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275 Cards in this Set
- Front
- Back
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What kind of muscle exists at the end of the GI tubes?
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skeletal
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What kind of epithelium exist at the ends of the GI tube?
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Stratified Squamous
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What kind of epithelium exists at the middle of the GI tube?
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simple columnar
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Name the 6 major sphincters of the tube
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Upper and lower esophageal, pyloric, iliocecal, internal and external anal
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Name the 4 histological layers of the GI tract from lumen out
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mucosa, submucosa, muscularis externa, adventitia/serosa
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Define serosa
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Connective tissue + peritoneum
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Where is the Na/K ATPase located in the cell membrane?
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Basolateral side
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What layer is directly beneath the epithelium and contains connective tissue, lymphocytes, and glands?
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lamina propria
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What 3 layers for the mucosa?
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epithelium, lamina propria, muscularis mucosa
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Ulcers damage down into which histological layer?
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submucosa
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Nerve plexies in the submucosa are called...
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Meissner's/submucosal
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Submucosal glands are found where in the GI tract?
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esophagus and duodenum
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Submucosal glands found in the duodenum are called what?
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Brunner's Glands
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The 2 layers of muscularis externa from deep to superficial are called ...
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circular and longitudinal
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Nerve plexies in the muscularis externa are called ...
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Myenteric/ auerbach's plexies
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Evaginations called villi only exist in the where?
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small intestine
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Invaginations in the stomachs are called ...
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pits and glands
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Invaginations in the small/large intestine are called what?
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crypts of lieberkuhn
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What kind of smooth muscle exists in the GI tract? (hint: gap junctions)
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Single unit
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Myogenic pacemaking creates a tone called ...
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basal electric rhythm
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Major acid producing cells in the stomach are called ...
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parietal cells
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3 phages of digestion are
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cephalic, gastric, intestinal
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3 salivary glands are
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parotid, submandibular, sublingual
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Cells that squeeze the acinus in the salivary glands and are single unit smooth muscle are called
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myoepithelial cells
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Mucus/serous: parotid, sublingual, submandibular
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Parotid: serous, sublingual: mucus, submandibular: both
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Serous fluid is produced in the which portion of the acinus?
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serous demilune
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The muscularis mucosa is most think in the which part of GI tract?
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esophagus
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Where is intrinsic factor produced?
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stomach
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What type of cell produces and secretes bicarb in the stomach?
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surface mucous cells of the pit
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What are the 3 types of cells in the neck region of stomach glands?
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Stem, neck mucous, Parietal
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What do neck mucous cells in stomach glands look like histologically?
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champagne glass
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What do parietal cells look like histologically?
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fried eggs
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Which cells make pepsinogen?
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Chief
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Which cells make gastrin?
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neuroendocrine
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What are some specific things taken up in the ileum?
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Bile salts and vitamin B12/IF
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Permanent folds in the small intestine are called what?
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Plicae circulares
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What are two types of cells located on the intestinal villus?
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Goblet cells and enterocytes
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What is the layer of microvilli on the enterocytes called?
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Brush border
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What is the layer of enzymes on top of the enterocytes called?
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Glycocalyx
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What is the purpose of goblet cells?
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Stores and secretes mucus
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Which brush border enzyme activates trypsinogen?
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enterokinase
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Name the types of cells located in the crypts of lieberkuhn of the small intestine
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paneth, neuroendocrine, stem
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what is the function of paneth cells?
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secrete lysozyme and defesin for antibacterial purposes
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What are the purposes of brunner's glands?
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secrete alkaline serous solution to neutralize chyme
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how do defesins work?
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small charged particles insert into bacterial membrane to make them more vulnerable to antibacterials
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Peyer's patches are especially noticeable where in the gut tube?
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ileum
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Cells that pinocytose luminal contents and present antigens to peyer;s patches are called what?
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M cells
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what is the taenia coli?
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longitudinal muscularis externa in 3 thick bands
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How are cells arranged in the islet of langerhans?
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beta cells on inside, alpha and delta cells on outside
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Alpha, beta, and delta cells in the islets of langerhans produce which proteins?
