Hormones & Clinical Flashcards Preview

GI Greenfield > Hormones & Clinical > Flashcards

Flashcards in Hormones & Clinical Deck (60):
1

Gastrin
Released where?

Receptor?

Actions?

Stimulates release?

Inhibits release?

G Cells of stomach, high in number in pylorus

Receptor: CCKb --> IP3

Actions:
- Stimulate parietal cells to release HCl
- Growth of gastric mucosa
- increase histamine release

Stimulates:
- Gastric distension
- Alkaline environment
- small peptides and AA
- vagal stimulation

Inhibits:
- Somatostatin
- Secretin
- Acidic pH <1.5

2

Histamine
Released where?

Receptor?

Actions?

Stimulates release?

Inhibits release?

Enterochromaffin-like cells (ECL) in gastric glands

H2 receptor --> cAMP

Increase H+ from parietal cells

Stimulates:
- gastrin
- Vagus

Inhibits:
- Somatostatin
- Acidic pH

Note: NOT A PEPTIDE

3

Somatostatin/
Released where?

Receptor?

Actions?

Stimulates release?

Inhibits release?

- GI mucosa D cells
- Hypothalamus
- Exocrine pancreas

Receptor:
Direct - Gi --> blocks adenlyl cylcase --> low cAMP
Indirect - blocks H2 and CCKb

Actions:
- inhibit gastrin and histamine
- inhibit glucagon and insulin release
Stimulates:
- High acidity
- Sympathetic

Inhibit:
- Vagus
- Helicobacter pylori

4

Ghrelin
Released where?

Receptor?

Actions?

Stimulates release?

Inhibits release?

Gastric cells

Receptor: ?

Action:
increase appetite

Stimulates: Fasting state

Inhibits: Fed State

5

Cholecystokinin
Released where?

Receptor?

Actions?

Stimulates release?

Inhibits release?

I cells of duodenuma nd jejunum

Receptor: CCKa (on ductal cells of pancreas) and CCKb

Actions:
- Increase pancreatic enzyme
- increase HCO3 secretion
- contract gallbladder
- relax sphincter of Oddi
- growth of exocrine pancreas and gallbladder
- decrease gastric emptying by decreasing contratinos and increasing gastric distensibility

Stimulates:
- Fatty acids, peptides and small AA (mainly phenylalaine, methionine and tryptophan) coming into Small Intestine

Inhibits:
Fasting?

6

Secretin
Released where?

Receptor?

Actions?

Stimulates release?

Inhibits release?

S cells of duodenum and jejunum

Receptor: on ductal cells in pancreas

Actions:
- increase HCO3 and bile
- decrease H+ secretion
- inhibit gastrin
- Neutralizes duodenum acid (w/o this, pancreatic enzymes would not be activated)
- Decrease gastric emptying

7

GIP
Released where?

Receptor?

Actions?

Stimulates release?

Inhibits release?

K cells in duodenum and jejunum

Receptor: ?

Actions:
- increase insulin secetion from pancreatic B cells
- decrease H+

Stimualted:
+ Gastrin
+ Glucose, free
+ Fatty
+ Peptides and AA

Think of GIP = Glucose; Icky fats; Peptides

8

Neurotransmitter: ACh

Source?

Actions?

Source: Cholinergic pre-ganglion everywhere,
post ganglionnic for Parasympathetic and Sympathetic Sweat glands

Actions:
- contract smooth muscle
- relax sphincters
- increase saliva, gastric and pancreatic secretions

Directly stimulates:
Parietal cells --> H+
ECL --> Histamine
D cells --> Somatostatin
G cells --> Gastrin

9

Neurotransmitter: Norepinephrine:

Source?

Actions?

Source: Adrengeric neurons:
Post ganglionic of symptathetic

Actions -
- relax smooth muscle
- contract sphincters
- increase saliva

10

NT: VIP (Vasoactive intestinal peptide)

Source?

Actions?

Source:
- ENS neurons peptidergic - Post ganglion Parasympathetic

Actions:
- Relax smooth muscle
- increase intestinal, pancreatic secretion

- Most well known for relaxing LES

11

NT: Nitric Oxide

Source?

Actions?

Source: ENS neuron
Released in front of bolus to relax muscle via Vagus

Actions: Relaxes muscle, vasodilates

Stimulates: Bolus

Inhibits: Fasting

12

NT: Enkephalins

Source?

