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GI > Study guide > Flashcards

Study guide Flashcards

1
Q

Bilirubin is a major end product of _____

A

hemoglobin degradation

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2
Q

Bilirubin can be used to diagnose _____ and ____

A

hemolytic blood diseases

liver disease

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3
Q

Bilirubin is conjugated with _____ (80%) or ____ (10%), and excreted into ______ and into the intestines as a “bile pigment”.

A

glucuronide (80%) or sulfate (10%)

excreted into bile canaliculi

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4
Q

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.

A

conjugated bilirubin

from obstructive liver disease (blood flow through liver is obsructed)

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5
Q

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.

A

urobilinogen

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6
Q

Ureter blood supply: “Randy goes crazy if angered”

A

Renal, gonadal, common iliac, internal iliac and aorta
“Randy goes crazy if angered”

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7
Q

greater splencnic nerve comes into the abdomen right through the ____ and goes up to _____

A

right crus

goes up to celiac plexus

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8
Q

Aortic haitus

A

Aortic haitus – azy, thoracic duct and aorta (AATD)

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9
Q

Esophageal haitus

A

– esophagus , A/p vegal trunks

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10
Q

Caval haitus

A

– IVC, Right phrenic nerve

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11
Q

How do the splnencnics enter abdomen?

A

Splencnics go through cruses

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12
Q

Right gonadal vein terminates in _____
L gonadal in ______

A

Right gonadal vein terminates in IVC
L gonadal in L renal vein

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13
Q

L GO vein terminates in _____
R GO in _____

A

L GO vein terminates in splenic vein
R GO in gastro-duadonal vein

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14
Q

L colic terminates in ___
R colic vein terminates in ___

A

L colic terminates in inferior mesenteric vein
R colic vein terminates in SMV

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15
Q

L suprarenal vein terminates in the ______

R suprarenal vein terminates in the ____

A

L suprarenal vein –> L renal vein

R suprarenal vein –> IVC

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16
Q

L hepatic terminates in ____
R hepatic terminates in_____

A

BOTH in IVC

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17
Q

Cremasteric reflex is innervated by

A

genital branch of genito femoral nerve ( runs anterior to psoas muscle)

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18
Q

Adrernal glands get flow from these 3 vessels

A

Adrernal glands get flow from inferior phrenic artery and Celiac trunk nad renal artery

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19
Q

Extrinsic nerve plexus are found ___

A

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,)

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20
Q

elevated levels of 3 liver enzymes indicate liver failure or infection. Whihc one is specific for liver disease?

A

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.

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21
Q

yellow of urine is due to ___, if urine is darker, distinct from the yellow, then ___ is being excreted (NOT normal)

A

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)

22
Q

(~20-40%) of the urobilinogen is absorbed in the ___ and can be recycled into ___ or ___

A
  • terminal ileum
  • recycled into small intestine or enter systemic circulation
23
Q

Pepsinogen is secreted where?

A

secreted in chief cells of oxynitic glands

converted to pepsin at pH below 5

starts digestion of proteins in stomach

24
Q

___ is secreted by upper portion of oxynic and pyloric glands, protect epithelial lining of stomach

A

HCO3- and mucus

25
Q

Intrinsic factors

A

secreted by parietal cells

bind to B12

controlled by same things as HCL

26
Q

Ach, gastrin and histamine increase secretion of Hcl in stomach by…

A

increasing intracellular Calcium/IP3 or cAMP in parietal cells, which increases activity of H+–K+ATPase pump and thus H+ secretion

27
Q

Between meals, when there is no food in duadonum, gall bladder is ____ and spincter of oddi is ____

A
  • gall bladder is relaxed and filling with bile
  • spincter of Oddi is closed
28
Q

Vasovagal reflex

A

When chyme enters duadoneum:

  1. CCK increases and activates vagal afferents
  2. contraction of gallbladder (Ach)
  3. relaxation of spinchter of Oddi (VIP and NO)
29
Q

On a CT an enlarged fatty liver shows up ____ compared to spleen. Normal liver shows up…

A

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.

