Gastrointestinal System — MCQs

Gastrointestinal System Indian Medical PG Practice Questions and MCQs

Question 541: Which hormone is secreted by the "Delta cells" of the stomach?

A. Cholecystokinin
B. Gastrin-releasing peptide
C. Somatostatin (Correct Answer)
D. Secretin

Explanation: ***Somatostatin*** - **Delta cells (D cells)** in the stomach and pancreas secrete **somatostatin**, a potent inhibitory hormone. - Somatostatin **inhibits the release of gastrin**, histamine, secretin, cholecystokinin, and gastric acid secretion, acting as a "universal off switch." *Cholecystokinin* - **Cholecystokinin (CCK)** is primarily secreted by **I cells** in the duodenum and jejunum. - Its main functions include stimulating gallbladder contraction and pancreatic enzyme secretion. *Gastrin-releasing peptide* - **Gastrin-releasing peptide (GRP)**, also known as **bombesin**, is a neuropeptide released from **enteric neurons**. - It stimulates the release of **gastrin** from G cells. *Secretin* - **Secretin** is secreted by **S cells** in the duodenum in response to acidic chyme entering the small intestine. - Its primary role is to stimulate the pancreas to release **bicarbonate-rich fluid** to neutralize gastric acid.

Question 542: Which of the following statements regarding the lower esophageal sphincter is TRUE?

A. It relaxes in response to swallowing. (Correct Answer)
B. It remains contracted during swallowing to prevent regurgitation.
C. Its tone is primarily influenced by the myogenic properties of the smooth muscle.
D. It contracts in response to gastric distension.

Explanation: ***It relaxes in response to swallowing.*** - The **lower esophageal sphincter (LES)** normally maintains high resting tone to prevent gastroesophageal reflux but **relaxes completely during swallowing** to allow passage of food into the stomach. - This relaxation (called **receptive relaxation**) is mediated by **vagal nerve stimulation** through release of nitric oxide (NO) and vasoactive intestinal peptide (VIP). - The relaxation occurs **before the peristaltic wave arrives**, allowing coordinated transit of the bolus. *It remains contracted during swallowing to prevent regurgitation.* - This is **incorrect** - the LES must **relax during swallowing** to allow food passage into the stomach. - Failure of LES relaxation during swallowing is the pathophysiology of **achalasia**, leading to dysphagia. - The LES only maintains contraction between swallows to prevent reflux. *Its tone is primarily influenced by the myogenic properties of the smooth muscle.* - While the LES contains smooth muscle with intrinsic myogenic properties, its tone is **predominantly regulated by neural and hormonal factors**. - **Neural control:** Vagal cholinergic pathways (increase tone), non-adrenergic non-cholinergic (NANC) pathways with NO and VIP (decrease tone). - **Hormonal factors:** Gastrin increases tone, while progesterone, CCK, and secretin decrease tone. *It contracts in response to gastric distension.* - This is **incorrect** - gastric distension actually triggers **transient LES relaxations (TLESRs)**, which are the primary mechanism of physiological reflux. - TLESRs are vagally mediated reflex responses that allow venting of gastric air. - Increased LES contraction in response to gastric distension would be counterproductive.

Question 543: What is the average daily volume of pancreatic secretion in humans?

A. 5.0 L
B. 10 L
C. 1.5 L (Correct Answer)
D. 2.5 L

Explanation: ***1.5 L*** - The **pancreas** produces approximately **1.5 liters (1200-1500 mL) of pancreatic juice** daily in humans. - This secretion is rich in **digestive enzymes** (amylase, lipase, proteases) and **bicarbonate** for neutralization of gastric acid in the duodenum. - This is the standard value cited in **major physiology textbooks** (Ganong, Guyton & Hall). *2.5 L* - **2.5 liters** overestimates the typical daily pancreatic secretion volume. - This value may represent **combined secretions** from multiple sources or confuse pancreatic output with total upper GI secretions. - Normal pancreatic secretion ranges from **1-2 liters**, making 2.5 L above the physiological range. *5.0 L* - **5.0 liters** represents an abnormally high volume for daily pancreatic secretion alone. - This volume is closer to the **total daily secretions** from stomach, pancreas, and bile combined. - Not consistent with **normal pancreatic physiology**. *10 L* - **10 liters** is grossly excessive for pancreatic secretion and represents approximately the **total volume of all gastrointestinal secretions** (saliva, gastric, pancreatic, bile, intestinal) combined daily. - This is **not physiologically realistic** for pancreatic output alone.

Question 544: What triggers the cephalic phase of gastric secretion?

