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3 Flashcards

1
Q

Which arteries innervate the foregut, midgut and hindgut?

A

Foregut – celiac artery

Midgut – superior mesenteric artery

Hindgut – inferior mesenteric artery

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2
Q

Which direction does the line of attachment of the ventral and dorsal mesogastrium swing to as the foregut develops

A

The line of attached of the ventral mesogastrium swings the R and forms the lesser curve and top of proximal duodenum.

The line of attachment of the dorsal mesogastrium swings to the L and forms the greater curve of the stomach and underside of the proximal duodenum.

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3
Q

Where does the ventral mesogastrium line of attachment run along?

A

Lesser curve of the stomach

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4
Q

Where does the dorsal mesogastrium line of attachment run along?

A

Greater curve of the stomach

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5
Q

Which section is the ascending and descending colon a part of?

A

Ascending colon – midgut
Descending colon – hindgut

2/3 of proximal transverse colon = midgut
1/3 of distal transverse colon = hindgut

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6
Q

List the accessory digestive organs

A

Teeth, tongue, salivary glands, liver, gallbladder and pancreas

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7
Q

What is the duodenum involved in breaking down mainly?

A

Proteins

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8
Q

What are Brunner’s glands and where are they located?

A

Produce mucus-rich alkaline secretion containing bicarbonate to neutralise stomach acid.

Duodenum (above the hepatopancreatic sphincter)

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9
Q

What are micelles?

A

Lipid molecules that arrange themselves in a spherical form in aqueous solutions.

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10
Q

What does the submucosa consist of?

A

Areolar connective tissue; has many blood and lymph vessels, submucosa plexus, glands

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11
Q

What are the 2 main types of nerves that are innervating the GIT?

A

Intrinsic (ENS) and extrinsic (ANS)

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12
Q

What does stimulating the parasympathetic system do in the GIT?

A

Increases GI secretions and motility by increasing enteric nervous system activity.

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13
Q

What kind of emotions may slow down digestion?

A

Anger, fear, anxiety

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14
Q

What lies between the layers of muscularis?

A

Myenteric plexus

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15
Q

What does the peritoneum consist of?

A

Simple squamous epithelium layer (mesothelium) with underlying supporting layer of areolar tissue.

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16
Q

What makes peritoneum different to pericardium and pleura?

A

Peritoneum is the largest serous membrane of the body.

It has folds that binds organs to each other and to walls of abdominal cavity.

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17
Q

What is the purpose of the folds of the peritoneum?

A

Mesentery and mesocolon – hold intestines loosely allowing muscular movements with contractions.

Protection from damage

Attaches organs to abdominal cavity.

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18
Q

What is the largest peritoneal fold called?

A

Greater omentum

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19
Q

What attaches the liver to the anterior abdominal wall and diaphragm?

A

Falciform ligament

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20
Q

What does the mesentery fold do?

A

Binds jejunum and ileum to posterior abdominal wall

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21
Q

List the 5 peritoneal folds.

A 
Greater omentum, 
Falciform ligament, 
Lesser omentum, 
Mesentery, 
Mesocolon
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22
Q

Which peritoneal fold binds the transverse colon and sigmoid colon to the posterior abdominal wall?

A

Mesocolon

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23
Q

Which peritoneal fold attaches the stomach, duodenum and transverse colon?

A

Greater omentum

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24
Q

How many layers does the greater omentum have?

A

4 layers because it doubles back onto itself

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25
Q

Where does the lesser omentum attach?

A

Stomach and duodenum to the liver.

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26
Q

What do the 4 muscles of the tongue with the prefix ‘–glossus’ do?

A

They are the extrinsic muscles that manoeuvre food for chewing, shaping into rounded mass and force food to back of mouth for swallowing.

Names:

  • Genioglossus
  • Hyoglossus
  • Styloglossus
  • Palatoglossus.
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27
Q

Which tongue muscles are used for speaking and swallowing?

A

Intrinsic

4 paired intrinsic muscles of the tongue originate and insert within the tongue, running along its length.

  • Superior longitudinal muscle
  • Inferior longitudinal muscle
  • Vertical muscle
  • Transverse muscle.
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28
Q

What type of epithelium does the oral mucosa have?

A

Thick stratified squamous

Needs to be thick because oral cavity lining is subjected to lots of wear and tear

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29
Q

What would happen if the salivary gland is occluded?

A

Painful enlargement of gland, infection can contract into the gland from oral cavity.

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30
Q

What are the vestibule and oral cavity?

A

Vestibule – space between lips and teeth

Oral cavity proper – behind teeth and gums to fauces (opening between oral cavity and throat)

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31
Q

Name the 3 types of salivary glands and say where they are found

A

Parotid– inferior and anterior to ears.

Submandibular – medial and inferior to body of mandible

Sublingual – under tongue and mylohyoid muscle

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32
Q

Which salivary gland consists of only serous acini?

A

Parotid

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33
Q

Which of the salivary glands are the largest? Where does its duct open into the mouth?

A

Parotid, parotid duct pierces buccinator muscle to open into vestibule (opposite upper 2nd maxillary molar)

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34
Q

Which salivary glands lie between (under) the tongue and mylohyoid muscle?

A

Sublingual

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35
Q

Are the submandibular or sublingual glands most superior and lateral?

A

Sublingual glands are superior and lateral to submandibular glands

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36
Q

What are the boundaries of the mouth? – roof, floor, lateral walls, anterior, posterior

A 
Roof – hard and soft palate 
Floor – mylohyoid muscle
Lateral walls – cheeks (buccinator muscles, connective tissue, mucous membrane, skin)
Anterior – labia
Posterior – palatoglossal folds
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37
Q

List the 4 muscles of mastication and their functions.

A

Temporalis – elevation and retraction of mandible
Masseter – elevation of mandible
Lateral pterygoid – protrusion and side-to-side movements of mandible
Medial pterygoid – elevation and side-to-side movements of mandible

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38
Q

What is the 5th muscle that is an accessory muscle of mastication?

A

Buccinator – accessory mastication muscle

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39
Q

What is the function of the motor neurons of the myenteric plexus?

A

Control gut motility

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40
Q

What is the function of the motor neurons of the submucosal plexus?

