Term
| Diarrhea is defined as ____________ of stool in 24 hours with a normal Western diet. |
|
Definition
|
|
Term
| Acute diarrhea lasts less than: |
|
Definition
|
|
Term
| Chronic diarrhea lasts greater than: |
|
Definition
|
|
Term
| What 2 viruses have we learned that can cause acute diarrhea with inflammation? |
|
Definition
norovirus (norwalk virus)
rotavirus |
|
|
Term
| What 5 bacteria have we learned that can cause acute diarrhea with inflammation? |
|
Definition
staph aureus
bacillus cereus
clostridium perfringens
e. coli (enterotoxigenic)
vibrio cholerae |
|
|
Term
| What 3 protozoa have we learned that can cause acute diarrhea with inflammation? |
|
Definition
giardia lamblia
cryptosporidium
cyclospora |
|
|
Term
| What virus have we learned about that can cause acute diarrhea without inflammation |
|
Definition
|
|
Term
| What 6 bacteria have we learned that can cause acute diarrhea without inflammaiton? |
|
Definition
e. coli (enteroinvasive)
e. coli (enterohemorrhagic; 0157:H7)
clostridium dificile
shigella
salmonell
campylobacter jejuni |
|
|
Term
| What protist have we learned about that can cause acute diarrhea without inflammation? |
|
Definition
|
|
Term
| What 2 main categories of non-infectious causes of acute diarrhea have we learned? |
|
Definition
medications
ischemia
(others) |
|
|
Term
| What kinds of medications can cause acute diarrhea? |
|
Definition
antibiotics
chemotherapy
cardiac medications
(others) |
|
|
Term
| What is the ischemic illness that can cause acute diarrhea? |
|
Definition
|
|
Term
| With chronic diarrhea, you are mostly concrned about the quality of the diarrhea. What 3 categories of diarrhea are you looking for? |
|
Definition
|
|
Term
| Watery chronic bacteria is caused by _____________ processes or ____________ processes. |
|
Definition
|
|
Term
| What are 2 causes of chronic osmotic watery diarrhea? |
|
Definition
osmotic laxatives
carbohydrate malabsorption |
|
|
Term
| What are the 6 main categories of causes of chronic secretory watery diarrhea? |
|
Definition
infectious (viruses, bacteria, protozoa)
microscopic colitis (unknown cause)
drugs
neoplasia
endocrine
functional
other |
|
|
Term
| What are 3 major categories of causes of chronic inflammatory diarrhea? |
|
Definition
| neoplasia Inflammatory Bowel Disease (IBD) infection (bacteria, viruses, protozoa) other |
|
|
Term
| What are the 2 categories of causes of chronic fatty diarrhea? |
|
Definition
fat mal-absorption
fat mal-digestion |
|
|
Term
Explain the following mnemonic:
TINMAN-VD misc. |
|
Definition
The general causes of ill-health are:
Trauma
Infectious
Neoplasia
Metabolic-Endocrine
Auto-Immune (immune/inflammatory)
Neurologic
Vascular
Drugs
miscellaneous |
|
|
Term
| What are the 3 parts of the small intestine, from proximal to distal? |
|
Definition
duodenum
jejunum
ileum
(from longest word to shortest) |
|
|
Term
| The duodenum begins at _____________________, ends at ____________________, and is about _____________ long. |
|
Definition
the pyloric junction of the somach
the ligament of Treitz (aka the suspensory ligament)
12-15 inches |
|
|
Term
| The ligament of Treitz is aka |
|
Definition
|
|
Term
| In which of the 3 parts of the small intestine do pancreatic and biliary secretions enter? |
|
Definition
|
|
Term
| The jejunum starts at the _______________________ and is about ___________ long. |
|
Definition
ligament of Treitz (aka suspensory ligament)
7-8 feet long |
|
|
Term
| Which of the 3 parts of the bowl is the mixing bowl of chyme and digestive enzymes? |
|
Definition
|
|
Term
| Which of the 3 parts of the small intestine is the major site of digestion & absorption? |
|
Definition
|
|
Term
| Which of the 3 parts of the small intestine is the site of intrinsic factor and bile absorption? |
|
Definition
|
|
Term
| The ileum averages __________ long. |
|
Definition
|
|
Term
| What medical support must you give to a person who has had their ileum removed? |
|
Definition
| you must give vitamin B12 shots because the ileum is the site of intrinsic factor absorption. |
|
|
Term
|
Definition
| Moves food in short segments (2-12 inches at a time, in an oral to aboral (away from the mouth) direction |
|
|
Term
| What is different about the way segmental peristalsis vs. non-preistaltic random constrictions move food? |
|
Definition
peristalsis ONLY moves food from oral to aboral
non-peristaltic contractions move chyme orally AND aborally |
|
|
Term
|
Definition
| causes pancreatic and biliary ducts to release HCO3-, neutralizing acid chyme in the small intestine |
|
|
Term
| At what pH do digestive enzymes have their maximum activity? |
|
