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Gastroenterology > Introduction to Gastroenterology > Flashcards

Introduction to Gastroenterology Flashcards

1
Q

List some GI alarm symptoms

A

Anemia
dysphagia
Odynophagia
Hematemesis
Melena/hematochezia
Unintentional weight loss
Recurrent vomiting
Abdominal mass
Jaundice
Anorexia
steatorrhea

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1
Q

A vague, intensely disagreeable sensation of sickness or “queasiness” with or without vomiting

A

Nausea

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2
Q

The forceful expulsion of gastric contents through a relaxed upper esophageal sphincter and open mouth

Coordinated gastric, abdominal, and thoracic contractions

A

Vomiting

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3
Q

What are the stimulators of vomiting?

A

Gastrointestinal Viscera
Vestibular system
Higher CNS centers (cortex and limbic system)
“Chemoreceptor trigger zone”

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4
Q

List some causes of vomiting

A

Food poisoning
Gastroenteritis
Drug reactions
Vestibular responses
Systemic illness
Peritoneal irritation
Obstruction
Gastric stasis
Pancreatic disease
Biliary disease
Pregnancy
Gastric outlet obstruction
Gastroparesis
Intestinal dysmotility
Psychogenesis
CNS or systemic disorders

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5
Q

What are some complications of vomiting?

A

Dehydration
Pulmonary aspiration
Metabolic disturbances - Hypokalemia, Metabolic alkalosis
Azotemia secondary to loss of gastric contents
Boerhaave’s syndrome
Mallory-Weiss tear

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6
Q

What is the treatment for vomiting?

A

Treat the underlying cause!

Most cases of acute vomiting are mild and self limiting

Symptomatic treatment - Clear oral fluids, Small feedings

Antiemetics can be given to treat or prevent vomiting - Ondansetron (Zofran), Promethazine (Phenergan)

Severe, acute vomiting may require hospitalization - IV fluids, metabolic disturbances corrected

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7
Q

Term used to describe upper abdominal symptoms - Persistent or recurrent pain or discomfort centered in the upper abdomen

Synonymous with indigestion

Characterized by: Early satiety, Postprandial fullness

A

Dyspepsia

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8
Q

List some causes of dyspepsia

A

Food Intolerance
Drug Intolerance
Infection
Gastric Tract Dysfunction

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9
Q

What type of dyspepsia is described below?

Patients tend to be younger

Have a variety of abdominal and GI symptoms

Increased incidence of anxiety or depression

A

Non-Ulcer Dyspepsia

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10
Q

What type of dyspepsia is described below?

Patient typically older (>55)

Often smoke and consume alcohol

Pain is changed with food or meals

A

Ulcer Dyspepsia

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11
Q

A perception of abnormal bowel movements

Hard stools, Straining, Decreased frequency, Feeling of incomplete evacuation

Typically increased in older patients and women

One of the most common complaints seen by PCPs and gastroenterologists

A

Constipation

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12
Q

What is the medical criteria for constipation?

A

<3 bowel movements per week and/or excessive straining with defecation

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13
Q

Constipation is associated with what factors?

A

Medications
Sedentary lifestyle
Poor caloric intake
Low fiber diet

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14
Q

List some causes of constipation

A

Diet (most common cause)
Medications
Structural abnormalities
Cystic Fibrosis
Systemic endocrine disorders
Slow colonic transport
Pelvic floor dysfunction
Irritable Bowel Syndrome
Colonic atony/dysmotility
MC in kids – function constipation (act of intentionally withholding bowel movement)

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15
Q

What is the most common cause of constipation?

A

Diet (most common cause)

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16
Q

What is the most common cause of constipation in children?

A

function constipation (act of intentionally withholding bowel movement)

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17
Q

What are some treatment options for constipation?