A

Control secretion

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41
Q

What are the 2 types of sensory neurons of the ENS of the GIT?

A

Chemoreceptors – responds to chemical changes in food within the lumen

Mechanoreceptors – activated when food distends the walls of GI organs

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42
Q

What is the function of the sensory neurons in the GIT?

A

Detect stimuli in the lumen

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43
Q

Where is the submucosal plexus found?

A

Within the submucosa

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44
Q

Where is the myenteric plexus found?

A

Between the longitudinal and circular smooth muscles of the muscularis layers.

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45
Q

What does parietal peritoneum line?

A

Walls of abdominal cavity

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46
Q

What does visceral peritoneum line?

A

Some of the organs in the cavity

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47
Q

Where does the peritoneal cavity lie relative to the parietal and visceral peritoneum?

A

Between them.

Contains lubricating serous fluid.

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48
Q

What are the 2 types of muscles of the tongue?

What is their function?

A

Extrinsic – move tongue side-to-side, in and out (manoeuvre food)

Intrinsic – alter shape and size (for speaking and swallowing)

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49
Q

Which nerve innervates the teeth and gums?

A

Maxillary nerve

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50
Q

Where does the oropharynx lie relative to the oral cavity?

A

Posterior to the oral cavity

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51
Q

What are the folds running off from either side of the uvula?

A

Anterior fold – palatoglossal fold

Posterior fold – palatopharyngeal fold

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52
Q

What is located between anterior (palatoglossal) and posterior (palatopharyngeal) folds?

A

Tonsillar fossa

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53
Q

What is the function of the uvula?

A

Prevents swallowed food from entering nasal cavity

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54
Q

What are the functions of the incisors, canines, premolars and molars?

A

Incisors – cut food
Canines – tear food
Premolars – crush and grind food
Molars – grind food

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55
Q

At which vertebral level does the pharynx end?

A

C6

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56
Q

Where does the oesophagus start and end relative to the vertebral levels?

A

C6 – start

T10 – end

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57
Q

Where does the oesophagus pierce the diaphragm?

A

T10

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58
Q

What is the narrowing where the pharynx and oesophagus meet called?

A

Pharyngo-oesophageal narrowing

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59
Q

What type of muscle is the upper and lower oesophageal sphincters made from?

A

Upper – skeletal

Lower – smooth

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60
Q

Which sphincter prevents gastro-oesophageal reflux?

A

Lower oesophageal sphincter

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61
Q

List the 3 anatomic constrictions of the oesophagus.

A

Pharyngo-oesophageal narrowing

Upper oesophageal sphincter

Lower oesophageal sphincter

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62
Q

What is the histological colour change at the gastro-oesophageal junction. And what causes it?

A

Pink to red

The blood vessels are closer to surface with a simple columnar layer and more further away with the pink stratified squamous epithelium.

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63
Q

Name the vertical lines that make up the 9 divisions of the abdominal regions

A

L and R midclavicular lines

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64
Q

Name the horizontal lines that make up the 9 divisions of the abdominal regions

A

Transpyloric plane

Transtubercular plane

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65
Q

The stomach is fixed proximally at the what?

A

Diaphragm

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66
Q

What is the distance from incisors to gastro-oesophagus junction?

A

40cm

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67
Q

What nerve supplies the stomach?

A
  1. Sympathetic fibres via splanchnic nerves and celiac ganglion supply blood vessels and musculature
  2. Parasympathetic fibres from the medulla travel in the gastric branches of the vagi
  3. Sensory vagal fibres – gastric secretion.
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68
Q

What nerve supplies the jejunum and ileum?

A

Lesser splanchnic nerves

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69
Q

What nerve supplies the gallbladder?

A

Celiac plexus supplies sympathetic innervation, the vagus nerve supplies parasympathetic innervation, and the right phrenic nerve conveys sensory information.

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70
Q

List the 4 functions of the stomach

A

 Mixes saliva, food, gastric juice to form chyme

 Secretes gastrin into blood

 Secretes gastric juice which contains HCl, pepsin, intrinsic factor

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71
Q

List 3 functions of the stomach

A

 Mixes saliva, food, gastric juice to form chyme

 Secretes gastrin into blood

 Secretes gastric juice which contains HCl, pepsin, intrinsic factor

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72
Q

What is the function of the ligament of Treitz?

A

Attaches the duodenojejunal flexure to the anterior wall

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73
Q

What is gastrin secreted by?

What is gastrin?

What function does it have?

A

Secreted by: G cells in the pyloric antrum (stomach), duodenum, pancreas

A peptide hormone that stimulates secretion of gastric acid (HCl) by the parietal cells of the stomach and aids in gastric motility.

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74
Q

Where does the pancreatic duct and common bile duct meet?

A

Hepatopancreatic ampulla

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75
Q

What does secretions from the pancreas and bile duct enter through into the duodenum?

A

Major duodenal papilla

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76
Q

What does secretions from the pancreas and bile duct enter through into the duodenum?

A

Major duodenal papilla

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77
Q

What is the uncinated process?

A

Hook-shaped projection/protuberance from a bone/organ.

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78
Q

What chemical gives pancreatic juice a slightly alkaline pH?

A

Sodium bicarbonate

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79
Q

How is white adipose tissue used for energy?

A

It’s moved to the liver, muscle and kidney.

The fat is turned into a ketone body which can be used by body cells and brain (only in starvation state).

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80
Q

Name the enzymes in pancreatic juice.

A

Pancreatic amylase, trypsin, chymotrypsin, caryboxypeptidase, andelastase, pancreatic lipase, ribonuclease, deoxyribonuclease

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81
Q

What does the Ventral Mesogastrium run along?

A

The lesser curve of the stomach

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82
Q

What is neovascularisation?

A

Formation of new blood vessels between adjacent blood vessels

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83
Q

What type of an ulcer causes pain to start about 2-3 hours after eating?

A

Duodenal ulcer

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84
Q

List the 4 muscles making up the abdominal wall.

A

Rectus abdominus, transverse abdominus, internal oblique, external oblique

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85
Q

What is the aponeurosis?

A

Layers of flat broad tendons with wide attachment area

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86
Q

What forms the inguinal ligament?

A band running from the pubic tubercle to the anterior superior iliac spine.

