Term
| Does GI smooth muscle have motor end plate? |
|
Definition
|
|
Term
| Difference between ECA and ERA for GI muscle contraction |
|
Definition
ECA - BER/SWPs produced by ICCs
ERA - APs overlying SWPs that allow for muscular contraction |
|
|
Term
| Primary vs Secondary Peristalsis |
|
Definition
Primary - preceded by swallow
Secondary - not preceded by swallow; due to luminal distension sensed by stretch receptors |
|
|
Term
| 2 functional areas of the stomach and what they do |
|
Definition
ORAD (Fundus) - superior; volume reservoir; receptive relaxation mediated by CN X
CAUDAD (Antrum) - inferior; mixing and propulsion; pacemaker along greater curve |
|
|
Term
|
Definition
| Delayed gastric emptying for contents HIGH in - acidity, osmolarity, fat and protein content |
|
|
Term
| Where does the MMC occur? |
|
Definition
| From stomach to the distal small bowel; only occurs during fasted state |
|
|
Term
| MAIN form of motility in LARGE BOWEL? |
|
Definition
|
|
Term
| MAIN form of propulsion in LARGE BOWEL? |
|
Definition
|
|
Term
| Causes of decreased LES pressure leading to GERD |
|
Definition
Food - EtOH, chocolate, fats
Benzo's, CCBs
Trauma, Smoking, Pregnancy |
|
|
Term
| 2 complications of chronic esophagitis? |
|
Definition
Peptic stricture - mechanical obstruction
Barrett's esophagus - intestinal metaplasia (get columnar epithelium with goblet cells) |
|
|
Term
|
Definition
|
|
Term
| Most effective drug for GERD |
|
Definition
|
|
Term
| Findings on endoscopy for eosinophilic esophagitis |
|
Definition
| Vertical furrowing; corrugated rings - felinization of esophagus |
|
|
Term
|
Definition
|
|
Term
| 3 findings for achalasia on esophageal manometry |
|
Definition
Hypertensive LES
Failure of LES to open
NO peristalsis |
|
|
Term
| In what condition is a bird's beak image seen on upper GI series? |
|
Definition
|
|
Term
| Rx for most primary esophageal motility disorders? |
|
Definition
CCBs, nitrates
Reassurance |
|
|
Term
| What esophageal disorder presents with atypical cardiac like chest pain and rosary bead appearance on upper GI series? |
|
Definition
|
|
Term
| Two causes of acute gastritis |
|
Definition
Chemical - #1 NSAID (most common AG cause)
Stress - sepsis, shock |
|
|
Term
| Pathogenesis of acute gastritis |
|
Definition
Chemical - decreased mucin and PG production (leads to impaired blood flow and HCO3-)
Stress - microvessel ischemia and necrosis |
|
|
Term
| Pathogenesis of HP infection and chronic gastritis |
|
Definition
Produces urease - decrease mucin, somatostatin production and increase gastrin production
Increased gastrin from locally increased pH from low mucin secretion |
|
|
Term
| Neoplasms associated with H pylori |
|
Definition
MALT lymphoma - do not need chemo, just HP eradication
AdenoCA - multifocal atrophic gastritis, get intestinal metaplasia within the gastric epithelium |
|
|
Term
| Where are gastric ulcers vs. duodenal ulcers most common |
|
Definition
| GU - antrum; DU - 1st segment |
|
|
Term
| Pathogenesis of HP infection and PUD |
|
Definition
HP infection increases damage with increased urease; get increased gastrin, decreased mucin production
HP causes DUODENAL ULCERS |
|
|
Term
| Pathogenesis of NSAID use and PUD |
|
Definition
NSAIDs decrease local defences by decreasing PG levels
NSAIDs cause gastric ulcers |
|
|
Term
| Presentation of gastric vs. duodenal ulcers? |
|
Definition
GU - pain during meal; always have to biopsy; 70% due to NSAID use
