Week 3 Flashcards
learning objs for Tbl 2
Interpret a Forest plot
Discuss the relationship between GERD and ulcers and the following risk factors: H.pylori infection, coffee consumption, age, gender, bmi, pepsinogen I/II ratio, smoking, and alcohol
Describe the benefits of a cross-over study design
Draw the mechanism of dumping syndrome
Evaluate therapeutic options including pasireotide in the treatment of dumping syndrome
Malrotation
midgut herniates at 4th week and returns approx 10th week
rotates around the axis of SMA 270 degrees counterclockwise
see birds beak
complete nonrotation of the gut
ligament of treitz on the right side of abdomen does not cross midline
for malrotation what do you do before and after surgery
resuscitate first decompress the stomach with NG tube or they would have a cardiac collapse because they don’t have enough intravascular volume
place a foley
after the main procedure (i guess during the surgery tho) you take out the appendix because future appendectomy would present in the LUQ and would be confusing…..
ion status of pyloric stenosis
hypokalemic, hypochloremic metabolic alkalosis from vom
give normal saline until they start making urine, THEN replace the potassium one they have the “extracellular space” for it
intussusception
inversion of the small bowel into the large (usually)
think of the water snake toys
colicky abdominal pain “bring up their legs for a couple minutes, cry, and then they are fine. repeat every couple minutes. Bilious emesis, previous URI (causes lymphoid aggregates in the terminal ileum to increase), currant jelly stool (mucosal ischemia - order is lymphatic obstruction, venous congestion, arterial congestion, ischemia and necrosis)
where does the pelvic diaphrgm insert
“hangs” from a thickened layer of fascia on the obturator internus
muscles that make up the pelvic diaphram
levator ani (anterior) (contains the muscle from back to front iliococcygeus, pubococcygeus, puborectalis)
coccygeus is further back than those (AKA ischiococcygeus)
(piriformis is posterior to the coccygeus
What muscle connects the back of the pubic bone with the coccyx?
pubococcygeus
what structures go out of the greater siatic foramen in back into the lesser siatic foramen
pudendal nerve, artery, vein
hey curve around the ischial spine
what does the obturator nerve innervate
the adductors of the legs
what goes from the coccyx to the ischial spine
coccygeus
the pelvic abdomen originates from this muscle
Tendinous arch of obturator internus
what go in between piriformis and coccygeus
sciatic nerve
inferior gluteal N,A,V
pudendal (but it comes back in through the greater sciatic foramen)
what muscle extends anteriorly from the pubic bone to the ischial spine
obturator internus
what muscle goes from the posterior portion of the tendinous arch of the obturator internus to the coccygeus
iliococcygeus
what forms the “puborectal sling”
puborectalis
what are peptides cotransported with in order to get into the enterocyte
H+
Pept1 cotransporter
during the cephalic and gastric phases, vagal stimulation causes release of pancreatic enzyme including this peptide that isn’t in first aid so its not in my other flashcards
Monitor peptide
this and CCK-RP cause release of CCK from I cells into the blood
what part of the brain is important in monitoring energy expenditure vs energy intake
hypothalamus
neuropeptide-y
increases ghrelin
agouti related peptide
increases ghrelin
GIP
stimulus
target
effect
gastric inhibitory peptide
glucose, fatty acids, amino acids in small intestine
targets beta cells of pancreas
stimulates insulin release, inhibits gastric emptying and acid secretion
kupffer cells
macrophages of the liver
what cells secrete cytokines inducing collagen production by stellate cells, which causes portal hypertension and hepatic encephalopathy
kupffer cells
bacteria convert bile into
urobilinogen - goes to urine and is converted to urobilin (makes urine yellow)
what compound make poop brown
stercobilin
made from urobilinogen
what makes a gall stone
unconjugated bilirubin most of the time
what makes primary bile acids from cholesterol
7alpha-hydroxylase
reabsorbed bile acids (chenodoxycholic and cholic acid) inhibit this enzyme
primary bile acids
how do they become more effective
chenodoxycholic and cholic acid
become more effective when conjugated to glycine or taurine
cholestyramine
bile acid sequestrant
sequesters bile acids, which drives more creation of bile acids from cholesterol
decreases cholesterol levels
lithocholic acid
a secondary bile acid created by bacterial deconjugation that is cytotoxic
can be sulfated leading to its excretion
how to make conjugated bilirubin
condition in infants who cannot make it?
