010715 stomach disorders 2 Flashcards Preview

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Flashcards in 010715 stomach disorders 2 Deck (23):
1

fundus

upper part of the greater curvature

2

normally, at the distal stomach, what is the motor fxn like?

baseline slow wave activity (3/min) mediated by interstitial cells of Cajal

contractions that are vagally mediated sweep in a ring towards pylorus

3

how does the pyloric sphincter react to food coming into antral ring?

it times its closure with oncoming antral ring contractions to act as a sieve for large particles

4

triturition

larger solids in the somtach at the antral ring are retropelled back by the pyloric sphincter

5

secretin is released when?

in response to entry of lipids, amino acids, or HCl into the duodenum

6

CCK is release when?

in duodenum in response to delivery of fat

7

glucose-dependent insulinotropic peptide is secreted when?

secreted in sm intestine in response to glucose delivery

also secreted in response to colonic fermentation of carbs and intraduodenal gluatmine, aminoa acids, fatty acids

8

effect of GIP

inhibitory effect on gastric motility occurs earlier than effects on insulin secretion

9

glucose's effect on gastric emptying

glucose empties at constant rate from stomach regardless of concentration

however, if blood glucose levels are high, it delays solid and liquid meal emptying from stomach

10

gastric emptying scintigraphy

nuclear medicine test to assess emptying non-invasively

detects amt retained at set points in time

11

gastric emptying scintigraphy results depend on

meal used (will determine the normal values)

12

fasting motor activity

occurs at end of meal
occurs every 90 min with fast
it's maximum strength, frequency (3/min) and coordination of contractions

to allow clearance of large indigestible solids from gut

13

consequences of accomodation failure?

limits amt that can be ingested w/o discomfort

food moves too rapidly into small bowel:
---excessive distension causes fluid to enter lumen due to osmotic gradient (results in bloating, pain, symptomatic hypotension)
---poor digestion (weight loss, nutrient deficiencies)
---unabsorbed foods get delivered to colon (colonic bacterial fermentation--increased flatus, bloating, cramps)
---initial rapid increased in blood glucose in small bowel due to lag in insulin response (hypoglycemia)
---unbuffered HCl goes to duodenum rapidly (ulcer, pain, maldigestion)

14

consequences of contraction failure

impaired triturition of solids
delayed delivery to intestine
retention of gastric contents

consequences: pain, early staiety, nausea, vomiting, poor drug delivery

15

consequences of MMC failure

bezoar formation, poor drug delivery, bacterial overgrowth

16

gastroparesis

delayed gastric emptying in the ABSENCE OF MECHANICAL OBSTRUCTION and in the presence of symptoms including early satiety, postprandial fullness, nausea, vomiting, bloating, and upper abd pain

17

causes of gastric sensory/motor dysfxn--structures intact

electrolyte disturbances (low K)-affects sm musc fxn
hyperglycemia
renal failure with uremia
hypothyroidism
mesenteric ischemia
cortical effects (motion sickness, stress)
meds

18

medication induced gastric emptying delay can be caused by what meds?

anticholinergics
opiates
NSAIDs
pramlintide
exenatide (GLP-1 receptor agnoist)
cyclosporine

19

causes of gastric motor dysfxn-motor structures are abnormal

infatile pyloric stenosis
hollow visceral myopathies
connec tissue disease (atrophy of sm musc)
gastric resection (ulcer surgery)
fundoplication wrap for reflux disease (alters accomodation)

20

causes of gastric motor dysfxn (neural structures abnormal)

Parkinson's
multiple sclerosis
amyloidosis
viral infection or autoimmune
paraneoplastic syndrome
TRAUMA/SURGICAL (VAGAL INJURY!!!!!!!!!!!!!)

21

visceral hyposensitivy

reduced ability to detect and respond to pathologic processes (greater complications-ulcer)

22

succussion splash implies

gas and fluid in an organ with obsruction

23

downstream effects of vagal injury caused by surgery/trauma

opposite effects on solids and liquids:
poor accomodation--liquids empty rapidly
poor antral grinding--solids empty slowly