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Patho > GI (exam 4) > Flashcards

GI (exam 4) Flashcards

1
Q

What parts of the body are a part of the GI tract?

A 
Mouth
Esophagus
Stomach
Small Intestine
Large Intestine
Rectum
Anus
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2
Q

Where does the majority of absorption occur?

A

Small intestine (90%)

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3
Q

When food passes through the GI tract is it considered to be internal or external?

A

External

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4
Q

What are the accessory organs of the GI system?

What do they do?

A

Liver
Gallbladder
Pancreas
Secrete substances into the GI to digest food

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5
Q

What are the functions of the GI tract?

A

Ingestion of food
Propulsion of food and wastes from mouth to anus (motility: segmentation and peristalsis)
Secretion of mucus, water, and enzymes
Mechanical digestion of food particles (masstication by mouth)
Chemical digestion of food particles
Absorption of digested food
Elimination of waste products by defacation

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6
Q

What are the 4 main organic substances we ingest?
What enzyme breaks each down?
Where does breakdown occur?

A

Carbs: amylase enzyme, in mouth and pancreas
Protein: proteases (pepsin, trypsin, chymokipsin), stomach secretes pepsin, pancreas secretes other two
Lipids: lipase after emulsification by bile, the liver produces bile, pancreas releases lipase
Nucleic acids: nuclease, DNA and RNA

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7
Q

What are the layers of the GI tract (inner to outer)?

Functions?

A

Mucosa: absorption
Submucosa: blood supply, glandular secretion
Muscularis: smooth muscle (2 layers: circular muscle layer- pinch and constrict, longitudinal muscle layer- propel food forward)
Serosa: visceral layer of peritoneum, serous membrane

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8
Q

What is the mesentery?

Function?

A

Part of the peritoneum

Holds everything in place

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9
Q

What is the job of the mouth?
What enzyme is released in the saliva?
Cranial nerves involved in mouth?
Teeth?

A

Chewing and mixing of food and saliva (start chemical digestion)
Amylase in saliva (carbs)
Taste buds: CN 7, 9: salty, sour, bitter, sweet, umami
Olfactory nerve: CN 1
32 permanent teeth

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10
Q

What are the salivary glands?

A

Submandibular (paired)
Sublingual (paired)
Parotid (paired)

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11
Q

What is in saliva?

What does it do?

A

Water with mucus, sodium, bicarb, chloride, potassium and amylase (carb digestion)
Start chemical digestion
Make a bolus of food to swallow

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12
Q

What is involved in swallowing (deglutition)?

Location/ Function?

A

Esophagus: peristalsis moves food
Upper esophageal sphincter: opening of esophagus, entrance
Lower esophageal sphincter (cardiac sphincter): enters into the stomach

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13
Q

What happens with an insufficient sphincter?

A

Can’t open or close, it is leaky

If lower sphincter get heartburn

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14
Q

What is a stenotic sphincter?

Risks?

A

To narrow of a sphincter
Upper: risk of choking
Lower: risk of vomitting

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15
Q

What is the stomach?
Muscles?
Parts of stomach?

A

Hollow, muscular organ that stores food, secretes digestive juices, mixes food with juices, propels partially digested food (chyme)
Muscle layers: longitudinal, circular, oblique (maximizes churning
Parts: cardiac sphincter- opening to stomach, pyloric sphincter- opening to duodenum, plylorus- called antrum and is lower region, fundus- upper rounded region, body

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16
Q

What is chyme

A

Bolus of food mixed with digestive juices

Gradually squirted into the duodenum

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17
Q

What is the order of food traveling in GI tract?

A 
Mouth
Upper esophageal sphincter
Esophagus
Lower esophageal sphincter
Stomach (Fundus, body, antrum)
Pyloric sphincter
Small Intestine (Duodenum, Jejunum, Ileum)
Ileocecal valve
Large Intestine (cecum, ascending colon, transverse colon, descending colon, sigmoid colo, rectum, anus)
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18
Q

What gastric juices are secreted in the stomach?

Functions?

A

Mucus: help protect the stomach lining
HCl acid: converts pepsinogen to pepsin to denature proteins
Enzymes: pepsin is the major one, to digest proteins
Hormones: gastrin (regulates digestive juices) and ghrlein (tummy grumbles)
Intrinsic factor: binds to B12 and allows for absorption (not enough results in pernicious anemia)

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19
Q

What are the glands/ pits of the stomach?

A

Parietal cells: HCl acid (antimicrobial properties and denatures proteins) and intrinsic factor
Chief cells: do chief job (break down proteins) through pepsinogen
G cells: gastrin, ghrlein

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20
Q

What nerves innervate the stomach?

