Nu Patho Study Guide Unit 6
1. ANATOMY OF GI SYSTEM Anatomy and function of the GI system components; normal intestinal flora.
(P.1393-97, 1400, 1409) - correct answer ✔✔The digestive system breaks down ingested food, prepares
it for uptake by the body's cells, provides body water, and eliminates wastes.
The functions of the GI system are ingestion of food; propulsion of food and wastes from mouth to anus;
secretion of mucus, water, and enzymes; mechanical digestion of food particles; chemical digestion of
food particles; absorption of digested food; and elimination of waste products by defecation. Consists of
GI tract and accessory organs—liver, gallbladder, and exocrine pancreas. (P. 1393) The GI tract consists of
mouth, esophagus, stomach, small intestine, large intestines, rectum, and anus. Has 4 layers of tissue:
mucosa, submucosa, muscularis, and serosa/adventitia (esophagus).
Enteric nervous system within GI tract controlled by local and autonomic nervous system—3 nerve
plexus: submucosal plexus, myenteric plexus, and subserosal plexus.
(P. 1395) Mouth - correct answer ✔✔reservoir for chewing and mixing food with saliva. 3 pairs salivary
glands (submandibular, sublingual, and parotid).
The esophagus and Stomach - correct answer ✔✔A hollow muscular tube that controls swallowing
substances from oropharynx to stomach. Each end of the esophagus has a sphincter: cricopharyngeal
muscle and cardiac sphincter. (P. 1397)
The stomach is a hollow muscular organ that stores food during eating, secretes digestive juices, mixes
food with juices, and propels partially digested food (chyme) into the duodenum of small intestine.
(P. 1400) The small intestine - correct answer ✔✔is about 5 to 6 m long and is functionally divided into
three segments: the duodenum, jejunum, and ileum. The duodenum essential role in mixing food with
digestive juices from the liver and pancreas. The jejunum and ileum facilitate intestinal motility and
support blood vessels, nerves, and lymphatics. The peritoneum is the serous membrane surrounding the
organs of the abdomen and lining the abdominopelvic cavity.
A central lacteal, or lymphatic capillary is contained within each villus and is important for the absorption
& transport of fat molecules. A person who has problems with lacteals will have alterations in fat
absorption. Digested fats move into the lacteals and eventually reach the liver through the systemic
circulation.
(P. 1408) The large intestine - correct answer ✔✔is approximately 1.5 m long and consists of the cecum,
appendix, colon, rectum, and anal canal. The cecum is a pouch that receives chyme from the ileum.
,Attached to the cecum is the vermiform appendix, has little or no physiologic function. From the cecum,
chyme enters the colon, four-parts that descends to the anal canal: ascending colon, transverse colon,
descending colon, and sigmoid colon. Most of the water is absorbed in the colon by diffusion and active
transport. By the time the fecal mass enters the sigmoid colon, the mass consists entirely of wastes and
is called the feces. The gastrocolic reflex initiates propulsion in the entire colon, usually during or
immediately after eating, when chyme enters from the ileum. This reflex causes the fecal mass to pass
rapidly into the sigmoid colon and rectum, stimulating defecation (rectosphincteric reflex). Defecation is
facilitated by squatting or sitting because these positions straighten the angle between the rectum and
anal canal and increase the efficiency of straining.
(P.1409) Bacteria from stomach to distal colon. Stomach is relatively sterile due to acid production. Bile
acid secretion, intestinal motility, and antibody production suppress bacterial growth in the duodenum,
and in the duodenum and jejunum there is a low concentration of aerobes: streptococci, lactobacilli,
staphylococci, enterobacteria, and Bacteroides. Anaerobes are found distal to ileocecal valve and
consists 95% of fecal flora and 1/3 of the solid bulk of feces: Bacteroides, clostridia, anaerobic
lactobacilli, and coliforms are the most common microorganisms from the ileum to the cecum.
(P. 1409) The liver, gallbladder, and exocrine pancreas - correct answer ✔✔all secrete substances
necessary for the digestion of chyme. These secretions are delivered to the duodenum through ducts.
The liver produces bile, which contains salts necessary for fat digestion and absorption. Between meals
bile is stored in the gallbladder. The exocrine pancreas produces enzymes needed for the complete
digestion of carbohydrates, proteins, and fats. The exocrine pancreas also produces an alkaline fluid that
neutralizes chyme, creating a duodenal pH that supports enzymatic action. The liver receives nutrients
absorbed by the small intestine and metabolizes or synthesizes these nutrients into forms that can be
absorbed by the body's cells. It then releases the nutrients into the bloodstream or stores them for later
use.
