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Step 1 First Aid 10: Gastrointestinal

Step 1 First Aid 10: Gastrointestinal

by rhymenoceros, Apr. 2011

Subjects: 1 10 aid first gastrointestinal step

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251 Cards in this Set

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	falciform ligament connects ___ and ___ it contains ___ it is derived from ___	liver anterior abdominal wall ligamentum teres fetal umbilical vein
	hepatoduodenal ligament connects ___ and ___ it contains ___ it connects the spaces ___ (2)	liver duodenum portal triad greater sac lesser sac
	portal triad	hepartic a. portal v. CBD
	gastrohepatic ligament connects ___ and ___ it contains ___	liver lesser curvature of stomach gastric a.s
	gastrocolic ligament connects ___ and ___ it contains ___	greater curvature of stomach transverse colon gastroepiploic a.s
	gastrosplenic ligament connects ___ and ___ it contains ___	greater curvature of stomach spleen short gastric a.s
	splenorenal ligament connects ___ and ___ it contains ___ (2)	spleen posterior abdominal wall splenic a. splenic v.
	esophagus has ___ epithelium	nonkeratinized stratified squamous
	4 layers of gut wall	mucosa submucosa muscularis serosa
	3 parts of mucosa	epithelium lamina propria muscularis mucosae
	2 features of submucosa	Brunner's glands Meissner's plexus
	Brunner's glands are located in ___ and do ___ they become hypertrophic in ___	duodenum (proximal to sphincter of Oddi) secrete HCO3- + mucus to neutralize chyme pH peptic ulcer disease
	Meissner's plexus does ___ (3)	regulation of secretion regulation of blood flow regulation of absorption
	3 features of muscularis	circular muscle layer Auerbach's plexus longitudinal muscle layer
	longitudinal muscle layer is on ___ circular layer is on ___	outside inside
	crypts of Lierberkuhn are located in ___ and do ___ (2)	whole small intestine enzyme secretion epithelial regeneration (stem cells)
	3 enzymes secreted from crypts of Lieberkuhn	maltase sucrase enteropeptidase
	___ has greatest absorptive surface area ___ has most goblet cells	duodenum (then j, then i) jejunum
	Peyer's patches are located in ___ (2) layers of ___	lamina propria submucosa ileum
	celiac trunk is located at level ___	T12
	SMA orifice is located at level ___	L1
	L renal a. orifice is located at level ___	L1
	gonadal a. orifices are located at level ___	L2
	IMA orifice is located at level ___	L3
	AA bifurcation is at level	L4
	foregut derivatives are ___ they are perfused by ___ they have PARA innervation by ___	stomach + proximal duodenum celiac trunk vagus
	midgut derivatives are ___ (5) they are perfused by ___ they have PARA innervation by ___	distal duodenum jejunum ileum ascending colon proximal 2/3 of transverse colon SMA vagus
	hindgut derivatives are ___ (4) they are perfused by ___ they have PARA innervation by ___	distal 1/3 of transverse colon descending colon sigmoid proximal rectum IMA pelvic nerves
	3 branches of celiac in CW order	L gastric splenic common hepatic
	common hepatic a. gives ___ (2) to become ___	gastroduodenal a. R gastric hepatic a. proper
	R. gastric a. anastomoses with ___ both perfuse ___	L gastric a. lesser curvature of stomach
	2nd part of duodenum is perfused by ___ from the ___	superior pancreaticoduodenal a. gastroduodenal a.
	greater curvature of stomach is perfused by ___ (2) from ___ on L and ___ from ___ on R	L gastroepiploic a. short gastric a.s splenic a. R gastroepiploic a. gastroduodenal a.
	a.s perfusing stomach which lack good anastomosis	short gastrics (if splenic a. is blocked)
	4 anastomoses which compensate for AA	internal thoracic sup. pancreaticoduodenal middle colic sup. rectal
	internal thoracic , a branch of ___, anastomoses with ___, a branch of ___, which anastomoses with ___, a branch of ___	subclavian sup. epigastric int. thoracic inf. epigastric ext. iliac
	sup. pancreaticoduodenal, a branch of ___, anastomoses with ___, a branch of ___.	gastroduodenal inf. pancreaticoduodenal SMA
	middle colic, a branch of ___, anastomoses with ___, a branch of ___	SMA L colic IMA
	4 (first order) portal vein tributaries	L gastric splenic SMV paraumbilical
	in addition to the first order portal vein tributaries, ___ feeds the SMV	IMV
	___ drains the rectum to the portal circulation___ (2) drains the rectum to the systemic circulation	sup. rectal v. middle rectal v. inf. rectal v.
