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Basic Training Study Guide > Gastroenterology & Delzicol > Flashcards

Gastroenterology & Delzicol Flashcards

1
Q

The ____ obtains nutrients from foods we eat.

A

GI System

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2
Q

The ____ is composed of a long, hollow, muscular tube that begins at the mouth and ends at the anus.

A

Esophagus

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3
Q

The central cavity or passage inside the GI tract is called the ___.

A

Lumen

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4
Q

List the 7 components of the GI tract in descending order.

A
  1. Oral Cavity
  2. Pharynx
  3. Esophagus
  4. Stomach
  5. Small Intestine
  6. Large Intestine
  7. Anal Canal
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5
Q

List the 3 components of the small intestine.

A
  1. Duodenum
  2. Jejunum
  3. Ileum
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6
Q

List the 6 components of the large intestine.

A
  1. Cecum
  2. Ascending Colon
  3. Transverse Colon
  4. Descending Colon
  5. Sigmoid Colon
  6. Rectum
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7
Q

____ is a substance that helps digest fats from the liver.

A

Bile

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8
Q

The GI tract is lined with specialized cells and underlying tissues called the

A

Mucosa

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9
Q

List the 6 functions of the GI tract.

A

MAISED

  1. Mechanical Processing
  2. Absorption
  3. Ingestion
  4. Secretion
  5. Excretion
  6. Digestion
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10
Q

___ occurs when food enters the GI tract via the mouth.

A

Ingestion

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11
Q

__ is the crushing and shearing of food using the teeth and tongue, swirling and churning motions of the stomach and intestine.

A

Mechanical Processing

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12
Q

___ is the chemical breakdown of food into molecules suitable for absorption.

A

Digestion

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13
Q

__ is when water, acids, enzymes, and other compounds are secreted into the GI tract to aid in digestion.

A

Secretion

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14
Q

__ is the movement of nutrients and water out of the digestive tract and eventually into the bloodstream.

A

Absorption

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15
Q

___ is the removal of waste products and indigestible foods, which leaves the body as feces.

A

Excretion

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16
Q

List the 5 components of the upper GI tract.

A
  1. Oral Cavity
  2. Pharynx
  3. Esophagus
  4. Stomach
  5. Duodenum
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17
Q

The ___ propels food from the oral cavity to the stomach.

A

Esophagus

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18
Q

The breakdown of food in the stomach primarily occurs in the ___.

A

Pylorus

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19
Q

Although the ___ is the first portion of the small intestine, it is classified as part of the upper GI tract.

A

Duodenum

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20
Q

The ___ receives acidic stomach contents called ___, as well as digestive secretions from the pancreas and liver.

A

Duodenum

Chyme

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21
Q

A major function of the Duodenum is ___?

A

To neutralize stomach acids before the damage the small intestine.

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22
Q

The lower GI tract consists of the last two sections of the ___, along with the ___, ___, and ____.

A

Small intestine….

Large intestine, Rectum, and Anal Canal

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23
Q

About ___% of digestion and nutrient absorption occurs in the small intestine.

A

90%

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24
Q

The small intestine averages about ___ft in length.

A

20ft

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25
Q

The small intestine, also called the ___, has 3 major segments. What are they?

A

small bowel

  1. Duodenum
  2. Jejunum
  3. Ileum
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26
Q

___ of the small intestine neutralizes chyme and receives digestive secretions.

A

Duodenum

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27
Q

___ of the small intestine performs most of the digestion and nutrient absorption.

A

Jejunum

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28
Q

___ of the small intestine controls entry into the colon at the ___ valve

A

Ileum

Ileum valve

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29
Q

The horseshoe shaped large intestine, or large bowel, begins at the end of the __ and extends to the ___.

A

Duodenum

Anus

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30
Q

The large intestine averages ___ft in length.

A

5ft

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31
Q

3 primary functions of the large intestine.

A
  1. Reabsorbs water while compacting intestinal contents into feces
  2. Absorbs vitamins
  3. Stores feces until time for defecation
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32
Q

__ is the beginning of the large intestine.

A

Cecum

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33
Q

__ of the large intestine is an expanded pouch that receives materials from the ileum.

A

Cecum

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34
Q

4 components of the colon

A
  1. Ascending Colon
  2. Transverse Colon
  3. Descending Colon
  4. Sigmoid Colon
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35
Q

Movement of feces from the ___ into the ___ triggers the urge to defecate.

A

Sigmoid Colon into the Rectum

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36
Q

The stomach’s average pH is between ____.

A

(1 - 2.5)

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37
Q

Secretions from the ___ raise the pH in the duodenum to near neutral levels

A

Pancreas

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38
Q

3 accessory organs of the digestive tract.

A
  1. Pancreas
  2. Liver
  3. Gallbladder
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39
Q

___ lies behind the stomach and secretes fluid to neutralize the acidity of the stomach acids of chyme entering the duodenum and helps digest food.

