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GI/Endo/Repro > Assessment 1 > Flashcards

Assessment 1 Flashcards

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1
Q

Parotid gland

A

Serous secretions

Salt, water, alpha amylase, lysozyme, lactoferrin

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2
Q

Submandibular gland

A

Mucins

More mucus, less water

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3
Q

Duodenum absorption

A

Water, iron, calcium

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4
Q

Jejunum absorption

A

Nutrients: sugars, AA, NaCl, Fe, Water

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5
Q

Ileum absorption

A

Bio salts

Bile salts

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6
Q

Colon absorption

A

NaCl, SCFA’s, Water

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7
Q

Mucins

A

Lubrication

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8
Q

Salivary alpha amylase

A

Digest starch/carbohydrates

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9
Q

Lingual lipase and salivary lipase

A

Digest fats

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10
Q

Lysozyme, secretory IgA, lactoferrin

A

Bacteria-static/cidal

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11
Q

Haptocorrin

A

Vit B12 chaperone

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12
Q

Exocrine pancreas

A

Alpha amylase
Trypsin, chymotrypsin, carboxypeptidase A/B and elastase
Lipase/Colipase
Nucleases

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13
Q

Splanchnic circulation

A

Portal vein from intestine directly to liver

Storage/metabolism/detoxification

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14
Q

Liver blood flow (2)

A

Portal vein: 80% input, nutrient rich, absorbed bile salts

Hepatic artery: 20% input, oxygen

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15
Q

GI smooth muscle

A

All smooht muscle except pharynx, 1st part of esophagus, external anal sphincter

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16
Q

3 layers of GI SM

A
  1. Outer longitudinal
  2. Inner circular
  3. Innermost oblique (stomach only)
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17
Q

SM contraction pathway

A

Ca binds calmodulin –> MLCK –> myosin phosphorylated –> contraction

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18
Q

Submucosal Plexus

A

Meissner’s

Between mucosa and circular muscle layers

Senses environment in lumen. Regulates GI blood flow, epithelial cell function

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19
Q

Myenteric plexus

A

Between circular and longitudinal layers

Larger and more cell bodies
Control motility

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20
Q

Peristalsis and interneurons

A

Distention sensed by mucosa

Interneurons contract proximal SM and relax distal SM

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21
Q

Interstitial Cells of Cajal

A

Pacemakers of GI tract, spontaneous electrical rhythmicity

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22
Q

3 stages of deglutition

A

Oral (voluntary): tongue movs bolus back and swallowing occurs

Pharyngeal (reflex): Pharynx momentarily becomes pathway for swallowing

Esophageal: Peristalsis

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23
Q

Esophageal phase

A

Bolus entering initiates primary peristalsis, LES/proximal stomach relaxes

Continued distention initiates secondary peristalsis

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24
Q

Lower esophageal sphincter relaxation (3)

