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GI/Endo/Repro > Assessment 1 > Flashcards

Assessment 1 Flashcards

1
Q

Parotid gland

A

Serous secretions

Salt, water, alpha amylase, lysozyme, lactoferrin

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2
Q

Submandibular gland

A

Mucins

More mucus, less water

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3
Q

Duodenum absorption

A

Water, iron, calcium

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4
Q

Jejunum absorption

A

Nutrients: sugars, AA, NaCl, Fe, Water

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5
Q

Ileum absorption

A

Bio salts

Bile salts

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6
Q

Colon absorption

A

NaCl, SCFA’s, Water

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7
Q

Mucins

A

Lubrication

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8
Q

Salivary alpha amylase

A

Digest starch/carbohydrates

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9
Q

Lingual lipase and salivary lipase

A

Digest fats

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10
Q

Lysozyme, secretory IgA, lactoferrin

A

Bacteria-static/cidal

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11
Q

Haptocorrin

A

Vit B12 chaperone

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12
Q

Exocrine pancreas

A

Alpha amylase
Trypsin, chymotrypsin, carboxypeptidase A/B and elastase
Lipase/Colipase
Nucleases

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13
Q

Splanchnic circulation

A

Portal vein from intestine directly to liver

Storage/metabolism/detoxification

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14
Q

Liver blood flow (2)

A

Portal vein: 80% input, nutrient rich, absorbed bile salts

Hepatic artery: 20% input, oxygen

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15
Q

GI smooth muscle

A

All smooht muscle except pharynx, 1st part of esophagus, external anal sphincter

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16
Q

3 layers of GI SM

A
  1. Outer longitudinal
  2. Inner circular
  3. Innermost oblique (stomach only)
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17
Q

SM contraction pathway

A

Ca binds calmodulin –> MLCK –> myosin phosphorylated –> contraction

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18
Q

Submucosal Plexus

A

Meissner’s

Between mucosa and circular muscle layers

Senses environment in lumen. Regulates GI blood flow, epithelial cell function

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19
Q

Myenteric plexus

A

Between circular and longitudinal layers

Larger and more cell bodies
Control motility

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20
Q

Peristalsis and interneurons

A

Distention sensed by mucosa

Interneurons contract proximal SM and relax distal SM

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21
Q

Interstitial Cells of Cajal

A

Pacemakers of GI tract, spontaneous electrical rhythmicity

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22
Q

3 stages of deglutition

A

Oral (voluntary): tongue movs bolus back and swallowing occurs

Pharyngeal (reflex): Pharynx momentarily becomes pathway for swallowing

Esophageal: Peristalsis

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23
Q

Esophageal phase

A

Bolus entering initiates primary peristalsis, LES/proximal stomach relaxes

Continued distention initiates secondary peristalsis

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24
Q

Lower esophageal sphincter relaxation (3)

A
  1. Swallowing
  2. Secondary peristalsis
  3. Transient LES relaxations
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25
Q

Ileal brake

A

Undigested food arrives in ileum –> gastric emptying/SI transit slowed

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26
Q

Duodenal phase

A

Endocrine: CCK
Paracrine: Serotonin via 5-HT4 receptor –> duodenal contraction

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27
Q

Migrating Motor Complex (MMC)

A

GI housekeeper

Sweep secretions and undigested food through SI

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28
Q

Large Bowel Contractions (2)

A

Non propagating/segmental: Mixes contents to absorb water - 95%

Propagating contractions (peristalsis): Propels contents forward, 5%, vary in speed/pressure

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29
Q

Slow propagating contractions

A

Less frequent, more powerful, ~6/day

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30
Q

Fast propagating contractions

A

More frequent, low amplitude

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31
Q

Gastro-colic reflex

A

Following meal, colonic motility increases

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32
Q

Defecation reflex

A

Distention of rectum

Rate of filling = urgency

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33
Q

Xerostomia

A

Lack of salivary secretions

Leads to cavities

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34
Q

Salivary secretion regulation

A

Autonomic nervous control

Para/Symp action on acinar cells, increase secretion

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35
Q

Alpha amylase (action and location of secretion)

A

Digest complex carbohydrates

Parotid: minor
Pancreas: Excess

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36
Q

Carbohydrate digestion in SI

A

Luminal enzymes in SI

Reduce variety of molecules (Fructose, Glucose, Galactose)

