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234 Cards in this Set
- Front
- Back
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A persistence of the vitaline duct is called what?
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Merkel's Diverticulum
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What does a true diverticulum consist of?
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all 3 layers of the GI
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How many degrees does the foregut rotate?
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90
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How many degrees does the mid gut rotate?
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270
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What supplies the foregut with blood?
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celiac artery
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What supplies the midgut with blood?
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superior mesenteric
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What supplies the hindgut with blood?
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inferior mesenteric
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What is the foregut comprised of?
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mouth to the second part of the duodenum- including the respiratory tract
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What is the midgut comprised of?
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second part of the dudenum to the splenic flexure
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Where does the mid gut develop?
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yolk sac
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What does the mid gut rotation require?
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cilliary action
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What is the name of the syndrome when the mid gut fails to rotate?
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Kartanger's syndrome
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What triad is Kartanger's characterized by?
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sinusitis, bronchiectasis, and situs inversus
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What is the hindgut comprised of?
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from the splenic flexure to the anus
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Where is the watershed area in the GI system?
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splenic flexure
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What area of the GI is most susceptable to ischemia?
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splenic flexure
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What 2 arteries meet at the splenic flexure?
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superior and inferior mesenteric
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What is Potter's Syndrome?
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flat face, inverted feet, oligohydraminos, no lungs, breech birth
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What sense gives the strongest urge to eat?
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sight
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What is the limbic system responsible for?
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basic urges
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What does the hippocampus do?
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move short term memory to long term memory
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What jobs does the amygdala do?
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reward, fear, mating
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What is the pineal gland responsible for?
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setting time- circadian rhythms
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When it's light outside, what are melatonin levels?
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low
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When it's dark outside, what are melatonin levels?
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high
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When are catabolic processes their highest?
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morning
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What a.a. is melatonin made from?
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tyrosine
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What hypothalamic nucleus does light and dark signals come from?
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suprachiasmatic nucleus
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Which part of the hypothalamus is the hunger center?
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lateral
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Which part of the hypothalamus is the satiety center?
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vento-medial nuclues
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What stimulates the lateral hypothalamus to make you hungry?
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decreased glucose
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What does destruction of the lateral hypothalamus cause?
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anorexia
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What is the stimulus of the vento-medial nucleus of the hypothalamus to tell you to stop eating?
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increased glucose
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What does destruction of the vento-medial nucleus cause?
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obesity
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What are the classic clues for anorexia nervosa?
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young female trying to please her mother, body dysmorphic disorder, BMI < 17
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What are the classic clues for bulimia?
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female trying to please her boyfriend, abrasion on knuckles, BMI > 25
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Which eating disorder purges?
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both anorexia and bulemia
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Prader-Willi is caused by a lesion where?
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the ventromedial nucleus of the hypothalamus
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Which parent does Prader-Willi come from?
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paternal
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What chromosome is prader-willi on?
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chromosome 15
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What percent of the time does amphetamines stimulate the satiety center?
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80%
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What percent of the time do amphetamines stimulate the hunger center?
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20%
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Where are amphetamines taken up?
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presynaptically
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Amphetamines stimulate the release of what?
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all catecholamines
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What do amphetamines do to the release of E, NE, and serotonin?
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increase
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What is the classic clue for amphetamine intoxication?
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vertical nystagmus
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The amphetamine, methylphenidate has a risk of what?
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dependence
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What is the more common name for methylphenidate?
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ritalin
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Pemoline is what kind of drug?
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amphetamine
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What is a dangerous side effect of pemoline?
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hepatic necrosis- off the market
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The amphetamine dexadrine (dexatrim) is used for what?
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OTC weight loss
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What 2 illegal amphetamines are common?
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LSD and PCP
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LSD gives hallucinations from what neurotransmitter?
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serotonin
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What are the classic clue that someone is on LSD?
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slow, lazy, hallucinate
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PCP gives hallucinations from what?
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serotonin
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What are the classic clues a patient is on PCP?
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vertical nystagmus and very violent, can move cars, etc
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How does ecstacy cause hallucinations?
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serotonin
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What are the classic clues to ecstacy use?
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see an aura and extreme thirst
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What part of the brain controls menses?
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hypothalamus
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What controls the warming and cooling of the body?
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hypothalamus
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What part of the brain cools?
