GI /hepatobiliary / nutrition Flashcards
1
Q
Spike potentials are caused by the entry of which electrolyte into the cell?
A
Ca+2 and a little Na+
2
Q
Three factors that can depolarize the GIT smooth muscle cells
A
Ach from PSNS stimulation
Stretching of the SM
GI hormones
3
Q
Three causes of tonic contractions
A
continuous repetitive spikes
Continuous influx of intracellular Ca+2
GI hormones
3
Q
What can cause hyperpolarization of the GIT smooth muscle cells
A
Epi/norepi (circulating or from SNS)
4
Q
Which component of the enteric nervous system is responsible for GI movement
A
myenteric plexus
5
Q
Which component of the enteric nervous system is responsible for secretion and absorption
A
submucosal plexus
6
Q
What nerve provides parasympathetic input to the majority of the GIT
A
Vagus
7
Q
What nerve provides parasympathetic input to the distal GIT
A
Pelvic
8
Q
What cells secrete gastrin and where are they located?
A
G cells in antrum of stomach and duodenum
9
Q
Stimulation for gastrin secretion (3)
A
Protein, GI distension, vagal stimulation
10
Q
Actions of gastrin
A
stimulate HCl secretion and promote growth of mucosa
11
Q
Inhibition of gastrin secretion (2)
A
acid in the duodenum, secretin
12
Q
What cells secrete CCK and where are they located?
A
I cells in the duodenum and jejunum
13
Q
Stimuli for CCK secretion
A
food intake (CHO, protein, fat) acid
14
Q
Actions of CCK (4)
A
gall bladder contraction
pancreatic enzyme and bicarb secretion
inhibit gastric emptying
inhibit appetite
15
Q
What inhibits CCK (1)
A
Trypsin
16
Q
What cells secrete secretin and where are they located?
A
S cells in the duodenum
17
Q
stimuli for secretin secretion (2)
A
gastric acid
fat
18
Q
Actions of secretin
A
stimulation of pancreatic fluid and bicarbonate secretion
Slows GI motility
Decreases gastrin/HCl secretion
19
Q
What cells secrete GIP and where are they located?
A
K cells of the duodenum and jejunum
20
Q
Stimuli for GIP secretion
A
fat and CHO
21
Q
The actions of GIP (3)
A
slow gastric emptying
stimulate insulin release
inhibit gastric acid secretion
22
Q
Inhibition of GIP
A
insulin and glucogon
23
Q
Free card
A
Great job studying
24
What cells secrete GLP-1 and where are they located?
L cells of the ileum and colon
25
Stimuli for GLP-1 secretion
Food in GIT especially CHO
26
Actions of GLP-1 (3)
Stimulate insulin release
Inhibit glucagon
Slow gastric emptying
27
exenatide and liraglutide MOA
GLP-1 antgoinst
28
exenatide and liraglutide indication
Improve weight loss and glycemic control in cats with DM (need to have some functioning pancreatic B cells)
29
What cells secrete motilin and where are they located?
