Anthony Shared "Step 1 FA Gastrointestinal" - 166 Picmonics

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Step 1 FA Gastrointestinal

Foregut Structures, Blood Supply and Innervation
Structures
Esophagus
Lower Respiratory Tract
Stomach
Proximal Duodenum
Liver
Gallbladder
Pancreas
Spleen
Vascular Supply
Celiac Artery
Innervation
Vagus Nerve
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2 mins
Midgut Structures, Blood Supply and Innervation
Structures
Distal Duodenum
Jejunum
Ileum
Appendix
Ascending Colon
Proximal 2/3 of Transverse Colon
Vascular Supply
Superior Mesenteric Artery
Innervation
Vagus Nerve
Lesser Splanchnic Nerve
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2 mins
Hindgut Structures, Blood Supply and Innervation
Structures
Distal 1/3 of Transverse Colon
Descending Colon
Sigmoid Colon
Rectum
Pectinate (Dentate) Line
Urogenital Sinus
Vascular Supply
Inferior Mesenteric Artery
Innervation
Lumbar Splanchnic Nerves
Pelvic Splanchnic Nerves
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2 mins
Omphalocele Vs Gastrochitis
Omphalocele
Failure of Midgut returning to abdominal cavity 
Assiociated with malformations
Gastroschisis
Protrusion
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2 mins
Congenital GI Abnormalities
Defects of anterior abdominal wall closure
Rostral fold closure: sternal defects (ectopia cordis)
Lateral fold: Omphalocele, gastroschisis
Caudal fold closure: Bladder extrophy
Duodenal Atresia
Failure to recanalize
Jejunal, Ileal, colonic atresia
Vascular accident (apple peel atresia)
Embryology
Midgut herniates through umbilical ring ~6 weeks
10th week returns to abdominal cavity
Midgut rotates counterclockwise while outside body
Pancreatic Buds Fuse around 8 Weeks
Ventral bud
Uncinate process
Dorsal Bud
Accessory pancreatic duct
Both contribute to head
Pancreas rotates around 2nd part of duodenum
Both contribute to main pancreatic duct
Failure to fuse= pancreatic divisium
Midgut malrotation--> Duodenal obstruction
Ladd's bands
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Tracheoesophageal Fistula (TEF)
Cause
Esophageal Atresia
Ends in Blind Pouch
Assessment
Coughing
Choking
Cyanosis
Drooling
Considerations
NPO
Surgical Emergency
Aspiration Pneumonia
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2 mins
Hypertrophic Pyloric Stenosis (HPS) Assessment
Mechanism
Hypertrophied Pylorus
Risk Factor
Macrolide Use
Assessment
3-6 Weeks of Age
Projectile Vomiting After Feeding
No Pain or Discomfort
Weight Loss
Dehydration
Hungry Baby
Olive Mass
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2 mins
Hypertrophic Pyloric Stenosis (HPS) Interventions
Treatment
Pyloromyotomy
Preoperative Care
Stabilize Fluid and Electrolyte Balance
Nasogastric Tube
Monitor Feeding
Postoperative Care
Start Formula or Breastfeeding Within 24 Hours
Feedings Every 4-6 hours
Full Feeding Within 2 days
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2 mins
Pancreas
Characteristics
Acinar Cells Release Digestive Enzymes
Ductal Epithelial Cells Release Bicarbonate
Islets of Langerhans
Beta Cells Release Insulin
Alpha Cells Release Glucagon
Delta Cells Release Somatostatin
Somatostatin Inhibits Alpha and Beta Cells
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3 mins
Annular pancreas and pancreatic divisum
Pancreatic divisum
pancreas with divide
failure for ventral and dorsal buds to fuse
at 8 weeks
can cause chronic abdominal pain
can cause chronic pancreatitis
mostly asymptomatic
Annular pancreas
antler pan
ventral bud forms ring around second part of duodenum
nausea/vomiting
obstruction
bilious vomiting
