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Step 1 Flash Cards > GI > Flashcards

GI Flashcards

1
Q

ventral pancreatic bud gives rise to

A
  • pancreatic head and main pancreatic duct, and uncinate process
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2
Q

annular pancreas

A
  • the ventral bud abnormally encircles 2nd part of the duodenum, forms a ring of tissue around the duodenum that can cause narrowing
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3
Q

pancreas divisum

A
  • ventral and dorsal pancreas fails to fuse at 8 weeks
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4
Q

midgut development timeline

A
  • exits through the umbilical ring week 6

- returns to abdominal cavity + rotates around the SMA week 10

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5
Q

retroperitoneal structures

A

SAD PUCKER

  • suprarenal (adrenal) glands
  • aorta and IVC
  • duodenum (2nd - 4th parts)
  • pancreas (except tail)
  • ureters
  • colon (ascending and descending)
  • kidneys
  • esophagus (lower 2/3)
  • rectum
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6
Q

which ribs overly the spleen, kidneys and liver

A
  • left 9-11 – spleen
  • right 8-11 – liver
  • left 12 - left kidnet
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7
Q

borders of the pleura

A
  • 7, 10, 12

- 7th in midclavicular line, 10th in midaxillary, and 12th in paravertebral

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8
Q

falciform ligament - structures contained

A
  • ligamentum teres hepatis (derivative of fetal umbilical vein)
  • derivative of ventral mesentery
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9
Q

hepatoduodenal ligament - structures contained

A
  • portal traid: hepatic artery, portal vein and CBD

- pringle maneuver - clamp this to prevent bleeding

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10
Q

gastrohepatic - structures contained/significance

A
  • gastric arteries

- separates greater and lesser sac on the right

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11
Q

gastrosplenic ligament - structures contained and signficance

A
  • short gastrics, left gastroepiploic vessels

- separates greater and lesser sac on the left

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12
Q

splenorenal ligament - structures contained

A
  • splenic artery and vein, tail of pancreas
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13
Q

layers of the gut wall - inside to outside

A
  • MSMS
  • mucosa (epithelium, lamina propria and muscularis mucosa)
  • submucosa (include submucosal nerve plexus – Meissner)
  • muscularis externa (includes myenteric nerve plexus – Auerbach)
  • serosa
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14
Q

crypts of Lieberkuhn

A
  • simple tubular glands that rest atop muscular mucosa

- present in the duodenum, jejunum, ileum and colon

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15
Q

Brunner glands

A
  • secrete alkaline mucus into the crypts, then into the lumen
  • present in the duodenal submucosa
  • hypertrophy seen in peptic ulcer disease
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16
Q

peyer patches

A
  • present in the ileum
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17
Q

plicae circularis

A
  • in the jejunum and ileum
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18
Q

goblet cells

A
  • in the ileum and colon

- larges number in the small intestine are in the ileum

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19
Q

SMA syndrome

A
  • when the transverse portion of the duodenum is entrapped between the SMA and aorta, causing intestinal obstruction
  • angle diminishes to < 20 degrees
  • precipitated by conditions that lower mesenteric fat (low body weight, severe burns, bed rest, pronounced lordosis)
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20
Q

esophageal varices connect

A
  • left gastric vein (portal) and esophageal veins (systemic)
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21
Q

caput medusae connects

A
  • umbilical veins (portal) and epigastric veins (systemic)
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22
Q

rectal varices connect

A
  • superior rectal vein (portal) to inferior/middle rectal veins (systemic)
  • will drain into internal pudendal veins and internal iliacs to react IVC
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23
Q

Zone 1 of the liver (periportal)

A
  • affected first by viral hepatitis and ingested toxins
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24
Q

Zone 3 of the liver (centrilobular)

A

affected 1st by ischemia, contains cytochrome p450 system, most sensitive to metabolic toxins, site of alcoholic hepatitis

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25
Q

CCK

A
  • produced in the I cells in the duodenum + jejunum
  • actions: inc pancreatic secretions, inc gall bladder contraction, inc sphincter of Odi relaxation, and decrease gastric emptying
  • increased by fatty acids, amino acids
  • CCK acts on neural muscarinic pathways to cause pancreatic secretion
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26
Q

gastrin

A
  • G cells (antrum of the stomach)
  • actions: increase gastric H+ secretion, growth of gastric mucosa, increased gastric motility
  • regulation: increased by stomach distention, alkalinization, amino acids, peptides and vagal stimulation, decreased by stomach pH < 1.5
  • increased in Zollinger-Ellison syndrome, PPI use and pernicious anemia
  • phenylalanine and tryptophan are potent stimulators
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27
Q

glucose dependent insulinotropic peptide (GIP)

