Anatomy/Physiology Flashcards
1
Q
Muscles of Mastication
A
temporalis, masseter, medial pterygoid, lateral pterygoid
2
Q
Muscles of mastication are supplied by
A
CN V3 (trigeminal)
3
Q
Movement of mouth occurs at which joint?
A
TMJ
4
Q
Lateral pterygoid - originates at ——- and inserts at ——–
A
Lateral pterygoid - originates at condyle of mandible and inserts at pterygoid plates
5
Q
Temporalis - originates at ———- and inserts at ————-
A
Temporalis - originates at coronoid process of mandible and inserts at temporal fossa
6
Q
Masseter - originates at ———— and inserts at —————–
A
Masseter - originates at angle of mandible and inserts at zygomatic arch
7
Q
Medial pterygoid - originates at ——- and inserts at —————
A
Medial pterygoid - originates from angle of mandible and inserts to pterygoid plate
8
Q
TMJ is made from ——–
A
mandibular fossa on temporal bone, head of condylar process and articular tubercle
9
Q
Oral cavity innervation = Superior ½ supplied by ------- Inferior ½ supplied by --------- Orbicularis oris supplied by ------ Gag reflex - motor supply --------- sensory supply --------
A
Superior ½ supplied by CN V2
Inferior ½ supplied by CN V3
Orbicularis oris supplied by CN VII
Gag reflex - motor supply CN IX & CN X, sensory supply CN IX
10
Q
Salivary Glands
Parotid - duct enters at ——- innervated by ——–
Submandibular - duct enters at ——- innervated by ——–
Sublingual - duct enters at ——- innervated by ——–
A
Parotid - upper 2nd molar, CN IX supply
Submandibular - enters floor of mouth and secretes via lingual caruncle, CN VII supply
Sublingual - lays in floor of mouth and secretes via several ducts superiorly, CN VII supply
11
Q
Tongue innervation =
A
Posterior 1/3rd - CN IX glossopharyngeal
Anterior 2/3rd - CN VII facial (taste), CN V3 trigeminal (general sensory)
12
Q
Tongue papillae
A
foliate, vallate, fungiform, filiform
13
Q
Intrinsic tongue muscles =
A
styloglossus, genioglossus, hyoglossus, palatoglossus
14
Q
Tongue muscles are innervated by
A
CN XII except palatoglossus (innervated by CN X)
15
Q
The pharynx is made up of the
A
Nasopharynx, Oropharynx and Laryngopharynx
16
Q
The 2 muscle layers of the pharynx are
A
Constrictor muscles (outer), Longitudinal muscles (inner)
17
Q
The outer muscle layer of the pharynx functions to
A
constrict sequentially and move food down the oesophagus
18
Q
The inner muscle layer of the pharynx functions to
A
elevate pharynx, close laryngeal inlet and shorten pharynx to aid swallowing
19
Q
The pharyngeal muscles are innervated by —–
A
CNX vagus nerve (constrictor + longitudinal layers), CNIX glossopharyngeal (longitudinal layer)
20
Q
Upper oesophageal sphincter
(cricopharyngeus) is at the level of ——
A
C6 (same level as Thyroid)
21
Q
Oesophagus sphincters =
A
Anatomical upper oesophageal sphincter and physiological LOS
22
Q
Oesophagus passes through diaphragm at —
Vena Cava passes through at —
Aorta passes through at —
A
Oesophagus = T10 IVC = T8 Aorta = T12
***I ate 10 Eggs at 12.
Vena cava has 8 letters = T8. Oesophagus has 10 letters = T10. Aortic hiatus= T12
23
Q
Layers of the digestive tract wall =
A
Mucosa, submucosa (connective tissue), muscularis externa, adventitia (outer connective tissue)
24
Q
Muscle in digestive tract wall
A
Circular muscle = part of muscularis externa, lengthens and narrows the lumen
Longitudinal = part of muscularis externa, shortens and widens the digestive tract
Muscularis mucosae = part of the mucosa layer, folds to aid in absorptive and secretory functions.
