Study guide Flashcards
Bilirubin is a major end product of _____
hemoglobin degradation
Bilirubin can be used to diagnose _____ and ____
hemolytic blood diseases
liver disease
Bilirubin is conjugated with _____ (80%) or ____ (10%), and excreted into ______ and into the intestines as a “bile pigment”.
glucuronide (80%) or sulfate (10%)
excreted into bile canaliculi
Circulating _______ is at low levels, and is not found in the urine UNLESS there is a build-up in the blood from _______ associated with jaundice.
conjugated bilirubin
from obstructive liver disease (blood flow through liver is obsructed)
In the intestines, bacterial action forms ______, and the majority of this product is absorbed into the portal blood and into systemic circulation. A portion is filtered at the kidneys and excreted into the urine.
urobilinogen
Ureter blood supply: “Randy goes crazy if angered”
Renal, gonadal, common iliac, internal iliac and aorta
“Randy goes crazy if angered”
greater splencnic nerve comes into the abdomen right through the ____ and goes up to _____
right crus
goes up to celiac plexus
Aortic haitus
Aortic haitus – azy, thoracic duct and aorta (AATD)
Esophageal haitus
– esophagus , A/p vegal trunks
Caval haitus
– IVC, Right phrenic nerve
How do the splnencnics enter abdomen?
Splencnics go through cruses
Right gonadal vein terminates in _____
L gonadal in ______
Right gonadal vein terminates in IVC
L gonadal in L renal vein
L GO vein terminates in _____
R GO in _____
L GO vein terminates in splenic vein
R GO in gastro-duadonal vein
L colic terminates in ___
R colic vein terminates in ___
L colic terminates in inferior mesenteric vein
R colic vein terminates in SMV
L suprarenal vein terminates in the ______
R suprarenal vein terminates in the ____
L suprarenal vein –> L renal vein
R suprarenal vein –> IVC
L hepatic terminates in ____
R hepatic terminates in_____
BOTH in IVC
Cremasteric reflex is innervated by
genital branch of genito femoral nerve ( runs anterior to psoas muscle)
Adrernal glands get flow from these 3 vessels
Adrernal glands get flow from inferior phrenic artery and Celiac trunk nad renal artery
Extrinsic nerve plexus are found ___
Extrinsic = Pre-vertebral plexus, runs anterior to ab aorta.
(celiac plexus on top of celiac trunk, superior hypogastric plexus around inf mesenteric artery, aortic plexus about half way in between the two,)
elevated levels of 3 liver enzymes indicate liver failure or infection. Whihc one is specific for liver disease?
ALT (alanine transaminase) – involved in protein metabolism, produced in hepatocytes ** a specific marker for liver disease**
AST (aspartate transaminase) – protein metabolism, but less specific than ALT (found in other tissues)
ALP (alkaline phosphatase) – found in all tissues, but concentrated in liver, bile duct, kidneys, bone and placenta. can be elevated in liver, and non-liver related diseases.
yellow of urine is due to ___, if urine is darker, distinct from the yellow, then ___ is being excreted (NOT normal)
urobilin (=oxidized urobilinogen, which came from bilirubin metabolized by intestinal bacteria.)
Conjugated bilirubin (Normally not excretd in urine, BUT when plasma conjugated bilirubin is elevated, excess is excreted in urine, makes a dark color in the urine)
(~20-40%) of the urobilinogen is absorbed in the ___ and can be recycled into ___ or ___
- terminal ileum
- recycled into small intestine or enter systemic circulation
Pepsinogen is secreted where?
secreted in chief cells of oxynitic glands
converted to pepsin at pH below 5
starts digestion of proteins in stomach
___ is secreted by upper portion of oxynic and pyloric glands, protect epithelial lining of stomach
HCO3- and mucus
Intrinsic factors
secreted by parietal cells
bind to B12
controlled by same things as HCL
Ach, gastrin and histamine increase secretion of Hcl in stomach by…
increasing intracellular Calcium/IP3 or cAMP in parietal cells, which increases activity of H+–K+ATPase pump and thus H+ secretion
Between meals, when there is no food in duadonum, gall bladder is ____ and spincter of oddi is ____
- gall bladder is relaxed and filling with bile
- spincter of Oddi is closed
Vasovagal reflex
When chyme enters duadoneum:
- CCK increases and activates vagal afferents
- contraction of gallbladder (Ach)
- relaxation of spinchter of Oddi (VIP and NO)
On a CT an enlarged fatty liver shows up ____ compared to spleen. Normal liver shows up…
Liver shows up darker compared to spleen, because of the increased fat content.
