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1. mouth- lips, oral cavity, hard & soft palate, teeth, tongue, taste receptors, salivary glands ( parotid, submaxillary, sublingual) Esophagus- upper 1/3 striated skeletal muscle distal 2/3 smooth muscle, lower Esophageal sphincter Stomach- contains gastric fluid and mucus, fundus, body antrum, rugae, chief cells Secrete pepsinogen, parietal cells secrete hydrochloric acid, water and intrinsic Factor SI- 23 ft long duodenum, jejunum, ileum, ileocecal valve prevents reflux of LI Content into SI, villi have goblet cells that secrete mucus and epithelial cells that Produce intestinal digestive enzymes, microvilli compose brush border, crypts of Lieberkuhn, Brunner cells secrete mucus LI- 5-6 ft long cecum and appendix, colon-ascending, transverse, Descending, sigmoid, rectum, anus, microorganisms- breakdown protein, bacteriaSynthesize Vit K and some Vit B and produce flatus 2. Function of Enteric nervous system- composed of 2 layers, known as the Gut brain, has ability to control movement and secretion of the GI tract 3. Auerbach’s Plexus- provides motor innervations to longitudinal and circular layer, secretomotor innervations to mucosa, has sympathetic and parasympathetic input 4. Meissner’s Plexus- has only parasympathetic fibers, innervate cells in epithelial and smooth muscle of intestine 5. activated by sight smell and taste of food, indirectly causes parietal cells to secrete HCl and directly stimulates chief cells to secrete pepsinogen 6. parasympathetic- rest and digest, mainly excitatory, peristalsis increased 7. Sympathetic-fight or flight, mainly inhibitory, peristalsis decreased. 8. mastication- chewing of food 9. saliva- lubricate and soften food, 10. amylase(ptyalin) which hydrolyzes starches to maltose 11. less than 7 acidic greater than 7 alkaline, saliva is 7.4 12. produce saliva which consists of water, protein, mucin, organic salts, salivary amylase, produce one liter a day, 13. Segmentation(mixing) and peristalsis(propulsion) 14. aboral-opposite or away from mouth 15. peristalsis-wavelike muscle contractions of alimentary tract that moves food along 16. stomach 3-4 hrs, SI 4 hrs LI till ya poop 17. appendicitis 18. LES-lower esophageal sphincter- prevents reflux of acidic gastric contents into esophagus pyloric sphincter- lets food into duodenum and prevents it from coming back up ileocecal- limit reflux of colonic contents into ileum 19. Chyme- food mixed with gastric secretions in SI 20. CCK in response to Chyme enters bloodstream and stimulates contraction of GB and relaxation of ODDI, also stimulates pancreas to synthesize enzymes for digestion of protein carbs and fat 21. crypts of lieberkuhn-contain base columnar cells that are stem cells for other epithelial types 22. Produced in stomach, promotes B12 absorption in SI 23. ph of stomach 1-1.5, HCl acid released by parietal cells contributes to pH, gastrin and somatostatin regulate secretion of stomach acid pH of duodenum 7, controlled by secretin which stimulates pancreas to release Fluid with high bicarbonate CCK- causes GB to release alkaline bile into Duodenum 24. hormones- gastrin, CCK, ghrelin, leptin,secretin, gastric inhibitory peptide neurotransmitter- acetylcholine, adrenalin 25. water soluble B/C and fat soluble D/E/A/K absorbed in SI 26. Vitamin K, B12, sodium, chloride and H2O 27. Vit K/and some B 28. Bile helps breakdown fat 29. salivary glands-1k-1500, stomach 2500,SI 3k, pancreas 700, liver/GB 1k 30. Colon extracts H2O from solid waste before it is eliminated from body. 31. ? 32. Vit D 34. lactobacilli, streptococci, candida albicans 33. digestion of self 34. Acidic environment 35. peristaltic rush- powerful wave of contractile activity that travels long distances down SI 36. 5-6 ft and 2 inches in diameter 37. Haustra-series of pouches that give LI its puckered look 38. the four parts are cecum and appendix, colon- ascending, transverse, descending, sigmoid, rectum, anus 39. ? ASCENDING COLON AND APPENDIX 40. ascending transverse descending sigmoid 41. secretes mucus which acts as lubricant and protects the mucosa 42. It extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided (largely bacteria) fermentation of unabsorbed material occurs.rectum keeps intestine sealed shut till need to pass feces arises. The anal canal serves to transmit and lubricate stool as it passes externally from the rectum 43. absorption of water and electrolytes, also forms feces and serves as reservoir for fecal mass 44. hausal churning-kneading action and propulsive peristalsis 45. ? 46. mucus 47. The main bacteria in the colon are Bacteroides, Bifidobacterium, Eubacterium, Coliforms, Streptococcus, Lactobacillus and Clostridium 48. ? 