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107 Cards in this Set
- Front
- Back
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Falciform ligament
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Function: connects liver to anterior abdominal wall
Contains: ligamentum teres Notes: derivative of fetal umbilical vein |
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Hepatoduodenal ligament
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Function: connects liver to duodenum
Contains: portal triad Notes: connects greater and lesser sacs |
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Gastrohepatic ligament
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Function: connects lesser curvature of stomach to liver
Contains: gastric arteries |
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Gastrocolic ligament
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Function: connects greater curvature of stomach to transverse colon
Contains: gastroepiploic arteries |
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Gastrosplenic ligament
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Function: connects greater curvature of stomach to spleen
Contains: short gastric arteries |
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Splenorenal
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Function: connects spleen to posterior abdominal wall
Contains: splenic artery and vein |
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Layers of the digestive tract
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Villi (small intestine)
Lamina propria Mucosa (absorption) Muscularis mucosa (support) Meissner's plexus (controls local secretions, blood flow, and absorption) Submucosa (glands) Muscularis externa - inner circular, outer longitudinal Auerbach's plexus (motility) Serosa |
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Portal-caval venous anastamoses
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Esophagus - esophageal varices (left gastric to esophageal)
Umbilicus - caput medusa (paraumbilical to superficial and inferior epigastrics) Rectum - internal hemorrhoids (superior rectal to middle and inferior rectal) Treatment for portal HTN - shunt between splenic and left renal veins |
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Internal hemorrhoids
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Symptoms: not painful, venous distention
Pathogenesis: venous drainage to superior rectal vein and portal system, portal HTN |
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External hemorrhoids
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Symptoms: painful venous distention
Pathogenesis: venous drainage to inferior rectal vein and IVC |
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Zones of the liver
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Zone 1 - periportal, affected by viral hepatitis first
Zone 2 - intermediate Zone 3 - pericentral zone (centrilobar), contains P-450 system, affected first by toxins, ischemia, and alcohol |
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Bile flow
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Gallbladder -> cystic duct -> common bile duct -> ampulla of Vater (joins with pancreatic duct in pancreas) -> sphincter of Oddi to duodenum
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Diaphragmatic hernia
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Symptoms: abdominal structures enter thorax (hiatal hernia - stomach herniates upward through esophageal hiatus, causes hourglass stomach)
Pathogenesis: defective development of pleuroperitoneal membrane in infants |
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Indirect inguinal hernia
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Pathogenesis: goes through internal inguinal ring and external inguinal ring into scrotum, infants due to failure of processus vaginalis to close, more common in males
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Direct inguinal hernia
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Pathogenesis: bulges through inguinal (Hesselbach's) triangle directly through abdominal wall medial to inferior epigastric artery, usually older men
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Femoral hernia
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Pathogenesis: protrudes below inguinal ligament through femoral canal and lateral to pubic tubercle, more common in women
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Peyer's patches
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Location: small intestinal submucosa and lamina propria
Structure: M cells take up antigen Immune: B cells stimulated in germinal centers, secrete IgA |
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Components of saliva
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Alpha amylase (ptyalin) - begins starch digestion
Bicarbonate - neutralizes bacterial acids Mucins - lubricate food Antibacterial secretory products Growth factors that promote epithelial renewal |
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Brunner's glands
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Location: duodenal submucosa
Function: secrete alkaline mucus to neutralize acid contents coming from stomach Pathology: hypertrophy in peptic ulcer disease |
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Gastrin
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Source: G cells of antrum of stomach
Action: increase gastric H+ secretion, motility, and growth of mucosa Regulation: increased by stomach distention, amino acids, peptides, vagus, decreased by low stomach pH Pathophysiology: increased in Zollinger-Ellison syndrome, phenylalanine and tryptophan stimulate it |
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Cholecystokinin
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Source: I cells in duodenum and jejunum
