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Med P1 > GI > Flashcards

GI Flashcards

1
Q

5 functions of the stomach

A
  1. disolve and continue digestion
  2. secrete pepsinogen/proteases
  3. activate the proteases
  4. kill microbes- HCL
  5. regulate emptying into the duodenum
  6. store and mix food; mechanical digestion
  7. lubrication
  8. priduce muous for mucosal defense against proteases and HCL
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2
Q

what cell secretes HCL in the stomach

A

parietal cell

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3
Q

apart from HCL, what else does the parietal cell secrete?

A

intrinsic factor, to help v. b12 absorption

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4
Q

what cell secretes pepsinogen in the stomach

A

chief cell

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5
Q

what is pepsinogen an example of?

A

a zymogen

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6
Q

what cell secretes pepsin

A

none. always secreted as the pepsinigen zymogen

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7
Q

is pepsin essential for protein digestion

A

no. only does 20% of total protein digestion. it only accelerates protein digestion

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8
Q

5 factors that decrease gastric emptying in the DUODENUM

A
  1. increased amino acids
  2. increased fat (most effective chemical stimulus)
  3. increased acidity
  4. increased duodenal distension
  5. increased hypertonicity in the duodenum
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9
Q

what 2 factors follow on from the duodenal factors to reduce gastric emptying

A
  1. increased neural stimlation of receptors that then act via short (enteric) neural pathways on the stomach & via long neural pathways on the parasympathetic and sympathetic nervous system
  2. increased release of enterogastrones
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10
Q

name 2 enterogasteones

A

cck, cholecytokinin

secretin

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11
Q

what is the main parasympathetic neurotransmitter acting on the stomach

A

acetylcholine

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12
Q

give one hormone and one paracrine agent that increases HCL production in the stomach

A

Hormone= gastrin

Paracrine agent= histamine

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13
Q

in terms of peptic ulcers, what is an ulcer

A

a breach of the mucosal surface

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14
Q

give 4 causes of peptic ulcers

A
  1. helicobacter pylori
  2. NSAIDs
  3. Gastrinomas- ie malignancies of G cell
  4. chemical irritants: alcohol, bile salts, dietary factors
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15
Q

3 things to treat peptic ulceration by helicobacter pylori

A
  1. 1 antibiotic
  2. another antibiotic
  3. proton pump inhibitors
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16
Q

what do H2 receptor antagonists do in the parietal cell

A

block the action of histamine, so reducing HCL production

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17
Q

a disease that involves delayed gastric emptying

A

gastropAresis

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18
Q

what is exchanged for cl- in the basolateral membrane of the parietal cell, in HCl secretion, to achieve electrical neutrality of the blood but also causes the alkaline tide

A

HCO3-

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19
Q

how is the alkaline tide affected by excessive vomiting and why

A

it is made more alkaline. because loss of H+ in the stomach lumen to vomiting reflexively increases the HC03- secretion into the blood at the basolateral membrane. so increasing the alkalinity of the blood leaving the stomach.

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20
Q

how do prostaglandin analogues stop NSAIDs like aspirin, causing peptic ulcers

A

provides prostaglandins ( so no need to rely on cyclo-oxygenase 1 to synthesise prostaglandins), so mucous secretion can still be stimulated by the pristaglandins, to act as a barrier agaist HCl and pepsin

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21
Q

what is the inherent rate of gastric motility by longitudinal muscle in the fundus and body?

