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GIGU > SAQ 1 > Flashcards

SAQ 1 Flashcards

1
Q

digestive diseases are Pandemic affecting ________ million Americans each year

Deadly: whats the 2nd deadliest cancer in the US?
what is the 3rd leading cause of death worldwide?

and Costly: total healthcare costs exceed 40 billion; cost to nation exceeds 90 billion

A

70-95 million

colorectal cancer

Diarrhea

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2
Q

a _______ is a type of pleural effusion. It results from lymphatic fluid (chyle) accumulating in the pleural cavity.

A

Chylothorax

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3
Q

the 3 layers of muscle in the large intestine are collectively called _________

A

tenia Colli

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4
Q 
what are the 8 layers of the GI tract?
from outside in:
1. visceral peritoneum (serous membrane)
2. Longitudinal Muscle
3. between longitudinal and circular muscles
4. Circular Muscle
5. expands for digestion
6.
7. muscularis mucosae
8.
A
  1. Serosa
  2. Longitudinal Muscle
  3. myenteric (Auerbach’s) nerve plexus
  4. Circular Muscle
  5. submucosal (Meissner’s) nerve plexus
  6. submucosa
  7. muscularis mucosae
  8. epithelial or muscle layer
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5
Q

what are the control mechanisms for the GI tract?

A

GI peptides
the autonomic control mechanisms are:
-Extrinsic- greater, lesser and least splanchnic nerve, Vagus and pelvic splanchnic (pregg para sympathetic/s2,s3,s4)

    -local/ intrinsic- submucosal plexus
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6
Q

what are the three gastrointestinal peptides/ modulators?

A

1- Endocrines
2- Paracrines
3- Neurocrines

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7
Q

ALL GI hormones (Endocrines) are peptides.

Endocrines are released in to the blood and act on ______ target cells

A

Distant

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8
Q

Some Paracrines are peptides (Somatostatin), some are not (histamine)

endocrine cells release and _______ to target cells.

Paracrine can act on ______ cells (__ or __)

A

diffuse

endocrine

+

-

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9
Q

neurocrines are ______________ which are sometimes peptides (VIP), some are not (Ach, NE)
- nerves release and ______ to target cells

A

neurotransmitters

diffuse

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10
Q

what is the neural control of the GI tract?

Intrinsic and Extrinsic

A 
Intrinsic= Enteric Nervous System
     -Myenteric (Auerbach's) plexus
     -Submucosal (Meissner's) plexus
Extrinsic Control= Autonomic nervous system
     -Parasympathetic= stimulates
            -Cholinergic (Ach)
            - peptidergic
     - Sympathetic= Inhibits (NE)
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11
Q

Mechanoreceptors detect ______________

A

pressure on mucosa such as the distension of a full stomach

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12
Q

the ENS is located from the esophagus to the anus and can be found between _______ and _______ SM layers.

A

longitudinal and circular

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13
Q

The ENS Myenteric plexus controls GI motility and has stimulatory and inhibitory influences.

what are the stimulatory?

what are the inhibitory?

A

stimulatory:
increase tonic contraction
increase propulsion (intensity / frequency)
Inhibitory:
Decreased Sphincter tone (pyloric, ileocecal and LES)

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14
Q

the ENS submucosal plexus is in the mucosal layer from esophagus to anus and its function is _______ control as well as _____, _____, and contraction of muscularis mucosa

A

local

secretion

absorption

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15
Q

what are the parasympathetic innervations to the GI tract?
- cranial divisions-_______
-sacral divisions-________
what percent of nerves contain afferent sensory fibers?

A

Vagus nerve- derived from foregut and midgut

pelvic splanchnic nerve- derived from hindgut

80%

neurons- 
     -preganglionic- long
     - postganglionic- short and entirely in
       the  ENS (gut wall)
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16
Q

where do the preganglionic neurons (long) originate? and synapse?

A

T5- L2

and synapse in the prevertebral ganglia

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17
Q

what provides sympathetic innervation to the entire gut, originates in the ganglia and terminates in to the ENS

A

Postganglionic neurons (LONG)

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18
Q

the sympathetic nerves also contain afferent sensory fibers, whats the percent? they are contained in the splanchnic nerves (GVA) and is responsible for _______ pain

A

50%

Ischimic

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19
Q

where do these nerves synapse?

