Flashcards in Hormones & Clinical Deck (60):
G Cells of stomach, high in number in pylorus
Receptor: CCKb --> IP3
- Stimulate parietal cells to release HCl
- Growth of gastric mucosa
- increase histamine release
- Gastric distension
- Alkaline environment
- small peptides and AA
- vagal stimulation
- Acidic pH <1.5
Enterochromaffin-like cells (ECL) in gastric glands
H2 receptor --> cAMP
Increase H+ from parietal cells
- Acidic pH
Note: NOT A PEPTIDE
- GI mucosa D cells
- Exocrine pancreas
Direct - Gi --> blocks adenlyl cylcase --> low cAMP
Indirect - blocks H2 and CCKb
- inhibit gastrin and histamine
- inhibit glucagon and insulin release
- High acidity
- Helicobacter pylori
Stimulates: Fasting state
Inhibits: Fed State
I cells of duodenuma nd jejunum
Receptor: CCKa (on ductal cells of pancreas) and CCKb
- 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
- Fatty acids, peptides and small AA (mainly phenylalaine, methionine and tryptophan) coming into Small Intestine
S cells of duodenum and jejunum
Receptor: on ductal cells in pancreas
- increase HCO3 and bile
- decrease H+ secretion
- inhibit gastrin
- Neutralizes duodenum acid (w/o this, pancreatic enzymes would not be activated)
- Decrease gastric emptying
K cells in duodenum and jejunum
- increase insulin secetion from pancreatic B cells
- decrease H+
+ Glucose, free
+ Peptides and AA
Think of GIP = Glucose; Icky fats; Peptides
Source: Cholinergic pre-ganglion everywhere,
post ganglionnic for Parasympathetic and Sympathetic Sweat glands
- contract smooth muscle
- relax sphincters
- increase saliva, gastric and pancreatic secretions
Parietal cells --> H+
ECL --> Histamine
D cells --> Somatostatin
G cells --> Gastrin
Source: Adrengeric neurons:
Post ganglionic of symptathetic
- relax smooth muscle
- contract sphincters
- increase saliva
NT: VIP (Vasoactive intestinal peptide)
- ENS neurons peptidergic - Post ganglion Parasympathetic
- Relax smooth muscle
- increase intestinal, pancreatic secretion
- Most well known for relaxing LES
NT: Nitric Oxide
Source: ENS neuron
Released in front of bolus to relax muscle via Vagus
Actions: Relaxes muscle, vasodilates
Source: ENS neuron; type of GRP
- contracts smooth muscle
- decreases secretions
NT: :Neuropeptide Y
Source: ENS neurons
Relax smooth muscle
decrease intestinal secretion
NT: Substance P
Source: ENS neurons; Peptidergic Parasymapthetic post ganglion; type of GPR
- contraction of smooth muscle (peristaltic
- increase salivary
Enterochromaffin cells in intestine
Initiate peristaltic reflex
Stimulates: Gastric distension
Upper duodenum by Parasympathetic
Actions: Sends through a wave every 90 minutes during fasting to clean up crap. Called the Migrating Myoelectric Complex
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
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.
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!
Acid comes into the duodenum, what cells are stimulated?
S cells --> secretin --> HCO3 to neutralize duodenum.
D cells --> Somatostatin --> HCO3 to neutralize duodenum
Your pt ate spam-ghetti, with garlic bread. That's a lot of carbs! What hormone responds?
Carbs = sugar --> K cells --> GIP --> insulin
What has the greatest increase in insulin, IV sugars or oral sugars?
What is the mechanism?
If it doesn't get into the stomach, can't activate GIP
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.
Acid is a big deal, and that's why it's regulated 3 ways:
What substance is associated with each of these regulatory pathways?
Paracrine - Histamine
Hormonal - Gastrin
Neuronally - Vagal, ACh.
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
A patient is anorexic. The real medical definition is -
lack of apppetite
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, ?
"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.
a profound and marked state of constituional disorder; general ill health and malnutrition
Coffee ground emesis
Denotes blood congealed and separated within gastric contents that takes the form of coffee grounds when in contact with acidic environment
Refernce to Gi. Acute paroxysmal abdominal pain
postprandial (after a meal) epigastric discomfort
Difficulty in swallowing
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)
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
Grey turner sign
Iliopsoas Muscle test
obturator muscel test
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
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
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.
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
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)
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
A pt is having trouble initiating swallowing; you take an Xray and see a structural disorder. What is this disorder, more than ikely?
A pt presents with trouble swallowing. Has more trouble swallowing solid foods than liquids, it is progressive and intermittent. Dx?
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?
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)
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
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
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
Helicobacter pylori can cause 4 scary dx. what are they?
how do you diagnose this
Breath test - tests urease
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
RUQ Pain develops 2-5 hours after eating. Dx?
RUQ pain develops 30 min after eating. Dx?
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
Pt here for ulcer pain. hit his head last week.
A firefighter pt is in for ulcer pain. Dx?
What is multiple endocrine neoplasia and what is it associated with?
neoplasia = mass.
So masses in the organs that are endocrine such as pituitary, parathyroid, pancreas
Pt has pain proximal of ligamentum of treitz. What is your main differential?
Upper GI bleed. from peptic ulcer disease, erosive gastritis, esophageal varices...
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
What do the following barium Xrays signify,
Narrowing of muscle?
Weird infolding in esophagus?
Lower esophageal ring, Shatzki
What is pH testing used for?
Plain film X Ray?
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,
What is HIDA testing used for?
EUS (endoscopic ultrasound)
ERCP endoscopic retrograde cholangiopancreatography
MRCP, Magnetic resonance cholangiopancreatography
Nuclear study for gallbladder . No gallbladder = cholecystitis.
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
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?
CMP because BMP does not have liver enzymes
If you suspected pancreatitis, what do you lab for?
gastrin. secretin stimulatino test
GGT, bilirubin, INR