Anatomy III Exam Flashcards
Where is TSH secreted from?
Anterior Pituitary
What hormones are released by posterior pituitary?
Oxytocin
ADH
What hormone is released by paraventricular nucleus?
Oxytocin
What hormone is released by supraoptic nucleus?
Antidiuretic Hormone
What are tropic hormones and gives some examples
target other endocrine glands
PRL, GH
What causes increase in IGF-1 from liver?
protein
exercise
fasting
sleep
What causes decrease in IGF-1 from liver?
insulin
stress (cortisol)
estrogen
Age of peak secretion from pineal gland?
1-5 year olds
What does calcitonin do and where is it secreted from?
thyroid
decrease Ca++
What does calcitriol do?
increase Ca++ by:
Inc GI absorption
Dec renal excretion
Inc bone resorption
What is bone resorption
osteoclast break down bone to release Ca++ (Inc Blood Ca++)
What are the three main layers of adrenal gland? (in to out)
Adrenal medulla
Adrenal cortex
connective tissue capsule
What are the layers of adrenal cortex (in to out)?
Zona reticularis
Zona fasciculata
Zona glomrulosa
What does the zona reticularis secrete?
DHEA progesterone estrogen testosterone androstenedione
What does the zona fasciculata secrete?
cortisol
What does the zona glomerulosa secrete?
aldosterone
What does the adrenal medulla secrete?
EPI
NE
What is the action of adrenal medulla?
fight or flight
What is the action of zona fasciculata?
regulate blood sugar anti-inflammatory immune response modification heart and blood vessel toning stimulate CNS stress rxn normalization
What is the action of zona reticularis?
antioxidant tissue repair sex hormones balance cortisol anti-aging
What is the action of zona glomerulosa?
aldosterone: inc Na+, dec K+, conserve water –> increase BP
What cell of pancreas secretes insulin?
Beta cell
where is pancreas located?
retroperiotoneal and
inferior and dorsal to stomach
what are Islets of Langerhans
pancreatic islets
contain alpha and beta cells
what is sphincter of Oddi?
where pancreatic duct opens
what does delta cells of pancreas secrete?
somatostatin –> inhibit insulin
What do Sertoli cells do and where are they?
testis
progress germ cells to spermatozoa
What do Leydig cells do and where are they?
testis
produce testosterone
What are granulosa cells?
ovarian cells that surround eggs to form follicles
What do granulosa cells secrete?
estrogen
progesterone
What does somatostastin do and where is it secreted from?
increase glucose
pancreatic delta cells
What do F cells do?
inhibit somatostatin
What does aldosterone do?
Na/K pump: Na in, K out –> water conservation –> increase BP
What is the alimentary canal?
mouth to anus GI tract
What do accessory digestive organs do?
secretions that contribute to food breakdown
What are the layers of alimentary canal?
Mucosa
Submucosa
Muscularis Externa
Serosa/Adventitia
What are the layers of the Mucosa layer and what do they each do?
lamina propria: nutrient absorption
muscularis mucosae: movement
Where is serosa and adventitia each present?
serosa: below diaphragm, intraperitoneal organs
adventitia: esophagus; retroperitoneal organs
What does the submucosa layer do?
vascular, lymphatics, and nerve supplies
What does the muscularis externa do?
peristalsis
What does the serosa/adventitia do?
reduce friction and lubricate
Mesenteric Adenitis
inflammation of lymph nodes
Meissner’s plexus (Submucosal)
regulates glands (enzymes) and smooth muscle
Auberchach’s plexus (Myenteric)
controls motility (pushes food down)
What are the tongue muscles and what do they each do?
Intrinsic: speech; not attached to bone
Extrinsic: protrude and deviate tongue; attach to bone
Lingual frenulum: tongue to floor of mouth
What layer does stomach have that the rest of the alimentary canal doesnt?
innermost oblique layer in muscular externa
What does the parietal cell of stomach secrete?
HCl
What does the chief cell of stomach secrete?
pepsinogen
What cell secretes gastrin in stomach
G cell (neuroendocrine cell)
What does the intrinsic factor in stomach do?
required for B12 absorption in intestines
What does somatostatin in the stomach do?
inhibit acid secretion
What does gastrin do?
regulates stomach secretion and motility
What does histamine in the stomach do?
help produce acid
What are the phases of gastric secretion?
