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Pathophysiology 1 > GI > Flashcards

GI Flashcards

1
Q

A Tracheo-Esophageal fistula puts infants at risk for what?

A

Aspiration PNA

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2
Q

What are the presenting symptoms of a T-E fistula?

A

Choking
Poor Feeding
Inability to pass an NG tube
Projectile vomiting

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3
Q

This is when amniotic fluid in utero development flows through the ureters and bladder and back into the amniotic cavity.

A

Polyhdramnios (excess amniotic fluid)

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4
Q

What does VACTERL stand for?

A 
Vertebral Defects
Anal Atresia
Cardiac Defects
Tracheo-Esophageal fistula 
Renal abnormalities
Limb/Bone Anomalies
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5
Q

The FOREGUT of the abdomen is made up of what organs?

SEVEN

A
  1. Esophagus
  2. Spleen
  3. Stomach
  4. Liver
  5. Gall Bladder
  6. Pancreas
  7. 1st / 2nd parts of the duodenum
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6
Q

What is the major blood supply of the structures in the foregut?

A

Blood: Celiac Trunk

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7
Q

Are the nerves of the great splanchnic that supplies the for gut pre or post synaptic?

A

Pre-synaptic

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8
Q

_____ (white/gray) rami communicates of the thoracic region send sympathetic fibers down and then _______ (sensory/motor) fibers originate in the gut then follow the sympathetic fibers back to the spinal cord.

A

White

Sensory

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9
Q

A celiac block is preformed at what vertebral level?

A

L1

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10
Q

The MIDGUT of the abdomen is made up of what organs?

SEVEN

A
  1. 3rd / 4th parts of the duodenum
  2. Jejunum
  3. Ileum
  4. Appendix
  5. Ascending colon
  6. Cecum
  7. Proximal 2/3 of the transverse colon
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11
Q

What is the major blood supply to the midgut?

A

Superior mesenteric artery

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12
Q

In what region of the abdomen would you expect a patient to complain of pain if it was involving structures of the foregut? midgut? hindgut?

A

Foregut: Epigastric (T5-9)

Midgut: Umbilical (T10-11)

Hindgut: Suprapubic (T12-L1)

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13
Q

What are the structures that compose the hindgut?

SIX

A
  1. Distal 1/3 of the transverse colon
  2. Descending colon
  3. Rectum
  4. Upper Anal Canal
  5. Urogenital sinus
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14
Q

T/F: Sympathetic fibers travel through the sympathetic chain and synapse at their own ganglia.

A

True

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15
Q

What are the 3 sub-plexuses of the Lumbar plexus (Splanchnic Nerves)?

(THINK: They follow the blood supply)

A
  1. Celiac Plexus
  2. Superior Mesenteric PLexus
  3. Inferior Mesenteric Plexus
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16
Q

What it the major blood supply to the hindgut?

A

Inferior mesenteric artery

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17
Q

What two types of fibers does the splanchnic nerves have?

A
  1. Visceral afferent

2. Thoracic sympathetic

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18
Q

This structure connects the pharnyx to the stomach, secretes some mucus, does not allow for absorption, is lined with stratified squamous cells to prevent injury, and has sphincters to prevent backflow.

A

Esophagus

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19
Q

This occurs due to chronic inflammation of the lower esophageal epithelium (chronic reflux), notable for growth of columnar epithelium, and can be seen with the presence of pre-malignant lesions

A

Barrett’s Esophagus

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20
Q

This attaches the stomach to the body wall dorsally and ventally

A

Mesogastrium

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21
Q

Which region of the stomach is mucus, pepsinogen, and HCL secreted from?

Which region of the stomach is mucus, pepsinogen, and gastrin secreted from?

A

Body

Antrum

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22
Q

T/F: The lesser and greater omentum arise from the peritoneum and attach to the stomach dorsally and ventrally?

A

True

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23
Q

These cells secrete mucus to protect against acidity.

A

Mucus cells

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24
Q

These cells secrete HCL

A

Parietal Cells

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25
Q

The secretion of HCL is triggered by products of _________, especially ________, arriving in the duodenum

A

Digestion

Peptides

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26
Q

This phase of stomach acid production occurs at the sight and smell of food and is responsible for about 1/3rd of stomach acid production

A

Cephalic Phase

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27
Q

These three chemicals produced in the body and stomach stimulate stomach acid release.

