Block 3 Flashcards
Sumatripan
Serotonin agonist for vomiting
Lingual nerve
Branch of mandibular nerve which provides sensory innervation to anterior 2/3
Which structure lies close to the parotid gland?
Facial nerve
What is the blood supply to the salivary glands?
External carotid artery and retromandibular vein
Where does IVC exit?
T8
What is normal gastirc ph?
2
What is released with gastrin?
Pepsin
When is gastric inhibitory peptide released?
In response to fatty acids
What is the effect of vasointestinal polypeptide?
Produced by small intestines and pancreas, Inhibits gastric acid secretion by stimulating somatostatin release.
Inguinal ligament origin
Arises from the external oblique aponeurosis
Which vessel lies behind the clavicle?
Subclavian vein
Level of hyoid bone
C3
Angle of Louis
Manubriosternal angle which is important indicator for the aortic arch
What lies medial to the dorsalis pedis artery?
Extensor hallucis longus tendon
Where does the inferior thyroid artery originate?
Thyrocervical trunk
Location of chemoreceptor trigger zone
Medulla in the floor of 4th ventricle outside the blood brain barrier
Where does aorta bifurcation occur into left and right common iliac arteries?
L4
Glossopharyngeal nerve
Sensation to posterior 1/3 of tongue
Carotid sheath components
Common carotid artery, Internal carotid artery, Internal jugular vein, Vagus nerve
Carotid sheath
Lies between sternocleoidomastoid and vertebrae. Anteriorly- pretracheal fasica, ansa cervicalis, vagus and hypoglossal nerves. Posteriorly formed-prevertebral fascia.Internal jugular vein, common carotid artery
Vocal folds
Innervated by recurrent laryngeal nerve
Innervation of stylohyoid
Facial nerve
What is the blood brain barrier not hghly permeable to?
Hydrogen ions
Which cahnnels are open during depolarisation?
Voltage gated na+
Which channles are open in repolarisation?
Voltage gated K+ channels
Which channels are open in hyperpolarisation?
Voltage gated Na+ channels that will close
What is the effect of cholecystokinin?
Increases gall bladder contraction and relaxation of sphincter of Oddi espeically after eating fatty food that can cause vomiting. It is produced by pancreatic and small intestine I cells and can cause pain in right abdominal region. It reduces gastric emptying
What is the effect of cholecystokinin?
Increases gall bladder contraction and relaxation of sphincter of Oddi espeically after eating fatty food that can cause vomiting. It is produced by pancreatic and small intestine I cells and can cause pain in right abdominal region. It reduces gastric emptying
S cells
Found in the duodenum and jejunum and roduce secretin to increase bicarbonate, water and electroyltes in pancreatic secretionspancreatic fluid
Effect of somatostatin
Inhibits histamine for gastric acid secretion, glucagon and insulin release, glucose in blood, lipolysis and bicarbonate. It inhibits gall bladder emptying and growth hromones. It decreases volume of secretion and inhibits release of TSH
Where is secretin released?
S cells in duodenum and jejunum
What forms the external spermatic fascia?
External oblique aponeurosis
What is the effect of prostaglandin?
Decrease gastric acid secretion
Pain in right upper oquadrant and intolerance to fatty foods
Gallstone. cholestasis
What reduces iron absorption?
Wholegrains, tea, coffee and wine.
What increases iron absorption?
Gastric acid secretion, vitamin C
What increases pancreatic enzyme secretion?
Cholecystokinin
What increases secretion of water and electroyltes in pancreatic secretions?
Secretin
Gastrin
Prodcued by G cells in stomach antrum. Binds to parietal cells CCK2 receptors to free Ca2+ storesCauses increase in acid secretion, gastric motility, pepsinogen and parietal cell maturation. M3 receptors on parietal cells are stimualted by acetylcholine
Which hormone is an indicator for pancreatic insufficiency?
Secretin
Which cells are in fundus?
Parietal cells and chief cells
What inhibits gastirc acid secretion?
Nausea and stympathetic innervation, somatostaitn, cholecystokinin and secretin
What increases gastric acid secretion?
Vagus nerve, histamine release.
What causes Na+.K+ exchange in salivary ducts?
Aldosterone
Where are bile salts absorbed?
Terminal ileum which is malabsorbed in Crohn’s disease
What is the innervation to the parotid gland?
Glossopharyngeal nerve
What controls endocrine cells of the pancreas?
Pancreatic polypeptide
What contracts behind food in oesophagus?
Circular smooth muscle
What propels food in the oesophagus?
Longitudinal smooth muscle
Where does anti-peristaltic waves occur?
In colon to maximise absoprtion
What is used to reduce diarrhoea?
Issues with pancretic exocrine function
What do chief cells produce?
Lipase and pepsinogen
What stimulates bile flow from liver to gallbladder?
Secretin
How are hydrogen ions produced by parietal cells?
Carbonic anhydrase
What is released in the cephalic phase?
HCL and gastrin from G cells
Which phase is acid secretion lowest?
intestinal phase
What is the effect of excess gastrin?
Malabsorption that leads to diarrhoea, weight loss
Umbilical vein progenitor
Ligamentum teres
Ductus venosus progenitor
Ligamentum venosus
Divison between foregut and midgut
Proximal duodenum
Foregut
Supplied by coeliac trunk, includes the oesophagus, liver, spleen, stomach proximal duodenum
Divison between midgut and hindgut
Splenic flexure- hindgut begins with the descending colon
Midgut
Supplied by superior mesenteric artery and begins with distal duodenum, jejunum, ileum, caecum, appendix, ascending colon, transverse colon
Hindgut
Supplied by inferior mesenteric artery and begins with descending colon, sigmoid colon, rectum, and superior anal canal
Where is vitamin K absorbed?
