A & P Quiz 7

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1.

"postprandial alkaline tide"

"alkaline tide" = parietal cells become pretty alkalotic - they exchange the bicarb for the chloride, bicarb gets in bloodstream and get an elevated level of alkaline/you get an elevated pH in your bloodstream after a meal

6.

2.

1st phase of gastric secretion

3 different classes of muscle levers:

First Class: ex. muscles at back of neck that hold your head up (see-saw - force & mass on opposite side of fulcrum) 1. Cephalic phase: before food arrives in stomach - reflex secretion; limbic system signaled by thought/smell/sight/taste
3.

2 elements of intervertebral disc 2 main categories of skeletal muscle fibers: 2nd phase of gastric secretion

1. anulus fibrosis = outside 2. nucleus pulposus = inside 1. Slow twitch 2. Fast twitch
7.

Second Class ex. gastrocnemius standing up on toes (force & mass on same side of fulcrum but the force application is outside of the mass) Third Class ex. flexing of forearm; throwing football/baseball (force & mass on same side of the fulcrum but the force application is inside of the mass) 3 muscle layers of the small intestine 3 segments of the small intestine 3rd phase of gastric secretion 1. Outer longitudinal layer 2. Inner circular layer 3. Submucosal muscle layer 1. Duodenum (20-30 cm): pyloric sphinctor to ligament of Treitz 2. Jejunum (~120 cm) doesn't have specific end: dense & deep circular folds (plicae) 3. Ilium (~150 cm) terminates at the iliocecal valve: few, short circular folds (plicae) 3. Intestinal phase: when chyme enters into duodenum (raising pH above 3) - initiates neuroendocrine response (various hormones released into blood and feedbacks to stomach to release gastrin to keep secreting HCl acid) *when pH in duodenum drops below 2, signals back to stomach to blunt HCl secretion by releasing secretin

4.

5.

8.

2. Gastric phase: when food enters stomach 2 things happen: (1) Stimulates stretch receptors (2) Stimulates peptide sensitive chemoreceptors *initiates reflex loops - most daily secretion results from this phase

9.

10.

4 parts of proximal small intestine

16.

Bile salts

-Synthesized from cholesterol in the liver -Stored in the gallbladder -act as detergents that bind fatty acids -they are recycled (but not getting rid of majority of bile salts in any one pass): secreted in presence of dietary fats -A by-product of destruction of aged RBCs -Alkaline, bitter-tasting yellowish green fluid -Contains bile salts, cholesterol, electrolytes, H2O **if total bilirubin is high, unconjugated bilirubin is high, and conjugated bilirubin is low = liver failure

17.

Bilirubin

1: Superior part of duodenum 2: Descending part of duodenum 3: Pyloric sphincter 4: Pylorus

11.

Acinar cells An adequate lateral C-spine must have what visible? Anatomy of cervical vertebra

-constitute about 90% pancreatic tissue -organized into grape-like clusters T1

18.

12.

Blood and nerve supply to lower GI tract

13.

1 - Vertebral Body (except for C1) 2 - Pedicle 3 - Transverse Foramen 4 - Anterior Tubercle 5 - Posterior Tubercle 6 - Superior Articular Process 7 - Lamina 8 - Spinous Process (except for C1 - has an anterior & posterior arch) 9 - Vertebral Foramen 10 - Spinal Nerve Sulcus
14.

-branches of superior & inferior mesenteric a. -Rectum & anus supplied by branches of Internal Iliac a. -Venous drainage into portal circulation via superior & inferior mesenteric v. -ANS via vagus until @ splenic flexure -Distal tract innervated via pelvic n.
19.

burst fracture is due to what?

anterior longitudinal ligament axial load (think of ER case where man jumped and landed on both feet and got bilateral midshaft burst fractures of femur)

15.

Appendix

blind pouch near base of cecum

20.

CCK

Secreted by duodenal I-cells -stimulates GB contraction & pancreatic acinar secretion -also acts as an enterogastrone (intestinal hormone that inhibits gastric activity & emptying) dependent pouch that receives chyme from jejenum -500-700 cc/d bound, in liver -glucuronic acid; excreted with the bile -goes to the intestine & out in urine, or out in feces, or re-circulated

26.

Describe the detoxification function of the liver Describe the inactivation function of the liver Describe the metabolic function of the liver

-phagocytosis of debris & bacteria -biotransforms & detoxifies organic compounds (vitamins, drugs) - CYP family of enzymes -liver enzymes alter some toxins for easier elimination

27.