25
Muscle type in the oesophagus =
Striated skeletal muscles in upper 1/3rd and SM in lower 2/3rds
26
Peristalsis is controlled by the ---- nervous system
enteric nervous system via the myenteric plexus in the muscularis mucosae (containing interstitial cells of Cajal - pacemakers connected to SM cells)
AND
extrinsic nervous system via opening of Ca channels to reach AP threshold in cells (can be hormonal/mechanical stimuli)
27
Peristalsis is triggered by ---- potentials
slow wave potentials that reach the threshold to trigger an AP and cause a contraction
28
Peritoneum =
continuous membrane lining the abdominal cavity walls and organs
29
Intraperitoneal organs = ------
| e.g. --------
covered in visceral peritoneum, minimal mobility e.g. liver, gallbladder, stomach, spleen, transverse colon, small bowel
30
Retroperitoneal organs = ------
| e.g. --------
only has visceral peritoneum on anterior surface, no mobility e.g. kidneys, pancreas, ascending and descending large bowel
31
Organs with a mesentery = ------
| e.g. --------
visceral peritoneum wraps around organ to form double layer, very mobile e.g. small bowel, transverse and sigmoid colon
32
Omentum = ----------
| Divides the peritoneal cavity into ----
Omentum = fold of visceral peritoneum
| Divides cavity into greater and lesser sac (communicate via omental foramen)
33
Pouches in the peritoneal cavity are formed by -----
Males = ----- pouch
Females = ----- pouch
Pouches in the peritoneal cavity are formed by peritoneum draping over superior part of pelvic organs
Males = recto-vesicular pouch (between bladder and rectum)
Females = rectouterine pouch (of Douglas) and vesico-uterine pouch
34
ACh results in {increased/decreased} peristalsis
| NO and VIP result in {increased/decreased} peristalsis
ACh results in increased peristalsis
| NO and VIP result in decreased peristalsis
35
- ------ = small bowel mesentery
| - ------ = large bowel mesentery
Mesentery proper = small bowel mesentery
| Mesocolon = large bowel mesentery
36
To get to the abdominal cavity, sympathetic nerves synapse at {pre-vertebral/post-vertebral} ganglia located at exit points of the ----------, then travel with the arteries (----------------)
Sympathetic nerves synapse at pre-vertebral ganglia located at exit points of the abdominal aorta; then travel with the arteries (periarterial plexuses)
37
To get to the abdominal cavity, presynaptic parasympathetic nerves travel on the -------------; then travel via the ----------------
Main parasympathetic fibres of abdominal cavity = --------- and ---------
Presynaptic parasympathetic nerves travel on the oesophagus; then travel via the periarterial plexuses
Main parasympathetic fibres of abdominal cavity = Vagus nerve and Pelvic Splanchnic nerve
38
Abdominal cavity visceral afferents run alongside {parasympathetic/sympathetic fibres}} back to the spinal cord
Pain from these areas can be perceived in their relevant dermatomes = --------- pain
Liver pain can be referred to ----------
Pancreatic pain can be referred to -----------
Abdominal cavity visceral afferents run alongside sympathetic fibres back to the spinal cord
Pain from these areas can be perceived in their relevant dermatomes (referred pain)
Liver pain can be referred to right shoulder
Pancreatic pain can be referred to back
39
In the abdominal cavity:
Vagus nerve - supplies the ------------
Pelvic Splanchnic nerve (S2, 3, 4) - supplies the -------------
Vagus nerve - supplies GI tract to distal transverse colon
| Pelvic Splanchnic nerve (S2, 3, 4) - supplies colon and anal canal
40
The abdominal wall consists of the ------------
skin to parietal peritoneum
41
Sympathetic nerves get from the CNS to abdominal organs via ----------------
Sympathetic nerves get from the CNS to abdominal organs via abdominopelvic splanchnic nerves (T5-L2)
42
Pre-vertebral ganglia are named according to ----------
their exit points, the same as the artery names; so coeliac, superior mesenteric, inferior mesenteric ganglia
43
Parasympathetic has a --------- outflow; sympathetic has a ------------- outflow
Parasympathetic has a craniosacral outflow; sympathetic has a thoracolumbar outflow
44
In appendicitis, the initial dull generalised pain is caused by --------------- nerves.
Later, the sharp localised pain is caused by ---------------- nerves.
In appendicitis, the initial dull generalised pain is caused by visceral afferent nerves.
