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Medicine - Year 1 > Block 3 - The Gastrointestinal System > Flashcards

Block 3 - The Gastrointestinal System Flashcards

1
Q

What are the three accessory organs to the upper GI?

A

Liver
Gallbladder
Pancreas

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2
Q

What aids the release of salivary enzymes from the mouth

A

The smell of the food

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3
Q

What division of the nervous system innervates the salivary glands?

A

Parasympathetic

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4
Q

What division of the nervous system innervates the salivary gland capsules?

A

Somatic nervous system

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5
Q

What are the 4 borders of the parotid gland?

A

Anterior: Posterior mandible
Inferior and Posterior: Sternomastoid muscles
Superior: Anterior ear

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6
Q

Where do the parotid ducts run?

A

Run along the mastered muscle
Pierce the buccinator
Enter the mouth at the upper 2nd molar

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7
Q

What fluid does the parotid duct have?

A

Serous

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8
Q

Where does the submandibular duct run?

A

Along the outside of the mylohyoid muscle and enters underneath the tongue either side of the sublingual papilla

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9
Q

What is the difference between the sublingual frenulum and the sublingual papilla?

A

Sublingual frenulum: attaches the tongue

Sublingual papilla: a bump where the sublingual frenulum ends

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10
Q

What fluid does the submandibular gland have?

A

Serous and mucus

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11
Q

Where does the sublingual gland exit?

A

Above the submandibular glands

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12
Q

What fluid does the sublingual gland release

A

Mucus fluid

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13
Q

What nerve supplies the maxillary teeth

A

Maxillary nerve

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14
Q

What nerve supplies the mandibular teeth

A

Mandibular nerve

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15
Q

What bone does the mandibular bone pass through

A

The mandibular bone

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16
Q

What is the blood supply to the mandibular teeth

A

Inferior alveolar artery

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17
Q

What is the blood supply to the maxillary teeth?

A

The maxillary artery

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18
Q

What is the condyle?

A

A bone at the top of the mandibular which articulated with the upper joint surface of the cranium at the temporomandibular joint

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19
Q

What nerve innervates the muscles of mastication?

A

The mandibular branch of the trigeminal nerve

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20
Q

What is the arterial and venous supply for the muscles of mastication

A

Maxillary artery

Superficial temporal veins

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21
Q

What are the four muscles of mastication

A

Temporalis muscle
Masseter muscle
Lateral Pterygoid
Medial Pterygoid

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22
Q

Does the lateral pterygoid or medial pterygoid close the mouth

A

Lateral closes

Medial opens

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23
Q

2 types of muscles in the tongue

A

Intrinsic and extrinsic

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24
Q

What are the four muscles in the tongue and their postitions

A

Genioglossus: genial spine on mandible –> glossus
Hyoglossus: hyoid –> glossus
Styloglossus: styloid –> glossus
Palatoglossus: palatoglossal folds –> glossus

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25
Q

What nerve supplies the muscles in the tongue?

Which muscle is the ‘odd one out’

A

Hypoglossal nerve

Palatoglossus by the Vagus nerve

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26
Q

What is the arterial and venous blood supply for the tongue muscles?

A

Lingual artery and veins

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27
Q

What is the landmark for the anterior 1/3 and posterior 2/3 of the tongue?

A

Circumvallate papilla

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28
Q

What is the general and special sensory nerve supply to the posterior tongue?

A

Glossopharangeal nerve

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29
Q

What is the general sensory nerve supply to the anterior tongue?

A

Lingual nerve (mandibular division of trigeminal)

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30
Q

What is the special sensory nerve supply to the anterior tongue?

A

Facial nerve

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31
Q

Why is the special sensory nerve supply important?

A

It tells you if the bolus is ready

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32
Q

What level of the vertebrae does the pharynx end at?

A

C6

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33
Q

What are the three stages of the swallowing reflex?

A

Oral
Pharyngeal
Oesophageal

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34
Q

Explain what happens during the pharyngeal

A

The uvulua and levator veli muscles pull the soft palate up.
The vocal folds and epiglottis close.
The larynx raises and the upper oesophageal sphincter opens

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35
Q

What are the four anatomical constrictions of the oesophagus and where are they found?

