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115 Cards in this Set
- Front
- Back
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What are Brunner's glands?
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Submucosal glands only in the duodenum that secrete alkaline mucus into the crypts of Lieberkuhn.
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How is the pancreas formed?
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Rotation of ventral bud to dorsal bud head.
Ventral bud - main pancreatic duct, uncinate process, part of head (inferior) Dorsal bud - accessory pancreatic bud (Santorini), body, tail, superior head |
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What are the stages of gastric acid secretion?
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Cephalic - ACh and vagal
Gastric - gastrin and then histamine from ECL cells Intestinal - YY binds ECLs inhibiting histamine. Decreasing acid secretion. |
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What does the midgut rotate around embryologically?
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270 degrees around the SMA in a CCW fashion. If abnormal, cecum ends up near RUQ with Ladd's bands. Can lead to intestinal obstruction and midgut volvulus.
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What is Auerbach's plexus?
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Myenteric plexus. does motility
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What is Meissner's plexus?
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Submucosal plexus modulating secretion and blood flow.
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Gastrin facts?
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Important is the four C-terminal amino acids.
Action - increase H secretion by parietal cells. AND GROWTH OF GASTRIC MUCOSA! |
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How does atropine affect acid secretion?
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blocks vagal stimulation of parietal cells. GRP stimulation by vagus of G cells continues.
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What makes gastrin?
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G cells of antrum.
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What are the most potent stimuli for gastrin secretion?
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Phenylalanine and tryptophan
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What inhibits gastrin secretion?
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High H, and somatostatin
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What stimulates CCK release?
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released by I cells of duodenal and jejunum by protein presence, fatty acid presence and monoglycerides. Not triglycerides.
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What structure is homologous with gastrin?
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CCK
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Action of CCK?
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gallbladder contraction, increased pancreatic enzyme and bicarb secretion, increase growth of exocrine pancreas and gallbladder. Inhibits gastric emptying
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Function of secretin?
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made by S cells of duodenum. Increases pancreatic bicarb secretion, increases bile production, inhibits H+ secretion of parietal cells.
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Stimuli for secretin?
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acid in duodenum, fatty acids in duodenum
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Secretin is structurally similar to?
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glucagon and GIP
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What is GIP?
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gastrin-dependent insulinotropic peptide. Made by K cells of duodenum.
Presence of carbs, fats, proteins --> secretion. Leads to insulin release and blocking H secretion of parietal cells. |
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What are the paracrine factors of GI system?
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Somatostatin and Histamine.
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What is somatostatin?
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secreted by D cells. Inhibited by vagal stimulation. Blocks GI hormones. Blocks H secretion.
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What is histamine?
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Made by mast cells/ECL cells. Increases parietal acid secretion.
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What is VIP?
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Made by pancreas exocrine. Relaxes GI smooth muscle and LES. Stimulates pancreatic bicarb secretion and blocks gastric H secretion.
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What are enkephalins?
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Secreted from nerves. Stimulate contraction of GI smooth muscle. Block intestinal secretion - opiates act here to stop diarrhea.
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What are slow waves?
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periodic oscillating membrane potentials originating in interstitial cells of Cajal. Made by opening of Ca channels and then opening of K channels.
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What things delay gastric emptying?
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Fat causing CCK production. Acid in duodenum. Hypertonic or hypotonic conditions of stomach.
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What drives MMC?
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motilin
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What mediates gastric receptive reflaxation?
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vagus
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What is the neurotransmitter mediating LES relaxation?
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VIP
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What is the gastroileal reflex?
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gastric contents (probably gastrin) trigger increased peristalsis from ileum and relaxation of ileocecal sphincter
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What is the gastrocolic reflex?
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Food in stomach increasing frequency of mass movements.
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How is saliva formed?
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Acinus secretes plasma basically. Ducts modify. Absorb Na and Cl. Secrete K. Seen accordingly with flow rates. Absorb HCO3 more with lower flowrates (even though secreted!).
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Other than renal tubules what can aldosterone affect?
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Salivary absorption of Na!
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Compare saliva to plasma?
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Saliva has higher K and HCO3.