A

Acetylcholeline (from the PSNS)
Gastrin
Histamine

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28
Q

This inhibits the release of stomach acid

A

Somatostatin

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29
Q

What are three ways to “turn down” HCL production?

A
  1. Turn down the PSNS (ACh inhibition - anticholinergics)
  2. Turn down Histamine (Antihistamine - H2 blockers)
  3. Turn down gastrin
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30
Q

These cells secrete pepsin

A

Chief cells

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31
Q

These cells secrete gastrin

A

Endocrine cells (aka G-Cells)

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32
Q

What are three conditions that cause “too much gastrin”?

A
  1. Gastrinoma (Gastrin secreting tumor)
  2. Zolinger-Ellison syndrome (duodenal ulcers and a pancreatic gastrin tumor)
  3. MEN1 (P3 –> Pancreas, Parathyroid, Pituitary)
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33
Q

This disease occurs when mucus and HCL are not in balance due to chronic inflammation, NSAID use, or cigarette smoking.

Loss of mucus is the most common cause

A

Peptic ulcer disease

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34
Q

This organ is created in the ventral fold of the mesogastrium and will remain connected ventrally by the falciform ligament.

A

Liver

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35
Q

This organ is created in the dorsal fold of the mesogastrium

A

Spleen

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36
Q

What are the functions (three) of the spleen?

A
  1. Early Hematoposis
  2. Mechanical filtration of aging/injured erythrocytes
  3. Infection control (clear bacteria, good for malaria, microorganism the host has no antibodies for)
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37
Q

This part of the small intestines is the first 2/3rds of the foregut.

A

Duodenum

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38
Q

T/F: The duodenum is the longest segment of the SI at 10-15 inches long

A

False (Its the shortest)

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39
Q

At what ligament doe the duodenum end?

A

Ligament of Treitz

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40
Q

T/F: The duodenum is freely mobile like the jejunum or ileum

A

False

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41
Q

This segment of the duodenum is the hormonal trigger to the gallbladder and pancreas

A

Superior (L1)

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42
Q

These glands are located in the superior segment of the duodenum and rapidly neutralize high-pH chyme for mucosa safety.

What do they secrete?

A

Brunner’s Glands

Bicarbonate
Mucus
Urogastrone

43
Q

What two cells does urogastrone inhibit?

IS this a negative or positive feedback loop with the stomach?

A

Chief and Parietal cells

Negative

44
Q

This segment of the duodenum is the delivery site for the pacreatic duct, common bile duct, gallbladder, and liver

A

Descending (L2)

45
Q

What is the name of the primary duct of the descending segment of the duodenum?

A

Ampalla of Vater (Sphincter of Oddi with lymphatics)

46
Q

Which two ducts open to the duodenum at this juncture?

A

Pancreatic

Bile Duct

47
Q

This is an acessory duct in the descending duodenum

A

Duct of santorini

48
Q

This segment of the duodenum is where digestion occurs and crosses the IVC and aorta

A

Horizontal (L3)

49
Q

This segment of the duodenum is where digestion is continued, it connects to the jejunum, and is where the bowel stops being retroperitoneal

A

Ascending (L2)

50
Q

These form when neutralization of stomach acid in the duodenum is not adequate or acid delivery is too high

A

Duodenal ulcers

51
Q

This organ is created as 2 outpouchings of the duodenum and empties into the Ampalla of Vater.

A

Pancreas

52
Q

This is the main pancreatic duct which runs the entire length of the pancreas.

This empties most of its exocrine products where?

Where does a portion of the head of the pancreas drain?

A

Pancreatic duct

Ampalla of Vater

Ampalla of Santorini

53
Q

Enzymes are produced in what type of cells in the pancreas?

A

Acinar cells

54
Q

T/F: Pancreatic enzymes a alkaline, clear, and mucus-like

A

True

55
Q

T/F: Pancreatic enzymes are typically released in their active forms

A

False (Released inactive, activated in the duodenum)

56
Q

This is an inflammation of the pancreas which causes epigastric and back pain

A

Pancreatitis

57
Q

What are some causes of pancreatitis?

