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Intro to GI lecture

Intro to GI

Describe the Cephalic phase of digestion. Seeing, smelling, and tasting food
Describe the gastric phase of digestion. arrival of food into the stomach stimulating gastric secretion.
Describe the intestinal phase of digestion. movement of chyme into the duodenum decreasing gastric secretion
What are the 3 fxns of the GI tract? -ingestion/propulsion/elimin of food -mech and chem digestion -absorption of food into cells
What are the fxns of the mouth? -masticaton/swallowing -mixing food w/ saliva -stim. of taste buds -speech
name the 3 salivary glands -parotid -submandibular -sublingual
initiation of carbohydrate digestion is done by what? salivary amylase
what are the 4 fxns of saliva? -carb digestion -lubricate food -high pH to protect enamel -immunoglobulin A prevents bacterial infects.
what are the etiologies of saliva gland disorders? bacterial/viral/autoimmune
What are symptoms of a salivary gland disorder? facial swelling and fever
what is another name for the upper esophageal sphincter? cricopharyngeal sphincter
what is another name for the lower eso. sphincter? cardiac sphincter
what are the 2 phases of swallowing? 1)oropharyngeal=formation of bolus and movement into eso. 2)esopharyngeal=bolus is moved down eso by peristalsis
Describe the voluntary and involuntary movement through eso. upper 1/3=voluntary, striated muscle lower 1/3=involuntary, smooth muscle
what causes heartburn? regurgitation of acidic contents into the esophagus
what are symptoms of heartburn? burning in the anterior chest
what is a special test for heartburn? 24 hour pH monitoring
what is Dysphagia? difficulty swallowing foods/liquids/saliva
What are the 2 locations of dysphagia? How can they be further classified? -oropharyngeal and esophageal -obstruction or neuromuscular
What are symptoms of dysphagia? choking, drooling, sensation of food being stuck in the throat
what are the special tests for dysphagia? -barium enema, endoscopy, and manometry
What is odynophagia? painful swallowing
What can cause odynophagia? -infections -mucousal lesions on the eso -heartburn
how do you visualize odynophagia? endoscopy
manometry measures the strength and coordination of peristalsis
24 pH monitoring measures pH and length of exposure in esophagus
barium swallow swallowed under fluoroscopy to detect obstruction or motility disorders
endoscopy direct visualization, opportunity for biopsies, foreign body removal and dilation of stricture
what are the 2 sphincters in the stomach? cardiac and pyloric
3 regions of the stomach? fundus, body, antrum
What are some fxns of the stomach? -store food -mix food w/ digestive juices -propel food to duodenum -absorption of alcohol
what do parietal cell secrete? HCl adn intrinsic factor
what do chief cells secrete? pepsinogen
what converts pepsinogen to pepsin? HCl
Why do you need intrinsic factor? required for intestinal absorption of B12.
What does pepsin do? breaks down proteins
What serves as a protective barrier in the stomach? mucous and bicarbonate
what do enterochromaffin-like cells secrete? Histamine HI--> stimulates gastric acid
what do D cells secrete? somatostatin
what does somatostatin do? inhibits gastric acid and pepsinogen
What two things are secreted to INCREASE gastric motility? 1)gastrin=secreted in response to partially digested protein in stomach 2)Motilin=secreted in repsonse to acid entering teh duodenum
What 2 things are secreted to DECREASE gastric motility? 1)secretin=decreases secretion of HCl, stimulates pancreatic alkaline secretions and liver to release bile 2)cholecystokinin=involved in contraction of gallbladder to release bile,and stim of pancreatic alkaline secretions
What is gastritis? inflammation of the stomach
what can cause gastritis? H. pylori, alcohol, NSAIDS, dietary irritants
What are symptoms of gastritis? gnawing epigastric discomfort, nausea, vomitting
How do you test fro gastritis? -endoscopy -h. pylori testing
What is peptic ulcer disease? a break in to mucosa resulting from pepsin and acid.
what is a complication of peptic ulcer dz? bleeding or perforation
tests for Peptic ulcer disease? -endoscopy -h. Pylori testing
3 parts of the small intestine? -duodenum -jejunum -ileum
what are the functions of the small intestine? -primary site of digestion and absorption -convert food to usable energy
What is the shortest segment of the SI? duodenum-1 foot
Where is iron absorbed? duodenum
what structure seperates the duodenum and the jejunum? ligament of trietz
Where is the primary site for chemical digestion? duodenum
Where are most nutrients absorbed? jejunum
what site is involved with the absorption of B12 and bile salts? Ileum
Where do the contents of the Ileum empty in to? cecum
80-90% of the water is absorbed where? small intestine
What are carbs broken down into? monosaccharides and disaccharides
what are proteins broken down into? amino acids and peptides by pancreatic enzymes
What is fat reduced to? fatty acids and monoglycerides
what is Ileus? loss of peristalsis
what can cause ileus? -recent surgery -electrolyte abnormalities -hypothyroidism -meds
what are some symptoms of Ileus? abdominal distension, constipation, and nausea and vomiting after meals
What are some causes for small bowel obstructions? -surgical adhesions -tumors -hernias
What are some symptoms of bowel obstruction? crampy ab pain, vomiting, decreased bowel sounds
How do you diagnose bowel obstruction? -ab x-ray -CT scan
What is the function of the large intestine? formation, storage, and evacuation of feces
what are haustral contractions? short segmental movements to increase the time for absorption of h2O and sodium.
