GI Pathophysio Flashcards
1
Q
vitamin a deficiency
A
night blindness
bitot spos (squamous cell prolif)
corneal perforation
2
Q
How to diagnose diverticulitis
A
clinical if mild
CT scan or ultrasound
3
Q
epithelium of the stomach
A
simple layer of columnar epithelial cells
secrete mucus and bicarb
pits provide glands access to the lumen
4
Q
symptoms of pancreatic exocrine insufficeincy
A
bulky foul smelling stool
oily residue in toilet water
5
Q
irritant laxatives
A
castor oil, senna
cause irritation of the enteric mucosa/nerves –> water secretion –> softer stool and increased peristalsis due to increased volume
may cause abdominal pain, flatulents
6
Q
bile acid deficiency
A
when bile salt pool is very low, get maldigestion of fat and fat soluble vitamins
from liver disease (low production) or ileal resection (low recycling)
7
Q
trituration
A
first, peristalsis down through stomach
terminal antral contraction closes pyloris
allows mixing of foodstuff into small particles until 1-2 mm
3-4 hours
8
Q
NSAIDs and ulcer formation
A
decrease mucin and HCO3 so HCl can touch the cell
injury to cell - HCl can get closer!
9
Q
vitamin D
A
fat solumble
storage form = 25OH, active form 1, 25 OH
found naturally in very few foods (fortified and sun)
calcium-phosphorus homeostasis (break down bone if not enough)
bone metabolism
10
Q
IBS
A
Rome criteria -
absence of detectable structural or biochemical abnormaility
abdominal pain
altered bowel habits (alternating between diarrhea and constimation)
abdominal pain is most universal!
11
Q
IBS-C
A
IBS with constipation
12
Q
how do you diagnose celiac disease?
A
high antibody levels to: TTG IgA, DPG (deaminated peptide)
abnormal small bowel biopsies
response to gluten free diet
13
Q
consequences of bacterial overgrowth
A
unconjugate bile acids
use vit b12
14
Q
treatment of pancreatic exocrine insufficiency
A
pancreatic enzyme supplements wiht food
15
Q
viberzi
A
binds to opioid receptors in GI tract controling motility and hypersensitivity
16
Q
types of glands in the cardia
A
branched and tortuous
mucus
endocrine
17
Q
pancreatic exocrine insufficiency
A
maldigestion of fat, protein, carbs
limited amylase, lipase, proteases
from CF, chronic pancreatitis, pancreatic resection
need to lose >90%
18
Q
pre-epithelial defense in the esophagus
A
lacks a definable surface mucus layer!
has saliva which contains mucins
surface squamous cells can not secrete bicarb! rel unprotected
19
Q
esohageal peristalisis in smooth muscle
A
inhibition followed by excitation
gradient of increasing inhibition (latency gradient)
20
Q
beri beri
A
B1 deficiency
dry - peripheral neruopathy
wet - CHF
21
Q
vitamin d deficiency
A
bone demineralization
hypocalcemia, hypophosphatemia
22
Q
B12 absorption
A
dietary intake (meat, dairy)
pepsin in the stomach cleaves protein from B12
secretion of IF by gastric parietal cells
bound to R protein
unbound - binds to IF in the intestine
in the ileum - special R and complex absorbed into blood
23
Q
diverticular bleeding pathophysiology
A
eccentric intimal thickening and medial thinning
segmental weakening
rupture where vessels run over the dome of a diverticulum
usually abrupt and painless - 75% stops on own
24
Q
erythromycin
A
primarily prokinetic
motilin receptor agonist
The main function of motilin is to increase the migrating myoelectric complex component of gastrointestinal motility and stimulate the production of pepsin. Motilin is also called “housekeeper of the gut” because it improves peristalsis in the small intestine and clears out the gut to prepare for the next meal.[7] A high level of motilin secreted between meals into the blood stimulates the contraction of the fundus and antrum and accelerates gastric emptying. It then contracts the gallbladder and increases the squeeze pressure of the lower esophageal sphincter. Other functions of motilin include increasing the release of pancreatic polypeptide and somatostatin[11]
25
uncomplicated diverticulosis
asymptomatic - incidental, increase fiber
symptomatic - bloating, constipation, passage of mucus, like IBS
26
bethanechol
prokinetic
muscarinic receptor agonist
27
Cholestyeramine (questran)
bile acid sequentrant, prevent reabsorption
bile acids, once complexed, are secreted in feces
lower plasma cholesteral
used to prevent diarrhea pst ileal resection
28
d-xylose test
for carb malabsorption
## Footnote
D-xylose = simple sugar, some absorbed and some excreted
If absorbed – some metabolized by liver and some excreted by kidney
If not absorbing – none in blood stream and none in urine
Fasting – empty bladder, blood draw
Drink solution of sugar water – 2 hours later, repeat bloodd draw and see if blood level went up properly
Collect urine over 5 hours and see if xylose is in there – if really low not absorbing properly and sign of absorption problem
29
sibship size and gastric cancer risk
higher risk of cancer in later bown
higher risk with brothers and sisters
early years of life affect health decades later
30
gastric motility of liquids
rapidly disperse through stomach and empty without delay
31
prokinetics
Prokinetics help strengthen the lower esophageal sphincter (LES) and cause the contents of the stomach to empty faster.
