GIR 2

What is the family of poorly absorbed, short chain carbohydrates

FODMAP Fermentable Oligo Di, Mono, and Polyols

stomach adenocarcinoma prognosis early and late:

-Early: > 90% 5-year survival -Late/advanced: 20% 5-year survival

Anorexia nervosa risk factors

-Female sex -Family history -Introverted, obsessive, and perfectionistic personality -Inability to resolve conflict -Low self-esteem -Family dysfunction

Stomach neuroendocrine tumor prognosis

-Generally good (especially when associated with autoimmune gastritis[AMAG]), considered cured after resection -Sporadic tumors (not associated with AMAG or MEN-I) may be more aggressive

Stomach Adenocarcinoma risk factors ____ infections ____ manufacturing ____ smoking ____ treatment Inherited:

-H. pylori infection -Rubber manufacturing industry -Tobacco smoking -Radiation - Inherited disorders (rarely) •FAP •Hereditary diffuse gastric cancer (CDH1 mutations)

Stomach neuroendocrine tumor risk factors

-MEN-I, autoimmune atrophic gastritis (AMAG)

Teratogenicity is most pronounced from day ___ to the end of the first trimester

20

Eosinophilic esophagitis treatment (3 things)

1. avoid eating whatever triggers this response 2. Topical Steroids, dupilumab, PPIs

Carbon monoxide binds ____ times tighter to hemoglobin, and makes the blood appear ____ colored

200 cherry red

1/2 of the population cannot absorb ___g of fructose at a time

25

stool osmotic gap equation

290 - 2[Na + K]

Oligosaccharides are ___-___(#) sugar units

3-10

Obesity BMI is ___+

30

____% of esophageal varices rupture

30%

Cryptospordium size ___ to ___ μm

4 to 6

Steatorrhea diet Less that ___g/day of long chain fatty acids

40

Bariatric Surgery is indicated for patients with BMI >___ or >35 with at least ___ serious comorbid conditions, after ___ months diet and exercise fail.

40 1 6

Although estimates vary, twin, family, and adoption studies show that the rate of heritability of BMI is high, ranging from ___%.

40-70

•Near 100% risk of colorectal adenocarcinoma in FAP by the age of ___ years

45

Colon cancer screening begins at age ___, or earlier if there is ____

45 family history

Incubation of rotavirus is ____ hours

48

Less than ___% of individual variation in BMI and adiposity traits can be accounted for by over 300 identified loci.

5

Treatment of lead poisoning is recommended for kids with >___ ug/dL blood lead level

5

The reduction of ____% of initial body weight reduces the risk of diabetes in at risk persons and the burden of comorbid diseases such as sleep apnea, urinary incontinence, improved health related quality of life, and reduction in medications for cardiovascular risk factors.

5-10

Smokers can have carboxyhemoglobin levels ____%

5-10%

Initial treatment of mild UC is _____

5-ASA

Three-drug regimen for CINV

5-HT antagonist (ondansetron) Dexamethasone NK1 antagonist (prochlorperazine)

Secretory diarrhea is < ____ mosm/kg

50

___% of Crohn's includes colon and small bowel

50%

Osmotic gap range

50-100mmol/kg

Acute CINV is mediated by

5HT3

Migraine-associated N/V tx

5HT3 antagonists

Acute CINV tx

5HT3 receptor antagonists

Medications are indicated after ___ months diet and exercise fail, for patients with BMI>30, or >___ with co-morbid conditions.

6 27

With secretory diarrhea, stool pH is usually ____

6.6 (normal, maybe slightly acidic but >5.6)

Colonic diverticulum ___% of population 60+ Commonly affects the ____ and ____ part of colon

60% left and sigmoid

Colon adenocarcinoma Prognosis -Based on stage -Overall 5-year survival (in US): ____% •Ranges from 15-91% depending on stage

65

Most gastric ulcers resolve in ___ weeks

8

Cyclospora is ___ to ___ μm

8 to 10

1. True or false: Blood Urea Nitrogen indicates protein catabolism by monitoring steps before the urea cycle and Urinary Urea Nitrogen indicates protein catabolism by monitoring steps after the urea cycle.

False; both detect urea after the urea cycle

2. True or false: During starvation, we expect Blood Urea Nitrogen to increase, but we do not expect a change in Urinary Urea Nitrogen.

False; both should increase

15. True or false: Amino acids must be either be ketogenic or glycogenic.

False; some are both

4. True or false: During starvation, alanine produced in the muscle reaches a sufficiently high level that it can provide sufficient carbon for hepatic gluconeogenesis to satisfy glucose requirements in the body.

False; we also need ketones

________: Autosomal dominant disorder with numerous colorectal adenomas

Familial adenomatous polyposis

Motion sickness treatment

Diphenhydramine Scopolamine for >12 y/o

V. vulnificus treatment

Doxycycline/ceftriaxone

Drug name/target for CINV that is not 5HT related

Dronabinol cannabinoid CB1R

Drug name/target for CINV and post-operative vomiting

Droperidol D2 antagonist

___ is the procedure of choice for diagnosis of uncomplicated peptic ulcer disease

EGD

Diagnosis of Adenovirus relies on ____ and _____

ELISA and PCR

Invasive/inflammatory diarrhea may have elevated ____ and ___, but these are non-specific findings of inflammation. You may also see low serum _____ level

ESR and CRP albumin

Purging disorder: Eating disorder characterized by recurrent purging behavior to influence weight or shape, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, in the absence of _________.

Eating disorder characterized by recurrent purging behavior to influence weight or shape, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, in the absence of binge eating.

Quantal dose response

Effect of increasing doses of drug across a population- drug does or does not cause a specific effect in an individual

Celiac disease is an immune response to ____ and ____ resulting in lymphocytes attacking small bowel epithelial cells

gluten and gliaden

After 2-3 days of a severe fast, _______ is/are used to make glucose in the body while _____ are spared

glycerol and FFA from TG; protein

After a meal, glucose is stored as ____ or FAs

glycogen

Crohn's treatment Goal: ____ Meds: (3)

goal: remission. meds: antibiotics (for infections), 5-ASA (for inflammation), steroids (for severe cases), and the biologics

What cell type do you see in Barretts esophagus that should not be there?

goblet cells

Characterize vibro

gram negative rod, motile, oxidase positive, halophilic

Characterize aeromonas/plesiomonas

gram negative, rod shaped, facultative anaerobes that cause GI disease, wound infection, invasive infection

Crohn's disease hallmarks include ____ and ____ ulcers with stricture

granulomas; deep

Candida esophagitis looks like ____ on EGD

gray-white plaques/psuedomembranes or ulcers

Visceral fat leads to: ____ inflammtion fat storage in the ____ places impaired regulation of ___ metabolism

greater wrong fat

What hormones cause morning sickness?

hCG, P4, E2

Periodic ulcer pain is due to ___

healing of the ulcer

Phentermine is contraindicated in patient with ____ disease

heart

reflux esophagitis is known as

heart burn

A patient who takes aspirin every day is at (high/low) risk for gastric ulcer

high

Microsatellite instability results in ___ mutation rate

high

Fuctose sources

honey, apples, pears, watermelon, mango

Excess protein is stored as ____

Fat; excess protein cannot be stored as protein.

insulin decreases lipolysis via decrease in acitivity of ___

hormone sensitive lipase

Lead poisoning in adults manifests as ____tension, cholic, anemia

hypertension

What endocrine problems cause nausea/vomiting?

hyperthyroidism, hyperparathyroidism, decreased cortisol, diabetes, pregnancy

Candida esophagitis treatment

Fluconazole

pyloric gland mucosa contains what cell types?

G and D cell areas of the stomach

Eosinophilic esophagitis histology findings (2): ____-like and at least ___ eosinophils per high power field.

GERD-like: papillary and basal hyperplasia, eosinophils At least 15 eosinophils per high power field, and in distal and proximal esophagus

Insulin stimulates uptake of glucose via translocation of the ___ transporter

GLUT4

Fructose intolerance is usually found in ___ (common abdominal disease)

IBS

Malabsorption of sugars mimics ___

IBS

What is a low FODMAP diet used for?