A
  1. Swallowing
  2. Secondary peristalsis
  3. Transient LES relaxations
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25
Ileal brake
Undigested food arrives in ileum --> gastric emptying/SI transit slowed
26
Duodenal phase
Endocrine: CCK Paracrine: Serotonin via 5-HT4 receptor --> duodenal contraction
27
Migrating Motor Complex (MMC)
GI housekeeper Sweep secretions and undigested food through SI
28
Large Bowel Contractions (2)
Non propagating/segmental: Mixes contents to absorb water - 95% Propagating contractions (peristalsis): Propels contents forward, 5%, vary in speed/pressure
29
Slow propagating contractions
Less frequent, more powerful, ~6/day
30
Fast propagating contractions
More frequent, low amplitude
31
Gastro-colic reflex
Following meal, colonic motility increases
32
Defecation reflex
Distention of rectum | Rate of filling = urgency
33
Xerostomia
Lack of salivary secretions Leads to cavities
34
Salivary secretion regulation
Autonomic nervous control Para/Symp action on acinar cells, increase secretion
35
Alpha amylase (action and location of secretion)
Digest complex carbohydrates Parotid: minor Pancreas: Excess
36
Carbohydrate digestion in SI
Luminal enzymes in SI Reduce variety of molecules (Fructose, Glucose, Galactose)
37
Lactase deficiency
Lactose cannot be absorbed, creates osmotic gradient in lumen and osmotic diarrhea
38
Sugar absorption channels
SGLT1 - Na dependent Glu transport GLUT5 - Fructose GLUT2 - basolateral Glu/Fru transport
39
Zymogens
Enzymes that need to be activated Pepsinogen + HCL --> Pepsin
40
Pancreatic zymogen activation
Enteropeptidase (intestinal epithelium) + Trypsinogen --> Trypsin Trypsin activates pancreatic zymogens
41
Peptide/AA absorption
Protein digested in lumen or surface peptidases AA absorbed all the way through Dipeptides absorbed all the way or digested to AA by cytoplasmic peptidases
42
Protein absorption channels
PEPT1 - H/dipeptide cotransport Na/AA co transport AA transport 100% absorbed by end of jejunum
43
2 phases of fat absorption
Luminal Mucosal
44
Steps of Luminal phase
Fat emulsification Lipolysis Solubilization by bile salts Diffusion to mucosa
45
Fat emulsification
Breakdown of large fat droplets to smaller ones via motility Stabilized by amphipathic fatty acids, dietary protein Need pH > 6
46
Lipolysis
Breakdown of triglycerides/fatty acids Pancreas is major source of lipases
47
Pancreatic lipase and bie salts
Bile salts block pancreatic lipase Need colipase to prevent bile salt inhibition
48
Bile salt secretion - CCK involvement
Dietary fats activate I cells which release CCK CCK contracts gallbladder and relaxes sphincter of Oddi = Bile salt release into gut lumen
49
Micelle
Bile salts surround emulsified fats/vitamins/cholesterol etc
50
Micelle benefits
Slower diffusion time Much higher concentration of fatty acid diffused via micelle
51
Mucosal phase steps
Uptake into intestinal epithelial cells Transport to ER Resynthesis of TG Formation of Chylomicron
52
Uptake into intestinal epithelial cells
FABP bind to FA and MG FABP lowers FA concentration
53
Transport to ER
FABP transports FA /MG to smooth ER if C chain > 12 Straight to blood if C chain short
54
Smooth ER step
Triglycerides and phospholipds reformed
55
Chylomicron formation
Occurs in Golgi Formed by TG, phospholipids, cholesterol, protein Apoproteins guide to basolateral side Enter lacteal and lymphatic system --> blood
56
Achalasia
Failure to relax of smooth muscle in any region of GI Loss of enteric inhibition = no relaxation
57
Inhibitory nitrergic neurons
Within myenteric plexus, mediate inhibition at LES
58
Esophageal Achalasia
Failure of LES relaxation - loss of nitrergic neuronal inhibition Viral or inflammation-->autoimmune that results in myenteric plexus inflammation Esophagogram: Birds beak appearance Dysphagia, regurgitation (non bilious/acidic), weight loss, chest pain (rare)
59
Distal Esophageal spasm
DES Uncommon disorder, impairment of neural function - corkscrew sign
60
DES vs Achalasia
Achalasia has no LES relaxation DES has relaxation but timing is off
61
Infantile hypertrophic pyloric stenosis
Non bilious vomiting in infants Gastric outlet obstruction, pyloric antrum abnormalities Olive like mass, RUQ
62
Hirschsprung disease
Lack of innervation of large bowel portions, cannot move stool
63
Internal anal sphincter Achalasia
Similar to Hirschsprung but ganglion cells present
64
Gastroparesis
