A Focus on the GI Pathologies:Intestinal and gallbladder pathologies ppt
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Questions and Answers

What is the primary function of the Brunner's glands in the superior duodenum?

  • Neutralizing acidic chyme with mucous and bicarbonate (correct)
  • Releasing hormonal triggers for the gallbladder and pancreas
  • Producing enzymes for protein digestion
  • Regulating the flow of bile into the duodenum

    • Which part of the duodenum is most commonly associated with duodenal ulcers?

  • Horizontal portion
  • Ascending portion
  • Superior portion (correct)
  • Descending portion

    • What is the function of the spleen in infection control?

  • Filtering out bacteria from the circulation
  • Recognizing and eliminating infected red blood cells (correct)
  • Activating complement proteins to fight infection
  • Producing antibodies against specific pathogens

    • What is the primary site of delivery for the stomach contents?

    <p>Duodenum</p> Signup and view all the answers

    What is the main function of the duodenum in digestion?

    <p>Chemical digestion of all macronutrients</p> Signup and view all the answers

    What is the anatomical feature of the duodenum that distinguishes it from the jejunum and ileum?

    <p>Retroperitoneal location</p> Signup and view all the answers

    What is the primary function of Brunner's glands in the duodenum?

    <p>Release bicarbonate and mucous to neutralize high-pH chyme</p> Signup and view all the answers

    What is the term for organs located behind the parietal peritoneum, without a mesentery?

    <p>Retroperitoneal</p> Signup and view all the answers

    What is the name of the duct that drains a portion of the head of the pancreas?

    <p>Ampulla of Santorini</p> Signup and view all the answers

    What are the enzymes produced by the exocrine cells of the pancreas typically released in?

    <p>Inactive form</p> Signup and view all the answers

    Where is pancreatic pain typically felt?

    <p>Mid-epigastric and back</p> Signup and view all the answers

    What can cause pancreatic injury and/or pain if a duct is blocked?

    <p>Zymogens are activated in the pancreas</p> Signup and view all the answers

    What is the term for inflammation of the pancreas?

    <p>Pancreatitis</p> Signup and view all the answers

    What is the job of the gallbladder?

    <p>Storing bile made by the liver</p> Signup and view all the answers

    What is the type of epithelium found in the mucosa of the gallbladder?

    <p>Simple columnar epithelium</p> Signup and view all the answers

    What type of symptoms might one have after a cholecystectomy?

    <p>All of the above</p> Signup and view all the answers

    What is the primary composition of cholesterol gallstones?

    <p>Bile salts and cholesterol</p> Signup and view all the answers

    What is the term for the liquid bile salts that are either more highly concentrated than normal or less motile than normal?

    <p>Gallbladder sludge</p> Signup and view all the answers

    What is the main reason why estrogen increases the incidence of gallstones?

    <p>It increases cholesterol composition of bile</p> Signup and view all the answers

    What is the term for the phenomenon where the gallbladder is unable to empty properly, leading to bacterial overgrowth and inflammation?

    <p>Gallbladder stasis</p> Signup and view all the answers

    What is the term for the inability to break down lactose into glucose and galactose?

    <p>Lactose intolerance</p> Signup and view all the answers

    What is the term for the phenomenon where food moves too quickly from the stomach into the small intestine, leading to diarrhea and cramping?

    <p>Dumping syndrome</p> Signup and view all the answers

    What is the term for the process by which bile salts emulsify fats, making them absorbable?

    <p>Emulsification</p> Signup and view all the answers

    What is the term for the removal of portions of the GI tract, leading to malabsorption?

    <p>Gastrointestinal resection</p> Signup and view all the answers

    What is the term for the inflammation of the intestine or colon, leading to malabsorption?

    <p>Crohn's disease</p> Signup and view all the answers

    What is the term for the phenomenon where the body is unable to absorb fats, leading to fatty stools and weight loss?

    <p>Steatorrhea</p> Signup and view all the answers

    What is the primary goal of giving a somatostatin agonist to a patient with dumping syndrome?

    <p>To inhibit insulin release and slow intestinal transit time</p> Signup and view all the answers

    What is the main characteristic of ulcerative colitis?

    <p>Continuous lesions limited to the mucosa</p> Signup and view all the answers

    What is the most common complication of mechanical bowel obstruction?

