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Clin Med- GI > Made Ridiculously Simple > Flashcards

Made Ridiculously Simple Flashcards

1
Q

Acid secretion

Churning

Releases food to duodenum

Secretes intrinsic factor

A

Stomach

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2
Q

Digestion

Absorption

A

Small intestine

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3
Q

Water reabsorption

Passage of stool

A

Large intestine

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4
Q

Where do these occur?

Chron’s disease

Obstruction

Tumors

A

ANYWHERE in GI tract!

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5
Q

Where do these occur?

Obstruction
Reflux
Esophagitis
Varices

A

Esophagus

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6
Q

Where do these occur?

Ulcer
Gastroparesis
Outlet obstruction
Gastritis
Pernicious anemia

A

Stomach

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7
Q

Where do these occur?

Malabsorption
Obstruction
Mesenteric ischemia

A

Small intestine

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8
Q

Where do these occur?

Diarrhea
Constipation
Obstruction
Mesenteric ischemia
Colitis

A

Large intestine

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9
Q

This is made in the stomach and binds vitamin B12

A

Intrinsic factor

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10
Q

Loss of intrinsic factor can result in….

A

Pernicious anemia (because of decreased B12 absorption)

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11
Q

Is there any digestion or absorption in the esophagus?

A

NO

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12
Q

Obstruction

Dysfunction of the muscle or its innervation

Outpouchings (diverticula)

Inability to prevent stomach contents from re-entering esophagus

A

Problems that can occur in the esophagus

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13
Q

The esphagus will:

have decreased peristalsis

be unable to relax the lower esophageal sphincter to allow passage of food

….if what is compromised?

A

Parasympathetic input

*parasymp does “rest and digest”…tells GI system to do all digestion related things!

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14
Q

Esophageal ______ can occur in scleroderma or other connective tissue diseases, as well at in Chagas disease

A

Dilation

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15
Q

The lower esophageal sphincter remains constricted and is unable to relax

later in disease, there is also failure to constrict: the lower 2/3 of the esophagus lose the ability to peristalse

A

Achalasia

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16
Q
A
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17
Q

In this disease, a poorly understood process destroys postganglionic parasympathetic neurons of the esophagus

A

Achalasia

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18
Q

The constricted sphincter and proximal dilation classically resemble a birds beak on a barium swallow imaging

A

Achalasia

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19
Q

Outpouchings of the esophagus

A

Diverticula

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20
Q

Lies just behing the upper esophageal sphincter

It is an outpouching of the lumen that causes food and drink to get stuck there instead of continuing down

Bc food gets stuck, sometimes pts regurgitate

A

Zenker’s diverticulum

(regurgitation would be undigested, since it has not yet reached the stoamch)

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21
Q

MC disorder of esophagus

Backwash of stomach acid up through the lower esophageal sphincter, which burns the esophagel mucosa (esophagitis)

A

GERD

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22
Q

Heartburn, sour taste in mouth, chest pain

Typically worse when bending over ot when lying down after eating

A

GERD

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23
Q

A premalignant condition

Metaplasia from squamous epithelium to columnar

predisposes to adenocarcinoma

A

Barrett’s esophagus

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24
Q

GERD

Meds (ie chemo)

Radiation

Chron’s disease

Infection

..can all cause?

A

Esophagitis

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25
Q

2 types of esophageal cancer

A

Adenocarcinoma

Squamous cell carcinoma

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26
Q

Barrett’s esophagus predisposes to ___________

Smoking and alcochol predispose to ________

A

Barretts –> Adenocarcinoma

Smoking/alcohol —> Squamous cell carcinoma

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27
Q

Dilation of esophageal veins, usually caused by liver disease/portal HTN

A

Esophageal varices

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28
Q

These dilated vein walls are more fragile and they are under high pressure, making them easy to rupture…causing esophageal bleeding

A

Esophageal varices

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29
Q

What is the appearance of blood from an esophageal varice?