21.

Cecum

28.

22.

Conjugated bilirubin

23.

Contraindications for Central Venous Access

-metabolizes carbs, proteins, fat (emulsifies fats to facilitate digestion), cholesterol, ammonia -metabolizes & synthesizes proteins: albumin, other plasma proteins, coagulation factors (utilizing vit K), urea -processes steroid hormones & vitamin D -up-take, transport, secretion of organic molecules from blood: anions (bilirubin), cations (anesthetics, antibiotics), neutral -synthesizes, secretes & recycles bile acids (enterohepatic circulation) -maintains glucose level during fasting via gluconeogenesis (amino acids & lactate) and glycogenolysis -stores energy (glycogen, lipids, ketone bodies)! -absorbs & stores fat-soluble vitamins (A, D, K, B12) -stores blood (removes worn out RBCs)

29.

-Uncooperative patient -Bleeding diathesis (e.g. DIC, etc.) -Skin infection over site -Contralateral pneumothorax, esp. if complete pneumothorax
24.

Describe the storage function of the liver

30.

Deep muscles of the back

Describe the three types of muscle

31.

Multifidus (green) -Stabilizers of vertebral column Rotators (red) Origin: transverse process of vertebra X -Brevis: spinous process of X-1 -Longus: spinous process of X-2
25.

Digestive enzymes of the small intestine work on what 3 major classes of foods: Does colonic movement occur during fasting? Does the colon have villi? During a single passage through the lobule what percentage of most metabolites are removed by the hepatocytes?

1. Carbohydrates 2. Proteins 3. Fats

32.

Yes - segmental movements occur

33.

No - just Rugae and Crypts of Lieberkuhn 60-100%

Defecation reflex

-complex, neurally controlled -includes voluntary & involuntary elements -As feces distends rectum, int. sphinctor relaxes -Afferents signal urge to defecate (Can be over-ridden)

34.

35.

Each actin filament is surrounded by how many myosins? Each myosin filament is surrounded by how many actin filaments? Electrochemical mechanism at NMJ

40.

Erector spinae group

36.

37.

-Ca++ initiates ACh release from presynaptic neuron -ACh opens cation channels (ligand-gated cation channels) -End Plate Potential (EPP) opens Na+ channel (voltage-gated) on surface of the cell -Resulting AP over entire surface of sarcolemma produces muscle fiber contraction

-Paired muscles & tendons -Origin: sacrum/tendinous -Insertion: lumbar-cervical lateral: iliocostalis intermediate: longissimus medial: spinalis
41.

38.

Endocrine pancreas

excitationcontraction coupling

4 specialized cell types secretes hormones into the bloodstream

39.

Enterohepatic circulation

-Recycling of bile salts -Primary & secondary bile acids

-AP very short -contraction brought about by high levels of calcium in cell, but lags behind peak calcium -calcium comes from SR -calcium levels continue to build and slowing decrease after AP

42.

Exocrine pancreas

46.

Function of goblet cells in the large intestine Functions of rectum and anus? Gallbladder

secrete mucus - lubricates fecal mass

47.

-Rectum stores feces -Anus controls defecation -A saclike organ that lies on the inferior surface of the liver -Store & concentrates bile between meals -Can hold ~90 mL -CCK reaches GB wall via blood & causes contractions of GB & relaxation of sphincter of Oddi -Gastrin has small CCK-effect -Volume -Chemical composition of gastric contents -Cholecystokinin ~ 20,000 gastric pits/cm2 in the stomach lining Each contains glandular cells: Parietal cells: throughout the pit Chief cells: located near base of pits -Bolus of chyme results in increased motor activity throughout colon -Gastrin & CCK stimulate, epinephrine inhibits this reflex GB can concentrate hepatic bile by 5x

48.

-an abdominal "salivary gland" -secretes enzymes (digest proteins) & alkaline fluids to assist in digestion = IMPORTANT TO KNOW -acinar cells: produce inactive precursor of digestive enzymes -duct cells: Wirsung duct - adds mucous & bicarbonate -secretions collect in acinar duct -travel through a network of converging ducts into the common bile duct -enter duodenum at duodenal papilla (Vater)
43.

49.

Gastric emptying is affected by: Gastric pits/glands

50.

51.

Gastrocolic reflex

External/lateral Pterygoid
52.

GB can concentrate hepatic bile by how much? Goblet cells

53.