define mass movement functions to propel intestinal contents...usually occurs after meals
What is reabsorbed in the gut and into the circulation? water, sodium, chloride
What is excreted in the feces? potassium and bicarbonate
What helps with fermentation of carbs that were not fully absorbed in the small intestine? bacteria (primarily anaerobes)
Bacteria make up what percent of the stool? 30-50%
What is the cause of Irritable bowel syndrome? -visceral hypersensitivity -depression/anxiety -psychosocial stress *there is no organic disease
What are symptoms of IBS? abdominal pain and altered bowel pattern
How is a diagnosis of IBS made? H&P
What is the etiology of inflammatory bowel disease? inflammation of the colon and other areas of the GI tract
What are 2 common IBDs? Crohn's disease and ulcerative colitis
how do you diagnose IBD? Colonoscopy and biopsy
What is the most common site for Crohn's disease? terminal ileum
What areas does ulcerative colitis occur? ALWAYS the rectosigmoid colon and may extend proximally
What types of lesions occur in Crohns Disease? Transmural, they may skip areas
What type of lesion is seen in Ulcerative colitis? mucousal=they are continuous
What causes appendicitis? obstruction of appendix leads to bacterial proliferation
What are the symptoms of appendicitis? periumbilical pain shifting to the right lower quadrant
How do you diagnose appendicitis? H&P and CT scan
What causes diverticular disease? increased luminal pressure produces out-pouchings usually in the sigmoid colon
What are complications of Diverticular disease? bleeding and infection
How do you diagnose diverticulosis? colonoscopy or barium enema
How do you diagnose diverticulitis? PE, leukocytosis, and CT scan
What are some symptoms of colorectal cancer? blood loss, change in stool
How do you diagnose CRC? fecal occult blood test, colonoscopy, sigmoidoscopy
What are the functions of the liver? gluconeogenesis, bile production, produce albumin and clotting factors, and absorb toxic material
Describe unconjugated bilirubin. bilirubin bound by albumin and is lipid soluble
Describe conjugated bilirubin. glucuronic acid in the liver conjugates bilirubin making it water soluble
Describe urobilirubin. Bacteria in the colon deconjugates bilirubin into urobilinogen which is reabsorbed and secreted in the urine.
What causes the yellowing of jaundice? accumulation of bilirubin on body tissues
What are some causes of Hepatitis? Viral=ABCDE, autoimmune, alcoholism, drug induced
What are some sypmtoms of hepatitis? fluelike, anorexia, malaise, nausea, jaundice, pale stools, dark urine, and hepatomegaly
What causes Cirrhosis of the liver? Viruses and alcohol lead to fibrosis, which leads to loss of function.
What are 2 complications of cirrhosis? portal hypertension and liver failure
what tests are done to look for and diagnose hepatitis or cirrhosis? 1)liver function tests 2)ultrasound or CT 3)biopsy=diagnostic
What are some complications of portal hypertension? -varices, encephalopathy, ascites
What causes ascites? accumulation of fluid in the peritoneal cavity from decreased oncotic pressure.
What causes encephalopathy? toxins produced in the gut pass into the systemic circulation and cause altered CNS symptoms.
What is secreted in response to high blood sugar? endocrine=insulin
what is secreted in response to low blood sugar? endocrine=glucagon
What is secreted by the exocrine pancreas? -trypsin/chymotrypsin -lipase -amylase -bicarb
What is the etiology of pancreatitis? autodigestion of the pancreas associated with alcohol abuse and gallstones
What are symptoms of pancreatitis? steady epigastric pain, vomiting and/or fever
What is the function of the gall bladder? store, concentrate and secrete bile. Stores 90cc of bile.
What is cholecystitis? inflammation of the gallbladder via a blocked cystic duct
What are symptoms of cholecystitis? steady right upper quad pain radiating to the scapula precipitated by fatty foods.
WBC elevated with infections, pain or stress. Decreased in viral infections or overwhelming bacterial infections.
Hemoglobin and hematocrit decreased with gastrointestinal bleeding...symptoms depend on rate of bleeding.
Aminotransferase(AST/ALT) markers of liver injury
Alkaline phosphatase elevated with bile duct obstruction
AMylase and lipase markers of pancreas inflammation. amylase rises quicker. Lipase is elevated longer
Electrolytes Na, K, HCo3, Cl vomiting/diarrhea/dehydration decrease
stool cultures used to find bacterial or viral source of infections
What is an ERCP? combines endoscopy with the injection of iodinated contrast agent into the biliary and pancreatic ducts
What is MRCP? Non-invasive technique for evaluating the biliary and pancreatic ductal systems using magnetic resonance.
What is a HIDA scan? neutrophils and macrophages are labeled with technetium 99m albumin and administered IV-time consuming and not readily available.
Created by: emeliza87