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350 Cards in this Set

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  • Back
Name the layers of the mucosa from lumen-->deeper.
Epithelium
Lamina propria
Muscularis mucosa
Name the layers of the wall of the GI tract.
Mucosa
Submucosa
Muscularis propria
Adventitia/serosa
Where Meissner's plexus found?
Submucosa
Where is Auerbach's plexus found?
Between the muscularis externa & muscularis interna in the muscularis propria
What are the contents of the submucosa?
Dense CT, vessels, GALT, submucosal glands, Meissner's plexus
Describe the muscularis propria.
Muscularis interna: circular
Muscularis externa: longitudinal
Where is the outermost layer of the GI tract wall adventitia & where is it serosa?
Retroperitoneal organs have adventitia
Peritoneal organs have serosa
What kind of epithelium is found in the esophagus?
Non-keratinized stratified squamous epithelium
Where are esophageal glands found in the esophagus?
Upper & lower 1/3s of the esophagus
What is the serosa made of?
Mesothelial cells
What kind of epithelial cells are found in the stomach?
Simple columnar epithelial cells
What is the structure of the stomach mucosa?
Epithelium invaginates into lamina propria to form gastric pits into which tubular glands empty.
What part of the glands empty into the gastric pits?
the isthmus
What makes up the isthmus of the mucosal glands of hte stomach?
reserve cells & parietal cells
What lines the neck of the mucosal glands of the stomach?
Reserve cells
Mucus neck cells
Parietal cells
What are the mucus neck cells?
Mucus-secreting cells scattered in very small numbers in the neck of the gastric glands of the stomach
Where are stem cells found in the stomach?
In the neck
What is morphology of stem cells in the gastric mucosa?
Indistinct low columnar cells
Where are the parietal cells found?
The neck of the gastric gland
What is the morphology of parietal cells?
Large, eosinophilic pyramidal cells w/central nucleus
What is the function of parietal cells?
Secrete HCl v& intrinsic factor
What activates parietal cells?
ACh
Histamine
What cells produce intrinsic factor?
Parietal cells
Where is carbonic anhydrase found?
IN parietal cells
What are chief cells?
Large basophilic cells w/basal nucleus & basal RER which produce pepsinogen
Which cells produce pepsinogen?
Chief cells
Where are chief cells found?
Basal portion of gastric glands
What stimulates chief cells?
ACh
What is mucin?
A protective coat on cell surface of gastric cells which traps HCO3, Na, K, and Cl
What do G cells produce?
Gastrin
Where are G cells found?
Pyloric glands
What are D cells?
Somatostatin-producing cells
Where are D cells found?
Pyloric glands
What does somatostatin do?
Inhibits the activity of other neuroendocrine cells
What does gastrin do?
Stimulates parietal cell secretion of H
What are A cells?
Glucagon-producing cells
Where are A cells found?
Throughout the gastric glands
What are EC cells?
Histamine-producing cells
Where are endocrine cells found in mucosal glands?
Base of gastric glands
Characterize the muscularis mucosa in the stomach.
Fairly thick w/SM strands extending into the lamina propria to facilitate the emptying of gastric glands
Where does the muscularis propria have 3 layers?
The stomach
What are the layers of the muscularis propria in the stomach?
Inner oblique
Middle circular
Outer longitudinal
What is a linear plant starch?
Amylose
What is a branched plant starch?
Amylopectin
What plant polysaccharide has an alpha-1,4 glycosidic bond?
Amylose
What plant polysaccharide has both an alpha-1,4 glycosidic bond and an alpha-1,6 glycosidic bond?
Amylopectin
What kind of bond does sucrose have?
alpha1,2 glycosidic
What kind of bond does lactose have?
beta1,4 glycosidic
What is in sucrose?
Glucose & fructose
What is in lactose?
Glucose & galactose
What sugar has an alpha1,1-glycosidic bond?
Trehalose
What is the function of alpha-amylase?
Hydrolysis of internal alpha1,4-glycosidic bonds between glucosyl residues
What is produced by alpha-amylase?
Maltose
Iso-maltose
Trisaccharides
Alpha-dextrins
What happens to salivary alpha-amylase?
