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Small intestine and colon and stomach Flashcards

1
Q

How long does food typically stay in the stomach?

A

3-5 hours

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2
Q

What is secreted into the stomach to absorb vitamin b12

A

Intrinsic factor

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3
Q

What is the purpose of the cardia, fundus and pylorus of the stomach?

A

Cardia: area of lower esophageal sphincter that secretes mucus
Fundus: upper pouchish area that secretes mucus and HCl and pepsin
Pylorus: Lower sphincter that pushes food into intestine

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4
Q

What’s the antrum?

A

The stomach part of the pylorus. The pylorus is just the name of the opening of stomach to small intestine

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5
Q

What allows the stomach to expand in volume?

A

Rugae

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6
Q

How much volume can a stomach hold?

A

1.5 gallons

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7
Q

How deep are the gastric glands in the antrum? the fundus? the cardia?

A

Most shallow in antrum and deepest in fundus

Cardia is intermediate

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8
Q

What are the gastric glands and what do they secrete?

A

Surface mucus cells: mucus and bicarb
Mucus neck cells: mucus
Parietal cells: Requires gastrin to be activated
Secretes HCl and intrinsic factor
Chief cells: Pepsinogen
Endocrine cells: G cells (increase gastrin) and D cells (decreases gastrin)

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9
Q

What is the pathophysiology for gastric ulcers?

A

Mucosal defects in stomach and early small intestine - recurrent ulcers

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10
Q

Symptoms of gastric ulcer?

A

Dull, gnawing pain
Blood in GI - Melena, Hematemesis, Guaiac (+) stools
Anemia

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11
Q

Predilection of gastric ulcers?

A

Slight predilection to men

15-65. P much all ages

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12
Q

Causes of gastric ulcers?

A

H pylori
Most people have it but only 10-15% get ulcers
NSAIDs/Aspirin
Damage surface cells - less mucus and bicarb produced

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13
Q

Tests for gastric ulcers?

A

H pylori serum antibody test
Urea breath test
Stool antigen test
Endoscopy most definitive

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14
Q

Treatment for gastric ulcers?

A

Triple therapy: PPI + clarithromycin + metronidazole
Stop NSAIDs/aspirin: if can’t add PPI or misoprostol
If severe bleeding: endoscopic hemostasis

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15
Q

Complications of gastric ulcers?

A

Bleeds, Perforations, edema that can lead to obstruction

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16
Q

Describe stress gastritis

A

Superficial nonulcerating lesions in stomach

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17
Q

What can cause stress gastritis?

A

Trauma, shock, sepsis, respiratory failure

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18
Q

Does stress gastritis typically cause bloody stools?

A

No, it’s just a focal lesion, but if it erodes deeper to submucosa, it could be a frank bleed

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19
Q

Pathophysiology of stress gastritis?

A

Stress = decreased gastric defense = decreased blood flow to area = decreased HCl and bicarb
OR could be an too much gastric acid in body

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20
Q

How do you treat stress gastritis?

A

Treat underlying cause and keep pH over 5

If becomes frank bleed of more than 6 units or if it’s recurrent, do surgery

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21
Q

What’s the 2nd leading cause of death in the US?

A

Gastric cancer

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22
Q

Predilection for gastric cancer?

A

Asians and S. Americans over 50

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23
Q

Risks of gastric cancer?

A

High nitrate foods (meats and fish)
Smoking and alcohol
Polyps, atrophy or gastritis of stomach

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24
Q

Symptoms of gastric cancer?

A

Typical cancer symptoms
Heart burn and anemia
Stomach pain and swelling
Full after small meals

