GI Anderson Flashcards
constrictor muscles for swallowing are innervated by
CN 10 mostly and CN 9
levator and tensor palati are innervation by
CN 5 and 10
palatophryngeus, palatoglossus,and salpingopharyngeus which are do deglutination and open the auditory tube are innervated by
CN 10
stylopharyngeus which elevated the larynx is innervated by
CN 9
gingivitis
calculus causes inflammation of gingival tissue
Vincent’s Angina/Trench Mouth/Necrotizing Gingivitis
mixed infection Borrelia Vincentii and Fusobacterium…young adults with poor oral hygiene
periodontitis
inflammation in periodontal ligament, alveolar bone, cementum of teeth
herpes stomatitis
cold sores, fever blisters, HSV I
leukoplakia
any hyperkeratotic lesion benign to malignant; strongly correlated to tobacco & alcohol
apthous stomatitis
canker sores, immune complex vasculitis, stress, hormonal changes, autoimmune, not herpes
Koplick’s spots
measles, precedes skin rash
thrush
candida albicans, babies, diabetics, antibiotics, KOH
Squamous Cell Carcinoma
tobacco, alcohol, Herpes Simplex I, syphilis,sunlight; lowerlip, tongue, floor of mouth; farther posterior=less well differentiated & more aggressive; poor prognosis, mestastasizes to lungs, liver, LN, bones
parotitis
mumps virus, can cause orchitis as sequelae
sjorgren’s syndrome
dry eyes, dry mouth, immune mediated destruction of lacrimal and salivary glands
what innervates the esophagus
CN 10
type of muscle in the upper esophagus
striated
type of muscle in the lower esophagus
inner circular, outer longitudinal
pharyngitis
Concomitant with viral upper resp. infection…Bacterial cause often beta hemolytic strep,
Post-strep Rheumatic fever & GN
Squamous Cell Carcinoma (Pharyngeal)
Smoking, Tend to grow silently until become unresectable, Spread to cervical LN or elsewhere
Hiatal Hernia
95% are sliding type, often from increased abdominal pressure, results in GERD
esophageal varices
Secondary to portal hypertension, alcoholic cirrhosis;
Distal esophagus & proximal stomach, asymptomatic until rupture
esophagitis
GERD, irritation, alcohol, smoking…sequelae is barret’s esophagus which converts squamous to columnar gastric cells=adenocarcinoma
adenocarcinoma
sequela of Barrett’s esophagus, male, smokers, distal esophagus
Squamous Cell Carcinoma of esophagus
Alcohol, smoking, fungal, nitrosamine containing foods, Zinc and other vitamin & mineral deficiencies may predispose, Mid to distal esophagus, dysphagia & obstruction
artery of the stomach
celiac artery is the main, also L and R gastric
gastric vein goes to
portal vein of liver
acute gastritis
NSAIDs, ETOH, smoking, stress, idiopathic,
Erosion of superficial epithelium, asymptomatic or ulcer-like pain
chronic gastritis
Often without erosions,
Autoimmune cause of lost parietal cells & IF, H. pylori, hypo or achlorhydria, B12 def.
most asymptomatic
hypochlorhydria
Chronic gastritis leading to atrophy of fundal mucosal cells …Immune mediated destruction of parietal cells…Hashimotos thyroiditis, Addisons; B 12 def, macrocytic anemia
Gastric Carcinoma
more common in asian countries, increased risk with type A blood
gastric ulcer
H Pylori in 75% of cases, less curvature, burning epigastric pain post-eating. Pain worse with food intake and better antacid/milk/fish
duodenal ulcer
75% of all PUD, H Pylori, burning epigastric pain 1-3 hours after eating, better eating
bile enters intestines through the
greater duodenal papilla…enzymes through greater and lesser
which part of the SI has the most lymphatics
ileum, called peyer’s patches
what is the sympathetic innervation to the jejunum
splanchnic…also has superior mesenteric artery/vein and vagus for parasympathetics
adynamic ileus
paralysis of bowel, often due to intestinal vascular obstruction
ischemic enteritis
Mucosal inflammation and ulceration caused by partial arterial occlusion, small vessel disease, venous obstruction, chronic vascular insufficiency…Most common in colon (i.e. ischemic colitis).
