Gastrointestinal Diseases And Drugs

Front 1

Lesser omentum?

Back 1

Holds the liver in its proper position.
Double layer of peritoneum that extends from the liver to the lesser curvature of the stomach and the start of the duodenum.

Front 2

Falciform ligament?

Back 2

Attaches the liver to the abdominal wall

Front 3

Greater omentum?

Back 3

Layer of fat the protects the abdominal tissues. Large fold of peritoneum that hangs down from the stomach. Extends from the stomach to the posterior abdominal wall after associating with the transverse colon.

Front 4

Retroperitoneum?

Back 4

Anatomical space in the abdominal cavity behind (retro to) the peritoneum. The duodenum, pancreas and rectum are retroperitoneal organs.

Front 5

Celiac trunk?

Back 5

a. First major branch of the abdominal aorta. Branches from the aorta around the level of the T12 vertebra in humans.

Front 6

Common hepatic artery?

Back 6

Short blood vessel that supplies oxygenated blood to the:
i. Liver
ii. Pylorus (a part of the stomach)
iii. Duodenum (a part of the small intestine)
iv. Pancreas

Front 7

Right gastric artery (pyloric artery)?

Back 7

Arises from the common hepatic artery, above the pylorus. Descends to the pyloric end of the stomach. Passes from right to left along lesser curvature of stomach. Supplies branches and joins left gastric artery

Front 8

Left gastric artery?

Back 8

Arises from the celiac artery. Runs along the superior portion of the lesser curvature of the stomach.
Branches also supply the lower esophagus.

Front 9

Splenic artery?

Back 9

a. Supplies oxygenated blood to the spleen
Branches from the celiac artery, and follows a course superior to the pancreas.

Front 10

Superior mesenteric artery?

Back 10

Arises from the anterior surface of the abdominal aorta, just inferior to the origin of the celiac trunk. Supplies the intestines from the lower part of the duodenum to the left colic flexure and the pancreas

Front 11

Inferior mesenteric artery?

Back 11

Supplies the large intestine from the left colic (or splenic) flexure to the upper part of the rectum.Supply includes:
ii. Descending colon
iii. Sigmoid colon
iv. Part of the rectum

Front 12

Portal system?

Back 12

The term “portal system” means capillaries attached to a vein and that vein being attached to another system of capillaries that then take blood back to the heart.

Front 13

Hepatic portal vein?

Back 13

a. Drains blood from the digestive system and its associated glands.
b. One of the main components of the hepatic portal venous system.

Front 14

Superior mesenteric vein (SMV)?

Back 14

Drains blood from the small intestine (jejunum and ileum).
Terminates behind the neck of the pancreas.

Front 15

Combines with the splenic vein to form the hepatic portal vein?

Back 15

Superior mesenteric vein (SMV)?

Front 16

Splenic vein?

Back 16

Joins with the superior mesenteric vein, to form the hepatic portal vein and follows a course superior to the pancreas, alongside of the similarly named artery, the splenic artery.

Front 17

Collects branches from the stomach and pancreas and most notably from the large intestine, which is drained by the inferior mesenteric vein and joins with splenic vein shortly before it forms the portal vein.

Back 17

Splenic vein

Front 18

Drains large intestine and terminates when reaching the splenic vein?

Back 18

Inferior mesenteric vein (IMV)

Front 19

Hepatic Portal Vein is formed by the union of the?

Back 19

● splenic vein and
● superior mesenteric vein and
● inferior mesenteric vein

Front 20

True or false, fats are NOT carried in the portal blood?

Back 20

True. Almost all of the fats absorbed from the intestinal tract into intestinal lacteals. Fats are then transported to the systemic circulation via the thoracic duct

Front 21

True or false, oxygen is the most important dilator in the intestinal vili?

Back 21

True

Front 22

Four (4) Major Layers of Tissue of the Alimentary Canal?

Back 22

Mesentary
Muscularis externa
Muscularis mucosa
Submucosa

Front 23

GI Mucosa (3 layers)?

Back 23

Mucus Lining of epithelium
Lamina propria
Muscularis mucosae

Front 24

Plicae (folds) that increase surface area?

Back 24

Mucus Lining of epithelium

Front 25

Connective tissue, nerves, capillaries and lymphoid tissue (GALT or MALT)?

Back 25

Lamina propria

Front 26

Location of dense connective tissue in the GI tract?

Back 26

Submucosa

Front 27

Responsible for peristalsis and segmentation?

Back 27

Muscularis externa

Front 28

Protective outer layer of visceral peritoneum consisting of squamous cells.

Back 28

Serosa

Front 29

Three Major Functions of the Motor Activity of the GI Tract?