A
  1. Gallstones (blocked duct)
  2. Enzyme activation prior to the duodenum (Alcohol)
  3. Infection
  4. Trauma
  5. Tumor
58
Q

T/F: In pancreatitis, the pancreas can autolyze its symogens

if this is ture……

This would cause an increase in what levels in a patients with pancreatitis?

A

True

Amylase / Lipase

59
Q

This is a sac-like structure that is inferior to the liver and stores bile until it is needed, does NOT have a muscularis mucosa, and does not produce its own secretions.

A

Gallbladder

60
Q

This layer of the gallbladder is made up of simple columnar epithelium with mucosal fold allowing for the GB to enlarge/shrink

A

Mucosa

61
Q

This layer of the gallbladder allows for contractions to occur

A

Muscularis Externa

62
Q

This layer of the gallbladder secures it in place

A

Adventitia

63
Q

Describe the path of bile from the liver, through the GB, and into the duodenum

A

Bile exits the liver and the R/L hepatic ducts and travels down to the cystic duct into the gallbladder

Bile then leaves the GB and travels into the CBD

From the CBD, it travels to the Sphincter of Oddi to enter the duodenum

64
Q

What is the medical term for crystallized, packed, and solidified stones in the gallbladder.

A

Cholelithiasis

65
Q

What are gallstones typical composed of?

A

Bile salt and cholesterol

66
Q

T/F: Gall stones occur when there is too much bile and not enough cholesterol

A

False (too much cholesterol, not enough bile)

67
Q

What hormone increases cholesterol composition and decrease GB motility?

A

Estrogen

68
Q

What can be problematic with gall stones in terms of bilary exit?

How would a patient develop cholecysitis?

What other problems may you see as a result of gall stones?

A

The many pathways of the biliary tree have only one exit.

Prolonged blockaged leads to bacterial overgrowth leading to infection and inflammation

Jaundice
Pancreatitis
Calcification
Rupture

69
Q

T/F: Control mechanisms of the GI system are governed by volume and composition of luminal contents

A

True

70
Q

GI control is _____ and _______

A

Neuronal

Hormonal

71
Q

Neuronal regulation comes from the _____ and the _____.

A

CNS

ENS (Enteric)

72
Q

What are two plexuses of the enteric nervous system?

What do these control?

A

Submucosal (secretions)

Myenteric (motility)

73
Q

What are the 4 layers of the GI tract (brief functions)?

A
  1. Mucosa (make/secrete digestive enzymes, endocrine for GI communication)
  2. Submucosa (Blood flow to the liver for filtration, innervation)
  3. Muscularis (Circular muscle, long muscle)
  4. Serosa (Outer layer)
74
Q

T/F: Submucosal and myenteric plexuses both have short and long reflex loops to/from the CNS and regions of the GI tract

A

True

75
Q

This reflex occurs when activity in the mouth stimulates motion of the lower GI tract

A

Gastro-Colic Reflex

76
Q

This is the lose of appetite despite physiologic stimulation that normally produces hunger

A

Anorexia

77
Q

T/F: Nausea is an objective experience associated with a number of conditions

A

False (Its subjective)

78
Q

This is the forceful emptying of the stomach and intestinal contents through the mouth.

A

Vomiting

79
Q

What is the vomit control center in the brain?

A

Medulla Oblongata

80
Q

What types of problems can vomiting induce?

A

Electrolyte imbalance
Acid-base disturbance
fluid loss

81
Q

This type of pain is often described to be originating in the peritoneum

A

Parietal (Somatic) Pain

82
Q

This type of pain is often described to be originating in the organs themselves

A

Visceral Pain

83
Q

This type of pain is often felt in another area other than where it originated from

A

Referred Pain

84
Q

This type of GI bleed occurs in the foregut (Stomach, Esophagus, Duodenum), is bright red in the emesis, or can have a “coffee-ground” appearance to the stool.

A

Upper GI Bleed

85
Q

This type of GI bleed occurs in the midgut/hindgut (jejunum, ileum, colon, rectum) and typically presents with bright red blood in the stools

A

Lower GI Bleed

86
Q

Bleeding that is not visible to the eye but detectable on hemeoccult tests in also referred to as being what?

