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GI high yield Flashcards

1
Q

swallowing muscles + innvervation

A

sup, mid, inf constrictor muscles

CN 9 + 10 (mostly vagus)

CN 9 + 10 (mostly vagus)

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2
Q

levtor and tensor palati function and innvervation

A

palate elevation and tension

CN 5 + 10

CN 5 + 10

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3
Q

palatopharyngeus, palatoglossus, salpingopharyngeus function and innvervation

A

deglutination, open auditory tube

CN 10

CN 10

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4
Q

stylopharyngeus function and innvervation

A

elevate larynx

CN 9

CN 9

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5
Q

esophagus innvervation

A

CN 10 vagus

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6
Q

sequelae of esophagitis/GERD

A

barretts esophagitis > metaplasia of mucosa in distal esophagus > squamous adenocarcinoma

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7
Q

attachments of stomach

A

lesser omentum (between liver and stomach)

greater omentum (peritoneal ligament)

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8
Q

causes of chronic gastritis

A

B12 def

h pylori

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9
Q

gastric vs dueodenal ulcer similarities and diff

A

gastric pain WORSE with food

duodenal ulcer pain BETTER eating

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10
Q

gastric and duodenal ulcers are associated with what infection

A

h pylori

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11
Q

pt with gastritis/ulcers not responding to tx, what are you concerned about?

A

gastric carcinoma

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12
Q

most digestion takes place

A

jejenum aand ileum

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13
Q

post gastric digestion begins in

A

duodenum

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14
Q

what portion of small intestine is shorter

A

jejenum

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15
Q

what portion of small intestine has more lymphatic and vascular activity

A

ileum

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16
Q

intususseption kids vs adults

A

kids can be normal

adults = BAD = tumor, obstruction, infarction. older pt gets, more likely obstruction > infarction

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17
Q

colon microbiology changes

A

outer layer is replaced by teniae coli (longitudinal smooth muscle); swaps out squeezing of small intestine for twisting contraction

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18
Q

internal syphincters are mediated by

A

stretch reflex; autonomic

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19
Q

external syphincters are mediated by

A

somatic voluntary skeletal muscle

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20
Q

appendicitis clinical characteristics

A

global periumbilical pain to RLQ
N/V, constipation, no gas
left shift CBC
McBurneys/rebound tenderness

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21
Q

diverticulitis clinical characteristics

A

similar to appendicitis but on LEFT side

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22
Q

diverticuli definition

A

herniation of colon mucosa through muscularies, submucosa, and adventitia; added “pouch” off haustration

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23
Q

diverticulosis vs diverticulitis

A
  • osis = have diverticuli

- itis = inflammation of diverticula (usually sigmoid colon)

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24
Q

colorectal carcinoma is associated with

A

UC, familial polyposis coli, Crohn’s; other inflammatory bowel dz

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25
Q

chron’s disease / regional enteritis sx

A

chronic granulomatous dz

mostly in small bowel (terminal ileum)

skip lesions/cobblestoning appearance (thick intestinal wall, lumen narrowed “string sign”)

fistulas to vagina, anus, bladder, peritoneum
polyarthritis, sacroiliitis
iritis, optic atrophy

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26
Q

chron’s dz vs ulcerative colitis

A

both young, caucasion; both can have iritis

crohn’s: beginning in terminal ileum, more painful, unexplained pain

UC: more diarrhea than pain, rectum or whole colon

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27
Q

UC sx

A

may be only rectum or cont in whole colon
ulceration with pseduopolyps (regenerating mucosa)

bloody mucoid diarrhea, stringy mucous

perforation, toxic megacolon

iritis

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28
Q

celiac dz etiology

A

gluten sensitive enteropathy

malabsorption secondary to inflammatory luminal swelling > cross antigen AI stimulation

crohn’s/UC like presentation

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29
Q

IBS dx

A

dx of exclusion

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30
Q

acute pancreatitis vs pancreatic cancer presentation

A

acute pancreatitis = VERY painful (epigastric radiating to mid back)

cancer = painless

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31
Q

causes of acute pancreatitis

A

obstructions/gallstones, heavy alcohol, choline deficiency

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32
Q

____ triples risk of pancreatic cancer

A

heavy tobacco smoking

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33
Q

liver failure indirect effects

A

clotting dysfunction

no removal of hormones > hormonal sx

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34
Q

3 regions of aorta in GI tract/vascular supply

A

celiac artery > esophagus, stomach, prox duo (foregut)
sup mesenteric > disital duo, rest of small int, asc colon (midgut)
inf mesenteric > transverse colon, rectum (hindgut)

