Gl Blood Supply and innervation Foregut | Ti2 [ | Sin branches tee eo we | rete gastrie ee ma = comnanan hepane “ae .. (ee capi gor, | guerre Celiac trun ectras anders yencreas Pl Soteen (guceaerend, = ssi Mid gue brancnes® — tine | ase dascenim IRRSASE poeteatec TP imocray’ | to proce 2g of [auedenal anteey, AGE pare yagi ‘Hancerse. cotens | Yea gegen scum aprendi ‘alesiong ceeummongpendy] Supence mesenteric artery See rene ZinlaisequeHawiese ae) (LoL GA REPoranches: ee ee )% paras pele > ur Tmademe | eb eect } spent, 1 CY acony = = sigmor a branches pera tena) | eure 1s a waters ~ superior rectal artey, inferior mesenteric artery “—e hindgat | U3 Abdominal Aorta +branches? Celiac Trunk Branches: + Celiac trunk: st prem cone on Left Left inddle hepate fever GASTTIC Se nal AS aie Ss eth penal a2 ey Some ae oS artes ae” oe gi sett tesreubafounen of 4 Pope stpein aay ene a . eistomuntal nue fon £m oe roferior mesenienc. ee Seema pees curse 9 Pre han oe cae, era eenrele bifuccahon ote ea - (14) eee ter parcearustere!)Isenemte colihs > 1) chronic + vagie pain, lose weight ble afraid teat Spams ly sma can see toner GI bleeding cvoss-sec hon, 2)SUEKEN usually aledomiral Pain , eldenty cause: blockage, © disease , A-Fib sags There 1s damage to #he wall, So have: veins faking 2 nutrients back “tb the hve Also, gas bubbbies in the. portal civculahon. Portossystenic Anastamoses : © Esophagus =>s¢e. esopnageal varices Lett gastric w/ esopnagent. Durmonicus = see caput medusa UMD! NCAl- w) Superheial and — interior epigastrr below Hhe umbilicus Superion epigastric and lateral Venous drainage /Poetal cireulahon : han ferne veto above the Umbs Keur © rectum => see internal henoc moras Superiorrectal <% muddie/infernor rectal (5199 of portal HTN; treat wy nt = es a }—>— {Zeirauabon Hereveread Y eternal nto GF ~onigha 1s superar Ye OF1910 15 veror rence edimate ieee e pechrate Ine wrod) (paintess bieasing) {oan bic tnronneus). (vSCeral innervafcn’ omane imneruanon),Anterior Abdominal wall real osha. pooneunsis Aeerpalimate meio ‘Avove oes ARCUATE renner cus mute, GLIA TU TVG Peed oy traronecsans Farce ET mT pane : per doncua Betow Linea Alba a une =A layer tendon so easy acess 40 abdorminal cavity =e" : ~ bled tess : — Traneveerals Ftc RISK of hernia wiincision bic ¥ bind less healing Rectus sheath > contains tne vectus absomins ond pyromidalis muses 7eReEne MUS ~0-sechons ore done below ine actual ine ble only the transversans fasera ard Ne Soe vise eure 10 ime weeus fess “UnferarsePIGIOEEEY» aro: tern sre RealGM AEE “inguinal TgORERE Quins with an interior epigasieie vein- “Rent ang the mati marge of He abderal nin rinj.Cntinues up perce the ArANSHEFSAIIS Fascia, pastes in Front ot sine. linea JémicirculariS ,and astends petween 4he Fectus abdominis and pos tevice Sheath {Arastomoses oboe ambrticus wi superio¢ epigastre aviery “Shenae epigasme areny-® arses ton ital trace fey vt wi veins, Ascites: accumulahen of flutd (usuatly serous) in abdommal cavi “considered Poimiabiespain’ -> velaied to the wl soma! Retound Tenderness: Pain upon removing pressure tothe aldomen. TEnused by aggravahen oF the parietal layer oF Ine perstoneum by Stretching /moving. “Sign oF inflammation oF organ Csdity? Shiftness of the muscles on tne belly area, which can be Felt when touched 0e pressed .sig mt a » boundary mgualngeeent oy : all alls auncavoge sesrqundele = mralles: Spelindne GORAY Feiseia => vas deferens, pang iforan ylenss Iyengas emates:@adadigament oh wtenusi(orig\n Us Fre gubernaculin’) ee gta Andee neersn => cogent allect = jn process vaginallS “eorougn due rib Aner’ ave adhesions, = dangerous. shranguianans , Hypothalamus + meme ARLUORE } “romget He leptin ‘culag ie A Povaventt! =YapperTe Hypothalainic —— Lp ne wapdic Actithy eS — [Ais done by pephde. VY ‘ahi comes Fram tne Sin reponse to eating). lesion lesion 4 ainorexre obesity,Swallowing? ae - ongaix—nucier (12110, 4,Renculue foemahon) medulla oblong we 2 ca “done by ON Emme siyeprarggeus (=> eran! Oc Lecarner For atceswRy neve. ieee o a AL \aleeal pnedullary syndrome shows & P tne Mouth ~Naluaey glands Is (Both Sensory ¥ motoe) + masseter + tempovalis Close moutn, ‘medial pterygoid "7 iegetrer do the side to side achen “laieral plerygond opens mouth t Salivaey gionds ora nother, MAjeR vomnor ES aroha (serous) “Solvay glande Crane) cigd mene, Submaneblar lave) _ * ~Submnilary Ged) Yo EN ingadlente # Meck fo Splenic exien , the porasympathehe