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ALS > Block 3 (Josie's Notes) > Flashcards

Block 3 (Josie's Notes) Flashcards

1
Q

Name the boundaries of the mouth?

A
  • Roof - Hard (front) and soft (back) palate
  • Floor - Mylohyoid muscle
  • Lateral walls - Cheeks
  • Anterior - Lips
  • Posterior - Palatoglossal fold
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2
Q

What divides the mouth into two spaces?

A
  • Teeth
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3
Q

What are the two areas of the mouth?

A
  • Vestibule - Area between the teeth and lips
  • Oral cavity proper - Area behind the teeth
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4
Q

What are the three glands?

A
  • Parotid gland
  • Submandibular gland
  • Sublingual gland
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5
Q

Describe the parotid gland?

A
  • Largest gland
  • Lies outside the boundaries of the oral cavity
  • Parotid duct passes across external Describe the submandibular gland surface of the masseter muscle then penetrates the buccinator muscle of the cheek and opens into the oral cavity
  • Secretes serous, watery saliva
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6
Q

Describe the submandibular gland?

A
  • Hooked shaped
  • Inferior to the angle of the mandible
  • Duct emerges to open on papillia beside the base of the frenulus of the tongue
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7
Q

Describe the sublingual gland?

A
  • Smallest gland
  • Immediately lateral to submandibular duct
  • Superior margin raises an elongated fold (sublingual fold)
  • Minor sublingual ducts open onto the crest of the sublingual fold
  • Major sublingual duct occasionally drains anterior part of gland, opens with submandibular gland at sublingual caruncle
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8
Q

What are the three major external regions of a typical tooth?

A
  • Crown - Visible portion above gums
  • Root
  • Neck - Constricted junction of the crown and root
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9
Q

What are the three types of teeth?

A
  • Incisors - Cutting food
  • Canines - Tearing food
  • Molars - Crushing and grinding food
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10
Q

What are the two muscles of the tongue?

A
  • Extrinsic tongue muscles - Move tongue side to side and in and out
  • Intrinsic tongue muscles - Alter shape of tongue, involved in swallowing and speech
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11
Q

Describe the histology of the oral cavity?

A
  • Thick stratified squamous epithelium supported by lamina propria
  • In mobile areas (e.g. soft palate, underside of tongue, floor of mouth, cheeks, and lips) the epithelium is not keratinised
  • In areas such as gums, hard palate, and most of the tongues upper surface, the epithelium is keratinised
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12
Q

What arteries supply the oral cavity?

A
  • Branches of external carotid artery
  • Lingual artery supplies the tongue
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13
Q

What veins drain the oral cavity?

A
  • Veins of the palate drain into the pterygoid venous plexus
  • Lingual veins drain into the internal jugular vein
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14
Q

Describe the lymphatic drainage of the oral cavity?

A
  • Submandibular
  • Submantal
  • Deep cervical
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15
Q

Which nerves supply the oral cavity?

A
  • Inferior alveolar nerve - Lower teeth
  • Lingual nerve - Anterior two thirds to the tongue
  • Glossopharyngeal nerve - Posterior third of the tongue
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16
Q

Name the four muscles of mastication?

A
  • Masseter
  • Temporalis
  • Medial pterygoid
  • Lateral pterygoid
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17
Q

What does the masseter muscle do?

A
  • Elevates the mandible
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18
Q

What does the temporalis do?

A
  • Elevation and retraction of the mandible
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19
Q

What does the medial pterygoid do?

A
  • Elevation and side-to-side mandible movement
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20
Q

What does the lateral pterygoid do?

A
  • Protrusion and side-to-side mandible movement
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21
Q

What is the buccinator?

A
  • Accessory muscle of mastication
  • Pulls back the angle of the mouth and flattens the cheek area
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22
Q

What nerve innervates the muscles of mastication?

A
  • Mandibular nerve (branch of trigeminal)
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23
Q

What three areas is the pharynx divided into?

A
  • Nasopharynx
  • Oropharynx
  • Larngopharynx
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24
Q

Where is the oropharynx?

A
  • Posterior to the oral cavity
  • Inferior to the soft palate
  • Superior to the upper margin of the epiglottis
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25
Q

What structure marks the border between the mouth and the pharynx?

A
  • The palatoglossal arch (formed by the glossopalatine muscle)
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26
Q

What is the palatopharyngeal arch?

A
  • Larger than the palatoglossal arch
  • Projects further towards the midline
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27
Q

What is the name of the depression between the palatoglossal and palatopharyngeal arches?

A
  • Tonsillar fossa
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28
Q

What structure occupies the tonsillar fossa?

A
  • Palatine tonsil
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29
Q

Where are the lingual tonsils?

A
  • Mucosa covering the posterior third of the tongue
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30
Q

What is the oesophagus?

A
  • Muscular tube passing between the pharynx and the stomach
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31
Q

Where does the oesophagus start and end? (2)

A
  • Begins at cricoid cartilage C6
  • Ends at the cardiac opening of the abdomen T10
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32
Q

Where is the upper oesophageal sphincter?

A
  • Between the pharynx and oesophagus
  • Relaxes during swallowing
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33
Q

Where is the lower oesophageal sphincter?

A
  • Between the oesophagus and the stomach
  • Reinforced by diaphragmatic crus - prevents gastro-oesophageal reflux
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34
Q

Name the four structures that the oesophagus can be compressed and narrowed?

A
  • Pharyngo-oesophageal junction
  • Arch of the aorta (superior mediastinum)
  • Left main bronchus
  • Gastro-oesophageal junction (oesophageal hiatus)
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35
Q

Describe the histology of the oesophagus?

