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Anderson Digestive Flashcards

1
Q

what innervates constrictor/swallowing muscles

A

CN 9 and 10 (mostly 10)

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2
Q

what innervates stylopharyngeus muscle?

A

CN9

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3
Q

what innervates and elevates palate?

A

CN 5 and CN 10

levator tensor palati

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4
Q

where is esophagus
what does it go through
innervated by

A

behind trachea
through esophageal hiatus in diaphragm
CN 10 (vagus)

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5
Q

what kind of muscle in esophagus?

A

upper is voluntary swallowing striated muscle

lower is involuntary peristalsis smooth muscle

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6
Q

most common pharyngeal cancer caused by smoking

A

SCC

spread to cervical LN etc

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7
Q

What needs to be ruled out with GERD?

A

hiatal hernia

sliding is most common

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8
Q

esophageal varices are often caused by

A

portal hypertension

- also alcoholic cirrhosis

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9
Q

metaplasia of distal esophagus is called ___

this causes what histological change____ and predisposes for _____

A

Barrett’s esophagus
squamous cell converts to columnar gastric cells
adenocarcinoma

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10
Q

layers of muscle in stomach

A

internal: oblique
middle: circular
external: longitudinal

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11
Q

attachments of stomach

main artery

A 
lesser omentum (hepato duodenal, hepato gastric ligaments)
greater omentum (peritoneal ligament): lots of fat and circulation off greater curvature of stomache.
  • celiac arteri (L and R gastric)
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12
Q

acute gastitis caused by

chronic gastritis caused by

A

NSAIDS, ETOH, smoking, stress
- erosions

autoimmune, loss of parietal cells and IF, H pylori, B12 def
- no erosions

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13
Q

immune mediated destruction of parietal cells in stomach

A

hypochlorhydria

  • also caused by chronic gastritis and hoshimotos thyroiditis, Addison’s
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14
Q

H. pylori predisposes ___

A

adenocarcinoma

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15
Q

compare gastric and duodenal ulcers

A

gastric: burning post-eating, better antacid, milk
duodenal: burning epigastric 1-3 hours after eating. Better eating, antacids

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16
Q

compare jejunum and ileum

A

ileum is longer, so has more blood flow, etc.

jejunum is shorter and less blood flow and lymphatic drainage, but there is more digestion going on.

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17
Q

where do mesenteries originate from

A

post abdominal wall

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18
Q

what could ileus or intususseption in adults be a sign of?

A

ischemic infarctive or metastatic cancer

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19
Q

involuntary smooth muscle

A

GI
resp
urinary
genital

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20
Q

what happens to muscle layers when you get to colon

A

lose layers of smooth muscle and have teniae coli: longitudinal bands that run length of colon to keep feces moving forward without peristalsis.

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21
Q

internal anal vs external anal sphincter

A
  • internal is smooth muscle and responds to stretch, autonomic control
  • external is striated muscle pudendal nerve and cognitive activity
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22
Q

iliocecal junction

A

end of ileum

cecum (appendix)

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23
Q

where is diverticulitis most common?

A

sigmoid colon

like appendicitis but on the left side

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24
Q

familial polyposis have increased risk for ___

A

colorectal cancer

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25
Q

Crohns vs UC

A

Crohns: skip lesions, more blood, more pain, fistulas

UC: more diarrhea, only rectum or continuous with whole colon

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26
Q

acute pancreatitis

A

abd pain, heavy alcohol use, autodigestion by proteases and lipase, elastases digest vessel walls, necrotic fat cells

lab: increase in amylase and lipase

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27
Q

acute liver failure

A

overwhelm liver with toxins
fulminant hep

go into kidney failure too

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28
Q

chronic liver failure

A

liver slowly dying
hypogonadism (phase 1 detox converts hormones and phase II…)
clotting problems (makes clotting proteins)
erythema
encephalopathy due to urea buildup because kidneys aren’t functioning

29
Q

cholestasis

A

prehepatic causes:end up with unconjugated bilirubin because liver can’t convert

extrahepatic: conjugated bile, but it backs up because it can’t get out

30
Q

blood supply to esophagus and stomach

to duodenum, small intestine, ascending colon, transverse colon

A

celiac

inf mesenteric

31
Q

what are the three blood supplies to stomach and what do they branch from?

A
  • splenic artery from celiac trunk gives short gastric and gastroepiploic arter that supply left side of stomach
  • left gastric: back left side of stomach off celiac trunk
  • right gastric from hepatic artery supplies right stomach

*all from celiac trunk

32
Q

portal (venus) circulation

where does portal vein come from?

A

inf mesenteric vein drains through splenic veins

sup mesenteric meets splenic and they become portal vein

33
Q

where do right and left gastric veins drain?

where does short gastric vein drain?

A

right and left gastric veins drain into portal

short gastric into gastroepiploic that drain into sup mesenteric vein

34
Q

portal venus drainage fails with portal HTN because ____ and this leads to ____

what diseases cause this?

A

portal veins can’t drain which leads to ascites and engorgement form anastamotic areas.

any liver disease causes this and so does third trimester of pregnancy

35
Q

when are varices and hemerroids common?