A

Upper oesophageal sphincer
Tracheal bifurcation and Left atrium: T4/5
Lower oesophageal sphincter

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36
Q

How long is the oesophagus

A

25cm

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37
Q

What vertebral levels does the oesophagus run from and to?

A

C6-T10

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38
Q

What happens to the oesophagus at the level of T 10?

A

It enters the diaphgram

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39
Q

What are the two muscles in the oesophagus which contract in peristalsis waves

A

Circular and longitudinal

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40
Q

Which constrictor muscle makes the upper oesophageal sphincter

A

Inferior constrictor muscle

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41
Q

What is the sensory and motor nerve supply to the oropharynx

A

Sensory: Pharyngeal pleux (formed by pharyngeal branches of the glossopharangeal nerve)
Motor: Vagus nerve

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42
Q

What is the epithelium in the oesophagus

A

Stratified Squamous

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43
Q

What is the epithelium in the stomach

A

Simple Columnar

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44
Q

What is the junction between the epithelium of the oesophagus and stomach called?

A

The squamo-columnar junction

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45
Q

Is the stomach, retro-peritoneal or peritoneal?

A

Peritoneal

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46
Q

What is the blood supply to the stomach?

A

Coeliac Trunk

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47
Q

What is the lymph supply to the stomach?

A

Coeliac Nodes

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48
Q

What is the nerve supply to the stomach and what 2 things does this lead to?

A

Vagus nerve

Peristalsis and secretory action

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49
Q

Is the left vagus nerve anterior or posterior?

A

Left: Anterior
Right: Posterior

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50
Q

How long is the duodenum?

A

25cm

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51
Q

What are the four parts of the duodenum called and are they peritoneal or retro-peritoneal?

A

D1: Superior (Peritoneal)
D2: Descending (Retro-peritoneal)
D3: Horizontal (Retro-peritoneal)
D4: Descending

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52
Q

What 2 things are posterior to the superior duodenum?

A

Common bile duct and gastroduodenal artery

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53
Q

How does fluid from the gallbladder and pancreas enter the duodenum?

A

The ducts join at the MAJOR DUODENAL PAPILLA and empty into the duodenum at the HEPATOPANCREATIC AMPULLA (OF VATER)

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54
Q

What 2 things are anterior and 2 things are posterior to the horizontal dudenum?

A

Anterior: Superior mesenteric artery and vein
Posterior: Inferior vena cava and aorta

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55
Q

What is the curvature of D4 supported by?

A

The ligament of Treitz

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56
Q

What are non-dietary loads?

A

Water and saliva

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57
Q

How much water is absorbed and consumed daily?

A

800ml absorbed

1200ml consumed

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58
Q

What are the 4 components of saliva (apart from enzymes)

A

Water, ions, amylase and lysosomes

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59
Q

Name the three phases of gastric secretion

A

Cephalic
Gastric
Intestinal

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60
Q

What are the 5 cells in the stomach?

A

Mucous, Parietal, Chief, Stem and Enteroendocrine

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61
Q

What are the roles of parietal cells and where are they found?

A

Secrete HCl and intrinsic factor

Gastric, fundus and pyloric sphincter

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62
Q

What is the role of chief cells and where are they found?

A 
Secrete pepsinogen (precursor of pepsin) and digestive enzymes
Cardiac and fundus
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63
Q

What is the role of enteroendocrine cells and where are they found?

A

Secrete protein hormones

Gastric

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64
Q

What cells release histamine and what does the histamine do?

A

ECL cells

Bind to H2 receptors to active adenylate cyclase –> cAMP

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65
Q

What cells release gastrin and what does the gastrin do?

A

Secreted from G cells

Bind to CCK receptors to activate phospholipase C –> release cytostolic Ca –> indirect histamine release

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66
Q

What is the role of Ach in the stomach?

