Term
|
Definition
| simultaneous contractions (with amplitude >30 mmHg)in 20 % or more of the esophagus |
|
|
Term
|
Definition
| Average distal esophageal peristaltic pressures exceeding 220 mmHg during 10 or more 5 mL liquid swallows |
|
|
Term
| Hypertensive lower esophageal sphincter |
|
Definition
| Resting lower esophageal sphincter pressure above 45 mmHg |
|
|
Term
| What causes diffuse esophageal spasms? |
|
Definition
|
|
Term
| Gross pathology of diffuse esophageal spasm |
|
Definition
Manometry reveals simultaneous contrations.
Endoscopy may be normal.
Barium may reveal normal, rosary bead, or corkscrew esophagus. |
|
|
Term
|
Definition
| a beaded apparance of esophagus, caused by areas of spasm and non-spasm in diffuse esophageal spasm (aka corkscrew esophagus) |
|
|
Term
|
Definition
an esophagus with wider and narrower parts, caused by areas of spasm and non-spasm in diffuse esophageal spasm
in barium radiography, can appear like the 2D representation of a corkscrew
aka rosary bead esophagus |
|
|
Term
| What is the clinical presentation of diffuse esophageal spasm? |
|
Definition
heartburn and/or severe chest pain
dysphagia |
|
|
Term
| How do you diagnose diffuse esophageal spasm? |
|
Definition
manometry
manometry showing simultaneous contractions (with amplitude >30 mmHg)in 20 % or more of the esophagus is diagnostic for diffuse esophageal spasm |
|
|
Term
| Zenker's diverticulum is just above the ___________ muscle |
|
Definition
cricopharyngeal muscle
(in Killian's triangle) |
|
|
Term
| Is Zenker's diverticulum anterior or posterior of the pharynx? |
|
Definition
|
|
Term
| What causes Zenker's diverticulum? |
|
Definition
congenitally weak pharynx wall
and/or chronically high pressures in the pharynx (due to high intrabolus pressures during swallowing or resistance to swallowing due to abnormalities of the Upper Esophageal Sphincter) |
|
|
Term
| What does Zenker's diverticulum look like in barium radiography? |
|
Definition
| an posterior outpouching of the esophagus just above the esophageal sphincter |
|
|
Term
| Who is more at risk for Zenker's diverticulum (age, gender)? |
|
Definition
usually in older adults (>60, esp. >75), but has been seen in children
majority of patients are male (not sure why) |
|
|
Term
| Signs & symptoms of Zenker's diverticulum |
|
Definition
Transient dysphagia may be noted early in course
Aspiration of food
Foul breath
Gurgling in throat
Appearance of a mass in the neck
Regurgitation of food in the mouth
Cachexia if longstanding dysphagia |
|
|
Term
|
Definition
| a thin mucosal fold that protrudes into the lumen of the esophagus and is covered with squamous epithelium, causing focal narrowing |
|
|
Term
| What kind of cells are proximal esophageal webs covered with? |
|
Definition
| stratified squamous epithelium |
|
|
Term
| Where do esophageal webs most often occur? |
|
Definition
| anteriorly in the cervical esophagus, causing focal narrowing in the postcricoid area |
|
|
Term
| Esophageal webs are most commonly associated with what diseases (4) |
|
Definition
gastroesophageal reflux
chronic graft-versus-host disease
blistering skin diseases.
Plummer-Vinson (or Paterson-Brown-Kelly) syndrome |
|
|
Term
| The most common neuromuscular cause of oropharyngeal dysphagia is __________ |
|
Definition
|
|
Term
|
Definition
| a connective-tissue disease related to polymyositis (PM) that is characterized by inflammation of the muscles and the skin. |
|
|
Term
|
Definition
| an auto-immune disorder in which antibodies block nicotinic acetylcholine receptors on the post-synaptic membrane |
|
|
Term
| In patients with oropharyngeal dysphasia, why should you do a barium swallow before doing an endoscopy? |
|
Definition
| to rule out Zenker's diverticulum--you don't want to unknowingly ram your endoscope into a diverticulum & puncture it |
|
|
Term
|
Definition
bone spur
(relevant to dysphagia b/c an osteophyte from the vertebra could compress the esophagus) |
|
|
Term
| Swollen lymph nodes may indicate ________, ________, or _________ |
|
Definition
infection
inflammation
neoplasia |
|
|
Term
| What are the 3 most common infectious causes of dysphagia? |
|
Definition
Candida albicans
Herpes
Cytomegalovirus (CMV), (human herpes virus 5)--a common virus that tends to infect the salivary glands |
|
|
Term
| How do symptoms differ for oropharyngeal vs. esophageal dysphagia? |
|
Definition
oropharyngeal will describe themselves as having trouble starting a swallow
esophageal will describe food getting stuck after being swallowed |
|
|
Term
| How will symptoms differ for motor causes of esophageal dysphagia vs. mechanical obstruction? |
|
Definition
motor causes--dysphagia to liquids & solids FROM THE BEGINNING
Mechanical obstruction—starts with dysphagia to solids, may progress to liquids |
|
|
Term
| Chagas’ disease is caused by the flagellate protozoan ____________ |
|
Definition
|
|
Term
| Where, geographically, is Chaga's disease most seen? |
|
Definition
|
|
Term
| What non-esophageal signs & symptoms would you see with Chaga's disease? |
|
Definition
| dilation of the urinary system and the GI tract. |
|
|
Term
| What syndrome does Trypanosoma Cruzi cause? |
|
Definition
|
|
Term
| What may aggravate symptoms of esophageal spasm in spastic motility disorders? |
|
Definition
Acid reflux
stress
hot or cold food
carbonated beverages |
|
|
Term
|
Definition
| failure of LES (Lower Esophegeal Sphincter) to relax leads food to back up in the esophagus and, eventually, to a lack of peristalsis |
|
|
Term
| If the bottom of the esophagus has a "bird's beak" appearance, that indicates ______________ |
|
Definition
|
|
Term
| Achalasia is failure of the LES (Lower Esophegeal Sphincter) to relax, which leads food to back up in the esophagus and, eventually, leads to : |
|
Definition
