Introduction to Gastroenterology Flashcards by Katie Keller

List some GI alarm symptoms

Anemia
dysphagia
Odynophagia
Hematemesis
Melena/hematochezia
Unintentional weight loss
Recurrent vomiting
Abdominal mass
Jaundice
Anorexia
steatorrhea

How well did you know this?

Not at all

Perfectly

A vague, intensely disagreeable sensation of sickness or “queasiness” with or without vomiting

Nausea

How well did you know this?

Not at all

Perfectly

The forceful expulsion of gastric contents through a relaxed upper esophageal sphincter and open mouth

Coordinated gastric, abdominal, and thoracic contractions

Vomiting

How well did you know this?

Not at all

Perfectly

What are the stimulators of vomiting?

Gastrointestinal Viscera
Vestibular system
Higher CNS centers (cortex and limbic system)
“Chemoreceptor trigger zone”

How well did you know this?

Not at all

Perfectly

List some causes of vomiting

Food poisoning
Gastroenteritis
Drug reactions
Vestibular responses
Systemic illness
Peritoneal irritation
Obstruction
Gastric stasis
Pancreatic disease
Biliary disease
Pregnancy
Gastric outlet obstruction
Gastroparesis
Intestinal dysmotility
Psychogenesis
CNS or systemic disorders

How well did you know this?

Not at all

Perfectly

What are some complications of vomiting?

Dehydration
Pulmonary aspiration
Metabolic disturbances - Hypokalemia, Metabolic alkalosis
Azotemia secondary to loss of gastric contents
Boerhaave’s syndrome
Mallory-Weiss tear

How well did you know this?

Not at all

Perfectly

What is the treatment for vomiting?

Treat the underlying cause!

Most cases of acute vomiting are mild and self limiting

Symptomatic treatment - Clear oral fluids, Small feedings

Antiemetics can be given to treat or prevent vomiting - Ondansetron (Zofran), Promethazine (Phenergan)

Severe, acute vomiting may require hospitalization - IV fluids, metabolic disturbances corrected

How well did you know this?

Not at all

Perfectly

Term used to describe upper abdominal symptoms - Persistent or recurrent pain or discomfort centered in the upper abdomen

Synonymous with indigestion

Characterized by: Early satiety, Postprandial fullness

Dyspepsia

How well did you know this?

Not at all

Perfectly

List some causes of dyspepsia

Food Intolerance
Drug Intolerance
Infection
Gastric Tract Dysfunction

How well did you know this?

Not at all

Perfectly

What type of dyspepsia is described below?

Patients tend to be younger

Have a variety of abdominal and GI symptoms

Increased incidence of anxiety or depression

Non-Ulcer Dyspepsia

How well did you know this?

Not at all

Perfectly

What type of dyspepsia is described below?

Patient typically older (>55)

Often smoke and consume alcohol

Pain is changed with food or meals

Ulcer Dyspepsia

How well did you know this?

Not at all

Perfectly

A perception of abnormal bowel movements

Hard stools, Straining, Decreased frequency, Feeling of incomplete evacuation

Typically increased in older patients and women

One of the most common complaints seen by PCPs and gastroenterologists

Constipation

How well did you know this?

Not at all

Perfectly

What is the medical criteria for constipation?

<3 bowel movements per week and/or excessive straining with defecation

How well did you know this?

Not at all

Perfectly

Constipation is associated with what factors?

Medications
Sedentary lifestyle
Poor caloric intake
Low fiber diet

How well did you know this?

Not at all

Perfectly

List some causes of constipation

Diet (most common cause)
Medications
Structural abnormalities
Cystic Fibrosis
Systemic endocrine disorders
Slow colonic transport
Pelvic floor dysfunction
Irritable Bowel Syndrome
Colonic atony/dysmotility
MC in kids – function constipation (act of intentionally withholding bowel movement)

How well did you know this?

Not at all

Perfectly

What is the most common cause of constipation?

Diet (most common cause)

How well did you know this?

Not at all

Perfectly

What is the most common cause of constipation in children?

function constipation (act of intentionally withholding bowel movement)

How well did you know this?

Not at all

Perfectly

What are some treatment options for constipation?

Dietary Measures - High fiber diet (25g per day), Reinforce importance of fluid and exercise

Bulking agents

Osmotic laxatives

Stool Surfactants

Chloride secretory agents

Opioid-Receptor Antagonists

Stimulant Laxatives (cathartic)

Biofeedback/manometry for neurogenic causes

Stop offending medication

Get immobile patient moving

How well did you know this?

Not at all

Perfectly

Nonabsorbable osmotic agents that increase secretion of water into intestinal lumen, softening stools and promoting defecation

Osmotic laxatives

How well did you know this?

Not at all

Perfectly

Enables water and fats to be incorporated into the stool

Stool Surfactants

How well did you know this?

Not at all

Perfectly

Stimulate intestinal chloride secretion through activation of chloride channels or guanycyclase C causing increased intestinal fluid and colonic transit

Chloride secretory agents

How well did you know this?

Not at all

Perfectly

Stimulate fluid secretion and colonic contraction

Stimulant Laxatives (cathartic)

How well did you know this?

