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Flashcards in GI Deck (161):
1

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

Esophagus, umbilicus, rectum, posterior abdominal wall

2

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

P: Left Gastric
C: Esophageal

3

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

P: Paraumbilical
C: superficial epigastric

4

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

P: superior rectal
C: Inferior rectal

5

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

P: Colic veins
C: retroperitoneal veins

6

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

Esophageal varices

7

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

Caput medusae

8

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

Internal hemorrhoids

9

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

Asymptomatic

10

What is the action and innervation of the external oblique

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

11

What is the action and innervation of the internal oblique

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

12

What is the action and innervation of the transversus abdominis

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

13

What is the action and innervation of the rectus abdominis

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

14

What is the action and innervation of the pyramidalis

A: tenses Linea alba
I: T12 or L1

15

What is the action and innervation of the cremaster muscle

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

16

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

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

17

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

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

18

What makes up the anterior border of the inguinal canal?

Aponeurosis of the external and internal oblique muscles

19

What makes up the posterior wall of the inguinal canal?

Transversalis fascia and conjoint tendon (medial third of canal)

20

What makes up the roof of the inguinal canal

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

21

What is the floor border of the inguinal canal

Inguinal ligament and lacunar ligament(medial third)

22

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

Skin

23

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

Dartos muscle

24

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

Colles fascia
Membranous layer of superficial fascia of perineum

25

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

External spermatic fascia

26

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

Cremaster muscle and fascia

27

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

No contribution

28

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

Internal spermatic fascia

29

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

Loose connective tissue including fat

30

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

Tunica vaginalis

31

What are the coverings of the testis
Deep to superficial

Tunica albuginea
Tunica vaginalis
-visceral
-parietal

32

What are the layers of the spermatic cord

External spermatic fascia
Cremasteric fascia
Internal spermatic fascia

33

Components of the spermatic cord

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

34

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

Stimulates acid secretion

G cells in the antrum of stomach

Small peptides, amino acids, gastric distention, vagal stimulation

35

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

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

36

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

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

S cells in the duodenum

Acid

37

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

Stimulates - insulin release
Inhibits - gastric acid secretion

K cells in duodenum and jejunum

Fatty acids, amino acids, oral glucose

38

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

Stimulates - gastric and intestinal motility

Duodenum and jejunum

Nerves

39

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

Inhibits - GI hormone release, gastric acid secretion

D cells in GI mucosa

Acid

40

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

Stimulates - gastric acid secretion

ECL cells

gastrin

41

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

Relaxes GI smooth muscle
Stimulates - intestinal secretion, pancreatic secretion

GI mucosa and smooth muscle

42

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

Stimulates - gastrin release

gastric mucosa

Vagal stimulation

43

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

Stimulate - contraction of smooth muscle
Inhibit - intestinal secretion

GI mucosa and smooth muscle

44

What are the fat droplets that hang off the colon

Appendices epiploicae

45

What are the longitudinal muscles of the colon

Teniae coli

46

What structures are primary retroperitoneal

Kidneys
Adrenal gland
Aorta
IVC
Testes
Bladder and ureters
Uterus
Rectum

47

What structures are secondarily retroperitoneal

Duodenum, middle
pancreas
Ascending colon
Descending colon

48

What is associated with the median umbilical fold

Obliterated urachus

49

What is associated with the medial umbilical folds

Obliterated umbilical arteries

50

What is associated with the lateral umbilical folds

Inferior epigastric vessels

51

What are the four gutters of the peritoneum

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

52

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

Subphrenic recess

53

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

Hepatorenal recess

54

What are the phases of gastric secretion

Cephalic
Gastric
Intestinal

55

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

L1
Skin of upper inguinal and suprapubic region, internal oblique and transversus abdominis

56

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

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

Internal oblique and transversus abdominis

57

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

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

58

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

L2 and L3
Skin of lateral and anterior thigh

59

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

L2-L4
Anterior thigh muscles

60

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

L2-L4
Medial thigh muscles

61

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

L4-L5
Joined sacral plexus in pelvis

62

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

T12
Skin and muscles of anterolateral abdominal wall

63

What constitutes as a indirect inguinal hernia

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

64

What constitutes a direct inguinal hernia

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

65

What persists that leads to indirect hernias

Processus vaginalis

66

What level is the transpyloric plane

L1

67

What level is each artery
Celiac
SMA
IMA
Aorta bifurcation

T12
L1
L3
L4

68

What level is the umbilicus and what dermatomes

L3-L4
T10

69

What are the two lesser omentum ligaments

Hepatoduodenal
Hepatogastric

70

What ligaments make up the greater omentum

Gastrophrenic
Gastrosplenic
Gastrocolic

71

What are the three branches of the celiac artery

Left gastric
Splenic
Common hepatic

72

What branches arise from the splenic artery

Short gastric
Left gastroepiploic

73

What are the branches from the common hepatic

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

74

What cells generate slow waves

Cells of Cajal

75

What is the order of contribution of saliva?

Submaxillary>parotid>sublingual

76

Why is saliva hypotonic to plasma?

