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GI Greenfield > Hormones & Clinical > Flashcards

Hormones & Clinical Flashcards

1
Q

Gastrin
Released where?

Receptor?

Actions?

Stimulates release?

Inhibits release?

A

G Cells of stomach, high in number in pylorus

Receptor: CCKb –> IP3

Actions:

  • Stimulate parietal cells to release HCl
  • Growth of gastric mucosa
  • increase histamine release

Stimulates:

  • Gastric distension
  • Alkaline environment
  • small peptides and AA
  • vagal stimulation

Inhibits:

  • Somatostatin
  • Secretin
  • Acidic pH <1.5
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2
Q

Histamine
Released where?

Receptor?

Actions?

Stimulates release?

Inhibits release?

A

Enterochromaffin-like cells (ECL) in gastric glands

H2 receptor –> cAMP

Increase H+ from parietal cells

Stimulates:

  • gastrin
  • Vagus

Inhibits:

  • Somatostatin
  • Acidic pH

Note: NOT A PEPTIDE

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3
Q

Somatostatin/
Released where?

Receptor?

Actions?

Stimulates release?

Inhibits release?

A
  • GI mucosa D cells
  • Hypothalamus
  • Exocrine pancreas

Receptor:
Direct - Gi –> blocks adenlyl cylcase –> low cAMP
Indirect - blocks H2 and CCKb

Actions: 
- inhibit gastrin and histamine
- inhibit glucagon and insulin release
Stimulates: 
- High acidity 
- Sympathetic

Inhibit:

  • Vagus
  • Helicobacter pylori
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4
Q

Ghrelin
Released where?

Receptor?

Actions?

Stimulates release?

Inhibits release?

A

Gastric cells

Receptor: ?

Action:
increase appetite

Stimulates: Fasting state

Inhibits: Fed State

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5
Q

Cholecystokinin
Released where?

Receptor?

Actions?

Stimulates release?

Inhibits release?

A

I cells of duodenuma nd jejunum

Receptor: CCKa (on ductal cells of pancreas) and CCKb

Actions:

  • Increase pancreatic enzyme
  • increase HCO3 secretion
  • contract gallbladder
  • relax sphincter of Oddi
  • growth of exocrine pancreas and gallbladder
  • decrease gastric emptying by decreasing contratinos and increasing gastric distensibility

Stimulates:
- Fatty acids, peptides and small AA (mainly phenylalaine, methionine and tryptophan) coming into Small Intestine

Inhibits:
Fasting?

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6
Q

Secretin
Released where?

Receptor?

Actions?

Stimulates release?

Inhibits release?

A

S cells of duodenum and jejunum

Receptor: on ductal cells in pancreas

Actions:

  • increase HCO3 and bile
  • decrease H+ secretion
  • inhibit gastrin
  • Neutralizes duodenum acid (w/o this, pancreatic enzymes would not be activated)
  • Decrease gastric emptying
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7
Q

GIP
Released where?

Receptor?

Actions?

Stimulates release?

Inhibits release?

A

K cells in duodenum and jejunum

Receptor: ?

Actions:

  • increase insulin secetion from pancreatic B cells
  • decrease H+
Stimualted: 
\+ Gastrin
\+ Glucose, free
\+ Fatty 
\+ Peptides and AA

Think of GIP = Glucose; Icky fats; Peptides

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8
Q

Neurotransmitter: ACh

Source?

Actions?

A

Source: Cholinergic pre-ganglion everywhere,
post ganglionnic for Parasympathetic and Sympathetic Sweat glands

Actions:

  • contract smooth muscle
  • relax sphincters
  • increase saliva, gastric and pancreatic secretions
Directly stimulates: 
Parietal cells --> H+
ECL --> Histamine
D cells --> Somatostatin
G cells --> Gastrin
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9
Q

Neurotransmitter: Norepinephrine:

Source?

Actions?

A

Source: Adrengeric neurons:
Post ganglionic of symptathetic

Actions -

  • relax smooth muscle
  • contract sphincters
  • increase saliva
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10
Q

NT: VIP (Vasoactive intestinal peptide)

Source?

Actions?

A

Source:
- ENS neurons peptidergic - Post ganglion Parasympathetic

Actions:

  • Relax smooth muscle
  • increase intestinal, pancreatic secretion
  • Most well known for relaxing LES
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11
Q

NT: Nitric Oxide

Source?

Actions?

