Gastrointestinal Flashcards – First Aid for the USMLE STEP 1

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  • What is the foregut?
    pharynx to duodenum
  • what is the midgut?
    duodenum to transverse colon
  • what is the hind gut?
    distal transverse colon to rectum
  • what are the developmental defects of anterior abdominal wall due to failure of rostral fold closure?
    sternal defects
  • what are the developmental defects of anterior abdominal wall due to failure of lateral fold closure?
    omphalocele gastroschisis
  • what are the developmental defects of the anterior abdominal wall due to failure of caudal fold closure?
    bladder exstrophy
  • what causes duodenal atresia?
    failure to recanalize (trisomy 21)
  • "jejunal, ileal, colonic atresia due to what?"
    vascular accident (apple peel atresia)
  • what happens in midgut development during the 6th week?
    midgut herniates through umbilical ring
  • what happens in midgut development during the 10th week?
    returns to abdominal cavity and rotates around SMA
  • what are the pathologies of midgut development?
    malrotation of midgut omphalocele intestinal atresia or stenosis volvulus
  • what is gastroschisis?
    "extension of abdominal contents through abdominal folds, not covered by peritoneum"
  • what is omphalocele?
    "persistence of herniation of abdominal contents into umbilical cord, covered by peritoneum"
  • what is the most common tracheoesophageal anomaly?
    esophageal atresia with distal tracheoesophageal fistula (85%)
  • EA with distal TEF results in what?
    "drooling, choking, vomiting on first feeding TEF allows air to enter stomach (visible on CXR)"
  • "in EA with distal TEF, cyanosis is secondary to what?"
    laryngospasm (to avoid reflux associated aspiration
  • what is the clinical test for EA with distal TEF?
    failure to pass NG tube into stomach
  • what happens in congenital pyloric stenosis?
    hypertrophy of the pylorus causes obstruction
  • clinical features of pyloric stenosis?
    palpable 'olive' mass in epigastric region nonbilous projectile vomiting in at 2 weeks of age
  • treatment for pyloric stenosis?
    surgical incision
  • incidence of pyloric stenosis?
    1/600 live births more often in first born males
  • pancreas is embryologically derived from what?
    foregut
  • ventral pancreatic buds contribute to what?
    pancreatic head and main pancreatic duct
  • uncinate process of pancreas is formed by what?
    ventral bud alone
  • dorsal pancreatic bud becomes what?
    everything else: - body - tail - isthmus - accessory pancreatic duct
  • what happens in annular pancreas?
    ventral pancreatic bud abnormally encircles 2nd part of the duodenum; forms a ring of pancreatic tissue that may cause duodenal narrowing
  • what happens in pancreas divisum?
    ventral and dorsal parts fail to fuse at 8 weeks
  • "embryologically, the spleen arises where?"
    in mesentery of stomach (hence is mesodermal)
  • spleen is supplied by what?
    foregut (celiac artery)
  • retroperitoneal structures include what?
    GI stuctures that lack a mesentery and non-GI structures
  • injuries to retroperitoneal structures can cause what?
    blood or gas accumulation in retroperitoneal space
  • which are the retroperitoneal structures?
    SAD PUCKER: Suprarenal (adrenal) gland Aorta and IVC Duodenum (2nd and 3rd parts) Pancreas (except tail) Ureters Colon (descending and ascending) Kidneys Esophagus (lower 2/3) Rectum (lower 2/3)
  • what are the important GI ligaments?
    Falciform Hepatoduodenal Gastrohepatic Gastrocolic Gastrosplenic Splenorenal
  • falciform ligaments connects what?
    liver to anterior abdominal wall
  • falciform ligament contains what structures?
    ligamentum teres hepatis (derivative of fetal umbilical vein)
  • falciform ligament is derivative of what?
    ventral mesentery
  • hepatoduodenal ligament connects what?
    liver to duodenum greater and lesser sacs
  • hepatoduodenal ligament contains what structures?
    "portal triad: hepatic artery, portal vein, common bile duct"
  • what is the Pringle maneuver?
    hepatoduodenal ligament may be compressed between thumb and index finger placed in omental foramen to control bleeding
  • gastrohepatic ligament connects what?
    liver to lesser curvature of stomach
  • gastrohepatic ligament contains what structures?
    gastric arteries
  • gastrohepatic ligament separates what?
    greater and lesser sacs on the right
  • gastrohepatic ligament may be cut during surgery for what?
    to access lesser sac
  • gastrocolic ligament connects what?
    greater curvature and transverse colon
  • what are the structures contained in the gastrocolic ligament?
    gastroepiploic arteries
  • gastrocolic ligament is part of what?
    greater omentum
  • gastrosplenic ligament connects what?
    greater curvature and spleen
  • what are the structures contained in gastrosplenic ligament?