IBS

_______ with biopsy should be performed in suspected crohns, UC, and neoplasm

ileocolonoscopy

Bile acids are primarily absorbed by an active Na+-dependent process that takes place in which part of the intestine?

ileum

GIST treatment: -Resection -____ for unresectable, metastatic, or recurrent GISTs that have KIT or PDGFRA mutations

imatinib

Esophageal perforation causes Iatrogenic: Non-iatrogenic:

Iatrogenic: can be mechanical or PCI Non-iatrogenic: often mechanical

Inflammatory bowel disease is a chronic condition resulting between microbiome of the gut and inappropriate ___ activation

immune

Irritable bowel syndrome _____ with defecation _____ triggers Does/does not present with blood Occurs during ______ time of day

improves emotional DOES NOT daytime

Lactase is ____, thus regularly consuming lactose should maintain the enzyme

inducible

Inflammatory diarrhea causes: (3)

infection IBD ischemic colitis

Cachexia: substantial loss of fat and lean body mass in the presence of chronic __________

inflammation

Osmotic diarrhea is diarrhea without ______

inflammation

H. pylori causes gastric ulcer through what mechanisms?

inflammation T cell activation chronic damage oxidative stress acid channels into epithelial cells

sialadenitis

inflammation of a salivary gland

Esophagitis

inflammation of the esophagus

Diverticulitis is like diverticulosis with extra _____ and usually less _____

inflammation; bleeding

_____ is the primary hormone responsible for direction of energy metabolism in the fed state

insulin

Barrett's esophagus replacement of normal squamous epithelium with ______

intestinal-type columnar epithelium and goblet cells

In the first 48 hours to 7 days of acetaminophen overdose, there is increase ____ pressure, hepatic ____, coma, multi-organ failure

intracranial encephalopathy

Rotavirus vaccine is contraindicated in kids with hx of SCID and ______

intussusception

___ and ___ supplements are usually required in celiac disease

iron and folic acid

"Thumbprinting" of bowel means:

ischemia

With secretory diarrhea, stool electrolyte composition is ______

isotonic

benefit to risk ratio

it is effective without causing an unacceptable level of harm to the user

Lead poisoning symptoms acute: ____ damage and GI irritation chronic: Plumbism: ____ anemia, GI ___ and abd pain, neurologic damage

kidney microcytic, constipation

Supporting features of bulimia nervosa

lack of self control disciative qualities emotional stressors

What are FODMAP examples?

lactose fructose fructo and galacto-oligosaccharides polyols

While the gut heals from celiac disease, in addition to avoiding gluten, avoid ___ and ___ to avoid diarrhea

lactose and fat

H pylori infection causes a dense ____ ____ ________ infiltrate

lamina propria lymphoplasmacytic (also neutrophils) The follicle in the center of the image is a lymphoid follicle.

High grade barretts esophagus treatment

laser ablation and endoscopic resection

Lead toxicity treatment Gastric ____ Calcium ____ for GI effects ____ therapy: CaNa2EDTA, BAL, penicillamine, succimer

lavage calcium gluconate Chelation

Arsenic poisoning treatment ____ or emesis ____ is preferred for acute poisoning ____ is preferred for chronic poisoning

lavage dimercaprol succimer

salicylate overdose treatment Gastric ____ _____ to alkalize the urine and increase excretion in the urine _____ if renal function is impaired

lavage sodium bicarb dialysis

Acetaminophen overdose treatment

lavage in early stages acetylcysteine (NAC) within 8-12 hours liver transplant

galacto-oligosaccharides sources

legumes

_____ hormone decreases in weight loss

leptin

H pylori attaches to ____ antigens

lewis

Colonic ischemia is rarely ________

life threatening

Eosinophilic esophagitis endoscopy findings (3):

linear furrows esophageal rings possible strictures

Insulin increases fatty acid uptake and TAG storage via increase in activity of ___

lipoprotein lipase

13. A primary site for amino acid catabolism in the well fed state is in the ___(tissue)____

liver

Entamoeba histolytica often migrates to the _____

liver

Glucagon primary site of action is the ____

liver

The urea cycle occurs in the _____ organ

liver

Dietary lipids are in the form of ___-chain fatty acids

long

Ca++ and Mg++ are (low/high) in fat malabsorption

low

Dry hair, hair loss, fluid retention/swelling makes you think _____

low protein

Stomach lymphoma microscopy appearance: diffuse sheets of _____

lymphocytes

HNPCC, hereditary non-polyposis colorectal cancer, AKA _____

lynch syndrome

Cajal cells

make slow waves for membrane potentials, GI pacemaker activity makes smooth muscles leaky to let Ca2+ come in and K+ to go out

Celiac disease presentation

malabsorption, diarrhea

Facial paralysis with a salivary gland tumor indicated the cancer could be _____

malignant

Stomach adenocarcinoma: Intestinal type ____ lesion infiltrating malignant glands with _____ production ____ pathway

mass mucin WNT

Kwashiorkor disease presents with: Fat and lean _____ _______ from low plasma oncotic pressure hair _____ and color change skin _____

mass loss edema pluckability breakdown

Esophageal squamous cell carcinoma EGD appearance

mass-like lesion, infiltrate and diffuse thickening

What are 3 major causes of GI nausea and vomiting

mechanical/obstruction motility/functional infection/inflammatory

Where is the emetic center located?

medulla oblongata

UC indications for surgery Toxic ____ ______ Medical intractibility _______ degeneration

megacolon hemorrhage malignant

GIST are the most common ____ tumor of the abdomen

mesenchymal

Colonic ischemia is the most common form of ______

mesenteric ischemia

Refeeding syndrome

metabolic alterations that may occur during nutritional repletion of starved patients

Cyanide poisoning treatment formation of ______ via nitrates _____ binds to cyanide ion to form cyanocobolamin, excreted in the urine

methemoglobin hydroxocobalamin

The digestive phase of dietary lipids for lipolysis and micelle formation requires ____ and _____, respectively

pancreatic lipase; conjugated bile acids

Medium chain triglycerides do not require ____ to be absorbed

pancreatic lipolysis

Examples of Pica foods

paper, chalk, gum

Trans-epithelial tranpsort of ions in the intestinal lumen uses transport proteins to drive transcellular transport of ions using ATP to create a gradient. The gradient allows _______ transport of fluid through tight junctions

paracellular

Vibrio _________ are associated with oysters from the gulf coast

parahaemolyticus

The ____ senses low Ca++ and signals to the body to increase absorption/resorption

parathyroid glands

Autoimmune metaplastic atrophic gastritis leads to anti-body mediated destruction of ____ cells and _____ factor

pareital; intrinsic

C. difficile creates a _____ colitis

pseudomembranous

chemo-related nausea treatment

psychological support, benzos, step ups: 5HT, neurokinin antagonist, corticosteroids

CMV esophagitis ulcers have a ____ appearance

punched out erosions

Hypopion

pus in the anterior chamber of the eye

18. Transaminase use the _______ form of vitamin B6 as a cofactor.

pyridoxal phosphate

(one/many) types of cancer are common in lynch syndrome

Many: Carcinomas of endometrium, stomach, small bowel, ovary, gallbladder, hepatobiliary tract, pancreas, urinary tract, kidney, brain, and prostate, as well as sebaceous skin tumors.

Most common stomach lymphoma type

Marginal zone B-cell lymphoma

Boerhaave syndrome risk factors

severe retching and vomiting

HSV esophagitis presents with ____ and ____ that may coalesce into extensive areas of erosion

shallow vescicles/"volcano" ulcers

What are the layers of the eosphagus?

squamous epithelium, muscularis mucosa, submucosa, muscularis propria

digestible polysaccharides include: (2)

starch and glycogen

With secretory diarrhea, stool volume (decrease/increase/stay the same) with fasting

stay the same

Malabsorption of fats, like in celiac disease, leads to

steatorrhea

The classic celiac disease symptom is ____

steatorrhea

light colored, foul smelling stools that are soft and bulky, difficult to flush/float, stick to sides of the toilet, think ________

steatorrhea

C. diff diagnosis

toxins A and B ELISA/latex agglutination

11. True or false: The liver can produce both glutamate and aspartate using alanine as the only substrate?

true

14. True or false: A ketogenic amino acid is one that is catabolized into metabolites that can be used to synthesize lipids.

true

enterokinase deficiency presents as ______ deficiency. This is because enterokinase is only located in the _____ and functions to cleave ____ to avoid pancreatic breakdown

trypsin duodenem trypsin

Primary sclerosing cholangitis is associated with (UC/CD)

ulcerative colitis

Chronic gastritis: Chronic inflammation of stomach mucosa, may lead to ____, atrophy, metaplasia > carcinoma, lymphoma

ulcers

Opioid overdose symptoms

unconsciousness miosis slow, shallow respirations

One of the primary cell signature expression markers of brown adipocytes is the presence of _____

uncoupling protein 1, UCP1.

Preceeding Refeeding syndrome: Prolonged ______ Depletion of intracellular _____

undernutrition electrolytes: specifically phosphorus

BUN is a measure of post-liver _____ (pre-kidney-filration)

urea

The ___ breath tests for H. pylori infection using radio-tagged carbon

urea

Serotonin signaling from ECL cells is transmitted to the vomiting center via ____

vagas nerve

Overeating causes vomiting by activation of the ___ nerve that transmits signals to the ___ ____

vagas; vomiting center

Barretts esophagus is a ____-red appearance under EGD

velvety

H1 receptor antagonists reduce nausea/vomiting by: blocking Histamine binding H1 at _____

vestibular nuclei

Causes of osmolar gap (6)

Methanol Ethanol Acetone Diuretics Isopropyl alcohol Ethylene glycol Notice that 5 out of 6 of these are alcohols...

Giardia treatment

Metronidazole

Trichomonas vaginalis treatment

Metronidazole (patient and partner)

Sotalol overdose treatment ____ and ____ for torsades

Mg+2 and isoproterenol for torsades

The big 9 food allergens

Milk Eggs Peanuts Treenuts Soy Fish Shellfish Wheat Sesame

A patient presents with torsades following toxic ingestion. What is the most likely thing they took? What is the treatment?

