Flashcards in Final Exam -- GI Disease II (Stomach and Intestines) Deck (87):
The average stomach can hold how much food/liquid, at maximum?
Gastric glands in the stomach have surface mucus cells, mucus neck cells, parietal cells, chief cells, and endocrine cells. What do surface mucus cells secrete?
Mucus and bicarbonate
Gastric glands in the stomach have surface mucus cells, mucus neck cells, parietal cells, chief cells, and endocrine cells. What do mucus neck cells secrete?
Gastric glands in the stomach have surface mucus cells, mucus neck cells, parietal cells, chief cells, and endocrine cells. What do parietal cells secrete?
Hydrochloric acid and intrinsic factor
Gastric glands in the stomach have surface mucus cells, mucus neck cells, parietal cells, chief cells, and endocrine cells. What do chief cells secrete?
Gastric glands in the stomach have surface mucus cells, mucus neck cells, parietal cells, chief cells, and endocrine cells. What do endocrine cells secrete?
Depends on the type. G cells secrete gastrin; D cells secrete somatostatin
Peptic ulcer disease is a mucosal defect in the stomach or small intestine. What symptoms area associated with this condition? What symptoms would be cause for alarm?
Typical symptoms: epigastric pain with gnawing, dull, or "hunger like" sensation
Alarm symptoms: possibly indicate a bleed and include melena (black, tarry stool), hematemesis (vomiting blood), guaiac-positive stool (blood in stool but not visible), anemia.
What are the causes of peptic ulcer disease?
H. Pylori, NSAIDs, or aspirin
True or false: the majority of patients infected with H. Pylori develop peptic ulcers.
False; only 10-15% of patients infected with H. Pylori develop peptic ulcers.
True or false: eradication of H. Pylori decreases ulcer recurrence to less than 10%
Testing for peptic ulcer disease can be done with an antibody test (for H. Pylori antibodies), urea breath test, stool antigen test, and endoscopy. Which of these tests does not differentiate an active vs past infection of H. Pylori?
Testing for peptic ulcer disease can be done with an antibody test (for H. Pylori antibodies), urea breath test, stool antigen test, and endoscopy. Which of these tests is used for definitive diagnosis?
Testing for peptic ulcer disease can be done with an antibody test (for H. Pylori antibodies), urea breath test, stool antigen test, and endoscopy. Which of these tests is used to confirm eradication of H. Pylori after 6 weeks of therapy?
Stool antigen test.
Briefly outline the pharmacologic therapy for a peptic ulcer.
Withdraw from NSAIDs and aspirin if possible; if not, add a proton pump inhibitor or misoprostol. Also eradicate H. Pylori with triple therapy (PPI and 2 different antibiotics for 7-14 days).
Stress gastritis is characterized by superficial erosions in the stomach that occur after what types of events?
Physical trauma, shock, sepsis*, or respiratory failure.
Stress gastritis is caused by a decreased defense mechanism to gastric acid, which can be caused by a reduction in blood flow, mucus, and bicarbonate secretion.
Treatment for stress gastritis involves keeping the stomach pH greater than 5.0, and 80% of patients stop bleeding with supportive care. An indication for surgery would be if bleeding recurs or persists and requires more than how many units of blood?
True or false: worldwide, gastric cancer is the 2nd most common cancer and the 4th leading cause of cancer death.
False; worldwide, it is the 4th most common cancer and the 2nd leading cause of cancer death.
What are the nutritional risk factors for gastric cancer?
Salted meats/fish, high nitrate consumption, smoking, and alcohol.
What are the medical risk factors for gastric cancer?
H. Pylori infection, prior gastric surgery, adenomatous polyps, and gastric atrophy and gastritis
What are the symptoms of gastric cancer?
Poor appetite, weight loss, abdominal pain, sense of fullness after small meals, heartburn, nausea, vomiting, swelling or fluid buildup in abdomen, anemia.
How is gastic cancer diagnosed?
Endoscopy with biopsy. Endoscopic ultrasonography can be used to see the extent of the cancer.
What is the treatment for gastric cancer?
Gastrectomy with regional lymphadenectomy, chemotherapy, radiotherapy
What enzyme is released by both the mouth and the pancreas and is used for the digestion of carbohydrates?
