Term
| What is the difference between inflammatory and non-inflammatory diarrhea? What agents cause each? |
|
Definition
NON-INFLAMMATORY DIARRHEA: no WBCs, small intestine, watery diarrhea; caused by toxigenic bacteria (E. Coli or V. cholera), viruses, protozoa, pre-formed bacterial toxin in food.
INFLAMMATORY DIARRHEA: fecal WBCs, large intestine, low volume of stool with mucus, blood/pus caused by bacteria (shigella. campylobacter, e. coli), toxins (C diff, EHEC), E. histolytica |
|
|
Term
| What are the curved gram neg rods? |
|
Definition
| Vibrio, Helicobacter, Campylobacter |
|
|
Term
| Campylobacter spp and H. pylori require what type of atmosphere to grow? |
|
Definition
microaerophilic
Microaerophiles need oxygen because they cannot ferment or respire anaerobically. However, they are poisoned by high concentrations of oxygen |
|
|
Term
| How can Vibrio, Helicobacter and Campylobacter be differentiated from the Enterobacteriaceae family? |
|
Definition
| they are OX+ whereas most enterobacteriaceae are OX- |
|
|
Term
| Which gram neg curved rods have a 'seagull appearance'? |
|
Definition
|
|
Term
| Which gram neg curved rods have corkscrew motility? |
|
Definition
|
|
Term
| Which gram neg curved rods grows best at 42C? |
|
Definition
|
|
Term
| Which gram neg curved rods has a single polar flagellum? |
|
Definition
|
|
Term
| Which type of Vibrio cholera serotype O1 has a longer survival in water and has a higher rate of subclinical infections? |
|
Definition
El Tor
(other type of O1 is Classical) |
|
|
Term
| How does the A1 cholera toxin leads to profuse rice water diarrhea? |
|
Definition
| A1 enters cells and catalyzes ADP-ribosylation of Gs alpha which results in irreversible activation of adenylate cyclase and continuous production of cAMP. Excess cAMP causes decreased absorption of Na+ from the intestinal lumen and excess secretion of Cl-, pulling water into the lumen. |
|
|
Term
| Which diarrheal disease starts with a non-specific prodrome of abdominal discomfort, vomiting and loose stools? |
|
Definition
Cholera
A prodrome is an early symptom (or set of symptoms) that might indicate the start of a disease before specific symptoms occur. |
|
|
Term
| Which requires a higher inoculum to cause diarrhea: Vibrio or Campylobacter? |
|
Definition
| Vibrio (it is very sensitive to gastric acid) |
|
|
Term
| What bacteria is linked to Guillain-Barre Syndrome? How? |
|
Definition
Campylobacter jejuni
Cross-reaction with a bacterial ganglioside-like LOS structure and human peripheral nerve gangliosides. Triggers demyelination and axonal degeneration --> ascending paralysis |
|
|
Term
| What is the number one mechanism of transmission for C. jejuni? |
|
Definition
|
|
Term
| What diseases are assoc with H. pylori? |
|
Definition
| gastric/duodenal ulceration (PUD), gastritis, gastric adenocarcinoma (intestinal type), MALT lymphoma, chronic immune thrombocytopenia |
|
|
Term
| Where is the most common site of H. pylori adherence? How does it set up an environment for itself? |
|
Definition
antrum of stomach
secretes urease which makes a mini-alkaline environment by forming ammonia |
|
|
Term
|
Definition
| Combination of proton pump inhibitor and two antibiotics (amoxicillin, clarithromycin, metronidazole, tetracycline) for 10-14 days |
|
|
Term
| How can you clinically tell the difference between Campylobacter and Vibrio diarrhea? |
|
Definition
C. jejuni -- fever, blood and pus in stool
V. cholera -- no fever, watery diarrhea |
|
|
Term
| What organism grows on TCBS agar? |
|
Definition
|
|
Term
| What cells make up a normal esophagus? |
|
Definition
| NKSSE = non-keratinizing stratified squamous epithelium |
