Upper GI II

Question 1

What is the innervation of the stomach?

Answer 1

Left vagus nerve running posterior to the esophagus, giving rise to the anterior vagal trunk

Question 2

Which part of the vagus sits anterior to the esophagus? Posterior?

Answer 2

Left in front

Right in back

Question 3

What is the eponym for the vagus nerve on the stomach?

Answer 3

Nerve of latarjet

Question 4

What is the indication for ligating the vagal nerve to the stomach?

Answer 4

Refractory PUD since the vagal nerve increases gastrin sectretion

Question 5

Why do you want to preserve the innervation to the pylorus of the stomach during a vagotomy?

Answer 5

Lessen the dumping of food into the duodenum

Question 6

What is the nerve that is commonly missed during a vagotomy of the stomach?

Answer 6

Criminal nerve of Grassi (on the superior/posterior aspect of the stomach)

Question 7

A patient with gastric cancer also presents with obstruction of the pancreatic ducts. Why?

Answer 7

Cancer may spread through lymph node to the head of the pancreas

Cancer could grow from stomach in direction of pancreas

Question 8

What are the three structures of the small intestines that increase the surface area? (list in order)

Answer 8

Plica circularis
Villi
Microvilli

Question 9

What are the four histological signs of celiac disease?

Answer 9

a. Enterocytes are disarrayed
b. Villus atrophy
c. Crypt (intestinal gland) hyperplasia
d. Inflammation of lamina propria

Question 10

What plica circularis is a fold of what layer of the GI tract?

Answer 10

Mucosa and submucosa

Question 11

Where in the small intestines are the plica circularis not well defined?

Answer 11

Distal ileum

Question 12

Villi are fold of what layer of the GI tract?

Answer 12

Mucosa

Question 13

What is the epithelium associated with the villi?

Answer 13

Simple columnar with goblet cells

Question 14

Where are the blood vessels located within the villi? What else is in this area?

Answer 14

Lamina propria

Lacteals

Question 15

Where do most duodenal ulcers occur?

Answer 15

Ampulla

Question 16

What is the major issue with posteriorly located duodenal ulcers?

Answer 16

May penetrate through the wall and erode the gastroduodenal artery and pancreas

Question 17

What is the radiological sign of an anterior duodenal perforation?

Answer 17

AIr beneath the right hemidiaphragm

Question 18

What are the four parts of the duodenum?

Answer 18

Ampulla
Descending
Inferior (horizontal)
Ascending

Question 19

What part of the duodenum is intraperitoneal?

Answer 19

Ampulla

Question 20

What would happen if there is an ulcer on the anterior part of the duodenum?

Answer 20

Air will fill up peritoneal cavity

Question 21

What is the ligament of treitz?

Answer 21

Muscle that connects the distal duodenum to the right crus ligament, and aids in the movement of chyme from the distal duodenum to the proximal jejunum

Question 22

What vertebral level is the celiac artery at?

Answer 22

L1

Question 23

Does the celiac artery run anterior or posterior to the duodenum?

Answer 23

Anterior

Question 24

An embolus traveling down the aorta will most likely enter the SMA or the celiac trunk? Why?

Answer 24

SMA since the artery comes off obliquely

Question 25

What is the "nutcracker" aspect of the SMA that can lead to SMA syndrome?

Answer 25

If there is not enough fat between the SMA and the aorta, the angle between the two will decrease, pinching off the duodenum and causing a BO

Question 26

The common bile duct and the pancreatic duct unite where?

Answer 26

Within the wall of the 2nd part forming the hepatopancreatic ampulla

Question 27

Who usually gets intussusception? What is the most common type?

Answer 27

Children Ileum into the cecum

Question 28

What is the major issue with intussusception?

Answer 28

Infarct/necrosis

Question 29

Currant jelly appearance to the stool in a child may indicate what? What is this from?