A
  • Non-keritanised stratified squamous epithelium
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36
Q

What arteries supply the oesophagus?

A
  • thoracic aorta
  • bronchial arteries
  • ascending branches of the left gastric artery
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37
Q

What nerves supply the oesophagus?

A
  • Vagus and sympathetic trunk
  • Splanchnic nerves involved in detection of pain
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38
Q

Name the four areas of the stomach?

A
  • Cardia - Surrounds the opening of the oesophagus
  • Fundus - Area above the cardiac orifice
  • Body - Largest region of the stomach
  • Pylorus - Divided into the pyloric antrum and pyloric canal
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39
Q

What is the greater curvature?

A
  • Point of attachment for gastrosplenic ligament and greater omentum
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40
Q

What is the lesser curvature?

A
  • Point of attachment for the lesser omentum
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41
Q

What secreted gastric juice?

A
  • Gastric mucosal glands
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42
Q

What does gastric juice contain? (5)

A
  • HCl
  • Mucus
  • Pepsin
  • Lipase
  • Intrinsic factor
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43
Q

What are rugae?

A
  • Folds in the stomach lining when the stomach is empty
  • Folds flatten after eating when the stomach is distended
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44
Q

Describe the pylorus?

A
  • Marked on the surface by the pyloric constrictor
  • Contains a thickened ring of gastric circular muscle (pyloric sphincter)
  • Pyloric sphincter surrounds the distal opening of the stomach (pyloric orifice)
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45
Q

Describe the histology of the stomach?

A
  • Simple columnar
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46
Q

What are the three types of exocrine cells in the glands?

A
  • Mucous neck cells - Secrete mucous
  • Parietal cells - Produce intrinsic factor and HCl
  • Chief cells - Secrete pepsinogen and gastric lipase
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47
Q

What are G cells?

A
  • Secrete gastrin (stimulates gastric acid secretion)
  • Found mainly in the pyloric antrum
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48
Q

What are the two sets of gastric lymph nodes?

A
  • Superior gastric glands
  • Inferior gastric glands
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49
Q

Describe the innervation of the stomach?

A
  • Sympathetic - Splanchnic nerves and celiac ganglion
  • Parasympathetic - Vagus
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50
Q

What are the three divisions of the small intestine?

A
  • Duodenum
  • Jejunum
  • Ileum
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51
Q

What marks the beginning and the end of the small intestine?

A
  • Beginning - Pyloric orifice
  • End - Ileocecal fold
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52
Q

Where is the duodenum located?

A
  • Next to the head of the pancreas
  • Retroperitoneal (except at the beginning which is connected to the liver by the hepatoduodenal ligament)
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53
Q

What are the four parts of the duodenum?

A
  • Superior part
  • Descending part
  • Inferior part
  • Ascending part
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54
Q

Where is the major duodenal papilla located and what is it?

A
  • Located in the descending part of the duodenum
  • Entrance for bile and pancreatic ducts
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55
Q

What is the minor duodenal papilla?

A
  • Entrance for accessory pancreatic duct
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56
Q

What is the suspensory muscle of the duodenum also known as?

A
  • Ligament of Treitz
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57
Q

What does the ligament of Treitz do?

A
  • Connecting the junction between the duodenum, jejunum, and duodenaljejunal flexure to connective tissue
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58
Q

Describe the distinguishing features of the jejunum?

A
  • Proximal two-fifths of the small intestine
  • Thicker wall
  • Inner mucosal lining has numerous prominent folds that circle the lumen (plical circulares)
  • Less prominent arterial arcades
  • Longer vasa recta
  • Supplied by jejunal arteries from the superior mesenteric artery
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59
Q

Describe the distinguishing features of the ileum?

A
  • Distal three-fifths of the small intestine
  • Thinner walls
  • Fewer/less prominent plical circulares
  • Shorter vasa recta
  • More arterial arcades
  • More mesenteric fat
  • Supplied by ileal arteries from the superior mesenteric artery
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60
Q

What does MALT stand for?

A
  • Mucosa-associated lymphoid tissue
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61
Q

What are Peyer’s patches?

A
  • Aggregations of GALT (gut associated lymphoid tissue)
  • Usually in the ileum
  • Important for the immune surveillance of the intestinal lumen and in facilitating the generation of the immune response within the mucosa
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62
Q

What is the purpose of the ileocecal folds?

A
  • Prevents reflux from the cecum to the ileum
  • Regulates passage of contents from the ileum to the cecum
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63
Q

What marks the beginning and the end of the large intestine?

A
  • Beginning - Distal end of ileum (Ileocecal folds)
  • Ends - Anus
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64
Q

What does the large intestine do?

A
  • Absorbs fluids and salts from the gut contents - forms faeces
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65
Q

What are the five structures of the large intestine?

A
  • Cecum
  • Appendix
  • Colon
  • Rectum
  • Anal canal
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66
Q

What are the four divisions of the colon?

A
  • Ascending colon
  • Transverse colon
  • Descending colon
  • Sigmoid colon
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67
Q

What is the flexure between the ascending colon and transverse colon?

A
  • Right colic flexure (hepatic flexure)
  • Just below the liver
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68
Q

What is the flexure between the transverse colon and the descending colon?

A
  • Left colic flexure (splenic flexure)
  • Just below the spleen
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69
Q

What are omental appendices?

A
  • Peritoneal covered accumulations of fat
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70
Q

What are teniae coli?

A
  • Longitudinal muscle in the walls
  • Three narrow bands
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71
Q

What are haustra?

A
  • Bulges of the colon
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72
Q

What are plica semilunaris?