A 
Vagus nerve (X)--> gastrin--> histamine (increase inflammation)--> parietal cells--> HCl
Autonomic Nervous System
Parasympathetic Nervous System
Involuntary
Release gastric juices
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21
Q

What are the phases of gastric secretion in the stomach?

A

Cephalic phase: brain part, thinking about food and salivate, cognitive phase
Gastric phase: stomach part, chemical signal, chemoreceptors (smell and taste) due to food exposure, secrete saliva and gastric
Intestinal phase: food leaves the stomach and enters the intestine, decrease secretions, inhibition phase

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22
Q

How long is the small intestine?
What is the main job?
What are the segments?

A

5-6 meters long
Absorption
3 segments: duodenum (10-12 inches, secretions from pancrease, liver and gallbladder enter here, bicarb to stop acidic digestive juices), jejunum, ileum

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23
Q

What makes up the edges of the small intestine?

Functions?

A

Villi: increase surface area for absorption, have epithelial cells with microvilli on it
Microvilli: increase surface area for absorption, form brush border
Lacteal: drains fat away

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24
Q

What are the pancreatic enzymes?

Functions?

A

Amylase: carb digestion
Trypsinogen and Chymotrypsinogen: protein digestion
Lipase: fats/ lipids digestion
Nuclease: RNA/ DNA

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25
Q

Where are bile salts made?

Stored?

A

Made in the liver

Stored in the gallbladder

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26
Q

What is absorbed in the intestines?

A 
Carbohydrates
Proteins
Fats
Water
Electrolytes
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27
Q

What are the parts of the large intestine?

A

Cecum
Appendix: hang off the cecum, immune function- microbial flora storage
Colon (ascending, transverse, descending, sigmoid)
Rectum
Anus

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28
Q

What is the leading are for GI obstruction? Constipation? Colorectal cancer?

A

Sigmoid colon and rectum
Obstruction leads to constipation
Incidence of GI cancers highest in sigmoid and rectum and most fatal

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29
Q

Where are there high levels of intestinal bacteria?

Low levels?

A

Stomach: relatively sterile due to HCl acid
Duodenum: low due to bile acid secretion, motility and antibody production
Jejunum: low concentration of anerobes
Distal to ileocecal valve: highest # in colon

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30
Q

What is the hepatic portal system?

A

Venous drainage system
Highly nutrient rich deoxygenated blood into the liver and bad things
Liver filters and detoxifies it before it enters the vena cava

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31
Q

What are the types of cells in the liver?

Functions?

A

Hepatocytes: filter cells
Sinusoids: specialized capillaries
Kupffer cells: macrophages

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32
Q

What is the common bile duct?

A

Drains the bile away from the liver

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33
Q

What is bile?
Where is it produced?
What is it formed by?

A

Bile is an alkaline, bitter-tasting yellowish green fluid containing bile salts (emulsify fats), cholesterol, bilirubin, electrolytes and water
Bile is produced in liver (stored in gallbladder)
Formed by hepatocytes and secreted into the bile cancaliculi

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34
Q

What are the functions of the liver?

A

Blood storage
Bacterial and foreign particle removal
Synthesizes plasma proteins/ clotting factors
Produces bile
Metabolizes fats, proteins, and carbs
Detoxification of metabolic products/ wastes
Storage of minerals and vitamins

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35
Q

What is the function of the gallbladder?

A

Store and concentrate bile between meals

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36
Q

What are the regions of the pancreas?

Function?

A

Exocrin region: hormones (digestive)
Endocrin region: insulin and regulate blood sugar
Secrete enzymes

37
Q

What are the secretions of the pancreas?

A 
Bicarb
Zymogens (trypsinogen, chymotrypsinogen, procarboxypeptidase)
Pancreatic amylase
Pancreatic lipase
Nucleases
38
Q

What happens if zymogens are activated to early?

A

Once activated zymogens digest proteins

If activated to early they autodigest pancreas cells

39
Q

What are symptoms of GI dysfunction?

A

Anorexia: lack of appetite
Vomiting
Nausea: most common symptom, subjective experience
Retching: dry heaving, non productive vomiting
Abdominal pain: non specific, referred pain, dull, achy pain
Constipation: most often in sigmoid or rectum
Diarrhea: increased frequency or increased volume, fluidity, weight of the feces
GI bleeding

40
Q

What are the types of diarrhea?

When do they occur?

