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1

inhibits the contraction of gallbladder

somatostatin (by inhibiting CCK & secretin)

2

CCK

increases gallbladder contraction
increases pancreatic enzymes

stimulated by: fatty food

3

secretin

increases pancreatic HCO3
increases production of bile acid by hepatocytes

4

vagus nerve stimulates secretion of

CCK & secretin

5

pancreatic juice composition

- enzymatic components:
(trypsinogen, etc)

- aqueous components:
(bicarbonate, etc)

6

what activates trypsinogen? to what?

enterokinase
to Trypsin

7

acute pancreatitis

when pancreatic enzymes are activated within the pancreas

leads to no digestion of fats, malabsorption, presence of fatty food

features: severe epigastric (upper abdominal) pain, which RADIATES TO THE BACK

8

chronic pancreatitis

due to: repeated acute inflammation

trypsin is activated early, activating the other enzymes, causing autodigestion of the pancrease

features: steatorrhea

9

hepatocyte produce

bile acid (from cholesterol)

10

formation of bile salts from bile acids

liver produces: primary bile acids

sm. intestine: turns primary bile acids into secondary bile acids

liver: conjugates secondary bile acids into bile salts

11

function of bile salts

emulsification of lipids

(attaches to lipid to break it down, gets removed by co-lipase, so pancreatic lipase can bind)

12

what is absorbed in the terminal ileum?

bile salts
B12

13

bilirubin comes from where

RBCs

14

Cholelithiasis vs Choledocholithiasis

Cholelithiasis:
gallstones in the gallbladder

Choledocholithiasis:
gallstones in the bile ducts

15

cause for cholesterol gallstone formation

excess cholesterol

16

cause for pigment gallstone formation

excess calcium

17

pre-hepatic (hemolytic) jaundice

causes:
hemolytic anemias
G6PD deficiency
Rh incompatibility

pathophysiology:
- HYPERBILIRUBINEMIA (increased unconjugated)
- no bilirubin in urine
- INCREASED URINE UROBILINOGEN

18

hepatic jaundice

causes:
infection, alcoholism, cirrhosis

pathophysiology:
- HYPERBILIRUBINEMIA (increased unconjugated and conjugated)
- INCREASED BILIRUBIN IN URINE
- normal/decreased urine urobilinogen

19

post-hepatic (obstructive) jaundice

causes:
gallstone, pancreatic cancer

pathophysiology:
- HYPERBILIRUBINEMIA (increased conjugated)
- INCREASED BILIRUBIN IN URINE
- DECREASED URINE UROBILINOGEN

20

*** .A patient’s abdominal pain is subdued after eating. Which of the following is true regarding contraction of the gallbladder following a meal?

It occurs in response to cholecystokinin

21

*** A 26-year-old male presents to the emergency room with a 48-hour bout of diarrhea with steatorrhea. Which of the following best accounts for the appearance of excess fat in the stool?

Decreased bile salt pool size

22

*** A 32-year-old woman presents to the Emergency Department with abdominal pain and diarrhea accompanied by steatorrhea. Gastric analysis reveals a basal acid output (12 mmol/h) greater than normal (<5 mmol/h). The steatorrhea is most likely due to which of the following?

Inactivation of pancreatic lipase due to low duodenal pH

23

*** An 18-year-old female decides to get a tattoo for her birthday. Two months later she presents with a fever, right upper quadrant pain, nausea, vomiting, and jaundice. Which of the following lab values would most likely be found in a patient with infectious hepatitis?

An increase in both direct and indirect plasma bilirubin

24

Parietal cell secretion

HCl
Intrinsic Factor

25

Chief cell secretion

Pepsinogen

26

G cell secretion

Gastrin

27

Mucous cell secretion

Mucous
Pepsinogen

28

intrinsic factor deficiency

pernicious anemia

29

concentration of HCl inside of the stomach depends on

H+-K+ exchanger

30

Antimuscarinic agents and what it inhibits

atropine

blocks M3 on parietal cells

31

Gastrin-receptor antagonists and what it inhibits

Proglumide

blocks CCKb receptors (from Gastrin)

32

H2-R antagonists and what it inhibits

Cimetidine

blocks the action of histamine on Parietal cells

33

Inhibitors of the proton pump and what it inhibits

Omeprazole

blocks H+-K+ ATPase (blocks everything)

34

Prostaglandins E2 and what it inhibits

Misoprostol

blocks secretion of HCl

35

Mucosal protective agents and action

Sucralfate

binds to an ulcer crater, coating it and protecting it from acid and pepsin

36

Somatostatin

inhibits gastric H+ secretion
(blocks work of all enzymes)

37

secretin inhibits

G cell secretion

38

Peptic ulcer

mucosal damage or ulceration in stomach or duodenum

39

Gastric Ulcer vs Duodenal Ulcer

Gastric Ulcer
- stomach
- 1-2hr after eating
- hematemesis (vomiting blood)
- pain increases with meal

Duodenal Ulcer
- duodenum
- 2-5hr after eating
- hematochezia (bloody stool)
- pain decreases with meal

40

* Peptic Ulcer treatment

1. Antacids
- neutralizes gastric acid

2. Agents decreasing secretion of gastric acid
- Inhibitors of the proton pump(PPI)

3. Agents protecting mucosal barrier
- Prostaglandins

4. Agents eradicating helicobacter pylori
- Antimicrobial treatment

41

*** A 42-year-old salesman presents with the chief complaint of intermittent mid epigastric pain that is relieved by antacids or eating. Gastric analysis reveals that basal and maximal acid output exceed normal values. The gastric acid hypersecretion can be explained by an increase in the plasma concentration of which of the following?