Back 29

Segmentation
Peristalsis
Sphincters

Front 30

The enteric nervous system concentrates in two specific areas:

Back 30

1. Submucosal plexus
2. Myenteric plexus

Front 31

The enteric nervous system can also be stimulated directly from the hypothalamus via sight, taste and smell. This occurs through ______.

Back 31

long reflexes

Front 32

Long nerve fibers from the GI to the brain are Extrinsic nerves. What do they signal?

Back 32

Extrinsic Primary Afferent Nerves (EPAN) notify CNS of GI processes that are relevant to energy and fluid homeostasis and the sensations of discomfort (nausea and vomiting) and pain

Front 33

The major stimulant of Extrinsic Primary Afferent Nerves (EPAN) is?

Back 33

Distention (stretch)

Front 34

The _____ cranial nerve innervates most of the GI organs

Back 34

10th

Front 35

_______ nerves innervate the lower intestines, anus and bladder.

Back 35

Pelvic splanchnic

Front 36

The sympathetic nervous system (SNS) acts through short pre-glanglionic nerves stimulating long post-ganglionic nerves that synapse in the chain ganglia?

Back 36

False, the pre-ganglionic nerves are not synapsing in the chain ganglia. Instead, they synapse just beyond the chain ganglia in the pre-vertebral ganglia.

Front 37

True or false, the parasympathetic system is excitatory?

Back 37

True

Front 38

The function of 5HT-4 in the gut is to?

Back 38

Enhance the release of more ACh, thus enhancing contraction

Front 39

Tegaserod?

Back 39

5-HT4 agonist manufactured by Novartis and used for the management of irritable bowel syndrome and constipation

Front 40

True or false, zelnorm was withdrawn due to increased risks of heart attack or stroke.

Back 40

True

Front 41

Of the 6 major gastric reflexes, which one is inhibitory?

Back 41

Enterogastric

Front 42

Most important substance stimulating gastric acid release?

Back 42

Gastrin (stomach and duodenum)

Front 43

Acts on pancreatic ducts, causes secretion of bicarbonate & water, secretion of bile from liver and may inhibit gastric emptying

Back 43

Secretin (duodenum)

Front 44

Stimulates release of bile from gall bladder, secretion of pancreatic enzymes from acinar cells and may inhibit gastric emptying?

Back 44

Cholecystokinin (duodenum and jejunum)

Front 45

Slows stomach motility and secretions?

Back 45

Gastric Inhibitory Peptide (GIP) (duodenum and jejunum)

Front 46

Clearing hormone. Only works in absence of food to clear the GI tract. Very powerful stimulant of contraction?

Back 46

Motilin (duodenum and jejunum)

Front 47

Inhibits secretion of endocrine hormones as well as histamine, gastric acid, rate of gastric emptying. Relaxes vascular smooth muscle in liver, causing a decrease in blood flow in esophagus. Also decreases bile secretions.

Back 47

Somatostatin – in stomach and duodenum, pancreas – INHIBITORY

Front 48

Transmitter released by distention and noxious stimuli. Involved in contraction of GI smooth muscle and nausea and vomiting.

Back 48

Serotonin, from EC cells.

Front 49

Octreotide?

Back 49

Sandostatin, an octopeptide that mimics natural somatostatin pharmacologically, though is a more potent inhibitor of growth hormone, glucagon, and insulin than the natural hormone.

Front 50

Used to decrease bleeding from esophageal varices?

Back 50

Octreotide

Front 51

Glands the secrete the most saliva?

Back 51

Submandibular Glands

Front 52

4 stomach sections, top to bottom?

Back 52

i. Cardia
ii. Fundus
iii. Body or corpus
iv. Pylorus or antrum

Front 53

Stomach section secreting the greatest amount of gastric acid, enzymes and intrinsic factor

Back 53

Body or Corpus

Front 54

Area of gastrin secretion but no gastric acid secretion?

Back 54

Antrum region

Front 55

Two stomach areas secreting gastric acid?

Back 55

ii. Fundus
iii. Body or corpus

Front 56

Gastric acid is secreted by?

Back 56

Parietal cells

Front 57

Pepsinogen is secreted by?

Back 57

Chief cells

Front 58

Mucous is secreted by?

Back 58

Goblet cells

Front 59

Bicarbonate ions are secreted by?

Back 59

Surface epithelial cells

Front 60

Gastric acid is secreted in response to?

Back 60

histamine (via H2 receptors), acetylcholine (M3 receptors) and gastrin (CCK2 receptors).

Front 61

Ezyme unique to the parietal cells that transports H+ against a concentration gradient of about 3 million to 1

Back 61

Hydrogen potassium ATPase (H+/K+ ATPase) is

Front 62

Parietal cells also produce?

