big fat review Flashcards
1
Q
retroperitoneal organs
A
2nd and 3rd segments of duodenum
kidneys
oesophagus
pancreas
2
Q
2ndarily retroperitoneal organs
A
ascending and descending colon
3
Q
intraperitoneal organs
A
stomach, liver, spleen
4
Q
what do parietal cells do
A
secrete intrinsic factor for absorption of vitamin B12
5
Q
role of jejenum
A
nutrient absoprtion
6
Q
ileum contains
A
payers patches of lymphoid tissue for immune responses
7
Q
ileum absorbs
A
bile acids, water, B12
8
Q
gut is controlled through
A
hormones and neural control
9
Q
Sympathetic control of gut
A
Greater T5-T9 Stomach (epigastric)
Lesser T9-T10 SI to transverse colon (umbilical)
Least T10-11 transverse colon to sigmoid colon (suprapubic)
10
Q
Parasympathetic control of gut
A
vagus nerve (oesophagus to transverse colon)
pelvic splanchnic nerve (transverse colon to anal cana)
11
Q
Enteric nervous system
A
Meissner’s plexus/submucosal (controls blood flow and secretions)
Auerbach’s plexus/myenteric (gut motility and sphincter action)
12
Q
What do enteroendocrine cells do
A
release hormones into the gut
13
Q
Gastrin production and role
A
produced from G cells in the stomach, increase acid secretion
14
Q
CKK production and role
A
Produced by I cels in the duodenum and jejunum, stimulates pancreatic and gallbladder secretion by relaxing sphincter of Oddi
15
Q
Secretin production and role
A
S cells in duodenum, stimulated by acid, causes an increase in bicarbonate and decreases acid production
16
Q
Gastric inhibitory polypeptide production and role
A
Duodenum and jejenum, causes an increase of insulin and decreased acid production
17
Q
Appendicitis pain
A
Central abdo pain due to visceral peritoneum
Right lower abdomen pain due to parietal peritoneum which is somatic
18
Q
Gall stones pain
A
Right upper quadrant and right shoulder tip pain
19
Q
Back pain could be
A
Pancreatitis or AAA
20
Q
Layers of the gut
A
Mucosa
Submucosa
External muscle layer
Serosa
21
Q
mucosa layers
A
epithelial layer (hormones and mucous)
lamina propria (IgA)
muscular mucosae
22
Q
only sphincter under voluntary control
A
external anal
23
Q
Role of enterocytes
A
simple columnar, transport substances
24
Q
Role of goblet cells
A
secrete mucous
25
Role of gastric mucous cells
Secrete mucous containing more bicarbonate
26
Arcuate line above and below
Above = Internal oblique splits
Below = all three muscles anterior to rectus abdominus muscle
27
Where is arcuate line
Halfway between umbilicus and pubic symphysis
28
Permanent folds in GI tract
plica circulares
29
Temporary folds in GI tract
rugae
30
Crypts contents
Stem cells
Paneth cells (antibacterial)
Enteroendocrine cells (secrete hormones)
31
What connects the stomach to the transverse colon
Gastrocolic ligament
32
What connects the stomach to the spleen
Gastrosplenic ligament
33
What connects the liver to the anterior abdominal wall
Falciform ligament
34
What connects the liver to the diaphragm
Triangular ligament
35
Exocrine glands features
Ducts, acini (enzymes and serous), tubules (mucus such as Brunners glands in duodenum)
36
Gut tube features
4th week
endoderm lined
Covered in splanchnic mesoderm
37
Foregut midgut and handout
foregut = oesophagus to midpoint of duodenum
Midgut = midpoint of duodenum and proximal 2/3 transverse colon
Hindgut = distal 1/3 transverse colon, upper anal canal
38
large cavity through which the gut tube descends
intraembryonic coelom
39
respiratory formation
respiratory diverticulum, tracheoesophageal septum
40
Left sac contributes to
greater sac
41
Dorsal and ventral mesentery connected by
epiploic foramen
42
Dorsal mesentery forms
Greater omentum
43
Midgut opening to yolk sac/umbilicus
vitelline duct
44
Rotations
3 x 90 degrees
45
Defects from rotation can lead to
volvulus
46
Yolk sac remnants outcomes
Vitelline cyst, fistula
Meckel's diverticulum
47
Meckel's diverticulum features
