1
Q
Where is ADH produced, where is it released from. What precipitates its release and where does it act?
A
Produced in hypothalamus
Released from posterior pituitary
Released due to reduced circulating volume and AT2
Acts on DCT
2
Q
MAP equation
A
DBP + (SBP-DBP)/3
3
Q
Boundaries of posterior mediastinum
A
Anterior Pericardium
Vertical part of the diaphragm
Posterior Lower 8 thoracic vertebrae
On each side Mediastinal pleura
4
Q
Contents of posterior mediastinum
A
Esophagus
* Thoracic aorta
* Azygos vein
* Thoracic duct
* Vagus nerve
* Sympathetic nerve trunks
* Splanchnic nerves
5
Q
Oesophagus level
A
C6 (cricoid cartilage) to T10
6
Q
Achalasia
A
Esophageal achalasia is an esophageal motility disorder involving the smooth muscle layer of the esophagus and the
lower esophageal sphincter (LES). It is characterized by incomplete LES relaxation, increased LES tone, and lack of
peristalsis of the esophagus
7
Q
Constrictions of the esophagus
A
Cricoid cartilage
Aortic arch
Left bronchus
Diaphragmatic hiatus
8
Q
Innervation of oesophagus
A
Parasympathetic - vagus
Symph - Cervical and thoracic sympathetic trunks (T1-T10)
9
Q
Pathophysiology of ARDS
A
Acute Phase
Widespread destruction of capillary endothelium.
Neutrophils and cytokine release
Fluid seeps into airspace, stiffening the lungs
Chronic Phase
Fibroproliferation and collagen deposit leading to extensive lung scarring
10
Q
ECA branches
A
Some angry lady figured out PMS
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Maxillary
Superficial temporal
11
Q
Nerve passing anterior to ECA and level of origin/bifurcation of CCA
A
Hypoglossal nerve
C4
12
Q
Define thoracic inlet
A
The thoracic inlet, also called the superior thoracic aperture or thoracic outlet, is the opening at the top of the chest cavity connecting it to the neck, bounded by the first thoracic vertebra, first ribs, and manubrium of the sternum, serving as a critical passageway for the trachea, esophagus, major blood vessels (subclavian artery/vein, brachiocephalic veins), nerves (brachial plexus), and the lung apices. Its anatomy is crucial in diagnosing conditions like thoracic outlet syndrome (TOS), where compression of these structures causes pain and neurological symptoms.
13
Q
Path of splenic artery
A
The splenic artery, the largest branch of the celiac trunk, follows a characteristically tortuous (serpentine) course to the left, running retroperitoneally along the superior border of the pancreas. It travels behind the stomach, through the splenorenal ligament, to reach the splenic hilum.
14
Q
Organs at L1
A
Pylorus of stomach
Fundus of gallbladder
Neck of pancreas
Kidneys
Liver
SMA
15
Q
Transpyloric plane surface anatomy
A
Halfway between jugular notch and pubic symphysis
16
Q
Midinguinal point vs midpoint of inguinal ligament
A
The mid-inguinal point (MIP) is halfway between the anterior superior iliac spine (ASIS) and the pubic symphysis, marking the location where the femoral artery becomes palpable
midpoint of the inguinal ligament is halfway between the ASIS and the pubic tubercle
17
Q
What goes through jugular foramen
A
The internal jugular vein, the brain’s main venous drainage, and three crucial cranial nerves: the glossopharyngeal (IX), vagus (X), and spinal accessory (XI) nerves
18
Q
What goes through foramen lacerum
A
The greater petrosal nerve, deep petrosal nerve (which join to form the nerve of the pterygoid canal), small meningeal arterial branches, and emissary veins
19
Q
What goes through carotid canal
A
ICA
20
Q
What ligaments attach liver to diaphragm
A
Triangular and coronary ligament
21
Q
What does the pulmonary trunk divide into
A
Left and right pulmonary arteries
21
Q
What level does the pulmonary trunk divide into
A
T5
22
Q
What lies in the lung hilum and how many of each structure
A
1 bronchus
2 arteries
2 veins
23
Q
What structure is most anterior at lung hilum
A
Pulmonary vein
24
What is chloride shift
Shift of chloride ion to the intracellular compartment of RBC in exchange of bicarb ion
25
How urobilinogen formed & how does it circulate
- Its a colorless byproduct of bilirubin metabolism from by decojugation of bilirubin by gut flora.