	in portal HTN, L. gastric v. anastomoses with ___	esophageal v.
	in portal HTN, paraumbilical v. anastomoses with ___ (2)	inferior epigastric v. (from common iliac) superficial epigastric v. (from int. iliac)
	in portal HTN, sup. rectal v. anastomoses with ___ (2)	middle rectal v. inf. rectal v.
	internal hemorrhoids are above ___ they are/aren't painful they are perfused by ___ from ___ they are drained by ___	pectinate line aren't sup. rectal a. IMA sup. rectal v.
	external hemorrhoids are below ___ they are/aren't painful they are perfused by ___ from ___ they are drained by ___	pectinate line are inf. rectal a. internal pudendal a. inf. rectal v.
	internal/external hemorrhoids are associated with portal HTN	internal
	zone I of liver is near ___ it is the first to be affected by ___ zone III of liver is near ___ it is the first to be affected by ___ (3)	portal triad viral hepatitis central vein ischemia toxins alcoholic hepatitis
	CYP is expressed in zone ___	III
	liver capillaries are called ___ they don't have ___ the endothelial cells lining them have ___	sinusoids basement membrane fenestrations (100-200 nm)
	fenestrations in sinusoid epithelium allow ___ (2) to enter ___	plasma macromolecules space of Disse
	space of Disse separates ___ and ___	sinusoid endothelium basolateral side of hepatocytes
	apical side of hepatocytes faces ___	bile canaliculi
	Kupffer cells are ___s located in liver ___s	MQ sinudoids
	Ito cells are aka ___ cells they live in ___ they do ___ (2)	stellate space of Disse fat storage vitamin A storage
	___ is associated with pathological Ito cell behavior; in this state, ___ decreases ___ (3) increases	cirrhosis vitamin A storage proliferation chemotaxis collagen synthesis
	borders of femoral triangle	sartorius (lateral) adductor longus (medial) inguinal ligament (superior)
	2 contents of femoral triangle (lateral to medial)	femoral n. femoral sheath
	3 contents of femoral sheath (lateral to medial)	femoral a. femoral v. femoral canal
	7 layers of abdominal wall from external to internal	skin subcutaneous tissue external oblique internal oblique transversus abdominis transversalis fascia parietal peritoneum
	5 layers of spermatic cord from outside to in	skin external spermatic fascia cremaster muscle + fascia internal spermatic fascia vestige of processus vaginalis
	___ in abdominal wall becomes external spermatic fascia	superficial + deep fascia of external oblique
	___ in abdominal wall becomes cremaster muscle	superficial + deep fascia of internal oblique
	___ in abdominal wall becomes internal spermatic fascia	transversalis fascia
	___ in abdominal wall becomes vestige of processus vaginalis	parietal peritoneum
	rectus abdominis muscle is enclosed by ___	rectus sheath
	rectus sheath receive fibers from ____ (3)	external oblique internal oblique transversus abdominis
	___ is a smaller muscle which runs alongside rectus abdominis	pyramidalis
	diaphragmatic hernias can occur in ___ due to malformation of ___	babies pleuroperitoneal membrane
	2 kinds of hiatus hernias ___ is more common	sliding (GE junction moves) paraesophageal (stomach moves up but GEJ stays) sliding
	barium XR finding in hiatus hernia	hourglass stomach
	gastrin is made by ___ cells in ___ it does ___ (3) release is triggered by ___ (3) and inhibited by ___	G antrum parietal cell H+ pumping gastric mucosal proliferation gastric motility stomach distention AAs in stomach (esp F, W) vagal tone gastric pH<1.5
	CCK is made by ___ cells in ___ (2) it does ___ (3) release is triggered by ___	I duodenum jejunum increased pancreatic secretion increased gallbladder contraction reduced gastric emptying fatty content in duodenum
	secretin is made by ___ cells in ___ it does ___ (3) release is triggered by ___	S duodenum pancreatic HCO3- secretion reduced gastric H+ increased bile secretion acidic chyme in duodenum
