GI exam 4 Flashcards
What do pancreatic acinar cells do?
Secrete digestive proenzymes
What is the Digestive system? What makes it up?
Hollow tube that extends from the mouth to the anus.
What is the function of the GI tract?
Absorption and to regulate and coordinate motility and sections.
What are the 3 layers of muscles in the stomach?
Longitudinal, circular, and mucosal
What controls the digestive system?
Hormones and autonomic nervous system.
What happens when we eat?
We trigger hormones that will stimulate or inhibit action.
Muscular contractions or gastric motility
Secretion of enzymes that aid in digestion
What controls extrinsic of GI system?
Acetylcholine
Intrinsic has how many neurons and can it work independently of the CNS input?
1000000 neurons and yes it can function independent of CNS input
Activity of GI system can be modified by what?
Extrinsic input
Extrinsic is controlled by what?
CNS
Which peptide lines the stomach with G cells and increases acid and glandular mucosa?
Gastrin peptides
Which peptide is parietal cells of the stomach and increases acid?
Histamine peptide
Which peptide is enterochromaffin cells found in the gastric gland and gastric mucosa and stimulates motility?
Motilin
Which peptide is in the duodenum and jejunum and is most potent humoral stimulator of fluid and bicard secretion by pancreas?
Secretin peptide
Which peptide is produced in the stomach and breaks down protein?
Pepsin peptide
How does food move?
Starts in oropharynx-food boils is formed-UES where relaxation occurs, reflex barrier, prevents entry of air into the esophagus during respiration-esophageal body, peristalsis, esophageal clearance of gastric reflux- LES, needs to relax to allow food into stomach, prevents regurgitation from the stomach. Barrier between the stomach and esophagus, often the site of issue with GERD
What does the UES do? Upper esophageal sphincter
Reflex barrier, prevents entry of air into the esophagus during respiration
What does LES do? Lower esophageal sphincter
Relaxes to allow food into the stomach, prevents regurgitation from the stomach, barrier between the stomach and esophagus.
Where is the site of issue most common in GERD?
LES
When given a PPI for GERD, what happens, how does it work?
Relaxes the LES, but often times there can be too much relaxation causing GERD from regurgitation from the stomach.
What happens once the food bolus reaches the stomach?
It gets mixed and churned into chime, gastric juices are increased and food is propelled to the pyloric sphincter.
What happens or is known as the pyloric pump?
Contractions of the stomach get stronger and push up against the pyloric sphincter until it begins to open and some of the chime spills out. This continues until the stomach is empty.
What is dumping syndrome and signs and symptoms?
Dumping syndrome is when the pyloric sphincter is incompetent and allows too much chime to enter the duodenum at one time.
People feel faint, tachycardia. Can happen with bariatric surgery.
What are the 4 phases of the proton pump in stomach where gastric acid is secreted?
- Basal- when we are sleeping and it’s very low
- Cephalic- “I smell bacon” pump turns on
- Gastric- food has arrived, pumps on at full speed
- Intestinal- “Elvis has left the building”, down to 10% maximal output. When chime is spilling in
When would you want to take a PPI to be more effective, Prilosec, Prevacid, Nexium?
Take PPI at Basal phase
What are the 3 phases of the pyloric sphincter?
- Swallowing phase
- Mixing and propulsion
- Gastric emptying phase
Where does the swallowing phase take place?
Esophagus
Where does the mixing and propulsion phase take place?
Stomach
Where does the gastric emptying phase take place?
Past the pyloric sphincter and into the duodenum
What is the liver responsible for?
Responsible for cleaning the blood, produces bile to aid in the digestion of fats, stores fat soluble vitamins ADEK, and helps to maintain blood sugar.
what is Vitamin A essential for?
Vision
What is Vitamin D essential for?
Bone health
What is Vitamin K essential for?
Blood clotting
What is Vitamin E essential for?
Limiting free radical damage
What does the gallbladder do?
Stores bile and releases bile when needed to digest fat
What could happen when gallbladder is removed?
Diarrhea and it fat malabsorption
What happens to the bile when gall bladder is removed?
It continuously drains into the intestine
What are the 2 functions of the pancreas?
Exocrine- 95% of gland consists of exocrine tissue that will produce pancreatic enzymes to help with digestion.
Endocrine- 5% of gland consists of cells called islets of Langerhans to regulate blood sugar.
Pancreatic juices are released into what during exocrine function of pancreas?
Pancreatic duct
What does the pancreatic duct join with to form the ampulla of Vater?
Common bile duct
What does the common bile duct and pancreatic duct make?
Ampulla of vater
Where is the ampulla of Vater located?
Duodenum
Bile from what two places help digest fats, carbs and proteins?
Bile from the liver and pancreatic juices in the duodenum.
Trypsin and chymotrypsin break down what?
Proteins
Amylase digests what?
Carbs
Lipase breaks down what?
Fats
A dysfunction of ampulla of Vater can cause what?
Increase in bilirubin,can become inflammed with gall stones causing elevated liver function tests, can cause vomiting.
What is the cardinal sign of GERD?
Heartburn
Can GERD happen in infants and why?
Yes, it can start at 6months due to the underdeveloped GI tract, which is why we introduce food slowly.
What is GERD mostly associated with?
Pressure abnormalities in the LES but can be motility disorder, vital hernia, drugs(calcium channel blockers) and obesity.