imnervahen 1s Vogus (x). * Paranmpatnetic does serous Jecrehens, Sympatmehe dees mucinous the Valwary gland 1S the only organ in ninich ane Parasyinpatnehe and Sympathetic’ work tyether to increase secrenons, * nase > digestion starts in the mouti, PRU be due to Acute Paneveahhs 2) Acute Abdommal. Condihons ISectopIC pr ike ruptured appendicitis Pregnancy , ruptured ulcer inflammaton of Salwaey gland, uke ‘the pardhd gland. (usuaity means win need surgery) UP pioicing Start digestion wi stomach, ‘ 68 eaual tut not mace, Pons in Salva s PCOS, KY, J NACI Ceomperd S| Plasma Cone.) ~ Rates ~Alse as anhbacter al propemes, lacroPerrin, TmocyanateS, NaAsdelensin en?wmet tisnceDSjeogen's syndrome dryness ob eye mast eke. BIE OF lymphucyses infil lmie F land. ~Autormmune 2 associated wi SL + “PASE OF Wyonphonna, T Take biopsy From tips D mus ~ perond gland wHommanon orchins Desalaay stores ato Salohtmia ss > vubrand bula’= mest common, hypercuicemia /gput can cause ie Tsecendery fe intechon oe leads te Stone. Drago “sn meg penari ene ese =pavohd gland = Tay Loasteciaied wifacial nerve prob leras. @ wartnns disease ALraties) mnstoiog ically = neterctrphes. Lymphoid hse in salary giands APINNdeY cystadenoma. ly yn phamectosis) mat commen manga inne anne Celt carcinoma * HOB PLEUEDAARALS on GRA cise oF trque JER 12 AE conte svops ie sae ron SRERPARGIARI=> Pamnful/vesicies => CBAC A ‘end /feot mouth —7 * Servicofacial ump w/ sinus discharge => /SGHAORICC TSG * edi QUARQiAd > ceiulins oF Submandibu iar /sublingual spaces Pan go back 40 pharyne/carohd sheath — extends down 40 the mediashnum “Caren aheat. davtains commen Cayond ariceyjinicenal Cavond arty, internal yugulan vein « vagus newel) , dee cerweal Iywptt Modes strep pyogenes , Echo =) Strawrerry tongue, vas g loneculonepheths = Group A strep. * GlEPRFISH> ron deficiency anemia. ,yamn BIZ] Folie owed def, vitemic C niacin def, eBy nypetnyrdisen (cretimisen) .wyslens tarnor, ACTOMMEGaALy » Amyloiaes, Downs syndrome. (really sia! mardine), > associated “more wicarwer. Ls squamous” hyperpioia of tne epidermal yurrace. Smoking, alcohol, HPY. 2 mapcsite = lower lip. ° for Sure ends up cancerous : wickham Siae.“Tumors > pictures! UPPEFNP=OSANEENTCEREASHA (no invasion) = ble of Wawaves . {ers => non-inFechous > pemphigus = Sieven- Johnson —» rash, si © erythera ruth forme SBENEEE Ulerahen in moutn SHUAPBEIPITH§ Steroids Colchicine Thad \dom ides SE Thaoounetio. (no libs Pigmentahen of mucosa on, eae 1 Peute-Jepher Fp ene: Mamrenbian +f musa on woth «it Kaxcuiancy =ineran 5 ramatmcas fly, ~ # risk of cancer * Addison's also has yr Pb poser FIN and Mucosa =>allceayy 1 medication. gmeniahon > see tines Tefacychnes > aiscoiorahe ob } Fouriae 7 Porphyria. ' onchi bifureaton Soren ‘Arch of the Aoeta > behind it \S the trachea + bronchi bil « rai “THR ACI eel a ‘pavasympatnee: Veins 5 azygous 0 henitaygout > eonnechan perween ‘Aepomana % SVE/IVE and yecieves fom foracie watt Sympartene: pavanymneatrene I ty epclion 1 propria nual < submucosa, ‘chreular muscle tong rie. <—Hnoraneduct/anygous venBsophagus, Dysphagia ‘Adenephagia (pain) Solid 5 tiqurd ote #Wqued # Alkaline >acdie. -=-think anatomical -=think Punchonal © candida =! ed ena erga © HSy uee vesicies{become uke) tongitinal uler conpretin wetonderma 117 longitairal wee foninndeee Site exo Pee SEAT systemic He racyaine Crrnuscles (rhabto/ compo) Cis eat Inclusion body. (ACHR > 1 (injenievie weubenUceiil) OF degenera hen of attock by ‘enka! america > REduvig bug) Dato colon # ino peristalhe movement “Te want velox spluncte® (iafiae tnltton /botox), {Side note: VIP 15 usuaily the Neuretransmiiees VIP Penis oirelUphINERERS vo. 0 sohd — liquid Anatomic (etocanen of dysphagia =a big clue) can be anywhene, but mat cw ts te male then the iower, ten upper. / reispanng toes Peesep hace! web» mucous tlemy, NET par (due fo Chvonic er Fah), * Pummer-Vinson—risk ofcances, bat usually preceded by GERD to Show “Beathoromdrra-sne ice of aca, !EOMMPeRME valves. S myastenia gras dysphagia mneck. = Associated / smoking sfunga) in feeron $ =Dasperg ious => histolegrcaly vee, keratin pearis Also w}lower > Schatzl Ring ‘See nests ¢# squamous ceils wlaburdant eosmope Cyfelatme ancdirtnct bares: “See aRens of Feta 2aGERD: 7 Reflex 9F Bule (acid 1s fhege but Bile 1s more important) ~ Risk faces Danytting that inteBReres w//pressuBe gradient, Ie. Obesity, pregnancy» fumocek @ derys in stomach ermphying (ize