DU - pain after meal; may get relief with meal; 95% due to HP infection |
|
|
Term
|
Definition
HOPP
Hemorrhage, Obstruction, Perforation, Penetration |
|
|
Term
| PUD Rx for < 40 yo or 40+ yo |
|
Definition
<40 - start with PPI and HP serology; if healed check with breath test if serology was positive; if not healed do upper GI endoscopy
40+ - START W/ ENDOSCOPY; need 4-8 week PPI therapy; only biopsy gastric |
|
|
Term
| Differences in mechanism of PPI vs. H2 Antagonist? |
|
Definition
PPI - decrease HCl release only
H2 - decrease HCl, pepsin and secretory volume response |
|
|
Term
|
Definition
321 - Amoxil, Clarithromycin, PPI - 2x day, 1 week
If pen allergic - use Flagyl instead of Amoxil |
|
|
Term
| 1st line antidiarrheal = ? |
|
Definition
|
|
Term
| What does pepto bismol have antimicrobial activity against? |
|
Definition
|
|
Term
| Acute vs. chronic diarrhea |
|
Definition
Acute < 4 weeks
Chronic is 4+ weeks |
|
|
Term
| 4 types of diarrhea pathophys |
|
Definition
Osmotic (e.g. Celiac)
Secretory (e.g. Cholera
Inflammatory (e.g. Crohn's, UC)
Motility (e.g. IBS) |
|
|
Term
| With is Zollinger-Ellison syndrome? |
|
Definition
| Gastrin secreting tumor of the pancreas leading to HYPERACIDITY |
|
|
Term
| Allergic reaction to what in Celiac? |
|
Definition
PROLAMINS (gliadins, secalins, hordeins; wheat, rye, barley)
Get immune complex formation with killer T cells |
|
|
Term
|
Definition
Antiendomysial and tissue transglutaminase IgA
TTG is best; need to be on wheat containing diet
Gold standard Dx - BIOPSY |
|
|
Term
| Skin manifestation of celiac |
|
Definition
|
|
Term
| What type of diarrhea does Cholera cause? |
|
Definition
| SECRETORY - toxin increases cAMP to cause increased Cl secretion and decreased Na absorption; rice water diarrhea |
|
|
Term
|
Definition
|
|
Term
| What type of diarrhea does C diff cause? |
|
Definition
Inflammatory
See pseudomembranes and white plaques |
|
|
Term
| What kind of diarrhea does O157 and Shigella cause? |
|
Definition
INFLAMMATORY
O157 - same as cholera toxin; do not Rx
Shigella - cytotoxin + direct cell invasion; Rx - ciprofloxacin |
|
|
Term
|
Definition
| Rx - metronidazole for organisms; parmomycin for cysts |
|
|
Term
| 2 chemicals that can control MMC |
|
Definition
|
|
Term
| Small vs. Large Bowel Diarrhea? |
|
Definition
Small - large volume, infrequent, non-urgent
Large - small volume, frequent, urgent |
|
|
Term
| Examples of promotility agents? |
|
Definition
Linaclotide - activate guanlyate cyclase C to increase HCO3 and Cl secretion into lumen
Prucalopride - 5-HT(4) receptor agonist; activate primary afferent neuron (IPAN) to increase peristalsis |
|
|
Term
|
Definition
Bulk - form gels; fibre, bran, cellulose
Osmotic - lactulose, sorbitol, sugars
Stimulant - increase NaCl secretion; Ducolax
BOTH BULK AND OSMOTIC increase IPAN activity to increase peristalsis |
|
|
Term
| Prokinetics examples of these drugs? |
|
Definition
Metoclopramide - DA antagonist; decreased receptive relaxation, increased LES tone, decreased pylorus tone; anti-emetic
Domperidone - DA antagonist; also anti-emetic, but worse than metoclopramide
Erythromycin - increase MMC activity (motilin receptor) |
|
|
Term
| Where do most anti-emetics work? |
|
Definition
At CTZ in medulla - trigger zone
Act as DA-ANTAGONISTS mainly (metoclopramide, domperidone) |
|
|
Term
| BEST ANTI-EMETIC in terms of efficacy |
|
Definition