A

pregnancy and liver malfunction

36
Q

what causes caput medusae

A

periumbilical veins which can’t drain in later pregnancy, portal HTN due to liver damage

37
Q

mucosa of stomach
submucosal plexus is there for
myenteric plexus is there for

A

longitudinal muscle is outer decreases length
inner circular muscle: decreases diameter

submucosal/meissners plexus for gland secretion
myenteric/auerbach’s plexus for smooth muscle contractions/motility

38
Q

histamine ____

G cells secrete ____

A

stimulates gastric H+

gastrin

39
Q

what do somatostatin and histamine do? What are they?

A

somatostatin: inhibits GI hormone release and acid secretion
histamine: stimulates gastric acid H+ secretion

  • both are paracrines
40
Q

what secretes CCK and what does it do?

A

secreted from I cells in duodenum and jejunum
stimulates contraction of gallbladder and relaxation of sphincter of oddi
increases pancreatic enzymes and bicarb secretion

41
Q

where is secretin secreted and what does it do?

A

secreted from S cells of duodenum
increases pancreatic and biliary bicarb secretion
decreases gastric acid secretion because stomach is empty

42
Q

where is GIP secreted and what does it do?

A

duodenum and jejunum

increases insulin secretion and decreases H+ secretion

43
Q

what stimulates the release of bile?

A

CCK from duodenum and jejunum

44
Q
  • what do chief cells secrete?
  • parietal cells
  • mucus cells
  • G cells
A
  • chief cells: pepsinogen
  • parietal cells: HCl and intrinsic factor (IF)
  • mucus cells: mucus
  • G cells: gastrin
45
Q 
where are carbs digested?
amino acids
iron
vit B12
bile salts
fatty acids
lipids
proteins
A 
carbs: duodenum and jejunum
amino acids: duodenum and jejunum
iron: duodenum
vit B12: terminal ileum
bile salts: terminal ileum
fatty acids: mycelized though entire sm intestine
lipids: sm intestine
proteins: sm intestine
46
Q

where is the common hepatic duct in relation to the common bile duct?

A

hepatic duct is above cystic duct and bile duct is below

47
Q

one organ that can mix arterial and venus blood

this blood is presented to

A

liver

hepatocytes

48
Q

kupfer cells

bile canaliculi

A

in liver - immune cells

produce bile

49
Q

what is bile created from?
what does bile do?
most bile is

A

from cholesterol (primary: cholic acid and chenodeoxycholic acid)
secondary: deoxycholic and lithocholic acids are converted from primary bile acids by bacteria
bile micelles fat
most bile is reabsorbed

50
Q

how do you hold on to bile?

why do you want to hold on to bile?

A

fiber

so that liver is forced to use more cholesterol to make more bile

51
Q

how are bile acids conjugated to form bile salts?

A

glycine and taurine

52
Q

urobilinogen and stercobilinogne

A

urobilinogen: reabsorbed and absorbed by kidneys and excreted as urobilin
stercobilinogen: stays in stool and gives it color

53
Q

rate limiting step in bile acid synthesis

A

hydroxly group introduced at carbon 7 by 7-alpha-hydroxylase

inhibited by cholic acid

54
Q

what type of hepatitis can lead to hepatic carcinoma?

which type is related to transfusions?

A

hep B

B and C

55
Q

liver cancer

what is it associated with?

A

hepatocellular carcinoma

HBV/HCV, cirrhosis, viruses

56
Q

4 F’s of cholelithiasis?

A

Female
Fat
Forty
Fertile

57
Q

2 types of stones in gallbladder

A

cholesterol and pigment (unconjugated bilirubin)

58
Q

where do medium and long chain fatty acids go?

A

to lymph, not blood stream as chylomicrons

59
Q

where does right lymphatic drain?

left?

A

right subclavian

left subclavian via thoracic duct

60
Q

where does lipid absorption start?

A

lingual lipase in mouth

stomach: heat liquifies lipids
- gastric lipase breaks down TG, short and med chain FAs which absorb directly into portal circulation

61
Q

deficiencies: A,D,E,K

A

A: night blindness
D: rickets, osteomalacia
E: ataxia
K: factor 2,7,9,10 bleeding disorders

62
Q

Vit B deficiencies

A

B1 (thiamin): beriberi
B2 (riboflavin): (FAD) cheilosis/glossitis (pellegra)
B3 (niacin): (NAD)
B5 (pantothenic acid): burning feet, HA, nausea
B (pyridoxine (PLP): microcytosis, neuropathy
B12 (cyanocobalamin): macrocytosis, pernicious anemia, neuropathy

63
Q

How does B12 free folate?

A

B12 frees folate from its bound form to its coenzyme form (THF) by releasing a methyl group and creates methionine from homocysteine.
N-5-methyl- THF

64
Q

in what type of reactions is vitamin c used

biotin?

A

hydroxylation reactions

cofactor in carboxylation reactions

65
Q

what does vit K do besides clotting?

A

moves Ca in body

CT and bone function

66
Q

vitamin A forms

storage form?

A

retinol (active)

retinol ester (non active)

cartotinoids (two retinols together): want to reduce to retinol
- thyroid needs retinol

***storage form: retinol palmate

67
Q

parietal cells secrete

chief cells secrete

enteroedocrine

A

Hcl
pepsin

gastrin (from G-cells)

68
Q

3 organs involved in vit D synthesis

A

skin: to cholecalciferol
liver: to 25-hydroxyl
kidney: 1-25-dihydro D3 (active)
- Ca out of bone (stim osteoclasts)
- Ca absorption in intestine
- increases serum Ca

69
Q

what preserves glutathione?

what is needed to make glutathione?

A

vit C

cysteine and methionine and glycine make glutathione

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