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25
Workup for gastric cancer?
Endoscopic ultrasound | CT/MRI/PET scan
26
Prognosis for gastric cancer
20% survival rate (obviously better if found early)
27
What are the parts of the small intestine called starting at the stomach?
DJ Ill! Duodenum Jejunum Ileum
28
What's the function of the small intestine
Absorb nutrients from chyme from stomach
29
What enzyme digests carbs?
Amylase: mouth and pancreas | Other enzymes from small intestine
30
What enzyme digests proteins?
Pepsin (chief cells) and trypsin (as trypsinogen from pancreas)
31
What enzyme digests fats?
Bile from liver and lipase
32
What happens to carbs before they're digested?
Broken into mostly glucose, but also fructose and galactose
33
Where are proteins mostly absorbed?
Jejunum
34
Where are fats absorbed?
Small intestine in general
35
What else does the small intestine absorb?
Water, electrolytes, vitamins
36
What disease is a result of T cells reacting to proline and glutamine in food?
Celiac's
37
Predilection for Celiac's?
Adult white female with thyroid problems or DMI | More likely to get it if exposed at early age
38
Symptoms of Celiac's?
Asymptomatic | Greasy, smelly pale poops
39
Pathophysiology of Celiac's?
Person eats gluten, broken down into proline and glutamate. T cells activated, cytokines released and mucosal membranes are damaged
40
What lab tests would you do for Celiac's?
anti-tTGA (tissue transglutiminase) IgA test HLA-DR2 gene test Most definitive: Biopsy and try stopping gluten for a while
41
How do you treat Celiac's? How to do you ensure patient compliance?
Stop eating gluten and make sure not malnourished | Do anti-tTGA test to ensure compliance
42
How long does it take for mucous membranes to recover from Celiac's?
6 - 24 months
43
What is gluten?
Proline and glutamine
44
What were the tests for Celiac's again?
anti tTGA HLA DR2 Biopsy/try to stop eating gluten (Definitive)
45
What is another name for gastrinoma?
Zollinger Ellison syndrome
46
Epidemiology of Gastrinoma?
Middle aged white males with MEN1 gene
47
Symptoms of gastrinoma
Heart burn, abdominal pain and diarrhea
48
Pathophysiology of gastrinoma?
Tumor occurs in gastrinoma triangle (Gall bladder, pancreas and s. intestine) that secretes gastrin. Gastrin activates parietal cells to release HCl and intrinsic factor. Too much HCl = more ulcers and small intestine
49
How would you work up a gastrinoma?
Endoscopy, MRI, CT, ultrasound to view it Determine [HCl] in body less than 100pg/mL normal Greater than 1000pg/mL = danger
50
Treatment for gastrinoma?
Remove gastrinoma | PPI, Somatostatin analog of D cells (decreases gastrin)
51
Prognosis for gastrinoma?
No metastases: 90% 5 year survival | Metastases to liver: 20% 5 year survival
52
What do gut bacteria synthesize in the large intestine?
Vitamins B and K
53
What is the role of the large intestine?
Water and electrolyte absorption (Na, K, CL)
54
List the parts of the small intestine as it leaves the small intestine
Cecum, Ascending, Transverse, Descending, Sigmoid
55
What's irritable bowel syndrome and how long does it typically last?
Tummy pain linked with bowel function. Usually lasts about 6 months
56
What relieves pain associated with IBS?
Pooping
57
Epidemiology of IBS?
Ladies 20-40 years old. About 15% population affected
58
What tests can you run for IBS?
No direct tests. Just rule out other diseases
59
Pathogenesis of IBS?
Increased colon motility after meals Increased pain sensitivity upon gut stimulation Stomach flu
60
Risk factors for IBS?
Psych issues, abuse
61
Treatment of IBS?
Fix poops with antidiarrheals, laxatives or suppositories Antidepressants and psychotherapy Change diet and add fiber
62
Prognosis of IBS?
Chronic and relapsing but greater than 60% respond to Tx
63
What're the types of IBD?
Ulcerative colitis | Crohn's
64
Similarities between ulcerative colitis and Crohn's?
Idiopathic Increase number of poops Decrease poop consistency results in weight loss
65
What are some very general differences between ulcerative colitis and Crohn's?
Crohn's: Rt lower abdominal pain, Discontinuous, May include ileum, Pain Ulcerative colitis: Lt lower abdominal pain, continuous, never includes ileum, blood
66
How does Crohn's affect the structure of the colon?
Very inflamed and cobblestoney. Can affect anything from esophagus to colon
67
How does Ulcerative colitis affect the structure of the colon?
Many ulcers. Results in pseudopolyps and can also result in bleeding. Inflam starts at anus and goes up. Also have crypt distortions (cell type)
68
What are other systemic manifestations that can occur with IBD?
1/3 of people with IBD also have systemic manifestations Eyes: Episcleritis and uveitis Skin: Erythema and gangrene Joints: Peripheral arthritis and ankylosing spondylitis
69
How do you diagnose IBD?
Imaging with sigmoid, capsule, colon, or double balloon endoscopy (Double balloon is colon to small intestine) Can also do CT with contrast* and MRI
70
How do you treat IBD?
Antiinflammatories: Corticosteroids and tesalazine If Crohn's, may also need surgery Colectomy. If Ulcerative colitis may need ileal pouch-anal anastomoses Resection of inflamed tissue (usually ileum) for Crohn's
71
What's a diverticula?
Outpouching of large intestine wall
72
Who is more prone to diverticula? | Less prone?
Older males. Vegetarians are less prone
73
What is the cause of diverticulitis?
When diverticula gets filled with poop, causing inflammation and microperforation
74
Symptoms of diverticulitis?
Nausea, vomitting, diarrhea and constipation as well as abdomen pain
75
How would you diagnose diverticulitis
Health Hx and Imaging via CT and ultrasound
76
How do you treat diverticulitis with no perforation?
Antibiotics and liquid diet
77
How do you treat diverticulitis with perforation?
Rest colon, antibiotics and hospitalization for surgery
78
Prevalence of colorectal cancer?
2nd most common cancer. Seen in men over 50
79
Risk factors of colorectal cancer?
FHx, High fat, low fiber diet, sedentary lifestyle
80
Symptoms of colorectal cancer?
Abdominal pain, fecal impacting/obstruction, bleeding, constipation and tiny poops
81
At what age should you get screened for colorectal cancer? How often should you get one?
50 years old Sigmoidoscopy: 3-5 years Colonoscopy: 10 years
82
Compare and contrast sigmoidoscopy and colonoscopy.
Sigmoidoscopy may miss 50% of lesions. Best done with fecal occult blood test. Patient NOT sedated Colonoscopy much better. Sees entire colon and can biopsy and remove polyps. Patient sedated
83
How would you treat colorectal cancer?
Colon resection, prophylactically remove polyps
84
What's the hallmark sign of Gardner's syndrome?
Many many many (a garden of) polyps in large intestine
85
What is Gardner's syndrome?
Subtype of FAP (familial adenomatous polyposis)
86
What hereditary pattern is Gardner's?
Autosomal dominant (APC) or autosomal recessive (MYH)
87
When should a child be screened for Gardner's? | When should they get genetic testing?
Screened at 12 yo | Genetic testing at 10yo
88
How would you treat Gardner's?
Resection
89
What may we notice in a patient with Gardner's? What could we do if we notice this sign?
CHRPEs (AKA POFLs or Bear tracks) | Refer to PCP

Systemic Final (8 decks)

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