Physiology/Clin Path Flashcards
1
Q
Where are valvulae conniventes aka folds of Kerckring located and what are their purpose?
A
(Located in the small intestines, increase the absorptive surface of the small intestines)
2
Q
What are the three mechanisms by which the GI mucosa absorbs things?
A
(Active transport, diffusion, and solvent drag)
3
Q
What are the four goals of GI mucosal transportation?
A
(Provide appropriate substrates for various processes, maintain correct pH in GI lumen, maintain correct osmolarity of GI lumen, and contribute to plasma osmolarity maintenance)
4
Q
Are the tight junctions of the absorptive GI mucosa leaky or tight?
A
(Leaky)
5
Q
Movement of water is passive, active, or both?
A
(Passive)
6
Q
When the chyme is hyperosmotic, will water move to blood or chyme?
A
(Chyme)
7
Q
Chloride is mostly absorbed by diffusion as it follows what other electrolyte?
A
(Sodium)
8
Q
Where does water secretion in the GI mucosa typically take place?
A
(Crypts (of Lieberkuhn))
9
Q
Where is the location of the largest amount of water absorption in small animal species?
A
(Small intestines)
10
Q
Where is the location of the largest amount of water absorption in large animal species?
A
(Colon)
11
Q
Which of the chambers of the stomach is the largest in neonatal ruminants?
A
(Abomasum)
12
Q
What is the purpose of the esophageal groove?
A
(Divert milk from the reticulorumen directly into the abomasum)
13
Q
What nerve is responsible for the closure of the esophageal groove?
A
(Vagus nerve)
14
Q
What is the esophageal groove closure reflex stimulated by in calves? Three answers.
A
(Anticipation of suckling, act of suckling, and fluid containing calcium and sodium)
15
Q
What hormone can stimulate the esophageal groove closure reflex in older animals and what is that hormone a response to?
A
(Antidiuretic hormone in response to dehydration)
16
Q
What triggers the development of rumen papillae?
A
(Volatile fatty acids)
17
Q
Calf access to (grain or hay) decreases the time to weaning?
A
(Grain)
18
Q
Is lignin digestible?
A
(No)
19
Q
Is protein content higher or lower in younger grass?
A
(Higher)
20
Q
What facilitates the breakdown of mono and oligosaccharides in ruminants?
A
(Ruminal microbes)
21
Q
Is ruminal digestion anaerobic or aerobic?
A
(Anaerobic)
22
Q
What is the purpose of the fluid associated bacteria in the rumen?
A
(Digest dissolved nutrients)
23
Q
What is the purpose of ruminal fungi?
A
(Plant cell wall digestion)
24
Q
What is the volatile fatty acid ratio resultant of digestion of a high fiber diet?
A
(70:20:10, 70% acetate, 20% propionate, 10% butyrate)
25
Acetate is oxidized throughout the body to generate what?
(ATP)
26
Propionate is completely removed from portal blood by the liver and is the major substrate for what process?
(Gluconeogenesis)
27
Which of the volatile fatty acids is increased when you put a ruminant on a grain diet?
(Propionate)
28
(T/F) Fats are either partially broken down by fermentation in the rumen or not broken down at all before being passed to the small intestine to be absorbed as in monogastric species.
(T)
29
What enzyme in the abomasum is important for the breakdown of bacterial cell walls to allow the small intestines to absorb microbial protein, which is a major source of protein in ruminants?
(Lysozyme)
30
What nerve provides the extrinsic nervous control of the reticulorumen contractions?
(Vagus nerve)
31
When the dorsal vagus nucleus receives input that the pH is decreasing in the rumen, will contractions decrease or increase?
(Decrease)
32
An ingesta that is made up primarily of grain, succulent forage, and/or finely chopped feed is associated with more or less reticuloruminal movement?
(Less)
33
During which part of the primary contraction (steps listed below) is material pushed into the omasum?