A

Dietary Measures - High fiber diet (25g per day), Reinforce importance of fluid and exercise

Bulking agents

Osmotic laxatives

Stool Surfactants

Chloride secretory agents

Opioid-Receptor Antagonists

Stimulant Laxatives (cathartic)

Biofeedback/manometry for neurogenic causes

Stop offending medication

Get immobile patient moving

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18
Q

Nonabsorbable osmotic agents that increase secretion of water into intestinal lumen, softening stools and promoting defecation

A

Osmotic laxatives

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19
Q

Enables water and fats to be incorporated into the stool

A

Stool Surfactants

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20
Q

Stimulate intestinal chloride secretion through activation of chloride channels or guanycyclase C causing increased intestinal fluid and colonic transit

A

Chloride secretory agents

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21
Q

Stimulate fluid secretion and colonic contraction

A

Stimulant Laxatives (cathartic)

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22
Q

Chronic use of these agents may result in loss of normal colonic neuromuscular function

A

Stimulant Laxatives (cathartic)

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23
Q

What are some treatment options for constipation in pediatrics?

A

Hydration
Increase dietary fiber
Decrease dairy products
Karo syrup
Bowel training
Medications - Softeners (after age 1), laxatives, enemas (premeasured in pedi size)
Referral - concerning findings or conservative treatment unsuccessful

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24
Q

Complication of stimulant laxatives

The most common cause of this condition is stimulant laxatives
(such as Senna)

Benign condition, not cancerous

Does not become cancerous

A

Melanosis Coli

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25
Q

What is the most common cause of Melanosis Coli?

A

stimulant laxatives

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26
Q

Severe impaction of stool may result in obstruction

A

Fecal Impaction

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27
Q

What are some predisposing factors of fecal impaction?

A

Severe psychiatric disease
Bedridden
Medications
Neurogenic disease of colon/spine

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28
Q

What are some treatment options for fecal impaction?

A

Short term: Impaction relief (DRE, Enemas, Disimpaction)

Long term: aimed at keeping stools soft and regular

Prevention:
Gastrocolic reflex – 30 minutes after eating breakfast
Avoid prolonged bathroom sessions
Regular bowel schedule

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29
Q

What methods are used to evaluate fecal impaction?

A

DRE
Radiograph
Air Contrast Barium Enema

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30
Q

Fecal impaction in children – having wet stools, but they’re impacted

Watery part is leaking out

Unable to sense the need to defecate because of stretching internal
sphincter by the retained fecal mass

A

Encopresis

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31
Q

What is the most common cause of Encopresis?

A

Most common cause is constipation, sometimes by fear of toilet/potty training (fecal withholding)

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32
Q

What is the clinical presentation of encopresis?

A

Daytime or nighttime soiling

Repeated passage of stool in inappropriate places (poop in their pants)

Child will soil their pants down their backs and legs

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33
Q

What are the treatment options for encopresis?

A

Treat the constipation
Educate for behavioral strategies
Enema for clean out
Miralax or pedialax to soften stool
Treat underlying disorder if applicable

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34
Q

Involuntary or voluntary release of gas from the stomach or esophagus

Normal physiologic reflex and does not indicate GI pathology

A

Eructation (Belching)

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35
Q

Normal volumes range from 500 to 1500mL/day

Frequency: 6-20 times a day

Sources/Causese: Swallowed air, bacterial fermentation of undigested
carbohydrates (increased fiber), malabsorption, lactase deficiency

A

Flatus

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36
Q

Definition: increased stool frequency >3 BM/day, or liquidity of feces

Varies from a self-limited annoyance to a severe, life threatening
illness

Patients may use this term to refer to:
Increased frequency of bowel movements
Increased stool liquidity
Sense of fecal urgency
Fecal incontinence

A

Diarrhea

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37
Q

What is the definition of acute diarrhea?

A

Acute is less than 3-4 weeks

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38
Q

What are the mechanisms of diarrhea?

A

Osmotic
Secretory
Malabsorptive
Exudative
Increased intestinal motility

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39
Q

In what percentage of cases, the course of acute diarrhea is mild and
self-limited lasting 5 days or less?

A

90%

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40
Q

Pre-liver bilirubin 🡪 conjugated in the liver

Not water soluble, therefore no bilirubin in urine

Stool and urine color normal

Typically mild jaundice

A

Unconjugated Bilirubinemia (Indirect)

41
Q

What are the two main causes of unconjugated bilirubinemia (Indirect)?