A

Inferior border by the external abdominal oblique aponeurosis and is continuous with the fascia lata of the thigh.

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87
Q

Which 2 muscles that make up the abdominal wall are at right angles to one another?

A

Internal and external oblique.

External (hands in pocket direction).

Internal (hips to medial linea alba)

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88
Q

Which 2 abdominal muscles are at right angles to one another?

A

Internal and external oblique.

External (hands in pocket direction).

Internal (hips to medial linea alba)

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89
Q

Which 4 abdominal muscles form the anterolateral abdominal wall?

A

External oblique, internal oblique, transverse abdominus, rectus abdominis, pyramidalis

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90
Q

Which abdominal muscle originates from the crest of pubis and pubic symphysis?

A

Transverse abdominus

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91
Q

Which abdominal muscle inserts are the costal cartilages 5-9 and xiphisternum?

A

Rectus abdominus

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92
Q

Is the rectus abdominus or the transverse abdominus most deep?

A

Transverse abdominus

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93
Q

Which abdominal muscle originates from the lumbar fascia, iliac crest, costal cartilages 7-12?

A

Transverse abdominus

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94
Q

What is the linea alba?

A

A fibrous structure that runs down the midline of the abdomen

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95
Q

At the level of the umbilicus how does the aponeurosis cover the rectus abdominus?

A

External oblique and ½ internal oblique pass anteriorly to the rectus abdominus and the other ½ f internal oblique and transverse abdominus passes posteriorly.

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96
Q

At the level of the umbilicus how does the aponeurosis cover the rectus abdominus?

A

External oblique and ½ internal oblique pass anteriorly to the rectus abdominus and the other ½ of internal oblique and transverse abdominus passes posteriorly.

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97
Q

Which arteries supply the rectus abdominus and what is their function?

A

Inferior and superior epigastric arteries; to increase the intra-abdominal pressure –> .allows defecation, depress ribs, supports intestines.

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98
Q

What double fold of the peritoneum attaches transverse and sigmoid colon to the posterior abdominal wall?

A

Mesocolon

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99
Q

What is the purpose of the hole in the anterolateral abdominal wall?

A

Allows the spermatic cords in men and round ligament in women to reach the testes/uterus by passing through the inguinal canal.

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100
Q

What passes through the deep inguinal ring, through the canal, out the superficial inguinal ring?

A

Spermatic cords – men

Round ligament of uterus- women

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101
Q

Why is the inguinal canal a point of weakness?

A

Pressure on this area of weakness can lead to a direct or indirect hernia. Indirect more common

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102
Q

What is fascia?

A

A band or sheet of connective tissue, beneath the skin that attaches, stabilises, encloses, and separates muscles and other internal organs.

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103
Q

What forms the deep inguinal ring?

A

Transverse abdominal muscle and fascia

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104
Q

What forms the superficial inguinal ring?

A

External oblique muscle

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105
Q

What forms the spermatic cord?

A

Ductus deferens, nerves, lymph and blood vessels

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106
Q

What double fold of the peritoneum attaches jejunum and ileum to the posterior abdominal wall?

A

Mesentery

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107
Q

Through which inguinal ring does the ductus deferens enter the inguinal canal?

A

Deep inguinal ring

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108
Q

What does the duodenum receive and where from?

A

Gastric chyme (stomach), pancreatic juice (pancreas), bile (liver)

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109
Q

Where does bile emulsify fats into micelles?

A

Duodenum

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110
Q

Where is iron absorbed?

A

Duodenum

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111
Q

Where are most nutrient absorbed?

A

Jejunum

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112
Q

How long is the large intestine?

A

5ft

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113
Q

How long is the large intestine?

A

5ft

152.4cm

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114
Q

Name the parts that makeup the LI in order.

A

Duodenum, jejunum, ileum

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115
Q

What is the ileocecal junction?

A

Where the ileum (SI) meets the caecum (LI).

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116
Q

What causes ulcer formation? – tongue, peptic, duodenal

A

Tongue – biting the tongue disrupts the lining which allows bacteria to get in and cause disruption of the underlying tissue.

Peptic – disruption of stomach lining allows bacteria to enter and disrupt underlying tissues

Duodenal – digestive tract

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117
Q

List the main regions of the stomach.

A

Cardia, fundus, body, antrum, pylorus

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118
Q

Which type of cells can be found in the cardia, pylorus and fundus?

A

Neck cells – mucus secretion

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119
Q

Which type of cells can be found in the fundus?

A

Parietal/oxyntic – produces HCL (activating pepsinogen) and IF

Chief cells – secretes proteolytic enzymes e.g. pepsinogen (precursor of pepsin)

Neck cells – mucus

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120
Q

Chief cells of the stomach produce pepsinogen and chymosin. What is chymosin also known as?

What is its role?

A

Chymosin, known also as rennin, is a proteolytic (protease) enzyme related to pepsin.

Its role in digestion is to curdle or coagulate milk in the stomach, a process of considerable importance in the very young animal.

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121
Q

Which type of cells in the stomach produces HCl?

A

Parietal cells

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122
Q

What do chief cells secrete?

A

Proteolytic enzymes

Pepsinogen + Chymosin

Pepsinogen is activated into pepsin when it comes in contact with HCl produced by gastric parietal cells.

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123
Q

What activates pepsinogen in the stomach?

A

HCl

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124
Q

What causes bleeding around a stomach ulcer?

A

Blood vessels around the ulcer base if degraded

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125
Q

What is immediately inferior to the fundus?

A

Body of the stomach

Makes up the bulk of stomach

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126
Q

What is the pyloric part of the stomach made up of?

A

Pyloric atrium – wider, more lateral part

Pyloric canal – narrow part

Pylorus and sphincter – distal sphincteric region, has thicker circular layer of smooth muscle that controls the discharge of contents through the pyloric orifice.

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127
Q

Which type of histamine receptors increases acid secretion and cardiac stimulation?

A

H2

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128
Q

Where can H3 receptors be found?

A

Myenteric plexus, presynaptic sites in the brain

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129
Q

What do H2 receptor antagonists do?

A

Block histamine receptors in the gastric mucosa, cardiac muscle, brain and mast cells.

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130
Q

What class are the following drugs: cimetidine, ranitidine, famotidine?

