GI MARTIN Flashcards
(198 cards)
1
Q
What are the two groups of organs in the digestive system?
A
GI tract/Alimentary canal
Acessory digestive organs
2
Q
What group of digestive system organs is a continous tube that extends from the mouth to the anus?
A
GI Tract/Alimentary Canal
Mouth
Pharynx
esophagus
stomach
small intestine
large intestine
3
Q
What group of organs make up the acessory digestive organs?
A
Teeth
tongue
salivary glands
liver
gallbladder
pancreas
4
Q
The abdomen is divided into what regions?
A
Intrathoracic
True abdomen
Retroperitoneal
5
Q
What organs are in the intrathoracic region?
A
Liver
Gallbladder
Spleen
Stomach
Transverse colon
6
Q
What organs are in the true abdomen?
A
Small intestines
Large intestines
Liver (lower)
Bladder
Female: uterus, fallopian tubes and ovaries
7
Q
What organs does the retroperitoneal abdomen contain?
A
Kidneys
Urters
Pancreas
Posterior Duodenum
Asc and Desc Colon
Inf Vena Cava
8
Q
What region lies behind the throacic and true abdominal regions?
A
Retroperitoneal
9
Q
What are the six basic functions of digestion?
A
Ingestion
Secretion
Mixing and propulsion
Digestion
Absorption
Defecation
10
Q
What function of digestion involves taking in food and liquid through the mouth?
A
Ingestion
11
Q
What GI function that produces water, acid, buffers and enzymes to aid in digestion?
A
Secretion
12
Q
What is the mixing and propulsion basic function of the GI system?
A
Smooth muscle contraction and relaxation, perastalsis, moving food along the GI tract
13
Q
What function is described as mechanical and chemical process that breaks down food?
A
Digestion
14
Q
Which function takes small molecules from digestion and used by cells?
A
Absorption
15
Q
Defecation is described as what?
A
elimination of materials not absorbed by our body ingestion
16
Q
What are the layers of the GI tract?
A
Mucosa
Submucosa
Muscularis
Serosa
17
Q
Which layer of the GI tract is the innermost lining and is in direct contact of substances passing through?
A
Mucosa
18
Q
Which layer of the GI tract contains skeletal muscles and smooth muscles?
A
Muscularis
19
Q
What layer of the GI tract is made up of areolar connective tissue that bind the mucosa to the muscularis and contains blood and lymph vessels which assist with food molecule absorbtion?
A
Submucosa
20
Q
What are the two layers of the serosa?
A
Visceral peritoneum
Parietal peritoneum
21
Q
Which layer of the serosa is the outermost layer around the organs of the GI tract??
A
Visceral
22
Q
Which layer of the serous lines the walls of the abdominal cavity?
A
Parietal peritoneum
23
Q
What are the other layers found in the visceral peritoneum?
A
Greater omentum
Mesentery
24
Q
Which part of the visceral peritoneum is described as the fatty apron and drapes over the transverse colon and small intestine?
A
Greater omentum
25
Which part of the visceral peritoneum binds the small intestine to the posterior abdominal wall?
Mesentery
26
What are the three pairs of the salivary glands that aid the GI tract?
Parotid
Submandibular
Sublingual
27
What enzyme begins the digestion of starches in the mouth?
Salivary amylase
28
Mucous is produced by salivary glands to do what?
lubricate food
29
Retro organs/structures:
S
A
D
P
U
C
K
E
R
S- suprarenal (adrenal) glands
A- aorta/inferior vena cava
D- duodenum (posterior)
P- pancreas
U- ureters
C- colon (asc/desc)
K- kidneys
E- esophagus
R- rectum
30
What type of tissue is the esophagus lines with?
Stratified squamous epithelium
31
What are the two sphincters at the ends of the esophagus?
Upper esophageal sphincter (UES)
Lower esophageal sphincter (LES)
32
Which esophageal sphincter is voluntary controlled?
UES
33
Which esophageal is involuntary controlled and may contribute to GERD if not function properly?
LES
34
What are the phases of swallowing?
Voluntary
Pharyngeal
Esophageal
35
Which phase of swallowing is when food is forced into the oropharynx by the tongue?
Voluntary
36
Which phase of swallowing begins when the bolus (food or water) is in the oropharynx?
