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Year 2 Metabolism > Overview > Flashcards

Overview Flashcards

1
Q

Four muscles of the anterior abdominal wall are?

A

External oblique
Internal oblique
Transverse abdominis
Rectus abdominis - vertical

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2
Q

Rectus sheath is formed by?

A

Aponeurosis of the three layers of muscle of anterior abdominal wall

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3
Q

Linea alba is?

A

Where the anterior abdominal wall muscles meet

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4
Q

Inguinal ligament is formed by?

A

Free border of the external oblique

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5
Q

Rectus abdominis runs enclosed in what?

A

Rectus sheath

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6
Q

Vessels running in the rectus sheath are?

A

Epigastric vessels - superior and inferior

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7
Q

Arcuate line is?

A

Inferior epigastric artery perforates this to leave the rectus sheath superiorlyM

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8
Q

Inferior epigastric artery originates from which artery?

A

External iliac

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9
Q

Superior epigastric artery originates from which artery?

A

Internal thoracic

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10
Q

McBurney’s point is?

A

One third from asis to the umbilicus

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11
Q

McBurney’s point is landmark for?

A

Appendix

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12
Q

Umbilicus is at what vertebral level?

A

T10

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13
Q

Xiphoid is at what vertebral level?

A

T7

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14
Q

Where do the testes develop?

A

Posterior abdominal wall next to the kidneys

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15
Q

Most anterior layer of the testes is?

A

Tunica vaginalis

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16
Q

Inguinal canal is?

A

Through here is descent of the testes during development from posterior to anterior

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17
Q

The testes lies between which two layers?

A

Peritoneum

Transversalis fascia

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18
Q

Contents of the spermatic cord are? x3

A

Testicular vessels
Ilioinguinal nerve
Genitofemoral nerve

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19
Q

Conjoint tendon formed from what? x2

A

Transversalis abdominis

Internal oblique

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20
Q

Spermatic cord is composed of? x4

A

Transversalis fascia
Internal oblique muscle
External oblique muscle
Superficial fascia

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21
Q

Innervation of the dartos muscle is?

A

Genitofemoral nerve

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22
Q

Nerve root of genitofemoral nerve is?

A

L1 and L2

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23
Q

Function of dartos muscle is? x2

A

Ruggae formation

Temperature control

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24
Q

Innervation of the cremaster muscle is?

A

L1 and L2

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25
Q

Function of the cremaster muscle is? x1

A

Cremaster reflex

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26
Q

Cremaster reflex innervation?

A

Genito - motor part causes movement

Femoral - sensory to the thigh

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27
Q

Direct inguinal hernia is through?

A

Hassleback’s triangle - orange anatomy booklet look at

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28
Q

Indirect inguinal hernia is through?

A

Inguinal canal into the scrotum

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29
Q

Inguinal hernias direct/indirect are either lateral or medial to which artery?

A

Inferior epigastric artery

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30
Q

Where is the deep inguinal ring located?

A

Midpoint of the inguinal ligament

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31
Q

Inguinal canal contains what in females? x2

A

Round ligament of the uterus

Ilioinguinal nerve

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32
Q

Inguinal canal contains what in males? x2

A

Spermatic cord

Ilioinguinal nerve

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33
Q

When does the external iliac artery become the femoral artery?

A

Past the inguinal ligament

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34
Q

What is the muscle seen most anterior on a CT at level L2?

A

Rectus abdominis

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35
Q

Caudate lobe of the liver is anterior or posterior?

A

Posterior

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36
Q

Quadrate lobe of the liver is anterior or posterior?

A

Anterior

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37
Q

Three components of the portal triad are?

A

Bile duct
Hepatic artery proper
Portal vein

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38
Q

What should be compressed to prevent a hepatic bleed?

A

Components of the portal triad

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39
Q

What is the Pringle manoeuvre?

A

Large clamp of the hetatoduodenal ligament to prevent bleeding from the liver

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40
Q

Hepatoduodenal ligament is in close relation to whcih three structures?

A

Liver
Duodenum
Gallbladder

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41
Q

Blood supply to the liver is via which artery?

A

Coeliac trunk

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42
Q

Hepatic portal vein is formed from?

A

Splenic vein

Superior mesenteric vein

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43
Q

Hepatic portal vein forms where?

A

Posterior to the head of the pancreas

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44
Q

Where does the inferior mesenteric vein join?

A

Joins to the splenic vein

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45
Q

What is liver cirrhosis?

A

Fibrosis of liver tissue

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46
Q

Three causes of live cirrhosis?

A

Alcoholic liver disease
Metastases
Heart failure

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47
Q

Normal portal pressure is?

A

9mmHg

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48
Q

Pressure in the IVC?

A

2-6mmHg

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49
Q

Portal pressure gradient is?

A

Pressure difference between portal pressure and pressure in the IVC

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50
Q

Portal hypertension is?

A

When portal pressure gradient is >10mmHg

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51
Q

Consequence of portal hypertension is?

A

Splenomegaly

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52
Q

Oesopageal varices are due to anastoses between which arteries?

A

Oesophageal vein and left gastric vein

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53
Q

Ascites is?

A

Excess fluid in the peritoneal space

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54
Q

Two main causes of ascites?

A

Portal hypertension

Hypoalbuminemia

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55
Q

Blood supply above and below the pectinate line is?

A

Superior rectal artery

Inferior rectal artery

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56
Q

Innervation above and below pectinate line is?

A

Inferior hypogastric plexus

Inferior rectal nerves from pudendal nerves

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57
Q

Epithelium above and below pectinate line is?

A

Columnar

Stratified squamous

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58
Q

Common bile duct (of biliary tree) drains into?

A

The major duodenal papilla

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59
Q

Bile is secreted by which organ?

A

The liver

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60
Q

Function of gall bladder?

A

Concentration of bile

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61
Q

Murphy’s test tests for?

A

Inflamed gall bladder

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62
Q

Inflamed gall bladder is known as?

A

Cholecystitis

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63
Q

Blood supply to the gallbladder is?

A

Cystic artery

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64
Q

Cystic artery runs through which triangle?

A

Calot’s triangle

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65
Q

Duct joining onto the pancreatic duct is?

