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Exam #4 CLINICAL CASES Flashcards

(34 cards)

1
Q

What condition involves LES fails to relax (possibly due to myenteric plexus degeneration)?

A

Achalasia

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2
Q

What condition involves loss of LES tone?

A

Reflux Esophagitis

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3
Q

MOA of Atropine? Action of Atropine?

A

Inhibits ACh binding to parietal cell

- Inhibits HCl secretion

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4
Q

MOA of Cimetidine? Action of Cimetidine?

A

Inhibits histamine binding from H2 receptor

- Inhibits HCl secretion

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5
Q

MOA of Omeprazole? Action of Omeprazole?

A

Inhibits the H/K pump directly = proton pump inhibitor

- Inhibits HCl secretion

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6
Q

What condition involves excess acid secretion +/- GMB damage?

A

Peptic Ulcer Disease

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7
Q

What is a possible bacterial cause of Peptic Ulcer Disease? What is another possible cause?

A

H. pylori

- Also NSAIDs

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8
Q

What are four potential treatments for Peptic Ulcer Disease?

A
  • H2 blockers
  • Omeprazole
  • Pepto-Bismol
  • Abx if H. pylori
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9
Q

With vomiting, what two structures are contracted and which four are relaxed?

A

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)

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10
Q

What is the primary component of gallstones? What three things increase the formation of gallstones?

A

Cholesterol

Gallstone formation increased with…

  • Bile stasis (poor turnover)
  • Supersaturation of cholesterol in bile
  • Nucleating factors (composition)
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11
Q

What can initiate gallstone formation via beta-glucuronidase?

A

E. coli

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12
Q

What symptom do Carb Digestion/Absorption Disorders cause? What is often the cause?

A

Osmotic diarrhea due to unabsorbed carbs as a result of enzyme deficiency

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13
Q

What symptom does Lactase Deficiency cause?

A

Osmotic diarrhea due to unabsorbed lactose

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14
Q

What enzyme is low with Pancreatic Insufficiency (CF), and what does this result in?

A

Low trypsin = decreased protein absorption

- Causes malabsorption

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15
Q

What is Hartnup Disease? What part of protein digestion is NORMAL with this disorder?

A

Congenital defect in transport of neutral AAs

- Dipeptide/tripeptide transport normal

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16
Q

What is Cystinuria? What does this result in?

A

NO transporter for dibasic AAs (cystine, lysine, arginine) in gut/kidney
- Results in AAs lost in urine

17
Q

What is Whipple’s Disease, and what does it mean for lipids?

A

Abnormal absorption

- Lipids digested but NOT transported

18
Q

Diarrhea results in what lab abnormality and acid-base disorder?

A
  • Metabolic acidosis

- Hypokalemia

19
Q

What condition involves increased cAMP stimulates Cl- secretion → Na+ and water follow Cl- into lumen and this causes osmotic diarrhea?

A

Secretory Diarrhea = Cholera

20
Q

What condition involves gastrinoma = increased gastrin secretion?

A

Zollinger-Ellison Syndrome (ZES)

21
Q

What condition involves gastrin secretion NOT regulated by feedback = always secreted?

A

Zollinger-Ellison Syndrome (ZES)

22
Q

What two symptoms are seen with Zollinger-Ellison Syndrome (ZES)?

A
  • Oily diarrhea/steatorrhea

- Gastric ulcers

23
Q

What two tests can be used to evaluate for Zollinger-Ellison Syndrome (ZES)?

A
  • Secretin Stimulation Test

- Pentagastrin Stimulation Test

24
Q

What condition involves the Secretin Stimulation Test, and how does this work?

A

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
25
What condition involves the Pentagastrin Stimulation Test, and how does this work?
Zollinger-Ellison Syndrome (ZES) - If given Pentagastrin, H+ stimulates further secretion so if ZES and given pentagastrin → no effect on H+ (H+ already maximal so no effect) - IF no ZES, H+ would increases with Pentagastrin
26
What is the treatment for Zollinger-Ellison Syndrome (ZES)?
Omeprazole
27
What two symptoms are seen with an Ileal Resection?
- Oily diarrhea/steatorrhea | - Foul-smelling stools
28
What condition involves bile slats lost faster than liver can replace; lipid digestion impaired?
Ileal Resection
29
What two treatments are recommended for Ileal Resection?
- Cholestyramine | - Vitamin B12 injections
30
What are the three possible pathophysiology components involving Peptic Ulcer Disease (PUD)?
- Mucous barrier lost - High H+/high Pepsin - Combination of both
31
With Peptic Ulcer Disease (PUD) caused by H. pylori, what is the cause of gastric ulcers (3)?
- Bacteria colonization of gastric mucous/epithelial cells - Bacteria release cytotoxins - Bacteria release urease alkalinizes stomach = can survive longer
32
With Peptic Ulcer Disease (PUD) caused by H. pylori, what is the cause of duodenal ulcers?
Low somatostatin → high gastrin - Leads to high H+ AND low HCO3
33
What two tests can be used to evaluate Peptic Ulcer Disease (PUD) caused by H. pylori?
- Serology testing (H. pylori antibodies) | - 13C-urea breath test
34
What two treatments are recommended for Peptic Ulcer Disease (PUD) caused by H. pylori?
- Abx | - Omeprazole