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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
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