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Patho exam 3 > Gastro > Flashcards

Gastro Flashcards

1
Q

What type of diarrhea is associated with lactose-intolerance and malabsorption?

A

osmotic type of diarrhea

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2
Q

What are the layers of the alimentary canal from deep to superficial?

A

Mucosa
Submucosa
Muscular externa
serosa

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3
Q

What is the mucosa composed of?

A

Mostly epithelium and some CT, surrounded by a thin layer of smooth muscle

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4
Q

Which layer has blood vessels, lymph nodes, lymph vessels and nerve endings?

A

Submucosa

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5
Q

In what part of the mucosa are digestive enzymes secreted?

A

Mucosal epithelium

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6
Q

What secretes mucus for lubrication?

A

Goblet cells

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7
Q

T/F: the submucosa is composed of two layers of connective tissue

A

False submucosa if composed of soft CT

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8
Q

What are Peyer patches? What are they similar to?

A

Lymph nodes similar to tonsils

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9
Q

What are two layers that compose the muscular externa?

A

Inner and outer layers of smooth muscle

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10
Q

Describe the orientation of the inner and outer layers of the musclular extern. how do they run?

A

Inner layer – encircles the canal

outer layer – longitudinal and lies in the direction of the canal

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11
Q

Which muscles surrounds the stomach?

A

Inner layer – encircles the canal
outer layer – longitudinal
Third layer of oblique smooth muscle

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12
Q

Why is there a 3rd layer of muscle in the stomach?

A

Stomach needs to mix the food

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13
Q

What is syncytium?

A

To function as a coordinated unit

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14
Q

What is the serosa part of in the alimentary canal?

A

Visceral peritoneum

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15
Q

What is the serosa composed of?

A

Connection tissue covered with squamous epithelial cells

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16
Q

Name the functions of serious fluid

A

Keep alimentary canal moist

Allows for friction free movement of the intestine

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17
Q

What is found between each of the four layers of the G.I. tract?

A

Network of nerves

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18
Q

The serosa layer of the G.I. tract is connected to what?

A

Mesentery

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19
Q

What comprises enteric plexus?

A

Myenteric and submucosal plexus

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20
Q

What type of controls are there on the gut?

A

Sympathetic
Parasympathetic
Spinal Cord
Brain Stem (Reflexive)

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21
Q

Which nerve plexi is responsible for Movement?

A

Myenteric plexus

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22
Q

What is SuBmucosal plexus responsible for controlling?

A

G.I. secretions and local blood flow

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23
Q

What are the cranial nerves associated with innervation of the gut?

A

Vagus nerve

Glossopharyngeal nerve

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24
Q

What are the two plexi in the GI that regulate GI controls?

A

Submucosal plexus

Myenteric plexus

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25
Q

List the digestive process (7) – I poop more crap and secrete shit

A 
Ingestion 
Propulsion mechanical digestion
chemical digestion
Absorption
Secretion
Storage and elimination
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26
Q

T/F: absorption is the passage from the GI tract to the blood/lymph vessels and could be active or passive

A

T

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27
Q

T/F: secretion is the elimination out of the GI tract

A

false secretion is the elimination into the GI tract (lumen)

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28
Q

What general structures are involved in digestion?

A

alimentary canal and accessory structures

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29
Q

Where does mechanical digestion occur? And what is that process called in each location?

A

Mouth – chewing
Stomach – churring
Small Intestines – segmentation

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30
Q

What are the two components of propulsion?

A

Swallowing and peristalsis

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31
Q

What organs are involved in peristalsis?

A

Esophagus, stomach, small intestine, large intestines

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32
Q

What is mainly absorbed from the sigmoid colon?

A

Water

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33
Q

What is ECL what is it secreted?

A

“entero chromafin like cells” - type of neuroendocrine cell that synthesize and secrete histamine in the stomach

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34
Q

What does GIP stand for?

A

– gastric inhibitory peptide

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35
Q

Other than mucus, what is secreted into the small intestine?

A

Hormones: CCK, secretin, GIP, and other

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36
Q

Does any digestion occur in the large intestine?

A

None except for bacteria

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37
Q

What does the oral cavity and esophagus digest?

A

Carbohydrates and some fats

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38
Q

What is secreted in the oral cavity and esophagus?

A

Saliva

lipase

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39
Q

Where does absorption begin in the alimentary canal? And what is absorbed there?

A

The stomach and lipid soluble substances are absorbed (aspirin or alcohol)

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40
Q

What happens during peristalsis?

A

Leading wave of relaxation due to: the gut senses stretch muscle before distention to constrict  post area relaxes

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41
Q

What is segmentation? what happens to the bolus?

A

Mixing and churning

Shearing forces cause the bollus to split in half

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42
Q

What is found in saliva?