The spleen and liver normally have a similar amount of fat/water/soft tissue composition, therefore show up same shade.
Primary esophegeal perastalsis is through ____ and initiated by ____
secondary peristalisis is through _____ and ___
primary – though vagus and initiated by swallowing (vagus synapses on the myenteric plexus in primary peristalsis.)
secondary – through local stretch and enteric nervous system.
liver regulates ___ and __ metabolism
carbohydrate, lipid and protein metabolism
primary functions of the liver can be separated into 3 major components:
Vascular- storage and filtration of blood
Metabolic- carbohydrate, lipid and protein metabolism
Secretory/excretory- bile formation and secretion
The pancreatic acenar cells are the ___ cells. they synthesize ___ in ____ and secrete them via ____
exocirne cells, synthesiz digestive pancreatic enzymes in rER and secrete them through exocytosis of zymogen granules ( ex: trypsinogen, amylase, lipase )
Both arterial and portal blood mix in the _____ of the liver as they flow towards the _____
liver sinusoids, flow towards the central vein
Ulcerative colitis (UC) affects ____, start in ___ and can extent proximally in a continuous fashion.
–Affect only colon
–Start in rectum, contenous up the colon
–Total colectomy is curative
Crohn’s diseas affects ____. Contenous or patches?
–Can affect entire GI tract (patchy disease)
4 complications of Crohn’s disease
–stricture, fistula, abscess, perianal disease
–Surgery is needed to treat complications, but is not curative
The two types of inflammation of the GI tract… and difference between the two
–Ulcerative Colitis (UC): colon only, mucosa and submucosa
–Crohn’s Disease: anywhere in the GI tract, transmural inflammation
Symptoms Specific to Crohn’s
–Intra-abdominal abscess
–Perianal abscess
–Fistula (bowel-skin; bowel-viscus)
Interplay of 3 factors is key to the development of IBD
- genetic predisposition
- Mucosal Immune System (Immuno-regulatory Defect)
- Environmental Triggers (Luminal Bacteria, Infection)
mneumonic for the 4 anastomoses
“Eat In Crappy Resturants”
- esopageal varices
- internal hammoroids
- caput medusa
- retropitoneal anastamoses
Water absorption occurs primarily in ___. The colon reclaims ~ 0.5 L while dehydrating the chyme to feces.
jejunum and ileum reabsorbs ~ 8.5 ml
colon reclaims ~ 0.5 L
Most bile absorption occurs in the terminal ileum via _____
via 2ndary active transport with Na+ (sodium)
Proteins digestion in the intestinal lumen is carried out by ____, and these brush border proteases ____
Pancreatic proteases: trypsin, chymotripsin, elastase, carboxypeptidase
Brushborder peptidases: amino-peptidase, amino, oligopeptidase, etc.
How do digested lipids enter nad exit enterocytes?
- enter via diffusion (as MG, lysoPL, ch, ffa)
- get re-esterified in smoothER of enterocytes, get packages within lipoprotein coat (chylomicron)
- chylomicron leaves via exocytosis
MG, lysoPL, ch, ffa→ TG,PL, ch ester→ chylomicron
3 causes of diarrhea
1) Viral/bacteiral infection or antibiotics
2) irritation to intestines (garlic-laden food, spicy food, or inflammation–IBD)
3) unabsorbed osmotic agents – undigested carbs (lactose intolerence), bile, laxatives)
Diarrhea is a result of increase in fluid and pressures in the lower GIT that leads to …
increased motility, decreased absorption (not enough time to reabsorb water, pushed out too quick)
most of our commnesal bacteria is in ___, they can process plant polysaccarides and make ___
ileum and colon
vitamins (K and biotin)
Bacterial digestion of ___ is the main source of gas that will be expelled as flatus.
starches/sugars/fiber
Which sugars can enter enterocytes? How do these enter/exit and get to blood?
- only glucose, galactose, and fructose (monosaccharides) enter enterocytes and also blood
- Glucose and galactose can use sGLT1 transporters to enter (enters with Na+)
- Fructose has its own transporter/carrier
* all 3 use facilitated transport to exit. then diffuse to capillaries
