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Flashcards in GI, USMLE Deck (244):
1

Derivatives of foregut

Pharynx to duodenum

2

Derivatives of midgut

Duodenum to proximal 2/3 of transverse colon

3

Derivatives of hindgut

Distal 1/3 of transverse colon to rectum

4

Developmental defects: Failure of rostral fold closure

Sternal defects

5

Developmental defects: Failure of lateral wall closure

1) Omphalocele 2) Gastroschisis

6

Developmental defects: Failure of caudal fold closure

Bladder extrophy

7

Developmental defects: Failure to recanalize

Duodenal atresia

8

Developmental defects: Duodenal atresia is seen in what genetic disorder

Trisomy 21

9

Developmental defects: Due to vascular accident

Jejunal, ileal, and colonic atresia

10

Developmental defects: Jejunal, ileal, and colic atresia is aka

Apple peel atresia

11

Midgut development: Herniates through umbilical ring at

6th week

12

Midgut development: Returns to abdominal cavity and rotates around SMA at

10th week

13

Developmental defect: Extrusion of abdominal contents through abdominal folds, not covered by peritoneum

Gastroschisis

14

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

Omphalocele

15

Gastroschisis: Constant size

Less than or equal to 5cm

16

Derivatives of midgut

Duodenum to transverse colon

17

Tracheoesophageal anomalies: Most common

EA with distal TEF

18

Gastroschisis: Constant location

Right of the umbilical cord

19

Retroperitoneal structures

SAD PUCKER 1) Suprarenal gland 2) Aorta and IVC 3) Duodenum (2nd, 3rd, and 4th parts) 4) Pancreas (except tail) 5) Ureters 6) Colon (ascending and descending) 7) Kidneys 8) Esophagus (lower 2/3) 9) Rectum (upper 2/3)

20

Pentalogy of Cantrell

1) Epigastric omphalocele 2) Cleft sternum 3) Anterior diaphragmatic hernia (Morgagni) 4) Absent pericardium 5) Cardiac defects (ectopia cordis/VSD)

21

Tracheoesophageal anomalies: Most common

EA with distal TEF

22

Tracheoesophageal anomalies: EA with distal TEF, signs

1) Drooling with first feeding 2) Cyanosis secondary to laryngospasm 3) Abdominal gas

23

Tracheoesophageal anomalies: EA with distal TEF, clinical test

Failure to pass NGT into stomach

24

Palpable olive in epigastric region

Hypertrophic pyloric stenosis

25

Hypertrophic pyloric stenosis: Characteristics of vomitus

Non-bilous, projectile, at 2 weeks of age

26

Hypertrophic pyloric stenosis: Treatment

Surgical incision

27

Pancreas: Derived from

Foregut

28

Ligaments: Gastrocolic ligament connects

Greater curvature of stomach and transverse colon

29

Pancreas: Ventral pancreatic bud abnormally encircles 2nd part of duodenum and may cause duodenal narrowing

Annular pancreas

30

Pancreas: Ventral and dorsal parts fail to fuse at 8 weeks

Pancreas divisum

31

Spleen: Derived from

Mesoderm

32

Blood supply: Foregut

Celiac artery

33

Blood supply: Midgut

SMA

34

Blood supply: Hindgut

IMA

35

Ligaments: Connects liver to anterior abdominal wall

Falciform ligament

36

Ligaments: Falciform ligament, content

Ligamentum teres hepatis

37

Ligaments: Connects liver to duodenum

Hepatoduodenal ligament

38

Ligaments: Hepatoduodenal ligament, contents

Portal triad

39

Portal triad

1) Portal vein 2) Hepatic artery 3) Common bile duct

40

Ligaments: Hepatoduodenal ligament, compressed between thumb and index finger in the omental foramen to stop bleeding