more gerd?
combined prokinetic/amtoe,etoc
32
mixed micelles
transport lipolytic products (mostly fA and MG)
hydrophilic part on outside
33
vitamin K
dietary from plants, synthesize by gut bacteria
essential to function of blood clotting factors
34
bulk laxatives
i.e. metamucil, citrucel
absorb water, increase in stool volume triggers stretch receptors and causes reflex peristalsis that propels bowel contents forward
safe, most physiologic
fiber laxatives
12 hrs to tdays to work
vegetable fibers
35
stimulant laxatives
derivatives of phenolphtalein
induce high amplitude propagated colonic contracts
appear to be safe!
rescue agents when no BM for several days
36
37
opiates
systemic antidiarrheals
slow peristalsis - allow increased water reabsorption
38
gastric motility of solids
lag phase then trituration
rate depends on nutrient content too (fat is slowest)
39
fundoplication
surgical repair for hiatal hernia
## Footnote
The important one is called a surgical fundoplication, where the stomach, the fundus of the stomach over here (black arrow) which was originally over here (lavender arrow) is wrapped around the LES and sort of adds to its pressure.
40
how to diagnose gastroparesis
EGD to r/o obstruction
scintigraphy = gold standard
41
IBS pathophysiology
genetic/social factors + food and stress lead to symptoms
42
pseudoachalasia
malignancy (gastric)
paraneoplastic
chagas
eosinophilic gastroenteritis
infiltrative process at LES
43
tissue transglutaminase
deamidates or crosslinks gliadin - increasing its affinity for receptors on WBCs
44
folate
DNA synthesis
45
pathogenesis of diabetic gastroparesis
chronic hyperglycemia --\> neuropathic changes and dysfunctional innervation through the vagus --\> delayed gastric emptying due to autonomic neuropathy
46
Transient lower esophageal sphincter relaxations (TLESR)
occur primarily postprandially (facilitate belching)
occur in healthy and GERD pts in the same amt
propriton of reflux related to TLESR is greater in patients w GERD1
Well, what’s happening is all of a sudden in these sort of recordings, we see that in certain patients, they get these transient relaxations that are not associated with a a swallow (points at blue arrow segment)
So the sphincter just relaxes on its own, it’s usually a very prolonged relaxation, and that if you noticed, can cause the esophageal acidity to go down for a long period of time after it’s already relaxed for awhile and the reflux bolus goes up, you try to swallow it back down, but even so you might get a prolonged exposure of the esophagus to acid.
47
48
Barrett's Esophagus
in response to acid reflux normal squamous epithelium may be replaced by columnar epithelium of the specialized intestine type
## Footnote
1% chance of adenocarcinoma (increasing!)
