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Advanced Pathophysiology > GI Disorders > Flashcards

GI Disorders Flashcards

1
Q

hormone that is produced in adipose cells

A

leptin

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2
Q

the most common site affected by UC

A

rectum and sigmoid colon

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3
Q

client with 5Fs risk factors most likely has…

A

cholelithiasis

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4
Q

Mother-infant transmission of Hepatitis B Virus (HBV) will have a high vertical transmission rate when the woman is seropositive for both hepatitis B surface antigen (HBsAg) and _______

A

HBeAg ( Hep B viral protein)

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5
Q

Gastric ulcers are more likely to be seen in patients aged ______

A

55-65

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6
Q

A colon lesion that may result in obstruction is most likely to be found in the ______

A

descending colon

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7
Q

The primary diagnostic marker for acute pancreatitis is…

A

serum lipase

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8
Q

Blockage of the bile duct by gallstones or tumor will result in…

A

obstructive jaundice

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9
Q

Epigastric pain that is relieved by food is suggestive of…

A

duodenal ulcer

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10
Q

hereditary nonpolyposis colorectal cancer is an example of a _________ risk factor

A

non-modifiable

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11
Q

condition caused by reflux of acid and pepsin into the esophagus through the lower esophageal sphincter (LES) that causes erosion of esophageal lining (mucosal injury)

A

GERD

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12
Q

condition of precancerous lesions in the esophogas which can lead to adenocarcinoma

A

Barrett’s esophogas

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13
Q

Risk Factors for ______:
Obesity
Hiatal hernia
Drugs that relax the LES (Ca+ channel blockers, nitrates, nicotine)

A

GERD

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14
Q

Causes of ______:
abnormalities in LES
anything that alters closing strength of LES
increased abdominal pressure

A

GERD

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15
Q

foods/drink that relax the LES

A

caffeine
alcohol
fatty foods
chocolate

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16
Q

severity of esophagitis depends on…

A

composition of gastric contents

exposure time

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17
Q

Heartburn (wet burp/regurgitation) is worse with…

A

within 1 hour of eating
lying down
increased abdominal pressure

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18
Q 
Clinical Manisfestations of \_\_\_\_\_\_:
heartburn
asthma
chronic cough
dysphagia w/ weight loss
sinusitus
laryngitis
chest pain
A

GERD

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19
Q

How GERD is diagnosed?

A

patient history
clinical manifestations
endoscopy

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20
Q 
Findings in endoscopy that confirm \_\_\_\_\_\_:
hyperemia
edema
erosion
strictures
inflammation
poor closure of LES
Barrett's (biopsy)
A

GERD

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21
Q

injury to protective mucosal layer of the stomach resulting in inflammation of the lining (deep or superficial) that occurs with or w/o hemorrhage

A

gastritis

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22
Q 
acute causes of \_\_\_\_\_\_\_:
chemicals
NSAIDS
alcohol
histamine
metabolic disorders (uremia)
h.pylori
shock/hypotension
A

gastritis

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23
Q

NSAIDS cause gastritis by…

A

being COX1 inhibitors- inhibits mucoasal prostaglandins

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24
Q

prostaglandin action in the stomach

A

stimulate mucous production

suppress inflammation

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25
Q

h.pylori action in the stomach

A

inflammation

increased gastric secretions

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26
Q

symptoms of h.pylori in the stomach

A

pain

n/v

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27
Q

chronic causes of ______:
chronic inflammation
mucosal atrophy
epithelial metaplasia

A

gastritis

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28
Q

h.pylori results in _____ gastritis

A

antral

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29
Q

most rare and most severe type of chronic gastritis that affects the fundus and leads to gastric atrophy

A

Type A: Fundal/Immune

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30
Q

more common type of chronic gastritis that affects the antral

A

Type B: Antral/Non-Immune

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31
Q

Type B chronic gastritis causes

A

chronic alcohol use
NSAIDS
tobacco use

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32
Q

Type B chronic gastritis can result in high levels of…

A

hydrochloric acid

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33
Q

increased secretion of hydrochloric acid leads increases risk of _______

A

duodenal ulcers

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34
Q

condition when Type B gastritis progresses to include Type A and antrum is more severely involved

A

Type AB: Pan Gastritis

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35
Q

type of gastritis associated with secretion of bile and pancreatic secretions into the stomach causing chemical injury

