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Physiology II Exam 1 > GI module 1 > Flashcards

GI module 1 Flashcards

1
Q

What are the structures of the alimentary canal?

A

The alimentary canal is the GI tract:

Mouth, esophagus, stomach, SI, LI, rectum, anus

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2
Q

What are the accessory organs of the digestive system?

A

Liver, gallbladder, exocrine pancreas

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3
Q

name the layers of the GI tract from inner to outer

A

Mucosa
submucosa
muscularis
adventitious (serosa)

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4
Q

Which layer needs to be smooth enough to be able to pass and absorb/neutralize stool?

A

mucosa layer

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5
Q

What are the 3 parts of the mucosa layer of the GI tract?

A

Mucosa epithelium
lamina propria
muscularis mucosae

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6
Q

Which layer of the mucosa allows local movement and has a role in IBD and or secretion/absorption dysfunction?

A

Muscularis mucosae

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7
Q

What layer of the GI tract contains glands and associated ducts?

A

submucosa

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8
Q

What are the sublayers of the muscular layer of the GI tract?

A

Circular

Longitudinal

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9
Q

What is the adventitious (serosa) layer made up of?

A

connective tissue

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10
Q

What part of the Nerovous system is the enteric system part of?

A

ANS

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11
Q

What is the parasympathetic system responsible for in the GI?

A

Excitatory action

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12
Q

What is the sympathetic system responsible for in the GI?

A

Inhibitory action

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13
Q

What are the 3 enteric plexuses?

A 
submucosal plexus (meissner)
Myenteric plexus (Auerbach)
Subserosal plexus
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14
Q

What plexus is also known as the Meissner plexus?

A

submucosal

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15
Q

what plexus is also known as the Auerbach plexus?

A

Myenteric

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16
Q

Where is the submucosal plexus located and what is it responsible for?

A

Submucosa

Secretion

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17
Q

Where is the myenteric plexus located and what is it responsible for?

A

Between circular and longitudinal layers of muscular

Motility

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18
Q

What is the subserosal plexus responsible for in the GI tract?

A

ANS innervation of BV and CT

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19
Q

What are the 3 general functional components of enteric plexuses?

A

Sensory neurons
Motor
Interneurons

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20
Q

What do the sensory neurons in the enteric plexus monitor in the GI tract?

A

Chemical status

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21
Q

What do the motor neurons in the enteric plexus control in the GI tract?

A

Motility (peristalsis)
Blood flow (smooth muscle of GI vasc.)
Secretions (cells of mucosa/submucosa)

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22
Q

What do the the interneurons of the enteric plexus control in the GI tract?

A

Communication between sensory and motor _ mechanism for intrinsic control (short loop reflexes)

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23
Q

What do the terms appetite and satiety mean?

A

appetite - Hunger

satiety - sensation of fullness

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24
Q

What two centers (nuclei) control appetite and satiety?

A 
Lateral center (appetite)
Medial center (satiety)
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25
Q

Where are the centers for appetite and satiety located?

A

hypothalamus

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26
Q

What hormone is released by the stomach and sends a chemical message to the brain to stimulate appetite?

A

Ghrelin

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27
Q

What hormones stimulate the medial center in the brain to suppress appetite?

A

GI hormones (CCK, GLP-1 etc.)
Leptin
PYY
Insulin

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28
Q

Where is Leptin released from and what is significant about it?

A

Fat cells and chief cells

It is the longest lasting of all the hormones that stimulate appetite

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29
Q

Where is PYY released from

A

the SI after a meal

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30
Q

When is Insulin released?

A

by pancreas after increased blood glucose after a meal

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31
Q

What hormone is effected in obesity leading to more weight gain?

A

“leptin resistance” leads to effectiveness of sensation of satiety to be blunted.

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32
Q

What occurs when Ghrelin levels are decreased?

A

decreased levels in obesity

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33
Q

Which GI hormones are considered “fast acting”

A

Ghrelin
PYY
Insulin

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34
Q

When do Ghrelin levels rise?

A

just before a meal

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35
Q

What is the pathway of nerves in the sympathetic system?

A

Thoracic and lumbar regions

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36
Q

What is the function of the sympathetic system on the GI tract?

A

inhibitory-
decreased peristalsis
inhibits blood flow to GI tract

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37
Q

What is the pathway of the parasympathetic system in the GI tract?

A

Vagus nerve and pelvic nerves of the sacral plexus

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38
Q

What is the primary function of the parasympathetic system in the GI tract?

