GEM Exam 1 ACTUAL UPDATED
QUESTIONS AND CORRECT ANSWERS
what structures are affected in an intrabdominal GS wound? - CORRECT ANSWERS -
small bowel (50%)
- large bowel (40%)
- liver (30%)
- vasculature (25%)
foregut location and blood supply - CORRECT ANSWERS - distal esophagus to the upper
third of the duodenum
- celiac trunk
midgut location and blood supply - CORRECT ANSWERS - posterior 2/3 of duodenum to
splenic flexure
- SMA
hindgut location and blood supply - CORRECT ANSWERS - splenic flexure to pectinate
line
- IMA
celiac trunk major branches - CORRECT ANSWERS - 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 - CORRECT ANSWERS collateral circulatory loop around large intestine
- can bypass obstruction in SMA or IMA
venous drainage in hut - CORRECT ANSWERS - splenic vein drains celiac
,- IMV drains hindgut
- these branches meet SMV to form the hepatic portal vein which goes to the liver
portal hypertension - CORRECT ANSWERS 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 - CORRECT ANSWERS renal, gonadal, iliac
- L renal vein goes directly into IVC (can get obstructed with an aneurysm in SMA)
foregut innervation - CORRECT ANSWERS - 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 - CORRECT ANSWERS - 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 - CORRECT ANSWERS - 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 - CORRECT ANSWERS gall bladder problem
RLQ pain - CORRECT ANSWERS appendix problem
,LUQ pain - CORRECT ANSWERS spleen problem
LLQ pain - CORRECT ANSWERS possible kidney problem
where does the esophagus have striated and smooth muscle? - CORRECT
ANSWERS striated m. @ pharyngeal end and smooth m. @ gastric end
where will stomach contents pool if it gets perforated? - CORRECT ANSWERS omental
bursa (lesser peritoneal sac)
characteristics of jejunum - CORRECT ANSWERS red, thicker walls, less fat, simple
arcades, long vasa recta
characteristics of ileum - CORRECT ANSWERS pink, thin walls, more fat, less plicae
circulars, layered arcades, short vasa recta
what happens @ 4 weeks gestations (2) - CORRECT ANSWERS - embryo undergoes
folding (cranio-caudal and lateral)
- oropharyngeal membrane breaks down
intraperitoneal organs - CORRECT ANSWERS - 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 - CORRECT ANSWERS parts are behind peritoneal membrane
-2nd, 3rd, and 4th parts of duodenum, Pancreas (all but tail), Ascending colon, Descending
colon, Rectum (superiormost)*
primarily retroperitoneal - CORRECT ANSWERS completely behind peritoneal
membrane
, - Kidneys & Ureters, Adrenal (Suprarenal) glands, Rectum (most), Anal canal
what happens at 7 weeks? - CORRECT ANSWERS cloacal membrane breaks down
polyhydramnios - CORRECT ANSWERS increased amniotic fluid
- seen in: double bubble, esophageal atresia, duodenal atresia
oligohydramnios - CORRECT ANSWERS decreased amniotic fluid
esophageal development and derivation - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS dorsal mesentery
lesser peritoneal sac origin - CORRECT ANSWERS ventral mesentery
how does the stomach rotate? - CORRECT ANSWERS 90 degrees CLOCKWISE, the left
vagus nerve rotates with it (forms anterior vagal trunk)
spleen origin - CORRECT ANSWERS splanchnic mesoderm
QUESTIONS AND CORRECT ANSWERS
what structures are affected in an intrabdominal GS wound? - CORRECT ANSWERS -
small bowel (50%)
- large bowel (40%)
- liver (30%)
- vasculature (25%)
foregut location and blood supply - CORRECT ANSWERS - distal esophagus to the upper
third of the duodenum
- celiac trunk
midgut location and blood supply - CORRECT ANSWERS - posterior 2/3 of duodenum to
splenic flexure
- SMA
hindgut location and blood supply - CORRECT ANSWERS - splenic flexure to pectinate
line
- IMA
celiac trunk major branches - CORRECT ANSWERS - 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 - CORRECT ANSWERS collateral circulatory loop around large intestine
- can bypass obstruction in SMA or IMA
venous drainage in hut - CORRECT ANSWERS - splenic vein drains celiac
,- IMV drains hindgut
- these branches meet SMV to form the hepatic portal vein which goes to the liver
portal hypertension - CORRECT ANSWERS 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 - CORRECT ANSWERS renal, gonadal, iliac
- L renal vein goes directly into IVC (can get obstructed with an aneurysm in SMA)
foregut innervation - CORRECT ANSWERS - 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 - CORRECT ANSWERS - 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 - CORRECT ANSWERS - 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 - CORRECT ANSWERS gall bladder problem
RLQ pain - CORRECT ANSWERS appendix problem
,LUQ pain - CORRECT ANSWERS spleen problem
LLQ pain - CORRECT ANSWERS possible kidney problem
where does the esophagus have striated and smooth muscle? - CORRECT
ANSWERS striated m. @ pharyngeal end and smooth m. @ gastric end
where will stomach contents pool if it gets perforated? - CORRECT ANSWERS omental
bursa (lesser peritoneal sac)
characteristics of jejunum - CORRECT ANSWERS red, thicker walls, less fat, simple
arcades, long vasa recta
characteristics of ileum - CORRECT ANSWERS pink, thin walls, more fat, less plicae
circulars, layered arcades, short vasa recta
what happens @ 4 weeks gestations (2) - CORRECT ANSWERS - embryo undergoes
folding (cranio-caudal and lateral)
- oropharyngeal membrane breaks down
intraperitoneal organs - CORRECT ANSWERS - 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 - CORRECT ANSWERS parts are behind peritoneal membrane
-2nd, 3rd, and 4th parts of duodenum, Pancreas (all but tail), Ascending colon, Descending
colon, Rectum (superiormost)*
primarily retroperitoneal - CORRECT ANSWERS completely behind peritoneal
membrane
, - Kidneys & Ureters, Adrenal (Suprarenal) glands, Rectum (most), Anal canal
what happens at 7 weeks? - CORRECT ANSWERS cloacal membrane breaks down
polyhydramnios - CORRECT ANSWERS increased amniotic fluid
- seen in: double bubble, esophageal atresia, duodenal atresia
oligohydramnios - CORRECT ANSWERS decreased amniotic fluid
esophageal development and derivation - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS dorsal mesentery
lesser peritoneal sac origin - CORRECT ANSWERS ventral mesentery
how does the stomach rotate? - CORRECT ANSWERS 90 degrees CLOCKWISE, the left
vagus nerve rotates with it (forms anterior vagal trunk)
spleen origin - CORRECT ANSWERS splanchnic mesoderm
