Made Ridiculously Simple Flashcards
(112 cards)
1
Q
Acid secretion
Churning
Releases food to duodenum
Secretes intrinsic factor
A
Stomach
2
Q
Digestion
Absorption
A
Small intestine
3
Q
Water reabsorption
Passage of stool
A
Large intestine
4
Q
Where do these occur?
Chron’s disease
Obstruction
Tumors
A
ANYWHERE in GI tract!
5
Q
Where do these occur?
Obstruction
Reflux
Esophagitis
Varices
A
Esophagus
6
Q
Where do these occur?
Ulcer
Gastroparesis
Outlet obstruction
Gastritis
Pernicious anemia
A
Stomach
7
Q
Where do these occur?
Malabsorption
Obstruction
Mesenteric ischemia
A
Small intestine
8
Q
Where do these occur?
Diarrhea
Constipation
Obstruction
Mesenteric ischemia
Colitis
A
Large intestine
9
Q
This is made in the stomach and binds vitamin B12
A
Intrinsic factor
10
Q
Loss of intrinsic factor can result in….
A
Pernicious anemia (because of decreased B12 absorption)
11
Q
Is there any digestion or absorption in the esophagus?
A
NO
12
Q
Obstruction
Dysfunction of the muscle or its innervation
Outpouchings (diverticula)
Inability to prevent stomach contents from re-entering esophagus
A
Problems that can occur in the esophagus
13
Q
The esphagus will:
have decreased peristalsis
be unable to relax the lower esophageal sphincter to allow passage of food
….if what is compromised?
A
Parasympathetic input
*parasymp does “rest and digest”…tells GI system to do all digestion related things!
14
Q
Esophageal ______ can occur in scleroderma or other connective tissue diseases, as well at in Chagas disease
A
Dilation
15
Q
The lower esophageal sphincter remains constricted and is unable to relax
later in disease, there is also failure to constrict: the lower 2/3 of the esophagus lose the ability to peristalse
A
Achalasia
16
Q
A
17
Q
In this disease, a poorly understood process destroys postganglionic parasympathetic neurons of the esophagus
A
Achalasia
18
Q
The constricted sphincter and proximal dilation classically resemble a birds beak on a barium swallow imaging
A
Achalasia
19
Q
Outpouchings of the esophagus
A
Diverticula
20
Q
Lies just behing the upper esophageal sphincter
It is an outpouching of the lumen that causes food and drink to get stuck there instead of continuing down
Bc food gets stuck, sometimes pts regurgitate
A
Zenker’s diverticulum
(regurgitation would be undigested, since it has not yet reached the stoamch)
21
Q
MC disorder of esophagus
Backwash of stomach acid up through the lower esophageal sphincter, which burns the esophagel mucosa (esophagitis)
A
GERD
22
Q
Heartburn, sour taste in mouth, chest pain
Typically worse when bending over ot when lying down after eating
A
GERD
23
Q
A premalignant condition
Metaplasia from squamous epithelium to columnar
predisposes to adenocarcinoma
A
Barrett’s esophagus
24
Q
GERD
Meds (ie chemo)
Radiation
Chron’s disease
Infection
..can all cause?
A
Esophagitis
25
2 types of esophageal cancer
Adenocarcinoma
Squamous cell carcinoma
26
Barrett's esophagus predisposes to \_\_\_\_\_\_\_\_\_\_\_
Smoking and alcochol predispose to \_\_\_\_\_\_\_\_
Barretts --\> Adenocarcinoma
Smoking/alcohol ---\> Squamous cell carcinoma
27
Dilation of esophageal veins, usually caused by liver disease/portal HTN
Esophageal **varices**
28
These dilated vein walls are more fragile and they are under **high pressure**, making them easy to rupture...causing esophageal bleeding
Esophageal varices
29
What is the appearance of blood from an esophageal varice?
Bright red! (undigested)
\*in contrast to digested blood (ie gastric or duodenal ulcers) which appears like coffee grounds
30
The _____ cells of the stomach secrete acid by pumping H+ into the stomach lumen in exchange for K+
\*this mechanism is **stimulated by** **gastrin, histamine and Ach**
\*this mechanism if _inhibited by somatostatin, prostaglandins, secretin, and VIP_
parietal
31
Gastrin
Histamine
Acetylcholine
..stimulate or inhibt acid production in stomach?
STIMULATE!
32
Somatostatin
Prostaglandins
Secretin
VIP (vasoactive intestinal peptide)
Stimulate or inhibit acid secretion in the stomach?
INHIBIT
33
2 basic pathophysiological causes of ulcer formation?
1. decreased mucosal protection
2. increased acid production
**\*\*H PYLORI LEADS TO ULCER FORMATION BY _BOTH_ MECHANISMS**
34
Prostaglandins _(increase/decrease)_ mucus secretion in the stomach?
INCREASE
35
This drug class **decreases mucus secretion** because they block prostaglandin pathways
NSAIDs
..this can lead to ulcer formation
36
What do tobacco and alcohol do to mucosal protection in the stomach?
