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Gastroenterology > Intro to GI > Flashcards

Intro to GI Flashcards

1
Q

What are the 13 cardinal symptoms of GI Pathology

A
  1. Anorexia
  2. Nausea
  3. Vomiting
  4. Swallowing Problems
  5. Hiccups (Singuitus)
  6. Chest Pain
  7. Heart Burn
  8. Dyspepsia
  9. Gas
  10. Abdominal Pain
  11. Constipation
  12. Diarrhea/Malabsorption
  13. GI Bleeding
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2
Q

This mechanism of abdominal pain is not sensitive to cutting, tearing, or crushing – it is only sensitive to stretching and distention.

A

Mechanical

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3
Q

This mechanism of abdominal pain is due to the obstruction of blood flow from distention or mesenteric vessel thrombosis

A

Ischemic

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4
Q

This mechanism of abdominal pain is due to mediators of inflammation such as histamine, bradykinin, and serotonin

A

Chemical

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5
Q

This type of neuron is responsible for rapid conduction with abdominal pain.

A

Type A Fibers

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6
Q

This type of neuron is responsible for slow conduction with abdominal pain.

A

Type C Fibers

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7
Q

This type of abdominal pain is due to a stimulus acting on an organ or visceral peritoneum. Because most organs do not have any nerve fibers, the pain might be mild or poorly localized.

A

Visceral Pain

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8
Q

What type of neurons are involved in Visceral Abdominal Pain?

A

Type C Fibers

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9
Q

This type of abdominal pain is localized due to a higher density of neurons and more intense than visceral pain. This type of pain travels via peripheral nerves to the spinal cord at the dermatones. It also lateralizes.

A

Parietal or Somatic Pain

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10
Q

What type of neurons are involved in Parietal/Somatic Pain?

A

Type A and C fibers

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11
Q

This type of abdominal pain is a visceral pain that is felt in another area of the body and occurs when organs share a common nerve pathways. Usually poorly localized.

A

Referred Pain

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12
Q

This condition is defined as the absence of desire to eat. Often assc with nausea, abdominal pain and diarrhea. May involve a GI tract disorder, cancer, heart or renal dz.

A

Anorexia

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13
Q

This condition is described at the forceful emptying of the stomach and intestinal contents through the mouth.

A

Vomiting

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14
Q

What can trigger vomiting?

A

Intestinal Vagal or Sympathetic (afferent) stimuli
Such as:
1. CNS or Peripheral D/o (migraines, vestibular disorders, meningitis, etc.)
2. Severe pain
3. Distention of stomach or duodenum

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15
Q

What is the actual mechanism of vomiting?

A

Activation of the chemoreceptor trigger zone in the medulla (emetic center).

  • 5-HT3 is released from the enterochromaffin cells and can stimulate this
  • D2 receptors can also affect this
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16
Q

How do you treat vomiting?

A
  1. 5-HT3 antagonists like Zofran, Domperidone, Metoclopramide (Reglan)
  2. D2 antagonists like Phenergan (Promethazine) – these are also H1 antagonists
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17
Q

This condition is defined as difficult or infrequent defecation (<3 bowel movements per week). It affects up to 28% of the population.

A

Constipation

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18
Q

In the Bristol Meyers Stool Scale, Type 1 and 2 stool is usually associated with what condition?

A

Constipation

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19
Q

In the Bristol Meyers Stool Scale, Type 5, 6 and 7 stool is usually associated with what condition?

A

Diarrhea

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20
Q

In the Bristol Meyers Stool Scale, Type 3 and 4 stool is usually associated with what condition?

A

Ideal Stool

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21
Q

What can cause constipation?

A
  1. Low-residue diet
  2. Sedentary lifestyle
  3. Delayed, non-spontaneous defecation
  4. Drug induced (opiates, anticholinergics, antacids)
  5. Systemic dzs like hypothyroidism or diabetes
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22
Q

How would you evaluate suspected Constipation?

A
  1. Abdominal X-Ray 2 view
  2. CT of the Abdomen w/ contrast
  3. CT or MR Enterography w/contrast
  4. Flexible Sigmoidoscopy to the splenic flexure
  5. Colonoscopy (intubate the ileocecal valve and distal ileum)
  6. Barium Enema (hardly used)
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23
Q

How do you treat constipation?

