Chapter 41 Flashcards
Persons who have GERD have (increased, decreased) resting tone of the (upper, lower) esophageal sphincter; the symptoms include heartburn & chronic (constipation, cough).
decreased, lower, cough
The most common type of hiatal hernia is (paraesophageal, sliding); this type (is, is not) associated with GERD.
sliding, is
Acute obstruction high in the small intestine causes (vomiting, constipation) first, acute obstruction low in small intestine causes (vomiting, constipation) first.
vomiting, constipation
With acute mesenteric ischemia, the damaged intestinal mucosa cannot produce enough mucus to protect itself from (acid, digestive enzymes); bacteria invade the (healthy, necrotic) intestinal wall, eventually causing (peritonitis, malabsorption).
digestive enzymes, necrotic, peritonitis
Neurons in the (subthalamic, arcuate) nucleus play a major role in regulating appetite, food intake, & energy metabolism; hormones that circulate in the blood serve as (central, peripheral) signals to this area when their concentrations increase or decrease in relation to (body fat mass, liver function).
arcuate, peripheral, body fat mass
(Peripheral, Visceral) obesity is associated with a greater risk for metabolic syndrome, T2DM, & CV complications; resistance to (adiponectin, leptin) & decreased production of (adiponectin, leptin) contribute to the insulin resistance in obesity.
Visceral, leptin, adiponectin
Cirrhosis & hepatitis can cause (posthepatic, intrahepatic) portal hypertension; severe right-sided heart failure can cause (post-hepatic, intrahepatic) portal HTN.
Cirrohosis & hepatitis = intrahepatic HTN
LHF = post-hepatic HTN
The most accepted theory of ascites formation involves the combination of portal (vasodilation, hypertension) & splanchic (vasodilation, hypertension).
portal HTN and splanchic vasodilation
Ascites can be complicated by (bacterial, viral) peritonitis?
Bacterial
The (blue, yellow) color of jaundice usually appears first in the (skin, sclera of the eye).
yellow, sclera of the eye
Major cause of these clinical manifestation of cirrhosis: PORTAL HTN or HEPATOCYTE DYSFUNCTION? esophageal varices jaundice hepatic encephalopathy hemorrhoids splenomegaly caput medusae hypoalbuminemia
PORTAL HYPERTENSION results in:
esophageal varices, hemorrhoids, splenomegaly, & caput medusae
HEPATOCYTE DYSFUNCTION results in:
jaundice, hepatic encephalopathy, & hypoalbuminemia (more cellular level dysfunction)
TYPES OF HEPATITIS & CHARACTERISTICS
Route of Transmission:
Fecal-oral (F-O)
parenteral (P)
Sexual (S)
Hep A Hep B Hep C Hep D Hep E
Trans- F-O, P, P & S P F-O, P, F-O
mission & S &S
Acute or Acute Both Both Chronic Acute
Chronic?
Carrier No Yes Yes Yes No
state?
What is the difference between GERD & NERD?
GERD involves reflux of acid & pepsin from stomach to esophagus & causes esophagitis.
NERD (non-erosive RD) involves similar symptoms but no visible signs of erosion.
What is difference between type A & type B chronic gastritis?
Type A: Caused by autoimmune damage primarily of gastric funds (leads to pernicious anemia)
Type B: Chronic gastritis caused by non-immune mechanisms (H. pylori, chronic ETOH, NSAIDs) & primarily affects gastric antrum
What is the difference between maldigestion & malabsorption?
Maldigestion is faulty chemical breakdown of nutrients, takes place in intestinal lumen or at brush border of intestinal mucosa of small intestine.
Malabsorption is failure of intestinal mucosa to transport digested nutrients from intestine to blood or lymph.
What is the difference between metabolic pathways in short-term & long-term starvation?
Short-term starvation (3-4 days): body responds with glycogenolysis & gluconeogenesis with only a small amount of protein catabolism (LIKE WHEN FASTING FOR RITUALS, RELIGIOUS OBSERVATIONS, ETC.)
Long-term starvation (+4 days): body responds with lipolysis & eventually proteolysis, which can cause death (LIKE IN ANOREXIA NERVOSA)
What is the difference between alcoholic cirrhosis & biliary cirrhosis?
ALCOHOLIC: damage begins with hepatocytes
BILIARY: damage begins in bile canaliculi & bile ducts
Disorder caused by absence of an enzyme causes bloating, crampy pain, diarrhea, & flatulence after ingesting milk.
Lactase deficiency
This is a functional gastrointestinal disorder characterized by abdl pain & altered bowel habits.
Irritable bowel syndrome
A disorder characterized by rapid gastric emptying of hypertonic chyme after bariatric surgery causing tachycardia, hypotension, pallor, diaphoresis, cramping, nausea, & diarrhea.
