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Patho II > The Gastrointestinal Tract > Flashcards

The Gastrointestinal Tract Flashcards

1
Q

What is the function of the GI Tract?

A

consumes, digests, and eliminates food

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2
Q

What does the Upper Division contain?

A

Oral Cavity
Pharynx
Esophagus
Stomach

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3
Q

What is the function of the upper division of the GI tract?

A

helps with food consumption

Start of chemical digestion

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4
Q

What does the Lower Division contain?

A

Small Intestine
Large Intestine
Anus

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5
Q

What is the function of the lower division of the GI tract?

A

absorption of nutrients

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6
Q

What does the Hepatobiliary System contain?

A

Liver
Gallbladder
Pancreas

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7
Q

What is the function of the hepatobiliary system of the GI tract?

A

accessory system that secreted digestive enzymes

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8
Q

What are the 4 layers of the GI wall?

A

Mucosa
Submucosa
Muscle
Serosa

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9
Q

What is the function of the peritoneum?

A

large serous membrane that lines the abdominal cavity

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10
Q

What layer is the parietal peritoneum?

A

outer layer

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11
Q

What layer is the visceral peritoneum?

A

inner layer

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12
Q

What is the peritoneal cavity?

A

space between the two layers

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13
Q

What is the function of the mesentery?

A

double layer of peritoneum containing blood vessels and nerves that supplies the intestinal wall

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14
Q

What is the epithelium?

A

most exposed part of the mucosa

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15
Q

What is the epithelium composed of?

A

simple columnar epithelium or stratified squamous epithelium

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16
Q

What cells can be found within the epithelium?

A

Goblet cells

Endocrine cells

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17
Q

What is the function of Goblet cells?

A

Secrete mucus

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18
Q

What is the function of Endocrine cells?

A

secrete hormones into blood

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19
Q

What does the lamina Propia contain?

A

Myofibroblasts
Blood Vessels
Nerves
Immune Cells

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20
Q

What is the muscularis mucosa?

A

Layer of smooth muscle

Helps with continued peristalsis

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21
Q

What layers are found within the Mucosa?

A

Epithelium
Lamina Propia
Muscularis Mucosa

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22
Q

What layers are found within the Submucosa?

A

Major Blood and lympathics vessels
Submucosal plexus
Elastic fibers with collagen

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23
Q

What layers are found within the Muscularis externa?

A

Circular Muscle
Myenteric Plexus
Longitudinal Muscle

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24
Q

What is the other name for the submucous plexus?

A

Meissner’s plexus

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25
Q

What is the function of the submucosa layer of the GI wall?

A

stretches with increased capacity

Maintains shape of the intestine

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26
Q

What is the function of the Muscular layer of the GI wall?

A

Continued Peristalsis

Movement of digested material out of and along the gut

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27
Q

What is the other name for the Myenteric Plexus?

A

Auerbach’s plexus

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28
Q

What is the serosa?

A

A serous membrane that covers the muscularis externa of the digestive tract in the peritoneal cavity

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29
Q

What is swallowing coordinated by?

A

Medulla swallowing center

Cranial Nerves V, IX, X, and XII

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30
Q

What do salivary glands secrete?

A

Bicarbonate

Salivary Lipase

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31
Q

What does the Stomach secrete?

A 
Hydrochloric Acid
Pepsin
Gastric Lipase
Intrinsic Factor
Mucus
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32
Q

What is the action of bicarbonate?

A

moistens food

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33
Q

What is the action of salivary lipase?

A

digests food

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34
Q

What is the action of hydrochloric acid?

A

kills bacteria

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35
Q

What is the action of pepsin?

A

digests protein

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36
Q

What is the action of Gastric lipase?

A

Digests fat

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37
Q

What is the action of intrinsic factor?

A

Aids in vit. B12 absorption

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38
Q

What is the action of mucus?

A

protects the stomach lining

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39
Q

What is Agenesis?

