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147 Cards in this Set
- Front
- Back
Gastrin
stim inhib |
G cells of antrum
Stim for secr: 1. AA in stomach - esp Phenylalanin + tryptophan 2. Gastric Distention 3. Vagal stim: vis GRP Inhib: 1. acid in stomach |
|
Zollinger ellison syndrome
|
Gastrin secr from non beta cell tumors in pancreas.
|
|
CCK
actions stim for rls (from where) |
Secr by I cells of duodenum and jejunum
actions: 1. Contract gallbladder 2. relax sphincter of Oddi 3. Pancr enzyme rls and growth 4. Inhibit gastric emptying Stim for rls: 1. Small peptides and AA 2. Fatty Acids + Monoglycerides (not TG) |
|
Secretin
|
S cells of duodenum
action: 1. Pancr bicarb rls 2. Inhibit parietal H+ secr 3. Stim bicarb and H20 secr in liver and incr bile production stim: 1. H+ in duodenum 2. Fatty Acids in duodenum |
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GIP
|
found in K cells of duodenum and jejunum
Action: 1. Stimulates Insulin rls after oral glucose load 2. Inhibits H+ secr Stim 1. Glucose, AA, fatty acids |
|
Paracrines
Somatostatin Histamine |
Diffuse over short distance
Somatostatin: Action: 1. Inhibits rls all GI hormones 2. Inhibits H+ secr 3. Inhibited by vagal stimulation Histamine: Mast cells of gastric mucosa 1. Stim H+ secr directly and potentiates gastrin and vagal effects |
|
VIP
|
Neurocrine
1. relaxation of GI smooth muscle 2. Inhibits gastric H+ rls 3. Stim pancr Bicarb secr secr in islet cell tumors and mediates cholera toxin |
|
GRP (bombesin)
|
Neurocrine
Vagal rls that innervate gastric G cells stimulats Gastrin Rls |
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Enkephelens (met and leu)
|
Neurocrine
Secr from nerves in GI mucosa and smooth muscle. stimulates contraction of GI smooth muscle - esp LES, pyloric and ileocecal sphincters. Inhibits intestinal secretion |
|
Slow wave
|
oscillating membrane potentials
Not AP - although they determine the pattern of AP Controlled by activation/deactivation of Na/K pump Incr probability of AP Varies in different regions but is constant and characteristic for each part Not influenced by neural or hormonal input while AP is. Sets max freq of contractions Lowest in stomach 3/min fastest in duodenum 12/min |
|
Swallowing
|
Controlled By medulla
laryneal contraction to close glottis and elevate larynx Peristalsis begins in pharynx and UES relaxes Upper 1/3 of esophagus is striated muscle. Food enters esoph and UES contracts 1' peristalsis 2' peristalsis clears leftover As food approaches LES - VIP from vagal fibers relax it. |
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Relaxation of LES
|
VIP from vagal stimulation
|
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Migrating Myoelectric Complex
|
Mediated by Motilin
90 min interval contractions that clear stomach of residual food. |
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Gastric empyting
|
1. Fastest with isotonic substances
2. Fat inhibits it (due to CCK) 3. H+ in duodenum inhibits it due to neural reflex. |
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Gastroileal Reflex
|
Mediated by Gastrin and extrinsic nervous sys
Food in stomach triggers peristalsis in ileum and ileocecal valve relaxation |
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Defecation
|
1.Rectum fills with feces and contracts, internal anal sphincter relaxes (rectosphincteric reflex)
2. Urge to poo 3. External Anal sphincter voluntarily relaxes ->Valsalva Maneuver (expiring against a closed glottis) |
|
Gastrocolic reflex
|
Gastric distention leads to incr freq of MASS MOVEMENTS in colon.