A

Occult

87
Q

Name FOUR things that commonly cause GI symptoms..

A
  1. Stenosis
  2. Regurgitation/Insufficiency
  3. Abnormal movements of the GI tract (too fast/slow)
  4. Inflammation/Trauma
88
Q

What are THREE things inflammation or trauma cause in the GI tract?

A
  1. Can affect absorption (osmotic issues)
  2. Can effect secretion in the GI tract
  3. Can cause bleeding
89
Q

This disease of the esophagus typically presents with difficulty swallowing or vomiting up solid food.

Common causes include….

GERD
NG Tube use
Ingestion of Corrosive substances
Infection/Inflammation
Iatrogenic Injury (Endoscopy)

How would you treat this disease?

A

Esophageal Stricture

Tx: Esophageal dilation

90
Q

This disease of the esophagus occurs when there is a tightening of the lower esophageal sphincter that fails to relax typically due to degredation of the myenteric plexus.

Sx include….

Pain
Vomitting
Distended Esophagus (can hold up to 1L of putrid infected material putting the patient at risk for aspiration PNA)
Weight Loss
Ulceration
Esophageal Perforation
A

Esophageal Achalasia

91
Q

This disease of inflammation to the esophagus presents similarly to GERD (Cough, Painful Swallowing, Worse when lying down) and is most commonly caused by GERD

A

Esophagitis

92
Q

This disease of the stomach is described as delayed gastric emptying which is most commonly caused by neuropathy (DM patients at highest risk).

Sx include…..

Anorexia
Vomiting
Retained gastric contents
Bezoars

A

Gastroparesis

93
Q

What are FOUR neurological contributors to gastroparesis?

A
  1. Poor neurological feedback from the duodenum to the stomach
  2. Vagal dysfunction (decrease plyoric sphincter tone)
  3. Poorly coordinated peristalsis
  4. Peripheral neuropathy of enteric nerves
94
Q

This is a mass of hardened, undigested food trapped in the digestive tract.

How is it treated?

A

Bezoar (“Protect from Poison”)

Tx: Lithotripsy, Endoscopic Morcellation, Coca-Cola Dissolution

95
Q

This disease of the stomach involves a narrowing of the opening between the stomach and the duodenum, which can be acquired or congenital.

Sx include…..

Epigastric pain
Nausea
Succussion splash
Malnutrition
Vomiting

How is this disease treated?

A

Pyloric Obstruction/Stenosis

Tx:

NG Tube
IVF and electrolytes
PPI or H2 blockers
Surgery/Stenting

96
Q

Describe a “succussion splash”?

A

The sound of the stomach filled with liquids or gases which is heard by auscultating over the the epigastric region and shifting the abdomen side-to-side

97
Q

Pyloric stenosis is more commonly seen in adult or children?

A

Children (happens in the first few weeks of life)

Can happen in adults but typically damage to the pyloric sphincter needs to occur to cause stenosis or hypertrophy

98
Q

What is the classic symptom of pyloric stenosis?

A

Projectile vomiting

99
Q

What are concerning complications of of projectile vomiting?

(THINK: pH)

A

Metabolic alkalosis

100
Q

What happens to blood volume as a result of projectile vomiting and how do the kidneys respond?

A

Blood volume decreases causing BP to decrease at the afferent arterioles (Na+ content of filtrate decreases) which causes JG cells to release renin

101
Q

These TWO signs of plyoric stenosis are described as a mass in the epigastrium.

A

Almond or Olive sign

102
Q

What is the most common causative agent of gastritis r peptic ulcers?

A

H. pylori

Small, curved, gram-positive organisms

103
Q

What does H. pylori produce? (Two)

What doe this do and how does it affect acidity?

A

Urease which converts urea into ammonia which neutralizes acidity allowing it to flourish

H. pylori also produces an enzyme that that break down the stomachs mucus layer

104
Q

What is the dominant affect of H. pylori in the antrum of the stomach?

Fundus?

Pyloris?

A

Antrum: Decreased mucus production

Fundus: Decreased acid and pepsin production, stomach tissue atrophy, atrophic gastritis, increased risk for stomach CA

Pyloris: Decrease somatostatin production resulting in increased gastrin and HCL production

Pathophysiology 1 (2 decks)

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