Action: increase pancreatic secretion, gallbladder contraction, and decrease gastric emptying Regulation: increased by fatty acids and amino acids Pathophysiology: pain after fatty food ingestion in cholelithiasis due to increased CCK |
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Secretin
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Source: S cells in duodenum
Action: increase pancreatic HCO3- secretion, bile secretion, decrease gastric acid secretion (neutralize acids to allow pancreatic enzymes to function) Regulation: increased by fatty acids, acid in duodenal lumen |
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Somatostatin
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Source: D cells in pancreatic islets and GI mucosa
Action: decrease gastric acid and pepsinogen, pancreatic and small intestinal fluid, gallbladder, and insulin/glucagon release Regulation: increased by acid, decreased by vagal stimulation Pathophysiology: used to treat VIPoma and carcinoid tumor |
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Glucose-dependent insulinotropic peptide
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Source: K cells of duodenum and jejunum
Action: decrease gastric H+ secretion, increase insulin secretion Regulation: increased by fatty acids, amino acids, and oral glucose |
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Vasoactive intestinal polypeptide
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Source: parasympathetics in gallbladder and small intestine
Action: increase intestinal water and electrolytes, relax intestinal smooth muscle Regulation: increased by distention and vagal stimulation, decreased by adrenergics Pathophysiology: VIPoma (pancreatic islet cell tumor, copious diarrhea) |
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Nitric oxide
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Action: increase smooth muscle relaxation of LES
Pathophysiology: loss of NO increases LES tone and causes achalasia |
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Motilin
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Source: small intestine
Action: produces MMCs (flushes debris out) Regulation: increased in fasting state |
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Intrinsic factor
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Source: parietal cells of stomach
Action: Binds B12 for uptake in terminal ileum Pathophysiology: destruction of parietal cells causes pernicious anemia |
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Gastric acid
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Source: parietal cells
Action: decreases stomach pH Regulation: increased by histamine, ACh, gastrin, decreased by somatostatin, GIP, prostaglandins, secretin Pathophysiology: gastrinoma - gastrin-secreting tumor that causes continuous high levels of acid and ulcers |
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Pepsin
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Source: chief cells of stomach
Action: protein digestion Regulation: increased by vagal stimulation, local acid |
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HCO3-
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Source: mucosal cells in stomach and duodenum, Brunner's glands in duodenum
Action: neutralizes acid Regulation: increased by secretin |
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Trypsinogen
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Converted to trypsin by enterokinase/enteropeptidase from duodenal mucosa
Activates other proenzymes for digestion Secreted by pancreas |
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Carbohydrate digestion
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Salivary amylase starts digestion by hydrolyzing alpha-1,4 linkages
Pancreatic amylase hydrolizes starch to oligosaccharides and disaccharides Oligosaccharide hydrolases at brush border (rate limiting), produces monosaccharides Glucose taken up by SGLT1 (Na dependent) Fructose taken up by GLUT-5 |
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Iron absorption
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Duodenum as Fe2+
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Folate absorption
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Jejunum
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B12 absorption
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Ileum, with bile salts
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Biliburin
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Product of heme metabolism
Conjugated with glucuronate Excreted in bile Jaundice if elevated |
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Salivary gland tumors
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Location: mostly parotid gland
Types: pleomorphic adenoma (painless, movable mass, high recurrence), Warthin's tumor (in lymph node), mucoepidermoid carcinoma |
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Achalasia
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Symptoms: progressive dysphagia, bird's beak on barium swallow, increased risk of esophageal carcinoma
Pathogenesis: loss of myenteric plexus, high LES pressure, Chagas' disease or CREST |
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GERD
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Symptoms: heartburn and regurgitation on lying down
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Esophageal varices
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Symptoms: painless bleeding of submucosal veins in lower 1/3 of esophagus
Pathogenesis: portal HTN |
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Mallory-Weiss syndrome
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Symptoms: painful mucosal lacerations at GE junction due to severe vomiting, hematemesis
Pathogenesis: alcoholics, bulimics |
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Boerhaave syndrome
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Symptoms: transmural esophageal rupture
Pathogenesis: violent retching |