Most likely took TCAs Treatment: Mg2+, sodium bicarb

Antral gastritis causes duodenal ulcers because the ulcers kill ___ cells, resulting in less ___ and increased acid production

S; somatostatin

The sugar and sodium co transporter is the _____

SGLT-1

Drug idiosyncrasies are believed to be due to

SNPs

The following key words are associated with: -Secrete neuro-active hormones -Many patterns of growth: nests, trabeculae (cords), solid -Cells are uniform, moderate cytoplasm, stippled or salt-and-pepper chromatin

Stomach - Neuroendocrine tumor (carcinoid)

What pathways does the CTZ use to illicit vomiting?

Straight to vomiting center, and to a lesser extent the solitary tract nucleus

Delayed CINV is mediated by

Substance P

NK1 pathway begins with ____ activating the neurokinin receptor 1

Substance P

A 6-year-old girl was brought to the family medicine clinic with abdominal colic, constipation, anorexia, frequent headaches, irritability, and fatigue. Upon examination, peripheral motor neuropathy (wrist and foot drop) was noted. Laboratory results revealed microcytic anemia with basophilic stippling. Which of the following would be the preferred orally effective chelator for treating this child?

Succimer

Before starting Crohn's biologics treatments, you need to test for ____

TB

Cholera specimen culture media is called:

TCBS Thiosulfate citrate bile salts sucrose

Vibrio attaches to epithelial cells with ____

TCP

Cyclospora treatment

TMP-SMX

Crohn's is mediated by what lymphocyte?

Th1

UC is mediated by what lymphocyte?

Th2

______ is the treatment modality for severe UC

biologics

Russell's sign

calluses on the knuckles or back of the hand due to repeated self-induced vomiting over long periods of time

The most appropriate nutritional therapy for weight loss is one that results in negative ___ balance, and one that the patient will adhere.

caloric

PSC increases risk for _______ and ______ cancer

cholangiocarcinoma; gallbladder

Shallow ulcerations, friable mucosa, lose of haustra indicates:

UC

B12 deficiency is often due to _____; a disease state where there is reduced Cl-H+

achlorhydia

Zollinger-Ellison syndrome results in ____ hypersecretion secondary to high gastrin levels

acid

Why do peptic ulcers occur?

acid and pepsin damages the gastric mucosa

Secretory diarrhea due to cholera results in: dehydration ______osis due to bicarb loss hypo_____ (electrolyte imabalance) Cardiac ______

acidosis hypokalemia cardiac arrhythmia

What important vitamin D regulator is the kidney responsible for?

activation of vitamin D from 25(OH)D to 1,25(OH)2D, these also regulate Ca++ levels

Apple shaped abdominal fat is more ____ and (harder/easier) to lose

active; easier

HSV esophagitis treatment

acyclovir

Barrett's esophagus can predispose someone to ____

adenocarcinoma

Barrett's esophagus increases risk for _____ cancer

adenocarcinoma

ulcerative colitis increases risk for _____

adenocarcinoma

Ectopic fat accumulation leads to altered release of _____

adipokines

sympathomimetic overdose treatment: maintain ____ and respiration control convulsions with IV_____ activated ____ avoid ______ and ____

airway diazepam charcoal beta blockers, vasopressors

_____ is released from muscles during fasing for the liver to use during gluconeogenesis

alanine

During fasting, plasma levels of ____, acetoacetate, and ______ may be elevated to maintain energy demands of the body

alanine; β hydroxybutyrate

Colon adenocarcinoma risk factors:

alcohol, red meat, body fat, IBD Protective: hormone replacement therapy

atypical anorexia nervosa: all the criteria for anorexia nervosa are met, except that despite significant ______, the individual's weight is within or above the normal range

all the criteria for anorexia nervosa are met, except that despite significant weight loss, the individual's weight is within or above the normal range

Crohn's disease is inflammatory bowel disease that includes ____ parts of the intestines; "____" lesions

all; skip

Eosinophilic esophagitis is due to ____

allergy

Serotonin syndrome symptoms ___ mental status ___ (sudden muscle jerks) ___reflexia ___ia ___ (sweating)

altered myoclonus hyperreflexia ataxia diaphoresis

Elevated BUN indicates increased _________ metabolism

amino acid

During starvation, glutamine can be used in the kidney for gluconeogenesis. This can be measured with urine _______

ammonia

anabolism vs catabolism

anabolism (building up) and catabolism (breaking down)

Liver abcess from entamoeba histolytica is described as ______

anchovy paste

______ removes bile acids by forming insoluble complexes with bile acids in the intestines, which are then excreted in the feces, and therefore can reduce the bile acid diarrhea.

cholestyramine

______ (APC pathway) resulting in high levels of DNA somatic copy-number alterations, with DNA gains/amplifications and losses/deletions affecting a smaller group of genes

chromosomal instability

Orlistat is contrindicated in patients with: (2)

chronic malabsorption syndrome and cholestasis

esophageal varices risk factors

cirrhosis, portal htn

Crohn's disease of the oral mucosa may present with

cobblestoning

____ (3) increase brown fat composition in the body

cold, exercise, fasting

Chronic mesenteric ischemia is less severe because of _____

collaterals

PSC should initiate _____ cancer screening

colon

osmotic diarrhea is solute driven in the ____ part of the intestine

colon

_____ adenocarcinoma is the most common GI cancer, incidence peaks at ____ years old

colon 60-70 years

Ulcerative colitis is inflammatory bowel disease that is confined to the _____; "____" pattern of inflammation

colon continuous

Precursor lesions of colon cancer are called

colon adenoms

Meckel's diverticulum

congenital outpouching of distal ileum

celiac endoscopy appearance

cracked earth appearance

Erythema nodosum with diarrhea may indicate

crohn's disease

What are the two subtypes of IBD?

crohns and ulcerative colitis

Ulcerative colitis histology findings: crypt _____

crypt abscess

Chronic colitis results in _____ distortion with intraepithelial ____

crypt; lymphocytes

ulcerative colitis treatment -change ____ to avoid mechanical trauma -drugs to reduce ____

diet inflammation

Initial treatment of short-bowel syndrome includes establishing an effective _____ and the judicious use of _____ to reduce stool output.

diet opiates

Stomach adenocarcinoma: diffuse type _____ thickening sheets of cells sometimes called _____ ring _____ pathway risk factor is family history of ____ cancer

diffuse signet CDH1 breast

Methylene blue works as an _____ carrier, regenerating Fe2+

electron

Reduced gastric ______ illicits vomiting/nausea

emptying

Skim milk has a faster gastric ______ rate than whole milk, therefore is more likely to induce lactose intolerance.

emptying

Phentermine MOA

enhanced NE and dopamine neurotransmission

Ion transport in the intestines is a baalance between 3 things:

enteric nervous system immune system endocrine system

C. perfringens causes ____ (GI problem)

enteritis

Lanugo can occur in starvation/restrictive eating and is defined as:

fine, soft hair, especially that which covers the body and limbs of a human fetus or newborn.

Villous Adenoma: _____-like villous architecture

finger

_____ are holes formed in crohns that connect the enteric system to another organ

fistula

Indications for Crohn's disease surgical intervention: (2)

fistula strictures

____ shaped ulcer is seen in colon biopsy with histolytica

flask

Stool antigen detection from O&P detects ____ and ____ parasites

giardia and cryptosporidium

Colon adenocarcinoma Microscopic appearance -Adenocarcinoma = _____ formation, mucin production -Invasive malignant glands extending into the _____ or deeper into the colonic wall -Often has central ____ -May have poorly differentiated (no glands) or ____ features

gland submucosa necrosis signet ring

Crohn's disease of the tongue may present with

glossitis: red, shiny, smooth

Hepatic gluconeogenesis is stimulated by (3)

glucagon epi and NE low levels of insulin

Beta blocker overdose treatment _____ for bradycardia and hypotension _____ for conduction defects

glucagon sodium bicarb

During the fasting state, proteins from muscles are hydrolyzed to provide ________

gluconeogenic AA

Ketogenic implies the ability to make lipids/ketones and NOT ______

glucose

Lactase degrades glucose into which two monosaccharides?

glucose and galactose

____ and ____ are the amino acids that are the entry to the urea cycle

glutamate and aspartate

Movement in the labrinth of the inner ear causes stimulation of the ____ nuclei via _____ receptor(s)

vestibular; histamine, muscarinic (which is why benadryl works for motion sickness)

Motion sickness is transmitted via the ___ nerve

vestibulo-cochlear

Cholera is caused by

vibrio cholera

celiac disease microscopy appearance includes blunting of ___, increased intraepithelial ____ cells marked ____ hyperplasia

villi, lymphocytes crypt

Consequences of gliadin ingestion _____ atrophy decreased _____ absorption atrophy leads to decreased ____ and ____, resulting in pancreatic insufficiency _____ overgrowth

villous nutrient CCK; secretin bacterial

Viral inclusions of HSV esophagitis show _____ in sqamous cells at margin of ulcer called ____ bodies

viral inclusions; cowdry

retching is the reverse movement of the stomach without ____

vomit

Vibrio _____ is more likely to cause systemic diseases

vulnificus

Microsporidia presentation Normal patients: AIDS: Ocular ________

watery diarrhea, nausea and cramping AIDS causing chronic diarrhea and wasting keratoconjunctivitis

aphthous ulcers

"canker sores"; small, painful, round ulcers in the oral mucosa of unknown cause, seen in CD

Avoidant/restrictive food intake disorder "______" eating, usually in those with OCD, _____. Not linked to _______.