	somatostatin is made by ___ cells in ___ (2) it does ___ (5) release is triggered by ___ and inhibited by ___	D islets of langerhans GI mucosa reduced GH release reduced gastric H+ reduced gastric enzymes reduced pancreatic exocrine secretion reduced pancreatic endocrine secretion (insulin + glucagon) acidic chyme vagal stimulation
	gastric inhibitory peptide is made by ___ cells in ___ (2) it does ___ (2) release is triggered by ___ (3)	K duodenum jejunum reduced gastric H+ increased insulin release FFA AA Glc
	GIP is aka ___	Glc-dependent insulinotropic peptide
	vasoactive intestinal polypeptide is made by ___ (3) it does ___ (3) release is triggered by ___ (2) and inhibited by ___	PARA ganglia in sphincters PARA ganglia in gallbladder PARA ganglia in small intestine increased intestinal water secretion increased intestinal electrolyte secretion relaxation of sphincters distention vagal tone SYM tone
	NO effect on GI	smooth muscle relaxation
	motilin is made by ___ it does ___ release is triggered by ___	small intestine migrating motor complexes fasting
	ghrelin is made by ___ cells in ___ it does ___ (3) release is triggered by ___ and inhibited by ___	P/D1 gastric fundus GH release ACTH release PRL release preprandial postprandial
	intrinsic factor is made by ___ cells in ___ it does ___	parietal cells gastric body/fundus B12 binding
	H+ is made by ___ cells in ___ release is triggered by ___ (3) and inhibited by ___ (4)	parietal gastric body/fundus HA ACh gastrin somatostatin GIP PGs secretin
	pepsinogen is made by ___ cells in ___ it does ___ release is triggered by ___ (2)	chief gastric body/fundus peptide cleavage vagal tone H+
	HCO3- is made by ___ cells in ___ (4) and ___ in duodenum it does ___ release is triggered by ___	mucosal salivary glands stomach duodenum pancreas Brunner's glands H+ neutralization secretin
	GI hormone elevated in Prader-Willi	Ghrelin
	GI hormone deficiency associated with achalasia	NO
	GI hormone elevation causing copious diarrhea	VIP
	GI hormone used to treat VIPoma another tumor it's used for is ___	somatostatin carcinoid
	GI hormone elevated in Zollinger-Ellison syndrome	gastrin
	3 kinds of salivary gland	parotid submaxillary sublingual
	___ glands are most serous ___ glands are most mucinous	parotid sublingual
	salivary secretion has SYM stimulation from ___ and PARA stimulation from ___ (2)	superior cervical ganglion CN7 CN9
	low salivary flow makes ___ saliva high flow makes ___ saliva	hypotonic isotonic
	ACh acts on stomach via ___R this and the ___R are linked to ___	M3 CCK_B (gastrin) G_q
	gastric G_q does ___ to cause H+ secretion	activates H+ ATPase
	H+ in parietal cells is produced by ___ and is exchanged by ___ for ___	CA ATPase K+
	HA acts on parietal cells via ___R this is linked to ___ it causes gastric H+ secretion by ___ing	H2 G_s activating ATPase
	pancreatic zymogens are activated by ___, which is activated by ___ released by ___	trypsin enterokinase/enteropeptidase duodenal mucosa
	gut absorption of glucose is via ___ gut absorption of galactose is via ___ gut absorption of fructose is via ___	SGLT1 SGLT1 GLUT5
	absoprtion through SGLT requires ___	Na+
	bile acids are absorbed in ___ B12 is absorbed in ___ Fe is abosrbed as ___ in ___ folate is absorbed in ___	ileum ileum Fe2+ duodenum jejunum
	salivary gland tumors are most commonly in ___	parotid
	most common salivary gland tumor	pleomorphic adenoma
	pleomorphic adenoma is a painful/painless mass it is mobile/fixed	painless mobile
	most common salivary malignancy	mucoepidermoid carcinoma
	3 causes of esophagitis	GERD infection chemical ingestion
	3 infections causing esophagitis	HSV1 CMV candida
	Plummer-Vinson syndrome pw ___ (3)	dysphagia glossitis Fe deficiency anemia
	dysphagia in Plummer-Vinson is 2/2	esophageal webs
