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Patho II > GI Tract 1 > Flashcards

GI Tract 1 Flashcards

1
Q

Controls motility

A

Myenteric plexus

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2
Q

Controls Secretion and blood flow

A

Submucosal plexus (Meissner’s plexus)

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3
Q

Release in response to meal:
Increases H secretion by gastric _____
Stimulates growth of _____ - trophies action

A

Gastrin; parietal cells; gastric mucosa

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4
Q

Gastrin is secreted from ____ of the gastric antrum in response to what?

A

G cells;
Small peptides & amino acids (phenylalanine & tryptophan)
Distension of stomach
Vagal stimulation

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5
Q

What inhibits gastrin release?

A

Acid (H) in the lumen of the stomach (-ve feedback)

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6
Q

Occurs when gastrin is secreted by non-Beta-cells of pancreas —> hypertrophy of gastric mucosa

A

Zollinger-Ellison syndrome

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7
Q

How is bile ejected?

A

Cholecystokinin (CKK) stimulates contraction of GB —> relaxation of sphincter of Oddi

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8
Q

How does cholecystokinin (CKK) affect the pancreas?

A
  1. Stimulates pancreatic enzyme secretion
  2. Potentiate secretin-induced stimulation of pancreatic HCO3 secretion
  3. Stimulates growth of exocrine pancreas
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9
Q

Fatty meals stimulate ____ to slow gastric emptying allowing for more time for intestinal digestion & absorption

A

CCK

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10
Q

Stimuli for CCK

A

Fatty acids & monoglycerides in duodenum

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11
Q

Actions are coordinated to reduce H in the lumen of the small intestine. “Nature’s antacid”

A

Secretin

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12
Q

How does secretin work?

A
  1. Stimulates pancreatic HCO3 (neutralizes H in intestinal lumen)
  2. Stimulates HCO3 & H2O secretion by the liver & increase bile production
  3. Inhibits H secretion by gastric parietal cells
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13
Q

Secretin is released by the ____ in response to H+ in the lumen of the duodenum

A

S cells of duodenum

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14
Q

_____ is the principle stimulus for delivery of pancreatic enzymes & bile into small intestine

A

CCK

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15
Q

Swallowing is innervated by what nerve?

A

Vagus & glossopharyngeal nerve

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16
Q

GERD ___ LES pressure while achalasia ___ LES pressure

A

Decreases; increases

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17
Q

Gastric contraction increases by ______ and decreases by _______

A

Vagal stimulation; sympathetic stimulation

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18
Q

Factors delaying gastric emptying:

A

Obesity, pregnancy, opioids, DM, trauma, pain

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19
Q

Propulsion of chyme toward large intestine is coordinated by what?

A

Enteric NS

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20
Q

Increases LES & gastric motility, decreased tone of pyloric sphincter & relaxes duodenum
No effect on gastric pH
Increases action of Sux by inhibiting plasma cholinesterase

A

Metoclopramide

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21
Q

Absence of the enteric NS resulting in constriction of the involved segment, marked dilation & accumulation of intestinal proximal to constriction & severe constipation

A

Megacolon (hirschsprung’s dz)

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22
Q

Mendelson syndrome

A

Aspiration pneumonitis

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23
Q

____ cells of stomach produce Pepsin

A

Chief

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24
Q

____ is a protein that helps to absorb vit B12 in the duodenum. Cannot absorb w/o it

A

Intrinsic factor

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25
Q

Kills bacteria, breaks down food, & converts pepsinogen.

Stimulated by what?

A

HCl;

Gastrin, vagal stim (ACh), & histamine

26
Q

Parietal cells (body) secrete what?

A

HCl & intrinsic factor

27
Q

______ cells secrete _____ that is broken down to pepsin. Stimulated by?

A

Chief; pepsinogen; vagal stim (ACh)

28
Q

____ cells (antrum) secrete _____ that stimulate acid secretion. It is stimulated/inhibited by?

A

G; gastrin;
Vagal stim (via GRP)
Inhibit by: somatostatin & H in stomach

29
Q

_____ cells secrete ____ which is a lubricant that protects form H. Stimulated by?

A

Mucous, mucous, vagal stim (ACh)

30
Q

______ inhibits the H/K pump and blocks H secretion. Why can this cause hypergastrinemia?

A

Omeprazole; no acid = no inhibition of gastrin —> rebound phenomenon leading to more acidity “hypergastrinemia”

31
Q

______ is released by mast cells in the gastric mucosa. It stimulates H secretion by activating _____ on the parietal cell membrane

A

Histamine; H2 receptors

32
Q

H. Pylori has high ____ activity and converts urea to ____, which damages the gastric mucosa

A

Urease; NH3

33
Q

H secretion is ___ with gastric ulcers and ____ with duodenal ulcers

A

Decreased; increased

34
Q

Gastrin secreting tumor that continually secretes large amounts of gastrin into blood.
Increases acid secretion —> ulcers
20% a/w ______

