Week2 Flashcards
The three major salivary glands are the submandibular, the sublingual, and the parotid glands
The submandibular gland is a __ acinus gland with mucous and ___ cells
The sublingual gland is a ___ acinus gland and has what function?
The parotid gland is a __ acinus gland and secretes ___ via plasma cells
*** If you see serous demilune cells, think ___
Mixed, serous demilune
Mucous, lubricates oral cavity
Serous, IGA
Submandibular *** PROBS A TEST QUESTION
All three of the salivary glands dump into the intercalated ducts, and then to the ___ duct, which is involved in transport of ions and water
**AKA stuff gets modified by the duct system
Acini -> Intercalated -> Striated -> Intralobular -> Interlobular -> Lobar -> Main duct
Straited duct
The function of the saliva is three fold
1) It ___ the mucosa
2) It has a ___ function which depends on the antibacterial functions of three constituents of saliva including ___, which attacks the walls of bacteria, ___ which chelates iron necessary for bacterial growth, and ___ which neutralizes bacteria and viruses
3) It also has a digestive function that relies on ___, which initiates the digestion of carbs in the oral cavity, and ___, which participates in the hydrolysis of dietary lipids
Lubricates
Protective, Lysozymes, Lactoferrins, and IGA
Digestive function
Amylase, Lingual lipase
The target for Rabies and Mumps virus is the ___ gland
Parotid
The pancreas is a combined endocrine and exocrine gland.
The endocrine component is the ___ and is mainly regulated by glucose metabolism
The exocrine component is served by its __ cells which secrete the digestive enzymes into the intercalated ducts and ___ cells are involved with the GI part and are continuous with the low cuboidal epithelial lining of the intercalated duct and characteristic for the pancreas via secreting mucin to keep duct lubricated and secreting bicarbonate
Islets of Langerhans
Acinar, Centroacinar cells
Remember from before, ___ that is produced by gastroenteroendocrine cells (G-cells) of the duodenal mucosa bind to specific receptors of pancreatic acinar cells and stimulates the release of zymogens
___ also helps to increase the flow of pancreatic fluid via acting on the cells of the duct system (centroacinar cells) to help stimulate bicarbonate solution
__ stimulation can also cause Ach to be released and enzymes secreted into the acinar lumen
** So CCK = acts on ___ cells and Secretin acts on the __ system cells
CCK
Secretin
Vagal (via parasympathetic nerve)
Pancreatic acini, intercalated duct
If the zymogens released into the pancreas are activated to early, or if the trypsin inhibitor (which prevents the activation of trypsin and other proteolytic enzymes in the acinar lumen and ducts) is defective, then the disease ___ can occur aka autodigestion of the pancreatic acini
Acute pancreatitis
The structural and functional unit of the liver is the ___.
Blood pools from a mixture of the ___ and ___ into sinusoidal spaces (small blood vessels), surrounded by hepatocytes, which then gets collected via a central venule.
Blood and Bile flow through ___ directions because bile is made by the hepatocytes (which surround the sinusoidal spaces) and it moves out to the bile duct
Hepatic lobule
Hepatic portal vein, proper hepatic artery
Opposite
There are some specialized cells within the sinusoids that are not hepatocytes including macrophages called __ cells that are involved in the breakdown and recycling of old red blood cells.
**Blood drains from hepatocytes -> small bile ducts -> common hepatic duct -> common bile duct (once combined with the cystic duct) -> Duodenum
The endothelium which lines the liver sinusoids is fenestrated and does not have a continuous basement membrane (discontinuous capillaries) and therefore it is very easy for leakage to occur. The space between the fenestrated endothelium and cords is called the space of __, and blood can move through these spaces and absorbed via microvilli on the hepatocytes to bring in protein and other plasma components
Hepatic __ cells are located at intervals within the space of Disse and function as a storage site for __ and ___
Kupffer
Disse
Hepatic stellate cells (ITO cells), fat and vitamin A
Bile, produced by hepatocytes, flows in the opposite direction of the blood. It is transported through bile ___ into the canal of ___ and then into the bile duct in the portal triad space
Canaliculi, Hering (also called cholangiole)
___ is secretion into the blood stream and ___ is secretion into a duct
Hepatocytes can be endocrine and exocrine, and the ___ domain is where absorption of blood-borne substances occurs and the secretion of plasma proteins occurs via microvilli extending into the space of Disse
** Hepatocytes also contain SER
Endocrine, exocrine
Basolateral domain
___ is a mixture of organic and inorganic substances produced by hepatocytes and the ___ stores, concentrates, and releases bile
The ___ is what allows bile to move into the gallbladder through the ampulla of Vater (Hepatopancreatic Ampulla)
Bile
Gallbladder
Sphincter of odi
Exocrine glands, which secrete their products directly into ducts, can be divided into simple, simple and branched, or compound (aka branched).