A

Binds to M 2 receptors to increase intracellular calcium and cAMP to activate downstream protein kinases and the proton pump

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67
Q

What three substances lead to activation of the H+/K+ ATPase and lead to acid secretion

A

Histamine, Gastrin and Ach

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68
Q

When and where is the hormone gastrin secreted?

What is its role?

A

Secreted by the stomach in response to protein
Stimulates secretion of acid and pepsinogen
Prevents gastric emptying by increasing gastric motility

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69
Q

When and where is the hormone secretin secreted?

What is its role?

A

Secreted by the duodenum in response to acid
Inhibits gastric acid production
Increases secretion from the pancreas and bile duct

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70
Q

When and where is the hormone CCK secreted?

What is its role?

A

Secreted by the duodenum in response to fat
Inhibits gastric secretion and motility
Increases secretion from the pancreas and bile duct

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71
Q

When and where is the hormone somatostatin secreted?

What is its role?

A

Secreted from D cells in the stomach and duodenum in response to acid
Inhibits gastric secretion

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72
Q

What does swelling of the stomach cause in regards to acid secretion?

A

Inhibition of gastric secretion

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73
Q

What is glucose-dependent insulinotropic peptide?

A

Stimulates insulin secretion when glucose increases

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74
Q

What condition does Heliobacter Pylori cause?

A

Gastritis

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75
Q

8 enzymes released from the small intestine

A

Chymotrypsin, Dipeptidases, Disaccharides, Elastase, Lipase, Pancreatic amylase, Phospholipase, Trypsin

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76
Q

Where in the small intestine does digestion and absorption occur?

A

Jejumum: Continuting digestion
Ileum: Absorption

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77
Q

What is the leftover chyme fermented to in the large intestine

A

Acetate, propionate, butyrate

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78
Q

Where is water absorbed from?

A

Large intestine

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79
Q

What is the venous draining from the small intestine?

A

Hepatic portal vein

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80
Q

What is the lacteal drainage from the small intestine

A

Thoracic duct

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81
Q 
What are the precursors for:
Pepsinogen
Chymompsinogen
Pro-elastase
ProCarboxypeptidases
Pro-aminopeptidases
A 
Pepsinogen: Pepsin
Chymompsinogen: Chymotrypsin
Pro-elastase: Elastase
Pro-carboxypeptidases: Carboxypeptidases 
Pro-aminopeptidases: Aminopeptidases
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82
Q

How long do cells take to migrate up the crypt

A

48 hours

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83
Q

What is the region of the crypt which separates the under-developed cells from the developed ones?

A

The proliferate region

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84
Q

What happens to dipeptides in the enterocytes?

A

They are converted to cytoplasmic peptides then amino acids

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85
Q

Which specific fatty acids are absorbed by chylomicrons?

A

Ones with more than 12 carbon atoms

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86
Q

Another name for non-starch polysaccharides

A

Dietary fibre

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87
Q

Define glycemic index

A

Relative ability of carbohydrate to increase blood glucose levels.
Increased index = absorbed faster = increase levels faster

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88
Q

What is an increase in glucose related to?

A

Insulin secretion

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89
Q

What are the 2 roles of bacteria in the colon?

A

Regulate metabolites and secrete small chain fatty acids

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90
Q

What are the names of the small chain fatty acids released by bacteria in the gut and what are their roles?

A

Acetate
Propionate: Inhibits appetite and intake
Butyrate: Protects against colorectal cancer

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91
Q

4 benefits of non-starch polysaccharides

A

Absorbs and clears bile acids, cardiogens and cholesterol
Bacterial fermentation in the colon
Increases viscosity of the gut leading to slower absorption

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92
Q

What is lactylose broken down into in the gut? (2)

A

Hydrogen and methane

93
Q

What is the role of neck cells and where are they found?

A

They produce mucus

Cardia, pylorus and fundus

94
Q

How is stomach acid made?

A

CO2 + H20 –> HCO3- + H+

HCO3- is returned to the blood in exchange for Cl-
H+ is pumped into the stomach in exchange for K+

95
Q

How does Heliobactor Pylori cause inflammation?

