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YEAR 2 GI > Week 1 > Flashcards

Week 1 Flashcards

1
Q

4 roles of the GI system

A

Digestion
Absorption
Secretion
Motility

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2
Q

What are the accessory components of the gI tract

A

Teeth tongue salivary glands (parotids, sublingual, submandibular) Pancreas liver gallbladder

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3
Q

How many meters long

A

8
Small intestine is 7

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4
Q

What acid in stomach and why

A

HCL to sanitise

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5
Q

What is in the large intestine

A

Colon rectum and Anus

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6
Q

Where are the most nutrients absorbed and most digestion then

A

Small intestine

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7
Q

Two ways that’s nutrients are absorbed

A

Diffusion or active transport

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8
Q

4 layers throughout GI tract are

A

Adventia
Submucosa
Muscularis propria
Mucosa

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9
Q

What from saliva breaks long carbs to sugars

A

Amylase from saliva

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10
Q

How long can digestion take

A

5 hours

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11
Q

What is adventitia

A

Thick fibrous connective tissue

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12
Q

The muscularis externa layer of the GI system contracts automatically. Yes or no

A

Yes
How food moves

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13
Q

What are the two layers of the muscularis externa and purpose

A

Inner circular = contract behind food
Outer longitudinal = relaxes and lengthens to pull food forward

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14
Q

Inner circular layer and outer longitudinal layer of the muscularis externa layer in GI system: working together what is this called

A

Peristalsis

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15
Q

Where might the inner circular layer of the muscularis externa thicken? And why?

A

At oesophageal sphincters (looks like waves) because remember, inner circular layer contracts to push. Needs extra push in the wave/bump/sphincter

Think that circular = a ball pushing things along

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16
Q

What’s between the circular and longitudinal muscle layer?

A

Plexus of nerves to coordinate contraction called the myenteric plexus

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17
Q

So what happens when the myenteric plexus (between muscles layers of the muscularis externa) is activated?

A

Smooth muscle relaxation

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18
Q

Where is the blood and lymphatics in the layers in the GI tract?

A

Sub mucosa

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19
Q

So it’s: Adventitia, muscularis externa, sub mucosa, then what?

A

Mucosa (muscularis interna)

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20
Q

What are the three layers of the mucosa/ muscularis interna

A

Muscularis mucosa
Lamina propria
Epithelial

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21
Q

What does the epithelial layer of the GI tract do( part of the mucosa /muscularis interna).

A

It secrets mucus for digestive enzymes

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22
Q

What does the muscularis mucosa of the mucosa (interna) layer of gi tract do

A

It’s smooth muscle for breaking down food

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23
Q

Lamina propria of the mucosa/ muscularis interna does what?

A

Contains blood and lymph nodes

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24
Q

Where is the EsophaGeal sphincter?

A

At entrance to stomach

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25
Q

Is the muscularis externa at the esophageal thick or thin?

A

Thick. Think- it’s the circular and longitudinal muscle layers that push food. Vs the mucosa

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26
Q

What is the sphincter at the end of the stomach called

A

Pyloric sphincter

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27
Q

The lining of the stomach included what

A

Gastric pits that release gastric secretions

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28
Q

What three parts of the gastric secretions?

A

HCL, pepsin enzyme which chops up proteins, and mucus which protects the stomach.

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29
Q

Three parts of the small intestine. Dude judge I’ll

A

Duodenum
Jejunum
Ileum

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30
Q

Describe surface of the stomach and why

A

Villi for absorption

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31
Q

What’s chyme

A

Fluid that passes from stomach to the small intestine, consisting of gastric juices and partly digested food

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32
Q

Where does the liver sit?

A

Under the right dome of the diaphragm.

