GI

compromise/break of the stomach lining commonly caused by H. pylori infection

A. Esophagitis
B. Barrett’s Esophagus
C. Dysphagia
D. Hiatal Hernia
E. GERD
F. Gastritis
G. PUD

G. PUD

inflammation of the esophagus

A. Esophagitis
B. Barrett’s Esophagus
C. Dysphagia
D. Hiatal Hernia
E. GERD
F. Gastritis
G. PUD

A. Esophagitis

return of gastric contents into the esophagus

A. Esophagitis
B. Barrett’s Esophagus
C. Dysphagia
D. Hiatal Hernia
E. GERD
F. Gastritis
G. PUD

E. GERD

stomach protrusion above the diaphragm

A. Esophagitis
B. Barrett’s Esophagus
C. Dysphagia
D. Hiatal Hernia
E. GERD
F. Gastritis
G. PUD

D. Hiatal Hernia

metaplasia of the esophagus that increases risk of esophageal adenocarcinoma

A. Esophagitis
B. Barrett’s Esophagus
C. Dysphagia
D. Hiatal Hernia
E. GERD
F. Gastritis
G. PUD

B. Barrett’s Esophagus

inflammation of the stomach lining

A. Esophagitis
B. Barrett’s Esophagus
C. Dysphagia
D. Hiatal Hernia
E. GERD
F. Gastritis
G. PUD

F. Gastritis

Gastritis causes

alcohol, NSAIDs, H. Pylori, autoimmune

Gastritis anemia complication

decreased intrinsic factor, vitamin B12 deficiency

difficulty swallowing

A. Esophagitis
B. Barrett’s Esophagus
C. Dysphagia
D. Hiatal Hernia
E. GERD
F. Gastritis
G. PUD

C. Dysphagia

Dysphagia can be caused by (3)

narrowing (obstruction, strictures, tumors)
lack of salivary secretion
neuromuscular

Hiatal Hernia presentation

asymptomatic or chest pain, palpitation, difficulty swallowing

Hiatal Hernia concern

constriction/strangulation due to twisting of the trachea

GERD: ____________ abdominal pressure, ____________ lower esophageal sphincter pressure

increased, decreased

GERD treatments

proton pump inhibitors, H2 receptor blockers, antacids

What are the common causes of PUD

H. pylori

What is the underlying pathology of PUD and explain the connection between H pylori infection and acid secretion and ulceration

H. pylori infection leads to ulceration of mucosa; recruitment of mast cells that release histamine that increases acid release that enhances ulceration

Why was the epigastric pain experienced in PUD relieved by eating?

food absorbs acid, so pain relieved

One complication of PUD is anemia. Explain how anemia might occur

- bleeding + loss of intrinsic factor (pernicious anemia)
- decreased absorption of vit B12

How is PUD diagnosed and what is what is the importance of the urea breath test?

symptoms; endoscopy; urea breath test (urease formed by the bacteria); stool antigen test; blood test/ELISA

one test for H. pylori is an antibody test, called an ELISA. Explain how antibody can be used to diagnose H. pylori infection?

antibody test = hx
antigen test = current
- ELISA = antibody test for hx of infection

a PUD patient was being treated with H2 receptor antagonists. How does this therapy work, and why would it be beneficial?

H2 receptor antagonist: blocks histamine receptors, prevents stimulation of acid release

Why would a PUD patient be treated with amoxicillin? Why omeprazole?

