Paul's Weight Loss And Kemal's Obesity Flashcards
Which way do external oblique abdominis muscle fibres run?
Forwards and downwards
What percentage of fat should a baby have?
14%
What are the superficial veins that drain upwards from the umbilicus called?
Thoraco-epigastric or thoraco-abdominal veins
What is Wilson’s disease?
Impaired billary secretion of Cu2+ so there is build up of Cu2+ in liver causing brain and liver damage
What do B-100 receptors do?
Remove LDL cholesterol from circulation
What are the attachments of the internal oblique abdominis?
The lateral half of the inguinal ligament, iliac crest and thoracolumbar fascia are the attachments and the muscle inserts onto ribs 9-12 and linea alba. The inferior part of the muscle inserts onto pubic crest
What is the new orally active chelator?
Deferiprone
What is the precursor for ketone body formation?
Fatty acid oxidation in the fasting state
Which way do transverse abdominis muscle fibres run?
Transversely arranged
What does zinc deficiency cause?
Severe skin lesions could lead to death by infection
What does acetyl-CoA carboxylase do?
Produces manoyl-CoA from acetyl-CoA in fatty acid synthesis
Describe the guarding reflex
If the parietal peritoneum is irritated the anterior abdominal muscles may contract spontaneously to provide resistance to pressure and reduce movement that may permit spread of infection
Where does the inguinal ligament run?
Between the anterior superior iliac spine and the pubic tubercle
Which organs are secondary retroperitoneal? (pussy cat dolls)
P = Pancreas
C = Colon (only ascending and descending)
D = Duodenum (only parts 2-4)
How much of metabolised energy is lost as heat?
50%
How are transferin levels affected by iron overload?
They decrease
What omega is linoleic acid?
Omega 6
What are mesenteries?
Posterior slings of visceral peritoneum that loop around parts of the alimentary tract
What do high levels of ferritin indicate?
Iron overload
What are the complications of diabetes?
Microangiopathy (thickening of basement membrane)
Retinopathy (blindness)
Neuropathy (postural hypotension, impotence, foot ulcers)
What is a good source of thiamine?
Raw fish
How must insulin be structurally changed before it is active?
Pro insulin must have C-peptide cleaved from it by proteolysis to become active
What is another name for the gastro-hepatic ligament?
The lesser omentum
What inhibits carnitine shuttle, preventing B-oxidation of lipids?
Manoyl- CoA
Where is the lesser sac?
A space trapped behind the stomach
How many iron molecules can one ferritin bind?
4300
How will a thiamine deficiency manifest?
Dry Beri Beri- skinny bandy legs, symmetrical peripheral neuropathy
Wet Beri Beri- swelling in face and oedema as well as karsakoff’s psychosis (mainly in alcohols)
Why may troponin levels be raised in patients with malabsorption?
Heart damage due to lack of vitamins D
Which mutation leads to type I genetic haemochromatosis?
HFE
What is haemosideran?
Insoluble iron storage
What does transversus abdominis do?
Abdominal compression during forced expiration and stabilisation of the back
How is ventral mesentery different to dorsal mesentery?
It is shorter and has a gap under it allowing communication between the two halves of the peritoneum cavity
What forms the inguinal canal’s walls, floor and roof?
The anterior wall is formed by external oblique aponeurosis and internal oblique aponeurosis in its lateral third. The posterior wall is formed by the fascia transversalis and by the conjoint tendon in its medial third. The floor is formed from the upturned lower border of external oblique abdominis which forms the inguinal ligament. The roof is formed of conjoint tendon.
What is the greater omentum?
A doubled layered fat filled apron of peritoneum arising from the greatr curvature of the stomach which hangs over the transverse colon and expands to cover small instestine
How might an indirect inguinal hernia occur?
It may emerge through the deep ring and travel the length of the inguinal canal exiting where the wall is weaker at the superficial inguinal ring
Where is biotin (b7) found?
Gut flora, peanuts, chocolate, egg yolks
How is the iron from transferin taken up by cells?
