GI II Flashcards
eosphageal varices
left gastric to esophageal
umbilical varices
paraumbilical to small epigastric
rectal varices
superior rectal to middle and inferior rectal
tx of varices
transjugular intrahepatic portosystemic shunt
portal vein to hepatic vein
pectinate line
hindgut meets ectoderm
above - internal hemorrhoid(not pain), adenocarcinoma
- supply - IMA
- drain - inferior mesenteric vein to portal system
below - external hemorrhoid (pain), fissure, SCC
- supply - inferior rectal artery
- drain - inferior rectal v to pudendal v, to IVC
anal fissure
MC posterior
liver zones
1 - periportal - viral hepatitis and cocaine
2 - intermediate - yellow fever
3 - centrilobular - ischemia, P450, toxins, alcohol
zone 1 liver
portal triad
zone 3 liver
central vein
lowest O2
hepatocyte orientation
apical - bile canal
basolateral - sinusoid
head of pancreas tumor
obstruct common bile duct
ampulla of vater
drainage of common bile duct and pancreatic duct to duodenum
organization of femoral region
nerve artery vein empty space lymphatics
NAVEL
femoral triangle
femoral vein, artery, and nerve
fascia of spermatic cord
external spermatic fascia - ext oblique
cremaster muscle and fascia - int oblique
internal spermatic fascia - transversalis fascia
diaphragm hernia
commonly left side
sliding - MC - GE junction displaced upward
paraesophageal - fundus into thorax
hiatal hernia
stomach through esophageal hiatus of diaphragm
indirect hernia
internal inguinal ring and external ring
lateral inferior epigastric artery
MC in males
direct hernia
through transversalis fascia - hesselbach triangle
-through external ring only
medial inferior epigastric artery
older men
femoral hernia
below inguinal ligament
through femoral canal
MC in females
hessel bach triangle
inferior epigastric vessels
lateral border rectus abdominus
inguinal ligament
gastrin
from G cells
-antrum of stomach and duodenum
stimulus - low pH and vagus
increased gastric H+ secretion and motility
somatostatin
from D cells
-pancreatic islets and GI mucosa
stimulus - acid and vagus
decreased gastric acid secretion
decreased pancreas and small intestine secretion
decreased gallbladder contraction
decreased insulin and glucagon release
octreotide
somatostatin analog
tx - acromegaly, insulinoma, carcinoid syndrome, variceal bleeding
cholecystokinin
from I cells - duodenum, jejunum
increased pancreatic secretion
increased gallbladder contraction
decreased gastric emptying
sphincter of oddi relaxation
stimulus - fatty acid and AAA
secretin
from S cells - duodenum
increased pancreatic bicarb secretion
decreased gastric acid secretion
increased bile secretion
stimulus - acid, fatty acids in duodenum
GIP
from K cells of duudenum and jejunum
exocrine - decreased gastric H+ secretion
endocrine - increased insulin release
stimulus - fatty acid, AA, oral glucose
motilin
from small intestine
produce migrating motor complexes
stimulus - fasting state
erythromycin
motilin receptor agonist
-to stimulate intestinal peristalsis
VIP
from PS ganglia - sphincters, gallbladder, small intestine
stimulate water and electrolyte secretion
relax intestinal smooth m and sphincters
stimulus - distention and vagal input
VIPoma
non-a non-B islet cell pancreatic tumor
copious water diarrhea
hypoK
achlohydria
intrinsic factor
parietal cell of stomach
bind B12 - for uptake in terminal ileum
autoimmune desturction parietal cells
chronic gastritis and pernicious anemia
gastric acid
from parietal cells of stomach
stimulus - histamine, ACh, gastrin
inhibited by - somatostatin, GIP, PG, secretin
gatsrinoma
gatrin secreting tumor - high level of acid and ulcers
pepsin
from chief cells of stomach
protein digestion
pepsinogen to pepsin - in acid
HCO3
from mucosa cells - stomach, duodenum, salivary glands, pancreas, and brunner glands (duodenum)
neutralize acid
stimulus - pancreatic and biliary secretin
gastrin regulation of acid secretion
through effect on ECL - enterochromaffin cells
histamine release occurs - direct effect on parietal cells