Cephalic
Gastric
Intestinal
What enzyme increases the pH of chyme and what is it secreted by?
Secretin
GIP
CCK
by duodenum
upper esophageal sphincter blood supply
inferior thyroid artery
vein drains from inferior thyroid vein to brachiocephalic v.
thoracic esophagus blood supply
thoracic aorta, bronchial arteries
veins drain from azygous vein to superior vena cava
lower esophagus blood supply
left gastric and left splenic arteries
veins drain from gastric veins to portal system
What is esophageal varices caused by?
portal hypertension, cirrhosis. liver disease
What arteries supply greater curve of stomach
L/R gastro-omental arteries
What arteries supply lesser curve of stomach
L/R gastric a.
What arteries supply fundus of stomach
short gastric a.
What is caput medusa?
portal hypertension with accumulation of peritoneal fluid
What does secretin stimulate?
secretion of sodium bicarbonate from pancreas and bile in liver
What supplies upper duodenum?
gastroduodenal artery
What supplies most of small intestines?
superior mesenteric artery
What layer of small intestines is villi and microvilli in?
mucosa
What is Crypts of Lieberkuhn?
immune cells and STEM cells in mucosa layer of small intestine
What is the strongest layer of small intestine?
submucosa
Where are Brunners Glands and what does it do
duodenum submucosa increase pH (alkaline secretions and inhibit chief and parietal cells)
What are in the submucosal layer and what does each do?
brunners glands: increase pH
peyers patches: lymph nodules in ILEUM
lacteals: lymph capillary absorbs fats in villi
Where is Peyers patches?
Ileum submucosa
Does small intestines have serosa or adventitia?
serosa
gastroileal reflex
food in stomach –> ileum segmentation (constriction) –> gastrin release –> ileocecal sphincter relax –> chyme to large intestine
Peristalsis v. Segmentation
Peristalsis: moves
Segmentation: mix and churn
Bile functions
digest/absorb fat
excrete bili
What are epiploic appendages?
fatty sacs on colon
What is a haustrum?
balloon pouches of colon
teniae coli
3 longitudinal bands
contracts to produce bulges (haustra)
What parts of large intestines have serosa layer?
transverse and sigmoid
What supplies large intestines?
superior mesenteric artery: lower duodenum to 2/3 of transverse colon
inferior mesenteric artery: descending, sigmoid, rectum
Which hemorrhoids do not hurt?
internal hemorrhoidal plexus
What vitamins does large intestine produce?
Vitamin B and K
When does defecation occur?
when external sphincter VOLUNTARILY relax
What are the quadrants of liver where are they ?
Right: seen on all views
Left
Caudate: posterior to left, by IVC
Quadrate: inferior to left (between falciform lig and gallbladder)
What is the round ligament?***
fibrous remains of fetal umbilical vein
What gives 75% of hepatic blood supply?
portal vein
What does portal vein collect from?***
distal esophagus stomach small/large intestines pancreas spleen
What is bile canaliculi?
small tubes that collect bile secreted from hepatocytes; merge to form bile ductiles –> merge into common bile duct
bilirubin
product of RBC breakdown (heme)
“hilum of liver”
porta hepatis
what is cystic duct and what does it join with?
duct of gallbladder
merge with common hepatic duct
–> common bile duct
what is the Portal Triad and where is it?
Hepatic vein: nutrients
Hepatic artery: O2
Bile duct
@each of 6 corners of lobules
Kupffer cells
hepatic stellate macrophages on sinusoid wall
“Space of Disse”
where plasma filtered into lymph
between hepatic cells and epithelial cells
Hepatic sinusoid
vascular channels;
between central vein and hepatic a/v
most versatile and multifunctional cell in body
hepatocyte
Hepatocyte functions***
thousands of enzymes store glycogen breakdown RBC Synthesize plasma proteins produce non-essential AA gluconeogenesis hormones detox bile urea
what is urea produced from?
