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GI Exam 1 > Organs of the GI Tract > Flashcards

Organs of the GI Tract Flashcards

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1
Q
  • What are the main organs of the GI Tract?
A
  • Esophagus
  • Stomach
  • SI
    • Duodenum
    • Ileum
    • Jejunum
  • Large Intestine
    • Cecum
    • Ascending colon
    • Transverse Colon
    • Descending Colon
    • Sigmoid Colon
    • Rectum
  • Liver
  • Gallbladder
  • Pancreas
    Spleen
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2
Q

What level are the following anatomical structures located:

  • Esophagus
  • Stomach
  • Pylorus
A
  • Esophagus: T10-T11
  • Stomach: T11
  • Pylorus: L1
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3
Q
  • Esophagus
    • Passes thru _ of the diaprhagm at what spinal level?
    • Enters _ of the stomach at what spinal level?
    • Attached to diaphragm via _ ligament
A
  • Right crus of diaphragm at T10
  • Enters cardiac orifice of stomach at T11
  • Phrenicoesophageal ligament
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4
Q
  • What are the three esophageal constrictions?
A
  • Cervical
    • Pharyngo-esophageal junction controlled by cricopharyngeus muscle
  • Thoracic (2 Part)
    • Esophagus in contact with aorta and left main bronchus
  • Diaphragmatic
    • As it passes through the esophageal hiatus at T10
    • Implicated in hiatal hernias
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5
Q
  • Para-esophageal hernias
A
  • Usually asymptomatic
  • Normal GEJ
  • Fundus protrudes into thorax
  • Less chance of GERD
  • Left side more common (liver is in the way on the right side)
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6
Q
  • Sliding hiatal hernia
A
  • Most common
  • GEJ displaced superiorly
  • *Cardia portrudes into thorax**
  • Hourglass stomach
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7
Q
  • Identify the parts of the stomach
A
  1. Esophagus
  2. Cardia
  3. Angular incisure
  4. Pylorus
  5. Duodenum
  6. Pyloric antrum
  7. Lesser curvature
  8. Greater Curvature
  9. Body
  10. Fundus
  11. Cardial Notch
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8
Q
  • The stomach is a _ structure
A
  • Dynamic/intraperitoneal structure
  • Not fixed:
    • Obese people have higher displaced stomach compared to very thin people
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9
Q
  • Anteriorly, the stomach relates with _
A
  • Diaphragm
  • Left lobe of liver
  • Anterior abdominal wall
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10
Q
  • Inferolaterally, the stomach relates with _
A
  • Transverse colon
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11
Q
  • Posteriorly, the stomach relates with _
A
  • Diaphragm
  • Spleen
  • Left upper kidney and syprarenal gland
  • Pancreas
  • Omental bursa (lesser sac)-stomach forms most of its anterior wall
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12
Q
  • Important ligaments of the stomach
A
  • Gastrohepatic
    • ​Connects lessure curvature of stomach to the liver
    • *Contains gastric vessels*
  • Gastrocolic
    • ​Connects greater curvature to transverse colon
    • *Contains gastroepiploic vessels and part of the greater omentum*
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13
Q
  • Label the following
A
  1. Pylorus
  2. Transpyloric plane
  3. Transtubercular plane
  4. Cardial Orifice of Stomach
  5. Pyloric Antrum
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14
Q
  • Gastric ulcer
A
  • Occurs in stomach
  • 70% related to H. Pylori
  • Left curvature ulcer can cause hemorrhage from left gastric artery
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15
Q
  • Duodenal/Peptic Ulcer
A
  • Ulcer of the pylorus or duodenum
  • 90% related to H.Pylori
  • 65% occur on posterior wall of first part of duodenum
  • Complications
    • ​Hemorrhage from gastroduodenal a. for posterior ulcers in first part of duodenum
    • Ulcer in first part of duodenum can cause adhesions with liver and gallbladder
    • Anterior ulcer can perforate into peritoneal space
    • Pancreas may be affected
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16
Q
  • Vagotomy:
  • Types
  • What is it used to treat?
A
  • GERD
  • Truncal: Removes all nerves of the stomach and other portions of the GI tract
  • Selective Gastric: Just stomach
  • Selective Proximal: Proximal part of the stomach
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17
Q
  • Random histo question: Where are parietal cells located in the stomach? what do they do?
A
  • Fundus and body of the stomach
  • Secrete HCl
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18
Q
