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350 Cards in this Set
- Front
- Back
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Name the layers of the mucosa from lumen-->deeper.
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Epithelium
Lamina propria Muscularis mucosa |
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Name the layers of the wall of the GI tract.
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Mucosa
Submucosa Muscularis propria Adventitia/serosa |
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Where Meissner's plexus found?
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Submucosa
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Where is Auerbach's plexus found?
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Between the muscularis externa & muscularis interna in the muscularis propria
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What are the contents of the submucosa?
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Dense CT, vessels, GALT, submucosal glands, Meissner's plexus
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Describe the muscularis propria.
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Muscularis interna: circular
Muscularis externa: longitudinal |
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Where is the outermost layer of the GI tract wall adventitia & where is it serosa?
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Retroperitoneal organs have adventitia
Peritoneal organs have serosa |
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What kind of epithelium is found in the esophagus?
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Non-keratinized stratified squamous epithelium
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Where are esophageal glands found in the esophagus?
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Upper & lower 1/3s of the esophagus
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What is the serosa made of?
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Mesothelial cells
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What kind of epithelial cells are found in the stomach?
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Simple columnar epithelial cells
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What is the structure of the stomach mucosa?
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Epithelium invaginates into lamina propria to form gastric pits into which tubular glands empty.
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What part of the glands empty into the gastric pits?
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the isthmus
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What makes up the isthmus of the mucosal glands of hte stomach?
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reserve cells & parietal cells
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What lines the neck of the mucosal glands of the stomach?
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Reserve cells
Mucus neck cells Parietal cells |
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What are the mucus neck cells?
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Mucus-secreting cells scattered in very small numbers in the neck of the gastric glands of the stomach
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Where are stem cells found in the stomach?
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In the neck
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What is morphology of stem cells in the gastric mucosa?
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Indistinct low columnar cells
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Where are the parietal cells found?
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The neck of the gastric gland
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What is the morphology of parietal cells?
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Large, eosinophilic pyramidal cells w/central nucleus
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What is the function of parietal cells?
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Secrete HCl v& intrinsic factor
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What activates parietal cells?
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ACh
Histamine |
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What cells produce intrinsic factor?
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Parietal cells
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Where is carbonic anhydrase found?
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IN parietal cells
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What are chief cells?
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Large basophilic cells w/basal nucleus & basal RER which produce pepsinogen
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Which cells produce pepsinogen?
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Chief cells
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Where are chief cells found?
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Basal portion of gastric glands
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What stimulates chief cells?
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ACh
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What is mucin?
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A protective coat on cell surface of gastric cells which traps HCO3, Na, K, and Cl
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What do G cells produce?
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Gastrin
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Where are G cells found?
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Pyloric glands
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What are D cells?
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Somatostatin-producing cells
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Where are D cells found?
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Pyloric glands
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What does somatostatin do?
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Inhibits the activity of other neuroendocrine cells
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What does gastrin do?
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Stimulates parietal cell secretion of H
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What are A cells?
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Glucagon-producing cells
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Where are A cells found?
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Throughout the gastric glands
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What are EC cells?
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Histamine-producing cells
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Where are endocrine cells found in mucosal glands?
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Base of gastric glands
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Characterize the muscularis mucosa in the stomach.
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Fairly thick w/SM strands extending into the lamina propria to facilitate the emptying of gastric glands
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Where does the muscularis propria have 3 layers?
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The stomach
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What are the layers of the muscularis propria in the stomach?
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Inner oblique
Middle circular Outer longitudinal |
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What is a linear plant starch?
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Amylose
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What is a branched plant starch?
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Amylopectin
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What plant polysaccharide has an alpha-1,4 glycosidic bond?
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Amylose
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What plant polysaccharide has both an alpha-1,4 glycosidic bond and an alpha-1,6 glycosidic bond?
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Amylopectin
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What kind of bond does sucrose have?
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alpha1,2 glycosidic
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What kind of bond does lactose have?