A

H2 receptor antagonist

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131
Q

Which type of histamine receptors are found in gastric mucosa, cardiac muscle, brain, smooth muscle, immune cells, myenteric plexus, endothelium of brain, and mast cells?

A 
Gastric mucosa – H2
Cardiac muscle – H2
Brain – H2
Smooth muscle – H1, H2
Immune cells – H4
Myenteric plexus in GIT– H3
Endothelium brain – H1
Mast cells – H2
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132
Q

Which anti-nausea medication has no effect on motion sickness?

A

5HT3 receptor antagonist

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133
Q

What is the action of PPIs?

A

Reduce H+ secretion from the parietal cells.

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134
Q

Which class of drug acts on parietal cells to reduce acid secretion?

A

PPIs

E.g. omeprazole, esomeprazole, pantoprazole

Indication: Acid reflux, stomach and duodenal ulcers

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135
Q

Is omeprazole reversible or irreversible?

A

Irreversible

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136
Q

What are canaliculi?

A

Microscopic canals

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137
Q

How can NSAIDs cause ulcer formation?

A

They inhibit prostaglandins which maintains the stomach lining by reducing gastric acid secretion and increasing mucus and HCO3- secretion

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138
Q

What is given with NSAIDs to prevent ulcer formation?

A

Misoprostol

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139
Q

What is misoprostol?

A

Synthetic analog of natural prostaglandin E1

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140
Q

What is the function of thromboxanes?

A

A vasoconstrictor and potent hypertensive agent, and it facilitates platelet aggregation

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141
Q

What is arachidonic acid?

A

Eicosanoic acid – saturated fatty acid with a 20-carbon chain

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142
Q

What happens in the body when the vomiting reflex is activated?

A

Contraction of diaphragm and abdominal muscles, lower oesophageal sphincter relaxation, stomach squeezed, antiperistalsis, closure of glottis, respiration stop

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143
Q

What do muscarinic receptor antagonists do?

A

Block ACh receptors

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144
Q

What is 5HT3 (hydroxytryptamine) used for?

A

Prevent chemotherapy and radiotherapy induced NandV by reducing activity of the vagus nerve

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145
Q

On inhalation and exhalation where does the liver move?

A

Inhalation – down below rib cage

Exhalation – as high as the 4th IC space

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146
Q

List the 6 main functions of the liver.

A

Nutrient metabolism, protein synthesis, storage, excretion, filters blood and phagocytosis

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147
Q

What are transaminase enzymes?

A

Enzymes that amino groups are transferred to. They transfer the amino group to a different keto-acid forming the amino acid corresponding to that keto-acid

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148
Q

What are the following: ALT, AST and glutamate aminotransferase?

A

Transaminases (enzymes)

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149
Q

What is carried from the liver and gallbladder to the duodenum?

A

Liver – bile salts and bilirubin

Gallbladder – bile (concentrated)

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150
Q

What are the 3 types of amino acids?

A

Essential – cannot be synthesised by the body

Semi-essential – can be synthesised in body, demand may exceed synthetic capacity under metabolic stress/trauma.

Nonessential – can be synthesised by transamination

151
Q

What does the cystic duct from gallbladder join to form the common bile duct?

A

Common hepatic duct

152
Q

Name some of the proteins synthesised by the liver.

A

Albumin, coagulation factors, complement factors, transferrin, protease inhibitors

153
Q

Adipose issues take up glucose and turn it into what?

A

Glycerol which binds to fatty acids –> triglycerides

154
Q

What 2 ducts anastomose to form the common hepatic duct from liver?

A

R and L hepatic ducts.

155
Q

What does the liver store?

A

Iron (ferritin), copper, vitamins A, B12, D, E, K, glycogen.

156
Q

What is the peritoneum divided into?

A

Greater and lesser peritoneal sacs.

The greater sac comprises most the peritoneal cavity. The lesser sac (also known as the omental bursa) is smaller and lies posterior to the stomach and lesser omentum.

157
Q

What does the liver excrete?

A

Bile salts, bilirubin

158
Q

What is the function of bile?

A

Helps SI digest fats and absorb fats, cholesterol, fat soluble vitamins.

159
Q

What does the liver filter the blood for?

A

Oestrogen, aldosterone, vasopressin, alcohol, amphetamines barbiturates, steroids.

160
Q

What does aldosterone do?

A

Hormone that acts mainly in the kidneys to aid in the conservation of sodium, secretion of potassium, water retention and to stabilize blood pressure.

161
Q

What is copper needed for in the body?

A

Copper works with iron to help the body form RBCs.

162
Q

What does vitamin K do in the body?

A

Important role in blood clotting

163
Q

What does vitamin B12 (cobalamin) do in the body?

A

Production of RNA and DNA. Works with B9 to make RBCs.

B9 - folate

164
Q

Which vessel(s) can be found in the perivenous end of a liver sinusoid?

A

Central vein

165
Q

Where is pain from gallstones referred to?

A

Right hypochondriac region

166
Q

What is hypercalcitoninemia associated with?

A

Low calcium levels

167
Q

Name the 4 semi-essential amino acids

A

Glutamine, arginine, glycine, proline

168
Q

Where does deamination take place?

A

Primarily in the liver, glutamate also deaminated in kidneys

169
Q

When does deamination occur?

A

If there is an excess of protein intake.

Amino acid is converted to ammonia.

170
Q

What’s the difference between deamination and transamination?

A

Deamination – removal of an amine group from molecule.

Transamination – release of amino group from amino acid

171
Q

What is cholelithiasis?

A

Presence of gallstones (concentrations that form in the biliary tract, usually in gallbladder)

172
Q

What is left when an amino group is removed from an aa?

A

Keto-acid

173
Q

What does the transaminase enzyme accept?

A

Amino group

174
Q

What does the transaminase enzyme transfer onto an acceptor?

A

Amino group

175
Q

Is biotransformation phase 1 or 2 of drug metabolism?

A

Phase 1

176
Q

Is synthesis phase 1 or 2 of drug metabolism?

A

Phase 2

177
Q

In immune damage to gastric parietal cells which intestinal secretion is affected?

A

HCl and intrinsic factor

178
Q

What is intrinsic factor?