| dilation of the esophagus with a lack of peristalsis |
|
|
Term
| Achalasia is failure of the ______________ to relax |
|
Definition
| Lower Esophageal Sphincter (LES) |
|
|
Term
| Although we're not sure why, people with achalasia may have chest pain because: |
|
Definition
| backed up food ferments in the esophagus |
|
|
Term
| Why do you have to do an endoscopy with achalasia? |
|
Definition
| because it could be secondary to another disorder, such as a neoplasia |
|
|
Term
|
Definition
| Multi-system disorder due to small vessel vasculitis & proliferation of connective tissue in organs with fibrosis |
|
|
Term
| Why would someone with scleroderma have dysphagia? |
|
Definition
| because the smooth muscle fills up with fibrosis, leading to lack of motility |
|
|
Term
| Which part of the esophagus does scleroderma most affect, and why? |
|
Definition
the bottom 2/3 of the esophagus because the bottom 1/3 is smooth muscle, the middle 1/3 is mixed smooth & striated muscle, & the top 1/3 is all striated muscle
scleroderma mostly affects smooth muscle |
|
|
Term
| If you suspect a motility disorder of the esophagus, what test do you need to do? |
|
Definition
|
|
Term
|
Definition
Lower esophageal ring
(a Schatzki ring can lead to steakhouse syndrome) |
|
|
Term
| Where do esophageal rings and esophageal webs occur? |
|
Definition
| esophageal rings mostly occur in the bottom portion of the esophagus (where they are called Schatzki rings), while webs can occur anywhere in the esophagus |
|
|
Term
| Which is typically more serious: an esophageal ring or an esophageal web? |
|
Definition
| esophageal rings are more serious |
|
|
Term
|
Definition
esophagus appears to have series of concentric rings that almost looks like the trachea; the esophagus is fragile and there is a risk of perforation
associated with eosinophilic esophagus |
|
|
Term
|
Definition
a condition in which the esophagus is infiltrated with eosinophils; the esophagus is fragile and at risk of perforation; may have feline esophagus, when the esophagus has a series of rings and looks a bit like the trachea (so-called b/c this is what a normal cat esophagus looks like)
most commonly seen in adolescent & young adult men (though it can be seen in children or adults)
often have a history of food impaction
May have a history of environmental allergies |
|
|
Term
| Who is most likely to get eosinophilic esophagus? |
|
Definition
adolescent males & young adult men
(though it can be seen in children and older adults) |
|
|
Term
| What causes esophageal strictures? |
|
Definition
repeated/heavy irritation of esophagus or cancer
ex., GERD, infectious esophagitis, post surgical resection for esophageal/laryngeal cancer, radiation, pill esophagitis |
|
|
Term
| What is the most noticeable symptom of esophageal or gastric cardia cancer? |
|
Definition
weight loss (more than with other types of dysphagia)
(the gastric cardia is the part of the stomach directly attached to the esophagus) |
|
|
Term
Explain the following mnemonic:
13 is unlucky for the esophagus |
|
Definition
| patients will typically start having problems with dysphagia when the esophagus narrows to <= 13 mm |
|
|
Term
| The four muscles of the tongue are |
|
Definition
styloglossus (side of tongue; attaches to styloid process of the temporal bone)
hyoglossus (bottom-back of tongue; attaches to hyoid bone in neck)
genioglossus (bottom-front of tongue; attaches to the hyoid bone & the middle of the posterior surface of the mandible)
palatoglossus (top-back of tongue; attaches to the palate) |
|
|
Term
| All 4 muscles of the tongue are innerveated by the ____________ nerve, except for the palatoglossus, which is innervated by the ________ nerve |
|
Definition
hypoglossal (XII)
vagus (X) |
|
|
Term
| What 2 muscles pull the tongue back? |
|
Definition
styloglossus (connects sides of the tongue to the styloid process of the temporal bone)
hyoglossus (connects bottom of tongue to hyoid bone) |
|
|
Term
| What 2 muscles elevate the tongue? |
|
Definition
Styloglossus (connects sides of the tongue to the styloid process of the temporal bone
palatoglossus (connects top-back of tongue to the palate)
|
|
|
Term
| What 2 muscles depress the tongue? |
|
Definition
hyoglossus (connects bottom of tongue to hyoid bone)
genioglossus (connects bottom-front of tongue to the middle of the posterior surface of the mandible & the hyoid bone)
|
|
|
Term
| What muscle protrudes the tongue? |
|
Definition
genioglossus (connects bottom-front of tongue to the middle of the posterior surface of the mandible & the hyoid bone)
|
|
|
Term
| What muscle originates from the styloid process of temporal bone (a spike of bone extending down from the inside surface of the temporal bone, deep to the ear) and inserts on the side & bottom of the tongue? |
|
Definition
|
|
Term
| What nerve innervates the styloglossus? |
|
Definition
|
|
Term
| What does the styloglossus muscle do? |
|
Definition
pulls tongue back and up
(the styloglossus connects the sides of the tongue to the styloid process of the temporal bone)
|
|
|
Term
| What muscle originates on the hyoid bone (a horseshoe-shaped bone in the anterior neck between the chin & the thyroid cartilage) and inserts on the side & bottom of tongue? |
|
Definition
|
|
Term
| What nerve innervates the hyoglossus muscle? |
|
Definition
|
|
Term
|
Definition
| a horseshoe-shaped bone in the anterior neck between the chin & the thyroid cartilage |
|
|
Term
| What does the hyoglossus muscle do? |
|
Definition
pulls tongue down & back
(connects bottom of tongue to hyoid bone)
|
|
|
Term
| What muscle originates from the genial tubercle of the mandible (a little bump in the middle of the posterior side of the mandible) and inserts on the bottom of tongue and the hyoid bone (a horseshoe-shaped bone in the anterior neck between the chin & the thyroid cartilage)? |
