GIT 2 Flashcards by bailey craig

isotonic with plasma and persists during fasting
increase cAMP activity internal factor
vibrio cholera, carcinoid syndrome

secretory diarrhea

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sugars absorb water
external factor
stopped with fasting

osmotic diarrhea

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purulent, bloody stools that persist on fasting

exudative diarrhea

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voluminous
bulk stools with increase osmolarity combines with excess stool fat
oil O red and Sudan black

Malabsorption

best initial test to confirm malabsorption

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HLA DQ2 and HLA DQ8
anti gliaden
IgA
transglutaminase
anti endomysial

celiac

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atrophy of villi of small intestine decrease surface area

increase number of intra epithelial lymphocytes

celiac

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diarrhea 
flatulence 
weight loss
fatigue 
skin rash 
vit def

tx: decrease gluten and villi will regenerate

celiac

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complications of celiac

dermatitis herpitiformis - papillary dermis id effected
IgA nephropathy - hematuria and proteinuria
NHL - due to CD4/ B cells

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biopsy location for celiac

jejunum

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abnormal DX test

no DX in urine or blood

intestinal dz or surgery of intestine

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normal DX test

will see DX in blood and urine

pancreatic dz

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tropheryma whillpelli - rod shaped bacilli

causes fatty diarrhea

whipples

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micro: foamy macrophages located in lamina propria contain PAS +
diastase resistent

whipples

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fever
steatorrhea - macrohages compress lacteals (malabsorption)
joint pain
swollen lymph nodes 
psych problems

whipples

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cell steps in celiac

CD4 + –> produce IL and B cells –> IL prd T helper cells; B cells prod Ig (gluten/gliaden) –> Ig attack gluten in intestine and also villi of intestine

antibodies prod in peyers patches and become bigger

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atrophy of apical villous cell - enterocytes at the tip have lactose
infants develop explosive, watery, frothy, stools and abdominal distention
tx: stop dairy - villi regenerate
screening test: acidic stool; increase stool osmolarity

lactose def

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cell death in lactose def

apoptosis

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AR
1st year of life
impaired formation of apoB
fat stays in enterocytes

A beta lipoproteinemia

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low plasma TAGS and cholesterol levels
chylomicrons, VLDLs and apoB are entirely absent from blood

features: acanthocytes, progressive ataxia, rhinitis pigments (vit E)

A beta lipoproteinemia

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hematopoietic system - malabsorption

anemia from iron, pyridoxine, folate and vit b12 and bleeding from vit K def

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Musculoskeletal system - malabsorption

osteopenia - fracture lining
tetany from hypocalcemia
tetany from hypomagnesium
vit D def

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endocrine system - malabsorption

enlarged parathyroid enlargement

decrease vit D –> decrease reabsorption of Ca –> causing increase parathyroid hormone = secondary hyperparathyroidism

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night blindness 
xerophthalmia 
blindness
squamous metaplasia
infection

vit A

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bleeding 2, 7, 9, 10

vit K

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rickets in children | osteomalacia in adults

vit D

``` prevents fatty acid from oxidation spinocerebellar retinal degeneration neuromusclular dz hemolytic anemia decrease cell membrane (increase ROS) causing hemolysis of RBCs ```

vit E

Protozoa causing exudate diarrhea

Entamoeba histolytica

diarrhea after few days: affects peter patches - lymphocytes in stool

salmonella typhi

dsRNA child self limiting only GIT

rotavirus

ds DNA adult and child GIT and rest of body - conjunctivitis

adenovirus

diagnostic test for both detection of antigen in stool

PCR and ELISA

undercooked beef O157 H7 shiga toxin inhibit 60s ribosomal unit inhibit protein synthesis and cell death

E coli

hemorrhage colitis HUS acute renal failure bloody diarrhea 2-5 days after meal

e coli

milk or mayo 1-6 hrs exudate stool increase WBC

S aureus

watery diarrhea normal mucosa doesn't cause tissue damage - non necrotic acidosis increase cAMP in stool Gs intracellular --> + transcription factor --> increase mucin and decrease bicarb

vibrio cholera

lymphocytes in stool | 12-72 hrs after meal

salmonella enteritidis

provokes autoimmune reaction | binds to the micro fold (M cells) at peyers patches

shigella

reiter syndrome in S flexneri (shigella)

HLA HB 27 red eye conjunctivitis chronic arthritis can't poop

caused by antibiotic use or PPI for H pylori fever pain, bloody diarrhea pseudomembrane formation over mucosa

C dif

pus sticking to mucosa yellow exudate tissue damage - necrotic inhibits actin maintenance (toxin B and A) - release cytokines

pseudomembranous colitis

curved rod shaped non spore forming gram neg microaerophilic bacteria

campylobacter enterocolitis

``` reactive arthritis HLA B27 GBS - myelin loss (d/d MS tingling & eye problem and B12 def degeneration) Schwann cells affected maltoma tingling after diarrhea ```

campylobacter enterocolitis

prod flask shaped undermined ulcer in submucosa bloody exudative diarrhea amebic liver abscess - RUQ amoeba engulfs RBCs - erythrophagocytosis portal vein thrombosis ( normal liver and lung abscess - anchovy paste)

entamoeba histolytica

giardia causes

steatorrhea

donor CD8 cell by extrinsic apoptosis (shrunken cell with halo) (mech Fas/FasL or granzyme) 15 days after BM transplant severe watery/ bloody diarrhea

graft vs host

presents chronic but can acute occurs at any part of GIT transmural inflammation non caseating granuloma - TH1 cells

crohns

skip lesions | MC at ileocecal junction aka regional ileitis

crohns

RLQ pain because transmural inflammation +/- blood

crohns

rubbery thick wall - string sign linear ulceration creeping fat

crohns

crohns complications

``` fistula - fecal matter can be found in urine, vagina or skin adenocarcinoma - rare migratory poly arthritis aphthous ulcers uveitis erythrema nodosum decrease bile salts ```

Dx test for uveitis

slit lamp test

Dx test for crohns

pANCA | anti saccaromyces cerevisiae (ASCA)

tx for crohns

surgery at ileocecal junction

presents at acute and very painful limited to colon affects mucosa and submucosa

inhibition of MMP9

loss of haustra and ulcer extensive continuous lesions bloody diarrhea with stingy, mucoid material LLQ pain

back wash ileitis pseudopolyps lumen wide normal mucosa with no dedicated blood supply

crypt abscess filled with neutrophils dysplasia glandular architecture distortion

complications of UC

migratory poly arthritis HLA B27 hepatic primary sclerosis cholangitis - pANCA - jaundice toxic megacolon - gangrene adenocarcinoma

adenocarcinoma in UC

left colon after 10 years early Tp53 mutation

``` excess serotonin very stressed abdominal pain bloating relieved by defecation change in bowel habit solid pellet like stool ```

IBS

GIT 2 Flashcards

(61 cards)