Colon
Hstology of oesophagus
Stratified squamous epithelia
Histology of oesophageo-gastric junction
Simple columnar epithelia
Histology of upper oesophagus
Skeletal muscle- cricopharyngeal and inferior constrictor muscle
Histology of lower oesophagus
Smooth muscle- reinforced by right diaphragmatic crus
Chemoreceptor trigger zone
Area in fourth ventricle which induces vomiting. Doapmine, serotonin, acetylcholine, opioids and substance P are involved.
What are the blood supplies to the liver?
Hepatic artery and hepatic portal vein
Where does the hepatic artery receive blood?
Oxygenated, so it receives blood from general criculation such as pulmonary artery and coeliac trunk.
What is the majority of liver blood supply?
Hepatic portal vein
What does the portal vein transmit?
Nutrient rich blood which is poor in oxygen from the organs
Where does the heaptic vein drain?
Into the IVC
Functional unit of liver?
Lobule
Where do the contents of the liver drain?
Into the hepatic vein or lymphatic system via the sinusoids.
What are the features of the sinusoids?
Hexagonal endothelial channels which receive mixed blood from hepatic artery and portal vein to drain into the hepatic vein. They contain pores to allow nutrients to pass. The lumen of the endothelium contains Kuppfer cells. The lobules have connective tissues.
Perivenous end
Lower oxygen conc closest to the central vein. Site of glycolysis, glycogenesis, lipgenesis, ketogenesis and glutamine and bile acid biosynthesis. Drug metabolism phase 1 and phase 2 (conjugation) occur here
Periportal end
Higher oxygen conc for gluconeogenesis, cholesterol and urea biosynthesis
Where does bile enter gall bladder?
Cystic duct, which receives bile from common bile duct
Where does cholestasis occur?
Hartmann’s pouch, mucosal fold in neck ofgall bladder.
Where does bile leave the gall bladder?
Common bile duct
What forms the common bile duct?
Cystic duct and common hepatic duct
What forms the common hepatic duct?
Left and right hepatic duct
Where does bile enter the duodenum?
Major duodenal papilla. Papilla is at the end of the ampulla channel. Common bile duct combines with pancreatic duct and they are regulated by sphincter of Oddi.
What substance flows in the opposite direction to blood in the liver?
Bile.
What produces bile?
Hepatocytes
Location of Kuppfer cells
Lumen of sinusoid enodthelium
What is the space of Disse
Space between hepatocytes and endothelium/sinusoids
What is portal hypertension?
When there is inflammation or scarring of the liver which increases blood pressure in the liver and may cause backflow.
Where are the products or liver stores released into the blood?
From hepatocytes, it is released into the space of Disse.
What is the alternative drainage to the hepatic vein in the sinusoids?
Lymphatic system.
Location of caudate lobe?
Between IVC fissure and ligamentum venousum between left and right lobe
What is ligamentum venosus?
Remnant of the ductus venousus and is attached to the portal vein
Location of quadrate lobe
Below portal hepatis in the right lobe
What is the histology of the gall bladder?
3 layers- mucosa, muscularis externa and serosa. There is no submucosa.
What is mucosa of gall bladder?
Microvilli, simple columnar epithelia and lamina propia below but no goblet cells.
What is the lamina propia?
Lies underneath epithelia and above the muscle layer, which provides blood suppyly to epithelia and allow it to change shape with smooth muscle contractions.
What is muscularis externa of gall bladder?
Smooth muscle in random orientation and connective tissue.
What is the serosa of the gall bladder?
Mesothelium connective tissue layer contianing BV, Lymphatic vessels and adipose tissue.
Which part of the gall bladder is attached to the liver?
Adventitia- where it is not attached to the iver, it has the serosa layer instead.
How are amino acids transported into epithelia of small intestine?
Carrier protein which co-trnasports amino acids and sodium ions. If it is a di or tripeptide, they will be hydrolysed by intracellular enzymes.
Duct of Wirsung
Joins pancreas to common bile duct to release secretions
Histology of large intestine?
Mucosa with columnar eptuhelia, goblet cells, lamina propia and no villi. It has a submucosa for BV and nerves. Muscularis propia and serosa
What is the layers of the muscularis propia?
inner circular and outer longitudinal muscle which lie beneath lamina propia and form outermost mucosa layer. Separated from muscularis propia by submucosa.
What is the layers of muscularis externa/propia?
Inner oblique muscle, middle ciruclar muscle and outer longitudinal muscle. In the large intestine, tthe outer longitudinal muscle forms the taeniae coli.
Histology of oesophagus
Mucosa, muscularis mucosa, submucosa, muscarlis propia/externa and serosa
What is the mucosa of the oesophagus?
Stratified squamous non keratinising eptihelia, lamina propia. It does not have goblet cells unless it is diseased called Barrett’s
What level is the gastroesphagueal junction?
T11/T12
Mechanism of acid secretion?
CO2 and H20 enter the parietal celland converted by carbonic anhydrase to HCO3- and H+. Acid is released as H+ via H+/K+ exchanger proton pump. Aklaline tide occurs to maintain pH for basolateral membrane where CL- is pumped in in exchange for HCO3- out which causes temporary pH increase.
What pH must the stomach acid be to treat ulcers?
Above 3
