Flashcards in Upper Gastrointestinal Tract Deck (91):
Name the two folds that make up the Pillars of Fauces.
Palatoglossal fold, and palatopharyngeal fold.
What's in the tonsilar fossa between the Pillars of Fauces?
Name the three pairs of salivary glands.
Parotid, submandibular, and sublingual.
Which salivary gland empties into the vestibule opposite the second upper molar?
How long is the parotid duct?
How long is the submandibular duct?
Which artery is enclosed in the parotid gland?
Which muscle does the parotid duct penetrate through to enter the vestibule?
Which nerve innervates the submandibular duct?
Where are the deep and superficial portions of the submandibular gland?
The superficial portion is below the mylohyoid muscle, and the deep portion curves round to extend above the mylohyoid muscle.
What is the opening of the submandibular duct into the oral cavity by the frenulum of the tongue called?
The sublingual papilla.
Where is the sublingual gland?
Immediately lateral to the submandibular duct, in the sublingual fossa against the medial surface of the mandible.
Where does saliva drain from sublingual duct into oral cavity?
Through minor sublingual ducts and occasionally through major sublingual duct which empties into oral cavity through sublingual papilla along with submandibular duct.
Which blood vessels supply the parotid gland?
The external carotid artery and external jugular vein.
Which blood vessels supply the submandibular and sublingual glands?
The facial and lingual arteries and veins.
Which lymph nodes do the salivary glands drain into?
The lymph nodes on and in parotid gland, and the cervical lymph nodes in the neck.
What innervates the parotid gland?
The glossopharyngeal (IX) nerve.
What innervates the submandibular and sublingual glands?
Parasympathetic facial nerve (VII)
What is the Pouch of Morrison?
The hepatorenal recess.
What is the deepest part of the abdominal cavity when someone is lying supine?
The hepatorenal recess - so any fluid will collect there.
What is the clinical significance of the bare area of the liver?
The liver is in direct contact with the diaphragm, so lymphatic vessels can flow from the liver through the diaphragm into the thorax, which is a potential path for the spread of cancer.
What is the name of the opening of the lesser sac below the portal triad in the hepatoduodenal ligament?
The foramen of Winslow (epiploic foramen). Think DAVE.
State the borders of the epiploic foramen (foramen of Winslow).
Anterior = hepatoduodenal ligament.
Posterior = peritoneum covering inferior vena cava.
Superior = peritoneum covering caudate lobe.
Inferior = peritoneum covering start of duodenum and hepatic artery.
Left lateral = gastrosplenic ligament, and splenorenal ligament.
How many segments are there in the liver?
Why are you more likely to get hepatosplenomegaly rather than just hepatomegaly?
The liver and spleen are related, they're both supplied by the coeliac trunk, and the splenic vein joins the superior mesenteric vein to form the hepatic portal vein. If the liver gate enlarged, the blood flow in it is restricted, which forces more blood "downstream" to the spleen.
What is the function of the gallbladder?
To store and concentrate bile.
Where does the gallbladder get its blood supply?
Cystic artery - a branch of the right hepatic artery.
What is the name of the circular muscle around the ampulla of Vater?
Sphincter of Oddi.
What is the name of the hepatopancreatic ampulla?
Ampulla of Vater.
What is the term for stones in the billiard tree?
To get a radiograph of cholelithiasis, where do you look?
The junction between L1 and the 12th rib (basically, next to L1).
In the liver, what are the cells in zone 1 called and what are their specialised functions?
Periportal cells - they receive blood which has the highest oxygen and nutrient content so are least vulnerable to ischaemia and cholestasis, and first to store glucose as glycogen and carry out glycogenolysis, but most vulnerable to viral infections.
They carry out oxidative functions like B oxidation of fatty acids, gluconeogenesis, and cholesterol synthesis.
In the liver, what are the cells in zone 3 called and what are their specialised functions?
