حياة العظماء !

أبعد بلوغي خمس عشرة ألعب

وألهو بلذات الحياة وأطرب

ولي نظر عال ونفس أبية

مقاما على هام المجرة تطلب

وعندي آمال أريد بلوغها

تضيع إذا لاعبت دهري وتذهب

ولي أمة منكودة الحظ لم تجد

سبيلا إلى العيش الذي تتطلب

على أمرها أنفقت عمري تحسرا

فما طاب لي طعم ولا لذ مشرب

وماراق لي نوم وإن نمت ساعة

فإني على جمر الغضا أتقلب

إن مشكلة العالم هي أن الأغبياء و المتعصبين دائما واثقين من أنفسهم فى حين أن العقلاء تملئهم الشكوك فى أنفسهم. "برتراند راسل"

تجديد !

لاتبحث عمّا أكتبه الآن ..

.فقد يتغير العالم بعد خمس سنوات ...

فسوف أواكب عالمي وأغير آرائي فالواقع يفرض علي هذا .. لأن البقاء على الماضي تخلف ...

وسأقبل نقد الذين ينسخون ماقلته قبل خمس سنوات ويقولون انظروا فقد غير رأيه !!مستثنيا من ذلك مبادئي الأسلامية !!----------

ربما نقبل رأي شخص ما ..

ويخالفنا بالأصل !

ونرد رأي شخص ما .. ويوافقنا بالأصل !

إن كنت أنت إمّعة ,, فأبشرك بالقاع .. لا تتجاوزه .. فأنت ستبدأ من القاع وستمكث فيه !!

ما الهم الذي تحمله ؟

ما الهم الذي تحمله ...؟! الهم حمله على النفس صعب , كأنك تقول لشخص من الأشخاص " ضع يدك على هذا الجرح لك تكتشف أن هذا .. هو موضع الألم ..." نعم الألم هو من الهموم ولكن الهم للدين هل يكون ألماً؟؟
أخي في الله .. جميعنا خلق الله له قلب واحد وعقل واحد فتجد نادرا من الشباب في المجتمع هموم قلبه تحكمها عقولهم لأن العاطفة لها دور كبير . . ! وكثير ما تجد أن الشباب قلوبهم هي التي تحكمهم . فهل العقل هو الذي يجمع الهموم أم يحل مشاكل بعض الهموم؟
وهل القلب يستطيع أن يحل مشاكل وهموم وفيه عاطفة الميل إلى محاب النفس؟ الشباب هي كلمة لو فكرنا بها لكانت هم غامض للقارئ والمستمع .. لماذا؟ لتعدد أصناف الشباب.
هم الدين عندما يكون في قلب شخص معين ويستطيع أن يؤثر في موضوع معين في الدين لوجد من الأشخاص من يحمل هم موضوع آخر لهذا الدين . فمن يجمع الهموم لتخرج جيل يقول: "ربنا لا تزغ قلوبنا بعد إذ هديتنا".
تحرك الهم في داخل القلب يعني معنى أن الشريان الذي يحمل هذا الهم إلى العقل بحاجة إلى نقطة انتظار وتفكر قبل أن يصل الهم إلى العقل أتدري لماذا؟ لكي يصل الهم خالصا من المشوبات ويكون وصل هم ديني ويستطيع العقل تصريفه في الوقت المناسب .
الهم لا يكون ظاهراً في العادة أتدري لماذا ؟ لأن مقر الهم داخل الجسم وهو القلب فتجد لا يرتاح من الهم إلا الميت لأن القلب توقف وخرجت الروح .

Viral hepatitis

السلام عليكم ورحمة الله وبركاته ..

سامبوزيوم

Viral hepatitis

Rapid review

تجميعه خطيرة ..

دعواتكمـ

طبيب طموح .... لكن لاطموح مع الراحة !

هنا ..وليس إلا هنا ..ستجد ما يروق لك ويطيب خاطرك ..وتجارب من هم عانوا في الحياة مع صغر سنهم ..إلا إنهم لا زالوا يبحثون عن الأمل ..همسة :كل قائد يخشى من أن يموت له جندي من صفه ... فأخبره أن الحياة تحتاج تضحية <---- لا يوجد مكان للجبناء !هاهي انقضت 3 سنوات بألامها ...وبقي ابتسامة النجاح ..نسينا الهم والسهر ...وبقيابتسامة المريض ... وهو يتمثل بالشفاء , واسأل الله أن يكون هذا الهدف بعد رضى الله ..هذه جزء مما ستجدونه بين أيديكم .. من تجارب و اطلالات ..وأسأل الله الاعانةهمسة :سلم النجاح ....... يبدأ بخطوة !غريب أمرك يا دنيا .. ألم نكن صغارا ... نوقر الأطباء حينما يمسحون على رؤوسنا .. وهم يقولون مابك شيء حبيبي بكرة بتقوم بالسلامة !فهل معقولة ..أنا سأقوم بهذا العمل بعد سنوات قليلة !!! أسأل الله لي ولكم التوفيق ..همسة :الدنيا سجن المؤمن .. وجنة الكافر .

