MSA Revision Flashcards
1
Q
What is the clinical name for altered taste in the mouth?
A
Dysgeusia
2
Q
What structure is affected by SI benign tumours
A
Ampulla of Vater
3
Q
Where do SI adenocarcinomas occur?
A
Duodenum
4
Q
What layer of the GI tract is not included in the oesophagus?
A
Serosa
5
Q
What lies deeper circular or longitudinal smooth muscle?
A
Circular
6
Q
When do spike potentials occur automatically?
A
-40mV
7
Q
What does VIP inhibit?
A
Sphincter muscles
8
Q
What stimulates Gastrin release?
A
- Protein
- Distention
- Nerve
9
Q
Where are G cells located?
A
- Antrum
- Duodenum
- Ileum
10
Q
Where are I cells located?
A
- SI
11
Q
What does CCK stimulate?
A
- Pancreatic enzyme secretion
- Pancreatic bicarbonate secretion
- Gallbladder contraction
12
Q
What does CCK inhibit?
A
Gastric emptying
13
Q
What is Secretin stimulated by?
A
- Acid
- Fat
14
Q
Where are S cells found?
A
SI
15
Q
What does Secretin stimulate
A
- Pepsin secretion
- Pancreatic bicarbonate secretion
- Biliary bicarbonate secretion
- Growth of exocrine pancreas
16
Q
What does secretin inhibit?
A
Gastric acid secretion
17
Q
What stimulates Gastric Inhibitory Peptide?
A
- Protein
- Fat
- Carbohydrate
18
Q
What cells secrete gastric inhibitory peptide?
A
K cells
19
Q
Where are K cells located?
A
Duodenum and Jejunum
20
Q
What does GIP stimulate?
A
Insulin release
21
Q
What does GIP inhibit?
A
Gastric acid secretion
22
Q
What stimulates motilin secretion?
A
- Fat
- Acid
- Nerve
23
Q
What cells secrete Motilin?
A
M cells
24
Q
Where are M cells located?
A
Duodenum and jejunum
25
What does Motilin stimulate?
- Gastric motility
| - Intestinal motility
26
What can increased blood flow to GI tract be due to?
- Vasodilators released from GI mucosa e.g CCK, VIP
- From GI glands e.g bradykinin
- Via decreased O2 concentration in gut wall due to increased metabolism
- Via subsequent adenosine release
27
What is the mastication process controlled by?
Brain stem nuclei
- Reticular areas for rythmical chewing
- Additional involvement from hypothalamus/amygdala/cerebral cortex
28
What part of the oesophagus acts as the lower oesophageal sphincter?
Last 3cm of oesophageal circular muscle
29
How long does it take for a wave to pass from the pharynx to stomach?
8 - 10 seconds
30
What does food entering the stomach form in the orad portion of the stomach?
Concentric circles
- Newest food lies closest to oesophaeal opening
- Oldest nearest outer wall
31
What is the vagovagal reflex?
- Food stretches stomach
- Vagovagal reflex, stomach -> brain stem -> back to stomach
- Decreased tone in stomach body wall
- Wall buldges progressively outward
- Greater quantities of food accomodated
32
What is the intrinsic defecation reflex mediated by?
- Rectal enteric NS
33
What is the parasympathetic defecation reflex?
- Fortifies intrinsic reflex
| - Involves sacral segments of spinal cord
34
What do probiotics produce?
- Lactic acid
| - Bacteriocins
35
What is antibiotic-use colitis called?
Pseudomembranous colitis (C. difficile)
36
What percentage of immunoglobulins/antibodies does the GI tract contain?
60%
37
What factors decrease secretion of saliva?
- Sleep
- Dehydration
- Atropine
38
What is H+ secreted into the lumen via?
H+-K+ ATPase
39
How does Cl- enter into the lumen?
Via diffusion through an apical channel
40
Where are pancreatic enzymes stored?
Zymogen granules
41
Where is the aqueous component of pancreatic secretion released from?
Centroacinar and ductal cells
42
What cells in a pancreatic duct modify the (ion) composition resulting in a fluid secretion rich in HCO-3
Ductal cells
43
What are the components of pancreatic fluid?