A

the complete absence of the esophagus

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40
Q

What is Atresia?

A

incomplete development of the esophagus

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41
Q

What is more common: Agenesis or Atresia?

A

Atresia

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42
Q

Where does atresia occur most commonly?

A

at or near the tracheal bifurcation sometimes with a fistula

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43
Q

What is atresia usually associated with?

A

Congenital heart defects
Genitourinary Malformations
Neurologic Disease

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44
Q

When is atresia usually discovered?

A

shortly after birth when the baby regurgitates during feeding

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45
Q

What can atresia lead to?

A

Aspiration
Suffocation
Pneumonia
Severe fluid and Electrolyte imbalances

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46
Q

What is acquired stenosis?

A

inflammatory scarring

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47
Q

What can cause acquired stenosis?

A

GERD
Irradiation
Systemic Sclerosis
Caustic Injury

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48
Q

What is a Diaphragmatic Hernia?

A

Incomplete formation of the diaphragm allows the abdominal viscera to herniate into the thoracic cavity

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49
Q

What is Omphalocele?

A

Occurs when closure of the abdominal musculature is incomplete and the abdominal viscera herniates into a ventral membranous sac

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50
Q

What is Meckel’s Diverticulum?

A

True Diverticulum

Blind outpouching of the alimentary tract that communicates with the lumen

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51
Q

What causes Meckel’s Diverticulum?

A

Failed involution of the vitelline duct

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52
Q

What is the Vitelline duct and when is it normally supposed to disappear?

A

connects yolk sac to developing GI tract

after 9 weeks of gestation

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53
Q

What may also be present with Meckel’s Diverticulum?

A

Ectopic Pancreatic or gastric tissue

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54
Q

What are the classical Symptoms of Meckel’s Diverticulum?

A

Occult Bleeding = Bright red bleeding per rectum (BRBPR)

Abdominal pain resembling acute appendicitis or obstruction

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55
Q

What is the rule for Meckel’s Diverticulum and what does it mean?

A

Rule of 2s

Occurs in 2% of population
Present within 2 ft. of ileocecal valve
approx. 2 inches long
2X as common in men
Symptomatic by age 2
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56
Q

What is pyloric stenosis?

A

Narrowing of pyloric areas of the stomach

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57
Q

What is pyloric stenosis caused by?

A

hyperplasia of pyloric muscularis externa which obstructs the gastric outflow tract

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58
Q

Who is pyloric stenosis more common in?

A

3-5X more common in males

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59
Q

How many live births does it occur in?

A

1 in 300-900

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60
Q

Who are at an increases risk of developing pyloric stenosis?

A 
Monozygotic twins
Dizygotic twins
Siblings
Turner Syndrome
Trisomy 18
Exposure to erythromycin or azithromycin
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61
Q

When and what does pyloric stenosis present as?

A

3-6 weeks of life

New-onset regurgitation
Projectile, non-bilious vomiting after feeding
Frequent demands for re-feeding

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62
Q

What may aggravate pyloric stenosis?

A

Edema

Inflammatory Changes in mucosa and submucosa

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63
Q

What is the acquired form of pyloric stenosis?

A

Antral Gastritis

Peptic Ulcers close to pylorus

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64
Q

What causes Hirschsprung Disease?

A

Failure of migration of neural crest cells

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65
Q

What do neural crest cells form?

A

form the plexuses of the GI tract

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66
Q

Who is most at risk of developing Hirschsprung disease and how many live births does it occur in?

A

1 in 5000 births

Those with Down Syndrome

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67
Q

What does Hirschspring disease present with?

A

Failure to pass meconium in immediate postnatal period

No secretions or peristalsis of GI tract

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68
Q

What is the most important clinical feature of Hirschsprung disease?

A

Congenital Aganglionic MegaColon

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69
Q

What are the major threats of Hirschsprung Disease?

A

Enterocolitis
Fluid and Electrolyte Imbalances
Perforation
Peritonitis

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70
Q

What causes Achalasia?