A

Hemolysis (hemolytic anemias)

Inherited – Gilbert’s disease, Crigler-Najjar

42
Q

Dark urine with jaundice

Light colored stools if obstruction

A

Conjugated Bilirubinemia (Direct)

43
Q

What are some causes of Conjugated Bilirubinemia (Direct)?

A

Hepatocellular dysfunction

Biliary obstruction – most common cause

Inherited: Dubin-Johnson syndrome- rare, benign condition seen in pregnancy, EtOH, OCP use

Viral

Metabolic

Biliary tract disease

Vascular

Autoimmune liver disease

Hepatotoxins

44
Q

What is the most sensitive test for synthetic liver function is what?

A

the PT

45
Q

List some worrisome symptoms in hyperbilirubinemia

A

Onset of hepatic encephalopathy
Vitamin K resistant prolongation of PT
Cerebral edema
Bili > 18
Rising serum creatinine
Rising serum bilirubin with decreasing AST/ALT
Rising serum creatinine
Hypoglycemia
Sepsis
Ascites
pH <7.3 in acetaminophen overdose

46
Q

Caused by hyperbilirubinema

Can be caused by ABO incompatibility or Rh incompatibility

Yellowing of skin, eyes, and mucus membranes

A

Jaundice

47
Q

Irritation of phrenic or vagus nerve

A

Hiccups

48
Q

Definition: bleeding that occurs below the Ligament of Treitz

A

Lower GI Bleed

49
Q

What are the four major zones of the stomach?

A

Cardia
Fundus
Corpus
Antrum

50
Q

Gastric acid secretion by parietal cells of the gastric mucosa is
controlled by what?

A

ACh – increases acid; muscarinic receptor M1

Histamine – increases acid; H2 receptor

Gastrin – increases acid

Prostaglandins E2 and I2 – decrease acid

51
Q

Gastric juices are combined secretions of what?

A

Mucous cells: mucus

Parietal cells: HCl, Intrinsic factor

Chief cells: Pepsinogen I, Pepsinogen II

52
Q

What do parietal cells secrete?

A

HCl, Intrinsic factor

53
Q

What do chief cells secrete?

A

Pepsinogen I, Pepsinogen II

54
Q

What hormone is described below?

secreted by G cells

In response to food entry

Increases stomach motility

primary mediator of gastric acid secretion

Promotes increased constriction of LES

A

Gastrin

55
Q

What hormone is described below?

Secreted by I cells of jejunum

In response to fatty substances

Increases gallbladder contractility 🡪 bile

Stimulates pancreatic secretion

Regulates gastric emptying and bowel motility

Induces satiety

A

Cholecystokinin

56
Q

What hormone is described below?

Produced by duodenal mucosa

With entry of gastric juice from the stomach

Stimulates pancreatic fluid/bicarb secretion (Neutralizes the acidity of stomach contents)

A

Secretin

57
Q

What hormone is described below?

Peptide

Increases appetite

Stimulates GH secretion

Produces weight gain

A

Ghrelin

58
Q

Starts at the dentate line - Ends at the anal verge

Junction of anal mucosa and perianal skin

A

Anal Canal

59
Q

Circular muscle

Involuntary muscle

Contracted at rest

A

Internal sphincter of the anus

60
Q

Voluntary striated muscle of the anus

A

External sphincter

61
Q

What is the anorectal function?

A

Stores and releases intestinal waste products (Holds 650-1200mL of waste)

Hemorrhoid plexus - Maintain continence and minimize trauma during bowel movements

Progressive distension of the rectum will cause continuous inhibition of the internal sphincter and relaxation of external sphincter 🡪 urge to defecate

62
Q

Majority of the liver is made up of what type of cells?

A

hepatocytes

63
Q

The liver has a dual blood supply. Name to two sources and what percentage is attributed to each?

A

20% from the hepatic artery

80% from the portal vein

64
Q

What is the function and importance of the hepatocytes?

A

Important I the synthesis of many important serum proteins, hormonal
factors, and growth factors

Involved in the regulation of nutrients, production of bile and its carriers, conjugation of bilirubin, and the detox of drugs for excretion

65
Q

What is the function of bile?