Stomach cannot empty Can be associated with diabetes No mechanical obstruction Bloating, nausea, vomiting Test gastric emptying with radioactive marker
65
Dumping syndrome
Rapid gastric emptying Large food particles delivered to SI and hard to digest Osmotic gradient into lumen and osmotic diarrhea
66
Early vs late dumping
Early: Soon after eating GI symptoms and vasomotor symptoms: flushing, perspiration, tachycardia, hypotension Late: Delayed onset. Hypoglycemia, sweating, hunger, weakness, confusion, syncope
67
Intestinal Pseudo obstruction
Rare disorder Repetitive/continuous symptoms of bowel obstruction Dilated bowel in absence of lumen occlusion Abdominal distention, bilious vomiting, Const/Diar Absence of ICC's
68
Functional gastrointestinal disorders
Various disorders with combo of ab pain/discomfort and changes in bowel habits Functional heartburn IBS Typical symptoms, normal PE, absence of alarm symptoms (GI bleed, fam history of colorectal cancer, weight loss)
69
IBS
Irritable Bowel Syndrome Recurrent Ab pain or discomfort at least 3 days a month with: improvement with defecation, change in stool frequency, change in stool appearance IBS-C IBS-D IBS-M
70
Functional Dyspepsia
No structural abnormality | Epigastric pain, epigastric burning, early satiation, bothersome postprandial fullness
71
COnstipation
Infrequent bowel movements, passage of hard stools Motility abnormality: Decrease in HPAC Drug induced abnormality: Increase mixing contractions, decrease propagating contractions
72
Metoclopramide
Prokinetic agent Antireflux, gastroparesis, anti emetic UGI dopaminergic stimulation
73
Cisapride
UGI - prokinetic Gastroparesis 5-HT4 agonist - enhance ACh release Not used in US because of arrhythmias
74
Bethanechol
Prokinetic Gastroparesis Cholinergic agonist
75
Dumping syndrome treatment
Dietary manipulation Medications (usually not necessary): PPI - slow digestion Anti-cholinergic/octreotide - slow transit
76
Intestinal pseudo obstruction meds
Prokinetic: Neostigmine
77
Physiological control of emesis (4)
Chemoreceptor zone: 5HT4, D2, NK1 Vestibular: H1, Muscarinic Cerebral cortex GI: 5HT3, D2, NK1
78
CNS anti emetics
Phenzothiazines Ethanolamines Piperazines Cannabinoids
79
ANS antiemetics
Anti-cholinergics
80
CNS and ANS anti emetics
Metoclopramide Ondansetron - selective hHT3 antagonist
81
IBS drugs
Antismasmodics Tricyclic antidepressants SSRI's Bulk forming laxatives Antimotility agents 5HT3 antagonists 5HT4 agonists - cisapride (not in US)
82
Sympathetic Route 1
Preganglion fiber --> white ramus --> paravertegral ganglion --> synapse --> gray ramus --> postganglionic axon
83
Sympathetic Route 2
Preganglion --> white ramus --> travel up/down paravertebral ganglion --> synapse --> gray ramus --> postganglionic axon
84
Sympathetic route 3 (Thoracic)
Preganglion --> white ramus --> synapse --> splanchnic nerve to target
85
Sympathetic route 4
Preganglion --> white ramus --> splanchnic nerve to target organ --> synapse on organ
86
Aortic plexus
Pre/post ganglionic sympathetic fibers Prasympathetic fibers GVA's
87
Superior hypogastric plexus
Formed from aortic plexus that juts out at bifurcation
88
Right and Left hypogastric nerves
Bifurcation of superior hypogastric plexus at sacral promontory
89
Pelvic splanchnic nerves
S2-4 intermediolateral cell column
90
Inferior hypogastric plexus
Pelvic splanchnic + Hypogastric nerves
91
Sacral Splanchnic
From sacral sympathetic chain GVE
92
Greater splanchnic nerve | Level, ganglion location
T5-9 Celiac ganglion Foregut
93
Lesser splanchnic nerve | Level, ganglion
T10-11 | Superior mesenteric ganglion
94
Least splanchnic nerve
T12 | Aorticorenal ganglion
95
Salivary Acini HCO3 secretion (channels)
NKCC = solute entry Cl + HCO3 co transport exit Water goes through
96
Salivary Duct HCO3 secretion
N/K ATP-ase HCO3/Cl exchange Bicarb out, Cl in Na/K exchange on luminal side Hypotonic KHCO3 fluid
97
High flow - salivary secretion
Only Acinar
98
Low flow - salivary secretion
Duct equilibrium | Hypotonic fluid
99
Oxyntic gland
Mucus/HCO3 HCl/Intrinsic factor Pepsinogen
100
Pyloric Gland
Mucus/HCO3 Gastrin/Somatostatin
101
Gastric bicarb secretion (channels)
Blood CO2 + H20 --> H + HCO3 HCO3/Cl luminal exchange
102
Mucus secretion and protection
Mucins and bicarb secreted, cross links with secreted bicarb Protect stomach lining Buffers H and blocks pepsin
103
Gastric gland components
Chief cell | Parietal cell
104
Chief cell
Secretes pepsinogen
105
Parietal cell secretions
HCl | Intrinsic factor