Later, the sharp localised pain is caused by somatic sensory nerves of the body wall (the parietal pleura becomes involved as the appendix is more inflamed)
45
Abdominal wall muscles - superficial >> deep =
external oblique > internal oblique > transverse abdominis > rectus abdominis
46
Plane between epigastric and umbilical regions =
| Plane between umbilical and pubic regions =
Plane between epigastric and umbilical regions = subcostal plane (T10)
Plane between umbilical and pubic regions = transtubecular plane
47
Spinal region
Foregut =
Midgut =
Hindgut =
Spinal region
Foregut = T6-9
Midgut = T8-12
Hindgut = T12-L2
48
Organs
Foregut =
Midgut =
Hindgut =
```
Foregut = Oesophagus to D2, Liver, Gallbladder, Spleen, ½ pancreas
Midgut = D2 to proximal ⅔ transverse colon, ½ pancreas
Hindgut = Distal ⅓ transverse colon, proximal ½ anal canal
```
49
Vasculature
Foregut =
Midgut =
Hindgut =
```
Foregut = Coeliac axis (T12), Splenic vein, Coeliac lymph nodes
Midgut = SMA (L1), Superior mesenteric vein (drains into hepatic portal vein), Superior mesenteric lymph nodes
Hindgut = IMA (L2), Inferior mesenteric vein (drains into splenic vein then hepatic portal vein), Inferior mesenteric lymph nodes
```
50
The stomach muscle layers differ from the rest of the GI tract because ----------
the stomach has an oblique layer in muscularis externa
51
Areas of stomach (superior >> inferior) =
fundus > carida > body > (antrum) > pylorus (pyloric sphincter at end)
52
The mechanical regions of the stomach are:
1)
2)
1) Orad = fundus and proximal body - tonic contraction, no slow wave activity, minimal mixing to allow starch to digest
2) Caudad = distal body and antrum - phasic contraction, slow wave activity present, retropulsion
53
3 phases of gastric secretion in the stomach =
1) Cephalic - before food reaches the stomach, increased HCl secretion
2) Gastric - stomach distension causes increase in HCl secretion via mechanoreceptors
3) Intestinal - after food has left the stomach
54
3 secretagogues inducing HCl secretion in the stomach =
1) ACh - activates parietal cells, inhibits D cells
2) Gastrin - activates parietal cells
3) Histamine - activates parietal cells to secrete HCl
55
In cephalic phase of gastric secretion in the stomach, vagal stimulation promotes release of ------------
3 secretogogues (ACh, gastrin, histamine) which increase HCl secretion
56
Control of hunger occurs in the ------
hypothalamus
57
- ------------ neurons go to the feeding centre in the lateral hypothalamic area and stimulates appetite
- ------------- neurons go to the satiety centre in the ventromedial nuclei and inhibits appetite
Orexigenic neurons go to the feeding centre in the lateral hypothalamic area and stimulates appetite
Anorexiogenic neurons go to the satiety centre in the ventromedial nuclei and inhibits appetite
58
Orexigenic neurons go to the ---------- centre in the ------------- hypothalamic area and ---------- appetite
Anorexiogenic neurons go to the ---------- centre in the ventromedial nuclei and --------- appetite
Orexigenic neurons go to the feeding centre in the lateral hypothalamic area and stimulates appetite
Anorexiogenic neurons go to the satiety centre in the ventromedial nuclei and inhibits appetite
59
Secretion of HCl by gastric parietal cells occurs via
H/K/ATPase pump (proton pump)
60
Vomiting centre is in the -------
Medulla
| Many different pathways and stimuli e.g. toxin, mechanical, motion etc
61
Blood supply to the stomach all originates from the --------
coeliac trunk
62
Right and left gastric arteries run along the -------curvature of the stomach (anastamose)
Right and left gastro-omental arteries run along the ---------- curvature of the stomach (anastamose)
Right and left gastric arteries run along the lesser curvature of the stomach (anastamose)
Right and left gastro-omental arteries run along the greater curvature of the stomach (anastamose)
63
- --------------- arteries run along the lesser curvature of the stomach (anastamose)
- --------------- arteries run along the greater curvature of the stomach (anastamose)
Right and left gastric arteries run along the lesser curvature of the stomach (anastamose)
Right and left gastro-omental arteries run along the greater curvature of the stomach (anastamose)
64
Gastrin is released by ----- cells in the -----------
| Function =
Gastrin is released by G cells in the gastric antrum, duodenum.