A

Type C Gastritis

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36
Q

break or ulcer of the mucosal lining of the lower esophagus, stomach or duodenum

A

Peptic Ulcer Disease

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37
Q 
Risk Factors for \_\_\_\_\_\_:
Genetics
H. Pylori
ASA & NSAIDS
ETOH
smoking
COPD
obesity
Stress (unknown why) 
Age < 65 y.o
A

Peptic Ulcer Disease (PUD)

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38
Q

most common form of ulcer

A

duodenal

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39
Q

duodenal ulcers are most commonly caused by…

A

h.pylori and NSAIDS

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40
Q

duodenal ulcers are negatively associated with…

A

gastric cancer

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41
Q 
symptoms of \_\_\_\_\_\_\_:
chronic/intermittent abdominal pain
pain occuring 30 min-2 hrs after eating
pain relieved by ingestion of food
weight gain
A

duodenal ulcers

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42
Q

PUD is diagnosed with…

A

UGI, endoscopy, and h.pylori tests

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43
Q

______ testing is recommended for any peptic ulcer

A

h.pylori

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44
Q

90% of DU and 80% of GU are caused by…

A

h.pylori

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45
Q

bacteria that releases toxins and enzymes that promote inflammation and ulcers

A

h.pylori

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46
Q

h.pylori infections cause increase of…

A

acid
pepsin
gastrin
pepsinogen

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47
Q

ulcers in the antral portion of the stomach that are more prevalent in adults 55-65 yo caused by defect that increases permeability of hydrogen ions in the mucosa

A

gastric ulcers

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48
Q 
Risk Factors for \_\_\_\_\_\_\_:
H. Pylori
NSAIDS
duodenal reflux
Type A: Immune chronic gastritis
A

Gastric Ulcers

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49
Q

Symptoms of _______:
pain that occurs immediately after eating then relieved
N/V
anorexia

A

Gastric Ulcers

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50
Q

inflammation of the vermiform appendix due to obstruction by fecalith (stone made of feces)

A

appendicitis

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51
Q 
Symptoms of \_\_\_\_\_\_\_\_:
epigastric or peri-umbilical pain in 1st 24 hrs increasing in intensity over 3-4 hrs
RLQ pain with rebound tenderness at McBurney's point
n/v
anorexia
fever
diarrhea (especially in children)
sense of constipation
LLQ tenderness
leukocytosis (on CBC)
A

appendicitis

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52
Q

presence of out-pouching herniations of mucosa through the colon muscular wall

A

diverticular disease

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53
Q 
Risk Factors for \_\_\_\_\_\_\_\_\_:
Older age (>60)
Smoking
Obesity
Genetic predisposition
Diet
Physical inactivity
ASA /NSAIDS
A

diverticular disease

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54
Q

Diverticular Disease is most common in…

A

left colon (descending and sigmoid colon)

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55
Q

chronic inflammatory disease most commonly of the mucosa of the rectum and sigmoid colon, where large ulcers form

A

Ulcerative Colitis (UC)

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56
Q

UC starts at the rectum but may extend to…

A

the entire colon

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57
Q 
Clinical Manifestations of \_\_\_\_\_:
bloody diarrhea
water diarrhea
passage of purulent mucous
lower abdominal pain
rare: shock w/ severe blood loss
A

Ulcerative Colitis (UC)

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58
Q

in acute phase of UC, fever is caused by…

A

activated macrophages and cytokines

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59
Q

UC for multiple years (7-10) can increase risk of…

A

colon cancer

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60
Q 
Risk Factors for \_\_\_\_\_\_\_:
20-40 yo
Family Hx
Jewish descent
Caucasian and northern European
A

Ulcerative Colitis (UC)

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61
Q

UC is limited to _____ and does not involve _____

A

mucosa, skip lesions

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62
Q

in chronic UC, _______ develops from rapidly regenerating epithelium

A

inflammatory polyps

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63
Q

an idiopathic, autoimmune, inflammatory disorder that may affect any part of the GI tract from the mouth to the anus (ascending and transverse colon most common sites)

A

Chron’s Disease

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64
Q

inflammatory bowel disorder that results in transmural inflammation and skip lesions (normal areas interspersed with abnormal areas)

A

Chron’s Disease

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65
Q

progression of Chron’s causes

A

abscess formation

crypt destruction

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66
Q

cobblestone projections of inflamed tissue/fissures, surrounded by areas of ulceration

A

Chron’s Disease

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67
Q

Chronic inflammation of all layers of intestinal wall resulting from blockage of lymphoid and lymphatic vessels

