Term
| What is the normal transit time in motility of the bowel? |
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Definition
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Term
| What is the treatment for slow transit constipation? |
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Definition
| fiber, osmotic laxatives, and careful w/ stimulant laxatives |
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Term
| What diagnosis may mimic symptoms of IBS and the rectal exam shows mal function of pelvic floor muscles? |
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Definition
| Outlet obstruction to defecation |
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Term
| How do we treat outlet obstruction to defecation? |
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Definition
| rule out rectocele or rectal internal prolapse and give biofeedback/muscle relaxation exercises |
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Term
| What obstruction is caused by a vagotomy, diabetes, amyloidosis and a paraneoplastic syndrome with small cell carcinoma of the lung? |
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Definition
| Gastroparesis and chronic intestinal pseudo-obstruction |
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Term
| What medications, especially anticholinergics cause gastroparesis and chronic pseudo-obstruction? one med ! |
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Definition
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Term
| Smooth muscle disorders of the gut can be caused by what two disease processes? |
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Definition
| systemic sclerosis and amyloidosis |
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Term
| What is essential in diagnosing chronic intestinal pseudo obstruction or gastroparesis? |
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Definition
| family history/medication history |
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Term
| What is the differential diagnosis for chronic psedoobstruction/gastroparesis? |
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Definition
| mechaninical obstruction/ functional GI disorders, eating disorders |
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Term
| How do we treat gastroporesis? what about long term therapy |
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Definition
| low fiber, low fat, give iron, folate, calcium, Vitamins D, K, B12 increase liquid component of diet, if long term treat w/ GI tube |
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Term
| What is an impaired relaxation of the stomach upon ingestion of food, high caloric content of liquid phase of stomach contents will speed up transit times? May have antral dysfunction? |
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Definition
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Term
| What is treatment of dumping syndrome? avoid what? add what? |
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Definition
| avoid high nutrietnt liquids, add guar gum/pectin |
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Term
| What is post vagotomy diarrhea, short bowel syndrome, biabetic diarrhea, carcinoid diarrhea? what results due to these disorders/procedures? |
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Definition
| Rapid transit dysmotilites of small bowel |
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Term
| In the diet of the rapid transit dysmotilities of small bowel, what do they avoid and reduce and what should they correct? |
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Definition
| avoid hyperosmolar drinks (i.e. soda) reduce fat, correct deficiencies of calcium magnesium ,potassium, and water /fat soluble vitaminss |
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Term
| In the pharmacotherapy of rapid transit dysmotilites of small bowel, what is the first step drug? how about the second drug and step three drug? |
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Definition
| one: opioid agent before meals second is verapamil or clonidine (must taper) and three: octreotide SQ |
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Term
| What are the diseases producing malabsorption and maldigestion clinically defined as? |
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Definition
| malabsorptio nof fat, although other nutrients are affected |
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Term
| When there is small bowel disease: there is deficiences of what kinds of vitamins due to fat malabsorption? |
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Definition
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Term
| in Small bowel disease there is deficiency of what vitamin if terminal ileum is affected? and what other three are listed in the notes |
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Definition
| B12/ folic acid, calcium, and magnesium |
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Term
| In liver/biliary tract disease there is an association w/ what disorder of the bones and what vitamin deficiency for clotting? |
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Definition
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Term
| When there is pancreatic exocrine insufficiency there is lots of what in the stool? |
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Definition
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Term
| What will a person with malabsorption/maldigestion manifest in symptoms with? what is up w/ their weight? how will stool look, smell, and appear in toliet? |
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Definition
| weight loss, increased frequency of BM, very stinky, and sticks to toliet |
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Term
| What tests do we use to measure fecal fat? |
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Definition
| qualitative (Sudan III and Quantitative |
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Term
| When x-ray of abdomen is done we see calcifications in chronic____ |
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Definition
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Term
| What do we biopsy for gluten sensitive enteropathy, hypogammaglobulinemic sprue, tropical sprue, whipple and others |
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Definition