A

Accessory pancreatic duct

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66
Q

Gallstones most likely to get lodged where?

A

(Distal end of hepatopancreatic) ampulla

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67
Q

What is the ampulla of Vater?

A

Where the pancreatic duct and the common bile duct meet

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68
Q

How to recognise the components of the portal triad?

A

Common bile duct - more brown in colour
Hepatic portal vein - very LARGE
Hepatic artery proper - smaller vessel

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69
Q

Pancreas is retro or intraperitoneal?

A

Retroperitoneal

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70
Q

Blood supply to the pancreas is?

A

Splenic artery from the coeliac trunk

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71
Q

Blood supply to the head of the pancreas is? x2

A

Superior and inferior pancreatoduodenal arteries

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72
Q

Superior pancreatoduodenal artery origin?

A

Gastroduodenal artery

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73
Q

Inferior pancreatoduodenal artery origun?

A

Superior mesenteric artery

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74
Q

Pancreatic duct opens into where?

A

Major duodenal papilla

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75
Q

Accessory pancreatic duct opens into where?

A

Minor duodenal papilla

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76
Q

Relation of IVC to liver?

A

IVC passes through the posterior region of the liver

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77
Q

Fundus of gallbladder is at which vertebral level?

A

L1

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78
Q

Liver metastasis is common from the GI tract why?

A

Due to drainage via the portal veins from the GI tract to the liver

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79
Q

Swelling of what would occur with gastric tumour?

A

Swelling of Virchow’s node

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80
Q

Nutmeg liver is?

A

Congestion of the liver - accumulation of RBCs

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81
Q

Surrounding the major duodenal papilla is?

A

Sphincter of Oddi

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82
Q

Origin of cystic artery is?

A

Left hepatic artery

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83
Q

Endocrine vs. exocrine

A

Endocrine - secrete straight into the blood

Exocrine - secrete into duct

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84
Q

Cushing’s syndrome is?

A

Excess levels of cortisol - symptoms of this

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85
Q

Common symptoms of Cushing’s syndrome is? x4

A

Fat deposits in the face - round face
Reddish/purple stretch marks on thighs, stomach, arms, legs
Weight gain
Loss of libido

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86
Q

Pituitary gland sits where and in which bone?

A

In sella turcica of the sphenoid bone

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87
Q

Infundibulum is?

A

Pituitary stalk - between posterior pituitary and the hypothalamus

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88
Q

Cells of anterior pituitary are?

A

Secretory

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89
Q

Cells of posterior pituitary are?

A

Neuronal

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90
Q

Blood supply to the anterior pituitary?

A

Superior hypophyseal artery

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91
Q

Origin of superior hypophyseal artery?

A

Internal carotid artery

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92
Q

Communication between pituitary gland adn the hypothalamus is?

What is transmitted through this system?

A

Hypothalamo-hypophyseal portal system

Blood - contains neurotransmitters

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93
Q

Blood supply to the posterior pituitary and the infundibulum? x3

A

Superior hypophyseal artery
Inferior hypophyseal artery
Infundibular artery

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94
Q

Hormones released by the anterior pituitary? x7

A 
ACTH
TSH
LH
FSH
PRL
GH
MSH
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95
Q

Hormones secreted by the posterior pituitary x2?

A

ADH

Oxytocin

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96
Q

Two components of the adrenal gland?

A

Adrenal cortex

Adrenal medulla

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97
Q

Adrenal cortex secretes which hormones? x3

A

Aldosterone
Cortisole
Corticosterone

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98
Q

Adrenal medulla secretes which hormones? x2

A

Adrenaline

Noradrenaline

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99
Q

Three zones of the adrenal cortex?

A

Cortex
Zona glomerulosa - mineralocorticoid aldosterone
Zona fasciculata - glucocorticoid cortisol
Zona reticularis - androgen testosterone
Medulla

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100
Q

Shape of the right adrenal gland is?

A

Pyramidal

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101
Q

Shape of the left adrenal gland is?

A

Crescent

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102
Q

Blood supply to the adrenal glands? x3

A

Superior suprarenal arteries
Middle suprarenal artery
Inferior suprarenal artery

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103
Q

Origin of superior suprarenal artery

A

Inferior phrenic artery

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104
Q

Origin of middle suprarenal artery

A

Abdominal aorta - by the SMA

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105
Q

Origin of inferior suprarenal artery

A

Renal artery

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106
Q

Venous drainage from the adrenal gland is?

A

Large suprarenal vein

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107
Q

Suprarenal vein drains to where on the right hand side?

A

IVC

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108
Q

Suprarenal vein drains to where on the left hand side?

A

Left renal vein

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109
Q

Four strap muscles are?

A

Thyrohyoid
Sternothyroid
Omohyoid
Sternohyoid

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110
Q

What is the largest strap muscle?

A

Sternohyoid - left side

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111
Q

What level is the thyroid gland?

A

C5-T1

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112
Q

Three components of the thyroid gland?

A

Left lobe
Right lobe
Isthmus

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113
Q

Blood supply to the thyroid is via? x2

A

Superior thyroid artery

Inferior thyroid artery

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114
Q

Origin of superior thyroid artery is?

A

External carotid artery

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115
Q

Origin of inferior thyroid artery is?

A

Subclavian artery

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116
Q

Superior thyroid vein drains into?

A

Internal jugular vein

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117
Q

Middle thyroid vein drains into?

A

Internal jugular vein

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118
Q

Inferior thyroid vein drains into?

A

Brachiocephalic vein

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119
Q

Nerves surrounding thyroid gland which could be damaged in surgery?

A

Recurrent laryngeal nerves

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120
Q

How many parathyroid glands?

A

Four

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121
Q

Five regions of the pancreas are?

A 
Tail
Body
Neck
Head
Ulcinate process
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122
Q

Bile is produced by which organ?

A

Liver

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123
Q

Bile is secreted when?

A

Upon consumption of food

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124
Q

How can the omohyoid muscle be recognised?

A

This is the one that loops and curves as it comes inferiorly down

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125
Q

What is the relation of the recurrent laryngeal nerve to the common carotid artery?

A

Runs medially to the common carotid

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126
Q

What is the relation of the vagus nerve to the common carotid artery?

