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Liz's Clinical Chemistry Module 4 > Gastric, Intestinal, and Pancreatic Function > Flashcards

Gastric, Intestinal, and Pancreatic Function Flashcards

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1
Q

Three functions of the stomach

A
  • Movement of food to the duodenum
  • Secretion of digestive enzymes, intrinsic factor, and HCl
  • Partial digestion of proteins
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2
Q

Anatomical location of the stomach by naming the three distinct zons

A
  • Fundus
  • Body
  • Antrum
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3
Q

Specific cell type of the fundus

A
  • Surface epithelial cells

- Mucus cells

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4
Q

Specific cell type of the body

A
  • Surface epithelial cells
  • Mucus cells
  • Parietal cells
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5
Q

Specific cell type of the antrum

A
  • Mucus cells,
  • G-cells
  • Chief cells
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6
Q

Specific secretion(s) of surface epithelial cells

A

To produce mucus and shed and proliferate rapidly (every 3 days)

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7
Q

Specific secretion(s) of mucus cells

A

Secrete mucus

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8
Q

Specific secretion(s) of parietal cells

A
  • HCl

- Intrinsic factor

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9
Q

Specific secretion(s) of chief cells

A

Pepsin → pepsinogen

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10
Q

Specific secretion(s) of G-cells

A

Gastrin stimulates the parietal cells to produce HCl

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11
Q

Five functions of gastric HCl

A
  • Converts pepsinogen → pepsin
  • Activates rennin (milk curdling enzyme)
  • Combines w/ food proteins to form acid metaproteins which are more easily digested by pepsin
  • Prevent bacterial multiplication in the stomach
  • Prevents precipitation of ingested Ca2+ so that soluble Ca2+ may be absorbed
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12
Q

Four stimuli for gastrin release

A
  • When proteins, amino acids, and Ca2+ enter the stomach
  • Vagus nerve is activated and releases acetylcholine
  • Antrum is distended
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13
Q

Three phases of gastric secretion

A
  • Cephalic phases
  • Gastric phase
  • Intestinal phase
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14
Q

Cephalic phase

- Stimuli and specific secretion(s) produced

A

Vagus nerve, stimulated by site and smell, stimulates parietal cells to produce HCl and G-cells to produce gastrin

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15
Q

Gastric phase

- Stimuli and specific secretion(s) produced

A
  • In the stomach, gastrin release stimulates parietal cells to produce more HCl
  • Local antral distension stimulates further production of gastrin and therefore HCl
  • Chief cells respond to acidic environment, pepsinogen is produced that is rapidly converted to pepsin at pH 3
  • Chyme is produced (mucus-containing solution)
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16
Q

Intestinal phase

- Stimuli and specific secretion(s) produced

A
  • Ingested food helps neutralize HCl
  • Secretion is released, inhibiting gastrin-stimulated acid production and gastric motility
  • Gastric secretions cease
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17
Q

Three functions of gastric fluid

A
  • Initiation of protein digestion
  • Physical and chemical preparation of ingested food for absorption
  • Secretion of intrinsic factor to promote vitamin B12 absorption in the ileum
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18
Q

Four normal constituents of gastric secretions

A
  • HCl
  • Enzymes (pepsin (most important), salivary amylase, gastric lipase)
  • Mucus
  • Intrinsic factor
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19
Q

Three abnormal constituents of gastric fluid

A
  • Blood
  • Food
  • Organic acids
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20
Q

Appearance of fresh blood in the stomach

A

Red

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21
Q

Appearance of blood that has remained in the stomach for a period of time

A

Old blood is converted to hematin by the acidic pH and has a “coffee grounds” appearance

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22
Q

Four indications for gastric analysis

A
  • Aid in evaluation of patients w/ recurrent ulcer disease
  • Aid in diagnosis of Zollinger-Ellison syndrome by demonstrating a hypersecretory state
  • Determine if patient is able to secrete HCl at all (pernicious anemia)
  • Determine the completeness of vagotomy after gastric surgery
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23
Q

Basal Acid Output (BAO)

- Specific diagnostic use for gastric function assessment

A

No stimulation after you fast and you measure if outputting acid → determine baseline pH

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24
Q

Maximum Acid Output (MAO)- Specific diagnostic use for gastric function assessment

A

Important in determining if the patient has low acidity or anacidity

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25
Q

Serum gastrin

- Specific diagnostic use for gastric function assessment

A

Useful in diagnosis of the Zollinger-Ellison syndrome

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26
Q

Schilling test

- Specific diagnostic use for gastric function assessment

A

Useful in the diagnose of pernicious anemia

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27
Q

Hollander test

- Specific diagnostic use for gastric function assessment

A

Useful in determining the completeness of vagotomy in peptic ulcer treatment (should not be ↑ in vagotomy)

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28
Q

Recognize five lab findings in stomach cancer

A
  • Achlorhydria in gastric fluid
  • Anacidity or hypoacidity of gastric fluid
  • Blood (“coffee grounds” appearance) in gastric fluid
  • Iron deficiency anemia due to blood loss
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29
Q

