Gastro - Final Exam [LCCW]

Cancer (tumors of the small intestine), represent what % of GI tumors?

3-6%

Most benign tumors of the small intestine are what? (2 things)

Adenomas and mesenchymal tumors

Adenomas of the small intestine occur where?

At the ampulla of Vater

In what age group are tumors of the small intestine usually seen?

Age 30-60 with occult blood loss

What are polyps?

Tumorous mass that protrudes into the lumen. Usually start as sesile (broad base to it) but with traction will become pedunculated (an elongated stalk of tissue)

Polyps may form as a result of what?

Abnormal mucosal maturation, inflammation or architecture (non-neoplastic)

Polyps that arise from proliferation and dysplasia are called what?

Adenomatous polyps precursor of carcinoma

Hamartomatous polyps and peutz-jeghers are also examples of what?

Non-neoplastic polyps

Colorectal carcinoma peak incidences occur around what age?

60-80

What are the 5 main risks for colorectal cancer?

1) Excess dietary caloric intake

2) low content of veggie fibers

3) high content of refined carbs

4) red meat (BOOOOOO)

5) Decreased intake of protective micronutrients

Reduced fiber leads to what?

Decreased stool bulk, increased fecal transit time, and altered bacterial flora

Iron-deficient anemia is usually observed in whom?

An older male with colorectal cancer, due to bleeding

T/F with early detection of colorectal carcinoma, chances of survival go up?

True

Detection of [what] is key for detection of colorectal carcinoma?

Polypoid tumors

Irritable bowel syndrome has what symptoms?

1) abdominal pain or discomfort reported as cramping, bloating, gas, diarrhea and/or constipation

2) affects the colon

T/F Irritable bowel syndrome is a disease?

False. It's a functional disorder.

Doctors aren't sure what causes it.

T/F Irritable bowel syndrome doesn't damage the bowel?

True. It's painful, but it doesn't damage the bowel or lead to other health problems.

How are symptoms of Irritable bowel syndrome relieved?

A bowel movement

other helps can be found with Diet changes (ADD FIBER) medicine, and stress relief may help too! Eating smaller meals may also help.

What are some "other symptoms" of Irritable Bowel Syndrome?

Whitish mucus in stool,

swollen abdomen

The feeling that you may not have finished a movement

T/F woman have more symptoms of irritable bowel syndrome when they're on their period?

True

What foods should you avoid with irritable bowel syndrome?

Fatty foods

milk products

chocolate

alcohol

caffeine

carbonated beverages

What medicines can help with Irritable bowel syndrome?

Laxatives (constipation)

Antispasmodics (colon spasms)

Antidepressants (stress/depression)

T/F Liver and Gallbladder are accessory glands?

True

The liver produces [what] for export to the duodenum?

Bile

Which side of the abdomen does the liver mostly reside?

Right side

What are the 4 lobes of the liver called?

Right

Left

Caudate (back)

Quadrate (front) - next to gallbladder

Which ligament is a mesentery found between the rt and lt lobe on the front attaching to the anterior abdominal wall?

Falciform ligament

*divides liver into 2

Which ligament is found inferiorly on the falciform lig?

The round ligament of the liver

The remnant of the "fetal umbilical v" is called what?

The round ligament of the liver

Which ligament attaches the liver to the diaphragm?

The coronal ligament

*at very Rt and Lt there's a stretching that forms triangular ligaments

The right and left hepatic ducts leave the liver, join together to form what?

The common hepatic duct

Cystic and common hepatic duct join together and become what?

Common Bile Duct

The liver is formed of what?

Hexogonal structural units called "liver lobules"

*size of a sesame seed

T/F Plates of hepatocytes are located within the liver lobules?

True

What does the portal triad consist of and where is it located?

It's at each of the six corners of the liver lobule.

Includes: Bile Duct, Portal artery, and portal vein

The liver sinusoids pass between where?

Between the plates

Blood from the hepatic AA and the portal VV travel through the sinusoids to what?

They Central Vein, which goes on to the interlobular vein!

The interlobular vv eventually dumps where?

into the hepatic vv, which dump into the inferior vena cava.

Kupffer cells are found where and what do they do?

in the walls of the sinusoids

They remove bacteria and dead blood cells

Bile within the liver, flows through where?

Through bile canaliculi (aka canal of hering) that runs between the hepatocytes toward the bile ducts in the triad

What's the space between the sinusoids and hepatocytes called?

Space of disse

The space of Disse contains what?

Quiescent stallate cells, which store Fat and fat soluble vitamins

Quiescent stallate cells store what?

Fat and fat soluble vitamins (ADEK)

What is the general composition of bile?

Yellow-green alkaline solution containing bile salts, pigments, cholesterol, fat and lecithin

Bile salts facilitate absorption of what?

Fat and cholesterol

Bile salts are reabsorbed by what?

Enterohepatic circulation (at ileum)

Liver produces how much bile a day?

500-1000ml/day

General composition of the gall bladder?

Thin green walled musculature sac about 4 inches long

Where does the gallbladder reside?

Under liver inferior to right lobe

What does the gallbladder do?

Stores bile that is produced by the liver when it's not immediately needed.

What happens to bile in the gallbladder?

