Exam #4 CLINICAL CASES

Question 1

What condition involves LES fails to relax (possibly due to myenteric plexus degeneration)?

Answer 1

Achalasia

Question 2

What condition involves loss of LES tone?

Answer 2

Reflux Esophagitis

Question 3

MOA of Atropine? Action of Atropine?

Answer 3

Inhibits ACh binding to parietal cell

- Inhibits HCl secretion

Question 4

MOA of Cimetidine? Action of Cimetidine?

Answer 4

Inhibits histamine binding from H2 receptor

- Inhibits HCl secretion

Question 5

MOA of Omeprazole? Action of Omeprazole?

Answer 5

Inhibits the H/K pump directly = proton pump inhibitor

- Inhibits HCl secretion

Question 6

What condition involves excess acid secretion +/- GMB damage?

Answer 6

Peptic Ulcer Disease

Question 7

What is a possible bacterial cause of Peptic Ulcer Disease? What is another possible cause?

Answer 7

H. pylori

- Also NSAIDs

Question 8

What are four potential treatments for Peptic Ulcer Disease?

Answer 8

• H2 blockers
• Omeprazole
• Pepto-Bismol
• Abx if H. pylori

Question 9

With vomiting, what two structures are contracted and which four are relaxed?

Answer 9

CONTRACTED: diaphragm and abdominal muscles
- Diaphragm contracted, abdominal muscles contract = increases intraabdominal pressure

RELAXED: stomach, esophagus, LES, UES
- Stomach, esophagus, LES relax so stomach is squeezed between diaphragm and viscera → UES relaxes, vomit projected into mouth (glottis closed to prevent aspiration)

Question 10

What is the primary component of gallstones? What three things increase the formation of gallstones?

Answer 10

Cholesterol

Gallstone formation increased with…

• Bile stasis (poor turnover)
• Supersaturation of cholesterol in bile
• Nucleating factors (composition)

Question 11

What can initiate gallstone formation via beta-glucuronidase?

Answer 11

E. coli

Question 12

What symptom do Carb Digestion/Absorption Disorders cause? What is often the cause?

Answer 12

Osmotic diarrhea due to unabsorbed carbs as a result of enzyme deficiency

Question 13

What symptom does Lactase Deficiency cause?

Answer 13

Osmotic diarrhea due to unabsorbed lactose

Question 14

What enzyme is low with Pancreatic Insufficiency (CF), and what does this result in?

Answer 14

Low trypsin = decreased protein absorption

- Causes malabsorption

Question 15

What is Hartnup Disease? What part of protein digestion is NORMAL with this disorder?

Answer 15

Congenital defect in transport of neutral AAs

- Dipeptide/tripeptide transport normal

Question 16

What is Cystinuria? What does this result in?

Answer 16

NO transporter for dibasic AAs (cystine, lysine, arginine) in gut/kidney
- Results in AAs lost in urine

Question 17

What is Whipple’s Disease, and what does it mean for lipids?

Answer 17

Abnormal absorption

- Lipids digested but NOT transported

Question 18

Diarrhea results in what lab abnormality and acid-base disorder?

Answer 18

• Metabolic acidosis

- Hypokalemia

Question 19

What condition involves increased cAMP stimulates Cl- secretion → Na+ and water follow Cl- into lumen and this causes osmotic diarrhea?

Answer 19

Secretory Diarrhea = Cholera

Question 20

What condition involves gastrinoma = increased gastrin secretion?

Answer 20

Zollinger-Ellison Syndrome (ZES)

Question 21

What condition involves gastrin secretion NOT regulated by feedback = always secreted?

Answer 21

Zollinger-Ellison Syndrome (ZES)

Question 22

What two symptoms are seen with Zollinger-Ellison Syndrome (ZES)?

Answer 22

• Oily diarrhea/steatorrhea

- Gastric ulcers

Question 23

What two tests can be used to evaluate for Zollinger-Ellison Syndrome (ZES)?

Answer 23

• Secretin Stimulation Test

- Pentagastrin Stimulation Test

Question 24

What condition involves the Secretin Stimulation Test, and how does this work?

Answer 24

Zollinger-Ellison Syndrome (ZES)
- Secretin stimulates gastrin release from gastrinoma cells so if ZES and given secretin → gastrin increases

• IF no ZES, gastrin is low/unchanged

Question 25

What condition involves the Pentagastrin Stimulation Test, and how does this work?

Answer 25

Zollinger-Ellison Syndrome (ZES)
- If given Pentagastrin, H+ stimulates further secretion so if ZES and given pentagastrin → no effect on H+ (H+ already maximal so no effect)

• IF no ZES, H+ would increases with Pentagastrin

Question 26

What is the treatment for Zollinger-Ellison Syndrome (ZES)?

Answer 26

Omeprazole

Question 27

What two symptoms are seen with an Ileal Resection?

Answer 27

• Oily diarrhea/steatorrhea

- Foul-smelling stools

Question 28

What condition involves bile slats lost faster than liver can replace; lipid digestion impaired?

Answer 28

Ileal Resection

Question 29

What two treatments are recommended for Ileal Resection?

Answer 29

• Cholestyramine

- Vitamin B12 injections

Question 30

What are the three possible pathophysiology components involving Peptic Ulcer Disease (PUD)?

Answer 30

• Mucous barrier lost
• High H+/high Pepsin
• Combination of both

Question 31

With Peptic Ulcer Disease (PUD) caused by H. pylori, what is the cause of gastric ulcers (3)?

Answer 31

• Bacteria colonization of gastric mucous/epithelial cells
• Bacteria release cytotoxins
• Bacteria release urease alkalinizes stomach = can survive longer

Question 32

With Peptic Ulcer Disease (PUD) caused by H. pylori, what is the cause of duodenal ulcers?

Answer 32

Low somatostatin → high gastrin - Leads to high H+ AND low HCO3

Question 33

What two tests can be used to evaluate Peptic Ulcer Disease (PUD) caused by H. pylori?

Answer 33

• Serology testing (H. pylori antibodies)

- 13C-urea breath test

Question 34

What two treatments are recommended for Peptic Ulcer Disease (PUD) caused by H. pylori?

Answer 34

• Abx

- Omeprazole