Term
| What are 3 mechanisms of gastric reflux? |
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Definition
| Transient lower esoph sphinc relx, hypotensive LES, Hiatal hernia; all are worsened by gastric distention and foods |
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Term
| What are the classic symptoms of GERD? |
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Definition
| Heartburn, regurgitation, dysphagia if complication |
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Term
| Any patient who requires continual medical therapy, has bleeding, dysphagia, or weight loss while on therapy requires what diagnostic technique? |
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Definition
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Term
| Patient with persistent heartburn but with normal Endoscpy have what test? |
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Definition
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Term
| A peptic stricture is tested via barium swallow, what causes it? |
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Definition
| Healing of ulcerative esophagitis causes collagen depostition and solid food dysphag |
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Term
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Definition
| Adenocarcinoma via cyclinD and p53 and p16 |
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Term
| What is the possible mechanism of GERD induced asthma? |
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Definition
| Microaspiration with consequent bronchospasm and vago-vagal reflex causing bronchoconstriction |
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Term
| What are the most effective therapies for GERD? |
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Definition
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Term
| Malabsorption can occur without diarrhea, but if there is a problem in the terminal ileum, what doesn |
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Definition
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Term
| ID the nutrient malabsorbed from these symptoms - steatorrhea/weight loss, gas/diarrhea, muscle wasting/edema, anemia, diarrhea, night blindness, osetopenia, wound healing impairment, bruising, cheilosis/glottitis/neuropathy, paraesthesias/tetany. |
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Definition
| Fat, carbs, protein, iron/folic/B12, bile salts, vit a, vit d, vit e, vit k, b vitamins, ca/mg |
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Term
| ID which is small bowel diarrhea aka crohns and which is left sided diarrhea aka UC. 1. reservoir capacity, large stool, 2. low capacity, small frequent stools, urgency, tesenmus, mucus, blood. |
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Definition
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Term
| What is the test for protein and carb malabsorption? |
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Definition
| Protein - a1-antitrypsin clearance, carb- H2 breath test. |
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Term
| What is the major cause for steatorrhea? |
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Definition
| Pancreatic insufficiency with no lipase causing indegstion of fat, the low bicarb also inactivates enzymes |
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Term
| The two major causes for impaired luminal hydrolysis causing malabsoption is pancreatic exocrine insufficiency and Zollinger-Ellison syndrome. What are the causes for each? |
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Definition
| Alcholo, obstructing cancer, CF; gastrinoma causes gastrin secretion inducing heavy acid production which inactivates enzymes and causes malabsoption |
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Term
| There are 3 types of lactase defcient congenital, delayed onset, and acquired and it occurs most heavily in blacks and Asians - what is produced heavily in the colon as a result? |
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Definition
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Term
| Abetlipoproteinemia is an auto rec disorder that causes what? |
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Definition
| Defect in production of apolipoprotein B which prevents absoption of fat and fat soluble vitamins. |
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Term
| The result of Celiac disease is diarrhea due to autoimmune reaction to gliadin form of gluten, transglutaminase is used to diagnose, but what are the histo findings since this can cause t-cell lymphoma and small bowel cancer? |
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Definition
| Villous atrophy, crypt hyperplasia, inflammation primarily in the jejunum; dermatitis herpetiformis also seen |
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Term
| Tropical sprue and whipples disease are both malasoptive disease caused by what? |
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Definition
| Bacteria, whipple is tropheryma whipleei |
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Term
| What two food additives can cause malsorption? |
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Definition
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Term
| Diverticulosis is a non-threatening result of intra-colonic pressure and low fiber diets, what is it and what are complications? |
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Definition
| Outpuching of all 3 gut wall layers (true) or 2 mucosa and submucosa (false) most commonly in sigmoid colon, and can cause bleeding or diverticulitiis due to trapped feces/infection. |
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Term
| Most diverticulosis is asymp or painless rectal bleeding, and the 3 pearls are vasa recta chronic injury, right sided > left, consider angiodysplasia. However, what is treatmen? |
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Definition
| Supportive unless it doesn |
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Term
| What are the signs of diverticulitis? |
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Definition
| LLQ pain, fever, leukopcytosis, peritonitis with rebound; moderate is unable to eat; sever requires resection |
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Term
| IBD is thought to results from an abnormal immune response to bacterial/environmental triggers in the genetically susceptible individual, what is the gene for Crohns? |
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Definition
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Term
| Ulcerative colitis begins distally, and is typically classified as ________ colonic lesion involving rectum. Crohn |
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Definition
| continuous , discontinuous |
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Term
| Serologic tests for UC and Colitis Crohns is _______, but for small bowel crohns is ____________. |
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Definition
| pANCA, antibody to normal flora bacteria like e coil and pseudo |
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Term
| Migratory arthritis, uveitis, erythema nodosum, pyoderma gangrenosum, sclerosing cholangitis are all extraintestinal manifestations of ________ and _______. |
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Definition
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Term