Origin: temporal fossa by 2 heads: 1. Great wing of sphenoid 2. infratemporal crest & lat. pterygoid plate Insertion: condyle of mandible @ TMJ articulation
44.

facial expressions Fast twitch muscle

universal within our species FT, Type II -Shorter max. tension time -Higher tension -Fatigues much more quickly than slow twitch fibers -Sub-types: *Type IIa (Fast-twitch Oxidative Glycolytic; FOG) *Type IIb (Fast-twitch Glycolytic; FG)

45.

-Proportion increases along length of bowel -Relatively few in duodenum, many in colon -Secrete mucin (mucus that allows chyme as it gets more dehydrated to move along more smoothly)
54.

have to have ______ to complete a cycle

ATP

55.

have to have _______ in order for actin and myosin to form a functional unit Hepatic blood supply

calcium

59.

How does botox work?

56.

1. Hepatic a. -Branch of celiac a. -Branches: cystic a. (GB), gastroduodenal a. -Anastomosis w/ Sup mesenteric a. 2. Hepatic portal vein -Drains stomach, intestines, pancreas & spleen -Carries nutrients & contaminants (drugs, toxins, bacteria, byproducts of blood-cell recycling) absorbed through intestinal mucosa or produced in spleen
60.

-botulinus toxin -~40% homology w/ tetanus toxin -Toxin blocks cholinergic transmission by forming a cap so vesicles cannot release Ach so don't get contraction of that motor unit so decreased muscle contraction (botox relaxes the wrinkles) -Heavy chain + light chain transit axon separately -Double chain product is active form How does caffeine/theophyilline/chocolate affect ryanodine receptors? How does muscle contract? Primes the ryanodine receptors in SR membrane, making them more ready and able to respond quicker to depolarization Huxley & Niedergerke/Huxley & Hanson (1954) won the Nobel Prize for figuring out how actin & myosin interact/how muscle contraction occurs -I band (I=isotropic=light can go through it) shortens w/ contraction -Z-disc distance decreases w/contraction -No A-band (A=anisotropic=does not allow light to pass through) & no force when myosin removed

**Blood from both mixes together (so venous and arterial) in the hepatic sinusoids Passes out of liver via central, hepatic veins to IVC
57.

61.

Hepatic circulation

58.

Hepatocytes

=The main cell type in liver -Constitutes ~60% of all liver cells -The most versatile cell type in the human body -Carries out all the main liver functions -Produce ~100 g/day of proteins -Continuously synthesizes bile acids (metabolites of cholesterol)

62.

How does the black widow spider toxin work?

68.

Internal/medial Pterygoid

-Latrotoxin : homology w/ glucagon-like peptide-1 (GLP-1) family -Activates g-coupled protein receptor -Ca++ channel opens in presynaptic nerve -Release of Ach = muscle spasms & cramping (esp. abdominal cramping)
63.

Origin: palatine bone & tuberosity of maxilla Insertion: ramus & angle of mandible
69.

Intestinal Uptake of Lipids

How does the blood supply of tendons compare to ligaments? how will a vagotomy affect HCl secretion? If vomiting blood (hematemesis), coming from where? Indications for Central Venous Access

Tendons have a better blood supply than ligaments (ligaments connect bone-tobone)

-Lipids must be absorbed from the small intestine -They are essentially insoluble in aqueous environment of intestine -Emulsification of dietary lipids is accomplished by means of bile salts -Mixed micelles are formed by bile salts, triacylglycerols and pancreatic lipase Some fluid & e-lytes are absorbed by epithelial cells

70.

Is anything absorbed in the colon? Know what impingement looks like on CT and MRI

64.

will abolish HCl secretion *H2 blocker or proton pump inhibitors are much better! ABOVE the ligament of Treitz; in either duodenum, esophagus, stomach, nose, lungs

71.

65.

66.

72.

Kuppfer cells

-IV/abx & unavailable peripheral -CVP measurement -Chemo or TPN

67.

Immune cells (macrophages)

73.

Levers

Internal anal sphincter usually maintained in state of _____ by ____?

contraction; SNS

-Bones act as lever arms -Joints act as fulcrums/pivots -Muscles exert forces to move loads (every muscle of the body is one of the 3 types of levers) *3 different classes: -classes have to do w/where fulcrum is relative to where the force is applied

74.

List the 4 general functions of the liver

1. Metabolize 2. Detoxify 3. Inactivate 4. Store 1. Count both ways and look for clues -Dens of C2 -Ribs (some people have "riblets") 2. Lamina of thyroid cartilage 3. Spinal alignment

78.