- Some are excreted in the feces after oxidation (stercobilinogen) and some are reabsorbed into the portal circulation again. Some of the reabsorbed urobilinogen is again excreted by the liver but small amounts enter the systemic circulation and are excreted in urine.
26
Define pseudocyst and what are its contents?
Collection of amylase-rich fluid enclosed in a wall of fibrous or granulation tissue.
27
Why is the calcium level is low in pancreatitis?
In early stage:
auto-digestion of mesenteric fat by pancreatic enzymes and release of free fatty acids (chelate calcium), which form calcium salts (saponification of fat).
Later stages:
due to complication like:
- sepsis
- also hypoalbuminemia
- and transient hypoparathyroidism.
28
Glasgow criteria: PANCREAS:
PaO 2 < 8 kPa (normal: 10-13 kPa)
* Age > 55
* Neutrophils > 15,000
* Calcium < 2 mmol [after 48h]
* Renal (urea) > 16 mmol/L (normal: (2.5-6.7))
* Enzymes (LDH) > 600 (after48h)
* Albumin < 32 g/L (after 48h)
* Sugar (glucose) > 10 mmol/L
29
How would you manage an ECF?
SNAAPP:
1- Sepsis control [just say this, here not say sepsis 6]
2- Nutritional support :
- liaise with a dietician
- asking him to recommend a TPN regimen that adequately meets the patient's calorific needs.
3- Anatomical assessment:
- CT with (IV & oral) contrast for abdomen and pelvis
- Fistulogram
4- Adequate fluid and electrolyte replacement:
Guided by U&Es and blood investigations.
5- Protect skin to prevent excoriation
6- Planned surgery:
- Within one month after a trial of conservative measures.
- or If pt developed complications: Distal obstruction /Intraabdominal sepsis
30
What're the hormones involved in calcium homeostasis?
PTH: (increases calcium) by:
1- Stimulate bone resorption >> Increase serum calcium
2- It increases Calcium reabsorption in the kidney
3- Increases the formation of vitamin D (1, 25 dihydroxycholecalciferol) in the kidney.
* Vitamin D: (increases calcium) by:
1- Increases Ca +2absorption from the intestine
2- increases Ca +2reabsorption in the kidneys
* Calcitonin: (decrease calcium) by:
1- inhibits bone resorption
2- Stimulate the excretion of calcium in the kidney
31
How is vitamin D3 formed?
7-dehydrocholesterol converted in the skin to Cholecalciferol [under the influence of UV light].
- Cholecalciferol is converted in the liver to 25- hydroxy Cholecalciferol [ by 25- hydroxylase enzyme ]
- 25- hydroxy Cholecalciferol is converted in the kidneys 1, 25-dihydroxycholecalciferol which is active form [by the enzyme 1alpha-hydroxylase].
32
What is stroke volume?
Stroke volume (SV) is the volume of blood pumped from the left ventricle of the heart with each beat, averaging 60–80 mL in a resting adult.
EDV - ESV
33
describe pain pathway from receptors to brain?
A-delta fibers are fast (sharp pain)
2- C fibers are slow (dull pain)
Pain fibres to dorsal horn to spinothalamic tract to end in thalamus.
34
how does Angiotensin II act?
- Arteriolar constriction.
2- secretion of aldosterone.
35
: How does aldosterone act to maintain circulating volume?
- Stimulates the reuptake of Na + and water by acting on the receptor at the junction between DCT and collecting duct.
36
What are the mechanisms by which the kidneys increase osmolarity in the renal medulla?
The descending limb of the loop of Henle is permeable to water but impermeable to solutes, thus water moves across the tubular wall into the medullary space, making the filtrate hypertonic
* Sodium is actively transported out of the thick ascending limb which is impermeable to water. This creates an osmotic pressure drawing water from the descending limb into the hyperosmolar medullary space, making the filtrate hypertonic.
* The countercurrent flow within the descending and ascending limb thus increases, or multiplies the osmotic gradient between tubular fluid and interstitial space.
37
What is the results of mucosal atrophy?
translocation of bacteria
38
What is refeeding syndrome? Why it's fatal?
It is a metabolic disturbance which occur :
- when feeding a person following a period of starvation.
- Or in patient receiving artificial feeding.
Leading to metabolic consequences which are:
1- electrolytes disturbance ( Hypophosphataemia, Hypokalaemia, Hypomagnesaemia ).
