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Patho Exam 3 > GI > Flashcards

GI Flashcards

0
Q

The accessory organs of the GI system? (3)

Chyme does not go through here

A

Gallbladder
Liver
Pancreas

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1
Q

Digests and absorbs nutrients?

A

GI tract

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2
Q

This does not absorb a lot, it secretes (adds) water to make mixture isotonic?

A

Stomach

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3
Q

The stomach can absorb ____ (water, ETOH, some drugs).

A

non-polar molecules

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4
Q

This occurs in the stomach? (an example of this is aspirin)

A

Ion trapping

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5
Q

Aspirin is absorbed in the stomach by ion trapping (ASA=weak acid), pKa 3.5 > when placed in a pH of 1.5 it will be ____ (therefore no charge). This neutral ASA molecule is non-polar and small enough to go through the plasma membrane and into the blood (pH 7.4). ASA will now be ____ & can not go back through plasma membrane and into the stomach.

A
  • nonionized

- ionized

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6
Q

Contents leave the stomach (known as chyme) it will be ___, slurry (watery/chunky) and at a pH of ___ this stuff will go into the duodenum. Duodenum does not like a pH of 1.5, needs to raise pH & neutralize acid > it does this with ___.
What is the chemical equation?

A
  • isotonic
  • 1.5-2
  • Bicarb
  • H2O + CO2 -> H2CO3 -> H+ + HCO3
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7
Q

1) In duodenum, ___ goes back into the blood & ___ is dumped into the duodenum.
2) In the stomach, ___ goes into the blood & ___ goes into the stomach.
3) After eating food in the stomach, ___ is dumped into the stomach & a lot of ___ into the blood. Therefore we are slightly ___ IMMEDIATELY after we eat. But once chyme enters duodenum and H+ are dumped back into blood we go back to being ___.

A

1) H+ HCO3
2) HCO3 H+
3) H+ HCO3
Alkaline
neutral

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8
Q

If we vomit all that food out > vomiting out acid, so losing acid and retaining bicarb > we are going to be ___.

A

Alkaline

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9
Q

1) ___ does not absorb a lot, water moves in and out, when chyme leaves here it is ___ (watery).
2) Start digestion in mouth with ___ & in stomach (a little) with ___ from the pancreas.
3) But it is here that we really start breaking down food, where we really get serious about digestion?

A 
1) Stomach
isotonic
2) salivary amylase
proteases
3) Duodenum
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10
Q

Where we do most of our absorption?

-pulling in carbs, proteins & fats

A

Jejunum

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11
Q

This takes in bile from GB to emulsify fats?

-recycle bile and reabsorb it and send it back to the liver.

A

Ileum

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12
Q

Digestion begins in the mouth with chewing, which breaks down food ___ & mixes it with saliva. Swallowing propels chewed food through the esophagus to the stomach where acids and stomach motility liquify it further. Next the liquified food enters the ___, where secretions of the intestinal walls, liver, GB, pancreas digest it into absorbable nutrients. Nutrients are absorbed through ___ and unabsorbed wastes enter the ___ (___), where fluids are removed. Solid wastes then enter the rectum and leave the body thru the anus.

A
  • mechanically
  • small intestine
  • intestinal walls
  • large intestine (colon)
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13
Q

1) Absorb iron, calcium, fats, sugars, water, proteins, vitamins, magnesium, sodium?
2) Absorb water & electrolytes?
3) Absorb water & alcohol?
4) Absorb sugars & proteins (carbs & fats)?
5) Absorb bile salts, vitamin B12 & chloride?

A

1) Duodenum
2) Colon
3) Stomach
4) Jejunum
5) Ileum

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14
Q

The most common way people with alcoholic cirrhosis die?

A

Ruptured Esophageal Varices

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15
Q

Dilated submucosal veins = ?

A

Esophageal varices

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16
Q

*Inflammation of the stomach? (2 varieties, 2 separate things)
1) Chronic Gastritis = not long standing of acute, from ___.
Leads to ___.
2) Acute Gastritis = leads to ___ (wear tissue down).

*Stomach Cancer = ?

A
  • Gastritis
    1) H. pylori
  • Peptic ulcers
    2) Acute gastric ulceration

*Gastric Carcinoma

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17
Q

~pH of stomach is ___, ___ in lining/lumen of stomach (will destroy whatever comes in contact with it). Want to keep our important cells away from them > so we form long, deep ___ (mucous covered)-keeps important cells safe. Cells in the crypts turnover very quickly, replace how often?

A
  • 1.5
  • proteolytic enzymes
  • crypts
  • 2x a week
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18
Q

___ are depressions in the epithelial lining of the stomach. At the bottom of each pit is one or more ___.
~___ produce the enzymes of gastric juice.
~___ produce stomach acid.

A

Gastric pits
-tubular gastric glands
~Chief cells
~Parietal cells

19
Q

~___ secretion by parietal cell.
~In stomach parietal cell = ___ goes into blood & ___ goes into lumen of stomach.
~H+ will replace our #1 cation which is ___, but a lot less ___ in blood because we have a lot more ___ in blood than normal isotonic fluid.
~This basically gives us ___ & ___ to describe the stomach.

