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hsf 3 exam 1 Flashcards

1
Q

what are the ONLY 2 ventral mesenteries?

A

lesser omentum and falciform ligament

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2
Q

what is the dorsal most part of the dorsal mesentery?

A

splenorenal ligament
contains the tail of the pancreas, making it the only part that is intraperitoneal

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3
Q

the transverse mesocolon…

A

fuses with the posterior layer of the GREATER omentum

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4
Q

lesser sac is between…

A

stomach and pancreas

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5
Q

the root of the mesentery proper begins at…

A

duodenal-jejunal flexure

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6
Q

what is significant about the ascending part of the duodenum?

A

it is secondarily retroperitoneal but not covered by peritoneum AT ALL

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7
Q

horizontal part of the duodenum begins at?

A

inferior duodenal flexure

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8
Q

what is significant about the genitofemoral n in females?

A

only sensory in females

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9
Q

what are the paired branches that come off the ab aorta?

A

lumbar, renal, gonadal, suprarenal, subcostal, and inferior phrenic

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10
Q

what are the main tributaries of the IVC?

A

common iliac, lumbar, renal, gonadal, and hepatic veins

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11
Q

what veins drain directly into the portal vein?

A

right and left gastric veins
cystic vein
superior pancreaticoduodenal vein
paraumbilical vein

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12
Q

what forms the portal vein?

A

splenic and superior mesenteric veins

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13
Q

what are the 4 portal-caval anastomoses?

A
  1. esophageal branches of L gastric v with veins in lower thoracic esophagus (esophageal varicosities)
  2. paraumbilical veins with superior and inferior epigastric veins; superficial epigastric veins –> external iliac and femoral veins (caput medusae)
  3. colic veins to retroperitoneal veins (veins of Retzius) –> drain into lumbar veins –> IVC (ascites)
  4. superior rectal veins with middle/inferior rectal veins (anorectal varicosities)
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14
Q

explain the peri-arterial plexus

A

postganglionic sympathetic fibers and preganglionic parasympathetic fibers travel via peri-arterial plexuses to target

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15
Q

explain visceral afferent innervation of the ab organs

A

foregut produces pain in epigastric region
midgut produces pain in periumbilical region
hindgut produces pain in the suprapubic and hypogastric region

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16
Q

explain sympathetic splanchnic nerves

A

carry preganglionic sympathetic fibers from SYMPATHETIC TRUNK to PREVERTEBRAL GANGLIA in PREVERTEBRAL PLEXUS, also carry visceral afferent fibers

thoracic, lumbar, and sacral splanchnic nerves

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17
Q

explain parasympathetic splanchnic nerves

A

carry preganglionic parasympathetic fibers from S2-S4 to lower part of prevertebral plexus (INFERIOR HYPOGASTRIC PLEXUS), synpase with ganglia in wall of target orgrans

pelvic splanchnic nerves

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18
Q

left sagittal fissure contains…

A

ligamentum teres (anterior)
ligamentum venosum and root of lesser omentum (posterior)

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19
Q

smooth muscle non-sphincter…

A

inhibits contraction by NE

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20
Q

how are the GI segments controlled?

A

skeletal muscle –> contraction by Ach, relaxation by Ach esterase (UES, external anal sphincter, upper 1/3 esophagus)

smooth muscle sphincter –> contraction by NE, relaxation by NO/VIP (LES, internal anal sphincter, oddi, pylorus, ileocecal)

smooth muscle non-sphincter –> contracted by Ach, relaxation by NO/VIP, NE inhibits contraction (these are used for mixing and peristalsis, bottom 2/3 of esophagus)

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21
Q

what is hirschprung disease?

A

absence of MYENTERIC plexus where there is an aganglionic section in the distal colon

cannot relax the internal anal sphincter, causing distention of sigmoid and descending colon

in newborns, seen when there is no first stool

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22
Q

how is VIP different from the other inhibitory neurotransmitters?

A

NE, ATP, NO decrease motility and secretions

VIP STIMULATES secretions, INHIBITS motility

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23
Q

Explain ECL cells

A

activated by stretch, releases serotonin, increase contraction and secretions

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24
Q

What is Carcinoid syndrome?

