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Tung Tung Tung Tung Sahur > GIT anat & physio > Flashcards

GIT anat & physio Flashcards

1
Q

Which regions are covered by the liver

A

R hypochondriac, Epigastric, R lumbar

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1
Q

Which regions are covered by the gallbladder

A

R hypochondriac, R lumbar

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1
Q

Which regions are covered by the stomach

A

Epigastric, Umbilicus, L hypochondriac

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1
Q

Which regions are covered by the large intestines

A

Cecum and appendix = R iliac
Asc colon = R lumbar
Desc colon = L lumbar, L iliac
Sigmoid colon = L iliac, hypogastric

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1
Q

What is the position of the transpyloric plane and the structures passing through it

A

L1, CC9
Duodenum
Kidney hilum
Pancreas neck
SMA

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1
Q

Which regions are covered by the small intestines

A

Duodenum = Epigastric, Umbilical
Jejunum = LUQ
Ileum = RLQ

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1
Q

Which regions are covered by the pancreas

A

Epigastric, L hypochondriac

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1
Q

Which regions are covered by the spleen

A

L hypochondriac

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1
Q

Where is the arcuate line

A

3/4 down abdominal muscles

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1
Q

What are the layers of the abdominal wall

A

Skin

Camper’s fascia

Scarpa’s fascia

Ext/Int oblique, Neuromuscular bundle, Transversalis Abdominis w Deep investing fascia between muscle layers

Extraperitoneal fat

Parietal peritoneum

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1
Q

Which part of the abdominal wall is prone to infection

A

Inferior to arcuate line
Only has anterior rectus sheath => weaker => blood spreads easier => risk of infection

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1
Q

Where is the position of the inguinal canal and rings

A

Canal from anterior superior iliac spine -> pubic tubercle

Deep ring = Posterior wall, midpoint of inguinal ligament
Superficial ring = Anterior wall, superior and medial to pubic tubercle

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1
Q

What are the boundaries of Hesselbach’s triangle

A

Rectus abdominis
Inf epigastric artery
Inguinal ligament

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1
Q

Which organs are intraperitoneal

A

Stomach
Duodenum
Jejunum
Ileum
Transverse/sigmoid colon
Liver and spleen

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1
Q

What are the features of the greater omentum

A

Wraps around inflamed parts to isolate the inflammation
Contains gastroomental arteries

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1
Q

Compare direct and indirect inguinal hernias

A

DIrect
- Pass through Hesselbach’s triangle
- Suppressed by cough reflex
- Older people

Indirect
- Pass through deep ring => canal
- Younger people
- More commo

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1
Q

Which organs are retroperitoneal

A

Suprarenal glands
Kidneys
Ureters
Rectum

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1
Q

What are the borders of the esophagus

A

starts at C6, penetrates diaphragm at T10

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1
Q

Describe oesophagus histology

A

Mucosa = Stratified squamous epithelium
Submucosa = Meissner’s plexus w blood vessels
Muscular Externa = upper 1/3 striated, mid 1/3 mix, lower 1/3 SM
Adventitia = Loose connective tissue

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1
Q

What are the parts of the stomach

A

Fundus, Body , Cardia, Pylorus
Cardiac/ Pyloric orifices
Greater/Lesser curvature

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1
Q

Describe stomach histology

A

Mucosa = Simple columnar cells w gastric glands and pits, w parietal and chief cells
Submucosa = Rugae
Muscular Externa => Ext peristalsis
Serosa = Covered in extraperitoneum

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1
Q

What are the relations of the stomach

A

Anterior = Liver, Diaphragm
Stomach bed = Pancreas, L kidney, Transv colon
Posterior = Lesser sac, spleen and splenic A

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1
Q

What are the surfaces, recesses and ligaments of the liver

A

Hepatorenal, Subphrenic recesses
Diaphragmatic, Visceral surfaces
Falciform ligament and Ligamentum Trees/Venosum