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beta1,4 glycosidic
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What is in sucrose?
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Glucose & fructose
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What is in lactose?
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Glucose & galactose
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What sugar has an alpha1,1-glycosidic bond?
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Trehalose
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What is the function of alpha-amylase?
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Hydrolysis of internal alpha1,4-glycosidic bonds between glucosyl residues
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What is produced by alpha-amylase?
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Maltose
Iso-maltose Trisaccharides Alpha-dextrins |
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What happens to salivary alpha-amylase?
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Inactivated by the low pH of the stomach
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What are the 2 types of alpha-amylase?
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Pancreatic & salivary
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What is maltase-glucoamylase?
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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 |
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What is a limitation of maltase-glucoamylase?
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Cannot digest isomaltose
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What is done by sucrase-isomaltase?
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Sucrase=cuts alpha-12 bonds in sucrose
Isomaltase=cuts alpha-1,6 bonds in isomaltose & alpha-dextins & alpha-1,4 bonds in maltose & maltotriose |
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What is done by trehalase?
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cuts alpha-1,1 glycosidic bond in trehalose
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What does lactase do?
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Cuts beta-1,4 glycosidic bond in lactose
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What is the result of a maltase-glucoamylase deficiency?
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Chronic diarrhea which improves w/starch-free diet
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What is the result of a sucrase-isomaltase deficiency?
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Symptoms of sucrose intolerance but can tolerate normal amounts of starch in diets
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What enzyme deficiency is frequent in Greenland?
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Sucrase-isomaltase deficiency
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What is the result of a trehalase deficiency?
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Nausea, vomiting, severe GI distress upon trehalose consumption
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What is a primary lactase deficiency?
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Nonpersistent lactase deficiency
The natural decrease in lactase levels after infancy |
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What is a secondary lactase deficiency?
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Lactase deficiency caused by intestinal injury
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What can cause a secondary lactase deficiency?
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Kwashiorkor, colitis, gastroenteritis, sprue, XS EtOH consumption
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What is the glycemic index?
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A measure of how rapidly blood glucose levels rise after consumption
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How do fructose, galactose, and glucose move into the interstitium from the cytosol?
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Facilitated transport
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What is produced by metabolism of undigestible starch by colonic bacteria?
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Hydrogen
Carbon dioxide Methane Short-chain fatty acids (acetic acid, propionic acid, butyric acid) Lactate |
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Name two low digestible carbohydrates which can be added to the diet.
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Pectins
Beta-glucan |
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How are low digestible carbs helpful in the diet?
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Bind bile acids & reduce carb absorption
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What anatomic landmark corresponds w/the upper esophageal sphincter?
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C5-C6
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What is the most common location of esophageal atresia?
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Near tracheal bifurcation
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What is esophageal achalasia?
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Failure of relaxation of the lower esophageal sphincter w/proximal dilation
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What are the 3 separable defects of esophageal achalasia?
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Aperistalsis
Incomplete relaxation of LES Increased resting tone |
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What is the morphology of esophageal achalasia?
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Dilation of esophagus above the LES
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What is the treatment for esophageal achalasia?
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Dilation or surgery
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What is Plummer-Vinson syndrome?
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Anemia
Atrophic glossitis Upper esophageal webs Dysphagia |
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What is the a typical patient with upper esophageal webs?
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Women w/iron deficiency anemia
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What are Schatzki's rings?
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Lower esophageal webs
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Where are Schatzki's rings most commonly found?
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Caudal 5cm of the esophagus @ the squamocolumnar junction
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What is associated with Schatzki's rings?
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hiatal hernia
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What is associated with esophageal achalasia?
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Increased carcinoma risk
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What are the two types of hiatal hernias?
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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%) |
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What are possible complications of hiatal hernias?
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Bleeding
Ulcers Perforation Barrett's esophagus Strangulation possible in rolling hiatal hernia |
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What can be used to diagnose hiatal hernias?
