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225 Cards in this Set
- Front
- Back
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9 retroperitoneal structures
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duodenum
ascending colon descending colon kidney/ureters pancreas (not tail) aort ivc adrenal gland rectum |
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duodenal parts that are retroperitoneal
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2nd
3rd and 4th |
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pancreas parts that are retroperitoneal
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except tail
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stomach to prox. duodenum + liver, gb, pancreas
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foregut
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distal duod to prox 2/3 t. colon
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midgut
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distal 1/3 t. colon to upper portion of rectum
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hindgut
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blood supply of foregut
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celiac
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blood supply of midgut
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sma
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blood supply of hindgut
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ima
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branches of celiac trunk
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left gastric
splenic common hepatic |
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main bs of the stomach
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celiac trunk
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arteris with poor anastomoses if splenic artery is blocked
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short gastric
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stron anastomoses w/in stomach
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l and r gastroepiploics
l and r gastrics |
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muscles of mastication
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masseter
temporalis medial and lateral pterygoid |
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origin of internal thoracic/mammary
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subclavian
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origin of superior epigastric
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internal thoracic
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origin of inferior epigastric
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external iliac
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origin of super. pancreaticoduodenal
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celiac trunk
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origin of inf. pancreaticduodenal
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sma
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origin of middle colic
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sma
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origin of left colic
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ima
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origin of superior rectial
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ima
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origin of middle rectal
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internal iliac
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go over the anastamosis that compensate if ab. aorta is blocked
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internal thoracic <->
s. pancreaticoduodenal <-> middle colic <-> superior rectal <-> |
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esophageal varices
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left gastric -> azygous
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external hemorrhoids
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superior -> inf. rectal
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caput medusae
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paraumbilical -> inferior epigastric
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varices seen in portal hypertension
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esophageal varices
external hemorrhoids caput medusae |
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portal-systemic anastamoses (5)
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1. left gastr -> azygous
2. superior -> inf. rectal 3. paraumbillical -> inferior epigastric 4. retroperitoneal -> renal 5. retroperitoneal -> paravertabral |
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pro-kinetic agents that is a d2 receptor antagonist
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metoclopromide
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axn of metoclopramide
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increases resting tone
increases contractility increases LES tone increases motility (doesn't increase transit time through colon) |
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gastro drug with parkinsonian effect
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metoclopramide (d2 receptor agonist)
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diabetic and post-surgery gastroparesis
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metoclopramide
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metoclopramid drug interactions
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dig
diabetic agents |
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contraindication with metoclopramide
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small bowel obstruction
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uses ser receptors to increase ach release at myenteric plexus
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cisapride
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moa of cisaprise
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uses ser receptors to (+) ach release at myenteric plexus.
-increases esophageal tone, increases gastric and duodenal contracility, improves transit time |
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serious interation with cisapride
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torsades de pointes with erythromycin, ketoconazole, nefazodone, fluconazole
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5-ht antagonist and antiemetic
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ondansetron
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controls vomiting postoperatively and in patients undergoing cancer chemo
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ondansetron
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se of ondansetron
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he and constipation
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sulsalazine
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combo of sulfapyridine (anti- bacterial) and mesalamine (anti-infl.)
