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Clin Med- GI > Physiology > Flashcards

Physiology Flashcards

1
Q

How many parts are there to the GI tract?

A

3: upper, middle, lower

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2
Q

What makes up the upper portion of the GI tract?

A

Mouth Esophagus Stomach

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3
Q

What makes up the middle portion of the GI tract?

A

Small intestine ( duodenum, jejunum, ileum)

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4
Q

Where most digestive and absorptive processes occur..

A

Middle portion of GI tract (small intestine)

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5
Q

Salivary glands

Liver

Pancrea

A

Accessory organs

produce secretions that aid in digestion

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6
Q

Digestive enzymes produced by ______ _______ help breakdown food

*enzymes for initial digestion of LIPIDS and STARCHES

A

Salivary glands

(in mouth)

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7
Q

Conduit for passage of food from pharynx to stomach

A

Esophagus

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8
Q

Smooth Muscle

Mucosal glands

Submucosal glands

Pharyngoesophageal sphincter

Gastroesophageal spincter

A

Structures in the esophagus

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9
Q

Provides peristaltic movements needed to move food

A

Smooth muscle of esophagus

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10
Q

Secrete mucus to protect its surface and aid in food lubrication

A

Mucosal and submucosal glands

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11
Q

Circular layer of striated muscle

Keeps air from entering esophagus and stomach during breathing

Prevents backup into trachea

A

Pharyngoesophageal spincter

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12
Q

Circular muscle remains tonically contracted

Prevents backup into esophagus

Zone of high pressure that prevents reflux of gastric contents into esophagus

Relaxation during swallowing, allowing easy propulsion of esophageal contents into stomach

A

Gastroesophageal spincter

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13
Q

Function= storage reservoir

*made up of= fundus, body, pyloric region, pyloric sphincter

A

Stomach

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14
Q

Prevents regurgitation (from duodenum)

Keeps one-way passage

Helps control rate of emptying

A

Pyloric sphincter

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15
Q

22 cm (10 in) long

Contains opening for the COMMON BILE DUCT and MAIN PANCREATIC DUCT

A

Duodenum

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16
Q
A
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17
Q

A fluid synthesized by the liver that breaks down lipids

A

Bile

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18
Q

Facilitates digestion of:

lipids

carbohydrates

proteins

A

Pancreatic juices

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19
Q

Food is digested and absored in the…..

A

Jejunum and ileum

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20
Q

1.5 m (5 ft)

Divided into: cecum, colon, recutm and anal canal

A

Large intestine

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21
Q

Blind pouch that projects down at the junction of the ileum and colon

A

Cecum

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22
Q

Lies at the upper border of the cecum

Prevents the return of feces from the cecum into the small intestines

A

Ileocecal valve

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23
Q

Mostly for water reabsorption

storage channel, waste, elimination

A

Large intestine

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24
Q

Mucosal layer

Submucosal layer

Muscularis externa

Serosal layer

A

4 layers of gastrointestinal wall

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25
Q

Made up of:

Epithelum lining (single layer of cells)

Laminar propriae (loose connective tissue)

Muscularis mucosa (smooth muscle)

A

Inner mucosal layer of GI wall (aka mucosa)

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26
Q

Where are microvilli (fingerlike projections that increase surface are) found?

A

In the lamina propria of the mucosa

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27
Q
  1. production of mucus that protects and lubricates inner linning
  2. secretion of digestion enzymes that break food down
  3. absorption of the breakdown products of digestion
  4. maintence of a barrier
A

Function of mucosal layer of GI tract

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28
Q

Lymphatics within the mucosa serves as the body’s….

