Gastrointestinal system SAQs PDF

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Anatomy of Anterior abdominal wall

figure 1 A

B

Figure 2

A F B C E

D Figure 3

1. List the five bony landmarks around the anterior abdominal wall. 2. List the 4 main muscles of the anterior abdominal wall 3. Which part of the skin is more vascular and has a bigger nerve supply? 4. Label all blue arrows on figure 1. 5. Describe the distribution of the superficial fascia on the anterior abdominal wall. 6. Labe; figure 2. 7. Fill in the following table: Muscle Origin Insertion Function Eternal oblique Internal oblique Tranversus Abdominis Rectus abdominis 8. Which muscles contribute to the rectal sheath anteriorly as well as posteriorly in the following regions: a. Above the costal margin b. Between the costal margin and arcurate line. c. Below the arcurate line? 9. Which two arteries are found in the rectus sheath? 10. Name the layers in front of the abdominal muscles. 11. Name the layers behind the abdominal muscles. 12. Name the three folds of the posterior abdominal wall and list their contents. 13. Which two folds are remnants of structures found in the foetus? What are they remnants of? 14. Label the arteries A-E in figure 3 that supply the anterior abdominal wall. 15. Which vein drains the upper part of the abdominal wall? 16. Which vein drains the lower part of the abdominal wall? 17. Which nerves supply the skin and muscles of the anterior abdominal wall? 18. Which nerves supply the inferior part of the abdominal wall? 19. Which structures do the male and female inguinal canal have in common? 20. Which structures are found in the male inguinal canal but not the female? 21. Which structure is found in the female inguinal canal but not the males? 22. Describe the walls of the canal: a. Anteriorly b. Posteriorly

23.

24.

25.

26. 27. 28. 29.

Anatomy of the upper GI A

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C Figure 4

figure 5

c. Roof d. Floor Describe the relations of the deep inguinal canal: a. Above b. In front and laterally c. Medially Describe the relations of the superficial inguinal canal: a. Base b. Apex c. Medially d. Laterally The spermatic cord enters through the _____________ inguinal ring and exits through the ______________ inguinal ring. Define a hernia. Define an inguinal hernia. Differentiate between a direct inguinal hernia and an indirect one. What are the boundaries of the Hesselbach’s triangle? a. Medially b. Laterally c. Anteriorly

1. What type of epithelia line the oral cavity? 2. What are the boundaries of the oral cavity: a. Superiorly b. Inferiorly c. Laterally? 3. In the oral cavity, which 5 structures are most important to examine? 4. Name the three ducts and their origins that release saliva into the oral cavity. 5. Which pharyngeal pouch does the palatine tonsil develop from? 6. Where are the palatine tonsils located? 7. What is the clinical importance of the paratonsillar vein? 8. Figure 4 shows the Waldeyer’s ring. Label the tonsil A-C found in it. 9. What structure found on the tongue does the thyroid diverticulum develop from? 10. Which nerve supplies the muscles of the tongue? Which muscle is an exception and what nerve supplies it instead? 11. What is the most major taste bud on the tongue and which nerve supplies it? 12. Which sensory nerve supplies: a. The anterior 2/3 (blue) of the tongue. b. The posterior 1/3 (yellow) of the tongue. 13. What is the widest point if the pharynx?

Figure 6

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D Figure 7

Figure 8

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14. What is the narrowest point of the pharynx? 15. What is the most common site of origin for the nasopharyngeal carcinoma? 16. What is the nasopharyngeal isthmus and what is its clinical relevance? 17. Name the three external circular muscles of the pharynx. 18. Which cranial nerves supply the pharynx? 19. Which nerve lies in the piriform fossa? 20. During anaesthesia, when the endotracheal tube is placed, to prevent anaesthetic gases from passing into the stomach explain the position in which the head must be placed. 21. What is Killian’s dehiscence? What is its relevance? 22. What level does the oesophagus start? 23. Which artery supplies the abdominal part of the oesophagus? 24. What type of venous drainage does the abdominal part of the oesophagus have? 25. List the 4 natural constructions of the oesophagus. 26. What is a hiatal hernia? 27. Describe the location of the stomach 28. What connects the stomach to the liver? 29. What structure hangs from the greater curvature of the stomach? 30. Name the artery posterior to the lesser sac. 31. List the 5 organs posterior to the lesser sac. 32. Name the two anterior relations of the stomach. 33. List 4 types of damage a perforation of a gastric ulcer in the posterior wall could result in? 34. Name the foramen that links the greater omentum to the lesser omentum. 35. What is its clinical importance? 36. What are this foramen’s boundaries? A. ANTERIORLY B. POSTERIORLY C. SUPERIORLY D. INFERIORLY 37. Label all arrows in figure 6. 38. Describe the blood supply of the stomach: a. Across the lesser curvature b. Across the greater curvature c. Across the fundus 39. Name 2 veins that drain from the stomach. 40. Why is resection of a tumour difficult around the lower part of the oesophagus and 1st part of the duodenum? 41. Label the arteries in Figure 7. 42. Which gastric nerves stimulate the secretion of gastric acid? 43. What is the level of the transpyloric plane? List 3