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use of sulfasalazine
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UC/chron's
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se's are malaise, nausea, sulfa toxicity, reversible oligospermia
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sulfasalazine
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pro-inflammatory cytokine; monoclonal ab to TNF-alpha
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infliximab
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uses of infliximab
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RA and chron's
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toxicities are resp. infection, fever, hypotension
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infliximab toxicity
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antacid overuse
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alters gastric/urinary ph; delays gastric emptying; affects absorption, bioavailability, or urinary excretion of other drugs
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aloh overuse
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constipation
hypophosphatemia p. muscle weakness osteodystrophy seizures |
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mg oh overuse
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diarrhea
hyporeflexia hypotension cardiac arrest |
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cahco3 overuse
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hypercalcemia
rebound acid increase |
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block m1 and m3 receptors
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muscarinic antagonists = pirenzepine, propantheline
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muscarinic receptor blockers that treat peptic ulcers
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muscarinic antagonists = pirenzepine and propantheline
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toxicities are tachy + dry mouth + difficulty focusing eyes
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muscarinic antagonisits = pirenzepine and propantheline
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pge analog to treat nsaid-induced peptic ulcerts
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misoprostol
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uses of misoprostol
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nsaid-induced pud
maintain pda induces labor |
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increases production/secretion of gastic mucous barrier while decreasing acid production
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misoprostol
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opiates for diarrhea
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loperamide
diphenoxylate |
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cellulose to treat constipation
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psyllum
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glucose derivative to treat constipation
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sorbitol
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used to clean colon b4 endoscopy
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mg citrate
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gentle antispasmodic
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docusside na
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binds ulcer base, allowing hco3 secretion to reestablish ph gradient in mucus
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bismuth and sucralfate
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triple therapy
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metro
bismuth amoxicillin |
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use with faster ulcer healing and traveller's diarrhea
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bismuth and sucralfate
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ireeversible inhibits h/k-atpase in parietal cells
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proton pump inhibitors = omeprazole, lansoprazole
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treats pud, gastritis, gerd, zollinger-ellison syndrome, 1st line of gastrinomas
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proton pump inhibitors = omeprazole, lansoprazole
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reversibly blocks h2 receptors, so less h is secreted by parietal cells
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h2 blockers =
cimetidine, ranitidine, famotidine, nizatidine |
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h2 blocker that's a potent inhibitor of p-450
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cimetidine
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h2 blocker with antiandrogen effects (prolactin release, gynecomastia, impotence, decreased libido in men)
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cimetidine
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gastro drugs that can cross bbb and placenta
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h2 blockers
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h2 blockers that decrease the renal excretion of creatinine
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cimetidine and ranitidine
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irregular capillaries with fenestrated endothelium in the liver
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sinusoids
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at basal surface of haptocyte for lymph drainage
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spade of disse (perisunusoidal space)
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sunusoids drain here
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central vein
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where hindgut meets ectoderm
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pectinate line
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femoral triangle
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femoral vein, artery, nerve
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femoral sheath
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femoral vein, artery, and canal (deep inguinal lymph nodes)
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site of protrusion of indirect hernia
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internal inguinal ring
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site of protrusion of direct hernia
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abdominal wall
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protrusion of peritoneum through an opening, usually a site of weakness
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hernia
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defective development of peritoneal membrane in an infant
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diaphragmatic hernia
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hernia in which stomach herniates upward through esophageal hiatus of diaphram
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hiatal hernia
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failure of processus vaginalis to close
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indirect inguinal hernia
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protrudes through the inguinal/hesselbach's triangle
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direct inguinal hernia
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leading cause of bowel incarceration
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femoral hernia
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hesselbach's triangle
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inferior epigastric artery
lateral border of rectus abdominis inguinal ligament |
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mucinous salivary glands
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submandibular
sublingual |
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serous salivary glands
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parotid
lingual |
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stomach secretions
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gastric acid
intrinsic factor hco3- pepsin gastrin |
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autoimmune destruction of parietal cells causes
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chronic gastritis and pernicious anemia
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required for b12 uptake in terminal ileum
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intrinsic factor
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stimulants of gastric acid production
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hist
ach gastrin |
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inhibitors of gastric acid production
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somatostain
gip prostaglandin secretin |
