Gastrointestinal and Musculoskeletal Disorders

Comprehensive vocabulary flashcards covering gastrointestinal and musculoskeletal disorders, pharmacology, pathophysiology, and clinical management from the lecture slides.

Dysphagia

Difficulty swallowing that presents with coughing, choking, a feeling of food being stuck in the back of the throat, regurgitation, and weight loss; evaluated via barium swallow or endoscopy.

Hiatal Hernia

Protrusion of the upper portion of the stomach through the diaphragm into the thoracic cavity, causing acid reflux; treated with small meals, weight control, antacids, and fundoplication surgery.

Gastroesophageal Reflux Disease (GERD)

The backward movement of gastric chyme and pepsin into the esophagus, causing heartburn and epigastric pain that worsens when lying down or after meals; can lead to Barrett's esophagus.

Barrett's Esophagus

A complication of chronic GERD characterized by strictures, spasms, and edema that narrow the esophageal lumen and produce premalignant tissue changes that may progress to adenocarcinoma.

Metoclopramide (Reglan)

A prokinetic drug that increases tone and motility of the GI tract by enhancing acetylcholine action, and suppresses emesis by blocking dopamine and serotonin receptors in the chemoreceptor trigger zone (CTZ).

Autoimmune Gastritis

A chronic autoimmune form of gastritis characterized by parietal cell destruction (causing a loss of intrinsic factor, hydrochloric acid, and vitamin B12 absorption) and chief cell damage (causing lack of pepsinogen).

Curling's Ulcer

An acute stress ulcer that develops in patients with extensive burns or shock as a consequence of gastric mucosal ischemia.

Cushing's Ulcer

An acute stress ulcer associated with severe central nervous system (CNS) trauma, caused by parasympathetic stimulation leading to excessive gastric acid secretion.

Peritonitis

An inflammatory response of the serous membrane lining the abdominal cavity and covering visceral organs; characterized by severe abdominal pain, rebound tenderness, high fever, and a board-like, rigid abdomen.

Hematochezia

The passage of bright red or maroon-colored fresh blood through the rectum, typically indicating lower gastrointestinal bleeding.

Zelnorm (Tegaserod)

A $5\text{-HT}_4$ receptor agonist indicated for the treatment of irritable bowel syndrome with constipation (IBS-C) in women that stimulates enteric sensory neurons to enhance peristalsis.

Alosetron (Lotronex)

A $5\text{-HT}_3$ receptor antagonist prescribed for severe diarrhea-predominant IBS (IBS-D) in women; requires enrollment in an FDA REMS program due to the risk of ischemic colitis and severe bowel obstruction.

Low-FODMAP Diet

A dietary protocol low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols implemented for 6 to 8 weeks to alleviate symptoms of irritable bowel syndrome.

Ulcerative Colitis (UC)

A chronic inflammatory bowel disease marked by superficial, continuous ulcerations of the mucosal layer starting in the rectum and progressing proximally through the colon, causing bloody diarrhea ($>20$ stools/day) and crypt abscesses.

Crohn's Disease

A chronic inflammatory bowel disease characterized by transmural inflammation, skip lesions, and a cobblestone appearance that can affect any part of the GI tract (most commonly the terminal ileum) and frequently forms fistulae.

Infliximab (Remicade)

A biological monoclonal antibody that binds to and inactivates tumor necrosis factor-alpha ($\text{TNF-}\alpha$) to suppress inflammation in Crohn's disease and ulcerative colitis.

Celiac Disease

A genetic autoimmune disorder triggered by ingestion of gluten (wheat, barley, and rye) that leads to mucosal destruction of the small intestine, steatorrhea, nutrient malabsorption, and peripheral neuropathies.

Diverticulitis

Inflammation or infection of herniated mucosal outpouchings (diverticula) in the colonic wall, most commonly manifesting with lower left quadrant (LLQ) pain, tenderness, nausea, and leukocytosis.

Clostridium difficile (C. diff)

A Gram-positive, spore-forming anaerobic bacillus associated with broad-spectrum antibiotic therapy that causes severe diarrhea, pseudomembranous colitis, and toxic megacolon; treated with oral vancomycin or metronidazole.

Portal Hypertension

A sustained elevation of pressure within the portal venous system of $\ge 10\,\text{mmHg}$ (normal $\approx 3\,\text{mmHg}$), commonly resulting from cirrhosis and leading to splenomegaly, ascites, and esophageal varices.

Hepatic Encephalopathy

A neuropsychiatric syndrome resulting from severe liver dysfunction or portosystemic shunting, where unmetabolized neurotoxins such as ammonia accumulate and impair CNS function; treated with lactulose.

Hepatorenal Syndrome

Functional renal failure accompanied by advanced liver disease characterized by oliguria, hypotension, and systemic vasodilation alongside intense renal vasoconstriction without intrinsic renal pathology.