2- Abnormal fluid balance.
39
what are types of valve in valvular replacement surgery?
- Tissue valve
2- Mechanical valve
40
What is definition of DIC?
- It is a pathological consumptive coagulopathy due to activation of the coagulation and fibrinolytic systems, leads to formation of micro thrombi in many organs with the consumption of the clotting factors and platelets.
41
What the Chest x-ray findings in pulmonary edema?
A. Alveolar edema (bat wing or butterfly)
B. Kerley B lines
C. Cardiomegaly
D. Dilated prominent upper lobe vessels
42
Can you explain why the patient is oliguric?
The most common cause is due to the physiological stress response to surgery in the first 24–36 hours post-operatively. This is due to circulating glucocorticoids and mineralocorticoids inducing salt and water retention.
* Surgical trauma and various anaesthetic gases also stimulate the release of vasopressin from the posterior pituitary, stimulating post-operative solute-free water retention.
* Congestive heart failure with low renal perfusion
43
Where is the central respiratory centers? Where is peripheral chemoreceptors?
- Centeral: Pons and Medulla oblongata
- peripheral: aortic arch and carotid bodies
44
How the diuretics work?
Action of furosemide?
- Site of action: thick ascending limb of loop of Henle
- Mechanism: inhibit Na/K/2CL pump thus preventing NaCl absorption, so the distal convoluted tubules tries to preserve Na + and lose K+
Osmotic diuretics:
mannitol (osmosis) – large molecules which increase the osmotic pressure in the tubules resulting in water secretion
K+ sparing diuretics:
spironolactone (aldosterone antagonist) acts on DCT on Na/K pumps
Thiazide diuretics:
DCT (inhibit Na reabsorption)
Amiloride :
(binds to Na+ channel at DCT)
45
why raised Bicarbonate in acute volume loss
Due to increasd bicarbonate uptake in renal tubules in response to loss of chloride in order to maintain electrochemical neutrality.
46
Why hyponatremia in acute volume loss
kidneys excrete more NaHCO3 to reduce blood alkalinity.
47
Using Holiday-Segar formula:
100ml/kg/day for the first 10kg of weight
* 50ml/kg/day for second 10kg of weight
* 20ml/kg/day for the weight over 20kg
48
What is the SIADH?
syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by excessive free water retention and impaired water excretion, leading to dilutional hyponatremia.
49
Describe the common pathway of Clot formation?
1- Activated Factor 10 with the help of activated factor 5 will transform factor 2(prothrombin) to thrombin .
2- Thrombin will:
hydrolyses fibrinogen (factor 1) to fibrin
also activates factor 13 to form cross-linked fibrin clot
50
what is osteoid?
protein mixture secreted by osteoblasts that forms the organic matrix of bone.
51
Patient shows Xray with pleural plaques. What are pleural plaques?
They are well-circumscribed plaques of dense collagen that are often calcified.
52
Mention types of necrosis
1* Coagulative
2* Liquefactive
3* Caseous
4* Fat
5* Fibrinoid
6* Gangrenous
53
What's adenocarcinoma?
Malignant tumor formed from glandular structures in epithelial tissue
54
define MEN?
Group of related conditions
- inherited as autosomal dominant
- characterized by hyperplasia or neoplasia of the endocrine organs.
55
Structures passing in front of aorta
Celiac trunk and branches
* SMA
* Splenic vein
* Left renal vein
* Body of the pancreas
* 3 rd part of duodenum
* Root of mesentery
56
What is the space between abdominal wall and the liver?
Subpherinic space
57
Where does the left lobe of the liver extend to on surface anatomy?
Can extent to left 5th intercostal space mid-clavicular line.
58
What structures separates right and left lobes of liver?
Falciform ligament (anteriorly)
2* Fissure [for ligamentum teres and ligamentum venosum (posteroinferiorly)].
59
Look at liver diagram again
60
What does falciform ligament attach liver to?
Diaphragm
61
what are the attachments of diaphragm?
Sternal part >> Xiphoid process of the sternum.
2- Costal part >> Inner surface of the lower six costal cartilage.
3- Vertebral part:
* Right crus >> (L1, L2, L3)
* Left crus >> (L1, L2)
* Median arcuate ligament >> (between the 2 crura)
* Medial arcuate ligament >> (extends from the side of the body of L1 to the tip of the transverse process of L1)
* Lateral arcuate ligament>> (extends from the tip of the transverse process of L1 and is inserted into the lower border of the 12th rib)
62
What lobe is gallbaldder next to?