75.

List the things you should be evaluating when looking at Cspine AP x-rays

List the things you should be evaluating when looking at CSpine Odontoid x-rays

76.

List the things you should be evaluating when looking at CSpine Lateral x-rays

= "money" shot in c-spine series for visualizing C1 (atlas), C2 (axis) -C2: superior articular facets -the dens -bifid spinous process of C2
79.

-3 Smooth Arcs: anterior, posterior, spinolaminar -Dens: follows the line of the ant body of Axis -odontoid process -Zygapophyseal Articulation of C6-C7 (C7=blue) -spinous process of C7 = vertebra prominens -T1
77.

List the things you should be evaluating when looking at Lumbar Spine AP x-rays

used to look at spinal alignment

80.

List the things you should be evaluating when looking at CSpine Oblique x-rays

List the things you should be evaluating when looking at Thoracic Spine AP & Lateral xrays

-mastoid process -L C3-C4 intervertebral foramina (contains spinal nerve - can get impinged) = only useful for visualizing these -L and R 1st rib -DON'T look at this film for spinal alignment

AP = used to evaluate spinal alignment (oblique T-spine has minimal value) -clavicles on an erect film are at ~T2-3 -base of the lungs are at ~ T10 (pic: scoliosis)

81.

Liver acinus

83.

Masseter

-Defines zones of arterial perfusion to hepatic cells -Long axis defined by 2 portal CVs -Short axis defined by 2 PTs -Each central vein forms end point of 6 acini *Clinically import: patterns of degeneration, regeneration, toxic effects in liver parenchyma*
82.

Liver lobules
84.

-closes the mouth; clamping down of jaw -2 portions: 1. Superficialorigin: zygomatic process (maxilla) & ant. zygomatic arch insertion: angle & lower ramus of mandible 2. Deep portionorigin: post. zygomatic arch insertion: upper ramus & coronoid process of mandible Metabolism of Bilirubin

=anatomic structure of the liver "Classic" lobule: a six-sided prism 2 mm long x 1 mm in diameter -blood comes in via portal triad (hepatic artery, portal vein, bile duct) on each corner of the lobule and flows toward the middle to the many central veins of the liver (bile flows in the opposite direction) -so arterial AND venous blood in the lobules -surrounds all the hepatocytes which "do their thing on the blood" -outer areas are well oxygenated b/c of arteries (zone 1); inner areas are not well oxygenated (zone 3) -central vein collects the mixed blood and ultimately the central veins coalesce into IVC

85.

Motor unit

-Single motor neuron + all muscle fibers it innervates (not necessarily adjacent!) -Multiple units can be recruited -At motor unit level, activation is all-or-none

86.

Motor unit recruitment permits a graded response

90.

Neck Muscles

more motor units required to lift up a heavier object *finer movements - less muscle fibers per motor unit *gross movements - lots of muscle fibers per motor unit
87.

-Levator scapulae -Platysma (plateeeeesma!): superficial muscle of anterior neck -Splenius capitus (at beck of neck) -Sternocleidomastoid -Trapezius: multisegment muscle (4)
91.

MRI of herniated disc at L3-L4

Neuromuscular junctions (NMJ)

place where signal from nerve goes to sarcolemma of a cell -all-or-none excitatory signal
92.

88.

Muscle fiber

On what x-ray view can the "Scotty Dogs" be seen? What is important to note about them?

-Single cell (composed of myofibrils that contain lots of sarcomeres) -Contains multiple nuclei & mitochondria
89.

lumbar spine oblique view = good for viewing intervertebral articulations -be sure that "Scotty dogs"are standing on each others shoulders, with no broken ears or broken feet
93.

Muscles of mastication

-Masseter -Temporalis -Internal/medial & external/lateral pterygoid

Pancreas has how many separate functional units?

2 separate functional units: 1. digestion - exocrine 2. glucose metabolism - endocrine

94.

Pancreatic secretion involves how many phases? And what other organ has the same number and types of phases? Parts of lumbar vertebra on transverse CT scan

1. Cephalic phase 2. Gastric phase 3. Intestinal phase stomach!

97.

Portal lobule

95.

CTs look up at the patient from their feet L on R R on L

96.

