Week 4 GI Part 3 Flashcards

(197 cards)

1
Q

What are the main classes of antidiarrheal agents?

A

Opioid agonists, somatostatin analogues, adsorbents, bile acid sequestrants

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2
Q

What is diarrhea defined as?

A

The passage of ≥ 3 loose or liquid stools within 24 hours

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3
Q

Classify diarrhea based on duration.

A
  • Acute: ≤ 2 weeks
  • Persistent: > 2 weeks but < 4 weeks
  • Chronic: ≥ 4 weeks
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4
Q

Classify diarrhea based on etiology and pathophysiology.

A
  • Infectious diarrhea: Inflammatory, Noninflammatory
  • Noninfectious diarrhea: Secretory, Osmotic, Malabsorption, Inflammatory, Altered motility
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5
Q

What are the general management strategies for diarrhea?

A
  • Supportive care
  • Antimicrobials for specific infectious etiologies (not routinely required)
  • Antidiarrheal agents
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6
Q

What are the contraindications for using antidiarrheal agents?

A
  • Diarrhea with fever
  • Bloody or mucoid stool
  • Diarrhea caused by Clostridioides difficile and Shigella
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7
Q

What is the mechanism of action for opioid agonists used as antidiarrheal agents?

A

Act on mu receptors in the myenteric and submucosal plexus to inhibit peristalsis, decrease secretion, and increase colonic transit time

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8
Q

Name two opioid agonists used for their antidiarrheal activity.

A
  • Loperamide
  • Diphenoxylate
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9
Q

What is the primary indication for loperamide?

A

Symptomatic relief in noninvasive diarrhea, mild traveler’s diarrhea, chronic diarrhea with inflammatory bowel disease (IBD)

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10
Q

What are common adverse effects of opioid agonists?

A
  • Nausea
  • Abdominal cramps
  • Constipation
  • Allergic reactions
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11
Q

What are the contraindications for using diphenoxylate?

A
  • Invasive diarrhea
  • Pseudomembranous colitis
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12
Q

What is the mechanism of action for somatostatin analogues?

A

Inhibit the release of serotonin and other GI peptides and hormones, decreasing intestinal fluid secretion and GI motility

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13
Q

What is a key indication for octreotide?

A

Secretory diarrhea caused by carcinoid syndrome, VIPoma, or gastrinoma

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14
Q

What are some adverse effects of somatostatin analogues?

A
  • Nausea
  • Abdominal pain
  • Gallstone formation
  • Steatorrhea
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15
Q

Name three medications classified as adsorbents.

A
  • Bismuth subsalicylate
  • Kaolin
  • Pectin
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16
Q

What is the mechanism of action for adsorbents?

A

Coat the GI tract, allowing binding and elimination of infectious pathogens and toxins

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17
Q

What should bismuth subsalicylate not be used for?

A
  • Allergy to salicylates
  • GI bleed
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18
Q

What is the primary indication for bile acid sequestrants?

A

Bile acid malabsorption diarrhea

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19
Q

What is the mechanism of action for bile acid sequestrants?

A

Bind excess bile acids, forming insoluble compounds that decrease secretion of water and electrolytes

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20
Q

What is hepatitis D virus (HDV)?

A

A small enveloped, single-stranded RNA virus that requires hepatitis B virus for assembly and secretion

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21
Q

How is hepatitis D virus transmitted?

A
  • Parenterally
  • Unprotected sexual intercourse
  • Perinatally
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22
Q

What is the clinical presentation of hepatitis D infection?

A

Classical viral hepatitis, often in conjunction with hepatitis B

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23
Q

What is the management for acute cases of hepatitis D?

A

Supportive care

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24
Q

What is the management for chronic cases of hepatitis D?