A

Runs laterally to the common carotid

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127
Q

Where does the phrenic nerve run in relation to the aortic arch?

A

Between the aortic arch (lateral) and the lung (medial)

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128
Q

Which kidney is the most inferior?

A

Right (liver)

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129
Q

What vertebral level are the kidneys?

A

12th rib

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130
Q

What is the significance of the renal angle and where is this?

A

Inferior border of the 12th rib

Examine for tenderness here - kidneys/intestines

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131
Q

What is Morrison’s pouch?

A

Hepatorenal recess

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132
Q

What is Gerota’s fascia?

A

Renal fascia - the kidneys have their own fascia

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133
Q

What is the significance of Gerota’s fascia?

A

This is one of the last reserves of fat to be digested

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134
Q

Innervation to the kidneys is from which nerve roots?

A

Renal plexus T10-T12

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135
Q

What are the different divisions of the kidney?

A

Pelvis
Major calyx
Minor calyx

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136
Q

Where do the renal arteries leave the aorta?

A

L2

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137
Q

Where is the renal vein?

A

L2

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138
Q

Division of the different renal arteries?

A

Renal artery
Segmental arteries
Interlobar arteries
Interlobular arteries

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139
Q

How many lobar arteries are there per renal pyramid?

A

One lobar artery per renal pyramid

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140
Q

What is the cardiac output to the kidneys?

A

1/4 of the cardiac output - 1200ml/min

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141
Q

How do varicose testicular veins relate to the kidney?

A

A tumour in the renal vein can block the testicular vein and cause varicose veins

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142
Q

What does the ovarian artery/vein relate to in the male?

A

Testicular vein

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143
Q

Where does the testicular vein drain to?

A

Renal vein

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144
Q

Where does the ovarian vein drain to (left and right)?

A

Left - renal vein

Right - IVC

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145
Q

What is the origin of the ovarian/testicular artery?

A

Aorta - vertebral level L2 (just inferior to renal artery)

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146
Q

What are the three layers of the ureter wall?

A

Transitional epithelial mucosa
Smooth muscle muscularis
Fibrous connective tissue andventitia

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147
Q

Where are the three msot likely places for a kidney stone to lodge?

A

Pelvo-uritary junction
Cystouretic junction
Pelvic brim

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148
Q

What are the three nerves involved in sensation of the ureters?

A

Ilioinguinal and iliohypogastric

Genitofemoral

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149
Q

Three layers of the bladder are?

A

Transitional epithelial mucosa
Thick muscular - detrousa muscle
Fibrous adventitia

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150
Q

What is the trigone?

A

Triangular area of the bladder outlined by the openings for the ureters and the urethra

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151
Q

Why is the trigone clinically important?

A

Infections tend to persist in this region

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152
Q

Where is bladder pain referred to and describe this pain?

A

Referred to the back - presents as back pain

Pack pain that will not go away - persistent

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153
Q

What are the sphincters of the urethras and are these present in males or females?

A

Internal urethral sphincter - only males

External urethral sphincter - males and females

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154
Q

Which of the urethral sphincters are voluntary/involuntary?

A

Internal - involuntary

External - voluntary

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155
Q

Which muscle assists the external urethral sphincter?

A

Levator ani muscle

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156
Q

How can you recognise the left renal vein on an L2 CT?

A

Long shape

Crosses the aorta to join onto the IVC

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157
Q

Give the give nerves of the lumbar plexus

A 
Subcostal nerve
Iliohypogastric nerve
Ilioinguinal nerve
Genitofemoral nerve
Lateral cutaneous nerve
Femoral nerve
Obturator nerve
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158
Q

What is the biggest nerve of the lumbar plexus?

A

Femoral nerve

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159
Q

Trigone is made up from?

A 
Two ureters (female)/uretic orifice (male)
Urethra
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160
Q

Origin of uterine artery is?

A

Internal iliac artery

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161
Q

Normal blood glucose level is?

A

3.5-5mmol/L

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162
Q

Four reasons the brain is so dependent on the maintenance of blood glucose levels?

A

Cannot synthesise glucose
Cannot store glucose in significant amounts
Cannot metabolise substrates other than glucose (apart from ketones)
Cannot extract enough glucose from extracellular fluid at low concentrations

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163
Q

Two substrates the brain can use for metabolism are?

A

Glucose

ketone bodies

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164
Q

Alpha cells of the pancreas produce?

A

Glucagon

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165
Q

Beta cells of the pancreas produce?

A

Insulin

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166
Q

Delta cells of the pancreas produce?

A

Somatostatin

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167
Q

PP cells of the pancreas produce?

A

Pancreatic polypeptide

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168
Q

Epsilon cells of the pancreas produce?

A

Ghrelin

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169
Q

Endocrine portion makes up what percentage of the pancreas?

A

2%

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170
Q

Three step process in the production of insulin?

A

Preproinsulin
Proinsulin
Insulin

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171
Q

Preproinsulin composed of how many amino acids?

A

110

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172
Q

Proinsulin composed of how many amino acids?

A

86

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173
Q

Insulin composed of how many amino acids?

A

51

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174
Q

Proinsulin cleaved to form what in the production of insulin?

A

Insulin - 51 amino acids

C-peptide - 35 amino acids

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175
Q

When does insulin synthesis occur?

A

Only when increased levels of insulin are required

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176
Q

Glucose enters beta cells through which transporter?

A

GLUT1

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177
Q

What enzyme is the glucose sensor for insulin secretion in beta cells?

A

Glucokinase

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178
Q

When is insulin secreted?

A

When glucose levels exceed 5mM

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179
Q

Is insulin constantly synthesised?

A

No

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180
Q

Glycolysis: glucose is converted to what?

A

Glucose-6-phosphate

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181
Q

Glycolysis: glucose-6-phosphate is converted into what?

A

Pyruvate

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182
Q

Pyruvate is metabolised via which cycle?

A

Krebs

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183
Q

Krebs cycle results in what? x2

A

Raised ATP:ADP ratio in the cell

This causes closure of the K+ channels at the membrane and hence, membrane depolarisation

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184
Q

Entry of glucose into the beta cell has what effect on the membrane?

A

Membrane depolarisation

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185
Q

Entry of glucose into the beta cell has what effect on K+ channels?

