Random extra GI questions Flashcards
What do parietal cells secrete?
Gastric acid (HCl) & intrinsic factor
What stimulates the release of CCK?
- what cells produce CCK?
- what does CCK do?
Fat/chyme entering duodenum stimulates release of CCK from L-cells in the gut
- stimulates pancreatic acinar cells to release zymogens
- also acts as a hunger suppressant
In a patient with RUQ pain, fever, and jaundice, what is the most likely diagnosis? What is this group of three symptoms called?
Triad of symptoms is Charcot’s Triad.
–> indicates Cholangitis –> Medical Emergency!!
What GI problem has pathology with transmural infection of the colon?
Crohn’s disease
Which disease is associated with initial infection of rectum and proximal progression?
Pathologically, is this a continuous or patchy disease?
Ulcerative colitis.
Continuous disease.
What histological layers of the intestinal walls get affected by ulcerative colitis?
Just the mucosal layer. It is a superficial disease.
What is fulminant colitis?
What is it a major risk factor for?
Very severe ulcerative colitis with bloody diarrhea, fever, transmural inflammation, and perforation.
Risk for toxic mega colon.
In which type of disease would removal of the colon be a cure?
Ulcerative colitis (because it doesn’t extend into the small intestine whereas Crohn’s may involve entire GIT)
Which colonic disease has patchy discontinuous inflammation?
Crohn’s disease
Why is the approach to DDx of liver disease?
ie. Categories of dx’s to consider with liver problems.
- EtOH
- metabolic (especially with fam Hx)
- NAFLD
- infection (usually viral)
- autoimmune
- drugs (Rx or non-Rx)
- also consider infiltrative diseases (sarcoidosis, diffuse mets, TB)
What does a high IgA indicate?
EtOH overuse
What does a high IgG indicate?
Autoimmune liver disease & cirrhosis
What does a high IgM indicate?
Primary biliary cirrhosis
What is the 1000+ club?
- list club members.
Disease where ALT & AST are elevated above 1000.
Includes the following diseases:
- acute viral hepatitis
- drug induced (acetaminophen)
- ischaemia
- acute biliary obstruction
If you want to test a patient to see if he/she has an acute infection of Hep A, what test would you order and why?
IgM because this is elevated in acute infection whereas IgG would be elevated if the patient had ever had exposure to Hep A.
If patient has fatty infiltration of the liver, what are the three most common causes of this?
- NAFLD
- EtOH
- viral Hepatitiss
What is the mechanism for how stenosis can occur due to Crohn’s disease?
Transmural inflammation –> fibrosis & scarring –> stenosis
What is dysentery?
Bloody and mucousy diarrhea
What is suggested by a finding of neutrophils in intestinal crypts?
Cryptitis
What’s the most likely mechanism of disease in a patient with painful jaundice?
Extrahepatic obstruction
What intestinal disease shows pathology with edematous ‘cobblestone-like’ mucosa?
Crohn’s disease
What’s the most common type of colonic adenoma?
Other causes?
Tubular adenoma is most common.
Others include colloid adenoma and tubulovillous adenoma.
Where are the majority of colorectal cancers located?
Ascending colon/cecum
&
Sigmoid colon/rectum
What is the treatment of IBD?
Anti-inflammatory (5-ASA)
& Immunosuppresant (Azathioprine)
& anti-TNF therapy (Infliximab)
Where in the GIT are tight junctions (paracellular transport) most permeable?
Small intestine
Which requires energy, paracellular transport or transcellular transport?
Transcellular requires energy at the apical and/or basal membrane.
What is the mechanism for diarrhea in celiac sprue?
- Decreased brush border enzymes
- Villus atrophy & malabsorption
- Crypt hyperplasia & increased secretion
- Inflammation-induced hypersecretion from crypt
Where are bile salts mostly absorbed?
Ileum
Where is Vit B12 absorbed?
Ileum
Where is calcium absorbed?
All through small bowel
Where are carbs & proteins mainly absorbed?
Most in proximal small bowel and tapers off as they progress through small bowel.
Where is Fe absorbed?
Duodenum
Where is folate absorbed?
What B vitamin is this?
Duodenum.
Folate = B9
What B vitamin is thiamin?
B1
Where are lipids mainly absorbed?
Jejunum & proximal ileum
Histologically, what is a sign of Barrett’s esophagus?
Intestinal epithelium (presence of goblet cells) in esophagus.
What are some causes of SCC (squamous cell carcinoma) of the esophagus?
- Alcohol overuse
- nutrition deficits
- smoking
- HPV virus
- nitrosamines in water/food
How is gastritis classified?
- list the types of gastritis.
Acute vs. chronic
Acute: hemorrhagic/erosive gastritis
Chronic: H. pylori, autoimmune, & multifocal atrophic gastritis
H. pylori gastritis is further classified into atrophic and non-atrophic gastritis.
A superficial band of inflammatory cells in the lamina propria of the stomach lining and neutrophils in the gastric pits would indicate what?
H. pylori gastritis
What would be seen on a histological section of a stomach from someone who had a gastric ulcer?
Erosion - through the muscularis mucosa
Which gross portion of the stomach is the most involved with H. pylori infection?
Antrum
What is a worrisome complication of H. pylori infection?
Gastric cancer (carcinoma) or MALT lymphoma. Also causes ulcers.
What are the HLA types associated with Celiac disease?
HLA DQw2
&
HLA DQ8
How does autoimmune gastritis work & what can it lead to?
Immune destruction of secretory cells.
Ab to parietal cells &/or IF.
Loss of IF decreases Vit B12 absorption –> pernicious anemia.
What type of neoplasm in the stomach is linked to HIV?
Kaposi’s sarcoma
What types of neoplasms can be present in the stomach?
- epithelial
- stromal
- lymphoid
- vascular
What type of neoplasm is Kaposi’s sarcoma?
Vascular
What does a signet ring cell indicate?
Poorly differentiated cancer
What is a lab test for Celiac disease?
Why?
TTG (transglutaminase) along with IgA.
Direct gliadin toxicity causes inflam response (t-cells) and leads to release of transglutaminase
What is Marasmus?
Deficiency of energy and protein –> depleted body fat & muscle wasting –> very thin appearance
What is Kwashiorkor?
Protein deficiency –> muscle atrophy and lots of edema
Which intestinal disease is more prone to rupture?
Crohn’s
Which intestinal disease is more likely to develop stricture?
Crohn’s
- if stricture is seen in UC, should suspect cancer
What is the diagnostic criteria for diagnosing IBS?
Symptoms for > 6 months.
& 2 of the following:
- pain relieved with bm
- onset of pain a/w change in stool frequency
- onset of pain a/w change in stool appearance
What are the pacemaker cells of the GIT?
Interstitial cells of Cajal –> make slow-wave action potentials that set the rate of peristalsis
Where exactly are the parietal cells, chief cells, mucous neck cells, & paracrine cells located?
In gastric pits (oxyntic glands)
What are the enteroendocrine cells of the stomach?
- where exactly are they located?
G cells
- located in pyloric glands
D cells (paracrine) - located in pyloric and glastric glands
What are 4 functions of gastric acid?
- Bacteriostatic
- Activate enzymes
- Initiates protein denaturation
- Facilitates absorption of Fe/Ca/VitB12