A

Pancreas

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40
Q

The ___ lies in the upper right abdomen. It produces bile which helps digest food.

A

Liver

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41
Q

The ___ receives, stores, and concentrates bile from the liver and secretes it into the Duodenum when stimulated by a fatty meal.

A

Gallbladder

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42
Q

Ulcerative Colitis is a GI disorder that primarily involves the __ and ___.

A

Rectum and Colon

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43
Q

In Ulcerative Colitis (UC), ____ occurs in the rectum and may continuously extend upward into the colon.

A

Mucosal Inflammation

44
Q

The most common procedure used to detect a GI tract disorder is ___.

A

Endoscopy

45
Q

___ and ___ are the two most common and best understood types of IBD.

A

Ulcerative Colitis and Crohn’s Disease

46
Q

___ are the mainstay of therapy for inducing and maintaining remission in mildly to moderately active UC. ___ are also effective in inducing and UC remission but are not recommended for maintenance therapy.

A

Aminosalicylates

Corticosteroids

47
Q

__ is an immune-mediated condition causing chronic intestinal inflammation.

A

IBD - Inflammatory Bowel Disease

48
Q

Both UC and CD are __ in origin.

A

Idiopathic

49
Q

In CD, the inflammatory changes may involve any part of the GI tract, however the most common sites of involvement are the __ & __.

A

Terminal Ileum and Cecum

50
Q

___ is often characterized by discontinuous lesions referred to a skip lesions, with normal mucosa seen between areas of inflammation.

A

Crohn’s Disease

51
Q

The inflammation seen in CD tends to be ___, involving all layers of the bowel wall.

A

Transmural

52
Q

UC inflammation starts in the __ and extends proximally to any length of the colon in a continuous manner (no skip lesions).

A

Rectum

53
Q

Unlike CD, the inflammation of UC is limited to the ___, and the ulcerations seen at endoscopy are diffuse and superficial.

A

Mucosa

54
Q

___ is the study of populations to determine the frequency and distribution of disease.

A

Epidemiology

55
Q

Gender distribution is equal in UC, however in CD, ___ are slightly more affected.

A

Females

56
Q

Pea age for onset in CD and UC is ___, with a secondary peak occurring between ___.

A

15yr-30yr

60y-80yr

57
Q

There is a paradoxical environment between ___ and IBD. In CD, it is shown to have increased need for surgery, flare ups, and post-op recurrence rates. Conversely in UC, it can be negatively correlated with disease activity.

A

Smoking

58
Q

__ is the study of the causes or origin of a disease or disorder.

A

Etiology

59
Q

UC is a disease that affects the ___ of the colon, but usually not the small intestine.

A

Mucosa

60
Q

UC is categorized into 4 categories based on severity, what are they?

A
  1. Ulcerative Proctitis
  2. Proctosigmoiditis
  3. Left-Sided UC
  4. Pancolitis
61
Q

____ is the mildest form of UC and affects 15-20cm of the rectum. This accounts for 25%-30% of all UC cases.

A

Ulcerative Proctitis

62
Q

___ is a form of UC that is limited to the rectum and sigmoid colon. It accounts for 15%-20% of all UC cases.

A

Proctosigmoiditis

63
Q

__ is a form of UC that extends beyond the sigmoid up to the splenic flexure. It accounts for 30%-40% of all UC cases.

A

Left-Sided Ulcerative Colitis

64
Q

__ is a form of UC that is inflammation of the whole colon. It accounts for 20% of all UC cases.

A

Pancolitis

65
Q

3 main symptoms of Ulcerative Colitis.

A
  1. Bloody Diarrhea
  2. rectal urgency to defecate
  3. tenesmus

also abdominal cramps and rectal bleeding

66
Q

___ is a term for the feeling that one needs to defecate, even though the bowl may be empty.

A

Tenesmus

67
Q

Patients with UC have variable presentations from mild to most severe. In a small percentage of patients with ___ colitis, the bowel injury can lead to massive dilation of the colon. These patients usually require hospitalization and possible surgery.

A

Pancolitis

68
Q

Any patient with rectal bleeding or diarrhea should be considered for a diagnosis or ___.

A

IBD - Inflammatory Bowel Disease

69
Q

In UC patients, recent ___ has been associated with flares or new onset UC.

A

smoking cessation

70
Q

__ or __ with biopsy is the very best procedures for diagnosing UC.

A

Colonoscopy or Sigmoidoscopy w/biopsy

71
Q

In patients with suspected UC or disease relapse, the most important laboratory studies are ___.

A

Stool Studies

72
Q

Treatment for UC has 5 “step-up” approaches depending on severity. List the 5 approaches.

A
  1. Oral or Rectal steroids / 5-ASA
  2. Oral Steroids
  3. Immunomodulators / Biologics
  4. IV Steroids / IV Cyclosporine
  5. Surgery
73
Q

Drugs containing ___ (melamine preparations) are the mainstay of therapy for inducing and maintaining remission in mildly to moderate UC.

