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GI Flashcards

1
Q

What is the main blood supply to the foregut, midgut and hindgut?

A

foregut: coeliac trunk
midgut: superior mesenteric artery
hindgut: inferior mesenteric artery

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2
Q

What is the main nerve supply to the foregut, midgut and hindgut? Where do each of them leave the spinal cord?

A

foregut: greater splanchnic nerve: T5-T9
midgut: lesser splanchnic nerve: T10-T11
hindgut: least splanchnic nerve: T12

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3
Q

Where on the spinal cord does the sympathetic chain run?

A

T1 - L2

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4
Q

Describe the structure of the stomach.

A 
Oesophagus
Cardiac sphincter
Cardia
Fundus
Body
Antrum
Pylorus
Pyloric sphincter
Duodenum

Smaller c-shaped curve= lesser curvature
Larger c-shaped curve= greater curvature

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5
Q

What is the name for the muscular ridges in the stomach?

A

reggae

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6
Q

What is the name for the two openings of the stomach?

A 
top= cardiac orifice 
bottom= pyloric orifice
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7
Q

What two sphincters are in the stomach?

A

cardiac sphincter

pyloric sphincter

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8
Q

Describe the arterial supply to the stomach.

A

Blood supply arises from coeliac artery

Branches of coeliac artery are:
Hepatic artery- supplies liver
Splenic artery- supplies spleen
Left gastric artery- supplies left side of lesser curvature

Splenic artery branches to:
Short gastric: supplies fundus
Left gastroepiploic: supplies left side of greater curvature

Hepatic artery branches to:
Right gastric: supplies right side of lesser curvature
Pancreatoduodenal: supplies duodenum

Pancreatoduodenal artery branches to:
Right gastroepiploic: supplies right side of greater curvature

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9
Q

Describe the arterial supply to the midgut.

A

Supplied by superior mesenteric artery

Superior mesenteric branches to:
Ileocolic/ ileocecal artery: supplies cecum and ileum
Right colic: supplies ascending colon
Middle colic: supplies 2/3 of transverse colon

The marginal artery of Drummond is formed from ileocecal, right colic and middle colic arteries. Coming off this is the arcades and vasa recta which lie in the mesentery and supply the jejunum

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10
Q

Describe the arterial supply of the hindgut.

A

Supplies by inferior mesenteric artery

Inferior mesenteric branches to:
Left colic: supplies remaining 1/3 of transverse colon and descending colon
Sigmoid: supplies sigmoid colon
Superior rectal: supplies rectum and upper part of anal canal

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11
Q

What are the 4 parts of the duodenum?

A 
starts at pylorus 
superior duodenum 
descending duodenum
inferior duodenum
ascending duodenum
ends at duodenaljejunal junction
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12
Q

Where does the common bile duct empty into?

A

the descending duodenum

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13
Q

Where does the main pancreatic duct empty into?

A

the descending duodenum

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14
Q

Via what entrance does the common bile duct and main pancreatic duct drain into?

A

The major duodenal papillae

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15
Q

Describe the mucosa of the duodenum.

A

superior duodenum has smooth mucosa, the rest has plicae circularis

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16
Q

What is the function of plicae circularis?

A

increase surface area of duodenum

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17
Q

List the differences between the jejunum and the ileum.

A

length: ileum longer
diameter: jejunum wider
wall: jejunum thick double wall, ileum thin wall
colour: jejunum deep red, ileum pale pink

peyer’s patches: jejunum has very few, ileum has many

blood supply: jejunum has longer arteries and few vasa recta, ileum has short arteries and many vasa recta

mesentery: more fatty at ileum

crypts of lieberkuhn: jejunum has shallow crypts, ileum has normal depth crypts

villi: jejunum has long and narrow villa, ileum has short and wide villi

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18
Q

What is the function of Peyer’s patches?

A

immune surveillance of small intestine

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19
Q

Describe the anatomy of the large intestine

A 
ileum leads into cecum via ileocecal valve
appendix attached to cecum
ascending colon
right colic (hepatic) flexure
transverse colon 
left colic (splenic) flexure
descending colon
sigmoid flexure
sigmoid colon
rectum
anus
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20
Q

What are taenia coli?

A

3 longitudinal ribbons of smooth muscle on the outside of ascending, transverse, descending. sigmoid colon

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21
Q

What are haustra?

