Term
| What segments of the GI tract are Brunner's glands vs. Peyer's patches located? |
|
Definition
Brunner's = duodenum; secrete alkaline fluid to counteract acidity of chyme
Peyer's = ileum; aggregations of lymph nodules that are local sources of lymphocytes |
|
|
Term
| Which layer of the gut wall are Peyer's patches located in? |
|
Definition
|
|
Term
| Are there goblet cells in the stomach? |
|
Definition
|
|
Term
| What is secreted by foveolar cells in the stomach? |
|
Definition
Also known as surface mucous cells
Secrete a thick, alkaline mucous to prevent autodigestion |
|
|
Term
| How many layers are in the muscularis externa in the stomach? |
|
Definition
| 3 - inner oblique, middle circular, outer longitudinal |
|
|
Term
|
Definition
Gastric Pits - contain foveolar and mucous neck cells which secrete HCO3- rich mucous
Gastric Glands - have parietal, chief and enteroendocrine cells; deeper in the stomach mucosa |
|
|
Term
| Secretions from PARIETAL CELLS? |
|
Definition
1) Secrete HCl in response to presence of gastrin
2) Secrete IF to aid in B12 absorption in terminal ileum |
|
|
Term
| How to differentiate parietal vs. chief cells on microscopy? |
|
Definition
Parietal - eosinophilic, no granules, lots of mitochondria
Chief - basophilic, lots of rough ER |
|
|
Term
| Secretions from CHIEF CELLS? |
|
Definition
| Secrete pepsinogen and lipase |
|
|
Term
| Secretions from ENTEROENDOCRINE CELLS of the STOMACH? |
|
Definition
| Secrete gastrin (stimulate HCl release) and serotonin into general circulation; contain many secretory vesicles |
|
|
Term
| 5 methods of increasing SA for absorption in small intestine? |
|
Definition
1) Overall length
2) Plicae circulares - semicircular folds w/ submucosa in middle
3) Villi - finger-like proections w/ lamina propria
4) Microvilli - brushborder on enterocytes
5) Glycocalyx |
|
|
Term
| Where are Paneth cells located in the small intestine and what is their function? |
|
Definition
Located at base of Crypts of Lieberkuhn
Secrete lysozme as an antimicrobial cell
*NB: located only in small intestinal crypts, not in large intestinal crypts |
|
|
Term
| What two substances are secreted by the enteroendocrine cells of the small intestine? |
|
Definition
Secretin - control water homeostasis; regulate acid secretion by stomach and HCO3-secretion by pancreas (pH control)
CCK - stimulate GB contraction to release bile |
|
|
Term
| What portion of the gut connected to the yolk sac via the VITELLINE DUCT? |
|
Definition
|
|
Term
| Characteristics of Meckel's diverticulum? |
|
Definition
Occurs when the vitelline duct fails to close in fetus
2% incidence, 2 inches long, about 2 feet up from ileocecal junction, most commonly present at 2 yrs of age |
|
|
Term
| Differences in associations with dorsal and ventral mesenteries? |
|
Definition
Dorsal mesentery - associated with ALL 3 regions of the gut
Ventral mesentery - associated ONLY with foregut (think formation of lesser omentum) |
|
|
Term
| What is the embryological origin of the distal rectum and anal canal? |
|
Definition
|
|
Term
| Before rotations the greater vs. lesser curves of the stomach are on which sides (ventral vs. dorsal) of the developing foregut? |
|
Definition
Greater curve = dorsal
Lesser curve = ventral |
|
|
Term
| In its final position which vagus nerve (L vs. R) is on the ANTERIOR of the stomach? |
|
Definition
|
|
Term
| Which germ layer forms the parenchyma of the liver? |
|
Definition
| ENDODERM (foregut structure) |
|
|
Term
| Dorsal vs. ventral pancreatic buds? |
|
Definition
Ventral bud - from liver bud (hepatic diverticulum), forms the head and uncinate process; usually main pancreatic duct comes from ventral bud
Dorsal bud - comes from dorsal mesentery; becomes body and tail of pancreas |
|
|
Term
| Where is the lesser sac relative to the stomach? |
|
Definition
|
|
Term
| What ligament connects the spleen to the posterior wall? |
