Hepatic artery

Inflammation of this layer of peritoneum causes rebound tenderness and guarding

Parietal peritoneum

Brough about by congestion of the venous drainage of the abdomen

Ascites

Paracentesis at the midline goes through these layers (7)

1) Skin 2) Superficial fascia 3) Deep fascia 4) Linea alba 5) Transversalis fascia 6) Extraperitoneal fat 7) Parietal peritoneum

Paracentesis lateral to the inferior epigastric artery and above the deep circumflex artery goes through these layers (7)

1) Skin 2) External oblique 3) Internal oblique 4) Transversus abdominis 5) Transversalis fascia 6) Extraperitoneal fat 7) Parietal peritoneum

Branches of the splenic artery (2)

1) Left gastroepiploic 2) Short gastric

Branches of the common hepatic artery (3)

1) Right gastric 2) Right and left hepatic 3) Gastroduodenal

Branches of the gastroduodenal artery (2)

1) Right gastroepiploic 2) Superior pancreaticoduodenal

Branches of the SMA (5)

1) Inferior pancreaticoduodenal 2) Middle colic 3) Right colic 4) Ileocolic 5) Jejunal-ileal

Branches of the IMA (3)

1) Left colic 2) Sigmoid 3) Superior rectal

Common site of aortic aneurysm

Just proximal to the bifurcation at L4

Occlusion of the celiac artery results in collateral circulation by way of anastomosis between

Pancreaticoduodenal and gastroduodenal arteries

Branch of celiac artery eroded: Penetrating ulcer of posterior wall of stomach

Splenic

Branch of celiac artery eroded: Lesser curvature of stomach

Left gastric

Posterior wall of 1st part of duodenum

Gastroduodenal

Erosion of celiac circulation may present as referred pain at

Shoulder

Tributaries of IVC (8)

1) Right and left hepatic 2) Right suprarenal 3) Right gonadal 4) Right and left renal 5) Inferior phrenic 6) Lumbar 7) Right and left common iliac 8) Median sacral

May be compressed by aneurysm of SMA causing renal and adrenal htn

Left renal vein

Tributaries of portal venous circulation

1) Superior mesenteric 2) Inferior mesenteric 3) Splenic 4) Left gastric 5) Paraumbilical

Length of esophagus

25 cm

Esophagus: Enters the stomach at

Cardia

Continuous above with laryngeal part of pharynx at the level of

Passes through diaphragm at the level of

T10

Structures through diaphragm: T8

IVC and right phrenic via Caval hiatus

Structures through diaphragm: T10

Esophagus and vagus via esophageal hiatus

Structures through diaphragm: T12

Aorta, thoracic duct, and azygos vein via aortic hiatus

Esophageal constrictions

1) Upper/Pharyngoesophageal 2) Middle/Thoracic 3) Inferior/Diaphragmatic

Upper esophageal constriction is caused by

Cricopharyngeus muscle

Middle esophageal constriction is caused by

Aortic arch and left main bronchus

Inferior esophageal constriction is caused by

Esophageal hiatus

T/F Esophageal constrictions are common sites of carcinoma

Relations of the esophagus in the neck: Anterior (2)

1) Trachea 2) Recurrent laryngeal nerves

Relations of the esophagus in the neck: Posterior (2)

1) Prevertebral layer of deep cervical fascia 2) Vertebral column

Relations of the esophagus in the neck: Lateral

Thyroid gland

Relations of the esophagus in the thorax: Anterior (4)

1) Trachea 2) Left recurrent laryngeal nerve 3) Left main bronchus 4) Pericardium

Relations of the esophagus in the thorax: Posterior (5)

1) Bodies of thoracic vertebrae 2) Thoracic duct 3) Azygos vein 4) Right posterior intercostal artery 5) Descending thoracic aorta

Relations of the esophagus in the thorax: Right (2)

1) Mediastinal pleura 2) Azygos vein

Relations of the esophagus in the thorax: Left (4)

1) Left subclavian 2) Aortic arch 3) Thoracic duct 4) Mediastinal pleura

Relations of the esophagus in the abdomen: Anterior

Posterior surface of left lobe of liver

Relations of the esophagus in the abdomen: Posterior

Left crus of diaphragm

Arterial supply to the esophagus: Upper 3rd

Inferior thyroid artery from subclavian

Arterial supply to the esophagus: Middle 3rd

Descending thoracic aorta

Arterial supply to the esophagus: Lower 3rd

Left gastric artery from celiac trunk

Venous drainage of the esophagus: Upper 3rd

Inferior thyroid vein

Venous drainage of the esophagus: Middle 3rd

Azygos vein

Venous drainage of the esophagus: Lower 3rd

Left gastric vein

Lymphatic drainage of esophagus: Upper 3rd

Deep cervical

Lymphatic drainage of esophagus: Middle 3rd

Superior and inferior mediastinal

Lymphatic drainage of esophagus: Lower 3rd

Celiac

Management for oesophageal haemorrhage from varicose by balloon insertion

Sengstaken-Blakemore Balloon Insertion

Average distance between external nasal orifices and stomach

44 cm

Capacity of stomach

1.5 L

Part of esophagus near the GEJ

Cardia

Part of esophagus that is dilated superiorly

Fundus

Part of esophagus between the fundus and pylorus (major part)

