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Patho II > GI Tract 1 > Flashcards

GI Tract 1 Flashcards

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1
Q

Controls motility

A

Myenteric plexus

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2
Q

Controls Secretion and blood flow

A

Submucosal plexus (Meissner’s plexus)

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3
Q

Release in response to meal:
Increases H secretion by gastric _____
Stimulates growth of _____ - trophies action

A

Gastrin; parietal cells; gastric mucosa

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4
Q

Gastrin is secreted from ____ of the gastric antrum in response to what?

A

G cells;
Small peptides & amino acids (phenylalanine & tryptophan)
Distension of stomach
Vagal stimulation

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5
Q

What inhibits gastrin release?

A

Acid (H) in the lumen of the stomach (-ve feedback)

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6
Q

Occurs when gastrin is secreted by non-Beta-cells of pancreas —> hypertrophy of gastric mucosa

A

Zollinger-Ellison syndrome

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7
Q

How is bile ejected?

A

Cholecystokinin (CKK) stimulates contraction of GB —> relaxation of sphincter of Oddi

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8
Q

How does cholecystokinin (CKK) affect the pancreas?

A
  1. Stimulates pancreatic enzyme secretion
  2. Potentiate secretin-induced stimulation of pancreatic HCO3 secretion
  3. Stimulates growth of exocrine pancreas
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9
Q

Fatty meals stimulate ____ to slow gastric emptying allowing for more time for intestinal digestion & absorption

A

CCK

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10
Q

Stimuli for CCK

A

Fatty acids & monoglycerides in duodenum

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11
Q

Actions are coordinated to reduce H in the lumen of the small intestine. “Nature’s antacid”

A

Secretin

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12
Q

How does secretin work?

A
  1. Stimulates pancreatic HCO3 (neutralizes H in intestinal lumen)
  2. Stimulates HCO3 & H2O secretion by the liver & increase bile production
  3. Inhibits H secretion by gastric parietal cells
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13
Q

Secretin is released by the ____ in response to H+ in the lumen of the duodenum

A

S cells of duodenum

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14
Q

_____ is the principle stimulus for delivery of pancreatic enzymes & bile into small intestine

A

CCK

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15
Q

Swallowing is innervated by what nerve?

A

Vagus & glossopharyngeal nerve

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16
Q

GERD ___ LES pressure while achalasia ___ LES pressure

A

Decreases; increases

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17
Q

Gastric contraction increases by ______ and decreases by _______

A

Vagal stimulation; sympathetic stimulation

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18
Q

Factors delaying gastric emptying:

A

Obesity, pregnancy, opioids, DM, trauma, pain

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19
Q

Propulsion of chyme toward large intestine is coordinated by what?

A

Enteric NS

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20
Q

Increases LES & gastric motility, decreased tone of pyloric sphincter & relaxes duodenum
No effect on gastric pH
Increases action of Sux by inhibiting plasma cholinesterase

A

Metoclopramide

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21
Q

Absence of the enteric NS resulting in constriction of the involved segment, marked dilation & accumulation of intestinal proximal to constriction & severe constipation

A

Megacolon (hirschsprung’s dz)

