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91 Cards in this Set
- Front
- Back
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What does the falciform connect and what structure is in it which is a derivative of what?
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connects Liver to anterior abdominal wall; Ligamentum teres - derivative of fetal umbilical vein
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What does the hepatoduodenal ligament connect and what structures are contained in it?
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Liver to duodenum; Contains the portal triad - hepatic artery, portal vein, common bile duct
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What does the gastrohepatic ligament connect? what structure does it contain?
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Liver to lesser curvature of stomach; Contains gastric arteries
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What does the gastrocolic ligament connect and what structure is contained in it? The ligament is part of what larger structure?'
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Greater curvature of stomach to transverse colon; Contains gastroepiploic arteries; Part of the greater omentum
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What does the gastrosplenic ligmanet connect? What structure is contained in it?
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Greater curvature and spleen; Short gastric vessels; Also separates left greater and lesser sac
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What ligament connects the spleen to the posterior abdominal wall and contains the splenic artery and vein?
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Splenorenal
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What are the three components of the mucosa in the gut wall and what ar their functions?
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Epithelium (absorption), lamina propria (support), muscularis mucosae (motility)
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What nerve plexus is associated with the submucosa layer? What does it regulate?
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Meissner's; regulates local secretions, blood flow, and absorption
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Where is the myenteric enteric nerve plexus located, what is another name for it, and whatdoes it regulate?
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Auerbach's is located between inner (circular) and outer (longitudinal) layers of smooth muscle in GI tract wall - coordinates motility along entire gut wall
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What vertebral level does the celiac artery sprout from the aorta and what parasympathetic nerve supplies the foregut?
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Vagus nerve; T12-L1
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What vertebral level does the SMA arise from the aorta and what parasympathetic nerve supplies the midgut?
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Vagus nerve; L1
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What vertebral level does the IMA arise from the aorta and what parasympathetic nerve supplies the aprt of the gut that the IMA supplies?
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Pelvic nerve; L3
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What are the three major branches of the celiac trunk?
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Splenic artery, left gastric artery, and common hepatic artery
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What is a possible collateral circulation pathway from the subclavian to the external illiac?
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Internal thoracic/mammary (subclavian) --> superior epigastric (internal thoracic) --> inferior epigastric (external illiac)
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What is a possible collateral circulation pathway from the celiac trunk to the SMA?
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Superior pancreaticoduodenal (celiac trunk) --> inf. pancreaticoduodenal (SMA)
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What is a possible collateral circulation pathway from the SMA to the IMA?
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Middle colic (SMA) to Left colic (IMA)
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What is a possible collateral circulation pathway from the IMA to the internal iliac?
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Superior rectal (IMA) to Middle rectal (internal iliac)
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Name the three sites of portosystemic anastomoses and what veins are involved.
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1. Esophagus (left gastric with esophageal veins) 2. Umbilicus (paraumbilical with superficial and inferior epigastric veins) 3. Rectum (superior rectal with middle and inferior rectal veins)
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Where can a portocaval shunt be placed to relieve portal hypertension?
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Between splenic and left renal veins
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Arterial and venous supply below the pectinate line
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Arterial: inferior rectal artery (branch of internal pudendal artery). Venous: inf rectal vein --> internal pudendal vein --> internal iliac vein --> IVC
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Below pectinante line is innervated by what nerve which is a branch of what?
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Inferior rectal nerve (branch of pudendal nerve)
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What side of the hepatocyte faces bile canaliculi and what side faces the sinusoids?
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Apical surface - bile canaliculi, basolateral surface - sinusoids
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Zone III: pericentral vein (centrilobular) zone has what particular features?
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Affected 1st by ischemia, Contains P-450 system, Most sensitive to toxic injury, Alcoholic hepatitis affects it
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What is another name for the perisinusoidal space?
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Space of Disse
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What is the organization of the femoral region from lateral to medial?
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Nerve, Artery, Vein, Empty space, Lymphatics (NAVEL)
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What structure in the femoral triangle is not in the femoral sheath
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Femoral nerve
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What are the borders of the femoral triangle?
