GIT PHYSIOLOGY CASE STUDY

Name: ___________________________________ Matric No. _____________ Date: __________

Note: In this case study session, you’ll be dealing with TWO GIT cases.

Please do all pre-class activities in your own sketches (drawings) and handwriting.

Learning Outcome

At the end of the case study session, the students should be able to

1. Define GERD and list down the signs and symptoms associated with GERD.
2. Describe the regulation of motility and secretion of the GIT and how they are affected in
patients with GIT diseases.
3. Describe the pathophysiology of GERD.
4. Discuss the mechanism of regulation of HCl secretion in the stomach.
5. Discuss how chronic pancreatitis alters the functions of the pancreas.
6. Discuss the pathophysiology of chronic pancreatitis

Pre-class preparation

Revise the following topics:

 Revise Modules 1 – 4 of the GI systems

 Read on GERD and pancreatitis
 Revise mechanisms of intercellular communication.

Please do the following activities and bring your work to class. You will submit these activities
together with more activities that you will be doing in the online class. This will make the use
of class time more meaningful and efficient.

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CASE 1

A 32-year-old man presents to his primary care provider complaining of a persistent pain in his
chest and upper abdomen. He describes the pain as “burning” and notes that bouts have become
increasingly frequent after meals over the last 4 to 6 months and are worse at night while he is
lying down. He initially dismissed the episodes as indigestion and has tried a variety of over-the-
counter (OTC) antacids for relief, with varying success. However, an unusually prolonged
episode of intense pain during a recent business trip alarmed him, and he admits to some anxiety
that he may be “heading down the same road” as his father, toward premature heart disease.

On questioning, the patient adds that he frequently experiences regurgitation, which leaves an
unpleasant taste. He had not linked the regurgitation to the recurrent pain, but he agrees that
the 2 symptoms may coincide. He says that he often wakes in the morning with a particularly
sour taste in his mouth. He is a smoker and frequently relies on benzodiazepines for insomnia.
He denies difficulty in swallowing and has not experienced weight loss.

Physical examination: normal

Blood pressure: 135/80 mm Hg

Laboratory Values
Complete blood cell count and laboratory values: within normal range
Serum lipid values:
• Total cholesterol: 210 mg/dL
• Low-density lipoprotein cholesterol: 145 mg/dL
• High-density lipoprotein cholesterol: 47 mg/dL
• Triglycerides: 160 mg/dL

1. Provide your own hand-drawn diagram of the entire GIT including the accessory organs. Label
completely. Locate all the sphincters. Locate the probable location of the problem faced by this
patient. Why do you exclude that the patient has heart problem?
2. Draw a general cross-section of the GIT to indicate all of the layers. Draw the tissues and cells that
make up each layer. Discuss their functions. Which layer is associated with pain (burning
sensation) perceived by the patient? Explain the perception of pain. Hint: receptor à afferent
pathway à control centre (cortex).
3. Draw a cross-section of the GIT where the lower oesophageal sphincter (LES) is situated.
a. Indicate the tissue layers surrounding the lumen of this area. Focus on the muscle layer that
forms the sphincter.
b. Indicate the nerve supply (intrinsic and extrinsic) to the muscle layer.
c. How is opening and closure of the LES regulated?
d. Compare and contrast between peristalsis of the oesophagus and tonic contraction of the
sphincter. Justify based on mechanism.
e. What could be the problem in this patient? Locate it in your diagram.
4. Draw the histological layers that form the stomach wall. Focus on the epithelial cells that form the
glands in the mucosal layer. Label all the modified epithelial cells that form the endocrine and
exocrine glands in the stomach. Discuss their functions and regulation. Which secretion from the
stomach could cause problems to the tissues that make up the lower oesophageal areas? Why?

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CASE 2

A 40-year-old man who had been a heavy drinker for many years, went to see his general
practitioner. He had made two previous visits over the past year due to recurrent episodes
of abdominal pain. Although the pain had been intermittent at first, it was now
continuous. The patient also said that he had lost a considerable amount of weight since his
last visit.

Upon enquiry the pain was described to originate in the epigastrum, and to radiate through
to the back. The patient was very thin and the doctor noticed that he was mildly jaundiced.
The doctor arranged for the patient to be admitted for a few days for tests so that his
condition could be diagnosed. He was submitted to an X-ray examination, and serum and
urine analyses were performed. The patient's stools were collected over three days. These
were seen to be pale-coloured and bulky, indicating a high fat content (steatorrhea). The
patient's response to secretin was also tested. This involved an injection of secretin (1
CU/kg body weight) and continuous aspiration of the duodenal contents until the water and
bicarbonate output had returned to the initial level.

The blood tests showed a reduced serum pancreatic isoamylase, but increased bilirubin and
alkaline phosphatase. Urine analysis confirmed the presence of glycosuria (glucose in the
urine), indicating that the patient was diabetic. The secretin test indicated a decreased
pancreatic secretory response as manifest by a low level of HCO3- secretion. The patient
was prescribed pethidine to control the pain. He was advised to abstain completely from
alcohol, and to try to eat regular meals.

1. Draw a diagram showing a normal pancreas, liver and gall bladder with ducts leading to the
duodenum. Label the diagram completely including the exocrine and endocrine glands of the
pancreas.

2. Draw and label the acinar cells (including duct cells) of an exocrine gland of the pancreas of
a normal person showing a duct leading to the pancreatic duct. What do the acinar cells and
duct cells secrete? How are these secretions regulated? Compare these to the condition of
the patient.

3. Draw the histology of the liver to show the organization of the hepatocytes in a lobule. Draw
the portal triad. Explain the perfusion of hepatocytes with blood coming from the portal vein
and hepatic artery. Explain the formation of bile. Discuss the flow of bile and bilirubin into
the bile ducts, the gall bladder and the duodenum via the ampulla of Vetter. Is there any
problem with the hepatobiliary system in the patient? What if the ducts are obstructed?

4. Draw the cross section of the duodenum to show different tissue layers. Focus on the
epithelial cells that make up the villi and the crypts of Lieberkühn. Explain their
modification to perform absorptive functions, digestive functions and other functions. Draw
the capillaries and lacteals that extend into the villi. Locate the associated neurons. Discuss
these processes in the patient.