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Step 1 12.17.12
GI I
| Question | Answer |
|---|---|
| What happens when retroperioneal structures are injured? | can cause blood or gas to accumulate in the retroperitoneal space |
| What is a mnemonic for the structures in the retroperiotoneal space? | SAD PUCKER: Suprarenal (adrenal) gland, Aorta and IVC, duodenum (2nd,3rd,4th), pancreas (except tail), ureters, descending and ascending colon, Kidneys, esophagus (lower 2/3), rectum (upper 2/3) |
| What does the falciform ligament connect and what structures does it contain? | connects liver to anterior abdominal wall, contains ligamentum teres |
| What im the embryological origin of the falciform ligament and ligamentum teres? | derivative of fetal umbilical vein |
| What does the hepatoduodenal ligament connect and what important structures odes it contain? | connects liuver to duodenum, contains the protal triad: hepatic a., portal v, common bile duct |
| What is the use of the hepatoduodenal ligament in surgery? | can be compressed by fingers placed in omental formaen to control bleeding |
| What does the gastrohepatic ligment connect and what important structures does it contain? | connects liver to lesser curvature of stomach. contains the gastric arteries |
| What does the gastrohepatic ligament separate? What is its application in surgery? | separates the right greater and lesser sacs. can be cut to access the lesser sac |
| What does the gastrocolic ligmanet connect? What important structures does it contain? | greater curvature of stomach to transverse colon. contains the gastroepiploic arteries |
| What gastrocolic ligament is a part of what larger structures? | greater omentum |
| What does the gastrosplenic ligmanet connect and what important structures does it contain? | connects greater curvature of stomach to spleen. contains the short gastrics |
| What does the gastrosplen ic ligament separate? | left grater and lesser sacs |
| What does the splenorenal ligament connect and what structures does it contain? | connects spleen to posterior abdominal wall. contains the splenic a and v |
| What are the 4 major layers of the gut wall? | Inside to outside: 1. mucosa 2. submucosa 3. muscularis externa 4. serosa/adventitia |
| What are the 3 parts of the gut mucosa and what is the role of each? | 1. epithelium (absorbtion), 2.lamina propria (suport), 3. muscularis mucosa (motility) |
| What key nerve complex lies within the gut submucosa? | submucosal nerve complex(Meissner's) |
| What key nerve complex lies within the muscularis externa? | the myenteric nerve plexus (Auerbach's) |
| What are the frequencies of the basal electric rhythym in the stomach vs duodenum vs ileum? | stomach: 3 waves/min. duodenum:12 waves/min. ileum:8-9 waves/ min |
| What is the histology of the esophagus? | nonkeratinized squamous epithelium |
| What is the histology of the stomac? | gastric glands |
| What is the histology of the duodenum? | villi and microviklli. Brunner's glands (submucosa) and crypts of Lieberkuhn |
| What is the histology of the jejunum? | jejunum has largest number of goblet cells. Plicae circulares and crypts of Lieberkuhn |
| What is the histology of the colon? | crypts but no villi |
| How do arteries supplying the GI structures vs other branch off the aorta? | GI structural arteries brach anteriorly. arteries supplying non GI structures will branch laterally |
| What level does the celiac trunk brach off the aorta? | T12 |
| What level does the left renal artery branch off of the aorta? | L1 |
| What level does the superior mesenteric artery brach off the aorta? | L1 |
| What level do the testicular or ovarian arteries brach off the aorta? | L2 |
| What level does the inferior mesenteric artery brach off the aorta? | L3 |
| What level is the bifurcation of the abdominal aorta? | L4 |
| What is the artery, parasympathetic innervation and vertebral level of the embryonic foregut? | artery: celiac. PSNSI:vagus. Vertebral level: T12/L1 |
| What structures are contained in the embryonic forgut? | stomach to the proximal duodenum, liver, gallbladder, pancreas, spleen (mesoderm) |
