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Board Review 2020 > Gastrointestinal Pancreas > Flashcards

Gastrointestinal Pancreas Flashcards

1
Q

Name 4 different secretions of the exocrine Pancrease?

A

Bicarb
Amylase
Lipase
Proteolyic enzyems (trypsogen, chymotrypsogen)

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2
Q

What are the stimulators and inhibitors of the cephalic phase?

A

Stim: Sight, smell, taste- stimulate cerebral cortex and vagus nerve
Inhibits: SNS— decreases HCL and pepsin

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3
Q

What are the stimulators and inhibitors of the gastric phase

A

Stim: Stretch receptor, stimulates locally as well vago-vago reflex.
Inhibits: SNS, Stomatostatin

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4
Q

When food enters the stomach what is stimulated

A

Stimulate enteroendocrine G-Cells in the gastric glands to release gastrin. It is also the partial digested protiens

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5
Q

What are the actions of gastrin

A

Parietal cells: Bind to CCK2 receptors; increase intracellular calcium; then pump out H+ and in K+
Chief cells: Binds to CCK2, increases Ca release; leads to vesiclues of pepsinogen excocytosis- activated by H+ in the lumen

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6
Q

How is pepsinogen activated

A

It is activated to pepsin at a pH of 1.8-3.5

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7
Q

What is somatostatin and where is it released

A

Antrum D- cells. Released due to really low pH and will act on receptor of G cells to stop gastrin release and at parietal cells

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8
Q

What are the stimulators and inhibitors of parietal cells

A

Stim: ACh through M3— increse Ca levels; Gatsrin; Histamines through H2 receptors
Inhibit: Somatostatin, Prostaglandin E2

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9
Q

What are the stimulators and inhibitors of chief cells

A

Stim: Gastrin, Histamine H2 receptors;
Inhibit: Secretin

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10
Q

What do mucous cells do

A

Secrete to form mucosal barrier to protect cells from acid.
Electrolytes, phospholipdis, mucin protiens, and HCO3-
95% water

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11
Q

What are the function of duodenal G cells

A

Stimulated by increase protien

Secrete intestinal gastrin which acts on parietal and chief cells

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12
Q

What are the function of duodenal S cells

A

Stimulated with incrased protons and FA
Release Secretin
inhibits antrial G celles and Cheif cells
Liver stimulate hepatocytes to convert cholesterol to bile
Pancrease to epithlealial cells to make HCO3-

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13
Q

What are the function of enteroendocrine I cells

A

Stimulated by increase protiens, glucose, and fats
CCK- cholecystokin
Pariteal cells- inhibit proton pump
Liver potientates acteions of secretin

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14
Q

What are the effects of CCK

A

Gall bladder- stimulate to contract
Sphincter of Odi (bile/pancreas) relaxes at duodenum
Pancrease acini for trypsinogyn, lypase, amylase, chylotrypsinogen

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15
Q

What doe K cells do

A

Simulated by increased fats and glucose
Rleases gastric inhibiting peptide
Decreased parietal cell H/K antiporter
Stimulates inusulin release

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16
Q

Who doe chemoreceptors act in the face of extreme H+ concentration

A

Inhibit the Vagus nerve

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17
Q

What is the muscle of the esophagus.

A

Dogs: Striated the entire length

Cats Distal portion (1/3~) smooth muscle

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18
Q

What are the stretch mechanism in the stomach

A

Cephalic phase- receptive relaxation via vagus nerve stimulation
Gastric- bolus stretches in stomach and get local VIP/NO to get adaptive stretch (myenteric reflex)

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19
Q

What is gastric accommodation

A

Increase in gastric volume has a constant gastric pressure to a certain limit.

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20
Q

How does gastrin act on gastric motility

A

Allows more relaxation/stretch

Stimulate pump motility

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21
Q

How does intestinal resivor affect the stomach

A

Stimulate CCK, Secretin, and GIP and will cause relaxation of stomach and decrease gastric motility to allow the duodenum more time.

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22
Q

How does the mixing/emptying function of the stomach work

A

Pacemaker cells in the body stimulate contraction from body to antrum becoming more intense.
In pylorus have three regions that lead to the mixing effect as only the middle with pulpose through where the distal will contract the pylorus to close.