|
Definition
|
|
Term
| What nerve innervates the genioglossus muscle? |
|
Definition
|
|
Term
| What does the genioglossus muscle do? |
|
Definition
pulls tongue down & forward
genioglossus (connects bottom-front of tongue to the genial turburcle in the middle of the posterior surface of the mandible & to the hyoid bone)
|
|
|
Term
| If CN XII (hypoglossus) has a lower motor neuron lesion, what happens when the tongue is protruded? |
|
Definition
| tongue points toward the lesion when protruded b/c affected genioglossus isn’t contributing to protrusion |
|
|
Term
| If CN XII has a lower motor neuron lesion, the tongue points toward the lesion when protruded because the affected ____________ muscle isn’t contributing to protrusion |
|
Definition
genioglossus
("genio" = chin; genioglosus connects the tongue to the chin; pulls it down & forward) |
|
|
Term
| What muscle originates on the aponeurosis of soft palate and inserts on the dorsolateral (top-side) side of tongue? |
|
Definition
|
|
Term
| What nerve innervates the palatoglossus? |
|
Definition
vagus (X)
(the palatoglossus connects the top-back of the tongue to the palate; it is the only of the 4 tongue muscles that is not innervated by CN XII, the hypoglossal nerve)
|
|
|
Term
| What does the palatoglossus muscle do? |
|
Definition
elevates tongue
(the palatoglossus connects the top-back of tongue to the palate)
|
|
|
Term
| All of the muscles of mastication are innervated by the _____________ nerve |
|
Definition
|
|
Term
| What are the 4 muscles of mastication? |
|
Definition
Temporalis (connects the temporal bone to the mandible; passes under the zygomatic arch)
masseter (connects the posterior zygomatic arch to the mandible)
medial pterygoid (connects the maxilla, or upper jaw, to the angle of the jaw)
lateral pterygoid (connects the posterior maxilla to the posterior mandible, just below & in front of the ear) |
|
|
Term
| What 3 muscles of mastication elevate the mandible? |
|
Definition
Temporalis
masseter
medial pterygoid |
|
|
Term
| What 2 muscles of mastication retract the mandible? |
|
Definition
|
|
Term
| What 2 muscles of mastication stick the jaw out? |
|
Definition
| Lateral & medial pterygoids |
|
|
Term
| What muscle of mastication depresses the mandible? |
|
Definition
|
|
Term
| What muscle originates on the temporal fossa (a shallow depression on the sides of the skull), passes under the zygomatic arch, and inserts on the the coranoid process of the mandible (a little rounded pointy bit that comes up under the cheek bone)? |
|
Definition
|
|
Term
| What nerve innervates the temporalis muscle? |
|
Definition
|
|
Term
| What does the temporalis muscle do? |
|
Definition
| elevates & retracts the mandible |
|
|
Term
What muscle originates on the lower border & medial surface of zygomatic arch and inserts on the lateral surface of coronoid process of the mandible (a little rounded pointy bit that comes up under the cheek bone), ramus of the mandible (posterior border of mandible), & the angle of the mandible (inferior & posterior)?
[image] |
|
Definition
|
|
Term
| What nerve innervates the masseter muscle? |
|
Definition
|
|
Term
| What innervates the lateral pterygoid muscle? |
|
Definition
|
|
Term
| What does the lateral pterygoid muscle do? |
|
Definition
| depresses & protracts (pushes forward) mandible |
|
|
Term
What muscle originates on the medial surface of maxilla inserts on the medial surface of infero-posterior angle of mandible & and ramus (posterior border) of the mandible?
[image] |
|
Definition
|
|
Term
| What nerve innervates the medial pterygoid muscle? |
|
Definition
|
|
Term
| What does the medial pterygoid do? |
|
Definition
elevates & protracts (pushes forward) the mandible
[image] |
|
|
Term
| The nasopharynx communicates with the nasal cavities through the nasal _______ |
|
Definition
|
|
Term
| Where does the nasopharynx become the oropharynx? |
|
Definition
|
|
Term
| The ___________ (nasopharynx/oropharynx/laryngopharynx)is connected with the tympanic cavity through the auditory (Eustachian) tube |
|
Definition
|
|
Term
| The ___________ (nasopharynx/oropharynx/laryngopharynx)contains the pharyngeal tonsils. |
|
Definition
|
|
Term
| The nasopharynx contains the ___________ tonsils in its posterior wall |
|
Definition
|
|
Term
| The oropharynx extends from the ________ to the _____________ |
|
Definition
soft palate
top of the epiglottis |
|
|
Term
|
Definition
| the passage from the mouth to the oropharynx |
|
|
Term
| The oropharynx contains the __________ tonsils. |
|
Definition
|
|
Term
| The ___________ (nasopharynx/oropharynx/laryngopharynx)contains the palatine tonsils. |
|
Definition
|
|
Term
| The laryngopharynx extends from the _________________ to the ___________________ |
|
Definition
top of the epiglottis
bottom of the cricoid cartilage |
|
|
Term
| The laryngopharynx contains the ____________ recesses, one on each side of the opening of the larynx, in which swallowed foreign bodies (e.g., food) may be lodged |
|
Definition
|
|
Term
| How many pharyngeal arches does a human embryo have and what are they numbered? |
|
Definition
5 arches: 1, 2, 3, 4, & 6
(lower animals have 6 arches, but we're missing #5) |
|
|
Term
| Viewed in cross-section, each pharyngeal arch is a swelling with __________ between the arches on the outside of the embryo and ___________ on the inside |
|
Definition
|
|
Term
| An embryo has _________ clefts with, the first cleft between the _______ and _________ pharyngeal arches |
|
Definition
|
|
Term
| What 3 things does each pharyngeal arch have? |
|
Definition
A Cranial nerve
An Artery
Cartilage |
|
|
Term
| What nerve innervates pharyngeal arch 1? |
|
Definition
|
|
Term
How does the following mnemonic help remember the nerves that innervate the pharyngeal arches?