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37
Q

Lactase deficiency

A

Lactose cannot be absorbed, creates osmotic gradient in lumen and osmotic diarrhea

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38
Q

Sugar absorption channels

A

SGLT1 - Na dependent Glu transport

GLUT5 - Fructose

GLUT2 - basolateral Glu/Fru transport

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39
Q

Zymogens

A

Enzymes that need to be activated

Pepsinogen + HCL –> Pepsin

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40
Q

Pancreatic zymogen activation

A

Enteropeptidase (intestinal epithelium) + Trypsinogen –> Trypsin

Trypsin activates pancreatic zymogens

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41
Q

Peptide/AA absorption

A

Protein digested in lumen or surface peptidases

AA absorbed all the way through

Dipeptides absorbed all the way or digested to AA by cytoplasmic peptidases

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42
Q

Protein absorption channels

A

PEPT1 - H/dipeptide cotransport

Na/AA co transport

AA transport

100% absorbed by end of jejunum

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43
Q

2 phases of fat absorption

A

Luminal

Mucosal

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44
Q

Steps of Luminal phase

A

Fat emulsification
Lipolysis
Solubilization by bile salts
Diffusion to mucosa

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45
Q

Fat emulsification

A

Breakdown of large fat droplets to smaller ones via motility

Stabilized by amphipathic fatty acids, dietary protein

Need pH > 6

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46
Q

Lipolysis

A

Breakdown of triglycerides/fatty acids

Pancreas is major source of lipases

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47
Q

Pancreatic lipase and bie salts

A

Bile salts block pancreatic lipase

Need colipase to prevent bile salt inhibition

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48
Q

Bile salt secretion - CCK involvement

A

Dietary fats activate I cells which release CCK

CCK contracts gallbladder and relaxes sphincter of Oddi = Bile salt release into gut lumen

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49
Q

Micelle

A

Bile salts surround emulsified fats/vitamins/cholesterol etc

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50
Q

Micelle benefits

A

Slower diffusion time

Much higher concentration of fatty acid diffused via micelle

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51
Q

Mucosal phase steps

A

Uptake into intestinal epithelial cells
Transport to ER
Resynthesis of TG
Formation of Chylomicron

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52
Q

Uptake into intestinal epithelial cells

A

FABP bind to FA and MG

FABP lowers FA concentration

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53
Q

Transport to ER

A

FABP transports FA /MG to smooth ER if C chain > 12

Straight to blood if C chain short

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54
Q

Smooth ER step

A

Triglycerides and phospholipds reformed

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55
Q

Chylomicron formation

A

Occurs in Golgi

Formed by TG, phospholipids, cholesterol, protein

Apoproteins guide to basolateral side

Enter lacteal and lymphatic system –> blood

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56
Q

Achalasia

A

Failure to relax of smooth muscle in any region of GI

Loss of enteric inhibition = no relaxation

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57
Q

Inhibitory nitrergic neurons

A

Within myenteric plexus, mediate inhibition at LES

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58
Q

Esophageal Achalasia

A

Failure of LES relaxation - loss of nitrergic neuronal inhibition

Viral or inflammation–>autoimmune that results in myenteric plexus inflammation

Esophagogram: Birds beak appearance

Dysphagia, regurgitation (non bilious/acidic), weight loss, chest pain (rare)

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59
Q

Distal Esophageal spasm

A

DES

Uncommon disorder, impairment of neural function - corkscrew sign

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60
Q

DES vs Achalasia

A

Achalasia has no LES relaxation

DES has relaxation but timing is off

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61
Q

Infantile hypertrophic pyloric stenosis

A

Non bilious vomiting in infants

Gastric outlet obstruction, pyloric antrum abnormalities

Olive like mass, RUQ

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62
Q

Hirschsprung disease

A

Lack of innervation of large bowel portions, cannot move stool

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63
Q

Internal anal sphincter Achalasia

A

Similar to Hirschsprung but ganglion cells present

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64
Q

Gastroparesis

A

Stomach cannot empty

Can be associated with diabetes

No mechanical obstruction

Bloating, nausea, vomiting

Test gastric emptying with radioactive marker

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65
Q

Dumping syndrome

A

Rapid gastric emptying

Large food particles delivered to SI and hard to digest

Osmotic gradient into lumen and osmotic diarrhea

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66
Q

Early vs late dumping

A

Early: Soon after eating
GI symptoms and vasomotor symptoms: flushing, perspiration, tachycardia, hypotension