A

3 contractions per minute. increased by the vagus nerve

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22
Q

which muscle layer is outermost in the stomach? longitudinal or circular

A

circular

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23
Q

what 2 substances are released by the enteric nerves to mediate stomach muscle relaxation, receptive relaxation on swallowing

A

nitric oxide and serotonin

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24
Q

where in the stomach are parietal cells most abundant

A

body and fundus

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25
Q

where in the stomach are chief cells most abundant

A

body and fundus

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26
Q

where in the stomach does the most contraction take place due to a thicker muscle layer

A

the antrum (between the body and pyloris)

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27
Q

which enteroendocrine cell secretes:

  1. gastrin
  2. somatostatin
  3. histimine
A
  1. G cells
  2. D cells
  3. enterochromaffin cells (ECL cells)
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28
Q

what cells secretes mucous in the stomach

A

goblet cells

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29
Q

where in the stomach are goblet cells most abundant

A

cardia and pylorus. which also lack parietal and chief cells

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30
Q

what zymogen is secreted into the small intestine, by the pancreas, to digest polypeptides and what is its active form

A

trypsinogen; trypsin

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31
Q

in the normal, free of ulcers, state, how does the stomach protect against HCl and pepsin. namw 4

A
  1. alkaline mucous
  2. replacement of damaged epithelial cells of the stomach
  3. tight junctions between the epithelial cells
  4. feedback loops that ensure mucous secretion is always sufficient
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32
Q

out of the: cephalic, gastric and intestinal phase of acid secretion in the stomach, which one is purely inhibitory and what substances cause this

A

intestinal phase; cck (cholecytokinin) ans secretin

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33
Q

what does secretin do in the intestinal phase of inhibiting HCl release

A

inhibits gastrin release, promotes somatostatin release

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34
Q

what part of the small intestine is prone to peptic ulceration

A

the duodenum just beyond the pyloric sphincter of the stomach

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35
Q

what artery can duodenal peptic ulcers erode into and cause to bleed

A

the gastroduodenal artery

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36
Q

give 3 structure in the small intestine and not the large intestine

A

plicae circularis, peyer’s patches, fat in the mesentery of the small bowel

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37
Q

where in the small intestine does most absorption take place

A

the jejnum

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38
Q

what are peyers patches

A

small submucosal lymph nodes in the wall o the ileum

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39
Q

in the intestine, which layer of muscle is on the outside

A

longitudinal muscle

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40
Q

is the jejnum inta or extraperitoneal?

A

intra

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41
Q

what marks the end of the small intestine

A

the iliocecal valve

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42
Q

what are the 4 parts of the duodenum

A

superior, descending, horizontal, ascending

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43
Q

at which division of the duodenum is the major papilla

A

the descending duodenum

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44
Q

where does the large intestine start

A

the iliocecal valve, with the ioliocecal orifice in between

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45
Q

are the ascending and descending colon intra or extraperitoneal?

A

extraperitoneal

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46
Q

what is the longidudinal muscle in 3 bands in the colon?

A

taenia coli

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47
Q

at what point along the colon do the taenia coli become a continuous layer of longitudinal muscle

A

the recto-sigmoid junction

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48
Q

give 3 things in the large intestine not in the small intestine

A

haustrations, taenia coli and appendices epiploicia

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49
Q

what do the appendices epiploicia mark?

A

where the blood vessels penetrate the bowel wall, to supply the mucosa and submucosa.

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50
Q

what is at mcburney’s point

A

the base of the appendix

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51
Q

why do different people get different symptoms with appendicitis

A

because the appendix is mobile and so can hit alot of different structure when inflamed depending on the position of its apex

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52
Q

where does the hindgut end

A

the distal part of the anal canal

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53
Q

give 3 things that the ileum has that the jejnum doesnt

A

peyer’s patches, more arcades, shorter vasa recta

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54
Q

give 3 divisions of the superior mesenteric artery

A

the middle colic artery, the right colic artery, the iliocolic artery

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55
Q

what artery vascularises the ascending colon

A

the right colic artery, a branch off the superior mesenteric

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56
Q

what are the 2 divisions of the right colic artery

A

ascending and descending

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57
Q

what are the 2 branches of the the iliocolic artery

A

superior and inferior

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58
Q

what does the inferior branch of the iliocolic artery supply?