What can be protective on some genotypes with GERD?
H. Pylori
Can you treat right away without biopsy or definitive do?
Yes!!
PPI
Or histamine blocker l-Pepsid
What is gastritis and what can cause it?
It is inflammation of the mucosa which can be associated with erosions and bleeding and can be caused by H pylori, NSAIDS, bile reflux, ETOH, radiation, trauma and stress.
Of a patient has recurrent nausea and PPI are not helping, what could they have?
Gastritis
What are the 2 types of gastric polyps?
- Hyper plastic- more common typically benign
2. Adenomatous- greater risk for malignancy and progression
What is the size of a gastric polyp that is low risk and high risk for cancer?
Low risk- less than 0.5cm
High risk- greater than 1.5cm
What are some characteristics of peptic ulcer disease?
Peak age is 55-65 More common in males 35% will have complications 3000 deaths per year 10% associated with malignancy
In peptic ulcer disease when are symptoms worse?
When they are eating
What bacteria is often found in peptic ulcer disease?
H pylori
Why are symptoms worse when they eat with peptic ulcer disease?
Because of the increased acid production of the proton pump.
When do symptoms occur with a duodenal ulcer?
1 to 2 hours after they eat
What can cause duodenal ulcers?
H pylori, tobacco, mucosa is not protective against the acid b/c of chronic prednisone use- this is why we do GI prophylaxis with prednisone use.
What does prednisone do to the tissues? What disorder takes prednisone and typically gets ulcers?
Prednisone thins the tissues, COPD patients take prednisone a d are at risk for ulcers.
What are the symptoms of diverticulitis?
Low cramping of abd, diarrhea, constipation, distension, flatulence, LLQ pain, possible fever and leukocytes. Confirmed with a CT with contrast.
why is there tenderness in the LLQ on diverticulitis?
It is happening in the sigmoid colon.
IBS is the disease of what?
Motility
What are the 3 parts to IBS?
- Altered GI motility
- Visceral hyperalgesia
- Psychopathology
What is your typical patient with IBS?
Stress, anxiety, can have diarrhea when stressed. Gas pains.
Is IBS and inflammatory bowel disease the same?
No, inflammatory bowel disease is an autoimmune disease
What is happening in inflammatory bowel disease?
Alterations of epithelial barrier functions, immune reactions to intestinal flora, abnormal Tcell response.
What are examples of inflammatory bowel disease?
Ulcerative colitis and chrons.
What are common manifestations of ulcerative colitis?
It is found in colon and rectum without “skip” lesions, it involves mucosal layer, typically have bloody stools and anti neutrophil cytoplasmic antibody.
What are common manifestations of chrons?
Encompasses all GI tract with “skip” lesions and goes through entire intestinal wall, commonly has abd pain and steatorrhea and antisaccharomyces cerevisiae antibody.cobblestone appearance.
What are types of liver disease?
NASH- “fatty” liver, it can progress to cirrhosis and can be a type that does not.
Hepatitis C- found in baby boomer
Obstructive pattern-elevated bilirubin
Alcoholic cirrhosis
Autoimmune hepatitis
If someone is a baby boomer and a alcoholic what should you check and what does it put them at risk for?
Check for Hep c, and check alpha feta protein yearly because it can detect liver cancer.
What do you need to other to check liver function and bilirubin?
CMP
What could be a problem in an obstructive pattern in liver disease?
Gall stone is obstructing the duct
Just because they don’t have elevated liver doesn’t mean they don’t have advanced cirrhosis, why?
If hepatic cells are inflammed they are going to have an elevated liver function test, but if they have died they will have normal liver function test
What two things are 98% predictive of cirrhosis?
Spider angioma and elevated LFT
What can happens with cirrhosis?
Portal hypertension
What is portal hypertension?
Abnormally high blood pressure in the portal venous system primarily caused by resistance to petal blood flow.
What is the normal pressure of portal venous system and what is considered high?
Normal is 3mm Hg
High is 10mm Hg
What are the causes of portal hypertension?
Prehepatic
Intrahepatic
Posthepatic
What can portal hypertension lead to?
Esophageal varies rupture or gastric varies may rupture
What medication is used to treat portal hypertension?
Nadalol
What are manifestations of gallbladder disease?
RUQ pain, right shoulder pain, bloating, chest pain, they can become necrotic and gangrenous.
If alkaline phosphate is elevated on liver test what is that indicating?
Gallbladder disease
What are the two radiology procedures for gallbladder?
US to checking for gall stones and thickening of wall
Hydra scan to check the function
What can pancreatitis be associated with?
ETOH and cholelitjiasis
Pancreatitis is caused by what?
Injury or damage to pancreatic cells and ducts, causing a leakage of pancreatic enzymes into the pancreatic tissue.
What do the pancreatic do when they leak into the pancreatic tissue?
Cause auto digestion of pancreatic tissue and leak into the bloodstream to cause injury to blood vessels and other organs.
What can happen in pancreatitis?
Fat embolus
What is treatment for pancreatitis?
Resolves with fluids and GI rest, but can turn south quickly.
What can develop in severe acute cases of pancreatitis?
SIRS and ARDS
What fluids are best for pancreatitis and why?
LR, it helps to dilute pancreatic enzymes. Also no eating so enzymes are not released.
What function does Kupffer cells have?
Remove bacteria and foreign particles from blood in the hepatic sinusoids.
