GIT Flashcards
(155 cards)
1
Q
on abd CT, what structures are very dark/black
A
air/air filled structures
ex: antrum of stomach, hepatic/splenic flexures of colon
2
Q
black on abd CT indicates
A
hypodense area
3
Q
on abd CT, what appears dark grey
A
fat
4
Q
on an abd CT, what appears mid-grey
A
water
5
Q
mid-grey on abd CT indicates
A
isodense
6
Q
on abd CT organs and muscle appear
A
somewhat bright
7
Q
on abd CT, bones and vessels appear
A
very bright
8
Q
very bright on CT indicates
A
hyperdense
9
Q
when you use contrast on abd CT, what changes occur in bv density
A
they become more dense → get lighter
as time goes on → less bright as contrast disseminates into tissues/organs
10
Q
significance of ligament of treitz (4)
A
transition from foregut to midgut → blood supply from celiac to superior mesenteric
separates upper GI from lower GI bleed
anchors duodenum
superior retention band → allows for embryological rotation
11
Q
if LOT is displaced, think
A
malrotation/volvulus
12
Q
ligament of treitz extends from ___
to __
A
diaphragm
duodenojejunal flexure
13
Q
inguinal ligament spans from the __
to the __
A
ASIS
pubic tubercle
14
Q
inguinal ligament anchors the __
to the __
A
external oblique
pelvis
15
Q
protection fxn of inguinal ligament
A
protects structures as they pass from pelvic cavity into thigh and inguinal canal
16
Q
structures related to inguinal ligament
A
external oblique
iliopsoas
pectineus
NAVEL
lateral cutaneous n
lymphatics
17
Q
what structures pass thru the inguinal canal in males (2)
A
spermatic cord
genitofemoral n
18
Q
what structures pass through the inguinal canal in females
A
round ligament of uterus
ilioinguinal n
genitofemoral n
19
Q
the inguinal canal runs obliquely between the __
A
inguinal rings
20
Q
what structures pass under the inguinal canal
A
NAVEL
iliopsoas
iliacus
psoas major
femoral branch of genitofemoral n
lateral cutaneous n
21
Q
hernias associated w. inguinal ligament
A
inguinal hernia
femoral hernia
22
Q
bulge above inguinal ligament
A
inguinal hernia
23
Q
weakness in anterior abd wall 2/2 to gubernaculum and descent of the testes around the ligament → protrusion of intestines thru inguinal ligament
A
inguinal hernia
24
Q
bulge below inguinal ligament
A
femoral hernia
25
*usually* caused congenital birth defect in abd wall
indirect inguinalhernia
26
usually caused by weakness in muscles of abd wall that develops over time or dt straining/heavy lifting
direct inguinal hernia
27
protusion medially into inferior epigastric vessels w.in hesselbach's plexus
direct hernia
28
what is hesselbach's triangle
region of lowe, anterior abd wall or groin
29
inferior border of hesselbach's triangle
inguinal ligament
30
lateral border of hesselbach's triangle
rectus sheath/rectus abdominus
31
superiolateral border of hesselbach's triangle
inferior epigastric vessels
32
which type of hernia is associated w. hesselbach's triangle
direct
33
protrusion through small and inflexible femoral ring below the inguinal ligament
femoral hernia
34
type of hernia that usually can not be reduced and compromises blood supply
strangulated
35
type of hernia that can be reduced early on, but can become strangulated
incarcerated
36
types of hernias
epigastric
direct inguinal → near opening of inguinal canal
indirect inguinal → at opening of inguinal canal
femoral → femoral canal
umbilical
incisional
37
what are the important abdominal splanchnic nerves
greater, lesser, least splachnic nerves -\> T5-T11 and/or 12
lumbar splanchnic nerves -\> L1, L2
pelvic splanchnic: L3-L4
sacral splanchnic nerves: L4-S4
38
lumbar splanchnic nerves
L1
L2
39
pelvic splanchnic nerves
S2-S4
40
thoracic splanchnic nerves
T1 - L2
41
SNS innervation of the abdomen
T1-L2
greater splanchnic nerves
lesser splanchnic nerves
least splanchnic nerves
lumbar splanchnic nerves
42
greater splanchnic nerves
T5-T9
43
the greater splanchnic nerves innervate the
foregut
44
lesser splanchnic nerves
T10-T11
45
least splanchnic nerves
T11 and/or T12
46
greater splanchnic nerves supply sympathetic innervation to the
foregut