2% of population, 2 feet from ileocaecal valve, 2:1 male to female ratio (most common malformation of GI tract)
48
What causes pyloric stenosis
hypertrophy of circular muscle
49
Result of recanalisation failure
Atresia
50
Gastroschisis and omphaleocoele difference
Gastroschisis = not covered, amniotic fluid
Omphalocoele = covered by thin membrane
51
Above and below pectinate line
Above = visceral peritoneum from endoderm
Below = parietal peritoneum from ectoderm (can localise pain) (somatic)
52
Hindgut abnormalities
Imperforate anus (anal membrane doesn't rupture)
Anal agenesis (doesn't migrate down enough)
Hindgut atresia (cloacal dividing defect, abnormal opening)
53
Saliva composition 6
Water
mucins
bicarbonate
amylase
lingual lipase
IgA
54
Neural control of salivary glands
Submandibular and sublingual = facial nerve
Glossopharyngeal does parotid gland
55
What drugs cause dry mouth
Anti muscarinic
56
Swallowing in babies
epiglottis more superior and diverts milk laterally
57
problems with saliva
Xerostomia = dry mouth
Mumps = swelling of parotid gland
58
neural control of swallowing and gag reflex
Mechanoreceptors, glossopharyngeal, medulla, vagus, pharyngeal constrictors
59
3 phases of swallowing:
Oral, pharyngeal, oesophageal
60
Oral phase
voluntary, bolus pushed towards back of mouth, bolus touches pharynx wall
61
Pharyngeal phase
Involuntary, soft palate raises and seals off nasopharynx, pharyngeal constrictor muscles push bolus down, vocal cords close and larynx elevates closing epiglottis, UOS opens
62
Oesophageal phase
involuntary, UOS closes, peristalsis
63
Oesophagus pierces diaphragm at
T10
64
Muscle in oesophagus
Skeletal at top then smooth at bottom
65
4 narrowings in oesophagus
Pharynx
Arch of aorta
Bronchi of left lobe
Just before piercing diaphragm
66
GORD
can cause metaplasia, Barrett's oesophagus
67
what prevents reflux
diaphragm
Smooth muscle
Mucosa rosette
Acute angle of entry
Compression when abdominal pressure rises
68
what makes up a hernia
sac, covering, contents
69
epigastric hernia cause
linea alba during straining
70
Femoral hernia key points
More common in women, can become incarcerated or strangulated
71
inguina canal hernias occur mostly in
men due to processus vaginalis descent
72
Structure of inguinal canal
Floor - inguinal ligament
Roof - internal oblique and transversalis fascia
Posterior wall - transverse abdominus
Anterior wall - External oblique aponeurosis
73
Indirect inguinal hernia
Goes through deep ring and then superficial
Lateral to epigastric vessels
More common on right side as testis descend lower
74
Direct inguinal hernia
Hesselbachs triangle
Inferior epigastric vessels superior border, inguinal ligament inferior border, rectus abdominus medial border
75
3 regions of stomach
cardia, fundus, antrum
76
Cheif cells secrete
Pepsinogen
77
G cells secrete
gastrin
78
Enterochromaffin like cell secretes
histamine
79
D cells secrete
somatostatin
80
Stomach acid roles
proteins unravel, activates proteases/zymogens, innate immune response,
81
what allows more food to enter stomach without raising pressure
receptive relaxation
82
G cells mostly found in
antrum
83
what type of cells found mostly in cardia
mucous secreting
84
What cells are abundant in pyloric region
G and D cells
85
Phases of digestion
Cephalic, gastric, intestinal
86
stomach defenses
mucus, high turnover of epithelial cells, prostaglandins
87
What weakens stomach defenses
alcohol, NSAIDs, helicobacter pylori
88
Chronic gastritis can be caused by
autoimmune or helicobacter
89
Causes of peptic ulcer disease
stomach acid, H pylori, NSAIDs
90
Diagnosing stomach pathology
Endoscopy, urease breath test for helicobacter, CXR, blood test for anaemia
91
Stomach pathology treatments
H pylori - amoxicillin and clarithromycin, stop NSAIDs, PPIs, H2 blockers
92
why is urease produced