A

Closure of K+ channels

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186
Q

K+ channels at the membrane of the beta cell are normally opened or closed?

A

Open

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187
Q

Membrane depolarisation and closure of K+ channels in the beta cell results in what? x2

A

Opening of voltage gated Ca2+ channels - insulin secretion

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188
Q

Beta cells release insulin in how many phases?

A

Two

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189
Q

Describe the first phase of insulin release

A

Rapid release to rapidly increase blood glucose levels

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190
Q

Describe the second phase of insulin release

A

Sustained, slow release of newly formed vesicles

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191
Q

Stored insulin is released in the first or the second stage?

A

First

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192
Q

Newly synthesised insulin is released in the first or the second stage?

A

Second

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193
Q

Two amino acids that trigger insulin release?

A

Arginine

Leucine

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194
Q

Hormone that triggers insulin release?

A

GLP-1

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195
Q

Peptide that triggers insulin release?

A

GIP

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196
Q

Acid that triggers insulin release?

A

Fatty acids

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197
Q

Neurotransmitters that trigger insulin release? x2

A

Acetylcholine

CCK

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198
Q

How can arginine cause insulin release?

A

Directly depolarise the membrane

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199
Q

How can leucine cause insulin release?

A

Activation of glutamate dehydrogenase (GDH) and KIC

200
Q

What is the receptor that GLP-1 acts on to cause insulin release?

A

GLP-1R

201
Q

What is the receptor that free fatty acids act on to cause insulin release?

A

GPR40

202
Q

What type of receptor is the insulin receptor?

A

Transmembrane tyrosine kinase receptor

203
Q

What are the two subunits of the IR?

A

Intracellular beta subunit

Extracellular alpha subunit

204
Q

Where does insulin bind to the IR?

A

Extracellular alpha subunit

205
Q

What is glucose converted to in muscles?

A

Glycogen

206
Q

Location of GLUT2

A

Pancreas
Liver
Small intestine
Kidney

207
Q

Location of GLUT3

A

Brain

Testes

208
Q

Location of GLUT4

A

Muscle
Fat
Heart

209
Q

GLUT1 location

A

Ubiquitous e.g. beta cells

210
Q

Akt is?

A

Protein kinase B

211
Q

Three functions of Akt?

A

Translocation of GLUT4 to the plasma membrane
Phosphorylation of glycogen synthase kinase
Inactivation of glycogen synthase kinase

212
Q

Overall function of Akt?

A

Increased glucose transport and glycogen synthesis

213
Q

Effect of insulin at adipocytes? x3

A

Stimulates glucose uptake
Stimulates lipogenesis
Inhibits lipolysis

214
Q

Insulin inhibits which enzyme at adipocytes?

A

Lipase

215
Q

Four functions of insulin at the liver

A

Enhances glucose uptake - glucokinase
Increases glycogen synthesis
Increases lipogenesis
Inhibits gluconeogenesis

216
Q

Function of glucokinase is?

A

Glucose to glucose-6-phosphate

217
Q

Function of insulin on protein synthesis? x4

A

Stimulates transport of amino acids into cells e.g. valine, leucine, tyrosine
Increases translation of messenger mRNAs
Inhibits catabolism of proteins
Inhibits gluconeogenesis

218
Q

Why does insulin increased amino acid uptake?

A

To inhibit gluconeogenesis

Amino acids are the main substrate for glucose synthesis

219
Q

During fasting, glucose metabolism is prioritised to which organ?

A

The brain

220
Q

Two substrates for gluconeogenesis are?

A

Amino acids

Glycerol

221
Q

Acetyl-CoA is converted into what during long term fasting?

A

Ketone bodies

222
Q

What can be used for gluconeogensis in anaerobic conditions adn via what pathway?

A

Lactate

Cori cycle

223
Q

Where does the cori cycle occur?

A

Liver

224
Q

Two enzymes that can reduce the activity of insulin are?

A

Serine kinase

Threonine kinase

225
Q

Two consequences of insulin resistance?

A

Hyperglycaemia

Dyslipidaemia

226
Q

At what blood glucose level is inuslin secreted?

A

Blood glucose > 5mmol/L

227
Q

What is the hormone responsible for blood glucose level maintenance during fasting?

A

Glucagon

228
Q

Alpha cells secrete?

A

Glucagon

229
Q

Beta cells secrete?

A

Insulin

230
Q

Delta cells secrete?

A

Somatostatin

231
Q

PP cells secrete?

A

Pancreatic polypeptide

232
Q

Epsilon cells secrete?

A

Ghrelin

233
Q

Glucagon is how many amino acids long?

A

29 aa

234
Q

Glucagon is composed of how many chains?

A

One

235
Q

Insulin is composed of how many chains?

A

Two

236
Q

Stages of glucagon synthesis are?

A

Preproglucagon
Proglucagon
Glucagon

237
Q

Two amino acids that can result in the release of glucagon?

A

Alanine

Arginine

238
Q

Three factors that can stimulate glucagon secretion?

A

Reduced blood glucose concentration < 3.5mmol/L
Increased blood amino acids especially alanine and arginine
Increased exercise

239
Q

Exercise can increased glucagon secretion to what extent?

A

Increases four to five fold

240
Q

What type of receptor is the glucagon receptor?

A

G-protein coupled receptors

241
Q

How many times does the glucagon receptor span the membrane?

A

Seven times

242
Q

What does the glucagon receptor activate upon glucagon binding? Give the three stages

A

Adeno-cyclase

This activates cAMP

This activates protein kinase A

243
Q

Increased glucagon binding to its receptor results in the overall secretion of what?

A

Protein kinase A

244
Q

Three functions of glucagon at the liver

A

Increased amino acid uptake for gluconeogenesis
Ihibition of PFK-1
Inhibition of pyruvate kinase

245
Q

Two enzymes involved in gluconeogenesis in the liver?

A

Pyruvate kinase

Phosphate kinase

246
Q

Enzyme that breaks down triglycerides is?

A

Lipase

247
Q

Effect of insulin on lipase?

A

Inhibition

248
Q

Effect of glucagon on lipase?

A

Activation

249
Q

Triglycerides are broken down to?

A

Fatty acids and glycerol

250
Q

Fatty acids and glycerol - how are these used for metabolism?