Inactivated by the low pH of the stomach
What are the 2 types of alpha-amylase?
Pancreatic & salivary
What is maltase-glucoamylase?
An exoglucosidase which cuts alpha-1,4 linkage @ the nonreducing end of an alpha-dextin & cuts the alpha-1,4 linkage in maltose
Cuts alpha-1,4 linkages
What is a limitation of maltase-glucoamylase?
Cannot digest isomaltose
What is done by sucrase-isomaltase?
Sucrase=cuts alpha-12 bonds in sucrose
Isomaltase=cuts alpha-1,6 bonds in isomaltose & alpha-dextins & alpha-1,4 bonds in maltose & maltotriose
What is done by trehalase?
cuts alpha-1,1 glycosidic bond in trehalose
What does lactase do?
Cuts beta-1,4 glycosidic bond in lactose
What is the result of a maltase-glucoamylase deficiency?
Chronic diarrhea which improves w/starch-free diet
What is the result of a sucrase-isomaltase deficiency?
Symptoms of sucrose intolerance but can tolerate normal amounts of starch in diets
What enzyme deficiency is frequent in Greenland?
Sucrase-isomaltase deficiency
What is the result of a trehalase deficiency?
Nausea, vomiting, severe GI distress upon trehalose consumption
What is a primary lactase deficiency?
Nonpersistent lactase deficiency
The natural decrease in lactase levels after infancy
What is a secondary lactase deficiency?
Lactase deficiency caused by intestinal injury
What can cause a secondary lactase deficiency?
Kwashiorkor, colitis, gastroenteritis, sprue, XS EtOH consumption
What is the glycemic index?
A measure of how rapidly blood glucose levels rise after consumption
How do fructose, galactose, and glucose move into the interstitium from the cytosol?
Facilitated transport
What is produced by metabolism of undigestible starch by colonic bacteria?
Hydrogen
Carbon dioxide
Methane
Short-chain fatty acids (acetic acid, propionic acid, butyric acid)
Lactate
Name two low digestible carbohydrates which can be added to the diet.
Pectins
Beta-glucan
How are low digestible carbs helpful in the diet?
Bind bile acids & reduce carb absorption
What anatomic landmark corresponds w/the upper esophageal sphincter?
C5-C6
What is the most common location of esophageal atresia?
Near tracheal bifurcation
What is esophageal achalasia?
Failure of relaxation of the lower esophageal sphincter w/proximal dilation
What are the 3 separable defects of esophageal achalasia?
Aperistalsis
Incomplete relaxation of LES
Increased resting tone
What is the morphology of esophageal achalasia?
Dilation of esophagus above the LES
What is the treatment for esophageal achalasia?
Dilation or surgery
What is Plummer-Vinson syndrome?
Anemia
Atrophic glossitis
Upper esophageal webs
Dysphagia
What is the a typical patient with upper esophageal webs?
Women w/iron deficiency anemia
What are Schatzki's rings?
Lower esophageal webs
Where are Schatzki's rings most commonly found?
Caudal 5cm of the esophagus @ the squamocolumnar junction
What is associated with Schatzki's rings?
hiatal hernia
What is associated with esophageal achalasia?
Increased carcinoma risk
What are the two types of hiatal hernias?
Sliding hernia: short esophagus that extends above the diaphragm & pulls the stomach into the thorax (80%)
Rolling hernia: portion of the cardia rolls into the thorax (20%)
What are possible complications of hiatal hernias?
Bleeding
Ulcers
Perforation
Barrett's esophagus
Strangulation possible in rolling hiatal hernia
What can be used to diagnose hiatal hernias?
Roentgenograms
What is Mallory-Weiss syndrome?
Lacerations/tears in the esophagus following severe vomiting
More common in EtOHics
What are the three sites that esophageal diverticula are commonly found at?
Above UES (Zenker's)
Middle of esophagus
Above LES
What is seen in scleroderma affecting the esophagus?
Fibrosis of the esophageal wall w/atrophy of smooth muscle
Can see luminal narrowing, atrophic mucosa, ulcerations
What are the microscopic findings of reflux esophagitis?