Lower Na and Cl. |
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Stimulants of saliva?
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Parasympathetic and Sympathetics.
Conditioning, food, nausea and smell = para. Increase IP3 and Ca from ACh. Sympt - NE and cAMP. |
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What blocks parasympathetic stimulation?
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Dehydration, fear, sleep, anticholinergic drugs.
Atropine also blocks ACh release. |
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What type of cholinergic receptors are on acinar and ductal cells?
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Muscarinic
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What do chief cells make? where are they?
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Pepsinogen. Body of stomach.
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Describe ion movement with HCL secretion of parietal cells?
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H and Cl go out. HCO3 leaves to blood stream. Cl comes in exchange for HCO3.
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What does vagal stimulation do for stomach?
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ACh to parietal - increase IP3: open Ca - release acid.
Indirect - with G cells - release gastrin. Due to GRP. |
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Secondary messengers for gastrin and Vagus nerve in parietal?
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IP3
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Secondary messenger for Histamine, Somatostatin, PGs in pareital cells?
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cAMP
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Method of somatostatin and acid?
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Direct leads to Gi leading to decreased levels of cAMP.
Indirect - block release of histamine and gastrin. |
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Changes in secretion with gastric ulcers?
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gastric H+ secretion decreased because H leaks back. Gastrin levels increased bc decreased secretion increases this secretion.
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Changes in secretion with duodenal ulcers?
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Gastric H+ secretion increased. Gastrin secretion in response to a meal is increased.
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Test for H pylori?
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Urease test. Give 13C urea. Measure 13C CO2.
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Composition of pancreatic secretion to plasma?
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Isotonic. High flow rates - much higher HCO3 and lower Cl.
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Pancreatic second messengers for secretin vs CCK.
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Secretin - cAMP
CCK - IP3 |
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Contrast function of secretin and CCK on pancreas?
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Secretin - increase ductal HCO3 secretion
CCK - increase acinus production |
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Products of lactase?
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glucose and galactose
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Products of sucrase?
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fructose and glucose
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How are glucose and galactose transported into cells from intestinal lumen?
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Na+-dependent cotransport (SGLT-1) supported by Na/K basolateral ATPase.
Transported out of cell by facilitated diffusion with GLUT-2. |
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Action of amylase?
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break 1,4-glycosidic bonds in starch
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What proteins can be absorbed?
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amino acids to tripeptides. tripeptides and dipeptides absorbed by H+ codpendne transport.
Amino acid done by Na codependent trasnport like glucose and galactose. |
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Causes for malabsorption of lipids/steatorrhea?
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Too high of a pH - degrades pancreatic lipase
Pancreatic disease Ileal resection Bacterial overgrowth Decreased number of intestinal cells Failure of synthesis of apoB |
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Absorption of lipids?
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Micelles bring products to surface. Fatty acids, monoglycerides, and cholesterol diffuse across the luminal membrane into the cells.
Re-esterified to TGs, chol ester, and phospholipids. |
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Lack of apo B is?
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abetalipoproteinemia
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Absorption of K?
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Paracellular passive.
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K secretion in GI?
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Secreted in colon by aldosterone. Diarrhea can lead to hypokalemia?
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Mechanism of cholera toxin?
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Diarrhea by stimulating Cl secretion. Cholera toxin catalyzes ADP ribosylation of alpha subunit of Gs activating AC. cAMP opens Cl channels. Get secretory diarrhea.
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Calcium mechanism of absorption?
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helped by 1,25 vit D and activation of calbindin D-28K.
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Embryologically what will obstruction of a gut artery lead to?
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Apple peel atresia. Still see obstruction = bilious vomiting.
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What does improper fusion of ventral and dorsal pancreatic buds lead to?
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Pancreas divisum. silent
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What does improper migration of pancreatic buds lead to?
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Annular pancreas. Obstructive.
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What is duodenal ulcer pain relieved by?
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food and antacids
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Types of vitelline ducts that persist?
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1) Persist - passes meconium
2) Meckel - open at ileum 3) Sinus - open at umbilicus 4) Enterocyst - open in middle |
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What is a risk factor for duodenal atresia?