Proteins are digested by what pepsin from the stomach, trypsinogen from the pancreas, and trypsin/chymotrypsin/elastase from the small intestine.
In which portion of the small intestine does protein digestion and absorption occur?
Celiac disease is a chronic autoimmune disease characterized by malabsorption and diarrhea precipitated by ingestion of food products containing gluten. CD is more common in people with what other conditions?
Type I diabetes and thyroid disorder.
Wheat, barley, and rye are high in content of _______ and ______, which resists digestive processes in patients with celiac disease.
Glutamine and proline*
What are the symptoms of celiac disease?
Diarrhea, weight loss, fatigue, flatulence, anorexia, abdominal discomfort, and greasy, foul-smelling, voluminous pale stools. The patient may be asymptomatic, however.
What laboratory testing can be done for celiac disease?
IgA anti-tissue transglutaminase (anti-tTGA) and HLA-DQ2 allele
What is the gold standard for diagnosis of celiac disease?
Mucosal intestinal biopsy* and response to dietary withdrawal of gluten*.
What is the name for a gastrin-secreting non-beta islet cell tumor? What effect does it have on gastric acid?
Gastrinoma, aka Zollinger-Ellison Syndrome. It causes increased gastric acid secretion that leads to ulceration in the stomach and small intestine.
What percentage of patients with Zollinger-Ellison Syndrome have Multiple Endocrine Neoplasia type 1?
What percentage of gastrinomas are malignant?
What are the symptoms of Zollinger-Ellison Syndrome?
Abdominal pain (from the ulcer), heartburn, diarrhea.
Workup for Zollinger-Ellison Syndrome involves endoscopy (for diagnosis of the ulcer), imaging to locate the gastrinoma, and testing of serum gastrin level. What is considered a normal serum gastrin level?
Less than 100 pg/mL
Workup for Zollinger-Ellison Syndrome involves endoscopy (for diagnosis of the ulcer), imaging to locate the gastrinoma, and testing of serum gastrin level. What level of serum gastrin is indicative of a gastrinoma?
More than 1000 pg/mL
Treatment for a gastrinoma involves surgical removal and then medication for long term therapy. What medications can be used?
Proton pump inhibitor and somatostatin analog
The 5 year survival rate for a person with a gastrinoma drops severely if there has been metastasis to the liver.
What are the major roles of the large intestine?
Water absorption and electrolyte exchange.
Bacteria makes up 30% of the dry weight of fecal matter and helps synthesize which vitamins?
Vitamins B and K
Irritable bowel syndrome (IBS) is characterized by abdominal pain or discomfort linked with bowel function and persists at least 6 months. What relieves the pain or discomfort?
True or false: some patients with IBS have en exaggerated colon motility response to meal ingestion.
True or false: about 2/3 of IBS patients experience decreased pain sensitivity in gut stimulation.
False; 2/3 have increased pain sensitivity in gut stimulation
There is an 11% chance of developing IBS following what type of sickness?
What are some of the risk factors for IBS?
Anxiety depression, personality disorders, history of childhood sexual abuse, and domestic abuse in women.
IBS has between 50% and 70% comorbidity with psychiatric disorders, chronic pelvic pain, temporomandibular joint disorder, and chronic fatigue sydrome, and 20-50% with fibromyalgia.
What are some treatment options for IBS?
Dietary modification, fiber supplements, psychotherapy, antidiarrheals, laxatives, suppositories, SSRIs, TCAs
What two conditions make up inflammatory bowel disease?
Crohn's disease and ulcerative colitis.
Comparing Crohn's Disease and Ulcerative Colitis, which features remitting inflammation that is discontinuous?
Comparing Crohn's Disease and Ulcerative Colitis, which features remitting inflammation that is continuous?
Comparing Crohn's Disease and Ulcerative Colitis, which features lower left abdominal pain?
Comparing Crohn's Disease and Ulcerative Colitis, which features lower right abdominal pain?
Comparing Crohn's Disease and Ulcerative Colitis, which tends to include the ileum?
Comparing Crohn's Disease and Ulcerative Colitis, which does not include the ileum?