A
  • Semilunar folds of mucosa separating the haustra coli
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73
Q

Describe the four layers of epithelium of the lower GI tract? (4)

A
  • Mucosa - Columnar epithelia, including goblet cells
  • Submucosa - Contains blood vessels and meissner’s nerve plexus
  • Muscularis propria - Contain the inner circular, outer longitudinal muscles and myenteric (auerbach’s) nerve plexus
  • Serosa - Visceral peritoneum
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74
Q

What is the arterial supply to the colon?

A
  • Superior mesenteric artery - Ascending and part of the transverse colon
  • Inferior mesenteric artery - Rest of the transverse, descending, and sigmoid colon
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75
Q

Describe the lymphatic drainage of the colon?

A
  • Thoracic duct (empties into the left subclavian vein)
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76
Q

What is the enteric nervous system (ENS)?

A
  • Mesh-like system of neurons that controls the function of the GI system
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77
Q

What are the two ganglia of the ENS?

A
  • Myenteric (Auerbach’s) plexus
  • Submucosal (Meissner’s) plexus
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78
Q

What is the myenteric plexus?

A
  • Located in the muscularis propria
  • Receives messages from vagus nerve
  • Contracts muscle cells - peristaltic waves
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79
Q

What is the submucosal plexus?

A
  • Located in the submucosa
  • Function is not clearly defined
  • May be partly inhibitory in the stomach
  • In the intestines it is believed to work with the myentetic plexus in producing peristaltic waves and increasing digestive secretions
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80
Q

What is the start of the rectum called?

A
  • Rectosigmoid junction
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81
Q

What are the rectal folds?

A
  • Transverse folds that support the weight of faecal matter
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82
Q

Is the rectum covered by peritoneal?

A
  • Upper third is covered by peritoneum
  • The rest is retroperitoneal
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83
Q

What are anal columns?

A
  • Vertical folds produced by an infolding of the mucous membrane and some of the muscular tissue
  • Contain a network of arteries and veins
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84
Q

What is the opening of the anal canal called?

A
  • The anus
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85
Q

What kind of muscle is the internal sphincter?

A
  • Smooth muscle (involuntary)
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86
Q

What does the levator ani muscle do?

A
  • Plays a vital role in supporting pelvic organs
  • Prevents urinary incontinence
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87
Q

What kind of muscle is the external sphincter?

A
  • Skeletal muscle (voluntary)
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88
Q

What is the arterial supply to the rectum and anal canal?

A
  • Superior, middle, and inferior rectal arteries (from inferior mesenteric artery)
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89
Q
  • Superior, middle, and inferior rectal arteries (from inferior mesenteric artery)
    Describe the lymphatic drainage of the rectum and anal canal?
A
  • Superficial inguinal lymph nodes (lower half)
  • Internal iliac lymph nodes (upper half)
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90
Q

Which nerves innervate the rectum and anal canal?

A
  • Inferior hypogastric nerve plexus (upper half)
  • Somatic inferior rectal nerve (lower half)
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91
Q

What are the two layers of superficial fascia?

A
  • Superficial fatty layer (camper’s)
  • Deep membranous layer (scarpa’s)
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92
Q

What is camper’s fascia?

A
  • Superficial fatty layer of superficial facia
  • Contains fat, varies in thickness
  • Continuous over inguinal ligament with superficial fascia of the thigh
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93
Q

What is scarpa’s fascia?

A
  • Deep membranous layer of superficial fascia
  • Thin and membranous, contains little or no fat
  • Continues into thigh (fuses with deep fascia)
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94
Q

What are the five muscles in the anterolateral group of abdominal wall muscles?

A
  • Three flat muscles - Pass anteriorly and are replaced by aponeurosis as they continue towards the midline
  • External oblique
  • Internal oblique
  • Transverse abdominis
  • Two vertical muscles - Near midline, enclosed within a tendinous sheath formed by aponeurosis of the flat muscles
  • Rectus abdominis
  • Pyramidalis (only in 10%)
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95
Q

What are the vertical muscles enclosed in?

A
  • Rectus sheath - Layering of aponeurosis of external and internal oblique and transverse abdominis
  • Encloses upper three-quarters of the rectus abdominis
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96
Q

What is the transversalis fascia?

A
  • Thin aponeurotic membrane which lies between the inner surface of the transverse abdominis and the extraperitoneal fascia
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97
Q

What is extraperitoneal fascia?

A
  • Connective tissue which separates the transversalis fascia from the parietal peritoneum
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98
Q

What is the peritoneum?

A
  • Thin serous membrane
  • Lines walls of abdominal cavity, at points reflects on to the viscera (organs of the abdominal cavity)
  • Parietal peritoneum - Lining walls
  • Visceral peritoneum - Lining viscera
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99
Q

What is the space between the peritoneum called?

A
  • Peritoneal cavity
  • Closed in men, semiclosed in women (uterine tubes)
  • Potential space, contains thin film of fluid to act as a lubricant and fight infections
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100
Q

What are the two sacs of the peritoneal cavity?

A
  • Greater sac - Most of the peritoneal cavity
  • Lesser sac (omental bursa) - Smaller sac posterior to the liver and stomach, continuous with the greater sac through the omental foramen
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101
Q

What is the inguinal canal?

A
  • Slit-like passage
  • Begins at the deep inguinal ring
  • Extends downwards and medial for about 4cm
  • Ends at the superficial inguinal ring
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102
Q

Name the contents of the inguinal canal?

A
  • Gential branch of genitofemoral nerve
  • Ilioinguinal nerve
  • Spermatic cord (men)
  • Round ligaments of uterus (women)
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103
Q

Where is the deep inguinal ring located?

