GI Lumen Pathologies

Question 1

2 pathophys mechanisms of constipation

Answer 1

Transit times

Muscular function

Question 2

Failure of pelvic floor muscles or anal sphincter to relax with defecation

Answer 2

Dyssynergic defecation or ANISMUS

Question 3

Impaired colonic motor activity with infrequent bowel movements and straining

Answer 3

Slow-transit constipation

Question 4

Normal rate of stool passage but difficulty with stool evacuation from low-residue, low-fiber diet

Answer 4

Normal transit, or FUNCTIONAL constipation

Question 5

Nonabsorbable substance in the intestine draws water into the lumen by osmosis - causing large volume diarrhea

Answer 5

Osmotic Diarrhea

seen in dumping syndrome, lactose intolerance

Question 6

Form of large volume diarrhea caused by excessive mucosal secretion of chloride of bicarb-rich fluid (like what??) or inhibition of net sodium absorption

Answer 6

Secretory Diarrhea

can cause metabolic acidosis

Question 7

Excessive motility which decreases transit time, mucosal surface contact, and opportunities for fluid absorption

Answer 7

Motility diarrhea

Question 8

What metabolic effect can secretory diarrhea have, on account of excessive secretion of bicarb fluid?

Answer 8

Metabolic acidosis

Question 9

Antimotility treatments

Answer 9

loperamide (opiate)

atropine (lomotil)

Acetylcholine antagonist

Question 10

How do adsorbents work for diarrhea?

Answer 10

Attapulbite or Polycarbophil

Bind toxins and bacteria in the colon

Also bind water, to make poo more solid

Question 11

Usual etiology of maldigestion issues

Answer 11

Enzyme deficiency (lactose intolerance)

Pancreatic insufficiency (cystic fibrosis*** or any other pancreatic disease)

Question 12

Usual etiology of malabsorption issues

Answer 12

Intestinal mucosa - can’t absorb and transport nutrients into bloodstream

Inflammation of intestine or colon

Crohns or UC
Salmonella / Shigella infection

Question 13

Pancreatic enzymes

Answer 13

Lipase
Amylase
Trypsin
Chymotrypsin

Question 14

Pathophys of lactose intolerance

Answer 14

Inability to break down LACTOSE (disaccharide) into GLUCOSE and GALACTOSE

Lactose goes to colon, fermented by bacteria > causes gas, cramping, and osmotic diarrhea

Question 15

What does lactose break down into, in the presence of lactase?

Answer 15

GLUCOSE and GALACTOSE

Question 16

Causes of bile salt deficiency?

Answer 16

Liver disease
Bile duct obstruction
Gallbladder removal

Question 17

Result of bile salt deficiency

Answer 17

Maldigestion

Steatorrhea, fat-soluble vitamin deficiency (A D E K)

Question 18

What digestion problem might happen after a pyloroplasty or a partial gastrectomy?

Answer 18

Dumping syndrome - hypertonic chyme rapidly empties from stomach into small intestine, (15-30mins after eating) causing

osmotic diarrhea 
cramping
nausea
hypotension
diaphoresis
tachycardia

Question 19

Pharm tx for dumping syndrome that would slow intestinal transit time and inhibit insulin release

Answer 19

Somatostatin

Question 20

IBD most commonly diagnosed in

Answer 20

Ages 20-40, Jewish decent

Question 21

Pathophys of IBD can include

Answer 21

Altered epithelial barrier function
Immune response to intestinal flora
Abnormal T cell responses
Autoantibodies

Question 22

Key pathophys characteristics of UC

Answer 22

Lesions are Continuous and limited to the mucosal layer

Lesions are NOT transmural

Question 23

Key pathophys characteristics of Crohns

Answer 23

Can affect any part of the tract, from mouth to anus

Granulomatous mucosa

Lesions have “cobblestoned” appearance, because they pass through many layers of mucosa - ENTIRE INTESTINAL WALL - making bowel thicker

Lesions are NOT continuous, and OFTEN transmural (opposite of UC)

Question 24

Why do lesions in Crohns have a cobblestone appearance?

Answer 24

Because they pass through many layers of mucosa, making bowl thicker

Question 25

Increased risk of colon cancer in with bowel disorder

Answer 25

Ulcerative colitis

Question 26

Signs of Crohns

Answer 26

Abdominal pain and diarrhea

Anemia from malabsorption of B12 and folic acid

Question 27

In which IBD is steatorrhea more common?

Answer 27

Crohns