Isotonic fluid
| - Na+ K+ Cl- and HCO-3
44
What are bicarbonate ions in pancreatic ductal cells exchanged with?
Cl-
45
What cells produce pancreatic enzymes?
Acinar cells
46
What are the 3 main pancreatic proteolytic enzymes?
- Trypsinogen
- Chymotrypsinogen
- Procarboxypeptidase
(all inactive zymogens to prevent self digestion)
47
What enzyme activates trypsin from trypsinogen?
Enteropeptidase (aka) enterokinase
48
Where is enteropeptidase found?
Luminal border of cells lining duodenal mucosa
49
What does trypsin activate?
- More trypsinogen
- Chymotrypsinogen to chymotrypsin
- Procarboxypeptidase to carboxypeptidase
50
What percentage of pancreatic secretion is during the intestinal phase?
80%
51
What stimulates acinar cells to produce enzymes?
- CCK
| - ACh potentiates
52
What is the major stimulus for HCO-3 secretion?
Secretin (Ach and CCK potentiate)
53
What percentage of bile is made up of phospholipids?
40%
54
How much water and electrolytes do enterocytes secrete?
~ 1800 ml/day
55
What is secreted by the colon?
Alkaline mucus
- High K+ and HCO-3
- To protect against H+ produced by gut bacteria and to lubricate
- No digestive enzymes
56
What does amylase digest?
Starch so a 1-4 glycosidic bonds
57
What are the products of amylase breaking down starch?
- Maltose
- Maltotriose
- a-limit dextrin
58
What are the products of amylase digested by?
Oligosaccharidases (attached to the enterocyte mucosal membrane of brush border of epithelial cells)
59
What do alpa-glucosidases break?
alpha 1-4 glycosidic bonds to remove singgle glucose units from the non reducing end of the polymer
60
What does isomaltase cleave?
alpha-1-6-glycosidic bonds in the alpha-limit dextrin oligosaccharidases on alpha limit dextrin
61
What bond does the disacharidase sucrase break?
alpha 1-2 glycosidic bond Gluc-Fruc
62
What bond does the disacharidase maltase break?
alpha 1-4 glycosidic bond Gluc-Gluc
63
What bond does lactase break?
Beta 1-4 glycosidic bond
| galactose-glucose
64
What transporter absorbs glucose and galactose?
SGLT 1
65
What do endopeptidases hydrolyse?
Interior peptide bonds of proteins
66
What do exopeptidases hydrolyse?
One amino acid at a time
67
What turn trypsinogen into trypisn?
Enterokinase (brush border)
68
What are the enzymes which break down oligopeptides?
- Oligopeptidases
- Aminopeptidases
(Brush border enzymes)
69
What products of protein digestion can be taken up and by what mechanism?
- Amino acids (Na cotransport)
- Dipeptides (H+ cotransport)
- Tripeptides (H+ cotransport)
Di and tris are further broken down in the enterocyte
70
What are the enzymes which break down protein in the pancreatic phase?
- Trypsin
- Chymotrypsin
- Carboxypeptidase
71
What are the 4 main types of lipids?
- Fats/oils
- Phospholipids
- Cholesterol and cholesterol esters
- Fatty acids
72
What is the flow of saliva protprtional to?
- High flow rate =
- Increased HCO-3, Na+ & Cl-
Decreased K+ slightly
73
What do myoepithelial saliva cells do?
Stimulated by neural input to eject saliva
74
What do acini cells secrete in salivary glands?
Primary secretion (isotonic)
- Na+, Cl-, K+, HCO3-
- Amylase and mucin production
75
What are the 3 main types of lipid digestive enzymes?
- Lipases
- Phospholipases
- Cholesterol esterases
76
What percentage of ingested lipids are hydrolysed by salivary/gastric lipases?
~ 10%
77
How do chylomicrons enter the lymph?
- Golgi apparatus exocytosis them across basolateral membrane
- Too big to enter vascular capillaries
- Enter lymphatic capillaries (lacteals) by moving between the endothelial cells that line the lacteals
78
How are bile salts reabsorbed?
Enterohepatic circulation via terminal ileum (95%)
79
What percentage of people have IBS?
11% of population
80
How do you diagnose IBS in the UK?