Comparing Crohn's Disease and Ulcerative Colitis, in which is abdominal pain more prominent?
Comparing Crohn's Disease and Ulcerative Colitis, in which is GI bleeding more prominent?
1/3 of patients with IBD have manifestations in the eyes, skin, or joints*. What eye manifestations are there?
Episcleritis and anterior uveitis
1/3 of patients with IBD have manifestations in the eyes, skin, or joints. What skin manifestations are there?
Erythema nodosum, pyoderma gangrenosum, psoriasis, dermatitis, erthematous rash, uticaria
1/3 of patients with IBD have manifestations in the eyes, skin, or joints. What joint manifestations are there?
Ankylosing spondylitis and peripheral arthritis
Diagnosis for IBD is based on endoscopy and imaging (CT with contrast*, MRI)
True or false: with ulcerative colitis, medical therapy has 70% success rate for remission.
Crohn's Disease is pharmaceutically treated with what kinds of drugs?
Corticosteroids and Mesalazine
True or false: most patients with Crohn's disease are well controlled with medicine and never end up needing surgery.
False; most CD patients require surgery at least once in their lifetime.
What surgery is used to treat ulcerative colitis?
Colectomy with ileal pouch-anal anastomosis
What surgery is used to treat Crohn's disease?
Resection (typically of the ileus)
Diverticula is an acquired herniation of the small weak areas of the colon's muscular wall. It is a common occurrence with age* except in patients with what kind of diet?
Though most (80%) patients with diverticula are asymptomatic, what symptoms are experienced by the other 20%?
Caused by inflammation or infection of the diverticula: acute lower abdominal pain (intermittent or constant), N&V, anorexia, and diarrhea or constipation.
Diagnosis for a diverticula is based on what?
Clinical history and CT or ultrasound
Colorectal cancer is the second leading cause of cancer mortality among men and women combined. What are the risk factors for colorectal cancer?
Family history of colorectal cancer or polyps, IBD, older age, history of smoking, high fat/low fiber diet, sedentary lifestyle
What are the symptoms of colorectal cancer?
Constipation, small-caliber stool, fecal impaction or obstructive symptoms, pain/bloating, acute or chronic GI bleed, bowel obstruction.
What are the screening recommendations for colorectal cancer?
Begin at age 50 and do either a sigmoidoscopy every 3-5 years or a colonoscopy every 10 years.
Comparing sigmoidoscopy and colonoscopy, which evaluates only the descending colon?
Comparing sigmoidoscopy and colonoscopy, which evaluates the entire colon?
Comparing sigmoidoscopy and colonoscopy, which requires that the patient be sedated?
Comparing sigmoidoscopy and colonoscopy, which does not require that the patient be sedated?
Comparing sigmoidoscopy and colonoscopy, which is more suitable for screenings if combined with fecal occult blood testing (FOBT)?
Gardner's Syndrome is a subtype of familial adenomatous polyposis (FAP) that eventually leads to colorectal cancer if left untreated. Gardner's Syndrome can be caused by what sort of inheritance patterns in which mutated genes?
Autosomal dominant in APC gene (90%) or autosomal recessive in MYH gene (8%)
What are the screening recommendations for patients with a first degree relative with Gardner's Syndrome??
Sigmoidoscopy every 1-2 years beginning at age 12; genetic counseling after age 10-12
True or false: if left untreated, all Gardner's Syndrome patients will develop colon cancer by age 35-40.
In 75% of patients with Gardner's Syndrome, there are multiple, bilateral familiar CHRPEs (sometimes called pigmented ocular fundus lesions of FAP, or POFLs)
Which of the stomach/intestine conditions discussed in class has a higher prevalence in men?
Gastric cancer, Zollinger-Ellison Syndrome, colorectal cancer, and peptic ulcer disease (though just barely)
Which of the stomach/intestine conditions discussed in class has a higher prevalence in women?
Celiac disease and irritable bowel syndrome
True or false: patients with irritable bowel syndrome (IBS) present with abdominal pain, inflammation of the bowel, and GI bleeding.
False; this is indicative of inflammatory bowel disease (IBD)
Crohn's disease tends to affect which part of the GI?
A gastrinoma secretes what substance?