Shared Flashcard Set

Details

Block 7 - Week 6
GI
45
Medieval Studies
12/01/2009

Additional Medieval Studies Flashcards

 


 

Cards

Term
What are 3 mechanisms of gastric reflux?
Definition
Transient lower esoph sphinc relx, hypotensive LES, Hiatal hernia; all are worsened by gastric distention and foods
Term
What are the classic symptoms of GERD?
Definition
Heartburn, regurgitation, dysphagia if complication
Term
Any patient who requires continual medical therapy, has bleeding, dysphagia, or weight loss while on therapy requires what diagnostic technique?
Definition
Endoscopy
Term
Patient with persistent heartburn but with normal Endoscpy have what test?
Definition
Constant pH monitoring
Term
A peptic stricture is tested via barium swallow, what causes it?
Definition
Healing of ulcerative esophagitis causes collagen depostition and solid food dysphag
Term
Barret
Definition
Adenocarcinoma via cyclinD and p53 and p16
Term
What is the possible mechanism of GERD induced asthma?
Definition
Microaspiration with consequent bronchospasm and vago-vagal reflex causing bronchoconstriction
Term
What are the most effective therapies for GERD?
Definition
PPI
Term
Malabsorption can occur without diarrhea, but if there is a problem in the terminal ileum, what doesn
Definition
Bile salts
Term
ID the nutrient malabsorbed from these symptoms - steatorrhea/weight loss, gas/diarrhea, muscle wasting/edema, anemia, diarrhea, night blindness, osetopenia, wound healing impairment, bruising, cheilosis/glottitis/neuropathy, paraesthesias/tetany.
Definition
Fat, carbs, protein, iron/folic/B12, bile salts, vit a, vit d, vit e, vit k, b vitamins, ca/mg
Term
ID which is small bowel diarrhea aka crohns and which is left sided diarrhea aka UC. 1. reservoir capacity, large stool, 2. low capacity, small frequent stools, urgency, tesenmus, mucus, blood.
Definition
1 is crohns, 2 is UC
Term
What is the test for protein and carb malabsorption?
Definition
Protein - a1-antitrypsin clearance, carb- H2 breath test.
Term
What is the major cause for steatorrhea?
Definition
Pancreatic insufficiency with no lipase causing indegstion of fat, the low bicarb also inactivates enzymes
Term
The two major causes for impaired luminal hydrolysis causing malabsoption is pancreatic exocrine insufficiency and Zollinger-Ellison syndrome. What are the causes for each?
Definition
Alcholo, obstructing cancer, CF; gastrinoma causes gastrin secretion inducing heavy acid production which inactivates enzymes and causes malabsoption
Term
There are 3 types of lactase defcient congenital, delayed onset, and acquired and it occurs most heavily in blacks and Asians - what is produced heavily in the colon as a result?
Definition
H2, CO2, fatty acids
Term
Abetlipoproteinemia is an auto rec disorder that causes what?
Definition
Defect in production of apolipoprotein B which prevents absoption of fat and fat soluble vitamins.
Term
The result of Celiac disease is diarrhea due to autoimmune reaction to gliadin form of gluten, transglutaminase is used to diagnose, but what are the histo findings since this can cause t-cell lymphoma and small bowel cancer?
Definition
Villous atrophy, crypt hyperplasia, inflammation primarily in the jejunum; dermatitis herpetiformis also seen
Term
Tropical sprue and whipples disease are both malasoptive disease caused by what?
Definition
Bacteria, whipple is tropheryma whipleei
Term
What two food additives can cause malsorption?
Definition
Sorbitol and olestra
Term
Diverticulosis is a non-threatening result of intra-colonic pressure and low fiber diets, what is it and what are complications?
Definition
Outpuching of all 3 gut wall layers (true) or 2 mucosa and submucosa (false) most commonly in sigmoid colon, and can cause bleeding or diverticulitiis due to trapped feces/infection.
Term
Most diverticulosis is asymp or painless rectal bleeding, and the 3 pearls are vasa recta chronic injury, right sided > left, consider angiodysplasia. However, what is treatmen?
Definition
Supportive unless it doesn
Term
What are the signs of diverticulitis?
Definition
LLQ pain, fever, leukopcytosis, peritonitis with rebound; moderate is unable to eat; sever requires resection
Term
IBD is thought to results from an abnormal immune response to bacterial/environmental triggers in the genetically susceptible individual, what is the gene for Crohns?
Definition
NOD2/CARD15
Term
Ulcerative colitis begins distally, and is typically classified as ________ colonic lesion involving rectum. Crohn
Definition
continuous , discontinuous
Term
Serologic tests for UC and Colitis Crohns is _______, but for small bowel crohns is ____________.
Definition
pANCA, antibody to normal flora bacteria like e coil and pseudo
Term
Migratory arthritis, uveitis, erythema nodosum, pyoderma gangrenosum, sclerosing cholangitis are all extraintestinal manifestations of ________ and _______.
Definition
UC, Crohns
Term
Hemorrhoids are congenital vascular cushions in the lower rectum and anus. They are a combination of arteries, veins, and connective tissue. What are the risk factors?
Definition
Family, low fiber, straining, constipation, urgency, preggers, prior operations to anus.
Term
