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SPM--Unit 3--Week 21--Vomiting
N/A
320
Medical
Graduate
12/02/2010

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Cards

Term
What is acute gastritis?
Definition
a transient gastric mucosal inflammatory process. In more severe cases there may be mucosal erosion, ulceration, hemorrhage, hematemesis, melena, or, rarely, massive blood loss.
Term
What will you see with an endoscope in a case of acute gastritis?
Definition
Endoscopically, you may see redness, erosions, & ulceration of the mucosa.
Term
Clinical features of acute gastritis.
Definition

variable degrees of epigastric pain.

nausea & vomiting

GI blood loss (hematemesis/melena)

Term
Melena
Definition
black, tarry feces associated with gastrointestinal hemorrhage
Term
What would you see with a microscope if you looked at a biopsy of mild acute gastritis? Moderate/severe gastritis?
Definition
Mild acute gastritis: the lamina propria shows moderate edema and slight vascular congestion.
The surface epithelium is intact. although scattered neutrophils may be present among the epithelial cells or within mucosal glands.

Moderate/severe gastritis: erosions (loss of superficial epithelium causing a defect in the mucosa that does not cross the muscularis mucosa); hemorrhage; acute inflammatory infiltrate, purulent exudate.
Term
What would you see with a microscope if you looked at a biopsy of healing gastritis?
Definition

Epithelial regeneration

Elongation of gastric pit

Pseudostratified appearance of superficial epithelium

Residual cluster of neutrrophils in the gastric pit

Term
What is acute gastric ulceration?
Definition
discontinuity or break in stomach epithelium due to a transient gastric mucosal inflammatory process.
Term
Curling ulcers & cushing ulcers are two types of _________ ulcers
Definition
stress
Term
Curling's ulcer
Definition
an acute peptic ulcer of the duodenum resulting as a complication from severe burns when reduced plasma volume leads to sloughing of the gastric mucosa
Term
Cushing's ulcer
Definition
a gastric ulcer produced by elevated intracranial pressure; occurs in the stomach, distal esophagus, and proximal duodenum
One possible explanation for the development of Cushing ulcers is the stimulation of vagal nuclei due to the increased intracranial pressure which leads to increased secretion of gastric acid.
Term
Melena
Definition
black, tarry feces associated with gastrointestinal hemorrhage
Term
Why are cushing ulcers (due to high intracranial pressure) a particular concern?
Definition
because they carry a high risk of perforation
Term
Explain the following mnemonic:
CuRling is buRning
cuSHing is cruSHing
Definition
curling ulcers are gastric stress ulcers from burns covering a large part of the body

cushing ulcers are due to high (crushing) intra-cranial pressure
Term
How do NSAIDs cause ulcers?
Definition

NSAIDs block the synthesis of prostaglandins

 

Prostaglandins which enhance bicarbonate secretion, inhibit acid secretion, promote mucin synthesis, and increase vascular perfusion.

Term
What are 3 ways that high intracranial pressure is thought to lead to cushing's ulcers?
Definition

1. high pressure directly stimulates the vagal nuclei, which causes hypersecretion of gastric acid.

 

2. Systemic acidosis, a frequent finding in these settings, may also contribute to mucosal injury by lowering the intracellular pH of mucosal cells.

 

3. Hypoxia and reduced blood flow caused by stress-induced splanchnic vasoconstriction also contributes to the pathogenesis of acute ulcers.

Term
If you looked at an acute gastric ulcer with an endoscope, what would it look like?
Definition
Lesions described as acute gastric ulcers range in depth from shallow erosions caused by superficial epithelial damage to deeper lesions that penetrate the depth of the mucosa.
Acute ulcers are rounded, “punched out” lesion with very clean edges, less than 1 cm in diameter.
The ulcer base is frequently stained brown to black by acid digestion of extravasated blood and may be associated with transmural inflammation and local serositis.
Term
You see an ulcer in the stomach with an irregular shape and indistinct borders (it doesn't look "punched out"). What should you do?
Definition
take a biopsy Ulcers due to acute gastritis are usually round, "punched out" lesions with clear, clean edges. An appearance different than that could indicate cancer.
Term
What would you see with a microscope if you looked at a biopsy of an acute gastric ulcer?
Definition

Microscopically, acute ulcers are sharply demarcated, with essentially normal adjacent mucosa.

 

Depending on the duration of the ulceration, there may be a suffusion of blood into the mucosa and submucosa and some inflammatory reaction.

 

Conspicuously absent are the scarring and thickening of blood vessels that characterize chronic peptic ulcers.

Term
Clinical features of acute gastric ulcers.
Definition
variable degrees of epigastric pain
nausea and vomiting
I blood loss (hematemesis/melena)
gastric perforation
obstruction
Term
The most common cause of chronic gastritis
Definition
H. pylori infection
(though it may be H. pylori + other factors)
Term
Your patient, who has recently recovered from an H. pylori infection, asks you if she should wear gloves while changing her cat's litter box to avoid re-infecting herself. Is that a good way to prevent H. pylori infection? Why or why not?
Definition

No. Humans are the only known hosts of H. pylori.

 

(It's not known for sure, but transmission is most likely oral-oral or fecal-oral)

Term
What are some causes other than H. pylori (or along with H. pylori) that can contribute to chronic gastric ulcers?
Definition
psychologic stress
caffeine
alcohol
tobacco
radiation injury
chronic bile reflux
mechanical injury
involvement by systemic disease such as Crohn disease, amyloidosis, or graft-versus-host disease
Term
Chronic gastritis is long-standing gastric mucosal inflammatory process that is usually secondary to:
Definition
H. pylori infection
Term

What is amyloidosis?

 

What problems can amyloidosis of the stomach cause?

Definition

a variety of conditions in which amyloid proteins are abnormally deposited in organs and/or tissues.

 

can contribute to chronic gastric ulcers

Term
What are risk factors, in the US, for H. pylori infection?
Definition
poverty
household crowding
limited education
African-American or Mexican-American ethnicity
residence in rural areas
birth outside of the United States
Term
antrum of the stomach
Definition
the portion of the stomach just proximal to the pyloric spincter (the bottom of the stomach)
Term
Where in the stomach does H. pylori mostly live?
Definition

in the mucous of the stomach, mostly on the surface off the stomach, but some in the neck of the gastric pits (near the top)

 

Mostly in the antral part of the stomach.

Term
What will signs & symptoms will a person with chronic gastric ulcers show?
Definition

variable degrees of epigastric pain

upper GI discomfort

nausea and vomiting

 

possibly GI blood loss (hematemesis/melena), gastric perforation, or obstruction

Term
Why is it advantageous to H. pylor that it produces urease?
Definition
urease generates ammonia from endogenous urea and thereby elevates local gastric pH
Term
How does H. pylori move through the stomach lumnen?
Definition
with its flagellum
Term
foveolar cells
Definition
Mucus producing cells which cover the inside of the stomach, helping protect it from the corrosive nature of the contents it contains. They are often found lining the gastric pits
Term
H. pylori have _______, which help them stick to foveolar cells in the stomach.
Definition

adhesins

 

Foveolar cells are mucus producing cells which cover the inside of the stomach, helping protect it from the corrosive nature of the contents it contains. They are often found lining the gastric pits

Term
What would you see with an endoscope if looking at a stomach with an active H. pylori infection?
Definition

antral mucosa is usually erythematous and has a coarse or even nodular appearance. May show ulceration/erosions.