A

Pegylated interferon alfa (PEG-IFN-α)

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25
What is the structure of hepatitis D virus?
* Family: Kolmioviridae * Genus: Deltavirus * Single-stranded circular RNA * Negative-sense genome
26
What is the family and genus of Hepatitis D virus?
Family: Kolmioviridae, genus: Deltavirus
27
What type of genome does Hepatitis D virus have?
Single-stranded circular RNA (ssRNA)
28
What is the diameter of the Hepatitis D virus?
Approximately 36 nm
29
What distinguishes Hepatitis D virus from classical satellite viruses?
HDV does not have sequence similarity with hepatitis B virus (HBV)
30
How does Hepatitis D virus replicate?
Relies on host-cell machinery for replication
31
What percentage of individuals with hepatitis B worldwide have HDV coinfection?
About 5%
32
What are the most common transmission routes for Hepatitis D?
* Unprotected sexual intercourse * Parenterally (shared IV drug needles) * Mother to child
33
What are the host risk factors for Hepatitis D infection?
* Persons who inject drugs (PWIDs) * Individuals with unprotected sex with multiple partners * Men who have sex with men (MSM) * HIV infection * Hemodialysis * Infants born to HBV-positive mothers
34
What is the clinical presentation of HDV infection?
* 90% of cases are asymptomatic * Nausea * Vomiting * Jaundice * Fever * Tiredness * Dark urine * Abdominal pain
35
What is the incubation period for HDV coinfection?
1–6 months
36
What is the incubation period for HDV superinfection?
2–8 weeks
37
What laboratory markers are used for diagnosing HDV?
* HbsAg * Anti-HDV IgM * HDV RNA * IgM anti-HBc * Serum HDAg
38
What is the management approach for acute HDV disease?
Supportive, no specific therapy available
39
What is the primary prevention method for Hepatitis D?
Vaccination against HBV
40
What are the structural proteins of Hepatitis C virus?
* Core * Envelope 1 (E1) * Envelope 2 (E2)
41
What are the types of nonstructural proteins in Hepatitis C virus?
* NS2 * NS3 * NS4A * NS4B * NS5A * NS5B
42
What are the two main previous treatments for acute Hepatitis C infection?
* Interferon alfa (IFN-α) * Ribavirin
43
What is the success rate of direct-acting antivirals (DAVs) for chronic Hepatitis C?
> 90% success rate
44
What is the mechanism of action of Interferon alfa (IFN-α)?
* Inhibits viral entry into a cell * Inhibits protein processing * Inhibits replication
45
What type of liver disease can Hepatitis D infection lead to?
Hepatocellular carcinoma (HCC)
46
What is a common laboratory marker indicating severe disease in HDV infection?
Hypoalbuminemia
47
What are the symptoms associated with HDV superinfection?
* Severe acute hepatitis * Exacerbation of chronic hepatitis B * Cirrhosis * Hepatocellular carcinoma (HCC)
48
What is the role of hepatitis B surface antigen (HbsAg) in Hepatitis D?
It is part of the envelope of the Hepatitis D virus
49
What is the difference between coinfection and superinfection in HDV?
* Coinfection: occurs simultaneously with HBV * Superinfection: occurs in individuals already infected with HBV
50
What are the mechanisms through which N-α works?
* Induces intracellular signals responsible for inhibition of viral entry into a cell * Inhibits protein processing * Inhibits replication * Modulates the immune system by increasing expression of MHC molecules, phagocytic activity, and activity of CD8+ T cells and natural killer cells ## Footnote These mechanisms contribute to its antiviral effects.
51
What are the pharmacokinetic properties of N-α?
* Available in IV, IM, and SC forms * Poor oral bioavailability * Slow absorption * Metabolized through proteolysis by endogenous proteases * Excretion via renal and biliary routes ## Footnote These properties affect how N-α is administered and its effectiveness.
52
List the indications for N-α.
