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Patho 2 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Accessory organs of digestive system

A

Liver, gallbladder, + exocrine pancreas

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2
Q

Layers of the GI tract inner to outer

A

Mucosa
Submucosa
Muscularis
Adventitious serosa

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3
Q

Mucosa layer of the GI tract consists of

A 
Mucosa epithelium
Lamina propria (loose network of epithelium)
Muscularis mucosae (allows local mvmt of mucosa; role in BD/secretion/absorption dysfxn)
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4
Q

Submucosa layer of the GI tract consists of

A

Glands + assoc. ducts

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5
Q

Muscularis layer of the GI tract consists of

A

Circular + longitudinal layers

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6
Q

Adventitious layer of the GI tract consists of

A

connective tissue

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7
Q

The enteric nervous system is considered part of the

A

ANS

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8
Q

The enteric nervous system functions

A

autonomously

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9
Q

The enteric nervous system is influenced extrinsically via

A

parasympathetic/sympathetic nervous systems

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10
Q

Three Enteric plexus

A

Submucosal plexus
Myenteric plexus
Subserosal plexus

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11
Q

The submucosal plexus is also known as

A

Meissner plexus

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12
Q

The myenteric plexus is also known as

A

Auerbach plexus

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13
Q

The submucosal plexus is located in

A

submucosa

SECRETION

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14
Q

The myenteric plexus is located

A

Btwn circular + longitudinal layers of muscularis

MOTILITY

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15
Q

Subserosal plexus is the

A

ANS innervation of BV + CT

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16
Q

Three general functional components of enteric plexus

A

Sensory neurons
Motor neurons
Interneurons

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17
Q

Sensory neurons monitor

A

Distention + the “chemical status” of the GI tract

Sensory afferents via SYMPATHETIC nerves

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18
Q

Clinical of sensory neurons

A

GI visceral pain

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19
Q

Three stimuli of GI visceral pain from sensory neurons

A

Distention-stretching/perforation
Chemical-inflammation/immune response
Ischemia-lactate, H+, K+

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20
Q

Motor neurons control

A

Motility-peristalsis
Blood flow-smooth muscle of GI vasculature
Secretions-cells of the mucosa/submucosa including chief cells, parietal cells, + mucus cells

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21
Q

Interneurons

A

Communication btwn sensory + motor

Mechanism for intrinsic control short loop reflexes

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22
Q

Appetite

A

hunger

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23
Q

Satiety

A

sensation of fullness/satisfied

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24
Q

2 centers located in the hypothalamus control appetite + satiety

A

Lateral center-appetite

Medial center-satiety

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25
Q

Lateral center appetite center function

A

Stimulate appetite

Excitatory to hunger contractions in stomach

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26
Q

Stimuli of lateral appetite center

A

Smell, visual, taste, hearing
Physiological depletion of nutrient/energy stores
Memory/fantasy-limbic/insular lobes
Gastric hormone- GHRELIN