A. On food entering stomach
B. On food entering intestine
C. On seeing food (Correct Answer)
D. On stress

Explanation: ***On seeing food*** - The **cephalic phase** of gastric secretion is initiated by sensory input such as the sight, smell, taste, or even the thought of food. - This phase is mediated by the **vagus nerve**, stimulating gastric acid and enzyme secretion in anticipation of food arrival. *On food entering stomach* - This describes the initiation of the **gastric phase** of digestion, where mechanical stretch and chemical presence of food in the stomach stimulate further secretions. - The gastric phase primarily involves local reflexes and hormonal mechanisms (like **gastrin** release), rather than purely sensory input from the head. *On food entering intestine* - This marks the beginning of the **intestinal phase** of digestion, which involves both stimulatory and inhibitory signals for gastric secretion. - The primary role of the intestinal phase is to regulate the rate at which chyme enters the small intestine and to coordinate bile and pancreatic enzyme release. *On stress* - While stress can impact digestive function, it typically affects the **autonomic nervous system** in a generalized way, often leading to inhibition of digestion or altered motility. - Stress does not specifically trigger the cephalic phase of gastric secretion, which is a physiological response linked to nutrient anticipation.

Question 545: Motilin secretion is decreased in which of the following states?

A. Thirsty
B. Starving
C. Ingested meal (Correct Answer)
D. Interdigestive state

Explanation: ***Ingested meal*** - Motilin secretion is **decreased after a meal** due to the presence of food in the small intestine, which stimulates other gastrointestinal hormones and neuronal reflexes that inhibit motilin release. - The primary role of motilin is to stimulate **gastric and intestinal motility** during fasting, clearing residual food and preventing bacterial overgrowth, making its activity counterproductive during digestion. *Thirsty* - **Thirst** is primarily regulated by antidiuretic hormone (ADH) and the renin-angiotensin-aldosterone system, and it does not directly impact motilin secretion. - Motilin's main function is related to gut motility, largely independent of the body's hydration status. *Starving* - Motilin levels tend to be **higher during fasting or starvation**, as it plays a crucial role in initiating the **migrating motor complex (MMC)**, which sweeps undigested material through the gastrointestinal tract. - This activity prevents bacterial overgrowth and prepares the gut for the next meal; thus, its secretion is increased, not decreased. *Interdigestive state* - The **interdigestive state** refers to the period between meals, which is synonymous with a fasting or starving state. - During this period, motilin secretion is **increased** to stimulate the **migrating motor complex (MMC)**, which is essential for gut cleansing.

Question 546: What is the effect of acetylcholine on the Lower Esophageal Sphincter (LES)?

A. Causes contraction (Correct Answer)
B. Causes relaxation
C. No effect on LES
D. Contraction followed by relaxation

Explanation: ***Correct Option: Causes contraction*** - Acetylcholine acts on **M3 muscarinic receptors** on LES smooth muscle cells to cause **contraction** - This is part of the **excitatory cholinergic pathway** that maintains LES tone and prevents gastroesophageal reflux - Acetylcholine is released from **excitatory motor neurons** in the myenteric plexus *Incorrect: Causes relaxation* - LES relaxation during swallowing is mediated by **nitric oxide (NO)** and **vasoactive intestinal peptide (VIP)**, NOT acetylcholine - These inhibitory neurotransmitters are released from separate **inhibitory motor neurons** - The relaxation response during swallowing is due to activation of the inhibitory pathway, which suppresses cholinergic tone *Incorrect: No effect on LES* - Acetylcholine has a significant effect on the LES - It is one of the key neurotransmitters maintaining basal LES tone - Loss of cholinergic input can lead to decreased LES pressure *Incorrect: Contraction followed by relaxation* - Acetylcholine itself causes only contraction - The swallowing reflex involves coordinated activation of inhibitory (NO/VIP) and suppression of excitatory (acetylcholine) pathways - The sequence of events is neural, not a biphasic response to acetylcholine alone

Question 547: What percentage of gastric secretion is attributed to the cephalic phase?