A
  • secreted by K cells (duodenum, jejunum)
  • actions: exocrine – decreases gastric H+ secrtion, endocrin – increases insulin release
  • regulation: increased by fatty acids, amino acids, oral glucose
  • this is why oral glucose is more rapidly utilized than IV glucose
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28
Q

motilin

A
  • source: small intestine
  • actions: produces MMCs
  • increases in fasting state
  • motilin receptor agonists (erythromycin_ are used to stimulate intestinal peristalsis
29
Q

secretin

A
  • source: S cells in the duodenum
  • actions: increase pancreatic HCO3-, decrease gastric acid secretion and increase bile secretion
  • regulation: increased by acid and fatty acids in the lumen of the duodenum
30
Q

somatostatin

A
  • inhibitory hormone secreted by D cells in the pancreatic islets and GI mucosa
  • decreases gastric acid and pepsinogen secretion, decreased gallbladder contraction, decreases insulin and glucagon release
  • increased by acid, decreased by vagal stimulation
  • has anti-growth effects
  • H pylori leads to chronic antral inflammation that decreases the number of D cells
31
Q

VIP

A
  • source: PS ganglia in the sphincters, gall bladder and small intestine
  • increases intestinal water and electrolyte secretion, increased relaxation of intestinal smooth muscle and sphincters
  • increased by distention and vagal stimulation, decreased by adrenergic input
32
Q

VIPoma

A
  • non-alpha, non-beta islet cell tumor that secretes VIP

- copious Watery Diarrhea, Hypokalemia, and Achlorhydia (WDHA)

33
Q

intrinsic factor

A
  • source: parietal cells (stomach)
  • vitamin B12 binding protein required for uptake in the terminal ileum
  • AI destruction of parietal cells –> chronic gastritis and pernicious anemia
34
Q

gastric acid

A
  • secreted by parietal cells in the stomach
  • action – decreases stomach pH
  • secretion increased by histamine, Ach and gastrin
  • secretion decreased by somatostatin, GIP, prostaglandin, secretin
35
Q

gastrinoma

A

gastrin secreting tumor that causes high levels of acid secretion and ulcers (duodenal and jejunal) refractory to medical therapy

36
Q

pepsin

A
  • secreted by chief cells of the stomach
  • action - protein digestion
  • regulation - increased by vagal stimulation, local acid
  • inactive pepsinogen in cleaved to pepsin by H+
37
Q

cells in the body of the stomach

A

chief cells and parietal cells

38
Q

cells in the antrum of the stomach

A

G cells, mucous cells and D cells

39
Q

cells in the duodenum

A

I, S and K cells

40
Q

gastric parietal cell mediators

A
  • Ach (via M3) and gastrin (via CCKb) stimulate Gq and increases IP3/Ca, which increases H/K ATPase activity
  • histamine binds H2 receptor and increases cAMP through Gs, which increases H/K ATPase activity
  • prostaglandins, misoprostol and somatostatin decrease cAMP via Gi, decreasing H/K ATPase activity
41
Q

trypsinogen

A
  • converted to trypsin (protease) by enterokinase/enteropeptidase and then goes on to cleave/activate other enzymes
  • enteropeptidase deficiency: impaired trypsin formation leading to diarrhea, growth retardation and hypoproteinemia
  • serine peptidase inhibitor secreted by acinar cells (trypsin inhibitor)
42
Q

D-xylose absorption test

A

distinguishes GI mucosal damage from other causes of malabsorption
- would be normal in pancreatic insufficiency/after pancreatic surgery

43
Q

carb absorption

A
  • glucose and galactose taken up by SGLT1
  • fructose taken up by GLUT5
  • all transported to the blood by GLUT 2
44
Q

iron absorbed in the ….

A

duodenum

- so pts s/p gastrojejunostomy will need Fe supplements

45
Q

folate absorbed in the ….