1. Parasympathetic impulse 2. CCK and Gastrin |
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Saliva
|
High Bicarb, K+. Lipase and alpha amylase. Hypotonic secretions
acinus -isotonic soln ductal cells -imperm to H20 reabsorb Na + Cl while secreting K+ and Bicarb. Aldosterone works here to incr Na resorpt and K+ secr. Low flow rates = High K+ High flow rates = close to plasma Psym (cn 7,9): Incr saliva by vasodiation. (IP3->Ca). Atropine-> dry mouth Sym: Incr saliva and gland growth via beta rec -> incr cAMP DECR: fear, sleep, dehydration, anticholinergics |
|
Alkaline tide
|
Parietal cells rls HCl. Via CA exchanges Cl for bicarb in the blood.
|
|
Gastric Secr
|
PCells: H+ and Intrinsic factor
Chief cells: pepsinogen G cells: gastrin Parietal cells have CA, secretes H+ via K+/H+ ATPase (blocked by omeprazole).Alkaline tide. H+ secr: 1. Vagal stim via direct Ach on parietal cells (muscarinic - IP3:Ca++, and GRP(bombesin) on G-cells. 2. Histamine: H2 receptors on parietal cells (cAMP). (cimetidine) 3. Potentiation Inhibition of H+ secr: 1. pH <3.0 2. Chyme in duodenum - mediated by GIP (FA in duodenum) + Secretin (H+ in duodenum) |
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Pancr Secr
|
Isotonic - high in Na and Bicarb, lipase, amylase, proteases
Acinus: high Na and Cl Duct: Cl bicarb exchange, H2O permeable Slow flow: NaCl High flow: Na + Bicarb Regulation: Secretin (cAMP): responds to duodenal H -_stim bicarb exchange in ducts incr secr CCK (IP3-Ca): response to small peptides, AA, FA in duodenum - acts on pancr acinar cells to incr enzyme secr, + potentiates secretin Ach: vagal resposne to same things as CCK - potentiates secretin |
|
Gallbladder
|
rls bile
Bile: bile salts, cholesterol, phospholipids, bile pigments Bile is made in the liver and stored and concentrated (isomotic reabsorption) 1' bile acids(cholic, chenodeoxycholic) synth from cholest in liver. 2' bile acids(deoycholic, lithocholic) from bacterial conversion intestine. Conjugated with taurine or glycine: to form bile salts (taurocholic) Interdigestive period -gallbladder filling CCK and Ach stimulate rls. |
|
Recirc of bile
|
Occurs in terminal ileum
Na-bile acid cotransport circ back to liver. |
|
Site of B12 intrinsic factor absorption
|
Ileum
|
|
Absorption
Carbs |
Small intestine
digestion by brush border glucosidases and alpha amylase to monosachs Na dependent secondary active cotransport of glucose and galactose Facilitated diffusion of Fructose Dig would inhibit this transport |
|
Absorption
proteins |
endo/exopeptidases, pepsin, trypsin(and other pancr zymogens)
Absorbed as AA,di/tripeptides Na-dep cotransport |
|
Abetaliproproteinemia
|
AR
Lack of apoB thus inability to transport CM out of intestinal cells. enterocytes congested with lipid Acanthocytes (burr cells) No CM, VLDL, or LDL in blood |
|
Steatorrhea
|
Cf, pancreatitis
Hypersecretion of Gastrin: low pH inactivates pancreatic lipase Ileal resection: depleted bile acid pool Bacterial overgrowth: deconjugation of bile acids leading to early absorption. Decr intestinal cells: sprue Failure to make apoB - can't make CM |
|
hypokalemia in diarrhea and diuretics
|
In diarrhea the high flow rate causes an incr K+ gradient in the colon - like the distal tubule
Also aldo stimulates K+ secr here as well. |
|
Cholera
|
Cl is primary ion secreted in GI - Na goes with it.
Mediated by cAMP. Cholera stimulates Cl secr by activating adenylate cyclase -> incr cAMP and NaCl secr. |
|
Ca++ absoprtion
|
via vit D dependent Ca++ binding protein
in small intestine. |
|
Iron absorption
|
reduced to Fe++, binds apoferritin in cell, circ in blood bound to tranferrin.
|
|
Celiac trunk branches
|
Begins as aorta comes out of diaphragm at T12
Consists of: Left side: Splenic artery, left gastric artery. Rt side: common hepatic (gastroduodenal, hepatic) |
|
Gastrometental arteries
|
Right gastroomental is a branch off of the gastroduodenal art
Left gastroomental branch off of the splenic art. Can survive with just the right -in esophageal resections. |
|
What can be perforated by a perforating duodenal peptic ulcer?
|
The gastroduodenal artery lies right behind it.
