Anderson Digestive Flashcards
What condition is parotitis and orchitis associated with?
Mumps
What is the difference in muscle between the lower and upper esophagus?
Upper: striated muscle
Lower: smooth muscle
What is the most common type of hiatal hernia?
Sliding
What are some common causes of esophageal varices?
Portal HTN, alcoholic cirrhosis
What is a sequelae of GERD that can lead to adenocarcinoma?
Barrett’s esophagus - squamous cells converted to columnar gastric cells
What are the three muscle layers of the stomach? What are the two attachments?
Internal - Oblique
Middle - Circular
External - Longitudinal
Lesser and greater omentum (METS can go here)
Main artery to stomach? Veins?
Innervation of stomach?
Celiac a.
Gastric v. to portal v.
Sympathetic, splanchnic preganglionics, celiac plexus, parasympathetic (vagus)
Chronic or acute gastritis: NSAIDs, ETOH, smoking, stress Autoimmune w/ loss of parietal cells and IF Erosion of superficial epithelium H. pylori Most asymptomatic, without erosion
Acute Chronic Acute Chronic Chronic
Gastric or duodenal ulcer: 25% of all PUD H. pylori ~75% Better eating Worse with food Burning epigastric pain Assoc w/ MEN or blood type O NSAIDs, Smoking, Blood type A
Gastric Both Duodenal Gastric Both Duodenal Gastric
What is the respective portion of the duodenum, jejunum, and ileum?
D: 12 in
J: 40% of small intestine, less blood flow/lymph (peyer’s patches)
I: 60% of small intestine, more blood flow/lymph (peyer’s patches)
Name the pathology:
Paralysis of ileum, often due to vascular obstruction
Vascular compromise of intestine leading to necrosis
Vascular compromise of the GI leading to mucosal inflammation
One segment of SI telescopes into distal segment
General condition with inflammation of the GI
Adynamic Ileus Intestinal infarction Ischemic enteritis Intusesseption Gastroenteritis
What is the name of the longitudinal smooth muscle in the large intestine? What are the pouches in the wall called?
Teniae coli
Haustra
Name the colon segments in order.
Ascending, hepatic flexures, transverse, splenic flexures, descending sigmoid
What type of muscle is the internal sphincter? how is it controlled?
What type of muscle is the external sphincter? how is it controlled?
Internal: smooth muscle, autonomic control
External: striated, pudendal nerve - conscious control
Name the pathology:
Herniation of colon mucosa through muscularis, submucosa, and adventitia.
Inflammation of above herniations
Varicosities inside and outside the anus
Giardia, ameba, viral/bacterial infection
Polypoid masses in proximal colon, METS, M>W, 60-70yo
Diverticulosis Diverticulitis Hemorrhoids Microbial colitis Colorectal carcinoma
Crohn's vs. UC: Bloody stools Skip lesions throughout the intestines Cobblestoning/fistulas Limited to rectum/colon Pseudopolyps Usu. more abdominal pain
UC Crohn's Crohn's UC UC Crohn's
T/F: 60% of pancreatic cancer is the head.
T
What is migratory thrombophlebitis/clots assoc. with pancreatic cancer?
Trousseau’s syndrome
Name the pathology:
inflammation of the exocrine pancreas, pain radiates to back
toxic damage from acetaminophen
hepatitis, cirrhosis, metabolic disorders
reduction of bile flow
Acute pancreatitis
Acute liver failure
Chronic liver failures
Cholestasis
What are some intrahepatic and extrahepatic causes of cholestasis?
Intra - viral, alcohol, drugs, sepsis
Extra - gallstones in common bile duct, neoplasm of pancreatic head, pancreatitis
Three sources of blood supply to stomach and their source:
Splenic a. -> short gastric a.
Celiac a. -> left gastric a.
Hepatic a. -> right gastric a.
Where does the inferior mesenteric vein drain? (hepatic v. or splenic v.)
Splenic!
Then hepatic
The short gastric v. drains into the ______ which drains in the _______.