Definition
| 6.5-8 (pretty much neutral) |
|
|
Term
| What cells secrete secretin? |
|
Definition
S cells
(Secretin increases the secretion of watery bicarbonate solution by Brunner's Glands in the epithelium of the pancreatic duct; it also tells the pancreas to produce insulin, suppresses gastrin production from G cells, and increases pepsin production by Chief cells) |
|
|
Term
| How is the secretion of secretin controlled? |
|
Definition
| S cells are in the duodenum & jejunum. When they sense acid, the release secretin into the blood. |
|
|
Term
| S cells are in the ________ and _______. When they sense acid, the release secretin into the ___________. |
|
Definition
|
|
Term
| What does CholeCystoKinin (CCK) do? |
|
Definition
it causes the gallbladder to release bile & pancreatic enzymes into the intestine
more specifically, it causes the smooth muscle in the gallbladder to contract and the smooth muscle in the gallbladder DUCT to release |
|
|
Term
| What cells produce CholeCystoKinin (CCK)? |
|
Definition
|
|
Term
| How is the release of Cholecystokinin (CCK) controlled? |
|
Definition
I cells, which are in the duodenum & jejunum, release CCK into the blood when they sense the presence of food
(mnemonic: I make it rain...in the gut--I cells produce CholeCystoKinin into the blood, which causes the gallbladder to rain bile into the gut) |
|
|
Term
| I cells, which are in the _________ & ________, release CCK into the __________ when they sense the presence of food |
|
Definition
|
|
Term
| What does Gastric Inhibitory Peptide (GIP) do? |
|
Definition
| it acts on the endocrine pancreas (we THINK that it's priming the pancreas to produce insulin) |
|
|
Term
| What cells produce Gastric Inhibitory Peptide (GIP)? |
|
Definition
K cells
(GIP is believed to prep the pancreas to produce insulin; Gastric Inhibitory Peptide is an old name based on old beliefs about what the GIP does) |
|
|
Term
| K cells, which produce Gastric Inhibitory Peptide (GIP), are in the ___________ and ________ |
|
Definition
|
|
Term
| Does Gastric Inhibitory Peptide (GIP) inhibit the stomach? |
|
Definition
| No. People once thought it did, but it actually works on the endocrine tissue of the pancreas (it MIGHT prep the pancreas to produce insulin) |
|
|
Term
| What is the main function of motilin? |
|
Definition
| the main function of motilin is to increase the migrating myoelectric complex component of gastrointestinal motility and stimulate the production of pepsin. Migrating myoelectric complexes are waves of activity that sweep through the intestines every 1-1.5 hours during fasting state. |
|
|
Term
| Migrating myoelectric complexes |
|
Definition
| waves of activity that sweep through the intestines every 1-1.5 hours during fasting state, moving food toward the anus. |
|
|
Term
|
Definition
| the serous membrane that forms the lining of the abdominal cavity — it covers most of the intra-abdominal organs. It is composed of a layer of mesothelium supported by a thin layer of connective tissue. The peritoneum both supports the abdominal organs and serves as a conduit for their blood and lymph vessels and nerves. |
|
|
Term
|
Definition
| a smooth membrane consisting of a thin layer of cells which secrete serous fluid that acts as a lubricant, smoothing friction between moving internal parts of the body |
|
|
Term
|
Definition
| various bodily fluids that are typically pale yellow and transparent, and of a benign nature, that fill the inside of body cavities (ex., peritoneum produces peritoneal fluid) |
|
|
Term
| the outer layer of the peritoneum; attached to the abdominal wall |
|
Definition
|
|
Term
| inner layer of the peritoneum; wrapped around the internal organs that are located inside the intra-peritoneal cavity |
|
Definition
|
|
Term
| The parietal peritoneum has the same blood supply, lymph vasculature, & innervations as: |
|
Definition
|
|
Term
| What kinds of sensation is the parietal peritoneum sensitive to? |
|
Definition
pressure
pain
heat
cold
laceration |
|
|
Term
| Is pain from the parietal peritoneium well-localized or not? |
|
Definition
|
|
Term
| The visceral peritoneum has the same blood supply, lymph vasculature, and innervations as: |
|
Definition
|
|
Term
| What kinds of sensation is the visceral peritoneum sensitive to? |
|
Definition
stretch
chemical irritation
(insensitive to touch, heat, cold, & laceration) |
|
|
Term
| Is pain from the visceral peritoneum well-localized or not? |
|
Definition
|
|
Term
| Pain from the visceral peritoneum is usually referred to the: |
|
Definition
|
|
Term
Where is irritation in the following portions of the gut generally felt?
