GASTROINTESTINAL SYSTEM1
CONSTRUCTIVE RESPONSE QUESTIONS
1. List the functions of HCI in stomach. What prevents damage to mucous membrane of
stomach? (2+8)
2) Describe mechanism of Hcl secretion and explain pathophysiology of peptic ulcer. (5+5)
14) Describe entero-hepatic circulation of bile salts with the help of well labeled diagram.
Add a note on its significance.(6+2+2)
15) Describe mechanism of secretion and regulation of bile. (5+5)
16) What are different types of salivary glands? Describe the composition and functions
of saliva.(2+2+6)
17) Explain the digestion of carbohydrates and proteins.(5+5)
in vomiting reflex with the help of
18) Define vomiting and explain sequence of events
suitable diagram. (1+7+2)
19) Describe composition and functions of pancreatic juice. (5+5)
9) Describe composition and regulation of secretion of pancreatic juice (5+5)
Describe the movements of small
10) Enumerate types of contractions in small intestine.
intestine with labeled diagram. (2+8)
11) What is deglutition? Describe deglutition reflex. Add a note on disorders of deglutiotion.
(1+6+3)
12) Describe composition, functions and regulation of secretion of Gastric Juice. (2+2+6)
13) What are types of gastric motility? Describe mechanism of gastric emptying. (2+8)
of colon.
(5+5)
14) Describe the movements of colon. Add a note on disorders
defecation reflex. (2+4+4)
15) What is defecation? Describe pathway and mechanism of
smooth muscles.
16) What are different types of couplings seen in seen in gastrointestinal
in G I smooth
Describe basal electrical rhythm, slow waves and action potential
seen
muscles. (2+2+3+3)
Describe functions of gastrin and
17) What are types of gastro intestinal hormones?
cholecystokinin. (2+4+4)
hormones of secretin family. Describe their functions. (2+8)
18) Enumerate G.I
19) Describe liver function tests to assess
synthetic functions and metabolic functions of liver
(6+5)
20) Explain the digestion and absorption of fats and add a note on role of bile salts in
digestion of fats. (5+5)
CLINICAL BASED QUESTIONS
Case:1
At a grand
birthday party, looking at sumptuous, lavish spread of food at the table, Mohan had
watering of mouth.
1. Describe the reflex mechanism behind it.
2. Elaborate all the changes that have occurred in his
gastrointestinal tract after looking at
lavish spread of food.
3. Explain composition and functions of saliva.
4. Describe the regulation of
salivary secretion.
Case:2
Peter went to a five star hotel for a party, where seven course meals were served starting with
Soup.
1. Explain the physiological basis of having a soup or appetizers before meal.
2. Describe the mechanism of receptive relaxation.
3. Describe the motility of filled stomach.
Case:3
50 year old Rohan visited OPD with complaints of loose, heavy, foul-smelling, fat-filled stool
since 6 months. He was also having history of muscle weakness and weight loss since 6 months.
He had past history of pancreatic carcinoma for which he was
operated last year.
On examination, he had pallor.
On investigations, fecal fat content was higher.
1. What could be the problem with Rohan?
2. Enumerate pancreatic enzymes. What is their role in digestion?
3. Describe the regulation of exocrine pancreatic secretions.
Case:4
25 yexr od IT enginea visited a phyiian wi tae
since 3 weeks, He als omplaired of
cmpizias oi pzin in per ef anazmen
On investigations,
bketinsg domen ad dark coicred sonl s e 5 dz
yastric furctisn tests revezied, incresei besel aid
revealed erosíon of gasttic mcona auga nisog
1. What could be the
andho ulcerative lesions wae vsu
2. What are the causes of his
probable diagrOiS?
condition?
3. What are the phases of
gastric aid secaetion?
4. Define basal acid
output?
5. How is it measured?
Case:5
A 42 year old obese female visited
casualty with complaints of severe pain in upper igs poriona
of abdomen since 4 hours. She was also having rausea and
vomining Ab
ultrasonography revealed presence of gallbladder stones obstructing common bik duct.
. What will be the consequences
of gallbladder stone?
2. What are the functions of bile secretions
3. Explain the regulation of bile secretion.
4. What are the functions of gallbladder?
5. Describe enterohepatic circulation of bile salts.
6. Compare and contrast gallbladder and liver bile.
Case:6
50 year old male patient visited OPD with complaints of diff+culty in swallowing both solid and
liquid food since two weeks. He was also having chest pain and regurgitation of food along with
it. Oesophageal manometry revealed loss of distal esophageal peristalsis and incomplete
relaxation of lower esophageal sphincter.
