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GI Key Points Flashcards

1
Q

What does parietal cells stimulated?

A

Secrete HCI by acetylcholine (neural), gastrin (endocrine), and histamine (paracrine).

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2
Q

What are the secretion of HCI pathways for?

A

Key targets for pharmacological drugs aimed to decrease gastric acid production

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3
Q

What includes the regulation and coordination of activity along the GI tract?

A

Neural, hormonal, and local paracrine mediators, along with a robust mucosal immune system and microbiota.

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4
Q

What enteric nervous system allows some functions of?

A

To proceed autonomously, independent of control by the parasympathetic and sympathetic branches of the autonomic nervous system.

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5
Q

What is the function of endocrine regulation links sensory signaling from distal segments?

A

To release hormones that coordinate activity in proximal segments and vice versa according to the state of digestion and absorption of a meal

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6
Q

The gut bacteria outnumber the total number of cells in the human body. True or False

A

True

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7
Q

What are the functions of a normal flora?

A

Protect the host from pathogenic invading bacteria.
Provide certain metabolites not produced by the host ( Vit K)
Aid in digestion of fiber and production of short chain fatty acids
Deconjugate bile acids, aiding in recirculation for lipid digestion and absorption

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8
Q

What are the dysfunction/alterations of normal flora are implicated in?

A

C. Diff infection
Irritable bowel syndrome and other GI disorders
Neural and mental health disorders through the microbiota-gut-brain axis

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9
Q

What is esophageal obstruction?

A

Stenosis due to chronic inflammation, or achalasia due to failure of LES to relax

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10
Q

What is esophageal varies?

A

Dilated veins resulting from portal hypertension

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11
Q

What is gastroesophageal reflux disease (GERD)?

A

Common disorder caused by a combination of reduced lower esophageal sphincter (LES) tone and gastric hyperacidity

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12
Q

What are the factors that promote reflux?

A

Alter the pressure gradient across the LES:
Increased thoracic pressure (deep breathing)
Increased abd pressure (lying down, Valsalva maneuver, obesity, pregnancy, straining)

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13
Q

What is esophageal cancer?

A

Chronic GERD can lead to Barrett esophagus and adenocarcinoma

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14
Q

What does alcohol and tobacco exposure linked to?

A

Squamous cell carcinoma

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15
Q

What does the gastric acid contribute to?

A

Damage and ulcer formation of the stomach mucosa or more commonly the duodenal mucosa.

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16
Q

What does the ulcer formation results from?

A

Imbalance of protective forces and damaging forces

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17
Q

What is the most common factor in recurrent ulcer formation?

A

Infection by Helicobacter Pylori

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18
Q

What is gastritis?

A

inflammation of stomach lining, often from overuse of anti-inflammatories

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19
Q

What is gastric cancer?

A

Often from untreated chronic gastritis

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20
Q

What is PUD?

A

Erosion of the mucosa

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21
Q

What is gastroparesis?

A

Decreased motility

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22
Q

What causes diarrhea?

A

Results from excess GI secretion, hypermotility, presence of undigested osmotically active particles, and malabsorption.

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23
Q

What does diarrhea with bleeding is associated with?

A

Certain GI infections and inflammatory bowel disease (IBD)

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24
Q

What is IBD?

A

Includes Crohn disease and ulcerative colitis. Painful disorders that present with intermittent diarrhea, malabsorption, blood loss, and structural abnormalities.
- Fam hx of IBD + comorbidity with other immune disorders

