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Block 3 > Week 1 > Flashcards

Week 1 Flashcards

1
Q

What are the boundries of the anterior abdominal wall?

A
  • Superior-right and left
    • 7-10th ribs and xiphoid process
  • inferior
    • Inguil ligament and superior margins of pelvic girdle
  • lateral
    • lateral abdominal wall
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2
Q

What are the layers of the anterior abdominal wall?

A
  • Skin
  • Superficial fascia
    • Campers
    • Scarpa’s
  • Muscle with investing fascia
    • external oblique
    • internal oblique
    • transversus abdominis
    • rectus abdominis
  • transversalis fascia
  • parietal peritoneum
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3
Q

When the external oblique contracts how does the body move?

A
  • rotates truck to opposite side
  • raises intra-abdominal pressure
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4
Q

What is the innervation of external oblique?

A
  • T7-T11
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5
Q

When the internal oblique contracts, how does the body move?

A
  • contraction rotates truck to same side
  • compresses abdominal viscera
  • supports back muscles
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6
Q

When the transversus abdominis contracts, what happens to the body?

A
  • compresses abdominal viscera
  • supports intrinsic back muscles
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7
Q

Innervation of Internal Oblique

A
  • T6-T11 and L1
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8
Q

Innervation of transversus abdominis?

A
  • T6-T11 and L1
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9
Q

What happens to the body when the rectus abdominis contracts?

A
  • flexes the trunk against resistance
  • compresses abdominal viscera
  • stabilizes tilt of pelvis
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10
Q

What are the contributions of the rectus sheath?

A
  • Divided by the Arcuate line
    • above the line: trasversus abdominis and internal oblique because the rest are under the rectus abdominius
    • Below line: all of the aponeurotic fibers of the external, internal and transversus
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11
Q

What is the blood supply to the abdominal wall?

A
  • T10 and T11
  • musculophrenic (arises from internal thoracic)
  • Subcosta
  • first lumbar
  • superior epigastric (internal thoracic)
  • deep inferior epigastric (external iliac)
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12
Q

What nerve supplies the major labia in females and anterior wall of scrotum in males?

A
  • Iliohypogastric nerve
  • Iolioinguinal nerve
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13
Q

Where is there an anastomomic connection in the anterior abdominal wall?

A
  • between the superior epigastric artery and the inferior epigastric artery
  • allows for collateral blood flow
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14
Q

What sits in the inguinal canal?

A
  • Males - spermatic cord
  • Females - round ligament of the uterus
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15
Q

What makes up the internal lining of the inguinal canal?

A
  • trasversalis fascia
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16
Q

What makes up the inguinal canal?

A
  • Anterior wall: external oblique aponeurosis, lateral side is reinforced by internal oblique
  • Posterior wall: trasnversalis fascia, medial side reinforced by interal oblique and transversus abdominis
  • Roof: laterally-transversalis fascia, centerally-musculoaponeurotic, arches-internal oblique and transversus abdominis, medially-external oblique
  • Floor: laterally-iliopubic tract, centrally by infloded inguinal ligament and medially by lucanar ligmanet
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17
Q

What is the name of the layer of the peritoneam that is dragged by the testes?

A

processus vaginalis

when it closes it becomes the tunica vaginalis

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18
Q

What folds make up the internal wall?

A
  • lateral umbilical fold (2) - lateral umbilical fold formed by deep inferior epigastric vessels and cover them
  • median umbilical fold - apex of bladder to umbilicus and covers median umbilical ligament
  • medical umbilical fold (2) - cover medial umbilical ligaments formed by occluded parts of umbilical arteries
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19
Q

What are the borders of the inguinal triangle?

A
  • Medial - rectus abdominis
  • Lateral - deep inferior epigastric
  • Inferior - inguinal ligament
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20
Q

What is the weak point in the inguinal triangle?

A
  • Conjoint tendon
    • made up of the transversus muscle and internal oblique
    • if the two muscles make a high arch
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21
Q

What is a direct hernia?

A
  • passes through the Hesselbach’s triangle
  • protursion medial portion of inguinal canal, medial to inferior epigastric artery
  • mesh repair
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22
Q

What is an indirect hernia?

