GI high yield Flashcards
(192 cards)
1
Q
swallowing muscles + innvervation
A
sup, mid, inf constrictor muscles
CN 9 + 10 (mostly vagus)
CN 9 + 10 (mostly vagus)
2
Q
levtor and tensor palati function and innvervation
A
palate elevation and tension
CN 5 + 10
CN 5 + 10
3
Q
palatopharyngeus, palatoglossus, salpingopharyngeus function and innvervation
A
deglutination, open auditory tube
CN 10
CN 10
4
Q
stylopharyngeus function and innvervation
A
elevate larynx
CN 9
CN 9
5
Q
esophagus innvervation
A
CN 10 vagus
6
Q
sequelae of esophagitis/GERD
A
barretts esophagitis > metaplasia of mucosa in distal esophagus > squamous adenocarcinoma
7
Q
attachments of stomach
A
lesser omentum (between liver and stomach)
greater omentum (peritoneal ligament)
8
Q
causes of chronic gastritis
A
B12 def
h pylori
9
Q
gastric vs dueodenal ulcer similarities and diff
A
gastric pain WORSE with food
duodenal ulcer pain BETTER eating
10
Q
gastric and duodenal ulcers are associated with what infection
A
h pylori
11
Q
pt with gastritis/ulcers not responding to tx, what are you concerned about?
A
gastric carcinoma
12
Q
most digestion takes place
A
jejenum aand ileum
13
Q
post gastric digestion begins in
A
duodenum
14
Q
what portion of small intestine is shorter
A
jejenum
15
Q
what portion of small intestine has more lymphatic and vascular activity
A
ileum
16
Q
intususseption kids vs adults
A
kids can be normal
adults = BAD = tumor, obstruction, infarction. older pt gets, more likely obstruction > infarction
17
Q
colon microbiology changes
A
outer layer is replaced by teniae coli (longitudinal smooth muscle); swaps out squeezing of small intestine for twisting contraction
18
Q
internal syphincters are mediated by
A
stretch reflex; autonomic
19
Q
external syphincters are mediated by
A
somatic voluntary skeletal muscle
20
Q
appendicitis clinical characteristics
A
global periumbilical pain to RLQ
N/V, constipation, no gas
left shift CBC
McBurneys/rebound tenderness
21
Q
diverticulitis clinical characteristics
A
similar to appendicitis but on LEFT side
22
Q
diverticuli definition
A
herniation of colon mucosa through muscularies, submucosa, and adventitia; added “pouch” off haustration
23
Q
diverticulosis vs diverticulitis
A
- osis = have diverticuli
- itis = inflammation of diverticula (usually sigmoid colon)
24
Q
colorectal carcinoma is associated with
A
UC, familial polyposis coli, Crohn’s; other inflammatory bowel dz
25
chron's disease / regional enteritis sx
chronic granulomatous dz
mostly in small bowel (terminal ileum)
skip lesions/cobblestoning appearance (thick intestinal wall, lumen narrowed "string sign")
fistulas to vagina, anus, bladder, peritoneum
polyarthritis, sacroiliitis
iritis, optic atrophy
26
chron's dz vs ulcerative colitis
both young, caucasion; both can have iritis
crohn's: beginning in terminal ileum, more painful, unexplained pain
UC: more diarrhea than pain, rectum or whole colon
27
UC sx
may be only rectum or cont in whole colon
ulceration with pseduopolyps (regenerating mucosa)
bloody mucoid diarrhea, stringy mucous
perforation, toxic megacolon
iritis
28
celiac dz etiology
gluten sensitive enteropathy
malabsorption secondary to inflammatory luminal swelling > cross antigen AI stimulation
crohn's/UC like presentation
29
IBS dx
dx of exclusion
30
acute pancreatitis vs pancreatic cancer presentation
acute pancreatitis = VERY painful (epigastric radiating to mid back)
cancer = painless
31
causes of acute pancreatitis
obstructions/gallstones, heavy alcohol, choline deficiency
32
____ triples risk of pancreatic cancer
heavy tobacco smoking
33
liver failure indirect effects
clotting dysfunction
| no removal of hormones > hormonal sx
34
3 regions of aorta in GI tract/vascular supply
celiac artery > esophagus, stomach, prox duo (foregut)
sup mesenteric > disital duo, rest of small int, asc colon (midgut)
inf mesenteric > transverse colon, rectum (hindgut)
35