A

Decreased Nitric Oxide and Vasoactive Intestinal Peptide

Increased Acetylcholine

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71
Q

What is Achalasia?

A

Increased tone of the lower esophageal sphincter

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72
Q

What are the symptoms of Achalasia?

A 
Dysphagia for solids and liquids
Difficulty in Belching
Regurgitation
Chest Pain
Weight Loss
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73
Q

What is primary achalasia caused by?

A

Ganglion cell degeneration

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74
Q

What is secondary achalasia caused by?

A

Chagas Disease
Diabetic Neuropathy
Infiltrative Disorders (malignancy, amyloidosis, or sarcoidosis)
Lesions of dorsal motor nuclei (polio, surgical ablation)

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75
Q

What is secondary achalasia associated with?

A

Down syndrome
Alacrima
Adrenal insufficiency

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76
Q

What is esophagitis?

A

Inflammation of the esophagus

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77
Q

What is hematemesis?

A

vomiting of blood

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78
Q

What are the esophageal causes of Hematemesis?

A 
Lacerations (Mallory-Weiss Syndrome)
Esophageal Perforation (cancer)
Varices (cirrhosis)
Reflux Esophagitis (erosive)
Esophageal ulcers
Barrett esophagus
Adenocarcinoma
Squamous cell carcinoma
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79
Q

What is Reflux Esophagitis?

A

reflux of gastric contents into the lower esophagus

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80
Q

What is reflux esophagitis caused by?

A

Loose tone of lower esophageal sphincter

Increased Abdominal Pressure

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81
Q

What is the other name for reflux esophagitis?

A

GERD

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82
Q

What covers the tract from the mouth to the end of the esophagus?

A

stratified squamous epithelia

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83
Q

What covers the tract from the stomach to the anus?

A

ciliated columnar epithelium

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84
Q

What is the function of the ciliated columnar epithelium?

A

to protect that area from acid erosion

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85
Q

What causes increased abdominal pressure?

A 
Alcohol/Tobacco
Obesity
CNS depressants
Pregnancy
Hiatal hernia
Decreased gastric empyting
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86
Q

What is decreased gastric emptying called?

A

gastropiesis (sp?)

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87
Q

What are the clinical features of Reflux Esophagitis?

A

Heartburn
Dysphagia
Regurgitation of sour-tasting gastric contents

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88
Q

What are the complications of Reflux Esophagitus?

A 
Ulceration
Blood vomiting
Melena
Stricture development
Barrett Esophagus
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89
Q

What is melena?

A

blood in stool

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90
Q

What are esophageal varices?

A

Abnormal dilation of the veins at the junction between the portal and systemic venous systems

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91
Q

What causes esophageal varices?

A

portal hypertension

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92
Q

Who are esophageal varices most present in?

A

nearly half of patients with cirrhosis

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93
Q

What is the concern with esophageal varices?

A

bleeding

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94
Q

What is Barrett Esophagus?

A

complication of chronic GERD characterized by intestinal metaplasia

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95
Q

What is the intestinal metaplasia that occurs in Barrett esophagus?

A

replacement of normal stratified squamous epithelium lining to simple columnar epithelium with goblet cells

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96
Q

What patients is Barrett esophagus most common in?

A

white males 40-60 yrs. old

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97
Q

What are patients with Barrett esophagus at an increased risk of having?

A

Esophageal adenocarcinoma

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98
Q

How is Barrett esophagus identified?

A

By endoscopy and biopsy

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99
Q

What is the 7th leading cause of cancer deaths?

A

Esophageal tumors

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100
Q

What are the two most common types of esophageal cancer?

A

Squamous cell carcinoma

Adenocarcinoma

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101
Q

Where does squamous cell carcinoma usually occur?

A

middle 3rd of esophagus

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102
Q

Where does adenocarcinoma usually occur?

