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GI Liver Renal > GI > Flashcards

GI Flashcards

0
Q

The esophagus is lined by _____cells

A

Squamous cells

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1
Q

The GI tract consists of

A

Mouth, esophagus, stomach, small intestines, large intestines.

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2
Q

The esophagus is ______ strong

A

Mechanically

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3
Q

Stomach acid does what?

A

Kills most bacteria, denatures proteins.

Makes an isotonic slurry

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4
Q

Small intestines tonicity is greater than, less than, or equal to the tonicity of blood?

A

Equal to.

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5
Q

What controls the pyloric sphincter?

A

The pH of the duodenum. Has to be pH ~8, when pH is high enough duodenum will signal pyloric sphincter to relax and let out more chyme

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6
Q

The large intestine reabsorbs

A

Na+, Cl-, water

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7
Q

Feces is mostly bacteria. What type?

A

Bacteroides, e.coli.

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8
Q

The appendix serves as

A

Reservoir for bacteria, immune organ (where immune cells can find their antigens)

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9
Q

The stomach can absorb what?

A

Water, alcohol, ASA. It can also lose water. (Ingest a gallon of water, will absorb more to increase concentration in the stomach)

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10
Q

The duodenum absorbs these 9 things

A

Fe2+, Ca2+, mg2+, Na+, water, protein, fat, sugar, vitamins

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11
Q

The jejunum absorbs (2)

A

Sugar, protein

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12
Q

The ileum absorbs (3)

A

Bile salts, vitamin b12, Cl-

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13
Q

The colon absorbs (4)

A

Water, Na+, Cl-, HCO3-

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14
Q

Three anatomical/motor esophageal disorders are:

A

Hiatal hernia, achalasia, esophageal varices

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15
Q

Two types of esophagitis

A

GERD, Barrett esophagus

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16
Q

Two types of esophageal cancer

A

Squamous cell, adenocarcnoma

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17
Q

95% of hiatal hernias are

A

Sliding hernia

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18
Q

What is hiatal hernia?

A

Stomach protrudes into esophageal hiatus. (Food can get stuck in the portion of stomach that is above the diaphragm)

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19
Q

T/F hiatal hernias decreases with age

A

False- increases with age

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20
Q

Achalasia is a problem with the lower esophageal sphincter (LES) and it’s inability to _____properly

A

Open/ relax

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21
Q

Achalasia presents with these 3 things

A
  1. Aperistalsis
  2. Incomplete relaxation of LES
  3. Increased resting tone of LES
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22
Q

Achalasia can lead to

A
  • dysphasia
  • mucosal inflammation/ulceration
  • squamous cell carcinoma
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23
Q

Esophageal varices result from

A

Portal hypertension

Or impaired portal blood flow

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24
Q

Esophageal varices are most common in these patients

A

Alcoholic cirrhosis

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25
Q

Esophageal varices are present in how many of all cirrhosis patients?

A

2/3

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26
Q

What are some issues with esophageal varices rupturing?

A

1- hematemesis
2- 20-30% death rate with episode
3- 70% chance of rebleed if they aren’t the 20-30% that died

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27
Q

GERD is when the LES does not ____ properly

A

Close

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28
Q

Contributing causes of GERD

A

Obesity, hiatal hernia, vagal nerve abnormalities

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29
Q

Problems with GERD

A

Heartburn, Barrett esophagus (if left untreated)

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30
Q

What happens in GERD

A

Stomach acid backs up through open sphincter, erodes esophagus

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31
Q

Barrett esophagus has what type of cells

A

Metaplastic columnar epithelium with goblet cells. (Acid destroys the normal stratified squamous cells)

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32
Q

Barrett esophagus can lead to cancer T/F

A

True. Leads to adenocarcinoma.

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33
Q

With Barrett esophagus the goblet cells protect the esophagus because it secretes mucus. Does this solve the problem?

A

No, still have reflux and heartburn. Fix the reflux!

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34
Q

Squamous cell carcinoma is caused by:

A

Tobacco/alcohol, achalasia, hot tea

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35
Q

Adenocarcinoma of the esophagus is caused by:

A

Barrett esophagus. Most common in US

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36
Q

s/s of esophageal adenocarcinoma?

A

Dysphasia and obstruction. (Occurs late in progression)

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37
Q

Chronic gastritis is caused by:

A

H. Pylori

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38
Q

Acute gastritis is resolved by

A

Treating the underlying cause

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39
Q

Peptic ulcers result from

A

Chronic gastritis

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40
Q

How does the stomach protect itself from it’s own HCl?

A

The cells are deep in the gastric pits and crypts, the mucous layer also protects them

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41
Q

Which cells secrete HCl?

A

Parietal cells

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43
Q

What is the one equation we should all know?

A

CO2+ H2O —- H2CO3 ——

HCO3- + H+

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44
Q

H+ is pumped into the stomach lumen in exchange for?

