Alterations in Nutrition/Metabolism:
GI, Liver, Gallbladder, Pancreas

Reading:

Porth, C.M. (2007)  Essentials of Pathophysiology:  Selected portions of chapters 27-29.

Purposes:

Review the normal anatomy and physiology of the gastrointestinal system as a basis for understanding the pathophysiological changes that occur in disease;

Describe the mechanisms of common manifestations of alterations in motility and secretion in the GI tract;

Discuss the pathophysiologic bases of disorders of nutrient ingestion, digestion, and absorption;

Summarize the pathophysiologic process involved in selected hepatobiliary disorders.

Reading Guide:

Again, as in the last module, to help you determine which parts of the chapters are to be emphasized, refer to the written syllabus for guidance on included topics. 

Also, review the textbook website at http://thePoint.LWW.com/PorthEssentials for links to chapter-related resources with animations and chapter review questions.

Terminology:

Study Questions:

1. What are the major functions of the esophagus, stomach, small intestine, large intestine, liver, gallbladder, and pancreas (exocrine portion)?
2. What anatomical characteristics of the small intestine contribute to its function of absorption of foodstuffs?
3. What are the three main parts of the stomach?
4. Would you expect caffeine and alcohol to have any effect on a patient with gastroesophgeal reflux disease (GERD)? Why?
5. Why does a vagotomy have any effect on the symptoms of peptic ulcer disease? What effect does parasympathetic innervation have on the GI tract generally? To which parts of the GI tract is the sympathetic nervous system stimulatory?
6. Trace the sequence of events that leads from ingestion of a high protein meal to the secretion of pancreatic enzymes? What hormone is an intermediary in this process?
7. What are the three main parts of the small intestine? In which part does the majority of fluid absorption from the gut occur? How much water absorption occurs in the large intestine?
8. What are the sphincters or valves that define the beginning and end of the small intestine?
9. What are the names of the two reflexes that inhibit gastric motility and small intestine motility?
10. When chyme is present in the small intestine, causing secretin to be secreted by the small intestine, what is the effect on motility of the stomach and intestine? Why is this effect desirable?
11. What is the major stimulus for defecation? When is this stimulus the strongest? Why? How would you use this information in helping a person with constipation? What other advice would you give a person with constipation?
12. What are the main manifestations of GI bleeding?
13. If occult bleeding of the GI tract is by definition not visible, how would you know if a patient had this?
14. Compare the manifestations of blood loss in the GI tract in the two situations of acute large losses and chronic blood loss.
15. What is a common causative agent that brings about gastritis?
16. As you compare duodenal and gastric ulcers:
    What is the location of each?
    Which occurs most frequently?
    Which gender is affected more?
    Which occurs more frequently in a younger population (<50 years of age)?
    Which follows a pain ® food ® relief pattern?
    Which is more likely to cause pain at night?
    
17. What is a Curling ulcer? A Cushing ulcer?
18. What are the three major complications of peptic ulcer disease?
19. What is a complication of a gastrectomy? What causes the increased pulse, weakness, pallor, sweating that occur with this complication and why does this occur?
20. Where does a pyloric obstruction occur? What is an example of a problem in infants that could cause a pyloric obstruction?
21. What is another name for congenital aganglionic megacolon?
22. What are two main inflammatory diseases of the intestines? Which has characteristic "skip lesions"? Which is more likely to result in bloody diarrhea? Which is limited to the large intestine (bowel)? Which involves the whole thickness of the intestinal wall? Which is more likely to have malignant potential? Which is also known as regional enteritis?
23. Why would an infant with gluten-sensitive enteropathy have pale bulky stools?
24. Which of the liver functions is especially important for absorption of fats and fat soluble vitamins?
25. Which of the liver functions helps maintain capillary oncotic pressure?
26. From where does the ammonia which the liver converts to urea come? What are the effects if the liver is damaged and cannot process ammonia? What is the condition called when this occurs?
27. What stimulates the release of bile from the gallbladder? If bile is critical to normal digestion, how do people manage after a cholecystectomy?
28. What is the basic cause of jaundice in liver diseases?
29. Why is portal hypertension a problem for patients with liver disease? (What are the effects of the condition?)
30. How might you know if a patient had ascites?
31. From Table 27-5 in the text, compare hepatitis A and hepatitis B:
    Which has the more abrupt onset?
    Which is also called serum hepatitis? Infectious hepatitis?
    Which has the higher mortality?
    Which is spread in a manner similar to the way HIV infection is spread?
    Which can be spread by chronic carriers?
    Which is more likely to result in chronic disease?
    Which can be vaccinated against?
32. Which type of cirrhosis is most related to ingestion of alcohol?
33. What are some manifestations of abnormal bilirubin metabolism?
34. Why is the liver a primary site for metastatic cancers?
35. How are the clinical manifestations for uncomplicated cholelithiasis and cholecystitis different (which would have signs of infection/inflammation)?
36. Why might a male patient with cirrhosis of the liver have a loss of masculine characteristics and the development of some feminine characteristics?
37. What are the effects of the two divisions of the autonomic nervous system on exocrine pancreatic secretion?
38. What is the purpose of bicarbonate ions in pancreatic juices?
39. What is the function of duodenal enterokinase relative to pancreatic digestive enzymes?
40. What effect does cholecystokinin/pancreozymin have on pancreatic secretions?
41. Why is acute pancreatitis a severe disorder? (What causes the shock that is sometimes seen?)
42. What are the main differences between acute and chronic pancreatitis?
43. Why is cancer of the pancreas a serious cancer?
44. What is Zollinger-Ellison syndrome? With what other GI disease might it be confused?

Exercise:

Answer the true/false questions in Module 9 Exercise. Be sure to complete it, so that you can receive extra credit! To add to your learning, if the correct answer is false, make a mental note about what change would be necessary to make the statement true.

Discussion Group:

The deadline to participate in the discussion group for this module is midnight, Dec. 10th.

You're on the home stretch of the course now! Finish this module by Nov. 27 to stay on schedule.   This material will be covered on the exam on Tuesday, Dec. 12, 2006, 3-6 p.m. in 1025 Orr Major.