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Pop Alie Flashcards

1
Q

Draw a diagram showing how pancreatic duct cells secrete/release bicarbonate ions (8)

A

1) Co2 diffuses into cells:
CO2 + H20 => H2Co3 => H+ + HCO3- (carbonic anhydrase)

2) HCO3 exchanges with Cl- at lumen by electrochemical gradient
3) Na/H exchange at BASOLATERAL membrane into bloodstream (Secondary active transport)
4) Na gradient maintained by Na/K EXCHANGE pump (PRIMARY active transport, use ATP)

5) K returns to blood - K channel (left side of cell)
Cl returns to blood, Cl- channel (right side of cell)
Na+ moves back to right side??

NB. CFTR will have disfunction in that channel

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2
Q

b) Explain why the pancreas must make bicarbonate ions (2)

A

• Neutralises acid chyme from the stomach:

o Prevents damage to duodenal mucosa
o Raises pH to optimum range for pancreatic enzymes to work

• Washes low volume enzyme secretion out of pancreas into duodenum

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3
Q

a) What are the three components of total energy expenditure? (3)

A

o Thermogenesis
o Physical activity
o Resting energy expenditure (BMR - basal metabolic rate)

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4
Q

Define obesity using BMI including units (1)

A

> 30kg/m2 = obese

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5
Q

a) Name and explain the mechanisms of the two drugs licensed for dealing with Obesity in the UK (4 marks)

A

Orlistat – a weight loss agent which inhibits PANCREATIC LIPASE and hence intestinal fat absorption.

Victoza – GLP-1 RECEPTOR AGONIST, inhibits acid secretion and gastric emptying in thestomach, decreases food intake by increasingsatietyin brain.

Belviq – contains lorcaserin, which is a SEROTONIN AGONIST, serotonin increases satiety in brain by inhibiting dopamine release.

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6
Q

Explain obesity’s prevalence in the West using the thrifty gene hypothesis (2)

A
  • Thrifty genes are specific genes which increase metabolic efficiency and fat storage.
  • In the Western culture, there is plentiful food and little exercise so these genes predispose their carriers to obesity and diabetes.
  • It was evolutionary sensible to put on weight to prepare for times when food was not abundant.
  • Thin humans didn’t survive famines, so didn’t pass their genes on to modern humans.

Evidence: Populations historically prone to starvation became most obese when exposed to Western diet and sedentary lifestyle.

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7
Q

a) What is the max unit limit of alcohol for man and woman? and work out the amount of units in 8 pints a day for a week?

A

3-4 units a day for men, 2-3 units a day for women

21 units a week for men, 14 units a week for women

Percentage * volume = amount of alcohol in the drink

One alcohol unit = 8gof pure alcohol

Amount of alcohol in drink / 8 = number of units in the drink

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8
Q

a) This followed with a table asking how albumin, alanine transferase, bilirubin and alkaline phosphatase changed with a hepatic disorder.

A

Albumin decreases
Alanine aminotransferase increases
Bilirubin increases
Alkaline phosphatase increases

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9
Q

What is haematamesis?

A

Vomiting of blood

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10
Q

What are the differences between large and small intestine?

A
  • LARGE INTESTINE has no villi
  • Fewer enteroendodrine cells
  • No paneth cells
  • Glycocalyx does not contain digestive enzymes
  • Higher number of goblet cells
  • More Peyer’s patches
  • Contains intestinal flora
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11
Q

a) Why do goblet cells increase in number along the large intestine, towards the rectum?

A
  • Goblet cells produce mucus
  • Mucus facilitates passage of increasingly solid colonic contents, and covers bacteria and particulate matter
  • ACh stimulates goblet cell secretion
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12
Q

Draw a schematic of the arcuate nucleus and its effect on energy homeostasis. 10 marks!

A

LOOK ON SHEET 10 MARKS

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13
Q

a)

Label the substance/transporters on a proximal tubule cell for glucose absorption.

A

Na/H counter transport

Na+ and glucose
Na+ and amino acid
BTH co-transport

Na/K on other side - left
Glucose and amino acids on other side

Na+ entry down a large electrochemical gradient can bring about the ‘uphill’ entry of glucose and amino acids and exit of H+

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14
Q

a) Given a diagram of a cardiomyocyte and you have to label the substances that exchange to keep the Ca2+ low in the cell (with the sarcoplasmic reticulum).

A

LOOK ON SHEET

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15
Q

a) What do glucose absorption and maintaining cardiomyocyte’s Calcium ion levels low?
High glucose absorption, high glomerular filtration, high BP, low Ca2+ because it is bound to troponin for cardiac diastole.

A

Glucose -> Reproton? -> ATP -> CaATPase

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16
Q

Which transporter is common to the PCT and cardiac myocyte?

A

Na+/K+ ATPase

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17
Q

Given ERCP of liver and biliary tree:

a) What is this?