proteins, fat) “deugi= ant-choinergics, gavhoparesis Desometvirg aratorocaiy related ESELe. heart burn, chest pain (tights redurral dry cough, infniase as Homa wall aise Find entinophis on biopsy y complication of Barret's => Adenacarcinamnae Ochatasia is unt ely to be aStociated w/adenocarcmowa Carisk: =>.squawous cen Carcinonell), Zenker's diverteulun: ~falie,ala 0. pulswn. defect in cricopnaryt- geus muscie web CPlummee-vinson syndrome) Ring of SchatzH “Texchon? e fue divereutam wwe > inramwathione ar Cale “Tb bok of ‘neastinim infant Patswn: ~Ralse epipheenic diverhcukin > isk of GERD SUDING ESOPHAGUS?” gurcene —» DEF oF Les J—tes = MO Symptoms usualy, but i ies “there ave sympions, Usually GERD» ROLLING ¢ . EDPHAGEAL VARICES: VE — patacsophagea) = treatment? inflate. fo i) ee peri, ON eat esting = RISK oF obstruchen) ue laser, causes Shrangu lahen. mostofion deain causet . hematemesi s Dare inaering er ea 1 ogy Welss=> ble of elchng /vomrting., ‘ Lt ee meee Me orang = akoroles aren Ponsious about pas buleraia 2) Borelias dense) ~> An upper GI bleeding. FL iran earage te sete al au get air at medsAnicxoe, vagis—> stomach, hepahpiiany STOMACHS Poslerer vogis-» gest oF Gl Lessee omentavo contains the el poSicnor Jurface = recond tne ot gastric wicee (spleni@ ate) as the 1.) gaenter arntria as te Cie qs pi we SS o behind ste mnach the pancreas, artenesjms Csplente)- ~ most commen sie agit gunoeern’ = behind thats estersacvo 1 foc opine uicer/ 7 ae pancreahe cyst wall Fee uthore vancee (preity Frames) : ~gasine ulcer postcnorly can be comphcated by pancreat h s (acute Fun ous ores es eye el tec reredes Bo0y Foe vitarmun BIZ rts that te Pyioms persin — weugoendecrine cells ave vcattered cells + gashin ~lack oF gasirins lack oF acid secrenen, however Here ave also &-cells n-4ve pancrens 80 HAE not ainays a big deal.“Tos much aad Lge HA blockers ,dggon't complefeliy steps ir b/o SHI) amd me “rps perachor Clmeundine > amhamodliogeuc , - Al jibe p4sd (ba iyoontine) > wwpotonee. werk) near a : “ually bloce iF took adeace: jw Heo (ate) Weiniy Wt acbinse CI” 4 baad tees noc €1Cs” frag) to rmauntivn balernce va 8 Ded occemen pr eabine ee useol in when a guahinerna. SE! Wk. emupranple > TUES Binole adie a wie (Vilvi0 Jone ablcadine), SF nerhaone Syadroue_ 1Ro0 dep... (Fet—> Fem), —frutnaarctoplombansman ae Go Id Sabds ne 22 jhe B Lip Otapren : Prvteinurion , P22! Hi brain = Iron He => in rionadn, =? 5 wae C fan Ge a2. conhavhihy = 1P3/o—6 Mi => Bowker Ms > onchlyp tq omasdsiaan > Gi PGS in pantetal Celld => nhl aadseowher AD Shiai nmruow seorehin CLES iWhibdna. oyCe ~cloarical ule (peptic steer) hy mead gabe mucosa. > Jughly contagion, F dymenemesdaraocrateal wf) mALTome = ft, © oe gedaan Gaohits — non 6 Panaling. iui — ppanidhbetle Mentions Srypupiac piowos ore Plast, hyperhopy GM wer Zes. 2 vei “= eee “rrucLrple ulecwoy her edyma A Unusual locourer ee Go¥ha1 Toon |stsach ah Pfs) Uinefachog. ~SMOEINA =) Weim wl mever Srl! (F no “reapne af heading Mt. Ano), Men faint ZESe Compicashono Gf Aout geatuns 7 bern, perfre.ters (pzedins ) came clrramt,e/bshuchin chown rc *comen Goatin wm 2 pee: pebopant > qoahenelenecartlinoms mpfr ye. 7 pa rind “Btw ‘oda ulon v ast ae HO wadeatorsin ine i Coe uCAMCHUD, ee bce hoo Weer, you. want romohantey uel sans 2 a nate apa ee tg neuenducdemal ve qaotrc utes. Car amy camer in GI Atods fo cag’ los =) Caches BG), Virchow's noden — Led Uuprac lavicutor sniengeumene. wg IA Ming Joseph > noduuteor Acommrasis Mignicano > arg comees [wou ) m Loe © cmautin. “3 6) metestanie ly bad Sede (al) Lyme mics wovelly, ace um alt abyge.. Werea hwu = smu os vue J (C 4 \ on / a a ie fas Fr gG % ee : ‘id we seca , Nai uy lane * lipaok ane Me ate ABD a Pero Onitymestnat dont ned (neqee-achvaton. by ae snecer Zip* FAN: Absmphen. =>mucoras Colum Sukmuscese - Qyner's =) mules H03~ BRAY Bruwviny DHCO37 5 mnaeLatofaphen prdblennro, be Atiye=> week 9 Lee peed back wna: bine \& no connachi ling of gol => youll sions Jock of pamorwahe pocredmo, A > Fear Rin gull. bloc ( TPN angociated vf Rok oe no mucosal chlo, (no qo bind, shrmuilarron- Punter ce ee fatty aolde Adc jrcacudeac-GIST- most comumm jocarwn =o rerun > coral utlo wrwsteuhon - C- vt gene CD INF Chi FRue hat PIANC p | Rrinton’s diseane Lorn Cause soenidons, yeinylis::nen= hod fed ly werhowe @aobric lymphoma > B cobb >, “eee type AB ponslocahere (11, 18), no CD23 => Xantromatos>) g's wi feo cella in wall of umah > goon As yulour. a8 , ahopne gyal QUE facta Smoked, ACh ing, ype AA blowd qnowp eed FH, rate oncom 2 ae =? 