Kupffer cells (macrophages) in the sinusoids of the liver remove bacteria and foreign particles from blood
in the hepatic circulation.
ANKYLOSING SPONDYLITIS Know Ankylosing spondylitis: pathophysiology, etiology, prevention, clinical
manifestations, diagnostics, treatment and complications (pg. 1572-1574) - correct answer ✔✔is the
most common of a group of inflammatory arthropathies known as spondyloarthropathies. It is a chronic
inflammatory joint disease characterized by stiffening and fusion (ankylosis) of the spine and sacroiliac
joints.
Patho: The exact cause of AS is unknown but its high association with the histocompatibility antigen
human leukocyte antigen (HLAB27) has been known for decades. New research has shown that
misfolding of HLA-B27 occurs in the endoplasmic reticulum (ER). As misfolded proteins accumulate, it
results in a stress response of the ER and increased production of interleukin-23 (IL-23), a potent
cytokine that may also act on T-helper 17 cells, promoting their survival. Th17 cells, in turn, produce the
inflammatory cytokine. In AS, the primary pathological problem is uncontrolled bone formation rather
, than bone destruction seen with most other types of arthritis. The end results of AS are fibrosis,
ossification, and fusion of the joint, primarily the sacroiliac joints and the vertebral column.
In the early phases of AS, T cells and macrophages invade and cause erosion of the cartilage at different
sites. AS involves inflammation of fibrocartilage in cartilaginous joints, primarily the vertebrae. The
fibrous tissue of the joint, capsule, the cartilage that surrounds intervertebral disks, the enthuses, and
periosteum are infiltrated by inflammatory cells. As inflammatory cells (chiefly macrophages) and
lymphocytes infiltrate and erode bode and fibrocartilage in joint structures, repair begins. Fibroblasts
synthesize and secrete collagen. The collagen becomes organized into fibrous scar tissue that eventually
undergoes calcification and ossification.
All the cartilaginous structures of the joint are replaced by ossified scar tissue, causing the joint t fuse, or
lose flexibility. Bone repair changes the contour
BILIRUBINBilirubin, what is it? Bilirubin cycle? Pg. 1411-1412 - correct answer ✔✔Bilirubin is a byproduct
of destruction of aged red blood cells. It gives bile the greenish black color and produces the yellow tinge
of jaundice. Aged red blood cells are taken up and destroyed by macrophages of the mononucluear
phagocyte system, primarily in the spleen and liver. (macrophages in the liver are Kupffer cells). Within
these cells, hemoglobin is separated into its component parts - heme and globin. The globin part is
further degraded into amino acids, which are recycled to form new protein. The heme is converted to
biliverdin. The iron attaches to transferrin in the plasma and can be stored in the liver or used by bone
marrow to make new red blood cells. The biliverdin is enzymatically converted to bilirubin in the
macrophage of the mononuclear phagocyte system and released into plasma. In plasma, bilirubin binds
to albumin and is known as unconjugated bilirubin, or free bilirubin (lipid soluble). In the liver,
unconjugated bilirubin moves from plasma in the sinusoids into the hepatocyte. Within hepatocytes, it
joins with lucuronic acid to form conjugated bilirubin (water soluble). Conjugation transforms bilirubin
from a lipid soluble substance that can cross biologic membranes to a water soluble secretion that is
excreted in bile. When conjugated bilirubin reaches the distal ileum and colon, it is deconjuated by
bacteria and urobilinogen. Urobilinogen is reabsorbed into the intestines and transported to the kidney
excreted as urobilin (giving urine the yellow color). A small amount of urobilin is recirculated back into
the liver and eliminated in feces as stercobilin, which contributes to stools brown color.
-Unconjugated bilirubin (UCBR): In the plasma, bilirubin binds to albumin and is known as UCBR, or free
bilirubin, which is lipid soluble.
-Conjugated bilirubin (CBR): UCBR moves from plasma in the
BONE ANATOMY & CYCLE Know anatomy of bone, know bone cycle. Pg. 1512-1516 - correct answer
✔✔Mature bone is a rigid and flexible connective tissue consisting of cells, fibers, a gelatinous material
(ground substance) and large amounts of crystallized minerals, mainly calcium, that give bone its rigidity.
The structure elements of bone are in TABLE 43-1. Bone cells enable bone to grow, repair itself, change
shape, and continuously synthesize new bone tissue and resorb (dissolve or digest) old tissue. The fibers
in bone are made of collagen, which gives bone its tensile strength. Ground substance acts as a medium
for the diffusion of nutrients, oxygen, metabolic wastes, biochemical, and minerals between bone tissue
1. ANATOMY OF GI SYSTEM Anatomy and function of the GI system components; normal intestinal flora.
(P.1393-97, 1400, 1409) - correct answer ✔✔The digestive system breaks down ingested food, prepares
it for uptake by the body's cells, provides body water, and eliminates wastes.
