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Pathophysiology > GI > Flashcards

GI Flashcards

1
Q

Food/nutrients do not become a part of the internal environment until …

A

absorbed into the blood or lymphatics

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2
Q

GI structure: 4 parts

A

upper, middle, lower and accessory

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3
Q

what makes up the upper GI ? what does it do?

A

mouth, esophagus, stomach

initial receptacle, initiation of digestion

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4
Q

what makes up the middle GI ? what does it do?

A

small intestine- duodenum, jejunum, ileum

most absorption and digestion processes occur

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5
Q

what makes up the lower GI ? what does it do?

A

cecum, colon, rectum

storage for elimination

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6
Q

what makes up the accessory GI ? what does it do?

A

salivary glands, liver, pancreas (an gallbladder)

produces secretions that aid in digestion

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7
Q

what is the mouths job in digestion?

A

entrance, mastication and directs food toward esophagus

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8
Q

physical characteristics of esophagus

A

10 in long, muscular and collapsible, sits behind trachea

epithelial layer to lubricate and protect its surface

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9
Q

esophagus: upper third vs lower third - what are they made up of?

A

Upper third is skeletal striated muscle gradually replaced with smooth muscle until smooth muscle completely covers the lower third

lower third: Peristalsis of smooth muscle helps to move food along tube

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10
Q

movements of small vs large intestine

A

small: break up food AND move it along
large: larger movements to move food along tract

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11
Q

what are the upper and lower sphincters of the GI tract?

A

upper: pharyngoesophageal
lower: gastroesophageal

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12
Q

where is the gastroesophageal sphincter located?

A

about 3cm above stomach

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13
Q

GI lower/gastroesoph. sphincter: when is it contracted vs relaxed?

A
  • Remains contracted (tonic) causing an area of high pressure to keep contents in stomach
  • Receptive relaxation when eating
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14
Q

the gastroesophageal sphincter aids in maintenance of what?

A

aids in maintenance of high pressure area around lower sphincter to prevent reflux

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15
Q

how does the gastroesophageal sphincter enter the diaphragm?

A

Passes through a “hiatus” (an entry) through the diaphragm into the stomach

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16
Q

what is a haital hernia?

A

haital hernia- protrusion of stomach up through this haitus for gastroesoph. sphincter - causes regurg of food contents from stomach

  • the majority are gradual and asymp.
  • if become symptomatic then one can consider sugery
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17
Q

what is the residual volume of the stomach? how much can it hold before intraluminal pressure rises?

A

50mL (how much usually stays in the stomach)

1000mL

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18
Q

what are the different portions of the stomach? entry, upper, main, lower and exit?

A 
Entry is the cardiac orifice 
Fundus is upper portion 
Body is the main portion
Antrum is the lower portion
Pyloris is the exit
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19
Q

what is the pyloris?

A

exit of the stomach: a ring-like muscle that contracts, controls the rate of gastric emptying. The pyloric sphincter allows for controlled delivery of the acidic chyme to the duodenum

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20
Q

how long are each part of the small intestine?

A

duodenum: 10 inches

jejunum and ileum: 23 ft

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21
Q

how do bile and pancreatic enzymes get into the small intestine? what do they do there?

A

duodenum contains openings for the common bile and main pancreatic ducts
- bile and pancreatic enzymes enter to help aid in digestion, which takes place in the jejunum and ileum

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22
Q

function of the jejunum and ileum?

A

digestion and absorption of food

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23
Q

the duodenum helps ___ acidic chyme

A

alkalyze with bile and HCO3

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24
Q

when is the duodenum “ready” to receive food stuff/chyme from the stomach?

A

when it is alkalytic enough to receive the acidity

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25
Q

how long is the large intestine?

A

4.5-5ft

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26
Q

what are the parts of the large intestine?

A

cecum, colon, rectum and anal canal

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27
Q

what is the cecum?

A

Blind pouch at the junction of the ileum and the colon

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28
Q

where is the appendix?

A

The appendix arises from the cecum about 1 in (2.5 cm) from ileocecal valve

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29
Q

where is the ileocecal valve? what does it do?

A

Ileocecal valve (upper border of cecum) prevents fecal matter from back-flowing into the small intestine

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30
Q

what are the parts of the colon?

A

Ascending –> hepatic flexure–>transverse–>splenic (left colic) flexure –> descending–>sigmoid

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31
Q

what are the 4 layers of the GI wall?

A

mucosal (innermost lumen), submucosal, muscularis externa, peritoneum/serosa

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32
Q

What are 5 important jobs of the mucosal layer of the GI wall?

A
  • Mucous lubricates and protects
  • Secretion of digestive enzymes
  • Absorption
  • Barrier to noxious or pathologic organisms
  • Contains the Lymphatics – first line of immune defense
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33
Q

what are the 3 sublayers within the first GI layer (mucosal)

A

3 parts innermost to outermost: Epithelium–>Lamina propria (connective tissue)–>muscularis mucosae (smooth muscle)

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34
Q

what is significant about the epithelial sublayer of the mucosal layer of the GI wall?