وبعد الكرب فرج ..ومع العسريسرين .... لتعلم أن الله أرحم بك من أمك ,,كلنا معرضون للفشل .. " في كل شيء "لكن من منا يعرف أن يتعامل مع هذا الفشل !لذا ..المشكلة ليست في السقوط .... وإنما من لا يستطيع أن ينهض !...همسة :ما أسهل أن تكون عاقلا . . بعد فوات الآوان ..همسة أخرى :خير لك أن تسأل مرتين من أن تخطأ مرة واحدة

حينما .. تؤوي إلى فراشك .. وأقد أغلقت الأنوار ..تذكر أن الدنيا قد أغلقت بوجهك .. وأنك لا ترى شيئا ؟؟لكن أوقد شمعة .. وانظر النور من خلالها ..هل ستبقى لا ترى شيئا .... أم حدث فرق !هذا هو الأمل . ..

الحياة ...بين ماضوحاضر ومستقبل ..فكلنا ... يبكي على ماضيه ...وكلنا .. أشغله مستقبله ...وضيعنا ... الحاضر ..!!لا .. لنسعى إلى التغيرولنجعل شعارنا الآن .. الآن ..الساعة الفائتة .. ماتتوالقادمة ... في علم الغيب ..ولنطور أنفسنا بساعتنا هذه .!همسة :" ليس من الضروري أن نعرف كل شيء بالحياة ... لكن يجب أن نعمل بما نعرف "

النجاح ..ن = نحو القمة .ج = جمال الأخلاق .ا = أمل لاينقطعح = حب الخير للغير ..

كيف يمكن لنا ان نتغلب على الخوف من الفشل؟التوكل على الله +الإراده+احترامك لذاتك+الثقة بالنفس+التفاؤل+الهمة العالية+التفكير +المهاره=جيش لايقهر بإذن الله أبداااااا وتجربه ناجحهالتوكل على الله((من توكل على الله فقد كفاه))((احفظ الله يحفظك احفظ الله تجده تجاهك إذا سألت فاسأل الله وإذا استعنت فاستعن بالله))الإراده((وتذكر لايصاب الإنسان بالبلل إذا كان بعيدا عن الماء))يقول ابن المقفع((يدين العالم للإرادة أكثر مما يدين للحكمه))احترامك لذاتك((اذا وضعت قيمه لنفسك فهي مفتاح للسعاده لاتنتظر ان يحترم الاخرون ذاتك وانت لم تقدرها و تحترمها))الثقه بالنفس((إن عدم الثقه بالنفس يعطل امكانياتك اكثر من اي صعوبه تواجهها لواجتمعت معا عدم ثقه بالنفس +صعوبات= خوف وفشل وهروب من المواجههالتفاؤل((تفائلوا بالخير تجدوه)) كيف تريد النجاح ونظرتك سلبيه للامور وتراهن على الفشل قبل البدايه ،تذكروا((البلاء معقود بالمنطق))الهمه العاليه((من كانت همته عاليه وطموحه واسع فتلك أولى خطوات السلم وبداية الاستمرار لنعي جيدا إن مانحصل عليه دون جد وثمن وتعب ليس له قيمه))التفكير((خطوات التفكير السليم وحسن الظن والابتداء بالحسن كلها خطوات نحو تفكير صحيح والتفكير السليم يعمل على تزويدنا بادوات ومهارات تفيدنا في تحقيق اهدافنا ))إذا كنت ذا رأي فكن ذا تدبر ،،،،فإن فساد الرأي أن تتعجلاالمهاره((اتقان المهاره وطريقة اتقان شئ ما تسهيل للوصول للهدف المراد تحقيقه وإذا احسنت استثمار مهاراتك التي حباك الله بها وصقلتها فسوف تحقق أكثر مما كنت تحلم به طوال عمرك )

هيا لنصنع من هذه الصفحة ناجحين ,,معا نحو التغير للأفضل !

هيا .. هيا ..كن أسد مع الأسود ..عش حياة العزة ..قلب نظرك في السماء , ودع عنك الحضيض !اعرف من أين تبدأ خطوة القمة .. واحذر من القفز << فربما تسقط ! " خطوة - خطوة " تصل لمبتغاك ..!اصنع من الليمون شرابا حلواً !همسة :الكلمة .. إما قلها في الخير .... أو تحلى بالسكوت .