0 blood. qrup=au0k. oe - pamexaie ony a Gon Pp seers i BENDA —Pengy wa 7 pbelecge= ned gushe, ge ig Jeune «vats wallet) Prox fos Lipps bed sequlonnavoee>spnnela pedal, sewn Oise -torer val oO) : ge ina i” 7 So ee menah of eonly age om wie ale Y | sma, be of fee i omomaly ontbecolumeae epitreluny Aearhonal : rrusces For mixing > meee muscle —>7 Fisk For cance ebay mesenchymal “ste = Fetomyoma sinthatee of movenent = totersh Na) Cells oF cajal IS in intersh Runvinese renchyrrale ~ Stomach funchons: deid secreton, 1F pep: 11 pepsin, Aiorg the lester curvaruee, mpang, asorphon of aleohot., rere 1S no ruge ble it make Sa canal ‘Acid Secrenan phases: Od 2 ce ¥ cephalic: > think about food ,srrel\ feud | See food = secretions increase ; done by Ie eigasizie > fundus rewyes to acromadate feod— ra 5 scand. ch» panel! Prater Pump lnhubtns —» FHC! Gq (ee ormeprazele) 4 dacs F completely ‘stop iF but helps. Le. Clnehdine> ant cindogemc(oewnal? Guy dug, merachon vat ose oF MC TAEIN, BION = go Want tD Y “p REALLY block: cid, block Ye. veleMse? etal cell. 5 anon 0115 eensed od FEE wineg.) +0 maunta Hes cs mange = (ior® loved alk} “side ebfects: omeprazole in long tine Use fine 26) obteR Whe CON IEE ya, 1) napneehe sundreme (neta Y ranean asamp 2) cold sats 04 a problem 3) Capioprit -can get won dehciency peoause Feta Fev" - ae PP: woo ib go used 90 lee oe gastrnoma-“Too much acid gWve HY biockees ever though Hdoesnst completely stop vb > Cimehdine ~u onegat: pert ns pancreatic enzymes * a arena Gi —) Cucral cellS—> HCOr —y Gunae—renavmes E (plockage=7 aurodgeshon). an oar ae oe rempenterennrlcs ae nen seeny yen. BOHM LE= UppeRTel bleed Ample of Vater oe distal = loner 6t bed: popenng mage gia ‘smn ~Soince of edsi= “Senda ny Orci mas pundenal ANE. |<] =F you have pancreahns From an eaely age, double bubble sign due to a congenial anamely, anig= we “4 “esecacd oas mere Oth 1 tage cnr o¢ vac one Function : inctton : Absorphon—> mucosa= Colima Sbmucosarhas Beurwers gands =Pmarer Heos-Problems : . PROCES Iss Redback inhubstion Fatty acids/ Ammo Acids Shima “no tuntvachity a8 40N bladder pgunsiones ieee steinaie ee *No 6 B Stimulation a esrenhal fatty ac 4 ALE oF ordchidomie acids, a J” Piateny duavren, hypokalemia yaehtornydna. (ako pancreane chotera) Tinhibits aad : “ND ulcers (wee Ze). “diseases oF the duodenum ‘eMpS, ver hculum :inHowmahen, perterathon “Least kel te be cancer. Pephe uicer disease : Gastric Duntedenad ulcer lessee ene anim P00 , +9 Spat enh Lr nua eye sorean uicee =ating, mate at ge eng ‘bleeding, perforated, pertrons=> gas in erect postion. “medically wreaked by eradicahng 1, PyioRi Lo ZaAnhbehes +P; weronidate, Bundt) -otnee: + Crohm's cam atieed uodenuen #180 15 absorved heve. [lc anease matt Set here Jo get Fe deficiency anemia /oWd acid, ~ Fe \s abrorved under the conve! of the. iver Lheftitecytes) = nepeidio which Y 4ne absorphon oF tein, shepcidin 1s am Ocute PPOFE poten so als Jen im inFlamwaghen ,OMPHALOCE LE eel fen weeks ite abdominal cauhy isn't bi enough so hive. PAsCLOGICAL HERNIA, ao wl prolapse .dnel once 5 big ough, they come back cut Hida by Peomes back Countere-clockwise « “RISO. WO the WO, have ANE Jeyunwin ‘oa needs fo end ue IM the. RD So foe the Abdominal contents to be 1M Ae Aight place, |The contents have 4o be brought back in (they come back In counter olockw ise) 2)The jeyureum/cecum has to descend down to FLO = DEFECT inf RoTATIN/CLOSING = 0 mphalocele «IF mot covered 17 Periteneuma = gastroschisiS—> Mas a riskoF eeryérahon He oF ans. S1F cecum doesmit descend = undescended Op peri = game. histology as duodenum. HONEVER more villi 1 Increase Ine Surface aeea FoR Abs PMON ond Here are tess Crys + cellS = brush border Cel (ilke thyroid, PCTete). These ake always active. yotneye gonna be columnar pens. Ly Ee when actwe wi ve catbeidaly when nef F columns. , ‘ave Continuahon oF the PICA Circularis ,6o TS Rough. Theee Age IES In the veuM So SueggENS Can Rui the wall together and 1F HFS roughn they Enow us4he yeunuN- * eum also has Peyer's Patches. tsiymph roses, so can get tymphadenihs- FUNCtioNs Absorption 50 mayor peoblem associate = malabsorphen stinefest to find the cave of # e nonesacc had C 2 = Enzymatic pancreatic rush woxeer) Anatomical ~ biopsy of Si- neaemal (,racousal, vk barcer) = be Lactase.z> lactose \ntplerane ~ hastoioqyca tty, 0 bopsY wll show someteg Ly