Pharyngeal
37
What phase of swallowing is occuring when the bolus moves past the UES into the esophagus?
Esophageal
38
How is food pushed through the esophagus?
peristalsis
39
What is the j-shaped organ that serves as a reservoir and mixing chamber?
Stomach
40
What is the PH enviroment in the stomach?
Acidic
PH of 2 (1.5-3.5)
41
What is the sphincter at the tip of the duodenum where the stomach extends?
pyloric sphincter
42
The stomach can accommodate what volume of food or liquid?
6.4 liters
43
What are the four main regions of the stomach?
Cardia
Fundus (helmet)
Body
Pylorus
44
Gastric glands secrete what types of exocrine gland cells that combine to make gastric juice?
Mucous neck cells
Chief cells
Parietal cells
45
What does mucous neck cells secrete?
Mucous
46
What do chief cells secrete?
Pepsinogen, inactive gastric enzyme
47
What do parietal cells produce?
Hydrochloric acid and intrinsic factor
48
What converts pepsinogen to pepsin?
hydrochloric acid (HCL) from parietal cells
49
What is secreted that is involved in the absorption of vitamin B12?
Intrinsic factor
50
What cells secrete the hormone gastrin into the blood stream?
G cells
51
What is the major hormonal regulator of HCL secretion?
Gastrin
52
What is the term of the thick liquid in the stomach that is made up of gastric juices and macerated food particles?
Chyme
53
What organ in the digestion process has endocrine and exocrine function?
Pancreas
54
What are the specialized areas in the pancreas that contains alpha, beta and delta cells?
islets of Langerhans
55
What is the most common cell in the islets of Langerhans?
Beta Cells
56
What do beta cells produce?
Insulin
57
What is the hormone that is produced by alpha cells?
Glucagon
58
What is glucagon's role in the body?
Prevent blood glucose levels from dropping too low
59
What ducts does pancreatic juice go through and combine with to form the hepatopancreatic duct?
pancreatic duct
common bile duct
60
What sphincter does the common bile duct pass through to the duodenum?
Sphincter of Oddi
61
What is the clear, colorless liquid that is made up of enzymes with a pH of 7.1-8.2 and contains mostly water, salts and sodium bicarbonate?
Pancreatic juice
62
What enzymes are located in pancreatic juice?
Trypsin
Chymotrypsin
Pancreatic amylase
Pancreatic lipase
Ribonuclease
63
Trypsin and chymotrypsin are responsible for what?
Protein digestion
64
Proteins are broken down into what by trypsin and chymotrypsin?
amino acids, dipeptides and tripeptides
65
Pancreatic amylase digests what?
Starches or carbohydrates
66
Carbs are broken down into what by pancreatic amylase?
monosaccharides
67
Pancreatic lipase is responsible for digestion of what?
Triglycerides or fat
68
Fats are broken down by pancreatic lipase into what?
monoglycerides and fatty acids
69
Ribonuclease digest what?
nucleic acid
70
What is the second largest organ in the body below the diaphragm?
Liver
71
The liver is responsible for what?
Carbohydrate metabolism
Lipid metabolism
Protein metabolism
Process drugs and hormones
Excrete bilirubin
Store vitamins and minerals
Activate vitamin d
72
What in the liver is responsible for metabolic, secretory and endocrine functions?
Hepatocytes
73
What is the chemical responsible for the brown color of human feces?
stercobilin
74
What is the pear-shaped sac that hands from the inferior margin of the liver?
Gallbladder
75
What is the function of the gallbladder?
stores bile
aids in chemical digestion
76
The left and right hepatic ducts transfer bile and waste into what structure?
common hepatic duct
77
The cystic duct transfer bile from the gallbladder and joins the common hepatic duct to form what structure?
common bile duct
78
The common bile duct and the pancreatic duct combine to form what structure?
hepatopancreatic duct
79
the hepatopancreatic duct passes through the sphincter of Oddi into what structure?
duodenum
80
The small intestinal glands contain what 3 types of endocrine cells?
S
CCK
K
81
What do S cells secrete that stimulates secretion of pancreatic juice?
Secretin
82
What do CCK cells secrete?
Cholecystokinin
83
Cholecystokinin does what?
regulates gastric emptying
stimulates bile and pancreatic juice secretion
relaxation of the sphincter of oddi
feeling of satiety (feeling full to satisfaction)
84
What is secreted by K cells that stimulates the release of insulin?