A. 20% (Correct Answer)
B. 70%
C. 10%
D. 100%

Explanation: ***20%*** - The **cephalic phase** of gastric secretion is initiated by the sight, smell, taste, or even thought of food and accounts for approximately **20-30%** of total gastric acid secretion. - This phase is mediated by the **vagus nerve**, stimulating parietal cells (via acetylcholine) and G cells (via gastrin-releasing peptide) to release acid and gastrin, respectively. *70 %* - **70%** represents the approximate contribution of the **gastric phase** to total gastric secretion, which is the largest phase. - This phase is activated by the presence of food in the stomach, distension, and the presence of amino acids and peptides. *10%* - **10%** is a value that is too low for the cephalic phase; it typically accounts for a more significant portion of initial acid secretion. - This percentage is sometimes associated with the intestinal phase, which produces a smaller amount of acid secretion after chyme enters the duodenum. *100%* - **100%** is incorrect because gastric secretion is a complex process involving multiple phases (cephalic, gastric, intestinal), each contributing a portion of the total secretion. - Each phase has distinct stimuli and regulatory mechanisms, ensuring a coordinated digestive response.

Question 548: Which type of carbohydrate is absorbed most efficiently from the gastrointestinal tract?

A. Disaccharides
B. Polysaccharides
C. Monosaccharides (Correct Answer)
D. 5-carbon sugars

Explanation: ***Monosaccharides*** - **Monosaccharides**, like glucose and fructose, are the simplest forms of carbohydrates and do not require further digestion. - They are directly absorbed into the bloodstream from the intestinal lumen via specific **transporters** on the enterocyte membrane. *Disaccharides* - **Disaccharides**, such as sucrose and lactose, must first be broken down into their constituent monosaccharides by **brush border enzymes** (e.g., lactase, sucrase) before absorption can occur. - This additional enzymatic step makes their absorption less efficient than that of monosaccharides. *Polysaccharides* - **Polysaccharides**, including starch and glycogen, are complex carbohydrates requiring extensive digestion by enzymes like **amylase** in the mouth and small intestine. - This multi-step breakdown into monosaccharides is the least efficient process and takes the longest time. *5-carbon sugars* - While 5-carbon sugars (**pentoses**) like ribose and deoxyribose are monosaccharides and can be absorbed, they are not a primary energy source in the diet and are not absorbed as efficiently or in as large quantities as the metabolically more significant 6-carbon monosaccharides (hexoses like glucose). - The question asks which *type* of carbohydrate is most efficiently absorbed, and **monosaccharides** as a general category (including 6-carbon sugars) are the most efficient.

Question 549: Ptyalin is secreted by?

A. Gastric gland
B. Salivary gland (Correct Answer)
C. Duodenal gland
D. Pancreatic gland

Explanation: ***Salivary gland*** - **Ptyalin**, also known as **salivary amylase**, is an enzyme produced by the salivary glands. - Its primary role is to initiate the **digestion of carbohydrates** (starches) in the mouth. *Gastric gland* - Gastric glands primarily secrete **hydrochloric acid** and **pepsinogen**, involved in protein digestion. - They do not produce ptyalin or enzymes for carbohydrate digestion. *Duodenal gland* - Duodenal glands (Brunner's glands) secrete alkaline mucus to protect the duodenum from acidic chyme. - They are not involved in the production of carbohydrate-digesting enzymes like ptyalin. *Pancreatic gland* - The pancreas produces **pancreatic amylase**, which continues starch digestion in the small intestine. - While it secretes an amylase, it is distinct from salivary amylase (ptyalin) and released into the duodenum, not the mouth.

Question 550: Which of the following statements about gastric secretion is true?

A. Inhibited by curare
B. Stimulated by nor adrenaline
C. Increased by stomach distention (Correct Answer)
D. Stimulated by an increase in tonic activity

Explanation: ***Increased by stomach distention*** - **Stomach distention** activates local reflexes and the **vagovagal reflex**, leading to the release of **acetylcholine** and **gastrin**, which stimulate gastric acid secretion during the gastric phase. - This is a physiological response that prepares the stomach for digestion of incoming food. *Inhibited by curare* - **Curare** is a **nicotinic acetylcholine receptor antagonist** that primarily affects neuromuscular junctions, causing muscle paralysis. - It does not directly inhibit the primary mechanisms of gastric acid secretion, which are largely mediated by **muscarinic acetylcholine receptors**, histamine, and gastrin. *Stimulated by nor adrenaline* - **Noradrenaline** (norepinephrine) is a neurotransmitter of the **sympathetic nervous system**, which generally **inhibits** gastric motility and secretion. - Activation of alpha-2 adrenergic receptors can decrease gastric acid secretion. *Stimulated by an increase in tonic activity* - This statement is vague; "tonic activity" can refer to various physiological processes. If it refers to **sympathetic nervous system** tonic activity, it would **inhibit** gastric secretion. - If it implies increased vagal tone (parasympathetic activity), then secretion would be stimulated, but the phrasing is not precise enough to be unequivocally true for gastric secretion in general.

Practice by Chapter

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