cmuggyqterteres wlarsuechordases 1S acobose , give post-prerdial = eb rile for diapers. n nayor side wae C000 4 ern tnougnine etfect= matabsorp nor uc aricnest “pe same \F there 1s a PRobIEM wi fat malabsoreren ConFivm It wl fecal Fat. => stain wi gudan black (witt be ®). ou Do a blopgy to Conhrma tne cause,MALABSORPTION PROBLEMS. Celiacalsease teopical sprue. whippie's Crohn's uscase. Abetal Popretenewnia. Celiac disease qutoimmunc => $0 wilt have otner Heeidétary, Gs : Hemorrnagic ufo immune prabemy Tetangectasi@ Ut MAMUNE 160 wi re #7 QIK foR herpentormdermanh eR pel pave RISK OF lymphoma (esp. T-Cel-> CD4 ) fw, LEER (Pe ner pentormdermannsa> iene ined were CP graae * IgA, s0 Celiac 1S anti ~iga {but can be a-Ig6. * HLA-D@ 2 +8 class IL, TF helper ce ns (THA !TH2) 80 the destruchon 15 both celtrmediated AND onhbédy meaiaied. * AlleegiC +0 gliadin vensihuity expressed by overachuily of TH2/THA STH IP Ls a150 involved > sSHmulates Neutrophils, macroprages * Antibodies ave. agains erdomysiue rtransghiaminase oe Oise rmmonecy ies Bells « tiadin. ~Gladin stimulates epithelial cells tO express IIs Waich Chmutates COB and that srimulates NS - = Badin will Cress the epithehal cells to be deaminated by Hssue. Crransgivtaminate => important 4 deaminale 1+) Hne deaminaied kind. wall Shmulate the BO, = mayor cytokines = INF ¥ + © RISE of “Iymphocyhe colts £1 Risk oF adenocarcinoma Since Wi QuOWMMUne HELE 1S an 4 rISk FOR CUD! =K cusll get tron deficiency anernia and microcyne hypechromic anernia > oheck Jeaum Fereiha level Arsh bic HU tne mort Porshe. and tnen Check T16C. Tropical Sprue- * E.coli + gram neg. eod “histeey of travel > typically targets Folic Acid sTReatment= Annbiones: Wnipple’s disease systemic j v0 have constiutenal symproms : prusually wie wimatabsoRpton ond lympnadenapathy, sein and neurological ober eee of Bar usuoly arecte tHe whole. wresine go ican attach The Chased jerId.= gram@od but hoed 40 be seen. . nema Whippel: BOCAERIA= 9 . inact VPAS@ SO once MB's EGt Hhem.rnen the PAS vtAINe them posite. = found 19 te lamina propria, will Find macra phages w/the bacteria. Give anmbiohes. FoR a tong Hime Ly Tmp-EmX cephalosporins (omce gram © Rods awe vo sensitve) cones Disease. “ SSieme Graber rom ene mouth to tne ahus bub most Common site. e wood Veui = oe tunis whene: wh Bia getsabioeked) bile 1s abroebed and FAM Vit > will also get Etdney stones oxalate will precipitate: eskip leS}onS j agtarihs: (more later)= Ho Beta = ro B-100,e¢ BAB NO 48, = Mo ChytornicRon NO 100 = Ne VLDL carrier of Rat Prom the vee — Fatty wer, 9 lipid = CEll_ membrane problem mental retardation - © RbC'S ARE Abnormal bIC not enough +> make Proper membyane ~ahemolyhe anemia Cextrovascuiad * neuRoiogicat Heeiditaay Hemorrhagic telangiectasia: = ill Se@chtarted, vessels =7 lyrmphane vesrels! -AHIS 1S bic fat through He Ynofaciccluct gPes fromm Tne interstrhum and lymph uptates it back to QP =cysizina chyli iS below tne dlaphrargen Hen Ye Thoracic duct qhen crosres at T4, goes UP.ete. Giardia Lombha: ~common Cawie oF fat matabsor prion = Steatorvhea Teommon in Homosexuals. LOWER INTESTINE: =19 MoRMAl CRYPIS oF Leber kinuth, have Paneth ces Ls more crypts in Lage intestine = eosinophe granules"> antmerobal Clay mucus.ceerenen) ‘Draeenca Acute Coneonie >2weekS agosto eniecins infectious probiers) ascii tung 465t FR Bia ve poemal PH Merce an 8 7 Chugh oserlaetty gaP) oy -diarenea-ssecretoryshighvouny SE dan eh a Noxatwe, Wee woroyanvinng pUsrhve iF Here |S itn neminenes" fpighh Fat in Stool fosmot 0 Vols A ; ~no mflatnmation {no wlac's in Stoo!) intlornmatony? low volume, wbc® Can he. bloody. Nozmat aecens AE OCK I HCeNNS MLE 9 eer etn D- Cells Rake —> yuma! ann Ke cells males GIP ‘F-cells/PP nme» ancien Polypephde, fi-cens -mmile_, a p-. \ osmolarity of fecal Ago- 2L1varekt) iP noemmal osmone goo (<50) eck Stool weigh aN se 4, HK vaxatve abuse, LBS[Debyerctusion) (on endaseory Seedor® stains, melanosis cols),‘Prarenen + __ Brody / \ tery vomit No vomiting / _ vN rover mn FeveR — wiofevee ccjoser vAlum pertringes J \ \ =qraedia Lomnoro Beal) TEREC = Cayptococeus sporduon feveR wo fevee wocs|iees. “PEmorenAge {alwarys tm aeownune- \ oe ala fom@omied PTS) EPEC +B. CeReLs a mn \ [ped's) x Stoyin Rureus we STIMONM get EC Cog cam be ae 4 eels eatin marth fever no fever Hes SYR pon dvhcil Fi Oo Crolero. oe duhale. KCOMPYIOACR Jeyunh at re coxte ee ee anes ‘oiody eanellfisih —— viPoma, 035 eyaott Cornmnen ee] wesc: FRE, -NoRD anttiort C= cepnaboteen) clindamycin Gunde 1s yorcay ver Yor atove Ye dtiprgm, rnowievee, The excep ons fon endometriosis) = can Tec wf Metrondaele ren. Vancornyein Ae Singellaparroagionty ‘Gee Thavow view ean be a. cause oF reactme artnet» Soniga foxn Wvero-toxia) EHEC arse uses the sant ene, -saimonerta. con invade the. biooa vesters =>sepricemia ‘Lasiougning 0 F rmucout- & Yersinia Enterocoly NCA intreachve- condi hens, Guitlain - Barre 08 peachve Artinc HS ~ ids /claygoneetenters 4 Emtamebn HIStOlyncA by attack colon en) peed 4) etiney inva ord oortact. fwee (Adee) TG subphrenic aoicests » 1s Recal-oral->honos Tron. SE OF Pretozet tavasian ~ Pask-Sraped ulcee, “Hee yurcnien Fetneca the > JorSot Jejunum/iicu Wyimph node s= | GBT mawmies abpendicrn = tae one the APC SOF theinteshine. yphoderihs. Ss. EHS ene MM-CCUS whch ome soody Trarened CAN be cauted py \RD> UC =the viNus thar Can Cause bloody diarrhea = Cm in AIDS = Ave qnaning diarnen * constipamen 2 concce OF 16S by exchusien- LG axeast 3 cays/menth for 42> \ol0monthS. =e ynepe rs FeveR NOTIBS. Pere ‘treatment, ‘anti-depressants / anti -annety. rpay-reheved alter defecation -woe suse ur *mMectel'S piverhculum= OtRue one 3 99 tech experimental > Comphcanensé ually asymprome, -opstructen ; inflammahon (“tis")> dwerheulths, ulcerahon beading, PerForahen, peritonshs =mos} Common = bleeding + Acompucahen of lower 61 bleeding Mectel’s divertculaae ts # Remember the Rules of 2 Ls won def.anemia. 1 kids ~éither meckel'S diverhculum ~0R woems + Use the BUIAC est tents oR RCs instool. SANDER Complicanon= intessuception. ~ tlavaginatien, oF ileum inside the Cecum 1S the most Common caused by tratten (il Fe inFlammanon). =fed-currant Jeily because of mucus Txt lee tey to Bull itwlair vac Large intestine: (Wmaph arainages. om /im pecancne VERVE Supply: K on Right Side Lett PeMeYpHianene (82,5354), Transverse colons — Ly infeeioe bordee oF the pancreas Stomaeh smmesonginas > behind r= tet wethra ‘ast./desc. colon= @etro peritoneal. ~The layers are the same has more Gobiet cells (Foe mucus vecrenon) OR Secretion of =Recal motterial => Plona C2,(oli Fecalisyete:). } absorbed in tre tleumy vitamin K=>JHRUCTUREs THE longitudinal MUSCIES UE Lonaerued 1b > PUNT v, fe. cordenve rene 6 all the. tudinal muscles Come togemer=tnesiaet of it, Appendix > wire GC intlammation. A complicahon= Risk oF ‘aw peRfora nen PS 05 intraper tonead o S Cues eres yeauses B) JO RISE of peritonit a obstruction SS =» inypertrophy GF Hnore| alwaysdo PREg tert ptuwed Cysrs eis det ‘be anda minal, prods.CANCER oF Appendixs OIUN alscoloranon ot the Tip Bt He Appendix . ~cartinoid >NOserotonin yndrome bic tS Cuch a LHe amount she liver can vandle it. 4 homevwe, in tre terminal eum ierotanin Reach 400 much to break down and can lead to sttnons, ng the liver ig 180 partorit will go tothe Rignt heaRE i LF Here 1S cin ASD, then wiltAnd i+ on the leftside« See Spasne bronchioles, ditahing Alushing , prurt iis cicivrhea, ete. & lef 6ide can destroy Vero fonin- => secre Ry darned. TReatMents~oMaorahn (OCF woe). (CRCINOMA 4 ako o paer oF msn syndrome. =smokIng = pro techve Lawonee) Ivectable Bowel Disease ~Appendet omy = prokecive, Fic te tagth oF ScieesSirevafite. Couns =the “col park 4e0S us that Its ony the Colon (iEall= pan colts). -the “ultee" part Superficial b> & \& psuedopolyps (no epitrelial Ces, gust the. body/tr yng 4o heal ltsele) = tOXIC megacolon ~Gamage trun eeburds, nen damage => RISK fi Carver). ~Conhnuous ~lead pipe ble the barunt lookS Smeotin, {chronic cond inans: ee wlocut Plone) Joe tp attract fab. coused tobe cated rors disease. eee Hens. = SIP tesions Ss srRieg fesiens AY an boku LEM, “Gao wat dee creeping Fat Bs | > RITE of Actula/ Assure (usually anat) -31F hsfure if due to Crohn's, most \rkely tp be > Porieripely maidisiorer en. Teese gangreanim-2/enk oF Kidney sceasestrua noeremob -Seonegunve reactive aethrits,NOD2 granulomas INFY, MPs THA want tne valacyelic . SinFinximab & b-mPe, memohouie lower @l Bleeds -distal to ligament of Tietz (jejunum t dawn) Ls have to check for blood diseases « Rugs ok biood disorders =>Meckel's diverMeulum wr kids usually (onost common, oLD Right Left Ceeddion) (diver newts) Lv Ls pulsion ( False) Angiodysplasias open APro\anse Ca tiated our wi Ap iertes | ‘ damage rhe as ; aon D> Any Wer BY peobien RISE Pactor =constpation comprienon— diverhcul hs, Rae eT mene ete. (MNS 1184). > divernculi hs => mumicking