x****n
发帖数: 893 | 1 2. A 56-year-old man with alcoholism comes to the physician because of a 2-
month history of increasingly severe stomach pain and increased volumes
offoul-smelling
stool; he also has had a 9-kg (20..Jb) weight loss during this period. He
has a history of multiple visits to the emergency department because of
severe abdominal pain.
He has consumed one bottle of red wine daily for 5 years. His temperature is
37"C (98.6"F). Physical examination shows epigastric tendemess. His fasting
serum
glucose concentration is ISO mgfdL. A CT scan of the abdomen shows
pancreatic calcifications. The most likely cause of th is patienfs current
symptoms is a decrease
in which of the fo llowing?
o A) Bile acid synthesis
o B) Colonic bacteria
o C) Duodenal pH
o D) Fecal elastase
o E) 7a-Hydroxylase activity
答案是b？？？我选了a |
c***y
发帖数: 811 | |
s********o
发帖数: 3319 | 3 C?
EtOH --> chronic pancreatitis --> decreased HCO3- secretion |
s*******1
发帖数: 428 | 4 My guess is :D
The question is asking for the causes of this patient's current symptoms.
For my understanding, the current symptoms are 1. epigastric pain; 2. foul-
smelling stool.
So, 1. Epigastric pain is caused by chronic pancreatitis.
2. Foul-smelling stool is caused by lack of pancreatic enzyme.
Fecal elastase from wiki:
Chymotrypsin-like elastase family member 3B also known as elastase-3B,
protease E, or fecal elastase is an enzyme that in humans is encoded by the
CELA3B gene.[1][2][3]
Clinical literature that describes human elastase 1 activity in the pancreas
or fecal material is actually referring to chymotrypsin-like elastase
family, member 3B (this protein).[4]
Fecal elastase is a medical test that measures how well the pancreas is
functioning.
The fecal elastase test measures the concentration of the elastase-3B enzyme
found in fecal matter with an enzyme-linked immunosorbent assay (ELISA).
Results of this test can give a good indication of exocrine pancreatic
status, and the test is less invasive and expensive that the current "gold
standard", secretin-cholecystokinin test.[5] Levels of fecal elastase lower
than 200 μg / g of stool indicate an exocrine insufficiency. Correlations
between low levels and chronic pancreatitis[6] and cancer[7] have been
reported.
【在 x****n 的大作中提到】
: 2. A 56-year-old man with alcoholism comes to the physician because of a 2-
: month history of increasingly severe stomach pain and increased volumes
: offoul-smelling
: stool; he also has had a 9-kg (20..Jb) weight loss during this period. He
: has a history of multiple visits to the emergency department because of
: severe abdominal pain.
: He has consumed one bottle of red wine daily for 5 years. His temperature is
: 37"C (98.6"F). Physical examination shows epigastric tendemess. His fasting
: serum
: glucose concentration is ISO mgfdL. A CT scan of the abdomen shows
|
s********o
发帖数: 3319 | 5 you are right. good to know. thanks.
the
【在 s*******1 的大作中提到】
: My guess is :D
: The question is asking for the causes of this patient's current symptoms.
: For my understanding, the current symptoms are 1. epigastric pain; 2. foul-
: smelling stool.
: So, 1. Epigastric pain is caused by chronic pancreatitis.
: 2. Foul-smelling stool is caused by lack of pancreatic enzyme.
: Fecal elastase from wiki:
: Chymotrypsin-like elastase family member 3B also known as elastase-3B,
: protease E, or fecal elastase is an enzyme that in humans is encoded by the
: CELA3B gene.[1][2][3]
|
p********t
发帖数: 411 | 6 Corrected answer is C. I'm sure. |
s********o
发帖数: 3319 | 7 interesting. I was shocked when I saw snowfox's answer and explanation...
【在 p********t 的大作中提到】
: Corrected answer is C. I'm sure.
|
c****e
发帖数: 188 | 8 I agree with A.
Many patients with chronic pancreatitis have low serum cholesterol that
results in low level of bile acid synthesis. Bile salts from the liver are
needed to break down and absorb fat. Any condition that results in decreased
lipase or bile salts can cause steatorrhea (foul smelling stool).
is
fasting
【在 x****n 的大作中提到】
: 2. A 56-year-old man with alcoholism comes to the physician because of a 2-
: month history of increasingly severe stomach pain and increased volumes
: offoul-smelling
: stool; he also has had a 9-kg (20..Jb) weight loss during this period. He
: has a history of multiple visits to the emergency department because of
: severe abdominal pain.
: He has consumed one bottle of red wine daily for 5 years. His temperature is
: 37"C (98.6"F). Physical examination shows epigastric tendemess. His fasting
: serum
: glucose concentration is ISO mgfdL. A CT scan of the abdomen shows
|
s********o
发帖数: 3319 | 9 A is not correct. liver has no problem here.
decreased
【在 c****e 的大作中提到】
: I agree with A.
: Many patients with chronic pancreatitis have low serum cholesterol that
: results in low level of bile acid synthesis. Bile salts from the liver are
: needed to break down and absorb fat. Any condition that results in decreased
: lipase or bile salts can cause steatorrhea (foul smelling stool).
:
: is
: fasting
|
g*******n
发帖数: 91 | 10 Could be C. Foul-smelling stool means fat malabsorption. In this case,it
might be more related to pancreatic lipase inactivation and bile acid
precipiation, rather than proteases, like elastase. In alcoholic chronic
pancreatitis suggested by pancreatic calcifications, lipase is often
inactivated by very low intraduodenal pH. Bile acid is also precipitated due
to very low intraduodenal pH (often less than 4). |
s*******1
发帖数: 428 | 11 This is a reasonable explanation. Thanks.
due
【在 g*******n 的大作中提到】
: Could be C. Foul-smelling stool means fat malabsorption. In this case,it
: might be more related to pancreatic lipase inactivation and bile acid
: precipiation, rather than proteases, like elastase. In alcoholic chronic
: pancreatitis suggested by pancreatic calcifications, lipase is often
: inactivated by very low intraduodenal pH. Bile acid is also precipitated due
: to very low intraduodenal pH (often less than 4).
|
x****n
发帖数: 893 | 12 what causes low ph? secretin is made in duodenum not pancreas.
due
【在 g*******n 的大作中提到】
: Could be C. Foul-smelling stool means fat malabsorption. In this case,it
: might be more related to pancreatic lipase inactivation and bile acid
: precipiation, rather than proteases, like elastase. In alcoholic chronic
: pancreatitis suggested by pancreatic calcifications, lipase is often
: inactivated by very low intraduodenal pH. Bile acid is also precipitated due
: to very low intraduodenal pH (often less than 4).
|
g*******n
发帖数: 91 | 13 Yes, secretin may regulate bicarbonate production from pancreatic duct and
duodenal Brunner's gland. Even if secretin production is intact, it's action still needs intact or healthy effector organs.
A inflamed and damaged pancreas in chronic pancreatitis decreases pancreatic
bicarbonate secretion significantly, thus contributing to very low
intraduodenal pH.Also,long-term oversecretion of gastric acid stimulated by
alcohol abuse may also play a role. |