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alpha = glucagon, beta = insulin. delta = somatostatin
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gall bladder releases bile in reaction to which protein?
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CCK
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What are the constituents of bile?
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bile salts, bilirubin, cholesterol, H2O, IgA, ions
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what is special about the gall bladder mucosa layer?
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lacks muscularis mucosa
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What are the two types of motility in the GI tract?
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propulsive movements - peristalsis.
Mixing = segmentation |
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What nerves supply parasympathetic innervation to the gut tube?
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vagus and pelvic
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How are smooth muscle tension and frequency of contractions determined?
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Frequency = basal electric rhythm, tension = neurotransmitters
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What does distention of the tract by a bolus do to the longitudinal and circular muscles on the oral and aboral sides of the bolus during peristalsis?
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Oral = contract circular, relax longitudinal
Aboral = relax circular, contract longitudinal |
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Neurotransmitters that relax GI smooth muscle are...
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NO, ATP, vasoactive intestinal peptide
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Neurotransmitters that contract GI smooth muscle are...
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ACh, substance P
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Describe 3 steps of deglutition
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1: voluntary, oral cavity then bolus pushed by tongue to oropharynx
2: involuntary, glottis covers trachea, UES relaxes 3: involuntary, esophageal peristalsis |
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What is special about the muscularis externa layers of the stomach
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has an innermost oblique layer
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Rate of emptying for different types of biochemical compounds
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carbs, then proteins, then fat
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Steps involved in emesis
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1. salivation + sensation of nausea (centrally controlled)
2. reverse peristalsis from upper small intestine to stomach 3. abdominal muscles contract, UES and LES relax 4. gastric contents ejected |
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Name three enzymes released by small intestine in response to food entering it
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CCK, secretin, glucose dependent insulinotrophic peptide = GIP
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What does the hormone secretin do in the small intestine?
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increases release of bicarb juices by pancreas
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Name and describe the intestinal reflexes mediated by both ENS and external innervation
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gastroileal = stomach activity stimulates mvmt of chyme through ileocecal spincter
gastrocolic = food in stomach stimulates mass mvmt in stomach |
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What hormone initiates migrating motor complex?
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Motilin
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What are the three phases of migrating motor complex?
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1. quiescent
2. motility increases, contractions irregular, fails to propel luminal content 3. 5-10 min intense contractions to ileocecal valve, pylorus fully open |
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What are the 2 types of motility in the large intestine?
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haustration and mass mvmt
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During mass mvmt, semilunar valves and taenia coli relax, which causes loss of what that can be seen on CT?
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haustrations
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What is the rectoanal inhibitory reflex?
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relax int anal spincter due to increased pressure from feces and simultaneously contract EAS
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CFTR is sensitive to which secondary messenger?
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cAMP
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How does Cl move from the basolateral side into the cell of the crypts in the small intestine?
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NKCC1 channels
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Which transporter is responsible for the acidity of the stomach?
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H/K ATPase
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What do prostaglandins do to mucus production in the stomach?
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increase it
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How is Vit B12 carried from the stomach to absorption in ileum?
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B12 binds salivary R protein in stomach, pancreatic proteases remove R protein in duodenum, IF from stomach then binds in duodenum, uptake in terminal ileum
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Describe the variation of stomach acid secretion amount during the interdigestive phase
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highest in evening and lowest in morning before waking
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Name 3 hormones that have receptors on parietal cells to increase HCl secretion and what secondary messenger they use
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Ach - Ca
Histamine - cAMP Gastrin - Ca |
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What is the receptor on parietal cells for gastrin?
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CCK-B
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How to hormones that regulate HCl secretion from parietal cells crosstalk?
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Gastrin can activate histamine, Ach activates gastrin and histamine
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What is the alkaline tide?
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transient metabolic alkalosis due to increased bicarb in blood from bicarb Cl exchanger which is compensated by respiratory acidosis
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Single largest source of carbs in our diet?
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amylopectin
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Name products of amylase digestion of amylopectin
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maltose, maltotriose, alpha-limit dextrin
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Name 5 enterocyte surface enzymes that convert small polysaccharides to sugar monoomers and what are their reactants and products?
