Witwer - GI Tract Flashcards
1
Q
4 layers of the GI tract
A
- mucosa
- submucosa
- muscular layer
- serosa/adventitia
2
Q
inner layer of GI tract
A
mucosa
3
Q
contents of mucosal layer
A
epithelium
lamina propria
muscularis mucosae
4
Q
epithelium of mucosal layer contains
A
goblet cells → secrete mucus
5
Q
lamina propria of mucosal layer contains
A
bv
nerves
immune cells
6
Q
fxn of muscularis mucosae of mucosal layer
A
aids peristalsis
7
Q
what does the submucosa layer contain
A
nerves
bv
elastic collagen fibers
8
Q
fxn of submucosa
A
supports mucosa
9
Q
contents of muscular layer
A
longitudinal and circular smooth muscle
10
Q
fxn of muscular layer
A
peristalsis
11
Q
what is the serosa adventitia made of and where is it located
A
contains: loose CT
located: outside of bowel wall
12
Q
fxn of the serosa/adventitia
A
secretes fluid to decrease friction of bowel on bowel
supporting CT
13
Q
what holds all the layers of the GI tract together
A
mesentary
14
Q
a lot of GI tract pain originates from the
A
mesentery
15
Q
fluid volume of saliva ingested/day
plus
H2O ingested/day
A
1500 mL/day
plus
2000 mL/day
→ 3,500 mL/day
16
Q
volume of bile produced/day
A
500 mL
17
Q
volume of gastric secretions produced/day
A
2000 mL
18
Q
volume of pancreatic juiced produced/day
A
1500 mL
19
Q
volume of intestinal secretions/day
A
1500 mL
20
Q
how much water is reabsorbed by the small bowel and colon/day
A
8900 mL
21
Q
components of the enteric nervous system
A
meissner plexus
auerbach plexus
22
Q
both the meissner and auerbach plexus are innervated by what nerve
A
vagus
23
Q
meissner and auerbach plexus are considered part of the __ NS
A
autonomic
24
Q
the enteric ns is innervated by both the __
and __,
but can function __
A
PNS → vagus n
SNS
independently
25
fxn of meissner's plexus
secretomotor → secretions of glands into bowel wall
26
which layer of the GI tract contains meissner's plexus
submucosa
27
fxn of auerbach plexus
peristalsis
28
auerbach plexus is same-same
myenteric plexus
29
which layer of the GI tract contains auerbach's plexus
muscularis propria
30
meissner's plexus has __ innervation
to the \_\_
PSNS secretomotor
mucosa
31
auerbach's plexus has \_\_
and \_\_
innervation
PSNS and SNS peristalsis motor
32
causes of dysphagia
GERD
esophageal ca
esophageal web
stricture
zenker's diverticulum
dermatomyositis
myasthenia gravis
stroke
systemic sclerosis → CREST
achalasia
33
dysphagia for solids is a symptom of
obstructive lesion → tumor or stricture
34
dysphagia for liquids is a symptom of
nerve damage
esophageal spasm
35
causes of solid dysphagia (4)
esophageal ca
esophageal web
stricture
zenker's diverticulum
36
what are the 2 types of dysphagia
oropharyngeal
lower esophageal
37
oropharyngeal dysphagia is __ dysmotility
striated m
38
dysphagia for solids is __ dysmotility
smooth m
39
what 2 esophageal tumors can cause dysphagia
adenocarcinoma
squamous cell carcinoma
40
mc adenocarcinoma
distal esophagus
41
mc precursor to adenocarcinoma
barrett's esophagus
42
neuromuscular causes of esophageal dysphagia
achalasia
systemic sclerosis
CREST
43
mc neuromuscular d.o of esophagus
achalasia
44
what do you think when you see, incomplete relaxation of LES dt loss of myenteric fibers and inhibitory neurons in myenteric plexus
achalasia
45
achalasia causes (2)
dilation of esophagus proximal to LES
absent peristalsis
46
acquired form of achalasia
chaga's dz
47
radiographic appearance of achalasia
bird beak appearance
48
sx of achalasia
nocturnal regurgitation
dysphagia for liquids and solids
hiccups
cp and heart burn
nocturnal cough from aspiration
difficulty belching
49
achalasia causes dysphagia for
liquids
AND
solids
50
mc congenital anomaly of the esophagus
trachoesophageal fistula
51
mc form of tracheoesophageal fistula
A2
52
what is polyhydraminos
excessive accumulation of amniotic fluid → uterus becomes larger than normal → swallowed amniotic fluid not reabsorbed in fetal small bowel → air in stomach
53
polyhydraminos can cause
trachoesophageal fistula
54
sx of trachoesophageal fistula
difficulty w. feeding
aspiration pna in newborn
often coexisting congenital abnormalities
55
when do you dx trachoesophageal fistula
shortly after birth
56
how do you determine if there is a blockage of the esophagus
place NG tube into esophagus to see if it goes into stomach like it normally should
57
immune barriers agains bacterial invasions from bacteria in bowel are located in
dense mucous layer
58
what are the 2 layers of mucus in the GIT wall
thin outer layer
dense inner layer
59
the thin outer layer of mucus in the GIT wall contains
microbes
60
the dense inner mucosal layer of the GI tract wall contains
antimicrobial peptides
61
there is also an immune cell layer in the
intestinal epithelial wall
62
what is the immune system in the liver if microbes make it that far
reticuloendothelial immune cells
63
fxn of mucus
protects epithelial cells in linings of respiratory, digestive, urogenital, auditory, and visual systems from pathogenic fungi, bacteria, viruses
64
mucus production is increased during (4)
infxns
allergies
asthma
increased histamines
65
how is the immune system involved in protection against bacterial invasions from bacteria in the bowel
microbiome → acts as gatekeeper and trains T-cells
66
pneumocystis pna and candida esophagitis are both
complications of AIDS/immunocompromised pt's
67
candida esophagitis presents w.
