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ESA 3 > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

What is the tonicity of saliva?

A

Hypotonic

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2
Q

What is the pH of saliva?

A

Usually alkaline, due to potassium and bicarbonate, can be from slightly acidic to pH 8

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3
Q

Contents of saliva (6)

A 
Mucins
Amylase
Lingual lipase
IgA
Lysozyme
Lactoferrin
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4
Q

Purpose of mucins?

A

lubrication

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5
Q

Function of saliva? (7)

A 
Lubrication for speech
Transmits infections
Digestion
Solvent for taste molecues
Lubrication of food
Dental hygiene
Lysozyme to kill pathogens
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6
Q

What is Xerostomia?

A

Dry mouth, sign of dehydration

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7
Q

Location of salivary glands? (3)

A

Sublingual
Submandibular
Parotid

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8
Q

Location of entry of salivary ducts? (3)

A

Sublingual - lateral
Submandidular - medial
Parotid - opposite crown of 2nd upper molar tooth

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9
Q

Neural control of salivary glands (5)

A

Autonomic
Parasympathetic
Sympathetic causes slight increase in production but mostly vasconstriction
Sublingual and Submandibular - chorda tympani (CN VII)
Parotid - Glossopharyngeal (CN IX)

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10
Q

What effect would antimuscarinic drugs have?

A

Cause xerostomia

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11
Q

Stages of swallowing (3)

A

Oral preparatory phase
Pharyngeal phase
Oesophageal stage

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12
Q

Describe the oral preparatory phase? (3)

A

Voluntary (CN V3)
Pushes bolus to pharynx
Once bolus touches pharyngeal wall, pharyngeal phase starts

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13
Q

Describe the pharyngeal phase? (5)

A

Involuntary
Soft palate seals off nasopharynx (CN V3)
Larynx elevates closing epiglottis (Suprahyoid muscles)
Vocal cords adduct (CN X)
Opening of upper oesophageal sphincter

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14
Q

Describe the oesophageal phase? (3)

A

Involuntary
Closure of UOS
peristaltic wave caries bolus downwards

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15
Q

Main nerves involved in swallowing? (40

A

CN V3 (soft palate)
CN IX
CN X
CN XII (intrinsic muscles of the tongue)

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16
Q

How can babies eat and swallow at the same time?

A

Their epiglottis projects into the nasopharynx and their necks are shorter, meaning the epiglottis is always protecting the laryngeal inlet and the aspiration of fluid, but they can’t talk until epiglottis moves out of the way

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17
Q

Neural control of swallow and gag reflex? (5)

A 
Mechanoreceptors at the back of the throat
CN IX
medulla
CN X
Pharyngeal constrictors
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18
Q

Which parts of the control of the head and neck are close in the brain?

A

Control of face and swallowing close so can both be affected

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19
Q

Describe the anatomical position of the oesophagus? (2)

A

Posterior to trachea

Right of aorta

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20
Q

Where does the narrowing of the oesophagus occur? (4)

A

UOS
Where aorta crosses oesophagus
where left main bronchus crosses the oesophagus
oesophageal hiatus where it passes through diaphragm

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21
Q

Prevention of gastro-oesophageal reflux (5)

A

LOS formed of smooth muscle
Diaphragm which causes narrowing of oesophagus
Intra-abdominal oesophagus compresses when intra-abdominal pressure rises
Mucosal rosette at cardia prevents backflow
actue angle of entry of oesophagus

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22
Q

What muscular changes occur as you move distally in the oesophagus?

A

Goes from skeletal to smooth, in the middle there is a mix

23
Q

What is a hernia?

A

A protrusion of the abdominal contents beyond the normal confines of the abdominal walls

24
Q

What are the parts of the hernia (3)

A

The sac
The contents of the sac
The covering of the sac

25
Q

What is the sac made of?

A

peritoneum

26
Q

What is the contents of the sac?

A

contents that would usually be confined to the abdominal cavity i.e. loops of bowel, omentum etc.

27
Q

What are the coverings if the sac?