1.
What could be the probable diagnosis?
2. Explain the cause of his condition.
3. What happens at lower oesophageal sphincter during swallowing.
4. Describe pharyngeal and oesophageal phases of deglutition.
Case:7
Smita was fasting for complete 24 hours. Now she has strong desire for food, started having
pain in abdomen and she could feel gurgling sensation in the abdomen.
1. What could be her condition?
2. What is migrating motor complex?
3. How are they related to basal electrical rhythm?
4. What is the role of migrating motor complex?
5. Describe the mechanism of gastric emptying.
Case:8
5 year old boy, brought to pediatrics OPD
by his mother with chief complaint of defecation in a
short time after every meal.
1. What could be behind this behaviour?
reason
2. Describe the
physiological basis behind the same.
3. Describe the
regulation of gastric emptying
Case:9
30 year old Ravi had a problem of chronic constipation. Physician advised him to have a lot of
fiber rich diet.
1. Explain the physiological basis behind it.
2. What are the different types of dietary fibers?
3. Explain the importance of dietary fibers.
4. Describe the mechanism of defecation.
5. What is colonic transit time?
6. What is constipation and what are its causes?
Case:10
Milind ate rice meal at the time of dinner.
Explain the mechanism of digestion and absorption of it.
Case:11
Mahesh loves a lot of fried fatty food.
1. Explain how the fried fatty food is digested and absorbed by his
2. What is gastrointestinal tract.
prerequisite for the starting of digestion of such food?
Case:12
Gastric secretion starts even by sight, smell or thought of delicious food which indicates
interaction between GIT and CNS.
1. What is gut brain axis?
2. What is gut microbiota?
3. How does it affect gut brain axis?
4. What is the
significance of gut brain axis?
Case:13
Mangesh was a 28
year old
male, who was
antacid medication repeatedly for the same. suffering from recurrent acidity. He was
and again, physician advised him Because of recurrence of the taking
1. Explain the various
to
undergo gastric function tests. same
problem again
gastric function tests with their clinical
significance.
Case:14
A 45 year old
female, 3 years back underwent
follow up she observed to have partial gastrectomy to reduce obesity. On
tingling numbness in both lower limbs. regular
On investigations, haemoglobin was 9.5 g/dl. Peripheral blood smear
RBCs showed large sized
1.
What could be the
probable diagnosis?
2. What is the relation of her
symptoms with partial gastrectomy?
3. Explain the
physiological mechanism behind it.
Case:15
40 year old female
suspected of having acute pancreatitis. She was advised exocrine
was
pancreatic function tests by the physician.
1. Explain the various exocrine
pancreatic function tests along with their clinical
significance.
Case:16
Satish is a known alcoholic.
Currently, he is having yellowish discoloration of eyes and palms.
He is also complaining of
bulging of abdomen. He had similar episode in the past. Physician
advised him to perform liver function tests.
1. Explain the various liver function tests and explain their clinical
2. What is the significance.
pathophysiological mechanism of yellowish discolouration of eyes and
palms?
Case:17
A 32 year old business executive visited Medicine OPD with
stomach which is relieved by food. Further he revealed that he is a
complaints of pain on empty
chain smoker.
1. What could be the
probable diagnosis?
2. What could be the
pathophysiological mechanism underlying his condition?
3. Give physiological basis of
treating
the above condition.
4. What are the natural mechanisms to protect gastric mucosa?
Case:18
Reetu is 6 week pregnant having vomiting and nausea since she knew
about her pregnancy.
1. What are the various stimuli
causing vomiting.
2. Describe the events
occurring in vomiting reflex.
Case:19
Lata had a normal delivery. On immediate examination after
birth, her newborn baby boy was
normal. He passed urine, 2 hours after birth. He was taking feed well. But he did not passed
stool for 5 days after birth.
On examination, he had distended abdomen.
On investigations, Barium study revealed large bowel dilatation with distal obstruction.
1. What is the probable diagnosis?
2. What happens in this condition?
3. Deseribe the movements of colon?
Case:20
Soham is suffering from recurrent acidity. He was prescribed proton pump inhibitor drug by a
general practitioner.
