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Flashcards in GI, USMLE Deck (244)
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1
Q

Derivatives of foregut

A

Pharynx to duodenum

2
Q

Derivatives of midgut

A

Duodenum to proximal 2/3 of transverse colon

3
Q

Derivatives of hindgut

A

Distal 1/3 of transverse colon to rectum

4
Q

Developmental defects: Failure of rostral fold closure

A

Sternal defects

5
Q

Developmental defects: Failure of lateral wall closure

A

1) Omphalocele 2) Gastroschisis

6
Q

Developmental defects: Failure of caudal fold closure

A

Bladder extrophy

7
Q

Developmental defects: Failure to recanalize

A

Duodenal atresia

8
Q

Developmental defects: Duodenal atresia is seen in what genetic disorder

A

Trisomy 21

9
Q

Developmental defects: Due to vascular accident

A

Jejunal, ileal, and colonic atresia

10
Q

Developmental defects: Jejunal, ileal, and colic atresia is aka

A

Apple peel atresia

11
Q

Midgut development: Herniates through umbilical ring at

A

6th week

12
Q

Midgut development: Returns to abdominal cavity and rotates around SMA at

A

10th week

13
Q

Developmental defect: Extrusion of abdominal contents through abdominal folds, not covered by peritoneum

A

Gastroschisis

14
Q

Developmental defect: Persistence of herniation of abdominal contents into umbilical cord, covered by peritoneum

A

Omphalocele

15
Q

Gastroschisis: Constant size

A

Less than or equal to 5cm

16
Q

Derivatives of midgut

A

Duodenum to transverse colon

17
Q

Tracheoesophageal anomalies: Most common

A

EA with distal TEF

18
Q

Gastroschisis: Constant location

A

Right of the umbilical cord

19
Q

Retroperitoneal structures

A

SAD PUCKER 1) Suprarenal gland 2) Aorta and IVC 3) Duodenum (2nd, 3rd, and 4th parts) 4) Pancreas (except tail) 5) Ureters 6) Colon (ascending and descending) 7) Kidneys 8) Esophagus (lower 2/3) 9) Rectum (upper 2/3)

20
Q

Pentalogy of Cantrell

A

1) Epigastric omphalocele 2) Cleft sternum 3) Anterior diaphragmatic hernia (Morgagni) 4) Absent pericardium 5) Cardiac defects (ectopia cordis/VSD)

21
Q

Tracheoesophageal anomalies: Most common

A

EA with distal TEF

22
Q

Tracheoesophageal anomalies: EA with distal TEF, signs

A

1) Drooling with first feeding 2) Cyanosis secondary to laryngospasm 3) Abdominal gas

23
Q

Tracheoesophageal anomalies: EA with distal TEF, clinical test

A

Failure to pass NGT into stomach

24
Q

Palpable olive in epigastric region

A

Hypertrophic pyloric stenosis

25
Q

Hypertrophic pyloric stenosis: Characteristics of vomitus

A

Non-bilous, projectile, at 2 weeks of age

26
Q

Hypertrophic pyloric stenosis: Treatment

A

Surgical incision

27
Q

Pancreas: Derived from

A

Foregut

28
Q

Ligaments: Gastrocolic ligament connects

A

Greater curvature of stomach and transverse colon

29
Q

Pancreas: Ventral pancreatic bud abnormally encircles 2nd part of duodenum and may cause duodenal narrowing

A

Annular pancreas

30
Q

Pancreas: Ventral and dorsal parts fail to fuse at 8 weeks

A

Pancreas divisum

31
Q

Spleen: Derived from

A

Mesoderm

32
Q

Blood supply: Foregut

A

Celiac artery

33
Q

Blood supply: Midgut

A

SMA

34
Q

Blood supply: Hindgut

A

IMA

35
Q

Ligaments: Connects liver to anterior abdominal wall

A

Falciform ligament

36
Q

Ligaments: Falciform ligament, content

A

Ligamentum teres hepatis

37
Q

Ligaments: Connects liver to duodenum

A

Hepatoduodenal ligament

38
Q

Ligaments: Hepatoduodenal ligament, contents

A

Portal triad

39
Q

Portal triad

A

1) Portal vein 2) Hepatic artery 3) Common bile duct

40
Q

Ligaments: Hepatoduodenal ligament, compressed between thumb and index finger in the omental foramen to stop bleeding

