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PPE Revision > GI > Flashcards

GI Flashcards

1
Q

What is the general blood supply to the midgut?

A

Superior mesenteric artery

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2
Q

What is the general blood supply to the hindgut?

A

Inferior mesenteric artery

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3
Q

What are the derivatives of the foregut?

A

Oesophagus to duodenum (proximal to bile duct), includes liver, gallbladder, pancreas

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4
Q

What are the derivatives of the midgut?

A

Duodenum (distal to bile duct) to proximal 2/3rd of transverse colon

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5
Q

What are the derivatives of the hindgut?

A

Distal 1/3rd of transverse colon to anal canal

Bladder and urethra

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6
Q

What are the 3 pairs of salivary glands? What do they secrete?

A

Parotid - serous secretions
Sub-maxillary - both
Sub-lingual - mucus secretions

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7
Q

Which salivary gland produces the most secretions?

A

Sub-maxillary - 75%

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8
Q

What ducal modifications occur to saliva?

A

Decrease Na
Increase K
Increase bicarbonate

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9
Q

Describe secretion of serous saliva

A

Acinar cells secrete isotonic fluid with enzymes (determines volume)
Duct cells modify saliva (determines composition)

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10
Q

How does ductal modification of saliva change when it is stimulated to when it is at rest

A

At rest: low volume, hypotonic, neutral/acidic, few enzymes

Stimulated: high volume, less hypotonic, alkaline, lots of enzymes

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11
Q

What is the afferent pathway for salivary secretion?

A

Afferent information from mouth/tongue, nose stimulate facial and glossopharyngeal nerves

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12
Q

What is the efferent stimulation for salivary secretion?

A

Facial nerve - submandibular ganglion - sub-maxillary and sub-mandibular glands
Glossopharyngeal nerve - otic ganglion - parotid gland

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13
Q

How does increased parasympathetic activity change salivary secretions?

A

Promotes primary secretions and bicarbonate secretion

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14
Q

How does increased sympathetic activity change salivary secretions?

A

Reduced blood flow so causes dry mouth

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15
Q

What are the layers of the oesophagus?

A

Mucosa (non-keratinised stratified squamous epithelia, laminar propria, muscularis mucosa)
Sub mucosa - contains glands
Muscularis externa (circular and longitudinal)

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16
Q

What are the phases of swallowing?

A
  1. Mastication produces bolus
  2. Voluntary phase
  3. Pharyngeal phase
  4. Oesophageal phase
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17
Q

What occurs during voluntary phase of mastication?

A

Bolus moved to pharynx by tongue

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18
Q

What occurs during pharyngeal phase of mastication?

A

Pressure receptors in palate and anterior pharynx send afferent information to swallowing centre in brain causing:

  1. Inhibition of respiration (soft palate blocks nasal cavity)
  2. Raises larynx
  3. Closes glottis by epiglottis
  4. Open upper oesophageal sphincter
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19
Q

What occurs during oesophageal phase of mastication?

A

Rapid peristaltic wave down oesophagus

Opening of lower oesophageal sphincter

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20
Q

Give a primary and secondary cause of dysphasia

A

Primary - Achalasia

Secondary - obstruction/compression

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21
Q

What are the anatomical mechanisms that prevent gastro-oesophageal reflux?

A
  1. Lower oesophageal sphincter - physiological
  2. Angle of His - angle at which oesophagus enters stomach
  3. Right crus of diaphragm - increased abdominal pressure tightens right crus around oesophagus
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22
Q

What the general blood supply to the foregut?

A

Celiac trunk

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23
Q

What does the greater omentum connect? And from what is it derived embryonically?

A

Connects greater curve of stomach to transverse colon

Derived from dorsal mesentary

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24
Q

What does the lesser omentum connect? And from what is it derived embryonically?

A

Connects lesser curve of stomach to liver

Derived from ventral mesentary

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25
Q

What attaches liver to anterior abdominal wall?

A

Falciform ligament

26
Q

Describe the rotation of the midgut

A

270 degrees in counter-clockwise fashion

27
Q

What are the consequences of malrotation with regards to the midgut?

A

Causes hypermobile gut - more likely to cause volvulus (bowel obstruction caused by bowel abnormally twisting on itself)
Incomplete rotation - left sided colon
Reversed rotation - duodenum passes anterior to transverse colon

28
Q

Describe the consequence of the cloaca splitting in two with regards to anal canal

A 
Superior part (above pectinate line) derived from hindgut
Inferior part (below pectinate line) derived from ectoderm
Consequences for innervation, blood supply, epithelia, lymphatic drainage
29
Q

Describe the difference in blood supply, innervation, lymphatic drainage and epithelial lining above and below the pectinate line

A

Above pectinate line (hindgut derivative):
Blood supply: inferior mesenteric artery
Innnervation: S2-S4 pelvic, parasympathetic
Epithelia: Simple columnar
Lymphatic drainage: internal iliac nodes

Below pectinate line (derived from ectoderm):
Blood supply: pudendal artery
Innervation: S2-S4 pudendal nerve, somatic
Epithelia: stratified squamous, non-keratinised
Lymphatic drainage: superficial inguinal nodes

30
Q

What is a Meckel’s diverticulum?

A 
Results due to persistent of vitelline duct
'Cul-de-sac' in ileum
Rule of 2's:
  2% of population affected
  2 feet from ileocaecal valve
  2 inches long
  Usually detected in under 2's
  2:1 male:female
31
Q

What are the different abnormalities that can arise from a persistent vitelline duct?