|
Definition
|
|
Term
| Which mesentery forms the falciform ligament? |
|
Definition
| VENTRAL mesentery (which also forms lesser omentum) |
|
|
Term
| Parts of the gut that are INTRAPERITONEAL? |
|
Definition
Stomach, 1st part of duodenum, jejunum, ileum
Cecum, appendix, T colon, sigmoid colon
Liver, spleen, tail of pancreas |
|
|
Term
| Parts of the gut that are seconarily retroperitoneal? |
|
Definition
2nd-4th parts of duodenum
Ascending and descending colon
Rectum
All of pancreas except for tail |
|
|
Term
|
Definition
| R crus of diaphragm + thickening of esophageal wall at level of T10 |
|
|
Term
| What two structures is the L recurrent laryngeal nerve in between? |
|
Definition
Esophagus and trachea
With hoarseness think mass in esophagus or mediastinal lymph node enlargement |
|
|
Term
| Blood supply to the esophagus |
|
Definition
Upper 1/3 = inferior thyroid
Middle 1/3 = esophageal aortic branches
Lower 1/3 = L gastric + inferior phrenic |
|
|
Term
|
Definition
Stratified squamous, usually non-keratinized
Can become keratinized in chronic smokers |
|
|
Term
|
Definition
| Level of L3 - lowermost point of the costal margins |
|
|
Term
| Intertubercular Plane VS. Transtubercular Plane |
|
Definition
Intertubercular -- L5 level, level of ischial tubercles
Transtubercular/Supracristal -- L3/4, highest points on iliac crests (about the level of umbilicus) |
|
|
Term
| _______ fascia is continuous with the fascia of the perineum (Colle's fascia) |
|
Definition
Scarpa's
Scarpa = speedo covering |
|
|
Term
| Anterior vs. posterior layer of rectus sheath? |
|
Definition
Anterior - aponeuroses of IO and EO
Posterior - aponeuroses of IO and transversus abd |
|
|
Term
| Relevance of the arcuate line with regards to rectus sheath? |
|
Definition
Inferior to the arcuate line all tendons pass anterior to the rectus abd (sits directly on transversalis fascia)
The arcuate line is also where the inferior epigastric artery enters the rectus abd |
|
|
Term
| The aponeurosis forms which two structures in the inguinal region? |
|
Definition
Inguinal ligament
Superficial inguinal ring |
|
|
Term
| Main blood supply to the anterior abdominal wall is the? |
|
Definition
Inferior epigastric artery (from external iliac)
Also supplied by superior epigastric from int thoracic |
|
|
Term
| Which nerve root does NOT enter rectus sheath? |
|
Definition
|
|
Term
| Path of ilioinguinal nerve (L1)? |
|
Definition
| Travels THROUGH superficial ring into inguinal canal |
|
|
Term
| Where do inguinal hernias pass relative to the pubic tubercle? |
|
Definition
| They pass SUPERIOR and MEDIAL to the tubercle |
|
|
Term
| What forms the deep inguinal ring? |
|
Definition
Opening of the transversalis fascia (just above mid-point of inguinal ligament)
Deep inguinal ring is LATERAL to inferior epigastric artery |
|
|
Term
| What are the boundaries of the inguinal canal? |
|
Definition
Floor - inguinal ligament
Roof - fibres of IO and transversus abd
Posterior - transversalis fascia
Anterior - EO aponeurosis |
|
|
Term
| What forms the external and internal spermatic fascia? |
|
Definition
External --> from EO
Internal --> from transversalis fascia
Recall that cremaster is from IO |
|
|
Term
|
Definition
Originates at DEEP ring
Passes THROUGH inguinal canal
Enters scrotum via superficial ring
Herniation is LATERAL to inferior epigastric |
|
|
Term
|
Definition
Originates at SUPERFICIAL ring
Does NOT pass through canal
Rarely enters scrotum
Herniation MEDIAL to inferior epigastric |
|
|
Term
|
Definition
Basically the entire peritoneal cavity proper (except for lesser sac)
Communicates w/ lesser sac via omental foramen |
|
|
Term
|
Definition
Paracolic - lateral to asc/desc colon
Paravertebral - medial to asc/desc colon |
|
|
Term
| Where is the hepatorenal recess? |
|
Definition
| In between liver and R kidney - potential space, can get fluid accumulation with ascites, hemoperitoneum |