adrenal medulla
47
lesser splanchnic nerves supply sympathetic innervation to the
midgut
48
least splanchnic nerves supply sympathetic innervation to the
kidneys
49
the greater. lesser, and least splanchnic nerves run from
T5-T12
50
lumbar splanchnic nerves
L1-L2
51
lumbar splanchnic nerves innervate
bladder
ductus deferens
prostate
52
PSNS innervation of the abdomen
sacral splanchnic nerves from the inferior hypogastric plexus -\> L4-S4
pelvic splanchnic nerves -\> S2-S4
53
pelvic splanchnic nerves innervate the
hindgut
54
extrinsic innervation of the GIT is __ (2)
intrinsic innervation of the GIT is \_\_
SNS, PSNS
enteric NS
55
what is the prevertebral plexus
where the splanchnic nerves combine with fibers from other levels to exit the trunk
56
the prevertebral plexus contains (3)
PSNS visceral afferents from the vagus n
PSNS fibers from the pelvic splanchnic n to inferior hypogastric plexus
SNS visceral afferents from the thoracic and lumbar splanchnic nerves
57
main vessel of the portal venous system
portal vein
58
portal vein drains blood from the \_\_
to the \_\_
for \_\_
GIT, gallbladder, pancreas
liver for detox/filtration
59
blockage of the portal vein increases abdominal \_\_
and causes \_\_
pressure
anastomoses/varices
60
what are portocaval anastamoses
connections btw portal system and superior/inferior vena cava
61
umbilical vein to anterior abdominal wall anastomoses
caput medusa
62
what veins drain into the portal vein
superior mesenteric
inferior mesenteric
splenic
left and right gastric
pancreatic
63
lower esophagus anastomosis
left gastric v
esophageal veins
64
anal canal anastomosis
superior, middle, inferior rectal veins
65
umbilicus anastomosis
paraumbilical veins
small epigastric veins
66
hepatic and splenic flexure anastomosis
omental v
colonic v
67
large/small intestine anastomosis
retroperitoneal v
68
what structures are close to the posterior pancreas
aorta
SMA
left renal vessels
left kidney
left suprarenal gland
69
structures on medial and lateral sides of pancreas
gallbladder
spleen
70
structure on superior/inferior side of pancreas
stomach
duodenum
71
the head of the pancreas is on the __ side of the pancreas
and lies with the __ of the duodenum
at the __ vertebral level
right
C curve
2nd
72
the tip of the pancreas extends across the abdominal cavity almost to the
spleen
73
the collecting ducts of the pancrreas empty digestive juices into the
pancreatic duct
74
the pancreatic duct runs from the \_\_
to the __ of the organ
head
tail
75
the pancreatic duct empties into the \_\_
at the __ of the
alongside the \_\_
duodenum/duodenal papilla
lesser curve/ampulla of vater
common bile duct
76
adenocarcinoma of the head of the pancreas leads to obstruction of the \_\_
and a main symptom is
CBD
painless jaundice
77
acute pancreatitis leads to formation of \_\_
bc the body is trying to wall off enzymes from leaking into the \_\_
pseudocysts
retroperitoneal cavity
78
why are the kidneys spared in pancreatitis
they are surrounded by gerotas fascia → protects them from digestive enzymes
79
enteric ns includes
myoenteric → Auerbach's plexus
submucosa → Meissner's plexus
80
enteric ns is a __ network
of __ (2) neurons
self sufficient
sensory and motor
81
what does the enteric ns coordinate (3)
peristalsis
secretions
blood flow
82
the enteric ns is independent, but can be modified by __ (2)
SNS
PSNS
83
cramping, burning, gnawing, colicky pain
visceral
84
visceral pain is caused by
distension of viscous/hollow organ
85
in visceral pain, __ stimuli
trigger \_\_
in \_\_
noxious
nociceptors
viscera
86
visceral pain can be accompanied by
sweating
nausea
pallor
restlessness
87
visceral pain may or may not correspond w. \_\_
and can NOT be \_\_
dermatomes
elicited on pe
88
somatoparietal pain involves noxious stimuli of the \_\_
peritoneum
89
somatoparietal pain may be described as
intense
localized
90
somatoparietal pain is aggravated by
moving
coughing
91
somatoparietal pain impulses travel with \_\_
NOT with \_\_
somatosensory spinal nerves
ANS
92
somatosensory pain corresponds w.