A. Biphasic contraction of the reticulum
B. Caudal moved peristaltic type contraction of dorsal sac
C. Caudal moving contraction of ventral sac
D. Cranial moving contraction of dorsal sac
E. Repeat once then secondary contraction
(During reticular contractions so during A)
34
Which of the steps of secondary contraction, listed below, is critical to eructation (as in, if this step did not occur, the animal would be unable to eructate)?
A. Cranial wave starting in caudal dorsal blind sac
B. Above wave continues over the dorsal sac
C. Cranial sac relaxes and cranial pillar elevates which allows liquid ingesta to move away from the cardia
D. Gas enters the esophagus and is eructated
(C)
35
Regurgitation occurs just before the initiation of a primary or secondary contraction of the rumen?
(Primary)
36
What are the four layers of the GI tract from outermost to innermost?
(Serosa, longitudinal smooth muscle, circular smooth muscle, submucosa, and mucosa)
37
What is the function of segmentation contractions in small intestinal motility?
(Mixing → ‘chop’ up the chyme, promotes progressive mixing of chyme with secretions)
38
What is the function of peristaltic waves?
(Propulsion → progression of chyme towards the ileocolic junction, also spreads chyme out along the intestinal mucosa)
39
The small intestinal interdigestive phase aka the ‘housekeeper’ phase is a migrating motor complex that is triggered in response to what hormone?
(Motilin)
40
What are three hormones that enhance small intestinal motility?
(Gastrin, cholecystokinin, and motilin)
41
What are two hormones that decrease small intestinal motility?
(Secretin and glucagon)
42
(T/F) The products of the luminal phase of digestion are too big to enter an enterocyte cell.
(T)
43
(T/F) The products of the mucosal phase of digestion are too big to enter an enterocyte cell.
(F)
44
What two products are produced by hosted microbes in herbivores that allows them to obtain usable carbohydrates from insoluble sources?
(Cellulase and hemicellulase)
45
Where does fermentation of insoluble carbohydrates occur in horses versus ruminants?
(Ruminants → rumen, equine → cecum and colon)
46
What are the products of pancreatic amylase action on carbohydrates contained in chyme and are they able to enter enterocytes?
(Di and trisaccharides, still too big to enter enterocytes)
47
What type of enzymes does the mucosal phase use to further break down the products of luminal carbohydrate digestion and where are they located?
(Enterocyte enzymes (maltase, sucrase, lactase, and isomaltase) that are bound to microvilli)
48
(T/F) Proteins are not stored so they require continuous dietary supply.
(T)
49
Can protein be converted to glucose?
(Yes, amino acids can be utilized to produce any/all of protein, CHO, or fat)
50
(T/F) Microbial protein is an additional and essential protein source in ruminant species.
(T)
51
What is the end product of protein breakdown in the gastric luminal phase?
(Proteoses → partly broken down but still big proteins)
52
Can amino acids simply diffuse into enterocytes?
(No, all methods of amino acids entering enterocytes is facilitated or active)
53
What effect does fat have on the gastric emptying rate?
(Decreases it)
54
What is the term for the process that reduces fats into tiny bits to allow enzymes access to their surface?
(Emulsification)
55
Where does emulsification occur in the body?
(Duodenum)
56
Once fat is emulsified, what enzyme hydrolyzes it into fatty acids and monoglycerides?
(Pancreatic lipase)
57
(T/F) All enteric digestion of fats occurs in the luminal phase of digestion.
(T)
58
When fat enters the duodenum, it triggers the release of what hormone that then tells the gallbladder to contract and send bile to the duodenum?
(Cholecystokinin)
59
What effect does secretin have on the major duodenal papilla?
(Relaxes it → allows for bile release into duodenum)
60
What is the term for a water soluble aggregate of bile digested triglycerides, cholesterol, etc.?
(A micelle)
61
Since chylomicrons are too big to enter capillaries, where do they enter systemic circulation?
(Enter lacteals then eventually enter systemic circulation via the thoracic duct)
62
What are the two parts of the pancreas?
(Endocrine and exocrine)
63
What is the term for the groups of endocrine pancreatic cells?
(Islets of Langerhans)
64
What three types of cells are located in the islets of Langerhans?