It will concentrate from absorption of water and ions

T/F Liver has a dual blood supply?

True

*the hepatic aa (300 ml/min) and the hepatic portal vv (1050ml/min)

The hepatic portal vv brings blood to liver from where?

The gut, spleen and pancreas

The liver holds how much (%) of body's total volume?

10%

The blood leaves the liver via what/to where?

The hepatic veins to the inferior vena cava

The Celiac trunk branches into which 3 main arteries?

Left gastric artery

Splenic artery

Common Hepatic Artery

The splenic aa (of the liver) further divides into what?

The Pancreatic branches and the left gastroepiploic artery

The Common Hepatic aa further divides into what?

The proper hepatic aa and the Gastroduodenal aa

The proper hepatic aa has what 2 branches?

The left and Right hepatic arteries

*Right further branches into the cystic artery

The Gastroduodenal artery has what 3 branches?

Rt Gastric artery

Pancreaticoduodenal artery

Rt Gastroepiploic artery

The left Gastroepiploic artery branches off of what main artery?

The Splenic artery

The right gastroepiploic artery branches off of what main artery?

The Gastroduodenal artery

T/F Liver's main function is bile synthesis and secretion?

True

HDL is important for what?

The transport of fat to liver

VLDL is important for what?

The transport of fat to adipocytes

LDL is important for what?

The transport of fat to tissue (mm)

T/F Insulin causes an increase in glycogen?

True

T/F Glucagon causes a decrease in glycogen?

True

How much of plasma protein concentrate in the blood is made by hepatocytes?

90%

What's the protein made by hepatocytes that helps regulate the osmotic pressure in blood?

Albumin

What minerals does the liver help store/Transport?

Iron (toxic to the body) and copper

What does "phase 1" of liver detox consist of?

Mixed oxidation/reduction reaction

decreased toxicity of the toxin

makes it water soluble

may use cytochrome P450

**If this is enough, it won't go on to Phase 2

What does "phase 2" of liver detox consist of?

Conjugation

can get free radicals from this

What's the additional secretion added by Bile ducts (in addition to the liver)?

Watery solution of sodium and bicarbonate (are added by epithelial cells stimulated by secretin )

What is happening to the duodenum and sphincter of oddi when the liver secretes bile?

The walls of the duodenum contract and the sphincter of oddi relaxes

The MOST potent stimulus in Bile secretion of the liver is what?

CCK

What's the name of the pathology that's among the top 10 causes of death, and is commonly caused by alcoholism and viral hepatitis?

Cirrhosis

What are the characteristics of Cirrhosis?

- Bridging fibrosis septae-bands of fibrous scars linking portal tracts

- Parenchymal nodules formed from injury/inflammation and fibrosis

"liver becomes covered in scar tissue which hinders function"

60-70% cause of cirrhosis is due to what?

Alcoholic liver disease

10% cause of cirrhosis is due to what?

Viral hepatits

5-10% cause of cirrhosis is due to what?

Biliary disease

10-15% cause of cirrhosis is due to what?

Cryptogenic cirrhosis

5% cause of cirrhosis is due to what?

Genetics.

Primary hemochromatosis

Which 2 causes of cirrhosis are rare?

Wilson disease

Alpha-Antitrypsin deficiency

(in the case of Cirrhosis)

It is the progressive fibrosis and reorganization of what?

The vascular architecture of Sinusoids

What type of collagen does the space of Disse usually contain?

Type IV collagen

(in the case of Cirrhosis)

In Cirrhosis, what types of collagen are deposited in the lobule by the activated stellate cells (thus creating new vascular channels)?

Types I and III

(in the case of Cirrhosis)

T/F it shunts blood around the parenchyma?

True

(in the case of Cirrhosis)

continuous fibrosis eventually causes what?

*what does that lead to?

Loss of fenestrations in the sinusoidal endothelial cells.

This leads to loss of exchange between the plasma and hepatocytes. Also leads to increased resistance of the plasma traveling through sinuses

(in the case of Cirrhosis)

What happens when Albumin is decreased?

It causes a decrease in osmotic blood pressure, which then causes edema and Ascites ( = big belly)

Portal hypertension is the resistance of what?

Portal blood flow

What can the portal hypertension be divided into?

Prehapatic, intrahepatic, and posthepatic

Prehepatic portal hypertension:

Obstructive thrombosis and narrowing of the portal vein. Splenomegaly can also shunt a lot of blood into the splenic vein

Posthepatic portal hypertension:

Right-sided heart failure, constrictive pericarditis, and hepatic vein outflow obstruction.

Intrahepatic Portal hypertension:

Major cause of cirrhosis, which accounts for most causes of portal hypertension.

What are the 4 major consequences of portal hypertension?

- A scites

- Formation of partosystemic venous shunts = Esophageal varices, hemorrhoids, peri-umbilical varices

- Congenetive splenomegaly

- Hepatic encephalopathy

Jaundice is described as:

A yellowish discoloration of the skin and sclera (icterus) due to retention of pigemented bilirubin

Bilirubin is derived from what?

Heme degradation

Heme (from old erythrocytes) is oxidized by what to what?

Heme oxygenase to biliverden

Biliverden is reduced to unconjugated bilirubin from what?

Biliverden reductase