VPHY 4200E Case 2

upper abdominal

pancreatitis pain may be experienced as a dull and steady pain in the ? region

midline, back

pancreatitis may be characterized by pain on the ? of the abdominal cavity that radiates to the lower thoracic region of the ?

neurological

usually if pain intensifies, ? issues occur, including vomiting

alcohol

the patient consumes a great amount of ?, smokes tobacco and has mild hypertension, major depressive disorder, and a family history of hypertriglyceridemia

hypertriglyceridemia

excessive amount of triglycerides in the blood

88

the patient's O2 saturation was about ?%

sympathetic

pain may cause high BP due to ? nervous system stimulation

left

the patient's WBC test showed a ? shift

WBC, ALT, AST, amylase, lipase

the patient's ?, ?, ?, ?, and ? test results came back high

AST, ALT

it can be important to examine the ratio of (ALT/AST) to (ALT/AST)

tachycardia

the patient's EKG showed ?

plasma proteins

include albumins and globulins; account for colloid osmotic pressure

colloid osmotic pressure (P)

pressure exerted by plasma proteins on permeable membranes in the body

albumins

plasma proteins that are produced by the liver, mainly for colloid osmotic P and buffering blood pH

globulins

include alpha and beta (produced by the liver, aid in transport of lipids and fat-soluble vitamins); include gamma globulins (immunoglobulins)

O2, CO2

hemoglobin transports ? and ?

neutral

granules of neutrophils may be seen by staining with a(n) ? dye

acidic

granules of eosinophils may be seen by staining with a(n) ? dye

alkaline

granules of basophils may be seen by staining with a(n) ? dye

granulocytes

a group of leukocytes containing granules in their cytoplasm; neutrophils, eosinophils, and basophils

neutrophil/polymorphonuclear

most abundant white blood cell; first line of defense

50-70

neutrophils account for ___% of total white blood cells

agranulocytes

a group of leukocytes without granules in their nuclei; lymphocytes, monocytes

thrombocytes (platelets)

fragments of megakaryocytes

leukocytosis

an increase in the number of white blood cells; usually caused by a bacterial infection and/or inflammation

left

a (left/right) shift indicates leukocytosis

bone marrow

neutrophil organ of origin

97, 100

normal arterial Hb saturation rate is about ?%, and the PO2 is about ?%

shallow

high respiratory rate along with a low O2 saturation rate indicates that breathing is ?

12-16

normal respiration rate is about ? breaths per minute

smoking

the patient's O2 saturation rate was low because of his ?, which impedes gas exchange in the lungs

hypoxemia

decreased O2 in the blood

hypoxia

decreased O2 for the body's use

O2 saturation rate

low ? causes both hypoxemia and hypoxia

plasma

one way that O2 is transported in the blood is in its dissolved form in ?

dissolved

? O2 in the blood is directly responsible for PO2 in the blood

Hb-O2

oxyhemoglobin

hemoglobin

one way that O2 is transported in the blood is by combining with ? in RBCs, which does not contribute to PO2

sequential

loading and unloading of the blood O2 is a ? process--O2 molecules are dissolved first, the dissolved O2 diffuse to RBCs, and then they bind to Hb

loading, O2, high

the (loading/unloading) of (O2/CO2) occurs at the pulmonary capillaries, where there is (low/high) PO2

dissolved, diffuse, Hb

in the loading and unloading of the blood O2, O2 molecules are ? first, then those molecules ? to RBCs, and then they bind to ?

systemic capillaries

site of O2 unloading and CO2 loading

ml/dl blood/mmHg

solubility of O2 is 0.003 ?

low

O2 has a very (low/high) solubility

solubility, PO2

amount of O2 dissolved in plasma = ? x ?

40, 75

the average PO2 of the systemic veins at rest is about ? mmHg, and the average Hb saturation rate is about ?%

O2 capacity

the maximal (theoretical) amount of O2 bound to Hb (100% saturation); every Hb molecule is bound to O2

1.34

each g of functional Hb binds ? mL O2

mL/g

units for O2/Hb molecule

Hb

O2 capacity only depends on ? concentration in the blood

g Hb/dL blood, 1.34 mL O2/g Hb

O2 capacity (mL/dL blood) = ? x ?

testosterone

men have higher Hb concentrations because ? stimulates Hb production

low

individuals with anemia have (low/high) O2 capacity

high

individuals with polycythemia have (low/high) O2 capacity

increases

polycythemia (increases/decreases) the workload on the heart to pump blood

75

average O2 saturation rate of systemic veins

PO2

Hb saturation rate depends on ?