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anterior hypothalamus cools
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How does the anterior hypothalamus cool?
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it inhibits NE
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What does a lesion of the anterior hyperthalamus cause?
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hypothermia
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What part of the hypothalamus controls warming?
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posterior hypothalamus
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What does a lesion of the posterior hypothalamus cause?
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hyperthermia
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How does acetametaphen stop fever?
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it stimulates the anterior hypothalamus and blocks the posterior hypothalamus so your fever doesn't go back up
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What are the symptoms of an acetametaphen toxication?
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microsteatosis, Reye syndrome in children
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How do you reverse acetametaphen toxicity?
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N-Acetylcystine
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What system respond to stress first?
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parasympathetic
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Parotid glands are controlled by what CN? What comes out when stimulated?
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9- water
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Lingual glands are controlled by what CN? What comes out when stimulated?
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7- serous
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Sublingual glands are stimulated by what CN? What comes out when stimulated?
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7- mucous
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Submandibular glands are stimulated by what CN? What comes out when stimulated?
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7- mucous
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What are carbachol and bethanecol used for?
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post-surgery urinary retention- stimulates bladder emptying
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Pseudoephedrine is used to treat what?
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stress incontinence
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Right shoulder pain after drinking is caused by what?
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liver enlarged, presses on diaphragm and diaphragm refers pain to the right shoulder
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What inheritance is cystic fibrosis?
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AR
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A mutation is what gene causes cystic fibrosis? What chromosome?
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CFTR on chromosome 7
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What actually causes cystic fibrosis?
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defective chloride transport- chloride traps sodium making secretions very thick
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In cystic fibrosis pts, what is the NaCl content in their sweat?
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increased
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In cystic fibrosis pts, what is the NaCl content in internal secretions?
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decreased
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What are the worst bacterial enemies to CF pts?
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staph aureus and pseudomonas
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If a CF pts has a fever, how must your treat?
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staph with 1 antibiotic and pseudomonas with 2 antibiotics
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How do you diagnose CF?
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pilocarpine- Cl sweat test
< 40 normal 40-60 heterozygous > 60 CF |
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Lipase in saliva breaks down what?
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fat
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Amylase in saliva breaks down what?
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alpha 1,4 bonds
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What is esophagitis? What will you see?
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tissue inflammation, you will see T-cells and macrophages
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What will be seen with Barrett's esophagus?
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short to long columnar cells
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What is Mallory Weis Syndrome?
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superficial tears in the submucosa
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What causes Mallory Weis?
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alcohol consumption and vomiting
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What is Boorhaave's syndrome?
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rupture of the esophagus
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When do primary teeth fall out?
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8 years
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What are the 4 muscles of mastication?
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massester, temporalis, medical pterygoids, lateral pterygoids
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What is the only muscle of mastication that opens the jaw?
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lateral pterygoid
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What CN is all muscles of mastication innervated by?
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CN 5
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What brachial arch does all muscle of mastication develop from?
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1st
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The stylopharyngeus is innervated by what CN?
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9
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What nucleus innervates the UES by way of CN 10?
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nucleus ambiguus
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What is the most common tracheal-esophageal fistula?
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C-type
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What does a C-type TE fistula present with?
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projectile vomiting on first feeding
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What are the symptoms of an H-type TE fistula?
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choke and cough every feeding
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Where does Zencker's diverticula occur?
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above the UES
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What are the symptoms of Zencker's?
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halitosis, coughs up food
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Where is a traction diverticula found?
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below the UES, but above the LES
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What are the symptoms of traction diverticula?
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halitosis
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How often are pts with a history of GERD screened?
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upper endoscopy every 2-3 years
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What is given to pts with GERD?
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proton pump inihibitors
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What is receptive relaxation in the stomach?
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relaxation of the LES and the orad to accept food into the stomach
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What does a vagotomy cause?
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eliminates receptive relaxation
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What is it called when your bowel makes sounds during a fast?
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migrating myoelectric complexes (MMC)
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What is MMC mediated by?
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motilin
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How often do MMCs occur?
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every 90 minutes
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What is the function of the MMC?
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to clear the stomach of any residue from a previous meal
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How long goes gastric emptying take?
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3 h
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What 2 factors slow or inhibit gastric emptying?
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fat or H+ in the duodenum
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What are all duodenum hormones?
