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93 Cards in this Set
- Front
- Back
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Submucosa
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S for Secretion
Submucosal nerve plexus (meiSSner's) |
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Muscularis externa
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M for Myenteric nerve plexus (Auerbach's)
cell bodies for parasymp nervous system inner circular layer; outer longitudinal |
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Basal electric rhythm
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Stomach: 3 waves/min
Duodenum: 12 waves/min Ileum: 8-9waves/min (x4, then -4) |
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Brunner's glands
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in submucosa of DUODENUM
secrete alkaline mucus to neutralize acid *only GI submucosal glands *hypertrophy in PUD |
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Peyer's patches
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in lamina propria and submucosa of Ileum (close to the dirty colon!)
unencapsulated lymphoid tissue; contains specialized M cells that take up antigen -B cells stimulated in germinal centers differentiate into IgA-secreting plasma cells IgA = IntraGut Antibody |
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Collateral circulation
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1. internal thoracic/mammary (subclavian) <--> superior epigastric (internal thoracic) <--> inf epigastric (external iliac)
2. Sup pancreaticoduodenual (celiac) <--> inf pancreaticoduodenal (SMA) 3. Middle colic (SMA) <--> Left colic (IMA) 4. Sup rectal (IMA) <--> middle rectal (int iliac) |
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Pectinate line
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Above:
internal hemorrhoids visceral innervation, painless adenocarcinoma superior rectal a. (IMA) superior rectal vein (to IMV and portal system) Below: external hemorrhoids inf rectal n. (off pudendal n.) painful squamous cell carcinoma (ectoderm) inferior rectal a. (off int pudendal a.) inf. rectal v. (to int pudendal, int iliac, IVC) |
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Spermatic cord
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external spermatic fascia from external oblique
cremasteric muscle from internal oblique internal spermatic fascia from transversalis fascia |
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Hesselbach's triangle
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inguinal ligament
inf epigastric a. lateral border of rectus abdominis |
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Gastrin
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G cells of antrum
H+ secretion (thru stim of ECL cells to release histamine) growth of gastric mucosa gastric motility increase by stomach distention, AA< peptides, vagal stim, alkalinization decrease by pH <1.5 Phe and Tryp are stimulators Zollinger-Ellison Hyperparathyroid --> Ca --> increased gastrin and ulcers |
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Cholecystokinin
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I cells (duo and jejun)
pancreatic secretion, gallbladder contraction/Oddi relaxation decrease gastric emptying Increased by FA and AA *acts on neural muscarinic pathways to cause pancreatic secretion |
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Secretin
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S cells (duo)
"I have a secret: I'm BI" for BIle and BIcarb Increase pancreatic bicarb, allowing panc enzymes to fcn Bile secretion Decrease gastric acid secretion Increased by acid, FA in duo |
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Somatostatin
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D cells (panc islets, GI mucosa)
decrease: gastric acid, pepsinogen, fluid secretion, gallbladder contraction, insulin and glucagon Increased by acid decreased by vagal stimulation **anti-growth hormone |
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GIP
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gIp; I for inhibitory and insulin
Gastric inhibitory peptide/Gluc-dependent insulinotropic peptide K cells (duo, jejun) Decrease H+ secretion Increase insulin release Increased by FA, AA, oral glucose |
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VIP
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Vasoactive intestinal polypeptide
parasymp ganglia in sphincters, gallbladder, sm intestine Increases intestinal water and electrolyte secretion relaxation of intestinal smooth muscle and sphincters Increased by distention and vagal stimulation decreased by adrenergic input |
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VIPoma
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non-alpha, non-beta islet cell pancreatic tumor
*copious diarrhea |
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Nitric oxide
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increase smooth muscle relaxation, including LES
*loss of NO implicated in achalasia (increased LES tone) |
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Motilin
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Small intestine
produces migrating motor complexes (MMC) increases in fasting state |
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Intrinsic factor
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Parietal cells of stomach
B12 binding protein (uptake in terminal ileum) |
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Gastric acid
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Parietal cells of stomach
Increased by histamine, Ach, gastrin decreased by somatostatin, GIP, PG, secretin |
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Pepsin
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Chief cells of stomach (chief of the pep squad)
Protein digestion increased by vagal stim and local acid Pepsinogen --> pepsin activated by H+ |
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Bicarb
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Mucosal cells (stomach, duo, salivary glands, pancreas) and Brunner's glands (duo)
-neutralizes acid -increases pancreatic and biliary secretion with SECRETIN Bicarb trapped in mucus that covers gastric epithelium |