A

-Epithelial cells have rapid turnover rate of 4-5 days and are shed in stool: Rapid healing without scar tissue

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35
Q

2 kinds of muscle in the muscularis externa of the GI wall?

A

longitudinal and circular

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36
Q

submucosal layer of GI wall

A

Connective tissue layer

Blood vessels, nerves, and structures responsible for secreting digestive enzymes

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37
Q

what are the two main parts of the GI peritoneum?

A

two continuous layers: parietal (attached to abd. wall) and visceral (attached to organ wall)

38
Q

what is the peritoneum of the GI? clinical importance?

A

Loosely covers the organs and the body cavity creating a peritoneal cavity (potential space)
Serous fluid creates an area of low friction
Ascites- an accumulation of fluid in the peritoneal space

39
Q

what is the mesentary?

A

A double fold of peritoneum that encloses a portion or all of one abdominal organ attaching it to the abdominal wall
Contains BLOOD SUPPLY, NERVES, and lymphatic vessels supplying intestinal wall

40
Q

what is the omentum?

A

double layer of peritoneum from stomach or proximal duodenum to adjacent organs or abdominal wall

41
Q

what are the two parts of the omentum?

A

greater and lesser

42
Q

what is the greater omentum? what does it do?

A

mobile, Double layer of peritoneum that folds down from the stomach to cover the transverse colon and folds of the intestines
Protects the intestines from cold or injury (fatty) and serves to contain infection or in response to inflammation (adhesions)

43
Q

what is the lesser omentum? what does it do?

A

Connects the liver to the lesser curvature of the stomach

Really doesn’t do much

44
Q

what do we worry about with the mesentary?

A

mesentaric infarctions - leads to hyperemic mesentary (very red) - out of proportion abdominal pain

45
Q

3 main players in motility

A
  1. Enteric Nervous System Innervation
  2. ANS Innervation
  3. Intestinal Smooth Muscle
46
Q

enteric nervous system: where is it? where does it come from?

A

Lies entirely within the walls of the gut; it’s the intrinsic innervation of the gut; a division of the autonomic nervous system

47
Q

what is the intrinsic vs extrinsic innervation of the gut?

A

intrinsic: enteric nervous system
extrinsic: ANS (sympathetic and parasympathetic)

48
Q

regulation of the two enteric system networks/plexus (myenteric and submucosal) are from what 3 things?

A

Regulation occurs by local influences, input from the ANS, and communication between the two

49
Q

A system of ganglionic cells that extend along the length of the gastrointestinal wall.. is known at the what?

A

enteric nervous system

50
Q

myenteric (aeurbach) plexus: location and purpose?

A

Located between the circular and longitudinal muscle layers

Mainly concerned with motility along the length of the gut (because it’s between two layers of muscle)

51
Q

what are the two enteric networks/plexuses? which works along the entire length and which only some segments?

A

myenteric (auerbach)- entire length (small and large intestine)
submucosal (meissner) - segments

52
Q

submucosal (meissner) plexus : location and purpose ?

A

Located between the mucosal layer and the circular muscle layer of the intestinal wall

Mainly concerned with controlling the function of each segment of intestinal tract

53
Q

the submucosal plexus Integrates signals received from the mucosal layer into ____, _____ and _______

A

local control of motility, intestinal secretions, and absorption of nutrients

54
Q

parasympathetic mainly supplied by what? stimulation = ?

A

vagus nerve ( w/ postganglionic neurons in myenteric nas submucosal plexuses) and the pelvic nerve

stimulation: excitatory: increased motility and secretions

55
Q

what is the vagus vs pelvic nerve responsible for?

A 
Vagus nerve responsible for parasympathetic innervation of:
Stomach 
Ileum and  Small intestine
Cecum
Ascending colon
Transverse colon

Parasympathetic Fibers of the Pelvic nerve responsible for
Remainder of the colon

56
Q

sympathetic stimulation of the gut is largely excitatory or inhibitory

A

inhibitory (decreased motility and secretions )

57
Q

sympathetic stimulation of the GI through…

A

thoracic chain of the sympathetic ganglia

58
Q

4 parts of thoracic ganglia

A

Celiac Ganglia, Superior mesenteric ganglia, Inferior mesenteric ganglia, and hypogastric ganglia

59
Q

sympathetic control is largely mediated by altering the activity of ____, to do what 4 things ?

A 
intramural neurons:
Controls mucous secretion
Reduces motility 
Enhances sphincter function
Increases the vascular smooth muscle tone of the blood vessels that supply the GI tract
60
Q

Movement of food particles along the alimentary canal is done through ______
Motion is influenced by_____, ______ and ______ influences

A

smooth muscle contraction

local, humoral, and neural

61
Q

3 types of movements ?