Late: Delayed onset. Hypoglycemia, sweating, hunger, weakness, confusion, syncope

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67
Q

Intestinal Pseudo obstruction

A

Rare disorder

Repetitive/continuous symptoms of bowel obstruction

Dilated bowel in absence of lumen occlusion

Abdominal distention, bilious vomiting, Const/Diar

Absence of ICC’s

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68
Q

Functional gastrointestinal disorders

A

Various disorders with combo of ab pain/discomfort and changes in bowel habits

Functional heartburn
IBS

Typical symptoms, normal PE, absence of alarm symptoms (GI bleed, fam history of colorectal cancer, weight loss)

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69
Q

IBS

A

Irritable Bowel Syndrome

Recurrent Ab pain or discomfort at least 3 days a month with: improvement with defecation, change in stool frequency, change in stool appearance

IBS-C
IBS-D
IBS-M

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70
Q

Functional Dyspepsia

A

No structural abnormality

Epigastric pain, epigastric burning, early satiation, bothersome postprandial fullness

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71
Q

COnstipation

A

Infrequent bowel movements, passage of hard stools

Motility abnormality: Decrease in HPAC

Drug induced abnormality: Increase mixing contractions, decrease propagating contractions

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72
Q

Metoclopramide

A

Prokinetic agent

Antireflux, gastroparesis, anti emetic

UGI dopaminergic stimulation

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73
Q

Cisapride

A

UGI - prokinetic

Gastroparesis

5-HT4 agonist - enhance ACh release

Not used in US because of arrhythmias

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74
Q

Bethanechol

A

Prokinetic

Gastroparesis

Cholinergic agonist

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75
Q

Dumping syndrome treatment

A

Dietary manipulation

Medications (usually not necessary): PPI - slow digestion
Anti-cholinergic/octreotide - slow transit

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76
Q

Intestinal pseudo obstruction meds

A

Prokinetic:

Neostigmine

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77
Q

Physiological control of emesis (4)

A

Chemoreceptor zone: 5HT4, D2, NK1

Vestibular: H1, Muscarinic

Cerebral cortex

GI: 5HT3, D2, NK1

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78
Q

CNS anti emetics

A

Phenzothiazines

Ethanolamines

Piperazines

Cannabinoids

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79
Q

ANS antiemetics

A

Anti-cholinergics

80
Q

CNS and ANS anti emetics

A

Metoclopramide

Ondansetron - selective hHT3 antagonist

81
Q

IBS drugs

A

Antismasmodics

Tricyclic antidepressants

SSRI’s

Bulk forming laxatives

Antimotility agents

5HT3 antagonists

5HT4 agonists - cisapride (not in US)

82
Q

Sympathetic Route 1

A

Preganglion fiber –> white ramus –> paravertegral ganglion –> synapse –> gray ramus –> postganglionic axon

83
Q

Sympathetic Route 2

A

Preganglion –> white ramus –> travel up/down paravertebral ganglion –> synapse –> gray ramus –> postganglionic axon

84
Q

Sympathetic route 3 (Thoracic)

A

Preganglion –> white ramus –> synapse –> splanchnic nerve to target

85
Q

Sympathetic route 4

A

Preganglion –> white ramus –> splanchnic nerve to target organ –> synapse on organ

86
Q

Aortic plexus

A

Pre/post ganglionic sympathetic fibers
Prasympathetic fibers
GVA’s

87
Q

Superior hypogastric plexus

A

Formed from aortic plexus that juts out at bifurcation

88
Q

Right and Left hypogastric nerves

A

Bifurcation of superior hypogastric plexus at sacral promontory

89
Q

Pelvic splanchnic nerves

A

S2-4 intermediolateral cell column

90
Q

Inferior hypogastric plexus

A

Pelvic splanchnic + Hypogastric nerves

91
Q

Sacral Splanchnic

A

From sacral sympathetic chain

GVE

92
Q

Greater splanchnic nerve

Level, ganglion location

A

T5-9
Celiac ganglion
Foregut

93
Q

Lesser splanchnic nerve

Level, ganglion

A

T10-11

Superior mesenteric ganglion

94
Q

Least splanchnic nerve

A

T12

Aorticorenal ganglion

95
Q

Salivary Acini HCO3 secretion (channels)