Quadrate lobe
63
Blood supply of stomach and origin?
: Arterial supply:
- lesser curvature :
1- left gastric artery >> from celiac trunk
2- right gastric arteries >> from hepatic artery
- greater curvature:
1- left gastroepiploic artery >> from splenic artery
2- right gastroepiploic artery >> gastroduodenal from hepatic artery
- fundus:
1- short gastric arteries >> from splenic artery
B: Venous drainage:
* Left gastric vein → portal vein
* Right gastric vein → portal vein
* Left gastroepiploic → splenic vein
* Short gastric veins → splenic vein
* Right gastroepiploic vein → SMV
64
External oblique origin and nerve supply
The outer surface of the lowest eight ribs
T7-T12
65
Conjoint tendon formation and nerve innervation
Internal oblique and tranversus abdominis
Ilioinguinal nerve (L1)
66
Great auricular nerve sensory and nerve root
C2-C3
1- skin lower half of auricle
2- skin over parotid gland
3- angle of the mandible
67
Neck muscles and anatomy
68
What divides submandibular gland? What is function
Mylohyoid muscle
- via the mylohyoid nerve.
- which is a division of the inferior alveolar nerve, a branch of the mandibular division of the trigeminal nerve.
1- elevate the hyoid bone
2- elevate the oral cavity
3- and depress the mandible.
69
What is thyroglossal cyst ?
a fibrous cyst >> that forms from a persistent thyroglossal duct.
70
What is the Supply of RLN?
1- Supplies all intrinsic laryngeal muscles except cricothyroid muscle.
2- Sensory innervation of the mucous membranes of the larynx below the vocal cords.
71
Foramen of skull
72
What're the muscles supplied by the oculomotor nerve ?
Superior rectus
2- Inferior rectus
3- Medial rectus
4- Inferior oblique
5- Levator palpebrae superioris
6- Sympathetic fibres to Muller’s muscle
7- Sphincter pupillae
73
What's the first sign appears when oculomotor nerve is affected due to high in ICP? Why?
First sign is mydriasis
Why?
Because icreased ICP >> compression of oculomotor nerve so the parasympathetic supply will be affected >>> leaving sympathetic supply of sphincter puplea muscle unopposed.
74
What is the anatomical explanation of raised ICP leading to papiledema?
Optic nerve surrounded by 3 layers of meninges with CSF so raised ICP will be transmitted through optic nerve causing papilledema.
75
what is the possible route of infection spread from middle ear to brain?
- direct erosion of bone
- infected thrombophlebitis of emissary veins
- mastoid air cells
76
What clinical signs of cavernous sinus thrombosis?
Painful Proptosis
- 3rd, 4th, 6th cranial nerve affection >> (ophthalmoplegia)
- Gradual loss of vision.
- Signs of meningitis
77
Mention the middle cranial fossa boundaries.
Anterior:
1- Lesser wing of sphenoid.
2- Anterior clinoid process.
Posterior:
1- Petrous part of temporal bone
2- Dorsum sellae
Laterally:
Squamous part of the temporal bone
78
What're the other branches of facial nerve rather than terminal branches?
within facial canal:
1- nerve to stapedius
2- chorda tympani
3- greater petrosal nerve (pre ganglionic to lacrimal)
after leaving skull(motor)
1- nerve to stylohyoid
2- nerve to posterior belly of digastric
3- posterior auricular nerve (occipital belly of occipito frontalis muscle)
79
Which muscle is supplied by the facial nerve after leaving the facial canal rather than muscles of facial expression?
Stylohyoid
80
Describe the course of vertebral artery starting from arch of atlas
Crosses transversely across the posterior arch of the atlas.
- then Vertebral artery enters the skull through the foramen magnum.
- Inside the skull, the 2 vertebral arteries pass upwards, forwards and medially in the subarachnoid space to reach the anterior aspect of the medulla oblongata.
- then they unite together at the lower border of the pons to form the basilar artery.
81
What're the boundaries of the posterior mediastinum? Mention the name of the line separating it from superior mediastinum.
A: Boundaries:
Anterior :
- Pericardium
- Vertical part of the diaphragm
Posterior :
- Lower 8 thoracic vertebrae.
On each side:
- Mediastinal pleura
Inferior:
- diaphragm
B: the line separating it from superior mediastinum.