These glands can be further divided into tubular or alveolar glands and depending on what type of product they release, they can be either ___ (thick and rich in glycoprotein secretion) or ___ (watery fluid)
Finally, these glands can have different secretory mechanisms, if they release the product via exocytosis, it’s called ___, if they release an entire whole cell as the secretory product it’s called ___, and if the products is released with a small amount of the apical cytoplasm of the secretory cell it’s called ___
What type of cells are Salivary gland cells?
Mucous, serous
Merocrine, Holocrine, Apocrine
Branched tubuloalveolar glands
For the posterior abdominal wall muscles, the __ and __ muscles help you flex your thigh at the hip.
The ___ and ___ muscles fixes the ___ rib during deep ___
Psoas Major and Iliacus
Psoas minor and Quadratus Lumborum, 12th, inspiration
____ is when a patient presents with lumbosacral pain, difficulty standing up straight and pain in the contralateral gluteal region
Psoas Syndrome
What are the three peripheral origins that insert onto the central tendon?
The right and left Crus of the diaphragm meet at the ____, and the right Crus is longer and forms the muscular ___ hiatus
The ___ ligament connects the two crura anterior to the aortic hiatus
Sternal origin (xiphisternal joint), Costal origin (costal margin), and Vertebral origin (Vertebral body T12)
Aortic Hiatus, Esophageal
Median arcuate ligament
There are three arcuate ligaments, the Median forms an opening for the ___, the Medial forms an opening for the ____, and the lateral arcuate ligament forms and opening for the ___
** The ___ and __ muscles have close relationships with many abdominal structures
Aortic Hiatus, Gap for Psoas Major M. and sympathetic trunk, Gap for Quadratus Lumborum M. And subcostal nerve and vessels
Psoas Major, and Iliacus
There are various sites for a diaphragmatic hernia.
___ hernias occur between the sternal and costal parts of the diaphragm in the Sternocostal Triangle (also called anterolateral gap)
The other type is a __ Hernias and this occur in the ___ triangle, located between the ___ rib and the ___
___ Hernias are when the pleuroperitoneal membranes fail to fuse with other components of the diaphragm (Left posterolateral defect)
Parasternal Hernias
Pleuroperitoneal Hernias, Lumbocostal, 12th Rib, Diaphragm
Congenital Diaphragmatic
What three arteries supply blood to the superior surface of the diaphragm?
What arteries supply blood to the inferior surface of the diaphragm?
Pericardiacophrenic, Musculphrenic, and Superior Phrenic A
Inferior Phrenic A
The ONLY motor innervation to the diaphragm is via the __ nerve, C___
The sensory innervation to the central portion (central tendon) is the __ nerve and to the peripheral portion it’s the __ nerve
Phrenic (C3, C4, C5)
Phrenic, Intercostal
Lymph drainage on the superior surface of the diaphragm goes either to the ___ nodes if it’s from the Anterior or Middle Diaphragmatic Nodes, or the to __ nodes if it’s from the Posterior Diaphragmatic Nodes
The inferior surface has the __ and __ nodes
Parasternal Nodes (**think sternum is more anterior), Mediastinal Nodes
Celiac nodes and Superior Lumbar nodes
** ONE OF THESE WILL BE ON THE TEST
If cancer is found in the lumbar lymph nodes (aka Para-aoritc lymph nodes), it is ___ cancer
If cancer is found in the superficial inguinal lymph nodes, it is __ cancer
Above the pectinate line, the lymph is drained into __ nodes, and below it’s drained into __ nodes
Testicular Cancer
Scrotal Cancer
Internal Iliac Nodes, Superficial Inguinal Nodes
Going back to Paracolic Gutter stuff and the free flow of fluid between the supracolic and infracolic compartment, the ___ ligament, which connects the colon with the diaphragm, prevents the spread of fluid ____ on the __ side of the body
Phrenicocolic ligament, superiorly
Left (via left paracolic gutter)
What 4 nodes merge to drain lymph into the intestinal lymphatic trunk?
The Cisterna chyli receives drainage from what three trunks?