|
|
Term
| Lymph drainage above vs. below umbilicus? |
|
Definition
Above = axillary nodes
Below = superficial inguinal nodes |
|
|
Term
| Relation of the hernia to Hasselbach's triangle? |
|
Definition
Indirect inguinal hernia = OUTSIDE of triangle, because it goes through DEEP ring
Direct inguinal hernia = INSIDE of triangle, because it is near superficial inguinal ring |
|
|
Term
| Borders of Hesselbach's triangle? |
|
Definition
Medial = linea semilunaris
Inferior = inguinal ligament
Superolateral = inferior epigastric vessels |
|
|
Term
| Patent processus vaginalis can lead to... |
|
Definition
| Typically an INDIRECT inguinal hernia |
|
|
Term
| Processus vaginalis is made of _______ |
|
Definition
|
|
Term
| The lesser omentum connects which two organs? |
|
Definition
Lesser curve of the stomach and the liver
Hepatduodenal, hepatogastric, hepatoesophageal ligaments |
|
|
Term
| What part of the duodenum contains the major duodenal papilla? |
|
Definition
| 2nd portion -- where CBD and main pancreatic duct open into the duodenum |
|
|
Term
| What is the ligament that suspends the 4th part of the duodenum from the posterior wall? |
|
Definition
| Suspensory ligament of Treitz |
|
|
Term
| Function of acinar vs. duct cells in the pancreas? |
|
Definition
Acinar - secrete panc ENZ (exocrine function)
Ductal - secrete HCO3- |
|
|
Term
| Functional unit of the exocrine pancreas? |
|
Definition
|
|
Term
| Exocrine pancreas stains __________ than islets |
|
Definition
DARKER
Acini are darker than islets in pancreas |
|
|
Term
| Pathway of the duct system in the pancreas? |
|
Definition
| Intercalated ducts to interlobar ducts to main ducts |
|
|
Term
| Epithelium in the pancreatic ducts? |
|
Definition
| Columnar epithelium - duct cells (produce HCO3) |
|
|
Term
| Secretin causes... (2 things) |
|
Definition
Release of alkaline fluid from pancreas (lots of HCO3), neutralizes stomach acid and creates optimum pH
Decreases gastrin release in stomach to indirectly slow down acid release |
|
|
Term
| Types of pancreatic proteases (4)? |
|
Definition
Trypsin
Chymotrypsin
Elastase
Carboxypeptidase |
|
|
Term
| Why do you get referred shoulder pain in inflammation of the subphrenic space? |
|
Definition
| Because I say so. Don't question me James. |
|
|
Term
| What level of the aorta does the celiac trunk branch off? |
|
Definition
T12
3 main branches - common hepatic, L gastric, splenic |
|
|
Term
| What level of the aorta does SMA branch off? |
|
Definition
| L1 (transpyloric plane level) |
|
|
Term
| What level of the aorta does the IMA branch off? |
|
Definition
|
|
Term
| What are the main branches off the SMA (proximal to distal) |
|
Definition
Inferior Pancreaticoduodenal
Middle Colic
Intestinal (multiple)
R Colic
Ileocolic |
|
|
Term
| What are the main branches off the IMA? |
|
Definition
L Colic
Sigmoid(s)
Superior Rectal |
|
|
Term
| What artery forms the main anastomosis between SMA and IMA? |
|
Definition
| Marginal Artery of Drummond |
|
|
Term
| What side of the large bowel is supplied by SMA vs. IMA? |
|
Definition
SMA = right side
IMA = left side |
|
|
Term
| What is longer jejunum or ileum? |
|
Definition
| Ileum (3/5 of remaining small bowel after duodenum) |
|
|
Term
| Difference between vasa rectae in jejunum vs ileum? |
|
Definition
Jejunal VR are LONG
Ileal VR are SHORT |
|
|
Term
| How many rows of arcades are there in the jejunum vs. the ileum? |
|
Definition
Jejunum = have 1-2 rows
Ileum = have 4-5 rows |
|
|
Term
| What delineates upper and lower GI bleeds? |
|
Definition
| The duodenojejunal flexure |
|
|
Term
| 3 distinct features of the large intestine? |
|
Definition
Haustra
Teniae Coli
Epiploic Appendages (Appendices Epiploae) |
|
|
Term
| Where is the appendix typically found? |
|
Definition
| Posterior aspect of the cecum in the RETROCECAL FOSSA |
|
|
Term