A

Facilitates digestion: emulsification, absorption of fat (via micelles), solubilize cholesterol

66
Q

Breakdown product of hemoglobin metabolism

direct (conjugated): water soluble
Indirect (unconjugated): lipid soluble

A

Bilirubin

67
Q

What percentage of serum bilirubin is unconjugated in healthy adults?

A

90% of serum bilirubin

68
Q

Bile secretion is controlled by what two factors?

A

Parasympathetic stimulation via vagus

Hormonal stimulation

69
Q

These two enzymes together are collectively referred to as transaminases

A

AST and ALT

70
Q

LFTs are markers of what?

A

markers of injury

71
Q

Albumin, Coagulation factors, and conjugation of bilirubin are markers of what?

A

markers of liver function

72
Q

Elevated in hepatocellular inflammation or destruction/necrosis

A

LFTs

73
Q

Indicator of hepatic excretion

A

Bilirubin

74
Q

Marker of the liver’s continued ability to synthesize important proteins

A

Albumin

75
Q

Production increases with hepatic injury, obstruction, bone destruction

A

Alkaline phosphatase

76
Q

These enzymes make up the LFTs

A

AST
ALT
LDH

77
Q

List some common causes of LFT elevations

A

NAFLD
Toxins
Viral

78
Q

List some uncommon causes of LFT elevations

A

Liver cancer
rhabdomyolysis

79
Q

The pancreaticobiliary system is composed of what?

A

Gallbladder
Cystic duct
Ducts

80
Q

Distensible sac - 30-50mL that concentrates and stores bile

A

Gallbladder

81
Q

Formed in the liver

Modified and stored in the gallbladder, bile ducts

Emulsifies lipids

Transports wastes

A

Bile

82
Q

Retroperitoneal gland 12-15cm long

Posterior to stomach

Consists of head, central body, and tail

A

Pancreas

83
Q

What percentage of exocrine and endocrine cells make up the pancreas?

A

99% exocrine acini cells
1% endocrine islets cells

84
Q

Pancreatic duct joins common bile duct which forms the what?

A

hepatopancreatic ampulla of Vater

85
Q

The hepatopancreatic ampulla of Vater empties into the duodenum at what landmark?

A

major duodenal papilla

86
Q

The major duodenal papilla is controlled by what?

A

Sphincter of Oddi

87
Q

The list pancreatic secretions

A

Amylase
Lipase
Deoxyribonuclease and ribonuclease
Sodium bicarbonate
Proteases

88
Q

Muscular tube connecting the oropharynx to the stomach

Begins at the level of the cricoid cartilage

Approximately 25cm long

Internal circular and external longitudinal layers of muscle

A

Esophagus

89
Q

The esophagus has three constrictions where adjacent structures produce impressions, name them

A

Cervical constriction: Upper esophageal sphincter

Thoracic constriction: First crossed by the arch of the aorta then where it is crossed by the left main bronchus

Diaphragmatic constriction: Where it passes through the esophageal hiatus of the diaphragm

90
Q

Irregular circumferential line also known as the gastric rosette

A

Z line

91
Q

What is the Z line?

A

At the GE junction, the transition from esophageal to gastric mucosa is seen

92
Q

Substernal burning sensation

A

Heartburn (pyrosis)

93
Q

Difficulty swallowing

A

Dysphagia

94
Q

Painful swallowing

A

Odynophagia

95
Q

List some diagnostic studies used to evaluate the esophagus

A

Esophagogastroduodenoscopy (EGD)
Barium swallow
Esophageal pH monitoring
Esophageal Manometry

96
Q

This study allows for direct visualization and capable of biopsy, variceal banding, dilation, or stent placement

A

Esophagogastroduodenoscopy (EGD)

97
Q

This study differentiates between mechanical and motility disorders

Able to visualize reflux of barium

A

Barium Swallow

98
Q

This study records esophageal pH and correlates acid reflux to
patient’s symptoms

A

Esophageal pH Monitoring

99
Q

This study is used to assess esophageal motility and function

A

Esophageal Manometry

Gastroenterology (9 decks)

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