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Pathophys II - Exam 2 > Witwer - GI Tract > Flashcards

Witwer - GI Tract Flashcards

1
Q

4 layers of the GI tract

A
  1. mucosa
  2. submucosa
  3. muscular layer
  4. serosa/adventitia
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2
Q

inner layer of GI tract

A

mucosa

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3
Q

contents of mucosal layer

A

epithelium

lamina propria

muscularis mucosae

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4
Q

epithelium of mucosal layer contains

A

goblet cells → secrete mucus

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5
Q

lamina propria of mucosal layer contains

A

bv

nerves

immune cells

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6
Q

fxn of muscularis mucosae of mucosal layer

A

aids peristalsis

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7
Q

what does the submucosa layer contain

A

nerves

bv

elastic collagen fibers

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8
Q

fxn of submucosa

A

supports mucosa

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9
Q

contents of muscular layer

A

longitudinal and circular smooth muscle

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10
Q

fxn of muscular layer

A

peristalsis

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11
Q

what is the serosa adventitia made of and where is it located

A

contains: loose CT
located: outside of bowel wall

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12
Q

fxn of the serosa/adventitia

A

secretes fluid to decrease friction of bowel on bowel

supporting CT

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13
Q

what holds all the layers of the GI tract together

A

mesentary

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14
Q

a lot of GI tract pain originates from the

A

mesentery

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15
Q

fluid volume of saliva ingested/day

plus

H2O ingested/day

A

1500 mL/day

plus

2000 mL/day

→ 3,500 mL/day

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16
Q

volume of bile produced/day

A

500 mL

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17
Q

volume of gastric secretions produced/day

A

2000 mL

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18
Q

volume of pancreatic juiced produced/day

A

1500 mL

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19
Q

volume of intestinal secretions/day

A

1500 mL

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20
Q

how much water is reabsorbed by the small bowel and colon/day

A

8900 mL

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21
Q

components of the enteric nervous system

A

meissner plexus

auerbach plexus

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22
Q

both the meissner and auerbach plexus are innervated by what nerve

A

vagus

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23
Q

meissner and auerbach plexus are considered part of the __ NS

A

autonomic

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24
Q

the enteric ns is innervated by both the __

and __,

but can function __

A

PNS → vagus n

SNS

independently

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25
Q

fxn of meissner’s plexus

A

secretomotor → secretions of glands into bowel wall

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26
Q

which layer of the GI tract contains meissner’s plexus

A

submucosa

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27
Q

fxn of auerbach plexus

A

peristalsis

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28
Q

auerbach plexus is same-same

A

myenteric plexus

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29
Q

which layer of the GI tract contains auerbach’s plexus

A

muscularis propria

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30
Q

meissner’s plexus has __ innervation

to the __

A

PSNS secretomotor

mucosa

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31
Q

auerbach’s plexus has __

and __

innervation

A

PSNS and SNS peristalsis motor

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32
Q

causes of dysphagia

A

GERD

esophageal ca

esophageal web

stricture

zenker’s diverticulum

dermatomyositis

myasthenia gravis

stroke

systemic sclerosis → CREST

achalasia

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33
Q

dysphagia for solids is a symptom of

A

obstructive lesion → tumor or stricture

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34
Q

dysphagia for liquids is a symptom of

A

nerve damage

esophageal spasm

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35
Q

causes of solid dysphagia (4)

A

esophageal ca

esophageal web

stricture

zenker’s diverticulum

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36
Q

what are the 2 types of dysphagia

A

oropharyngeal

lower esophageal

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37
Q

oropharyngeal dysphagia is __ dysmotility

A

striated m

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38
Q

dysphagia for solids is __ dysmotility

A

smooth m

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39
Q

what 2 esophageal tumors can cause dysphagia

A

adenocarcinoma

squamous cell carcinoma

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40
Q

mc adenocarcinoma

A

distal esophagus

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41
Q

mc precursor to adenocarcinoma

A

barrett’s esophagus

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42
Q

neuromuscular causes of esophageal dysphagia

A

achalasia

systemic sclerosis

CREST

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43
Q

mc neuromuscular d.o of esophagus

A

achalasia

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44
Q

what do you think when you see, incomplete relaxation of LES dt loss of myenteric fibers and inhibitory neurons in myenteric plexus

A

achalasia

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45
Q

achalasia causes (2)

