Term
| Name the portions of the SI |
|
Definition
| Duodenum, jejunum then ileum |
|
|
Term
| What are the functions of the SI? |
|
Definition
• Neutralization of acid
• Action of enzymes
• Absorption of food elements
• Mixing and propulsion |
|
|
Term
| What are the functions of the colon? |
|
Definition
• Water absorption
• storage |
|
|
Term
| What is the fluid load in the human body? |
|
Definition
|
|
Term
| How much water comes from oral intake? |
|
Definition
|
|
Term
| How much of the fluid load reaches the colon? |
|
Definition
|
|
Term
| How much water is excreted in the feces? |
|
Definition
|
|
Term
|
Definition
| That the secretory and absorptive capacities are roughly equal (9L into GI, 9L out) |
|
|
Term
| (T/F) Normal function of this system is well below its maximum function |
|
Definition
|
|
Term
| Why is important to maintain fluid homeostasis? |
|
Definition
| Water aids in the function of the epithelia |
|
|
Term
| How is mucosa pathology prevented normally, even with the constant challenge to structural integrity and physiological functions? |
|
Definition
Immune function:
- Ag sampling
- Oral tolerance
- Secretory IgA |
|
|
Term
| (T/F) Both immediate and delayed immune responses are critical to GI pathology |
|
Definition
|
|
Term
| What does prior sensitization to Ag allow? |
|
Definition
|
|
Term
| Is celiac disease a disease of the SI or LI? |
|
Definition
|
|
Term
| What is it? What causes it? |
|
Definition
- Immune response driven by gluten
- Always a genetic component |
|
|
Term
| How does it start? How is it prevented? |
|
Definition
| Wheat introduction to diet; abstinence from wheat |
|
|
Term
| What are acute pathologies? |
|
Definition
|
|
Term
| What are chronic pathologies associated with celiac? |
|
Definition
|
|
Term
| What is the result of the immune response to wheat? |
|
Definition
| Damage to villi in the upper GI |
|
|
Term
| What is the consequence of this? |
|
Definition
| "Flattened" villi - reduced surface area for absorption therefore reduced abs -> weight loss |
|
|
Term
| What causes the immune response seen? |
|
Definition
| Auto-immune reaction: Ab cross-links gluten and intestinal epithelia |
|
|
Term
| (T/F) There are auto-antibodies to gluten and transglutaminase-2 |
|
Definition
|
|
Term
| What helps promote this immune response? |
|
Definition
| An innate response to glandin |
|
|
Term
| What is the difference between celiac disease and gluten intolerance? |
|
Definition
- Celiac disease is antibody-mediated, life-long with fairly significant health risks
- Gluten intolerance is distinct – not immune mediated. |
|
|
Term
| What is seen in gluten intolerance? |
|
Definition
| Mild, non-specific factors |
|
|
Term
| (T/F) Lactose intolerance is an allergy |
|
Definition
| False, it is an intolerance to milk/milk products |
|
|
Term
| What causes lactose intolerance? |
|
Definition
| A bacterial response to undigested lactose |
|
|
Term
| What are the symptoms of LI? |
|
Definition
| Nausea, cramps, bloating, gas, diarrhea |
|
|
Term
| (T/F) Most adults are deficient in lactase |
|
Definition
|
|
Term
| Which race has unusual lactase function? |
|
Definition
|
|
Term
| Most allergy stuff covered immu (T1) |
|
Definition
|
|
Term
| What is immunological personality? |
|
Definition
| An individuals immunological system - different people have different reactions to various pathogens (sensitivity/responsiveness is a spectrum) |
|
|
Term
| What preserves immunological personality? |
|
Definition
- response to bacteria
- other luminal pathogens
- LACK of response to self
- food antigens |
|
|
Term
| (T/F) Intestinal organisms are few and far between, and play little to no role in an individuals well being |
|
Definition
| False, they are numerous, and critical for health and disease |
|
|
Term
| What pathogens can cause infections? |
|
Definition