The functions of the GI system are ingestion of food; propulsion of food and wastes from mouth to anus;
secretion of mucus, water, and enzymes; mechanical digestion of food particles; chemical digestion of
food particles; absorption of digested food; and elimination of waste products by defecation. Consists of
GI tract and accessory organs—liver, gallbladder, and exocrine pancreas. (P. 1393) The GI tract consists of
mouth, esophagus, stomach, small intestine, large intestines, rectum, and anus. Has 4 layers of tissue:
mucosa, submucosa, muscularis, and serosa/adventitia (esophagus).
Enteric nervous system within GI tract controlled by local and autonomic nervous system—3 nerve
plexus: submucosal plexus, myenteric plexus, and subserosal plexus.
(P. 1395) Mouth - correct answer ✔✔reservoir for chewing and mixing food with saliva. 3 pairs salivary
glands (submandibular, sublingual, and parotid).
The esophagus and Stomach - correct answer ✔✔A hollow muscular tube that controls swallowing
substances from oropharynx to stomach. Each end of the esophagus has a sphincter: cricopharyngeal
muscle and cardiac sphincter. (P. 1397)
The stomach is a hollow muscular organ that stores food during eating, secretes digestive juices, mixes
food with juices, and propels partially digested food (chyme) into the duodenum of small intestine.
(P. 1400) The small intestine - correct answer ✔✔is about 5 to 6 m long and is functionally divided into
three segments: the duodenum, jejunum, and ileum. The duodenum essential role in mixing food with
digestive juices from the liver and pancreas. The jejunum and ileum facilitate intestinal motility and
support blood vessels, nerves, and lymphatics. The peritoneum is the serous membrane surrounding the
organs of the abdomen and lining the abdominopelvic cavity.
A central lacteal, or lymphatic capillary is contained within each villus and is important for the absorption
& transport of fat molecules. A person who has problems with lacteals will have alterations in fat
absorption. Digested fats move into the lacteals and eventually reach the liver through the systemic
circulation.
(P. 1408) The large intestine - correct answer ✔✔is approximately 1.5 m long and consists of the cecum,
appendix, colon, rectum, and anal canal. The cecum is a pouch that receives chyme from the ileum.
,Attached to the cecum is the vermiform appendix, has little or no physiologic function. From the cecum,
chyme enters the colon, four-parts that descends to the anal canal: ascending colon, transverse colon,
descending colon, and sigmoid colon. Most of the water is absorbed in the colon by diffusion and active
transport. By the time the fecal mass enters the sigmoid colon, the mass consists entirely of wastes and
is called the feces. The gastrocolic reflex initiates propulsion in the entire colon, usually during or
immediately after eating, when chyme enters from the ileum. This reflex causes the fecal mass to pass
rapidly into the sigmoid colon and rectum, stimulating defecation (rectosphincteric reflex). Defecation is
facilitated by squatting or sitting because these positions straighten the angle between the rectum and
anal canal and increase the efficiency of straining.
(P.1409) Bacteria from stomach to distal colon. Stomach is relatively sterile due to acid production. Bile
acid secretion, intestinal motility, and antibody production suppress bacterial growth in the duodenum,
and in the duodenum and jejunum there is a low concentration of aerobes: streptococci, lactobacilli,
staphylococci, enterobacteria, and Bacteroides. Anaerobes are found distal to ileocecal valve and
consists 95% of fecal flora and 1/3 of the solid bulk of feces: Bacteroides, clostridia, anaerobic
lactobacilli, and coliforms are the most common microorganisms from the ileum to the cecum.
(P. 1409) The liver, gallbladder, and exocrine pancreas - correct answer ✔✔all secrete substances
necessary for the digestion of chyme. These secretions are delivered to the duodenum through ducts.
The liver produces bile, which contains salts necessary for fat digestion and absorption. Between meals
bile is stored in the gallbladder. The exocrine pancreas produces enzymes needed for the complete
digestion of carbohydrates, proteins, and fats. The exocrine pancreas also produces an alkaline fluid that
neutralizes chyme, creating a duodenal pH that supports enzymatic action. The liver receives nutrients
absorbed by the small intestine and metabolizes or synthesizes these nutrients into forms that can be
absorbed by the body's cells. It then releases the nutrients into the bloodstream or stores them for later
use.