- imaginary horizontal line
82
Name 6 structures that lie in the posterior mediastinum?
Thoracic aorta
* Azygos vein
* Thoracic duct
* Esophagus
* Vagus nerve
* Sympathetic nerve trunks
* Splanchnic nerves
83
What part of the diaphragm the oesophagus pass through?
Right crus
84
What communicates the spinal roots and post ganglionic fibers?
white ramus communicans + grey ramus communicans
85
What are the tributaries of the azygous system
Pericardial veins
* Mediastinal veins
* Esophageal veins
* Bronchial veins
* Hemiazygos and accessory hemiazygos
* Right superior intercostal vein
* right Lower posterior intercostal veins
... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
86
Abnormal cervical vertebrae
C1: no body & no spine
- C2: has dens
- C7: long spinous process
87
What is the significance of internal vertebral veins?
These are connections of plexus of valveless veins that drain deep veins that drain organs of the pelvis such as the prostate and rectum.
- so in case of malignancy or infection in these organs >> easily spreads to the veins plexus around the vertebral area.
88
Femoral canal boundaries ?
- Medial: lacunar ligament
- Lateral: femoral vein
- Anterior: inguinal ligament
- Posterior: pectineal ligament
89
Femoral triangle boundaries ?
- Superiorly:
Inguinal ligament.
- Laterally:
Sartorius
- Medially:
Adductor longus
- Floor:
1- Iliopsoas
2- pectineus
3- adductor longus
- Roof:
1- Fascia lata and Superficial fascia
2- Superficial inguinal lymph nodes
3- Long saphenous vein
90
Plantarflexion muscles
Gastrocnemius
* Plantaris
* Soleus
Tibialis posterior
* Flexor digitorum longus
* Flexor hallucis longus
91
Where is the insertion of tibialis anterior, posterior & sal Peroneous longus and brevis?
Tibialis anterior :
1- Medial cuneiform
2- first metatarsal
Peroneous longus :
1- Medial cuneiform
2- first metatarsal
Tibialis posterior:
1- Navicular
2- medial cuneiform
Peroneus brevis :
Tuberosity of 5th metatarsal
92
What are the muscle inserted in medial cuneiform
1- Tibialis anterior
2- Tibialis posterior
3- Peroneus longus
93
What's choriocarcinoma?
Malignant teratomatus neoplasm with placenta-like differentiation.
94
What tissue section Immunohistochemical marker confirm diagnosis of choriocarcinoma?
Beta- hCG
95
What's alpha fetoprotein?
Protein normally produced by yalk sac in fetus
- it may indicate yalk sac differentiated teratoma.
96
How does H.pylori survive in the stomach
By production of urease which converts urea to ammonia which increase pH.
97
HyperPTH
1o - high PTH high ca2
2o - high pth low ca2
3o - high pth high ca high phos
98
What are hemorrhoids?
Swollen and bulging veins in the lower rectum and anus.
The anal cushions function normally when they are fixed to their proper sites within the anal canal by fibromuscular ligaments, which are the anal remnants of the longitudinal layer of the muscularis propria from the rectum (Treitz's ligaments).
* When these submucosal fibres fragment (as by prolonged and repeated downward stress related to straining during defecation), the anal cushions are no longer restrained from engorging excessively with blood and may result in bleeding and prolapse.
99
What's the pathogenesis of thrombosed piles?
Acute thrombosis results from sudden raised pressure causing rupture of the vascular plexus leading to a blood clot at the anal verge.
* Any activity requiring excessive abdominal straining such as over-exercising can cause this
100
How does atherosclerosis occur?
Endothelial injury—and resultant endothelial dysfunction—leading to increased permeability, leukocyte adhesion, and thrombosis
* Accumulation of lipoproteins (mainly oxidized LDL and cholesterol crystals) in the vessel wall
* Platelet adhesion
* Monocyte adhesion to the endothelium, migration into the intima, and differentiation into macrophages and foam cells
* Lipid accumulation within macrophages, which release inflammatory cytokines
* Smooth muscle cell recruitment due to factors released from activated platelets, macrophages, and vascular wall cells
* Smooth muscle cell proliferation and ECM production
101
What's the mechanism of thrombus formation?
1- An atheromatous plaque is suddenly disrupted by intra-plaque hemorrhage or mechanical forces
2- this will expose sub-endothelial collagen and necrotic plaque contents to the blood.