A

the pouches of the colon

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22
Q

What is the venous drainage of the colon?

A

ascending, transverse colon: superior mesenteric vein

descending, sigmoid colon: inferior mesenteric vein

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23
Q

What is the marginal artery of Drummond?

A

anastomosis of the superior and inferior mesenteric artery and gives of arcades and vasa recta, important in ensuring blood supply to colon

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24
Q

List the differences between the small and large intestine.

A

size: small intestine longer and thinner, large intestine shorter and wider
muscle: small intestine has longitudinal muscle layer that is continuous, large intestine is not continuous but has 3 muscles= tenae coli
wall: small intestine has smooth wall, large intestine has haustrations

plique circularis: internal membrane of small intestine has PC, colon doesn’t

villi: small intestine mucous membrane has villi, colon doesn’t

peyer’s patches: small intestine has them, colon doesn’t

haustrations: small intestine has none, colon does

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25
What are the three muscles of the abdominal wall and what is the function of each?
1. External Oblique- contralateral rotation of torsa 2. Internal Oblique- bilateral contraction compresses abdomen, unilateral contraction ipsilaterally rotates torso 3. Transverse Abdominus- compression of abdomen
26
In what direction do the fibres of the external oblique run?
inferomedially (as if into your pockets)
27
In what direction do the fibres of the internal oblique run?
superomedially
28
What joins the muscles of the abdominal wall?
aponeurosis called the RECTUS SHEATH
29
What is another name for the arcuate line and where does it lie?
semicircular line of Douglas about 1/3 of distance between umbilicus and pubic symphysis
30
Name the 9 sections of the abdomen from right to left, up to down.
right hypochondrium epigastric left hypochondrium right lumbar umbilical left lumbar right iliac hypogastric left iliac
31
What vertical and horizontal lines separate the 9 sections of the abdomen?
vertical: 2 midclavicular lines horizontal: upper: subcostal plane lower: intercristal plane
32
Where is McBurney's point and what is it's significance?
2/3 of the way from umbilicus to anterior iliac spine | this is where the appendix lies
33
Where is the transpyloric plane? What does it cross?
L1 gallbladder, pancreas, pylorus, duodenal-jejunal flexure, kidney
34
What are the boundaries of the foregut, midgut and hindgut?
foregut: mouth to common bile duct midgut: common bile duct to 2/3 along transverse colon hindgut: 2/3 along transverse colon to anal canal
35
What does the remnant of the urachus give?
median umbilical ligaments
36
What does the remnant of the foetal umbilical arteries give?
medial umbilical ligaments
37
Describe the epithelium of the lips.
``` outer= highly keratinised squamous epithelium inner= less keratinised squamous epithelium ```
38
Describe the epithelium of the tongue.
``` stratified squamous (dorsal- keratinised, ventral- nonkeratinised) ```
39
Describe the epithelium of the oral cavity.
stratified squamous non-keratinising
40
Describe the epithelium of the oesophagus.
stratified squamous non-keratinising
41
Describe the epithelium of the stomach.
simple glandular columnar
42
Describe the epithelium of the small intestine.
simple columnar with crypts and villi
43
Describe the epithelium of the colon and rectum.
simple columnar with no villi
44
Describe the epithelium of the anal canal.
stratified squamous, becomes keratinised at distal end
45
What are the 3 types of tongue papillae and where do each type lie?
filiform: anterior 2/3 fungiform: mushroom-shaped at sides and tip circumvallate: dome-shaped, arranged in a V- shape, separates anterior 2/3 and posterior 1/3
46
What type of tongue papillae don't contain tastebuds?
filiform
47
What are Fordyce's spots?
non-pathological papule that contain serous glands and can be found on the surface of the inner lip and genitalia
48
What are the two muscle layers of the oesophagus?
outer: longitudinal inner: circular
49
What can GORD/ Barrett's oesophagus do to the lower oesophagus?
can transform it into more of a gastric mucosa
50
What 2 components are found in the stomach epithelium?
gastric pits | contains secretory cells
51
What are the 3 muscle layers of the stomach?
outermost: longitudinal fibres middle: circular fibres innermost: oblique fibres
52
List the cells of the stomach, what they secrete and where they are found.