sympathetic supply of GI
celiac > esophaus, stomach, prox duo
| inf mesenteric > distal duo, everything else
36
parasympathetic supply of GI
CN 10 (vagus) > esophagus, somatic, small int, asc colon
pelvic splanchnic (S2,3,4) > transverse colon, rectum
37
3 branches off celiac artery
right gastric off hepatic
left gastric off celiac
gastroepiploic and short gastric off splenic
38
most abdominal circulation drains back through
liver/portal circulation
39
vein drainage to GI
stomach, esophagus > portal v
small int, asc colon > sup mesenteric v > portal
transverse colon, rectum > inf mesernteric v > splenic v > portal
40
portal backups/HTN happen in
anastomatic areas
hemmorhoidial plexi > hemmorhoids
esophageal venus plexi > esophageal varices
umbilical v > caput medusae (roadmap of v on abdomen)
41
2 most common causes portal HTN
alcoholic cirrhosis
| pregnancy
42
submucosal (meissner's) plexus
autonomic plexus controlling mucous membrane activity
secretion + blood flow
43
myenteric (auerbach's) plexus
autonomic plexus controlling inner circular and outer longitudal smooth muscle activity
motility
44
extrinsic innvervation GI tract
autonomic
PNS: excitatory, vagus + pelvic splanchnic
SNS: inhibitory, prevertebral ganglia (T8-L2)
45
intrinsic innvervation GI tract
enteric nervous sys (local reflexes)
Myenteric (auerbach’s) plexus - motility
Submucosal (meissners) plexus - secretion and blood flow
| myenteric and submucosal plexi
46
histamine action on GI
stomach
| stimulates gastric H+
47
gastrin action in GI
stomach
stim H+ and gastric mucosa
+ AA, stomach distention, vagal (PNS)
- gastric acid, secretin, GIP
48
CCK action in GI
duedenum/jejenum
stim GB contraction, Oddi relaxation, panc enzyme and bicarb secretion, inhibit gastric emptying
+ AA, FA
49
secretin action in GI
duedenum/jejenum
stim pabcreatic and GB bicarb secretion
inhibits gastric emptying
+ H+, FA
50
GIP action in GI
duedenum/jejenum
stim insulin secretion, inhibits gastric acid secretion
+ oral glucose, AA, FA
51
chief cells mainly secrete
pepsinogen
52
parietal cells mainly secrete
HCl, intrinsic factor
53
G cells mainly secrete
gastrin
54
absorption site of carbs
duedenum, jejenum
55
absorption site of AA
duedenum, jejenum
56
absorption site of iron
duedenum (as Fe2+)
57
absorption site of B12
terminal ileum
58
absorption site of bile salts
terminal ileum
59
main liver branches
R + L hepatic > common hepatic
cystic > gallbladder
meeting of common hepatic and cystic > common bile duct
60
minor duedenal papilli recieves from
| major duedenal papilli recieves from
minor: accessory pancreatic duct
| major (Oddi): choledochal, primary pancreatic
61
function of bile
mycellize/separate fat
62
primary bile acids
cholic acid
| chenodeoxycholic acid
63
secondary bile acids
deoxycholic acid
| lithocholic acid
64
common site for mets
liver
65
cholecystitis vs cholelithiasis
cystitis: inflammation of GB, RUQ pain worse with eating
lithiasis: gallstones, often asymp, or same sx as cystitis
66
major risk of cholelithiasis
leaving GB > obstruction of liver or pancreas
67
absorption in GI
monosaccharides (all polysaccharides broken down by brush border enzymes to monosacchardies)
glucose + galactose via Na cotransporter
fructose via facilitated diffusion
68
3/4 of body (left) drainage
cisterna chyli to thoracic duct
69
1/4 of body (right) lymphatic drainage
right duct
70
3/4 of body (left + middle) drainage
cisterna chyli to thoracic duct
71
lymphatic ducts drain into what veins
subclavian v
72
diff between med/long chain FA and protein/carb absorption
FA: lymphatics (heart before liver)
| P/C: portal circulation
73
absorption of H2O in colon/large int
most absorped in small int but colon absorbs about 90% of water from the chyme it received; large dehydrating organ
74
water soluble vitamins
B1, 2, 3, 5, 6, 12
C
folacin
biotin
75
fat soluble vitamins
A
D
E
K
76
vit A function + def
rhodopsin/vision