Greater splanchnic

Lesser splanchnic

Least Splanchnic

A

Greater splanchnic @ cilliary

Lesser splanchnic @ Superior Mesenteric

Least Splanchnic@ Inferior Mesenteric

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20
Q

sensory afferent neurons

-stimulation of afferent neurons is responsible for 3 things: ____, ______ and ____.

A
  • distention of the gut wall
  • non Specific irritation of the gut mucosa
  • specific chemical stimuli

stimulation can excite or inhibit;
- intestinal movements and secretions

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21
Q

Local or short loop GI reflexes affect _______

the long loop reflexes are ______, ______ and __________

A

secretion, peristalsis, mixing movements

gastrocolic reflex- your morning shit
enterogastric reflex- inhibitory GI motility
colonileal reflex- distension of colonand decreased motility of Illium

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22
Q

what is the Vagovagal reflex?

it controls gastric and secretory activity in the GI tract

A

stomach/ duodenum send afferent stimulation to brain stem which then sends efferent stimulus back to stomach/ duodenum

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23
Q

what is the defecation reflex?

A

the colon/ rectum sends afferent stimulus to spinal cord which sends efferent stimulus back to colon/ rectum

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24
Q

Pain reflex leads to overall _______ of GI tract

A

inhibition

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25
Q

Nervous and hormonal influences do not function independently…

neural activity-
Hormones-

A
  • release of hormones
  • neural activity

sources of stimuli:

  • environmental
  • within body
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26
Q

Splanchnic circulation components:

feed arteries: 25-30%- there are 3

A

components- GI tract, Spleen, Pancreas and liver

feed arteries:
1-celiac artery- stomach & spleen
2- superior mesenteric artery- small intestine, pancreas, proximal colon
3- inferior mesenteric artery- majority of colon

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27
Q

what is the venous drainage of the splanchnic circulation

A

portal vein goes to liver sinusoids which go to hepatic vein

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28
Q

Von kupher cells are aka ______ and remove bacteria

A

reticuloendothelial cells

1/2-1/3 nutrients are removed and stored in the liver

29
Q

countercurrent oxygen loss- circulatory shock, decreased cardiac output, hypotension and mechanical obstruction leads to :

  • splanchnic blood flow greatly _______
  • Villus tip or entire villus suffers ischemic _____
  • absorbtion capabilities ________
A

reduced

death

diminished

30
Q

________ is a nucleated mass of protoplasm produced by merging of cells

A

syncytium

31
Q

these _______ ______ __ _____ are pacemaker cells that conduct action potential independant of nervous/ hormonal stimuli

  • produce slow waves
A

Interstitial cells of cajal

32
Q

true action potential occurs when slow waves reach a threshold of ____ causing voltage gated calcium channels to _____.

A
  • 40mV

- open

33
Q

what can depolarize the membrane?

A
  • Stretching of muscle
  • stimulation by Ach
  • stimulation by parasympathetic nerves
  • stimulation by GI hormones
34
Q

what factors can hyperpolarize the membrane?

A
  • effect of NE or EN

- stimulation of sympathetic nerve

35
Q

propulsive movements is also known as

A

peristalsis

36
Q

chopping and shearing movements/ mixing movments are called ______

A

segmentation

37
Q

what is the”law of the gut”

A

distension- contraction with down stream receptive relaxation

38
Q

stimuli that initiate peristalsis?

A
  • law of the gut
  • irritation of gut epithelium
  • parasympathetic nervous system
39
Q

what are the functions of peristalsis?

A

myenteric plexus is required

  • atropine decreases peristalsis
  • if there’s a congenital absence then there is NO peristalsis
40
Q

Mastication and deglutition is governed by ______ nerve?

A

trigeminal

41
Q

in which stage of deglutition is respiration interrupted?

A

the Pharyngeal stage

42
Q

the upper esophageal (hypopharyngeal) sphincter is formed by the inferior constrictor and ________

A

cricopharyngeus muscle

43
Q

receptive relaxation of the LES ahead of the peristalic wave is mediated by ________ fibers in the vagus nerve

A

peptidergic

44
Q

_______ is a failure of the LES to relax and leads to impeded flow of solids and liquids into stomach, aperistalsis of esophagus, elevates resting tone of LES with lack of relaxation…

A

Achlasia

45
Q

_______ is associated with low resting tone, inappropriate relaxation, or decreased postprandial pressure. acid from the stomach moves up into the esophagus and irritates tissue

A

GERD

46
Q

distension of the stomach has a limit of _____ to _____ liters

A

0.8-1.5

47
Q

__________ reflex is a decrease in muscle tone of the stomach wall; curves receptive relaxation

A

Vagovagal

48
Q

what is the most important motor function of the stomach?