A

Source: ENS neuron
Released in front of bolus to relax muscle via Vagus

Actions: Relaxes muscle, vasodilates

Stimulates: Bolus

Inhibits: Fasting

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12
Q

NT: Enkephalins

Source?

Actions?

A

Source: ENS neuron; type of GRP

  • contracts smooth muscle
  • decreases secretions
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13
Q

NT: :Neuropeptide Y

Source?

Actions?

A

Source: ENS neurons

Relax smooth muscle
decrease intestinal secretion

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14
Q

NT: Substance P

Source?

Actions?

A

Source: ENS neurons; Peptidergic Parasymapthetic post ganglion; type of GPR

Actions:

  • contraction of smooth muscle (peristaltic
  • increase salivary
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15
Q

Serotonin
Released where?

Receptor?

Actions?

Stimulates release?

Inhibits release?

A

Enterochromaffin cells in intestine

IPAN receptors

Initiate peristaltic reflex

Stimulates: Gastric distension

Inhibits: fasting

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16
Q

Motilin
Released where?

Receptor?

Actions?

Stimulates release?

Inhibits release?

A

Upper duodenum by Parasympathetic

Actions: Sends through a wave every 90 minutes during fasting to clean up crap. Called the Migrating Myoelectric Complex

Stimulates: Fasting

inhibits: Feeding

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17
Q

A pt eats a super fatty meal. What hormone responds?

A

CCK & GIP is stimulated by fat.

I cell–> CCK –> Pancreatic lipase & Gallbladder bile

K cell –> GIP –> insulin

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18
Q

A pt eats a meal high in protein. In the GI tract, what hormone responds?
In the duodenum what hormone responds?

A

In the GI tract, the ONLY hormone that is not inhibitory is GASTRIN.
Other unique features of gastrin:
- Only Gastric hormone receiving neuron stimulation via vagus
- Only hormone with a negative feedback loop
- Only Gastric hormone to increase motility.

Duodenum:
Peptide –> I cell –> CCK –> pancreas –> trypsin, chymotrypsin, elastase, carboxypeptidase A & B

Think of CCK as the pancreas dude, whenever you need pancreatic stuff, ask CCK!

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19
Q

Acid comes into the duodenum, what cells are stimulated?

A

S cells –> secretin –> HCO3 to neutralize duodenum.

D cells –> Somatostatin –> HCO3 to neutralize duodenum

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20
Q

Your pt ate spam-ghetti, with garlic bread. That’s a lot of carbs! What hormone responds?

A

Carbs = sugar –> K cells –> GIP –> insulin

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21
Q

What has the greatest increase in insulin, IV sugars or oral sugars?
What is the mechanism?

A

ORAL
Bc GIP.
If it doesn’t get into the stomach, can’t activate GIP

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22
Q

Food distends the stomach what hormone responds?

A

Food! We need to acidify it! but we also need to protect our stomach from the acid. So at the SAME TIME our bodies make: gastrin and prostaglandin!

Stretch –> Gastrin –> Parietal cells –> H+
Stretch –> prostaglandin –> Mucus

Also serotonin for peristaltic reflex:
Stretch –> enterochromaffin –> Serotonin –> peristalsis

This idea is from Kaplan, but Rogers and the book say prostaglandin inhibits H+; FirstAid has nothing to say about it.

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23
Q

Acid is a big deal, and that’s why it’s regulated 3 ways:
Paracrine-ly
Hormonally
and Neuronally.
What substance is associated with each of these regulatory pathways?

A

Paracrine - Histamine
Hormonal - Gastrin
Neuronally - Vagal, ACh.

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24
Q

A pt presents with white clay colored stools, what does this mean?
what medical term do you write in your Observation part of your SOAP note?