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Isomaltase = alpha-limit dextrin to glucose
maltase = maltose and maltotriose to glucose lactase = lactose to glucose and galactose sucrase = sucrose to glucose and fructose trehalase = trehalose to glucose |
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Sxs of lactose intolerance and pathophys
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1. gas = byproduct of lactose breakdown by bacterial
2. diarrhea = osmotic diarrhea from increases lactose in stool |
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Name the transporters that uptake sugar monomers of the apical side of enterocytes and which monomers
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SGLT1 = Na/Glucose or Na/Galactose cotransport
GLUT5 = Fructose |
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Name the transporters that uptake sugar monomers of the basolateral side and which monomers
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GLUT2 glucose, galactose, fructose
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Why does oral rehydration involve glucose?
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SGLT1 can operate in the setting of secretory diarrhea (increased cAMP)
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How do infants uptake peptides in enterocytes?
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pinocytosis
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How does the PEP T1 transporter work?
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Proton/di-tri-peptide cotransporter,
Proton gradient maintained by NHE |
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Which lipids cannot be made by body?
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linoleic and arachidonic acid
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How are bile acids converted to bile salts?
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add glycine/taurine (neg charge)
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Bile is recycled where through what circulation?
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distal ileum, enterohepatic circulation
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Summary of lipid digestion
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dietary fats -> lingual and gastric lipase -> pancreatic lipase (hydrolyzes triglycerides into FFA) -> bile salts solubilize into micelles, FFAs transported into enterocytes -> triglycerides resynthesized into chylomicrons, released to lacteal
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Which are the fat soluble vitamins?
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A,E,D,K
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Most Na absorption happens in ?
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Jejunum
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Which channel uptakes sodium into enterocytes of the colon?
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Epithelial sodium channels (ENaC)
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Describe how chloride absorption is different in proximal intestines and distal ileum/colon
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proximal - through loose tight junctions, follows Na
Distal - Cl/HCO3- exchanger |
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Describe how potassium is absorbed in the colon
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transcellular, K+ normally high in cells due to Na/K ATPase but gradient is due to decrease in luminal water -> passive flux of K into cells
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How is Ca gradient maintained so that it can be absorbed into cells?
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intracellular Ca stores
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How does Vit D increase Ca absorption?
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Vit D 25-hydroxylated in liver -> 1-hydroxylated in kidney in presence of PTH -> binds to cytoplasmic receptor, activates transcription of Ca binding proteins and Ca ATPase molecules
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How is Ca pumped from the enterocytes to the blood?
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Ca ATPase
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What are the two possible fates of Fe after it is absorbed into enterocytes?
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binds to apoferritin to form ferritin and stays in cell
binds to transferrin and goes into blood |
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What are the components of oral rehydration therapy?
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antibiotics + KHCO3 (prevent hypokalemia + metabolic acidosis) + glucose/amino acids + NaCl (facilitate absorption of electrolytes and water)
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Differentiate between non-inflammatory and inflammatory diarrhea
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Non-inflammatory is watery and the pathology is from the small bowel. Inflammatory has increased leukocytes and the pathology is in the colon
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Name pathogens responsible for non-inflammatory diarrhea
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Cholera, norovirus, rotavirus, ETEC, giardia
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Name pathogens responsible for inflammatory diarrhea
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C. jejuni, shigella, salmonella, EHEC, C. diff
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Compare major differences between norovirus and rotavirus infections
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Noro: family and community epidemics, older children + adults, 1-2 day duration
Rota: sporadic, infants, 5-8 day duration |
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How do you treat shigella infection?
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Manganese
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Most common cause of bacterial acute diarrhea in all ages
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Campylobacter
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What muscles comprise the upper esophageal sphincter?