49
serotonin
imp NT and gut signaling molecule
major modulator brain-gut communication
activates enteric neurotransmission to initiate peristalsis and secretion
50
selenium deficiency
cardiomyopathy
51
vitamin E
anti-oxidant
52
short bowel with SHORT ileal resection
bile salt diarrhea
bile acids are incompletely reabsorbed for circulation back to the liver
bile acid spillage into the colon is irritating causing a secretory diarrhea
Tx: bile acid resins
53
percent weight loss
(UBW - Actual BW)/UBW x 100
54
3 hypotheses of diverticuli
1. altered colonic wall structure: weak pts in the colon wall where the vasorecta penetrate from the muscularis propria into the submucosa
2. abnormal motility: normally pressures are equal through colon, but increased segmentation in diverticular colons --\> increased intraluminal pressures --\> predisposes to hernieation
3. dietary fiber: less risk with more fiber! fiber increases colon diameter, bulks stool, prevents increased P
55
hydrogen breath test
to test for lactase deficiency
HBT – lactase maldigestion
Fasting – blow into tube and blow baseline hydrogen methane production, drink lactos and blow into the tube every 20 min for a few hours
If gas levels peak to certain pt – lactose is not digested and lactase is delivering a lot of gas
If symptoms also – they are lactose intolerant –
56
short bowel syndrome
severe malabsorption condition following extensive small bowel resection
post duodeal length less than 5 feet
prone to severe diarrhea and weight loss due to rapid transit, lack of intestinal surface area, bile acid spillage, residual disease (crohns)
causes:
adults - intestinal ischemia, crohns volvulus trauma
children -- congenital
57
niacin
B3
58
fundic accomodation
swallow initiation - fundus undergoes vagally mediated (NITROUS OXIDE!) relaxation - as meal enters the stomach, tnic and phasic contractions are inhibited - 2-3x increase in gastric volume!
59
h pylori and esophageal disease
60
vitamin e deficiency
hemolytic anemia
neuro (ataxia, peripheral neuropathy, myopathy
61
if eye or vision problems?
vit A
zinc 9f night blindness
62
Treatment for SIBO
antibiotics
correct underlying cause
63
mucosal phase of digestion
brush border hydrolysis
transport into epithelial cells (enterocytes)
when abberent - malabsorption
64
reciporcal relationship between adenocarcinomas of stomach and esophagus
65
if oily scaling around nares?
riboflavin or zinc deficiency
66
treatment of IBS
mutlidiscplinary
education and reassurance
dietary (avoid exacerbations w lactose, low FODMAP diet)
stress management
meds
67
how to diagnose achalasia?
endoscopy (not swallowing)
barium swallow
manometry\*\* gold standard
68
gliadin
one of two types of protein that are components of gluten in wheat
contains the toxic AA sequences
69
secretagoges
Amitzia
latest laxatives
stimulate net efflux of ions and water into the intestinal lumen
accelerate transit and facilitate defectatin
activates Cl channels on apical - Cl rich fluid secretion - softens stool, increases motility, promotes Pm
70
pantothenic acid
B5
71
HLA DQ2 and HLA DQ8
receptors
on WBCs bind gliadin fragments and trigger an inflammatory cascade
celiacs
cytokines --\> more inflam cells --\> tissue damage
\*\*during this process abs against TTG and deaminated gliadin develop
72
adherence pedistal
h pylori forms with epithelial cell to insert proteins
## Footnote
Consistent with that is the fact that HP is very smart and understand human biology well
* Slide shows epithelial cell and HP that have been cocultured
* Epithelial cell has formed adherence pedestal [points to supporting structure at bottom of oval blob]
* Helical cell has instructed the cell to form the pedestal through polymerization of actin
73
colonic diverticulosis
sac like protrusion of the colonic wall
mucosa and submucosa herniate through the muscularis
74
intrinsic LES
smooth muscle
gastric sling fibers
So, remember the LES is sort of a complex apparatus
It’s made up of intrinsic components, so we have the smooth muscle layers of the lower esophagus coming down so that’s the longitudinal and circular muscle layers.
And then there’s also an extrinsic component which is primarily made up of diaphragm so when there is no hernia or no sort of anatomical defect, this diaphragm contributes to the tone of the LES.
75
symptoms of SIBO
gas/bloat
diarrhea
maybe B12 deficiency? Bacteria uses B12
76
treatment for lactase deficiency
limit lactose containing foods
use lactase supplements
77
esophageal cancer and cancer
adenocarcinoma!
