GI, USMLE Flashcards
(244 cards)
1
Q
Derivatives of foregut
A
Pharynx to duodenum
2
Q
Derivatives of midgut
A
Duodenum to proximal 2/3 of transverse colon
3
Q
Derivatives of hindgut
A
Distal 1/3 of transverse colon to rectum
4
Q
Developmental defects: Failure of rostral fold closure
A
Sternal defects
5
Q
Developmental defects: Failure of lateral wall closure
A
1) Omphalocele 2) Gastroschisis
6
Q
Developmental defects: Failure of caudal fold closure
A
Bladder extrophy
7
Q
Developmental defects: Failure to recanalize
A
Duodenal atresia
8
Q
Developmental defects: Duodenal atresia is seen in what genetic disorder
A
Trisomy 21
9
Q
Developmental defects: Due to vascular accident
A
Jejunal, ileal, and colonic atresia
10
Q
Developmental defects: Jejunal, ileal, and colic atresia is aka
A
Apple peel atresia
11
Q
Midgut development: Herniates through umbilical ring at
A
6th week
12
Q
Midgut development: Returns to abdominal cavity and rotates around SMA at
A
10th week
13
Q
Developmental defect: Extrusion of abdominal contents through abdominal folds, not covered by peritoneum
A
Gastroschisis
14
Q
Developmental defect: Persistence of herniation of abdominal contents into umbilical cord, covered by peritoneum
A
Omphalocele
15
Q
Gastroschisis: Constant size
A
Less than or equal to 5cm
16
Q
Derivatives of midgut
A
Duodenum to transverse colon
17
Q
Tracheoesophageal anomalies: Most common
A
EA with distal TEF
18
Q
Gastroschisis: Constant location
A
Right of the umbilical cord
19
Q
Retroperitoneal structures
A
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
Q
Pentalogy of Cantrell
A
1) Epigastric omphalocele 2) Cleft sternum 3) Anterior diaphragmatic hernia (Morgagni) 4) Absent pericardium 5) Cardiac defects (ectopia cordis/VSD)
21
Q
Tracheoesophageal anomalies: Most common
A
EA with distal TEF
22
Q
Tracheoesophageal anomalies: EA with distal TEF, signs
A
1) Drooling with first feeding 2) Cyanosis secondary to laryngospasm 3) Abdominal gas
23
Q
Tracheoesophageal anomalies: EA with distal TEF, clinical test
A
Failure to pass NGT into stomach
24
Q
Palpable olive in epigastric region
A
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
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
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
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
243
Largest branch of the splenic artery
Left gastroepiploic artery
244
Largest branch of the celiac trunk
Splenic artery