A

Carbohydrate Digestion – Amylase

Has Immunoglobulins

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43
Q

What stimulates saliva secretions?

A

Parasympathetic and beta adrenergic

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44
Q

What are the salivary glands?

A

Parotid gland
Submandibular gland
Sublingual gland

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45
Q

Explain what happens during swallowing (be specific)

A

Bollus is pressed up your palate and you upper esophageal spincter is contracted
The sphincter then relaxes to allow food to pass and contracts again to prevent it from coming back up

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46
Q

What are the two sphincters in the esophagus?

A

UES

LES

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47
Q

What sphincter is located at the entrance of the stomach and prevents acid reflux?

A

LES aka cardiac

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48
Q

What do circular muscles do during deglutition? What happens to the bolus?

A

Circular muscles contract above the bolus pushing the bolus down

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49
Q

What do longitudinal muscles do during deglutition? What happens to the bolus?

A

Contract which shortens the passageway ahead for the bolus

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50
Q

Name the 4 roles of the stomach

A 
MACE
Mechanical digestion
absorptions
Chemical digestion
Enteroendocrine function
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51
Q

What chemicals are involved in chemical digestion in the stomach?

A

Pepsin

Hydrochloric acid

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52
Q

What are the 3 muscular layers of the stomach?

A

Outer - longitudinal layer
Inner - circular layer
3rd layer - oblique layer (body)

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53
Q

What are the secretory stomach cells?

A

Mucus neck cells
Parietal cells
Chief cells
Enteroendocrine cells

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54
Q

What are the gastric hormones?

A

Gastrin

Somatostatin

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55
Q

What do parietal cells secrete?

A

HCl and intrinsic factor

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56
Q

What is intrinsic factor important for?

A

Absorption of B12

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57
Q

What releases pepsinogen?

A

Chief cells

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58
Q

Which hormone inhibits stomach secretory activity and gastric emptying?

A

Somatostatin

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59
Q

Which gastric hormone is secreted by the stomach and duodenum?

A

Somatostatin

60
Q

What hormone is responsible for stimulating secretory activity, gastric emptying and contractions of the intestines?

A

gastrin

61
Q

What are the three phases of Gastro secretion?

A

Cephalic phase
Gastric phase
intestinal phase

62
Q

T/F: during the cephalic phase though taste smell or tactile sensation of food causes a parasympathetic neurons (vagus) to stimulate secretion of hydrochloric acid and pepsin in the stomach and gastrin in the lower stomach to the blood steam stimulating pepsin and hcl secretion to upper stomach

A

T

63
Q

T/F: during gastric phase distention causes the vagus nerve to send signals to medulla oblongata and causes more pepsin and hcl to be secreted

A

T

64
Q

T/F: during the intestinal phase chyme enters the duodenum and secretion stops when it contains enough lipids or the ph has reached 3.5

A

T

65
Q

List the 3 responses to decrease gastic secretion

A

Medulla oblongata inhibits secretions
Bloodstream via hormones
Local reflex inhibits secretions

66
Q

What hormones are secreted in the Duodenum?

A

Secretin

Cholecystokinin (CCK)

67
Q

What stimulates secretin?

A

Acidic chyme

68
Q

What is secretin stimulated by and what does it inhibit/stimulates?

A

Stimulated by acidic chyme
Inhibits gastric gland secretions and gastric motility
Increases output of pancreatic juices and bile (partietal chief relax)

69
Q

What does Cholecystokinin (CCK) increase/stimulate?

A

Increases production of pancreatic juices

Stimulates gallbladder to expel bile

70
Q

What does bile do?

A

Emulsifies fat, product is bilirubin

71
Q

What does bile contain?

A 
BPCF 
Bile salts
Pigments
Cholesterol
fats
72
Q

How much bile is produced in just one day?

A

700-1200 bile/day

73
Q

What does the enterohepatic circulation recycle?

A

Bile salts

74
Q

What are the functions of the liver?

A 
MR VIDS
Metabolizes nutrients and bilirubin
Metabolic detoxification
Stores minerals and vitamins
Vascular and hematologic functions
Recycles bile salts 
Some cells play a role in the immune system
75
Q

Describe how the blood travels through the liver

A

From the portal vein up the portal venules across sinusoids to central vein  through interlobular to hepatic vein  Vena Cava now full of nutrients

76
Q

What does the portal triad consist of?

A

Bile duct
Portal arteriole
Portal venule

77
Q

When are bacteria most likely to migrate out of the gut? What can this cause?

A

Ulcer and causes septis or endocarditis

78
Q

what cells associated with liver function remove bacteria?

A

Reticulo endothelial cells

79
Q

What are the mechanisms that promote the secretion of bile?