Receptor mediated endocytosis into the cell after which the receptor- transferin complexes migrate into clathrin coated pits. Intravesicalar pH increases to 5.5 and clathrin coat is lost. Fe2+ released and taken up by ferritin and transferin moves back to cell surface
What is satiety?
The hypothalamus initiating the sensation of fullness
Which nerve supplies the muscle fibres of the conjoint tendon?
Ilioinguinal nerve from L1
Which anterior abdominal wall muscle lacks supply from L1 (ilioinguinal nerve)?
External oblique abdominis
What percentage of fat should a woman have?
28% fat
What does orlistat do?
Decreases fat absorption in small intestine to combat obesity but causes steahorrea if not taken with low fat diet
What are the symptoms of type I genetic haemochromatosis be?
Liver failure, diabetes mellitus, cardiac failure, pigmentation of skin
Where do lymph nodes above the umbilicus drain to?
Axillary nodes
What do external obliques abdominis muscles do?
The right external oblique pulls the right side of the chest to downwards to the left hip and vice versa
What exits through the superficial inguinal ring?
Ductus deferens in male and round ligament of the uterus in female
What does Camper’s fascia contain?
Superficial veins and fat together with cutaneous nerves
What is secreted to imitate hunger when stomach is empty?
Gherlin and neuropeptide
What is the origin of the inferior epigastric artery?
The ascending artery from the external iliac
What is Merke’s disease?
The inability to absorb copper from small intestine
What will happen in defective LDL receptors?
High LDLs as not taken up by liver
What does the lateral crus of the superficial inguinal ring attach to?
The pubic tubercle
What does vitamins b12 do and where is it found?
It is a carrier of methyl groups in metabolism of branched amino acids and it can only be found in animal products so vegans must take supplements
How is BMR calculated?
kJ/ hour/ kg body weight and accounts for energy used in basic bodily functions
What muscles lie posteriorly are are pre vertebral muscles?
Quadratus lumborum and psoas major
Which muscles form anterior rectus sheath above the umbilicus?
External oblique and half of internal oblique
What is the linea alba?
The avascular white line where muscles meet in the midline of the abdomen
What causes ketoacidosis in diabetes type 1?
No insulin release on excess keto acid production so excessive protein breakdown continues to happen
What causes pernicious anaemia?
Loss of gastric parietal cells which secrete intrinsic factor which is essential for b12 absorption in the ilieum
Why does the female have two pouches at the lowest point of the perineal cavity and what are they called?
Females have the rectouterine pouch of Douglas and the vesicouterine pouch in front because the fold of peritoneum over the uterus divides the fossa between anterior and posterior folds of peritoneum into two.
What are irons main functions apart from oxygen carriage?
Oxidative energy production, mitochondrial respiration, inactivation of harmful O2 radicals and ribonuclease reductase in DNA synthesis
What are the energy contents of fat, alcohol, carbohydrates and proteins?
Fat: 9.2 cal/g
Alcohol: 7cal/g
Carbohydrate and protein: 4cal/g
Where do the superior and inferior epigastric arteries anastomose?
At the level of the umbilicus
Where are femoral hernias?
Through the femoral canal which is behind the inguinal ligament and lateral to public tubercule
What are the 9 divisions of the abdomen(from left to right, superior to inferior)?
Most superiorly there is the epigastric region with right and left hypochondriac regions either side. Then there is the umbilical region with left and right lumbar regions either side. Most inferiorly there is the hypogastric region with left and right iliac regions either side.
What is the superficial inguinal ring?
The exit point of the inguinal canal
What does acytl transferase do?
Picks up cholesterol from tissues when activated by Apo A1 on HDLs
Which muscle divides pelvis from perineum?
Pelvic diaphragm
What is endo-abdominal fascia?
The layer of deep fascia inside the layers of muscles, lining the whole abdomino-pelvic cavity
When does Fe2+ produce hydroxyl radicals?
In the presence of the enzymes superoxide
What are the attachments of transversus abdominis?
Originates from the internal surfaces of bone and cartilage forming thoracic inlet and iliac crest. It also arises from lateral third of inguinal ligament as well as thoracolumbar fascia and medially to the linea alba.
Which mutation leads to type II genetic haemochromatosis?