DECREASE! ...predisposing to ulcers
37
Why do stress ulcers occur?
(due to sepsis, burns, hemorrhage, etc.)
Decreased perfusion to stomach can lead to decreased mucosal protection
38
Gastrin, produced by G cells, stimulates.....
acid secretion
39
In this syndrome...
a pancreatic tumor called a gastrinoma secretes excess gastrin
\***the increase in gastrin secretion by the gastrinoma leads to increased acid production, causing ulcers**
Zollinger-Ellison syndrome
40
This diagnosis can be provd by marked elevation in serum gastrin and by elevation fo serum gastrin in response to secretin
Zollinger-Ellison Syndrome
41
\_\_\_\_\_\_\_ is a hormone normally produced by the small intestine when food arrives from the stomach
\***stimulates the pancreas to secrete bicarb, which neutralizes the duodenal contents**
Secretin
SECRETIN NEUTRALIZES DUODENAL CONTENTS VIA BICARB
42
Secretin inhibits.....
Gastrin secretion
43
If a pancreas has a gastrinoma, secretin will do what to gastrin levels?
INCREASE
(gastrin will stimulate gastric acid production...ultimately leading to ulcer formation)
44
A positive secretin test (ie elevation of serum gastrin in response to secretin) is diagnostic for.....
Zollinger-Ellison Syndrome
45
Pain
N/V (with blood sometimes)
Melena
Changes in appetite
\***if severe, can lead to perforation of the duodenal or gastric wall**
Ulcers
46
These can present as acute abdominal pain with air under the diaphragm visible on XRay
Perforated ulcers
47
In which site would ulcer pain get worse **immediately after eating?**
Gastric ulcers
48
Which site would ulcer pain get worse **some time after eating?**
Duodenal ulcer
49
What diagnostic will definitively diagnose a gastric or duodenal ulcer?
Endoscopy
**\*gastric ulcers should ALWAYS be biopsied to rule out cancer**
50
Which drug class...
Directly affect acid secretion by blocking H+/K+ pump in the parietal cells
PPIs
51
Which drug class....?
Decrease stimulation of the parietal cells by blocking histamine
H2 blockers
52
Where are H2 receptors located?
Parietal cells
53
How do **Sucralfate** and **Misoprostol** work?
They increase mucosal protection
\*Misoprotol increase prostaglandins
\*Sucralfate provides a coating
54
A condition in which antibodies **form against the parietal cells**, leading to loss of intrinsic factor (and therefor unable to absorb B12)
Pernicious anemia (aka autoimmune gastritis)
55
"from the inside" causes:
- foreign body
- gastric polyp
- gastric cancer
"from the outside" causes:
-pancreatic tumor
Obstruction causes of the pyloric sphincter
56
Symptoms of an obstructed pyloric sphincter?
**Vomit!\***
Early satiety
Abdominal distention
57
A palpable olive-like mass on exam and visible waves of peristalsis
...presentation of?
Congenital pyloric sphincter
(the "olive" mass is the hypertrophied sphincter)
58
Stomach is under the control of which nervous system?
Enteric Nervous System
59
Parasympathetic input to stomach comes from the Vagus Nerve.
A problem with parasympthetic nerves to stomac can lead to decreased stomach muscle activity and.....
Gastroparesis (paralysis of the stomach)
60
H. Pylori
Pernicious anemia
Radiation
...all predispose to?
Gastric cancer
61
MC type of gastric cancer
Adenocarcinoma
62
N/V
Early satiety
GI bleeds
Gastric cancer
..usually occur late in dz so prognosis generally poor
63
Food is churned and broken down in the stomach
then, arrives in small intestine which stimulates the release of what by the duodenum?
Cholecystokinin (CCK)
and
Secretin
64
What secretes CCK and Secretin? and when?
Secreted by the duodenum
..when food from the stomach reaches the small intestine
65
Most common part of the colon for diverticula?
Descending (LLQ)
66
If lactose is not broken down by lactase enzyme, it ends up in the lg intestine (instead of being absorbed in the small intestine)
\*this increase in solute concentration in the lg intestine causes....
water to be drawn into the lumen ---\> **diarrhea**
67
Genetic
Abdominal pain
Lower GI bleeding
Change in bowel habits
and/or obstruction
Colon cancer (adenocarcinoma)
68
Regular screening of:
Fecal occult blood testing
Flexible sigmoidoscopy
Barium contrast Xray
and/or colonoscopy
..recomended for age?
50+
69
Which 2 conditions make up inflammatory bowel **disease**
Chron's disease
Ulcerative colitis
70
Difference between ulcerative colitis and chron's?
Ulcerative colitis is limited to colon and has continuous ulcerations
Chron's can occur anywhere from mouth to anus and has interrupted, multiple ulcerations
71
Causes **transmural inflammation** (crossing histologic boundaries)
and **fissures** (boundary crossing tears)
Chron's disease
72
Chron's disease can cause what type of anemia?