| Those that can evade gastric sterilization and colonize in the intestine |
|
|
Term
| What is the consequence of exogenous bacterial colonization in the GIT? |
|
Definition
- The balance of native and foreign flora is off
- Colony may secrete toxins |
|
|
Term
| (T/F) Clostridium difficile is a opportunistic bacteria, but is not troubling to humans |
|
Definition
| False, it is persistent and very troubling |
|
|
Term
| Describe the infection cycle with C-diff |
|
Definition
1. Infection
2. Treatment
3. Re-infection
4. Resistance |
|
|
Term
| What are the 7 symptoms of C-diff infection? |
|
Definition
| Diarrhea, vominting, sensitivity to light, headache, severe dehydration, low BP, dilated LI |
|
|
Term
| (T/F) Diarrhea is a common response to intestinal infection |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Describe 2 ways that this is accomlished |
|
Definition
- Increased water secretion or decreased absorption
- Complex signalling increases motility of intestine |
|
|
Term
| What are 3 common causes/ways diarrhea is started? |
|
Definition
| - CNS - Infection - Damage to absorptive area |
|
|
Term
| (T/F) it is a protective mechanism |
|
Definition
|
|
Term
| (T/F) The young and elderly are more at risk for diarrhea |
|
Definition
|
|
Term
| Which species of e.coli is foreign to humans? |
|
Definition
|
|
Term
| What occurs when humans encounter this species? |
|
Definition
- Pain
- Diarrhea (with blood)
- Vomiting |
|
|
Term
| (T/F) This bacteria produces a toxin |
|
Definition
|
|
Term
| What are two consequences of toxin escape from the intestine? |
|
Definition
| It can cause hemolysis and kidney damage if 10-15% of toxin escapes |
|
|
Term
| (T/F) The young and elderly are more at risk to mortality after infection from this disease |
|
Definition
|
|
Term
| What is the veriform appendix? |
|
Definition
| An appendage of the cecum |
|
|
Term
| What causes appendicitis? |
|
Definition
| Blockage, which leads to inflammation |
|
|
Term
| What results from appendicitis? |
|
Definition
- Local infection
- Inflamm
- Swelling
- Necrosis
- Pain |
|
|
Term
| (T/F) Rupture of the appendix leads to abscess |
|
Definition
|
|
Term
| What is the role of the omentum in appendicitis? |
|
Definition
| Can mobilize and seal off the ruptured appendix |
|
|
Term
| What occurs if the issue is not resolved? |
|
Definition
|
|
Term
| What does inadequate inflow of blood to the intestines lead to? |
|
Definition
|
|
Term
| What does inadequate outflow of blood to the intestines lead to? |
|
Definition
|
|
Term
| How is intestinal obstruction related to this? |
|
Definition
| Obstruction can prevent adequate bloodflow in both directions |
|
|
Term
| List 4 causes causes obstruction of the intestine? |
|
Definition
| - Mechanical causes - Developmental causes - Inflammation (inflammatory stricture) - Tumour |
|
|
Term
| Name the 4 classes of mechanical obstruction |
|
Definition
1. Intussusception
2. Volvulus
3. Adhesions
4. Strangulation |
|
|
Term
| Describe what happens with intussusception |
|
Definition
| Telescoping of intestinal segment into adjacent region (mucosa moves from one segment to another so it overlaps) |
|
|
Term
| What allows the telescoping action? |
|
Definition
|
|
Term
| Why are toddlers more likely to have this happen? |
|
Definition
| Because they still have young/developing GIT |
|
|
Term
| What else can cause this? |
|
Definition
|
|
Term
| What occurs if untreated? |
|
Definition
| Perfusion problems lead to ischemia and necrosis |
|
|
Term
|
Definition
| A twist in the loop of the gut |
|
|
Term
|
Definition
| Failure of the mesentary to retain organization, due to mal-development of the mesentary |
|
|
Term
| (T/F) There is no known congenital predisposition linked with this |
|
Definition
|
|
Term
| How can adhesions cause a mechanical obstruction of the intestines? |
|
Definition
| Improper connections of adjacent intestinal segments or other adjacent organs |