Basal cell hyperplasia
Upward lamina propria
Increased eosinophils
What are complications of reflux esophagitis?
pain
bleeding
stricture
ulcer
Barrett's
What might be found in the hx of a person w/eosinophilic esophagitis?
Asthma, atopy, peripheral eosinophilia
How is eosinophilic esophagitis diagnosed?
Rule out reflux
Bx of middle 1/3 of esophagus showing increased eosinophils
What is the treatment for eosinophilic esophagitis?
Steroids x 6 weeks
What are typical causes of esophageal varices?
Cirrhosis, portal vein thrombosis, Budd-Chiari, acute pyelophlebitis
Where are esophageal varices most common?
Distal 1/3 of the esophagus
How is Barrett's esophagus diagnosed?
Endoscopy: salmon colored mucosa in the esophagus
Biopsy: columnar epithelium w/intestinal metaplasia & goblet cells
What is the clinical course of Barrett's?
Dysphagia, retrosternal pain, sometimes hematemesis or melena
INCREASED risk of adenocarcinoma!!!
What is a benign esophageal tumor?
Leiomyoma
What is the epidemiology of adenocarcinoma of the esophagus?
M>F
Black>White
What is the microscopic appearance of esophageal adenocarcinoma?
Dark, disorganized glands & huge nuclei
Where are esophageal adenocarcinomas most commonly found?
Distal 1/3
Where are squamous cell carcinomas of the esophagus most commonly found?
Middle 1/3 of the esophagus
What is the epidemiology of squamous cell carcinoma of the esophagus?
M>F
Black>White
What are the risk factors for squamous cell carcinoma of the esophagus?
Nitrosamines, nitrates, fungal contamination of food, Vinson-Plummer, achalasia, esophagitis
What type of cancer can have keratin pearls?
Squamous cell carcinoma
What are the risk factors for peptic ulcer disease?
NSAID use
H. pylori
Cigarette smoking
Chronic liver dz, lung dz, renal failure
What is the most common presenting symptom of peptic ulcer disease?
Epigastric pain
What utility does an upper GI xray have in the diagnosis of peptic ulcers?
Best for duodenal ulcer craters or deformed duodenal bulb
Misses 20% of ulcers
What lab studies might be done for a patient w/PUD?
Antibody studied for H. pylori
Gastrin levels
What is the standard diagnosing method for PUD?
Endoscopy
What kind of patient more commonly gets gastric ulcers?
Elderly female patients
What kind of ulcer has a greater risk of cancer: duodenal or gastric?
Gastric
Does every duodenal ulcer have to be biopsied?
no
Ulcers in what location have an increased association w/NSAID use?
Gastric
How can NSAIDs cause ulcers?
Break mucosal barrier & inhibit prostaglandin synthesis
What are the goals of therapy for PUD?
Reduce symptoms
Accelerate healing
Prevent complications
Reduce recurrences
How can mucosal integrity be enhanced in the treatment of PUD patients?
Discontinuation of NSAIDs/ASA
Sucralfate
What are the major complications of PUD?
Perforation
Penetration
Obstruction
Hemorrhage
What are the S&S of perforation of an ulcer?
Free air in the abdomen
Sudden, severe, diffuse pain
What is the difference between perforation & penetration?
Penetration is the penetration of an ulcer into adjacent viscera (eg pancreas)--> a "closed perforation"
What are the S&S of penetration?
Intense pain radiating to the back
What causes obstruction as a complication of PUD?
Edema & scarring of peri-pyloric ulcers
What are the S&S of hemorrhage as a complication of PUD?
Nausea, hematemesis, melena, dizziness
What makes re-bleeding more likely in a bleeding ulcer?
Visible vessel in the ulcer crater
What can cause treatment failure in peptic ulcer disease?
Inadequate treatment
Incorrect diagnosis
Host factors (compliance, ASA use)
Hypersecretory state (gastrinoma/ZE syndrome)
What is Zollinger-Ellison syndrome?
Gastrin secreting tumor, most commonly in the pancreas & duodenum
What are the genetics of Zollinger-Ellison syndrome?
80% sporadic
20% associated w/MEN-1 (autosomal dominant)
What is the presentation of Zollinger-Ellison syndrome?