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33
Q

Purpose of liver in food stuff

A

Provides bile salts for digestion/ absorption of fats in small intestine

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34
Q

Purpose of pancreas

A

Digestive enzymes for digestion of fats, carbs, and proteins

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35
Q

Purpose of gall bladder

A

Stores and concentrates bile of the liver

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36
Q

Is water absorption of small or large intestine

A

Large

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37
Q

Is chemical digestion small or large intestine

A

Small intestine

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38
Q

Where is the bacterial fermentation?

A

In the large intestine

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39
Q

So does any nutrient absorption occur in the large intestine?

A

No, only small

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40
Q

What’s the second name for the Adventitia?

A

Serosa. What it’s called in the peritoneal cavity

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41
Q

What part of the mucosa results in the secretion of and synthesis of digestive enzymes

A

The epithelium

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42
Q

The oesophagus and the rectum attaches to surrounding structures via what layer/tunic

A

The adventitia

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43
Q

Which nervous system for the submucosal and myenteric plexuses

A

Enteric nervous system (independent control of gut function)

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44
Q

Sympathetic or parasympathetic increases secretion and motility?

A

Parasympathetic increases secretion and motility OBVIOUSLY

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45
Q

Sympathetic for gut is what nerve

A

Splanchnic nerve

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46
Q

Parasympathetic for gut is what nerve

A

Vagus nerve

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47
Q

Arterial supply to the GI tract comes from where?

A

Descending abdominal aorta

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48
Q

So obviously we have the 3 edges of the colon, ascending transverse then descending, but which is on the right and which is on the left?

A

Ascending is on the right and decanting is on the left

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49
Q

What’s the part of the colon by the rectum called?

A

Sigmoid colon

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50
Q

What are the 4 signalling types?

A

Para auto Endo exo

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51
Q

What’s paracrine signalling (2)

A

Short distance chemical message , locally coordinate activities

Think paranoid about neighbours

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52
Q

What’s autocrine signalling and when’s it important to consider?

A

Cell signals to itself, releasing ligand to bind receptors to its own surface

Reinforce its cell purpose- cancer

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53
Q

What type of cell signalling are hormones involved with?

A

Endocrine

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54
Q

If salivation occurs parasympathetic, surely that’s the vagus nerve?

A

No
Salivation comes from facial and glossopharyngeal nerves

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55
Q

Off the descending aorta, two main arteries/ groups of arteries that feed GI and liver?

A

Hepatic artery and digestive tract arteries

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56
Q

The hepatic artery feeds what

A

The liver

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57
Q

What comes from the liver to feed the IVC?

A

Hepatic vein

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58
Q

What vein travels from GI tract to go through liver?

A

Hepatic portal vein. Not to be confused with hepatic vein, which is after. Think hepatic portal to enter the liver- portal first

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59
Q

What’s the arterial supply of GI tract from abdominal aorta? (3)

A

Celiac
Superior mesenteric artery
Inferior mesenteric artery

Think celiac as in stomach, and it’s all messy and bloody (artery) down there

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60
Q

Celiac trunk supplies what (4)

A

Liver
Pancreas
Small intestine
Stomach

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61
Q

Superior mesentery artery (vice versa for the vein) supplies what

A

Small intestine
Of large intestine:
Caecum
Ascending
Transverse Colon

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62
Q

Inferior mesentery artery feeds what (vice versa for the vein)

A

Descending colon
Sigmoid colon
Rectum

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63
Q

Inferior

A
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64
Q

What veinous drainage for stomach and what for pancreas?

A

Gastric veins for stomach
Splenic vein for pancreas

Both stomach and pancreas fed from celiac trunk

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65
Q

So what are the breakdown products of carbs?

A

Hexose sugars/ monosaccharides like glucose, galactose and fructose

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66
Q

At what breakdown point are carbs absorbed by the small intestine?

A

At hexose sugar level, so like monosaccharides like glucose, galactose, fructose

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67
Q

Are there any issues absorbing monosaccharides by the small intestine?

A

No

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68
Q

When can the small intestine absorb disaccharides?

A

When they’ve been broken down into monosaccharides

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69
Q

Where and how are disaccharides broken down in the small intestine?