"picky" eating, usually in those with OCD, autism spectrum. Not linked to body image.

Clinical symptoms of viral gastroenteritis:

"stomach flu" non-bloody diarrhea, vomitting

anorexia nervosa DSM-V criteria: * Weight at least _____% below normal * Intense _____ of gaining weight or becoming fat * Disturbance of body _____ - Sometimes excessive exercising

* Weight at least 15% below normal * Intense fear of gaining weight or becoming fat * Disturbance of body perception - Sometimes excessive exercising Must meet all three

Esophageal squamous cell carcinoma risk factors

- Alcohol - Hot liquids - Esophageal web (Plummer-Vinson syndrome) - Zenker Diverticula - Cigarettes

GERD microscopy would show ____ (3 things)

- basal hyperplasia (too blue) - vascular papilla approaching the midpoint - Eosinophils

Sialolithiasis Most common location? What causes it?

- calcification within a gland or duct - Wharton's duct is the most common site - may cause obstruction; swelling seen during eating - dehyrdration and infectious causes

Esophageal Squamous Cell Carcinoma treatment

-Chemotherapy/ radiation -Surgery

Esophageal Squamous Cell Carcinoma Prognosis

-Early (superficial) tumors: 85% at 5-years -Late (deeper invasion, lymph node metastasis): less than 20% at 5 years [most common]

bulimia nervosa DSM-V criteria -Recurrent episodes of _____ eating -Recurrent inappropriate compensatory behavior to prevent ______ -Binge eating and inappropriate compensatory behavior both occur on average _____ per week for 3 months -Self-evaluation is unduly influenced by _______ and ______

-Recurrent episodes of binge eating (eating an amount of food larger than most people would eat in a similar time frame and under similar circumstances AND a sense of lack of control over eating during the episode) -Recurrent inappropriate compensatory behavior to prevent weight gain (vomiting, laxatives, diuretics, other medications, fasting, excessive exercise) -Binge eating and inappropriate compensatory behavior both occur on average once per week for 3 months -Self-evaluation is unduly influenced by body shape and weight

Fecal calprotectin -stool marker for ___ -used to monitor _____ -used to differentiate ____ vs. ____

-stool marker for IBD ​ -used to monitor medication efficacy ​ -used to differentiate IBD vs. IBS​

Microsporidia size is ___ to ___ μm

1 to 2

H. pylori triple therapy

1. Amoxicillin 2. Clarithromycin 3. PPI (omeprazole)

Low grade vs high grade squamous dysplasia low: proliferation of cells in _____ thickness of epithelium high: full-thickness dysplasia, high risk for _____

1/3-1/2 carcinoma

Bleeding happens in ___% of peptic ulcers

10

Colon cancer screening is once every ___ years

10

Osmotic gap diarrhea is > ____ mosm/kg

100

•At least _____ polyps are necessary for classic FAP, but may have 1000s

100

Oral/IV iron is recommended if serum ferritin falls below ____ ng/mL and TSAT <____%

100; 20

The incubation period of viral gastroenteritis

12-60 hours

A low calorie diet is ____ a day for women and ____ a day for men

1200-1800 1500-1800

A normal BMI is between __ and __.

18.5-24.9

The small intestine secretes (Blank 1: 2 things) and absorbs Blank 2, while the large intestine absorbs (Blank 3: 3 things) and secretes (Blank 4: 2 things)

1: bicard and chloride 2: sodium chloride 3: sodium, potassium, SCFA 4: chloride and potassium

Secretory diarrhea is characterized by a loss of large volumes of Blank 1 fluid/material, with a stool pH in the Blank 2 range and an osmotic gap of Blank 3.

1: isotonic 2. acidic 3. <50 mosm/kg

Within the Blank 1 nutrients, vitamins, minerals, and water are absorbed, while in the colon, primarily only Blank 2 is absorbed.

1: proximal small intestine 2. water

Osmotic diarrhea is often caused by ingestion of poorly absorbed Blank 1 or Blank 2 and can be characterized by a Blank 3 stool pH (6.6 is normal) and an osmotic gap of Blank 4.

1: sugars 2: ions 3: decreased 4. >100 mosm/kg

Water and solute transport are restricted after secretion or absorption by Blank 1 situated between epithelial cells. Membrane Blank 2 drive ion transport across cells while electrochemical gradients allow Blank 3 transport.

1: tight junctions 2. transport proteins 3. paracellular

Ondansetron is not recommended in the ___ trimester

1st

A new drug is being studied in a phase II trial for diabetes. The end-point used for therapeutic efficacy is maintenance of blood glucose at 120 mg/dL. Side effects of the drug include minor muscle pain. The study reveals that a 100 mg/kg dose is ED50 while a 200 mg/kg dose is TD50 (increased muscle pain). Which of the following is the therapeutic index for this new drug?

2

Normally, there are ____ villi for every one crypt

2

Norovirus is shed for up to ______ weeks

2

Meckel's diverticulum rule of 2's 2% of the ______ have a Meckel's diverticulum. 2% of those are ______ 2 feet of the _______ valve _____ are 2 times more likely to have Usually diagnosed _____ the age of 2

2% of the population have a Meckel's diverticulum. 2% of those are symptomatic, 2 feet of the ileocecal valve Males are 2 times more likely to have Usually diagnosed before the age of 2

____ amino acids are essential

9

Stomach lymphoma 5 year prognosis

90%

____% of water is absorbed in the colon

90%

Anion gap

= Na - (Cl + HCO3) Normal is between 8 and 12

Definition of diarrhea Frequency: Amount/weight: Acute: Persistent: Chronic:

>3 times per day >250 grams/day acute <2 weeks persistent 2-4 weeks chronic >4 weeks

Gastric ulcer: greater than ___ break in the lining of the stomach that extends to the submucosa

>5mm

Steatorrhea is defined as a condition when stool fat excretion increases to which percentage of dietary fat intake?

>7%

23. The two nitrogens of urea are derived from A) Aspartate and ammonia B) Glutamate and ammonia C) Ornithine and ammonia D) Adinine and ammonia

A

Toxidrome

A syndrome caused by a dangerous concentration of toxins in the body.

What are the fat soluble vitamins

A, D, E, K

The cholera toxin is a ____ toxin

A-B

The CTZ releases ____ which stimulates the vomiting center

ACh

Cyrptospordium diarrhea is worse in _____ patients

AIDS

Causes of metabolic acidosis

ATMUDPILES

Arsenic As5+ substitutes for inorganic phosphate in production of ___

ATP

____ is the most common cause of acute liver failure in the western world

Acetaminophen

____ nausea is defined as nausea and/or vomiting occurring within 24 hours of chemotherapy administration.

Acute

_______: epithelial neoplasms that range from small, often pedunculated, polyps to large sessile lesions. Most do not progress into carcinoma.

Adenoma

sympathomimetic toxidrome

Agitation, tachycardia, HTN, elevated temp, diaphoresis (sweating distinguishes from anticholinergic toxidrome where there will not be sweating)

The ABCDTs

Airway Breathing Circulation Drugs Temperature

Microsporidia treatment

Albendazole Fumagillin

Mesenteric ischemia

An interruption of the blood supply to the mesentery. Collateral arteries widen

Drug name/target for CINV delayed phase

Aprepitant NK1 antagonist

____ toxicity is a metal toxin causing hemolysis and hemoglobinurea, skin discoloration, vasodilation, arrhythmia, GI distubances, kidney damage

Arsenic

Zenkers diverticulum complications

Aspiration pneumonia, fistula, ulceration, cancer

Cholera toxin forms antibodies against toxin subunit ____

B

Water soluble vitamins

B and C

ileal resection nutrition complications; Reduced B__ and ___

B12 and Magnesium

If the MCV is over 100 ng/mL, supplement dietary ___ and ___

B12 and folate

AMAG treatment

B12 supplement and iron

Vitamin B12 deficiency looks like ___ deficiency

B9 Folate

Insulin secretion in the fasting state, and after a glucose load, increases linearly with ____

BMI

esophageal adenocarcinoma risk factors

Barrett's esophagus/GERD obesity tobacco male sex H pylori* may be protective?

GERD can progress to _____ esophagus and ____

Barretts and strictures

Warthin tumor

Benign cystic tumor with abundant lymphocytes and germinal centers (lymph node-like stroma); 2nd most common tumor of the salivary gland

anticholinergic toxidrome. (alice in wonderland symptoms)

Blind as a bat (Mydriasis) Mad as a hatter (Altered mental status) Red as a beet (vasodilation, flushed) Hot as a hare (febrile) Dry as a bone (no secretions/diaphoresis) Bowel and bladder lose their tone Heart runs alone (tachycardia) Common causes: Atropine, antihistamines, scopalamine, antipsychotics

NSAIDS cause gastric ulcers through what mechanism?

