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big fat review Flashcards

1
Q

retroperitoneal organs

A

2nd and 3rd segments of duodenum
kidneys
oesophagus
pancreas

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2
Q

2ndarily retroperitoneal organs

A

ascending and descending colon

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3
Q

intraperitoneal organs

A

stomach, liver, spleen

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4
Q

what do parietal cells do

A

secrete intrinsic factor for absorption of vitamin B12

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5
Q

role of jejenum

A

nutrient absoprtion

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6
Q

ileum contains

A

payers patches of lymphoid tissue for immune responses

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7
Q

ileum absorbs

A

bile acids, water, B12

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8
Q

gut is controlled through

A

hormones and neural control

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9
Q

Sympathetic control of gut

A

Greater T5-T9 Stomach (epigastric)
Lesser T9-T10 SI to transverse colon (umbilical)
Least T10-11 transverse colon to sigmoid colon (suprapubic)

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10
Q

Parasympathetic control of gut

A

vagus nerve (oesophagus to transverse colon)
pelvic splanchnic nerve (transverse colon to anal cana)

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11
Q

Enteric nervous system

A

Meissner’s plexus/submucosal (controls blood flow and secretions)

Auerbach’s plexus/myenteric (gut motility and sphincter action)

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12
Q

What do enteroendocrine cells do

A

release hormones into the gut

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13
Q

Gastrin production and role

A

produced from G cells in the stomach, increase acid secretion

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14
Q

CKK production and role

A

Produced by I cels in the duodenum and jejunum, stimulates pancreatic and gallbladder secretion by relaxing sphincter of Oddi

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15
Q

Secretin production and role

A

S cells in duodenum, stimulated by acid, causes an increase in bicarbonate and decreases acid production

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16
Q

Gastric inhibitory polypeptide production and role

A

Duodenum and jejenum, causes an increase of insulin and decreased acid production

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17
Q

Appendicitis pain

A

Central abdo pain due to visceral peritoneum
Right lower abdomen pain due to parietal peritoneum which is somatic

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18
Q

Gall stones pain

A

Right upper quadrant and right shoulder tip pain

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19
Q

Back pain could be

A

Pancreatitis or AAA

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20
Q

Layers of the gut

A

Mucosa
Submucosa
External muscle layer
Serosa

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21
Q

mucosa layers

A

epithelial layer (hormones and mucous)
lamina propria (IgA)
muscular mucosae

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22
Q

only sphincter under voluntary control

A

external anal

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23
Q

Role of enterocytes

A

simple columnar, transport substances

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24
Q

Role of goblet cells

A

secrete mucous

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25
Q

Role of gastric mucous cells

A

Secrete mucous containing more bicarbonate

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26
Q

Arcuate line above and below

A

Above = Internal oblique splits

Below = all three muscles anterior to rectus abdominus muscle

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27
Q

Where is arcuate line

A

Halfway between umbilicus and pubic symphysis

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28
Q

Permanent folds in GI tract

A

plica circulares

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29
Q

Temporary folds in GI tract

A

rugae

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30
Q

Crypts contents

A

Stem cells
Paneth cells (antibacterial)
Enteroendocrine cells (secrete hormones)

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31
Q

What connects the stomach to the transverse colon

A

Gastrocolic ligament

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32
Q

What connects the stomach to the spleen

A

Gastrosplenic ligament

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33
Q

What connects the liver to the anterior abdominal wall

A

Falciform ligament

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34
Q

What connects the liver to the diaphragm

A

Triangular ligament

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35
Q

Exocrine glands features

A

Ducts, acini (enzymes and serous), tubules (mucus such as Brunners glands in duodenum)

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36
Q

Gut tube features

A

4th week
endoderm lined
Covered in splanchnic mesoderm

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37
Q

Foregut midgut and handout

A

foregut = oesophagus to midpoint of duodenum
Midgut = midpoint of duodenum and proximal 2/3 transverse colon
Hindgut = distal 1/3 transverse colon, upper anal canal

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38
Q

large cavity through which the gut tube descends

A

intraembryonic coelom

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39
Q

respiratory formation

A

respiratory diverticulum, tracheoesophageal septum

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40
Q

Left sac contributes to

A

greater sac

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41
Q

Dorsal and ventral mesentery connected by

A

epiploic foramen

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42
Q

Dorsal mesentery forms

A

Greater omentum

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43
Q

Midgut opening to yolk sac/umbilicus

A

vitelline duct

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44
Q

Rotations

A

3 x 90 degrees

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45
Q

Defects from rotation can lead to

A

volvulus

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46
Q

Yolk sac remnants outcomes

A

Vitelline cyst, fistula

Meckel’s diverticulum

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47
Q

Meckel’s diverticulum features

A

2% of population, 2 feet from ileocaecal valve, 2:1 male to female ratio (most common malformation of GI tract)