A

NKCC = solute entry
Cl + HCO3 co transport exit
Water goes through

96
Q

Salivary Duct HCO3 secretion

A

N/K ATP-ase

HCO3/Cl exchange
Bicarb out, Cl in

Na/K exchange on luminal side

Hypotonic KHCO3 fluid

97
Q

High flow - salivary secretion

A

Only Acinar

98
Q

Low flow - salivary secretion

A

Duct equilibrium

Hypotonic fluid

99
Q

Oxyntic gland

A

Mucus/HCO3

HCl/Intrinsic factor

Pepsinogen

100
Q

Pyloric Gland

A

Mucus/HCO3

Gastrin/Somatostatin

101
Q

Gastric bicarb secretion (channels)

A

Blood CO2 + H20 –> H + HCO3

HCO3/Cl luminal exchange

102
Q

Mucus secretion and protection

A

Mucins and bicarb secreted, cross links with secreted bicarb

Protect stomach lining

Buffers H and blocks pepsin

103
Q

Gastric gland components

A

Chief cell

Parietal cell

104
Q

Chief cell

A

Secretes pepsinogen

105
Q

Parietal cell secretions

A

HCl

Intrinsic factor

106
Q

Parietal cell HCl secretory pathway

A

Gastric H,K-ATPase

H out, K in, K recycled by K channel

107
Q

Intrinsic factor

A

B12 binding protein between duodenum and ileum

Receptor mediated endocytosis and degradation of IF in ileum

108
Q

Haptocorrin

A

Salivary gland B12 binding protein

Degraded by pancreatic proteases

109
Q

Parietal cell HCl regulation

A

H,K-ATPase stored in vesicles

Signal pushes vesicles to membrane, can take time

110
Q

Transcobalamin II

A

Intestinal B12 binding protein

Binds B12 in ileal epithelium, transcellular transit across epithelium

111
Q

PGE2 and stomach protection

A

Increases protective measures: Mucus/bicarb secretion

112
Q

NSAIDS/H pylori and stomach protection

A

Reduce Bicarb secretion

113
Q

Nicotine/gastrinomas/H pylori

A

Increase acid secretion

114
Q

Regulation of acid secretion: ECL/Gastrin/Somatostatin/Pasaymp control

A

ECL: Release histamine, acts on parietal cell to increase H,K-ATPase activity

Gastrin: Regulates ECL
More H,K-ATPase in parietal cells

Somatostatin: Inhibits Gastrin

Parasympathetic ACh: Stimulates Gastrin, Parietal cell
Inhibits Somatostatin

115
Q

Duodenal Bicarb secretion

A

Electrogenic or Electroneutral NaHCO3 secretion

HCO3/Cl exchange
HCO3 channel

116
Q

Cholera toxin mechanism

A

Via cAMP: Stimulates Cl secretion into lumen, inhibits Na/Cl uptake into epithelial cell

Diarrhea

117
Q

Enterotoxin vs Cytotoxin

A

Enterotoxin: Biochemical alteration only

Cytotoxin: Morphological alterations

118
Q

Inflammatory vs non inflammatory diarrhea

A

Non inflammatory: Watery, no blood, dehydration

Inflammatory: Mucoid and bloody, ab pain, small volume

119
Q

Exocrine pancreas secretions

A

Acinar: 80% Enzymes/NaCl

Duct cells: 5%
NaHCO3/water

120
Q

Pancrease secretion and flow

A

high flow = ductal

Low flow = acinar

121
Q

Pancreatic bicarb secretion channels

A

HCO3/Cl exchange with Cl recycling

Carbonic anhydrase

122
Q

Pancreatic regulation by duodenum

A

Fat –> I cells –> CCK –> act on acinar cells –> stimulate protein secretion

Acid secretion –> S cells –> Secretin acts on duct cells –> bicarb secretion

123
Q

Gut tube embryological origin

124
Q

Secondary retroperitoneal structures

A

Duodenum
Pancreas
Ascending and descending colon

125
Q

Foregut, midgut, hindgut blood supply

A

Foregut: Celiac artery
Midgut: Superior mesenteric artery
Hindgut: Inferior mesenteric artery

126
Q

Ventral mesentery associated with….