Gastroepiploic v.
Inf. mesenteric v.
Breaks the rules!!
What conditions could lead to portal HTN? What are signs of portal HTN?
Liver cancer, alcoholism/cirrhosis, pregnancy.
Hemorrhoids, esophageal varices, caput medusae
What two plexuses make up the enteric nervous system?
Meissner’s - submucosal - secretion
Myeneteric (Auerbach’s) - motility
What does each cell secrete? What is the effect?
G - cells
I - cells
S - Cells
Gastrin - stimulates H+
CCK - stimulates GB contraction, pancreatic enz secretion, inhibits gastric emptying
Secretin - stimulates GB and pancreatic secretions, inhibits gastric emptying
What are the two main hormones in the stomach that stimulate H+?
Gastrin and Histamine (type 2 receptors)
What stimulates and inhibits gastrin?
(+) amino acids, stomach distention, vagal input
(-) enough H+, secretin, GIP
What are the three hormones of the duodenum/jejunum involved in digestion? What stimulates their release?
CCK: (+) AA, fatty acids
Secretin: (+) H+ and fatty acid
Gastrin Inhibitory Peptide (GIP): (+) oral glucose, AA, fatty acid
What does gastrin inhibiting peptide (GIP) accompish?
Stimulates insulin secretion, inhibits gastric acid secretion - regulates/balances gastrin/histamine.
Compare endocrine, paracrine, and neurocrine.
Endocrine: global - secretion, circulation, systemic, target cell
Paracrine: local - diffusion, target cell
Neurocrine: local - action potential, target cell
More cells! What do they secrete and where in the stomach are they: Chief cells Parietal cells Mucus cells (goblet cells) G-cells
Fundus/corpus - Pepsinogen
Fundus/corpus - HCl, Intrinsic factor
Fundus/corpus/antrum - Mucus
Antrum - Gastrin
T/F: GI motility consists of slow waves superimposed by action potentials which propagate the contraction through the GI.
T
Where is it aborbed? Carbs AA Iron Vit B12 Bile Salts
Duodenum/jejunum Duodenum/jejunum Duodenum Terminal ileum Terminal ileum
The combination of the hepatic and bile duct is called the _________.
The common bile duct.
What controls bile release?
Choledochus sphincter - smooth muscle around common bile duct.
What comprise the major and minor papilla in the duodenum?
Major: Sphincter of Oddi - pancreatic/hepatic/GB secretions
Minor: Accessory pancreatic duct
T/F: The liver mixes venous and arterial blood.
T
What are the immune cells of the liver called?
Kupffer (Littoral) cells
Primary or secondary bile acid: Cholic acid Deoxycholic acid Lithocholic acid Chenodeoxycholic acid
Primary - synthesized by the body from cholesterol
Secondary - converted from primary by SI bacteria
Primary
Secondary
Bile acids vs. bile salts.
Acids - conjugated to AA, glycine or taurine
Salts - cholesterol product
What is reticuloendothelial tissue?
Spleen, liver, bone marrow
What is the form of bilirubin that goes into the stool? into the urine?
Sterocobilin
Urobilin
Name the Hepatitis:
Fecal-oral, self-limiting, no chronic state
Chronic, risk for hepatic cancer
Acute and chroic, can lead to hepatic carcinoma, vertical transmission
Hep A
Hep C
Hep B
Name the CN(s): Constrictor muscles (swallowing) Palate elevation and tension Deglutination, open auditory tube Elevate larynx
9 & 10
5 & 10
10
9
How is glucose and galactose absorbed at the brush border? Fructose?
Na+ cotransporter
Facilitated diffusion
Chylomicron or micelle:
In lumen of GI
Exocytosed into lymphatics
Micelle
Chylomicron
Which side of lymphatics drains 3/4 of the body? 1/4?