A

retropulsion from the antrum

49
Q

peristaltic contractions in the antrum cause mixing in the stomach and a pumping action called _______ _____

A

pyloric pump

50
Q

during gastric emptying, liquids leave by pressure gradient. ____-____% empty in one hour

A

50-75%

51
Q

during gastric emptying, solids leaving the stomach are dependent on antral mixing and size reduction. ___ to _____% empty in one hour

A

25-30%

52
Q

the rate of gastric emptying is regulated by signals coming from the _______ and ________

A

stomach and duodenum

53
Q

______ is secreted by “G” cells found in the antrum of the stomach and has mild to moderate stimulatory effects on motor functions

A

Gastrin

54
Q

Gastric food volume causes local _______ reflexes that promote gastric emptying

A

Myenteric

55
Q

duodenal factors that inhibit stomach emptying are ______,______ and ______

  • also fats and CCK as well as hormones like secretin and GIP
A

presents of irritants and acidic chyme, breakdown products of protein digestion
hypotonic and hypertonic fluids

56
Q

_________ are mixing contractions that stretch the intestinal wall and elicits localized concentric contractions

A

segmentations

57
Q

________ aka peristalsis is weak net movement of 1 cm/ min; takes 3-5 hours for chyme to pass from pylorus to ileocecal valve

A

Propulsion

58
Q

afferent stimulation in the stomach causes efferent stimulation of the small intestine which is termed as ______ reflex

A

gastroenteric

59
Q

Gastrin, CCK, Motilin, insulin and serotonin ______ intestinal motility and _____ and glucagon (produced by alpha cells of pancreatic islet) ______ small intestine motility

A

enhance

secretin

inhibit

60
Q

________ ______ is an intense irritation of mucosa in the small intestine and causes diarrhea

A

peristaltic rush

61
Q

the __________ valve slows ileal emptying, thus favoring more absorbtion in the small intestine

  • an example of irritation is appendicitis which decreases intestinal motility
  • patients with a restriction of the illium will suffer from steatorrhea (fattty stool)
A

illeocecal

62
Q 
name the three distinct features of the large intestine:
1. tenia colli
2.
3.
and what are the major functions?
A
  1. haustrations
  2. epiploical appendiges

absorbtion of water and electrolytes as well as the storage of fecal matter

63
Q

electrolytes are absorbed in the ________ which is also responsible for mixing patterns that expose fecal material to colonic mucosa for absorbtion of fluid and dissolved substances

A

Haustrations

64
Q

the internal anal sphincter is controlled by the _____ _____ nerve while the external sphincter and the puborectalis has voluntary control due to GSE fibers courtosy of the ___________ nerve.

A

pelvic splanchnic

puedendal

65
Q

perioneointestinal reflex, renointestinal reflex and the vesicointestinal reflex are all examples of _________ reflexes

A

autonomic

66
Q

vomiting has 3 stages, what are they and what activities define them?

A
  1. Nausea-hypersalivation, decreased ar absent peristalsis, increased duodenal and proximal jejunal tone
  2. Retching- spasmodic respiratory movement, pyloric stomach contracts, upper part relaxes, herniation of abdominal esophagus and proximal stomach, secretion of mucus by stomach increases, acid secretion decreases
  3. vomiting- forceful extrusion of gastric contents, contraction of abdominal muscles and pylorus
    * if hypopharyngeal sphincter (UES) is contracted, no vomiting occurs and contents return to stomach
67
Q

the _________ neural pathway to bile ducts, mesenteric vasculature, heart, duodenum, kidney, pharynx, uterus, renal pelvis, bladder and testicles coordinates activities during vomiting

A

Afferents

68
Q

___________ trigger zone in area postrema in the floor of the 4th ventricle stimulates vomiting. dopamine is also the neurotransmitter used which increases apomorphine and bromocriptine

A

chemoreceptor

GIGU (6 decks)

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