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stomach Flashcards

1
Q

R vagus

A

posterior wall

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2
Q

L vagus

A

anterior wall

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3
Q

layers of stomach

A 
mucosa
lamina propia/deep mucosa
submucosa
muscularis- inner oblique, middle circular, outer longitudinal
serosa
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4
Q

body/fundus is lined by what type of mucosa

A

oxytinic–>secretes acid

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5
Q

antrum/pyloris + mucosa

A

pyloric- gastrin

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6
Q

submucosa

A

deep connective tissue- colllagen/elastin

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7
Q

what makes up oxytinic cells

A 
surface mucous cells
mucous neck cells
parietal cells at neck
chief cells at base
endocrine cells- ECL (histamine), D cells-somato
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8
Q

3 fx of stoamch

A

reservoi
digeston
controlled emptyings

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9
Q

surface/ncek mucous cells

A

HCO3, mucous

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10
Q

parietal cells

A

H+

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11
Q

chief cells

A

lipases

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12
Q

antrum

A

g cells, surface and mucus, d cells

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13
Q

3 known parietal stimulants

A

Ach
gastrin
histamine

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14
Q

alkaline tide

A

HCO3- recycled from hcl generation and gose to surface mucosa to be usd to protec gastric ucosa

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15
Q

agents that disturb barrier of neutralization

A

weak acids
alcohol
NSAiDS
detergents

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16
Q

three pathways mediting response to a meal

A

endocrine- sensor villi
neurocrine neve stim
paracrine- histamine, CCk somato

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17
Q

what drives the cephalic phase

A

parasymp (vagus) secreting Ach and GRP

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18
Q

two things driving gastric phase

A

fundal distention–>mechanoR–>increase parietal cell secretion
vagally-mediatd arch (parietal and g cells)

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19
Q

low ph inhibits

A

gastrin

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20
Q

intestinal phase

A

mediated by chyme entry into duodenum around 1st hr post-meal–>slows gastric emptying and decreases acid secretion passively (decrease distention) and actively by inhibitors

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21
Q

aminoacids in small intestine

A

stimulate release of gastrin

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22
Q

secretin, Gip

A

inhibit gastric acid secretion

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23
Q

cells in isthus

A

suface mucous- insoluble visible mucous and HCO3- to form protective mucous gel neutralizatio zone

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24
Q

neck cells

A

ucous neck cells
parietal cells
stem cells

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25
base cells
chief cells- pepsinogen & gastric lipase ECL cells-histamine D cells- somatostatin
26
SMS is inhibited by
vagal stim
27
duodenal gland cells
icell, s cell, Gip
28
CCK
in response to AA and FAs | inhibits gastric emptying
29
secretin
inhibits H+ secretion by parietal cells | promotes bicarb secretion by panc
30
Gip
inhibits h+ secretion from gastric parietal cells
31
when is hemorrhage most likely
posterior penetrating duodenal ulcer
32
perforation
anterior penetrating duodenal or gastric ulcer
33
gastric ulcers commonly
lesser curvature of stomach at junction of antrum and body or in pre-pyloric region of antrum
34
duodenal main location ulcer
duodenal bulb
35
jejunal ulcer often secondary to
zollinger-ellison syndrome
36
tests for hyplori
bx-rapid urease test urea breath test serum Ab to H pylori stool antigen test
37
how do nsaids cause ulcers
pGE2 fro cox 1-->increase mucus secretion, increase mucosal blood flow, increase HCO3- increase epitelial cell restitution and proliferation
38
tx of ulcers
antacids decrease acid production (h2ra, ppi) increase mucosal protection (dec drugs, stop smoking, increase dissacharides, increase PGE2) eradicate hplori
39
SE NaHCO3
alkalosis, hyperNa
40
CaCo3 SE
increase Ca--> more gastrin
41
AlOH3 SE
constipating, binds to PO4 (bone pain), binds drugs
42
MGOH2
cathartic
43
what is diff about cimetidine vs rani, fom, & nizatidine (h2ra)
cimetidine interacts with CP450 | anti-androgen-->gynecomastia, mental confusion
44
best tx ulcers
ppi
45
tx for hpylori
bismuth + tetra or metronidazole | amoxi/clarithomycin
46
zonger ellison syndome
gastrinoma- lots of gastrin diarrhea, steatorrhea due to low pH overload-->inact of lipases main place is duodenal wall, bu also panc
47
ZES gastrinomas often part of
MEN1 syndrome
48
dx ZES
give secretin
49
cushing ulcer
due to intracranial trauma
50
posterior duo ulcers have potential to
perforate into pancreas-->pancreatitis
51
important to bx gastric ulcer to rule out
carcinoma
52
acute erosive gastritis
more advanced gastrics w/ erosion of tissue above muscularis
53
curling ulcer
urns
54
stress ulcer
extends to submucosa- burns ,shock, trauma
55
stess ulcer tset
hemoccult + pos stools + visible change on EGF
56
type a chronic gastritis
affects fundus and body, spares antrum | typically autoimmune
57
type b chronic gastritis
typically secondary to h pylori infection | antrum predom
58
types of gastric malignancies
carcinoma lymphoma neuroendocrine/carcinoid tumor stromal tumor--intestinal cell of cajal
59
types of gastric carcinomas
``` intestinal type (from dysplasia of gastric cells) diffuse type (de novo) ```
60
px of gastric adenocarcinoa
early- does not penetrate muscularis | late- does
61
diffuse tumor gies what sign
krukenberg- ovarian met, usually bilateral | signet ring
62
other gastric adenocarcinoma distant sign
virchow's sister mary joseph sign leser-trelat sign--explosive onset of multiple seb kertaoses
63
TYPES of gastric lymphoma
chronic h pylori | b cell lymphoma of MALT lymphomas-- can progress to NHL
64
ealy vs late gastric lymphoma
early: t cell dep; h pylori--> t cells--> b cells **need abx later stages: t cell indep, t{11:18)
65
gastric carcinoids
indolent edocrine tuors--ECL cells in oxytinic ucosa
66
Gi stromal tumor
pacemaer cajal cells | pos for act mutation in ckit (CD117) and PDGFRa tyrosine kinase

GI (12 decks)

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