Module 13 : GI Tract Flashcards
1
Q
esophagus
A
- muscular tub e
- passes through hiatus of the diaphragm at T 10
- anterior to aorta
- enters superomedial aspect of the stomach (cardia)
- GE junction marks juncture of the greater and lesser curvatures of the stomach
2
Q
stomach
A
- left hypochondirum
- epigastric regions
- peritoneal
- lower aspect crosses midline and terminates at the duodenum
- 6 parts
+ cardia
+ fundus
+ body
+ greater curve
+ ;esser curve
+ pylorus
3
Q
cardia
A
- surrounds lower esophageal sphincter
4
Q
fundus
A
- rounded portion
- superior and left of cardia
5
Q
body
A
- large central portion
6
Q
lesser curve
A
- concave medial portion
7
Q
greater curve
A
- convos lateral portion
8
Q
pylorus
A
- pyloric canal, pyloric antrum
- disstal aspect of stomach
- on an empty stomach lies on right of midline
- fully distended shifts 5-8cm to the right off midline
9
Q
small bowel
A
- 3 parts
+ duodenum
+ jejunum
+ ileum
10
Q
duodenum
A
- shortest widest and most fixed
- 4 parts
+ first part
+ second part
+ third part
+ fourth part
11
Q
first part of duodenum
A
- superior/ bulb
- intraperitoneal
- from pylorus running upward and backward to level of GB neck
12
Q
second part od duodenum
A
- descending
- retroperitoneal
- CBD and main pancreatic duct insertion
13
Q
third part of duodenum
A
- transverse/horisontal
- retroperitoneal
14
Q
fourth part of duodenum
A
- ascending
- runs superior and to the peft
- retroperitoneal
15
Q
jejunum
A
- intraperitoneal at ligament of treitz (connects bowel to diaphragm)
- arranged in multiple loops
- occupies the umbilical and left iliac regions
16
Q
ileum
A
- longest portion
- umbilical hypogastric right iliac and pelvic regions
- joins large bowel at ileocecal sphincter
- ileum and jejunum anchored to posterior abdominal wall by mesentery
17
Q
large bowel / colon
A
- multiple division
- cecum ascending transverse descending sigmoid rectum and anal canal
18
Q
cecum
A
- pouch like portion at origin of ascending colon
- right lower quadrant
- appendix extends from inferior portion
- retroperitoneal
19
Q
appendix
A
- blind ended tubular structure
- opens into cecum
20
Q
ascending colon
A
- retro peritoneal
- superior path along right flank
- from right iliac fossa to visceral surface of right lobe
- hepatic flexure
+ connect ascending and transverse colon
+ 90 degree curve shadows kidney
21
Q
transverse colon
A
- intraperitoneal
- travels horizontally across mid abdomen anterior to duodenum
- splenic flexure
+ bends downward 90 degrees inferior to spleen connecting transverse to descending colon
22
Q
descending colon
A
- retroperitoneal
- descends on left side of abdomen to left iliac fossa
- extends over pelvic brim
23
Q
sigmoid colon
A
- terminal end of colon
- projects inward toward midline e
- sits anterior to sacrum
24
Q
rectum
A
- descends into true pelvis
- ends at anal canal
25
anal canal
- rectum penetrates levator ani mussen to become anal canal
26
GI anatomy
```
- continuous tube with 4 concentric layers
+ mucosa
+ submucosa
+ muscularis
+ serosa
```
27
mucosa
- epithelial lining loose connective tissue
- muscular mucosa
- innermost layer
- protects absorbs secretes
- hypo echoic
28
submucosa
- connective tissue blood vessels lymphatic
- nourishes surrounding tissue and transports absorbed nutrients
- hyper echoic
29
muscularis
- smooth muscle in circular and longitudinal
- responsible for movement of tube and its contents
- hyopechoic
30
serosa
- outer layer
- protection
- hyperechoic
31
stomach - anatomy
- characteristic folds called rugae
+ increase expansion and surface area
- parallel to long axis of stomach
- disappear in distended state
32
small bowel anatomy
- folds called valvulae conniventes
- do not disappear when intestine is distended
- 3-5mm apart
- most prominent in duodenum and first half jejunum
33
large bowel anatomy
- huastral markings
| + 3-5 cm apart
34
gut signature
- district layered appearance of gut on ultrasound do to different acoustic properties of histological layers of GI tract
35
sonographic appearance
- uniform and compressible
- average thickness
+ 3mm (distended)
+ 5 mm (non distended)
- assess bowel for motor activity
- keyboard sign = valvulae conniventes
- austral marking = ascending and descending colon
36
physiology
- primary function = digestion and absorption
- largest endocrine organ
- ingestion of flood stimulates release of hormones from endocrine cells in mucosa
37
GI hormones
- gastrin
- cholecystokinin
- secretin
38
gastrin
- released by stomach
| - stimulates secretion of gastric acid
39
cholecystokinin
- CCK
| - released by duodenum controls GB contraction
40
secretin
- released by duodenum to stimulate release of bicarbonate from panc to neutralize stomach acid
41
ultrasound land mark - ge junction
- anterior and left of aorta
42
ultrasound landmark - stomach
- antrum is anterior to panc
43
ultrasound landmark - duodenum
- lateral to panc head
44
ultrasound landmark - jejunum
- inferior to body and talk of pan
| - anterior to left kidney
45
ultrasound landmark - cecum
- medial to ASIS and iliopsoas
46
ultrasound landmark - appendix
- posterior to cecum
47
ultrasound landmark - ascending colon
- anterior lateral to low pole of right kidney
48
ultrasound landmark - transverse colon
- inferior to pan and stomach
49
ultrasound landmark - descending colon
- adjacent to left flank over lw pole left kidney
50
ultrasound land mark - sigmoid
- anterior to external iliac
- poster to uterues
- posterior to bladder
51
vasculature
- celiac superior and inferior mesenteric arteries supply small and large bowel
- venous return from small and large bowel into portal system
- gastric artery and vein supply and drain stomach
52
ultrasound assesemnt
- asses diameter content and motor activity
53
wall thickness
```
- normal
+ 3 mm distendne
+ 5 mm undistended
- if thickened
+ symmetric = inflammation
+ asymmetric = malignancy
```
54
content of lumen
- excessive amounts of fluid
+ hyper secretion
+ mechanical obstruction
+ paralytic ileus
55
activity
```
- increases with
+ mechanical bowel obstruction
+ or inflammation
- decreases with
+ paralytic ileum
+ end stage mechanical obstruction
```
56
ultrasound prep and technique
- no prep fasting drinking water
- high frequency linear
- slow graded compression
- normal gut should compress and gas displaced
- use caution where tender