A

~Hydrochloric acid
~Bicarb, H+
~Sodium, sodium, hydrogen
~Hydrochloric acid & isotonic

20
Q

1) Damaging this influences H. Pylori, urease, toxins, gastric acidity, peptic enzymes, drugs?
2) With this will see atrophy, intestinal metaplasia, lymphoid aggregates, neutrophil infiltrates?
3) With this will see 4 layers necrotic debris, inflammatory layer, granulation tissue, fibrous scar?

A

1) Gastric Mucosa
2) Chronic Gastritis
3) Peptic Ulceration

21
Q

___ is now rare but used to be #1. Big change is due to ___, changes in ___. Used to preserve food soaked in salt.

A
  • Stomach cancer
  • Refrigeration
  • food storage
22
Q

Carcinoma account for > 90% of ___.

1) These have decreased in frequency? Causes most stomach cancers. Very prevalent 80 years ago, now non-existent in the U.S.
2) These have not decreased in frequency? Risk factors are poorly understood, but ___ is often absent. We DO SEE this is the U.S.

A

Stomach cancers

1) Intestinal-type adenocarcinoma
2) Diffuse carcinoma
- H. Pylori

23
Q

~Small intestine with ___ on the outside > ___ > ___ (myenteric plexus) > ___ > ___
~Large intestine looks like this except it has ___ & less ___.
~Digestive glands may empty their products into the lumen of the GI tract by way of ___.

A
  • serosal layer on the outside
  • muscle
  • submucosal layer
  • mucosal layer
  • absorptive epithelial cells
  • three muscular rings
  • less surface area
  • ducts
24
Q

___ uniquely challenged by acidity coming out of stomach needs to quickly change pH from ___ to ___ or will get ulcers.

A
  • Duodenum

- 1.5 to 8 (increase pH)

25
Q

Name the sphincters?

A
  • Upper esophageal sphincter
  • Lower esophageal sphincter
  • Pyloric sphincter
  • Ileocecal sphincter
  • Internal & external anal sphincters
26
Q

~Thru the intestine we have the ___.

~Get to the ___ > ___ > ___ > ___ > ___ > ___ we absorb the water & it gets thicker as we go.

A
  • cecum
  • ascending
  • transverse
  • descending
  • sigmoid
  • rectum
27
Q

-Break down carbs (starch) into ___ (fructose, glucose, galactose). If we don’t break them down they stay in the lumen & ___ will absorb them & cause cramping & bloating.
~Occurs in a ___.

A
  • monosaccharides
  • bacteria
  • Malabsorption syndrome
28
Q

Proteins broken down into small polypeptides > dipeptides & tripeptides. ___ break down to amino acids.

  • Only want ___ coming into the body.
  • If ___ manage to get into the body intact or as ___ will be pro-inflammatory. Immune system will recognize them as foreign and will raise antibodies against them = ___.
A

-Brush Border enzymes
~Amino acids
~Proteins, polypeptides
~Hypersensitivity

29
Q

Fats we eat = ___. Take glycerol and pack it into a ___.

  • Can only absorb ___, ___, ___ & reassemble them.
  • If we can’t take in fats, the fats will stay in the lumen, ___ will use the fats & cause overgrowth of ___ = cramping, bloating.
A
  • Triglycerides
  • chylomicron
  • monoglycerides
  • glycerol
  • free fatty acids (FFAs)
  • bacteria
  • bacteria
30
Q

~Glucose & Galactose are taken in with ___. ___ transporter & __ transporter.
~This makes uptake of ___ very aggressive.
~This is also how we take in ___ > water will follow solute > lumen in the small intestine will stay ___. Will reabsorb most water in the ___ because this is where we absorb the most ___ & other solutes in the lumen. (Fructose uses passive transport).

A 
~sodium co-transporters
~sodium glucose coupled transporter 
~sodium galactose coupled transporter
~monosaccharides 
~sodium
~isotonic
~small intestine
~sodium
31
Q

Blood supply:

1) ___ will supply the small intestine & large intestine up to the splenic flexure.
2) ___ will supply from the splenic flexure down to the end.
3) What is the most poorly vascularized part of the GI tract (the SMA & the IMA should overlap but they don’t)?
4) ___ gets enough blood flow, but if blood flow is impaired (ex: hypovolemia with decreased BP) this is most at risk!!

A

1) Superior mesenteric artery
2) Inferior mesenteric artery
3) Splenic flexure
4) Splenic flexure

32
Q

*Diarrhea 20 hours from ___ to ___ to absorb water from GI tract. But if it zips through can’t absorb water and the feces are ___ > diarrhea.

