Midterm Flashcards
(403 cards)
1
Q
In what quadrant do you find the head of the pancreas?
A
RUQ
2
Q
In what quadrant do you find the jejunum and proximal ileum?
A
LUQ
3
Q
In What quadrant do you find the majority of the ileum?
A
LLQ
4
Q
In what quadrant do you find the 1-3rd parts of the duodenum?
A
RUQ
5
Q
xiphisternal plane
A
T9
7th cartilage
6
Q
What is midway across the rectus abdominis
A
T11
8th costal cartilage
7
Q
Transpyloric plane
A
L1
tip of 9th rib
junction of lines semilunaris and costal margin halfway from sternal notch to pubic symphysis
8
Q
What are some of the organs that the transpyloric plane transects?
A
gall bladder, origins of SMA and IMA, transverse mesocolon, kidneys
9
Q
Subcostal plane
A
L3
bottom of 10th costal cartilage
10
Q
Supracristal plane
A
L4
iliac cress
11
Q
Transtubercular plane
A
L5
passing through iliac tubercles
12
Q
Interspinous plane
A
S2
ASIS
13
Q
Suprapubic plane
A
top of pubic tubercles
14
Q
superficial to deep abdominal wall stuff GO
A
skin camper fascia scarpa fascia superficial investing fascia external oblique intermediate fascia internal oblique deep investing fascia transversus abdominis trasversali fascia extraperitoneal fat parietal peritoneum
15
Q
If you screw up the urethra and it begins to bleed why will blood accumulate in the abdomen?
A
scarpa fascia becomes dartos fascia in the wee wee
16
Q
If you want to work on the kidneys and not contaminate there eat of the abdomen what do you not cut into
A
transversals fascia
17
Q
Whats the little muscle that attaches to the linea alba to make more tension?
A
pyramidalis
18
Q
What muscle does a patient need to strengthen if they have anterior abdominal tilt?
A
rectus abdominis
19
Q
What muscles helpmate the conjoint tendon?
A
internal oblique and transversus abdominis
20
Q
What layer is the cremastermuscle from?
A
internal oblique layer
21
Q
What makes up the anterior wall of the rectus sheath above the arcuate line?
A
external oblique
anterior lamina of internal oblique aponeurosis
22
Q
What makes up the posterior wall of the rectus sheath above the arcuate line?
A
posterior lamina of the internal oblique aponeurosis
transversus abdominis aponeurosis
transversals fascia
23
Q
Below the arcuate line what makes up the anterior wall of the rectus sheath?
A
aponeurotic layers of all three muscle layers
24
Q
Below the arcuate line what makes up the posterior wall of the rectus sheath?
A
transversalis fascia
25
Above the arcuate line where are the neurovascular stuff in relation to the rectus sheath? Below the arcuate line?
posterior
| anterior
26
What nerve does sensation around the belly button?
T10
27
What nerve does sensation over the iliac crest and upper inguinal?
iliohypogastric L1
28
What nerve does sensation of lower inguinal region, mons pubis, anterior scrotum or labia majora, and medial thigh?
ilio-inguinal L1
29
What do you have to watch out for paramedian incisions?
epigastric arteries
30
Where do you do subcostal incisions to avoid what?
2.5cm inferior to costal margin
| avoid 7th and 8th spinal nerves
31
What nerves do you need to identify and preserve for suprapubic incisions?
iliohypogastric and ilio-inguinal
32
What kind of hernia is commonly seen in obese people and its through the linea alba?
umbilical
33
What is a hernia that is in the linea semilunaris? Where will it be in relation to the arcuate line and why?
spigelian
| below thats the thinner region
34
IF someone has cancer deep in the abdomen by the button where will it go?
lumbar or common iliac nodes
35
If someone has ball cancer where will it go?
lumbar lymph nodes
36
If someone has melanoma by the button where will it go/
parasternal nodes
37
If someone has melanoma by the wee wee where will it go?
superficial inguinal nodes
38
What is the fold that goes from button to bladder? What was it as a fetus?
median umbilical fold
| urachus
39
What do the medial umbilical folds cover and what did the folds use to be?
medial umbilical ligaments
| umbilical arteries
40
What do the lateral umbilical folds cover?
inferior epigastric vessels
41
Through what fossa do you see direct hernias?
medial inguinal fossa
| aka triangle or Hasselbachs
42
Through what fossa do you see indirect hernias
lateral inguinal hernia
| includes deep inguinal hernias
43
what embryologic structure gets messed up to cause prune belly syndrome?
hypaxial musculature that has to travel through lateral plate mesoderm
44
Where will flank hernias protrude?
superior and inferior lumbar triangles
45
What do pelvic hernias protrude through?
pelvic foramina or pelvic floor
46
What do you call hernias that protrude through the pelvic foramina?
sciatic or obturator
47
What do you call hernias that protrude through the pelvic floor?
perineal hernias
48
what are the 4 general layers of GI organs
mucosa
submucosa
muscularis externa
serosa / adventia
49
what are the 3 layers of the mucosa
epithelium, lamina propria, muscularis mucosae
50
in what layers do you find glands?
lamina propria and sometimes submucosa
51
what is the purpose of the muscularis mucosa found in the mucosa layer of the GI tract
help with mucosal mobility
52
in which layers of the GI tract do we find blood vessels and nerves
submucosa and muscularis externa
53
what are the two layers of the muscularis externa
inner circular layer
| outer longitudinal layer
54
what is the main purpose of the muscularis externa
peristalsis
55
what do we call the outer most layer of the GI tract if the GI organ is intraperitoneal
serosa
56
what do we call the outer most layer of the GI tract if the GI organ is retroperitoneal
adventitia
57
what is the purpose of serosa
reduce digestive friction (intraperitoneal)
58
what is the purpose of adventita
attach to surrounding structures (retroperitoneal)
59
what type of epithelium do we find in the esophagus? how about the stomach?
esoph- stratefied sqamous, nonkeratinized
| stomach- simple columnar
60
describe the transition we see in muscular mucosae between esophagus and stomach
no MM in esophagus until the very last part and there it is continuous with MM in stomach
61
what happens to the mucosa in the stomach during contraction
folds into rugae
62
Portal hypertension causes what abnormality of the esophagus and stomach?
Verices in the submucosal veinous plexus
63
The outermost layer of the esophagus is what?
Adventitia until diaphragm, serosa below diaphragm
64
The outermost layer of the stomach is what?
Serosa
65
How do sympathetic nerves get. From. Prevertebral ganglion. (Where they synapse))) to the organ where they do their job?
They ride on peri-arterial plexuses
66
What does sympathetic stimulation do to GI
Decrease motility
67
Where do sympathetic nn synapse
Prevertebral ganglion (celiac, aorticorenal, superior and inferior mesenteric ganglia)
68
Which spinal segments make up the greater splanchnic n? And what division of autonomics is this?
T 5-9, sympathetics
69
Which spinal segments make up the lesser splanchnic n? And what division of autonomics is this?
T 10-11, sympathetics
70
Which spinal segments make up the least splanchnic n? And what division of autonomics is this?
T12, sympthetic
71
Which spinal segments make up the lumbar splanchnic nn? And what division of autonomics is this?
L1-3, sympathetic
72
Where does the greater splanchnic nerve synapse?
Celiac ganglion
73
Where do parasympathetic fibers synapse?
At the end organ
74
What does parasympathetic stimulation do to GI
Increase motility and secretions
75
Vagus n supplies parasympathetics to what GI structures?
All prior to left colic (splenic) flexure
76
Who supplies all GI organs with parasympathetics after the left colic (splenic) flexure?
Pelvic splanchnic nn
77
Who responds to local stimuli in the GI system
Enteric nervous system
78
What are the 2 components of the enteric nervous system
Submucosal plexus of meissner, myenteric plexus of auerbach
79
What autonomic supply do we find between inner circular and outer longitudinal layers of muscularis externa?
Myenteric plexus of auerbach (enteric)
80
How does the muscularis externa change as we move down the esophagus
Upper: Striated (skeletal)
Middle: mixed
Lower: mostly SM
81
The upper esophageal sphincter is made up of what muscle
Cricopharyngeal
82
The lower esophageal sphincter is made of what muscle
NOT a real muscular sphincter just pinched as esophagus passes through the diaphragm
83
What is the condition where gastric contents get into esophagus to cause heartburn among other symptoms
GERD
84
What is the condition where stratefied squamous epithelium in esophagus is replaced by metaplastic columnar epithelium after chronic GERD
Barrett esophagus
85
What are the 4 sections of the stomach
Cardia, fundus, body, pyloric antrum
86
Where in the stomach do we find enteroendocrine and G cells
Pyloric antrum
87
What do parietal cells do
Secrete HCl and intrinsic factor
88
Why is intrinsic factor necessary for us?
It binds vitB12 to keep it for use later
89
What do chief cells do
Secrete pepsinogen
90
What do gastroenteroendocrine cells do
Make peptide hormones to signal other cells
91
Enteroendocrine cells secrete peptide hormones that cause who to secrete gastrin
g cells
92
Enteroendocrine cells secrete peptide hormones that cause who to secrete somatostatin
D cells
93
Enteroendocrine cells secrete peptide hormones that cause who to secrete histamine and serotonin
enterochromaffin like cells (ECL)
94
Enteroendocrine cells secrete peptide hormones that cause other endocrine cells to secrete ghrenlin which does what
increases hunger when the stomach is empty
95
What happens when we cant make intrinsic factor in the parietal cells?