A
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29
Q

Helps with lubrication

Dense connective tissue

Veins, arteries, nerves- responsible for secreting digestive enzymes

A

Submucosal layer of GI

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30
Q

made up of 2 concentric and thick layers of smooth muscle:

inner (circularly arranged)

outer (longitudinally arranged)

in between the 2 layers= connective tissue layer with nerves (control smooth muscles, blood, lymph)

**FACILITATES MOVEMENT OF GI TRACT

A

Muscular externa

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31
Q

Serous membrane with a layer of squamous epithelium (mesothelium)

Small amount of underlying connective tissue

most superficial layer

A

Serosa (mesothelium)

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32
Q

Encloses portion of abdominal viscera

Attaches to abdominal wall

Contains: blood and lymphatic vessels

Holds organs in places

Stores fat

A

Mesentary double layer

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33
Q

Double layered extension or fold of peritoneum that passes from the stomach or proximal part of the duodenum to adjacent organs in the abdominal cavity

A

Omentum

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34
Q

Extends from stomach to transverese colon and intestinal folds

Contains fat

Mobile and moves with peristalsis

Often forms adhesions adjacent to inflamed organs, which prevents spread of infection

Curshions organs against injury (provides insulation)

A

Greater omentum

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35
Q

Extends between transverse fissure of the liver to the lesser curvature of the stomach

A

Lesser omentum

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36
Q

Intermittent contractions that mix and move things along

Found in the esophagus, antrum, small intestine

A

Rhythmic motility

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37
Q

Movement found in sphincters

Strong muscle bands that prevent movement in wrong direction

Constant contraction without relaxation periods

Found in: lower esophagus, upper stomach, iliocecal valve, internal anal sphincters

A

Tonic motility

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38
Q

Cells are electrically coupled by low resistance pathways

Allow electrical initiation to muscle contractions

Gap junctions where messages are passed quickly and readily

Large bundles of fiber

A

Unitary cells

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39
Q

Create SLOW waves- rhythmic, spontaneous oscillations in membrane potentials

Range= 3-12 minutes

Generated by thin layer of interstitial cells

Bring closer to threshhold potential

A

Pacemaker cells

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40
Q

The GIs own nervous system

*lies entirely within the wall of the GI tract

composed of 2 plexuses:

  • Outer myenteric (Aurebach)
  • Innter submucosal (Meissner)
A

Enteric nervous system

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41
Q

Which enteric nervous system plexus…

Located between cells

Linear chain of interconnecting neurons

*concerned maily with motility along the length of the gut

A

Myenteric plexus

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42
Q

Which enteric nervous system plexus….

Lies between submucosal and mucosal layers

Responsible for: local control of motility, intestinal secretions, absorption of nutrients

*integrates signals from muscle layer and lumen, stretch receptors

A

Submucosal Plexus

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43
Q

Monitor the stretch and distention of the GI tract wall

A

Mechanoreceptors

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44
Q

Monitor the chemical composition

  • Osmolality
  • pH
  • Digestive products of protein
  • Fat metabolism
A

Chemoreceptors

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45
Q

These cells do not create APs or initiate muscle contraction

*just bring it closer to potential

Slow waves of membrane oscillations

(no calcium channels)

A

Pacemaker cells

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46
Q

Parasympathetic NS innervates the GI system mostly through….

A

Vagus nerve

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47
Q

Thoracic chain of ganglia

Celiac

Superiror mesenteric ganglia

Inferior mesenteric ganglia

A

Sympathetic innervation of the GI system

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48
Q

Starts voluntary

Becomes involuntary

becomes involuntary as food or fluid reaches the pharynx

A

Swallowing

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49
Q

Trigeminal N.

Glossopharyngeal N.

Vagus N.

Hypoglossal N

A

Innervation of oral and pharyngeal phase

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50
Q

Vagus N. is the innervation of which phase?

A

Esophageal phase

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51
Q

Bolus collected in back of mouth

Get into position/ ready to be pushed backwards

A

Oral (voluntary) phase of swallowing

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52
Q

Soft palate pulls upward to close off nasopharynx to prevent regurgitation

Vocal folds close off trachea

Reflexes push things down into esophagus

A

Pharyngeal (involuntary) phase

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53
Q

Primary peristalsis (voluntery, upper 1/3 with striated muscle)

Secondary peristalsis (involuntary, lower 2/3 smooth muscle)

A

Esophageal phase of swallowing

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54
Q

Pressure in the lower esophageal sphincter is normally _____ than pressure in the stomach

prevents reflex of gastric contents

A

GREATER!

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55
Q

How does bolus get past the gastroesphageal spincter into stomach?