A

Bright red! (undigested)

*in contrast to digested blood (ie gastric or duodenal ulcers) which appears like coffee grounds

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30
Q

The _____ cells of the stomach secrete acid by pumping H+ into the stomach lumen in exchange for K+

*this mechanism is stimulated by gastrin, histamine and Ach

*this mechanism if inhibited by somatostatin, prostaglandins, secretin, and VIP

A

parietal

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31
Q

Gastrin
Histamine
Acetylcholine

..stimulate or inhibt acid production in stomach?

A

STIMULATE!

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32
Q

Somatostatin

Prostaglandins

Secretin

VIP (vasoactive intestinal peptide)

Stimulate or inhibit acid secretion in the stomach?

A

INHIBIT

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33
Q

2 basic pathophysiological causes of ulcer formation?

A
  1. decreased mucosal protection
  2. increased acid production

**H PYLORI LEADS TO ULCER FORMATION BY BOTH MECHANISMS

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34
Q

Prostaglandins (increase/decrease) mucus secretion in the stomach?

A

INCREASE

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35
Q

This drug class decreases mucus secretion because they block prostaglandin pathways

A

NSAIDs

..this can lead to ulcer formation

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36
Q

What do tobacco and alcohol do to mucosal protection in the stomach?

A

DECREASE! …predisposing to ulcers

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37
Q

Why do stress ulcers occur?

(due to sepsis, burns, hemorrhage, etc.)

A

Decreased perfusion to stomach can lead to decreased mucosal protection

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38
Q

Gastrin, produced by G cells, stimulates…..

A

acid secretion

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39
Q

In this syndrome…

a pancreatic tumor called a gastrinoma secretes excess gastrin

*the increase in gastrin secretion by the gastrinoma leads to increased acid production, causing ulcers

A

Zollinger-Ellison syndrome

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40
Q

This diagnosis can be provd by marked elevation in serum gastrin and by elevation fo serum gastrin in response to secretin

A

Zollinger-Ellison Syndrome

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41
Q

_______ is a hormone normally produced by the small intestine when food arrives from the stomach

*stimulates the pancreas to secrete bicarb, which neutralizes the duodenal contents

A

Secretin

SECRETIN NEUTRALIZES DUODENAL CONTENTS VIA BICARB

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42
Q

Secretin inhibits…..

A

Gastrin secretion

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43
Q

If a pancreas has a gastrinoma, secretin will do what to gastrin levels?

A

INCREASE

(gastrin will stimulate gastric acid production…ultimately leading to ulcer formation)

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44
Q

A positive secretin test (ie elevation of serum gastrin in response to secretin) is diagnostic for…..

A

Zollinger-Ellison Syndrome

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45
Q

Pain
N/V (with blood sometimes)
Melena
Changes in appetite

*if severe, can lead to perforation of the duodenal or gastric wall

A

Ulcers

46
Q

These can present as acute abdominal pain with air under the diaphragm visible on XRay

A

Perforated ulcers

47
Q

In which site would ulcer pain get worse immediately after eating?

A

Gastric ulcers

48
Q

Which site would ulcer pain get worse some time after eating?

A

Duodenal ulcer

49
Q

What diagnostic will definitively diagnose a gastric or duodenal ulcer?

A

Endoscopy

*gastric ulcers should ALWAYS be biopsied to rule out cancer

50
Q

Which drug class…

Directly affect acid secretion by blocking H+/K+ pump in the parietal cells

A

PPIs

51
Q

Which drug class….?

Decrease stimulation of the parietal cells by blocking histamine

A

H2 blockers

52
Q

Where are H2 receptors located?

A

Parietal cells

53
Q

How do Sucralfate and Misoprostol work?

A

They increase mucosal protection

*Misoprotol increase prostaglandins
*Sucralfate provides a coating

54
Q

A condition in which antibodies form against the parietal cells, leading to loss of intrinsic factor (and therefor unable to absorb B12)

A

Pernicious anemia (aka autoimmune gastritis)

55
Q

“from the inside” causes:

  • foreign body
  • gastric polyp
  • gastric cancer

“from the outside” causes:
-pancreatic tumor

A

Obstruction causes of the pyloric sphincter

56
Q

Symptoms of an obstructed pyloric sphincter?

