NS 4410 FINAL EXAM QUESTIONS WITH
ANSWERS 100% CORRECT
parietal cells - ANSWER secrete HCl and intrinsic factor
G cells - ANSWER secrete gastrin
chief cells - ANSWER secrete pepsinogen
mucus cells of stomach - ANSWER secrete mucin and bicarbonate
receptors that activate HCl secretion - ANSWER Histamine receptors (H2)
Gastrin receptors
Muscarinic receptors (M3)
gastric acid secretion inhibited by - ANSWER PGE2, secretin and somatostatin
GERD classification - ANSWER 1. non-erosive
2. erosive esophagitis
3. Barrett's esophagus
Barrett's esophagus - ANSWER metaplasia of esophageal mucosa
what keeps food in the stomach? - ANSWER 1. LES (closed normally)
2. pressure difference
3. gravity
what protects the esophagus? - ANSWER 1. mucus
2. peristalsis
3. bicarbonate from saliva
4. prostaglandins
PGE2 - ANSWER inhibits gastric acid secretion
PGF2alpha - ANSWER increases sphincter pressure, induce esophageal contractions
extrinsic lower esophageal sphincter - ANSWER right crus of diaphragm, relaxes with
swallowing
intrinsic LES - ANSWER thickening circular smooth muscle, maintains contraction with
,myogenic and neurogenic factors
pathophysiology of GERD - ANSWER 1. gastroesophageal junction incompetence
2. increased abdominal pressure (loss pressure gradient)
3. reduced esophageal clearance
4. gastric factors (delayed emptying or hyper secretory states)
types of hiatal hernia - ANSWER sliding, para-esophageal, mixed, giant
risk factors for sliding hiatal hernia - ANSWER increasing age, smoking, obesity
aggravating factors of GERD - ANSWER laying down, bending at waist, large meals,
tight clothing, alcohol, smoking, weight gain/obesity
relieving factors of GERD - ANSWER sitting up, antacids
sx of GERD - ANSWER post prandial (or at night) heartburn, chest pain, may radiate to
back/shoulder/throat, reflux, chronic cough, laryngitis, belching, hoarseness, dysphagia
risk factors for GERD - ANSWER family history, older than 50, overweight/obese/weight
gain/waist circumference, smoking, NSAID use
dx GERD - ANSWER sx and relief with PPI med
possibly endoscopy, then esophageal pH or Bravo capsule
GERD complications - ANSWER esophagitis, esophageal strictures, Barrett's
esophagus, esophageal adenocarcinoma
- laryngitis, hoarseness, reflux induced asthma, aspiration pneumonia, reflux cough
syndrome, dental erosion
metformin decreases absorption of what? - ANSWER B12
gastroparesis is more common in individuals with what 2 conditions? - ANSWER GERD
and DM
is gastroparesis more common in males or females? - ANSWER females
what are the 3 stages of gastric motility? - ANSWER 1. accomodation
2. trituration
3. emptying
ghrelin and gastric motility - ANSWER increases appetite, stimulates
GLP-1 and gastric motility - ANSWER increases satiety, inhibits motility when food
reaches duodenum
,neuronal control of gastric motility - ANSWER vagus -> astral contraction
enteric NS -> coordinates muscle contraction
interstitial cells of Cajal -> pacemaker cells
pathophysiology of diabetic gastroparesis - ANSWER increased oxidative stress from
hyperglycemia -> reduced relaxation/contraction, loss of pyloric relaxation -> reduced
accommodation, delayed emptying
symptoms of gastroparesis - ANSWER n/v, upper abdominal pain, early satiety,
prolonged post-prandial fullness, loss appetite, bloating, belching
complications of gastroparesis - ANSWER malnutrition, dehydration, poor blood glucose
control with dm
management of gastroparesis - diet - ANSWER symptom improvement
1. low fat, only soluble fiber
2. avoid carbonated beverages, alcohol and smoking
3. small frequent meals
4. remain upright after meals
5. maybe pureed foods, liquid nutritional supplements
6. hydration
gastroparesis medications - ANSWER pro kinetic to increase emptying,
anti-nausea/emetic meds
in what ways is the gastric mucosa protected against injury? - ANSWER mucus layer,
high cell turnover, prostaglandins
prostaglandins - ANSWER stimulate mucus production, inhibit HCl, regulate blood flow
to mucosa
hostile factors to gastric mucosa? - ANSWER NSAIDS, H. Pylori, gastric acid, pepsin
NSAIDs and gastric damage - ANSWER COX inhibitors and reduce synthesis of
prostaglandins
, H. Pylori gastritis - ANSWER 1. penetrates mucous layer
2. urease on surface to generate buffer
3. attachment to gastric epithelium
4. enzymes released toe rod gastric mucosal cells
5. VacA cytotoxin, CagA protein evoke intense inflammatory response in mucosa
gastritis symptoms - ANSWER asymptomatic
indigestion, heartburn, epigastric abdominal pain/ache/burning, nausea
maybe vomiting, bleeding, ulceration
maybe worse or better with eating
when remove irritant, sx resolve
maybe epigastric tenderness
diagnosing gastritis - ANSWER EGD with biopsy
blood test for antibodies to IF or parietal cells
urea breath test (test for H. Pylori)
stool test for H Pylori
management of gastritis - ANSWER antibiotics for H. Pylori, stop NSAIDs, alchohol
- meds to decrease acid secretion
- stop smoking (increases risk ulcer formation)
foods that may increase acid secretion (gastritis) - ANSWER coffee, caffeine, alcohol
foods that may cause direct gastric irritation (gastritis) - ANSWER pepper, chili,