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Roentgenograms
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What is Mallory-Weiss syndrome?
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Lacerations/tears in the esophagus following severe vomiting
More common in EtOHics |
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What are the three sites that esophageal diverticula are commonly found at?
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Above UES (Zenker's)
Middle of esophagus Above LES |
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What is seen in scleroderma affecting the esophagus?
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Fibrosis of the esophageal wall w/atrophy of smooth muscle
Can see luminal narrowing, atrophic mucosa, ulcerations |
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What are the microscopic findings of reflux esophagitis?
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Basal cell hyperplasia
Upward lamina propria Increased eosinophils |
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What are complications of reflux esophagitis?
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pain
bleeding stricture ulcer Barrett's |
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What might be found in the hx of a person w/eosinophilic esophagitis?
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Asthma, atopy, peripheral eosinophilia
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How is eosinophilic esophagitis diagnosed?
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Rule out reflux
Bx of middle 1/3 of esophagus showing increased eosinophils |
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What is the treatment for eosinophilic esophagitis?
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Steroids x 6 weeks
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What are typical causes of esophageal varices?
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Cirrhosis, portal vein thrombosis, Budd-Chiari, acute pyelophlebitis
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Where are esophageal varices most common?
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Distal 1/3 of the esophagus
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How is Barrett's esophagus diagnosed?
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Endoscopy: salmon colored mucosa in the esophagus
Biopsy: columnar epithelium w/intestinal metaplasia & goblet cells |
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What is the clinical course of Barrett's?
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Dysphagia, retrosternal pain, sometimes hematemesis or melena
INCREASED risk of adenocarcinoma!!! |
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What is a benign esophageal tumor?
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Leiomyoma
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What is the epidemiology of adenocarcinoma of the esophagus?
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M>F
Black>White |
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What is the microscopic appearance of esophageal adenocarcinoma?
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Dark, disorganized glands & huge nuclei
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Where are esophageal adenocarcinomas most commonly found?
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Distal 1/3
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Where are squamous cell carcinomas of the esophagus most commonly found?
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Middle 1/3 of the esophagus
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What is the epidemiology of squamous cell carcinoma of the esophagus?
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M>F
Black>White |
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What are the risk factors for squamous cell carcinoma of the esophagus?
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Nitrosamines, nitrates, fungal contamination of food, Vinson-Plummer, achalasia, esophagitis
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What type of cancer can have keratin pearls?
|
Squamous cell carcinoma
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What are the risk factors for peptic ulcer disease?
|
NSAID use
H. pylori Cigarette smoking Chronic liver dz, lung dz, renal failure |
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What is the most common presenting symptom of peptic ulcer disease?
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Epigastric pain
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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 |
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What lab studies might be done for a patient w/PUD?
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Antibody studied for H. pylori
Gastrin levels |
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What is the standard diagnosing method for PUD?
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Endoscopy
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What kind of patient more commonly gets gastric ulcers?
|
Elderly female patients
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What kind of ulcer has a greater risk of cancer: duodenal or gastric?
|
Gastric
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Does every duodenal ulcer have to be biopsied?
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no
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Ulcers in what location have an increased association w/NSAID use?
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Gastric
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How can NSAIDs cause ulcers?
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Break mucosal barrier & inhibit prostaglandin synthesis
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What are the goals of therapy for PUD?
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Reduce symptoms
Accelerate healing Prevent complications Reduce recurrences |
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How can mucosal integrity be enhanced in the treatment of PUD patients?
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Discontinuation of NSAIDs/ASA
Sucralfate |
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What are the major complications of PUD?
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Perforation
Penetration Obstruction Hemorrhage |
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What are the S&S of perforation of an ulcer?
|
Free air in the abdomen
Sudden, severe, diffuse pain |
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What is the difference between perforation & penetration?
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Penetration is the penetration of an ulcer into adjacent viscera (eg pancreas)--> a "closed perforation"
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What are the S&S of penetration?