A
  • cecum to anus

- isotonic

33
Q

Diarrhea
*Most common tends to cause mucosal epithelial cells to lose chloride into the lumen?
~Means that we won’t take up ___, so we won’t take up ___.
~If dumping ___ into the lumen, ___ & ___ will follow all being dumped into small intestine.
~Now have saline-like fluid in ___ reaches the large intestine & is excreted as really thin diarrhea (salt water).

A

*Cholera (Vibrio cholerae) = secretory
~sodium, water
~chloride, sodium, water
~small intestine

34
Q

Diarrhea
With Cholera people die from ___, going to lose ___ from GI tract. Have to treat with ___. Cholera (bacteria) lives in rivers (third world countries), spreads rapidly. Need to give these people 24 L of water/day but no clean water > used to knock out entire cities. Don’t get cholera in U.S. because no one has it and better waste removal systems.

A
  • dehydration
  • 1L/hour
  • 1L/hour
35
Q
  • Diarrhea*
  • Small plastic molecules, polyethylene glycol (PEG) we do not have enzymes to digest it > so we can’t absorb it > so it stays in the lumen of the small intestines? Acts as an ___ agent. Holds ___ in the small intestine > gets to large intestine > can’t absorb it & continues to hold ___ - cleans out whole ___ = ___ (PEG holding water in the lumen of the GI tract).
A
  • Gut Lavage (Golytely) = osmotic
  • osmotic agent
  • water
  • water
  • colon
  • osmotic diuretic
36
Q
  • Diarrhea*
  • Destruction of epithelial layer. Something is killing the mucosal epithelial cells > if we lose a whole bunch of epithelial cells at once we now have a bunch of dead cells in the lumen of the GI tract?
  • This causes 2 problems:
    1) a lot of dead cells in the lumen of the GI tract
    2) not a lot of live cells to breakdown nutrients/contents to absorb it
A

*Exudative (shigella, salmonella, campylobacter)

37
Q

Exudative = ?

A

Poor absorption

38
Q
  • Diarrhea*
  • Lactose intolerance > person consumes milk > lactose not broken down because we don’t have lactase > lactose stays in lumen of GI tract (can’t absorb it)?
  • ___ overgrows causing gas, bloating & diarrhea
  • Need to consume something that you CAN’T ABSORB for bacteria to feed on & cause diarrhea.
A
  • Malabsorption (Giardia, lymphatic obstruction, defective absorption)
  • Bacteria
39
Q
  • Diarrhea*
    1) ___ = still have problem if you don’t eat anything.
    2) ___ = no problem if not taken.
    3) ___ = if don’t eat anything will still have diarrhea, also will still have it if don’t drink anything > die of dehydration.
    4) ___ = need to eat something you can’t absorb for bacteria to feed on & cause diarrhea.
A

1) Exudative
2) Osmotic
3) Secretory
4) Malabsorption

40
Q
  • Diarrhea*
  • Will mostly see decreased motility (with both surgery & drugs)?
  • increased motility caused by ???
A
  • Deranged motility

- hyperthyroidism

41
Q

~Hookworm latches on intestines & sucks blood causing ___.
~Effective against ___ (immune system will try to attack it, so hookworm has to suppress the immune system, so the hookworm suppresses the immune system just enough so its not going to attach something on the GI tract - which is why it suppresses ____. *Prevent with indoor plumbing = how hookworm went away in U.S.

A

~Anemia
~Crohn’s Disease
~hypersensitivity disorder

42
Q
  • Hookworm big problem is ?

- Hookworm effective against ??

A
  • anemia

- Crohns & Asthma

43
Q

Stuff moving thru large intestines - as it goes thru it it gets thicker & thicker thru large intestine? - if aren’t eating enough ___ can get pouches/diverticula with fecal pellets more common as?
~Worse on ___ (___) because thats where feces get thicker & thicker.

A
  • Diverticulosis/Diverticulitis
  • fiber
  • people get older
  • descending colon (LLQ)
44
Q
  • So ___ not a big problem BUT ___ (when they get inflamed becomes a problem).
  • Treatment = eat more ___ when your younger so you don’t have constipation. No constipation = No diverticula.
  • Fecal pellets get stuck in diverticula (out-pouching of ?)
A
  • Diverticula
  • Diverticulitis
  • fiber
  • large intestine
45
Q

Tumors of the Colon:

1) ___ = a tumorous mass protruding into the lumen
2) ___ = having a stalk
3) ___ = not having a stalk
4) ___ = increased number of cells - not cancer
5) ___ = not cancerous

A

1) Polyp
2) Pedunculated
3) Sessile
4) Hyperplastic
5) Non-neoplastic

46
Q

1) ___ = abnormal disorganized growth, may or may not be cancer
2) ___ = neoplastic polyps arising from epithelial proliferation & dysplasia
3) ___ = cancer arising from adenomatous polyps (98% of colorectal cancers)
4) Can’t get adenocarcinoma of the ___.
5) 90% of colon cancer are ___ (of the ___).

A

1) Neoplastic
2) Adenoma
3) Adenocarcinoma
4) small intestine
5) adenocarcinoma (of the large intestine)

Patho Exam 3 (4 decks)

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