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64 Cards in this Set
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The Absorption of B12
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1. Salivary Glands Secrete R protein haptocorrin which binds B12 to prevent acid denaturation in Stomach
2. stomach parietal cells (located midway down gastric pits) secrete intrinsic factor R factor binds B12 in stomach once released from food by Acid 3. Pancreatic proteases cleave R factor which is immediately bound by intrinsic factor (to prevent degredation in SI by pancreatic enzymes) 4. IF-B12 complex abosrbed in distal ileum by IF specific receptor |
#biochemistry #nutrition #gastrointestinal
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Haptocorrin
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R factor
secreted by salivary glands binds to B12 to prevent hydrolysis by gastric acidity degraded by pancreatic proteases (where IF binds to prevents proteolytic degradation of B12) |
#biochemistry #nutrition #gastrointestinal
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Elderly Patient with Anemia and negative Fecal Occult Blood
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Probably B12 deficiency 2° aging → gastric atrophy → [relative] achlorhydria → poor B12 release from eaten foods
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#biochemistry #nutrition #gastrointestinal #hematology
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Diarrhea, Weight Loss, Arthralgia
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Whipple's Dz
"Foamy" PAS+ M∅ Mn: CAN of Whipped Cream Cardiac Sx Arthralgias Neurologic Sx |
#gastrointestinal #microbiology #pathology
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Acute Stress Ulcers
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Trauma/Shock/Burns
Curling Ulcers: duodenal 2° to hypoxia Cushing Ulcers: Esophagus, Stomach, Duodenum 2° to ↑ ICP → Vagal Stim → H+ hypersecretion; prone to perforate |
#gastrointestinal #pathology #ulcers
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Curling Ulcers
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duodenal ulcers 2° to shock hypoxia
NB: not Cushing Ulcers: Esophagus, Stomach, Duodenum 2° to ↑ ICP → Vagal Stim → H+ hypersecretion; prone to perforate |
#gastrointestinal #pathology #ulcers
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Cushing Ulcers
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Esophageal, Gastric, Duodenal Ulcers
2° to ↑ ICP → Vagal Stim → H+ hypersecretion; prone to perforate NB: not Curling Ulcers: duodenal ulcers 2° to shock hypoxia |
#gastrointestinal #pathology #ulcers
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Erosions vs Ulcers
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Erosions do not cross muscularis mucosa
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#pathology #gastrointestinal
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epigastric pain following food after ~30 min → weight loss
no abnormalities on scope |
chronic mesenteric ischemia 2° to atherosclerotic narrowing of Celiac Trunk, SMA or IMA
microscopy would reveal atrophy |
#gastrointestinal #pathology
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Cauliflower mass in sigmoid colon causing mucoid diarrhea
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villous adenoma
NB: carcinoid tumors also cause diarrhea, but not polypoid (?) |
#pathology #gastrointestinal #neoplasia
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Zenker Diverticulum
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Esophageal Diverticium 2° inncreased pressure 3* to crichopharyngeal hypertony
crichopharyngeal muscles don't relax, more force required to push food → outpouching retained food, regurgitation, aspiration all complications |
#pathology #gastrointestinal
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Refractory PUD
Gastric Hypertrophy 2° to ? |
Gastrin (ZE)
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#pathology #gastrointestinal
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Cystic pancreatic lesion 3 weeks post pancreatitis
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pancreatic pseudocyst 2° pancreateic enzymatic degradation of pancreas
not a true cyst, lined by fibrosis and granulation ts, no epithlelium most commonly lesser peritoneal sac posterior to stomach |
#pathology #gastrointestinal
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Conoloscopy Findings:
protuberant mass Likely Dz? |
adenocarcinoma
biopsy: dysplastic mucosa w/ gland formation |
#pathology #gastrointestinal
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Conoloscopy Findings:
multiple ulcers and mucosal erosions Likely Dz? |
CMV
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#pathology #gastrointestinal
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Conoloscopy Findings:
nonulcerative inflammation Likely Dz? |
cryptosporidium
biopsy: basophilic clusters seen on surface of intestinal mucosal cells |
#pathology #gastrointestinal
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Conoloscopy Findings:
numerous discrete flash-shaped ulcerations Likely Dz? |
entamoeba histolytica
biopsy: trophozoites contianing RBC's |
#pathology #gastrointestinal
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Conoloscopy Findings:
violet flat maculopaular lesions & hemorrhagic nodules Likely Dz? |
Kaposi's sarcoma
HHV-8 biopsy: spindle shpaed tumor cells w/ small vessel proliferation |
#pathology #gastrointestinal
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Biopsy Findings:
dysplastic mucosa w/ gland formation Likely Dz? |
adenocarcinoma
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#pathology #gastrointestinal
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Biopsy Findings:
basophilic clusters seen on surface of intestinal mucosal cells Likely Dz? |
cryptosporidium
nonulcerative inflammation |
#pathology #gastrointestinal
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Biopsy Findings:
trophozoites containing RBC's Likely Dz? |
entamoeba histolytica
numerous flask shaped uilcerative lesiosn |
#pathology #gastrointestinal
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Biopsy Findings:
spindle shaped tumor cells with small vessel proliferation Likely Dz? |
Kaposi's sarcoma
HHV-8 |
#pathology #gastrointestinal
