Gastrointestinal II Flashcards
(136 cards)
1
Q
What are the 2 functions/divisions of the pancreas?
A
Endocrine
Exocrine
2
Q
What 2 hormones make up the Endocrine Pancreas?
A
Insulin
Glucagon
3
Q
What does the Exocrine pancreas produce?
A
Pancreatic Juice
4
Q
What makes up pancreatic juice?
A
Bicarb (neutralizes gastric acid)
Digestive enzymes
5
Q
What is pale in a pancreatic slide?
A
Islets, alpha cells (insulin and glucagon)
6
Q
What is darker in a pancreatic slide?
A
Exocrine cells
*90%
7
Q
What is the pH of pancreatic juice?
A
7.6-8.2
8
Q
How does pancreatic juice exit the pancreas into the duodenum?
A
Main Pancreatic Duct
9
Q
How much pancreatic juice is secreted each day?
A
1500 mL
10
Q
What is the pH of duodenal contents after exposure to pancreatic juice?
A
6.0-7.0
11
Q
What are the 3 control points for Bile and Exocrine secretions from the Pancreas?
A
Bile duct sphincter
Pancreatic duct sphincter
Sphincter of Oddi
12
Q
T/F
Sphincter of Oddi controls release of bile and pancreatic juice.
A
True
13
Q
What is the opening of bile/pancreatic juice into the duodenum?
A
Papilla of Vater
14
Q
Pancreatic juice enzymes that break down carbs and lipids include:
A
Pancreatic amylase
Pancreatic lipase
Colipase
15
Q
4 Proteases in Pancreatic juice.
A
Trypsinogen
Chymotrypsinogen
Procarboxypeptidase (A/B)
Proelastase
16
Q
2 enzymes in pancreatic juice that break down nucleic acids:
A
Ribonuclease
Deoxyribonuclease
17
Q
What catalyzes Trypsinogen > Trypsin?
A
Enterokinase
aka enteropeptidase
18
Q
Where is enterokinase found?
Function?
A
Brush border (enzyme) Trypsinogen > Trypsin
19
Q
What enzyme converts chymotrypsinogen, proelastase, and procarboxypeptidase (A/) into its active forms?
A
Trypsin
*via Enterokinase
20
Q
What congenital abnormality can lead to protein malnutrition?
A
Enterokinase deficiency
21
Q
As a protective measure, what does pancreatic tissue contain?
A
Trypsin inhibitors
22
Q
2 hormones that stimulate pancreatic secretion:
Difference in secretion?
A
Secretin - high HCO3-, low in Enzymes
CCK - high enzyme, low HCO3-
23
Q
Aside from CCK, what is another high enzyme pancreatic stimulant?
A
Vagal parasympathetic
*reflex, much lower amount than CCK
24
Q
T/F
Small amounts of pancreatic digestive enzymes normally leak into the circulation
A
True
25
What does increased plasma pancreatic amylase and lipase indicate?
What's wrong at the level of the tissue?
Acute pancreatitis
Inflammation/necrosis pancreatic acinar cells
26
What do enzymes do in pancreatitis to pancreatic tissue?
Fat necrosis
27
What do most cases of acute pancreatitis result from?
| 2 things
Gallstones
| Alcohol abuse
28
What condition might activate pancreatic enzymes whilst still in pancreas?
Gall stones/pancreatic obstruction
| exact mechanism unknown
29
T/F
| Alcohol damage to pancreas by unknown mechanism
True
30
What 2 effects does alcohol have on the pancreas?
Stimulates secretions
| Contracts Sphincter of Oddi
31
Other than alcohol and gallstones, what is acute pancreatitis associated with?
(5 things)
```
Hyperlipidemia
Hyperparathyroidism
Infections (viral)
Trauma (abdominal/surgical)
Drugs (steroids/thiazide diuretics)
```
32
Tachycardia, hyptotension, cool and clammy skin, and fever and indicative of what?
(also hypocalcemia and jaundice)
Acute pancreatitis
33
What is the most common symptom of acute pancreatitis?
Severe epigastric and abdominal pain
| radiates to the back
34
What does "pancreatic cancer" usually refer to?
Ductal Adenocarcinoma
35
What cell does more than 95% of malignant neoplasms in the pancreas arise from?
Exocrine cells
36
What are the most common symptoms of exocrine pancreatic cancers?
Pain
Jaundice
Weight loss
37
How are cancers in the head of the pancreas different from those in the tail?
4 things
most numerous (60-70%)
jaundice
steatorrhea (fat in feces)
weight loss
38
What are 3 major risk factors for pancreatic cancer?
Smoking
High mass/low activity
Chronic pancreatitis
*also 5-10% familial risk
39
What is the most common lethal genetic disease among caucasions?
Cystic Fibrosis
40
What causes Cystic Fibrosis symptoms in cell?
| Genetic?
