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GI > W1 GI (except Biochem and embryology) > Flashcards

W1 GI (except Biochem and embryology) Flashcards

1
Q

accessory organs of GI system

A
  • salivary glands
  • pancreas
  • hepatobiliary system (liver and gall bladder)
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2
Q

where does carbohydrate digestion begin

A

mouth- salivary amylase

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3
Q

type of muscle in oesophagus

A

upper 2/3= skeletal muscle

lower 1/3= smooth muscle

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4
Q

layers of GI tract

A

mucosa
submucosa
muscularis externa
serosa/adventitia

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5
Q

describe contents of mucosa

A
  • mucosa epithelium with exocrine and endocrine glands
  • lamina propria-capillaries, enteric neurons, lymphoid tissue
  • muscularis mucosa
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6
Q

describe submucosa

A

connective tissue
larger blood and lymph vessels
submucosal plexus

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7
Q

describe muscularis externa

A

circular and longitudinal smooth muscle

myenteric plexus

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8
Q

describe serosa

A

connective tissue

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9
Q

additional layer to GI tract in stomach

A

oblique muscle

internal to circular muscle

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10
Q

where is skeletal muscle found in the GI tract

A

mouth, pharynx, upper oesophagus, external anal sphincter

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11
Q

what is aucherbach’s plexus

Function

A

myenteric plexus

motility and sphincters

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12
Q

what is meissner’s plexus

A

submucosal plexus

modulates epithelia and blood vessels

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13
Q

Describe how slow wave activity can occur in smooth muscle cells and nerves involved

A 
gap junctions
L type Ca2+
interstitial cells of cajal 
enteric nerves, autonomic nerve, hormones 
slow waves
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14
Q

Describe location of interstitial cells of cajal

A

Between circular and longitudinal muscle
gap junctions between themselves and smooth muscle
bridge nerve endings and smooth muscle

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15
Q

Difference between slow wave activity in intestine and stomach

A

depolarisation must reach a threshold in the intestine, but not in the stomach

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16
Q

how does slow wave activity vary along GI tract

A

increases from stomach to SI

decreases from SI to LI

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17
Q

Parasympathetic innervation of GI tract

A

Vagal nerves from medulla-oesophagus to ascending colon

Pelvic nerves from s2-s4- ascending colon to anus

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18
Q

Sympathetic innervation of GI tract

A

synapses at prevertebral ganglia (celiac, superior and inferior mesenteric)
thoracolumbar region

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19
Q

Location of ENS

A

entirely in gut wall

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20
Q

Example of local reflex and describe them

A

peristalsis
intrinsic
sensory neuron stimulated and will cause effector neuron to bring about effect via interneuron
up to 10cm, oral to aboral

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21
Q

short reflex

A

intestino intestinal inhibitory reflex
autonomic nervous system
relaxation of parts of tract

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22
Q

long reflex

A

Gasto-ileal reflex
vago-vagal reflex
CNS
communication between distant parts of GI tract

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23
Q

peristalsis

A

wave of relaxation then contraction in aboral direction

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24
Q

which substances cause contraction and relaxation in peristalsis

A

contraction-substance P and ACh

relaxation- VIP and NO

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25
Q

segmentation

A

mixing and churning

contraction of circular muscle

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26
Q

what is haustration

A

segmentation in LI

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27
Q

when does segmentation occur in SI

A

fed state

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28
Q

colonic mass movement

A

sweep of contraction forcing faeces to rectum in colon

2/3 per day

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29
Q

migrating motor complex

A

powerful sweep form stomach to terminal ileum in SI

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30
Q

Name the sphincters in GI tract and muscle type

A 
UOS (skeletal)
LOS (smooth)
pyloric sphincter (smooth)
ileocecal sphincter (smooth)
IAS (smooth)
EAS (skeletal)

+sphincter of Oddi (pancreas and SI)

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31
Q

epithelium of oral cavity, oropharynx and laryngopharynx

A

stratified squamous epithelium

only keratinised around teeth and hard palate

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32
Q

Describe the surface of the tongue

A

anterior 2/3: stratified squamous epithelium, papillae

posterior 1/3: stratified squamous epithelium which lacks papillae, except for circumvallate papillae, has lymphoid tissue which aggregates at submucosa

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33
Q

Describe the surface of the tongue

A

anterior 2/3: stratified squamous epithelium, papillae

posterior 1/3: smooth stratified squamous epithelium which lacks papillae, except for circumvallate papillae, has lymphoid tissue which aggregates at submucosa

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34
Q

nerve supply of tongue

A

anterior 2/3: facial nerve

posterior 1/3: glossopharyngeal

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35
Q

Name 4 types of papillae on tongue and which has no taste buds?