|
|
Appendicitis
periumbilical pain becoming mcburneys pt |
Periumbilical pain early because of T10 dermatome
Mcburneys point due to inflamed parietal peritoneum there leading to rebound and pt tenderness late stage |
|
Anastomosis in portal HTN
|
Reroute to the Vena Cava
1. Esophageal Varices - Azygous Veins (systemic) + left gastric (portal) 2. Periumbilical: Epigastrics (systemic) umbilical vein (portal) 3. Hemorrhoids Inferior rectals (systemic) Superior rectals (portal) 4. Retroperitoneal renal and paravertebral |
|
Cystohepatic triangle
|
For finding cystic artery in cholecystectomy
Hepatic Tiss Cystic Duct Common hepatic |
|
Peptic ulcer duodenum
|
always H. Pylori
ass with asa, smoking, primary hyperparathyroid, MENI, zollinger ellison |
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Crohns
|
anypart of GI
lower incidence of colon cancer fistulas cobblestone appearance affects entire thickness Skip lesions Granulomas |
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celiac Sprue cancer accociation
|
enteropathy type Tcell lymphoma
|
|
Carcinoid tumor
|
Most commonly in appendix where it never mets.
Can be in small intestine When mets to liver can cause carcinoid syndrome: diarrhea, flushing, bronchospasm, valvular lesion on right side of heart. |
|
Common extra intestinal manifestations of crohns and ulcerative colitis
|
uveitis, scleritis, ascending cholangitis, polyarthritis, sacral ileitis, pyoderma gangrenosum, erythema nososum
|
|
Ulcerative colitis
|
Colon cancer
always involves rectum only involves mucosa and submucosa, pseudopolyps CRYPT ABCESS toxica megacolon perforation |
|
Ulcers:
in burns brain injury entamoeba histolytica |
Curling gastric Ulcer
Cushing gastric Ulcer Flask shaped ulcer - colitis |
|
Peutz Jeghers
|
Hamartomous polyps of colon and small intestine,
melanotic spots on hands, lips, hands, genitals Incr chance for adenocarcinoma of colon or elsewhere. |
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Gardner syndrome
|
AD
numerous adenomatous polyps osteomas soft tiss tumors |
|
Turcot Syndrome
|
adenomatous polyps
CNS tumors |
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Presentation of rectosigmoid colon vs right colon cancer
|
Rectosigmoid colon presents in an annular manner leading to early obstruction, blood in stool
Right colon: no obstruction, IDA from chronic occult blood loss |
|
Cloaca
|
terminal end of the hindgut pouch
partitioned by the urorectal septum into... rectum, upper anal canal, UG sinus. |
|
Pectinate Line
|
above line:
Adenocarcinoma, Rectum, internal iliac LN +inf mesenteric LN Columnar epith superior rectal artery (IMA) painless internal hemorrhoids Inferior hypogastric plexus Drainage: Sup rectal vein->inferior mesenteric vein->portalsystem Below line: SCC Superficial inguinal nodes stratified squamous epith inf rectal arteries (internal pudendal) painful hemorrhoids inf rectal nerves Drainage: inf rectal vein->internal pudendal vein-> internal iliac vein-> IVC |
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Anorectal agenesis
|
rectum ends in blind sac above puborectalis due to urorectal septum def
can be accompanied by rectovesical fistula rectourethral fistula rectovaginal fistula |
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Anal agenesis
|
anal canal ends in blind sac below the puborectalis due to urorectal septum def
can be accompanied by rectovesical fistula rectourethral fistula |
|
Femoral Triangle
|
Sartorius, Inguinal ligament, adductor longus
Femoral sheath: (N) Artery, Vein, femoral canal (LN) |
|
Physiologic Jaundice of newborn
|
Bililights
unconjugated bilirubin due to deficient glucuronyl transferase |
|
Criglar Najjar Syndrome
|