Rome IV:
- 1 day/week in last 3 months
abdo pain related to defecation + frequency and/or appearence of stools
+ 2 of the following
- Change in how you pass
- Bloating/harness
- Worse after eating
- Mucus
81
What are the putative biological causes of IBS?
- Abnormal muscle contractions
| - Serotonin receptors
82
What are the 1st line treatments for IBS?
- Antidiarrhoeal (loperamide)
- Laxatives (not lactulose)
- Antispasmodics
83
What are the second line IBS treatments?
- Antidepressants (TCAs then SSRIs if ineffective)
| - Laxatives (linaclotide only if previous laxatives have not worked)
84
What can the causes of chronic gastritis be?
- Active chronic (H pylori
85
What immunoglobulin itissue s associated with coeliac disease?
IgA tTG
86
When is dermatitis hermatiformis usually diagnosed?
50 - 69
87
How is DH diagnosed?
Skin biopsy
88
What does vomitting in a newborn plus polyhyramnios suggest?
Upper GI (esophageal, duodenal, ileal) atresia
89
What characteristic sign confirms duodenal atresia?
Double bubble
90
What is responsible for 80% of all small bowel obstructions in adults?
Incarcerated hernias
91
What are the 3 possible ways the intestine may be malrotated?
- Obstruction of duodenum may result from congenital peritoneal bands (Ladds bands) which run over the duodenum from the caecum in the RUQ
- Midgut volvulus
- Internal hernia in the mesentary
92
How much does the SI rotate in the embryo?
270 degrees counter-clockwise
93
When does the SI herniate and when does it return?
- 6 weeks
| - 10 - 12 weeks
94
What are the causes of paralytic ileus?
- Postoperative
- Peritonitis
- Low potassium
- Pelvic and spinal fractures
- Parturition
95
What is cullen's sign?
Blood from retroperitoneum to umbilicus along gastrohepatic and falciform ligament and then subsequently to subcutaneous umbilical tissues through connective tissue covering of the round ligament
96
What is grey turners sign?
- Haemorrhagic fluid spreading from the posterior pararenal space to the lateral edge of the quadratus lumborum muscle and therafter to the subcutaneous tissue by means of a defect in the fascia of the flank
97
What is the cholera toxin made up from?
Oligomeric complex 6 protein subunits
- 1 copy of A subunit (enzymatic)
- 5 copies of B subunit (receptor binding)
98
What E. coli is responsible for sporadic cases and outbreaks of gastroenteritis?
VTEC / EHEC
99
What is the most common cause of diarhoea in the developed world?
Campylobacter jejuni
100
What is the structure of campylobacter jejuni?
Helical bacillus
101
What is ORS made from?
- Glucose 13.6g/L
- Sodium chloride 2.6g/L
- Potassium chloride 1.5g/L
- Trisodium citrate dihydrate 2.9g/L
102
What type of hormone is gastrin?
Polypeptide hormone
103
What causes the adherence of E coli?
- Pilli / fimbriae
| - Pedestal formation
104
What is the histological appearence of C. jejuni?
- Inflammation of entire mucosa
- Vilous atrophy
- Necrotic debris in crypts
- Thickening of Basement Membrane
105
Describe the pathogenesis of Salmonella infection?
- Ingestion of large numbers of bacteria
- Absorption to epithelial cells in terminal section of small intestine
- Penetration of cells and migration to lamina propria
- Multiplication in lymphoid follicles
- Inflammatory response mediates release of prostaglandins
- Stimulation of cAMP
- Release of fluid and electrolytes causing diarrhoea
106
How are salmonella cells transported around the body
In macrophages
107
What are the 2 types of typhoid vaccine?
- Oral (attenuated) (booster after 5 years)
| - Parenteral (capsular polysaccharide) (booster after 2 years)
108
What is the structure of listeria monocytogenes?
Coccobaccillus
109
What does listeria monocytogenes usually present as?
Meningitis
110
What are the 3 main types of viral diarrhoeal pathogen?
- Rotavirus
- Norovirus
- Enteric adenovirus
111
Where does the rotavirus infection multiply?
tips of villi
112
What is the nematode that migrates through the anus and causes intense scratching?
Enterobius vermicularis
113
What worm is associated with walking barefoot?