| Ondansetron - 5-HT(3) receptor antagonist |
|
|
Term
| Lingua villa nigrosa pathophys? |
|
Definition
| Decreased hygiene; defective desquamation + hypertrophy of papillae; porphyrins from bacteria cause black tongue |
|
|
Term
|
Definition
1st - add fibre intake
2nd - add saline laxative
3rd - add pro kinetic (metoclopramide, domperidone) |
|
|
Term
| Pathogenesis of gastroenteritis? |
|
Definition
Day 1 - villi destruction, enterocyte infection, cause fluid transudate into lumen
2-3 - start healing; 6-10 - back to normal |
|
|
Term
| #1 cause of traveler's diarrhea? |
|
Definition
|
|
Term
| Rx for traveler's diarrhea? |
|
Definition
| Loperamide (Immodium) + ciprofloxacin |
|
|
Term
| What can a gastric emptying scan diagnose? |
|
Definition
| GASTROPARESIS (if >50% retained at 2 hrs or 10% at 4 hrs) |
|
|
Term
| What is the most sensitive scan for cholecystitis? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Rome III Criteria for IBS |
|
Definition
| 3+ days of the month in last 3 months, at least 2 of - relieved by defecation, abnormal appearance/consistency, abnormal frequency; need onset 6+ months before Dx |
|
|
Term
|
Definition
Altered GI motility
Visceral hyperalgesia
Intestinal microflora
Psychopathology
Food sensitivity |
|
|
Term
| ___% of dyspepsia cases are functional |
|
Definition
|
|
Term
|
Definition
T cell inflammation - commensal microbes + environmental factors + defective barrier = exaggerated immune response
Too much CD4+ T cell activation and regulatory T cell inactivity |
|
|
Term
| Main T cell culprit in IBD pathogenesis? |
|
Definition
|
|
Term
| Extra intestinal manifestations of CROHN'S |
|
Definition
Erythema Nodosum
Renal Stones
Iritis/Uveitis
Arthritis
Aphthous Ulcers
Non-Caseating granulomas |
|
|
Term
|
Definition
Pyoderma gangrenosum
Spondylosing ankylitis
Hypercoagulable
PSC |
|
|
Term
| What part of the gut is always involved in UC? |
|
Definition
|
|
Term
| Characteristics of Crohn's vs. UC |
|
Definition
Crohn's - transmural, skip lesions, can be anywhere in bowels, fissuring ulcers, granulomas
UC - mucosal; continuous; only in colon/rectum; shallow ulcers |
|
|
Term
| #1 affected area by Crohn's? |
|
Definition
Ileo-cecal
Most commonly see small bowel only for Crohns - 40% |
|
|
Term
|
Definition
Ulcerative proctitis
L sided colitis
Pancolitis |
|
|
Term
| Rx algorithm for Crohn's Vs. UC |
|
Definition
Crohn's - 5-ASA for small or budesonide for large bowel; if not then azothiaprine, MTX, infliximab (anti-TNF Ab)
UC - 5-ASA, if steroid independent use Azathioprine, Infliximab
Can use prednisone for flares for both |
|
|
Term
| Which form of IBD is more likely to have hematochezia? |
|
Definition
|
|
Term
| Which form of IBD is associated with cancer? |
|
Definition
| UC - due to PSC and cholangiocarcinoma risk |
|
|
Term
| Bile is made of 4 things... |
|
Definition
| Bile salts, pigments, phospholipids, electrolytes |
|
|
Term
AST and ALT levels in viral or toxic injury
AST and ALT levels in alcoholic hepatitis |
|
Definition
Viral - AST, ALT > 1000
Alcohol - see 2:1 AST:ALT ratio, but less than 500 for each |
|
|
Term
|
Definition
|
|
Term
| Causes of conjugated vs. unconjugated hyperbilirubinemia? |
|
Definition
Unconjugated - hemolysis, Wilson's
Conjugated - any kind of viral or toxic hepatitis or cholecystitis |
|
|
Term
| If conjugated hyperbilirubin - hepatic vs. chole |
|
Definition
Hepatic - elevated ALT, AST; increased INR decreased albumin