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Salivary glands
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Serous on the Sides (parotid)
Mucinous in the Middle (sublingual) 1. alpha-amylase (ptyalin): starch digestion 2. Bicarb: neutralizes oral bacterial acids 3. Mucins: lubrication 4. Antibacterial products 5. Growth factors: epithelial renewal Symp (sup cervical ganglion T1-T3): thick Parasymp (CN7, 9): serous low flow rate: hypotonic high flow rate: isotonic (more NaCl) *CN7 runs thru parotid |
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Pancreatic enzymes
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alpha-amylase
lipase, phospholipase A, colipase Proteases: trypsin, chymotrypsin, elastase, carboxypeptidases (secreted as zymogens- proenzymes) Trypsinogen: converted to trypsin by enterokinase/enteropeptidase from duodenal mucosa *trypsin activates other proenzymes and more trypsinogen |
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3 forms of carb metabolism
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1. Salivary amylase: hydrolyzes alpha1,4 linkages --> disacchardies (maltose and alpha-limit dextrins)
2. Pancreatic amylase: duodenum --> oligosaccharides and disaccharides 3. Oligosaccharide hydrolases: brush border of intestine. RATE-LIMITING STEP in carb digestion; produce monosaccharides Only monosach: absorbed by enterocytes Glucose and galactose taken up by SGLT1 (Na+-dependent) (Sodium GLucose coTransporter) Fructose taken up by facilitated diffusion by GLUT-5 (FRUT GLUT 5) -all transported to blood by GLUT-2 |
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Vit/Mineral absorption
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Fe: duodenum
Folate: jejunum B12/Bile: terminal ileum |
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Cu secretion
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in bile; but not in Wilson's
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Salivary gland tumors
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1. Pleomorphic adenoma: MC, parotid, benign
2. Warthin's tumor: benigng; heterotopic gland tissue trapped in a lymph node 3. Mucoepidermoid carcinoma: MC malignant |
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Achalasia
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loss of myenteric (Auerbach's) plexus --> failure of relaxation of LES
-can be due to Chagas |
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Scleroderma & esoph
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esophageal dysmotility involving low pressure prox to LES
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Esophageal strictures
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lye ingestion and acid reflex
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Plummer-Vinson
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1. Dysphasia: Esophageal webs
2. Iron-def anemia 3. Glossitis Plummers DIG through esophageal webs increase risk SQUAMOUS cell carcinoma |
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Esophageal Cancer
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RFs/Causes:
Alcohol/Achalasia Barrett's Cigarettes Diverticula: Zenker's Esophageal web/Esophagitis Familial GERD Hot dogs (nitrosamines) |
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Tropical sprue
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like celiac's but probably infxn bc responds to abx
**can affect ENTIRE small bowel tx: abx, folate |
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Celiac's
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PROXIMAL small bowel
autoantibodies to gluten (gliadin) and transglutaminase; lymphocytic infiltrate in lamina propria *assoc with dermatitis herpetiformis -increase risk malignancy: T cell lymphoma |
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Whipple's Disease
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Tropheryma whippelii (gram +); PAS+ macrophages
sxs: arthralgias, cardiac and neuro sxs Tx: abx (10days IV + 1yr bactrim) |
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Abetalipoproteinemia
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decrease synthesis of apoB --> can't generate chylomicrons --> decrease secretion of cholesterol, VLDL into blood --> fat accum in enterocytes
-malabsorption and neuro sxs (night blindness, ataxia, acanthocytosis) Tx: vit E (ADEK) |
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Curling's ulcer
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from burns; decrease plasma vol --> sloughing of mucosa
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Cushing's ulcer
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brain injury --> increased vagal stim --> Ach --> H+
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Chronic gastritis (nonerosive)
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AB
Type A in the Body/fundus Autoantibodies to parietal cellsAnemia (pernicious Achlorhydria Type B: in Antrum H-pylori --> increased risk MALToma |
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Menerier's disease
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gastric hypertrophy with protein loss, parietal cell atrophy, and increased mucous cells
precancerous Rugae of stomach so hypertrophied --> looks like brain gyri |
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Stomach cancer
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adenocarcinoma
aggressive local spread and mets to nodes/liver (celiac nodes) assoc: NitrosAmines Achlorhydria type A blood chronic gastritis features: Signet ring cells (bc of mucin) acanthosis nigricans linitis plastica: diffusely infiltrative (leather bottle) |
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Virchow's node
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left supraclavicular node from stomach mets
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Krukenberg
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bilateral mets to ovaries (see signet rings cells, mucus)
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Sister Mary Joseph's nodule
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subcutaneous periumbilical mets
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Crohn's