A

Pringle maneuver

41
Q

Ligaments: Liver to lesser curvature of stomach

A

Gastrohepatic ligament

42
Q

Ligaments: Gastrocolic ligament connects

A

Greater curvature of stomach and transverse colon

43
Q

Ligaments: Gastrocolic ligament, content

A

Gastroepiploic arteries

44
Q

Ligaments: Gastrosplenic ligament connects

A

Greater curvature of stomach and spleen

45
Q

Ligaments: Gastrosplenic ligament, content

A

1) Short gastrics 2) Left gastroepiploic vessels

46
Q

Ligaments: Spleen to posterior abdominal wall

A

Splenorenal ligament

47
Q

Ligaments: Splenorenal ligament, contents

A

1) Splenic artery and vein 2) Tail of pancreas

48
Q

Derivatives of ventral pancreatic bud

A

1) Head 2) Main pancreatic duct 3) Uncinate process

49
Q

Layers of gut wall: Erosion extends up to

A

Mucosa

50
Q

Layers of gut wall: Ulcer extends up to

A

Submucosa

51
Q

Frequency of slow waves: Duodenum

A

12/min

52
Q

Frequency of slow waves: Ileum

A

8-9/min

53
Q

Histology: Esophagus

A

Nonkeratinizing stratified squamous epithelium

54
Q

Histology: Stomach

A

Gastric glands

55
Q

Histology: Duodenum

A

Villi and microvilli

56
Q

Histology: Location of Brunner’s glands

A

Submucosa of duodenum

57
Q

Histology: Location of crypts of Leiberkuhn

A

1) Duodenum 2) Jejunum 3) Ileum

58
Q

Histology: Plica circulares

A

1) Jejunum 2) Proximal ileum

59
Q

Histology: Peyer’s patches

A

Lamina propria and submucosa of ileum

60
Q

Histology: Contains largest number of goblet cells in the INTESTINE

A

Ileum

61
Q

Histology: Colon

A

1) Crypts without villi 2) Goblet cells

62
Q

Branches of abdominal aorta in order downwards (10)

A

1) Inferior phrenic artery 2) Celiac trunk 3) Left middle suprarenal artery 4) SMA 5) Right and left renal arteries 6) Left testicular/ovarian artery 7) Right testicular/ovarian artery 8) IMA 9) Bifurcation: Left and right common iliac 10) Median sacral artery

63
Q

Transverse portion of duodenum (3rd part) is entrapped between SMA and aorta causing intestinal obstruction

A

SMA syndrome

64
Q

Vertebral levels: Celiac trunk

A

T12

65
Q

Vertebral levels: SMA

A

L1

66
Q

Vertebral levels: Left renal artery

A

L1

67
Q

Vertebral levels: IMA

A

L3

68
Q

Vertebral levels: Bifurcation of abdominal aorta

A

L4

69
Q

Watershed region

A

Splenic flexure

70
Q

Main blood supply of stomach

A

Celiac trunk

71
Q

Branches of celiac trunk

A

1) Common hepatic 2) Splenic 3) Left gastric

72
Q

Sites of portosystemic anastomoses

A

1) Esophagus 2) Umbilicus 3) Rectum

73
Q

Clinical signs of portal hypertension based on anastomoses

A

1) Esophageal varices 2) Caput medusae 3) Internal hemorrhoids

74
Q

Portal-systemic: Esophagus

A

Left gastric-esophageal

75
Q

Portal-systemic: Umbilicus

A

Paraumbilical-superficial and inferior epigastric, superior epigastric, lateral thoracic