A

A glycoprotein produced by the parietal cells of stomach. It’s necessary for absorption of vitamin B12 (cobalamin) later in the small intestine.

179
Q

What is pepsinogen?

A

A substance secreted by stomach wall and converted into the enzyme pepsin by gastric acid.

180
Q

What is secretin?

A

A hormone released into bloodstream by duodenum (especially in response to acidity) to stimulate secretion by the liver and pancreas. Inhibits gastric acid production.

181
Q

Which muscles retract the mandible?

A

Temporalis

182
Q

What is impedance?

A

Obstruction / opposition to passage or flow, as of an electric current or other form of energy.

The resistance in alternating current circuits.

183
Q

Which structure is normally bimanually palpable?

A

Kidneys

184
Q

Which structures does the transpyloric plane cut?

A

The pylorus of stomach, tips of 8th costal cartilages, lower border of 1st lumbar vertebra

185
Q

What does the gallbladder store?

A

Bile from the liver

186
Q

What is the function of bile?

A

Absorption of the fat-soluble substances (e.g. vitamins A, D, E, K).

Besides its digestive function, bile serves also as the route of excretion for bilirubin, a by-product of RBCs recycled by liver.

187
Q

What do you ballot?

A

Kidneys

188
Q

What happens in phase 1 of drug metabolism?

A

Biotransformation: oxidation, hydrolysis, hydroxylation, deamination. Involves cytochrome P350 enzymes.

189
Q

What is hypercalcaemia?

A

High calcium (Ca2+) level in the blood serum.

Major cause = overactive parathyroid glands (hyperparathyroidism).

190
Q

The parathyroid gland is the major control mechanism for what?

A

Parathyroid – calcium.

191
Q

What does the thyroid control?

A

Thyroid – metabolic rate, heart and digestive functions.

192
Q

Which muscles move the mandible side-to-side?

A

Lateral and medial pterygoid

193
Q

What muscles are found in the lateral walls of the oral cavity?

A

Buccinator

194
Q

Failure to re-absorb bile salts is caused by what?

A

Several gut-related problems, main 1 = chronic diarrhoea.

195
Q

Which nerve(s) innervate the muscles of mastication?

A

Branches of the mandibular nerve which is a branch of the trigeminal nerve

196
Q

What is the inside of the oral cavity lined by?

A

Mucous membrane, non-keratinised stratified squamous

197
Q

What effect will obstruction of the common bile duct have?

A

Bile builds up in liver and jaundice develops due to the increasing levels of bilirubin in the blood.

198
Q

What separated the oral cavity from the nasal cavity?

A

Front – hard palate and back – soft palate

199
Q

What are D2 receptor antagonists?

A

Examples include: chlorpromazine, metoclopramide

They bind to D2 dopamine receptors in the chemoreceptor trigger zone and competitively inhibits dopamine. Controls NandV.

200
Q

What is perphenazine?

A

D1 and D2 receptor antagonist.

Controls severe NandV in adults.

201
Q

What is ondansetron?

A

5-HT3 receptor antagonist.

Prevents NandV associated with chemotherapy and radiation.

202
Q

What do PPIs inhibit?

A

H+/K+-ATPase enzyme in gastric parietal cells and blocks final step in gastric acid secretion.

Treatment of peptic ulcers, benign gastric ulcers, heartburn, GERD.

203
Q

What do histamine receptor antagonists treat?

A

H1 R An – competitively inhibits H1 receptors in vomiting centre in the CTZ. Treats NandV and dizziness.

H2 R An – competitive H2 inhibitor at parietal cells  supresses normal secretion of gastric acid.

204
Q

Promethazine, cinnarizine and cyclizine are all examples of what?

A

H1 receptor antagonists. Treatment of N+V.

205
Q

Which classes of drug treat peptic ulcer diseases?

A

H2 R An – e.g. ranitidine

(PPIs) H+/K+-ATPase An – e.g. omeprazole, esomeprazole

Antacids – e.g. Mg trisilicate, gaviscon

206
Q

What is orlistat?

A

Lipase enzyme inhibitor.

Treats hyperlipidaemia.

207
Q

Where does absorption of most nutrients takes place in the intestines?

A

Jejunum

208
Q

Where does the external oblique originate and insert?

A

Origin – 8 digitations from inferior 8 ribs

Insertion – iliac crest, pubic tubercle, linea alba

209
Q

Which abdominal muscle originates from the lumbar fascia and iliac crest?

A

Internal oblique

210
Q

What is the difference between the duodenum, jejunum and ileum in terms of glands found and secretions.

A

Duodenum – Brunner’s glands – alkaline secretion to neutralise stomach acid, nutrients are broken down, fats –> micelles,

Jejunum – Lining specialised for absorption for the nutrients which were broken down in duodenum,

Ileum – Peyer’s patches – pathogens, lining secretes proteases carbohydrase enzymes

211
Q

What is the difference between the duodenum, jejunum and ileum in terms of diameter.

A

Duodenum – Larger than both jejunum and ileum

Jejunum – larger than ileum, plicae circularis and villi increase SA

Ileum – smaller diameter than ileum and duodenum

212
Q

What is the difference between the duodenum, jejunum and ileum in terms of, things absorbed.

A

Duodenum – Fe

Jejunum – Mg, most nutrients

Ileum – Vit B12

213
Q

Where in the intestines is Mg and most nutrients absorbed?

A

Jejunum

214
Q

Where in the intestines is vitamin B12 absorbed?

A

Ileum

215
Q

Where in the intestines is iron absorbed?

A

Duodenum

216
Q

What is the difference between the duodenum, jejunum and ileum in terms of blood supply.

A

Duodenum – coeliac trunk and superior mesenteric artery
Jejunum – superior mesenteric artery
Ileum – superior mesenteric artery

217
Q

What forms the rectus sheath?

A

By the aponeuroses of the 3 flat muscles (external oblique, internal oblique, transverse abdominis) and encloses rectus abdominis, and pyramidalis muscles.

218
Q

Where are Peyer’s patches found?

A

Ileum

219
Q

Function of Peyer’s patches

A

Fighting pathogens

Secreting proteases and carbohydrases enzymes

220
Q

What forms the anterior wall of the rectus sheath?