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Response to intestinal bacteria
*Th1 --> granulomas *NF-kB --> cytokine production -from mouth to colon; usually terminal ileum and colon -skin lesions, rectal sparing -transmural -cobbletone mucosa, creeping fat, string sign -ulcers, fissures, fistulas -noncaseating granulomas, lymphoid aggregates -migratory polyarthritis, erythema nodosum tx: steroids, infliximab |
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Ulcerative Colitis
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Autoimmune
increased Th2 -always rectal; only as far as colon, continuous -mucosal and submucosal -friable mucosal pseudopolyps with freely hanging mesentary -lead pipe: loss of haustra -crypt abscesses, ulcers, bleeding -can become toxic megacolon, colorectal CA -bloody diarrhea -pyoderma gangrenosum, primary sclerosing cholangitis, ankylosing spondylitis, uveitis tx: sulfasalazine, 6MP, infliximab, colectomy |
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Esophageal diverticula
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1. Zenker's: at junction of pharynx and esophagus; halitosis, dysphagia, obstruction
2. Traction: middle 3. Epiphrenic: bottom |
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Meckel's
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persistence of vitelline duct or yolk stalk
*MC congenital anomaly of GI tract dx: pertechnetate study: ectopic uptake of gastrin secreting areas |
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Viral cause of intussusception
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adenovirus in children
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Hirschsprung's
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congenital megacolon characterized by lack of ganglion cells/enteric nervous plexuses (Auerbach's AND Meissner's)
*failure of neural crest cell migration *increased risk with Down's |
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Down's
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CHAD has Downs"
Celiacs HIrschsprung Annular pancreas Duodenal atresia |
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Angiodysplasia
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tortuous dilation of vessels --> bleeding
most often in cecum, terminal ileum, ascending colon dx: angiography |
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Peutz-Jeghers
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auto dom
nonmalignant hamartomas in GI tract + hyperpigmented mouth, lips, hands, genitalia *increased risk of CRC and other visceral malignancies |
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FAP
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auto dom mutation of APC gene
2 hit hypothesis always involves rectum |
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Gardner's
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FAP + osseous and soft tissue tumors, retinal hyperplasia
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Turcot's
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FAP + malignant CNS tumor (medulloblastoma)
TURcot for TURban |
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Hereditary nonpolyposis CRC (Lynch)
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auto dom mutation of DNA mismatch repair genes
= microsatellite instability pathway *prox colon always involved |
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Genes involved in CRC
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loss of APC gene (colon at risk) --> K-RAS mutation (adenoma) --> Loss of p53 (carcinoma)
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Carcinoid tumor
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neuro-endocrine cells
50% of small bowel tumors MC site: appendix, ileum, rectum MC malignant in small intestine EM: see dense core bodies produce 5-HT --> carcinoid syndrome if mets BFDR: bronchospasm flushing diarrhea right-heart lesions (murmurs) |
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Micronodular cirrhosis
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<3mm; uniform size
Cause: metabolic: Alcohol Hemochromatosis Wilson's |
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Macronodular cirrhosis
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>3mm, varied size
significant liver injury --> necrosis Postinfectious Drug-induced hepatitis increased risk HCC |
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Esophageal varices tx
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propanolol or nadolol
octreotide |
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Reye's
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childhood hepatoencephalopathy when take ASA with viral infxn (VZV, influenza B)
findings: mito abnormalities, fatty liver, hypoglycemia, coma ASA metabolites decrease beta-oxidation by reversible inhibition of mitochondrial enzyme |
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Alcoholic cirrhosis
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micronodular shrunken liver with "hobnail" appearance
sclerosis around central vein (zone III) |
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Hepatic Angiosarcoma
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AngioSarcoma assoc with ArSenic, vinyl chloride
malignant endothelial neoplasm |
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Autoimmune hepatitis
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+ Anti-smooth muscle
+ANA + LKM (liver kidney microsomal) - anti-mitochondrial |
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A1AT deficiency
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codominant trait
cirrhosis and emphysema PAS+ globules in liver |
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Hepatocellular jaundice
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conjugated & unconj
increased urine bili nl or low urine urobilinogen |
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Obstructive jaundice
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conjugated
increased uruine bili low urine urobilinogen (no bili going into gut) |
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Hemolytic
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Unconj