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1
Q

How can the liver be divided

A

Anatomical =. Falciform ligament splits L/R lobes

Functional
- L & Quadrate lobe
- Caudate lobe
- R lobe

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1
What are the relations to the liver
Sup = Diaphragm Post = R kidney, Colon, Esophagus Inf = Stomach, GB Medial = Pancreas
1
Describe liver histology
Hexagonal liver lobule w central vein Portal triad @sinusoid corners = Hepatic A/V, bile duct Kupffer cells = macrophages Space of Disse w hepatic stellate cells = Vit A storage
1
What is the location of the gallbladder and where is it palpated
Lies on liver visceral surface Palpated at CC9
1
What are the relations to the gallbladder
Sup = Liver Inf = Duodenum, Transv colon Post = R kidney, IVC
1
What is the innervation of the gallbladder
Right phrenic nerve
1
Describe gallbladder histology
Simple columnar w microvili
1
Describe the flow of bile in the biliary tree
L/R hepatic duct => Common hepatic duct Common hepatic duct + Cystic duct => Common bile duct Common bile duct + Pancreatic duct => Ampulla of Vater
1
Where is the spleen located
Lies against left rib 9-11
1
What are the relations to the spleen
Ant = stomach Post = Diaphragm, Ribs 9-11 Medial = Pancreas tail
1
What are the cells of the pancreas
Pale endocrine regions = Islets of Langerhans Exocrine regions = Acinar &. Ductal cells
1
What are the parts of the pancreas
Head, neck, body, tail & ucinate process
1
What are the relations to the pancreas
Head = Duodenum, Bile duct Neck = SMA/V, Splenic V Body = L kidney Tail = Spleen hilum
1
Describe the duct system of the pancreas
Main pancreatic duct => Ampulla Accessory pancreatic duct => Duodenum
1
Which vessel does the liver receives most of its blood supply from
Portal vein
1
Describe small intestine histology
Mucosa - Simple columnar epithelium - Brush border, Goblet, Paneth, Endocrine cells - Pilae circulares, vili, microvili Submucosa - Meissner's plexus - Brunner's gland (Duodenum) - Peyer's patches (Ileum)
1
Which part of the duodenum is most prone to ulcers
1st part
1
Which part of the duodenum is intraperitoneal
1st part
1
Compare the Jejunum to Ileum
Jejunum - prox 2/5 - Wider and thicker walls -Less prominent arterial arcades - Longer vasa recta Ileum - Distal 3/5 - Narrower and thinner walls - More prominent arterial arcades - Shorter vasa recta
1
What is the function of the ileocecal valve
Prevent reflux into ileum
1
What are the features of the colon
Omental appendices = Small fatty projections Triple Taenia coli = longitudinal SM bands Haustra = sacs
1
Describe colon histology
Mucosa = no vili Submucosa = Meissner's plexus Muscular Externa = Taenia coli
1
Describe rectum histology
Upper 2/3 simple columnar Lower 1/3 simple squamous
1
How does the rectum form
Upper 2/3 originate from hindgut Lower 1/3 from ectoderm
1
Describe anus epithelium
Above pectinate line - Simple columnar - Lacks pain sensation Below pectinate line - Stratified squamous - Sensitive to pain
1
What are the sphincters of the anus and their innervation
Int sphincter = Inf hypogastric plexus & pelvic splanchnic nerve Ext sphincter = Pudendal => Inf rectal nerve
1
What is the innervation of the midgut
Parasympathetic = Vagus nerve Sympathetic = Sup mesenteric ganglion => Lesser splanchnic (T10-12)
1
What is the innervation of the foregut
Parasympathetic = Vagus nerve Sympathetic = Greater splanchnic (T5-9)
1
What is the innervation of the hindgut
Parasympathetic = Pelvic splanchnic Sympathetic = Inf mesenteric ganglion => Lumbar splanchnic (L1,2)
1
Where is pain referred to for different parts of the GIT
Foregut = Epigastric Midgut = Umbilicus Hindgut = Hypogastric
1
What is the lymphatic drainage of the GIT
Foregut = Celiac nodes Midgut = Sup Mesenteric nodes Hindgut = Inf Mesenteric nodes
1
What are the 3 main branches of the abdominal aorta
Celiac trunk (T12) => foregut SMA (L1) => midgut IMA (L3) => hindgut
1
Describe circulation of the spleen
