GI Exam 1 > Upper GI Anatomy > Flashcards

Upper GI Anatomy Flashcards

(73 cards)

Study These Flashcards
1
Q

Basic architecture of GI wall:

A
  • Four main layers:
    1) mucosa -
    a) epithelium on basal lamina
  • stratified squamous in proximal and anal canal bu everything inbetween is simple columnar
    b) lamina propria
  • has lymphatics
  • ALL GLANDS EXCEPT DUODENAL AND ESOPHAGUS
    c) muscularis mucosae
    2) submucosa -
  • has lymphatics
  • HAS GLANDS ONLY DUODENUM AND ESOPHAGUS
    3) muscularis externa/propria
  • inner circular
  • outer longitudinal
    4) Serosa
  • esophagus has adventitia - no mesothelium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Submucosal (Meissners) Plexus:

A

a) parasympathetic postganglionic neurons and their processes and sympathetic postganglionic fibers; b) regulates:
- the activity of the muscularis mucosae,
- the secretory activity of glands, and blood flow.

**-muscular contractions, glands, and blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Myenteric (auerback’s) plexus:

A

a) parasympathetic postganglionic neurons and sympathetic postganglionic fibers;
b) regulates the activity of the muscularis externa (inbetween circular and longitudinal muscular layer)

-controls peristalsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q
  • Achalasia-
  • what happens?
  • What components involved?
  • appearance term?
A
  • distal esophagus- loss of inhibitory neurons that make up the myentic plexuc - relax the smooth muscle (hyperpolarize) after you swallow.
  • So if these nerves arent working you get a lot of contraction of distal esophagus = birds beak appearance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

*Hirschsprung disease

A

-rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Barretts Esophagus

A
  • metaplasia stratified squamous to simple columnar with goblet cells (mucous secretion for protection)
  • z-line demarcation between stomach and esophagus is not clear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How to confirm Barretts esophagus?

A

Need to see goblet cells with alcian blue stain - stains acidic muco-substances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What third of the esophagus is most likely to harbor an adenocarcinoma?

A

distal third - usually due to barretts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What third of the esophagus is most likely to harbor a squamous cell carcinoma?

A

middle third!

due to alcohol and or tobacco use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What type of esophageal cancer would most likely cause hoarseness?

A

SCC - why? Bc recurrent alryngeal nerve loops around aorta right around the middle third of the esophagus where SCC would most likely occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Esophageal constriction areas:

A

i. At level of UES (junction of esophagus with pharynx - cricopharyngeus muscle)
ii. At level of aortic arch
iii. At level of left primary (main) bronchus
iv. Diaphragmatic where esophagus passes through esophageal hiatus (level of T10) of diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Endoscopy - relationship to esophageal constrictions?

A
  • need to be cautious with constrictions to not penetrate wall of esophagus at junctions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pill esophagitis - relationship to esophageal constrictions? Age group most affected?

A
  • pills can get lodged at constriction areas = may cause irritation and inflammation
  • elderly most affected- their esophagus has less motility and decreased saliva (lubrication)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Esophageal diverticula:

1) weakness exists where in the wall?
2) name of diverticulum formed?

A
  • cricopharyngeus and thyropharyngeus muscles have a transition area between them = Killian triangle.
  • Pharyngoesophageal (Zenker’s) diverticulum (70%) - rotting food that gets stuck there or endoscopy can poke through easy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where would you ligate the inferior thyroid artery when performing a thyroidectomy?

A
  • need to maintain arterial supply to esophagus (provided by inf thyroid artery) so you need to ligate at an area AFTER the cervical branch to the esophagus has been given off.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

esophageal varicies and veins

-when?

A
  • usually with hepatic portal hypertension -liver cirrhosis
  • blood trying to get back to heart but cant go through liver = use esophageal veins so veins are huge = could burst = spitting/vomiting blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Where do lymph and metastatic cells flow more readily?

-significance of these areas of flow?

A

-in the submucosal lymphatic channels

  • submucosal lymphatics arranged longitudinally so the metastatic cells can spread far crainially and caudally
  • (neck, mediastinum, and abdominal cavity can be affected)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

lymph flow from upper third of esophagus goes..

A

to the neck LN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

lymph flow from lower 2/3 goes to?

A

to abdominal LN such as celiac LN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is a chylothorax?

A

During esophageal surgery if the thoracic duct is damaged (passes behind the esophagus) then lymph will leak into abdominal cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

gastrin secreting cells are located in? what does gastrin do?

A
  • pyloric glands

- stimulates parietal cells (in glands of fundus and body of stomach) to secrete HCl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Ulcer - stomach:

A

inflammation in the wall of the stomach that can invade all layers of the stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

If inflammation is confined to mucosa of stomach we call it a

A

erosion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Once inflammation in stomach gets into submucosa we call it a(n)?