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27
Q

Ghrelin released by

A

stomach

hunger hormone

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28
Q

Medial center (satiety center) function

A

suppress appetite

inhibitory to hunger contractions in the stomach

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29
Q

Medial satiety center stimuli

A

GI hormones
Leptin
PPY
Insulin

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30
Q

GI hormones which stimulate the medial satiety center are released during

A

ingestion CCK, GLP-1 short term

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31
Q

Leptin which is a stimulus for the medial satiety center is released by

A

fat cells + chief cells

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32
Q

PPY a stimuli of the medial satiety center is released by

A

Small intestine after a meal

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33
Q

Insuliin, a stimulus for the medial satiety center is released by

A

pancreas after increased blood glucose after meal

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34
Q

Obesity hormones

A

Leptin

Ghrelin

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35
Q

Leptin a satiety hormone is _____ in obesity

A

Increased

Leptin resistance causes decreased effectiveness

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36
Q

Ghrelin is _____ in obesity

A

Decreased

Physiological strategy to signal feeding is adequate

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37
Q

Fast acting hunger hormone

A

Ghrelin

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38
Q

Levels of ghrelin ____ just before meals

A

rise

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39
Q

Most circulating levels of Ghrelin are produced in

A

the stomach

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40
Q

Other roles of ghrelin other than hunger

A

memory, sleep

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41
Q

Leptins long term role

A

Energy balance + suppressing food intake

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42
Q

Leptin is released from

A

fat cells

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43
Q

Fast acting counteraction hormone to ghrelin post feeding

A

PYY

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44
Q

PYY is released from the

A

small intestine

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45
Q

Other than PYY another fast acting hormone post feeding is

A

Insulin

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46
Q

Insulin is released from

A

the pancreas

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47
Q

Extrinsic regulation of the GI tract

A

ANS + Enteric nervous system

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48
Q

Sympathetic system pathway of extrinsic regulation

A

Nerves of sympathetic tract in thoracic + upper lumbar regions

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49
Q

Function of the sympathetic system

A

Inhibitory to GI tract-dec. peristalsis + secretions

Inhibit blood flow

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50
Q

Parasympathetic system Pathway

A

Vagus nerve esophagus to transverse colon + pelvic nerves of sacral plexus

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51
Q

Function of parasympathetic system

A

Excitatory to GI tract
Inc. peristalsis + secretion
Relax involuntary sphincters of GI tract
Facilitate blood flow to GI tract

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52
Q

Intrinsic regulation of the enteric nervous system

A

2 neural networks located w/in the multiple layers of the intestinal walls
Feedback on itself + function autonomously
Brain in the gut

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53
Q

Specific functions of enteric nervous system

A

Controls motility
Regulation of fluid exchange + local GI blood flow
Regulation of gastric + pancreatic secretion
Regulation of gastrointestinal endocrine cells
Defense reaction
Entero-enteric reflexes
ENS + CNS interaction

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54
Q

Enteric nervous system control motility by

A

peristalsis, sphincter control

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55
Q

Enteric regulation of fluid exchange + local GI blood flow

A

Regulates permeability to ions thus influence fluid
Influences vasodilation of BV
Influences fluid secretion

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56
Q

Regulation of GI endocrine cells from the enteric nervous system

A

Intrinsic system can signal release of GI hormones

Excessive serotonin released from GI walls=n/v

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57
Q

Defense reactions of the enteric nervous system

A

Vomit, diarrhea, + exaggerated propulsive motility reflexes

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58
Q

Entero-enteric reflexes from the enteric nervous system

A

Signaling system btwn regions of GI tract
Gastric activity stimulates small intestine motility + relaxation of ileocecal valve
Small intestine activity signals release of enzymes from pancr

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59
Q

There are more than ____ neurotransmitters in the intrinsic nervous system

A

20+
Excite smooth muscle: Ach + substance P
Inhibit smooth muscle: NO + VIP

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60
Q

Two systems that regulate the GI tract

A

Extrinsic para + sympathetic

Intrinsic w/in GI wll

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61
Q

Extrinsic system directly influences the

A

intrinsic system

Excitatory/inhibitory to gastric secretions

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62
Q

Three salivary glands

A

Submandibular
Sublingual
Parotid

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63
Q

Autonomic control of saliva

A

Parasympathetic + sympathetic systems stimulate salivary glands
SECRETION OF SALVA NOT CONTROLLED BY HORMONES

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64
Q

Saliva is composed of

A

water w/mucus, sodium, bicarbonate, chloride, + potassium

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65
Q

Bicarbonates in saliva function

A

Maintain pH in the mouth to neutralize bacteria (tooth decay)

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66
Q

Saliva pH

A

6.4-7

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67
Q

Salivary amylase

A

Digestion initiated in mouth

Amylase begins first steps to breaks down carbohydrates

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68
Q

Immunoglobulin A igA in saliva

A

Prevents infections

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69
Q

Saliva summary

A

Control pH
Starch digestion
Immune defense

70
Q

Esophagus musculature

A

Upper third striated voluntary muscle
Middle third mixed
Lower third involuntary muscle