Ulcers (90%)
Diarrhea
Recurrent/severe PUD w/o H. pylori or NSAID use
How is Zollinger-Ellison syndrome diagnosed?
High fasting gastrin level
Secretin stimulation test
somatostatin receptor scintigraphy to localize the tumor
What is the treatment for Zollinger-Ellison syndrome?
Surgical resection or, in metastasized, high dose PPI therapy + somatostatin analogs
What is the treatment for H. pylori?
2 weeks of 3 drug therapy:
Antibiotics
Bismuth
PPIs
What is associated w/H. pylori infection?
MALT lymphoma
Gastric cancer
Describe the structures producing the huge surface area of the small intestine.
1. Plicae circularis (Kerchring's valves)=increase 3x
2. Intestinal villi=increase 10x
3. Brush border of microvilli=20-30x
What are Kerchring's valves?
Permanent circumferential folds of mucosa & submucosa
What are intestinal villi?
projections of mucosa (epithelium & lamina propria)
Where are Brunner's glands?
Submucosa of the duodenum
What are Brunner's glands?
Tubuloacinar glands that secrete alkaline mucus
What are Goblet cells?
Unicellular mucus-secreting glands scattered throughout the intestine
What is the morphology of goblet cells?
Apical cup w/mucus granules
Basal nucleus & prominent Golgi
What are the crypts of Lieberkuhn?
Simple tubular glands in the lamina propria or both small & large intestine which function in absorption & secretion
What are the enterocytes?
Columnar epithelial cells which line the villi of the small intestine
What is the structure of the microvilli?
Core has bundles of F-actin anchored to the plasma membrane by myosin I & calmodulin & cross-linked w/villin & fimbrin
Actin filaments end in a terminal web of horizontally-oriented cytokeratin intermediate filaments & spectrin fibrils
What is the glycocalyx?
Surface coating of the microvilli that contains various digestive enzymes bound to the plasma membrane
What enzymes are embedded in the glycocalyx?
Lactase, sucrase, maltase
enterokinase, aminopeptidase
How are amino acids & disaccharides absorbed?
Active transport in the microvilli
Where are fatty acids & monoglycerides esterified?
SER of the enterocytes
How do chylomicrons leave the villi?
Central lacteal
What are Paneth cells & where are they located?
Immune cells of the small intestine found @ the base of intestinal glands
secrete lysozyme, defensin, TNF
What do S cells secrete?
Secretin
What do K cells secrete?
GIP
What does GIP do?
inhibits gastric acid secretion
What do I cells secrete?
CCK
What do D cells secrete?
Somatostatin
What do EC cells secrete?
Serotonin & substance P
What do Mo cells secrete?
motilin
What do D1 cells secrete?
VIP
What form the core of villi?
Lamina propria
Where are intestinal stem cells found?
Lower 1/3 of the gland
What happens to the lacteals?
They form a lymphatic plexus that empties into the submucosal lymphoid nodules
Where are Peyer's patches found?
Small intestine
Increase in number from duodenum-->ileum
What are Peyer's patches?
Group of lymphoid follicles in the mucosa & submucosa
What is the dome portion of the Peyer's patch?
Contains B cells & separates follicle from overlying epithelium
What covers the Peyer's patch?
Follicle-associated epithelium consisting of M cells & enterocytes
What are M cells?
Specialized epithelial cells derived from epithelial "stem cells" which take up antigens into endocytic vesicles
Describe the movement of IgA in the small intestine.
Plasma cells in the lamina propria produce IgA dimers linked by J chains
Dimers bind to poly-IgA receptors on basal surface of enterocytes-->internalized
secretory component binds to dimers before released
What is the outermost covering of the small intestine?
Duodenum=adventitia
Jejunum & ileum=serosa
How do Goblet cell numbers vary from duodenum-->ileum?
Increase
How do the villi vary from duodenum-->ileum?
Duodenum=leaflike
Jejunum=long
Ileum=short
how do the plicae circularis vary from duodenum-->ileum?
Increase from duodenum-->jejunum
Decrease from jejunum-->ileum
Describe the histology of the appendix.
Mucosa=straight tubular glands
What is the hallmark of the appendix?
