Review Session Flashcards
What blood vessels come off the splenic artery?
- Greater and dorsal pancreatic (body and tail)
- Left Gastroomental (greater curvature) and short gastric
What blood vessels come off the common hepatic
- R gastric (lesser omentum
- Gastroduodenal artery
- Panc duodenal artery
Portal/systemic for estoph
-gastric vein to esoph
Portal/systemic for caput
paraumbilical to superficial abd
Portal/systemic for rectum
superior rectum–>middle and inferior rectal vein
List pathophys of GERD
- TLESR (most impt)
- LES hypotonia
- Hiatal hernia
- Obesity
- Pregnancy (pressure and estrogen)
- Poor esophageal peristalsis
- Reduced saliva production
Two risk factors for adenocarcinoma
GERD and Barrett’s esoph
Treatment of GERD
- Lifestyle modification
- Antacids
- H2 blockers (Ranitidine and Famotidine)
- PPI
- Surgery (not as common anymore)
List the aggressive factors of peptic ulcer
Acid, pepsin, bile salts
List defensive factors of peptic ulcer
- Mucus/mucosal barrier
- bicarb
- blood flow
- cell regeneration
- PGs (aspirin and NSAIDs inhibit these)
Major etiologies of peptic ulcer disease
- H pylori
- NSAIDs
- Hypersecretory states (ZES)
NSAIDs have what effect?
PG inhibition and antiplatelet (systemic)
Topical events also
Symptoms of DU?
- Epigastric burning pain dev 1-3 hrs after meal
- Pain relieved by food or antacids (food triggers activations, end up getting bicarb sec via secretin etc which provides relief and neut of acid after eating, transient)
Complications of DU?
Bleeding, obstruction, perforation
What bv is in danger with DU?
Gastroduodenal artery
Is ZES common?
Rare
Clinical ZES
- Aggressive PU disease
- Diarrhea
- Heartburn
- Hemorrhage
- Perforation
What syndrome is ZES associated with
MEN1 syndrome
How fast are gastric slow waves?
3/min
What causes gastroparesis
- idiopathic
- post surgical
- diabetic
- meds related
Causes of esophagitis
- GERD
- Pill
- Allergy
- Crohn’s dis
- Viral CMV/HSV
- Radiation
What causes esophageal disease?
- Herpes (punched out ulcers)
- CMV (nuclear/cytoplasmic inclusions, large ulcers)
- Candida (white plaques on endoscopy)
- KS (AIDS)
- Lymphoma (immunosupp, rare)
Eosinophilic Esophagitis
-Allergic response to antigen, dysphagia
Risk factors of squamous cell carcinoma
Smoking, alcohol, achalasia, lye ingestion
Risk factor of barretts
GERD
How are carbs transported in?
Na coupled transport of monosaccharides
List the factors necessary for lipid absorption
- bile salts
- panc lipase
- bicarb
- panc colipase
What forms a chylomicron?
TG and apoproteins
How much liters of fluid/d does small intestine see?
9-10 L
How much water is abs in small bowel?
all but 1.5L
Where is water absorbed fastest in small bowel?
Ileum
Ion transport by crypt cells
- Cl secretion by apical membrane
- Regulated by cAMP
How much water does colon see and abs?
sees 1.5L and abs 1.4L
Describe abs and sec of colon
Surace cell:
- abs: water, Cl, Na
- sec: K+, bicarb
Crypt:
-sec: Cl
Does the small bowel secrete bicarb or k?
no
What is SCFA?
Short chain fatty acids produced by colonic bacteria that nourish colonocytes from undigested carbs
What infectious disease can cause colitis?
- Shigella
- Salmonella
- Campylobacter
What is microscopic colitis?
Lymphocytic colitis
Collagenous colitis
–>get watery diarrhea
–Chronic mucosal inflammation in absence of endoscopic or radiologic abnormalities
What is ischemic colitis?