 

(remember, the antrum is the lower part of the stomach, between the body and the pylorus)

Term
What would you see with a microscope if looking at biopsy of a stomach with an active H. pylori infection?
Definition

You would see flagellated bacteria within the superficial mucus overlying epithelial cells in the surface and neck regions

inflammatory infiltrate includes variable numbers of neutrophils within the lamina propria, including some that cross the basement membrane to assume an intraepithelial location and accumulate in the lumen of gastric pits to create pit abscesses

In addition, the superficial lamina propria includes large numbers of plasma cells, often in clusters or sheets, and increased numbers of lymphocytes and macrophages

Intraepithelial neutrophils and subepithelial plasma cells are characteristic of H. pylorigastritis.

Term
Autoimmune gastritis is characterized by antibodies against __________ cells & ____________
Definition
parietal
intrinsic factor
Term
Auto-immune gastritis is characterized by reduced serum _________ concentration
Definition
pepsinogen
Term
What kind of malnutrition does auto-immune gastritis cause, and why?
Definition
vitamin B12 deficiency (pernicious anemia)
because auto-immune gastritis involves auto-antibodies against parietal cells (which produce intrinsic factor), as well as directly against intrinsic factor. Intrinsic factor is necessary for absoprtion of B12
Term
achlorhydria
Definition
when gastric acid is not produced in the stomach
Term
hypochlorhydria
Definition
when less than normal amounts of gastric acid are produced in the stomach
Term
Would you expect stomach acid to be unusually high or unusually low in auto-immune gastritis.
Definition
unusually low
(auto-immune gastritis includes auto-antibodies against parietal cells, which produce intrinsic factor and gastric acid)
Term
What 2 things do parietal cells produce?
Definition
intrinsic factor
gastric acid
Term
What kind of cell in the stomach produces gastric acid?
Definition
parietal cells
Term
What 2 things do chief cells produce in the stomach? (one of them it doesn't produce all of the time)
Definition

pepsinogen

rennin

Term
What is the purpose of rennin?
Definition
curdles milk in newborns, slowing down gastric emptying
Term
Explain how the urea breath test for H. pylori works.
Definition
Patients swallow a capsule containing urea made from an isotope of carbon. If H. pylori is present in the stomach, the urea is broken up and turned into carbon dioxide. Samples of exhaled breath are collected, and the isotopic carbon in the exhaled carbon dioxide is measured.
Term
What test would you most likely use to test for the presence of H. pylori?
Definition
urea breath test
Term
Mean age of diagnosis of auto-immune gastritis
Definition
~60
Term
Which gender is at greater risk for auto-immune gastritis?
Definition
women
(women are typically at greater risk for most auto-immune diseases)
Term
Auto-immune gastritis leads to hyperplasia of what cells, and why?
Definition

G cells.

 

Autoimmune gastritis is associated with loss of parietal cells, which are responsible for secretion of gastric acid and intrinsic factor. The absence of acid production stimulates gastrin release (gastrin stimulates parietal cells to release gastric acid), resulting in hypergastrinemia and hyperplasia of antral gastrin-producing G cells.

 

(hyperplasia is proliferate; hypertrophy is getting bigger)

Term
What will you see if you look at the stomach of a person with auto-immune gastritis with an endoscope?
Definition
diffuse mucosal damage of the acid-producing mucosa within the body and fundus of the stomach.

Loss of rugae.
Term
What would you see with a microscope if you looked at a biopsy of the stomach of a person with auto-immune gastritis?
Definition
damage of acid-producing mucosa
infiltrate composed of lymphocytes, macrophages, and plasma cells.
Lymphoid aggregates may be present.
Term
What signs and symptoms would you expect from a person with auto-immune gastritis?
Definition

variable degrees of epigastric pain, upper GI discomfort, nausea, and vomiting GI blood loss (hematemesis/melena)

Possibly gastric perforation or obstruction.

Patient may exhibit signs & symptoms of B12 deficiency (anemia, sub-acute combined degeneration of spinal cord).

 

Patient may also exhibit other auto-immune disorders like Hashimoto thyroiditis, insulin-dependent (type I) diabetes mellitus, Addison disease, primary ovarian failure, primary hypoparathyroidism, Graves disease, vitiligo, myasthenia gravis, and Lambert-Eaton syndrome.

Term
What is a peptic ulcer?
Definition
Peptic ulcers are defects in the gastrointestinal mucosa that extend through the muscularis mucosae
Term
Where do peptic ulcers most commonly occur?
Definition
most commonly in the antrum of the stomach
second most commonly in the duodenum
Term
What's the difference between a peptic ulcer and a gastric ulcer?
Definition
a gastric ulcer is any discontinuity or break in stomach epithelium due to a gastric mucosal inflammatory process.

Peptic ulcers are ulcers in the GI tract in which the defect extends through the muscularis mucosae (so some peptic ulcers are gastric ulcers, and some gastric ulcers are peptic ulcers)
Term
Meckel's diverticulum
Definition

A small bulge in the distal ileum present at birth. 

It is a remnant of the connection from the yolk-sac to the small intestine present during embryonic development.

 

Occasionally, a Meckel's diverticulum will contain stomach mucosa (no one knows why), which will secrete stomach acid and ulcerate the unprotected small intestine.

Term
If you find an ulcer in the GI tract, how many more ulcers would you typically expect to find?
Definition
None. Ulcers are usually solitary. More than 2 or 3 ulcers may indicate Zollinger-Ellison syndrome.
Term
What would you expect to see with an endoscope if you looked at a peptic ulcer.
Definition
round to oval
sharply punched-out defect
Base of ulcer is smooth and clean
Term
What do G cells in the stomach produce?
Definition
gastrin
Term
What would you expect to see with a microscope if you looked at a biopsy of a peptic ulcer?
Definition
sharply punched-out defect (mucosa on either side is unaffected)
The base of peptic ulcers is smooth and clean as a result of peptic digestion of exudates
blood vessels may be evident
In active ulcers the base may have a thin layer of fibrinoid debris underlaid by a predominantly neutrophilic inflammatory infiltrate.
Beneath this, active granulation tissue infiltrated with mononuclear leukocytes and a fibrous or collagenous scar forms the ulcer base
Term
Describe the pain associated with peptic ulcers.
Definition
Epigastric burning or aching pain
The pain tends to occur 1 to 3 hours after meals during the day, is worse at night, and is relieved by alkali or food.
Term
What is epigastric pain?
Definition
pain that occurs in the top-middle region of the abdomen (the epigastrium, or epigastric region)
Term
What would you expect to see if you did an EGD endoscopy of a person with Zollinger-Ellison syndrome?
Definition
Multiple peptic ulcers in stomach (most commonly in the fundus, the part of the stomach between the cardia & the body) and duodenum (first part of the small intestine).
Term
What causes Zollinger-Ellison syndrome?
Definition
gastrin-secreting tumors, gastrinomas, that are most commonly found in the small intestine or pancreas.
Term
Where are the gastrin-secreting tumors that cause Zollinger-Ellison syndrome most commonly found?
Definition
in small intestine and pancreas
Term
What would be most remarkable about the stomach taken from the autopsy of a person who had had Zollinger-Ellison syndrome? Why?
Definition
The mucosa of the stomach would be twice as thick as normal
Because Zollinger-Ellison leads to a 5-fold increase of parietal cells, as well as hyperplasia of mucous cells, and proliferation of endocrine cells within the acid-producing mucosa
Term
In Zollinger-Ellison, gastrin-producing tumors lead parietal cells to produce too much gastric acid, which leads to hyper-production of:
Definition
mucin
Term
You look into the stomach of a person with an endoscope and find 7 ulcers. What do you think they might have?
Definition