A

Aponeuroses of external oblique and ½ internal oblique

221
Q

What forms the posterior wall of the rectus sheath?

A

Aponeuroses of ½ internal oblique and transverse abdominus

222
Q

What is the arcuate line?

A

Area of transition between having a posterior wall and no posterior wall

223
Q

Where is the rectus abdominus directly in contact with the transversalis fascia?

A

Approx. midway between umbilicus and pubic symphysis; below the arcuate line

224
Q

Where does the submandibular and lesser sublingual gland ducts open into?

A

Both open into the floor of the mouth

225
Q

What are the phases of gastric secretion?

A

Cephalic – before food enters tract (stimulated by sight or smell of food due to stimulation of vagus nerve)

Gastric – food is in the stomach

Intestinal wave – food enters the intestines

226
Q

Which salivary glands secrete mostly mucous? What do they have?

A

Sublingual salivary glands.

They have mostly mucous acini and few serous acini.

227
Q

Which salivary glands secrete mostly serous but have a mucosa acini also?

A

Submandibular glands.

Have mostly serous acini and few mucosa acini.

228
Q

Which muscles elevate the mandible?

A

Temporalis, medial pterygoid, masseter

229
Q

What do the enteroendocrine cells of the stomach secrete?

A

Protein hormones such as VIP and somatostatin.

Gastrin is secreted from a type of these called G cells in the pyloric region of the stomach.

230
Q

Which muscles depress (protrusion) the mandible?

A

Lateral pterygoid

231
Q

Which cranial nerve innervates the muscles of mastication?

A

CNV

232
Q

Which artery supplies the masseter muscle?

A

Masseteric artery

233
Q

Which branches of the maxillary artery supplies the lateral pterygoid and medial pterygoid muscles?

A

Pterygoid branch

234
Q

Which artery supplies the temporalis muscle?

A

Deep temporal artery

235
Q

How long is the duodenum and list the 4 parts?

A

25cm

Superior, descending, inferior, ascending

236
Q

Which part of the duodenum has the major duodenal papilla?

A

Descending

237
Q

Which part of the duodenum is the ligament of Treitz found at?

A

Ascending

238
Q

What does intrinsic factor aid?

A

Absorption of vitamin B12

239
Q

How does H2 receptor stimulation lead to cardiac stimulation?

A

By the activation of adenylyl cyclase –> activates cAMP –> activates a protein kinase signalling cascade –> proton pump comes to surface of cell –> exchange H+ in to lumen for K+ out.

240
Q

What do H2 receptor antagonists cause?

A

Less stomach acid.

241
Q

Name all 4 receptors that can be targeted to reduce nausea and vomiting.

A

Muscarinic receptors

H1 receptors

5HT3 receptors - Ondasterone, Dolasetron

D2 receptors - Metoclopramide,

242
Q

Where liver is in direct contact with the diaphragm.

A

Caused by the folding of the coronary ligament giving an anterior and posterior ligament.

243
Q

How many surfaces does the liver have?

A

2, visceral and diaphragmatic

244
Q

What is the hepatorenal recess?

A

Deepest (lowest) part of the abdominal cavity where fluid will gather when the patient is in the supine position.

Lies between the R lobe of the liver, R kidney, and R colic flexure.

245
Q

What is the ligamentum teres?

A

The round ligament of the liver (or ligamentum teres, or ligamentum teres hepatis) is a degenerative string of tissue that exists in the free edge of the falciform ligament of the liver.

The round ligament divides the left part of the liver into medial and lateral sections.

246
Q

Superiorly what does the faliciform ligament split into?

A

The coronary ligament

247
Q

How many hepatic veins drain into inferior vena cava?

A

3 usually draining from the left, middle, and right parts of the liver

248
Q

What are the extra lobes on the R lobe of the liver?

A

Caudate (superior) and quadrate (inferior)

249
Q

What separates the caudate and quadrate lobes of the R lobe of the liver?

A

The porta hepatis

250
Q

Anatomically are the caudate and quadrate lobes on the L or R and why?

A

Left because they are supplied by the L hepatic artery

251
Q

What is in the porta hepatis?

A

Ducts, veins and arteries.

252
Q

In the porta hepatis what is the order of its contents as you move left and superiorly?

A

Ducts, artery, vein

253
Q

Does the hepatic artery enter or leave the liver?

A

Enter

254
Q

Does the hepatic portal vein enter or leave the liver?

A

Enter

255
Q

Does the hepatic vein enter or leave the liver?

A

Leave

256
Q

How many sections does the liver have?

A

8

257
Q

What is the function of the gallbladder?

A

Store and concentrate bile

258
Q

What is the function of the pancreas?

A

Secrete digestive enzymes into duodenum

259
Q

How does the superior mesenteric artery reach the liver?

A

Via the hepatic portal vein

260
Q

What is the function of the spleen?

A

Storage and breakdown of RBCs

261
Q

What does the breakdown of RBCs produce?

A

Bilirubin

262
Q

What makes the origin of the spleen different from other GI structures?

A

Spleen – mesodermal origin

Other GI structure – endoderm origin

263
Q

What is the diaphragmatic surface of the spleen in contact with?

A

Diaphragm and ribs 9-11 posteriorly.

264
Q

Where is pain from appendicitis referred to after inflammation has occurred?

A

Right iliac region

265
Q

Where is pain from kidney stones felt?

A

R and L lumbar regions

266
Q

Where are chylomicrons formed and why what?

A

In the ER of the absorptive cells (enterocytes) of the SI.

267
Q

What do alpha and beta pancreatic cells produce?

A

A – glucagon (increases blood glucose levels)

B – insulin (decreases blood glucose levels)

268
Q

What do Kupffer cells of the liver phagocytose?

A

Aged RBCs, WBCs and some bacteria.

269
Q

What is the function of lipoproteins?

A

Transport fatty acids, triglycerides, cholesterol to and from body cells in aqueous blood

270
Q

What is used to make bile salts?

A

Cholesterol

271
Q

Which cells synthesizes most plasma proteins?

A

Hepatocytes

272
Q

What is transamination?

A

Transfer of an amino group to a keto acid. It can convert essential amino acids to non-essential amino acids.

273
Q

How many essential amino acids are there?