106
Parietal cell HCl secretory pathway
Gastric H,K-ATPase H out, K in, K recycled by K channel
107
Intrinsic factor
B12 binding protein between duodenum and ileum Receptor mediated endocytosis and degradation of IF in ileum
108
Haptocorrin
Salivary gland B12 binding protein Degraded by pancreatic proteases
109
Parietal cell HCl regulation
H,K-ATPase stored in vesicles Signal pushes vesicles to membrane, can take time
110
Transcobalamin II
Intestinal B12 binding protein Binds B12 in ileal epithelium, transcellular transit across epithelium
111
PGE2 and stomach protection
Increases protective measures: Mucus/bicarb secretion
112
NSAIDS/H pylori and stomach protection
Reduce Bicarb secretion
113
Nicotine/gastrinomas/H pylori
Increase acid secretion
114
Regulation of acid secretion: ECL/Gastrin/Somatostatin/Pasaymp control
ECL: Release histamine, acts on parietal cell to increase H,K-ATPase activity Gastrin: Regulates ECL More H,K-ATPase in parietal cells Somatostatin: Inhibits Gastrin Parasympathetic ACh: Stimulates Gastrin, Parietal cell Inhibits Somatostatin
115
Duodenal Bicarb secretion
Electrogenic or Electroneutral NaHCO3 secretion HCO3/Cl exchange HCO3 channel
116
Cholera toxin mechanism
Via cAMP: Stimulates Cl secretion into lumen, inhibits Na/Cl uptake into epithelial cell Diarrhea
117
Enterotoxin vs Cytotoxin
Enterotoxin: Biochemical alteration only Cytotoxin: Morphological alterations
118
Inflammatory vs non inflammatory diarrhea
Non inflammatory: Watery, no blood, dehydration Inflammatory: Mucoid and bloody, ab pain, small volume
119
Exocrine pancreas secretions
Acinar: 80% Enzymes/NaCl Duct cells: 5% NaHCO3/water
120
Pancrease secretion and flow
high flow = ductal | Low flow = acinar
121
Pancreatic bicarb secretion channels
HCO3/Cl exchange with Cl recycling Carbonic anhydrase
122
Pancreatic regulation by duodenum
Fat --> I cells --> CCK --> act on acinar cells --> stimulate protein secretion Acid secretion --> S cells --> Secretin acts on duct cells --> bicarb secretion
123
Gut tube embryological origin
Endoderm
124
Secondary retroperitoneal structures
Duodenum Pancreas Ascending and descending colon
125
Foregut, midgut, hindgut blood supply
Foregut: Celiac artery Midgut: Superior mesenteric artery Hindgut: Inferior mesenteric artery
126
Ventral mesentery associated with....
Foregut
127
Esophageal atresia
Blind ending esophagus
128
Esophageal stenosis
Esophageal narrowing
129
Esophagotracheal fistula
Esophagus connected to trachea
130
Polyhydraminos
Cannot swallow amniotic fluid --> Buildup of amniotic fluid
131
Stomach development Vagal nerve location
Dorsal end grows (greater curvature) Rotates 90 degrees so greater curvature is on left Left vagal nerve becomes anterior, right becomes posterior
132
Pyloric stenosis
Thickening of muscle that happens several weeks after birth Palpable olive in RUQ, projectile vomiting
133
Spleen mesenchymal location
Within dorsal mesegastrium
134
Spleen development after stomach rotation
Spleen rotates to left Divides dorsal mesogastrium into gastrosplenic and splenorenal ligaments
135
Duodenal atresia
Vomiting with bile Due to recanalization of duodenum Double bubble sign
136
Liver development
Grows into ventral mesentary, touches diaphragm Separates ventral mesentery into falcoform ligament and lesser omentum
137
Lesser omentum containsL
Hepatogastric ligament Hepatoduodenal ligament
138
Pancreas development
Ventral bud swings around right of duodenum, fuses with dorsal bud Ducts connect and form main pancreatic duct
139
Annular pancreas
Ventral buds rotate in opposite direction and constrict bile opening
140
Greater omentum formation
Expansion of gastrosplenic ligament
141
Midgut development
Primary intestinal loop herniates into umbilical cord --> 90 degree rotation (SI on right, LI on left) --> rotates 180 degrees and pulls back in
142
Intraperitoneal viscera
Stomach Jejunum/Ileum Transverse colon Sigmoid colon
143
Omphalocele
Abdominal contents protrude through umbilical ring - normal herniation that doesn't return to ab cavity Contents covered by amniotic cavity/parietal sac
144
Gastroschisis
Ab contents protrude through ab wall NOT covered by parietal sac/ amniotic cavity
145
Umbilical hernia
Less severe omphalocele Ab contents protrude through umbilical ring to lesser extent Covered by skin
146
Non rotation
Absence of second 180 degree rotation Left sided colon
147
Reversed rotation
180 degree rotation in wrong direction
148
Mixed rotation