odynophagia →
*can be presenting sign*
68
GERD increases risk for what esophageal changes
metaplasia of normal stratified epithelium of lower esophagus to glandular simple columnar from acid injury → **barrett's esophagus**
69
in barrett's esophagus, __ epithelium
changes into __ epithelium
normal stratified
glandular simple columnar
70
barrett's esophagus can turn into
ulceration w. stricture
## Footnote
**adenocarcinoma of esophagus**
71
fxn of gastrin
increase HCl production from parietal cells
72
gastrin is secreted from __ cells
in response to \_\_
G
antra distension
73
gastrin secreting tumor is called
zollinger ellison syndrome
74
zollinger ellison syndrome is caused by
non beta islet cells in islets of langerhans secreting gastrin
75
primary tumors in zollinger ellison syndrome (3)
pancreas
duodenum
lymph nodes
76
zollinger ellison syndrome is \_\_
to \_\_% malignant
60
90
77
zollinger ellison syndrome can be associated w. what syndrome
MEN1
78
zollinger ellison triad
multiple peptic ulcers resistant to therapy (fulminating)
gastric acid hypersecretion
non-beta islet cell tumors of pancreas
79
what do you think when you see PUD + diarrhea and peptic ulcer dz w.o H.pylori or NSAIDs
zollinger ellison syndrome
80
fxn of cholecystokinin
stimulates gallbladder contractions → bile salts secreted into duodenum
81
cholecystokinin is secreted by
I cells in mucosa of small bowel
82
fxn of secretin
regulates H20 homeostasis
83
secretin is secreted by
S cells in duodenum
84
fxn of gastric inhibitory peptide
deceases both gastric acid release and motility
85
enteroglucagon fxn
decreases gastric acid and motility
86
water sources that aid the digestive process (6)
saliva
ingested water
gastric secretions
pancreatic juices
intestinal secretions
bile secretions
87
vomiting causes (3)
loss of water and acid
dehydration
metabolic alkalosis
88
diarrhea causes (4)
dehydration
electrolyte imbalance
kidney failure
malabsorption
89
salivary gland water contribution
1500 mL/day
90
gastric secretions water contribution
2000 mL/day
91
pancreatic secretions H2O contribution
1500 mL/day
92
bile secretions H2O contribution
500 mL/day
93
intestinal secretions H2O contribution
1500 mL/day
94
how much water is reabsorbed by the small bowel and colon/day
8900 mL/day
95
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
hiatus hernia
96
incidence of hiatus hernia increases w.
age
97
hiatus hernia is a condition of herniation of the \_\_
into the \_\_
stomach
chest
98
hiatus hernia is associated w. __ 80% of the time
GERD
99
what do you think when you see, transient relaxation of LES → reflux of acid/bile into distal esophagus → ineffective clearance of reflux material
GERD
100
GERD can cause occasional aspiration into the
trachea
101
rf for GERD
etoh
caffeine
fatty food
chocolate
pregnancy
hiatal hernia
102
mc cause of heartburn
GERD
103
major complication of GERD
barrett's esophagus → adenocarcinoma
104
sx of GERD
non cardiac cp
heartburn/indigestion
nocturnal cough/asthma
acid injury to enamel
early satiety/abd fullness
bloating/belching
105
esophageal spasms can mimic
MI
106
3 mc causes of cirrhosis
hepatitis
etoh
metabolic syndromes → NAFLD
107
serious esophageal complication of cirrhosis
portal htn → esophageal varices
108
what do you think when you see, dilated submucosal left gastric veins
esophageal varices
109
mc cause of death in cirrhosis
esophageal varices
110
what is boerhaave's syndrome
rupture of distal esophagus 2/2 to retching
111
besides boerhaave's syndrome, 4 other causes of esophageal rupture
endoscopy
barrett's
ulcers
malignancy
112
mc cause of esophageal rupture
endoscopy
113
sx of boerhaave's syndrome
odynophagia
hamman's sign
tachypnea
dyspnea
cyanosis
fever
shock
114
boerhaave's syndrome is \_\_% fatal if untreated
100%
115
hamman's sign is associated w.
boerhaave's syndrome
116
complications of boerhaave's syndrome (3)
pneumomediastinum
pleural effusion
mediastinitis
117
mackler's triad is associated w.
boerhaave's syndrome
118
what is mackler's triad
vomiting
cp
subcutaneous emphysema
119
what is this CXR showing
boerhaave syndrome
120
mallory weiss tear
severe tear of distal esophagus/proximal stomach 2/2 to retching
121
what are these showing
candida esophagitis
122
swallowing is coordinated by \_\_
and initiated by \_\_
swallowing/deglutition center in medulla/pons
touch receptors in pharynx
123
4 phases of swallowing
oral preparatory
oral phase → buccal
pharyngeal phase
esophageal phase
124
sensory and motor components of swallowing
CN V
CN VII
CN IX
CN X
CN XI
CN XII
125
which cn innervates sensation to anterior ⅔ of tongue
CN V
126
which cn innervates taste on anterior ⅔ of tongue
CN VII via chorda tympani
127
which cn innervates taste and sensation on posterior ⅓ of tongue
cn IX
128
which cn innervates sensation from mucous membranes of pharynx, larynx, esophagus, and abd viscera
CN X
129
which cn assists w. swallowing
cn XI
130
which cn innervates motor nerves to the tongue
XII