Actions?

Source: ENS neuron; type of GRP

- contracts smooth muscle
- decreases secretions

13

NT: :Neuropeptide Y

Source?

Actions?

Source: ENS neurons

Relax smooth muscle
decrease intestinal secretion

14

NT: Substance P

Source?

Actions?

Source: ENS neurons; Peptidergic Parasymapthetic post ganglion; type of GPR


Actions:
- contraction of smooth muscle (peristaltic
- increase salivary

15

Serotonin
Released where?

Receptor?

Actions?

Stimulates release?

Inhibits release?

Enterochromaffin cells in intestine

IPAN receptors

Initiate peristaltic reflex

Stimulates: Gastric distension

Inhibits: fasting

16

Motilin
Released where?

Receptor?

Actions?

Stimulates release?

Inhibits release?

Upper duodenum by Parasympathetic

Actions: Sends through a wave every 90 minutes during fasting to clean up crap. Called the Migrating Myoelectric Complex

Stimulates: Fasting

inhibits: Feeding

17

A pt eats a super fatty meal. What hormone responds?

CCK & GIP is stimulated by fat.

I cell--> CCK --> Pancreatic lipase & Gallbladder bile

K cell --> GIP --> insulin

18

A pt eats a meal high in protein. In the GI tract, what hormone responds?
In the duodenum what hormone responds?

In the GI tract, the ONLY hormone that is not inhibitory is GASTRIN.
Other unique features of gastrin:
- Only Gastric hormone receiving neuron stimulation via vagus
- Only hormone with a negative feedback loop
- Only Gastric hormone to increase motility.

Duodenum:
Peptide --> I cell --> CCK --> pancreas --> trypsin, chymotrypsin, elastase, carboxypeptidase A & B

Think of CCK as the pancreas dude, whenever you need pancreatic stuff, ask CCK!

19

Acid comes into the duodenum, what cells are stimulated?

S cells --> secretin --> HCO3 to neutralize duodenum.
D cells --> Somatostatin --> HCO3 to neutralize duodenum

20

Your pt ate spam-ghetti, with garlic bread. That's a lot of carbs! What hormone responds?

Carbs = sugar --> K cells --> GIP --> insulin

21

What has the greatest increase in insulin, IV sugars or oral sugars?
What is the mechanism?

ORAL
Bc GIP.
If it doesn't get into the stomach, can't activate GIP

22

Food distends the stomach what hormone responds?

Food! We need to acidify it! but we also need to protect our stomach from the acid. So at the SAME TIME our bodies make: gastrin and prostaglandin!

Stretch --> Gastrin --> Parietal cells --> H+
Stretch --> prostaglandin --> Mucus

Also serotonin for peristaltic reflex:
Stretch --> enterochromaffin --> Serotonin --> peristalsis

This idea is from Kaplan, but Rogers and the book say prostaglandin inhibits H+; FirstAid has nothing to say about it.

23

Acid is a big deal, and that's why it's regulated 3 ways:
Paracrine-ly
Hormonally
and Neuronally.
What substance is associated with each of these regulatory pathways?

Paracrine - Histamine
Hormonal - Gastrin
Neuronally - Vagal, ACh.

24

A pt presents with white clay colored stools, what does this mean?
what medical term do you write in your Observation part of your SOAP note?

Absence of secretion of bile

Acholic

25

A patient is anorexic. The real medical definition is -

lack of apppetite

26

You may call any serious acute intraaabdominal condition that has sx of pain, tenderness, muscular rigidity and usually needs emergency surgery by it's correct medical term which is, ?

Acute abdomen

27

"Oh my!" Your attending states," this patient has borborygmi!"
Wtf is he talking about?

A rumbling noise caused by propulsion of gas through the intestines.

"Propulsion of gas" :'D sorry I cannot stop laughing at this phrase.

28

Cachexia

a profound and marked state of constituional disorder; general ill health and malnutrition

29

Coffee ground emesis

Denotes blood congealed and separated within gastric contents that takes the form of coffee grounds when in contact with acidic environment

30

Colic

Refernce to Gi. Acute paroxysmal abdominal pain

31

Dyspepsia
Dysphagia

postprandial (after a meal) epigastric discomfort
Difficulty in swallowing

32

Edentulous
ERCP
Eructation
EUS

Edentulous - having no teeth
ERCP - endoscopic retrograde cholangiopancreatopgraphy
Eructation: expulsion of swallowed air. Burping. It literally means burping.