Cl- channel defect
| CTFR gene
41
What does the Cl- channel defect cause in Cystic Fibrosis?
Exocrine gland malfunction
* increases viscosity in mucus and Cl- concentration in sweat and tears
* *sweat test for diagnosis
42
3 Clinical manifestations of Cystic Fibrosis.
Chronic pulmonary disease
Pancreatic insufficiency
Meconium ileus
43
What is a liver lobule?
Hexagonal structure of Portal triads, Sinusoids, and Central vein
44
How many triads (tetrads) are in a liver lobule?
6
45
What 4 structures are in a triad
Portal Vein
Hepatic artery
Bile duct
Lymphatic
46
What travels from the Portal vein to the Central vein in a liver lobule?
Sinusoid
47
Where are the Hepatic macrophage?
| Another name?
Sinusoid lining
Kupffer cells
48
What runs parallel to the sinusoids?
Bile canaliculi
*drain bile produced by hepatocytes
49
What is the term for the arrangement of hepatocytes within lobules?
Hepatic cords
*sinusoids separate
50
What is unique about the liver's bloodflow?
Mixing of blood from Hepatic artery and Portal vein in the Central vein in lobes
51
Trace blood from the sinusoidal mixing:
Central vein
Hepatic vein
Inf. vena cava
Right atrium
52
What's special about the fenestrated endothelium in sinusoids?
No basement membrane
*blood washes freely over hepatocytes
53
Where does blood wash freely over hepatocytes?
| 2 names
Space of Disse
| perisinusoidal space
54
Sinusoidal blood flows in what direction?
Toward Central Vein
55
What could happen in pressure increases drastically in the portal vein and sinusoids?
Ascites
56
Because of the spaces of Disse, the liver must...
have high Lymph flow
57
What is the term for drugs entering the portal vein first?
First Pass Effect
58
Normal pathway into Bile duct:
Rt/Lt Hepatic ducts
Common Hepatic Duct
Gall bladder or Bile duct
59
What % of liver cell weight can be glycogen?
8%
*more than muscle at 1-3%, but less total glycogen
60
T/F
| Protein degradation occurs alost exclusively in the liver
True
61
```
What class of enzymes is required for deamination?
What are they (2)?
```
Aminotransferases
AST and ALT
62
Other than deamination, what can AST and ALT do?
Synthesize non-essential AA's within hepatocytes
63
What can too much ammonia in the blood cause?
Hepatic coma
| Hepatic encephalopathy
64
2 terms for too much urea in the blood.
Azotemia
Uremia
*toxic to other tissues
65
What is the normal Blood Urea Nitrogen (BUN) level?
5-26 mg/dL
66
T/F
| GI bleeding can cause Uremia
True
*due to bacteria creating nitrogenous wastes
67
4 contents in the protein coated chylomicron:
FFA
Cholesterol
Phospholipids
TG's
68
What is the important liver enzyme in endogenous cholesterol synth?
HMG-CoA reductase
69
What is the only way the body can eliminate excess cholesterol?
Bile
70
In what 2 conditions is Ketogenesis likely to occur?
Fasting
Type I diabetes
71
What hormones are degraded by the liver?
All steroid hormones
| T3 and T4
72
Name 4 steroid hormones degraded by the liver:
Cholesterol
Aldosterone
Cortisol
Progesterone
73
How is iron stored in the liver?
| Before stored is called?
Ferritin
| Apoferritin
74
How is iron taken up in the stomach?
| Transferred in the blood?
Gastroferritin
| Transferrin
75
What vitamins are stored in large quantities in the liver?
A
B12
D
76
What is the most important enzyme system for metabolism/drug detox in the liver?
Cytochrome P450
77
What happens between Phase I and Phase II in drug pathways?
Metabolism
78
What is the difference between Phase I and Phase II in drug metabolism?
Phase I - drug unchanged, modified, or inactive
Phase II - Conjugate is eliminated
79
Cytochrome P450 enzymes are denoted by...
CYP (letter, number, letter)
80
What type of enzyme is Cytochrome P450?
Phase I
81
Conjugative enzymes are what type?
Phase II
82
What do conjugative enzymes do?
| How?
Make metabolites more polar/hydrophilic
| Endogenous substrate added
83
What is the most common/important conjugation rxn?
Glucuronidation
84
What can lead to decreased metabolism of drugs?
CP 450 inhibition
85
What can increase metabolism of drugs?
CP 450 induction
86
What step of Vitamin D activation is taken in the Liver?
Cholecalciferol > 25-Hydroxycholecalciferol
*Hydroxylation
87
What are the 3 major plasma proteins?
| Where are they formed?
Albumin (liver)
Globulin (liver, lymphoid)
Fibrinogen (liver)
88
T/F
| Albumin supplies 50% buffering capacity of the blood.
