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Old 01-18-2012
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A 39-year-old woman presents with dyspnea, fatigue, pallor, tachycardia, anosmia, and diarrhea. Laboratory results are: hematocrit 32% (normal 36.144.3%), MCV 102 femtoliters (fL) [(normal 7898 fL)], 0.3 % reticulocytes (normal 0.52.0%), 95 pg/mL vitamin B12 (normal 200900 pg/mL), and an abnormal stage I of the Schilling test. Autoantibodies are detected to a cell type that is found in a region shown in the accompanying diagram. In which region would those cells be found?







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Old 01-19-2012
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: The woman in the scenario suffers from pernicious anemia resulting from autoantibodies to the parietal cells, which are responsible for the production of intrinsic factor as well as HCl. The abnormal stage I Schilling test is indicative of a deficiency in intrinsic factor. Chief cells and parietal cells are found in the fundus (region A). Chief cells synthesize pepsinogen and parietal cells produce HCl and intrinsic factor. The gastric (fundic) glands contain mucous cells, chief cells, and parietal cells. Intrinsic factor is required for absorption of vitamin B12 from the small intestine. The diagram shows the anatomic relationship between the esophagus, stomach, and duodenum. The esophagus (C) joins the stomach in the cardiac region (D). The pylorus (F) contains shorter glands with deeper pits than those of the fundus and body. Those glands contain more mucous cells and many gastrin-secreting enteroendocrine cells. Food entering the pylorus stimulates the release of gastrin that stimulates HCl production by the parietal cells. The pylorus connects with the duodenum (G), which contains the mucus and bicarbonate-neutralizing secretion of the Brunner's glands. The wall of the stomach consists of the mucosa (epithelium, lamina propria, and muscularis mucosa), submucosa, muscularis externa, and serosa (B) lined by a mesothelium.
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