A

ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Cause of most ulcers?
H pylori
26
How do we treat stomach ulcers that are refractory (not responding to therapy)?
- remove pylorus | - why? contain gastrin secreting cells
27
What landmark is used to distinguish body of stomach from pylorus region?
the angular notch
28
Zollinger-Ellison syndrome | -what is it? problem?
parietal cell tumor in gastrinoma triangle - secretes a lot of gastrin = a lot of HCl = really low pH = ulcers
29
Gastrinoma triangle boudaries?
- where cystic and hepatic ducts meet - where the second part of duodenum meets thrid part of duodenum - where the body/neck area of the pancreas
30
What test do you do to find zollinger-ellison syndrome/gastrinoma?
-immunocytochemistry must be positive for gastrin in tumor biopsy
31
Zollinger-ellison syndrome: | - distinguishing feature with endoscopy?
prominent rugae due to increased parietal cell mass
32
6 arteries to the stomach?
- R gastric - L gastric (branch from celiac trunk - feeds cardiac area) - R gastroomental (branch of gastroduodenal) - L gastroomental (branch of splenic) - gastruduodenal (from common hepatic a.) - splenic - fundic area via short gastric branches
33
How may gastric blood flow be provided if celiac trunk is occluded?
- Superior mesenteric connects with celiac trunk branches - inferior pancreaticoduedenal a. - anastamose with gastroduodenal branches
34
Ligation of left gastric artery? Problems?
Ligation may be a problem if left gastric is giving off a branch (usually left hepatic a instead of common hepatic a splitting into L and R hepatic a's) that feeds the liver
35
Gastric vagal innervation and ulcers - how can we use this innervation to our advantage?
- alternative to removing the pylorus | - We could denervate the vagal area supplying the BODY and FUNDUS = less stimulation of parietal cells
36
Two main nerves from the vagus that supply stomach wall?
- R vagus runs down posterior stomach --> posterior nerve or latarjet (supplies some pylorus from posterior side) - L vagus runs down anterior side of stomach - Anterior nerve of Latarjet (terminal branches to pylorus) YOU WANT TO WIPE OUT PARASYMPATHETIC TO THE BODY AND FUNDUS
37
How may gastric cancer progress to pancreatic duct obstruction?
- 2 mech: a) get cancer that penetrates the posterior wall of stomach that lays on the pancreas and invades pancreas too = potential pancreatic duct obstruction b) more common: cancer begins at distal greater curvature and spreads into R gastro-omental LNs and the cells would move into LN that are in the head of the pancreas = possible duct obstruction
38
Structural mods that increase SA in small intestines:
1) Plica circularis - 3x increase 2) villus- folded mucosa and lamina propria of mucosa - 10x increase 3) Microvillus - on each columnar cell -20x increase
39
Where are plicae circularis better developed?
duodenum and jejunum
40
What happens to small intestines in enteritis?
the plicae circulares are thickened
41
Gluten enteropathy? What happens?
Signature features: 1) enterocytes (columnar cells) are disarrayed 2) villus atrophy 3) crypts of leiberkun (sp?) (intestinal gland) hyperplasia 4) inflammation of lamina propria (swelling + immune cells)
42
How many parts to the duodenum?
4- | superior --> descending --> inferior or horizontal-->ascending
43
Part 1 of duodenum - find wht?
find duodenal ulcers - 90%
44
Ligament of treitz: does what?
Suspends duodenal flexure
45
Upper GI bleed is where?
above ligament of trietz
46
Lower GI bleed is where?
below ligament of trietz
47
Embolic occlusion in abdomen more likely to occur where?
SMA - most likely next is IMA celiac trunk is wide and comes off almost perpendicularly
48
SMA syndrome?
vascular compression of the duodenum by the SMA (lordosis needed too)
49
Intussesception - what is it?
when the proximal segment telescopes into distal segment
50
most common intussesception?
ileocolic bc of size - ileum is smaller and colon is nicely larger so good size difference for this to happen
51
most common cause of intussusception
cancer
52
most common position of appendix
retroceccal | retroileal
53
pathogenesis of appendix?
usually some poop gets stuck in the appendix and glands of appendix continue to secrete stuff = increased pressure = decrease blood flow to appendix
54
diverticula occur where?
sites of weakness in colon wall
55
what layers in a false diverticulum?
mucosa and submucosa
56
potential sites of weakness in the colon wall?
The longitudinal bands do not completely surround the colon tube - only have 3 bands of longitudinal muscle where there is no longitudinal band all you have is the circular muscle = weak parts WITH nerves and blood vessels are more weak than those without
57
How may a fissue or fistula form in IBD - Crohns?
if the inflammation penetrates all layers
58
What is a fistula?
when you get a fissure that break through the wall of another nearby organ ... so like colon into bladder or another part of the colon or whatever
59
Test for fistula bw colon and bladder?
give charcoal to eat - if charcoal shows up in urine you know you have a funky problem
60
Crohns enterocutaneous fistula is between?
intestinal segment and anterior wall of abdominal wall
61
Colon and cancer obstruction - more likely which side?
Right side -ascending and larger diameter more often cancer But Obstruction more likely left descending bc diameter is smaller
62
Which segment of the colon is most vulnerable to ischemia?
Critical point of griffiths - splenic flexure - the arteries are narrowest here
63
Where would you ligate the IMA in open repair of an AAA?
proximal to the arc of riolan - connects middle colic artery and something else
64
Artery the anastamoses the IMA and SMA?
marginal artery
65
Aneurism of SMA - what happens to marginal and arc of riolan arteries?
Increase in size due to increase in flow through IMA
66
Can rectum get diverticula?
NO! it has continuous layers (internal circular and longitudinal) so not much potential for weakness
67
top of the anal columns is where the?
anal canal begins
68
the distal aspect of the anal columns meets up with the?
pectinate line - and make a slight anal sinus and valve at this point
69
Inflammatory state in the anal sinus due to poop that hardens and blocks the area off?
inflammation can penetrate wall and can form abscess or fistula) bw external and internal anal sphincter - most commonly moves from anal sinus and form abscess in perianal region
70
most common fistula in anal area?
intersphincteric fistula (40%)
71
what is the anatomic basis of pancreatic tumors causing ascites and jaundice?
jaundice - pressure on common hepatic duct and backs up into liver ascites = pressure on hepatic portal = portal HTN = accumulation of fluid
72
What is riedel's lobe?
when the right lobe of the liver grows down really low into the pelvic area
73
Triangle of Calot: - reference point for? - borders:
- gallbladder removal | - cystic artery, cystic duct, common hepatic duct
GI Exam 1
flashcards
Decks in class (11)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions