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Catch Up > 5/26 > Flashcards

5/26 Flashcards

1
Q

Portal Vein

A
  • Formed by junction of splenic and SMA, also recieves blood from IMA
  • Drains into liver and supplies oxygen and nutrients
  • Generally maintains a higher BP than most veins
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2
Q

Porto-Caval Anastamoses

A
  • In portal hypertension will enlarge to drain blood
  • Superior and inferior rectal give hemerroids
  • Left gastric and esophageal give varicies
  • Periumbilical veins give caput medusa (inferior and superior epigastric)
  • Retroperitoneal around kidney and liver
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3
Q

Esophageal Varicies

A
  • Treat with beta blockers

- TIPS can be used (portocaval shunt in liver)

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4
Q

Portocaval shunt

A

Most commonly with Splenic vein and left renal vein

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5
Q

Budd Chiari

A

Thombosis of hepatic artery

  • Often due to polycythemia
  • Cause acute onset portal backup
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6
Q

Kidney

A

Ascends from sacral region

-Horeshoe can be trapped on IMA

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7
Q

Ureter

A

Mucular and innervated by PANS

  • 3 tight spots
  • At ureteropelvic junction
  • As it crosses anteriorly to the common illiac
  • As it flows into the bladder
  • Also passes under gonadal veins (Water under the bridge)
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8
Q

Adrenals

A
  • Sit atop kidneys
  • Superior suprarenal artery from phrenic
  • Middle suprarenal directly off aorta
  • Inferior suprarenal from renal
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9
Q

Embryo

A

Mesenephros: contributes to the mesonephric duct and ureteric bud

  • Ureteric bud become collecting system. UReter to collecting ducts
  • Glomerulus from metenephric mesoderm
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10
Q

Aorta

A

-Runs through diaphragm at T12 with thoracic duct and azygous vein
-Phrenic
-Renal
-Suprarenal
Lumbar
Median sacral
ureteric
gonadal
-Bifurcates into common illiacs at L4

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11
Q

IVC

A

Runs on right side of aorta

-Crosses diaphragm through central tendon at T8

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12
Q

Thoracic DUct

A

Just posterior and to the right of the aorta

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13
Q

Preaortic Nodes

A

Collect Lymph from GI

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14
Q

Paraaortic

A

COllect lymph from gonads etc

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15
Q

Femoral Nerve

A

L2-L4

  • Controls knee extensors and some hip flexion also skin on anterior and lateral leg
  • Runs through the femoral triangel, outside the femoral sheath lateral to the artery and nerve
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16
Q

Paravertebral Ganglia

A

Sympathetic chains

-Carry preganglionic SANS

17
Q

Prevertebral Ganglia

A

-Plexuses that carry cell bodies of post ganglionic SANS

18
Q

Electron Acceptors

A

NAD and NADPH, use B3, niacin as cofactor/backbone

-NAD is for catabolic energy producing proceses and NADPH is for anabolic processes (HMP shunt)

19
Q

Hexokinas

A

-Hexokinase is uqbiquitaly expresses in tissues and is a high affinity (low Km) and low capacity (low Vmax) enzyme that serves to trap glucose in periheral tissues under normal intrameal glucose conentrations

20
Q

Glucokinase

A
  • Present only in the liver and pancreatic beta cells
  • Low affinity but high capacity
  • Under high glucose levels such as post meal, large quantities are trapepd in liver and pancreas
  • Glucose is trapped as glucose 6 phosphate which can run down glycolysis
  • Glucose 1 phosphate is used for glycogen storage
21
Q

Glycolysis

A
  • Uses glucose and generats ATP, Pyruvate
  • Subtrate level phosphorylation
  • Activated by low energy levels (AMP/ADP) and inhibited by high energy levels (Citrate, and ATP)
  • PFK-1 is the rate limiting enzyme
22
Q

Glycolysis in the liver

A

In the liver glyoclysis can also be used as a starting point for the creation of other products

  • Fructose 2,6 BPG is created by PFK-2 which is a positive feedback on PFK-1 and allows glycolysis to occur at a more rapid rate
  • Glucagon reduces 2,6 BPG levels through Gs cAMP
  • Insulin increases 2,6 BPG levels by decreasing cAMP
23
Q

Pyruvate Kinase

A
  • Catalyses conversion of Phosphoenolpyruvat to pyruvate
  • Deficency leads to impaired energy production due to derranged NAD/NADH levels in RBC this leads to hemolysis
  • Second most commor form of intravascular hemolytic anemia, no Hienz bodies will be present
24
Q

Pyruvate Pathways

A
  • Lactate
  • Alanine
  • OAA (GNG)
  • Acetyl CoA (TCA)
25
Q

Lactate dehydrogenase

A

Turns pyruvate into lactate and regenerates NAD from NADH.

  • NAD is necessary for glycosysis to run, and NADH impairs glycosysis
  • Seen in exercising skeletal muscle and glyocolytic tissues
  • RBC, Lens, Cornea, Testes
26
Q

ALT

A

Pyruvate turned into alanine,

  • Liver specific
  • Takes pyruvate prodcued in muscle and returns it as alanine
  • Requries B6 (transaminase reaction)
27
Q

Pyruvate Carboxylase

A
  • Requires Biotin

- Turns pyruvate into OAA for GNG or TCA cycle

28
Q

Pyruvate Dehydrogenase

A
  • Pyruvate turned into Acetyl CoA
  • Requires B1, B2, B3, B5 (CoA), and lipoic acid
  • Allows for entry of acetyl Coa into TCA cycle
  • Activated by exercise (Increase NAD/NADH ratio, Ca, ADP/AMP) all signs of energy usage
  • ALpha ketoglutarate pathway of TCA cycle is very similar enzyme
29
Q

PDH defects

A
  • Viatmin Deficencies (thiamin) is very common
  • Congential X linked presenting as neurologic dysfunction
  • Treatement for congenital is to avoid glucose entry into TCA. Ketogenic diet (High in lysine and leucine only ketogenic AA’s)
  • Arsenic poisoning impairs lipoic acid function and prevents PDH function. Rice water stools, abdominal pain, and breath smells like garlic

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