Severe Familial unconjugated hyperbilirubinemia
1. Serious glucuronly tranferase deficiency - kernicterus and death 2. Less serious can be tx with phenobarbitol |
|
Dubin Johnson
Rotor |
conjugated bilirubinemia caused by deficient tranport - black liver
Rotor syndrome same without pigment |
|
Hepatitis E virus
|
enterically transmitted
Water borne epidemic High incidence of mortality in pregnancy |
|
Viral hepatitis
|
EBV -mono often has liver component
CMV - infant liver, immunocompromised HSV1 infant liver, IC Yellow fever: midzonal necrosis, councilman bodies |
|
Leptospirosis
|
jaundice, renal failure, hemorrhagic phenomenon
|
|
Echinococcus Granulosos
|
ingested tapeworm eggs from dog feces and sheep poo
Hydatid Dz of the liver |
|
Schistosomiasis mansoni/japonicum
|
adult worms lodge in portal vein and its branches. Eggs lead to granulomas -> portal HTN
|
|
Microvesicular fatty liver
|
Reye syndrome
Fatty liver of pregnancy Tetracycline |
|
Alcoholic Liver dz
|
fatty change
focal liver necrosis, N/T infiltrate Mallory bodies (alcoholic hyaline) Perivenular Fibrosis |
|
primary sclerosing cholangitis association
|
Ulcerative Colitis
incr incidence of cholangiocarcinoma |
|
Wilson's Dz
|
Decr ceruloplasmin
liver dz Kayser Fleischer ring - periphery of cornea, renal tubular damage leads to aminoaciduria and glycosuria |
|
Budd chiari syndrome
ass dz |
thombosis of major hepatic veins (posthepatic portal HTN)
abdominal pain, jaundice,ascities, liver failure Ass: polycythemia, pregnancy, liver cancer, abdominal malignancy |
|
Hepatic Adenoma
|
Ass with oral contraception
when subcapsular can rupture -> severe intraperitoneal hemorrhage. |
|
Hepatocellular Carcinoma
|
Hepatic malignancies usually mets
From cirrhosis HBV Aflatoxin B1 (nuts/grain- point mut in p53) Incr alpha feto protein early hematogenosu spread |
|
Cholangiocarcinoma
|
Bile duct carcinoma
Clonorchis Sinensis, thorotrast Originates in intrahepatic biliary epith |
|
Hemangiosarcoma
|
rare malignant vascular tumor of hepatic.
PVC, Thorotrast, Arsenic |
|
Cholethiasis group
|
Fat bitches with many kids
|
|
Common bile duct obstruction
|
Obstructive jaundice
conjugated hyperbilibuinemia hypercholesterolemia incr Alk Phos hyperbilirubinuria |
|
Cholelithiasis manifestations
|
Fatty Food Intolerance
Biliary Colic Common bile duct obstruction Ascending cholangitis Cholecystitis Acute pancreatitis Gallstone ileus Mucocele Malignancy |
|
Cholesterolosis
|
strawberry gallbladder
yellow cholesterol flecks on mucosal surface |
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Courvoisier Law
|
Tumors that obstruct common bile duct result in enlarged distended gallbladder, obstructing stones do not
|
|
Pancreatic Carcinoma
|
Most often head of pancreas causing obstructive jaundice
Carcinoma of tail can cause islet cell destruction and DM Migratory Thrombophlebitis (trousseau sign), obstructive jaundice + distended papable gallbladder. |
|
Oligosacharidases
|
on brush border of duodenum -
rate limiting step in carbohydrate digestion produces monosacharides from oligos and disachs. |
|
AST
ALT Amylase |
Viral Hepatitis: ALT>AST
Alco Hepatitis: AST>ALT MI: AST Amylae: Acute Pancreatitis + Mumps |
|
Hepatolenticular degenetion
|
wilson dz
basal gang degen cirrhosis choreiform mvmt dementia Tx with penicillamine AR |
|
Tx for Wilsons
|
Penicillamine
AR |
|
Micronodular cirrohsis
|
Alcoholic hepatitis
Hematchromatosis Wilsons dz |
|
Macronodular cirrhosis
|
Post necrotic post hepatic
HBV HCV |
|
Jaundice
Hepatocellular Obstructive Hemolytic |
Hepatic: conjug/unconj hyperbilirubinemia, incr urine bili, nl/decr urine urobilinogen
Obstructive: conjug hyperbili, incr urine bili, decr urine urobili Hemolytic: unconj bilirubinemia, absent urine bili, incr urine urobili |