A 
layers if the abdominal wall 
Transversus abdominis
Internal oblique
External oblique
Transversalis fascia
28
Q

Where do weaknesses of the abdominal wall occur? (4)

A

Inguinal canal
Femoral canal
Umbilicus
Sites of previous incisions

29
Q

What is the inguinal canal? (3)

A

Oblique passage through the lower part of the abdominal wall
In males abdomen to testis
In females round ligament from uterus to labia majora

30
Q

What is the processus vaginalis?

A

A pouch of peritoneum that accompanies the testis on their descent and normally eventually disintegrates
If this doesn’t disintegrate this leaves a communication between the peritoneal cavity and the scrotum

31
Q

What structures form the floor of the inguinal canal? (2)

A

Inguinal ligament laterally

Lacunar ligament medially

32
Q

What structures form the roof of the inguinal canal? (2)

A

Internal oblique

Transverse abdominus

33
Q

What structures form the posterior wall of the inguinal canal? (3)

A

Transversalis fascia
Deep ring laterally
Conjoint tendon medially

34
Q

What is the conjoint ligament?

A

common ligament of the internal oblique and the transverse abdominis that attaches to the crest of the pubis, reinforces an otherwise weak area of the posterior wall

35
Q

What structures form the anterior wall of the inguinal canal? (2)

A

The aponeurosis of the external oblique

Superficial ring medially

36
Q

Clinical features of the inguinal hernia (4)

A

Most common abdominal hernia
Indirect is the most common of the 2
Most common in men (7:1)
Mainly right sided

37
Q

Types of inguinal hernia? (2)

A

Direct

Indirect

38
Q

Features of a indirect inguinal hernia (3)

A

Enters deep ring, travels through inguinal canal, exits via superficial ring
Depending on where processus vaginalis was obliterated can potentially descend into testis
Location: Lateral to inferior epigastric vessels

39
Q

Features of direct inguinal hernia (2)

A

Bulges through Hesselbach’s triangle straight through superficial ring
Location: Medial to inferior epigastric vessels

40
Q

Hesselbachs triangle (2)

A 
Area of relative weakness in abdominal wall
Borders:
Medial - rectus abdominis
Superior - inferior epigastric vessels
Inferior - lacunar ligament
41
Q

What are the consequences of herniation of the small bowel?

A

Bowel obstruction

42
Q

Features of a femoral hernia (3)

A

Occur through femoral ring, medial to femoral vein
Mostly in females due to width of hips
Can easily become incarcerated and not reducible
Exit via saphenous opening

43
Q

Hernia strangulation (3)

A

Compromised blood supply
Necrosis
Sepsis

44
Q

Borders of the femoral ring (4)

A

Posterior - inguinal ligament
Anterior - Pectineus
Lateral - Femoral vein
Medial - Lacunar ligament

45
Q

Types of umbilical hernia (3)

A

Congenital
Acquired infantile
Acquired adult

46
Q

Types of congenital hernia (2)

A

Omphalocele

Gastrochisis

47
Q

What is an Omphalocele?

A

From week 6 to 8 of the embryological development of the GIT the primary intestinal loop herniates into through the umbilicus into the umbilical cord, rotating 90 degrees counterclockwise around the SMA. If there is improper retraction of the intestinal loop in the 11th week, it remains outside of the abdominal cavity, but is covered in peritoneum.
Associated with neural tube defects and cardiac malformations

48
Q

What is Gastroschisis?

A

Failure of the closure of the abdominal wall during folding if the embryo can leave a hole, usually to the right of the belly button, through which abdominal contents can herniate. It is not covered in peritoneum and can be irritated by the amniotic fluid causing inflammation.

49
Q

Meckel’s diverticulum

A

Failure of the disintegration of the vitelline duct

50
Q

Describe an acquired infantile umbilical hernia

A

Contents of the abdominal cavity herniates through weakness in scar of umbilicus, resolves itself after a few years

51
Q

Describe an acquired adult umbilical hernia

A

occurs in the linea alba region of the umbilicus, affects women more than men

52
Q

Describe and epigastric hernia

A

Occurs through linea alba between xiphoid process and umbilicus
Starts with a small hernia of extra-peritoneal fat
Chronic straining forces more fat out which can eventually pull peritoneum through

53
Q

Symptoms of a hernia

A

Pain
Vomiting
Sepsis

54
Q

What is meant by the term incarcerated?

A

A hernia that has become stuck and is irreducible

ESA 3 (5 decks)

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