Not at all

Perfectly

Chronic use of these agents may result in loss of normal colonic neuromuscular function

Stimulant Laxatives (cathartic)

How well did you know this?

Not at all

Perfectly

What are some treatment options for constipation in pediatrics?

Hydration
Increase dietary fiber
Decrease dairy products
Karo syrup
Bowel training
Medications - Softeners (after age 1), laxatives, enemas (premeasured in pedi size)
Referral - concerning findings or conservative treatment unsuccessful

How well did you know this?

Not at all

Perfectly

Complication of stimulant laxatives The most common cause of this condition is stimulant laxatives (such as Senna) Benign condition, not cancerous Does not become cancerous

Melanosis Coli

What is the most common cause of Melanosis Coli?

stimulant laxatives

Severe impaction of stool may result in obstruction

Fecal Impaction

What are some predisposing factors of fecal impaction?

Severe psychiatric disease Bedridden Medications Neurogenic disease of colon/spine

What are some treatment options for fecal impaction?

Short term: Impaction relief (DRE, Enemas, Disimpaction) Long term: aimed at keeping stools soft and regular Prevention: Gastrocolic reflex – 30 minutes after eating breakfast Avoid prolonged bathroom sessions Regular bowel schedule

What methods are used to evaluate fecal impaction?

DRE Radiograph Air Contrast Barium Enema

Fecal impaction in children – having wet stools, but they’re impacted Watery part is leaking out Unable to sense the need to defecate because of stretching internal sphincter by the retained fecal mass

Encopresis

What is the most common cause of Encopresis?

Most common cause is constipation, sometimes by fear of toilet/potty training (fecal withholding)

What is the clinical presentation of encopresis?

Daytime or nighttime soiling Repeated passage of stool in inappropriate places (poop in their pants) Child will soil their pants down their backs and legs

What are the treatment options for encopresis?

Treat the constipation Educate for behavioral strategies Enema for clean out Miralax or pedialax to soften stool Treat underlying disorder if applicable

Involuntary or voluntary release of gas from the stomach or esophagus Normal physiologic reflex and does not indicate GI pathology

Eructation (Belching)

Normal volumes range from 500 to 1500mL/day Frequency: 6-20 times a day Sources/Causese: Swallowed air, bacterial fermentation of undigested carbohydrates (increased fiber), malabsorption, lactase deficiency

Flatus

Definition: increased stool frequency >3 BM/day, or liquidity of feces Varies from a self-limited annoyance to a severe, life threatening illness Patients may use this term to refer to: Increased frequency of bowel movements Increased stool liquidity Sense of fecal urgency Fecal incontinence

Diarrhea

What is the definition of acute diarrhea?

Acute is less than 3-4 weeks

What are the mechanisms of diarrhea?

Osmotic Secretory Malabsorptive Exudative Increased intestinal motility

In what percentage of cases, the course of acute diarrhea is mild and self-limited lasting 5 days or less?

90%

Pre-liver bilirubin 🡪 conjugated in the liver Not water soluble, therefore no bilirubin in urine Stool and urine color normal Typically mild jaundice

Unconjugated Bilirubinemia (Indirect)

What are the two main causes of unconjugated bilirubinemia (Indirect)?

Hemolysis (hemolytic anemias) Inherited – Gilbert’s disease, Crigler-Najjar

Dark urine with jaundice Light colored stools if obstruction

Conjugated Bilirubinemia (Direct)

What are some causes of Conjugated Bilirubinemia (Direct)?

Hepatocellular dysfunction Biliary obstruction – most common cause Inherited: Dubin-Johnson syndrome- rare, benign condition seen in pregnancy, EtOH, OCP use Viral Metabolic Biliary tract disease Vascular Autoimmune liver disease Hepatotoxins

What is the most sensitive test for synthetic liver function is what?

the PT

List some worrisome symptoms in hyperbilirubinemia

Onset of hepatic encephalopathy Vitamin K resistant prolongation of PT Cerebral edema Bili > 18 Rising serum creatinine Rising serum bilirubin with decreasing AST/ALT Rising serum creatinine Hypoglycemia Sepsis Ascites pH <7.3 in acetaminophen overdose

Caused by hyperbilirubinema Can be caused by ABO incompatibility or Rh incompatibility Yellowing of skin, eyes, and mucus membranes

Jaundice

Irritation of phrenic or vagus nerve

Hiccups

Definition: bleeding that occurs below the Ligament of Treitz

Lower GI Bleed

What are the four major zones of the stomach?

Cardia Fundus Corpus Antrum

Gastric acid secretion by parietal cells of the gastric mucosa is controlled by what?

ACh – increases acid; muscarinic receptor M1 Histamine – increases acid; H2 receptor Gastrin – increases acid Prostaglandins E2 and I2 – decrease acid

Gastric juices are combined secretions of what?

Mucous cells: mucus Parietal cells: HCl, Intrinsic factor Chief cells: Pepsinogen I, Pepsinogen II

What do parietal cells secrete?

HCl, Intrinsic factor

What do chief cells secrete?