night blindness
77
vit D function + def
GI, inc Ca absorp
rickets/osteomalacia
78
vit E function + def
antioxidant
ataxia
79
vit K function + def
carboxylation glutamate, ca chelation w glutamate
factor 2, 7, 9, 10 bleeding disorders
80
B1 function + def
aldehyde transfer, decarboxylation
beriberi
81
B2 function + def
H+ transfer, FMN-FAD (flavins)
cheilosis/glossitis
82
B2 function + def
H+ transfer, FMN-FAD (flavins)
cheilosis/glossitis
83
B3 function + def
H+ transfer, NAD-NADP
pellegra (dementia, diarrhea, dermatitis)
84
B6 function + def
AMINO group transfer, de + trans aminations
microcytosis, neuropathy
85
B12 function + def
METHYL transfer, methionine syn
macrocytosis, pernicious anemia
86
B12 function + def
METHYL transfer, methionine syn
macrocytosis, pernicious anemia, neuropathy
87
vit C function + def
H transfer, hydroxylation of proline and lysine
scurvy
88
biotin function + def
carboxylation
seborrheic dermatitis, nervous disorders, bound by avidin (in egg white)
89
folate function + def
methyl transfer
macrocytosis, glossitis, colitis
90
B1 name
thiamin
thiamin pyrophosphate
91
B2 name
riboflavin
92
B3 name
niacin, niacinamide
93
B5 name
pantothenic acid
94
B6 name
pyroxidine
pyridoxal-5-phosphate
95
B12 name
cyanocobolamin
96
skin vs liver vs kidney forms vit D
skin: cholecalciferol
liver: 25dihydro
kidney: 24,25 dihydro
97
Type of muscle that makes up most of GI tract
Smooth muscle (involuntary)
98
Upper esophagus vs lower esophagus function/histology
Upper = swallowing, striated muscle
Lower = peristalsis (inner circular, outer longitudinal smooth muscle)
99
Esophagus anatomy points
Post to trachea in larynx
Passes ant to aorta below bronchial bifurcation
Descends through esophageal hiatus in diaphragm
100
Parts of stomach
Cardia, pyloric spinchters
Fundus
Body, lesser curvatures
Body
101
Musculature of stomach
Internal = oblique
Middle = circular
External = longitudinal
102
Artery of stomach
Celiacs artery (L and R gastric AA)
103
Innervation of stomach
Sympathetic (blocks peristalsis)
-splanchic preganglionics
-Celiac plexus
Parasympathetic (inc peristalsis) - vagus n
104
Veins of stomach
Gastric veins - to portal vein - to liver
105
Jejunum vs ileum
Jejunum
upper 40% small intestine
Ileum
Lower 60% small intestine
More arterial arcades
More lymphatics (payers patches)
Both
Sup mesenteric A + V
N:
-symp: splanchics
-para: vagus
106
Large intestine tissue
Teniae coli - longitudinal smooth muscle
Haustra - pouched wall
107
Colon segments
Ascending
Hepatic fixture
Transverse
Splenic fixture
Descending
Sigmoid
108
Internal and external sphincter of anus tissue
Internal - smooth muscle, autonomic control
External - striated muscle, pudendal nerve, conscious control
109
Nerves large intestine
Parasympathetic = pelvic splanchnics (past ascending colon)
Sympathetic = hypogastric plexus
110
Vessels large intestine
Asc colon - sup mesenteric
Rest of colon - inf mesenteric
111
Iliocecal junction components
Ileum (terminal)
Iliocecal valve
Cecum
Appendix
112
Celiac supplies
Esophagus > stomach
113
Sup mesenteric supplies
Duodenum, small intestine, asc colon
114
Inf mesenteric supplies
Transverse colon > rectum
115
Esophagus and stomach sym/parasympathetic supply
Symp = celiac
Para = vagus (10)
116
Duodenum, small intestine, ascending colon sym/parasympathetic supply
Symp = inf mesenteric
Para = vagus (10)
117
Transverse colon and rectum sym/parasympathetic supply
Symp = inf mesenteric
Para = pelvic splancnic
118
What artery comes off celiac
Celiac > splenic > gastroepiploic + short gastric
Celiac > L gastric
Hepatic > R gastric
119
GI circulation drains back through
Portal circulation
120
Foregut GI
Esophagus to upper duodenum (at level of pancreatic duct/common bile duct insertion/ampulla of vater), pancreas
121
Midgut GI
Lower duodenum to proximal 2/3 transverse colon
Week 6 - physiologic herniation of midgut through umbilical ring