dermatomes
93
example of somatoparietal pain
appendicitis pain localizing at McBurney's point
94
referred pain involves \_\_
and __ afferents
visceral
somatic
95
pain that involves visceral and somatic afferents from different anatomic regions that converge on second order neurons in the spinal cord at the same level
referred pain
96
example of referred pain
diaphragmatic irritation from a subphrenic abscess is interpreted by brain as coming from shoulder
97
is referred pain localized
yes! well localized
98
in appendicitis, __ fibers carry pain sensations that
enter spinal cord with __ fibers
at __ level
and pain is referred to \_\_
visceral afferent
sympathetic fibers
T10
T10
99
appendicitis pain begins as \_\_\_
and after 6-10 hours localizes to \_\_
and becomes __ pain
central periumbilical colicky **visceral**
RLQ
constant **somatoparietal**
100
cholecystitis pain begins at __ initially
then __ pain
then spreads to \_\_
midline
RUQ
right shoulder
101
diverticulitis pain begins at the \_\_
and then moves to the \_\_
lower abd midline
LLQ
102
the foregut extends from the \_\_
to the \_\_
esophagus
proxima duodenom (papilla/ampulla of vater)
103
blood supply to the foregut is via the \_\_
and it is drained via the \_\_
celiac a and its branches
splenic v
104
branches of the celiac a
left gastric
splenic
common hepatic
105
the midgut extends from the \_\_
to the \_\_
distal descending duodenum
proximal ⅔ of transverse colon
106
blood supply to the midgut is via \_\_
and it is drained by the \_\_
superior mesenteric a
superior mesenteric v
107
the superior mesenteric vein joins the __ vein
to form the __ vein
splenic
hepatic portal
108
the hindgut extends from the \_\_
to the \_\_
distal ⅔ of transverse colon
rectum
109
blood supply to the hindgut is via the \_\_
and it is drained via the \_\_
inferior mesenteric a
inferior mesenteric v
110
the splenic v, inferior mesenteric v, and superior mesenteric v
all join to form the \_\_,
which drains into the \_\_
hepatic portal v
IVC
111
in a malrotation and midgut volvulus, the foregut rotates \_\_
and the midgut rotates \_\_
around the axis of the \_\_
clockwise
counterclockwise
superior mesenteric a
112
midgut volvulus occurs when normal 270 degree twisting at around __ weeks in fetal development does not occur
9
113
this initial malrotation causes the \_\_
to wrap around a portion of the \_\_,
which causes obstruction, ischemia, infarct
mesentery
small bowel
114
sx of midgut volvulus
**bilious vomiting**
hemodynamic instability
abd distension
115
what do you think when you see, congenital diaphragmatic hernia, congenital heart dz, and omphalocele
midgut volvulus
116
what is the small bowel mesenteric root
origin of the mesentery of the small intestine
117
where is the normal small bowel mesenteric root
central portion of the abdomen
extends from duodenojejunal flexure → extends downward to the right of the ileocecal junction
118
the small bowel mesenteric root connects the small bowels to the
posterior abd wall
119
transient relaxation of the LES → reflux of acid and bile into distal esophagus → ineffective esophageal clearance → reflux
GERD
120
relaxation of upper esophageal sphincter allows food and acid to enter the
pharynx
+/- trachea
121
sx of GERD
non cardiac pain