78
vitamin c deficiency - clinical manifestations
swollen bleeding gums
loose teeth
petechiae
periungal hemorrhage
impaired wound healing
arthalgias, joint effusions
corkscrew hair
anemia
79
cause of achalasia
uncertain
autoimmune?
altered inhibitory innervation of smooth muscle
loss of peristalsis
failure of les relaxation
80
tricyclic antidepressents
IBS
inhibitory effect on gut - alleviate symptoms at a very low dose
\*amitripyline - take at sub depression levels
81
IBS-M
constipation and diarrhea
82
the bowel disorders
IBS
functional diarrhea
functional constipation
83
inhibitory innervation in the esophagus
more distal
84
how do you diagnose pancreatic exocrine insufficiency?
fecal elastase level -
## Footnote
Stool test – elastase – if enough pancreatic enzymes are in bowel and going into stool
Stool test to measure amt in the stool
85
86
types of glands in antrum
endocrine
mucus
g cells (gastrin)
87
impedence-pH monitoring
place transnasally for 24 hours
can detect liquid, air, reflux
adds impedence data - detection of changes in ersistance - detects all liquid reflux events from stomach to esophagus
88
area postrema
has chemoreceptor trigger zone (CTZ) sensitive to many stimuli
89
diverticulitis
likely due to increased lumenal pressure and thickened particulate matter that causes wall erosion, inflammation, perforation
uncomplicated
complicated - abcess, fistula, peritonitis (LLQ pain, nausea, fever)
90
cobalamin
B12
91
h pylori induces what kind of cancer?
adenocarcinoma
92
deficiency if neurologic?
B (1, 12)
vit E
93
dopamine antagonists
antiemetic
i.e. prochlorperazine
have peripheral prokinetic effects --\> increase motility of the GI tract --\> increases rate of gastric emptying
caution in patients w parkinsons!
94
soluble fiber
undigested until it reaches the colon
includes pectins, guar gum
used to thicken diarrhea
95
96
anticholinergics
systemic antidiarrheals
increase intestinal muscle tone and peristalsis
lots of side effects
97
prostiglandins
increased mucus and bicarb secretion
increase mucosal blood flow
98
riboflavin
B6
99
manometry
primary tool to measure esophageal peristalsis
record intraluminal pressure!
100
biphasic of h pylori
101
cyclin D1
HP can affect host cell genes in cell cycle
•Diagram shows effect of helicobac on cyclinD1 expression
oThis is one target gene shown as an ex but there are many others
* When helicobac sees cells, it binds to cell, launch CagA appartatus, injects CagA, gets phosphorylated and interacts with MAP kinases (e.g. ERK1/2, p38, JNK)
* MAPK phosphorylate transcription factors that work upstream of important genes like cyclin D1 that affect cell cycle progression
This is another example of how HP is talking to human cells
102
chromium deficiency
glucose intoleance (high blood sugar)
peripheral neuropathy
103
anticholinergics
antiemetic
esp for vestibular and gi disorders
104
post absorptive phase of digestion
processing within enterocyte
transport into blood stream and lymphatics
105
conditions of maldigestion
impaired nutrient hydrolysis
lactose intolerance
pancreatc insufficiency
small bowel bacteria over growth
bile acid deficiency
106
insoluble fiber
passes through intestine mostly unchanged
includes lignin, cellulose
used to treat mild constipation
107
extrinsic LES
diaphragmatic crural fibers
anchored by phrenoesophageal ligament
So, remember the LES is sort of a complex apparatus
It’s made up of intrinsic components, so we have the smooth muscle layers of the lower esophagus coming down so that’s the longitudinal and circular muscle layers.
And then there’s also an extrinsic component which is primarily made up of diaphragm so when there is no hernia or no sort of anatomical defect, this diaphragm contributes to the tone of the LES.
