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Flashcards in Gastrointestinal III Deck (116):
1

Border between the duodenum and jejunem:

Duodenojejunal flexure

2

How long is the duodenum?
Jejunem?
Ileum?

10-12 inches
8 feet
12 feet

3

What are the 3 surface levels of the small intestine?

Plicae curculares (macrovilli)
Villi
Microvilli

4

What is at the bottom of a villus?

Crypt of Liberkuhn

5

What type of cell is generally found on the surface of the vili?
What's found on their surface?

Surface absorptive cells

Brush border enzymes

6

Name 4 cell types in a Crypt of Liberkuhn.

Goblet
Enteroendocrine
Regenerative
Paneth

7

What does an enteroendocrine cell secrete?
(3 things)

CCK
Secretin
GIP

8

What do Paneth cells secrete?

Lysozyme

(and other bacterial agents)

9

What morphological cell type is found in the intestine?

Columnar epithelial

10

T/F
Enzymes in the stomach can break down carbs

False

11

3 disaccharides:

Sucrose
Lactose
Maltose

12

What degrades polysaccharides into disaccharides and oligosaccharides?

Pancreatic amylase

13

How are glucose and galactose absorbed in the gut?
What type of transport is this?

SGLT-1 cotransporter (w/ Na+)

Secondary active transport
(this goes against conc. gradient)

14

How does Fructose enter the intestinal cell?
What type of transport is this?

GLUT5

Facilitated diffusion

15

Once in the enterocyte, how do monosaccharides exit to the capillaries?

What type of transport is this?

GLUT2

Facilitated diffusion

16

What does SGLT1 require?

Na+ cotransporter
(enters with - goes same direction as glc/galactose)

17

What is absent is Lactose Intolerance?

Lactase

*leads to fermentation

18

How does the stomach break down proteins?

Incompletely denatures with Pepsin
(not broken down into single AA's)

19

Where does protein break down into individual AA's?

What does this? (2 things)

Brush border

Aminopeptidases and Proteases

*proteases = active pancreatic enzymes

20

Name 3 secondary brush border enzymes that break down protein?

Amino-oligopeptidase
Aminopeptidase
Dipeptidyl aminopeptidase

21

How are single AA's and small peptides transported into the enterocyte?
(2 ways)

SGLT1
(with Na+)

GLUT5 Facilitated diffusion
(same as Frc)

22

What is the 1st step a Fat Globule goes through once in the duodenum?

Emulsification
(by bile acids)

23

What 2 things coat an emulsification droplet?

Lecithin (phospholipid)
Bile acids

24

What breaks down an emulsification droplet into 2 FFA's and a monoglyceride?

Pancreatic Lipase
Colipase

25

What do FFA's and Monoglycerides combine with to form micelles?
What coats the micelle?

Cholesterol
Fat soluble vitamins (ADEK)

Bile acids coat

26

Once the Micelle enters enterocyte, how are they repackaged into Chylomicrons?
(4 ingredients)

FFA's and monoclycerides re-form triglycerides

phospholipids
cholesterol
protein shell

27

What is a lacteal?

Lymphatic capillary opening

28

How are chylomicrons secreted into lacteals?

Golgi packages and exocytosis

29

How does all fat enter the bloodsteam?

Thoracic duct

(juncture subclavian and jugular veins)

30

How long does it take after eating a fatty meal for fat to travel through lymph and enter blood?

What is this called?

Within an hour

Lipemia

31

What is the half-life of a chylomicron?

Less than 60 minutes

32

Where are chylomicrons removed from the blood?

Adipose
Liver

33

What do adipose and liver contain large quantities of that allows for fat absorption?

Lipoprotein Lipase

34

What does Lipoprotein Lipase do to a chylomicron?

Hydrolyzes Triglycerides into FA's and glycerol

35

What are the 5 classes of lipoproteins?

Chylomicrons
VLDL
IDL
LDL
HDL

36

What does the "density" refer to in categorizing lipoproteins?

