PBL Topic 4 Case 4 Flashcards
What is the function of the ileocecal valve?
- Prevents backflow of faecal contents from the cecum into the ileum
- By closing when excessive pressure building up in cecum
What is the function of the ileocecal sphincter?
- Remains constricted
- To slow emptying of ileal contents into cecum
Identify factors that affect the degree of contraction of the ileocecal valve and intensity of peristalsis in the terminal ileum
- Distension of the cecum
- Irritation in the cecum
- Via the myenteric reflex in the gut wall and extrinsic autonomic nerves
Identify the functional anatomy of the colon
- Proximal half is concerned with absorption of water and electrolytes
- Distal half is concerned with storage of faecal matter
Outline the role of of serotonin on peristalsis in the colon
- Released from neuroendocrine cells
- In response to luminal distension
- Which activates HT4 receptors
- Which results in activation of sensory neurons (calcitonin gene-related peptide)
Outline the process of mixing movements in the colon
- Combined contraction of circular muscles and longitudinal muscle
- Causes unstimulated portion to bulge outward (haustration)
- Disappears and reappears in a nearby area
- Provides mixing and propulsion
What are mass movements?
- Propulsive movements
- Which takes over propulsive role of haustrations
How frequently do mass movements occur?
- One to three times per day
- For about 15 minutes at a time
Outline the process of mass movement
- Constrictive ring occurs in response to distended or irritated point in transverse colon
- Portion distal to ring loses its haustration and contracts as a single unit
- Which propels faecal contents down the colon
- Relaxes after 2-3 minutes and another mass movement occurs more distally
Identify two reflexes involved in the facilitation of mass movements
- Gastrocolic reflex and duodenocolic reflex
- Which arise from distension or irritation of stomach/duodenum
- And are transmitted by way of autonomic nervous system
Why is the rectum typically empty of faeces?
- Sphincter
- Sharp angulation
Outline the process of defecation
- Mass movement forces faeces into rectum
- Contraction of rectum
- Relaxation of anal sphincters
Identify the two anal sphincters
- Internal sphincter, composed of circular smooth muscle
- External anal sphincter, composed of striated voluntary muscle that surrounds the internal sphincter
Identify the innervation of the external anal sphincter
- Pudendal nerve
What is the intrinsic reflex?
- Distension of rectal wall
- Initiates afferent signals through the myenteric plexus
- To initiate peristaltic waves in the descending colon. sigmoid and rectum
- And relaxation of the internal sphincter
What is the parasympathetic defecation reflex?
- Stimulation of nerve endings in rectum
- Which are transmitted into spinal cord
- And then reflexly back to descending colon, sigmoid and rectum by way of pelvic splanchnic nerves
- Which greatly intensify the peristaltic waves and relax the sphincters
Identify three factors that increase the intra-abdominal pressure and force faecal contents into rectum
- Deep breath which moves the diaphragm downward
- Closure of glottis
- Contraction of abdominal wall muscles
What is the peritoneointestinal reflex?
- Results from irritation of the peritoneum
- Strongly inhibits the excitatory enteric nerves
- To cause intestinal paralysis (especially in patients with peritonitis)
What are the renointestinal and vesicointestinal reflexes
- Inhibition of intestinal activity
- As a result of kidney or bladder irritation
How do the crypts of Lieberkuhn in the large intestine differ to those in the small intestine?
- No villi
How do the epithelial cells in the large intestine differ to those in the small intestine?
- No enzymes
- Consist mainly of mucus secreting cells
Identify three causes of mucus secretion in the large intestine
- Direct, tactile stimulation of the epithelial cells
- Local nervous reflexes
- Stimulation of the pelvic splanchnic nerves
Identify three protective functions of mucus in the large intestine
- Excoriation by chyme
- Bacterial activity
- Faecal acids
Identify the mechanism of diarrhoea
- Irritation of large intestine
- Causes secretion of extra large quantities of water and electrolytes and viscid alkaline mucus
- Which dilutes irritating factors
Identify one advantage and one disadvantage of diarrhoea
- Causes rapid movement of irritating factor towards anus to be expelled
- Loss of large quantities of water and electrolytes causing dehydration
How many mL of chyme pass through the ileocecal valve into the large intestine each day? How many mL of this remains in faeces?
- 1500 ml
- 100 ml
How is the large intestine adapted to absorb sodium ions more completely?
- No back-diffusion of ions
- Due to tighter gap junctions
- Allows for a steeper concentration gradient
What is the role of bicarbonate ion secretion in the large intestine?
