Hepatobiliary/GI Flashcards
1
Q
obstructive jaundice bili type
A
conjugated bili (DIRECT) that cannot get into circulation
2
Q
does obstructive jaundice have plasma bili
A
yes
3
Q
does obstructive jaundice have urine bili
A
yes
4
Q
hemolytic jaundice bili type
A
unconjugated (INDIRECT) because its tightly bound to albumin
5
Q
does hemolytic jaundice have plasma bili
A
yes
6
Q
does hemolytic jaundice have urine bili
A
no
7
Q
markers of liver injury
A
AST
ALT
AP
8
Q
markers of liver function
A
albumin
total bili
9
Q
albumin levels in cirrhosis
A
low albumin
10
Q
total bili levels in liver failure
A
incr unconjugated
decr conjugated
11
Q
hepatocellular abnormality levels to check
A
ALT/AST
12
Q
cholestatic abnormality check levels of
A
AP +- TB
13
Q
NALD liver enzymes
A
ALT>AST
14
Q
ALD liver enzymes
A
AST>ALT
15
Q
cirrhoiss
A
decr albumin
incr sinusoid resistance
incr portal pressure
ascites
16
Q
treat ascites
A
suck out fluids
give albumin
17
Q
gastrin cells
A
G cells in stomach/duodenum
18
Q
gastrin stimuli
A
AAs
food
vagal stim
19
Q
gastrin effects
A
incr H+
incr mucosa
incr motility
20
Q
CCK cells
A
I cells in duodenum/jejunum
21
Q
CCK stimuli
A
AAs
FFAs
22
Q
CCK effect
A
GB contraction
sphincter of oddi relax
incr pancreas enzyme
incr bicarb
decr emptying
incr pancreas/GB trophic effects
23
Q
secretin cells
A
S cells in duodenum/jejunum
24
Q
secretin stimuli
A
incr H+ (pH < 4.5)
FFA
25
secretin effect
incr pancreatic/biliary bicarb
decr H+
decr mucosa
incr pancreatic trophic effects
26
GIP/GLP cells
K/L cells in duodenum/jejunum
27
GIP/GLP stimuli
oral glucose
AAs
FFAs
28
GIP/GLP effects
incr pancreatic insulin
decr H+
29
somatostatin cells
D cells in pancreatic islets and GI mucosa
30
somatostatin stimuli
incr H+
31
somatostatin effects
decr GI hormones
decr H+
decr pancreatic enzyme/bicarb
decr GB contraction
32
motilin cells
M cells in duodenum/jejunum
33
motilin stimuli
decr vagal signaling
34
motilin effect
incr motor complex to clear debris and prevent SIBO
35
sympa GI
decr motility
decr secretions
sphincter constriction
vasoconstriction
35
Para/Enteric GI
incr motility
incr secretions
sphincter relaxation
vasodilation
36
enteric: VIP
incr sm muscle relaxation
37
enteric: GRP
incr gastrin secretion
38
how are ICC coupled to SMC
through L type Ca2+ channel
39
what determines the max rate of contraction
slow wave/basal electrical rhythm
40
when do contractions occur
when threshold spike frequency is met
41
incr spike frequency
incr contraction strength
42
what inhibits slow wave/BER
decr ACH
incr epi
43
what cranial nerves contribute to salivation
CN VII - facial
CN IX - glossopharyngeal
44
what is the primary regulator of salivation
parasympathetics
45
what is different about sympathetic stimulated saliva
high protein content
46
what does stress do to saliva
vasoconstricts
decreasing saliva
47
what increases salivary flow rate
Ach
48
high flow rate saliva content
high Na+
high bicarb
high Cl-
49
low flow rate saliva content
low Na+
low bicarb
low Cl-
50
which flow rate saliva is more plasma liek
high flow rate
51
NET salivary reabsorption
Na+
Cl-
are less than that of plasma
52
NET salivary secretion
K+
bicarb
are greater than that of plasma
53
saliva tonicity
hypotonic
54
3 mechanisms to regular stomach acid
Vagal
G cells
ECL cells
55
rank strength of stomach acid regulation mechanisms
hist>Ach>gastrin
56
increased H+ secreation causes
incr somatostatin
57
somatostatin inhbitis
G cells
ECL cells
parietal cells
to decrease HCl
58
primary stimulat for pancreatic enzyme secreation
CCK
59
what potentiates CCK
Ach
60
secretin role in pancreas
secretes bicard to ensure neutral pH for enzymes function
61
what potentiates secretin
CCK and Ach
62
what increases bicarb secretion
increased secretin triggers bicarb release in pancreas
63
pancreatic juice pH
8.6 (alkaline)
64
pancreatic juice breakdown
high Na+
high bicarb
low Cl-
low K+
65
plasma breakdown
high Na+
low bicarb
high Cl-
low K+
66
difference between plasma and pancreatic juice
pancreatic juice is higher in bicarb and lower in Cl-
67
what enzyme digests starch
amylase
68
what proenzymes digrest proteins
trypsinogen
chymotrypsinogen
procarboxypeptidase
peolastase
69
what activates trypsinogen
enteropetidase activates trypsinogen to trypsin
70
what activates poelastase
trypsin
71
why are some enzymes in the pancrease inactive?