Pernicious anemia
96
What do the testes follow when they migrate?
gubernaculum
97
What layer of the anterior abdominal wall does NOT contribute to the spermatic chord?
transversus abdominus m
98
What does the tunica vaginalis form from?
peritoneum
99
What does the internal spermatic fascia form from?
transversalis fascia
100
What does the cremasteric fascia form from?
internal abdominal oblique
101
What does the external spermatic fascia form from?
external oblique
102
How can you differentiate between a hydrocele and a hematocele?
transillumination
| hydrocele will illuminate
103
How does a kid get a hydrocele?
persistent processus vaginalis
104
What makes up the floor of the inguinal canal?
inguinal ligament
105
What do you find in the subinguinal space?
hip flexors
| femoral nerve, artery, vein
106
What do you find in the inguinal canal?
spermatic cord or round ligament of uterus
| blood and lymph vessels
107
What makes up the anterior wall of the inguinal canal?
external oblique
108
What makes up the lacunar ligament and where do you find it?
continuation of inguinal ligament
anterior wall of inguinal canal
attaches to superior pubic ramus
109
What makes up the pectinate ligament and where do you find it?
lacunar ligament
anterior wall of inguinal canal
runs along pectineal line
110
What does the medial crus attach to? Lateral crus?
media- pubic crest
| lateral- pubic tubercle
111
What opens up to make the superficial inguinal ring?
external oblique aponeurosis
112
What forms the conjoint tendon?
internal oblique and transverses abdominal muscles
113
What does the conjoint tendon insert on and what does it form?
pubic crest and pectineal line
| posterior wall of inguinal canal
114
What innervates the cremaster muscle?
genital femoral nerve
115
What is the main thing that makes up the posterior wall of the inguinal canal?
transversalis fascia
116
What do you call the thickened inferior margin of the transversalis fascia? What does it form?
iliopubic tract
| floor of inguinal canal
117
Where is the deep inguinal canal located? What goes through it?
lateral to inferior epigastric artery
| vas deferens, testicular vessels, round ligament of uterus
118
What does a direct inguinal hernia protrude through?
anterior abdominal wall
119
What does an indirect inguinal hernia protrude through?
deep inguinal ring
120
What usually leads to a direct inguinal hernia?
weak conjoint tendon
121
What are the boundaries of the inguinal triangle?
```
inguinal ligament (inferior)
lateral border of rectus abdominis (medial)
inferior epigastric artery (lateral)
```
122
what are the two types of inguinal hernias and their relations to the inferior epigastric a?
indirect- lateral
| direct- medial
123
What two things attach to the pectineal line?
conjoint tendon
| lacunar ligament
124
In what layer of the anterior abdominal wall is the deep inguinal ring found?
transversalis fascia
125
what condition is characterized by premalignant stomach disease with massive gastric folds and excess mucous production due to mucous cell hyperplasia
menetriers disease
126
pernicious anemia occurs when we cannot make what 2 things in parietal cells
intrinsic factor, HCl
127
how might we stop excessive HCl production in patients who have chronic ulcer problems
vagotomy (so we don't stimulate parietal cells to make HCl)
128
what population is predisposed to developing ulcers
chronic anxiety
129
helicobacter pylori causes peptic ulcers by eating away at which layer of the GI tract
mucosa
130
Between the jejunum and ileum, which one has more vascularity?
jejunum
131
Between the jejunum and ileum, which one has longer vasa recta?
jejunum
132
What are the arcades in the jejunum like compared to the ileum?
fewer and larger
133
What two veins make up the hepatic portal vein?
splenic vein and superior mesenteric
134
What do the right and left gastric veins drain into?
portal vein
135
What is the rectal blood supply above the pectinate line and what is it a branch of?
superior rectal a
| branch of IMA
136
What is the venous drainage of above the pectinate line and what does it drain into
superior rectal v
- > IMV
- > portal
137
What kind of hemorrhoids develop above the pectinate line and are they painful?
internal
| not painful: visceral innervation
138
What is the blood supply below the pectinate line? What is it a branch of?
inferior rectal a
| branch of internal pudendal a
139
What is the venous drainage below the pectinate line? What does it drain into?
inferior rectal v-> internal pudendal v-> internal iliac v-> common iliac v -> IVC
140
What kind of hemorrhoids develop below the pectinate line? Are they painful?
external
| somatic innervation so yes
141
what is the pringle maneuver? what is it used for?
```
compress portal triad in hepatoduodenal ligament
control bleeding (liver and cystic a)
```
142
What do the fingers pass through in the pringle maneuver?
omental foramen
143
What does the esophageal veins anastomoses link together in the portal and caval systems?
```
left gastric vein (portal)
azygos v (caval)
```
144
How dos the inferior mesenteric v anastomose with the caval system?
superior (portal) and inferior/middle (caval) vv
145
What veins remain closed unless there's portal hypertension? What do they anastomose with?
para-umbilical v
| epigastric vv
146
What do the visceral vv come from and what do they anastomose with?
SMV or IMV
| posterior abdominal wall vv and diaphragm vv
147
If you develop liver cirrhosis how can you redirect the blood flow?
portosystemic shunts
| put portal vein into the IVC
148
In nutcracker syndrome what compresses what?