  • The duodenum is located on the _ plane (L3)
A
  • Subcostal
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19
Q
  • The 1st part of the duodenum is _ and the rest is _ (in terms of peritoneum)
A
  • Peritoneal
  • Retroperitoneal
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20
Q
  • Which artery is an area of concern for stab/gunshot wound victims stabbed near the duodenum?
A
  • Superior mesenteric artery
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21
Q
  • The Ligament of Treitz is a _ muscle
  • What is its function?
A
  • Suspensory
  • Separates upper and lower GI tract
  • Connects Diaphragm to Duodenum
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22
Q
  • Anterior relationship to superior duodenum
  • Posterior
  • Medial
  • Superior
  • Inferior
  • Lateral
A
  • Anterior
    • Peritoneum
    • Gallbladder
    • Quadrate lobe of liver
  • Posterior
    • Bile duct
    • Gastroduodenal Artery
    • Hepatic Portal Vein
    • IVC
  • Medial
    • Pylorus
  • Superior
    • Neck of Gallbladder
  • Inferior
    • Neck of Pancreas
  • Vertebral Level
    • L1
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23
Q
  • Descending duodenum:
  • Anterior relationship
  • Posterior relationship
  • Medial relationship
  • Superior relationship
  • Inferior relationship
  • Vertebral Level
A
  • Anterior
    • ​Transverse colon
    • Transverse mesocolon
    • Coils of small intestine
  • Posterior
    • ​Hilum of right kidney
    • Renal vessels
    • Ureter
    • Psoas Major
  • Medial
    • ​Head of Pancreas
    • Pancreatic duct
    • Bile Duct
  • Superior
    • ​Superior part of duodenum
  • Inferior
    • ​Inferior part of duodenum
  • Vertebral Level
    • ​Right of L2-L3 (Subcostal Plane)
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24
Q
  • Inferior Duodenum relationships:
  • Anterior
  • Posterior
  • Medial
  • Superior
  • Inferior
  • Vertebral Level
A
  • Anterior
    • ​SMA
    • SMV
    • Coils of small intestine
  • Posterior
    • ​Right psoas major
    • IVC
    • Aorta
    • Right ureter
  • Superior
    • ​Head and unicate process of pancreas
    • Superior mesenteric vessels
  • Inferior
    • ​Coils of small intestine (ilium)
  • Vertebral Level
    • ​Anterior to L3
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25
* **Ascending duodenum relationships:** * Anterior * Posterior * Medial * Superior * Inferior * Vertebral Leveln
* **Anterior** * ​Beginning of root of mesentary * Coils of jejunum * **Posterior** * **​**Left psoas major * Left margin of aorta * **Medial** * **​**SMA * SMV * Unicate process of pancreas * **Superior** * **​**Body of pancreas * **Inferior** * **​**Coils of jejunum * **Vertebral Level** * **​**Left of L3 Vertebra
26
* Most of the jejunum is in the _ quadrant * Most of the ileum is in the _ quadrant * The jejunum and ileum are attached to the posterior abdominal wall via _ which starts at which spinal level _ and ends at the _ junction at L5?
* LUQ * RLQ * Mesentary * L2 * Ileocecal Junction (L5)
27
* **_Key anatomical features of the jejunum_**
* **High vascularity** * **Long vasa recta** * **Few large loops of arcades** * **_Large, tall and closely packed circular folds_** * **_Few lymphatic nodules (peyer's patches)_**
28
* **_Key anatomical features of the ileum_**
* **Less vascular** * **Short Vasa Recta** * **Many short loops of arcades** * **_Low and sparse circular folds (absent in distal part)_** * **_Many lymphatic nodules (Peyer's Patches)_**
29
* Identify the portion of the small intestine shown
* Ileum
30
* Identify the portion of the small intestine shown below
* Jejunum
31
* Identify the portion of the small intestine shown below
* Jejunum
32
* Identify the portion of the small intestine shown below
* Ileum
33
* ***_Meckel Diverticulum_***
* **Can be detected via technitium-99m scan (contain ectopic gastric or pancreatic tissue)** * **True diverticulum (contains mucosa, submucosa, and muscularis)** * **Most common congenital anomoly of GI tract** * **Most common pathological lead point for intussusception** * **Symptomatic when ectopic tissue is present** * **_Rule of 2s_**: * 2 times more likely in males * 2 inches long * 2 ft from ileocecal valve * 2% pop * _Common in first 2 years of life if symptomatic_ * _2 types of epithelium may be present_ * _Sx:_ * _​Blood per rectum_ * _Visible discomfort in RLQ_
34
* ***_Intussusception_***
* **Telescoping of proximal bowel segment into distal segment** * **_Common at iliocecal jx_** * **_Shown by Target sign on US_** * **_Mostly Children_** * **_Idopethic v. Meckel (kids) v. tumor v. adults_**
35
* Which two structures meet at the iliocecal junction? * Which spinal level and plane is this located?