Inferior and superior mesenteric nodes and celiac nodes (These three make up Pre-Aortic group), and the lumbar lymph nodes (Para-aortic)
Lumbar trunks (left and right), Intestinal trunk, Descending thoracic trunk
The lumbar plexus is ventral primary rami and goes from __ to ___ and the lumbar plexus becomes the first branch of the sacral plexus and lumbosacral trunk at ___ and ___
T12-L4(L5)
L4-L5
Name the vertebral segments for all the nerve stuff we need to know of the Lumbar Plexus
1) Subcostal
2) Iliohypogastric
3) Ilioinguinal
4) Genitofermoal
5) Lateral femoral cutaneous
6) Obturator anterior divisions
7) Femoral posterior divisions
8) Lumbosacral trunk
1) T12
2) L1 (sometimes T12)
3) L1
4) L1 and L2
5) L2 and L3
6) L2 and L3 and L4
7) L2 and L3 and L4
8) L4 and L5
Autonomic plexuses are collections of sympathetic _____ axons and parasympathetic ___ axons as well as some visceral sensory axons
Preganglionic sympathetic fibers for the abdominopelvic splanchnic nerves originate from the spinal cord at __ - __
Postganglionic, Preganglionic
T5-L2 (L3)
If you want to get autonomics, aka sympathetics to the gut, how would you do so?
Splanchnic nerve pathway
General visceral afferents (GVAs) aka pain fibers, travel with sympathetic ___s
If you feel pain on the right side of your body around T6, it’s most likely ___ pain
Pain on the right side of the body around T10-T12 could be what two organs?
Pain on the left side of the body around T5-T9 could be what organ?
GVEs (General Visceral efferents)
Gallbladder
Cecum or Appendix
Stomach
The abdominal reflex (light stroking of lower abdominal wall causing a rippling of the underlying abdominal muscles) is caused by the ___ nerve
The cremasteric reflex is caused by stroking the adjacent medial thigh, which is sensed via the ___ nerve and ___ nerve that innervates this portion. ** Note, this would be considered the ___ limb of the cremasteric reflex
When these sensory fibers get activated, they synapse in the spinal cord and activate the motor fibers of the ___ nerve, which causes the cremaster muscle to contract and elevate ** Note, this would be considered the __ limb of the cremasteric reflex
Iliohypogastric
Ilioinguinal and femoral branch of the genitofemoral nerve, afferent (sensory)
Genital branch of the genitofemroal nerve, Efferent (motor)
The vagus nerve, that supplies parasympathetic innervation, is also referred to as cranial nerve __
Ten (X)
The epithelial lining and glands are made from ___ and the lamina propria, submucosa, muscularis layers and serosa adventitia is from ___
Endoderm, splanchnic mesoderm
** The falciform ligament and lesser omentum are created from ___ mesentery, along with the liver
**Note that the liver divides the ventral mesentery into the __ and ___, and it forms as an out-pocketing of the foregut
The spleen is derived from ___ mesentery
The gallbladder and bile ducts come from ___ mesentery
Remember, pancreas has two parts that develop from ventral (major pancreatic duct) and dorsal (accessory pancreatic duct) mesentery
Ventral
Falciform ligament and lesser omentum
Dorsal
Ventral
During development of the esophagus, the lungs bud off of it and eventually they should detach, however a small part remains connected and this is referred to as a tracheoesophageal septum. If this does not occur, it is called a ___ and if the upper esophagus ends in a blind pouch, it’s called an ___
The esophagus can also be narrowed, called esophageal stenosis, or completly blocked off, called esophageal ___
Tracheoesophageal fistula (TEF), aplasia, atresia
For the stomach, the __ surface grows faster than the __ surface and at the same time it rotates clockwise
** If you see a baby with projectile vomiting, and no bile (not green) then the problem is ___
Don’t get this confused with the presentation of a child who also projectile vomits, but their vomit is green (aka it has bile in it). This problem is called ___
Dorsal (greater curvature), ventral (lesser curvature)
Hypertrophic pyloric stenosis
Duodenum atresia (completely blocked) ** This occurs in the second or third part of the stomach, so bile has gotten in there
^** If the ileum or jejunum is also blocked, this could result in the bile vomit as well aka **malrotation or a volvulus would also cause this condition**
^* Presents with double bubble sign
During development, you have the umbilical vein carrying blood from the placenta to to the ___ and then into the IVC. When you cut off the umbilical vein after birth, you no longer need the ductus venosus as well and becomes the ___
Ductus venosus, ligamentum venosum
