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Tosu Aris Intro To GI > Intro To Alimentary System > Flashcards

Intro To Alimentary System Flashcards

1
Q

Which are the solid organs of the digestive system? (4)

A

The accessory organs.

Salivary glands
Liver
Pancreas
Gallbladder

Why ate the salivary glands so important? Could we live without them?

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2
Q

Recall the symptoms of Sjogrens disease

A

See canva patient ‘Kathy’

Fatigue- extreme like altitude sickness
Aches
Eye dryness
Vaginal dryness
Mouth dryness

May have eye ulcers, dental cavities, candida infections of mouth and vagina

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3
Q

Why would you have dental cavities in Sjogren’s disease?

A

Saliva is there with antibacterial properties, and lubrication on the teeth that protect them when grinding and chewing (imagine those sumo wrestlers on the teeth).

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4
Q

What med is used in sjogrens to stimulate tear and saliva production?

A

Pilocarpine (oral)

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5
Q

Hydroxycholoroquine is what and used for what

A

It’s a DMARD used for: sjogrens, lupus, RA, and also malaria weirdly enough

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6
Q

What antibodies for sjogrens and what image to remember

A

It’s that florist shop: Abrola.

Anti ss-a and anti ss-b, aka anti-ro and anti-la

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7
Q

What quick test with filter paper can you do for sjogrens, and what test do you use for diagnosis?

A

Schirmir test
And
Blood test aka serology test

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8
Q

What’s a serology test

A

Antibody test

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9
Q

Why do we need the 99% of water component saliva, apart from softening and moistening?

A

Dilute particles to reduce the osmotic pressure, which was raised because the food has been broken down.

Osmotic pressure is essentially the pressure needed to stop water from moving through a semipermeable membrane when it’s trying to balance out the concentration of dissolved stuff on both sides. It’s like the pressure you’d feel if you were trying to keep a bunch of people from pushing through a door to get to the other side

So MORE dilution, more water in the saliva = isotonic/ same concentration everywhere, everything’s equal.

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10
Q

What catalyses the breakdown of polysaccharides like starch and glycogen into what?

A

A-amylase, into disaccharides

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11
Q

Structure of the oesophagus

A
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12
Q

Function of the oesophagus

A
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13
Q

Structure of the atomach

A
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14
Q

Function of the stomach

A
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15
Q

How many muscles does it take to swallow?

A

26

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16
Q

How many nerves does swallowing involve?

A

6

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17
Q

Which two nervous system mechanisms control chewing? (2)

A

Voluntary- somatic nerves for skeletal muscles of mouth and jaw

Chewing Reflex via mechanoreceptors

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18
Q

We can eat for hours. This is made easier by the chewing reflex. When pressure of food is felt by mechanoreceptors, what happens?

A

Inhibition of jaw muscles I.e. they relax

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19
Q

What three salivary glands do we have

A

Sublingual
Submandibular
Parotid

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20
Q

The parotid glands extend from where

A

Top of the ear and mainly irrigates top/upper part of the mouth

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21
Q

Which salivary gland is most used when you’re talking

A

The sublingual, irrigates just under the tongue

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22
Q

The polysaccharide starch can be broken into the disaccharides. For starch, which are these?

A

Maltose and glucose

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23
Q

Where are the two places that a-amylase is secreted?

A

Salivary glands and also the pancreas

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24
Q

Autocrine vs endocrine vs exocrine vs paracrine

A

Auto- works on same cell
Para- works on neighbouring cells
exo- ducts
endo- directly into bloodstream

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25
Q

Layers of the alimentary canal???

A

Mucosa-
epithelium, lamina propria (absorb and secrete)
muscularis mucosae (for motility)

Submucosa- large blood vessels, neurons, lymph nodes

Muscularis externa

Serosa/ adventitia

this ms,ms and within mucosa, ELM like elmfield terrace

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26
Q

When Serosa/ adventitia? (This is connective tissue)

A

Serosa = in peritoneal cavity
Adventitia otherwise eg rectum

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27
Q

Muscularis externa is made up of what two muscle layers

A

Circular- inner layer (constricts lumen, makes lumen smaller) and longitudinal (shortening in length of GIT)

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28
Q

Two plexuses ie the intramural ones?