intestinal infarction
Incomplete or complete necrosis, gangrene and perforation due to any cause of vascular compromise (occlusive or non-occlusive)
intusseption
one segment of SI telescopes into immediate distal segment
nerve of the external sphincter
pudendal
vessel to the ascending colon
superior mesenteric
vessel to entire color other than ascending
inferior mesenteric
parasympathetic nerves of large intestine
pelvin splanchnics
sympathetic nerve to large intestine
hypogastric plexus
diverticulosis
Herniation of colon mucosa through muscularis, submucosa & adventitia
diverticulitis
Inflammation of diverticula, usu sigmoid colon, like appendicitis on left side
Colorectal Carcinoma
60-70 yo males, low fiber diet, bacteria convert primary bile acids to secondary carcinogenic acids, CEA marker in later stages
regional enteritis/Crohns
skip lesions, string sign, cobblestoning appearance, pain more than diarrhea
chronic UC
rectum or whole colon, continuous, ulceration with pseudopolyps, bloody mucoid diarrhea, toxic megacolon
acute pancreatitis
exocrine pancreas inflammation
pancreatic cancer
duct cells of exocrine pancreas, heavy smoking triples risk, 60% in head of the pancreas, jaundice, mostly silent until late
Trousseau’s syndrome
migratory thrombophlebitis/clots
acute liver failure
fulminant hepatitis, toxic damage
cholestasis
reduction of bile flow, elevated serum bilirubin and alk phos
what two things comprise the enteric nervous system of the GI tract
submucosal plexus (Meissner’s) and myenteric plexus (Auerbach’s)
Myenteric (Auerbach’s) Plexus does
motility
Submucosal (Meissner’s) Plexus does
secretion and blood flow
gastric H is stimulated by
histamine
gastrin comes from
G cells
CCK in the duodenum/jejunum comes from
I cells
secretin in the duodenum/jejunum comes from
S cells
paracrines
somatostatin, histamine
somatostatin
inhibits GI hormone release and acid secretion
histamine
stimulates gastric H secretion
enkephalins
stimulate GI contraction at sphincters, stop fluid and electrolyte release
pepsinogen is secreted by
chief cells
parietal cells secrete
HCL and IF
B12 is absorbed in the
terminal ileum
iron is absorbed in the
duodenum
carbs and amino acids are absorbed in the
duodenum and jejunum
bile salts are absorbed in the
terminal ileum
difference b/w the common hepatic duct and the common bile duct
common bile duct comes after the cystic duct from the gall bladder has joined with the common hepatic duct
primary bile acids
synthesized from cholesterol…cholic and chenodeoxycholic acid
secondary bile acids
converted from primary bile acids by bacteria in intestines…deoxycholic and lithocholic acids
bile acids are conjugated w/ ___ to form
glycine or taurine to form bile salts
bilirubin comes from
RBCs that have died
bile acids are synthesized in the
liver
the rate limiting step in bile acid synthesis is
the introduction of a hydroxyl group at Carbon 7 of the steroid ring by 7-alpha-hydroxylase which is inhibited by cholic acid
function of bile acids
emulsifying agents in the intestine helping to prepare dietary triglycerides and other complex lipids for degradation by pancreatic enzymes
function of bile salts
provide only significant mechanism for cholesterol excretion
hepatitis A
children, fecal oral, no carrier or chronic state
Hep B
blood born, maternal/fetal, acute and chronic hepatitis, cirrhosis which may lead to hepatic carcinoma
Hep C
blood born, chronic, cirrhosis in 5-10 years, risk for hepatic cancer
Wilson’s Dz (copper) can cause
cirrhosis
cholelithiasis
female, fat, forty, fertile
all amino acids are absorbed by
Na dependent cotransport
describe right lymphatic drainage
upper right half of body only…right lymphatic duct drains to right subclavian
describe left lymphatic drainage
drains most of the body. cysterna chyli drains lower half, joins thoracic duct and then drained to left subclavian
deficiency of Vit A
night blindness
deficiency of vit D
rickets/osteomalacia
deficiency of vit E
ataxia
deficiency of vit K
factor 2/7/9/10 bleeding disorders
deficiency of B1
beriberi
deficiency of B2
cheilosis/glossitis
deficiency of B3
pellagra (dementia, diarrhea, dermaitits)
deficiency of B5
bruning feet/HA/nausea
deficiency of B6
microcytosis/neuropathy
deficiency of B12
macrocytosis/pernicious anemia/neuropathy
deficiency of vit C
scurvy
deficiency of biotin
seborrheic dermatitis, nervous disorders, macrocytosis/glossitis/colitis
a free radical turns ascorbate to
dehydroascorbic acid
major storage site of Vit E is
fat
most potent form of tocopherol (vit E)
alpha tocopherol
storage of vitamin A
in the liver as retinyl palmitate
vitamin D process in skin
uv light converts 7-hydroxycholesterol to cholecalciferol (D3)
vitamin D process in liver
cholecalciferol (D3) from skin is turned to 25-hydryo-D3 by 25-hydrozylase enzyme
vitamin D process in kidney
25-hydro-D3 has two potential pathways. To take more Ca into bone and lower serum Ca 24-hydroxylase with turn 25-hydro-D3to 24,25-Dihydro-D3…to take calcium out of bone and increase serum Ca 1-alpha-hydrozylase will turn 25-hydro-D3 to 1,25-Dihydro-D3
what does PTH do to affect Ca
inactivates 24-hydroxylase enzyme in the kidney so that less calcium is taken from blood to bone
what micromineral is needed to metabolize alchohol
zinc
what micromineral is used in muscle contraction
magnesium
glutathione is preserved by
ascorbate