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Inferior constrictor/cricopharyngeus
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Contraction of what muscles closes the nasopharynx
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soft palate
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Define oropharyngeal dysplasia
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Inability to initiate a swallow or transfer a food bolus into esophagus
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What is zenker's diverticulum
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outpouching of esophagus leading to regurgitation or bacterial colonization (halitosis)
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Discuss sensitivity of barium esophagealgram for GERD
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neg 10-20% of time
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Discuss how the LES is impaired in GERD
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dec. basal tone, inc transient LES relaxation
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Risk factors for GERD
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obesity, high fat diet, caffeine/alcohol, smoking, meds that affect LES or GI peristalsis (narcotics)
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Gold standard for GERD diagnosis
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24 hr pH study
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Define achalasia and pathophys
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disorderly peristalsis and incomplete relaxation of LES. Loss of parasymp input
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Classic imaging finding for achalasia
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"bird's beak" on barium swallow
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Most effective option of treatment of achalasia
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surgical myotomy
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standard of diagnosis for achalasia
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esophageal manometry
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Achalasia predisposes pt to what type of cancer?
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squamous cell carcinoma of esophagus
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Standard of diagnosis for esophageal stricture
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endoscopy with biopsy
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Difference in sxs between diffuse esophageal spasm and stricture
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Stricture = solid dysphagia first, then liquids
DES = both solids and liquids, chest pain after eating |
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Achalasia can occur secondary to ...
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diabetic autonomic neuropathy, malignancy
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Histologic findings in esophagitis
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elongation of papillae and basal cell hyperplasia
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3 infectious diseases that cause esophagitis
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herpes, candida, CMV
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Endoscopy and histology findings of Herpes infectious esophagitis
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punched out ulcers
multinucleated cells, intranuclear viral inclusions (cowdry A) |
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Endoscopy and histology findings for candida esophagitis
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white plaques w fibrinopurulent exudate
Pseudohyphae and budding yeast upon GMS and PAS stain |
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Endoscopy and histology findings for CMV esophagitis
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Punched out ulcers
Cyto- and nucleomegaly and intracytoplasmic inclusions |
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Eosinophilia with trachealization: what disease?
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eosinophilic esophagitis
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Increased eosinophils <20/hpf in distal esophagus: what disease?
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GERD
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What stains for mucin?
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Alcian blue
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Glands in the cardia of the stomach contains what types of cells?
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neck mucus
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Glands in the body and fundus of the stomach contain what type of cells?
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mucus, parietal, chief, endocrine, enterochromaffin-like (ECL)
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Enterochromaffin-like cells produce what?
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histamine
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Antral-pyloric glands contain what kind of cells?
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mucus, endocrine (gastin + somatostatin producing)
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Gastric emptying is slowed in response to what normally?
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decrease pH, fatty acids and caloric density, increase osmolality
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Most common cause of gastroparesis
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Diabetes
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Most common drugs that can cause gastroparesis
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Narcotics, TCAs, CCBs, b-blockers, EtOH, THC, Tobacco
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What kind of diet should be recommended for diabetic gastroparesis?
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small, frequent meals, low fat, low fiber
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Medications used for diabetic gastroparesis?
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metoclopramide, domperidone, anti-emetics
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Association btw autoimmune atrophic gastritis and what kind of neoplasm?
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Carcinoid tumor
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4 types of gastritis
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infectious, lymphocytic, eosinophilic, associated w systemic disease
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Pathophys of H. Pylori ulcers
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Produces urease which produces ammonia which neutralizes H+, also corkscrews into bicarb rich mucus to weaken it
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Which exotoxin in H. pylori causes inflammation and inhibits T cells attempt to clear it?
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VacA
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Discuss the acid output and physiologic consequences of antral predominant H. pylori infection?
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more acid secretion and duodenal ulcers
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What happens to SST and gastrin levels in acute infection?
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Increase SST, decrease gastrin
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What happens to SST and gastrin levels in chronic antral gastritis?
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decrease SST, increase gastrin
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Diagnosis of H. Pylori that requires pts to be off PPIs
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Rapid urease test after biopsy
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Which tests can diagnose H. Pylori without requiring biopsy?
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blood antibody, stool antigen, urea breath test
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What is a major problem with the blood antibody test for H. pylori infection?
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positive with prior infection
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First line treatment of H. Pylori
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Triple therapy: PPI + Clarithromycin + amox 10-14 days
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Rescue quadruple therapy for H. pylori?