|
|
Term
| What esophageal disorder presents with vomiting, polyhydramnios, abdominal distension and aspiration at or soon after birth? |
|
Definition
| Tracheoesophageal fistula |
|
|
Term
| What is a thin cord-like noncanalized segment of the esophagus associated with a proximal blind pouch and lower pouch leading to the stomach |
|
Definition
|
|
Term
| What disease causes disordered esophageal motility and inability to relax LES? |
|
Definition
achalasia ("bird's beak deformity")
--due to damaged ganglion cells in myenteric plexus |
|
|
Term
| What infection can cause achalasia? |
|
Definition
|
|
Term
| Where is the smooth and striated muscle located in the esophagus? |
|
Definition
| The upper third of the muscularis is striated muscle, the middle third both smooth muscle and striated muscle, and the lower third predominantly smooth muscles. |
|
|
Term
| What is the name for longitudinal tears at the esophageal junction? |
|
Definition
|
|
Term
| Clinically, how can a doctor tell the difference between hematemesis from M-W tears and from esophageal varices? |
|
Definition
| hematemesis from esophageal varices is painless |
|
|
Term
| What is the name for esophageal rupture? |
|
Definition
|
|
Term
| What disease might cause nocturnal regurgitation and aspiration of undigested food? |
|
Definition
|
|
Term
| What is the route of blood flow causing esophageal varices? |
|
Definition
lower esophageal veins drain into the left gastric vein which drains into the portal vein. Portal HTN causes a backup.
*the majority of esophageal veins, however, drain by azygous vein into the SVC and are not affected. |
|
|
Term
| What are two most common viruses and single fungal agent responsible for infectious esophagitis? |
|
Definition
Fungal = candida – pseudomembranes with fungal structures and neutrophils covering mucosal surface
Viral = cytomegalovirus (CMV) – single, deep ulcer
and Herpes simplex virus (HSV) – multiple, shallow “punched out” ulcers. On histology, you can see multinucleated cells with intranuclear inclusions |
|
|
Term
| What is the single most important risk factor for adenocarcinoma of the esophagus? |
|
Definition
| Barrett's Esophagus (seen in 10% of pts with GERD) |
|
|
Term
| What histological changes are seen in Barrett's esophagus? |
|
Definition
| Metaplasia of lower esophageal mucosa from normal stratified squamous epithelium to nonciliated columnar epithelium with goblet cells (cells usually found lower in the gastrointestinal tract). |
|
|
Term
| What the two criteria required to diagnose Barrett's? |
|
Definition
1. endoscopic appearance of ‘salmon’ or red velvet colored mucosa (columnar epithelial lining)
2. histologic evidence of intestinal metaplasia: presence of GOBLET CELLS |
|
|
Term
| What are the major risk factors for squamous cell carcinoma of the esophagus? |
|
Definition
**alcohol and tobacco (most common)
very hot tea
achalasia
esophageal web (eg. Plummer-Vinson)
esophageal injury (eg. lye ingestion) |
|
|
Term
| What are the major risk factors for adenocarcinoma of the esophagus? |
|
Definition
| Barrett's esophagus long segment aka >3cm increases risk 30-40x, tobacco, obesity |
|
|
Term
| What autoimmune connective tissue disorder causes damage to small blood vessels and progressive fibrosis in skin/organs, including GI involvement 90% of the time (difficulty swallowing and reflux)? |
|
Definition
| scleroderma (systemic sclerosis) |
|
|
Term
| Which type of esophageal cancer is more common in rural and underdeveloped areas? |
|
Definition
|
|
Term
| Which type of esophageal cancer can be poorly differentiated with signet ring cells? |