= bile secretion function of the liver -Morphologic center is bile duct -Outer margins are imaginary lines drawn between 3 central veins closest to bile duct -Central veins & portal triads at corners -Acini are conceptual units related to arterial supply -bile flows out toward bile duct (triangle is where flow of bile comes from) *3 zones of O2 supply (I, II, III in red): outer areas are well oxygenated b/c of arteries (zone 1); inner areas are not well oxygenated (zone 3) - SO cells that surround the central vein are not well oxygenated so these cells are particularly sensitive to injury
98.

parts of the colon

Posterior cervical muscles

1: Splenic flexure 2: Cecum 3: Appendix 4: Ascending colon 5: Transverse colon 6: Descending colon 7: Sigmoid colon 8: Ileum (distal section of small intestine) 9: Haustra (unique to the large intestine)

99.

radiographic hallmark of small bowel obstruction (SBO)

= stair-steps or laddering (chyme sinking to bottom, air staying at top when standing) -can see surgical clips - very common to have small bowel obstruction post surgery

100.

Role of Kuppfer cell's role in ETOH injury

104.

Secretin

hormone secreted by S-cells in mucosa of upper small intestine: -stimulates secretion of HCO3- & H2O by pancreatic duct cells -inhibits gastrin release & gastrin's effect on stomach parietal cells *fun fact: was the first hormone that was isolated - by Starling!

105.

Secretion of Bile

- W/ chronic alcohol ingestion, endotoxin from intestinal bacteria moves into liver -Endotoxin activates Kupffer cells (interacts w/ CD14) -Generates cytotoxic factors (O2-) & signaling molecules (eg TNF-) stimulating inflammatory response & get a kind of autoimmune response -TNF- is a key factor in ETOH injury in alcoholic liver disease (alcohol can also directly injure the liver)
101.

-Bile is formed by hepatocytes & secreted into bile canaliculi -Canaliculi-ductules-ducts -stored in the gall bladder -Enterohepatic circulation Type I, Slow-twitch Oxidative; SO -Longer max tension time -Lower tension -High endurance

106.

Slow twitch muscle

107.

Small intestine anatomy

sacral promontory Absorptive cells: -Apical surface area of each is greatly increased by an array of microvilli (brush border)
108.

anterior edge of the lumbosacral articular surface

102.

solid anatomical ring structures always break in __ places

Sarcomere

2! *This transverse plane CT of C1 demonstrates that solid anatomical ring structures always break in 2 places
109.

-space b/w Z-lines -Bio-crystal: Light & EM

103.

sarcoplasmic reticulum

-special kind of endoplasmic reticulum -stores calcium, outside of the intracellular space (away from actin/myosin) but not outside the muscle cell

Spinous processes of what cervical vertebrae are bigger than the others?

C2, C7

110.

spondylolysis vs. spondylolisthesis

114.

T tubules

111.

Stellate cells

extensions of sarcolemma that go from outer surface of cell deep into the sarcolemma -part of a system that causes calcium release -contain extracellular fluid -Store Vit. A -Contractile: may regulate blood flow
112. 115.

Temporalis

Sternocleidomastoid

-deep to zygomatic arch Origin: temporal fossa Insertion: coronoid process & ramus of mandible
116.

Tendon

Origin: manubrium & medial clavicle Insertion: 2 different insertions: mastoid process (temporal bone) & superior nuchal line
113.

suboccipital triangle

-Oblique capitus inferior -Oblique capitus superior -Rectus capitus posterior [Major (& minor)] ="headache triangle" 117. Tinea coli -These muscles are among those w/ highest density of stretch receptors in the body -Afferent neurons localize to same CNS area as some extraocular afferents

-Connective tissue -Connects skeletal muscle to bone -Golgi-tendon organs sense muscle force (send feedback to spinal cord throughout the entire range of muscle activity) 3 linear muscle bands

118.

Triads

124.

What 3 things are inhibitors of HCl secretion? What are surface mucosa cells located and what do they secrete?

somatostatin, secretin, prostaglandins

125.

-T-tubule is flanked by terminal cisternae of sarcoplasmic reticulum and junctional foot processes (arrows: junctional foot processes) -Ryanodine receptor in SR membrane -Dihydropyridine receptor in T-tubule membrane *When depolarization wave comes thru ttubules, causes Ca++ release from SR thru channels into space outside of T-tubule (intracellular space within the muscle fiber) = not calcium-induced calcium release like in cardiac muscle BUT depolarizationinduced calcium release!!
119.

located everywhere, esp. pylorus; secrete alkaline mucus = gastric mucosal barrier -Via PNS input -Can be damaged by bacteria, viruses, drugs e.g. ASA (ASA injures mucosal cells by inhibiting prostaglandins which help surface mucosal cells) histamine (when stimulated by Ach from the parasympathetic NS, i.e. vagus nerve); -when take H2 blockers, blocking receptors for histamine

126.