Some Say Marry Money, But My Brother Says Big Boobs Matter Most |
|
Definition
The nerves that innervate the pharyngeal arches are the “both” nerves: CN V (arch 1), VII (arch 2), IX (arch 3), and X (arches 4 & 6)
I Some
II Say
III Marry
IV Money
V But
VI My
VII Brother
VIII Says
IX Big
X Boobs
XI Matter
XII Most |
|
|
Term
| What cartilage, bones, muscles, and skin does the first pharyngeal arch become? |
|
Definition
Mandible bone
Bones of inner ear
Muscles of mastication
A tiny muscle in the ear (tensor tympani)
Most of facial skin & cartilage (from the bottom of the eyes down) |
|
|
Term
| What nerve innervates pharyngeal arch 2? |
|
Definition
|
|
Term
| What muscles does pharyngeal arch 2 give rise to? |
|
Definition
| the muscles of facial expression |
|
|
Term
| What cranial nerve innervates pharyngeal arch 3? |
|
Definition
|
|
Term
| What bone & muscle does pharyngeal arch 3 give rise to? |
|
Definition
Hyoid bone
Stylopharyngeus muscle |
|
|
Term
| What nerve innervate pharyngeal arch 4? |
|
Definition
|
|
Term
| What cartilage & muscles does pharyngeal arch 4 give rise to? |
|
Definition
Cricoid & thyroid cartilage
Some Constrictor muscles of pharynx & larynx |
|
|
Term
| What nerve innervates pharyngeal arch 6? |
|
Definition
|
|
Term
| The 1st pharyngeal pouch gives rise to the: |
|
Definition
| auditory (Eustachian) tube |
|
|
Term
| The 1st pharyngeal cleft gives rise to: |
|
Definition
| the external meatus of the ear |
|
|
Term
| The 3rd pharyngeal pouch gives rise to: |
|
Definition
| the thymus and inferior parathyroid glands |
|
|
Term
| The 4th pharyngeal pouch gives rise to the: |
|
Definition
| superior parathyroid glands |
|
|
Term
| Explain the role that pharyngeal arch 1 has in the development of the tongue. |
|
Definition
| it gives rise to the anterior 2/3 of the tonge |
|
|
Term
| Explain the role that pharyngeal arch 2 has in the development of the tongue. |
|
Definition
| it is mostly pushed aside, but it contains CN VII facial, which leaves a small branch that conveys taste |
|
|
Term
| Explain the role that pharyngeal arch 3 has in the development of the tongue and soft tissue of the mouth & oropharynx. |
|
Definition
it gives rise to the:
posterior 1/3 of tongue
Palatine tonsil
Lingual tonsil |
|
|
Term
| Explain the role that pharyngeal arch 4 has in the development of the soft tissue of the throat |
|
Definition
| it gives rise to the epiglottis |
|
|
Term
| What nerve carries general sensation from the anterior 2/3 of the tongue? What nerve carries taste from the anterior 2/3 of the tongue? |
|
Definition
CN V-3 (3rd brnach of the trigeminal)
CN VII (facial) |
|
|
Term
| What nerve carries general sensation & taste for the posterior 1/3 of the tongue? |
|
Definition
|
|
Term
| What nerve carries general sensation for the very back bit of the tongue & the throat just below the tongue, and taste for the very back bit of the tongue? |
|
Definition
|
|
Term
|
Definition
| is a little outgrowth of the embryo that will become the whole respiratory tree |
|
|
Term
|
Definition
congenital malformation in which the esophagus has no lumen (completely closed)
(there are several forms; most commonly the esophagus meets up with the trachea) |
|
|
Term
| tracheoesophageal fistula |
|
Definition
trachea & esophagus don’t split properly; esophagus is blind
(most common form of esophageal atresia) |
|
|
Term
| What are tunics, with regard to the esophagus, and how many are there? |
|
Definition
tunics are layers
there are 4 |
|
|
Term
| name the 4 tunics of the esophagus, from inside out. |
|
Definition
Mucosa
submucosa
muscularis externae
adventicia |
|
|
Term
| Where are brunner's glands found? |
|
Definition
in the duodenum
(Brunner's produces Bicarbonate--it makes basic mucous to neutralize the stomach acid) |
|
|
Term
|
Definition
glands found in proximal duodenum, above the hepatopancreatic sphincter (Sphincter of Oddi).
The main function of these glands is to produce a mucus-rich alkaline secretion (containing bicarbonate) in order to protect the duodenum from the acidic content of chyme (which is introduced into the duodenum from the stomach), provide an alkaline condition for the intestinal enzymes to be active, thus enabling absorption to take place, and lubricate the intestinal walls.
(Brunners --> Basic) |
|
|
Term
| Where in the GI tract are villi found? |
|
Definition
| the small intestine (duodenum, jejunum, & ileum) |
|
|
Term
|
Definition
a thin, not very strong layer of contractile muscle at bottom of mucosa, which contributes to peristalsis
contractions cause longitudinal folding of mucosa when not distended by food bolus |
|
|
Term
| Contractions of the muscularis mucosae causes _____________ (concentric/longitudinal) folding of mucosa when not distended by food bolus |
|
Definition
|
|
Term
| The muscularis externae is typically arranged in 2 layers. How is the muscle arranged within these 2 layers? |
|
Definition
Inner circular layer
Outer longitudinal layer |
|
|
Term
| About how long is the esophagus in an adult? |
|
Definition
|
|
Term
| How many sphincters are in the esophagus and where are they? |
|
Definition
|
|
Term
| Which esophageal sphincter is anatomical and which is physiological? |
|
Definition
o Upper sphincter is an anatomically distinct structure.
o Lower sphincter is physiological (based on diaphragm contraction, intralumenal pressure and unidirectional peristalsis). |
|
|
Term
| What 2 types of glands are found in the esophagus? |
|
Definition
| superficial and submucosal |
|
|
Term
| Where are superficial glands found in the esophagus? |
|
Definition
| only in proximal & distal esophagus (not in the middle) |
|
|
Term
| Where are submucosal glands found in the esophagus? |
|
Definition
| found throughout esophagus |
|
|
Term
| What do superficial glands in the esophagus secrete? |
|
Definition
| neutral mucin (that is, not acidic or basic) |
|
|
Term
| What do submucosal glands in the esophagus secrete? |
|
Definition
|
|
Term
| Why do cells in glands have a lot of mitochondria? |
|
Definition
| they need a lot of energy to produce secretions |
|
|
Term
Esophageal superficial glands are similar to ___________ glands in the stomach
|
|
Definition
cardiac
(The cardiac glands of the stomach secrete primarily neutral mucus. They are responsible for ~10% of the mucous in the stomach. They are few in number and occur close to the cardiac orifice where the esophagus joins the stomach.) |
|
|
Term
|
Definition
glands found in the cardiac stomach
• Simple tubes, coiled at lower end
Produce 10% of mucosal volume
Similar in structure & function to esophageal superficial glands |
|
|
Term
| What glands produce 10% of the volume of mucous produced in the stomach? |
|
Definition
|
|
Term
|
Definition
fundic glands
(because they're found in the body & fundus of the stomach) |
|
|
Term
| Where are gastric chief cells found? |
|
Definition
in the bottom of a gastric gland
(gastric glands are in the body & fundus of the stomach) |
|
|
Term
| Where are parietal cells found? |
|
Definition
in the neck of a gastric gland in the stomach
(gastric glands are in the body & fundus of the stomach) |
|
|
Term
| gastric chief cells are aka _________ cells |
|
Definition
|
|
Term
| Describe the histological appearance of gastric chief cells. |
|
Definition
Cuboidal to columnar
Basal nucleus
contain very eosinophilic (dark blue-purple) granules of pepsinogen |
|
|
Term
|
Definition
| an inactive enzyme precursor |
|
|
Term
|
Definition
| an inactive enzyme precursor |
|
|
Term
| the predominant proteolytic enzyme in the stomach |
|
Definition
|
|
Term
| What do gastric chief cells produce? |
|
Definition
pepsinogen (a zymogen of pepsin, the predominant proteolytic enzyme in the stomach)
(a chief cell is a cell that produces a zymogen; from the french "chef cell" b/c it makes stuff) |
|
|
Term
| Describe the histology of gastric parietal cells |
|
Definition
Infoldings of cell membrane form tortuous secretory canaliculi
Can be quickly moved from inactive to active form (which are?)
