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86 Cards in this Set
- Front
- Back
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Intrinsic factor is secreted by what stomach cell? |
Parietal cells
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What is the function of Intrinsic factor ? |
Vitamin B12 binding protein (required for b12 uptake in terminal ileum) |
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Auntoinmune destruction of parietal cell produces |
Chronic gastritis Pernicious anemia |
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Gastric acid is secreted by what stomach cell? |
Parietal cells |
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What is the function of Gastric acid? |
Decrease stomach PH |
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What substances increase gastric acid secretion? |
somatostatin, GIP, prostaglandin, secretin |
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Gastrin-secreting tumor that causes high levels of acid secretion and ulcers refractory to medical therapy |
Gastrinoma |
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Pepsin is secreted by what stomach cell? |
Chief cells |
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What is the function of Pepsin? |
Protein digestion |
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Increased by vagal stimulation and local acid |
Pepsin |
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Hco3 is secreted by what stomach cell? |
Mucosal cells (stomach , duodenum, salivary glands, pancreas) and Brunner glands |
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What is the function of HCO3 ? |
Neutralizes acid |
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Increased by pancreatic and biliary secretions with secretin |
HCO3 |
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What drugs can stimulated stomach G cells ? |
Phenylalanine Tryptophan CA+
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What drug block vagal stimulation of parietal cells ? |
Atropina |
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What drugs can inhibit H2 receptors in Parietal cells ? |
H2 blockrs -cimetidin -ranitidine -famotidin |
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Located in duodenal submucosa, secrete salkaline mucus, hypertrophy seen in peptic ulcer disease, neutralizes gastric acid |
Brunner glands |
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What is the function of omeprazol ? |
Is a proton pump inhibitors |
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What are the prekinetic agents ? |
Increases in ACH,5-HT and decrease D2
-Bethamechol -Neostigmine -Metroclopramide -Macrolides
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Gastrin-secreting tumor of pancreas or duodenum, can causes recurrent ulcers in distal duodenum and jejumun, may be associated with MEN 1 |
Zollinger-Ellison syndrome |
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What are the clinical presentation of Zolliger-Ellison syndrome ? |
Abdominal pain (peptic ulcer disease, distal ulcers) Diarrhea (malabsorption) |
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Acute gastritis can by caused by |
-Stress -NSAIDS -Alcohol -Burns (curling ulcer) -Brain injury (cushing ulcer)
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Disruption of mucosal barrier, inflammation can be caused by dicrease in gastric mucosa protection |
Acute gastritis |
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Autoimmune disorder characterized by Auntoantibodies to parietal cell |
Chronic gastritis Type A (fundus/body) |
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Most common type of gastritis caused by H.pylori infection |
Chronic gastritis Type B (antrum)
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Chronic gastritis type B can increases risk of |
MALT lymphoma and Gastric adenocarcinoma |
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Causes gastric hypertrophy with protein loss, parietal cell atrophya, increased mucous cells and increased risk of gastric adenocarcinoma |
Menetrier disease |
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Decreases mucosal protection against gastric acid, pain is greater with meals, 70% is caused by H.pylori infection, others causes NSAIDs, increased risk of carcinoma |
Gastric ulcer |
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Decreases mucosal protection or increases gastric acid secretion, pain decreases with meals, 100% is caused by H.pylori infection, other cause zollinger-ellison syndrome, generally bening |
Duodenal ulcer |
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What are the ulcer complications? |
-Hemorrhage -Perforation |
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A ruptured gastric ulcer on the lesser curvature of the stomach bleeds from which artery? |
Left gastric artery |
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A ruptured ulcer on the posterior wall of the duodenum bleeds from which artery? |
Gastroduodenal artery |
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What ulcer complication shows free air under diaphragm on chest radiograph? |
Perforation |
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What is the treatment for ulcer hemorrhage? |
Somatostatin (octeotride) |
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What drugs are used in the triple therapy for H.pylori infection? |
-Proton pump inhibitor -Clarithromycin -Amoxicillin or Metronidazole |
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What drugs are used in the quadruple therapy for H.pylori infection? |
-Bismuth -Metronidazole -PPI -Tetracycline |
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Can affect absorption, bioavailability, or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying |
Antacid use |
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What are the SE of aluminum hydroxide? |
Constipation and hypophosphatemia; proximal muscle weakness, osteodystrophy, seizures |
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What are the SE of calcium carbonate? |
-Hypercalcemia, rebound acid increase -Stimulates G cells to produce gastrin |
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What are the SE of magnesium hydroxide? |
-Diarrhea -Hyporeflexia -Hypotension -Cardiac arrest |
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In what moths of life congenial pyloric stenosis is most commoly? |
1st month |
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Hypertrophy of the pylorus causes obstruction, palpable "olive" mass in epigastric region,impaired stomach emptying, nonbilious projectile vomitin, metabolic alkalosis, hypochloremia, hypokalemia |
Cogenital pyloric stenosis |
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What is the treatment of congenital pyloric stenosis? |
Surgical incision |
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Fibrous band of scar tissue commonly forms after surgery, most common cause of small bowel obstruction |