Amoxicillin: treats bacterial infection
omeprazole: proton-pump inhibitor that blocks pumping of acid

Why would a PUD patient be treated with magnesium-containing antacids. How might it contribute to loose bowel movements

magnesium-containing antacid: neutralize acid, promotes osmotic shift = loose BM (diarrhea)

Jeff was just diagnosed with a disorder of the esophagus that is characterized by the replacement of squamous epithelial cells that normally line the esophagus with cells that normally line the intestine in a process called intestinal metaplasia. This condition, which has an increased risk of esophageal adenocarcinoma would best be classified by which one of the following terms?
A. Esophagitis
B. Dysphagia
C. Gastroesophageal reflux disorder
D. Barrett’s esophagus

D. Barrett’s esophagus

Jaime has a hiatal hernia. Which one of the following statements about hiatal hernia is CORRECT?
A. Hiatal hernia can be caused by anything that decreases abdominal pressure.
B. Hiatal hernia can be caused by anything that increases the lower esophageal sphincter pressure.
C. Hiatal hernia is typically associated with reflux and is rarely asymptomatic.
D. Hiatal hernia is sometimes referred to as the “great mimic” since it can present with a number of misleading symptoms, including cardiac symptoms like chest pain, shortness of breath, or heart palpitations.

D. Hiatal hernia is sometimes referred to as the “great mimic” since it can present with a number of misleading symptoms, including cardiac symptoms like chest pain, shortness of breath, or heart palpitations.

chronic inflammatory conditions of the colon and small intestines including Crohn’s and ulcerative colitis

A. Gastroenteritis
B. Irritable Bowel Syndrome
C. Inflammatory Bowel Disease (IBD)
D. Crohn’s Disease
E. Ulcerative Colitis

C. Inflammatory Bowel Disease (IBD)

Type of IBD characterized by “skip lesions” that can extend through all 3 layers of and anywhere in the GI tract

A. Gastroenteritis
B. Irritable Bowel Syndrome
C. Inflammatory Bowel Disease (IBD)
D. Crohn’s Disease
E. Ulcerative Colitis

D. Crohn’s Disease

Characterized by abdominal pain, changes in bowel movement patterns (constipation/diarrhea) with no inflammation

A. Gastroenteritis
B. Irritable Bowel Syndrome
C. Inflammatory Bowel Disease (IBD)
D. Crohn’s Disease
E. Ulcerative Colitis

B. Irritable Bowel Syndrome

Type of IBD characterized by confluent involvement of (generally) the mucosal layer confined to the colon

A. Gastroenteritis
B. Irritable Bowel Syndrome
C. Inflammatory Bowel Disease (IBD)
D. Crohn’s Disease
E. Ulcerative Colitis

E. Ulcerative Colitis

Inflammation of the GI tract

A. Gastroenteritis
B. Irritable Bowel Syndrome
C. Inflammatory Bowel Disease (IBD)
D. Crohn’s Disease
E. Ulcerative Colitis

A. Gastroenteritis

causes of Gastroenteritis

infection (bacterial, viral), blood/immune cells

Explain the underlying process for the pathology associated with Crohn’s Disease.

chronic inflammation (autoimmune?, microbiome, genetics)

Is Crohn’s disease classified as either inflammatory bowel disease or irritable bowel syndrome, and which other condition is also associated with this same classification?

inflammatory bowel disease, Ulcerative Colitis

What regions of the tract are involved in Crohn’s Disease?

any region of the tract involved

Explain how each of the signs or symptoms of Crohn’s Disease, including abdominal pain, diarrhea, fatigue, and weight loss, anemia, relate to the underlying pathophysiology?

abdominal pain (nerve exposure, stenosis)
diarrhea (malabsorption; steatorrhea)
fatigue (anemia; malnutrition)
weight loss (malabsorption; anorexia)
anemia (malabsorption, blood loss)

risk factors for Crohn's Disease?

Fam Hx (mutations associated, 30X increased risk)
smoking (environmental)
stress (decreased immunity?)
microbiome (unclear, but important)

What are diagnostic strategies for Crohn's Disease?

challenging; biopsy (endoscopy), imaging (patency, ulcer, complications), blood tests (inflammation, infection)

Why might a PUD patient be treated with corticosteroids or mercaptopurine? What about use of antibiotics and supplements?

corticosteroids (anti-inflammatory)
mercaptopurine (autoimmune)
antibiotics (alter microbiome)
supplements (malabsorption)

Which one of the following statements about gastroenteritis is CORRECT?
A. Gastroenteritis is caused by bacterial, but not viral, infections.
B. Gastroenteritis is an inflammatory process of the gastrointestinal tract.
C. Blood in the stool is more commonly associated with viral infections that cause gastroenteritis than bacterial ones.
D. Gastroenteritis is an inflammatory process of the small intestine, but not the stomach.

