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SF4 > GI > Flashcards

GI Flashcards

1
Q

What are the areas of anastomoses between the portal system and caval system?

A

Esophagus, umbilicus, rectum, posterior abdominal wall

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2
Q

What are the portal and caval vessels that anastomose at the esophagus

A

P: Left Gastric
C: Esophageal

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3
Q

What are the portal and caval vessels that anastomose at the umbilicus

A

P: Paraumbilical
C: superficial epigastric

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4
Q

What are the portal and caval vessels that anastomose at the rectum

A

P: superior rectal
C: Inferior rectal

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5
Q

What are the portal and caval vessels that anastomose at the posterior abdominal wall

A

P: Colic veins
C: retroperitoneal veins

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6
Q

What symptoms presents when there is blockage in the portal/caval system at the esophagus

A

Esophageal varices

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7
Q

What symptoms presents when there is blockage in the portal/caval system at the umbilicus

A

Caput medusae

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8
Q

What symptoms presents when there is blockage in the portal/caval system at the rectum

A

Internal hemorrhoids

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9
Q

What symptoms presents when there is blockage in the portal/caval system at the posterior abdominal wall

A

Asymptomatic

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10
Q

What is the action and innervation of the external oblique

A

A: Flex and rotate trunk, compress and support abdominal viscera
I: T7-T11 throacoabdominal nerves and T12 subcostal

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11
Q

What is the action and innervation of the internal oblique

A

A: flex and rotate trunk, compress and support abdominal viscera
I: T7-T11 thoracoabdominal, T12 subcostal, L1 iliohypogastric and ilioinguinal

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12
Q

What is the action and innervation of the transversus abdominis

A

A: rotate and flex trunk, compress and support abdominal viscera
I: flex and rotate trunk, compress and support abdominal viscera

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13
Q

What is the action and innervation of the rectus abdominis

A

A: flexes trunk and compresses abdominal viscera
I: T7-T11

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14
Q

What is the action and innervation of the pyramidalis

A

A: tenses Linea alba
I: T12 or L1

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15
Q

What is the action and innervation of the cremaster muscle

A

A: elevates testis
I: L1 and L2 via gentian branch of genitofemoral nerve

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16
Q

What does the iliohypogastric provide sensory for and what levels contribute to this nerve

A

Sensory to the skin of the lower abdominal wall, upper hip and upper thigh, from L1

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17
Q

What does the ilioinguinal provide sensory to and from what vertebral levels does this nerve arise?

A

Sensory to the skin of the lower abdominal wall and anterior scrotum/labium majus, level L1

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18
Q

What makes up the anterior border of the inguinal canal?

A

Aponeurosis of the external and internal oblique muscles

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19
Q

What makes up the posterior wall of the inguinal canal?

A

Transversalis fascia and conjoint tendon (medial third of canal)

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20
Q

What makes up the roof of the inguinal canal

A

Muscle fibers and aponeurosis of the internal oblique muscle and transversus abdominis muscle

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21
Q

What is the floor border of the inguinal canal

A

Inguinal ligament and lacunar ligament(medial third)

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22
Q

Given the anterior abdominal layer, what layer does it contribute to around testis and spermatic cord:
Skin

A

Skin

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23
Q

Given the anterior abdominal layer, what layer does it contribute to around testis and spermatic cord:
Camper’s fascia

A

Dartos muscle

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24
Q

Given the anterior abdominal layer, what layer does it contribute to around testis and spermatic cord:
Scarpa’s layer

A

Colles fascia

Membranous layer of superficial fascia of perineum

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25
Q

Given the anterior abdominal layer, what layer does it contribute to around testis and spermatic cord:
Aponeurosis of external oblique

A

External spermatic fascia

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26
Q

Given the anterior abdominal layer, what layer does it contribute to around testis and spermatic cord:
Internal oblique and aponeurosis

A

Cremaster muscle and fascia

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27
Q

Given the anterior abdominal layer, what layer does it contribute to around testis and spermatic cord:
Transversus abdominis muscle

A

No contribution

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28
Q

Given the anterior abdominal layer, what layer does it contribute to around testis and spermatic cord:
Transversalis fascia

A

Internal spermatic fascia

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29
Q

Given the anterior abdominal layer, what layer does it contribute to around testis and spermatic cord:
Extraperitoneal fat

A

Loose connective tissue including fat

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30
Q

Given the anterior abdominal layer, what layer does it contribute to around testis and spermatic cord:
Parietal peritoneum