A

Fatty acids - acetyl coA for ATP synthesis

Glycerol - glycolysis

251
Q

What is the role of the carnitine shuttle?

A

Allows the beta oxidation of fatty acids

252
Q

Carnitine shuttle requires which enzyme?

A

CPT-1

253
Q

Which hormone activates CPT-1

A

Glucagon

254
Q

When is acetyl-coA converted into ketone bodies?

A

Once oxaloacetate stores are depleted

The acetyl-coA now undergoes a different pathway to produce ketone bodies

255
Q

Two hormones that inhibit the release of glucagon?

A

Insulin

Somatostatin

256
Q

How long does the glycogen reserve typically last?

A

24 hours

257
Q

Catecholaimes are? x2

A

Noradrenaline

Adrenaline

258
Q

Catecholamines are secreted from where?

A

Adrenal medulla

259
Q

Catecholamines are released in response to? x2

A

Stress

Hypoglycaemia

260
Q

Catecholamines are synthesised from which two amino acids?

A

Phenylalanine

Tyrosine

261
Q

Function of adrenaline on blood glucose levels?

A

Same effect as glucagon - inhibits insulin secretion and stimulates glycogenolysis

262
Q

Alternative name for adrenaline?

A

Epinephrine

263
Q

Glucocorticoids are what type of hormone?

A

Steroid hormones

264
Q

Overall effect of catechoalimes?

A

Increases blood glucose and fatty acid levels

265
Q

Name a glucocorticoid

A

Cortisol

266
Q

Cortisol is secreted in response to what?

A

ACTH

267
Q

Four effects of cortisol on blood glucose regulation?

A

Enhances gluconeogenessis
Inhibits glucose uptake and utilisation
Stimulates muscle proteolysis
Stimulates adipose-tissue lipolysis

268
Q

Overall function of cortisol

A

Rapid mobilisation of amino acids and fatty acids from cellular stores

269
Q

Two other functions of cortisol are?

A

Maintenance of BP

Suppression of inflammation

270
Q

Long term elevated cortisol levels can result in? x2

A

Proteolysis

Muscle wasting

271
Q

Glucocorticoids are released by which part of the kidney?

A

Zona fasciculatat of the adrenal cortex

272
Q

Growth hormone has an effect on which three tissues/organs?

A

Adipose tissue
Skeletal muscle
Liver

273
Q

Name of T3 thyroid hormone?

A

Triiodothyronine

274
Q

Name of T4 thyroid hormone?

A

Thyroxine

275
Q

Thyroid hormones activate what type of receptors and roll of this??

A

Nuclear receptors - activates transcription of large number of genes

276
Q

T3/T4 - which is more potent and by what amount?

A

T3 is more potent than T4 - about four times more

277
Q

T3/T4 - which is more rapidly acting?

A

T3

278
Q

T3 - action of duration is how long?

A

10-12 days

279
Q

T4 - action of duration is how long?

A

2-3 days

280
Q

Three specific functions of the thyroid hormone are?

A

Increased number adn activitiy of mitochondria
Stimulates carbohydrate metabolism
Stimulats fat metabolism

281
Q

Overall action of thyroid hormones?

A

Increase the basal metabolic rate

282
Q

Incretins are what type of hormone?

A

GI hormones

283
Q

Two most common incretins are?

A

Glucagon like peptide-1 (GLP-1)

Gastric inhibitory peptide (GIP)

284
Q

Incretins effect on blood glucose control?

A

Increase insulin synthesis

285
Q

Actions of GLP-1

A

Promotes satiety
Slows gastric emptying
Inhibits glucagon secretion
Stimulates insulin

286
Q

Undernutrition is?

A

Malnutrition due to reduced supply of food or inability to digest, assimilate and utilise necessary nutrients

287
Q

What are macronutrients?

A

Nutrients required in high quantities e.g. protein

288
Q

What are micronutrients?

A

Nutrients required in lower quantities e.g. calcium, iron, manganese

289
Q

Prevalence of undernutrition in the UK?

A

5%

2-3 million

290
Q

Most vulnerable to undernutrition? x5

A 
Chronic diseases
Elderly
Recently discharged from hospital
Low income
Socially isolated
291
Q

Four consequences of undernutrition in the community?

A

Falls
Depression
Infection
Dependency

292
Q

Five consequences of undernutrition in hospital?

A 
Increased morbidity
Increased length of stay
Increased dependency
Increased mortality
Increased costs of care`
293
Q

Reduced nutritional intake causes of undernutrition?

A 
Anorexia
Treatment side effects
Pain
Dysphagia
Physical disability
Nil by mouth
294
Q

Increased nutritional requirements causing undernutrition?

A

Inflammation/infection
Pyrexia
Tissue healing
Metabolic effects

295
Q

Increased nutritional losses causing undernutrition?

A

Malabsorption

Would exudate/burns

296
Q

Consequences of undernutrition?

A 
Decreased muscle mass
Organ failure
Apathy
Change in behaviour/personality
Bedridden 
Depression
Fatigue
297
Q

MUST stands for?

A

Malnutrition universal screening tool

298
Q

Five steps to MUST?

A 
BMI
Weight loss score
Acute disease effect
Overall risk of malnutrition
Management guidlines
299
Q

How frequently is MUST carried out in the UK?

A

Upon admission to hospital and each week thereafter

300
Q

Subjective global (SGA) assessment differs to MUST because?

A

Takes into account physical appearance e.g. oedema, ascites, fat stores

301
Q

Clinical anthropometrics - two ways to assess nutrition in a patient and what are these assessing for?

A

Skin fold thickness (fat)

Mid upper arm circumference (muscle)

302
Q

Four other nutritional assessments?

A

Imaging - DEXA, US
Bioelectric impedance analysis
Handgrip dynamometry

303
Q

Four laboratory investigations to assess nutrition?

A

Anaemia - blood
Plasma proteins
Vitamin and mineral concentrations
Immune response

304
Q

Basal metabolic rate (BMR) is?

A

Obligatory energy requirements of the body in a well state when not moving

305
Q

DIT stands for and this is?

A

Thermic effect of food - energy required to digest food

306
Q

Protein requirements for adult?

