Systemic Diseases and The GI Tract Flashcards
What is the cause of gastroparesis in diabetes, and how is it tested?
Autonomic neuropathy
-> Measured via gastric emptying study, where a radiolabelled meal is consumed, and time to be released from the stomach is measured via radiosignature
What are the complications of gastroparesis in diabetes? General treatment? Why is glycemic control important?
Bezoars - like hairballs, concretions of vegetable matter which build up in stomach and cannot be moved
Malnutrition and poor glycemic control may result
Treatment: Prokinetics, better glycemic control (also controls ischemia to bile and overgrowth of Candidiasis in esophagus)
What causes intestinal diarrhea in diabetes and what are the consequences?
Loss of sympathetic tone -> unopposed cholinergic tone leading to secretion
Stasis can lead to bacterial overgrowth -> bile salt deconjugation and fat malabsorption, further causing diarrhea
What is the treatment for intestinal stasis with bacterial overgrowth in diabetes?
Antibiotics like rifaximin to clear the gut bacteria, vitamin and nutrient replacement
How does diabetes cause fecal incontinence and how is it a real problem?
Sympathetic denervation of the smooth muscle in the IAS leads to required voluntary contraction by EAS striated muscle to maintain continence
-> causes problems at night where you shit yourself because you aren’t awake to think about your need to contract EAS
How is anal sphincter tone measured? What will be the diabetes abnormality?
Ano-rectal manometry studies
-> inflate balloon in rectum, the IAS should relax and the EAS will contract in normal patients
Diabetics have decreased resting IAS tone
What liver disease is seen in diabetes?
Steatohepatitis -> fibrosis & cirrhosis
With accumulation of Mallory-Denk hyaline like in alcoholic hepatitis
How does thyroid disease contribute to GI symptoms?
Hypothyroid - slows everything down, constipation
Hyperthyroid - speeds everything up -> increased stool frequency = diarrhea
What GI manifestations does hyperparathyroidism and its associated hypercalcemia cause?
Constipation or diarrhea
Calcium stimulates gastrin -> Hypergastrinemia -> peptic ulcer disease + diarrhea
Calcium stimulates pancreas -> pancreatitis
Note: ZE syndrome (gastrinoma) associated with parathyroid adenoma
What are the GI manifestations of renal failure?
Angiodysplasias everywhere (unknown why) -> bleeds and subsequent iron deficiency anemia
Pancreatitis and “nephrogenic ascites” - assocatied with renal failure, reason unknown
Duodenal polyps - hypertrophy of Brunner’s glands, reasons unknown
What symptoms do each of the following drugs cause?:
- Calcium channel blockers (Non-DHP)
- Magnesium
- Aluminum (i.e. hydroxide)
- Ca channel blockers i.e. verapamil - cause constipation (clogged toilet in sketchy)
- Magnesium - near osmotic laxatives in sketchy (Must Go to bathroom)
- Aluminimum amount of feces - constipation
What two drugs are especially associated with esophageal ulcers?
Doxycycline
Bisphosphonates
What are the manifestations of GI symptoms in scleroderma similar to? Include the ano-rectal manometry result?
Very similar to diabetes, with lots of stasis and dysmotility
Neuropathies in the condition -> complete loss of LES and IAS tone
-> worse fecal incontinence than diabetes with no maintenance of IAS tone, severe GERD from loss of LES tone
What are the important manifestations of autoimmune diseases like SLE, RA, and polyarteritis nodosa in the GI tract?
Pancreatitis - think of the “A” in the I GET SMASHED mnemonic
Acalculous cholecystitis - inflammation and hypoperfusion leads to cholecystitis without stones
What does amyloidosis of the GI tract cause?
Malabsorption, cholestatic liver disease, motility disorders, and GI blood loss due to malabsorption
What are the GI manifestations of polymyositis and dermatomyositis? Include the ano-rectal findings?
Striated muscle weakness
- > loss of UES / upper esophagus function
- oropharyngeal dysphagia
- > loss of EAS
- severe fecal incontinence
What are the biggest causers of problems in GI tract of in uncontrolled HIV?
Esophagus - Candidate, CMV, HSV
Stomach - CMV
Small intestine - Mycobacterium avium complex, TB (miliary), Cryptosporidium, CMV
Colon - CMV
What GI problems does Schistosomiasis cause?
Colitis / Proctitis from egg deposition and granuloma formation in mucosa / submucosa
Hepatic fibrosis - eggs washed into portal flow, hepatic granulomas and fibrosis in pre-hepatic sinusoidal space. Causes portal hypertension
What are the GI symptoms of Graft-versus-Host disease?
Bleeding, diarrhea, malabsorption, protein-losing enteropathy
In liver: “vanishing bile duct” syndrome -> cholestasis / jaundice
What are the most common GI problems of pregnancy?
Nausea / vomiting - hyperemesis gravida
GERD / heartburn - estrogen and progesterone cause LES dysfunction, and increased intraabdominal pressure allow acid to leak thru LES
What is the fulminant liver disease of pregnancy and what is seen on liver pathology?
Acute fatty liver of pregnancy -> relieved by delivering child
MICROvesicular fatty change
What GI tract anomaly is seen more commonly in aging and is also seen in renal failure?
GI tract angiodysplasis
How does stomach acid and motility change with age?
Acid - goes down (hypo/achlorhydria), but usually causes few problems
Motility - decreases