Function = H+ secretion, decreases stomach contractions, delays gastric emptying to aid digestion
65
CCK is released by ----- cells in the -----------
| Function =
CCK is released by l cells in the duodenum, jejunum
| Function = bile secretion, satiety, pancreatic enzymes eg lipase
66
Secretin is released by ----- cells in the -----------
| Function =
Secretin is released by S cells in the duodenum
| Function = HCO3- (bicarbonate) secretion
67
Motilin is released by ----- cells in the -----------
| Function =
Motilin is released by M cells in the duodenum, jejunum
| Function = Initiates MMC during fasting state
68
GIP is released by ----- cells in the -----------
| Function =
GIP is released by K cells in the duodenum, jejunum
| Function = Insulin release from pancreatic B cells
69
GLP-1 is released by ----- cells in the -----------
| Function =
GLP-1 is released by L cells in the bowel
| Function = promotes insulin secretion & inhibits glucagon
70
Ghrelin is released by ----- cells in the -----------
| Function =
Ghrelin is released by Gr cells in the gastric antrum, small bowel
Function = Stimulates hunger
71
Somatostatin is released by ----- cells in the -----------
| Function =
Somatostatin is released by D cells in the pyloric gland area
Function = Inhibits HCl secretion
72
Pepsinogen is released by ----- cells in the -----------
| Function =
Pepsinogen is released by Chief cells in the Oxyntic mucosa (gastric mucosa)
Function = Combines with HCl to form pepsin and break down protein
73
Histamine is released by ----- cells in the -----------
| Function =
Histamine is released by Enterochromaffin like cells in the Oxyntic mucosa (gastric mucosa)
Function = Stimulates HCl
74
Gastroferrin is released by ----- cells in the -----------
| Function =
Gastroferrin is released by parietal cells in the Oxyntic mucosa (gastric mucosa)
Function = B12 & Fe2+ absorption
75
Leptin is released by ----- cells in the -----------
| Function =
Leptin is released by adipose cells
| Function = inhibits hunger
76
Small bowel sections = ------- >> -------- >> --------
duodenum > jejunum > ileum
77
Pain from the duodenum is felt in the ------- region
epigastric region
78
In the duodenum, ---------- gland in the submucosa will release alkaline mucous in order to -------------
Brunner’s gland in the submucosa will release alkaline mucous to neutralise the acidic chyme.
79
Pancreatic secretions in the duodenum =
```
Digestive enzymes (protease, amylase, TAG-lipase) from acinar cells
Alkaline fluid to neutralise acid
```
80
Biliary secretions in the duodenum =
Bile salts break down large lipids for attack by TAG lipases
81
Pancreatic and Biliary secretions are released into the duodenum via ----------
the major duodenal papilla
82
The superior part of the duodenum is {intraperitoneal/retroperitoneal} while the rest (descending, horizontal and ascending) is {intraperitoneal/retroperitoneal}
Both the jejunum and ileum are {intraperitoneal/retroperitoneal}
The superior part of the duodenum is intraperitoneal while the rest (descending, horizontal and ascending) is retroperitoneal.
Both the jejunum and ileum are intraperitoneal.
83
Jejunum begins at around vertebrae level -------
L2
84
Mucosa in the jejunum is highly folded for absorption - folds are called -------------
plicae circularis
85
Pain from midgut organs is usually felt in the ------- region
umbilical region
86
What is absorbed in the small bowel?
```
Lipids (triglycerides, cholesterol, phospholipids)
Na and water
Carbohydrates
Proteins
Calcium (covered in Endocrine)
Iron
Vitamins
```
87
Ingested lipids are broken down by ---------------
churning, gastric enzymes and duodenal secretions - increasing the surface area to then be broken down by lipases
88
Lipid absorption
broken down by lipases in duodenum
>> form emulsion droplets with bile salts
>> CCK releases TAG lipases from pancreas to hydrolyse TAGs
>> small fatty acid chains diffuse across enterocytes into blood
AND
>> large fatty acid chains move via transport mechanisms and are resynthesised into triglycerides in enterocytes >> incorporated into chylomicrons
89
How are small chain fatty acids AND large chain fatty acids absorbed into blood?
