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147 Cards in this Set

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Gastrin
stim
inhib
G cells of antrum
Stim for secr:
1. AA in stomach - esp Phenylalanin + tryptophan
2. Gastric Distention
3. Vagal stim: vis GRP
Inhib:
1. acid in stomach
Zollinger ellison syndrome
Gastrin secr from non beta cell tumors in pancreas.
CCK
actions
stim for rls (from where)
Secr by I cells of duodenum and jejunum
actions:
1. Contract gallbladder
2. relax sphincter of Oddi
3. Pancr enzyme rls and growth
4. Inhibit gastric emptying
Stim for rls:
1. Small peptides and AA
2. Fatty Acids + Monoglycerides (not TG)
Secretin
S cells of duodenum
action:
1. Pancr bicarb rls
2. Inhibit parietal H+ secr
3. Stim bicarb and H20 secr in liver and incr bile production
stim:
1. H+ in duodenum
2. Fatty Acids in duodenum
GIP
found in K cells of duodenum and jejunum
Action:
1. Stimulates Insulin rls after oral glucose load
2. Inhibits H+ secr
Stim
1. Glucose, AA, fatty acids
Paracrines
Somatostatin
Histamine
Diffuse over short distance
Somatostatin:
Action:
1. Inhibits rls all GI hormones
2. Inhibits H+ secr
3. Inhibited by vagal stimulation
Histamine:
Mast cells of gastric mucosa
1. Stim H+ secr directly and potentiates gastrin and vagal effects
VIP
Neurocrine
1. relaxation of GI smooth muscle
2. Inhibits gastric H+ rls
3. Stim pancr Bicarb secr

secr in islet cell tumors and mediates cholera toxin
GRP (bombesin)
Neurocrine
Vagal rls that innervate gastric G cells
stimulats Gastrin Rls
Enkephelens (met and leu)
Neurocrine
Secr from nerves in GI mucosa and smooth muscle.
stimulates contraction of GI smooth muscle - esp LES, pyloric and ileocecal sphincters.
Inhibits intestinal secretion
Slow wave
oscillating membrane potentials
Not AP - although they determine the pattern of AP
Controlled by activation/deactivation of Na/K pump
Incr probability of AP
Varies in different regions but is constant and characteristic for each part
Not influenced by neural or hormonal input while AP is.
Sets max freq of contractions
Lowest in stomach 3/min
fastest in duodenum 12/min
Swallowing
Controlled By medulla
laryneal contraction to close glottis and elevate larynx
Peristalsis begins in pharynx and UES relaxes
Upper 1/3 of esophagus is striated muscle.
Food enters esoph and UES contracts
1' peristalsis
2' peristalsis clears leftover
As food approaches LES - VIP from vagal fibers relax it.
Relaxation of LES
VIP from vagal stimulation
Migrating Myoelectric Complex
Mediated by Motilin
90 min interval contractions that clear stomach of residual food.
Gastric empyting
1. Fastest with isotonic substances
2. Fat inhibits it (due to CCK)
3. H+ in duodenum inhibits it due to neural reflex.
Gastroileal Reflex
Mediated by Gastrin and extrinsic nervous sys
Food in stomach triggers peristalsis in ileum and ileocecal valve relaxation
Defecation
1.Rectum fills with feces and contracts, internal anal sphincter relaxes (rectosphincteric reflex)
2. Urge to poo
3. External Anal sphincter voluntarily relaxes ->Valsalva Maneuver (expiring against a closed glottis)
Gastrocolic reflex
Gastric distention leads to incr freq of MASS MOVEMENTS in colon.
1. Parasympathetic impulse
2. CCK and Gastrin
Saliva
High Bicarb, K+. Lipase and alpha amylase. Hypotonic secretions
acinus -isotonic soln
ductal cells -imperm to H20 reabsorb Na + Cl while secreting K+ and Bicarb. Aldosterone works here to incr Na resorpt and K+ secr.