A
  • Through lateral portion of inguinal canal
  • Usually through patent processus vaginalis and follows descent of testis
  • hernia sac will be surrounded by same layers as testis
  • mesh repair
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23
Q

What is a femoral hernia?

A
  • follows femoral vein but inferior to inguinal ligament
  • lateral to lacunar ligament
  • 3% of hernias, more common in older women
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24
Q

What are the borders of the femoral canal?

A
  • Superior - Inguinal ligament
  • Medial - lucunar ligament
  • Inferior - pectineal ligament
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25
Q

What is a mesentary?

A

pathways for vessels and nerves to reach abdominal organs but not remain where they are not needed

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26
Q

What arises from endoderm for the GI tract?

A

Mucosa and glands

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27
Q

What arises from splanchnic mesoderm of lateral plate?

A

Surrounding CT and SM

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28
Q

Where is dorsal mesentary found?

A

found throughout most of the entire abdominal gut tube

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29
Q

Where is the ventral mesentery?

A

Remains to support the developing liver and gall bladder but it disappears further down the GI tract

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30
Q

What is primarily retroperitoneal?

A
  • Structures that never have a mesentery
    • rectum
    • thoracic esophagus
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31
Q

What is secondarily retroperitional?

A
  • Structures that loose their mesentery
    • pancreas
    • ascending and descending colon
    • duodenum
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32
Q

How is stomach formed?

A
  • 90º rotation with anterior surface turning to right
  • two landmarks develop
    • greater curvature
    • lesser curvature
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33
Q

What is the greater omentum?

A
  • four-layered connecting the greater curvature of stomach and the duodenum to connect to the anterior surface of transverse colon and its mesentery
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34
Q

Where is the lesser omentum?

A
  • very small
  • connects the lesser curvature and proximal part of duodenum to liver
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35
Q

How is the midgut formed?

A
  • midgut starts to rapidly grow and enter yolk stalk
  • midgut rotation is 270º counterclockwise as it continues to grow
  • midgut will then we enter the abdomen
  • cecum will be in be lower right quadrant
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36
Q

What is a volvulus?

A

Any form of rotation of the gut tuve

  • can be dangerous because it can block blood flow
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37
Q

What is gastroschisis?

A
  • lateral walls of abdomen dont fully close so expanding GI tract goes through hole
  • 1:10k births
  • lateral to connecting stalk but not covered by amnion so it can be damaged by amiontic fluid
  • not associated with chromosomal defect
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38
Q

What is omphalocele?

A
  • herniation of abdominal viscera through enlarged umbilical ring
  • failure of intestine to return to body but is covered of epithelium so it is protected against
  • associated with high rate of infant mortality and severe defects
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39
Q

What is mechel’s or ileal diverticulum?

A
  • most common GI developemntal abnormaility
    • 2-4% of population but most are asymptomatic
  • results in a small portion of vitelline duct persists
  • Avestigial remant of yolk salk
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40
Q

How is the hindgut developed?

A
  • partitioning of cloaca by the urorectal septum that seperates urinary system from hindgut
  • formation of anal canal
    • pectinate line seperates from hindgut from proctode
    • above line-endoderm
    • below line-ectoderm
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41
Q

What is Hirschsprung diesease or aganglionic megacolon?

A
  • failure of migration of neural crest cells into the developing gut tube
  • usually affects rectum and sigmoid colon and results in section of gut tube that lack ganglia and unalbe to contract
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42
Q

What are the different types of surgical incisions?

A
  • Midline
    • through linea alba
    • strogest area to close
    • minimal nerve injury
  • Transverse incision
    • goes through external and internal obliques, transversus and possibly rectus
    • minimize nerve injury
    • weaker incision that can lead to hernias
  • Laproscopic surgery
    • minimalist approach
    • small incisions so less chance for hernias
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43
Q

Should inguinal hernias be fixed?

A
  • most common 3/4th of cases
  • children-yes because they will get worse
  • adults-can wait if asymptomatic but most will have surgery
  • two types
    • direct
    • indirect
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44
Q

Do umbilical hernias need to be fixed?

A
  • babies-most will close by age 2 if not or becomes symptomatic it must be repaired
  • adults need to be repaired
  • 6% of hernias
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45
Q

What cells line the gingiva and hard palate?

