Exam 1 Material

Question 1

Antacids

Answer 1

calcium or sodium blockers, treatment for GERD

Question 2

Histamine-2 receptor blockers

Answer 2

dimetidine, ranitidine, Famotidine, Nizatidine, treatment for GERD, decreases HCl acid secretion

Question 3

Proton Pump Inhibitors

Answer 3

Omeprazole, Iansoprazole, Esomeprazole, Pantoprazole, Rabeprazole, treatment for GERD

Question 4

Prokinetic/LES Pressure Changing Agent

Answer 4

Metoclopromide, Bethanechol, keeps LES closed better by also causes pyloric sprinter to open more and empty better

Question 5

Protective barrier (foaming) agent

Answer 5

Gaviscon, floats on top of gastric contents and prevents acid breakthrough if reflux occurs

Question 6

Barrett’s esophagus

Answer 6

changes cell types in esophagus from simple squamous to columnar, which increases risk for esophageal cancer

Question 7

Genetic Information Nondiscrimination Act

Answer 7

GINA, Bush administration, barred genetic discrimination in the federal government, states followed

Question 8

Chromosomal disorders

Answer 8

genetic disease due to chromosome piece missing or replicated, ex. Down syndrome

Question 9

Single gene disorders

Answer 9

PKU, cystic fibrosis, genetic diseases

Question 10

Multi-factorial disorders

Answer 10

genetic component but also environmental influence, genetic disease

Question 11

Nutrigenetics

Answer 11

how genes effect response to diet, like SNPs, modify diet to adjust for changes in genes to modify impact of SNP (phenotype), like folate and PKU

Question 12

Nutrigenomics

Answer 12

how diet (environment) effects expression of genes, like epigenetics

Question 13

TAS2R38 Gene

Answer 13

taste receptor gene, 3 SNPs, most common haplotype (allele) is Proline, Alanine, Valine (PAV) - bitter sensitivity, Alanine, Valine, Isoleucine (AVI) - bitter insensitivity, depends on which 2 alleles and environment

Question 14

MTHFR 677 C -> T

Answer 14

methylenetetrahydrofolate (methylene THF) reductase, enzyme in folate metabolism, impaired function increases concentration of homocysteine in blood, also impaired folate status increases risk for NTD 5x, may have protective effect for colorectal cancer (nonimpaired folate), increased risk of CVD

Question 15

Hyperhomocysteinemia

Answer 15

MTHFR 677 TT genotype, increases plasma homocysteine, increases vascular disease risk, but adequate folate reduces homocysteine concentration

Question 16

Agouti gene

Answer 16

affects coat color in mice, hypomethylation - yellow and fat (expression), hypermethylation - brown and thin (lack of expression), modify via mother’s diet

Question 17

Acetylation of histones

Answer 17

opens up DNA for access (de-acetylation compacts histone again)

Question 18

Histamine

Answer 18

vagus nerve stimulates histamine production, histamine binds to receptor to product HCl acid

Question 19

Factors that affect mucosal integrity

Answer 19

Induce mucosal integrity: Helicobacer pylori infection, NSAIDs/aspirin, steroids. Reduce mucosal blood flow: smoking, trauma/burn injury. Both: excessive alcohol

Question 20

Prostaglandins

Answer 20

stimulate production of mucus, NSAIDs (like aspirin) interfere with production

Question 21

H. Pylori in gastritis and PUD

Answer 21

Barry J. Marshall and J. Robin Warren

Question 22

Peptic Ulcer Disease

Answer 22

erosion of mucosal lining of stomach or duodenum

Question 23

Achalasia

Answer 23

motility disorder - failure of LES to relax properly, disordered swallowing, to much acetylcholine, not enough vasoactive inhibitory peptide (VIP) or nitric oxide (imbalance)

Question 24

Esophagitis causes

Answer 24

Infection, irritating agents, intubation, radiation (which may turn chronic)

Question 25

Factors that increase acid secretion

Answer 25

pepper, alcohol, caffeine, decaff coffee, stress (increase Ach and HCl), higher than normal max and basal acid production, Zollinger Ellison syndrome

Question 26

Zollinger Ellison syndrome

Answer 26

gastrin-producing tumors, usually small, can be anywhere, only effect stomach (stimulates it to produce HCl acid)

Question 27

H. Pylori and PUD

Answer 27

produce urease/toxins, burrow in mucus layer of stomach, secrete cytokines (proteins interact with epithelial cells/attract macrophages & neutrophils/inflammation results/cell death, exogenous factors contribute to impaired mucosal defense

Question 28

Urease

Answer 28

metabolizes urea into carbon dioxide and ammonia to make pH higher (more basic) and better micro environment for H. pylori

Question 29

Indications for gastric surgery

Answer 29

gastric retention, severe/uncontrolled hemorrhage, perforation, ZE syndrome (rare)

Question 30

Vagotomy

Answer 30

parietal cell (secretes gastrin) vagotomy (selective), or truncal vagotomy + pyloroplasty (cut out whole vagus nerve)

Question 31

Pyloroplasty

Answer 31

pyloric sphincter widen because no vagus nerve to say when to open or close

Question 32

Billroth I gastric surgery

Answer 32

Removal of part of stomach with anastomosis (reconnection) of proximal end of intestine (duodenum) to distal end of remaining stomach

Question 33

Billroth II gastric surgery

Answer 33

Removal of part of stomach, anastomosis of remaining stomach along a section of the intestine (jejunum), skip duodenum

Question 34

Roux-en-Y gastric surgery

Answer 34

bypasses most of the stomach by constructing a small stomach pouch and connecting jejunum directly to the pouch (used for obese patients)

Question 35

Normal defense and repair mechanisms

Answer 35

mucus production, bicarbonate production, removal of excess acid by blood flow, renewal and repair of epithelial cells (every 2-3 days).

Question 36

Level 1 National Dysphagia Diet

Answer 36

moderate to sever dysphagia with poor oral phase ability, reduced ability to protect airway, baby food

Question 37

Level 2 National Dysphagia Diet

Answer 37

transition to more solid foods, chewing ability required, mild to moderate oral and/or pharyngeal dysphagia, chopped or minced food

Question 38

Level 3 National Dysphagia Diet

Answer 38

transition to regular diet, adequate dentition and mastication required, mid oral and/or pharyngeal dysphagia

Question 39

6 food elimination diet

Answer 39

cow's milk protein, soy, peanuts, wheat, egg, fish/shellfish

Question 40

Gluten free labeling

Answer 40

less than 20 ppm/serving, not 0 gluten because cannot test, only for foods under FDA restriction

Question 41

Uracil misincorporation

Answer 41

not an epigenetic modification, incorporates uracil into DNA when in a folate deficiency, causes DNA strand breaks and instability