A

K+ via the H+/K-ATPase pump.

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45
Q

Since H+ is now in the lumen, what ion follows it?

A

Cl-

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46
Q

Cl- is pumped into the cell in exchange for what?

A

HCO3-

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47
Q

If your blood is slightly alkaline, how do you fix it?

A

dump the HCO3 you just picked up into the duodenum

48
Q

What is the alkaline tide?

A

when bicarb is transported into the interstitial fluid, slightly increasing the pH.

49
Q

Chronic gastritis is symptomatic/asymptomatic, and is a result of

A

usually asymptomatic. A result of chronic inflammation caused by H. Pylori

50
Q

What are s/s of chronic gastritis?

A
  1. upper abdominal discomfort
  2. n/v
  3. ulcers
51
Q

Peptic ulcers are

A

chronic lesions anywhere in GI tract exposed to acid peptic juices.

52
Q

Peptic ulcers are commonly found where

A

98% proximal duodenum, and stomach 4:1

53
Q

T/F people with H.Pylori infections get peptic ulcers

A

False. only 10-20% of people with H.Pylori get gastric ulcers. 70% of the population carry H.Pylori.

54
Q

Aggravating factors of peptic ulcers:

A
  1. NSAIDS
  2. Smoking
  3. Alcohol
  4. Corticosteroids
  5. High stress personality? / spicy foods (not on the list but he keeps talking about it)
55
Q

S/S of peptic ulcers

A
  1. epigastric pain
  2. n/v
  3. Hemorrhage and perforation
56
Q

T/F: Peptic ulcers can lead to cancer

A

false. Peptic ulcers impair quality of life, they don’t shorten it.

57
Q

Acute Gastritis is caused by (10)

A
  1. Heavy NSAID use (aspirin)
  2. Excess ETOH use
  3. Heavy Smoking
  4. Chemotherapy
  5. Uremia
  6. Systemic infections
  7. Severe stress (trauma, burns, surgery)
  8. Ischemia and shock
  9. ingestion of caustic agents (acid or base)
  10. mechanical trauma (NG tube placement
58
Q

s/s acute gastritis

A

epigastric pain with n/v, hematemesis and/or melena

59
Q

treatment for acute gastritis

A

get rid of the underlying cause. Gastric mucosa will recover if you get rid of the culprit.

60
Q

Acute gastric ulcers result from

A

mucosal defects from severe stress. (focal)

61
Q

causes of acute gastric ulcers include (4)

A
  1. severe trauma (sepsis, major surgery)
  2. extensive burns
  3. trauma to CNS or intracerebral bleed
  4. gastric irritants (NSAIDS)
62
Q

Stomach cancer was mainly caused by what during the 1930s?

A

Salting, smoking and pickling foods. (refrigeration has caused a significant decline in stomach cancers today)

63
Q

Gastric Carcinomas account or what percentage of all stomach cancers?

A

> 90%

64
Q

Causes of intestinal type adenocarcinomas (decreased in frequency now)

A
  1. nitrites/nitrates to preserve meat
  2. smoked food
  3. pickled food, excess salt
  4. decreased fruit/veggies in diet
  5. Chronic gastritis
  6. H. Pylori infection
65
Q

T/F: Diffuse carcinomas are caused by H.Pylori

A

false, usually absent. Diffuse carcinomas rare, risk factors poorly understood.

66
Q

Gastric Carcinoma is the ___ leading cause of cancer death worldwide.

A

2nd. Lung Ca is 1st.

67
Q

Developmental anomaly of the intestines is:

A

Hirschsprung disease: congenital megacolon

68
Q

Vascular d/o of the intestines include

A

ischemic bowel dz and hemorrhoids

69
Q

Diarrheal dz of the intestines include

A

infectious enterocolitis, malabsorption syndromes

70
Q

Idiopathic inflammatory bowel diseases are

A

Ulcerative colitis, Crohns

71
Q

The enteric plexus of the SI includes ____ and ____ and they ______

A

Myenteric (between circular and longitudinal muscle layer) and submucosal (between circular muscle and submucosa) and plexus innervate the muscles of the SI.

72
Q

The muscularis of the SI has how many layers? They are :

A
  1. Circular layer, longitudinal - for peristalsis
73
Q

The intestinal mucosa is made of what 3 layers

A
  1. mucous epithelium - simple columnar goblet cells
  2. lamina propria
  3. muscularis mucosae - causes villi to move
74
Q

Describe the small and large intestines in terms of villi

A

Duodenum, tall villi, deep crypts. moving toward large intestines have shorter villi. Microvilli are on all of the cells. Villi = increased surface area

75
Q

Starch is broken down into ____ and ____ by _______ (what enzyme?)

A

Dextrins and oligosaccharides by salivary amylase

76
Q

_____(enzyme) breaks dextrin and oligosaccharides into ___, ____ and ____

A

pancreatic amylase breaks dextrin and oligosaccharides into lactose, maltose, and sucrose.