B. Gastroenteritis is an inflammatory process of the gastrointestinal tract.

Which one of the following represents an inflammatory disease that is associated with patches of granulomatous lesions surrounded by normal healthy tissue, sometimes referred to as “skip lesions”?
A. Gastroenteritis
B. Irritable Bowel Syndrome
C. Crohn’s Disease
D. Ulcerative Colitis

C. Crohn’s Disease

urgency to vomit

Nausea

forceful expulsion of gastric contents

Vomiting

loss of appetite or lack of desire for food

Anorexia

Zollinger-Ellison syndrome where there is overproduction of gastrin

A. Diarrhea
B. Secretory Diarrhea
C. Osmotic Diarrhea
D. Motility Diarrhea
E. Dysentery

B. Secretory Diarrhea

Chronic inflammation associated with visible blood in the stool as seen in E. histolytica infection

A. Diarrhea
B. Secretory Diarrhea
C. Osmotic Diarrhea
D. Motility Diarrhea
E. Dysentery

E. Dysentery

General term for small volume (inflammatory) or large volume (non-inflammatory) increase in frequency or fluidity of defecation

A. Diarrhea
B. Secretory Diarrhea
C. Osmotic Diarrhea
D. Motility Diarrhea
E. Dysentery

A. Diarrhea

Person with lactose intolerance that consumes dairy products

A. Diarrhea
B. Secretory Diarrhea
C. Osmotic Diarrhea
D. Motility Diarrhea
E. Dysentery

C. Osmotic Diarrhea

Alteration of the autonomic nervous system that changes the transit time through the bowel.

A. Diarrhea
B. Secretory Diarrhea
C. Osmotic Diarrhea
D. Motility Diarrhea
E. Dysentery

D. Motility Diarrhea

Inflammatory diarrhea (_________ volume), fever, blood, dysentery, invasive bacteria

small

Non-inflammatory diarrhea (_________ volume), non-bloody, toxin-producing bacteria, parasite, virus

large

Chronic Diarrhea reasons

* Osmotic: ___________
* Secretory: ___________
* Motility: ___________

- osmotic shift
- extra fluid
- innervation

difficult or infrequent passage of stools; dehydration, low-bulk diet, lack of exercise, medications

Constipation

partial/complete blockage of small (90%)/large (10%) bowel

Intestinal Obstruction

mechanical vs non-mechanical Intestinal Obstruction

fruit pit or toxicity

outpockets in the colon that are not inflamed

Diverticulosis

inflammation of the diverticula

Diverticulitis

inflammation of the peritoneum

Peritonitis

any number of conditions where there is a problem absorbing sufficient nutrients/fluids

Malabsorption Syndrome

response to gluten; autoimmune response; malabsorption

Celiac Disease

hematemesis

vomiting blood

melena

upper bleed that passes through the stool

hematochezia

lower bleed that passes through the stool

Explain the association between celiac disease and weight gain in children.

Consequence of immune response can alter the villi and preventing or limiting absorption of nutrients

Celiac disease is often associated with constipation and diarrhea. Explain the connection between the underlying pathophysiology and these presentations.

changes in villi can give rise to diarrhea and constipation. Some of this can be related to the failure to absorb nutrients (i.e., lactose intolerance) or fluids; inflammation can lead to stricturing and bowel obstruction that contributes to constipation.

Individuals with celiac disease often suffer from anemia. Explain why, and the connection between anemia and fatigue. Sometime folks with celiac disease suffer from osteopenia. What is osteopenia and the relationship between this disease and celiac disease?