A

Fungiform
circumvallate (V line)
foliate
filiform (no taste buds, keratin)

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36
Q

name the tonsils

A

palatine tonsils
pharyngeal tonsils
lingual tonsils
tubal tonsils

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37
Q

Barrets Oesophagus

A

gastric reflux damages squamous epithelium of oesophagus, metaplasia to SI epithelium
pre-cancerous

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38
Q

Epithelium of cardia

A

simple columnar

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39
Q

Describe gastric pits in stomach

A

Gastric pit- 1 to 7 gastric glands- mucous cells

isthmus has mostly parietal cells
neck-mucous and parietal cells
fundus- chief , parietal and endocrine cells

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40
Q

What do parietal cells produce

A

HCl

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41
Q

what do chief cells produce

A

pepsinogen

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42
Q

gastric pits in cardia, fundus and pylorus

A

cardia- deep, coiled, less numerous
body- shallow, straight
pylorus- deep, coiled, more numerous

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43
Q

Location and function of Brunners glands

A

Duodenum submucosa

secrete alkaline fluid

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44
Q

Tallest and smallest villi in SI

A

tall-jujunum

small- ilium

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45
Q

Describe lymphoid follicles in SI

A

infrequent in jejunum

Peyer’s patches in ilium submucosa

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46
Q

location and function of paneth cells

A

crypts of Lieberkühn
anti-bacterial
regulate gut flora
secrete lysosomes and defensins

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47
Q

enteroendocrine cell function

A

secrete hormones

eg CCK, VIP

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48
Q

Arrangement of Longitudinal muscle in the LI

A

split into 3 strands

teniae coli

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49
Q

epithelium of anal canal

A

non-keratinised stratified squamous epithelium

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50
Q

Exact location of myenteric plexus

A

Ganglia between circular and longitudinal muscle

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51
Q

portal triad

A

hepatic artery (from left heart)
hepatic portal vein (from gut)
bile duct

also lymphatic tissue and nerves

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52
Q

number of hepatic veins and where they go

A

3

go to IVC

53
Q

Describe the liver capsule

A

layer of mesothelial cells (simple squamous)

then connective tissue capsule

54
Q

Structure of liver lobule

A

hexagonal
centrolobular vein
portal triad at each corner

55
Q

what cells line bile ducts

A

cholangiocytes

56
Q

how to differentiate between contents of portal triad

A

start with bile duct- lined with simple cuboidal epithelium
HA more rounded than HPV
HPV is usually the largest
thin walled and no blood cells- LV

57
Q

Structure of hepatocytes and sinusoids

A

hepatocytes- sheets/plates

sinusoids- spaces, blood channels

58
Q

direction of blood flow in hepatocyte

A

PT to CV

59
Q

name of space between hepatocytes and sinusoids

A

Space of Disse or perisinusoidal space

microvilli of hepatocytes project into this space

60
Q

how are sinusoids adapted to their function

A

Fenestrated, so plasma can access hepatocytes but blood cells can’t get out

61
Q

what does the space of disse contain which supports the liver

A

Reticular fibres (Type III collagen) and type I collagen

62
Q
  • Where are hepatic stellate cells found?
  • Other name for hepatic stellate cells
  • Function of hepatic stellate cells
  • What can Hepatic stellate cells do in disease
A
  • space of disse
  • Ito cells
  • modified fibroblasts which make connective tissue, store Vitamin A in fat droplets in their cytoplasm
  • Can transform into myofibroblasts and produce scar tissue in liver (cirrhosis)
63
Q

what are kupffer cells

A

liver macrophages

also remove old RBC

64
Q

direction and mechanism of movement of bile in lobules

A

hepatocytes to bile ducts in PT via bile canaliculi (tight junctions)

