CHAPTER 28- GASTROINTESTINAL HORMONES.txt

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scottmreis
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CHAPTER 28- GASTROINTESTINAL HORMONES.txt
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2012-01-07 18:03:45
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  1. Gastrin:
    • 1) produced by G-cells in antrum
    • 2) Secretion stimulated by:
    • 1- amino acids
    • 2- vagal input (ACh)
    • 3- calcium
    • 4- EtOH
    • 5- antral distention
    • 6- pH >3
    • 3) Secretion inhibited by:
    • 1- pH <3
    • 2- somatostatin
    • 3- secretin
    • 4- CCK
    • 5- vasoactive intestinal peptide
    • 6- gastric inhibitory peptide
    • 4) Target cells-
    • 1- parietal cells
    • 2- chief cells
    • 5) Response-
    • 1- increased HCl
    • 2- increased intrinsic factor
    • 3- increased pepsinogen
  2. Omeprazole
    blocks H/K ATPase of parietal cell (final pathway for H+ release)
  3. Somatostatin:
    • 1) produced by D (somatostatin) cells in antrum
    • 2) secretion stimulated by acid in duodenum
    • 3) Target cells- many; is the great inhibitor
    • 4) Response:
    • Inhibits release of:
    • 1-HCl
    • 2- insulin
    • 3- glucagons
    • 4- secretin
    • 5- GIP
    • 6- motilin
    • 7- neurotensin
    • 8- enteroglucagon
    • 9- decreased pancreatic and biliary output
  4. Octreotide:
    • (somatostatin analogue)
    • - can be used to decrease pancreatic fistula output
  5. Gastric inhibitory peptide
    • 1) produced by K cells in duodenum
    • 2) secretion stimulated by:
    • 1- amino acids
    • 2- glucose
    • 3- long-chain fatty acids
    • 4- decreased pH
    • 3) Target cells:
    • 1- parietal cells of stomach
    • 2- beta cells of pancreas
    • 4) Response;
    • 1- decreased HCl secretion and pepsin
    • 2- increased insulin release
  6. CCK:
    • 1) produced by I cells of duodenum and jejunum
    • 2) Secretion stimulated by:
    • 1- amino acids
    • 2- fatty acid chains
    • 3) Response:
    • 1- gallbladder contraction
    • 2- relaxation of spincter of Oddi
    • 3- increased pancreatic enzyme secretion
    • 4- some increase in intestinal motility
  7. Secretin
    • 1) produced by S cells of duodenum
    • 2) secretion stimulated by:
    • 1- fat
    • 2- bile
    • 3- pH <4
    • 3) secretion inhibited by:
    • 1- pH>4
    • 2- gastrin
    • 4) Response:
    • 1- increases pancreatic HCO3- release
    • 2- increases bile flow
    • 3- inhibits gastrin release (this is reversed in patients with gastrinoma)
    • 4- inhibits HCl release
    • 5)
    • High pancreatic duct output- high HCO3, low Cl-
    • Slow pancreatic duct output- high Cl-, low HCO3 (carbonic anhydrase in duct exchanges HCO3- for Cl-)
  8. Vasoactive intestinal peptide:
    • 1) produced by cells in gut and pancreas
    • 2) Secretion stimulated by:
    • 1- fat
    • 2- acetylcholine
    • 3) Response:
    • 1- increased intestinal secretion (water and electrolytes
    • 2- increased motility
    • 3) inhibits gastrin release
  9. Insulin
    • 1) released by beta cells of the pancreas
    • 2) secretion stimulated by:
    • 1- glucose
    • 2- glucagons
    • 3- CCK
    • 3) Secretion inhibited by:
    • 1- somatostatin
    • 2- pancreatostatin
    • 4) Response-
    • 1- cellular glucose uptake
    • 2- promotes protein synthesis
  10. Glucagon
    • 1) released by alpha cells of the pancreas (also from alpha cells in the stomach, intestine)
    • 2) Secretion stimulated by:
    • 1- decreased glucose
    • 2- increased amino acids
    • 3- increase acetylcholine
    • 4- increased gastrin-releasing peptide
    • 3) Secretion inhibited by:
    • 1- increased glucose
    • 2- increased insulin
    • 3- somatostatin
    • 4) Response:
    • 1- glycogenolysis
    • 2- gluconeogenesis
    • 3- lipolysis
    • 4- ketogenesis
    • 5- decreased gastric acid secretion
    • 6- decreased pancreatic secretion
    • 7- decreased intestinal motility
    • 8- decreased stomach motility
    • 9- increased LES pressure
    • 10- decreased MMCs
  11. Pancreatic polypeptide:
    • 1) secreted by islet cells in pancreas
    • 2) Secretion stimulated by:
    • 1- food
    • 2- vagal stimulation
    • 3- other GI hormones
    • 3) Response- decreased pancreatic and gallbladder secretion
  12. Motilin
    • 1) released by intestinal cells of gut
    • 2) Secretion stimulated by:
    • 1- duodenal acid
    • 2- food
    • 3- vagus input
    • 4- gastrin-releasing peptide
    • 3) Secretion inhibited by:
    • 1- somatostatin
    • 2- secretin
    • 3- pancreatic polypeptide
    • 4- duodenal fat
    • 4) Response:
    • 1- increased intestinal (small bowel) motility--> erythromycin acts on this receptor
  13. Bombesin (gastrin-releasing peptide):
    • 1) increased intestinal motor activity
    • 2) increased pancreatic enzyme secretion
    • 3) increased gastric acid secretion
  14. Peptide YY-
    1) released from terminal ileum following a fatty meal--> inhibits acid secretion and stomach contraction; inhibits gallbladder contraction and pancreatic secretion
  15. Anorexia
    mediated by hypothalamus
  16. Bowel recovery
    • 1) small bowel: 24hrs
    • 2) stomach: 48 hours
    • 3) large bowel: 3-5 days

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