Human Physiology Case Studies Exam
Questions With Correct Answers
Gastrointestinal /Case /History /- /Case /19 /- /verified /answers-✔✔A /26-year-old /business
/executive /complained /of /a /dull /pain /(heartburn) /behind /the /sternum. /The /pain /was
/postprandial /(occurred /after /meals) /and /disappeared /within /a /few /minutes /to /an /hour. /It /was
/often /associated /with /belching /and /often /was /worse /on /lying /down /or /on /exertion /after
/heavy /meals. /Sometimes /it /radiated /to /the /back, /jaws, /shoulders, /and /down /the /inner
/aspects /of /the /arms, /simulating /angina /pectoris. /X-rays /revealed /a /small /portion /of /the
/stomach /above /the /diaphragm, /and /an /endoscopic /biopsy /revealed /mucosal /inflammation.
/Esophageal /manometry /(determining /pressures /at /the /lower /esophageal /sphincter, /LES)
/revealed /decreased /LES /pressure. /Esophageal /pH /monitoring /showed /reflux /of /gastric
/contents /into /the /esophagus /and /provided /direct /evidence /of /gastroesophageal /reflux.
/Recommended /treatment /for /this /individual /is /avoidance /of /strong /stimulants /of /gastric /acid
/secretion /(e.g., /coffee, /alcohol) /and /avoidance /of /certain /drugs /(e.g., /anticholinergics), /and
/specific /foods /(fats, /chocolates, /whole /milk, /and /orange /juice), /and /smoking, /all /of /which
/reduce /LES /competence. /Elevation /of /the /head /of /the /bed /by /about /six /inches /is /also
/recommended. /Suggested /treatments /also /include /the /use /of /cholinergic /agonists /(e.g.,
/bethanechol) /and /the /use /of /histamine /(H2) /antagonists /(cimetidine).
What /is /the /disorder /of /this /26-year-old /business /executive? /- /verified /answers-✔✔a /hiatal
/hernia, /which /is /a /structural /defect /in /which /a /weakened /diaphragm /allows /a /portion /of /the
/stomach /to /pass /through /the /esophageal /opening /into /the /chest, /where /pressure /increases
What /mechanisms /normally /prevent /gastric /reflux /into /the /esophagus /when /lying /down /or
/bending /over? /- /verified /answers-✔✔adequate /lower /esophageal /pressure /at /the /lower
/esophageal /sphincter
Why /are /anticholinergic /agents /avoided /and /cholinergic /agonists /recommended /in /the
treatment /of /gastrointestinal /reflux? /- /verified /answers-✔✔the /PS /division /of /the /ANS
/
, /innervates /the /lower /esophageal /sphincter, /so /cholinergic /agonists /would /increase /LES
/contraction, /preventing /gastric /reflux. /
Antiocholinergic /agents /would /decrease /LES /pressure.
Why /are /histamine /antagonists /recommended? /- /verified /answers-✔✔Because /they /reduce
/gastric /acidity /by /selectively /blocking /H2 /receptors /(which /mediate /gastric /secretion)
Why /is /elevation /of /the /head /of /the /bed /recommended? /- /verified /answers-✔✔to /encourage
/gravitational /flow /of /the /gastric /contents /toward /the /pyloric /end /of /the /stomach,
What /is /the /normal /pH /of /the /esophagus? /- /verified /answers-✔✔6-7
Of /the /stomach? /- /verified /answers-✔✔3-5
Predict /values /for /the /gastroesophageal /patient /in /this /case /for /lower /esophageal /and
stomach /pH /- /verified /answers-✔✔lower /esophageal /pH /would /be /approximately /3-5.
/
stomach /pH /would /not /change
Gastrointestinal /Case /History /- /Case /20 /- /verified /answers-✔✔A /45-year-old /store /manager
/complained /of /a /burning, /gnawing /pain, /moderately /severe, /almost /always /in /the /epigastric
/region. /The /pain /is /absent /when /he /awakens, /appears /in /midmorning, /and /is /relieved /by
/food /but /recurs /two /to /three /hours /after /a /meal. /The /pain /often /awakens /him /at /1 /or /2 /a.m.
/An /endoscopic /examination /and /x-ray /studies /with /barium /showed /normal /stomach /function
/but /the /presence /of /duodenal /ulcers. /Gastric /analysis /demonstrated /that /the /gastric /juice /pH
/fell /to /1.9 /with /pentagastrin /stimulation /(6µg/kg /s.c.). /Fasting /serum /gastrin /levels /were
/normal. /Recommended /treatments /for /this /individual /follow.
Antacids: /15-30 /mL /of /liquid /or /two /to /four /tablets /one /to /three /hours /after /each /meal /and /at
/bedtime /for /six /weeks.
