GI Flashcards
(92 cards)
1
Q
GA 3.5 wks GI embryology
A
foregut and hindgut present
liver bud
2
Q
GA4wk GI
A
esophagus and stomach separate
intestines is a single tube
hepatobiliary derived from foregut
pancreas derived from midgut
3
Q
GA 5-9 GI
A
Wk 7: mouth, esophagus and stomach in normal position
intestinal tube elongates and herniates into umbilical cord
the tube undergoes a series of rotations
villi form in jejunum (week 9)
4
Q
GA10 GI
A
tube reenters abdominal cavity after rotated 270deg
formation of microvilli
crypts of lieberkuhn appear
5
Q
GA 12 GI
A
parietal cells in stomach
mature taste buds
formation of islet cells and bile secretions
6
Q
GA13 GI
A
muscularis and muscle layers of intestine appear
disaccharides present
7
Q
GA16 GI
A
swallowing and sucking ability (not coordinated)
lipase can be detected but remains deficient
trypsin present
8
Q
GA14 GI
A
villi present throughout intestines
meconium present
9
Q
GA18
A
ganglion cells
10
Q
GA19
A
crypts well developed
11
Q
GA20-24 GI
A
mouth amylase
ciliated columnar cells
maltase
sucrase
amylase liver 22 weeks
12
Q
GA28 GI
A
adult level disaccharidases
lactase increases
13
Q
GA32
A
normal gastric emptying
HCl detected instomach
14
Q
34-36
A
coordinated suck and swallow
rapid peristalsis
lactase adult level
15
Q
intraepithelial lymphocytes timing and features
A
GA 8
immune cell - defense
16
Q
intestinal absorptive epithelium timing and features
A
GA 9
absorption
17
Q
goblet cells timing and features
A
GA8-10
mucin, protection
18
Q
enteroendocrine cells timing and features
A
GA9-11
hormone producting
19
Q
paneth cells timing and features
A
GA11-12
antimicrobial peptides
20
Q
stem cells timing and features
A
GA?? early
give rise to epithelial cells
21
Q
Microfold (M) cells timing and features
A
GA 17
uptake antigen for presentation
22
Q
Dendritic cells timing and features
A
GA 19
APC
23
Q
tight junctions timing and features
A
GA 10
barrier defences
24
Q
crypt villus architection GA
A
12
25
Peyers patches timing and features
GA19
patches of lymphoid tissue for immune response
26
salivary and pancreatic amylase timing
present at 22 weeks
adult levels 3 months postnatal age
27
glucoamylase (a-dextrinase) timing and function
normal at birth
removes glucose from end of starch
28
intestinal disaccharidases
adult levels at 28 weeks except lactase which is adult level at 36 weeks
29
intestinal transporters of glucose
into enterocyte SGLT1 active
out of enterocyte into circulation GLUT1
30
intestinal transporters of fructose
into enterocyte GLUT5 passive
out of enterocyte into circulation GLUT2
31
where are chymotrypsin and trypsin
duodenal fluid
decreased in preterm and FT infants
32
peptidases timing
well developed early
33
GI pH in neonates vs adults
increased due to decreased HCl secretion compared to adults
34
components of fat digestion
1. triglyceride hydrolysis by lipases (lingual, GI, pancreatic)
2. bile acid emusification
3. micelle formations
35
components of fat absorption
1. FFA and monoglycerides transfer easily
2. triglycerides reform in enterocytes
3. chylomicron formation
4. chylomicron enters portal blood or lymphatics
36
preterm infant fat malabsorption attributed to
reduced bile acid secretion
decreased pancreatic lipase (adult levels at 6 months; lingual and gastric are okay)
37
function of secretin
stimulates pancrease to release bicarbonate slowing gastric emptying
38
gastrin inhibitory peptide function
stimulated by protein and fat
slows gastric empyting
decreases gastrin
39
maltose broken down to
glucose x 2
40
sucrose broken down to
Fructose + glucose
41
lactose broken down to
galactose + glucose
42
posterior pharyngeal perforation on XR
tracks towards right of spine rather than normal left into gastric bubble
43
eophageal duplication location and diagnosis
posterior mediastinal mass
ultrasound
44
rate of TEF
1/4500
45
VACTERL
verterbral
anal
cardiac
TE
radial/renal
limb
46
pathophysiology of TEF
abnormal formation in GA4
47
GER vs GERD
GERD has complications ie. growth failure, pain, mucosal damage, aspiration
48
GERD occurrence
6-7% term
3-10% preterm < 1500g
49
etiology of duodenal atresia
failure of **recanalization GA8-10** after obliteration of lumen by **epithelial proliferation** during **GA6-7**
50
location of duodenal atresia
second part of duodenum
51
occurrence of duodena atresia and jejunal/ileal atresia
1/20000-40000
1/1500-5000
52
proportion of atresia in locations of the jejunal/ileal
proximal jejunum 31%
distal jejunum 20%
proximal ileum 13%
distal ileum 36%