Canalicluli & microvilli contain a lot of H+-K+-ATPase
Lots of mitochondria (~40% of cell volume; densly packed) |
|
|
Term
| What are the 2 functions of gastric parietal cells? |
|
Definition
Secrete lots of Hydrochloric acid (HCl) into the gastric gland, lowering the pH in the stomach lumen
Synthesizes & secretes intrinsic factor (a glycoprotein necessary for vitamin B12 absorption in the proximal small intestine) |
|
|
Term
|
Definition
| a glycoprotein necessary for vitamin B12 absorption in the proximal small intestine |
|
|
Term
| What is unusual about the subcutaneous fat in the neck? |
|
Definition
| it's thinner than in other parts of the body |
|
|
Term
| a thin muscle spread over the front of the neck like a sheet |
|
Definition
|
|
Term
| What does the platysma do? |
|
Definition
Lifts the neck skin from the neck.
Pulls down the corners of the mouth (as in a grimace) |
|
|
Term
| In the neck, the fascia beneath the subcutaneous fat, which surrounds all of the structures of the neck is the ___________ fascia |
|
Definition
|
|
Term
| The ________ fascia forms the carotid sheath on either side of the neck, which a single layer of fascia running through the center of the neck (in front of the pre-vertebral fascia) connecting the carotid sheaths |
|
Definition
|
|
Term
| What 3 things does the carotid sheath surround? |
|
Definition
the common carotid artery
the internal jugular vein
the vagus nerve |
|
|
Term
| The ___________ fascia surrounds the trachea, thyroid, and esophagus |
|
Definition
|
|
Term
| What 3 things does the pretracheal fascia surround? |
|
Definition
| trachea, thyroid, and esophagus |
|
|
Term
| The __________ fascia surrounds the vertebra and associated muscles |
|
Definition
|
|
Term
| What does the prevertebral fascia surround? |
|
Definition
| the vertebra & associated muscles |
|
|
Term
|
Definition
| the back portion of the tracheal fascia; situated just behind the pharynx |
|
|
Term
| a potential space behind the buccopharyngeal fascial portion of the pre-tracheal fascia and in front of the alar fascia |
|
Definition
|
|
Term
| What is the relationship between the retropharyngeal space and the danger space? |
|
Definition
| the retropharyngeal space is in front of the danger space (the alar fascia is in between them) |
|
|
Term
| The retropharyngeal space extends from the ______________ to the _________________ |
|
Definition
base of the skull
posterior mediastinum |
|
|
Term
| a potential space behind the alar fascia & in front of the pre-vertebral fascia |
|
Definition
|
|
Term
| The danger space extends from the ___________ to the _____________ |
|
Definition
base of the skull
diaphragm |
|
|
Term
| Pott’s disease of the spine |
|
Definition
| tuberculosis of the spine |
|
|
Term
| Why does tuberculosis of the spine (Pott's disease of the spine) typically cause pain and illness (for as long as years), but not endanger life? |
|
Definition
| because it is contained by the prevertebral fascia |
|
|
Term
| What can happen if tuberculosis of the spine breaks through the prevertebral fascia to the retropharyngeal space? |
|
Definition
| the microbes can gain access to the systemic circulation by way of the thoracic duct, which can lead to septicemia & death |
|
|
Term
| Microbes in the retropharyngeal space can gain access to the systemic circulation by way of the ______________________ |
|
Definition
thoracic duct
(the largest lymphatic vessel in the body; it takes most of the lymph from the body & drains into the left brachiocephalic vein |
|
|
Term
| What are 2 ways that a retropharyngeal abscess can be dangerous. |
|
Definition
Can cause swelling that can interfere with breathing
Can also gain access to the systemic circulation by way of the thoracic duct, which can lead to septicemia, death (if untreated) |
|
|
Term
| What do the suprahyoid muscles with relation to swallowing? |
|
Definition
|
|
Term
| What do the infrahyoid muscles with relation to swallowing? |
|
Definition
| pull the hyoid bone back down after swallowing |
|
|
Term
| What are the 4 suprahyoid muscles? |
|
Definition
mylohyoid ("myl" means "mill"; same root as "molars"--molars to hyoid)
digastric (2 bellies)
geniohyoid ("genio" is chin--chin to hyoid)
stylohyoid (hyoid to styloid process of temporal bone) |
|
|
Term
| What are the 4 infrahyoid muscles? |
|
Definition
sternohyoid
omohyoid
sternothyroid
thyrohyoid
(note: all of these name a structure below the hyoid bone; omo means shoulder b/c the omohyoid actually goes through the shoulder & attaches to the shoulder blade) |
|
|
Term
|
Definition
| middle compartment of the thorax |
|
|
Term
| What are the borders of the mediastinum? |
|
Definition
Bordered on each side by the 2 pulmonary cavities (Covered on each side by mediastinal pleura)
Bordered on top by superior thoracic aperture
Bordered on bottom by diaphragm |
|
|
Term
| The mediastinum contains all thoracic viscera and structures except: |
|
Definition
|
|
Term
| What 4 divisions is the mediastinum divided into? |
|
Definition
superior
posterior
anterior
middle |
|
|
Term
| What part of the mediastinum contains the aortic arch? |
|
Definition
|
|
Term
| The esophagus runs through the superior mediastinum and the ________ inferior. |
|
Definition
|
|
Term
| Where, in relation to the trachea, does the esophagus travel through the mediastinum? |
|
Definition
|
|
Term
| The esophagus passes through the _________________ in the diaphragm |
|
Definition
|
|
Term
| In the abdomen, where does the esophagus pass relative to the liver? |
|
Definition
| it passes posterior to the liver |
|
|
Term
| When measuring the distance into the esophagus, the distance is measured from the: |
|
Definition
|
|
Term
| What extra-esophageal structure constricts the esophagus in the neck? |
|
Definition
| the cricopharyngeus muscle |
|
|
Term
