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Systemic Final > Small intestine and colon and stomach > Flashcards

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
Q

Workup for gastric cancer?

A

Endoscopic ultrasound

CT/MRI/PET scan

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26
Q

Prognosis for gastric cancer

A

20% survival rate (obviously better if found early)

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27
Q

What are the parts of the small intestine called starting at the stomach?

A

DJ Ill!
Duodenum
Jejunum
Ileum

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28
Q

What’s the function of the small intestine

A

Absorb nutrients from chyme from stomach

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29
Q

What enzyme digests carbs?

A

Amylase: mouth and pancreas

Other enzymes from small intestine

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30
Q

What enzyme digests proteins?

A

Pepsin (chief cells) and trypsin (as trypsinogen from pancreas)

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31
Q

What enzyme digests fats?

A

Bile from liver and lipase

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32
Q

What happens to carbs before they’re digested?

A

Broken into mostly glucose, but also fructose and galactose

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33
Q

Where are proteins mostly absorbed?

A

Jejunum

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34
Q

Where are fats absorbed?

A

Small intestine in general

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35
Q

What else does the small intestine absorb?

A

Water, electrolytes, vitamins

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36
Q

What disease is a result of T cells reacting to proline and glutamine in food?

A

Celiac’s

37
Q

Predilection for Celiac’s?

A

Adult white female with thyroid problems or DMI

More likely to get it if exposed at early age

38
Q

Symptoms of Celiac’s?

A

Asymptomatic

Greasy, smelly pale poops

39
Q

Pathophysiology of Celiac’s?

A

Person eats gluten, broken down into proline and glutamate. T cells activated, cytokines released and mucosal membranes are damaged

40
Q

What lab tests would you do for Celiac’s?

A

anti-tTGA (tissue transglutiminase) IgA test
HLA-DR2 gene test
Most definitive: Biopsy and try stopping gluten for a while

41
Q

How do you treat Celiac’s? How to do you ensure patient compliance?

A

Stop eating gluten and make sure not malnourished

Do anti-tTGA test to ensure compliance

42
Q

How long does it take for mucous membranes to recover from Celiac’s?

A

6 - 24 months

43
Q

What is gluten?

A

Proline and glutamine

44
Q

What were the tests for Celiac’s again?

A

anti tTGA
HLA DR2
Biopsy/try to stop eating gluten (Definitive)

45
Q

What is another name for gastrinoma?

A

Zollinger Ellison syndrome

46
Q

Epidemiology of Gastrinoma?

A

Middle aged white males with MEN1 gene

47
Q

Symptoms of gastrinoma

A

Heart burn, abdominal pain and diarrhea

48
Q

Pathophysiology of gastrinoma?

A

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
Q

How would you work up a gastrinoma?

A

Endoscopy, MRI, CT, ultrasound to view it
Determine [HCl] in body
less than 100pg/mL normal
Greater than 1000pg/mL = danger

50
Q

Treatment for gastrinoma?

A

Remove gastrinoma

PPI, Somatostatin analog of D cells (decreases gastrin)

51
Q

Prognosis for gastrinoma?

A

No metastases: 90% 5 year survival

Metastases to liver: 20% 5 year survival

52
Q

What do gut bacteria synthesize in the large intestine?

A

Vitamins B and K

53
Q

What is the role of the large intestine?

A

Water and electrolyte absorption (Na, K, CL)

54
Q

List the parts of the small intestine as it leaves the small intestine

A

Cecum, Ascending, Transverse, Descending, Sigmoid

55
Q

What’s irritable bowel syndrome and how long does it typically last?

A

Tummy pain linked with bowel function. Usually lasts about 6 months

56
Q

What relieves pain associated with IBS?

A

Pooping

57
Q

Epidemiology of IBS?

A

Ladies 20-40 years old. About 15% population affected

58
Q

What tests can you run for IBS?

A

No direct tests. Just rule out other diseases

59
Q

Pathogenesis of IBS?

A

Increased colon motility after meals
Increased pain sensitivity upon gut stimulation
Stomach flu

60
Q

Risk factors for IBS?

A

Psych issues, abuse

61
Q

Treatment of IBS?

A

Fix poops with antidiarrheals, laxatives or suppositories
Antidepressants and psychotherapy
Change diet and add fiber

62
Q

Prognosis of IBS?

A

Chronic and relapsing but greater than 60% respond to Tx

63
Q

What’re the types of IBD?

A

Ulcerative colitis

Crohn’s

64
Q

Similarities between ulcerative colitis and Crohn’s?

A

Idiopathic
Increase number of poops
Decrease poop consistency
results in weight loss

65
Q

What are some very general differences between ulcerative colitis and Crohn’s?

A

Crohn’s: Rt lower abdominal pain, Discontinuous, May include ileum, Pain

Ulcerative colitis: Lt lower abdominal pain, continuous, never includes ileum, blood

66
Q

How does Crohn’s affect the structure of the colon?

A

Very inflamed and cobblestoney. Can affect anything from esophagus to colon

67
Q

How does Ulcerative colitis affect the structure of the colon?

A

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
Q

What are other systemic manifestations that can occur with IBD?

A

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
Q

How do you diagnose IBD?

A

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
Q

How do you treat IBD?

A

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
Q

What’s a diverticula?

A

Outpouching of large intestine wall

72
Q

Who is more prone to diverticula?

Less prone?

A

Older males. Vegetarians are less prone

73
Q

What is the cause of diverticulitis?

A

When diverticula gets filled with poop, causing inflammation and microperforation

74
Q

Symptoms of diverticulitis?

A

Nausea, vomitting, diarrhea and constipation as well as abdomen pain

75
Q

How would you diagnose diverticulitis

A

Health Hx and Imaging via CT and ultrasound

76
Q

How do you treat diverticulitis with no perforation?

A

Antibiotics and liquid diet

77
Q

How do you treat diverticulitis with perforation?

A

Rest colon, antibiotics and hospitalization for surgery

78
Q

Prevalence of colorectal cancer?

A

2nd most common cancer. Seen in men over 50

79
Q

Risk factors of colorectal cancer?

A

FHx, High fat, low fiber diet, sedentary lifestyle

80
Q

Symptoms of colorectal cancer?

A

Abdominal pain, fecal impacting/obstruction, bleeding, constipation and tiny poops

81
Q

At what age should you get screened for colorectal cancer? How often should you get one?

A

50 years old
Sigmoidoscopy: 3-5 years
Colonoscopy: 10 years

82
Q

Compare and contrast sigmoidoscopy and colonoscopy.

A

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
Q

How would you treat colorectal cancer?

A

Colon resection, prophylactically remove polyps

84
Q

What’s the hallmark sign of Gardner’s syndrome?

A

Many many many (a garden of) polyps in large intestine

85
Q

What is Gardner’s syndrome?

A

Subtype of FAP (familial adenomatous polyposis)

86
Q

What hereditary pattern is Gardner’s?

A

Autosomal dominant (APC) or autosomal recessive (MYH)

87
Q

When should a child be screened for Gardner’s?

When should they get genetic testing?

A

Screened at 12 yo

Genetic testing at 10yo

88
Q

How would you treat Gardner’s?

A

Resection

89
Q

What may we notice in a patient with Gardner’s? What could we do if we notice this sign?

A

CHRPEs (AKA POFLs or Bear tracks)

Refer to PCP

Systemic Final (8 decks)

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