SMA can compress L renal v and maybe duodenum
149
What unique pain is seen with nutcracker syndrome?
left testicular pain
150
what are the pelvic splanchnic nerves derived from?
anterior rami of spinal nerves S2-S4
151
What are the presynaptic parasympathetic fibers to the inferior hypogastric plexus?
pelvic splanchnic nerves
152
Who conducts the general visceral afferent pain fibers?
sympathetic nerves
153
What conducts the general visceral afferent visceral reflex fibers?
parasympathetic nerves
154
What sympathetic and parasympathetic nerves make up the superior mesenteric plexus?
sympathetic- greater and lesser splanchnic nn
| parasympathetic- median root from celiac plexus (branch of posterior vagal trunk)
155
What sympathetic and parasympathetic nerves make up the inferior mesenteric plexus?
sympathetic- lumbar ganglia of sympathetic trunk
| parasympathetic- medial root from inter mesenteric plexus (continuation of vagus)
156
Wat type of fibers make up the superior hypogastric plexus?
only sympathetic
157
what connects the superior and inferior hypogastric plexi?
r/l hypogastric nerves
158
What nerves make up the inferior hypogastric plexus?
sacral splanchnic nn
| s2-s4 sacral spinal nerves (pelvic splanchnic nn)
159
what two transverse planes help mark the nine different quadrants
subcostal and transtubercular
160
what transverse plane is used for the four quadrants and what vertebra level is it at?
transumbilical
| between L3 and L4
161
the parietal peritoneum contacts the body wall, is supplied by the same neurovasculature that supplies that region of the body wall, and is sensitive to what kind of stimuli
pressure, pain, temp
162
the visceral peritoneum covers organs, is supplied by the same neurovasculature that supplies the organ, and is sensitive to what kind of stimuli
stretch, chemical irritation, ischemia
163
the ventral mesentery gives rise to which adult structures
hepatogastric and hepatoduodenal ligaments (the lesser omentum)
164
what is the name of the ligament that connects the liver to the anterior body wall
falciform ligament
165
the dorsal mesentery gives rise to which adult structures
gastrosplenic ligament
166
what is the name of the ligament that connects spleen to posterior body wall
splenorenal (lienorenal) ligament
167
what is the path that neurovasculature must take to reach intraperitoneal organs
it travels in the mesentery
168
what does it mean for an organ to be primarily retroperitoneal?
the organ never had a mesentery
169
what does it mean for an organ to be secondarily retroperitoneal?
the organ formed in mesentery but later fused to the posterior body wall
170
which organs are retroperitoneal
SAD PUCKER (suprarenal glands, aorta, IVC, duodenum 2-3, pancreas except tail, ureters, ascend and descend colon, kidneys, esophagus above diaphragm, rectum)
171
which retroperitoneal organs used to have a mesentery but then fused to posterior body wall
secondary retroperitoneal: duodenum, pancreas, ascending and descending colon
172
what vessel(s) are contained within the gastrosplenic ligament
L gastroepiploic a
173
what vessel(s) are contained within the hepatoduodenal ligament
portal triad (proper hepatic a, portal v, bile duct)
174
what vessel(s) are contained within the splenorenal ligament
splenic a
175
where can we find the lesser momentum
between liver and stomach (made of hepatoduodenal and hepatogastric ligaments)
176
the greater and lesser sac communicate via
the epiploic foramen
177
the epiploic foramen is an opening in the what
lesser omentum
178
what are the boundaries of the epiploic foramen
anterior- hepatoduodenal ligament
posterior-IVC
superior- caudate lobe of liver
inferior-first part of duodenum
179
if the posterior aspect of the stomach ruptures, the spilled contents will be contained within what structure
lesser sac
180
if the intestines herniate into the lesser sac, why can't we just cut one side of the epiploic foramen to pull them out?
because all the borders of the foramen are vascularized
181
an inflamed or injured pancreas can lead to pancreatic fluid drainage into the lesser sac (omental bursa) and we call this what
pancreatic pseudo-cyst
182
together the gastrophrenic, gastrosplenic, transverse mesocolon, and gastrocolic ligament are borders for what space in the abdomen
greater sac
183
what separates the peritoneal cavity into supra colic and infra colic compartments
transverse mesocolon
184
what organs are superior to the transverse mesocolon (supra colic compartment)
stomach, spleen, liver
185
what organs are inferior to the transverse mesocolon (infra colic compartment)
small intestine, ascending and descending colon
186
supracolic and infracolic compartments can communicate via
paracolic gutters
187
what is the inferior most place for fluid (ascites) to be when the patient is upright
rectouterine (or rectovesicular) pouch
188
at which spinal levels can you find the pancreas
head at L2 tail angles up to L1
189
the pancreas is cradled in parts ___ of the duodenum and the tail tickles the ___
1-3, spleen
190
why do adhesions occur between areas of peritoneum
damage causes inflammation and fibrin production makes the area sticky- layers of peritoneum attach to one another
191
this structure is very mobile within the abdomen and functions to prevent adherence of visceral and parietal peritoneum. it can also adhere to inflamed organs (like the appendix) to wall off and protect other viscera in the event of a rupture
greater omentum
192
sometimes during gallbladder removal we accidentally sever the cystic artery: how can we locate where the bleed is coming from
clamp hepatoduodenal ligament to stop bleed and then release to see where the blood is coming from
193
esophageal hiatus is an opening in the diaphragm that occurs at what spinal level
T10
194
the first (upper) esophageal constriction is an anatomical sphincter created by what
cricopharygeal m
195
there is an esophageal constriction in the thoracic region called the bronchoarotal constriction and the esophagus is being compressed by what specifically here
L main bronchus + aortic arch
196
what is the physiological sphincter of the esophagus
diaphragmatic constriction at T10
197
type of hiatal hernia that involves funds of stomach and its associated peritoneum rupturing through diaphragm
para esophageal hernia
198
which type of hiatal hernia at the diaphragm is associated with symptoms of regurgitation
sliding hiatal hernia
199
type of hernia where lower esophagus and cardia of stomach rupture through diaphragm (more common type)
sliding hiatal hernia
200
what nerves are associated with the esophagus
the anterior and posterior vagal plexus surround esophagus
201
the lesser curvature of the stomach ends at a point called ___ before the pyloric canal begins
