GI Flashcards
dysphagia causes
anasthetic, neuro defects, oesophageal tumour
saliva contains
amylase, Iodide, alkaline, calcium, lysozymes
secretions of salivary glands?
parotid - serous
sub max - mixed
sublingual - mucus
saliva secretion cell
ductal side has NaKATPase and HCO3-Cl antiporter. ECF side has Na-KATPase, KCl symporter, and Na-H antiporter
stimulated saliva and resting properties
stimulated - increase volume, hco3, enzymes, more hypotonic
resting - slightly alkaline
sympathetic and PS innervation of salivary glands
symp - superior cervical ganglion (decrease volume)
PS - glossopharyngeal (increase volume)
swallowing process
bolus to pharynx then pressure receptor in palate. Glottis closes, larynx lifts, resp inhibited
solids and liquids dysphagia. or solids then liquids
solids and liquids - motility problem
solids then liquids - mechanical obstruction
what is achalasia
failure of smooth muscle to contract e.g. upper oesophageal sphincter
components of lower oeso sphincter
+ve intra-abdo pressure, gastric rugae, acute angle, right cruz of diaphragm
gastric cells and secretions
Neck - mucus and HCO3
parietal - HCl and intrinsic
Chief - pepsinogen
G cell - gastric
cephalic, gastric and intestinal phase
cephalic - CNS stimulates acid
gastric - neutralisation, peptides and distention stimulate gastrin
intestinal - decrease pH and peptides stimulates secretin secretion which inhibits gastrin.
Where secretin from. what stimulate and its action. CCK too
from S cells of duodenum
stimulates HCO3 from pancerase and bile from liver
stimulated by low ph in duodenum
CCK from duodenal APUD cells. stimulates enzymes from pancreas and gall bladder and stim by FAs and AAs in duodenum
what causes atresias, stenosis, exampholos, gastroichisis
atresia - failure of anal membrane to rupture
stenosis - failure of recanalisation usually in duodenum
exampholos - gut and peritoneum herniates through umbilical cord
gastroischisis - failure of abdo wall to close, no sac
action of obliques
fleex trunk, rotate, compress and support abdo viscera
what is divariation recti and ectopia cordia and meckels
DR - widening of linea alba
ectopia - heart outside thoracic due to failure of ventral mesoderm
meckels - 2 ft from ilieocecal valve, gastric or pancreatic tissue, 2 inches
referred pain from cardic, gastric, duodenum, gallbladder, hepatic, retroperitoneal
cardiac - chest, neck, left shoulder
oesophagus - epigastric
gastric - back
duodenum - epigastric or umbilicus
gallbladder - right hypochondriac, R lumbar and R shoulder
hepatic - epigastric, R hypochondriac, R neck shoulder and back
retroperitoneal - back pain
diaphragmatic irritation causes
spleen, ectopic pregnancy, perforated ulcer
borders hasselbachs triangle
inguinal ligament, inf epigastric artery and vein, rectus sheath
inguinal canal borders
ant - internal oblique fascia
post - transversalis fascia
inf - inguinal ligament
sup - aponeurosis of obliques
which strangulated more inguinal or femoral
femoral
presentation, treat gastritis
presents - GORD. dyspepsia, epigastric pain, lying down and hot drinks worse
treat - lose weight, decrease alcohol and fatty foods. Amoxicillin and clarithromycin and omeprazole. Endoscopy
symptoms of gastric and duodenal ulcer. treat?
gastric - worse at night, worse when aeating. relieved with antacids. N&V. weight loss, haematemssis. treat with clarith and amoxici and omeprazole
duodenal - better when eating. delayed pain when acid secreted into duodenum
where are the stomach cells found? stomach histology
columnar cells with glands.
cardia - G cells
Fundus and body - neck, parietal, chief cells
pylorus - neck and g cells
gastric vsculature
see book
coeliac trunk, gastroepiploic, R L short gastric, proper hepatic, gastroduodenal, splenic
drainge of gastric and gastroeipoloic
gastric into hepatic
gastroepiploic into superior mesenteric
properties of chyme
hypertonic, acidic, partially digested
components of liver bile acid dependent and independent
dependent - cells lining canalliculi secrete. cholesterol, bile acid (e.g. chenodeoxycholic acid) and pigments
independent - cells lining bile ducts. alkaline juices
describe how bile acid recycled
reabsorbed in terminal ileun post bacterial conjugation and then back to liver
gall stones symptoms
right hypochondriac pain, radiate to back or R shoulder, N&V, fatty meal = worse
endocrine pancreas secertionsq
alkaline juice and enzyme (chymotrypsinogen, trypsinogen, carboxypeptidase, amylase, lipase)
what is cholecystatis and symptoms
cystic duct obstructed. fever, oedema, increase WCC,
what is biliary cholic and symptoms
biliary duct obstructed. jaundice.