A

By brush border enzymes in the brush border (made of microvilli)

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70
Q

The brush border of intestinal lining is the site of what

A

Terminal carbohydrate digestion

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71
Q

If there is deficiency in disaccharidases, produced by the intestinal brush border, what could this result in?

A

Well: this interferes with the breakdown and absorption of carbohydrates, so may result in abdominal pain gas bloating diarrhoea

72
Q

What would lactose be broken down by?

A

An enzyme called lactase, so it would become glucose and galactose

73
Q

When sucrose is broken down by sucrase what does it become?

A

Sucrose = glucose and fructose.

Think that ‘s’ is the big sound. And then glucose and fructose are more glutular

74
Q

Where is glucose stored?

A

As glycogen, in our liver or in our muscles

75
Q

What enzyme is starch degraded by?

A

Starch is degraded into glucose by amylase

76
Q

Where is amylase present?

A

In saliva, and in pancreatic juices.

(So starch can be degraded in mouth and in the duodenum)

77
Q

Can humans digest cellulose?

A

No

78
Q

What can cellulose be degraded by?

A

Certain bacteri

79
Q

Why is cellulose important?

A

Assists digestive system by keeping food moving through the gut thus preventing constipation

80
Q

How does cellulose prevent constipation?

A

Can’t be degraded so helps food move, adds bulk and therefore hastens passage

81
Q

If cellulose cannot be degraded by humans then why does the enzyme cellulase exist?

A

Because that’s the enzyme that certain bacteria can produce

82
Q

What’s the problem in lactose intolerance?

A

A problem with the enzyme lactase. So it’s either not there or there is a defect with it.

83
Q

Why is there diarrhoea in lactose intolerance?

A

Lactose builds up, creating an osmotic pressure. So then water wants to go inside the intestine from the blood. So diarrhoea

84
Q

So if lactose is just sitting there in the large intestine, what happens to it?

A

Bacteria starts to ferment/degrade it and therefore form acids therefore irritation and gastric discomfort

85
Q

What are the three ways nutrients are absorbed?

A

1) trans cellular = through the cell
2) para cellular = through tight junctions
3) vectorial transport = needing a pump

86
Q

How does protein digestion work?

A

It happens in the stomach with HCL and protease enzymes, broken into amino acids, which then move to the small intestine.

87
Q

Amino acids are absorbed how?

A

Vectorial transport.

88
Q

All digested fat is in the form of what

A

Triacylglycerol

89
Q

Where does fat digestion occur?

A

Small intestine

90
Q

Digestive process steps of fats to tri- and monoglycerides

A

1) Bile salts emulsify because your triglyceride is insoluble, and attaches fats to the microvilli for absorption

2) bile organises fat into micelles of lipids and bile acids

3) while lipase converts the triglycerides in the micelles and breaks them into glycerol and fatty acids.

4)these can go through the small intestinal epithelial and into the lymphatics

91
Q

Why must ingested fats be emulsified? (3)

A

Triglyceride is insoluble, so must be emulsified by bile salts
Also makes smaller and stops them from reforming
Smaller = better for lipase to convert into glycerol and fatty acids

92
Q

Emulsification requires what

A

Mechanical disruption of large lipid droplets into small droplets by muscularis externa of stomach and or intestines

93
Q

What does the liver do

A

Make bile

94
Q

How does body know to release bile?

A

Chyme stimulates a hormone from epithelial of small intestine which travels to hall bladdsr

95
Q

How does the body know to release lipase enzyme (which converts triglycerides of micelles into fatty acids and glycerol)?

A

Because chyme stimulates epithelial cells of small intestine to secrete hormone into the blood, which travels to pancreatic duct into duodenum

96
Q

What does lipase do

A

Travels from pancreas down pancreatic duct to the duodenum, grabs the triglycerides in micelles and converts it to fatty acids and glycerols which can go through lymphatics

97
Q

What enzymes break down peptide chains into single amino acids?

