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GI First Aid > GI General Principles > Flashcards

GI General Principles Flashcards

1
Q

Retroperitoneal structures; mnemonic?

A

SAD PUCKER; suprarenal gland, aorta and IVC, duodenum (2,3,4), pancreas (except tail), ureters, colon (ascending and descending), kidneys, esopahgus, rectum

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2
Q

Falciform ligament…connects?…contains?

A

Liver and abd wall…contains ligamentum ters hepatis (remnant of fetal umbilical vein)

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3
Q

Heptoduodenal ligament…connects?…contains?

A

Liver and duodenum…Portal triad (common bile duct, portal vein, heptatic artery)

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4
Q

Gastrohepatic ligament…connects?…contains?

A

Liver and less curvature of stomach…Gastric arteries…cut this to gain access to lesser sac during surgery

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5
Q

Gastrocolic ligament…connects?…contains?

A

Greater curvture and transverse colon…gastroepiploic arteries

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6
Q

Gastrosplenic ligament…connects? Contains?

A

Greater curvature and spleen…Gastric and gastroepiploic arteries

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7
Q

Splenoreal ligament…connects….contains?

A

Spleen to posterio wall…splenic artery and vein and tail of pancreas

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8
Q

Basal electric rhythm of stomac, duodenum and ileum

A

Stomach 3/min, duodenum 12/min => ileum 8-9/min

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9
Q

Layers of gut wall (inside to outside)

A

MSMS - mucosa, submucoasa, msucularis externa, Serosa

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10
Q

Mucosal layer…functions?…contains?

A

epithelium (think donut), lamina propria, muscularis mucosa…absorption, support, motility (resp.)

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11
Q

Submucosa…functions?…contains?

A

Submusocal nerve plexus….Meissner’s plexus (parasympathetic) which innervates the muscuaris mucosa (for motility)

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12
Q

Muscularis Externa….functions? Contains?

A

Myenteric nerve plexus aks Auerbach’s (sympathetic and parasympathetic) which controls GI tract motility

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13
Q

Serosa…functions? Contians?

A

Support and can help connect to abd. Walls, etc. (aka adventitia

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14
Q

Histology of Esophagus

A

Nonkeratinized squamous

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15
Q

Histology of Stomach

A

Gastric glands

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16
Q

Histo of duodenum

A

Villi and microvilli (for absorption), Brunner’s glands (secretes HCO3- and mucus), crypts of Lieberkuhn (secretes intestinal digestive enzymes)

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17
Q

Hidto of jejunum

A

Plicae circulares (folds in mucosa) and crypts of Leiberkuhn

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18
Q

Histology of ileum

A

Peyer’s Patches (in lamina prop and submucosa…which help with immunity …M-cells, with T-cells and B-cells…lymph nodes of the GI?), Plicae circulares, and crypts of Lieberkuhn…MOST GOBLET CELLS IN SMALL INTESTINE FOUND HERE

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19
Q

Histo of colon

A

Crypts but no villi, lots of goblet cells

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20
Q

Celiac Trunk….comes off of? Branches? Supplies? At the level of?

A

Abd. Aorta, main branhces are: splenic artery, left gastric (which also gives esophageal branch), common hepatic artery (which also gives hepatoduodenal artery; supplies: stomach, pancreas, spleen, proximal duodenum, gall bladder, liver; Level = T12

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21
Q

SMA…Level? Supplies?

A

comes off below the celiac (at L1), distal duodenum up to 2/3 of transverse colon

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22
Q

IMA…level? Supplies?

A

L3…supplies distal 1/3 of transverse colon down to upper rectum

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23
Q

Anastamosis of the stomach blood supply?

A

Left and right gastric arteries; left and right gastroepiploic arteries…concept: collateral circulation occurs in the “pairs of arteries”: Superior epigastric with infereior epigastric, middle colic with left colic…superior rectal with middle and inferior rectal

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24
Q

Three main portosystemic anastamoses

A

Esophagus (left gastric with esophageal veins), umbilical (paraumbilical with sup and inf epigastric), rectal (superior rectal with middle and inf rectal veins)

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25
Q

Clinical signs of portal hypertension (anastamoses)

A

Esophageal varices (can lead to bleeding, hemoptysis), caput medusa (umbilical), INTERNAL hemorrhoids

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26
Q

Pectinate/dentate line…define?…differences in clinical?

A

Where endoderm becomes ectoderm near the anus…above line we get INTERNAL hemerrhoids and adenocarcinoma (not painful because it receives visceral innervation)…below line we get external hemeerhoids and squamouc cell carcinoma (painful because of pudendal)

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27
Q

Is the inner muscular layer circumferential or longitudinal?

A

Circumferential

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28
Q

Order of contents of the femoral triangle

A

Lateral to medial; nerve-artery-vein-lymphatics

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29
Q

Contents of femoral sheath

A

Vein and artery and lymph nodes; NOT the nerve

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30
Q

Gastrin source

A

G-cell of stomch antrum

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31
Q

Gasrin action

A

Increase gastric acid secretion (via ECL cells), increase gastric mucosa, increase motility

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32
Q

Gastrin regulation

A

Increas release due to stomach distention, alkalinization, amino acids, peptides, vagus nerve. Decrease due to acidic stomach pH.

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33
Q

What two aminoacids are potent stimulators of gastrin?