Hemojeulin
What is Crohn’s disease?
An inflammation of the GI wall from lumen to serosa usually in the terminal ileum
What are retro and intra-peritoneal organs?
Organs without mesentery are retroperitoneal and organs with mesentery are intraperitoneal
What bounds the abdomen above and below?
Above the diaphragm and below the upper border of the sacrum and the pelvic brim
Where are thoracic abdominal nerves derived from?
Anterior rami of T6/7- L1 spinal nerves
What is vitamin K used for and what will it’s deficiency cause?
Used as coagulation factor so deficiency will increase clotting time
What do all group B vitamins have in common?
They are all co enzymes in metabolic pathways
What is the tunica vaginalis?
In development there is a protrusion of peritoneal membrane called the processus vaginalis. The tunica vaginalis is the terminal portion of this. It is an isolated sac of serous fluid which the testes are embedded in and it acts as a cushion
Where is the deep inguinal ring?
A finger’s breath above the mid-point of the inguinal ligament
What is a ligament in the context of peritoneum?
The connection between organs that was dorsal mesogastrium in the embryo e.g. gastro-splenic and spleno-renal ligaments
When is fat synthesised?
When there’s excess glucose in the blood because preferentially glucose will be converted to glycogen until liver is full
Where do lymph nodes below the umbilicus drain to?
Superficial inguinal nodes of the groin
What will vitamins A deficiency manifest as?
Gel like appearance of eyes and lack of night vision
Which muscles form posterior rectus sheath above the umbilicus?
Half of internal oblique, transversus abdominis and transversalis fascia
What will happen in Apo C-11 deficiency?
Increased chylomicrons and VLDL
List the lipoproteins in order of density from high to low
HDLs are most dense then LDLs then IDLs then VLDLs then finally chylomicrons
Where is folate found?
Green vegetables, liver and whole grains
What did the falciform ligament used to be?
A double fold of mesogastrium that connected the liver to the anterior abdominal wall
What activates lipoprotein lipase?
Insulin
How can we test for a patent processus vaginalis?
The tunica vaginalis will swell upon coughing
Which mutation leads to type III genetic haemochromatosis?
Transferin receptor
What are the linea semi-lunaris?
A lateral curved line caused by the fusion of aponeuroses of the anterior abdominal wall muscles either side of the rectus sheath
What are the crura of the superficial inguinal ring?
The medial and lateral margins of the ring are formed by a split in the aponeurosis
What does the medial crus of the superficial inguinal ring attach to?
The pubic crest
What are the pair of muscles that run vertically down the anterior abdominal wall?
The rectus abdominal muscles
What does pyrioxidine (b6) do in the body? What causes a deficiency in it?
Essential for metabolism and haemopoiesis esp glucose conversion to glycogen.
Deficiency caused by TB medicine
How does TAG cross cell membranes after being transported by chylomicrons from small intestine?
Broken down by lipoprotein lipase in capillary then reassembled after cross membrane as fatty acids and glycerol
What is fat used for in the body?
Phospholipid bilayer, precursor for eisosanoids, thromboxanes and prostaglandins
When do superficial veins of the abdomen become visible?
When there is blockage of venous drainage such as in liver disease, causes caput medusae or Medusa’s head
What is the inner layer of the superficial fascia of the abdominal wall called?
Scarpa’s fascia
What does vitamin D do?
Acts as steroid hormone by binding receptors which interact with DNA. Ensures calcium absorption from the gut
What omega is linolenic acid?
Omega 3
What does the internal oblique abdominis do?
Stabilises lumbar spine and rotates trunk when pelvis is anchored
What opening joins greater and lesser sac?
Epiploic foramen
What does biotin do?
It is a prosthetic group for carboxylation in metabolic reactions
What is kwashiorkor?
Protein deficiency manifested as decreased oncotic gradient exerted by blood giving rise to oedema esp in stomach
What is ferritin and how saturated is it usually?
A soluble iron storage molecule which is 2/3 times saturated
Which substances stimulate insulin?
Growth hormone, amino acids and glucose in blood, GI secretin secretion, glucagon release
Where is niacin (b3) found in the diet and what does it do in the body?