|
Definition
|
|
Term
| Which type of esophageal cancer can present with chest pain, although EKG will be normal? |
|
Definition
|
|
Term
| Which type of esophageal cancer is more common in African-Americans than Caucasians? |
|
Definition
|
|
Term
| Which type of esophageal cancer is associated with a subconscious change from solid to liquid diet? |
|
Definition
|
|
Term
| Which type of esophageal cancer is associated with p53 point mutations and p16/INK4a mutation? |
|
Definition
|
|
Term
| Which type of esophageal cancer is associated with p53 point mutations, c-ERB-B2, cyclin D1, cyclin E amplification, mutation of Rb tumor suppressor, loss of p16/INK4a, hypermethylation of p16/INK4a, increased epithelial expression of TNF and NF-kB? |
|
Definition
|
|
Term
| Where do upper, middle and lower esophageal cancers metastasize? |
|
Definition
upper (20%) -- cervical lymph nodes
middle (50%) -- mediastinal, paratracheal and tracheobronchial lymph nodes
lower (30%) - gastric and celiac lymph nodes |
|
|
Term
| What cells secrete the mucous layer in the stomach? |
|
Definition
|
|
Term
| What side of the diaphragm usually herniates? |
|
Definition
|
|
Term
| What congenital GI anomaly presents 2-3 weeks after birth with persistent projectile, nonbilious vomiting? what is the treatment? |
|
Definition
pyloric stenosis (3:1 M:F)
treatment = myotomy aka surgical splitting |
|
|
Term
| What is the difference between gastric erosions and ulcers? |
|
Definition
| erosion do not cross muscularis mucosa; ulcers extend through the musc. mucosa into the submucosa or deeper |
|
|
Term
| Etiologies of acute gastritis? |
|
Definition
| NSAIDs, alcohol, uremia, H. Pylori, chemotherapy, chemical, radiation, high altitudes, ICU patients (shock) |
|
|
Term
| What is the name of an acute gastric ulcer due to severe burns? |
|
Definition
|
|
Term
| What is the name of an acute gastric ulcer due to upper GI/intracranial disease? what is the mechanism of ulcer production? |
|
Definition
Cushing ulcer
stimulation of vagus n. leads to increased Ach production and therefore acid secretion |
|
|
Term
| Etiologies of chronic gastritis? |
|
Definition
| H. pylori infection in antrum (most important) and autoimmune destruction of parietal cells in body and fundus. In AIG, CD4(+) T cells express a transgenic T-cell receptor specific for a peptide from the H(+)/K(+) ATPase proton pump, a protein expressed by parietal cells in the stomach. Destruction of these cells leads to achlorhydria, hypergastrinemia and pernicious anemia. |
|
|
Term
| What type of cancer does chronic gastritis pose a risk for? |
|
Definition
| gastric adenocarcinoma intestinal type |
|
|
Term
| What are the effects of NSAIDs on the gastric mucosa? |
|
Definition
| NSAIDs can cause acute gastritis by interfering with the cytoprotection normally provided by prostaglandins or reduced bicarbonate secretion (either way increases susceptibility of the gastric mucosa to injury). Prostaglandins improve blood flow, favor production of mucous and bicarb, inhibit acid secretion by parietal cells. This can lead to acute gastric ulceration. |
|
|
Term
| Which gastric adenocarcinoma variant is associated with metaplasia due to chronic gastritis? |
|
Definition
|
|
Term
| Which gastric adenocarcinoma variant is associated with signel ring cells? |
|
Definition
|
|
Term
| What are the risk factors for Intestinal Type Gastric Adenocarcinoma? |
|
Definition
Environmental = chronic gastritis, nitrosamines in smoked foods, blood type A
Genetic = FAP -->Familial Adenomatous Polyposis |
|
|
Term
| What are the risk factors for Diffuse Type Gastric Adenocarcinoma? |
|