76
Q

Portal-systemic: Rectum

A

Superior rectal-middle and inferior rectal

77
Q

Portal hypertension, management: Shunts blood to systemic circulation

A

TIPS

78
Q

Hindgut: Derived from

A

Endoderm

79
Q

Where endoderm and ectoderm meet

A

Pectinate/dentate line

80
Q

Above pectinate line: Internal vs external hemorhhoids

A

Internal

81
Q

Above pectinate line: Arterial supply

A

Superior rectal from IMA

82
Q

Above pectinate line: Venous drainage

A

Superior rectal- Inferior mesenteric - Portal system

83
Q

Above pectinate line: Lymphatic drainage

A

Deep nodes

84
Q

Above pectinate line: Carcinoma

A

Adenocarcinoma

85
Q

Below pectinate line: Internal vs external hemorrhoids

A

External

86
Q

Below pectinate line: Carcinoma

A

Squamous cell carcinoma

87
Q

Below pectinate line: Arterial supply

A

Inferior rectal from internal pudendal

88
Q

Below pectinate line: Venous drainage

A

Inferior rectal-internal pudendal-internal iliac-IVC

89
Q

Below pectinate line: Lympatic drainage

A

Superificial inguinal nodes

90
Q

Innervation: Internal hemorrhoids

A

Visceral

91
Q

Innervation: External hemorrhoids

A

Somatic

92
Q

Apical surface of hepatocytes face

A

Bile cannaliculi

93
Q

Basolateral surface of canaliculi face

A

Sinusoids

94
Q

Liver: Sinusoids drain into

A

Central vein

95
Q

Liver: Central vein drains into

A

Hepatic veins-systemic circulation

96
Q

Liver: Zones

A

1) I, periportal 2) II, intermediate 3) III, pericentral vein or centrilobular

97
Q

Liver: Blood flow through zones

A

I-II-III

98
Q

Liver: Bile flow through zones

A

III-II-I

99
Q

Liver zone: Affected first by ischemia

A

Zone III

100
Q

Liver zone: Contains P450 system

A

Zone III

101
Q

Liver zone: Most sensitive to toxic injury

A

Zone III

102
Q

Liver zone: Site of alcohol hepatitis

A

Zone III

103
Q

Biliary structures: Common hepatic duct is formed by

A

Right and left hepatic ducts

104
Q

Biliary structures: Cystic duct branches from

A

Common hepatic duct

105
Q

Biliary structures: Common bile duct is formed by

A

Cystic duct and common hepatic duct

106
Q

Biliary structures: Common bile duct and pancreatic duct have a common opening called

A

Ampulla of Vater

107
Q

Diaphragmatic hernia: Most common

A

Hiatal (through the oesophageal hiatus)

108
Q

Diaphragmatic hernia: Most common hiatal hernia

A

Sliding hiatal hernia

109
Q

Diaphragmatic hernia: Stomach in sliding hiatal hernia

A

Hourglass stomach

110
Q

Diaphragmatic hernia: Displaced upward in sliding hiatal hernia

A

GE junction

111
Q

Diaphragmatic hernia: Displaced upward in paraesophageal hernia

A

Fundus of stomach

112
Q

3 layers of spermatic fascia

A

1) External spermatic fascia 2) Cremasteric muscle 3) Internal spermatic fascia

113
Q

Indirect inguinal hernia: Protrudes through

A

1) Internal inguinal ring 2) External inguinal ring

114
Q

Indirect inguinal hernia: Lateral vs medial to the inferior epigastric artery

A

Lateral

115
Q

Indirect inguinal hernia: Defect

A

Failure of obliteration of processus vaginalis

116
Q

Indirect inguinal hernia: Male vs female

A

Male

117
Q

Indirect inguinal hernia: Sac covering

A

All 3 layers of spermatic fascia

118
Q

Direct inguinal hernia: Protrudes through

A

1) Hesselbach’s (inguinal) triangle in the abdominal wall 2) External inguinal ring