Body

Distal part of stomach

Pylorus

Sharp indentation of the stomach that approximates the junction of the body and pylorus

Angular incisura/notch

Concave border of stomach

Lesser curvature

Convex border of stomach

Greater curvature

Level of the cardiac orifice of stomach

6th left costal cartilage 2-4 cm from median plane at the level of T10 or T11

Level of the fundus of stomach

5th left rib, MCL

Level of the greater curvature of stomach

Up to 10th costal cartilage

Level of the pyloric antrum of stomach

9th costal cartilage or at L1 approximately 1.25 cm from midline

Level of the pyloric canal of stomach

Right side, L2-L4

Layer that hypertrophies in hypertrophic pyloric stenosis

Muscularis externa

Anterior relations of stomach (3)

1) Diaphragm 2) Left lobe of liver 3) Anterior abdominal wall

Posterior relations of stomach (2)

1) Omental bursa 2) Pancreas

On which the stomach rests when a person is lying supine

Stomach bed

Forms the stomach bed

Structures forming the posterior wall of the omental bursa

Structures forming the posterior wall of the omental bursa (6)

1) Left dome of diaphragm 2) Spleen 3) Left kidney and adrenal gland 4) Splenic artery 5) Pancreas 6) Transverse mesocolon and colon

Blood supply of stomach: Lesser curvature

Right and left gastric arteries

Blood supply of stomach: Greater curvature

Right and left gastroepiploic arteries

Blood supply of stomach: Fundus

Short gastric artery

Largest branch of the celiac trunk

Splenic artery

Largest arterial supply to the stomach and smallest branch of the celiac trunk

Left gastric artery

Venous drainage of stomach: Right and left gastric

Portal vein

Venous drainage of stomach: Left gastroepiploic and short gastric

Splenic vein to the portal vein

Venous drainage of stomach: Right gastroepiploic

Superior mesenteric to portal vein

PSY supply to the stomach (2)

1) Anterior vagal trunk from left vagus 2) Posterior vagal trunk from right vagus

PSY supply to stomach

T6-T9

Most gastric ulcers occur at

Lesser curvature, directly above the incisura

Carcinomas of the stomach are mostly found in

Distal 3rd

Distance from nasal orifices: Proximal esophageal narrowing

18 cm

Distance from nasal orifices: Middle esophageal narrowing

28 cm

Distance from nasal orifices: Distal esophageal narrowing

44 cm

Length of duodenum

25 cm

Duodenojejunal junction is seen at what level

Parts of duodenum

1) Superior 2) Descending 3) Horizontal 4) Ascending

Length of part of duodenum: Superior

5 cm

Length of part of duodenum: Descending

7-10 cm

Length of part of duodenum: Horizontal

6-8cm

Length of part of duodenum: Ascending

5 cm

Level of part of duodenum: Superior

Level of part of duodenum: Descending

L1-3

Level of part of duodenum: Horizontal

Level of part of duodenum: Ascending

L3-2

Blood supply of duodenum: Superior part

Superior pancreaticoduodenal

Blood supply of duodenum: Inferior part

Inferior pancreaticoduodenal

Venous drainage of duodenum: Superior part

Superior pancreaticoduodenal to portal

Venous drainage of duodenum: Inferior part

Inferior pancreaticoduodenal to superior mesenteric

Duodenal ulcers most often occur at: Anterior vs posterior wall

Perforation of ulcers most often occur at: Anterior vs posterior wall

Blood type with increased risk of gastric ulcer

Blood type with increased risk of duodenal ulcer

Most commonly eroded artery in gastric ulcer perforation

Left gastric artery

Most commonly eroded artery in duodenal ulcer perforation

Gastroduodenal

Jejunoileal segment: Jejunal part

Proximal 2/5

Jejunoileal segment: Ileal part

Distal 3/5

Jejunoileal segment: Length

6-7 m

Quadrant: Jejunum

LUQ

Quadrant: Ileum

RLQ

Jejunum: Color

Deep red

Jejunum: Caliber

2-4 cm

Jejunum: Wall

Thick & heavy

Jejunum: Vascularity

Greater

Jejunum: Vasa rect

Long

Jejunum: Arcades

Few, large

Jejunum: Fat

Less

Jejunum: Plicae circularis

Large, tall

Jejunum: Lymphoid nodules

Few

Ileum: Color

Paler pink

Ileum: Caliber

2-3 cm

Ileum: Wall

Thin and light

Ileum: Vascularity

Less

Ileum: Vasa recta

Short

Ileum: Arcades

Many

Ileum: Fat

Ileum: Plicae circulares

Low, sparse, absent in distal segment

Ileum: Lymphoid nodules

Many

Instussuceptus vs intussucipiens: Proximal segment that invaginates

Instussuceptus

Instussuceptus vs intussucipiens: Distal segment that receives invaginating segment