Definition
Genetics: germ-line mutation in CDH1 (E-Cadherin encoding)
E cadherin is a protein that contributes to epithelial cell adhesion |
|
|
Term
| What is the difference between early and advanced gastric carcinoma? |
|
Definition
early = limited to mucosa/submucosa and >90% 5 year survival
advanced = invasion of muscularis propria <20% 5 year survival |
|
|
Term
|
Definition
| Gastric adenocarcinoma metastatic to supraclavicular node |
|
|
Term
| What is a Krukenberg tumor? |
|
Definition
| Gastric adenocarcinoma metastatic to ovaries |
|
|
Term
| What is Sister Mary Joseph's nodule? which type of gastric carcinoma is it mostly seen with? |
|
Definition
gastric carcinoma metastasis to the periumbilical area
intestinal type |
|
|
Term
| What are the layers of active ulcers? |
|
Definition
| fibrinoid Necrosis, Inflammatory infiltrate (neutrophils predominate), active Granulation tissue with mononuclear cells, fibrous/collagenous Scar |
|
|
Term
| What is hyperplasia of foveolar cells with hypoproteinemia called? |
|
Definition
|
|
Term
| What do 25% of patients with ZE Syndrome also have? |
|
Definition
| MEN-1 =Multiple endocrine neoplasia type 1, part of a group of disorders that affect the endocrine system through development neoplastic lesions in pituitary, parathyroid gland and pancreas. |
|
|
Term
| what are the majority of gastric polyps? |
|
Definition
| hyperplastic polyps with no malignant potential |
|
|
Term
| What type of gastric polyp is increased in FAP and accounts for 10% of stomach polyps? |
|
Definition
| adenomatous polyp - malignant potential, 30% have a focus of cancer |
|
|
Term
| Which type of gastric cancer is associated with linitis plastica? |
|
Definition
|
|
Term
| Which form of gastric adenocarcinoma is decreasing in incidence? |
|
Definition
|
|
Term
| Where are the majority of carcinoid tumors found? what type of cells do they arise from? |
|
Definition
jejunum and ileum (>40%)- multiple and aggressive
neuroendocrine cells |
|
|
Term
| what is the most common site for extranodal lymphomas? |
|
Definition
| gastric lymphoma (>80% assoc with H pylori infection) |
|
|
Term
| What are GISTs? What type of cells do they arise from? |
|
Definition
| Gastrointestinal Stromal Tumors -- arise from the interstitial cells of Cajal, the pacemaker cells for gut peristalsis |
|
|
Term
| What do 75-80% of GISTs have mutations in? what does this gene do? |
|
Definition
| CD117 (C-kit) mutations which lead to activation of the tyrosine kinase signaling pathway, promoting cell proliferation and inhibiting apoptosis. Histologically, spindle cells become epithelioid over time. Treat with imatinib |
|
|
Term
| What is Meckel's Diverticulum? |
|
Definition
Persistence of omphalomesenteric duct (vitelline duct)
Disease of 2’s:
2% of population (mostly asymptomatic)
2:1 M:F
2” in length
2 ft of ileocecal valve
2 types of ectopic tissue in 1/2 of cases (gastric and pancreatic)
2 major complications (pain with inflammation; hemorrhage with ulcer) |
|
|
Term
| What congenital disorder is due to absence of ganglion cells? What other disorder is this associated with? |
|
Definition
| Hirschsprung Disease -- leads to megacolon, failure to pass meconium. Associated with Down Syndrome |
|
|
Term
| What portion of the GI tract is always affected by Hirschsprung? |
|
Definition
|
|
Term
| What is the treatment for Hirschsprung? |
|
Definition
| removal of aganglionic section of bowel |
|
|
Term
| What is the most commonly acquired GI emergency in preemies? |
|
Definition
| Necrotizing Enterocolitis |
|
|
Term
| What is the name of the skin blistering disease associated with Celiac Disease? |
|
