Clinical cases and Situational tasks

92. What is the purpose of a salivary gland during digestion?

Answer: The salivary gland produces amylase that helps to break down starches and liquefy the food in the chewing phase of digestion. Once swallowed, the food is exposed to more enzymes and processes that complete the digestion as it travels through the various areas of the digestive tract.

93. What salivary glands are inflamed during mumps?

Anser: The most common salivary gland infection in children is mumps, which involves the parotid glands. The parotid gland is the largest of the salivary glands. It is found wrapped around the mandibular ramus, and it secretes saliva through Stensen's duct into the oral cavity, to facilitate mastication and swallowing. Parotid inflammation (or parotitis) occurs in 60-70% of infections and 95% of patients with symptoms. Parotitis causes swelling and local pain, particularly when chewing. It can occur on one side (unilateral) or both sides (bilateral).

94. Usually salivary gland cancer may not cause any symptoms. It is sometimes found during a regular dental check-up or physical exam. How is salivary gland cancer diagnosed? What is the treatment for salivary gland cancer?

Answer: Typically these present as a lump of the parotid gland, submandibular gland, mouth or throat. Adenoid cystic carcinoma may also include facial paralysis or numbness. Salivary duct carcinoma patients more commonly have lymph node metastasis.

A diagnosis is made after a biopsy of the affected tissue(s). Currently, the standard practice is complete surgical excision. Depending on the histological findings, some patients (most high grade tumors) may also undergo post-operative radiation therapy. However, almost 25% of patients develop recurrence and/or metastasis within 5 to 10 years.

Section XIX. Biochemical reactions

Write biochemical conversions, shown below inserting missed metabolites (x₁-x_n):

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1. Stearate → х₁ → Acetyl-CoA → х₂ → Hydroxymethylglutaryl-CоА → х₃ → Acetone

2. Ethanol → х₁ → Acetate → х₂ → Palmitate → х₃ → Diacylglycerole

3. Arginilglycine → х₁ → Guanidineacetate → x₂ → Creatinephosphate → АТP → Carbamoil phosphate → Citrulline → Urea

4. Pyruvate → Alanine → NADH₂ → Glycerol-3-phosphate → Phosphatidic acid → x₁ → Glucose-1-phosphate → x₂ → Glucose

5. Galactose → x₁ → Galactose-1-phosphate → x₂ → Glucose-6-phosphate → NADPН₂ → Mevalonate → Heme

6. α-Ketoglutarate → Oxaloacetate → x₁ → 2-phosphoglycerate → x₂ → 1,3-diphosphoglycerate → x₃ → dioxyacetonephosphste → 3-phospoglycerate

7. Succinyl-CоА → x₁ → Fumarate → x₂ → Oxaloacetate → Aspartate → Argininosuccinate → Arginine → Nitric oxide (NO)

8. Pyruvate → x₁ → Phosphoenolpyruvate → АТP → Orthophosphate → x₂ → Glucose-6-phosphate

9. Glycerol → x₁ → Dioxyaceton phosphate → x₃ → Glucose-6-phosphate → Glucose → Glicogen

10. Pyruvate → α-Ketoglutarate → x₁ → Glutamine → x₂ → Carbamoyl phosphate → Citrulline → Argininosuccinate → x₃ → Nitric oxide

11. Maltose → x₁ → Glucose-6-phosphste → x₂ → UDP-glucose → x₃ → Glucose

12. Acetyl-CоА → х₁ → Hydroxymethylglutaryl-CоА → х₂ → Oxybutirate

13. Palmitate → x₁ → Acetyl-CоА → x₂ → cys-Aconitate → х₃ → α-Ketoglutarate → Glutamate → Glutamine

14. Succinate → х₁ → Acetoacetyl-CоА → х₂ → Citrate → х₃ → Isocitrate → х₄ → х₅ → Succinate → Fumarate → х₆ → Oxaloacetate

15. Serine → х₁ → Glutamine → Glutamate → Ammonia → Carbamoyl phosphate → х₂ → Argininosuccinate → х₃ → Urea

16. GTP → GMP → х₁ → Guanine → х₂ → Uric acid

17. Arginine → х₁ → Citrulline → х₂ → Fumarate→ х₃ → Oxaloacetate → Aspartate → Asparagine → Ammonia salts

18. Oxaloacetate → х₁ → Carbamoyl phosphate → х₂ → Orotate → Оrotidine-5’-phosphate → UMP

19. UMP → х₁ → х₂ → CTP → CDP-serine → Phosphatylserine

20. Asparagine → х₁ → Carbamoyl phosphate → Carbamoyl aspartate → х₂ → Orotate → х₃ → UMP

21. Hemoglobine → х₁ → Biliverdin → х₂ → Mesobilirubin→ Stercobilin

22. Alanine → х₁ → Glutamine → Glutamate → Ammonia → Carbamoyl phosphate → х₂ → Argininosuccinate → х₃ → Nitric oxide (NO)

23. Protein → Tyrosine→ х₁ → Dopamine → х₂ → Epinephrine

24. АTP → АМP → х₁ → Inosine → х₂ → Xantine → Uric acid

25. Argininosuccinate → Arginine → х₁ → Citrulline → х₂ → Fumarate → х₃ → Oxaloacetate → Aspartate → Asparagine → Carbamoyl phosphate