Foregut
Midgut
Hindgut |
|
Definition
Foregut-->epigastric pain
Midgut-->umbilical pain
Hindgut-->pubic pain |
|
|
Term
|
Definition
| organs that are internal to parietal peritoneum and invaginated into & surrounded by visceral peritoneum |
|
|
Term
|
Definition
| organs that are outside the parietal peritoneum & only partially covered by pariteoneum |
|
|
Term
| The kidneys are ___________peritoneal |
|
Definition
| retroperitoneal (a type of extra-peritoneal) |
|
|
Term
| The bladder is _________peritoneal |
|
Definition
| sub-peritoneal (a type of extra-peritoneal) |
|
|
Term
|
Definition
| potential space between the parietal & visceral layers of the peritoneum; contains a thin film of peritoneal fluid |
|
|
Term
|
Definition
| a reflection of the peritoneum that is raised form the body wall by underlying blood vessels, ducts, and ligaments formed by obliterated fetal vessels |
|
|
Term
|
Definition
| fold in the anterior parietal peritoneum from the top of the bladder up to the umbilicus; covers the median umbilical ligament |
|
|
Term
| Median umbilical ligament |
|
Definition
| a fibrous remnant of the urachus, which joined the top of the bladder to the umbilicus |
|
|
Term
|
Definition
| 2 folds lateral to the median umbilical fold; cover the medial umbilical ligaments |
|
|
Term
| Medial umbilical ligaments |
|
Definition
| formed by occluded parts of the umbilical arteries |
|
|
Term
|
Definition
| 2 folds lateral to the medial umbilical folds; cover the inferior epigastric vessels |
|
|
Term
| Mesentery (small intestinal mesentery) |
|
Definition
| a double layer of the peritoneum that suspends the jejunum & ileum from the posterior abdominal wall; the visceral & parietal peritoneum join at the mesentery |
|
|
Term
|
Definition
| the portion of the mesentery that attaches the ileum to the appendix & the appendix to the posterior abdominal wall; contains the appendicular artery |
|
|
Term
|
Definition
| a double-layered extension or fold of the the peritoneum that passes from the stomach and proximal part of the duodenum to adjacent organs in the abdominal cavity |
|
|
Term
|
Definition
| hangs down from the stomach and proximal duodenum (like an apron over the small intestine), then loops back up & attaches to the anterior surface of the transverse colon and its mesentery |
|
|
Term
|
Definition
| smaller than the greater omentum; goes from the top (lesser curvature) of the stomach and proximal duodenum up to the liver; o Also connects the stomach to a triad of structures the run between the duodenum & liver in the free edge of the lesser omentum; o Includes the hepatogastric ligament & hepatoduodenal ligament |
|
|
Term
|
Definition
| a double layer of peritoneum that connects an organ with another organ or to the abdominal wal |
|
|
Term
|
Definition
(“scythe-shaped” ligament)—a ligament that attaches the visceral peritoneum of the liver to the parietal peritoneum on the anterior body wall
Passes down the front of the liver & divides the liver into right & left lobes
o encloses the round ligament of the liver & para-umbilical veins in its inferior free edge |
|
|
Term
| Round ligament of the liver |
|
Definition
| the obliterated umbilical vein; found inside the inferior free margin of the falciform ligament |
|
|
Term
| The hepatogastric & hepatoduodenal ligaments are continuous parts of the __________________ |
|
Definition
|
|
Term
|
Definition
| connects the liver to the lesser curvature of the stomach; the membranous part of the lesser omentum |
|
|
Term
|
Definition
| connects the liver to the duodenum; the thickened free edge of the lesser omentum |
|
|
Term
|
Definition
| attaches the liver to the diaphragm; consists of 3 ligaments joined together (the upper part of the falciform ligament, left triangular ligament, & right triangular ligament) |
|
|
Term
|
Definition
| connects the left lobe of the liver to the diaphragm |
|
|
Term
| right triangular ligament |
|
Definition
| connects the right lobe of the liver to the diaphragm |
|
|
Term
| The gastrophrenic, gastrosplenic, & gastrocolic ligaments are part of the ______________, and have a continuous attachment along the _________________ of the stomach |
|
Definition
greater omentum
greater curvature |
|
|
Term
|
Definition
| connects the upper part of the greater curvature of the stomach to the bottom surface of the diaphragm |
|
|
Term
|
Definition
| connects the greater curvature off the stomach to the spleen |
|
|
Term
|
Definition
| the apron-like part of the greater omentum, which descends from the stomach, turns under, and then ascends to the transverse colon |
|
|
Term
|
Definition
| attaches the left colic flexure to the diaphragm; the left border of the transverse mesocolon |
|
|
Term
| Peritoneal recess (aka peritoneal fossa) |
|
Definition
| a pouch of periotoneum that is formed by a peritoneal fold |
|
|
Term
|
Definition
| the main part of the peritoneal cavity. A surgical incision through the anterolateral abdominal wall enters the greater sac |
|
|
Term
| lesser peritoneal sac (omental bursa) |
|
Definition
| extensive, sac-like cavity that lies posterior to the stomach & lesser omentum |
|
|
Term
|
Definition
| connects the greater peritoneal sac & lesser peritoneal sacs (omental bursa); lies posterior to the heptaoduodenal ligament |
|
|
Term
|
Definition
| grooves between the lateral part of the ascending or descending colon & the posterolateral abdominal wall |
|
|
Term
|
Definition
| attaches the transverse colon to the posterior abdominal wall |
|
|
Term
| The liver is ______________ peritoneal |
|
Definition
|
|
Term
| Where is the liver in the abomen? |
|
Definition
Occupies the right upper quadrant & extends across the midline into the left upper quadrant
towards the front
nestles up against the diaphragm |
|
|
Term
|
Definition
a short but deep fissure, about 5 cm long, extending transversely across the under surface of the left portion of the right lobe of the liver, nearer its posterior surface than its anterior border.
Vessels, ducts, lymphatics, & nerves enter the liver through the porta hepatis |
|
|
Term
| What does the hepatoduodenal ligament contain? |
|
Definition
the trunk of the hepatic triad:
bile duct
hepatic artery proper
hepatic portal vein |
|
|
Term
| Trace the flow of bile from the right hepatic duct to the dudoenum. |
|
Definition
| Right hepatic duct (+ left hepatic duct) --> common hepatic duct (+ cystic duct)--> common bile duct (+ pancreatic duct) --> ampulla of Vater --> enters duodenum |
|
|
Term
| Just above the pelvis, the abdominal aorta splits into the the _____________________, each of which divides in a(n) ______________________________ and a(n) ___________________________ |
|
Definition
| common iliac arteries internal iliac artery external iliac artery |
|
|
Term
|
Definition
a short artery (<2cm) that branches of the anterior off the abdominal artery at the level of T12 & then splits into the common hepatic artery & gastroduodenal artery.