angular incisure
202
the stomach sits posteriorly to
left lobe of liver
203
the pylorus of the stomach is found at what spinal level
L1 - transpyloric plane
204
the 1st part of the duodenum is connected to what named mesentery
hepatoduodenal ligament
205
what is the thickened area of the 1st part of the duodenum that is very susceptible to ulcers
duodenal bulb
206
duodenal ulcers commonly cause bleeding from ___ artery that runs posterior to the 1st and 2nd parts
gastroduodenal a
207
the 2nd part of the duodenum runs inferiorly until it reaches what plane
subcostal (L3)
208
where do the bile duct and pancreatic duct enter the duodenum
2nd part (duodenal papilla / hepatopancreatic ampulla)
209
what 2 important vessels cross anteriorly to the 3rd part of the duodenum (they sit right in between pancreas and this area of duodenum)
SMA and vein
210
the SMA compresses the 3rd part of the duodenum and the L renal vein in this disorder
nutcracker syndrome
211
the 4th part of the duodenum is associated with what ligament
sispensory ligament of Treitz
212
the suspensory ligament of treitz (duodenum) connects the 4th part of the duodenum to what structure
R crus of diaphragm
213
the 4th part of the duodenum sits anteriorly to which major m
psoas major
214
in which quadrant do we find jejunum
LUQ
215
in which quadrant do we find ileum
RLQ
216
which part of the small intestine is highly vascular with long vasa recta and long arcade loops
jejunum
217
which part of small intestine has lots of plicae circulates but few peyers patches
jejunum
218
which part of small intestine has thin walls
ileum
219
which part of small intestine has thick walls
jejunum
220
which part of small intestine has less vasculature, short vasa recta, lots of short arcade loops,
ileum
221
which part of small intestine has few plicae circulares but many peyers patches
ileum
222
teniae coli are 3 bands of longitudinal m in the large intestine that produce what structure
haustra (sacculations)
223
what is the purpose of haustra in the large intestine
slow movement of feces
224
at what spinal level can we find the ileocecal valve
L5 transtubercular plane
225
what do you call the point 1/3 of the distance from ASIS to umbilicus and what do we find here
mcburney point, appendix
226
what produces pain during appendicitis
stretching of visceral peritoneum OR contact with parietal peritoneum if it gets really swollen
227
the ascending colon extends from the cecum to what
hepatic flexure
228
the hepatic flexure occurs in what plane
transpyloric L1
229
the transverse colon extends from __ to __ in the T12 plane
hepatic flexure to splenic flexure
230
condition where colon begins to form outpouchings where feces can get stuck and infected causing inflammation usually in the sigmoid colon
diverticulosis (if inflamed its diverticulitis)
231
condition where part of the sigmoid colon gets twisted (and possibly strangulated) and swells up many times its normal size leading to constipation, fecal compaction, ischemia, necrosis
volvulus
232
the spleen is attached to other viscera by which ligaments
gastrosplenic and splenorenal
233
the spleen sits against the body wall on which side
left
234
liver is held to anterior body wall by which ligament
falciform
235
the embryological remnant of the ligamentum venous is
ductus venosus (shunted blood from IVC)
236
the embryological remnant of the round ligament of liver is
L umbilical v
237
name the location where the portal triad enters the liver in the hepatoduodenal ligament
porta hepatis
238
which functional lobe of the liver is in the R anatomical lobe but the L functional lobe
IV
239
the anatomical caudate lobe of the liver is which functional lobe
I
240
the gallbladder usually is found adhered to the liver at eh
hepatic fossa
241
the gallbladder sends bile into hepatic duct via the ___ duct
cystic
242
cholelithiasis (gallstones) form in the gallbladder and are made of what
cholesterol crystals
243
what is a symptom of a blocked cystic duct (via gallstone probably)
biliary colic (RUQ)
244
this test involves having patient exhale, and doctor presses on gallbladder and tells pt to inhale (positive test would be pain or the breath catching upon inhale)
murphys sign
245
murphys sign is positive on the R side of patients with what condition
biliary colic
246
if gallstones block the narrowest part of the bile passageway, ___, it can lead to pancreatitis and jaundice
the hepatopancreatic ampulla
247
during cholecysto-enteric fistula an inflamed gallbladder adheres to nearby organs such as the duodenum fusing and allowing passage of gallstones which likely get caught where
ileocecal valve
248
what is the term meaning a gallstone got stuck at the ileocecal valve and is causing bowel obstruction
gallstone ileus
249
this condition occurs if the yolk stalk of the embryo remains into adulthood creating a finger like pouch that can be free or attached to umbilicus - if inflamed it produces pain that looks much like appendicitis
ileal (meckel) diverticulum
250
why do we need to be careful when performing needle biopsy of spleen or liver
these guys sit so far superiorly that if we aren't careful we may puncture costodiaphragmatic recess unnecessarily which can lead to inflammation of pleura
251
this commonly occurs in 2-12 wk old babies when the mm surrounding the distal stomach cannot relax leading to vomitting without bile
pylorospasm
252
thickening of a certain area of SM that inhibits gastric emptying
congenital hypertrophic pyloric stenosis
253
ulcers most commonly caused by what bacteria
helicobacter pylori
254
an ulceration of the posterior stomach can erode into the pancreas and can cause peritoneal hemorrhage via what artery
splenic
255
the foregut often produces referred pain to which region of the abdomen
epigastric
256
the midgut often produces referred pain to which region of the abdomen
pari umbilical
257
the hindgut often produces referred pain to which region of the abdomen
hypogastric
258
during development the midgut herniates into the umbilical cord and then returns as organs shrink in size. upon returning it rotates 270 degrees about what axis
the SMA
259
due to ulcerative colitis (crohns), a pt may need parts of colon removed. what is the new pathway established to end the GI tract in these patients
stoma (artificial opening) created
colostomy- cutaneous opening for terminal colon
ileostomy- terminal ileum sutured to anterolateral abdominal wall
260
whats the most commonly ruptured organ and why
spleen- so close to ribs (ruptures when they break)
261
its usually ok to remove the whole spleen because most of its jobs can be taken over by who
bone marrow and liver
262
the most common abberant hepatic arteries do not arise from the proper hepatic artery but instead they come from where?