Celiac trunk => Splenic A Splenic V => Portal V
1
Describe circulation of the stomach
Arterial - Fundus & Greater curve = Splenic A => L/R GO A - Lesser curve = L gastric A // Common hepatic A => Hepatic A proper => R gastric A Venous - Short gastric/ L GO V => Splenic V - R GO V => SMV
1
Describe blood supply of the esophagus
L gastric A
1
Describe blood supply of the GB
R hepatic A => cystic artery
1
Describe circulation of the liver
- Common hepatic A => Hepatic A proper => L/R hepatic A => liver - Portal V => liver Hepatic vein => IVC
1
Describe circulation of the pancreas
Arterial same as duodenum + Splenic A Venous same as duodenum + Pancreatic V => Splenic V
1
Describe circulation of the duodenum
Arterial - Common hepatic A => Gastroduodenal A => Sup PDA - SMA => Inf PDA Venous - PDV => SMV
1
Describe circulation of the jejunum & ileum
SMA & SMV
1
Describe blood supply of the ascending colon
SMA - Ileocecal A => ant/post cecal A - R colic A
1
Describe blood supply of the transverse colon
SMA => middle colic A IMA => L colic A
1
Describe blood supply of the sigmoid colon
IMA => Sigmoidal A
1
Describe blood supply of the descending colon
IMA => L colic A
1
Describe circulation of the rectum and anus
Arterial - IMA => Sup rectal A - Int iliac A => Mid/Inf rectal A Venous - Rectal V => IMV
1
How is storage stimulated in the stomach
Receptive relaxation (peristaltic waves) Feedback relaxation (SI signals) Adaptive relaxation - Distension => vagus nerve => medulla => release NO & VIP => SM relax *VIP = vasoactive intestinal peptide
1
How is the GIT regulated neurally
Short reflex = interneurons of ENS Long reflex - Vagal afferents => medulla - Vagal efferents => ENS
1
What are the processes that occur in the mouth
Mastification = Mixing of food w saliva amylase Swallowing = Oral bolus formation => Pharyngeal swallow reflex and UES open => Oesophageal primary/secondary peristalsis
1
How does churning occur in the stomach
Antrum peristalsis pushes bolus towards closed pylorus => Antrum churns trapped material => Breakdown and mixing w pepsin => Muscular activity pushes bolus back => Repeat
1
How is gastric motility regulated
Stimulated by gastrin, ACh Inhibited by CCK, secretin and GIP *GIP = gastric inhibitory peptide
1
What affects gastric emptying rate
Liquids empty faster than solids Acid pH inhibits emptying Hypertonicity inhibits emptying Fatty acids inhibit emptying
1
Briefly describe small intestine motility
Peristalsis = moves bolus forward Segmentation = coordinated contraction breaks up bolus Migrating Motor Complex = sweeps food debris into colon during absence of food & prevents migration of colonic flora
1
How is colon peristalsis regulated
Stimulated by gastroduodenal distension => Gastro-colic/duodenal reflex Inhibited by opiates
1
How is small intestine motility reguated
Peristalsis = distension Segmentation = bolus presence => local reflex MMC = motilin
1
Describe the changes that occur when defecation is desired
Int sphincter = Rectum distension => Rectosphincteric reflex => relaxation Ext sphincter & pelvic muscle relax; Abdominal muscles contract
1
Describe the changes that occur when defecation is not desired
Sacral nerves => involuntary reflex => ext sphincter contracts
1
What is secreted by the stomach
HCl = Parietal cells IF = Parietal cells Pepsinogen = Chief cells Gastrin = G cells
2
How is HCl secreted
CO2 + H2O -> H2CO3 (carbonic anhydrase) => H+/K+ ATPase pumps out H+ => blood exchanges HCO3- for Cl- => Cl- passively transported across parietal cells
2
How is HCl secretion regulated
Cephalic phase (30%) = Emotions, smell/taste/sight of food => vagus nerve Gastric phase (60%) = Stretch/chemoreceptors =>vagus nerve/ gastrin Intestinal phase (10%) = Decrease SI pH => vagus nerve/ gastrin
3
How is IF secretion regulated
Stimulated by gastrin, histamine and vagus nerve
3
How is pepsinogen activated
Autocatalytic => pepsin (sped up by acid pH) - highest activity at pH 3 - inactivated by duodenum alkaline pH
4
How is pepsinogen secretion regulated