(celiac come from the Greek koilia, meaning belly) |
|
|
Term
| The celiac trunk is a short artery (<2cm) that branches of the anterior off the abdominal artery at the level of T12 & then splits into the ___________________, ______________, and ____________________ |
|
Definition
common hepatic artery
left gastric artery
splenic artery |
|
|
Term
| The hepatic artery proper arises from the __________ by splitting with the ______________ |
|
Definition
common hepatic artery
gastrodudodenal artery |
|
|
Term
| The common hepatic artery is a short artery that arises from the ____________ and splits into the _____________, \and ____________ |
|
Definition
common hepatic artery
hepatic artery proper
gastroduodenal artery |
|
|
Term
| The hepatic artery proper splits into the __________________, which goes to the lesser curvature of the stomach, the __________________, and the __________________ |
|
Definition
right gastric artery
left hepatic artery
right hepatic artery |
|
|
Term
| The right hepatic artery gives rise to the _________________, which feeds the gallbladder. |
|
Definition
|
|
Term
| What's the difference between food poisoning & food intoxication? |
|
Definition
Food poisoning—food contaminated with a pathogenic microorganism that replicates in your body releasing toxins
Food intoxication—food contaminated with a toxin produced by a microorganism (quicker onset of symptoms) |
|
|
Term
| The most common bacterial cause of gastroenteritis in the U.S. |
|
Definition
|
|
Term
Is campylobacter jejuni gram positive or negative?
What shape is it?
Is it motile or non-motile? |
|
Definition
Gram negative
spiral rod
motile |
|
|
Term
Campylobacter jejuni grows best at which of the following?
1. refrigerator temp
2. room temp
3. Houston in August temp
4. cooking temp |
|
Definition
| Houston in August temp (108 degrees Farenheit) |
|
|
Term
| Campylobacter jejuni causes significant damage to the mucosa of the _________, _________, and _____________. |
|
Definition
|
|
Term
| Sources of campylobacter infection. |
|
Definition
zoonotic (poultry, cattle, sheep)
contaminated food, milk, or water |
|
|
Term
| Symptoms of campylobacter jejuni gastroenteritis? |
|
Definition
abdominal pain
fever
2-3 days of diarrhea (possibly with blood & pus) |
|
|
Term
| How do you treat campylobacter jejuni gastroenteritis? |
|
Definition
usually self-limiting
may be treated with antibiotics |
|
|
Term
| Campylobacter jejuni gastroenteritis is particularly a problem in peolpe who: |
|
Definition
decrease or neutralize their stomach acid
(it's easily killed by gastric acids) |
|
|
Term
| What serious sequellae have been linked to campylobacter jejuni? |
|
Definition
Guillain-Barre syndrome
reactive arthritis |
|
|
Term
| What are campylobacter jejuni's air needs? |
|
Definition
| requires microaerophilic conditions with low O2 & high CO2 |
|
|
Term
Are clostridium gram positive or negative?
What shape are they?
What are their air needs? |
|
Definition
gram positive
rods
strict anaerobes |
|
|
Term
| 2 virulence factors of clostridium are that they produce ______________ and have rapid ______________ |
|
Definition
| numerous toxins growth rate |
|
|
Term
| Where do clostridium live? |
|
Definition
soil, water, sewage
part of normal intestinal flora |
|
|
Term
| Where do botulism spores generally germinate in botulism contracted by an adult? |
|
Definition
| in food (particularly improperly canned food); the adult gets sick from ingesting toxins |
|
|
Term
| Where do botulism spores generally germinate in botulism contracted by an infant? |
|
Definition
| in the GI tract (baby gets sick from toxins produced in the GI tract) |
|
|
Term
| Symptoms of foodborne (adult) botulism. How long does it take symptoms to develop after ingestion of toxins? |
|
Definition
weakness, dizziness, blurred vision, constipation (important!)
nuerological problems, including respiratory paralysis, can become severe or even fatal
symptoms develop within 1-3 days |
|
|
Term
| Who is most likely to get botulims in the US? |
|
Definition
| infants (especially <6 months) |
|
|
Term
| What are common sources of botulism spores ingested by babies? |
|
Definition
soil & dust
honey (important!)