(Alpha, beta, and delta cells)
65
What are the two types of cells related to the exocrine pancreas?
(Acinar and ductal cells)
66
What do the acinar cells secrete?
(Digestive enzymes)
67
What do the ductal cells secrete?
(Bicarbonate)
68
Why is the bicarbonate that is secreted by the ductal cells imperative to the function of the exocrine pancreas?
(The acinar cells only function in a neutral pH)
69
What type of appetite will an exocrine pancreatic insufficiency patient have?
(Increased, ravenous)
70
What is the term for the inactive form of pancreatic enzymes?
(Zymogens)
71
Why are pancreatic enzymes transported to the duodenum in an inactive form?
(So that they do not digest the pancreatic tissue)
72
What enzyme converts zymogens into their active form?
(Enterokinase)
73
What is the test of choice for evaluating the exocrine function of the pancreas in a canine patient?
(Trypsin-like immunoreactivity)
74
The release of acetylcholine and cholecystokinin, which stimulate the acinar cells of the exocrine pancreas, are triggered by the presence of what in the duodenum?
(Amino acids and fats)
75
The presence of hydrochloric acid in the duodenum stimulates the release of what hormone that stimulates the ductal cells of the exocrine pancreas?
(Secretin)
76
What do alpha cells of the endocrine pancreas secrete?
(Glucagon)
77
What do beta cells of the endocrine pancreas secrete?
(Insulin)
78
What does insulin promote?
(Cellular nutrient uptake and storage)
79
What does glucagon promote?
(Cellular nutrient mobilization and release)
80
Does glucagon stimulate or inhibit gluconeogenesis?
(Stimulate)
81
Does insulin stimulate or inhibit gluconeogenesis?
(Inhibit)
82
What effect does glucagon have on glycogen and lipids?
(Stimulates the breakdown of both → glycogenolysis and lipolysis)
83
What effect does insulin have on glycogen, protein, and lipids?
(Stimulates the creation of them for storage purposes → glycogenesis, proteogenesis, lipogenesis)
84
What is the most potent stimulant for beta cells in the pancreas?
(Increased blood glucose)
85
Does glucagon stimulate or inhibit insulin secretion?
(Stimulate)
86
Decreased blood glucose stimulates or inhibits alpha cell secretions?
(Stimulates)
86
Does insulin stimulate or inhibit glucagon secretion?
(Inhibit)
87
Does insulin stimulate or inhibit glucagon secretion?
(Inhibit)
88
What is the purpose of delta cells (so what do they secrete) and their secretions?
(Delta cells secrete somatostatin which inhibit both alpha and beta cell secretions)
89
What is acute pancreatitis?
(Activation of pancreatic digestive enzymes within the pancreas which leads to autodigestion of the pancreas and surrounding tissue)
90
Is serum amylase included in a routine CBC/chem?
(Yes)
91
What are the three causes of increased amylase?
(Pancreatitis, decreased GFR, and pancreatic neoplasia)
92
You got a CBC/chem back on a dog that you had seen for the first time without getting medical records and their lipase was increased, what do you need to determine from their medical records once you get them that could explain this increase as nonpathologic?
(If they have been on glucocorticoids recently)
93
What types of neoplasms can increase lipase serum levels?
(Pancreatic, GI, biliary, and hepatic)
94
Greater than how many times the upper reference interval should AMS and/or LPS be to indicate pancreatitis?
(>3-4x URI)
95
(T/F) A normal AMS and LPS rules out pancreatitis.
(F)
96
What is the specific pancreatic lipase test that is more specific and sensitive for pancreatitis in dogs and cats?
(Pancreatic lipase immunoreactivity/PLI)
97
You use a SNAP cPL on a patient that has a 2 day history of anorexia and abdominal discomfort and it comes back positive, what is your next step?
(Treat for pancreatitis but send out confirmatory test)
98
Why is there a mild to no increase in AMS/LPS with acute episodes in a chronic pancreatitis patient?