Stimulated by vagus nerve, gastrin
5
How is gastrin secretion regulated
Stimulated by vagus nerve and gastric distension
5
What are the secretions of the pancreas
Enzymes (Acinar cells) = A-amylase, Lipases, Nucleases, Proteases HCO3- (Ductal cells) Endocrine (Islets of Langerhans) = Insulin Glucagon, Somatostatin, Ghrelin
5
Describe pancreas protease auto protection
Proteases - Synthesised at low pH => inhibits proper folding - Compartmentalised - Secreted as zymogens w protease inhibitors
5
What are the effects of gastrin
Increase HCl, pepsinogen, pancreatic secretions Increase GI motility Increase GI mucosa growth
5
What are the functions of pancreatic enzymes
A-amylase = Complex carbs => Disaccharides Lipases = Fat => FFA Nucleases = Nucleic acid breakdown Proteases = Enterokinase => Trypsinogen -> Trypsin => activates other proteases
5
What are the functions of Cholecystokinin
Increase enzyme rich pancreatic secretions Increase GB SM contraction & Oddi sphincter relaxation => increase bile release Decrease hepatic bile salts Decrease gastric emptying rate
5
What is the origin of cholecystokinin and how is it regulated
Secreted by I cells Stimulated by fatty/amino acids Inhibited by trypsin
5
How are pancreatic secretions regulated
Cephalic/ Gastric phase = Sight/smell/presence of food => vagus nerve directly activate Acinar & Ductal cells or via gastrin release by G cells Intestinal phase - H+ => Increase secretin by S cells => Ductal cells => increase HCO3- - Protein/Lipid breakdown => Increase CCK by duodenal I cells => increase Acinar cell secretions
6
Describe the process of bile synthesis, release and reabsorption
Liver synthesises bile acids and salts -> common hepatic duct -> GB CCK => GB contract and sphincter Oddi relax => Bile release into duodenum Reabsorbed at terminal ileum via Na+ dependant co-transport
6
What is secreted by the intestines
Small intestine = Cl- and HCO3- Large intestine = HCO3-, Cl- and K+
6
Describe the process of small intestine secretion
HCO3- = H2O + CO2 -> HCO3- + H+ (carbonic anhydrase) => H+ into plasma (NHE3) HCO3- into SI (CFTR) Cl- = Na+/K+/Cl- ATPase => Cl-, K+ co-transport into cell => Cl- into SI (CFTR)
6
How are intestinal secretions regulated
Stimulated by mucosa irritation and gut distension => ACh and PG
6
How are carbs digested and absorbed
Amylase breakdown carbs -> disaccharides => SI lactase, maltase etc => disaccharide -> monosaccharides Absorbed at duodenum and jejunum - Glucose, Galactose, Xylose = SGLT1 - Fructose = facilitated transport
6
How are fats digested and absorbed
Emulsified by bile => lipases => fat -> FFA SCFA = synthesised by colon flora, absorbed in colon MCFA = Micelle/chylomicron formation / re-esterification not required LCFA - Micelle formation passes mucin -> microvili => absorbed by diffusion/ carrier-mediated transport - Re-esterification => Chylomicrons => Exocytosis -> lacteals => thoracic duct
6
How are proteins digested and absorbed
Pepsin and proteases => proteins -> oligopeptides and AA => SI peptidases => peptides -> AA Absorbed by duodenum and jejunum (colon 10%) - AA = Na+/AA secondary active transport - Di/Tripeptides = carrier transport - Proteins = degraded by intracellular peptidases
7
How is Vit B12 processed and absorbed
Acid pH + pepsin releases B12 from proteins => Haptocorrin binds B12 => proteolytic degradation => release B12 => binds w IF => absorbed at terminal ileum
7
List the functions of the liver
Bile production Metabolism Protein synthesis (albumin/clotting factors) Vit D activation for Ca2+ reabsorption Detoxification Vit/mineral storage Extramedullary hematopoiesis
7
Briefly describe the metabolism of carbs in the liver
Glucose-6-phosphatase => export glucose from glycogens stores
7
Briefly describe the metabolism of lipids in the liver
VLDL & triglyceride synthesis Ketogenesis
7
Briefly describe the metabolism of proteins in the liver
Plasma protein synthesis eg albumin Deamination and urea cycle

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