A

jejunum and ileum

46
Q

B12 is absorbed in the …

A

terminal ileum along with bile acids, requires IF

47
Q

peyer patches

A
  • in the lamina propria and submucosa of the ileum
  • contain M cells that sample antigens
  • IgA secreting plasma cells produce secretory IgA that deal with the intraluminal antigen
48
Q

bile

A
  • made by cholesterol 7-a hydroxylase
  • functions: digestion and absorption of lipids and fat-soluble vitamins, cholesterol excretion, antimicrobial activity (via membrane disruption)
49
Q

heme oxygenase

A
  • breaks heme down to biliveridin

- responsible for the green discoloration of bruises

50
Q

pleomorphic adenoma

A
  • benign mixed tumor (stromal and epithelial)
  • the most common salivary gland tumor, usually involves the parotid gland
  • painless, well-circumscribed, mobile mass
  • recurs if incompletely excised, which happens a lot because it has irregular borders
51
Q

warthin tumor

A
  • aka pupillary cystadenoma lymphomatosum
  • benign cystic tumor with germinal centers (lymphoid tissue)
  • usually involves the parotid gland
52
Q

mucoepidermoid carcinoma

A
  • most common malignant tumor and has mucinous and squamous components
  • typically presents as painless, slow-growing mass
  • commonly involves the parotid and affects the facial nerve
53
Q

achalasia

A
  • inability to relax the LES because of loss of the myenteric (Auerbach) plexus
  • progressive dysphagia to solids and liquids
  • increased risk of SCC
  • can be 2/2 Chagas disease
54
Q

eosinophilic esophagitis

A

infiltration of eosinophils in the esophagus in atopic pts

  • food allergens –> dysphagia, heartburn, strictures
  • unresponsive to GERD therapy
55
Q

esophagitis

A
  • associated with reflux, infection in immunocompromised or chemical ingestion
  • candida - white psuedomembrane
  • HSV-1 - punched out ulcers
  • CMV - linear ulcers
56
Q

Plummer Vinson Sydnrome

A
  • triad of dysphagia (due to esophageal webs), iron deficiency anemia and glossitis (beefy red tongue)
57
Q

barrett esophagus

A
  • glandular metaplasia that replaces nonkeratinized squamous epithelium with intestinal epithelium (nonciliated columnar with goblet cells)
  • increased risk for esophageal adenocarcinoma
58
Q

esophageal carcinoma

A
  • adeno most common in the US, squamous everywhere else
  • adeno on the bottom 1/3
  • adeno RF: barretts, cigarettes, fat, GERD
  • squamous RF: alcohol, cigarettes, hot drinks, lye ingestion, esophageal webs, diverticula, achalasia
  • squamous on the top 2/3
  • nodes they go to: upper 1/3 –> cervical nodes, middle 1/3 –> mediastinal, bottom 1/3 –> celiac/gastric
59
Q

acute gastritis

A
  • disruption of the mucosal barrier leads to inflammation

- can be caused by stress, NSAIDs, alcohol, uremia, burns (Curling ulcer), brain injury (Cushing ulcer), and chemo

60
Q

Curling Ulcer

A
  • due to severe burns –> decreased plasma volume –> sloughing of the gastric mucosa
61
Q

Cushing ulcer

A
  • due to increased ICP –> increased vagal stimulation –> increased Ach action on parietal cells –> increased acid
62
Q

type A chronic gastritis

A
  • autoimmune attack on parietal cells, pernicious anemia, and achlorhydria (low acid production by the stomach leads to increased gastrin secretion and G cell hyperplasia in the antrum)
  • associated with other AI disorders
63
Q

type B chronic gastritis

A

most common type, associated with H pylori infection

- increased risk of MALT lymphoma, gastric adenocarcinoma and ulcers

64
Q

mentrier disease

A
  • gastric hypertrophy with protein loss, parietal cell atrophy, and increased mucous cells
  • precancerous
  • rugae of the stomach are so hypertrophied that they look like brain gyri
65
Q

stomach cancer - intestinal type

A
  • associated with H pylori, nitrosamines, tobacco, achlorhydria, AI chronic gastritis
  • commonly on lesser curvature, looks like ulcer with raised margins
  • pts with blood type A have higher risk
66
Q

stomach cancer - diffuse type

A
  • not associated with H pylori
  • signet ring cells
  • will infiltrate the stomach wall and cause thickening/leathery appearance (linitis plastica)
67
Q

gastric ulcer

A
  • pain Greater with meals
  • usually on the lesser curvature - if they bleed it comes from the left gastric artery
  • H pylori 70% of the time, also NSAIDs
  • increased risk for carcinoma, happen in older people
68
Q

duodenal ulcer

A
  • pain Decreases with meals
  • H pylori almost always
  • associated with Z-E syndrome
  • generally benign
  • can see hypertrophy of the brunner glands
  • if they bleed it is the gastroduodenal artery

Step 1 Flash Cards (36 decks)

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