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Semester 3 > GI Session 1 > Flashcards

GI Session 1 Flashcards

1
Q

What are the three narrowings of the oesophagus?

A

Cricopharyngeal sphincter
Broncho-aortic constriction
Inferior oesophageal sphincter

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2
Q

Is the inferior oesophageal sphincter a true sphincter?

A

No, physiological caused by diaphragmatic constriction and angle made with junction of stomach

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3
Q

How far is oesophagsatric mucosal junction from the incisors?

A

40 cm

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4
Q

What is visible on endoscopy of the oesophagus at the oesophagogastric mucosal junction?

A

Pale pink squamous epithelium –> dark red gastric epithelium

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5
Q

What is hiatus hernia?

A

Where the cardia and fundus of the stomach push through the oesophageal opening in the diaphragm

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6
Q

What is Barrett’s oesophagus?

A

Chronic acid exposure cause metaphase of squamous epithelium to gastric columnar epithelium

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7
Q

What are the five regions of the stomach?

A 
Cardia
Fundus
Body
Pyloric antrum
Pylorus
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8
Q

Where is gastric ulceration most commonly seen in the the stomach?

A

At the lesser curvature

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9
Q

Which part of the stomach is removed in sleeve gastrectomy in bariatric surgery?

A

Greater curvature

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10
Q

Where do peptic ulcers which bleed slower than those in the duodenum develop?

A

Pyloric canal

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11
Q

Describe the nervous control of the oesophagus.

A

Superior 1/3 voluntary

Inferior 2/3 autonomic

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12
Q

What gives arterial supply to the superior 2/3 of the oesophagus?

A

Systemic arteries: inferior thyroid and aortic branches

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13
Q

What gives venous drainage to the superior 2/3 of the oesophagus?

A

Systemic veins: inferior thyroid and Azygos branches

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14
Q

What gives arterial and venous drainage to the inferior 1/3 of the oesophagus?

A

Portal system: L gastric branch of coeliac trunk, L inferior phrenic artery, drains into L gastric vein

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15
Q

What causes oesophageal varices?

A

In portal hypertension blood can’t pass through portal hepatic vein so there is a reversal of blood flow through porto-systemic anastomoses –> oesophageal submucosal veins dilate with increased flow

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16
Q

What controls entry of stomach contents into the duodenum?

A

Pyloric sphincter at the end of the pyloric canal formed by muscular thickening

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17
Q

What are rugae in the stomach?

A

Longitudinal gastric folds that allow for expansion of the stomach

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18
Q

What overlaps the first portion of the duodenum?

A

Liver and gallbladder

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19
Q

Describe the position of the second part of the duodenum.

A

Descends retroperitoneal around the head of the pancreas

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20
Q

What is the significance of the embryological origin of the second part of the duodenum?

A

Marks transition from embryonic foregut to midgut therefore receives blood supply from coeliac trunk and SMA

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21
Q

Describe the passage of the third part of the duodenum.

A

Runs transversely at L2/3 level crossing the aorta below SMA origin

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22
Q

Describe the position of the fourth part of the duodenum.

A

Retroperitoneal and ascends to left of midline where it turns to form the duodenojejunal flexure

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23
Q

What happens to the duodenum as it forms the duodenojejunal flexure?

A

Becomes intraperitoneal and has a mesentery

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24
Q

Why is the first part of the duodenum most likely to ulcer?

A

Lack of mucus and acidity of contents which is yet to be neutralised by addition of HCO3-

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25
Q

What happens if a duodenal ulcer in the first part of the duodenum erodes anteriorly or posteriorly?

A

Anteriorly –> peritonitis
Posteriorly –> perforates gastroduodenal artery causing massive haemorrhage or erodes into pancreas causing severe pain in lumbar region

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26
Q

What an lead to gallstone ileus?

A

Erosion of a gallstone causing a choledocoduodenal fistula which the stone can then pass through

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27
Q

What supports the duodenojejunal flexure?

A

Ligament of Treitz

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28
Q

What signifies the opening of the main pancreatic duct into the duodenum?

A

Major duodenal papilla

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29
Q

What controls release of contents from the pancreatic duct into the duodenum?