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35
Q

sympathetic supply of GI

A

celiac > esophaus, stomach, prox duo

inf mesenteric > distal duo, everything else

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36
Q

parasympathetic supply of GI

A

CN 10 (vagus) > esophagus, somatic, small int, asc colon

pelvic splanchnic (S2,3,4) > transverse colon, rectum

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37
Q

3 branches off celiac artery

A

right gastric off hepatic
left gastric off celiac
gastroepiploic and short gastric off splenic

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38
Q

most abdominal circulation drains back through

A

liver/portal circulation

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39
Q

vein drainage to GI

A

stomach, esophagus > portal v

small int, asc colon > sup mesenteric v > portal

transverse colon, rectum > inf mesernteric v > splenic v > portal

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40
Q

portal backups/HTN happen in

A

anastomatic areas

hemmorhoidial plexi > hemmorhoids

esophageal venus plexi > esophageal varices

umbilical v > caput medusae (roadmap of v on abdomen)

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41
Q

2 most common causes portal HTN

A

alcoholic cirrhosis

pregnancy

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42
Q

submucosal (meissner’s) plexus

A

autonomic plexus controlling mucous membrane activity

secretion + blood flow

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43
Q

myenteric (auerbach’s) plexus

A

autonomic plexus controlling inner circular and outer longitudal smooth muscle activity

motility

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44
Q

extrinsic innvervation GI tract

A

autonomic

PNS: excitatory, vagus + pelvic splanchnic
SNS: inhibitory, prevertebral ganglia (T8-L2)

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45
Q

intrinsic innvervation GI tract

A

enteric nervous sys (local reflexes)

Myenteric (auerbach’s) plexus - motility

Submucosal (meissners) plexus - secretion and blood flow

myenteric and submucosal plexi

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46
Q

histamine action on GI

A

stomach

stimulates gastric H+

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47
Q

gastrin action in GI

A

stomach
stim H+ and gastric mucosa

+ AA, stomach distention, vagal (PNS)
- gastric acid, secretin, GIP

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48
Q

CCK action in GI

A

duedenum/jejenum

stim GB contraction, Oddi relaxation, panc enzyme and bicarb secretion, inhibit gastric emptying

+ AA, FA

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49
Q

secretin action in GI

A

duedenum/jejenum

stim pabcreatic and GB bicarb secretion
inhibits gastric emptying

+ H+, FA

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50
Q

GIP action in GI

A

duedenum/jejenum

stim insulin secretion, inhibits gastric acid secretion

+ oral glucose, AA, FA

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51
Q

chief cells mainly secrete

A

pepsinogen

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52
Q

parietal cells mainly secrete

A

HCl, intrinsic factor

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53
Q

G cells mainly secrete

A

gastrin

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54
Q

absorption site of carbs

A

duedenum, jejenum

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55
Q

absorption site of AA

A

duedenum, jejenum

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56
Q

absorption site of iron

A

duedenum (as Fe2+)

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57
Q

absorption site of B12

A

terminal ileum

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58
Q

absorption site of bile salts

A

terminal ileum

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59
Q

main liver branches

A

R + L hepatic > common hepatic
cystic > gallbladder

meeting of common hepatic and cystic > common bile duct

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60
Q

minor duedenal papilli recieves from

major duedenal papilli recieves from

A

minor: accessory pancreatic duct

major (Oddi): choledochal, primary pancreatic

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61
Q

function of bile

A

mycellize/separate fat

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62
Q

primary bile acids

A

cholic acid

chenodeoxycholic acid

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63
Q

secondary bile acids

A

deoxycholic acid

lithocholic acid

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64
Q

common site for mets

A

liver

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65
Q

cholecystitis vs cholelithiasis

A

cystitis: inflammation of GB, RUQ pain worse with eating
lithiasis: gallstones, often asymp, or same sx as cystitis

