Upper GI Flashcards
(194 cards)
Gastrin1) where is it produced and by what cells?2) what is secretion stimulated by3) what inhibits secretion4) target cells5) response to hormone6) How does Omeprazole (PPIs) work
1) G cells in stomach ANTRUM2) amino acids, vagal input (acetylcholine), calcium, ETOH, antral distention, pH>3.03) pH
Somatostatin1) where is it produced and by what cells?2) what is secretion stimulated by3) target cells4) response to hormone5) How does Octreotide work and when to use
1) produced by D (somatostatin) cells in the stomach ANTRUM2) acid in duodenum3) many, it is the great inhibitor!4) inhibits gastrin and HCl release; inhibits release of insulin, glucagon, secretin and motilin. Decreases pancreatic and biliary output5) Somatostatin analogue. Can be used to decrease pancreatic fistula output
CCK1) where is it produced and by what cells?2) what is secretion stimulated by3) response to hormone
1) produced by I cells of the DUODENUM2) amino acids and fatty acid chains3) gallbladder contraction, relaxation of sphincter of Oddi, increases pancreatic enzyme secretion
Secretin1) where is it produced and by what cells?2) what is secretion stimulated by3) what inhibits secretion4) response to hormone
1) S cells of DUODENUM2) fat, bile, pH4.0, gastrin4) increased pancreatic HCO3- release, inhibits gastrin release (this is reversed in pts with gastrinoma), and inhibits HCl release-high pancreatic duct output-> increased HCO3-, decreased Cl–slow pancreatic duct output-> increased Cl-, decreased HCO3- (carbonic anhydrase in duct exchanges HCO3- for Cl-
Vasoactive intestinal peptide1) where is it produced and by what cells?2) what is secretion stimulated by3) response to hormone
1) produced by cells in gut and pancreas2) fat, acetylcholine3) increased intestinal secretion (water and electrolytes) and motility
Glucagon1) where is it produced and by what cells?2) what is secretion stimulated by3) what inhibits secretion4) response to hormone
1) mainly alpha cells of pancreas2) stimulated by decreased glucose, increased aa’s, acetylcholine3) inhibited by increased glucose, increased insulin, somatostatin4) glycogenolysis, gluconeogenesis, lipolysis, ketogenesis, decreased gastric acid secretion, decreased GI motility, relaxes sphincter of Oddi.
Insulin1) where is it produced and by what cells?2) what is secretion stimulated by3) what inhibits secretion4) response to hormone
1) beta cells of the pancreas2) glucose, glucagons, CCK3) somatostatin4) cellular glucose uptake, promotes protein synthesis
pancreatic polypeptide1) secreted by what cells?2) secretion stimulated by?3) response to hormone
1) islet cells in pancreas2) food, vagal stimulation, other GI hormones3) decreased pancreatic and gallbladder secretion
Motilin1) where is it produced and by what cells?2) what is secretion stimulated by3) what inhibits secretion4) response to hormone and what drug acts on it’s receptor to stimulate motility
1) intestinal cells of gut2) duodenal acid, food, vagus input3) somatostatin, secretin, pancreatic polypeptide, duodenal fat4) increased intestinal motility (small bowel, phase III peristalsis)-> erythromycin acts on this receptor
1) Bombesin (Gastrin-releasing peptide) actions2) Peptide YY- where is it released from and actions3) what organ mediates anorexia4) what is the order/timeframe of bowel recovery from surgery
1) increases intestinal motor activity, increases pancreatic enzyme secretion, increases gastric acid secretion2) released from terminal ileum following fatty meal-> inhibits acid secretion and stomach contraction, inhibits gallbladder contraction and pancreatic secretion3) hypothalamus4) Small bowel fnc returns within 24 hoursstomach in 48 hours and large bowel in 3-5 days
Esophagus anatomy1) layers of the esophageal wall2) muscle ina- upper 1/3 of esophagusb- middle and lower 2/3 of esophagus3) blood supply to cervical esophagus4) blood supply to thoracic esophagus5) blood supply to abdominal esophagus6) venous drainage
1) mucosa (squamous epithelium), submucosa, and muscularis propria (longitudinal muscle layer); NO serosa2) a- striated muscle; b-smooth muscle3) inferior thyroid artery4) vessels directly off the aorta5) left gastric and inferior phrenic arteries6) hemi-azygous and azygous veins in chest
Esophagus anatomy1) where do lymphatics drain2) where do the right and left vagus nerves travel and what do they supply3) where does the thoracic duct travel and insert4) MC site of esophageal perforation (usually with EGD)5) cause of aspiration with brainstem stroke