Zollinger-Ellison syndrome

 

(ulcers are usually solitary, and you'll rarely find more than 2 unless the person has Zollinger-Ellison)

Term
Menetrier’s disease
Definition
Hypertrophic gastropathy characterized by giant cerebriform (resembling the brain) enlargement of the rugal folds due to epithelial hyperplasia without inflammation
Term
What causes Menetrier's disease?
Definition
excessive secretion of transforming growth factor--α (TGF-α) causes epithelial hyperplasia, which causes the rugae to grow big
Term
What would you expect to see if you looked at the stomach of a person with Menetrier's disease with an endoscope?
Definition

Irregular enlargement of the gastric rugae in the body and fundus of the stomach (may look like brain gyri)

the antrum is generally spared.

Some areas may look like polyps.

Term
What would you expect to see if you used a microscope to look at a biopsy of the stomach of someone with Menetrier's disease.
Definition
Histologically, the most characteristic feature is hyperplasia of foveolar mucous cells. The glands are elongated with a corkscrew-like appearance and cystic dilation is seen. Mild inflammation, intra-epithelial lymphocytosis may be present. Diffuse or patchy glandular atrophy, evident as hypoplasia of parietal and chief cells, is typical.
Term
What signs and symptoms would you expect to see in a person with Menetrier's disease?
Definition
low plasma protein levels
weight loss
diarrhea
peripheral edema
Term
Why do people with Menetrier's disease have low plasma protein levels?
Definition

The altered gastric mucosa secretes massive amounts of mucus, which passes through the GI system and out of the body, losing protein from the body.

 

(Menetrier's--mucous cells secrete massive amounts of mucous & hyprtrophy until the rugae of the stomach look like brain gyri, increasing the total mass of the stomach significantly)

Term
polyps
Definition
nodules or masses that project above the level of the surrounding mucosa
Term
Are upper GI polyps common?
Definition
yes; up to 5% of upper GI endoscopies show polyps
Term
At what age are polyps most commonly seen?
Definition
age 50-60
Term
Familial adenomatous polyposis (FAP)
Definition
an inherited condition in which numerous polyps form mainly in the epithelium of the large intestine.
Term
What 3 acute emergencies of the GI tract can vomiting and nausea indicate?
Definition

Obstruction

Perforation

Peritonitis

Term
What problems could vomiting and nausea lead to that are not acute emergencies but still warrant hospitalization?
Definition
Dehydration
electrolyte imbalance
Term
gastroparesis
Definition
a motor condition that affects the ability of the stomach to empty its contents
Term
turgor
Definition
pressure within cells
(ex., low turgor occurs with dehydration)
Term
How do you asses skin turgor when you suspect dehydration?
Definition
pinch skin on back of hand (or on tummy of infant). With good hydration, skin immediately returns to initial shape.

If dehydrated, the pinch will remain for a bit
Term
What 2 areas of the brain regulate vomiting?
Definition
Area postrema
Nucleus Tractus Solitarius (NTS)
Term
Area postrema
Definition

a part of the medulla oblongata on the floor of the fourth ventricle, which contains a chemoreceptor trigger zone sensitive to drugs, toxins, & neurotransmitter (one of the few "holes" in the blood-brain barrier)

 

the area postrema is one of 2 areas of the brain the stimulate vomiting (the other is the solitary nucleus)

Term
Nausea
Definition
the urge to vomit
Term
vomiting
Definition
forceful, coordinated act of expelling gastric contents through the mouth
Term
regurgitation
Definition
effortless movement of stomach content into the esophagus & mouth
not associated with distress or pain
individual may feel hungry immediately after
normal occurrence in neonates, treatable by child positioning, spontaneously disappears after the first several months of life
Term
When is regurgitation normal?
Definition
in neonates

treatable by positioning child spontaneously disappears after the first several months of life
Term
retching
Definition
spasmodic movements of respiratory muscles against closed glottis and contractions of the abdominal muscles without expulsion of gastric contents

Diaphragm raises
Abdominal wall muscles constrict
Movement of gastric muscles
Relaxation of cardia
Term
Rumination
Definition
chewing & swallowing of regurgitated food that has come back to the mouth within minutes of eating (not normal for human beings)
Term
Cephalic phase of digestion
Definition

before the food reaches the stomach (while you are preparing to eat)

 

Initiated by the thought, image, smell, or sight of food

 

Initiates salivary & gastric secretions (getting more acidic) in anticipation of entry of food into the gastrointestinal system.  Cephalic phase causes 30% of acid response to a meal

Term
The cephalic phase of digestion is mediated by innervation of the stomach via the _________________
Definition
vagus nerve (CN X)
Term
gastric phase of digestion
Definition
while the food is in the stomach (while you are eating)
Initiated by the entry of food into the stomach
Term
What are some stimuli that increased the acidity of the stomach lumen?
Definition

anticipation of food

Stomach Distention

 

Ingestion of:

Peptides & Amino acids

Calcium

Alcohol (especially wine)

Caffeine

Coffee

Term
What happens to the lumen of the stomach when you anticipate food?
Definition
it gets more acidic
(The cephalic phase causes 30% of the acid response to a meal)
Term
Intestinal phase of digestion
Definition
after the food leaves the stomach
Most of digestion happens in this phase
Mediated by neural & humoral stimulation in the upper duodenum
Term
Acinar cell
Definition
any cell in a many-lobed berry-like cluster, such as alveoli and the termination of exocrine glands
Term
How does saliva differ from plasma?
Definition
hypotonic to plasma
V. low in Na+ & Cl-
High in K+ & HCO3-
Term
As you eat, what happens to your saliva?
Definition

It becomes more abundant

 

It comes to resemble plasma more closely (because it doesn't spend as much time in the salivary ducts being modified)