A
  • Midpoint between anterior superior iliac spine and pubic symphysis
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104
Q

Where is the superficial inguinal ring located?

A
  • Superior to the pubic tubercle, triangular opening in the aponeurosis of the external oblique
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105
Q

Name the boundaries of the inguinal canal?

A
  • Anterior wall - Aponeurosis of external oblique
  • Posterior wall - Transversalis fascia
  • Roof - Arching fibres of transverse abdominus and internal oblique
  • Floor - Inguinal ligament
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106
Q

What are the two surfaces of the liver?

A
  • Diaphragmatic surface - Anterior, superior, and posterior
  • Visceral surface - Inferior
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107
Q

Name the two recesses associated with the liver

A
  • Subphrenic recess - Separates diaphragmatic surface from the diaphragm, divided into left and right areas by falciform ligament
  • Hepatorenal recess - Part of the peritoneal cavity that separates the liver from the right kidney and suprarenal gland
108
Q

What covers the visceral surface of the liver?

A
  • Visceral peritoneum (except the fossa of the gallbladder and the porta hepatis)
109
Q

What does the falciform ligament do?

A
  • Connects liver to anterior abdominal wall
110
Q

What does the hepatogastric ligament do?

A

Connects liver to stomach

111
Q

What does the hepatoduodenal ligament do?

A
  • Connects the liver to the duodenum
112
Q

What does the left and right triangular ligaments and the anterior and posterior coronary ligaments do?

A
  • Connects the liver to the diaphragm
113
Q

What is the bare area?

A
  • Part of the liver on the diaphragmatic surface where there is no intervening peritoneum
114
Q

What are the four lobes of the liver?

A
  • Right lobe
  • Left lobe
  • Caudate lobe
  • Quadrate lobe
115
Q

What divides the liver into left and right lobes?

A
  • Fossa of the gallbladder
  • Inferior vena cava
116
Q

Which lobe do the caudate and quadrate lobes arise from?

A
  • Right lobe (but are functionally distinct)
117
Q

What is the name of the small hexagonal functional units of the liver?

A
  • Lobule
118
Q

What does a lobule consist of?

A
  • Central vein (hepatic venule) surrounded by 6 hepatic portal veins and 6 hepatic portal arteries
119
Q

What connects the hepatic venule and the surrounding arteries and portal veins?

A
  • Sinusoids
120
Q

What are the two types of cells in the sinusoids?

A
  • Kupffer cells
  • Hepatocytes
121
Q

What is a kupffer cell?

A
  • Macrophage that captures and breaks down old, worn out red blood cells
122
Q

What is a hepatocyte?

A
  • Cuboidal epithelial cells lining the sinusoids
  • Perform most of the livers functions
123
Q

Describe periportal zone 1?

A
  • Nearest to the entering vascular system (receives the most oxygenated blood)
  • Hepatocytes here are specialised for oxidative functions
124
Q

Describe periportal zone 3?

A
  • Poorest oxygenation
  • Hepatocytes are most important for glycolysis
125
Q

What arteries supply the liver?

A
  • Right and left hepatic artery (from the hepatic artery proper - coeliac trunk)
126
Q

What veins drain the liver?

A
  • Hepatic veins
127
Q

Describe the lymphatic drainage of the liver?

A
  • Hepatic lymph nodes
  • Subpyloric lymph nodes
128
Q

What nerves innervate the liver?

A
  • Hepatic nerve plexus
129
Q

Where does the liver receive blood from?

A
  • Hepatic artery - Receives oxygenated blood
  • Hepatic portal vein - Receives deoxygenated blood from the GI tract containing newly absorbed nutrients, drugs, microbes, and toxins
130
Q

Where is the gallbladder located?

A
  • Visceral surface of the liver in a fossa between the right and quadrate lobes
131
Q

What are the three divisions of the liver?

A
  • Fundus
  • Body
  • Neck
132
Q

What does the gallbladder do?

A
  • Stores and concentrates the bile produced in the liver
133
Q

How does the gallbladder concentrate bile?

A
  • In the concentration process water and ions are absorbed by the gallbladder mucosa
134
Q

Describe gallbladder mucosa?

A
  • Simple columnar epithelia arranged in rugae
  • No submucosa
  • Has smooth muscle fibres which contract to eject the contents into the cystic duct
135
Q

What duct is formed when the cystic duct joins the common hepatic duct?

A
  • Bile duct
136
Q

What is formed when the bile duct joins with the pancreatic duct?

A
  • Hepatopancreatic ampulla (ampulla of vater)
137
Q

At what structure does the ampulla of vater enter the descending duodenum?

A
  • Major duodenal papilla
  • Surrounded by sphincter of oddi
138
Q

What arteries supply the gallbladder?

A

Cystic artery (from right hepatic artery)

139
Q

What veins drain the gallbladder?

A
  • Cystic veins (drain into the portal vein and liver)
140
Q

Describe the lymphatic drainage of the gallbladder?

A
  • Cystic lymph nodes
141
Q

Describe the innervation of the gallbladder?

A
  • Sympathetic - Celiac plexus
  • Parasympathetic - Vagus
  • Sensory - Right phrenic nerve
142
Q

What are the five parts of the pancreas?

A
  • Head - Lies within the C-shaped concavity of the duodenum
  • Uncinate process - Projects from the lower part of the head
  • Neck
  • Body - Elongated, extends from neck to tail
  • Tail
143
Q

Is the pancreas covered with peritoneum?

A
  • Mostly retroperitoneal, except for small part of the tail
144
Q

Describe the route of the pancreatic duct?

