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85 Cards in this Set

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What is the first GI disorder that can arise?
Swallowing problems
What directly damages the swallowing reflex?
Damage to CN 5, 9, 10.
3 diseases that commonly cause swallowing center damage in the brain stem:
-Polio
-Encephalitis
-Stroke
What inherited disease damages the voluntary motor pathway for swallowing?
Muscular dystrophy
What 2 neuromuscular transmission disorders cause paralysis of swallowing muscles?
-Myesthenia gravis
-Botulism
What induced thing causes failure to swallow?
Deep anesthesia
What is the main problem caused by swallowing disorders?
Food enters the airway.
What is the result of deep anesthesia induced swallowing problems?
Vomit into your airway
What is Achalasia?
Failure of the lower esophageal sphincter to relax during swallowing - remains spastic.
What causes Achalasia?
Damage to the myenteric plexus
What mechanism is lacking in achalasia?
Receptive relaxation
what is the result of chronic achalasia?
Megaesophagus able to hold 1L of food
What results from megaesophagus?
infection due to long periods of static food, caught up at the spastic esophageal sphincter.
What are 2 treatments for megaesophagus?
-Balloon dilation
-antispastic drugs
3 common disorders of the STOMACH:
1. Gastritis
2. Gastric atrophy
3. Peptic ulcers
What is Gastritis?
Inflammation of the gastric mucosa
Causes of Gastritis:
-Irritations
-Ulcerations
-Bacterial infections
What is Gastric atrophy?
-Loss of gastric mucosal layers
Result of gastric atrophy:
Little to no mucosal secretions - lose mucus, HCl, and IF
What results from lack of HCl?
Pepsin can't work on proteins - food is poorly digested.
What results from lack of IF?
Pernicious anemia
What causes Peptic Ulcers?
Imbalanced ratio of
-Acid Secretion
vs.
-Mucosal secretion
What is a peptic ulcer?
Excoriorated area of the stomach or small intestine
5 causes of peptic ulcers:
-High acid/peptic content
-Irritation
-Poor blood supply
-Poor mucus secretion
-Infection of H pylori
Most common site of peptic ulcers:
Pylorus
2 ways that the stomach and sm intestine are protected from acid:
-Mucous secretions (5 types!)
-Alkaline Juice secretions from pancreas and bile and brunner's
Where are brunner's glands?
In the upper duodenum
How is acid secretion normally inhibited?
By negative feedback of HCl on Gastrin secretion from pyloric glands, and the ENS nerves
What is inhibited by Gastrin inhibition?
-Gastric sercretions and motility
What does acid secretion inhibit? Stimulate?
Inhibits: Gastrin secretion
Stimulates: Secretin secretion
What is the effect of Secretin?
Stimulated Bicarb solution from the ducts of the Pancreas and Bile duct.
What is the Main causative agent of peptic ulcers?
H. Pylori
Other causes of peptic ulcers?
-Alcohol
-Smoking
-Aspirin
Why does aspirin cause peptic ulcers?
Because it inhibits Cox-1 from making prostaglandins, which are needed to protect the stomach.
Normal action of Prostaglandins in the stomach:
Stimulate cAMP to promote mucus secretions of goblet cells and Brunner's glands.
What patients get peptic ulcers from aspirin?
Chronic arthritis patients
How can you help arthritis patients' pain but not give them peptic ulcers?
Give Cox-2 inhibitors - the main cox enzymes in the stomach are Cox-1 so you are ok with this.
What are 2 common causes of peptic ulcers in the initial part of the duodenum?
2X normal HCl secretion due to
-bacterial irritation
-Psychic disturbances (stress)
How does Smoking cause peptic ulcers?
It stimulates the release of ACh and enhances HCl secretions.
2 types of treatments for peptic ulcers:
-Antibiotics
-Ranitidine
What is Ranitidine?
An acid suppressent that blocks histamine so it can't stimulate HCl secretions from parietal cells.
What is the common name for Ranitidine?
Nexium - the purple pill
2 General types of disorders in the SMALL INTESTINE:
-Pancreatic disturbances
-Malabsorption
What results from pancreatic insufficiency (failure)?
The inability to digest food.