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66
Q

major risk of cholelithiasis

A

leaving GB > obstruction of liver or pancreas

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67
Q

absorption in GI

A

monosaccharides (all polysaccharides broken down by brush border enzymes to monosacchardies)

glucose + galactose via Na cotransporter
fructose via facilitated diffusion

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68
Q

3/4 of body (left) drainage

A

cisterna chyli to thoracic duct

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69
Q

1/4 of body (right) lymphatic drainage

A

right duct

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70
Q

3/4 of body (left + middle) drainage

A

cisterna chyli to thoracic duct

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71
Q

lymphatic ducts drain into what veins

A

subclavian v

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72
Q

diff between med/long chain FA and protein/carb absorption

A

FA: lymphatics (heart before liver)

P/C: portal circulation

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73
Q

absorption of H2O in colon/large int

A

most absorped in small int but colon absorbs about 90% of water from the chyme it received; large dehydrating organ

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74
Q

water soluble vitamins

A

B1, 2, 3, 5, 6, 12
C
folacin
biotin

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75
Q

fat soluble vitamins

A

A
D
E
K

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76
Q

vit A function + def

A

rhodopsin/vision

night blindness

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77
Q

vit D function + def

A

GI, inc Ca absorp

rickets/osteomalacia

78
Q

vit E function + def

A

antioxidant

ataxia

79
Q

vit K function + def

A

carboxylation glutamate, ca chelation w glutamate

factor 2, 7, 9, 10 bleeding disorders

80
Q

B1 function + def

A

aldehyde transfer, decarboxylation

beriberi

81
Q

B2 function + def

A

H+ transfer, FMN-FAD (flavins)

cheilosis/glossitis

82
Q

B2 function + def

A

H+ transfer, FMN-FAD (flavins)

cheilosis/glossitis

83
Q

B3 function + def

A

H+ transfer, NAD-NADP

pellegra (dementia, diarrhea, dermatitis)

84
Q

B6 function + def

A

AMINO group transfer, de + trans aminations

microcytosis, neuropathy

85
Q

B12 function + def

A

METHYL transfer, methionine syn

macrocytosis, pernicious anemia

86
Q

B12 function + def

A

METHYL transfer, methionine syn

macrocytosis, pernicious anemia, neuropathy

87
Q

vit C function + def

A

H transfer, hydroxylation of proline and lysine

scurvy

88
Q

biotin function + def

A

carboxylation

seborrheic dermatitis, nervous disorders, bound by avidin (in egg white)

89
Q

folate function + def

A

methyl transfer

macrocytosis, glossitis, colitis

90
Q

B1 name

A

thiamin

thiamin pyrophosphate

91
Q

B2 name

A

riboflavin

92
Q

B3 name

A

niacin, niacinamide

93
Q

B5 name

A

pantothenic acid

94
Q

B6 name

A

pyroxidine

pyridoxal-5-phosphate

95
Q

B12 name

A

cyanocobolamin

96
Q

skin vs liver vs kidney forms vit D

A

skin: cholecalciferol
liver: 25dihydro
kidney: 24,25 dihydro

97
Q

Type of muscle that makes up most of GI tract

A

Smooth muscle (involuntary)

98
Q

Upper esophagus vs lower esophagus function/histology

A

Upper = swallowing, striated muscle

Lower = peristalsis (inner circular, outer longitudinal smooth muscle)

99
Q

Esophagus anatomy points

A

Post to trachea in larynx

Passes ant to aorta below bronchial bifurcation

Descends through esophageal hiatus in diaphragm

100
Q

Parts of stomach

A

Cardia, pyloric spinchters
Fundus
Body, lesser curvatures
Body

101
Q

Musculature of stomach

A

Internal = oblique
Middle = circular
External = longitudinal

102
Q

Artery of stomach

A

Celiacs artery (L and R gastric AA)