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for protein digestion at the stomach
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pepsin
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secretes pepsin
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chief cells of stomach
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stimulates pepsin release
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vagal stimulation and
local acid |
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prevents audodigestion
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hco3-
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secrets hco3-
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mucosal cells of stomach and duodenum
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hormone that stimulates bicarb release
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secretin
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effects of gastrin
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increases gastric acid secretion
increases growth of gastric mucosa increases gastric motility increases histamine production increases enterochromaffin cells |
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stimulated by stomach distention, a.a.'s, peptides, vagal stimulation
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gastrin
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inhibits gastrin secretion
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low ph <1.5
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increases pancreatic hco3- while inhibiting gastric acid secretion, gastric emptying
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secretin
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inhibited by secretin and low ph
stimulated by fatty acids and amino acids |
cck
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stimulates pancreatic secretions,
stimulates gall bladder contraction (bile), inhibits gastric emptying |
cck
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inhibits gastric acid secretion while stimulating insulin release
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gip
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stimulated by fatty acids, amino acids, oral glucose
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gip
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purely inhibitory gi secretions
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somatostatin
gip |
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source of vip
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parasympathetic ganglia in sphincters, gall bldder, small intestine
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non alpha, non-beta islet cell pancreatic tumor that causes COPIOUS DIARRHEA
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VIPOMA
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stimulates intestinal water and electrolyate secretion, while relaxing smooth muscle and sphincters
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vip
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axns of somatostatin
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decrease gastric acid and pepsinogen secretion;
low pancreatic and small intestine fluid secretion; decreases gallbladder contraction; decreases ins/glucagon secretion |
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with antigrowth hormone effects
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somatostatin
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converts trypsinogen to trypsin
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enterokinase
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implicated in increasing les tone in achalasia when inhibited
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NO
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activates all proenzymes
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trypsinogen
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proenzymes for protein digestion
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proteases - trypsin, chymotrypsin, elastase, carboxypeptidases
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lipase
phospholipase A colipase |
fat digestion
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alpha amylase
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starch digestion
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starts all of digestion by hydrolyzing alpha 1,4 linkages
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salivary amylase
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rate-limiting step in carb digestion
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oligosaccharide hydrolases
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glucose and galactose uptake by enterocytes
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sglt1
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fructose uptake by enterocytes
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facilitated diffusion by glut-5
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monosaccharide transport to blood
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glut-2
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flow of blood in liver
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from apical to basolateral surface
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flow of bile in liver
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from basolateral to apical surface
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zone of liver most sensitive to toxic injury
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periportal zone
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zone of liver affected first by viral hepatitis
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periportal zone
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zone of liver containing p450
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pericentral vein zone
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zone of liver affected first by ischemia
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pericentral vein zone
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zone of liver affected first by ischemia
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periportal zone
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bile acid conjugated to glycine or taurine
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bile
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only significant mechanism for cholesterol excretion
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bile
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ba swallow shows dilated esophagus with an area of distal stenosis
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achalasia
(bird's break) |
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cause of secondary achalasia
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chagas disease
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loss of myenteric pressure
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achalasia
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glandular neoplasia of the esophagus
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barrett's esophagus
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risk of esophageal adenocarcinoma
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gerd and barrett's esophagus
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hammon's sign
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subcutaneous emphysema seen with boorhave's syndrome
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risks of esophageal ca
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ABCDEF
A - achalasia, alcohol B - barrett's esophagus C - cigarettes D - diverticula (zenker's) E - esophageal web (plummer vinson), esophagitis (due to reflux, irritants, infxn.) F - familial |
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1st born male w/ projectile vomiting and 2 weeks of age and "olive" mass
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congenital pyloric stenosis
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diarrhea + steattorhea + abnormal xylose test (only small bowel involvement)
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c. sprue
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increased risk of t cell lymphoa
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c. sprue
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older man with diarrhea and steatorrhea + cardiac, neurologic, and arthralgic symptoms
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whipple's disease
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mc dissacharide deficiency
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lactase deficiency
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malabsorptive syndrome causing osmotic diarrhea with milk intake
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lactose intolerance
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pancreatic insufficiency causes malabsorption of these...
