GI Week 4 Flashcards
Match the prototype patient with each of the following diseases.
- Diverticular Bleeding
- Ischemic Coltiis
- Microscopic Colitis
A. Most common cause of bleeding in patient >60 years old
B. Older female with left sided pain and bloody diarrhea
C. Older female with autoimmune disease presenting with watery diarrhea
Answer: 1. Diverticular bleeding – A. Most common cause of bleeding in patient >60 years old
- Ischemic Colitis – B. Older female with left sided pain and bloody diarrhea
- Microscopic Colitis – C. Older female with autoimmune disease presenting with watery diarrhea Lecture: 156b Clinical Feature of Colonic Disorders
Select which of the following are associated with Primary peritonitis vs Secondary peritonitis. (Note it may be helpful to write a list under each heading of Primary Peritonitis and Secondary Peritonitis).
Monomicrobial
Polymicrobial
No inciting event
Due to perforation of GI/GU organ
Increased WBC (neutrophils)
In setting of cirrhosis/ascites
Paracentesis with neutrophil >250/mm3
Broad spectrum antibiotics
Ceftriaxone/Ciprofloxacin (against gram (-) bacilli)
Treat with surgery
Answer:
Primary Peritonitis: Monomicrobial, no inciting event, In setting of cirrhosis/ascites, Paracentesis with neutrophil >250/mm3, Ceftriaxone/Ciprofloxacin
Secondary Peritonitis: Polymicrobial, Due to perforation of GI/GU organ, Increased WBC, Broad Spectrum antibiotics, Treat with surgery
Lecture: 157b Infectious Diseases of Luminal GI Tract
Learning Objective: 1. Describe the pathogenesis of primary peritonitis (spontaneous bacterial peritonitis and how it differs from secondary peritonitis. (MSK1b) 2. Describe the paracentesis findings (cell count and culture results) that distinguish primary from secondary peritonitis. (MSK3c)
Match how each component is absorbed in the intestine.
Glucose/Galactose
Amino Acids
Fructose
Na+ Cotransport
Facilitated Diffusion
Answer: Glucose/Galactose – Na+ cotransport
Amino Acids – Na+ cotransport
Fructose – Facilitated diffusion
Explanation: Glucose and Galactose are absorbed by cotransport with Na+ by SGLT1. Fructose is absorbed by facilitated diffusion by GLUT5. Each amino acid has its own selective cotransporter that transports it across the cell membrane with Na+. There’s also some H+-amino acid cotransport.
Lecture: 158b Absorption of Carbohydrates & Proteins Learning Objective: 5. Compare the membrane transport mechanisms responsible for uptake of sugars, amino acids and di-peptides by intestinal epithelial cells. [MKS-1a]
Name one oral medication you might use to treat IBS characterized by constipation and one oral medication you might use to treat IBS characterized by diarrhea. (Bonus: for mechanism of action)
Answer: IBS-Constipation: Linaclotide or Lubiprostone/Plecanatide – activates Cl- channels, which increase Cl- in the lumen and water follows making for faster, softer stools
IBS-Diarrhea: Rifaximin – antibiotic, good for patients with small intestine bacterial overgrowth (SIBO) or Eluxadoline – opioid agonist, so slows digestive tract and relieves pain
Lecture: 159b Functional GI Disorders Learning Objective: 5. Describe the pathogenic rationale underlying specific treatment regimens for IBS. [MKS-1b,1e]
Which of the following are associated with Crohn’s Disease or Ulcerative Colitis? (Note: it may be helpful to write these on a piece of paper under headings of “Crohn’s Disease” and “Ulcerative Colitis”)
Mucosal and submucosal ulcers
Transmural lesions
Skip lesions
Continuous involvement starting at rectum
LLQ pain with bloody diarrhea
RLQ pain with non-bloody diarrhea
Crypt abscesses
Neutrophils
Lymphocytes
Granulomas Cobblestone mucosa and strictures
Loss of haustra
Answer: Crohn’s Disease: transmural lesions, skip lesions, RLQ with non-bloody diarrhea, lymphocytes, granulomas, Cobblestone mucosa and strictures
Ulcerative Colitis: Mucosal and submucosal ulcers, Continuous involvement starting at rectum, LLQ with bloody diarrhea, Crypt abscesses, neutrophils, Loss of haustra
Lecture: 160b Clinical Features of IBD Learning Objective: 1. Explain what inflammatory bowel disease is and list the similarities and differences between Crohn’s disease versus ulcerative colitis. [MKS-1b]
Which of the following would be at highest risk of progressing from adenoma to carcinoma?