O2 content (O2 concentration)

the total, actual amount of O2 in the blood (plasma and RBCs together)

dissolved O2, Hb-O2

O2 content = ? + ?

O2 capacity, saturation rate

O2 bound with Hb = ? x ?

98

>?% of O2 transported in the blood is in Hb-O2 form

4.6 mL

O2 content unloaded to the peripheral tissues = ?/dL blood in a normal subject

2.8 mL

O2 content unloaded to the peripheral tissues in this patient = ? /dL blood

17.7 mL

the Hb-O2 of this patient was ?/dL arterial blood

61

?% of O2 normal unloading amount at peripheral tissue results in hypoxemia and hypoxia

amylase

pancreatic enzyme that digests starches into disaccharides; sources are the saliva, pancreas, and other organs; no zymogen

pancreatic lipase

enzyme that digests triacylglycerol into monoacylglycerol and fatty acids

high

pancreatitis commonly causes (low/high) levels of amylase and lipase in the bloodstream

alanine transaminase (ALT)

liver enzyme that is liver specific

aspartate transaminase (AST)

liver enzyme that is present in multiple organs

AST/ALT ratio

very useful measure to differentiate causes of liver damage

2:1

an AST/ALT ratio of ? or greater indicates alcoholic liver disease

skeletal, ALT

in ? muscle, ?converts pyruvate to alanine; alanine is transported via blood to liver; used as a mechanism for skeletal muscle to eliminate NH2 while replenishing its energy

liver, ALT

in the ?, ? converts alanine back to pyruvate

gluconeogenesis, urea cycle

in the liver, ALT converts alanine back to pyruvate for ? and for the ?

urea

NH2 is transported from muscle to the liver in the form of alanine, which is converted to ? and excreted through urine

adrenal medulla

secretes epinephrine and norepinephrine; short-term stress--need glucose for CNS and skeletal muscle--increased glycogenolysis leads to hyperglycemia under stress--increased lipolysis (glucagon-like effects)

adrenal cortex

secretes glucocorticoids (e.g. cortisol); long-term stress; increased hypothalamic CRH, leading to increased pituitary ACTH, and finally increased glucocorticoids secretion; increased glucagon secretion leads to glycogenolysis, causing hyperglycemia; increased lipolysis, ketogenesis, and hyperketoemia; increased protein breakdown, gluconeogenesis, causing hyperglycemia

glucocorticoids

long-term stress causes an increase in the secretion of a class of hormones called ?

endocrine

(endocrine/exocrine) function of pancreas: islets of Langerhans secrete insulin and glucagon

exocrine

(endocrine/exocrine) function of pancreas: secrete pancreatic juice

acinar cells

secrete enzymes into ducts that are delivered to digestive tract (exocrine)

ductal cells

secrete HCO3- and water to neutralize acidic chyme so that enzymes can function

zymogens

most pancreatic enzymes are produced as inactive proenzymes, packed in ?

secretin (HCO3-), cholecystokinin (CCK, pancreatic digestive enzymes)

pancreatic exocrine secretion is stimulated by ? and ?

pancreatic duct

the largest duct along the pancreas; collects pancreatic juice, which goes to the opening of the small intestine

zymogens

granules that perform exocytosis and secrete enzymes into the acinar lumen--the enzymes travel through a duct and merge into the pancreatic duct

GEP (gastroenteropancreatic)

? endocrine cells are GI epithelial cells that secrete hormones (such as secretin and CCK)

small intestine

secretin and cholecystokinin (CCK) are secreted by the ? (organ)

secretin

stimulates water and bicarbonate secretion in pancreatic juice

cholecystokinin (CCK)

stimulates contraction of gallbladder; stimulates secretion of pancreatic juice enzymes; controls satiety

acidic

stimuli for small intestine secretion of secretin are ? content in the duodenum and fat

duodenum

secretin is used to help digest food in the ?

fat

stimuli for small intestine secretion of CCK are ?, protein, and acid

contraction, relaxation, bile

cholecystokinin effect: (contraction/relaxation) of the gallbladder and (contraction/relaxation) of the Sphincter of Oddi for ? release

digestive enzymes

CCK effect: pancreatic secretion of ?

satiety

CCK produces ? to food by signaling to the hypothalamus; important because digestion of fat takes a while

enterokinase

a duodenal enzyme that activates trypsinogen (from the pancreas) to trypsin

trypsin

an enzyme from the pancreas that digests proteins in the small intestine

lipase

pancreatic enzyme necessary to digest fats--no zymogen