71
Q

Upper esophageal sphincter cricopharyngeus muscle location

A

Jct. of lower pharynx + esophagus

Approximately @ level of cricoid cartilage

72
Q

Function of UES

A

Prevent air from entering esophaguss during ventilation

73
Q

Lower esophageal sphincter location

A

Narrowing of the esophagus proximal to the junction of esophagus to stomach

74
Q

Function of lower esophageal sphincter

A

Barrier to the reflux regurgitation of the acidic content of the stomach

75
Q

LES is maintained by

A

increased smooth muscle tone

76
Q

Resting tone of the LES

A

Inc to 20mmHg

77
Q

Belching

A

Air pressure in stomach exceeds LES pressure

78
Q

GI tract consists of

A

Mouth, esophagus, stomach, small intestine, large intestine, rectum, + anus

79
Q

DVT thrombus formation

A

Accumulation of clotting factors/platelets forms thrombus
Thrombus composed of RBC, platelets, leukocytes held together w/fibrin
Inflammation perpetuates thrombus growth
Thrombus creates “back pressure” leading to edema

80
Q

Thrombus often form near

A

valves

81
Q

Thrombus composed of

A

RBC, platelets, leukocytes + held together w/fibrin

82
Q

Thrombus creates _____ leading to edema

A

back pressure

83
Q

Factors in formation of DVT

A

Venous stasis
Endothelial damage
Hypercoaguable states

84
Q

DVT umbrella

A

Insertion of umbrella serves as a catch/filter mechanism to block dislodged emboli from traveling to the heart + pulmonary circulation

85
Q

Wells Criteria for identification of DVT

A

Active cancer +1
Paralysis, paresis, or recent plaster immobilization of LE +1
Bedridden >3d/major surgery w/in 4wks +1
Thigh + calf swollen +1
Calf swelling 3cm greater than asymptomatic side +1
Pitting edema +1
Dilated superficial veins in sx leg only +1
Alernative dx as or more likely then DVT -2

86
Q

Wells criteria scores

A
87
Q

To decrease risk of DVT

A

Ankle pumps
TEDs
Intermittent pneumatic compression (vena flow)

88
Q

Diseases of the arteries

A 
Aneurysm
Thrombi/emboli formation
PAD
Hypertension
Hypotension
Atherosclerosis
89
Q

PAD two types

A

Atherosclerotic

Non-atherosclerotic thomboangiitis obliterians + raynauds

90
Q

Types of atherosclerosis

A

PAD
CAD
MI
Acute coronary syndromes

91
Q

Pathogenesis of blood vessel breakdown in an abdominal aortic aneurysm

A

Proteolytic degradation of aortic wall connective tissue
Inflammation + immune responses
Biochemical wall stress
Molecular genetics

92
Q

Molecular genetics as a cause of abdominal aneurysm

A

Family hx

93
Q

Biochemical wall stress as a cause of abdominal aneurysm

A

Thoracic/abdominal aorta may be predisposed d/t collagen/elastin make-up
Calcified plaque formation in wall redistribute wall stresses
Once AAA started wall stress accelerated dilation/development

94
Q

Inflammation + immune responses causing abdominal aortic aneurysm

A

Transmural infiltration of LYMPHS + MONOS

95
Q

Proteolytic degradation of aortic wall connective tissue causing abdominal aortic aneurysm

A

Destruction of elastin + collagen in the media + adventitia

Loss of medial smooth muscle cells w/thinning of the vessel wall

96
Q

MC origin of an arterial thromboembolism is

A

heart valve disease
Dislodged left heart valve may obstruct
Lower, coronary, + cerebral circulation

97
Q

Other forms of arterial emboli

A

Air
Fat
Amniotic fluid
Bacteria, foreign matter

98
Q

Air causing arterial emboli

A

IV lines, chest trauma

99
Q

Fat causing an arterial thromboembolism

A

Long bone fractures

100
Q

Amniotic fluid causing an arterial thromboembolism

A

intra-abdominal pressures of child birth may introduce amniotic fluid into the mothers blood stream

101
Q

MC form of peripheral artery diseases PAD, number one reason for amputations in US, + 16x greater risk of heart dz/stroke w/in next 10yrs

A

Atherosclerotic PAD

102
Q

Chron’s dz can affect

A

any part of the GI tract

103
Q

Chrohns dz peak onset

A

15-25yo

104
Q

In chrohns dz males/females mc?