Prominent lymphoid follicles in the lamina & submucosa
How does GALT in the appendix change during a lifetime?
Increases from birth-->10y
Decreases after
Describe the epithelial cells of the colon.
NO villi only crypts
Goblet cells in crypts
Endocrine cells scattered
How do Goblet cells vary through the colon?
The increase in number from cecum-->rectum
Describe the lamina propria of the colon.
Has Peyer's patches extending through muscularis mucosa into submucosa
Describe the muscularis propria of the colon.
Muscularis interna is cricular & complete
Muscularis externa becomes the teniae coli
What are appendices epiploicae?
Sac of adipose tissue unique to the colon
Describe the mucosa of the rectum.
Deep intestinal glands lined mostly by goblet cells
Muscularis propria has 2 complete layers
What is the pectinate line?
Line inscribing the bottom of the anal valves.
Where is the internal hemorrhoidal venous plexus w/in the wall?
submucosa
What forms the internal anal sphincter?
Inner circular layer of the muscularis propria
What forms the external anal sphincter?
skeletal muscle
What are complications of GERD?
esophagitis, esophageal stricture, Barret's, malignancy
Nissen fundoplication is used to treat what?
GERD, not always successful
What are risk factors for Barrett's esophagus?
Male sex
Reflux symptoms
Age
What is the treatment for Schatzki's ring?
Endoscopic esophageal dilation w/aggressive reflux treatment w/PPIs
Where does Zenker's diverticulum occur?
Above the UES
What is the treatment for Zenker's diverticulum?
Diverticulectomy w/cricopharyngeal myotomy if symptoms are present
What is the most common type of esophageal cancer worldwide?
Squamous cell carcinoma
What is the most common type of esophageal cancer in the US?
Adenocarcinoma
What are the risk factors for esophageal cancer?
EtOH, Tobacco, Barrett's, head & neck CA, achalasia, obesity
What presents with elevated LES pressure, incomplete LES relaxation, and aperistalsis by manometry?
Esophageal Achalasia
What presents with simultaneous, prolonged contractions w/interimittent peristalsis?
Diffuse Esophageal Spasm
What presents with high pressure peristaltic contractions but normal LES relaxation?
Nutcracker esophagus
What presents with decreased or absent LES pressure & decreased or absent peristalsis?
Hypomotility d/t CT disease
What shows a bird's beak on barium swallow study?
Achalasia
How is esophageal achalasia treated?
Heller myotomy, botox injection, endoscopy dilation of LES
How is diffuse esophageal spasm treated?
Aggressive GERD w/PPIs
How is nutcracker esophagus treated?
Ca2+ channel blockers (diltiazem)
Nitrates
Aggressive GERD w/PPIs
How is hypomotility w/CT disease treated?
GERD therapy
Treat underlying disease
What does a corkscrew esophagus on a barium swallow study suggest?
diffuse esophageal spasm
What is a typical presentation of eosinophilic esophagitis?
Young male w/solid food dysphagia or intermittent food impaction
What are endoscopic & histologic findings consistent with eosinophilic esophagitis?
Endo: ringed esophagus seen in proximal & mid-esophagus
Bx: increased intraepithelial lymphocytes
What are common medications to cause pill esophagitis?
Aledronate
Tetracycline
Doxycycline
KCl
quinidine
NSAIDs
Theophylline
What are the endoscopic findings of pill esophagitis?
ulceration in mid-esophagus
What is the treatment for CMV esophagitis?
Ganciclovir
What is the treatment for HSV esophagitis?
Acyclovir
What is the treatment for Candida esophagitis?
Antifungal (Diflucan)
What is the source of pepsin?
chief cells
What is the difference between diaphragmatic & hiatal hernias?
Diaphragmatic hernias are not where the esophagus passes through the diaphragm
What is a complication of diaphgramatic hernia?
Pulmonary compromise
What causes pyloric stenosis?
Hypertrophy of the muscularis propria
What presents with non-bilious projectile vomiting wtih an "olive" mass?
Pyloric stenosis
How do gastric diverticula appear in the cardia?
Isolated lesions
How gastric diverticula appear in the antum?
With healing ulcer
What is the morphology of acute gastritis?