A
  • Begins at tail
  • Passes through body
  • In lower part of head joins the bile duct to form the hepatopancreatic ampulla (ampulla of vater)
  • Enters the descending duodenum at the major duodenal papila
  • Accessory pancreatic duct empties at the minor duodenal papilla (above the major)
145
Q

What two regions are the cells of the pancreas divided into?

A
  • Exocrine
  • Endocrine
146
Q

Describe the structure of the exocrine pancreas?

A
  • 98% of pancreas
  • Arranged in acini
147
Q

Describe the structure of the endocrine pancreas?

A
  • 2% of pancreas
  • Arranged in Islets of Langerhans
148
Q

What arteries supply the pancreas?

A
  • Splenic artery (main)
  • Gastroduodenal artery (from common hepatic)
149
Q

What veins drain the pancreas?

A
  • Splenic vein
  • Portal vein
  • Superior mesenteric vein
150
Q

Describe the lymphatic drainage of the pancreas?

A
  • Pancreaticosplenic nodes
151
Q

Describe the innervation of the pancreas?

A
  • Vagus nerve
  • Thoracic splanchnic nerve
152
Q

Name the functions of the liver

A
  • Produces bile
  • Excretion of bilirubin
  • Helps metabolise fat
  • Metabolises protein
  • Metabolises carbohydrates
  • Stores vitamins and minerals
  • Filters the blood
  • Phagocytosis
  • Activation of vitamin D
153
Q

Describe the function of bile?

A
  • Helps small intestine digest fats and absorb fats, cholesterol, and some vitamins
154
Q

Describe the excretion of bilirubin?

A
  • Absorbed by the liver and secreted in bile
  • Metabolised in the small intestine by bacteria
  • Eliminated in faeces
155
Q

How does the liver help metabolise fat?

A
  • Bile breaks down fat to make it easier to digest
  • Hepatocytes store some triglycerides
  • Synthesises lipoproteins which transport fatty acids, triglycerides, and cholesterol
  • Synthesising cholesterol
  • Uses cholesterol to make bile salts
156
Q

How does the liver help metabolise proteins?

A
  • Liver enzymes break down proteins
  • Hepatocytes deaminate amino acids
  • Hepatocytes synthesise plasma proteins
157
Q

How does the liver help metabolise carbohydrates?

A
  • Body breaks down carbohydrates into glycogen which is stored in the liver
  • Liver breaks down glycogen into glucose and releases it into the blood to maintain normal blood sugar levels
158
Q

Which vitamins and minerals does the liver store?

A
  • Fat soluble vitamins - A, D, E, and K
  • B12
  • Iron (in the form of ferritin)
159
Q

Why does the liver filter the blood?

A
  • To remove certain substances so they don’t build up and cause damage
160
Q

Which cells in the liver act as phagocytes?

A
  • Kupffer cells
  • They phagocytise old red blood cells, white blood cells, and some bacteria
161
Q

How does the liver assist in the activation of vitamin D?

A
  • In the liver vitamin D (cholecalciferol) is converted to calcidiol (25-hydroxycholecalciferol)
  • Calcidiol is then converted in the kidneys to calcitriol (1,25-diydroxycholecalciferol)
162
Q

What is the main enzyme group in drug metabolism?

A
  • Cytochrome P450 in the smooth ER
163
Q

What are the two phases of drug metabolism?

A
  • Phase 1 - Reduction, hydrolysis, or oxidation (the resulting metabolise is often chemically active)
  • Phase 2 - Conjugation (attaching ionising group makes metabolite more water soluble)
164
Q

What are normal blood glucose levels?

A
  • 100mg/dL
165
Q

Which cells in the pancreas release insulin?

A
  • Beta cells
166
Q

What does the liver do when there is an increases glucose concentration in the blood?

A
  • Glycogenesis - Stores glucose and glycogen
167
Q

Which cells in the pancreas release glucagon?

A
  • Alpha cells
168
Q

What does the liver do when there is a decreased glucose concentration in the blood?

A
  • Glycogenolysis - Breaks down glycogen into glucose
  • Gluconeogenesis - Converts non-carbohydrate substances into glucose
169
Q

What nerve innervated the muscles of mastication?

A
  • Trigeminal nerve
170
Q

What controls the chewing process?

A
  • Nuclei in the brainstem
  • Stimulation of taste centres causes rhythmic chewing movements
171
Q

Describe the chewing reflex?

A
  • Presence of bolus initiates reflex inhibition of muscles, allows lower jaw to drop
  • This drop initiates a stretch reflex of the jaw muscles
  • Leads to rebound contraction, automatically raises jaw to cause the closure of teeth
  • Compression of bolus against the lining of the mouth inhibits the jaw muscles again
  • Process is repeated
172
Q

What are the three phases of swallowing?

A
  • Oral phase
  • Pharyngeal phase
  • Oesophageal phase
173
Q

What happens during the oral phase of swallowing?

A
  • Tongue pushes bolus to back of throat (pharynx)
  • Voluntary part of swallowing
174
Q

What happens during the pharyngeal phase of swallowing?

A
  • Stimulation of tactile receptors in oropharynx initiates swallowing reflex
  • Tongue blocks oral cavity
  • Soft palate blocks nasal cavity
  • Vocal folds close to protect airways, larynx is pulled up with epiglottis flipping over to cover trachea
  • Upper oesophageal sphincter opens
175
Q

What happens during the oesophageal phase?

A
  • Bolus is propelled down the oesophagus by peristalsis
  • Larynx moves back to original position
  • Peristaltic waves move gastric contents down into the pyloric antrum
176
Q

What is retropulsion in the stomach?