|
|
Term
| (T/F) This involves the inner and outer layers of the intestine |
|
Definition
|
|
Term
| What 3 tissues are involved? |
|
Definition
- Mesentary
- Serosa
- Omentum |
|
|
Term
| How can the improper joining arise? |
|
Definition
- Healing
- Ongoing inflammation |
|
|
Term
| (T/F) Complete blockage occurs |
|
Definition
| False, it is really only a limitation, rather than blockage |
|
|
Term
| How can strangulation of the intestines come about? |
|
Definition
| Herniation of the abdominal muscle (ie inguinal hernia) allows a loop of intestine to protrude through, trapping and constriction of the intestine occurs |
|
|
Term
| Name two congenital obstruction issues |
|
Definition
1. Atresia
2. Congenital aganglionosis (Hirschprung's) |
|
|
Term
| What is intestinal atresia? |
|
Definition
| A blind end within the intestine, caused by failure in intestinal development |
|
|
Term
| Is it located to a specific region of the intestine? |
|
Definition
|
|
Term
| (T/F) Atresia is a common pathology |
|
Definition
|
|
Term
| What causes the obstruction in Hirschprung's? |
|
Definition
| A non-propulsive region causing a functional obstruction |
|
|
Term
| What are the effects on the colon upstream? |
|
Definition
| Distention, toxicity risk |
|
|
Term
| What causes this non-propulsive region? |
|
Definition
| No enteric neurons in therefore no motility in constricted segment |
|
|
Term
|
Definition
| The surgical excision and reconnection of the intestinal segments |
|
|
Term
| Which two plexi are affected in Hirschsprung's? |
|
Definition
1. Submucosal
2. Myenteric |
|
|
Term
| What is a colic, and what does it signal? |
|
Definition
| Reccurent abdominal pain (as opposed to unremitting pain), is a key symptom of obstructive disorder |
|
|
Term
| What are the initial symptoms of mechanical intestinal obstruction |
|
Definition
- Acute pain
- Vomiting
- Proximal contractions and accumulated contents increase pressure, causing further secretions and block of venous outflow |
|
|
Term
| What is the consequence of obstruction, if it is complete? |
|
Definition
| No downstream reabs of water and ions |
|
|
Term
| What pathologies results from this? |
|
Definition
- endotoxemia
- bacterial overgrowth
- ischemia (possibly necrosis) |
|
|
Term
| What occurs if the occlusion is not cleared? |
|
Definition
| Failure of gut motility (ileus) |
|
|
Term
| List two symptoms/dangers of ileus |
|
Definition
- Loss of bowel sounds
- Risk of perforation and peritonitis |
|
|
Term
| What 3 things help correct the pathologies associated with occlusion |
|
Definition
- Surgical removal of obstruction
- Antibiotis
- Electrolytes |
|
|
Term
|
Definition
| Functional paralysis of the intestine |
|
|
Term
| What are the symptoms of functional paralysis? |
|
Definition
- NO colicy pain
- No reflex contracitons
- No bowel sounds |
|
|
Term
| What does ileus always follow and why? |
|
Definition
| Intestinal manipulation - nerves are cut during manipulation |
|
|
Term
| (T/F) It will spontaneous reverse |
|
Definition
|
|
Term
| (T/F) Ileus isn't associated with disease |
|
Definition
|
|
Term
| Ileus associated with serious trauma or disease can be a significant source of morbitity - list the pathologies associated with unfixed ileus |
|
Definition
| Bacterial overgrowth, intestinal damage, peritonitis, sepsis/bacteremia/shock and mortality |
|
|
Term
| Which is the most serious consequence? |
|
Definition
|
|
Term
| What structures does peritonitis affect? |
|
Definition
- Parietal and visceral peritoneum
- Mesentary
- Omentum |
|
|
Term
| Where is the peritoneum located, and what does it do? |
|
Definition
- Lines cavity and covers viscera
- Responds to/participates in inflammation |
|
|
Term
| (T/F) The peritoneum is a thin, highly vascularized and innervated membrane |
|
Definition
|
|
Term
|
Definition