    <p>Perforation of the bowel wall</p> Signup and view all the answers

    What is the primary mechanism of constipation?

    <p>Prolonged transit time of feces in the colon</p> Signup and view all the answers

    What is the primary difference between ulcerative colitis and Crohn disease?

    <p>Location of lesions in the GI tract</p> Signup and view all the answers

    What is the primary complication of fecal impaction?

    <p>Peritonitis</p> Signup and view all the answers

    What is the primary mechanism of inflammatory bowel disease?

    <p>All of the above</p> Signup and view all the answers

    What is the primary treatment for dumping syndrome?

    <p>All of the above</p> Signup and view all the answers

    What is the primary difference between normal transit constipation and slow-transit constipation?

    <p>Impaired colonic motor activity</p> Signup and view all the answers

    What is the primary characteristic of Crohn disease?

    <p>Multilayer lesions in the small intestine</p> Signup and view all the answers

    Which type of diarrhea is caused by the inhibition of net sodium absorption or excessive mucosal secretion of chloride or bicarbonate-rich fluid?

    <p>Secretory diarrhea</p> Signup and view all the answers

    What is the primary complication of intestinal inflammation?

    <p>All of the above</p> Signup and view all the answers

    What is the primary goal of treatment for diarrhea?

    <p>Restore fluid and electrolyte balance</p> Signup and view all the answers

    What is the name of the condition characterized by out-pouchings of colonic mucosa through weakened areas in the muscular wall of the large intestine?

    <p>Diverticulosis</p> Signup and view all the answers

    What is the name of the medication that is an opiate and is used to treat diarrhea?

    <p>Loperamide</p> Signup and view all the answers

    What is the name of the condition characterized by inflammation of an out-pouching, usually caused by bits of fecal material trapped within the opening of the out-pouchings?

    <p>Diverticulitis</p> Signup and view all the answers

    Study Notes

    Foregut

    • The spleen is not part of the GI system, but it plays a crucial role in:
      • Early hematopoiesis
      • Mechanical filtration of aging/injured erythrocytes
      • Infection control, effective against pathogens within RBCs, like Malaria
      • Clearance of bacteria from the circulation
      • Clearance of microorganisms that the individual hasn't made a specific host antibody against

    Duodenum

    • The duodenum is the site of delivery for the stomach, pancreas, liver, and gallbladder
    • Acidic chyme from the stomach must be neutralized in the duodenum to prevent:
      • Duodenal ulcer, most commonly occurring in the superior portion
    • The duodenum is responsible for:
      • All types of digestion (protein, carbs, fats, nucleic acids)
      • A large part of digestion, while other areas focus on absorption
    • Anatomic features of the duodenum:
      • Shortest segment of the small intestine
      • Starts at the pyloric sphincter and ends at the Ligament of Treitz
      • Almost completely retroperitoneal, not freely mobile in the abdominal cavity
      • The pancreatic head nestles within its "C" curve
    • Segments of the duodenum:
      • Superior: releases hormonal triggers for the gallbladder and pancreas
      • Descending: pancreatic duct and common bile duct empty here
      • Horizontal: digestion occurs here; crosses the IVC and aorta
      • Ascending: continued digestion; connects to the jejunum
    • Brunner's glands:
      • Unique to the proximal duodenum
      • Release bicarbonate and mucous to neutralize chyme
      • Rapidly neutralize high-pH chyme to protect the intestinal mucosa and enable intestinal enzymes to function
      • Also secrete urogastrone, which inhibits the stomach's chief cells and parietal cells

    Pancreas

    • The pancreas has both exocrine and endocrine functions
    • It is retroperitoneal, arising from the wall of the duodenum
    • Located mainly at L2, with parts including:
      • Head
      • Neck
      • Body
      • Tail
    • The pancreatic ducts:
      • The main pancreatic duct runs the entire length of the pancreas
      • Empties its exocrine products at the Ampulla of Vater, where it joins the common bile duct
      • A portion of the head of the pancreas usually drains via a different duct (the accessory pancreatic duct) at the Ampulla of Santorini
    • Pancreatic juice:
      • A secretion of pancreatic enzymes in a clear alkaline medium
      • Enzymes produced by the exocrine cells of the pancreas
      • Alkaline mucous liquid from the pancreatic ductal cells
      • Flows to the duodenum via the pancreatic duct system
      • Enzymes typically released in inactive form and activated by membrane-bound activators in the duodenum
    • Pancreatic pain:
      • May be felt in the mid-epigastric region (foregut) and/or the back due to the retroperitoneal location
      • Can be caused by zymogens (pre-enzymes) of the pancreas activating early and causing tissue damage

