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225 Cards in this Set

  • Front
  • Back
9 retroperitoneal structures
duodenum
ascending colon
descending colon
kidney/ureters
pancreas (not tail)
aort
ivc
adrenal gland
rectum
duodenal parts that are retroperitoneal
2nd
3rd and 4th
pancreas parts that are retroperitoneal
except tail
stomach to prox. duodenum + liver, gb, pancreas
foregut
distal duod to prox 2/3 t. colon
midgut
distal 1/3 t. colon to upper portion of rectum
hindgut
blood supply of foregut
celiac
blood supply of midgut
sma
blood supply of hindgut
ima
branches of celiac trunk
left gastric
splenic
common hepatic
main bs of the stomach
celiac trunk
arteris with poor anastomoses if splenic artery is blocked
short gastric
stron anastomoses w/in stomach
l and r gastroepiploics
l and r gastrics
muscles of mastication
masseter
temporalis
medial and lateral pterygoid
origin of internal thoracic/mammary
subclavian
origin of superior epigastric
internal thoracic
origin of inferior epigastric
external iliac
origin of super. pancreaticoduodenal
celiac trunk
origin of inf. pancreaticduodenal
sma
origin of middle colic
sma
origin of left colic
ima
origin of superior rectial
ima
origin of middle rectal
internal iliac
go over the anastamosis that compensate if ab. aorta is blocked
internal thoracic <->
s. pancreaticoduodenal <->
middle colic <->
superior rectal <->
esophageal varices
left gastric -> azygous
external hemorrhoids
superior -> inf. rectal
caput medusae
paraumbilical -> inferior epigastric
varices seen in portal hypertension
esophageal varices
external hemorrhoids
caput medusae
portal-systemic anastamoses (5)
1. left gastr -> azygous
2. superior -> inf. rectal
3. paraumbillical -> inferior epigastric
4. retroperitoneal -> renal
5. retroperitoneal -> paravertabral
pro-kinetic agents that is a d2 receptor antagonist
metoclopromide
axn of metoclopramide
increases resting tone
increases contractility
increases LES tone
increases motility
(doesn't increase transit time through colon)
gastro drug with parkinsonian effect
metoclopramide (d2 receptor agonist)
diabetic and post-surgery gastroparesis
metoclopramide
metoclopramid drug interactions
dig
diabetic agents
contraindication with metoclopramide
small bowel obstruction
uses ser receptors to increase ach release at myenteric plexus
cisapride
moa of cisaprise
uses ser receptors to (+) ach release at myenteric plexus.

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