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Questions and Answers
Which of the following substances stimulates gastric secretion?
What is one of the primary functions of the gastric mucosa?
Which of the following is a common cause of Peptic Ulcer Disease?
Which complication is associated with gastritis?
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Which medication class is used to reduce stomach acid secretion?
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What risk factor is associated with duodenal ulcers?
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Which sphincter is located at the entrance of the stomach?
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What is a key treatment for immediate support in cases of severe gastritis?
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What is the primary trigger for systemic activation during the third phase of acute pancreatitis?
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Which of the following symptoms is NOT directly associated with acute pancreatitis?
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What is the most common cause of chronic pancreatitis?
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Which electrolyte imbalance is commonly associated with chronic pancreatitis?
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Which treatment is indicated for managing fluid resuscitation in acute pancreatitis?
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What is NOT a component of the 'classic triad' associated with the diagnosis of chronic pancreatitis?
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In acute pancreatitis, which factor can mimic a myocardial infarction (MI)?
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Which condition is likely to develop in approximately half of patients suffering from chronic pancreatitis?
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What is the primary focus of medical therapy for peptic ulcer disease?
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Which medication is NOT considered a proton pump inhibitor?
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What is a potential complication of using antacids?
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Which of the following is a potential side effect of H2-receptor antagonists?
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In what scenario is surgical intervention considered for patients with peptic ulcer disease?
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What is a common symptom of gastric neoplastic disease?
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Which therapeutic option is specifically aimed at preventing ulcers in NSAID users?
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What significant alteration should be considered when administering H2-receptor antagonists?
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What is a primary reason for performing a total pancreatectomy?
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Which layer of the small intestine contains immune cells and helps protect against pathogens?
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What is the role of the Auerbach plexus in the small intestine?
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During a partial pancreatectomy, which organ is NOT typically removed?
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What type of anesthesia is generally preferred for a pancreatectomy procedure?
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Which function is associated with the sympathetic nervous system in the context of the small intestine?
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What type of pain management might be used postoperatively for patients undergoing pancreatectomy?
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What is the primary muscle type found in the muscularis propria of the small intestine?
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What is the primary distinction between maldigestion and malabsorption?
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Which symptom is most indicative of maldigestion?
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Which of the following is NOT a potential cause of pancreatic insufficiency?
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What is the main function of the large intestine?
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Which artery is NOT involved in the blood supply to the large intestine?
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Which statement regarding electrolyte absorption in the large intestine is accurate?
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What structures are considered parts of the large intestine?
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Which type of inflammatory bowel disease primarily affects the distal ileum and proximal colon?
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Study Notes
Stomach
- Stimulated by acetylcholine, gastrin, and histamine
- Inhibited by somatostatin, duodenal acid, and negative feedback from gastrin
- Contains glands responsible for various functions
- Fundus: Secretes mucus for protection and hydrochloric acid for digestion
- Antrum: Secretes mucus for protection and gastrin (a hormone)
- Sphincters: Lower esophageal sphincter (LES) and pyloric sphincter
- Stores up to 1.5 liters of fluid
- Food storage up to 4 hours
- Other functions:
- Barrier against pathogens (acidic environment and immune function)
- Temperature regulation of ingested substances
- Secretion of intrinsic factor (for vitamin B12 absorption)
Peptic Ulcer Disease
- Loss of stomach lining due to inflammation, can extend deeper into the stomach wall
- Types: Acute vs. Chronic (most common)
- Causes:
- H. pylori infection (most common)
- NSAID use
- Complications: Hemorrhage, perforation, obstruction
-
Duodenal ulcers:
- More common in men 45-65 and women >55
- Caused by excess acid and pepsin
- Can involve the lower stomach
Gastritis
- Inflammatory disorder of the stomach lining (gastric mucosa)
- Also called stress ulcers, erosive gastritis, or hemorrhagic gastritis
- Can cause life-threatening bleeding
- Causes:
- Multifactorial: physical trauma, shock, sepsis, medications, chemicals, or H. pylori infection
- Reduced blood flow, mucus, or bicarbonate secretion
- Reduced prostaglandins
- Stress: Hypoxia, sepsis, or organ failure
- Symptoms: Upper GI bleeding
Therapeutic Options in Peptic Ulcer Disease
-
Goals:
- Relieve symptoms
- Heal the ulcer
- Prevent recurrence
- H. pylori eradication: Main focus of medical therapy
-
Medications:
- Antacids: Short-term symptom relief, can cause acid rebound and milk-alkali syndrome
- H2-receptor antagonists: Block acid secretion, adjust dosage for kidney function, potential side effects include altered drug metabolism, mental confusion, and decreased blood flow
- Proton pump inhibitors: Most effective acid blockers
- Sucralfate: Promotes healing and protects the ulcer, minimal side effects
- Misoprostol: Prevents ulcers in NSAID users, minimal side effects
- Antibiotics: Eradicate H. pylori
- Surgery: Reserved for intractable symptoms despite medication. Complications: bleeding, perforation, obstruction
Gastric Neoplastic Disease
- Second most common cancer worldwide
- Causes:
- Alcohol abuse
- Gallstones
- Other factors: trauma, infections, medications
Acute Pancreatitis
- Causes:
- Alcohol abuse
- Gallstones
- Other factors: trauma, infections, medications
- Symptoms:
- Pain (severe, radiating)
- Nausea, vomiting, and fever
- Hypotension
- Treatment:
- Fluid resuscitation
- Pain management (avoid morphine)
- Nutritional support
- Surgery (for gallstones)
- CRP level
-
Anesthetic:
- Choice depends on patient presentation
- Anticipate labile hemodynamics and altered hepatic function
Chronic Pancreatitis
- Permanent damage to the pancreas with inflammation, scarring, and tissue destruction
- Causes:
- Most common: Alcohol abuse (70% of cases)
- Other causes: Smoking, genetics, autoimmune disease, duct obstruction
- Diagnosis:
- Classic triad: steatorrhea, pancreatic calcification, diabetes mellitus
- Steatorrhea only occurs with very low lipase secretion
-
Reasons for surgery:
- Ductal obstruction
- Pancreatic stones or cysts
- Trauma
- Tumors (benign or malignant)
- Chronic pancreatitis
- Endocrine tumors
-
Surgery types:
- Partial pancreatectomy: Removes part of pancreas, duodenum, gallbladder, and bile duct.