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PPI + metronidazole + tetracycline + bismuth
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Gastropathies called by...
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NSAIDs, ethanol, stress
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Name 4 common causes of stress ulcers in ICU patients
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CNS injury, burns, prolonged mechanical ventilation, coagulopathy
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Prevalence of gastric ulcers and duodenal ulcers male vs. female
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GU: m=f
DU: m>f |
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Air under the diaphragm on CXR indicates what?
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intraabdominal perforation
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Most mild endoscopic stigmata that warrants tx in addition to PPI
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nonbleeding visible vessel
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Epidemiology of gastric adenocarcinoma
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2nd most common cancer and cause of cancer death in the world
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Most common type of gastric polyps
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hyperplastic
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Most common type of mesenchymal tumor
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GIST
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Cell of origin for GIST
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interstitial cell of Cajal
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Mutations in which gene drive development of GIST?
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c-kit encoding transmembrane receptor tyrosine kinase
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Tx for GIST
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Imatinib
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3 types of gastric carcinoid
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autoimmune atrophic gastritis, zollinger-ellison syndrome (MEN1), sporadic
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Cancers associated with H. pylori
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Gastric adenocarcinoma and MALT lymphoma
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Fundic gland polyps occur in what patient populations?
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FAP and long term PPI patients
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Pathology of fundic gland polyp
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cystic dilation of fundic gland
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Characteristic of high grade dysplasia
|
loss of polarity
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Two main forms of gastric cancer
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intestinal type and diffuse type (signet ring cells)
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What type of gastric cancer is the polyp a precursor lesion to?
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intestinal type
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Gene mutation in hereditary diffuse type gastric cancer vs. hereditary intestinal gastric cancer
|
Intestinal: FAP
Diffuse: CDH1 |
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Gross findings of diffuse type gastric cancer
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linitis plastica
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Specific lymph node that gastric cancer metastasizes to
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left supraclavicular (virchow's)
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GISTs are staged based on what?
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size
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Clinical syndrome associated with carcinoid
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MEN1
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What kind of mass are carcinoids likely to present as?
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submucosal mass
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Classic site of origin for carcinoid
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small intestine
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MALT lymphoma B/T cells?
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B cell
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How do you distinguish bile duct cells in the portal triad?
|
They are cuboidal
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What do stellate cells store?
|
Fat and vitamin A
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Stellate cells can get activated to produce what?
|
Type I collagen
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What happens in the hepatocyte histologically when there are large amounts of toxins?
|
increased SER
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What is the lab test result and pathophys in Gilbert's disease?
|
increased unconj. bilirubin
stress induced decrease in action of conjugating enzyme |
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What is the lab test result and pathophys of Dubin-Johnson Syndrome?
|
Increased conjugated bilirubin w/o ALT and AST elevation
Mutation in MRP2 which transports conjugated bilirubin into the bile caniliculus |
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Neutrophils characteristic of which type of hepatitis?
|
steatohepatitis
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Eosinophils common in which type of hepatitis?
|
drug injury
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Plasma cells common in which type of hepatitis?
|
autoimmune
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Pattern of lymphocytes in acute and chronic hepatitis
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Acute - panlobular
Chronic - spotty, clusters |
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Stereotypical sequence of fibrosis in chronic hepatitis
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No -> Portal -> Periportal -> Bridging -> Cirrhosis
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Which hepatitis virus is a dsDNA virus and what are the others?
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HBV, ssRNA
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Which hepatitis virus is transmitted by fecal-oral route?
|
A and E
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Which hepatitis virus does not cause chronic liver disease?
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Hep A and Hep E
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What is the frequency of chronic liver disease for HBV?
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10%
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What is the frequency of chronic liver disease for HCV?
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80%
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Which hepatitis virus eludes antibodies made against it because of genetic instability?
|
HCV
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Characteristic histologic feature of autoimmune hepatitis
|
Spotty plasma cell rich infiltrate
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Primary biliary cirrhosis affects what caliber of bile duct?
