UB PGY 412 - Final Exam Study Guide (58 pages)

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Final Exam Study Guide

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Final Exam Study Guide


The last test will emphasize information about digestive and renal pathologies. The second part of the test will cover past material on cardiovascular, endocrine, respiratory, fluid and electrolyte, and neurological pathologies.

Study Guide
University at Buffalo, The State University of New York
Pgy 412 - Applied Physiology
Applied Physiology Documents
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PGY 412 Final Exam Study Guide Gastrointestinal Disorders Lecture 1 Overview and Esophagus Esophageal pathology o Obstruction Inside foreign object tumor ring web Outside lung cancer enlarged lymph nodes secondary to metastasis or tuberculosis Symptoms dysphagia difficulty swallowing regurgitation o Dysfunction of esophageal muscle or its innervation failure to contract or to relax Achalasia LES Lower Esophageal Sphincter remains constricted Eventually esophageal walls become dilated and peristalsis is lost Bird s beak appearance on barium swallow Faulty parasympathetic control Failure to contract scleroderma Chagas disease destroy collagen Failure to relax diffuse esophageal spasm that mimics symptoms of angina o Diverticula outpouchings Distal obstruction leads to proximal esophagus contracting more forcefully Pulsion Diverticula esophageal wall weakens leading to an outpouching Traction Diverticula due to lymph nodes Zenker s Diverticulum just behind UES Upper Esophageal Sphincter regurgitation of undigested food pulsion type of diverticulum o Gastroesophageal Reflux Disease GERD Most common disorder of esophagus Esophagitis acid burn of lower esophagus Hiatus Hernia protrusion or herniation of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm Increased gastric pressure opening LES due to decreased gastric emptying obstruction or gastric paresis Worsens when lying down or bending over Barrett s Esophagus lining of the is damaged by stomach acid and changed to a lining similar to that of the stomach o Esophageal cancer Adenocarcinoma caused by Barrett s Esophagus Squamous cell carcinoma caused by smoking and alcohol Dysphagia Upper airway obstruction o Esophageal varices Dilations of esophageal veins associated with Portal Venous Hypertension Esophageal veins are dilated due to collateral veins from Portal system Delicate bleed easily Acute bleed Undigested red Chronic bleed Digested dark coffee grounds Lecture 2 Stomach The stomach can be divided into three parts The fundus is the top portion the body is the middle portion and the antrum is the lower portion The inside of the stomach contains many folds called rugae The chief cells of the stomach secrete pepsinogen The parietal cells of the stomach secrete HCl and intrinsic factor The secretion of HCl involves neurocrine endocrine and paracrine stimulation as well as direct and indirect stimulation o G cell secretes gastrin o ECL enterochromaffin like Blockers and inhibitors o H 2 receptor Tagamet Zantac o H K ATPase pump Prilosec Nexium Aciphex Turning off the G cells o Low pH in the gastric lumen stimulates the secretion of somatostatin from the D cell somatostatin inhibits the G cells from releasing gastrin Turning on the G cells o Vagus nerve sends acetylcholine to GRP neuron which releases GRP and stimulates the G cell to secrete gastrin o Vagus nerve once again transmits acetylcholine but this time it stimulates a cholinergic neuron which inhibits the D cell with more acetylcholine therefore allowing gastrin to be secreted o The presence of digested protein in the lumen of the stomach stimulates gastrin secretion Turning off the parietal cells decreasing HCl secretion o Somatostatin o Prostaglandins help with mucus formation o Secretin o VIP Turning on the parietal cells increasing HCl secretion o Histamine o Gastrin o Acetylcholine Regulation by secretin o S cell secretes secretin Ulcer o Most common cause is Helicobacter Pylori H Pylori bacteria damages the mucosal protective layer and causes inflammation that increases acid secretion o Decreases mucosal protection A decrease in prostaglandins creates a decrease in mucus secretion NSAIDS and COX inhibitors block inflammation but also block mucus secretion COX 2 inhibitors has specific targets that reduces the risk of developing an ulcer Alcohol and tobacco decrease mucus secretion o Physiological stress shock sepsis burns and trauma Decrease in gastric blood flow decreases mucus protection o Increased acid secretion Ethanol Caffeine Zollinger Ellison Syndrome gastrin secreting tumor in pancreas elevates plasma gastrin Secretin test administration of secretin should cause minimal no change in gastrin levels with a normal pancreas since secretin inhibits gastrin secretin will actually stimulate gastrin secretion in a gastrinomal pancreas o Signs and symptoms Pain Nausea Vomiting either red undigested blood or brown digested blood Tarry stools melena Changes in appetite Perforation of gastric duodenal wall x ray shows air in peritoneal cavity Timing Gastric ulcers pain occurs while eating Duodenal ulcers pain occurs much later after eating o Treatment Antibiotics eradicate H Pylori Magnesium calcium salts or NaHCO3 neutralize acid Decrease acid production Rantidine H2 receptor blocker Omeprazole H K pump blocker Increase mucus production Sucralfate viscous gel Misoprostal synthetic prostaglandin Gastritis inflammation of stomach o H Pylori o NSAIDS o Stress o Alcohol o Caffeine o Radiation o Crohn s Disease autoimmune disease that causes lesions throughout GI tract o Reflux of bile and or pancreatic secretions Loss of intrinsic factor needed to absorb vitamin B12 which is used for red blood cell production o Gastric resection removal of a portion of the stomach o Autoimmune gastritis antibodies against parietal cells o Leads to pernicious anemia decrease in number of blood cells because they are not being produced due to absence of intrinsic factor and vitamin B12 Gastric obstruction o Pyloric sphincter inside foreign body gastric polyp gastric cancer o Pyloric sphincter outside pancreatic tumor o Pylorus can be scarred by acid o Pyloric stenosis stays closed usually congenital Gastroparesis paralysis of the stomach o Vagus nerve dysfunction Acetylcholine release CNS control o Anticholinergic drugs Atropine psychotropic drugs o Narcotic analgesics Morphine Demerol Gastric cancer o Most common in people of Asian descent o H Pylori o Irritants alcohol caffeine smoked fish capsaicin radiation Lecture 3 Intestines Regulation by cholecystokinin CCK Acinar cell secretions o Luminal digestive enzymes Pancreatic Amylase active Prolipases inactive zymogens Proenzyme proteases inactive zymogens Trypsinogen converted to Trypsin by Enterokinase Chymotrypsinogen secretion of zymogens protects pancreas from autodigestion Enterocyte enzymes and transporters o Disaccharidases Brush Border o Sodium Glucose transporter SGLT o GLUT proteins o Amino

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