no urine bili (acholuria; not water soluble) increased urine urobilinogen (gut bacteria) |
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Crigler-Najjar
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type I: absent UDP-glucuronyl transferase
type II: decreased amount; can give phenobarb to increase liver enzyme synthesis |
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Dubin-Johnson
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Conjugated hyperbili: defective liver excretion
*black liver |
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Rotor's
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like Dubin-Johnson, but more mild
no black liver |
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Gilbert's
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mildly decreased UDP-glucuronyl transferase or decreased bili uptake
asx |
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Wilson's
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Asterixis, Ataxia
BG degeneration Ceruloplasmin (decreased), cirrhosis, CA, Cu, corneal deposits Dementia, dyskinesia, dysarthria Hemolytic anemia Fanconi's syndrome (PCT defect of reabsorption) |
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Hemochromatosis
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ABCD:
A3 Bronze Cirrhosis DM "bronze diabetes" can be due to chronic transfusions (beta-thal major) labs: increased ferritin, FE; decreased TIBC tx: deferoxamine, repeated phlebotomy assoc with HLA-A3 |
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Primary biliary cirrhosis
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autoimmune
lymphocytic infiltrate and granulomas *Anti-mitochondrial a.b. *assoc with other autoimmune (RA, celiac, CREST) middle aged female |
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Primary sclerosing cholangitis
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unknown cause
concentric "onion skin" bile duct fibrosis: alternating strictures and dilation with "beading" of intra and extrahepatic bile ducts on ERCP *men *hypergammaglobulinemia (IgM) *60% are P-ANCA assoc with UC -can lead to secondary biliary cirrhosis -can lead to cholangiocarcinoma |
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Secondary biliary cirrhosis
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due to extrahepatic biliary obstruction:
gallstones, stricture, pancreatitis, CA *can lead to ascending cholangitis |
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Pigment stones
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radiopaque
chronic hemolysis, alcoholic cirrhosis, advanced age, biliary infxn |
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Acute pancreatitis
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GET SMASHED
Gallstones ETOH Trauma Steroids Mumps Autoimmune Scorpion sting Hypercalcemia/HyperTG ERCP Drugs: Sulfa, NRTIs, Ritinavir -can lead to DIC, ARDS, fat necrosis, hypoCa, pseudocyst, infxn, multiorgan failure, hemorrhage chronic calcifying pancreatitis (asso with alcohol and smoking) --> increased risk panc CA |
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Pancreatic adenocarcinoma
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CEA, CA-19-9
*assoc with smoking and chronic panc, but NOT ETOH * assoc with Trousseau's syndrome: migratory thrombophlebitis: hypercoag due to malignancy (similar to non-bacterial thrombotic endocarditis) *Courvoisier's sign: obstructive jaundice with palpable gallbladder CEA also assoc with CRC |
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Cimetidine
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H2 blocker
potent inhib of p450 antiandrogenic effects: PRL release, gynecomastia, impotence -can cross BBB --> confusion, dizziness, HA Cimetidine and ranitidine decrease renal excretion of creatinine |
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Bismuth, sucralfate
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bind to ulcer base, providing physical protection; allow bicarb secretion to reestablish pH gradient in mucous layer
*speed ulcer healing, traveler's diarrhea |
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H. pylori tx
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PPI
Metronidazole Amoxicillin (or tetracycline) Bismuth |
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Misoprostol
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PGE1 analog
increase production and secretion of gastric mucous barrier; decrease acid production *prevent NSAID-induced peptic ulcers *maintain PDA *induce labor tox: diarrhea; CI in women trying to get pregnant |
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Pirenzepine
Propantheline |
muscarinic antag
Block M1 receptors on ECL cells --> decrease histamine secretion Block M3 receptors on parietal cells (decrease H+ secretion) tx: tachy, dry mouth, etc. |
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Octreotide
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somatostatin analog; anti-growth, inhibitory hormone
use: acute variceal bleeds (decrease portal pressure, vasoconstriction); acromegaly, VIPoma, carcinoid tumors tox: nausea, cramps, steatorrhea |
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Infliximab
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monoclonal antibody to TNF
proinflammatory cytokine tx: Crohn's, UC, RA Tox: reactivation TB, fever, hypotension |
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Sulfasalazine
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Sulfapyridine (antibacterial) + 5-ASA (anti-inflam)
-activated by colonic bacteria use: IBD (if path in colon) tox: sulfa tox, malaise, nausea, reversible oligospermia |
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Ondansetron
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Zofran
5-HT3 antag anti-emetic postop vomiting and ppl on chemo tox: HA, constipation (tryptans used for HA!!) |
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Metoclopramide
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Reglan
D2 antag; 5-HT4 agonist increase gut motility, LES tone, contractility use: post surg gastroparesis, N/V, pro-kinetic tox: parkinsonian effects, restlessness, fatigue, depression, interaction with digoxin and diabetic agents, decrease seizure threshold |