108
if beefy red tongue?
any of the Bs! 2, 3, 12
folate, protein, iron
109
B vitamin deficiency clinical signs
cheilosis (swollen lips), angular stomatitis (scaly only around nose)
seborrheic dematitis
anemia
110
gluten
storage protein in wheat, rye, barley
rich in prolamine and glutamine which leads to incomplete digestion by intestinal enzymes
long peptide results which passes through the epithelial barrier and triggers an immune reaction in genetically susceptible individuals
111
symptoms of diabetic gastroparesis
early satiety
bloating
nausea and vomiting
occasional bezoar development (accumulated indigestable material)
112
Linzess
actiaves guanylate cyclase c receptor on lumenealsurface of intestinal epithelal cells - opens CFTR and Cl secretion happens
113
IBS-D
IBS with diarrhea
114
excitatory innervation in esophagus
more proximal
115
h pylori and ghrelin
more ghrelin without h pylori
116
copper deficiency
impaired bone density
microcytic anemia
117
small intestinal bacterial overgrowth (SIBO)
excess build up of bacteria in upper small bowel
bacteria deconjugates bile acids and leads to impaired fat processing and absorption
118
red flags for NOT IBS
weight loss
nocturnal
fam history of colon cancer
blood mixed w stool
recent abx
119
lactase deficiency
inadequate levels of lactase in BB
lactase levels are highest after birth and decline after weaking
without lactase, lactose is not broken down into glucose and galactose
undigested lactose pulls water into lumen (osmotic)
this lead to rapid transit into the colon - bacteria ferment lactose and generate gas
primary = congenital , asians, africans, mediterranian
secondary - infectious enteritis, celiac, ibd
120
gastroparesis cause
30% = long standing diabetes
30% idiopathic (post viral?)
collagen vasc disease
amyloidosis
121
harris benedict equation
energy requirements
122
functional esophageal disorders
heartburn
chest pain
dysphagia
globus
123
hiatal hernia
GERD associated
## Footnote
So you have the esophagus smooth muscle coming down here. This would be the intrinsic LES (black arrow) with longitudinal and circular muscle layers. But now it’s been displaced from the diaphragm. Since normally the diaphragm adds to its pressure, that makes it inherently low pressure here (at the LES). Not only that, you have acid production happening right here directly (lavender arrow) and you can see that that might make it a little more easy to have acid coming up
A hiatal hernia (this is not a great picture of that), but it’s essentially when part of the stomach pushes up through the diaphragm and displaces the LES smooth muscle portion from the esophagus, from the diaphragm and sort of causes the whole apparatus to be a little bit separate and now you have acid production coming right here above the diaphragm and it can more easily come up.
124
NSAID ion trapping
wak acids!
once ionized, NSAIDs remain water soluble and "trapped" inside cell
125
factors in early life that can contribute to IBS
abuse
maternal deprivation
GI infections
abx
microbiome
early: diff factors cause development of abnormalities in ENS, visceral sensation, brain gut interactions, mental health
later: common environmental triggers like food and stress
126
tissue injury in celiac
increased intraepithelial lymphocytes
crypt hyperplasia
villous blunting
127
thiamin
B1
128
functional gastrointestinal disorders
multidetermined disorders
composite factors effect everything
gut mucosa, microflora, ENS, extrinsic neural connections, signalling brain and sc
129
treatment of achalasia
\*decrease P in LES (gravity promotes emptying)
1. pharma (botox)
2. dilation of LES/surgical myotomy (cut through muscle)
3. POEM - balloon tipped catheter
130
131
vitamin A
retinol
vision, immune function
132
osmotic laxatives
i.e. golytely (colo prep)
hypertonic agents draw fluid into lumen by osmosis and cause diarrhea
may cause electrolyte defects
effect in 3 hrs
133
laxatives
production of a soft formed stool over a period of 1 day or more
propmt fluid evacuation of the bowel - more intense
for constimation (pain, decreaseamt of strai, pre-exams)
134
retching
labored rhythmic respiratory activity and abdominal contractions that usually precede vomiting
builds up P gradient for vomiting
135
treatment of vomiting
treat complications (replace Na, water, K)
identify and treat underlying cause if possible
symptomatic relief
preventative measures (cancer therapy)
136
antihistimines
i.e. meclizine
esp for vestibular disorders
antiemetic
137
CCK
triggered by dietary fat in duodenum
1. chyme entering duodenum causes enteroendocrine cells of the duodenal wall to release secretin but FATTY PROTEIN induces cck
2. cck and secretin enter blood stream
3. upon reaching pancreas, cck induces secretion of pancreatic juice (enzyme rich) - secretin causes more HCO3
138
GERD triggers
large meals
fatty spicy acid foods
bending, stooping, lying down
frequency of reflux related symptoms varies widely
lifting, staining, strenuous activities
139
adsorbants
pepto!