infant milk power |
|
|
Term
| What are symptoms of botulism in an infant? |
|
Definition
constipation
failure to thrive
may progress to paralysis (floppy baby syndrome) |
|
|
Term
| Are adults or infants who contract botulism more likely to die of it? |
|
Definition
adults (mortality rate 5-15%)
(vs. infants, with low 1-2% mortality rate)
however, infants are more likely to get botulism |
|
|
Term
| What is the treatment for botulism? |
|
Definition
antitoxin
ventilatory support |
|
|
Term
| Botulism is an "A-B" toxin. What is the A subunit? What is the B subunit? |
|
Definition
the A subunit is the toxin
the B subunit is a ligand that binds to receptors on neurons |
|
|
Term
| How does the botulism toxin survive the stomach? |
|
Definition
| It is complexed with proteins that protect it from stomach acid. |
|
|
Term
| What bacterium is a major cause of gastroenteritis, and also cuases gas gangrene |
|
Definition
|
|
Term
| Where is clostridium perfringens commonly found? |
|
Definition
normal flora bacterium of the gut
found in soil & feces-contaminated water |
|
|
Term
| If you get food poisoning from clostridium perfringens, where did you probably get it from? |
|
Definition
| contaminated meat that was not refrigerated properly |
|
|
Term
| What are the symptoms of gastroenteritis from clostridium perfringens. What is the typical incubation period? |
|
Definition
watery diarrhea
abdominal cramps
18-24 hours |
|
|
Term
| The type of clostridium perfringens that most commonly causes gastroenteritis is type ___, which produces toxin ____ |
|
Definition
|
|
Term
| How does clostridium perfringen type A's enterotoxin cause diarrhea? |
|
Definition
| disrupts ion transport in the ileum, leading to fluid loss |
|
|
Term
| The 2nd most common type of clostridium perfringens that causes gastroenteritis is type _____, which produces _____ toxin. |
|
Definition
|
|
Term
| How is the diarrhea caused by clostridium perfringens type C different than that caused by type A, and why? |
|
Definition
type C often causes bloody diarrhea (while type A just causes watery)
this is because type C produces beta toxin, which forms pores |
|
|
Term
| What microbe is the most common cause of antibiotic-associated GI disease? Second most common? |
|
Definition
| Clostridium dificile candida albicans |
|
|
Term
| What antibiotic is most likely to lead to clostridium perfringens overgrowth and consequent gastroenteritis? |
|
Definition
|
|
Term
| What 2 digestive enzymes do the salivary glands produce? |
|
Definition
alpha-amylase
lingual lipase |
|
|
Term
| What 2 digestive enzymes does the stomach produce? |
|
Definition
|
|
Term
| What 9 digestive enzymes does the pancreas secrete? |
|
Definition
alpha-amylase
trypsin
chymotrypsin
carboxypeptidase
elastase
lipase-colipase
phospholipase A2
cholesterol esterase
nuclease |
|
|
Term
| What 8 digestive enzymes does the intestinal mucosa produce? |
|
Definition
enterokinase
sucrase
maltase
lactase
terhelase
alpha-dextrinase (aka isomaltase)
amino-oligopeptidase
dipeptidase |
|
|
Term
| Enzyme produced primarily by the pancreas, and a little bit by the saliva, which breaks down starches into maltose & small polymers of 3 to 9 glucose molecules |
|
Definition
|
|
Term
| What does alpha amylase do? |
|
Definition
| breaks down starches into maltose & small polymers of 3 to 9 glucose molecules |
|
|
Term
|
Definition
| simple columnar epithelial cells found on the surface of the lumen in the small intestine & colon |
|
|
Term
| What 4 enzymes inside enterocytes break down di- and oligosaccharides? |
|
Definition
lactase
sucrase
maltase
alpha-dextrinase |
|
|
Term
|
Definition
| breaks down lactose into galactose & glucose |
|
|
Term
|
Definition
| breaks down sucrose (table sugar) into fructose & glucose |
|
|
Term
|
Definition
| breaks down maltose into 2 glucose molecules |
|
|
Term
| What does alpha-dextrinase do? |
|
Definition
| breaks down small glucose polymers into glucose molecules |
|
|
Term
| What does alpha-dextrinase do? |
|
Definition
| Breaks down small glucose polymers into glucose molecules |
|
|
Term
| 80% of the monosaccharides that make up the di- oligo- and polysaccharides we eat are ___________ |
|
Definition
|
|
Term
| Protein (especially collagen) beings to break down via the actions of ______ in the stomach |
|
Definition
|
|
Term
| What 4 proteases does the pancreas release? |
|
Definition
Trypsin
Chymotrypsin
Carboxylpeptidase
Proelastase (zymogen for elastase) |
|
|
Term
|
Definition
| Splits proteins into small polypeptides (same as chymotrypsin) |
|
|
Term
| What does chymotrypsin do? |
|
Definition
| Splits proteins into small polypeptides (same as trypsin) |
|
|
Term
| What does carboxylpolypeptidase do? |
|
Definition
| Cleaves individual amino acids from the carboxyl ends of polypeptides |
|
|
Term
| What does proelastase do? |
|
Definition
| It is the zymogen for elastase, which digests elastin fibers that partially hold meats together |
|
|
Term
| Where does the breakdown of protein mostly occur? |
|
Definition
| In the upper small intestine (duodenum & jejunum) |
|
|
Term
| Where does final digestion of proteins occur? |
|
Definition
| Inside the Enterocytes of the duodenum & jejunum |
|
|
Term
| Proteolytic enzymes are activated and destroyed very ________ (rapidly/slowly) |
|
Definition
|
|
Term
| 2 kinds of Inflammatory Bowel Disease (IBD). |
|
Definition
Crohn's disease
Ulcerative colitis |
|
|
Term