A

Peptidases

98
Q

What happens to stuff that isn’t absorbed in the small intestine? Eg fiber

A

Into the colon of the large intestine. When the chyme hits the Cecum of the colon, it’s met by the bacteria of the large intestine called the gut microbiome.

99
Q

Bowel = what

A

Intestines

100
Q

What’s peristalsis?

A

Wave like muscle contractions that move food through the digestive tract- starts in the esophagus until anus

101
Q

What happens to water as chyme moves via peristalsis through the large intestine?

A

Excess water absorbed from chyme, until feces are in the rectum.

102
Q

What triggers the defecation reflex? How do we balance being ready to defecate Vs actually defecating?

A

When the rectum is filled and stretched, signals travel to parasympathetic neurons in the spinal cord, initiating the defecation reflex.

So rectum contracts (to push out) but internal anal sphincter relaxes.

Meanwhile signals are sent to the brain stem and thalamus, so you can choose when to allow the external anal sphincter to relax

103
Q

How many anal sphincters are there?

A

Internal and external sphincters

104
Q

Are fat micelles absorbed?

A

No
Lipase digests fat into monoglycerides, and fatty acids (aka lipase digestion products) which can then be absorbed by the small intestine…

105
Q

So when exactly are fatty acids and glycerols converted to tricyglycerols

A

When they enter epithelial cells, and are in the process of being absorbed. When they enter the smooth endoplasmic reticulum and become tricyglycerols, and processed through the Golgi apparatus, and exocytosed into extracellular fluid that way.

106
Q

fat droplets aka chylomicrons can’t pass through the capillary basement membrane of a blood vessel, so where do they go?

A

Into lacteals between endothelial cells

107
Q

What’s a lacteal?

A

A lymphatic vessel of the small intestine, which absorb digested fats.

108
Q

Fat soluble vitamins eg EKAD follow what route

A

Same route as fat molecules

109
Q

Absorption route of water soluble vitamins? (E.g. b,c etc.)

A

Passive diffusion or carrier mediated transport

110
Q

How is vitamin b12 absorbed?

A

1) HCL in stomach, separates vitamin B12 from the protein it’s attached to.

2) freed vitamin b12 combines with a protein made by stomach called intrinsic factor and then absorbed

111
Q

Why is vitamin b12 important?

A

Helps make DNA, and keeps body’s blood and nerve cells healthy

112
Q

What happens when there is vitamin B12 deficiency?

A

Pernicious anaemia (failure of red blood cell maturation)

113
Q

How much of daily ingested iron will actually go across the intestine into the blood?

A

Only like 10%

114
Q

What’s a cell of the intestinal lining called?

A

Enterocyte

115
Q

What is a Micelle made of

A

Bile salt and monoglycerides and fatty acids and phospholipids

116
Q

What produces intrinsic factor? (Needed for vitamin b12 absorption)

A

Parietal cells of the stomach
They also produce HCL

117
Q

How long does pernicious anaemia occur?

A

3 years

118
Q

Stents for stable angina patients prevent how many heart attacks and extends the lives of patients how much

A

Prevents zero heart attacks. Nobody that’s having a heart attack needs a stent.

(Stents May improve chest pain in some patients, albeit briefly)

119
Q

Good blood pressure and what might be bad;

A

Good = 120/80
At risk = more than that
Bad = 140/90

120
Q

Relative risk reduction vs absolute risk reduction. Eg chance of heart attack = 80%. Add stent and risk of heart attack reduces by 20% so..

A

Relative risk = 25% reduction
Absolute risk = 20%

121
Q

High score of ASSIGN score? (Chance of developing cardiovascular disease).

A

20 or higher.
Remember that it doesn’t include lifestyle factors.