Low flow rates = High K+
High flow rates = close to plasma
Psym (cn 7,9): Incr saliva by vasodiation. (IP3->Ca). Atropine-> dry mouth
Sym: Incr saliva and gland growth via beta rec -> incr cAMP
DECR: fear, sleep, dehydration, anticholinergics
Alkaline tide
Parietal cells rls HCl. Via CA exchanges Cl for bicarb in the blood.
Gastric Secr
PCells: H+ and Intrinsic factor
Chief cells: pepsinogen
G cells: gastrin
Parietal cells have CA, secretes H+ via K+/H+ ATPase (blocked by omeprazole).Alkaline tide.
H+ secr:
1. Vagal stim via direct Ach on parietal cells (muscarinic - IP3:Ca++, and GRP(bombesin) on G-cells.
2. Histamine: H2 receptors on parietal cells (cAMP). (cimetidine)
3. Potentiation
Inhibition of H+ secr:
1. pH <3.0
2. Chyme in duodenum - mediated by GIP (FA in duodenum) + Secretin (H+ in duodenum)
Pancr Secr
Isotonic - high in Na and Bicarb, lipase, amylase, proteases
Acinus: high Na and Cl
Duct: Cl bicarb exchange, H2O permeable
Slow flow: NaCl
High flow: Na + Bicarb
Regulation:
Secretin (cAMP): responds to duodenal H -_stim bicarb exchange in ducts incr secr
CCK (IP3-Ca): response to small peptides, AA, FA in duodenum - acts on pancr acinar cells to incr enzyme secr, + potentiates secretin
Ach: vagal resposne to same things as CCK - potentiates secretin
Gallbladder
rls bile
Bile: bile salts, cholesterol, phospholipids, bile pigments
Bile is made in the liver and stored and concentrated (isomotic reabsorption)
1' bile acids(cholic, chenodeoxycholic) synth from cholest in liver.
2' bile acids(deoycholic, lithocholic) from bacterial conversion intestine.
Conjugated with taurine or glycine: to form bile salts (taurocholic)
Interdigestive period -gallbladder filling
CCK and Ach stimulate rls.
Recirc of bile
Occurs in terminal ileum
Na-bile acid cotransport circ back to liver.
Site of B12 intrinsic factor absorption
Ileum
Absorption
Carbs
Small intestine
digestion by brush border glucosidases and alpha amylase to monosachs
Na dependent secondary active cotransport of glucose and galactose
Facilitated diffusion of Fructose
Dig would inhibit this transport
Absorption
proteins
endo/exopeptidases, pepsin, trypsin(and other pancr zymogens)
Absorbed as AA,di/tripeptides
Na-dep cotransport
Abetaliproproteinemia
AR
Lack of apoB thus inability to transport CM out of intestinal cells.
enterocytes congested with lipid
Acanthocytes (burr cells)
No CM, VLDL, or LDL in blood
Steatorrhea
Cf, pancreatitis
Hypersecretion of Gastrin: low pH inactivates pancreatic lipase
Ileal resection: depleted bile acid pool
Bacterial overgrowth: deconjugation of bile acids leading to early absorption.
Decr intestinal cells: sprue
Failure to make apoB - can't make CM
hypokalemia in diarrhea and diuretics
In diarrhea the high flow rate causes an incr K+ gradient in the colon - like the distal tubule
Also aldo stimulates K+ secr here as well.
Cholera
Cl is primary ion secreted in GI - Na goes with it.
Mediated by cAMP.
Cholera stimulates Cl secr by activating adenylate cyclase
-> incr cAMP and NaCl secr.
Ca++ absoprtion
via vit D dependent Ca++ binding protein
in small intestine.
Iron absorption
reduced to Fe++, binds apoferritin in cell, circ in blood bound to tranferrin.
Celiac trunk branches
Begins as aorta comes out of diaphragm at T12
Consists of:
Left side: Splenic artery, left gastric artery.
Rt side: common hepatic (gastroduodenal, hepatic)
Gastrometental arteries
Right gastroomental is a branch off of the gastroduodenal art
Left gastroomental branch off of the splenic art.
Can survive with just the right -in esophageal resections.
What can be perforated by a perforating duodenal peptic ulcer?