	2 structural defects associated with esophageal ca	Zenker's diverticulum esophageal webs
	___ is most common esophageal ca worldwide ___ is most common in US	SCC none- SCC=adeno
	esophageal SCC happens in ___ of esophagus esophageal adenoca happens in ___ of esophagus	upper 2/3 lower 1/3
	celiac has Abs to ___ (2) ___ is used for screening	gliadin TTG anti-TTG
	skin abnormality associated with celiac	dermatitis herpetiformis
	malignancy associated with celiac	T cell Ly (moderately increased risk)
	2 kinds of acute gastritis	Curling ulcer (burn patient) Cushing ulcer
	in Cushing ulcer ___ causes ___ which causes ___	brain injury high vagal tone H+ hypersecretion
	2 kinds of chronic gastritis ___ is more common	A B B
	type A chronic gastritis affects ___ it is caused by ___ and causes ___ (2)	body/fundus autoimmunity pernicious anemia achlorhydria
	type B chronic gastritis affects ___ it is caused by ___	antrum HP
	menetrier's disease pw ___ (4) it is a RF for ___	gastric hypertrophy parietal cell atrophy increased mucous cells protein loss stomach cancer
	in menetrier's disease ___ are hypertrophied	stomach rugae
	4 RFs for gastric adenoca	dietary nitrosamine achlorhydria chronic gastritis type A blood
	gastric/duodenal ulcers have worse pains with meals	gastric
	___% of gastric ulcers have HP infection ___% of duodenal ulcers do	70 almost 100
	3 complications of duodenal ulcer	bleeding penetration of pancreas perforation
	inflammation in ulcerative colitis involves ___ layers	mucosa submucosa
	gross histopath in UC (2)	pseudopolyps loss of haustra
	3 UC complications	malnutrition toxic megacolon CRC
	diarrhea in UC is always ___	bloody
	2 extra-GI UC manifestations	pyoderma gangrenosum PSC
	2 UC drugs	sulfasalazine infliximab
	sulfasalazine is related to ___	aminosalicylic acid
	4 extra-GI manifestations of Crohn's	migratory polyarthritis erythema nodosum ankylosing spondylitis uveitis
	2 Crohn's drugs	CS infliximab
	irritable bowel syndrome has ___ with at least 2 of ___ (3)	recurrent abdominal pain pain improves with defecation change in stool frequency change in stool appearance
	IBS pw ___ or ___ or ___	diarrhea constipation alternating diarrhea + constipation
	tx for IBS	symptomatic
	diverticulitis can cause ___ bleeding complication of diverticulitis	bright red rectal colovesical fistula (pneumaturia)
	colonic polyps are most commonly in ___ ___% are non-neoplastic ____ polyps are precancerous	rectosigmoid 90 adenomatous
	most common non-neoplastic polyp	hyperplastic
	T/F: juvenile polyposis syndrome has elevated CRC risk	true
	Peutz-Jeghers polpys are ___s	hamartoma
	3 extra-GI manifestation of Peutz-Jeghers	hyperpigmentation of lips hyperpigmentation of hands hyperpigmentation of genitals
	Peutz-Jeghers has elevated risk of ___	CRC
	CRC is ___th most common cancer in US	3
	Gardner's syndrome is FAP + ___ (3)	osseous tumors soft tissue tumors retinal hyperplasia
	Turcot's syndrome is FAP + ___	malignant CNS tumor
	CRC in proximal colon pw ___ (3)	dull pain Fe deficiency anemia fatigue
	CRC in distal colon pw ___ (3)	obstruction colicy pain hematochezia
	tumor marker for CRC	CEA
	without risk factors, screening for CRC starts at age ___ with ___ (2)	50 occult blood colonoscopy
	___% of FAP progress to CRC ___% of Lynch syndrome population progresses to CRC	100 80
	FAP is a ___ trait it always involves ___	AD rectum
	Lynch syndrome is a ___ trait	AD
	3 stages of adenoma-ca sequence	polyp development polyp growth transformation
	gene linked to polyp development in adenoma-ca sequence	APC
	gene linked to polyp growth in adenoma-ca sequence	K-Ras
	gene linked to transformation in adenoma-ca sequence	p53
	carcinoid is most commonly in ___ only ___ carcinoid tumors have carcinoid syndrome	small intestine metastatic
	micronodular cirrhosis is associated with ___ (3) nodules are ___ mm	EtOH Wilson's disease hemochromatosis <3