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Esophageal strictures
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Pathogenesis: lye ingestion
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Esophagitis
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Pathogenesis: reflux, HSV-1/CMV/candida infections, chemical ingestion
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Plummer-Vinson syndrome
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Symptoms: dysphagia (esophageal webs), glottitis, iron deficiency anemia
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Barrett's esophagus
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Symptoms: glandular metaplasia of stratified squamous epithelium with intestinal columnar epithelium in distal esophagus, leads to adenocarcinoma
Pathogenesis: GERD |
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Esophageal cancer risk factors
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Alcohol/achalasia
Barrett's esophagus Cigarettes Zenker's diverticulum Esophageal webs/esophagitis Familial |
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Esophageal cancer types
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Squamous in upper and middle 1/3
Adenocarcinoma in lower 1/3 |
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Celiac sprue
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Symptoms: steatorrhea, antigliadin antibodies, blunting of villi, lymphocytes in lamina propria, decreased jejunal absorption, dermatitis herpetiformis, T cell lymphoma, increased tissue transglutaminase
Pathogenesis: autoimmune against gliadin in wheat in proximal small bowel |
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Whipple's disease
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Symptoms: malabsorption, PAS-positive macrophages in lamina propria, arthralgias, cardiac and neurologic
Pathogenesis: tropheryma whippelii (gram positive) infection, older men |
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Disaccharidase deficiency (lactose is most common)
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Symptoms: normal-appearing villi, osmotic diarrhea
Pathogenesis: injury, infection |
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Pancreatic insufficiency
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Symptoms: malabsorption of fat and fat-soluble vitamins
Pathogenesis: CF, cancer, chronic pancreatitis |
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Acute erosive gastritis
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Symptoms: inflammation of gastric mucosa
Pathogenesis: stress, NSAIDs, alcohol, uricemia, burns (Curling's ulcer from decreased plasma volume), brain injury (Cushing's ulcer with increased vagal stimulation and acid production) |
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Chronic (nonerosive) gastritis
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Type A (fundus and body) - autoimmune antibodies to parietal cells, pernicious anemia, and achlorhydria, gastric body
Type B (antrum) - H pylori infection, risk of MALToma, gastric antrum |
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Menetrier's disease
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Symptoms: gastric hypertrophy, parietal cell atrophy, more mucous cells, precancerous
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Stomach adenocarcinoma
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Symptoms: signet ring cells, acanthosis nigricans, Virchow's node (left supraclavicular node metastasis), Krunkenberg tumor (bilateral ovarian metastasis, mucinous, signet ring), liver metastasis
Pathogenesis: smoked foods, achlorhydria, chronic gastritis, type A blood |
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Gastric ulcer
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Symptoms: pain greater with meals, weight loss
Pathogenesis: H pylori, NSAIDs |
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Duodenal ulcer
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Symptoms: pain that decreases with meals, weight gain, hypertrophy of Brunner's glands, bleeding, penetration into pancreas, perforation, obstruction
Pathogenesis: H pylori infection, inreased gastric acid secretion or decreased mucosal protection |
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Crohn's disease
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Symptoms: skip lesions of terminal ileum or colon, rectal sparing, cobblestone mucosa, creeping fat (string sign on barium swallow), fistulas, linear ulcers and fissures, noncaseating granulomas and lymphoid aggregates, malabsorption, diarrhea (bloody or non-bloody), migratory polyarthritis, erythema nodosum, ankylosing spondylitis, uveitis
Pathogenesis: postinfectious Treatment: steroids, infliximab |
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Ulcerative colitis
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Symptoms: colon inflammation, continuous colonic lesions, rectal involvement, mucosal and submucosal inflammation, friable pseudopolyps, ulcers, bleeding, stenosis, megacolon, colorectal cancer, bloody diarrhea
Pathogenesis: autoimmune Treatment: sulfasalazine, infliximab, colectomy |
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Appendicitis
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Symptoms: initial diffuse periumbilical pain, localized to right side, nausea, fever, peritonitis
Pathogenesis: obstruction of appendicular lumen Treatment: appendectomy |
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Diverticulitis
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Symptoms: left lower quadrant pain, fever, leukocytosis, perforation, peritonitis, abscess formation, bowel stenosis, rectal bleeding, fistula
Pathogenesis: inflammation of diverticula (mostly in sigmoid colon) |
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Zenker's diverticulum
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Symptoms: halitosis (trapped food particles, dysphagia, obstruction)