|
Gilberts vs Crigler Najjar vs Dubin Johnson
|
Gilberts: decr UDP glucuronyl transferase, unconjugated bilirubin
Crigler Najjar: absent UDP glucuronyl transferasae, incr unconjugated bili Dubin Johnson: incr conjugated bili. due def excretion |
|
Charcot triad of cholgitis
|
1. Jaundice
2. Fever 3. RUQ pain |
|
Beading on ERCP
|
primary sclerosing cholangitis
intra/extra hepatic inflamm of bile ducts alternating strictures and dilation -> beading Can lead to 2' biliary cirrhosis. |
|
incr serum antimitocondrial antibodies
|
Intrahepatic, primary autoimmune biliary cirrhosis,
severe obstructive Jaundice Incr alk Phos pruritis, hypercholesterolema |
|
alpha FP
|
Hepatoma (hepatocellular carcinoma)
HBV,HCV Alfatoxin alpha1 antitrypsin def, wilson dz hemachromatosis. |
|
Reye Syndrome
|
Hepatoencephaly
Microvesicular fatty liver following viral infection with asa. hypoglycemia |
|
Cholesterol gallstones
|
radiolucent
ass with obesity crohns native americans CF advanced age clofibrate rapid weight loss multiparity |
|
Acute pancreatitis
|
Gallstones
Ethanol Trauma Steroids Mumps AI dz Scorpion sting eDrugs (sulfa, didanosine) |
|
H. Pylori triad
|
Amoxicillin/tetracycline/metronidazole
Omeprazole Bismuth Subsalicylate |
|
Enterochromafin cell
|
Histamine rls
Potentiated by M1 Gastrin Inhibited by Somatostatin |
|
Misoprostol
4 functions |
PGE1 analog
1. Used in Peptic ulcer therapy to incr mucus protection 2. Keeps PDA 3. Labor induction 4. Abortifacient |
|
Muscarinic Antags gastric
|
Pyrenzipine, propantheline
1. Block M3 on ECL - decr HIS secr 2. Block M1 on parietal cell - decr H+ |
|
Infliximab
|
Anti TNF alpha antibody
Crohns + RA |
|
Antacid overuse
|
Can all cause hypokalemia
1. AlO3 - constipation, hypophosphatemia 2. MgOH - diarrhea 3. CaCO3 - hypercalcemia, rebound acid incr |
|
Annular pancreas
|
leads to obstruction of the duodenum
|
|
Most common benign tumor of stomach
|
leiomyoma
|
|
Dumping Syndrome
|
Postvagotomy
Unimpeded passage of hypertonic food into duodenum leading to distention as a result of osmotic flow into lumen Sweating, lightheadedness, reactive hypoglycemia |
|
Bowel obstruction
small intestine large intestin |
Small intestine- adhesions
Large - neoplasms |
|
Most common cause of lower GI bleed
|
diverticulosis
|
|
Shigella
|
Bloody diarrhea
bismuth, ampicillin, cipro, TMP/SMX high infectivity |
|
Salmonella
|
Bloody diarrhea
Supportive therapy |
|
Campylobacter Jejuni
|
Bloody diarrhea
supportive therapy erthromycin LEADING CAUSE OF FOOD POISONING |
|
C-diff
|
Watery diarrhea
Exotoxin mediated pseudomembranes Metronidazole, oral Vancomycin |
|
ETEC
|
Watery diarrhea
bismuth, TMP/SMX, Doxycycline, cipro |
|
EHEC
|
Bloody diarrhea
supportive therapy |
|
Yersinia
|
bloody diarrhea
supportive |
|
Gastroenteritis
|
#1 Rotovirus
most common cause of diarrhea in children #2 Adenovirus |
|
Entamoeba histolytica
|
bloody diarrhea
metronidazole |
|
Giardia
|
foul smelling watery diarrhea
metronidazole |
|
Cyptosporidium
|
watery diarrhea
supportive therapy |
|
Portal Triad
|
Portal Vein
Hepatic artery common hepatic duct |
|
Galactosemia
|
Galactose 1 phosphate uridyl transferase
Cataracts cirrhosis MR |
|
PKU
|
phenyalanine hydroxylase
musty odor cerebral myelin degen MR |
|
MSUD
|
branched chain alpha ketoacid DH
Can't metabolize Leucine, Isoleucine, Valine Neurolgic sx High mortality |
|
HBV
dx |
Window period:
Detectable HBcAg-Ab Undetectable HBsAg or HBsAG-Ab HBsAB: means recovery and immunity |
|
Hepatitis jaundice
|
20-50% direct/total bili ratio
hepatic damage-> leaky bile ducts -> rls of Conjugated Bili to blood Inability of liver to conjugate bili -> unconjugated bilirubinemia |