A

Urease –> Ammonia + Carbonic acid

96
Q

What does the pH of the stomach need to be to initiate healing?

A

Above 3

97
Q

What type of response is vomiting?

A

Reflex response

98
Q

6 examples of internal nausea

A

Abdomen, headache, heart attack, pain, pregnancy, viral infection

99
Q

4 examples of external nausea

A

Motion sickness, alcohol/food poisoning, medication

100
Q

4 pathways that lead to the vomiting centre in the medulla and the triggers for these pathways

A

Cerebral cortex: Anxiety and raised intracranial pressure
Peripheral: Gastric stasis, radiation and chemotherapy
Chemo-receptor trigger zone: Drugs and hyperglycaemia
Vestibular input: Vestibular neuritis

101
Q

What receptors are found in the vomiting centre in the medulla?

A

Ach (M), H1, 5HT2, mu, NK1

102
Q

What is the blood supply to the foregut, midgut and hindgut?

A

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

103
Q

What organs are in the foregut (6), midgut (5) and hindgut (5)

A

Foregut: Oesophagus, stomach, liver, gallbladder, pancreas, proximal duodenum
Midgut: Distal duodenum, jejunum, ileum, ascending colon, 2/3 of transverse colon
Hindgut: 1/3 of transverse colon, descending+sigmoid colon, rectum, proximal anal canal

104
Q

What are the 5 layers of the anterolateral abdominal wall

A

Skin –> fatty superficial fascia (Camper’s) –> membranous superficial fascia (Scarpa’s) –> Abdominal muscles –> Transversalis fascia –> parietal peritoneum

105
Q 
External Oblique:
Where does it originate?
Where do the fibres run?
What does it insert onto? - what is this?
What makes up the bottom of it?
A

Origin: Inferior 8 ribs
Fibres: Inferomedial fibre orientation
Insertion: Linea alba (a white fibrous band from the xiphoid process to the pubic sympysis)
Bottom: Inguinal ligament

106
Q 
Internal oblique:
Where does it originate?
Where do the fibres run?
What does it insert onto and how?
What ribs does it attach to?
A

Origin: Lumbar fascia and iliac crest
Fibres: Superomedial fibre orientation
Insertion: Joins the inguinal ligament, linea alba and pectin pubis via the conjoint tendon
Ribs: Attaches to the 10-12 ribs

107
Q 
Transverse abdominis:
Where does it originate?
Where do the fibres run?
What is its relationship with the internal oblique
What does it insert onto?
A

Origin: Lumbar fascia and iliac crest
Fibres: Transverse fibre orientation
Internal oblique: Joins the inguinal ligament with it and helps to form the conjoint tendon
Insertion: Xiphisternum, linea alba and pubic crest

108
Q

Rectus abdominis:
Where does it originate?
What does it insert onto?
How does it form a ‘6 pack’?

A

Origin: Pubic crest and symphysis
Insertion: 5-9 costal cartilages and xiphisternum
6 pack: Due to 3 tendinous insertions

109
Q

When do the muscles become aponeurotic?

A

At the 9th costal cartilage

110
Q

What is different about the layering of the muscles above and below the arcuate line?

A

Above: External oblique anterior to rectus abdominis; internal oblique splits around it and transverse abdominis posterior

Below: All three are anterior to the rectus abdominis

111
Q

What are the borders of the inguinal canal?

A

Floor: Inguinal ligament from external oblique (Medial = Lacunar ligament)
Anterior: Aponeurosis external oblique (Lateral = internal oblique)
Roof: Transversus abdominis, internal oblique and transversalis fascia
Posterior: Transversalis fascia

112
Q

What type of membrane is peritoneum?

A

Serous membrane

113
Q

Define intraperitoneal

A

Inside peritoneal cavity and surrounded by visceral peritoneum

114
Q

Define retropertioneal

A

Behind parietal peritoneum

115
Q

Define infraeritoneum

A

Below the cavity

116
Q

Define mesentary

A

Double fold of peritoneum which attaches intestines to the posterior abdominal wall to allow blood to reach the organs.