127
Q

Esophageal atresia

A

Blind ending esophagus

128
Q

Esophageal stenosis

A

Esophageal narrowing

129
Q

Esophagotracheal fistula

A

Esophagus connected to trachea

130
Q

Polyhydraminos

A

Cannot swallow amniotic fluid –> Buildup of amniotic fluid

131
Q

Stomach development

Vagal nerve location

A

Dorsal end grows (greater curvature)

Rotates 90 degrees so greater curvature is on left

Left vagal nerve becomes anterior, right becomes posterior

132
Q

Pyloric stenosis

A

Thickening of muscle that happens several weeks after birth

Palpable olive in RUQ, projectile vomiting

133
Q

Spleen mesenchymal location

A

Within dorsal mesegastrium

134
Q

Spleen development after stomach rotation

A

Spleen rotates to left

Divides dorsal mesogastrium into gastrosplenic and splenorenal ligaments

135
Q

Duodenal atresia

A

Vomiting with bile

Due to recanalization of duodenum

Double bubble sign

136
Q

Liver development

A

Grows into ventral mesentary, touches diaphragm

Separates ventral mesentery into falcoform ligament and lesser omentum

137
Q

Lesser omentum containsL

A

Hepatogastric ligament

Hepatoduodenal ligament

138
Q

Pancreas development

A

Ventral bud swings around right of duodenum, fuses with dorsal bud

Ducts connect and form main pancreatic duct

139
Q

Annular pancreas

A

Ventral buds rotate in opposite direction and constrict bile opening

140
Q

Greater omentum formation

A

Expansion of gastrosplenic ligament

141
Q

Midgut development

A

Primary intestinal loop herniates into umbilical cord –> 90 degree rotation (SI on right, LI on left) –> rotates 180 degrees and pulls back in

142
Q

Intraperitoneal viscera

A

Stomach
Jejunum/Ileum
Transverse colon
Sigmoid colon

143
Q

Omphalocele

A

Abdominal contents protrude through umbilical ring - normal herniation that doesn’t return to ab cavity

Contents covered by amniotic cavity/parietal sac

144
Q

Gastroschisis

A

Ab contents protrude through ab wall

NOT covered by parietal sac/ amniotic cavity

145
Q

Umbilical hernia

A

Less severe omphalocele

Ab contents protrude through umbilical ring to lesser extent

Covered by skin

146
Q

Non rotation

A

Absence of second 180 degree rotation

Left sided colon

147
Q

Reversed rotation

A

180 degree rotation in wrong direction

148
Q

Mixed rotation

A

All other rotational disorders

149
Q

Volvulus

A

Twisting of intestines around itself = obstruction/ischemia

150
Q

Ileal (Meckel’s) diverticulum

A

Incomplete regression of vitelline duct

Diverticulum, cyst, fistula

151
Q

Cloaca development

A

Primitive urogenital sinus and rectum

152
Q

Cloacal membrane development

A

Urogenital membrane

Anal membrane

153
Q

Formation of anus

A

Anal membrane mesoderm thickens and sinks in = anal pit

Anal membrane breaks down

154
Q

Anal agenesis

A

Anal pit fails to form

Most difficult to fix

155
Q

Imperforate anal membrane

A

Failure of anal membrane to breakdown

156
Q

Anal stenosis

A

Incomplete breakdown of anal membrane

157
Q

Lesser sac formation

A

Liver swings to right and decreases space

Lesser sac behind stomach because of stomach rotation

158
Q

Interdigestive period

A

MMC’s every 90min

Motilin initiates MMC

159
Q

Motilin regulation

A

Duodenal acid
Vagus stimulation

Initiates MMC/increase gastric emptyin

160
Q

Digestive period phases

A

Cephalic phase
Gastric phase
Early Intestinal phase
Late Intestinal phase

161
Q

Cephalic phase

A

Neuronal stimuli (thinking about food)

Salivary secretion
Acid release via gastrin
Pancreatic enzyme/bile secretion via gastrin