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23
Q

What is the enteric-gastric reflex

A

Distension of the duodenum leads to SNS stimulation of the pylorus to contract.
Low pH, high osmolality and prescence of fat

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24
Q

What is a migrating motor complex and where does it occur

A

Occurs in a fasting state: in the stomach and intestines
Motilin released resultiing in parastatlic wave that goes from body to pylorus.
Used to move larger particles
Cats don’t have MMC, rather less vigorous spikes

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25
Q

What is the vomit reflex

A

Coordinated by the brainstem
Relaxation of the stomach and LES. Closing of the pylorus
Contraction of intraabdominal muscles increase intra ab pressure
Chest cavity expands decreasing intrathoracic pressure and that of the esophagus.
Oppening of the upper esophageal sphencter
Glottis closes to prevent aspiration

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26
Q

Where is and what acts on the vomiting center

A

Medulla
Ach, dopamine, 5HT3, histamine
Stimulated by both the CTZ, and nucleus tracts solitaris

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27
Q

Where is and what acts on the chemoreceptor trigger zone

A

Floor of the fourth ventricle- incomplete bbb

dopamine, Ach, 5HT3, histamine opiods, neurokin 1

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28
Q

Were is and what acts on the nucleus tracts solitaris

A

Vestibular

Ach, Histamine, dopamine, 5HT3, Neurokin 1

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29
Q

What is the MOA of chlorpmazine

A

A1, D2, M1 antagonists

Works at the CTZ and emetic center

30
Q

What is the MOA for ondansetron

A

5HT3 Anatagonist

CTZ, vagus afferent

31
Q

What is the MOA for maropitant

A

NK1 anatagonist- blocks substance P

CTz, emetic center

32
Q

What is the MOA of metoclopramide

A

D2 antagonist, 5Ht3 Anatagonist, 5HT4 agonist

CTZ

33
Q

Where does metoclopramide have its effect

A

increases LES, increases frequency and amplituded of antril contractions, inhibits releacin
Side effects are CNS stimulation- excitation, tremors, aggression SSRI

34
Q

What are the mechanisms of movement in the small intestine

A

Propulsive- digesitve phase moves food forwards. Also has MMC
Non propulses- interdigestive period. Contract titghtly in alternating segments, Contents move back and forth

35
Q

What is intestinointestinal inhibition

A

Enteric nervous system reflex

grossly distended bowel leads to contractile activity in the rest of the bowel to be inhibited.

36
Q

How does the ileocolic sphincter work

A

Prevents retrograde movement from colon
Primarily constricted.
Peristalsis results in relaxation and closes with increased colonic pressure

37
Q

What is the gastric colic reflex

A

Distension in stomach leads to increased motility and mass movements in teh colon.
Afferent limb is stomach distension
efferent limb is mediated by CCK and gastrin

38
Q

What is the MOA for cisapride

A

Sertonergic 5HT4 agonist
Increases LES pressure, and distal esophageal motility in cats.
Stomach increased gastric emptying at 0.5-1 mg/kg
Jejunal pike burst migration and increase in propulsive motility

39
Q

What is the MOA for ranitidine

A

Ach inhibitor
Increase gastric antral contractions
Dogs propication of colonic on tractions

40
Q

How does erythromycin have gastric motility effects

A

Macrolides positively stimulate motilin to work directly on smooth muscle

41
Q

What is regurgitation

A

Passive ejection of material from upper gastrointestinal tract.
No reflex arc so airway is not able to be protected

42
Q

What is granulamotous colitis in boxers

A

Associated with E.COli

also reported in french bulldogs and border collies

43
Q

What is the MOA for NSAID/Steroid ulcers in the stomach

A

Prostaglandin inhibititoin via cycloxengenase 1 & 2
Decrases epithelial mucous production and decrease bicarb secretion
Decrease mucosal blood flow.
It also decreases negative feedback on parietal cells

44
Q

What is the MOA of hepatic induced ulcers

A

Increased gastrin secretion and mucosal blood flow alterations

45
Q

What is the MOA of uremic induced ulcers

A

Decreased gastric excretion through teh kidneys due to decreased renal clearance

46
Q

What is the MOA of Misoprostol

A

Prostoglandin E1 analogue

47
Q

What is the MOA of sucralfate

A

Dissociated to sucrose octassulfate and alumunim hydroxide (ALOH)
Bind ulcerated mucosa to prevent diffusion of hydrogen ions and inactiving pepsin
May reduce efficacy of other medications due to chelation by alumnium
More effective as suspension

48
Q

What is the phys of pancreatitis

A

Mechanisms in place to prevent early activitation of trypsin become overwhelmed.
Trypsin activates other pancreatic enzymes leading to autodigestion

49
Q

What are the three categories of acute pancreatitis

A

Mild- no organ failure, resolves in 1 week
Mod: Transient organ failure of co morbidities; may resolve without treatment or require speciality care
Severe: persistant organ failure > 48 hours, increased mortality

50
Q

What is the anatomical difference in the pancreatic ducts of dogs and cats

A

Dogs have two pancreatic ducts which do not combine generally with the CBD
Cats have 1 duct that hoins the CBD prior to entering the duodenum

51
Q

What electrolyte abnormality is associated with a poor outcome.