A

Submucosal and a myenteric

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29
Q

Mouth and esophagus rectum and anus, what cells

A

Stratified squamous

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30
Q

Stomach, small and large intestine what cells

A

Simple columnar, only one layer for easy absorption

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31
Q

That picture I took- nerves of the GI system

A
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32
Q

Salivation: this has two stimulators / controlling nerves (for autonomic- remember it’s not voluntary therefore not somatic!)

What are they?

A

Parasympathetic (vagus) and sympathetic (splanchnic nerve)

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33
Q

What three main arteries supply the GIT?

A

Celiac trunk, super and inferior mesenteric artery

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34
Q

The small intestine is fed by what two arteries

A

Celiac and superior mesenteric

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35
Q

The colon is fed by what two arteries, and where is the split?

A

S and I mesenteric arteries…. Descending and Cecum is the I

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36
Q

Venous drainage of GI tract ????

A
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37
Q

Maltose is what?

A

Glucose and glucose

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38
Q

Sucrose is what

A

Glucose and fructose

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39
Q

Lactose is what

A

Glucose and galactose

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40
Q

Where and what can degrade cellulose

A

Bacteria in the large intestine

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41
Q

What is a PPI

A

a proton pump inhibitor, for example omeprazole. Its used to treat gastric reflux, stomach ulcers, H pylori infections etc. They bind to the proton pump to inhibit gastric acid secretion.

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42
Q

Poly saccharides the have alpha 1,4 glycosidic bond. What enzyme is the only one that can break that?

For example, this polysaccharide could be starch

A

amylase, which can be found in saliva, and pancreatic juices (which are released into the duodenum)

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43
Q

Sodium potassium pump: where exactly is this located in the lining of the stomach? How is it involved in carb absorption?

A

the basolateral side of the epithelium

3 Na out, 2 K in

It provides a concentration gradient for sodium, so that the SGLT1 transporter on the apical side, lets in both glucose and Na

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44
Q

Glucose transport from lumen to blood relies on what three pumps/transporters? Draw this is unsure.

A

basolateral membrane: Na/K pump creates gradient for sodium

SGLT1 transporter lets in both Na and glucose and galactose

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45
Q

Normal glucose levels in the blood

A

between 4 and 7 mmol/l, whereas prediabetes is

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46
Q

Sodium plus glucose rehydration in the case of cholera. Why?

A

glucose encourages sodium to enter via the sglt1, and water follows sodium

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47
Q

Proteins are what

A

Polymers of amino acids linked together by peptide bonds

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48
Q

Fat soluble vs water soluble vitamins. Which are the fat soluble?

A

A D E K

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49
Q

water soluble vitamins are not stored in the body. They can be easily lost when you poo such as
and except which one?

A

B and C. Except B12, which can be stored in the liver

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50
Q

where are fat soluble vs water soluble vitamins absorbed

A

Fat soluble = in the duodenum as fat molecules, vs water soluble is in both small and large

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51
Q

why would most of the food we eat be formed from macromolecules?

A

In order to keep osmolarity low, so that you don’t attract too much water. We need a controlled breakdown, or we’ll suddenly withdraw a lot of water to keep osmolarity

e.g. glucose = glycogen, amino acids = protiens

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52
Q

maltose, sucrose and lactose are disaccharides broken down by what?

A

maltase, sucrase, and lactase

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53
Q

where are carbs broken down and absorbed?

A

in the small intestine

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54
Q

how are carbs absorbed?

A

transcellularly or paracellularly

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55
Q

What pumps/transport do proteins use to be absorbed, after being broken down?

A

3 different.

First of all, the Na/K pump to create gradient, and then the SAAT1 pump to let in amino acids and Na. I.e. the sodium/ amino acid transporter.
Then they are transported across the basolateral membrane via facilitated diffusion

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56
Q

peptide bonds in proteins are hydrolysed by what

A

proteases and peptidases

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57
Q

Amino acids use the sodium-amino acid transporter one to enter on the apical side. (SAAT1). What about di or tri-peptides?

A

They would use PEPT1

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58
Q

What transporter does penicillin use to enter on the apical side?

A

PEPT1

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59
Q

What three types of ‘lipases’ digest fats?

A

lingual
gastric
pancreatic

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60
Q

what ‘hurdles’ need to be overcome for the pancreatic lipase to be secreted?