Centrilobular or perivenous - they receive blood with the lowest oxygen and nutrient content because the hepatocytes lining the sinusoids have absorbed a lot. They are most vulnerable to ischaemia. and the problem is exacerbated by alcohol consumption.
They're last to regenerate, and first to start accumulating fat, but they're less vulnerable to toxins and an obstructed bile duct.
They function in glycolysis, ketogenesis, lipogenesis, cytochrome P450 based drug detoxification.
What do gastric parietal cells secrete?
Intrinsic factor (for absorption of vitamin B12 in the ileum), and protons and chloride ions into the cannaliculi to produce HCl.
What does somatostatin do?
It is secreted by D cells in the pancreas and inhibits the secretion of other pancreatic endocrine hormones e.g insulin and glucagon.
What does secretin do?
Secreted by the epithelial cells of the duodenum in response to gastric acid, it stimulates the secretion of pancreatic juice from the pancreas which contains bicarbonate to neutralise the acid.
Which cells secrete gastrin?
G cells in the antrum.
Which cells secrete histamine?
Which cells secrete 5-HT (serotonin), which stimulated vomiting?
What are paneth cells?
Antimicrobial cells in the crypts of Lieberkühn in the GI tract, just below the stem cells.
What is the function of the basal cells in the epithelium of the bronchi?
They're stem cells which divide to replace the pseudo stratified columnar cells lost by abrasion.
What is the function of the clara cells in the mucosa of the bronchi?
Non-mucous, and non-cilliated secreting cells, that secrete substances to protect the epithelium and detoxify harmful substances that have been inhaled.
What's the muco-cilary escalator?
It's the process in the trachea where the cilia of the epithelial cells beat to move mucous up the trachea into the mouth, so that harmful particles can be swallowed and digested in the stomach.
What are type 2 pneumocytes?
Roughly cuboidal, granular cells in the alveoli that secrete surfactant to stop alveoli collapsing.
What are type 1 pneumocytes?
Very flat epithelial cells with a large surface area that make up the majority of the alveolus, and gas exchange occurs across them.
Name the 5 regions of the stomach.
Cardia, fundus, body, antrum, pylorus.
What are the mucosal folds in the stomach called?
What is aspirin, and what is its side effect?
A COX inhibitor, which reduces the gastric mucosal barrier and so causes gastritis and ulceration due to its blockage of COX-1 and inhibition of prostaglandins production.
How does misoprostol decrease HCl secretion?
Inhibits adenylate cyclase to decrease intracellular cAMP and reduce proton pump activity.
What type of secretion is released by the parotid gland?
Serous (watery saliva)
Which lymph nodes do the salivary glands drain into?
Lymph nodes in and on parotid gland, and cervical lymph nodes in the neck.
At which vertebral levels does the oesophagus start and finish, and how long is it?
Starts at C6, finishes at T10, ~25cm long
What are the three anatomical constrictions of the oesophagus?
Pharyngo-oesophageal junction (skeletal muscle)
Trachea bifurcation (level T4/T5)
What is the clinical significance of the left atrium being directly anterior to the oesophagus?
You can do a transoesophageal echocardiogram, which has higher resolution and can look through the mitral valve.
What type of epithelium lines the mouth, oropharynx, laryngopharynx and oesophagus?
Non-keratinised stratified squamous epithelium.
What type of epithelium lines the stomach?
Simple columnar epithelium.
Why is there a colour change from pale pink to brighter red at the gastro-oesophageal junction?
The submucosal blood vessels are much closer to the surface when the epithelium is simple columnar than when it is stratified squamous (one layer of cells stead of several layers).
What is a Barrett's oesophagus?
The physiological gastro-oesophageal junction (where the epithelium changes from stratified squamous [pale pink] to simple columnar [brighter red]) moves upwards so that some of the epithelium of the oesophagus has changed to simple columnar. It is a complication of GORD and a precursor for cancer.
What is dyspepsia?
What is dysphagia?
What is McBurney's point?
1/3 of the way from anterior superior iliac spine to umbilicus - position of the vermiform appendix.