Protein coat

37

VLDL, IDL, LHL, and HDL are sythesized by the...

Liver

38

What type of lipoprotein contains low levels of TG's and high cholesterol and phospholipid?

LDL

39

What type of lipoprotein contains high TG's and moderate cholesterol and phospholipids?

VLDL

40

What are the only lipoproteins generally monitored?

LDL and HDL

41

How do Statins work?

HMG CoA Reductase inhibitors

42

All statin drugs end in...

statin

43

What is an adverse effect of statins?

Myopathy

44

What statin side effect refers to muscle pain or weakness without increased creatine kinase?

Myalgia

45

What statin side effect entails:
muscle pain/weakness
no increase creatine kinase
elevated CK

Myositis

46

What entails:
very high CK
increased creatinine
dark urine
myoglobunuria

Rhabdomyolysis

47

What is the prevalence of muscle complaints while taking statins?

1 in 10

48

7 risk factors for statin myopathy:

Age
Small size
High dose
Liver/renal disease
Diabetes
Hypothyroidism
other meds

49

What is the function of high dose Nicotinic Acid/Vita B3/Niacin?

Lowers lipid levels

50

What are the 3 preparations of Niacin used to lower lipid levels?

Immediate release
Sustained release
No-flush (inositol hexaniacinate; nicinamide)

51

Niacor is a _____ Niacin.

Immediate release

52

Niaspan and slo-niacin are _____ Niacins

Sustained/extended release

53

What is the most potent agent for raising HDL levels?

Niacin

54

T/F
The exact mechanism of Niacin's lowering lipid levels is poorly understood

True

55

By how much does Niacin Lower LDL and increase HDL?
Reduce TG's?

LDL - reduce 5-25%
HDL - increase 15-35%
TG's - 20-50%

56

What percentage of population is intolerant to Niacin?

This is mediated by?

50-60%

Prostaglandin

57

What blunts the Niacin flushing effect?

NSAID 30 minutes prior

58

Name 3 Bile Acid Binding Resins:

Colestipol
Cholestyramine
Colesevalam

59

What 2 effects to Bile Acid binding resins have in the small intestine?

Decreased emulsification
Bile acid reabsorption prevention

*liver increases production because of latter

60

T/F
Resins have little effect on HDL/TG's in blood

True

61

By how much can Resins decrease Plasma HDL?

30% with max dose

62

6 side effects of Bile Acid binding resins:

Constipation
Bloating
Flatulence
Nausea
Vomiting
Dyspepsia (indigestion)

63

What can relieve resin side effect symptoms?

Increased dietary/supplemental fiber

64

7 drugs/substances Bile Acid binding Resins bind:

ADEK
Folate
Thiazides
Tetracyclines
Warfarin
Propanolol
Penicillin

65

How can drug-drug interactions be reduced when using Resins?

Stagger time
(take hours after taking medications0

66

Water absorption in the gut is ______ to solute movement.

Secondary

67

How is K+ absorbed?

Passively via solvent drag

68

What is the active form of Vitamin D that is responsible for Calcium absorption?
What does it do?

1,25 dihydroxycholecalciferol

Stimulated enterocyte Calbindins

69

How are fat soluble vitamins absorbed?

Similar to fat

70

How are most water soluble vitamins absorbed?

Simple diffusion

71

What absorbs IF-Vitamin B12 complexes?

Ileal cells

72

How much time does chyme spend in the small intestine?

3-5 hours

73

How are peristalsis and segmentation controlled?
What inhibits?
What excites?

Autonomic
Sympathetic
Parasympathetic

74

The Vagus nerve regulates what in the intestine?
in pancreas?

Parasympathetic segmentation/peristalsis

Secretion pancreatic enzymes

75

What are the longitudinal bands of the large intestine called?

Teniae coli

76

What are the outpouchings of the large intestine called?