* Chronic hepatitis B * Hepatitis C (acute and chronic, in combination with ribavirin) * Chronic hepatitis D * Chronic hepatitis E * Non-Hodgkin lymphoma * Malignant melanoma * Hairy cell leukemia * Kaposi sarcoma * Condylomata acuminata * Follicular lymphoma * Polycythemia vera * Essential thrombocythemia ## Footnote These conditions highlight the therapeutic uses of N-α.
53
What are common adverse effects of N-α?
* Flu-like syndrome * Transient increase in liver enzymes * CNS effects (mood disorders, seizures, confusion, suicidal thoughts) * Bone marrow suppression (neutropenia, thrombocytopenia, anemia) * Induction of autoantibodies and autoimmune disease * Severe infections * Ischemic and hemorrhagic conditions ## Footnote These side effects should be monitored during therapy.
54
What are the contraindications for N-α?
* Decompensated liver disease * Autoimmune diseases * Prior history of cardiac arrhythmia * Uncontrolled seizure disorder * Pregnancy ## Footnote These contraindications are critical for patient safety.
55
What drug interactions are associated with N-α?
* Increased serum levels of methadone and theophylline * Increased risk of liver failure with didanosine * Increased risk of myelosuppression with zidovudine and clozapine ## Footnote Awareness of these interactions is important for managing patient treatment.
56
What is the chemistry of Ribavirin?
* Guanosine analogue * Prodrug metabolized into active form within cells ## Footnote Understanding its chemistry helps explain its mechanism of action.
57
What is the mechanism of action of Ribavirin?
* Interferes with the synthesis of guanosine triphosphate (GTP) * Inhibits viral RNA-dependent polymerase * Results in inhibition of viral replication and protein synthesis ## Footnote This mechanism underscores its role in antiviral therapy.
58
What are the pharmacokinetics of Ribavirin?
* Rapidly absorbed * Bioavailability increases with high-fat meals and decreases with antacids * Large volume of distribution * Not protein bound * Metabolized in the liver * Excreted primarily in urine and feces ## Footnote These factors influence dosing and effectiveness.
59
List the indications for Ribavirin.
* Chronic hepatitis C (in combination with IFN) * Chronic hepatitis E * Respiratory syncytial virus infection * Specific viral hemorrhagic fevers (e.g., Lassa fever) ## Footnote Indicates its diverse uses in viral infections.
60
What are the common adverse effects of Ribavirin?
* Pruritis * GI upset * Depression * Hemolytic anemia (dose-dependent) ## Footnote Monitoring for these side effects is essential during treatment.
61
What are the contraindications for Ribavirin?
* Anemia * Significant cardiovascular disease * Severe renal impairment * Pregnancy (teratogenic) ## Footnote These contraindications are important for patient safety.
62
What drug interactions are significant with Ribavirin?
* Increased risk of mitochondrial toxicity with didanosine * Myelosuppression with azathioprine and zidovudine ## Footnote Awareness of these interactions is crucial in patient management.
63
List medications in the NS3A/4A Protease Inhibitors class.
* Simeprevir (discontinued in the US) * Glecaprevir * Grazoprevir * Paritaprevir * Voxilaprevir ## Footnote These medications are critical in treating hepatitis C.
64
What is the mechanism of action of NS3A/4A Protease Inhibitors?
Inhibit NS3/4A serine protease necessary for HCV replication ## Footnote This action is vital for the effectiveness of these drugs.
65
What are the pharmacokinetics of NS3A/4A Protease Inhibitors?
* Protein-bound distribution * Metabolized by cytochrome P450 enzymes (mainly CYP3A) * Excreted mainly in feces ## Footnote Understanding pharmacokinetics helps inform dosing and potential interactions.
66
What are the indications for NS3A/4A Protease Inhibitors?
Used in combination therapy to treat chronic hepatitis C ## Footnote This therapy is essential for managing hepatitis C effectively.
67
What are common adverse effects of NS3A/4A Protease Inhibitors?
* Nausea * Headache * Fatigue * Diarrhea * Rashes and photosensitivity * Hepatic decompensation * Reactivation of hepatitis B ## Footnote Monitoring for these effects during treatment is important.