ammonia and CO2
Cirrhosis
when hepatocyte death > reproduction
Kupffer cell functions***
destroy RBC
produce AB/plasma proteins/bile pigments
phagocytosis
activation –> early alcohol induced liver injury
Liver functions
produce bile salts eliminate bili metabolise steroid hormones drug detox produce urea breakdown carbs, fat, protein recycle and store minerals and vitamins remove bacteria coagulation
How is hemoglobin metabolized?
by spleen
globin: cut up and AA recycled
heme: iron and bili (iron stored in liver; bili in liver)
Which is direct and indirect bilirubin?
conjugated bili = direct (measured)
unconjugated = indirect (calculated; bound to albumin)
Which bili is water soluble and which is not?***
conjugated = water soluble unconjugated = insoluble
What level of total bili indicated diseased state?
4mg/dL or more
Dark urine means…
elevation of direct bili (bc soluble)
What happens to bilirubin in bowels?
bacteria metabolize conjugated bili to urobilinogen
What happens to urobilinogen
- reabsorbed and secreted in urine (yellow)
2. or exit colon and convert to urobilin and stercobilin (brown feces)
How is bilirubin conjugated?
glucuronyl transferase in hepatocyte combine bili and glucuronic acid
cause of jaundice
excessive RBC destruction
impaired bili uptake
decrease bili conjugation
bile flow obstruction
cause of prehepatic jaundice
excessive hemolysis
cause of intrahepatic jaundice
impaired conjugation or removal of bili in bile
cause of posthepatic jaundice
obstruction of bile between liver and intestine
absorptive state of liver***
break down carbs and proteins –> liver regulate levels (storage as glycogen/triglycerides or usage or synthesize protein) –> enter portal vein –> IVC
postabsorptive state of liver***
- plasma glu level <80 –> break glycogen to glu
2. after 4+hrs of this and if get to <70, gluconeogenesis (glu from alt sources like adipose, AAs)
what happens in transamination?
amine switched from AA to keto acid –> AA forms glutamic acid
what happens in oxidative deamination?
amine of glutamic acid (ammonia) combines with CO2 –> urea
keto acid modification
keto acids from transamination altered to enter Krebs cycle –> ATP
what happens to pts with excessive ammonia?
confused; hepatic encephalopathy
What is urea?
CO2 + Ammonia; way for body to remove ammonia
HIGH AST
alcohol hepatocyte damage
HIGH ALT
viral hepatocyte damage
HIGH ALK PHOS
biliary canaliculi/duct obstruction (or bone issues)
HIGH GGT
Alcohol abuse
or obstruction
Bile duct obstruction signs
elevated ALK PHOS and GGT
Early liver failure
hepatosplenomegaly
late liver failure
small liver
Portal hypertension manifestations
ascites
hemorrhoids
esophageal > gastric varicose –> GI bleed
spider angiomata
hepatocyte destruction manifestations
hypocoagulation jaundice hepatic encephalopathy (coma and death!) feminization (testicular failure) ascites/edema
Albumin
produced in liver and keeps fluid in blood and prevent leakage
low levels: kidney/liver problem
hepatorenal syndrome
cirrhosis can lead to poor renal blood supply –> renal failure –> death
3 systems of alcohol metabolism
Alcohol dehydrogenase (ADH) system –> liver cytoplasm
Microsomal ethanol-oxidizing system (MEOS) –> ER
Catalase –> peroxisomes
what is the function of transitional epithelium of mucosal layer of bladder?
expands!
trigone
opening of ureters and urethra; triangular
afferent arteriole and efferent arteriole
afferent: blood enter glomerulus
efferent: exit glomerulus
podocyte
wrap around capillaries in bowman’s capsule with basement membrane
proximal convoluted tubule
REabsorption: ions, AA, glu, H2O (65%) back in blood
ACTIVE
SGLT2 inhibitor
account for 90% of glu reabsorption
What does the Loop of Henle do (Asc/Desc)?
Descending: passively absorb water (drive by osmolarity from asc)
Ascending: actively pump out salts (Na, K, Cl)
What does the distal convoluted tubule do?
absorb ions, monitor pH
low pressure –> macula densa cells stimulate JG cells of afferent arteriole to release renin –> increase BP
Collecting ducts
Multiple distal convoluted tubules dump into duct
absorb water
breakdown Urea!
