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GI Flashcards

1
Q

GA 3.5 wks GI embryology

A

foregut and hindgut present
liver bud

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2
Q

GA4wk GI

A

esophagus and stomach separate
intestines is a single tube
hepatobiliary derived from foregut
pancreas derived from midgut

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3
Q

GA 5-9 GI

A

Wk 7: mouth, esophagus and stomach in normal position

intestinal tube elongates and herniates into umbilical cord
the tube undergoes a series of rotations
villi form in jejunum (week 9)

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4
Q

GA10 GI

A

tube reenters abdominal cavity after rotated 270deg
formation of microvilli
crypts of lieberkuhn appear

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5
Q

GA 12 GI

A

parietal cells in stomach
mature taste buds
formation of islet cells and bile secretions

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6
Q

GA13 GI

A

muscularis and muscle layers of intestine appear
disaccharides present

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7
Q

GA16 GI

A

swallowing and sucking ability (not coordinated)

lipase can be detected but remains deficient
trypsin present

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8
Q

GA14 GI

A

villi present throughout intestines
meconium present

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9
Q

GA18

A

ganglion cells

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10
Q

GA19

A

crypts well developed

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11
Q

GA20-24 GI

A

mouth amylase
ciliated columnar cells

maltase
sucrase

amylase liver 22 weeks

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12
Q

GA28 GI

A

adult level disaccharidases
lactase increases

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13
Q

GA32

A

normal gastric emptying
HCl detected instomach

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14
Q

34-36

A

coordinated suck and swallow
rapid peristalsis
lactase adult level

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15
Q

intraepithelial lymphocytes timing and features

A

GA 8
immune cell - defense

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16
Q

intestinal absorptive epithelium timing and features

A

GA 9
absorption

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17
Q

goblet cells timing and features

A

GA8-10
mucin, protection

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18
Q

enteroendocrine cells timing and features

A

GA9-11
hormone producting

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19
Q

paneth cells timing and features

A

GA11-12
antimicrobial peptides

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20
Q

stem cells timing and features

A

GA?? early
give rise to epithelial cells

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21
Q

Microfold (M) cells timing and features

A

GA 17
uptake antigen for presentation

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22
Q

Dendritic cells timing and features

A

GA 19
APC

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23
Q

tight junctions timing and features

A

GA 10
barrier defences

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24
Q

crypt villus architection GA

A

12

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25
Q

Peyers patches timing and features

A

GA19
patches of lymphoid tissue for immune response

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26
Q

salivary and pancreatic amylase timing

A

present at 22 weeks
adult levels 3 months postnatal age

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27
Q

glucoamylase (a-dextrinase) timing and function

A

normal at birth
removes glucose from end of starch

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28
Q

intestinal disaccharidases

A

adult levels at 28 weeks except lactase which is adult level at 36 weeks

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29
Q

intestinal transporters of glucose

A

into enterocyte SGLT1 active
out of enterocyte into circulation GLUT1

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30
Q

intestinal transporters of fructose

A

into enterocyte GLUT5 passive
out of enterocyte into circulation GLUT2

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31
Q

where are chymotrypsin and trypsin

A

duodenal fluid
decreased in preterm and FT infants

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32
Q

peptidases timing

A

well developed early

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33
Q

GI pH in neonates vs adults

A

increased due to decreased HCl secretion compared to adults

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34
Q

components of fat digestion

A
  1. triglyceride hydrolysis by lipases (lingual, GI, pancreatic)
  2. bile acid emusification
  3. micelle formations
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35
Q

components of fat absorption

A
  1. FFA and monoglycerides transfer easily
  2. triglycerides reform in enterocytes
  3. chylomicron formation
  4. chylomicron enters portal blood or lymphatics
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36
Q

preterm infant fat malabsorption attributed to

A

reduced bile acid secretion
decreased pancreatic lipase (adult levels at 6 months; lingual and gastric are okay)

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37
Q

function of secretin

A

stimulates pancrease to release bicarbonate slowing gastric emptying

38
Q

gastrin inhibitory peptide function

A

stimulated by protein and fat
slows gastric empyting
decreases gastrin

39
Q

maltose broken down to

A

glucose x 2

40
Q

sucrose broken down to

A

Fructose + glucose

41
Q

lactose broken down to

A

galactose + glucose

42
Q

posterior pharyngeal perforation on XR

A

tracks towards right of spine rather than normal left into gastric bubble

43
Q

eophageal duplication location and diagnosis

A

posterior mediastinal mass
ultrasound

44
Q

rate of TEF

A

1/4500

45
Q

VACTERL

A

verterbral
anal
cardiac
TE
radial/renal
limb

46
Q

pathophysiology of TEF

A

abnormal formation in GA4

47
Q

GER vs GERD

A

GERD has complications ie. growth failure, pain, mucosal damage, aspiration

48
Q

GERD occurrence

A

6-7% term
3-10% preterm < 1500g

49
Q

etiology of duodenal atresia

A

failure of recanalization GA8-10 after obliteration of lumen by epithelial proliferation during GA6-7