A

Sphincter of Oddi

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30
Q

What does ulceration in the second part of the duodenum suggest?

A

Pancreatic disease

Zollinger-Ellison syndrome

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31
Q

What is Zollinger-Ellison syndrome?

A

Gastrin-secreting tumour stimulates parietal cells to maximal activity

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32
Q

What can form in the third part of the duodenum if either the aorta or duodenum is diseased?

A

Aorto-duodenal fistula

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33
Q

What is seen following dramatic weight loss in the third part of the duodenum?

A

SMA syndrome where aorta and SMA press on the third part of the duodenum causing partial/complete obstruction

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34
Q

What an happen in the duodenum in deceleration injury?

A

Traction injury caused by ligament of Treitx pulling of duodenojejunal flexure and causing subsequent perforation

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35
Q

Where does the ligament of Treitz descend from?

A

Right crus of diaphragm

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36
Q

What does contraction of the ligament of Treitz aid?

A

Persistalsis

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37
Q

Describe the passage of the common bile duct.

A

Passes behind duodenum to run in a groove within the pancreas entering the duodenum at the Ampulla of Vater

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38
Q

Where can the Pringle manoeuvre to control hepatic haemorrhage be applied?

A

Along the free edge of the lesser omentum where the common bile duct, portal vein and artery run

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39
Q

What are the components of the biliary tree?

A

Intrahepatic ducts –> R and L hepatic ducts –> common hepatic duct –> +cystic duct from gallbladder –> common bile duct

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40
Q

What do S/S of jaundice, dark urine and pales stool indicate?

A

Blockage of the common bile duct causing disruption of entero-hepatic bile salt

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41
Q

What is painless obstructive jaundice commonly secondary to?

A

Tumour: carcinoma of head of pancreas, cholangiocarcinoma, adenocarcinoma of duodenum, liver tumour causing extrinsic pressure

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42
Q

What does painful obstructive jaundice suggest?

A

Gallstone disease

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43
Q

What attaches the small bowel to the posterior abdominal wall?

A

15 cm long mesentery from DJ flexure to R sacroiliac joint

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44
Q

Why does the jejunum have a thicker wall than the ileum?

A

More, larger and taller pliae circulares

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45
Q

Why is the jejunum deeper red than the ileum?

A

Greater blood supply

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46
Q

What atrophies in coeliac disease?

A

Deep crypts with tall villi of jejunal wall

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47
Q

What can cause luminal obstruction of the ileum in lymphoma?

A

Enlargement of the abundant Peyer’s patches

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48
Q

What are Peyer’s patches which are found in the ileum?

A

Aggregates of lymphoid tissue

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49
Q

What is Meckel’s diverticulum?

A

Embryological remnant in distal ileum with gastric mucosa that secretes acid

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50
Q

What is the rule of 2s that Meckel’s diverticulum follows?

A

Seen in 2% of the population
2 inches long
Presents at 2 y.o.
2 ft from iliocaecal valve

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51
Q

Which quadrants is the jejunum mainly located in?

A

L and R upper quadrants

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52
Q

Which quadrants is the ileum mainly situated in?

A

R and L lower quadrants

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53
Q

Is the colon longer in males or females?

A

Females

54
Q

How long is the colon typically?

A

100-180 cm

55
Q

What forms the taenia coli?

A

3 longitudinal bands of muscle along the length of the colon

56
Q

Where do the taeni coli converge and what is the result of this?

A

In appendix which makes its lumen look triangular

57
Q

What forms saculations in the colon?

A

Longitudinal bands of muscle being shorter than the colon

58
Q

What prevents back flow of colonic contents during persistalsis?

A

Iliocaecal valve

59
Q

Why is the rectum lumen circular?

A

Due to thick circular muscle needed to for formed stool passage

60
Q

What breaks the appearance of the circular lumen of the rectum?

A

Haustral folds

61
Q

What is the dentate/pectineal line formed by?

A

Valves of Ball from vertical columns of Morgagni

62
Q

What is the significance of the pectineal line?

A

Watershed for supply and drainage

63
Q

What supplies and drains the rectum above the pectineal line?