False
15%
89
What blood clotting factors aren't made in the liver?
III
IV
XIII
90
What are the 4 organic constituents of Bile?
| %'s?
bile salts - 50
phospholipids - 40
cholesterol - 4
bile pigments (like bilirubin) - 2
91
Where does bile pick up electrolytes and water?
Bile duct lining secretions
92
What are the 2 primary bile acids produced by hepatocytes?
Cholic acid
| Chenodeoxycholic acid
93
What are the secondary bile acids a portion of primaries are converted into by intestinal bacteria?
Deoxycholic acid
| Lithocholic acid
94
Why is bile converted into bile salts?
Amphipathic
| both hydrophobic/hydrophilic
95
What is converted into a Bile Salt?
| with what?
Secondary bile acids
(deoxycholic acid and Lithocholic acid)
Glycine and Taurine
96
What is the most common Phospholipid in the bile?
Lecithin
| also amphipathic
97
What accounts for the majority of cholesterol breakdown in the body?
Synth bile acids
500 mg/day
98
T/F
| cholesterol is eliminated in the bile as a waste product
True
*but only some
99
What is the waste product of hemoglobin degradation?
Bilirubin
100
How is free bilirubin (Unconjugated bilirubin) transported in the blood?
Albumin
101
What does the liver do with Free Bilirubin?
Conjugates
| Excretes into bile
102
What is attached in the conjugation of Bilirubin?
| What enzyme catalyzes this rxn?
Glucuronic Acid
Glucoronyl transferase
103
What is more water soluble, conjugated or unconjugated bilirubin?
Conjugated
104
T/F
| Bile contains lipophilic drug and antigen-antibody complex waste products
True
105
What doesn't flow into the central canal?
Bile ducts
106
3 steps of Bile Synthesis:
Secretion into canaliculi
Pick up HCO3-, ions, and water
(this accounts for 900 mL/day)
1/2 bile stored in Gall Bladder btwn meals
107
By how much is Bile concentrated in the Gall Bladder?
10-20 fold
108
T/F
| Bile that reached the duodenum is a mixture between dilute and concentrated
True
from gall bladder and liver
109
What are the 2 important functions of Bile?
Alternate Excretory route (other than kidney)
| Lipid Digestion/Absorption
bile salts and Lecithin
110
What duct connects the Hepatic Duct to the Gallbladder?
Cystic Duct
111
CCK 2 actions concerning bile:
Contracts gall bladder
| Relaxes Sphincter of Oddi
112
What stimulates ion and water secretion in bile ducts?
Secretin
113
What neurotransmitter contracts Gall Bladder via Parasympathetic response?
Ach
114
What mechanism dominates during the "interdigestive" periods concerning the gall bladder?
2 functions?
SNS Beta-2
Fills gall bladder and closes sphincter of Oddi
115
What is the term for inflamed Gall bladder wall?
Cholecystitis
116
Steady severe pain URQ radiating to shoulder or back indicates what?
*also fever, leukocytosis, nausea, vomiting, anorexia
Acute cholecystitis
*gallstone disease
117
Chronic cholecystitis is almost always associated with what?
Gall stones
118
What is the most common complication associated with Cholecystitis?
Gangrene (20%) followed by Perforation (2%)
119
Presence of gallstones is called:
Cholelithiasis
120
Most gallstones in US and Europe (90%) are what type?
Cholesterol stones
121
What 3 factors are involved in gallstone formation?
Bile Stasis (from stone in gall bladder)
Supersaturation
Inflammation (cholecystitis)
122
What size gallstone usually passes?
less than 8 mm
123
What can large gallstones cause?
Jaundice
| obstructed flow
124
What increases intra-gallbladder pressure and causes RUQ pain?
(pain can radiate)
Biliary colic
125
T/F
| Oral contraceptives and rapid weight loss can cause gallstones
True
126
T/F
| Pregnancy can cause cholelithiasis
True
127
T/F
| Cholecystectomy can cause duodenal emptying to decrease
False
*common bile duct dilates, more bile after meals
128
What is the cure for Physiological Jaundice of the newborn?
Light breaks bili
129
Why would Liver disease cause osteomalacia?
No VitaD
| No Ca++
130
Bilirubin levels in Hepatic disease would be what in the blood?
Increased
| UN-bili and CON-bili
131
In liver disease, what would the Albumin and Total protein levels be in the blood?
Low
*not making
132
T/F
| Gamma-glutamyl transferase decreases in liver failure
False
133
What does Prothrombin time do in liver failure?
Increase
*no more clotting factors
134
UN-bili increases
| CON-bili same
Pre-hepatic disease
135
UN-bili increases
| CON-bili increases
Intra-hepatic disease
| Post-hepatic disease
136
What tumor can cause an increase of UN-bili and CON-bili?
Pancreatic tumor (in head)