    "short gastrics, left gastroepiploic vessels"
  • gastrosplenic ligament separates what?
    greater and lesser sacs on the left
  • splenorenal ligament connects what?
    spleen to posterior abdominal wall
  • what are the structures contained in the splenorenal ligament?
    splenic artery and vein tail of pancreas
  • function of mesentery?
    binding of digestive tract to abdominal wall
  • function of mesothelium in digestive tract?
    protective coating; reduction of friction
  • function of serosa in digestive tract?
    support
  • function of the outer longitudinal muscle layer in digestive tract?
    motility
  • what is the function of the glands in the submucosal layer of the digestive tract?
    secretion
  • what is the function of the myenteric plexus in the digestive tract?
    control muscle contractions
  • what is the function of the inner circular layer of muscle in the digestive tract?
    motility
  • what is the function of the submucosal plexus in the digestive tract?
    control of secretory activity
  • what is the function of the muscularis mucosae in the digestive tract?
    mucosal motility
  • what are the layers of the gut wall from outside to inside?
    MSMS Mucosa Submucosa Muscularis externa Serosa (intraperitoneal)/Adventitia (retroperitoneal)
  • functional components of digestive tract mucosa?
    epithelium (absorption) lamina propria ( support) muscularis mucosa (motility)
  • digestive tract submucosa includes what?
    Submucosal nerve plexus (Meissner's)
  • digestive tract muscularis externa includes what?
    Myenteric nerve plexus (Aurbach's)
  • ulcers in digestive tract can extend which layers?
    "can extend into submucosa, inner or outer muscle layer"
  • erosions in digestive tract extend into which layers?
    mucosa only
  • what is the frequency of slow waves in the stomach?
    3 waves/min
  • what is the frequency of slow waves in the duodenum?
    12/ min
  • what is the frequency of slow waves in the ileum?
    8-9 waves/min
  • what is the histology of the esophagus?
    nonkeratinized stratified squamous epithelium
  • what is the histology of the stomach?
    gastric glands
  • what is the histology of the duodenum?
    Villi and microvilli (increase) absorptive surface. Brunner's glands (submucosa) and crypts of Liberkuhn
  • what is the histology of the jejunum?
    Plicae circulares and crypts of Lieberkuhn
  • what is the histology of the ileum?
    "Peyer's patches (lamina propria, submucosa) plicae circulares (proximal ileum) crypts of Lieberkuhn"
  • what structure has the largest number of goblet cells in the small intestine?
    ileum
  • what is the histology of the colon?
    "has crypts but no villi, numerous goblet cells"
  • vertebral level of celiac trunk branching off abdominal aorta?
    T12
  • vertebral level of the superior mesenteric artery branching from abdominal aorta?
    L1
  • vertebral level of left renal artery branching from abdominal aorta?
    L1
  • vertebral level of the inferior mesenteric artery branching from the abdominal aorta?
    L3
  • vertebral level of the bifurcation of the abdominal aorta?
    L4
  • arteries supplying GI structures branch from the abdominal aorta in what direction?
    anteriorly
  • arteries supplying non-GI structures branch from the abdominal aorta in what direction?
    laterally
  • SMA syndrome occurs when what?
    "the transverse portion (third segment) of the duodenum is entrapped between SMA and aorta, causing intestinal obstruction"
  • which artery supplies the foregut?
    celiac
  • what is the parasympathetic innervation of the foregut?
    Vagus
  • what is the vertebral level of the celiac artery?
    T12/L1
  • what are the foregut structures supplied by the celiac artery?
    "stomach to proximal duodenum; liver, gallbladder, pancreas, spleen"
  • what artery supplies the midgut?
    SMA
  • what is the parasympathetic innervation of the midgut?
    Vagus
  • what is the vertebral level of the SMA?
    L1
  • what are the midgut structures supplied by the SMA?
    distal duodenum to proximal 2/3 of transverse colon
  • what artery supplies the hindgut?
    IMA
  • what is the parasympathetic innervation of the hindgut?
    Pelvic
  • what is the vertebral level of the IMA?
    L3
  • what are the hindgut structures supplied by the IMA?
    distal 1/3 of transverse colon to upper portion of rectum; splenic flexure is a watershed region
  • what are the branches of the celiac trunk?
    common hepatic splenic left gastric
  • short gastrics have poor anastomoses if what is blocked?
    splenic artery
  • strong anastomoses exist between which distal celiac trunk branches?
    left and right gastroepiploics left and right gastrics
  • "if branches of the abdominal aorta are blocked, which arterial anastomoses compensate?"
    1. Sup. epigastric <--> inf. epigastric (external iliac) 2. sup. pancreaticoduodenal (celiac trunk) <--> inf. pancreaticoduodenal (SMA) 3. Middle colic (SMA) <--> L. colic (IMA) 4. Sup. rectal (IMA) <--> middle and inf. rectal (internal iliac)
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