Definition
|
|
Term
| How does Celiac Disease present in infants, children and adults? |
|
Definition
Infants: diarrhea, failure to thrive, abdominal distention, anorexia, weight loss, irritability
Older children: (non classic symptoms), abdominal pain, nausea, vomiting, bloating or constipation
Adults: diarrhea, flatulence, weight loss, and fatigue, anemia |
|
|
Term
| Pathogenesis of Celiac Disease? |
|
Definition
| Upon exposure to gliadin, and specifically to three peptides found in ’prolamins’, the enzyme tissue transglutaminase (tTG) modifies the protein, and the immune system cross-reacts with the small-bowel tissue, causing an inflammatory reaction. In other words, the tTG modifies gliadin in such a way that it looks like a T cell epitope and the HLA DQ2 (or DQ8) on APC will present it to the T cells which will secrete INFg and TNFa to destroy the epithelium.. Gliadin also stimulates enterocytes to produce IL-15 which triggers T cells to attack the enterocytes. That leads to villous atrophy and malabsorption |
|
|
Term
| how do you diagnose celiac disease? |
|
Definition
biopsy -- loss of villi, crypt hyperplasia, increased intraepithelial CD8 lymphocytes
serologic studies -- antibodies to tissue transflutaminase (TTG), deaminated gliadin, endomysium |
|
|
Term
| what protozoa presents with bloody diarrhea? |
|
Definition
|
|
Term
| How do you clinically differentiate collagenous colitis and lymphocytic colitis? |
|
Definition
BOTH: chronic watery diarrhea 3-20x per day, radiographic studies are unremarkable, endoscopic findings are normal
NEED TO BIOPSY:
collagenous colitis -- band of collagen beneath surface epithelium
lymphocytic colitis -- no subepithelial collagen
PT POPULATION
collagenous colitis -- middle age and older women
lymphocytic colitis -- M:F 1:1 |
|
|
Term
| What is the infectious disease agent responsible for pseudomembraneous colitis? antibiotic associated with this colitis? |
|
Definition
pathogen = toxin-forming strain of C. diff grows in a yellow-green false membrane on colon
antibiotics = broad spectrum, especially Clindamycin, destroys normal gut flora |
|
|
Term
| Disease that results in fat malabsorption and steatorrhea due to PAS+ macrophages in the SI villi lamina propria? |
|
Definition
| Whipple Disease, caused by gram-pos Tropheryma whippelii organism |
|
|
Term
| Location of Crohn Disease vs UC? |
|
Definition
Crohn: mouth to anus but most common is terminal ileum; skip lesions
US: always involves rectum, can extend proximally up to cecum |
|
|
Term
|
Definition
|
|
Term
| IBD limited to mucosa/submucosa? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| IBD with non-bloody diarrhea? |
|
Definition
|
|
Term
| IBD associated with primary sclerosing cholangitis? |
|
Definition
| seen in both, but more associated with UC |
|
|
Term
| IBD with risk of toxic megacolon? |
|
Definition
|
|
Term
| IBD associated with greater risk of colon carcinoma? |
|
Definition
| UC (but still seen in Crohn) |
|
|
Term
| What types of small bowel obstructions are most common? |
|
Definition
80% = mechanical obstruction such as hernias, adhesions or volvulus
15% = tumor or infarction |
|
|
Term
| What are the most common locations for volvulus? |
|
Definition
| sigmoid (most common) and cecum |
|
|
Term
| What type of hemorrhoids are painful? |
|
Definition
|
|
Term
| What type of colonic polyps are associated with rectal prolapse? |
|
Definition
|
|
Term
| What type of colonic polyps are commonly found in children <5? |
|
Definition
Hamartomatous polyps
-benign if solitary, could progress to carcinoma if child has many (Juvinile Polyposis Syndrome) |
|
|
Term