Blocks COX-1 that is important for prostaglandin synthesis PGs maintain the mucus barrier

22. Positive nitrogen balance is seen in all of the following conditions except. A) pregnancy B) a growing child C) fever D) a body builder

C

24. Blood urea decreases in all of the following conditions, except A) Liver failure B) Pregnancy C) Renal failure D) Urea cycle disorders

C

tricyclic antidepressants overdose symptoms: TRICyclic Antidepressants

C - coma C - convulsions C - cardiac dysrhythmias (widened QRS/prolonged QT) A - Acidosis

_____ genes of H pylori allow the bacteria to transport pro-inflammatory signals into epithelial cells

CAG

Restrictive diet treatment Gain weight to optimal levels ___ therapy Medications: (2)

CBT SSRI and appetite stimulating meds

Deep ulcerations, cobblestoning, creeping fat, bowel wall thickening, linear ulcers, fissures, decribes:

CD

Smoking makes (CD/UC) symptoms worse

CD

Secretory diarrhea is commonly caused by increased Cl- movement via activation of the ____ channel by _____

CFTR via cAMP

What are 3 major causes of non-GI nausea and vomiting

CNS endocrine/metabolic Toxins/medications

5-HT receptor antagonists reduce nausea/vomiting by working at the _____

CTZ

D2 receptor antagonists reduce nausea/vomiting by working at the _____

CTZ

What happens following CTZ stimulation?

CTZ stimulates the nearby vomiting center to cause emesis

A stimulated vestibular nuclei will stimulate the ___

CTZ which then stimulated the vomiting center (not corrent, it goes straight to the vomiting center)

Chronic mesenteric ischemia risk factors: _____ disease smoking ______

CV atherosclerosis

GIST tumors arise from ____ cell types

Cajal

stomach lymphoma risk factors

Chronic inflammation, Helicobacter pylori infection

What are vascular cause of gastric ulcers

Churg-strauss mastocytosis

2 Drug names/targets for GERD and gastroparesis

Cisapride 5HT4 agonist, ACh (can't use this in pts with heart problems) Metoclopramide D2 antagonist and 5HT4 agonist

A limited degree of ileum dysfunction results in a decrease in bile acid reabsorption in the ileum, and an increase in the delivery of bile acids to the large intestine. This stimulates active ____ secretion and causes diarrhea.

Cl-

What are the 4 subtypes of IBS?

Constipation Diarrhea Mixed Unspecified

organophosphate poisoning symptoms

Constricted Pupils, Diarrhea, urination, Muscle weakness, Bradycardia, Bronchospasm, Bronchorrhea, Emesis, Lacrimation, Sweating, Salivation, Seizures, GI cramping

Pyoderma gangrenosum: Painful pustule quickly progressing to ragged ulcer with sharply marginated violaceous border and undermined edges. It may be a manifestation of _____

Crohn's disease

Serotonin syndrome treatment

Cyproheptadine, dantrolene and propanolol, supportive treatment

Kidney failure nutritional consequences Decreased production of Vitamin ___ Decreased ___ hormone Decreased glucose Decreased degradation of bioactive ____ Accumulation of water and ____, ____ waste

D EPO peptides (insulin, glucagon, etc) electrolytes, nitrogenous

cholinergic toxidrome

DUMBBELSS/SLUDGE and the killer B's Salivation Lacrimation Urination Defication Gastro upset Emesis Bradycardia, Bronchorrhea, Bronchospasm Also mioisis and lethargy Organophosphates, carbamates, mushrooms

What IBS is most common?

Diarrhea

Cholinesterase inhibitor poisoning: DUMBBELSS

Diarrhea Urination Miosis Bronchospasm Bradycardia Excitation of skeletal muscle Lacrimation Sweating Salivation

Gastric neuroendocrine tumors •Type I -Arise in _____ (disease) -Good prognosis •Type II -Associated with _____ (mutation) -Gastrin hyper-______ -Approximately ____% of GNETs -Moderate prognosis •Type III -Sporadic____ -Approximately ___% of GNETs -Poor prognosis

Gastric neuroendocrine tumors •Type I -Arise in autoimmune metaplastic atrophic gastritis (AMAG) -Approximately 75% of GNETs -Good prognosis •Type II -Associated with MEN I -Gastrin hypersecretion (Zollinger Ellison) -Approximately 5-10% of GNETs -Moderate prognosis •Type III -Sporadic GNETs -Approximately 15% of GNETs -Poor prognosis

Zollinger-Ellison syndrome

Gastrin-secreting tumor associated with ulcers

celiac disease treatment

Gluten-free diet

Describe H. pylori

Gram negative rod with flagella

Cholera Toxin blocks GTPase activity of ___

Gs

The ______ transporter is the final step in gastric acid secretion

H+K+ATPase

stomach lymphoma early treatment Eradication of ____ infection resolves lymphoma if at an early stage If late: _____

H. pylori Chemotherapy

What are the top causes of gastric ulcers?

H. pylori, then NSAIDS

Cadida esophagitis is seen in ____ patients

HIV

HSV esophagitis is seen in ___ patients

HIV

The celiac disease gene is within the ___ genes

HLA

Immunosuppressed esophagitis pathogens

HSV, CMV, candida

Zenkers diverticulum presentation

Halistosis, gurgling in throat, weight loss, pneumonia

___ is a more bioavailable form of iron

Heme

Muscarinic receptor antagonists example

Hyoscine

Drug name/target for motion sickness, post-op, pre-surgery N/V

Hyoscine M1 antagonist

Orlistat MOA

Inhibits lipase in the GI thus preventing breakdown of fat and fat absorption

Most GIST tumors have activating mutations in ____

KIT

Colonic ischemia presentation Extreme pain in the ____ Most commonly affects ____ areas ___% resolve spontaneously

LLQ Watershed 85%

_____ fat cells lead to inflammation

Large

Cyclospora diagnosis reveals ____ colored oocysts on _____ on Stool OnP

Light pink to purple; AFB

Anorexia nervosa restricting type

Lose weight by cutting out sweets and fattening snacks, eventually eliminating nearly all food Show almost no variability in diet

As fat increases in the body, ___ (cell type) increases its presence in the fat store

M1 macrophages

___ is the macrophage that predominates in healthy fat stores

M2

Oncologic gastric ulcers are most commonly due to

MALT, gastric adenocarcinoma

Mutations in ____ genes results in lynch syndrome

MLH and MSH

Lynch syndrome is due to a mutation in the ____ pathway

MSI microsatellite repair

How do you differentiate Boerhaave from Mallory-Weiss syndrome?

Mallory-Weiss: hematemesis, longituinal lacerations, alcoholics and bulimics Boerhaave: painful, forceful vomiting, normal people

A 50-year-old emaciated man is brought to the Emergency Department. He is agitated, tachycardic, and hypertensive. Upon arrival, he has a seizure. Which of the following symptoms support the diagnosis as amphetamine overdose?

Mydriasis

GIST risk factor

NF1

___ receptor blockers are more effective for later onset/delayed chemo-related nausea/vomiting

NK1

Delayed CINV tx

NK1 receptor antagonists, corticosteroids, palonosetron

What receptors in the higher centers of the brain illicit vomiting?

NK1, cannabinoid

Diverticular bleed treatment

NPO Angiography tx if stable Surgical resection if unstable

Colonic ischemia treatment bowel rest: __________ antibiotics Stop medications that cause ________ Colonic ______

NPO Broad spectrum vasoconstriction decompression

Boerhaave syndrome treatment Bowel rest: NPO IV ____ IV ____ Possibly ______

NPO IV antibiotics IV PPI Possibly surgery

Mallory-Weiss treatment Bowel res: ____ IV _____ IV _____ Anti______ Possible EGD dx and ablation

NPO IV nutrition IV PPI Antiemetics Possible EGD dx and ablation

Diverticulitis treatment Bowel rest: ____ Antibiotics: _____ and ______

NPO ciprofloxacin and metronidazole

Monosaccharide absorption can be increased if sugar is administered with ___ and water

Na+

Following Rotavirus, villous atrophy leads to decreased ___ absorption and loss of ____

Na+ K+

Most B vitamins are ___ dependent for absorption

Na+ cotransporter

Cryptospordium treatment

Nitazoxanide AIDS: Start ARVT

Does H. Pylori invade gastric cells?

No

What are the vibrio cholera serotypes?

O1 and O139

Which weight loss medication has a side effect profile that includes oily stools and fecal discharge?

Orlistat

Why is caloric and protein intake monitored closely in CKD?

Overeating causes kidney damage due to excess nitrogenous wastes. Undereating breaks down body stuffs, also contributing to kidney damage. Low proteins limits phosphorus, nitrogenous waste, etc.

