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GEM > 2.09 Reflexes, Fluid, and Electrolyte Balance > Flashcards

2.09 Reflexes, Fluid, and Electrolyte Balance Flashcards

1
Q

What is the basal state of stomach secretion?

A

low H+ secretion
circadian rhythm
lower between meals

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2
Q

What are the 3 phases of acid secretion?

A

cephalic
gastric
intestinal

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3
Q

Phase where 30% HCl secreted into gastric lumen prior to entry of food into stomach sensed by chemo/mechanoreceptors (stimuli) mediated by vagus nerve?

A

cephalic phase

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4
Q

What are the mechanisms at play for the cephalic phase?

A

vagus nerve
parietal cells
ECL cells
GRP - G cells
(inhibition) D cells-somatostatin

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5
Q

Phase where 60% Hcl secreted with food now in the stomach stimulated by distension and partially digested proteins (G cells)?

A

gastric phase

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6
Q

Gastric phase mechanism?

A

Local ENS reflex - ACh

Vagoavagal reflex
(Antral G cell + ECL)
ACh + GRP + Gastrin

Gastrin-Histamine Stim

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7
Q

What receptor does ACh attach to on the Antral G cell, ECL cell, and parietal cell respectively?

A

M3

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8
Q

Phase where 10% HCl secreted when food leaving the stomach and entering the intestine, the small intestine can signal the stomach to make more acid since it doesn’t have parietal cells?

A

Intestinal Phase

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9
Q

Mechanism for intestinal phase?

A

protein digestion products trigger
(G cell + endocrine cell + absorbed AA)
gastrin & “entero-oxyntin” to parietal cells

Nervous & Humoral

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10
Q

hormone
released by the duodenum in response
to acidic chyme entering from the
stomach

A

Secretin (from S cells)

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11
Q

Secretin will work to trigger what from the pancreas to help
neutralize the acid in the upper
duodenum?

A

bicarbonate
(HCO3-)

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12
Q

What generally excites pepsin and acid production?

A

parasympathetics

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13
Q

What CCK? What does it do?

A

From I cells @duodenum they allow pancreas,
gallbladder, stomach
Increase enzyme secretion, contracts
gallbladder, decreases gastric emptying

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14
Q

What is absorbed at the small intestine?

A

Water, Sodium, Chlorine, Potassium

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15
Q

What is secreted at the small intestine?

A

HCO3

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16
Q

How much of the 8.5L/day fluid load that reaches the small intestine is reabsorbed?

A

6.5L/day

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17
Q

What makes up the body fluid load that the small and large intestine work at reabsorbing?

A

food, saliva, secretions (gastric, pancreatic, bile, small intestine)

18
Q

How much of the 2L/day fluid that reaches the colon reabsorbed? How much is excreted in feces?

A

1.9L/day reabsorbed

0.1L/day excreted

19
Q

What is the max absorptive capacity of the colon?

A

4-6L/day

20
Q

What is absorbed at the distal colon?

A

Water, Na, Cl

21
Q

What is secreted at the distal colon?

A

K+ and HCO3

22
Q

What happens if there is excess fluid at the colon?

A

diarrhea

23
Q

What is required to maintain the Na+ driving force across the apical membrane?

A

Na+/K+ pump

24
Q

What kind of absorption is dominant in the small intestine?

A

Na+ nutrient coupled (ex. glucose + AA)

25
Q

An increased prevalence of what in the intestinal lumen can help enhance Na+ absorption?

A

glucose or amino acids

26
Q

How does glucose stimulate more Na+ reabsorption at small intestine?

A

osmotic
gradients (cAMP independent)

27
Q

What can you recommend that a mild dehydrated and acidotic patient with diarrhea take to replenish absorption?

A

oral rehydration solution (ORS)
(Glucose + electrolytes)

28
Q

How does the small intestine and colon absorb Na+?

A

apical and basolateral membrane transport
processes (passive and active)

29
Q

How does the small intestine and colon absorb Cl-?

A

apical and basolateral membrane transport
processes or paracellular/transcellular* (passive)

30
Q

What are the ways that Cl- can be reabsorbed?

A

passive trans/paracell
Cl-HCO3 exchange
Na-H parallel

31
Q

Where does the electrogenic Cl- secretion occur?

A

crypts of small and large intestine

32
Q

What are the Cl- secretion mechanisms?

A

Na-K pump
Na/K/Cl cotransporter
2 types of K+ channels

33
Q

What is the Cl- channel present at the apical membrane?

A

cystic fibrosis
transmembrane conductance
regulator [CFTR]

34
Q

The net result of Cl- secretion is responsible for what?

A

secretion of NaCl

35
Q

What parts of the GI are responsible for the dynamic K+ reabsorb/secrete balance?

A

small intestine
absorbing K+

distal intestine secreting K+

36
Q

How does K+ absorption in small
intestine likely occurs?

A

solvent drag

37
Q

How does passive K + secretion in
colon occurs?

A

lumen-negative
Vm via tight junctions

38
Q

How is active K + secretion
mediated?

A

aldosterone
and cAMP

39
Q

Where does active K+ secretion take place and what fuels it?

A

distal colon fueled by apical H-K pump

40
Q

What are common Vitamin K food sources?

A

brussels sprouts, pork chops, avocadoes, broccoli, kale, spinach, liver, chicken, kiwi, prune, green beans and peas

GEM (28 decks)

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