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NPLEX I > Digestive System > Flashcards

Digestive System Flashcards

1
Q

Remember

A

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

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2
Q

Stylopharyngeal muscle

A

Elevated pharynx and larynx

Innervation: Glossopharyngeal nerve

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3
Q

Gingivitis

A

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

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4
Q

Periodontitis

A

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

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5
Q

What is the hardest substance in the human body?

A

Enamel

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6
Q

Herpes simplex virus

A

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

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7
Q

Oral and genital herpes

A

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

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8
Q

Leukoplakia

A

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

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9
Q

Pharyngitis

A

Concomitant with viral upper resp. infection.

Bacterial cause often beta-hemolytic strep

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10
Q

Squamous Cell carcinoma

A

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

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11
Q

Hiatal hernia

A

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

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12
Q

Esophageal varices

A

Secondary to portal hypertension, alcoholic cirrhosis

Distal esophagus and proximal stomach, asymptomatic until rupture

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13
Q

Esophagitis: GERD

A

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

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14
Q

Squamous Cell Carcinoma

A

Alcohol, smoking, fungal, nitrosamine containing foods

Zinc and other vitamin and mineral deficiencies may predispose

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15
Q

What ar the parts of the stomach?

A

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

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16
Q

What are the parts of the stomach?

A

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

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17
Q

What are the attachments of the stomach?

A

Lesser omentum

Greater omentum

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18
Q

What artery supplies the stomach?

A

Arteries derived from the CELIAC trunk

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19
Q

Acute gastritis

A

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

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20
Q

Chronic gastritis

A

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

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21
Q

Hypochlorhydria

A

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

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22
Q

Gastric ulcer

A

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

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23
Q

Duodenal Ulcer

A

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

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24
Q

Gastric carcinoma (cancer)

