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NPLEX I > Digestive System > Flashcards

Digestive System Flashcards

1
Q

Remember

A

In the vascular system, the alpha 1 receptors cause constriction
In the GI tract, they cause paralysis

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2
Q

Stylopharyngeal muscle

A

Elevated pharynx and larynx

Innervation: Glossopharyngeal nerve

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3
Q

Gingivitis

A

Gingiva = gums
-itis = inflammation
Periodontitis can occur if gingivitis is not treated

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4
Q

Periodontitis

A

Peri = around
don = tooth
-itis = inflammtion
Inflammation and destruction of structures around the teeth
or
Inflammation in periodontal ligament, alveolar bone, cementum of teeth

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5
Q

What is the hardest substance in the human body?

A

Enamel

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6
Q

Herpes simplex virus

A

Some people have symptoms and some not
Mouth and genitals are areas affected
Two types: HSV1 and HSV2
HSV1 affects the mouth usually and HSV2 affects below the waist usually
Herpes virus very typically settles inside the ganglia of the face and close to the genitals for LIFE!

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7
Q

Oral and genital herpes

A

Primary infection is often asymptomatic
When it does cause symptoms:
- Usually affects children
- Causes lesions, with fever and enlarged lymph nodes

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8
Q

Leukoplakia

A

condition in which one or more white patches or spots (lesions) forms inside the mouth. Leukoplakia is different from other causes of white patches such as thrush or lichen planus because it can eventually develop into oral cancer.

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9
Q

Pharyngitis

A

Concomitant with viral upper resp. infection.

Bacterial cause often beta-hemolytic strep

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10
Q

Squamous Cell carcinoma

A

Smoking
Tend to grow silently until become unresectable
Spread to cervical LN or elsewhere

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11
Q

Hiatal hernia

A

95% are sliding type - meaning they are accustomed to moving based on pressure.
Often due to increased abdominal pressure
Results in GERD

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12
Q

Esophageal varices

A

Secondary to portal hypertension, alcoholic cirrhosis

Distal esophagus and proximal stomach, asymptomatic until rupture

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13
Q

Esophagitis: GERD

A

Irritation, alcohol, food intolerance, infections
Decreased lower esophageal tone - hematemesis (vomiting blood) in worst cases.
Sequele is Barret’s esophagus = metaplasia of the distal esophagus
Squamous cells convert to columnar gastric cells
Sequele = adenocarcinoma

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14
Q

Squamous Cell Carcinoma

A

Alcohol, smoking, fungal, nitrosamine containing foods

Zinc and other vitamin and mineral deficiencies may predispose

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15
Q

What ar the parts of the stomach?

A

Cardiac and pyloric sphincters, lesser and greater omentum, fundus, greater and lesser curvature, body, musculature: internal, circular, longituginal

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16
Q

What are the parts of the stomach?

A

Cardiac and pyloric sphincters, lesser and greater omentum, fundus, greater and lesser curvature, body, musculature: internal, circular, longitudinal

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17
Q

What are the attachments of the stomach?

A

Lesser omentum

Greater omentum

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18
Q

What artery supplies the stomach?

A

Arteries derived from the CELIAC trunk

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19
Q

Acute gastritis

A

Acute gastritis is a sudden inflammation or swelling in the lining of the stomach
NSAIDs, ETOH, smoking, stress, idiopathic
Erosion of superficial epithelium, ulcer-like pain

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20
Q

Chronic gastritis

A

Often without erosions
Autoimmune cause of loss of parietal cells and intrinsic factor
H. pylori, hypo/ achlorhydria, B12 deficiency
Most are asymptomatic or smoldering

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21
Q

Hypochlorhydria

A

Chronic gastritis leading to atrophy of fundal mucosa cells.
Immune-mediated destruction of parietal cells
Associated with:
Hashimoto’s thyroiditis, Addison’s; B12 def, macrocytic anemia

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22
Q

Gastric ulcer

A

25% of all peptic ulcer diseases (PUD)
Male = female
H. pylori ~ 75% of cases
- Blood type A, NSAIDS, SMOKING, Bile reflux
Lesser curvature
COmplications: Perforation and bleeding
Burning epigastric pain post-eating. Pain WORSE with food.