تذكر أن بداية السيل قطرة .. فلا تيأس بأنك في أول المشوار ,,الجبل مجموعة حصى ..والسيل مجموعة قطرات ..فالبداية كانت لاتذكر ...فاحرص أن تكون نهايتك مخلدة !

همسة : العظماء ... اشتقوا اسماءهم من العظمة ..حينما تكون عظيما .. سيكون هناك تافهون يسعون وراء زلاتك ..فإن رأيتهم بدؤوا بنبش سيرتك وتجريحها ..فاعلم أنك وصلت مرتبة العظماء !

الماء إن لم يتجاوز رأسك فلن يغرقك ..!فاسعى إلى أن تغطيه بالمعرفة ... كي لايغرقه الجهلى !^^^أتمنى أن تكون سهلة الفهم ..

جميعنا يدعويارب همي كبير ...هل مرة جربت أن تقول ..يا هم ربّي كبير !

ما أجمل أن ترى الحياة بعين الأمل .. خاصة إن اصبت ببدنك ..أتذكر رسالة الايميل ؟لاحياة مع اليأس !حينما كان رجل يمارس الرياضة وهو لا يملك إلا جزء من جسمه العلوي .. أما السفلي فمبتور !ومع ذلك يبتسم !هنا تتحطم جميع طرق اليأس ليتبين للمعافى أنه بإمكانه تحطيم أرقاما قياسية بالنجاح ... ولكنه للأسفمتكاسل !

الغربة ..تصنع رجالا ..

الحياة ...شمس .. " مثال للتعب "وظلال .. " مثال للراحة "من مكث في الظلال .. أتته الشمس فأزاحت ظله !ومن مكث في الشمس أتاه الظل !

MCQs - physiology - GIT

Digestive system

1- As regards salivary secretion, all are true EXCEPT:
a) Comes mostly from the parotid, submandibular & sublingual glands.
b) Has a mucous component.
c) Has a serous component.
d) Is largely under hormonal control.

2- Concerning salivary secretion, all are true EXCEPT:
a) Is entirely under neural control.
b) Has a constant composition regardless of the rate of secretion.
c) Contains salivary amylase.
d) Is important in keeping the mouth and throat moist at all times.

3- The saliva:
a) Contains no organic substances.
b) Is markedly increased in amount after sympathetic stimulation.
c) Secretion is increased after injection of atropine.
d) Secreted by the submandibular glands is about 70% of the total secretion.

4- Saliva is characterized by all the following EXCEPT:
a) Its concentration of K+ is the same as that in the plasma.
b) Its Na+ & Cl– concentrations are lower than those in the plasma.
c) Its osmotic pressure & pH are lower than their corresponding values in the plasma.
d) It exerts an antibacterial action.

5- The act of the swallowing is associated with:
a) Movement of food into the nasopharynx.
b) Opening of the glottis.
c) Inhibition of respiration.
d) Constriction of the upper esophageal sphincter.

6- Deglutition is accompanied by all of the following EXCEPT:
a) Relaxation of the upper esophageal sphincter.
b) Contraction of the pharyngeal wall muscles.
c) Closure of the larynx by epiglottis.
d) Pulling the soft palate downwards.

7- The process of swallowing (deglutition):
a) Consists of 5 phases all of which are involuntary.
b) Can easily occur while the mouth is open.
c) Is controlled by a centre in the medulla & lower pons that initiates a peristaltic wave in the pharyngeal musculature.
d) In the buccal phase the tongue moves downwards and the larynx is depressed.

8- The primary esophageal peristalsis differs from the secondary peristalsis in that the former:
a) Occurs after the latter.
b) Is independent of neural control.
c) Is initiated by swallowing.
d) Is confined to the upper part of the esophagus.

9- About the process of swallowing, all the following is true EXCEPT:
a) As a peristaltic wave passes along the esophagus, the cardiac sphincter & stomach wall relax.
b) The esophageal musculature below the pharynx contains skeletal (striated) muscle which entirely under control of the vagi nerve.
c) Food doesn’t enter the trachea mainly due to approximation of the vocal cords.
d) The voluntary phase includes the period during which food passes through both the buccal cavity and pharynx.

10- The salivary secretion:
a) Is produced by a nervous mechanism only.
b) Digests starch to glucose.
c) Has the largest volume relative to other digestive juices.
d) Is hyperosmotic relative to the plasma.

11- The salivary secretion:
a) Has a constant composition regardless the rate of secretion.
b) Is a simple process of filtration of the plasma.
c) Is entirely under neural control.
d) Is under control of the cerebral cortex only.

12- Gastric secretion is increased by:
a) Sympathetic stimulation.
b) Acid in the duodenum.
c) Stimulation of stretch receptors in the wall of the stomach.
d) Heypertonicity of duodenum.