Anemia can result from failure to absorb iron or intrinsic factor; anemia reduces oxygen carrying capacity (fatigue); reduced calcium absorption can lead to osteopenia (decreased bone density)

Increase in the frequency and fluidity of bowel movements due to lactose intolerance is best referred to as
A. Secretory diarrhea
B. Motility diarrhea
C. Osmotic diarrhea
D. Bloody diarrhea

C. Osmotic diarrhea

A person suffering from an esophageal tear comes to the ED vomiting up blood. This scenario would best be described as
A. Hematemesis
B. Hematochezia
C. Melena
D. Lower gastrointestinal bleed

A. Hematemesis

icterus of skin, sclerae, mucous membranes from hyperbilirubinemia

Jaundice

pre-hepatic, hepatic, post-hepatic jaundice

- healthy liver, but it is overwhelmed
- liver is hurtin (hepatitis, cirrhosis)
- outflow (gallstone, tumor) is blocked

direct bilirubin
- conjugated or un conjugated?
- water or fat soluble?
- processed by the liver?

- conjugated
- water
- processed

indirect bilirubin
- conjugated or un conjugated?
- water or fat soluble?
- processed by the liver?

- unconjugated
- fat
- not processed

bile/phospholipids required for fat absorption, vitamins?

vitamin ADEK

multiple functions compromised with liver dysfunction that can have a plethora of manifestations

Disordered Hepatic Metabolism

Liver disease associated with insulin resistance.

A. Drug Induced Liver Disease
B. Alcoholic Liver Disease
C. Non-Alcoholic Liver Disease
D. Portal Hypertension
E. Liver Failure

C. Non-Alcoholic Liver Disease

Can occur when 80 - 90% of liver function is lost.

A. Drug Induced Liver Disease
B. Alcoholic Liver Disease
C. Non-Alcoholic Liver Disease
D. Portal Hypertension
E. Liver Failure

E. Liver Failure

Acetaminophen overdose is a common cause of this type of liver disease.

A. Drug Induced Liver Disease
B. Alcoholic Liver Disease
C. Non-Alcoholic Liver Disease
D. Portal Hypertension
E. Liver Failure

A. Drug Induced Liver Disease

Mediated by acetaldehyde that accumulates when the detoxification system is overwhelmed.

A. Drug Induced Liver Disease
B. Alcoholic Liver Disease
C. Non-Alcoholic Liver Disease
D. Portal Hypertension
E. Liver Failure

B. Alcoholic Liver Disease

Abnormally high blood pressure in the portal venous system that can lead to ascites.

A. Drug Induced Liver Disease
B. Alcoholic Liver Disease
C. Non-Alcoholic Liver Disease
D. Portal Hypertension
E. Liver Failure

D. Portal Hypertension

liver inflammation, infection (virus A - E), intoxication

Hepatitis

toxins overwhelm the ability of the liver to detoxify; toxic intermediate formed and damages liver

Drug Induced Liver Disease

alcohol dehydrogenase (MeOS) forms acetaldehyde that is toxic intermediate

Alcoholic Liver Disease

fatty liver disease NOT due to alcohol abuse; associated with insulin resistance

Non-Alcoholic Liver Disease

irreversible liver damage characterized by replacement of normal tissue with scar tissue

Liver Cirrhosis

identify the major underlying causes of cirrhosis. Explain how chronic alcohol abuse is related to liver disease. What is the normal detoxification process for alcohol; what is the toxic intermediate that accumulates during alcohol excess? How does this relate to fatty liver associated with alcoholic liver disease?

Typically caused by toxin or infection (alcohol, hepatitis B/C, NAFLD). Alcohol is processed by the liver using the MeOS system, but when in excess the liver cannot handle detoxification and acetaldehyde increases, causing direct damage to the liver. Alteration of metabolism can increase fat in liver

Define PT and explain why it is prolonged in a Liver Cirrhosis patient

Prothrombin Time that measures average time for blood to clot; delayed in person with cirrhosis because they do not synthesize sufficient clotting factors.