A

Tunica vaginalis

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31
Q

What are the coverings of the testis

Deep to superficial

A

Tunica albuginea
Tunica vaginalis
-visceral
-parietal

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32
Q

What are the layers of the spermatic cord

A

External spermatic fascia
Cremasteric fascia
Internal spermatic fascia

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33
Q

Components of the spermatic cord

A 
Testicular artery
Ductus deferens and artery
Pampiniform plexus
Lymphatics
Genital branch of genitofemoral nerve (L1,2)
Cremasteric artery
Autonomic nerves
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34
Q

Name the action, site of release, and releaser for the following peptide:
Gastrin

A

Stimulates acid secretion

G cells in the antrum of stomach

Small peptides, amino acids, gastric distention, vagal stimulation

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35
Q

Name the action, site of release, and releaser for the following peptide:
CCK

A

Stimulates - gallbladder contraction, pancreatic enzyme secretion, pancreatic bicarbonate secretion, satiety
Inhibits - gastric emptying

I cells of the duodenum and jejunum

Small peptides, amino acids, fatty acids, CCK-RP, monitor peptide

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36
Q

Name the action, site of release, and releaser for the following peptide:
Secretion

A

Stimulates - pancreatic bicarbonate secretion, biliary bicarbonate production
Inhibits - gastric acid secretion

S cells in the duodenum

Acid

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37
Q

Name the action, site of release, and releaser for the following peptide:
GIP

A

Stimulates - insulin release
Inhibits - gastric acid secretion

K cells in duodenum and jejunum

Fatty acids, amino acids, oral glucose

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38
Q

Name the action, site of release, and releaser for the following peptide:
Motilin

A

Stimulates - gastric and intestinal motility

Duodenum and jejunum

Nerves

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39
Q

Name the action, site of release, and releaser for the following peptide:
Somatostatin

A

Inhibits - GI hormone release, gastric acid secretion

D cells in GI mucosa

Acid

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40
Q

Name the action, site of release, and releaser for the following peptide:
Histamine

A

Stimulates - gastric acid secretion

ECL cells

gastrin

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41
Q

Name the action, site of release, and releaser for the following peptide:
VIP

A

Relaxes GI smooth muscle
Stimulates - intestinal secretion, pancreatic secretion

GI mucosa and smooth muscle

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42
Q

Name the action, site of release, and releaser for the following peptide:
GRP

A

Stimulates - gastrin release

gastric mucosa

Vagal stimulation

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43
Q

Name the action, site of release, and releaser for the following peptide:
Enkephalins

A

Stimulate - contraction of smooth muscle
Inhibit - intestinal secretion

GI mucosa and smooth muscle

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44
Q

What are the fat droplets that hang off the colon

A

Appendices epiploicae

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45
Q

What are the longitudinal muscles of the colon

A

Teniae coli

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46
Q

What structures are primary retroperitoneal

A 
Kidneys
Adrenal gland
Aorta
IVC
Testes
Bladder and ureters
Uterus
Rectum
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47
Q

What structures are secondarily retroperitoneal

A

Duodenum, middle
pancreas
Ascending colon
Descending colon

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48
Q

What is associated with the median umbilical fold

A

Obliterated urachus

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49
Q

What is associated with the medial umbilical folds

A

Obliterated umbilical arteries

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50
Q

What is associated with the lateral umbilical folds

A

Inferior epigastric vessels

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51
Q

What are the four gutters of the peritoneum

A

Right and left lateral (paracolic)
Right of mesentery (infracolic)
Left of mesentery (infracolic)

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52
Q

What is the space called between the diaphragm and liver on either side of the falciform ligament

A

Subphrenic recess

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53
Q

What is the lowest part of the abdominopelvic cavity when the patient is lying down?