A

Excitatory
Increase peristalsis and secretions
relax involuntary sphincters of GI tract
facilitate blood flow to GI tract.

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39
Q

Peristalsis requires ______ and ______ so the vagus nerve has a “dual” role in smooth muscle of the GI tract?

A

relaxation and contraction

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40
Q

Intrinsic system can feedback on itself and function autonomously. This is referred to as “____________”

A

brain in the gut

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41
Q

Wha is the general function of the Myenteric (auerbach’s)plexus?

A

controls motility

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42
Q

What is the general function of the submucosal plexus (Meissner’s)?

A

Secretion and absorption

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43
Q

What are the 7 specific functions of the enteric nervous system?

A

Motility
Regulation of Fluid exchange and local GI blood flow
Regulation of gastric and pancreatic sensation
Regulation of GI endocrine cells
Defense reaction
Entero-enteric reflexes
ENS and CNS interaction

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44
Q

What are the primary excitatory neurotransmitters in the intrinsic nervous system?

A

Ach and sub P

45
Q

What are the primary inhibitory neurotransmitters in the intrisic nervous system?

A

NO and VIP

46
Q

What is the summary job of the Extrinsic nervous system?

A

Directly influences the intrinsic system

By Parasympathetic and sympathetic nervous system

47
Q

What is the summary job of the intrinsic nervous system (enteric)?

A 
Myenteric plexus (Auerbach's)-muscular layers controls motility
Submucosal (Meissner's)-located within/beneath mucosal layers so controls secretions
48
Q

What are the 3 salivary glands of the mouth?

A

Submandibular
sublingual
Parotid

49
Q

What controls the stimulation of salivary glands?

A

Both parasympathetic and sympathetic systems

NOT hormones

50
Q

t/f saliva is controlled by hormones?

A

F!! it is controlled by parasymp and sympathetic systems

51
Q

What makes up saliva? Why?

A

Water-controls pH
Salivary amylase-Starch digestion
IgA-immune defense

52
Q

What kind of muscle is the esophagus made up of?

A

Upper third-striated (voluntary)
Middle-mixed
Lower-smooth (involuntary)

53
Q

Where is the UES located?

A

junction of lower pharynx and esophagus

approx at level of cricoid cartilage

54
Q

What is the normal tone of the UES?

A

50mmHg (can be up to 70/80 if totally constricted)

55
Q

UES is considered a/n ___________ sphincter?

A

Anatomical

56
Q

What is the function of the UES?

A

Prevents air from entering esophagus during ventilation

57
Q

Location of the LES?

A

Narrowing of the esophagus at junction of esophagus and stomach

58
Q

What is the normal tone of the LES?

A

20mmHg

59
Q

LES is considered a/n ____________ sphincter?

A

Not a true anatomical sphincter

60
Q

What is the function of the LES?

A

Barrier to reflux of acidic content of stomach

61
Q

What is the only voluntary phase of swallowing?

A

Oropharyngeal

62
Q

What occurs during the oropharyngeal phase?

A

Chen the food and push it posteriorly

63
Q

What occurs during the pharyngeal phase?

A

Soft palate closes off nasopharynx
Epiglottis closes off larynx/trachea
Food is pushed into the esophagus

64
Q

How long does it take for food to be pushed into the esophagus?

A

1-2 seconds

65
Q

What are the two involuntary phases of swallowing?

A

Pharyngeal phase

esophageal phase

66
Q

What occurs during the esophageal phase?

A

Bolus enters esophagus and ends as the bolus enters the stomach

67
Q

How long does the esophageal phase of swallowing take?

A

5-10 seconds (or more)

68
Q

What phase does the dual innervation of the UES (relaxation followed by contraction) propagating down occur?

A

esophageal phase

69
Q

Esophageal muscular pressures range from ______- _____?

A

35-80mmHg

70
Q

Upper and lower esophagus tends to have a pressure ranging from ____ - _____?

A

60-80 mmHg

71
Q

Mid esophagus pressures tend to be ____ - _____?

A

30-45 mmHg

72
Q

Less than ______ mmHg contraction may leave food residue within the esophagus

A

Less than 30mmHg

73
Q

What stimulus increases the forces of esophageal contraction?

A

tension (distention)

74
Q

What nerve pathway controls peristalsis?

A

Parallel vagal inhibitory and excitatory pathways (Vagus nerve)

75
Q

What are the peristaltic excitatory signalers in the vagus nerve?

A

Ach

76
Q

What are the peristaltic inhibitory signalers in the vagus nerve?