| Worldwide, 50% of child deaths under the age of 5 are caused by: |
|
Definition
|
|
Term
| Does secretory diarrhea persist or stop with fasting? |
|
Definition
|
|
Term
| Secretory diarrhea is ________(hypotonic/hypertonic/isotonic) with plasma. |
|
Definition
|
|
Term
| What 5 viruses or virus families are the most common causes of viral entercolitis? |
|
Definition
rotavirus
norwalk viruses
adenoviruses
caliciviruses
astro viruses |
|
|
Term
| What would a biopsy of the intestine of a person with viral enterocolities look like under a microscope? |
|
Definition
small intestine shows modestly shorter villi
lamina propria is inflammaed (infiltrated with immune cells; mostly lymphocytic)
virus particles sometimes are seen by electron microscopy |
|
|
Term
| Clinical features of viral enterocolities |
|
Definition
diarrhea, anorexia, headache, fever
symptoms may start from hours to several days after infection
acute illness last 1-7 days (depending on the virus) |
|
|
Term
| Does osmotic diarrhea stop or continue during fasting? |
|
Definition
|
|
Term
| Is secretory diarrhea watery, bloody, or fatty? |
|
Definition
|
|
Term
| Is osmotic diarrhea watery, bloody, or fatty? |
|
Definition
|
|
Term
| How does lactulose treatment work? |
|
Definition
lactulose is a treatment for constipation
lactulose is a disaccharide that the body can't break down, so it pulls water osmotically in the gut |
|
|
Term
| Disaccharidase deficiency is aka |
|
Definition
|
|
Term
| Clinical presentation of disacchardiase deficiency (lactose intolerance). |
|
Definition
after intake of dairy product, develop:
abdominal bloating
abdominal cramps
diarrhea
floating stools
foul smelling stools
gas (flatulence)
malnutrition
nausea
slow growth in children
weight loss |
|
|
Term
| How do you diagnose disaccharidase deficiency (lactose intolerance)? |
|
Definition
clinical presentation
lactose tolerance test (on an empty stomach, you drink a liquid that contains lactose & no other sugar; then they test your blood glucose level several times to see if it rises) |
|
|
Term
| How does the morphology of the GI tract change in disaccharidase deficiency (lactose intolerance)? |
|
Definition
| no change on imaging or pathologic studies |
|
|
Term
| What is the treatment for disaccharidase deficiency (lactose intolerance)? |
|
Definition
remove dairy products from diet
lactase enzymes can be taken in capsule or chewable tablet form |
|
|
Term
|
Definition
| diarrhea that occurs with purulent, bloody stools |
|
|
Term
| Does exudative diarrhea persist or stop with fasting? |
|
Definition
|
|
Term
| What are the 2 main categories of causes of exudative diarrhea? |
|
Definition
infectious diarrhea
idiopathic Inflammatory Bowel Disease
(exudative diarrhea = purulent, bloody diarrhea) |
|
|
Term
| 4 microbes that commonly cause exudative diarrhea. |
|
Definition
shigella
salmonella
campylobacter
entamoeba histolytica
(exudative diarrhea = purulent, bloody diarrhea) |
|
|
Term
| Inflammatory Bowel Disease (IBD) |
|
Definition
refers to 2 chronic inflammatory diseases of the GI tract:
ulcerative colitis
Crohn's disease |
|
|
Term
| What is the distribution of ulcerative colitis? |
|
Definition
| it starts at the rectum and spreads upwards through the colon from there |
|
|
Term
| What is the distribution of Crohn's disease? |
|
Definition
| It forms skip lesions throughout the colon, usually sparing the rectum |
|
|
Term
| Which part of the bowel wall is usually involved in ulcerative colitis? |
|
Definition
| inner mucosa & submucosa only |
|
|
Term
| Which part of the bowel wall is usually involved in Crohn's disease? |
|
Definition
| transmural (extending through the entire wall) |
|
|
Term
| At what age do people most often present with Inflammatory Bowel Disease? What ethnic group is most likely to get it? |
|
Definition
|
|
Term
Explain the following mnemonic:
U are shallow
the Crone is deep |
|
Definition
Ulcerative colitis only involves the mucosa & submucosa
Crohn's disease involves the entire colon wall |
|
|
Term
| Clinical presentation of Crohn's disease |
|
Definition
chronic diarrhea
weight loss
right lower quadrant abdominal pain (mimicking acute appendicitis)
(mnemonic: U are shallow; the Crone is deep) |
|
|
Term
| How do you diagnose Crohn's disease? |
|
Definition
colonoscopy with ileoscopy (that is, also look at the ileum)
tisue biopsy |
|
|
Term
Explain the following mnemonic:
This Crohn is a MILF that i met outside the BAR |
|
Definition
outside--these are symptoms of Crohn's that occur outside of the intestines
M—mouth ulcers
I—iris inflammation
L—leg ulcers (and on rest of skin, but mostly on legs
F—fingertip clubbing
B—bile duct inflammation
A--arthritis
R—red nodules on skin
|
|
|
Term
| What bowel disease causes pseudopolyps, and whate are pseudopolyps? |
|
Definition
| Ulcerative colitis--the gut has areas that stick out like polyps, but are actually just less-affected mucosa surrounded by damaged mucosa. |
|
|
Term
| What are 3 strong risk factors of Crohn's disease? |
|
Definition
white race, especially Ashkenazi jews
age (2 peaks at 15-40 yrs & 60-80 years)
family history of Crohn's |
|
|
Term
| At what age do people most commonly present with Crohn's disease? |
|
Definition
2 peaks:
15-40 years
60-80 years |
|
|
Term
| 4 radiological features of Crohn's disease |
|
Definition
cobblestone mucosa
asymmetric involvement (string sign--very narrow spots)
fistulas (remember: the crone is deep!)