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

77

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

Reabsorb Na and Cl
Secrete K and HCO3

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

78

What is xerstomia

Dry mouth

79

What is Sjogren’s syndrome

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

80

What initiates primary peristaltic contraction of the esophagus

Swallowing

81

what initiates secondary peristaltic contraction in the esophagus

Presence of food

82

What is GERD

Gastroesophageal reflux disease
Caused by low tone of LES, reflux of stomach acid

83

What is a hiatal hernia

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

84

What is Barrett’s esophagus

Constant injury to esophagus causing cell growth
Untreated can lead to esophageal cancer

85

What is achalasia

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

86

What is eructation

Belching

87

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

When the proximal stomach relaxes to accommodate ingested food

Vagovagal reflex

Initiated by dissension of the stomach

88

What is the purpose of retropulsion?

When food is propelled back and forth to mix

89

What hormone causes migrating myoelectric complexes

Motilin

90

What is gastroparesis

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

91

What are the components of gastric juice

HCl
Pepsin
Mucus
IF

92

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

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

What is pernicious anemia

Absence of IF, resulting in malabsorption of Vit B12

94

Explain the mechanism in which parietal cells secrete HCl

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

How does ACh, histamine, and gastrin stimulate acid secretion

They increase the number of channels on the apical membrane

96

What cells release histamine

ECL cells

97

What activates ECL cells to release histamine

Gastrin

98

What inhibits acid secretion

Low pH in stomach
Somatostatin
Chyme in duodenum

99

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

Basal secretion

100

What directly stimulates gastric secretions? (Food type)

Proteins

101

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

Cephalic - vagal stimulation

102

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

Gastric phase - vagal and G cells releasing gastrin

103

What is the function of enterocytes

Digestion, absorption, and secretion

104

What is the function of goblet cells in the small intestine

Secrete mucus

105

What is the function of crypt cells

Stem cells for enterocytes and goblet cells

106

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

Segmentation

107

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

To propel food forward

108

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

Migrating myoelectric complex

Clears remaining chyme in the small intestine

109

What is the intestinointestinal reflex

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

110

What is the peristaltic reflex

Contractions that move intestinal contents along the small intestine

111

What is the gastroileal reflex

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

112

What is the gastrocolic reflex

Urge to defecate shortly after starting a meal

113

What is ileus

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

What cells produce peptidases, lipases, and amylase

Acinar cells

115

Which cells secrete pancreatic juice with high concentrations of HCO3

Centroacinar and duct cells

116

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

At low flow rates, primarily Na and Cl

High rates, Na and HCO3

117

How is pancreatic juice formed

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

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

Otherwise they will digest the pancreas

119

What is the negative feedback loop for the pancreatic bicarbonate secretion

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

What role does CCK play on acinar cells in the pancreas

Causes increase enzyme secretion

121

What stimulates the vagovagal reflex

Acid, fat, and protein digestion

122

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

Pancreatitis

123

What is the most likely reason a patient has chronic pancreatitis

Repeated episodes of acute pancreatitis

124

What is wrong with cystic fibrosis patients

Cl channel defect
Malabsorption and steatorrhea

125

During what period is bile stored in the gall bladder

Inter digestive

126

What are the main components of bile

Bile acid
Phospholipids
Cholesterol

127

What is the primary way the body gets rid of cholesterol

Bile excreted in feces

128

What is the primary phospholipid found in bile

Lecithins

129

What gives bile its pigmentation

Bilirubin

130

What are the most common causes of jaundice

Increased destruction of blood cells
Obstruction of bile duct or damage to liver cells

131

What is enterohepatic circulation used for

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

132

What is the rectosphincteric reflex

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

133

What is Hirschsprung’s disease

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

134

What is the method for fructose absorption within the intestine?

Via facilitated diffusion. Cannot go against concentration gradient

135

Why are some individuals lactose intolerant?

They lack the enzyme lactase, therefore they cannot breakdown lactose

136

What is sucrase-isomaltase deficiency

Inherited disorder where the patient cannot digest sucrose and isomaltose

137

What are gurgling noises heard in the intestines

Borborygmi

138

What are the two sources of proteins

Endogenous - secretory proteins and cells shed into GI lumen

Exogenous - dietary

139

Why do we need enterokinase to be secreted?

converts trypsinogen to trypsin

140

What form do a majority of proteins get absorbed as?

Di- and tri- peptides

141

What is cystinuria

Affects uptake of basic amino acids

142

What is Hartnup disease

Affects uptake of neutral AAs

143

What is familial iminoglycinuria

Affects uptake of proline and hydroxyproline

144

What is the most readily absorbed form of iron

Here

145

What enzyme breaks down heme to release iron

Heme oxygenase

146

Ferrous or ferric absorbs easier

Ferrous

147

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

Ascorbic acid (vit C) or Dcytb along brush borders

148

Why is apoferritin necessary for iron absorption

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

149

What transports iron out of the cell

Ferroportin

150

What liver derived peptide regulates iron

Hepcidin

151

How do hepcidin levels change when iron levels are high

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

152

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

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

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

Na-glucose co-transporter or Na-H exchanger

Na-Cl cotransport

Na channels

154

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

Osmotic diarrhea

155

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

Secretory diarrhea

156

Diarrhea due to infection by bacteria or virus

Inflammatory/infectious diarrhea

157

What are the main causes of secretory diarrhea

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

158

What is the mechanism behind secretory diarrhea

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

159

What are the causes of inflammatory diarrhea

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

160

What is the mechanism behind inflammatory diarrhea

Kills intestinal spells resulting in inability to absorb

161

What parts of the GI tract are affected by aging

Mouth, esophagus, stomach, small intestine, large intestine