how duct cells secrete hco3
basolateral side - NaKatpase, naHantiporter
CO2 diffuses in then becomes HCO3 and then into lumen
how fats digested in guts
bile acids emulsify. lipases. FAs to unstirred layer. RME. made into TAGs then chylomicrons.
ligaments of liver
see book
triangular, coronary, falciform
biliary tree
see book
R L hepatic, common hepatic, common bile, cystic, pancreatic, sphincter of oddi
pancreas artery
splenic
pancreatic drainage
head - superior mesenteric
tail - splenic
adaptive and innate GI defences
adaptive - GALT
innate - acid, enzymes, mucus, peristalsis
achlorhydra symptoms
anemia (impaired iron absorption). increase infection from salmonella, shigella, cholera, H pylori
liver failure symptoms
hepatic encephalopathy, portal hypertension in cirrhosis
symptoms of portal hypertension and cirrhosis
caput medusa, varices, shunting, splenomegaly, palmar erthyema, dupuytrens, jaundice, anemia, flapping tremor,, spider naevi, ascites
investigations for hepatitis
jaundice, increase ALT (and AST), clotting increased
which is specifc to liver ALT or AST
ALT. L for liver
test for cholecystitis
bilirubin (conjugated) and ALP
prehepatic signs and causes
unconj bilirubin, increase LDH, anaemia
immune cause, infection (malaria), spherocytosis
hepatic jaundice signs and causes
increase ALT and AST, increase conj and unconj, clotting abnormal.
cirrhosis, hepatitis B virus, alcohol, paracetemol
post hepatic signs and causes
increase conj, and ALP
gall stones, cancer, pancreatitis
alcohol disease on liver
fatty liver due to increase NADH leading to FA and TAG deposits. THEN hepatitis due to acetaldehyde. then cirrhosis and wernickes encephalopathy
causes of cirrhosis
wilsons, alcohol, hep B, autoimune
portal system anastamosis
oesophageal, rectal, caput medusae (para umbilical veins)
pancreatitis symptoms
shock, pain, vomiting, sepsis, increase insulin
chronic - malabsorption, decrease weight, DM, jaundice
glucose into cell
SGLT1 and then into ECF via GLUT2
what does large intestine absorb
vitamins and water
how calcium absorbed and taken into guts
absorbed by PTH via Vit D activation. Via facilitated diffusion into cell and then Ca-ATPase into ECF
explain how iron absorbed
iron + gastric acid then to transferrin and then RME
what does oral rehydration contain
glucose and na
how segmenting in intestine works
pacemakers fire quicker at stomach end than at large intestine end.
features of jejunum and ileum
jejunum - dark red, thick wall, no peyers
ileum - pink, thin, peyers
which one does smoking help with UC or CD?
UC
features of UC
continous, rectal involvement, gross bleeding, mucosal ffriability, pseudopolyps
CD and UC treatment
CD - corticosteroids, methotrexate, azathioprine
UC - same and colectomy
why baxcteria in gut good
vitamins, kill pathogens, MALT stimulate
what bacteria cause gastroentiritis
campylobacter, salmonella, listeria
what causes gingivitis and travellers diarrhoea
gingivitis - strep mutans
travellers diarrhoea - e coli
gastric cancer symptoms and appearances and spread
epigastric pain, vomiting, weight loss
appearance - fungating, ulcerative, infiltrative
spread - local, trans-coelemic (liver, peritoneum, ovaries), lymph
large intestine cancer cause
familial adenomatous polyposis, DCC gene
what is ileus, toxic megacolon and lead pipe colon
ileus - loss of peristalsis
toxic megacolon - v dilated colon (IBS deterioratioN)
lead pipe - severe UC. no haustra
small bowel colic symptoms and cuases
vomiting, distention, constipation, pain 2-3 mins
cause - adhesions, hernia, tumour, inflamm
large bowel colic symptoms and cuases
symptoms - vomit faeces, distention, consitpation,. pain 10-15 mins
cause - hernia, cancer, volvulus
