Phys: Gallbladder Pancreas

Question 1

What controls the relaxation of the Sphincter of Oddi?

Answer 1

CCK

Question 2

What forms the Ampulla of Vater?

Answer 2

Pancreatic duct and common bile duct

Question 3

What cells of the pancreas secrete digestive enzymes?

Answer 3

Acinar cells

Question 4

What duodenal enzyme activates pancreatic enzymes?

Answer 4

Enteropeptidase

Question 5

What do centroacinar and duct cells do to the enzymes produced by acinar cells?

Answer 5

Dilute them and make them rich in sodium and bicarbonate!

Question 6

What is the target of enteropeptidase?

Answer 6

Trypsinogen

Question 7

What is triggering activation of acinar cells during cephalic and gastric phases?

Answer 7

Parasympathetics via dorsal motor nucleus of vagus…release of acetylcholine on muscarinic receptors of acinus

Question 8

During what phase is most of the pancreatic enzyme release happening?

Answer 8

Intestinal phase

Question 9

What cells release CCK?

Answer 9

I cells

Question 10

H+ ions cause S cells to release what during the ___________phase.

Answer 10

Secretin

Intestinal

Question 11

What does secretin do?

Answer 11

Activates pancreatic duct cells to secrete bicarbonate

Question 12

Where are the CCK receptors?

Answer 12

Acinar cells…trigger further fusion of zymogens

Question 13

What triggers CCK-RP release from pancreas?

Answer 13

Amino acids

Fatty acids

Question 14

What does CCK increase the release of in the pancreas?

Answer 14

Monitor peptide and pancreatic enzymes

Question 15

What do pancreatic enzymes do to CCK and Monitor protein?

Answer 15

Digest them! Turning off CCK secretion

Question 16

What does CCK do to gall bladder?

Answer 16

Contraction

Question 17

Where does enteropeptidase come from?

Answer 17

Brush border of Duodenum

Question 18

Hereditary pancreatitis occurs due to a mutation in the trypsinogen PRSS1 gene causes activation of digestive enzymes in the pancreas which can lead to inflammation…..Autosomal dominant or recessive?

Answer 18

Dominant!

Alteration of one allele is enough to change the phenotype

Question 19

What does the duodenal pH need to be in order to secrete secretin?

Answer 19

(I can’t think of it at the moment) but its acidic :/

Ooooo! Its

Question 20

Do you predict a patient on a proton pump inhibitor will have increased or decreased duodenal bicarbonate secretion posprandially?

Answer 20

Decreased!

There won’t be an acid signal to induce secretin release

Question 21

What does secretin do?!

Answer 21

Initiates secretion of bicarbonate solution by pancreatic duct cells!

Question 22

What second messenger does secretin operate through?

Answer 22

cAMP

Question 23

What second messenger does CCK operate through?

Answer 23

Ca++

Question 24

Where was the alkaline tide generated? (organ)

Answer 24

Stomach

Question 25

What would be a consequence on bicarbonate secretion in a pancreas with cystic fibrosis?

Answer 25

Decreased bicarbonate | **Pancreatic insufficiency--90 % reduction in amount of enzymes reaching intestine

Question 26

What can alcohol do to acinar cells?

Answer 26

Hyperstimulate them...premature activation of trypsin...this can lead to cell death

Question 27

Why would you see malabsorption of fat with pancreatitis?

Answer 27

Because we aren't going to have sufficient colipase and lipase in the duodenum...won't be able to cleave TAG to have fatty acids packaged into micelles to be absorbed!

Question 28

What part of the brain is important in regulating energy homeostasis?

Answer 28

Hypothalamus

Question 29

What cells release GLP-1? *Glucagon-like peptide

Answer 29

L cells

Question 30

What cells release GIP? *Glucose-dependent insulinotropic peptide

Answer 30

K cells

Question 31

What does GLP-1 do to levels of insulin and glucagon?

Answer 31

Increases insulin, decreases glucagon

Question 32

What are the positive regulators of insulin secretion?

Answer 32

GLP-1 Amino acids CCK ACh

Question 33

What are the inhibitors of Insulin secretion?

Answer 33

Somatostatin | NE

Question 34

What things act as satiety signals to decrease food intake and increase energy expenditure? Act at hypothalamus

Answer 34

GLP1 CCK Insulin Leptin

Question 35

If someone has low Leptin, what would you expect?

Answer 35

Don't get satiety signal...always eating! Likely obese

Question 36

What peptide hormone stimulates appetite? Where is it produced?

Answer 36

Ghrelin | Fundus of stomach

Question 37

What peptides are involved in the Ghrelin pathway?

Answer 37

Neuropeptide Y | Agouti-related peptide

Question 38

What cells of the pancreas does gastrin activate during cephalic/gastric phases?

Answer 38

Acinar cells

Question 39

Name some of the cool stuff our liver does! 5 general categories

Answer 39

Detoxifies drugs & bacteria Metabolizes carbs, fat, protein Stores glycogen, fat, V B12, A, K Synthesizes good stuff for our circulatory system Makes bile! Enables lipid uptake and excretion of lipophilic molecules

Question 40

Why is there a lot of Smooth ER in the liver?

Answer 40

Because it makes cholesterol!

Question 41

Hepatic triad

Answer 41

Portal vein Hepatic artery Common bile duct (reverse direction of the other 2)

Question 42

How does blood leave the liver?

