GI FInal Flashcards
IBD is most common among what race, specifically what descent?
most common among caucasians, specifically jewish descent
Crohn’s Disease typically takes place where? describe location
occurs anywhere but rectum is often spared, and has skip lesions
Ulcerative Colitis takes place where? describe location
UC takes place in sigmoid colon, starts at the rectum, and is continous
What part of the intestine does crohn’s ileitis typically effect?
terminal ileum 85%
crohn’s ileocolitis typically occurs where?
small and large intestine 40-55% of time
Name the condition: “cobblestone appearance”
Crohn’s disease
What is the term used when Crohns disease affects the entire depth of the bowel wall
transmural
T/F Granulomas can be seen on a crohns disease biopsy of tissue
T
Common symptoms of Crohns disease 3
Constant abdominal pain, weight loss, diarrhea
PE signs of crohns
+/- low grade fever, RLQ abdominal tnederness, possible abdominal mass, perineal abnormailites
Steps of progressive bowel obstruction of crohns
- inflammation causes thick tissues. 2. fistula heal and leave fibrosis 3. can lead to strictures
Abnormal lab results of crohns
CBC, ESR, CRP, nutritional deficiences
A vertebral fracture is a complication to what GI condition? why?
Crohns, d/t vitramin d deficiency, inc. glucocorticoid intake, and hypocalcemia
procedure of choice for diagnosing crohns?
colonoscopy, better than tissue biopsy
T/F for the majority of the time crohns and UC are not distinguishable from each other
False, 85% they are distinguishable
4 possible treatment for crohns
antiinflammatories, antibiotics, nutritional support, and surgery
Which is more common: crohns or UC?
UC
UC superficial or deep inflammation?
superficial mucosal infalmamation
Symptoms of UC 5
abrupt onset, bloody diarrhea, lower abdominal pain, rectal bleding, tenesmus
Tenesmus def
urgency to have bowel movement with incomplete feeling of evacuation
How is UC abodminal pain relieved?
relieved by having a bowel movement
UC tends to have abdominal masses, whereas crohns does not. T/F
F. Crohns=possible Abdominal masses; UC= NO abdominal masses
Mild UC = bleeding? fever? number of bowel movements?
rectal bleeding, no fever, less than 4 BM
Moderate UC= bleeding? BM?
moderate bleeding, 4-6 BM
Severe UC=Bleedings? Fever?
Severe bleeding and FEVER, with some hemorrhage, perforatin, gangrene
complications to UC
toxic megacolon, colon cancer
complications to both UC and Crohns
colon cancer
T/FTreating bowel disease will most likely rid pyoderma gangrenosum.
False
2 extraintestinal findings of IBD
pyoderma gangrenosum and erythema nodosum
Dysentery Def
bloody diarrhea of any cause
Bacterial causes of dysentery commonly include
shigella, salmonella, e coli, campylobacter
most common cause of travelers diarrhea
E coli
most common parasitic cause of dysentery for travelers to india/tropical locations
Entamoeba histolytica
Mechanism of transmission of infectious dysentery
consumption of food/water that contains fecal material of pathogens of human/animals
Treatment for dysentery
PCP hydration, antibiotics
Common treatment contraindication for dysentery is
anti diarrheal meds
Possible side effects of antidiarrheal meds in dysentery pts 3
hemolytic uremic syndrome, toxic megacolon, fever
most common cause of non bloody acute diarrhea? second most commoN?
infectious agents is 1. medications is 2
acute, non bloody diarrhea is usually accompanied by nausea vomiting, called ?
gastroenteritis
Nonbloody diarrhea etiology 2. what are they called
working with children=rotavirus
drinking out of a stream=giardia
Food poisoning def
ingestion of a toxin produced by bacteria
Bacillus cereus is most commonly ingested after eating what
fried rice
which of the following can be ingested following eating potato salad?
staph aureus
which of the following can be ingested following eating seafood?
vibrio species
which of the following can be ingested following eating pourly reheated meals/poultry
clostridium perfringens
anti diarrheal meds are safe for
non dysentery diarrhea patients
foods that are easily digested when someone has diarrhea
toast, banana, apple sauce,
antibiotic induced diarrhea can be cause by 2 things
- reduced digestive function
2. allowing the overgrowth of pathogens like Clostridium difficile
DEF: hematochezia
fresh blood in the stool
patient over 50 Y.O. with painless bleeding, DX
colon cancer till proven otherwise
benign painless hematochezia can be caused by
hemorrhoids, colon cancer, eating beets
Duodenum is
retro peritoneal
3 functions of the small intestine
1 nutrient absorbition and digestion. 2. delivery of undigested waste/waste to large intestine 3. Immune system, GALT, 70% of immune system
liver and gall bladder provide BLANKK while pancreas provides BLANKK
liver/GB=bile; pancreas=bi carb and enzymes
food that has been properly digested enters absorptive epithelial cells called
enterocytes
chyme absorbtion into enterocytes occurs via 2
active transportation and passive diffusion
where is the main nutrient absorption location
jejunum
where does water and small ions get absorbed?