Pepsinogen I, Pepsinogen II

What hormone is described below? secreted by G cells In response to food entry Increases stomach motility primary mediator of gastric acid secretion Promotes increased constriction of LES

Gastrin

What hormone is described below? Secreted by I cells of jejunum In response to fatty substances Increases gallbladder contractility 🡪 bile Stimulates pancreatic secretion Regulates gastric emptying and bowel motility Induces satiety

Cholecystokinin

What hormone is described below? Produced by duodenal mucosa With entry of gastric juice from the stomach Stimulates pancreatic fluid/bicarb secretion (Neutralizes the acidity of stomach contents)

Secretin

What hormone is described below? Peptide Increases appetite Stimulates GH secretion Produces weight gain

Ghrelin

Starts at the dentate line - Ends at the anal verge Junction of anal mucosa and perianal skin

Anal Canal

Circular muscle Involuntary muscle Contracted at rest

Internal sphincter of the anus

Voluntary striated muscle of the anus

External sphincter

What is the anorectal function?

Stores and releases intestinal waste products (Holds 650-1200mL of waste) Hemorrhoid plexus - Maintain continence and minimize trauma during bowel movements Progressive distension of the rectum will cause continuous inhibition of the internal sphincter and relaxation of external sphincter 🡪 urge to defecate

Majority of the liver is made up of what type of cells?

hepatocytes

The liver has a dual blood supply. Name to two sources and what percentage is attributed to each?

20% from the hepatic artery 80% from the portal vein

What is the function and importance of the hepatocytes?

Important I the synthesis of many important serum proteins, hormonal factors, and growth factors Involved in the regulation of nutrients, production of bile and its carriers, conjugation of bilirubin, and the detox of drugs for excretion

What is the function of bile?

Facilitates digestion: emulsification, absorption of fat (via micelles), solubilize cholesterol

Breakdown product of hemoglobin metabolism direct (conjugated): water soluble Indirect (unconjugated): lipid soluble

Bilirubin

What percentage of serum bilirubin is unconjugated in healthy adults?

90% of serum bilirubin

Bile secretion is controlled by what two factors?

Parasympathetic stimulation via vagus Hormonal stimulation

These two enzymes together are collectively referred to as transaminases

AST and ALT

LFTs are markers of what?

markers of injury

Albumin, Coagulation factors, and conjugation of bilirubin are markers of what?

markers of liver function

Elevated in hepatocellular inflammation or destruction/necrosis

LFTs

Indicator of hepatic excretion

Bilirubin

Marker of the liver’s continued ability to synthesize important proteins

Albumin

Production increases with hepatic injury, obstruction, bone destruction

Alkaline phosphatase

These enzymes make up the LFTs

AST ALT LDH

List some common causes of LFT elevations

NAFLD Toxins Viral

List some uncommon causes of LFT elevations

Liver cancer rhabdomyolysis

The pancreaticobiliary system is composed of what?

Gallbladder Cystic duct Ducts

Distensible sac - 30-50mL that concentrates and stores bile

Gallbladder

Formed in the liver Modified and stored in the gallbladder, bile ducts Emulsifies lipids Transports wastes

Bile

Retroperitoneal gland 12-15cm long Posterior to stomach Consists of head, central body, and tail

Pancreas

What percentage of exocrine and endocrine cells make up the pancreas?

99% exocrine acini cells 1% endocrine islets cells

Pancreatic duct joins common bile duct which forms the what?

hepatopancreatic ampulla of Vater

The hepatopancreatic ampulla of Vater empties into the duodenum at what landmark?

major duodenal papilla

The major duodenal papilla is controlled by what?

Sphincter of Oddi

The list pancreatic secretions

Amylase Lipase Deoxyribonuclease and ribonuclease Sodium bicarbonate Proteases

Muscular tube connecting the oropharynx to the stomach Begins at the level of the cricoid cartilage Approximately 25cm long Internal circular and external longitudinal layers of muscle

Esophagus

The esophagus has three constrictions where adjacent structures produce impressions, name them

Cervical constriction: Upper esophageal sphincter Thoracic constriction: First crossed by the arch of the aorta then where it is crossed by the left main bronchus Diaphragmatic constriction: Where it passes through the esophageal hiatus of the diaphragm

Irregular circumferential line also known as the gastric rosette

Z line

What is the Z line?

At the GE junction, the transition from esophageal to gastric mucosa is seen

Substernal burning sensation

Heartburn (pyrosis)

Difficulty swallowing

Dysphagia

Painful swallowing

Odynophagia

List some diagnostic studies used to evaluate the esophagus

Esophagogastroduodenoscopy (EGD) Barium swallow Esophageal pH monitoring Esophageal Manometry

This study allows for direct visualization and capable of biopsy, variceal banding, dilation, or stent placement

Esophagogastroduodenoscopy (EGD)

This study differentiates between mechanical and motility disorders Able to visualize reflux of barium

Barium Swallow

This study records esophageal pH and correlates acid reflux to patient’s symptoms

Esophageal pH Monitoring

This study is used to assess esophageal motility and function

Esophageal Manometry

Introduction to Gastroenterology Flashcards

(100 cards)