|
Parasitic Cholangitis
|
Roundworm: Ascaris Lumbricoides
Liver flukes: clonorchis sinensis, fasciola hepatica Biiary tract obstruction -> jaundice and extreme itching, dark urine, pale feces |
|
Appetite supressor drug
|
Sibutramine
MAOi inhibits seratonin and NE breakdown |
|
Family of HBV, HCV, HAV, HEV
|
HBV- hepadnavirus - dsDNA enveloped
HCV - flavivirus - enveloped RNA virus HEV - calcivirus -naked capsid RNA HAV - picornavirus |
|
Phenylenediamine
|
Test oxidase
For Campylobacter, neisseria, helicobacter, vibrio - all positive Enterobacteriacease (all oxidase negative) Flood colonies with pd and if it turns black they are oxidase + |
|
Fibrin production test
|
test for coagulase production
S. Aureus and Yersinia pestis |
|
Lecithinase Test
|
Naglars Reaction
distinguish Clostridium perfringins from others that also cause myonecrosis |
|
Biggest SE of HBV tx
|
interferon
Depression |
|
Urease positive organisms
|
H. Pylori, Proteus, nocardia, cryptococcus, ureaplasma
|
|
Retropharyngeal space
|
The retropharyngeal space is located immediately posterior to the nasopharynx, oropharynx, hypopharynx, larynx, and trachea. The visceral (ie, buccopharyngeal) fascia, which surrounds the pharynx, trachea, esophagus, and thyroid, forms the anterior border of the retropharyngeal space. Bounded posteriorly by the alar fascia, the retropharyngeal space is bounded laterally by the carotid sheaths and parapharyngeal spaces. It extends superiorly to the base of the skull and inferiorly to the mediastinum at the level of the tracheal bifurcation (see anatomy figure in Image 1).
Two other potential spaces (ie, danger space, prevertebral space) also are present. The danger space is formed anteriorly by the alar fascia and posteriorly by the prevertebral fascia. The prevertebral space is bounded anteriorly by the prevertebral fascia and posteriorly by the longus colli muscles of the spine. The danger space extends down the mediastinum to the level of the diaphragm, while the prevertebral space continues to the insertion of the psoas muscles. |
|
Chewing muscles
temporalis medial and lateral pterygoid mylohyoid digastric |
Temporalis: posterior mvmt of jaw
Lateral pterygoid: moves lower jaw fwd Medial pterygoid: elevates jaw mylohyoid: depress jaw Digastric: depress jaw |
|
free edge of lesser omentum has what stx
|
portal vein, hepatic artery, common bile duct
|
|
What protein in CM activates LPL
|
endoth brush border LPL is activated by APO CII
without it you would have chylomicronemia - |
|
APO AI
|
major apo prot in HDL
|
|
APO B48
|
found uniquely in CM
prot that initally combines TG, phosphlipids, chol esters for CM formation |
|
APO B100
|
VLDL, IDL, LDL
is the stx for putting on TG, phospholipids, chol, chol esters etc |
|
APO E
|
all lipoproteins
helps lipoproteins bind cell surface rec. |
|
Anti microsomal abs
Antimitochondrial abs |
Hashimotos thyroiditis
primary biliary cirrhosis |
|
Hemochromatosis
labs |
AR
incr serum ferritin incr iron decr TIBC |
|
Drug of choice for Crohns flare ups
|
prednisone
|
|
Megestrol
|
progesterone derivative
that stimulates appetite |
|
tegaserod
|
5-HT4 partial agonist
used to stim peristalsis with constipation predominant IBS |
|
dronabinol
|
cannabinoid
antiemetic to control nausea induced by chemotherapy |
|
Meclizine
|
H1 antagonist
for motion sickness and true vertigo |
|
Docusate
|
stool softener
detergent that allows water and fat to mix. prevents constipation |
|
Bicasodyl
|
irritant laxatives
castor oil senna |
|
glycerin
|
lubricating laxatives
mineral oi |
|
Octatreotide
|
somatostatin analogue
for variceal bleeding for diarrhea in endocrine d/o like carcinoid, gastrinoma, glucagonoma |