A

Absence of secretion of bile

Acholic

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25
A patient is anorexic. The real medical definition is -
lack of apppetite
26
You may call any serious acute intraaabdominal condition that has sx of pain, tenderness, muscular rigidity and usually needs emergency surgery by it's correct medical term which is, ?
Acute abdomen
27
"Oh my!" Your attending states," this patient has borborygmi!" Wtf is he talking about?
A rumbling noise caused by propulsion of gas through the intestines. "Propulsion of gas" :'D sorry I cannot stop laughing at this phrase.
28
Cachexia
a profound and marked state of constituional disorder; general ill health and malnutrition
29
Coffee ground emesis
Denotes blood congealed and separated within gastric contents that takes the form of coffee grounds when in contact with acidic environment
30
Colic
Refernce to Gi. Acute paroxysmal abdominal pain
31
Dyspepsia | Dysphagia
postprandial (after a meal) epigastric discomfort | Difficulty in swallowing
32
Edentulous ERCP Eructation EUS
Edentulous - having no teeth ERCP - endoscopic retrograde cholangiopancreatopgraphy Eructation: expulsion of swallowed air. Burping. It literally means burping. EUS: endoscopic ultrasound (do not get this confused with UES, upper esophageal sphincter)
33
GGT | Globus Pharyngeus
GGT: Gamma glutamyl trasnferase Foreign body in neck that does not interefere with swallowing (sometimes relieved by swallowing). Usually in anxious of OCD pts. Often attributable to GERD
34
DX: Cullen sign Courvoisier's Sign Grey turner sign Iliopsoas Muscle test KUB XRAY Lloyd punch McBurney's point Heel Strike Guarding MRCP Murphy sign obturator muscel test psoas sign Rigidity Rovsings sign
Cullen: Ecchymosis around embilicus (periumbilical) secondary to hemorrhage enlarged no tender gallbladder secondary to pacnreatic disease or cancer Grey: Flank ecchymoisis secondary tohemorrhage ilipsoas: pt flex hip against reistance. Inflmmation from appendix KUB: Kidney Ureter Bladder xray Lloyd punch: punch dat kidney for stone or infection dx McBurney's point: where appendix is. Heel Strike = striking the heel of a supine pt for appenticitis Guarding: protective resopnse in muscle from pain or fear of movement MRCP: Magnetic Resonance Cholangiopancreatography Murphy: Cholecystitis test, palpate under right costal margin, + if stop breathing or pain obturator: flex pt thigh and rotate internally. appendix if pain. Psoas: retrocecal appendix. RLQ pain & passive right hip extension Rigid: hard abdomen Rovsings sign: Pain in RLQ, rebound tenderness
35
Ulcers: Curling ulcer Cushing ulcer ulcer
Curling: stress ulcer. peptic ulcer of duodenum in pt with extensive superficial burns Cushing: stress ulcer. peptic ulcer occuring from severe head injury or other lesion in Central nervous system ulcer: local defect of surface of organ. Shedding of inflamed necrotic tissue
36
``` Easy Peasy: Flatus Gastritis Esophagitis Cholestasis ``` Nausea Rebound tendneress Regurgitation Retch Steatorrhea Vomiting
Flatus: Farting Inflammation of stomach Esophagtis: inflammation of esophagus Cholestasis: Gall stones (Stoppage or suppression of bile flow, due to factors within or outside the liver; intrahepatic or extrahepatic cholestasis) Nausea: impending urge to vomit Rebound: Pain on the come back Regurg: effortless reflux of liquid in absence of N/V Retching: Closed glottis while trying to vomit Steatorrhea: fat greasy stools Vomiting: Forceful ejection of upper gut contents; if unfamiliar with the term, ask Eric.
37
Hematemesis Hematochezia Icterus Melena Mittelschmerz
Vomiting blood Hematochezia: Passage of bright red blood stool Icterus = jaundice. Yellow dude Melena = dark colored stool, tarry. Non odorous, sticky. Mittelschmerz: menstruation lower abdominal pain. No rebound tenderness
38
Obstipation Odynophagia Pneumobilia Pneumomediastinum pneumoperitoneum pyrosis
severe intractable constipation due to intestinal obstruction odynophageia: painful swallowing pneumobilia: abnormal presence of gas in bile pneumomediastinum: air in mediastinum. Interfere with respiration and circulation. = pneumothorax or pneumopericardium! pneumopertoneum gas in peritoneum pyrosis: substernal burning (heartburn)
39
``` Tenesmus UGIB Ureterolithiasis Virchow's node Vomiting ```
ineffectual and painful straining at stool; if unfamiliar, ask Trevor UGIB: Upper GI bleeding Ureterolithiasis: stone from kidney in ureter Virchow's node: left supraclavicular mass that means cancer
40