skip lesions (remember: The CRONE & fat granny SKIPping on the cobblestones AWAY from the REC) |
|
|
Term
| Clinical presentation of ulcerative colitis. |
|
Definition
bloody diarrhea, chronic diarrhea (or both)
lower abdominal pain
fecal urgency
extraintestinal manifestations. |
|
|
Term
| How do you diagnose ulcerative colitis? |
|
Definition
clinical signs
endoscopy with biopsy
stool culture is negative for infectious agents |
|
|
Term
| Ulcerative colitis increase the risk of: |
|
Definition
pathogen infection of the gut
(and even toxic megacolon, which has a risk of perforation) |
|
|
Term
| 3-5% of pateints with ulcerative colitis will develop _________________ of the gut. |
|
Definition
|
|
Term
| 2 strong risk factors of getting Ulcerative Colitis, and 1 strong risk factor of relapse. |
|
Definition
Family history of inflammatory bowel disease
HLA-B27 (a type of MHC Class I)
infection-->relapse |
|
|
Term
| Radiological signs of ulcerative colitis |
|
Definition
loss of haustral folds ("lead-pipe appearance")
mucosal/submucosal ulceration
pseudopolyps |
|
|
Term
Explain the following mnemonic:
a granny & an old crone skipping down a cobbleltone road away from the wreck. |
|
Definition
These are features of Crohn's disease (old crone) that are not features of ulcerative colitis:
granny--granulomas
skipping--skip lesions
cobblestone--cobblestone appearance
away from the wreck--the rectum is usually spared |
|
|
Term
explain the following mnemonic
paNCa
aSCa |
|
Definition
paNCa is No Crohn's--Perinuclear Anti-Nutrophil Cytoplasmic Antibodies are associated ulcerative colitis, but NOT crohn's
aSCa is Si, Crohn's--Anti-Saccharomycese Cerevisae Antibody is a sign of Crohn's disease |
|
|
Term
| Is bloody diarrhea more associated with ulcerative colitis or Crohn's disease? |
|
Definition
|
|
Term
| 4 categories of causes of diarrhea due to deranged motility |
|
Definition
irritable bowel syndrome (IBS)
GI surgical resection
diabetic neuropathy
hyperthyroidism |
|
|
Term
| Irritable Bowel Syndrome (IBS) |
|
Definition
| functional bowel disorder characterized by chronic abdominal pain and discomfort that occurs for at least 3 days of the week for a period of 3 months, in the absence of any detectable organic cause |
|
|
Term
| What relieves the abdominal paint of Irritable Bowel Syndrome (IBS)? |
|
Definition
|
|
Term
| How do you typically diagnose protozoan gastroenterology |
|
Definition
| by O&P (ova & parasite) examination of a wet mount slide of stool |
|
|
Term
| How does balantidium coli move? |
|
Definition
cilia
(balantidium coli is a ciliated protozoan that causes a GI illness) |
|
|
Term
| Describe the trophozoite of Balantidium coli. |
|
Definition
large oval covered with short cilia
50-100 um long
narrower at one end
cytostome (invagination that functions as a mouth) at the narrow end
large, dark, bean-shaped macronucleus with small, round micronucleus attached |
|
|
Term
| Describe the cyst of balantidium coli |
|
Definition
round
large, dark, bean-shaped macronucleus with small, round micronucleus attached |
|
|
Term
Explain the following
Balantidium eats a Bean |
|
Definition
| balantidium coli has a large, dark, bean-shaped macronucleus (with a small, round, micronucleus attached), in both cyst & trophozoite forms |
|
|
Term
| Describe the appearance of Cryptosporidium parvum. |
|
Definition
small round structures (5-7 um) found just inside the brush border of enterocytes
difficult to differentiate more than that (or to tell trophozoites from cysts) with a light microscope |
|
|
Term
| Where in the gut is Cryptosporidium parvum found? |
|
Definition
| just inside the brush border of enteroctyes |
|
|
Term
Explain the following mnemonic:
Little histolytica
likes donuts & cigars
Grownups eat one donut each
and have some blood of ours.
Describe other features of histolytica appearance not explained in the mnemonic |
|
Definition
cysts (little histolytica) contains 4 ring-and-dot (donut) nucleu, along with cigar-shaped chromatoidal bars. Cysts are also round.
Trophozoites contain 1 ring-and-dot nucleus, no chromatoidal bars, and usually have ingested RBCs visible as dark circles. The trophozoite is 10-15 um and irregular shaped. |
|
|
Term
Explain the following mnemonic, as well as other features of giardia lamblia's appearance.
Giardia lamblia’s just the most.
It starts as a flower & ends as a ghost. |
|
Definition
Cysts have 4 round nuclei (the flower) and retracted flagella (the stem & leaves of the flower). Cysts are round or oval.