M cells of duodenum and jejunum
30
Stimuli for motilin
fat and acid, also cyclically secreted
31
action of motilin
increased GI motility
32
Inhibition of motilin
food ingestion
33
Stimuli for peristalsis (3)
distension
mucosal irritation
PSNS stimulation
34
two forms of GI mixing
Peristalsis and there is a sphincter blocking forward motion
intermittent segmental contraction
35
portal vein drains blood form which organs
GIT
spleen
pancreas
36
GI hormones that can cause vasodilation of splanchnic circulation (4)
CCK
VIP
gastrin
Secretin
37
three phases of deglutition
voluntary
pharyngeal
esophageal
38
CN is involved in coordinating swallowing
5, 9, 10, 12
39
What is primary peristalsis in the esophageal phase of swallowing
continuation of pharyngeal peristaltic wave
40
What is secondary peristalsis in the esophageal phase of swallowing
triggered by food in the esophagus
Myenteric NS --> vagus eff --> medulla --> vagus and glossopharyngeal aff
41
What occurs when food enters the distal esophagus
reciprocal relaxation of LES
42
function of LES
prevent reflux of acidic contents into the esophagus
43
What organ has the most impact on the timing of gastric emptying
duodenum
44
Name one factors that increase the rate of gastric emptying
increased volume of food in the stomach
45
factors that slow gastric empying that are not hormones (4)
distension of duodenum
irritation of duodenal mucosa/acidity of chyme
increased osmolality of chyme
protein breakdown products in SI
46
4 hormones that inhibit gastric emptying
CCK
GIP
Secretin
GLP-1
47
Role of the Ileoceal valve (2)
prevent backflow of colonic contents into the colon
prolongs chyme in the ileum for absorption
48
What happens to the ileocolic sphincter when the cecum is distended
It tightens
49
the function of the colon and locations of these functions (2)
absorb water and electrolytes - proximal half
store poop - distal half
50
What nerve provides PSNS innervation to the internal anal sphincter
pelvic N
51
factors that increase secretion from GI glands (5)
PSNS stimulation
tactile stimulation
GI distension
mucosal irritation
GI hormones
52
two components of saliva and their function
serous - digest starch via alpha-amylase
Mucus - lubercation
53
Electrolytes normally in high concentration in saliva (relative to plasma)
K+ HCO3-
54
Electrolytes normally in low concentration in saliva (relative to plasma)
Na Cl
55
simulation of salivation (4)
PSNS stimulation
nausea
tactile stimulation
taste
56
vasodilators will (increase/decrease) salivation
increase
57
What cells secrete pepsinogen
Chief cells
58
What is needed to activate pepsinogen into pepsin
Low pH (~3)
59
Stimulation for pepsinogen secretion (2)
acid in stomach
PSNS stimulation
60
What cells secrete HCl
parietal cells
61
What cells secrete intrinsic factor
parietal cells but also exocrine pancreas in dogs
62
What GI cells secrete histamine
ECL cells
63
What are 3 chemicals that increase HCl secretion
ACh via PSNS
Histamine
Gastrin
64
What stimulates histamine release from GIT
gastrin
65
What is the purpose of intrinsic factor
needed absorbtion of B12 in the ileum
66
What are the three phases of gastric secretion? Which one is the most important
Cephalic
gastric - most important
intestinal
67
What is one physical factor that decreases gastric secretion
food in SI
68
What 4 hormones decrease gastric secretion
Secretin
VIP
GIP
Somatostatin
69
What activates trypsinogen into trypsin
enterokinase
70
How do the other pancreatic digestive enzymes besides trypsinogen get activated
trypsin
71
what is the product of amylase digetsion
di- and tri-saccharides
72
what is the product of lipase digestion
free fatty acids and monoglyceride
73
what is the product of trypsin and chymotrypsin