| Appendix pain is typically felt when pressure is put on what surface landmark? |
|
Definition
| McBurney's point (1/3 of distance between ASIS and umbilicus) |
|
|
Term
| When the rectum passes through the pelvic diaphragm, it becomes ______ |
|
Definition
|
|
Term
| What line delineates the upper 2/3 and lower 1/3 of the anal canal? |
|
Definition
|
|
Term
| Epithelium of upper vs. lower anal canal? |
|
Definition
Upper 2/3 = columnar epithelium
Lower 1/3 = stratified squamous |
|
|
Term
| What two "signs" may be positive in appendicitis? |
|
Definition
Psoas sign - pain when extending thigh at the hip
Obturator sign - pain when abducting thigh |
|
|
Term
| What is the sympathetic innervation to the foregut? |
|
Definition
| Greater splanchnics (T5-9); join celiac plexus |
|
|
Term
| What is the sympathetic innervation to the midgut? |
|
Definition
| Some greater splanchnics not synapsing in the celiac plexus synapse in superior mesenteric ganglia |
|
|
Term
| Parasympathetic for foregut/midgut vs. hindgut? |
|
Definition
Foregut/midgut -- vagal nerves
Hindgut -- pelvic splanchnics (S2-4) |
|
|
Term
| What is the main input for the anterior vagal trunk? |
|
Definition
L vagus
**NB - L vagus is on ANTERIOR side of the stomach, so makes sense |
|
|
Term
| What is the main input for the posterior vagal trunk? |
|
Definition
R vagus
**NB - R vagus is on POSTERIOR aspect of stomach |
|
|
Term
| Where does the vagus nerve enter the abdomen? |
|
Definition
| Via the esophageal hiatus in the diaphragm |
|
|
Term
| How do the pelvic splanchnics reach the hindgut and what nerve roots are they? |
|
Definition
They are nerve roots S2-S4
Reach hindgut via the pelvic/inferior hypogastric plexus |
|
|
Term
| How can one describe "visceral pain"? |
|
Definition
| Poorly defined, vague, poorly localized pain in the abdomen |
|
|
Term
| Difference between somatic and visceral pain |
|
Definition
Somatic - well described and defined, sharp pain
Visceral - dull pain, poorly localized |
|
|
Term
| In acute appendicitis, where is the referred pain typically? |
|
Definition
|
|
Term
| What type of pain would be caused by peritonitis of the anterior abdominal wall? |
|
Definition
|
|
Term
| What are the 3 groups of nodes involved in lymph drainage of the GI tract? |
|
Definition
Primary Peripheral Nodes - next to gut wall
Intermediate Nodes - along arterial branches (e.g. middle colic)
Central Nodes - along MAIN trunks (SMA, IMA) |
|
|
Term
| Describe the drainage of lymph in the stomach |
|
Definition
Drainage depends on whether you are to the R or L of an imaginary line drawn on the anterior aspect, parallel to the greater curvature
If to the R -- drain to regional nodes on lesser curve
If to the L -- drain to L and R gastroepiploic, splenic nodes
Eventually, all drains into celiac nodes (central nodes) |
|
|
Term
| What ligament separates the two lobes of the liver? What mesentery is its origin? |
|
Definition
Falciform ligament
Comes from the ventral mesentery (is an embryological remnant from the umbilical vein) |
|
|
Term
| What two ligaments does the falciform ligament split into on the liver's superior diaphragmatic surface? |
|
Definition
Becomes the L and R coronary ligaments (
"crown ligaments") |
|
|
Term
| What is the ligamentum teres and where is it located? |
|
Definition
It is the embryological umbilical vein
Located on the visceral aspect of the liver, to the L of the quadrate lobe and gall bladder |
|
|
Term
| The gall bladder is immediately to the R of which liver lobe? |
|
Definition
|
|
Term
| Anatomically, the quadrate and caudate lobes appear to be part of the _____ lobe |
|
Definition
Right lobe of the liver
BUT, functionally they have same blood supply and drainage as the L lobe |
|
|
Term
| Which 3 vessels are located at the porta hepatis? |
|
Definition
| The CBD, the hepatic artery proper, the portal vein |
|
|
Term
| Which omentum is attached inferiorly to the porta hepatis? |
