GI histology and pathophys Flashcards
(95 cards)
1
Q
major functions of the GI tract
A
ingestion fragmentation digestion absorption elimination of waste defense - big one
2
Q
4 major layers of GI tract
A
mucosa
submucosa
muscular propria
adventitia
3
Q
layers of mucosa in GI tract
A
epithelium lamina propria (defense) muscularis mucosae (smooth muscle)
4
Q
things found in submucosa
A
collagenous tissue blood vessels glands lymphatics nerves
5
Q
role of submucosa
A
- binds mucosa to muscular wall
- secretion
- supply
- control
6
Q
layers of muscularis propria
A
inner circular muscle layer
outer longitudinal muscle layer
7
Q
role of muscularis propria
A
provide peristaltic contraction
8
Q
4 types of mucosa in GI
A
protective
secretory
absorptive
lubricative
9
Q
protective mucosa feature/location
A
- epithelium is squamous cells
- oral cavity, pharynx, esophagus, anus
10
Q
secretory mucosa feature/location
A
- closely packed tubular glands
- stomach
11
Q
absorptive mucosa feature/location
A
- finger-like projections
- small intestine
12
Q
lubricative mucosa feature/location
A
- closely packed straight tubular glands (elongated)
- large intestine
13
Q
air pressure level in esophogus
A
low (-5mmHg)
14
Q
anti reflux barriers
A
- lower esophageal sphincter
- diaphragmatic sphincter
- acute angle of stomach and esophagus connection
15
Q
functions of stomach
A
fragmentation
digestion
16
Q
parts of stomach
A
fundus
body
pylorus
17
Q
cell types found in stomach
A
mucus
parietal
chief
18
Q
mucus cell function
A
mucus secretion in stomach
19
Q
parietal cell function
A
acid secretion
20
Q
chief cell function
A
pepsin secretion
21
Q
3 segments of small intestine
A
duodenum
jejunum
ileum
22
Q
length of small intestine
A
23 feet
23
Q
ways small intestine increases surface area
A
- plicae circulares are folds of mucosa/submucosa
- numerous villi and crypts on the mucosal surface
- microvilli on the villi
24
Q
amylase role
A
convert poly-, di- or mono-saccharides to glucose and maltose
25
role of disaccharidase and oigosaccaridase
convert maltose to monosaccharides
26
carbohydrate digestion sequence
- poly, di, and mono saccharides broken down to glucose/maltose
- maltose broken down to monosaccharidrd that are then absorbed
27
pepsin role
protease - breaks proteins down to poly peptides
28
where do amino acids go after the breakdown of peptides
liver
29
what needs to happen to digest fats
emulsification and then lipases can break them down
30
stomach absorbs what
water
alcohol
aspirin
31
duodenum absorbs what
```
iron, calcium, magnesium, sodium
fats
monosaccharides
water
AA's
```
32
jejunum absorbs what
monosaccharides
| AA's
33
Ileum absorbs what
bile salts
Vit B12
chloride
34
colon absorbs what
water
| electrolytes
35
functions of colon
absorb water
store stool
propel stool
36
primary reservoir for stool
ascending colon
37
cellular components of large intestine
```
large glands
goblet cells - secretion
absorptive cells
blood vessels
lymphatic
```
38
mucosa-associated lymphoid tissues (MALT)
- defense mechanism
- T and B cells
- most active during childhood
39
GERD
symptoms/complications due to reflux of gastric contents into esophagus or beyond
-may or may not have erosions
40
GERD prevalence
10-20%
no difference between males/females
males may have more erosive esophagits
41
potential causes of GERD
- decreased lower esophageal sphincter pressure
- decreased mucosal resistance to acid
- decreased esophageal or gastric motility
- decreased salivary buffering of acid
42
drugs that may reduce LES pressure
anticholinergics
barbiturates
amlodipine
estrogen/progesterone
43
drugs that irritate esophageal mucosa
nsaids
aspirin
bisphophonates
potassium
44
main symptoms of GERD
heartburn
regurgitation
chest pain
dysphagia
45
ALARMD symptoms
- anemia
- loss of weight
- anorexia
- recent onset
- melena or hematemesis
- dysphagia
46
GERD diagnosis
-if heartburn/regurgitation you may presume GERD and treat with PPI
47
when to do endoscopy in GERD patients
if they have ALARMD symptoms
48
H.pylori screening in GERD
not recommended
49
ambulatory reflux monitor
catheter that goes through the nose and down the esophagus to monitor pH
50
complications of GERD
erosive esophagitis
esophageal strictures
Barrett's esophagus (>50 y/o)
esophageal adenocarcinoma
51
peptic ulcer disease
- injury to digestive tract resulting in mucosal break