| What is the artery, parasympathetic innervation and vertebral level of the embryonic midgut? | Artery: SMA. PSNSI: vagus. Verterbral level: L1 |
| What structures come from the embryonic midgut? | distal duodenum to proximal 2/3 of transverse colon |
| What is the artery, parasympathetic innervation and vertebral level of the embryonic hindgut? | Artery: IMA. PSNSI: pelvic. vertebral level: L3 |
| What structures come from the embryonic hindgut? | distal 1/3 of transverse colon to upper portion of rectum; splenic flexure is a watershed region |
| What are the 3 major branches of the celiac trunk? | common hepatic, splenic, left gastric |
| What happens to the anastomoses of the short gastric aa. if the splenic artery is blocked? | they become poor |
| What are 2 key sources of anastomoses in the blood supply to the stomach? | 1. left and right epiploics 2. left and right gastrics |
| What are 4 major collateral circulations that allow for the overcoming of a blocked abdominal aorta? | 1.sup.epigastric (int. thoracic/mamillary)-->inf. epigastric (ext. illiac) 2. superior pancreaticduodenal (celiac trunk)<--> inf. pancreaticduodenal (SMA) 3. middle colic (SMA) <--> L colic (IMA) 4. sup. rectal (IMA) <--> middle rectal (internal illiac) |
| What is the anastomosis occuring at the esophagus? What clinical sign would be indicative of its engorgement? | left gastric--->esophageal. see esophageal varices |
| What is the anastomosis at the umbilicus? What is a clinical sign of its engrogement? | paraumbilical<--> superficial and inferior epigastric. see caput medusae |
| What is the anastomosis at the rectum? What is a clinical sign of its engorgement? | superior rectal---> middle and inferior rectal. see internal hemorrhoids |
| What are the 3 portosystemic anastomoses and what does their engorgement suggest? | 1. esophageal varices 2. caput medusae 3. internal hemorrhoids. their engorgement suggests portal hypertension |
| What is a percutaneuous surgical procedure to relieve portal hypertension? | transjugular intraheptic portal shunts (TIPS) between portal vein and hepatic vein |
| What forms the pectinate (dentate) line? | when the endoderm of the hindgut meets the ectoderm of the analcanal |
| What is the arterial supply and venous drainage of the area above the pectinate line? | arterial supply from superior rectal a (IMA). venous drainage to supeiror rectal vein--> inferior mesenteric vein-->portal system |
| What are 2 clinical problems associated with the area above the pectinate line? | adenocarcinoma, internal hemmoroids |
| What are 2 clinical problems associated with the area below the pectinate line? | external hemmoroids, squamous cell carcinomas |
| What is the arterial supply and venous drainage of the area below the pectinate line? | arterial supply from inferior rectal artery from internal pudenadal artery. venous drainage to inferior rectal vein-->internalpudendal venin--->internal iliac vein--->IVC |
| What is a major difference between internal and external hemmoroids? | internal are painless because they get visceral innerrvation, but external are painful because they are ectodermal and receive somatic innervation |
| What do the apical and basolateral surfaces of hepatocytes face? | apical: bile cavaliculi. basolateral: surface faces sinusoids |
| What is zone 1 of the liver? What disease affects it first? | periportal zone. first affected in viral hepatitis |
| What is zone II of the liver? | intermediate zone |
| What is zone III of the liver? what diseases affect it first? | pericentral vein zone: affected first by ischemia, contains the P-450 system, most sensitive to toxins, alcoholic hepatitis |
| What can gallstones that reach the ampulla block? | both the bile and pancreatic ducts |
| What can a tumor of the head of the pancrase obstruct? | common bile duct |
| What is a menmonic for the structures in the femoral region? | go lateral to medial to find your NAVEL: nerve-artery-vein-empty space- lymphatics |
| What does the femoral triangle contain? | fenoral vein, artery, nerve. venous near the penis |
| What does the femoral sheath contain? | contains femoral vein, artery, and canal but not the femoral nerve |
Created by:
tjs2123
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