| Hemorrhoids are congenital vascular cushions in the lower rectum and anus. They are a combination of arteries, veins, and connective tissue. What are the risk factors? |
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Definition
| Family, low fiber, straining, constipation, urgency, preggers, prior operations to anus. |
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Term
| Internal hemorrhoids are caused by prolapse of the rectal hemorrhoidal plexus proximal to the dentate line and are covered by columnar epithelium. What are symptoms? |
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Definition
| Symptoms include painless rectal bleeding with defecation, protrusion, swelling, soilage, and anorectal pain |
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Term
| Treatment of early stage hemorrhoids is medical and includes bulking agent such a fiber supplementation, stool softeners, zinc oxide or hydrocortisone containing ointments or suppositories. What if that doesn |
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Definition
| More advanced symptomatic hemorrhoids are treated nonoperatively with injection sclerotherapy, rubberband ligation, or infrared coagulation. Refractory or advanced hemorrhoids are treated with surgical excision. |
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Term
| External hemorrhoids can acutely thrombose [become clotted] and produce painful swelling that peaks at 3 days and can last 7-14 days. What type of epithelium is involved? |
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Definition
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Term
| Acute anal fissure is usually incited by a large, hard stool. Other causes include diarrhea or trauma to anal canal. This causes painful defecation with bleeding and post-defecatory anal spasm. Most fissures are located in posterior midline [80-85%] with a minority in the anterior midline [15-20%]. |
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Definition
| What is cause of multiple fissures? IBD, infection, malign |
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Term
| Most fissures will heal spontaneously within 4 to 6 weeks. Chronic anal fissures persist after 6 weeks due to increased sphincter tone from anal spasm which leads to hypoxia and decreased blood flow. What is treat? |
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Definition
| First line treatment of fissures includes chemical relaxation [sphincterolytic therapy] with topical muscle relaxing ointments such as diltiazem, nitroglycerin, and nifedipine. Fiber supplementation and stool softeners are also useful. Fissures refractory to medical therapy are treated surgically. Options include Botox injection [botulinum toxin A] into the internal anal sphincter with fissurectomy [excision of fissure] |
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Term
| The most common etiology of anal abscess and fistula is cryptoglandular disease which is due to an obstruction of the anal crypt opening of the anal gland. Other etiology of perianal abscess and fistula include: Crohn |
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Definition
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Term
| Anal warts are caused by the __________. Colonization of the anogenital region with this is common in the general population and is sexually transmitted. High grade Anal intraepithelial neoplasia (AIN) is a high grade dysplastic lesion associated with subsequent development of anal cancer especially in HIV. What is treat? |
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Definition
| HPV, Anal warts are treated with fulguration or chemical cauterization. |
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Term
| IBS is characterized by chronic or recurrent abdominal pain and/or discomfort associated with altered bowel habits (e.g., diarrhea, constipation or alternating diarrhea and constipation). Women are twice as frequently affected as men. What is pathophys? |
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Definition
| A dysregulated brain gut axis resulting in altered gut motility and visceral hypersensitivity is felt to be the principal pathophysiologic mechanism underlying IBS. |
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Term
| Stress can induce IBS, what else is big factor? |
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Definition
| Post-infectious and diarrheal causes |
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Term
| The hallmark symptoms of IBS are chronic abdominal pain and/or discomfort associated with altered bowel habits (diarrhea, constip, or both). How is it diagnosed? |
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Definition
| ROME III criteria, moderate sensitivity, highly specific. There is no recommendation for a battery of tests, except celiac and micro colitis |
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Term
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Definition
| Traditional therapies such as antidiarrheal agents, laxatives, antibiotics, pschychotropic and tricyclic antidepressants may be effective in treating particular symptoms of IBS. However, lifestyle change best. |
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Term
| What is the diff btw peptic ulcer and erosion? |
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Definition
| Erosion shallow to superficial mucosa only, ulcer penetrates muscularis mucosa and beyond >5mm diameter |
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Term
| H. pylori, NSAIDS, viral infections, tobacco/cocaine, Zollinger-ellison agstrinomas are all causes of __________. |
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Definition
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Term
| Transmissino of H. pylori is person-per, fecal oral, with a high prevlance in society. It can cause acute and chronic gastritis, PUD, adenocarcinoma, MALT lymphoma. How does it survive the stomach? |
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Definition
| Urease dumps ammonia into area to survive; eradicative via antibio over 90%, anti acids >30% |
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Term
| Duodenal ulcers are when pain is decreased with meals, what is Pathophysiology since 100% have H. pylori? |
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Definition
| Antral-dominant H. pylori causes gastritis, down somatostatin, ups gastric acid, metaplasia, duoadenitis, then ulcer |
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Term
| Gastric ulcer have Greater pain with food, seen in older folk, NSAIDS, abnormal gastroduodenal reflux. What is non-invasive H. pylori test? |
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Definition
| Serology, stool antigen, urea breath test |
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Term
| Normally you test and treat ulcers with PPI plus clrith and amoxi, but when should you skip and scope early? |
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Definition
| Bleeding, vomting, weight loss, severe pain or other cancer signals |
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Term
| Duodenal ulcers have too much acid so surgical technique is ___________ or suture for hemorrhage or perf; Gsatric ulcers have decreased acid resistance so surgical is ____________ or excision for hemo or perf. |
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Definition
| Truncal Vagotomy(vagus), antrectomy |
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