A 
Gastrinoma (Zollinger-Ellison syndrome);
MEN I (parathyroid, pancreas, & pituitary)
35
Q

Symptoms of Zollinger-Ellison syndrome

A

Secretory diarrhea (gastrin inactivates lots of digestive enzymes-> malabsorption)
Weight loss
Steatorrhea (bc pancreatic enzymes are inactivated by very high acid)
Severe ulcers (located in atypical places & a/w complications)

36
Q

Dx of Zollinger-Ellison syndrome

A

High fastening gastrin level (nl <100)
Secretin stimulation test
CT to see the tumor

37
Q

MCC OF GERD

A

Abnormal relaxation of LES (decreased tone) <13 mmHg (nl 29 mmHg)

38
Q

Test of choice for GERD dx

A

Endoscopy with biopsy

39
Q

What is definitive proof that acid reflux is causing symptoms?

A

24-hr pH monitor in LE

40
Q

Gradual progression of obstructive type dysphagia. Solid&raquo_space; liquids

A

Peptic strictures

41
Q

Transformation of squamous to columnar mucosa, premalignant, requires surveillance biopsies searching for dysplasia. Resulting cancer is ____

A

Barrett’s esophagus; adenocarcinoma

42
Q

Pain greater with meals: weight loss
H pylori infxn in 70%; NSAID (inhibit PG secretion)
D/t ⬇️ mucosal protection against gastric acid
⬆️ smokers, ETOH, stress

A

Gastric ulcer

43
Q

Pain Decreases with meals: weight gain
Almost 100% have h pylori infxn that inhibits somatostatin
D/t ⬆️ gastric acid or ⬇️ mucosal protection

A

Duodenal ulcer

44
Q

Why does pain decrease with meals in duodenal ulcer?

A

It causes more bicarb to come neutralize the acid

45
Q

Anorexia nervous is characterized by:

A

Hypokalemia, hyponatremia, hypochloremia, & metabolic alkalosis

46
Q 
Abdominal pain, crampy, fever, diarrhea (w/o blood, pus, mucous)
Weight loss
Perinatal dz (anal fissure, fistula, abscess)
Anemia (iron deficiency or megaloblastic)
A

Crohn’s dz “regional enteritis”

47
Q

Tx fro Crohn’s dz

A

Folate, iron, & B12

Sulfasalazine

48
Q

Diffuse mucosal or submucosal thickening (not transmural)
Bloody diarrhea
Toxic megacolon
Typically dz of young people

A

Ulcerative colitis

49
Q 
Any portion of GIT, the terminal ileum (hall mark), small intestine & colon. 
Discontinuous lesion (skip lesions), rectal sparin
A

Crohn’s dz

50
Q

Transmural inflammation, cobblestone mucosa, bowel wall thickening “string sign”, linear ulcers, fissures

A

Crohn’s dz

51
Q

Caused by increased pressure and weakness of walls and is a/w ____ fiber diet

A

Diverticulosis; low

52
Q

LLQ pain “left sided appendicitis”.

Complications include:

A

Diverticulitis; perforation, peritonitis, abscess formation, or bowel stenosis

53
Q

Reduced or absent peristalsis and increased pressure at LES with incomplete relaxation with swallow.
D/t loss of nitric oxide producing inhibitory neuron in ______

A

Achalasia; myenteric plexus

54
Q

Tx for achalasia

A

Pneumatic dilation, CCBs, injection of botulinum toxins in LES, or surgical myotomy

55
Q

Fibrosis of lower 2/3 of esophagus/ decreased peristalsis and decreased resting pressure.
Secondary to diffuse esophageal spasm “nutcracker” esophagus

A

Scleroderma esophagus

56
Q

Outpouching of esophagus. Halitosis, regurgitation of days old food
Dysphagia (obstruction)
Extreme caution during NG tubing

A

Zenker’s Diverticulum

57
Q

Mucosal tear after severe vomiting, coughing, or retching.
Upper GI bleeding (bright red)
Found in alcoholics & bulimics
Vasopressin or angiographic embolization

A

Mallory-Weiss Syndrome

58
Q

Composition of pancreatic secretion

A

High volume (up to 3L)
Much higher HCO3 conc than plasma (pH 8.3)
Pancreatic lipase, amylase, and proteases

59
Q

Stimulation of pancreatic secretion

A

Secretin “natures antacid”
CCK
ACh (via vagus) acts like CCK

60
Q

Cystic fibrosis is from defective _____ genes on chromosome 7 and a defect in ____ caused by mutation

A

CFTR; Cl channels

Patho II (11 decks)

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