Week 10 - returns to abdominal cavity and rotates around sup mesenteric artery
122
Hindgut GI
Distal 1/3 of transverse colon to anal canal above pectinate line
123
Ventral and dorsal pancreatic buds >
Ventral > uncinate process, main pancreatic duct
Dorsal > body, tail, isthmus, accessory pancreatic duct
Both > pancreatic head
124
Layers of gut wall (inner to outer)
MSMS
Mucosa
Submucosa
Muscularis externa
Serosa (intraperitoneal) / adventitia (retroperitoneal)
125
Mucosa micro
Epithelium, lamina propria, muscularis mucosa (erosions in the mucosa only)
126
Submucosa micro
Submucosal nerve plexus (Meissner) and secretes fluid
127
Muscularis externa micro
Myenteric nerve plexus (auerbach) between circular and longitudinal layers of muscle
motility (ulcers can extend into Submucosa and muscle layer)
128
Esophagus micro
Nonkeritanized stratified squamous cells
Upper 1/3 striated muscle, lower 2/3 smooth muscle
Mucosal (squamous) cells line innermost layer, change to columnar epithelium at the GI junction (Z line)
129
Location esophagus
Post to trachea in larynx
Passes ant to aorta below bronchial bifurcation
Descends through esophageal hiatus in diaphragm
130
hepatocytes
Liver cells - perform metabolic, synthetic, storage, catabolic, excretory functions
Apical surface of hepatocytes face bile canaliculi. Basolateral surface faces sinusoids
131
Kupffer cells
Liver cells - macrophages, form the lining of sinusoids; protect against infection and circulating toxins
Activated they release cytokine such as ILs, interferons, and TGF a and B
132
Esophagus innervation
Upper 1/3 - recurrent laryngeal branches of vagus
Lower 2/3 - parasympathetic vagus
133
Functions of esophagus
Upper - swallowing (striated muscle)
Lower - peristalsis (inner circular, outer longitudinal smooth muscle)
134
Stellate cells
Liver cells - (ito cells) - specialized storage capacities. Contain fat, Vit A, and other lipid soluble vitamins.
Secrete extracellular matrix components inc collagen, laminin, proteoglycans.
In disease states, can make in great excess > hepatic fibrosis > cirrhosis
135
Pancreatic ducts fuse during week
7
136
Micro pancreas
Exocrine - pancreatic acini cells, centroacinar cells
Endocrine - islets of langerhans, alpha cells, beta cells, delta cells, PP cells
137
Pancreatic acini cells
Spherical collections of pyrimidal cells. Nasally situated, strong basophilic cytoplasm
138
Centroacinar cells
Spindle-shaped cells in the exocrine pancreas. extension of the intercalated duct into each pancreatic acinus.[1] commonly known as duct cells. secrete an aqueous bicarbonate solution under stimulation by the hormone secretin. secrete mucin.
139
Islets of langerhans
Pancreatic cell, Secretes insulin and glucagon
140
Alpha, beta, delta, PP cells of pancreas
Alpha - glucagon
Beta - insulin
Delta - somatostatin/GHiH
PP - pancreatic polypeptides
141
Pancreas location
Retroperitoneum
Head corresponds with curve of duodenum overlying the body of the 2nd lumbar vertabra and vena cava
Sphincter of oddi - smooth muscle surrounds end of common bile duct and pancreatic duct (relaxes from CCK)
142
Circulation pancreas
Head and uncinate process - pancreaticduodenal arteries (from gastroduodenal and sup mesenteric)
Body and tail - pancreatic arteries (from splenic, gastroduodenal, and sup mesenteric)
143
Pancreas functions
Exocrine: secretion of digestive enzymes, ions, and water into duodenum
-trypsin,chymotrypsin - digest proteins
-amylase - digest carbs
-lipase - break down fats
Endocrine: release of insulin, glucagon, somatostatin
144
Release of pancreatic enzymes is stimulated by
Vagus nerve
145
Pancreatic secretion phases
Cephalic (vagus)
Gastric (vagus)
Intestinal (hormonal)
146
Parietal cells
Stomach cells; HCL acid secretion. Contain receptors for ach, gastrin, histamine
147
Muscularis of stomach in > out
Oblique, circular, longitudinal
148
Duodenum micro