A

metastatic liver tumor induces FLUSHING, DIARRHEA/CRAMPS, and BRONCHOSPASM

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25
Explain D cells
activated by acid, secrete somatostatin, decrease gastric H+ secretion, pancreatic enzyme and bicarb secretion, and gallbladder contraction octreotide is a vasoconstrictor
26
Explain ECL-like cells
activated by vagal stimulation, releases histamine, increase gastric H+ secretion (give H2 blockers to decrease acid)
27
What is GERD?
when the LES is over-relaxed, which means the contents from the stomach can leak back into the esophagus and cause GI metaplasia of the lower esophagus (Barrett's esophagus) --> leads to adenocarcinoma factors that can cause GERD: eating close to bedtime and lying flat, often will say behind the sternum
28
what is achalasia?
when the LES is contracted and cannot relax, SMC peristalsis produces an obstruction of the esophagus which can lead to megaesophagus px might present inability to eat a lot, nausea, and BAD BREATH
29
Is the primary or secondary peristalsis of the esophagus affected by a vagotomy?
primary peristalsis will not occur after a vagotomy but secondary will
30
What is gastroparesis?
decreased gastric motility and emptying of the stomach in absence of obstruction in diabetes, this is due to reduced peristalsis from diabetic NEUROPATHY of GI tract px will feel sick after eating
31
What is dumping syndrome?
food moves too quickly from the stomach to the intestine cause ECF volume depletion and GI distress (nausea, vomiting, pain, bloating)
32
what factors stimulate or inhibit peristalsis?
stimulate = motilin, serotonin, gastrin, prostaglandins, CCK, and insulin i nhibit = epinephrine, glucagon, and secretin
33
what hormones inhibit motilin?
gastrin and cck
34
what are the different processes that are impaired by vagotomy?
- primary peristalsis of esophagus - ileocecal junction - receptive relaxation and accommodation of stomach - phase II of MMC for fasting - cephalic phase of gastric secretion
35
what type of stools are recommended?
types 3-5
36
what are the two ways to induce mass movement?
gastrocolic reflex = distension of stoamch from food duodenocolic reflex = distension of duodenum from chyme
37
what is the cue for defecation?
distention of rectum/rectal wall
38
what is the intestino-intestinal reflex?
if there is severe distention, then bowel activity is inhibited to prevent damage
39
what is Gilbert Syndrome?
mild decrease in UDP-glucuronosyltransferase young adult with stress bening, isolated increase in INDIRECT bilirubin
40
what is Crigler-Najjar Syndrome?
SEVERE decrease in UDP-glucuronsyltransferase NEONATAL increase in INDIRECT bilirubin risk of KERNICTERUS
41
what is Dubin-Johnson Syndrome?
defective hepatic EXCRETION of CONJUGATED/DIRECT bilirubin BLACK PIGMENTED LIVER, benign
42
what is Rotor Syndrome?
defective hepatic STORAGE of CONJUGATED bilirubin mild, benign jaundice, LIVER IS NOT BLACK
43
what is obstructive jaundrice
blockage of extrahepatic bile flow, increase CONJUGATED/DIRECT builirubin Causes: gallstones, strictures, and pancreatic tumors dark urine and pale stools
44
what is Sjogren syndrome?
autoimmune attack on exocrine glands that decrease tears and saliva causes xerostomia (dry mouth), dental caries (because there's less saliva, there is also less bicarb to neutralize the acid), difficulty swallowing (less saliva to moisten the food) xerostomia can be treated with pilocarpine (muscarinic agonist to increase saliva secretion)
45
what is autoimmune atrophic gastritis?
ab-mediated destruction PARIETAL CELLS --> decrease HCL and intrinsic factor --> leads to B12 deficiency --> pernicious anemia and neurological degeneration because B12 is important for DNA synthesis and myelination MACROCYTIC ANEMIA, can compensate with folate but not for long px may be vegan or vegetarian
46
what is the significance of PPI?
most effective inhibitor of PARIETAL CELLS (decrease HCl) --> bind IRREVERSIBLY to proton pumps
47
what does vomiting cause?
metabolic alkalosis
48
what is ECL inhibited by?
somatostatin
49
what is the strongest stimulus of the gastric phase?
ACh which is strongly inhibited by ATROPINE
50
explain gastric response to a meal
before meal = low pH --> increase somatostatin --> decrease gastrin --> decrease acid secretion early meal = food buffers H+ --> decrease somatostatin --> increase gastrin --> increase acid secretion (via ENS, vagal tone, and proteins) late meal = pH falls --> increase somatostatin --> decrease G cells, ECL, and parietal cells --> decrease acid secretion chyme in duodenum --> increase secretin and GIP --> inhibit G cells, parietal cells, and ECL