A
  1. 5g/day

0. 75kg/day

307
Q

Nitrogen requirement for adult?

A

8.5g

308
Q

Four indications for gastrostomy feeding?

A

Reduced consciousness - brain injury
Unsafe swallow - e.g. PD
Pre-head and neck cancer surgery/radiotherapy
Special e.g. CF

309
Q

What is meant by gastrostomy?

A

Opening of the stomach for the provision of food

310
Q

What is parenteral feeding?

A

Other than mouth and GI tract e.g. IV

311
Q

Indications for parenteral feeding? x5

A 
Intestinal obstruction
Short bowel e.g. Chron's
Small bowel fistula
Acute pancreatitis
GI motility disorders
312
Q

Consequences of refeeding syndrome?

A 
Hypokalaemia (drop in electrolytes)
Magnesaemjia
Phosphataemia
Thiamine deficiency
Oedema (salt retention)
313
Q

Annual cost of malnutrition to NHS England?

A

19.6 billion

314
Q

Can overweight patients be malnourished?

A

Yes

315
Q

Underweight BMI is?

A

<18.5

316
Q

Healthy BMI is?

A

18.5-24.5

317
Q

Overweight BMI is?

A

> 24.5

318
Q

Obese BMI is?

A

> 30

319
Q

Three surrogate methods to measure the height of a patient?

A

Knee height
Demispan
Ulna length

320
Q

Two consequences of surrogate measurements of height?

A

Overestimate height

Underestimate BMI

321
Q

Surrogate method to measure weight?

A

Mid upper arm circumference (MUAC)

322
Q

MUAC for underweight individual?

A

<23.5

323
Q

MUAC for overweight individual?

A

> 32

324
Q

Extent of mild peripheral oedema?

A

Ankle

325
Q

Extent of moderate peripheral oedema?

A

Knee

326
Q

Extent of severe peripheral oedema?

A

Sacrum

327
Q

Three major causes of hypoalbuminemia?

A

Inadequate protein intake
Inflammation
Sepsis

328
Q

Hypoalbuminemia and capillary wall relation?

A

Capillary walls become more porous - albumin leaks out - leads to hypoalbuminemia

329
Q

Albumin levels of patients with anorexia nervosa?

A

Normal

330
Q

Normal range of albumin?

A

35-50g/l

331
Q

Who is at risk for refeeding syndrome?

A

Any patient with very little food intake for >5 days

332
Q

Disadvantages of parenteral nutrition? x5

A 
Risk with the placement
Risk of sepsis from catheter
Long term - disordered liver function
Risk of gut atrophy
Psychological effects
Cost
333
Q

pH controls what in the body? x2

A

Speed of enzymatic reactions and speed of electrical reactions

334
Q

Acid is?

A

H+ donor

335
Q

Base is?

A

H+ acceptor

336
Q

Acidic pH is?

A

<7

337
Q

Normal blood pH?

A

7.35-7.45

338
Q

Acidaemia pH?

A

<7.35

339
Q

Alkalaemia pH?

A

> 7.45

340
Q

pH range causing death?

A

<6.8

>8

341
Q

Three methods by which H+ is continually added to the body?

A

Acids - breakdown of foods e.g. proteins
CO2 metabolically produced
Acids from metabolic activity e.g. lactic acid

342
Q

Three systems to regulate pH are?

A

Chemical buffer
Respiratory centre in brain
Renal

343
Q

Timescale for chemical buffer onset?

A

Immediate

344
Q

Timescale for brain respiratory centre onset?

A

1-3 mintutes

345
Q

Timescale for renal control of pH onset?

A

Hours to days

346
Q

Three major chemical buffer systems are?

A

Bicarbonate
Proteins
Phosphate

347
Q

Which system can eliminate excess acids/bases from the body?

A

Only the renal system

348
Q

Anion gap is?

A

Difference between measured anions and cations

349
Q

Anion is?

A

Negative charge

350
Q

Cation is?

A

Positive charge

351
Q

Normal anion gap range is?

A

8-12mEg/L (with K+)

12-16mEg/L (without K+)

352
Q

What is generally excluded for the calculation of the anion gap?

A

Potassium

353
Q

Causes of elevated gap acidosis?

A

Loss of bicarbonate

354
Q

Causes of lack of bicarbonate x3

A

Severe diarrhoea
Laxative abuse
Villous adenoma

355
Q

Causes of reduced kidney H+ excretion? x4

A

Ketoacidosis
Lactic acidosis
Renal failure
Toxic ingestions

356
Q

Causes of low gap acidosis? x4

A

Haemorrhage
Nephrotic syndrome
Intestinal obstruction
Liver cirrhosis

357
Q

Control of pH at the proximal convoluted tubule?

A

Reabsorption of all filtered bicarbonate

358
Q

Enzyme involved in the reabsorption of bicarbonate at the proximal convoluted tubule?

A

Carbonic anhydrase

359
Q

Control of pH at the distal convoluted tubule?

A

Active excretion of H+

360
Q

Specialised cells at the distal convoluted tubule are?

A

Intercalated cells - reversed polarity

361
Q

Two types of intercalated cells?

A

Alpha

Beta

362
Q

Alpha intercalated cells secrete and absorb?

A

Secrete H+

Absorb HCO3-

363
Q

Beta intercalated cells secrete and absorb?

A

Secrete HCO3-

Absorb H+

364
Q

Tubular cells function?

A

Secrete HCO3- and absorb H+ when the body is in alkalosis

365
Q

H+ is traded for which ion?

A

H+

366
Q

Unionised drug features x3

A

Low polarity
High lipid solubility
Can permeate the membrane

367
Q

Ionised drug features x3

A

High polarity
Lower lipid solubility
Difficult to permeate the membrane

368
Q

Cause of respiratory acidosis?

A

Hypoventilation

369
Q

Cause of respiratory alkalosis?

A

Hyperventilation

370
Q

Cause of metabolic acidosis? x3

A

Diarrhoea
Keto acidosis
Lactic acidosis

371
Q

Cause of metabolic alkaosis x3

A

Vomiting
Hypokalaemia
Ingestion of HCO3-

372
Q

One unit is how much alcohol?

A

10ml of pure alcohol

373
Q

Which organ primarily metabolises alcohol?

