010715 stomach disorders 2

Question 1

fundus

Answer 1

upper part of the greater curvature

Question 2

normally, at the distal stomach, what is the motor fxn like?

Answer 2

baseline slow wave activity (3/min) mediated by interstitial cells of Cajal

contractions that are vagally mediated sweep in a ring towards pylorus

Question 3

how does the pyloric sphincter react to food coming into antral ring?

Answer 3

it times its closure with oncoming antral ring contractions to act as a sieve for large particles

Question 4

triturition

Answer 4

larger solids in the somtach at the antral ring are retropelled back by the pyloric sphincter

Question 5

secretin is released when?

Answer 5

in response to entry of lipids, amino acids, or HCl into the duodenum

Question 6

CCK is release when?

Answer 6

in duodenum in response to delivery of fat

Question 7

glucose-dependent insulinotropic peptide is secreted when?

Answer 7

secreted in sm intestine in response to glucose delivery

also secreted in response to colonic fermentation of carbs and intraduodenal gluatmine, aminoa acids, fatty acids

Question 8

effect of GIP

Answer 8

inhibitory effect on gastric motility occurs earlier than effects on insulin secretion

Question 9

glucose’s effect on gastric emptying

Answer 9

glucose empties at constant rate from stomach regardless of concentration

however, if blood glucose levels are high, it delays solid and liquid meal emptying from stomach

Question 10

gastric emptying scintigraphy

Answer 10

nuclear medicine test to assess emptying non-invasively

detects amt retained at set points in time

Question 11

gastric emptying scintigraphy results depend on

Answer 11

meal used (will determine the normal values)

Question 12

fasting motor activity

Answer 12

occurs at end of meal
occurs every 90 min with fast
it’s maximum strength, frequency (3/min) and coordination of contractions

to allow clearance of large indigestible solids from gut

Question 13

consequences of accomodation failure?

Answer 13

limits amt that can be ingested w/o discomfort

food moves too rapidly into small bowel:

• –excessive distension causes fluid to enter lumen due to osmotic gradient (results in bloating, pain, symptomatic hypotension)
• –poor digestion (weight loss, nutrient deficiencies)
• –unabsorbed foods get delivered to colon (colonic bacterial fermentation–increased flatus, bloating, cramps)
• –initial rapid increased in blood glucose in small bowel due to lag in insulin response (hypoglycemia)
• –unbuffered HCl goes to duodenum rapidly (ulcer, pain, maldigestion)

Question 14

consequences of contraction failure

Answer 14

impaired triturition of solids
delayed delivery to intestine
retention of gastric contents

consequences: pain, early staiety, nausea, vomiting, poor drug delivery

Question 15

consequences of MMC failure

Answer 15

bezoar formation, poor drug delivery, bacterial overgrowth

Question 16

gastroparesis

Answer 16

delayed gastric emptying in the ABSENCE OF MECHANICAL OBSTRUCTION and in the presence of symptoms including early satiety, postprandial fullness, nausea, vomiting, bloating, and upper abd pain

Question 17

causes of gastric sensory/motor dysfxn–structures intact

Answer 17

electrolyte disturbances (low K)-affects sm musc fxn
hyperglycemia
renal failure with uremia
hypothyroidism
mesenteric ischemia
cortical effects (motion sickness, stress)
meds

Question 18

medication induced gastric emptying delay can be caused by what meds?

Answer 18

anticholinergics
opiates
NSAIDs
pramlintide
exenatide (GLP-1 receptor agnoist)
cyclosporine

Question 19

causes of gastric motor dysfxn-motor structures are abnormal

Answer 19

infatile pyloric stenosis
hollow visceral myopathies
connec tissue disease (atrophy of sm musc)
gastric resection (ulcer surgery)
fundoplication wrap for reflux disease (alters accomodation)

Question 20

causes of gastric motor dysfxn (neural structures abnormal)

Answer 20

Parkinson's
multiple sclerosis
amyloidosis
viral infection or autoimmune
paraneoplastic syndrome
TRAUMA/SURGICAL (VAGAL INJURY!!!!!!!!!!!!!)

Question 21

visceral hyposensitivy

Answer 21

reduced ability to detect and respond to pathologic processes (greater complications-ulcer)

Question 22

succussion splash implies

Answer 22

gas and fluid in an organ with obsruction

Question 23

downstream effects of vagal injury caused by surgery/trauma

Answer 23

opposite effects on solids and liquids:
poor accomodation–liquids empty rapidly
poor antral grinding–solids empty slowly