Digestion Flashcards
What enzyme does the salivary glands and pancreas breaks down dietary carbohydrates?
Salivary glands - salivary amylase
Pancreas - Pancreatic amylase
What are the 3 breakdown products of dietary carbohydrates?
What are there breakdown products?
Sucrose - Glucose and fructose
Maltose - Glucose x2
Lactose - Glucose and galactose
What do parietal cells secrete that helps in the digestion of dietary protein?
H+ and Cl- > HCL
What do chief cells secrete that helps in the digestion of dietary protein?
Pepsinogen that gets converted to pepsin by HCL from parietal cells.
What enzyme does the duodenum release that helps to break peptides?
Duodenum release enterokinase, which converts trypsinogen into trypsin
What organ releases trypsin and other pro-enzymes?
Pancreas (exocrine part)
How do the salivary glands, stomach, gastric chief cells and gall bladder help in the digestion of dietary fats?
Salivary glands - lingual lipase
Stomach - mechanical emulsification
Chief cells - Gastric lipase
Gall bladder - Bile (from liver)
What enzyme does the pancreas release that breaks down triglycerides?
Pancreatic lipase converts triglycerides into monoglycerides and FAs
You encounter Mr T in clinic; he is 56 years old and a retired plumber. The nurse practitioner draws some blood for routine tests and measures his height (176 cm) and weight (123 kg). He has been trying to watch what he eats, but has made very few changes since his diagnosis last year. He mentions that he’s not as thirsty as he used to be, and no longer suffers from blurred vision. Once the blood is drawn you notice on the request card that one of the tests is called glycated haemoglobin (HbA1C).
What is his likely condition?
Identify on one of your flowcharts where the underlying problem can be addressed.
What treatment(s) would you recommend?
Identify three potential consequences if left untreated.
T2DM
Insulin insensitivity; not enough insulin release (on food intake)
Lifestyle modifications, weight loss, glucose-lowering medications
Diabetic nephropathy, diabetic retinopathy, diabetic foot-foot ulcers
On your PCH hospital attachment you meet a patient during a walk-in rapid access chest pain clinic. Mr P, a 45-year old male, has been suffering from episodic central chest pain. The chest pain does not radiate down the left arm and is not associated with breathlessness. He adds that the pain does not disappear with rest. Anecdotally, he mentions that he has been experiencing a throaty cough, despite not having any other cold-like symptoms. The cardiology SpR refers the patient for an exercise tolerance test, which comes back negative.
What is your diagnosis?
What does an exercise tolerance test involve?
Identify on one of your flowcharts where the underlying problem can be addressed.
What treatment would you recommend?
GORD
Recording heart function whilst increasingly intensive
Parietal cells - H+ ions (acid overproduction)
Proton pump inhibitor for 4-8 weeks (Omeprazole, lansoprazole)
Offer H2 receptor antagonist if protein pump inhibitor doesn’t work.
On your GP placement you encounter Miss G, a 14-year old girl that has been experiencing periodic abdominal pain and excessive flatulence. She is passing frequent watery stools, and experiences nausea- like symptoms which are affecting her at school. She notices that her symptoms are worst around 10:00 a.m. and she eats a normal diet for her age (i.e. cereal for breakfast, sandwiches and crisps for lunch, and a cooked meal for dinner).
What is your diagnosis?
Explain her symptoms in the context of her diagnosis.
Identify on one of your flowcharts where the underlying problem can be addressed.
What treatment(s) would you recommend?
Lactose intolerance
Pain and flatulence caused by commensal bacteria feeding off undigested sugars.
Watery stools due to increased motility and osmotic potential.
Timing important for milk as she eats cereal (has milk) for breakfast, but not gluten (as sandwiches don’t lead to symptoms - i.e. no lactose).
Lack of lactase acting on lactose.
Avoid milk and other dairy products (lifestyle change)
During a work experience placement in an obstructive sleep apnoea clinic your consultant sees Mrs H, a non-diabetic 39-year old female, for her annual check-up. She is compliant with her continuous positive airway pressure (CPAP) device, which keeps her airway patent at night, so her nocturnal apnoeas are well- controlled. However, she is keen to get off the device as the noise of the machine is keeping her husband up at night. She is keen to lose weight (2015: 142 kg; today: 148 kg) and has tried diet and exercise with little success. Her blood glucose is normal. She is reluctant to pursue surgical options and asked if there are any pharmacological treatments that may help.
What is obstructive sleep apnoea?
Identify on one of your flowcharts where the underlying problem can be addressed.
Would there be any side effects?
Is it appropriate to treat obesity with surgery and/or medication?
Closure of airways overnight due to cervical obesity, fluid migration
& decreased airway tone. Causes frequent desaturations resulting in microarousal, preventing effective sleep & regular hypoxic dips in saturation.
Obesity is affecting breathing. more soft tissue in mouth and throat. Pancreatic lipase can be targeted.
Pancreatic lipase
Steatorrhoea, flatulence, abdominal pain
Treat patients without discrimination
