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37 Cards in this Set
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- Back
What is the function of pancreatic ductal cells?
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Modify the initial pancreatic secretions by secreting HC03- (to neutralize acidic chyme in the duodenum) and absorbing Cl (via a Cl- -HC03- exchange)
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What prompts the release of secretin by the S cells of the duodenum?
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H+ in the duodenal lumen
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Which pancreatic cells does secretin act upon?
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Ductal cells which secrete HC03-
Thus acid delivered to the duodenum from stomach prompts secretin release; which tells pancreas to release HC03 into the duodenal lumen to neutralize the H+ |
Which hormone prompts the release of zymogens (amylase, lipases, proteases) from pancreatic acinar cells?
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CCK
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Which duodenal cells release CCK to act on pancreatic acinar cells?
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I cells
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Where in the GI tract are bile salts absorbed?
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Ileum
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Where in the GI tract is vitamin B12 joined with intrinsic factor absorbed?
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Ileum
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Which enzyme activates trypsinogen?
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Enterokinase/enteropepdidase
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What is the time difference between acute and chronic diarrhea?
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Acute = 1-3 days
Chronic = weeks-months |
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What does the diarrhea look like if there is GI inflammation?
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Exudative diarrhea; presence of blood or pus in stool
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Where does the diarrhea look like if the diarrhea is water?
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Secretory (increased secretion or inhibited absorption) ex; cholera
Osmotic: result of maldigestion when nutrients in lumen pull water from cells |
Which infectious enterocolitis organism invades and destroys mucosal epithelial cells, producing bloody, purulent and painful exudative diarrhea?
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Shigella
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Which organism makes toxins which can cause water or bloody secretory diarrhea?
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Enterotoxigenic E. Coli (ETEC); traveler's diarrhea
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Which organism makes preformed toxins which cause explosive, water, secretory diarrhea?
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Staphylococcus aureus and vibrios
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What is the histology of osmotic diarrhea?
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Mucosa functions and looks normal
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What kind of diarrhea is characterized by a reduction during fasting?
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Osmotic diarrhea; there are no nutrients in the lumen to pull water from the cells inwards
ex; lactose intolerance |
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Which enzyme is missing in lactose intolerance?
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Lactase; can't break down lactose so it stays in lumen, pulling water into lumen and causing osmotic diarrhea
Lactose tolerance test = give dairy product to see if pt gets diarrhea; see if diarrhea stops after removal of dairy product |
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What kind of morphological findings would you find in a lactose intolerant patient with osmotic diarrhea?
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No morphologic abnormalities seen on imaging studies, in the mucosa, or in the mucosal epithelial cells
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A patient presents with painless abdominal discomfort and exudative diarrhea. Endoscopy is notable for GI inflammation.
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Ulcerative Colitis; only effects mucosa so doesn't mess with nerves and is painless
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Which parts of the GI tract does ulcerative colitis involve?
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Starts in rectal mucosa and progresses to proximal large intestine; leads to ulcers and mucosa damage with frequent diarrhea with mucus and blood
ONLY involves inner mucosal and submucosal layers |
A patient presents with PAINFUL exudative diarrhea. Endoscopy reveals terminal ileum inflammation.
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Chron's Disease; inflammation involves entire bowel wall, irritates bowel wall nerves and produces pain (Ulcerative Colitis is usually painless)
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What are the two types of inflammatory bowel diseases?
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Chron's Disease (painful)
Ulcerative Colitis (painless) |
Which inflammatory bowel disease mimics acute appendicitis with its right lower quadrant abdominal pain?
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Chron's Disease
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What is the notable radiographic and endoscopic appearance of Chron's disease?
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'cobblestone' appearance of the ascending and transverse colon
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What is the notable endoscopic apperance of ulcerative colitis?
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Extensive ulceration of the mucosa with pseudopolys
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What is the significant of "a fat granny and an old crone skipping down a cobblestone road away from the wreck"
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Chron's disease; skip lesions; wall appearance = thick w/ cobblestone appearance; granulomas present; wreck = rectal sparing
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What is the primary suceptibility gene for Chron's disease?
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NOD2/CARD15 - intracellular pathogen recognition receptor
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Which disease is characterized by abdominal discomfort in the absence of any detectable cause; relived by defecation through diarrhea or constipation or both
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Irritable Bowel Syndrome; functional bowel motility disorder
Often related to stress (jimmy!) |
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A patient presents with abdominal distension, vomiting, diarrhea, weight loss, and fatigue AFTER ingestion of gliadin containing products.
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Celiac Sprue
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What are the notable endoscopic findings in gluten-sensitive enteropathy (celiac sprue)?
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Scalloping of the small bowel folds; mosaic pattern to the mucosa (cracked mud appearance); promiennce of submucosa blood vessels
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What happens to the cryps of Lieberkuhn in celiac sprue?
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Proliferation so crypts get filled in; partial or complete villous atrophy
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What serum autoantibodies would you expect to find in celiac disease?
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Autoantibodies to gluten (gliadin) in wheat and other grains
IgA Ab to endomysium AutoAb to transtglutaminase 2 |
A patient presents with diarrhea, steatorrhea, abdominal pain, weight loss, arthralgias, CNS and cardiac problems. Tissue biopsy reveals presence of a PAS-positive macrophages containing bacilli.
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Whipple's Disease; caused by gram positive bacillus Tropheryma whipplei; presence outside macrophages is indicator of active disease
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Which organism causes whipple's disease?
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Tropheryma whippeli (gram positive); infects villi and blunts them
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What causes diarrhea in whipples disease?
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Infection with t. whipplei results in intestinal sores and thickening of villi (club like appearance due to infection); damaged intestinal lining fails to properly absorb nutrients causing diarrhea and malnutrition
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How do you treat eosinophilic gastroenteritis (EG)?
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After definitive diagnosis with eonsinophilic infiltration of biopsy tissue (20 eosinophils per high power field), tx with corticosteroids
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What is the most common cause of intraluminal bile salt deficiency resulting in malabsorption with steatorrhea?
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Gallbladder stones
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