The gastroduodenal artery lies right behind it.
Appendicitis
periumbilical pain
becoming mcburneys pt
Periumbilical pain early because of T10 dermatome
Mcburneys point due to inflamed parietal peritoneum there leading to rebound and pt tenderness late stage
Anastomosis in portal HTN
Reroute to the Vena Cava
1. Esophageal Varices -
Azygous Veins (systemic) + left gastric (portal)
2. Periumbilical:
Epigastrics (systemic) umbilical vein (portal)
3. Hemorrhoids
Inferior rectals (systemic)
Superior rectals (portal)
4. Retroperitoneal
renal and paravertebral
Cystohepatic triangle
For finding cystic artery in cholecystectomy
Hepatic Tiss
Cystic Duct
Common hepatic
Peptic ulcer duodenum
always H. Pylori
ass with asa, smoking, primary hyperparathyroid, MENI, zollinger ellison
Crohns
anypart of GI
lower incidence of colon cancer
fistulas
cobblestone appearance
affects entire thickness
Skip lesions
Granulomas
celiac Sprue cancer accociation
enteropathy type Tcell lymphoma
Carcinoid tumor
Most commonly in appendix where it never mets.
Can be in small intestine
When mets to liver can cause carcinoid syndrome: diarrhea, flushing, bronchospasm, valvular lesion on right side of heart.
Common extra intestinal manifestations of crohns and ulcerative colitis
uveitis, scleritis, ascending cholangitis, polyarthritis, sacral ileitis, pyoderma gangrenosum, erythema nososum
Ulcerative colitis
Colon cancer
always involves rectum
only involves mucosa and submucosa,
pseudopolyps
CRYPT ABCESS
toxica megacolon
perforation
Ulcers:
in burns
brain injury
entamoeba histolytica
Curling gastric Ulcer
Cushing gastric Ulcer
Flask shaped ulcer - colitis
Peutz Jeghers
Hamartomous polyps of colon and small intestine,
melanotic spots on hands, lips, hands, genitals
Incr chance for adenocarcinoma of colon or elsewhere.
Gardner syndrome
AD
numerous adenomatous polyps
osteomas
soft tiss tumors
Turcot Syndrome
adenomatous polyps
CNS tumors
Presentation of rectosigmoid colon vs right colon cancer
Rectosigmoid colon presents in an annular manner leading to early obstruction, blood in stool
Right colon: no obstruction, IDA from chronic occult blood loss
Cloaca
terminal end of the hindgut pouch
partitioned by the urorectal septum into...
rectum, upper anal canal, UG sinus.
Pectinate Line
above line:
Adenocarcinoma, Rectum, internal iliac LN +inf mesenteric LN
Columnar epith
superior rectal artery (IMA)
painless internal hemorrhoids
Inferior hypogastric plexus
Drainage: Sup rectal vein->inferior mesenteric vein->portalsystem
Below line:
SCC
Superficial inguinal nodes
stratified squamous epith
inf rectal arteries (internal pudendal)
painful hemorrhoids
inf rectal nerves
Drainage: inf rectal vein->internal pudendal vein-> internal iliac vein-> IVC
Anorectal agenesis
rectum ends in blind sac above puborectalis due to urorectal septum def
can be accompanied by
rectovesical fistula
rectourethral fistula
rectovaginal fistula
Anal agenesis
anal canal ends in blind sac below the puborectalis due to urorectal septum def
can be accompanied by
rectovesical fistula
rectourethral fistula
Femoral Triangle
Sartorius, Inguinal ligament, adductor longus
Femoral sheath:
(N)
Artery, Vein, femoral canal (LN)
Physiologic Jaundice of newborn
Bililights
unconjugated bilirubin due to deficient glucuronyl transferase
Criglar Najjar Syndrome
Severe Familial unconjugated hyperbilirubinemia
1. Serious glucuronly tranferase deficiency - kernicterus and death
2. Less serious can be tx with phenobarbitol
Dubin Johnson
Rotor
conjugated bilirubinemia caused by deficient tranport - black liver
Rotor syndrome same without pigment
Hepatitis E virus
enterically transmitted
Water borne epidemic