Kupffer cells (macrophages) in the sinusoids of the liver remove bacteria and foreign particles from blood
in the hepatic circulation.
ANKYLOSING SPONDYLITIS Know Ankylosing spondylitis: pathophysiology, etiology, prevention, clinical
manifestations, diagnostics, treatment and complications (pg. 1572-1574) - correct answer ✔✔is the
most common of a group of inflammatory arthropathies known as spondyloarthropathies. It is a chronic
inflammatory joint disease characterized by stiffening and fusion (ankylosis) of the spine and sacroiliac
joints.
Patho: The exact cause of AS is unknown but its high association with the histocompatibility antigen
human leukocyte antigen (HLAB27) has been known for decades. New research has shown that
misfolding of HLA-B27 occurs in the endoplasmic reticulum (ER). As misfolded proteins accumulate, it
results in a stress response of the ER and increased production of interleukin-23 (IL-23), a potent
cytokine that may also act on T-helper 17 cells, promoting their survival. Th17 cells, in turn, produce the
inflammatory cytokine. In AS, the primary pathological problem is uncontrolled bone formation rather
, than bone destruction seen with most other types of arthritis. The end results of AS are fibrosis,
ossification, and fusion of the joint, primarily the sacroiliac joints and the vertebral column.
In the early phases of AS, T cells and macrophages invade and cause erosion of the cartilage at different
sites. AS involves inflammation of fibrocartilage in cartilaginous joints, primarily the vertebrae. The
fibrous tissue of the joint, capsule, the cartilage that surrounds intervertebral disks, the enthuses, and
periosteum are infiltrated by inflammatory cells. As inflammatory cells (chiefly macrophages) and
lymphocytes infiltrate and erode bode and fibrocartilage in joint structures, repair begins. Fibroblasts
synthesize and secrete collagen. The collagen becomes organized into fibrous scar tissue that eventually
undergoes calcification and ossification.
All the cartilaginous structures of the joint are replaced by ossified scar tissue, causing the joint t fuse, or
lose flexibility. Bone repair changes the contour
BILIRUBINBilirubin, what is it? Bilirubin cycle? Pg. 1411-1412 - correct answer ✔✔Bilirubin is a byproduct
of destruction of aged red blood cells. It gives bile the greenish black color and produces the yellow tinge
of jaundice. Aged red blood cells are taken up and destroyed by macrophages of the mononucluear
phagocyte system, primarily in the spleen and liver. (macrophages in the liver are Kupffer cells). Within
these cells, hemoglobin is separated into its component parts - heme and globin. The globin part is
further degraded into amino acids, which are recycled to form new protein. The heme is converted to
biliverdin. The iron attaches to transferrin in the plasma and can be stored in the liver or used by bone
marrow to make new red blood cells. The biliverdin is enzymatically converted to bilirubin in the
macrophage of the mononuclear phagocyte system and released into plasma. In plasma, bilirubin binds
to albumin and is known as unconjugated bilirubin, or free bilirubin (lipid soluble). In the liver,
unconjugated bilirubin moves from plasma in the sinusoids into the hepatocyte. Within hepatocytes, it
joins with lucuronic acid to form conjugated bilirubin (water soluble). Conjugation transforms bilirubin
from a lipid soluble substance that can cross biologic membranes to a water soluble secretion that is
excreted in bile. When conjugated bilirubin reaches the distal ileum and colon, it is deconjuated by
bacteria and urobilinogen. Urobilinogen is reabsorbed into the intestines and transported to the kidney
excreted as urobilin (giving urine the yellow color). A small amount of urobilin is recirculated back into
the liver and eliminated in feces as stercobilin, which contributes to stools brown color.
-Unconjugated bilirubin (UCBR): In the plasma, bilirubin binds to albumin and is known as UCBR, or free
bilirubin, which is lipid soluble.
-Conjugated bilirubin (CBR): UCBR moves from plasma in the
BONE ANATOMY & CYCLE Know anatomy of bone, know bone cycle. Pg. 1512-1516 - correct answer
✔✔Mature bone is a rigid and flexible connective tissue consisting of cells, fibers, a gelatinous material
(ground substance) and large amounts of crystallized minerals, mainly calcium, that give bone its rigidity.
The structure elements of bone are in TABLE 43-1. Bone cells enable bone to grow, repair itself, change
shape, and continuously synthesize new bone tissue and resorb (dissolve or digest) old tissue. The fibers
in bone are made of collagen, which gives bone its tensile strength. Ground substance acts as a medium
for the diffusion of nutrients, oxygen, metabolic wastes, biochemical, and minerals between bone tissue