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small
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Characteristic finding of primary biliary cirrhosis
|
anti-mitochondrial
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Associative disease with primary sclerosing cholangitis
|
Ulcerative cholitis
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Primary diagnostic tool for primary sclerosing cholangitis
|
Cholangiography
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Characteristic histiological feature found in primary sclerosing cholangitis
|
periductal "onion-skin" fibrosis
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Pathophys of alcohol steatohepatitis
|
1. delivers large carb load to liver
2. stimulate peripheral lipolysis 3. Decreases beta oxidation due to accumulation of downstream reagents 4. decrease lipoprotein export 5. alcohol metabolites |
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What are Mallory bodies and what disease are they associated w?
|
Ropy cytoplasmic inclusions in hepatocytes
Steatohepatitis |
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Pathophys of non-alcoholic fatty liver disease
|
Increased peripheral lipolysis = major factor
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Hereditary hemochromatosis mode of inheritance
|
autosomal recessive
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Mutation in what protein is responsible for Wilson disease? (what does the protein do?)
|
transporter involved in bile excretion of copper
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Mode of inheritance of Wilson
|
autosomal recessive
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What happens to alpha 1 antitrypsin protein in liver disease?
|
misfolded protein accumulated in hepatocyte endoplasmic reticulum
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Major risk factor for cholangiocarcinoma
|
primary sclerosing cholangitis
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What cells are involved in a hemangioma?
|
dilated vascular spaces
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Second most common primary hepatic mass is
|
focal nodular hyperplasia
|
|
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Which benign mass is associated with oral contraceptive use?
|
hepatocellular adenoma
|
|
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What is seen in microscopy for hepatocellular adenoma
|
Proliferative hepatocytes of normal trabecular thickness (1 cell) and unpaired arterioles
|
|
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Location in hepatocyte of AST vs. ALT
|
AST = cytosol and mitochondria
ALT = cytosol |
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Organ expression: AST vs. ALT
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AST: liver, heart, muscle, blood
ALT: liver only |
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AST:ALT ratio >2 is suggestive of what and why?
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alcoholic liver disease
lower ALT from hepatic deficiency of pyridoxine (B6) - cofactor in ALT preferential alcohol-induced injury to mitochondria enriched in AST |
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Localization of alk phos in liver
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microvilli of bile canaliculus
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Elevated alk phos indicative of
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cholestatic/infiltrative liver disease
biliary obstruction bone disease pregnancy |
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Bilirubin test values for hemolytic jaundice and pathophys
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Pathophys: too much unconjugated bilirubin in blood
Unconj: elevated |
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Biliary obstruction bilirubin lab tests
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Direct bilirubin elevated
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Genetic basis for Gilbert's disease
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mutation in promoter region of gene encoding UDP-GT
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Bilirubin lab results for Gilbert's disease
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increased indirect
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Genetic basis of Crigler-Najjar Syndrome
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autosomal recessive, UDP-GT deficiency
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Pathophys of Dubin-Johnson syndrome
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impariment of biliary excretion of conjugated bilirubin
Mutation of MRP-2 gene |
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Elevated tissue transglutamidase Ab is indicative of which disease?
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Celiac
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Elevated tissue transglutamidase Ab is indicative of which disease?
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Celiac
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What lab tests go into the MELD score and if all three tests are normal what is the score?
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INR, CrCl, Bilirubin
Normal = 6 |
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what are the two physiologic causes of portal hypertension?
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increased resistance and increased blood flow
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What type of portal hypertension is schistosomiasis?
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pre-sinusoidal
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What type of portal hypertension is budd-chiari syndrome and what is it also called?
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post-hepatic, hepatic vein thrombosis
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How does increased portal venous inflow happen in the pathophys of cirrhosis?
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splanchnic vasodilation
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Why does infection cause increased risk of variceal bleed in pts with cirrhosis?
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Bacterial translocation increases nitric oxide production which increases splanchnic vasodilation
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What is the equation for HVPG and what is normal?
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wedged hepatic venous pressure - free hepatic venous pressure
Normal = 3-5 mmHg |
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What HVPG number indicates great risk of variceal bleed?
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>12
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What is the HVPG in pre-sinusoidal/pre-portal cirrhosis
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normal
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What is the HVPG in sinusoidal or post-sinusoidal cirrhosis?