1) upper 2/3 drain cephalad; lower 1/3 caudad2) -Right vagus- travels on posterior stomach as it exits chest and becomes celiac plexus. Also has criminal nerve of Grassi which can cause persistently high acid levels postop if left undivided after vagotomy-Left vagus- travels on anterior stomach. goes to liver and biliary tree3) Travels from right to left at T4-5 as it ascends in the mediastinum. Inserts into left subclavian vein4) cricopharyngeus muscle5) failure of cricopharyngeus muscle to relax
Upper esophageal sphincter1) distance from incisors2) muscle3) nerve innervation4) normal EUS pressure at rest5) normal EUS pressure with food bolus
1) 15cm2) cricopharyngeus muscle (circular muscle, prevents air swallowing)3) recurrent laryngeal nerve4) 60 mmHg5) 15mmHg
Lower esophageal sphincter1) distance from incisors2) what is the resting state3) nl LES pressure at rest4) nl LES pressure with food bolus
1) 40cm2) normally contracted at resting state (prevents reflux). relaxation mediated by inhibitory neurons. Anatomic zone of high pressure but NOT an anatomic sphincter3) 15mmHg4) 0 mmHg
Anatomic areas of esophageal narrowing
at cricopharyngeus muscle, compression by the left mainstem bronchus at aortic arch, and diaphragm
Stages of swallowing1) what initiates it2) primary peristalsis- what initiates3) secondary peristalsis- what initiates4) Tertiary peristalsis5) resting state of UES and LES bw meals
1) CNS2) occurs with food bolus and swallow initiation3) occurs with incomplete emptying and esophageal distention, propagating waves4) non-propagating, non-peristalsing (dysfunctional)5) contracted
Swallowing mechanism
soft palate occludes nasopharynx, larynx rises and airway opening is blocked by epiglottis, cricopharyngeus relazes, pharyngeal traction moves food into esophagus.LES relaxes soon after initiation of swallow (vagus mediated)
Which side should you approach from in surgery for repair of1) cervical esphagus2) upper 2/3 thoracic esophagus3) lower 1/3 thoracic esophagus
1) left2) right (avoids aorta)3) left (left-sided course in this region)
Hiccoughs1) causes2) what nerves are part of the reflex arc
1) gastric distention, temperature changes, ETOH, tobacco2) vagus, phrenic, sympathetic chain T6-12
Esophageal dysfunction1) primary causes2) secondary causes3) best test for heartburn4) best test for dysphagia or odynophagia5) best test for meat impaction
1) achalasia, diffuse esophageal spasm, nutcracker esophagus2) GERD (most common), scleroderma3) endoscopy (can visualize esophagitis)4) barium swallow (better at picking up masses)5) endoscopy (dx and rx)
Pharyngoesophageal disorders1) In what part of swallowing is the prbm?2) causes3) T/F- liquids are worse than solids for these disorders4) Plummer-Vinson syndrome- components of syndrome and rx
1) trouble in transferring food from mouth to esophagus2) MC neuromuscular disease- myasthenia gravis, muscular dystrophy, stroke3) True4) upper esophageal web, Fe-deficient anemiarx- dilation, Fe; screen for oral CA
Esophageal Diverticula1) Zenker’s Diverticuluma- what causes itb- is it true or false diverticulumc- locationd-symptomse-dxf-rx
1) a) increased pressure during swallowing 2/2 failure of cricopharyngeus to relaxb) false diverticulum located posteriorlyc- between the pharyngeal constrictors and cricopharyngeusd- upper esophageal dysphagia, choking, halitosise- barium swallow studies, manometry, risk for perf with EGD and Zenker’sf-cricopharyngeal myotomy, Zenker’s itself can either be resected or suspended. L cervical incision-L cervical incision, leave drains in, get esophogram on POD#1
Esophageal Traction Diverticulum1) True or False diverticulum2) cause3) location4) sx5) rx
1) true diverticulum2) inflammation, granulomatous disease, tumor 3) usually in mid-esophagus and lies lateral4) regurgitation of undigested food, dysphagia5) excision and primary closure if symptomatic, may need palliative therapy (ie- XRT) if due to invasive CA. if asx, leave alone
Esophageal Epiphrenic diverticulum1) what disorders are associated2) location3) sx4) dx5) rx
1) esophageal motility disorders (ie-achalasia)2) in distal 10cm of esophagus3) most are asx. can have dysphagea and regurgitation4) esophagram and esophageal manometry5) rx- diverticulectomy and esophageal myotomy on the side opposite the diverticulum if sx