13- Concerning hydrochloric acid secretion, all are true EXCEPT:
a) Is secreted by parietal cells in the stomach.
b) Its secretion can be stopped by H2 receptor blocking.
c) Gastrin, acetylcholine & histamine can stimulate its secretion.
d) Occurs due to passive diffusion of H+.

14- Hydrochloric acid secretion by parietal cells:
a) Requires dissociation of water with subsequent exchange of H+ with Na+.
b) H+ is actively secreted into the canaliculus in exchange for K+.
c) Cl– enters the parietal cell in exchange for Na+ ions.
d) No energy is needed for this process.

15- As regards gastrin hormone, all are true EXCEPT:
a) Increased HCl secretion.
b) Is released by vagal stimulation.
c) Is released by stomach distention.
d) Presence of acid in the stomach stimulated its release.

16- Concerning secretin hormone, all are true EXCEPT:
a) Increases pancreatic secretion of HCO3–.
b) Causes contraction of pyloric sphincter.
c) Augments the action of CCK in producin pancreatic secretion rich in enzymes.
d) Is secreted by the pancreas.

17- Secretin hormone:
a) Is released when fat is present in small intestine.
b) Causes contraction of the gall bladder.
c) Decreases gastric acid secretion & motility.
d) Stimulates pancreatic secretion of insulin.


18- As regards cholecystokinin (CCK), all are true EXCEPT:
a) Products of protein digestion stimulate its release.
b) Causes contraction of the all bladder and relaxion of sphincter of Oddi.
c) Increase gastric motility and secretion.
d) Causes secretion of pancreatic juice rich in enzymes.

19- Concerning vomiting, all are true EXCEPT:
a) Is a forceful expulsion of the gastric contents through the mouth.
b) Is a complex reflex act, which is coordinated by vomiting centre in the medulla.
c) Results in loss of fluid which may lead to circulatory collapse.
d) Accompanied by elevation of diaphragm to squeeze out the gastric contents.

20- Concerning regulation of pancreatic secretion:
a) Presence of food in the stomach directly increases pancreatic secretion.
b) Sight or smell does not affect pancreatic secretion.
c) CCK augments the action of secretin in producing pancreatic secretion rich in HCO3–.
d) Pancreatic secretion is entirely under hormonal control.

21- In the stomach:
a) Secretion of enzymes is by parietal (oxyntic) cells.
b) Secretion of acid is from parietal cells.
c) Gastrin is secreted by the same cells that secrete acid.
d) The main digestive function is the breakdown of charbohydrates.

22- Concerning salivary amylase, all are true EXCEPT:
a) Is secreted mainly by the parotid glands.
b) Is a protein in nature.
c) Is secreted in response to parasympathetic stimulation.
d) Is most active at pH 1-2.

23- Function of the stomach include the following, EXCEPT:
a) Storage of food during digestion.
b) Secretion of intrinsic hemopoietic factor into the lumen.
c) Secretion of secretin into the blood.
d) The maintenance of iron in the ferrous state.

24- Gastric emptying is delayed by all the following EXCEPT:
a) Vagotomy.
b) Fat in the duodenum.
c) Secretin.
d) Increased fluidity of the chyme.

25- Gastric emptying:
a) Is slowest if the food is soft and rich in carbohydrates.
b) Is inhibited by excessive acidity in the duodenum.
c) Is accelerated by presence of fat or hypertonic solutions in the duodenum.
d) Is delayed by distension of the stomach and by vagal stimulation.

26- HCl secretion includes all the following processes EXCEPT:
a) Active transport of H+ into the gastric lumen.
b) H+ is exchanged for K+ from the extracellular fluid.
c) HCO3– diffuses into the extracellular fluid in exchane for Cl–.
d) It is associated with production of postprandial alkaline tide.

27- The cephalic phase of gastric secretion:
a) Occurs when food reaches the stomach.
b) Is not accompanied by release of GRP (gastrin-releasing peptide).
c) Is controlled by the vagi nerves.
d) Is not blocked by injection of atropine.

28- The gastric juice has all the following characteristics EXCEPT:
a) It contains an alkaline secretion from the surface epithelium.
b) Its pH is always less than 3.
c) It contains the intrinsic factor which is essential for vitamin B12 absorption.
d) Its antibacterial action is produced by its mucus content.

29- Gastric secretion is inhibited by all the following EXCEPT:
a) Presence of excess protein digestive products in the stomach.
b) Certain emotions e.g. fear & depression.
c) Certain GIT hormones e.g. secretin, CCK & VIP.
d) The enterogastric reflex.