High incidence of mortality in pregnancy
Viral hepatitis
EBV -mono often has liver component
CMV - infant liver, immunocompromised
HSV1 infant liver, IC
Yellow fever: midzonal necrosis, councilman bodies
Leptospirosis
jaundice, renal failure, hemorrhagic phenomenon
Echinococcus Granulosos
ingested tapeworm eggs from dog feces and sheep poo
Hydatid Dz of the liver
Schistosomiasis mansoni/japonicum
adult worms lodge in portal vein and its branches. Eggs lead to granulomas -> portal HTN
Microvesicular fatty liver
Reye syndrome
Fatty liver of pregnancy
Tetracycline
Alcoholic Liver dz
fatty change
focal liver necrosis, N/T infiltrate
Mallory bodies (alcoholic hyaline)
Perivenular Fibrosis
primary sclerosing cholangitis association
Ulcerative Colitis
incr incidence of cholangiocarcinoma
Wilson's Dz
Decr ceruloplasmin
liver dz
Kayser Fleischer ring - periphery of cornea,
renal tubular damage leads to aminoaciduria and glycosuria
Budd chiari syndrome
ass dz
thombosis of major hepatic veins (posthepatic portal HTN)
abdominal pain, jaundice,ascities, liver failure
Ass: polycythemia, pregnancy, liver cancer, abdominal malignancy
Hepatic Adenoma
Ass with oral contraception
when subcapsular can rupture -> severe intraperitoneal hemorrhage.
Hepatocellular Carcinoma
Hepatic malignancies usually mets
From cirrhosis
HBV
Aflatoxin B1 (nuts/grain- point mut in p53)
Incr alpha feto protein
early hematogenosu spread
Cholangiocarcinoma
Bile duct carcinoma
Clonorchis Sinensis, thorotrast
Originates in intrahepatic biliary epith
Hemangiosarcoma
rare malignant vascular tumor of hepatic.
PVC, Thorotrast, Arsenic
Cholethiasis group
Fat bitches with many kids
Common bile duct obstruction
Obstructive jaundice
conjugated hyperbilibuinemia
hypercholesterolemia
incr Alk Phos
hyperbilirubinuria
Cholelithiasis manifestations
Fatty Food Intolerance
Biliary Colic
Common bile duct obstruction
Ascending cholangitis
Cholecystitis
Acute pancreatitis
Gallstone ileus
Mucocele
Malignancy
Cholesterolosis
strawberry gallbladder
yellow cholesterol flecks on mucosal surface
Courvoisier Law
Tumors that obstruct common bile duct result in enlarged distended gallbladder, obstructing stones do not
Pancreatic Carcinoma
Most often head of pancreas causing obstructive jaundice
Carcinoma of tail can cause islet cell destruction and DM
Migratory Thrombophlebitis (trousseau sign), obstructive jaundice + distended papable gallbladder.
Oligosacharidases
on brush border of duodenum -
rate limiting step in carbohydrate digestion
produces monosacharides from oligos and disachs.
AST
ALT
Amylase
Viral Hepatitis: ALT>AST
Alco Hepatitis: AST>ALT
MI: AST
Amylae: Acute Pancreatitis + Mumps
Hepatolenticular degenetion
wilson dz
basal gang degen
cirrhosis
choreiform mvmt
dementia
Tx with penicillamine
AR
Tx for Wilsons
Penicillamine
AR
Micronodular cirrohsis
Alcoholic hepatitis
Hematchromatosis
Wilsons dz
Macronodular cirrhosis
Post necrotic post hepatic
HBV
HCV
Jaundice
Hepatocellular
Obstructive
Hemolytic
Hepatic: conjug/unconj hyperbilirubinemia, incr urine bili, nl/decr urine urobilinogen
Obstructive: conjug hyperbili, incr urine bili, decr urine urobili
Hemolytic: unconj bilirubinemia, absent urine bili, incr urine urobili
Gilberts vs Crigler Najjar vs Dubin Johnson
Gilberts: decr UDP glucuronyl transferase, unconjugated bilirubin
Crigler Najjar: absent UDP glucuronyl transferasae, incr unconjugated bili
Dubin Johnson: incr conjugated bili. due def excretion
Charcot triad of cholgitis
1. Jaundice
2. Fever
3. RUQ pain
Beading on ERCP
primary sclerosing cholangitis
intra/extra hepatic
inflamm of bile ducts alternating strictures and dilation -> beading
Can lead to 2' biliary cirrhosis.