119
Q

Direct inguinal hernia: Sac covering

A

External spermatic fascia

120
Q

Direct inguinal hernia: Population

A

Older men

121
Q

Direct inguinal hernia: Lateral vs medial to the inferior epigastric artery

A

Medial

122
Q

Where common iliac veins come together to form IVC

A

L4-L5

123
Q

Where lymph nodules are located in the GIT wall

A

Lamina propria of mucosa

124
Q

GI Histology: Mucosal epithelium

A

Simple cuboidal/columnar

125
Q

GI Histology: Lamina propria

A

Blood and lymphatic vessels

126
Q

GI Histology: Muscularis mucosa

A

Inner circular, outer longitudinal

127
Q

GI Histology: Submucosa

A

Blood vessels, lymphatics, connective tissue, Meissner plexus

128
Q

GI Histology: Serosa

A

Connective tissue

129
Q

GI Histology: Esophagus, muscularis mucosa

A

LONGITUDINAL smooth muscle

130
Q

GI Histology: Esophagus, muscularis externa

A

1) Upper 3rd: Striated 2) Middle 3rd: Striated + smooth 3) Lower 3rd: Smooth

131
Q

GI Histology: SI mucosa

A

1) Villi and microvilli (brush border) 2) Mucus-secreting goblet cells 3) Absorptive enterocytes

132
Q

GI Histology: Frequency of villi and microvilli in SI (greatest to least)

A

Duodenum > jejunum > ileum

133
Q

GI Histology: SI (duodenum, jejunum, ileum) and LI mucosal glands

A

Crypts of Leiberkuhn

134
Q

GI Histology: Duodenal submucosa

A

Brunner glands

135
Q

Brunner glands secrete

A

Alkaline secretion (HCO3)

136
Q

Atrophy vs hypertrophy of Brunner glands: PUD

A

Hypertrophy

137
Q

GI Histology: Plicae circulares are found

A

Submucosa of jejunum and ileum

138
Q

GI Histology: Aggregates of nodules of UNENCAPSULATED lymphatic tissue

A

Peyer’s patches

139
Q

GI Histology: Where Peyer’s patches are found

A

Ileal lamina propria and submucosa

140
Q

GI Histology: Cells that overlie Peyer’s patches

A

M cells

141
Q

GI Histology: M cells, function

A

APCs

142
Q

GI Histology: Colonic mucosa

A

Smooth, devoid of villi

143
Q

GI Histology: Muscularis externa of colon

A

3 longitudinally oriented bundles, taenia coli

144
Q

GI ligaments

A
145
Q

Ligamentum teres hepatis is an embryological remnant of

A

Left umbilical vein

146
Q

A fold of peritoneum extending from stomach to adjacent abdominal organs

A

Omentum

147
Q

Double layer of peritoneum extending from liver to lesser curvature of stomach and proximal part of duodenum

A

Lesser omentum

148
Q

Lesser omentum consists of (2)

A

1) Hepatogastric ligament 2) Hepatoduodenal ligament

149
Q

Connects liver to lesser curvature of stomach

A

Hepatogastric ligament

150
Q

Hepatogastric ligament, content

A

Left and right gastric arteries

151
Q

Hepatogastric ligament, separates what 2 structures

A

Right greater and lesser sacs

152
Q

Structure that may be cut during surgery to access the lesser sac

A

Hepatogastric ligament

153
Q

Hepatoduodenal ligament, content

A

Porta hepatis

154
Q

Porta hepatis consists of

A

1) Portal vein 2) Hepatic artery 3) CBD

155
Q

Lesser sac communicates with greater sac through

A

Epiploic foramen of Winslow

156
Q

Epiploic foramen of Winslow is located where

A

Posterior to the free edge of the lesser momentum (hepatoduodenal ligament)

157
Q

A temporary cross-clamping of hepatoduodenal ligament containing portal triad at epiploic foramen (of Winslow) for control of hepatic bleeding during liver surgery or donor hepatectomy for living liver transplantation

A

Pringle maneuver

158
Q

Where index finger is passed for Pringle maneuver

A

From the greater sac, through the epiploic foramen, and into the lesser sac

159
Q

Structure compressed in the Pringle maneuver

A

Hepatic artery

160
Q

A quadruple layer of peritoneum that hangs down like an apron from the greater curvature of the stomach and proximal part of the duodenum