30- Stomach emptying is delayed by all the following EXCEPT:
a) Certain GIT hormones e.g. secretin, CCK & GIP.
b) Presence of excess fat in the meal.
c) Moderate gastric distention.
d) The enterogastric reflex and bilateral vagotomy.

31- About the gastric motility, all the following is true EXCEPT:
a) It increases by the vagal stimulation & decreases by symp. stimulation.
b) It decreases by the enterogastric reflex and by the secretin & CCK hormones.
c) It increases by overdistention of the stomach.
d) It decreases in response to presence of excess fat in the duodenum.

32- Gastric HCl secretion:
a) Occurs secondary to active transport of H+ by the parietal cells into the lumen of the stomach.
b) Is increased by administration of histamine.
c) Is inhibited by the secretin hormone & H2 receptor blockers (e.g. cimetidine).
d) All of the above.

33- The act of vomiting:
a) is produced mainly by contraction of the gastric musculature.
b) May be associated with reverse peristalsis in the esophagus.
c) May lead to respiratory alkalosis (if prolonged).
d) Is coordinated by a centre in the sacral region of the spinal cord.

34- Which of the following statements is true?
a) The intrinsic factor is secreted by the parietal cells of the gastric mucosa.
b) The stomach normally absorbs about 30% of the ingested food.
c) The secretion of gastric juice is associated with increased H+ in the blood.
d) The gastric juice is essential for the digestion of both fat & protein.

35- Concerning HCl secretion, all the following is true EXCEPT:
a) It is associated with increased pH of the gastric venous blood.
b) It is stimulated by gastrin, acetylcholine, histamine & norepinephrine.
c) The energy required is derived from ATP breakdown.
d) There is an active transport of H+ from the oxyntic cells into the gastric lumen and K+ in the opposite direction.

36- Concerning pancreatic juice:
a) Gastrin is an important stimulant of secretion of bicarbonate by the pancreas.
b) Secretin inhibits the secretion of pancreatic juice.
c) Cholecystokinin (CCK) stimulates the secretion of pancreatic enzymes.
d) Sight or smell of food does not affect pancreatic secretion.

37- Concerning the pancreas, all are true EXCEPT:
a) It is an exocrine organ.
b) It is an endocrine organ.
c) It receives innervation from the autonomic nervous system.
d) Increase in secretion is accompanied by vasoconstriction of pancreatic arterioles.

38- Secretin:
a) Acts as a powerful cholagogue.
b) Is secreted as a result of vagus nerve stimulation.
c) Stimulates gastric secretion.
d) Is released as a result of contact of acid chyme to the duodenal mucosa.

39- About CCK, all the following is true EXCEPT:
a) It causes contraction of the gallbladder wall.
b) It produces a pancreatic secretion rich in enzymes.
c) It potentiates the action of secretin on the pancreas.
d) It inhibits both gastric and intestinal motility.

40- The pancreatic secretion:
a) Is the primary source of HCO3– for neutralization of HCl in the intestine.
b) Is secreted by the pancreatic acini only.
c) Is the least important digestive juice.
d) Is associated with rise of the blood pH.

41- Concerning bile and bile salts, all are true EXCEPT:
a) Bile salts are emulsifying agents.
b) Bile are concentrated in the gall bladder.
c) Bile salts promote lipid absorption by forming water soluble micells.
d) Its secretion from the liver is intermittent.

42- Bile salts:
a) Are derived from hemolysed RBCs.
b) Breakdown fats to fatty acids.
c) Are among the most important physiologic cholertics.
d) Are essential in digestion of carbohydrates.

43- As regards contraction of the gall bladder:
a) It is stimulated by a fat-rich meal or amino acids in the duodenum.
b) It is stimulated by atropine.
c) It occurs in response to cholecystokinin.
d) It occurs simultaneously with the contraction of the sphincter of Oddi.

44- All the following statements about cholecystokinin (CCK), are true EXCEPT:
a) CCK is released by fat in the small intestine.
b) CCK increases pancreatic enzyme secretion.
c) CCK contracts sphincter of Oddi.
d) CCK decreases gastric emptying.

45- The stimulation of release of pancreatic secretions normally involves all the following EXCEPT:
a) Acetyl choline.
b) Cholecystokinin.
c) Histamine.
d) Secretin.

46- The bile salts:
a) Are essential for absorption of proteins.
b) Are essential for absorption of vitamins A, B & C.
c) Are concentrated in the gall bladder.
d) Are not reabsorbed from the small intestine.

47- All the following increase bile secretion from the liver EXCEPT:
a) Secretin.
b) CCK.
c) Increased hepatic blood flow.
d) The enterohepatic circulation of the bile salts.

48- Obstructive jaundice:
a) Results from excessive destruction of the RBCs.
b) Involves excretion of urine having a normal colour.
c) Involves excretion of stools darker than normal.
d) Causes excess fat loss in the stools.