Symptoms of pancreatic failure:
-Wasting
-Fat in feces
3 causes of pancreatic insufficiency:
-Pancreatitis
-Pancreatic duct blockage
-Removal of pancreatic head due to cancer
What blocks the pancreatic duct?
Gallstones
What is pancreatitis? 2 types?
Inflammation of the pancreas
-Chronic
-Acute
Most common cause of pancreatitis:
Excess alcohol intake
What happens in pancreatitis?
The pancreatic enzymes are held in the duct long enough that they overwhelm Trypsin Inhibitor and active Trypsin digests the pancreas itself.
What is the common name for malabsorption?
Sprue
What is idiopathic sprue, often seen in what population?
Gluten-intolerance - often seen in pediatrics
How does gluten affect idiopathic sprue patients?
Directly destroys enterocytes.
What causes Tropical sprue?
Bacteria
What is the problem in tropical sprue?
Irritation of the intestines causing inflammation and copious secretions.
What is a major symptom of severe sprue?
Steatorrhea - excess fat in stools due to increased secretions.
4 problems that develop as a result of sprue:
1. Severe nutrition deficiency
2. Osteomalacia
3. Insufficient clotting (K)
4. Pernicious anemia (IF)
3 types of disorders of the LARGE INTESTINE:
1. Constipation
2. Diarrhea
3. Spinal Cord paralysis causing inability to defecate
Common cause of constipation:
Consistent inhibition of the natural urge to defecate.
Result of chronic constipation:
MEgacolon
Common name for megacolon:
Hirschsprung's disease
What is Hirschsprung's disease?
A lack of ganglion cells in the Myenteric plexus, resulting in no defecation reflexes or peristaltic power propulsion.
What happens to the colon in hirschsprung's?
-Asc/Transv/Desc colon distend
-Sigmoid is small and spastic
3 types of diarrhea:
-Enteritis
-Psychogenic
-Ulcerative
What is enteritis?
Inflammation due to virus/bacteria in the GI tract
How specifically does Cholera toxin cause diarrhea?
-Toxin stimulates cGMP
-Stimulates secretion from Crypts of Lieberkuhn in ilium
How much loss does Cholera toxin cause?
10-12 L per day of water
Much K and HCO3
What is ulcerative colitis?
An immune disorder where the walls of the lg intestine become inflamed and ulcerated.
What causes the diarrhea in ulcerative colitis?
Increased motility - mass movements occur all day instead of only 10-30 min.
Usual therapy for ulcerative colitis:
Ileostomy (bag)
What type of SC injury impairs defecation?
Upper spinal cord
What component of defecation is impaired by an upper SC injury?
The voluntary component
How is defecation achieved in spinal cord injuries?
By exciting the process with an enema; then the involuntary reflex in the lower spinal cord takes over.
What is the function of vomiting?
To clear the GI tract when excessively irritated, distended, of excitable.
What transmits the impulse for vomiting from the GI tract to the brain?
CN 5, 7, 9, 10, 12
Where in the brain do impulses for vomiting go?
To Vomiting Center - a collection of nuclei in the brain stem.
What type of info is carried in the aforementioned cranial nerves?
MOTOR Impulses FROM the vomiting center
What carries impulses for vomiting FROM gi tract TO the vomiting center?
-Vagal visceral afferents
-SNS visceral afferents
What carries the motor impulses from the vomiting center to the GI tract?
CN 5,7,9,10,12 -> upper GI
Vagal/SNS efferents -> lower GI
Spinal nerves -> Diaphragm and Abdominal muscles
What type of motility precludes vomiting?
Antiperistalsis - retropulsive
Function of antiperistalsis:
Moves contents of sm intestine and stomach into esophagus.
What must relax for vomiting to occur?
Relaxation of the Esophageal-gastric sphincter
6 steps in vomiting:
1. Deep breath
2. Raise hyoid bone/larynx
3. Close glottis
4. Close nares (lft soft palate)
5. Contract abdominal muscles
6. Complete relaxation of lower esophageal sphinter
What region of the brain is responsible for the relationship of drugs and motion to vomiting?
The Chemoreceptor Trigger Zone
What drugs can excite this center?
-Morphine
-Digitalis