A

Decreased calcium

52
Q

Why does Kaluresis not occur despite aldosterone stimulation in GI obstruction

A

RAAS activationd due to hypovolemia,
Angiotensin II inhibits, decrased GFR, and PCT/DCT increased Na reabsorption
Called aldosterone paradox

53
Q

What are the indications for septic abdomen or bile peritonitis.

A

Lactate fluid: peripheral > 2.5 mmol/L
Glucose peripheral: Fluid > 20 mg/dl
Bile: Bilirubin Fluid: Serum > 2

54
Q

When can you not use lactate and glucose for abdominal fluid

A

DPL- diagnostic peritoneal lavage

Post surgical abdomens/ abdomens with drains

55
Q

What increases the survival of GDV

A

Lacated < 4 mmol/L, lactate clearance 40% reduction after rescitation
> 6 mmol/L increase cost of care and gastric wall necrosis more likely

56
Q

Where is decompression for GDV generally performed

A

Area of tympamy in the dorsolateral region 1-3 cm caudal to the right 13 th rib

57
Q

What is the gastric pressure thought to occlude venous return via azogus

A

Intragastric pressure of > 20 mmHg

58
Q

What is the MOA of Apomorphine

A

Central acting non selective Dopamine (D2) agonist

Vomiting by stimulating D2 receptors in the medullary CTZ

59
Q

How is intrabdominal hypertension defined in dogs

A 
Normal 0 - 7.4 mmHg
Mild 7.4-14.7 mmHg
Mod 14.7-25.7
Severe > 25.7
Sustained
60
Q

How is intraabdominal hypertension measured in dogs

A

Via intravesicular pressure generally U-bladder
Sterilely placed foley catheter. Urine is emptied
Instill 1 ml/kg of 0.9% Na CL
Connect to pressure transducer zeroed at the level of the pubic symphysis
Obtain while dog is standing

61
Q

How does IAH lead to decreased CO, GFR, and UO

A

Increase in afterolad (mechanical compression of vessels)

Decrease in preload from caudal vena cava

62
Q

List the complications of esophageal foreign bodies

A

esophagitis, aspiration pneumonia, esophageal perforation, stricture
Pneumothorax, pneumomediastinum, bronchoesophageal fistula
CPA, Death

63
Q

Compare H2RA vs. PPI

A

PPI: More effective at increasing gastric PH over time
takes several days to be effective
Availability of pantropazole
H2RA: effective on first day of tx, can give with a meal, prolonged administration may decreased effectiveness overtime
Famotidine may increase mucous and bicarbonate secretion in stomach

64
Q

What are differentials for rbc microcytosis

A 
GI bleeding
Copper deficency
Chronic liver disease- PSS
Lead poisioning
Breed: Shiba Inu, Akita
65
Q

What are negative prognostic factors in PLE

A

medium body weight
Altered BUN (both increase/decrease)
Decreased serum albumin

66
Q

How does octeotide work

A

Somatostatin analogue
decreased GI motility
Hormone alterations in intestines, pancrease, pituitary

67
Q

How does xylazine induce vomiting in cats

A

Centrally mediated alpha 2 adrenergic agonist
Stimulus in CTZ
Blocked/reversed by yohimbe

68
Q

What is the assessment of radiographs for intestinal dilation in dogs.

A

SI: L5 mid body 2.5-2.4 times

variable

69
Q

What is the MOA for lidocaines other than arrhythmic properties

A

Na channel blockade, inhibition of G-coupled protien, and inhibition of NMDA Recptors
CRI: Decrease Opiod doses, Reduce MAC

70
Q

What are unique characiteristics of BIPS

A

The smaller BIPS have a constent gastric emptying rate with 75% leaving
Larger BIPS do not empty as well

Board Review 2020 (37 decks)

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