117
Q

Define omentum

A

Fold of peritoneum that attaches the intestines to other organs; covers the abdominal contents, has a blood supply and fat deposits

118
Q

What is the epichoric foramen

A

A hole that connects the greater and lesser omentum

119
Q

What are the 4 muscles in the posterior abdominal wall

A

Diaphragm, quadratus, ilicais and psoas major

120
Q

What is the epithelium in the small intestines?

A

SIMPLE COLUMNAR

121
Q

What is the nerve and blood supply to the small intestine

A

Vagus nerve

Superior Mesenteric Artery

122
Q

How long are the small intestines?

A

3-5m

123
Q

Jejunum:

How much of the intestine does it make up?
What stomach quadrant is it found in?
What are the walls and calibre like?
What are the folds on the inside called?
What is the blood supply?
A 
Proportion of intestine: Upper 2/5
Quadrant: ULQ
Walls and calibre: Thick
Folds: Pilicae Circularis
Blood: Less arterial arcades and more vasa recta
124
Q

Ileum:

How much of the intestine does it make up?
What stomach quadrant is it found in?
What are the walls and calibre like?
What 3 things are absorbed?
What is the blood supply?
A 
Proportion of intestine: Lower 3/5
Quadrant: R hypogastric region
Walls and calibre: Thin
Absorption: B12, bile salt and lipids
Folds: Pilicae Circularis
Blood: More arterial arcades and less vasa recta
125
Q

What is the Meckel’s Diverticulum and where is it found?

A

Remnant of the vitelline duct

2 feet from the ileocaecal junction

126
Q

How long is the large intestine

A

5 feet

127
Q

What type of peritoneal organ is the large intestine?

A

Intraperitoneal: Caecum, transverse and sigmoid
Retroperitoneal: Ascending and descending

128
Q

What are the three characteristic features of the large intestine?

A

Taeniae coli: 3 longitudinal muscular strands that contract to move the faeces
Haustra: Bulges to keep the shape
Appendices epiploicae: Fat deposits

129
Q

What are the two openings for the appendix?

What does the appendix open into?

A

Ileo-caecal valve and orifice of the appendix

Opens 2cm inferior to the ileocaecal valve into the posteromedial canal

130
Q

Where is the appendix situated?

A

6-9cm behind the caecum/ileum

131
Q

What is the appendix’s mesentary?

A

Mesoappendix

132
Q

What is the blood supply to the appendix?

A

Appendicular artery

133
Q

Where is the rectum situated?

A

Between S2 and the pelvic floor

134
Q

Where does the rectum end?

A

The anorectal junction

135
Q

Where is faeces stored?

A

In the rectal ampulla on top of the transverse rectal folds

136
Q

What peritoneum is the rectum made from?

A

Upper 1/3: Parietal peritoneum
Mid 1/3: Parietal peritoneum anteriorly
Lower 1/3: Infraperitoneal

137
Q

How long is the anus

A

4cm

138
Q

What is the epithelium of the anus?

A

Stratified squamous

Keritanised below the pectinate line

139
Q

Is the anus made from endoderm or ectoderm?

A

Endoderm above pectinate line

Ectoderm below pectinate line

140
Q

What is the blood supply to the anus?

A

Above the pectinate line: Superior rectal artery + vein

Below the pectinate line: Inferior and middle rectal arteries

141
Q

Parasympathetic and sympathetic nerve supply to the smooth muscle of the anus and the vertebral origin of these nerves

A

Parasympathetic: Pelvic splanchnic nerve (S234)
Sympathetic: Inferior hypo-gastric pleux (T11-L2)

142
Q

What fibres trigger defecation?

A

Visceral sensory fibres

143
Q

Nerve supply to the skeletal muscle of the anus

A

Inferior anal nerve

144
Q

Explain the defecation reflex

A

Stretch receptor –> rectum contacts and shortens

Voluntary control of external sphincter

145
Q

What are the fat soluble vitamins?

A

A,D,E,K

146
Q

What class of molecule are cholesterol and cholesterol esters?