A

gastric acid and presence of partially digested fats stimulate our secretary and CEO: secretin (stimulates bicarbonate production for optimum pH) and CCK (stimulates pancreases for pancreatic lipase, and also the liver to release bile

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61
Q

how does bile emulsify fats/lipids

A

bile salts and phospholipids on the outside, with hydrophobic internally, surrounding the the fatty acids and monoacylglycerol, polar on the outside.

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62
Q

how are the micelles absorbed in the apical side?

A

they turn back into fatty acids and monocylglycerides

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63
Q

what happens to the fatty acids and monocylglycerides on the basolateral side?

A

well they become chylomicrons, then pass through lacteals and enter the lymphatic system

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64
Q

how is iron absorbed? Then what happens? (2)

A

iron is absorbed by being transported across the duodenal brush border by DMT1. 1) it can be found combining with ferritin, and being stored. 2) Unbound iron binds to transferrin

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65
Q

what drugs might inhibit iron absorption

A

PPI’s as need right pH

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66
Q

PepT1 is a transporter on apical needed for larger amino acids ie di and tri peptides to be absorbed in- as they can’t use the usual sodium/amino acid transporter. How is this activated?

A

By the sodium hydrogen pump which pumps out hydrogen ions to create a pH microclimate

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67
Q

in layers of the gut: we know the muscularis externa is made up of circular, then longitudinal muscle layers. What, then, is the muscularis mucosae of the mucosa?

A

just the muscularis interna that is there for local movement of the mucosa

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68
Q

what is motility, how does it work

A

the ability of an organism to move independently via metabolic energy

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69
Q

what’s segmentation

A

churning up, moving food back and forth, of circular muscles to make lumen smaller

70
Q

what’s peristalsis

A

moving from mouth to arse, constriction of longitudinal muscles to shorten lumen

71
Q

where is water absorption

A

large intestine

72
Q

where is meissner’s plexus located?

A

submucosa

73
Q

which plexus is located between the circular and longitudinal muscles in the muscularis externa? (msMs)

A

Myenteric. That makes sense. It innervates the MAIN muscles. ( the muscularis interna/mucosa is located in the mucosa and is involved in local movement only in the mucosa.

74
Q

difference between the serosa and the peritoneum- after all, they are both similar in being two layered- having a visceral layer and a parietal layer.

A

serosa- means visceral layer is touching organs that are within the peritoneum. includes stomach, spleen, liver, duodenum and transverse colon. binds these organs together

vs adventitia is for the retroperitoneal and binds the organs outside the p. cavity to the abdominal wall

75
Q

parasympathetic of the GIT is from the vagus nerve. What is the exception?

A

salivation = facial and glossopharyngeal

76
Q

inhibitory control of GIT is what nerve

A

splanchnic, is sympa

stimulatory is vagus obvs cuz its parasympa

77
Q

veinous drainage of stomach

A

gastric veins

78
Q

veinous drainage of pancreas

A

splenic vein

79
Q

veinous drainage of small, caecum, ascending, and transverse =

A

superior mesenteric vein

80
Q

descending, sigmoid and rectum veinous drainage =

A

the inferior mesenteric vein

81
Q

When in development is body axis established?

A

week 2

with the gene PTX2

82
Q

week two embryology
vs
week 3

A

week 2 = bilaminar disc formation

week 3 = trilaminar disc formation

83
Q

one word to describe embryology between wee 3 and week 8?

A

organogenesis

84
Q

Exposure to teratogenic drugs during which weeks can cause organ malformation?

A

3-8 because this is when organogenesis occurs

85
Q
A

The right vagus nerve supplies posterior part of the stomach and the left vagus supplies the anterior wall of the stomach.

86
Q

Abdominal wall muscles come from which germ layer

A

Mesoderm

87
Q

Peritoneum coverings come from which germ layer

A

Mesodermal

88
Q

Connective tissue comes from which germ layer

A

Mesoderm

89
Q

Epithelial lining of the GI comes from which germ layer

A

Endoderm

90
Q

spleen is what origin

A
91
Q

where does the midgut extend to?

A

opening of the bile duct to the proximal 2/3 of the transverse colon

makes sense because bile duct is related to the liver, and the liver originates in the hindgut

92
Q

what week does umbilical herniation (of midgut) occur?