3- then Platelets adhere, aggregate, and are activated, releasing thromboxane A2, adenosine diphosphate (ADP), and serotonin—causing further platelet aggregation and vaso-spasm.
4- Activation of coagulation by exposure of tissue factor and other mechanisms adds to the growing thrombus.
5- finally Within minutes, the thrombus can evolve to completely occlude the coronary artery lumen.
102
Why immunocompromised in SCD
Autosplenectomy - increased risk of encapsulated organisms
103
what are the functions of spleen?
1- Extramudllary hemopoiesis.
2- removal of abnormal RBCs
3-defense mechanism against incapsulated organisms
4- synthesis of IG
104
How to treat Post transplant lymphoproliferative disorder?
- Decrease immunosuppressive therapy dose
- or change the type of immunosuppressive therapy
105
What're the causative factor for "PTLD" Post transplant lymphoproliferative disorder?
Opportunistic viral infection by CMV and EBV due to immunosuppression.
106
Gout vs pseudogout
Gout - monosodium urate, needle shaped, negative
Pseduogout - calcium pyrophoshate, rhomboid, weakly positive
107
What activates intrinsic and extrinsic pathways? How can you test each?
Intrinsic pathway is activated by vessel injury which will lead to activation of factor 12 > tested by APTT
* Extrinsic pathway is activated by tissue thromboplastin released by the damaged cells > tested by PT and INR
108
What are hypersensitivity types?
Type I :
- Anaphylactic
- mediator >> IgE
- eg: Asthma and Hay fever
Type II :
- Cytotoxic
- mediator >> IgG, IgM
- eg: Autoimmune hemolytic anemia.
Type III :
- Immune complex
- mediator >> IgG, Ig A, IgM
- eg: acute glomerulonephritis
Type IV :
- Delayed type
- Mediator >> (T-cells)
- eg: TB
109
What're the pathological sequence in HCV
1. Acute Hepatitis
2. Chronic Hepatitis
3. Liver cirrhosis & portal hypertension
4. Liver cell failure
5. HCC
110
How could IVDU causes venous ulcer? What are the 4 pathological processes?
We have many mechanism of leg venous ulcer :
1- venous HTN >> which can cause ulceration.
2- trauma from injection
3- chemical effect >> due to irritative quantities of abused drugs (cocaine)
4- local thrombophlebitis.
111
what factors is involved in intrinsic pathway?
Factors XII, XI, IX and X
112
How hyperparathyroidism is caused in renal failure?
Abnormalities in renal tubular absorption of phosphate → Hyperphosphatemia.
2- decrease production of 1,25-dihydroxy vitamin D → hypocalcemia.
- Hyperphosphatemia and hypocalcemia >> increase PTH secretion >> secondary hyperparathyroidism.
113
What're the types of stones?
- Calcium stones [ oxalate and phosphate ]
- Struvite stones
- Uric acid stones
- Cystine stones
114
What is the most common renal cell carcinoma?
Clear cell carcinoma.
115
What is the most common renal cell carcinoma in patients with acquired cystic kidney disease, renal failure, and dialysis?
Papillary cell carcinoma.
116
What is R1?
Microscopic residual tumour
117
Define granulation tissue?
Combination of proliferating fibroblast, loose connective tissue, new blood vessels and scattered chronic inflammatory cells. Forms a type of tissue that is unique to healing wounds and is called granulation tissue.
118
What is the fate of granulation tissue?
remodeling and wound contraction and eventually scarring 2 to 3 weeks
119
Which layer is affected in pseudoaneurysm?
- Tunica Intema and media.
is collection of blood between media and adventitia.
120
What is GIST?
gastro intestinal stromal tumor
- a type of cancer that begins in the GI tract arise mainly in the stomach and small intestine.
- Arise from interstitial cell of Cajal found in the gastrointestinal muscularis propria.
121
Function of bile?
- Emulsification of fat into micelles.
- thus provides a greatly increased surface area for the action of the enzyme pancreatic lipase.
- Bile salt anions are hydrophilic on one side and hydrophobic on the other side.
-they aggregate around droplets of lipids to form micelles, with the hydrophobic sides towards the fat and hydrophilic sides facing outwards.
- Also the hydrophilic sides are negatively charged, and this prevents fat droplets coated with bile from re-aggregating into larger fat particles.
122
What is bilirubin conjugated to?
Conjugates to glucuronic acid by the enzyme glucuronyl transferase
123
MRCS B
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