2.04

Question 1

PUD Causes

Answer 1

H.Pylori (50% cases)
NSAIDs
Zollinger-Ellison syndrome

Question 2

Non-invasive H.pylori tests

Answer 2

C-13 breath test
Serological test (IgG)
Stool antigen

Question 3

Invasive H.Pylori tests

Answer 3

Urease test (via biopsy)
Histology (via biopsy)
Culture (via biopsy)

Question 4

PUD Ix

Answer 4

*Endoscopy * (definitive Ix)

Obs
H.pylori testing
ECG
FBC
LFTs
Amylase/Lipase

Question 5

Zollinger-Ellison pathophys

Answer 5

Gastrinoma
- Produces gastrin
Increases gastric acid production

Question 6

H.pylori PUD pathophys

Answer 6

Colonises antrum (least acidic)
- secretes urease - converts urea to ammonia
- pH rises around receptors - increases GA production

Question 7

PUD general clinical features

Answer 7

Epigastric pain
Dyspepsia
Haematemesis
Melena
Anaemia symptoms

Question 8

Types of Peptic ulcers

Answer 8

Duodenal
Gastric

Question 9

Duodenal ulcers CFs

Answer 9

Pain, day and night
Worse when hungry
Subsides after eating
Relieved w/ antacids

Question 10

Duodenal ulcer complication

Answer 10

Rupture
- Posterior ulcers will bleed from gastroduodenal artery

Question 11

Gastric ulcer CFs

Answer 11

Epigastric pain (worse after meal)
Anorexia & weight loss

Question 12

1st line H.Pylori eradication therapy

Answer 12

7 day course
- PPI
- Amoxicillin
Clarithromycin/Metronidazole

If allergic to penicillin:
- PPI
- Clarithromycin
- Metronidazole

Question 13

Which pancreatic cells secrete digestive enzymes?

Answer 13

Acinar cells (exocrine)

Question 14

Which pancreatic cells secrete bicarbonate?

Answer 14

Ductal cells (exocrine)

Question 15

What do acinar cells produce?

Answer 15

Digestive enzymes: amylase, lipase, proteases

Question 16

What is the function of bicarbonate from ductal cells?

Answer 16

Neutralizes stomach acid in duodenum

Question 17

Which pancreatic cells secrete insulin?

Answer 17

Beta (β) cells

Question 18

Which pancreatic cells secrete glucagon?

Answer 18

Alpha (α) cells

Question 19

Which pancreatic cells secrete somatostatin?

Answer 19

Delta (δ) cells

Question 20

Which pancreatic cells secrete pancreatic polypeptide?

Answer 20

PP (F) cells

Question 21

Which pancreatic cells secrete ghrelin?

Answer 21

Epsilon (ε) cells

Question 22

What is the role of insulin?

Answer 22

Lowers blood glucose by promoting uptake/storage

Question 23

What is the role of glucagon?

Answer 23

Raises blood glucose by promoting glycogenolysis & gluconeogenesis

Question 24

What is the role of somatostatin?

Answer 24

Inhibits insulin, glucagon, and GI hormones

Question 25

What does pancreatic polypeptide do?

Answer 25

Regulates pancreatic secretions and GI motility

Question 26

What does ghrelin do?

Answer 26

Stimulates hunger and GH release

Question 27

Which cells release gastrin?

Answer 27

G-cells in the stomach antrum

Question 28

What triggers gastrin release?

Answer 28

Stomach distension, proteins, vagal stimulation (ACh)

Question 29

What does gastrin do?

Answer 29

Increases gastric acid (HCl) secretion from parietal cells

Question 30

What inhibits gastrin?

Answer 30

Low pH and somatostatin

Question 31

Which cells release secretin?

Answer 31

S-cells in the duodenum

Question 32

What triggers secretin release?

Answer 32

Acidic chyme in the duodenum

Question 33

What does secretin do?

Answer 33

Stimulates pancreatic bicarbonate secretion; inhibits gastric acid

Question 34

Which cells release CCK?

Answer 34

I-cells in the duodenum

Question 35

What triggers CCK release?

Answer 35

Fats and proteins in chyme

Question 36

What does CCK do?

Answer 36

Stimulates gallbladder contraction, pancreatic enzyme release; slows gastric emptying

Question 37

Which cells release somatostatin?

Answer 37

D-cells in the stomach and pancreas

Question 38

What does somatostatin do?

Answer 38

Inhibits gastrin, secretin, CCK, insulin, and glucagon

Question 39

When is somatostatin released?

Answer 39

In response to low pH or high hormone levels

Question 40

Which cells release motilin?

Answer 40

M-cells of the small intestine

Question 41

When is motilin released?

Answer 41

During fasting (cyclically)

Question 42

What does motilin do?

Answer 42

Stimulates migrating motor complex (MMC) to clean out gut

Question 43

Which cells release GIP?

Answer 43

K-cells in the duodenum/jejunum

Question 44

What triggers GIP release?

Answer 44

Glucose and fats in the small intestine

Question 45

What does GIP do?

Answer 45

Stimulates insulin release (incretin effect); inhibits gastric acid

Question 46

Which cells release GLP-1?

Answer 46

L-cells in the ileum and colon

Question 47

What triggers GLP-1 release?

Answer 47

Nutrients in the distal gut (esp. carbohydrates)

Question 48

What does GLP-1 do?

Answer 48

Increases insulin, decreases glucagon, slows gastric emptying

Question 49

Which cells release histamine (in GI tract)?

Answer 49

ECL cells in the stomach

Question 50

What does histamine do?

Answer 50

Stimulates HCl secretion from parietal cells via H2 receptors

Question 51

Which hormone makes you feel hungry?

Answer 51

Ghrelin, secreted by the stomach

Question 52

What does ghrelin do?

Answer 52

Stimulates hunger and growth hormone release

Question 53

Which cells release pancreatic polypeptide?

Answer 53

PP (F) cells in the pancreas

Question 54

What does pancreatic polypeptide do?

Answer 54

Regulates pancreatic exocrine secretion and gut motility

Question 55

Which cells release peptide YY (PYY)?

Answer 55

L-cells in the ileum and colon

Question 56

When is PYY released?

Answer 56

After a meal, especially high-fat

Question 57

What does PYY do?

Answer 57

Suppresses appetite and slows gastric emptying