Answer 29

Intussusception, with the stool being the sloughed off portion of the intestines

Question 30

What is Mcburney's point?

Answer 30

1/3 distance from ASIS to the umbilicus

Question 31

What is the pathogenesis of appendicitis?

Answer 31

Goblet cells secrete into the appendix, but is blocked by a fecalith

Question 32

What is the dividing landmark between the upper and lower intestines?

Answer 32

Ligament of Treitz

Question 33

What are diverticula? What are true diverticula?

Answer 33

Outpocketings of the colonic wall, with true diverticula involving the mucosa, submucosa, and muscularis externa layers

Question 34

What is the difference between "true" and "false" diverticula?

Answer 34

True = Mucosa, submucosa, and muscularis externa involvement False = Mucosa and submucosa

Question 35

What is the most common site of diverticula?

Answer 35

Sigmoid colon

Question 36

What is the modification to the GI tract muscular layer in the large intestine? What is the clinical significance of this?

Answer 36

Muscularis externa becomes a smaller, fibrous band (taenia coli), meaning that diverticula have an easier time forming

Question 37

What is the significance of the vasa recta from the marginal artery penetration of the small intestines?

Answer 37

Site of weakness for diverticula to form

Question 38

Why is the rectum spared when it comes to diverticula?

Answer 38

Tenia coli combine, and increase the strength

Question 39

Why is the most common site of diverticula formation in the 2nd part of the duodenum?

Answer 39

Where the pancreatic and bile duct penetrate the intestines

Question 40

What is Crohn's disease?

Answer 40

IBD that can involve any layer of the GI tube, and can create fistulas through the GI tract

Question 41

Which side of the larger intestines is larger? What is the clinical significance of this?

Answer 41

Right side If there is an obstruction in the left side of the intestines, it is more likely to cause an obstruction

Question 42

Which part of the intestines is more likely to produce BRBPR: left or right side?

Answer 42

Left

Question 43

What are the branches of the SMA? (4)

Answer 43

Right colic Middle colic Marginal Ileocolic

Question 44

What segment of the intestine is most susceptible to ischemia? Why?

Answer 44

The left colic flexure since the marginal artery is smallest there (point of Griffiths)

Question 45

What are the branches of the IMA? (2)

Answer 45

Left colic | Sigmoid branches

Question 46

Where would you ligate the IMA to repair a AAA?

Answer 46

Proximally in the arc of Riolan to maintain blood supply to the marginal artery

Question 47

What are the three vertices of the triangle of calot? What is the significance of this?

Answer 47

Cystic artery Cystic duct Common hepatic duct Aids in the removal of gallbladder

Question 48

How can pancreatic tumors create ascites and jaundice?

Answer 48

Tumors of the pancreatic head can place pressure on or invade the hepatic portal vein and common bile duct.

Question 49

True or false: pancreatic tumors can obstruct the pylorus of the stomach and the IVC

Answer 49

True

Question 50

What is the capsule that cover the liver and gallbladder?

Answer 50

Glisson's capsule

Question 51

What hepatic zone is the main zone of alcohol and drug metabolism?

Answer 51

Zone 3

Question 52

What is the dentate (pectinate) line?

Answer 52

Line in the rectum that changes from autonomic innervation to somatic innervation

Question 53

Almost all anorectal abscesses originate from infection of what?

Answer 53

Anal glands

Question 54

What are the structures in the abdomen that are retroperitoneal?

Answer 54

``` Suprasdrenal Aorta/IVC Duodenum Pancreas Ureters Colon (descending and ascending) Kidneys Esophagus Rectum ``` (SAD PUCKER)

Question 55

Name the layers of the GI tract from superficial to deep.

Answer 55

Serosa Muscularis externa Submucosa Mucosa

Question 56

Where are the crypts of Lieberkuhn?

Answer 56

Ileum

Question 57

Where are the peyer's patches?

Answer 57

Ileum--for immuno surveillance