A

dilation of esophagus proximal to LES

absent peristalsis

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46
Q

acquired form of achalasia

A

chaga’s dz

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47
Q

radiographic appearance of achalasia

A

bird beak appearance

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48
Q

sx of achalasia

A

nocturnal regurgitation

dysphagia for liquids and solids

hiccups

cp and heart burn

nocturnal cough from aspiration

difficulty belching

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49
Q

achalasia causes dysphagia for

A

liquids

AND

solids

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50
Q

mc congenital anomaly of the esophagus

A

trachoesophageal fistula

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51
Q

mc form of tracheoesophageal fistula

A

A2

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52
Q

what is polyhydraminos

A

excessive accumulation of amniotic fluid → uterus becomes larger than normal → swallowed amniotic fluid not reabsorbed in fetal small bowel → air in stomach

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53
Q

polyhydraminos can cause

A

trachoesophageal fistula

54
Q

sx of trachoesophageal fistula

A

difficulty w. feeding

aspiration pna in newborn

often coexisting congenital abnormalities

55
Q

when do you dx trachoesophageal fistula

A

shortly after birth

56
Q

how do you determine if there is a blockage of the esophagus

A

place NG tube into esophagus to see if it goes into stomach like it normally should

57
Q

immune barriers agains bacterial invasions from bacteria in bowel are located in

A

dense mucous layer

58
Q

what are the 2 layers of mucus in the GIT wall

A

thin outer layer

dense inner layer

59
Q

the thin outer layer of mucus in the GIT wall contains

A

microbes

60
Q

the dense inner mucosal layer of the GI tract wall contains

A

antimicrobial peptides

61
Q

there is also an immune cell layer in the

A

intestinal epithelial wall

62
Q

what is the immune system in the liver if microbes make it that far

A

reticuloendothelial immune cells

63
Q

fxn of mucus

A

protects epithelial cells in linings of respiratory, digestive, urogenital, auditory, and visual systems from pathogenic fungi, bacteria, viruses

64
Q

mucus production is increased during (4)

A

infxns

allergies

asthma

increased histamines

65
Q

how is the immune system involved in protection against bacterial invasions from bacteria in the bowel

A

microbiome → acts as gatekeeper and trains T-cells

66
Q

pneumocystis pna and candida esophagitis are both

A

complications of AIDS/immunocompromised pt’s

67
Q

candida esophagitis presents w.

A

odynophagia →

can be presenting sign

68
Q

GERD increases risk for what esophageal changes

A

metaplasia of normal stratified epithelium of lower esophagus to glandular simple columnar from acid injury → barrett’s esophagus

69
Q

in barrett’s esophagus, __ epithelium

changes into __ epithelium

A

normal stratified

glandular simple columnar

70
Q

barrett’s esophagus can turn into

A

ulceration w. stricture

adenocarcinoma of esophagus

71
Q

fxn of gastrin

A

increase HCl production from parietal cells

72
Q

gastrin is secreted from __ cells

in response to __

A

G

antra distension

73
Q

gastrin secreting tumor is called

A

zollinger ellison syndrome

74
Q

zollinger ellison syndrome is caused by

A

non beta islet cells in islets of langerhans secreting gastrin

75
Q

primary tumors in zollinger ellison syndrome (3)

A

pancreas

duodenum

lymph nodes

76
Q

zollinger ellison syndrome is __

to __% malignant

A

60

90

77
Q

zollinger ellison syndrome can be associated w. what syndrome

A

MEN1

78
Q

zollinger ellison triad

A

multiple peptic ulcers resistant to therapy (fulminating)

gastric acid hypersecretion

non-beta islet cell tumors of pancreas

79
Q

what do you think when you see PUD + diarrhea and peptic ulcer dz w.o H.pylori or NSAIDs

A

zollinger ellison syndrome

80
Q

fxn of cholecystokinin

A

stimulates gallbladder contractions → bile salts secreted into duodenum

81
Q

cholecystokinin is secreted by

A

I cells in mucosa of small bowel

82
Q

fxn of secretin

A

regulates H20 homeostasis

83
Q

secretin is secreted by

A

S cells in duodenum

84
Q

fxn of gastric inhibitory peptide

A

deceases both gastric acid release and motility

85
Q

enteroglucagon fxn

A

decreases gastric acid and motility

86
Q

water sources that aid the digestive process (6)