Glucose-dependent insulinotropic peptide (GIP)
85
What are three segments of the small intestine?
Duodenum
Jejunum
Illeum
86
What is the landmark located on the duodenum that demarcates upper and lower GI in relation to bleeds?
ligament of trietz
87
What does the duodenum attach to?
pyloric sphincter of the stomach
88
What is the middle section of the small intestine that primary function is the absorption of sugars, amino acids and fatty acids?
Jejunum
89
What segment of the small intestine attaches to the large intestine via the ilececal sphincter and absorbs the remaining nutrients, B12 and bile salts?
Ileum
90
Where are bile salts recycled from the ileum to for reuse?
Liver and gallbladder
91
What are the two types of digestion
Mechanical
Chemical
92
Mechanical digestion consist of what?
segmentation and peristalsis
93
Chemical digestion is performed via what?
Pancreatic enzymes, bile and intestinal juice
94
Absorption of nutrients into their simplest form is done by what?
microvilli and villi of GI Tract
95
What is the last part of the GI tract?
Large intestine
96
What are the four regions of the large intestine?
Cecum
Colon
Rectum
Anal canal
97
What is the first segment of the large intestine where the appendix attaches?
Cecum
98
What region is broken down into ascending, transverse, descending and sigmoid portions?
Colon
99
What region of the large intestine connects the sigmoid colon to the anus?
Rectum
100
What is the last 2-3 cm of the rectum which consists of internal and external sphincters?
Anal canal
101
Which anal canal sphincter is voluntarily controlled?
External
102
What are the three phases of digestion?
Cephalic
Gastric
Intestinal
103
What phase of digestion involves the smell, sight and sound or thought of food that activates neural centers in the brain to stimulate salivary glands and gastric glands?
Cephalic
104
What phase of digestion starts when food enters the stomach?
Gastric
105
What is released when food enters the stomach during the gastric phase?
Gastrin
106
What does gastrin do when it is secreted?
Promotes the release of gastric juice
Relaxes the pyloric sphincter
Promotes gastric emptying
107
What phase of digestion starts when food enters the small intestine?
Intestinal
108
What occurs during the intestinal phase of digestion?
Gastric emptying is slowed and pancreatic juices are secreted for absorption and digestion
109
What topics should be focused on during the HPI?
Abdominal Pain
Indigestion
Nausea and vomiting
Diarrhea
Constipation
Fecal incontinence
Jaundice
Dysuria
Urinary frequency or incontinence
Hematurua
Past medical or surgical history
Family history
Personal and social history
110
Persistent pencil like stool may indicate what?
Stenosis from scarring or malignancy
111
LIght tan/gray stools means what?
Obstructive jaundice
112
Tarry black stool indicates what?
Upper GI bleed
113
Bright red blood in stool indicates what?
Lower GI bleed
114
What are the two classifications of diarrhea?
Acute
Chronic
115
Diarrhea <2 weeks is commonly caused by what?
infectious agents
bacterial toxins
116
What is the prime absorptive surface for the GI Tract?
small intestine
117
Acute gastroenteritis is usually caused by what?
Infectious agents
118
Chronic diarrheal illness are classified as?
Osmotic
Inflammatory
Secretory
Chronic infection
Malabsorption
Motility disorders
119
Osmotic chronic diarrheal illness are from what?
increase in osmotic load by excessive intake or diminished absorption
120
What are some examples that can cause osmotic chronic diarrheal illness?
Medications
Zollinger-Ellison Syndrome
121
What chronic diarrheal illness is present when the mucousal lining of the intestine is inflammed?
inflammatory
122
What are some examples of causes for inflammatory diarrheal illnesses?
Inflammatory bowel disease
malignancy
123
Secretory chronic diarrheal illness occur due to what?
increased secretory activity occurs
124
What is an example of a chronic infections and parasite that can cause chronic diarrhea?
Giardia Lamblia
125
What are examples of malabsorption syndromes that can cause chronic diarrheal illness?
Celiac disease
Whipple
Crohn disease
Lactose intolerance
126
What is an example of a motility disorder than can cause chronic diarrheal illness?
