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Questions and Answers
Which biochemical test is often used to diagnose defective absorption of dietary fat?
Which biochemical test is often used to diagnose defective absorption of dietary fat?
- Iron (Fe+2) and Ferritin
- Serum albumin
- Xylose absorption rate
- Faecal fat estimation (correct)
What condition may bacterial growth in the small intestine cause?
What condition may bacterial growth in the small intestine cause?
- Enhanced protein absorption
- Increased plasma cholesterol levels
- Functional deficiency of bile secretion (correct)
- Decreased plasma glucose levels
In the case of biliary obstruction, what is the likely result for faecal fat estimation?
In the case of biliary obstruction, what is the likely result for faecal fat estimation?
- Not indicated
- Normal
- Decreased
- Increased (correct)
Which of the following is NOT a common test used to diagnose defective intestinal absorption?
Which of the following is NOT a common test used to diagnose defective intestinal absorption?
Excessive losses into the intestinal lumen can cause a marked reduction in which protein?
Excessive losses into the intestinal lumen can cause a marked reduction in which protein?
What is the xylose absorption result in chronic pancreatitis?
What is the xylose absorption result in chronic pancreatitis?
Which enzyme is responsible for hydrolyzing lactose in the small intestine?
Which enzyme is responsible for hydrolyzing lactose in the small intestine?
What is the significance of a rise in blood glucose of less than 1.1 mmol/L in the lactose intolerance test?
What is the significance of a rise in blood glucose of less than 1.1 mmol/L in the lactose intolerance test?
What measurement is indicative of excessive fermentation of undigested lactose in the large intestine?
What measurement is indicative of excessive fermentation of undigested lactose in the large intestine?
Which disease is associated with a defect in the transport mechanism for cystine?
Which disease is associated with a defect in the transport mechanism for cystine?
What is a key symptom of protein-losing enteropathy?
What is a key symptom of protein-losing enteropathy?
Which amino acid absorption issue is specifically seen in Hartnup disease?
Which amino acid absorption issue is specifically seen in Hartnup disease?
Which cells in the stomach secrete hydrochloric acid (HCl)?
Which cells in the stomach secrete hydrochloric acid (HCl)?
Which hormone acts as a potent stimulator of gastric juice production?
Which hormone acts as a potent stimulator of gastric juice production?
What is the main effect of the pentagastrin test?
What is the main effect of the pentagastrin test?
Hyperacidity in the stomach is most commonly found in which condition?
Hyperacidity in the stomach is most commonly found in which condition?
Which type of food acts as a physiological stimulant for the release of gastrin hormone?
Which type of food acts as a physiological stimulant for the release of gastrin hormone?
What does an abnormally high level of gastric acid (HCl) above the normal range indicate?
What does an abnormally high level of gastric acid (HCl) above the normal range indicate?
Which condition is characterized by no response to administration of pentagastrin?
Which condition is characterized by no response to administration of pentagastrin?
What volume of resting gastric juice is considered normal?
What volume of resting gastric juice is considered normal?
Which hormone is responsible for enhancing the secretion of bicarbonate (HCO3) from the pancreas?
Which hormone is responsible for enhancing the secretion of bicarbonate (HCO3) from the pancreas?
In chronic pancreatitis, what would you expect the faecal fat estimation and xylose absorption rate to be?
In chronic pancreatitis, what would you expect the faecal fat estimation and xylose absorption rate to be?
Which hormone enhances the release of insulin and inhibits gastric secretion?
Which hormone enhances the release of insulin and inhibits gastric secretion?
Which of the following conditions is characterized by an increase in faecal fat estimation and a normal xylose absorption rate, but vitamin B12 absorption is not indicated?
Which of the following conditions is characterized by an increase in faecal fat estimation and a normal xylose absorption rate, but vitamin B12 absorption is not indicated?
What is the role of motilin in gastrointestinal function?
What is the role of motilin in gastrointestinal function?
In which part of the gastrointestinal tract is cholecystokinin primarily active?
In which part of the gastrointestinal tract is cholecystokinin primarily active?
Which test can be used to evaluate the efficiency of the small intestine by monitoring fat excretion?
Which test can be used to evaluate the efficiency of the small intestine by monitoring fat excretion?
What is the primary function evaluated by the Schilling test?
What is the primary function evaluated by the Schilling test?
Which of the following is NOT a typical cause of intestinal malabsorption?
Which of the following is NOT a typical cause of intestinal malabsorption?
Which test involves measuring plasma vitamin A levels before and after its administration?
Which test involves measuring plasma vitamin A levels before and after its administration?
What is a common effect of biliary disease on digestion?
What is a common effect of biliary disease on digestion?
In the context of malabsorption, which organ's dysfunction can lead to deficiencies in digestive enzymes for proteins, fats, and carbohydrates?
In the context of malabsorption, which organ's dysfunction can lead to deficiencies in digestive enzymes for proteins, fats, and carbohydrates?