- Sudden and temporary reduction of blood flow to the colon
- Due to vasculitis, mechanical, thrombotic, embolic, hemodynamic instability, neutrophilic infiltration and edema
NOD2
younger pts
How long after pancolitis does cancer begin?
7-10 years after pancolitis
Where do abscesses form with CD?
Into the peritoneal cavity
TPMT mutation
Check for this because otherwise make too much 6-TGN which is the active drug and get adverse events like leukopenia/death
What drugs do we use to treat c dif?
Oral metronidazole, vancomycin and fecal transplant in refractory cases
How are lipids absorbed?
- Formation of chylomicrons that enter lacteal
- Medium chain TGs enter portal vein
Sucralfate
- Binds to GI mucosa and stimulates bicarb and PGE2 production
- Not absorbed
- Inc resistance to proteolysis by pepsin
- No effect on gastric acid production
List two H2 pump inhib
Ranitidine and Famotidine
-use for GERD, GU and DU
Omeprazole
- PPI
- stomach–>small intestine (basic)–>absorbed–>taken in–>Protonated and sulfonated
- Duration 17 hrs
PPIs uses
GERD, DU, GU, H. pylori, ZES
Are antacids synergistic with other drugs?
no
When should you take misoprostol?
Along with NSAIDs to prevent GU
-bloating and diarrhea=side effects
Antibodies for celica
EMA, TTG
HLA for celiac
HLA-DQ2 and DQ8
What is celiac associated with?
Dermatitis herpetiformis
Oral manifestations of IBD
Pyostomatitis vegetans
oral lesions that precede intestinal findings
Melanosis coli
Brown mucosa caused by accumulation of lipofuscin in macrophages of lamina propria due to lax
-anthraquinone
CMV disease
- Immunosuppressed patients
- watery or bloody diarrhea
Diagnostic tests of CMV
- CMV rapid antigen, PCR or culture of blood
- Sigmoidoscopy or colonoscopy with biopsy (viral inclusions on pathology)
How do you treat CMV?
Ganciclovir
Treatment for cholerae
- IV or oral rehydration
- Particular attention to bicarb and K+
- Abx: tetracycline, fluoroquinolones, TMP-SMX
IBS definition
- Recurrent abdominal discomfort for at least 3 days per month in preceding 3 mo with at least 2/3…
- Relief with defecation
- onset associated with change in stool form or appearance
- change in stool freq
Causes of IBS
- Brain gut interactions
- Abnormal motility
- Visceral hypersensitivity
- Altered gut flora
- Psychosocial factors
What do you have that says you don’t have IBS?
- Rectal bleeding
- Nocturnal or progressive abdominal pain
- Wt loss
- Anemia, elevated inflammatory markers, electrolyte abnormalities
Sessile serrated adenoma
Base of glands are broad and expanded and serration goes down to the base of the crypt. Have malignant potential
Always remove
Juvenile Polyp
- Not dysplastic
- Gland dilation
- SMAD4 mutation
Colonic polyps
- Hyperplastic
- Most common diminutive polyp
- No malignant potential
- Serrated appearance
FAP inc risk of what kinds of cancers?
SB and colonic adenocarcinomas also have extra-intestinal manifestations
Lynch syndrome has what kinds of colic lesions?
Right sided colonic lesions
What mutation in lynch syndrome?
DNA mismatch repair, germline
What mutation in peutz-jegher syndrome?
STK11/LKB1
- ->pigmentation and hamartomatous polyps
- ->arborizing smooth muscle
Where else does STK11/LKB1 inc cancer for?
pancreas, liver, lungs, breast, ovaries, uterus, testicles
Hep A serologic course
ALT then IgM then IgG
Hep B serologic course, acute
HBsAg then IgM and total anti-HBc inc at the same time then anti HBs
Hep B serologic course, chronic
- HBsAg and total anti-HBc reaches peak as IgM decreases
- HBeAg stays high throughout
Hep C serologic course chronic
Symptoms come with anti-HCV
Biliverdin
from heme
