GI Flashcards by Danielle Deines

What fetal GI structures develop at 3.5 weeks?

Foregut and hindgut

Liver bud

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What fetal GI structures develop at 4 weeks?

Esophagus and stomach separate (foregut)
Intestine (single tube)
Hepatobiliary system (foregut)
Pancreas (midgut)

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What fetal GI structures develop at 5-9 weeks?

Mouth, esophagus, stomach move to normal position
Intestine herniates into umbilical cord, rotation occurs
Jejunal villi form

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What fetal GI structures develop at 10 weeks?

Intestines return to abdomen
Microvilli form
Crypts of Lieberkuhn develop

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What fetal GI structures develop at 12 weeks?

Parietal cells (stomach)
Taste buds
Muscularis/muscle layers (13)
Disaccharides
Islet cells 
Bile secretion

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What fetal GI structures develop at 16 weeks?

Sucking/swallowing
Villi throughout intestine (14)
Meconium
Lipase
Trypsin

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What fetal GI structures develop at 18 weeks?

Ganglion cells

Crypts (19)

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What fetal GI structures develop at 20-24 weeks?

Amylase (oral)
Ciliated columnar cells
Maltase
Sucrase
Pancreatic amylase (22)

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What fetal GI structures develop at 28 weeks?

Disaccharidases at adult levels (30)

Lactase ^

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What fetal GI structures develop at 32 weeks?

Normal gastric emptying

HCl detected in stomach

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What fetal GI structures develop at 34-36 weeks?

Coordinated suck/swallow
Rapid peristalsis
Lactases at adult levels (36)

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What are the enzymes that aid in carbohydrate digestion?

Pancreatic amylase
Glucoamylase
Intestinal disaccharidases
Colonic bacteria
Glucose transport
Lactase

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When does the fetus develop pancreatic amylase

Present at 22 weeks

Decreased secretion at birth

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What is the function of glucoamylase?

Fully active at birth
Located in intestinal brush border
Removes glucose from end of starch

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What are the glucosidases/disaccharidases and when do they reach normal levels?

Sucrase
Maltase
Isomaltase

28 weeks

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What is the role of colonic bacteria in carbohydrate digestion?

Ferment malabsorbed carbohydrates to acids–>
colonic absorbtion

Colonic salvage pathway

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Where does glucose transport occur in the GI tract?

In the small intestine

Less efficient with decreasing gestational age

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Lactase reaches adult levels at

36 weeks

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Chymotrypsin and trypsin are present in the

Duodenum

Decreased in preterm and term infants

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Dipeptidase is present in

Mucosa

Present early in gestation

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Amino acid transport capacity reaches normal levels at

Early gestation

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Fat digestion occurs primarily through the action of

Bile acids

Pancreatic lipase

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To compensate for decreased bile acids and pancreatic lipase at term, preterm and term infants digest fats through

Lingual lipase
Gastric lipase
Breast milk lipase
Chylomicron formation
Increased medium chain fatty acids in diet

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Enzymes present in the mouth are

Salivary amylase

Lingual lipase

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Enzymes present in the stomach are

``` Pepsinogen Acid Chyme Intrinsic factor Gastrin Gastric lipase ```

Pancreatic enzymes are

``` Pancreatic amylase Chymotrypsinogin Chymotrypsin Trypsinogen Trypsin Pancreatic lipase ```

Liver produces ____ for digestion

Bile

Small intestine enzymes are

``` Enterokinase Glucoamylase Disaccharidases (maltase, sucrase, lactase) Amino peptidases Dipeptidase Intestinal Cholecystokinin Secretin Gastrin inhibitory peptide Motilin ```

Large intestine contributes to digestion through the

Salvage pathway

Esophageal duplication presents as

Posterior mediastinal mass that can compress trachea and cause respiratory distress Can also compress esophagus and cause feeding intolerance

Esophageal cysts are

Located in muscular wall and lined by ciliated, gastric, or squamous epithelium

The most common type of TEF is

Esophageal atresia with distal TEF (85%)

Most TEFs are

``` Isolated anomalies (30-40% with other anomalies) Rarely familial ``` Can be associated with VACTERL

Occurrence of pyloric stenosis is associated with

3/1,000 birth 5 to 1 males>>>females O and B blood types

Duodenal atresia is commonly associated with

``` Trisomy 21 Malrotation CHD Annular pancreas Esophageal atresia GU anomalies ```

Duodenal atresia occurs due to

Failed recannelization of intestinal tube, 8 to 10 weeks gestation

Jejunal-ileal Atresia most often occurs with _____ atresia in the _____

Single atresia | Distal ileum

Jejunal-ileal Atresia occurs due to

Ischemic injury after intestinal development

Small left colon syndrome is associated with

``` Maternal diabetes Maternal hypothyroidism Maternal toxemia / magnesium Prematurity Cecal perforation ```

Microcolon is a result of

Functional immaturity of the ganglion cells

Colonic atresia is caused by

Ischemia

Most infants with hirschsprung disease are

Male (80%) and related to an individual who also has hirschsprung disease

hirschsprung disease is associated with

``` Trisomy 21 Heterochromia Waardenberg syndrome Congenital deafness 13Q deletion Pheochromocytoma Neurofibromatosis Neuroblastoma ```

hirschsprung disease most often occurs in the

Rectosigmoid colon

Meconium plug is differentiated from meconium ileus by

Location in the colon, in contrast with meconium ileus which involves distal ileum

Meconium plug is caused by

Immaturity of myenteric plexus nerve cells in the colon

Imperforate anus associated with rocker bottom perineum usually indicates

Sacral agenesis

Pancreatic insufficiency associated with Schwachmann-Diamond syndrome includes

Bone marrow dysfunction Short stature Normal sweat test

Pancreatic insufficiency associated with cystic fibrosis includes

Chr 7 508 position mutation CFTR chloride transporter abnormality ``` FTT vitamin k malabsorption Hypocalcemia Cholestasis Rectal prolapse Nasal polyps Peptic ulcers Pancreatitis ```

Pentalogy of Cantrell includes

``` Sternal cleft Anterior midline diaphragmatic abnormality Pericardial defect Ectopic cordis Omphalocele ```

All infants with gastroschisis also have

Malrotation

Omphalocele is more common in

Males (3:1) | Association with other defects/syndrome (59-89%)

Associated syndromes with omphalocele are

Trisomy 13, 18, 21 Pentalogy of Cantrell Beckwith-Wiedeman OEIS

Cause of omphalocele is

Intestinal loops fail to return to abdomen at 11 weeks | Somatic folds fail to complete abdominal wall at 18 weeks

The ________ distinguishes upper from lower GI bleeding

Ligament of Treitz

___% of infants <1500g will develop NEC

10%

Bloody stools and focal pneumatosis is NEC stage ____

Abdominal findings including edema/ascites with portal venous gas on x-ray is NEC stage ____

Diffuse systemic signs with abdominal edema/erythema and persistent bowel loops distention is NEC stage ____

NEC stage 3B is marked by

Pneumoperitoneum

Prognosis for short bowel syndrome is worse if

Colon resected Ileocecal valve removed >25cm bowel+ ileocecal valve resected >40cm resected without valve

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GI Flashcards

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