Test Flashcards
Which abdominal organ is perfused by branches of celiac and superior mesenteric artery?
Pancreas
- sigmoid colon
- spleen
- urinary bladder
- gallbladder
- rectum
Which one drains directly into the caval system?
Only urinary bladder, meaning everything else takes the route of portal to caval
What normally increases basal acid output in stomach?
Alkanization of the antrum
What does the myenteric plexus contain in regards to para/sympathetics
- Nerve cell bodies of parasympathetic ganglia
- postganglionic axons of parasympathetic ganglia
- postganglionic acons of sympathetic ganglia
Which parts of the GI tract contain simple columnar cells?
Stomach, small intestines, large intestines
What do paneth cells do?
They are found only in the crypts of the small intestine where they manage gut flora via lysozyme secretions. They are no macrophages
Why does the sublingual gland have very few striated ducts?
Striated ducts participate in ion and water transport. They reabsorb sodium and calcium ions to make saliva hypotonic. Sublingual acini are mostly mucous secreting so they do not need that modification
A boy swallows a diamond ring. When will it pass the stomach?
4-8 hours after eating because during the digestive period (2-4 + 2-4 hours) the pyloris is narrow or closed. It opens wide in the interdigestive period
How do nonsteroidal anti-inflammatory drugs contribute to stomach ulcers?
NAIDS inhibit the production of prostaglandins which stimulate the secretion of bicarbonate to protect the mucosa.
How does phototherapy reduce jaundice?
It oxidizes bilirubin to a water soluble form which is non toxic and excreted in the urine
What are the classic symptoms of hypertriglyceridemia
Chylomicrons and VLDL likely elevated
Milky white plasma, eruptive xanthomas, enlarged liver and spleen, pancreatitis.
What is the only diarrhea that causes blood and leukocytes in stool?
Invasive diarrhea
What are intraperitoneal?
Jejunum Ileum Transverse Sigmoid colon Stomach
What are secondary retroperitoneal
Ascending Descending colons Pancreas Duodenum Kidney (primary?)
Patient says she is always tired and feels cold. She gave birth to a healthy baby and has heavy menses.
She is vegeterian and doesn’t eat fruit. What is likely low in this patient?
iron/ferritin
- low vitC
- non heme iron
fatigue and feels cold
What is nitrogen balance
Negative; whether protein intake is insufficient
Positive: whether protein intake is too much (growth spurt)
You only care about essential amino acids.
ex: adult is placed on diet that lacks tyrosine but is otherwise balanced.
=in nitrogen balance because tyrosine is nonessential.
Patient has body weight less than 60% of normal with muscle wasting. Nothing else
Marasmus
not Kwashikor because in that state there is protein malnutrition relative to calories so they are in the 60-80% of ideal body weight.
Hypoalbunemia is a KEY symptom so they have distended bellies with edema.
What is the folate trap?
The consequence of cobalamin deficiency on folate metabolism.
lacking B12 leads to the accumulation of two things:
- homocysteine
- N5-methyl tetrahydro folate.
As a result there is a decrease in tetrahydrofolate (THF)
Even with sufficient folate, this will present it self so its really about cobalamin.
inactivation of Na+/K+ ATPase will decrease absorption of which nutrient?
Glucose because it is cotransported with sodium in SGLT-1. The ATPase provides the engine that drives it.
Villus atrophy will decrease digestion of what
Carbs, proteins, and lipids. (and nucleic acids)
Villi contain brush borders that contain hydrolyase activity important for the digestion of carbohydrates, proteins and nucleic acids. Lipids are digested by pancreatic enzymes however it is MALABSORBED
A patient has an ileal ressection. She feels fine after eating breakfast but has diarrhea after lunch and dinner.
Bile acids are produced during the interdigestive period at night. That bile is stored in the gallbladder.
The amount of bile secretion into the duodenum is highest in the morning. After that, the lack of bile recycling means low bile level.
What percentage of bile acids are returned to the liver?
95% of CONJUGATED bile salts are reabsorbed by the small intestine and 5% are lost in feces.
That means bile secreted from the liver is 95% old, 5% new.
The deconjugation only occurs in the colon and includes only 5% of the secreted bile salts.
Bile doesn’t have that urine excretion component like bilirubin.
A newborn baby experiences severe diarrhea that worsens with meals. What is likely mutated?
SGLT-1. Because the baby has impaired glucose and sodium reabsorption, that draws water out and makes the diarrhea worse.
What do Kupffer cells do
Primary function is translocate intestinal bacteria.