A

Types of LIPIDS

147
Q

What is the role of bile salts, amphiphatic lipids and cholesterol in lipid digestion?

A

Create a polar surface on small droplets to prevent them from re-combining with each other.
Amphiphatic lipids: Hydrophobic and hydrophilic aiding with transportation

148
Q

What is the role of colipase?

A

Prevents lipase re-associating with the fat droplet

149
Q

What is added to the triglyceride inside the enterocytes to make a cylomicron?

A

Apo(lipo)protein

150
Q

What are the 3 lipid degrading enzymes?

A

Lingual lipase:Secreted from Ebner’s glands on dorsal surface of tongue
Gastric lipase: Acid activated
Pancreatic Triglyceride lipase: Bile salt activated

151
Q

How are bile salts made and what are they made from (12)

A

Cholesterol breakdown
Alkaline phosphatase, bile salts, bilirubin, cholesterol, fat, fatty acids, inorganic salts, lecithin, monoacylglycerol, monoacylphospholipases, mucin, pigments, phospholipids and water

152
Q

How do bile salts get their polarity?

A

Added to glycine and taurine

153
Q

Where is CCK released from?

A

Duodenal mucosa

154
Q

What allows bile into the duodenum?

A

Sphincter of Oddi

155
Q

What is triacylglycerol digested into?

A

Triacylglycerol –> Diacyclycerol (FAST)

Diacyclycerol –> 2-monoacylglycerol (SLOW)

156
Q

How is phosphatidylcholine digested?

A

Into lysophospharidylcholine by PLRP2

157
Q

How are cholesterol esters digested?

A

Into cholesterol and fatty acids by cholesterol ester hydrolase

158
Q

How are phospholipids digested?

A

Lysolipids and fatty acids

159
Q

What are chylomicrons made from and where are they assembled?

A

Cholesterol, glycerides, phospholipids, proteins and vitamins
Endoplasmic reticulum and golgi apparatus

160
Q

What is the role of peripheral apoproteins

A

Stabilises and stops accumulation of fat in enterocytes

161
Q

What is the role of lipoprotein lipase?

A

Removes fatty acids from the cylomicron to allow them to diffuse into cells

162
Q

What is beige adipose tissue

A

White adipose tissue that can turn brown under certain stimuli

163
Q

10 roles of omega 3

A

Blood clotting; brain cell membranes; increases brain and joint function; decreases cancer, heart disease and diabetes risk; decreases inflammation; increases growth and development

164
Q

3 main sources of omega 3 and foods they are found in

A

Alpha-linolenic acid: Walnuts, veg and soy beans
Eicosapenranenoic acid: Fatty fish and oil
Docosahexanoic acid: Fatty fish and oil

165
Q

8 roles of omega 6

A

Regulates brain growth and development; regulates metabolism; increases inflammation; stimulates hair and skin growth; maintains bones; reproduction

166
Q

3 main sources of omega 6 and foods they are found in

A

Linolenic acid: Corn, veg oil, soy beans and seeds
Gamma-linolenic acid: Veg and plant oils
Arachodonic acid: Wheat, poultry and egg

167
Q

2 roles of omega 7

2 sources of omega 7

A

Decreased inflammation; insulin resistance

Produced by body or in foods with palmitic acid (e.g. nuts)

168
Q

4 roles of omega 9

2 sources of omega 9

A

Decreased inflammation; increased joint health and healing; disease prevention

Produced by body or in foods with oleic acid (e.g. olive and veg oils)

169
Q

Where is conjugated linoleic acid found?
What is its structure?
What is its role?
2 side effects

A

Cheese, milk and red meat
2 double bonds separated by a single bond
Increases fat metabolism and anticardiogenic
Side effects on pancreas and insulin resistance

170
Q

Where is the liver in relation to the diaphragm?

A

Inferior and posterior

171
Q

What type of gland is the liver?

A

Accessory digestive gland

172
Q

What are the 8 functions of the liver?

