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GI FINAL EXAM
N/A
139
Medical
Professional
01/16/2015

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Term
Does GI smooth muscle have motor end plate?
Definition
NO
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
Enterogastric Reflex
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
SEGMENTATION
Term
MAIN form of propulsion in LARGE BOWEL?
Definition
MASS MOVEMENTS
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
Sx for GERD
Definition
Nissen fundoplication
Term
Most effective drug for GERD
Definition
PPI
Term
Findings on endoscopy for eosinophilic esophagitis
Definition
Vertical furrowing; corrugated rings - felinization of esophagus
Term
#1 SCREEN for dysphagia?
Definition
BARIUM SWALLOW
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
ACHALASIA
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
DIFFUSE ESOPHAGEAL SPASM
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
PUD complications
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
HP Eradication Regime?
Definition
321 - Amoxil, Clarithromycin, PPI - 2x day, 1 week

If pen allergic - use Flagyl instead of Amoxil
Term
1st line antidiarrheal = ?
Definition
OPIOIDS
Term
What does pepto bismol have antimicrobial activity against?
Definition
H pylori
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
Celiac serology?
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
Dermatitis herpetiformis
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
Can Rx Cholera with?
Definition
Ciprofloxacin
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
How to treat entamoeba?
Definition
Rx - metronidazole for organisms; parmomycin for cysts
Term
2 chemicals that can control MMC
Definition
Motilin
Erythromycin
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
Types of laxatives
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
Rx for constipation
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
Enterotoxigenic E. coli
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
HIDA scan
Term
#1 chronic GI disorder?
Definition
IBS
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
5 mechanisms of IBS
Definition
Altered GI motility
Visceral hyperalgesia
Intestinal microflora
Psychopathology
Food sensitivity
Term
___% of dyspepsia cases are functional
Definition
75%
Term
IBD pathogenesis
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
CD4+ cell
Term
Extra intestinal manifestations of CROHN'S
Definition
Erythema Nodosum
Renal Stones
Iritis/Uveitis
Arthritis
Aphthous Ulcers
Non-Caseating granulomas
Term
Extra intestinal of UC
Definition
Pyoderma gangrenosum
Spondylosing ankylitis
Hypercoagulable
PSC
Term
What part of the gut is always involved in UC?
Definition
RECTUM
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
3 presentations of UC
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
UC
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
Liver function tests?
Definition
Albumin
INR
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
HEP A
Term
#1 cause of viral hepatitis world wide?
Definition
HEP B
Term
#1 cause of liver Tx?
Definition
HEP C
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
2:1 (but both < 400)
Term
________ fibrosis from alocholic hepatitis
Definition
PERIVENULAR FIBROSIS
Term
#1 cause of chronic hepatitis is
Definition
VIRAL HEP (HBV/DV, HCV)
Term
Budd Chiari Syndrome
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
Rx for Autoimmune Hep
Definition
Prednisone/Azathioprine
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
#1 benign liver mass
Definition
HEMANGIOMA
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
VIRAL HEP (HBV, HCV)
Term
N America #1 cause of HCC
Definition
EtOH ABUSE
Term
#1 site of metastasis of HCC
Definition
LUNGS
Term
What serum marker is elevated in HCC
Definition
alpha fetoprotein
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
Types of GB stones
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
Klatskin Tumor
Definition
Extrahepatic cholangiocarcinoma at the confluence of the R and L hepatic ducts
Term
Choledochal Cyst
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
EtOH
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
Duodenojejnual flexure
Term
Causes of UGI bleeds
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
LGI Bleeds
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
Polyps or cancer
Term
Rx of anal fissures
Definition
1st - high fibre (decrease constipation)
2nd - diltiazem gel, topical NG
3rd - botox
Term
Best medical therapy for anal fissures
Definition
Diltiazem gel
Term
Only type of painful hemorrhoids
Definition
Grade IV
Term
Most sensitive test for cholecystitis?
Definition
HIDA scan
Term
Triangle of Calot
Definition
Cystic duct
Common hepatic duct
Cystic artery
Term
Charcot's Triad
Definition
RUQ/epigastric pain
FEVER
OBSTRUCTIVE JAUNDICE (CONJUGATED)
Term
Reynold's Pentad
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
CECUM (widest diameter)
Term
B3 deficiency
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
SCC risk factors
Definition
In high incidence - nutrition deficiency
In N America - smoking, EtOH
Term
Main cause of gastric cancer
Definition
H Pylori
Term
Intestinal vs. Signet Ring Gastric CA
Definition
Intestinal - hematogenous spread to liver
Signet - peritoneal spread to ovaries (Krukenberg)
Term
FOBT Screening
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
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