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Flashcards in GI Deck (104)
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1

A Tracheo-Esophageal fistula puts infants at risk for what?

Aspiration PNA

2

What are the presenting symptoms of a T-E fistula?

Choking
Poor Feeding
Inability to pass an NG tube
Projectile vomiting

3

This is when amniotic fluid in utero development flows through the ureters and bladder and back into the amniotic cavity.

Polyhdramnios (excess amniotic fluid)

4

What does VACTERL stand for?

Vertebral Defects
Anal Atresia
Cardiac Defects
Tracheo-Esophageal fistula
Renal abnormalities
Limb/Bone Anomalies

5

The FOREGUT of the abdomen is made up of what organs?

SEVEN

1. Esophagus
2. Spleen
3. Stomach
4. Liver
5. Gall Bladder
6. Pancreas
7. 1st / 2nd parts of the duodenum

6

What is the major blood supply of the structures in the foregut?

Blood: Celiac Trunk

7

Are the nerves of the great splanchnic that supplies the for gut pre or post synaptic?

Pre-synaptic

8

_____ (white/gray) rami communicates of the thoracic region send sympathetic fibers down and then _______ (sensory/motor) fibers originate in the gut then follow the sympathetic fibers back to the spinal cord.

White

Sensory

9

A celiac block is preformed at what vertebral level?

L1

10

The MIDGUT of the abdomen is made up of what organs?

SEVEN

1. 3rd / 4th parts of the duodenum
2. Jejunum
3. Ileum
4. Appendix
5. Ascending colon
6. Cecum
7. Proximal 2/3 of the transverse colon

11

What is the major blood supply to the midgut?

Superior mesenteric artery

12

In what region of the abdomen would you expect a patient to complain of pain if it was involving structures of the foregut? midgut? hindgut?

Foregut: Epigastric (T5-9)

Midgut: Umbilical (T10-11)

Hindgut: Suprapubic (T12-L1)

13

What are the structures that compose the hindgut?

SIX

1. Distal 1/3 of the transverse colon
2. Descending colon
3. Rectum
4. Upper Anal Canal
5. Urogenital sinus

14

T/F: Sympathetic fibers travel through the sympathetic chain and synapse at their own ganglia.

True

15

What are the 3 sub-plexuses of the Lumbar plexus (Splanchnic Nerves)?

(THINK: They follow the blood supply)

1. Celiac Plexus
2. Superior Mesenteric PLexus
3. Inferior Mesenteric Plexus

16

What it the major blood supply to the hindgut?

Inferior mesenteric artery

17

What two types of fibers does the splanchnic nerves have?

1. Visceral afferent
2. Thoracic sympathetic

18

This structure connects the pharnyx to the stomach, secretes some mucus, does not allow for absorption, is lined with stratified squamous cells to prevent injury, and has sphincters to prevent backflow.

Esophagus

19

This occurs due to chronic inflammation of the lower esophageal epithelium (chronic reflux), notable for growth of columnar epithelium, and can be seen with the presence of pre-malignant lesions

Barrett's Esophagus

20

This attaches the stomach to the body wall dorsally and ventally

Mesogastrium

21

Which region of the stomach is mucus, pepsinogen, and HCL secreted from?

Which region of the stomach is mucus, pepsinogen, and gastrin secreted from?

Body

Antrum

22

T/F: The lesser and greater omentum arise from the peritoneum and attach to the stomach dorsally and ventrally?

True

23

These cells secrete mucus to protect against acidity.

Mucus cells

24

These cells secrete HCL

Parietal Cells

25

The secretion of HCL is triggered by products of _________, especially ________, arriving in the duodenum

Digestion

Peptides

26

This phase of stomach acid production occurs at the sight and smell of food and is responsible for about 1/3rd of stomach acid production

Cephalic Phase

27

These three chemicals produced in the body and stomach stimulate stomach acid release.

Acetylcholeline (from the PSNS)
Gastrin
Histamine

28

This inhibits the release of stomach acid

Somatostatin

29

What are three ways to "turn down" HCL production?

1. Turn down the PSNS (ACh inhibition - anticholinergics)
2. Turn down Histamine (Antihistamine - H2 blockers)
3. Turn down gastrin

30

These cells secrete pepsin

Chief cells

31

These cells secrete gastrin

Endocrine cells (aka G-Cells)

32

What are three conditions that cause "too much gastrin"?

1. Gastrinoma (Gastrin secreting tumor)
2. Zolinger-Ellison syndrome (duodenal ulcers and a pancreatic gastrin tumor)
3. MEN1 (P3 --> Pancreas, Parathyroid, Pituitary)

33

This disease occurs when mucus and HCL are not in balance due to chronic inflammation, NSAID use, or cigarette smoking.

Loss of mucus is the most common cause

Peptic ulcer disease

34

This organ is created in the ventral fold of the mesogastrium and will remain connected ventrally by the falciform ligament.

Liver

35

This organ is created in the dorsal fold of the mesogastrium

Spleen

36

What are the functions (three) of the spleen?