A

The liver

374
Q

Which two enzymes iare involved in the metabolism of alcohol?

A

Alcohol dehydrogenase

Aldehyde dehydrogenase

375
Q

Alcohol is metabolised into what end product?

A

Acetate

376
Q

Alcohol dehydrogenase enzyme results in the production of what?

A

Acetaldahdye

377
Q

Four effects of alcoholic liver disease

A

Hepatic steatosis
Alcoholic hepatitis
Cirrhosis
Alcoholic pancreatitis

378
Q

HCV is?

A

Hepatitis C

379
Q

Two features of HCV virus?

A

Single stranded

RNA

380
Q

Presentation of acute HCV? x2

A

Acute

Nonspecific e.g. lethargy, abdominal pain

381
Q

What is cirrhosis? how is this formed?

A

Pathological end stage for any chronic live disease

This is irreversible liver damage - fibrosis

382
Q

Cells activated in cirrhosis?

A

Stellate cells

383
Q

Proliferation of which cells in cirrhosis?

A

Fibroblasts

384
Q

Clinical features of cirrhosis? x4

A

Jaundice
Melaena
Skin - spider naevi
Hands - palmar erythema

385
Q

Three complications of cirrhosis?

A

Portal hypertension
Hepatorenal failure
Hepatocellular failure

386
Q

Albumin levels in cirrhosis?

A

Reduced?

387
Q

Prothrombin time in cirrhosis?

A

Prolonged

388
Q

Mortality risk from liver transplant?

A

One year

389
Q

Main cause of acute liver disease?

A

Drugs e.g. paracetamol

390
Q

Five causes of chronic liver disease

A 
Viral hep B/C
Alcoholic liver disease
Autoimmune hepatitis
Primary metabolic disorders
Hepatocellular carcinoma
391
Q

Prognosis from liver transplant?

A

90% one year survival

70-85% 5 year survival

392
Q

Definition of DM?

A

Chronic, non-communciable disease characterised by hyperglycaemia

393
Q

Two causes of DM

A

Insulin deficiency

Insulin resistance

394
Q

Prevalence of diabetes in the UK?

A

3.5 million

395
Q

Global prevalence of diabetes? - percentage

A

9%

396
Q

Which DM is autoimmune?

A

DM1

397
Q

Two causes of DM

A

Insulin deficiency

Insulin resistance

398
Q

Prevalence of diabetes in the UK?

A

3.5 million

399
Q

Global prevalence of diabetes? - percentage

A

9%

400
Q

Cause of DM1?

A

Immune T cell mediated disruption of pancreatic Beta cells in islets
Insulin deficiency

401
Q

Treatment for DM1?

A

Lifelong insulin injections

402
Q

Common age of onset of DM1?

A

<30 years

403
Q

Genetics accounts for what percentage of DM1?

A

40-50%

404
Q

Most common type of DM is?

A

DM2

405
Q

Common characteristics of patient with DM2?

A

Overweight/obese

406
Q

Two genes related to DM2 development?

A

GKRP

PPARG

407
Q

Four risk factors for DM2 development?

A

Obesity - BMI > 31
Family history
Increasing age
Ethnicity

408
Q

Main cause of DM2?

A

Insulin resistance - insulin is being secreted but the receptors are nto responding
Lack of phosphorylation of insulin receptor

409
Q

What type of receptor is the insulin receptor?

A

Tyrosine kinase

410
Q

Why is age a risk factor for DM2?

A

Increased inflammation adn mitochondrial dysfunction

411
Q

Physiological conditions causing insulin resistance x2 (non pathological)

A

Pregnancy

Body weight gain

412
Q

Cause of insulin resistance - obesity

A

Accumulation of lipids and free fatty acids

Chronic inflammation

413
Q

Causes of insulin resistance - hyperinsulinaemia

A

Increased lipid synthesis

414
Q

Physiological response to non-pathological insulin resistance?

A

Generation of new beta cells - islet compensation

415
Q

Two components of islet compensation? x2

A

Islets increase in size

Islets increase in number

416
Q

Five mechanisms of islet compensation?

A 
Increased glucokinase activity
Increased malonyl coA
Fatty acids bind to GPR40
GLP-1 binding to receptor
Release of Ach from parasympathetic
417
Q

Islet compensation in diabetics

A

Some people do not develop islet compensation - they then develop diabetes

418
Q

Why do all obese people not develop diabetes?

A

Some will have islet compensation

419
Q

MODY is?

A

Maturity onset Diabetes of the Young

Present at birth

420
Q

Inheritance of MODY?

A

Autosomal dominant

421
Q

Prevalence of gestational diabetes in Europe?

A

2-6%

422
Q

How is DM2 diagnosed? x2

A

One abnormal plasma glucose and presence of symptoms (>11 or >7 fasting)
OR two abnormal fasting venous plasma glucose (>7 fasting)

423
Q

Test used to diagnose DM2?

A

Oral glucose tolerance test - fast and then measure blood glucose levels

424
Q

Blood test used to diagnose DM2?

A

HbA1c

425
Q

Advantages of HbA1c?

A

Reliable
Stable compared to glucose
Easy to sample
At patient’s convenience - no need to fast

426
Q

HbA1c level for diabetes?

A

48mmol/mol

427
Q

What does HbA1c measure?

A

Glycation of Hb

428
Q

Action of metformin?

A

Inhibition of gluconeogenesis at the liver

429
Q

Metformin drug type?

A

Biguianide

430
Q

Acetyl-coA is converted into what during long term fasting?

A

Ketone bodies

431
Q

Two drugs that increase GLP-1 for DM2?

A

Sitagliptin - inhibits DDP-4

Metformin - increase GLP-1

432
Q

Hypoglycaemia defined as?

A

Blood glucose <3.9mmol/L

433
Q

Five causes of hypoglycaemia

A 
Alcohol excess
Insulinoma - tumour of beta cells
Excessive exercise
Reactive hypoglycaemia - high carb meal
Type 1 diabetes - injection + missed meal
434
Q

Four physiological responses to hypoglycaemia?

A

Decreased insulin secretion
Increased glucagon secretion
Increased adrenaline secretion
Sympathetic response - behavioural - increased carbohydrate digestion

435
Q

Two physiological responses to prolonged hypoglycaemia?