Irritable bowel syndrome
127
Acute infectious diarrhea can be classified into what two types?
inflammatory and non inflammatory
128
Inflammatory acute infectious diarrhea will have what symptoms that are not present in non-inflammatory diarrhea?
Bloody diarrhea
129
Inflammatory diarrhea suggest colonic involvement by what?
invasive bacteria
parasites
toxin production
130
What are the typical complaints of an infectious inflammatory diarrhea patient?
bloody, small-volume stools
fever
abdominal cramps
tenesmus
fecal urgency
131
What are common causes of inflammatory diarrhea?
shigella
salmonella
Escherichia coli
E coli O157:H7
132
acute non inflammatory diarrhea is generally milder and caused by virus or toxins that interfere with what?
salt and water balance
133
What are common causes of acute non inflammatory diarrhea?
Virus
- rotavirus
- norwalk virus
- vibrions
Enterotoxin-producing e. coli
food borne agents
Protozoal
134
A toxin that has a short incubation period, 1 -6 hrs post consumption, is usually
preformed
135
What conditions warrant evacuation for a patient with diarrhea?
Signs of inflammatory diarrhea
-fever
-bloody
-abdominal pain
Six or more unformed stools in 24 hrs
Profuse water diarrhea or s/s of dehydration
136
Peritoneal findings for a patient with diarrhea may be present in what conditions?
C difficile
enterohemorrhagic E coli.
137
When is hospitalization required for a diarrhea patient?
Severe dehydration
toxicity
marked abdominal pain
138
Treatment for diarrhea includes?
Rehydration
Diet
Antidiarrheal Agents
139
What are examples of antidiarrheal agents?
Loperamide
Bismuth Subsalicylate
Empiric Antibiotic therapy
140
What is the condition in which there is histologic evidence of inflammation of the epithelial or endothelial of the stomach?
Gastritis
141
What are the three categories of gastritis?
Erosive and hemorrhagic
Nonerosive and nonspecific
Specific types?
142
Erosive and hemorrhagic gastritis or gastopathy are typically diagnosed how?
Endoscopy
143
Erosive and hemorrhagic gastritis is commonly found in what patients?
Alcoholics
Critically Ill
NSAID users
144
Erosive and hemorrhagic gastritis presents asymptomatically but may cause what sxs?
epigastric pain
Nausea
Vomiting
Hematemesis (usually nonspecific)
145
Treatment of erosive or hemorrhagic gastritis includes what? NSAID? Alcohol?
NSAID
-d/c, reduce or give with meals
-PPI 2-4 weeks
Alcohol
-d/c alcohol
-H2 receptor antagonist, PPI
146
What is the most common digestive complaint in the US?
Constipation
147
What are some multifactorial causes of constipation?
Decreased fiber and fluid intake
Systemic disease
Medications
Structural abnormalities
Slow colonic transit
IBS
Hirschsprung disease
148
What are some systemic diseases that can cause constipation?
hypothyroidism
hyperparathyroidism
diabetes
chronic neurologic disorders
149
What medications may cause constipation?
Calcium channel blockers
iron
narcotic analgesics
antipsychotics
150
What are some structural abnormalities that can cause constipation?
Colonic mass w/ obstruction
Neoplasm (adenocarcinoma)
Anal fissure
151
Slow colonic transit is often found in what patients?
chronic laxative abuse
psychogenic or idiopathic
152
Symptoms of constipation include what?
Infrequent stool
excessive straining
sense of incomplete evacuation
need for digital manipulation
153
What type of imaging would you want for a patient complaining of constipation?
upright chest
abdominal flat and erect
154
What are the lines of treatment for a constipation patient?
1st-lifestyle
2nd-stool softening or laxative
3rd-suppositories or enema
4th-fecal disimpaction
155
What lifestyle changes would you make for someone with constipation?
increase water
increase fiber
strict dietary changes
exercise regimen
156
Fiber supplementation generally takes how long to become effective?
7-10 days
157
What emollient is used for constipation?
Docusate sodium 100mg BID
158
What stimulant is used for constipation?
Bisacodyl 5-15mg QD or 10 PR TID
159
What are the saline laxatives used for constipation?
Magnesium hydroxide 15-30ml QD
Magnesium citrate 100-300ml QD-BID
160
What suppository may be given for constipation?
glycerin PR QD
161
Complicated or chronic cases of constipation should have what disposition?