| A loose sheet of tissue that mobilizes to sites of inflammation within the intestin and attaches to the outside |
|
|
Term
| What can omentum migration lead to? |
|
Definition
|
|
Term
| What does the parietal peritoneum cover? |
|
Definition
| Lines the abdominal and pelvic cavities |
|
|
Term
| What does the visceral peritoneum cover? |
|
Definition
| External surfaces of intestinal tract and other organs |
|
|
Term
|
Definition
| A fused, double layer of parietal peritoneum suspending from the intestines |
|
|
Term
| Why is infection of peritoneal cavity so dangerous? |
|
Definition
| Because it is highly vascularized, it allows the rapid expression of infection |
|
|
Term
| List the 4 key symptoms/events indicating perforation of the peritonium |
|
Definition
1. Guarding (reflex contraction of abdominal muscle)
2. Fluid accumulation in peritoneal cavity
3. Ileus
4. Systemic infection |
|
|
Term
| What two things can cause peritoneal perforation? |
|
Definition
1. Chemical irritation
2. Bacterial peritonitis |
|
|
Term
| List 8 aspects/components to diagnostic testing in GI |
|
Definition
Nutritional balance – eg., fat and steatorrhea
Breath testing – bacterial overgrowth
Barium meal/enema and radiology
Surgery: investigation, resection/repair
Endoscopy
ERCP
Manometry
pH monitoring |
|
|
Term
|
Definition
| Endoscopic retrograde cholangiopancreatography |
|
|
Term
| What organ does it analyze? |
|
Definition
|
|
Term
| (T/F) you can remove gallstones with this treatment |
|
Definition
|
|
Term
| (T/F) you can perform a sphincterotomy on the sphincter of Oddi with this treatment |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is the primary concern when there is blood in the stool? |
|
Definition
|
|
Term
| What does fresh blood in the stool indicate? |
|
Definition
| Local source of blood (ie lower GIT) |
|
|
Term
| What does black/tarry blood in the stool indicate? |
|
Definition
|
|
Term
| How is cryptic blood detected? |
|
Definition
|
|
Term
| (T/F) Hemoccult is indicated by cryptic blood in stool |
|
Definition
|
|
Term
| (T/F) Intestinal tumours of epithelial origin are the most common |
|
Definition
|
|
Term
| Which cancer is the single greatest concern? |
|
Definition
|
|
Term
| (T/F) Metaplasia occurs with colon cancer, from adenoma to adenosarcoma progression |
|
Definition
|
|
Term
| (T/F) Haemorrhagic adenomas are not a source of blood in the stool |
|
Definition
|
|
Term
| Describe general approach to handling GI cancers |
|
Definition
| Early detection and then treatment |
|
|
Term
| How is the cancer treated? |
|
Definition
- Removal
- Prevention of growth
- Detection of metastases |
|
|
Term
|
Definition
| Venous pressure expands perianal rectal veins |
|
|
Term
| (T/F) There are both internal and external hemmorrhoids |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| False, 50% of people have them by aged 50 |
|
|
Term
| List two possible associated complications |
|
Definition
- Constipation
- Incontinence |
|
|
Term
| What is often used to treat them? |
|
Definition
- Banding
- Cautery
- Surgery |
|
|
Term
|
Definition
| Small pockets formed by rings of smooth muscle |
|
|
Term
| How often do mass contractions occur in the colon? |
|
Definition
|
|
Term
| What are diverticulota, and what causes it? |
|
Definition
| Small out-pocketings of colonic wall caused by a low fibre diet |
|
|
Term
|
Definition
| Inflammation of diverticula |
|
|
Term
| (T/F) The cause of diverculitis is hard to establish |
|
Definition
| True (may be linkd with small seeds from fruit) |
|
|
Term
| What does it mean, if you have pain with constipation or diarrhea with no other symptoms? |
|
Definition
| Likely irritable bowel syndrome |
|
|
Term
|
Definition
| Stress and life events that affect the motility and perception of intestinal sensations |
|
|
Term
| (T/F) IBS is diagnosed by exclusion |
|
Definition
|
|
Term