	macronodular cirrhosis is associated with ___ (2) nodules are ___ mm	infectious hepatitis drug-induced hepatitis >3
	___ cirrhosis is associated with HCC	macronodular
	aminotransferase pattern for viral hepatitis	ALT>AST
	aminotransferase pattern for alcoholic hepatitis	AST>ALT
	aminotransferase pattern for MI	high AST
	liver enzyme for alcoholism	GGT
	ALP is elevated in ___ (3)	obstructive liver disease bile duct disease bone disease
	amylase is elevated in ___ (2)	acute pancreatitis mumps
	lipase is elevated in ___	acute pancreatitis
	Reye's syndrome is a reaction to ___ in context of ___ occurring in ___	aspirin viral disease children
	Reye's syndrome pw ___ (3)	hepatoencephalopathy hypoglycemia coma
	histopath of Reye's syndrome	microvesicular fatty change
	2 viruses associated with Reye's syndrome	VZV influenza B
	mechanism of Reye's syndrome	impaired beta oxidation
	microscopic finding in alcoholic hepatitis	Mallory bodies
	Mallory bodies are ___	eosinophilic cytoplasmic inclusions
	in cirrhosis, fibrosis occurs near ___	central vein
	marker for HCC	AFP
	because of ___, HCC can cause ___	hematogenous spread Budd-Chiari syndrome
	microscopic finding in a1AT deficiency	PAS+ globules in liver
	3 kinds of jaundice	prehepatic (hemolytic) intrahepatic posthepatic (obstructive)
	prehepatic jaundice has ___ hyperbilirubinemia, ___ urine bilirubin, and ___ urine urobilinogen	indirect no high
	intrahepatic jaundice has ___ hyperbilirubinemia, ___ urine bilirubin, and ___ urine urobilinogen	mixed high normal/low
	posthepatic jaundice has ___ hyperbilirubinemia, ___ urine bilirubin, and ___ urine urobilinogen	direct high low
	3 steps of post-conjugation bilirubin metabolism these are done by ___ ___ is colorless ___ is colored	unconjugation bilirubin -> urobilinogen uroblinogen -> urobilin gut bacteria urobilinogen urobilin
	T/F: AST is present in cytosol T/F: AST is present in mitochondria	true true
	T/F: ALT is present in cytosol T/F: ALT is present in mitochondria	true false
	patients with renal failure have low ___ activity	ALT
	in general ___ is higher than ___ in liver disease. 3 exceptions are	ALT AST alcohol fatty liver cirrhosis
	4 illicit drugs which cause abnormal AST/ALT	PCP ecstasy anabolic steroids cocaine
	6 viruses which can cause severe ALT, AST elevation	hep A-E HSV
	ALP is increased in ___ (2 populations)	pregnant women children
	in bone ALP is expressed by ___	osteoblasts
	3 kinds of infiltrating diseases which cause elevated ALP	granulomatous disease amyloidosis malignancy
	deficient enzyme in Gilbert's is ___, which causes deficient ___. this causes elevated ___. jaundice can be corrected with ___.	UDPGT bilirubin conjugation indirect bilirubin phenobarbital
	deficient enzyme in Crigler-Najjar is ___. difference from Gilbert's is ___.	UDPGT zero enzyme expression in Crigler
	Crigler-Najjar type ___ is the most severe. it causes ___	1 death in infancy
	Crigler-Najjar type 2 can be treated with ___	phenobarbital
	___ is deficient in Dubin-Johnson and Rotor's syndromes enzyme is ___	secretion of conjugated bilirubin into canaliculi OAT (organic anion transporter)
	gross histopath of Dubin-Johnson (but not Rotor's)	black liver
	defective enzyme in Wilson's disease it does ___	APT7B attachment of Cu to ceruloplasmin
	defective ATP7B in Wilson's disease causes ____ inside hepatocytes and ____ (2) in blood stream	Cu accumulation release of ceruloplasmin without Cu (apoceruloplasmin) rapid degradation of ceruloplasmin
	4 abnormal lab tests in Wilson's disease	LFTs serum ceruloplasmin serum Cu urine Cu
	in Wilson's, serum ceruloplasmin is ___ serum Cu is ___ urine Cu is ___	low low high
	Keyser-Fleischer ring is located in ___	cornea
	blood abnormality in Wilson's disease	hemolytic anemia
	tx for Wilson's	penicillamine