A

Osmotic diarrhea: electrolyte change that draws fluid into diarrhea
Secretory diarrhea: bacterial toxins in our intestinal lumen (food poisoning)
Motility diarrhea: increased movement of food through GI tract decreasing absorption, increasing diarrhea, nerve or smooth muscle issue (caffeine)

41
Q

What are the types of GI bleeds? Where are they located?

A

Upper gastrointestinal bleeding: esophagus, stomach, duodenum
Lower gastrointestinal bleeding: jejunum, ileum, colon, rectum

42
Q

What is hematemesis?

When does it occur?

A

Vomiting blood

Upper GI bleed

43
Q

What is hematochezia?

Where does it occur?

A

Red bloody stools

Bleed in sigmoid or rectum

44
Q

What is melena?

Where does it occur?

A

Black, tarry stools

Bleed in jejunum, ileum or first half of colon

45
Q

What is dysphagia?

How do we get it?

A

Motility disorder, difficulty swallowing

Get it through achalasia, which is the loss of nervous control or function

46
Q

What is gastroesophageal reflux?

A

GERD
Reflux of chyme from stomach to esophagus
If it causes esophagus inflammation= Reflux Exophagitis
Cardiac sphincter insufficiency

47
Q

What is a hiatal hernia?

Types?

A

Motility disorder
Protrusion of upper portion of stomach through diaphragmatic hiatus into thorax
Sliding
Paraesophageal

48
Q

What is a pyloric obstruction?

A

Motility disorder
Blocking or narrowing of opening between stomach and duodenum
Leads to violent vomiting soon after eating

49
Q

What is dumping syndrome?

A

Motility disorder
Rapid emptying of chyme from a surgically created residual stomach into the small intestine
Pyloric insufficiency
Clinical complication of partial gastrectomy or pyloroplasty surgery
Inducing violent diarrhea

50
Q

What is an intestinal obstruction?

A

Motility disorder
Anything that prevents flow of chyme through the intestinal lumen or failure of normal intestinal motility
Mechanical blockage= true intestinal obstruction

51
Q

What is an ileus?

A

Motility disorder
Obstruction of the intestines from folding, pinching, or lack of peristalsis
An intestinal obstruction (not a mechanical blockage)
ileus= bad blood flow= ischemia= necrosis

52
Q

What is a peptic ulcer?

A

Peptic ulcer is an umbrella for all upper GI ulcers
A break or ulceration in the protective mucosal lining of the lower esophagus, stomach (gastric ulcers) or duodenum
When it erodes through mucosa and submucosa and hit muscle layer= true ulcer

53
Q

What are the types of peptic ulcers?

A

Duodenal ulcers (most common)
Gastric ulcers
Stress ulcers

54
Q

What are duodenal ulcers?

A

Most common peptic ulcer
Small intestine
Cause: Helicobacter pylori infection (#1) , hypersecretion of stomach acid and pepsin, use of NSAIDS (#2), acid production by cigarette smoking

55
Q

What are gastric ulcers?

A

Stomach ulcers

Cause: overuse of NSAIDS (#1), helicobacter pylori infection (#2)

56
Q

What are stress ulcers?

A

Peptic ulcer related to severe illness, neural injury or systemic stress/ trauma

57
Q

What is maldigestion?

What does it lead to?

A

Failure of the chemical processes of digestion

Leads to malabsorption

58
Q

What is malabsorption?

A

Failure of the intestinal mucosa to absorb digested nutrients

59
Q

What is pancreatic insufficiency?

A

Insufficient pancreatic enzyme production

Causes: pancreatitis, pancreatic carcinoma, pancreatic resection, cystic fibrosis

60
Q

What is lactase deficiency?

A 
Lactose intolerant
Inability to break down lactose
Causes gas (cramping, pain, flatulence, etc), osmotic diarrhea
61
Q

What is bile salt deficiency?

A

Can’t emulsify fats or absorb fat soluble vitamins
Can result from liver disease and bile obstructions
Fatty stools, diarrhea, loss of fat- soluble vitamins (A, D, E, K)

62
Q

What are the fat soluble vitamin deficiencies?

A

Vitamin A: night blindness, retinal cells
Vitamin D: decreased calcium absorption, bone pain, osteoporosis, fractures
Vitamin K: needed for clotting, prolonged prothrombin time, purpura, petechiae
Vitamin E: regulates cell processes

63
Q

What is gastritis?

A

Inflammation of stomach lining (gastric mucosa)
Acute gastritis: consumption of NSAIDs or alcohol
Chronic gastritis: infection (H. pylori)

64
Q

What is ulcerative colitis?

