Beruflich Dokumente
Kultur Dokumente
Specialty Examination
Rule of thirds:
1/3 of questions are simple no study needed.
1/3 of questions you will answer from experience.
1/3 of questions you will not know, studying will
not help (with combination of studying and
experience you can make an educated guess in
1/3).
Digestion
Process by which large molecules in
diet are broken down into smaller ones,
which are acceptable to the
enterocytes for absorption.
Absorption
Process by which contents of the small
bowel enter the mucosal epithelial
cells, and eventually the portal vein or
lymphatics.
Protection
Barrier to entry of pathogens and
toxins
Inhibition of Saliva
Anticholinergics, analgesics,
antispasmodics, antidiarrheals,
antidepressants, antihistamines,
antihypertensives, antipsychotics,
and diuretics
Stimulation of Saliva
Pilocarpine 5mg po tid
Esophagus
Transports food to stomach
Pharyngeal lipase hydrolyzes
triglycerides to diglycerides and fatty
acids
Stores, mixes,
and grinds
food to form
an emulsion
Gastroesophageal
Junction
Incisura
Pylorus
Duodenal
Bulb
Cardia
Body
Antrum
F
u
n
d
u
s
Mucous Cell
Parietal Cell
Zymogen Cell
Lymph Nodule
Argentaffine Cell
Muscularis Mucosae
Pyloric Glands
Submucosa
Acid
pH 1-3
Mucous gel
layer
Bicarbonate / Mucus
pH 7
Gastric lumen
Gastric mucosa
Zymogen
Cell
Mucous
Cell
Parietal
Cell
Small Intestine
Major organ for nutrient absorption
Absorptive surface enhanced by plicae
circulares, foldings called villi with surface
projections called microvilli
Final surface area about 1.7 m cm2
About 800 cm2 to absorb 1 Kcal (100-200
cm2/Kcal minimum)
Villus
Jejunum
Ileum
A. 3 tennis courts
B. 5 tennis courts
C. 1 tennis court
D. 10 tennis
courts
A. 3 tennis courts
B. 5 tennis courts
C. 1 tennis court
D. 10 tennis
courts
C. 2/3
B. 1/2
D. 3/4
C. 2/3
B. 1/2
D. 3/4
C. 3 feet
B. 5 feet
D. 1 foot
C. 3 feet
B. 5 feet
D. 1 foot
Nutrient Absorption
Sites of Nutrient
Absorption
Sites of Nutrient
Absorption
Good question
5. What nutrient
deficiency might be
expected if 3 feet
of the terminal
ileum is resected?
A. Iron
C. Vit B-12
B.
Magnesium
D.
Calcium
Sites of Nutrient
Absorption
Good question
5. What nutrient
deficiency might be
expected if 3 feet
of the terminal
ileum is resected?
A. Iron
C. Vit B12
B.
Magnesium
D.
Calcium
Sites of Nutrient
Absorption
Much harder
question
6. What nutrient
deficiency might be
expected if 3 feet
of the terminal
ileum is resected?
A. Iron
C. Vit B12
B.
Magnesium
D. Fat
Absorption of Water
A. Zinc Sulfate
C. Magnesium
Chloride
B. Sodium Chloride
D.Medium-Chain Fat
A. Zinc Sulfate
C. Magnesium
Chloride
B. Sodium Chloride
D.Medium-Chain Fat
Absorption of Water
Sodium absorption
is directly coupled
to absorption of
organic solutes
such as glucose,
amino acids, watersoluble vitamins,
and bile salts
Chloride passively
follows absorption
of sodium
Absorption of Potassium
in Small Bowel
Absorption of Calcium
Absorption of Calcium
Absorption of Magnesium
C. Magnesium
B. Sodium
D. Copper
C. Magnesium
B. Sodium
D. Copper
Absorption of Copper
C. Magnesium
B. Sodium
D. Copper
C. Magnesium
B. Sodium
D. Copper
Absorption of Zinc
Absorption of Zinc
Absorption of Iron
C. Lactose
B. Sucrose
D. Fructose
C. Lactose
B. Sucrose
D. Fructose
64
0.5
80
20
26
6.5
10
Luminal phase
Hydrolysis of starch by salivary and
pancreatic -amylases
Cleaves starches to yield limit dextrans, maltotriose, and
maltose
Brush-border phase
Hydrolysis by glycosidases to
monosaccharides:
glucose, galactose, and fructose
GLUT2
GLUT5
GLUT2
SGLT1
Galactos
e
Fructose
Glucose
Two types
Cellulosic: high molecular weight, nonsoluble (cellulose, wheat bran)
Noncellulosic: soluble (hemicelluloses,
pectin, gums, mucilages)
Cellulosic fiber
Contributes to fecal mass and water
content
Reduces mean stool transit time
96% of ingested
fat is absorbed daily
Triglycerides
Lipid Absorption
A. Arachidonic acids
C. Chenodeoxycholic
acids
B. Medium-chain fatty
acids
D. Picric acids
A. Arachidonic acids
C. Chenodeoxycholic
acids
B. Medium-chain fatty
acids
D. Picric acids
C. PepT1
B. Endopeptidase
D. SGLT1
C. PepT1
B. Endopeptidase
D. SGLT1
Malabsorption
Malabsorption
Normal Stool Composition
Water
100 ml
Sodium
4 mEq
Potassium
9 mEq
Chloride
2 mEq
Bicarbonate
0 mEq
From 3/week to 3/day considered normal
Diarrhea = stool weight > 200 to 500 g/24 h
Malabsorption - Screening
Tests
Malabsorption - Screening
Tests
Serum carotene
D-xylose absorption
Specialty Examination
Good Luck !!