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protein
fat vitamin A vitamin D vitamin E vitamin K |
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associated with dermatitis herpetiformis
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celiac sprue
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inflammation due to disruption of mucosal barrier of stomach
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acute gastritis
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ulcer due to burns
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curling's
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ulcer due to brain injury
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cushing's
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gastritis affecting the body
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chronic gastritis type A
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autoantibodies to parietal caells
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chronic gastritis type A
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3 A's of type A chronic gastritis
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Autoantibodies to parietal cells
Anemia - pernicious Achlorydia |
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gastritis affecting the antrum
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type b chronic gastritis
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gastritis caused by h. pylori infection
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type b chronic gastritis
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risk of MALT lymphoma
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type b chronic gastritis
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weight loss + chronic NSAID use + pain with meals
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gastric ulcer
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weight gain + h. pylori infection + pain relieved with meals
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duodenal ulcer
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clean "punched-out" margins
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ulcers
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raised, irregular margins
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gastric carcinoma
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ulcer comoplications
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bleeding
penetration perforation obstruction |
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mc stomach cancer
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adenocarcinoma
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spread of stomach ca
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early agressive spread and node/liver mets
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predisposes to stomach cancer
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nitrosamine
achlorydia chronic gastritis type A blood |
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diffusely infiltrative stomach ca
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linitis plastica
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supraclavicular mets from stomach
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virchow's node
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bilateral mets to ovaries from stomach
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krukenberg's tumor
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autoimmune ibd
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uc
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rectal sparing
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crohn's
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cobblestone mucosa
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chron's
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creeping fat
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chron's
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"string sign" on ba swallow of ibd
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chron's
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transmural ibd
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chron's
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psudopolyps with free hanging messentery ibd
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uc
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ibd with granulomas and lymph aggregates
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chron's
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bleeding with crypt abscesses and ulcers ibd
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uc
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toxic megacolon ibd
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uc
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colorectal carcinoma ibd
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uc
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perianal disease, malabsorption, strictures, and fistulas ibd
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chron's
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"lead pipe" colon
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uc
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blind pouch leading from alimentary tract lined by all 3 layers of gi tract
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diverticulum -
"true" |
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many divertiula cause increased intraluminal pressure
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diverticulosis
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inflammed diverticula causeing bright red rectal bleeding
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diverticulitis
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persistence of vitelline duct or yolk sac
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meckel's diverticulum
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meckel's epithelia
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gastric and pancreatic
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rule of 2's of meckel's
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2" long
2 ft from ileocecal valve 2 epithelia 2% population |
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mc congenital anomaly of gi tract
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meckel's
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herniated mucosal tissue to junction of pharynx and esophagus
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zenker's diverticulum
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sausage mass with currant jelly stool
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intussuception
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bird's beak on barium enema
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volvulus
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congenital megacolon
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hischsprung's
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lack of auerbach's and meissner's plexuses on intestinal biopsy
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hirschsprung's
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colonic polyps with sawtooth appearance; non-neoplastic
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hamartomas
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polyps that are more malignant: villous or saw-tooth appearance
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villous
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3rd mc cancer
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CRC
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"apple core" lesion on barium swallow xray
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colorectal cancer
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CRC tumor marker
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CEA
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risks for CRC
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villous adenomas
chronic ibd FAP HNPCC family hx |
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AD mutation on APC gene of chromosome 5
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FAP = familial adenomatous polyposis
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CRC with osseous and soft tissue tumors and retinal hyperplasia
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gardner's syndrome
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CRC with glioblastoma
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Turcot's
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HNPCC aka
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lynch syndrome
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mutation of dna repair gene due to mismatch repair
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lynch syndrome
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hamartomatous polyps of colon and small intestine with hyperpigmented lips
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peutz-jeghers
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benign polyposis syndrome associated with breat, stomach and ovary malignancies
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peutz-jeghers
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nodule of liver < 3cm; due to metabolic insults
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micronodular
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nodules > 3cm; due to postinfection or drug-induced hep
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macronodular
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may relieve portal hypertension
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portacaval shunt bt splenic vein and left renal vein
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effects of portal hypertension
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"HE CHAMPS" -
h - hemorrhoids e - esophageal varices c - caput medussae h - hetamamesis a - ascites m - melena p - peptic ulcer s - splenomegaly |
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"apple core" lesion on barium swallow xray
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colorectal cancer
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CRC tumor marker
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CEA
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risks for CRC
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villous adenomas
chronic ibd FAP HNPCC family hx |
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AD mutation on APC gene of chromosome 5
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FAP = familial adenomatous polyposis
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CRC with osseous and soft tissue tumors and retinal hyperplasia
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gardner's syndrome
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CRC with glioblastoma
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Turcot's
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HNPCC aka
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lynch syndrome
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mutation of dna repair gene due to mismatch repair
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lynch syndrome
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hamartomatous polyps of colon and small intestine with hyperpigmented lips
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peutz-jeghers
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benign polyposis syndrome associated with breat, stomach and ovary malignancies
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peutz-jeghers
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nodule of liver < 3cm; due to metabolic insults
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micronodular
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nodules > 3cm; due to postinfection or drug-induced hep
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macronodular
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may relieve portal hypertension
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portacaval shunt bt splenic vein and left renal vein
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effects of portal hypertension
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"HE CHAMPS" -
h - hemorrhoids e - esophageal varices c - caput medussae h - hetamamesis a - ascites m - melena p - peptic ulcer s - splenomegaly |