	main gene linked to primary hemochromatosis	HFE
	normally, HFE does ___ in ___ cells this allows the cells to ___ by ___ing	complexes with TfR duodenal crypt epithelial sense serum Fe levels endocytosing circulating Fe-Tf
	mutant HFE causes defective ___ which causes ___	Fe level sensing upregulation of Fe-absorption proteins (including ferroportin)
	hemochromatosis pw ___ (3)	cirrhosis DM skin pigmentation
	2 complications of hemochromatosis	HCC CHF
	PSC is associated with ___ finding on ERCP is ___ serum finding is ___ histopath is ___ complication is ___	UC beading IgM hypergammaglobulinemia bile duct onion skinning fibrosis 2' biliary cirrhosis
	1' biliary cirrhosis is associated with ___ (2) serum finding is ___	scleroderma CREST anti-mitochondrial Abs
	PSC and PBC pw ___ (5)	severe obstructive jaundice (dark urine, acholic stool) steatorrhea pruritus hypercholesterolemia hepatosplenomegaly
	complication of 2' biliary cirrhosis	ascending cholangitis
	in hemochromatosis, TIBC is ___ or ___	low normal
	dd of acute pancreatitis (10)	Gallstone EtOH Trauma Steroids Mumps Autoimmune Scorpion sting Hyperlipidemia/hypercalcemia ERCP Drugs (e.g. sulfa)
	electrolyte disturbance associated with acute pancreatitis	hypocalcemia
	2 life-threatening conditions associated with acute pancreatitis	DIC ARDS
	2 markers for pancreatic adenoca	CEA CA 19-9
	2 populations predisposed to pancreatic adenoca	Jewish African-American
	T/F: smoking is RF for pancreatic adenoca	true
	T/F: EtOH is RF for pancreatic adenoca	false (probably)
	H2 blockers end in ___	tidine
	4 cimetidine SEs	CYP inhibitor antiandrogenic effects CNS penetration reduced CCT
	4 cimetidine antiandrogenic SEs	high PRL gynecomastia low libido impotence
	3 cimetidine CNS SEs	confusion dizziness HA
	misoprostol is a ___ analog it does ___ (2) for stomach and ___ (2) in ob-gyn setting	PGE1 increased gastric mucus production decreased gastric H+ production uterine contractility cervical ripening
	misoprostol is indicated for ____ (4)	labor induction abortificant gastroprotection for NSAID tx PDA patency maintenance
	2 pathways for gastric H+ secretion	direct indirect
	in direct gastric H+ pathways, ___ from ___ cells causes ___ cells to ___	ACh postsynaptic vagal parietal release H+
	in indirect gastric H+ pathways, ___ from ___ cells causes ___ cells to ___. this causes ___ cells to ___, which causes ___ cells to ___.	Gastrin-releasing peptide (GRP) postsynaptic vagal G release gastrin enterochromaffin-like (ECL) release HA parietal release H+
	pirenzepine and ___ are ___s they are used for ___ (2)	propantheline muscarinic blockers decreasing gastric H+ secretion decreasing ECL HA secretion
	overdose of aluminum hydroxide antacid causes ___ (4)	constipation hypophosphatemia osteodystrophy neurological sx
	2 neurological aluminum hydroxide sx	proximal muscle weakness seizures
	4 magnesium hydroxide antacid overdose sx	diarrhea cardiac arrest hypotension hyporeflexia
	2 calcium carbonate antacid overdose sx	hypercalcemia rebound H+ hypersecretion
	electrolyte disturbance associated with all antacids	hypokalemia
	sulfasalazine is activated by ___	gut bacteria
	3 sulfasalazine SEs	nausea sulfonamide rxn oligospermia (reversible)
	ondansetron is a ___ it is used as ___	5-HT3 blocker anti-emetic
	2 ondansetron indications	post-op cancer chemo
	2 ondansetron SEs	headache constipation
	metoclopramide is a ___ it is indicated for ___ (2)	D2R blocker post-op gastroparesis DM gastroparesis
	metoclopramide increases GI ___ (4) but doesn't affect ___	resting tone contractility motility LES tone colon transit time
	5 metoclopramide SEs	parkinsonism restlessness drowsiness depression diarrhea
	metoclopramide interacts with ___ (2)	digoxin DM drugs
	metoclopramide is contraindicated in ___	SBO

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