A

IMA
Visceral pelvic splanchnic nerves
IMV
Mesenteric nodes

64
Q

What supplies and drains the rectum below the dentate line?

A

Internal iliac artery
Inferior rental nerve
Internal iliac vein
Iliac and inguinal nodes

65
Q

How does pain sensed above and below the dentate line compare?

A

Above is dull and poorly located, below is sharp and well localised

66
Q

Describe the position of the transverse colon with relation to surface markings.

A

Lies at umbilicus but may hang down into pelvis, esp in women

67
Q

What forms the iliocaecal valve?

A

Oblique entrance a partial invagination of the ileum

68
Q

How long is the ascending colon?

A

12-20 cm

69
Q

How long is the transverse colon?

A

45 cm

70
Q

How long is the descending colon?

A

22-30 cm

71
Q

Where is the appendix found?

A

3 cm below the iliocaecal valve

72
Q

Where does the caecum lie?

A

R iliac fossa

73
Q

What are the fat filled peritoneal tags on the colon called?

A

Appendices epiploicae

74
Q

How long is the sigmoid colon?

A

37 cm usually but can be up to 70 cm

75
Q

How do colonic tumours in the caecum present?

A

Mass
Change in bowel habit
Decreed iron levels –> anaemia
Pain

76
Q

What causes the caecum to dilate or perforate in large bowel obstruction?

A

Iliocaecal valve preventing back flow of air and colonic contents which cannot pass distally

77
Q

Where does the rectum extend from and to?

A

S3 –> anal canal

78
Q

Where is the most common location of colonic diverticulum?

A

Arterial entry point of sigmoid colon

79
Q

Are colonic diverticuli in the sigmoid colon true diverticuli?

A

No because they do not involve the entire thickness of wall of parent organ

80
Q

What can occur as a result of the length and loose mesenteric attachment of the sigmoid colon?

A

Sigmoid volvulus

81
Q

What are the S/S of sigmoid volvulus the same as?

A

Large bowel obstruction with clack cal radiological appearance

82
Q

How is sigmoid volvulus treated?

A

Flexible sigmoidoscopy

83
Q

Where do 50% of colon cancers arise?

A

Rectum

84
Q

Are tumours the same above and below the dentate line and why?

A

No, above has hindgut origin so is columnar epithelium and below is ectoderm so stratified squamous epithelium

85
Q

What causes haemorrhoids?

A

Varices in portal hypertension due to porto-systemic anastomoses in rectum

86
Q

How do haemorrhoids above and below the pectineal line compare?

A

Above are relatively painless so can be injected/banded

Below are very painful

87
Q

How long is the oesophagus?

A

25 cm

88
Q

What forms the alimentary canal?

A 
Mouth
Tongue
Pharynx
Oesophagus
Stomach
Small intestine
Colon
Appendix
Rectum
Anus
89
Q

What are the accessory organs to the alimentary canal?

A

Salivary glands
Liver
Gallbladder
Pancreas

90
Q

What forms the mucosa of the gut wall?

A

Epithelium, LP with aggregations of lymphocytes in Peyer’s patches, muscularis mucosae

91
Q

What forms the submucosa of the gut wall?

A

Layer of CT with glands, arteries, veins and nerves which are particularly on the outer edge near the muscle

92
Q

What forms the muscularis externae of the gut wall?

A

Outer longitudinal and inner circular layers of muscle which spiral down the gut to create peristaltic waves

93
Q

What forms the serosa of the gut wall?

A

CT covered by simple squamous epithelium which surrounds most but not all of the gut

94
Q

What does the serosa of the gut wall form?

A

Mesentery which contains arteries, veins and nerves

95
Q

What are the layers of the gut wall from innermost to outermost?

A

Mucosa
Submucosa
Muscularis externae
Serosa

96
Q

What are the major functions of the GI tract?

A 
Movement of food
Absorb nutrients
Mechanically disrupt food
Port of food entry
Eliminate residual waste material
Temporarily store food
Chemically digest food
Sterility
97
Q

Where is movement of food most rapid in the GI tract?

A

Oesophagus and rectum

98
Q

What are the major steps in the digestion of food?