Term
Saliva is filtrated from the plasma then modified in the ___________________
Definition
salivary ducts
Term
Fundus of the stomach
Definition
the portion of the stomach above and to the left of the cardiac orifice
Term
cardiac orifice of the stomach
Definition
where the esophagus empties into the stomach
Term
cardia of the stomach
Definition
the part of the stomach attached to the esophagus
Term
When you eat, what nerve carries the afferent signal that there is food in the stomach? What nerve carries the efferent signal for the fundus to relax? What humoral signal is also used to tell the fundus to relax?
Definition
Vagus nerve (CN X)
Vagus nerve (CN X)
Vasoactive Intestinal Polypeptide (VIP)
Term
vagovagal reflexes
Definition
GI reflexes where the afferent and efferent tracts are in the vagus nerve (CN X0
Term
How will you have to change your eating habits if you have a vagotomy?
Definition
you will have to eat smaller meals because the stomach will not stretch to receive food
Term
Gastric pit
Definition
dents in the stomach at entrances to the tubular shaped gastric glands.
Term
Parietal cells
Definition
big cells that produce stomach acid and intrinsic factor
Term
If you put someone on proton-pump inhbitors, what do you need to regularly test their serum for?
Definition

 B12 levels

 

parietal cells produce stomach acid and instrinsic factor--proton-pump inhibitors inhibit both functions.  If you take proton-pump inhibitors, you need to keep an eye on B12

Term
Mucuous neck cells produce
Definition

mucous & pepsinogen

 

(mucous neck cells are so-called because they reside in the upper part, or neck, of the gastric glands)

Term
G-cells produce
Definition
gastrin
Term
What does gastrin do?
Definition

stimulates the parietal cells of the stomach to secrete gastric acid (HCl)

 

increases motor activity in the colon

Term
Part of irritable bowel syndrome may be an oversensitivity to the chemical __________
Definition
gastrin

(gastrin is released when you eat a meal and increases colon motility; people with irritable bowel syndrome can often not get through a meal without going to the bathroom to have a BM)
Term
Enterochromaffin-like cells in the stomach produce
Definition
histamine
Term
After food enters the stomach, it's called _________
Definition
chyme
Term
What is the primary reason that the lumen of the stomach is so acidic?
Definition
to kill bacteria that enter via the mouth
Term
From what part of the stomach is gastrin released, and when?
Definition
G cells deep in the gastric glands of the antrum release gastrin when food reaches the pyloric part of stomach (that is, right when you start eating--food goes to the bottom of the stomach first )
Term
4 main types of learning
Definition
• Habituation & sensitization
• Classical conditioning
• Operant conditioning
• Modeling
Term
Habituation
Definition
learning in which repeated stimulation decreases a response

ex., “at first the allergy shots hurt, but I got used to it”
Term
Sensitization
Definition
learning in which unusually strong or painful stimulation causes increased a response

ex., “after the shooting, any loud noise freaks me out”
Term
Unconditioned stimulus
Definition
stimulus that would naturally cause a response (when a dog sees food, it salivates--food is an unconditioned stimulus)
Term
Unconditioned response
Definition
natural response (ex., dog salivates b/c of food, saliva is the unconditioned response)
Term
Neutral stimulus
Definition
stimulus that would not naturally cause a response (bell doesn’t naturally cause salivation)
Term
Conditioned response
Definition
trained response to neutral stimulus by associating it with the unconditioned stimulus (salivate when bell rings)
Term
Acquisition (with regard to learning)
Definition
development of conditioned response to neutral stimulus
Term
Extinction (with regard to learning)
Definition
if you ring the bell without giving the food, you can extinguish the conditioned response
Term
Spontaneous recovery (with regard to learning)
Definition

if a previously conditioned response was extinguished (ex., by ringing the bell multiple times without giving food), it can be revived by associating the neutral stimulus and conditioned response again (ex., by ringing the bell & giving food again)

 

It takes much less time to recover a conditioned response than to acquire the response in the first place

Term
Operant conditioning
Definition
learn from positive or negative consequences from interaction with environment
Subject is much more active than in classical conditioning
Term
Fixed ratio reinforcement schedule
Definition
reinforcement occurs after every X interactions with the environemnt

ex., every time toddler potties in potty, give a piece of candy
Term
Fixed interval reinforcement schedule
Definition
reinforce behavior after fixed intervals of time

ex., for every hour a toddler is dry (during potty training), give a piece of candy
Term
Variable ratio reinforcement schedule
Definition
Reinforce a behavior after variable repeats of the behavior

ex., slot machines
Term
Variable interval reinforcement schedule
Definition
reinforce behavior at varying intervals of time
Term
How does a fixed ratio reward reinforcement schedule affect the time of acquisition and extinguishment of behaviors?
Definition
you acquire the behavior quickly, but it also extinguishes quickly

ex., if a mouse gets a treat every time it presses a bar, then it will quickly learn to press the bar. However, if it stops getting treats when it presses the bar, it will quickly lose interest.
Term
How does a variable ratio reward reinforcement schedule affect the time of acquisition and extinguishment of behaviors?
Definition
variable ratio reinforcement leads to slow acquisition of behaviors, but also slow extinguishment

ex., if a mouse gets a treat after pressing the bar a random number of times, it will take a while to realize that it has to press the bar to get the treat. However, if it stops getting treats when it presses the bar, it will keep trying for a long time.
Term
Positive reinforcement
Definition
reinforcement by adding a good thing
Term
Negative reinforcement
Definition
reinforcement by taking away a bad thing

negative reinforcement is NOT the same thing as punishment!
Term
Punishment
Definition
unpleasant thing you do to decrease behavior
Term
Negative reinforcement seeks to __________ a behavior while punishment seeks to ____________ a behavior.
Definition
increase

decrease

(negative reinforcement is taking away something the person doesn't like if they perform a desired behavior)

(ex., "you don't have to do your chores if you do your homework without complaining" vs. "if you complain too much about your homework, you'll have to do extra chores")
Term
3 major functions of gastric acids
Definition

• Bacteriostatic (most important)

• Converts pepsinogen to pepsin

• Helps digest proteins a little

Term
Where does the H+ for HCl in gastric acid come from
Definition
CO2 + H2O <-> H2CO3 -> H+ + HCO3-

CO2 can be pulled from the blood or made in the stomach
Term
What happens to blood pH after a meal, and why?
Definition

It becomes a little alkaline

 

The H+ in stomach acid is made from water and CO2 pulled from the blood. Bicarbonate is a by-product, and most of it is dumped back into the blood.  Some of it is excreted by parietal cells to create a protective layer between themselves and the stomach acid.

 

CO2 + H2O <-> H2CO3 -> H+ + HCO3-

Term
What effect do histamine, gastrin, and acetylcholine have on stomach acid production separately? What effect do they have all together?
Definition
separately, each slightly increases stomach acid production

together, they increase stomach acid production a LOT
Term
The only digestive enzyme produced in the stomach of adults
Definition
Pepsinogen (becomes pepsin)
Term
Rennin
Definition
"REEN-en"
an enzyme produced in the stomach of infants that curdles milk proteins and causes milk to be retained longer in the stomach than it otherwise would be
Term
What 2 signals stimulate the secretion of pepsinogen?
Definition
Vagal stimulation as mediated by acetylcholine
Direct response to gastric acid
Term
What cleaves pepsinogen to form pepsin?
Definition
acid
Term
What treatment do you need if you don’t have intrinsic factor?
Definition
B12 injections (because without intrinsic factor, you can't absorb B12 from the intestine)
Term
You can live without most of the stomach and not need medical treatment (as long as you eat carefully), with one exception. What is the only medical treatment that you will definitely need?
Definition

you will need B12 shots

 

You cannot absorb B12 enterally without intrinsic factor, produced by parietal cells of the stomach.