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Superiorly: inguinal ligament; Laterally: sartorius; Medially: adductor longus
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What are the three layers within the spermatic cord?
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External spermatic fascia, cremasteric muscle and fascia, and internal spermatic fascia
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What are the two types of diaphragmatic hernias?
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Sliding hiatal hernia (GE jx displaced); Paraesophageal hernia (GE junction normal - cardia moves into thorax)
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Location of indirect inguinal hernia
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Lateral to inferior epigastric artery; goes through internal (deep) inguinal ring, external (superficial) inguinal ring, and into the scrotum
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Location of direct inguinal hernia; Passes though what structure
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Protudes through the inguinal (Hesselbach's) triangle - directly through abdominal wall medial to inferior epigastric artery; Goes through external (superficial) inguinal ring only
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Direct and indirect inguinal hernias: who does it happen mostly in
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Indirect: infants owing to failure of processus vaginalis to close; much more common inmales. Direct: usually in older men
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Location of femoral hernia
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Below inguinal ligament through femoral canal below and lateral to pubic tubercle
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Which hernia is the leading cause of bowel incarceration?
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Femoral hernia
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What cells take up antigen in Peyer's patches?
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M cells
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What layers of the GI are Peyer's patches found in?
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Lamina propria and submucosa
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What occurs with the B cells in germinal centers of Payer's patches?
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Differentiate into IgA secreting plasma cells which ultimately reside in lamina propria. IgA receives protective SECRETORY COMPONENT and is then transported across epithelium to gut to deal with intraluminal antigen
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What salivary gland is the ost serous? Most mucinous?
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Parotid - most serous. Sublingual - most mucinous
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What is another name for a-amylase?
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Ptyalin
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What is the purpose of bicarbonate in salivary secretions?
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Neutralizes oral bacterial acids, maintains dental health
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What is the function of mucins in salivary secretions and what are they compsed of?
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Glycoproteins - lubricate food
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What are the five components of salivary secretions?
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a-amylase, bicarbonate, mucins, antibacterial secretory products, growth factors that promote epithelial renewal
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What cranial nerve runs through the parotid gland?
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CN VII (does not innervate - CN IX innervates parotid)
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What part of the sympathethic system stimulates salivary secretion? What parasympathetic nerves?
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Sympathethic: T1-T3, superior cervical ganglion. Para: facial, glossopharyngeal
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Where are Brunner's glands located and what are their functions?
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Duodenal SUBMUCOSA: only GI submucosal gland; Secrete alkaline mucus to neutralize acid contents entering the duodenum from stomach
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Hypertrophy of what glands is seen in peptic ulcer disease?;
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Brunner's glands
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What are the actions of Gastrin?
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Increased H+ secretion, Increased growth of gastric mucosa, Increased gastric motility
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What GI hormone is responsible for increasing gastric H+ secretion, increasing growth of gastric mucosa, increasing gastric motility?
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Gastrin
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What increases gastrin secretion? Decreases it?
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Increase: stomach distention, amino acids, peptides, vagal stimulation. Dec by stomach pH < 1.5
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What hormone is increased in Zollinger-Ellison syndrome?
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Gastrin
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What cells secrete Gastrin?
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G cells
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What cells secrete Cholecystokinin?
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I cells
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What are the actions of Cholecystokinin
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Increased pancreatic secretion, Increased gallbladder contraction, Decreased gastric emptying
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What increases CCK secretion?
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Increased by fatty acids, amino acids
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Why does pain worsen after fatty food ingestion in cholelithiasis?\
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Inc. CCK
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Where are I cells located? What do they secrete?
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Duodenum, jejunum - CCK
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What is the action of Secretin?
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Inc. pancreatic HCO3- secretion, decreased gastric acid secretion, Inc. bile secretion, Inc. Brunner HCO3- secretion.
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What cells secrete Secretin and where are they located?
