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Summer Patho > GI anatomy and phys > Flashcards

GI anatomy and phys Flashcards

1
Q

what percent total body mass is GI

A

5%

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2
Q

what is the principle site where the immune system interfaces with a diverse array of antigens present in food and gut microbes

A

intestines

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3
Q

what are the two primary movements of the GI system?

A

mixing and propulsion

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4
Q

what are the GI layers from out to in?

A

serosa, longitudinal, circular, mucosa, epithelium

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5
Q

what GI layer contacts in order to shorten the length?

A

longitudinal muscle

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6
Q

what GI layer contracts to decrease the diameter

A

circular muscle layer

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7
Q

what GI layer contains the Meissner plexus - which transmits info from the epithelium to the enteric and CNS

A

submucosa

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8
Q

what GI layer senses contents and secretes enzymes, absorbs nutrients and excretes wasts

A

epithelium

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9
Q

extrinsic SNS stimulation causes

A

inihibition of GI motility - NE

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10
Q

extrinsic PSNS activity

A

excitatory - activates motility - Ach

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11
Q

enteric nervous system

A

independent nervous system that controls motility, secretion, and blood flow

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12
Q

myenteric plexus

A

extends length of GI tract, between longitudinal and circular muscle layers

stimulation = tonic contraction = increased rhythm and rate of contractions
inhibited by peptide secretions that impede movement to inhibit pyloric and ileocecal valve

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13
Q

submucosal (meissners) plexus

A

controls inner wall of each minute segment of intestine

originates in epithelium

controls secretions, absorption, and contraction of submucosal layer

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14
Q

esophagus and muscles

A

upper 1/3 = striated,

lower 2/3 = smooth

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15
Q

resting tone of upper sphincter

A

30-200mmhg

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16
Q

resting tone of lower esoph sphincter

A

10-45 mmhg

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17
Q

stomach

A

breaks food into chyme

intrinsic and extrinsic regualtion

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18
Q

G cells

A

secrete gastrin in stomach to stimulate parietal cells

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19
Q

parietal cells

A

secrete hcl to lower ph

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20
Q

chief cells

A

secrete pepsin at low ph to digest protein

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21
Q

what does gastrin and motilin do to contractions

A

increase strength and frequency

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22
Q

what does gastric inhibitory peptide do to contractions

A

inhibit

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23
Q

stomach emptying is prompted by

A

gastric distention, gastrin, NO

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24
Q

stomach emptying is inhibited by

A

duodenal stretch, increased fat content via cholecystokinin

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25
Q

gastric gland secretions

A

2L/day
oxyntic glands and pyloric glands secrete hcl, pepsinogen, intrinsic factor, and mucus to protect pyloric mucosa from stomach acid and they also produce gastrin

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26
Q

mechanism of HCL

A

parietal cells secrete HCL which has a pH of 0.8
at the same time HCO3 diffuses into blood so that gastric venous blood has higher ph than arterial blood when stomach is secreting acid

H+ occurs via the hydrogen potassium pump

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27
Q

HCL formation

A
  1. water dissociates into H and OH inside pariental cells
    - H is then secreted into small channel in exchange for K
  2. As H is pumped out and K is pumped in, OH accumulates and formrs HCO3
    - this is then exchanged across membrane for cl-
  3. water passes into canaliculus by osmosis
    - FINAL SECRETION from canaliculus is water and HCl
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28
Q

small intestine parts and function

A

maximize absorption of water, nutrients, and vitamins before large intestine
parts include duodenum, jujunem, and ilieum

<100,000 organisms per ml

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29
Q

fluid through intestines

A

9L of fluid enters small intestine each day (diet - 2L, secretion 7L) 1-2L pass into colon for H20 absorption

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30
Q

dudenum

A

begins pyloric sphincter

chemically digests chyme

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31
Q

jejunem

A

absorbs nutrients

32
Q

ileum

A

90% of nutrients have already been absorbed
absorbs vit b12
ends at ileocecal valve

33
Q

what is ileocecal valve

A

circular muscle that prevents reflux of colon into small intestine

34
Q

role of large intestine

A

reservoir for wast and indigestble material before elimination and absorbs any remaining electrolytes and water

35
Q

where is the highest concentration of organisms found an any ecosystem

A

large intestine

36
Q

pancreas

A

99% exocrine - secretes digestive enzymes
1% endocrine - regulates blood sugar by secreting insulin, glucagon, and somatostatin

secretes digestive enzymes and sodium bicarb into ducts that drain via the pancreatic duct and common bile duct into duodenum

