Week 2 Flashcards
what does intrinsic factor do
help absorption of b12
where are most of the parietal cells
where is most of the mixing and grinding of the stomach going on
fundus and body
antrum
what part of the stomach is richest in glands
body, where most of the parietal cells are
what stimulates g cells to produce gastrin
Amino acids
seeing food in your environment (cephalic phase) - preganglionic cholinergic nicotinic nerves release ACh to the GRP nerve, which releases GRP onto the gastrin cells
three molecules that positively upregulate your parietal cells
gastrin, histamine, ACh
atropine - what would it do to parietal cells
blocks ACh and inhibits acid secretion
what hormone does your duodenum secrete when it sees an increase in hydrogen ions during the intestinal phase
secretin - an enterogastrone secreted by S cells
blocks secretion of histamine by ECL cells and gastrin by g cells
this is called the intestinal phase
what happens to your somatostatin levels during the cephalic phase
Gastrin levels?
Histamine?
ACh?
its still on - somatostatin is regulated mostly by pH of the stomach
gastrin levels are turned on by GRP, even though somatostatin is still on
histamine and ACh are also on
how does H. pylori cause an ulcer
may be related to urease activity causing reduced somatostatin
trefoil factor
secreted by surface mucous cells, increases gastroprotection and may regenerate epithelial layer
gastroileal reflex
expansion of the stomach causes ileoceccal valve relaxation and transfer of contents from small to large bowel
gastrocolic reflex
induces the need to defecate after ingesting a meal
what are some bacteria in the mouth that actually protect you against dental carries?
some GOOD oral streptococci
S. sanguinis
S. mitis
they produce peroxides that are harmful to other streptococci
one of the most common bad streptococcal bacteria of the mouth
virulence factors?
strep mutants (viridans group)
(alpha hemolytic, optochin resistant)
virulence: adhesin like surface proteins (AgI/II) that are capable of binding to receptors in the pellicle
Glucosyltransferases - synthesize glucans, a polysaccharide that gives S, mutans additional binding sites, as it binds avidly and in large numbers to these polymers.
some keystone pathogens in peridontal disease
porphyromonas gingivalis
ludwig’s angina
skin infection on floor of the mouth, usually results from untreated dental infections. Swelling of infected area may block the airway or prevent swallowing of saliva
can see REDNESS OF NECK
a number of different bacteria can cause it. one bacteria may initiate and opportunistic bacteria invade
topical treatment for oral candidiasis
clotrimazole lozenge and nystatin suspension (swish and swallow)
virulence factors of H pylori
VacA: Pore forming cytotoxin that allows leakage of Ca from the epithelial cells of the gut - VACuumes all the calcium out
CagA: Type 4 secretion system is a needle that the bacteria use to inject CagA into the host cytosol, which affects the proliferative activities, adhesion, and cytoskeletal organization of epithelial cells. potentially assc with inactivation of tumor suppressor proteins. this system is HIGHLY PROINFLAMMATORY.
plicae circularis
in the small intestine, end at the illium
does the muscularis mucosae extend in to the villus?
na
difference between the villi and the plicae
villi are lined with all mucosal layer
plica are folds of submucosa
brunner’s glands
what do they do
where are they
secrete alkaline mucus into lumen of duodenum, neutralize chyme
in submucosa and lamina propria
peyers patches
aggregates of lymphatic nodules in the ileum
produce IgA
m-cells
in epithelium above patches(endocycytose antigen and transport it to underlying peyers patches)
in ileum
acinar ducts
ducts in the pancreas - entirely serous
this means they secrete enzymes - these enzymes help break down stuff in the gut (they make zymogens aka enzyme precursors)
inside is very eosinophillic, outside is basophillic
which has the more prominent capsule - parotid or pancreas
parotid
also lobules and interlobules or more easily seen in parotid
where do you see rokitansky aschodd sinuses
in the gall bladder
what has a very tall columnar epithelium
the gall bladder
fructose transporter protein
GLUT 5
function of GLUT 2
on the basolateral membrane of enterocytes.
transports monosaccharides into the blood
how to you make trypsin in the intestine
trypsinogen is converted to it by enteropeptidase
how do the enterocytes absorbe peptides
cotransported through PEPT1 with H+
how are amino acids transported into the enterocyts
cotransported with sodium (secondary active transport because of NaK ATPase)
what cells secrete pepsin and lipase
chief cells
which also secrete pepsinogen
why is lipase not overactive in the pancreas but it works in the lumen
colipase is only active in the lumen, and it is what allows lipase to bind to fat droplets and start cleaving
olestra
indigestible fat, too big to be absorbed
steatorrhea
fatty stool
orlistat
pancreatic lipase inhibitor
can cause weight loss, but most people on it get steatorrhea and cramping
can cause vitamin a,d,e,k deff.
what separates the mucosa from the submucosa in the intestine
muscularis mucosae (thin layer of smooth muscle)
submucosal (meissner’s) plexi
in the submucosa (duh)
largely comprised of parasympathetic post-ganglionic cell bodies, pre- and post-ganglionic parasympathetic fibers, and post ganglionic (duh) sympathetic fibers
Rokitansky-Aschoff
sinuses of rokitansky aschoff are large outpocketings in the main lumen of the GALL BLADDER
labss in pancreatitis
amylase and lipase elevated
lipase is more sensitive and specific
lipase will not show up in chronic pancreatitis
increased WBC left shift increased glucose dehydration LDH/AST up Ca down albumin down O2 down
look for swelling and inflammation on CT
erosion vs ulceration
ulceration go past the mucosa into the submucosa or further
organism that can cause gastritis that has a resevoir in cats, dogs, pigs, etc
helicobacter heilmannii - still use that diff-quick blue stain shit that isn’t in FA
“chronic atrophic gastritis”
usually this refers to autoimmune gastritis
most common metastatic tumors to the peritoneum
ovarian and pancreatic carcinoma
idiopathic retroperitoneal fibrosis
dense fibrosing process that can result in renal failure due to ureteral obstruction
can see calcification of the aorts
when do ya get spoon nails
plummer-vinson syndrome
List the three most common types of infectious esophagitis that can occur in immunocompromised patients.
