DLA 7+8 and Lecture 11+12

Question 1

pain of the appendix?

Answer 1

sympathetic supply

visceral afferents; T10

poorly localized until the appendix contacts and irritates the peritoneum
innervated by somatic nerves, thus will have a localized sharp pain

Question 2

pain of the gallbladder?

Answer 2

sympathetic supply

visceral afferents; T7-T9

will have epigastric/RUQ pain
may have discomfort in scapula

Question 3

sympathetic and parasympathetic of foregut

Answer 3

sym: greater thoracic splanchnic nerves
para: vagus

Question 4

sympathetic and parasympathetic of mid gut

Answer 4

sym: lesser and least thoracic splanchnic nerves
para: vagus

Question 5

sympathetic and parasympathetic of hindgut

Answer 5

sym: lumbar splanchnic nerves
para: pelvic splanchnic nerves

Question 6

role of falciform ligament?

Answer 6

liver is attached to the anterior abdominal wall

Question 7

lymph nodes of liver?

artery? vein?

Answer 7

celiac nodes

A: hepatic A.

V: hepatic and portal v.

Question 8

biliary colic?

Answer 8

usually caused by spasm of the smooth muscle of the gall bladder in an attempt to expel the gall stones

Question 9

Acute cholecystitis

Answer 9

pain in the right upper quadrant

may cause parietal peritoneum irritation which is supplied by phrenic nerve, thus may have pain in shoulder

Question 10

obstructive jaundice?

Answer 10

Obstruction of biliary tree by gall stone or compression by pancreatic growth

can lead to pancreatitis

Question 11

triangle of calot

Answer 11

boundaries:
liver
cystic duct - lateral
common hepatic duct - medial

contents:
cystic artery

Question 12

portal systemic anastomosis

Answer 12

1. lower end of the esophagus
   left gastric vein with azygos and hemiazygos veins
2. lower end of the anal canal
   superior rectal vein with inferior and middle rectal veins
3. umbilicus
   para-umbilical veins with superficial epigastric veins (caput medusa)

Question 13

blood and lymph of pancreas?

Answer 13

arteries:
Anterior & posterior inferior pancreaticoduodenal artery
pancreatic branches

veins: To portal vein
head and neck: SMV
body and tail: splenic V

lymph: celiac nodes and SM nodes

Question 14

pancreatic cancer

Answer 14

of the head may lead to obstructive jaundice (enlargement of gallbladder)

growth may compress portal veins, thus portal hypertension

Question 15

Von Gierke disease (Type 1 GSD)

Answer 15

high glycogen amount in liver and kidney

glucose-6-phosphate is deficient in liver and kidney cortex

enlargement of liver 
renal disease 
severe hypoglycemia between meals 
lactic acidosis 
failure to thrive 
hyperlipidemia 

treatment:
intake of corn starch

Question 16

pompe disease (type II GSD)

Answer 16

deficiency of lysosomal alpha 1,4 glucosidase

massive lysosomal glycogen accumulation in heart, muscle, and liver

clinical: 
cardiomegaly and hepatomegaly
weakness
progressive neuromuscular disorder 
elevated ck-mm 

infantile form: early death
late-onset: breathing issues (myopathy)

Question 17

Cori disease (Type III GSD)

Answer 17

4:4 transferase deficiency
abnormal glycogen structure

muscular weakness and hypotonia
cardiomyopathy and hepatomegaly
mild hypoglycemia

muscular dystrophy like condition

Question 18

anderson disease (type IV)

Answer 18

deficiency of the glycogen branching enzyme 4:6 transferase in liver and muscle

long glucose chains and less branches

enlarged liver, infantile cirrhosis, early death in childhood
muscular weakness and hypotonia
cardiomyopathy, weakened heart and lungs
hepatic scaring

Question 19

McArdle disease (type V)

Answer 19

deficiency of muscle phosphorylase
high levels of glycogen in muscle
can have increased ck-mm

temporary weakness and muscle cramping after exercise
myoglobinemia and myoglobinuria
less lactate

Question 20

Hers disease (type VI)

Answer 20

deficiency of hepatic phosphorylase
high levels of liver glycogen

hepatomegaly
growth retardation
mild fasting hypoglycemia

Question 21

Tarui disease (type VII)

Answer 21

reduced activity of the M subunit of PFK-1

lack of PFK-1 in muscle and RBCs

muscle cramping due to lack of ATP
hemolysis occurs