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Clinical Chemistry 1 > GI Function and Pancreatic Function > Flashcards

GI Function and Pancreatic Function Flashcards

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1
Q

What 5 regions make up the GI tract?

A
  1. Mouth
  2. Esophagus
  3. Stomach
  4. Small Intestine
  5. Large Intestine
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2
Q

What is the definition of digestion?

A

Process by which starches, proteins, lipids, and nucleic acids are degraded to molecules for absorption and use in body

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3
Q

The pancreas is an endocrine and exocrine gland. What does this mean?

A

Endocrine - synthesizes hormones

Exocrine - secrete enzymes to aid in digestion

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4
Q

The pancreas is connected to the small intestine by what?

A

The ampulla of Vater

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5
Q

The endocrine component of the pancreas is performed by what region/cells?

A

Islets of Langerhans

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6
Q

What 4 hormones do islet cells secrete?

A
  1. Insulin
  2. Glucagon
  3. Gastrin
  4. Somatostatin
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7
Q

What does the hormone insulin do?

A

Insulin lowers blood glucose levels by storing excess glucose as glycogen.

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8
Q

What does the hormone glucagon do?

A

Glucagon increases blood glucose level by converting glycogen to glucose

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9
Q

What does the hormone gastrin do?

A

Gastrin stimulates gastric fluid secretion

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10
Q

What does the hormone somatostatin do?

A

“somatostatin inhibits the secretion of many other hormones”

It is known to inhibit GI, endocrine, exocrine, pancreatic, and pituitary secretions.

Pituitary - inhibit growth hormone
GI - inhibit secretion of many of the other GI hormones, including gastrin, cholecystokinin, secretin and vasoactive intestinal peptide. Suppresses secretion of gastric acid and pepsin, lowers the rate of gastric emptying, and reduces smooth muscle contractions and blood flow within the intestine
Pancreas - inhibit the secretion of both insulin and glucagon and inhibit exocrine secretions

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11
Q

The exocrine component of the pancreas is performed by what cells?

A

Acinar cells

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12
Q

What are the 3 enzymes produced by the pancreas?

A

Produce enzymes important to digestion in small intestine. These enzymes include trypsin to digest proteins; amylase for the digestion of carbohydrates; and lipase to break down fats.

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13
Q

What kind of genetic disorder is cystic fibrosis?

A

Autosomal recessive disorder

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14
Q

What is cystic fibrosis?

A

Condition where pancreatic enzymes cant exit the pancreas because it is blocked with mucus. Causes ducts and acinar cells to dilate and convert into small cysts filled with mucus, preventing secretions from reaching duodenum. Buildup of enzymes causes inflammation of pancreas

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15
Q

What are the manifestations of cystic fibrosis in newborn, childhood, and adults?

A
  1. Intestinal obstruction (newborn)
  2. Pulmonary infections (childhood)
  3. Pancreas malabsorption (adults) - causes a change in the flow and amount of the pancreatic juice produced, juice contains enzymes that help the body to digest and abosrb nutrients such as fat, carbohydrate and protein.
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16
Q

Most pancreatic cancer begins where? Pancreatic cancer is frequently cancer of exocrine or endocrine?

A

Most pancreatic cancer begins in the acinar cells that line the ducts of the pancreas (pancreatic adenocarcinoma or pancreatic exocrine cancer)

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17
Q

Acinar cells line the ______, and islet of langerhans line the ________

A

Acinar cells line the ducts, and islet of langerhans line the capillaries.

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18
Q

What is pancreatitis? What is it caused by?

A

Inflammation of the pancreas. Caused by release of pancreatic enzymes from cells into surrounding pancreatic tissue. There is reflux of bile or duodenal contents into the pancreatic duct, resulting in autodigestion.

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19
Q

Which 3 conditions severely diminish pancreatic exocrine function, compromising digestion and absorption (malabsorption syndrome)

A
  1. Cystic fibrosis
  2. Pancreatic cancer
  3. Pancreatitis
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20
Q

What are 4 tests that can be done to evaluate pancreatic function?

A
  1. Secretin/CCK Test
  2. Fecal Fat Analysis
  3. Sweat Electrolyte determination
  4. Serum Enzyme
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21
Q

What is the function of secretin and CCK in the secretin/CCK test?

A

Secretin released in response to acid in small intestine to prevent acid burns. It inhibits secretion of gastric acid, and stimulates biliary and pancreatic ductular cells to secrete bicarbonate and water in response to the presence of acid in the duodenum to neutralize acid. Secretin stimulates the flow of bile from the liver to the gallbladder.

Cholecystokinin (CCK) stimulates the flow of bile by causing the gall bladder to contract and thus determine if the gall bladder is emptying properly. Also stimulates release of digestive enzymes by pancreas

The bicarbonate and digestive enzymes released together are collectively known as pancreatic juice, which travels to the small intestine, as shown below.

22
Q

What does the secretin/CCK test determine?

A

Direct determination of exocrine secretory capacity of pancreas

23
Q

What is the methodology of the secretin/CCK test?

A

Involves intubation and gathering of pancreatic fluid/secretions after stimulation by secretin followed by CCK. Secretions collected for 30, 60, or 80 minutes after administration of stimulants.

PH , secretory rate, enzyme activity (trypsin, amylase, or lipase) and amount of bicarbonate determined

24
Q

What is measured in the secretin/CCK test (4)?

A
  1. pH
  2. Secretory rate
  3. Bicarbonate
  4. Enzymes activity
25
Q

Fecal lipids are derived from 4 sources:

A
  1. Unabsorbed ingested lipids
  2. Lipids excreted into intestine
  3. Cells shed into intestine
  4. Metabolism of intestinal bacteria
26
Q

Sudan staining is the qualitative or quantitative method for fecal fat analysis?