A

Physical and chemical disruption –> sterile, neutral pH, isotonic solution –> absorption

99
Q

What causes physical and chemical disruption of food in the mouth?

A

Physical: teeth, tongue, muscles of mastication
Chemical: salivary amylase and lipase

100
Q

What protects teeth in the mouth?

A

High calcium concentration of saliva

101
Q

How much saliva is added to ingested food in the mouth?

A

1.5 l

102
Q

What provides innervation to the oesophagus?

A

Submucosal and myenteric plexuses

103
Q

Where is the myenteric plexus located?

A

Between circular and longitudinal layers of muscle in the oesophagus

104
Q

What gives paracrine control of motility and secretion in the GI tract?

A

Histamine controls gastric acid

Vasoactive substances control gastric blood flow

105
Q

Why is fluid balance in the GI tract delicate?

A

Large quantities that are vary variable are involved

106
Q

What gives neural control of motility and secretion in the GI tract?

A

Somatic: mouth, 1/3 oesophagus, last sphincter of anus
Autonomic: everything else via submucosal and myenteric plexuses with lots of neurotransmitters

107
Q

What gives endocrine control of motility and secretion in the GI tract?

A

Secretin, gastrin and CKK control gastric acid, alkali and enzyme secretion

108
Q

How much fluid is added to ingested food by the stomach?

A

2.5 l of gastric secretions

109
Q

Why does the stomach act as a necessary food store?

A

We eat faster than we can digest

110
Q

What is the purpose of receptive relaxation in the stomach?

A

So pressure doesn’t rise as it stretches from 50 ml to 4 l

111
Q

How does the stomach physically disrupt ingested food?

A

Contracts rhythmically to move dynamic rugae

112
Q

What cells are found in the stomach and what do they secrete?

A

Chief - enzymes
Parietal - acid and intrinsic factor
Goblet - mucus

113
Q

How does the stomach produce a hypertonic chyme?

A

Combines action of acid, enzymes and agitation increases the number of molecules present

114
Q

What are the main functions of the duodenum?

A

Dilution
Neutralisation of chyme
Iron absorption

115
Q

How much fluid is added to the contents of the duodenum?

A

9 l of water/alkali

116
Q

Where is water drawn from in the duodenum to make chyme isotonic?

A

ECF

117
Q

What is the function of Brunner’s glands, found above the Sphincter of Oddi?

A

Produce mucus rich alkaline solution to protect duodenum and inhibit gastric chief and parietal cell function

118
Q

What do the accessory organs secrete into the chyme in the duodenum?

A

Liver releases bile containing water, alkali and bile salts

Pancreas secretes alkali and enzymes

119
Q

How is digestion of chyme completed in the duodenum?

A

Secretion of enzymes by pancreas, liver and intestine

120
Q

What so the function of the jejunum?

A

Absorption of most nutrients

121
Q

What forms the jejunal mucosa?

A

Simple columnar epithelium
Lamina propria
Muscularis mucosa with microvilli and goblet cells

122
Q

What are pliae circulares?

A

Permanent circular folds of mucosa and submucosa that project into the jejunal lumen

123
Q

Why is gut transit reduced in the jejunum?

A

To give adequate time for absorption

124
Q

Describe the absorption which takes place in the jejunum.

A

Most active takes place proximally

Absorbs mainly sugars and a.a.

125
Q

What is the main function of the large intestine?

A

Drying of contents (although jejunum actually absorbs more water)

126
Q

How are useful small molecules absorbed in the large intestine?

A

By bacteria involved in vitamin synthesis and enterocytes

127
Q

What epithelium lines the large intestine?

A

Simple columnar with attached enzymes, crypts of Lieberkühn and lymphatic tissue

128
Q

What vitamins are synthesised by bacteria in the large intestine?

A

K
B12
Thiamine
Riboflavin

129
Q

What causes the urge to defecate?

A

Rapid propulsion of colonic contents into rectum causing it to stretch

130
Q

What can overcome the urge to defecate?

A

Reverse peristalsis

131
Q

How much water is removed from the colonic contents by the large intestine?

A

1.35 l

132
Q

How much water is removed from the contents in the small intestine?

A

12.5 l

Semester 3 (50 decks)

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