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Phase 1 Cards > GI > Flashcards

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
Q

What are the three muscles of the abdominal wall and what is the function of each?

A
  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
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26
Q

In what direction do the fibres of the external oblique run?

A

inferomedially (as if into your pockets)

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27
Q

In what direction do the fibres of the internal oblique run?

A

superomedially

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28
Q

What joins the muscles of the abdominal wall?

A

aponeurosis called the RECTUS SHEATH

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29
Q

What is another name for the arcuate line and where does it lie?

A

semicircular line of Douglas

about 1/3 of distance between umbilicus and pubic symphysis

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30
Q

Name the 9 sections of the abdomen from right to left, up to down.

A

right hypochondrium
epigastric
left hypochondrium

right lumbar
umbilical
left lumbar

right iliac
hypogastric
left iliac

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31
Q

What vertical and horizontal lines separate the 9 sections of the abdomen?

A

vertical:
2 midclavicular lines

horizontal:
upper: subcostal plane
lower: intercristal plane

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32
Q

Where is McBurney’s point and what is it’s significance?

A

2/3 of the way from umbilicus to anterior iliac spine

this is where the appendix lies

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33
Q

Where is the transpyloric plane? What does it cross?

A

L1

gallbladder, pancreas, pylorus, duodenal-jejunal flexure, kidney

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34
Q

What are the boundaries of the foregut, midgut and hindgut?

A

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

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35
Q

What does the remnant of the urachus give?

A

median umbilical ligaments

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36
Q

What does the remnant of the foetal umbilical arteries give?

A

medial umbilical ligaments

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37
Q

Describe the epithelium of the lips.

A 
outer= highly keratinised squamous epithelium 
inner= less keratinised squamous epithelium
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38
Q

Describe the epithelium of the tongue.

A 
stratified squamous 
(dorsal- keratinised, ventral- nonkeratinised)
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39
Q

Describe the epithelium of the oral cavity.

A

stratified squamous non-keratinising

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40
Q

Describe the epithelium of the oesophagus.

A

stratified squamous non-keratinising

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41
Q

Describe the epithelium of the stomach.

A

simple glandular columnar

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42
Q

Describe the epithelium of the small intestine.

A

simple columnar with crypts and villi

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43
Q

Describe the epithelium of the colon and rectum.

A

simple columnar with no villi

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44
Q

Describe the epithelium of the anal canal.

A

stratified squamous, becomes keratinised at distal end

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45
Q

What are the 3 types of tongue papillae and where do each type lie?

A

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

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46
Q

What type of tongue papillae don’t contain tastebuds?

A

filiform

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47
Q

What are Fordyce’s spots?

A

non-pathological papule that contain serous glands and can be found on the surface of the inner lip and genitalia

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48
Q

What are the two muscle layers of the oesophagus?

A

outer: longitudinal
inner: circular

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49
Q

What can GORD/ Barrett’s oesophagus do to the lower oesophagus?

A

can transform it into more of a gastric mucosa

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50
Q

What 2 components are found in the stomach epithelium?

A

gastric pits

contains secretory cells

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51
Q

What are the 3 muscle layers of the stomach?

A

outermost: longitudinal fibres
middle: circular fibres
innermost: oblique fibres

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52
Q

List the cells of the stomach, what they secrete and where they are found.

A

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

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53
Q

What are the layers of the stomach?

A

mucosa
submucosa
muscular propria
serousal surface

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54
Q

Where are Brunner’s glands and what do they do?

A

in the duodenum only

secrete alkaline mucus to neutralise chyme

55
Q

What is the distribution of goblet cells in the small intestine?

A

few in duodenum
many in jejunum
increase in number towards distal end of ileum

56
Q

Where are the lymph nodes in the jejunum?

A

lamina propria

57
Q

Where in the ileum are the Peyer’s patches?

A

lymphoid tissue in submucosa

58
Q

What are the 3 longitudinal bands of muscles in the colon?

A

taeniae coli

59
Q

What are the functions of saliva?

A

lubricant for mastication

maintaining oral pH

begins starch digestion

antibacterial

60
Q

How does saliva maintain oral pH? What is an appropriate range range for oral

A

bicarbonate/ carbonate buffer system

pH 6.2 - 7.4

61
Q

What enzyme is found in saliva?

A

alpha amylase

62
Q

What are the two types of saliva secretion and what is their function?

A

mucous: mucins for lubrication
serous: alpha amylase for starch digestion

63
Q

What are the 4 types of salivary gland, what innervates them and what type of secretion do they release?

A

Parotid: serous
Glossopharyngeal parasympathetic

Sublingual: mucous
Facial parasympathetic

Submandibular: mixed
Facial parasympathetic

Minor: all mucus except Von Ebner’s serous glands
Facial parasympathetic

64
Q

What are the differences between serous and mucus acini?

A 
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
Q

What are the components of a salivary duct?

A

Acini
Intercalated duct
Striated duct
Interlobular/ excretory duct

66
Q

What is the function of gastric mucous?

A

lubrication

protection of mucosa

67
Q

What is the function of gastric acid?

A

digestion
activates pepsinogen
kills pathogens

68
Q

What is the function of intrinsic factor?

A

absorption of vitamin B12 in terminal ileum

69
Q

What is the function of pepsinogen?

A

converted to pepsin which is a protease enzyme for digestion

70
Q

What is the function of gastric histamine?

A

stimulates HCl secretion

71
Q

What is the function of gastrin?

A

stimulates HCl secretion

stimulates histamine secretion

72
Q

What is the function somatostatin?

A

inhibits HCl secretion

73
Q

What are the stages of gastric acid secretion?

A

cephalic stage: ON
gastric stage: ON
gastric stage OFF
intestinal phase OFF

74
Q

What stimulates pepsinogen secretion?