122
Q

High ASSIGN score = do what? (Other than lifestyle of course)

A

Low dose aspirin to reduce the risk of blood clots (thrombosis)
Statin tablets to reduce cholesterol levels

123
Q

What do statins do

A

Lower cholesterol

124
Q

How long stay on statins for

A

Life usually, LDL cholesterol can return to high levels within weeka

125
Q

Quote from Jacob Bigelow about suffering and over involvement of doctors.

A

The amount of death and disease suffered by mankind would have been less if all disease were left to itself

We’re seeking hope- society wants advice from doctors, rather than accepting the inevitable limitations of our short lives. Yet some treatments offer no value. And overdiagnoses

126
Q

How often is chronic kidney disease picked up incidentally on routine blood tests, where patients remain symptomatic?

A

Often.
Labels are powerful! Diagnoses does result in annual monitoring of bloods and blood pressure. Implication on certain medications they can be prescribed

127
Q

Do sleeping tablets actually work?

A

Like 7/100 sleep better, marginally. But most people have no effect AT ALL, and even more people have side effects

128
Q

Hypertension definition was dropped form what to what

A

160 to 140

129
Q

What are the 4 questions to ask at a doctors appointment?

A

Benefits
Risks
Alternatives
Nothing

130
Q

What’s a portal systemic anastomoses?

A

Well whilst the hepatic portal collects nutrient rich, oxygen poor blood it’s all gotta connect somehwo

131
Q

What are the 4 sites of the portal-systemic anastomoses?

A

Azygous to esophageal vein with the left gastric vein

Rectal veins of the portal system and inferior and superior veins of the systemic system

Superficial epigastric veins with the para- umbilical veins of the abdominal wall

At colon, colic veins (portal system) with retriperitoneal veins (systemic system)

132
Q

Left gastric vein goes to where

A

Stomach

133
Q

Why anastomoses

A

Alternative route if blockage in liver and portal vein- veinous blood from gastro can still reach IVC

134
Q

Each organ has its own group of what

A

Lymph nodes

135
Q

Pre aortic nodes Vs para-aortic

A

Para = if vessels protrude either side of the aorta, pre = if vessel comes out anteriorly

136
Q

Celiac trunk comes out anteriorly to aorta for the foregut. So, all lymph will drain to what type of nodes at t12?

A

Pre-aortic nodes

137
Q

Plexus surrounding bifurcation of the aorta?

A

Superior hypogastric plexus

138
Q

Where is the inferior hypogastric plexus

A

Internal iliac arteries

139
Q

Most nerves from the spinal cord will synapse at the sympathetic chain. What about the nerves supplying abdominal organs?

A

Will go straight through the sympathetic chain without synapsing

140
Q

Where do nerves supplying abdomen synapse?

A

Pre aortic ganglia eg at
Celiac trunk ganglia
S and I mesenteric trunk ganglia

141
Q

Fibres from where that go the celiac trunk ganglion,what fibres what come from where

A

Sympathetic fibres coming from T5-9, I.e greater splanchnic nerve

142
Q

The greater splanchnic nerve is what and synapses where

A

T5-T9
Celiac ganglion
Then follows arteries off the trunk to the foregut

143
Q

What nerve supplies the foregut

A

Greater splanchnic nerve

144
Q

What fibres go the the superior mesenteric ganglion, as the lesser splanchnic nerve

A

T10 and T11
Goes to

NB. There is also the least, which is 12

145
Q

How many splanchnic nerves are these

A

Greater 5-9
Lesser 10 and 11
Least 12

146
Q

Which nerves go to the superior mesenteric ganglion

A

Least and lesser splanchnic

147
Q

Inferior mesenteric ganglia receives from what nerve

A

Lumbar splanchnic nerve, L1-3

148
Q

So the lumbar splanchnic nerve (and other ones) synapse with what type of fibre

A

A post synaptic fibre

149
Q

Hindgut mid and fore = what nerve

A

Greater splanchnic 5-9

Lesser and least 10,11 and 12

Lumbar l1-3

150
Q

What are the two PARA sympathetic nerves of the abdomen?