A

B C D G F Figure 9

E

important structures found in this plane. 44. Describe the surface anatomy of the second part of the duodenum. 45. Which 4 main vessels are related to the 3rd part of the duodenum? 46. Which part of the duodenum are you most likely to find an ulcer? Explain why. 47. Which 2 ducts are found to merge in the 2nd part of the duodenum? 48. Name the structures labelled as A, B, C,C D, E & F in Figure 9. 49. Describe the relations of the 2nd part of the duodenum: a. Retroperitonially b. Anteriorly c. Posteriorly d. Medially e. Laterally 50. Label the following arteries on figure 8 and 10. a. Coeliac trunk b. Common hepatic artery c. Gastroduodenal artery d. Right gastric artery e. Right gastro-epiploic artery f. Superior pancreatico-duodenal artery g. Inferior pancreatico-duodenal artery h. Superior mesenteric artery 51. List 4 differences between the jejunum and ileum in the table below: Ileum distal 3/5th Jejunum proximal 2/5th

Figure 10 52. 53. 54. 55. 56.

What are the two main functions of the mesentery? Name the major artery found in the mesentery. Name 2 plexuses that supply the small intestine. What is referred periumbilical pain? An alcoholic patient presented with cirrhosis and portal hypertension. He develops hematemesis due to rupture of oesophageal varices. Which part of oesophagus is involved? a. Cervical part b. Thoracic Part c. Abdominal Part 57. Which of the following arteries to stomach is a major supply and a direct branch of coeliac trunk? a. Right gastric b. Left gastric c. Left gastroduodenal

d. Right gastroduodenal

Development of the GIT Figure 11 B A C D E F

G H Figure 12

Figure 13 A

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D

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1. What layer of the germ disc does the gut develop from? What are the exceptions and where to these exceptions develop from? 2. In which direction does the developing embryo fold in? 3. What are the 3 main parts of the gut? 4. Explain the formation of the vitelline duct/vitellineintestinal duct. 5. Which layers of the mesoderm form the splanchnic and somatic mesoderm? 6. Where do the following regions begin and end: Foregut Pharyn geal gut Midgut Hindgut 7. What is a mesentery? 8. Where does the dorsal mesentery begin and end? 9. Give the names of the parts of the dorsal mesentery that cover the following organs: a. Stomach b. Duodenum c. Jejunum and ileum d. Colon 10. What is the derivative of the ventral mesentery? 11. What are the 2 divisions of the ventral mesentery? 12. List the 7 derivatives of the foregut in the digestive system. 13. Which epithelia of the mouth are a. endodermal in origin b. ectodermal in origin? 14. Where is the pharynx derived from? 15. Label figure 11 from A-H. 16. Label Figure 12. 17. Explain the development of the oesophagus. 18. Explain the rotation of the stomach. 19. How is the omental bursa space created? 20. How is the spleen connected to the posterior body wall and stomach? 21. How is the greater omentum formed? 22. Identify using the terms below A-E: A. Lesser omentum B. Falciform ligament C. Omental bursa D. Lienorenal ligament E. Gastrolienal ligament 23. Which parts of the foregut does the duodenum originate from, hence which arteries provide its blood supply? 24. Explain why the first part of the duodenum has a mesentery but the rest is fixed retroperitoneally? 25. What are the two derivatives of the liver bud? 26.

