A 38-year-old man comes to the clinic complaining of recurrent abdominal pain for the past 2 months. He reports a gnawing, dull pain at the epigastric region that improves with oral ingestion. He has been taking calcium carbonate for the past few weeks; he claims that “it used to help a lot but it’s losing its effects now.” Laboratory testing demonstrated increased gastrin levels after the administration of secretin. A push endoscopy visualized several ulcers at the duodenum and proximal jejunum. What characteristics distinguish the jejunum from the duodenum?
ALack of goblet cells
BCrypts of Lieberkuhn
CLack of submucosal Brunner glands
DPeyer patches
EPlicae circulares
A scientist is studying the mechanism by which the gastrointestinal system coordinates the process of food digestion. Specifically, she is interested in how distension of the lower esophagus by a bolus of food changes responses in the downstream segments of the digestive system. She observes that there is a resulting relaxation and opening of the lower esophageal (cardiac) sphincter after the introduction of a food bolus. She also observes a simultaneous relaxation of the orad stomach during this time. Which of the following substances is most likely involved in the process being observed here?
ANeuropeptide-Y
BSecretin
CGhrelin
DVasoactive intestinal polypeptide
EMotilin
A 38-year-old man comes to the physician because of an 8-month history of upper abdominal pain. During this period, he has also had nausea, heartburn, and multiple episodes of diarrhea with no blood or mucus. He has smoked one pack of cigarettes daily for the past 18 years. He does not use alcohol or illicit drugs. Current medications include an antacid. The abdomen is soft and there is tenderness to palpation in the epigastric and umbilical areas. Upper endoscopy shows several ulcers in the duodenum and the upper jejunum as well as thick gastric folds. Gastric pH is < 2. Biopsies from the ulcers show no organisms. Which of the following tests is most likely to confirm the diagnosis?
AUrea breath test
B24-hour esophageal pH monitoring
CSerum vasoactive intestinal polypeptide level
DUrine metanephrine levels
EFasting serum gastrin level
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