A

lower 3rd of esophagus

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103
Q

Which esophageal cancer is most common in the US?

A

Adenocarcinoma

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104
Q

Which esophageal cancer is most common worldwide?

A

Squamous cell carcinoma

105
Q

What are the risk factors for Squamous Cell carcinoma?

A 
Alcohol and Tobacco use 
Caustic esophageal injury
Achalasia
Tylosis
Plummer-Vinson syndrome
Diet deficient in fruits and veggies
Very hot beverages
Genetic abnormalities in p53 and EGFR
106
Q

What are the risk factors for Adenocarcinoma?

A 
Barrett esophagus
GERD
Hiatal hernia
Obesity
Smoking
Increased acid exposure - Zollinger ellison syndrome
107
Q

What is Zollinger Ellison syndrome?

A

multiple gastrinomas

108
Q

What are the Clinical Features of Esophageal Tumors?

A 
Dysphagia
Odynophagia
Progressively increasing obstruction
Prominent weight loss and debilitation
Hemorrhage and sepsis
109
Q

What is the 5 year survival rate of esophageal tumors?

A

<25%

110
Q

What are the four major regions of the stomach?

A

Cardia
Fundus
Body
Antrum

111
Q

What are the cardia and antrum lined by?

A

mucin secreting foveolar cells that form small glands

112
Q

What do the antral glands contain?

A

G cells

113
Q

What is the function of G cells?

A

release gastrin to stimulate parietal cells

114
Q

What is the function of parietal cells?

A

secrete luminal acid

115
Q

Where are parietal cells located?

A

Gastric fundus and body

116
Q

What else does the gastric fundus and body contain?

A

chief cells

117
Q

What is the function of chief cells?

A

produce and secrete digestive enzymes like pepsin

118
Q

What is acute gastritis?

A

Inflammation of gastric mucosa

Diverse set of disorders marked by gastric injury or dysfunction

119
Q

What are the causes of gastritis?

A 
NSAIDs
Alcohol
Bile
Stress Induced INjury
Acute Mucosal Erosion or Hemorrhage - Curling Ulcers or portal hypertension
120
Q

What are the asymptomatic symptoms of Gastritis?

A

variable degrees of:
Epigastric pain
Nausea
Vomiting

121
Q

What are the severe symptoms of Gastritis?

A 
Mucosal Erosion
Ulceration
Hemorrhage
Hematemesis
Melena
Massive Blood Loss is rare
122
Q

What do the crypts of leiberkahn contain?

A

stem cells

Paneth cells

123
Q

What is the pathogenesis behind gastritis?

A

loss of protective mechanism

124
Q

What is the pathogenesis of NSAID causes of gastritis?

A

Decrease in COX causing decrease in PGE2/I2 causing decreased mucosal protection

125
Q

What is the pathogenesis of H. pylori causes of gastritis?

A

decreased hydrochloric acid

126
Q

What is the pathogenesis of chemicals, alcohol, and radiation causes of gastritis?

A

direct epithelial injury

127
Q

What is the pathogenesis of chemotherapy as the cause of gastritis?

A

decreased epithelial regeneration

128
Q

What is the most common cause of Chronic gastritis?

A

H. pylori infection

129
Q

What is the most common cause of non H. pylori chronic gastritis?

A

Autoimmune diseases

130
Q

What does chronic gastritis normally present as?

A

antral gastritis with normal or increased acid production

131
Q

How does H. pylori survice the harsh acidic conditions of the stomach?

A

By producing urease

132
Q

What is the function of urease and how does it help the h. pylori?

A

It neutralizes stomach acid by reacting with urea to form ammonia which is toxic to human cells and causes an overproduction of stomach acid

133
Q

What are the virulence factors of H. Pylori?

A 
Flagella
Urease
LPS and Outer proteins
Exotoxins
Secretory enzymes
Effectors
Type IV secretion system
134
Q

What is the function of the LPS and outer proteins?