Alcoholic Cirrhosis

A progressive chronic liver disease caused by the toxic effects of alcohol that evolves through three distinct stages: fatty liver (reversible), alcoholic hepatitis (inflammation and necrosis), and end-stage cirrhosis (fibrotic nodular scarring).

Acute Pancreatitis

A severe, life-threatening inflammatory condition where pancreatic enzymes become prematurely activated within the parenchyma, resulting in autodigestion, fat necrosis, vascular hemorrhage, and elevated serum amylase and lipase.

Catharsis

The prompt, fluid evacuation of the bowel characterized by a fast, intense, and complete purgative response.

Gouty Arthritis

A metabolic arthritic disorder characterized by hyperuricemia and the deposition of monosodium urate crystals in synovial spaces, initiating severe leukocyte phagocytosis, joint inflammation, and exquisite pain.

Tophi

Large, gritty, chalky accumulations of monosodium urate crystals that form in the joints, cartilage, and soft tissues (such as the first metatarsophalangeal joint or earlobes) in patients with chronic gout.

Colchicine

An anti-inflammatory drug used for acute gout attacks that functions by inhibiting the migration of leukocytes to the site of urate crystal deposition.

Allopurinol (Zyloprim)

A xanthine oxidase inhibitor used prophylactically to prevent gout attacks by blocking the enzymatic production of uric acid.

Probenecid (Benemid)

A uricosuric agent that increases urinary uric acid excretion by blocking tubular reabsorption in the kidneys, preventing tophi formation.

Fibromyalgia

A chronic non-articular disorder characterized by widespread musculoskeletal pain, fatigue, and cognitive disturbances, diagnosed by localized tenderness in at least 11 of 18 specific tender points.

Osteoporosis

A metabolic bone disease characterized by diminished bone mineral density and increased structural porosity resulting from an imbalance where osteoclastic resorption exceeds osteoblastic formation.

Bisphosphonates

Anti-resorptive medications (such as alendronate/Fosamax and zoledronic acid/Reclast) that inhibit osteoclast activity; patients must remain upright for 30 minutes after taking with 8 oz of plain water.

Raloxifene (Evista)

A selective estrogen receptor modulator (SERM) that binds to estrogen receptors to increase bone mineral density and reduce vertebral fracture risk without increasing breast cancer risk.

Paget's Disease of Bone

A progressive metabolic bone disorder characterized by excessive osteoclastic bone resorption followed by rapid, disordered osteoblastic bone formation, resulting in enlarged, structurally weak, and deformed bones.

PANICS Mnemonic (Paget's Disease)

A clinical mnemonic capturing the signs and symptoms of Paget's disease: Pain in bone, Arthralgia, Neural deafness/nerve compression, Increased bone density, Cardiac failure, and Skull or sclerotic vertebra enlargement.

Osteomyelitis

An acute or chronic infectious inflammation of bone and bone marrow tissue (typically caused by Staphylococcus aureus) resulting in necrosis and abscess formation; diagnosed gold standard by bone biopsy.

Osteoarthritis

A non-inflammatory, progressive degenerative joint disorder characterized by the mechanical erosion of articular cartilage, subchondral bone sclerosis, and the formation of peripheral osteophytes (bone spurs).

R.I.C.E. Protocol

A standard musculoskeletal trauma management regimen: Rest, Ice (20 minutes at a time, 4 to 8 times daily), Compression (to reduce edema), and Elevation (6 to 10 inches above the level of the heart).

Pathologic Stress Fracture

A fracture that occurs when normal, everyday mechanical stress is applied to a bone that has been weakened by underlying disease such as osteoporosis or Paget's disease.

Fatigue Stress Fracture

A bone fracture resulting from repeated, unaccustomed, or abnormal mechanical loading applied to normal bone structure, commonly seen in athletes, runners, and military recruits.

Compartment Syndrome

A condition following trauma where increased tissue fluid pressure within an inelastic fascial compartment obstructs capillary perfusion and causes muscle ischemia; evaluated via the 6 P's and treated with fasciotomy.

Fat Embolism Syndrome

A systemic complication of long bone or pelvic fractures occurring when bone marrow fat globules enter venous circulation, occlude microvasculature, and trigger hypoxemia, altered mental status, and petechial rash.

Rhabdomyolysis

A life-threatening syndrome resulting from severe skeletal muscle breakdown that releases intracellular contents like myoglobin into the blood, leading to tea-colored urine, high creatine kinase ($\le 2000\times\text{normal}$), and acute kidney injury.

Malunion vs. Nonunion

Malunion is the healing of a fractured bone in an anatomically abnormal, angulated, or rotated position; nonunion is the complete arrest and failure of the biological processes of bone repair.

Critical Limb Ischemia

An advanced manifestation of peripheral vascular compromise characterized by severe ischemic rest pain, cool and pale extremity, diminished or absent pulses, and nonhealing arterial ulcers or tissue gangrene.