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22
Q

Mendelson syndrome

A

Aspiration pneumonitis

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23
Q

____ cells of stomach produce Pepsin

A

Chief

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24
Q

____ is a protein that helps to absorb vit B12 in the duodenum. Cannot absorb w/o it

A

Intrinsic factor

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25
Kills bacteria, breaks down food, & converts pepsinogen. | Stimulated by what?
HCl; | Gastrin, vagal stim (ACh), & histamine
26
Parietal cells (body) secrete what?
HCl & intrinsic factor
27
______ cells secrete _____ that is broken down to pepsin. Stimulated by?
Chief; pepsinogen; vagal stim (ACh)
28
____ cells (antrum) secrete _____ that stimulate acid secretion. It is stimulated/inhibited by?
G; gastrin; Vagal stim (via GRP) Inhibit by: somatostatin & H in stomach
29
_____ cells secrete ____ which is a lubricant that protects form H. Stimulated by?
Mucous, mucous, vagal stim (ACh)
30
______ inhibits the H/K pump and blocks H secretion. Why can this cause hypergastrinemia?
Omeprazole; no acid = no inhibition of gastrin —> rebound phenomenon leading to more acidity “hypergastrinemia”
31
______ is released by mast cells in the gastric mucosa. It stimulates H secretion by activating _____ on the parietal cell membrane
Histamine; H2 receptors
32
H. Pylori has high ____ activity and converts urea to ____, which damages the gastric mucosa
Urease; NH3
33
H secretion is ___ with gastric ulcers and ____ with duodenal ulcers
Decreased; increased
34
Gastrin secreting tumor that continually secretes large amounts of gastrin into blood. Increases acid secretion —> ulcers 20% a/w ______
``` Gastrinoma (Zollinger-Ellison syndrome); MEN I (parathyroid, pancreas, & pituitary) ```
35
Symptoms of Zollinger-Ellison syndrome
Secretory diarrhea (gastrin inactivates lots of digestive enzymes-> malabsorption) Weight loss Steatorrhea (bc pancreatic enzymes are inactivated by very high acid) Severe ulcers (located in atypical places & a/w complications)
36
Dx of Zollinger-Ellison syndrome
High fastening gastrin level (nl <100) Secretin stimulation test CT to see the tumor
37
MCC OF GERD
Abnormal relaxation of LES (decreased tone) <13 mmHg (nl 29 mmHg)
38
Test of choice for GERD dx
Endoscopy with biopsy
39
What is definitive proof that acid reflux is causing symptoms?
24-hr pH monitor in LE
40
Gradual progression of obstructive type dysphagia. Solid >> liquids
Peptic strictures
41
Transformation of squamous to columnar mucosa, premalignant, requires surveillance biopsies searching for dysplasia. Resulting cancer is ____
Barrett’s esophagus; adenocarcinoma
42
Pain greater with meals: weight loss H pylori infxn in 70%; NSAID (inhibit PG secretion) D/t ⬇️ mucosal protection against gastric acid ⬆️ smokers, ETOH, stress
Gastric ulcer
43
Pain Decreases with meals: weight gain Almost 100% have h pylori infxn that inhibits somatostatin D/t ⬆️ gastric acid or ⬇️ mucosal protection
Duodenal ulcer
44
Why does pain decrease with meals in duodenal ulcer?
It causes more bicarb to come neutralize the acid
45
Anorexia nervous is characterized by:
Hypokalemia, hyponatremia, hypochloremia, & metabolic alkalosis
46
``` Abdominal pain, crampy, fever, diarrhea (w/o blood, pus, mucous) Weight loss Perinatal dz (anal fissure, fistula, abscess) Anemia (iron deficiency or megaloblastic) ```
Crohn’s dz “regional enteritis”
47
Tx fro Crohn’s dz
Folate, iron, & B12 | Sulfasalazine
48
Diffuse mucosal or submucosal thickening (not transmural) Bloody diarrhea Toxic megacolon Typically dz of young people
Ulcerative colitis
49
``` Any portion of GIT, the terminal ileum (hall mark), small intestine & colon. Discontinuous lesion (skip lesions), rectal sparin ```
Crohn’s dz
50
Transmural inflammation, cobblestone mucosa, bowel wall thickening “string sign”, linear ulcers, fissures
Crohn’s dz
51
Caused by increased pressure and weakness of walls and is a/w ____ fiber diet
Diverticulosis; low
52
LLQ pain “left sided appendicitis”. | Complications include:
Diverticulitis; perforation, peritonitis, abscess formation, or bowel stenosis
53
Reduced or absent peristalsis and increased pressure at LES with incomplete relaxation with swallow. D/t loss of nitric oxide producing inhibitory neuron in ______
Achalasia; myenteric plexus
54
Tx for achalasia
Pneumatic dilation, CCBs, injection of botulinum toxins in LES, or surgical myotomy
55
Fibrosis of lower 2/3 of esophagus/ decreased peristalsis and decreased resting pressure. Secondary to diffuse esophageal spasm “nutcracker” esophagus
Scleroderma esophagus
56
Outpouching of esophagus. Halitosis, regurgitation of days old food Dysphagia (obstruction) Extreme caution during NG tubing
Zenker’s Diverticulum
57
Mucosal tear after severe vomiting, coughing, or retching. Upper GI bleeding (bright red) Found in alcoholics & bulimics Vasopressin or angiographic embolization
Mallory-Weiss Syndrome
58
Composition of pancreatic secretion
High volume (up to 3L) Much higher HCO3 conc than plasma (pH 8.3) Pancreatic lipase, amylase, and proteases
59
Stimulation of pancreatic secretion
Secretin “natures antacid” CCK ACh (via vagus) acts like CCK
60
Cystic fibrosis is from defective _____ genes on chromosome 7 and a defect in ____ caused by mutation
CFTR; Cl channels

Patho II (11 decks)

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