Small Bowel/ Colon

Question 1

• Tumors of the appendix common? 2 types? Can lead to?
  Small Intestine:
• Malabsorption leads to 4? Deficient in? (8)
  1.) Pan Insuf: How much must be lost? What malabs. first? Causes? (2)
  2.) Bacterial overgrowth: Due to? (4) B12? Folate? Treatment?
  3.) Celiac: Incidence increases with? Inflammatory? Atypical signs? (4) HLA’s? (2) APC type? Antibody? Treatment?
  4.) Tropical spure: Due to? Leads to?
  5.) Whipple’s Disease: Type bacteria? SI and what?
  6.) Mesenteric Ischemia: 2 types?

Answer 1

• Rare; Carcinoid, Epithelial
• Weightloss, diarrhea, steatorrhea, Panc. Insuffic.; DEAK, B12, Fe, Ca, D
  1. ) >90%; Fats; Chronic pancreatitis/ CF
  2. ) Anatomic, hypomobility (scleroderma/DM), lower acid, obstruction; low (bacteria eat it); high; Ciproflaxin
  3. ) Age; Yes; Iron def. anemia, derm. hep., osteoporosis, ataxia; DQ2/8; MHC2; tTG; diet change
  4. ) aerobic toxins; Megaloblastic anemia (B12/Folate)
  5. ) Gram +; neuro
  6. ) Chronic (CVD) and acute (thrombus)

Question 2

• SI tumors common? 2 types?
• 2 causes of diarrhea? 4 types?
• 1a.) Watery Osmotic: Due to?
• 1b.) Watery Secretory: 3 ex? Calculation?
  2. ) Fatty diarrhea: Due to? Ex? (4)
  3. ) Inflammatory: Ex? (4)
• No organic cause?

Answer 2

• No; Adeno from crohn’s, carcinoid
• Decrease absorption, increased secretion; fatty, watery, exudative, functional
  1a. ) Carb malabs; laxative
  1b. ) Cholera, IBS, DM; 290- 2(Na + K); >50 = osmotic
  2. ) Malabs.; Celiac, Whipples, Bac overgrowth, PI
  3. ) Infection, Crohns, UC, Ischemia
• IBS

Question 3

Colon:

1. ) IBD: Diagnosed how?
2. ) Microscopic Colitis: Typically in who? Prognosis? Autoimmune? Type of diarrhea? 2 types?
3. ) Ischemic Colitis: Usually where? Diarrhea? Recovery?
4. ) Infectious: Diarrhea? Bloody?
5. ) Drug induced?
6. ) Radiation: Proctotis when?
7. ) Diverdiculosis: Mostly in? Due to? (2) Hemorrhage due to? Painful?
8. ) Diverticulitis: What happens? Dx with? Not?

Answer 3

1. ) Direct visual and biopsy
2. ) Older women; good; yes; secretory; collagenous/lympho
3. ) Watershed regions; MILD!, 1-2 weeks
4. ) Yes; sometimes
5. ) NSAID
6. ) Years after radiation
7. ) Elderly; low fiber/increased colonic pressure; vasa recta bleed; no but heavy
8. ) Food gets lodged and infection occurs; CT/MRI; SCOPE!

Question 4

Dz of GI:

1. ) 4 ways to obstruct?
2. ) Celiac: What complexes with tTG? Type of lymphos? Related to what lymphoma?
3. ) Whipples: Villi swollen with?
4. ) Infectious: Common in US with contam. food? Worldwide problem with high infectivity and cause pseudo? Typhoid with this? 4 types? implicated by 3rd gen ceph?

Answer 4

1. ) Herniation, volvulus, adhesion, intussusception
2. ) a-glaidin peptide; T cell; EAT
3. ) Macs
4. ) Campylobacter; shigella, salmonella, e.coli, c diff

Question 5

• infectious Disease:
• Who does diarrhea effect? Leading reason for death? Treatment?
• Watery (non-inflamm) occurs where? Inflammatory where?
• Non-inflammatory:
  1. ) Cholera: cAMP? Histology? 3 other symptoms? Treat?
  2. ) Rota: How long? Effects? Vaccine? Route?
  3. ) Noravirus: Virulence? Length? Transmission? Commun?
  4. ) Giardia: Type of organism? Common in what?

