GI Tutorial 1

Question 1

2 aggressive factors for peptic ulcers

Answer 1

Pepsin secretion

Acid secretion

Question 2

3 protective factors for peptic ulcers

Answer 2

Mucus/bicarbonate secretion
Prostaglandins (mucosal blood flow)
Rapid turnover of gastric mucosa

Question 3

Why do peptic ulcers occur?

Answer 3

Due to an imbalance between aggressive factors and mucosal protective mechanisms

Question 4

3 factors that contribute to the gastric mucosal barrier

Answer 4

Bicarbonate rich mucus layer
Tight junctions
Luminal membrane of mucosal cells is impermeable for protons

Question 5

Causes of ulcers

Answer 5

Hyperacidity
NSAIDs and corticosteroids
Cigarette smoking
Alcohol
Stress
Coffee
Helicobacter pylori infection

Question 6

How can H pylori survive the acidic state?

Answer 6

Has urease that neutralizes the gastric acid by turning urea into ammonia
Creates a small atmosphere of neutral pH
Has exotoxins and other products to be able to invade the cells

Question 7

2 ways to treat peptic ulcers

Answer 7

Antibiotics (to treat the H pylori)

Proton pump inhibitors (to reduce acid secretion)

Question 8

How do NSAIDs work?

Answer 8

Block the COX enzymes
COX1 is constitutive and important for blood flow, platelets, and to protect the stomach
COX2 is responsible for pain and inflammation
Want drugs that are more specific for COX2 instead of COX1

Question 9

Zollinger Ellison syndrome

Answer 9

Tumor in pancreas that can cause the release of a lot of gastrin in the stomach, leading to peptic ulcers, diarrhea, and acid hypersecretion

Question 10

Why would too much acid in the duodenum lead to diarrhea?

Answer 10

Too acidic, so the pancreatic digestive enzymes do not work

Food is not broken down, and osmotic diarrhea occurs

Question 11

Barrett’s esophagus

Answer 11

The replacement of normal esophageal epithelium by stomach like epithelium which is columnar containing goblet cells

Question 12

Symptoms of acute pancreatitis

Answer 12

High serum levels of pancreatic lipase and pancreatic amylase
High WBC count

Question 13

Pathophysiology of acute pancreatitis

Answer 13

Inflammation from and insult or injury
Causes activation of pancreatic enzymes
Enzymes autodigest and cause fibrosis
Leads to thrombi and necrosis of tissue
Fat necrosis occurs
Fat binds to calcium
Results in hypocalcemia

Question 14

Salivary stimulation

Answer 14

All neural

Both parasympathetic and sympathetic stimulation stimulate secretion

Question 15

5 ways to detect H pylori

Answer 15

Histology
Breath test (C14-urea)
Urease test
ELISA
Rapid test

Question 16

5 causes of chronic pancreatitis

Answer 16

Ethanol abuse
Gallstones
Hyperparathyroidism
Congenital malformation
Idiopathic

Question 17

Exocrine insufficiency manifests as…

Answer 17

Steatorrhea and weight loss

Question 18

Endocrine insufficiency

Answer 18

May result from islet cell destruction

Leads to diabetes

Question 19

2 agents to treat pancreatitis

Answer 19

Somatostatin (decrease pancreatic secretion and motility)

Anticholinergic agents

Question 20

2 beneficial effects of prostaglandins

Answer 20

Promote platelet function

Protect the lining of the stomach from the damaging effects of acid

Question 21

3 harmful effects of prostaglandins

Answer 21

Inflammation
Pain
Fever