GI 5 Flashcards by Greg Eriksen

what is steatorrhea?

high fat content in stool

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explain 
nutritional balancing
breath testing 
barium meals
surgical inspection

these are ways to diagnose differently GI issues

nutritional balancing –> e.g. fat intake vs. steatorrhea
breath testing –> this can indicate bacterial overgrowth (more acidic)
barium meals –> used to allow X-rays to detect GI soft tissue
surgical inspection

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what are…
Endoscopy
sigmoidoscopy
colonoscopy

they are all long tubes with camera’s on them to be able to look at the inside of the GI tract

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why do we do a biopsy of the mucosa?

to see if the villi are still intact - secretory and absorptive functions are working

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what is an Endoscopic Retrograde cholangiopancreatography? (ERCP)

ERCP –> was designed to inject a catheter into the common bile duct, release dye, and view gallstones and the gallbladder.
- used in diagnosis and intervention

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how is ERCP used in intervention

used to perform sphincterotomy (Oddi) for gallstone removal. also be used for cauterization

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what is manometry?

pressure measurements in the esophagus and ano-rectal region.

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what pathology is a 24 hour pH detection relevant too?

GERD –> low esophageal pH indicates

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when there is blood in the stool there is a sign of some pathology –> what 3 kinds of blood in the stool can we see?

fresh –> indicates local bleed
Dark / Tar-like - indicates upper GI / gastric bleed
cryptic -> (hidden) - chemically detected and MAY be a sign of some bleeding cancer

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what is Hemoccult?

the way we can detect cryptic bleeding in stool -

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what is a hemorrhagic adenoma?

this is an intestinal cancer of the mucosal glands which can cause bleeding

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to solve cancer, segments of the GI tract can be resected with no conseuqence –> to or f?

true - however, the patient will experience short term ileus!! (functional paralysis)

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what is the most common cause of overt stool blood?

hemorrhoids

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what are hemorrhoids?

venous pressure expands rectal veins leading to hemorrhage. These can be external (closer to anus) or internal (closer to internal sphincter)

this is caused by gravity since we walk upright

hemorrhoids will occur in 50% of people by the time they are 50 years old

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what is banding for hemorrhoids?

place a rubber band around the veins in the area - prevents hemorrhage and vein distention

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what are the sections of the colon (8 but 2 aren’t ‘sections’)

ileo-cecal sphincter
cecum
ascending colon
transverse colon
splenic flexure (the bend)
descending colon
sigmoid colon (bending towards rectum)
rectum

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what is diverticulosis?

diverticulosis are small out-pockets that develop on the outside of your colon. They are believed to be caused by a low fiber diet.

these are quite common occurring in 50% of people over the age of 60

process of aging
typically harmless and asymptomatic

what is diverticulitis?

diverticulitis –> this is inflammation caused by diverticula. the cause may be involved with eating foods with small seeds.

may cause abscess or perforation
may result in bleeding in stool

what are haustra? What are segmental contractions and mass contractions

haustra - sections of circular muscle stay contracted making bulges in the colon - Michelin man
segmental <> – contractions of less than 1 min
mass <> – contractions of a few per day

over a period of time, repeated...
Pain + 
diarrhea 
constipation 
both

this may indicate?

Irritable bowel syndrome –> a collection of symptoms and subjective remarks which points to IBS

stress and the environment can alter gut motility and one’s perception of gut sensations

how is IBS diagnosed?

essentially to rule out all other causes of gut disturbances.
- rule out infection, IBD, diabetes, etc.
Rome criteria
- dntk the criteria

what is post-infectious IBS?

in some cases, people never fully recover from an infection. they get left with IBS - not entirely understood

IBS has been linked to onset after noxious or stressful events

what is hyper-haustration of IBS. What is rectal-balloon sensitivity?

patients with IBS have been shown to have increased haustra contractions which may occlude the lumen

IBS patients report unusually significant pain from rectal balloon tests compared to control

IBS is ‘real’ due to these findings + subjective pain remarks

what is inflammatory bowel disease, what are the 2 main kinds?

IBD –> chronic, unremitting inflammation of the gut. Associated with pain, Bloody stool, diarrhea, fever, etc.

There is no known cause and it is incurable. We treat symptoms (palliative) not curative.

Crohn’s disease
ulcertative colitis

what is the epidemiology of IBD?

onset is 15 or 50 typically progressive in the developed world (increasing prevalence) virtually non-existent in developping world --> perhaps differences in diet? - immigrants will catch up with prevalence within one generation!

``` t or f aspirin antibiotics steroids etanercept and infliximab these are the treatments ```

true - anti-TNF being most effective

explain Crohn's disease --> where it occurs, its characteristics in diagnosis (3)

Chron's disease is a form of IBD which can occur anywhere along the GI system - mouth to anus characteristic diagnosis - skip lesions - sections of inflamed area's followed by normal sections - alternating - cobblestoning of normal mucosa with surrounding fissured, inflamed tissue - intestinal wall thickening

where is the most common place for Crohn's to affect?

ileum

t or f, Crohn's inflammation is usually transmural covering the entire thickness of the gut wall

true

what is Crohn's disease fistula formation?

inappropriate connections between the GI tract caused by extensive inflammation this is a consequence of severe inflammation like an adhesion caused by inflammation

other than fistula, what is another consequence of severe inflammation in Crohn's disease?

fibrosis and intestinal obstruction --> stricturing disease abscess and adhesions may also occur

do fistula form in every Crohn's case?

what is stricturing disease? what is short gut syndrome?

stricturing disease is fibrosis and gut obstruction due to severe inflammation - associated with Crohn's short gut syndrome --> the stricture ^ must be resected to restore gut motility. however, a certain length (area) of the ileum needs to be retained for full function (note vitamin B12 absorbs exclusively in the ileum) --> short gut syndrome = the length is too small

after resection of the pathological area, can Crohn's reappear?

yes - not this contrast ulcerative colitis in which resection results in NO reappearance

What is ulcerative colitis?

another form of IBD - in this case the inflammation is contained to the colon - also characterized by pain, bleeding, fever, weight loss - appears / causes mucosal ulcer's (contrasted to Crohn's cobblestones and skip lesions) - increases risk of adenocarcinoma

true or false, UC may reappear after resection of the pathological area.

false - this is characteristic of Crohn's

t or f, IBD often takes a long time for diagnosis

true

t or f, IBD may cause growth retardation, weight loss, and malnutrition

true

resection, stricture-plasty, exteriorize the bowel temporarily or permanently - creates an ostomy are?

treatments for IBD resection - excision stricture-plasty - rearrangement exteriorize the bowel temporarily or permanently - ostomy --> medical device to collect waste from a system

what extra-intestinal complication may arise in IBD?

autoimmune complications

what are CARD and NOD2?

15% of IBD cases linked to CARD and NOD2 genes - Canada leads in IBD research