Pringle maneuver

41

Ligaments: Liver to lesser curvature of stomach

Gastrohepatic ligament

42

Ligaments: Gastrocolic ligament connects

Greater curvature of stomach and transverse colon

43

Ligaments: Gastrocolic ligament, content

Gastroepiploic arteries

44

Ligaments: Gastrosplenic ligament connects

Greater curvature of stomach and spleen

45

Ligaments: Gastrosplenic ligament, content

1) Short gastrics 2) Left gastroepiploic vessels

46

Ligaments: Spleen to posterior abdominal wall

Splenorenal ligament

47

Ligaments: Splenorenal ligament, contents

1) Splenic artery and vein 2) Tail of pancreas

48

Derivatives of ventral pancreatic bud

1) Head 2) Main pancreatic duct 3) Uncinate process

49

Layers of gut wall: Erosion extends up to

Mucosa

50

Layers of gut wall: Ulcer extends up to

Submucosa

51

Frequency of slow waves: Duodenum

12/min

52

Frequency of slow waves: Ileum

8-9/min

53

Histology: Esophagus

Nonkeratinizing stratified squamous epithelium

54

Histology: Stomach

Gastric glands

55

Histology: Duodenum

Villi and microvilli

56

Histology: Location of Brunner's glands

Submucosa of duodenum

57

Histology: Location of crypts of Leiberkuhn

1) Duodenum 2) Jejunum 3) Ileum

58

Histology: Plica circulares

1) Jejunum 2) Proximal ileum

59

Histology: Peyer's patches

Lamina propria and submucosa of ileum

60

Histology: Contains largest number of goblet cells in the INTESTINE

Ileum

61

Histology: Colon

1) Crypts without villi 2) Goblet cells

62

Branches of abdominal aorta in order downwards (10)

1) Inferior phrenic artery 2) Celiac trunk 3) Left middle suprarenal artery 4) SMA 5) Right and left renal arteries 6) Left testicular/ovarian artery 7) Right testicular/ovarian artery 8) IMA 9) Bifurcation: Left and right common iliac 10) Median sacral artery

63

Transverse portion of duodenum (3rd part) is entrapped between SMA and aorta causing intestinal obstruction

SMA syndrome

64

Vertebral levels: Celiac trunk

T12

65

Vertebral levels: SMA

L1

66

Vertebral levels: Left renal artery

L1

67

Vertebral levels: IMA

L3

68

Vertebral levels: Bifurcation of abdominal aorta

L4

69

Watershed region

Splenic flexure

70

Main blood supply of stomach

Celiac trunk

71

Branches of celiac trunk

1) Common hepatic 2) Splenic 3) Left gastric

72

Sites of portosystemic anastomoses

1) Esophagus 2) Umbilicus 3) Rectum

73

Clinical signs of portal hypertension based on anastomoses

1) Esophageal varices 2) Caput medusae 3) Internal hemorrhoids

74

Portal-systemic: Esophagus

Left gastric-esophageal

75

Portal-systemic: Umbilicus

Paraumbilical-superficial and inferior epigastric, superior epigastric, lateral thoracic

76

Portal-systemic: Rectum

Superior rectal-middle and inferior rectal

77

Portal hypertension, management: Shunts blood to systemic circulation

TIPS

78

Hindgut: Derived from

Endoderm

79

Where endoderm and ectoderm meet

Pectinate/dentate line

80

Above pectinate line: Internal vs external hemorhhoids

Internal

81

Above pectinate line: Arterial supply

Superior rectal from IMA

82

Above pectinate line: Venous drainage

Superior rectal- Inferior mesenteric - Portal system

83

Above pectinate line: Lymphatic drainage

Deep nodes

84

Above pectinate line: Carcinoma

Adenocarcinoma

85

Below pectinate line: Internal vs external hemorrhoids

External

86

Below pectinate line: Carcinoma

Squamous cell carcinoma

87

Below pectinate line: Arterial supply

Inferior rectal from internal pudendal

88

Below pectinate line: Venous drainage

Inferior rectal-internal pudendal-internal iliac-IVC

89

Below pectinate line: Lympatic drainage

Superificial inguinal nodes

90

Innervation: Internal hemorrhoids

Visceral

91

Innervation: External hemorrhoids

Somatic

92

Apical surface of hepatocytes face

Bile cannaliculi

93

Basolateral surface of canaliculi face

Sinusoids

94

Liver: Sinusoids drain into

Central vein

95

Liver: Central vein drains into

Hepatic veins-systemic circulation

96

Liver: Zones

1) I, periportal 2) II, intermediate 3) III, pericentral vein or centrilobular

97

Liver: Blood flow through zones

I-II-III

98

Liver: Bile flow through zones

III-II-I

99

Liver zone: Affected first by ischemia

Zone III

100

Liver zone: Contains P450 system

Zone III

101

Liver zone: Most sensitive to toxic injury

Zone III

102

Liver zone: Site of alcohol hepatitis

Zone III

103

Biliary structures: Common hepatic duct is formed by

Right and left hepatic ducts

104

Biliary structures: Cystic duct branches from

Common hepatic duct

105

Biliary structures: Common bile duct is formed by

Cystic duct and common hepatic duct

106

Biliary structures: Common bile duct and pancreatic duct have a common opening called