65
Q

Describe exocrine division of pancreas

how this enters duodenum

A

acinar cells
duct cells

enzymes- protease, lipase, nuclease, amylase
enter duodenum via pancreatic duct

66
Q

Describe endocrine pancreas

A

secretes hormones- insulin and glucagon

Islets of langerhaun (1-2%)

67
Q

in what form are enzymes released form exocrine pancreas

describe activation of trypsin

A

inactive proenzymes

when they reach pancreas, they are activated by enteropeptidase to covert trypsinogen into active trypsin

68
Q

Compare apical and basal parts of acinar pancreatic cells

A

apical- eosinophilic due to zymogen

basal- basophilic due to RER

69
Q

what is unique about pancreatic acinar cells

A

ducts extend into acinus

70
Q

Function of gall bladder

A

Stores and modifies bile

71
Q

layers of gall bladder

A 
simple columnar epithelium
lamina propria
loose connective tissue, blood and lymphatic vessels
smooth muscle
adventitia
72
Q

Removal of gall bladder

A

cholecystectomy

73
Q

How does gall bladder get bile from liver

A

actively pumping Na+ and Cl-from bile into spaces between epithelial cells, water follows,

74
Q

what causes gall bladder to contract

A

vagal control

hormones- CCK

75
Q

What is cholecystitis

potential cause

A

Inflammation of the gall bladder

could be caused by galls tones, leading to thickening of smooth muscle of the gall bladder

76
Q

How can we view GI tract

A

endoscope

77
Q

what is jaundice

A

yellowing of the sclera and the skin due to build up of bilirubin in the body

78
Q

What is bilirubin

A

breakdown products of RBC haemoglobin (spleen) and forms part of bile

79
Q

Location of lesser and greater omentum

in which omentum in the portal triad

A

Great omentum connects the stomach and the transverse colon

lesser omentum connects the stomach and duodenum to the liver

PT in the lesser omentum

80
Q
  • location of spleen and what ribs it is protected by
  • function of the spleen
  • difference between the function of the spleen in adults and children
A

left hypochondrium, protected by ribs 9-11
produces lymphocytes, mini blood transfusion, immune protection and response

adults- breaks down RBC
foetus- makes RBC

81
Q

What ribs protect the liver

A

ribs 7-11

82
Q

Describe the two ways of dividing the liver

A

four anatomical segments:
right lobe, left lobe, caudate and quadrate (on right lobe)

8 Functional segments - each have their own hepatic artery, HPV, bile duct and hepatic vein. (makes hepatic segmentectomy possible)

83
Q

Ligaments of the liver

A

Coronary ligament on the superior surface attaches liver to the diaphragm

Falciform ligament which divides right and left lobe

Ligamentum teres - embryological remnant of umbilical vein

84
Q

Describe venous drainage from the liver

A

3 hepatic veins drain into IVC

85
Q

Consequence of no valves on IVC and hepatic veins

A

hepatomegaly- rise in central venous pressure is directly transmitted to the liver

86
Q

what are the two clinically important recesses on the peritoneal cavity and clinical name and importance

A 
hepatorenal recess (morrisions pouch)
subphrenic recess

Peritonitis can cause pus in morrisons pouch-abscess formation and excess fluid will collect in hepatorenal cavity when lying down

87
Q

tube that comes off gall bladder

A

Cystic duct

bile flows in and out of GB

88
Q

Blood supply of GB

A

cystic artery

usually from right hepatic artery

89
Q

Presentation of gall bladder pain

A

foregut organ so will begin in epigastric region (T6-9)
can also occur in hypochondrial region
may refer to right shoulder - anterior diaphragm is irritated and its somatic sensory innervation comes from C3, 4, 5 which also carry somatic sensory to the shoulder so pain is referred to the shoulder

90
Q

Describe/draw the biliary tree

A

the right and left hepatic duct join to from the common hepatic duct. the hepatic duct and cystic duct join to from the biliary duct, which drains into the duodenum