| List the 4 inclusive IBS criteria that allow for prediction and analysis of treatment options |
|
Definition
Pain relieved by defecation
Duration of some months
Alternating nature of symptoms
A “trigger” factor |
|
|
Term
| (T/F) IBS is the least common disease in GI practice |
|
Definition
|
|
Term
| (T/F) The Rome criteria helps diagnose IBS |
|
Definition
|
|
Term
| What did research on animals regarding IBS lead to the identification of? |
|
Definition
Research identifies altered sensory threshold to intestinal distention in animal models due to:
a prior inflammatory or
noxious or
stressful event |
|
|
Term
| What is inflammatory bowel disease? |
|
Definition
| Relapsing/remitting inflammation of the GI tract haha |
|
|
Term
| (T/F) Both Crohn's and Ulcerative colitis are two distinct disease, that are both true chronic inflammation |
|
Definition
|
|
Term
|
Definition
|
|
Term
| (T/F) Both have a known cause |
|
Definition
|
|
Term
| Describe the hygiene hypothesis for IBD |
|
Definition
| Cleanliness disregulates immune system |
|
|
Term
| When is the average onset for IBD? |
|
Definition
|
|
Term
| (T/F) Treatments are only symptomatic and not curable |
|
Definition
|
|
Term
|
Definition
5-ASAs, antibiotics
steroids (glucocorticoids), other immune-suppressive agents (Imuran)
Infliximab/Remicade (anti-TNF antibodies) |
|
|
Term
| Where does chrons disease occur, and where is it most common? |
|
Definition
- Anywhere
- Ileum is most common
- thickened wall thickness |
|
|
Term
| What are two characteristics of chrons seen in radiography/endoscopy |
|
Definition
Skip lesions in ileum
Cobblestoning of normal mucosa with surrounding fissured, inflamed tissue |
|
|
Term
| (T/F) The lesions are transmural |
|
Definition
|
|
Term
| List the outcomes of severe lesions |
|
Definition
| 1.Abscess and adhesions, possible fistulae 2.Fibrosis, loss of compliance and obstruction (stricturing) |
|
|
Term
|
Definition
| Inappropriate connection between adjacent structures |
|
|
Term
| Where does Chron's usually occur? |
|
Definition
|
|
Term
| What is done to fix stricturing associated with CD? |
|
Definition
|
|
Term
| (T/F) CD may recur after being fixed |
|
Definition
|
|
Term
| What is short gut syndrome? Why does progrssive CD lead to it? |
|
Definition
| A lack of nutrients absorbed due to decreased surface area. If CD gets bad enough, the area for absorption decreases severely |
|
|
Term
| How does ulcerative colitis appear, pathologically? |
|
Definition
| As mucosal ulcers in the colon and/or rectum |
|
|
Term
| What are the 6 symptoms associated with UC? |
|
Definition
| Pain, bleeding, diarrhea, fever, anemia and weight loss |
|
|
Term
| (T/F) UC is limited to the colon and rectum |
|
Definition
|
|
Term
| (T/F) UC is associated with a decreaesed risk in adenocarrcinoma |
|
Definition
|
|
Term
| Does this disease reappear after resectionning of the colon? |
|
Definition
|
|
Term
| What is the main issue with IBD? |
|
Definition
| That there are widely variably disease symptoms, treatment responses and time course |
|
|
Term
| Why does IBD take a long time to diagnose? |
|
Definition
| Because the symptoms take time to develop |
|
|
Term
| What is the main symptom of IBD? Why would IBD cause this? |
|
Definition
| Growth retardation; IBD causes malnutrition |
|
|
Term
| (T/F) Flares are to be expected with IBD |
|
Definition
|
|
Term
| (T/F) IBD has many extra-intestinal manifestations, caused by autoimmune complications |
|
Definition
|
|
Term
|
Definition
- Iritis
- Arthritis
- Lupus
- Pyoderma |
|
|
Term
| (T/F) IBD has both no cure and no known cause |
|
Definition
|
|
Term
| What are some similarities between chron's and ulcerative colitis? |
|
Definition
- Both result from inappropriate activation of the mucosal immune system
- Genetic factors contribute to susceptibility but are not alone the cause
- Both have similar environmental contributing factors |
|
|