What do enterochromaffinlike (ECL) cells secrete? What does a break in the neck of the "Scotty dog" signify?

127.

Unconjugated bilirubin

unbound, before gets to the liver -lipid-soluble, pretty toxic -has to be bound to albumin to be transported in circulation product in urine increases
128.

120. 121.

Urobilinogen valsalva _________ intraabdominal pressure? Vertebral regions

- may be a fracture of the pars interarticularis, which is specific for spondylolysis = a cause of low back pain What does a dislocation of C1/C2 look like on x-ray?

122.

1: Cervical 2: Thoracic 3 & 4: Lumbar/Sacral

123.

-Note the very wide intervetebral space between C1 & C2 -Also notice how evident the entire dens appears This represents a catastrophic injury
129.

vertebral structure

What drug affects dihyropyridine?

nifedipine - it is a calcium-channel blocker

130.

What finding does the phrase "Ice cream is falling off the cone" describe on an x-ray?

138.

what is the difference b/w the superior vs. inferior articular facet of C1?

superior articular facet is much larger

139.

What is the most important stimulus for CCK release? What is the role of aldosterone in colonic physiology? what is the second largest organ in humans?

Chyme (amino acids, peptide, long chain fatty acids) in duodenum

Dens fracture
131.

140.

What gives bile a greenish black color and produces the yellow tinge of jaundice? What increases gastric motility? What inhibits gastric motility? What inhibits GB contractions? what is needed to break the bond b/w actin and myosin? What is one of the strongest muscles in your body? (Hint: in dogs, it can generate 400 lbs of force)

bilirubin, a by-product of destruction of aged RBCs

Aldosterone influences Na+/H2O absorption & K+ secretion

141.

132.

Gastrin, motilin & vagal input Secretin, cholecystokinin (CCK) & sympathetic activity (i.e. flight-or-fight response) VIP/acetylcholine inhibits GB contractions ATP
142.

133.

134.

liver -1 hepatocyte has the functional capacity to do all the things that the liver does! What muscle(s) close the mouth? What muscle(s) open the mouth? What muscles may contribute to eye/head coordination? Internal pterygoid, masseter, temporalis

135.

136.

143.

External pterygoid

144.

masseter muscles
137.

What is primarily absorbed in the small intestine?

water (primarily), electrolytes -85-90% absorbed into body in the small intestine (rest absorbed in the colon) **water can follow osmotic gradients in either direction (in or out of digestive tract): why cholera causes waterydiarrhea that just never stops

-Oblique capitus inferior -Oblique capitus superior -Rectus capitus posterior [Major (& minor)]
145.

What physical position facilitates alignment of ago-rectal angle?

squatting

146.

What ribs are a common cause of impingement syndrome? What separates the colon into haustra? What structures pass through the vertebral foramen? What type of movement happens in the colon? What will a gallbladder US show when the patient has gallstones?

cervical ribs -Neurological or vascular deficits distally -Due to compression of soft tissue structures between the anomalous & 1st rib Semi-lunar folds

154.

Zones of the portal lobules

147.

148.

Spinal cord ligaments epidural fat dura, arachnoid, pia mater spinal fluid arteries and veins
155.

-Zone 1 encircles the portal triads - O2 rich blood enters via hepatic arteries -Zone 2 is located in between -Zone 3 located around central veins oxygenation is poor Zymogen inactive precursor of digestive enzymes

149.

Segmental colonic movement of semisolid waste

150.

-stone itself in the gallbladder -sonic shadow cast by gallstone

151.

Where are chief cells located and what do they secrete? Where are G cells located and what do they secrete? Where are parietal cells located and what do they secrete?

they are located near the base of pits; secrete pepsinogen (inactive precursor of pepsin) located in the lower part of the stomach; secrete gastrin (when stimulated directly by gastrin-releasing peptide from the parasympathetic nervous system) located near the base of pits, just beneath the chief cells; secrete HCL & intrinsic factor (when stimulated by histamine & gastrin as well as Ach directly via vagus) (antrum lacks parietal cells) -when take proton-pump inhibitors, blocking H+K+ATPase & thus release of hydrogen ions (decreasing release of HCL)

152.

153.