anti-dairrheal
coat the gut wall
bnd to causative bugs or toxins and permit elimination
140
treatment of compilcated diverticulitis
abscess
need to be drained and resect
141
selective serotinin RAs
esp to prevent chemo-induced nausea and vomiting
142
iron deficiency
facilitates oxygen delivery to tissue
deficiency - microcytic anemia
143
zinc deficiency risk and symptoms
at risk if chronic diarrhea
symp: scaly red rash around nose, mouth, eyes, groin
diarrhea (viscous cycle)
poor wound healing
impaired immune
decreased night vision
altered taste
144
treatment for short bowel syndrome
antidiarrheal medications
nutritional support - dietary interventions
complicated cases could require intestinal transplant
145
causes of SIBO
stasis!
from impaired motility or structural factors
Stasis – slow motility (structural, things not moving) – post surgery, connection sit that’s a pocket
146
scintigraphy
gastric emptying - gold standard for gastroparesis
solid/liquid emptying by radioloabeled meal
measure every 15 min for 4 hours
retention of \>10% of solids at 4 hours = diagnosis
147
conditions of malabsorption
\*\*impaired mucosal absorption of nutrients
loss of SA (celiac, small bowel syndrome, radiation), impaired lymph transport
148
PUFA
omega 6 and omega 3
lineoleic and lineolenic
essential FA can't be made
149
treatment of gastroparesis
correct nutritional issues/electrolte problems
glucose control (if diabetic)
consider meds
150
gastroparesis in diabetcs
commonly have aberrant fundic accomodation
associated w dyspepsia and bloating
151
regurgitation
effortless movemeent of gastric contents toward the mouth without characteristic motor and autonomic changes seen w vomiting
152
types of glands in fundus
parietal
chief
endocrine
mucus
153
vitamin c
collagen synthesis, wound healing
154
riboflavin
B2
155
diverticulosis epidemiology
age related! almost all in older people
left sided in western
right sided in asia and africa
156
short bowel with long ileal resection
bile acids are so poorly absorbed htat the liver can't synthesize enough to keep levels adequate
leads to fat maldigestion and malabsorption
restrict fat intake in diet
supplement with MCT oil
157
lubricant laxative
i.e. stool softener (colace), mineral oil
lubricates and softens stool
retards water reabsorption
works in 6-8 hrs little laxative effect
lowers surface tension of stool allowing water to enter and softening!
158
antispasmodics
anticholinergics
given based on the presuption that pain is due to intestinal spasm 0 minimally effective
Bentyl, LEvsin
159
pellagra
B3 deficiency - dermatitis, diarrhea, dementia
hyperpigmentation without uv exposure
160
GERD progression
normal
inflammed
baretts
dysplasia
adenocarcinoma
So this slide I’ll get back into a little bit later, just to give an overview of what reflux disease can progress into.
So, when you have a normal esophagus like in the video it should be looking sort of whitish, we say pearly white, the epithelium should be stratified squamous, and then, as acid starts to comes up into the esophagus over time, you can get the development of what’s called esophagitis. I’ll have another little video later, looking at that. And that’s really when your defense against acid in the esophagus is overwhelmed by the amount of reflux of acid up from the stomach and you can get esophagitis. On endoscopy it will look like this with sort of erosions and redness (erythema) coming out (pointing to second picture from left) And microscopically, there’s just a little more acid going through the layers.