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Intense pain radiating to the back
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What causes obstruction as a complication of PUD?
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Edema & scarring of peri-pyloric ulcers
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What are the S&S of hemorrhage as a complication of PUD?
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Nausea, hematemesis, melena, dizziness
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What makes re-bleeding more likely in a bleeding ulcer?
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Visible vessel in the ulcer crater
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What can cause treatment failure in peptic ulcer disease?
|
Inadequate treatment
Incorrect diagnosis Host factors (compliance, ASA use) Hypersecretory state (gastrinoma/ZE syndrome) |
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What is Zollinger-Ellison syndrome?
|
Gastrin secreting tumor, most commonly in the pancreas & duodenum
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What are the genetics of Zollinger-Ellison syndrome?
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80% sporadic
20% associated w/MEN-1 (autosomal dominant) |
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What is the presentation of Zollinger-Ellison syndrome?
|
Ulcers (90%)
Diarrhea Recurrent/severe PUD w/o H. pylori or NSAID use |
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How is Zollinger-Ellison syndrome diagnosed?
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High fasting gastrin level
Secretin stimulation test somatostatin receptor scintigraphy to localize the tumor |
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What is the treatment for Zollinger-Ellison syndrome?
|
Surgical resection or, in metastasized, high dose PPI therapy + somatostatin analogs
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What is the treatment for H. pylori?
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2 weeks of 3 drug therapy:
Antibiotics Bismuth PPIs |
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What is associated w/H. pylori infection?
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MALT lymphoma
Gastric cancer |
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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 |
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What are Kerchring's valves?
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Permanent circumferential folds of mucosa & submucosa
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What are intestinal villi?
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projections of mucosa (epithelium & lamina propria)
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Where are Brunner's glands?
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Submucosa of the duodenum
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What are Brunner's glands?
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Tubuloacinar glands that secrete alkaline mucus
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What are Goblet cells?
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Unicellular mucus-secreting glands scattered throughout the intestine
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What is the morphology of goblet cells?
|
Apical cup w/mucus granules
Basal nucleus & prominent Golgi |
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What are the crypts of Lieberkuhn?
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Simple tubular glands in the lamina propria or both small & large intestine which function in absorption & secretion
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What are the enterocytes?
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Columnar epithelial cells which line the villi of the small intestine
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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 |
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What is the glycocalyx?
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Surface coating of the microvilli that contains various digestive enzymes bound to the plasma membrane
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What enzymes are embedded in the glycocalyx?
|
Lactase, sucrase, maltase
enterokinase, aminopeptidase |
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How are amino acids & disaccharides absorbed?
|
Active transport in the microvilli
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Where are fatty acids & monoglycerides esterified?
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SER of the enterocytes
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How do chylomicrons leave the villi?
|
Central lacteal
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What are Paneth cells & where are they located?
|
Immune cells of the small intestine found @ the base of intestinal glands
secrete lysozyme, defensin, TNF |
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What do S cells secrete?
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Secretin
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What do K cells secrete?
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GIP
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What does GIP do?
|
inhibits gastric acid secretion
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What do I cells secrete?
|
CCK
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What do D cells secrete?
|
Somatostatin
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What do EC cells secrete?
|
Serotonin & substance P
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What do Mo cells secrete?
|
motilin
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What do D1 cells secrete?
|
VIP
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What form the core of villi?
|
Lamina propria
|
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Where are intestinal stem cells found?
|
Lower 1/3 of the gland
|
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What happens to the lacteals?
|
They form a lymphatic plexus that empties into the submucosal lymphoid nodules
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Where are Peyer's patches found?
|
Small intestine
Increase in number from duodenum-->ileum |
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What are Peyer's patches?
|
Group of lymphoid follicles in the mucosa & submucosa
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What is the dome portion of the Peyer's patch?
|
Contains B cells & separates follicle from overlying epithelium
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What covers the Peyer's patch?