A 
Bile production
Decomposes RBC
Detoxification and breakdown of hormones and drugs
Metabolises nutrients for energy
Produces hormones
Regulates glycogen storage
Stores, fat, vitamins and minerals
Synthesises plasma proteins
173
Q

What is the bare area of the liver?

A

A mesentary formed from the dorsal and ventral mesogastrum during embryonic development of the foregut

174
Q

What is the peritoneal ligament?

A

A double fold of peritoneum which attaches the anterior abdominal wall and diaphragm to the liver

175
Q

What is the lesser omentum?

What is the hepatic duodenal ligament?

A

A ligament that connects the liver to the stomach

On the lesser edge; separates the greater and lesser sac

176
Q

What is the top and bottom surface of the liver called?

A

Top: Diaphragmatic
Bottom: Visceral

177
Q

How are the coronary ligaments formed?

A

Formed due to the liver obliterating the parietal peritoneum so the parietal and visceral fuse.
Occurs as the falciform ligament and visceral peritoneum move backwards

178
Q

What is the subphrenic recess?

A

A gap in the peritoneal cavity between the abdomen and liver

179
Q

What is the hepatorenal recess also known as?
Where is it?
Why is it clinically significant?

A

The pouch of Morison
Under the liver and above the kidney
Deepest part of the peritoneal cavity when the patient is lying –> fluid collects here after injury

180
Q

What is the ligamentum teres a remnant of?

A

The umbilical vein

181
Q

What veins branch off the vena cava into the liver?

A

Right, middle and left hepatic veins

182
Q

What order do vessels enter the porta hepatis?

A

Bile DUCT; Hepatic ARTERY proper, portal VEIN

183
Q

What is the ligamentum venosum?

A

A remnant of the ductus venosus

184
Q

Where do the bile ducts travel in the liver?

A

Within the hepatoduodenal ligament on the free edge of the liver (entry to the lesser sac)

185
Q

What does the left hepatic artery, vein and duct supply?

A

The left lobe

The caudate and quadrate (anatomical right)

186
Q

How many segments of the liver are there?

A

8

187
Q

What is the trans-pyloric plane?

What does it contain?

A 
An imaginary horizontal line across the body which contains:
Neck of pancreas
Pylorus of stomach
Hilum of kidneys
Fundus of galbladder
L1 vertebrae
Origin of portal vein + superior mesenteric artery
D2 (sphincter of oddi)
9th costal cartilages
188
Q

2 functions of the pancreas

A

Digestive enzymes and hormones

189
Q

What is the embryonic derivative of the spleen?

A

Mesoderm

190
Q

What is the difference between the diaphragmatic and visceral surface of the spleen?

A

Diaphragmatic: Convex and smooth
Visceral: Convex ad irregular with notches

191
Q

How can you repair a ruptured spleen?

A

Greater omentum used as a pressure pad

192
Q

What ribs are in line with the spleen?

A

9th and 11th

193
Q

Blood supply to the kidneys

A

Renal arteries and veins

194
Q

What type of peritoneum organ is the kidney?

A

Retroperitoneal

195
Q

What pathway do the lymphtics follow?

What is the exception to this?

A

Same pathway as the coeliac and splenic nodes
Anterior liver drains into the phrenic lymph nodes
Posterior liver drains into the hepatic lymph nodes

196
Q

3 parts of the gallbladder

A

Fundus, body and neck

197
Q

What is the blood supply to the gallbladder?

A

Cystic and right hepatic artery

198
Q

What does the hepatopancreatic sphincter of oddi receive fluid from?

A

The hepatopancreatic ampulla

199
Q

What is ERCP?

A

Endoscopic reterograde cholandroancreatography

200
Q

What marks the transition from foregut –> midgut

A

The hepatopancreatic sphincter of oddi

201
Q

What hormone leads to Glycogenesis?

A

Insulin

202
Q

What hormone leads to glycogenolysis?

A

Glucagon and Adrenaline (via second messenger)

203
Q

How much cholesterol is produced every day?

A

1g

204
Q

How is cholesterol produced

A

Acetyl CoA –A–> Isopentenyl –B–> Pyrophosphate –> Squalene –> Cholesterol

Enzyme A: Enzyme HMG-CoA reductase
Enzyme B: Enzyme X6

205
Q

What do statins target?