____ stain can show candida pseudohyphae

PAS

Diagnosis of norovirus is confirmed with ____

PCR

In the first 24-48 hours of acetaminophen overdose, there is elevated ___ time and increase serum _____ levels

PT/INR transaminase

Acute Mesenteric ischemia presentation ______ out of proportion to exam findings Nausea, emesis Transient ______ CBC: _____

Pain diarrhea leukocytosis?

Cryptospordium stain _______ colored oocysts on _____ stain

Pink-red Acid-Fast

idiopathic onion skin fibrosis of bile duct

Primary sclerosing cholangitis pathogenesis

Histolytica will show trophozoites in ______ in stool O&P

RBC

______ polyp/lesion are precursor adenocarcinomas with serrated/widened bases

Sessile serrated

_____ (up to 1 cm) have no substantial malignant potential and do not affect colonoscopic surveillance intervals

Small hyperplastic polys

AJCC staging 0-IV

Stage 0: Carcinoma in situ (CIS) Stage I: Tumor is small and has not spread anywhere else Stage II: Tumor has grown, but has not spread Stage III: Tumor is larger and may have spread to surrounding tissues and/or lymph nodes Stage IV: Metastatic cancer

Hormesis

The favorable effects at low doses of physical, chemical, or biological agents that have adverse effects at higher dose levels.

C. diff has two toxins:

Toxin A: enterotoxin Toxin B: cytotoxin

What is the treatment of gastric ulcers?

Treat H. pylori (tripple therapy) or stop NSAIDS, antacids/anti-secretory (H2 or PPI), mucosal protective agents (pepto-bismol)

20. True or false: Urea is a product of cleaving the end of the side chain of arginine?

True

3. True or false: The urea cycle involves both enzymes in the cytosol and enzymes in the mitochondria.

True

8. True or false: If the nitrogen is removed from alanine, the remaining carbon backbone is a pyruvate molecule.

True

Mutations of the APC gene: a key negative regulator of the ____ signaling pathway

WNT

Smoking is a risk factor for what type of salivary gland tumor

Warthin's tumor

fructans sources

Wheat, rye, onions, garliic

Leptin, adiponectin, and other adipokines are among the proteins secreted by which adipocyte?

White

Serotonin syndrome

With any drug that ↑5-HT (e.g., SSRIs with MAO inhibitors, SNRIs, TCAs)

19. Does the transaminase reaction include a modified enzyme state?

Yes: after removing the nitrogen from an amino acid, the nitrogen stays bound to the enzyme until it is transferred to a different carbon skeleton

Folate absorption is ___ dependent

Zn

idiosyncrasies to a drug means a patient has a ____ response to a drug

abnormal

Cyclospora presentation

abrupt watery diarrhea, nausea and cramping

Rumack-Matthew Nomogram used to assess the risk posed by ____, but it is only valid for acute doses.

acetaminophen

A mismatch between visual and proprioceptive stimuli causes ____ and ____ release in brainstem autonomic centers, resulting in vomiting.

acetylcholine and histamine

___ and ___ must cross the blood brain barrier to provide anti-nausea/vomiting

anti-histamine and anti-cholinergic

Pro-longed use of _____ can reduce levels of colonic microflora, therefore reduce this compensation, and increase symptoms of lactose intolerance.

antibiotics

Antihistamines without _______ activity are typically not used to N/V

anticholinergic

_______ nausea is defined as nausea and/or vomiting that is triggered by sensory stimuli associated with chemotherapy administration.

anticipatory

What are the three D2 classes?

antipsychotic -azines metaclopropmide droperidol

H pylori prefers the ____ over the body of the stomach

antrum

9. _____ is an amino acid that is made in the urea cycle, but it is still essential in the diet.

arginine

Top associated finding for UC

arthritis

stomach adenocarcinoma presentation: -Often _____ or with vague symptoms similar to chronic gastritis and peptic ulcer disease •Dyspepsia, dysphagia, nausea -____, early satiety at later stages

asymptomatic weight loss

Stomach lymphoma presentation are often ____, but may have epigastric pain, hematemesis, and ____

asymptomatic; melena

Cholinesterase inhibitor poisoning treatment ____ in small dose, then increase as needed ____ to reactivate the AChE enzyme

atropine 2-pralidoxime

Disorders of amino acid metabolism are generally ______ traits

autosomal recessive

>100 cm of terminal ileum resection impairs _____ absorption which results in steatorrhea

bile acids

Organophosphates MOA

bind to and irreversibly inhibit AChE. ACh builds up.

diverticulosis: Painless rectal _____ because Vasa recta penetrate the mucosal wall.

bleeding

Diverticula

blind pouch anywhere in the enteric tract

The chemoreceptor trigger zone is in direct contact with ____

blood

Inflammatory bowel disease symptoms ____ in stool ____ (time of day) Weight ___ May or may not resolve with ____

blood nocturnal loss defecation

The chemoreceptor trigger zone (CTZ) is an area of the medulla oblongata that receives inputs from _______ drugs or hormones, and communicates with other structures in the vomiting center to initiate vomiting.

blood-borne

Glutamine to glucose metabolism in the kidney cannot be measured in the ________

blood; the ammonia byproduct is immediately excreted in the kidneys.

Diarrhea from histolytica

bloody

Excess protein is stored as ___

body fat

Cold/β3 agonism causes ______ of adipocytes

bowning/beiging

______ nausea and vomiting is defined as nausea and/or vomiting that occurs within 5 days post chemotherapy despite optimal antiemetic regimen used; requires rescue therapy with other antiemetics.

breakthrough

Eosinophils appearence under microscopy

bright pink-eosin staining

_____ adipocytes have more mitochondria and have an increased role in energy expenditure

brown

Crohn's disease findings on colonoscopy

bumpy, irritated, ulcerated lesions with cobblestoning, skip lesions of normal tissues

CKD Stage 4 Dietary management Weight-stable ___________ intake Low ____; 0.6-0.8 g/kg/day (60% high ____ value) No ____ restriction Low ____ 1500-2000mg Low potassium, phosphorus Moderate calcium Monitor potassium, adjust accordingly

caloric protein, biologic fluid (helpful to drink more water) sodium

Marasmus

caloric insufficiency, body fat stores are depleted, muscle wasting

Additional screening in patients with Crohn's disease Heightened suspicion for: _______ (due to immune suppression therapy) osteo______ nutritional ____ vaccine

cancer (due to immunesuppression due to therapy) osteoporosis Nutritional Conjugate pneumococcal

Common pathogens of esophagitis

candida and HSV-1

Reduction of ____ leads to increase in HDL, decrease in glucose and A1c

carbohydrates

Bloating, gas, diarrhea symptoms makes you think _____

carbs/sugars not digested

Increased 5-HIAA may indicate

carcinoid syndrome

Beta blocker overdose symptoms ____ disturbances ____tension increase _____ interval ____ and hyperkalemia

cardiac hypotension PR interval (prolonged QT can occur with massive ingestion and sotalol) hypoglycemia and hyperkalemia

Overeating causes vomiting by increasing pressure in the stomach, pushing the ___ open

cardiac sphincter

Crohn's disease histology includes ______ with full thickness inflammation

caseating granulomas

The _____ can transmit signals to the vomiting center and can cause vomiting due to emotion, smell, etc.

cerebrum

Lead poisoning treatment

chelation therapy

Esophageal adenocarcinoma treatment

chemo, radiation targeted HER2 therapy surgical resection

Ondansetron is good for treating ___-related nausea but can cause ___ upset

chemo; GI

Colon adenocarcinoma Treatment -Resection -____ depending on stage •For advanced tumors: test for _____, NRAS, BRAF, HER2 •Carcinomas with ____ may show poor response to some forms of chemotherapy but good response to immunotherapy

chemotherapy KRAS MSI

Rotavirus is the #1 cause of ______

childhood diarrhea

Crypts function primarily for _____

chloride secretion

Nitrate induced Methemoglobinemia has ____ colored blood and is treated with _____ blue

chocolate methylene

Carcinoid syndrome results in cutaneous ______ sweating ________spasm abdominal pain ____rrhea (seen with liver metasatses)

cutaneous flushing, sweating, bronchospasm, abdominal pain, diarrhea (seen with liver metasatses)

Drug name/target for prevention of migraine N/V

cyproheptadine; H1 and 5HT2 antagonist

Cyanide complexes with ferric iron of _____

cytochrome oxidase

Clostridium are saprophytic, meaning they love _____

dead organic matter

As fat stores increase in the body, there is a (decrease/increase) sensitivity to insulin

decrease

With osmotic diarrhea, stool pH is (decreased/increased), usually pH (greater than/less than) ____

decreased <5.3 (normal 6.6)

1,25-dihydroxycholecalciferol increases when plasma Ca++ ____

decreases

Rome IV criteria for IBS Recurrent abdominal pain at least 1 day/week in the last 3 months associated with 2 of the 3: -related to ___ -change in stool ___ -change in stool ___

defecation frequency form

Viral gastroenteritis complications:

dehydration and electrolyte abnormalities

Pyruvate _____ is an irreversible reaction

dehydrogenase

_____ nausea is defined as nausea and/or vomiting occurring at least 24 hours post chemotherapy administration; often peaks between 48 and 72 hours.

