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88 Cards in this Set
- Front
- Back
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Gastin is secreted from G cells in what part of the stomach?
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Antrum
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Gastrin is secreted in response to what stimuli?
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increased pH or presence of Amino Acids
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What effect does gastrin have on parietal cells and how is it accomplished?
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increases HCL production; binds membrane receptor --> increased intracellular Ca --> phosphorylate H+/K+ATPase
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Where are Peyer's patches found in the GI tract? Where are they most noticeable?
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Small Intestine; Ileum
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Where in the gastric glands are chief cells most prominent?
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Base of the gland
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Where are the Auerbach plexi found?
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Between circular and longitudinal layer of muscularis externa
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In what parts of the GI tract do you find glands that extend from the submucosal layer?
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Esophagus, Duodenum (Brunner's)
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Which salivary gland has a mostly serosal secretion? Mostly mucosal? Mixed?
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Parotid; Sublingual; Submandibular
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What is a serosal Demilune?
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Serosal gland cell over mucosal - small canaliculi btwn mucosal cells convey serous material
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How can you distinguish a mucus from a serous secreting cell in a salivary gland?
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serous = round, central nucleus; mucosal = flat, basal nucleus
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What epithelial cells are found in the neck of a gastric gland? In the body/base?
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Neck: stem, parietal, neck mucus cell; Base/Body: Parietal, neuroendocrine, chief
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What is the function of M cells in the small intestine?
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Present Ag to lymphocytes and macrophages
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What happens to the IgA Ab secreted by B cells in the small intestine?
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It is trancytosed through to luminal surface of an epithelial cell to provide antibacterial protection
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Why is the large intestine capable of absorption and not further digestion?
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there are no digestive enzymes at the epithelial cell surface
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Enzyme secretion in the pancreas is under control of what hormones?
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CCK and secretin
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What hormones are secreted by the Islet cells in the pancreas?
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Glucagon and insulin
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Water soluble vitamins are almost completely absorbed in the upper small intestine, with what exception?
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B12 absorbed in ileum by B12-IF complex
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What cells make intrinsic factor?
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Parietal cells
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How do lipids move from the bile-salt micelles to the inside of enterocytes?
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Lipids move in and out of micelles. When they strike the cell surface they are able to passively diffuse.
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How do chylomicrons enter the lacteals?
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Chylomicrons are packaged in secretory vesicles and exocytosed from the cell
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Which brush border enzyme is responsible for the conversion of alpha-limit dextrin to glucose
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Sucrase-Isomaltase breaks 1,6-linkages
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What is the histological marker of Chronic gastritis?
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infiltration of plasma cells into the lamina propria of mucosa
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The presence of PMN cells in the epithelium of the stomach precludes what type of gastritis?
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Acute
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Why is chronic autoimmune gastritis restricted to the body and fundus of the stomach?
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Autoantibodies are targeted against parietal cells
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What are the eventual results of autoimmune chronic gastritis?
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Megoloblastic anemia, achlorydia first, neuroendocrine stimulation leads to hyperplasia and cardinoid tumor genesis later in the course
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Acute gastritis is usually caused by one of two things: what are they?
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Chemical (NSAIDS, EtOH, tobacco) or stress (chronic infection, post-op, trauma)
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What is the most common form of tracheoesophageal fistula?
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Proximal esophagus ends in blind pouch, distal esophagus connected to trachea
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A three week old infant is brought to clinic for projectile vomiting. On exam he is found to have a palpable epigastric mass and visible peristalsis. What is the condition and recommended treatment?
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Infantile hypertrophic pyloric stenosis (hypertrophy of muscularis propria of pylorus --> narrowing at antrum --> dilation of proximal stomach) Tx: Pyloromyotomy
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Meckel's Diverticulum is a partial persistence of what duct?
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Vitteline (connects lumen of gut to yolk sac)
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Where is a Meckel's diverticulum most commonly found?
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terminal ileum
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What is the most common presentation of Meckel's diverticulum?
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Asymptomatic
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Omphalocele develops from the failure of what embyonic occurence?
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Return of intestines to abdominal cavity
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Malrotation of the intestines is associated with what complication?
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Volvulus (because the lg intestine is not fixed in the retroperitoneum)
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Name four congenital abnormalities of the gastrointestinal system.
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Malrotation, omphalocele, stenosis/atresia, duplication
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Stenosis and atresia typically present in conjuction with other abnormailities or with what disease?
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cystic fibrosis
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What leads to Hirschpring's Disease?
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arrest of the neural crest migration at some point before anus
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What segment of bowel is dilated in Hirschpring's Disease?
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Proximal to aganglionic segment
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What region of bowel is always involved in Hirschpring's Disease?
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Rectum, segment can be short or long proximal to that
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What ganglia are missing in Hirschpring's Disease?
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Both Auerbachs and meissners are missing
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What happens to premature infants that leads to Neonatal necrotizing Enterocolits?
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Hypoemia (such as in RDS) --> blood shunted away from intestine --> organisms invade --> formation of gas gangrene --> perforation and peritonitis
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Gastrischisis differs from omphalocele in what way?
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lacks an amniotic covering
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What is the difference between ulcer and erosion?
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erosion destroys superficial mucosa, ulcer penetrates through mucosa
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H pylori predisposes to what type of cancer?
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intestinal gastric cancer
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What are the two types of gastric cancer?
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diffuse (individual cells invade and create fibrosis, endophitic) and intestinal (single lesion, exophitic)
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How can you distinguish the different types of hypertrophic gastropathies?
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Elevated serum gastrin on ZE, Hyperplasia parietal cells leads to H+ overproduction of both ZE and hypersecretory-hypertrophic, no increase in H+ on Menetriers
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What protective factors exist to protect the gastric mucosa from injury?