incr serum antimitocondrial antibodies
Intrahepatic, primary autoimmune biliary cirrhosis,
severe obstructive Jaundice
Incr alk Phos
pruritis,
hypercholesterolema
alpha FP
Hepatoma (hepatocellular carcinoma)
HBV,HCV
Alfatoxin
alpha1 antitrypsin def,
wilson dz
hemachromatosis.
Reye Syndrome
Hepatoencephaly
Microvesicular fatty liver
following viral infection with asa.
hypoglycemia
Cholesterol gallstones
radiolucent
ass with
obesity
crohns
native americans
CF
advanced age
clofibrate
rapid weight loss
multiparity
Acute pancreatitis
Gallstones
Ethanol
Trauma
Steroids
Mumps
AI dz
Scorpion sting
eDrugs (sulfa, didanosine)
H. Pylori triad
Amoxicillin/tetracycline/metronidazole
Omeprazole
Bismuth Subsalicylate
Enterochromafin cell
Histamine rls
Potentiated by
M1
Gastrin
Inhibited by Somatostatin
Misoprostol
4 functions
PGE1 analog
1. Used in Peptic ulcer therapy to incr mucus protection
2. Keeps PDA
3. Labor induction
4. Abortifacient
Muscarinic Antags gastric
Pyrenzipine, propantheline
1. Block M3 on ECL - decr HIS secr
2. Block M1 on parietal cell - decr H+
Infliximab
Anti TNF alpha antibody
Crohns + RA
Antacid overuse
Can all cause hypokalemia
1. AlO3 - constipation, hypophosphatemia
2. MgOH - diarrhea
3. CaCO3 - hypercalcemia, rebound acid incr
Annular pancreas
leads to obstruction of the duodenum
Most common benign tumor of stomach
leiomyoma
Dumping Syndrome
Postvagotomy
Unimpeded passage of hypertonic food into duodenum leading to distention as a result of osmotic flow into lumen
Sweating, lightheadedness, reactive hypoglycemia
Bowel obstruction
small intestine
large intestin
Small intestine- adhesions
Large - neoplasms
Most common cause of lower GI bleed
diverticulosis
Shigella
Bloody diarrhea
bismuth, ampicillin, cipro, TMP/SMX
high infectivity
Salmonella
Bloody diarrhea
Supportive therapy
Campylobacter Jejuni
Bloody diarrhea
supportive therapy
erthromycin
LEADING CAUSE OF FOOD POISONING
C-diff
Watery diarrhea
Exotoxin mediated pseudomembranes
Metronidazole, oral Vancomycin
ETEC
Watery diarrhea
bismuth, TMP/SMX, Doxycycline, cipro
EHEC
Bloody diarrhea
supportive therapy
Yersinia
bloody diarrhea
supportive
Gastroenteritis
#1 Rotovirus
most common cause of diarrhea in children
#2 Adenovirus
Entamoeba histolytica
bloody diarrhea
metronidazole
Giardia
foul smelling watery diarrhea
metronidazole
Cyptosporidium
watery diarrhea
supportive therapy
Portal Triad
Portal Vein
Hepatic artery
common hepatic duct
Galactosemia
Galactose 1 phosphate uridyl transferase
Cataracts
cirrhosis
MR
PKU
phenyalanine hydroxylase
musty odor
cerebral myelin degen
MR
MSUD
branched chain alpha ketoacid DH
Can't metabolize Leucine, Isoleucine, Valine
Neurolgic sx
High mortality
HBV
dx
Window period:
Detectable HBcAg-Ab
Undetectable HBsAg or HBsAG-Ab
HBsAB: means recovery and immunity
Hepatitis jaundice
20-50% direct/total bili ratio
hepatic damage-> leaky bile ducts -> rls of Conjugated Bili to blood
Inability of liver to conjugate bili -> unconjugated bilirubinemia
Parasitic Cholangitis
Roundworm: Ascaris Lumbricoides
Liver flukes: clonorchis sinensis, fasciola hepatica
Biiary tract obstruction -> jaundice and extreme itching, dark urine, pale feces
Appetite supressor drug
Sibutramine
MAOi
inhibits seratonin and NE breakdown