A

Hepatorenal recess

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54
Q

What are the phases of gastric secretion

A

Cephalic
Gastric
Intestinal

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55
Q

Name the level that the nerve arises and the distribution of the nerve:
Iliohypogastric

A

L1

Skin of upper inguinal and suprapubic region, internal oblique and transversus abdominis

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56
Q

Name the level that the nerve arises and the distribution of the nerve:
Ilioinguinal

A

L1
Skin of the lower Inguinal Region, groin and medial thigh

Internal oblique and transversus abdominis

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57
Q

Name the level that the nerve arises and the distribution of the nerve:
Genitofemoral

A

L1 and L2
Genital branch - motor to cremaster muscle
Femoral branch - skin of medial thigh

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58
Q

Name the level that the nerve arises and the distribution of the nerve:
Lateral femoral cutaneous

A

L2 and L3

Skin of lateral and anterior thigh

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59
Q

Name the level that the nerve arises and the distribution of the nerve:
Femoral

A

L2-L4

Anterior thigh muscles

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60
Q

Name the level that the nerve arises and the distribution of the nerve:
Obturator

A

L2-L4

Medial thigh muscles

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61
Q

Name the level that the nerve arises and the distribution of the nerve:
Lumbosacral trunk

A

L4-L5

Joined sacral plexus in pelvis

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62
Q

Name the level that the nerve arises and the distribution of the nerve:
Subcostal

A

T12

Skin and muscles of anterolateral abdominal wall

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63
Q

What constitutes as a indirect inguinal hernia

A

Through deep ring in lateral inguinal fossa
Usually transverses entire canal
Lateral to inferior epigastric artery
Congenital

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64
Q

What constitutes a direct inguinal hernia

A

Through peritoneum and transversalis fascia in Hesselbach’s triangle
Medial to inferior epigastric
Acquired

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65
Q

What persists that leads to indirect hernias

A

Processus vaginalis

66
Q

What level is the transpyloric plane

A

L1

67
Q 
What level is each artery
Celiac
SMA
IMA
Aorta bifurcation
A

T12
L1
L3
L4

68
Q

What level is the umbilicus and what dermatomes

A

L3-L4

T10

69
Q

What are the two lesser omentum ligaments

A

Hepatoduodenal

Hepatogastric

70
Q

What ligaments make up the greater omentum

A

Gastrophrenic
Gastrosplenic
Gastrocolic

71
Q

What are the three branches of the celiac artery

A

Left gastric
Splenic
Common hepatic

72
Q

What branches arise from the splenic artery

A

Short gastric

Left gastroepiploic

73
Q

What are the branches from the common hepatic

A 
Proper hepatic
-right gastric
-left and right hepatic
-cystic (from right hepatic)
Gastroduodenal
-supraduodenal
-Superior pancreaticoduodenal
-right gastroepiploic
74
Q

What cells generate slow waves

A

Cells of Cajal

75
Q

What is the order of contribution of saliva?

A

Submaxillary>parotid>sublingual

76
Q

Why is saliva hypotonic to plasma?

A

Because water cannot move out of the saliva, yet ions can

77
Q

What direction are ions moving in the salivary ducts and how does this change when salivation flow rate increases

A

Reabsorb Na and Cl
Secrete K and HCO3

HCO3 increases with flow rate and the saliva becomes closer to isotonic

78
Q

What is xerstomia

A

Dry mouth

79
Q

What is Sjogren’s syndrome

A

Dry mouth due to damage to salivary gland or radiation to head/neck area

80
Q

What initiates primary peristaltic contraction of the esophagus

A

Swallowing

81
Q

what initiates secondary peristaltic contraction in the esophagus

A

Presence of food

82
Q

What is GERD

A

Gastroesophageal reflux disease

Caused by low tone of LES, reflux of stomach acid

83
Q

What is a hiatal hernia

A

When the stomach passes through the hiatus in the diaphragm, acid reflux barrier weakened

84
Q

What is Barrett’s esophagus

A

Constant injury to esophagus causing cell growth

Untreated can lead to esophageal cancer

85
Q

What is achalasia

A

Neuromuscular disorder of lower 2/3 of esophagus, absence of peristalsis, LES cannot relax
Food accumulates in esophagus

86
Q

What is eructation

A

Belching

87
Q

What is receptive relaxation? What mediates it and what initiates it?

A

When the proximal stomach relaxes to accommodate ingested food

Vagovagal reflex

Initiated by dissension of the stomach

88
Q

What is the purpose of retropulsion?