A

Qualitative

27
Q

Gravimetric method is the qualitative or quantitative method for fecal fat analysis?

A

Quantitative

28
Q

What is the methodology of Sudan staining?

A

Sudan stain will stain fecal lipids yellow-orange to red. Increases in fat and undigested meat fibers indicate steatorrhea of pancreatic origin

29
Q

What is steatorrhea?

A

Increased fat in feces

30
Q

What is the methodology of the Gravimetric method?

A

The entire fecal specimen is emulsified with water. A portion is acidified to form free fatty acids, and lipids are extracted into petroleum ether and ethanol. After evaporation of solvents, lipid residue is weighed.

31
Q

Sweat electrolyte test is useful for what diagnosis

A

Diagnosis of cystic fibrosis

32
Q

Why is sodium and chloride elevated in cystic fibrosis patients in the sweat electrolyte test

A

Normally the cystic fibrosis transmembrane conductance regulator (CFTR) serves as a channel, letting chloride out of cells and into the surrounding fluid and also reducing sodium absorption (chloride and sodium move together). People who have CF have higher levels of chloride in their sweat because chloride is unable to move in or out of the body’s cells (lack of channel causes thick mucus) which is what causes it to build up

33
Q

What is the methodology of the sweat test?

A

An electric current (iontophoresis) is used to administer the sweat inducing drug (Pilocarpine Nitrate) into a selected clean skin area and sweat is collected on small disc and analyzed for sodium and chloride concentrations

34
Q

In children, levels of sweat sodium and chloride above _______ are diagnostic for CF. In adults, levels above _______ are diagnostic.

A

Children > 60 mmol/L

Adults > 80 mmol/L

35
Q

Which serum enzymes are used to test pancreatic function?

A

Amylase and Lipase

36
Q

What are 4 stimuli triggering gastric fluid secretion? Which is the biggest stimuli?

A
  1. Neurologic impulses from brain transmitted by vagus nerve
  2. Distention of stomach with food or fluid
  3. Contact with protein breakdown products with gastric mucosa
  4. Hormone gastrin (most potent)
37
Q

What are the 3 inhibitors of gastric fluid secretion?

A
  1. High gastric fluid acidity, which decreases release of gastrin by G cells in the stomach.
  2. Gastric inhibitory polypeptide (GIP), released by K cells in the duodenum
  3. Vasoactive intestinal polypeptide (VIP), released by cells in intestine
38
Q

What is the function of gastrin and where is released?

A

Stimulates gastric fluid secretion, produced by G cells in the stomach and pancreas

39
Q

What do K cells in the duodenum secrete?

A

Gastric inhibitory polypeptide

40
Q

What are the 3 purposes to perform gastric analysis?

A
  1. Occassionally, evaluate pernicious anemia in adults
  2. Hypersecretion of gastric fluid caused by secreting tumor (Zollinger-Ellison syndrome)
  3. Check acid secretion during ulcer treatment (reduce rate of acid secretion)
41
Q

Why can gastric fluid analysis help evaluate pernicious anemia?

A

Pernicious anemia is a condition where there is a decrease in red blood cells when the body can’t absorb enough vitamin B-12. Vitamin B12 can only be absorbed by the body if bonded to the intrinsic factor. Parietal cells in the stomach produce gastric fluid, which has intrinsic factor in it.

Pernicious anemia can be due to destruction of parietal cells or the inability of bonding of the intrinsic factor to vitamin B12.

42
Q

What is Zollinger-Ellison syndrome?

A

Zollinger-Ellison syndrome is a rare condition in which one or more tumors form in your pancreas or the upper part of your small intestine (duodenum). These tumors, called gastrinomas, secrete large amounts of the hormone gastrin, which causes your stomach to produce too much acid. The excess acid then leads to peptic ulcers, as well as to diarrhea and other symptoms.

43
Q

What is used as a stimulus to gastric secretion for gastric analysis?

A

Pentagastrin

44
Q

What test is done to measure gastric acid? What is the methodology?

A
45
Q

Digestion is predominantly a function of the small intestine or large intestine?

A

Small intestine

46
Q

Massive absorption in the small intestine is due to (3):

A

Mucosal folds, villi, microvilli in 20 ft long small intestine allow massive absorption

47
Q

_____ liters of ingested water, food, and secretions from salivary glands, stomacg, pancreas, and biliary tract enters duodenum. Only ____ liters of fluid material reaches cecum.

A
48
Q

What does the large intestine do?

A

Absorb water and changes waste from liquid into stool (feces)

49
Q

What are the three tests to evaluate intestinal function?

A
  1. Lactose Tolerance Test
  2. D-xylose absorption test
  3. Serum carotenoids
50
Q

What is the methodology of the lactose tolerance test?

A

Lactase is an enzyme produced in epithelial cells that line small intestine. intestinal epithelial cells, have finger-like projections called microvilli that absorb nutrients from food as it passes through the intestine. Lactase functions at the brush border to break down lactose.

Two hours after drinking a liquid that contains high levels of lactose, you’ll undergo blood tests to measure the amount of glucose in your bloodstream. If your glucose level doesn’t rise, it means your body isn’t properly digesting and absorbing the lactose-filled drink (lactase deficiency)

51
Q

What is the methodology of the D-xylose absorption test?

A

D-xylose does not require pancreatic enzymes to break down and is unaltered. It is not a typical sugar found in body. So this test is soley to test intestinal absorption and not exocrine pancreatic insufficiency.

52
Q

How can serum carotenoids show malabsorption?

A

Clinical Chemistry 1 (6 decks)

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