Family of HBV, HCV, HAV, HEV
HBV- hepadnavirus - dsDNA enveloped
HCV - flavivirus - enveloped RNA virus
HEV - calcivirus -naked capsid RNA
HAV - picornavirus
Phenylenediamine
Test oxidase
For
Campylobacter, neisseria, helicobacter, vibrio - all positive
Enterobacteriacease (all oxidase negative)
Flood colonies with pd and if it turns black they are oxidase +
Fibrin production test
test for coagulase production
S. Aureus and Yersinia pestis
Lecithinase Test
Naglars Reaction
distinguish
Clostridium perfringins from others that also cause myonecrosis
Biggest SE of HBV tx
interferon
Depression
Urease positive organisms
H. Pylori, Proteus, nocardia, cryptococcus, ureaplasma
Retropharyngeal space
The retropharyngeal space is located immediately posterior to the nasopharynx, oropharynx, hypopharynx, larynx, and trachea. The visceral (ie, buccopharyngeal) fascia, which surrounds the pharynx, trachea, esophagus, and thyroid, forms the anterior border of the retropharyngeal space. Bounded posteriorly by the alar fascia, the retropharyngeal space is bounded laterally by the carotid sheaths and parapharyngeal spaces. It extends superiorly to the base of the skull and inferiorly to the mediastinum at the level of the tracheal bifurcation (see anatomy figure in Image 1).

Two other potential spaces (ie, danger space, prevertebral space) also are present. The danger space is formed anteriorly by the alar fascia and posteriorly by the prevertebral fascia. The prevertebral space is bounded anteriorly by the prevertebral fascia and posteriorly by the longus colli muscles of the spine. The danger space extends down the mediastinum to the level of the diaphragm, while the prevertebral space continues to the insertion of the psoas muscles.
Chewing muscles
temporalis
medial and lateral pterygoid
mylohyoid
digastric
Temporalis: posterior mvmt of jaw
Lateral pterygoid: moves lower jaw fwd
Medial pterygoid: elevates jaw
mylohyoid: depress jaw
Digastric: depress jaw
free edge of lesser omentum has what stx
portal vein, hepatic artery, common bile duct
What protein in CM activates LPL
endoth brush border LPL is activated by APO CII
without it you would have chylomicronemia -
APO AI
major apo prot in HDL
APO B48
found uniquely in CM
prot that initally combines TG, phosphlipids, chol esters for CM formation
APO B100
VLDL, IDL, LDL
is the stx for putting on TG, phospholipids, chol, chol esters etc
APO E
all lipoproteins
helps lipoproteins bind cell surface rec.
Anti microsomal abs

Antimitochondrial abs
Hashimotos thyroiditis

primary biliary cirrhosis
Hemochromatosis
labs
AR
incr serum ferritin
incr iron
decr TIBC
Drug of choice for Crohns flare ups
prednisone
Megestrol
progesterone derivative
that stimulates appetite
tegaserod
5-HT4 partial agonist
used to stim peristalsis with constipation predominant IBS
dronabinol
cannabinoid
antiemetic to control nausea induced by chemotherapy
Meclizine
H1 antagonist
for motion sickness and true vertigo
Docusate
stool softener
detergent that allows water and fat to mix. prevents constipation
Bicasodyl
irritant laxatives
castor oil
senna
glycerin
lubricating laxatives
mineral oi
Octatreotide
somatostatin analogue
for variceal bleeding
for diarrhea in endocrine d/o like carcinoid, gastrinoma, glucagonoma