Mucous: secretes mucous, found in mucosa Parietal: secretes HCl and intrinsic factor, found in body and fundus Chief cells: secretes pepsinogen, found in body and fundus Enteroendocrine/ G cells: secretes gastrin, found in pyloric antrum ECL cells: secrete histamine, found in mucosa D cells: secrete somatostatin, found in antrum
53
What are the layers of the stomach?
mucosa submucosa muscular propria serousal surface
54
Where are Brunner's glands and what do they do?
in the duodenum only secrete alkaline mucus to neutralise chyme
55
What is the distribution of goblet cells in the small intestine?
few in duodenum many in jejunum increase in number towards distal end of ileum
56
Where are the lymph nodes in the jejunum?
lamina propria
57
Where in the ileum are the Peyer's patches?
lymphoid tissue in submucosa
58
What are the 3 longitudinal bands of muscles in the colon?
taeniae coli
59
What are the functions of saliva?
lubricant for mastication maintaining oral pH begins starch digestion antibacterial
60
How does saliva maintain oral pH? What is an appropriate range range for oral
bicarbonate/ carbonate buffer system pH 6.2 - 7.4
61
What enzyme is found in saliva?
alpha amylase
62
What are the two types of saliva secretion and what is their function?
mucous: mucins for lubrication serous: alpha amylase for starch digestion
63
What are the 4 types of salivary gland, what innervates them and what type of secretion do they release?
Parotid: serous Glossopharyngeal parasympathetic Sublingual: mucous Facial parasympathetic Submandibular: mixed Facial parasympathetic Minor: all mucus except Von Ebner's serous glands Facial parasympathetic
64
What are the differences between serous and mucus acini?
``` Serous: dark staining nucleus nucleus in basal third small central duct secretes water and alpha amylase ``` ``` Mucus: pale staining "foamy" nucleus nucleus at base large central duct secretes mucous (water and glycoproteins) ```
65
What are the components of a salivary duct?
Acini Intercalated duct Striated duct Interlobular/ excretory duct
66
What is the function of gastric mucous?
lubrication | protection of mucosa
67
What is the function of gastric acid?
digestion activates pepsinogen kills pathogens
68
What is the function of intrinsic factor?
absorption of vitamin B12 in terminal ileum
69
What is the function of pepsinogen?
converted to pepsin which is a protease enzyme for digestion
70
What is the function of gastric histamine?
stimulates HCl secretion
71
What is the function of gastrin?
stimulates HCl secretion | stimulates histamine secretion
72
What is the function somatostatin?
inhibits HCl secretion
73
What are the stages of gastric acid secretion?
cephalic stage: ON gastric stage: ON gastric stage OFF intestinal phase OFF
74
What stimulates pepsinogen secretion?
acetylcholine- parasympathetic
75
At what pH is pepsinogen converted to pepsin?
pH 2
76
What percentage of protein digestion is done by pepsin?
20%
77
What is the volume of an empty and max volume stomach?
empty stomach: 50mL | max volume: 1.5L
78
How does the volume of the stomach increase when eating?
via receptive relaxation
79
How is receptive relaxation mediated?
acetylcholine: parasympathetic (vagus nerve) | nitric oxide + serotonin (enteric)
80
Describe the process of peristalsis in stomach.
occurs in response to arriving food ripple movement begins in body more powerful contraction wave in antrum pyloric sphincter closes (so not much chyme can enter duodenum) antral contents forced back to body for mixing
81
What are the pacemaker cells of the stomach?
interstitial cells of cajal
82
How often does the stomach contract?
3 times per minute
83
What increases the strength of gastric contractions?
gastrin | gastric distension
84
What decreases the strength of gastric contraction?
``` duodenal distension increased duodenal fat increase in duodenal osmolarity decrease in duodenal pH increased sympathetic NS stimulation decreased parasympathetic NS stimulation ```
85
What are the protective mechanisms of gastric mucosa?
alkaline mucus on luminal surface tight junctions between epithelial cells rapid cell replacement of damaged cells by stem cells in base of pits feedback loops for regulation of gastric acid secretion
86
What is the consequence of insufficient gastric mucosa defence?
peptic ulcers
87
What are the causes are peptic ulcers?
helicobacter pylori infection NSAIDs chemical irritants (alcohol, bile salts) gastronome
88
What is BMR?
basal metabolic rate = the amount of energy needed to stay alive at rest
89