A

Chron’s Disease

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68
Q

Clinical Manifestations of _________:
only sx may be “irritable bowel”
Intermittent bouts of fever, diarrhea (if the diarrhea is bloody, it isn’t as severe or bloody as seen with ulcerative colitis)
> 5 stools per day
RLQ pain and may have RLQ mass and tenderness.
Anemia may occur due to malabsorption of iron, B12 and folic acid
Weight loss
Anal fissure, perianal abscess and fistulas
Steatorrhea (excretion of abnormal amounts of fat with the feces d/t reduced absorption of fat by the intestines)

A

Chron’s Disease

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69
Q

Diverticula form at _____ in the colon wall

A

weak points where arteries penetrate

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70
Q

lack of fiber and altered intestinal microbe might contribute to…

A

diverticular disease

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71
Q

_____ and ______ causes intestinal wall thickening and contributes to increased pressure and herniation

A

increased collagen and elastin deposits

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72
Q 
Symptoms of \_\_\_\_\_\_\_:
may be asymptomatic
diarrhea
constipation
flatulence
A

Diverticulosis

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73
Q

Symptoms of _______:
fever
acute LLQ pain
leukocytosis

A

Diverticulitis

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74
Q

chronic inflammatory disease most commonly of the mucosa of the rectum and sigmoid colon where large ulcers form

A

Ulcerative Colitis

75
Q

UC could be caused by…

A

dietary habits
infection
genetics
immunology

76
Q

____ protects against UC

77
Q

UC begins as inflammation at the base of _____

A

the crypts of Lieuberkuhn

78
Q

Cardinal feature of Chron’s Disease

A

granulomas that form on the intestinal wall

79
Q

Chron’s Disease increases risk of…

A

intestinal adenocarcinoma

80
Q

a disorder of brain-gut interaction characterized by abd pain with altered bowel habits

A

Irritable Bowel Syndrome (IBS)

81
Q

IBS is more common in _____

A

women, youth, middle-aged

82
Q

Hep A is transmitted through…

A

fecal-oral

83
Q

enzyme that digests carbs/sugars

84
Q

enzyme that digests protein

85
Q

when tripsin regurgitated back to the pancreas

A

auto digestion

86
Q

What lab tests do we order for appendicitis?

A

CBC w/ diff (WBC >10k w/ left shift)

87
Q

type of colon polyp that has 100% chance of becoming cancer

A

familial adenomatous polypopsis

88
Q 
These manifestations are indicative of problem with the \_\_\_\_\_\_\_\_ colon:
pedunculated polyps
anemia (Fe deficient)
fatigue
dark red/mahogony stools (melena)
unusual to see obstruction
89
Q

These manifestations are indicative of problem with the ________ colon:
small sessile polyp/lesion that can ulcerate
grows circumferentially
bright red rectal bleeding
obstruction (in 8-20% of cases, this is the only sx)
progressive abd distention, pain, n/v, constipation

A

descending

90
Q

________ is usually asymptomatic until advanced disease

A

colorectal cancer

91
Q

higher risk for cancer is associated with _____ ulcers

92
Q

alarm signs with IBS

A 
pain that awakens the patient at night
fever
bleeding
anemia
sudden weight loss
93
Q

type of ulcers seen in patients w/ increased ICP in the esophagus or stomach

A

Cushing’s ulcers

94
Q 
Risk Factors for \_\_\_\_\_:
age less than 40
family hx
jewish descent
slight increase in women
more common in smokers
95
Q

These GI disorders cause that cause _____:
ulcers
cancer
esophogeal varices

A

Iron deficient anemia

96
Q

pre-hepatic or excessive bili production (hemolysis)

A

unconjugated

97
Q

pre-hepatic or excessive bili production (hemolysis) results in _____ bilirubin

A

unconjugated (indirect)

98
Q

hepatic, post-hepatic or extra-hepatic type of bilirubin

A

conjugated (direct)

99
Q

hormones associated with obesity

A

leptin
ghrelin
adinopectin

100
Q

Where is leptin produced?

A

in adipose cells

101
Q

What does obesity cause concerning leptin?

A

increases it

102
Q

Where is ghrelin produced?

103
Q

Ghrelin is produced in response to…

104
Q

Adinopectin is produced where?

A

abdominal (visceral) fat

105
Q

In obesity, what happens with adinopectin?

A

decreases it so risk for CV disease is increased

106
Q

_____ are more often affected by pyloric stenosis

107
Q

Which ethnic group is more affected by pyloric stenosis?

108
Q

True celiac Sprue Disease is what type of disease?