cayenne, chili peppers
ANSWERS 100% CORRECT
parietal cells - ANSWER secrete HCl and intrinsic factor
G cells - ANSWER secrete gastrin
chief cells - ANSWER secrete pepsinogen
mucus cells of stomach - ANSWER secrete mucin and bicarbonate
receptors that activate HCl secretion - ANSWER Histamine receptors (H2)
Gastrin receptors
Muscarinic receptors (M3)
gastric acid secretion inhibited by - ANSWER PGE2, secretin and somatostatin
GERD classification - ANSWER 1. non-erosive
2. erosive esophagitis
3. Barrett's esophagus
Barrett's esophagus - ANSWER metaplasia of esophageal mucosa
what keeps food in the stomach? - ANSWER 1. LES (closed normally)
2. pressure difference
3. gravity
what protects the esophagus? - ANSWER 1. mucus
2. peristalsis
3. bicarbonate from saliva
4. prostaglandins
PGE2 - ANSWER inhibits gastric acid secretion
PGF2alpha - ANSWER increases sphincter pressure, induce esophageal contractions
extrinsic lower esophageal sphincter - ANSWER right crus of diaphragm, relaxes with
swallowing
intrinsic LES - ANSWER thickening circular smooth muscle, maintains contraction with
,myogenic and neurogenic factors
pathophysiology of GERD - ANSWER 1. gastroesophageal junction incompetence
2. increased abdominal pressure (loss pressure gradient)
3. reduced esophageal clearance
4. gastric factors (delayed emptying or hyper secretory states)
types of hiatal hernia - ANSWER sliding, para-esophageal, mixed, giant
risk factors for sliding hiatal hernia - ANSWER increasing age, smoking, obesity
aggravating factors of GERD - ANSWER laying down, bending at waist, large meals,
tight clothing, alcohol, smoking, weight gain/obesity
relieving factors of GERD - ANSWER sitting up, antacids
sx of GERD - ANSWER post prandial (or at night) heartburn, chest pain, may radiate to
back/shoulder/throat, reflux, chronic cough, laryngitis, belching, hoarseness, dysphagia
risk factors for GERD - ANSWER family history, older than 50, overweight/obese/weight
gain/waist circumference, smoking, NSAID use
dx GERD - ANSWER sx and relief with PPI med
possibly endoscopy, then esophageal pH or Bravo capsule
GERD complications - ANSWER esophagitis, esophageal strictures, Barrett's
esophagus, esophageal adenocarcinoma
- laryngitis, hoarseness, reflux induced asthma, aspiration pneumonia, reflux cough
syndrome, dental erosion
metformin decreases absorption of what? - ANSWER B12
gastroparesis is more common in individuals with what 2 conditions? - ANSWER GERD
and DM
is gastroparesis more common in males or females? - ANSWER females
what are the 3 stages of gastric motility? - ANSWER 1. accomodation
2. trituration
3. emptying
ghrelin and gastric motility - ANSWER increases appetite, stimulates
GLP-1 and gastric motility - ANSWER increases satiety, inhibits motility when food
reaches duodenum
,neuronal control of gastric motility - ANSWER vagus -> astral contraction
enteric NS -> coordinates muscle contraction
interstitial cells of Cajal -> pacemaker cells
pathophysiology of diabetic gastroparesis - ANSWER increased oxidative stress from
hyperglycemia -> reduced relaxation/contraction, loss of pyloric relaxation -> reduced
accommodation, delayed emptying
symptoms of gastroparesis - ANSWER n/v, upper abdominal pain, early satiety,
prolonged post-prandial fullness, loss appetite, bloating, belching
complications of gastroparesis - ANSWER malnutrition, dehydration, poor blood glucose
control with dm
management of gastroparesis - diet - ANSWER symptom improvement
1. low fat, only soluble fiber
2. avoid carbonated beverages, alcohol and smoking
3. small frequent meals
4. remain upright after meals
5. maybe pureed foods, liquid nutritional supplements
6. hydration
gastroparesis medications - ANSWER pro kinetic to increase emptying,
anti-nausea/emetic meds
in what ways is the gastric mucosa protected against injury? - ANSWER mucus layer,
high cell turnover, prostaglandins
prostaglandins - ANSWER stimulate mucus production, inhibit HCl, regulate blood flow
to mucosa
hostile factors to gastric mucosa? - ANSWER NSAIDS, H. Pylori, gastric acid, pepsin
NSAIDs and gastric damage - ANSWER COX inhibitors and reduce synthesis of
prostaglandins
, H. Pylori gastritis - ANSWER 1. penetrates mucous layer
2. urease on surface to generate buffer
3. attachment to gastric epithelium
4. enzymes released toe rod gastric mucosal cells
5. VacA cytotoxin, CagA protein evoke intense inflammatory response in mucosa
gastritis symptoms - ANSWER asymptomatic
indigestion, heartburn, epigastric abdominal pain/ache/burning, nausea
maybe vomiting, bleeding, ulceration
maybe worse or better with eating
when remove irritant, sx resolve
maybe epigastric tenderness
diagnosing gastritis - ANSWER EGD with biopsy
blood test for antibodies to IF or parietal cells
urea breath test (test for H. Pylori)
stool test for H Pylori
management of gastritis - ANSWER antibiotics for H. Pylori, stop NSAIDs, alchohol
- meds to decrease acid secretion
- stop smoking (increases risk ulcer formation)
foods that may increase acid secretion (gastritis) - ANSWER coffee, caffeine, alcohol
foods that may cause direct gastric irritation (gastritis) - ANSWER pepper, chili,
cayenne, chili peppers