hb/indigestion
nocturnal cough/asthma
early satiety/abd fullness
bloating/belching
esophageal spasms
122
complications of GERD
barrett's esophagus
adenocarcinoma
123
esophageal spasms can mimic
MI
124
most dependent portion of peritoneal cavity when supine
hepatorenal fossa (morrison's pouch)
125
most dependent portion of the peritoneal cavity when upright
pelvis pouch of douglas
126
what is the pelvis pouch of douglas
furthest point of abdominopelvic cavity in women
127
clinical significance of heaptorenal fossa and douglas pouch
these places fill w. fluid or air first if there is swelling/inflammation of abdomen
128
what is free air in the abdomen called
pneumoperitoneum
129
what will fluid/inflammation in the hepatorenal fossa/douglas pouch look like on CXR
corners may look rounded
130
contents of porta hepatis
common bile duct
hepatic a proper
hepatic portal v
131
where does CBD enter duodenum
thru sphincter of oddi at ampula of vater on lesser curve of duodenum
132
2 types of abnormal bowel gas patterns
functional/adynamic ileus
mechanical obstruction
133
irritation/inflammation → loss of peristalsis → dilated non functioning bowel
functional/adynamic ileus
134
functional/adynamic ileus can be \_\_
or \_\_
1-2 loops of bowel
generalized
135
in a functional/adynamic ileus, BS are
and there may be signs of \_\_
hypoactive/quiet
inflammation/irritation
136
what do you think when you see, dilated loops of bowel
+/- air fluid levels
ileus
bowel obstruction
137
what causes a true mechanical obstruction of the bowel (5)
adhesions
tumors
hernias
intusussception
IBD
138
BS in mechanical obstruction will sound \_\_
and pain will be \_\_
hyperactive
cramping
139
transpyloric plane pe correlation
L1 vertebral body
140
subcostal plane pe correlation
L3 vertebral body
141
supracristal plane pe correlation
L4 vertebral body
142
abdominal viscera pe correlation
above the costal margins
143
spleen physical exam correlation
ribs 9-11
144
the liver crosses the
midline
145
inguinal ligament runs from the \_\_
to the \_\_
ASIS
pubic tubercle
146
the inguinal canal and the superficial inguinal ring are \_\_
to the pubic tuercle
superolateral
147
the deep inguinal ring is midway between the \_\_
and the \_\_
ASIS
pubic tubercle
148
the femoral pulse is just below the
deep inguinal ring
just below the midline of the ASIS and pubic symphysis
149
what is the transpyloric plane
axial plane midway btw jugular notch and superior border of pubic symphysis
150
the transpyloric plane crosses what structures
L1 vertebra
pylorus
pancreatic neck
duodenojejunal neck
fundus of gallbladder
9th costal cartilage
hila of kidneys
origin of portal v
transverse mesocolon
2nd part of duodenum
superior mesenteric a origin
hilum of spleen
termination of spinal cord
151
supracolic structures
liver
spleen
gastric fundus
152
infracolic structures
small intestine
colon
153
what is the subcostal plane
horizontal plane passing thru lower limits of 10th costal cartilage
marks boundary btw hypochondriac and epigastric regions
marks boundary between lateral and umbilical regions
154
where is the bifurcation of the abdominal aorta
supracristal plane
L4
155
what is the supracristal plane
transverse plane lying at the upper most part of pelvis
between superior iliac crest