A
  • Keratinized stratified squamous
  • Parakeratinized (wet) stratified squamous
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46
Q

What cells the mucoas everywhere else except the tongue?

A
  • Stratified squamous
  • parakeratinized stratified squamous
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47
Q

What are the cells are on the tongue?

A
  • Papillae
  • taste buds on dorsal surface
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48
Q

What cells cover areas exposed to severe abrasion?

A

keratinized cells

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49
Q

What seperates the two sides of the lip?

A

orbicularis onis muscle

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50
Q

What gives the lips the red color?

A
  • the Vermillion line (parakeratinized) lines the lip
  • red color because of superficial capillary plexus reaches surface
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51
Q

What is an angular defect?

A

a right angle forms when a damaged lip and fixed with sutures. Instead should be superglued and butterfly bandages to get it smooth

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52
Q

Explain enamel?

A
  • produced by ameloblasts
  • only a set amount made in a lifetime
  • hardest substance in body
  • ectoderm
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53
Q

Explain Dentin

A
  • sits underneath enamel
  • creates dentin tubules that lead from the outer border of dentin with innervation from the pulp chamber
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54
Q

Name the regions of the tooth

A
  • Crown
  • Neck - at gingival line
  • Root
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55
Q

Where is the tooth situated in?

A
  • alveolar bone
    • very trabeculated
  • periodontal ligment attaches tooth to bone
  • cementum - cementoblasts
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56
Q

What are the four types of lingual papillae?

A
  • Filiform papillae
  • Fungiform papillae
  • Foliate papillae
  • Circumvallate
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57
Q

What do filiform papillae do?

A
  • lack taste buds
  • increase friction between the tongue and food
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58
Q

What do Funigorm papillae do?

A
  • occur on the margin on tongue. look at like mushrooms
  • on the sides of the tongue
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59
Q

What are foliate papillae?

A
  • not abundant
  • mainly found in babies
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60
Q

What seperates the anterior and posterior portions of the tongue?

A
  • Circumvallate are arranged in a v shape
  • each is surrounded by large crypts to allow foods to bathe the papillae
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61
Q

what are lingual frenulum?

A
  • the ligament that connects the tongue to the floor
  • either either has deep lingual veins
  • great site for drug delivery
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62
Q

What are the three types of taste bud cells?

A
  • Neuroepithelial sensory
  • Supporting cells
  • Basal cells
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63
Q

What are the 5 types of tastes?

A
  • Bitter
  • Salty
  • Sweet
  • umami
  • sour
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64
Q

What are the regions of the palate?

A
  • hard palate anterior 2/3
    • bone
    • keratinized stratified squamous
  • Soft palate posterior 1/3
    • contracts during swallowing
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65
Q

What are the cell types of the salivary gland?

A
  • Serous and mucous cells
  • Myoepithelial cells
    • myosin/actin
  • Plasma cells/IgA
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66
Q

Properties of parotid salviary glands

A
  • largest and empthing ducts open at second molar
  • serous secretion
  • 30% of saliva
  • gets infected during mumps
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67
Q

What are the properties of submandibular?

A
  • mixed gland
  • primarily serous
  • 60% of salvia
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68
Q

Describe sublingual

A
  • mixed gland
  • primarily mucous
  • 10% of saliva
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69
Q

What controls salivary compostion and osmolarity?

A

Duct epithelium

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70
Q

What controls the volume of saliva?

A
  • parasympathetic increase
  • sympathetic decrease
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71
Q

What is GULT?

A
  • Gut associated lymphoid tissue
    • diffuse lymphatic tissue
    • lympathtic nodules (submucosa/lamina propia)
    • Tonisils
72
Q

What is Waldeyer’s Ring?

A
  • Tonsillar ring - encircles the entrance of GI and respiratory tracts
    • palatine
    • tubual
    • pharyngeal
    • lingual
73
Q

Where are submucosal glands located?

A

esophagus and duodenum

74
Q

Where are Meissner’s plexus?

A

also called the submucosal plexus in the bottom of the submucosa

75
Q

Where is Auerbachs plexus located?