Recognize causes for gastric and peptic ulcers

A
  • Helicobacter pylori
  • Smoking
  • Caffeine
  • Alcohol
  • Stress
  • Physical stress
  • Acid and pepsin
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
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30
Q

List the specific cause for the Zollinger-Ellison Syndrome

A

Gastrinoma

- Gastrin-secreting tumor of malignant cells in the duodenum or from a tumor in a non-beta islet cells of pancreas)

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31
Q

Four typical lab findings for Zollinger-Ellison Syndrome

A
  • BAO > 10mEq/hour
  • MAO usually < 25% higher than BAO (i.e., both are high all the time)
  • ↑ volume of secretion (160-800 mL/hour)
  • Serum gastrin levels 2-20,000x normal!!!
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32
Q

Cause of pernicious anemia

A

Gastric problems are caused by malfunctioning parietal cells, responsible for HCl production and secretion of intrinsic factor (IF)

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33
Q

Six typical lab findings I pernicious anemia

A
  • Anacidity
  • ↓ gastric secretion volume
  • Gastric atrophy
  • ↑ serum gastrin (>200 pg/mL)
  • Macro-ovalocytes
  • Hypersegmented neutrophils
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34
Q

Function of the duodenum

A
  • Has 6 major hormones to aid in digestion and protection of the intestinal lining
  • Intraluminal hydrolysis of starch, proteins, and lipids
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35
Q

Function of the ileum

A
  • Absorption of vitamin B12 and whatever products of digestion that were not absorbed by the duodenum
  • Diffuse neuroendocrine system cells secrete gastrin, secretion, and cholecystokinin into the bloodstream
36
Q

Function of the large intestine

A
  • Absorption of water from the remaining indigestible food matters
  • Absorption of vitamins that are created by bacteria inhabiting the colon
  • Fecal compaction until it can be eliminated
37
Q

Cholecystokinin-pancreozymin (CCK-PZ)

- Source

A

Secreted by I cells of duodenum when digested proteins/fats enter duodenum

38
Q

Cholecystokinin-pancreozymin (CCK-PZ)

- Stimulus

A

Secreted by I cells when protein and fats enter the duodenum

39
Q

Cholecystokinin-pancreozymin (CCK-PZ)

- Three physiological effects

A
  • Pancreas to produce enzymes
  • Gall bladder to contract and empty contents
  • Sphincter of Oddi to relax to allow gall bladder and pancreatic contents to enter duodenum
40
Q

Secretin

- Source

A

S cells both the duodenum and jejunum

41
Q

Secretin

- Stimulus

A

Released when acidified contents of stomach reach duodenum (pH < 5)

42
Q

Secretin

- Two physiological effects

A
  • Acts in synergy w/ CCK for release of pancreatic enzymes

- Stimulates secretion of large amt of diluent pancreatic fluid rich in sodium bicarbonate

43
Q

Gastric inhibitory peptide

- Physiological effects

A

Stimulates insulin release and is responsible for rapid metabolism of an oral glucose load

44
Q

Vasoactive intestinal polypeptide

- Physiological effects

A

Causes relaxation of gut circular smooth muscle as well as smooth muscle in blood vessels, causing vasodilation
- Also stimulates pancreatic secretion

45
Q

Motilin

- Physiological effects

A

Stimulates the contraction of the smooth muscles of the GI tract and contracts the lower esophageal sphincter

46
Q

Somatostatin

- Physiological effects

A
  • Most potent inhibitor of endocrine secretions
  • Inhibits release of GI and pancreatic hormones, as well as the release of GH and TSH
  • Inhibits actions of all these hormones on their target tissues
47
Q

Compare Crohn’s disease w/ ulcerative colitis

A 
Both: 
- Form of inflammatory bowel disease
- Autoimmune etiology
- Genetic
Crohn's
- Can affect any portion of the intestine
- 10-30% test positive for ANCA test
Colitis
- Disease of large intestine ONLY
- 60-80% test positive for ANCA test
48
Q

Celiac disease

- Cause

A

Hypersensitivity to grains (gluten)

  • Genetics
  • Immune system
  • Environment
49
Q

Celiac disease

- Symptoms

A
  • Abdominal bloating and pain
  • Chronic constipation and/or diarrhea
  • Weight loss
  • Pale, foul-smelling stool
  • Flatulence
    (many more, see slide 108)
50
Q

Celiac disease

- Treatment

A

Remove gluten from diet

51
Q

Best screening test for colon cancer

A

Occult blood test

52
Q

Carcinoid syndrome

- Symptoms

A

Tumors produce serotonin which cause the symtpoms of:

  • Hypertension
  • Flushing
  • Wheezing
  • Diarrhea
  • Right-sided valvular disease
53
Q

Carcinoid syndrome

- Lab diagnosis

A

Screen for 5-HIAA in urine

54
Q

Carcinoid syndrome

- Treatment

A

Surgical excision of the tumor(s) is the only treatment

55
Q

Endocrine functions of the pancreas

A
  • Beta cells secrete insulin
  • Alpha cells secrete glucagon
  • Delta cells secrete gastrin and somatostatin
56
Q