Where does urea go from collecting ducts?
major part of urine released; some urea held to increase osmolarity of medulla and drive water resorption in Loop of Henle
Where does collecting duct connect to?
collecting duct –> renal calyx –> pelvis –> ureter –> bladder –> urethra
Diuretics and what are they used for?
increase rate of volume output
Usage: edema, HTN, intoxication
Osmotic diuretic
Mannitol
not easily reabsorbed and increases osmolarity in urine –> water retention/in
Loop diuretic
Lasix
blocks Na/Cl co transporters in Ascending Limb of Loop–> decrease active absorption –> increase water retention in urine
lose K tho
Thiazide diuretics
hydrochlorothiazide (HCTZ)
blocks Na/Cl co transporters in DISTAL tubule
aldosterone antagonists
spironolactone (aldactone)
inhibit aldosterone in collecting tubule; decrease Na resorption and decrease K secretion
sodium channel blockers
triamterene
also blocks Na out/K in pump; Na stays in Collecting tubule, drawing water in, K stays in medulla
doesnt affect aldosterone system
What is a K sparing diuretic?
aldosterone antagonist, sodium channel blockers
K stays in medulla
What is the leading cause of kidney failure
diabetes
Second cause of kidney failure
HTN
What are the three categories of acute renal failure?
- prerenal: decreased blood to kidney
- intrarenal: abnormality in kidney
- postrenal: obstruction
what is chronic renal failure?
progressive and irreversible loss of nephrons (complications after 70-75% loss)
remaining nephrons enlarge
fourchette and what is opposite of it anteriorly?
frenulum of labia minora (posterior)
prepuce of clitoris (anteriorly)
What are Skene’s glands (paraurethral glands) and what is it analogous to in the male?
lesser vestibular glands
male prostate
where are Bartholin’s glands?
right beneath fascia
greater vestibular glands/bulbourethral glands
What length of pelvic outlet might prevent fetus passage?
< 9.5cm
What is the most uncommon bony pelvis type and what can happen with it?
platypelloid
C section
What are the types of bony pelvis?
anthropod: AP>transverse; not good
platypelloid: not good
android: wide transverse
gynecoid: most spacious (more common); best
What do Kegel exercises do and what muscle does it target?
strengthen pelvic floor muscle (pubovaginalis)
help w/incontinence
What are the pelvic floor muscles
levator ani: iliococcygeus, pubococcygeus, puborectalis
Most likely muscle damage in child birth?
pubococcyeus
What is the pouch of Douglas?
rectouterine pouch
What cells are in the middle of cervix?
columnar epithelia
swabbed in pap smears
What are the four parts of fallopian tube?
infundibulum
ampulla
isthmus
uterine part
what is the introitus?
vaginal vestibule
What structure has fimbriae?
infundibulum
Where does fertilization occur in the fallopian tube?
ampulla
Where is the most common site for ectopic pregnancy?
ampulla
What layer does the ovary not have and why?
peritoneum
to expel oocyte
which ligament of uterus looks like bat wings and what does it do?
broad ligament
encloses uterus, holds nerves and vessels
What keeps the ovaries up and in place?
suspensory ligament of ovaries
What layer is shedded during menses?
stratum functionalis of endometrium
What artery constricts during menses?
spiral artery –> necrosis of stratum functionalis
veinous drainage of lateral 2/3 of uterus
pampiniform plexus–>ovarian veins–>IVC(R)/renal vein(L)
veinous drainage of medial 2/3 of uterus
uterine plexus–> internal iliac
What are the lymph nodes of the pelvis?
superficial inguinal nodes: external genitalia, anus sacral nodes: lower third vagina internal common iliac external: lumbar nodes: upper uterus, ovaries
External perineal innervation
ilioinguinal nerve and genitofemoral nerve
pudendal nerve
perineal branch of post femoral cutaneous
coccygeal and last sacral
what is most common acute complicatin of lymph node dissection?
pelvic hemorrhage
what lymph node should you sample when dealing with ovarian cancer?
aortic and subaortic nodes bc metastasis spreads in cephalad direction