A

adheres to host cells and inflammation

135
Q

What are the secretory enzymes released by H. pylori?

A

Mucinase
Protease
Lipase

136
Q

What is Peptic Ulcer Disease?

A

Deep lesion in mucosa of stomach or duodenem

137
Q

What is peptic ulcer disease a complication of?

A

chronic gastritis

138
Q

What is peptic ulcer disease most commonly associated with?

A

H. pylori infection
NSAIDs
Cigarette smoking

139
Q

What are the clinical features of peptic ulcer disease?

A 
Epigastric burning
Iron Deficiency anemia
Hemorrhage
Perforation
Nausea/Vomiting
Bloating
Belching
Significant Weight Loss
140
Q

What are complications of peptic ulcer disease?

A

Bleeding
Perforation
Obstruction

141
Q

What causes antral gastritis?

A

H. pylori causing increased acid and decreased bicarbonate

142
Q

What does antral gastritis cause?

A

antral/duodenem ulcers

143
Q

What does H. pylori cause in the fundus/body?

A

gastric atrophy

144
Q

What does gastric atrophy cause?

A

Intestinal metaplasia

145
Q

What should be considered colon adenocarcinoma unless proven otherwise?

A

Iron deficiency anemia in post menopausal women or elderly men

146
Q

What are the most common types of gastric polyps?

A

Inflammatory and Hyperplastic Polyps

147
Q

What is the pathogenesis of inflammatory and hyperplastic polyps?

A

H. pylori causes chronic gastritis which leads to reactive hyperplasia which causes the polyps

148
Q

What size of the polyp requires it to be resected and biopsied?

A

> 1.5 cm

149
Q

What are 25% common gastric polyps and who do they most often occur in?

A

Fundic Gland Polyps

In younger people

150
Q

What are fundic gland polyps most commonly associated with?

A

individuals with familial adenomatous polyposis (FAP)

151
Q

What causes fundic gland polyps?

A

proton pump inhibitory therapy which causes increased gastrin and causes the gland to overgrow

152
Q

What are the clinical features of fundic gland polyps?

A

They can be asymptomatic or associated with:
Nausea
Vomiting
Epigastric pain

153
Q

What is the most common malignancy of the stomach?

A

Gastric adenocarcinoma

154
Q

What are the two morphological types of gastric adenocarcinoma?

A

Intestinal type

Diffuse type

155
Q

What does the intestinal type have?

A

bulky mass

156
Q

What characterizes the diffuse type?

A

it spreads and invades wall of GI tract

157
Q

What are the early symptoms of gastric adenocarcinoma?

A

Similar to Chronic Gastritis and peptic ulcer disease

158
Q

What are the advanced symptoms of Gastric adenocarcinoma?

A 
Weight Loss
Anorexia
Early Satiety
Anemia
Hemorrhage
159
Q

What are the precursors to Gastric adenocarcinoma?

A

Gastric dysplasia

Adenomas

160
Q

What mutations cause Gastric adenocarcinoma?

A

BRCA2

TP53

161
Q

What are the clinical features associated with Intestinal Obstruction?

A 
Abdominal pain
Distinction
Vomiting
Constipation
Hypovolemia
Metabolic Acidosis
162
Q

What is the most common cause of intestinal obstruction?

A

Adhesions

163
Q

What is a hernia?

A

Any weakness or defect in the abdominal wall that permits a protrusion of a serosa-lined pouch of peritoneum called a hernia sac

164
Q

What is a volvulus?

A

Twisting of bowel

165
Q

What is intussesception?

A

Segment of the intestine telescopes into the immediately distal segment and is constricted by a wave of peristalsis

166
Q

Who is intussesception most common in?

A

Children less than 2

167
Q

What is a common cause of intestinal obstruction in pregnancy?

A

Volvulus

168
Q

What is the most common cause of intestinal obstruction in places other than the US?

A

Hernia

169
Q

What is the majority of the GI tract’s arterial supply?