bilirubin is conjugated with glucuronic acid by the enzyme glucuronyltransferase
the enzyme is slow to start up in babies, leading to jaundice
Infants who have a developmental deficiency in UDP-glucuronyl transferase are unable to hepatically metabolize the antibiotic drug chloramphenicol (binds 23s of 50s and prevents peptidyl transferase) which requires glucuronidation. This leads to gray baby syndrome
decreased activity in gilbert syndrome, absent in crigler-najjar
3 things that are symported with sodium in the enterocyte
glucose, bile salts, amino acids
where is most diatary iron absorbed
what transporters
duodenum
HT (heme transporter)
DMT1 (transports ferrous Fe2 form)
SGLT1
sodium glucose transporter
symports glucose with sodium
in chronic pancreatitis which is first to go: endocrine or exocrine function
first to go is exocrine
type I autoimmune pancreatitis
what cells
what do they do
lymphocytic sclerosing of pancreas with IgG4 producing plasma cells
makes a hard mass that feels and looks like pancreatic cancer
somewhat analogous to sarcoid - where diverse organ manifestations are linked by the same histopathological problem
what causes pancreatic pseudocysts
why are they called pseudo
acute pancreatitis, trauma
inflammatory fibrous cyst that lacks an epithelial lining
(pseudocyst)
account for 75% of cysts in the pancreas. Cyst fluid are high in amylase
IPMN
intraductual papillary mucinous neoplasm
this tumor communicates with the pancreatic duct and lacks ovarian type stroma
see dilated ducts on ERCP (Endoscopic retrograde cholangiopancreatography)
get really long columnar cells on histo. nuclei get dark, large, and rounded
can lead to pancreatic exocrine carcinoma
most common location of pancreatic carcinoma
head
how do you diagnose pancreatic carcinoma
endoscopic ultrasound fine needle aspiration
EUS FNA
pancreatic neuroendocrine neoplasms
differences from pancreatic carcinoma
body or tail of pancreas instead of head
well circumscribed!!
hyperinsulinemia
pancreatic neoplasm assc with MEN
pancreatic neuroendocrine neoplasm
what do you order if you want to see if someone has gall stones
ultrasound
radiolucent on xray (most of them)
you see yellow stuff in a gall bladder and you don’t want to look like an idiot in front of a pathologist that cares as much as nelson. what do you say
it’s cholesterolosis
benign
foamy macrophages full of cholesterol
what structures are in the hepatoduodenal ligament
common bile duct
hepatic artery
portal vein
skeletal muscle of the pharynx and upper esophagus derived from the ___
supplied by what nerve
branchial arch mesoderm
vagus
what nerves supply the hindgut
S234
pelvic splanchnics
what gives rise to much of the diaphragm
what nerve does it have in it
transverse septum
phrenic nerve (c3,4,5)
what embryological structure forms the liver
ventral mesentery
two ligaments of the ventral mesentery
hepatogastric
hepatoduodenal
what nodes does the proctodeum (lower third of the anal canal) drain into
superficial inguinal nodes
what nodes does the hind gut portion of the anal canal (upper third of the anal canal) dain into
inferior mesenteric nodes
what cleaves an alpha 1,1 bond
trehalase
fiber is converted to what by bacteria in the lumen of the gut
acetate
two carbon short chain F.A.
what component of human breast milk can be converted to short chain FA in the gut of a healthy infant
oligosaccharides
main insoluble fibers
lignin cellulose hemicellulose
they decrease GI Transport time.
main form of fiber in metamucil
Psyllium
soluble, viscous fiber. Indigestible and hold a lot of water
what is a substrate for amylasy - alpha1,4 bonds or beta
alpha - like simple starch
example of beta would be cellulose (plant cell walls)
lignins
branched polymers of phenolic subunits. found in stems and seeds of fruits
what is abundant in apples, strawberries, and apples lmao
whats the backbone
pectins
backbone: galacturonic acid
“wound repair” carbohydrate of trees
gum arabic
what found in oatmeal is completely fermented by gut bacteria to short chain FA
beta-glucans
homopolymers of glucopyranose
bacteria breaks down stuff to provide fuel for colonocytes
what is the stuff?
what is the transporter
they break down fiber into short chain FA
get uptaken by monocarboxylate transporter
SCFAs effect our immunity how
act as a ligand for GPR43
e.g. in the macrophage inflammatory cytokines go down, IL-10 goes up (antiinflammatory.
GPR43 in adipose
decreased fat storage as TAG, and decreases insulin sensitivity when activated
(mice with over expressed GPR43 are leaner)
pyloric stenosis assc with what antibiotic
systemic use of erythromycin when the baby is born (not in the eye)
why would you not want to be on a macrolide fro 14 days according to pruneski (f)
because of induction of the migrating motor complex
diarrhea
what pumps hydrogen out of the parietal cell
a K+ H+ ATPase
antibodies for celiacs
tissue trans glutaminase (TTG)