polypetides
74
What chemical inhibits the activation of pancreatic enzymes in the pancreas
trypsin inhibitor
75
How is H+ secreted into the gastric lumen
Production of H+ from water via carbonic anhydrase
H+ / K+ ATP ase on luminal membrane
76
How is Cl sectreted into the gastric lumen
HCO3 - / Cl- counter transport on basolateral membrane
Cl diffusion into lumen via channel
77
How is bicarbonate secreted by the pancreas
Na / HCO3- co transporter on basolateral side
HCO3-/Cl- counter transport on luminal side
78
What are 3 stimuli for pancreatic secretion
Ach via PSNS
CCK
Secretin
79
three functions of bile acids
emulsify large fat particles
aid in digestion of fat
excretion of waste and excess cholesterol
80
Bile salts are approximately --% reabsorbed
94%
81
What do Brunner's glands secrete
mucous
82
What do Leiberkun crypts secrete
mucous
water and electrolytes
digestive enzymes
83
What do colonic glands secrete
mucous and bicarb
84
What organ in the body is effective at using pyruvate as an energy substrate
cardiac mycocytes
85
Role of VLDL
Carry triglycerides to the tissues
86
Role of LDL
Transport cholesterol to the tissues
87
Role of HDL
transport cholesterol to the liver
88
What vitamin is needed for aminotransferase
B6
89
What cytokines promote liver regneration
IL-6, TNFalpha
90
what cytokine terminates liver regeneration
TGFbeta
91
Enzymes involved in many phase 1 reactions
cytochrome P450
92
Role of peptide YY
decreased appetite
93
RER formula
RER = 70 (BW kg) ^0.75
94
life stage factor for a growing animal < 4 mo
2
95
life stage factor for a growing animal < 4 mo
3
96
life stage factor for a normal adult animal
1.4 - 1.6
97
life stage factor for an obese / inactive animal
1
98
Chachexia definition
energy expenditure > energy intake
99
three conditions associated with cachexia
The three C's
CKD
CHF
Cancer
100
Starvation definition
depletion of body nutrients
101
most common bloodwork change in refeeding syndrome
HYPOphosphotemia
102
bloodwork changes associated with refeeding
HYPOphosphotemia
HYPOkalemia
HYPOmagnesemia
HYPOcalcemia
103
recommendation for calories to feed in concern for refeeding syndrome
1/3 RER
104
Cause for increased folate on GI panel
dysbiosis
105
causes for decreased folate GI panel (3)
malabsorption
destruction of GI carriers
proximal infiltrative disease
106
Causes of low cobalamin on GI panel (2)
Severe ileal disease
EPI
107
indication for fecal float
looking for ova and cysts
108
Indication for fecal smear
looking for mobile protozoa (giardia, trichomonads), larvae, amoeba, might see ova too but less sensitive than float
109
indication for fecal sediment
fluke ova, some helminth ova sink
110
Indication for Baermann
any respiratory worm
111
indication for fecal culture
Tritrichomonas foetus
112
three drugs that might cause gingival hyperplasia
Ca+2 channel blockers
Cyclosporine
phenobarbital
113
What to do if you really want to treat gingival hyperplasia
brush teeth
azithromycin
114
Stomatitis is associated with which feline viruses
calicivirus
FHV-1
FIV and FeLV
115
pathophysiology MMM
autoimmune reaction to temporalis, masseter, and pterygoid MM --> inflammation, pain, swelling --> atrophy
116
Dx MMM
Ab titer for 2M fibers
117
fibrous osteodystrophy is related to what diease
hyperparathyroidism
118
Fetal structure that fails to close resulting in PSS
ductus venous
119
extrahepatic shunts are a failure of what fetal blood system
cardinal
120
intrahepatic shunts are a failure of what fetal blood system
vitelline
121
When does ductus venosus normallly close
3-10 days
122
breeds associated with microvascular dysplasia (3)
Maltese
Yorkie
Carin terriers
123
acquired PSS arise secondary to -----
Portal hypertension
124
Appearance of acquired shunts