Back 62

intrinsic factor

Front 63

Intrinsic factor is required for?

Back 63

absorption of vitamin B12 in the diet

Front 64

Hormone produced mainly by P/D1 cells lining the fundus of the human stomach and epsilon cells of the pancreas that stimulates appetite?

Back 64

Ghrelin

Front 65

Ghrelin is also produced in the ____, where it stimulates the secretion of growth hormone from the anterior pituitary gland

Back 65

hypothalamic arcuate nucleus

Front 66

Opposite of Ghrelin, decreases appetite?

Back 66

Leptin

Front 67

Hepatopancreatic sphincter that controls secretions from the liver, pancreas, and gallbladder into the duodenum of the small intestine

Back 67

Sphincter of Oddi

Front 68

The main function of these glands is to produce an alkaline secretion (containing bicarbonate) in order to:
protect the duodenum from the acidic content of chyme (which is introduced into the duodenum from the stomach); provide an alkaline condition for the intestinal enzymes to be active, thus enabling absorption to take place; lubricate the intestinal walls.

Back 68

Brunner glands

Front 69

Site of greatest absorption?

Back 69

Jejunum

Front 70

Main function is to absorb vitamin B12 and bile salts, water and products of digestion not absorbed by the jejunum

Back 70

Ileum

Front 71

Peyer’s patches are found in the?

Back 71

Ileum

Front 72

The crypts of Lieberkühn (or intestinal glands) are glands found in the epithelial lining of the small intestine and colon. The crypts secrete the enzymes:

Back 72

i. Sucrase
ii. Maltase
iii. Endopeptidases (Enterokinase)
iv. Exopeptidases

Front 73

Turns trypsinogen (a zymogen from the pancreas) to trypsin, indirectly activating a number of pancreatic digestive enzymes

Back 73

Enterokinase

Front 74

AMITIZA?

Back 74

lubiprostone) is approved to treat Chronic Idiopathic Constipation in adults and Irritable Bowel Syndrome with Constipation (IBS-C) in women 18 years of age and older

Front 75

Lubiprostone works by stimulating

Back 75

Chlorine pump

Front 76

The main inducer of the mechanisms involved in vomiting?

Back 76

Serotonin

Front 77

The most effective antiemetics constituting the single greatest advance in the management of nausea and vomiting in patients with cancer

Back 77

5-HT3 inhibitors

Front 78

Approved 5-HT3 inhibitors include:

Back 78

1. Dolasetron (Anzemet),
2. Granisetron (Kytril)
3. Ondansetron (Zofran)
4. The newest 5-HT3 inhibitor, Palonosetron (Aloxi),

Front 79

Emend?

Back 79

iAprepitant. Substance P inhibitor shown to be effective in controlling the nausea of cancer chemotherapy in the delayed phase.

Front 80

Pneumonic for VOMIT?

Back 80

(V)estibular(O)bstruction(M)ind(I)nfection(T)oxins

Front 81

Part of the brain that controls vomiting?

Back 81

Area postrema

Front 82

Area of the brain which receives inputs from blood-borne drugs or hormones, and communicates with the Vomiting center, to initiate vomiting?

Back 82

Chemoreceptor trigger zone (CTZ)

Front 83

Substance-P acts on?

Back 83

NK-1 receptors

Front 84

Most important phase in regards to pancreatic exocrine secretion?

Back 84

Intestinal phase

Front 85

Specialized macrophages located in the liver that form part of the reticuloendothelial system (aka: mononuclear phagocyte system)

Back 85

Kupffer cells

Front 86

Simulates the secretion of bile from the gall bladder

Back 86

Cholecystokinin

Front 87

Stimulates release of bile from the liver?

Back 87

Secretin

Front 88

Small pouches caused by sacculation that give the colon its segmented appearance?

Back 88

Haustra

Front 89

Runs the length of the large intestine. and actually replaces some of the longitudinal muscle of the muscularis externa?

Back 89

taenia coli

Front 90

Sphincter muscle situated at the junction of the small intestine (ileum) and the large intestine?

Back 90

ileocecal valve

Front 91

Lactinex?

Back 91

Lactobacillus, a probiotic supplement used to replace microorganisms (gut flora) in the human intestines and colon

Front 92

Antihistamines:

Back 92

1. Buclizine – Bucladin-S
2. Cyclizine – Marezine
3. Dimenhydrinate – Dramamine
4. Diphenhydramine – Benadryl
5. Meclizine – Antivert, Bonine, Dramamine (less drowsy formula)
6. Promethazine – Phenergan

Front 93

Alkylamine antihistamines?