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25
What is functional GI disorders (FGIDs)?
Known as disorders of gut-brain interactionsW
26
What is the underl ying patho of FGIDs?
Irritable bowel syndrome involves abnormal motility, visceral hypersensitivity, microbial dysbiosis, altered mucosal immune function, and altered CNS processing of sensory input.
27
What is Celiac disease?
An immune disorder characterized by sensitivity to dietary gluten - a protein found in wheat, barley and rye. Omitting all gluten from the diet restores normal gut structure and function
28
What is Peptic Ulcer Disease?
Erosion of mucosa most commonly in the stomach and duodenum.
29
What is the risk factors/causes for Peptic Ulcer Disease?
Increased risk by hyperacidity, smoking (reduced gastric mucosal blood flow), reflux of small intestines biles acids or digestives enzymes into stomach. NSAIDS - H. Pyloric (colonization promote recurrent ulceration) & chronic gastric inflammation increase risk of stomach cancer
30
What is Gastroparesis?
Decreased stomach motility that results in slower gastric emptying, nausea, vomiting and abd pain.
31
What is the most common cause of gastroparesis?
Diabetic neuropathy Occur following surgical incision of stomach wall (disrupt ENS pathways) or vagus nerve
32
What is Lactose Introlerance?
Inability to digest lactose due to deficiency in the brush border enzyme lactase.
33
What is a small bowel obstruction (SBO)?
small bowel passages are blocked, proximal buildup of gas and gastric contents. Lead to ischemic necrosis of the bowel and life threatening
34
What is Pre and Postnatal development of the GI tract?
Includes complex processes of folding and rotation to fit all of the components into the abd cavity. - Anomalies can arise in several GI tract segments during process and can be detected on fetal U/S and repaired in affected neonate.
35
What does the Pre and Postnatal development depends on?
Exposure of the GI tract to ingested substances including amniotic fluid in the uterus, as well as many growth factors, maternal & fetal hormones and nutrients. - Increasing dietary postweaning further matures the GI processes of digestion, absorption, and immune function.
36
What is the most common disorders of GI tract in infants and children?
Infectious gastroenteritis in children and Gastroesophageal reflux in infants
37
What increases the incidence of swallowing difficulties and GERD in older adults?
Disorders affecting the teeth, oral muscles, and LES(lower esophageal sphincter) Usually, function of GI tract is maintained throughout lifetime.
38
What is the changes of GI in older adults?
Sedentary lifestyle and lack of dietary fiber can lead to chronic constipation which is a common complaint in older adults. - Meds taken for chronic conditions can have GI SE including constipation. - Diverticular disease becomes more common w/ age
39
What is the largest solid organ in the body?
Liver - It is highly vascular and receives 25% if cardiac output and 25% blood flow supplies by hepatic artery and remainder from portal vein.
40
What is the portal vein?
Combines venous outflows from most of abd organs, including stomach, pancreas, spleen, small intestine, and large intestine.
41
Liver receives blood enriched in the products of digestion and absorption as well as high concentrations of pancreatic hormones ( insulin and glucagon) True or False
True
42
What is the functional unit of the liver?
Lobule, roughly hexagonal structure consisting of plates hepatocytes surrounding large permeable capillaries called sinusoids. - Blood flows from branches of hepatic artery and portal vein at the periphery of lobule through the sinusoids to the central vein.
43
What is a hepatocytes?
Polarized cells with surfaces facing the sinusoids and other surfaces facing bile canuliculi (site of bile secretion) - Bile flows outward between hepatocytes to the perimeter of the lobule to enter branches of biliary tree.
44
What is a Kupffer cells?
Resident of macrophages of lifer conducting surveillance for foreign proteins and organisms entering GI tract
45
What is the major function of the liver?
Metabolic homeostasis, regulating levels of circulating glucose over daily cycles of feeding and fasting, and is responsible for production and uptake of several lipoproteins.
46
Describe the major synthetic processes of the liver— focusing first on bile.
Liver produces bile, fluid enriched in salts needed for fat digestion and absorption and provides a route for excretion of waste products such as bilirubin. It also synthesizes urea, reducing buildup of toxic ammonia.
47
Describe the major synthetic processes of the liver. How biles constituents are made, stored, and secreted, and second, on the proteins made by the liver and how they are made, stored, and secreted.
The liver prepares hydrophobic endogenous and exogenous compounds (xenobiotics) for excretion by phase 1 and phase 2 chemical reactions.
48
What is the phase 1 of chemical reactions for liver?
Modify the parent compound, generally adding an oxygen-containing moiety that is chemically reactive.
49
What is the phase 2 of chemical reaction liver?
Reactions conjugate a small hydrophilic molecule to the modified parent compound, increasing its hydrophilicity and facilitating renal excretion.
50
What happens to the compound that went through chemical reaction in liver?
Bilirubin only undergo conjugation reactions that facilitate their excretion in the bile and by the kidneys. - Fate of heme groups released on breakdown of RBCs and from other body sources is conversion to unconjugated bili that travels to liver for conjugation and excretion.
51
What is the acute liver disorders?
Hep A virus and drug-induced liver injury (DILI) may be time-limited and result in complete recovery and regrowth of normal tissue.
52
What are the causes of chronic liver disease?
Infections with Hep B virus and Hep C Virus from chronic alcohol ingestion, or from obesity-associated nonalcoholic fatty liver disease
53
Can Hep B and Hep C be cured?
Chronic HBV and HCV infections can be managed in HBC or CURED in HCV by antiviral drugs
54
What is the patho for chronic liver disease?
Local inflammatory responses to insults, potentiated by cytokines released from resident of Kupffer cells. - Acitivation of local stellate cells aka lipocytes promotes increased extracellular matrix deposition in space of Disse surrounding sinusoids. - Sinusoidal endo cells develop reduced permeability, these normally wide vessels narrow and hepatic vascular resistance increases.
55
What does the cirrhosis progression results in?
Portal hypertension with a host of consequences including splanchnic vascular engorgement, splenomagaly, and development of shunt flow bypassing liver, hepatic encephalopathy, and ascites formation
56
What age is a time for greater risk of drug-induced injury/
Liver metabolism of drugs and toxins is not fully developed until age of 2 years making infancy and early childhood greater risk
57
What are the genetic and developmental abnormalities that account for some childhood liver disorders?
a 1-antitrypsin deficiency (AATD) and biliary atresia are rare
58
Nonalcoholic fatty liver disease is increasing in children and adolescents. True or False
True
59
What is fact about healthy older adults who do not have systematic patterns of altered liver function tests?
More susceptible to Drug-induced liver injury (DIDI).
60
What liver damage can be more extensive in older adults who have immune conditions?
Immune-mediated liver damage can be more extensive in older adults, who are also more vulnerable to alcoholic liver disease (ALD) and NAFLD.
61
What is true about Hepatitis in older adults?
Under-recognized and can progress more rapidly to hepatocellular carcinoma.
62
What treatment of GI disorders increasingly relies on?
Immune blocking therapies
63
What is function of bile?
Dietary fat digestion and absorption as well was absorption of fat-soluble vitamins
64
Which of the following gut mediators is most likely to inhibit intestinal motility?
Opioid peptides
65
Which bacterial species is linked to recurrent gastric ulcers?
Helicobacter pyloric
66
Which is the most common cause of bowel obstruction in young children?
Intussusception
67
Which of the following is a reason why infants are at risk of hyperbilirubinemia?
The immature liver is not able to sufficiently transport bilirubin.
68
Which of these conditions is most likely to increase indirect (unconjugated) and total bilirubin, while keeping relatively normal levels of direct (conjugated) bilirubin?
Hemolytic anemia

Patho (8 decks)

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