Ancylostoma duodenale
114
What tapeworm is associated with raw pork?
Taenia Solium
115
Hat causes amoebic ulcers?
E. histolytica
116
TMN staging?
```
Tis in situ
T1 submucosa
T2 muscularis propria
T3 adventitia
T4 adjacent structures
N0 no node spread
N1 regional node metastases
M0 no distant spread
M1 distant metastases
```
117
Describe the pathogenisis of shigella spp infection?
- Attaches to mucosal epithelium of distal ileum and colon
- Causes inflammation and ulceration
- Rarely invasive
- Produces shiga Toxin
- Dysentary
118
What bug is associated with animal guts and soil?
Clostridium perfringens
119
What percentage of benign tumours of the stomach are non neoplastic?
90%
120
Where are gastric carcinomas usually located?
- Pylorus and antrum (50-60%)
- Cardia (25%)
- Lesser (40%)
- Greater (12%)
121
How can gastric adenocarcinomas be described?
Lintis plastica (leather bottle)
122
Where do gastric lymphomas usually take place?
Mucosa or superficial submucosa (5% of all gastric maligancies)
123
What type of virus is HAV?
Single stranded RNA
124
What type of virus is HBV?
Double strnaded DNA
125
What is used to treat HBV?
- Pegylated interferon
| - Nucleoside analogues such as oral lamivudine
126
What is the usual HCV treatment?
- Ribavirin + pegylated interferon
127
What type of virus is HDV?
- Small (35nm) circular single-stranded RNA
| - Needs HBV
128
What type of virus is HEV?
- SS RNA
- Non-enveloped
- Pregnancy
129
What is the LAuren classification?
- Intestinal type: neoplastic
| - Diffuse type: non-neoplastic produces signet ring, mucin production
130
How are IBDs treated?
- Aminosalicylates e.g. mesalazine
- DMARDs e.g methotrexate
- Infliximab
- Corticosteroids
- Symptomatic relievers (analgesics, laxatives, constipatora)
- Surgery
131
What does post-hepatic jaundoce appear with?
- Dark urine and pale stools
132
What do Kupffer cells do?
Phagocytose old blood cells, bacteria and foreign materials from the bloodstream/gut
133
What does fibrosis + regeneration lead to in the liver?
Cirrhosis
134
What does low caeruloplasmin mean?
Wilson's disease
135
What types of malignant cancers can one get in the anal canal?
- Basaloid pattern
- Squamous cell carcinoma
- Adenocarcinoma
- Malignant melanoma
136
What do T-cell lymphomas associate with?
Long-standing malabsorption syndrome
137
What is carcinoid syndrome due to?
Excess of serotonin
138
What are carcinoid tumours derived from?
Endocrine cells (2% of all colon cancers)
- Solitary lesion usually
- Appendix most common site
139
What do indirect hernias pass through?
The deep inguinal ring
140
Motion sickness derives from where?
Vestibular apparatus
141
What are the 2 patterns of H-plyori associated gatritis?
Diffuse involvement of antrum and body
- Atrophy, fibrosis, intestinal metaplasia
- Associated with gastric ulcer and cancer
Antral but not body involvement
- Gastric acid secretion increased
- Associated with duodenal ulcer
142
Autoimmune chronic gastritis is associaed with what?
loss of acid secretion and intrinsic factor associated with marked gastric atrophy and intestinal metaplasia increased risk of gastric cancer
143
What intestinal worm has a scolex for attachement
T. Solium
144
What does billirubin need to be above to cause jaundice?
>40umol/L
145
What gene causes haemochromatosis?
HFE gene (recessive)
146
What does Wilson's disease have low levels of?
Caeruloplasmin
147
What are the metabolic consequences of acute pancreatitis?
- Decreased Calcium
- Decreased albumin
- Increased glucose
- High serum amylase
- Massive fluid losses
148
How is chronic hepatitis classified?
- Type - aetiology
- Grade - degree of inflammation
- Stage - degree of fibrosis
149
How is cirrhosis classified morphologically?
- Micronodular -<3mm
- Macronodular > 3mm
- Mixed
150
What substance causes hepatic encephalopathy
Ammonia
151
What is non-alcoholic steatohepatitis?