A

autoimmune

109
Q

Celiac disease affects the _____ of the GI track

A

small bowel

110
Q

What triggers gluten sensitivity?

111
Q

Percentage of people w/ true celiac disease?

112
Q

The most common site of lesions in Chron’s

A

ascending and transverse colon

113
Q

If the small intestine is involved in Chron’s, the most common site would be…

A

distal small intestine

114
Q

endoscopy may show strictures or fistula in patient with…

115
Q 
tissue sample of small intestine shows 
atrophy
blunting of villi
increased intraepithelial lymphocytes &amp; other immune cells
normal mucosal thickness
in what disease?
116
Q 
Symptoms of \_\_\_\_\_\_\_\_\_:
tachycardia
hypotension
pallor
weakness
sweating
dizziness
abd pain
epigastric fullness
n/v
diarrhea
B12, folate, Ca+, fat-soluble vitamin deficiency
A

Dumping Syndrome

117
Q

______ bilirubin increases because the body metabolizes the heme component of the red blood cell that was destroyed.

A

unconjugated (indirect)

118
Q

Intrahepatic disorders can lead to _________ hyperbilirubinemia

A

conjugated or unconjugated

119
Q

What level of serum bilirubin on labs would you expect to see jaundice?

A

2.5-3 mg/dL

120
Q

3 phases of bilirubin metabolism

A

prehepatic
intrahepatic
posthepatic

121
Q

prehepatic bilirubin metabolism

122
Q

intrahepatic bilirubin metabolism

A

hepatocellular disease

123
Q

posthepatic bilirubin metabolism

A

obstructive

124
Q

posthepatic bilirubin metabolism

A

obstructive/ extrahepatic

125
Q

lab findings of acute Hep B

A

+ HbsAg

+Anti-HBc IgM

126
Q

lab diagnosis of Hep C

A

serum HCV RNA
anti-HCV IgG
elevated alanine aminotransferase

127
Q

IBS-C

A

IBS w/ constipation

128
Q

IBS-D

A

IBS w/ diarrhea

129
Q

IBS-M

A

IBS w/ diarrhea & constipation

130
Q

symptoms of IBS are relieved by…

A

defecation

131
Q

this condition has a 40% chance of developing into colorectal cancer

A

Hereditary nonpolyposis CRC

132
Q

signs of colorectal tumor in the ________ colon:
melena (dark red/mahogany stools)
possible anemia
normal shaped stool

133
Q 
signs of colorectal tumor in the \_\_\_\_\_\_\_\_ colon:
intermittent cramping
fullness
obstruction (due to lumen narrowing)
pencil/ribbon-like stool
bright red bleeding
A

descending

134
Q 
signs of colorectal tumor in the \_\_\_\_\_\_\_\_ :
obstruction
bowel habit change
constipation
diarrhea
urgent need to defecate upon awakening
dull ache in rectum/sacrum
135
Q 
Risk Factors for \_\_\_\_\_\_:
age > 50
red meat consumption
alcohol use
smoking
African American descent
obesity
Type II DM
A

Colorectal Cancer

136
Q

type of polyp that traverses the muscularis mucosae and becomes invasive and highly malignant

A

adenomatous polyp

137
Q

criteria for for polyps to have malignant potential:

A

> 2 cm
numerous
villous architecture

138
Q

exogenous chemicals that stimulate adipogenesis and fat storage and interfere with neuroendocrine control of appetite and satiety

139
Q

hormone that promotes insulin resistance and increased blood glucose

140
Q

High levels are ineffective at decreasing appetite and energy expenditure

A

Central Leptin Resistance

141
Q

Ghrelin enhances…

142
Q

hormone that has has insulin-sensitizing, anti-inflammatory, and antiatherogenic properties until visceral obesity occurs

A

adiponectin

143
Q

In _____ obesity, levels of adiponectin decrease, and this contributes to insulin resistant and Type 2 DM, as well as cardiovascular disease.

