(F) L5: GITP Function: Stomach Flashcards
Major Zones
- Important for mucus secretion
- The mucus protects the lining of the stomach
Cardiac
Major Zones
Consists of the 2 significant cells: Parietal and Chief Cells
Body
Major Zones
- The location or secretion site of HCl, enzymes, mucus, and intrinsic factors due to the presence of the different cells
Body
Major Zones (Body)
These cells secrete mucus
Surface Epithelial Cells
Major Zones (Body)
These secrete HCl and intrinsic factors
Parietal Cells
Major Zones (Body)
This gives the stomach its acidic pH, which is important for digestion
HCl
Major Zones (Body)
This binds with vitamin B12 in order to be protected from the stomach’s acidity
Intrinsic Factors
Major Zones (Body)
These are responsible for the synthesis and secretion of serotonin
Enterochromaffin Cells
Major Zones (Body)
These produce pepsinogen (type 1 or 2)
Chief Cells
Major Zones (Body)
This, when combined with HCl will be deactivated and converted to pepsin
Pepsinogen
Note: Pepsin is the activated form of pepsinogen
Major Zones
This houses the antrum, pyloric canal, and sphincter
Pyloric
Major Zones (Pyloric)
This portion is made up of G cells which secretes gastrin
Antrum
Major Zones (Pyloric)
This is the primary GI hormone that stimulates the parietal cells to secrete gastric acid or HCl
Gastrin
Major Zones (Pyloric)
These portions (2) are important to prevent the direct passing through of the stomach contents into the intestines
- Pyloric canal
- Sphincter
What is the end product of digestion in the stomach?
Chyme/Gastric Secretion
Stimuli for Gastric Secretion
Gastric secretions occur in response to various stimuli, when gastric fluid decreases in pH, it is usually less than what?
3.5
Note: That pH is deadly for most microbes
Stimuli for Gastric Secretion
This acid protects the stomach from foreign microorganisms
Gastric Acid
Stimuli for Gastric Secretion
Consists of the vagal nerves (for smelling) which stimulates the stomach to secrete gastric fluid
Neurologic Stimuli
Stimuli for Gastric Secretion
This is due to the expansion of the mucosal lining
Stomach Distention
Stimuli for Gastric Secretion
The stomach secretes these breakdown products of proteins (usually amino acids, proteins, and polypeptides) which usually means that something needs to be digested
Secretagogues
Stimuli for Gastric Secretion
The most potent stimulus for gastric fluid secretion
Gastrin
Regulators of Gastric Secretions
These (2) are produced by the pancreas, not the stomach
- Secretin
- Cholecystokinin (CCK)
Regulators of Gastric Secretions
These (2) inhibit gastric secretion
- Gastric Inhibitory Polypeptide (GIP)
- Vasoactive Intestinal Polypeptide (VIP)
Regulators of Gastric Secretions
Produced by the pancreas:
A. Is secreted by K cells
B. Is secreted by H cells
C. Both
D. Neither
C. Both
Regulators of Gastric Secretions
Gastric Inhibitory Polypeptide (GIP)
A. Produced by the stomach
B. Produced by K cells
C. Both
D. Neither
B. Produced by K cells
Note: It is NOT produced in the stomach, only present
Regulators of Gastric Secretions
Vasoactive Inhibitory Polypeptide (VIP)
A. Produced by the pancreas
B. Produced by H cells
C. Both
D. Neither
D. Neither
Note: VIP is Vasoactive INTESTINAL Polypeptide, inhibitory is GIP
Regulators of Gastric Secretions
GIP and VIP
A. Produced by the pancreas
B. Inhibits gastric secretion
C. Both
D. Neither
C. Both
Gastric Diseases
- A HYPERsecretory and HYPERacidic stomach is present
- Related with pancreatic cell carcinoma/gastrinoma (tumors that produce gastrin)
- An increased gastrin leads to further stimulation of HCl secretion
- Presents with abdominal pain, dyspepsia, weight loss, chronic diarrhea, and GI bleeding
Zollinger-Ellison Syndrome
Gastric Diseases
TOF: A hyposecretion of gastric fluid leads to a hyperacidity of the stomach
False (HYPERSECRETION)
Gastric Diseases
An increase in gastrin stimulates the stomach to secrete more of what?
