GI Stomach.Secretions

Question 1

What are the 2 gastric secretions?

Answer 1

Acid and pepsinogen (which is then turned into pepsin).

Question 2

What are the 3 phases of the digestive process?

Answer 2

1. Cephalic phase 2. Gastric phase 3. Intestinal phase

Question 3

What occurs during the cephalic phase?

Answer 3

The thought of food (within the cerebral cortex) —> stimulates taste and smell receptors —> hypothalamus and medulla stimulate the vagus nerve —> stimulates parietal cells to increase stomach secretory activity.

Question 4

What occurs during the gastric phase?

Answer 4

Eat food —> stomach distends and activates stretch receptors —>

Question 5

What stimulates the intestinal phase?

Answer 5

Chyme entering the duodenum and acid (low pH).

Question 6

What occurs during the intestinal phase?

Answer 6

Gastrin is released into the blood via the intestine.

Question 7

What are the protective mechanisms within the stomach?

Answer 7

• Mucus - Bicarbonate - Prostaglandins - Epithelial renewal (our entire gut lining turns over every few weeks).

Question 8

When there is pathology of the alimentary canal, there is an imbalance of what?

Answer 8

Protective and aggressive factors.

Question 9

Why do NSAIDs affect the GI tract?

Answer 9

Because prostaglandins are needed for protection of the GI tract, so inhibiting these —> increased acid, decreased bicarbonate, and decrease mucus production —> damage mucosal layer and weaken the barrier of the GI tract.

Question 10

What is H Pylori?

Answer 10

A spiral shaped, flagellated, gram negative bacteria.

Question 11

How is H Pylori spread?

Answer 11

Exact route is unknown, but likely fecal/oral or oral/oral. **We are likely colonized with this bacteria very early.

Question 12

What is the hallmark symptom of peptic ulcer disease?

Answer 12

Epigastric pain, described as gnawing, dull, aching, or “hunger-like.” Present in 80-90% of all patients.

Question 13

What are common methods of relief of epigastric pain with PUD?

Answer 13

Antacids and food.

Question 14

What symptom is unusual to be seen with PUD, and should make you think malignancy?

Answer 14

Weight loss

Question 15

Is fecal occult blood commonly seen in patients with PUD?

Answer 15

No, it is only seen in 1/3 of patients.

Question 16

What 3 habits must you ask patients about if you are concerned about PUD?

Answer 16

• Use of OTC pain medications - ETOH use - Smoking

Question 17

How is a peptic ulcer diagnosed?

Answer 17

Definitive diagnosis —> Gastric biopsy via endoscopy. Can also do serum assay or urea breath test for H Pylori, but these are not diagnostic.

Question 18

How is PUD treated?

Answer 18

1. Relief of symptoms: H2 blockers or PPIs (x4-6 weeks). 2. If H Pylori positive, treat with antibiotics. 3. Change in habits, smoking cessation, ETOH cessation. 4. Effective pain management —> try to get off NSAIDs.

Question 19

What is Zollinger-Ellison syndrome?

Answer 19

Gastrinoma (gastrin secreting tumor) and hypergastrinemia.

Question 20

What are the diagnostic tests for Zollinger-Ellison syndrome?

Answer 20

1. Occult blood test 2. Fasting gastrin level > 150pg/mL. 3. Secretin test: IV secretin given —> gastrin level spikes over 200. 4. Imaging (preferably CT or PET, endoscopy not likely to be positive).

Question 21

What is the definition of diarrhea?

Answer 21

3 or more liquid or semi-solid stools daily for 2-3 days. - Increase in the frequency of defecation and the fluidity and volume of feces.

Question 22

What are the 3 major mechanisms of diarrhea?

Answer 22

1. Osmotic 2. Secretory 3. Motility

Question 23

What are the 3 causes of diarrhea?

Answer 23

1. Infection 2. Toxin 3. Dietary (changes, allergies, or issues).

Question 24

What is osmotic diarrhea?