EUS: endoscopic ultrasound (do not get this confused with UES, upper esophageal sphincter)

33

GGT
Globus Pharyngeus

GGT: Gamma glutamyl trasnferase
Foreign body in neck that does not interefere with swallowing (sometimes relieved by swallowing). Usually in anxious of OCD pts. Often attributable to GERD

34

DX:
Cullen sign

Courvoisier's Sign

Grey turner sign

Iliopsoas Muscle test

KUB XRAY

Lloyd punch

McBurney's point

Heel Strike

Guarding

MRCP

Murphy sign

obturator muscel test

psoas sign

Rigidity

Rovsings sign

Cullen: Ecchymosis around embilicus (periumbilical) secondary to hemorrhage

enlarged no tender gallbladder secondary to pacnreatic disease or cancer

Grey: Flank ecchymoisis secondary tohemorrhage

ilipsoas: pt flex hip against reistance. Inflmmation from appendix

KUB: Kidney Ureter Bladder xray

Lloyd punch: punch dat kidney for stone or infection dx

McBurney's point: where appendix is.

Heel Strike = striking the heel of a supine pt for appenticitis

Guarding: protective resopnse in muscle from pain or fear of movement

MRCP: Magnetic Resonance Cholangiopancreatography

Murphy: Cholecystitis test, palpate under right costal margin, + if stop breathing or pain

obturator: flex pt thigh and rotate internally. appendix if pain.

Psoas: retrocecal appendix. RLQ pain & passive right hip extension

Rigid: hard abdomen

Rovsings sign: Pain in RLQ, rebound tenderness

35

Ulcers:
Curling ulcer

Cushing ulcer

ulcer

Curling: stress ulcer. peptic ulcer of duodenum in pt with extensive superficial burns

Cushing: stress ulcer. peptic ulcer occuring from severe head injury or other lesion in Central nervous system

ulcer: local defect of surface of organ. Shedding of inflamed necrotic tissue

36

Easy Peasy:
Flatus
Gastritis
Esophagitis
Cholestasis

Nausea

Rebound tendneress

Regurgitation

Retch

Steatorrhea

Vomiting

Flatus: Farting
Inflammation of stomach
Esophagtis: inflammation of esophagus
Cholestasis: Gall stones (Stoppage or suppression of bile flow, due to factors within or outside the liver; intrahepatic or extrahepatic cholestasis)

Nausea: impending urge to vomit

Rebound: Pain on the come back
Regurg: effortless reflux of liquid in absence of N/V

Retching: Closed glottis while trying to vomit

Steatorrhea: fat greasy stools

Vomiting: Forceful ejection of upper gut contents; if unfamiliar with the term, ask Eric.

37

Hematemesis
Hematochezia
Icterus

Melena
Mittelschmerz

Vomiting blood

Hematochezia: Passage of bright red blood stool

Icterus = jaundice. Yellow dude

Melena = dark colored stool, tarry. Non odorous, sticky.

Mittelschmerz: menstruation lower abdominal pain. No rebound tenderness

38

Obstipation

Odynophagia

Pneumobilia

Pneumomediastinum

pneumoperitoneum

pyrosis

severe intractable constipation due to intestinal obstruction

odynophageia: painful swallowing

pneumobilia: abnormal presence of gas in bile

pneumomediastinum: air in mediastinum. Interfere with respiration and circulation. = pneumothorax or pneumopericardium!

pneumopertoneum gas in peritoneum

pyrosis: substernal burning (heartburn)

39

Tenesmus
UGIB
Ureterolithiasis
Virchow's node
Vomiting

ineffectual and painful straining at stool; if unfamiliar, ask Trevor

UGIB: Upper GI bleeding

Ureterolithiasis: stone from kidney in ureter
Virchow's node: left supraclavicular mass that means cancer

40

A pt is having trouble initiating swallowing; you take an Xray and see a structural disorder. What is this disorder, more than ikely?

Zenger's Divertiulum

41

A pt presents with trouble swallowing. Has more trouble swallowing solid foods than liquids, it is progressive and intermittent. Dx?

Peptic stricture

42

A pt presents with trouble swallowing, has more trouble swallowing solid foods than liquids, it has not gotten any worse (not progressive) and is intermittent. dx?

schatzki ring

43

a pt presents with trouble swallowing any type of substance, solid or liquid. What is most likely causing the dysphagia?