|
Definition
|
|
Term
| What is the H-zone of the liver? |
|
Definition
On the left side -- the ligamentum venosum superiorly, ligamentum teres inferiorly
On the R side -- line connecting IVC to GB
Joined by a horizontal line crossing the porta hepatis |
|
|
Term
| What is "Pringle's maneuver"? |
|
Definition
Clamping off the hepatoduodenal ligament (lesser omentum) to prevent blood flow to the liver
Done because all 3 vessels in the porta hepatis are located within this ligament |
|
|
Term
| What are the 3 main branches off the celiac trunk from R to L? |
|
Definition
Common Hepatic (R)
Splenic (mid)
L Gastric (L) |
|
|
Term
| Where is the hepatic artery relative to the portal vein at the hilum? |
|
Definition
| Hepatic artery proper passes ANTERIOR to the portal vein at the porta hepatis |
|
|
Term
| What are the main branches off of the common hepatic artery? |
|
Definition
Hepatic Artery proper
Gastroduodenal
R Gastric
R Gastroepiploic - branched from gastroduodenal |
|
|
Term
| What is the origin of the R vs. L gastro-epiploic arteries? |
|
Definition
R = from gastroduodenal (common hepatic)
L = from splenic |
|
|
Term
| What part of the colon is particularly at risk for colonic ischemia? |
|
Definition
| Splenic flexure (watershed area) |
|
|
Term
| Where does most of the blood coming to the liver come from? |
|
Definition
| Portal vein (2/3 of the liver's total blood) |
|
|
Term
| What are the FOUR MAIN PORTO-SYSTEMIC ANASTOMOSES? |
|
Definition
Paraumbilical w/ epigastric/femoral
L Gastric Vein w/ azygos
Rectal w/ internal iliac
Intestinal veins w/ lumbar |
|
|
Term
| In portal HTN, portal venous blood can backflow into the venous system and cause certain clinical findings. Name 3 and the 3 porto-systemic anastomoses that allow this to happen. |
|
Definition
Esophageal Varices - due to L gastric + azygos shunt
Caput Medusa - due to paraumbilical + epigastric and femoral shunt
Hemorrhoids - due to rectal and internal iliac vein shunt |
|
|
Term
| Where does the gall bladder come into contact mainly with the anterior abdominal wall? |
|
Definition
At intersection point between costal arch and R linea semilunaris
Pain on palpation at this point is a positive Murphy's sign |
|
|
Term
| Difference between positive Murphy's sign vs. McBurney's sign |
|
Definition
Murphy's = checking for acute cholecystitis; point of intersection between R costal margin and R linea semilunaris
McBurney's = checking for appendicitis; 1/3 distance between R ASIS and umbilicus |
|
|
Term
| Describe the passage of bile through the biliary tree into the CBD? |
|
Definition
Stored in the gall bladder, when GB contracts, gets forced through the neck into the cystic duct
The cystic duct meets with the common hepatic duct (formed by R and L hepatic ducts) to form the CBD |
|
|
Term
| How are hepatocytes arranged in the liver? |
|
Definition
| As radial plates, surrounding central veins |
|
|
Term
|
Definition
|
|
Term
| Path of blood flow through liver (from portal vein...) |
|
Definition
| Portal vein to portal venule to sinusoid to central venule to hepatic vein |
|
|
Term
| What is the Space of Disse? |
|
Definition
| The perisinusoidal space in between the hepatocytes and sinusoids |
|
|
Term
| Where do hepatocytes secrete bile into? |
|
Definition
|
|
Term
| What are Kupffer cells and where are they located? |
|
Definition
| They are motile phagocytic cells located in the liver sinusoids; break down remnants of RBCs and other shit |
|
|
Term
| What two cells line sinusoids? |
|
Definition
Endothelium (fenestrated)
Kupffer cells (phagocytic) |
|
|
Term
| What type of epithelium is located in the GB? |
|
Definition
| Simple columnar w/ brush border |
|
|
Term
| Does the GB have a serosa? |
|
Definition
|
|
Term
| How is bile concentrated in the GB? |
|
Definition
| Pump NaCl from lumen into epithelial cells to create osmotic gradient for H2O to follow |
|
|