A

Meckel’s diverticulum
Vitelline cyst
Vitelline fistula

32
Q

What are the abnormalities that can arise from defects in abdominal wall?

A

Gastroschisis - failure of abdominal wall to close during lateral folding of embryo, results in gut tubes outside body cavity
Omphalocoele - persistence of physiological herniation into umbilical cord, results in epithelial layer covering defect

33
Q

What is the arcuate line?

A

Point at which transversalis fascia and posterior part of internal oblique fascia does not cover rectus abdominus posteriorly
Occurs 1/3rd distance between umbilicus and pubic crest

34
Q

Explain the difference between somatic referred pain and visceral referred pain

A

Somatic referred pain - pain felt in proximal part of somatic nerve felt at distal dermatome
Visceral referred pain - visceral afferent pain fibres follow somatic fibres back to same spinal cord segment, CNS perceives visceral pain as coming from somatic portion of the body

35
Q

What is the difference of the peritoneal cavity in males and females?

A

Completely closed in males

Communicates with fallopian tubes in females

36
Q

What is the ligamentum teres and where is it located?

A

Remnant of umbilical vein

Located in free edge of falciform ligament

37
Q

Define a hernia

A

Protrusion of an organ or the fascia of a organ through the wall of the cavity that normally contains it

38
Q

What are the contents of the inguinal canal in males and females?

A

Males: spermatic cord, ilioinguinal nerve
Females: round ligament of uterus, ilioinguinal nerve

39
Q

What is the difference between direct and indirect hernia?

A

Direct - protrudes through weakened area on transversalis fascia (Hasselbach’s triangle), travels through only part of the inguinal canal
Indirect - protrudes through deep inguinal ring and travels through inguinal canal and out through superficial inguinal ring

40
Q

Name the cells of the gastric pits and what they secrete

A

Chief cells - Enzymes
Parietal cells - Acid and intrinsic factor
Neck cells - Mucus
Endocrine cells (G-cells) - Gastrin

41
Q

What causes secretion of gastrin?

A

Increased pH
Peptides
ACh

42
Q

What receptors do histamine and acetyl choline work on in the stomach to secrete acid?

A

Histamine - H2

ACh - M3

43
Q

What are the phases of control for acid secretion?

A

Cephalic - autonomic stimulation due to sight, smell, taste, thought
Gastric - food buffers acid (disinhibits gastrin), release of peptides (gastrin release), distension of stomach (ACh release). Gastrin and ACh cause histamine release
Intestinal (stomach emptying) - chyme stimulates hormone release (antagonises gastrin), decreased pH (inhibits gastrin)

44
Q

Describe stomach defenses

A

Mucus ‘unstirred’ layer
Bicarbonate released in to unstirred layer - reacts with acid of stomach
Mucus and alkali secretion stimulated by prostaglandins

45
Q

What are the branches of the coeliac trunk?

A

Splenic artery
Common hepatic artery
Left gastric artery

46
Q

What is the blood supply to the lesser curve of the stomach?

A

Left and right gastric arteries

47
Q

What is the blood supply to the greater curve of the stomach?

A

Left and right gastroepiploic arteries

48
Q

What is the epiploic foramen?

A

Entrance to the lesser sac

49
Q

What are the properties of chyme leaving the stomach? And how is it corrected?

A

Acidic - Bicarbonate secretion from pancreas, liver and duodenal mucosa
Hypertonic - osmotic movement of water into lumen from duodenum
Partially digested - digestion completed by enzymes from pancreas and duodenal mucosa

50
Q

What is the most likely location of a gallstone causing biliary colic?

A

Hartmann’s pouch

51
Q

Causes of pancreatitis

A

G - gallstones
E - ethanol
T - trauma

S - steroids
M - mumps
A - autoimmune
S - scorpion bite
H - hyperlipidaemia
E - ERCP/iatrogenic
D - drugs
52
Q

Where is CCK realeased from and what are it’s actions?

A

APUD cells

Causes contraction of gallbladder, release of enzymes from pancreas, potentiates secretin’s action

53
Q

What is bile composed of?

A

Bile acids and pigments - bile acid dependent

Alkaline juice from intrahepatic duct cells - bile acid independent

54
Q

What are the two bile acids?

A

Cholic acid

Chendocholic acid

55
Q

Which veins are implicated in oesophageal varicies

A

Left gastric vein to oesophageal vein

56
Q

Which veins are implicated in a caput medusa

A

Para umbilical vein to epigastric vein

Para umbilical vein only opens in portal hypertension

57
Q

Which veins are implicated in hemorrhoids

A

Superior rectal veins to middle and inferior rectal veins

58
Q

What stimulates alkaline juice secretion from the pancreas and what causes its release

A

Secretin released in response to low PH from the jejenum

59
Q

Describe the breakdown of alcohol

A

Ethanol > Acetaldehyde (via alcohol dehydrogenase) > acetate (via acetaldehyde dehydrogenase)

60
Q

Describe how contents are moved along within the small intestines

A

Segmentation causes gentle agitation
Intestinal pacemakers at intervals, frequency highest at stomach end - intestinal gradient
Causes intermittent contraction of smooth muscle

61
Q

Describe how contents are moved along within the large intestines

A

Haustral shuttling - contraction of muscle in haustra shuffles contents back and forth
Mass movement - infrequently there is a peristaltic wave from transverse through to descending colon - often triggered by eating, gastro-colic reflex

PPE Revision (16 decks)

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