| what type of colonic polyp is most common, has a serrated edge, and has no malignant potential? |
|
Definition
|
|
Term
| What syndrome is associated with polyps having tree-like projections? How is it inherited? What other clinical symptoms are present? |
|
Definition
Peutz-Jeghers Syndrome
autosomal dominant (loss of LKB1/STK11 gene)
clinical: mult polyps, melantotic mucosal and cutaneous pigmentation; inc risk for colorectal, breast and gynecologic cancers. |
|
|
Term
| What 3 factors make polyps more likely to progress from adenoma to carcinoma? |
|
Definition
| >2cm, sessile growth, villous histology |
|
|
Term
| How is Familial Adenomatous Polyposis inherited? |
|
Definition
APC mutation (5q21)
100% develop colorectal adenocarcinoma. Prophylactic colectomy is the standard therapy but pts often develop adenomas at other sites such as ampulla of Vater and the stomach. |
|
|
Term
| What are the two variants of FAP? |
|
Definition
Gardner syndrome (FAP with fibromatosis and osteomas)
Turcot Syndrome (FAP with CNS tumors) |
|
|
Term
|
Definition
| another name for HNPCC; low number of polyps, cancer at young age |
|
|
Term
| What is the most common way that colorectal carcinoma arises? second most common? |
|
Definition
most common = adenoma-carcinoma sequence: APC mutation -> K-ras mutation (formation of polyp) --> p53 mutation/inc COX expression (carcinoma)
second way: Microsatellite instability due to defective DNA copy mechanisms |
|
|
Term
| Signs of right sided colon carcinoma? |
|
Definition
|
|
Term
| Signs of left sided colon carcinoma? |
|
Definition
| pencil-like stools, blood-streaked stool, LLQ pain |
|
|
Term
| What are the T (tumor size) stages of colorectal carcinoma? |
|
Definition
T1 - invading submucosa
T2 - invading muscularis propria
T3 - invading subserosal tissues
T4 - invades to visceral peritoneum, other organs, or perforates |
|
|
Term
| What is a benign dilatation of the appendix lumen by mucinous secretions called? |
|
Definition
|
|
Term
| What is a proliferation of benign neoplastic cells in the appendix that may rupture due to dilatation by mucinous material? |
|
Definition
|
|
Term
| Name for appendix carcinoma? |
|
Definition
| Appendix mucinous cystadenocarcinoma |
|
|
Term
| Clinical condition caused by cancerous cells (usually appendix mucinous cystadenocarcinoma) that produce abundant mucin or gelatinous ascites? |
|
Definition
|
|
Term
| What anatomical structure divides upper GI from lower GI? |
|
Definition
| Ligament of Treitz (suspensatory muscle of the duodenum) |
|
|
Term
| Clinical presentation of UGI bleed? |
|
Definition
| hematemesis or melena (foul-smelling, sticky tar-like black material) |
|
|
Term
| Clinical presentation of LGI bleed? |
|
Definition
| hematochezia, BRBPR (bright red blood per rectum)or maroon stool, FOBT+ stool |
|
|
Term
| What is the difference between shock and orthostatic hypotension in terms of blood loss? |
|
Definition
Shock: 40% decrease in BV
Orthostatic: 20-25% decrease in BV |
|
|
Term
|
Definition
PUD (75%)
esophago-gastric varices (10%)
Mallory-Weiss Tear (7%) |
|
|
Term
What percent of UGI will rebleed if you find:
Active bleeding
visible vessel
adherent clot
flat, pigmented spot
clean ulcer base |
|
Definition
Active bleeding - 55%
visible vessel - 43%
adherent clot - 22%
flat, pigmented spot - 10%
clean ulcer base - <5% |
|
|
Term
| Therapy for esophagogastric varices? |
|
Definition
Medical (VP, NTG, octreotide*, B-blockers)
Endoscopic (injection, ligation, glues)
Radiologic (TIPS*, embolization)
Surgical (shunts, transection, splenectomy) |
|
|
Term
What is the clinical outcome from each of these NG tube aspirates?