A
  1. Fiber Supplements (polycarbophil, psyllium, guar gum, methyl cellulose)
  2. Osmotic laxatives (polyethylene glycol like miralax of glycolax, fleets phosphosoda, magnesium citrate)
  3. Stool Softeners (Docusate sodium)
  4. Stimulant of fluid secretion such as bisacodyl and colchicine or 5-T4 Agonists like Zelnorm
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24
Q

This condition is defined as an increase in the frequency of defecation and fluidity, volume and weight of feces. 3+ stools per day, 200+ g/day.

A

Diarrhea

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25
Q

This type of diarrhea is defined as excessive amounts of water/secretions in the intestines.

A

Large Volume Diarrhea

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26
Q

This type of diarrhea is defined as the feces volume not being increased due to excessive intestinal motility.

A

Small Volume Diarrhea

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27
Q

What are the three mechanisms of Diarrhea?

A
  1. Osmotic
  2. Secretory
  3. Motility
28
Q

This type of diarrhea mechanism is usually caused by the resection of the small bowel, or surgical bypass, or a fistula formed between the loops.

A

Motility Diarrhea

29
Q

This type of diarrhea mechanism forms large volume diarrhea due to excess mucosal secretion of chloride. It is primarily due to inflammatory bacterial infections like E. coli, cholera or salmonellea.
It could also be caused by non-inflammatory causes like giardiasis, rotavirus, and neoplasms.

A

Secretory Diarrhea

30
Q

Diabetic Neuropathy and IBD can cause this type of diarrhea to occur.

A

Secretory Diarrhea

31
Q

This type of diarrhea mechanism is due to nonabsorbable substance that draws water into the lumen by osmosis. This causes a large volume diarrhea. This could be due to magnesium, sulfate or phophate salts, lactase deficiency (lactose intolerance) or through the use of sugar substitutes like sorbitol and sucralose.

A

Osmotic Diarrhea

32
Q

This type of diarrhea can cause dehydration, electrolyte imbalance, metabolic acidosis and weight loss

A

Chronic Diarrhea

33
Q

This type of diarrhea is commonly occurring in a less than 2 weeks span. It can present with fever, cramping pain, or bloody stools.

A

Acute Diarrhea

34
Q

Let’s investigate diarrhea!

A

The history is very important!

When did the diarrhea start?
Did they consume contaminated food?
Have they traveled recently?
Are they on meds like abx, diuretics, bp meds, etc that can cause this?

Consider doing a stool study (culture, leukocytes, lactoferrin, calprotectin, bacterial toxins, antigens, CRP, ESR

35
Q

How do we treat diarrhea?

A
  1. Restore fluids orally or through IV
  2. Correction of nutritional deficiencies in cases of chronic diarrhea or malabsorption
  3. Fiber supplements/opioid meds like imodium or lomotil
  4. Most cases of acute pathogenically derived diarrhea are viral
  5. Abx care be used if the etiology is bacterial (cipro, metronidazole, rifaximin)
36
Q

This condition is defined as bleeding in the esophagus, stomach or duodenum. It is usually caused by peptic ulcers, esophageal or gastric varices, or Mallory-Weiss tear at the GE junction.

A

Upper GI Bleed

37
Q

How would identify an Upper GI Bleed?

A
  1. Hemetemesis

2. Occult Blood

38
Q

This is a condition where there are trace amounts of blood in normal appearing stool due to slow, chronic loss of blood that isn’t obvious.

A

Occult Blood

39
Q

This is a condition that is the presence of blood in the vomitus (fresh, bright red OR dark and grainy coffee grounds). Usually a UGI bleed proximal to the ligament of Treitz.

A

Hemetemesis

40
Q

This is a condition defined as bleeding below the ligament of Treitz or from the jejunum, ileum, colon, or rectom. This could be due to polyps, IBD, diverticulosis, vascular ectasia/AVMs or hemorrhoids.

A

Lower GI bleed

41
Q

How would you identify a Lower GI Bleed?

A
  1. Melena
    2 Hematochezia
  2. Occult Blood
42
Q

This is a condition where there is a passage of dark, tarry, foul-smelling stools (50-100 cc).

43
Q

This is a condition where there is a passage of bright red or maroon colored blood from the rectum.

A

Hematochezia

44
Q

This condition is caused by the outpocketing of colonic mucosa through weaknesses in muscle layers in the colon wall. Most patients are asymptomatic but about 1/3 will develop LLQ pain and irregular bowel habits. 5%

A

Diverticulosis

45
Q

This is the inflammation, abscess formation and sometimes perforation of a diverticulum. Commonly presents with a mild/moderate LLQ pain, constipation, diarrhea, nausea/vomiting, fever, and sometimes a palpable mass.