Answer 5

• Old/young; Dehydration; Rehydration
• SI; Colon
  1. ) Increase; Fine; Met Acid (lose bicarb), hypoglycemia, hypokalemia; NaCl and glucose
  2. ) Prolonged; Develping world; Live Atten., F-O
  3. ) High; short; F-O; Yes
  4. ) Protozoa; water

Question 6

Inflammatory:
1.) Campylobacter Jejuni: Common?
2.) EHEC: Effects who? Can lead to? (2) Verotoxin binds what?
3.) C. Diff: Almost always? Type of organism? Toxin?
Enteric Fever:
1.) Salmonella Typhi: Type of bacteria? Passed how?

Answer 6

1. ) MOST COMMON for all ages
2. ) HUS and Thromb. throbocytopenic purpura; renal endothelial cells
3. ) Nosocomial; Gram + rod; A/B
4. ) GNR; F-O via food/water

Question 7

• Colonic Polyps:
  a. ) Hyperplastic: Common? Shape? Benign? Location?
  b. ) Adenomatous: Prolif of? Side? 3 steps?
• 3 risk factors?
  1. ) FAP: AD of what gene? Must remove? + Fibromatosis/osteomas? + CNS tumor?
  2. ) HNPCC: Microsattelite? Mutation to what? Side? Leading to?
  3. ) Increased risk of Strep Bovis with?

Answer 7

a. ) Yes; Serrated; Yes; Left colon
b. ) Glands; Right; APC mutation (Chrom 5) –> KRAS forms polyp –> CA = p53 mutation/ Increased COX expression
- Size > 2 cm; sessile; villous
1. ) APC on Chrom 5; Colon/rectum; Gardner; Turcot
2. ) Instability; Mismatch repair; left; Iron defic. anemia
3. ) Carcinomas

Question 8

• Pediatric GI Disease:
• common in both adults and kids? (3)
  1. ) TE fistula: Often related to? (2) H-Type (4%) leads to?
  2. ) Infantile Hyper. Pyloric Stenosis: Presents when? More common in? Vomit type?
  3. ) Meckel Diverticulum: Most common: 2’s? Abnormal remnant of? Histology? Diagnose via?
  4. ) Omphalocele: Due to? Assoc with? (2) Intestines do what? Covering?
  5. ) Gastrothises: Due to? Covering? Assoc with?
  6. ) Intestinal Malrotation: Vomit? Midgut what?

Answer 8

• Celiac, IBD, H. Pylori
  1. ) Cardiac defect/eso achlasia; resp. issues
  2. ) 3 wks; males; non-bilious
  3. ) Yes (2%/ 2 cm/ 2yo); vitalline duct; gastic/panc. tissue; Technetium-99 scan
  4. ) Increased liver size; other mals/incr. maternal age; herniate; peritoneal and amniotic covering
  5. ) Rectus ab wall defect; no amniotic; nothing
  6. ) Billious; volvulus

Question 9

• Pediatric GI Disease:
  7. ) GI Duplication: Cystic or?
  8. ) Intestinal Atresia: Duo common with? Etiology? Poly? Vomit?
  9. ) Imperforate Agenesis: Assoc. with? Seen with?
  10. ) Hirschprungs: Defect in? Can lead to? Treatment? Mutations in?
  11. ) Neonate nectrotizing enterocolitis: Often in?
  12. ) 2 types of esophagitis? Treatments?

