Physio PA of Digestive System

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_______________ takes place in mouth stomach and SI while ___________ takes place in SI
digestion nutrient absorption
teeth, tongue, salivary glands, liver, gallbladder, pancreas
accessory organs of digestion
tongue is made of _________ innervated by
skeletal m hypoglossal nerves
taste buds, cover tongue and filled with gustatory cells
gustatory cells
sensory receptors within a taste bud w/ pore for nerve signals
taste bud impulses transmitted by _______________ nerves to taste areas:
facial + glossopharyngeal (7 + 9) parietal-temporal cortex
location of ____________ at parotid, submandibular and sublingual
major and serous salivary glands
location of ____________ at labial, buccal, glossopalatine, palatine and lingual
minor salivary glands
serous salivary glands secrete
ptyalin - a-amylase to digest starches
mucous salivary glands secrete
mucin - lubrication + protection
acinar cells of salivary gland
produces initial saliva
how do the ductal cells of salivary gland modify the initial saliva
alters conc of electrolytes
myoepithelial cells of salivary gland
in acini and intercalated ducts, contract to eject saliva to mouth
how does saliva buffer food
acidic foods buffered by bicarbonate ions
GFs in saliva role
epidermal GFs heal ulcers in mucous membrane of mouth
lysozyme role in saliva
enzymes destroy bacteria - non specific immune defense
___________ is ph 6-7
which innervation control is dominant in saliva secretion
parasympathetic (high blood flow increases saliva)
saliva is made from
blood plasma
2 stages of salivary secretion
1 - acinar cell secretes NaCl rich primary saliva = isotonic 2 - primary saliva modified along ductal tree - hypotonic (permeable to water)
flow rate of saliva change as
ionic composition changes, depending on contact w/ ductal cells
under which conditions is saliva most similar to plasma
during maximal salivation (least modification)
what is different about HCO3- in composition of saliva
secreted by ductal cells, highest conc at high flow rates
how is salivary ph differentiated for viewing
w/ methyl red + bromo blue
salivary cotinine test
determines exposure to nicotine, immunoassay w/ monoclonal atb coated gold + traps
level 1 in salivary cotinine test demonstrates what
use of tobacco
alcohol salivary test (AST)
qualitative, detects ethyl alcohol, line if greater than 0.02% BAC
where are mucins secreted
mucous neck cells of gastric glands by surface epithelial cells of stomach
mucus gel is subject to ______ by pepsins which dissolves the mucus layer
what protects stomach lining
mucus + HCO3-
how does h. pylori manifest
antral gastritis
flagella, urease, adhesins, toxins are features that help the virulence of what
h. pylori
chronic antral h. pylori gastritis may progress to
pangastritis + intestinal metaplasia
urea breath test tests what
h. pylori's production of urease
what are h. pylori stool antigen tests used for
diagnosis and confirmation it was cured
positive test of IgA H. pylori
C + T lines present
what does IgG ini h. pylori not distinguish
bw previous exposure and acute infection
___________ diagnoses GORD and treats ulcers + polyps, for finding and treating cause of bleeding
how are biopsies performed in endoscopy
at least 3 sites in stomach + duodenum, atb avoided
best time to take rapid urease test
at time of gastroscopy
culture from endoscopy biopsy allows determination of
atb susceptibility
internal structure of pancreas is similar to that of
salivary glands
pancreatic juice
protein rich alkaline secretions
pancreatic digestive enzymes are secreted by pancreatic ____________, and large volumes of _______________ are secreted by the small ductules and larger ducts leading from the acini
acini sodium bicarbonate solution
pancreatic secretions flow to join hepatic duct and empties into ________ via _________-
duodenum thru Vater papilla, surrounded by sphincter of Oddi
each secretory unit of the pancreas is composed of
acinus + intercalated duct
pancreatic juice is secreted in response to