A

Greater omentum

161
Q

Greater momentum consists of

A

1) Gastrosplenic 2) Splenorenal 3) Gastrocolic ligaments

162
Q

Connects greater curvature of the stomach to the spleen

A

Gastrosplenic ligament

163
Q

Gastrosplenic ligament, separates what 2 structures

A

Left greater and lesser sacs

164
Q

Connects the spleen to the posterior abdominal wall

A

Splenorenal ligament

165
Q

Splenorenal ligament, runs between what 2 structures

A

1) Hilum of spleen 2) Left kidney

166
Q

Gastrocolic ligament, contents

A

Left and right gastroepiploic arteries

167
Q

Liver histology

A
168
Q

Portal vein supplies ___% of liver blood supply

A

75

169
Q

T/F Portal vein carries deoxygenated blood

A

T

170
Q

Central veins empty into

A

Sublobular veins

171
Q

Sublobular veins of the liver converge to form

A

Hepatic veins

172
Q

Pores of liver sinusoids are __nm in diameter

A

100-200

173
Q

T/F A basement membrane lies between vascular endothelium and underlying hepatocytes

A

F

174
Q

Lies between basal surfaces of hepatocytes and basal surface of endothelial cells

A

Space of Disse

175
Q

Site of exchange of materials between blood and hepatocytes

A

Space of Disse

176
Q

Functional unit of hepatic parenchyma

A

Liver acinus

177
Q

First liver cells affected by viral hepatitis

A

Cells in zone 1 (periportal)

178
Q

Liver zone that contains CY450 enzyme system

A

Zone III

179
Q

First liver cells affected by ischemia

A

Cells in zone III

180
Q

First liver cells affected by alcoholic hepatitis

A

Cells in zone III

181
Q

Liver cells most sensitive to toxic injury

A

Zone III cells

182
Q

Anal canal is divided into

A

1) Upper 2/3, visceral 2) Lower 1/3, somatic

183
Q

Anal canal: Upper 2/3 is derived from

A

Endoderm (hindgut)

184
Q

Anal canal: Lower 1/3 is derived from

A

Ectoderm (proctodeum)

185
Q

Anal canal: Location of pectinate line

A

Inferior limit of anal valves

186
Q

Anal canal, upper 2/3: Epithelial lining

A

Simple columnar

187
Q

Anal canal, upper 2/3: Lymphatic drainage

A

Internal iliac LN

188
Q

Anal canal, lower 1/3: Lining epithelium

A

Stratified squamous

189
Q

Anal canal, lower 1/3: Venous drainage

A

Inferior rectal vein > internal pudendal vein > IVC

190
Q

Anal canal, lower 1/3: Innervation

A

Inferior rectal from pudendal nerve

191
Q

Femoral sheath: ___cm deep to the inguinal ligament

A

3-4

192
Q

Femoral sheath: Contents

A

1) Femoral artery 2) Femoral vein 3) Femoral canal

193
Q

T/F Femoral canal encloses the femoral nerve

A

F

194
Q

Femoral sheath: Lateral compartment

A

Femoral artery

195
Q

Femoral sheath: Intermediate compartment

A

Femoral vein

196
Q

Femoral sheath: Medial compartment

A

Femoral canal

197
Q

Femoral canal: Contents

A

1) Loose CT 2) Fat 3) Lymphatics 4) Deep inguinal LN of Cloquet

198
Q

Base of femoral canal

A

Femoral ring (superior end)

199
Q

Femoral triangle, boundaries: Superior

A

Inguinal ligament

200
Q

Femoral triangle, boundaries: Lateral

A

Sartorius

201
Q

Femoral triangle, boundaries: Medial

A

Adductor longus

202
Q

Femoral triangle, boundaries: Floor (3)

A

PIA 1) Pectineus 2) Iliopsoas 3) Adductor longus

203
Q

Femoral triangle, boundaries: Roof

A

1) Fascia lata 2) Cribriform fascia

204
Q

Femoral triangle: Contents (Lateral to medial)