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23
Q

Duodenal Ulcer

A

75% of all PUD
Male/Female 2:1
Burning epigastric pain, 1-3 hours after eating BETTER EATING
H. pylori > 90% of cases

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24
Q

Gastric carcinoma (cancer)

A

Always in DDX of gastritis or ulcer Sn/Sx which d not respond to treatment
Better to have biopsy/endoscopy done to rule out gastric carcinoma
More common in the upper stomach (cardia). Faster aggressive growth.
Antrum, pyloric and lesser curvature. Slow insidious
Increased risk:
- blood type A
- ulcers of the greater curvature
Increase incidence:
- Smoking, chronic gastritis, nitrosamines, pickled foods.

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25
Q

Remember

A

THree parts of the small intestine:
Duodenum, jejunum, and ileum.
Jejunum is shorter than the ileum
In the jejunum, there are fewer arterial arcades than the ileum and fewer lymphatics
In the ileum, you will find Peyer’s patches, more arterial arcades than jejunum, more lymphatics.

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26
Q

adynamic ileus

A

paralysis of intestinal motility.

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27
Q

What is the main blood supplier of the small intestine?

A

Superior mesenteric artery

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28
Q

Why is there collateral circulation to the small intestine?

A

Because the small intestine has a high demand for oxygen and is highly susceptible to injury from ischemia.

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29
Q

Intussusception

A

Most common intestinal obstruction in infants and young children.
Not normal in adults - this is BAD
Happens in the ileocecal region. Ileum into the cecum.

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30
Q

Gastroenteritis

A

Gastrointestinal tract viral infection (lasts 12hrs - 3 days).
Primary transmission - Oral-fecal route
Viruses - epithelium damage- osmotic diarrhea (three stools daily), vomiting.
Children: rotavirus
Adult: norovirus

Fever, diarrhea, vomiting, cramps, dehydration

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31
Q

Large intestine

A

The muscularis layer goes away and is replaced by the teniae coli which runs longitudinally.
Lar intestine has haustra (sacs)

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32
Q

Remember

A

The internal sphincters (rectal or urinary) are mediated by stretch reflexes. They are invonlutary.

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33
Q

Appendicitis

A 
Inflammation of vermiform apprendix.
Adolescents and young adults
Bacterial
McBurney's point rebound tenderness
Periumbilical pain RLQ with nausea and vomiting, constipation, no gas
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34
Q

Diverticulitis

A 
Inflammation of the diverticula of the haustra of the colon due to insoluble material and bacteria.
Pain
Fever
Nausea
Change in bowel pattern
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35
Q

Diverticulosis

A

Added haustrations to the colon
Not everyone has it.
Usually found in people > 60 yrs of age

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36
Q

Colorectal carcinoma

A

60-70 yo males > females

Associated with ulcerative colitis, polyposis coli, Chron’s disease.

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37
Q

Hemorrhoids

A

Varicosities in inferior hemorrhoidal plexus
Symptoms:
Lumps on the anus may become swollen and painful
Mucus in your rectum that may make you feel like you haven’t passed stool
ItchingCauses:
Overweight, pregnancy, heavy objects, constipation or diarrhea for a long time, anal sex

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38
Q

Chronic granulomas disease

A

Development of granulomas which are collections of immune cells that cluster together when they can’t kill pathogens
Autoimmune
Fever, diarrhea, vitamin B12 def
Skip lesions

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39
Q

Chronic ulcerative colitis

A 
More common in 20-25 years 
May affect only rection
Ulceration with pseudopolyps
Bloody mucoid diarrhea
Iritis is common
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40
Q

Celiac disease

A

Gluten-sensitive enteropathy
Malabsorption secondary to inflammatory luminal swelling
Celiac sprue presents with bulky, greasy stools, diarrhea, flatulence
Can be genetic or autoimmune
Weight loss, fatigue any age
Abates with gluten removal

41
Q

Irritable Bowel syndrome

A

Recurrent abdominal pain and abnormal bowel motility (diarrhea or constipation)
The pain improves after a bowel movement.
Functional disorder
females more than males
pain after eating
It is a dx of exclusion (chronic gastritis, cancer, etc)

42
Q

Inflammatory bowel disease

A

Share same characteristics of IBS, but has inflammation, ulcers, or other damage to the bowel.

