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Pathophys 2, Midterm > GI > Flashcards

GI Flashcards

1
Q

Where does the storage and further processing occur?

A

Liver

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2
Q

Peristaltis is contolled by what?

A

ANS

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3
Q

What are the 4 layers of GIT?

A

Mucosa (inner)
Submucosa
Muscularis
Serosa (advetia) continuous with mesentary

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4
Q

What is the name of the intrinsic nervous network of GI?

A

Enteric nervous system

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5
Q

What is the short (ENS reflex) loop?

A

Stimulus -> GIT receptors (mecano) -> ENS plexus -> smooth mucles and glands -> mucosal response

GIT receptors can -> brain and
Brain –> ens plexus (long reflex(vaso vagal reflex) )

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6
Q

What does tbe vagus nerve carry?

A

Parasympa and sympa fibers

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7
Q

What does the taste and food odours do on salivation?

A

Increase salivatipn and gastric juice secretion

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8
Q

What are the 3 glands for salivation?

A

Parotid
Submandibular
Sublingual

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9
Q

Saliva is:

A

Hypoosmotic
Neutral ph7.4

Regulated by ANS only
And para/sympa increase secretion

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10
Q

In saliva, what is ptyalin and mucus?

A

Ptyalin: carbohydrate digestion

Mucus : lubrication

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11
Q

What are the 3 mucles of esophagus?

A

Striated (at UES)
Mixed
Smooth (below LES)

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12
Q

The UES (upper esophagus sphincter) is ?

A

Relaxed

When contraction: prevent air into esophagus

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13
Q

The LES (lower esophagus sphincter) :

A 
Usually Contracted (precent gastric reflux) 
Relaxed : allows bolus to enter stomach
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14
Q

What is the oropharyngel phase of swallowing?

A

Voluntary
Regulated by trigeminal and brainstem

  1. Pressure to pharynx
  2. Reflex protecting airways
  3. Relax UES
  4. Contract pharyngeal constrictors
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15
Q

What is the esophageal phase of swallowing?

A
  1. Primary peristaltis in esophagus
  2. Relax LES
  3. Accomodate tgrough gastric relaxation

Vagal relax of LES

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16
Q

What is absorbed in stomach?

A

Alcohol and NSAIDs

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17
Q

Where does the vagus innervation occur?

A

Fundus (upper portion)

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18
Q

What is the proximal stomach?

A

Body of stomach, serosa to mucosa

Storage and receptive relaxation

Stops at pacemaker cells

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19
Q

What is the role of the pacemaker cells?

A

Basic electrical rhythm (BER)

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20
Q

What is the distal stomach?

A

Atrum, pylorus

Gastric peristalsis (max 3 min) 
Gastrin & parasympa  activity = increase 
Secretin & sympa activity = decrease
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21
Q

Gastrin ?

A

Increase peristalsis with parasympa

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22
Q

Secretin?

A

Decrease peristalsis with sympa

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23
Q

Gastric mixing

A

Antral systole -> increase velocity -> retropulsion

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24
Q

Gastric emptying:

A

Pyloric sphincter always open

Fluid: pressure
Solid: peristalsis

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25
What does the enterogastric reflex do?
Decrease rate of emptying
26
What is enterogastric reflex?
Neural and hormonal Short and long Cholecystokinin (CCK) and secretin
27
What are the determinants of enterogastric reflex?
1. Duodenal distension 2. Chyme hyperosmolarity 3. Very acidic chym pH 4. High fat content
28
What is pepsinogene and pepsin
Pepsinogen : inactive form of pepsin Pepsin : activated by gastric acid <2 digest proteins Pepsin desactivated in intestine by alkaline pH Ach increase secretion
29
Intrinsic factor
B12 abs
30
Gastroferritin
Increase iron absorption
31
Enterochromaffin-like cells (ELC) ?
Histamine -> increase HCl secretion
32
G-cells
Gastrin : increase HCl secretion
33
D-cells
Somatostatin -> decrease HCl
34
What are the fonctions of gastric glands?
Mucous neck cell : mucus secretion Chief cell: pepsinogene Parietal cell: HCl, intrinsic factor, gastroferritin Endocrine cell: histamin, gastrin, somatostatin
35
What are the main functions of gastric acid?
HCl in stomach HCo3 in urine Dissolve food Bactericidal agent Pepsinogen-> pepsin
36
What is the 3x defense of gastric mucosal barrier?
1. Mucus buffer layer (HCO3) 2. Tight junctions 3. Rapid mucius neck cell turnover
37
What is the role of prostaglandins in GMB?
Increase mucus & decrease acid secretion NSAIDs (aas) inhib prostaglandin -> decrease GMB
38
H pylori
Kill mucuous cells + increase gastrin -> decrease GMB
39
What are the phases of gastric secretion?
Cephalic: thought, smell, taste of food Gastric: stomach distension Intestinal: histamine and digested proteins
40
What is secreted in cephalic phase?
Ach
41
What is secreted in gastric phase?
Gastrin
42
What is secreted in intestinal phase?
Histamine
43
What does CCK and secretin?
Decrease secretion Enterogastric reflex Digested proteins increase secretion of histamine
44
What is the main function of small intestin?
Complete digestion and absorption
45
Role of vili and microvili
Bush border -> increase surface area
46
Brush border
Increase surface area | Digestive enzymes & absorption
47
What is the ileocecal sphincter ?
Opening to colon
48
Paneth cells
In crypts of lieberkuhm | Antibio secretions
49
What are the cells in Crypts of Lieberhühn?
Paneth Goblet Enterocytes
50
Goblet cells
Alkaline mucus secretion
51
Enterocytes
Absorption
52
What is ileogastric reflex ?
Ileum distension decrease gastric motility
53
What is enterointestinal reflex?
Intestinal distension decrease -> decrease intestinal motility
54
What is gastroileal reflex?
Gastric motility increase ileum motility and sphincter relax
55
Ileocolic reflex?
Colon distension -> ileal sphincter constriction
56
What does the stomach digest and absorbe?
Water and alcohol
57
What in digested and absorbed in duodenum
Calcium, Sodium, Mg, iron Fats, sugars, proteins Water, vitamins
58
Digested and absorbed in jejunun?
Sugar, proteins
59
Digest/abs in ileum
Bile salts, B12, chloride
60
Abs in colon
Water, electrolytes
61
How are carbohydrates absorbed?
Via sodium-glocose co-transporter and GLUT
62
Intestinal glucose abs is
Insulin independent
63
Hiw are proteins absorbed?
Via sodium-dependent carriers
64
How are fats abs?
Whit micelles
65
What are mucelles?
Amphipathic Bile salts -> absileum -> recycled at liver
66
Gastrocolic reflex
Gastric secretion increase colon motility
67
Macrophage (kupffer cell)
Infection prevention
68
Hepatocyte
Detox blood & release nutrients
69
Liver functions
``` Lipid storage Testos and estrogen metabo Rbc destruction Bilirubin metabo Bile and plasma prot synthesis ```
70
What is bile secretion?
Liver -> hepatocyres synthesis cholesterol to form 1° bile acids -> galbladder -> duo/jejunun -> ileum -> actively transported across intestinal lumen into 2° bile acids -> diffuse passively across lumen -> hepatic portal vein -> duo/jeju -> rectum
71
Who abs and destroy old RBC?
Kupffer cells Makes heme and globin Heme -> iron and bilirubin
72
What happens to iron and globin after RBC destruction?
Heme-> Iron -> iron pool | Globin -> amino acid pool
73
Gallbladder contraction increase by
CCK | Vagus nerve
74
2 types fluid by pancreas
1. Enzyme rich: digestion Vagus and CCK increase secretion 2. HCO3 : neutralization Secretin increase secretion
75
What does anterokinase do?
In duodenal mucosa | Trypsinogen to trypsin
76
What are the muscular events to vomiting
1. Duodenal + gastric retrograde peristalsis 2. LES relaxes + diaphragm & abdo contractions 3. Increase thoracic pressure force open UES -> chyme expulsion Parasympa control Medulla
77
What is CTZ?
Chemoreceptor trigger zone Outside BBB Drugs and toxins
78
Osmotic diarrhea
Subs malabs -> osmose in colon -> large volume
79
Secretory diarrhea