49. water, bacteria, unabsorbed minerals, undigested foodstuffs, bile pigments and desquamated epithelial cells 50. reflex action involving voluntary and involuntary control, feces in rectum Stimulate sensory nerve endings that produce desire to defecate, parasympathetic Nerve fibers produce contraction of rectum and relaxation of internal anal Sphincter, defecation is controlled voluntarily by relaxing the external anal canal Sphincter when desire to defecate is felt 51. ? 52. ? 53. anemia-atrophy of gastric mucosa, result of cobalamin malabsorption Bleeding tendenciesConstipation- reduction in dietary fiber, reduced fluid intake and decreased Physical activity 53. SI jejunum most of them ileum-b12 LI- Vit K biotin, NaCl chloride potassium 55. Parietal cells in stomach release intrinsic factor, intrinsic factor promotes Cobalamin absorption in Ileum. No intrinsic factor or ileostomy you give B12 shots 56. The digestion process of starch is started in mouth by amylase (ptyalin) 57. Dysphasia, odynophagia- pain when swallowing in mouth or esophagus, water brash, eructation, pain in jaw or back, Barrett’s epithelium 58. Lifestyle modification and nutritional therapy 59. Antireflux procedures – to reduce reflux of gastric contents by enhancing the integrity of the LES. The fundus is wrapped around the lower portion of the esophagus to reinforce and repair defective barrier. Nissen fundoplication 60Nissen 61. Prevent respiratory complications, maintain F&E, prevent infection 62. It is an H2 receptor blocker – are a class of drugs used to block the action of histamines on parietal cells in the stomach, decreasing the production of acid by these cells. 63. zantac- H2R blocker decrease the secretion of HCl by the stomach 64. sulcrafate- antiulcer drug, cytoprotective properties 65. Protnix (Pantroprazole) - PPI decrease gastric HCl acid secretion 66. Gastrostomy tube may be needed 67. PEG- fewer risk, no general anesthesia, NG short term feedings, decreased likelihood of regurgitation and aspiration, can be placed in comatose pt, easily clogged 68. Ranges from localized injury of epithelial cells to desquamation and destruction of the mucosa, with mucosal congestion, edema, and hemorrhage. 69. NSAIDS-have direct irritating effects on the gastric mucosa, inhibit synthesis of Prostaglandins that are protective to the gastric mucosa, Cytotec prevents ulcers by protecting stomach lining and decreasing HCl 70. H pylori produces urease to protect itself from destruction? 71. Antibiotic biaxin, amoxicillin or tetracycline, along with flagyl, PPI- prilosec 72. Anorexia, N/V wt loss, dyspepsia treat with antacids, sulcralfate 73. Sharp abd pain, rigid abd 74. Obstruction of intestine due to paralysis of intestinal muscles 75. These vitamins are absorbed in ileum. 76. Diarrhea or steatorrhea, signs of malnutrition and multiple vitamin and mineral Deficiencies, lactase deficiency and bacterial overgrowth, oxalate kidney stone 77. The urea breath test is a rapid diagnostic procedure used to identify infections by H.pylori a spiral bacterium implicated in gastritis, gastric ulcer, and peptic ulcer disease. It is based upon the ability of H. pylori to convert urea to ammonia. Urea breath tests are recommended in leading society guidelines as a preferred noninvasive choice for detecting H. pylori before and after treatment. 78. Rapid diagnostic procedure to identify infection of h pylori 79. CEA carcinoembryonic antigen- tumor marker 80. rectosigmoid over 50% 81 Crohn’s- wt loss may be severe, infrequent rectal bleeding, tenesmus is rare, Recurrent at site of anastamosis UC- fever during acute attacks, minimal incidence of malabsorption and Nutritional deficiencies, occasional granulomas, fistulas are rare, occasional Strictures, rare anal abscess, cured with colostomy 82 abscess that is characteristic of UC in the mucosa of LI 83. Small superficial ulcerations with granulomas 84. Seen in crohn’s affected area separated by non affected area 85.? 86. Because disease usually recurs at area of anastamosis 87. It is a sudden cure. 88. High fiber prevent constipation bulk laxatives 8 glasses of H20, decreased intake of fat and red meats, exercise, wt reduction, avoid increase in intrabdominal Pressure-tight clothes vomit, lifting, bending 89. anorexia-abn wt loss, self starvation, fear of wt gain, lanugo, refusal to eat, Continuous dieting, hair loss, sensitivity to cold, compulsive exercise, absent or Irregular menses, dry skin, constipation, Bulimia- binge eating and self induced vomiting, normal wt for ht, macerated Knuckles, swollen salivary glands, broken blood vessels in eyes, and dental Problems 90. Jejunoileal bypass- reduces absorption in SI, join jejunum to distal segment of Ileum, could cause short bowel syndrome, malabsorption of nutrients, decreased K Ca Vit B Gastric stapling- small pouch, limits oral intake to 50-60 ml for morbidly obese, Increase frequency of meals and replace Vit and minerals