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Intro to GI

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