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48
Q

What causes pyloric stenosis

A

hypertrophy of circular muscle

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49
Q

Result of recanalisation failure

A

Atresia

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50
Q

Gastroschisis and omphaleocoele difference

A

Gastroschisis = not covered, amniotic fluid
Omphalocoele = covered by thin membrane

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51
Q

Above and below pectinate line

A

Above = visceral peritoneum from endoderm

Below = parietal peritoneum from ectoderm (can localise pain) (somatic)

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52
Q

Hindgut abnormalities

A

Imperforate anus (anal membrane doesn’t rupture)
Anal agenesis (doesn’t migrate down enough)
Hindgut atresia (cloacal dividing defect, abnormal opening)

53
Q

Saliva composition 6

A

Water
mucins
bicarbonate
amylase
lingual lipase
IgA

54
Q

Neural control of salivary glands

A

Submandibular and sublingual = facial nerve

Glossopharyngeal does parotid gland

55
Q

What drugs cause dry mouth

A

Anti muscarinic

56
Q

Swallowing in babies

A

epiglottis more superior and diverts milk laterally

57
Q

problems with saliva

A

Xerostomia = dry mouth

Mumps = swelling of parotid gland

58
Q

neural control of swallowing and gag reflex

A

Mechanoreceptors, glossopharyngeal, medulla, vagus, pharyngeal constrictors

59
Q

3 phases of swallowing:

A

Oral, pharyngeal, oesophageal

60
Q

Oral phase

A

voluntary, bolus pushed towards back of mouth, bolus touches pharynx wall

61
Q

Pharyngeal phase

A

Involuntary, soft palate raises and seals off nasopharynx, pharyngeal constrictor muscles push bolus down, vocal cords close and larynx elevates closing epiglottis, UOS opens

62
Q

Oesophageal phase

A

involuntary, UOS closes, peristalsis

63
Q

Oesophagus pierces diaphragm at

A

T10

64
Q

Muscle in oesophagus

A

Skeletal at top then smooth at bottom

65
Q

4 narrowings in oesophagus

A

Pharynx
Arch of aorta
Bronchi of left lobe
Just before piercing diaphragm

66
Q

GORD

A

can cause metaplasia, Barrett’s oesophagus

67
Q

what prevents reflux

A

diaphragm
Smooth muscle
Mucosa rosette
Acute angle of entry
Compression when abdominal pressure rises

68
Q

what makes up a hernia

A

sac, covering, contents

69
Q

epigastric hernia cause

A

linea alba during straining

70
Q

Femoral hernia key points

A

More common in women, can become incarcerated or strangulated

71
Q

inguina canal hernias occur mostly in

A

men due to processus vaginalis descent

72
Q

Structure of inguinal canal

A

Floor - inguinal ligament
Roof - internal oblique and transversalis fascia
Posterior wall - transverse abdominus
Anterior wall - External oblique aponeurosis

73
Q

Indirect inguinal hernia

A

Goes through deep ring and then superficial
Lateral to epigastric vessels
More common on right side as testis descend lower

74
Q

Direct inguinal hernia

A

Hesselbachs triangle
Inferior epigastric vessels superior border, inguinal ligament inferior border, rectus abdominus medial border

75
Q

3 regions of stomach

A

cardia, fundus, antrum

76
Q

Cheif cells secrete

A

Pepsinogen

77
Q

G cells secrete

A

gastrin

78
Q

Enterochromaffin like cell secretes

A

histamine

79
Q

D cells secrete

A

somatostatin

80
Q

Stomach acid roles

A

proteins unravel, activates proteases/zymogens, innate immune response,

81
Q

what allows more food to enter stomach without raising pressure

A

receptive relaxation

82
Q

G cells mostly found in

A

antrum

83
Q

what type of cells found mostly in cardia

A

mucous secreting

84
Q

What cells are abundant in pyloric region

A

G and D cells

85
Q

Phases of digestion

A

Cephalic, gastric, intestinal

86
Q

stomach defenses

A

mucus, high turnover of epithelial cells, prostaglandins

87
Q

What weakens stomach defenses

A

alcohol, NSAIDs, helicobacter pylori

88
Q

Chronic gastritis can be caused by

A

autoimmune or helicobacter

89
Q

Causes of peptic ulcer disease

A

stomach acid, H pylori, NSAIDs

90
Q

Diagnosing stomach pathology

A

Endoscopy, urease breath test for helicobacter, CXR, blood test for anaemia

91
Q

Stomach pathology treatments

A

H pylori - amoxicillin and clarithromycin, stop NSAIDs, PPIs, H2 blockers

92
Q

why is urease produced

A

bacteria convert urea to ammonium to protect them from stomach acid and help flagella adhere