A
  • Food particles are too large to fit through the pyloric sphincter so are forced back into the body of the stomach
177
Q

What do the food particles eventually form after being mixed with gastric acid?

A
  • Chyme
178
Q

What is gastric emptying?

A
  • When food particles are small enough they can pass through the pyloric sphincter
179
Q

Describe the secretion of gastric acid?

A
  • Cl- and Na+ are secreted actively from parietal cells into the lumen of the canaliculus
  • This creates a negative potential across the membrane that causes K+ and some Na+ to diffuse out
  • Carbonic anhydrase catalyses the reaction between CO2 and H2O to form carbonic acid, which dissociates into H+ and HCO3-
  • H+ leave cell through H+K+ATPase antiporter, at the same time Na+ is actively reabsorbed
  • H+ and Cl- mix together, they are secreted into the lumen of the oxyntic gland
180
Q

What are the three phases in secretion that increase the secretion of gastric acid?

A
  • Cephalic phase - Secretion stimulated by anticipation of eating and the smell or taste of food
  • Gastric phase - Secretion stimulated by distension of the stomach and by amino acids present in the food
  • Intestinal phase - Stimulated by small intestine distension and by amino acids
181
Q

Which areas of the brain are activated by the cephalic phase?

A
  • Cerebral cortex
  • Hypothalamus
  • Brain stem
182
Q

What does the activation of the facial and glossopharyngeal nerve lead to?

A
  • Stimulation of the salivary glands to secrete saliva
183
Q

Describe the neural regulation of the gastric phase?

A
  • Food distends stomach stimulating stretch receptors
  • Chemoreceptors monitor pH of chyme
  • Nerve impulses propagate to the submucosal plexus and activate parasympathetic and enteric neurons
  • Results in waves of peristalsis and continued secretion of gastric acid
  • When gastric emptying occurs the pH decreases and distension is lessened - suppressing stimulation of gastric juice
184
Q

Which cells release gastrin?

A
  • G cells in response to distension, partially digested proteins, high pH, caffeine, and ACh
185
Q

What does gastrin do?

A
  • Stimulated gastric glands to secrete large amounts of gastric juice
  • Strengthens contraction of lower oesophageal sphincter to prevent reflux
  • Increases motility of stomach
  • Relaxes pyloric sphincter
186
Q

At what pH is gastrin secretion inhibited?

A
  • <2
187
Q

Describe the neural regulation of the intestinal phase? (4)

A
  • Distension of the duodenum causes the enterogastric reflex
  • Stretch receptors send nerve impulses to medulla
  • Inhibit parasympathetic and stimulate sympathetic
  • Inhibits gastric motility and increases contraction of pyloric sphincter
188
Q

Which hormones are involved in the intestinal phase?

A
  • Cholecytokinin (CCK) - Stimulates secretion of pancreatic juice, contraction of gallbladder, relaxed sphincter of Oddi, contraction of pyloric sphincter
  • Secretin - Secreted from S cells in glands of small intestine, stimulates flow of pancreatic juice rich in HCO3- to buffer acidic chyme, inhibits secretion of gastric juice
189
Q

What is absorbed in the duodenum?

A
  • Iron
190
Q

What is absorbed in the jejunum?

A
  • Folate, glucose, fatty acids, amino acids
191
Q

What is absorbed in the ileum?

A
  • B12, bile salts
192
Q

What is resistant starch?

A
  • Starch and starch degradation products that escape from digestion in the small intestine
  • Can have powerful health benefits such as improved insulin sensitivity, lower blood sugar, reduced appetite
193
Q

What is produced when dietary fibre is fermented in the colon?

A
  • Short-chain fatty acids
194
Q

Describe carbohydrate digestion

A
  • Begins in the mouth with salivary amylase
  • Acidic pH of stomach destroys salivary amylase
  • Those starches not already broken down are cleaved by pancreatic amylase in pancreatic juice
  • Brush-border enzyme (α-dextrinase) acts on resulting α-dextrins, clipping off one glucose at a time
  • Sucrose, lactose, and maltose aren’t acted on until they reach the small intestine
195
Q

How is maltose broken down?

A
  • Into two glucose monomers by maltase
196
Q

How is sucrose broken down?

A
  • Into glucose and fructose by sucrase
197
Q

How is lactose broken down?

A
  • Into glucose and galactose by lactase
198
Q

Describe carbohydrate absorption?

A
  • Monosaccharides pass from the lumen of the small intestine through the apical membrane via facilitated diffusion (fructose) or active transport coupled with Na+ (glucose and galactose)
  • Move out through basolateral surfaces via facilitated diffusion and enters capillaries
199
Q

Describe protein digestion?

A
  • Begins in the stomach with pepsin
  • Enzymes in pancreatic juice (trypsin, chymotrypsin, carboxypeptidase, and elastase) continue to break down proteins into peptides
  • Protein digestion is completed by two peptidases in the brush border
200
Q

What does aminopeptidase do?

A
  • Cleaves off amino acid
201
Q

What does dipeptidase do?

A
  • Splits dipeptides into single amino acids
202
Q

How and where are amino acids absorbed?

A
  • Active transport
  • Duodenum and jejunum
203
Q

How do amino acids enter capillaries?

A
  • 3 fatty acids
  • 1 glycerol
204
Q

What is emulsification?

A
  • Breaking up of fat globules into much smaller emulsification droplets
  • Increases surface area where water soluble lipase can work to digest tag
205
Q

What do emulsified fat globules form when they associate with bile salts?

A
  • Emulsification droplets
206
Q

What enzyme releases free fatty acids?