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inhibitory
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What 4 things are secreted in the stomach?
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HCL, pepsinogen, intrinsic factor, mucus
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What does HCl do?
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reduces the pH for the conversion of pepsinogen to pepsin
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Why is pepsinogen converted to pepsin?
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pepsin is for protein digestion
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What is the function of intrinsic factor?
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absorption of B12
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What is the function of mucus?
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to protect the stomach lining
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How does aspirin act?
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it irreversibly blocks COX 1 and COX 2
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Where is COX 1 mainly found?
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GI
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Where is COX 2 mainly found?
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joints
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What drug keeps the PDA open?
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alprostadil
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What drug can cause a spontaneous abortion?
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misoprostyl
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What does misoprostyl do?
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replaces PGE
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What do NSAIDS block?
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reversibly block COX
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What is the only COX 2 inhibitor on the market?
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celecoxib
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A Cushing's ulcer is due to?
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ICP
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A Curling's ulcer is due to?
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burns
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A stress ulcer is due to?
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NE
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What is the D.O.C. for acid reflux?
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PPi
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Where is type A gastritis located?
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in the body of the stomach
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What are the 4 A's associated with Type A gastritis?
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autoimmune etiology, antiparietal cell antibody, atropic gastritis, adenocarcinoma risk
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Where is type B gastritis located?
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antrum
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What causes type B in the antrum?
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breakdown of barrier- NOT too much acid
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What is type B gastritis associated with?
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H. pylori
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If someone had bariatric surgery, what type must the gastitis be? Why?
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Type B, because the body of the stomach has been removed
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How do you treat peptic ulcer disease?
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2 Ab's and a PPi- always!
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When is the pain worse with a gastric ulcer?
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during a meal
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Where is a gastric ulcer located?
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antrum
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What percent of the time is a gastric ulcer associated with H. pylori?
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70%
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How often is gastric ulcer associated with cancer?
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20%
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When is the pain worse for a duodenal ulcer?
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30-40 minutes after a meal
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Where is a duodenal ulcer located?
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2nd part of the duodenum
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What percent of the time is a duodenal ulcer associated with H. pylori?
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95%
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What is the cancer risk with a duodenal ulcer?
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< 1%
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Why do pts. with duodenal ulcers gain weight?
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because eating stops the pain b/c the pyloric valve is closed tight
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What is a bezoar?
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a mass made of indigestible material
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What is the most common bezoar?
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hair
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What are the 2 types of hiatal hernieas?
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sliding and rolling
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What is the most common type of hiatal hernia?
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sliding- 90%
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What happens with a sliding hiatal hernia?
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the fundus slides into the esophageal hiatus
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What is the most common cause of a sliding hiatal hernia?
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obesity, restrictive lung disease
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What is a rolling hiatal hernia due to?
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defect in the diaphragm
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What is the major risk associated with rolling hiatal hernias?
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strangulation and infarction
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What causes Minetriere's disease?
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large rugal folds and hyperplasia of goblet cells
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What is seen in Minetriere's disease?
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a lot of protein in the stool- NOT from kidney
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What causes pyloric stenosis?
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hypertrophy of the pyloric muscle
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What does an infant with pyloric stenosis do?
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projectile vomit
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When does pyloric stenosis present?
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3-4 weeks of life
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How do you treat pyloric stenosis?
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correct fluids and electrolytes and cut muscle
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Where is there no protein digestion?
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mouth
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Where does significant protein digestion occur?
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stomach
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Where is protein digestion finished?
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small bowel
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Where is there a significant amount of sugar digestion?
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in the mouth
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Where does sugar digestion stall? Where is it completed?
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stalls in the stomach and it is completed in the small bowel
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Where are fats completely digested?
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small bowel
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What are the function of zymogens?
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inactivate enzymes
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What is trypsin activated by?
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enterokinase
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Once trypsin is cut, what does it do?
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activates all the other enzymes
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What is the mechanism of action for amylase?
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breaks alpha 1,4 glycosidic bonds
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Maltose is broken down into what?
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glucose
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Sucrose is broken down into?
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glucose and fructose
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Lactose is broken down into?
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glucose and galactose
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What is the most common primary disacharidase def?
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sucrase
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What is the most common severe abdominal pain?
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pancreatitis
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How is pancreatitis described?
