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PreClinEazy X Cardiff Medsoc GASTR OINTESTINAL Eliza HydePCS Anatomy of the GI tract Digestion and absorption in upper GI Fed and fasting states Hormones involvedAnatomy of the GI Tract Anterior Abdominal Wall Superficial Layers Deep Layers Skin Muscles Camper fascia Extraperitoneal fat Scarpa fascia Transversalis fascia Deep fascia Parietal peritoneum Rectus Sheath Inguinal Hernias Males: spermatic cord / Females: round ligament of uterus Arcuate line marks 2 openingDeep inguinal ring (transversalis fascia) / Superficial inguinal lower border of ring (external oblique muscle) posterior rectus sheathInguinal Hernias PATHOPHYSIOLOGY CLINICAL FEATURES • Indirect: hernia extends through inguinal • Abnormal protrusion through weak canal and lateral to epigastric artery points in wall • Direct: hernia extends through • Can occur at either inguinal canal abdominal wall into inguinal triangle DIAGNOSIS TREATMENT • Indirect: if pressure applied to deep inguinal ring, • Repaired during surgery to push bulge back into place and to strengthen wall hernia WILL NOT reappear when patient coughs • Direct: if pressure applied to deep inguinal ring, hernia WILL reappear when patient coughs • Greater Omentum • Lesser Omentum Components of GI Tract • Mesentery • Mesocolon • Peritoneal Ligaments: gastrocolic, gastrosplenic, splenorenal, hepaticMajor Peritoneal Folds 2 Types: • Parietal • Visceral Peritoneal Cavity: • Contains peritoneal fluid • Peritoneal folds create greater and lesser sac • Sacs connected by epiploic foramen Abdominal Aorta - Several paired branches - 3 unpaired branches: SMA, IMA, coeliac trunk Main Arteries and V eins Portal Triad - Bile duct - Hepatic artery - Portal vein Diaphragm 3 Openings: • Caval hiatus (T8) • Aortic hiatus (T12) • Oesophageal hiatus (T10)Anatomy of the Gut Liver PRODUCES bile Liver Gallbladder STORES bile Lobes: • Right • Left • Quadrate • Caudate Fissures: • Ligamentum teres • Falciform ligament • Coronary ligament • Lateral ligamentsAnatomy of the Pancreas and IntestinesPortal Venous System Kidneys Muscles of Posterior Abdominal Wall Diaphragm Quadratus Lumborum Aortic hiatus Deepest back muscle Vena Caval hiatus Supplied by subcostal nerve Oesophageal hiatus Psoas Major Anterior rami of L1-L4 Psoas Minor Anterior ramus of L1 Question 1 A 43 year old male presents to his GP surgery with a A) Direct inguinal hernia. The GP palpates his abdomen and applies pressure to the deep inguinal ring whilst the patient B) Umbilical coughs. The hernia does not reappear on coughing. C) Indirect inguinal What type of hernia does the man have? D) Epigastric E) DiaphragmaticA 43 year old man presents to his GP surgery with a A) Direct inguinal hernia. The GP palpates his abdomen and applies pressure to the deep inguinal ring whilst the patient B) Umbilical coughs. The hernia does not reappear on coughing. C) Indirect inguinal What type of hernia does the man have? D) Epigastric E) Diaphragmatic Question 2 A 74 year old woman presents to the emergency A) Normal department with colicky abdominal pain. The patient reported acute onset right iliac fossa pain with B) Gallstone associated vomiting. After examination, an X-ray of her abdomen was taken: C) Liver cirrhosis D) Hernia E) Broken rib What could this be showing?A 74 year old woman presents to the emergency A) Normal department with colicky abdominal pain. The patient reported acute onset right iliac fossa pain with B) Gallstone associated vomiting. After examination, an X-ray of her abdomen was taken: C) Liver cirrhosis D) Hernia E) Broken rib What could this be