A
  • also called the myenteric plexus
  • located between the circular and longitudinal layer
76
Q

What are the three muscularis externa regions in the esophagus?

A
  • Upper: striated (skeletal)
  • Middle: mix of striated andSM
  • Lower: SM
77
Q

What is the final layer of the esophagus?

A
  • Adentitia - above diaphragm
  • Serosa - below diaphragm
78
Q

What is teh gastroesophageal sphincter?

A
  • Physioligcal - lower portion
  • Anatomical - proximal portion
79
Q

What is contained in the epithelium of the stomach?

A
  • Mucosa lining cells (very important for maintaing stomach integrety) line the gastric pit
80
Q

What is contained in the lamina propria layer of stomach?

A
  • SM, CT, gastric glands and lymphatic nodules
  • covers entire pit and covers stretched out
81
Q

What makes of the muscularis mucosae/muscularis externa?

A
  • inner incomplete oblique muscle
  • Middle circular muscle
  • outer longtiduinal
82
Q

What is rugae?

A
  • longitudinal fold of gastric mucosa and submucosa
  • folds allow the stomach to distend
83
Q

Why is bicarbonate important in the stomach?

A
  • trapped in thick viscous mucous make by mucous lining cells
  • also made by parietal cell and enter fenestrated capillary in lamina propria
  • increases pH to protect stomch epithelium
84
Q

What are the regions of the stomach?

A
  • Cardiac-cardiac glands
    • short glands, longer pits
  • Fundus and body- gastric glands
    • working region of stomach
    • short pits, long glands
  • Pyloric region - pyloric glands
    • really long pits, short glands and produces mucous
85
Q

Cells of the body/fundus region

A
  • Mucus Neck Cells
  • Stem or regenerative cells
  • Parietal cells
  • Chief Cells
  • Enteroendocrine cells
86
Q

Describe Parietal Cells

A
  • Secrete HCL and gastric intrinsic factor (GIF)
    • pushes HCl out of intracellular canaliculi
  • Tubulovesicular system-extra plasma membrane
    • reservior for porton pumps
  • Abudant mito
87
Q

What does Gastric intrisic factor (GIF) do?

A
  • binds to vit B12
  • absorbtion in ileum
  • important for RBC production
  • lack of GIF causes pernious anemia
88
Q

Describe Chief Cells?

A
  • secretes pepsinogen and precursors to renin and lipase
    • contained in zymogen granules
  • Lots of ER
89
Q

Describe Enteroendocrine

A
  • Special stain to see them
  • produce endocrine and paracine secretion
  • full of secretory vesicles
90
Q

How often is the surface mucous and mucous neck cells?

A
  • Replaced every 3-6 days
91
Q

How often are the cells of the gastric gland replaced?

A
  • parital cells 150-200 days
  • Chief and enteroendrocine cells 60-90 days
92
Q

What are the segments of the esophagus?

A
  • Segment 1- cervical UES
  • Segment 2 - upper thoracic includes tracheal bifurcation
  • Segment 3 - mid thoracic
  • Segment 4 - Distal LES
93
Q

What muscle makes up the upper esophageal sphincter?

A
  • Cricopharyngeal muscle
94
Q

What are the regions of the pharynx?

A
  • Nasopharynx
  • Oropharynx
  • Laryngopharynx
95
Q

What are the sequence of events for swallowing?

A
  1. Elevation of tongue
  2. Closeure of nasopharynx
  3. UES relaxes
  4. Closeure and protection of airway
  5. pharyngeal peristalsis
96
Q

Where is the swallowing center located

A

Located in the medulla

97
Q

What is achlasia?

A
  • also known as a bird’s beak
  • condition with aperistaltic contractions, increased intraesophageal and failure of LES to relax
98
Q

Symtoms of achalasia

A
  • Dysphagia (difficulty swallowing)
  • regurgitation
  • chest pain
  • forceful choking
  • coughing
  • heartburn
  • weightloss
99
Q

Treatment of achalasia

A
  • Onabotulinumtoxin A (botox, Allergan) - injections into LES, temporary but works less overtime
  • Sublingual Nifedipine (Ca2+ channel blocker) improves outcomes in 75% of patients
  • Endoscopic Balloon Dilation successful in 85% of patients but requires multiple interventions
  • Laparoscopic myotomy
  • Peroral Endoscopic myotomy (POEM) - removal of SM cells of LES
100
Q

What is GERD?