* Ileum and cecal colon (large colon) * L5-Transtubercular
36
Diverticulitis can cause pain in the _ of adults
LLQ Patients also typically present with diarrhea
37
* Identify the following features of the large intestine
1) Omental appendices 2) Mesocolic tenia coli 3) Cecum 4) Haustra (**not present in patients with ulcerative colitis)**
38
* ***_Where is McBurney's Point Located? Which anatomical feature does palpation of it assess?_***
* **1/3 of the way between right ASIS and umbilicus** * **Appendix**
39
* ***_What does Murphy's sign test for?_***
* Gallbladder function * **Palpate inferior to right costal margin on inspiration and assess for discomfort**
40
* Palpation below the **left** costal margin assesses which organ?
* Spleen
41
3 of _ converge on the appendix
* Omental tenia
42
* Features of the sigmoid colon
* **Located** **From iliac fossa to S3** * **S shaped loop** * **Teniae coli terminate at the recto-sigmoid junction** * **Has long mesentary: sigmoid mesocolon** * **Most common site of _volvulus in the elderly population_**
43
* ***_Volvulus_***
* **Rotation of loop of bowel** * **Can cause constipation, ischemia, and necrosis** * **Midgut volvulus more common in infants \*(2/3 terminal duodenum to transverse colon)** * **Sigmoid volvulus more common in elderly** * **Coffee bean sign on X ray**
44
* Key features of the liver
* Largest abdominal organ * Occupies RUQ-can extend to left anterior axillary line if enlarged * **top is located at xiphisternal plane (t9)** * Will move inferiorly on inspiration which will aid palpation * **Clinical note:** * **​**When doing biopsy, go superior to 10th rib, hold exhalation so collapsed lung will not occur
45
* What are the anatomical lobes of the liver? * **What ligament separates them?** * What are the accessory lobes of the right anatomic lobe?
* Right and left (NO FUNCTIONAL SIGNIFICANCE) * **Falciform Ligament** * **Quadrate lobe** * **​Left hemi-liver** * **Caudate lobe** * **​Functionally separate**
46
* ***_What are the main ligaments of the liver?_*** * ***_What do these ligaments connect?_***
* **Falciform ligament** * **​**Connects right and left anatomic lobes * Connects liver to anterior abdominal wall * **Round ligament (Teres)****​** * **​**remnant of umbilical vein * **Ligamentum venosum** * **​**Used to be the ductus venosus that shunted blood from the fetal liver * **Hepatoduodenal Ligament** * **_​Contains the proper hepatic artery, bile duct, and portal vein_** * **_Anterior boundary of epiploic foramen_**
47
* The _ maneuver can be used to identify if a hemorrhage is coming from the proper hepatic artery or some accessory artery to the liver
* Pringle
48
* ***_FUNCTIONAL LOBES OF THE LIVER_***
* ***_Separated into right and left based on primary division of portal triad_*** * ***_EXCEPTION: Caudate lobe-receives blood from both portal bundles_*** * ***_Important for hepatic segmentectomies_***
49
\_ line goes from fundus of gallbladder superiorly to the diaphragm
* **Cantlie**
50
* ***_FUNCTIONAL LOBES OF THE LIVER (KNOW THIS)_***
51
* Key features of the gallbladder
* Between **IV and V segments of the liver** * Has fundus, body, and neck * **_Attach to common bile duct via cystic duct_**
52
* **The common bile duct meets with the _ duct and empties into the ampulla of Vater (aka the hepatopancreatic ampulla) in the second part of the duodenum**
* **pancreatic**
53
* If a gallstone or blockage occurs, which segments are affected?
* Segments proximal to the blockage
54
**Cholelithiasis**
* Gallstones * **Can lead to cholecystitis**
55
* Which population is at risk for **cholecystitis** * **How do you test for it?**
* Female, fertile, forty, fat (4 fs) * Murphy's sign * Palpate RUQ and ask patient to inhale * Sudden halt of inspiration d/t pain is (+) sign
56
**_*\_ is caused by an obstruction of the common bile duct*_**
* **_Choledocolithiasis_**
57
* ***_\_ is the obstruction of the ileocecal junction from a gallstone_***
* **Gallstone ileus** * **Basically the gallstone travels down to the ileocecal valve**
58
* Key features of the spleen
* Largest lymphatic organ * **LUQ** * **Vulnerable to blunt trauma**
59
* Relationships of the spleen: * Anterior * Posterior * Inferior * Medial
* **Anterior** * Stomach * **Posterior** * Diaphragm * Ribs 9-11 * **Inferior** * Left colic flexure * **Medial** * Left kidney
60
* ***_Ligaments of the spleen and their contents_***
* **Splenorenal ligament** * Connects spleen to kidney * **Contains splenic artery (main blood supply to the spleen)** * **Gastrosplenic ligament** * **​**Connects fundus of stomach to superior pole of spleen * **Contains short gastric arteries to supply above areas**

GI Exam 1 (10 decks)

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