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Diphenoxylate
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opiod used motility diarrhea
often combined with atropine as lomotil |
#pharmacology #drugs #gastrointestinal
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Frequency:
Esophageal Cancers |
Adenocarcinoma > Squamous Cell Carcinoma
People are fatter and smoking less |
#neoplasia #pathology #gastrointestinal
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HNPCC adenocarcinoma vs Sporadic Adnocarcinoma
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HNPCC
<50 yo right sided multiple arise from apparently normal ts caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2 Sporadic >50 yo left sided single arise from adenomatous polyps genetics: adenoma → CA sequence: APC, K-ras, p53 & finally DCC |
#pathology #neoplasia #genticdzs #gastrointestinal
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Right Sided Adenocarcinoma
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HNPCC
<50 yo right sided multiple arise from apparently normal ts caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2 |
#pathology #neoplasia #genticdzs #gastrointestinal
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MLH1
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HNPCC
<50 yo right sided multiple arise from apparently normal ts caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2 |
#pathology #neoplasia #genticdzs #gastrointestinal
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MLH2
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HNPCC
<50 yo right sided multiple arise from apparently normal ts caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2 |
#pathology #neoplasia #genticdzs #gastrointestinal
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MSH6
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HNPCC
<50 yo right sided multiple arise from apparently normal ts caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2 |
#pathology #neoplasia #genticdzs #gastrointestinal
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PMS2
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HNPCC
<50 yo right sided multiple arise from apparently normal ts caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2 |
#pathology #neoplasia #genticdzs #gastrointestinal
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Colonic Adenocarcinoma in a 30 yo
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HNPCC
<50 yo right sided multiple arise from apparently normal ts caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2 |
#pathology #neoplasia #genticdzs #gastrointestinal
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Colonic Adenocarcinoma in a 70 yo
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Sporadic
>50 yo left sided single arise from adenomatous polyps genetics: adenoma → CA sequence: APC, K-ras, p53 & finally DCC |
#pathology #neoplasia #gastrointestinal
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Gastric Adenocarinomas
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2 variants
signet ring: do not form glands, contain mucin diffusely involve stomach wall, often infiltrate cause "leather bottle" linitis plastica intestinal type resemble colon cancers: grow as well demarcated masses of well formed glands |
#pathology #gastrointestinal #neoplasia
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Rugal thickening of stomach
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indicative of ZE sro
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#pathology #gastrointestinal #neoplasia
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"leather bottle" stomach
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signet rinng gastric adenocarcinoma: do not form glands, contain mucin
diffusely involve stomach wall, often infiltrate cause "leather bottle" linitis plastica |
#pathology #gastrointestinal #neoplasia
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linitis plastica
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signet rinng gastric adenocarcinoma: do not form glands, contain mucin
diffusely involve stomach wall, often infiltrate cause "leather bottle" linitis plastica |
#pathology #gastrointestinal #neoplasia
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Pathogenesis of Crohn's Nephrolithiasis
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normally dietary Ca2+ binds dietary Oxalate → insoluble salts → oxalate excretion
Crohns: loss of bile acids → impaired fat absorption → Ca2+ FA Soap formation → excretion → unbound oxalate taken up → Calcium Oxalate Stones Radiopaque Octahedrons |
#pathology #gastrointestinal #nephrology #nephrolithiasis #inflammation
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Fever, GI distress, Hepatosplenomegaly, Periumbilical Rose Spots
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Salmonella typhi
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#microbiology #gastrointestinal #hepatobiliary #pathology
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Rectal Prolapse in Children
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CF
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#pathology #geneticdzs #gastrointestinal
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Osmotic Laxitives
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Polyethylene Glycol
& Magnesium Chloride |
#pharmacology #gastrointestinal
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Microbe: produce diarrhea with small innoculum
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Entamoeba Histolytica (1)
Giardia (1) Shigella (10) Campylobacter jejuni (500) |
#microbiology #gastrointestinal
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Plummer Vincent Sro
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Triad of
Iron Deficiency Anemia (Spoon Nails aka Koilonychia) Glossitis Esophageal Webbing (Dysphagia) |
#pathology #hematology #gastrointestinal
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Anemia + Dysphagia
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Plummer Vincent Sro
Triad of Iron Deficiency Anemia (Spoon Nails aka Koilonychia) Glossitis Esophageal Webbing (Dysphagia) |
#pathology #hematology #gastrointestinal
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Spoon Nails + Dysphagia
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Plummer Vincent Sro