68
What drug interactions are associated with NS3A/4A Protease Inhibitors?
* Can enhance hypoglycemic effect of antidiabetic medications * Increased serum concentrations of some statins * CYP3A4 inducers and inhibitors alter levels ## Footnote Understanding these interactions is critical for patient safety.
69
List medications in the NS5A Inhibitors class.
* Daclatasvir (discontinued in the US) * Ledipasvir * Velpatasvir * Elbasvir * Ombitasvir * Pibrentasvir ## Footnote These medications are key in the treatment of hepatitis C.
70
What is the mechanism of action of NS5A Inhibitors?
* Bind to NS5A and inhibit viral replication ## Footnote This mechanism is crucial for their therapeutic effects.
71
What are the pharmacokinetics of NS5A Inhibitors?
* Generally well absorbed * Protein bound distribution * Metabolized by CYP system (often CYP3A4) * Mainly eliminated in feces ## Footnote Understanding these pharmacokinetics informs clinical use.
72
What are the indications for NS5A Inhibitors?
Used in combination therapy for chronic hepatitis C ## Footnote This indicates their role in effective hepatitis C management.
73
What are common adverse effects of NS5A Inhibitors?
* Headache * Fatigue * Nausea * Hepatic decompensation * Reactivation of hepatitis B ## Footnote Monitoring for these side effects is essential during treatment.
74
What drug interactions are significant with NS5A Inhibitors?
* Can enhance hypoglycemic effect of antidiabetic medications * Increased serum concentrations of some statins * CYP3A4 inducers and inhibitors alter levels ## Footnote Awareness of these interactions is crucial for patient management.
75
What are the classifications of NS5B RNA-Dependent RNA Polymerase Inhibitors?
* Nucleoside/nucleotide polymerase inhibitors (NPIs): sofosbuvir * Non-nucleoside polymerase inhibitors (NNPIs): dasabuvir ## Footnote This classification is critical for understanding their mechanisms.
76
What is the mechanism of action of NS5B RNA-Dependent RNA Polymerase Inhibitors?
* NPIs compete with nucleotides and incorporate into viral RNA, halting replication * NNPIs allosterically bind to NS5B, inhibiting its function ## Footnote This mechanism is essential for their antiviral activity.
77
What are the pharmacokinetics of NS5B RNA-Dependent RNA Polymerase Inhibitors?
* Protein bound distribution * NPIs phosphorylated in hepatocytes * Dasabuvir metabolized by CYP2C8 and CYP3A * Excretion: sofosbuvir primarily in urine, dasabuvir primarily in feces ## Footnote Understanding these properties informs clinical usage.
78
What are the indications for NS5B RNA-Dependent RNA Polymerase Inhibitors?
Used in combination therapy for chronic hepatitis C ## Footnote This indicates their role in effective hepatitis C management.
79
What are common adverse effects of NS5B RNA-Dependent RNA Polymerase Inhibitors?
* Fatigue * Headache * Insomnia * Nausea * May reactivate hepatitis B ## Footnote Monitoring for these effects is important during treatment.
80
What drug interactions are associated with NS5B RNA-Dependent RNA Polymerase Inhibitors?
* Can enhance hypoglycemic effect of antidiabetic medications * Increased serum concentrations of some statins * Amiodarone increases bradycardia risk with sofosbuvir ## Footnote Awareness of these interactions is crucial for patient management.
81
What are the first-line agents for tuberculosis?
* Rifampin * Isoniazid * Pyrazinamide * Ethambutol ## Footnote These agents are essential in treating tuberculosis.
82
What is the mechanism of action of Rifampin?
Inhibits DNA-dependent RNA polymerase, blocking mRNA synthesis ## Footnote This mechanism is critical for its antibacterial effects.
83
What are the pharmacokinetics of Rifampin?
* Reduced absorption by food * Lipophilic and widely distributed * Hepatic metabolism * Mainly excreted in bile/feces ## Footnote Understanding pharmacokinetics helps inform dosing and effectiveness.
84
What are common adverse effects of Rifampin?