43
Q

Acute pancreatitis

A

a great amount of variation of symptom picture
It is very painful
causes:
- heavy alcohol use, choline deficiency, gallstones
Constant epigastric pain radiating to mid-back
Elevated serum amylase and lipase
Pancreas being digested by enzymes, that is why it is painful

44
Q

Pancreatic cancer

A

Asymptomatic almost until the end
heavy tobacco smoking triples risk
Heavy consumption of fats and meat
Diagnosed at high stage and high grade due to being asymptomatic
Renal failure from liver failure because kidneys are getting all the toxins

45
Q

Acute liver failure

A

Fulminant hepatitis, toxic damage from acetaminophen, halothane, carbon tetrachloride, antidepressants
DIC, renal failure

46
Q

Chronic liver failure

A

Hepatitis, cirrhosis, inherited metabolic disorders

Clotting dysfunction

47
Q

Cholestasis

A 
Chole = bile
Statis = static, inactivity
48
Q

Hepatocellular cholestasis

A

intra-hepatic
Estrogen inhibits the excretion of bile acids, keeping them in the hepatic cells
Conjugated bilirubin builds up in the cell, crossing through the membrane getting into the bloodstream
High levels of estrogen have been linked to this.

49
Q

Obstructive cholestasis

A

outside the liver
physical blockage
gallstones

50
Q

How is the descending aorta divided?

A

Celiac trunk, superior, and inferior mesenteric.

51
Q

How many blood supplies does the stomach have?

A

3
Gastro epiploic - a branch of the splenic artery
Direct branch out of the celiac trunk called left gastric artery
Right gastric artery coming from the hepatic artery

52
Q

What would cause portal hypertension?

A 
Right-side heart failure, pregnancy, and hepatic disease
Signs:
- Esophageal varices
- Rectal hemmorhoids 
- Capite medusa
53
Q

Remember

A

GI structure
Submucosal plexus - mucus membrane activity
Myenteric - longitudinal smooth muscle activity

54
Q

GI tract innervation

A

Extrinsic Innervation

  • Parasympathetic NS - excitatory, carried by Vagus and Pelvic Splanchnic nerves
  • Sympathetic NS - Inhibitory, carried by prevertebral ganglia T8-L2

Intrinsic Innvervation
- Enteric Nervous system
Two plexi - myenteric plexus and submucosal plexus

55
Q

GI Regulation

Stomach

A

Histamine stimulates gastric acid

G Cells = gastrin stimulates H+ and gastric mucosa

56
Q

GI Regulation

Duodenum/Jejunum

A

I Cells = CCK stimulates gall bladder contraction and Oddi Relaxation; Pancreatic enzymes and bicarbonate secretion - inhibits gastric emptying
S cells - secretin: stimulates pancreatic and gallbladder bicarbonate secretion - inhibits gastric emptying
GIP stimulates insulin secretion - inhibits gastric acid secretion

57
Q

What does histamine do in the stomach?

A

Stimulates the gastric acid pump

Histamine type 2 receptors activate de proton pump.

58
Q

G cells make what?

A

Gastrin stimulates acid production and mucosal activity

59
Q

What does the CCK do?

A

It stimulates the gallbladder to contract and also the relaxation of the sphincter of Oddi.
It also makes pancreatic enzymes and bicarbonate to be secreted. Also, it stops stomach emptying

60
Q

Hormone

A

used to be released from ductless glands, endocrine glands into the bloodstream, they go peripherally and make something happen

61
Q

Paracrine

A

Short enteroendocrine secretion
Somatostatin: inhibits GI hormones release and acid secretion
Histamine: Stimulates gastric acid secretion

62
Q

Neurocrines

A

Neuronal synthesis, synaptic release, target cell activation

Enkephalins: Stimulate GI contraction at sphincters, stop fluid and electrolyte release

63
Q

What do chief cells produce?

Where are they located?

A

pepsinogen.

chief cells are located at the base of glands distributed throughout the fundus and corpus of the stomach.

64
Q

Pepsinogen and pepsin

A

a substance that is secreted by the stomach wall and converted into the enzyme pepsin by gastric acid.
Pepsin is a stomach enzyme that serves to digest proteins found in ingested food. Gastric chief cells secrete pepsin as an inactive zymogen called pepsinogen.

65
Q

Parietal cells

A

Parietal cells within the stomach lining secrete hydrochloric acid that lowers the pH of the stomach.
They also secrete intrinsic factors for complexing with B 12 to absorb B12

66
Q

Where are carbs absorbed?

A

Duodenum and jejunum

67
Q

Where are amino acids absorbed?