162
Q

Gastric phase

A

Gastrin increases = Acid secretion into stomach

Lower salivary secretion

163
Q

G17 vs G34 Location & difference in food states

A

Antrum: G17
Duodenum: G34

Fasting: G34 > G17
Post prandial: G17 = G34

Food = G17 increase

164
Q

Gastrin regulation

A

Gastrin releasing peptide (Parasymp control)

Peptides/AA/Calcium

Somatostatin (-)

Low pH (-)

165
Q

Early intestinal phase

A

Low Gastrin and Motilin
More Secretin, CCK, Incretins

Fed motility pattern: Short peristaltic waves + segmentation to mix

166
Q

Secretin

A

Released from S cell in response to acidic environment

Act on Pancreas, release HCO3 from duct

167
Q

CCK

A

Need to be sulfonated and amidated to function

Gall bladder contraction/S o Oddi relaxation

Pacreatic release of enzymes from acinar cells

168
Q

Monitor peptide

A

Actively digested by proteases/lipases

No proteases/lipases = active monitor peptide = stimulation of I cell and CCK release

169
Q

Incretins

A

GLP-1
GIP

Luminal glucose releases into blood –> plasma glucose induces incretins to release insulin from pancreas

170
Q

Late intestinal phase

A

Food enters colon
Decrease CCK/Secretin
Bile salts recaptured
Motilin and MMC return

171
Q

Adenocarcinoma of esophagus

A

Distal esophagus

Associated with Barrett, dysplasia, reflux esophagitis

172
Q

Low grade dysplasia

A

Increased proliferation

Increased N:C ratio

173
Q

High grade dysplasia

A

Loss of nuclear polarity

Bizarre glandular architecture

174
Q

Squamous cell carcinoma

A

90-95% esophageal cancers

Alcohol, smoking, diet, HPV

175
Q

2 Histological types of gastric cancer

A

Intestinal: Differentiated, chronic gastritis, high risk areas

Diffuse: Less differentiated, de novo, Signer ring cells

176
Q

GIST

A

Gastrointestinal stromal tumor

Stomach>SI>other

ICC?

177
Q

PUD drug combinations

A

Clarithromycin+amoxicillin/metronidazole + PPI

Clarithromycin + tetracycline + PPI

178
Q

Antacid types

A

Aluminum
Magnesium
Calcium

179
Q

Aluminum antacid

A

Least potent
Constipation
Phosphate binder

180
Q

Magnesium antacid

A

Most potent, diarrhea, hypermagnesemia

181
Q

Calcium antacid

A

Rapid, constipation, hypercalcemia/alkalosis

Good Ca supp

182
Q

H2 antagonists

A

Cimetidine: P450 inhibitor - drug interactions

CNS side effects

183
Q

Misoprostil

A

Stimulates PGE2 receptors

Inhibits acid secretion, promotes bicarb/mucus secretion

Limited to active PUD

184
Q

Sucralfate

A

Combines with protein exudate to form barrier around ulcer base

Minimal side effects

185
Q

PPI

A

Omeprazole

186
Q

GERD drugs

A

Metaclopramide
Cisapride
Bethanechol

187
Q

Neonate bilious vomit –> Few dilated loops = ?

A

Proximal bowel obstruction - UGI

188
Q

Neonate bilious vomit –> Many dilated loops = ?

A

Distal bowel obstruction - Enema

189
Q

UGI –> Duodenal obstruction/corkscrew

A

Midgut volvulus

190
Q

Midgut volvulus scan characteristics

A

Doppler flow

SMA/SMV switched

191
Q

UGI –> double bubble

A

Duodenal atresia

192
Q

UGI –> multiple bubble

A

Jejunal atresia

193
Q

Enema –> small distal w/ size transition

A

Hirschsprung disease

194
Q

Enema –> small colon w/ abrupt end

A

Colonic atresia

Very dilated loops

195
Q

Enema –> micro-colon/pearls on a string/abdominal distention

A

Meconium ileus

Cystic fibrosis

196
Q

Enema –> micro colon/TI abruptly ends/failure to pass meconium

A

Ileal atresia

197
Q

Enema –> Colitis/micro colon/Looks like a fucking disaster

A

Total Hirschsprung disease

GI/Endo/Repro (8 decks)

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