|
Follicle-associated epithelium consisting of M cells & enterocytes
|
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What are M cells?
|
Specialized epithelial cells derived from epithelial "stem cells" which take up antigens into endocytic vesicles
|
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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 |
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What is the outermost covering of the small intestine?
|
Duodenum=adventitia
Jejunum & ileum=serosa |
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How do Goblet cell numbers vary from duodenum-->ileum?
|
Increase
|
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How do the villi vary from duodenum-->ileum?
|
Duodenum=leaflike
Jejunum=long Ileum=short |
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|
how do the plicae circularis vary from duodenum-->ileum?
|
Increase from duodenum-->jejunum
Decrease from jejunum-->ileum |
|
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Describe the histology of the appendix.
|
Mucosa=straight tubular glands
|
|
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What is the hallmark of the appendix?
|
Prominent lymphoid follicles in the lamina & submucosa
|
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How does GALT in the appendix change during a lifetime?
|
Increases from birth-->10y
Decreases after |
|
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Describe the epithelial cells of the colon.
|
NO villi only crypts
Goblet cells in crypts Endocrine cells scattered |
|
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How do Goblet cells vary through the colon?
|
The increase in number from cecum-->rectum
|
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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
|
|
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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?
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Isolated lesions
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How gastric diverticula appear in the antum?
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With healing ulcer
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What is the morphology of acute gastritis?
|
Hemorrhage, erosion, edema, acute lymphocytic infiltrate
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What is the morphology of reactive gastritis/gastropathy?
|
Elongated, almost corkscrew glands
Vascular congestion Neutrophils @ surface Minimal inflammation |
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What are the most common causes of acute gastritis?
|
NSAIDs
Bile acids EtOH Stress Shock |
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What is acute gastritis erosion & ulceration?
|
Extension of acute erosive gastritis to form well-demarcated focal ulcers
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What is Type A Chronic Gastritis?
|
In adults w/pernicious anemia
antibodies to IF & parietal cells Also Chronic Fundal or Body Gastritis |
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What can occur in chronic antral gastritis if the patient does not have antibodies to IF?
|
Gastric ulcers or gastric carcinoma
H. PYLORI!!!! |
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What is Chronic Environmental gastritis?
|
No autoantibodies
Type B or AB Chronic gastitis |
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What is the morphology of chronic gastritis?
|
flat epithelium, atrophy, chronic inflammation, intestinal metaplasia
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What are large gastric folds usually d/t?
|
ZE Syndrome: gastrin-stimulated rugal hypertrophy
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What is Menetriers?
|
large gastric folds d/t hypertrophy of mucin-producing glands
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|
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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 |
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Where are most duodenal ulcers located?
|
1st part of duodenum
|
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|
Where are most gastric ulcer located?
|
Antrum @ lesser curvature
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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) |
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What is the importance of hyperplastic gastric polyps?
|
Differentiate from adenomas
No malignant potential |
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What are fundic gland polyps?
|
Dilated gastric glands
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What is the significance of gastric adenomas?
|
40% have cancer or adjacent cancer
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What are gastric leiomyomas?
|
Benign polyps
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What type of gastric cancer is on the decline?
|
Intestinal-type adenocarcinoma but NOT diffuse-type
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What are the risk factors for gastric adenocarcinoma?
|
Nitrites, genetics, adenoma, chronic atrophic gastritis, H. pylori
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What is the morphology of intestinal-type adenocarcinoma?
|
Polypoid-gland forming w/intestinal metaplasia
mitotic figures in gland irregular cells & necrosis |
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What is the morpholog of diffuse-type adenocarcinoma?
|
signet rign cellls
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What are common metastasis of gastric carcinoma?
|
regional lymph nodes, lvier, lungs, peritoneum, ovaries (krukenberg), Virchows
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What is the c-kit mutation related to?
|
GIST
|
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What is the origin of GIST?
|
Interstitial cells of Cajal
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Where can a GIST be found?
|
Anywhere in GI tract
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What is c-kit?
|
constitutive actvation of the tyr kinase pathway
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What is the treatment for GIST?
|
resection & treatment w/tyrosine kinase inhibitor (STI571)
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What is the morphology of GIST?
|
spindle & epithelioid cells
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What are the H2 blockers?
|
-tidines
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What are the side effects of the H2 blockers?
|
bradycardia, confusion
Cimetidine inhibits p450-->inhibits androgen synthesis |
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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
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What are the PPIs?
|
-azoles
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What are the side effects of the PPIs?