In cereals and proteins. It is NAD and NADP in redox reactions
Which cells produce somatostatin?
Delta cells of islets of Langerhans
What does folate do?
Transfer reactions in pyridine and purine synthesis (DNA/RNA synthesis) and amino acid metabolism
What compartments does the transverse mesocolon divide the greater sac of the peritoneal cavity into?
Supra and infra-colic departments
What are the two main intermediary factors involved in insulin affecting transcription?
Ras and MAPK
Which nerves supply the anterior abdominal muscles?
Thoracic abdominal nerves
Why does the stomach have a greater and lesser curvature?
In development one side grew faster than the other
Where is an inguinal hernia?
Above the inguinal ligament and medial to the pubic tubercule
What lies deep to deep fascia in the anterior abdominal wall?
A layer of loose connective tissue known as extra-peritoneal fat. Posteriorly this is known as retro-peritoneal fat
What does vitamin C do?
Used for hydroxylation of lysine and proline in collagen formation and stabilisation. Maintains Fe2+ in ferrous state so it can be used
What does sibutramine do?
Increases serotonin levels and inducing feelings of happiness and decreases appetite to combat obesity
How is insulin release stimulated in the islets of Langerhans?
Glucose and amino acid entry through low affinity channels gives rise to more ATP, closing K+ channels on the cell membrane and opening Ca2+ channels. This increased intracellular Ca2+ stimulates release of insulin vesicle
What are the superficial veins that drain downwards from the umbilicus called?
The superficial epigastric veins
What is the function of rectus abdominis?
As a flexor of the trunk and depressor of the rib cage
Which vitamins are fat soluble? How regularly should they be consumed?
A K D and E are fat soluble, can be stored in the body so no need for regular consumption
Which mutation leads to type IV genetic haemochromatosis?
Ferroportin
Which artery supplies rectus abdominis by piercing the thin layer below the arcuate line?
Inferior epigastric artery
What are the attachments of Scarpa’s fascia?
It binds to the fascia lata of the thigh below the inguinal ligament, structures in the perineum as well as thoracolumbar fascia and the fascia lata of buttock and thigh posteriorly
What are the water soluble vitamins? How regularly must they be consumed?
The B group and C, must be regularly consumed
Where do testes descend from?
The posterior abdominal wall
Where is vitamin K found?
Gut flora, green leafy vegetables, milk, cereals
What percentage of fat should a man have?
14%
What is excess fluid in the tunica vaginalis known as?
Hydrocele
Where do thoracic abdominal nerves run?
Around trunk sandwiched between internal oblique abdominis and transversus abdominis muscles
What are the normal amounts of iron zinc and copper needed by a typical 70kg adult per day?
2-3 g of iron and zinc
140 mg of copper
What can toxicity of vitamin A (retinol and carotene) do?
Lead to birth defects, hair loss, hepatic dysfunction
Which two minerals are essential to form oxygen carrying proteins such as cytochrome oxidase?
Fe2+ and Cu2+
What is the lesser omentum?
It is a double layer of peritoneum attached to the lesser curvature of the stomach and the liver
Where do rectus abdominis arise from and insert to?
Arises from pubic crest and inserts onto the lower costal cartilages
Why is mid arm circumference a better indicator of body composition than mid leg?
Overweight patients often have oedema in their legs
What vitamin are low birth weight babies likely to be deficient in?
Vitamin D
How small can the small intestines be and still function?
From their full 6m to 120 cm as long as key structures like the terminal ilieum are intact
What is the outer layer of superficial fascia of the abdominal wall called?
Camper’s fascia
How does insulin stimulate uptake of glucose into muscle and adipose tissue?
Binds to receptor which activates Akt/PKB which up regulates GLUT-4 by releasing them from vesicles and translocating them to cell membrane
Where is riboflavin (b2) found in the diet? What does it do in the body?
Milk and dairy products. It is FAD in FMN redox reactions
What are the attachments of the external oblique abdominis?
The lower ribs (5-12), the anterior part of the iliac crest posteriorly, it forms the inguinal ligament posteriorly and inserts onto the pubic tubercle, it interdigitates with the linea alba
Where are umbilical hernias?