- Helps to neutralise the acidic end products of bacterial action
- Provides an exchange transport process for chloride ions
- Which helps to create an osmotic gradient for absorption of water
identify substances formed as a result of bacterial activity in the large intesitne
- Vitamin K
- Vitamin B12
- Vitamin B1 (thiamine)
- Vitamin B2 (riboflavin)
- Flatus gases
Identify three gases that make up flatus
- Carbon dioxide
- Methane
- Hydrogen gas
Identify the components of faeces
- 3/4 water 1/4 solid
- 30% dead bacteria
- 40% undigested roughage
- Dried constituents of digestive juices
- Bile pigments
- Inorganic matter
- Protein
Why is faeces brown?
- Stercobilin
- Urobilin
- Derivatives of bilirubin
Outline the four stages of the cell cycle
- G1: Preparation for DNA synthesis
- S phase: DNA synthesis
- G2 phase: Preparation for division
- M Phase: Mitosis
Which stages of the cell cycle constitute interphase?
- G1
- S
- G2
Where are the two checkpoints located in the cell cycle? What is the importance of them?
- Before S phase and M phase
- Halts the cell cycle in response to DNA damage
- To maintain genetic stability
What is G0?
- Quiescent phase
- Where cells are not rapidly divide
What are positive and negative regulators?
- Positive regulators control the changes necessary for cell division
- Negative regulators control positive regulators
Identify two families of proteins that control the progress through the cell cycle, and the way in which they control this
- Cyclins and cyclin dependent kinases
- Cyclin activates CDK
- Which allows CDK to phosphorylate the proteins necessary for a particular step in the cycle
How is cyclin degraded?
- Ubiquitin / protease system
- Enzymes add small molecules of ubiquitin to cyclin
- Which directs the cyclin to a proteasome where it is degraded
Identify the main cyclins involved in the cell cycle and their associated CDK
- Cyclin A: CDK1 + CDK2
- Cyclin B: CDK1
- Cyclin D: CDK4 + CDK6
- Cyclin E: CDK2
Outline the role of Cyclin D in cell cycle control
- Binds with CDK4 + CDK6
- To phosphorylate retinoblastoma protein
- Which allows passage of cells from G0 to G1
Which phases of the cell cycle are controlled by each cyclin?
- G1-S: Cyclin E
- S-G2: Cyclin E and Cyclin A
- G2-M: Cyclin A and Cyclin B
Outline the process of mitosis
- Prophase: Condensation of chromosomes, disintegration of nuclear membrane
- Metaphase: Chromosomes align on equator of cell
- Anaphase: Mitotic apparatus captures and draws chromosomes to opposite poles of cell
- Telophase: Formation of nuclear membranes, cytokinesis
Identify two negative regulator of the cell cycle
- Hypophosphorylated Rb
- CDK Inhibitors
Identify the two families of CDK inhibitors
- CIP family: p21, p27, p57
- Ink family p16, p19, p15
How does the p53 gene induce DNA repair?
- Codes for p53 protein
- Which accumulates in cells
- Activates transcription factors such as p21
- Which inactivates cyclin / CDK complexes
- Thus preventing Rb phosphorylation
- Arresting cell at checkpoint 1
Which cyclin is thought to be involved in arresting the cell cycle at checkpoint 2?
- Cyclin B
Outline the extrinsic pathway of apoptosis
- Binding of TNF to the death domain of a Fas receptor (e.g. CD95)
- Causing Fas receptors to trimerise
- And activate an initiator caspase (caspase 8)
Outline the intrinsic pathway of apoptosis
- p53 activates BCL-2 proteins e.g. Bax, Bak
- Which promote release of cytochrome C from mitochondria
- Which complexes with Apaf-1
- This complex combines with procaspase 9 to activate it
- Which orchestrates the effector caspase pathway
What is the apoptosome?
- Complex of cytochrome C, Apaf-1 and procaspase 9
Outline the execution phase of apoptosis
- Executioner caspases cleave DNA repair enzymes, protein kinase C and cytoskeleton components
- DNAase cuts DNA between nucleosomes
- Nucleus shrinks (pyknosis) and fragments (karyorrhexis)
What is the role of apoptotic initiating factor (AIF)?
- Enters cell nucleus and triggers cell suicide
What is a polyp?
- Protuberant growth
- Divided into epithelial and mesenchymal polyps
- Which are subdivided into benign and malignant categories
Identify four types of benign epithelial polyps
- Adenomas
- Hamartomatous
- Hyperplastic
- Inflammatory
What is the incidence of adenomas?
- 20% of population
Identify the types of adenomas
- Tubular: 75%
- Villous: 10%
- Tubulovillous: 15%
Identify three structural features of a tubular adenoma
- Pedunculated
- Smaller (<10 mm in diameter)
- Crypts lined by mucus secreting epithelium
Describe the structure of a villous adenoma
- Sessile
- Larger (20 mm in diameter)
- Villi lined by columnar epithelium showing dysplasia