91
Q

where does celiac trunk branch from

A

celiac trunk is the 1st branch of three branches of abdominal aorta

92
Q

at what vertebral level does the cephalic trunk arise at

A

T12

93
Q

Branches of celiac trunk

A

splenic artery
hepatic artery
left gastric artery

94
Q

Blood supply of the stomach

A

right and left gastric arteries to the lesser curvature
right and left gasto-omental arteries to greater curvature

both anastomose together

95
Q

where do the left and right gastric arteries arise from

A

left- celiac trunk

right-

96
Q

Blood supply of the liver

A

Hepatic artery

Branches into right and left hepatic artery

97
Q

Function of hepatic portal vein

A

Drains blood from the foregut, midgut, hindgut to the liver

98
Q

Function of splenic vein

A

Drains blood from foregut

99
Q

function of inferior mesenteric vein

A

drains hindgut

100
Q

function of superior mesenteric

A

drains midgut

101
Q

what is colicky pain

A

pain that comes and goes, due to obstruction

102
Q

Describe two ways in which abdomen can be divided

A

4 quadrants- RUQ, LUQ, LLQ, RLQ
9- Epigastric, R and L hypochondrium,
umbilical, R and L lumbar
Public, R and L inguinal

103
Q

what is a) intraperitoneal b) retroperitoneal c) within a mesentery

A

a - completely surrounded in peritoneum eg liver
b - only on anterior surface eg kidneys, pancreas
c - double layer of peritoneum, hanging from posterior abdominal wall-intestine

104
Q

how do the greater and lesser omentum communicate with eachother

A

through the omental foramen

105
Q

pouch in males

A

rectovesical pouch

106
Q

pouches in females

A 
vesicouterine pouch
rectouterine pouch (pouch of Douglas)
107
Q

Treatment of ascites

A

Paracentesis or abdominocentesis
needle is inserted lateral to the rectus sheath to avoid inferior epigastric artery which arises from the external iliac artery

108
Q

Contents of foregut, midgut and hindgut and how origins come about

A

Embryological origins-
foregut: oesophagus to mid duodenum and liver, GB and 1/2 of the pancreas

midgut: second half of duodenum to proximal 2/3rds of
the transverse colon and other 1/2 of pancreas

hindgut: distal 1/3rds of transverse colon to proximal 1/2 of the anal canal

109
Q

where are the thoracoabdominal nerves

A

7th-11th intercoastal spaces

110
Q

Where is the subcostal nerve

A

12th intercostal space

111
Q

how do sympathetic nerves get to abdominal organs

A

exit spinal cord at T5-L2
leave spinal cord via abdominopelvic splanchnic nerves and synapse at the prevertebral ganglia anterior to the aorta
hitch a ride with the arteries to smooth muscles and glands

112
Q

Sympathetic nerves of adrenal gland

A

T10-L1 and enter abdominopelvic splanchnic nerves but do not synapse with pre vertebral ganglia, synapse directly onto cells

113
Q

Parasympathetic innervation of abdominal organs

A

vagus nerve travels on oesophagus, then in periarterial plexus around the abdominal aorta and synapse at organs, supplying up to the distal end of transverse colon

pelvic nerves (S2,3,4) provide descending colon to the anus

114
Q

Visceral afferent of the foregut

A

T6-9

115
Q

Visceral afferents of midgut

A

T8-12

116
Q

Visceral afferents of the hindgut

A

T10-L2

117
Q

Where does pain originating from foregut tend to be felt

A

epigastric

118
Q

Where does pain originating from midgut tend to be felt

A

umbilical

119
Q

Where does pain originating from hindgut tend to be felt

A

pubic

120
Q

why may pain from liver be felt in upper shoulder

A

Liver is on underside of diaphragm irritating it, diaphragm and upper shoulder is innervated with C3, C4, C5

121
Q

effect of CCK on gall bladder

A

contraction

122
Q

gold standard investigation for suspected biliary dyskinesia.

A

CCK-HIDA

123
Q

pH of stomach

A

2

124
Q

what do Parietal cells secrete

A

HCl, Ca, Na, Mg and intrinsic factor

125
Q

what do chief cells secrete

A

pepsinogen

126
Q

what do Surface mucosal cells secrete

A

mucus and bicarbonate

127
Q

where are bile salts absorbed

A

terminal ileum

128
Q

how much bile enters duo per day

A

500ml-1.5L

GI (7 decks)

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