77
Q

Brush Border enzymes (lactase, maltase, sucrase) breaks down lactose, maltose and sucrose into what?

A

Galactose, glucose and fructose

78
Q

Proteins are broken down into _____ and ____ by (what enzyme) in the presence of HCl?

A

proteoses and peptones by pepsin in the presence of HCl

79
Q

Proteoses and Peptones are broken down into small polypeptides and dipeptides by which pancreatic enzymes?

A

trypsin, chymotrypsin, carboxypeptidase

80
Q

Brush Border enzymes break down small polypeptides and dipeptides into what?

A

Amino acids ( brush border enzymes are aminopeptidase and dipeptidase)

81
Q

Unemulsified fats are broken down into ______ and fatty acids and _____ and fatty acids

A

monoglycerides and glycerol

82
Q

emulsifying agents are:

A

bile acids, fatty acids, monoglycerides, lecithin, cholesterol and protein.

83
Q

what other enzymes help break down unemulsified fats?

A

pancreatic lipases

84
Q

Monoglycerides are absorbed by ____ in the villi and transported to the liver in the systemic circulation which receives lymphatic flow from ____ or _____

A

Lacteals. lymphatic flow from thoracic duct or hepatic portal vein.

85
Q

glycerol and short chained fatty acids are absorbed by _____ in the villi and transported to the liver by _____

A

capillaries. transported by the portal vein

86
Q

The ____ of the large intestines receives the least amount of blood flow.

A

splenic flexure

87
Q

The superior mesenteric artery supplies what?

A

ascending and transverse colon to the splenic flexure

88
Q

the inferior mesenteric artery supplies what?

A

descending colon from the splenic flexure to the rectum

89
Q

blood supply to the sigmoid colon returns to central circulation via ____

A

the hepatic portal system

90
Q

blood supply from the rectum returns to central circulation via ____

A

the IVC

91
Q

Congenital disease where part of the colon is aganglionic

A

Hirschsprung or congenital megacolon

92
Q

Hirschsprung lacks ____ and _____ plexuses

A

Meissner and Auerbach myenteric

93
Q

Problems that can occur with Hirschsprung

A

obstruction, enterocolitis, perforation

94
Q

how is Hirschsprung fixed?

A

remove aganglionic portion. (small section okay, can cause diarrhea if a large portion is removed.

95
Q

Where does Hirschsprung “begin”?

A

at the anus and travels “back” upwards.

96
Q

Ischemic bowel disease occurs most commonly in what section of bowel?

A

Splenic flexure

97
Q

_____ or _____ can result in infarction of the bowel

A

acute occlusion or hypoperfusion

98
Q

Causes of ischemic bowel disease

A
  1. arterial thrombosis
  2. arterial embolism
  3. venous thrombosis
  4. nonocclusive ischemia (cardiac failure, shock, dehydration, vasoactive drugs)
  5. mechanical obstruction (volvulus, stricture, herniation)
99
Q

Hemorrhoids are the result of ______

A

persistent elevated venous pressure in hemorrhoidal plexus and causes vatical dilations

100
Q

You can get hemorrhoids by

A

straining during defecation, pregnancy, hepatic portal hypertension

101
Q

the types of diarrhea are:

A

Secretory, osmotic, exudative, malabsorption, deranged motility

102
Q

Vibrio Cholerae (cholera) is what type of diarrhea?

A

secretory

103
Q

destruction of the epithelial layer by shigella, salmonella and campylobacter is what type of diarrhea?

A

exudative

104
Q

Malabsorption diarrhea is caused by

A

Giardia, lymphatic obstruction, defective absorption (lactose intolerance)

105
Q

Golytely will cause what type of diarrhea

A

Osmotic

106
Q

Deranged motility is caused by

A

surgery, hypothyroidism

107
Q

Bacterial cells dump Cl into the intestinal lumen, and causes water to stay in the intestines. this is caused by what?

A

Secretory diarrhea from vibrio cholera.

108
Q

Vibrio cholerae is seen in places close to

A

lakes, rivers, estuaries. raw seafood from these places can cause cholera.

109
Q

idiopathic inflammatory bowel disease consists of

A

Crohns and ulcerative colitis

110
Q

_____ has skip lesions

A

Crohns

111
Q

Pseudopolyps are present in ___

A

Ulcerative colitis

112
Q

____ begins at the rectum and is contiguous

A

ulcerative colitis

113
Q

Fistulas can form from deep chiasms that become transmural in ____

A

crohns

114
Q

You can determine if a pt has ___ by colonoscopy or sigmoidoscopy

A

ulcerative colitis

115
Q

Fever is common in UC or Crohns

A

crohns

116
Q

abdominal pain is present in UC or Crohns

A

crohns

117
Q

rectal bleeding is present in UC or Crohns

A

UC

GI Liver Renal (2 decks)

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