** PROBS A TEST QUESTION
An atresia (complete closure) of the biles ducts causes no bile to go from the liver into the GI system. This causes pale stool (since not bile is getting into intestines), dark urine (since bilirubin is being filtered by the kidney), and Jaundice (due to the high levels of bilirubin in the blood) and this is called ___
Extrahepatic biliary atresia
A ___ pancreas is when the ventral and dorsal pancreatic buds form a ring around the duodenum instead of coming together properly and this presents as a duodenal obstrution
Annular
An ___ atresia occurs in the proximal ___, has a short intestine and the portion distal to the defect is coiled around the mesenteric remnant
Apple peel
Jejunum
Abnormally positioned viscera, leading to increased risk of entrapment of portions of the intestine is called ___ and a characteristic feature of this is ___ (peritoneal tissue that attatches the cecum to the abdominal wall and creates an obstruction of the duodenum
Abnormal twisting of the intestines, that compromises the intestine or the blood flow is called a ___
Malrotation
Ladd’s bands
Volvulus
The enfolding of one segment of the intestine within another is ___
Intussusception
*** ONE OF THESE WILL BE A TEST QUESTION
A ___ is a herniation of the gut contents, into the umbilical cord, that does not return to the body AND IS INCASED IN A MEMBRANOUS SAC
^ FUCKING KNOW THAT IF IT’S ENCASED IN A MEMBRANOUS SAC, IT’S AN OMPHALOCELE
A ___ is a herniation of the gut contents out into the amniotic cavity due to a defect in the anterior abdominal wall musculature to close during folding
^ KNOW THAT IF IT IS FREE IN THE AMNIOTIC CAVITY AKA GUT CONTENTS NOT SURROUNDED BY A MEMBRANE AKA NOT CONTAINED WITHIN THE UMBILICAL CORD, IT IS A GASTROSCHISIS
Omphalocele
Gastroschisis
A defect in the musculature of the anterior abdominal wall (deficient or absent, urinary tract anomalies, and undescended testicles (cryptorchidism) lead to a diagnosis of ___
^ Not due to a defect in the closure of the anterior abdominal wall like in gastroschisis, it’s due to the fact that the wall itself is absent or weak
Prune belly (or Eagle-Barrett) syndrome
^ Called PBS
** THIS IS A BILLION PERCENT GOING TO BE ON THE TEST
The Vitelline duct, which is a connection out to the yolk sack when the yolk sack was pulled out into the umbilical cord, sometimes does not close off like it should and this can forms an outpocketing of the ileum, called Meckel’s diverticulum
So once again, KNOW THAT MECKEL’s DIVERTICULUM AKA ILEAL DIVERTICULUM IS A REMNANT OF THE VITELLINE DUCT
If feces is leaking from the umbilicus, think ____
Vitelline duct, Meckel’s diverticulum
Vitelline fistula (also called umbilical fistula, and Dr. Cole referred to it as a Ileal/Meckel’s fistula)
The failure of neural crest cells to migrate during intestinal development down to the hindgut (most common) to form the __ ganglion cells, causing no Myenteric plexus to form (since the neural crest cells are suppose to become the ganglion cells), is ___ disease
This is a motor disorder of the colon that causes a functional intestinal obstruction and affects BOTH plexuses and without ____ innervation, the **colon can’t relax or undergo peristalsis **
Colonic, Hirschsprung disease
Parasympathetic
Anorectal malformations can occur via abnormalities in the formation of the cloaca and/or urorectal septum.
They can be classified as __ if the anal canal ends as a blind sac BELOW the pelvic diaphragm and are ___ if the blind pouch ends ABOVE the pelvic diaphragm
Which one is better?
Low, High
Low, because the pelvic diaphragm contributes to fecal contents
Name the enzyme
1) Stimulates gastric acid secretion
2) Stimulates secretion of pancreatic enzymes
3) Stimulates secretion of water and bicarbonate
4) Strong stimulant of appetite and growth hormone
5) Inhibits gastric secretion and mobility
1) Gastrin
2) Cholecystokinin (CCK)
3) Secretin
4) Ghrelin
5) Gastric inhibitory peptide
Intestinal glands (large and small intestines) are called ___, so if you see this then think of the enterocytes, goblet cells, paneth cells, and G-cells…
** Don’t confuse this with gastric glands that contain different cell types and are located ONLY in the stomach!
Crypts of Lieberkuhn
The exocrine function of the pancreas is served by ___ cells that secrete digestive enzymes into the intercalated ducts and the duct cells called ___ cells that supply an alkaline buffer solution
Pancreatic acinar, centroacinar
The exocrine function of the pancreas is served by ___ cells that secrete digestive enzymes into the intercalated ducts and the duct cells called ___ cells that supply an alkaline buffer solution
Pancreatic acinar, centroacinar