Internal hemorrhoids are caused by prolapse of the rectal hemorrhoidal plexus proximal to the dentate line and are covered by columnar epithelium. What are symptoms?
Definition
Symptoms include painless rectal bleeding with defecation, protrusion, swelling, soilage, and anorectal pain
Term
Treatment of early stage hemorrhoids is medical and includes bulking agent such a fiber supplementation, stool softeners, zinc oxide or hydrocortisone containing ointments or suppositories. What if that doesn
Definition
More advanced symptomatic hemorrhoids are treated nonoperatively with injection sclerotherapy, rubberband ligation, or infrared coagulation. Refractory or advanced hemorrhoids are treated with surgical excision.
Term
External hemorrhoids can acutely thrombose [become clotted] and produce painful swelling that peaks at 3 days and can last 7-14 days. What type of epithelium is involved?
Definition
Squamous
Term
Acute anal fissure is usually incited by a large, hard stool. Other causes include diarrhea or trauma to anal canal. This causes painful defecation with bleeding and post-defecatory anal spasm. Most fissures are located in posterior midline [80-85%] with a minority in the anterior midline [15-20%].
Definition
What is cause of multiple fissures? IBD, infection, malign
Term
Most fissures will heal spontaneously within 4 to 6 weeks. Chronic anal fissures persist after 6 weeks due to increased sphincter tone from anal spasm which leads to hypoxia and decreased blood flow. What is treat?
Definition
First line treatment of fissures includes chemical relaxation [sphincterolytic therapy] with topical muscle relaxing ointments such as diltiazem, nitroglycerin, and nifedipine. Fiber supplementation and stool softeners are also useful. Fissures refractory to medical therapy are treated surgically. Options include Botox injection [botulinum toxin A] into the internal anal sphincter with fissurectomy [excision of fissure]
Term
The most common etiology of anal abscess and fistula is cryptoglandular disease which is due to an obstruction of the anal crypt opening of the anal gland. Other etiology of perianal abscess and fistula include: Crohn
Definition
ID and antibiotics
Term
Anal warts are caused by the __________. Colonization of the anogenital region with this is common in the general population and is sexually transmitted. High grade Anal intraepithelial neoplasia (AIN) is a high grade dysplastic lesion associated with subsequent development of anal cancer especially in HIV. What is treat?
Definition
HPV, Anal warts are treated with fulguration or chemical cauterization.
Term
IBS is characterized by chronic or recurrent abdominal pain and/or discomfort associated with altered bowel habits (e.g., diarrhea, constipation or alternating diarrhea and constipation). Women are twice as frequently affected as men. What is pathophys?
Definition
A dysregulated brain gut axis resulting in altered gut motility and visceral hypersensitivity is felt to be the principal pathophysiologic mechanism underlying IBS.
Term
Stress can induce IBS, what else is big factor?
Definition
Post-infectious and diarrheal causes
Term
The hallmark symptoms of IBS are chronic abdominal pain and/or discomfort associated with altered bowel habits (diarrhea, constip, or both). How is it diagnosed?
Definition
ROME III criteria, moderate sensitivity, highly specific. There is no recommendation for a battery of tests, except celiac and micro colitis
Term
Treat IBS?
Definition
Traditional therapies such as antidiarrheal agents, laxatives, antibiotics, pschychotropic and tricyclic antidepressants may be effective in treating particular symptoms of IBS. However, lifestyle change best.
Term
What is the diff btw peptic ulcer and erosion?
Definition
Erosion shallow to superficial mucosa only, ulcer penetrates muscularis mucosa and beyond >5mm diameter
Term
H. pylori, NSAIDS, viral infections, tobacco/cocaine, Zollinger-ellison agstrinomas are all causes of __________.
Definition
Peptic ulcers
Term
Transmissino of H. pylori is person-per, fecal oral, with a high prevlance in society. It can cause acute and chronic gastritis, PUD, adenocarcinoma, MALT lymphoma. How does it survive the stomach?
Definition
Urease dumps ammonia into area to survive; eradicative via antibio over 90%, anti acids >30%
Term
Duodenal ulcers are when pain is decreased with meals, what is Pathophysiology since 100% have H. pylori?
Definition
Antral-dominant H. pylori causes gastritis, down somatostatin, ups gastric acid, metaplasia, duoadenitis, then ulcer
Term
Gastric ulcer have Greater pain with food, seen in older folk, NSAIDS, abnormal gastroduodenal reflux. What is non-invasive H. pylori test?
Definition
Serology, stool antigen, urea breath test
Term
Normally you test and treat ulcers with PPI plus clrith and amoxi, but when should you skip and scope early?
Definition
Bleeding, vomting, weight loss, severe pain or other cancer signals
Term
Duodenal ulcers have too much acid so surgical technique is ___________ or suture for hemorrhage or perf; Gsatric ulcers have decreased acid resistance so surgical is ____________ or excision for hemo or perf.
Definition
Truncal Vagotomy(vagus), antrectomy