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S cells - in duodenum
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What causes increased release of Secretin?
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Acid, fatty acids in lumen of duodenum
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What cells secrete Somatostatin? Located where?
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D cells (pancreatic islets, GI mucosa)
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What is the action of somatostatin in the GI tract?
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Decreased gastric acid and pepsinogen secretion, Dec. pancreatic and small intestine fluid secretion, Dec. gallbladder contraction, Dec. insulin and glucagon release
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How is somatostatin secretion in GI incrased, how is it decreased?
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Increased: by acid; Decreased, by vagal stimulation
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What two conditins is somatostatins used to treat?
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VIPoma and carcinoid tumors
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What cells secrete Glucose-dependent insulinotropic peptide? Located where?
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K cells (duodenum, jejunum)
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What are the functions of GIP (glucose-dependent insulinotropic peptide)
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1. Exocrine: Decrease gastric H+ secretion. 2. Endocrine: Increase insulin release
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What increases Glucose-dependent insulinotropic peptide (GIP)?
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Fatty acids, amino acids, oral glucose
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Where dfoes Vasoactive intestinal polypeptide (VIP) come from?
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Parasympathetic ganglia in sphincters, gallbladder, small intestine
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What is the action of vasoactive intestinal polypeptide?
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Increased intestinal water and electrolyte secretion, Increased relaxation of intestinal smooth muscle and sphincter
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What increases, decreases VIP secretion?
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Increase by distention and vagal stimulation, Decreased by adrenergic input
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Where is a VIPoma located and what does it produce?
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Islet cell pancreatic tumor that produces copious diarrhea
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What is the action of nitric oxide?
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Increased smooth muscle relaxation, including LES
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Loss of what is implicated in increased lower esophageal tone of achalasia?
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NO
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What is the action of motilin and where is it secreted?
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Small intestine; produces migrating motor complexes (MMCs)
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What increases the secretion of motilin?
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Increases in the fasting state
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What increases the secretion of gastric acid by parietal cells? Decreases?
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Increases - Histamine, ACh, Gastrin; Decreases - somatostatin, GIP, Prostaglandin, secretin
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What cell releases pepsin?
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Chief cells
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What increases pepsin release?
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Vagal stimuation, local acid
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What cells release HCO3- in the GI system?
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Mucosal cells (stomach, duodenum) and Brunner glands (duodenum)
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What are the receptors on the parietal cell for ACh, Gastrin, and Histamine?
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M3 receptor; CCKb receptor; H2 receptor
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What signal transduction pathways do ACh and Gastrin activate in the parietal cell?
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Gq, IP3/Ca2+
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What signal transduction pathway does histamine activate in the parietal cell?
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Increase cAMP
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What are the 3 pancreatic enzymes responsible for fat digestion?
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Lipase, phospholipase A, colipase
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What are the 4 proteases released by the pancreas?
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Trypsin, chymotrypsin, elastase, carboxypeptidases
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What enzyme activates trypsinogen and what is its function?
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Converted to active trypsin by enterokinase/enteropeptidase. Trypsin activates other proenzymes and more trypsinogen
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What bond does salivary amylase hydrolyze to yield what?
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a-1,4 linkages to yield disaccharides
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Glucose and galactose are taken up by what channel which is dependent on what? fructose is taken up by what channel?
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glucose and galactose: SGLT (Na+ dependent) and Fructose: GLUT-5 (facilitated diffusion)
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What channel transports all monosaccharides from the enterocyte into the blood?
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GLUT-2
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Where are iron, folate, and B12 absorbed?
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Iron: as Fe2+ in duodenum. Folate: jejunum B12: in ileum with bile acids
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Bile acids are bile salts conjugated to what to make them what?
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Conjugated to glycine or tuarine to make them water soluble
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Bile is made up of what?
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Bile salts, phospholipids, cholesterol, bilirubin, water, and ions
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What is urobilinogen excreted in urine as? What is urobilinogen secreted in feces as?
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Urine: urobilin; Feces: stercobilin
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