A
  • movement of stomach acid into esophagus that can cause problems with the lining of the stomach
101
Q

What are the symptoms of GERD?

A
  • heartburn
  • chest pain
  • sore throat
  • hoarseness
  • regurgitation of foods/liquids
  • foods or meds can worsen GERD symptoms
102
Q

What is the treatment of GERD?

A
  • Intermittent/mild - LSM and non-presecription strength therpay
  • Symtomatic - LSM and prescription H2RA or PPI
  • Moderate/severe - LSM and prescription strenth PPI or H2RA
103
Q

What is Barretts Esophagus?

A
  • 5-10% of GERD patients develop Barretts
  • Metaplasia of esophagus
  • can lead to esophagogastric adenocarcinoma
104
Q

How do you treat Berretts Esophagus?

A
  • Modified PPI
  • Aspirin and other NSAIDs are thought to prevent esophageal cancer
105
Q

What is Gastroparesis?

A
  • Delayed gastric emptying
106
Q

What are the symptoms of gastroparesis?

A
  • Vomiting
  • postprandial nausea
  • epigastric fullness after eating just a few bites
  • abdominal bloating
  • heartburn
  • changes in blood sugar levels
  • lack of appetite, weight loss malnutrituion
107
Q

What is pyloric stenosis and what are the symptoms?

A
  • Pyloric sphincter cant relax and unable to digest foods

Symptoms

  • presents in the first weeks of life in infants
  • patinet usually becomes hypokalemic, hypochloremic to cause metabolic alkalosis
  • episodes of projectile, nonbilious vomiting
108
Q

What is intestinal/colonic pseudo obstruction and what are the symptoms?

A
  • intestinal walls are hypomotile, resembles a true obstruction but no blockage is present
  • caused by problems with SM, enteric nerves or ICC

Symptoms

  • abdominal pain
  • vomiting
  • diarrhea
  • weightloss, malnutirtion
  • enlargement of various parts of small intestine or bowl
109
Q

Why do gallstones form?

A
  • too much absorption of water from bile
  • too much cholesterol
  • too much absortion of bile acids from bile
110
Q

What are gallstone symptoms?

A
  • Stones cause sudden pain in the upper right abdomen because the block the biliary duct
111
Q

What are the two types of gallstones?

A
  • cholesterol stones - usually green-yellow color
  • pigmetn stones - dark color made of bilirubin
112
Q

How do you treat gallstones?

A
  • Laparscopic cholecystectomy - but only for symptomatic gallstones
113
Q

What is diverticular disease?

A
  • Outpocketings of the mucosa of the (sigmoid) colon because of muscle weakness
  • pressure created by trying to move stool causes weak spots and colon bulges
  • low-fiber diet is the main cause
  • complications can lead to death
114
Q

What is irritable bowl syndrome?

A
  • patient has chronic abdominal pain, discomfort, bloating
  • spasms occur only after mild colonic stimulation tend to have more sensitive colons
  • leads to constipation
  • can get it after GI infection but cause unknown
  • chocolate, milk, alcohol can make it worse
115
Q

What is Inflammatory Bowel Disease

A
  • Crohn’s disease or ulcerative colitis
  • cause unknown
  • person suffers from persistent abdominal pain, bowel sores, diarrhea, fever, intestinal bleeding or weight loss
116
Q

What is rectal prolapse?

A
  • Rectum turns itself inside out
  • straining, aging, and weakening of ligaments that support rectum can cause rectal prolapse
  • may be hidden or internal
117
Q

What is peptic ulcer disease

A
  • chronic inflammation of stomach and duodenum
  • duodenal ulcers more common than stomach ulcers
  • caused by increased stomach acid
  • Symptoms
    • upper abdominal pain, usually an hour or two after meal
    • nausea
118
Q

What is scleroderma and its two types?

A
  • chronic autoimmune diesase that has thickening of skin from increased deposits of collagen
  • localized
    • affects skin and musculoskeletal system
  • systemic
    • widespread skin changes and internal organ damde
    • cause cause arthritis, slow contractions of GI, muscle inflmmation
119
Q

What is sjogren’s syndrome?