Questions With Correct Answers
Gastrointestinal /Case /History /- /Case /19 /- /verified /answers-✔✔A /26-year-old /business
/executive /complained /of /a /dull /pain /(heartburn) /behind /the /sternum. /The /pain /was
/postprandial /(occurred /after /meals) /and /disappeared /within /a /few /minutes /to /an /hour. /It /was
/often /associated /with /belching /and /often /was /worse /on /lying /down /or /on /exertion /after
/heavy /meals. /Sometimes /it /radiated /to /the /back, /jaws, /shoulders, /and /down /the /inner
/aspects /of /the /arms, /simulating /angina /pectoris. /X-rays /revealed /a /small /portion /of /the
/stomach /above /the /diaphragm, /and /an /endoscopic /biopsy /revealed /mucosal /inflammation.
/Esophageal /manometry /(determining /pressures /at /the /lower /esophageal /sphincter, /LES)
/revealed /decreased /LES /pressure. /Esophageal /pH /monitoring /showed /reflux /of /gastric
/contents /into /the /esophagus /and /provided /direct /evidence /of /gastroesophageal /reflux.
/Recommended /treatment /for /this /individual /is /avoidance /of /strong /stimulants /of /gastric /acid
/secretion /(e.g., /coffee, /alcohol) /and /avoidance /of /certain /drugs /(e.g., /anticholinergics), /and
/specific /foods /(fats, /chocolates, /whole /milk, /and /orange /juice), /and /smoking, /all /of /which
/reduce /LES /competence. /Elevation /of /the /head /of /the /bed /by /about /six /inches /is /also
/recommended. /Suggested /treatments /also /include /the /use /of /cholinergic /agonists /(e.g.,
/bethanechol) /and /the /use /of /histamine /(H2) /antagonists /(cimetidine).
What /is /the /disorder /of /this /26-year-old /business /executive? /- /verified /answers-✔✔a /hiatal
/hernia, /which /is /a /structural /defect /in /which /a /weakened /diaphragm /allows /a /portion /of /the
/stomach /to /pass /through /the /esophageal /opening /into /the /chest, /where /pressure /increases
What /mechanisms /normally /prevent /gastric /reflux /into /the /esophagus /when /lying /down /or
/bending /over? /- /verified /answers-✔✔adequate /lower /esophageal /pressure /at /the /lower
/esophageal /sphincter
Why /are /anticholinergic /agents /avoided /and /cholinergic /agonists /recommended /in /the
treatment /of /gastrointestinal /reflux? /- /verified /answers-✔✔the /PS /division /of /the /ANS
/
, /innervates /the /lower /esophageal /sphincter, /so /cholinergic /agonists /would /increase /LES
/contraction, /preventing /gastric /reflux. /
Antiocholinergic /agents /would /decrease /LES /pressure.
Why /are /histamine /antagonists /recommended? /- /verified /answers-✔✔Because /they /reduce
/gastric /acidity /by /selectively /blocking /H2 /receptors /(which /mediate /gastric /secretion)
Why /is /elevation /of /the /head /of /the /bed /recommended? /- /verified /answers-✔✔to /encourage
/gravitational /flow /of /the /gastric /contents /toward /the /pyloric /end /of /the /stomach,
What /is /the /normal /pH /of /the /esophagus? /- /verified /answers-✔✔6-7
Of /the /stomach? /- /verified /answers-✔✔3-5
Predict /values /for /the /gastroesophageal /patient /in /this /case /for /lower /esophageal /and
stomach /pH /- /verified /answers-✔✔lower /esophageal /pH /would /be /approximately /3-5.
/
stomach /pH /would /not /change
Gastrointestinal /Case /History /- /Case /20 /- /verified /answers-✔✔A /45-year-old /store /manager
/complained /of /a /burning, /gnawing /pain, /moderately /severe, /almost /always /in /the /epigastric
/region. /The /pain /is /absent /when /he /awakens, /appears /in /midmorning, /and /is /relieved /by
/food /but /recurs /two /to /three /hours /after /a /meal. /The /pain /often /awakens /him /at /1 /or /2 /a.m.
/An /endoscopic /examination /and /x-ray /studies /with /barium /showed /normal /stomach /function
/but /the /presence /of /duodenal /ulcers. /Gastric /analysis /demonstrated /that /the /gastric /juice /pH
/fell /to /1.9 /with /pentagastrin /stimulation /(6µg/kg /s.c.). /Fasting /serum /gastrin /levels /were
/normal. /Recommended /treatments /for /this /individual /follow.
Antacids: /15-30 /mL /of /liquid /or /two /to /four /tablets /one /to /three /hours /after /each /meal /and /at
/bedtime /for /six /weeks.