A

Chronic inflammatory disease that causes ulceration of the colonic mucosa
Large intestine
May increase colon cancer risk

65
Q

What is Crohn’s disease?

A

Idiopathic inflammatory disorder
Affects any part of digestive tract
Causes skip lesions (regions of bad, skip regions of good), and cobblestone effect (because of deep ulcerations, look like cobblestone)

66
Q

What is diverticular disease of the colon?

A

Diverticula: out pouching of colon wall, weakening of wall, herniations of mucosa through muscle layers of colon wall (sigmoid)
Diverticulosis: having 1 or more diverticula, weakened wall
Diverticulitis: inflammatory stage of diverticulosis, food particles enter and get stuck causing inflammation and infection

67
Q

What is appendicitis?

A

Inflammation of the veriform appendix

Right lower quadrant with rebound tenderness (pain when release not press in)

68
Q

What is irritable bowel syndrome?

A 
Idiopathis
No specific structural or biochemical alterations 
More common in women
20-40 year olds
Increase diarrhea
69
Q

What is obesity?

A

Increase in body fat mass
BMI greater than 30
Apple: above waist
Pear: below waist

70
Q

What are eating disorders characterized by?

A

Abnormal eating behavior
Weight regulation
Disturbed attitudes about body weight, shape and size

71
Q

What country has the highest eating disorder rate?

Lowest?

A

USA highest

Sweden lowest

72
Q

What is anorexia nervosa?

A

Refuses to eat

Can lose 25-30% of ideal body weight as a result of fat/ muscle depletion

73
Q

What is bulimia nervosa?

A

Body weight remains near normal
Want weight loss
Binge eating (2 episodes per week for 3 months)
Self-induced vomiting
Pitted teeth, pharyngeal and esophageal inflammation, tracheoesophageal fistulas, rectal bleeding

74
Q

What is starvation?
What is cachexia?
Effects of it?

A

Decreased caloric intake
Wasting away
Short term: glycogenolysis, gluconeogenesis
Long-term: marasmus (skin and bones), kwashiorkor (distended belly)

75
Q

What is portal hypertension?

A

High BP in portal venous system caused by resistance to portal blood flow
Intrahepatic
Posthepatic

76
Q

What are consequences of portal HTN?

A

Varices: back up venous blood, can lead to vein rupture and GI bleed
Splenomegaly
Ascites
Hepatic encephalopathy

77
Q

What is hepatic encephalopathy?

A

Neurologic syndrome of impaired cognitive function
Rapid development during fulminant hepatitis
Slow development during chronic liver disease

78
Q

What is jaundice?

Types

A

Lack of bilirubin metabolism in liver
Obstructive jaundice: posthepatic obstruction, intrahepatic obstruction
Hemolytic jaundice: prehepatic jaundice, excessive hemolysis of RBCs or absorption of hematoma

79
Q

What is viral hepatitis?

Types?

A

Systemic viral disease of acute or chronic inflammation that primarily affects liver
A
B
C, D, E and G

80
Q

How is Hepatitis A transmitted?

Risk factors?

A

fecal-oral transmission route
Crowded, unsanitary conditions
Food and water contamination

81
Q

How is Hepatitis B transmitted?
What can it cause?
Treatment?

A

Transmitted through contact with infected blood, body fluids, contaminated needles
Maternal transmission if infected during 3rd trimester
Can cause chronic hepatitis
Vaccine available

82
Q

Hepatitis C?

A

Responsible for most cases of post transfusion hepatitis
50-80% of cases result in chronic hepatitis
infections related to IV drug use

83
Q

Hepatitis D?

A

Depends on hepatitis B for replication

84
Q

Hepatitis E?

A

Fecal-oral transmission

Developing countries

85
Q

Hepatitis G?

A

Recently discovered

Parentally and sexually transmitted

86
Q

What is Cirrhosis?

Steps of it?

A

Irreversible inflammatory disease that disrupts liver function and even structure
Biliary channels become obstructed and cause portal HTN
1. Alcoholism
2. Liver cirrhosis
3. Hepatic portal HTN
4. Esophageal varices–> hematoemisis (puking blood)
5. Acitis

87
Q

What is cholecystitis?

A

Obstruction or inflammation of gallbladder

Most common cause of gallbladder problems

88
Q

What is cholelithiasis?

A

Gallstone formation
Cholesterol: most common
Pigmented: cirrhosis

89
Q

What is pancreatitis?

A

Inflammation of pancreas
Caused by injury or damage to pancreatic cells and ducts
Chronic pancreatitis is related to chronic alcohol abuse

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