multiple tortuous extrahepatic shunts near kidneys
125
MST for medical management alone PSS
10 months
126
breeds associated with Cu storage disease (3)
Bedlington terrier
Labs
Doberman
127
The gene associated with Bedlington terrier Cu storage disease
COMMD1
128
Chelators for treating Cu storage disease (2)
D- penicillamine
trientine
129
Mineral supplement for maintenance of Cu storage disease and MOA
Zinc, decreases Cu absorbtion
130
Causes of prehepatic portal hypertension (4)
obstruction
mass
thrombus
fibrosis
131
Causes of hepatic portal hypertension (2)
hepatitis
Cirrhosis **most common**
132
Post hepatic portal hypertension (3)
obstruction or large veins
R CHF
pericardial disease
133
Protein of effusion for portal hypertension if it is prehepatic or presinusoidal
<2.5
134
Protein of effusion for portal hypertension if it is sinusoidal, or posthepatic
>2.5
135
ALP is more liver specific in (cats/dogs)
cats
136
active metabolite of acetaminophen for toxicity in cats
NAPQI
137
Cats lack what that makes them susceptible to acetaminophen toxicity
UT61A6
138
True or false cats experience hepatotoxicity from phenobarbital
false
139
Histopath change to liver with aflatoxin
vacuolization and cirrhosis
140
pathophysiology of amatatoxin from Amatia mushrooms
inhibit RNA polymerase
141
pathophysiology of cyanotoxin from blue-green algae
hyperphosphorylation, glutathione toxicity, and hepatic necrosis
142
histoapth change acute pancreatitis
neutrophilic inflammation
143
histoapth change chronic pancreatitis
lymphoplasmacytic inflammation and fibrosis
144
breed predisposition of acute pancreatitis
mini schnauzer
yorkie
145
breed predisposition of chronic pancreatitis
Boxer
CKCS
cocker
Collies
146
BW change that predisposes to pancreatitis
elevated triglycerides
147
Iatrogenic factors that can predispose to pancreatitis
drugs
GA
148
endocrine disease that can predispose to pancreatitis
Cushings
hypothyroid
Diabetes mellitus
149
best test for pancreatitis in dogs and cats
cPLI/fPLI
150
what can cause a false positive on a PLI
renal disease
151
What is the main source of energy for enterocytes
glutamine
152
Best Dx for PLE
fecal alpha protease inhibitor
153
HGE is associated with what infection
clostridium
154
How long to see response of strick hydrolyzed diet
10 weeks
155
three negative prognostic factors for IBD
hypoalbuminemia
severe disease
concurrent pancreatitis
156
Most common subtype of IBD in dogs
Lymphoplasmacytic
157
Second most common subtype of IBD in dogs
eosinophilic
158
breeds predisposed to eosinophilic enteritis
boxer
Doberman
159
Nonneoplastic cause of multiple GI masses in a cat
feline sclerosing eosinophilic fibroplasia
160
Breed associated with hereditary lymphoplasmacytic enteritis
Basenji
161
Breed associated with concurrent PLE PLN
Soft-coated wheaten terrier
162
Bloodwork changes associated with lymphangiectasia
Low protien
low Calcium
low magnesium
low cholesterol
low lymphocytes
163
how much do you need to remove for short bowel syndrome
2/3
164
How much liver function needs to be lost for a decrease in albumin or glucose
75%
165
Form of bilirubin that can last over 2 weeks
deltabilirubin
166
indirect liver function that is not affected by PSS
bilirubin
167
causes for elevated bile acids (3)
shunt
hepatic disease
cholestasis
168
normal preprendial and postprandial bile acids
< 15 , <25
169
Confounders for unexplained results on bile acids test (4)
intermittent GB contraction
lipemia
failure of GB contraction
severe ileal disease
170
Normal ammonia
<45
171
reasons for elevated ammonia (4)
PSS
hepatic metabolism issue (hepatic lipidosis)
hepatic failure
LSPAR
172
sensitivity of elevated ammonia for PSS
98%, specificity 89%
173
test you can do if you think ammonia should be high and it's not