Candida
herpes simplex
CMV
esophageal mucosa shows burrows, concentric rings, and is studded with whitish-gray nodular plaques
biopsy shows marked reactive squamous hyperplasia
patient is allergic to stuff in the stem probs
what other cells are you looking for and what is the likely diagnosis
eosinophilic esophagitis
only 40-50% of them show mild levels of eosinophils
EGFR amplification: what cancer of the upper gi system
adenocarcinoma
most common benign mesenchymal tumor of the esophagus
leiomyoma
menetrier’s
excessive secretion of transforming growth factor alpha (TGF-alpha) Diffuse hyperplasia of foveolar epithelium of the body and fundus of the stomach. Patients also experience protein losing enteropathy and hypoproteinemia, with diarrhea, weight loss, and peripheral edema. Some cases of Menetrier’s disease are associated with an infection (e.g. CMV in children).
at risk for gastric adenocarcinoma
what is a gastrinoma
causes what syndrome
neuroendocrine tumor most commonly found in the pancreas and small bowel, can cause increased gastrin secretion (zollinger-ellison)
assc with MEN type I
FAP causes what type of stomach polyp
cystic fundic gland (also caused by PPIs) and gastric adenoma
also is associated with gastric adenocarcinoma
Mesenchymal polypoid proliferation composed of a mixture of stromal spindle cells, small blood vessels, and inflammatory cells, particularly eosinophils.
inflammatory fibroid polyp
tumor in the stomach (usually) that has a gain of function mutation of the gene encoding receptor tyrosine kinase KIT
GIST
cells differentiate towards interstitial cells of Cajal.
can also have mutations that activate a receptor tyrosine kinase called platelet-derived growth factor receptor alpha
imatinib used for what gastric thing
GIST
imatinib is a tyrosine kinase inhibitor
neutrophil count in ascitic fluid that indicates infection
250/ml
microbes that cause carries vs ones that cause gingivitis
which are gram +? -?
carries = positive
peridontal disease = negative
azole mech
block production of ergosterol and causes an accululation of toxic sterols, causing membrane stress
block the enzyme lanosterol demethylase
thing that can treat peptic ulcer disease that can precipitate abortion
misoprostol
drug used for peptic ulcers that can cause gynecomastia
cimetidine, an H2 blocker
also inhibits CYPs (“cimminon” rolls in mneumonic)
antibiotic used for h pylori that causes anorexia, nausia, vom, diarrhea
clarithromycin
diclofenac
what is it
what is it given with sometimes to prevent a stomach thing
NSAID
given with misoprostol (PGE analogue) to stop it from causing ulcers
sucralfate
Sucralfate is a sucrose sulfate-aluminium complex that binds to the ulcer, creating a physical barrier that protects the gastrointestinal tract from stomach acid and prevents the degradation of mucus. It also promotes bicarbonate production and acts like an acid buffer with cytoprotective properties.
can be given in the ICU for stress ulcers
class of clarithromycin
macrolide, binds 50s subunit
drugs that cause anorexia, blurred vision, constipation, confusion, dry mouth, sedation
atropine, pirenzipine
the antimuscarinics (M1 blockers)
blocks acid secretion in the stomach
-tidine
which one inhibits cyp450, what SE does it have
H2 blocker
cimetidine - gynecomastia, impotence in males, galactorrhea in females
antacid that causes constipation?
which causes diarrhea?
aluminum - aluminimum amount of feces
magnesium - osmotic diarrgea
which antacid causes mild alkalosis? which can cause severe alkalosis? Milk-alkali syndrome?
calcium carbonate - mild systemic alkalosis
sodium bicarbonate - severe metabolic alkalosis
both cause milk alkali syndrome (hypercalcemia with impaired renal function if taken with dairy products
what is sucralfate
what can’t you take it with and why
acid in stomach converts it to a paste –> sticks to ulcer like a band-aid
requires acidic environment (can’t give with PPIs or H2 blockers)
esomeprazole vs omeprazole
some people are poor metabolizers (CYP2C19) of omeprazole, so they use esomeprazole
esomeprazole is the same active ingredient, but the stereochemistry is different and doesn’t need to be activated as much
bradycardia and hypotension
what ulcer treatment drug
H2 blocker
tidines
confusion, hallucinations, agitation
what ulcer treatment drug
H2 blockers
tidines
DOC in zollinger-ellison to stop acid secretion
PPI
what is the secretin test and what is it used for
give secretin to the patient to stimulate bicarb release from the pancreas
in a normal patient, the pH would go up
in a ZE syndrome patient, the pH stays low
PPIs interfere with the secretin test, causing a false neg in ZE syndrome
what drug used for h pylori SHOULD be taken with a meal
tetracycline
what does monitor peptide do
it and CCK-RP cause release of CCK from I cells into the blood
these are shut off when trypsin cleaves them
function of GLP-1
released from what cells
secreted from intestinal L cells, causes increased insulin and decreased glucagon with glucose is ingested
Gliptins increase it’s stability
IgG4 related disease we talked about
type 1 autoimmune pancreatitis