delayed

Chronic poisoning of arsenic leads to ____ ____ cancer of ____ and ____

dermatitis nephritis liver and bladder

Eosinophilic esophagitis can present with ____ (outside the GI symptoms)

dermatitis, asthma, allergic rhinitis

PEPT1 moves ___ and ___ into the intestinal cell

di and tripeptides

Drug name/target for childhood motion sickness

diphenhydramine ant-histamine

How does hyperthyroidism result in nausea/vomiting

direct thyrotoxic vomiting, increased estrogen

C. diff treatment

discontinue antibiotics In severe cases, metronidazole/vanc

esophageal adenocarcinoma location

distal 1/3 of esophagus

pseudodiverticulum

does not include muscularis propria e.g. Zenker's esophageal diverticulum, common colon "ticks"

Drug name/target for CINV

dolasetron 5HT3 antagonist

Post-operative anti-emetic D2 antagonist

droperidol

D2 receptor antagonists adverse effects

drowsiness seizure extrapyramidal effects hyperprolactinemia diarrhea

muscarinic receptor antagonists side effects

dry mouth, blurry vision, drowsiness

Colon adenocarcinoma presentation -No signs/symptoms ___ (detected increasingly with screening) -Advanced left-sided carcinomas may present with change in ______, abdominal distention, hematochezia, obstruction -Advanced right sided carcinomas: fatigue, ______, anemia

early bowel habits weight loss

Chronic mesenteric ischemia often presents with pain after _____

eating

Inflammatory bowel disease history

eating, traveling, antibiotics, smoking allergies, sick contacts, antibiotics, sexual, has this happened before, weight loss, blood in stool

Binge eating disorder: Over-_____ without ______ At least ___ a week for for 3 months often seen in individuals with concurrent disorders: _____

eating; compensatory mechanisms once bipolar, MDD, GAD

Insoluble fiber, like wheat, (exacerbates/helps) IBS because it is ______ On the other hand, plant fiber is beneficial.

exacerbate; non-fermentable

Colon adenocarcinoma Gross appearance -Often an ___ mass -May be present as a diffuse, circumferential ____

exophytic (meaning grows outward) thickening

16. True or false: Transamination reactions are only important in the catabolism of ketogenic amino acids.

false

7. True or false: When protein is catabolized, nitrogen is converted to urea in the urea cycle, but the carbon backbone from the amino acid does not play a role in metabolism.

false

With osmotic diarrhea, stool volume decreases with _____

fasting

Pancreatic insufficiency diet Low _____ Exogenous pancreatic enzymes

fat

Metaclopromide SE

fatigue extrapyramidal side effects increased prolactin (lactation)

Giardia symptoms

fatty diarrhea, bloating, flatulence

UC surgical resection complications for future family planning women include complications related to ________ due to the proximity of related organs in the pelvis.

fertility

Diverticulitis presentation

fever, anorexia, LLQ pain, obstipation, fever/leukocytosis

Indigestible polysaccharides include ____

fiber

Norwalk is often spread from ______ workers

food

Crohn's disease treatment Avoid ____ that influence intestinal inflammation Medications; ______ (e.g., metronidazole, ciprofloxacin) for inflammatory mass, ______, Surgery; Resection on diseased GI tract

food Aminosalicylates; corticosteroids

3 Most common causes of vomiting in adults?

food poisoning, migraines, chemotherapy

Cyclospora infection often comes from contaminated ______

food, oocytes in fruits and vegetables

Trichomonas vaginalis presentation

foul-smelling, greenish discharge, itching and burning vaginitis

Invasive inflammatory diarrhea is characterized by: (3)

frequent small-vollume bloody stools Also tenesmus, fever, abd pain

Barrett esophagus dysplasia has glandular changes that look like ____ glands

fused

CMV treatment

gancyclovir

Peptic Ulcer Disease (PUD): sore on the mucous membrane of the stomach, duodenum, or any other part of the gastrointestinal system exposed to _____ juices; commonly caused by infection with Helicobacter pylori bacteria

gastric

H. pylori infection that antrum predominant results in high ___ secretion

gastric acid

Soluble fiber slows ________

gastric emptying

Most common causes of vomiting in infants?

gastric reflux, food allergy, viral gastroenteritis, milk intolerance, infection, bowel obstruction

Smoking may prolong the healing process of _____

gastric ulcers

AMAG Diagnosis: high ___, anti-____ or anti-____ factor antibodies, ____-cytic anemia, lack of ____ cells on biopsy of stomach.

gastrin parietal; intrinsic macro- parietal

Transition from normal epithelial stem cells to adenomas to carcinomas, with stepwise accumulation of____ abnormalities.

genetic and epigenetic

What three chemicals poison heme protein? ____ oxidize hemoglobin to Fe3+ ___ binds to hemoglobin and blocks O2 ___ inhibits cytochrome C oxidase, blocks respiration

methemoglobin inducing agents (nitrates) carbon monoxide cyanide

Histolytica treatment

metronidazole Paromomycin in pregnancy

Esophageal squamous cell carcinoma location

mid esophagus

Physical activity goals for obesity minimum ____ steps Prefer over ____ ___ minutes of moderate intensity aerobic activity or ___ minutes vigorous Resistance training ___ times per week

minimum 5000 steps Prefer over 10,000 150 - 300 minutes of moderate intensity aerobic activity or 75 - 150 minutes vigorous Resistance training 2 times per week

opioid toxidrome

miosis, sedation, respiratory depression

Fat soluble vitamins require ___ for absorption

miscelles

Only _____ sugars are absorbed

monosaccharide

Adenovirus may be excreted for _____ after infection

months

Rapid small intestine transit time makes lactase deficiency symptoms (more/less) likely.

more

H1 receptor antagonists are good for treating ___ and ___

motion sickness and morning sickness

signet ring carcinoma has ____ in the center of the cell

mucin

What are the layers of the stomach?

mucosa, muscularis mucosa, submucosa, muscularis propria, subserosa

H. pylori infection in the antrum and fundus, this reduces ___ production

mucus

What are the 4 defenses against gastric ulcer?

mucus, bicarb, pH gradient, prostaglandin (increases mucus secretion)

Cowdry bodies have a _____ (3 things) appearance

multinucleated, marginated chromatin, molded nuclei

Cerebrum/brain events trigger vomiting center through ______ receptors

muscarinic

The vomiting center has ____ receptors

muscarinic

Muscarinic receptor antagonists reduce nausea/vomiting by working on the ___

muscarinic receptors in vomiting center

5 neurotransmitters of vommiting

muscarininc, serotonin, histamine, dopamine, neurokinin

17. In the starved state, there is a high rate of amino acid catabolism in the ____(tissue)___ that leads to high levels of ______ in the blood.

muscle alanine/urea

Mannitol sources

mushrooms, cauliflower, sugar free candies

opioid overdose treatment

naloxone; opioid antagonist

Pernicious anemia symptoms ____ degeneration, weakness ____ (tingling/numbness in extremities)

nerve parasthesia

What are the three pathways of stomach acid secretion

neural (vagas nerve), hormonal (G cells), paracrine (ECL/histamine)

Candida appearance under microscopy might show _____ (white blood cell type)

neutrophils

Alanine is used as a carrier of ____

nitrogen

The physiological signal of fasting is ______ lost in the urine

nitrogen

Nitrogen balance =

nitrogen in - nitrogen out + 4 grams Nitrogen in = dietary protein/6.25

Iron deficient state increase absorption of _____ iron

non-heme

Glucagon is synthesized by

pancreatic alpha cells

Pica DSM-V Criteria A patient persistently eats _____, nonfood material for ≥ ___ month. Ingestion of these materials is inappropriate for the developmental level of the patient. Ingestion of these materials is not part of a _____ tradition. If ingestion occurs in a patient with another disorder, it is sufficiently persistent and severe to warrant specific treatment. Not diagnosed in those under ___ years old

non-nutritious; 1 cultural 2

C. diff is commonly acquired

nosocomially

Esophageal varices treatment

octreotide β blockers to reduce htn banding, ligation

Raffinose is a ___ccharide from beans

oligosaccharide

____ fat is more linked to CV disease

omental/visceral

____ cholinesterase inhibtors are irreversible

organophosphate

Lactose intolerance due to lactase deficiency leads to bloating, diarrhea and gas due to ______

osmosis

Giardia causes _____ diarrhea

osmotic

Lactose intolerance creates a _____ diarrhea

osmotic (because undigested sugars pull water into the GI tract)

________ is a common cause of vestibular related N/V

otitis media

CMV has a _____ appearance under microscopy

owl-eye, large cells

hyperbaric ____ can be used in severe CO poisoning

oxygen

Carbon monoxide poisoning treatment ____ administration avoid ____ drugs

oxygen respiratory stimulating

Ion trapping to remove toxins changes the ___ of urine, resulting in ionization of weak acids, thus "trapping" them and preventing reabsorption

pH

Odynophagia

painful swallowing

tenesmus

painful, ineffective defecation

salivary gland tumor presentation Painful or painless? Risk factors

painless mass and swelling in the mouth radiation, cancer treatments, smoking, viral infection, industrial exposure