A
  • autoimmune disease that has immune cells attack and destroy glands that produce teas and salivia
  • associated with rheumatoid arthritis
  • Symptoms
    • dry mouth and eyes
    • may cause skin, nose and vaginal dryness and affect many other organs
120
Q

How is primary peristalsis initiated?

A
  • trigged by swallowing
  • takes 5-10s
  • wave is intiated through the coordination of contraction (ACh) and relaxation (NO)
    • latency controlled by NO
121
Q

How is secondary peristalsis initiated?

A
  • activation of stretch receptors
    • distention activates intrinsic sensory neurons in myenteric plexus which then turns on both ascending excitatory and descending inhibitory
  • swallow is not present
122
Q

What is contained in the nucelus ambiguous?

A
  • motor neurons to muscles of pharynx and striated muscles of esophagus
    • vagal nerves onto skeletal muscle release ACh to contract
  • swallow induced peristalsis is due to activation of lower motor neurons
123
Q

What is contained in the Dorsal Motor/vagal nucleus (DMN)?

A
  • activates inhibitory and exitatory myenteric motor neurons to SM but not the actual muscle
    • rDMN release ACh to cause contraction
    • cDMN release NO to cause relaxatioin
124
Q

What is contained in the nucleus solitaries?

A
  • integrates sensory information
  • cell bodies are located here
125
Q

What causes oropharyngeal dysphagia?

A
  • dysphagia is difficulty swallowing
  • caused by
    • failure of propulsion
    • obstructions to flow
    • combination of both
126
Q

What is myasthenia gravis?

A
  • Autoimmune disease that causes circulating antibodies to block ACh receptors at postsynaptic neuromuscular juntion
  • ebrophonium allows more ACh into cleft but has lots of side effects
127
Q

What is pollo?

A
  • Enters environment through feces and spreads through fecal-oral route
  • caues failure of propulsion
128
Q

What is Dermatomyositis

A
  • acquired muscle diesease called inflmmatory myopathies
  • problems swallowing
  • characterized by inflammation and a skin rash
  • cause unknown but more common in women
129
Q

What is polymyositis?

A
  • Similar to dermatomyositis but without skin rash
  • diffculty swallowing, muscle weakness, stiffness or soreness, SOB
  • inhibits transmission of signal
130
Q

What is Nutcraker esophagus?

A
  • causes dysphagia to both solids and liquids and chest pain
  • have stronger than normal contractions in the middle of the esophagus
131
Q

What is a histal hernia?

A
  • When part of the stomach pushes upward through the diaphragm
  • many dont show symptoms but can have GERD
132
Q

What is GI motility?

A
  • Muscular distortion of GI tract that puts pressure on gut contents
    • reduced intraluminal pressure = storage/accommodation
    • increased force = flow/propulsion
  • motor patterns can also cause mixing
133
Q

What are layers of SM in the GI and what are there effects when they contract?

A
  • Circular
    • radial contriction and dilation
  • Longitudinal
    • Shortening and lengthening
134
Q

What are the motor behaviors of the stomach

A
  • Accommodation
  • Antral
  • peristalsis
135
Q

Motor behaviors of the small intestine

A
  • peristalsis
  • mixing
  • segmentation
136
Q

Motor behaviors of the colon

A
  • Haustration
  • Propulsion
137
Q

Describe the properties of SM

A
  • have dense bodies where actin and myosin bind instead of Z lines
  • slow rate of contraction but force is comparable to skeletal muscle
  • can short to half of original length when contracted
138
Q

How does smooth muscle contract

A
  • increased cytosolic Ca2+ due to
    • voltage dependent Ca2+ channels
    • release of intracellular Ca2+ stores (IP3 gated)
    • other channels
    • membrane exchangers/pumps
139
Q

How doe SM relax?

A
  • Decreased cytosolic Ca2+
    • K+ (depolarization)
    • Ca2+ reuptake into stores
    • membrane exchangers/pumps
    • mito
140
Q

Which arrangement of SM is the fastest?

A
  • Cells arranged in parallel move faster
141
Q

What is the ICC?