Hemorrhage, erosion, edema, acute lymphocytic infiltrate
What is the morphology of reactive gastritis/gastropathy?
Elongated, almost corkscrew glands
Vascular congestion
Neutrophils @ surface
Minimal inflammation
What are the most common causes of acute gastritis?
NSAIDs
Bile acids
EtOH
Stress
Shock
What is acute gastritis erosion & ulceration?
Extension of acute erosive gastritis to form well-demarcated focal ulcers
What is Type A Chronic Gastritis?
In adults w/pernicious anemia
antibodies to IF & parietal cells
Also Chronic Fundal or Body Gastritis
What can occur in chronic antral gastritis if the patient does not have antibodies to IF?
Gastric ulcers or gastric carcinoma
H. PYLORI!!!!
What is Chronic Environmental gastritis?
No autoantibodies
Type B or AB Chronic gastitis
What is the morphology of chronic gastritis?
flat epithelium, atrophy, chronic inflammation, intestinal metaplasia
What are large gastric folds usually d/t?
ZE Syndrome: gastrin-stimulated rugal hypertrophy
What is Menetriers?
large gastric folds d/t hypertrophy of mucin-producing glands
What are the six most common sites for peptic ulcers in order of frequency?
Duodenum
Stomach
Esophagus
Margins of stoma of gastroenterostomy
Meckel's diverticulum w/gastic mucosa
Gastrojejunum in ZE syndrome
Where are most duodenal ulcers located?
1st part of duodenum
Where are most gastric ulcer located?
Antrum @ lesser curvature
What are the 4 histologic zones of an ulcer?
1. Thin layer of fibrinoid debris (fibrin)
2. Active nonspecific inflammation (PMNs)
3. Granulation tissue
4. Scar (fibrosis)
What is the importance of hyperplastic gastric polyps?
Differentiate from adenomas
No malignant potential
What are fundic gland polyps?
Dilated gastric glands
What is the significance of gastric adenomas?
40% have cancer or adjacent cancer
What are gastric leiomyomas?
Benign polyps
What type of gastric cancer is on the decline?
Intestinal-type adenocarcinoma but NOT diffuse-type
What are the risk factors for gastric adenocarcinoma?
Nitrites, genetics, adenoma, chronic atrophic gastritis, H. pylori
What is the morphology of intestinal-type adenocarcinoma?
Polypoid-gland forming w/intestinal metaplasia
mitotic figures in gland
irregular cells & necrosis
What is the morpholog of diffuse-type adenocarcinoma?
signet rign cellls
What are common metastasis of gastric carcinoma?
regional lymph nodes, lvier, lungs, peritoneum, ovaries (krukenberg), Virchows
What is the c-kit mutation related to?
GIST
What is the origin of GIST?
Interstitial cells of Cajal
Where can a GIST be found?
Anywhere in GI tract
What is c-kit?
constitutive actvation of the tyr kinase pathway
What is the treatment for GIST?
resection & treatment w/tyrosine kinase inhibitor (STI571)
What is the morphology of GIST?
spindle & epithelioid cells
What are the H2 blockers?
-tidines
What are the side effects of the H2 blockers?
bradycardia, confusion
Cimetidine inhibits p450-->inhibits androgen synthesis
How do the H2 blockers work?
Block histamine from binding to H2 histamine receptors on parietal cells-->blocks histamine-stimulated increase in proton pump activity
What are the PPIs?
-azoles
What are the side effects of the PPIs?
hypochlorhydria
decreased calcium absorption
How do PPIs work?
weak base accumulates in parietal cells & inhibits the proton pump
List the agents that decrease acid secretion.
H2 blockers
PPIs
Cholinergic blockers
What are the cholinergic blockers?
atropine
propantheline
What are the s/e of sodium bicarb?
systemic absorption
compromise of low Na diets
What are the s/e of calcium carbonate?
chalky
constipation
hypercalcemia
What are the s/e of aluminium hydroxide?
constipation, drug absorption, phosphate loss, Al toxicity
What are the side effects of Mg(OH)2, MgCO3 MgO, or Mgtrisilicate?
Laxative
Mg toxicity
What is the slowest acting antacid?