associated wlangio pias! ly hemolytic ie Spnormnocyne Lamerocyne 00 ble oF Joss oF biood ‘appondcihs pubon feb most commen couse oF hemolyhe veer ieedivg_> ral Pave anemia in The elderly in Flammahon=>Seals Up “xe VewOConsrictors , |ike. vauopresnin area oF damage. era “Yess, bleeding competed fe Giver neu losispolyps oOo ef Non precancerous ~ pRECaMEROUS oChamar tomas ) vine polyps 'S rhered ta erot precancerous ae iv Adenoma. << NM (tes Peute-Jeugners syndane) 4 herd eugners synde asee | aes Lemmutocutaneous pigmentaanen wv 5 colon polyps EAP (#0) ~Cexicena mobhiferternen «5 Ow YUL sivo paiyps usually, ADL WA). SaMpe\, ious Tubulae —_ legion ~Leneyhhe/Puretonul peb7A2) — @ arg gem. =osveamalGbeor — mot Common prerentahon one Cagardeners Parbdeninal: pein Fe due eames fo Imussec PHON=> RISK of ei Obsrruchon Gtureot's Cosee. Pigmenianon > do endoscopy next Qolon canter > rupee plone SirFlammatey polyes 2 ee Sens, erate gmeaiiumn —_-R>L (muines goatierahon vy) pld= ulceranve Cons ~auppic “Coe 151 > yne Right Gide get weon-det- anemia. mutatens » ee = — DA Ape ) Lose methylahor “Y oe ae dees Adenoen, fy oa tea aden Cerngpn elarlya. ion) eet “paren) oF BdenBMA Canicr gene quate. > ade wa. grade3 (iuee grade Noe can ane adeno canciones~ taking Aspirin intrilorts COX 1 3 lonly ” Gipnornaal An HoWin\ANOMD ) Colon Caneta = Bed most common Comin. > Heridrlary Non-polypors Colon cancer =o defect in DNA Repaie probems.. LLynch-4). oNNeR Cantees— Lynth-2. usually Female.endomer tat. what part of Celt Cycle? G2 we thing, DWAREepHe defecr Metastasis = Iocat— adeno carcinowe murhiple repiens of we porall Circulanen > liver To heat bub poturnors of nenet SO lungs 1s wuneee iF goes tein bone ane brain, > onte meresiasized , wnuied chemotherapy: so 6-FUIS the ‘best bpnen. L endrcerdins—> UrReP BoUS—> NaCl genninve. New murmur culteLoe eo thy VOLES, associated vith MLH and MH genes & cannot Repaie ble laces proofreading,Hepatobitiagy + = cyte bul From tne foregut sakes the gall bladder, SN Je Also mates hepahc bd. veel Bloes: celiac trunk~shepakc artery « Venous: cyshe vein» porta vein Lmaph Nodes: eventually 49 perfaurte LN'Carin che Furchon: tore bite, absorb water to concen Bile, a ot ‘produce mucous Clots ¥ an obstucton) puunder hormonal nivel: Cck7.00 use ve Fo asress vegrity of gal badder. “hese acwatly uch, | ent ran Gall ladder Parasympatnetic-» dees contraction jouches dupdenan Located at the intra) border ot arecinie muscles, “gem yntereotat caehlage Cholecysts-> rurphy's Sigh = #ae deeper breath Yo push the GB to tne es eee : N) Lalots A aeeret Gall Bladder Stones mest ane radiolucent, says ae) Settee cert commr ‘Brown, Buck. " = A cholesienal infecous = because: of bilirubin (urvenyugsel) =4 bite (usally greta Gremoiyes) ie demske seclses Sains Langage a gs ne a ‘Acetyl-coA Beducle, crstesterol enti? wae Acute Choleeyshts a ae at oo feces. sel eer deficiency on bagel membrane, Soatecystt + Due te stress (symp. ovrachahy learn a Elin ascending tem” vafeemstruen ich testers fon Ehbleductnek. Ee havetheart} nals Stak fens estes nnsing na ME tnauceRs of Hmg-coA “efoto up /obenatna mente ~ Cagbolwarates ‘cule tan lead to ok ruphre souk ret nseng = Estragen Chrome Cheleeysns Cre bata high tetra So increased risk oor = Fete females ournes fat, = greety everything ehrns Asti ecb lancepagedl "ta mild pain ron sme m te oF svegh, chan Crens-mecote WE of cancen- Frc ne pan, Uhaprent more in frales ~ G1 aymplwvieigns but related fo rghtde. HEU) shennghe aner, “Stans have a rise fe lwem probs Saale ee ec = Risk Factors berides cheonc choleoyhhs he cancers ‘seam pain. harng tone Feng me: =O) prise watts eaeted = have do chuiecyretons GoReuer GALL BLABDEE) ~ tie erasers gt nee ‘ouminown cous lenign, don have-fo tae remave,obstruction Sethe GB will enlarge ble of Hee smuaus! a no dice painful Bequse someting m the har tect “usualy “brown's coming ram al Bladder Cehotel mass) 8 Common bale duck eho dvechaiecyshhe) ~ SYmeteas /signs: obstruction Jawidice ue gs Aik trem dare | suave feo) et } lab vanes tm Branhs ae, Ast [ obsructve J ava Le - oe aur ) rate ames ee anes aon — 17 Awwnor = chelorenss seinesis (hese pate eke) ererr rrr een eT eeerttay caer ee Crean end rst ob cane, | sega we ‘sRenalas penta: Shore 3 + hyplesion + anki (oo base Chats fad) frat, of gram = - Shimer can be caused by Chrome Chany “Pewaey seleaoss inj Cholongihs = extrahepehe manly men->aMnune-> ee pamnstesinen vinnce> aie en “BD oe UC atsiahant Cpcawca)® *Sonon sein ie du” * aviernaning shires w/atanan {=O} rae Biany Or nesis mans dae te biysbrechon, eh ate “All pita ach arent canes 1 eh obits she nad ob the parent (ve nse» pane ie obcrichn 14 fm ouinde (Carvanyé igh “stores biectng the ampula of vake-rwsually muddy snes, ead fo aufodgerrinn oF pancrea spe! 1S 6p ge sce in ne ses ealyoitng, poled, ES ef ahananal brHrchon. ‘la shone teu) ~ dont gue contrachhly deugs van sttruchon eyo go wget (co no coterie) by gue thin paral eu “dln $96 morpnne Acts on te ampulla oF voice vavedsaee 15.50 gue pepecdinet +H stone Jonas cutee, can get a hota. aie buhies “ho Fistula but at) bubbles Tacans its ClesiiduunpevingensDrawer Perot _spente has deesal pancrealie arenes. r * peritoneal except tall nga locates in the epigastric, pomhing back {Galt aiagonai ~aniener inden 1s te mide boen, ~ 4stOWM. on i ~ Rebient vo it ewe painful ‘hate oniee nid Pain Ser enone gents obehathe jaune Shoay aed som Endocrine. Pancreas: ne foto somarorian YAP. oe Ba an Exoenne Pancreas =CIr are always cer. to coy" ~ Felon cates more Hox = @ flow rase= moral should be setae seurehon. 4 ld = secre» wea WEATONE pancreas, Faamaye i cceg she Ponds: ees mason EYES > gue mem veereha but “enavme, Hébs> isn't highs origin oF cancer, Ute tre, SLEINEE ce sya at etm pce we PcT in kidneys. ‘Sica et ea ee ses Se hare a Fe a tat onead at ea Eaptngonnin, “Teensimes nece gpa hbo, aBipi na aca on pote bane mdse, peeutht Urtrven statin exert ogee tapas earnaanlite seypiia 16 proce specif, ut hand eteature. eyshe fibrosis [Eisler The enaynes necs tone m alklne-enaronment —PAOgensis AB wntaon (AF 28) * by recrehn nthe Beannees "Gree panel protein Felehens ends to tance, wees ‘nic Causing) ehrame Gi DmoRe acid Can lead to Brunner's hy : yrerplasia Any defect can eaute malebovehen. (Quick anatomy) Gbstrithon wmatved tae? 271103 Fong ane er aL RtENE aia seco Lo ‘CT for proarmuscle enti st % eunuaihamgrocieve Cg ctenag trey on guatats hanarun cate opaangy astm her ot ventral timer ponereriy” ‘aul EGER amar pancreat te the-budrOhabes, “SONY ES etc abieNe Vertrally Strangulanion Be vee delren =e F roles but avert fore the. o\agnosise “svi chloe, Ventral maltsane min pancrcahcdith rosa elental diferente, * panceeatic divism. noement fly nr Gru of panereantes eaten eons) dutheeya gy a RetaSe pancreas =) 4 pans cones eat chronic eremorhagte “smost Comeam oqute = acule-pancreahhs. + # Alcohol horus vet) & mort anmton duck) — €Pancreahe oneyne = nazmal indues. ~G glucose = 4 (bic cause of bm) “ERCP (erxeduce) Type Sinvuins Utramaheing _ ~PISK oF cancer “pantreas. 7 ~ tnalabsorption (sigh ot #)- mainly fat alabmephen. “eepceb Att ductal ceil dead: AE /+4Cnyicry ich -avropmed pancreate (Worn Ohwenntematay— ae > type 41,4, A-TAG= 4 FEA'S wnpancceane capilones by pancreahe Wease~ i & Hs Vvoimally, Fa @kistw StmIM pains 40, albumin but if Feeuen TAG: ee Jie Cee of FAL Dbunding catacty OF albunen and Tends avec ‘male Coupeebin Injury fo te pant aie cobs YF hypercakemia,(aun be mavect). woes fete pancreas? damage to Ud w) cca panensabre => Viewa cogent) Trancceane. acinar te (tare er ence Hove 7 mort common. ; Puta obstruchen), which riggers he abnOvmAl cause of pancurths mes aon at rgprva imide te acinar es by or Testatmalenemes. “Tryesin achyate offer = dsm re ‘rokonne entry eFe.op aubedige! isn’ ump ade fan Jone fente NELFOMeIng pancreAhnt. ~ Maura cent belt). “Pesiecnve: mechanisins to limite amount mort case = aatf-tied. oF trgpemogen teak bttomes premahuely : iotenob treat envated: ab IV Autd. » “Zorapiicanons ‘}Seie ern, nb ka ye nt . vem 6 ureved BY Ponceateaciner cee Andis MEDICATIONS didanonne (Neri) con cause ‘ingen niin. Ices citer Panereanns, (@nirnral, protein ryntusss se aituete fonttte: shear Teed machine to lethal by cleaving oer Pgprn metesute. revue ru preanon,arrneenuhaus, —PEEBIORY Pancreanis x mutations mS Sulfa DIUPEWS (huneremtdia). punctewhe pSucddoyst « potennal compcurion ob — antennae Fane oa ens sian os Gataaae Me etic enane shat marndts es Be back ble vir Iaammaiorg (0 18 the walls a PAE SUTBuMding organs ele eee nN : ¥ceveria tedecweto predict prognosis > “bine /estn " ee T)saponfeahon Ciatnceratsy = Soar Luect> Wold besmolenporurcas{ete). = Compicahone Cyehnuin) pancast\@) web Lp puso ml eg en beep Hee Ae setone ence. Ap wet fern fabaegsss AROS“ omgepoamauane cpt are g se 2 Aacdtee” YAnetinen hd kpc & eat Me senMester ea i pancreas Hunt. 5) bn