93
Q

feature of chyme

A

isotonic

94
Q

Hormones in duodenum

A

CCK (pancreatic enzymes, Gallbladder contraction and sphincter of Oddi relaxation) and secretin (production of aqueous bicarbonate from pancreas)

95
Q

Pancreatic secretions

A

mostly endocrine stimulated by vagus nerve, CCK and Secretin

96
Q

When can pancreatic secretions be stopped

A

blockage of ampulla of vater, amylase and lipase found in blood, gall stones (ascending cholangitis and acute cholecystitis (no jaundice))

97
Q

features of zones of liver

A

Zone 1 most prone to toxic substance, zone 3 to ischaemia

98
Q

bile acid production and role

A

secreted by liver and stored in gallbladder, emulsifies fats,

Secreted into canaliculi by hepatocytes, Conjugated to form bile salt

form micelle, chylomicrons

99
Q

billurubin outcomes

A

Stercobilin and urobilinogen

100
Q

measuring liver/bile duct dysfunction

A

Coag factors, Albumin, Hb, ALP, AST, Gamma GT

101
Q

types of jaundice

A

Pre hepatic- dark stools
Intra hepatic- dark urine
Post hepatic - pale stools, urine dark

102
Q

hepatitis consequences

A

inflammation and necrosis, liver failure, can cause hepatic encephalopathy

103
Q

consequence of liver fibrosis

A

cirrhosis, varices (oesophagogastric junction, anorectal, ligamentum teres)

104
Q

Causes of bile duct obstruction

A

gallstones, pancreatic cancer, liver mets

105
Q

cholangitis symptoms

A

infection in bile ducts from E coli due to obstruction. Fever, pain and jaundice

106
Q

Glucose metabolism

A

SGLT 1 into enterocytes, GLUT 2 into blood

107
Q

Mineral uptake

A

Calcium passively paracellularly, needs vitamin D

iron - needs H+ for co transport

108
Q

Protein digestion

A

Pepsinogen

trypsinogen to trypsin by enteropeptidase

Enzymes either exo or endo peptides

pepT1 into cell and converted to amino acids by cytosolic peptidases

109
Q

coeliac disease

A

gliadin triggers antibody response, flattened vili and elongated crypts

110
Q

Crohns features

A

Cobblestone appearance
Skip lesions
Transmural
Perianal disease
Oedema
Granulomas
Strictures
Fistulas
Mouth ulcers
Non bloody stools

111
Q

UC features

A

Friable mucosa
Loss of haustra
Superficial
Starts at rectum and moves proximal
Only colon
Can cause cancer
Pseudopolyps
Crypt abscesses
Bloody stools

112
Q

other risks of IBD

A

arthritis, uveitus, cholangitis

113
Q

acute gut ischaemia

A

embolism from atrial fib is most common cause, large WBC, severe abdo pain

114
Q

Types of gut bleeding

A

Haematemesis, melaena, haematochezia

115
Q

Causes of GI bleeding

A

peptic ulcer, oesphageal varices, bleeding diverticula disease, ectopic pregnancy

116
Q

Bowel obstruction results

A

dehydration, increased haematocrit, vomiting = metabolic acidosis, hypo potassium

117
Q

GI infections usual treatment

A

fluid rehydration and pain meds, treatment if immunosupressed

118
Q

Water diarrhoea after travelling

A

Cyclospora parasite or cryptosporidium

119
Q

Campylobacter features

A

Bloody diarrhoea, grram negative, contaminated poultry

Can lead to reactive arthritis, muscle paralysis

120
Q

Most common cause of epidemic gastroenteritis

A

Nororvirus

121
Q

Shigella features

A

Shiga toxin, bloody diarrhoea, gram negative rod

122
Q

oesophageal cancer

A

dysphagia presentation

Squamous cell carcinomas mostly (lower 1/3rd can be adenocarcinoma)

123
Q

gastric cancer

A

adenocarcinomas, in cardia or antrum (can be gastric lymphomas or stromal tumours)

124
Q

Upper Gi symptoms

A

dysphagia, epigastric pain, malaria, haematemesis, Jaundice

125
Q

Lower GI symptoms

A

obstruction, per rectum bleeding, tenesmus, changes in bowel habits

126
Q

Reasons for changes in bowel habits

A

Thyroid, IBD, drugs, coeliac disease, cancer

127
Q

Liver cancer common presentation

A

Jaundice, hepatomegaly, craggy liver, ascites

Hepatocellular carcinoma, common site for mets

128
Q

Pancreatic cancer

A

painless jaundice
adenocarcinoma
mostly in head

129
Q

Large bowel cancer

A

adenocarcinoma
polyps can become cancerous
left side of colon
obstructive symptoms

GI (22 decks)

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