A

9

274
Q

Where are bile acids absorbed and what happens once they are absorbed?

A

Bile salts (acids) are usually absorbed in the terminal ileum, taken up by the liver and re-secreted.

275
Q

What is the cofactor (a substance whose presence is essential for the activity of an enzyme) for transaminase enzymes?

A

Vitamin B6

Pantothenic acid

276
Q

What happens in phase 2 of drug metabolism?

A

Synthesis: conjugation with glycine, sulphate, glucuronic acid.

277
Q

What is the 1st pass effect?

A

On each liver pass a fraction of the drug is converted into inactive metabolites.

278
Q

Where are ammonia concentrations the highest and why?

A

Liver

As this is ammonia is produced.

279
Q

Sinusoids in liver drain fluid towards which structure?

A

Hepatic vein

280
Q

Where do hepatic veins carry blood to?

A

Inferior vena cava

281
Q

Where is pain from a stomach ulcer is referred?

A

Epigastric region

282
Q

Where is small bowel pain referred?

A

Umbilical region

283
Q

Which organ enlarges from the left hypochondrium towards the right iliac fossa?

A

Spleen

284
Q

What does aldosterone mediate?

A

It regulates electrocytes and blood pH

285
Q

High aldosterone causes what?

A

High aldosterone = water retention which increases blood vol which increases BP

286
Q

What is raised concentration of cortisol associated with?

A

Cushing’s syndrome

287
Q

What is Cushing’s syndrome?

A

Hypercortisolism – hormonal disorder caused by prolonged exposure of the body’s tissues to high levels of cortisol.

288
Q

What is conjugation?

A

Conjugation – attachment of an ionised group to the drug

289
Q

What is detoxification?

A

Detoxification – addition of another substance to drug/toxic substance to render it less effective (harmful).

290
Q

What does phase 2 of drug metabolism lead to?

A

More polar and less reactive metabolites.

291
Q

What are liver sinusoids lined with?

A

Primary liver cells (hepatocytes)

292
Q

From which artery does blood enter the liver lobule?

A

Hepatic artery – oxygen rich

293
Q

What is the ‘terminal hepatic venule end’ a.k.a?

A

Perivenous end

294
Q

Why is blood in the perivenous end oxygen deprived?

A

Because the blood has travelled along the sinusoids in the liver lobules which use up much of the oxygen.

295
Q

Is the periportal zone (1) or centrilobaular (perivenous) zone (3) affected greater during a time of ischaemia and why?

A

Centrilobaular (zone 3) because it has the poorest oxygenation.

296
Q

Which zone is most susceptible to viral hepatitis and why?

A

Zone 1 – periportal zone because it is nearest to the entering vascular supply.

297
Q

What are zone 1 hepatocytes specialised for?

A

Oxidative liver functions including:

  • Gluconeogenesis,
  • Beta oxidation of fatty acids
  • Cholesterol synthesis.
298
Q

Which type of hepatocytes are specialised for glycolysis, ketogenesis, lipogenesis and cytochrome P450 based drug detoxification reactions?

A

Centrilobaular zone 3 cells

299
Q

Summary of zone 1 and zone 3 hepatocyte functions.

A

1 - Gluconeogenesis, beta oxidation of fatty acids, cholesterol synthesis.

3 - Glycolysis, ketogenesis, lipogenesis and cytochrome P450 based drug detoxification reactions

300
Q

Which vessel(s) can be found in the periportal end of a liver sinusoid?

A

Portal venule and hepatic arteriole

301
Q

How is HCl secreted from gastric parietal cells?

A

As Cl- and H+

302
Q

Where is peristaltic waves observed in the stomach?

Note where the waves are more frequent.

A

Antrum (most propulsion occurs) < body < fundus

303
Q

When does retropulsion occur?

A

When food is too large to fit through the pyloric sphincter and is forced back to the body of stomach

304
Q

What is gastric emptying and how does it occur?

A

When food particles in chyme are small so they pass through the pyloric sphincter.

305
Q

What is somatostatin?

A

A hormone released from D-cells in stomach and duodenum in response to acid.

Inhibits gastric secretion.

306
Q

What is gastrin?

A

A hormone secreted by the stomach in response to food especially protein.

307
Q

What are villi in small intestines made from?

A

Goblet cells (secrete mucus), arteries, veins (go to the hepatic portal vein), lacteals (used in fat absorption).

308
Q

Why are proteases secreted as inactive precursors?

A

So, they don’t digest the digestive tract itself.

309
Q

What is glycaemic index?

A

Relative ability of carbohydrate food to increase blood glucose levels.

310
Q

What is resistant starch?

A

Starch that escape digestion in SI of healthy people.

311
Q

Where is alcohol absorbed?

A

20% - stomach

80% - small intestine

312
Q

Where are acids and bases absorbed?

A

Large intestine

313
Q

Name the fat-soluble vitamins.

A

A, D, E K

314
Q

What is emulsification and where does it occur?

A

Lipid is liquefied and emulsified into small droplets which increases the SA. In the mouth and stomach at 37 degrees.

315
Q

Where do micelles uptake into enterocytes occur?

A

Jejunum

316
Q

How are micelles formed?

A

Lipid droplets are mixed with amphipathic bile salts.

317
Q

What do chylomicrons exocytose into?

A

Lacteals which are like lymph ducts.

318
Q

What are chylomicrons?

A

Re-esterified lipids + apoproteins.

319
Q

What is steatorrhea and what causes it?

A

Presence of excess fat in faeces

Pancreatic insufficiency causes it (or not enough bile)

320
Q

How are bile salts absorbed?

A

They must be broken down in the ileum then 95% of the breakdown products are reabsorbed into lymphatics and transported back to liver to be remade and reused.

321
Q

What does omega 3 do?

A

Anti-inflammatory

Controls blood clotting

Build cell membranes in the brain

Normal growth and development

322
Q

What is a hepatic lobule?

A

A small division of the liver defined at the histological scale.

Anatomical liver lobes are not the same thing.

323
Q

What does omega 6 do?

A

Pro-inflammatory; brain functions, normal growth and dev

324
Q

What enzyme does pancreatic juice stop the action of?

A

Stomach acid

325
Q

Absorption of what substance may be most affected by disease of the terminal ileum?