Through the umbilicus
Name the retroperitoneal organs (sad pucker)
S = suprarenal glands
A = Aorta and IVC
D = Duodenum (all but the 1st part)
P = Pancreas (all but the tail)
U = Ureter and bladder
C = Colon (ascending and descending)
K = Kidneys
E = Esophagus
R = Rectum (Lower two-thirds)
What is the rectus sheath formed of?
Aponeurotic muscle tendons and transversalis fascia around the rectus abdominis
What are the boundaries of the inguinal triangle?
Medially is linea semilunaris, laterally is the inferior epigastric artery and the inferior border is the inguinal ligament
Why does alcoholism cause thiamine deficiency? (B1)
It inhibits active transport absorption of thiamine from intestine by inhibiting thiamine phosphorylase (which activates thiamine)
What will happen in deficiency of apo proteins involved in remnant uptake?
High chylomicrons and VLDL remnant as many remnants in blood
How is satiety signalled?
By leptin
What layers must the testes transverse to reach the scrotum?
Transversus abdominal fascia then the internal oblique the external oblique
What is mesentery?
A sling for an organ of the abdomen made of a double fold of membrane which wraps some organs and provides the visceral peritoneum covering
What inhibits hormone sensitive lipase to inhibit breakdown of glycerol and fatty acids?
Insulin
What is sorbitol?
An artificial sweetener used by diabetics to alleviate symptoms
How is glycogen synthase activates?
Dephosphorylartion
Name the intraperitoneal organs (salted spurs)
S = Stomach
A = Appendix
L = Liver
T = Transverse colon
D = duodenum (only the 1st part, though)
S = Small intestines
P = Pancreas (only the tail though)
R = Rectum (only the upper 3rd)
S = Sigmoid colon
S = Spleen
Which way do internal oblique abdominis muscle fibres run?
Backwards and downwards
When is direct herniation of the inguinal region likely and why?
Should the lower fibres of the conjoint muscle be paralysed. Since they are supplied by L1 ilioinguinal nerve, if this is lesioned e.g. by a slipped disc then the abdominal wall will herniate.
What is the junction between upper and lower rectus sheath called?
The arcuate line
What are the lines that form the divisions of the abdomen?
Two horizontal and two vertical lines forming the 9 divisions. The vertical lines are mid-clavicular and called lateral lines. The horizontal lines are, superiorly, transpyloric plane (across pylorus of stomach) and, inferiorly, the transtubercular plane (plane between two tubercles of iliac crest)
How does movement of the cojoint tendon prevent herniation?
It moves downwards like a shutter as it contracts, to protect the lower half of the inguinal triangle which is particularly vulnerable to herniation as it is only covered with thin fascia transversalis
What activates manoyl CoA production in the fed state?
Insulin
What will vitamins D deficiency manifest itself as?
Rickets
What forms rectus sheath in the lower abdomen posteriorly?
Transversalis fascia only
What is a fistula?
Abnormal communication between two epithelial surfaces
What is a hernia?
A protrusion through the body wall where the muscle layer is weak so peritoneum is pushed towards the skin where pressure is lower
What will happen in lipoprotein lipase deficiency?
Increased chylomicrons and VLDLs
Where is the greater sac?
A space in front of the stomach and liver
Where is the rectovesical pouch in males?
A fossa between anterior and posterior folds of peritoneum, the lowest point of the perineal cavity
What is the conjoint tendon?
The aponeurotic tendon of lower part of transversus abdominis and internal oblique abdominis fuse to form this tendon which inserts onto the pubic crest
What is the origin of the superior epigastric artery?
A continuation of the thoracic artery of the chest which becomes know as the superior epigastric when it crosses the costal margin
What are the three layers of lateral abdominal muscles?
External and internal obliques and transversus abdominis
Which substances inhibit insulin?
Adrenaline, cortisol
What is marasmus?
General deficiency of energy and protein causing muscle wasting and 40% loss of body weight in the first year of life
What forms rectus sheath in the lower abdomen anteriorly?
Aponeurotic sheaths