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hypochlorhydria
decreased calcium absorption |
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How do PPIs work?
|
weak base accumulates in parietal cells & inhibits the proton pump
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List the agents that decrease acid secretion.
|
H2 blockers
PPIs Cholinergic blockers |
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What are the cholinergic blockers?
|
atropine
propantheline |
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What are the s/e of sodium bicarb?
|
systemic absorption
compromise of low Na diets |
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What are the s/e of calcium carbonate?
|
chalky
constipation hypercalcemia |
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What are the s/e of aluminium hydroxide?
|
constipation, drug absorption, phosphate loss, Al toxicity
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What are the side effects of Mg(OH)2, MgCO3 MgO, or Mgtrisilicate?
|
Laxative
Mg toxicity |
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What is the slowest acting antacid?
|
AlOH3
|
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|
what antacid has the shortest duration?
|
NaHCO3
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What is the order of ease of absorption of the cations found in antacids?
|
Na>>Ca>Mg>Al
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What is the problem associated w/cation absorption?
|
systemic alkalinization
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What does sucralfate do?
|
Becomes viscous & binds to damaged mucosa after being exposed to acid
Can incease angiogenesis |
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What are the side effects of sucralfate?
|
D/t excess Al3+ absorption
do NOT use with PPIs |
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What do you NOT use w/PPIs?
|
Sucralfate
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What does bismuth subsalicylate do?
|
Binds to damaged mucosa & increases mucus production
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What are the s/e of bismuth subsalicylate?
|
decrease H. Pylori growth
Temporarily turn feces, teeth, tongue black |
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What is a prostaglandin analog?
|
Misoprostol
|
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What do prostaglandin analogs do?
|
Increase mucus & bicarb production in the stomach
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What are the s/e of prostaglandin analogs?
|
Increased uterine contractions
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What antibiotics are given to treat H. pylori infections?
|
Metronidazole
Tetracycline Amoxicillin Clarithromycin |
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What is metoclopromide?
|
DA agonist which may sensitize tissues to ACh
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|
|
What are the side effects of metoclopromide?
|
Sedation, increased prolactin, depression, Parkinson-like syndrome
|
|
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What does erythromycin do?
|
Binds to & activates motilin receptors in the gut
|
|
|
What are the s/e of erythromycin?
|
pseudomembranous colitis
ototoxicity cardiotoxicity |
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What is dioctal sodium sulfosuccinate?
|
a detergent which changes the surface tension of the guts
|
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Why should mineral oil NEVER be used?
|
aspiration of mineral oil can lead to lipid pneumonia
decreases absorption of fat-soluble nutrients |
|
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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
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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
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What is bismuth subsalicylate's use in treating diarrhea?
|
binds to some toxins
|
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What is simethicone?
|
treat diarrhea
decreases pai ncaused by GI gas & decreases surface tension of gas pockets |
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|
Waht is octreotide?
|
somatostatin analog give IV or subQ for diarrhea
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|
|
What drugs are used to treat IBS?
|
Antidepressants
Antiepileptics Metoclopromide, anticholinergics, antidiarrheals (lopermiade) |
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What is sulfasalazine?
|
5-ASA + sulfa antibiotic
|
|
|
What is mesalamine?
|
encapsulated 5-ASA
|
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What is olsasalazine?
|
5-ASA dimer
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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
|
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|
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
|