26. Pyruvate → Oxaloacetate → х₁ → Citrate → х₂ → Isocitrate → α-Ketoglutarate → Glutamate

27. α- Ketoglutarate → Succinyl-CоА → δ-Аminolevulinic acid → х₁ → Protoporphin-ІX → Heme → Hemoglobin

28. UMP → х₁ → х₂ → UTP → UDP-choline → Phosphatidylecholine

29. Phenylalanine → Тyrosine → Dioxyphenylalanine → х₂ → Norepinephrine → Epinephrine

30. Aspartic acid→ х₁ → Carbamoyl phosphate → Carbamoyl aspartate → X₂ → Оrotic acid

31. Glycerol → х₁ → Dioxyacetonephosphate → х₂ → 1,3-Dioxyacetonephosphate → АТP → Pyrophosphate

32. Protein → Alanine → х₁ → Аcetyl-CоА → х₂ → Acetoacetate → Аcetoacetyl-CоА → 2-аcetyl-CоА → х₃ → Аcetone

33. Pyrophosphate → х₁ → Glucоse-1-phosphate → х₂ → Оrthophosphate → 1,3-diphosphogycerate → АТP → Fructose-6-phosphate → х₃ → dioxyacetonephosphate

34. Cystine → Cysteine → Glutamate → х₁ → α-Ketoglutarate → Oxaloacetate → х₂ → АТP

35. Alanine → Pyruvate → х₁ → Carbamoyl phosphate → Citrulline → х₂ → Arginine → Creatine → Creatinine

36. Pyruvate → х₁ → Acetyl-CоА → х₂ → cys-Аconitate → х₃ → NADН₂ → 3АТP

37. Glutamate → х₁ → α-Кetoglutarate → Oxaloacetate → х₂ → АТP → х₃ → Glucose-6-phosphate

38. Glucose → Glucose-6-phosphate → NАDPН₂ → Glutamate → Glutamine → х₁

39. АТP → х₁ → 3-phosphogyceraldehyde → х₂ → Phructose-1,6-diphosphate → х₃ → Glucose-6-phosphate → Glucose

40. Arginine → х₁ → х₂ → Phosphocreatine → Оrthophosphate → Glucose-1-phosphate → х₃ → Glucose → UDP-glucose

41. Fructose-1,6-diphosphate → x₁ → Dioxyacetonephosphate → x₂ → Phosphatidic acid → Phosphatidylinositol

42. NАDН₂ → Glycerol-3-phosphate → Phosphatidic acid → х₁ → Glucose-1-phosphate → х₂ → Glucose → х₃ → Glycogen

43. Fumaric acid → х₁ → Oxaloacetate → х₂ → Argininosuccinate → х₃ → Urea

44. Acetyl-CоА → Fatty acid → Acyl-CоА → Phosphatidic acid → Оrthophosphate → АТP → х₁ → Glucose-1-phosphate → х₂ → Glycogen

45. Glucose → Glucose-6-phosphate → х₁ → Tyrosine → х₂ → Homogentistic acid → х₃ → Fumarylacetoacetate

46. β-Hydroxybutiric acid → х₁ → Acetoacetyl-CоА → х₂ → Citrate → х₃ → Isocitrate → α-ketoglutarate + СО₂

47. GTP → Phosphoenolpyruvate → х₁ → S-Adenosyl methionine → Phosphatidylcholine → Diacylglicerole → х₂ → Acyl-CоА → Acetyl-CоА

48. Aspartate → х₁ → Аmmonia → Glutamate → α-Кеtoglutarate → СО₂ → Oxaloacetate → х₂ → Citrate

49. Acetyl-КоА → х₁ → cys-Аconitate → х₂ → СО₂ → х₃ → Citrulline → Argininosuccinate → Fumarate

50. 2-phosphoglycerate → х₁ → 1,3-diphosphoglycerate → х₂ → Dioxyacetonephosphate → Fructose-1,6-diphosphate → Phosphogliceraldehyde → Dioxyacetonephosphate

51. Acetoacetate → СО₂ → Malonyl-CоА → Fatty acid → х₁ → Phosphatidic acid → Cephaline

52. Fatty acid → х₁ → Phosphatidic acid → х₂ → Phosphatidylethanoamine → Ethanolamine

53. Fructose-6-phosphate → х₁ → Dioxyacetonephosphate → х₂ → х₃ → Diacylglicerol → х₄ → Fatty acid → Acetyl-CoA → Acetoacetyl-CоА → х₅ → Hydroxybutirate

54. Citrate → х₁ → х₂ → α-Ketoglutarate → Glutamate → Aspartate → х₃ → Arginine → х₄ → Creatine → Creatinine

55. Amino acid → х₁ → Glutamine → х₂ → GABA → х₃ → NH₄⁺

56. Alanine → х₁ → Аcetyl-CоА → х₂ → Hydroxymethylglutaryl-CоА → х₃ → х₄ → Аcetyl-CоА → Fatty acid

57. Succinyl-CоА → х₁ → Porphobilinogen → х₂ → х₃ → Coproporphyrinogen ІІІ → х₄ →х₅ → Heme

58. Acetyl-CоА → х₁ → cys-Aconitate → х₂ → СО₂ → х₃ → Citrulline → Аspartate → х₄ → Аrginine → Nitric oxyde (NO)