* Hepatic toxicity * Rash * Orange/red discoloration of bodily secretions * Hemolytic anemia * Neutropenia * Flu-like syndrome ## Footnote Monitoring for these side effects is essential during treatment.
85
What are the contraindications for Rifampin?
* Hypersensitivity to rifampin * Liver disease * Concurrent use with protease inhibitors ## Footnote These contraindications are important for patient safety.
86
What is the mechanism of resistance to Rifampin?
Mutations in the rpoB gene reduce drug binding ## Footnote This understanding is crucial for managing drug resistance.
87
What is the mechanism of action of Isoniazid?
Inhibits mycolic acid synthesis, affecting mycobacterial cell wall ## Footnote This mechanism is essential for its antibacterial effects.
88
What are the pharmacokinetics of Isoniazid?
* Well absorbed orally * Widely distributed * Metabolism via acetylation ## Footnote Understanding pharmacokinetics helps inform dosing and effectiveness.
89
What is the absorption characteristic of isoniazid?
Well absorbed orally, but may be reduced or delayed by food
90
How is isoniazid distributed in the body?
Widely distributed throughout the body
91
What is the metabolism of isoniazid largely determined by?
Genetically determined hepatic metabolism via acetylation
92
What percentage of Caucasians and Blacks are rapid acetylators of isoniazid?
50%
93
What percentage of Asians and those of the Alaska and Arctic regions are rapid acetylators of isoniazid?
80%–90%
94
What is the primary route of elimination for isoniazid?
Renal (up to 96% excreted unchanged)
95
What effect does isoniazid have on the cytochrome P (CYP) hepatic enzyme system?
Inhibition leads to drug interactions and increased concentration of other drugs
96
List some drugs that interact with isoniazid
* Carbamazepine * Phenytoin * Theophylline
97
What are the main adverse effects of isoniazid?
* Hepatic: ↑ liver function tests (hepatotoxicity) * Neurologic: peripheral neuropathy, ataxia, paresthesia, headache, depression, seizures * Hematologic: hemolytic anemia * Immunologic: flu-like syndrome, drug-induced systemic lupus erythematosus * Rash
98
What are the contraindications for isoniazid?
* Hypersensitivity or previous severe reaction to INH * Precaution in liver disease
99
What mutations contribute to resistance to isoniazid?
* Mutation of inhA (protein involved in mycobacterial cell wall synthesis) * Mutation of KatG (down-regulated enzyme activity)
100
What is pyrazinamide a synthetic analogue of?
Nicotinamide
101
What is the active form of pyrazinamide?
Pyrazinoic acid (POA)
102
What is the mechanism of action of pyrazinamide?
Uncertain, likely involves protonated POA diffusing back into the cell
103
How is pyrazinamide absorbed?
Rapid absorption with oral bioavailability of approximately 90%
104
What are the adverse effects of pyrazinamide?
* Hepatic: ↑ liver function tests (hepatotoxicity) * Hyperuricemia * Nongouty polyarthralgia * GI upset * Thrombocytopenia, sideroblastic anemia * Rash, photosensitivity
105
What are the contraindications for pyrazinamide?
* Hypersensitivity to pyrazinamide * Acute gout * Severe hepatic damage * Not safe in pregnancy
106
What mutation leads to resistance against pyrazinamide?
Mutation of pncA (encodes pyrazinamidase)
107
What is the mechanism of action of ethambutol?
Inhibits arabinosyltransferase, disrupting mycobacterial cell wall synthesis
108
What are the adverse effects of ethambutol?
* Optic neuropathy * Hepatotoxicity * GI symptoms * Hematologic issues * Headache, dizziness, confusion * Peripheral neuritis
109
What are the contraindications for ethambutol?
* Hypersensitivity to ethambutol * Optic neuritis
110
What are the aminoglycosides used for tuberculosis treatment?
* Streptomycin * Amikacin
111
What is the mechanism of action of bedaquiline?
Inhibits mycobacterial ATP synthase
112
What is a common adverse effect of bedaquiline?
QT prolongation
113
What is the mechanism of action of cycloserine?
Blocks peptidoglycan production, disrupting mycobacterial cell wall synthesis