Over time that acid reflux esophagitis we think is really the next step into going into Barrett’s esophagus. Now what is Barrett’s esophagus, Barrett’s is when the actual squamous mucosa starts changing, it’s called metaplasia and we’ll get into that in detail a little bit later. But the mucosa essentially becomes specialized into intestinal metaplasia. So, it becomes columnar and starts looking almost like the small intestine
After awhile, with prolonged acid in the esophagus with Barrett’s, the cells can become dysplastic which really is the next step into cancer.
So classically, you know, what we think is with acid reflux over time there’s a chance the patients can go from normal to esophagitis, to Barrett’s to dysplasia and then finally adenocarcinoma.
161
quantitative fecal fat test
for fat malabsorbtion
start 100g fat diet 2-3 days before study and continue through study
collect stool over 72 hours
if \>7 g of fat in stool per day
162
5-HT Agonists
Tegoserod
accelerates gastric emptying and small bowel transit
for constipation dominant IBS - side effect is mild diarrhea
only if no response to fiber or laxatives
163
abdominal pain in IBS
visceral nerves affected
pain is diffuse and poorly localized
164
acid pocket
reservoir from which reflux originates after a meal
lag phase - food sits in fundus - why some more prone to GERD
increase reflux if closer to esophagus
can differ in patietns
165
treatment of uncomplicated diverticulitis
clear liquid diet
antibiotics
166
antiemetics
anti-vomiting
dopamine antagonists
serotinin antagonists
tricyclic antidepressants
167
Schilling test
assess cause of B12 deficiency
1. oral B12 and intramuscular B12 - asses absorption by measuring urinary excretion over 24 hours - if low proceed to part 2 to see if it's due to lack of IF
2. labeled B12 is given with IF - if urinary excretion is normal - the patient has perniscous anemia (IF deficiency)
3. give vit b12 and antibiotics - if normalizes, bacterial overgrowth is cause
4. give B12 and panc enzymes - if normalizes pancreatic insufficiency is the cause
168
celiac disease
autoimmune where gluten triggers an immune raeaction that damages the small intestinal lining
169
functional gastroduodenal disorders
dyspepsia
nausea
vomiting
170
functional anorectal disorders
defectation disorders
fecal incontenance
anorectal pain
171
most common causes of peptic ulcer disase
h pylori
NSAIDs
172
GERD alarm symptoms
dysphagia
bleeding
weight loss
chest pain
173
gastric slow waves
always present, regular electrical pattern (produced by ICC!)
propigate circumerentially and migrate toward pylorus
do not lead to contractions by themselves! contractions occur on crests of slow waves
max contractions is directly related to slow wave frequency
174
deficiency if joint pain/weakness?
vit c
175
complication of achalasia
aspiration pneumonia
esophageal cancer risk (squamous - stasis esophagitis, adeno - GERD after LES disruption)
176
CagA
h pylori
## Footnote
HP produces protein called CagA and has type 4 secretion system used to export CagA and other materials from HP and directly inject into epithelial cells
* CagA has tyrosine phosphorylation domains that are recognized by host cell kinases like Sarc and Abl
* Phosphorylated protein [blue blob labeled Y-P] has many different activities within epithelial cells
* HP has whole repertoire of CagA or no CagA that signal the host in different ways
177
gastric lag phase
most solids stay in proximal stomach for 30-60 min
contractions then get food toward antrum
178
features of achalasia
incomplete relaxation of LES causes functional obstruction of esophagus
until hydrostatic P \> LES P
dysphagia liquids/solids
difficulty belching
weightloss, CP, heart burn
179
5-HT antagonists
\*\*diarrhea predominant IBS!
receptors on ENS sensory neurons
slow colonic transit and increase colonic compliance
reduce intestinal sensitivity to distention
180
types of unsaturated fats
MUFA - omega 9
PUFA - omega 6 and omega 3 (lineoleic and lineoenic) - essecntal FA and can't be made
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octreotide (sandostatin)
mimis somatostatin
inhibits secretion of gastrin, cck, glucagon, gh, insulin, secretin
reduces secretion offluids and motility
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luminal phase of digestion
intraluminal substrate hydrolysis by various enzymes
maldigestion when abberant!
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Nucleus tractus solitarius
may serve as central pattern generator for vomiting and taking in input via area postrema
then project to various motor nuclei in the vomiting reflex