showing?Digestion and AbsorptionPhases of Digestion Cephalic Gastric Intestinal PROTEINS 1 2 3 • Endopeptidases: • Exopeptidases: • Amino Acids: • Pepsin (stomach) • Carboxypeptidase A • Passive absorption • Trypsin, chymotrypsin, • Facilitated diffusion • Carboxypeptidase B elastase (pancreatic • Active transport juice) CARBOHYDRA TES Amylase Brush Border Transporters • Saliva • Isomaltase • SGLT1 • Maltase → 2x glucose • Pancreas • GLUT1 • Sucrase → glucose + • Yields maltose, • GLUT2 fructose maltotrioses, glucose • GLUT5 units • Lactase → glucose + galactose LIPIDS Bile Salts Micelles • Initially composed of monoacylglycerols • Large lipid droplets emulsified to and bile salts increase SA • Water-soluble fatty acids can now • From chyme, pass through unstirred layer to epithelial surface be absorbed • Repackaged as triacylgycerols in GA → • Non water-soluble FAs insoluble chylomicronsFed and Fasted States FED FASTED Insulin Glucagon Glycogenesis Enzyme synthesis Glycogenolysis Gluconeogenesis Ketogenesis Glucose stored Blood glucose decreases Glucose-1-phosphate Glucose-6-phosphate Triglyceride production Maintains blood glucoseHormones Involved Gastrin Somatostatin Ghrelin • G cells • D cells • Stomach • Distended stomach / vagal • Increased hydrogen conc. • Hunger nerve → Suppresses gastrin, • Increases on empty → Histamine (ECL), pepsinogen glucagon, insulin stomach (chief cells) Secretin CCK Leptin • S cells • I cells • Fat cells • Acidic conditions in • Food in duodenum • Satiety duodenum → Inhibits gastrin • Increases after a → Pancreatic secretions, bile → Stimulates gallbladder production contraction meal Question 3 A 54-year-old man has been training for a marathon. As part A Insulin; gluconeogenesis of his exercise programme, he participates in fasted workouts. At one stage of training, he begins intermittent fasting which B Glucagon; glycogenesis involves going without food for 16 hours. C Insulin; glycogenolysis During this period, which hormone will be released and what D Glucagon; gluconeogenesis process will it trigger? E Ghrelin; glycogenolysisA 54-year-old man has been training for a marathon. As part A Insulin; gluconeogenesis of his exercise programme, he participates in fasted workouts. At one stage of training, he begins intermittent fasting which B Glucagon; glycogenesis involves going without food for 16 hours. C Insulin; glycogenolysis During this period, which hormone will be released and what D Glucagon; gluconeogenesis process will it trigger? E Ghrelin; glycogenolysisR eferences https://quizlet.com/382231421/figure-2330c-diagram/ https://quizlet.com/292409950/rectus-sheath-anatomy-diagram/ https://step1.medbullets.com/gastrointestinal/110018/inguinal-canal https://anatomyqa.com/inguinal-hernias/ https://www.slideshare.net/ananthatiger/constrictions-of-ureter https://www.corewalking.com/psoas-quadratus-lumborum/ https://www.chegg.com/learn/topic/digestion-and-somatostatinhttps://en.wikipedia.org/wiki/Peritoneum https://www.researchgate.net/figure/llustration-of-the-abdominal-aorta-and-branches_fig1_258198736 https://www.exploringnature.org/db/view/Liver-Structures-and-Functions-A-Closer-Look-Advanced https://firstaidteam.com/2020/03/02/mnemonic-monday-structures-of-the-diaphragm/ https://mindthebleep.com/abdominal-x-rays/ https://www.britannica.com/science/liver https://columbiasurgery.org/pancreas/pancreas-and-its-functions https://www.uobabylon.edu.iq/eprints/publication_4_9942_6381.pdf https://basicmedicalkey.com/16-2/ https://www.kidneychat.com/kidney-anatomyPLEASE FILL OUT THE FEEDBACK FORM PLEASE TUNE IN TO OUR REMAINING SESSIONS THIS WEEK