R from SMA
| L from L gastric
263
during hepatic cirrhosis, especially during chronic alcoholism, the liver tissue (normally responsible for detox) is replaced by what
fat and fibrous tissue
264
in severe cases of portal HTN, we must bypass the liver by inserting what
portocaval/portosystemic shunt
265
is the celiac artery intra or retroperitoneal ? if intraperitoneal what mesentery does it run in?
retro
266
is the common hepatic artery intra or retroperitoneal ? if intraperitoneal what mesentery does it run in?
retro
267
is the proper hepatic artery intra or retroperitoneal ? if intraperitoneal what mesentery does it run in?
intraperitoneal - hepatoduodenal L
268
is the gastroduodenal artery intra or retroperitoneal ? if intraperitoneal what mesentery does it run in?
retro
269
is the left gastric artery intra or retroperitoneal ? if intraperitoneal what mesentery does it run in?
retro
270
is the splenic artery intra or retroperitoneal ? if intraperitoneal what mesentery does it run in?
retro
271
is the short gastric artery intra or retroperitoneal ? if intraperitoneal what mesentery does it run in?
intraperitoneal - gastrosplenic ligament
272
is the left gastroepiploic artery intra or retroperitoneal ? if intraperitoneal what mesentery does it run in?
intraperitoneal - gastrosplenic ligament
273
is the superior mesenteric artery intra or retroperitoneal ? if intraperitoneal what mesentery does it run in?
intraperitoneal - THE mesentery
274
in what layer do we find burners glands
submucosa
275
who's job is it to secrete alkaline mucous when there is acid in the duodenum
bruners gland
276
what part of the intestine does this describe: many plicae circulars proximally, long finger like villi, no burners glands or peyers patches
jejunum
277
what part of the intestine does this describe: short finger like villi, fewer plicae shircularis, no burners glands, lotsfo goblet cells and many peyers patches
ileum
278
who lives in the germinal center (of a peyers patch/GALT/lymph node?)
proliferating b cells
279
who lives in mantle zone (of a peyers patch/GALT/lymph node?)
resting B cells
280
where do T cells live (within a peyers patch/GALT/lymph node?)
between follicles
281
who brings the antigen to the peyers patch to be digested
M cell
282
where do you find goblet cells along GI tract
small and large intestine
283
the vermiform appendix is similar to the histology of the colon except for what distinguishing feature
abundant lymph
284
describe the epithelium in the rectum above the pectinate line
simple columnar
285
describe the epithelium in the rectum below the pectinate line
stratefied squamous
286
what are the 4 degrees of folding in the small intestine
plicae circulares, villi, microvilli, crypts
287
these cells are only in small intestine and they have eosinophilic apical granules and they secrete lysozyme, TNF alpha, and defensins
paneth cells
288
what do paneth cells secrete and where do they live?
defensins, TNF alpha, lysozyme
| small intestine
289
whats the job of an enterocyte
nutrient absorbtion
290
what cell has the job of protecting the GI tract from auto digestion by pancreatic enzymes
goblet cells do this by secreting protective mucous
291
what do m cells do
take the antigens to peyers patches
292
which cells have eosinophilic subnuclear granules
enteroendocrine cells
293
what do enteroendocrine cells secrete
CCK, secretin, gastrin
294
which parts of the large intestine have an adventitia?