Chole - elevated ALP, GGT |
|
|
Term
| Causes of intrahepatic vs. extra hepatic cholestasis? |
|
Definition
INTRA - PBC, sepsis
EXTRA - PSC, GB stones |
|
|
Term
| Cirrhosis caused by what cell type? |
|
Definition
| Stellate/Ito cells - cytokines from Kupffer cells cause them to turn into fibroblasts; start collagen deposition; leads to vascular shunting |
|
|
Term
| Micro vs. Macronodular Cirrhosis |
|
Definition
Micro - more likely EtOH; < 3 mm
Macro - more likely viral; > 3 mm |
|
|
Term
| #1 cause of acute viral hep? |
|
Definition
|
|
Term
| #1 cause of viral hepatitis world wide? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| How to differentiate between acute and chronic hepatitis? |
|
Definition
| Time frame - Acute < 6 mos; Chronic > 6 |
|
|
Term
| Differences between sAg, sAb, cAb for Hep B |
|
Definition
sAg - measures active infection; acute or chronic
sAb - measures vaccination status
cAb - measures any exposure; IgM if acute, IgG if chronic |
|
|
Term
| HBV is ____ virus; whereas HCV is _____ |
|
Definition
HBV - DNA; HCV - RNA
Need cells to replicate for HCV; therefore to get HCC from HCV need cirrhosis first |
|
|
Term
| AST:ALT ratio in acute alcoholic hepatitis? |
|
Definition
|
|
Term
| ________ fibrosis from alocholic hepatitis |
|
Definition
|
|
Term
| #1 cause of chronic hepatitis is |
|
Definition
|
|
Term
|
Definition
| Venous occlusion causing venous congestion in liver; thrombosis in either hepatic vein or IVC; congestion in zones 2 and 3 in Rappaport model of liver |
|
|
Term
| #1 cause of vascular liver disease= |
|
Definition
| R sided CHF leading to passive venous congestion |
|
|
Term
| MARKERS FOR AUTOIMMUNE HEPATITIS |
|
Definition
High IgG
+ ANA
+ anti-smooth muscle Ab |
|
|
Term
|
Definition
|
|
Term
| PSC - characteristics and Rx |
|
Definition
Large duct disease; seen with UC, risk for cancer
Elevated ALP (1st sign); ERCP Dx
Rx - biliary stents to open |
|
|
Term
| PBC - characteristics and Rx |
|
Definition
Small duct disease; present with itching; 9:1 female to male
Dx - anti-mitochondrial Ab, elevated IgM
Rx - ursofalk |
|
|
Term
| #1 cause of elevated liver ENZ |
|
Definition
| NAFLD; #1 liver abnormality in N America |
|
|
Term
|
Definition
|
|
Term
| #1 liver malignancy and #1 primary malignancy |
|
Definition
#1 malignancy = metastasis from breast or lung, or GI
#1 primary = HCC |
|
|
Term
| Worldwide #1 cause of HCC |
|
Definition
|
|
Term
| N America #1 cause of HCC |
|
Definition
|
|
Term
| #1 site of metastasis of HCC |
|
Definition
|
|
Term
| What serum marker is elevated in HCC |
|
Definition
|
|
Term
| What childhood liver tumour is associated with familial adenomatous polyposis |
|
Definition
| Hepatoblastoma (see markedly elevated aFP levels) |
|
|
Term
| Thorotrast can cause which cancers |
|
Definition
| Angiosarcoma > cholangiosarcoma > HCC |
|
|
Term
| Cholelithiasis vs. Choledocholithiasis |
|
Definition
Choleith = stones in GB; 80% asymptomatic
Choledocho = stones in extra hepatic ducts; *** only one that can cause ascending cholangitis |
|
|
Term
|
Definition
Cholesterol
Black Pigment
Brown Pigment |
|
|
Term
| Pathogenesis of cholesterol stones |
|
Definition
| Supersaturation (too much cholesterol, too little phospholipid, too little bile salts) - crystallization, nucleation, growth |
|
|
Term
| Black vs. Brown Pigment Stones |
|
Definition