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mid-epigastric, boring through to the back
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What is the most common cause of pancreatitis in children?
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trauma, infection
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What is the most common cause of pancreatitis in adults?
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alcohol, gallstones
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What infection causes pancreatitis in children?
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cox B and mumps
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What pain medication does not constrict the sphincter of oddi?
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meriperidine
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What is the marker for pancreatic cancer?
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CA19-9
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What are most gallstones made of?
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cholesterol- 80%
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Where do most gallstones get lodged?
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cystic duct- 90%
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If a stone is stuck in the cystic duct, what does alkaline phosphate look like?
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normal
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If a gallstone gets lodged in the common bile duct, what does alkaline phosphatase levels look like?
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increased
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What are the 3 clues for a common bile duct stone?
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pancreatitis, high alkaline phosphatase, high WBC and fever
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What are bile acids made from?
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cholesterol
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When cholesterol goes to the liver to be made into bile salts, what is it made into?
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cholic and chenodeoxycholic acid
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What are cholic and chenodeoxycholic acids conjugated to?
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glycine and taurine to form bile salts
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What 2 drugs clear cholesterol from the body?
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cholestyramine and colestipol
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What pneumocyte does pneumocystis jerveci affect?
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type 1
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What does hyperglyceridemia predispose to?
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xanthelesma and pancreatitis
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What does hypercholesterolemia predispose to?
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early coronary artery disease and xanthomas
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What causes hypercholesterolemia?
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defective LDL transport
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Where are xanthomas from hypercholesterolemia found?
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achilles tendons
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In type 1 familial dyslipidemia, what is elevated?
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chylomicrons- hyperchylomicronemia
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In type 1 familial dyslipidemia, what is the defect?
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liver LPL deficiency
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In type 2a familial dyslipidemia, what is elevated?
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LDL
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In type 2a familial dyslipidemia, what is the defect?
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B100
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In type 2b familial dyslipidemia, what is elevated?
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LDL and VLDL
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In type 2a familial dyslipidemia, what is the deficiency?
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receptor problem
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In type 3 familial dyslipidemia, what is elevated?
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IDL
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In type 3 familial dyslipidemia, what is the deficiency?
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apoB
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In type 4 familial dyslipidemia, what is elevated?
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VLDL
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In type 4 familial dyslipidemia, what is the deficiency?
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hepatic overproduction of VLDL
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In type 5 familial dyslipidemia, what is elevated?
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VLDL and chylomicrons
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In type 5 familial dyslipidemia, what is the deficiency?
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C2
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What drugs are used to treat cholesterol problems?
|
statins
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How do the statins work?
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inhibit HMG-CoA reductase
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What are the main side effects of statins?
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myositis and hepatitis
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WHen using niacin to treat a cholesterol problem, how does it work?
|
blocks VLDL
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What is the main drug used to treat a triglyceride problem?
|
gemfibrozil
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How does gemfibrozil work?
|
increases LPL
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In an intravascular hemolysis, what is it always tied to?
|
autoimmune
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What is a clue to know it's intravascular hemolysis?
|
schistocytes- broken RBCs
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What is the problem in an extravascular hemolysis?
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something is wrong with the RBC membrane
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What is a clue to know it's an extravascular hemolysis?
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splenomegaly
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If a patient notices blood on the outside of stool, where is the bleed?
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descending colon
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Where does the majority of reabsorption happen?
|
jejunum
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Where is 90% of all iron reabsorbed?
|
duodenum
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Where are all of the fat soluble vitamins reabsorbed?
|
ileum
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What do loperamide and diphenoxylate do?
|
decrease diarrhea
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What does mineral oil do?
|
lubes the bowel to make deficating easier
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Who should mineral oil not be given to? Why?
|
pregnant women, induces labor
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Crohn's is associated with what sex?
|
women
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UC is associated with whom?
|
men
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What is the risk of cancer with UC?
|
1% per year
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A child with massive UGI bleeding is caused by what?
|
meckel's diverticulum
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An adult with massive UGI bleeding is caused by what?
|
peptic ulcer disease
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What is the most common cause of lower GI bleeding in newborns, infants, and children?
|
newborns- swallowed maternal blood
infants- anal fissure children- polyps |
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What is the most common cause of lower GI bleeding in adults, and elderly?
|
adults- IBD
elderly- angiodysplasia |