Term
What are the 2 ways the gastric mucosa prevents H+ ions from leaking back into the mucosa? How else does it protect itself from stomach acid?
Definition
Anatomical—cell membranes & tight junctions between cells

Physiological—diffused H+ ions are transported back to lumen

Parietal cells produce a tiny bit of HCO3- that produces a neutral layer between themselves & the acid
Term

Explain what's wrong with the following statement: "Mucous protects the stomach muscoa from stomach acid"

Definition

Mucous membrane is more to protect tissues from physical abrasion & cuts. But, if tissue is broken or damaged, underlying cells are exposed to acid, and an ulcer can start

 

the stomach mucosa protects itself from acid by: Anatomical—

cell membranes & tight junctions between cells

Physiological—

diffused H+ ions are transported back to lumen

Parietal cells produce a tiny bit of HCO3- that produces a neutral layer between themselves & the acid

Term
Main cause of stomach ulcers
Definition
Helicobacter pylori
Term
How does Helicobacter pylori cause stomach ulcers?
Definition

It secretes agents that stick to the cell surface and break down the tight junctions between cells. 

 

These tight juntions form an anatomical barrier between the stomach acid and the mucosa, so without them the stomach acid can enter and damage the mucosa.

Term
What treatments do you give someone with ulcers?
Definition
Antibiotics (to kill H. pylori)

Drugs to decrease stomach acidity:
Acid pump inhibitors
Antacids
H2 receptor blockers

Surgery (rare)
Vagotomy
Antrectomy
Term
95% of people with duodenal ulcers and 100% of patients with gastric ulcers have:
Definition
H. pylori infection

But the majority of people have H. pylori & no ulcers—we don’t know why that is
Term
Can an ulcer be life threatening?
Definition
Yes. If the ulcer erodes all the way through to arteries, you can bleed out
Term
What are 4 common things that weaken the mucosal barrier of the stomach?
Definition
H. pylori
Aspirin & other NSAIDs
Ethanol
Bile salts (from vomiting)
Term
What are 4 common things that strengthen the mucosal barrier of the stomach?
Definition
Mucus
HCO3-
Prostaglandins (PGs)—that’s why NSAIDs cause problems
Epidermal growth factor
Term
Is H. pylor gram positive or gram negative?
Definition
gram negative
Term
What are the 2 plexuses in the gut?
Definition

Myenteric plexus

(between the longitudinal and circular layers of muscularis externa in the GI tract; provides motor innervation to both; contains sympathetic & para-sympathetic fibers)

 

Plexus of the Submucosa

(pierces the circular muscular layer & lies in the submucosa of the GI tract; innervates the muscularis mucosa & the mucous membrane; contains para-sympathetic fibers only)

Term
What is the difference between multi-unit and unitary/single unit smooth muscle?
Definition
Multi-unit:
o Like skeletal muscle, each muscles cell is innervated
o No gap junctions
o Each cell must be activated to contract

Unitary/Single unit:
o Whole layer acts as one syncitium—stimultion of 1 cells causes whole layer to contract
o Contains gap junctions
Term
In smooth muscle, most of the Calcium comes from:
Definition
outside of the cell

(this is possible because smooth muscle cells are slimmer than skeletal muscle cells)
Term
When Ca2+ enters smooth muscle, it binds to ___________
Definition
calmodulin (CaM)
Term
After Ca2+ enters smooth muscle, it binds to calmodulin (CaM), and the Ca2+-calmodulin complex activates _____________
Definition
Myosin Light Chain Kinase (MLCK)
Term
In smooth muscle, _____________ phosphorylates light chains in myosin heads & increase myosin ATPase activity
Definition
Myosin Light Chain Kinase (MLCK)
Term
The myosin in skeletal muscle is like an old man's thing that needs Viagra to energize it. What is it's Viagra?
Definition
Myosin Light Chain Kinase (MLCK)
Term
Why are none of the viruses that cause gastroenteritis enveloped?
Definition
because an envelope wouldn't be able to make it through the stomach acid, so it wouldn't be good for fecal-oral transmission
Term
Why are all the viruses that commonly cause gastroenteritis easily transmissible on fomites?
Definition
because the lack of envelope means that they can resist dessication
Term
What virus is the most common cause of gastroenteritis in young children?
Definition
Rotavirus
Term
Where does rotavirus most commonly cause outbreaks?
Definition
pre-schools, day care, and among hospitalized infants
Term
Which of the following is more likely to cause a fever? adenovirus rotavirus
Definition

rotavirus usually causes a fever (Rotavirus Raises temperature)

 

adenovirus rarely causes a fever (adenovirus, NO fever)

Term
A 2-year-old has a fever and is throwing up. What virus do they most likely have?
Definition
rotavirus
Term
A 2-year-old is throwing up. They do not ever develop a fever throughout the course of their illness. What virus do they most likely have?
Definition
adenovirus
Term
What 2 viruses most commonly cause gastroenteritis in young children (under age 3)?
Definition
adenovirus
rotavirus
Term
A 5-year-old catches a virus and starts throwing up. Why is it probably not adenovirus or rotavirus?
Definition
Most people have had adenovirus and rotavirus by age 3 and are immune for the rest of their lives
Term
Who is most likely to get adenovirus? Rotavirus? Norwalk virus?
Definition
adenovirus & rotavirus--most likely children < age 3

Norwalk virus--older children & adults
Term
What family does adenovirus belong to?
Definition
adenoviridae
Term
What family does hepatitis A belong to?
Definition
picornaviridae
Term
What family does rotavirus belong to?
Definition
reoviridae
Term
What family does calicivirus belong to?
Definition
caliciviridae
Term
What family does Norovirus (aka Norwalk virus) belong to?
Definition
Caliciviridae
Term
What family does astrovirus belong to?
Definition
astroviridae
Term
Describe the envelope, capsid, & genome morphology of adenovirus.
Definition
naked
deltaicosahedral capsid
linear dsDNA
Term
Describe the envelope, capsid, & genome morphology of hepatitis A virus.
Definition
naked
icosahedral capsi
(+)ssRNA
Term
Describe the envelope, capsid, & genome morphology of rotavirus .
Definition
naked
3-layered icosahedral capsid
11 segs of dsRNA
Term
Describe the envelope, capsid, & genome morphology of calicivirus
Definition
naked
hexagonal/spherical icosahedral capsid
(+)ssRNA
Term
Describe the envelope, capsid, & genome morphology of Norovirus (Norwalk virus).
Definition
naked hexagonal/spherical icosahedral capsid (+)ssRNA (it's a member of the caliciviridae family, so these are the same as calicivirus)
Term
Describe the envelope, capsid, & genome morphology of Astrovirus
Definition
naked
icosahedral capsid
(+)ssRNA
Term
Reoviridae, such as rotavirus, unlike many viruses, need to produce their own ____ because of the type of cells they infect.  Explain.
Definition

polymerase

 

because they infect terminally differentiated enterocytes near the tips of villi in the small intestine. These cells don't express polymerase because they are non-dividing