A

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

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25
Remember
THree parts of the small intestine: Duodenum, jejunum, and ileum. Jejunum is shorter than the ileum In the jejunum, there are fewer arterial arcades than the ileum and fewer lymphatics In the ileum, you will find Peyer's patches, more arterial arcades than jejunum, more lymphatics.
26
adynamic ileus
paralysis of intestinal motility.
27
What is the main blood supplier of the small intestine?
Superior mesenteric artery
28
Why is there collateral circulation to the small intestine?
Because the small intestine has a high demand for oxygen and is highly susceptible to injury from ischemia.
29
Intussusception
Most common intestinal obstruction in infants and young children. Not normal in adults - this is BAD Happens in the ileocecal region. Ileum into the cecum.
30
Gastroenteritis
Gastrointestinal tract viral infection (lasts 12hrs - 3 days). Primary transmission - Oral-fecal route Viruses - epithelium damage- osmotic diarrhea (three stools daily), vomiting. Children: rotavirus Adult: norovirus Fever, diarrhea, vomiting, cramps, dehydration
31
Large intestine
The muscularis layer goes away and is replaced by the teniae coli which runs longitudinally. Lar intestine has haustra (sacs)
32
Remember
The internal sphincters (rectal or urinary) are mediated by stretch reflexes. They are invonlutary.
33
Appendicitis
``` Inflammation of vermiform apprendix. Adolescents and young adults Bacterial McBurney's point rebound tenderness Periumbilical pain RLQ with nausea and vomiting, constipation, no gas ```
34
Diverticulitis
``` Inflammation of the diverticula of the haustra of the colon due to insoluble material and bacteria. Pain Fever Nausea Change in bowel pattern ```
35
Diverticulosis
Added haustrations to the colon Not everyone has it. Usually found in people > 60 yrs of age
36
Colorectal carcinoma
60-70 yo males > females | Associated with ulcerative colitis, polyposis coli, Chron's disease.
37
Hemorrhoids
Varicosities in inferior hemorrhoidal plexus Symptoms: Lumps on the anus may become swollen and painful Mucus in your rectum that may make you feel like you haven't passed stool ItchingCauses: Overweight, pregnancy, heavy objects, constipation or diarrhea for a long time, anal sex
38
Chronic granulomas disease
Development of granulomas which are collections of immune cells that cluster together when they can't kill pathogens Autoimmune Fever, diarrhea, vitamin B12 def Skip lesions
39
Chronic ulcerative colitis
``` More common in 20-25 years May affect only rection Ulceration with pseudopolyps Bloody mucoid diarrhea Iritis is common ```
40
Celiac disease
Gluten-sensitive enteropathy Malabsorption secondary to inflammatory luminal swelling Celiac sprue presents with bulky, greasy stools, diarrhea, flatulence Can be genetic or autoimmune Weight loss, fatigue any age Abates with gluten removal
41
Irritable Bowel syndrome
Recurrent abdominal pain and abnormal bowel motility (diarrhea or constipation) The pain improves after a bowel movement. Functional disorder females more than males pain after eating It is a dx of exclusion (chronic gastritis, cancer, etc)
42
Inflammatory bowel disease
Share same characteristics of IBS, but has inflammation, ulcers, or other damage to the bowel.
43
Acute pancreatitis
a great amount of variation of symptom picture It is very painful causes: - heavy alcohol use, choline deficiency, gallstones Constant epigastric pain radiating to mid-back Elevated serum amylase and lipase Pancreas being digested by enzymes, that is why it is painful
44
Pancreatic cancer
Asymptomatic almost until the end heavy tobacco smoking triples risk Heavy consumption of fats and meat Diagnosed at high stage and high grade due to being asymptomatic Renal failure from liver failure because kidneys are getting all the toxins
45
Acute liver failure
Fulminant hepatitis, toxic damage from acetaminophen, halothane, carbon tetrachloride, antidepressants DIC, renal failure
46
Chronic liver failure
Hepatitis, cirrhosis, inherited metabolic disorders | Clotting dysfunction
47
Cholestasis
``` Chole = bile Statis = static, inactivity ```
48
Hepatocellular cholestasis
intra-hepatic Estrogen inhibits the excretion of bile acids, keeping them in the hepatic cells Conjugated bilirubin builds up in the cell, crossing through the membrane getting into the bloodstream High levels of estrogen have been linked to this.
49
Obstructive cholestasis
outside the liver physical blockage gallstones
50
How is the descending aorta divided?
Celiac trunk, superior, and inferior mesenteric.
51
How many blood supplies does the stomach have?
3 Gastro epiploic - a branch of the splenic artery Direct branch out of the celiac trunk called left gastric artery Right gastric artery coming from the hepatic artery
52
What would cause portal hypertension?
``` Right-side heart failure, pregnancy, and hepatic disease Signs: - Esophageal varices - Rectal hemmorhoids - Capite medusa ```
53
Remember
GI structure Submucosal plexus - mucus membrane activity Myenteric - longitudinal smooth muscle activity
54
GI tract innervation
Extrinsic Innervation - Parasympathetic NS - excitatory, carried by Vagus and Pelvic Splanchnic nerves - Sympathetic NS - Inhibitory, carried by prevertebral ganglia T8-L2 Intrinsic Innvervation - Enteric Nervous system Two plexi - myenteric plexus and submucosal plexus
55
GI Regulation | Stomach
Histamine stimulates gastric acid | G Cells = gastrin stimulates H+ and gastric mucosa
56
GI Regulation | Duodenum/Jejunum