Haustra

77

What exists between the Teniae coli?

Haustra

78

Where is the appendix?

Cecum

79

T/F
Large intestine lack villi on the mucosa.

True

80

What 4 cells exist in the Crypts of Lieberkuhn of the Large Intestine?

Absorptive
Goblet
Endocrine
Regenerative

81

Histologically, the luminal surface of the Large intestine is....

Flat

82

How many different species of bacteria live in the Large intestine?

500

83

What accounts for the slightly acidic nature of stool?

Organic acids produced by bacterial fermentation in Large intestine

84

T/F
Many normal intestinal flora have a low pH optimum, while many pathogens favor neutral environments.

True

85

T/F
Bile salts and certain drugs are metabolized in the Large intestine

True

86

T/F
Vitamin K, B12, and folic acid are all made by intestinal flora.

True

87

4 Mechanisms producing diarrhea:

Increased osmotic load
Increased secretion
Inflammation
Decreased absorption time

88

What causes osmotic diarrhea?

Unabsorbable substances

*think lactose intolerance

89

What type of diarrhea does Cholera produce?

Secretory

90

What type of diarrhea includes mucosal diseases?

Exudative

91

T/F
Parkinson's, MS, hypothyroidism, diabetic neuropathy can all cause constipation

True

92

T/F
Calcium channel blockers, opiates, anti-cholinergics, diuretics, Fe supplements, aluminum antacids all cause constipation.

True

93

T/F
There are no structural or biochemical abnormalities in IBS

True

94

What is the proposed cause of IBS?

Dysregulation of intestinal motor/sensory functions modulated by CNS

*also stress a factor

95

What bowel disease can manifest in the mouth?
What does not?

Crohn's
Ulcerative colitis

96

2 Inflammatory bowel diseases:

Crohn's
Ulcerative colitis

97

T/F
Both Crohn's and Ulcerative Colitis have a causative agent

False

98

Where does Ulcerative Colitis usually occur?

Colon only

99

Where does Crohn's disease usually occur?

Ileum and Colon

100

In Crohn's disease, the bowel wall appears thick but the inflammation is _____
In Ulcerative colitis the bowel wall appears thin but the inflammation is _____

Transmural

Limited to mucosa/submucosa

101

What condition results from high intraluminal pressure on weak areas of the bowel wall?

Diverticulosis

*refers to bumps on the outer colon

102

In Diverticulosis, the _____ layer herniates through the _____ layer.

mucosal

muscularis

103

When diverticulosis becomes inflamed:

Diverticulitis

104

What is associated with complaints of pain in the LLQ?
(also nausea, vomiting, tenderness, fever, elevated WBC)

Diverticulitis

105

What defining characteristic does acute appendicites have?

Rebound tenderness

106

Name 4 mechanical intestinal obstructions:

Herniation
Adhesion
Volvulus
Intussusception

107

What is associated with the Valsalva maneuver?

Defecation

(glottis voluntarily closes, abs and diaphragm contract)

108

T/F
Peptic ulcers, esophageal varices, hemorrhoids, blood clotting disorders all can cause GI tract bleeding

True

109

What refers to blood in the vomit?

Hematemesis

110

What type of odorous stools originate from bleeding high in the GI tract?

Melena

111

4 Predisposing factors for Adenocarcinoma of the Colon and Rectum:

Polyps
Long-standing UC
Genetic factors
Low fiber, high animal fat diet

112

T/F
Taking Niacin at night can reduce negative side effects

True

113

T/F
Increased dental caries is associated with Crohn's

True

114

T/F
The ulcerations associated with Colitis can be expressed on the face during a flare up.
Also, oral lesions pop up during symptomatic phase

True

115

T/F
GERD leads to caries.

False

*although demineralization does

116

T/F
Chronic liver disease can lead to dearth of clotting factors that manifest as petechia in the mouth. It can also present as jaundice. Hep B is major factor.

False

Hep C is the major factor worldwide

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