inactive stoerage prevents pancreas autodigestion
72
which enzyme does fat digestion
lipase
73
which enzymes digest nucleic acids
deoxyribonuclease
ribonuclease
74
what makes primary bile
liver
75
what are the components of primary bile
bile salts + cholesterol + lecithin
76
what concentrates bile
the gallbladder
77
what must you have to get bile out of the gall bladder
CCK
78
what allows the sphincter of oddi to relax during bile secretion
increased NO
increased VIP
79
what are the 2 functions of the ileum
B12 absorptions
ABST - bile salt reabsoprtion
80
what % of bile salts are reabsorbed
95%
81
liquid bile ratio
10:3:1
high bile salt
high lecithin
low cholesterol
82
cholelithiasis
gall stones
83
what factors favor gall stone formation
low bile salt
low lecithin
high cholesterol
84
saliva bicarb and K+
high bicarb
high K+
85
what inhibits saliva
sleep
dehydration
atropine
86
enzymes in salivaryformation
alpha amylase
lingual lipase
87
HCl formation stimulated by
gastrin
histamine
parasympathetics
88
HCl inhibited by
decr stomach pH
chype
somatostatin
89
gastric pepsinogen is stimulated by
parasympathetics
90
pancreatic secretions are _____ in bicarb
high bicarb
91
pancreatic secretions are stimulated by
secretin
CCk
parasympathetics
92
pancreatic enzymes
pancreatic lipase
amylase
protease
93
what stimulates pancreatic enzymes
CCk
parasympathetics
94
bile is stimulated by
CCK
and parasympathetics
95
bile is inhibited by
illeal resection
96
gi contraction types
segmentation
tonic contraction
peristalsis
97
segmentation occurs in
stomach
intestines
98
tonic contraction occurs in
sphincters
99
peristalsis occurs in
esophagus
stomach
intestines
100
Gi contractions are driven by
smooth muscle cells via the BER from ICCs
101
what nerves contribute to swallowing
glossopharyngeal
vagal
102
where is the swallowing center
medulla
103
resting position of UES
contracted due to somatic Ach stimulus
104
how do you relax the UES
stop sending Ach
105
resting position of LES
contracted due to autonomic Ach stimulating enteric neuron to release vNE stimulus
106
what relaxes LES
Ach stimulating enteric neuron to release NO/VIP
107
UES is what type of muscle
skeletal
108
LES is what type of msucle
smooth
109
esophagus is what type of muscle
upper 1/3 = skeletal
lower 2/3 = smooth
110
is swallowing voluntary or involuntary
voluntary
111
what about peristalsis?
reflexive
112
4 things that can trigger vomiting
pain/anticipation
anesthetics
pharynx/stomach stimuli
motion sickness
113
pain works on
cortical centers
then vomiting center
114
anesthetics impact the
CTZ
115
pharynx/stomach stimuli triggers
visceral afferents in the CTZ and NTS
116
motion sickness impacts
NTS
117
CTZ nTs
dopa
ach
serotonin
histamine
opiods
neurokinin-1
118
NTS Nts
dopa
ach
serotonin
histamine
neurokinin-1
119
vomiting center nts
dopa
ach
serotonin
histamine
120
what is open during vomiting
UES
LES
121
what closes during vomiting
nares
diaphragm contracts
122
what forces vomit out
delta P
when diaphragm contracts
abs increase stomach pressure