Exocrine functions of the pancreas

A

80% of mass is made of acinar cells, grape-like cluster that produce digestive enzymes

57
Q

Insulin

- Physiological effects

A

Uptake of glucose

58
Q

Glucagon

- Physiological effects

A

Release of glucose from glycogen

59
Q

Gastrin

- Physiological effects

A

HCl production

60
Q

Consequences of secretin and CCK-PZ release on the pancreas

A

Secretin:
- Made when acidic stomach contents reach duodenum
- Responsible for bicarbonate release
- Gastrin production in the stomach
CCK-PZ
- Made by intestinal cells
- Responsible for enzyme release from pancreatic acnar cells

61
Q

Consequences of Vagus nerve stimulation on the pancreas

A

Can cause pancreatic fluid secretion during cephalic phase of digestion

62
Q

Five enzymes produced by the pancreas and their substrates

A
  • Amylase
  • Lipase
  • Chymotrypsin
  • Trypsin
  • Elastase
63
Q

Substrate of amylase

A

Acts on starch and CHOs

64
Q

Substrate of lipase

A

Acts on triglycerides

65
Q

Substrate of chymotrypsin

A

Cleaves peptide bonds following phenylalanine, tryptophan, and tyrosine residues

66
Q

Substrate of trypsin

A

Acts on proteins by catalyzing the hydrolysis of peptide bonds

67
Q

Substrate of elastase

A

Acts on elastin

68
Q

Cystic Fibrosis

- Cause

A
  • Autosomal recessive

- Most common genetic mutation is delta-F508 on the long arm of c’some 7

69
Q

Cystic Fibrosis

- Symptoms

A

Disrupts the function of several organs by clogging tubes?

70
Q

Cystic Fibrosis

- Clinical course

A

Meconium ileus at birth (bowel obstruction)

  • Chronic respiratory infections
  • Malabsorption w/ failure to thrive
  • Median survival: 30 years
71
Q

Cystic fibrosis

- Lab findings

A

Sweat chloride measurement >60 mEq/L on two occasions

72
Q

Cancer at the head of the pancreas

- Typical symptoms and lab findings

A
  • Detected earlier than other pancreatic cancers

- Jaundice, weight loss, anorexia, nausea

73
Q

Cancer of beta cell tumors

- Typical symptoms and lab findings

A

Causes very low blood sugars and associated symptoms

74
Q

Cancer of alpha cell tumors

- Typical symtpoms and lab findings

A
  • Have a very poor prognosis

- Detected later b/c of lots of diseases that could cause hyperglycemia

75
Q

Acute pancreatitis

- Common causes

A
  • Cholelithiasis (gallstones)
  • Excess alcohol intake
  • Trauma, mumps, thrombosis, drugs
  • Idiopathic
76
Q

Acute pancreatitis

- Common symptoms

A

Acute abdominal pain radiating to the upper back

77
Q

Acute pancreatitis

- Length of time that amylase and lipase remain elevated in the serum after an attack

A
  • Amylase rises w/in 24 hours → returns to normal in 3-4 days
  • Lipase rises about the same time → stays elevated for 2 weeks
78
Q

Most common cause of chronic pancreatitis

A

Alcoholism

79
Q

Two indirect tests used to diagnose chronic pancreatitis

A

Measure fecal chymotrypsin and fecal elastase-1

80
Q

Specific diagnostic usefulness of the measurement of elastase-1

A
  • Secreted in any inflammatory state

- Sensitive and specific marker of chronic pancreatitis

81
Q

Specific diagnostic usefulness of the measurement of trypsin

A
  • Highly sensitive indicator of pancreatic disease

- Recommended as a screening test for cystic fibrosis in 5- day old infants

82
Q

Which conditions may lead to malabsorption?

A
  • Pancreatic insufficiency
  • Celiac disease
  • Resection of ilium
  • Parasitic infection of the gut (see slide 159)
83
Q

Why do patients w/ malabsorption syndrome have steatorrhea, weight loss, vitamin deficiencies, anemia, edema, coagulation disorders, and osteomalacia?

A

Deficiencies of fat and water-soluble vitamins

84
Q

Four tests used to evaluate malabsorption syndrome

A
  • Carotene
  • Microscopic examination of stool for fat
  • D-xylose absorption test
  • Breath hydrogen test
85
Q

D-xylose absorption test

- Principle and specific area of the GI tract that is assessed

A

Assesses the functional integrity of the small intestine

86
Q

Breath hydrogen test

- Specific diagnostic usefulness

A

Assesses whether malabsorption is caused by bacterial overgrowth or a lactase deficiency

87
Q

Describe the multiple endocrine neoplasia (MEN) syndrome

A

Occurrence of tumors involving two or more endocrine glands w/in a single patient
- Two types → MEN-1 (Wermer’s syndrome); MEN-2 (Sipple’s syndrome)

Liz's Clinical Chemistry Module 4 (5 decks)

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