Long standing h. pylori infection can result in a loss of ___ and ___ cells that are replaced with ___ cells in the stomach

parietal and chief goblet (intestinal metaplasia)

Oxynitic Mucosa

parietal and chief cells of the stomach

85% of salivary gland tumors arise in the ___

parotid gland

Once dipeptides and tripeptides are inside the intestinal cell, they are broken down into individual amino acids by cytoplasmic _____

peptidases

CT is diagnostic choice for ___ ulcer disease

perforated

What are the top 3 associated Crohn's symptoms 1. ______ manifestations other than hemorrhoids 2. ____-degree relative with IBD 3. ____ loss

perianal first weight

Clinical presentation of peptic ulcer

periodicity of epigastric pain, sometimes pain is resolved with food

AMAG leads to ____ anemia

pernicious/ megaloblastic anemia

10. Someone with phenylketonuria lack the ___(enzyme)_____ that converts __(AA)___ to __(AA)____. Therefore, for individuals with this disease, __(AA)____ is an essential amino acid, even though it is not an essential nutrient for unaffected individuals.

phenylalanine hydroxylase phenylalanine tyrosine tyrosine

During refeeding following a prolonged starvation, dietary glucose stimulates insulin, which moves _____ into cells for ATP. This causes extremely low levels of ATP for the following ____ hours of refeeding.

phosphorus 12-72

Yersinia can be found in what common farm animal?

pigs

Microsporidia stains _____ color on ______ stain

pink to red trichrome

GIST Gross appearance -Solid, well-circumscribed mass with _____ (color) fleshy cut surfaces in the wall of the stomach -Centered on _____ propria, but may extend to involve mucosa

pink-tan muscularis

What are the names of the drugs used for migraine associated N/V?

pizotyline amitriptyline

Cryptospordium can be transmitted in

pools, daycares

MCT's exit the intestine via the ____

portal vein (not the lymphs like the rest of dietary lipids!)

A "beads on string" appearance of the bile ducts indicates

primary sclerosing cholangitis

Kwashiorkor Disease

protein deficiency with appropriate caloric intake

Therapeutic index TI = TD50/ED50 definition:

refers to the relationship between toxic and therapeutic dosing, therapeutic index of a drug is the ratio of the dose that produces toxicity to the dose that produces a clinically desired or effective response

______ nausea is defined as nausea and/or vomiting that occurs in subsequent chemotherapy cycles despite maximum antiemetic protocol.

refractory

Rumination DSM-5 criteria Repeated _____ of food for ___ month(s) Not related to other GI disorders Not related to other food-related _______ disorders

regurgitation; 1 anorexia nervosum, etc.

Vomiting requires ____ of lower esophageal sphincter, ____ of diaphragm and abd muscles, and __crease heart rate

relaxation; contraction, increased HR

Anxiety and stress can cause nausea/vomiting by release of catecholamines which _____ the stomach, reduces ____ flow, resulting in gastroparesis

relaxes; blood

What is the role of ECL cells in nausea/vomiting?

release 5-HT in response to cytotoxic agents

stomach adenocarcinoma treatment (3)

resection chemo targeted HER2 therapy

Esophageal perforation symptoms

retrosternal pain, dysphagia, fever, severe hypotension

Cholera diarrhea is described as

rice-water stool

Cholera treatment rehydration with IV _______ antibiotics: (2)

ringers lactate single dose doxycycline azithromycin for kids/pregnant

Osmolar gap

sOsm = 2[Na+] + [Glucose/18] + [BUN/2.8] >15 gap is highly suggestive of alcohol poisoning

High magnification shows the bland cytology of a NET/carcinoid. The chromatin texture, with fine and coarse clumps, is frequently described as a "____________" pattern.

salt and pepper

Drug name/target for motion sickness in children >12y/o

scopolamine anti-acetylcholine

<100 cm of terminal ileum resected decreases absoprtion of bile acids but results in _____ diarrhea. Secondarily can cause ____ stones

secretory kidney stones

What causes migraine-associated N/V

serotonin

Celiac disease diagnosis: serum anti-____ or anti-____ biopsy

serum anti-TTG or anti-gliaden

The half-life of naloxone is (shorter/longer) than opioids?

shorter, repeat naloxone doses necessary

What sensory inputs illicit vomiting

sight/smell/pain inner ear movement pharynx gag reflex stomach and small intestine chemoreceptors blood-borne emetics

Diverticulitis CT diagnosis criteria ____ diverticula Thickened colonic wall >___mm Inflammation within _____ fat and/or collection of contrast or fluid

sigmoid >4mm pericolic

Crohn's presents with _____ lesions

skip

Secretory diarrhea is a crypt secretion-driven diarrhea in the ____ part of the intestine

small

GIST Presentation -____ when small -Symptoms due to ___ effect when large, may ulcerate causing bleeding

small mass

Margin of safety MS = TD1/ED99

small is bad

tricyclic antidepressent overdose treatments _______ for pH _______ (ion) for torsades _______ for siezures Avoid ____ antiarrthymics

sodium bicarb Mg2+ diazepam Class IA

What is the main inihibitor of acid secretion in the stomach?

somatostatin

GIST Microscopic - _____ cells more common, but epithelioid cells also possible -Immunohistochemical stains for ____ and DOG1 usually positive

spindled KIT

Boerhaave syndrome

spontaneous esophageal rupture due to forceful vomiting

Characterize clostridium

spore-forming gram positive bacilli

A cancer of the mid esophagus is ____

squamous carcinoma

Esophageal squamous cell carcinoma microscopy appearance squamous epithelium invading _______ variably sized "_____" epithelial cells, ________

squamous epithelium invading submucosa variably sized "nests" epithelial cells, keratinization

Gastrointestinal stromal tumors (GIST) commonly arise in the

stomach

Ondansetron inhibits 5HT receptors in the ____ AND the _____

stomach; CTZ

Celiac disease can be silent until it is triggered by ____

stress

Bulimia nervosa often presents with _______-abuse, including _____ and _____. There is a ___% prevalance of one of concaminant disorders

substance alcohol and stimulants 30%

What are the mucosal protective agents for peptic ulcers? (3)

sucralfate (coats ulcers), pepto bismol (coats ulcers), misoprostol (PGE1 analog)

Sorbitol sources

sugar free candies, apples, pears, peaches

treatment of pregnancy nausea/vommiting

supportive care, dietary measures, safe anti-nausea meds

Scopolamine is used for prophylactic

surgery N/V

esophageal varices: swollen, varicose veins at the ______ end of the esophagus. Usually (painful/painless)

swollen, varicose veins at the lower end of the esophagus. Usually not painful

sympathomimetic overdose symptoms ventricular ____ or fibrillation ____tension ____ dilation siezures, coma, death

tachycardia hypertension pupil

nucleus tractus solitarius is a structure in the medulla that receives input from ____ receptors, can mediate signals from CTZ to vomiting center

taste (but I feel like there were a handful of correct answers here)

Mallory-Weiss syndrome

tear of distal esophagus from retching in alcoholic or bulimic

Pharmacologic Risk is defined as:

the probability that injury will result from exposure to a substance under specified conditions of dose and route of administration

Stomach lymphoma EGD appearance: _____ of the wall of the stomach, ____ mucosa

thickening, nodular

Basal layer of squamous epithelium is (thick/thin)

thin, only a few cells thick

_____ junctions restrict flow of solutes in the intestines

tight

salicylate overdose symptoms include ____ and dizziness, metabolic _____, hyper_____, coma, respiratory failure

tinnitus acidosis hyperpyrexia

Studies of individuals on the National Weight Control Registry, who have successfully lost and maintained a loss of 30 pounds for at least one year, indicate that frequent ___________ is a common behavior among successful weight loss maintainers. They typically exercise ___ minutes or more daily. Body weight monitoring during weight maintenance is thought to be an important way to allow one to quickly respond to a small weight gain.

weighing 60

BMI is calculated by

weight divided by the square of height

IBS abdominal pain should NOT be associated with

weight loss rectal bleeding anemia nocturnal or progressive pain

Stomach Neuroendocrine Tumor are ____ differentiated epithelial neoplasms

well

Trichomonas vaginalis diagnosis is ____ mount, with a characteristic "______" cervix, and detected on fluid ____

wet strawberry PCR

Norovirus is more common in the ___ months

winter

Rotavirus peak season is

winter/spring March

21. The 1980's focused on low fat diets. The first decade of this century focused on low carb diets. There is a current focus on high protein diets. Can you get fat on a high protein diet?

yes

______ is a pseudodiverticulum through Killian's triangle near upper esophageal sphincter.

zenkers diverticulum

Esophageal adenocarcinoma prognosis late-stage

~10-20% 5 year survival

________ in the brush border membrane hydrolyze polysaccharides to monosaccharides

α-glucosidase

fiber is made of _______ bonds

β-glycosidic

Prolonged QT is caused by ____ stimulation and intense sympathetic activation

β1 receptor