A

Vitamin B12, bile salts

326
Q

What is ranitidine and how does it differ from omeprazole?

A

Randitdine – H2 receptor antagonist

Omeprazole – PPI

327
Q

Where are most lipids absorbed in the GIT?

A

Small intestines

328
Q

What is the taenia coli?

A

3 separate longitudinal ribbons of smooth muscle on the outside of the ascending, transverse, descending and sigmoid colons.

329
Q

What is the vermiform appendix?

A

A blind-ended tube connected to the cecum, from which it develops in the embryo.

330
Q

What is trypsinogen?

A

Precursor to trypsin (which is formed in the duodenum).

331
Q

What are Paneth cells?

A

In the SI, Paneth cells residing at bottom of intestinal crypts are the key effectors of innate mucosal defence.

332
Q

What are enterocytes?

A

Simple columnar epithelial cells found in the small intestine which are involved in digestion of molecules.

333
Q

The pancreas is the source of what?

A

Insulin, glucagon, proteases, pancreatic lipase, amylase, bicarbonate

334
Q

What would cause reduced formation of micelles?

A

Low bile salts

335
Q

What is the exogenous lipid transport pathway?

A

Dietary lipids are transported from the intestines to the liver through the blood and there their path ends.

336
Q

What is the endogenous lipid transport pathway?

A

Triglycerides and cholesterol produced in liver are transported to tissues where they are metabolised.

337
Q

What do apoproteins regulate?

A

Which lipoprotein is made

338
Q

How does the size of chylomicrons compare to that of other lipoproteins?

A

They are larger

339
Q

What are chylomicrons synthesised from?

A

Triglycerides, lipoproteins and apoproteins

340
Q

In the blood, what digests chylomicrons?

A

Lipoprotein lipase

341
Q

What can fatty acids be taken up by?

A

Adipose tissue, muscle cells.

342
Q

What are chylomicron remnants and what happens to them?

A

They are what’s left to chylomicrons after they’ve been metabolised. They bind to specific receptor (apoE) on liver cells and are endocytosed.

343
Q

Major reduction in lipase production is caused by what?

A

Pancreatitis

344
Q

Reduced formation of chylomicrons is caused by what?

A

Poor gut absorbance

345
Q

Where does protein digestion begin?

A

Stomach – HCl and pepsin

346
Q

Which are the main absorptive cells in the small intestines?

A

Enterocytes – simple columnar epithelial cells

347
Q

How is LPL (lipoprotein lipase) expression linked to insulin?

A

When there’s a spike of insulin (after eating) LPL is activated. Insulin upregulates LPL.

348
Q

List the stages in the endogenous pathway.

A

Triglycerides from liver to peripheral tissues.

VLDL > IDL > LDL forward cholesterol transport.

When cholesterol high LDL > HDL (reverse cholesterol transport).

349
Q

What are VLDL produced from?

A

From chylomicron remnants in the liver.

350
Q

What is the function of HDLs?

A

Transport cholesterol from tissues back to liver (turns into bile) when cholesterol is excess.

351
Q

What is forward cholesterol transport?

A

When cholesterol transported from liver to tissues

352
Q

What can be used to control hypercholesterolemia?

A

Statins, bile acid sequestrant, fibrates

353
Q

How do statins work?

A

Targets HMG CoA reductase enzymes and elevates HDL levels.

354
Q

How do bile acid sequestrant work?

A

Alters the amount of bile acid is secreted.

355
Q

How do fibrates work?

A

Alters lipoprotein catabolism to alter the levels of HDL and LDL in the body.

356
Q

Free fatty acids are produced and transported to the liver in which 2 stages?

A

Ketogenesis and beta-oxidation

357
Q

Describe the structure of white adipose tissue.

A

White – one big droplet.

358
Q

Describe the structure of brown adipose tissue.

A

Brown – multiple smaller lipid droplets (contain mitochondria)

359
Q

In chronic pancreatitis which intestinal secretion is affected?

A

Lipase production

360
Q

A raised concentration of what is associated with colicky abdominal pain?

A

Calcium

361
Q

Why is bile acid needed for action by lipases to occur on dietary fats?

A

Bile salts must emulsify the fats –> increase SA –> enhance lipase action.

Lipases degrade triacylglycerol –> monoacyglycerols, free fatty acids and glycerol –> taken up by intestinal epithelial cells.

362
Q

What responds to low calcium concentration?

A

Parathyroid hormone

363
Q

Removal of the gall bladder causes what?

A

Poor storage and concentration of bile salts.

364
Q

What is the peritoneum made up of?

A

A layer of mesothelium supported by a thin layer of connective tissue. It’s conduit for blood and lymphatic vessels, nerves of abdo organs.

365
Q

What happens to chylomicrons once they are absorbed by enterocytes?

A

Secreted through the basolateral membrane into the lacteals where the join lymph.

366
Q

What is a consequence of obstruction to the common bile duct?

A

Reduced formation of micelles.

367
Q

Where does the foregut run from?

A

Mid-oesophagus –> 2nd part of duodenum (ampulla of Vater)

368
Q

Where does the midgut from?

A

Ampulla of Vater –> 2/3rd transverse colon.

369
Q

What is the dentate line?

A

Embryology changes from endodermal –> ectodermal; it’s in rectum.

370
Q

Which arteries supply the foregut, midgut and hindgut?

A

Foregut – coeliac trunk

Midgut – superior mesenteric A.

Hindgut – inferior mesenteric A.

371
Q

Name all the intraperitoneal organs

A

Liver

Stomach

Spleen

First 5cm of duodenum

Jejunum

Ileum

Transverse colon

Appendix

Sigmoid colon

Upper 3rd of rectum

372
Q

Where does the hindgut end?

A

Point of the rectum known as the dentate line.

373
Q

Which nerves supply the foregut, midgut and hindgut?

A

Foregut – superior splanchnic

Midgut – lesser splanchnic

Hindgut – least splanchnic

374
Q

Name all retroperitoneal organs.

Organs that lie on posterior abdominal wall and are covered by peritoneum only = retroperitoneal.

A

Distal duodenum (most)

Caecum

Ascending colon

Descending colon

Pancreas

Kidneys

A (22 decks)

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