114
What are the first-line treatments for Mycobacterium leprae?
* Dapsone + rifampin for tuberculoid leprosy * Dapsone + rifampin + clofazimine for lepromatous leprosy
115
What is the incidence of Crohn's disease?
Approximately 3–20 per 100,000 adults per year
116
What is a common risk factor for Crohn's disease?
Smoking
117
What genetic factors are associated with Crohn's disease?
* HLA-B27 * NOD2
118
What are common clinical presentations of Crohn's disease?
* Intermittent, non-bloody diarrhea * Crampy abdominal pain
119
What is the diagnosis for Crohn's disease established by?
Endoscopy with biopsy showing transmural inflammation and noncaseating granulomas
120
What are common complications of Crohn's disease?
* Malabsorption * Malnutrition * Intestinal obstruction or fistula * Increased risk of colon cancer
121
What is the primary immune response involved in Crohn's disease?
Recruitment and activation of cytotoxic cells
122
What cytokines are released by Th1-mediated cells in the GI wall?
Pro-inflammatory cytokines
123
What is the consequence of lack of down-regulation of immune responsiveness after an infection?
Chronic inflammation leading to granulomas
124
List some types of intestinal tissue damage seen in Crohn's disease.
* Edema * Ulcerations * Erosions * Necrosis
125
What are possible severe outcomes of transmural inflammation in Crohn's disease?
* Intestinal perforation * Fistulas
126
What are the chronic effects of repetitive episodes in Crohn's disease?
* Scarring * Fibrosis * Obstruction of the intestinal wall
127
What is the most common site of inflammation in Crohn's disease?
Terminal ileum and proximal colon
128
True or False: The rectum is often involved in Crohn's disease.
False
129
What are common GI manifestations of Crohn's disease?
* Chronic, intermittent diarrhea * Crampy abdominal pain * Odynophagia or dysphagia * Flatulence and bloating * Fecal incontinence * Signs of malabsorption
130
What general symptoms are associated with Crohn's disease?
* Low-grade fever * Fatigue * Pallor * Dyspnea * Palpitations * Loss of appetite * Weight loss * Failure to thrive in children
131
List some extraintestinal manifestations of Crohn's disease.
* Aphthous ulcers * Gallstone formation * Kidney stones * Pyoderma gangrenosum * Erythema nodosum * Eye inflammation * Peripheral arthritis * Ankylosing spondylitis * Clubbing of fingertips * Primary sclerosing cholangitis
132
What can trigger reactivation of Crohn's disease during asymptomatic periods?
* Physical stress * Psychological stress * Sudden dietary changes * Smoking
133
What initial symptoms suggest Crohn's disease?
* Abdominal pain * Chronic intermittent diarrhea * Fatigue * Weight loss
134
What laboratory findings are common in Crohn's disease?
* Anemia * Leukocytosis * Thrombocytosis * Electrolyte imbalance * Iron deficiency * Vitamin B deficiency * Increased ESR and CRP
135
What imaging studies are useful for assessing Crohn's disease?
* Abdominal CT * MRI * X-ray with barium swallow
136
What are the macroscopic findings in a colonoscopy for Crohn's disease?
* Skip lesions * Ulcers * Fissures * Fistulas
137
What are common treatments for Crohn's disease?
* Smoking cessation * Vitamin B12 and D * Antidiarrheal agents * Antibiotics * Corticosteroids * Immunomodulators * Anti-TNF therapies
138
What surgical intervention may be necessary in Crohn's disease?
Intestinal resection
139
What complications can arise from Crohn's disease?
* Bowel obstruction * Intestinal perforation * Fistulas * Abscess * GI bleeding * Perianal disease * Increased risk of colorectal cancer
140
What are differential diagnoses for Crohn's disease?
* Infectious colitis * Celiac disease * Irritable bowel syndrome (IBS) * Lactose intolerance * Ulcerative colitis
141
What is the definition of a peptic ulcer?
A mucosal defect in the wall of the stomach or duodenum that penetrates the muscularis mucosa
142
What is the most common cause of peptic ulcer disease?
Helicobacter pylori infection