49- An obstruction of the common bile duct:
a) Does not affect absorption of vitamins.
b) Leads to clay-coloured stools.
c) Causes increased formation of prothrombin by the liver.
d) Causes no change in the normal colour of urine.

50- In hepatic jaundice:
a) Both haemobilirubin & cholebilirubin blood levels are decreased.
b) The liver functions are depressed & the plasma albumin level is decreased.
c) The urine colour is normal while that of the stools is darker than normal.
d) Fat digestion & absorption are not affected.

51- Concerning obstructive jaundice:
a) Van-den Berg reaction is biphasic.
b) Is accompanied by tachycardia and itching.
c) The colour of the stool is darker than normal due to high content of strecobilin.
d) Is accompanied by steatorrhea.

52- Concerning hepatic jaundice:
a) The urine is dark due to increased urobilinogen.
b) It is due to increased hemolysis of RBCs.
c) Van-den Berg reaction shows only direct response.
d) Fat digestion and absorption is decreased.

53- Concerning cholagogues and choleretics:
a) Secretin hormone is a cholagogue.
b) Mg sulfate increases hepatic bile formation.
c) CCK-PZ is a choleretic.
d) Bile salts increase hepatic bile formation.

54- Concerning bile salts:
a) They have no role in digestion and absorption of fat.
b) They inhibit pancreatic lipase.
c) They have a solvent effect on cholesterol preventing its precipitation.
d) They are completely excreted in stools.

55- The segmentation (mixing) movements in the GIT:
a) Occur only in the small intestine.
b) Depend on the extrinsic autonomic nerve supply.
c) Are increased by injection of atropine.
d) Are greatly helpful for the process of absorption.

56- The peristalsis in the small intestine:
a) Can occur in absence of the local nerve plexus.
b) Is myogenic in origin.
c) Plays a minimal role in food propulsion.
d) Is commonly reversed (antiperistalsis) in the duodenum & lower ileum.

57- Concerning absorption:
a) Short-chain fatty acids are absorbed through lacteals.
b) Bile salts of no importance in fat digestion and absorption.
c) Steatorrhea means increased protein content in stool.
d) Steatorrhea occurs in obstructive jaundice & severe pancreatic disease.

58- Concerning large intestine:
a) It contains villi for absorption.
b) Distention of proximal colon initiates defecation.
c) Ammonia can be formed from bacteria.
d) Digestion of cellulose occurs in human.

59- Defecation:
a) It is under voluntary control in infants.
b) During rest, the rectum is distended.
c) It is delayed by gastric colic reflex.
d) It occurs more likely just after meals.

60- In the colon, all are true EXCEPT:
a) Bacterial synthesis of vitamin K is of vital importance.
b) More than half of the water that enters the colon is absorbed from the contents.
c) Sympathetic stimulation results in enhanced motility.
d) The secretion lacks significant digestive enzymes.

61- The ileum is the principle site for the absorption of:
a) The products of fat digestion.
b) Bile salts.
c) Vitamin K.
d) Iron.

62- In infants, defecation follows a meal, the cause of colonic contraction in this situation is:
a) Gastroileal reflex.
b) Gastrocolic reflex.
c) Enterogastric reflex.
d) Increased circulating level of CCK.

DRUGS & GIT

Drugs & GIT:

A-Drugs causing Hepatotoxicity:

1. α-methyl dopa(α2-agonist-antiadrenergic-used in treatment of hypertension, is the drug of choice in hypertension during pregnancy).
2. Dantrole (direct skeletal muscle relaxant, ↓Ca release from sarcoplasmic reticulum, life-saving in malignant hyperthermia and neuroleptic malignant syndrome , given I.V).
3. Statins e.g; simvatatin (anti-hyperlipidemics).
4. Fibrates e.g; clofibrate (anti-hyperlipidemic).
5. Toxic doses of paracetamol (or if given with HME inhibitors as alcohol and phenobarbitone) due to accumulation of NABQI.
6. Colchicine (anti-inflammatory in gout).
7. Tolcapone( COMT-inhibitor used in parkinsonism with L-dopa).
8. Phenytoin( anti-epileptic+anti-arrhythmic).
9. Oxazolidinediones( anti-epileptic in petit-mal epilepsy).
10. Sodium Valproate (broad-spectrum antiepileptic).
11. MAO-inhibitors (anti-depressants).
12. Halothane (inhaled general anaesthetic).
13. Tetracyclines( antibiotics).
14. Sulphonamides( anti-bacterial).
15. Isoniazid.
16.
(Anti-T.B)Pyrazinamide.
17. Ethionamide.
18. Para-amino-salicylic acid.