Ampulla of Vater

107

Diaphragmatic hernia: Most common

Hiatal (through the oesophageal hiatus)

108

Diaphragmatic hernia: Most common hiatal hernia

Sliding hiatal hernia

109

Diaphragmatic hernia: Stomach in sliding hiatal hernia

Hourglass stomach

110

Diaphragmatic hernia: Displaced upward in sliding hiatal hernia

GE junction

111

Diaphragmatic hernia: Displaced upward in paraesophageal hernia

Fundus of stomach

112

3 layers of spermatic fascia

1) External spermatic fascia 2) Cremasteric muscle 3) Internal spermatic fascia

113

Indirect inguinal hernia: Protrudes through

1) Internal inguinal ring 2) External inguinal ring

114

Indirect inguinal hernia: Lateral vs medial to the inferior epigastric artery

Lateral

115

Indirect inguinal hernia: Defect

Failure of obliteration of processus vaginalis

116

Indirect inguinal hernia: Male vs female

Male

117

Indirect inguinal hernia: Sac covering

All 3 layers of spermatic fascia

118

Direct inguinal hernia: Protrudes through

1) Hesselbach's (inguinal) triangle in the abdominal wall 2) External inguinal ring

119

Direct inguinal hernia: Sac covering

External spermatic fascia

120

Direct inguinal hernia: Population

Older men

121

Direct inguinal hernia: Lateral vs medial to the inferior epigastric artery

Medial

122

Where common iliac veins come together to form IVC

L4-L5

123

Where lymph nodules are located in the GIT wall

Lamina propria of mucosa

124

GI Histology: Mucosal epithelium

Simple cuboidal/columnar

125

GI Histology: Lamina propria

Blood and lymphatic vessels

126

GI Histology: Muscularis mucosa

Inner circular, outer longitudinal

127

GI Histology: Submucosa

Blood vessels, lymphatics, connective tissue, Meissner plexus

128

GI Histology: Serosa

Connective tissue

129

GI Histology: Esophagus, muscularis mucosa

LONGITUDINAL smooth muscle

130

GI Histology: Esophagus, muscularis externa

1) Upper 3rd: Striated 2) Middle 3rd: Striated + smooth 3) Lower 3rd: Smooth

131

GI Histology: SI mucosa

1) Villi and microvilli (brush border) 2) Mucus-secreting goblet cells 3) Absorptive enterocytes

132

GI Histology: Frequency of villi and microvilli in SI (greatest to least)

Duodenum > jejunum > ileum

133

GI Histology: SI (duodenum, jejunum, ileum) and LI mucosal glands

Crypts of Leiberkuhn

134

GI Histology: Duodenal submucosa

Brunner glands

135

Brunner glands secrete

Alkaline secretion (HCO3)

136

Atrophy vs hypertrophy of Brunner glands: PUD

Hypertrophy

137

GI Histology: Plicae circulares are found

Submucosa of jejunum and ileum

138

GI Histology: Aggregates of nodules of UNENCAPSULATED lymphatic tissue

Peyer's patches

139

GI Histology: Where Peyer's patches are found

Ileal lamina propria and submucosa

140

GI Histology: Cells that overlie Peyer's patches

M cells

141

GI Histology: M cells, function

APCs

142

GI Histology: Colonic mucosa

Smooth, devoid of villi

143

GI Histology: Muscularis externa of colon

3 longitudinally oriented bundles, taenia coli

144

GI ligaments

A image thumb
145

Ligamentum teres hepatis is an embryological remnant of

Left umbilical vein

146

A fold of peritoneum extending from stomach to adjacent abdominal organs

Omentum

147

Double layer of peritoneum extending from liver to lesser curvature of stomach and proximal part of duodenum