1. Early Hematoposis
2. Mechanical filtration of aging/injured erythrocytes
3. Infection control (clear bacteria, good for malaria, microorganism the host has no antibodies for)

37

This part of the small intestines is the first 2/3rds of the foregut.

Duodenum

38

T/F: The duodenum is the longest segment of the SI at 10-15 inches long

False (Its the shortest)

39

At what ligament doe the duodenum end?

Ligament of Treitz

40

T/F: The duodenum is freely mobile like the jejunum or ileum

False

41

This segment of the duodenum is the hormonal trigger to the gallbladder and pancreas

Superior (L1)

42

These glands are located in the superior segment of the duodenum and rapidly neutralize high-pH chyme for mucosa safety.

What do they secrete?

Brunner's Glands

Bicarbonate
Mucus
Urogastrone

43

What two cells does urogastrone inhibit?

IS this a negative or positive feedback loop with the stomach?

Chief and Parietal cells

Negative

44

This segment of the duodenum is the delivery site for the pacreatic duct, common bile duct, gallbladder, and liver

Descending (L2)

45

What is the name of the primary duct of the descending segment of the duodenum?

Ampalla of Vater (Sphincter of Oddi with lymphatics)

46

Which two ducts open to the duodenum at this juncture?

Pancreatic
Bile Duct

47

This is an acessory duct in the descending duodenum

Duct of santorini

48

This segment of the duodenum is where digestion occurs and crosses the IVC and aorta

Horizontal (L3)

49

This segment of the duodenum is where digestion is continued, it connects to the jejunum, and is where the bowel stops being retroperitoneal

Ascending (L2)

50

These form when neutralization of stomach acid in the duodenum is not adequate or acid delivery is too high

Duodenal ulcers

51

This organ is created as 2 outpouchings of the duodenum and empties into the Ampalla of Vater.

Pancreas

52

This is the main pancreatic duct which runs the entire length of the pancreas.

This empties most of its exocrine products where?

Where does a portion of the head of the pancreas drain?

Pancreatic duct

Ampalla of Vater

Ampalla of Santorini

53

Enzymes are produced in what type of cells in the pancreas?

Acinar cells

54

T/F: Pancreatic enzymes a alkaline, clear, and mucus-like

True

55

T/F: Pancreatic enzymes are typically released in their active forms

False (Released inactive, activated in the duodenum)

56

This is an inflammation of the pancreas which causes epigastric and back pain

Pancreatitis

57

What are some causes of pancreatitis?

1. Gallstones (blocked duct)
2. Enzyme activation prior to the duodenum (Alcohol)
3. Infection
4. Trauma
5. Tumor

58

T/F: In pancreatitis, the pancreas can autolyze its symogens

if this is ture......

This would cause an increase in what levels in a patients with pancreatitis?

True

Amylase / Lipase

59

This is a sac-like structure that is inferior to the liver and stores bile until it is needed, does NOT have a muscularis mucosa, and does not produce its own secretions.

Gallbladder

60

This layer of the gallbladder is made up of simple columnar epithelium with mucosal fold allowing for the GB to enlarge/shrink

Mucosa

61

This layer of the gallbladder allows for contractions to occur

Muscularis Externa

62

This layer of the gallbladder secures it in place

Adventitia

63

Describe the path of bile from the liver, through the GB, and into the duodenum

Bile exits the liver and the R/L hepatic ducts and travels down to the cystic duct into the gallbladder

Bile then leaves the GB and travels into the CBD

From the CBD, it travels to the Sphincter of Oddi to enter the duodenum

64

What is the medical term for crystallized, packed, and solidified stones in the gallbladder.

Cholelithiasis

65

What are gallstones typical composed of?

Bile salt and cholesterol

66

T/F: Gall stones occur when there is too much bile and not enough cholesterol

False (too much cholesterol, not enough bile)

67

What hormone increases cholesterol composition and decrease GB motility?

Estrogen

68

What can be problematic with gall stones in terms of bilary exit?

How would a patient develop cholecysitis?

What other problems may you see as a result of gall stones?

The many pathways of the biliary tree have only one exit.

Prolonged blockaged leads to bacterial overgrowth leading to infection and inflammation

Jaundice
Pancreatitis
Calcification
Rupture

69

T/F: Control mechanisms of the GI system are governed by volume and composition of luminal contents

True

70

GI control is _____ and _______

Neuronal

Hormonal

71

Neuronal regulation comes from the _____ and the _____.

CNS

ENS (Enteric)

72

What are two plexuses of the enteric nervous system?

What do these control?

Submucosal (secretions)

Myenteric (motility)

73

What are the 4 layers of the GI tract (brief functions)?

1. Mucosa (make/secrete digestive enzymes, endocrine for GI communication)

2. Submucosa (Blood flow to the liver for filtration, innervation)

3. Muscularis (Circular muscle, long muscle)

4. Serosa (Outer layer)

74

T/F: Submucosal and myenteric plexuses both have short and long reflex loops to/from the CNS and regions of the GI tract

True

75

This reflex occurs when activity in the mouth stimulates motion of the lower GI tract

Gastro-Colic Reflex

76

This is the lose of appetite despite physiologic stimulation that normally produces hunger

Anorexia

77

T/F: Nausea is an objective experience associated with a number of conditions

False (Its subjective)

78

This is the forceful emptying of the stomach and intestinal contents through the mouth.