A

5-ASA (Aminosalicylates)

74
Q

5-ASA act ____, so the active drug needs to be delivered directly to the site of disease.

A

Topical

75
Q

Oral 5-ASA formulations are available and grouped into 3 categories based on delivery mechanism. They are?

A
  1. Prodrugs
  2. Delayed Release
  3. Controlled Release
76
Q

___ is a type of oral 5-ASA that must undergo a chemical conversion before becoming the active pharmacological agent.

A

Prodrug

77
Q

___ is a type of oral 5-ASA that is covered in a pH dependent coating that dissolves to release 5-ASA in the GI tract.

A

Delayed Release

78
Q

Asacol (now Delzicol) is a ___ formulation for delivering mesalamine. It is coated in a __ resin that protects the drug from the release in the more acidic small bowel.

A

Delayed Release

Eudragit-S

79
Q

The Asacol, ___ coated tablets release 5-ASA at a pH of __ starting in the terminal ileum.

A

Eudragit-S

7

80
Q

Asacol HD is a pH dependent release formulation. It is coated in 2 layers. The outer coating is a combination of ____ and ___ begins to breakdown at a pH of _ to _ midway through the small intestine and the inner coating of ___ begins to break down at a pH of 7 in the terminal ileum.

A

Eudragit-S and Eudragit-L
5 to 6
Eudragit-S

81
Q

__ is a type of oral 5-ASA that is independent of pH. These delivery systems slowly dissolve throughout the small intestine and colon.

A

Controlled Release

82
Q

___ are often used as an initial induction agent in moderately to severely active UC.

A

Corticosteroids

83
Q

___ are drugs that specifically inhibit the body’s immune response.

A

Immunomodulators

84
Q

__ are drugs that are derived from living organisms. They include a range of products such as vaccines, allergenics, gene therapy, tissues, etc.

A

Biologics

85
Q

Nonpharmacologic treatments for UC include __ and __.

A

probiotic and nutritional therapy

86
Q

__ are living, nonpathogenic bacteria that when ingested, are thought to alter/improve the bacterial balance in the GI tract.

A

probiotics

87
Q

__ is the standard procedure for UC. It consists of removing the entire colon and creating an end ileostomy for the ileostomy bag.

A

Proctocolectomy

88
Q

List the 3 big competitors of Delzicol (Warner Chilcott)

A
  1. Lialda
  2. Apriso
  3. Pentasa
89
Q

Delzicol is an aminosalicylate indicated for the treatment of __ and for the ___.

A

Treatment of mild to moderately active UC

Maintenance of UC in remission

90
Q

Delzicol’s recommended dosage for treatment of mild to moderate UC is ___ (equivalent to __ daily) for __ weeks.

A

800mg (2 400mg pills)
2.4g daily
6 weeks

91
Q

Delizcol’s recommended dosage for the maintenance of remission UC is __ daily in divided doses.

A

1.6g daily

92
Q

Should Delzicol be swallowed whole, without breaking, cutting, or chewing?

A

Yes

93
Q

Dose of Delzicol should be given how long before and how long after a meal?

A

1 hour before a meal

2 hours after a meal

94
Q

What is the contraindication of Delzicol?

A

Patients with hypersensitivity to mesalamine, aminosalicylates, or Delzicol’s ingredients.

95
Q

The most common adverse reactions (observed in ≥ 5% of patients) were:

A

Abdominal pain, eructation, pain, headache, back pain, diarrhea, rash, dyspepsia, rhinitis, flu syndrome, asthenia, flatulence, vomiting, fever, arthralgia, constipation, and GI Bleeding

96
Q

Does Delzicol have any drug reactions?

A

No - No drug reaction studies

97
Q

Use of Delzicol should be cautioned in what 4 types of patients?

A
  1. Geriatric
  2. Pediatric
  3. Nursing Mothers
  4. Renal Impairments
98
Q

In Geriatric patients using Delzicol, ___ should be monitored.

A

Blood cell counts

99
Q

Delzicol’s pregnancy category is __?

A

B

100
Q

Mesalamine is a ____ agent.

A

Non-Steroidal Anti-Inflammatory agent

101
Q

The Mechanism of Action of mesalamine is unknown, but appears to be __ rather than __.

A

Topical rather than systemic

102
Q

Delzicol delayed release capsules are supplied from the pharmacy as ___(color) capsules containing ___mg mesalamine.

A

Red

400mg

103
Q

The concurrent use of mesalamine with known ___ agents may increase the risk of renal reactions.

A

Nephrotoxic

104
Q

The concurrent use of mesalamine with ___ may increase blood disorders

A

Azathioprine

105
Q

The Tmax for mesalamine in delayed release formulations is absorbed after oral ingestion usually ranges from __to__hrs.

A

4 to 16hrs

106
Q

After Intravenous administration of mesalamine, the elimination half-life is approximately __.

A

40minutes

107
Q

Mesalamine is mainly excreted by the ___.

A

Kidneys

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