Answer 9

7.) Tubular
8.) Downs; ischemic; polyhydraminos; bilious
9.) Fistulas; Physical Exam
10.) ENS ganglion cells; megacolon; resection; RET gene
11.) Premi’s
12.) Reflux = Incomepetent GI sphincter or haital herniation; acid blockade
Allergic= Immine rx; eisino’s; steroids/diet

Question 10

• What causes SM contraction in GI? (2)
• BER? Stomach? Duo? Ileum?
• 3 phases of swallowing? Autonomic after what?
• Stomach storage increases? Not? Motility in stomach?
• Effect of fat in duo? Acid? Hyper/hypotonic?
• Role of gatrin from antrum? (3) Inhibited by? GIP?
• 2 parts of intestinal motility?
• 2 parts of colonic motility?

Answer 10

• ACH/pns
• Basal rate; 3/min; 12/min; 9/min
• Voluntary; pharyngeal; esophageal; past oropharynx
• Volume not pressure; starts slow in body and increases
• CCK to stim panc release and decrease gastric motility; secretin release = bicarb release and decreased molitiliy; slow gastric emptying
• Increase H+, motility and mucosa; somatostatin (SLOW); Insulin release
• Segmentation = BER; MMC b/n meals
• Mass movement (intense/long) and segmentation BER

Question 11

• Reflexive defecation? Occurs when? By what? Gastroileal? Gastrocolic?
• Stomach: Pumps on Lumen side? (3) BL sides? (3) Inside? PPI’s target what?
• 3 seretalogues? H released from? A/G direct effect? Indirect? What do somato/ PG’s do?
• Gastric acid follows what rhythm? Day? Night?
  1. ) Cephalic phase: Caused by? 3 effects?
  2. ) Gastric phase: Caused by effect?
  3. ) Intestinal phase: Caused by? Effect?
• 3 protective mechanisms?
• 3 roles of HCl?
• Swallowing: Supstream? (2) Downstream? (2)

Answer 11

• Relax IS and contract ES; After meal colonic activity; pelvic reflex; stomach activity stim chyme through ileocecal; food in stomach causes mass movement
• From diagram
• Histamine, ACH, gastrin; ECL cells; stim parietal cells; stim Histamine release; inhibit cAMP to shut off parietal
• Circadian; low acid; high
  1. ) High ACH/gastrin/inhibit somatostatin
  2. ) Vasovagal reflex to distend stomach; stim gastrin release
  3. ) AA’s/partially digested peptides; more gastrin
• Goblet cells, mucus, bicarb
• Denature protein, kill bacteria, pepsinogen to pepsin
• ACH/sub p contract; NO/ATP to relax

Question 12

• 3 absorbed sugars? Lactose into? Sucrose? Starches? Enzyme location?
• 3 luminal transports? 2 Blood transports?
• Increased carb consumption =? (2)
• Chief cells secrete? Active at? Cleaves where?
• Endopeptidases?
• Exopeptidases?
• Proteases activated by? This is activated by?
• Proteins absorbed as? (3) FAA cotrans with? D/T with? Which is faster?

Answer 12

• gla, glu, fru; glu/gal; glu/fru; glu/glu; brush borders
• Diagram
• More transporters and more absorption
• Pepsinogen; ph1-3; proteins at aromatic AA’s
• Hyrdolyze AA’s peptide bonds
• Hydrolyze one AA at a time
• Trypsin; enterokinase
• FAA; Di/Tri; Na; H+; Di/Tri

Question 13

• Lipid digestion: Mouth? Stomach? SI? Pancreas?
• Miscelles?
• Chylomicrons?
• Exoctytosed as? Into?
• Jejunum: 2 Lumen transports? 3 Blood?
• Colon: 2 Lumen? 2 Blood?
• Vit D: Intestine as? Liver as? Kidney as?

Answer 13

• Lingual ligase; gastric lipase/CCK to decrease emptying; fat droplet emulsified by bile salts; colipase/lipase
• Transport products of fats
• Resyntehsized in cell
• LDL/HDL; lacteals
• See diagram
• See diagram
• VD3, 25-OH-D3; 1,25-OH-D3