Dumping syndrome
This GI disorder manifests with asymptomatic presence of saclike outpouchings that are continuous with the GI tract lumen.
Diverticulosis - most common in age 60+, those with decreased dietary fiber, increased intracolonic pressure like with constipation, abnormal neuromuscular function, & alterations in intestinal motility.
OFTEN A BOARDS QUESTION (reads something like bright red bleeding with defecation, crampy pain, in a 75 year old female, two options are diverticulitis or hemorrhoids..so can be confusing if you don’t pay attention to patient’s age…just FYI)
This gastrin-secreting tumor causes gastric & duodenal ulcers, GERD with abdl pain & diarrhea
Zollinger-Ellison syndrome
Provision of nutrients after starvation should be done slowly and cautiously because this syndrome can occur when rapid provision of nutrients causes severe hypophosphatemia & other electrolyte imbalances that can be fatal.
Refeeding syndrome
This disease is progression from an asymptomatic form to a symptomatic form when saclike outpouchings of the continous GI tract lumen become inflamed
Diverticulitis
This disorder is characterized by increased serum bilirubin levels, primarily conjugated, due to obstruction of common bile duct.
Cholestatic jaundice
This type of jaundice is when serum bilirubin levels, both conjugated & unconjugated, are a result of failure of liver cells to conjugate bilirubin & failure of bilirubin to pass from liver to intestine.
hepatocellular jaundice
Necrosis of liver cells without preexisting liver disease or cirrhosis is known as ______ ________ _______, often due to acetaminophen overdose.
Acute liver failure
Functional dysphagia caused by loss of esophageal innervation is called?
achalasia
Protrusion of the upper part of the stomach through the diaphragm & into the thorax is called?
hiatal hernia (sliding hiatal hernia is the most common type)
Persons who have acute obstruction high in the small intestine are at risk for metabolic ___________, but those with acute obstruction low in the small intestine are at risk for metabolic _________.
alkalosis, acidosis
Acute gastritis often heals within a few ______, especially when injurious agents such as NSAIDs and alcohol are stopped.
days
Gastric & duodenal ulcers are both called ______ ulcers; risk factors include H. ________ and use of NSAIDs.
peptic, pylori
Although pancreatic insufficiency causes poor digestion of all nutrients, maldigestion of ______ due to lack of _______ is the chief problem.
fat, lipase
Divertula involve herniation of the_______ through the muscle layers; the most common location where diverticula develop is the ________.
mucosa; colon
Pain from appendicitis typically moves from the epigastric or ________ region to the ______ ______ _______.
periumbilical, RLQ
Obesity is defined as a BMI that exceeds _____kg/m2 & generally develops when caloric intake _______ caloric expenditure in genetically susceptible individuals.
30; exceeds
Cytokines & hormones secreted by adipose tissue are known as ______; in obesity, _______ that infiltrate adipose tissue secrete proinflammatory cytokines.
adipokenes, macrophages
Hepatitis ______ virus depends on hepatitis B virus in order to replicate.
D
Jaundice in viral hepatitis occurs during the _______ phase; when jaundice resolves, the ______ phase begins.
icteric; recovery
Cholecystitis occurs when a gallstone lodges in the _______ duct, the most common type of gallstone is made of _________.
cystic, cholesterol
The primary diagnostic marker for acute pancreatitis is elevated serum _______; chronic pancreatitis may be autoimmune or associated with chronic _______ abuse.
lipase, alcohol
Fatty liver is associated with chronic use of _______, or with ______ (including in children); although fatty liver is asymptomatic, persons who have it may develop steatohepatitis & may progress to ________, liver failure, or liver cancer.
alcohol, obesity; cirrhosis
Comparing Crohn’s Disease and Ulcerative Colitis
Crohn’s Disease Ulcerative Colitis
Fam Hx more common less common
Lesions entire GI tract, mostly Mostly rectum &
small & large intestine, colon, continuous
Skip-lesions lesions
Nature of involve entire wall Mucosal layer only
Lesions thickness
Fistulas/ Common Rare
Abscesses
Narrowed Common Rare
Lumen, poss
Obstruction
Recurrent Common Common
diarrhea
Blood in Less Common More Common
Stools
Clinical Remissions & Exac Remissions & Exac
Course
Type of cancer with its risk factors
Pancreatic, colon, primary liver, gastric, & esophageal
Heavy cigarette smoking - PANCREATIC
Familial adenomatous polyposis coli - COLON
H. pylori, high salt intake, nitrates & nitrites - GASTRIC
Cirrhosis, chronic hep B or C - PRIMARY LIVER CANCER
Alcohol & tobacco use, reflux - ESOPHAGEAL
Physical changes in the esophageal mucosa as a result prolonged exposure to acids & reflux (GERD) causing chronic inflammation, metaplasia, & dysplasia and is a risk factor for esophageal cancer
Barrett esophagus