Gastric secretion and motility Figure 14

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B

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1. Which cells secrete HCl? What is the other name for these cells? 2. Which cells secrete pepsinogen? 3. Which part of the stomach is gastric secreted in? 4. Label the types of secretory cells in Figure 14 5. List the function of the following contents of the exocrine gastric juices: a. HCl (3) b. Pepsinogen c. Gastric lipase d. Intrinsic factor (what is the extrinsic factor?) e. Gastrin (3) 6. What could be the effect of gastrinomas? 7. How are B12 replacements given to patients that are totally gastrectomised or have pernicious anaemia? 8. Is fat digestion normal in the absence of gastric lipase 9. Is protein digestion impaired in the absence of pepsinogen? 10. Is iron deficiency anaemia a frequent complication of partial gastrectomy? Why? 11. Which enteric nervous system is: a. Mostly motor? b. Mostly secretory? 12. Differentiate between the effects of the P.N.S and S.N.S on the gastric system. 13. Name one chemical and one mechanical stimulus that increases gastrin secretion. 14. Name the neurotransmitter that increases vagal discharge to increase gastrin secretion. 15. Name the neurotransmitter that stimulates increased acid secretion. 16. Name two non-intestinal stimuli that inhibit gastric secretion. 17. Name 4 intestinal hormones that inhibit gastric secretion. 18. Why does the pH in plasma and urine rise after meals? 19. List 4 transporters found in the parietal cells 20. List 3 mechanisms that result in increased gastric acid secretion hence list the corresponding drugs that would reduce acid secretion. 21. Explain 3 ways in which the stomach is protected by the corrosive acid it produces. 22. What would effects of NSAIDS and steroidal drugs be on the gastric mucosa? 23. What are the stimuli and inhibitors for the following phases of secretion: a. Cephalic b. Gastric c. Intestinal 24. Name 3 other stimuli for gastric secretion. 25. What are the two types of gastric contraction? Which part of the stomach to they occur in? Explain the difference between them. 26. Why must a man without a stomach eat small frequent

meals? 27. Where is the gastric pacemaker located? 28. What is the function of the gastric pacemaker? 29. Explain how the migrating motor complex (MMC) prevents bacteria from spreading from the colon to the ileum. 30. List the 3 types of gastric motility. 31. Describe the mechanism that allows the fundus to relax after a meal. 32. Which chemicals allow circular muscles to contract? 33. Which chemicals allow longitudinal muscles to relax? 34. Describe the nervous control of peristalsis reflex. 35. What chemical in the neurones allow them to sense stretching of the oesophagus? 36. Explain how meals are emptied from the stomach. 37. State 3 factors that: a. stimulate gastric emptying b. inhibit gastric emptying. 38. List 4 types of food that slow down gastric emptying. 39. Enteric neurones are involved in _________ reflexes whereas CNS centres are involved in _________ reflexes.

Oropharyngeal and oesophageal pathologies

Figure 15

Figure 16

1. What is the strongest defence of the oral cavity? Explain how it works. 2. Differentiate between HSV1 and HSV2. 3. Describe the gross pathology of the Herpes virus. 4. Which micro-organism leaves a honey coloured crust of burst vesicles? (figure 16) 5. Name the test to diagnose herpes. 6. Describe the microscopic morphology/zap smear of the herpes virus. 7. Which drugs are most likely to cause candidiasis? 8. Who are the 3 most likely type of patients to suffer from candidiasis? 9. What is the diagnostic appearance of candidiasis? 10. What test can confirm the presence of candidiasis and its subtype? 11. How can a clinician differentiate between leukoplakia and candidiasis? 12. A patient complained of painful, recurrent, shallow, hyperaemic ulcerations. They were covered by a thin exudate. Within 7-10 days the lesions spontaneously resolved. What is the most likely diagnosis? What is the best treatment for this condition? 13. Name 3 acute causes for glossitis. 14. Name two lesions in the oral cavity that are always premalignant. 15. Define leukoplakia. 16. Name 2 differential diagnoses for leukoplakia. 17. Identify which one of figure 17 or 18 are leukoplakia or candidiasis. 18. What test can be used to differentiate between candidiasis and leukoplakia?

figure 17

19. What is the most common type of upper GI cancer? 20. Differentiate between the 2 types of carcinomas shown in figure 19 and 20. 21. Define a diverticulum. 22. Differentiate between a Zenker diverticulum and an Epiphrenic one. 23. Name 3 major risks of a hiatal hernia. 24. What is the cause of dysphagia due to solids? 25. A patient showed glossitis and oesophageal webs. What is the most likely diagnosis? 26. Which one the diagrams in figure 21 is the most common form of tracheo-oesophageal atresia? 27. Define reflux oesophagitis. 28. State 4 causes of reflux oesophagistis. 29. Explain the effect of reflux oesophagitis (3). 30. Give 3 main clinical features of reflux oesophagitis. 31. State 3 major complications of reflux oesophagitis. 32. Define Barrett’s oesophagus. 33. What is the most common complication of Barrett’s oesophagus? 34. Describe the gross pathology of Barrett’s oesophagus using figure 22.