A

the structures of the right iliac fossa. it has 4 branches, ileal branch supplying the distal ileum, the coecal branch supplying the caecum, the appendicular branch supplying the apendix and the colic branch to supply the start of the ascending colon (which is then continued by the right colic artery and the descending branch of the middle colic artery)

59
Q

what artery off the abdominal artery supply the small bowel

A

the superior mesenteric artery

60
Q

what does he middle colic artery supply

A

the proximal 2 3rds of the transverse colon

61
Q

hat part of the pancreas does the superior mesenteric artery and vein travel over

A

the uncinate process

62
Q

at what level does the inferior mesenteric artery arise form he abdominal aorta

A

L3

63
Q

what part of the large intestine does the inferior mesenteric artery supply

A

left colic flexure to to the upper part of the rectum, so including the descending colon, sigmoid colon and part of the rectum

64
Q

give the 3 divisions of the inferior mesenteric artery

A

left colic artery, the lower left colic artery, sigmoid artery

65
Q

what artery forms the connection between the superior and inferior mesenteric arteries

A

the middle colic artery

66
Q

what 2 horizontal lines is the flank/lumbar region of the abdomen between

A

subcostal plane and transtubercular plane

67
Q

what are the 3 abdominal regions below the intetubercular plane

A

right and left iliac and hypogastric/suprapubic

68
Q

what 2 pints does the intertubercular plane join?

A

the tubercles of the iliac crests

69
Q

what does the subcostal plane join

A

the lowest part of the costal margins on both sides

70
Q

what vertebra is on the same plane as the subcostal plane and what does it demarcate

A

L2, the emergence of the superior mesenteric artery and the lower limit of the spinal cord in the adult

71
Q

at what vertebral level does the abdominal aorta bifurcate and what plane/ line is here

A

L4. the intertubercular plane

72
Q

where is the intercristal plane and what part of the pelvis does it run through

A

the junction between L4 and L5. the most superior portion of the pelvis posteriorly

73
Q

why is the intercristal plane relevant?

A

it is used during lumbar puncture and epidural anasthesia

74
Q

the transpyloric plane of addison is located half way between what 2 landmarks

A

the jugular notch (top of the manubrium) and the upper border of the pubic symphysis

75
Q

name 3 structures that line on the transpyloric plane

A

the pyrloris of the stomach, pancreas, and the gall bladder

76
Q

at which costal cartilage and vertebra is the transpyloric plane

A

9th and L1

77
Q

bcburneys point is a point 2 3rds of the way along a line that joins the umbilicus to the anterior superior iliac spine on the or right of the body?

A

right as the appendix is in the right iliac fossa

78
Q

in a thin patient, at what level is the umbilius, and why is this point special?

A

L3. emergence of the inferior mesenteric artery from the abdominal aorta

79
Q

in the lower quarter of the rectus abdominis, which side do the aponeuroses pass?

A

anterior only

80
Q

what name is given to the 3 aponeurosis that act to enclose the rectus abdominis

A

the rectus sheath

81
Q

what is the linea alba

A

this is in the middle of the abdomen formed by the meeting of the aponeuroses of: external oblique, internal oblique and transverse abdominis

82
Q

what vertebra is the xiphoid considered to be at

A

the 9th thoracic vertebra

83
Q

what vertebral level is the posterior superior iliac spine at?

A

S2

84
Q

what levels of the anterior rami innervate the abdominal mucles

A

T7-L1

85
Q

what does rectus abdominis muscle attach to superiorly

A

the xiphoid process

86
Q

what are the 5 functions that the abdominal muscles can be involved in

A

micturition, giving birth, assisting in breathing, vomiting, dificaction, protection of the abdominal viscera

87
Q

what is an aponeurosis

A

a flat tendinous sheath that continues on from a muscle

88
Q

what muscle is inferiorly attached to the tubis bone and in not present in everyone in the abdomen and what is its presumed action

A

the pyramidalis muscle. thought to tense the linea alba

89
Q

how many stages of deglutition are involuntary

A

2

90
Q

what is the mainn step of stage one of swallowing

A

pushing of the food in the mouth against the hard palate towards the oropharynx by the action of the tongue