Bacterial or viral -> increase secretions, decrease absorption -> large volume
80
Motility diarrhea
To fast, no abs -> small volume
81
Types of dysphagia
mechanical : tumor, compression of esophagus functional: neuromuscular disorders. impaired voluntary swallowing achalasia: loss inhib neurons in lower esophagus --> no relax LES
82
what is GERD? gastroeso reflux disease
abnormal LES relaxation/weak --> gastric reflux
83
4 types of intestinal obstruction
volvulus, herniation, adhesion, intussusception
84
intestinal obstruction pathophys
distension --> less fluid, E+ absorption --> alkalosis(high IO) or acidosis (LOW), ketosis, lactic acidosis
85
Why high IO --> alkalosis
less chloride and more HCO3
86
Why low or late IO makes acidosis ?
more H+ and less K | less bic and bile reabsorption
87
What is chronic gastritis?
chronic inflammation + mucosal atrophy + increase risk of cancer cause --> H+ pump and autoantibodies --> gastric mucosa atrophy and less secretions --> ulcers, pernicious anemia, bleeding, cancer
88
what are peptic ulcers?
inflammation et autogestion psycho stress ulcers
89
what are duodenal ulcers ?
acid secretion or muscle spasm relieved by antacids and meal remission/exacerbation
90
what is gastric ulcers?
more HCl secretion defective mucosa barrier no remission-exacerb increase cancer
91
stress ulcers
curling: burn injuries Cushing : more vagal activity after brain trauma coagulopathy
92
What is the difference between Crohn and Ulcerative colitis?
Crohn: idiopathic inflammatory disorder of GI Ulcerative: chronic inflammation of mucosal layer
93
Hallmarks of UC?
colon and rectum, continuous lesions autoimmune exacerbation-remission pancolitis: whole colon
94
Hallmarks of CD?
cell mediated cytotoxicity --> skip lesions | transmural inflammation --> crypts destruction
95
What is appetite regulation?
hypothalamus --> arcuate nucleus --> anorexins --> catabolic --> less appetite and more metabolism or orexins --> anabolic --> + appetite and less metabolism
96
obesity and adipocytes
low grade inflammation and adipokine (leptin& adiponectin) pattern alterations --> T2DM & cardiovascular disease
97
Leptin and obesity
eat ++ --> more leptin --> leptin resistance --> overeating --> weight gain --> hyperleptinemia --> more sympa activity --> HTN
98
Adiponectin and obesity
adiponectin secreted to increase insulin sensitivity. anti-inflammatoire & anti-arthrogenic obesity -->less adiponectin --> insulin resistance --> T2DM
99
What is Kwashiorkor?
protein insufficiency. normal fat
100
What is portal hypertension?
increase of 3-10 mmhg compli: varices, splenomegaly, respi dysfunction
101
what happens when liver dysfunction? on encephalopathy
collateral vessels formation --> shunt blood around liver to systemic circulation --> toxins normally absorbed in liver are in blood --> ammonia in brain --> increase gaba --> less neurotransmission --> lethargy --> coma --> death
102
What is the pathological Neonatal jaundice?
0-24h after birth more bilirubine production --> less excretion --> less liver conjugation metabolism - unconjugated = lipid-soluble --> BBB
103
What is kenictus?
chronic increase in unconjugated bilirubin in brain --> encephalopathy tx: phototherapy
104
what are the 4 clinical phases of hepatitis?
1. incubation 2. prodromal 3. icteric 4. recovery
105
What is the incubation phase of hepatitis?
infection
106
What is the prodromic phase of hepatitis?
about 2 weeks post-exposure contagious ++ ends with jaundice
107
what is the icteric phase ?
1-2 weeks post prodromal lasts 2-6 weeks hepatocellular necrosis + cholestasis liver enlargement + painful
108
What is the recovery phase of hepatitis?
6-8 weeks post exposure | jaundice resolution
109
What are the transmission modes of Hepatitis A,B,D,C,E ?
A: sex, fecal-oral, parenteral B,D: sex, parenteral, C: parenteral E: fecal-oral
110
Which hepatitis are chronic?
B,C,D
111
What does hep D require prior to infection?
infection by hep B
112
What is Viral hepatitis B (HBV) ?
DNA virus causes: cirrhose, chronic hepatitis, hepatocellular carcinoma
113
What are the markers of HBV?
HBsAg: active HBV HBeAg: HBV replication
114
Are there vaccines for Hep C ?
no, only interferon antiviral therapy
115
How does cirrhosis occur?
liver injury --> kupffer cell activation --> release inflammatory mediators --> fibrosis chronic damage + fibrosis regeneration cycle --> cirrhosis
116
what happens in alcoholic liver cirrhosis ?
alcohol --> increase acetaldehyde formation + inflammatory mediators --> necrosis
117
What happens during acute pancreatitis ?
duct obstruction --> acing cell injury --> intracellular activation of enzymes --> auto digestion --> trypsin --> cell injury, proteolyses, edema, thrombosis, hemorrhage, necrosis

Pathophys 2, Midterm (4 decks)

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