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Retroperitoneal organs (SADPUCKER)
SADPUCKER
S: Suprarenal glands
A: Aorta + IVC
D: Duodenum (except 1st part)
P: Pancreas (head and body)
U: Ureters + Bladder
C: Colon (ascending and descending)
K: Kidneys
E: Esophagus
R: Rectum
Secondarily Retroperitoneal
ACDC Party Down
AC: Ascending Colon
DC: Descending colon
P: Pancreas
D: Duodenum
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GI Ligaments
Falciform Ligament
Contains ligamentum teres
Ligamentum teres is derivative of fetal umbilical vein
Gastrohepatic ligament
Contains gastric vessels
Gastrohepatic ligament cut during surgery to access lesser sac
Hepatoduodenal Ligament
Contains portal triad
Gastrosplenic Ligament
Contains short gastric arteries
Contains left gastroepiploic vessels
Splenorenal Ligament
Contains splenic vessels
Contains tail of pancreas
Gastrocolic ligament
Contains epiploic arteries
Median Umbilical Ligament
Derivative of Allantois-->Urachus
Medial Umbilical ligaments
Derived from umbilical arteries
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Oral Cavity
Characteristics
Mouth
Mechanical Digestion
Salivary Amylase Begins Carbohydrate Breakdown
Lingual Lipase Begins Lipid Breakdown
Esophagus
Bolus
Peristalsis
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1 min
Small Intestine Absorption
Characteristics
Carbohydrates Undergo Active Transport
Amino Acids Undergo Active Transport
Small Lipids Undergo Passive Diffusion
Epithelial Cells
Intestinal Capillaries
Hepatic Portal Transports Nutrients
Liver
Large Lipids Transported as Chylomicrons
Lacteals Transport Chylomicrons
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2 mins
Small Intestine Digestion
Brush border enzymes
Pancreatic Enzymes are secreted via a Duct
Pancreas secretes bicarbonate
Brush Border activates Pancreatic Trypsin
Trypsin activates Chymotrypsin
Trypsin and Chymotrypsin digest Proteins
Gallbladder Releases Bile
Pancreatic Lipase breaks down Lipids
Goblet cells secrete mucus
Pancreatic Amylase breaks down Carbohydrates
Pancreatic Nucleases breakdown DNA/RNA
Digestion occurs in the Duodenum
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2 mins
Stomach Digestion
Characteristics
Chief Cells Secrete Pepsinogen
Pepsinogen Turned to Pepsin By H+
Protein Breakdown Begins
Mucous Cells Secrete Mucus and Bicarbonate
G Cells Secrete Gastrin
Gastrin Stimulates Parietal Cell HCl Release
Parietal Cells Secrete Intrinsic Factor
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2 mins
Mesenteric Ischemia
Signs and Symptoms
Severe Abdominal Pain
Bloody Diarrhea
Metabolic Acidosis
Diagnosis
Increased WBC
Increased Lactate (Lactic Acid)
X-ray
Air Within Bowel Wall
CT Angiography
Bowel Wall Edema
Treatment
Antibiotics
Emergent Surgical Intervention
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2 mins
Pectinate (dentate) line
Internal hemorrhoids
Adenocarcinoma
Superior rectal artery
Superior rectal vein
Painless hemorrhoid
Internal iliac lymph node
Squamous cell carcinoma
Painful hemorrhoid
Inferior rectal artery
Inferior rectal vein
External hemorrhoid
Anal fissure
Superficial inguinal lymph drainage
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Types of Hernias
Hiatal
Gastroesophageal Reflux Disease (GERD)
Inguinal
Men
Femoral
Women
Incisional
Umbilical
Consideration
Strangulation
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1 min
Hernia Interventions
Reduce Intra Abdominal Pressure
Avoid Straining and Lifting
Open Mouth Sneezing
Excision
Herniorrhaphy
Hernioplasty
Consideration
Scrotal Support
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1 min

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