Vomiting

79

What is the vomit control center in the brain?

Medulla Oblongata

80

What types of problems can vomiting induce?

Electrolyte imbalance
Acid-base disturbance
fluid loss

81

This type of pain is often described to be originating in the peritoneum

Parietal (Somatic) Pain

82

This type of pain is often described to be originating in the organs themselves

Visceral Pain

83

This type of pain is often felt in another area other than where it originated from

Referred Pain

84

This type of GI bleed occurs in the foregut (Stomach, Esophagus, Duodenum), is bright red in the emesis, or can have a "coffee-ground" appearance to the stool.

Upper GI Bleed

85

This type of GI bleed occurs in the midgut/hindgut (jejunum, ileum, colon, rectum) and typically presents with bright red blood in the stools

Lower GI Bleed

86

Bleeding that is not visible to the eye but detectable on hemeoccult tests in also referred to as being what?

Occult

87

Name FOUR things that commonly cause GI symptoms..

1. Stenosis
2. Regurgitation/Insufficiency
3. Abnormal movements of the GI tract (too fast/slow)
4. Inflammation/Trauma

88

What are THREE things inflammation or trauma cause in the GI tract?

1. Can affect absorption (osmotic issues)
2. Can effect secretion in the GI tract
3. Can cause bleeding

89

This disease of the esophagus typically presents with difficulty swallowing or vomiting up solid food.

Common causes include....

GERD
NG Tube use
Ingestion of Corrosive substances
Infection/Inflammation
Iatrogenic Injury (Endoscopy)

How would you treat this disease?

Esophageal Stricture

Tx: Esophageal dilation

90

This disease of the esophagus occurs when there is a tightening of the lower esophageal sphincter that fails to relax typically due to degredation of the myenteric plexus.

Sx include....

Pain
Vomitting
Distended Esophagus (can hold up to 1L of putrid infected material putting the patient at risk for aspiration PNA)
Weight Loss
Ulceration
Esophageal Perforation

Esophageal Achalasia

91

This disease of inflammation to the esophagus presents similarly to GERD (Cough, Painful Swallowing, Worse when lying down) and is most commonly caused by GERD

Esophagitis

92

This disease of the stomach is described as delayed gastric emptying which is most commonly caused by neuropathy (DM patients at highest risk).

Sx include.....

Anorexia
Vomiting
Retained gastric contents
Bezoars

Gastroparesis

93

What are FOUR neurological contributors to gastroparesis?

1. Poor neurological feedback from the duodenum to the stomach
2. Vagal dysfunction (decrease plyoric sphincter tone)
3. Poorly coordinated peristalsis
4. Peripheral neuropathy of enteric nerves

94

This is a mass of hardened, undigested food trapped in the digestive tract.

How is it treated?

Bezoar ("Protect from Poison")

Tx: Lithotripsy, Endoscopic Morcellation, Coca-Cola Dissolution

95

This disease of the stomach involves a narrowing of the opening between the stomach and the duodenum, which can be acquired or congenital.

Sx include.....

Epigastric pain
Nausea
Succussion splash
Malnutrition
Vomiting

How is this disease treated?

Pyloric Obstruction/Stenosis

Tx:

NG Tube
IVF and electrolytes
PPI or H2 blockers
Surgery/Stenting

96

Describe a "succussion splash"?

The sound of the stomach filled with liquids or gases which is heard by auscultating over the the epigastric region and shifting the abdomen side-to-side

97

Pyloric stenosis is more commonly seen in adult or children?

Children (happens in the first few weeks of life)

Can happen in adults but typically damage to the pyloric sphincter needs to occur to cause stenosis or hypertrophy

98

What is the classic symptom of pyloric stenosis?

Projectile vomiting

99

What are concerning complications of of projectile vomiting?

(THINK: pH)

Metabolic alkalosis

100

What happens to blood volume as a result of projectile vomiting and how do the kidneys respond?

Blood volume decreases causing BP to decrease at the afferent arterioles (Na+ content of filtrate decreases) which causes JG cells to release renin

101

These TWO signs of plyoric stenosis are described as a mass in the epigastrium.

Almond or Olive sign

102

What is the most common causative agent of gastritis r peptic ulcers?

H. pylori

(Small, curved, gram-positive organisms)

103

What does H. pylori produce? (Two)

What doe this do and how does it affect acidity?

Urease which converts urea into ammonia which neutralizes acidity allowing it to flourish

H. pylori also produces an enzyme that that break down the stomachs mucus layer

104

What is the dominant affect of H. pylori in the antrum of the stomach?

Fundus?

Pyloris?

Antrum: Decreased mucus production

Fundus: Decreased acid and pepsin production, stomach tissue atrophy, atrophic gastritis, increased risk for stomach CA

Pyloris: Decrease somatostatin production resulting in increased gastrin and HCL production