A
  • major control network that can organize SM contraction
  • gap junctions between ICC cells and SM at the myenteric plexus
    • hyperpolorizes SM to suppress spontaneous SM firing
    • causing a ring ling contraction
  • coordinates stimultaneous activation of LM and CM
142
Q

Describe the Abell scoring system

A
  • Grade 1
    • mild/intermittent symtoms that are controlled with LSM (diet mods/advoidance of aggetators)
  • Grade 2
    • moderate serve but not weight loss and require prokinetic drugs plus antimetic agents for control
  • Grade 3
    • unable to maintain oral nutrition and require frequent ER visits. Require intravenous fluids, meds, enteral or pareteral nutrition
143
Q

How can gastropariesis be diagnosed?

A
  • Upper GI endoscopy
  • Ultrasound
  • Scintigraphy-gastric emptying via radioisotope
  • Smart pill
  • Octanoic Acid breath test
144
Q

How is gastroparesis treated?

A
  • 6 small meals
    • chew food well, avoid high fat, fibrous foods
  • Prokinetic drugs
    • metoclopramid-increase GI tone but relaxes pyloric sphincter
    • Erythromycin - stimulates migrating motor complex an SM contraction
  • non med treatments
    • Gastric electrical stimulation
    • paraentral nutrition
145
Q

What are type 1 neurons

A
  • Rought cell body with short lamellar dendrites, single long axon
  • motor neurons and interneurons have this shape
146
Q

What are type II neurons?

A
  • large smooth cell bodies, multipolar (lots of axons)
  • filamentous dendrites
  • afferent (sensory neurons) and stimulate motor neurons
  • 20-30% of all enteric neurons
147
Q

How do enteric motor neurons connect to the SM?

A
  • Innervate ICC-IM and PDFRa-IM (inhibitory) rather than SM directory
    • ICC-IM can depolarize or hyperpolarize depending on the signal from enteric neurons
    • voltage changes will spread to adjacent cells
148
Q

What is the signal setup from mucosa to sensory (afferent) neurons?

A
  • Sensory neurons are not directly stimulated by luminal content but instead other cells release substnaces into lamina propria and are detected by neurons
  • Example
    • EC cells release 5-HT upon mechanical distortion of villi which binds to intrinsic afferents and extrinsic sensory neurons
149
Q

Describe myenteric interneurons

A
  • Most diverse class of enteric neurons
    • 4 descending subtypes
    • 1 ascending subtype
  • Activated by sensory (intrinsic afferent) neurons or are stretch sensitive themselves
  • synapse onto motor neurons or themselves (increase speed of signal)
150
Q

What is the innervation of the GI tract?

A
  • Vagus innervation for most of the upper GI tract
  • Pelvic nerve for the descending colon
  • sympathetics innervate the entire tract but only really constricts blood vessels or ongoing excitatory motor relexes
151
Q

How do you measure contractile behavirours in whole organs?

A
  • manometry
  • strain gauges
  • fluid propulsion
  • extracellular electrodes
  • video immagin
  • Ca2+ florescence
152
Q

What is the migrating motor complexe cycle?

A
  • its a burst of contractions that starts in the stomach and propagates through the intestine
    • triggers peristaltic waves to move things down the tract
  • broken into 3 phases
  • feeding interrupts the MMC cycle
153
Q

Name the regions of the stomach and their function

A
  • proximal stomach: fundus and corpus
    • reservior function
    • secretion and relaxation
  • Distal stomach: antrum
    • grinding of solids
154
Q

What are the three mechanisms that regulate gastric reservior function?

A
  • Receptive relaxation
    • swallowing induces this
  • Adaptive relaxation
    • local reflex via enteric inhibitory motor reflex
  • Feedback relaxation
    • based on nutrition reaching duodenum
155
Q

How does the vagovagal relex work?

A
  • afferent and efferent fibers of the vagus nerve coordinate gut stimuli via dorsal vagal complex
  • when food enters the stomach a “vagovagal” reflex goes from stomach to brain then back to stomach to relax SM unless it is interrupted then intra-gastric pressure increases
  • duodenal nutreints, osmolarity or pH alter gastric motility via vagovagal reflex
156
Q

What is retropulsion?