Intussucipiens

Intussusception: Most common

Ileocecal

Intussusception: More common, children vs adult

Children

Intussusception: Signs of obstruction

1) Right-sided colicky abdominal pain 2) Abdominal distention 3) Hematochezia

Pancreas: Anterior, R to L

1) Transverse mesocolon 2) Lesser sac 3) Stomach

Pancreas: Posterior, R to L

1) Bile duct 2) Portal and splenic veins 3) IVC 4) Aorta 5) SMA 6) Left psoas 7) Left suprarenal 8) Left kidney 9) Spleen

Pancreas: Parts

1) Head 2) Neck 3) Body 4) Tail 5) Uncinate process

Pancreas: Part that overlies superior mesenteric vessels

Neck

Pancreas: Part that lies to the left of the SMA and SMV

Body

Pancreas: Part that is closely related to the hilum of the spleen and left colic flexure

Tail

Pancreas: Uncinate process projects from

Inferior part of the head

Pancreas: Uncinate process extends medially to the left, posterior to the

SMA

Main vs accessory pancreatic duct: Extends the length of the pancreas

Main

Main vs accessory pancreatic duct: Enters the duodenum

Both

Main vs accessory pancreatic duct: Joins the bile duct

Main

Main pancreatic duct joins the bile duct to form the

Hepatopancreatic ampulla

Accessory pancreatic duct lies in the

Head

Pancreas: Blood supply (3)

1) Superior pancreaticoduodenal from gastroduodenal 2) Inferior pancreaticoduodenal from SMA 3) Pancreatic arteries from splenic

Pancreatectomy: With splenic artery ligation

Warshaw technique

Pancreas: Venous drainage

Mainly into splenic vein

Most common cause of extrahepatic obstruction of biliary system

Pancreatic CA

Pancreas: Cancer of body and neck may cause obstruction of (2)

1) Portal circulation 2) IVC

Liver: Structures located posteriorly (8)

1) Diaphragm 2) Right kidney 3) Hepatic flexure of colon 4) Duodenum 5) GB 6) IVC 7) Esophagus 8) Fundus of stomach

Liver: Covered by peritoneum except at

Posteriorly, called bare area

Ligamentum teres hepatis is located between what structures

1) Left lobe 2) Quadrate lobe

Ligamentum venosum is located between

1) Left lobe 2) Caudate lobe

Liver: Anatomical lobes

1) Left 2) Right

Liver: Right lobe is divided into

Caudate and quadrate lobes

Liver: Segments

1) Medial superior I 2) Lateral superior II 3) Lateral inferior III 4) Medial inferior IV 5) Anterior inferior V 6) Posterior inferior VI 7) Posterior superior VII 8) Anterior superior VIII

Liver: Apices of cross-sections of portal lobules

Central vein

Liver: Centers of cross-sections of portal lobules

Portal triad

Portal vein is formed by union of

1) Superior mesenteric vein 2) Splenic vein

Liver: % blood supplied by portal vein

70%

Liver: Biopsy is usually done at

Right 10th ICS MAL

Gallbladder: Lies at which surface of the liver

Inferior

Gallbladder: Capacity

30-50 mL

Gallbladder: Posterior relations

1) Transverse colon 2) 1st and 2nd parts of duodenum

Gallbladder: Cystohepatic triangle

Triangle of Calot

Triangle of Calot: Boundaries

1) Superior - Liver 2) Inferior - Cystic duct 3) Medial - Common hepatic duct

Triangle of Calot: Content

Cystic artery

Cystic artery is USUALLY a branch of

Right hepatic artery

Common site of impacted gallstone

Hepatopancreatic ampulla

Impacted gallstone at hepatopancreatic ampulla: Referred pain

Epigastric region

Stone blocking the cystic duct: Characteristic pain

Biliary colic

Describe biliary colic

Begins in the epigastric region but moves to a point where 9th costal cartilage intersects the lateral border of the rectus sheath

Dermatomes of referred pain of GIT

T5-L1

Valve of Houston is associated with what organ

Rectum

GI, Topnotch Flashcards

(236 cards)