What vitamin deficiency might be consistent with prolonged PT and how does this vitamin play a role in the clotting pathway?

Vitamin K is required for synthesis of factors; fat-soluble vitamin so requires bile from liver for sufficient digestion to allow absorption

What is the relationship between the liver and colloid osmotic pressure?

hypoalbuminemia; albumin = major colloid osmotic pressure

What is the mechanism responsible for feminization (gynecomastia) in a liver cirrhosis patient? Define biotransformation and explain where this process occurs in the hepatocyte. How does this relate to spider angioma that may be observed in patients with liver cirrhosis?

Failure to biotransform estradiol leads to gynecomastia and spider angiomas; biotransformation is conversion of molecule into a more water-soluble form.

What is meant by steatorrhea? Define the role of the liver in fat digestion and absorption. Could liver dysfunction alter fat absorption?

Steatorrhea is fat in the stool; release of bile and phospholipids act as emulsifying agents to promote fat digestion, which is required for fat absorption. Liver dysfunction leads to decrease bile/phospholipid release and thus compromises fat digestion/absorption so it stays in the feces.

What is the connection between liver dysfunction and jaundice? Why might a newborn baby have jaundice? What could you do to treat this patient?

hyperbilirubinemia; hepatic form can be due to liver dysfunction; Newborns may have delay in activating conjugation enzymes; hydration and phototherapy (bili-lights) are used

Why does our patient suffer from periods of mental confusion? What is the normal role of the liver in protein metabolism? How does the kidney assist in this process?

Hepatic encephalopathy, increased ammonia; liver cannot convert ammonia into urea for the kidney to filter.

Jim has jaundice that results from hemolysis. Jim’s jaundice would best be classified as which one of the following?
A. Pre-hepatic
B. Hepatic
C. Post-hepatic
D. Obstructive

A. Pre-hepatic

Which one of the following signs or symptoms of liver dysfunction results from failure to biotransform steroid hormones?
A. Edema
B. Encephalopathy
C. Gynecomastia
D. Coagulopathy

C. Gynecomastia

Progressive inflammation of the pancreas that can lead to T1DM

A. Cholelithiasis
B. Cholecystitis
C. Acute Pancreatitis
D. Chronic Pancreatitis
E. Liver Cancer
F. Pancreatic Cancer

D. Chronic Pancreatitis

Gallstone formation.

A. Cholelithiasis
B. Cholecystitis
C. Acute Pancreatitis
D. Chronic Pancreatitis
E. Liver Cancer
F. Pancreatic Cancer

A. Cholelithiasis

Common site of secondary tumors resulting from metastasis.

A. Cholelithiasis
B. Cholecystitis
C. Acute Pancreatitis
D. Chronic Pancreatitis
E. Liver Cancer
F. Pancreatic Cancer

E. Liver Cancer

Inflammation of the gallbladder typically in response to bile duct obstruction

A. Cholelithiasis
B. Cholecystitis
C. Acute Pancreatitis
D. Chronic Pancreatitis
E. Liver Cancer
F. Pancreatic Cancer

B. Cholecystitis

Rapid onset of inflammation of the pancreas that can result in vascular shock and ARDS.

A. Cholelithiasis
B. Cholecystitis
C. Acute Pancreatitis
D. Chronic Pancreatitis
E. Liver Cancer
F. Pancreatic Cancer

C. Acute Pancreatitis

Cancer associated with poor prognosis related to early and widespread metastasis.

A. Cholelithiasis
B. Cholecystitis
C. Acute Pancreatitis
D. Chronic Pancreatitis
E. Liver Cancer
F. Pancreatic Cancer

F. Pancreatic Cancer

Acute Pancreatitis: ____________ (reversible / irreversible) inflammation

reversible