HCl
Gastric Diseases
- No production of HCl and IF due to autoantibodies against the parietal cells
- May also be related to megaloblastic anemia due to the lack of B12
Achlorhydia
Gastric Diseases
TOF: Achlorhydia is the opposite of Zollinger-Ellison Syndrome
True
Gastric Diseases
Overproduction
A. Zollinger-Ellison Syndrome
B. Achlorydia
C. Both
D. Neither
A. Zollinger-Ellison Syndrome
Gastric Diseases
Autoantibodies against the parietal cells leads to the defective production of what? (2)
- HCl
- IF
Gastric Diseases
- Is related to megaloblastic anemia
- There is gastric atrophy (absence of HCl) resulting to a stomach pH of only 6
- Prone to intestinal infections
Pernicious Anemia
Gastric Diseases
- No production of IF and no reabsorption of Vitamin B12
- RBC production is decreased
Megaloblastic Anemia
Gastric Diseases
No production of HCl and IF
A. Pernicious Anemia
B. Megaloblastic Anemia
C. Achlorhydia
D. All of the above
D. All of the above
Note: C lacks both, A lacks HCl, and B lacks IF
Gastric Diseases
Is associated with damage to the stomach lining
Peptic Ulcer
Gastric Diseases
Is caused by H. pylori that can resist acidic pHs due to its mucus
Helicobacter pylori infection
Gastric Diseases
H. pylori is able to resist what pH by producing what?
Acidic pH is resisted by the mucus
Gastric Function Tests
This is done during the fasting state
Basal Acid Output (BAO)
Gastric Function Tests
This is done by taking the BAO after stimulation with gastrin-like substances like pentagastrin or histamine
Maximal Acid Output (MAO)
Gastric Function Tests
The measurement of HCl after fasting to measure the basal state
Basal Gastric Secretion Determination (same as BAO)
Gastric Function Tests
A state in which a patient has not eaten, or ingested anything
Basal State
Basal Gastric Output Determination
It is required that the patient is at a fasting state for how many minutes (+ a good night’s sleep) before collection?
60 minutes
Basal Gastric Output Determination
After the insertion of a nasogastric tube (NGT) for how many minutes, the patient is positioned with the trunk upright and slightly inclined to the left?
10-15 minutes
Basal Gastric Output Determination
This position is done order to ensure that the fluid collected really comes from the stomach
Doggy style eme lang, INCLINED TO THE LEFT dapat
If you see this, send a pic of a goat sa bamboorat gc with no context
Basal Gastric Output Determination
After the patient has been in the left sided position for 60 minutes, what is collected/aspirated?
Gastric Juice
Basal Gastric Output Determination
Concentration of free HCl is determined by what method?
Titration
Basal Gastric Output Determination
TOF: If gastric pH is less than 3.5, titration is not needed
False (titration is not needed if GREATER than 3.5)
Basal Gastric Output Determination
Male or Female Normal Values?
1. 0.2 to 3.8 mEq/hr.
2. 1 to 15 mEq/hr
- Female
- Male
Basal Gastric Output Determination
TOF: In the stimulation test, a patient is stimulated by giving food, or test meals after testing
False (BEFORE)
Basal Gastric Output Determination
In the stimulation test of parietal cells to produce HCl, what substance replaces histamine due to its production of adverse effects?
Pentagastrin
Note: BOTH can still be used, pentagastrin is just more preferred
Basal Gastric Output Determination
This is performed when there are abnormalities in the maximal acid output (MAO)
Gastric Acid Stimulation Test
Basal Gastric Output Determination
Male or Female Values of Gastric Acid Stimulation Test?
1. 18 to 28 mEq/hr.
2. 11 to 21 mEq/hr
- Male
- Female
Gastric Function Tests
- An indirect measurement
- The analyte amounting to 1000 to 4000 pg/mL serves as an indicator for Zollinger-Ellison Syndrome
- Elevated levels are seen in pancreatic alpha cell tumors
- Normal values lie within 50 to 150 pg/mL
Plasma Gastrin
Gastric Function Tests
Plasma gastrin levels of what range indicate Zollinger-Ellison Syndrome?
1000 to 4000 pg/mL
Gastric Function Tests
Elevated plasma gastrin levels are seen in what kind of tumor?
Pancreatic Alpha Cell Tumor
Gastric Function Tests
What is the normal reference value range of plasma gastrin?
50 to 150 pg/mL
What gastric disease are these symptoms referring to?
- Abdominal pain
- Dyspepsia
- Weight Loss
- Chronic Diarrhea
- GI Bleeding
Zollinger-Ellison Syndrome