19.
Anti-fungal
Ketoconazole.
20. Griseofulvin.

21. Cis-platin (anti-cancer).

B-Drugs causing Diarrhea:

1-Parasympathomietics: e.g Carbachol – Bethanecol -Neostigmine
(Stimulate M Receptors in Small Intestine)
2-Adrenergic Neurone Depressants : e.gGuanethidine –Reserpine
(They causes Parasympathetic Predominance)
3-Dantrolene which is direct skeletal muscle Relaxant
4- Oral Iron : e.g Ferrous Fermanate & Gluconate ,May cause black or bloody diarrhea
(Some oral iron causes constipation )
5-Magansium Oxide –Hydroxide –Trisilicate :used as Chemical antacids
6-Metoclopramide : Antemitic & Prokinitic
7-Domperidone: Antiemitic & Prokinitic
8-Purgatives (chemical & physical)
9-Colchicine : used in Acute gouty anthritis, may causes bloody diarrhea
10- Erthromycin : Anthmicrobial (Diarrhea is due to prokinietic
11-Broad Spectrum Antimicrobials (especially if not completely absorbed )
e.g Ampicillin –Tetraglclines- Chloramphenicol –Cophalosporins
(Due to Superinfection)
12-PG-Analogues :e.g Misoprostol (see Peptic ulcer)

C-Drugs Causing Constipation:

1-Antimuscarinic Drugs (Anticholinergic Drug =Parasympatholytics)
e.g: Atropine –Hyoscine-Antisecretory –Antispasmodic –Atropine substitutes
2-Opiod Analgesics: e.g Morphine –Mepridine –Loperamide-diphenoxylate (note that lopramide and diphenoxylate are not analgesics) they stimulate opioid receptors in GIT
3-Aluminum Hydroxide Gel :Act as Chemical & physical Antiacid
4-Calcium Carbonate :chemical Antacid
5-Calcium channel blockers :e.g Nifedipine –Veraparmil
6-Drugs Having marked ” Atropie-like Action”;e.g
-1st Generation (=sedating ) Anti-histaminics as Diphenhydramine
-Disopyramide : class I-Anti-arrhythmic
-Tricyclic anti-depressants as imipramin
-Carbamazepine : Anti-epileptic

D-Drugs Causing Nausea &Vomiting:

1-Opioid Analesics :e.g Morphine ,Methadone ,Meperidine
2-Cardiac Glycosides (Digitalis ) :e.g Digoxin ,digitoxin
3-Methylxanthin :e.g Aminophylline , Theophyline
4-D2-Agonists :e.g L-Dopa , Bromocriptine
5-Estrogen (oral contraceptive) causes mainly nausea
6-Cancer chemotherapy

E-Drugs causing Allergic Cholestatic Hepatitis :

1. Carbamazepine(anti-epileptic).
2. Tricyclic antidepressants (TCA's).
3. Chlorpromazine (anti-psychatic).
4. Erythromycin (antibiotic).
5. Chlorpromazine (anti-diabetic).
6. Oral contraceptives.
7. Rifanpicin(anti-T.B)
8. H2-blockers as Cimetidine (anti-ulcer).

F-Drugs activated by gastric acidic medium:

1-Chlorazepate (Benzodiazepine: anxiolytic &hypnotic)
2-Proton Pump Inhibitors e.g. Omeprazole (Antisecretory drugs used in treatmentof peptic ulcer)
3-Sucralfate (mucosal protective agent, used to prevent recurence)
N.B.:
Ketoconazole (Antifungal) absorption increases in acidic medium

G-Drugs destroyed by gastric acid:

1-Acid-sensitive penicillins(e.g. benzyl penicillinG, procaine penicillin , benzathine penicillin , methicillin , cabencillin , ureido-penicillins)
2- Erythromycin (to protect against HCL, erythromycin is given as enteric-coated tablets, or estolate ester is added to erythromycin)

H-Drugs destroyed by proteolytic enzymes: (Not effective orally)

1- Polypeptide antibiotics: Bacitracin & Polymixins
2- Polypeptide hormones: e.g. Insulin, Growth hormone, Glucagon, ACTH, ADH (vasopressin)

Appendix ...& acute appendicitis

Anatomy

The appendix is a narrow, hollow tube connected to the cecum. It has large aggregations of lymphoid tissue in its walls and is suspended from the terminal ileum by the mesoappendix, which contains the appendicular vessels . Its point of attachment to the cecum is consistent with the highly visible free taenia leading directly to the base of the appendix, but the location of the rest of the appendix varies .
It may be:

posterior to the cecum or the lower ascending colon, or both, in a retrocecal or retrocolic position;
suspended over the pelvic brim in a pelvic or descending position;
below the cecum in a subcecal location;
anterior to the terminal ileum, possibly contacting the body wall, in a preileal position or

posterior to the terminal ileum in a postileal position posterior to the terminal ileum in a postileal position

The surface projection of the base of the appendix is

at the junction of the lateral and middle one-thirds of a line from the anterior superior iliac spine to the umbilicus (McBurney's point). People with appendicular problems may describe pain near this location.