Pathogenesis: false diverticulum due to herniation of mucosal tissue at pharyngeal-esophageal border |
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Meckel's diverticulum
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Symptoms: bleeding, intussusception, volvulus, terminal ileal obstruction
Pathogenesis: congenital persistence of vitelline duct or yolk stalk, can contain ectopic acid-secreting gastric mucosa or panreatic tissue |
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Intussusception
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Symptoms: intraluminal mass
Pathogenesis: telescoping of one bowel segment into distal segment, compromise of blood supply, infants |
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Volvulus
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Symptoms: infarction, obstruction
Pathogenesis: twisting of bowel portion around its mesentery, elderly |
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Hirschsprung's disease
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Symptoms: chronic constipation early in life
Pathogenesis: failure of Auerbach's and Meissner's plexuses to migrate due to lack of neural crest cell migration, Down's syndrome |
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Duodenal atresia
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Symptoms: bilious vomiting, proximal stomach distention
Pathogenesis: failure to recanalize small bowel, Down's stndrome |
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Necrotizing enterocolitis
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Symptoms: necrosis and perforation of intestinal mucosa
Pathogenesis: prematurity |
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Ischemic colitis
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Symptoms: splenic flexure intestinal blood flow reduction
Pathogenesis: elderly |
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Colonic polyp
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Symptoms: rectosigmoid mass growing into lumen
Pathogenesis: villous (malignant, sessile, can produce mucus) or benign hyperplastic hamartoma |
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Colorectal cancer
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Symptoms: bleeding (right-sided), obstruction (left-sided), apple core lesion on barium, CEA tumor marker
Pathogenesis: chromosomal instability (sporadic, K-RAS and p53 mutations), villous colorectal adenomas, ulcerative colitis, FAP, HNPCC |
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Familial adenomatous polyposis (FAP)
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Symptoms: thousands of polyps in colon, involving rectum, soft tissue tumors and retinal hyperplasia (Gardner's), brain involvement (Turcot's)
Pathogenesis: APC gene mutation on chromosome 5q |
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HNPCC
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Symptoms: colonic polyps
Pathogenesis: mutation of DNA mismatch repair genes |
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Peutz-Jeghers syndrome
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Symptoms: benign polyps of colon and small intestine, hyperpigmented mouth, lips, hands, and genitalia
Pathogenesis: increased risk of other malignancies |
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Carcinoid tumor
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Symptoms: dense core bodies in EM, carcinoid syndrome (wheezing, diarrhea, flushing, right-sided heart murmurs)
Pathogenesis: small bowel tumor, only produces carcinoid if metastasized, can occur in appendix |
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Portal HTN
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Symptoms: esophageal varices, hematemesis, melena (peptic ulcer), caput medusa, ascites, hemorrhoids, splenomegaly
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Cirrhosis
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Symptoms: coma, scleral ictus, fetor hepaticus, spider nevi, gynecomastia, jaundice, testicular atrophy, bleeding tendency, anemia, ankle edema
Pathogenesis: diffuse fibrosis of liver with nodular regeneration, micronodular (metabolic insult), macronodular (liver i njury, infection, or drugs -> hepatocellular carcinoma) |
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AST and ALT markers
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ALT > AST for viral hepatitis
AST > ALT for alcoholic hepatitis AST for MI |
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Alkaline phosphatase
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Obstructive liver disease (HCC)
Bone disease Bile duct disease |
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Amylase and lipase
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Acute pancreatitis
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Ceruloplasmin
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Decreased in Wilson's disease
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Reye's syndrome
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Symptoms: fatty liver, hypoglycemia, coma in kids
Pathogenesis: virus treated with salicylates |
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Hepatic steatosis
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Symptoms: macrovesicular fatty liver change, reversible
Pathogenesis: moderate alcohol intake |
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Alcoholic hepatitis
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Symptoms: swollen and necrotic hepatocytes, neutrophils, Mallory bodies (intracytoplasmic eosinophilic inclusions)
Pathogenesis: sustained long-term alcohol consumption |
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Alcoholic cirrhosis
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Symptoms: micronodular irregular shrunken liver with hobnail appearance, sclerosis around central vein (zone 3), jaundice, hypoalbuminemia
Pathogenesis: irreversible alcoholic injury |