A

Diverticulitis

46
Q

If the diverticulitis causes a perforation, what signs/symptoms would you see?

A

Peritoneal pain

47
Q

What would imaging show on a patient with Diverticulitis?

A

Plain Film: Free Air

CT: Thickened Wall, paracolic fat infiltration.

48
Q

True/False: Colonoscopy & BE are contraindicated during acute phase of diverticulitis. However, sigmoidoscopy is possible .

49
Q

How do you treat Diverticulitis?

A
  1. Clear liquid diet
  2. Augmentin BID OR
  3. Cipro BID or Bactrim plus Flagyl (Metronidazole) BID (10 day tx)
  4. 20-30% required surgical resection
50
Q

Endoscopic Procedures are:

A
  1. Esophagogastroduodenoscopy (EGD)
  2. Enteroscopy/Push Enteroscopy
  3. Video Capsule Endoscopy
  4. Sigmoidoscopy and Colonoscopy
  5. Endoscopic Retrograde Cholangiopancreatography
  6. Endoscopic US
51
Q

Tell me all about EGD

A
  1. Visualizes the esophagus, stomach, and duodenum (to the 4th portion)
  2. Completed to dx dysphagia, odynphagia, Barrett’s esophagus, esophageal varices, PUD, GI bleed, gastric malignancies and celiac sprue
  3. Allows for therapeutic interventions like banding varices, rupture of esophageal rings/webs, dilation of LED (achlasia) and UGI bleed ablation
  4. Complications? <1% bleeding, 0.05-0.5% perforation and 1-5% sedation
52
Q

This is an imaging technique that allows views of the splenic flexure with no sedation

A

Flexible sigmoidoscopy

53
Q

This is an imaging technique that allows visualization of the entire colon and intubation of the IC valv and the TI.

A

Colonoscopy

54
Q

When do you perform a sigmoidoscopy or colonoscopy for diagnostic purposes?

A

Acute/Chronic Diarrhea, CRC screening, C. difficile colitis, IBD, surveillance, dysplasia, and polyps

55
Q

When do you perform a sigmoidoscopy or colonoscopy for intervention purposes?

A

Polypectomies

Thermal Ablation of Ectasis

56
Q

This is an imaging technique where you examine the small bowel beyond the ligament of Treitz. Uses a balloon to facilitate advancing the enteroscope. With this method you can biopsy and cauterize lesions.

A

Push or Balloon Enteroscopy

57
Q

When would you want to perform a Push/Balloon Enteroscopy?

A

SB Blood Loss
Irregularities identified in SB series
Crohn’s Dz

58
Q

This is an imaging technique that combines endoscope and fluoroscopy to visualize the biliary and pancreatic ducts. It uses a side arm elevator to guide a catheter into the ampulla of Vater.

59
Q

When do you perform ERCP for intervention purposes?

A

Spincterectomy
Removal of Common bile Duct stones
Placement of Stents

60
Q

When would you use ERCP?

A

Obstructive Jaundice
Cholangitis
Suspected sphincter of Oddi Dysfunction

61
Q

This imaging technique is used with an endoscope and a US transducer. It is only for diagnostic measures, not thereapeutic.

62
Q

When would you do a EUS?

A

Stage tumor depths
View pancreatic tail
Images of the mediastinum or GB

63
Q

What are Non-endoscopic Imaging Procedures

A 
Plain Abdominal Radiographs
Contrast Studies (UGI/SB/BE)
Transabdominal US
CT/CT Enterography
MRI/MRI Enterography
64
Q

This is a noninvasive way to get a view of the small bowel. It is only diagnostic, not therapeutic.

A

CT Enterography

65
Q

When would you do a CT Enterography?

A
  • Diagnosis, staging and follow-up of Crohn’s Disease and its complications.
  • Evaluation of abdominal pain, diarrhea, bloating or low-grade small bowel obstruction.
  • Evaluation of anemia/obscure gastrointestinal bleeding/small bowel tumors
  • Evaluation of diffuse small bowel diseases, such as celiac disease
  • Screening for strictures prior to capsule endoscopy to decrease risk of capsule retention.
66
Q

These tests involve no radiation but is lengthy. It is also diagnostic and not therapeutic.

A

MRE, MRCP, MRA

67
Q

When you would you perform MRE, MRCP, or MRA?

A 
MRE = SB (same as CTE)
MRCP = ductal dilation, strictures, stones, cysts; 
MRA = GI bleeding sites and mesenteric ischemia.

Gastroenterology (12 decks)

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