A. <1cm, sessile, villous
B. >2cm, sessile, villous
C. 2cm, pedunculated, tubular
D. <1cm, sessile, tubular
Answer: B. >2cm, sessile villous Explanation: Size bests predicts malignancy, so the best choice is the polyp that is >2cm. However, sessile (vs pedunculated) and villous (vs tubular) are also associated with increased risk of carcinoma progression.
Lecture: 161b Pathology of Colonic Disorders Learning Objective: 3. Describe Histological Classification of Polyps of the Large Intestine. [MKS-1b]
What are the screening guidelines for colorectal cancer in an otherwise healthy person with no family history?
Answer: Starting at age 50, colonoscopy every 10 years OR FIT/FOBT (fecal immunochemical test/ fecal occult blood test) every year with follow up colonoscopy if positive OR Flexible sigmoidoscopy every 5-10 years with follow up colonoscopy if positive OR CT colonography every 5 years OR FIT-fecal DNA combination every 3 years
Lecture: 162b Colorectal Cancer Learning Objective: 4. To explain the rationale for colorectal cancer screening and how available modalities are utilized. MSK 1f/knowledge
The growth chart shown below fits criteria for which of the following?
- Obese
- Overweight
- Failure to Thrive
- Normal
- Underweight
Answer: D. Failure to Thrive.
Explanation: Since this patient has crossed >2 major percentiles, this is considered failure to thrive. Possible causes include Cystic Fibrosis, Inflammatory Bowel Disease, Celiac Disease, and Non-organic (postpartum depression, improperly prepared formula etc). If this child was E. underweight, then their weight would be < than the 5th percentile. The answer would have been B. overweight if their weight was between the 85-95 percentiles and the answer would have been A. obese if the patient’s weight was larger than the 95th percentile. Normal is 5th percentile to 85th percentile.
Lecture: 163b Growth: Disease Specific Impact in Children
Learning Objective: 1. Interpret standard growth charts to assess well-being in pediatric patients. [MKS-3a]
Match the orexigenic (stimulates appetite) vs the anorexigenic (stimulates satiety) signals.
NPY
POMC
Leptin
Ghrelin
CART
AgRP
GLP-1
PYY
Answer: Orexigenic (stimulates appetite): NPY, AgRP, Ghrelin
Anorexigenic (stimulates satiety): POMC, CART, Leptin, GLP-1, PYY
Lecture: 164b Appetite Regulation and Energy Expenditure
Learning Objective: 3. Explain the gastrointestinal, endocrine and neural regulation of appetite control (MKS 1a)
In a patient with obesity, which of the following is increased, decreased or stays the same.
Basal Metabolic Rate
Thermic Effect of Food
Resting Energy Expenditure
Total Energy Expenditure
Non-Exercise Activity Thermogenesis
Answer:
Increased – Basal metabolic rate
Increased – Thermic Effect of Food
Increased – Resting Energy Expenditure
Increased – Total Energy Expenditure
Decreased – Non-Exercise Activity Thermogenesis
Lecture: 165b Etiology of Obesity
Learning Objective: 1. Define the energetics of obesity (MKS 1b)
Which of the following is NOT a dysfunction associated with obesity?
- Release of adipokines
- Increased mechanical burden
- Increased abdominal pressure
- Increased respiratory burden
- Increased Cardiovascular burden
- None of the above
Answer: F. None of the above
Lecture: 166b Pathophysiology of Obesity