How far is it from the incisors to gastro-oesophageal junction?
Name the 5 regions of the stomach.
Cardia, fundus, body, antrum, pyloric canal.
Which lymph nodes does the stomach drain into?
Coeliac lymph nodes.
Name the branches of the coeliac artery.
Left gastric, splenic, common hepatic, hepatic, gastro-duodenal, right gastric, right gastro-epiploic, pancreatico-duodenal, left gastro-epiploic.
What is the name and purpose of the folds of mucosa formed when the stomach is empty?
Rugae, because the stomach has to be able to expand, and muscle can stretch but mucosa can't.
Where is the transpyloric plane and what does it cut through?
Half way between the suprasternal notch and the pubic symphysis (level L1/L2)
Cuts through: tip of 9th costal cartilage, fundus of gall bladder, pyloric sphincter, hila of kidneys, origin of superior mesenteric artery, neck of pancreas, end of spinal cord, origin of portal vein, duodenojejunal flexure.
How long is the duodenum?
What type of organ is the duodenum?
What are the 4 parts of the duodenum?
D1 = superior part next to pylorus (peritoneal)
D2 = descending part, containing major and minor duodenal papilla (retroperitoneal)
D3 = inferior part, longest section (retroperitoneal)
D4 = ascending part, terminates at duodenojejunal flexure
What is the name of the ligament binding the duodenojejunal flexure to the posterior wall?
Ligament of Treitz
Name the 5 parts of the pancreas.
Uncinate process, head, neck, body, tail
What are the four layers of the stomach wall?
Mucosa - simple columnar epithelium, lamina propria, muscularis mucosa
Submucosa - areolar connective tissue
Muscularis - inner oblique layer, middle circular layer, outer longitudinal layer
Serosa - areolar connective tissue and simple squamous epithelium
Name the five types of cells in the gastric glands.
Mucous neck cells
What are the three stages of gastric acid secretion?
Cephalic - stimulated by vagus nerve on sight, smell, taste of food
Gastric - stimulated by gastric release due to food in stomach
Intestinal - stimulated by chyme in duodenum
What is the function of cholecystokinin (CCK)?
It is secreted by the duodenum in response to chyme. It inhibits gastric acid production and gastric motility, stimulates secretion from gall bladder and pancreas, induces satiety.
What is the function of glucose-dependent insulinotropic polypeptide (GIP)?
It stimulates insulin secretion in response to glucose in the duodenum.
What is the difference between the pain felt from a stomach ulcer and the pain felt from a duodenal ulcer?
Stomach ulcer - pain felt minutes after eating
Duodenal ulcer - pain felt two to three hours after eating
Where in the stomach are chief cells and parietal cells primarily found?
What causes peptic ulcers?
Disruption of the protective barrier which allows acid in to damage tissue and prevent healing (healing requires pH>3)
How does heliobacter pylori cause peptic ulcers?
Bacteria produces urease, that induces inflammation (gastritis), inflammation disrupts the protective layer which allows acid to infiltrate the mucosa and cause ulcer.
What are H1 receptors involved in?
Nerve impulses to the CTZ
What are H2 receptors involved in?
Gastric acid secretion
What is Zollinger-Ellison syndrome?
A gastrin secreting tumour causing overproduction of gastrin and recurrent ulcers.
What are the 6 things involved in vomiting?
Relaxation of gastro-oesophageal sphincter
Intrinsic contractions of the intestine
Raised hyoid bone and larynx, and opened upper oesophageal sphincter
Epiglottis and palate shut off nasopharynx and laryngopharynx
Rhythmic contraction of abdominal muscles and diaphragm contracts
Which type of anti-emetic is best for treating chemotherapy-induced vomiting?
Which antiemetic often causes drowsiness?
Histamine receptor antagonists
Where is pain from the stomach referred to?
Where is pain from the small intestine referred to?
The peri-umbilical area
Where is pain from the large intestine referred to?