143
What are common symptoms of peptic ulcer disease?
* Abdominal pain * Nausea * Early satiety
144
What can untreated peptic ulcer disease lead to?
* Bleeding * Perforation * Gastric outlet obstruction * Gastric cancer
145
What is the most common infection associated with peptic ulcer disease (PUD)?
Helicobacter pylori (H. pylori) ## Footnote H. pylori is responsible for 80%–90% of duodenal ulcers and 70%–80% of gastric ulcers.
146
Name two viruses that can contribute to peptic ulcer disease.
* Herpes simplex virus (HSV) * Cytomegalovirus (CMV) ## Footnote These viruses are less common causes compared to H. pylori.
147
What are some medications linked to peptic ulcer disease?
* Non-steroidal anti-inflammatory drugs (NSAIDs) * Bisphosphonates * Clopidogrel * Corticosteroids * Spironolactone * Chemotherapy * Sirolimus * Mycophenolate mofetil * Potassium chloride ## Footnote NSAIDs are the most common medications associated with PUD.
148
What hormonal condition is associated with peptic ulcer disease?
Gastrinoma (Zollinger-Ellison syndrome) ## Footnote This condition causes excessive gastric acid secretion.
149
Identify two chronic diseases that can lead to peptic ulcer disease.
* Cirrhosis * Renal failure ## Footnote Other chronic diseases include chronic obstructive pulmonary disease (COPD) and prolonged ICU stays.
150
What is an asymptomatic presentation in PUD?
70% of PUD patients are asymptomatic ## Footnote Symptoms may only present as complications like bleeding or perforation.
151
What is a classic symptom of a duodenal ulcer?
Abdominal pain 2–5 hours after eating and at night ## Footnote This pain occurs when acid is secreted without food.
152
What is the most accurate diagnostic test for peptic ulcer disease?
Esophagogastroduodenoscopy (EGD) ## Footnote EGD allows for direct visualization of ulcers.
153
What findings are typically associated with a gastric ulcer during EGD?
* Solitary discrete mucosal lesions * Punched-out smooth base * Benign lesions have smooth, rounded edges ## Footnote Irregular edges may indicate malignancy.
154
What is the first-line treatment for H. pylori eradication?
* Triple therapy: PPI + clarithromycin + amoxicillin or metronidazole * Bismuth-containing quadruple therapy: PPI + bismuth + tetracycline + metronidazole ## Footnote Confirm H. pylori eradication after treatment.
155
What are some indications for repeat endoscopy in gastric ulcers?
* Persistent symptoms despite treatment * Unclear etiology * Giant ulcer (> 2 cm) * Suspicion of malignancy * Evidence of ongoing bleeding * Failure to eradicate H. pylori ## Footnote Risk factors for gastric cancer also warrant repeat endoscopy.
156
What is a Dieulafoy lesion?
A vascular malformation in the stomach that ulcerates and causes massive bleeding ## Footnote This condition may require surgical intervention if endoscopic control is not achieved.
157
What are the main complications of peptic ulcer disease?
* Gastrointestinal bleeding * Perforation * Penetration * Gastric outlet obstruction * Gastric cancer ## Footnote Each complication presents with distinct symptoms and management strategies.
158
What is the primary treatment for gastric outlet obstruction due to PUD?
H. pylori eradication and PPIs ## Footnote Endoscopic dilation may be attempted if medical management fails.
159
True or False: Gastric cancer can be asymptomatic in early stages.
True ## Footnote Typically, gastric cancer presents with symptoms like bloating and early satiety in later stages.
160
What are some symptoms of gastrointestinal bleeding in PUD?
* Hematemesis * Melena * Anemia ## Footnote Chronic bleeding may present with low-grade symptoms.
161
What is the definition of gastritis?
Gastritis is the inflammation of gastric mucosa associated with mucosal injury.
162
What is the prevalence of gastritis in the population?
6.3 per 100,000 population.
163
What is the primary determinant of H. pylori gastritis in the pediatric population?
H. pylori prevalence: *10% in Western countries* *50% in developing countries*