(There is not enough pancreatic mass (d/t acinar necrosis resultant of continued inflammation) left to result in an increased AMS/LPS)
99
What is the more common cause of EPI in dogs?
(Idiopathic pancreatic acinar atrophy)
100
What is the more common cause of EPI in cats?
(Chronic pancreatitis with destruction of acinar cells)
101
Is a (decreased or increased) TLI test diagnostic for exocrine pancreatic insufficiency?
(Decreased TLI is diagnostic for EPI)
102
Why should patients be fasted when performing a TLI test?
(Trypsin is increased post prandially)
103
If you get a gray zone result on your TLI test that you performed on a fasted dog with no history/clinical signs of acute pancreatitis, what should you do?
(Retest in 1 month)
104
What are the two etiologies for decreased folate?
(Proximal SI disease or dietary deficiency)
105
Does EPI increase or decrease folate?
(Increase)
106
Does EPI increase or decrease cobalamin?
(Decrease)
107
(T/F) Folate and cobalamin will only be decreased in cases of chronic (so not acute) malabsorptive disease.
(T)
108
(T/F) Malabsorptive diseases should be tested for prior to maldigestive diseases.
(F, other way around)
109
What three structures form the ‘portal triad’?
(Portal vein, bile duct, and hepatic artery)
110
Which zone of the hepatic acinus receives the greatest oxygen content but is also the first to be affected by toxins?
(Zone 1)
111
Which zone is also known as the pericentral vein zone and is the most susceptible to ischemia?
(Zone 3)
112
Which cell type of the liver is responsible for biliary secretions and immune response?
(Cholangiocyte)
113
What are Kupfer cells?
(Hepatic macrophages)
114
In which zone is the highest number of Kupfer cells found?
(Zone 1)
115
Which cells of the liver store lipids and vitamin A?
(Stellate cells)
116
What are the three major functions of the liver?
(Processing of nutrients, synthesis, and protection and clearance)
117
Why does glycogen need to be broken down into glucose through glycogenolysis to be used in the body?
(Because glycogen is insoluble and unable to travel in the blood to tissue that needs it, glucose is soluble)
118
What do fatty acids undergo to create energy in the form of ketones, which occurs when glucose is not available?
(Beta oxidation)
119
All of the coagulation factors are synthesized in the liver with two exceptions, what are those two exceptions?
(von Willebrand factors and factor VIII)
120
What effect does hypoalbuminemia have on the Starling forces and what results from that effect?
(Decreased oncotic pressure → cavitary effusions and edema)
121
What is cholesterol used to synthesize in the liver and what is the purpose of the result?
(Bile salts → emulsify fat and fat soluble vitamins)
122
What is phase I of biotransformation of toxins/drugs mediated by?
(Cytochrome P450 proteins)
123
What is the purpose of phase II of biotransformation of toxins/drugs?
(Increase water solubility for excretion purposes)
124
What does the liver convert ammonia into to prevent it from entering systemic circulation and affecting the CNS?
(Converts ammonia to urea)
125
Unconjugated bilirubin is insoluble so it travels through blood and to the liver bound to what protein?
(Albumin)
126
What occurs in the liver to form conjugated bilirubin from unconjugated bilirubin?
(Glucuronidation of unconjugated bilirubin)
127
What two things can cause prehepatic jaundice?
(Overproduction of bilirubin and impaired uptake of bilirubin by the liver)
128
What is the main mode of excretion for excess copper?
(Through bile excretion)
129
What structure is the demarcation point between the hepatic ducts and the common bile duct?
(The cystic duct)
130
What hormone triggers interdigestive stage gallbladder contraction?
(Motilin)
131
What neurohormonal controls trigger gallbladder contraction postprandially? Two answers.
(Vagal stimulation and cholecystokinin secretion)
132
What hormone, which is released when bile salts enter the duodenum, induce relaxation of the gallbladder and contraction of the sphincter of oddi?
(Somatostatin)
133
As you (increase or decrease) hydrophilicity of bile acids, you increased cytotoxicity.
(Decrease)
134
What do cats use to conjugate bile acids?