Black - polymerized bilirbin; chronic hemolysis, EtOH cirrhosis; black and hard
Brown - bacterial lipid, cholesterol, bilirubin degradation; soft, brown and friable |
|
|
Term
| Acute Calculous vs. Acalculous Chole |
|
Definition
Calculous - 90%, better prognosis, stone blocking cystic duct; inflammation, ischemia, perforation
Acalculous - usually post Sx, critical illness; stasis, ischemia, perforation; higher mortality |
|
|
Term
|
Definition
| Extrahepatic cholangiocarcinoma at the confluence of the R and L hepatic ducts |
|
|
Term
|
Definition
| Congenital dilation of common bile duct; risk factor for extra hepatic cholangiocarcinoma |
|
|
Term
| 2 mechanisms of injury in acute pancreatitis |
|
Definition
Acinar injury - most commonly caused by EtOH
Duct obstruction - most commonly caused by stones |
|
|
Term
| #1 cause of chronic pancreatitis |
|
Definition
|
|
Term
| #1 way to dx chronic pancreatitis? |
|
Definition
| IMAGING, endoscopic U/S is most sensitive; secretin stimulation test is gold standard but non-practical |
|
|
Term
| Autoimmune pancreatitis has elevated |
|
Definition
| IgG4; looks like PSC in the pancreas |
|
|
Term
| Delineation between upper and lower GI bleeds |
|
Definition
|
|
Term
|
Definition
| PUD > esophagitis > varices |
|
|
Term
| How to medically treat varices presenting with UGI bleed |
|
Definition
Octreotide (portal venous vasoconstriction)
Propranolol (BB); octreotide only decreases bleeds, not mortality |
|
|
Term
|
Definition
| Diverticulosis > angiodysplasia > hemorrhoids (if < 50); colorectal CA (if > 50) |
|
|
Term
| #1 cause of LGI vs. UGI bleed |
|
Definition
LGI = diverticulosis
UGI = PUD |
|
|
Term
| #1 cause of chronic LGI bleed |
|
Definition
|
|
Term
|
Definition
1st - high fibre (decrease constipation)
2nd - diltiazem gel, topical NG
3rd - botox |
|
|
Term
| Best medical therapy for anal fissures |
|
Definition
|
|
Term
| Only type of painful hemorrhoids |
|
Definition
|
|
Term
| Most sensitive test for cholecystitis? |
|
Definition
|
|
Term
|
Definition
Cystic duct
Common hepatic duct
Cystic artery |
|
|
Term
|
Definition
RUQ/epigastric pain
FEVER
OBSTRUCTIVE JAUNDICE (CONJUGATED) |
|
|
Term
|
Definition
Charcot's (RUQ pain + fever + jaundice)
Hypotension
Confusion |
|
|
Term
| Small bowel obstruction causes |
|
Definition
SHAVING
Stricture, Hernia, Adhesions, Volvulus, Intususception, Neoplasm, Gallstone Ileus |
|
|
Term
| #1 perforation risk in large bowel = |
|
Definition
|
|
Term
|
Definition
| Pellagra - diarrhea, dermatitis, dementia |
|
|
Term
| Small intestine absorption |
|
Definition
Duodenum - Fe, Folate
Jejunum - Ca, Mg
Ileum - bile salts, B12, ADEK |
|
|
Term
| TPN from peripheral vs. central line |
|
Definition
Peripheral - 10% glucose, most kcal from FAT
Central - 25% glucose, most kcal from GLUCOSE |
|
|
Term
| Esophageal cancer in Western countries vs. rest of world |
|
Definition
Western - adenoCA > SCC
Rest - SCC >>> adeno |
|
|
Term
|
Definition
In high incidence - nutrition deficiency
In N America - smoking, EtOH |
|
|
Term
| Main cause of gastric cancer |
|
Definition
|
|
Term
| Intestinal vs. Signet Ring Gastric CA |
|
Definition
Intestinal - hematogenous spread to liver
Signet - peritoneal spread to ovaries (Krukenberg) |
|
|
Term
|
Definition
every 2 years past the age of 50; all abnormals go to colonoscopy or barium enema
CRC is 99% preventable |
|
|
Term
| #1 milk intolerance in kids= |
|
Definition
| Cow's Milk Protein Allergy |
|
|