A

Vagus and pelvic splanchnic nerve

151
Q

Where does the vagus nerve enter the abdomen

A

EsophaGeal opening

152
Q

Wher does the vagus nerve (uniquely) synapse ?

A

Not in a ganglion
But in the wall of the target organ
So VERY short post synaptic fubre

153
Q

Vagus nerve also joins what plexus after foregut

A

Superior mesenteric plexus of midgut

154
Q

Pelvic splanchnic nerve (sympathetic) goes where

A

Ascends with hypogastric nerves to the superior hypogastric plexus to inferior mesenteric plexus towards hindgut

155
Q

What’s vagotomy

A

Medical intervention to interrupt signals from the vagus nerve

156
Q

Effect of vagotomy on gastric secretion?

A

Reduces gastric secretion therefore treatment for peptic ulcers?

157
Q

Foregut, mid gut and Hindgut tends to refer pain to where

A

Epigastral region
Umbilical region
Suprapubic region

158
Q

Lumbar plexus is in which muscle

A

Psoas muscle

159
Q

What artery supplies the hall bladder?

A

Cystic artery, comes off hepatic artery

160
Q

How many layers of smooth muscle are in the muscular externa layer in the stomach?

A

3

Whereas usually 2 - circular muscle, longitudinal muscle

161
Q

Lining of the stomach when empty is thrown up into what folds?

A

Rugae

162
Q

What is the extra layer of the muscularis externa (which is usually) circular (inner) and external longitudinal layer?

A

An even inner layer of oblique muscle

163
Q

Peyers patches are lymph nodules present within the mucosa of the small intestine… which part?

A

Ileum

164
Q

Role of peyers patch in the ileum mucosa

A

Immune

165
Q

What type of epithelium is in the anal canal?

A

Stratified squamous - this is protective. (Vs columnar like rest of GI.)

166
Q

What type of epithelium is in the rectum?

A

Columnar like rest of the GI tract

167
Q

We use the TNM classification for cancer. What unique staging do we use for colorectal cancer?

A

Duke’s staging

168
Q

What’s the biggest treatment for colorectal cancer?

A

Surgery is the biggest
80% of patients will go through surgery

169
Q

Surgical treatment for colorectal cancer is undergone how?

A

Via the laparoscopic method

170
Q

Mainstay is surgery for colorectal cancer, and that is undertaken via laparoscopic method. When could cancer be resected endoscopically instead?

A

Very early cancers

171
Q

(Simple question). When would a partial hepatectomy occur in colorectal cancer?

A

When the cancer has metastasised to the liver. Significantly improves survival.

172
Q

When to do radiotherapy and chemo in colorectal cancer?

A

Before surgery in order to downstage the lesion

173
Q

Majority of cancer occurs where in the colon.
Affects screening how?

A

Left side
So often when we’re screening we can undertake a colonoscopy, or just the left side of the colon with by means of a sigmoidoscopy

174
Q

FAP is a risk factor for colorectal cancer. What is it?

A

Familial adenomatous polyposis

Where like multiple adenomas occur throughout the colon (sometimes even hundreds). Start at young age like 15, nearly everyone by 35

Chromosome 5

Most patients will develop colorectal cancer by the age of 40 unless untreated.

175
Q

Why prophylactic proctocolectomy by my ageish for FAP’s? (Familial adenomatous polyposis).

A

Most patients will develop colorectal cancer by the age of 40 unless untreated.

176
Q

Why do you do faecal elastase for pancreatic insufficiency?

A

Because elastase is a digestive enzyme for breaking down fats, carbs and proteins. If pancreas is working well you’ll have elastase in your stool.

177
Q

Arterial supply of the oesophagus?

A

Thoracic region = branches from thoracic aorta, and inferior thyroid artery
Abdominal region = left gastric artery and left inferior phrenic artery

YEAR 2 GI (7 decks)

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