G Cells:

produces gastrin

Chief Cells:

produce pepsinogen and gastric lipase

Parietal Cells:

produce HCL (hydrochloric acid) and intrinsic factor

Mucous Cells:

produce mucus

In the small intestine what helps create a large surface area for absorption?

Villi

The enzymes that metabolize the food in the small intestine are located in the:

brush border

Are the Brunner’s Glands alkaline or acidic? What is their purpose?

• Alkaline
• they help coat and protect the small intense from the acid of the stomach

What is the purpose of the Goblet Cells in the stomach?

Produce mucus for a second layer of protection to small intestine

What ensures FORWARD flow of stomach contents?

Ileocecal valve (prevents backflow)

Does the large intestine have villi?

NO

What two things are absorbed in large intestines?

Water and electrolytes

Where is the skeletal muscle in the GI tract located? (PEMA)

• mouth
• proximal
• esophagus
• anus

The autonomic nervous system has a sympathetic and parasympathetic component. In the GI tract know what nervous system plays what role

Sympathetic does:

• inhibits gastric secretions
• helps with motor activity

Parasympathetic does:

• helps with digestion, repair
• relaxation via the cranial, vagus nerves

When the body needs to improve digestion will it contract or relax the muscles in the GI tract?

Relax the muscles to allow improve movement

What enzyme is found in the small intestine?

What produced this enzyme?

• Pancreatic amylase
• pancreas

Where are amino acids broken down?

• Stomach
• intestines

Carbohydrates are absorbed back as:

Proteins are absorbed as:

• monosaccharides
• amino acids

If a patient is absorbing a lot of water and becoming overloaded, they will likely also have high levels of ______.

sodium

Dysphagia:

difficulty swallowing food due to neuromuscular incoordination, altered peristalsis esophagus or LES (lower esophageal sphincter) dysfunction.

Reverse peristalsis can eventually lead to:

Mallory-Weiss syndrome, GERD

This is interesting… intestinal gas comes from:

• swallowed air
• bacterial fermentation releasing gas
• lack of mobility

What is the definition of stomatitis?

• inflammation of the mouth and lips from (trauma, alcohol, smoking, drugs, radiation, chemo, herpes etc)

Mallory-Weiss syndrome commonly occurs in:

alcoholics

GERD symptoms are often mistaken for the symptoms of:

heart attack

Gastritis:

• inflammation of the lining of the stomach

(from alcohol, aspirin, toxins)

Gastroenteritis:

• inflammation of the lining of the intestines from bacteria, parasites from a virus (common: salmonella)

Ulcerative Colitis:

• inflammation of the rectum and colon, turning to abscesses and ulceration, can progress to cancer

What is the most common abdominal emergency surgery a result of?

appendicitis

How does peptic ulcer disease occur? What becomes damaged?

• Painful sores in the lining of the stomach, mucus that is supposed to protect the lining from the acid fails.
• Strips mucus: aspirin, alcohol, bile from duodenum

Three examples of mechanical obstruction of GI tract motility include:

• Adhesions
• Tumors
• Twisting
• Ileus (from surgery or trauma/external cause)

When the mucus lining in the GI tract is damaged this can lead to malabsorption of nutrient. This commonly occurs in patients with these diseases:

• Crohn’s disease (inflammatory bowel disease (IBD) causes swelling of tissues in digestive tract)
• Celiac disease (mucosa damages, pt develops intolerance to gluten)
• Tropical sprue (bacteria picked up from tropical climates, reduce enzymes in mucus, leaving it unable to develop properly)

Why is malabsorption post surgery so common? Are we damaging the lining like in the case of the other 3 disorders?

• Resections of specific parts of GI (stomach, large, small intestines), removing cilia, and all things that help you absorb, limiting space and capability of that organ to absorb once did.
• No we are not damaging the lining
• Solution- have patient eat smaller meals, to be better digested and properly absorbed

What is a good indication of being at risk for colon cancer?

• When patient has other colonic related issues like Crohn’s, polyps, ulcerative colitis- more susceptible to develop cancer from chronic damage

Tumors are likely to grow where in Japanese patients?

Gastric

Chronic damage to the colon from Crohn’s, polyps and ulcerative colitis can lead to:

colon cancer

What are the three functions of bile?

• Aids in lipid digestion
• Bilirubin transport
• Cholesterol transport

What is the primary function of the gallbladder?

Store bile

What stimulates the release of bile in the gallbladder?

cholecystokinin

What two functions does the pancreas have?

Exocrine function:

Endocrine function:

• Exocrine function: enzymes help with digestion
• Endocrine function: hormones to regulate blood glucose (insulin, glucagon)

What is the proper term for gallstones?

Cholelithiasis

Inflammation of the gallbladder is called:

Cholecystitis (pts have abdominal pain, problems digesting fatty foods)

Inflammation of the gallbladder is most common in:

• Obese
• Pregnant women

What is the term for abdominal pain resulting from a gallstone blocking the bile duct?

biliary colic

Are cholesterol gallstones typically soft or hard?

Soft, because they are made of cholesterol.