A

Celiac
Superior Mesenteric
Inferior Mesenteric

170
Q

What are the causes of Ischemic Bowl Disease?

A 
Severe Atherosclerosis
Aortic Aneurysm
Hypercoagulable states
Oral Contraceptive use
Embolization
Hypoperfusion
171
Q

What is ischemic bowel disease?

A

Necrosis of the GI tract

172
Q

What types of infarction occur in Ischemic bowl disease?

A

Mucosal
Mural
Transmural

173
Q

Where does a mucosal infarction occur?

A

In the superficial layer

174
Q

Where does the transmural infarction occur?

A

In the entire 4 layers

175
Q

What is the phase 1 of Ischemic bowel disease?

A

Hypoxia injury

176
Q

What is phase 2 of Ischemic bowel disease?

A

Reperfusion injury

177
Q

What are the clinical features of ischemic bowel disease?

A

Sudden onset of cramping
Left lower abdominal pain
Desire to defecate
Bloody diarrhea

178
Q

What is the cause of bloody diarrhea in ischemic bowel disease?

A

Shock and vascular collapse

179
Q

When is ischemic bowel disease most common?

A

In those 70 years of age or older

180
Q

What are the clinical features of Infectious Enterocolitis?

A 
Diarrhea
Abdominal Pain
Urgency
Perinatal discomfort
Incontinence
Hemorrhage
181
Q

What is the major cause of death worldwide?

A

Infectious Enterocolitis

182
Q

What is the cause of Infectious Enterocolitis?

A

E. Coli is most frequently responsible but etiology varies with age, nutrition, host immune status, and environmental influences

183
Q

What are the common bacterial agents of Infectious Enterocolitis?

A 
Cholera
Campylobacter jejuni
Shigella flexneri
Salmonella typhoid/enteriditis/typhirmurium 
E. Coli
C. Difficile
184
Q

Where does cholera occur?

A

Where there is a natural disaster

185
Q

How would a patient get cholera?

A

By drinking contaminated drinking water or contaminated food

186
Q

What are the symptoms of cholera?

A

Watery, rice stool diarrhea at a rate of 1L/hour

Vomiting following an incubation of 1-5 days

187
Q

What does cholera cause?

A 
Dehydration
Hypotension
Muscular cramping
Anura
Shock
Loss of consciousness 
Death
188
Q

What is the pathogenesis behind cholera and its secretory diarrhea?

A

Cholera toxin increases adenylate cyclase which increases cAMP

CAMP increase opens a chloride channel with causes sodium and water to also leave the cell =

Water diarrhea

189
Q

What bacteria causes Campylobacter Enterocolitis?

A

Campylobacter jejuni

190
Q

What is Campylobacter jejuni?

A

Most common bacterial enteric pathogen in developed countries

191
Q

What are the symptoms of Campylobacter Enterocolitis?

A 
Traveler’s Diarrhea/Watery Diarrhea
Dysentery
Reactive arthritis
Erythema Nodosum
Guillain-Barré syndrome
192
Q

What is Campylobacter Enterocolitis associated with?

A

Ingestion of improperly cooked chicken, unpasteurized milk or contaminated water

193
Q

What are the virulence factors of Campylobacter jejuni?

A

Motility
Adherence
Toxin production
INvasion

194
Q

Where does the bacteria proliferate?

A

In Lamina propia and mesenteric lymph nodes

195
Q

How does C. Jejuni invade the bacteria?

A

1) adheres to host cell
2) F-actin and/or microtubules rearrange at this site causing engulfment and bacterial uptake
3) host cell signaling molecules and pathways like the intracellular survival in campylobacter containing vacuoles cause infection

196
Q

What bacteria causes Shigellosis?

A

Shigella Flexneri

197
Q

What is shigella flexneri?

A

Gram negative unencapsulated, non-motile, facultative anaerobes

198
Q

What does Shigella flexneri secrete that causes the disease?