A

central (visceral)

144
Q

produces low grade inflammation of white adipose tissue and lipolysis

145
Q 
Risk Factors for \_\_\_\_\_\_\_\_:
Prolonged fasting or rapid weight loss
Pregnancy 
Oral contraceptives (progesterone slows bile)
Obesity
5Fs: female, forty, fat, fertile, fair
Diabetes
High fat diet
Low HDL and hypertriglyceridemia
Native Americans – especially Pima Indians
A

Cholelithiasis (Gallstones)

146
Q

type of gallstones that are associated with hyperbilirubinemia and may be brown or black

A

pigmented stones

147
Q

most common type of gallstones that are formed by bile that is saturated in cholesterol

A

cholesterol stones

148
Q 
Symptoms of \_\_\_\_\_\_\_\_:
*often asymptomatic*
epigastric and right hypochondrium pain 
intolerance of fatty foods &amp; cabbage
heartburn
flatulence
pruritus
jaundice
A

Cholelithiasis (Gallstones)

149
Q

acute inflammation of the gallbladder wall usually caused by bile duct obstruction and gallstones

A

cholecystitis

150
Q

cholecystitis may be accompanied by…

A

bacterial infection

151
Q

Symptoms of _______:
fever
leukocytosis
rebound tenderness and guarding
Severe RUQ pain that radiates to the back
Murphy’s sign: RUQ tenderness upon palpation of gallbladder

A

Cholecystitis

152
Q

lab diagnostics of cholecystitis

A

maybe…
elevated bilirubin
elevated alkaline phosphatase

153
Q

most common diagnostic tool for cholecystitis

A

Ultrasound

154
Q

most sensitive diagnostic tool for cholecystitis

155
Q 
epigastric or midabdominal pain that may radiate to the back
severe tenderness w/ palpation
n/v
abd distention
hypoactive bowel sounds
low fever
A

pancreatitis symptoms

156
Q

if there is a gallstone obstruction in pancreatitis, labs would show…

A

increased LFTs

157
Q

elevated lipase is primary marker for pancreatitis and what other labs will be affected?

A

leukocytosis
hyperlipidemia
hypocalcemia
elevated amylase

158
Q

pancreatitis is diagnosed by…

159
Q 
Complications of \_\_\_\_\_\_\_\_\_\_\_
ARDS
heart failure
renal failure
intraabdominal HTN
SIRS
A

pancreatitis

160
Q 
Symptoms of \_\_\_\_\_
RUQ pain
malaise
anorexia
nausea
low-grade fever
jaundice
dark urine
161
Q

incubation period of Hep A

A

15-50 days (avg 28)

162
Q

acute Hep A would have lab results of…

A

+ Anti-HAV IgM

163
Q

+ Anti-HAV IgG would indicate…

A

past infection and immunity to Hep A

164
Q

incubation period of Hep B

A

45-160 days (avg 120)

165
Q

liver cancer risk is greatest with coinfection of…

A

Hep B and Hep C

166
Q 
symptoms of \_\_\_\_\_
(discrete)
jaundice
elevated ALT
n/v
anorexia
fever
malaise
RUQ pain
167
Q 
prodomal stage of \_\_\_\_\_ could have no sx OR
rash
arthralgia
arthritis
angioedema
serum sickness
glomerulonephritis
jaundice
168
Q

lab findings of chronic Hep B

A

+ anti-HBc (total Hep B core antibody)

169
Q

lab finding of recovery or immunity to Hep B

A

+ anti-HBs (Hep B surface antibody)

170
Q

________ provides post-exposure prophylaxis to Hep B

A

HBV immunoglobulin

171
Q

Hep C is transmitted via

A

blood to blood

172
Q 
Symptoms of \_\_\_\_\_
Fever
fatigue
dark urine
clay-colored stool
abd pain
loss of appetite
N/V
joint pain
jaundice
173
Q

Causes of Esophagitis (P.I.E.C.E.)

A 
Pills (tetracyclines)
Infectious (HSV, Candida)
Eosinophils (Inflammatory)
Caustic (ingestion of poison)
Everything else or gErd
174
Q

incubation period of Hep C

A

14-180 days (avg 45 days)

175
Q

type of bilirubin that is water-soluble and appears in urine

A

unconjugated bili

176
Q

jaundice caused by excess hemolysis of RBC

A

hemolytic jaundice

177
Q

jaundice caused by gallstones, tumor or inflammation of the ducts

A

obstructive jaundice

178
Q

jaundice caused by decreased conjugation, cirrhosis or hepatitis

A

hepatocellular

179
Q

hemolytic jaundice = _______ bilirubin

A

unconjugated

180
Q

obstructive jaundice = _______ bilirubin

A

conjugated

181
Q

hepatocellular jaundice = _______ bilirubin

A

mostly conjugated but can be unconjugated

182
Q

celiac disease is most often seen in the ______

183
Q

in celiac disease, ______ enzymes and ____ are decreased

A

pancreatic; bile

184
Q

leptin sends signals to hypothalamus to _______ appetite but this stops working in obesity

Advanced Pathophysiology (10 decks)

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