Term
What does VP4 on reoviridae, such as rotavirus, do?
Definition
it is a spike protein on the surface of the capsid that helps the virus bond to and enter the cell
Term
A reoviridae, such as rotavirus, has an outer capside made of the glycoprotein ________, covered with spikes of the protein _________
Definition
VP7 VP4
Term
By the time rotavirus gets into the cell, how many capsid layers does it have?
Definition
2 (the outer capsid is lost in entering the cell)
Term
Why do reoviridae, such as rotavirus, need to increase Ca2+ within an infected cell?
Definition
because Ca2+ is necessary to form VP7, the glycoprotein that makes up the outer capsid
Term
What do reoviridae, such as rotavirus, use NSP4 protein for?
Definition
causes cell to release Ca2+ from endoplasmic reticulum (which causes cell to dump water & Cl-, which causes diarrhea)

disrupts tight junctions, allowing H2O and electrolytes to flow between adjacent cells

stimulates enteric nervous system
Term
What are the palpable bones of the abdomen?
Definition

xyphoid process

costal margin

tubercle of the iliac crest
anterior superior iliac spine

pubic tubercle

pubic crest

pubic symphysis

Term
Subcostal plane
Definition
a transverse plane of the abdomen beneath the lowest point of the costal margin
Term
Transtubercular plane
Definition
a transverse plane of the abdomen that passes through the iliac tubercles (at the level of L5)
Term
Right hypochondriac region
Definition
above the subcostal plane, right of the right midclavicular line
(Hypochondria “under the cartilage (of the breastbone)”)
Term
Epigastric region
Definition
above the subcostal plane, between the right & left midclavicular lines
(Epigastric “over the belly” )
Term
Left hypochondriac region of the abdomen
Definition
above the subcostal plane, left of the left midclavicular line
Term
Left lumbar region of the abdomen
Definition
between the subcostal plane & the transtubercular plane, left of the left midclavicular line
Term
Umbilical region of the abdomen
Definition
between the subcostal plane & the transtubercular plane, between the right and left midclavicular lines (umbilicus is about in the middle)
Term
Right lumbar region of the abdomen
Definition
between the subcostal plane & the transtubercular plane, right of the right midclavicular line
Term
Right inguinal region of the abdomen
Definition
below the transtubercular plane, right of the right midclavicular line
Term
Hypogastric region of the abdomen
Definition
below the transtubercular plane, between the left & right midclavicular line

(Hypogastric “under the belly”)
Term
Left inguinal region of the abdomen
Definition
below the transtubercular plane, left of the left midclavicular line
Term
Camper’s fascia
Definition

fatty layer directly under the skin of the abdomen

 

(you need a fatty layer to keep warm if you're going to go camping)

Term
Scarpa’s fascia
Definition
Membranous layer (fibrous connective tissue) under the subcutaneous fat in the abdomen. Continuous with other, named fascias in the perineum
Term
What are the 9 layers of the abdominal wall from outer to inner (at the front-side of the abdomen)
Definition

Skin

Camper’s fascia—fatty layer directly under the skin of the abdomen

Scarpa’s fascia—membranous layer (fibrous connective tissue under the subcutaneous fat in the abdomen. Continuous with other, named fascias in the perineum)

External oblique muscle

Internal oblique muscle

Transverses abdominis muscles

Transversalis fascia

Extraperitoneal fascia

Parietal peritoneum

Term
Deep inguinal ring
Definition
the upper, lateral end of the inguinal canal
Term
Superficial inguinal ring
Definition
the lower, medial end of the inguinal canal
Term
What 3 muscles make up the inguinal canal?
Definition
external oblique, internal oblique, & transverse abdominis
Term
The inguinal canal is wider in ______
Definition
males
Term
In males, what does the inguinal canal carry?
Definition
the spermatic cord (vas deferens + surrounding tissue)
Term
Spermatic cord
Definition
vas deferens + surrounding tissue
Term
The vas deferens (aka ductus deferens) carries sperm from the _________ to the __________
Definition
testes
ejaculatory ducts
Term

The testes and penis are right next to each other, yet the vas deferens has a somewhat circuitous pathway.  What is this pathway, and why is it circuitous? 

 

 

Definition

the vas deferens leaves the testes, goes up the inguinal canal, into the abdomen, and back down to the penis

 

During fetal development, the testes develop in the abdomen. During this time the path from the testes to the penis is more of a straight shot. However, at some point during development, the testes descend through the inguinal canal into the scrotum, dragging the vas deferens after them.

Term
In females, the inguinal canal contains the:
Definition
round ligament of the uterus
Term
Round ligament of the uterus
Definition
starts at the uterine horns, passes through the inguinal canal and continues on to the labia majora where its fibers spread and mix with the tissue of the mons pubis.
Term
Inguinal hernia
Definition
when part of the intestine protrudes through a weak spot in the inguinal canal or in the inguinal triangle
Term
Who is more likely to get inguinal hernias, and why?
Definition
males, because their inguinal canal is bigger than women's
Term
Are indirect or direct inguinal hernias more common?
Definition
indirect (inborn)
Term
Indirect inguinal hernia
Definition
• intestine passes through the (congenitally open) deep inguinal ring, inguinal canal, and superficial ring, and descends into the scrotum
Term
What causes an indirect inguinal hernia? (Why is the intestine able to enter the inguinal canal?)
Definition
the deep inguinal ring fails to close during embryonic development after the testicle has passed through it.
Term
The intestine descends all the way to the scrotum in ________ (direct/indirect) inguinal hernias.
Definition
indirect
Term
Are indirect inguinal hernias developed during life, or are they congenital?
Definition
congenital
Term
direct inguinal hernia
Definition
intestine is pushed through a weakened area of the abdominal wall muscles (posterior wall of the inguinal canal), but does not descend into the scrotum
Term
Are direct inguinal hernias acquired during life, or are they congenital?
Definition
acquired during life (although the weakenss in the posterior wall of the inguinal canal may be congenital)
Term
In which kind of inguinal hernia is the protruding intestine surrounded by a sac of peritoneum?
Definition
direct inguinal hernia
Term
The rectus sheath is formed by the fusion of the aponeuroses of what 3 muscles?
Definition
external oblique
internal oblique
transverse abdominis
Term
What is the relationship between the rectus sheath and the rectus abdominis in the upper abdomen? In the lower abdomen?
Definition
upper abdomen--surrounds the rectus abdominis

lower abdomen--passes in front of the rectus abdominis
Term
The iliohypogastric nerve arises from what nerve root?
Definition
L1
Term
The iliohypogastric nerve innervates the __________ and _____________ muscles.
Definition
internal oblique muscle
transverse muscle
Term
The iliohypogastric nerve divides into 2 branches:
Definition
the lateral cutaneous nerve
the anterior cutaneous nerve
Term
What skin does the lateral cutaneous branch of the iliohypogastric nerve innervate?
Definition
skin on the lateral side of the buttocks
Term
What skin does the anterior cutaneous branch of the iliohypogastric nerve innervate?
Definition
the skin superficial to the pubis
Term
What nerve root does the ilioinguinal nerve arise from?
Definition
L1
Term
What 2 muscles does the ilioinguinal nerve innervate?
Definition
the internal oblique muscle
the transverse oblique muscle
Term
What 2 branches does the ilioinguinal nerve give rise to?
Definition
the femoral branch the anterior scrotal nerve
Term
What skin does the femoral branch of the ilioinguinal nerve innervate?
Definition
the upper anterior and medial parts of the thigh
Term
What skin does the anterior scrotal nerve innervate in men? In women?
Definition
o in men, innervates the skin at the root of the penis & the anterior part of the scrotum

in women, innerves the skin of the mons pubis and the labium majus (pl., labium majora)
Term
The autonomic nervous system innervates _________ muscle, _______ muscle, and __________
Definition
cardiac
smooth
gland
Term
Each pathway in the autonomic nervous system involves ___ (#) neurons, which are:
Definition