A

Release of growth hormone

Release of cortisol

436
Q

Chronic macrovascular complication of diabetes?

A

Atherosclerosis

437
Q

Chronic microvascular complications of diabetes? x4

A

Nephropathy
Neuropathy
Retinopathy
Amputation

438
Q

Hyperglycaemia results in the activation of what main pathway?

A

Protein kinase C pathawy

439
Q

How can hyperactivation of PKCs damage blood vessels? x5

A 
Increased permeability
Increased occlusion
Increased ROS
Increased inflammation
Mitochondrial dysfunction
440
Q

Effect of hyperglycaemia on proteins?

A

Proteins can undergo post-translational modifications

441
Q

Non-proliferative diabetic retinopathy is?

A

Dilatation of the retinal veins and microaneurysms cause haemorhage and oedema

442
Q

Proliferative diabetic retinopathy is?

A

Growth of fragile new blood vessels from the optic disc - these then bleed and lead to detachment of the retina

443
Q

When does retinopathy typically occur in a diabetic?

A

After 20 years of poorly controlled diabetes

444
Q

Diabetic nephropathy - damage to the blood vessels are where?

A

Glomerulus

445
Q

Prevalence of diabetic nephropathy amongst patients with diabetes?

A

One third of diabetic patients

446
Q

Signs of diabetic nephroprathy x4

A

Proteinuria
Glomerular hypertrophy
Decreased glomerular filtration
Renal fibrosis

447
Q

Four types of diabetic neuropathy?

A

Peripheral
Autonomic
Proximal
Focal

448
Q

What percentage of diabetics develop some form of neuropathy?

A

60-70%

449
Q

Three examples of autonomic neuropathy in a diabetic?

A

Changes in digestion, bowel and bladder control
Erectile dysfunction
Affect cardiac nerves

450
Q

Proximal neuropath in a diabetic causes pain and weakness where? x3

A

Pain in thighs
Pain in hips
Weakness in legs

451
Q

Peripheral diabetic neuropathy affects what?

A

Hands
Arms
Feet
Legs

Loss of feeling

452
Q

Consequences of macrovascular complications in a diabetic? x3

A

Cerebrovascular disease - stroke
Heart disease - MI
Peripheral vascular disease - ulcers, gangrenes, amputations

453
Q

Main centre for appetite control in the brain is the?

A

Arcuate nucleus

454
Q

Arcuate nucleus is located where?

A

In the hypothalamus

455
Q

Orexigenic means?

A

Appetite stimulating

456
Q

Anorexigenic means?

A

Appetite suppressing

457
Q

Three orexigenic neurotransmitters?

A

NPY
AgRP
MCH

458
Q

Two anorexigenic neurotransmitters?

A

POMC - proopiomelanocortin - MAIN ONE THAT IS IMPORTANT

CART

459
Q

POMC binds to which receptor?

A

MCR4

460
Q

Deficiency in POMC can lead to?

A

Obesity

461
Q

Deletion/mutation in the MCR4 receptor in humans and mice can result in?

A

Obesity

462
Q

MCR4 mutations accounts for what percentage of severe childhood obesity?

A

5%

463
Q

MCR4 mutations accounts for what percentage of adult obesity?

A

0.5-2.5%

464
Q

Serotonin is orexigenic or anorexigenic?

A

Anorexigenic

465
Q

Two receptors that serotonin acts on?

A

Htr1b

HTr2c

466
Q

Effect of serotonin on the neurotransmitters for appetite?

A

Increased POMC

Decrease NPY

467
Q

Main anorexigenic neurotransmitter is?

A

POMC

468
Q

Htr1b serotonin receptor - whcih neurotransmitter system?

A

AgRP

469
Q

HTr2C serotonin receptor - which neurtrotransmitter system?

A

POMC

470
Q

Effect of ghrelin on appetite?

A

Orexigenic

471
Q

Ghrelin has an effect on which neurotransmitter?

A

NPY

472
Q

Nerve associated with ghrelin?

A

Vagus nerve

473
Q

Where is PYY 3-36 released from?

A

Gut

474
Q

When is PYY 3-36 released?

A

When there is something in the gut

475
Q

PYY 3-36 has an effect on?

A

NPY and POMC in hypothalamus

476
Q

Effect of PYY 3-36 on appetite regulation?

A

Anorexigenic - suppress NPY

477
Q

Where is GLP-1 produced and which cells?

A

Small intestine - L cells

478
Q

Effect of GLP-1 on appetite regulation?

A

Anorexigenic

479
Q

Where is ghrelin released from?

A

The stomach

480
Q

Cholecystokinin (CCK) is released from which two organs?

A

Duodenum

Small intestine

481
Q

Cells that released CCK are?

A

Enterendocrine cells

482
Q

Effect of CCK on appetite regulation?

A

Anorexigeni

483
Q

Leptin is a hormone secreted from where?

A

Adipose tissue

484
Q

Effect of leptin on appetite regulation?

A

Anorexigenic

485
Q

Effect of leptin on teh appetite regulatory neurotransmitters?

A

Drops AGRP levels

486
Q

Effect of insulin on appetite regulation?

A

Anorexigenic

487
Q

Effect of leptin on the appetite regulatory neurotransmitters?

A

Drops AGRP levels

488
Q

Leptin resistance is?

A

Ignorance of the effect of leptin - ceases to have an appetite supprsesing effect

489
Q

Role of malonyl coA in appetite regulation?

A

Controller of appetite linked to fatty acid metabolism

490
Q

The levels of Malonyl coA is controlled by what three factors?

A

AMPK enzyme
AMP/ATP ratio
Calcium regulated - ghrelin

491
Q

High levels of malonyl coA have what effect on appetite?

A

Appetite suppressing - anorexigenic

492
Q

Effect of cannabinoids on appetite regulation?

A

Increase appetite adn food consumption

493
Q

Cannabinoid receptor expressed in the hypothalamus is?

A

CB1

494
Q

Effects of SSRIs/5-HT on appetite regulation?

A

Appetite suppressing

495
Q

Current most successful appetite suppressing therapeutic?

A

GLP-1 agonist

Year 2 Metabolism (34 decks)

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