- Total pancreatectomy: Removes part of stomach, gallbladder, bile duct, spleen, lymph nodes, and entire pancreas.
-
Anesthesia:
- General endotracheal preferred, with muscle relaxants.
- Avoid nitrous oxide.
- Epidural or intrathecal morphine for pain control
-
Postoperative care:
- May require ventilation and ICU monitoring due to surgery duration and patient health
Small Intestine
-
Layers:
- Serosa: Outermost layer, single layer of cells.
-
Muscularis propria: Composed of smooth muscle for contraction.
- Auerbach plexus: Between muscle layers, controls motility and secretion.
-
Submucosa: Strongest layer, contains connective tissue and:
- Meissner plexus: Regulates blood flow, motility, and secretions.
-
Mucosa: Innermost layer, with folds and villi for increased surface area:
- Muscularis mucosae: Thin muscle layer separating mucosa and submucosa.
- Lamina propria: Connective tissue with immune cells and support functions.
- Epithelial layer: Covers villi and crypts, contains various cell types for absorption.
-
Immune function:
- Lamina propria: Has immune cells for protection.
- IgA antibodies: In lamina propria prevent pathogen entry.
-
Nervous system:
-
Autonomic nervous system:
- Parasympathetic: Increases motility and secretions.
- Sympathetic: Inhibits motility and causes vasoconstriction.
- Enteric nervous system: Intrinsic neurons within the wall of the small intestine, pancreas, and gallbladder, controls local functions like digestion and peristalsis.
-
Autonomic nervous system:
- Motility: Intestinal reflexes regulate movement and emptying.
- Absorption: Absorptive cells take up nutrients.
Maldigestion vs. Malabsorption
- Maldigestion: Refers specifically to the breakdown issue.
- Malabsorption: Refers to the absorption issue.
Causes of Maldigestion
- Pancreatic deficiency
- Lactase deficiency
- Bile salt deficiency
Pancreatic Insufficiency
- Usually present due to its large functional reserve.
- Other causes:
- Cystic fibrosis
- Fistulas
- Gallstones
- Ischemic enteritis
- Neoplastic diseases
- Diabetes mellitus
- Vitamin B6 or B12 deficiency
Key Symptom of Maldigestion
- Steatorrhea (fatty stool)
Large Intestine
-
Anatomy:
- Length: 3-5 feet
- Parts: Cecum, appendix, colon, rectum, anal canal
-
Blood Supply:
- Arteries: Superior mesenteric, inferior mesenteric, internal iliac
- Veins: Drain into portal venous system (except rectum)
-
Lymphatic Drainage:
- Upper rectum and colon: Superior rectal and inferior mesenteric nodes
- Lower rectum and anal canal: Inguinal lymph nodes
-
Innervation:
- Motor and secretory control: Myenteric plexus
- Sympathetic: T10-T12 (right), L1-L3 (left), presacral nerves (rectum)
- Parasympathetic: Vagus nerve (right & transverse colon), S2-S4 (descending colon, sigmoid colon, and rectum)
-
Functions:
- Store and expel waste
- Absorb water and sodium (mostly in the right colon)
- Efficient absorption: Only 100-200mL out of 1-2L daily fluid reaches the end
- Importance: Individuals with ileostomy need extra sodium intake
-
Electrolyte Balance
- Sodium: Actively reabsorbed, efficient process (5 mEq/day needed for balance)
- Potassium: Passively absorbed/secreted, lost in mucoid stools (colitis, villous adenoma)
- Chloride: Absorbed with sodium, exchanged for bicarbonate
Inflammatory Bowel Disease
-
Types:
- Crohn's disease: Affects any part of the GI tract, often the distal ileum and proximal colon.
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Description
Explore the anatomy and physiology of the stomach, including its functions and hormones. Additionally, delve into peptic ulcer disease, its types, causes, and potential complications. This quiz covers essential concepts related to stomach health and related disorders.