A

Body of gall bladder. Fundus, Body, Neck

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18
Q

b) 2 Gall Bladder’s functions:

A
  • Stores bile produced by the liver, released after meal for fat digestion
  • Acidifies bile
  • Concentrates bile by H2O diffusion following net absorption of Na+, Cl-, HCO3-
19
Q

2 Causes of obstruction at the LOWER end of the bile duct.

A

. Gallstones and tumours

20
Q

Where is the ERCP positioned?

A

ERCP is a procedure that enables your physician to examine the pancreatic and bile ducts.

Ampulla of Vater in 2nd part of duodenum

21
Q

a) Give 3 substances that stimulate the secretion of gastric acid in the stomach

A

o Gastrin
o Acetylcholine
o Histamine

22
Q

b) Give 3 cytological appearances of a parietal cell in its resting state

A

o Many mitochondria
o Cytoplasmic tubulovesicles
o Internal canaliculi (extend to apical surface)

23
Q

c) How is pepsinogen converted to its active form?

A

o Pepsinogen interacts with gastric acid to form pepsin, via autocatalysis.
o Pepsinogen has a conformation in which the active site is internal
o Acidic environment of the stomach exposes the active site
o Pepsin then further catalyses its own production once the active site is exposed (positive feedback)

24
Q

d) Briefly describe the cytological changes observed when a parietal cell transforms from resting state to active

A

o Tubulovesicles fuse with membrane and microvilli project into canaliculi
o All canaliculi fuse to form large reservoir extending to the apical surface and tubulovesicles infiltrate internal reservoir

25
Q

a) Name the enzyme secreted by the pancreas which digests carbohydrate, state where it acts and optimum conditions for its activity (4)

A

o Pancreatic alpha amylase
o Acts mainly in the lumen of the small intestine (some also adsorbs to the brush border)
o Needs Cl- for optimum activity and neutral/slightly alkaline pH

26
Q

b) Complete a table regarding the absorption of glucose and fructose - name the carrier proteins on apical and basolateral membranes and their mechanisms (6)

A

o Absorption of glucose is by secondary active transport (carrier protein and electrochemical gradient). Carrier protein = SGLT-1 on apical membrane.
o Absorption of fructose is by facilitated diffusion. Carrier protein = GLUT-5 on apical membrane and GLUT-2 facilitates exit at the basolateral membrane.

27
Q
  • which is a scan of the small intestine?
A

Enteroscopy

28
Q
  • interventional procedure to deal with gallstones in bile duct/pancreatic duct?
A

ERCP, Endoscopic retrograde cholangiopancreatography - endoscopy + xray, PTC - x ray and contrast agent into bile ducts, Cholecystectomy

29
Q
  • test for B12 absorption?
A

Schilling test

30
Q
  • Test for coeliac disease?
A

Tissue transglutaminase antibody (tTGA) and Endomysial antibody (EMA)

31
Q
  • Test for internal bleeding?
A

Imaging

32
Q
  • Causes hunger, increases appetite?
A

Ghrelin

33
Q
  • Gall-bladder contraction?
A

CCK - Cholecystokinin secreted by I cells in the mucosal epithelium of the duodenum and jejunum

34
Q
  • Secreted by L-cells?
A

GLP – glucagon like peptides or PYY

35
Q
  • secreted by white adipose tissue?
A

Leptin

36
Q
  • Inhibited by Ranitidine?
A

Histamine receptors

37
Q

List the types of cells and what they stimulate.

A

Endocrine D cells – somatostatin – universal inhibitor
S cells – secretin – stimulates pancreatic bicarbonate secretion
I cells – CCK – stimulates GB contraction, pancreatic enzyme release, delays gastric emptying
K cells – GIP – stimulates insulin secretion, released following ingestion
L cells – PYY – decreases appetite
L cells – GLP
Gastric antrum and upper SI - Gastrin – stimulates gastric acid secretion. Stimulated by AA and peptides in stomach, gastric distension, vagus nerves

38
Q

4) List of parts of colon

- various qs on attachments and blood supply

A

• The proximal transverse colon is supplied with blood by the middle colic artery (branch of superior mesenteric artery)

39
Q

A list of the causes of liver failure was given.

a) Alcoholic liver disease
b) Hepatitis B
c) Hepatitis C
d) Hemochromatosis
e) Portal thrombus
f) Etc…

A

The questions were far to detailed to remember but they gave you a couple of clinical features for each and you had to match it to the correct cause.

40
Q

6) Match the cell type (alimentary) to its function:

A

6) Match the cell type (alimentary) to its function:

o Carbonic anhydrase in paneth cells??

41
Q

What does Ratinidine block?

A

Histamine receptors

42
Q

What stimulates glycogenolysis?

A

Glucagon

43
Q 
7)	Random disease matching: 
o	Vomiting as a cause of 
o	What does helicobacter pylori cause? 
o	What causes acute pancreatitis? 
o	What cause liver cirrhosis?
A

metabolic alkalosis??

Chronic gastritis, gastric cancer

Gallstones.

Hep C

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