30
Q

Primary esophegeal perastalsis is through ____ and initiated by ____

secondary peristalisis is through _____ and ___

A

primary – though vagus and initiated by swallowing (vagus synapses on the myenteric plexus in primary peristalsis.)

secondary – through local stretch and enteric nervous system.

31
Q

liver regulates ___ and __ metabolism

A

carbohydrate, lipid and protein metabolism

32
Q

primary functions of the liver can be separated into 3 major components:

A

Vascular- storage and filtration of blood

Metabolic- carbohydrate, lipid and protein metabolism

Secretory/excretory- bile formation and secretion

33
Q

The pancreatic acenar cells are the ___ cells. they synthesize ___ in ____ and secrete them via ____

A

exocirne cells, synthesiz digestive pancreatic enzymes in rER and secrete them through exocytosis of zymogen granules ( ex: trypsinogen, amylase, lipase )

34
Q

Both arterial and portal blood mix in the _____ of the liver as they flow towards the _____

A

liver sinusoids, flow towards the central vein

35
Q

Ulcerative colitis (UC) affects ____, start in ___ and can extent proximally in a continuous fashion.

A

–Affect only colon

–Start in rectum, contenous up the colon

–Total colectomy is curative

36
Q

Crohn’s diseas affects ____. Contenous or patches?

A

–Can affect entire GI tract (patchy disease)

37
Q

4 complications of Crohn’s disease

A

–stricture, fistula, abscess, perianal disease

–Surgery is needed to treat complications, but is not curative

38
Q

The two types of inflammation of the GI tract… and difference between the two

A

–Ulcerative Colitis (UC): colon only, mucosa and submucosa

–Crohn’s Disease: anywhere in the GI tract, transmural inflammation

39
Q

Symptoms Specific to Crohn’s

A

–Intra-abdominal abscess

–Perianal abscess

–Fistula (bowel-skin; bowel-viscus)

40
Q

Interplay of 3 factors is key to the development of IBD

A
  • genetic predisposition
  • Mucosal Immune System (Immuno-regulatory Defect)
  • Environmental Triggers (Luminal Bacteria, Infection)
41
Q

mneumonic for the 4 anastomoses

A

“Eat In Crappy Resturants”

  • esopageal varices
  • internal hammoroids
  • caput medusa
  • retropitoneal anastamoses
42
Q

Water absorption occurs primarily in ___. The colon reclaims ~ 0.5 L while dehydrating the chyme to feces.

A

jejunum and ileum reabsorbs ~ 8.5 ml

colon reclaims ~ 0.5 L

43
Q

Most bile absorption occurs in the terminal ileum via _____

A

via 2ndary active transport with Na+ (sodium)

44
Q

Proteins digestion in the intestinal lumen is carried out by ____, and these brush border proteases ____

A

Pancreatic proteases: trypsin, chymotripsin, elastase, carboxypeptidase

Brushborder peptidases: amino-peptidase, amino, oligopeptidase, etc.

45
Q

How do digested lipids enter nad exit enterocytes?

A
  1. enter via diffusion (as MG, lysoPL, ch, ffa)
  2. get re-esterified in smoothER of enterocytes, get packages within lipoprotein coat (chylomicron)
  3. chylomicron leaves via exocytosis

MG, lysoPL, ch, ffa→ TG,PL, ch ester→ chylomicron

46
Q

3 causes of diarrhea

A

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)

47
Q

Diarrhea is a result of increase in fluid and pressures in the lower GIT that leads to …

A

increased motility, decreased absorption (not enough time to reabsorb water, pushed out too quick)

48
Q

most of our commnesal bacteria is in ___, they can process plant polysaccarides and make ___

A

ileum and colon

vitamins (K and biotin)

49
Q

Bacterial digestion of ___ is the main source of gas that will be expelled as flatus.

A

starches/sugars/fiber

50
Q

Which sugars can enter enterocytes? How do these enter/exit and get to blood?

A
  • 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

GI (40 decks)

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