A

When food is propelled back and forth to mix

89
Q

What hormone causes migrating myoelectric complexes

A

Motilin

90
Q

What is gastroparesis

A

Impaired or delayed gastric emptying usually caused by diabetes or mental health drugs

91
Q

What are the components of gastric juice

A

HCl
Pepsin
Mucus
IF

92
Q

What is the difference between the soluble and insoluble forms of mucus in the stomach

A

Soluble mucus is secreted by stimulation from the vagus nerve, mixes with solutions to make chyme

Insoluble is secreted by surface mucus cells, protects stomach, HCO3 trapped here and maintains pH at surface

93
Q

What is pernicious anemia

A

Absence of IF, resulting in malabsorption of Vit B12

94
Q

Explain the mechanism in which parietal cells secrete HCl

A

water and CO2 becomes H and HCO2 using CA. H is moved to the lumen by a K/H exchanger. HCO3 is moved to the blood stream by a Cl/HCO3 exchanger. Cl then moves into the lumen. Na/K ATPase and Na/H exchangers are found on the blood stream side

95
Q

How does ACh, histamine, and gastrin stimulate acid secretion

A

They increase the number of channels on the apical membrane

96
Q

What cells release histamine

A

ECL cells

97
Q

What activates ECL cells to release histamine

A

Gastrin

98
Q

What inhibits acid secretion

A

Low pH in stomach
Somatostatin
Chyme in duodenum

99
Q

What phase of secretion is always occurring in absence of all gastric stimulation

A

Basal secretion

100
Q

What directly stimulates gastric secretions? (Food type)

A

Proteins

101
Q

Which phase is activated by the sight, smell, and taste of food?

A

Cephalic - vagal stimulation

102
Q

What phase is stimulated by stretch of the stomach? What does this activate?

A

Gastric phase - vagal and G cells releasing gastrin

103
Q

What is the function of enterocytes

A

Digestion, absorption, and secretion

104
Q

What is the function of goblet cells in the small intestine

A

Secrete mucus

105
Q

What is the function of crypt cells

A

Stem cells for enterocytes and goblet cells

106
Q

What is the most common type of contraction in the small intestine

A

Segmentation

107
Q

Why do contractions occur at a higher frequency in the proximal small intestine than in the distal?

A

To propel food forward

108
Q

What are the contractions that occur about every 90 minutes and what is the purpose?

A

Migrating myoelectric complex

Clears remaining chyme in the small intestine

109
Q

What is the intestinointestinal reflex

A

Overdistension of one segment of intestine inhibits contractile activity everywhere else to prevent more chyme from being pushed into the full area

110
Q

What is the peristaltic reflex

A

Contractions that move intestinal contents along the small intestine

111
Q

What is the gastroileal reflex

A

Gastric secretion and emptying triggers increased peristalsis in ileum causing relaxation of ileocecal sphincter and movement of ileal contents into the large intestine

112
Q

What is the gastrocolic reflex

A

Urge to defecate shortly after starting a meal

113
Q

What is ileus

A

Loss of reduction in contractile activity of intestines, no obstruction. Leads to irritation of peritoneum, caused by surgery, electrolyte balance, acute or systemic illness

114
Q

What cells produce peptidases, lipases, and amylase

A

Acinar cells

115
Q

Which cells secrete pancreatic juice with high concentrations of HCO3

A

Centroacinar and duct cells

116
Q

Explain how aqueous content changes depending on rate of secretion in the pancreas

A

At low flow rates, primarily Na and Cl

High rates, Na and HCO3

117
Q

How is pancreatic juice formed

A

H2O and CO2 react with CA and form HCO3 and H. H is transported out of the cell and into the blood where it combines with HCO3 (pancreas blood then has a lower pH). HCO3 is transported across the apical membrane by the HCO3/Cl exchanger. Cl channel pumps Cl out of the cell (defected in cystic fibrosis)

118
Q

Why does trypsin and chymotrypsin need to be secreted in the inactive form

A

Otherwise they will digest the pancreas

119
Q

What is the negative feedback loop for the pancreatic bicarbonate secretion

A

When acid is present, secretin is released and travels through the blood back to the pancreas. Here, the acinar and ductal cells are stimulated to release bicarbonate. Bicarbonate then stops the release of secretin

120
Q

What role does CCK play on acinar cells in the pancreas

A

Causes increase enzyme secretion

121
Q

What stimulates the vagovagal reflex

A

Acid, fat, and protein digestion

122
Q

A patient presents to your office with abdominal pain. After lab results you see a greatly elevated serum amylase and lipase. Pt has diarrhea, fever, nausea and vomiting. Pt also has a history of gall stones. What’s your diagnosis