Associated with metabolic syndrome (DM 2, hypertension, increased triglycerides)
- Fat deposition in hepatocytes - can lead to cirrhosis
152
What makes billirubin water-soluble conjugated?
Glucaronic acid creating urobillinogen
153
Where zone would alcoholism affect?
Zone 3
| Autoimmune zone 1
154
WHat can fatty liver disease be known as?
Steatosis
155
What builds up due to hepatocyte damage a a result of steatosis?
- Mallory's hyaline
- Acetaldehyde binds do hepatocytes causing damage -> inflammatory reaction
- Inflammation -> fibrosis
156
What does cirrhosis mean simply?
Fibrosis(collagen) + Regeneration
157
What are transameriases?
AlT, AST
158
What is autoimmune chronic active hepatitis?
- Interface hepatitis (zone 1 destroyed by lymphocytes and briding between zone 1s)
- Plasma cells and swollen hepatocytes
- Fibrosis
- ANA, SMA, raised serum IgG and transaminases, anti-LKM (liver-kidney microsomal)
- Females>Males
- Usually presents mid to late teens
- Patients may benefit from steroids but later possibly more powerful drugs such as methotrexate
159
What is primary biliary cholangitis/cirrhosis?
- Females 40-50 usually
- Autoimmune destruction of bile duct epithelium - dense lymphocytic infiltration and granulomas
- Proliferation of small bile ducts
- Portal and bridging fibrosis
- Cirrhosis
- Not nessasrily jaundice, pruritis, xanthelasma, oedema
- Raised ALP + IgM, AMA,
- Anti-mitochondrial antibodies
160
What disease is associatd the primary biliary cholangitis?
Primary scleorosing cholangitis
| Associated with IBDs and bigger bile ducts, does not have antibody specificity and and associated with bile duct cancer
161
How is haemochromatosis treated?
- Regular venesection
| - Test iron and ferritin levels
162
What are the main causes of hepatocellular carcinoma?
- Hepatitis B (worldwide)
- Cirrhosis (in UK)
- Hep C
- Aflatoxins (fungal origin) also can cause
163
If the cells of the kidney become hypoxic what happens to EPO?
Increase release of EPO
164
What are the triggers that lead to increased EPO?
- Altitude
- Loss of RBCs due to haemorrhage
- Excessive RBC destruction
- Increase tissue oxygen demands
165
What determines the release of EPO?
Ability of RBCs to release oxygen not the absolute levels of RBCs
166
What happens 1 or 2 days after haemorrhage?
Reticulocyte levels in the blood rise rapidly due to EPO stimulating bone marrow cells to produce RBC
167
What happens to the levels of EPO as a result of chronic renal failure?
- Scarring results in a decrease in functioning cells and a drop in the release of EPO
- Lathargy and aneamia as there is a reduced capacity of RBCs to carry oxygen
168
What is 1, 25-dihydroxycholecalciferol involved in the regulation of?
Plasma calcium concentration
169
How does vitamin D become 1, 25-dihydroxycholecalciferol?
- Vitamin D hydroxylated by the liver to produce 25-hydroxycholecalciferol
- Kidneys add a further hydroxyl group to convert to 1, 25dihydroxyxholecalciferol (also called calcitriol).
170
What inhibits and promotes the adding of the hydroxyl group to 1,25-dihydroxyxholecalciferol?
- Promoted by parathyroid hormone
| - Inhibited by high plama phosphate levels
171
What is the main action of calcitrol?`
Stimulate the absorption of ingested calcium by increasing expression of the calcium channels used to transport calcium across the cell membrane of the intestinal mucosa. Phosphate absorption also increased. Stimulation of calcification of bone matrix through increased calcium and phosphate and also by direct stimulation of osteoblasts and osteoclasts fascilitating the remodelling of bone
172
What happens to calcitrol as a result of chronic renal failure?
- 25-hydroxycholecalciferol not converted to 1,25-dihydroxycholecalciferol, which can lead to hyperparathyroidism (reduced calcium levels stimulating growth of the gland)
- Osteomalacia (softening of bone) and osteoporosis (loss of bone tissue leading to brittle bones)
173
What is ulcerative colitis of the entire colon?
PANcolitis
174
Does UC lead to fibrosis?
