Unit 3 - Formative 3 D1 Monday

Front 1

A patient of Northern European descent presents with gliadin and tissue transglutaninase, blunting of villi and lymphocytes in the lamina propria. The patient also has a history of dermatitis herpetiformis.

Back 1

Celiac sprue; autoimmune mediated intolerane of gliadin (wheat) leading to steatorrhea (excess fat in stool)

Decreased mucosal absorption primarily affects the jejunum;

Front 2

A patient presents with abdominal bloating, floating and foul smelling stools and weight loss with diarrhea. Villi appear normal.

Back 2

Lactose Intolerance (Disaccharidase deficiency); osmotic diarrhea; since lactase is located at the tips of intestinal villi, self limited lactase deficiency can occur following injury (viral diarrhea)

Front 3

Patient presents with diarrhea, steatorrhea, weight loss and weakness. ROS is also notable for arthralgias, cardiac and neurologic symptoms. Biopsy reveals PAS-positive macrophages in intestinal lamina propria, mesenteric nodes.

Back 3

Whipple's diesase; infection with Tropheryma whippelii (gram positive)

Front 4

What is the function of intestinal plica?

Back 4

Mixing of intestinal content to prevent absorption diffusion issues

Front 5

Which part of the small intestine is the major site of digestion and absorption?

Back 5

Jejunum

Front 6

Which part of the small intestine is the site of intrinsic factor and bile absorption?

Back 6

Ileum; thinnest mucosa of the three segments (12-14 ft in length)

Front 7

Which part of the small intestine is the site of pancreatic and biliary secretion?

Back 7

Duodenum; thickest mucosa, only 12-15 inches in length

Pyloric junction -> ligament of Treitz

Chyme and digestive enzymes mixed here

Front 8

If you remove a patient's ileum what must you supplement with?

Back 8

Vitamin B12 shots; ileum is site of intrinsic factor absorption and will be excreted otherwise

Front 9

What is the correlation between the height of intestinal villi and renewal rate?

Back 9

Increased renewal rate = higher villi

Renewal rate is highest in duodenum; slowest in colon

Front 10

Where do the stem cells for villi renewal originate?

Back 10

The crypts

Front 11

Why can't you just start eating lots of food if you haven't eaten for awhile?

Back 11

Villi will be blunted and food will be poorly absorped = GI problems

Front 12

What structure is at the apical surface of the villi?

Back 12

Brush border/microvilli; responsible for the most surface area amplification

Front 13

What is the function of the central lacteal?

Back 13

Large fats are absorbed here; bypass liver and go straight to heart via subclavian vein

Front 14

What molecules are absorbed by intestinal blood vessels contained in the villi?

Back 14

amino acids, carbohydrates, and small fatty acids; travel to liver for processing

Front 15

What structure provides oxygenated blood with metabolites from peripheral tissues to the liver?

Back 15

Hepatic Artery

Front 16

What structure provides blood rich in absorbed nutrients from the GI tract as well as hemoglobin breakdown products from the spleen?

Back 16

Hepatic Portal Vein

Front 17

Where is bile synthesized and stored?

Back 17

Synthesized in liver; secreted into the common hepatic duct for storage in the gallbladder; secrted into the lumen of the intestine through the common bile duct

Front 18

What is the significance of the hepatopancreatic ampulla?

Back 18

Its the site of union between the pancreatic duct and the common bile duct; important anatomical landmark that marks the anatomical transition from foregut to midguit (point where celiac trunk stops supplying the gut and superior mesenteric artery takes over)

Front 19

What is the significance of the sphincter of oddi?

Back 19

Controls the introduction of bile and pancreatic secretions into the duodenum prevents entry of duodenal contents into the ampulla

Front 20

What is the total amount of input vs output of fluid in the GI tract?

Back 20

9L total input; 8.9 L absorbed

0.1L excreted in feces

Front 21

Describe the nature of small intestinal motility

Back 21

Since unmixed layers must be prevented, the chyme is tossed by nonperistaltic random contractions

Front 22

Which hormone stimulates pancreatic acinar cells to release their enzymes for digestion?

Back 22

Cholecystokinin (CCK); also slows gastric emptying and contracts gall bladder at the top and relaxes the lower tube right at the small intestine so it can release its contents

Front 23

Which hormone stimulates the molecules for acid neutralization in the duodenum?