A

Duodenum and jejunum

68
Q

Where is iron absorbed?

A

duodenum

69
Q

Vit. B12?

A

terminal duodenum

70
Q

Fatty acids?

A

terminal duodenum

71
Q

How is iron absorbed as?

A

Fe2+

72
Q

How is iron transported?

A

Transported as ferritin

73
Q

How is iron stored as?

A

Stored as ferritin and hemosiderin

74
Q

What duct received sources from the liver and gallbladder?

A

Common bile duct receives sources from the common hepatic duct and cystic duct.

75
Q

Major duodenual papila

AKA Oddi

A

received information from the common bile duct and pancreas (pancreatic duct)

76
Q

What percentage is the bile acid recycled?

A

about 98% of it after it does its job which is to micelle fats (separate the fat)

77
Q

Where is bile produced

A

In the liver by hepatocytes and stored inside the gallbladder

78
Q

What is bilirubin?

A

Bilirubin is a yellow compound that occurs in the normal catabolic pathway that breaks down heme in vertebrates. This catabolism is a necessary process in the body’s clearance of waste products that arise from the destruction of aged or abnormal red blood cells.
bilirubin has been shown to possess important functions as an antioxidant, but it also serves simply as a means to excrete unwanted heme, derived from various heme-containing proteins such as hemoglobin, myoglobin, and various P450 enzymes.

79
Q

Where are bile acids synthesized?

A

Synthesized from cholesterol in the liver only

80
Q

How are bile salts regulated?

A

The rate-limiting step in bile acid synthesis is the introduction of a hydroxyl group at carbon 7 of the steroid ring by 7-alpha-hydroxylase which is inhibited by cholic acid (a primary bile acid stored in the gall bladder).

81
Q

What is the function of bile acids?

A

Emulsifying agents in the intestine helping to prepare dietary triacylglycerol and other complex lipids for degradation by pancreatic enzymes. Bile salts also provide the only significant mechanism for cholesterol excretion

82
Q

Cirrhosis

A

Hepatitis C or C, Alcohol-induced
Primary biliary cirrhosis, Wilson’s disease (copper), iron etc
Signs and symptoms
- Jaundice, ascites, edema, encephalopathy, cachexia, palmar erythema
- Caput medusa, esophageal varices, portal hypertension
- Liver failure, renal failure secondary to liver disease

83
Q

Cholecystitis

A 
inflammation of gallbladder
gallstone in neck or cystic duct
RUQ or epigastric pain
pain when you eat
Usually resolves in 1-7 days
84
Q

Cholelithiasis

A

aka gallstones

70-80% are asymptomatic for decades

85
Q

Remember

A

3/4 of the body for lymphatics - left side of the face, left pec and arm, the whole abdomen down to the legs
1/4 - right face, right chest, and arm.

86
Q

Where do most of the absorption of water happen in the body?

A

Small intestine

87
Q

Diarrhea

A

excretion of water through feces 150 ml to 1.5 leters

88
Q

Dysenteric

A

about 1.5L of excretion of water

89
Q

Vitamin A

A

Part of Rhodopsin/Vision

Deficiency: Night blindness

90
Q

Vitamin D

A

GI (increase calcium absorption)

Def.: Rickets

91
Q

Vitamin E

A

Antioxidant

Def.: Ataxia

92
Q

Vitamin K

A

Carboxylation of glutamate/calcium chelation with glutamate

Def.: Factor 2, 7, 9, 10 bleeding disorder

93
Q

Vitamin B1 - Thiamine

A

Aldehyde transfer/ decarboxylation

Beriberi

94
Q

Vitamin B2 - Riboflavin

A

H+ transfer/FMN - FAD (flavins)

Cheilosis/Glossitis

95
Q

Vitamin B3 - Niacin

A

H+ transfer / NAD-NADP
Pellagra - 4 Ds:
Diarrhea, dementia, dermatitis, death

96
Q

Vitamin B5 - Pantothenic acid

A

Acyl group transfer / Co-A

Burning feet / HA / Nausea

97
Q

Vitamin B6 - pyroxidine

A

Amino group transfer

Microcytic anemia, Neuropathy

98
Q

Vitamin B7 - Biotin

A

carboxylation

Seborrheic dermatitis, nervous system disorders

99
Q

Vitamin B9 - Folate

A

Methyl transfer

Macrocytic anemia/ Glossitis/ colitis

NPLEX I (12 decks)

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