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Gastrointestinal System > Week 4 - Introduction to the Stomach > Flashcards

Week 4 - Introduction to the Stomach Flashcards

1
Q

What is the mechanism of action of NSAIDS/aspirin? Why are they not recommended for use in individuals with stomach ulceration?

A

Aspirin and NSAIDs block production of prostaglandins, as they inhibit cyclo-oxygenase, the enzyme that produces prostaglandins from arachidonic acid - used for treatment of fever.

Prostaglandins have an important role in the stomach in maintaining mucosal blood flow and supplying the epithelium with nutrients. Inhibiting prostaglandin production may exacerbate problems in the stomach.

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2
Q

What pharmacological interventions can be used to stop acid production in the stomach? Briefly outline the mechanism of action for each.

A
  1. Proton pump inhibitors: block the proton pump present in parietal cells
  2. H2 blockers: Block histamine receptors - histamine is a critical modulator of acid production
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3
Q

State examples of drugs for proton pump inhibitors and H2 blockers.

A

H2 blockers: cimetidine, ranitidine

Proton pump inhibitors: Omeprazole

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4
Q

State the direction in which the fibres of external oblique run.

A

Anteriorly and inferiorly

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5
Q

State 2 retroperitoneal blood vessels.

A
  1. Abdominal aorta

2. Inferior vena cava

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6
Q

Define pneumoperitoneum.

A

Air/gas in the peritoneal cavity

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7
Q

What are the causes of a pneumoperitoneum?

A
  1. Pathological

2. Laparoscopy: cavity inflated with CO2 so they can see what they are doing

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8
Q

Define visceral peritoneum

A

Part of peritoneum that envelops the intra-peritoneal organs - envelops the small bowel/liver

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9
Q

What is the greater omentum?

A

A fold of visceral peritoneum hanging down off the greater curve of the stomach

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10
Q

What is the lesser sac?

A

Part of the peritoneal cavity that lies behind the stomach

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11
Q

What is the foramen of Winslow (epiploic foramen)?

A

Communication between the greater and lesser sac

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12
Q

What is the recto-uterine pouch?

A

Pouch of Douglas

Extension of peritoneal cavity that lies between the rectum and uterus

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13
Q

What is the uterovesical pouch?

A

The extension of peritoneal cavity that lies between the uterus and bladder

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14
Q

What is the hepatorenal pouch?

A

The part of the peritoneal cavity that lies between the liver and right kidney - pouch of Morrison

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15
Q

What are the paracolic gutters? Why are they clinically important?

A

Part of the peritoneal cavity that lie lateral to the ascending and descending colon

In pathological states, they can transmit fluid

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16
Q

What are the attachments of the lesser omentum (fold of peritoneum)?

A

Liver to the lesser curve of the stomach and proximal duodenum

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17
Q

What is the gastrocolic ligament?

A

Peritoneal fold that extends between the transverse colon and the greater curve of the stomach
-Part of the greater omentum

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18
Q

What is the falciform ligament?

A
  • Peritoneal fold that attaches to the anterior abdominal wall and liver
  • In embryological terms: remnant of the ventral mesentery
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19
Q

What constitutes the mesentery of the small intestine?

A

The double fold of peritoneum that attached the small bowel (jejenum and ileum) to the posterior abdominal wall

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20
Q

What is the sigmoid mesocolon?

A

Fold of peritoneum that attaches the sigmoid colon to the posterior abdominal wall (sigmoid mesentery)

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21
Q

For what surgical procedure is a grid-iron (muscle-splitting) incision used?

A

Appendicectomy

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22
Q

For what surgical procedure is a Kocher incision used?

A
  • Removal of the gallbladder (cholecystectomy)

- Right subcostal region

23
Q

What surgical procedure uses a Pfannenstiel incision?

A
  • Caesarian section

- Lies horizontally above the pubis symphysis

24
Q

What is a laparatomy?

A

When the abdomen is opened through a large vertical (through the linea alba) midline incision which gives access to the abdominal contents

  • Laparascopic surgery uses a small series of incisions (a few cm each) through which instruments are passed
  • Nowadays, most cholecystectomies and some appendicectomies are performed using laparoscopic surgery
25
Q

What does the urachus connect?

A

The urachus connects the allantois to the dome of the bladder during fetal development - should obliterate after the first trimester

26
Q

What is the consequence of a patent urachus?

A

Urine can be transferred from the bladder to the umbilicus and leak out

27
Q

What is the consequence of a patent vitellointestinal duct?

A

Would allow the transfer of meconium

28
Q

What substances can chief cells produce?

A

Gastric lipase and pepsinogen

29
Q

What substances do parietal cells produce?