91
Q

what stage of swallowing is brought to consciousness and why

A

stage 1. so that we can use our memory to decide whether we should swallow the food if we’ve had it before

92
Q

what is the role of the masseter and buccinator muscles in the 1st stage of swallowing

A

pushing the food away from the vestibules, towards the oral cavity/tongue

93
Q

why must the mouth be closed in the 1st stage of swallowing

A

to have a rigid floor that the tongue can act against, as it is the movement of the tongue upwards and backwards that forms this stage

94
Q

at which anatomical position does swallowing now become involuntary

A

once past the oropharyngeal isthimus

95
Q

what is another name for the 2nd stage of deglutition

A

the pharyngeal stage

96
Q

what must relax to allow for the 3rd stage of deglutition to start and how does this take place?

A

the superior oesophageal sphincter. relaxation of the inferior constrictor

97
Q

what closes off the nasopharynx in the 2nd stage of swallowing to prevent food going the wrong way?

A

the soft palate

98
Q

is the hyoid bone depressed or elevated in the 2nd stage of deglutition? and what group of muscles are responsible for this

A

elevated. the suprahyoid muscles

99
Q

which is the fastest phase of swallowing and why

A

the pharyngeal phase because you must stop breathing for it

100
Q

what is the sequence of impulses that results in the raising of the soft palate and uvula in the 2nd stage of swallowing

A

receptors in the oropharynx are stimulated b y food there, these then send impulses to the deglutition centre of the medulla, this then send impulses back to cause contraction of muscles that elevate the soft palate and uvula, closing the nasopharynx

101
Q

what is the 3rd stage of swallowing called

A

the oesophageal stage

102
Q

does the hyoid bone rise or depress in the 3rd stage of deglutition

A

depresses, such that tract below it is made wider and shorter

103
Q

what is peristalsis in relation to deglutition

A

a continued and coordinated contraction of the longitudinal and circular muscle of the muscularis externa that pusshes the bolus towards the stomach

104
Q

in peristalsis, which muscle layer contracts above the bolus?

A

circular

105
Q

which sphincter is a physiological rather than anatomical sphincter? the lower oesophageal or pyloric one?

A

the lower/ inferior one

106
Q

what types of gland are in the oesophagus and what do they mainly secrete, why?

A

seromucous. mucous, to act as a lubricant for the bolus

107
Q

are the suprahyoid or infrahyoid muscles involved in the third stage of deglutition

A

infrahyoid

108
Q

name 4 infrahyoid muscles. what do these do during the 1st and 3rd stage of swallowing

A

sternothyroid, sternohyoid, omohyoid, thyrohyoid. they fix the hyoid bone, so allowing opening of the mouth by the suprahyoid muscles; depress the hyoid bone in the 3rd stage

109
Q

name the suprahyoid muscles in order from top to bottom

A

styloglosus, genioglossus, geniohyoid, mylohyoid, digastric, stylohyoid

110
Q

what plexuses innervates the constrictors

A

pharyngeal plexus, which involves the vagus and accessory CNs (10 and 11) that innervate the middle and inferior constrictors specifically
((5 does superior))

111
Q

the levator muscles is what helps to raise the soft palate in the 2nd sage of swallowing, what cranial nerve innervates it?

A

5, V3

112
Q

which of the tongue muscles is not innervated by the hypoglossal nerve (CN 12)

A

palatoglossus. it is innervated by the vagus nerve instead

113
Q

contraction of what 2 muscles of the tongue cause the fauces (openings either side of the uvula) to close/ move closer together

A

palatoglossus and palatopharyngeus. both of which are innervated by the vagus nerve!

114
Q

at what level along the vertebra does the forgut change from being called the pharynx to the oesophagus and why

A

c6 because the pharynx has both striated voluntary muscle and non striated smooth muscle, but the oesophagus only has smooth muscle

115
Q

the gag reflex is between which 2 cranial nerves

A

9 and 10

116
Q

what is choking due to?