103
Q

Innervation of stomach

A

Sympathetic (blocks peristalsis)
-splanchic preganglionics
-Celiac plexus

Parasympathetic (inc peristalsis) - vagus n

104
Q

Veins of stomach

A

Gastric veins - to portal vein - to liver

105
Q

Jejunum vs ileum

A

Jejunum
upper 40% small intestine

Ileum
Lower 60% small intestine
More arterial arcades
More lymphatics (payers patches)

Both
Sup mesenteric A + V
N:
-symp: splanchics
-para: vagus

106
Q

Large intestine tissue

A

Teniae coli - longitudinal smooth muscle

Haustra - pouched wall

107
Q

Colon segments

A

Ascending
Hepatic fixture
Transverse
Splenic fixture
Descending
Sigmoid

108
Q

Internal and external sphincter of anus tissue

A

Internal - smooth muscle, autonomic control

External - striated muscle, pudendal nerve, conscious control

109
Q

Nerves large intestine

A

Parasympathetic = pelvic splanchnics (past ascending colon)

Sympathetic = hypogastric plexus

110
Q

Vessels large intestine

A

Asc colon - sup mesenteric
Rest of colon - inf mesenteric

111
Q

Iliocecal junction components

A

Ileum (terminal)
Iliocecal valve
Cecum
Appendix

112
Q

Celiac supplies

A

Esophagus > stomach

113
Q

Sup mesenteric supplies

A

Duodenum, small intestine, asc colon

114
Q

Inf mesenteric supplies

A

Transverse colon > rectum

115
Q

Esophagus and stomach sym/parasympathetic supply

A

Symp = celiac
Para = vagus (10)

116
Q

Duodenum, small intestine, ascending colon sym/parasympathetic supply

A

Symp = inf mesenteric
Para = vagus (10)

117
Q

Transverse colon and rectum sym/parasympathetic supply

A

Symp = inf mesenteric
Para = pelvic splancnic

118
Q

What artery comes off celiac

A

Celiac > splenic > gastroepiploic + short gastric

Celiac > L gastric

Hepatic > R gastric

119
Q

GI circulation drains back through

A

Portal circulation

120
Q

Foregut GI

A

Esophagus to upper duodenum (at level of pancreatic duct/common bile duct insertion/ampulla of vater), pancreas

121
Q

Midgut GI

A

Lower duodenum to proximal 2/3 transverse colon

Week 6 - physiologic herniation of midgut through umbilical ring

Week 10 - returns to abdominal cavity and rotates around sup mesenteric artery

122
Q

Hindgut GI

A

Distal 1/3 of transverse colon to anal canal above pectinate line

123
Q

Ventral and dorsal pancreatic buds >

A

Ventral > uncinate process, main pancreatic duct

Dorsal > body, tail, isthmus, accessory pancreatic duct

Both > pancreatic head

124
Q

Layers of gut wall (inner to outer)

A

MSMS

Mucosa
Submucosa
Muscularis externa
Serosa (intraperitoneal) / adventitia (retroperitoneal)

125
Q

Mucosa micro

A

Epithelium, lamina propria, muscularis mucosa (erosions in the mucosa only)

126
Q

Submucosa micro

A

Submucosal nerve plexus (Meissner) and secretes fluid

127
Q

Muscularis externa micro

A

Myenteric nerve plexus (auerbach) between circular and longitudinal layers of muscle

motility (ulcers can extend into Submucosa and muscle layer)

128
Q

Esophagus micro

A

Nonkeritanized stratified squamous cells

Upper 1/3 striated muscle, lower 2/3 smooth muscle

Mucosal (squamous) cells line innermost layer, change to columnar epithelium at the GI junction (Z line)

129
Q

Location esophagus

A

Post to trachea in larynx

Passes ant to aorta below bronchial bifurcation

Descends through esophageal hiatus in diaphragm

130
Q

hepatocytes

A

Liver cells - perform metabolic, synthetic, storage, catabolic, excretory functions

Apical surface of hepatocytes face bile canaliculi. Basolateral surface faces sinusoids

131
Q

Kupffer cells

A

Liver cells - macrophages, form the lining of sinusoids; protect against infection and circulating toxins

Activated they release cytokine such as ILs, interferons, and TGF a and B

132
Q

Esophagus innervation

A

Upper 1/3 - recurrent laryngeal branches of vagus

Lower 2/3 - parasympathetic vagus

133
Q

Functions of esophagus

A

Upper - swallowing (striated muscle)

Lower - peristalsis (inner circular, outer longitudinal smooth muscle)

134
Q

Stellate cells

A

Liver cells - (ito cells) - specialized storage capacities. Contain fat, Vit A, and other lipid soluble vitamins.