A

Phenylalanine and tryptophan

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34
Q

CCK source

A

I-cells of duodenum/jejunum

35
Q

CCK action

A

Increase pancreatic protein secretion, increase gallbladder contraction, decrease gastric emptying, relaxes sphincter of Oddi

36
Q

CCK regulation

A

Increased by fatty acids, amino acids

37
Q

Secretin source

A

S cells of the duodenum

38
Q

Secretin action

A

Increase pancreatic HCO3 secretion, decrease gastric acid secretion, increase bile (liquid) secretion

39
Q

Secretin regulation

A

Increased by fatty acids and acid in lumen of duodenum

40
Q

What pH do pancreatic enzymes work at ideally?

A

Basic

41
Q

Somatostation source

A

D_cells (pancreatic islet,s GI mucosa)

42
Q

Somatostatin action

A

Decrease gastric acid and pepsinogen secretion; decrease pancreatic and small intestine fluid secretion, decrease gallbaldder contraction and decrease insulin/glucagon release

43
Q

Somatostation regulation

A

Increased by acidity and decrease by vagal stimulation

44
Q

Glucose-dependent insulinotropic peptide (GIP) source

A

K-cells (duodenum, jejunum)

45
Q

Glucose-dependent insulinotropic peptide (GIP) action

A

Exocrine: decrease gastric H+ secretion; endocrine: increase insulin release

46
Q

Glucose-dependent insulinotropic peptide (GIP) regulation

A

Increased by fatty acids, amino acids, oral glucose (NOT INJECTED GLUCOSE)

47
Q

Vasoactive intestinal polypeptide source

A

Parasympathetic ganglia

48
Q

Vasoactive intestinal polypeptide action

A

Increase intestinal watre and electrolyte secretion, relaxation of smooth muscles and sphincters

49
Q

Vasoactive intestinal polypeptide regulation

A

Increased by GI distention and vagal stimulation; decreased by adrenergic output

50
Q

Nitric oxide effect on LES

A

Decreases tone; loss of NO is implicated in achalasia

51
Q

Motilin source

A

Small intestine

52
Q

Motilin action

A

Produces migrating motor complexes (MMCs)

53
Q

Motilin regulation

A

Increases in fasting state

54
Q

Intrinsic factor source

A

Parietal cells

55
Q

Intrinsic factor action

A

Binds B12 in duodenum, uptake at terminal ileum

56
Q

Gastric acid source

A

Parietla cells in gastric body

57
Q

Gastric acid regulation

A

Increased by hiastmine, Ach, gastrin; lowered by somatostatin, GIP, prostaglandin, secretin

58
Q

How does gastrin increase HCL (gastric acid)?

A

It is secreted into circulation and then hits ECL cells (Enterochromaffin-like cells) which then release histamine which signals pariental cells to secrete HCL and intrinsic factor

59
Q

Pepsin source

A

Chief cells in gastric body

60
Q

Pepsin regulation

A

Increased by vagal stimulation, local acid

61
Q

What converts pepsinogen to pepsin?

A

Stomach acidity, then autocatalyzation

62
Q

Normal saliva tonicity

A

Hypotonic

63
Q

Effect of high flow rates on saliva tonicity

A

Isotonic

64
Q

Saliva ionic composition

A

High bicarb, low K, increase in Cl and Na as flow rates increase, decrease K+

65
Q

Pancreatic juice ionic composition

A

High Na, inverse relationshpi between HCO and Cl as flow rate increases, low K

66
Q

How do vagal cells stimulate G-cells?

A

Via GRP, NOT Ach - muscarinic antaognists have no affect!

67
Q

What ist he tonicity of pancreatic fluid?

A

Isotonic

68
Q

Level of CL and HCO3 in pancreatic fluid with low and high flow

A

Low flow => high Cl, high flow => high HCO3

69
Q

Enzyme composition of pancreatic secretions

A

amylase, lipase, phospholipase A, colipase; tryspin, chymotryspin, elastase, carboxypeptidase

70
Q

Where is trypsinogen activated?

A

Brush border by enterokinase/enteropeptidase

71
Q

Amylase hydrolyzes what bonds? Produces what sugar type?

A

Disaccharaides; maltose and alpha-limit dextras; hydroylyzes 1-4 alpha glycosidic linkages

72
Q

Where is iron absorbed

A

Duodenum

73
Q

Where is folate and B12 absorbed?

A

Folate - jejunum, B12 in Ileum with intrinsic factor

74
Q

In what form are the carbs absorbed in the GI tract?…catalyzed by which enzyme and important of this step?

A

Borken down from oligosacc and Absorbed as monsacc. Or disacchrides…catalyzed by oligosaccharide hydrolase (it is the rate limiting step)

75
Q

What transporter uptakes glucose from the GUT lumen

A

SGLT

76
Q

What transporter moves glucose from gut epithelial cells to the blood

A

GLUT 2

77
Q

What transporter uptakes fructose from the GUT lumen

A

GLUT 5

78
Q

What does the D-xylose absorption test tell you?

A

Distinguiishes GI mucosal damage from other causes of malabsorption

79
Q

Liver anatomy…Zone 1, 2, 3 conatins what?

A

1- Hepatic artery and portal vein (aka periportal zone…drains blood and it goes through the canniculi in Zone 2. Zone 3 has the central vein (that goes to systmic circulation and is now “clean”

80
Q

Viral hepatitis affects which liver zone first?

A

Zone 1

81
Q

Which liver zone is affected by ischemia first?

A

Zone 3

82
Q

Which liver zone has P450 system and is sensitive to toxic injury the most?

A

Zone 3

83
Q

Bilirubin metabolism…quick:

A

In macrophages: RBCs—> heme—> unconjugated bilirubin…..In blood: Uncong. Bilirubin binds with albumin…In Liver: UDP glucuronosyl transferase conjugates bilirubin…In gut: gut bacteria convert to urobilogen…80% goes to poop…20% goes back into circ and goes to pee

GI First Aid (3 decks)

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