A

females

105
Q

Family history of chrohns increases the risk

A

2-4xs w/first degree relative

106
Q

Etiology of Chrohns

A

Poorly understood genetics, autoimmune, + environmental

107
Q

Pathophys of chrohns

A

Inflammation extends all layers of intestinal wall
Defective immune/inflammatory regulation
Chronic granulomatous

108
Q

Chrohns can effect the ___ to the ___

A

mouth, anus

109
Q

Which part of the GI system is most often involved in Crohns

A

Distal ileum + proximal colon

110
Q

Skip lesions

A

In crohns two+ inflamed areas w/healthy bowel in btwn

111
Q

Tx of crohns

A

Antiinflammatory: Salicylate, corticosteroids, infliximab remicade

112
Q

Salicylate 5-ASA for crohns

A

anti-inflammatory typically used to tx mild-mod

113
Q

Corticosteroids for crohns

A

Mod-severe dz antiinflammatory

114
Q

Surgery for crohns is indicated when

A

65-75%
Multiple
Don’t respond to meds
Correct complications from obstruction, perforation, + abscess

115
Q

Types of surgery for crohns

A

Resection-small portion intestine removed
Adhesions/scarring creating obstructions
Stricturoplasty=chronic narrowing of intestinal lumen

116
Q

Ulcertive colitis total colectomy + ileorectal anastamosis IRA

A

Colon removed except the last 5inches of the rectum
Small intestine/ileum, surgically joined to upper rectum
After pt. has normal bowel fxn

117
Q

Colectomy with ileoanal pouch (restorative proctocolectomy) for ulcertive colitis

A

Colon + rectum removed leaving anal canal + sphincter muscles
New rectum made from SI +

118
Q

IBD examples of systemic manifestations

A

Orthopedic sx (peripheral jt. pain + back pain)

119
Q

Diverticulosis out pockets

A

In intestinal wall

85% asymptomatic

120
Q

Diverticulitis

A

Inflammation of colonic diverticula
Impacted w/fecal material
Perforations d/t inflammation
May/may not penetrate

121
Q

Diverticulitis most often affects

A

Sigmoid colon

122
Q

Colorectal cancer is estimated _____ of all newly dx cancer in US

A

8.5%

123
Q

Pathyphys of colorectal cancer

A

Develop from adenomatous glandular polyp
Initial mutant cancer cell develops in polyp
Slow growth on polyp as it progresses down stalk toward the deeper layers of the mucosa
If penetrates into submucosal it can reach lymphatic/bv pathway + become highly malignant
*Screening for removal of polyps critical for prevention

124
Q

Risk factors of colorectal cancer

A

> 50yo

125
Q

Screening for colorectal cancer

A

Colonoscopy more thorough + better screening
Flexible sigmoidoscopy limited in ability to screen (45% dec. in detection rate)
Protocols: >50 every 10y + DRE + fecal occult blood yearly

126
Q

Liver location

A

RUQ

127
Q

Weight of liver

A

Proportion to body size

2-3pounds

128
Q

Surface anatomy of the liver

A

R/L lobes-cantilies line

IVC to gallbladder

129
Q

Connective tissue of the liver

A

Falciform ligament

Glissons capsule

130
Q

Glissons capsule

A

Surrounds liver

Invaginaltes @ hilum of the liver

131
Q

Afferent pathways to the liver

A

Portal pathway 75% hepatic portal vein

Arterial pathway 25% hepatic artery

132
Q

Sinusoids of the liver

A

microvasculature

Outside of the hexagon straight to the central vein

133
Q

Efferent pathway from the liver

A

Central veins drain into hepatic veins

134
Q

Hepatic portal vein recieves blood from the

A

GI tract, spleen, + pancreas

135
Q

Hepatic portal anastomosis

A 
Collateral venous circulation w/numberous veins of abdominopelvic region
Gastroesophageal vein
Rectal vein
Paraumbilical vein
Portorenal vein
136
Q

Portal hypertension

A

Portal circulation congested blocked + reverses portal blood flow towards portal anastomoses
Occurs when cirrhosis develops

137
Q

Hepatic artery

A

Delivers oxygenated blood to liver
Accounts for 25% blood flow to liver
Originates from celiac trunk

138
Q

Hepatic artery + portal htn

A

Blood flow to liver from hepatic artery NOT impaired

Relative high amount of 02 delivered to hepatocytes is synergistic w/regeneration

139
Q

Stellate cells are located

A

in the disse space

140
Q

Stellate cells fxn

A

Store vit. A
Produce/secrete hepatic growth factors
Liver regeneration

141
Q

If stellate cells are stimulated via pahtology/disruption of enviornmental homeostasis