Triad of Iron Deficiency Anemia (Spoon Nails aka Koilonychia) Glossitis Esophageal Webbing (Dysphagia) |
#pathology #hematology #gastrointestinal
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Most common location of colon cancer
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rectosigmoid colon
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#pathology #neoplasia #gastrointestinal
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Palpable But Non-Tender Gallbladder
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Courvoisier Sign
indicative of adenocarcinoma of head of pancreas compressing bile duct Biggest environmental contributor: smoking |
#pathology #gastrointestinal
#neoplasia |
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Low Fiber Diet v CA
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Colonic Adenocarcinoma
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#pathology #gastrointestinal #neoplasia |
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Best Diagnostic Test for Distended, Tympanic Abdomen
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Potential Toxic Megacolon
Flat Plain X Ray Anything that invades (scope, enema) may induce perforation |
#pathology #diagnostics #gastrointestinal
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Pt cannot clear Giardia infx
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IgA deficiency
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#microbiology #immunology #gastrointestinal
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Where are ulcers not likely to be malignant
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Vast Majority of Ulcers Duodenal
Even when H pylori induced, not likely malignant Esewhere assoc. w/ malignancy Stomach: adenocarcinoma, maltoma Esophagus: adenocarcinoam Colon: annular "napkin rings" or UC (still ↑ risk) |
#neoplasia #pathology #gastrointestinal
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Layers of the Gastric Mucosa
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Surface: simple columnar epithelium which secretes mucus to protect lining
Gastric Pits short things Midway down Gastric PIts: parietal Cells: HCl & Intrinsic Factor Botton of the PIts: Cheif Cells: Pepsinogen |
#physiology #gastrointestinal
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Intestinal Invasion: Agents
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Salmonella
Shigella EIEC Campylobacter jejunu Entamoeba histolitica |
#microbiology #gastrointestinal
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"Stacked Brick" Intestinal Bacterial Adhesions
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Enteroaggregative E coli EAEC
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#microbiology #gastrointestinal
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What is absorbed in the duodenum?
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Iron
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#physiology #gastrointestinal
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Esophageal Neoplasm with Keratin Pearls
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Squamous Cell Carcinoma
EtOH & Tob Poor Px |
#pathology #neoplasia #gastrointestinal
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Gastrin secreting tumors
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Zollinger Ellison Sro
↑ histamine release from enterochromaffin like cells → ↑ ↑ H+ prodxn by parietal cells multiple ulcers in odd places diarrhea 2° to inactivated pancreatic enzymes |
#pathology #neoplasia #gastrointestinal
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Compare Crohn's to UC in terms of
Involvement, Cheif Complaint and Complications |
Crohns: anywhere along gut w/ skip lesions
inflammation of entire thickness w/ linear ulcerations & granulomas CC: abdominal pain>diarrhea Complications: Fistulas & Strictures UC: Starting from the rectum w/ continous progression only mucosal/submucosal only (thus no fistulas) CC: Bloody Diarrhea Complixn: Toxic Megacolon |
#pathology #gastrointestinal
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Brown Pigment Stones vs Black Pigment Stones
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black: hemolysis
brown: biliary tract infx |
#gastrointestinal #pathology
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Colonic Polyps
What features indicate malignant vs benign |
Non-neoplastic Polyps:
Hyperplastic (well differentiated w/ crypts and glands) Hamartomatous: sporatic or Peutz-Jeghers and Juvenile Polyposis Inflammatory: regenerating (Crohns) Lymphoid: children Neoplastic factors: Degree of dysplasia Villous>Tubular Size esp >4 |
#pathology #gastrointestinal #neoplasia
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Electrolytes through the pancreatic ducts
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released isotonic to plasma
regulated by secretin from duodenal S cells in response to H+ HCO3 exchanged for Cl along the way the more secretin, the more these exchange by the end, the more alkaline the secretions |
#physiology #gastrointestinal
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How does a cholecystectomy affect lipid digestion/absorption
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it does not affect where lipids are digested (duodenum) or absorbed (jejunum)
bile acids are still produced by the liver and released into entero-hepatic circulation what changes is a ↓ tolerance for eating a lot of fat at one sitting because there is no storage |
#physiology
#gastrointestinal |
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Lipid Digestion and Absorption: Locations
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Digestion: Dudoenum
Absorption: Jejunum |
#physiology
#gastrointestinal |
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Dermatitis herpetiformis 2° to GI pathology
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Celiac Dz
Small pruritic vesicles on extensor surfaces 2° to IgA deposition at tips of dermal papillae |
#pathology #gastrointestinal #skin
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Small pruritic vesicles on extensor surfaces in pt w/ GI problems
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Dermatitis herpetiformis of Celiac Dz
Staining will demonstrate IgA deposition at tips of dermal papillae |
#pathology #gastrointestinal #skin
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