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Term
| What percent of pancreatic exocrine function is destroyed before symptoms appear? |
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Definition
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Term
| What checks for p-aminobenzoic acid in urine after ingestion of bentiromide? |
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Definition
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Term
| Bile salts are absorbed in the distal___ and what percent are reabsorbed? |
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Definition
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Term
| What is associated w/ impaired CCK release and leads to decreased pancreatic lipase/bile acids delivered to small bowel in response to dietary fats? |
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Definition
| sluten sensitive enteropathy |
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Term
| The intestine becomes secretory instead of absorptive in what enteropathy? |
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Definition
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Term
| In gluten-sensitive enteropathy there is destruction of what border? |
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Definition
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Term
| What positive test for gluten sensitive enteropathy mkes the diagnosis confirmed? |
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Definition
| transglutaminase antibody |
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Term
| What test besides blood can help make a diagnosis in gluten sensitive enteropahty? |
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Definition
| small bowel biopsy: villi atrophy, abnormal enterocytes, increased lymphocytes, macrophages, increased crypts and mitotic figures |
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Term
| Antiendomysial antibody is present in what percent of gluten sensitive enteropahty? |
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Definition
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Term
| What is a disorder of patients that have GSE, have intensely pruritic, blistering lesions appear on knees, elbows shoulders and butt w/ IgA deposits in lesions, improves w/ gluten free diet, and dapsone helps skin lesions but not bowel problem? |
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Definition
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Term
| What disease makes developing GSE more common? |
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Definition
| Diabetes mellitus/autoimmune disorders |
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Term
| What is a disorder in puerto Ricans that involves weight loss, diarrhea, sore tongue in 70% of cases, edema in 25% and folate, B12 deficiency in 75-100% and a small bowel biopsy is needed to make diagnosis |
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Definition
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Term
| What is the treatment for Tropical Sprue? There is a supplement we give and an antibiotic...how long is the antibiotic given? |
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Definition
| folic acid 5mg/day and tetracyclin 2grams for a year |
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Term
| What is a Sprue that involes layers of collagen underneath the enterocytes of small bowel? diagnosis by small bowel biopsy. |
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Definition
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Term
| What is the largest lymphoid organ in the body? |
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Definition
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Term
| What occurs particularly w/ IgA deficiency, most COMMMON CAUSE of malabsorption is giardiasis treated w/ metronidazole for 10 days |
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Definition
| hypogammaglobunlinemic sprue |
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Term
| What is caused by a small bowel resection that reduces surface area resulting in malabsorption-in the ileum what is not reabsorbed? and what vitamin is not made? in the Jejunum what three vitamins are not absorbed? |
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Definition
| Small bowel diseases secondary to surg. and radiation: ileum for bile salts and vit B jejunum for folic acid, Ca2+ and Fe2+ |
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Term
| What is a rare multisystem diseae caused by the bacterium Tropheryma whippellii? |
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Definition
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Term
| In whipple disease, what age, sex are more effected? and w/ nondeforming____ |
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Definition
| middle age male arthritis |
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Term
| What are the cardinal manifestations of whipple disease? |
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Definition
| arthralgias, diarrhea, abdominal pain, weight loss |
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Term
| What lab tests (2) will identify whipple disease |
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Definition
| periodic acid Schiff positive macrophages in intestines and PCR to identify the 16S ribosomal RNA of T. whippellii |
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Term
| How do we treat Whipple disease? There are different antibiotics, 3 of them, and how would you advise your patient to take them? |
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Definition
| Penicillin 250 QIDI and streptomycin 1 Gram IM for 2 weeks followed w/ tetracycline 1 g/d for one YEAR!! |
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Term
| wHAT IS A CONGENITAL CONDITION WITH DEFORMED LYMPHATICS WHICH IMPAIR TRANSPORT OF CHYLOMICRONS FROM ENTEROCYTE TO MESENTERIC LYMPH DUCT? |
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Definition
| Intestinal lymphangiectasia |
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Term
| What is this disease? chylous ascites, chyluria, or chylometorrhea, protein losing enteropathy/lymphopenia, steatorrhea, lymphedmea of arms/legs |
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Definition
| Intestinal lymphangiectasia |
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