| What 2 thoracic structures outside of the esophagus normally constrict the esophagus in the thorax? |
|
Definition
the arch of the aorta
the left main bronchus |
|
|
Term
| phrenicoesophageal ligament |
|
Definition
| attaches the esophagus to esophageal hiatus in diaphragm |
|
|
Term
| Describe the 2 layers of muscle in the esphagus. |
|
Definition
an inner circular layer
an external longitudinal layer |
|
|
Term
| Describe the external, longitudinal layer of muscle in the superior 1/3, middle 1/3, and lower 1/3 of the esophagus |
|
Definition
superior 1/3--voluntary striated muscle
middle 1/3--mixed striated & smooth muscle
lower 1/3--smooth muscle |
|
|
Term
|
Definition
| a network of nerves that surrounds the distal esophagus |
|
|
Term
|
Definition
aka gastroesophageal junction
the point where the esophagus joins the stomach |
|
|
Term
| What does the z-line (gastroesophageal junction) look like with an endoscope? |
|
Definition
| a line between the pale pink stratified squamous epithelium of the esophagus and the darker pink simple columnar epithelium of the stomach? |
|
|
Term
| What kind of epithelium lines the esophagus? The stomach? |
|
Definition
stratified squamous epithelium
simple columnar epithelium |
|
|
Term
| What normally happens when food reaches the lower esophageal sphincter? |
|
Definition
| it pauses for a second, and then the LES relaxes reflexively and lets food into the stomach |
|
|
Term
| Why is the lower esophageal sphincter tonically constricted? |
|
Definition
| to prevent stomach contents from entering the esophagus |
|
|
Term
| What 3 arteries supply the thoracic part of the esophagus? What are these arteries branches of? |
|
Definition
inferior thyroid artery
bronchial artery
esophageal artery
the aorta |
|
|
Term
| The esophageal plexus is formed by the _____ trunk and ____________ turnk. |
|
Definition
vagal
thoracic sympathetic
(vagal carries parasympathetic fibers) |
|
|
Term
| What is the most noticeable symptom of scleroderma? |
|
Definition
| Hardened and thickened skin |
|
|
Term
|
Definition
| a disorder in which blood vessels tend to vasospasm, causing discoloration of the fingers, toes, and occasionally other areas. This condition can also cause nails to become brittle with longitudinal ridges. Emotional stress and cold are classic triggers of the phenomenon. |
|
|
Term
| What are 2 classic triggers of Raynaud's phenomenon? |
|
Definition
|
|
Term
| What is thought to be the cause of scleroderma? |
|
Definition
|
|
Term
| What can happen to the nails of a person with Raynaud's phenomenon? |
|
Definition
| This condition can cause nails to become brittle with longitudinal ridges. |
|
|
Term
| 25% of scleroderma patients develop a _______________________ |
|
Definition
| seronegative polyarthritis |
|
|
Term
| What are the 2 types of scleroderma? |
|
Definition
|
|
Term
| What syndrome might someone with limited scleroderma get? |
|
Definition
CREST syndrome
(Calcinois, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly) |
|
|
Term
| People with ________ (diffuse/limited) scleroderma may get CREST syndrome. |
|
Definition
limited
(Calcinois, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly) |
|
|
Term
| People with diffuse scleroderma often get __________________________, but not as part of ______________ syndrome |
|
Definition
Reynaud's
CREST(Calcinois, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia) |
|
|
Term
| What does CREST stand for? |
|
Definition
Calcinois
Raynaud’s phenomenon
esophageal dysmotility
sclerodactyly
telangiectasia (small dilated blood vessels)
(CREST syndrome is associated with limited scleroderma) |
|
|
Term
| __________ scleroderma involves widespread skin involvement, visceral involvement occurs early in the disease progression, & can be life-threatening |
|
Definition
|
|
Term
| In limited scleroderma, skin involvement is limited to: |
|
Definition
| fingers, forearms, and face |
|
|
Term
|
Definition
| calcium deposits in soft tissue |
|
|
Term
|
Definition
| a localized thickening and tightness of the skin of the fingers or toes, often accompanied by atrophy of underlying tissues (seen in limited scleroderma, as part of CREST syndrome) |
|
|
Term
|
Definition
| small dilated blood vessels near the surface of the skin or mucous membranes. They can develop anywhere on the body but are commonly seen on the face around the nose, cheeks, and chin, and may also be seen on the lower limbs (seen in limited scleroderma, as part of CREST syndrome) |
|
|
Term
| Which gender is 3 x more likely to get scleroderma? |
|
Definition
|
|
Term
| HLA-DR52a is associated with ______________ ____________ |
|
Definition
|
|
Term
| the most important fibrogenic agent in the body |
|
Definition
|
|
Term
| What cytokine most likely plays a role in scleroderma? |
|
Definition
TGF-Beta
(the most important fibrogenic agent in the body) |
|
|
Term
|
Definition
| is a type of helper T cell involved in immunity to helminthes & allergies (induces IgE), alternative macrophage activation (for healing instead of inflammation), and production of neutralizing antibodies (IgG4) |
|
|
Term
| The serum of nearly all patients with scleroderma is positive for ______________ |
|
Definition
| Anti-Nuclear Antibodies (ANA) |
|
|
Term
| __________ antibody is a type of Anti-Nuclear Antibody commonly found in patients with CREST syndrome |
|
Definition
Anti-centromere
Remember:
Calcinosis
Raynaud's syndrome
Esophageal dysmotility
Sclerodactyly
Telangiectasia |
|
|
Term
| __________ antibody is a type of Anti-Nuclear Antibody that is highly specific for & found in ~20% of patients with diffuse scleroderma |
|
Definition
|
|
Term
| What 2 test results, together, are diagnostic for scleroderma? |
|
Definition
presence of auto-antibodies (ANA, anti-centromere, anti-topoisomerase)
C-Reactive Protein (CRP) is NOT elevated (Remember: elevated CRP non-specifically indicates inflammation) |