A

Stretch receptors sense the bolus and tell sphincter to relax

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56
Q

CNS lesions (ie stroke)

Narrowing of esophagus (stenosis)

Muscle weakness

Functional obstruction

Lack of salivation

…can cause?

A

Dysphagia

(dysphagia= symptom, NOT a diagnosis)

57
Q

“Failure to relax”

Problem with lower esophageal sphincter

birds beak** is pathognomonic

primarily an issue with innervation

A

Achalasia

(glucagon can help relax sphincter)

58
Q

Glucagon

Nitro

Metoclopramide

…can be used to?

A

Help pass bolus of food

these will relax muscle/sphincter, allowing food to pass thru into stomach

59
Q

Seen in alcoholics

due to excessive vomit (often vomit blood)

Due to mucosal tears at the gastroesophageal junction

~10% of upper GI bleeds

A

Mallory-Weiss Syndrome

60
Q

Midsternal pain, discomfort..”heart burn”

due to problem with lower esophageal sphincter

worse with acidic foods and lying down

A

GERD

61
Q

Does GERD pain correlate with extent of mucosal injury?

A

NOPE.

62
Q

Often ER treats with…

“GI cocktail”: Benadryl, lidocaine, malox

What is this for?

A

Acute GERD tx

63
Q

Where are columnar cells normally found?

A

Intestines (where there is acid)

*excess acid in esophagus leads to change (squamous –> columnar..Barrett’s esophagus)

64
Q

The most potent signals for gastric motility come from….

A

Enteric nervous system

65
Q

Abnormally thick muscularis layer in the terminal pylorus

*vomitting

*olive/grape shaped mass on abdominal exam, vomitting child

A

Hypertrophic pyloric stenosis

66
Q

Decreased gastric muscle tone

Complication of visceral neuropathies (ie diabetes)

Can also be due to…surgical procedures that disrupt vagal activity

A

Gastric atony

67
Q

Obstructions (scar tissues, ulcers)

Gastric atony

Hypetrophic pyloric stenosis

All do what to the rate of digestion?

A

SLOWS rate!

*gastric retention

68
Q

What is the syndrome when digestion rate is too fast?

A

Dumping syndrome

69
Q

Complication of gastric surgeries

Rapid dumping of hydroacidid and hyperosmotic gatric secretions

Diarrhea, abdominal cramping

A

Dumping syndrome

70
Q

Slow contractions of the circular muscle layer

Contents moving forward and backward

Mixing the chyme with digestive enzymes from pancreas to make sure enough chyme is expose to mucosal surface area

*frequency increases after meals

*stimulated by receptors in stomach and intestine

A

Segmentation waves

71
Q

Rhythmic propulsive movements that propel chyme toward large intestine

Sequential relaxation

Ileocecal valve

A
72
Q

Peristaltic movements are influenced by which plexus?

A

Myentertic plexus

73
Q

Inflammation..can cause hyper or hypo motility

ileus (impairment of intestinal motility), especially post op
**delayed passage of chime

(hypermotility can lead to diarrhea..getting rid of infection)

A

Problems with small intestine motility

74
Q

impairment of intestinal motility, especially can after post op

A

Ileus

75
Q

Two types of movement seen in large intesine

A
  1. segmental
  2. propulsive
76
Q

Haustrations

Local digging- type action

Ensures all portions of fecal mass are exposed to the intestinal surface

A

Segmental movement (in lg intestine)

77
Q

Large segment contracts as a unit

Timing!..mass movement lasts about 30 seconds

Relaxation periods= 2-3 minutes

Then another mass movement

A

Propulsive movement (large intestine)

78
Q

Circular, involuntary smooth muscle

A

Internal anal sphincter

79
Q

Striated, voluntary muscle

Innervated by the pudendal nerve

A

External anal sphincter

80
Q

Which reflex….

Controlled by enteric nervous system

*Initiated by distention of the rectal wall with initiation of reflex peristaltic waves that spread through the descending colon, sigmoid colon and rectum

A

Intrinsic myenteric reflex

81
Q

Which reflex….