in between enterocyte cells at tight junctions
2 main types of diarrhea
osmotic and secretory
osmotic diarrhea=
secretory diarrhea=
O.D=water is drawn in by indigested particles,stops when pT fasts
S.D= intestinal crypt cells secrete too much water, DOES NOT STOP WHEN PT FASTS
why does a person have smelly poop and farts with lactose sensititvity?
the unabsorbed lactose gets into the colon and the colonic bacteria produces CO2 and H2 gases
T/F Prolonged chronic lactose sensitivity with intake of lactose can lead to weight loss and cramping abdominal pain
False, NO weight loss with lactose sensititivty
Describe the lactose hydrogen breath test, whats a positive test?
person ingests lactose, 3-8 hrs later hydrogen in breath is measured, inc. hydrogen =lactase deficienty
Explain the reaction of GALT when gluten is ingested?
GALT senses that gliadin is an enemy, causing enhanced lymphocyte respoinse and autoantibodies produced. leading to inflammatory cascade, villous atrophy, and decreased asorptive ability,
The symptoms of celiacs disease 6
diarrhea, flatus, smelly stools, abdominal distension, fatigue, weight loss
dermatologic sign of celiacs disease
dermatitis herpetiformis
Diagnostic labs for celiacs diseae 2`
anti-tissue transglutaminase antibody and IGA
Diagnositic procedure of choice for DDX celiacs
endoscopic biopsy of distal duodenum showing villous atrophy
BLANKK the number two cancer killer in the U.S.
colorectal cancer
lifestyle risks of developing colorectal cancer 6
obesity, smoking, drinking, diabetes, low fiber high fat, no exercise
describe the sequence of pathophysiology of colorectal cancer
normal mucosa–>adenamouts polyps–> carcinoma
polyps def
discrete lesions that protrudes into the intestinal lumen from the mucosa
what is the mechanism of cancerous cell change in colorectal cancer? 2
deactivation of tumor supressor genes or mutation in genes leading to oncogene activation
most colon cancers are due to BLANKKK mutations, sporadic or inheritied
sporadic
Lynch syndrome is AKA and involves what side of the colon?
herditary nonpolyposis colorectal cancer
2 types of polyps that can lead to cancer, which is more common?
adenomatous and serratus, adenomatous is more common
what size of polyp has the highest increased risk of malignancy?
greater than 2.5 cm
sessile or pedunculated shaped polyp has a higher risk of malignancy?
sessile has a higher rate of malignancy
two types of colon cancerous lesions that can form,
bulky adenocarcinoma and annular constricting carcinoma( apple core lesion)
most common location in colon for colon cancer to occur is the
rectosigmoid colon
3 sxs of colon cancer?
asymptomatic till late stage. 1. bleeding 2. weight loss 3. change in frequency of bowel movements
colon cancer can produce high levels of BLANKK that can be used s a tumor marker.
carcinoembrionic antigen
what test is preferred for fecal occult blood testing?
fecal immunochemical testing is most sensitive and specific
sigmoidoscopy should be done every BLANKK years, colonsoscopy should be done every BLANKK years?
sigmoid=5 years; colonsoxcopy = 10 years
regular screening shoudl occur in patients that are blankk y.o?
50-75 years old
If patient is positive for family hx of colon cnacer, when should screening begin?
at age 40 or 10 eyars before family members diagnosis
Describe the Rome III IBS criteria
recurrent abdomjinal pain at least 3 days per month in the last 3 months with 2 or more of: improved w/ defecation, change in frequency, change in stool appearance
if present, abdominal tenderness is located where in IBS
LLQ
What antibiotic is recommended for IBS?
rifaximin
duverticulosis is most common in what area of the colon?
sigmoid colon
what is the most common cause of hematochezia in patients that are older than 60 y.o
diverticulosis
Lab findins for diverticulitis show BLANKK. A BLANKK imaging can show diverticulitis.
LAB= leukocytosis. CT scan showsdiverticultis
What disease can cause chronic constipation? what hormone would you want to evaluate in the blood?
hypothyroidism, TSH
leading cause of appendix inflammation is by a
fecalith
peritonitis is most commonly caused by
infection
Is peritointis pain sensitive?
VERY
a secondary cause of perionitis is commonly
a perforation of a hollow viscus