Refer to gastroenterologist
162
What are the two types of hemorrhoids?
Internal
External
163
Hemorrhoids located above the dentate line are what?
Internal hemorrhoids
164
Which type of hemorrhoid has nervous innervation?
External hemorrhoids
165
What contributes to a water tight closure of the anal canal and are present universally unless a previous intervention has taken place?
Hemorrhoidal venous cushions
166
What are the common locations for internal hemorrhoids to occur?
right anterior
right posterior
left lateral
167
What causes hemorrhoids?
Straining
constipation
prolonged sitting
pregnancy
obesity
low fiber diets
168
Thrombosis of the external hemorrhoidal plexus results in what?
perianal hematoma
169
What type of pain is common with external hemorrhoid?
most severe within the first few hours but gradually eases over 2-3 days as edema subsides
170
How many stages of internal hemorrhoids are there?
Four
171
What are the four stages of internal hemorrhoids?
Stage I - confined to the anal canal
Stage II - gradually enlarged, may protrude from canal, reduces spontaneously
Stage III - Prolapsed, may require manual reduction post BM
Stage IV - Chronically protruding, unresponsive to manual reduction
172
What imaging would you get on a patient with hemorrhoids?
Colonoscopy for disease or sigmoid colon misinterpretation if bleeding is noted
173
What is the treatment of hemorrhoids?
Warm sitz bath
Analgesic and oinments
I&D hematoma
Lifestyle changes S-I and S-II
174
What is the definitive treatment of internal hemorrhoids?
surgical banding
175
What are anal fissures?
linear or rocket shaped ulcers usually <5mm in length
176
Anal fissures most commonly occur where?
posterior midline, 10% anteriorly
177
An anal fissure off of the midline may indicate what?
Serious disease or sexual assault
178
What are some chief complaints of a patient with anal fissures?
Severe, tearing pain during defecation followed by throbbing discomfort
179
What is the treatment plan for anal fissures?
Fiber
Sitz baths
Topical anesthetics
Oral analgesics
topical nitroglycerin/diltiazem/Botox (chronic)
180
What are the spaces where an anorectal abscess may form?
Perianal
intersphincteric space
ischiorectal space
deep post anal space
supralevator or pelvirectal space
181
What is the most common location for an anorectal abscess?
perianal
182
What is the least occurring location for an anorectal abscess?
supralevator
183
What may form in addition to an anorectal abscess as a common chronic sequela?
Fistula
184
What is the symptoms described by patients with anorectal abscess?
pain becomes worse immediately before BM, lessened after BM and persists between BM
185
Which abscess are easily palpable and are usually not accompanied by fever, leukocytosis and sepsis?
perianal abscess
186
What type of incision is recommended for a perianal abscess to prevent premature closure?
cruciate or elliptical
187
Broad spectrum antibiotics are given to anorectal abscess that have what symptoms?
fever
leukocytosis
valvular heart disease
cellulitis
188
What is the chronic manifestation of the acute perirectal process that forms an anal abscess?
anorectal fistula
189
What are the causes of a pilonidal abscess?
hair containing cysts
sinuses
staphylococcus aureas through ingrown hair
190
H pylori gastritis may be treated with what?
Triple or quadruple drug regimen BID x 2 weeks
191
What is the triple or quadruple drug regimen for H pylori gastritis?
PPI, AMOX, clarithromycin
PPI, Levofloxacin, AMOX
Metronidazole for AMOX if PCN allergy exists
192
What are the two types of inflammatory bowel disease?
Ulcerative colitis
Crohn's disease
193
What type of IBD is limited to the colonic mucosa?
Ulcerative colitis
194
Which type of IBD can affect any segment of the GI tract from mouth to anus and has transmural inflammation??
Crohn's disease
195
What are extra-intestinal manifestations of crohn's and UC?
Erythema nodosum, pyoderma gangrenosum, thromboembolic events
196
What is a extra-intestinal manifestation of only crohn's disease?
Oral ulcers, anorectal disease
197
what are extra-intestinal manifestations of UC only?
peripheral arthritis, spondylitis, episcleritis, uveitis, hepatitis and sclerosing cholangitis
198
What is the most common portion of the GI tract affected by Crohn's
terminal ilium