What is an approximate value for BMR in general?
24kcal/kg/day
90
What factors increase BMR?
``` overweight fever being male pregnancy caffeine hyperthyroidism exercise low temperature ```
91
What factors decrease BMR?
``` increase in age being female malnutrition starvation hypothyroidism ```
92
What is BMI?
body mass index
93
What is the formula for BMI?
weight / (height)^2 kg/m^2
94
What are the categories for BMI values?
``` <18.5 underweight 18.5-25 normal 25-30 overweight 30-40 obese >40 morbidly obese ```
95
What vitamins are fat soluble?
A D E K
96
Where are fat soluble vitamins absorbed?
ileum
97
What vitamins are water soluble?
B, C
98
Where are water soluble vitamins absorbed?
jejunum
99
How is vitamin B12 absorbed?
B12 ingested orally intrinsic factor produced by parietal cells in stomach B12 binds to intrinsic factor intrinsic factor binds to specific sites of terminal ileum epithelial cells B12 absorbed via endocytosis
100
What are the functions of vitamin A?
cellular growth and differentiation vision lymphocyte production skin and mucous membranes
101
What are the sources of vitamin A?
``` liver diary fruit and veg oily fish margarine ```
102
What are the consequences of vitamin A deficiency?
night blindness growth retardation increased infection susceptibility impaired hearing, taste and smell
103
What is the function of vitamin C?
collagen synthesis antioxidants absorption of non-haem iron
104
What are the sources of vitamin C?
citrus fruit green veg potatoes
105
What are the consequences of vitamin C deficiency?
scurvy bleeding gums aching bones
106
What is the function of vitamin B12?
erythrocyte formation DNA synthesis brain development
107
What are the sources of vitamin B12?
meat and fish eggs milk
108
What is the consequence of vitamin B12 deficiency?
pernicious anaemia
109
What is pernicious anaemia?
decrease in red blood cells due to lack of vitamin B12
110
What is the function of vitamin D?
calcium absorption in gut
111
What are the sources of vitamin D?
plants mushrooms UV light
112
What are the consequences of vitamin D deficiency?
frequency bone fractures muscle weakness bone pain
113
What is the function of vitamin E?
antioxidant | protects cell walls
114
What are the sources of vitamin E?
nuts and seeds | vegetable oil
115
What are the consequences of vitamin E deficiency?
muscle weakness | degeneration of retina
116
What is the function of vitamin K?
formation of clotting factors 2, 7, 9, 10 in liver
117
What are the sources of vitamin K?
green leafy veg | meat, eggs, cereal
118
What are the consequences of vitamin K deficiency?
no clotting factors gum bleeding easy bruising
119
Where does starch digestion begin? By what enzyme? By what pH?
alpha amylase in mouth at pH 6.7
120
What percentage of starch digestion occurs in small intestine?
95%
121
What enzymes in the small intestine digest starch?
pancreatic alpha amylase
122
Describe digestion and absorption of starch.
Digestion begins in mouth by alpha amylase 95% of digestion occurs in small intestine by pancreatic alpha amylase broken down into disaccharides enzymes of luminal surface membranes of small intestine epithelial cells break down disaccharides into monosaccharides monosaccharides are absorbed into the bloodstream
123
Describe protein digestion and absorption.
digestion begins in stomach by pepsin which breaks protein chains down into smaller fragments in small intestine peptides are further fragmented by pancreatic enzymes (endopeptidase) final digestion of acids by exopeptidase: by carboxypeptidase from pancreas in intestinal lumen by amino peptidase on luminal membrane of SI epithelial cells by intracellular peptidases absorbed into bloodstream
124
What is the most abundant substance in chyme?
water
125
How much water enters small intestine every day? How much of this enters the colon?
8000ml | 1500ml enters colon
126
What percentage of water absorption occurs in small intestine?
80%
127
Where is most water absorbed?
jejunum
128
What percentage of fluid is reabsorbed and what percentage in lost in stools?
98% reabsorbed | 2% lost in stools
129
How many ml of water is lost in stools every day?
200ml
130
How is sodium absorbed?
active transport | co-transport with glucose and amino acids
131
Why is sodium reabsorption important?
enhances osmotic gradient for water absorption
132
How is potassium absorbed?
passive diffision
133
How is chloride absorbed?
active transport in exchange for bicarbonate
134
Why is chloride absorption important?
makes intestinal contents more alkaline

Phase 1 Cards (9 decks)

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