A

week 6

93
Q

Which parts of the colon are retroperitoneal?

A

ascending and descending

94
Q

what’s the transverse mesocolon?

A

mesentery of the transverse colon

95
Q

mesentery of the small intestine is called what

A

the mesentery proper

96
Q

Symptoms of malrotation due to abnormal development.

A

One of the earliest signs of malrotation is abdominal pain and cramping caused by the inability of the bowel to push food past the obstruction.

Babies with cramps and pain due to malrotation frequently follow a typical pattern: they may draw their legs up and cry, settle for about 10 to 15 minutes and then begin to cry again.

97
Q

origin of the anal canal

A

the cranial part is endodermal in origin, whilst the caudal part is ectodermal in origin

98
Q

Blood supply to the anal canal.

A

The anal canal above the pectinate line is supplied by inferior mesenteric artery and below the pectinate line is supplied by internal pudendal artery, which is a branch of internal iliac artery.

99
Q

What’s a uro-rectal fistula

A

when the rectum has connection with the urethra- this usually occurs in males.

100
Q

what do the following germ layers, which develop during gastrulation.
ectoderm
mesoderm
endoderm

A

ectoderm = This forms everything that makes someone attractive and organs you can touch: skin, hair, teeth, nails. And then also mouth, anus, nostril linings. This also develops into the nervous system. Seeing someone attractive makes you nervous?

mesoderm = Mesoderm
MSK, CV, repro. I remember this as everything that makes a man attractive: their muscles and bone structure, their heart, and their reproductive organs.

endoderm = Genderless organs. The bladder, pancreas, thyroid, parathyroid, liver, lungs, GI tract.

101
Q

What happens just before gastrulation?

A

Bilaminar disc, hypoblast cells then epiblast cells
Then the primitive streak
Then migration of epiblast cells to form the third layer

102
Q

What happens in week 2 and 3 of embryonic development?

A

Week 2 = when the bilaminar disc development occurs.

Week 3 = when the trilaminar disc development occurs.

103
Q

If I’m picturing the development of the gut tube with the piece of paper imagery I had described in canva, then I can picture the folds to create the ‘floor’ of the tent. Those floor tiles actually become two layered. What are these two layers?

A

We’re talking about the mesodermal layers here. The mesoderm separates into visceral and parietal layers. That visceral one is the splanchnic lateral mesoderm, which becomes the muscularis externa

104
Q

The layers of the gut tube: mucosa and muscularis externa. Where do these layers originate?

A

Mucosa = the endoderm

Muscularis externa = think. It’s muscles. Must be the mesoderm.

And remember that the mesoderm develops into two layers? Well, we have the visceral/splanchnic layer that becomes the muscularis externa. The other parietal layer becomes like

105
Q

The endoderm extends out to become the umbilical cord and what duct

A

vitelline duct

106
Q

when might an umbilical hernia disappear

A

by 4-5 years

107
Q

where does the mesoderm rupture and why

A

pharyngeal membrane to become the mouth
cloacal membrane to become the anus and opening of the urogenital systems.

108
Q

why does your breath smell in the morning

A

because you have less saliva overnight

109
Q

the serous alveolus of salivary glands will secrete what

A

alpha-amylase and it will also secrete lysosomes.

110
Q

Function of lysosome in regards to saliva?

A

binds to bacteria, ruptures the wall, and kills it.

111
Q

Sympathetic is inhibitory everywhere in the GI tract except where?

A

the salivary gland.

112
Q

ALL of the GI tract is stimulated by what nerve (except the salivary glands)

A

the vagus nerve

113
Q

the salivary glands are stimulated by which cranial nerves

A

facial and glossopharyngeal

stimulation means profuse watery saliva, not viscous.

114
Q

the activation of which receptor leads to high mucus content in saliva

A

alpha one adrenoreceptors by norepinephrine

115
Q

the activation of which receptor leads to high amylase content in saliva

A

beta two adrenoreceptors

116
Q

The oesophagus is stratified squamous epithelium and is non-keratinised. The skin is stratified squamous epithelium, and is keratinised. Why is there a difference?

A

Because the oesophagus needs not be rigid, whereas the skin needs that extra rigidity and

117
Q

Function of glands in the oesophagus

A

ducts provide lubrication

118
Q

How does the muscularis externa split in the oesophagus?