Villi and microvilli - absorptive surface
Runners glands - secrete HCO3-
Crypts of lieberkuhn
149
Jejunum micro
Crypts of lieberkuhn
Plicae circulares
150
Ileum micro
Peyer patches
Plicae circulares
Crypts of lieberkuhn
Largest number of GOBLET CELLS in the small intestine
151
Colon micro
No villi
Crypts of lieberkuhn
Goblet cells abundant
152
Retroperitoneal structures
SAD PUCKER
Suprarenal (adrenal) glands
Aorta and IVC
Duodenum (parts 2-4)
Pancreas (except tail)
Ureters
Colon (desc and asc)
Kidneys
Esophagus (lower 2/3)
Rectum (partially)
153
Source of gastrin
G cells
Antrum of stomach, duodenum
154
Action of gastrin
Inc gastric H+
Inc growth of gastric mucosa
Inc gastric motility
Stim release of histamine from enterochromaffin-like cells
Stim H+ and gastric mucosa (gastric motility)
155
Gastrin regulation
Inc stomach distention/alkalinization, AAs, peptides, vagal stimulation via GRP
Dec pH < 1.5
Inc in chronic PPI use, h pylori atrophic gastritis, gastrinoma
156
Somatostatin source
D cells
Pancreatic islets, GI mucosa
157
Functions somatostatin
Dec gastric acid
Dec pepsinogen
Dec pancreatic secretion
Dec small int fluid secretion
Dec gallbladder contraction
Dec insulin and glucagon release
158
Regulation somatostatin
Inc acid
Dec vagal stimulation
159
Cholecystokinin source
I cells
Duodenum, jejunum
160
Cholecystokinin functions
Inc pancreatic secretion
Inc gallbladder contraction
Dec gastric emptying
Inc sphincter of oddi relaxation > release of pancreatic enzymes + bicarb via neural muscarinic pathways
161
Cholecystokinin Regulation
Inc fatty acids, amino acids
162
Secretin source
S cells
Duedenum
163
Secretin Functions
Inc pancreatic HCO3- (allows pancreatic enzymes to function)
Dec gastric H+
Inc bile acid secretin in liver
164
Secretin Regulation
Inc acid, fatty acids in lumen of duodenum
165
GDIP/GIP source
K cells
Duodenum, jejunum
166
GDIP/DIP Functions
Exocrine - dec gastric H+
Endocrine - inc insulin release
167
GDIP/DIP Regulation
Inc fatty acids, amino acids, oral glucose
168
Motilin source
Small intestine
169
Motilin Function
Produces migrating motor complexes (MMCs)
Inc intestinal peristalsis
170
Motilin Regulation
Inc in fasting states
171
Vasoactive intestinal polypeptide source
Parasympathetic ganglia in spinchetrs, gallbladder, small intestine
172
Vasoactive intestinal polypeptide Function
Inc intestinal water and electrolyte secretion
Inc relaxation of intestinal smooth muscle and spinchters
173
Vasoactive intestinal polypeptide Regulation
Inc distention and vagal stim
Dec adrenergic input
174
Nitric oxide function
Inc smooth muscle relaxation, inc LES
175
Ghrelin source
Stomach
176
Ghrelin Function
Inc appetite (GHROWLIN STOMACH)
177
Ghrelin Regulation
Inc fasting
Dec food
178
Intrinsic factor source
Parietal cells
Stomach
179
Intrinsic factor Action
Vit B12 binding protein
Required for B12 uptake in terminal ileum
180
Gastric acid source
Parietal cells
Stomach
181
Gastric acid function
Dec stomach pH
182
Gastric acid reg
Inc by histamine
Inc vagal stim (Ach)
Inc gastrin
Dec somatostatin
183
Pepsin soure
Chief cells
Stoamch
184
Pepsin function
Protein digestion
185
Pepsin regulation
Inc vagal stim (Ach)
Inc local acid
186
Bicarb source
Mucosal cells - stomach, duodenum, salivary glands, pancreas
Brunner glands - duodenum
187
Bicarb regulation
Inc by pancreatic and biliary secretion with secretin
188
What is the pectinate line
Dentate Line; where endoderm (hindgut) meets ectoderm
189
Lateral to medial femoral triangle
NAVL
Nerve, artery, vein, lymphatics
190
Absorption site of folate
Small bowel
191
Direct v indirect bilirubin
Direct - conjugated with glucuonic acid, water soluble
Indirect - unconjugated, water insoluble
192
bilirubin production and excretion pathway
Heme metabolized by heme oxigenase > biliverdin > reduced to bilirubin
Unconjugated bilirubin removed from blood by liver > onjugated with glucuronate > excreted in bile