Answer 42

Via central vein...enters IVC

Question 43

Major workforce cell of liver

Answer 43

Hepatocyte

Question 44

What type of cells are Kupffer cells?

Answer 44

Macrophage

Question 45

What enters the Space of Disse?

Answer 45

Sieving by RBCs to allow passage of chylomicron remnants into this space!

Question 46

What do stellate cells do?

Answer 46

Produce collagen and store lipids like Vitamin A

Question 47

What causes Jaundice?

Answer 47

Unconjugated bilirubin

Question 48

Cirrhosis

Answer 48

Hardening of liver due to irreversible deposition of excess collagen

Question 49

Describe the pathology of liver cirrhosis

Answer 49

Oxidative stress causes Kupffer cells to release cytokines inducing collagen production by stellate cells. Accumulation of collagen increases resistance to blood flow (portal hypertension) and reduced hepatic function (hepatic encephalopathy)

Question 50

What cells make bile?

Answer 50

Hepatocytes

Question 51

What is bilirubin conjugated to to promote excretion?

Answer 51

Glucuronic acid (via glucoronidase)

Question 52

Sx of unconjugated bilirubin build up

Answer 52

Abdominal pain Pruritis Jaundice

Question 53

Yellow pigment in urine

Answer 53

Urobilin

Question 54

Green color of bile

Answer 54

Conjugated bilirubin

Question 55

Yellow contributing to jaundice

Answer 55

Unconjugated bilirubin

Question 56

Brown color in poop

Answer 56

Stercobilin

Question 57

Amphipathic Which molecules are amphipathic?

Answer 57

Hydrophobic on one side. Hydrophilic on the other side. Helps make it soluble in aqueous environment *Primary bile acids

Question 58

What amino acids can bile acids be conjugated to to generate bile salts?

Answer 58

Glycine | Taurine

Question 59

Reabsorbed bile acids exert a negative feedback on what enzyme so you aren't synthesizing as many bile acids?

Answer 59

7-alpha hydroxylase

Question 60

What does bile acid sequestrant (cholestyramine) do to serum cholesterol levels?

Answer 60

Decrease because more cholesterol is being diverted to produce bile acids

Question 61

Why are glucose and amino acids reabsorbed from bile in the cholangiocytes of the canals of Hering?

Answer 61

To prevent bacteria overgrowth that could lead to deconjugation

Question 62

What transporter uptakes conjugated bile acids in the lieum?

Answer 62

sodium-dependent bile salt transporter (ASBT) through secondary active transport!

Question 63

What transporter transports bile acids to portal circulation?

Answer 63

Organic solute transporter (OST)

Question 64

Cholestasis

Answer 64

Impaired bile secretion...creates a higher risk of forming stones

Question 65

What hormone reduces gallbladder smooth muscle tone?

Answer 65

Progesterone (makes it more likely for things to precipitate because it can't contract as good!)

Question 66

2 types of cholelithiasis

Answer 66

cholesterol (most common) | Pigment stones

Question 67

Tx for cholesterol stones

Answer 67

increase bile acids--to promote solubilization of cholesterol

Question 68

Why might you have a bleeding disorder associated with gall stone blockage?

Answer 68

Decreased vitamin K absorption

Question 69

Explain the CCK regulation stuff

Answer 69

Monitor peptide is released during cephalic and gastric phases from the pancreas CCK-RP is released from the pancreas in intestinal phase When monitor peptide and CCK-RP hook up, they cause the release of CCK from I cells into the blood! CCK increases the release of monitor peptide and other pancreatic enzymes. Pancreatic enzymes digest luminal nutrients, CCK-RP and monitor peptide to turn of CCK secretion

Question 70

Who is the master regulator of the duodenal cluster unit?

Answer 70

CCK!!!

Question 71

What does CCK do to gallbladder, pancreas, stomach, sphincter of oddi, brain?

Answer 71

``` Gallbladder: contraction Pancreas: increase acinar secretion Stomach: Reduce emptying Sphincter of Oddi: relax Brain: decrease food intake ```

Question 72

What happens if someone has a PRSS1 gene mutation?

Answer 72

Hereditary pancreatitis...trypsinogen gene mutation that causes activation of enzymes IN THE PANCREAS rather than the duodenum....serious inflammation

Question 73

How can alcohol cause pancreatitis?

Answer 73

Can be metabolized into products that cause hyperstimulation of acinar cells --> Intracellular trypsin activation prematurely-->cell death!

Question 74

Why is pancreatic exocrine activity highest in intestinal phase?

Answer 74

Due to secretion of CCK and secretin!

Question 75

Where is CCK released from?

Answer 75

Duodenum (I cells)

Question 76

Why may a baby be jaundiced?

Answer 76

Delayed expression of Glucoronidase!! Can't conjugate bilirubin to glucoronic acid

Question 77

What is added to bile in the canals of Herring?

Answer 77

IgA and mucus

Question 78

What opens the Sphincter of Oddi?

Answer 78

CCK (I know I've over done this...but you should know it!)

Question 79

Cause of cholesterol stones?2

Answer 79

Too much cholesterol | Too little bile

Question 80

How can ZE syndrome cause steatorrhea?

Answer 80

H+ makes lipase not as active...poop out the fat!