AlOH3
what antacid has the shortest duration?
NaHCO3
What is the order of ease of absorption of the cations found in antacids?
Na>>Ca>Mg>Al
What is the problem associated w/cation absorption?
systemic alkalinization
What does sucralfate do?
Becomes viscous & binds to damaged mucosa after being exposed to acid
Can incease angiogenesis
What are the side effects of sucralfate?
D/t excess Al3+ absorption
do NOT use with PPIs
What do you NOT use w/PPIs?
Sucralfate
What does bismuth subsalicylate do?
Binds to damaged mucosa & increases mucus production
What are the s/e of bismuth subsalicylate?
decrease H. Pylori growth
Temporarily turn feces, teeth, tongue black
What is a prostaglandin analog?
Misoprostol
What do prostaglandin analogs do?
Increase mucus & bicarb production in the stomach
What are the s/e of prostaglandin analogs?
Increased uterine contractions
What antibiotics are given to treat H. pylori infections?
Metronidazole
Tetracycline
Amoxicillin
Clarithromycin
What is metoclopromide?
DA agonist which may sensitize tissues to ACh
What are the side effects of metoclopromide?
Sedation, increased prolactin, depression, Parkinson-like syndrome
What does erythromycin do?
Binds to & activates motilin receptors in the gut
What are the s/e of erythromycin?
pseudomembranous colitis
ototoxicity
cardiotoxicity
What is dioctal sodium sulfosuccinate?
a detergent which changes the surface tension of the guts
Why should mineral oil NEVER be used?
aspiration of mineral oil can lead to lipid pneumonia
decreases absorption of fat-soluble nutrients
What are the bulk-adding agents?
Bran
Methylcellulose
Psyllium
What are the gastric irritants used to treat constipation?
Anthraquinones:
Aloe
Cascara
Senna
Bisacdyl
What are the s/e of gastric irritants used to treat constipation?
liver damage
nephritis
What are the osmotic agents used to treat constipation?
MgSO4
Mg(OH)2
Polyethylene glycol
What is a secretion enhancer used to treat constipation?
pG derivative which activates chloride channels in the gut to increase secretion of intestinal fluid
What are the s/e of the secretion enhancer?
abdominal distension
nausea
What are the narcotic agents used to treat diarrhea?
Paragoric
Codeine
Morphine
Diphenoxylate
Loperamide
What is the different between loperamide and most other narcotic used to treat diarrhea?
does not cross BBB
What is bismuth subsalicylate's use in treating diarrhea?
binds to some toxins
What is simethicone?
treat diarrhea
decreases pai ncaused by GI gas & decreases surface tension of gas pockets
Waht is octreotide?
somatostatin analog give IV or subQ for diarrhea
What drugs are used to treat IBS?
Antidepressants
Antiepileptics
Metoclopromide, anticholinergics, antidiarrheals (lopermiade)
What is sulfasalazine?
5-ASA + sulfa antibiotic
What is mesalamine?
encapsulated 5-ASA
What is olsasalazine?
5-ASA dimer
What is balsalazine?
5-ASA prodrug
How do the 5-ASA works?
decreased prostaglandin synthesis, topical anti-inflammatory
What are the side effects of 5-ASA?
all can cause diarrhea
sulfasalazine=allergic response
Take 3-6 weeks to work
What is infliximab?
anti-TNF monoclonal antibody
What are the s/e of infliximab?
infections
What are the central emetics?
Apomorphine
Morphine
Cardiac glycosides
What are the reflex stimulants?
Ipecac
How does ipecac work?
emetine is an alkaloid which stimulates recpetors in the mucosa
What are the side effects of ipecac?
abuse
cardiotoxicity
What are the treatments for emesis?
Antihistamines
Anticholinergics
THC
Dopaminergic blockers
Serotonin receptor blockers
NK receptor blocker
What are the antihistamine antiemetics?
Diphenhydrazine
Meclizine
What are the anticholinergics antiemetics?
Scopolamine
What are the THC-based antiemetics?
THC (Dronabinol)
Nabilone
What are the dopaminergic blocker antiemetics?
Phenothiazines
Prodilorpenzine
How do dopaminergic blockers work as antiemetics?