|
|
Term
| What does elevated C-Reactive Protein (CRP)indicate? |
|
Definition
inflammation
(it's non-specific) |
|
|
Term
|
Definition
| a chronic systemic autoimmune disease characterized by dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostoma). |
|
|
Term
| What are the 2 main symptoms of Sjogren’s syndrome (SS)? |
|
Definition
|
|
Term
| What causes Primary Sjogren's Syndrome (SS)? |
|
Definition
Lymphocytes infiltrate & cause fibrosis in lacrimal & salivary glands, leading both to dry up
(No one knows why…maybe b/c of viral infection of salivary glands) |
|
|
Term
| What would you see if you took a biopsy of glandular tissue of lacrimal & salivary glands from a person with primary Sjogren's Syndrome? |
|
Definition
| dense infiltrate of CD4+ (helper) T cells |
|
|
Term
|
Definition
| dry mouth due to lack of saliva |
|
|
Term
| The presence of what 2 antibodies are highly specific for Sjogren's syndrome? |
|
Definition
antibodies against 2 ribonucleoprotein antigens
o SS-A (Ro)
o SS-B (La) |
|
|
Term
| A person has dry eyes and mouth. You don't know if they have scleroderma or Sjogren's Syndrome. If they have scleroderma, what would you expect to see in a biopsy of the lacrimal or salivary glands? |
|
Definition
fibrosis (but that could be either)
no lymphocytic infiltrate |
|
|
Term
| What is the C1 vertebra called? |
|
Definition
|
|
Term
| What is the C2 vertebra called? |
|
Definition
|
|
Term
| What muscle originates from the mastoid process (on the skull behind the ear) and inserts on the manubrium (top of sternum) & clavicle next to manubrium. |
|
Definition
|
|
Term
| What innervates the sternocleidomastoid? |
|
Definition
|
|
Term
| What does the sternocleidomastoid do? |
|
Definition
Unilateral contraction: turns neck so face is turned up & toward opposite side
Bilateral contraction: extends the neck |
|
|
Term
What originates from the back of the skull and the back of C7-T12 and inserts on the lateral 1/3 clavicle and the spine of the scapula?
[image] |
|
Definition
|
|
Term
| What is the motor innervation of the trapezius? |
|
Definition
|
|
Term
| What are the main actions of the trapezius muscle? |
|
Definition
| lift, retract, & depress scapula |
|
|
Term
What originates on the front or side of C1-C6 and inserts on the middle or side of C3-T3?
[image] |
|
Definition
|
|
Term
| What does the longus colli do? |
|
Definition
• Flexes neck toward muscle (antero-lateral)
• Rotates head opposite to side of contracting muscle |
|
|
Term
What is the difference between the following 2 phrases?
Flexing the neck
flexing the head |
|
Definition
Flexing the neck = bending forward or to the side at C2-C7
flexing the head = bending head forward or to the side at atlanto-occipital joint |
|
|
Term
What muscle originates at the bottom of occipital bone (in front of foramen magnum) and inserts on the front-side of C3-C6?
[image] |
|
Definition
|
|
Term
| What does the longus capitis? |
|
Definition
| flexes head (that is, bends head forward or to the side at atlanto-occipital joint) |
|
|
Term
What originates on the occipital bone (to the side of the foramen magnum)and inserts on the side of C1 (atlas)?
[image] |
|
Definition
|
|
Term
| What does the rectus capitis lateralis do? |
|
Definition
• flexes head (that is, bends head forward or to the side at atlanto-occipital joint)
• helps stabilize head |
|
|
Term
What originates on the occipital bone (in front of & to the side of the foramen magnum) and inserts on the front of C1 (atlas).
[image] |
|
Definition
|
|
Term
| What does the rectus capitis anterior? |
|
Definition
Flexes head (that is, bends head forward or to the side at atlanto-occipital joint)
[image] |
|
|
Term
What originates on the side of C4-C6 & inserts on the 1st rib (toward the front)?
[image] |
|
Definition
|
|
Term
| What does the anterior scalene do? |
|
Definition
Flexes neck (that is, bends head forward or to the side at C2-C7)
[image]
|
|
|
Term
| What are the 5 anterior vertebral muscles of the neck? |
|
Definition
longus colli
longus capitis
rectus capitis lateralis
rectus capitis anterior
anterior scalene |
|
|
Term
| What are the 4 lateral vertebral muscles of the neck? |
|
Definition
splenius capitis
levator scapulae
middle scalene
posterior scalene |
|
|
Term
What originates on the nuchal ligament and the back of C7-T3, and inserts on the mastoid process (the skull behind the ear)?
[image] |
|
Definition
|
|
Term
| What does the splenius capitis do? |
|
Definition
• Laterally flexes & rotates head & neck to same side o (note: flexion & rotation of head occur at C1/occiput; flexion & rotation of neck occur at C2-C7) • Acting bilaterally, extend head & neck (upright)
[image] |
|
|
Term
What originates on the back of C1-C4 and inserts on the superior part of medial border of scapula?
[image][image] |
|
Definition
|
|
Term
| What does the levator scapulae do? |
|
Definition
• Elevates scapula
• Tilts glenoid cavity of scapula inferiorly by lifting medial border of scapula |
|
|
Term
| What originates on the back of C2-C7 and inserts on the top of 1st rib (to the side)? |
|
Definition
|
|
Term
| What does the middle scalene muscle do? |
|
Definition
• flexes neck laterally
• elevates 1st rib during forced inspiration |
|
|
Term
What originates on the back of C2-C7 and inserts on the 2nd rib?
[image] |
|
Definition
|
|
Term
| What does the posterior scalene muscle do? |
|
Definition
• Flexes neck laterally • Elevates 2nd rib during forced inspiration
[image] |
|
|
Term
| What are the 4 superficial muscles of the posterior cervical region? |
|
Definition
descending part of trapezius
splenius capitis (extends the head & neck)
Splenius cervicis (extends the head & neck)
Longissiumus (continues down the spine; extends the spine) |
|
|
Term
What originates on the nuchal ligament and back of C7-T3, and inserts on the sides of C1-C2 (or C3)?
