A 41-year-old woman is brought to the emergency department by her family because of acute onset of right upper quadrant pain, nausea, and vomiting. For this case, it is important to remember that the common bile duct: a. Can be blocked by cancer in the body of the pancreas b. Drains bile into lateral aspect of the second part of the duodenum c. Lies in front of the right margin of the portal vein in the free edge of the lesser omentum d. Is formed by union of the right and left hepatic duct e. Joins the main pancreatic duct to reach the duodenum
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Step 1: The common bile duct is a tube that carries bile from the liver and gallbladder to the small intestine. Show more…
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Case D 14 A 43-year-old man presents to his gastroenterologist with symptoms of peptic ulcer disease. He states that he has a midepigastric burning pain that is relieved by eating food and worse on an empty stomach. The patient has been on numerous antacid medications without relief. He has had recurrent peptic ulcers for the last five years, with minimal relief with the usual treatments. A fasting gastrin level is drawn and found to be extremely elevated. After further tests are done, the patient is diagnosed with a gastrin-secreting tumor in the pancreas. 1. Explain how elevated gastrin levels could cause ulcers. 2. What cells are stimulated to secrete acid by gastrin? 3. How (decrease/increase/no effect) would ingesting antacids with and after a meal so that gastric pH does not decrease below pH 6 affect the secretion of gastrin, secretin, and pancreatic bicarbonate? Case D 15 A 43-year-old woman presents to the emergency department with the acute onset of abdominal pain. Her pain is located in the right upper quadrant (RUQ) and radiates to the right shoulder. She reports nausea and vomiting but no fever or chills. The RUQ pain is worse after she eats fatty meals. On examination the patient has severe right upper quadrant tenderness. Her white blood cell count is elevated, as are her liver function tests and alkaline phosphatase. The amylase and lipase levels are normal. An abdominal ultrasound reveals an enlarged gallbladder with multiple stones and gallbladder wall thickening. She is admitted to the hospital and undergoes a cholecystectomy. 1. Why would fatty foods aggravate the patient's right upper quadrant pain? 2. Why does the patient report pain in the right shoulder? 3. What is the stimulus for the secretion of cholecystokinin (CCK)? 4. What effect does CCK have on gastric emptying? On the gallbladder? 5. Why do gallstones lead to pain?
Madhur L.
is lateral. Two muscular sphincters keep the stomach contents from leaving the stomach. The esophageal sphincter keeps food and stomach acid from returning up the esophagus, and the pyloric sphincter prevents food from moving into the small intestine. Label Figure 10-6 with the terms provided. Examine the structure of the small intestine, shown in Figure 10-7. The main function of the small intestine is to absorb nutrients from its lumen and move them into the blood. In order to maximize absorption, the small intestine must have an increased surface area. This is accomplished by four major adjustments to the small intestine. Examine Figure 10-7, and determine four ways in which the surface area is increased. Part D: The Accessory Organs The liver receives the nutrient-rich blood from the intestines through the hepatic portal vein. As the blood flows through the liver, the nutrients are processed for further use by the body. Kupffer cells (macrophages of the liver) phagocytize foreign material and pathogens. The liver is divided into four lobes: from the anterior view, the right and left lobes can be clearly seen, separated by the falciform ligament. The hepatic vein, which carries the processed blood out of the liver and into the inferior vena cava, can be seen exiting the liver from the posterior side but is not visible on Figure 10-8. The caudate and quadrate lobes can be more easily seen from the inferior view. Also visible from the inferior view is the porta hepatis, the area of the liver where the hepatic portal vein, the hepatic artery, and the common hepatic duct enter and exit the liver. The gallbladder lies on the inferior surface of the liver, near the quadrate lobe. Bile is produced in the liver and travels down the common hepatic duct to the gallbladder where it is stored. The gallbladder releases the bile through the cystic duct into the bile duct. The bile duct joins the pancreatic duct at the hepatopancreatic ampulla. The bile is only released into the small intestine through the hepatopancreatic sphincter when food is in the intestine. It aids in the digestion of fat. The pancreas produces molecules necessary for digestion, including enzymes and ions, as a watery mix called pancreatic juice. The molecules are made in exocrine cells that secrete the digestive aids into the pancreatic duct. The pancreatic duct runs the length of the pancreas and joins the bile duct at the hepatopancreatic ampulla. A small offshoot of this duct, the accessory pancreatic duct, exits into the small intestine directly. Label Figure 10-8A-B with the provided terms.
Adi S.
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