Adhesion |
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Unexplained GI bleeding, anime, Tortuous dilation of vessels, hematochezia, most often fund in cecum, terminal ileum and ascending colon |
Angiodysplasia |
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Angiodysplasia can be confirmed by |
-Colonoscopy -Angiography |
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Causes early bilious vomiting with proximal stomach distention (double bubble on X-ray) associated with Down syndrome |
Duodenal atresia |
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Reduction in intestinal blood flow causes ischemia, pain after eating, wight loss, commonly occurs at splenic flexure and distal colon, affect elderly |
Ischemic colitis |
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Patient with jaundice comes in and you want to examine biliary tree and pancreatic duct. What procedure would you do? |
ERCP
Endoscope retrograde cholangio-pancreatogram
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Endoscope retrograde cholangio-pancreatogram may cause reversal flow and can cause? |
Pancreatitis |
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Gallstones that reach the common channel at ampulla of vater can block |
The bile duct The pancreatic duct |
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Tumors that arise in the head of the pancreas can cause obstruction of |
Common bile duct |
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Secreted by I cell (duodenum, jejunum) |
Cholecystokinin |
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Gastric hormone that increases pancreatic secretion, gallbladder contraction, sphincter of Oddi relaxation, secretion of bicarbonato and decrease gastric emptying |
Cholecystokinin |
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Cholecystokinin is regulated by |
Cholecystokinin increase by fatty acids and amino acids |
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Acts on neural muscarinic pathways to cause pancreatic secretion |
Cholecystokinin |
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Secreted by K cells (duodenum,jejunum) |
Glucose-dependent insulinotropic peptide (GIP) |
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Gastric hormone that decrease gastric H+ secretion and increase insulin release |
Glucose-dependent insulinotropic peptide (GIP) |
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Glucose-dependent insulinotropic peptide (GIP) is regulated by |
Increase by fatty acids, amino acids and oral glucose |
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Secreted by small intestine |
Motilin |
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Produces migrating motor complexs, increases smooth muscle contraction, esophageal sphincter, stomach, duodenum |
Motilin |
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Secreted by S cells (duodenum) |
Secretin |
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Increases pancreatic HCO3- secretion, bile secretion, decrease gastric acid secretion and inhibit parietal cell of stomach |
Secretin |
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Secretin is regulated by |
acid, fatty acids in lumen of duodenum |
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Secreted by D cells (pancreatic islets, GI mucosa) |
Somatostatin |
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Decreases gastric acid and pepsinogen secretion, pancreatic and small intestine fluid secretion, gallblader contraction, and insulin and glucagon release |
Somatostatin |
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Somatostatin is regulated by |
Somatostatin increase by acid and decrease by vagal stimulation |
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What hormones are inhibit by somatostatin ? |
-Gastrin -CCK -Secretin -GIP -VIP -Insulin -Glucagon |
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Secreted by parasympathetic ganglia in sphincters, gallbladder, small intestine |
Vasoactive intestinal polypeptide (VIP) |
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Increases intestinal water and electolyte secretion, relaxation of intestinal smooth muscle and sphincters, inhibit gastric acid and relaxes lower esophageal |
Vasoactive intestinal polypeptide (VIP) |
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Vasoactive intestinal polypeptide (VIP) is regulated by |
Vasoactive intestinal polypeptide (VIP) increase in distention and vagal stimulation and decrease by adrenergic input |
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Non-alfa, non-beta inlet cell pancreatic tumor that secretes VIP. present with watery diarrhea, hypokalemia, and achlorhydria |
VIPoma |
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Located in duodenal submucosa, secrete alkaline mucus, hypetrophy seen in peptic ulcer disease, neutralizes the gastric acid |
Brunner glands |
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What ligament connect liver to anterior abdominal wall ? |
Falciform ligament |
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What ligament connect liver to duodenum? |
Hepatoduodenal |
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What ligament connect liver to lesser curvature of stomach? |
Gastrohepatic |
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What ligament connect greater curvature and transverse colon? |
Gastrocolic |
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What ligament connect greater curvature and spleen? |
Gastrosplenic |
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What ligament connect spleen to posterior abdominal wall? |
Splenorenal |
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What structures are contained in the falciform ligament? |
Ligamentum teres hepatis (devivative of fetal umbilical vein) |
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What structures are contained in the hepatoduodenal ligament ? |
Portal triad: -Proper hepatic artery -Portal vein -Common bile duct
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What structures are contained in the gastrohepatic ligament ? |
Gastric arteries |
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What structures are contained in the gastrocolic ligament ? |
Short gastric, left gastroepiploic vessels |
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What structures are contained in the splenorenal ligament ? |
-Splenic artery and vein -Tail of pancreas |
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What are the retroperitoneal structures ? |
SAD PUCKER -Suprarenal glands -Aorta and IVC -Duodenum (2nd through 4th parts) -Pancreas (except tail) -Ureters -Colon (descending and ascending) -Kidneys -Esophagus (lower 2/3) -Rectum (partially) |
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What substances decrease gastric acid secretion? |
somatostatin, GIP, prostaglandin, secretin |