    Pancreatitis

    • Inflammation of the pancreas
    • Can occur when:
      • A duct is blocked, causing zymogens to activate early and cause tissue damage
      • Enzymes are activated prior to arriving at the duodenum
      • Secondary to infection, trauma, or pancreatic carcinoma
    • Symptoms of pancreatitis:
      • Portions of the pancreas can autolyze (auto-digest)
      • Cellular damage causes pancreatic enzymes to escape into the bloodstream at higher-than-normal rates
      • Elevated amylase and lipase are markers for pancreatitis

    Gallbladder

    • The gallbladder's primary function is to store bile made by the liver and release it when needed
    • Histology of the gallbladder:
      • Mucosa with folds to allow for enlargement
      • Simple columnar epithelium
      • Lots of mucosal folds to enable enlargement and shrinkage
      • Muscularis externa for contractions
      • Adventitia to hold the gallbladder in place
    • The normal biliary tree:
      • Bile exits the liver via the left and right hepatic ducts
      • Bile can travel into the gallbladder via the cystic duct
      • Bile leaves the gallbladder via the cystic duct and enters the common bile duct
      • There is only one way into and out of the gallbladder
      • The gallbladder and pancreas share the same exit point (Sphincter of Oddi) into the duodenum

    Gallbladder Problems

    • Most common problems:
      • Duct blockage
      • Inflammation
      • Infection
    • Symptoms after a cholecystectomy:
      • Fatty stools
      • Poor tolerance of high-fat meals
      • Dyspepsia
      • Nausea and vomiting

    Cholelithiasis

    • Gallstones are crystallized/packed/solidified stones of gallbladder content
    • Typically made of bile salts, cholesterol, and other substances
    • Pathogenesis of cholesterol gallstones:
      • More cholesterol in bile than can be dissolved
      • Bile in stasis for longer than normal
      • "Gallbladder sludge" increases the risk of gallstones
      • Decreased gallbladder motility, often caused by estrogen, increases the risk of gallstones
      • Pregnancy increases the incidence of gallstones

    Inflammatory Bowel Disease

    • Chronic, relapsing/recurring bowel inflammation of unknown origin
    • Genetics: familial, most commonly diagnosed in those 20 to 40 years old
    • Pathophysiology:
      • Alterations of epithelial barrier functions
      • Immune system reactions to intestinal flora
      • Abnormal T-cell responses
      • Presence of autoantibodies
    • Two main types:
      • Ulcerative colitis
      • Crohn disease

    Ulcerative Colitis

    • A chronic inflammatory disease that causes ulceration of the colonic mucosa
    • Sigmoid colon and rectum are most commonly affected
    • Characteristic lesions:
      • Continuous with no skipped lesions
      • Limited to the mucosa
      • Not transmural
    • Diarrhea (10 to 20 bowel movements per day)
    • Bloody stools
    • Cramps
    • Increased risk for colon cancer

    Crohn Disease

    • Granulomatous inflammation of the GI tract
    • Can affect any part of the digestive tract
    • Lesions:
      • Cobblestone appearance
      • Multilayer
      • Transmural
    • Abdominal pain and diarrhea are the most common signs
    • More than five stools per day
    • Anemia may develop due to malabsorption of vitamin B12 and folic acid

    Mechanical Bowel Obstruction

    • Blockage in the small or large bowel
    • Small bowel contents cannot travel "downstream"
    • Risk factors:
      • Prior surgery
      • Presence of carcinoma
      • Diseases causing gut inflammation/stricture (like IBD)
      • Volvulus and intussusception
    • Clinical manifestations:
      • Gas/chyme builds up and the bowel distends
      • Venous flow in the GI wall slows
      • Arterial flow slows
      • Bowel wall starts to die
      • Edema and bacteria escape from the bowel into the peritoneum
      • Peritonitis and bowel perforation are common

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    Description

    This quiz covers the functions of the spleen and the different parts of the duodenum, including their roles in digestion and infection control.

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