A

saliva

ingested water

gastric secretions

pancreatic juices

intestinal secretions

bile secretions

87
Q

vomiting causes (3)

A

loss of water and acid

dehydration

metabolic alkalosis

88
Q

diarrhea causes (4)

A

dehydration

electrolyte imbalance

kidney failure

malabsorption

89
Q

salivary gland water contribution

A

1500 mL/day

90
Q

gastric secretions water contribution

A

2000 mL/day

91
Q

pancreatic secretions H2O contribution

A

1500 mL/day

92
Q

bile secretions H2O contribution

A

500 mL/day

93
Q

intestinal secretions H2O contribution

A

1500 mL/day

94
Q

how much water is reabsorbed by the small bowel and colon/day

A

8900 mL/day

95
Q

what do you think when you see, weak ligaments attaching distal esophagus to diaphragm → allowing stomach to slide back and forth w.in esophageal hiatus

A

hiatus hernia

96
Q

incidence of hiatus hernia increases w.

A

age

97
Q

hiatus hernia is a condition of herniation of the __

into the __

A

stomach

chest

98
Q

hiatus hernia is associated w. __ 80% of the time

A

GERD

99
Q

what do you think when you see, transient relaxation of LES → reflux of acid/bile into distal esophagus → ineffective clearance of reflux material

A

GERD

100
Q

GERD can cause occasional aspiration into the

A

trachea

101
Q

rf for GERD

A

etoh

caffeine

fatty food

chocolate

pregnancy

hiatal hernia

102
Q

mc cause of heartburn

A

GERD

103
Q

major complication of GERD

A

barrett’s esophagus → adenocarcinoma

104
Q

sx of GERD

A

non cardiac cp

heartburn/indigestion

nocturnal cough/asthma

acid injury to enamel

early satiety/abd fullness

bloating/belching

105
Q

esophageal spasms can mimic

A

MI

106
Q

3 mc causes of cirrhosis

A

hepatitis

etoh

metabolic syndromes → NAFLD

107
Q

serious esophageal complication of cirrhosis

A

portal htn → esophageal varices

108
Q

what do you think when you see, dilated submucosal left gastric veins

A

esophageal varices

109
Q

mc cause of death in cirrhosis

A

esophageal varices

110
Q

what is boerhaave’s syndrome

A

rupture of distal esophagus 2/2 to retching

111
Q

besides boerhaave’s syndrome, 4 other causes of esophageal rupture

A

endoscopy

barrett’s

ulcers

malignancy

112
Q

mc cause of esophageal rupture

A

endoscopy

113
Q

sx of boerhaave’s syndrome

A

odynophagia

hamman’s sign

tachypnea

dyspnea

cyanosis

fever

shock

114
Q

boerhaave’s syndrome is __% fatal if untreated

A

100%

115
Q

hamman’s sign is associated w.

A

boerhaave’s syndrome

116
Q

complications of boerhaave’s syndrome (3)

A

pneumomediastinum

pleural effusion

mediastinitis

117
Q

mackler’s triad is associated w.

A

boerhaave’s syndrome

118
Q

what is mackler’s triad

A

vomiting

cp

subcutaneous emphysema

119
Q

what is this CXR showing

A

boerhaave syndrome

120
Q

mallory weiss tear

A

severe tear of distal esophagus/proximal stomach 2/2 to retching

121
Q

what are these showing

A

candida esophagitis

122
Q

swallowing is coordinated by __

and initiated by __

A

swallowing/deglutition center in medulla/pons

touch receptors in pharynx

123
Q

4 phases of swallowing

A

oral preparatory

oral phase → buccal

pharyngeal phase

esophageal phase

124
Q

sensory and motor components of swallowing

A

CN V

CN VII

CN IX

CN X

CN XI

CN XII

125
Q

which cn innervates sensation to anterior ⅔ of tongue

A

CN V

126
Q

which cn innervates taste on anterior ⅔ of tongue

A

CN VII via chorda tympani

127
Q

which cn innervates taste and sensation on posterior ⅓ of tongue

A

cn IX

128
Q

which cn innervates sensation from mucous membranes of pharynx, larynx, esophagus, and abd viscera

A

CN X

129
Q

which cn assists w. swallowing

A

cn XI

130
Q

which cn innervates motor nerves to the tongue

A

XII

Pathophys II - Exam 2 (4 decks)

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