A
  • large particles are pushed back into proximal stomach to clear the terminal antrum
  • done against a closed pylorus
157
Q

What is clustered contraction

A
  • slow migration down gut while mixing and doing some propulsion
158
Q

What is aboral contraction?

A
  • gaint peristalitic wave causing the dumping of the entire colon contents
  • like during diarreha
159
Q

What is segmentation?

A
  • Occurs in small intestine
  • mixing movements that results in no net movements of contents
160
Q

What are the motility patterns in small intestine?

A
  • Digest macromolecular nutrients
  • Absorb digestion products
  • Retain nutrients in small bowl until maximal digrestiona dn absorption can be done
161
Q

What are the colonic motility patterns?

A
  • Conservation of water and electrolytes
  • Formation, storage and periodic elimination of feces
162
Q

What is SIP Syncitinum?

A
  • Smooth muscle
  • Intestinal cells
  • PDGFR
163
Q

What is Small Bowel syndrome?

A
  • malabsorption syndrome from extensive intestinal resection
  • Small bowel is less than 200cm after surgery
  • can cause intestinal failure
    • remianing intestine cant maintian nutritional balance
164
Q

What are the etiologies of short bowel syndrome?

A
  • IBD
  • mesenteric infarction
  • radiation injury
  • congenital anomalies in childrens
    • gastroschisis, intestinal atresia, malrotation, necrotizing, enterocolitis
165
Q

What is citrulline?

A
  • produced by enterocytes of small bowel
    • can be a biomarker of remnant small bowel and function
  • AA involved in intermediary metabolism but not incorporated in proteins
  • involved in urea cycle to produce urea from ammonia
166
Q

What occurs during the loss of absorptive surface area of small bowel?

A
  • nutrient malabsorption
  • water and electrolyte malabsorption
167
Q

What occurs when you lose site-specific transport processes?

A
  • nutrient absorption may take place at any level of small intestine but at different rates
  • absorption of some compounds is restricted to certain areas of small intestine
    • Duodenum and proximal jejunum - Ca+, Mg+, PO4, Fe, water and fat soluble vitamins
    • Distal Ileum - cobalamin intrinsic factor complexes and bile acids are taken up by site specific proteins
168
Q

What occurs with the lose of site specific endocine cells and GI hormones?

A
  • Gi hormones
    • synthesis in testinal mucosa
    • distribution of site specific along GI tract
    • gastrin, CCK, secretin, GIP, and motilin
      • produced by endocrine cells
      • proximal GI tract
  • Half of patients develop hypergastrinemia
169
Q

Where are glucagon-like pepetide 1 and 2 and peptide YY are made?

A
  • made in ileum and proximal colon
  • GLP1/2 released by intraluminal fat and carbs
    • cause delay in gastric emptying and slowing of intestinal transit
170
Q

What occurs with loss of ileocecal valve?

A
  • Primary function to
    • sperate ileal and colonic contents
    • minimize bacterial colonization of small intestine
    • regulate emptying of ileal contents into colon
  • removed in most resections
    • decreases intestinal transit time
    • increases risk of small bowel bacterial overgrowth which can worsen nutrient and cobalamin malabsorption
171
Q

How does the intestine adapt to resection?

A
  • ileum looks more like jejunum with taller vilii and deeper crypts
    • over time it will icrease in ideal diameter and length
  • results of changes
    • increase absorptive SA
    • increase microvillous enzyme activity
    • can take 1 to 2 years to develop
172
Q

What structure is this? what vitamin does it require? What enzymes requires it?

A
  • TPP
  • Vitamin B1
  • PDH
173
Q

What structure is this and what PDH subunit needs this?

A
  • Lipoamine not vitamin required
  • E2
174
Q

What enzymes is this? What vitamin does it require? What PDH subunt needs it?

A
  • Coenzyme A
  • Vitamin B5
  • DLTA
175
Q

What coenzyme is this? What vitamin does it require? What PDH subunit requires it?

A
  • NAD+
  • Niacin (Vitamin B3)
  • DLDH
176
Q

What structure is this? What vitamin does it require? What PDH subunit requires it?

A
  • FAD+
  • Riboflavin (Vitamin B2)
  • DLDH
177
Q
A

Block 3 (8 decks)

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