bacteria convert urea to ammonium to protect them from stomach acid and help flagella adhere
93
feature of chyme
isotonic
94
Hormones in duodenum
CCK (pancreatic enzymes, Gallbladder contraction and sphincter of Oddi relaxation) and secretin (production of aqueous bicarbonate from pancreas)
95
Pancreatic secretions
mostly endocrine stimulated by vagus nerve, CCK and Secretin
96
When can pancreatic secretions be stopped
blockage of ampulla of vater, amylase and lipase found in blood, gall stones (ascending cholangitis and acute cholecystitis (no jaundice))
97
features of zones of liver
Zone 1 most prone to toxic substance, zone 3 to ischaemia
98
bile acid production and role
secreted by liver and stored in gallbladder, emulsifies fats,
Secreted into canaliculi by hepatocytes, Conjugated to form bile salt
form micelle, chylomicrons
99
billurubin outcomes
Stercobilin and urobilinogen
100
measuring liver/bile duct dysfunction
Coag factors, Albumin, Hb, ALP, AST, Gamma GT
101
types of jaundice
Pre hepatic- dark stools
Intra hepatic- dark urine
Post hepatic - pale stools, urine dark
102
hepatitis consequences
inflammation and necrosis, liver failure, can cause hepatic encephalopathy
103
consequence of liver fibrosis
cirrhosis, varices (oesophagogastric junction, anorectal, ligamentum teres)
104
Causes of bile duct obstruction
gallstones, pancreatic cancer, liver mets
105
cholangitis symptoms
infection in bile ducts from E coli due to obstruction. Fever, pain and jaundice
106
Glucose metabolism
SGLT 1 into enterocytes, GLUT 2 into blood
107
Mineral uptake
Calcium passively paracellularly, needs vitamin D
iron - needs H+ for co transport
108
Protein digestion
Pepsinogen
trypsinogen to trypsin by enteropeptidase
Enzymes either exo or endo peptides
pepT1 into cell and converted to amino acids by cytosolic peptidases
109
coeliac disease
gliadin triggers antibody response, flattened vili and elongated crypts
110
Crohns features
Cobblestone appearance
Skip lesions
Transmural
Perianal disease
Oedema
Granulomas
Strictures
Fistulas
Mouth ulcers
Non bloody stools
111
UC features
Friable mucosa
Loss of haustra
Superficial
Starts at rectum and moves proximal
Only colon
Can cause cancer
Pseudopolyps
Crypt abscesses
Bloody stools
112
other risks of IBD
arthritis, uveitus, cholangitis
113
acute gut ischaemia
embolism from atrial fib is most common cause, large WBC, severe abdo pain
114
Types of gut bleeding
Haematemesis, melaena, haematochezia
115
Causes of GI bleeding
peptic ulcer, oesphageal varices, bleeding diverticula disease, ectopic pregnancy
116
Bowel obstruction results
dehydration, increased haematocrit, vomiting = metabolic acidosis, hypo potassium
117
GI infections usual treatment
fluid rehydration and pain meds, treatment if immunosupressed
118
Water diarrhoea after travelling
Cyclospora parasite or cryptosporidium
119
Campylobacter features
Bloody diarrhoea, grram negative, contaminated poultry
Can lead to reactive arthritis, muscle paralysis
120
Most common cause of epidemic gastroenteritis
Nororvirus
121
Shigella features
Shiga toxin, bloody diarrhoea, gram negative rod
122
oesophageal cancer
dysphagia presentation
Squamous cell carcinomas mostly (lower 1/3rd can be adenocarcinoma)
123
gastric cancer
adenocarcinomas, in cardia or antrum (can be gastric lymphomas or stromal tumours)
124
Upper Gi symptoms
dysphagia, epigastric pain, malaria, haematemesis, Jaundice
125
Lower GI symptoms
obstruction, per rectum bleeding, tenesmus, changes in bowel habits
126
Reasons for changes in bowel habits
Thyroid, IBD, drugs, coeliac disease, cancer
127
Liver cancer common presentation
Jaundice, hepatomegaly, craggy liver, ascites
Hepatocellular carcinoma, common site for mets
128
Pancreatic cancer
painless jaundice
adenocarcinoma
mostly in head
129
Large bowel cancer
adenocarcinoma
polyps can become cancerous
left side of colon
obstructive symptoms
