ABSITE COMPREHENSIVE EXAM
QUESTIONS AND CORRECT ANSWERS
STUDY GUIDE
●● where does peristalsis occur in the stomach?
Answer: only distal (in antrum)
●● gastroduodenal pain sensation
Answer: through afferent sympathetic fibers (T5-10)
●● blood supply
Answer: celiac trunk ---> L gastric, common hepatic, splenic ---> L
gastroepiploic and short gastric (both branches of splenic) ---> stomach
..... greater curvature is supplied by R & L gastroepiploic (GDA branch,
splenic branch), short gastric (splenic)
●● mucosa epithelium type
Answer: simple columnar
●● physiology: cardia glands do what?
Answer: mucus secreting
,●● physiology: fundus and body glands - list
Answer: chief cells, parietal cells
●● physiology: chief cells function
Answer: secrete pepsinogen (1st enzyme in proteolysis)
●● physiology: parietal cells function, regulation
Answer: release H+ and intrinsic factor .... ACh (vagus nerve), gastrin
(G cells in antrum), histamine (mast cells) ---> cause H+ release .... (1)
ACh and gastrin activate phospholipase (PIP ---> DAG + IP3 to inc Ca),
Ca calmodulin activates phosphorylase kinase ---> inc H+ release ..... (2)
histamine activates anenylate cyclase ---> cAMP ---> activate protein
kinase A ---> inc H+ release .... ---> phosphorylase kinase and pka
phosphorylate H+/K+ ATPase to increase H+ secretion and K+
absorption
●● physiology: parietal cells - omeprazole MOA
Answer: block H/K ATPase (final pathway for H+ release)
●● physiology: inhibitors of parietal cells
Answer: somatostatin, PGE1, secretin, CCK
●● physiology: parietal cells - intrinsice factor function
Answer: bind B12 and the complex is reabsorbed in the terminal ileum
, ●● physiology: antrum and pylorus glands - function, types
Answer: mucus and HCO3 secreting glands ---> protect stomach ....
types = G cells (release gastrin) and D cells (secrete somatostatin, inhibit
gastrin and acid release) .... G cells release gastrin which is why
antrectomy helps PUD, inhib by H+ in duo, stimulated by amino acids,
ACh
●● physiology: Brunner's glands
Answer: in duodenum, secrete alkaline mucua
●● what is released with duodenal and antral acidification?
Answer: somatostatin, CCK, secretin
●● causes of rapid vs delayed gastric emptying
Answer: rapid = previous surgery (MC), ulcers ... delayed = DM,
opiates, anticholingergics, hypothyroidism
●● trichbezoars vs phytobezoars: describe, tx
Answer: tricho = hair = hard to pull out, tx = EGD usually inadequate,
likely need gastrostomy and removal .... phyto = fiber = often in DM
with poor gastric emptying, tx = enzymes, EGD, diet change
●● dieulafoy's ulcer
QUESTIONS AND CORRECT ANSWERS
STUDY GUIDE
●● where does peristalsis occur in the stomach?
Answer: only distal (in antrum)
●● gastroduodenal pain sensation
Answer: through afferent sympathetic fibers (T5-10)
●● blood supply
Answer: celiac trunk ---> L gastric, common hepatic, splenic ---> L
gastroepiploic and short gastric (both branches of splenic) ---> stomach
..... greater curvature is supplied by R & L gastroepiploic (GDA branch,
splenic branch), short gastric (splenic)
●● mucosa epithelium type
Answer: simple columnar
●● physiology: cardia glands do what?
Answer: mucus secreting
,●● physiology: fundus and body glands - list
Answer: chief cells, parietal cells
●● physiology: chief cells function
Answer: secrete pepsinogen (1st enzyme in proteolysis)
●● physiology: parietal cells function, regulation
Answer: release H+ and intrinsic factor .... ACh (vagus nerve), gastrin
(G cells in antrum), histamine (mast cells) ---> cause H+ release .... (1)
ACh and gastrin activate phospholipase (PIP ---> DAG + IP3 to inc Ca),
Ca calmodulin activates phosphorylase kinase ---> inc H+ release ..... (2)
histamine activates anenylate cyclase ---> cAMP ---> activate protein
kinase A ---> inc H+ release .... ---> phosphorylase kinase and pka
phosphorylate H+/K+ ATPase to increase H+ secretion and K+
absorption
●● physiology: parietal cells - omeprazole MOA
Answer: block H/K ATPase (final pathway for H+ release)
●● physiology: inhibitors of parietal cells
Answer: somatostatin, PGE1, secretin, CCK
●● physiology: parietal cells - intrinsice factor function
Answer: bind B12 and the complex is reabsorbed in the terminal ileum
, ●● physiology: antrum and pylorus glands - function, types
Answer: mucus and HCO3 secreting glands ---> protect stomach ....
types = G cells (release gastrin) and D cells (secrete somatostatin, inhibit
gastrin and acid release) .... G cells release gastrin which is why
antrectomy helps PUD, inhib by H+ in duo, stimulated by amino acids,
ACh
●● physiology: Brunner's glands
Answer: in duodenum, secrete alkaline mucua
●● what is released with duodenal and antral acidification?
Answer: somatostatin, CCK, secretin
●● causes of rapid vs delayed gastric emptying
Answer: rapid = previous surgery (MC), ulcers ... delayed = DM,
opiates, anticholingergics, hypothyroidism
●● trichbezoars vs phytobezoars: describe, tx
Answer: tricho = hair = hard to pull out, tx = EGD usually inadequate,
likely need gastrostomy and removal .... phyto = fiber = often in DM
with poor gastric emptying, tx = enzymes, EGD, diet change
●● dieulafoy's ulcer