(Taurine)
135
What do dogs use to conjugate bile acids? Two answers.
(Taurine and glycine)
136
Where are bile acids reabsorbed in the GI tract?
(Ileum)
137
(T/F) Hepatic enzyme leakage cannot indicate the cause or location of hepatic injury, just that there is an injury.
(T)
138
How can you determine between an increase in ALT or AST being due to liver or muscle disease on your CBC/chem in a small animal patient?
(CK will also be increased in a case of muscle disease)
139
What drugs can cause an increase in ALT?
(Anticonvulsants and steroids)
140
What disease in cats can cause an increase in ALT not related to muscle or liver disease?
(Hyperthyroidism)
141
If you have an increased AST, does this indicate an acute or chronic injury?
(Acute)
142
You are presented with a middle aged female intact dog whose ALT is lower than their AST, what abnormality is indicated?
(Pyometra)
143
AST is primarily used as a hepatocellular damage indicator in large or small animals?
(Large)
144
What are the two induction or cholestatic enzymes?
(ALP and GGT)
145
(T/F) Cholestasis of any cause results in production of the induction enzymes.
(T)
146
Why do cholestatic enzymes not readily ‘leak’?
(They are membrane bound)
147
Why can ALP be nonpathologically increased in young animals?
(ALP has a bone isoenzyme which is increased in growing animals)
148
Which species is ALP a good marker for cholestatic disease?
(Dogs)
149
You are presented with a feline patient who hasn’t eaten in a few days. Both ALP and GGT are increased but ALP is more increased than GGT, what is this indicating?
(This cat has hepatic lipidosis)
150
You are presented with an animal with a confirmed renal injury, would you expect both their urine and serum to contain GGT?
(Just urine, no serum increase of GGT with renal injury)
151
How does GGT levels in calves indicate failure of passive transfer?
(GGT is in mammary glands so it is in colostrum, if calves do not receive colostrum then their GGT will not be increased)
152
If you have decreased liver function, your…
Bilirubin will be increased or decreased?
(Increased)
153
If you have decreased liver function, your…
BUN will be increased or decreased?
(Decreased)
154
If you have decreased liver function, your…
Albumin will be increased or decreased?
(Decreased)
155
If you have decreased liver function, your…
Bile acids will be increased or decreased?
(Increased)
156
If you have decreased liver function, your…
Glucose will be increased or decreased?
(Decreased)
157
If you have decreased liver function, your…
PT/PTT times will be increased or decreased?
(Increased)
158
If you have decreased liver function, your…
Cholesterol will be increased or decreased?
(Decreased)
159
If you have a blockage of the canaliculi of the liver, do you expect your (unconjugated or conjugated) bilirubin to be increased?
(Conjugated)
160
If you have a failure at the level of the hepatocyte, do you expect your (unconjugated or conjugated) bilirubin to be increased?
(Unconjugated)
161
What species has a higher serum bilirubin than other species?
(Horses)
162
Horses can have an increase in bilirubin with gut stasis and inappetance, will the increased bilirubin be conjugated or unconjugated?
(Unconjugated)
163
The presence of bilirubin in the urine of what species usually indicates liver disease?
(Cats)
164
(T/F) Bilirubinuria is normal in dogs if their urine is concentrated (SG > 1.035).
(T)
165
What is indicated if your patient has only an increased preprandial bile acid (post is WNL)?
(Premature contraction of the gallbladder or they were unfasted)
166
What is indicated if your patient has decreased postprandial bile acids?
(Delayed gastric emptying or intestinal absorption disorder)
167
What changes would you expect to see on a bile acids test if you suspect there is altered portal blood flow, decreased hepatic function, or a biliary obstruction?
(Increased postprandial bile acids)
168
What are two physiologic causes of increased ammonia/decreased urea?
(High protein meals and intense exercise)
169
Portosystemic shunts, hepatic insufficiency, and disorders of the urea cycle will result in an increased/decreased ammonia and an increased/decreased urea.
(Increased ammonia, decreased urea)