A

Shiga toxin (Stx)

199
Q

What does shiga toxin cause?

A

Decreased protein synthesis

200
Q

What is shigellosis the most common cause of?

A

Blood diarrhea (dysentery)

201
Q

How is shigellosis transmitted?

A

Fecal-oral route or via contaminated water and food

202
Q

Who is shigellosis the most common cause of death in?

A

In children less than 5

203
Q

What are the clinical features of Shigellosis?

A

Incubation period - 1 week

Dysentery diarrhea
Fever
Abdominal Pain

204
Q

How does Shigella invade and cause inflammation?

A

1) crosses epithelial barrier through M-cells where they encounter macrophages
2) Binding of lipoprotein to TLR2 in macrophages results in production of IL-1 and IL-8
3) IL-8 causes PMN transmigration
4) death of cells

205
Q

What is the primary destructive force in Shigella infection?

A

PMNs

206
Q

What is the function of PMNs?

A

Cause chloride secretion through generation of a precursor to the secretagogue adenosine

Also causes ulceration of epithelium resulting in decrease in absorptive surface and maximizing permeability

207
Q

Which bacteria causes Salmonella exclusively in the GI tract only?

A

S. Enteriditis

S. Typhimurium

208
Q

How many cases of Salmonellsis are there per year and what does it cause?

A

More than 1 million cases

FOOD POISONING

209
Q

Who is salmonellosis most common in?

A

Young children and older adults

210
Q

When is the peak incidence of salmonellosis?

A

Summer and fall

211
Q

What are the clinical features of Salmonella?

A

Inflammatory Diarrhea

Fever resolving in 2 days

212
Q

How long does the diarrhea persist for with Salmonellisi?

A

Week or more with organisms being present in stool for several weeks

213
Q

What does the bacteria possess that cause Salmonellisis?

A

Virulence genes that encode a type III secretion system

214
Q

What is the Type 3 secretion system capable of?

A

Transferring bacterial proteins into M cells and enterocytes

215
Q

What bacteria causes typhoid fever?

A

S. Typhi

216
Q

What are the two things that can form due to S. Typhi?

A

Typhoid nodules

Typhoid ulcers

217
Q

Where do typhoid nodules occur?

A

Liver
Bone marrow
Lymph node

218
Q

What are the clinical features of Typhoid fever?

A 
Anorexia
Abdominal Pain
Bloating
Nausea/Vomiting
Bloody diarrhea followed by short asymptomatic phase
Rose spots
Extraintestinal complications
219
Q

What is E.coli?

A

Gram negative bacilli that colonize the healthy GI tract

Mostly nonpathogenic but can cause human disease

220
Q

What are the 4 strains of E. Coli?

A

Enterohemorrhagic
Enterotoxigenic
Enteroinvasive
Enteropathogenic

221
Q

What is the most dangerous form of enterohemorrhagic e. Coli?

A

O157H7

222
Q

What does enterohemorrhagic E. Coli secrete?

A

Shigella like toxin that inactivates ribosomes

223
Q

What is enterohemorrhagic E. Coli associated with?

A

Consumption of inadequately cooked ground beef

224
Q

What are the clinical features of enterohemorrhagic E. Coli?

A

Hemolytic Uremic Syndrome

225
Q

What does hemolytic uremic syndrome cause?

A

Lysis of RBS’s
Renal Failure
Thrombocytopenia

226
Q

What does enterotoxigenic E. Coli secrete?

A

Heat stable toxin (ST)

Heat-labeled toxin (LT)

227
Q

What is enterotoxigenic E. Coli similar to?

A

Cholera

228
Q

What does enterotoxigenic E. Coli cause?

A

Increase in adenylate cyclase/cAMP causing increased secretions

Secretory, non-inflammatory diarrhea
Shock in severe cases

229
Q

How is Enteroinvasive E. Coli transmitted?

A

Food
Water
Person to person contact

230
Q

What is so different about enteroinvasive E. Coli compared to the other strains of E. Coli?