A

acetylcholine- parasympathetic

75
Q

At what pH is pepsinogen converted to pepsin?

A

pH 2

76
Q

What percentage of protein digestion is done by pepsin?

A

20%

77
Q

What is the volume of an empty and max volume stomach?

A

empty stomach: 50mL

max volume: 1.5L

78
Q

How does the volume of the stomach increase when eating?

A

via receptive relaxation

79
Q

How is receptive relaxation mediated?

A

acetylcholine: parasympathetic (vagus nerve)

nitric oxide + serotonin (enteric)

80
Q

Describe the process of peristalsis in stomach.

A

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
Q

What are the pacemaker cells of the stomach?

A

interstitial cells of cajal

82
Q

How often does the stomach contract?

A

3 times per minute

83
Q

What increases the strength of gastric contractions?

A

gastrin

gastric distension

84
Q

What decreases the strength of gastric contraction?

A 
duodenal distension
increased duodenal fat
increase in duodenal osmolarity
decrease in duodenal pH
increased sympathetic NS stimulation
decreased parasympathetic NS stimulation
85
Q

What are the protective mechanisms of gastric mucosa?

A

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
Q

What is the consequence of insufficient gastric mucosa defence?

A

peptic ulcers

87
Q

What are the causes are peptic ulcers?

A

helicobacter pylori infection
NSAIDs
chemical irritants (alcohol, bile salts)
gastronome

88
Q

What is BMR?

A

basal metabolic rate = the amount of energy needed to stay alive at rest

89
Q

What is an approximate value for BMR in general?

A

24kcal/kg/day

90
Q

What factors increase BMR?

A 
overweight
fever
being male
pregnancy
caffeine 
hyperthyroidism
exercise 
low temperature
91
Q

What factors decrease BMR?

A 
increase in age
being female 
malnutrition 
starvation
hypothyroidism
92
Q

What is BMI?

A

body mass index

93
Q

What is the formula for BMI?

A

weight / (height)^2

kg/m^2

94
Q

What are the categories for BMI values?

A 
<18.5 underweight 
18.5-25 normal
25-30 overweight 
30-40 obese
>40 morbidly obese
95
Q

What vitamins are fat soluble?

A

A D E K

96
Q

Where are fat soluble vitamins absorbed?

A

ileum

97
Q

What vitamins are water soluble?

A

B, C

98
Q

Where are water soluble vitamins absorbed?

A

jejunum

99
Q

How is vitamin B12 absorbed?

A

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
Q

What are the functions of vitamin A?

A

cellular growth and differentiation
vision
lymphocyte production
skin and mucous membranes

101
Q

What are the sources of vitamin A?

A 
liver
diary
fruit and veg
oily fish
margarine
102
Q

What are the consequences of vitamin A deficiency?

A

night blindness
growth retardation
increased infection susceptibility
impaired hearing, taste and smell

103
Q

What is the function of vitamin C?

A

collagen synthesis
antioxidants
absorption of non-haem iron

104
Q

What are the sources of vitamin C?

A

citrus fruit
green veg
potatoes

105
Q

What are the consequences of vitamin C deficiency?

A

scurvy
bleeding gums
aching bones

106
Q

What is the function of vitamin B12?

A

erythrocyte formation
DNA synthesis
brain development

107
Q

What are the sources of vitamin B12?

A

meat and fish
eggs
milk

108
Q

What is the consequence of vitamin B12 deficiency?

A

pernicious anaemia

109
Q

What is pernicious anaemia?

A

decrease in red blood cells due to lack of vitamin B12

110
Q

What is the function of vitamin D?

A

calcium absorption in gut

111
Q

What are the sources of vitamin D?

A

plants
mushrooms
UV light

112
Q

What are the consequences of vitamin D deficiency?

A

frequency bone fractures
muscle weakness
bone pain

113
Q

What is the function of vitamin E?

A

antioxidant

protects cell walls

114
Q

What are the sources of vitamin E?

A

nuts and seeds

vegetable oil

115
Q

What are the consequences of vitamin E deficiency?

A

muscle weakness

degeneration of retina

116
Q

What is the function of vitamin K?

A

formation of clotting factors 2, 7, 9, 10 in liver

117
Q

What are the sources of vitamin K?

A

green leafy veg

meat, eggs, cereal

118
Q

What are the consequences of vitamin K deficiency?

A

no clotting factors
gum bleeding
easy bruising

119
Q

Where does starch digestion begin? By what enzyme? By what pH?

A

alpha amylase in mouth at pH 6.7

120
Q

What percentage of starch digestion occurs in small intestine?

A

95%

121
Q

What enzymes in the small intestine digest starch?

A

pancreatic alpha amylase

122
Q

Describe digestion and absorption of starch.

A

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
Q

Describe protein digestion and absorption.

A

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
Q

What is the most abundant substance in chyme?

A

water

125
Q

How much water enters small intestine every day? How much of this enters the colon?

A

8000ml

1500ml enters colon

126
Q

What percentage of water absorption occurs in small intestine?

A

80%

127
Q

Where is most water absorbed?

A

jejunum

128
Q

What percentage of fluid is reabsorbed and what percentage in lost in stools?

A

98% reabsorbed

2% lost in stools

129
Q

How many ml of water is lost in stools every day?

A

200ml

130
Q

How is sodium absorbed?

A

active transport

co-transport with glucose and amino acids

131
Q

Why is sodium reabsorption important?

A

enhances osmotic gradient for water absorption

132
Q

How is potassium absorbed?

A

passive diffision

133
Q

How is chloride absorbed?

A

active transport in exchange for bicarbonate

134
Q

Why is chloride absorption important?

A

makes intestinal contents more alkaline

Phase 1 Cards (9 decks)

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