B12 deficiency anemia
(from damage to terminal ileum, which decreases B12 absorption)
73
Aphthous ulcers
Sclerosing cholangitis (inflammation of bile ducts)
Skin findings (pyoderma gangrenosum, erythema nodosum)
Eye findings (iritis, scleritis)
Seen with inflammatory bowel disease
74
Can have inflammatory bowel disease increase your risk of colon cancer?
YES
75
If a pt vomits **bright red blood**, where must the bleed be coming from?
**ABOVE** the gastroesophageal sphincter/junction because this blood is **NOT DIGESTED**
76
If the pt vomits dark, "coffee ground" vomit, where must the bleed be coming from?
**BELOW** the gastroesophageal sphincter/junction because the blood **has been digested**
(**typically a gastric or duodenal ulcer)**
77
Causes of hematochezia (bright red blood in stool):
Bleeding hemorrhoids
Bleeding colon cancer
Bleeding diverticula
(bright red must mean close to exit)
78
Melena (dark, tarry stool) indicates a bleed where?
Upper GI bleed (has been digested)
ie bleeding ulcer
79
What vein drains the gut's venous system, carrying absobed nutrients to the liver?
Hepatic portal vein
80
\*Provides glucose during fasting (via gluconeogenesis and glycogenolysis)
\*detoxifies
\*stores glycogen
\*produces bile and other proteins/lipids
Functions of the liver
81
If there is liver failured and a **decreased ability to detoxify** the blood, what can happen?
Toxins in blood can build up, leading to hepatic encephalopathy
82
If there is liver failure and a decrease in gluconeogenesis, what can happen?
Fasting hypoglycemia
83
If there is liver failure and a **decrease in protein production**, what can happen?
Decreased production of clotting factors, **increasing the risk of bleeding**
84
If there is liver failure, which prevents the liver from secreting conjugated bilirubin or from conjugating bilirubin, what can happen?
Jaundice!
85
\_\_\_\_\_\_ emulsifies fats in the GI tract, facilitating their absorption
Bile
86
Bile is produced in the liver and then drains through the intrahepatic biliary system into the extra-hepatic......
biliary tree
87
A component of bile that is a product of the breakdown of old (or damaged) RBCs
Bilirubin
88
When RBCs break down, what type of bilirubin forms in circulation?
Unconjugated
(**the liver conjugates this, making conjugated bilirubin!**)
89
The liver turns the unconjugated bilirubin into conjugated bilirubin, which is secreted into the...
bile
90
Is jaundice due to an increase in conjugated or unconjugated bilirubin?
EITHER!
91
Unconjugated bilirubin is also called....
Indirect bilirubin
92
93
- increased production of bilirubin
- decreased uptake of bilirubin by the liver
- decreased conjugation of bilirubin by the liver
...will all cause an increase in?
Indirect bilirubin (and jaundice!)
94
What does hemolytic anemia do to bilirubin?
Increases production!
(bc bilirubin comes from the breakdown of old or damaged RBCs)
95
CHF reduces blood flow to the liver, which decreases delivery of bilirubing, resulting in....
unconjugated jaundice
96
Crigler-Najjar and Gilbert's syndrome cause what kind of jaundice?
Unconjugated
97
If the liver cannot secrete bilirubin into the bile ducts or if the biliary tree is obstructed, what kind of jaundice?
Conjugated jaundice
98
Toxin induced hepatic failure or infections
Alcoholics
Autoimmune hepatitis
....cause what type of jaundice?
Conjugated bilirubin jaundice
99
An obstruction of the biliary tree causes what kind of jaundice?
Conjugated
100
In liver disease, which 2 enzymes are released into circulation?
AST
ALT
101
When the biliary tree is obstructed, the cell of the bile ducts release.....
alkaline phosphatase
(alk ph**o**s=**o**bstruction)
...in long standing obstruction, AST and ALT may be elevated too, but not as much as alk phos
102
Alkaline phosphatase is mainly present in the cells of the....
bile ducts
(damage to the bile ducts will result in an increse of alk phos)
103
Injury to hepatocytes will result in elevation of?
AST and ALT
104
Which type of bilirubin is elevated in liver disease?
Conjugated
(secretion of bilirubin is a rate limiting step)
105
\_\_\_\_\_\_\_ is a serum protein synthesized by the liver
\*used to measure the liver's capacity for protein synthesis
Albumin
106
What happens to albumin levels in liver dz?
decrease
(albumin also decreases in inflammatory dz like trauma, malnutrition, and dzs that cause proteinuria)
107
\_\_\_\_\_\_\_\_\_\_\_\_\_ measures function in part of the clotting cascade
prothrombin time
108
If there is liver damage and deficient clotting (due to liver disease) what happens to the prothrombin time?
**elevated** prothrombin time
if there is deficient clotting factors due to liver dz
109
Prothrombin time assesses the extrinsic pathway of the clotting cascade, namely factor \_\_\_\_\_
Factor VII
110
Elevated prothrombin time is more associated with what type of liver dz?
Acute
111
A decrease in albumin is generally associated with what type of liver disease?
Chronic
112