A

Vomit!*

Early satiety

Abdominal distention

57
Q

A palpable olive-like mass on exam and visible waves of peristalsis

…presentation of?

A

Congenital pyloric sphincter

(the “olive” mass is the hypertrophied sphincter)

58
Q

Stomach is under the control of which nervous system?

A

Enteric Nervous System

59
Q

Parasympathetic input to stomach comes from the Vagus Nerve.

A problem with parasympthetic nerves to stomac can lead to decreased stomach muscle activity and…..

A

Gastroparesis (paralysis of the stomach)

60
Q

H. Pylori

Pernicious anemia

Radiation

…all predispose to?

A

Gastric cancer

61
Q

MC type of gastric cancer

A

Adenocarcinoma

62
Q

N/V
Early satiety
GI bleeds

A

Gastric cancer

..usually occur late in dz so prognosis generally poor

63
Q

Food is churned and broken down in the stomach

then, arrives in small intestine which stimulates the release of what by the duodenum?

A

Cholecystokinin (CCK)

and

Secretin

64
Q

What secretes CCK and Secretin? and when?

A

Secreted by the duodenum

..when food from the stomach reaches the small intestine

65
Q

Most common part of the colon for diverticula?

A

Descending (LLQ)

66
Q

If lactose is not broken down by lactase enzyme, it ends up in the lg intestine (instead of being absorbed in the small intestine)

*this increase in solute concentration in the lg intestine causes….

A

water to be drawn into the lumen —> diarrhea

67
Q

Genetic
Abdominal pain
Lower GI bleeding
Change in bowel habits
and/or obstruction

A

Colon cancer (adenocarcinoma)

68
Q

Regular screening of:

Fecal occult blood testing

Flexible sigmoidoscopy

Barium contrast Xray

and/or colonoscopy

..recomended for age?

A

50+

69
Q

Which 2 conditions make up inflammatory bowel disease

A

Chron’s disease

Ulcerative colitis

70
Q

Difference between ulcerative colitis and chron’s?

A

Ulcerative colitis is limited to colon and has continuous ulcerations

Chron’s can occur anywhere from mouth to anus and has interrupted, multiple ulcerations

71
Q

Causes transmural inflammation (crossing histologic boundaries)

and fissures (boundary crossing tears)

A

Chron’s disease

72
Q

Chron’s disease can cause what type of anemia?

A

B12 deficiency anemia

(from damage to terminal ileum, which decreases B12 absorption)

73
Q

Aphthous ulcers

Sclerosing cholangitis (inflammation of bile ducts)

Skin findings (pyoderma gangrenosum, erythema nodosum)

Eye findings (iritis, scleritis)

A

Seen with inflammatory bowel disease

74
Q

Can have inflammatory bowel disease increase your risk of colon cancer?

A

YES

75
Q

If a pt vomits bright red blood, where must the bleed be coming from?

A

ABOVE the gastroesophageal sphincter/junction because this blood is NOT DIGESTED

76
Q

If the pt vomits dark, “coffee ground” vomit, where must the bleed be coming from?

A

BELOW the gastroesophageal sphincter/junction because the blood has been digested

(typically a gastric or duodenal ulcer)

77
Q

Causes of hematochezia (bright red blood in stool):

A

Bleeding hemorrhoids

Bleeding colon cancer

Bleeding diverticula

(bright red must mean close to exit)

78
Q

Melena (dark, tarry stool) indicates a bleed where?

A

Upper GI bleed (has been digested)

ie bleeding ulcer

79
Q

What vein drains the gut’s venous system, carrying absobed nutrients to the liver?

A

Hepatic portal vein

80
Q

*Provides glucose during fasting (via gluconeogenesis and glycogenolysis)

*detoxifies

*stores glycogen

*produces bile and other proteins/lipids

A

Functions of the liver

81
Q

If there is liver failured and a decreased ability to detoxify the blood, what can happen?