A

Enzyme HMG-CoA reductase

206
Q

What is the role of HDL?

A

Mops up excess cholesterol and lipids from tissues to bring it back to the liver

207
Q

What happens during the condition ‘hypercholesterolemia?

A

No LDL receptors –> a build up of fat in the blood

208
Q

What 2 proteins are usually made in the liver?

A

Albumin and blood clotting factors

209
Q

How is protein metabolised?

A

Protein –> Ammonia –> Urea –> Urine

210
Q

How are erythrocytes broken down?

A

Haemoglobin –> Globulin –> Amino acids

Haemoglobin –> Haem –> Iron + Bilirubin

211
Q

What are the two phases of drug metabolism?

A

Phase 1: P450

Phase 2: Glucoronide added and secreted

212
Q

What is hepatitis?
What is hepatoma?
What is chirrhosis?

A

Hepatitis: Infection –> inflammation
Hepatoma: Tumour
Chirrhosis: Scar tissue due to overworked liver

213
Q

What is another name for jaundice?

3 major causes

A

Hyperbilirubinemia

Infectious hepatitis, bile duct obstruction and red blood cell destruction

214
Q

2 liver function tests involving enzymes

Where are these enzymes found?

A 
Alanine Aminotransferase (ALT): Found in the cytosol of hepatoytes
Asperate Aminotransferase (AST): In the heart, liver, kidney, brain and skeletal muscle
215
Q

2 liver function tests NOT involving enzymes

A

Albumin levels

Prothrombin time: A coagulation factor that records the time it takes to clot blood

216
Q

What happens during enterohepatic circulation?

A

The hepatic portal vein mops up unused bile

217
Q

What is the structure of bile?

A

4 benzene rings and similar to cholesterol

218
Q

How do bacteria make secondary bile salts?

A

Remove glycine/taurine which the liver had added to the bile salts to conjugate them

219
Q

4 functions of bile

A

Bilirubin excretion
Emulsifies fats
IgA antibodies
Neutralises stomach acid

220
Q

How is haemoglobin converted to bilirubin?

A

Haemoglobin –(A)–> Iron + Biliverdin –(B)–> Unconjugated bilirubin

Enzyme A: Haem oxygenase
Enzyme B: Biliverdin reductase

221
Q

What is the difference between unconjugated and conjugated bilirubin?
How is conjugated bilirubin made?

A

Unconjugated is insoluble so is bound to albumin

It is conjugated (water soluble) in the liver by glucuronyl-bilirubin transferase

222
Q

What happens to conjugated bilirubin in the intesine and blood?

A

Bacteria convert conjugated bilirubin –> Sterobilin (excreted in faeces or absorbed by the blood)

In the blood converted to Uribilin (excreted in urine)

223
Q

How did Van Den Bergh find the difference between conjugated and unconjugated bilirubin?

A

Conjugated is water soluble and alcohol soluble so showed a colour change when a reagent was added in both of these mixtures.
Unconjugated is water INSOLUBLE but alcohol soluble so only showed a colour change when the reagent was added in alcohol

224
Q

Example of pre-hepatic, hepatic and post-hepatic disease

A

Pre: Haemolytic anaemia
Hepatic: Hepatitis
Post: Obstructive jaundice

225
Q

What is the difference between Cholelothasis and Choledocholithiasis?

A

Cholelothasis: Obstruction of the cystic duct
Choledocholithiasis: Obstruction of the entire bile duct

226
Q

What is ascending cholangitis?

A

Inflammation of the whole bile duct

227
Q

What is biliary colic?

A

A gallbladder attack

228
Q

What is inflammation of the gallbladder called?

A

Calculus cholecystitis

229
Q

What are the 3 conditions needed to produce gallstones?

A

Bile must be supersaturated with cholesterol
Cholesterol must precipitate as solid cholesterol mono-hydrate crystals
Crystals must aggregate with other elements

Medicine - Year 1 (20 decks)

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