Answer 24

A nonabsorbable substance in the intestine draws excess water into the lumen —> increases stool weight and volume.

Question 25

What can cause osmotic diarrhea?

Answer 25

Lactase, pancreatic enzyme deficiency, and ingestion of excessive amounts of nonabsorbable sugars.

Question 26

What are the most common viral causes of infectious diarrhea?

Answer 26

Norovirus, rotovirus, and adenovirus.

Question 27

What are the most common bacterial causes of infectious diarrhea? Are these common?

Answer 27

Salmonella, campylobacter, shigella, E. coli, and C Diff. <10% of all diarrhea cases.

Question 28

What are the most common parasitic causes of infectious diarrhea?

Answer 28

Cryptosporidium, giardia, and entamoeba.

Question 29

What is the most common cause of inflammatory diarrhea? What are the common symptoms?

Answer 29

E Coli! Characterized by blood and pus in stool, as well as fever.

Question 30

What is secretory diarrhea?

Answer 30

Excessive mucosal secretion of fluid and electrolytes produce large-volume diarrhea without inflammation.

Question 31

What is small-volume diarrhea?

Answer 31

When a patient has inflammatory bowel disease or a fecal impaction, and has a small amount of diarrhea that is making its way around this occlusion.

Question 32

What is the cause of cholera?

Answer 32

Infection through contaminated food/water.

Question 33

What type of diarrhea does cholera cause?

Answer 33

An infectious diarrhea with an osmotic process.

Question 34

What is motility diarrhea?

Answer 34

Increased peristalsis —> improperly mixed foods and impaired digestion —> diarrhea.

Question 35

What are common causes of motility diarrhea?

Answer 35

Surgical resection, bypass of the small bowel, fistula formation between loops of bowel, or gastroparesis of diabetes.

Question 36

What are systemic effects of prolonged diarrhea?

Answer 36

—> Dehydration, electrolyte imbalance, weight loss.

Question 37

If a patient has inflammatory bowel disease, what are common associated symptoms with their diarrhea?

Answer 37

Fever, cramping pain, and blood stools.

Question 38

What is steatorrhea? What causes this?

Answer 38

Fat in the stool. Caused by malabsorption syndrome.

Question 39

What is your first treatment in question when a patient comes in with diarrhea?

Answer 39

Fluid and electrolyte replacement (this may be only treatment needed).

Question 40

What populations should you be more likely to treat with fluid and electrolyte replacement?

Answer 40

**Infants and children because they get dehydrated very quickly.

Question 41

What is celiac disease?

Answer 41

An immune response to gluten —> causes diffuse damage to proximal small intestine with malabsorption —> “permanent” dietary disorder.

Question 42

What population group has the highest risk for Celiac disease?

Answer 42

Caucasians (1:100)

Question 43

What is the pathophysiology of Celiac?

Answer 43

Antibody to gluten cross-reacts with structures related to smooth muscle connective tissues in the small intestine.

Question 44

How is celiac diagnosed?

Answer 44

Definitive diagnosis is biopsy. Autoantibodies can also be detectable now in serum.

Question 45

What is the difference between diverticulosis and diverticulitis?

Answer 45

• Diverticulosis is the simple herniation of colonic mucosa, ie the presence of diverticula. - Diverticulitis is the inflammation of a diverticulum; it presents w some similarities to appendicitis.

Question 46

Of those with diverticulitis, many people present with rectal bleeding. Who is most likely to bleed?

Answer 46

Those over age 60, with hx of HTN, atherosclerosis, or regularly use NSAIDs.

Question 47

What is the treatment of diverticulitis?

Answer 47

• Bowel rest (NPO) until bleeding stops. Then advance diet slowly. - If febrile, use antibiotics.

Question 48

If you get diverticulitis once, are you likely to get it again?

Answer 48

Yes, 25% of people get recurrence.