ascending, descending colon, and rectum
295
this stuff is digested by brush border and luminal enzymes into a byproduct that can irritate the tummy of the consumer
gluten
296
what areas of GI have the highest exposure to gluten and therefore symptoms of celiac disease
duodenum and jejunum
297
neutrophils gather at the tips of dermal papillae in resonse to an IgA reaction in which condition
dermatitis herpetiformis
298
dermatitis herpetiformis is a symptom of what other condition in 10% of patients
celiac disease
299
in dermatitis herpetiformis, we find skin lesions where ___ targeting gluten cross reacts with reticulin which is a protein anchoring the epidermis
IgA
300
atrophy of villi, elongated crypts, t cells in surface epithelium are all characteristic of what condition
celiac disease
301
this rectal sparing disease is an inappropriate mucosal immune activation where terminal ileum is affected and can adhere to surrounding structures creating fistulas
crohns disease
302
this Gi condition can be diagnosed histologically when we see granulomas and giant cells and there is lyphocytic infiltration
crohn disease
303
this condition always involves the rectum and is characterized by erlenmeyer flask ulcers and inflammation in mucosa along with crypt abcesses
ulcerative colitis
304
what is the first step in assessing abdominal imaging
identify solid organs
305
which imaging modality (CT or MRI) is better for finding renal stones
CT
306
at what vertebral level on CT do we begin to see the SMA
T12
307
What germ layer does the epithelium of the digestive system come from? Except for what?
endoderm
| mouth and anal canal which comes from ectoderm
308
What germ layer does the smooth muscle and connective tissue of the digestive system come from?
splanchnic mesoderm
309
Where do the autonomic ganglions of the digestive system come from?
neural crest cells
310
What division of the digestive system does the respiratory system come rom?
foregut
311
Up until what point of the GI tract is from the foregut?
pharynx to proximal duodenum
312
From what to what is the midgut?
small intestine to right half of transverse colon
313
What division of the digestive system gives rise to the epithelium of the urinary bladder and urethra?
hindgut
314
What vessels supply the foregut, midgut, hindgut?
foregut- celiac
midgut- SMA
hindgut- IMA
315
What is the axis of the midgut?
SMA
316
What do we call the part of the midgut that is herniating out into the umbilical cord during development?
vitello-intestinal duct
317
Where does the striated muscle of the esophagus come from?What about the smooth muscle?
pharyngeal arches 4 and 6
| smooth muscle from splanchnic mesoderm
318
During what week do you develop an abnormal passage between the trachea and esophagus because the folds failed to fuse and form a septum and what do you call it?
week 5
| tracheosophageal fistula
319
What do you call it if there is just a blind end to the esophagus?
esophageal atresia
320
So a kid is born and it just voms a ton of non bilious barf across the room. Likely diagnosis? What causes it?
hypertrophic pyloric stenosis
| circular and some longitudinal muscles of pylorus hypertrophies
321
What border of the stomach has the most growth and what does it become after rotation? Why does the inferior portion move up?
dorsal border -> greater curvature
| growth of liver
322
What do the muscles of the stomach come from?
splanchnic mesoderm
323
whats the modality of choice for visualizing biliary tree
ERCP
324
whats the modality of choice for visualizing abdominal arteries
digital subtraction angiography
325
whats the modality of choice for visualizing cholelithiasis
ultrasound
326
nutcracker syndrome is impingement of ___ by SMA
L renal V
327
superior mesenteric syndrome is impingement of ___ by SMA
duodenum
328
what is the most common cause of ascites
liver cirrhosis
329
what do you call an out pouch of esophageal wall adjacent to cricopharygeal m
zenkers diverticulum
330
what condition is characterized by lead pipe appearance of intestines due to spastic longitudinal mm or fibrosis in colon (and resulting loss of haustra)
ulcerative colitis
331
hepatic diverticulum gives rise to what?
liver and gallbladder
332
Where does the ventral pancreatic bud end up?What does it give rise to?
dorsally due to rotation to right
| head of pancreas
333
The dorsal pancreatic bud gives rise to what?
body and tail
334
Where do the ducts of the pancreas come from?
ventral primordia
335
So if a kid is vomming across the room but it's bilious what are we thinking?
anular pancreas
336
When does the midgut leave the abdomen and when does it come back?
6 weeks
| 10 weeks
337
What's the total amount of rotation that happens in the midgut?
270
338
So if the abdomens are outside the body in a baby but covered in a layer what's the dx and at what week did something go wrong?
omphalocele
| 10
339
So if a baby has loose guts out and about what's the dx and at what week did it happen? What went wrong?
gastroschisis
week 4
failure of abdominal wall to close
340
What does a congenital umbilical hernia perforate through?
umbilical ring
341
What do we call it when the neurocrest cells failed to innervate the gut? Where does it usually happen?
Hirschsprungs or congenital megacolon
| sigmoid and descending colon (myenteric plexus)
342
What are all the 2s that go with a Meckel's diverticulum?
```
2% of population
2ft form ileocecal junction
2 inches long
2 types of tissue (gastric and pancreatic)
2:1 male to female
```
343
What persists to cause Meckel's diverticulum? What does it connect?
vitelline duct
| ilium to abdominal wall
344
What does the urorectal septum divide the cloacal membrane into?
urogenital and anal membranes
345
What does the ectodermal part of the anal membrane come from?
proctodeum
346
So the superior part of the anal canal is from what? Inferior part?
superior- handgun
| inferior- proctodeum
347
SO if the rectum is connected to the urethra what failed?
the septum did separate the cloaca
348
What if a kid doesn't have a butthole but the urethra is normal, what failed?
ectoderm and endoderm didn't meet up and open up
349
What divides the heart from the abdomen and becomes the diaphragm?
septum transversum
350
What separates the lungs from the abdomen?
pleuoperitoneal membrane
351
What do the pleuroperitoneal and septum transverse membranes come from
somatic mesoderm
352
How do we close up the space between the pleuroperitoneal membrane and the septum transverse?