A

NO

77
Q

What occurs during primary peristalsis (5 step pathway)

A 
Oral phase 
Pharyngeal Peristalsis
UES relaxation
esophageal peristalsis
LES relaxation
78
Q

What phases are involved in primary peristalsis?

A 
Swallow reflex (voluntary phase)
Esophageal wave (involuntary phase)
79
Q

When does secondary peristalsis occur?

A

When the whole food bolus does not get passed down on the first try.

80
Q

What phase(s) are involved in the secondary peristalsis?

A

Esophageal peristaltic wave (DOES NOT include swallowing reflex).

81
Q

What occurs during secondary peristalsis? (pathway 3 steps)

A

Bolus or food residue DISTENTION causes intrinsic feedback to:

  1. Constrict esophagus above the distention
  2. Relax esophagus below distention
  3. Push residue/bolus along
82
Q

How long does it take for a single swallow of food to initiate esophageal contraction?

A

5-10 seconds

83
Q

Why is attempting to swallow food more frequently than 10-15 seconds difficult?

A

A short refractory period follows peristaltic contraction inhibiting ability to swallow a second bite of food.

84
Q

How long does it take to swallow a liquid?

A

1-2 seconds

85
Q

Why is it possible to swallow multiple sips of a drink under the normal 5-10 seconds that it would take to swallow food?

A

Deglutitive inhibitions prevents esophagus from ongoing contraction. This inhibitions causes the esophagus to stay relaxed to allow more liquid to descend.

86
Q

LES tone is a net result of what 3 factors?

A

Myogenic tone (independent of neural input)
Excitatory vagal tone (cholinergic)
Inhibitory vagal tone (nitregeic-Nitric Oxide)

87
Q

What are the factors the INCREASE LES pressure?

A

Vagus nerve influence (Ach)
Gastrin
Some meds to tx GERD

88
Q

What are the factors that DECREASE LES pressure?

A

Vagus nerve influence (NO, VIP)
Hormones-Progesterone, secretin, glucagon
Common foods/substances- are suggested (fried food, tomato, citrus etc.)

89
Q

Define the pathology of GERD

A

Decreased LES pressure and ineffective clearance of mechanism of secondary peristaltic waves.

90
Q

What does chronic recurrent GERD eventually cause?

A

Destruction of the esophageal wall (esophagitis)

91
Q

What medications are used to Tx. GERD?

A

Antacids-neutralize acid
Histamine-dec. acid secretion histamine receptors
PPI-stop acid secretion
Parasympathetic drugs-increase LES tone

92
Q

What might cause decreased LES/risk factors for GERD?

A 
Hiatal hernia
Pregnancy
Excess ETOH
tobacco
obesity
93
Q

Define Achalasia

A

LES fails to relax-pt get’s pain w/ eating and drinking

94
Q

What is achalasia also known as?

A

Cardiospasm

95
Q

What must be ruled out first clinically when DDX’ing for Achalasia?

A

Cardiac issue-strong mimicry.

96
Q

What are the tx strategies for achalasia?

A

Pneumatic dilation

Meds to relax LES

97
Q

Define Esophageal Varices

A

Severely dilated sub-mucosal veins in the esophagus

98
Q

What is the primary cause of esophageal varices?

A

Portal hypertension (common with cirrhosis)

99
Q

What do patients with esophageal varices have a strong tendency to develop?

A

Bleeding-chronic long term GI bleed can progress to severe systemic consequences/

100
Q

What MIGHT untreated GERD develop into?

A

Barrett’s esophagus

101
Q

What is Barrett’s esophagus

A

a condition in which abnormal cells develop in the esophagus due to exposure to stomach acidd

102
Q

What are the normal esophageal cells replaced with in Barrett’s esophagus?

A

Metaplastic columnar mucosa

103
Q

Do all patient with GERD develop BE?

A

NO

104
Q

Will all patients with BE develop cancer?

A

NO risk is 1:300

105
Q

T/f the amount of dysplasia in BE increases a patient’s risk of cancer?

A

True

106
Q

Where are polypoid mass adenocarcinomas most commonly found in the esophagus?

A

Lower

107
Q

What is the most common esophageal cancer in the US?

A

polypoid-Adenocarcinoma

108
Q

Where are Squamous cell carcinomas of the esophagus most commonly found?

A

upper esophagus

109
Q

What is the most common for of esophageal cancer in the world?

A

Esophageal squamous cell carcninoma

Physiology II Exam 1 (5 decks)

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