Which part of the digestive system is NOT involved in the direct breakup and lubrication of food?
Which part of the digestive system is NOT involved in the direct breakup and lubrication of food?
What role does gastric HCl play in the stomach?
What role does gastric HCl play in the stomach?
Which organ is responsible for digesting polysaccharides in the mouth?
Which organ is responsible for digesting polysaccharides in the mouth?
What is one of the functions of mucin protein in the mouth?
What is one of the functions of mucin protein in the mouth?
Which part of the small intestine is the first to receive chyme from the stomach?
Which part of the small intestine is the first to receive chyme from the stomach?
Which enzyme is inhibited by gastric HCl in the stomach?
Which enzyme is inhibited by gastric HCl in the stomach?
What is indicated by the plasma gastrin level?
What is indicated by the plasma gastrin level?
In which condition is the plasma gastrin level significantly reduced?
In which condition is the plasma gastrin level significantly reduced?
Which syndrome is characterized by severe peptic ulceration and excessive HCl production?
Which syndrome is characterized by severe peptic ulceration and excessive HCl production?
What induces the secretion of pancreatic juice?
What induces the secretion of pancreatic juice?
Which of the following hormones stimulate the secretion of bicarbonate (HCO3) from the pancreas?
Which of the following hormones stimulate the secretion of bicarbonate (HCO3) from the pancreas?
Which enzyme is NOT found in pancreatic juice?
Which enzyme is NOT found in pancreatic juice?
What are the primary components of pancreatic juice?
What are the primary components of pancreatic juice?
What is a common symptom of Zollinger-Ellison syndrome due to excessive HCl production?
What is a common symptom of Zollinger-Ellison syndrome due to excessive HCl production?
What is a primary cause of chronic pancreatitis?
What is a primary cause of chronic pancreatitis?
Which enzyme's stool test has shown promise as a diagnostic tool for chronic pancreatitis?
Which enzyme's stool test has shown promise as a diagnostic tool for chronic pancreatitis?
Carcinoma of the pancreas often results in which of the following?
Carcinoma of the pancreas often results in which of the following?
Which tumor marker is most sensitive for the detection of pancreatic carcinoma?
Which tumor marker is most sensitive for the detection of pancreatic carcinoma?
Which part of the digestive system is most involved in absorption?
Which part of the digestive system is most involved in absorption?
The xylose absorption test measures the ability of the small intestine to absorb which type of molecules?
The xylose absorption test measures the ability of the small intestine to absorb which type of molecules?
In a healthy subject, what percentage of the standard dose of xylose is excreted in urine over 5 hours?
In a healthy subject, what percentage of the standard dose of xylose is excreted in urine over 5 hours?
Which of the following can lead to low xylose excretion?
Which of the following can lead to low xylose excretion?
What is a major clinical risk associated with acute pancreatitis?
What is a major clinical risk associated with acute pancreatitis?
Which enzyme's activity is usually increased more than five times in acute pancreatitis?
Which enzyme's activity is usually increased more than five times in acute pancreatitis?
What is a specific confirmatory test for the occurrence of acute pancreatitis?
What is a specific confirmatory test for the occurrence of acute pancreatitis?
Which of the following increased enzymes can indicate the presence of gall stones causing acute pancreatitis?
Which of the following increased enzymes can indicate the presence of gall stones causing acute pancreatitis?
Which of the following measures is essential in managing acute pancreatitis?
Which of the following measures is essential in managing acute pancreatitis?
What is the role of C-reactive protein measurement in the management of acute pancreatitis?
What is the role of C-reactive protein measurement in the management of acute pancreatitis?
In acute pancreatitis, what is the probable cause of methaemalalbumunemia?
In acute pancreatitis, what is the probable cause of methaemalalbumunemia?
What is a recommended method to ensure nutrition in a patient with acute pancreatitis?
What is a recommended method to ensure nutrition in a patient with acute pancreatitis?
