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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
Crohns vs UC
Crohns: skip lesions, more blood, more pain, fistulas UC: more diarrhea, only rectum or continuous with whole colon
26
acute pancreatitis
abd pain, heavy alcohol use, autodigestion by proteases and lipase, elastases digest vessel walls, necrotic fat cells lab: increase in amylase and lipase
27
acute liver failure
overwhelm liver with toxins fulminant hep go into kidney failure too
28
chronic liver failure
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
cholestasis
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
blood supply to esophagus and stomach | to duodenum, small intestine, ascending colon, transverse colon
celiac | inf mesenteric
31
what are the three blood supplies to stomach and what do they branch from?
- 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
portal (venus) circulation | where does portal vein come from?
inf mesenteric vein drains through splenic veins | sup mesenteric meets splenic and they become portal vein
33
where do right and left gastric veins drain? where does short gastric vein drain?
right and left gastric veins drain into portal short gastric into gastroepiploic that drain into sup mesenteric vein
34
portal venus drainage fails with portal HTN because ____ and this leads to ____ what diseases cause this?
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
when are varices and hemerroids common?
pregnancy and liver malfunction
36
what causes caput medusae
periumbilical veins which can't drain in later pregnancy, portal HTN due to liver damage
37
mucosa of stomach submucosal plexus is there for myenteric plexus is there for
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
histamine ____ | G cells secrete ____
stimulates gastric H+ | gastrin
39
what do somatostatin and histamine do? What are they?
somatostatin: inhibits GI hormone release and acid secretion histamine: stimulates gastric acid H+ secretion - both are paracrines
40
what secretes CCK and what does it do?
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
where is secretin secreted and what does it do?
secreted from S cells of duodenum increases pancreatic and biliary bicarb secretion decreases gastric acid secretion because stomach is empty
42
where is GIP secreted and what does it do?
duodenum and jejunum | increases insulin secretion and decreases H+ secretion
43
what stimulates the release of bile?
CCK from duodenum and jejunum
44
- what do chief cells secrete? - parietal cells - mucus cells - G cells
- chief cells: pepsinogen - parietal cells: HCl and intrinsic factor (IF) - mucus cells: mucus - G cells: gastrin
45
``` where are carbs digested? amino acids iron vit B12 bile salts fatty acids lipids proteins ```
``` 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
where is the common hepatic duct in relation to the common bile duct?
hepatic duct is above cystic duct and bile duct is below
47
one organ that can mix arterial and venus blood | this blood is presented to
liver | hepatocytes
48
kupfer cells | bile canaliculi
in liver - immune cells | produce bile
49
what is bile created from? what does bile do? most bile is
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
how do you hold on to bile? | why do you want to hold on to bile?
fiber | so that liver is forced to use more cholesterol to make more bile
51
how are bile acids conjugated to form bile salts?
glycine and taurine
52
urobilinogen and stercobilinogne
urobilinogen: reabsorbed and absorbed by kidneys and excreted as urobilin stercobilinogen: stays in stool and gives it color
53
rate limiting step in bile acid synthesis
hydroxly group introduced at carbon 7 by 7-alpha-hydroxylase | inhibited by cholic acid
54
what type of hepatitis can lead to hepatic carcinoma? which type is related to transfusions?
hep B B and C
55
liver cancer | what is it associated with?
hepatocellular carcinoma | HBV/HCV, cirrhosis, viruses
56
4 F's of cholelithiasis?
Female Fat Forty Fertile
57
2 types of stones in gallbladder
cholesterol and pigment (unconjugated bilirubin)
58
where do medium and long chain fatty acids go?
to lymph, not blood stream as chylomicrons
59
where does right lymphatic drain? | left?
right subclavian | left subclavian via thoracic duct
60
where does lipid absorption start?
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
deficiencies: A,D,E,K
A: night blindness D: rickets, osteomalacia E: ataxia K: factor 2,7,9,10 bleeding disorders
62
Vit B deficiencies
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
How does B12 free folate?
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
in what type of reactions is vitamin c used biotin?
hydroxylation reactions cofactor in carboxylation reactions
65
what does vit K do besides clotting?
moves Ca in body | CT and bone function
66
vitamin A forms storage form?
retinol (active) retinol ester (non active) cartotinoids (two retinols together): want to reduce to retinol - thyroid needs retinol ***storage form: retinol palmate
67
parietal cells secrete chief cells secrete enteroedocrine
Hcl pepsin gastrin (from G-cells)
68
3 organs involved in vit D synthesis
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
what preserves glutathione? what is needed to make glutathione?
vit C cysteine and methionine and glycine make glutathione

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