Back 93

1. Chlorphenamine (Chlortrimeton)
2. Brompheniramine (Dimetane)
3. Triprolidine (Actidil)

Front 94

Piperizine antihistamines?

Back 94

1. Cyclizine (Marezine)
2. Hydroxyzine (Atarex/Vistaril)
3. Meclizine (Antivert/Bonine)
4. Cetirizine (Zyrtec)

Front 95

Phenthiazine antihistamine?

Back 95

Promethazine (Phenergan)

Front 96

2nd generation antihistamines?

Back 96

1. Terfenadine (Seldane)
2. Acrivastine (Semprex)
3. Astemizole (Hismonol)
4. Cetirizine (Zyrtec)
5. Loratadine (Claritin)
6. Desloratidine (Clarinex)
7. Azelastine (Astelin)*
8. Levocetirizine (Xyzal)
9. Fexofenadine (Allegra)

Front 97

The Theophyline salt of diphenhydramine?

Back 97

Dramamine

Front 98

H2 agonists?

Back 98

a. Ranitidine – Zantac
b. Famotidine – Pepcid
c. Cimetidine – Tagamet
d. Nizatidine – Axid

Front 99

Proton pump inhibitors?

Back 99

e. Esomeprazole – Nexium
f. Lansoprazole – Prevacid
g. Omeprazole – Prilosec
h. Rabeprazole – Aciphex
i. Pantoprazole - Protonix

Front 100

Key to H2 agonists?

Back 100

the imidazole group

Front 101

H-2 Receptor Antagonists block the H2 receptor on ________, thus limiting the effects of histamine on acid production

Back 101

parietal cells

Front 102

H2 agonist potency?

Back 102

Pepcid > Axid > Zantac > Tagament

Front 103

Proton pump inhibitors?

Back 103

1. Esomeprazole – Nexium
2. Lansoprazole – Prevacid
3. Omeprazole – Prilosec
4. Rabeprazole – Aciphex
5. Pantoprazole - Protonix

Front 104

True or false, PPIs are prodrugs and must get into the acid environment of the stomach to be activated?

Back 104

True

Front 105

PPIs are weak bases and would be destroyed by the acidic stomach environment?

Back 105

True

Front 106

PPIs are released in the small intestine?

Back 106

True

Front 107

PPis enter the parietal cell ionized?

Back 107

False, PPIs enter the parietal cell unionized and become trapped.

Front 108

Carafate?

Back 108

Sucrulfate, reacts with hydrochloric acid in the stomach to form a cross-linking, viscous, paste-like material.

Front 109

Anticholinergic/Antispasmotic Agents

Back 109

1. Dicyclomine – Bentyl
2. Hyoscyamine -Cystospaz, IB-Stat, Levbid, Levsin, Levsinex, NuLev)a. Atropine-like
3. Propantheline – Probanthine
4. Mepenzolate – Cantil
5. Belladonna
6. Methscopolamine – Pamine
7. Combinations a.Atropine, scopolamine, hyoscyamine + Pb
b. Chlordiazopoxide + Clidinium - Librax

Front 110

Reglan?

Back 110

Metoclopramide. i. Blocks Dopamine 2 Receptors in GI tract, causing increased motility of the smooth muscle of the stomach and small intestines

Front 111

Tigan?

Back 111

Trimethobenzamide

Front 112

Sulfasalazine?

Back 112

Azulfidine: 5-Aminosalicylates, Mainstay of Treatment for IBS.

Front 113

Dipendum?

Back 113

Olsalazine, delivers 2 molecules of Mesalazine (5-aminosalicylic acid) (5-ASA)

Front 114

Balsalazide?

Back 114

Colazal, releases mesalazine, also known as 5-aminosalicylic acid, or 5-ASA, in the large intestine

Front 115

iPentasa and Asocol?

Back 115

Pentasa and Asocol are coated to prevent acid destruction in stomach.
iPentasa releases throughout small intestines and colon.
iii. Asacol releases primarily in ileum and colon like the other mesalamine products

Front 116

Relistor?

Back 116

(Methylnaltrexone), new option for treating constipation due to opioids

Front 117

Kwashiorkor?

Back 117

Deficient intake of protein

Front 118

Marasmus?

Back 118

Deficient intake of both calories and protein over a long time period

Front 119

Most useful parameter to test for malnutrition in the hospital due to short half life of only 2 days.

Back 119

Thyroxine

Front 120

Most accurate test for malnutrition due to short half life, but cost restrictive

Back 120

Retinol binding protein

Front 121

Caloric requirements:

Back 121

b. 25 kcal/kg/day for adults
c. 30 kcal/kg/day for patients with infections, skeletal trauma
d. 35 kcal/kg/day for patients with major trauma
e. 40 kcal/kg/day for patients with major thermal injury