Integrated at level of sacral cord

When the nerve endings in the rectum are stimulated, signals are transmitted to the sacral cord and then reflexively back to the descending colon, sigmoid colon, rectum, anus and pelvic nerves

Increase peristaltic movements and relax the internal sphincter

A

Parasympathetic reflex

82
Q

Large volume, watery, non bloody

cramps, bloating, N/V, dehydration, hypokalemia

caused by: staph, E. coli, giardia, cholera, etc.

A

Noninflammatory diarrhea

83
Q

Projective vomit shortly after eating

..what is usually the cause?

A

Staph aureus

84
Q

Small volume, fever, bloody

usually affects the colon itself more (reason for smaller volume)

lower abdominal pain, urge to defecate comes on quick!

caused by: invasion (shigella) or toxin (c.diff)

A

Inflammatory diarrhea

85
Q

Length of acute vs. chronic diarrhea?

A

Acute..1-2 weeks

Chronic..longer than 3-4 weeks

86
Q

Transit time interferes with absorption

*water is being pulled into bowel

ie..lactose intolerance
if pt cannot digest lactose, it is undigested in lumen..which draws water into bowel and leads to diarrhea*

A

Osmotic diarrhea (chronic)

87
Q

Osmotic

Secretory

Inflammatory

Parasitic

Factitious

A

Causes of chronic diarrhea

88
Q

Pain, incontinence sometimes

frequency and urgency!

Colicky abdominal pain

ie..Chron’s, ulcerative colitis

A

Inflammatory diarrhea (chronic)

89
Q

Excessive laxative use can cause what type of chronic diarrhea?

A

Factitious

90
Q

Viral cause of diarrhea

*seen in kids mostly

*very virulent! dont need much of virus to get sick

big concern= dehydration

*vaccine against now

A

Rotavirus

91
Q

S. aureus

Shigella

Salmonella

Campylobacter

C diff

E. Coli

A

Bacterial causes of diarrhea

92
Q

Severe, life threatening complication of C.dif

toxins ruined membrane lining

A

Pseudomembranous colitis

93
Q

What happens to WBC count in c diff?

A

HIGH!!!!

94
Q

Shigella like toxin..gets into mucosal lining

bloody diarrhea

Can get into bloodstream…Hemolytic Uremic Syndrome
(hemolytic anema, thrombocytopenia, etc)

A

E Coli

95
Q

Tx for E. coli?

A

Nothing..let the body treat itself/flush it out

Tx symptomatically

NO ANTIBIOTICS!!..will worsen

96
Q

Persistent/recurrent sxs of abominal pain

Alter between diarrhea/constipation

Flatulence, bloating, nausea, anorexia

HALLMARK= abdominal pain relieved by defecation****

A

Irritable bowel syndrome

97
Q

Axial arthritis affecting spine, SI joints

*uveitis

Skin lesons- erythema nodosum

Stomatitis

Anemia

Hypercoagulability

Inflammation of bile duct

A

Inflammatory bile disease

98
Q

Can occur anywhere, but most common in distal colon

Skip Lesions in submucosa

Intermittent diarrhea (usually not bloody), colicky pain
weight loss, ulceration of perianal skin

bowel wall thickens overtime, rigid. “led pipe”

long term..can cause fistulas (which may make prone to bacterial infections)

A

Chron’s disease

99
Q

Bloody diarrhea, mucousy diarrhea
starts in rectum, moves proximally

nocturnal diarrhea, weakness, fatigue, thickened bowel wall

crypt abscesses*…HEMORRHAGES! psuedopolyps

complications= toxic megacolon, colon cancer

A

Ulcerative colitis

100
Q

Think what when you hear crypt abscesses

A

Ulcerative colitis

101
Q

Pseudo vs true diverticula

A

Psuedo= only musoca and sub muscoa involved

True= all layers!

102
Q

Presence of diverticula

May be asymptomatic

A

Diverticulosis

103
Q

Inflammation and perforation of diverticula

LLQ pain

first line tx usually “bowel rest”…dont eat much. clear fluids

if abscess forms…may eventually need antibiotics

A

Diverticulitis

104
Q
A
105
Q

Perforation with peritonitis

Hemorrhage

Bowel obstruction

Fistula

A

Possible diverticulitis complications

106
Q

Can be normal-transit (nothing wrong..just slowed down)

Can be slow-transit (innervation issue like Hirschsprung dz, which is a lack of ganglion cells/innervatin in the bowl)

A

Constipation

107
Q

New onset of constipation in elderly, might want to check what levels?