A
  • Lipase
207
Q

What do free fatty acids form when they associate with bile salts?

A
  • Micelles
208
Q

What do micelles do?

A
  • Transport poorly soluble monoglycerides to the surface of the enterocyte to be absorbed
  • Constantly breaking down and reforming
209
Q

What can micelles also contain?

A
  • Fat soluble vitamins (A, D, E, and K)
  • Cholesterol
210
Q

How are fats absorbed?

A
  • Monoglycerides are absorbed once freely dissolved
  • Micelles are not absorbed
211
Q

Describe what happens to fats inside the enterocyte?

A
  • Monoglycerides are resynthesised into TAG
  • TAG is packaged with cholesterol and fat soluble vitamins into chylomicrons
  • Chylomicrons are released by exocytosis in secretory vesicles at the basolateral surface of the enterocyte
  • Enter lacteals (lymphatic capillaries)
  • Flow into circulation via lymphatic vessels
212
Q

Why can’t chylomicrons enter the capillaries?

A
  • Too large
213
Q

What does the myenteric plexus do?

A
  • Stimulates muscles to contract in peristaltic waves
  • Helps keep muscle tone
  • Promotes secretion of intestinal juices
  • Allows sphincter to open
214
Q

What does the submucosal plexus do?

A
  • In the stomach works against myenteric plexus
  • In the intestines works with myenteric plexus
215
Q

What pancreatic cells secrete insulin?

A
  • Beta cells
216
Q

When is insulin secreted?

A

In response to high blood glucose

217
Q

What are the functions of insulin? (2)

A
  • Stimulation of anabolic processes - Promotes entry of amino acids and glucose into cells, stimulates glycogenesis
  • Inhibition of catabolic processes - Inhibits gluconeogenesis, inhibits fat breakdown and beta-oxidation of fatty acids and ketogenesis, inhibits glycogenolysis
218
Q

Name the hormones that oppose the action of insulin?

A
  • Glucagon
  • Cortisol
  • Catecholamines
  • Growth hormone
219
Q

What are the functions of glucagon?

A
  • Stimulate production of glucose from glycogen (glycogenolysis)
  • Stimulate production of glucose from non-carbohydrate substances (gluconeogenesis)
  • Generate energy from fatty acid beta-oxidation
220
Q

Which cell in the liver secretes bile?

A
  • Hepatocytes
221
Q

What does bile consist of?

A
  • Water
  • Bile salts
  • Cholesterol
  • Lecithin
  • Pile pigments
  • Several ions
222
Q

Name the principle bile pigment?

A
  • Bilirubin
223
Q

Describe bilirubin metabolism?

A
  • Old red blood cells are phagocytised in the liver, this liberates globin and bilirubin (derived from haem)
  • Iron and globin are recycled
  • Bilirubin is secreted into the bile which passes into the small intestine and then the large intestine
  • In the large intestine, bacteria convert bilirubin into urobiligen
  • Some urobiligen is absorbed back into the blood, converted to urobilin, and excreted in urine
  • Most urobiligen is excreted in the faeces in the form of stercobilin (gives faeces its brown colour)
224
Q

Summarise the breakdown of bilirubin

A
  • Bilirubin
  • Urobiligen
  • Urobilin or stercobilin
225
Q

What do bile salts do?

A
  • Role in emulsification
  • Form micelles
226
Q

How do bile salts return to the liver?

A
  • Bile salts are reabsorbed by active transport
  • Returned by the blood to the liver (enterohepatic circulation)
227
Q

What do lipids combine with to travel in the blood?

A
  • Protein to form chylomicrons
228
Q

What is a chylomicron?

A
  • Form in mucosal epithelial cells of the small intestine
  • Transport dietary lipids to adipose tissue for storage
229
Q

How are fatty acids taken up by adipocytes?

A
  • Apoprotein (apo C-2) activates endothelial lipoprotein lipase to removes fatty acids
230
Q

What removes chylomicron remnants from the blood?

A
  • Hepatocytes
231
Q

What are VLDLs?

A
  • Very low density lipoproteins
  • Form in hepatocytes
  • Transport triglycerides synthesised in hepatocytes to adipocytes for storage
  • Apo C-2 activates endothelial lipoprotein lipase which removes fatty acids
  • VLDLs are converted to LDLs
232
Q

What are LDLs?

A
  • Low density lipoproteins
  • Carry about 75% of the total cholesterol in the blood and deliver it to cell throughout the body for repairing cell membranes and synthesising steroid hormones and bile salts
233
Q

How do LDLs enter cells?

A
  • Apo B100
  • Broken down so the cholesterol is released
234
Q

What happens if LDLs are present in excessive numbers?

A
  • LDLs deposit cholesterol in and around smooth muscle fibres in arteries
  • Forms fatty plaques that increase the risk of coronary heart disease
235
Q

What are HDLs?

A
  • High density lipoproteins
  • Remove cholesterol from body cells and blood and transport it to the liver for elimination
  • Prevent accumulation of cholesterol in the blood
236
Q

Outline the body’s requirement for cholesterol?

A
  • Myelin sheath
  • Plasma membranes (build and maintain)
  • Intracellular transport, cell signalling, nerve conduction
  • Bile - Aids digestion and vitamin absorption
  • Precursor for vitamin D and steroid hormones
237
Q

Name the two sources of cholesterol in the body?

A
  • Food (e.g. eggs, dairy, beef, pork)
  • Synthesised by hepatocytes (most)
238
Q

Describe cholesterol metabolism?