A

NAVeL 1) Femoral nerve 2) Artery 3) Vein 4) Empty 5) Lymphatics

205
Q

Internal inguinal ring: Lies in

A

Transversalis fascia

206
Q

Internal inguinal ring: Relation to inferior epigastric vessels

A

Lateral

207
Q

External inguinal ring: Shape

A

Triangular

208
Q

External inguinal ring: Lies in

A

External oblique aponeurosis

209
Q

External inguinal ring: Relation to inferior epigastric vessels

A

Medial

210
Q

External inguinal ring: Lies lateral to

A

Pubic tubercle

211
Q

Inguinal canal, boundaries: Anterior wall

A

External and internal oblique aponeuroses

212
Q

Inguinal canal, boundaries: Posterior wall

A

Transversus abdominis and transversalis fascia aponeuroses

213
Q

Inguinal canal, boundaries: Roof

A

Internal oblique and transversus abdominis

214
Q

Inguinal canal, boundaries: Floor

A

Inguinal and lacunar ligament

215
Q

Inguinal canal: Contents in males

A

FANO x 3 1) Fascia: internal spermatic, cremasteric, external spermatic 2) Arteries: Testicular, artery to vas deferens, artery to cremaster 3) Nerves: Ilioinguinal, genital branch of genitofemoral, autonomics 4) Others: Vas deferens, pampiniform plexus, testicular lymphatics

216
Q

Inguinal canal: Contents in females

A

1) Ilioinguinal nerve 2) Round ligament of uterus

217
Q

Vertebral level: Gonadal artery

A

L2 (left higher than right)

218
Q

Branches of SMA (3)

A

1) Inferior pancreaticoduodenal 2) Middle colic 3) Right colic

219
Q

Inferior pancreaticoduodenal artery supplies

A

1) Distal duodenum 2) Head of pancreas

220
Q

Middle colic artery supplies

A

Proximal 2/3 of transverse colon

221
Q

Right colic artery supplies

A

Ascending colon

222
Q

Branches of IMA (3)

A

1) Left colic 2) Sigmoid 3) Superior rectal

223
Q

Left colic artery supplies

A

1) Distal 1/3 of transverse colon 2) Descending colon

224
Q

Sigmoid artery supplies

A

1) Descending colon 2) Sigmoid colon

225
Q

Superior rectal artery supplies

A

Superior 2/3 of rectum

226
Q

Renal arteries supply

A

1) Kidneys 2) Adrenal glands

227
Q

Vessel that accompanies vas deferens

A

Testicular artery

228
Q

Ovarian artery enters what ligament

A

Suspensory ligament of the ovary

229
Q

Innervation: Foregut

A

Vagus

230
Q

Innervation: Midgut

A

Vagus

231
Q

Innervation: Hindgut

A

Pelvic

232
Q

Arterial anastomoses that compensate for abdominal aorta blockage

A

1) Superior epigastric from internal thoracic from subclavian AND Inferior epigastric from external iliac 2) Superior pancreaticoduodenal (celiac trunk) and inferior pancreaticoduodenal (SMA) 3) Superior rectal (IMA) and middle rectal artery (internal iliac)

233
Q

Celiac trunk

A
234
Q

Left gastroepiploic artery is a branch of

A

Splenic

235
Q

Right gastroepiploic artery is a branch of

A

Gastroduodenal

236
Q

Right gastric artery is a branch of

A

Hepatic artery

237
Q

Portosystemic anastomoses: Anastomose at esophagus

A

Left gastric (esophageal branch) and esophageal (branch of azygos) veins

238
Q

Portosystemic anastomoses: Anastomose at the umbilicus

A

Paraumbilical and superficial & inferior epigastric

239
Q

Portosystemic anastomoses: Anastomose at the rectum

A

Superior rectal and middle & inferior rectal

240
Q

Innervation of Meissner’s plexus

A

PSY and SY

241
Q

Innervation of Auerbach’s plexus

A

PSY and SY

242
Q

Biliary structures

A
243
Q

Largest branch of the splenic artery

A

Left gastroepiploic artery

244
Q

Largest branch of the celiac trunk

A

Splenic artery