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P&T Block 3 Pulm & GI > L83 > Flashcards

L83 Flashcards

1
Q

Describe fat metabolism in the SI

A

Pancreatic enzymes break into FA
FA -> TG -> chylomicrons = absorbed into lymphatics
Short and medium chain FAs passively diffuse into portal circulation

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2
Q

Major enzyme for protein metab

A

Pepsin

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3
Q

What gets absorbed in the duodenum

A

Iron

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4
Q

3 things that get absorbed in the jejunum

A

Folate
Ca
Zn

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5
Q

What is absorbed in the ileum

A

B12, fat sol vitamins (ADEK), bile salts

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6
Q

What kind of ab pain makes you think SI

A

Worse after eating

Peri-umbilical

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7
Q

Describe inflam diarrhea

  • Volume: small or large
  • What’s in it
  • Associated symptoms
A

Small vol - frequent
Blood, WBC, mucous
Tenesmus, pain, fever

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8
Q

Diseases that present w/ inflam diarrhea

A

Infections, IBD, ischemia (acute)

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9
Q

Describe non-inflam diarrhea

  • Volume: small or large
  • What’s in it
  • Associated symptoms
A

Large volume: dehydration
Watery
No fever, etc

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10
Q

Diseases that present w/ watery diarrhea

A

IBS, medications

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11
Q

Equation to calculate stool osms

A

290 - [2 x (stool Na + )]

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12
Q

Define osmotic diarrhea

A

Gap > 50
Means that solutes aren’t being absorbed, therefore stay in GI lumen
Ex: lactose intol, artifical sugars
SO diarrhea gets worse after eating, better when you don’t

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13
Q

Define secretory diarrhea

A

Gap

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14
Q

Describe fatty diarrhea - what are the 2 reasons you might have this?

A

Floats
Smells BAD
Either due to maldigestion OR malabsorption of fats

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15
Q

How do you test for these in the stool:

  • Fat
  • Carbs
  • Protein
  • Bile salts
A

Fecal fat - just measure
Carbs - change diet (lactose)
Protein - alpha1 anti-trypsin clearance from stool
Bile salts - + bile acid binder, does it get better?

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16
Q

3 ways to visualize the SI

A

EGD = scope from above
Colonoscopy
Video capsule = to see the middle
- Otherwise radiology to see the middle SI = enterography

17
Q

What is Celiac disease - what kind of diarrhea

A

Ab vs gliadin
Disrupts tight jxns
Activates tissue transglutaminase = tTG -> more aggressive changes
Net: lose mucosa vili -> INFLAM diarrhea

18
Q

Halpotype for Celiac

A

DQ2/8

If you don’t have this, you don’t have Celiac

19
Q

Celiac presentation

A

Bloating + pain + diarrhea
Nutrient def
Anemia

20
Q

Skin lesion assicated with Celiac

A

Dermatitis herpetaformis

21
Q

What does Celiac look like on scope

A

Scalloping

22
Q

What does Celiac look like on histo - 3 features

A

Lose vili
Hyperplasia of crypts
Intraepithelial lymphocytes***

23
Q

Test for Celiac

A

Ab tTG = IgA

BUT if this comes back normal, pt might have associated IgA def

24
Q

Treat eosinophilic enteritis

A

Remove allergic food if able

Steroids

25
Q

What is tropical sprue?

A

Acts like Celiac, but h/o travel to Caribbean, India, Asia, Central/South America

26
Q

Treat tropical sprue

A

Tetracycline + high dose folate

27
Q

Whipple’s disease presentation

A

Malabsorption // weight loss
AMS
Joint pain

28
Q

Why do you care about Whipple?

  • Dx
  • Treat
A

Fatal w/o therapy
PAS+ macrophages on SI biopsy
Long term antibiotics

29
Q

What is disaccharidase def?

A

Lactose intolerance
More likely to be acquired than inherited
Will see increased exhaled H+ after eating disaccharides

30
Q

What is small intestine bacterial overgrowth? Which pts are you thinking about this for?

A

Excess bacteria deconj bile salts and eat up the B12
Mucosal damage
Crohn’s pts who have had ileal resection

31
Q

Dx and treat SIBO

A

Jejunal biopsy

+ Antibiotics and replace deficiencies

32
Q

What is Meckel’s diverticulum

A

CONGENITAL
Before 2 yrs old
Ectopic gastric tissue in SI that secretes H+ -> damages mucosa

33
Q

What do carcinoid tumors do in the GI more often than in the lung?

A

Carcinoid syndrome

  • Urine 5-HIAA levels
  • Chromograinin A levels in the blood
34
Q

2 malignant tumors of the SI

A

Adenocarcinoma

Lymphoma

35
Q

Chronic mesenteric ischemia

  • Define
  • Presentation
  • Dx
A

Gradual flow loss
Pain after eating = fear of eating -> weight loss
Dx w/ scan showing occlusion of 2/3 mesenteric vessels

36
Q

Acute mesenteric ischemia

- Presentation

A

Acute pain - above belly button
“Out of proportion to exam” - aka normal feeling belly
Bloody diarrhea

P&T Block 3 Pulm & GI (31 decks)

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