A

Pancreatitis

123
Q

What is the most likely reason a patient has chronic pancreatitis

A

Repeated episodes of acute pancreatitis

124
Q

What is wrong with cystic fibrosis patients

A

Cl channel defect

Malabsorption and steatorrhea

125
Q

During what period is bile stored in the gall bladder

A

Inter digestive

126
Q

What are the main components of bile

A

Bile acid
Phospholipids
Cholesterol

127
Q

What is the primary way the body gets rid of cholesterol

A

Bile excreted in feces

128
Q

What is the primary phospholipid found in bile

A

Lecithins

129
Q

What gives bile its pigmentation

A

Bilirubin

130
Q

What are the most common causes of jaundice

A

Increased destruction of blood cells

Obstruction of bile duct or damage to liver cells

131
Q

What is enterohepatic circulation used for

A

Secretion of bile must recirculate and be reused because there is not enough to fully digest.

132
Q

What is the rectosphincteric reflex

A

When fecal material forced into the rectum, rectum contracts and internal anal sphincter relaxes

133
Q

What is Hirschsprung’s disease

A

Congenital megacolon
Results in tonic contraction
Feces accumulates proximal to contraction leading to dilation of the colon

134
Q

What is the method for fructose absorption within the intestine?

A

Via facilitated diffusion. Cannot go against concentration gradient

135
Q

Why are some individuals lactose intolerant?

A

They lack the enzyme lactase, therefore they cannot breakdown lactose

136
Q

What is sucrase-isomaltase deficiency

A

Inherited disorder where the patient cannot digest sucrose and isomaltose

137
Q

What are gurgling noises heard in the intestines

A

Borborygmi

138
Q

What are the two sources of proteins

A

Endogenous - secretory proteins and cells shed into GI lumen

Exogenous - dietary

139
Q

Why do we need enterokinase to be secreted?

A

converts trypsinogen to trypsin

140
Q

What form do a majority of proteins get absorbed as?

A

Di- and tri- peptides

141
Q

What is cystinuria

A

Affects uptake of basic amino acids

142
Q

What is Hartnup disease

A

Affects uptake of neutral AAs

143
Q

What is familial iminoglycinuria

A

Affects uptake of proline and hydroxyproline

144
Q

What is the most readily absorbed form of iron

A

Here

145
Q

What enzyme breaks down heme to release iron

A

Heme oxygenase

146
Q

Ferrous or ferric absorbs easier

A

Ferrous

147
Q

Usually ferric is majority of dietary iron, what converts it to ferrous

A

Ascorbic acid (vit C) or Dcytb along brush borders

148
Q

Why is apoferritin necessary for iron absorption

A

Iron is cytotoxic so needs to be bind to apoferritin and forms ferritin.

149
Q

What transports iron out of the cell

A

Ferroportin

150
Q

What liver derived peptide regulates iron

A

Hepcidin

151
Q

How do hepcidin levels change when iron levels are high

A

Hepcidin levels are high when iron is in excess to decrease export of iron from enterocytes by internalizing ferroportin

152
Q

What is hemochromatosis, what can it contribute to, how is it treated

A

chronic absorption of too much iron
Can lead to cirrhosis and liver cancer

Can contribute to coronary artery disease, damage pancreas, diabetes, arthritis

Treated by removing blood

153
Q

How is sodium absorbed throughout the intestines:
Duodenum and jejunum
Ileum
Colon

A

Na-glucose co-transporter or Na-H exchanger

Na-Cl cotransport

Na channels

154
Q

When there is excess solute in the lumen that attracts water from intestinal wall in volumes that exceed absorptive capacity of gut

A

Osmotic diarrhea

155
Q

When excess stimulation of secretory cells in crypts of small intestine and colon

A

Secretory diarrhea

156
Q

Diarrhea due to infection by bacteria or virus

A

Inflammatory/infectious diarrhea

157
Q

What are the main causes of secretory diarrhea

A

Infections of intestine by bacteria (v. Cholerae or E. Coli)

Certain tumors

158
Q

What is the mechanism behind secretory diarrhea

A

Activation of Cl channels leading to excess secretion of Cl into the lumen. Na and H2O follow.

159
Q

What are the causes of inflammatory diarrhea

A

Infection via
bacteria (Salmonella, Campylobacter clostridium difficile (C. diff))
Viruses (rotaviruses, norovirus)

160
Q

What is the mechanism behind inflammatory diarrhea

A

Kills intestinal spells resulting in inability to absorb

161
Q

What parts of the GI tract are affected by aging

A

Mouth, esophagus, stomach, small intestine, large intestine

SF4 (2 decks)

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