HISTOLOGY

The general structure of the appendix conforms to that of the rest of the large intestine. In some mammals, the appendix is capacious and involved in prolonged digestion

of cellulose, but in humans its function is unknown.

the suspensory mesentery M in continuity with the outer serosal layer S. The serosa contains extravasated blood resulting from haemorrhage during surgical removal. The mesenteries conduct blood vessels, lymphatics and nerves .
The most characteristic feature of the appendix, particularly in the young, is the presence of masses of lymphoid tissue in the mucosa and submucosa

the lamina propria LP and upper submucosa SM are diffusely infiltrated with lymphocytes. Note that the mucosal glands are much less closely packed than in the large intestine. the lymphoid tissue also forms follicles F often containing germinal centres . These follicles bulge into the lumen and, like the follicles of Peyer's patches in the small intestine, are invested by a simple epithelium of M cells , which presumably facilitates sampling of antigen in the lumen

PATHOLOGY :

appendicitis is the most common acute abdominal condition the surgeon is called on to treat. Appendicitis is one of the best-known medical entities and yet may be one of the most difficult diagnostic problems to confront the emergency physician. A differential diagnosis must include virtually every acute process that can occur within the abdominal cavity, as well as some emergent conditions affecting organs of the thorax.Acute Appendicitis

(Inflammation in the right lower quadrant was considered a nonsurgical disease of the cecum (typhlitis or perityphlitis) until Fitz recognized acute appendicitis as a distinct entity in 1886)

causes :

Appendiceal inflammation is associated with obstruction in 50% to 80% of cases, usually in the form of a fecalith and, less commonly, a gallstone, tumor, or ball of worms (oxyuriasis vermicularis). Note .. Continued secretion of mucinous fluid in the obstructed viscus presumably leads to a progressive increase in intraluminal pressure sufficient to cause eventual collapse of the draining vein

Ischemic injury then favors bacterial proliferation with additional inflammatory edema and exudation, further embarrassing the blood supply. Nevertheless, a significant minority of inflamed appendices have no demonstrable luminal obstruction, and the pathogenesis of the inflammation remains unknown.

Morphology.

At the earliest stages, only a scant neutrophilic exudate may be found throughout the mucosa, submucosa, and muscularis propria. Subserosal vessels are congested, and often there is a modest perivascular neutrophilic infiltrate. The inflammatory reaction transforms the normal glistening serosa into a dull, granular, red membrane; this transformation signifies early acute appendicitis for the operating surgeon. At a later stage, a prominent neutrophilic exudate generates a fibrinopurulent reaction over the serosa . As the inflammatory process worsens, there is abscess formation within the wall, along with ulcerations and foci of suppurative necrosis in the mucosa. This state constitutes acute suppurative appendicitis. Further appendiceal compromise leads to large areas of hemorrhagic green ulceration of the mucosa and green-black gangrenous necrosis through the wall, extending to the serosa, creating acute gangrenous appendicitis, which is quickly followed by rupture and suppurative peritonitis.



Acute appendicitis. The inflamed appendix shown below is red, swollen, and covered with a fibrinous exudate.

The histologic criterion for the diagnosis of acute appendicitis is neutrophilic infiltration of the muscularis propria. Usually, neutrophils and ulcerations are also present within the mucosa. Since drainage of an exudate into the appendix from alimentary tract infection may also induce a mucosal neutrophilic infiltrate, evidence of muscular wall inflammation is requisite for the diagnosis.

Clinical Features

(1) pain, at first periumbilical but then localizing to the right lower quadrant; (2) nausea and/or vomiting; (3) abdominal tenderness, particularly in the region of the appendix; (4) mild fever; and (5) an elevation of the peripheral white blood cell count up to 15,000 to 20,000 cell/µL.

complications

perforation, uncommon complications of appendicitis include pyelophlebitis with thrombosis of the portal venous drainage, liver abscess, and bacteremia

diffrential diagnosis

mesenteric lymphadenitis, usually secondary to an enterocolitis (often unrecognized) caused by Yersinia or a virus; systemic viral infection; acute salpingitis; ectopic pregnancy; mittelschmerz (pain caused by trivial pelvic bleeding at the time of ovulation); cystic fibrosis; and Meckel diverticulitis.

TREATMENT

APPENDECTOMY .

Reference :

Gray's anatomy For Student

Wheater's Functional Histology 5th Edition

ROBBINS _ pathologic bases 7th edition