Passage
Obesity is a condition that affects over 30% of adults in the United States and is associated with comorbidities such as type 2 diabetes mellitus, heart disease, and cancer. For individuals with clinically severe obesity, defined as having a body mass index above 40 kg/m², lifestyle interventions may produce insufficient weight reduction. Weight loss surgery, such as Roux-en-Y gastric bypass (RYGB) , has proved to be the most effective clinical intervention for facilitating massive and immediate weight loss in clinically obese patients.In RYGB, the stomach is first divided into a small gastric pouch and a distal gastric remnant, which remains attached to the duodenum. Next, the jejunum is transected and its lower section is connected to the newly created gastric pouch to form the alimentary limb. This connection is typically created with surgical staples. The formation of the alimentary limb allows ingested food to bypass the region composed of the distal gastric remnant, the duodenum, and the upper jejunum; collectively termed the biliopancreatic limb. Finally, the lumen of the upper jejunum is reconnected to the lumen of the lower jejunum to allow enzymes and compounds to flow freely from the biliopancreatic limb into the alimentary limb.
Figure 1 RYGB surgically divides the digestive tract into the alimentary limb and the biliopancreatic limb, which then merge into the common limb.RYGB facilitates weight loss by reducing the functional volume of the stomach and altering intestinal anatomy to induce nutrient malabsorption. However, the procedure is associated with several complications, such as steatorrhea, or fatty stools, due to disruption of lipid digestion. Animal studies also suggest that RYGB promotes the growth of weight loss-inducing gut bacteria. Researchers have found that transplanting gut microbiota of obese postoperative RYGB mice into nonoperated, obese mice lacking gut flora may reproduce the therapeutic effects of RYGB in transplant-recipient mice.
Adapted from Bächler T, Le roux CW, Bueter M. How do patients' clinical phenotype and the physiological mechanisms of the operations impact the choice of bariatric procedure?. Clin Exp Gastroenterol. 2016;9:181-9.
-All of the following are secreted by cells in the alimentary limb of RYGB patients EXCEPT:

Question

Passage
Obesity is a condition that affects over 30% of adults in the United States and is associated with comorbidities such as type 2 diabetes mellitus, heart disease, and cancer. For individuals with clinically severe obesity, defined as having a body mass index above 40 kg/m², lifestyle interventions may produce insufficient weight reduction. Weight loss surgery, such as Roux-en-Y gastric bypass (RYGB) , has proved to be the most effective clinical intervention for facilitating massive and immediate weight loss in clinically obese patients.In RYGB, the stomach is first divided into a small gastric pouch and a distal gastric remnant, which remains attached to the duodenum. Next, the jejunum is transected and its lower section is connected to the newly created gastric pouch to form the alimentary limb. This connection is typically created with surgical staples. The formation of the alimentary limb allows ingested food to bypass the region composed of the distal gastric remnant, the duodenum, and the upper jejunum; collectively termed the biliopancreatic limb. Finally, the lumen of the upper jejunum is reconnected to the lumen of the lower jejunum to allow enzymes and compounds to flow freely from the biliopancreatic limb into the alimentary limb.

Figure 1 RYGB surgically divides the digestive tract into the alimentary limb and the biliopancreatic limb, which then merge into the common limb.RYGB facilitates weight loss by reducing the functional volume of the stomach and altering intestinal anatomy to induce nutrient malabsorption. However, the procedure is associated with several complications, such as steatorrhea, or fatty stools, due to disruption of lipid digestion. Animal studies also suggest that RYGB promotes the growth of weight loss-inducing gut bacteria. Researchers have found that transplanting gut microbiota of obese postoperative RYGB mice into nonoperated, obese mice lacking gut flora may reproduce the therapeutic effects of RYGB in transplant-recipient mice.
Adapted from Bächler T, Le roux CW, Bueter M. How do patients' clinical phenotype and the physiological mechanisms of the operations impact the choice of bariatric procedure?. Clin Exp Gastroenterol. 2016;9:181-9.
-All of the following are secreted by cells in the alimentary limb of RYGB patients EXCEPT:

Quizplus · Accepted Answer

11ecba2d_0fa3_5631_a3bf_db466cbd4b4c_MD0008_00 The stomach generally functions to churn, digest, and store food. According to the passage, the alimentary limb formed during RYGB consists of the gastric pouch (ie, surgically reduced stomach) and the attached lower jejunum. In RYGB patients, the smaller gastric pouch has the same function as a normal-sized stomach and secretes the following: The zymogen (inactive) pepsinogen is released by gastric chief cells and is converted into pepsin (active form) on mixing with hydrochloric acid (HCl) in the gastric juice. Pepsin then digests proteins in the stomach (Choice A). Gastrin, a peptide hormone released by gastric G cells, stimulates HCl secretion from parietal cells in the stomach and promotes stomach churning to assist gastric motility (Choice C). The stomach normally protects itself from autodigestion by HCl and proteolytic enzymes in the gastric juice. Mucus is released by mucous cells in the stomach to form a protective physical barrier against autodigestion (Choice D). Bicarbonate ions are released from stomach epithelial cells form a chemical buffer barrier under the mucus barrier. The pancreas generally secretes proteolytic enzymes (eg, trypsinogen, chymotrypsinogen) into the pancreatic duct, which empties into the duodenum to aid digestion of chyme in the lumen. However, in RYGB patients, the duodenum is located in the biliopancreatic limb. Accordingly, pancreatic trypsinogen is released from the pancreas and secreted into the duodenum within the biliopancreatic limb, not the alimentary limb. Educational objective: The cells in the stomach secrete the following: gastrin (from G cells) signals parietal cells to secrete HCl (from parietal cells); pepsinogen (from chief cells) cleaves polypeptides when activated by HCl; and mucus (from mucous cells) and bicarbonate (from epithelial cells) protect the stomach lining against autodigestion by gastric juice.

Passage Obesity Is a Condition That Affects Over 30% of Adults