A
  1. Acidic / fatty chyme entering duodenum causes release of cholecystikinin and secretin from DUODENAL WALL ENTEROENDOCRINE CELLS
  2. these hormones enter the bloodstream
  3. Bile slats abd secretin transported via bloodstream stimulate liver to produce bile more rapidly
  4. vagal stimulation causes weak contractions of gallbladder
  5. Cholecystokinin (blodstream) causes gallbladder to contract and hepatopancreatic sphincter to relax = bile enters duodenum
  6. Bile salts reabsorbed
80
Q

How does nutrients absorbed in the small intestines get back into systemic circulation?

A

Blood flow from the intestines goes from the intestines through the liver then into the IVC

81
Q

What is secreted by pancreas?

A

Pancreatic juices PAL = Pancreatic protease amylase and lipase
And bicarb

82
Q

What are the mechanisms that promote the secretion of pancreatic jucies?

A
  1. Acidic chyme entering duodenum causes enteroendocrine cells to release secretin and fatty protein rich chyme induces release of cholecystikinin
  2. these hormones enter the bloodstream
  3. Cholecystokinin induces release of pancreatic juices upon reaching the duodenum
    Secretin causes copious secretion of bicarb rich pancreatic juice
83
Q

What does CCK do?

A

Secretion of enzymes of pancreas

Gallbladder contract hepatopancreatic spintcher to contract

84
Q

What are the major roles of the small intestines?

A

Majority of water and salt absorption
Majority of nutrient absorption
segmentation mixes

85
Q

What increases the surface area in the small intestines?

A

Large circular folds are covered with Microvilli which contain a counter current system of capillaries

86
Q

What is the function of intestinal flora?

Prevents growth of opportunistic organisms

A 
It metabolizes: 
bile salts
 drugs
 nitrogenous substances, 
vitmain synthesis (e coli)
87
Q

Name some intestinal flora?

A

E coli clostridum cloriform

88
Q

How much do intestinal flora comprise distal to ileocecal valve?

A

1/3 of bulk of feces

89
Q

What is the role of the large intestine?

A

absorbs vitamins
absorbs water
stores and moves fecal material

90
Q

Whats involved in the digestion of carbs?

A

Salivary amylase and pancreatic amylase in the mouth and the small intest
Carbs converted to polsac then monosac by brush border enzymes in small intestine
-monosac in vili go to liver

91
Q

Whats involved in protein digestion? Absorbed?

A

Protein is broken down in the stomach by pepsin, when HCl is present.
The large poly pep are further broken down by pancreatic enzymes to small poly pep
Brush border enzymes break the small poly peps to amino acids
-Enter the capillary blood in the villi transported to liver via hepatic portal vein

92
Q

How are unemulsidied fats absorbed?
They are emulsified by the detergent action of bile salts and the pancreatic lipase (both in small intestine)
Monoglycerides and fatty acidenter intestinal cells via diffusion combine with… lymph ducts
Glycerol and fatty acid  capillary blood  villi  lacteal(middle of countercurrent) to to liver

A

They are emulsified by the detergent action of bile salts and the pancreatic lipase (both in small intestine)
Monoglycerides and fatty acid enter intestinal cells via diffusion combine with… lymph ducts
Glycerol and fatty acid capillary blood villi lacteal(middle of countercurrent) to to liver

93
Q

What is the emuslsification of fat?

A

Breakdown of large fat globlet into smaller droplets

94
Q

how does Bile acts as an emulsifying agent in the digestive tract?

A

Its nonpolar region binds to fat dispersing ingested fats into small globules

95
Q

When does Lipogenesis occur?

A

Too much glucose

96
Q

Glycogenesis vs gluconeogenesis

A

Glucose to glycogen

Aminoacid to glucose

97
Q

What is the breakdown biproduct of protein? How is the biproduct excreted?

A

ammonia –> urea –> urine

98
Q

What do carbs and lipids become?

A

Structural components of cells
Specialized derivative (steriod)
Energy
Storage

99
Q

What do amino acids become?

A

components of proteins

nitrogen containing derivative (hormones NT)

100
Q

what gets absorbed in the stomach, duodenum, jejunum, ileum, and colon?

A 
Stomach s.AW
Duodenum icfsw pmsv 
Jejunum J.PS
Ileum I.BBC
Colon C.EW
101
Q

Define anorexia

A

Lack of appetitie dispite stimuli that would normally producer hunger

102
Q

What are common sx associated with nausea?

A

Hypersalivation and tachycardia

103
Q

What is nonproductive vomiting?

A

Retching

104
Q

Define projectile vomiting

A

Spontaneous vomiting that doesn’t floowing nausea or retching

105
Q

What are the causes of constipation?

A 
Neurogenic disorders, 
functional or mechanical conditions, 
low-residue diet, 
sedentary lifestyle, 
excessive use of antacids
106
Q

What are the different mechanisms of diarrhea?

