Exam 4

Question 1

What cells secrete hydrochloric acid and intrinsic factor, gastroferrin?

Answer 1

Parietal cells

Parietal cells also secrete intrinsic factor and gastroferrin.

Question 2

What cells secrete pepsinogen?

Answer 2

Chief cells

Chief cells secrete pepsinogen which is then converted to pepsin in the presence of acid.

Question 3

What cells secrete gastrin?

Answer 3

G cells

G cells secrete gastrin which stimulates hydrochloric acid secretion.

Question 4

What cells secrete histamine?

Answer 4

Enterochromaffin-like cells

Enterochromaffin-like cells secrete histamine which stimulates hydrochloric acid secretion.

Question 5

What cells secrete somatostatin?

Answer 5

D cells

D cells secrete somatostatin which inhibits hydrochloric acid secretion.

Question 6

What is the function of the small intestine?

Answer 6

Includes duodenum, jejunum, and ileum where most absorption occurs

Villi are the functional units of the intestine where absorption occurs.

Question 7

What is the function of the large intestine?

Answer 7

Includes cecum, appendix, colon, rectum, anus

The large intestine absorbs water and electrolytes and has goblet cells but no villi for absorption.

Question 8

What is the function of the liver?

Answer 8

Largest solid organ; synthesizes bile, stores blood, metabolizes carbs, makes toxins less harmful, and stores minerals and vitamins

Hepatocytes are the functional unit of the liver.

Question 9

What is the function of the gallbladder?

Answer 9

Stores and concentrates bile between meals

The gallbladder forces bile to flow into the duodenum through the sphincter of Oddi.

Question 10

What is the function of bile?

Answer 10

Alkaline fluid necessary for fat digestion and absorption

Bile salts are required for the emulsification and absorption of fats.

Question 11

What is bilirubin?

Answer 11

Pigment by-product of aged red blood cell destruction in the liver and spleen

Unconjugated bilirubin is lipid soluble and present in circulation bound to protein.

Question 12

What is unconjugated bilirubin?

Answer 12

lipid soluble and can cross cell membrane, present in circulation bound to protein

Produces yellow tinge in jaundice.

Question 13

What is conjugated bilirubin?

Answer 13

combined with a sugar to water soluble by the liver so it can be excreted in the bile.

Question 14

What does a high percentage of unconjugated bilirubin indicate?

Answer 14

heme breakdown (hemolytic anemia) or inability of the liver to conjugate

Question 15

What does a high percentage of conjugated bilirubin indicate?

Answer 15

there is a problem with the secretion into bile like hepatitis, or obstruction.

Question 16

What is anorexia?

Answer 16

lack of desire to eat, non specific symptom

Question 17

What is vomiting?

Answer 17

forceful emptying of the stomach and intestinal contents. Can cause metabolic consequences like hyponatremia, hypokalemia, hypochloremia, and metabolic alkalosis.

Question 18

What is constipation?

Answer 18

infrequent or difficult defecation

-Normal transit: normal rate but difficulty from low residue, low fluid diet
-Slow transit: impaired colonic motor activity, infrequent BMs and straining
- Pelvic floor dysfunction: failure of the pelvic floor muscles or sphincter to relax

Question 19

What is diarrhea?

Answer 19

increased frequency or increased volume, fluidity, or weight. Can lead to dehydration, electrolyte imbalance, metabolic acidosis, and weight loss

-Large volume: caused by excessive amounts of water or secretions
-osmotic: nonabsorbable substance in the intestine draws water into the lumen by osmosis
-secretory: caused by excessive mucosal secretion of chloride or bicarb-rich fluid -Small volume: caused by increased intestinal motility
-motility: excessive motility decreases transit time, mucosal surface contact, and opportunities for fluid absorption

Question 20

What is the basic pathophysiology of abdominal pain?

Answer 20

stretching, inflammation, or ischemia

Question 21

What are the types of abdominal pain?

Answer 21

Parietal: in the peritoneum (localized and intense)
Visceral: in the organs themselves
RUQ: liver, gall bladder, bile duct
RLQ: appendix, right ovary/fallopian tube
LUQ: stomach, spleen
LLQ: descending colon, left ovary/fallopian tube

Question 22

What is melena?

Answer 22

black, tarry stools; upper GI bleed, Pepto-Bismol or iron intake

Question 23

What is dysphagia?

Answer 23

Difficulty swallowing can result from a mechanical or functional disorder.

-Mechanical:
-intrinsic: obstructions that originate in the wall of the esophageal lumen (tumors, strictures, diverticular herniations)
-extrinsic: originate outside the esophageal lumen and narrow the esophagus by pressing inward (tumor) Functional:
-caused by neural or muscular disorders that interfere with voluntary swallowing (CVA, PD)

Question 24

What is GERD?

Answer 24

Acid and pepsin refluxes from the stomach into the esophagus, causing esophagitis.

• Resting tone of LES tends to be lower than normal from either transient relaxation or weakness of the sphincter
  -Vomiting, coughing, lifting, bending, or obesity can contribute to GERD
  -Physiologic reflux: does not cause symptoms; acid is neutralized and clears in 1-
  3 minutes and LES tone is restored
  -NERD: symptoms but no visible mucosal injury
  -Reflux esophagitis: injury and inflammation
  -Manifestations: heartburn within 1 hour of eating, s/s worsen with lying down or increased intra-abdominal pressure

Question 25

Pyloric obstruction

Answer 25

The blocking or narrowing of the opening between the stomach and the duodenum Manifestations: epigastric pain, succession splash, vomiting that is copious and occurs several hours after eating (cardinal sign),