Lesser omentum

148

Lesser omentum consists of (2)

1) Hepatogastric ligament 2) Hepatoduodenal ligament

149

Connects liver to lesser curvature of stomach

Hepatogastric ligament

150

Hepatogastric ligament, content

Left and right gastric arteries

151

Hepatogastric ligament, separates what 2 structures

Right greater and lesser sacs

152

Structure that may be cut during surgery to access the lesser sac

Hepatogastric ligament

153

Hepatoduodenal ligament, content

Porta hepatis

154

Porta hepatis consists of

1) Portal vein 2) Hepatic artery 3) CBD

155

Lesser sac communicates with greater sac through

Epiploic foramen of Winslow

156

Epiploic foramen of Winslow is located where

Posterior to the free edge of the lesser momentum (hepatoduodenal ligament)

157

A temporary cross-clamping of hepatoduodenal ligament containing portal triad at epiploic foramen (of Winslow) for control of hepatic bleeding during liver surgery or donor hepatectomy for living liver transplantation

Pringle maneuver

158

Where index finger is passed for Pringle maneuver

From the greater sac, through the epiploic foramen, and into the lesser sac

159

Structure compressed in the Pringle maneuver

Hepatic artery

160

A quadruple layer of peritoneum that hangs down like an apron from the greater curvature of the stomach and proximal part of the duodenum

Greater omentum

161

Greater momentum consists of

1) Gastrosplenic 2) Splenorenal 3) Gastrocolic ligaments

162

Connects greater curvature of the stomach to the spleen

Gastrosplenic ligament

163

Gastrosplenic ligament, separates what 2 structures

Left greater and lesser sacs

164

Connects the spleen to the posterior abdominal wall

Splenorenal ligament

165

Splenorenal ligament, runs between what 2 structures

1) Hilum of spleen 2) Left kidney

166

Gastrocolic ligament, contents

Left and right gastroepiploic arteries

167

Liver histology

A image thumb
168

Portal vein supplies ___% of liver blood supply

75

169

T/F Portal vein carries deoxygenated blood

T

170

Central veins empty into

Sublobular veins

171

Sublobular veins of the liver converge to form

Hepatic veins

172

Pores of liver sinusoids are __nm in diameter

100-200

173

T/F A basement membrane lies between vascular endothelium and underlying hepatocytes

F

174

Lies between basal surfaces of hepatocytes and basal surface of endothelial cells

Space of Disse

175

Site of exchange of materials between blood and hepatocytes

Space of Disse

176

Functional unit of hepatic parenchyma

Liver acinus

177

First liver cells affected by viral hepatitis

Cells in zone 1 (periportal)

178

Liver zone that contains CY450 enzyme system

Zone III

179

First liver cells affected by ischemia

Cells in zone III

180

First liver cells affected by alcoholic hepatitis

Cells in zone III

181

Liver cells most sensitive to toxic injury

Zone III cells

182

Anal canal is divided into

1) Upper 2/3, visceral 2) Lower 1/3, somatic

183

Anal canal: Upper 2/3 is derived from

Endoderm (hindgut)

184

Anal canal: Lower 1/3 is derived from

Ectoderm (proctodeum)

185

Anal canal: Location of pectinate line

Inferior limit of anal valves

186

Anal canal, upper 2/3: Epithelial lining

Simple columnar

187

Anal canal, upper 2/3: Lymphatic drainage

Internal iliac LN

188

Anal canal, lower 1/3: Lining epithelium

Stratified squamous

189

Anal canal, lower 1/3: Venous drainage

Inferior rectal vein > internal pudendal vein > IVC

190

Anal canal, lower 1/3: Innervation

Inferior rectal from pudendal nerve

191

Femoral sheath: ___cm deep to the inguinal ligament

3-4

192

Femoral sheath: Contents

1) Femoral artery 2) Femoral vein 3) Femoral canal

193

T/F Femoral canal encloses the femoral nerve

F

194

Femoral sheath: Lateral compartment

Femoral artery

195

Femoral sheath: Intermediate compartment

Femoral vein

196

Femoral sheath: Medial compartment

Femoral canal

197

Femoral canal: Contents

1) Loose CT 2) Fat 3) Lymphatics 4) Deep inguinal LN of Cloquet

198

Base of femoral canal

Femoral ring (superior end)