A

Osmotic
Secretory
Motility

107
Q

T/F: diarrhea is the increase frequency of BM, increased volume fluidity and DECREASE in weight of the feces

A

f- increase

108
Q

What does diarrhea cause?

A

Weight loss
electrolyte imblance
metablolic acidosis
dehydration

109
Q

GI manifestations of actute Bacterial infection or viral infection

A

fever, w/ or w/o cramps

110
Q

IBS cause…?

A

Fever cramping bloody stool

111
Q

Streatorrhea is a sign of what?

A

Malabsorption

112
Q

What are types of ab pain?

A

Patiental
Visceral
Reffered

113
Q

What are the Biochemical mediators of the inflammatory response that stimulate organic nerve endings producing abdominal pain?

A

histamine, bradykinin, and serotonin

114
Q

Upper GI bleed comes from

A

SED

115
Q

Lower GI comes from

A

jeju ilium colon rectum

116
Q

What would cause an upper GI bleed?

A

Varcies (varicose around esophagus – increases pressure)
ulcer,
mallory –weiss (tear from vomiting)

117
Q

What can cause lower gi bleed?

A

Polyps
IBS
Cancer
Hemorroids

118
Q

How can you tell a pt is going into shock from a GI bleed?

A

With loss of 1000 ml or more, or 20-25% of blood volume loss within a few hrs
Herat Rate is greater than 100 BPM
Systolic BP is less than 100 mm Hg

119
Q

test for GI bleed

A

BMX CLUE

Barium Enema
MRI/CT
X-Rays – flat and upright

Cholecystogram – oral contrast
Liver Enzymes/Bilirubin/Serum Proteins
Ultrasound
Endoscopy – ERCP, Colonocopy

120
Q

What are disorder of motility?

A 
Dysphagia
Achalasia
GERD 
Hiatal hernia
Intestinal obstruction and ileus
121
Q

What are the types of dysphagia?

A

Mechanical or functional obstruction

122
Q

What is achalasia?

A

Denervation of smooth muscle in the esophagus and lower esophageal sphincter relaxation

123
Q

Whats the differnecce btwn gerd and reflux esophagitis?

A

Its called relux esophagitis when GERD causes inflammation

124
Q

What must a normal functioning LES maintain to prevent reflux?

A

a zone of high pressure to prevent chyme reflux

125
Q

What can contribute to GERD?

A

Condition that increase abdominal pressure

126
Q

What can continous GERD cause?

A

Barrett Esophagus – premalignant change

127
Q

List the manifestations of GERD (3)

A

Heartburn, regurgitation of chyme, and upper abdominal pain within 1 hour of eating

128
Q

What are the two types of hiatal hernia? Which one is better?

A

Sliding hiatal hernia*

Paraesophageal hiatal hernia

129
Q

What is an obstruction of the intestines called?

A

Ileus

130
Q

What is an ileus?

A

Any condition that prevents the flow of chyme through intestinal lumen OR failure of normal intestinal motility w/o an obstructing lesion

131
Q

Intestinal obstrruction presents with what manifestations?

A 
Colicky (comand an go) pain 
vomiting 
Distention
Hypovolemia
Metabolic acidosis
132
Q

How are GI obstructions characterized?

A

Acute or chronic
Partial or complete
Simple or strangulated
Functional or mechanical

133
Q

what are the causes of mechanical obstruction?

A

Volvulus = twist
Adhesion
Incarderation = strangulated
Intusssception = folding inward

134
Q

What layer does gastritis affect?

A

Mucosa

135
Q

Causes of gastritis?

A

h.Pylori and NSAIDS

136
Q

What are two types of gastritis?

A

Acute and chronic

137
Q

What is PUD?

A

A break or ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum

138
Q

What is the difference between superficial PUD ulcers and deep?

A

Superficial – slight Erosions

Deep - True ulcers

139
Q

Whats the most common type of peptic ulcer?

A

Duodenal

140
Q

What are the developmental factors of duodenal ulcers?

A

Hypersecretion of stomach acid and pepsin

Use of NSAIDs

141
Q

Where does gastric ulcers tend to develop?

A

antral region of the stomach

142
Q

What is the primary change in gstric ulcers?

A

increased mucosal permeability to hydrogen ions

Gastric secretion is normal of less than normal

143
Q

Whats the most common type of peptic ulcer?

A

Duodenal

144
Q

What are the developmental factors of duodenal ulcers?

A

Hypersecretion of stomach acid and pepsin
Use of NSAIDs
High gastrin levels
Acid production by cigarette smoking

145
Q

How does h pylori create ulcers?

A

Toxins and enzymes that promote inflammation and ulceration

Patho exam 3 (5 decks)

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