PP membrane grows forward and fuses with it
353
What things are secondarily retroperitoneal?
pancreas (except tail)
duodenum (2-4)
ascending and descending colons
354
What happens to the PP membranes in the adult diaphragm?
shrink, we can't tell where it went
355
What does the crura of the diaphragm come from?
dorsal mesentery of esophagus
356
What do the peripheral muscles of the diaphragm come from?
body wall
357
Why do congenital diaphragmatic hernias occur in the posterolateral diaphragm?
defective formation or fusion of PP membranes
358
What does the dorsal mesogastrium become?
greater omentum
359
What does the ventral mesogastrium become?
lesser omentum
360
Thoracic esophagus and anus are retro or intraperiotneal?
retro
361
So what ligaments does the dorsal mesogastrium give rise to?
splenorenal and gastrosplenic ligaments (greater omentum)
362
What ligaments does the ventral mesogastrium give rise to?
hepatoduodenal and hepatogastric
363
What things are secondarily retroperitoneal?
pancreas (except tail)
duodenum (2-4)
ascending and descending colons
364
SO a long term smoker has a tumor in the parotid with lymphoid tissues. What do we call it?
warthin tumor
365
A cancer in the head of a pancreas will cause what?
obstructive jaundice
366
How does the gallbladder look different from intestines?
no submucosa and there's a muscular layer but it's not muscularis mucosa
367
What type of glands lose part of their cell membrane when they secrete stuff? What's an example?
apocrine
| mammary glands
368
What's a characteristic thing we see with the parotid gland?
adipocytes
369
What cells are eosinophilic? What does this mean?
serous cells
| purple and pink
370
more serous than mucous
submandibuluar
371
What cells are characteristic of exocrine pancreas and what do they look like?
centroacinar cells
| light staiining
372
where in the spinal cord can you find sympathetic nerves
intermediolateral column of lateral horn
373
the vagus n supplies parasympathetics until what GI landmark before pelvic splanchnic nn take over?
splenic flexure
374
visceral afferent pathway for pain travels with what other nn
sympathetics (except below pelvic pain line)
375
below the pelvic pain line visceral afferents for pain travel with what nn?
pelvic splanchnics
376
innocuous stimuli stimulate afferent nn that run alongside of who to get to the CNS
parasympathetics
377
how long does acute abdominal pain last
less then 3 days
378
how long does subacute abdominal pain last
3 days- 3 weeks
379
how long does chronic abdominal pain last
3 weeks or more
380
visceral pain from the foregut organs is referred to what area
epigastric region
381
visceral pain from the midgut organs is referred to what area
periumbilical region
382
visceral pain from the hindgut organs is referred to what area
hypogastric or suprapubic region
383
visceral pain from the foregut organs is carried by what afferent nn
T6-9
384
visceral pain from the midgut organs is carried by what afferent nn
T8-10
385
visceral pain from the hindgut organs is carried by what afferent nn
T10-L1
386
early appenditis produces pain felt where? late appendicitis?
early: umbilical
late: R inguinal
387
visceral afferent pain from the liver travels in what spinal segments
T6-9
388
visceral afferent pain from the stomach travels in what spinal segments
T6-9
389
visceral afferent pain from the spleen travels in what spinal segments
T6-8
390
visceral afferent pain from the kidney travels in what spinal segments
T10-L1
391
visceral afferent pain from the pancreas travels in what spinal segments
T6-L2
392
visceral afferent pain from the duodenum travels in what spinal segments
T8-10
393
visceral afferent pain from the ileum/jejunum travels in what spinal segments
T8-10
394
visceral afferent pain from the ascending colon travels in what spinal segments
T10
395
visceral afferent pain from the transverse colon travels in what spinal segments
T11
396
visceral afferent pain from the descending colon travels in what spinal segments
T12-L1
397
visceral afferent pain from the sigmoid colon travels in what spinal segments
L2
398
visceral afferent pain from the rectum travels in what spinal segments
S2
399
where do you feel gastric ulcers ? What about if they perforate
epigastric pain increases with eating
| perforated: chronic, sharp and spreads
400
pain would occur where with acute cholecystitis
RUQ (referred to R shoulder)
401
what should we think if patient comes in with sudden, severe colicky pain from loin to groin and in the back, no fever, blood in urine, soft abdomen
passing kidney stone
402
old patient comes in with weight loss, hind gut visceral colicky pain, no flatus or feces, distended abdomen, mass in LLQ and increased bowel sounds what do we think it is
obstructivecancer of descending colon
403
A young woman comes in with hypostric pain radiating to sacral area, afebrile, with rectouterine pouch tenderness oh and she missed her last menstrual. Cycle whats going on?
Ruptured ectopic pregnancy