37
Q

pancreatic excretion

A

enzymes are secreted through pancreatic duct, joins common bile duct, and empties into duodenum via papilla of vater through sphincter of oddi

insulin is secreted directly into bloodstream via islets of langerhans

38
Q

pancreas exocrine is stimulated by

A

acetylcholine
chlecystokinin
secretin

39
Q

what is the basic functional unit of the exocrine pancreas

A

the acinus

40
Q

spleen pulps

A

white pulp - lymph/WBS

red pulp - venous sinous, reservoir for monocytes, macrophages for digesting RBCs

41
Q

spleen function

A

filtration, iron metabolism, prevention of infection, RBC and platelet storage

42
Q

is spleen involved in digestion

A

no - just shares blood supply

43
Q

what does splanchnic circulation include

A

gut, spleen, pancreas, liver

44
Q

reticulendothelial cells

A

remove bacteria and other articulate matter that might enter the blood from the GI tract, thus preventing direct transport of harmful agents to rest of body

45
Q

what does preop anxiety do to bowel function

A

inhibition d/t norepi release

give midaz

46
Q

volatile anesthetics and bowel function

A

depresses spontaneous activity and changes in intestinal tissue oxygenation

47
Q

which VA best reserved reactive hyperemia in patients that had periods of ischemia for resection and anastamosis

A

isoflurane

48
Q

propofol and bowel function

A

no difference

49
Q

nitrous oxide and bowel function

A

30x more soluble than nitrogen in blood and as such will diffuse into gas-containing cavities from the blood faster than the nitrogen already present in those cavities

avoid

50
Q

NDMR and bowel function

A

only effects skeletal muscle so GI motility remains intact

51
Q

succinylcholine and bowel function

A

produces an initial contraction, increases intragastric pressure, could overcome tone of LES and allow reflux

52
Q

neostigmine

A

increases PSNS activity and bowel peristalsis

partially offset by simultaneous glyco admin

53
Q

what is the best reversal choice for tenuous bowel anastamoses

A

sugammadex

54
Q

opioids and bowel function

A

reduce GI motility and constipation
d/t effect on peripheral mu receptors in the myenteric and submucosal plexus

stool will stay in gut for longer period of time, more water is absorbed, and stool becomes hard and dry leading to constipation

55
Q

what can you give to alleviate opioid induced constipation

A

laxative, stool softener, prokinetic

56
Q

ileus

A

a transient cessation of coordinated bowel motility after surgical intervention which prevents effective transit of intestinal contents and tolerance of oral intake

can last about 3-4 days postop

57
Q

surgical manipulation of gut

A

increases SNS stimulation of myenteric plexus, which promotes the influx of leukocytes into traumatized area which creates inflammatory cascade

can lead to peritonitis

58
Q

how long does regional anesthesia attenuate the incidence of ileus by

A

36h

59
Q

mesenteric ischemia

A

100% mortality if left untreated
can occur from strangulation, emboli, etc
painful

treatment - reperfuse, revasc, bowel resect

60
Q

colon resection

A

colon primarily absorbs water and a full colonic resection is compatible with life

61
Q

jejunem resection

A

primary site for digestion and absorption of nutrients, but ileum is able to adapt after resction

62
Q

ileum resection

A

ileum absorbs b12 and bile salts, if resected bile will enter the colon and stimulate fat and water secretion

63
Q

what can bowel anastamoses disrupt motor activity

A

due to transection of pacemaker myogenic cells

distal part to transection must rely on its own intrinsic slow wave transmission

64
Q

innervation to parietal peritoneum, abdominal wall muscles, and skin is supplied by

A

thoracoabdominal nerves

65
Q

innervation for upper abdomen (liver, stomach, pancreas, small bowel, and prox colon)

A

T5-L2

66
Q

innervation of lower abdomen (descending colon, sigmoid, rectum, bladder, ureter)

A

T9-L3

67
Q

colon, rectum, internal and external genitalia, and bladder

A

innervated by fibers from S2-4

68
Q

what do sympathetic afferent fibers transmit

A

visceral pain

69
Q

what do sympathetic efferent fibers do

A

inhibit peristalsis, gastric distention, and cause GI vasoconstriction

70
Q

PSNS supplies abd viscera via

A

vagus

71
Q

afferent PSNS fibers =

A

satiety, nausea, distention

72
Q

efferent PSNS fibers =

A

secretion, sphincter relaxation, and peristalsis

73
Q

characteristics of abdominal visceral pain

A

hard to control, poorly localized, strong affective response, referred usually, emotional association

74
Q

treatment for abdominal visceral pain

A

opioids, tylenol, NSAID, regional

75
Q

regional and abdominal visceral pain

A

blocks SNS not PSNS
failure may occur due to multiple cross plexus innervations
dilute LA are required when combined with another major regional technique

Summer Patho (10 decks)

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