>> small fatty acid chains diffuse across enterocytes into blood capillaries
AND
>> large fatty acid chains move via transport mechanisms into enterocytes, resynthesised into triglycerides and incorporated into CHYLOMICRONS. Released into LYMPH VESSELS by exocytosis
90
TAG
triglyceride (glycerol + 3 fatty acids)
91
Water movement out of the GI tract relies on ----
the movement of SODIUM (which produces osmotic force)
92
What are the most important sodium transporters?
Na/glucose and Na/amino acid transporters (post-prandial, in duodenum/jejunum)
93
The fat soluble vitamins are --------
| They are absorbed via ---------
A D E K
| passively diffuse into the enterocytes, incorporated into micelles/chylomicrons for release into lymphatics
94
The water soluble vitamins are -------
| They are absorbed via ---------
B C H
| transport across membrane with transporter. May involve Sodium transporter.
95
Digestive juices are produced throughout the small intestine by -------
Goblet cells (mucous) and crypts of Lieberkühn (aqueous salts)
96
3 main motility patterns of small intestine
1) SEGMENTATION- after meals, alternating contraction and relaxation of circular muscle to churn contents.
2) PERISTALSIS driven by the Migrating Motor Complex (MMC) - between meals. Sweeping contraction that clears debris through small intestine.
3) COLONIC MASS MOVEMENT - contraction that moves faeces into the rectum. Occurs a couple times/day
97
The Common Hepatic artery gives off the --------- to become the ---------------
The Common Hepatic artery gives off the Gas (gastroduodenal artery) to become the Proper Hepatic artery
98
The ---------- supplies the foregut organs
The coeliac trunk supplies the foregut organs
99
The ------------------- is an anastomosis between the IMA and SMA and can help prevent intestinal ischaemia.
The Marginal Artery of Drummond is an anastomosis between the IMA and SMA and can help prevent intestinal ischaemia.
100
The Marginal Artery of Drummond
an anastomosis between the IMA and SMA and can help prevent intestinal ischaemia.
101
The lumbar nodes drain lymph from the --------
pelvis, kidneys, abdominal wall, limbs
102
Venous drainage of GI tract
The inferior mesenteric vein (hind gut) drains blood into the Splenic Vein (foregut), which then drains into the Hepatic portal vein.
The superior mesenteric vein (midgut) drains directly into the Hepatic portal vein.
The hepatic portal vein goes through liver (cleaning blood from absorptive organs) and drains into IVC.
103
Large bowel parts
caecum > appendix > ascending colon > hepatic flexure > transverse colon > splenic flexure > descending colon > sigmoid colon > rectum
104
Paracolic Gutters are found ---------
on the lateral aspects of the ascending and descending colon (towards the abdominal wall and are part of the greater sac)
105
Haustra
‘bumps’ in the large bowel formed by tonic contraction of teniae coli
106
Teniae coli
3 longitudinal smooth muscle bands running from caecum to sigmoid colon
107
Omental appendices
fatty deposits
108
The splenic flexure lies {inferiorly/superiorly} to the hepatic flexure
The splenic flexure lies superiorly to the hepatic flexure
109
The walls of the large intestine have ----------- but NO --------
The walls of the large intestine have colonic folds, crypts & microvilli but NO villi
110
Ascending and descending colon are {intraperitoneal/retroperitoneal}
Transverse and sigmoid colon are {intraperitoneal/retroperitoneal}
Ascending and descending colon are retroperitoneal; transverse and sigmoid colon are intraperitoneal (so very mobile)
111
Colon primary functions
1) Net absorption of Na, Cl, H20
2) Absorption of short chain fatty acids (carbs not absorbed by small bowel are fermented by colonic flora into short chain fatty acids)
3) Net secretion of K, HCO3, mucus
112
3 main motility patterns of small intestine
1) HAUSTRATION - non-propulsive segmentation, allows for long transit time to absorb fluid & electrolytes
2) PERISTALTIC PROPULSION - mass movement of faeces into rectum, typically after breakfast, triggers defaecation reflex
3) DEFAECATION
113
Roles of colonic flora
1) Help with intestinal immunity by competing with pathogens
2) Promote motility
3) Synthesises vitamin K and free fatty acids
4) Helps in drug absorption (e.g. IBD drugs)