ammonia tolerance test
174
What vitamins will have decreased absorption with cholestasis
fat soluble (A, D, E, K)
175
CBC abnormality with PSS
microcytosis
176
RBC change indicative of liver disease
target cells
177
Bilirubinuria can be normal in (cats/dogs)
dogs
178
what % of dogs with PSS have ammonia biurate crystals
50%
179
Renal consequence of Cu storage disease
fanconi-like syndrome
180
main energy source for colonic epithelial cells
Butyrate
181
Most common cause of EPI
pancreatitis
182
Breed that gets EPI secondary to pancreatic acinar atrophy
GSD
183
Dx for EPI
TLI
184
Paraneoplastic syndrome for cats with pancreatic carcinoma
Alopecia and shiny skin
185
Cats have a low ability to synthesize ------ and when deficient they can develop retinal degeneration
taurine
186
cats require ------ for the urea cycle and deficiency can lead to hyperammonemia
arginine
187
cats cannot synthesize ---- from linoleic acid via -----
arachidonic acid
6 desaturase
188
consequences of arachidonic acid deficiency in cats (2)
repo failure
decreased plt aggrigation
189
cats are very susceptible to what vitamin deficiency
niacin (B3)
190
Vitamin A (retinol) is needed for (2)
formation of retinal pigments
growth and proliferation of epithelial cells
191
deficiency in vitamin A can cause (5)
skin scaling
Keritinzed cornea
repro-failure
epithelial infection - UTI, conjunctivitis
cessation of skeletal growth in young animals
192
Vitamin B1 (thiamine) is needed for
decarboxylation of pyruvic acid (carb and protein metabolism
193
Vitamin B1 (thiamine) deficiency causes (3)
demyelination
vasodilation
decreased GI secretion
194
Vitamin B3 (niacin) is used for
coenzyme in oxidative metabolism
195
Vitamin B3 (niacin) deficiency causes ---- in dogs
black tounge
196
Vitamin B2 (riboflavin) is used in
H+ acceptor for ECT
197
Vitamin B2 (riboflavin) deficiency causes
similar deficiency to B 1 and 2
198
Vitamin B5 (pantothenic acid) is used for
coenzyme for Co A metabolism
199
Vitamin B6 (pyridoxine) is needed for
coenzyme in amino acid synthesis and transport
200
Vitamin B6 deficiency causes (5)
Dermatitis
decreased growth
anemia
mental deterioration
fatty liver
201
Vitamin B12 (cobalamin) is used for
coenzyme for reduction in ribonucleotides --> deoxyribonucleotides
202
Vitamin B12 (cobalamin) deficiency causes
pernicious anemia
203
folic acid is needed for
synthesis of purines and thymine
204
folic acid deficiency causes
macrocytic anemia
205
Vitamin C (ascorbic acid) is used for
synthesis of collagen (prolyl hydroxylase)
206
Vitamin C (ascorbic acid) deficiency causes
scurvy - decreased wound healing, decreased bone growth, fragile blood vessels (bruising)
207
Vitamin D deficiency causes
hypocalcemia Ricketts
208
Vitamin E is used for
prevention of oxidation
209
Vitamin E deficiency causes
skin issue, repro failure, retinal degeneration
210
Mg deficiency causes (3)
CNS excitability, muscle spasms, arrhythmias
211
four mechanisms of diarrhea
osmotic
secretory
increased perimability
altered motility
212
Famotidine MOA
H2 receptor antagonist
213
Cimetidine MOA
H2 receptor antagonist
214
Ranitidine MOA
H2 receptor antagonist
215
Omeprazole MOA
PPI
216
Pantoprazole MOA
PPI
217
Sucralfate MOA
GI-Mucosal Protectant, preferentially binds to the proteinaceous exudates that are generally found at ulcer sites
218
Misoprostol MOA
Prostaglandin E1 Analogue, increases cell turnover, blood supply and HCO3- secretion GI mucosa inhibit basal and nocturnal gastric acid secretion as well as gastric acid secretions stimulated by food.
May be useful for prevention of GI lesions, especially those associated with NSAID therapy; appears ineffective in prevention of glucocorticoid-induced lesions.