A pt is having trouble initiating swallowing; you take an Xray and see a structural disorder. What is this disorder, more than ikely?
Zenger's Divertiulum
41
A pt presents with trouble swallowing. Has more trouble swallowing solid foods than liquids, it is progressive and intermittent. Dx?
Peptic stricture
42
A pt presents with trouble swallowing, has more trouble swallowing solid foods than liquids, it has not gotten any worse (not progressive) and is intermittent. dx?
schatzki ring
43
a pt presents with trouble swallowing any type of substance, solid or liquid. What is most likely causing the dysphagia?
Motility is messed up. Could be myenteric plexus (achalasia)
44
A pt presents with trouble swallowing. After imaging, you see a bird beak appearance . Dx and mechanism
Primary achalasia, loss of No produciing neurons in myenteric plexus, causing impaired relaxation of LES or resting pressure is high, keeping the LES closed
45
A pt presents with trouble swallowing and a good tan. After imaging, you see a bird beak appearance . Dx and mechanism
SEcondary achalsia from the parasie trypansoma cruzi
46
Your pt presents with gnawing, sharp or hunger like pain that is intermittent. They also have bloody stool. Your attending writes, "emesis, hematemesis, melena, hematochezia, and coffee ground poo". Since you know what all these words mean now, you correctly dx
GIB - Gastrointestinal bleeding ``` Coffee ground: coagulated blood vomit Emesis: coagulated blood Hematemesis: vomiting blood Melena: dark tarry stool hematochezia:bright red stool ```
47
Helicobacter pylori can cause 4 scary dx. what are they? how do you diagnose this
PUD Chronic gastritis Gastri adenocaracinoma MALT lymphoma Breath test - tests urease Fecal ag: Abs. not good bc abs stay forever so can't tell if you've treated it. Biopsy stains: Warthin-Starry Silver Stain to get an accurate test: must be off any H+ inhibiting medicines
48
RUQ Pain develops 2-5 hours after eating. Dx? RUQ pain develops 30 min after eating. Dx?
duodenal ulcer Gastric ulcer
49
A pt has a colonscopy and notes many ulcers on teh distal duodenum. This is hte 4th time this man has been in for ulcer pain. Dx?
Zollinger ellison gastrinoma
50
Pt here for ulcer pain. hit his head last week.
Cushing Ulcer
51
A firefighter pt is in for ulcer pain. Dx?
Curling ulcer
52
What is multiple endocrine neoplasia and what is it associated with?
Z-E Syndrome. neoplasia = mass. So masses in the organs that are endocrine such as pituitary, parathyroid, pancreas
53
Pt has pain proximal of ligamentum of treitz. What is your main differential?
Upper GI bleed. from peptic ulcer disease, erosive gastritis, esophageal varices...
54
Your pt has dysphagia and heart burn. Why would a colonscopy not be a good diagnostic test for this pt? What would be better?
Because colonscopy goes from rectum only to the ileocecal jxn EGD, goes from mouth to duodenum
55
What do the following barium Xrays signify, Bird beak? Narrowing of muscle? Weird infolding in esophagus?
Achalasia Lower esophageal ring, Shatzki Zenker's diverticulum
56
What is pH testing used for? Manometry? Plain film X Ray?
Acid reflux Achalasia; catheter that measures pressures when you swallow. Higher pressure means LES messing up Stones, kidney or gall; bowel obstruction; free air, KNOW FREE AIR,
57
What is HIDA testing used for? Ultrasound EUS (endoscopic ultrasound) ERCP endoscopic retrograde cholangiopancreatography MRCP, Magnetic resonance cholangiopancreatography
Nuclear study for gallbladder . No gallbladder = cholecystitis. Gallbaldder EUS: pancreatic masses, scope with ultrasound on it ERCP: scope with a catheter into biliary ducts MRCP: More stuff for biliary stuff. Non invasive, MRI
58
LFT Labs are important I guess. True liver functions include 3 things: but most physicians include what other labs with the liver labs: If you suspect liver disease do you order a BMP or CMP blood test?
INR/PT Albumin Cholesterol AST/ALT Alkaline phosphatase Bilirubin CMP because BMP does not have liver enzymes
59
If you suspected pancreatitis, what do you lab for? Zollinger Ellison? Liver?
lipase, amylase gastrin. secretin stimulatino test GGT, bilirubin, INR
60
What are they osteopathic sympathetic sensory levels of: ``` Appendix Esophagus Stomach Liver Gallbladder Small intestine Colon Pancreas ```
``` Appendix T12 Esophagus T2-T8 Stomach T5-T9 Liver T6-T9 Gallbladder T6-T9 Small intesitne T5-T9-12 (jej & ileum) Colon T9-L2 Pancreas T5-T11 ```

GI Greenfield (3 decks)

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