114
Water absorption in the colon occurs via ---------
1) Parallel Na/H & Cl/HCO3 exchange - proximal colon, during inter-digestive period, also allows passive absorption of Cl
2) Epithelial Na channels (ENaC) - distal colon, regulated by aldosterone, also allows passive absorption of Cl
115
The ---------------- muscle relaxes for defaecation and reflexively contracts during coughing/sneezing
Levator ani
116
Pelvic floor muscle
Levator ani
117
The sigmoid colon becomes the rectum anterior to vertebrae level --------
The rectum becomes anal canal anterior to the -------- bone
S3
| coccyx
118
Rectal varices vs. haemorrhoids
Rectal varices - related to portal hypertension, dilation of collateral veins
Haemorrhoids - prolapse of rectal venous plexuses, due to increased pressure
119
Internal vs external anal sphinctor
```
Internal = smooth muscle (involuntary), superior ⅔ of anal canal, tonic contraction, contracted by sympathetic nerves
External = skeletal muscle (voluntary), inferior ⅓ of anal canal, voluntary contraction in response to rectal ampulla distension (simultaneous relaxation of internal sphincter), contraction by puodendal nerve
```
120
Ishioanal fossae
On either side of anal canal
Filled with fat & loose connective tissue
Risk site for abscess formation
121
Pectinate Line
an embryological line between the endoderm (GI Tract) and ectoderm (skin)
122
Above vs below pectinate line
Above = visceral (all hindgut), autonomic nervous system, IMA supply, venous drainage to hepatic portal, inferior mesenteric lymph nodes
Below = parietal, somatic and pudendal nerves, internal iliac artery, venous drainage to systemic veins, superficial inguinal nodes
123
Nerve Supply to Rectum & Anal Canal
1) Sympathetic (contraction of internal anal sphincter, inhibits peristalsis) - T12-L2 - travel to inferior mesenteric ganglia, synapse, travel vis periarterial plexuses
2) Parasympathetic (inhibits internal anal sphincter, stimulates peristalsis) - S2,3,4 - pelvic-splanchnic nerves
3) Visceral afferents (sense stretch, ischaemia etc) - S2,3,4 - run with parasympathetics
4) Somatic Motor (contraction of external anal sphincter & puborectalis) - pudendal nerve (S2,3,4) and levator ani nerve (S3,4)
TIP: S2, 3, 4 keeps the 3 Ps off the floor (pee, poo, penis)
124
Pudendal nerve
Branch of sacral plexus that supplies the internal and
external anal sphincters
(exits pelvis via greater sciatic foramen and enters perineum via lesser sciatic foramen)
125
Liver functions
```
Carbohydrate, fat and protein metabolism
Production and secretion of bile
Storage
Immune protection
Interaction with hormones
Detoxify and metabolise drug
```
126
4 Main lobes of the liver
Right Lobe
Left Lobe
Caudate Lobe
Quadrate Lobe
127
The portal triad
Hepatic artery proper
Hepatic bile duct
Portal vein
128
How is blood and lymph circulated through liver lobules?
Blood will filter from a branch of the portal triad through the functional unit and be collected in the central vein of the lobule
At the same time, hepatocytes are producing bile that moves in the opposite direction out towards the bile duct in the portal triad. his will eventually flow into the hepatic duct and to the gallbladder.
129
The portal venous system drains blood from -------- through the -----------
The systemic circulation drains blood from ------------- into the ------------
The portal venous system drains blood from the midgut, foregut and hindgut through the liver.
The systemic circulation drains blood from all other organs and tissues into the SVC and IVC
130
Points of anastomosis between the systemic and portal systems.
1) Oesophagus (anastomosis between hepatic portal vein and azygous vein)
2) Anal canal (anastomosis between IMA and internal iliac vein)
3) Umbilicus (ligamentum teres is opened and blood flows to the inferior epigastric veins)
131
When the portal venous system resistance increases due to blockage, liver cirrhosis, etc. the blood will travel through ------------
the path of least resistance. Which is through anastomoses into systemic circulation, leading to dilatation at these points:
Oesophageal varices
Caput medusae
Rectal varices
132
Drug metabolism in liver
Phase 1 =
Phase 2 =
Phase 1 = activation - oxidise, hydrolyse, reduce the drug - making drug more polar.