51
what weakens the mucus layer?
H. Pylori, aspirin, ethanol, and bile salts
52
what strengthens the mucus layer?
mucus, bicarb, gastrin, and prostaglandins
53
what is Zollinger-Ellison syndrome?
gastrin-secreting tumor (gastrinoma) that is usually located in PANCREAS, since tumor is outside of stomach, it's not exposed to paracrine regulation of somatostatin causes overgrowth of stomach mucosa and duodenal ulcers from gastric acid idiopathic of MEN1 (parathyroid, pituitary, pancreas)
54
what is celiac spruce/disease?
malabsorption syndrome that is caused by hypersensitivity to wheat, gluten, gliadin, resulting in autoimmune DESTRUCTION OF VILLI osmotic diarrhea because gluten and gliadin bind to water, retain it in the lumen, leads to diarrhea
55
what is ulcerative colitis?
IBD colon only, continuous lesions, crypt distortion, pseudo-polyps, loss of haustra starts at RECTUM and moves upwards
56
what is Crohn's disease?
IBD any part of GI segment, skip lesions, deep ulcers and fissures, fat-wrapping, cobble-stoning, thickened wall
57
give an example of secretory diarrhea
cholera and E. Coli --> irreversibly increase cAMP (unable to breakdown with PDE4) --> massive Cl and water secretion --> secretory diarrhea
58
give an example of osmotic diarrhea
celiac spruce, PEG, Mg
59
what is VIPoma?
pancreatic tumor that increases VIP (increases Ca2+ or CFTR --> increase Cl- release) and leads to watery diarrhea
60
what is the difference between osmotic and secretory diarrhea?
osmotic = when something there is something in the lumen that can't be absorbed and draws water secretory = secreting lots of Cl- into the lumen
61
what is hemochromatosis?
hepicidin gene mutation --> decrease hepcidin production --> increase ferroportin --> increase GI iron absorption leading to iron overload --> cirrhosis and BRONZE DIABETES labs: increased iron, ferritin, and transferrin sat (CLASSIC TRIAD) tx: serial phlebotomy
62
membrane digestion is used for...
carbs and proteins
63
what happens in someone with glucose-galactose malabsoprtion syndrome?
SGLT1 mutation, bloating, osmotic diarrhea CAN ONLY ABSORB FRUCTOSE ex: newborn with severe diarrhea
64
what is Fanconi-Bickel syndrome?
GLUT2 deficiency results in severe growth restriction CANT ABSORB SUGARS
65
why is PEPT1 important?
has poor specificity so is used in drug absorption for a variety of drugs
66
what can steatorrhea be seen with?
Zollinger-Ellison syndrome (inhibits pancreatic lipase), biliary obstruction/cholecystectomy (reduce bile), pancreatic insufficiency (no enzymes), or IBD (low SA)
67
what happens in ABCG inactivating mutations?
SITOSTEROLEMIA (absorption of plant sterols), hypercholesterolemia, tendon XANTHOMAS, CVD
68
what is the function of ezetimibe?
prevents cholesterol absorption inhibits NPC1L1
69
where each of the nutrients absorption in the SI?
iron and calcium in mainly duodenum and sometimes jejunum carbs in duodenum and jejunum protein and carbs through whole SI B12 and bile salts in distal ileum
70
what is important about CYP2E1?
it is induced by ethanol so it is important in people who drink heavily or frequently
71
what is Aflatoxin B1?
potent hepatocarcinogen contaminate grains and nuts grown or stored in humid contions NOT TOXIC UNLESS ACTIVATED BY CYP2A1
72
what are the functions of the different CYPs?
CYP2E1 --> ethanol metabolism and acetaminophen metabolism (--> NAPQI) CYP2D6 --> converts codeine into morphine (poor metabolizers = DO NOT experience sig analgesic effects from codeine, ultra rapid metabolizers need lower dose to achieve analgesic effect) CYP3A4 --> inhibited by grapefruit juice
73
what is ankyloglassia?
short frenulum aka tongue-tied
74
what is pyrosis?
regurgitation of stomach acid into distal esophagus from cardia of stomach
75
how does pyloric stenosis present?
projectile vomiting with NO BILE content and olive shaped mass pyloric sphincter formed by SOX9 and BMP4
76
how does annular pancreas present?
duodenal obstruction with projectile vomiting WITH BILE ventral and dorsal pancreatic buds form a ring around the duodenum
77
how might malrotation present?
first week --> duodenal obstruction with bilious vomiting recurrent ab pain, intestinal obstruction, malabsorption, diarrhea, solid food intolerance, common bile duct obstruction, ab distension
78
what is imperforate anus syndrome?
absence of misplaced anal opening or anal opening is very near vaginal opening no passage of 1st still in 24-48 hrs

Diana's Flashcards (16 decks)

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