A

upper1/3 is skeletal muscle
lower 2/3 is smooth muscle

119
Q

Heartburn occurs when stomach contents pass through where

A

the lower esophageal sphincter

120
Q

why do we need oesophageal sphincters?

A

upper one guards the airway- stops air entering during breathing, and stops food from travelling up and causing aspiration

the lower one stops stomach contents from being regurgitated.

121
Q

why might babies regurgitate

A

upper oesophageal sphincter may not be completely working

122
Q

what part of swallowing is voluntary

A

pushing the bolus to the back of the mouth with the tongue

123
Q

To the patient, what does regurgitation feel like vs vomiting

A

vomiting is forceful expulsion of gastric contents, probably preceded by feelings of nausea

124
Q

After stomach cancer, with partial removal of the stomach, what life-style changes would someone need to make

A

they would need to have certain foods, as they wouldn’t have had the stomach digestion phase.

for example, whilst carb digestion starts in the mouth with amylase, protein digestion starts mainly in the stomach.

125
Q

where is intrinsic factor produced?

A

GASTRIC epithelial cells.

Whilst the absorption occurs in the distal ileum.

126
Q

what part of the stomach connects between it and the oesophagus?

A

the cardiac region.
because food first goes to the ‘heart’ of the stomach.

127
Q

why is the pyloric sphincter 4 layer?

A

Because it is inside the peritoneal cavity. so it has:
mucosa (elm)
submucosa
circular muscle
longitudinal muscle
serosa

128
Q

where is the antrum of the stomach?

A

closest to the greater curvature

129
Q

muscle layers in the stomach

A

circular
oblique - for twisting
longitudinal

130
Q

Purpose of rugae of the mucosa and submucosa of the stomach?

A

It’s kinda like different plates in the stomach to help the stomach contract to a smaller size, or enlarge

131
Q

In terms of histology, what makes the stomach distinguishable?

A

surface mucus cells, with gastric pits and gastric glands and presence of mucus neck, chief and parietal cells.

132
Q
A
133
Q

The esophagus has 3 constrictions which you need to be aware of if you are passing instruments through the oesophagus into the stomach; where are these?

A

Cervical region like 15 cm down from incisor teeth (IT)

Thoracic 20cm down where crossed by arch of aorta and also left main bronchus just after that

Diaphragmatic where is passes through the oesophageal hiatus of the diaphragm, 40cm from IT

134
Q

McBurney’s point

A
135
Q

The dermatomal level of the umbilicus is T10, what is the vertebral level?

A

L3-4- same as where the bottom of the kidneys are located

136
Q

external oblique insertion and origin

A

ribs 5-12 above, and onto the pubic tubercle, symphysis, and asis, iliac crest, linea alba

137
Q

ribs 7-10 either correlate to the external oblique muscles, or the costal margin. Which is it?

A

Ribs 7-10 contribute to the costal margin, whereas the external oblique muscles attach onto the 5th-12th ribs

138
Q

action of external oblique

A

abdominal press, lateral flexion, rotation, flexion of trunk when contracted bilaterally

139
Q

internal oblique is located deep to the external oblique. Attachments?

A

Originates from the inguinal ligament, iliac crest and lumbodorsal fascia. It inserts onto ribs 10-12

140
Q

lateral border of the rectus abdominus is demarcated by what surface anatomy

A

the Linea semi-lunaris lines

141
Q

why would a midline surgical incision be preferred?

A

Because that would be through the linea alba.

It can be extended the whole length of the abdomen by curving around the umbilicus. The linea alba is poorly vascularised, so blood loss is minimal, and major nerves are avoided. It can be used in any procedure that requires access to the abdominal cavity.

142
Q

whats the craic with the paramedian incision

A

Similar to the median incision, but is performed laterally to the linea alba, providing access to more lateral structures (kidney, spleen and adrenals). This method ligates the blood and nerve supply to muscles medial to the incision, resulting in their atrophy.

143
Q

the abdominal wall muscles are innervated by the thoracoabdominal/ intercostal nerves T7-11, and T12 the subcostal nerve. Why is T12 special

A

Because it is SUBcostal. It’s not an intercostal nerve. It’s special.