I Cells = CCK stimulates gall bladder contraction and Oddi Relaxation; Pancreatic enzymes and bicarbonate secretion - inhibits gastric emptying S cells - secretin: stimulates pancreatic and gallbladder bicarbonate secretion - inhibits gastric emptying GIP stimulates insulin secretion - inhibits gastric acid secretion
57
What does histamine do in the stomach?
Stimulates the gastric acid pump | Histamine type 2 receptors activate de proton pump.
58
G cells make what?
Gastrin stimulates acid production and mucosal activity
59
What does the CCK do?
It stimulates the gallbladder to contract and also the relaxation of the sphincter of Oddi. It also makes pancreatic enzymes and bicarbonate to be secreted. Also, it stops stomach emptying
60
Hormone
used to be released from ductless glands, endocrine glands into the bloodstream, they go peripherally and make something happen
61
Paracrine
Short enteroendocrine secretion Somatostatin: inhibits GI hormones release and acid secretion Histamine: Stimulates gastric acid secretion
62
Neurocrines
Neuronal synthesis, synaptic release, target cell activation | Enkephalins: Stimulate GI contraction at sphincters, stop fluid and electrolyte release
63
What do chief cells produce? | Where are they located?
pepsinogen. | chief cells are located at the base of glands distributed throughout the fundus and corpus of the stomach.
64
Pepsinogen and pepsin
a substance that is secreted by the stomach wall and converted into the enzyme pepsin by gastric acid. Pepsin is a stomach enzyme that serves to digest proteins found in ingested food. Gastric chief cells secrete pepsin as an inactive zymogen called pepsinogen.
65
Parietal cells
Parietal cells within the stomach lining secrete hydrochloric acid that lowers the pH of the stomach. They also secrete intrinsic factors for complexing with B 12 to absorb B12
66
Where are carbs absorbed?
Duodenum and jejunum
67
Where are amino acids absorbed?
Duodenum and jejunum
68
Where is iron absorbed?
duodenum
69
Vit. B12?
terminal duodenum
70
Fatty acids?
terminal duodenum
71
How is iron absorbed as?
Fe2+
72
How is iron transported?
Transported as ferritin
73
How is iron stored as?
Stored as ferritin and hemosiderin
74
What duct received sources from the liver and gallbladder?
Common bile duct receives sources from the common hepatic duct and cystic duct.
75
Major duodenual papila | AKA Oddi
received information from the common bile duct and pancreas (pancreatic duct)
76
What percentage is the bile acid recycled?
about 98% of it after it does its job which is to micelle fats (separate the fat)
77
Where is bile produced
In the liver by hepatocytes and stored inside the gallbladder
78
What is bilirubin?
Bilirubin is a yellow compound that occurs in the normal catabolic pathway that breaks down heme in vertebrates. This catabolism is a necessary process in the body's clearance of waste products that arise from the destruction of aged or abnormal red blood cells. bilirubin has been shown to possess important functions as an antioxidant, but it also serves simply as a means to excrete unwanted heme, derived from various heme-containing proteins such as hemoglobin, myoglobin, and various P450 enzymes.
79
Where are bile acids synthesized?
Synthesized from cholesterol in the liver only
80
How are bile salts regulated?
The rate-limiting step in bile acid synthesis is the introduction of a hydroxyl group at carbon 7 of the steroid ring by 7-alpha-hydroxylase which is inhibited by cholic acid (a primary bile acid stored in the gall bladder).
81
What is the function of bile acids?
Emulsifying agents in the intestine helping to prepare dietary triacylglycerol and other complex lipids for degradation by pancreatic enzymes. Bile salts also provide the only significant mechanism for cholesterol excretion
82
Cirrhosis
Hepatitis C or C, Alcohol-induced Primary biliary cirrhosis, Wilson's disease (copper), iron etc Signs and symptoms - Jaundice, ascites, edema, encephalopathy, cachexia, palmar erythema - Caput medusa, esophageal varices, portal hypertension - Liver failure, renal failure secondary to liver disease
83
Cholecystitis
``` inflammation of gallbladder gallstone in neck or cystic duct RUQ or epigastric pain pain when you eat Usually resolves in 1-7 days ```
84
Cholelithiasis
aka gallstones | 70-80% are asymptomatic for decades
85
Remember
3/4 of the body for lymphatics - left side of the face, left pec and arm, the whole abdomen down to the legs 1/4 - right face, right chest, and arm.
86
Where do most of the absorption of water happen in the body?
Small intestine
87
Diarrhea
excretion of water through feces 150 ml to 1.5 leters
88
Dysenteric
about 1.5L of excretion of water
89
Vitamin A
Part of Rhodopsin/Vision | Deficiency: Night blindness
90
Vitamin D
GI (increase calcium absorption) | Def.: Rickets
91
Vitamin E
Antioxidant | Def.: Ataxia
92
Vitamin K
Carboxylation of glutamate/calcium chelation with glutamate | Def.: Factor 2, 7, 9, 10 bleeding disorder
93
Vitamin B1 - Thiamine
Aldehyde transfer/ decarboxylation | Beriberi
94
Vitamin B2 - Riboflavin
H+ transfer/FMN - FAD (flavins) | Cheilosis/Glossitis
95
Vitamin B3 - Niacin
H+ transfer / NAD-NADP Pellagra - 4 Ds: Diarrhea, dementia, dermatitis, death
96
Vitamin B5 - Pantothenic acid
Acyl group transfer / Co-A | Burning feet / HA / Nausea
97
Vitamin B6 - pyroxidine
Amino group transfer | Microcytic anemia, Neuropathy
98
Vitamin B7 - Biotin
carboxylation | Seborrheic dermatitis, nervous system disorders
99
Vitamin B9 - Folate
Methyl transfer | Macrocytic anemia/ Glossitis/ colitis

NPLEX I (12 decks)

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