A

a failure to coordinate actions, so muscles and nerves aren’t coordinated. eg due to intoxication or brainstem lesions

117
Q

through which membrane is a tracheostomy done and what structure does this avoid

A

cricothyroid membrane. the isthmus of the thyroid gland

118
Q

GERD/GORD is gastroeosophageal reflux disease and what is it caused by? what pathology can it then cause? and what is the change occurring?

A

the lower oesophageal sphincter not closing. Barrett’s syndrome, due to dysplasia of the epithelium, a change from stratified squamous epithelium to simple columnar.

119
Q

what is given to treat heartburn

A

over the counter histamine, H2 blockers

120
Q

what are the layers of fascia called in order from behind the constrictors

A

buccopharyngeal, prevertebral and retropharyngeal fascia.

121
Q

where does the superior constrictor originate from

A

medial pterygoiod plate and pterygomandibular raphe

122
Q

where does the middle constrictor originate from?

A

the hyoid bone

123
Q

what are the 2 inferior constrictors

A

cricopharyngeus, thyropharyngeaus

124
Q

what fascia lines the inner surface of the constrictors and where does it rise up to above the constrictors

A

the pharyngobasilar fascia. the base of the skull

125
Q

what is the weak point in the inferior constrictor and why is it relevant

A

killian’s dehisscence. food can form in a pouch of mucosa if it goes through this weakness- called the pharyngeal diverticulum

126
Q

what nerve wraps around the stylopharyngeaus muscle

A

the glossopharyngeal nerve

127
Q

what action does the hypoglossal muscle cause to the tongue

A

depresses the tongue

128
Q

what nerve and artery pierce the thyroHYOID membrane to get to the larynx

A

the internal laryngeal nerve and the superior laryngeal artery

129
Q

what is the superior laryngeal artery a branch off?

A

the superior thyroid artery, which is a branch off the external carotid artery itself

130
Q

which tracheal ring cartilages are behind the thyroid gland’s isthmus?

A

2nd to 4th

131
Q

what is the inferior thyroid artery a branch off? and where did this come off originally

A

the thyrocervical trunk, which is a branch off the subclavian artery

132
Q

above what anatomical landmark is innervation by the internal laryngeal nerve and below it is innervation by the external laryngeal artery?

A

the vocal cords

133
Q

does the right recurrent nerve do sensory or motor?

A

motor

134
Q

what is the superior, middle and inferior thyroid veins a branch off

A

superior and middle=internal jugular vein. inferior= brachiocephalic

135
Q

what is the uvula a continuation of?

A

the soft palate

136
Q

what 3 muscles attach to the thyroid cartilage (extrinsic ones)

A

thyropharyngeus, sternothyroid, thyrohyoid

137
Q

when stretched, so tension, of the vocal ligaments, is lower or higher pitch sound produces?

A

higher

138
Q

what joint does the cricothyroid muscle operate?

A

the cricothyroid joint (a synovial joint)

139
Q

what intrinsic muscle attaches to the side of the vocal cords?

A

the thyroarytenoid muscle, part of it is called the vocalis muscle and actually inserts all the way along the vocal cords and is to adjust the tension of the fibres, it makes small adjustments

140
Q

what action does the transverse arytenoid muscle produce and how does this affect the vocal cords

A

adducts the arytenoid cartilages. widens the space between the vocal cords, so slackens them, leading to lower pitch sounds

141
Q

what nerve innervates the transverse arytenoid muscle

A

right recurrent laryngeal nerve

142
Q

what muscle is the only one that adducts the vocal cords? so opening the rima glottidis

A

the lateral cricoarythenoid muscle

143
Q

what 3 muscles abduct the vocal cords

A

oblique and transverse arytenoid and posterior cricoarytenoid

Med P1 (15 decks)

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