199

Femoral triangle, boundaries: Superior

Inguinal ligament

200

Femoral triangle, boundaries: Lateral

Sartorius

201

Femoral triangle, boundaries: Medial

Adductor longus

202

Femoral triangle, boundaries: Floor (3)

PIA 1) Pectineus 2) Iliopsoas 3) Adductor longus

203

Femoral triangle, boundaries: Roof

1) Fascia lata 2) Cribriform fascia

204

Femoral triangle: Contents (Lateral to medial)

NAVeL 1) Femoral nerve 2) Artery 3) Vein 4) Empty 5) Lymphatics

205

Internal inguinal ring: Lies in

Transversalis fascia

206

Internal inguinal ring: Relation to inferior epigastric vessels

Lateral

207

External inguinal ring: Shape

Triangular

208

External inguinal ring: Lies in

External oblique aponeurosis

209

External inguinal ring: Relation to inferior epigastric vessels

Medial

210

External inguinal ring: Lies lateral to

Pubic tubercle

211

Inguinal canal, boundaries: Anterior wall

External and internal oblique aponeuroses

212

Inguinal canal, boundaries: Posterior wall

Transversus abdominis and transversalis fascia aponeuroses

213

Inguinal canal, boundaries: Roof

Internal oblique and transversus abdominis

214

Inguinal canal, boundaries: Floor

Inguinal and lacunar ligament

215

Inguinal canal: Contents in males

FANO x 3 1) Fascia: internal spermatic, cremasteric, external spermatic 2) Arteries: Testicular, artery to vas deferens, artery to cremaster 3) Nerves: Ilioinguinal, genital branch of genitofemoral, autonomics 4) Others: Vas deferens, pampiniform plexus, testicular lymphatics

216

Inguinal canal: Contents in females

1) Ilioinguinal nerve 2) Round ligament of uterus

217

Vertebral level: Gonadal artery

L2 (left higher than right)

218

Branches of SMA (3)

1) Inferior pancreaticoduodenal 2) Middle colic 3) Right colic

219

Inferior pancreaticoduodenal artery supplies

1) Distal duodenum 2) Head of pancreas

220

Middle colic artery supplies

Proximal 2/3 of transverse colon

221

Right colic artery supplies

Ascending colon

222

Branches of IMA (3)

1) Left colic 2) Sigmoid 3) Superior rectal

223

Left colic artery supplies

1) Distal 1/3 of transverse colon 2) Descending colon

224

Sigmoid artery supplies

1) Descending colon 2) Sigmoid colon

225

Superior rectal artery supplies

Superior 2/3 of rectum

226

Renal arteries supply

1) Kidneys 2) Adrenal glands

227

Vessel that accompanies vas deferens

Testicular artery

228

Ovarian artery enters what ligament

Suspensory ligament of the ovary

229

Innervation: Foregut

Vagus

230

Innervation: Midgut

Vagus

231

Innervation: Hindgut

Pelvic

232

Arterial anastomoses that compensate for abdominal aorta blockage

1) Superior epigastric from internal thoracic from subclavian AND Inferior epigastric from external iliac 2) Superior pancreaticoduodenal (celiac trunk) and inferior pancreaticoduodenal (SMA) 3) Superior rectal (IMA) and middle rectal artery (internal iliac)

233

Celiac trunk

A image thumb
234

Left gastroepiploic artery is a branch of

Splenic

235

Right gastroepiploic artery is a branch of

Gastroduodenal

236

Right gastric artery is a branch of

Hepatic artery

237

Portosystemic anastomoses: Anastomose at esophagus

Left gastric (esophageal branch) and esophageal (branch of azygos) veins

238

Portosystemic anastomoses: Anastomose at the umbilicus

Paraumbilical and superficial & inferior epigastric

239

Portosystemic anastomoses: Anastomose at the rectum

Superior rectal and middle & inferior rectal

240

Innervation of Meissner's plexus

PSY and SY

241

Innervation of Auerbach's plexus

PSY and SY

242

Biliary structures

A image thumb
243

Largest branch of the splenic artery

Left gastroepiploic artery

244

Largest branch of the celiac trunk

Splenic artery