2

 

pre-ganglionic neuron

post-ganlionic neuron

Term
The __________ nervous system provides the fight-or-flight response.
Definition
sympathetic
Term
What effect does sympathetic innervation have on the following:
heart rate
bronchial lumen
coronary arteries
hair follicles
sweat glands
Definition
increases heart rate
dilates bronchial lumen
dilates coronary arteries
raises erector pili muscles in hair follicles
increases sweat
Term
Where are the cell bodies of the pre-ganglionic (primary) neuron of the sympathetic system?
Definition
in the lateral horn or intermediolateral cell column of spinal cord segments T1 - T3
Term
The fibers of the pre-ganglionic (primary) neuron of the sympathetic system exit the spine via the?
Definition
white rami communicantes
Term
After passing through the white rami communicantes, fibers of the pre-ganglionic nerve of the sympathetic system synapse on the post-ganglionic nureon in:
Definition
a sympathetic chain ganglion
Term
Where is the cell body of the post-ganglionic (secondary) neuron of the autonomic nervous system?
Definition
in a sympathetic chain ganglion
Term
Fibers of the post-ganglionic (secondary) nerve of the sympathetic nervous system leave the sympathetic chain ganglion & join each nerve via the:
Definition
gray rami communicantes
Term
Sympathetic trunks
Definition
a pair of bundled sympathetic post-ganglionic nerve fibers and visceral afferant fibers that travel down either side of the vertebra
Term
general visceral afferent (GVA) fibers
Definition
conduct sensory impulses (usually pain or reflex sensations) from the viscera, glands, and blood vessels to the central nervous system
Term
What fibers are carried in the sympathetic trunk?
Definition

ascending & descending pre-ganglionic sympathetic fibers

 

visceral afferent fibers

Term
formed by fusion of the inferior cervical ganglion with the first thoracic ganglion
Definition
cervicothoracic (stellate) ganglion
Term
Which are more widely distributed over the body: sympathetic or para-sympathetic fibers.
Definition
sympathetic fibers
Term
Pre-ganglionic (first-order neuron) cell bodies of the __________ nervous system are located in intermediolateral cell column (mostly) or lateral horn of spinal cord segments T1-T3
Definition
sympathetic
Term
What nerve root innervates the skin overlying the tip of the xiphoid process?
Definition
T7
Term
What nerve root innervates the skin of the umbilicus?
Definition
T10
Term
What nerve root innervates the skin just superior to the pubic symphysis?
Definition
T12
Term
What nerve root innervates the skin overlying the pubic symphisis?
Definition
L1
Term
The external obliques are superficial the the _________ _________
Definition
internal obliques
Term
What 2 nerves innervate the external obliques?
Definition
thoracoabdominal nerves
subcostal nerve
Term
What nerve roots feed into the thoracoabdominal nerves?
Definition
T7-T11
Term
What do the external obliques do?
Definition
Compresses & supports abdominal viscera
Flexes & rotates trunk
Active in forced expiration
Term
The internal obliques are deep to the ____________________, superficial to the ___________________
Definition
Deep to the external oblique, superficial to the transverses abdominis
Term
What 2 nerves innervate the Internal obliques?
Definition
Thoracoabdominal nerves
L1 nerves
(same as transverse abdominis)
Term
What do the internal obliques do?
Definition
Compresses & supports abdominal viscera
Flexes & rotates trunk
Term
The transverse abdominus is deep to:
Definition
the internal oblique
Term
What 2 nerves innervate the transverse abdominus?
Definition
Thoracoabdominal nerves
L1 nerves
(same as internal oblique)
Term
What are the main actions of the transverse abdominis?
Definition
Compresses & supports abdominal viscera
Depresses ribs (for forced expiration)
Term
The rectus abdominis is in the center of the abdomen superficial to the ____________________
Definition
external oblique
Term
What nerves innervate the rectus abdominis?
Definition
Thoracoabdominal nerves (anterior rami of the T6-T12 spinal nerves)
Term
What does the rectus abdominis do?
Definition
Flexes trunk (lumbar vertebrae)
Compresses abdominal viscera
Stabilizes & controls tilt of pelvis (anti-lordosis)
Depresses ribs (for forced expiration)
Term
The superficial epigastric artery arises from the __________________
Definition
femoral artery (the large artery of the hip & thigh)
Term
The superficial epigastric artery supplies:
Definition
the superficial abdominal wall of the pubic & inferior umbilical regions
Term
What artery supplies the superficial abdominal wall of the pubic & inferior umbilical regions?
Definition
superficial epigastric artery
Term
The superior epigastric artery is a direct continuation of the:
Definition
internal thoracic artery
Term
The superior epigastric artery supplies:
Definition
the superior half of the rectus abdominis muscle
Term
What artery supplies the superior half of the rectus abdominis muscle?
Definition
superior epigastric artery
Term
The inferior epigastric artery arises from the:
Definition
external iliac artery
Term
The inferior epigastric artery supplies the:
Definition
inferior half of the rectus abdominis muscle
Term
What artery supplies the inferior half of the rectus abdominis muscle?
Definition
inferior epigastric artery
Term
What artery is located within the layer of extraperitoneal fascia posterior to the spermatic cord or round ligament of the uterus?
Definition
inferior epigastric artery
Term
In the anterior abdominal wall, superficial lymphatic vessels superior to transumbilical plane primarily drain to _____________________ lymph nodes, though a few drain to _______________________ lymph nodes
Definition
axillary
parasternal
Term
In the anterior abdominal wall, superficial lymphatic vessels inferior to the transumbilical plane drain to __________________________ lymph nodes
Definition
superficial inguinal lymph nodes
Term
_________ lymph nodes are located at the anterior ends of the intercostal spaces
Definition
parasternal
Term
Deep lymphatic vessels of the anterior abdominal wall drain to what 4 groups of lymph nodes?
Definition
external iliac lymph nodes
common iliac lymph nodes
right lumbar lymph nodes
left lumbar lymph nodes
Term
What venous plexus drains the skin and subcutaneous tissue of the anterior abdominal wall?
Definition

subcutaneous venous plexus

 

(the subcutaneous venous plexus drains skin over much or all of the body)