No because it is not a chronic inflammatory disease comes and goes
175
What is UC associted with?
- Anaemia - iron-deficiency
- Raised inflammatory markers (C-reactive protein)
- Dehydration
- Crypt abcesses which bring neutrophils in destroying them pus in crypt
176
How does UC lead to an increased risk of colonic carcinoma?
- Chronic inflammatory changes damages cells
- Leads to dysplasia - colonectomy
- Increased risk of colonic carcinoma
177
What part of the GI tract is Crohn's most likely to affect?
Terminal ileum (can affected anywhere of GI tract)
178
What layers can Crohns affect?
All the way through the wall - fibrosis can occur - adhesions and fistula transmural inflammation, very hard to treat surgically, lymphocytes not neutrophils, granulomas, type 4 hypersensitivity reaction, not crypt abcesses
179
What extra-intestinal manifestations can UC and Crohn's cause?
- Inflammatory athropathies
- Erythema nodosum (Crohn's)
- Pyoderma gangrenosum
- Primary sclerosing cholangitis (UC)
- Iritis/Uveitis
- Aphthous ulcers/stomatitis
180
What does pseudomembranous colitis look like histologically?
- Explosing of pus, mucus necroting debris
181
What is diverticulitis?
Inflammation of the diverticulum due to feces filling them as a result of constipation
Left iliac fossa pain
182
What are the 2 central neural regulation centres in the medulla?
- CTZ
| - Vomitting (emetic centre)
183
What are types of anti-emetics?
- Antihistamines (H1)
- Antimuscarinics (M1)
- Dopamine antagonists (D2)
- 5HT3 antagonists
- Neurokinin1 receptor antagonists
- Synthetic cannabinoids (CB1)
- Steroids
- Other neuroleptics
184
Give an example of a anti-muscarinic?
Hyoscine hydrobromide (useful in motion sickness)
185
Give examples of antihistamines?
- Cinnarizine (motion sickness, vestibular disorders)
- Cyclizine (motion sickness)
- Promethazine (severe morning sickness)
186
Name some Dopamine (D2) receptor antagonists
- Phenothiazines
- Chlorpromazine
- Prochloperazine
- Domperidone
- Metoclopramide
187
Give an example of a 5HT3 antagonist?
Ondansetron
188
Give an example of a Neurokinin 1 receptor antagonist
Aprepitant
189
Give an example of a synthetic cannabi noid
- Nabilone
190
What steroid has anti-emetic effects?
Dexamethasone
191
What are the examples of laxatives
- Bulk ispaghula husk
- Stimulant senna
- Softner docusate
- Osmotic lactulose
- Peripheral opoid receptor antagonist methylnaltrexone bromide
192
Give an example of a antispasmodic
- Hyoscine butylbromide (bucospan)
| - Mebeverine
193
Give an example of a antimotility agent
Loperamide (imodium)
194
Give an example of a adsorbent which is used to treat chronic diarrhoea
Kaolin, light
195
What is useful in controlling diarhoea associated with diverticular diesease?
Bulk forming drugs e.g
| Ispaghula
196
What is used to treat gallstones?
Ursodeoxycholic acid
197
What is a bile acid sequestrant?
Colestyramine is an anion-exchange resin
- Forms an insolubele complex with bile acids in the intesine
- Relieves pruritus associated with partial biliary obstruction and primary biliary cirrhosis
- Used for hypercholesterolaemia
- Crohn's disease related diarrhoea
198
What is used to treat cestodes?
Praziquantel
199
What is used to treat nematodes?
Albendazole
200
What is used to treat schistosomiasis?
Praziquantel
201
What other bacteria causes filiaria to become dangerous?
Wolbachea causes inflammation also kills off males
202
How is cisterocosis prevented?
Meat inspection
203
How is filiriasis prevented?
Vecor control
204
What does ivermectin work against?
Sabies, bed bugs, filirea, lice
205
What is pyrantel used against?
Hookworms and roundworms
206
What are the different types of shistosoma forms caled?
- Cercariae in water to host
| - Miracidum from host to snail
207
Give examples of toxins which can cause food poisoning?