All other rotational disorders
149
Volvulus
Twisting of intestines around itself = obstruction/ischemia
150
Ileal (Meckel's) diverticulum
Incomplete regression of vitelline duct Diverticulum, cyst, fistula
151
Cloaca development
Primitive urogenital sinus and rectum
152
Cloacal membrane development
Urogenital membrane | Anal membrane
153
Formation of anus
Anal membrane mesoderm thickens and sinks in = anal pit Anal membrane breaks down
154
Anal agenesis
Anal pit fails to form Most difficult to fix
155
Imperforate anal membrane
Failure of anal membrane to breakdown
156
Anal stenosis
Incomplete breakdown of anal membrane
157
Lesser sac formation
Liver swings to right and decreases space Lesser sac behind stomach because of stomach rotation
158
Interdigestive period
MMC's every 90min Motilin initiates MMC
159
Motilin regulation
Duodenal acid Vagus stimulation Initiates MMC/increase gastric emptyin
160
Digestive period phases
Cephalic phase Gastric phase Early Intestinal phase Late Intestinal phase
161
Cephalic phase
Neuronal stimuli (thinking about food) Salivary secretion Acid release via gastrin Pancreatic enzyme/bile secretion via gastrin
162
Gastric phase
Gastrin increases = Acid secretion into stomach Lower salivary secretion
163
G17 vs G34 Location & difference in food states
Antrum: G17 Duodenum: G34 Fasting: G34 > G17 Post prandial: G17 = G34 Food = G17 increase
164
Gastrin regulation
Gastrin releasing peptide (Parasymp control) Peptides/AA/Calcium Somatostatin (-) Low pH (-)
165
Early intestinal phase
Low Gastrin and Motilin More Secretin, CCK, Incretins Fed motility pattern: Short peristaltic waves + segmentation to mix
166
Secretin
Released from S cell in response to acidic environment Act on Pancreas, release HCO3 from duct
167
CCK
Need to be sulfonated and amidated to function Gall bladder contraction/S o Oddi relaxation Pacreatic release of enzymes from acinar cells
168
Monitor peptide
Actively digested by proteases/lipases No proteases/lipases = active monitor peptide = stimulation of I cell and CCK release
169
Incretins
GLP-1 GIP Luminal glucose releases into blood --> plasma glucose induces incretins to release insulin from pancreas
170
Late intestinal phase
Food enters colon Decrease CCK/Secretin Bile salts recaptured Motilin and MMC return
171
Adenocarcinoma of esophagus
Distal esophagus | Associated with Barrett, dysplasia, reflux esophagitis
172
Low grade dysplasia
Increased proliferation | Increased N:C ratio
173
High grade dysplasia
Loss of nuclear polarity | Bizarre glandular architecture
174
Squamous cell carcinoma
90-95% esophageal cancers | Alcohol, smoking, diet, HPV
175
2 Histological types of gastric cancer
Intestinal: Differentiated, chronic gastritis, high risk areas Diffuse: Less differentiated, de novo, Signer ring cells
176
GIST
Gastrointestinal stromal tumor Stomach>SI>other ICC?
177
PUD drug combinations
Clarithromycin+amoxicillin/metronidazole + PPI Clarithromycin + tetracycline + PPI
178
Antacid types
Aluminum Magnesium Calcium
179
Aluminum antacid
Least potent Constipation Phosphate binder
180
Magnesium antacid
Most potent, diarrhea, hypermagnesemia
181
Calcium antacid
Rapid, constipation, hypercalcemia/alkalosis Good Ca supp
182
H2 antagonists
Cimetidine: P450 inhibitor - drug interactions | CNS side effects
183
Misoprostil
Stimulates PGE2 receptors Inhibits acid secretion, promotes bicarb/mucus secretion Limited to active PUD
184
Sucralfate
Combines with protein exudate to form barrier around ulcer base Minimal side effects
185
PPI
Omeprazole
186
GERD drugs
Metaclopramide Cisapride Bethanechol
187
Neonate bilious vomit --> Few dilated loops = ?
Proximal bowel obstruction - UGI
188
Neonate bilious vomit --> Many dilated loops = ?
Distal bowel obstruction - Enema
189
UGI --> Duodenal obstruction/corkscrew
Midgut volvulus
190
Midgut volvulus scan characteristics
Doppler flow | SMA/SMV switched
191
UGI --> double bubble
Duodenal atresia
192
UGI --> multiple bubble
Jejunal atresia
193
Enema --> small distal w/ size transition
Hirschsprung disease
194
Enema --> small colon w/ abrupt end
Colonic atresia | Very dilated loops
195
Enema --> micro-colon/pearls on a string/abdominal distention
Meconium ileus Cystic fibrosis
196
Enema --> micro colon/TI abruptly ends/failure to pass meconium
Ileal atresia
197
Enema --> Colitis/micro colon/Looks like a fucking disaster
Total Hirschsprung disease

GI/Endo/Repro (8 decks)

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