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GEM Exam 1 Questions & Answers 2023/2024

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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...

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  • November 6, 2023
  • 53
  • 2023/2024
  • Exam (elaborations)
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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

- celiac trunk



midgut location and blood supply - ANSWER-- posterior 2/3 of duodenum to splenic flexure

- SMA



hindgut location and blood supply - ANSWER-- splenic flexure to pectinate line

- IMA



celiac trunk major branches - ANSWER-- left gastric, common hepatic, splenic artery, superior
pancreaticoduodenal

- sup. pancreaticoduodenal anastomoses with inf. (from SMA) which can bypass a reduction in flow of
the celiac artery



marginal artery - ANSWER-collateral circulatory loop around large intestine

- can bypass obstruction in SMA or IMA



venous drainage in hut - ANSWER-- splenic vein drains celiac

- IMV drains hindgut

- these branches meet SMV to form the hepatic portal vein which goes to the liver

,portal hypertension - ANSWER-bulging superficial veins, hemorrhoids, hematemesis (vomit blood)

- 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)*



primarily retroperitoneal - ANSWER-completely behind peritoneal membrane

- Kidneys & Ureters, Adrenal (Suprarenal) glands, Rectum (most), Anal canal



what happens at 7 weeks? - ANSWER-cloacal membrane breaks down



polyhydramnios - ANSWER-increased amniotic fluid

- seen in: double bubble, esophageal atresia, duodenal atresia

, oligohydramnios - ANSWER-decreased amniotic fluid



esophageal development and derivation - ANSWER-tracheoesophageal folds fuse then close off to form
2 tubes (trachea and esophagus)

- elongates with descent of septum transversum

- distal esophagus (smooth m.) arises from foregut (splanchnic mesoderm), remainder from pharyngeal
arch mesenchyme (striated m.)



esophageal atresia - ANSWER-esophagus stops and trachea has an extra branch (90% associated w/
trachoesophageal fistula)

- present: polyhydramnios, increased oral secretions, respiratory distress,

- dx: CXR, bronchoscopy (after failed NG tube placement)

- tx: surgical repair



greater omentum origin - ANSWER-dorsal mesentery



lesser peritoneal sac origin - ANSWER-ventral mesentery



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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