Exam #4 CLINICAL CASES Flashcards
(34 cards)
What condition involves LES fails to relax (possibly due to myenteric plexus degeneration)?
Achalasia
What condition involves loss of LES tone?
Reflux Esophagitis
MOA of Atropine? Action of Atropine?
Inhibits ACh binding to parietal cell
- Inhibits HCl secretion
MOA of Cimetidine? Action of Cimetidine?
Inhibits histamine binding from H2 receptor
- Inhibits HCl secretion
MOA of Omeprazole? Action of Omeprazole?
Inhibits the H/K pump directly = proton pump inhibitor
- Inhibits HCl secretion
What condition involves excess acid secretion +/- GMB damage?
Peptic Ulcer Disease
What is a possible bacterial cause of Peptic Ulcer Disease? What is another possible cause?
H. pylori
- Also NSAIDs
What are four potential treatments for Peptic Ulcer Disease?
- H2 blockers
- Omeprazole
- Pepto-Bismol
- Abx if H. pylori
With vomiting, what two structures are contracted and which four are relaxed?
CONTRACTED: diaphragm and abdominal muscles
- Diaphragm contracted, abdominal muscles contract = increases intraabdominal pressure
RELAXED: stomach, esophagus, LES, UES
- Stomach, esophagus, LES relax so stomach is squeezed between diaphragm and viscera → UES relaxes, vomit projected into mouth (glottis closed to prevent aspiration)
What is the primary component of gallstones? What three things increase the formation of gallstones?
Cholesterol
Gallstone formation increased with…
- Bile stasis (poor turnover)
- Supersaturation of cholesterol in bile
- Nucleating factors (composition)
What can initiate gallstone formation via beta-glucuronidase?
E. coli
What symptom do Carb Digestion/Absorption Disorders cause? What is often the cause?
Osmotic diarrhea due to unabsorbed carbs as a result of enzyme deficiency
What symptom does Lactase Deficiency cause?
Osmotic diarrhea due to unabsorbed lactose
What enzyme is low with Pancreatic Insufficiency (CF), and what does this result in?
Low trypsin = decreased protein absorption
- Causes malabsorption
What is Hartnup Disease? What part of protein digestion is NORMAL with this disorder?
Congenital defect in transport of neutral AAs
- Dipeptide/tripeptide transport normal
What is Cystinuria? What does this result in?
NO transporter for dibasic AAs (cystine, lysine, arginine) in gut/kidney
- Results in AAs lost in urine
What is Whipple’s Disease, and what does it mean for lipids?
Abnormal absorption
- Lipids digested but NOT transported
Diarrhea results in what lab abnormality and acid-base disorder?
- Metabolic acidosis
- Hypokalemia
What condition involves increased cAMP stimulates Cl- secretion → Na+ and water follow Cl- into lumen and this causes osmotic diarrhea?
Secretory Diarrhea = Cholera
What condition involves gastrinoma = increased gastrin secretion?
Zollinger-Ellison Syndrome (ZES)
What condition involves gastrin secretion NOT regulated by feedback = always secreted?
Zollinger-Ellison Syndrome (ZES)
What two symptoms are seen with Zollinger-Ellison Syndrome (ZES)?
- Oily diarrhea/steatorrhea
- Gastric ulcers
What two tests can be used to evaluate for Zollinger-Ellison Syndrome (ZES)?
- Secretin Stimulation Test
- Pentagastrin Stimulation Test
What condition involves the Secretin Stimulation Test, and how does this work?
Zollinger-Ellison Syndrome (ZES)
- Secretin stimulates gastrin release from gastrinoma cells so if ZES and given secretin → gastrin increases
- IF no ZES, gastrin is low/unchanged