Secrete extracellular matrix components inc collagen, laminin, proteoglycans.

In disease states, can make in great excess > hepatic fibrosis > cirrhosis

135
Q

Pancreatic ducts fuse during week

A

7

136
Q

Micro pancreas

A

Exocrine - pancreatic acini cells, centroacinar cells

Endocrine - islets of langerhans, alpha cells, beta cells, delta cells, PP cells

137
Q

Pancreatic acini cells

A

Spherical collections of pyrimidal cells. Nasally situated, strong basophilic cytoplasm

138
Q

Centroacinar cells

A

Spindle-shaped cells in the exocrine pancreas. extension of the intercalated duct into each pancreatic acinus.[1] commonly known as duct cells. secrete an aqueous bicarbonate solution under stimulation by the hormone secretin. secrete mucin.

139
Q

Islets of langerhans

A

Pancreatic cell, Secretes insulin and glucagon

140
Q

Alpha, beta, delta, PP cells of pancreas

A

Alpha - glucagon
Beta - insulin
Delta - somatostatin/GHiH
PP - pancreatic polypeptides

141
Q

Pancreas location

A

Retroperitoneum
Head corresponds with curve of duodenum overlying the body of the 2nd lumbar vertabra and vena cava

Sphincter of oddi - smooth muscle surrounds end of common bile duct and pancreatic duct (relaxes from CCK)

142
Q

Circulation pancreas

A

Head and uncinate process - pancreaticduodenal arteries (from gastroduodenal and sup mesenteric)

Body and tail - pancreatic arteries (from splenic, gastroduodenal, and sup mesenteric)

143
Q

Pancreas functions

A

Exocrine: secretion of digestive enzymes, ions, and water into duodenum
-trypsin,chymotrypsin - digest proteins
-amylase - digest carbs
-lipase - break down fats

Endocrine: release of insulin, glucagon, somatostatin

144
Q

Release of pancreatic enzymes is stimulated by

A

Vagus nerve

145
Q

Pancreatic secretion phases

A

Cephalic (vagus)
Gastric (vagus)
Intestinal (hormonal)

146
Q

Parietal cells

A

Stomach cells; HCL acid secretion. Contain receptors for ach, gastrin, histamine

147
Q

Muscularis of stomach in > out

A

Oblique, circular, longitudinal

148
Q

Duodenum micro

A

Villi and microvilli - absorptive surface

Runners glands - secrete HCO3-

Crypts of lieberkuhn

149
Q

Jejunum micro

A

Crypts of lieberkuhn
Plicae circulares

150
Q

Ileum micro

A

Peyer patches
Plicae circulares
Crypts of lieberkuhn
Largest number of GOBLET CELLS in the small intestine

151
Q

Colon micro

A

No villi
Crypts of lieberkuhn
Goblet cells abundant

152
Q

Retroperitoneal structures

A

SAD PUCKER

Suprarenal (adrenal) glands
Aorta and IVC
Duodenum (parts 2-4)
Pancreas (except tail)
Ureters
Colon (desc and asc)
Kidneys
Esophagus (lower 2/3)
Rectum (partially)

153
Q

Source of gastrin

A

G cells

Antrum of stomach, duodenum

154
Q

Action of gastrin

A

Inc gastric H+
Inc growth of gastric mucosa
Inc gastric motility

Stim release of histamine from enterochromaffin-like cells

Stim H+ and gastric mucosa (gastric motility)