Back 23

Secretion; stimulates pancreatic and biliary ducts to release HC03 which neutralizes acid into CO2 and water

Front 24

What would happen if secretin was not released from the small intestinal S cells?

Back 24

No neutralization of acids; digestive enzymes have a pH optimum between 6.5 and 8 so you would also have enzyme dysfunctions

Front 25

Which intestinal cells release secretin?

Back 25

S cells

Front 26

Which intestinal cells release CCK?

Back 26

I cells

Front 27

Which molecules stimulate the release of CCK?

Back 27

Acid from stomach released secretin from wall of duodenum; also fats and amino acids

Front 28

What is the source, target, and action of gastrin?

Back 28

S: G cells in antrum of stomach
T: Parietal cells in stomach
A: Increases acid Secretion

Front 29

What is the source, target, and action of CCK?

Back 29

S: I cells in duodenum and jejunum
T: Pancreas, gall bladder, sphinceter of oddi
A: Enzyme secretion from acinar cells; contract gall bladder; relax sphincter of Oddi

Front 30

What is the source, target, and action of secretin?

Back 30

S: S cells in duodenum and jejunum
T: Ducts of pancreas and gall bladder
A: Increases bicarbonate ion secretion

Front 31

Which two hormones are not secreted from the jejunum?

Gastrin; CCK; Secretin; GIP; Motilin

Back 31

CCK and Gastrin

Front 32

where do lymphatics in the region above the umbilicus drain?

Back 32

Axillary lymph nodes

Front 33

Where do lymphatics in the region below the umbilicus drain?

Back 33

Superficial inguinal nodes

Front 34

What is the protective function of the greater omentum?

Back 34

Adheres to areas of inflammation; wraps itself around inflammed organs thus preventing diffuse peritonitis

Front 35

What is the function of the falciform ligament?

Back 35

Connects the liver to the diaphragm and the anterior abdominal wall

Front 36

Which abdominal ligament serves no function in adults?

Back 36

Ligamentum teres hepatis (round ligament of the liver); lies in the free margin of the falciform ligament and is formed after birth fro mthe remnant of the left umbilical vein

Front 37

Where does the coronary ligament attach and what does it form?

Back 37

Attaches at the diaphragmatic surface of the liver; encloses a triangular area of the lobe, the bare area of the liver (left right extensions form left and right triangular ligaments)

Front 38

Which condition is characterized by compression of the left renal vein between the abdominal aorta and the superior mesenteric artery?

Back 38

Nutcracker Syndrome; classically left flank pain

Front 39

What is the potential area between the liver and right kidney?

Back 39

Hepatorenal recess

Front 40

Compare and contrast the arcades and recta of the jejunum and ileum.

Back 40

Jejunum: 1-2 arcades (arterial bridges/cross links between the channels) and long vasa recta (straight vessels)

Ileum: Many arcades and short vasa recta

Front 41

Compare and contrast from where the systemic veins vs the portal system veins form

Back 41

Systemic V (those that drain trunk and limbs) form from cardinal veins
Portal System V: form from vitelline veins (that drain yolk sack)

Front 42

The inferior vena cava pretty much drains everything in the abdominal cavity EXCEPT what four things

Back 42

Gut, pancreas, gall bladder, spleen; these organs first drain into the portal veins which pass to the liver before draining into the vena cava

Front 43

What four organs input into the portal veins?

Back 43

Gut, gall bladder, pancreas, spleen

Front 44

Where is the site of a direct inguinal hernia?

Back 44

Inguinal Triangle

Front 45

What structure connects the duodenum to the diaphragm?

Back 45

Ligament of Treitz

Front 46

From which sacral nerves are the parasympathetics of the hindgut derived from?

Back 46

S2-S4 (pelvic splanchnic nerves)

Front 47

From which spinal nerve section is the sympathetic innervation of the hindgut along with visceral afferents derived from?

Back 47

Lumbar Splanchnic nerves

Front 48

Which vertebral levels are the epigastric (foregut) structures associated with?

Back 48

T6-T9 (T5 = level of xyphoid process)

Front 49

Which vertebral levels are the lingual ligament and pubis associated with?

Back 49

L1

Front 50

What vertebral level is the umbilicus associated with?

Back 50

T10