A
  • Oxidised by the liver into a variety of bile acids
  • 95% of bile acids reabsorbed from intestines, remainder are lost in the faeces
  • In the colon, cholesterol can be metabolised by the colonic bacteria
  • Converted to coprostanol and excreted in the faeces
239
Q

Name the five principle mediators that control parietal cell acid output?

A
  • Histamine - Stimulating
  • Gastrin -Stimulating
  • ACh - Stimulating
  • Prostaglandins (E2 and I2) - Inhibiting
  • Somatostatin - Inhibiting
240
Q

Describe the stimulation of gut secretion?

A
  • Gastrin is released from G cells
  • Gastrin acts on CCK2 receptors on ECL cells to release histamine
  • Histamine acts on parietal cells H2 receptors to elevate cAMP that activated the secretion of acid by the proton pump
  • Direct vagal stimulation also provokes acid secretion and releases ACh that acts on parietal cells M3 receptors
241
Q

Describe the inhibition of gut secretions?

A
  • Somatostatin excrete a tonic inhibitory influence on G cells, ECL cells, and parietal cells
  • Prostaglandins exert inhibitory effects predominantly on ECL cells
242
Q

Name some classes of drugs that alter motility?

A
  • Purgatives - Accelerate passage of food through the intestine
  • Agents that increase motility withouth purgation
  • Antidiarrhoeal drugs - Decrease motility
  • Antispasmodic drugs - Decrease smooth muscle tone
243
Q

Describe the mechanism of proton pump inhibitors? (3)

A
  • Irreversibly blocks the H+K+ATPase of parietal cells
  • Reduces gastric acids secretion by up to 99%
  • Aids the healing of duodenal ulcers, reduces pain from indigestion and heartburn
244
Q

Give some examples of proton pump inhibitors?

A
  • -zole
  • Omeprazole
  • Iansoprazole
  • Rabeprazole
245
Q

Describe the mechanism of histamine H2 receptor antagonists?

A
  • Competitively inhibits histamine actions at H2 receptors in upper GI tract and inhibits gastric acid secretion
  • Reduces gastric acid secretion by up to 90%
246
Q

Give some examples of histamine H2 receptor antagonists?

A
  • -idine
  • Ranitidine
  • Famotidine
247
Q

What are antacids?

A
  • Directly neutralise acid
  • Most antacids are salts of magnesium and aluminium
248
Q

How can antibiotics treat gastric ulcers?

A
  • H. pylori infection has been implicated as a causative factor in the production of gastric and duodenal ulcers
  • Eradication of H. pylori promotes rapid and long-term healing of ulcers
249
Q

What is nausea?

A
  • The conscious recognition of the subconscious excitation in an area of the medulla closely associated with or part of the vomiting centre
  • Often a prodrome of vomiting
250
Q

What can cause nausea?

A
  • Irritative impulses coming from the GI tract
  • Impulses that originate in the lower brain associated with motion sickness
  • Impulses from the cerebral cortex to initiate vomiting
251
Q

What is the CTZ?

A
  • Chemoreceptor trigger zone
  • Located within the area postrema
  • Recieves inputs from blood-borne drugs or hormones and communicates with other structures in the vomiting centre to initiate vomiting
252
Q

Name the five neurotransmitters involved in the control of nausea and vomiting?

A
  • ACh - muscarinic receptors
  • Dopamine - D2 receptors
  • Histamine - H1 receptors
  • Substance P - NK1 receptors
  • Serotonin - 5-HT3 receptors
253
Q

What are antiemetics?

A
  • Prevents vomiting
  • Antagonists of the neurotransmitter receptors
254
Q

Give some examples of antiemetics?

A
  • -estron
  • Dolasetron
  • Granisetron
  • Ondansetron
255
Q

What are emetics?

A
  • Induce vomiting
  • Agonists of the neurotransmitter receptors
256
Q

What are bile acid sequestrants?

A
  • Disrupt the enterohepatic circulation by combining with bile constituents and preventing their reabsorption from the gut
  • Classified as hypolipidemic agents but can be used for purposes other than lowering cholesterol
257
Q

Describe the mechanism of bile acid sequestrants?

A
  • Bile acids are prevented from being reabsorbed
  • Liver produces more bile acids to replace those that have been lost
  • Body used cholesterol to make bile acids
  • This reduces the amount of LDL cholesterol circulating in the blood
258
Q

Give some examples of bile acid sequestrants?

A
  • Cholestyramine
  • Colestipol
  • Colesevelam
259
Q

What are hypolipidemic agents?

A
  • Used to treat hyperlipidemia
  • These are lipid-lowering drugs
260
Q

Give some examples of hypolipidemic agents?

A
  • Statins
  • Fibrates
  • Orlistat
261
Q

Describe the mechanism of statins?

A
  • Inhibit HMG-CoA reductase which plays a role in the production of cholesterol
  • Increases LDL uptake by the liver
262
Q

Give some examples of statins?

A
  • -astatin
  • Atorvastatin
  • Fluvastatin
  • Lovastatin
263
Q

Describe the mechanism of fibrates?

A
  • Activate PPAR (peroxisome proliferator-activated receptors)
  • Induced the transcription of genes that facilitate lipid metabolism
  • Less effective in lowering LDL and triglyceride levels than statins
  • Increases HDL levels
264
Q

Give some examples of fibrates?

A
  • -fibrate
  • Bezafibrate
  • Ciprofibrate
  • Clofibrate
265
Q

Describe the mechanism of orlistat?

A
  • Inhibits pancreatic lipase (enzyme that breaks down triglycerides)
  • Prevents the absorption of around 30% of fats from the diet
  • Primary side effect include steatorrhea (oily, loose stools), faecal incontinence or urgent bowel movements

ALS (9 decks)

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