Motility is messed up. Could be myenteric plexus (achalasia)

44

A pt presents with trouble swallowing. After imaging, you see a bird beak appearance . Dx and mechanism

Primary achalasia, loss of No produciing neurons in myenteric plexus, causing impaired relaxation of LES

or resting pressure is high, keeping the LES closed

45

A pt presents with trouble swallowing and a good tan. After imaging, you see a bird beak appearance . Dx and mechanism

SEcondary achalsia from the parasie trypansoma cruzi

46

Your pt presents with gnawing, sharp or hunger like pain that is intermittent. They also have bloody stool. Your attending writes, "emesis, hematemesis, melena, hematochezia, and coffee ground poo". Since you know what all these words mean now, you correctly dx

GIB - Gastrointestinal bleeding

Coffee ground: coagulated blood vomit
Emesis: coagulated blood
Hematemesis: vomiting blood
Melena: dark tarry stool
hematochezia:bright red stool

47

Helicobacter pylori can cause 4 scary dx. what are they?

how do you diagnose this

PUD
Chronic gastritis
Gastri adenocaracinoma
MALT lymphoma


Breath test - tests urease
Fecal ag:
Abs. not good bc abs stay forever so can't tell if you've treated it.
Biopsy stains: Warthin-Starry Silver Stain

to get an accurate test: must be off any H+ inhibiting medicines

48

RUQ Pain develops 2-5 hours after eating. Dx?

RUQ pain develops 30 min after eating. Dx?

duodenal ulcer

Gastric ulcer

49

A pt has a colonscopy and notes many ulcers on teh distal duodenum. This is hte 4th time this man has been in for ulcer pain. Dx?

Zollinger ellison gastrinoma

50

Pt here for ulcer pain. hit his head last week.

Cushing Ulcer

51

A firefighter pt is in for ulcer pain. Dx?

Curling ulcer

52

What is multiple endocrine neoplasia and what is it associated with?

Z-E Syndrome.
neoplasia = mass.
So masses in the organs that are endocrine such as pituitary, parathyroid, pancreas

53

Pt has pain proximal of ligamentum of treitz. What is your main differential?

Upper GI bleed. from peptic ulcer disease, erosive gastritis, esophageal varices...

54

Your pt has dysphagia and heart burn. Why would a colonscopy not be a good diagnostic test for this pt?
What would be better?

Because colonscopy goes from rectum only to the ileocecal jxn


EGD, goes from mouth to duodenum

55

What do the following barium Xrays signify,
Bird beak?
Narrowing of muscle?
Weird infolding in esophagus?

Achalasia
Lower esophageal ring, Shatzki
Zenker's diverticulum

56

What is pH testing used for?

Manometry?

Plain film X Ray?

Acid reflux

Achalasia; catheter that measures pressures when you swallow. Higher pressure means LES messing up

Stones, kidney or gall;
bowel obstruction; free air, KNOW FREE AIR,

57

What is HIDA testing used for?

Ultrasound

EUS (endoscopic ultrasound)

ERCP endoscopic retrograde cholangiopancreatography

MRCP, Magnetic resonance cholangiopancreatography

Nuclear study for gallbladder . No gallbladder = cholecystitis.

Gallbaldder

EUS: pancreatic masses, scope with ultrasound on it

ERCP: scope with a catheter into biliary ducts

MRCP: More stuff for biliary stuff. Non invasive, MRI

58

LFT Labs are important I guess.
True liver functions include 3 things:
but most physicians include what other labs with the liver labs:

If you suspect liver disease do you order a BMP or CMP blood test?

INR/PT
Albumin
Cholesterol

AST/ALT
Alkaline phosphatase
Bilirubin


CMP because BMP does not have liver enzymes

59

If you suspected pancreatitis, what do you lab for?

Zollinger Ellison?

Liver?

lipase, amylase

gastrin. secretin stimulatino test

GGT, bilirubin, INR

60

What are they osteopathic sympathetic sensory levels of:

Appendix
Esophagus
Stomach
Liver
Gallbladder
Small intestine
Colon
Pancreas

Appendix T12
Esophagus T2-T8
Stomach T5-T9
Liver T6-T9
Gallbladder T6-T9
Small intesitne T5-T9-12 (jej & ileum)
Colon T9-L2
Pancreas T5-T11