Ch 13 GI Tract

digestive tract, AKA

alimentary tract

digestive tract is ________ long

8cm

part of the system that is below the diaphragm

Gastrointestinal tract

most proximal portion of the digestive system

mouth

parts of the digestive system

mouth, pharynx, esophagus, stomach, small intestine, large intestine/colon

extends from pharynx through the thoracic cavity, passes inferiorly through the diaphragm, and empties into the stomach

esophagus

distal esophagus attaches to the stomach =

gastoesophageal junction (GE junction)

Supporting ligaments:

gastrohepatic of the lesser omentum

lesser curvature of the stomach

Supporting ligaments:

greater omentum, gastrophrenic, gastrosplenic, linenorenal ligaments

greater curvature of the stomach

3 parts of stomach

fundus, body, pylorus

connects stomach to proximal duodenum

pylorus

mucosa and submucosa folds are called

rugae

small intestine measurements

5cm long

4cm in diameter

first part of small intestine is __________

proximal

the duodenum

C shaped

duodenum 4 parts:

1. superior

2. descending

3. transverse

4. ascending

included in small intestine:

duodenum, ileum, jejunum

distal to the duodenum are the __________ and ____________ of the small intestine

jejunum

ileum

appendix is part of the _______ intestine

large

the ileum meets the_________ at the ileocecal valve in the RLQ of the abdomen

cecum/proximal colon

attaches small intestine to the posterior abdominal wall

mesentery

inner wall of small intestine is marked by circular folds of mucous membrane called

villi

large folds of mucous membrane that project into the lumen of the bowel and help slow the passage of food and increase absorption

valvulae conniventes

consists of cecum, vermiform appendix, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum

large intestine

small pouches caused by sacculation that give colon its segmented appearance

haustra

after the cecum, the colon is termed

ascending colon

inferior branch of the _______________ supplies the upper esophagus

subclavian artery

____________ supplies the mid esophagus

descending thoracic aorta

supply the lower end of the esophagus

gastric branch of the celiac axis and the left inferior phrenic artery

the ________ supplies the duodenum through its right gastric, gastroduodenal, and superior pancreatic duodenal branches

celiac axis

the ____________ artery has multiple branches to the small bowel

superior mesenteric

the _________ system parallels the _______ system and empties into the portal venous system

venous

arterial

the _________, ____________, and ________ supply both the small and large intestine

celiac, SMA, and IMA

SMA branches that feed large and small intestine

ileocolic artery

right colic artery

middle colic artery

IMA branches that feed large and small intestine

left colic artery

sigmoid artery

superior rectal artery

released by the presence of fat in the intestine and regulates GB contraction and gastric emptying

CCK

released from small bowel to stimulate the secretion of bicarbonate to decrease the acid content of the intestine

secretin

food takes _____ days to get through colon

1-3

most common laboratory data

blood in stool

_______ may be present due to chronic blood loss

anemia

elevated WBC =

infection

CEA =

carcinoembryonic antigen

increased CEA =

inflammatory bowel disease

pneumoperitoneum =

air within peritoneal cavity

visualization of the GI tract may be difficult because __________ produces an echogenic shadow

intraluminal air

pneumoperitoneum produces what on US

a blank image

bowel has ____ layers

5 layers

innermost bowel layer

mucosa

mucosa layer is (hyper/hypo)

hyperechoic

2nd bowel layer

muscularis mucosa

thickest bowel layer

submucosa

submucosa is (hyper/hypo)

hyperechoic

4th bowel layer

muscularis propria

outermost bowel layer

serosa

normal bowel should be _________ and have observable __________

compressible

peristalsis

bowel should measure less than

5mm in thickness

bowel wall produces _______ color Doppler

little to no

hyperemia =

increased blood flow

hypoechoic external rim with hyperechoic center

target or pseudokidney sign

alternating echogenic and hypoechoic bowel layers make a _________ pattern

target or bulls-eye

GE junction appears to the ______ of the midline as a bulls-eye or target shaped structure ________ to the aorta

left

anterior

duodenum can be easily outlined with

water ingestion or change in position

small bowel _______ usually be seen with US

cannot

small bowel is under _____ thick

3mm

valvulae conniventes may be seen as linear echo densities spaced 3-5mm apart known as ________ sign

keyboard

appendix is a remnant of the apex of the _______

cecum

appendix located on the abdominal wall under _____________

McBurneys point

appendix length

1-9 in

2-20cm

average 3in 9cm

appendix is held in position by a fold of __________ that forms a ___________

peritoneum

mesentery

2/3 of appendix is covered, leaving the _________ 1/3 uncovered by peritoneum

distal

artery of the appendix

ileocolic artery

ileocolic artery runs _______ of appendix

entire length

a prominent fluid-filled colon may appear as a ________

mass

technique that should be used to help determine mass from actual colon

water-edema

duplication cysts are ___________ mistakes

embryologic

lined with alimentary tract epithelium

has well developed muscular wall

is contiguous with the stomach

criteria for duplication cyst

duplication cysts may come from ___________ or _________

pancreas

duodenum

duplication cysts are usually found on ______________ of the stomach

greater curvature

Sonographic findings:

appear anechoic with a thin inner hyperechoic rim (mucosa) and outer hypoechoic rim (muscle)

duplication cyst

intragastric mass; moveable intraluminal masses of congealed ingested materials

gastric bezoar

gastric bezoar 3 categories

Trichobezoars

Phytobezoars

Concretions

hair balls in young women

Trichobezoars

vegetable matter finding

phytobezoars

inorganic materials (sand, asphalt)

concretions

Sonographic findings:

complex mass with internal mobile components

usually imaged with XR or CT over US

gastric bezoar

gastric bezoar are usually visualized with what modalities

X-ray and CT

Benign tumors of GI tract

polyp, leiomyoma

outgrowth of tissue from the gastric wall

gastric polyp

most common tumor of the stomach

Leiomyoma

5th leading cause of cancer, 3rd cause of death from cancer

gastric carcinoma

gastric carcinoma more commonly occurs in the (what part of stomach)

pylorus

_____% of gastric carcinoma occur in pylorus

_____% occur in body/fundus

50

25

Sonographic findings:

hypoechoic, irregular-shaped bulky mass

gastric carcinoma

2nd most common malignant tumor of stomach

leiomyosarcoma

most common malignant tumor of stomach

Gastric carcinoma

mets to the stomach is ______

rare

mets to stomach may come from

melanoma, lung, or breast

small bowel loop obstruction is associated with dilation of the bowel loops _________ to the site of obstruction

proximal

classified as mechanical or non-mechanical

bowel obstruction and dilation

results from bowel being physically blocked by something

mechanical obstruction and dilation

intraluminal

bowel wall lesion

extrinstic hernia

volvulus

mechanical obstruction and dilation