Phase 2 = conjugation - add another functional group to the polarised molecule e.g. methyl, acetate, sulphate etc. - makes drug inactive, less toxic, available to be excreted by liver
133
Cytochrome P450
Family of enzymes that are present in hepatocytes and will oxidise drugs
134
The --------- joins with the ----------- to form the common bile duct (CBD)
The cystic duct joins with the common hepatic duct to form the common bile duct (CBD)
135
Calot’s Triangle
Where the cystic artery is located
| Borders - liver, common hepatic duct, cystic duct
136
Amphipathic
hydrophillic + hydrophobic
137
Bile is composed of -----------
water, bile salts, bilirubin, cholesterol; alkaline in nature
138
Liver hepatocytes make primary bile salts by converting ---------- >> ------------
cholesterol >> cholic acid
139
The intestines then dehydroxylate primary bile salts into -----------
deoxycholic acid (secondary bile salts)
140
When chyme enters the duodenum, ------- is secreted by l cells into the blood, triggering ---------
When chyme enters the duodenum, CCK is secreted by l cells into the blood, triggering gall bladder contraction and relaxation of the sphincter of Oddi (allowing bile to enter D2)
141
Action of bile
emulsifies lipids to aid breakdown and absorption
142
Bilirubin Excretion
1) old RBCs >> haem + globin, by macrophages
2) globin >> amino acids, and haem >> iron, protoporphyrin
3) protoporphyrin >> unconjugated bilirubin (UCB)
4) UCB (not water-soluble) binds to albumin to be transported to the liver
5) hepatocytes in the liver convert UCB >> conjugated bilirubin (CB)
6) CB secreted into the bile
7) in intestines, CB >> urobilinogen
Some urobilinogen >> stercobilin (gives faeces brown colour)
Some urobilinogen >> urobilin, in kidneys (gives urine yellow colour)
Some urobilinogen is recycled through the blood into the liver
143
What region of the abdomen is the spleen found in?
left hypochondrium
144
Anatomical relations of the spleen
Stomach anteriorly
Diaphragm posteriorly
Left Kidney medially
Splenic flexure inferiorly
145
Spleen function
Breaks down RBC to produce bilirubin
146
Anatomical relations of the pancreas
Duodenum sits in a C shape around pancreas.
Head- anterior to SMA branches (small projection - uncinate process - lying posterior)
Body- over Aorta at vertebrae level L2
Tail - anterior to left kidney, pointing to spleen
147
Arterial supply to pancreas
Superior and inferior pancreaticoduodenal artery anastomose and supply the pancreas
Inferior originates from SMA
Superior originates from gastroduodenal artery
148
Pain from pancreas can sometimes be referred to the back because --------
the pancreas is retroperitoneal and interacts with the posterior abdominal wall
AND also due to referred pain and convergence of several sensory afferent nerves at one ganglia.
149
Nerve supply to pancreas
Parasympathetic comes from --------------
Sympathetic comes from --------------
Parasympathetic comes from Vagus Nerve
| Sympathetic comes from Abdominopelvic splanchnic
150
Pancreas exocrine function
involves the production of digestive juices and enzymes by acinar cells, released VIA DUCTS (drain into collecting ducts and eventually the central pancreatic duct)
151
Pancreas endocrine function
involves the islet of langerhan release of insulin and glucagon, released INTO BLOOD
152
The ---------- duct and ---------- duct join together and form a widened duct: Ampulla of Vater
The main pancreatic duct and the common bile duct join together and form a widened duct: Ampulla of Vater
153
The digestive enzymes and bile are released into the small intestine through the -----------
Main Duodenal papilla.
154
Which muscle of mastication allows opening of the mouth?
Lateral pterygoid
155
Blood supply to lesser curvature of stomach =
| Blood supply to greater curvature of stomach =
lesser curvature = left gastric artery
| greater curvature = left and right gastro-omental arteries
156
The peritoneal cavity is lined by mesothelial cells that produce surfactant. True/false?
True