Two treatment options for gallstones:

• Dissolve with bile salts
• Lithotripsy not as effective

Best diagnostic test to visualize gallstones:

ultrasound

Two causes of acute pancreatitis:

• Alcoholism (most common)
• Biliary tract disease

For a patient with a severe case of acute pancreatitis it can lead to necrosis of the tissue. Lead to spread of bacterial infections Treatment options here is to ‘clean-up’:

• Debridement (remove dead tissue)
• Peritoneal lavage (remove any fluid/bacterial mess in area of infection)

What is our concern with a pseudocyst as a result of acute pancreatitis?

• It could rupture and bacterial travels into other parts of GI tract

What does ERCP stand for?

• Endoscopic retrograde cholangiopancreatography
• It is not only used for diagnostic imaging but also to administer treatments.

Two findings that differentiate a patient having chronic pancreatitis versus acute include:

• Calcification
• Parenchyma will be damaged, fibrosis will occur from scarring

Many patients with chronic pancreatitis will also develop other diseases and symptoms:

• Diabetes mellitus
• Malabsorption
• Weight loss (from malabsorption)
• Vitamin Deficiencies (from malabsorption

What are tell-tale signs of chronic pancreatitis on x-ray?

• Calcium, bone on x-ray, so in these patients you see calcifications will show up on abdominal x-ray

What is the purpose of a sphincterotomy?

What disease does it help treat?

• Enlarge bile or pancreatic opening
• Treat diabetes, pain, and inflammation

What covers and protects the liver?

Visceral Peritoneum

The liver can function at _______% capacity.

30

Hepatic disease often occurs secondary to:

• CHF
• Cancer
• Alcoholism
• infections

The liver has three hematologic/regulatory functions including:

• can temporarily store blood
• synthesize bilirubin
• synthesizes blood clotting factors

The liver also has excretory functions that can help

• excrete bile pigment
• cholesterol
• helps detox the body from drugs and other foreign substances

Jaundice is:

And occurs due to high levels of:

yellowing of the skin, whites of eyes and membranes

bilirubin

Damage to the liver causes patients to poorly absorb the following vitamins:

• A
• D
• E
• K

What supplies most of the blood to the liver? What is the disease process associated with it?

• Portal vein- supplies blood to liver
• Portal systemic encephalopathy: pts confused or vegetated/comatose from high ammonia levels

High ammonia levels as a result of liver disease can lead to: Portal systemic encephalopathy

These patients are often:

• Vegetated
• comatose

There are many types of Hepatitis but let’s focus on three and their routes of transmission:

• Hepatitis A:
• Hepatitis B:
• Hepatitis C:

• Hepatitis A: (HAV) found in feces of infected people
• Hepatitis B: (HBV) spread through infected body fluids
• Hepatitis C: (HCV) most serious type, spreads through blood

Which type of chronic hepatitis is the most progressive and destructive?

• Chronic active- leads to cirrhosis

In alcohol related Liver Disease patients often have a ______ liver.

Fatty

Hemochromatosis is high __________ absorption.

Wilson’s Disease is high ___________ levels.

iron

copper

What over the counter drug is known to cause the most damage to the liver?

Tylenol

Is liver transplant a common treatment option for liver cancer patients?

No

Why is liver resection commonly practiced and an optimal treatment option?

• Cuts off blood supply to the tumor

Role of hormones in the body. They help to:

• Reproduce
• Grow and develop
• Maintain homeostasis
• Produce energy for body via metabolism

What are three categories of hormones?

• Amines (Thyroid, catecholamines)
• Peptides (ANH (atrial natriuretic hormone) from atrium of heart, growth hormone, LH, FSH, insulin/glucagon, vasopressin/oxytocin)
• Steroids (sex hormones, corticosterone, aldosterone, vitamin D)

Describe specificity versus affinity in relation to hormones:

• Specificity:
• Affinity:

• Specificity: receptor matches the hormone
• Affinity: the strength of the bon to the hormone is strong

Describe up regulation versus down regulation of cells:

• Up regulation:
• Down Regulation:

• Up regulation: cell produces MORE receptors to pick up more hormone
• Down Regulation: the cell reduces amount of receptors, reduce it’s specificity (remember the more receptors, the higher specificity- less receptors, lower the specificity)

What is an example of hormones that practice permissiveness?

• Estrogen
• Progesterone
• Most effective together, the more estrogen, the more receptors a cell develops for progesterone

What is a gland responsible for the production and release of the most hormones?

• Pituitary gland

What TWO hormones are produced by the hypothalamus?

Where are these hormones then stored?

• Vasopressin (anti diuretic hormone)
• Oxytocin (contractions during labor, milk excretion from breasts)
• Posterior pituitary gland

Metabolism is the balance between __________ and __________.

anabolism

catabolism

Examples of anabolism (building of molecules, is constructive) include:

• Rest
• Healing
• Growth
• pregnancy

Examples of catabolism (breaking down of molecules, is destructive) include:

• stress
• disease
• fever
• starvation

The largest increase in basal metabolic rate occurs during:

• pregnancy 20-28% due to stress and demand on body

Is it normal for BMR to reduce as you age?

• Yes declines 2% per decade as you age

What is your body’s main energy source?

• Carbs (metabolized into glucose, which is ‘basic’ and simple energy source)

What supplies 2/3 of all cell’s energy requirements?

• Fats (all tissues use fat for energy (except brain cells), turn to adipose tissue when not metabolized)

How many amino acids are there in total?

How many are essential?

22

8

Why does skeletal muscle mass reduce as you age?

• Reduction in capability of synthesizing proteins