144
Q

inferior to the actuate line, what is deep to the rectus abdominus

A

the transversalis fascia

145
Q

explain rectus sheath before actuate line

A

eo and io superficial, deep = io and ta and transversalis fascia

146
Q

Caput medusa is the formation of dilated abdominal wall veins which extend from the umbilicus. Why might this occur?

A

The superficial veins might become dilated secondary to portal hypertension in severe cases. This can lead to

147
Q

content of inguinal canal

A

spermatic cord/round ligament

and ilioinguinal nerve

148
Q

bottom wall/ floor of inguinal canal

A

inguinal ligament
maLt inguinal ligament (and lacunar ligament? don’t even know what that is).

149
Q

anterior wall of inguinal canal

A

mAlt, two aponeurosis’

external oblique and reinforced by the internal oblique near the iliac crest

  • makes sense, because the internal oblique goes all the way to the iliac crest but the external oblique only goes to the pubic tubercle
150
Q

what forms the conjoined tendon and where does it insert?

if unsure see the youtube video ‘3D tour of the inguinal canal’

A

both the transversalis abdominis and the internal oblique, and it inserts onto the pubic tubercle. It was formed just after the internal oblique and the ta travel together to form the roof of the inguinal canal

151
Q

posterior wall of the inguinal canal

A

malT
2xT,
transversalis fascia and the conjoined Tendon

152
Q

roof of inguinal canal

A

io and ta, that at the corner forms the conjoined tendon
Malt
think 2xm, two muscles

153
Q

the deep inguinal ring is actually a hole in what

A

the transversalis fascia

154
Q

the superficial inguinal ring is actually a hole in what

A

the external oblique aponeurosis

cuz thats the anterior wall
we also see the internal oblique reinforcing part of the anterior wall

155
Q

98% of people are diagnosed with sjogrens after what symptom presents

A

nerve pain

156
Q

What anatomical point is used surgically to determine the location of the superficial inguinal ring?

A

The superficial inguinal ring can be located surgically by identifying the pubic tubercle. The superficial inguinal ring lies just superior and lateral to the pubic tubercle

157
Q

where is the deep inguinal ring located

A

halfway along the inguinal ligament, i.e. halfway between the ASIS and the pubic tubercle

158
Q

As the inguinal canal is forms an outpouching of the abdominal wall, the layers are pulled with it to form the wall of:

A

the spermatic cord and the scrotum

159
Q

list all the back muscles and their attachments. see teach me anatomy for answers because bro you should know this

A

an example answer:

quadratus lumborum. Comes from POSTERIOR iliac crest, lumbar vertebrae one to five, and 12th rib. Lateral flexion of torso, and bilaterally = extension of torso

160
Q

which abdominal posterior back muscle attaches to the femur

A

iliopsoas

161
Q

What does the central tendon of the diaphragm attach onto?

A

the pericardium

162
Q

What levels do the three major abdominal vessels come off?

A

T12 > celiac
L1 > superior mesenteric
L3 > inferior mesenteric

163
Q

Where does the inferior mesenteric vein drain into?

A

The splenic vein

164
Q

The foregut is supplied by the celiac trunk which comes off the aorta anteriorly at T12. Therefore, all lymph for foregut structures will drain to which lymph nodes?

A

Pre-aortic nodes at T12

165
Q

Name the prevertebral sympathetic ganglion

A

celiac ganglion
superior mesenteric ganglion
inferior mesenteric ganglion

so abdominopelvic splanchnic nerves synapse there then join the abdominal aortic plexuses

166
Q

what are the parasympathetic nerves

A

vagus nerve
pelvic splanchnic nerve s2, s3, s4

167
Q

What is the effect of vagotomy on gastric secretion?

A

A vagotomy reduces gastric acid secretion by cutting the vagus nerve at the gastroesophageal junction, which reduces the nervous stimulation of the parietal cells.

severe gastric peptide ulcer disease

168
Q

Referred pain of the gut region

A

The foregut tends to refer to the epigastric region. The midgut tends to refer to the umbilical region and the hindgut tends to refer to the suprapubic region.

169
Q

Referred pain is the reason why appendicitis pain is often initially described as an epigastric/umbilical pain. When the appendix is inflamed…

A

it then touches the peritoneum causing the pain to localise to the left iliac fossa.

170
Q
A

Tosu Aris Intro To GI (3 decks)

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