Term
In the anterior abdomen the subcutaneous venous plexus drains superiorly to the _____________ vein and _______________ vein, and inferiorly to the _____________ vein and ______________ vein
Definition

internal thoracic vein

lateral thoracic vein

 

superficial epigastric vein

inferior epigastric veing

Term
At what age are you most likely to get chronic gastritis? What gender is more likely to get them?
Definition
males age 50-60yo
Term
What 2 illnesses most pre-dispose a person to gastric adenoma?
Definition
Familial Adenomateous Polyposis (FAP)
chronic gastritis
Term
What you see if you looked with an endoscope at the stomach of a person with gastric adenoma?
Definition
solitary lesions <2cm in diameter, most commonly located in the antrum
Term
Below the body of the stomach, but above the pylorus is the _______ __________
Definition
pyloric antrum
Term
What would you see if you looked at a biopsy of a gastric adenoma with a microscope?
Definition

Gastric adenomas are composed of intestinal-type columnar epithelium

 

epithelial dysplasia is always present

 

(recall: dysplasia is abnormal cell development marked by Anisocytosis—cells of unequal size, Poikilocytosis—abnormally shaped cells, Hyperchromatism, and presence of mitotic figures—an unusual # of cells which are currently dividing)

Term
What signs and symptoms might a person with gastric adenoma present with?
Definition
may be asymptomatic
may present with nausea, vomiting, or epigastric pain
Term
In what 2 geographical locations is the incidence of gastric adenoma highest?
Definition

Japan

Eastern Europe

Term
Most common malignancy of the stomach, comprising over 90% of all gastric cancers.
Definition
gastric adenocarcinoma
Term
What are risk factors for gastric adenocarcinoma?
Definition
highest incidence in Japan & Eastern Europe
low fiber diet
dietary carcinogens (N-nitroso compounds and benzo[a]pyrene) for food preservation
Familial Adenomatous Polyposis
Term
"Doc, my mom had stomach cancer, gastric adenocarcinoma. Now you say I've got an ulcer from H. pylori, but it's not cancer. Is this ulcer gonna give me cancer?"
Definition
ulcers can be confused with cancer, but Peptic Ulcer Disease does NOT predispose a person to adenocarcinoma.
Term
How can you reduce your risk of gastric adenocarcinoma?
Definition
eat a lot of green, leafy vegetables and citrus fruits, which contain antioxidants such as vitamin C, vitamin E, and beta-carotene
Term
What would you see if you looked with an endoscope in the stomach of someone with intestinal-type gastric adenocarcinoma?
Definition
bulky tumors, exophytic (growing outward) mass, ulcerated tumor
Term
What would you see if you looked with an endoscope into the stomach of a person with diffuse gastric adenocarcinoma?
Definition
plastic texture
mass is difficult to locate
when there are large areas of infiltration, diffuse rugal flattening & a rigid, thickened wall may impart a "leather bottle" appearance
Term
What are the 2 main types of gastric adenocarcinoma?
Definition
intestinal-type gastric adenocarcinoma

diffuse gastric adenocarcinoma
Term
What would you see if you looked with a microscope at a biopsy of intestinal-type gastric adenocarcinoma?
Definition
columnar, gland-forming cells infiltrating through desmoplastic stroma
(desmoplastic stroma: fibrosis induced around some types of cancer)
Term
What would you see if you looked with a microscope at a biopsy of diffuse gastric adenocarcinoma?
Definition
signet-ring cells can be rocognized by their large cytoplasmic mucin vacuoles and peripherally displaced, crescent-shaped nuclei
Term

Describe signet-ring cells. 

 

What are they a hallmark of?

Definition

signet-ring cells can be rocognized by their large cytoplasmic mucin vacuoles and peripherally displaced, crescent-shaped nuclei

 

diffuse gastric adenocarcinoma.

Term
What signs & symptoms might a person with gastric adenocarcinoma present with?
Definition
epigastric pain
GI blood loss
nausea
vomiting
obstruction (if it tends to grow out in a mass--intestinal-type)
signs & symptoms of gastroparesis
Term
carcinoid tumor
Definition

carcinoid tumors arise from the diffuse components of the endocrine system

 

(ex., the tumors reponsible for Zollinger-Ellison Syndrome may be carcinoid tumors)

Term
At what age do carcinoid tumors most frequently appear?
Definition
the 60s
Term
Where are carcinoid tumors most likely to occur?
Definition
the majority are found in the GI tract (especially the small intestine)
2nd most common site: tracheobronchial tree & lungs
Term
Where in the stomach do carinoid tumors most commonly occur?
Definition
body & fundus
Term
Grossly, what do carcinoid tumors look like?
Definition
intramural or submucosal masses that creat small polypoid lesions
the overlying mucosa may be intact or ulcertaed
the tumors may invade deeply to involve the msentery
tend to be yellow or tan in color
very firm as a consequence of desmoplastic reaction (meaning that the tumor induces fibrosis in surround tissue), which may cuase kinking of hte bowl and obstruction
Term
What does a biopsy of a carcinoid tumor look like, microscopically?
Definition
islands, trabeculae (rods), strands, glands, or sheets of uniform cells with scant, pink granular cytoplasm and a round to oval stippled nucleus
in most tumors, there is minimal pleomorphism
Term
What are the clinical features of carcinoid tumor?
Definition
determined by the hormones
gastrin-producing carcinoids may cause Zollinger-Ellison Syndrome
Ileal carcinoids produce cutaneous flushing, sweating, bronchospasm, colicky abdominal pain, diarrhea, and right-sided cardiac vulvular fibrosis
Term

 Explain the following mnemonic: 

 

Cushing is Pushing;  Curling is Burning

Definition

Cushing’s ulcers are gastric (stomach, dudodenum, distal esophagus) stress ulcers as the the result of high intracranial pressure (pushing)

 

Curling ulcers are stress ulcers in the duodenum as the result of severe burns to the surface of the body

Term

 

Lamina propria

Definition
a thin layer of loose connective tissue which lies beneath the epithelium and together with the epithelium constitutes the mucosa
Term

Fill in and explain the following mnemonic:

 

Rotavirus Raises _____

AdeNOvirus, NO _______

Definition

Rotavirus Raises Temp

AdeNOvirus, NO Fever

 

Rotavirus & Adenovirus are the most common causes of GI infection in babies and children up to age 3.  They have very similar symptoms, except that Rotavirus causes a fever, and Adenovirus does not.

Term

Explain the following mnemonic:

 

INdirect is INborn

Direct Develops later

Definition

An indirect inguinal hernia is present from birth.  It is due to a developmental error in the embryo, in which the deep inguinal ring fails to close after the testicle has passed through it.  The intestine pushes through the deep inguinal ring during development and extends into the scrotal sac at birth.

 

A direct hernia develops after birth, when the intestine pushes through the posterior wall of the inguinial canal.  The weakness in the posterior wall, though, may be congenital or may develop later.

 

Term
What 3 chemicals induce the parietal cells to produce stomach acid?
Definition

histamine

gastrin (from parietal cells)

acetylcholine (from innervation by the vagus nerve)

 

Together, the 3 chemicals have a much stronger effect on acid production than any of them has individually.

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