GEM Exam 1 Questions & Answers 2023/2024
what structures are affected in an intrabdominal GS wound? - ANSWER-- small bowel (50%)
- large bowel (40%)
- liver (30%)
- vasculature (25%)
foregut location and blood supply - ANSWER-- distal esophagus to the upper third of the duodenum
- celia...
- 4 major sites: esophageal varies, caput medusa (periumbilical veins), hemorrhoids, small veins of
posterior abdominal wall
veins that flow into IVC - ANSWER-renal, gonadal, iliac
- L renal vein goes directly into IVC (can get obstructed with an aneurysm in SMA)
foregut innervation - ANSWER-- sympathetics: T5-T9 go to greater splanchnic n. and synapse CELIAC
GANGLIA then have LONG branches to target organs
- PS: vagus goes to celiac plexus then follow the celiac trunk and synapses in gut plexus then has SHORT
post-synaptic fibers to target organ
midgut innervation - ANSWER-- sympathetics: T10-T12 goes to lesser/ least splanchnic nerve and
synapses in the SMG then has long branches following SMA to target organ
- PS: vagus goes to SM plexus and follows SMA to gut plexus near target organ and synapses then has
SHORT post-synaptic fibers to target
hindgut innervation - ANSWER-- sympathetics: L1-L2 goes to lumbar splanchnic nerves and goes to the
IMG then has LONG branches that follow IMA to target organ
- PS: S2-S4 goes to sup/inf hypogastric plexus and follows arteries to gut plexus where it synapses and
has SHORT post-synaptic fibers to target
RUQ pain - ANSWER-gall bladder problem
RLQ pain - ANSWER-appendix problem
LUQ pain - ANSWER-spleen problem
LLQ pain - ANSWER-possible kidney problem
,where does the esophagus have striated and smooth muscle? - ANSWER-striated m. @ pharyngeal end
and smooth m. @ gastric end
where will stomach contents pool if it gets perforated? - ANSWER-omental bursa (lesser peritoneal sac)
characteristics of jejunum - ANSWER-red, thicker walls, less fat, simple arcades, long vasa recta
characteristics of ileum - ANSWER-pink, thin walls, more fat, less plicae circulars, layered arcades, short
vasa recta
what happens @ 4 weeks gestations (2) - ANSWER-- embryo undergoes folding (cranio-caudal and
lateral)
- oropharyngeal membrane breaks down
intraperitoneal organs - ANSWER-- mobile, wrapped in mesentary
Stomach, Liver, Gallbladder, Spleen, 1st part of duodenum, Jejunum, Ileum, Appendix, Cecum (though no
mesentery)*, Transverse colon, Pancreas (just the tail!)*
secondarily retroperitoneal - ANSWER-parts are behind peritoneal membrane
-2nd, 3rd, and 4th parts of duodenum, Pancreas (all but tail), Ascending colon, Descending colon,
Rectum (superiormost)*
how does the stomach rotate? - ANSWER-90 degrees CLOCKWISE, the left vagus nerve rotates with it
(forms anterior vagal trunk)
spleen origin - ANSWER-splanchnic mesoderm
- 10% of population has accessory spleen
double bubble sign - ANSWER-classic sign for duodenal atresia
- bubbles are before AND after pylorus
- MCC: failure of recanalization (especially by biliary apparatus)
- uncommon cause: annular pancreas
- see polyhydramnios
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