Secondary function is to prevent sepsis
Sepsis is the presence in tissues of harmful bacteria and their toxins, typically through infection of a wound.
What primarily causes the symptoms of dumping syndrome, discomfort after meals)
Hypoglycemia.
The food moves way to quickly from stomach to small intestine.
This causes rapid glucose absorption and excessive insulin release.
How are peptides absorbed.
Peptides are absorbed with a proton in the Pep1 channel.
THe proton is suppled by the NHE3 transporter which brings proton into the intestinal lumen and sodium in. That proton then acts like a shuttle in the symporter.
What is the first step of heme ring breakdown?
The opening of the ring to the linear bilirubin structure and then converted Fe2+ to Fe3+
Neonatal Jaundice
- it is the clinical consequence of levels of bilirubin glucuronyl transferase that are inadequate to meet the baby’s needs to process bilirubin further
- can be treated with phototherapy
- increased concentration of circulating unconjugated bilirubin causing jaundice and maybe kernicterus.
Patient has dark brown coloration of urine. He has conjugated hyperbilirubinemia, what would you expect from his bile relative to normal for:
- bilirubin
- urobilinogen
- bile acids
Bilirubin will be decreased (cause this sounds like an conjugated bilirubin export problem (MRP2?)
Urobilinogen will be decreased, you aren’t making urobilinogen that gets recycled and dumped into bile canaliculi
Bile acids: unchanged
What happens with increased insulin secretion?
- decreased blood glucose
- increased epinephrine and glucagon secretion
- increased anabolic activity
Deficiencies in what can cause cheilosis?
Cheilosis is the inflammator lesions or cracking at corners of the mouth. They can be caused by riboflavin, niacin, pyridoxine and iron deficiencies.
A lady has increased headaches, joint pain, nausea, vomiting and weightloss with dryness of the oral mucosa along with bony hyperostosis. What is she taking excess of?
Vitamin A toxicity can lead to bone pain, dermatitis, liver and spleen enlargement, nausea nad diarrhea
When taking warfarin, what vitamin should you advise on?
Vitamin K and actually avoid foods high in vitamin K. The whole point of warfarin is to inhibit vitamin K effects. You are comprimising the efficacy of warfarin.
What is the effect of trans fatty acids?
An increase in LDL with a modest decrease in HDL. It will have an increase in total cholesterol/HDL cholesterol ratio
Why are carbs protein sparing?
Why are insoluble fibers non-nutritive?
They prevent the use of protein breakdown in gluconeogenesis.
We cannot digest fibers so they are considered non-nutritive.
Which two proteins are involved as coenzymes or cofactors for the post-translational modification of proteins?
Vit K and C
What are characteristics of the mucosal layer in the jejunum
What are characteristics of the lamina propria
- has goblet cells
- lacks Brunners glands
- has a lamina propria
- has a muscularis mucosae
Lamina propria:
- has capillaries
- has nerve fibers
- has lymphocytes
stomach biopsy shows atrophic parietal cells in a pernicious anemic patient, the underlining neuroendocrine deficiency likely is…
Gastrin
During a meal, the pancreatic enzyme secretions are mediated by what?
Acetylcholine
What part of pancreatic secretion is stimulated by CCK?
The enzymatic part
Inhibition of sodium transport has the least effect on what?
monoglycerides have passive diffusion
-galactose, glucose, dipeptides, vitamin C are all mediated by sodium transport
An individual has steatorhea. THe fecal fat is primarily triglycerides. The most likely problem is
Inadequate pancreatic secretions because this is a DIGESTION problem not an ABSORBTION problem
Which nutrient has the highest absorption efficacy? Therefore where does most water absorption occur?
glucose, as the most osmotically active compound, the highest absorption is in the small intestine
How does dietary cholesterol affect HMG-coA reductase activity?
Dietary cholesterols are carried in chylomicrons to the liver. LDL is internalized by liver and peripheral tissue to deliver cholesterol as well. internalized cholesterol will decrease transcription of HMG CoA reductase thus leading to decrease in de novo cholesterol synthesis.
What three things occur in cholestatic jaundice?
Urine bilirubin is conjugated, malabsorption of fat is common, plasma bile acid concenrrations are increased
Describe the ion levels of gastric, pancreatic and salivary secretions
Gastric: HIGH proton HIGH chloride HIGH potassium LOW sodium
Pancreas:
HIGH bicarb
LOW chlorine
level sodium, potassium
Salivary: HIGH bicarb HIGH potassium LOW sodium LOW chloride