A

It is the only one that invades the epithelial host cells and doesn’t produce toxins

231
Q

What does Enteroinvasive E. Coli cause?

A

Dysentery

232
Q

What does enteropathogenic E. Coli cause?

A

Endemic diarrhea in children under 2

233
Q

How does enteropathogenic E. Coli work?

A

Attaches to epithelium and destroys microvilli in small intestine

234
Q

What is osmotic diarrhea caused by?

A

Failure to absorb food

235
Q

What is Pseudomembranoous Colitis caused by?

A

C. Difficile

236
Q

What are the risk factors for Pseudomembrance COlitis?

A

Advanced age
Hospitalization
Antibiotic treatment

237
Q

What are the clinical features of Pseudomembranous COlitis?

A 
Fever
Leukocytosis
Abdominal Pain
Cramps
Watery Diarrhea
Dehydration
Protein loss/hypoalbuminemia
238
Q

What is the major challenge with Pseudomembranous colitis?

A

Recurrent infection

239
Q

What is the mnemonic for Viral Gastroenteritis viruses?

A

CANCAR

Corona virus
Adenovirus
NOROVIRUS
Calcivirus
Astrovirus
ROTAVIRUS
240
Q

Who are most vulnerable to get Viral Gastroenteritis?

A

Children between 6-24 months

241
Q

Where are rotavirus outbreaks most common?

A

In hospital and daycare centers

Infection spreads quickly

242
Q

How many viral particles are required to cause Viral Gastroenteritis?

A

10 viral particles

243
Q

What does viral gastroenteritis typically cause?

A

Secretory and osmotic diarrhea

244
Q

What is the pathogenesis of Viral Gastroenteritis, particularly that caused by Rotavirus?

A

NSP-4 acts like a viral endotoxin and causes an increase in calcium inside the cell

This stimulates the enteric nervous system and activation of epithelial cell chloride secretion

This causes cell death and a reduction in absorptive surface of the intestine

245
Q

What parasites cause Parasitic Enterocolitis?

A 
Entamoeba hystolytica
Giardia Lamblia
Giant roundworm - ascaris lumbricoides
Threadworm - stronglyoides
Hookworm - Necator duodenale and ancylostoma duodenale
Pinworm - enterobius vermicularis
Whip worm - trichuris trichura
Cryptosporidium
246
Q

What is inflammatory bowel disease?

A

Inappropriate mucosal immune activation

247
Q

What are the two types of Inflammatory Bowel Disease?

A

Crohn Disease

Ulcerative Colitis

248
Q

What are the clinical features of Crohn Disease?

A

extremely variable

Intermittent Mild Diarrhea
Fever
Abdominal Pain
Iron deficiency anemia
Serum protein loss and hypoalbuminemia
Malabsorption of Vitamin B12 and bile salts
Fibrosing strictures of the terminal ileum
Fistulae
249
Q

What are the clinical features of Ulcerative Colitis?

A

Bloody Diarrhea with stringy, Mucosa material
Lower abdominal pain
Cramps that are temporarily relieved by defecation

250
Q

What are the trigger factors for Ulcerative Colitis?

A

Infectious enteritis

Stress

251
Q

Where does Crohn’s disease occur?

A

Ileum and colon

252
Q

What is the distribution of Crohn disease?

A

Skip lesions

253
Q

What is the type of inflammation with Crohn’s disease?

A

Transmural inflammation

254
Q

What type of ulcers are there in Crohn’s disease?

A

Deep, knife like

255
Q

Where does Ulcerative Colitis occur?

A

colon only

256
Q

What is the distribution of Ulcerative Colitis?

A

Diffuse

257
Q

What is the type of inflammation of Ulcerative colitis?

A

Limited to mucosa inflammation

258
Q

What type of ulcers occur in Ulcerative Colitis?

A

Superficial, broad-based

Patho II (16 decks)

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