Figure 18

Figure 19

Figure 20

Figure 21

Figure 22 35. Name one primary and one secondary motility disorder. 36. Explain the pathogenesis of Achalasia. 37. What is the most common clinical feature of Achalasia. 38. List 3 diagnostic tests for Achalasia. 39. Name the most common benign tumour is the UGIT. 40. Which gender is squamous cell carcinoma (SCC) most prevalent in? 41. Which one of the following is the most prevalent gross morphological feature of SCC? a. Polyploid b. Excavating c. Flat 42. Which part of the oesophagus does SCC mostly affect? 43. Which genetic mutation is the cause of adenocarcinoma? 44. Which part of the oesophagus does adenocarcinoma

mostly affect? Drug Therapy of Peptic Ulcer Disease and Dyspepsia Table 5 Drug MOA Side effects PPI: Omeprazole H2 receptor antagonist – cimetidine

Antacid – Aluminium hydroxide

Prostaglandin analogues misoprostol

Sucralfate

Bismuth compounds – subcitrate

Gastroduodenal Pathologies Table 6 H. pyloriCharacteristics associated

Autoimmune

1. Define a peptic ulcer. 2. Name 2 conditions that peptic ulcer disease (PUD) or (GU) is associated with. 3. How does H. pylori protect itself from the acid in the stomach? 4. How H. pylori infection results in excess acid secretion? 5. Why is the basal and nocturnal acid secretion increased in duodenal ulcers (DU) and normal/decreased in gastric ulcers (GU)? 6. Fill in the treatment approaches for various causative factors of gastric ulcers in table 5. 7. Explain how a patient on NSAIDS can suffer from gastric ulcers. 8. Give 3 types of agents that reduced gastric acid secretion and give an example of a drug for each. 9. What type of drug would you need to increase mucus secretion? Give an example. 10. Why must patients with gastric ulcers be given antibiotics also? 11. Describe the method of action of proton pump inhibitors (PPIs). 12. Fill in table 5 regarding the MOA and side effects of various drugs. 13. Which enzyme is primarily responsible for the metabolism of Omeprazole. What would a deficiency of this enzyme result in? 14. Why are patients on anticoagulants as well as PPIs at an increased risk of major cardiovascular events? 15. Why do patients taking PPIs have an increased risk of bone fracture? 16. Give an example of a sex-linked drug interaction of H2receptor antagonists. 17. A patient suffering from gastric ulcers was on PPI’s/H2receptor antagonists. Hyper-secretion reduced but shortly after the patient complained of abdominal discomfort. Explain the reason for this. 18. For patients suffering from cardiac disease, why is fluid retention worsened if prescribed antacids? 19. Why are antacids inadequate in treating for treatment of ulcer healing? 20. Which one of the drugs in table 5 is contraindicated in pregnancy? 21. Which one the drugs in table 5 is used for long-term maintenance of ulcers and prevents recurrence? 22. Which one of the drugs in table 5 also has anti-bacterial effects? 1. List 4 clinical features of gastritis. 2. What is malena? 3. Which blood cell is found in greatest number in acute gastritis?

4. 5. 6. 7.

Location on Inflammatory infiltrate Acid production Gastrin Other lesions Serology Sequelae Associations Figure 23

8. 9. 10. 11.

12. 13.

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C

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14. 15. 16. 17. 18. 19.

D Figure 24

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20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37.

State 2 main causes of an acute gastric ulcer. Describe the morphology of acute gastritis. What is a major sign of chronic gastritis? What is the most common complication of chronic gastritis? List 4 main pathogenic factors (causes) of chronic gastritis. List 3 types of chronic gastric diseases caused by H. Pylori. Which parts of the mucus is H. pylori concentrated on? List 4 factors that allow H. pylori to create an imbalance between gastroduodenal mucosal defensins and damaging the forces that overcome those defences. Name 3 methods of transmission for H. pylori. Explain how infection by H. pylori can result in an excess of acid production. Describe the gross morphology of chronic gastritis. Which blood cells are found in greatest abundance in chronic gastritis? Describe the microscopic morphology of chronic gastritis. Name 3 ways you can diagnose H. pylori infection. Name the most predominant type of autoimmune gastritis and where it occurs. Explain the reason for hypergastrinemia in autoimmune gastritis. How does AI Gastritis lead to pernicious anaemia/megaloblastic anaemia? Describe the pathogenesis of autoimmune gastric disease. Name 2 conditions associated with AI gastritis. Fill in table 6. List 3 main complications of chronic gastritis. Define peptic ulcer disease. Name 2 main causes of PUD. List three main complications of peptic ulcer disease. Which parts of the duodenum and stomach are most likely to get ulcerated. Describe the gross morphology of a peptic ulcer. Describe the microscopic morphology of a peptic ulcer. What are the features of benign ulcer? What is the greatest risk factor for gastric carcinoma? Which 2 sites of the stomach have the greatest incidences of gastric carcinoma? List 5 clinical symptoms of gastric carcinoma. Differentiated between early and advanced carcinoma. Identify the types of carcinoma in figure 23. What are the 2 types of microscopic classifications of gastric carcinoma and identify them on figure 24

Functional and Clinical Anatomy of Liver

Figure 15

Figure 16

1. Name the membrane that covers the liver 2. Describe the...