In trophozoites, the 2 median bodies (eyes) and trailing flagellae give it a ghost-like appearance. Trophozoites are teardrop shaped (front is round & back is pointed), 9-12 um long. |
|
|
Term
| How is giardia lamblia acquired? Is it acquired in cyst or trophozoite form? |
|
Definition
| it is acquired by fecal-oral route (trophozoites or cysts), or by ingestion of cysts from contaminated food or water |
|
|
Term
| Clinical features of giardia lamblia gastroenteritis. |
|
Definition
incubation 1-4 weeks
duration 10-14 days (multiple relapses possible)
it is also possible to be an asymptomatic carrier
watery, foul-smelling diarrhea
pain
flatulence
increased fat & mucus in the stool
gallbladder colic & jaundice |
|
|
Term
| Where in the body does giardia lamblia typically colonize? |
|
Definition
small intestine
occasionally the gallbladder |
|
|
Term
| Where in the world is giardia lamblia found? |
|
Definition
|
|
Term
| Is zoonosis likely for giardia lamblia? |
|
Definition
| no; transmission is primarily human-to-human |
|
|
Term
| How do you diagnose giardia lamblia? |
|
Definition
O&P (ova & parasite) first, but often missed.
Fecal immunoassays & PCR are more sensitive |
|
|
Term
| How do you get cryptosporidium? |
|
Definition
| fecal-oral or via contaminated food or water |
|
|
Term
| What stain reveals cryptosporidium? |
|
Definition
| acid-fast stain (stains pink) |
|
|
Term
| What is the first thing you do to treat acute diarrhea? |
|
Definition
rehydrate
and give electrolytes |
|
|
Term
| What is the first thing you do to treat chronic diarrhea? |
|
Definition
| endoscopy (you really need to know what it is first) |
|
|
Term
| How does psillium work? What is it used to treat? |
|
Definition
psillium is a "bulk-forming laxative"--it absorbs water & swells into a gel
it primarily is used to treat constipation: by forming bulk, it increases stretch, which increases gut motility
can also treat mild diarrhea (the symptom; not the underlying cause) by absorbing liquid from the diarrhea |
|
|
Term
| What are the side-effets of psillium |
|
Definition
| if not given with sufficient oral fluid, can cause constipation or even blockage |
|
|
Term
| Should you give psiliium to people with irritable bowel syndrome? |
|
Definition
| yes; only 1/6 of people with IBS benefit from it, but it's so safe that you should go ahead 7 try it |
|
|
Term
| The only really effective treatment for diarrhea (the symptom; not treating the underlying cause). |
|
Definition
|
|
Term
How do opioids combat diarrhea?
(think: high level, not biochemical) |
|
Definition
they decrease propulsive gut motility (more time in gut-->more water absorbed)
they increase non-propulsive gut motility (more mixing--> more water absorbed) |
|
|
Term
| Opioids are agonists at _________ receptors in the myenteric plexus, opening K + channels in, & hyperpolarizing, cholinergic neurons involved in motility. |
|
Definition
|
|
Term
| What are the 2 prototype opioids that we learned to treat diarrhea? |
|
Definition
|
|
Term
| Which is a safer drug for treating diarrhea, and why: diphenoxylate or loperamide? |
|
Definition
Loperamide is safer because it can’t cross the blood-brain barrier, so there is little risk for tolerance or dependence. Diphenoxylate can also act on the brain to cause respiratory depression.
(mnemonic: DIphenoxylate can reach the DIencephalon) |
|
|
Term
| What is added to diphenoxylate, and why? |
|
Definition
Atropine; to limit abuse
if diphenoxylate is used at above recommended dose, atropine causes unpleasant side-effects:
dry mouth & eyes
tachycardia
trouble peeing
dilated pupils |
|
|
Term
| Which is better for chronic treatment of diarrhea: diphenoxylate or loperamid? |
|
Definition
| Loperamide, because it can be used long-term without tolerance or dependence. Diphenoxylate has a risk of tolerance & dependence if used > 5 days. |
|
|
Term
| What is the difference between an opioid and an opiate? |
|
Definition
Opiates are derived from poppy pod sap
Opioids behave LIKE opiates |
|
|
Term
| Why is vancomycin usually an effective & well-tolerated therapy for toxigenic Clostridium dificile-associated diarrhea? |
|
Definition
| Vancomycin can cause a lot of side-effects, but it is not absorbed in the gut, so it’s good for treating gut infections without causing side-effects. |
|
|
Term
| When would oral vancomycin not be a good treatment for toxigenic Clostridium dificile-associated diarrhea? |
|
Definition
If the disease become systemic
Vancomycin is not absorbed in the gut, so it’s good for treating gut infections without causing side-effects, but oral vancomycin can’t be used to treat systemic infections. |
|
|
Term
| A man comes home from traveling with acute febrile diarrhea. Do you want to give him empiric antibiotics? Do you want to give him other treatments for diarrhea. |
|
Definition
| No. Acute diarrhea is usually self-resolving within a few days. May treat diarrhea if the patient insists, but remember that diarrhea helps the body flush away microbes & toxins. Do encourage the patient to hydrate and consume electrolytes. |
|
|
Term
| What class of drugs does diarrhea due to Irritable Bowel Syndrome sometimes respond to, which other kinds of diarrhea do not? |
|
Definition
|
|
Term
| Irritable Bowel Syndrome is likely to be worsened by: |
|
Definition
|
|
Term
explain the following mnemonic:
DIphenoxylate can reach the DIencephalon |
|
Definition
diphenoxylate is an opioid that is used to treat diarrhea
it can cross the Blood Brain Barrier
(whereas loperamid, Imodium, is also an opioid that treats diarrhea, but it doesn't cross the blood brain barrier) |
|
|
Term
Explain the following mnemonic:
I make it rain...in the gut |
|
Definition
| I cells produce CholeCysteKinin (CCK), which makes the gallbladder "rain" bile into the gut |
|
|