1. Explain the physiological mechanism behind it?
2. What are naturally present protective factors against development of this condition?
3. Describe the mechanism of gastric acid secretion.
4. Enlist the factors affecting gastric acid secretion.
Case:21
Smita is having acidity problem. She was prescribed histamine blocker drug by a physician.
1. Explain the role of histamine blockers here.
2. Describe the factors affecting gastric acid secretion.
3. What are the phases of gastric acid secretion?
4. Explain the functions of gastric acid.
Case:22
. A 41 years old nervous individual complains of pain in the upper abdomen, nausea, heart burn
and indigestion. Endoscopie findings : Reflux oesophagitis, a small gastric ulcer&duodenit
Treatment started with proton pump inhibitors, Sucralfate.
Q. Enumerate the causes of peptic ulcer.
Q. Describe the mechanism of secretion of HCl.
Case:23
43-year-old woman presents to the emergency department with the acute onset of
abdominal pain. Her pain is located to the right upper quadrant (RUQ) and radiates to the
right shoulder. She reports nausea and vomiting but no fever or chils. The RUQ pain is
worse after she eats fatty meals. On examination, the patient has severe RUQ tenderness.
Her white blood cell count is elevated, as are her liver function tests and alkaline
phosphatase level. The amylase and lipase levels are normal. An abdominal ultrasound
reveals an enlarged gallbladder with multiple stones and gallbladder wall thickening. She
subsequenty is admitted to the hospital and undergoes a cholecystectomy.
1. Why would fatty foods aggravate the patient's RUQ pain?
2. What effect does cholecystokinin (CCK) have on gastric emptying?
3. Why does CCK have some gastrin-ike properties?
actions
4. What are the other hormones of secretin family? Give their
Case:24
with thecomplaint of increased
A 34-year-old man presents to his primary care physician
foods. He notices that he sometimes has more
difficulty swallowing both solid and liquid and reports difficulty
difficulty when he is under stress. He often has chest pain and regurgitation
with achalasia (disorder of the
with belching. After a thorough examination, he is diagnosed
lower esophageal sphincter).
is composed of striated muscle and smooth
1. What part of the gastrointestinal (GI) tract
muscle?
2. What factors are responsible for the tonic
contraction of the lower oesophageal sphincter
(LES) between swallows?
responsible for regulating contraction and
3. What are the major neurotransmitters
relaxation of the LES?
4. What is gastric emptying
Case:25
A 43-year-old man presents to his gastroenterologist with symptoms of peptic ulcer disease. He
states that he has a mid epigastric 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 recurent peptic ulcers for the last 5 years, and has had minimal relief with the usual
treatments. A fasting serum 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. By what mechanism might elevated gastrin levels cause ulcers?
2. What cells are stimulated to secrete acid by gastrin?
3. What cells are responsible for secretion of intrinsic factor?
4. What is the pathophysiology of treatment of peptic ulcer?
Case:26
A 23-year-old male college student presents to his primary care physician with abdomina
pain, bloating, flatulence, and diarthea after eating ice cream. He denies fever, sick contacts,
or recent travel. His father has a history of similar symptoms. The patient is diagnosed with
lactose intolerance and is given medications to help him digest dairy products.
1. What products of carbohydrate digestion are absorbed in the small intestine?
2. What products of protein digestion are absorbed in the small intestine?
3. What products of lipid digestion are absorbed in the small intestine?
Case:27
A 43-year-old man presents to the physician's clinic with complaints of epigastric pain. After a
the patient is diagnosed with acid peptic disease. He is started on a
thorough workup,
medication that inhibits the "proton pump" ofthe stomach.
Questions:
i) What is acid peptic disease?
ii) What are protective mechanisms to protect from acid in stomach?
ii) What is proton pump in stomach? Which drug inhibits proton pump in stomach?
STRUCTURED QUESTIONS
1. Explain defecation reflex.
2. Describe 2nd Stage of Deglution.
3. Describe functions of gall bladder.
4. Dsecribe pathophysiology of Achalasia cardia.
5. Describe importance of dietary fibers.
6) Describe functions of liver
7) What is steatorhea? Explain its etiology.
8) What are functions of saliva?
9) Explain mechanism of secretion of HCI.
10) Describe malobsoprition syndrome.
11) Explain features of mastication.
12) Describe functions of large intestine.