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Downs
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What does Hirschprung's disease always affect?
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rectum
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How many grams to calories are proteins, carbs, fat?
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1g protein/carb = 4 cal
1 g fat = 9 cal |
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Faulty trypsinogen inactivation can lead to?
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Pancreatitis
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What do dilated bile canaliculi with green-brown plus and pigmented hepatic parenchyma suggests?
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Cholestasis
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Gastric finding with systemic macrocytosis?
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Gastric hypersecretion
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What does blocked H secretion, slow GI muscle, and treatment of somatostain suggest?
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VIPoma
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Action of Thiazolidinediones?
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Increase glut 4 expression on adipocyte membranes
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Appearance of mouth ulcers is indicative of what other disease?
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Crohn's
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Rx for hepatic encephalopathy?
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Lactulose - intestinal content acidification
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Dermatitis herpetiformis is seen with what other disease?
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celiac disease - villous atrophy
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Gastric bleeding can precipitate hepatic encephalopathy?
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yep
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Skin manifestation acanthosis nigricans can mean?
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GI malignancy
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Biopsy of ischemic colitis shows?
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Mucosal hemorrhage and patchy areas of necrosis
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How does bile affect bacteria?
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Messes up with surface membranes
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How to treat someone with diarrhea?
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Give saline
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Pentagastrin can be used to dx?
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Medullary carcinoma of thyroid, carcinoid syndrome
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Use for octreotide?
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Choice for varicosal esophageal bleeding
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Alkaline Phosphatase levels suggest?
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Biliary issues
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Ulcerative colitis with high AP suggests?
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Primary sclerosing cholangitis
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Seeing lymphocytic infiltrate and granulomatous destruction with pale stool and xanthelasma sounds like?
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Primary biliary cirrhosis
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What drugs increase gallstones?
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Fibrates and bile-binding resins
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Niacin can increase chances for what attack?
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Gout
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Porcelain gallbladder is risk factor for?
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Gallbladder carcinoma
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When can acalculous cholecystitis arise? risk for?
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Hospitalized or severely ill
-inflamed and enlarged gallbladder risk for performation and gangrene |
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Intestinal D-xylose test?
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Tests mucosal vs pancreatic issues
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High AP and think biliary also check?
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GGTP
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SMA syndrome?
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Duodenum compressed by SMA.
rf = lordosis or loss of mesenteric fat |
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Crohn's bx shows?
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Cobblestone. Granuloma. Transmural.
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Mouth bacteria?
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Fusobacterium, deptostreptococcus
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What process for hepatocytes is active?
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Secretion.
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Hepatic encephalopathy caused by?
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ammonia absorbed from gut
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Reye;s affect on liver?
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Microvesicular steatosis
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EtOH on liver?
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Mallory bodies, neutrophils, fibrosis
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Acetaminophen on liver?
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Centrilobular necrosis
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Risk factors for SCC of esophagus?
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Achalasia, EtOH, smoking, Plummer-Vinson
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What is retroperitoneal?
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Pancreas
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Biggest prognostic indicators for liver failure?
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Low albumin and PT
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Biopsy of hep B?
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fine granular ground glass appearance
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Hep C look?
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Lymphoid aggregates w/in portal tracts and steatosis areas
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Most likely prognosis for HCV?
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Chronic stable hepatitis.
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What is the only organ that can utilize glycerol produced by degradation of TGs?
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Liver. From glycerol kinase to make DHAP.
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Increased gallstones with Crohn's?
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Bile acid loss. Cholesterol precipitates.
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Hep B damage mediated?
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CD8 T lymphocyte response to viral antigens
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Types of gastric cancers?
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Adenocarcinoma - well demarcated, can grow within the lumen
Signet - infiltrative growth w/in stomach wall |
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Microbial cause of achalasia?
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Chagas
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Enzyme related to polyp development?
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COX2
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Arsenic, thorotrast, polyvinylc chloride cause what cancer?
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Liver angiosarcoma
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Treatment of Wilson's for Cu?
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Penicillamine
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Most common benign liver tumor?
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Cavernous hemangioma
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