A

HCl and intrinsic factor

30
Q

Where are G cells located?

A

Antrum

31
Q

Outline the factors which stimulate gastrin secretion.

A
  1. Peptides/amino acids in stomach lumen

2. Vagal stimulation: acetylcholine, gastrin-releasing peptide

32
Q

Outline how HCl production is inhibited in the stomach.

A
  1. When food leaves, pH drops: food acts as a buffer
  2. Low pH stimulates D cells which release somatostatin
  3. Somatostatin inhibits G cells and ECL cells
  4. Reduced vagal activity: reduced stomach distension
33
Q

Outline the steps involved in HCl production.

A
  1. Water split to produce H+ and OH-
  2. H+ moved into stomach lumen
  3. Cl- moved into stomach lumen: HCl formed in stomach lumen
  4. CO2 combines with OH - - forms HCO3-
  5. HCO3- moves into bloodstream: alkaline tide
34
Q

Outline the processes involved in the cephalic phase of digestion.

A
  1. 30% of total HCl
  2. Parasympathetic stimuli: smelling, tasting, chewing, swallowing
  3. Direct stimulation of parietal cells by vagus nerve
  4. Stimulation of G cells by vagus nerve: GRP released
  5. Anticipating food: gastric motility is increased slightly
35
Q

List what organs can be damaged in a wound at the umbilicus.

A

Small bowel

36
Q

List what organs can be damaged in a wound in the left hypochondrium.

A
  1. Small bowel
  2. Large bowel
  3. Spleen
  4. Lung tissue potentially injured
37
Q

List what organ can be damaged in the right flank.

A

Large bowel: ascending colon

38
Q

Outline the steps involved in the gastric phase of digestion.

A
  1. 60% of HCl produced
  2. Stomach distension stimulates vagus nerve which stimulates parietal cells and G cells
  3. Small peptides and amino acids stimulate G cells
  4. Food acts as a buffer in the stomach - removes inhibition on gastrin production
  5. Enteric NS and gastrin: strong smooth muscle contractions
39
Q

Outline the processes involved in the intestinal phase of digestion.

A
  1. 10% of HCl production
  2. Initially chyme stimulates gastrin production - partially digested proteins detected in duodenum (short phase)
  3. Soon overtaken by inhibition of G cells
  4. Detection of lipids activates enterogastric reflex: reduces vagal stimulation
  5. Chyme stimulates CCK and secretin (suppress secretion)
40
Q

What cells in the stomach secrete mucus and bicarbonate ions?

A
  1. Surface mucus cells

2. Neck cells in gastric glands

41
Q

Outline how mucus and bicarbonate ions protect the stomach lining.

A
  1. Form thick viscous alkaline viscous layer that adheres to the epithelium
  2. Epithelial surface kept at higher pH
42
Q

State some stomach defence mechanisms.

A
  1. Mucus and bicarbonate production
  2. High turnover of epithelial cells: helps keep epithelia intact
  3. Prostaglandins: maintain mucosal blood flow, supply epithelium with nutrients
43
Q

State some factors which breach stomach defences and briefly state the mechanism for each.

A
  1. Alcohol: dissolves mucus layer
  2. Helicobacter pylori: chronic active gastritis
  3. NSAIDs: inhibit prostaglandins
44
Q

What are a few consequences of breaching stomach defences?

A
  1. Gastritis
  2. Ulceration
  3. Reflux disease
45
Q

State some pharmacological interventions that can be used to decrease stomach acid production.

A
  1. H2 blockers: cimetidine, ranitidine

2. Proton pump inhibitors: omeprazole

46
Q

Which direction does the foregut rotate in?

A

Clockwise

47
Q

What is the lesser omentum derived from?

A

The ventral mesentery

48
Q

What organ develops within the ventral mesentery?

A

The liver

49
Q

What organ develops within the dorsal mesentery?

A

Spleen

50
Q

What causes the peritoneal cavity to be divided into the lesser and greater sacs?

A
  1. Development of the spleen and liver

2. Foregut rotation

51
Q

What does the dorsal mesentery develop into?

A
  1. The gastrosplenic ligament

2. Ligament from the spleen to the posterior abdominal wall

52
Q

Outline the derivatives of the mesenteries from anterior to posterior.

A
  1. Falciform ligament
  2. Lesser omentum
  3. Gastrosplenic ligament
  4. Connection between spleen and posterior abdominal wall
53
Q

What is the free edge of the lesser omentum?

A

Bottom edge of the ventral mesentery

54
Q

Outline the contents of the free edge of the lesser omentum from top to bottom.

A
  1. Hepatic artery
  2. Common bile duct
  3. Portal vein

Gastrointestinal System (8 decks)

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