A

Toxins in blood can build up, leading to hepatic encephalopathy

82
Q

If there is liver failure and a decrease in gluconeogenesis, what can happen?

A

Fasting hypoglycemia

83
Q

If there is liver failure and a decrease in protein production, what can happen?

A

Decreased production of clotting factors, increasing the risk of bleeding

84
Q

If there is liver failure, which prevents the liver from secreting conjugated bilirubin or from conjugating bilirubin, what can happen?

A

Jaundice!

85
Q

______ emulsifies fats in the GI tract, facilitating their absorption

A

Bile

86
Q

Bile is produced in the liver and then drains through the intrahepatic biliary system into the extra-hepatic……

A

biliary tree

87
Q

A component of bile that is a product of the breakdown of old (or damaged) RBCs

A

Bilirubin

88
Q

When RBCs break down, what type of bilirubin forms in circulation?

A

Unconjugated

(the liver conjugates this, making conjugated bilirubin!)

89
Q

The liver turns the unconjugated bilirubin into conjugated bilirubin, which is secreted into the…

A

bile

90
Q

Is jaundice due to an increase in conjugated or unconjugated bilirubin?

A

EITHER!

91
Q

Unconjugated bilirubin is also called….

A

Indirect bilirubin

92
Q
A
93
Q
  • increased production of bilirubin
  • decreased uptake of bilirubin by the liver
  • decreased conjugation of bilirubin by the liver

…will all cause an increase in?

A

Indirect bilirubin (and jaundice!)

94
Q

What does hemolytic anemia do to bilirubin?

A

Increases production!

(bc bilirubin comes from the breakdown of old or damaged RBCs)

95
Q

CHF reduces blood flow to the liver, which decreases delivery of bilirubing, resulting in….

A

unconjugated jaundice

96
Q

Crigler-Najjar and Gilbert’s syndrome cause what kind of jaundice?

A

Unconjugated

97
Q

If the liver cannot secrete bilirubin into the bile ducts or if the biliary tree is obstructed, what kind of jaundice?

A

Conjugated jaundice

98
Q

Toxin induced hepatic failure or infections
Alcoholics
Autoimmune hepatitis

….cause what type of jaundice?

A

Conjugated bilirubin jaundice

99
Q

An obstruction of the biliary tree causes what kind of jaundice?

A

Conjugated

100
Q

In liver disease, which 2 enzymes are released into circulation?

A

AST

ALT

101
Q

When the biliary tree is obstructed, the cell of the bile ducts release…..

A

alkaline phosphatase

(alk phos=obstruction)

…in long standing obstruction, AST and ALT may be elevated too, but not as much as alk phos

102
Q

Alkaline phosphatase is mainly present in the cells of the….

A

bile ducts

(damage to the bile ducts will result in an increse of alk phos)

103
Q

Injury to hepatocytes will result in elevation of?

A

AST and ALT

104
Q

Which type of bilirubin is elevated in liver disease?

A

Conjugated

(secretion of bilirubin is a rate limiting step)

105
Q

_______ is a serum protein synthesized by the liver

*used to measure the liver’s capacity for protein synthesis

A

Albumin

106
Q

What happens to albumin levels in liver dz?

A

decrease

(albumin also decreases in inflammatory dz like trauma, malnutrition, and dzs that cause proteinuria)

107
Q

_____________ measures function in part of the clotting cascade

A

prothrombin time

108
Q

If there is liver damage and deficient clotting (due to liver disease) what happens to the prothrombin time?

A

elevated prothrombin time

if there is deficient clotting factors due to liver dz

109
Q

Prothrombin time assesses the extrinsic pathway of the clotting cascade, namely factor _____

A

Factor VII

110
Q

Elevated prothrombin time is more associated with what type of liver dz?

A

Acute

111
Q

A decrease in albumin is generally associated with what type of liver disease?

A

Chronic

112
Q
A

Clin Med- GI (8 decks)

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