Organs of the GI Tract

Question 1

Where do each of these pierce the diaphragm:

IVC
Esophagus
Aorta

Answer 1

T8
T10
T12

Question 2

What level is the cardiac orifice of the stomach?

Answer 2

T11

Question 3

Muscle type of the UES

Voluntary or involuntary?

Muscle type of the LES

Voluntary of involuntary?

Answer 3

Striated m.
Voluntary

Smooth m.
Involuntary/physiologic

Question 4

Reflux disease

Answer 4

Food back-up due to patent LES, causing irritation

Question 5

Barrett’s esophagus

Answer 5

Constant irritation due to reflux causes squamous epithelium is replaced by patches of gastric glandular epithelium

Question 6

Hiatal hernia

2 types

Answer 6

Herniation of stomach through esophageal hiatus

Sliding H. H.

Paraesophageal H. H.

Question 7

Sliding hiatal hernia

Answer 7

Gastroesophageal junction displaced superiorly, thus piece of stomach above the diaphragm

Question 8

Paraesophageal hiatal hernia

Answer 8

Esophagus joins the stomach further down, not at normal cardiac region

Question 9

Level of pyloric sphincter

Associated w/ what line of reference?

Answer 9

L1

Transpyloric

Question 10

Purpose of rugae

Answer 10

Increase S.A. for digestion

Question 11

4 layers of the stomach

Answer 11

Mucosa, submucosa, muscularis externa, serosa (visceral peritoneum)

Question 12

Length of the duodenum

Answer 12

10 in or 12 finger breadths

Question 13

First/superior portion of duodenum is covered by what?

What else is w/in this?

Answer 13

Hepatoduodenal ligament

Portal triad - portal v., proper hepatic a., common bile duct

Question 14

What happens in the 2nd/descending part of the duodenum?

Answer 14

Bile duct and pancreatic duct enter at the hepatopancreatic ampulla (major duodenal papilla)

Question 15

Anatomical importance of 3rd/inferior part of duodenum

Answer 15

SMA and SMV run over it

Question 16

Importance of the 4th/ascending part of duodenum

Answer 16

Held to right crus of diaphragm by the suspensory ligament of the duodenum

Question 17

Importances of the suspensory ligament of the duodenum (3)

Answer 17

Landmark for duodenojejunal junction

Separates upper and lower GI (for looking for bleeds)

Used to measure the jejunum by surgeons

Question 18

Length of jejunum

How to distinguish

Answer 18

8-10 ft

Long vasa recta, simple arcades, more deeper plicae circulares

Question 19

Length of ileum

How to distinguish?

Answer 19

10-12 ft

Compound arcades, short vasa recta, smaller diameter, thinner wall, less plicae circulares

Question 20

Meckel’s Diverticulum

Answer 20

Congenital abnormality

Persistence of vitelline duct causes connection of ileum to umbilicus

Question 21

What’s the rule for Meckel’s Diveticulum?

Answer 21

Rule of 2’s:

2% of population
2 in long
2 ft from ileocecal valve
First 2 yrs of life
2 types of epithelia: gastric and pancreatic

Question 22

Arteries, veins, nerves, and lymph vessels for the small intestine are contained where?

Answer 22

The mesentery

Question 23

Muscle that cause haustrations in the large intestine

Answer 23

Taenia coli

Question 24

Function of cecum

Answer 24

Catches food falling from iliocecal orifice before it moves up ascending colon

Question 25

Describe the ileocecal valve

Answer 25

One-way valve with 2 "folds", not a true sphincter

Question 26

Appendicular artery is contained where? How to locate the appendix? Clinical location?

Answer 26

Mesoappendix Off cecum at junction of 3 taenia coli McBurney's Point

Question 27

Sources of blood for sigmoid colon From what?

Answer 27

Sigmoid aa. Superior rectal a. (a branch) IMA

Question 28

Pathway of the root of the mesentery (8)

Answer 28

``` Duodenojejunal junction 3rd part of duodenum Aorta IVC R. ureter R. gonadal vessels R. psoas major m. R. sacroiliac joint ```

Question 29

What surrounds the first part of the duodenum?

Answer 29

Superior - Omental foramen Inferior - head of pancreas Anterior - Q lobe of liver and GB Posterior - portal triad, gastroduodenal a.

Question 30

What surrounds the second part of the duodenum?

Answer 30

Posterior - R. ureter, hilum of R kidney Anterolateral - Ascending colon, R colic flexure, R lobe of liver Medial - head of pancreas, common bile duct, pancreatic duct

Question 31

What surrounds the 3rd part of the duodenum?

Answer 31

Anterior - SMA, root of mesentery, jejunum Posterior - R ureter, IVC, R gonadal vessels, aorta, psoas major m.

Question 32

What surrounds the 4th part of the duodenum?

Answer 32

Anterior - Root of mesentery, jejunum Posterior - L margin of aorta, medial border of psoas m.

Question 33

Pain from appendix inflammation is felt where? Pain from mesoappendix inflammation is felt where?

Answer 33

Epigastric region McBurney's Pt

Question 34

What is the critical point of Sudeck?

Answer 34

Area where lowest sigmoid a. has a poor anastamosis w/ the superior rectal a.

Question 35

Rectum and anus are separated by what? Which is where?

Answer 35

Anorectal line Superior ends of the anal columns

Question 36

The rectum is subdivided by what? Names?

Answer 36

Transverse rectal folds Superior, intermediate, inferior

Question 37

What is the anorectal flexure?

Answer 37

Sling formed by the ends of the puborectalis mm. on each side, inferior to the rectal ampulla

Question 38

Function of puborectalis m.

Answer 38

Voluntary control of defecation via opening of anal sphincter

Question 39

What is the pectinate line?

Answer 39

Line in anal canal joining the inferior ends of the anal columns

Question 40

Significance of the pectinate line?

Answer 40

Determines blood supply, lymph, innervation

Question 41

Superior to pectinate line gets blood, innervation, lymph from/to what?

Answer 41

Superior rectal a. Internal venous plexus --> portal system Lymph --> internal iliac nodes Visceral nerves, parasymphatics to S2-4

Question 42

Inferior to pectinate line gets blood, innervation, lymph from/to what?

Answer 42

Inferior rectal a. (from internal iliac a.) Blood to inferior rectal veins of caval system Superficial inguinal nodes Somatic nerves, so sensitive to pain, temp, touch

Question 43

Internal hemorrhoids

Answer 43

Rectum, enlarged/prolapsed internal rectal v., bleeding w/o pain

Question 44

External hemorrhoids

Answer 44

``` Anal canal Prolapse while passing stool Visible and palpable Thrombosis from pushing hard VERY painful ```

Question 45

Location of spleen

Answer 45

Between left ribs 9-11 at midaxillary line above L colic flexure

Question 46

Spleen develops from what embryonic layer

Answer 46

Mesoderm

Question 47

Held in place by what things?

Answer 47

Splenorenal ligament Gastrosplenic ligament

Question 48

Pancreas forms from what event?

Answer 48

Fusion of ventral bud and dorsal bud

Question 49

Abnormal fusion of buds in pancreas development leads to what?

Answer 49

Bilious vomiting Annular ring around superior duodenum --> vomiting bile

Question 50

Structures behind the body of the spleen

Answer 50

Aorta and IVC

Question 51

Clinical significance of thrombosis of the neck of the pancreas

Answer 51

Can constrict the SMA and SMV

Question 52

Ligamentum teres hepatis is the remnant of what?

Answer 52

Umbilical vein