53
etiology of jejunal/ileal atresia
after intestinal development
likely ischemic injury/malrotation/volvulus/ perforation
54
occurrence of polyhydramnios in jejunal and ileal atresia
1/3 in jejunum
less in ileal
55
etiology of colonic atresia
vascular compromise
56
risk of colonic atresia
1/1500-1/20000
57
risk of hirshprung
1/5000
80% male
recurrence 3-5%
58
hirshprungs associations
trisomy 21
heterochromia
waardenburg
congenital deafness
13q del
pheochromocytoma
NF
neuroblastoma
59
etiology of hirshprung
failure of complete cranial to caudal migration of neural crest cells at 8-10 weeks
aganglionic
abnormal parastalsis
60
Hirschprung:
percent with only rectosigmoid involvement
percent with complete colon involvement
75-80%
5-10%
61
small left colon syndrome location
splenic flexure transition zone
62
risk of imperforate anus
1/5000
63
types of fistulas in anorectal malformations of males and females
males - rectum to GU (rectovesical, rectoprostatic, rectobulbar) or perineal
females - perineal, vestibular, cloacal complex
64
What is Wangosteen Rice invertogram
used to be used to delineate level of ARM
65
abnormal fusion of lateral and cephalic folds of abdominal wall
pentalogy of cantrell
1. cleft sternum
2. anterior midline diaphragmatic abnormality
3. pericardial defect
4. ectopic cordis - heart without breastbone - just skin
5. upper abdominal omphalocoele
66
abnormal fusion of both lateral folds of abdominal wall
omphalocoele
67
abnormal fusion of the caudal and lateral folds of abdominal wall
cloacal or bladder exstrophy
hypogastric omphalocoele
68
OEIS complex
omphalocoele
extrophy of bladder
imperforate anus
spinal deformity
69
etiology of omphalocoele
intestinal loops fail to return to the abdominal cavity at 11 weeks or somatic folds fail to complete formation of the abdominal wall by 18 weeks GA
70
colorless meconium
cholestasis
71
intrahepatic duct diseases
neonatal idiopathic hepatitis
alagille paucity of intrahepatic with extrahepatic ducts
nonsyndromic paucity
72
extrahepatic duct obstruction
biliary atresia
sclerosing cholangitis
bile duct stenosis
choledochal cyst
bile plug
73
what are the MCC cholestasis
biliary atresia and idiopathic neonatal hepatitis account for 60-70%
74
what factors improve prognosis in short gut?
intact **ileum - bile acid absorption**
intact **ileocecal valve** - **delays transit** time allowing improved digestion and absoption and **prevents overgrowth** of colonic bacteria into the small intestines
75
without ileocecal valve how much intestines do you need
30-45 cm of intestines
76
air pattern progression on XR after birth
3 hours to small intestines
6-8 hours to large intestines
24 hours to rectum
77
malrotation with volvulus appearance on barium swallow
complete obstruction: birds beak
partial obstruction: spiral/corkscrew
78
when are stomach, small intestines and large intestines visible on fetal us
stomach: 13-15 weeks
small intestines - not well until third trimester in center of abdomen
large intestines - 22 weeks
79
echogenic bowel
most normal
chromosomal abnormalities ie tri 21
congenital infections ie CMV
mec ileus/peritonitis
atresia/volvulus
swallowed blood
proximal bowel obstruction
80
what is barium study good for?
opacifying stomach and intestines
malrotation or hirschprung
81
what is gastrograffin study good for>
meconium plug - increased osmolality draws water into lumen and releases plug
**monitor electrolytes**
82
what is iohexol or iopamidol study good for?
perforation
83
a defensins
peptides that interact with phospholipids in microbial cell membranes leading to pores/cell lysis
84
intestinal fatty acid binding protein
- released from mature enterocytes when cell membrane integrity is compromised
- detected in urine
- may reflect NEC
85
organs affected in GALD
liver, pancreas, thyroid, heart and adrenal
86
spared organs in GALD
spleen, LN, BM
87
glucagon like peptide 2
- antisecretory hormone regulating intestinal transport
- secreted by L cells in terminal ileum and colon
- increases intestinal blood flow
88
phases of intestinal motor activity during fasting
phase 1: quiescence
phase 2: irregular activity
phase 3: regular phasic propagating + clusters low amplitude non-propagating
89
MC genetic abnormality in omphalocoele
aneuploidy (tri 13, 18, 21)
90
method of diagnosing GALD
salivary gland biopsy
91
primary substrate for enterocytes that increases intestinal cell proliferation via mitogen activate protein kinases
glutamine
92
serum marker of enterocyte maturation
citrulline