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mucus, HCO3-, epithelial layer is hydrophobic and has tight junctions, cells repair and regenerate quickly, rich blood supply
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Gastrointestinal stromal tumor is responsive to what treatment?
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Gleevac
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What is the histologic presentation of lymphangiectasia?
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villous distension
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What can cause lymphangiectasia?
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congenitally dilated lymphatic, any disease that secondarily obstructs the lymphatics
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What is another name for celiac sprue?
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Gluten Enteropathy
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What are the antibodies targeted against in celiac sprue?
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gliadin and other grain oligopeptides, or to transaminase at brush border
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What is the histologic presentation of celiac sprue?
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villous blunting
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Acinar cells in the pancreas produce what?
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enzymes
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Ductal cells in the pancreas produce what?
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aqueous solution with HCO3-
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What function do the epithelial cells of the striated duct perform in the pancreas?
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modify ion content
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How does the CFTR protein aid in HCO3- production in the pancreas?
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HCO3- is cotransported with Cl- ions, which are then effluxed by CFTR
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CCK stimulates what type of secretion by the pancreas? What about secretin?
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CCK --> enzymes, secretin --> HCO3- and aqueous solution
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At low flow rates in the pancreas, what are the relative concentrations of HCO3- and Cl-?
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low flow rates = low HCO3- (high, high) while Cl- is opposite
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Is the salivary secretion more hypotonic at low or high flow rates?
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low
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What is the typical presentation of esophageal webs and rings?
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INTERMITTANT dysphagia
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What is the feature of diffuse esophageal spasm that helps distinguish it from achalasia?
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normal peristalsis still occurs in DES
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Name some of the organisms that cause diarrhea via a predominantly toxic mode of action.
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E. Coli, Cholera, C. Dif, Campylobacter
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What are some of the conqequences of the transmural inflammation seen in Crohn's Disease?
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Creeping fat (due to fibrosis at inflammed sites extending into pericolic fat), fissures into muscularis propria, perforation, fistulas
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Infection with what organism characteristically produces pseudomembranous colitis?
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C. Difficile
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What are the symptoms of amebiasis and what percentage of patients affected are symptomatic?
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crampy abdominal pain, diarrhea, fever, tenesmus, only 10%
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Describe the pathogenetic mechanisms whereby Appendicitis develops. Which mechanisms is usually limited to pediatric cases?
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obstruction can happen at any age, viral infection affects kids more than adults
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Of the two types of microscopic colitis, which is associated with a thin watery diarrhea? Lymphocyte infiltration of epithelium? More common in women? Associated with NSAID use?
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Both; both; Collagenous; Collagenous
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What cells are responsible for the firbrosis seen in chronic pancreatitis?
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Stellate cells
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What are the genetic mutations that infer a risk for chronic pancreatitis?
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CFTR, PRSS (trypsinogen gene), SPINK-1 (trypsin inhibitor)
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What is a secretin stimulation test?
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performed on suspected pancreatitis patients, baseline taken for 1 hr, decreased HCO3- secretion (<80mEq/L) suggests disease
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How can you distinguish between secretory and osmotic diarrhea?
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Osmotic gap <50 is secretory, secretory persists with fasting and id large volume
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What things can cause a secretory type diarrhea?
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Bacterial toxins, bile salt malabsorption, laxatives, neuroendocrine tumor and diabetic dz in which enteric nerves are disordered
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What treatments are available to patients with IBD?
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5ASAs work in UC, antibiotics in CD, prednisone to induce remission in both
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What are some of the risk factors associated with the development of gallstones?
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obesity, age, female gender, genetics lead to cholesterol hypersecretion; terminal ileum resection and Crohn's lead to decrease in bile acid secretion
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What is the best imaging technique for identifying gallstones?
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U/S
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What does steatorrhea, if present, suggest about the stage of chronic pancreatitis?
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late - only happens after 90% gland is damaged
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What is the difference between a pedunculated and a seeile polyp?
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Presence (if pedunculated) of a vascular stalk; sessile more likely to be malignant
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Where are annular colorectal carcinoma lesions more commonly found (what region of bowel)? What about bulky, exophitic lesions?
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Distally; proximally
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What is the hallmark dysplastic change in adenomatous polyps?
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extension of the proliferative zone beyond the mucosal base
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Villous Adenoma at the ampulla of Vater must be carefully evaluated for what common associated finding?
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underlying invasive carcinoma (these are histologically distinct from other adenomatous polyps)
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What is the least common part region of the bowel involed in colorectal carcinoma?
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preferentially found at right or left side more than transverse
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In the setting of Hereditary Non-Polyposis Colorectal Carcinoma syndrome, what other tumor might be seen in Tucot's presentation?
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GBM (as opposed to medulloblastoma seen in tucot's with APC mutation)
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What is one thing you should look for in a diabetic patient who is having trouble controlling their sugars?
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Periodontal diesase; oral infection
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What is the most commong chronic disease of childhood?
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Dental Caries
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What health and other issues are associated with dental caries in children?
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poor eating/nutrition, facial cellulitis, abscess formation, impairment of speech development, academic trouble, poor self-esteem
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Describe some of the endocrine functions of the liver.
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Making blood proteins (Clotting factors), glycoproteins, and lipoproteins, storing glycogen, metabolizing lipid soluble molecules and toxins
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What is the normal function of the stellate cells and where are they normally found?
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Take up fats and fat soluble molecules, found in Space of Disse
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What are some features of the hepatocyte and sinusoids that help maximize exchange of nutrients?
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fenestrated endothelium, micovilli and minimal basement membrane on hepatocyte
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