chyme presence in SI
___________ consists of inflammation and interstitial edema -> necrosis
acute pancreatitis
symptom of acute pancreatitis
severe epigastric and abd pain radiating to back
causes of acute pancreatitis
gallstones + alcohol abuse
lab tests for acute pancreatitis
serum amylase + lipase increased
in contrast to acute pancreatitis, the serum amylase and lipase levels are usually ________________ in chronic pancreatitis, additionally bilirubin and alkaline phosphatase are high
mildly elevated
hormone stimulation test for chronic pancreatitis utilizes
what are ERCP and MRCP tests used for
chronic pancreatitis
The most characteristic symptom of gallstone disease is
biliary colic
what serum elevations suggest cholestasis
bilirubin + alkaline phosphatase
inflammation of acute cholecystitis can spread, leading to irritation of gallbladder and dev of
empyema -> sepsis
digestion test
exam of stool w/ saline + Sudan III for lipid detection, Lugol for starch
gallbladder insufficiency, bowel movements and bad absorption in a digestion test are suggested how
high amounts lipids
in digestion test, what does increased muscle fibers suggest
pancreatic insufficiency and gastric hyposecretion
starch (reddish) in digestion test stool is related w/
carb consumption + high intestinal transit
stool w/ leukocytes is seen in ___________ and needs follow up culture
Charcot-Leyden crystals can be present in case of
Schilling test
for cobalamin malabsorption (pernicious anemia, pancreatitis)
The Fecal Occult Blood Test (FOBT)
detects blood in stool not visible, using double ATB sandwich assay not affected by diet
red meat and drugs (NSAIDs, aspirin, steroids) cause false positives in which test
___________ are for bleedings, inflammatory rectal disease + colorectal cancer
clinical application of VCE (video capsule endoscopy) is
evaluation of GI bleeding
__________ is an autoimmune disorder of SI caused by rxn to gliadin by transglutaminase
celiac disease
Antiendomysial antibodies of the immunoglobulin A (IgA) is what
serological test for celiac
2 types of IBD
UC (autoimmune) and CD (genetic)
elevated CRP, PLT, ESR and less HB are in which diseas
ulcerative colitis
which test is used to assess UC
elevated ESR, CRP, hypoalbuminemia and anemia are suggestive for which disease
liver is an organ with what type of structure
parenchymal structure
what is needed to diagnosis a hepatic patho
history + examination, but also advanced imaging + biopsy
hepatocytolysis syndrome
hepatocyte membrane dysfxn, enzymes leak into plasma
___________ are diagnosed by increased transaminases + LDH
hepatocytolysis syndrome
diff vs GOT and GPT
GOT is not specific, GPT is for hepatic lesions
acute vs chronic hep
acute has high increase of ALT + AST
Rittis ratio in chronic alcohol consumption
AST/ALT, increased in alcohol related patho, lower is hep
cholestatic syndrome
bile flow impaired from obstruction or atb
alkaline phosphatase + GGT are elevated in which syndrome
cholestatic syndrome
_____________ maintain oncotic p and assure normal clotting + gluconeogenesis
proteins of liver
most sensitive test for analyzing hepatocyte fxn (ex hepatodeficiency syndrome)
coag test - analyzes albumin, INR + glucose
inflammatory syndrome, seen in acute hep, shows high inflammatory markers and increase in
gamma globulins conc
jaundice can be classified as
pre, post and hepatic
___________ is represented by increased bilirubin production (rbc hemolysis) + total bi
prehepatic jaundice
hepatic jaundice
liver can't metabolize bi
Crigler-Najjar syndrome (neuro impairment) + Gilbert syndrome are associated w/ which type of jaundice
hepatic jaundice
type I vs II Crigler-Najjar
I (recessive) no glucuronyltransferase
mechanism of Dubin-Johnson + Rotor syndrome (hepatic jaundice)
transportation of conj bi impaired, dark spots on liver in Dubin Johnson
neonatal hepatic jaundice
limited phase after birth bcus glucuronyltransferase enzyme is not matured or breastfeeding
posthepatic jaundice
obstruction of bile ducts, increased conj bi