Bright red blood/clots
Coffee ground
clear
bilious |
|
Definition
1. Bright red blood/clots = active bleeding.
2. Coffee grounds = slow bleeding, oozing, stopped bleeding.
3. Clear = gastric juice; indeterminate (but 95% means that the bleeding has stopped).
4. Bilious = if you get bile, you can say the UGI bleed has stopped—BEST SITUATION*** |
|
|
Term
|
Definition
Diverticulosis (43%)
Angiodysplasia aka AV malformation (30%)
Neoplasia (9%)
colitis (9%) |
|
|
Term
| Where is the site of problem if pt has large vol, less frequent diarrhea? |
|
Definition
|
|
Term
| Where is the site of problem if pt has normal vol, more frequent diarrhea? |
|
Definition
|
|
Term
| Where is the site of problem if pt diarrhea with urgency without volume? |
|
Definition
|
|
Term
| What length of time determines chronic diarrhea? |
|
Definition
|
|
Term
| When must you investigate acute diarrhea? eg. stool culture or endoscopy |
|
Definition
| if there is evidence of tissue invasion (blood/pus), if the pt is immunocompromised or has AIDS |
|
|
Term
| What type of diarrhea is due to carbohydrate malabsorption? |
|
Definition
|
|
Term
| What type of diarrhea is due to inhibition of absorption or increase in intestinal secretion? |
|
Definition
|
|
Term
| What type of diarrhea is due to outpouring of blood, mucus and/or protein? |
|
Definition
|
|
Term
Which of the following symptoms would you expect the dyspeptic pt not to have?
A. Upper (epigastric) abdominal pain
B. Heartburn
C. Bloating
D. Early satiety
E. Weight loss |
|
Definition
|
|
Term
Which of the following clinical conditions would not be associated with dyspeptic symptoms?
A. GERD
B. Duodenal ulcer
C. Nephrolithiasis
D. Pancreatitis
E. Gastric ulcer |
|
Definition
|
|
Term
Which of the following are common clinical manifestations of GERD?
A. Heartburn
B. Chronic cough
C. Belching
D. Diarrhea
E. Regurgitation |
|
Definition
|
|
Term
Considering duodenal ulcers: which of the following measures is most effective in reducing recurrences?
A. H-2 antagonists
B. Proton pump inhibitors
C. Antacids
D. Eradication of Helicobacter pylori
E. Dietary modifications |
|
Definition
| Eradication of Helicobacter pylori |
|
|
Term
Which of the following diagnostic tools is unlikely to be helpful in evaluating the dyspeptic patient?
A. History/Physical examination
B. Upper GI endoscopy (EGD)/biopsy
C. Abdominal angiogram
D. Upper abdominal ultrasound
E. CT scan |
|
Definition
|
|
Term
| What is an "apple core lesion" associated with? |
|
Definition
|
|
Term
| Where do diverticula form? |
|
Definition
| Along colon’s mesenteric border where vasa recta penetrates the muscle wall. This forms a weak spot where the mucosa/submucosa herniate through the muscularis propria. |
|
|
Term
| When is surgery indicated in diverticulitis? |
|
Definition
| 2+ episodes of diverticulitis, fistula, IC pts |
|
|
Term
| where does most bleeding in diverticular disease occur? |
|
Definition
|
|
Term
| Rome IV Criteria for Dx IBS? |
|
Definition
| 12+ weeks (need not be consecutive) in past 12 months of abdominal pain/discomfort associated with 2/3 following features: symptoms relieved by defecation, onset assoc with change in stool freq, onset assoc with change in stool form/appearance |
|
|
Term
| What two types of serotonergic drugs are used to treat IBS? |
|
Definition
5HT3 antagonists (Alosterone, Cilanstron) treat diarrhea.
5HT4 agonists (Tegaserod, Prucalopride) and SSRIs treat constipation |
|
|
Term
| What is the only GI disease that IBS patients are at increased risk for (than the general population)? |
|
Definition
|
|
Term
| What percentage of the pancreas is exocrine/endocrine? |
|
Definition
exocrine = 85% -- acinar cells excrete digestive enzymes/proenzymes
endocrine = Islets of Langerhans secrete insulin, glucagon, somatostatin, PP, VIP and Serotonin |
|
|