| - usually in stomach or proximal duodenum
52
aggressive factors in PUD development
gastric acid
| pepsin
53
protective factors against PUD
mucus secretion
bicarbonate secretion
prostaglandins
54
causes of PUD
H.pylori
NSAID induced
stress-related (ICU patients)
55
H.pylori PUD is usually where
duodenum
56
NSAID induced PUD is usually where
stomach
57
symptoms of H.pylori PUD
epigastric pain
58
symptoms of NSAID induced PUD
usually asymptomatic
59
PUD that is acute
stress-related
60
symptoms of PUD
non-specific*
abdominal burning
fullness
cramping
61
symptoms of duodenal ulcers
pain 1-3 hours after meals or at night and is relieved by eating
62
symptoms of gastric ulcer
postprandial pain, n/v
| weight loss
63
PUD symptoms in elderly
usually asymptomatic
64
complications of PUD
bleeding - due to erosion into an artery
perforation - sudden sharp pain
gastric outlet obstruction
65
h.pylori transmission
usually fecal-oral
66
h.pylori risk factors
low socioeconomic status
many siblings
infected parent
contaminated water
67
where does h.pylori infect
between gastric mucus layer and surface epithelial cells
68
how does h.pylori protect itself
produces urease which converts urea in gastric juice to ammonia and CO2 to alkalinize the environment
69
complications of h.pylori
chronic gastritis
gastric and duodenal ulcers
malignancy
70
indications for h.pylori testing
- active or past PUD with no reported cure
- initiation of chronic NSAID
- unexplained iron deficiency anemia
- idopathic thrombocytopenic purpura
- low grade gastric MALT lymphoma
- Hx of endoscopic resection of early gastric cancer
71
when to consider non-endoscopic testing of h.pylori
< 60 with uninvestigated dyspepsia and no alarm symptoms
72
when is testing for h.pylori unnecessary
typical symptoms of GERD
| no PUD history
73
endoscopic tests for h.pylori
histology
culture of biopsy
biopsy rapid urease test
74
non-invasive h.pylori tests
antibody detection in serum (ELISA)
urea breath test
fecal antigen
75
h.pylori test of choice during active bleed or EGD
biopsy rapid urease test
76
most convenient h.pylori test
urea breath test
77
risk factors for NSAID induced ulcers or upper GI bleed
```
>65
hx of PUD
high does of NSAID
alcohol
cigarettes
bisphosphonates, SSRIs, corticosteroids, anticoags, antiplatelets
```
78
inflammatory bowel disease
chronic inflammatory disease of GI tract with alternating remission and recurrence
79
features of Crohns disease
- all segments can be affected (ileum and colon most common)
- transmural inflammation
- discontinuous distribution
80
features of ulcerative colitis
- limited to colon and rectum
- inflammation is mucosal only
- continuous distribution
81
crohns disease onset
usually 20-40s
82
ulcerative colitis onset
usually 30s
83
inflammatory bowel disease greatest incidence poplulation
developed countries and urban areas
| Jewish
84
risk factors for inflammatory bowel disease
- altered GI bacteria composition
- genetics
- cytokine dysregulation
- smoking (for crohns disease)
- nsaid and OC use
85
inflammatory bowel disease symptoms
```
abdominal pain
diarrhea
blood in stools
weight loss
fever
extraintestinal manifestations
```
86
gold standard for inflammatory bowel disease diagnosis
endoscopy with biopsies
87
labs to do when diagnosing IBD
```
cmp
cbc
crp
esr
fecal calprotectin
c.diff
stool culture
```
88
complications of crohn's disease
small bowel stricture and obstruction
fistulas
abscesses
intestinal cancer
89
complications of ulcerative colitis
- hemorrhoids, anal fissures
- perirectal abscesses
- toxic megacolon
- colonic stricture
- colorectal cancer
90
most commonly diagnosed GI condition
irritable bowel syndrome
91
Rome IV criteria for IBS
-recurrently abdominal pain (at least once weekly) with two or more of following
o related to defecation
o associated with change in stool frequency
o associated with change in stool appearance
92
typical symptoms of IBS
* diarrhea or constipation*
- bloating
- straining during defecation
- feelings of incomplete evacuation
93
IBS diagnosis
Rome IV criteria started at least 6 months prior and been present in last 3 months
94
IBS may be triggered by
- gastroenteritis
- food intolerances
- chronic stress
- diverticulitis
- surgery
95
IBS and serotonin
associated with an increase after meals in IBS with diarrhea