A

Tonic movements
Rhythmic movements
Peristaltic movements

62
Q

tonic movements

A

continuous movements that last min to hrs- occur at sphincters

63
Q

rhythmic movements

A

intermittent contractions: churning food and presenting it to the surface area of the GI tract for max abs

64
Q

peristaltic movements

A

rhythmic propulsive movements

force contents forward.

65
Q

what is pacemaker-generated smooth muscle?

A

Involuntary muscle- its activity arises spontaneously or through the activity of the autonomic nervous system.

66
Q

what does the “Greater tension development” for smooth muscle mean?

A

they can be stretched far.. unlike skeletal muscle where when theyre stretched too far, they lose the ability to contract

67
Q

smooth muscle contraction is initiated by what?

A

influx of Ca+

68
Q

smooth muscle is present in all of the GI tract EXCEPT what?

A

except pharynx, upper 1/3 of esophagus, and external anal sphincter

69
Q

mechanoreceptors vs chemoreceptors of the GI tract, what does each monitor?

A

mechano: Monitor the stretch and distention of the gut wall; distention of the bowel is the main stimulus for relaxation of the sphincters of the gut

Chemo: Monitor the chemical composition of the GI contents (i.e. pylorus to duodenum)

70
Q

what cranial nerves are part of the swallowing reflex?

A

CN 5,9,10 and 12 are part of swallowing reflex

trigem, glossopharyngeal, vagus, hypoglossal

71
Q

The swallowing reflex is a rigid sequence of events that starts off ______, but becomes _______ as it reaches the pharynx

A

voluntary, involuntary

72
Q

3 phases of swallowing

A

Three phases:

  1. Oral phase (voluntary) - food pushed to the back of the mouth where tongue lifts food to touch posterior pharynx
  2. Pharyngeal phase- epiglottis in place, bolus is moved backward through constrictive movements of the pharynx (swallow)
  3. Esophageal phase- walls stretch = peristalsis is initiated
73
Q

swallowing reflex happens in the ____ of the brain, if a pt can’t swallow what might you worry about?

A

medulla/pons

-a stroke in this area

74
Q

Pacemaker of the stomach is in the____ and peristalsis moves toward the _____, this contracts and occludes the ______ and sends the chyme back in the opposite direction.

A

middle/body
antrum
pyloris
(the churning of food stuff)

75
Q

what kind of sphincter is the pyrolis?

A

physiologic

76
Q

Hormonal mechanisms can also control gastric emptying in response to what?

A

pH, osmolar and fatty acid composition of the chyme

77
Q

two hormones to regulate gastric emptying: what are they and what do they do?

A

Cholecystokinin (regulates the contraction of the gallbladder in order to secrete stored bile)

Glucose-dependent insulinotropic peptide (AKA gastric inhibitory peptide) increases insulin secretion and decreases H+ secretion

78
Q

2 patterns of movement in the small intestine

A

peristalsis: move food along

segmental contractions: churn food and expose it to intestinal wall for absorption

79
Q

Peristalsis starts in the duodenum at ____ and continues but slows down in the ileum to _____
(these are Smooth muscle contractions)

A

12/min

9/min

80
Q

segmental waves/contractions are what type of muscle activity ?

A

Circular muscle activity

81
Q

Stretch at the distal ileum causes…

A

ileocecal valve to relax and allows the fluid to enter the cecum.

82
Q

colonic motility: two types of movements

A

haustrations and propulsive mass movements

83
Q

haustrations

A

Caused by small segments of haustra (“sacculations”) which produce a “digging” type movement designed to introduce all the contents to the bowel wall.

84
Q

propulsive mass movements

A

Propulsive movement caused by large segment constriction that moves the fecal matter forward
Normally initiates defecation.

85
Q

defecation is controlled by ___ and ___ sphincters

A

internal and external

86
Q

internal sphincter for defecation

A

involuntary

thickened smooth muscle inside anus

87
Q

external sphincter for defecation

A

voluntary

striated muscle

88
Q

two types of defecation reflexes

A

intrinsic myenteric reflex (mediated by enteric system)

and parasympathetic reflex

89
Q

intrinsic myenteric reflex for defecation

A

Initiated by distention of rectum sends impulses to increase the peristaltic waves in descending & sigmoid colon and rectum

90
Q

parasympathetic reflex for defecation

A

Nerve endings in the rectum are stimulated –>signals go to the sacral spinal cord and reflex back by way of the pelvic nerves to the descending & sigmoid colon, rectum and anus
Increase peristaltic waves and relax the internal sphincter.

91
Q

external sphincter is controlled by…

A

pudendal nerve (S2-S4) which is controlled by the cortex (voluntary)

92
Q

how does one control defecation- saving for “appropriate” times. ?

A

dont wanna poop: cortex inhibits the parasympathetic efferent impulses and constricts the external sphincter.

want to poop: Afferent impulses are easily fatigued – voluntary re-initiation of afferent impulses by abd contraction when more convenient to defecate

Pathophysiology (28 decks)

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