Left
Right
Name the vitamin deficiency: Night Blindness Beriberi Cheilosis/glossitis Scurvy Macrocytosis/Glossitis/Colitis Burning feet/HA/nausea Microcytosis/neuropathy
A B1 B2 C Folate (B9) B5 B6
Name the vitamin deficiency: Pellagra Pernicious anemia/neuropathy Rickets Ataxia Seborrheic dermatitis/nervous disorders Factor 2,7,9, 10 bleeding disorder
B3 B12 D E (antiox) Biotin K
Name the vitamin and what they do: B1 B2 B3 B5 B6 B12
Thiamin - oxidative carboxylation
Riboflavin - FMN/FAD
Niacin - NAD/NADH, dehydrogenase reactions
Pantothenic acid - Acety-CoA
Pyridoxine (P5P active) - Mg cofactor, used for AA metabolism
Cyanocobolamin - activates conversion of Homocystiene to Methionine
What is the active methyl-transfer enzyme made from folate?
Tetrahydrofolate
Name the vitamin and what they do: Vit C Folate Biotin Vit E
Ascorbate - hydroxylation reaction, reducing agent
B9 - part of methylation cycle
Carboxylase reactions - raw eggs inactive biotin
Tocopherol - minimized peroxide damage to cells
What are the key vitamin-K dependent proteins?
Coagulation proteins: factors 2,7,9, and 10
Anticoagulation proteins: C, S, and Z
Others: Osteocalcin and matrix-Gla protein
What are the fat soluble antiox? water soluble antiox?
Vit E
Asc, Glutathione
They all recycle each other.
Where are the two cell types carotenoids can be broken down into retinol?
Liver and GI cells
T/F: Carotenoid breakdown is dependent on thyroid hormone.
T
What is the active vitamin A hormone?
Retinal
What three tissues use vitamin A?
Eyes, epithelial tissues, gonads - acts as nuclear activator
What form is Vitamin A carried in the chylomicron/lymph system?
Retinyl-ester
What two forms of vitamin D are created in the kidney and what are their effects?
1,25 Dihydro D3 - Increase Ca resorption, absorption, reabsorption.
24,25 Dihydro D3 - Increase Ca deposition, absorption
What are the three organs involved in the creation of active vitamin D?
Skin - U.V. light converts to cholecalciferol
Liver - 25-hydroxylase converts to 25-hydro-D3
Kidney - 1-alpha-hydroxylase converts to 1,25-dihydro-D3
24-hydroxylase converts to 24,25-dihydro-D3
What pituitary hormone stimulates the production of one or the other D3 in the kidney?
+ PTH: 1,25-dihydro-D3 - increase serum Ca
- PTH: 24,25-dihydro-D3 - decrease serum Ca
What substance acts as antioxidant stabilizer in nature/plants? In humans, what do these substances stabilize?
Flavonoids
Mast cells
Where is Co-Q-10 made? What is it’s main use?
Formed in the cholesterol/HMG pathway (decreased w/ Statins)
Powerful antioxidant, preserves Vit E
What are three uses of alph-lipoic acid?
1) Cofactor for mitochondrial energy reactions
2) Substrate for Kreb cycle
3) Antioxidant
4) Sulfur component- weak metal ion chelator
What vitamin preserves/recycle glutathione for the methionine/homocysteine cycle?
Vitamin C
Name the macromineral:
Most abundant cation in the body, mostly in bones
Second most abundant mineral, also in bones
Serves as cofactor, activates B vits, cAMP formation
Major extracellular ion, fluid balance, acid-base
Major intracellular ion, acid-base
Ca++ Phos Mg++ Na+ K+
Name the micromineral:
Namely in Hg, O2 transport
Major cofactor, works with Vit A, needed for taste/vision
Part of cobalamin
Important for glutathione peroxidase, thyroid
Part of cartilage/bone matrix
Insulin function, glucose metabolism
Biosynthesis of thyroid hormone
Needed for cholesterol synthesis, normal brain fxn
In toothpaste, component of calcified tissues
Fe++ Zn++ Cu++ Co++ (Cobalt) Se++ (Selenium) Silicon Cr+++ (Chromium) Iodine Manganese Fluoride