219
Metoclopramide MOA
-Peripheral: dopamine antagonist - sensitizes upper GI smooth muscle to the effects of acetylcholine, stimulating motility of the upper GI tract without stimulating gastric, pancreatic, or biliary secretions
-Central: antagonizes dopamine D2 receptors, is a weak inhibitor of serotonin 5-HT3 receptors, and is an agonist of serotonin 5-HT4 receptors - sedative, antiemetic effects
220
Cisapride MOA
5-HT4-receptor agonist that enhances the release of acetylcholine at the myenteric plexus without stimulating nicotinic or muscarinic receptors or inhibiting acetylcholinesterase activity. Increasing lower esophageal peristalsis and sphincter pressure increases gastric contractions, accelerates gastric emptying, and promotes small and large intestinal motility
221
Erythromycin MOA prokinetic
5-HT3 agonist stimulating MMC and increasing gastric emptying and colonic activity in dogs
222
Maropitant MOA
neurokinin-1 (NK-1) receptor antagonist that acts in the emetic center within the CNS by inhibiting the binding of substance P
223
Ondansetron MOA
5-HT3 receptor antagonist peripherally on vagal nerve terminals and centrally in the chemoreceptor trigger zone (CRTZ)
224
Apomorphine MOA
stimulates dopamine receptors in the chemoreceptor trigger zone
225
Apomorphine reversal
Naloxone may reverse CNS effects and respiratory depression but will not reverse vomiting or cardiovascular effects
226
Ropinirole MOA
dopamine agonist that preferentially targets the D2 family receptors at the CTZ
227
Ropinirole reversal
Metoclopramide can be used to halt protracted vomiting and relieve other dopaminergic signs
228
Polyethylene glycol 3350 MOA
osmotic laxative agent that does not alter nutrient, glucose, or electrolyte absorption
229
Lactulose MOA
In the colon, lactulose is metabolized by resident bacteria, resulting in the formation of lactic, formic, and acetic acids, as well as carbon dioxide (CO2). The production of these free fatty acids (also known as volatile fatty acids) increases osmotic pressure in the bowel, drawing in water for a laxative effect and acidifying colonic contents. This acidification causes ammonia (NH3) to migrate from the blood into the colon, where it is trapped as the ammonium ion (NH4+) and expelled with the feces.
230
Crofelemer MOA
an antisecretory antidiarrheal agent that inhibits 2 types of chloride channels on the luminal membrane of enterocytes: 1) cyclic adenosine monophosphate-stimulated cystic fibrosis transmembrane conductance regulator (CFTR) chloride channels and 2) calcium-activated chloride channels, reducing Cl- and water loss in GIT
231
Capromorelin MOA
ghrelin receptor agonist
232
Mirtazapine MOA
antagonism at central presynaptic alpha-2–adrenergic receptors, which normally act as a negative feedback mechanism, inhibiting further norepinephrine (NE) release. By blocking these receptors, mirtazapine overcomes the negative feedback loop and causes a net increase in NE.
potent inhibitor of the 5-HT2, 5-HT3, and histamine (H1) receptors.
233
CMPA MOA
Canine-specific antibody
selectively binds to circulating canine parvovirus, neutralizing the virus and preventing viral infiltration into host cells.
234
Panoquelle (fuzapladib) MOA
inhibits the activation of leukocyte function antigen‐1 (LFA‐1) on the surface of inflammatory cells. This mechanism of action prevents the cells from adhering to the vascular endothelium and migrating into pancreatic and other injured tissue, and thereby it limits neutrophil-mediated inflammatory responses
235
Octreotide
ynthetic, long-acting analogue of somatostatin. It inhibits the synthesis and secretion of insulin (in both normal and neoplastic beta cells), glucagon, secretin, growth hormone, gastrin, and motilin.
236
Pancrelipase MOA
Pancrelipase is a combination of porcine lipase, proteases, and amylase, which help to digest and absorb fats, proteins, and carbohydrates
237
N-acetyl cysteine MOA
a thiol donor, stimulating glutathione synthesis, and is a free radical scavenger. It also improves hepatic blood flow through increased production of nitric oxide.
When administered into the pulmonary tree, acetylcysteine reduces the viscosity of both purulent and non purulent secretions and expedites the removal of these secretions via coughing
238
SamE MOA
methyl donor (necessary for many substances and drugs to be activated and/or eliminated)
239
Silymarin MOA
inhibits lipid peroxidase and beta-glucuronidase and acts as an antioxidant and free radical scavenger. Silymarin also inhibits the cytotoxic, inflammatory, and apoptotic effects of tumor necrosis factor (TNF)
240
Ursodeoxycholic Acid MOA
noncytotoxic bile acid, decreases intestinal absorption of cholesterol and suppresses hepatic synthesis and secretion of cholesterol, and ultimately reduces cholesterol saturation in the bile. In veterinary medicine, ursodiol is used for its choleretic (increased bile flow) properties.