50
Q

location of duodenal atresia

A

second part of duodenum

51
Q

occurrence of duodena atresia and jejunal/ileal atresia

A

1/20000-40000
1/1500-5000

52
Q

proportion of atresia in locations of the jejunal/ileal

A

proximal jejunum 31%
distal jejunum 20%
proximal ileum 13%
distal ileum 36%

53
Q

etiology of jejunal/ileal atresia

A

after intestinal development
likely ischemic injury/malrotation/volvulus/ perforation

54
Q

occurrence of polyhydramnios in jejunal and ileal atresia

A

1/3 in jejunum
less in ileal

55
Q

etiology of colonic atresia

A

vascular compromise

56
Q

risk of colonic atresia

A

1/1500-1/20000

57
Q

risk of hirshprung

A

1/5000
80% male
recurrence 3-5%

58
Q

hirshprungs associations

A

trisomy 21
heterochromia
waardenburg
congenital deafness
13q del
pheochromocytoma
NF
neuroblastoma

59
Q

etiology of hirshprung

A

failure of complete cranial to caudal migration of neural crest cells at 8-10 weeks
aganglionic
abnormal parastalsis

60
Q

Hirschprung:
percent with only rectosigmoid involvement
percent with complete colon involvement

A

75-80%

5-10%

61
Q

small left colon syndrome location

A

splenic flexure transition zone

62
Q

risk of imperforate anus

A

1/5000

63
Q

types of fistulas in anorectal malformations of males and females

A

males - rectum to GU (rectovesical, rectoprostatic, rectobulbar) or perineal

females - perineal, vestibular, cloacal complex

64
Q

What is Wangosteen Rice invertogram

A

used to be used to delineate level of ARM

65
Q

abnormal fusion of lateral and cephalic folds of abdominal wall

A

pentalogy of cantrell
1. cleft sternum
2. anterior midline diaphragmatic abnormality
3. pericardial defect
4. ectopic cordis - heart without breastbone - just skin
5. upper abdominal omphalocoele

66
Q

abnormal fusion of both lateral folds of abdominal wall

A

omphalocoele

67
Q

abnormal fusion of the caudal and lateral folds of abdominal wall

A

cloacal or bladder exstrophy
hypogastric omphalocoele

68
Q

OEIS complex

A

omphalocoele
extrophy of bladder
imperforate anus
spinal deformity

69
Q

etiology of omphalocoele

A

intestinal loops fail to return to the abdominal cavity at 11 weeks or somatic folds fail to complete formation of the abdominal wall by 18 weeks GA

70
Q

colorless meconium

A

cholestasis

71
Q

intrahepatic duct diseases

A

neonatal idiopathic hepatitis
alagille paucity of intrahepatic with extrahepatic ducts
nonsyndromic paucity

72
Q

extrahepatic duct obstruction

A

biliary atresia
sclerosing cholangitis
bile duct stenosis
choledochal cyst
bile plug

73
Q

what are the MCC cholestasis

A

biliary atresia and idiopathic neonatal hepatitis account for 60-70%

74
Q

what factors improve prognosis in short gut?

A

intact ileum - bile acid absorption
intact ileocecal valve - delays transit time allowing improved digestion and absoption and prevents overgrowth of colonic bacteria into the small intestines

75
Q

without ileocecal valve how much intestines do you need

A

30-45 cm of intestines

76
Q

air pattern progression on XR after birth

A

3 hours to small intestines
6-8 hours to large intestines
24 hours to rectum

77
Q

malrotation with volvulus appearance on barium swallow

A

complete obstruction: birds beak

partial obstruction: spiral/corkscrew

78
Q

when are stomach, small intestines and large intestines visible on fetal us

A

stomach: 13-15 weeks
small intestines - not well until third trimester in center of abdomen
large intestines - 22 weeks

79
Q

echogenic bowel

A

most normal
chromosomal abnormalities ie tri 21
congenital infections ie CMV
mec ileus/peritonitis
atresia/volvulus
swallowed blood
proximal bowel obstruction

80
Q

what is barium study good for?

A

opacifying stomach and intestines
malrotation or hirschprung

81
Q

what is gastrograffin study good for>

A

meconium plug - increased osmolality draws water into lumen and releases plug
monitor electrolytes

82
Q

what is iohexol or iopamidol study good for?

A

perforation

83
Q

a defensins

A

peptides that interact with phospholipids in microbial cell membranes leading to pores/cell lysis

84
Q

intestinal fatty acid binding protein

A
  • released from mature enterocytes when cell membrane integrity is compromised
  • detected in urine
  • may reflect NEC
85
Q

organs affected in GALD

A

liver, pancreas, thyroid, heart and adrenal

86
Q

spared organs in GALD

A

spleen, LN, BM

87
Q

glucagon like peptide 2

A
  • antisecretory hormone regulating intestinal transport
  • secreted by L cells in terminal ileum and colon
  • increases intestinal blood flow
88
Q

phases of intestinal motor activity during fasting

A

phase 1: quiescence
phase 2: irregular activity
phase 3: regular phasic propagating + clusters low amplitude non-propagating

89
Q

MC genetic abnormality in omphalocoele

A

aneuploidy (tri 13, 18, 21)

90
Q

method of diagnosing GALD

A

salivary gland biopsy

91
Q

primary substrate for enterocytes that increases intestinal cell proliferation via mitogen activate protein kinases

A

glutamine

92
Q

serum marker of enterocyte maturation

A

citrulline

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