Act in chemoreceptor trigger zone
What are the serotonin receptor blockers?
-setrons
What is an advantage of serotonin receptor blockers?
little to no effect on gastric motility or BP
What is a side effect of serotonin receptor blockers?
Constipation
What is aprepitant?
Neurokinin receptor inhibitor used for antiemesis
How does small intestine atresia or stenosis present?
Persistent vomiting in first 1-2 weeks
What is the lining of diverticula?
Mucosa & submucosa
What is a rare form of diverticula?
Blind loop syndrome caused by B12 deficiency
What is a remnant of an embryologic duct?
Meckel's diverticulum
What are the types of epithelium found in Meckel's diverticulum?
Gastric mucosa
Pancreatic rests
What is the rule of 2 & what does it pertain to?
2% of population
2x more common in males
2 feet from ileocecal valve
2 types of epithelium
Meckel's
What are predisposing conditions for ischemic bowel?
Arterial thrombosis
Arterial embolization
Venous thrombosis
Shock
What causes a transmural infarct?
Major mesenteric vessel occlusion
What is the morphology of ischemic bowel?
Congested, dusky, hemorrhagic thickened
Arterial occlusions show sharper edges than venous
When is the most common period for diagnosis of CD?
3rd decade
What is the morphology of CD?
segmented involvement of gut
thickened & inflexible wall
fat wrapping
serpentine ulcers
non-caseating granulomas
transmural inflammation
lymphoid aggregates
What are complications associated with CD?
anal fistulae & abscesses
bearclaw ulcer
fissures
What vitamin deficiencies are associated w/malabsorption?
AKDB12
What is Whipple's disease?
Rod-shaped bacilli in macrophages throughout the body
cured by abx
PAS + granules in macrophages
What kind of patient gets Whipple's disease?
White 4th-5th
What is intussuseption?
proximal bowel telescopes into distal bowel
What is volvulus?
complete twisting of a loop of bowel around its mesenteric base that can cause intestinal obstruction & infarction
Where is volvulus most common?
Sigmoid colon
What IBD spares the rectum?
CD
What IBD spares the anus?
UC
What is supplied by the SMA?
Right colon & 1/2 of transverse colon
What congenital anomaly is related to UG abnormalities?
Imperforate anus
Pigmented macrophages in the lamina propria are the result of what?
This is melanosis coli
Occurs d/t chronic laxative use
Define "hemorrhoid."
Varices of anal & perianal venous plexuses.
What are "dilated veins in the submucosa of the cecum & ascending colon"?
Angiodysplasia
Angiodysplasia of the right colon is most common in what demographic?
70s
What blood group is UC related to?
HLAB27
Autoantibodies to antimucopolysaccharide antigen occur in what disease?
UC
Colonic pseudopolyps are related with what disease?
UC
Distended glands willed w/mucin-containing PMNs & covered with a membrane composed of fibrin, mucin, and PMNs is the morphology of what disease?
Pseudomembranous colitis
What is the most common GI emergency of neonates?
Necrotizing enteritis
A chronic history of episodic watery diarrhea in an elderly person & a normal colonoscopy indicates what disease & what is its morphology?
Collagenous colitis (A) or lymphocytic colitis (B)
A: Thickened collagenous band is found beneath the surface epithelium
B: increased intraepithelial lymphocytes
What is a sessile serrated adenoma?
Morphology similar to hyperplastic polyp but basilar architectural distortion is premalignant, similar to adenoma
Where are villous adenomas most commonly found?
Rectosigmoid colon
What are the most symptomatic of the colonic polyps w/malignant potential?
Villous adenoma
A child has melanin pigmentation of the lips & digits & hamartomatous polyps. What is the disease & what is the malignant potential of this?
Peutz-Jehgers
Autosomal dominant
Minimal cancer risk
A person has colon adenomas & brain tumors. What heredofamilial polyposis is this?
Turcot's
John has colon adenomas & has had neoplasms of the bone and skin. What heredofamilial polyposis is this? What is the hereditary relation? What is the cancer risk?
Gardner's
Autosomal dominant
100% colon cancer risk
What heredofamilial polyposis syndrome is related to MLH1?
HNPCC