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elevated
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Which vasoconstrictor is given for portal HTN and is the 1st line therapy after a variceal bleed?
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Octreoside
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What are routine lab tests ordered on paracentesis for new onset ascites?
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protein/albumin, PMNs, and culture
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What is HVPG in post-hepatic portal hypertension?
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normal
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What does a serum-ascites albumin gradient of greater than 1.1 indicate?
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cirrhosis or cardiogenic ascites
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What measurement can you use to tell the difference between cirrhosis and cardiogenic ascites after getting a serum-ascites albumin gradient?
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In cirrhosis, total protein is low which in cardiogenic, total protein is high
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Pathophys characteristic of renal failure in hepatorenal syndrome
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marked arteriolar vasodilation in extra-renal circulation => renal vasoconstriction leading to reduced GFR
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What is a significant lab test of hepatorenal syndrome
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hypervolemic hyponatremia
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What is most common bacterial complication of cirrhosis and how is it diagnosed?
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spontaneous bacterial peritonitis - PMN count >250/mm3 of ascitic fluid
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Define bacterial translocation
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migration of viable microorganisms from the intestinal lumen to mesenteric lymph nodes (MLN) and other extraintestinal organs and sites
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Antibiotics to avoid in SBP therapy and most common organism
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animoglycosides, E. coli
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what is the definition of normal amount of bacteria in the small bowel?
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less than 10^5 organisms/ml
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During bacterial overgrowth of the small bowel, how will folate levels be like?
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normal to high
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What are two tests for small bowel bacterial overgrowth and which is the gold standard?
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GS: aspiration of duodenum with culture
Glucose-hydrogen breath test |
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Which HLA genes are positive in Celiac's
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HLA-DQ2 and HLA-DQ8
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How is celiac tested for?
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IgG antibodies to tissue transglutaminase
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What is the classic presentation of tropical sprue?
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megaloblastic anemia from B12 and folate deficiency
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What kind of bacteria causes Whipple's disease
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gram positive actinomycete I. whippelii
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Diagnosis: post-prandial abdominal pain, weight loss, sitophobia, malabsorption
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chronic mesenteric ischemia
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What are the 4 types of diarrhea
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watery, fatty, inflammatory, functional
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What are some carbs that cause watery diarrhea?
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lactose, sorbitol, fructose
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Equation for diagnosis of osmotic vs. secretory diarrhea
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290-2(stool Na + K)
If >50mOsm then osmotic, if <50 then secretory |
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4 mechanisms of inflammatory diarrhea
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1. stimulated secretion and inhibited absorption
2. stimulation of enteric nerves causing propulsive contractions and stimulated secretion 3. mucosal destruction and increased permeability 4. nutrient malabsorption |
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What does cholestyramine do and what is it used for?
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bile acid sequestrant
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Lower abd pain, hematochezia, mucus in stoll, tenesmus, chrohn's / UC?
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Ulcerative colitis
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Mid/lower abd pain, nausea/vomiting, fistulae, abscess, chrohn's or UC?
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Chrohn's
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Which inflammatory bowel disease can affect beyond the submucosa and cause fistulae and strictures?
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Crohn's
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Granulomas on biopsy indicates which inflammatory bowel disease?
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Crohn's
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Which inflammatory bowel disease commonly recurs after surgery
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Crohn's
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Which inflammatory bowel disease comes with toxic megacolon?
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UC
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What is the treatment for high grade dysplasia in a setting of inflammatory bowel disease?
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remove the colon
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what disease is associated with microscopic colitis
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celiac disease
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What are the 2 types of microscopic colitis which are their histologic features?
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Lymphocytic and collagenous
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What are the four main mechanical problems that can occur in the bowel?
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herniation, adhesions, volvulus, intussusception
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What forms the autoantibody in celiac disease?
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anti-gliadin peptide complexing with tissue transglutaminase
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Dermatological disease associated with celiac
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dermatitis herpetiformis
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Type of malignancies associated with celiac disease
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enteropathy associated T cell lymphoma and small intestinal adenocarcinoma
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