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46 Cards in this Set
- Front
- Back
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What is co-localization?
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Neurons that contain more than one type of transmitter.
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Which nerves innervates the longitudinal and circular muscles of the gut?
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Myenteric ganglia
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What neurotransmitters are used in the ENS? (6)
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1. Acetylcholine
2. Adenosine Triphosphate 3. b-Nicotinamide Adenine Dinucleotide 4. Nitric Oxide 5. Vasoactive Intestinal Peptide 6. Substance P |
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What excitatory neurotransmitter acts on longitudinal muscle?
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Acetylcholine
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Which excitatory neurotransmitters act on circular muscles? (3)
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Acetylcholine
Substance P Serotonin |
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Which neurotransmitters are inhibitory on longitudinal and circular muscles?
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Nitric Oxide
Vasoactive Intestinal Peptide Purines (ATP & b-NAD) |
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What percent of neurons in myenteric ganglia are sensory?
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33%
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What is the function of myenteric neurons?
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1. Regulate smooth muscle (Longitudinal & circular) contraction
2. Regulate endocrine/exocrine activity |
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What is the function of submucosal neurons?
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1. Regulate endocrine/exocrine activity
2. Motility of muscularis mucosae |
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What does the secretomotor neurons of the submucosal plexus release?
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Acetylcholine and/or VIP
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Ca2+ is increased intracellularly in the gut by which mechanisms? (5)
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1. Voltage dependent Ca2+ channels
2. Store-operated Ca2+ channels 3. Stretch activated Ca2+ channels 4. Receptor mediated IP3 production 5. Receptor operated Ca2+ channels (Direct and GPCR) |
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Inhibition of smooth muscle contraction results from what?
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Sympathetic nervous system
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What is "En Passage" Transmission?
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Neurotransmitters are released from varicosities which is then sprayed onto the smooth muscles.
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What are the 4 types of motility patterns?
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1. Tonic Contraction (Sphincters)
2. Rhythmic segmentation 3. Oscilatory (Pendular) Movements 4. Peristalsis |
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What are the major excitatory transmitters for peristalsis?
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ACh
Substance P |
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What are the major inhibitory transmitters for peristalsis?
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NO
VIP Purines (ATP, b-NAD) |
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Function of the esophagus (4)
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1. Deglution (Movement of food)
2. Prevent entry of air and reflux of gastric contents 3. Erucation (Belching or movement of gas from stomach to mouth) 4. Vomiting (Movement of gastric contents from stomach to mouth) |
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Where does sensory input to the CNS from upper esophagus travel to?
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Swallowing center
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Cell bodies of striated muscles of esophagus is located at ____? It also runs with what nerve?
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Located at the Nucleus Ambiguus
Runs with the Vagus |
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Smooth muscles of the esophagus is innervated by?
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Vagus nerve
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Lower esophageal sphincter is innervated by what nerve? which release what neurotransmitter?
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Vagus, releasing VIP and NO to relax sphincter.
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What moves residual food in the stomach and intestine during fasting?
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Interdigestive Migrating Myoelectric Complex.
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What are the major oxyntic glands and what do they release?
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1. Parietal (HCL, Intrinsic Factor)
2. Chief (Pepsinogen, Lipase) 3. Mucous Neck (Mucin) 4. ECL (Histamine) |
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What are the major pyloric glands and what do they release?
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1. Mucous (Mucous/HCO3)
2. G cells (Gastrin) 3. D cells (Somatostatin) |
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Where are the 2 types of pepsinogen found?
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Type I: Chief cells
Type II: Pyloric & Brunner's glands |
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Function of gastric acid (4)
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1. Act as bacteriostatic agent
2. Activate pepsinogen 3. Denature Protein 4. Facilitate absorption of Fe, Ca, Vitamin B12 |
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What stimulates mucus secretion for mucous neck cells of gastric glands? (5)
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1. Mechanical Stimulation
2. Vagal Stimulation 3. ACh 4. PG 5 Bacterial toxins |
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Function of Prostaglandins in the stomach
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1. Inhibit acid secretion
2. Prevent surface epithelial cell exfoliation 3. Increase mucosal blood flow 4. Stimulate mucus and bicarbonate secretion 5. Enhance synthesis of surface-active phospholipids that line the gastric mucosa |
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What are the major secretagogues for acid secretion in the stomach?
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1. Gastrin
2. Histamine 3. Acetylcholine |
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During the gastric phase, what reflex is activated by mechanical distension?
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Vago-vagal
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During the intestinal inhibition phase, what is being released?
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Enterogastrones:
- Serotonin - CCK - GIP & GLP-1 |
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What stimulates the enterogastric reflex?
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1. Low pH solution (<2.5)
2. Hypertonic sugar and salt solutions 3. Products of fat digestion. |
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Which ganglions are involved in the enterogastric reflex?
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1. Sympathetic prevertebral
2. Celiac |
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Who is important to rule for maligancy?
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Age: > 50
New onset with: - Weight loss - Gastrointestinal bleeding - Anemia - Dysphagia |
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What 2 major factors are associated with peptic ulcer?
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1. Helicobacter pylori
2. NSAIDs |
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How does H. pylori cause ulcers? (4)
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1. Gastric acid secretion
2. Gastric metaplasia 3. Immune responses 4. Mucosal defense muchanisms 5. Other contributing factors |
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What are the 2 virulence factors for H. pylori?
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1. Cytotoxin-associated gene A (CagA)
2. Vaculoating cytotoxin A (Vac A) |
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What are the indications for surgery of peptic ulcer?
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1. Failure of nonoperative management of an ulcer complication
2. Suspicion of malignancy 3. A gastric ulcer that has failed to heal after 12 weeks of medical therapy (Even if biopsies are benign) |
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What are the surgical options of peptic ulcer?
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1. Vagotomy
2. Antrectomy (Eliminate hormonal stimulation from antrum) 3. Decreasing the number of parietal cells via gastric resection. |
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What is hematemesis?
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Vomiting of blood or coffee-ground-like material
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What is Melena
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Black tarry stools
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What is hematochezia?
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Passage of marron or bright red blood or blood clots via rectum
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What are the major causes of upper GI bleed in adults?
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1. Peptic ulcer disease
2. Esophagogastric varices 3. Arteriovenous malformations 4. Mallory-Weiss tears 5. Tumours and eorsions 6. Dieulafoy's lesion |
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What are the steps in management of UGI bleeds?
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Endoscopy:
1. Identification of lesion 2. Stratification of risk of re-bleeding 3. Control of high risk lesions 4. Treatment of persistent/recurrent bleeding |
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When to call the surgeon in UGI bleeding?
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1. Hemodynamic instability despite vigorous resuscitation (> 3 unit transfusion)
2. Recurrent hemorrhage after initial stabilization (> 2 attempts w/ endoscopic hemostasis) 3. Shock associated with recurrent hemorrhage 4. Continued slow bleeding with a transfusion > 3 units/day |
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What is the medical treatment for acute ulcer bleed?
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IV Proton Pump Inhibitor
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