164
What are the common causes of gastritis?
*H. pylori infection* *Aspirin/NSAID use* *Autoimmune processes* *Infectious agents*
165
What symptoms are associated with gastric cancer?
*Bloating* *Early satiety* *Dysphagia* *Weight loss* *Cancer-related fatigue*
166
What is the diagnostic method for gastric cancer?
Endoscopy with biopsy.
167
What is the typical presentation of cholecystitis/cholelithiasis?
*Right upper quadrant pain* *Epigastric pain* *Nausea* *Vomiting*
168
What are the common symptoms of pancreatitis?
*Epigastric pain radiating to the back* *Nausea* *Vomiting* *Bloating*
169
What is the typical clinical presentation of viral gastroenteritis?
*Diffuse abdominal pain* *Vomiting* *Diarrhea* *Fever* *Watery diarrhea*
170
What does acute coronary syndrome typically present with?
*Chest pain* *Radiation to neck, shoulder, jaw, back, upper abdomen, or arm*
171
What are the predominant causes of chronic gastritis?
*Helicobacter pylori infection* *Autoimmune processes*
172
What is the pathophysiology of H. pylori-associated gastritis?
*Acute or chronic inflammation* *Increased acid production* *Mucosal injury*
173
What are the effects of chronic H. pylori gastritis?
*Atrophic glands* *Intestinal metaplasia* *Increased risk of gastric cancer*
174
What is autoimmune metaplastic atrophic gastritis (AMAG)?
Corpus-predominant inflammation associated with chronic T cell–mediated autoimmune disease.
175
What are the common causes of gastropathy?
*Drugs* *Alcohol* *Bile reflux* *NSAIDs* *Stress*
176
What are the common symptoms of AMAG?
*Asymptomatic or dyspepsia* *B12 deficiency symptoms*
177
What diagnostic studies are used for AMAG?
*Increased gastrin level* *Decreased pepsinogen I/II ratio* *CBC showing anemia*
178
What are the non-invasive tests for H. pylori?
*Stool antigen assay* *Urea breath test* *Serology for IgG*
179
What is the treatment for H. pylori-associated gastritis?
*Antibiotic regimen* *Proton pump inhibitors (PPIs)*
180
What complications can arise from gastritis?
*Intestinal-type gastric cancer* *MALToma*
181
What are the symptoms of Ménétrier's disease?
*Abdominal pain* *Nausea* *Vomiting* *Weight loss* *Diarrhea*
182
What differentiates peptic ulcer disease (PUD) from gastritis?
PUD involves full-thickness ulceration of gastric or duodenal wall.
183
What is the key symptom that can help differentiate MD from gastritis?
Weight loss and diarrhea ## Footnote These symptoms are significant in distinguishing between the two conditions.
184
What is the full name of PUD?
Peptic ulcer disease
185
What are common symptoms of peptic ulcer disease?
* Abdominal pain * Nausea * Vomiting * Upper gastrointestinal bleed ## Footnote These symptoms can vary in severity among patients.
186
What bacterium is commonly associated with peptic ulcer disease?
H. pylori
187
How is peptic ulcer disease diagnosed?
Endoscopy
188
What is cholelithiasis?
Gallstones obstructing cystic duct
189
What condition is associated with inflammation of the gallbladder?
Cholecystitis
190
What are the common presentations of cholecystitis?
* Right upper quadrant pain * Epigastric pain * Nausea * Vomiting ## Footnote Tenderness in the right upper quadrant is a distinguishing feature.
191
What differentiates viral gastroenteritis from acute gastritis?
Watery diarrhea
192
What are the typical symptoms of viral gastroenteritis?
* Diffuse abdominal pain * Vomiting * Diarrhea ## Footnote This condition is usually self-limited.
193
What is pancreatitis?
Inflammation of the pancreas
194
What are the common symptoms of pancreatitis?
* Epigastric pain radiating to the back * Nausea * Vomiting * Bloating ## Footnote Symptoms can vary based on whether the pancreatitis is acute or chronic.
195
What laboratory findings are typical in pancreatitis?
* Elevated amylase * Elevated lipase
196
True or False: Peptic ulcer disease only presents with abdominal pain.
False
197
Fill in the blank: Cholecystitis commonly presents with _______.
Right upper quadrant pain