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Hepatocellular carcinoma
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Symptoms: tender hepatomegaly, ascites, polycythemia, hypoglycemia, increased alphafetoprotein -> Budd-Chiari syndrome
Pathogenesis: hepatitis B/C, Wilson's disease, hemochromatosis, alpha-1 antitrypsin deficiency, alcoholic cirrhosis, carcinogens |
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Nutmeg liver
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Symptoms: congestion of blood in liver and necrosis, mottled appearance
Pathogenesis: right-sided heart failure, Budd-Chiari |
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Budd-Chiari syndrome
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Symptoms: varices, hepatomegaly, ascites, liver failure
Pathogenesis: occlusion of IVC or hepatic veins with centrilobular congestion, P-vera, pregnancy, HCC |
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Hepatocellular jaundice
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Symptoms: conjugated/unconjugated hyperbilirubinemia, increased urine bilirubin, normal urine urobilinogen
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Obstructive jaundice
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Symptoms: conjugated bilirubin (water soluble, can be excreted into urine), increased urine bilirubin, decreased urine urobilinogen
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Hemolytic jaundice
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Symptoms: unconjugated bilirubin, no urine bilirubin, increased urine urobilinogen (from heme metabolism)
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Gilbert's syndrome
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Symptoms: none
Pathogenesis: elevated unconjugated bilirubin due to decreased uptake, stress |
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Crigler-Najjar syndrome type 1
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Symptoms: jaundice, kernicterus (bilirubin in brain), increased unconjugated bilirubin
Pathogenesis: no UDP-glucuronyl transferase, presents early, death in first few years |
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Dubin-Johnson syndrome
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Symptoms: black liver
Pathogenesis: impaired liver excretion of conjugated bilirubin |
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Wilson's disease
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Symptoms: asterixis, basal ganglia degeneration, decreased ceruloplasmin, corneal deposits (Kayser-Fleischer rings), cirrhosis, HCC, dementia, hemolytic anemia
Pathogenesis: inadequate hepatic copper excretion into circulation as ceruloplasmin, copper deposition in liver, brain, cornea, kidneys, joints, AR |
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Hemochromatosis
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Symptoms: high total body iron, micronodular cirrhosis, diabetes mellitus, skin pigmentation (bronzing), CHF, risk of HCC, increased ferritin, iron, and transferrin saturation
Pathogenesis: deposition of hemosiderin, HLA-A3, AR, or chronic transfusion therapy |
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Primary sclerosing cholangitis
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Symptoms: beading of bile ducts, onion skin duct fibrosis, increased ALP, biliary cirrhosis
Pathogenesis: inflammation and fibrosis of bile ducts, ulcerative colitis |
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Biliary cirrhosis
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Symptoms: severe jaundice, steatorrhea, pruritis, hypercholesterolemia, increased ALP, increased serum mitochondrial antibodies (primary), increased conjugated bilirubin (secondary)
Pathogenesis: scleroderma, CREST, extrahepatic biliary obstruction, ascending cholangitis |
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Choesterol gallstones
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Symptoms: radiolucent, jaundice, fever, RUQ pain, fat soluble vitamin deficiency
Pathogenesis: obesity, Crohn's, CF, age, estrogens, multiparity |
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Pigment gallstones
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Symptoms: radiopaque, jaundice, fever, RUQ pain, fat soluble vitamin deficiency
Pathogenesis: RBC hemolysis, alcohol, age, biliary infection |
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Cholecystitis
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Symptoms: inflammation of gallbladder, increased ALP if ascending cholangitis
Pathogenesis: infection (CMV, cryptococcus), gallstones |
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Acute pancreatitis
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Symptoms: epigastric abdominal pain radiating to back, nausea, anorexia, elevated amylase and lipase, DIC, ARDS, fat necrosis, hypocalcemia, hemorrhage, infection
Pathogenesis: gallstones, ethanol, trauma, steroids, mumps, autoimmune, scorpion sting, hypercalcemia/lipidemia, sulfa drugs |
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Chronic pancreatitis
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Symptoms: steatorrhea, fat-soluble vitamin deficiency, DM
Pathogenesis: alcoholism |
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Pancreatic adenocarcinoma
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Symptoms: abdominal pain radiating to back, weight loss, migratory thrombophlebitis (Trousseau's syndrome), obstructive jaundice with palpable gallbladder (pancreatic head tumors)
Pathogenesis: more common in pancreatic head, cigarettes, Jewish and African-American males, CEA and CA-19-9 tumor markers |
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Gallstone ileus
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Symptoms: cramping mid-abdominal pain, abdominal distention, vomiting
Pathogenesis: cholecystenteric fistula allows gas in gallbladder and gallstone into ileocecal valve |