[image] |
|
Definition
|
|
Term
| What does the splenius cervicus do? |
|
Definition
• Laterally flexes & rotates head & neck to same side as muscle
o (note: flexion & rotation of head occur at C1/occiput; flexion & rotation of neck occur at C2-C7)
• Acting bilaterally, extend head & neck (upright |
|
|
Term
| What originates on the sides of T1-T5, splits into 2 parts, and then inserts on the posterior mastoid process (one part) and the sides of C2-C6 (the other part)? |
|
Definition
|
|
Term
| What does the longissimus muscle do? |
|
Definition
• Extends vertebral column
• Longissiumus capitis turns face ipsilaterally |
|
|
Term
What originates on the sides of C4-T5, splits into 2 parts, and then inserts on the occipital bone (one part) and the backs of C1-C7 (other part)?
[image] |
|
Definition
|
|
Term
| What does the semispinalis do? |
|
Definition
Contributes to contralateral rotation of the spine
Acting bilaterally: extends the spine (upright) |
|
|
Term
What originates on the side-back of C4-C7 and sides of T1-T3, and inserts on the back of vertebrae 2-4 segments below origin
[image][image] |
|
Definition
| Multifidus of cervical region |
|
|
Term
| What does the multifidus of the cervical region do? |
|
Definition
| stabilizes vertebrae during local movements of vertebral column |
|
|
Term
| What are the 3 layers of the esophageal mucosa, from the lumen outward? |
|
Definition
epithelium
lamina propria
muscularis mucosa
(submucosa) |
|
|
Term
|
Definition
|
|
Term
| Symptoms of Boorhave's syndrome (esophageal rupture). |
|
Definition
Sudden, VERY severe chest pain (retrosternal)
Has coughed up a lot of blood |
|
|
Term
| What is the immediate danger of Boorhave's syndrome (esophageal rupture) |
|
Definition
| Lets air into chest, which can push on heart & lungs |
|
|
Term
| rosary bead esophagus indicates |
|
Definition
diffuse esophageal spasm
(aka corkscrew esophagus) |
|
|
Term
|
Definition
| esophageal webs due to iron-deficient anemia |
|
|
Term
| Clinical signs of iron-deficiency anemia |
|
Definition
Pallor
crave ice (pica)
Spooning of nails |
|
|
Term
| Plummer-Vinson syndrome is common amongst: |
|
Definition
| pregnant women who don’t take prenatal vitamins |
|
|
Term
| What 2 things do you need to see before you diagnose Plummer-Vinson syndrome? |
|
Definition
blood test for iron deficiency
endosocopy to see esophageal webs |
|
|
Term
| Secondary achalasia cardia is due to: |
|
Definition
chaga’s disease
neoplasia pushing on LES from the outside or neoplasia of esophagus filling LES |
|
|
Term
| How does chaga's disease cause achalasia? |
|
Definition
| T. cruzi destroys of the myenteric plexus, which prevents the lower esophageal sphincter from recognizing the presence of food & relaxing |
|
|
Term
| Achalasia is due to the failure of __________ (excitatory/inhibitory) neurons |
|
Definition
|
|
Term
| What will you see with an endoscope if you look in the throat of someone with a candida infection? |
|
Definition
|
|
Term
| Candida esophagitis is mostly seen in patients who: |
|
Definition
| are immunocompromised (such as HIV+) |
|
|
Term
| You can treat candida esophagitis empirically without endoscopy if: |
|
Definition
| they have creamy white patches on their tongue or mouth |
|
|
Term
| What kind of cells in histology generally mean herpes esophagitis? |
|
Definition
| Multi-nucleated giant cells |
|
|
Term
| Mallory-Weiss tears are longitudinal tears in the esophagus that DON'T: |
|
Definition
penetrate through all the layers
(through all the layers would be eosphageal rupture, or Boorhave's syndrome) |
|
|
Term
| Who is most likely to get a Mallory-Weiss tear? |
|
Definition
| alcoholics, people with bulimia, and other people who vomit frequently |
|
|
Term
|
Definition
| Columnar epithelium moves into esophagus |
|
|
Term
| What causes Barrett's esophagus? |
|
Definition
long-term GERD
(reflux washes up columnar epithelial cells from stomach, which colonize the esopahgus) |
|
|
Term
| Histology of Barrett's esophagus |
|
Definition
invaginated (rugae) like stomach
goblet cells (big, round, empty-looking cells) |
|
|
Term
| What does Barrett's esophagus look like with an endoscope? |
|
Definition
| tongues of bright pink or salmon pink spreading out from cardiac sphincter into the paler pink normal esophageal mucosa |
|
|
Term
| Barrett’s esophagus is a pre-malignant condition for ____________ (type of cancer) in the esophagus |
|
Definition
|
|
Term
| What 3 kinds of tumors arise from the esophagus? |
|
Definition
adeonocarcinoma
squamous cell carcinoma
leiomyoma |
|
|
Term
| What is the main risk factor for squamous cell carcinoma in the esophagus? |
|
Definition
|
|
Term
Explain the following mnemonic:
S leads to S in the esophagus |
|
Definition
| Smoking leads to Squamous cell carcinoma of the esophagus |
|
|
Term
| What do you see histologically when looking at squamous cell carcinoma of the esophagus? |
|
Definition
Keratin pearls or nests (diagnostic)
(Mnemonic: PEARLS before Swine
Pearls mean Squamous cell carcinoma)
[image] |
|
|
Term
| What is the gross morphology of leiomyoma of the esophagus? |
|
Definition
little mushroom-shaped polyp with normal surface appearance
cross-section is very concentric |
|
|
Term
| What is the treatment and prognosis of leiomyoma |
|
Definition
treatment: remove the polyp
prognosis: leiomyoma is almost always benign; if you remove the polyp, they'll be fine |
|
|
Term
| What 3 acute emergencies originating in the GI tract can vomiting and nausea indicate? |
|
Definition
Obstruction
Perforation
peritonitis |
|
|
Term
Explain the following mnemonic with regard to esophageal neoplasia:
Mnemonic: PEARLS before Swine
|
|
Definition
| keratin Pearls mean Squamous cell carcinoma |
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Term
What cell is in the gastric pit (opening) of gastric glands?
What cell is in the neck?
What 2 cells are in the base? |
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Definition
mucous neck cells
parietal cells
chief cells
G cells |
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Term
| Where are cardiac glands in the stomach? What do they primarily produce? |
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Definition
They occur in the cardiac portion of the junction, close to the gastroesophageal junction
They primarily secrete mucous. |
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Term
Explain the following mnemonic:
Brunners makes it Basic |
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Definition
| Brunner's gland is a gland in the proximal duodenum that produces a basic mucous |
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