Gastrin

42

*** A patient with peptic ulcer disease is taken off their medication because of undesirable side effects. As a result, the patient has rebound gastric acid hypersecretion. Which of the following drugs best accounts for the observed result?

A proton pump inhibitor

43

Vomiting vs Diarrhea

Vomiting
- loss of HCl
- METABOLIC ALKALOSIS

Diarrhea
- loss of bicarbonate
- METABOLIC ACIDOSIS

44

Zollinger-Ellison syndrome (Gastrinoma)

gastrin-secreting tumor of the pancreas

increases H+ in stomach
inactivates pancreatic enzymes

45

Brunner’s glands

above the Sphincter of Oddi

produce a mucus-rich alkaline secretion and urogastrone

46

severe diarrhea can be caused by what in the intestinal fluid secretion

Enterotoxin
increased VIP
Increased Ach and serotonin

47

Cystic Fibrosis

mutation in the CFTR gene

causes malabsorption of fat

48

Gastric acid secretion increases when food enters the stomach because

(A) protein digestion products directly stimulate the parietal cells to release H
(B) food raises the pH of the stomach, allowing more acid to be released
(C) Both
(D) neither

C

49

A 42-year-old male is referred to a gastroenterologist for evaluation of refractory peptic ulcer disease. Subsequent endoscopic and laboratory data are suggestive of Zollinger-Ellison syndrome. The increased basal acid output and maximal acid output of the patient is best explained by an increase in the plasma concentration of which of the following?

a. Secretin
b. Somatostatin
c. Gastrin
d. Histamine

C

50

The major stimulus for gastric acid (HCl secretion during the cephalic stage is

(A) histamine
(B) gastrin
(C) secretin
(D) somatostatin
(E) ACh

E

51

Gastric acid (HCl) secretion is inhibited by

(A) somatostatin
(B) entero-oxyntin
(C) high pH
(D) amino acids
(E) ACh

A

52

starch digestion occurs where

begins in oral cavity, but mostly in SMALL INTESTINE

53

Glucose and Galactose transported from cell to blood by

GLUT2
(facilitated diffusion)

54

Glucose and Galactose transported from intestinal lumen to cells by

SGLT1
(cotransporter; active)

55

what solution is administered for dehydration

Na+ and Glucose mixture

56

Lactose Intolerance caused by

lack of brush-border enzyme Lactase

results in osmotic diarrhea, lactic acid, and gas

57

digestion of proteins

begins in stomach, but most occurs in the small intestine

58

absorption of amino acids goes along with?

Na+ (sodium)

59

absorption of Calcium requires?

what is calcium in the enterocyte?

requires Vitamin D3

Calbindin

60

Na+ absorption and K+ secretion are stimulated by what

aldosterone

61

Na+ absorption and K+ secretion are stimulated by what

aldosterone

62

*** An 18-year-old male with pernicious anemia lacks intrinsic factor, which is necessary for the absorption of cyanocobalamin. Vitamin B12 is absorbed primarily in which portion of the GI tract?

a. Stomach
b. Duodenum
c. Jejunum
d. Ileum
e. Colon

D

63

*** A 57-year-old man undergoes resection of the distal 100 cm of the terminal ileum as part of treatment for Crohn’s disease. The patient likely will develop malabsorption of which of the following?

a. Iron
b. Folate
c. Lactose
d. Bile salts
e. Protein

D

64

*** A 37-year-old male presents with dehydration and hypokalemic metabolic acidosis. This acid-base and electrolyte disorder can occur with excess fluid loss from which of the following organs?

a. Stomach
b. Ileum
c. Colon
d. Pancreas
e. Liver

C

65

*** A 70-year old woman presents with abdominal pain, microcytic anemia, and weight loss. Colonoscopy with biopsy confirms colon cancer. Which of the following statements about the colon is correct?

a. Absorption of Na+ in the colon is under hormonal (aldosterone) control
b. Bile acids enhance absorption of water from the colon
c. Net absorption of HCO3− occurs in the colon
d. Net absorption of K+ occurs in the colon
e. The luminal potential in the colon is positive

A

66

*** A patient’s abdominal pain is subdued after eating. Which of the following is true regarding contraction of the gallbladder following a meal?

a. It is inhibited by a fat-rich meal
b. It is inhibited by the presence of amino acids in the duodenum
c. It is stimulated by atropine
d. It occurs in response to cholecystokinin
e. It occurs simultaneously with the contraction of the sphincter of Oddi

D

67

*** An 18-year-old college student reports that she experiences severe abdominal bloating and diarrhea within 1 hour of consuming dairy products. The diarrhea and bloating can best be explained by which of the following?

a. A deficiency in the brush border enzyme lactase
b. Carbohydrate-induced secretory diarrhea
c. Decreased intestinal surface area
d. Decreased carbohydrate absorption
e. A decrease in exocrine pancreatic secretion

A

68

*** A newborn with severe diarrhea is found to have an inherited defect in a glucose transporter resulting in glucose/galactose malabsorption, necessitating a glucose- and galactose-free diet. Which of the following is the transport protein responsible for entry of glucose into the intestinal enterocyte?

a. Glut-2
b. Glut-5
c. SGLT 1
d. SGLT 2
e. SGLT 5

C

69

*** A morbidly obese male presents with hypertension, hyperlipidemia, and Type II diabetes mellitus. Dietary fat, after being processed, is extruded from the mucosal cells of the gastrointestinal tract into the lymphatic ducts in the form of which of the following?

a. Monoglycerides
b. Diglycerides
c. Triglycerides
d. Chylomicrons
e. Free fatty acids

D