155
Q

Gastrin regulation

A

Inc stomach distention/alkalinization, AAs, peptides, vagal stimulation via GRP

Dec pH < 1.5

Inc in chronic PPI use, h pylori atrophic gastritis, gastrinoma

156
Q

Somatostatin source

A

D cells

Pancreatic islets, GI mucosa

157
Q

Functions somatostatin

A

Dec gastric acid
Dec pepsinogen
Dec pancreatic secretion
Dec small int fluid secretion
Dec gallbladder contraction
Dec insulin and glucagon release

158
Q

Regulation somatostatin

A

Inc acid
Dec vagal stimulation

159
Q

Cholecystokinin source

A

I cells

Duodenum, jejunum

160
Q

Cholecystokinin functions

A

Inc pancreatic secretion
Inc gallbladder contraction
Dec gastric emptying
Inc sphincter of oddi relaxation > release of pancreatic enzymes + bicarb via neural muscarinic pathways

161
Q

Cholecystokinin Regulation

A

Inc fatty acids, amino acids

162
Q

Secretin source

A

S cells
Duedenum

163
Q

Secretin Functions

A

Inc pancreatic HCO3- (allows pancreatic enzymes to function)
Dec gastric H+
Inc bile acid secretin in liver

164
Q

Secretin Regulation

A

Inc acid, fatty acids in lumen of duodenum

165
Q

GDIP/GIP source

A

K cells
Duodenum, jejunum

166
Q

GDIP/DIP Functions

A

Exocrine - dec gastric H+

Endocrine - inc insulin release

167
Q

GDIP/DIP Regulation

A

Inc fatty acids, amino acids, oral glucose

168
Q

Motilin source

A

Small intestine

169
Q

Motilin Function

A

Produces migrating motor complexes (MMCs)

Inc intestinal peristalsis

170
Q

Motilin Regulation

A

Inc in fasting states

171
Q

Vasoactive intestinal polypeptide source

A

Parasympathetic ganglia in spinchetrs, gallbladder, small intestine

172
Q

Vasoactive intestinal polypeptide Function

A

Inc intestinal water and electrolyte secretion
Inc relaxation of intestinal smooth muscle and spinchters

173
Q

Vasoactive intestinal polypeptide Regulation

A

Inc distention and vagal stim
Dec adrenergic input

174
Q

Nitric oxide function

A

Inc smooth muscle relaxation, inc LES

175
Q

Ghrelin source

A

Stomach

176
Q

Ghrelin Function

A

Inc appetite (GHROWLIN STOMACH)

177
Q

Ghrelin Regulation

A

Inc fasting
Dec food

178
Q

Intrinsic factor source

A

Parietal cells
Stomach

179
Q

Intrinsic factor Action

A

Vit B12 binding protein
Required for B12 uptake in terminal ileum

180
Q

Gastric acid source

A

Parietal cells
Stomach

181
Q

Gastric acid function

A

Dec stomach pH

182
Q

Gastric acid reg

A

Inc by histamine
Inc vagal stim (Ach)
Inc gastrin

Dec somatostatin

183
Q

Pepsin soure

A

Chief cells
Stoamch

184
Q

Pepsin function

A

Protein digestion

185
Q

Pepsin regulation

A

Inc vagal stim (Ach)
Inc local acid

186
Q

Bicarb source

A

Mucosal cells - stomach, duodenum, salivary glands, pancreas

Brunner glands - duodenum

187
Q

Bicarb regulation

A

Inc by pancreatic and biliary secretion with secretin

188
Q

What is the pectinate line

A

Dentate Line; where endoderm (hindgut) meets ectoderm

189
Q

Lateral to medial femoral triangle

A

NAVL
Nerve, artery, vein, lymphatics

190
Q

Absorption site of folate

A

Small bowel

191
Q

Direct v indirect bilirubin

A

Direct - conjugated with glucuonic acid, water soluble

Indirect - unconjugated, water insoluble

192
Q

bilirubin production and excretion pathway

A

Heme metabolized by heme oxigenase > biliverdin > reduced to bilirubin

Unconjugated bilirubin removed from blood by liver > onjugated with glucuronate > excreted in bile

nplex (11 decks)

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