groin area (answer d), and intestinal dysfunction may be felt in the middle
or low back. Umbilical pain is typically referred from the appendix
(answer e).
Although the finger-like extensions of the gallbladder resemble villi,
they represent changes that occur in the mucosa with increasing age. The
thinness of the wall is the notable characteristic of the gallbladder. The bile is
synthesized by hepatocytes and transported from the liver to the gallbladder.
215.The answer is a.(Junqueira, pp 76, 78–79, 263, 265, 298–302, 310.)
The transmission electron micrograph is taken from the small intestinal
epithelium. Intraepithelial lymphocytes (labeled with the asterisks) are
lymphocytes that have crossed the basal lamina. The intraepithelial lym-
phocytes may respond to antigen in the lumen of the small bowel. In the
Peyer’s patches of the ileum lymphocytes in the lamina propria may
respond to antigen that has been sampled from the lumen and transported
by M cells in the Peyer’s patches. Enterocytes are the absorptive cells of the
gut and possess numerous microvilli on their apical surfaces. Goblet cells
synthesize and secrete mucins (answer b).Paneth cells and enteroen-
docrine cells contain granules, but secrete lysozyme [regulation of flora
(answer e)] and endocrine peptides (answer d),respectively. Mast cells
synthesize and secrete histamine and heparin (answer c).
216.The answer is b.(Kasper, pp 238–240. Guyton, pp 800–801. Young,
pp 274–279. Junqueira, pp 329–330, 332–333, 334–335.)The structure labeled
with the arrow is a bile duct and would contain elevated levels of bilirubin fol-
lowing hemolytic jaundice. Hemolytic jaundice is associated predominantly
with unconjugated hyperbilirubinemia. The overproduction of bilirubin
occurs because of accelerated intravascular erythrocyte destruction or resorp-
tion of a large hematoma. When hepatic uptake and excretion of urobilinogen
are impaired or the production of bilirubin is greatly increased (e.g., with
hemolysis), daily urinary urobilinogen excretion may increase significantly. In
contrast, cholestasis [arrested flow of bile due to obstruction of the bile ducts
(intrahepatic)] or extrahepatic biliary obstruction interferes with the intesti-
nal phase of bilirubin metabolism and leads to significantly decreased pro-
duction and urinary excretion of urobilinogen. Diapedesis of lymphocytes
across the endothelium of the postcapillary high endothelial venules of lym-
phoid organs (e.g., lymph nodes) increases during inflammation.
Gastrointestinal Tract and Glands Answers 335