- Emetic toxins of Bacillus cereus
- Enterotoxin of Staph aureus
- Neurotoxin of Clostridium botulinum
208
What intestinal helminth is associated with intestinal compromise?
Trichiuris
209
What is the posterior border of the oral cavity?
Palatoglossal arch
210
What does the buccinator attach to?
- Maxilla
- Mandible
- Pterygomandibular raphe where it fuses with the superior pharyngeal constrictor
211
What is the crossing over of buccinator fires lateral to the lips called?
Modiolus
212
What does the incisive formaen transmit?
Nasopalatine nerve
213
What does the greater palatine foramen transmit?
Greater palatine nerve
214
What makes up the soft palate?
Aponeurosis (periosteum + tendon of tensor veli palatini) + mucous glands + mucous membrane
215
What are the muscles of the soft palate?
- Palatoglossus
- Palatopharyngeus
- Levator veli palatini (all vagus)
- Tensor veli palatini (trigeminal)
216
What are the muscles of mastication?
- Medial pterygoid
- Lateral pterygoid (opens mouth)
- Masseter
- Temporalis (all supplied by CNV)
217
What can cause the mandible to protrude?
Lateral pterygoid
218
What muscle suspends the tongue?
Mylohyoid muscle
219
What are the papilla of the tongue involved in?
- Vallate papillae
- Foliate papillae
- Fungiform papillae (all taste)
- Filliform papillae (rough)
220
What muscle stops the tongue from falling backwards
Genio-glossus
221
What nerves cause salivary secretion?
- FAscial (sublingual & mandibular)
| - Glossopharyngeal (parotid)
222
What is the inguinal ligament an aponeurosis of?
External oblique
223
What is the lacunar ligament?
Forms the medial border of the femoral canal attaches to pubic pecten
Fibres from external oblique medial end
224
What is a defect in the aponeurosis of the external oblique just above the pubic tubercle called?
Supericial inguinal ring (medial opening of inguinal canal)
225
Where can lumbar hernias take place?
Thoracolumbar fascia
226
What is the conjoint tendon made from?
Transversus muscle and internal oblique muscle
227
What does the conjoint tendon form and what passes through this?
Inguinal falx which the spermatic chord passes through this
228
What does the inguinal canal connect?
Abdominal cavity to scrotum or labia majora
229
What is passes through the inguinal canal?
- Spermatic chord
- Round ligament of uterus
- Genital branch of genitofemoral nerve
- Illioinguinal nerve
230
What is the deep ring on?
Transversalis fascia
231
What are the borders of the inguinal canal?
```
Anterior
- External oblique
- Internal oblique laterally
Posterior
- Conjoint tendon medially
- Transversalis fascia laterally
Roof
- Arching inferior edges of internal oblique and transversus abdominis
Floor
- Inguinal ligament
- Lacunar ligament medially
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232
What is the difference in position of inguinal and femoral hernias?
- Femoral = below and lateral to pubic tubercle
| - Inguinal = Above and medial to pubic tubercle
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What does a direct inguinal hernia pass through?
- Weaker conjoint tendon
- Hasselbach's triangle
- Push through abdominal wall
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Indirect hernia
Abdominal contents pass through deep inguinal ring
| - Ceovered with all layers of spermatic cord
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What is the femoral sheath continous with?
Transersalis and iliac fascias
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Where does the femoral canal lie in relation to femoral neurovascular structures?
Medial in femoral sheath in vascualr camportment
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What is the femoral ring bounded by?
- Inguinal ligament (A)
- Lacunar ligament (M)
- Pectineus or pectineal ligament (P)
- Femoral vein (L)
- Closed by extraperitoneal tissue
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How are more likely to get femoral hernias?
Females (wider hips)
Strngulation more common in femoral
Inferior and lateral to pubic tubercle
239
What are the 3 important eleements in health promotion?
- A focus on tackling the determinants of health
- Working in partnership with a range of agencies and sectors
- Adopting a strategic approach using a range of complementary action to promote the health of the population
240
What are the 4 barriers to reducing alcohol consumption?
- Behavioural/cultural
- Economic
- Political
- Organisational
241
What are the 3 keys to unlock consent?
- Mature minor
- Parents (roght co-exist)
- Courts
242
What gene can predispose to obesity?
FTO