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Study Notes
Clinical Aspects of Digestion
Diseases of the Intestinal Mucosa
- May affect digestion or transport of dietary constituents
- Can cause functional deficiency of bile secretion, interfering with vitamin B12 and fat absorption
Bacterial Growth in Small Intestine
- Causes functional deficiency of bile secretion and interferes with vitamin B12 and fat absorption
Excessive Losses into the Intestinal Lumen
- Includes gastrointestinal diseases causing water, electrolyte, and protein loss, leading to a marked reduction in plasma albumin
Clinical Tests for Intestinal Malabsorption
- Serum albumin, alkaline phosphatase, cell blood count (RBC, WBC, MCV), iron (Fe+2) and ferritin, vitamin B12, faecal fat estimation, xylose absorption rate, calcium, phosphate, folic acid, and prothrombin time (PT)
Results of Biochemical Investigation for Causes of Defective Intestinal Malabsorption
- Chronic pancreatitis: increased faecal fat estimation, normal xylose absorption rate
- Pancreatic carcinoma: increased faecal fat estimation, normal xylose absorption rate
- Biliary obstruction: increased faecal fat estimation, not indicated for xylose absorption rate
Gastrointestinal Hormones
- Gastrin: stimulates gastric secretion, produced in the stomach
- Cholecystokinin: stimulates pancreatic secretion, produced in the duodenum and jejunum
- Secretin: stimulates HCO3 secretion from the pancreas, produced in the duodenum and jejunum
- Pancreatic polypeptide: inhibits pancreatic secretion, produced in the duodenum and jejunum
- Gastrin inhibitory polypeptide (GIP): enhances insulin release and inhibits gastric secretion, produced in the duodenum and jejunum
- Vasoactive intestinal poly peptide (VIP): acts as a neurotransmitter, regulates GI motility and secretion, produced in the GI tract
- Motilin: stimulates GI motility, produced in the duodenum and jejunum
Disaccharide Absorption Test (Lactose Intolerance Test)
- Used to investigate impaired disaccharide absorption
- Measures blood glucose levels after lactose ingestion
- Normal result: blood glucose level increases by at least 1.1 mmol/L
- Lactose intolerance: blood glucose level increase is less than 1.1 mmol/L
Test of H2 Breath
- Measures H2 levels in breath to diagnose lactose deficiency
- Undigested lactose is fermented by bacteria in the colon, producing high H2 levels
The Stomach
- Gastric juice contains HCl, intrinsic factor, pepsin, and mucus
- HCl and intrinsic factor are secreted by parietal cells
- Pepsin is secreted by zymogen cells
- Mucus is secreted by cells of the pyloric antrum
- Gastric juice production is stimulated by gastrin and food
The Gastric Function Tests
- Pentagastrin test: measures HCl response to pentagastrin injection
- Used to examine gastric acid secretion
- Resting gastric juice is normally small in volume and low in acid content
- Increased gastric acid secretion can indicate impaired gastric emptying due to pyloric stenosis
- Achlorhydria: low volume of secreted HCl, no response to pentagastrin
- Hyperacidity: increased output of HCl, found in cases of duodenal ulcer
Tests of Fat Absorption
- Faecal fat estimation: measures fat excretion in feces
- Used to diagnose malabsorption due to small intestine defects
- Vitamin A absorption test: measures plasma vitamin A levels after vitamin A administration
- Not commonly used as a general test for small intestine function
Test of Ileum Function (Schilling Test)
- Measures vitamin B12 absorption
- Used to diagnose pernicious anemia and ileum function defects
- Defect in ileum absorption function leads to low vitamin B12 excretion in urine
Causes of Intestinal Malabsorption
- Pancreatic diseases: lead to malabsorption of large molecules due to pancreatic enzyme deficiencies
- Biliary disease: deficiency of bile secretion can result in fat malabsorption
Plasma Gastrin
- Indicates rate of gastrin secretion by pyloric antrum
- Normally reduced in fasting state and increased in presence of food
- Hyperacidity: reduced plasma gastrin, found in duodenal ulcer cases
- Zollinger-Ellison syndrome: high plasma gastrin levels due to hyperplasia or neoplasia of gastrin-producing cells
- Gastritis: reduced plasma gastrin due to destruction of gastrin-producing cells
Zollinger-Ellison Syndrome
- Characterized by severe peptic ulceration and excessive HCl production
- High secretion of gastric juice, containing more than 100mmol/L HCl
- Plasma gastrin levels are significantly high
- Malabsorption and diarrhea are also present
The Pancreas
- Secreting pancreatic juice containing electrolytes and digestive enzymes
- Secretion induced by nervous stimuli and hormones secretin and cholecystokinin
- Chronic pancreatitis: characterized by inability to secrete digestive enzymes, leading to malabsorption
- Testing elastase enzyme in stool is a promising diagnostic test for chronic pancreatitis
Carcinoma of the Pancreas
- Difficult to diagnose, often results from metastasis, causing bile duct obstruction
- Detection of tumor marker CA-19-9 is very sensitive in this case
The Small Intestine
- Site of digestion and absorption, including duodenum, jejunum, and ileum
- Important for absorption process
Tests of Carbohydrate Absorption
- Measurement of carbohydrate metabolites (glucose): assesses intestinal absorption efficiency
- Xylose absorption test: measures xylose excretion in urine to test small intestine absorption
- Normal result: more than 2mg xylose excretion in 5-hour urine collection
- Impaired absorption: reduced xylose excretion, often observed in small intestine diseases
Pancreatic Disorders
- Acute pancreatitis: characterized by tissue necrosis, high risk of adult respiratory distress syndrome (ARDS) and renal failure
- Diagnosis: increased α-amylase, lipase, and trypsin levels, presence of methaemalalbumunemia
- Management: intravenous feeding, fluid and electrolyte balance, prophylactic antibiotics, and monitoring C-reactive protein levels
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