Anderson Digestive Flashcards by Meg Hammel

What condition is parotitis and orchitis associated with?

Mumps

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What is the difference in muscle between the lower and upper esophagus?

Upper: striated muscle
Lower: smooth muscle

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What is the most common type of hiatal hernia?

Sliding

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What are some common causes of esophageal varices?

Portal HTN, alcoholic cirrhosis

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What is a sequelae of GERD that can lead to adenocarcinoma?

Barrett’s esophagus - squamous cells converted to columnar gastric cells

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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)

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Main artery to stomach? Veins?

Innervation of stomach?

Celiac a.
Gastric v. to portal v.

Sympathetic, splanchnic preganglionics, celiac plexus, parasympathetic (vagus)

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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

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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

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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)

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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

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What is the name of the longitudinal smooth muscle in the large intestine? What are the pouches in the wall called?

Teniae coli

Haustra

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Name the colon segments in order.

Ascending, hepatic flexures, transverse, splenic flexures, descending sigmoid

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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

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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

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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

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T/F: 60% of pancreatic cancer is the head.

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What is migratory thrombophlebitis/clots assoc. with pancreatic cancer?

Trousseau’s syndrome

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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

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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

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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.

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Where does the inferior mesenteric vein drain? (hepatic v. or splenic v.)

Splenic!

Then hepatic

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The short gastric v. drains into the ______ which drains in the _______.

Gastroepiploic v.
Inf. mesenteric v.

Breaks the rules!!

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What conditions could lead to portal HTN? What are signs of portal HTN?

Liver cancer, alcoholism/cirrhosis, pregnancy.

Hemorrhoids, esophageal varices, caput medusae

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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.

``` 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.

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.

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 ```