A 
transform into fibroblastic fxn
Produce collegen
Myoblastic fxn
Contractile
Role in fibrosis
142
Q

Pit cells aka

A

Granular lymphocytes/NK cells

143
Q

Location of pit cells

A

Surface of endothelium of sinusoids

144
Q

Function of pit cells

A

s

145
Q

What produces the largest amount of lymph fluid in the body 20%

A

Liver

146
Q

Hepatic lymphatics drain fluid from

A

Disse space, glisson’s capsule,

147
Q

Two regional zones of hepatocytes in the lobule

A

Periportal hepatocytes-

Centrilobular hepatocytes

148
Q

Third regional zone sometimes described

A

Mid-way btwn periportal + centrilobule zones

149
Q

Periportal hepatocytes

A

First to receive 02 + nutrient rich blood

150
Q

Centrilobular hepatocytes

A

Last to receive blood so less O2 + nutrient availability
Susceptible to ischemia + necrosis
Region of drug metabolism (biotransformation)

151
Q

Liver physiological roles

A

Drug metabolism/biotransformation
Metabolism: carbs, fats, proteins
Storage: fat soluble + some water soluble vitamins like A, K, D, B12
Endocrine fxn

152
Q

Vitamin K

A

critical for clotting cascade

153
Q

Vitamin D

A

Precursor involved in conversion

154
Q

Liver carb metabolism regulates

A

Blood glucose
Initial mechanismm to reduce blood glucose (insulin mediated)
Synthesis of glycogen (glycogenesis)

155
Q

Glycogenesis

A

Liver stores glucose for future energy needs
Glycogen 10% total liver weight
Glycogen synthesized from glucose, amino acids + pyruvate

156
Q

Gluconeogensis

A

Production of glucose from non-carb source
Glucose can be produced from fatty acids, aa, + lactate
Important to maintain blood glucose during FASTING
Stimulated by glucagon + sympathetics

157
Q

Rate limiting step of glconeogenesis

A

Amount of available substrate + NOT liver enzymes

158
Q

Liver removes ____ + ____ from plasma

A

FFA, lipoproteins

159
Q

Fasting state of fat metabolism

A

Released into plasma from adipose tissue
FFA removed from plasma by liver
FFA in liver have 2 fates B oxidation + ketone body formation
Synthesize VLDL

160
Q

Feeding state fat metabolism

A

Chylomicron remnants are removed from plasma by the liver
TG from chylomicron remnants can be used for energy (FFA formation) or to synthesize VLDL
Cholesterol from chylomicron remnants used to synthesize VLDL

161
Q

Lipoprotein synthesis

A

The liver plays important role in synthesizing lipoproteins needed forr lipid transport in plasma

162
Q

Classes of lipoproteins

A

Chylomicrons
VLDL
LDL
HDL

163
Q

Chylomicrons

A

Largest diameter, most lipid, least conc. of proteins

Lipids 99% TG rich

164
Q

VLDL

A

Smaller diameter than chylomicron

Lipids 90% TG rich but not as much as chylomicron

165
Q

LDL

A

smaller in diameter than VLDL

Lipids 80% cholesterol rich

166
Q

HDL

A

Smallest diameter, least lipid, largest concentration of proteins
Lipids 40-60% cholesterol rich

167
Q

Lipoprotein removal

A

Liver plays important role in removal catabolism of lipoproteins
LDL removal
LDL receptors on the liver bind LDL + remove from circulation
Familial hypercholesterolemia
LDL receptor deficiency

168
Q

Hepatic cholesterol production

A

B oxidation of FFA in the liver creates acetyl CoA
Acetyl coA used for energy or can be used to synthesize cholesterol
Rate limiting step in cholesterol synthesis is conversion HMG CoA to mevalonate

169
Q

Dyslipidemia

A

LDL have critical role in atherosclerotic plaque formation

170
Q

Clinical of dyslipidemia

A

Statins
Dec. cholesterol synthesis by liver hepatocytes
Inc. production of LDL receptors on liver hepatocytes
Inc. uptake of LDL by liver hepatocytes
Dec. plasma cholesterol levels

Patho 2 (1 decks)

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