A

Thyroid (could be hypothyroid issue)

108
Q

Disease where there are no ganglion cells in bowel

*can lead to constipation (slow-transit)

A

Hirschsprung disease

109
Q

Sx: pain, distention, vomitting

can be mechanical cause: hernia, adhesions, intussesception, volvulus

can be paralytic cause

A

Obstruction

110
Q

“telescoping bowel”

MC abdominal emergency affecting children under 2

Intermittent symptoms

Tx and dx with=contrast, enema

A

Intussesception

111
Q

Twisting of bowel on own axis

can lead to obstruction

A

Volvulus

112
Q

If the obstruction is paralytic, are there bowel sounds?

A

NO

113
Q

Largest endocrine organ in the body

A

GI tract

114
Q

G cells in antrum of the stomach, duodenum

Stimulated by vagus nerve

Secretion inhibited by acid content of stomach antrum (pH under 2.5)

A

Gastrin

115
Q

Stimulates secretion of growth hormone

Acts as appetite stimulating signal from stomach when an increase in metabolic efficacy is necessry

A

Ghrelin

116
Q

Action= stimulates secretions of gastric acid and pepsinogen

Increases gastric blood flow

Stimulates gastric smooth muscle contraction

Stimulates growth of gastric acid and intestinal mucosal cells

A

Gastrin

117
Q
A
118
Q

Important mediator for appetite and meal size control

Made by I cells in intestinal mucosa

A

Cholecystokinin (CCK)

119
Q
  1. Mucus: lubricate and protect mucosal layer
  2. Digestive and asborption: secretion of enzymes to aid
A

2 functions of GI secretions

120
Q

50-200 ml leaves body in stool

Mostly…..

A

water and some Na, K

121
Q

Which part of ANS increases secretory activity?

A

Parasympathetic

122
Q
  1. protection and lubrication
  2. antimicrobial (lysozyme)
  3. digestion (ptyalin and amylase)
A

Functions of salivary secretions

123
Q
  • Gastric acid
  • Intrinsic factors

..produced by what cells?

A

Parietal cells

124
Q
  • Pepsin
  • Gastric lipase

…made by what cells?

A

Chief cells

125
Q

Gastrin

..producd by what cells?

A

G cells

126
Q

Molecules that:

break down prostaglandins
are lipid soluble

ie…NSAIDs, aspirin, ETOH, bile salts, etc.

A

Can damage gastric mucosa!

127
Q

Improve bloodflow to mucosal lining

Decrease acid secretion

Increase mucus production

overall…protects mucosal lining

A

Prostaglandins

128
Q

Tight junction of cells

Covered with hydrophobic lipid layer

Equal secretion of H and HCO3

A

Ways the gastric lining protects itself

129
Q

Secretes HCl

Intrinsic factor (necessary for absorption of vitamin B12)

A

Parietal cells

130
Q

Gastrin

Ach

Histamine

…all stimulate?

A

Gastric acid

131
Q

Cephalic (start thinking about food, salivating)

Gastric (HCl starts to get secreted)

Intestinal (Secretin suppresses gastric function)

A

3 phases of gastric acid stimulation

132
Q

Primary location affected by peptic ulcer disease?

A

Duodenum

133
Q

Gastrinoma (gastrin secreting tumor)

Diarrhea (bc more gastrin, changing osmotic gradient.secretory diarrhea)

*over 2/3 are malignant
generally diagnosed late!

A

Zollinger-Ellison Syndrome

134
Q
A
135
Q

Concentrated at site where contents from stomach and secetions
from liver and pancreas enter duodenum

Secrete large amounts of alkaline mucus that protects duodenum from acid content

A

Brunner glands

136
Q

Starch (50%)

Sucrose (30%)

Lactose (6%)

Maltose (1.5%)

A

Carbohydrates we digest/absorb

(need to be broken donw into monosaccharides before they can be absorbed)

137
Q
A
138
Q

Breakdown of large dietary fat globules

Increases number of triglycerides

A

Clin Med- GI (8 decks)

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