Gastrointestinal Disorders Quiz

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Questions and Answers

Which treatment is specifically indicated for severe cases of acute cholecystitis?

Analgesia

Cholecystectomy

NPO

Cholecystostomy tube (correct)

What is a hallmark manifestation of acute pancreatitis?

Chronic cough

Jaundice

Paralytic ileus (correct)

Hypotension

Which of the following is a primary treatment for chronic pancreatitis?

NPO status

Lifestyle modification (correct)

Cholecystectomy

Surgical resection of the pancreas

What is a common consequence of chronic pancreatitis on pancreatic tissues?

Formation of cysts Signup and view all the answers

What is indicated in the management of acute pancreatitis to alleviate pain?

Demerol Signup and view all the answers

What is a key characteristic of Ogilvie's Syndrome?

Colon distension greater than 8 cm Signup and view all the answers

Which factor is NOT typically associated with Irritable Bowel Syndrome?

Presence of structural abnormalities Signup and view all the answers

What role do Paneth cells play in the intestinal environment?

Synthesize and secrete antimicrobial peptides Signup and view all the answers

Which treatment is commonly utilized for managing symptoms of Irritable Bowel Syndrome?

Selective Serotonin Reuptake Inhibitors for pain control Signup and view all the answers

Which etiology is typically associated with the development of a paralytic ileus?

Intra-abdominal surgery or trauma Signup and view all the answers

What is a common pathophysiological factor in Inflammatory Bowel Diseases?

Impaired barrier function and translocation of bacteria Signup and view all the answers

Which type of cell primarily assists in nutrient absorption in the intestinal epithelium?

Enterocytes Signup and view all the answers

Which symptom is considered a hallmark of Irritable Bowel Syndrome?

Fecal urgency Signup and view all the answers

Which of the following is NOT a cause of constipation?

Increased physical activity Signup and view all the answers

What physical mechanism results from stimulation of the emetic center?

Projectile vomiting Signup and view all the answers

Which symptom is associated with constipation but not exclusively with diarrhea?

Bloating Signup and view all the answers

The condition causing an increase in frequency, volume, and fluid consistency of stool is known as:

Diarrhea Signup and view all the answers

What type of laxative works by drawing fluid into the colon?

Osmotic laxatives Signup and view all the answers

Which medication type is commonly associated with causing constipation as a side effect?

Narcotics Signup and view all the answers

What is a common complication of untreated constipation?

Hemorrhoids Signup and view all the answers

Which center is responsible for the sensation of nausea and the mechanism of vomiting?

Emetic center Signup and view all the answers

Which dietary recommendation is most likely to alleviate symptoms of constipation?

High residue diet Signup and view all the answers

What condition is commonly associated with elevated blood urea nitrogen (BUN)?

Hypovolemia/shock Signup and view all the answers

Which of the following is NOT a cause of upper gastrointestinal bleeding?

Diverticulosis Signup and view all the answers

What does bright red blood per rectum (BRBPR) typically indicate?

Lower gastrointestinal bleed Signup and view all the answers

Which procedure is most appropriate for diagnosing a suspected upper gastrointestinal bleed?

Endoscopy Signup and view all the answers

What is the primary location of ulceration related to H. pylori infection?

Duodenum Signup and view all the answers

Angiodysplasia is characterized by what type of vascular change?

Elastic dilation and thinning of vessel walls Signup and view all the answers

What does melena refer to in gastrointestinal bleeding?

Dark stools containing blood Signup and view all the answers

Which of the following conditions is most likely to cause injury or perforation in the esophagus?

Inflammatory esophagitis Signup and view all the answers

In gastrointestinal bleeding, what imaging procedure is least likely to be helpful in determining the source?

X-ray Signup and view all the answers

What does bowel obstruction result in?

Partial or complete failure of bowel movement Signup and view all the answers

What is the hallmark symptom indicative of encephalopathy in liver dysfunction?

Cognitive deficits and asterixis Signup and view all the answers

What leads to the necrosis of hepatocytes due to acetaminophen overdose?

Depletion of glutathione stores Signup and view all the answers

Which conditions can lead to the progression from compensated to uncompensated cirrhosis?

Alcohol consumption and chronic hepatitis Signup and view all the answers

Which compound is notably produced as a toxic metabolite by acetaminophen through oxidation?

N-acetyl Para benzoquinone (NAPQI) Signup and view all the answers

What initiates the transformation of stellate cells into myofibroblasts in liver cirrhosis?

Secretion of TGF beta growth factor by Kupffer cells Signup and view all the answers

Which factor contributes to vascular shunting in liver cirrhosis?

Development of collateral veins Signup and view all the answers

What is a potential risk for both compensated and uncompensated cirrhosis patients?

Hepatic carcinoma Signup and view all the answers

What is the effect of removing the stimulus causing liver damage before losing 90% of hepatocytes?

It enables regenerative hepatocyte mitosis Signup and view all the answers

What is the recommended maximum daily dose of acetaminophen for an adult?

4,000 mg Signup and view all the answers

Which symptom did Paul experience that indicates a potential liver issue?

Lethargy and confusion Signup and view all the answers

Which factor may have contributed to Paul’s acetaminophen toxicity?

Chronic alcohol use Signup and view all the answers

What could be a potential plan for Paul after his liver function levels normalize?

Gradually reintroduce physical activity Signup and view all the answers

What mechanism of action does acetaminophen have in treating pain?

Inhibits COX enzymes in the central nervous system Signup and view all the answers

What does acute liver failure result from concerning acetaminophen overdose?

Increased production of toxic metabolites Signup and view all the answers

Which of the following might be a critical consult for Paul’s condition?

Hepatology Signup and view all the answers

Study Notes

The Gastrointestinal System

The digestive system is composed of the GI tract and accessory organs
The GI tract is a series of hollow organs from the mouth to the anus.
There are four layers of tissue: mucosa, submucosa, muscularis externa, and serosa
The enteric nervous system controls the motility of the GI tract
Accessory organs include salivary glands, liver, pancreas, and gallbladder

Digestive System Structure

Mouth: site of mastication and mixing of food with saliva
32 permanent teeth
Tongue, hard & soft palate, taste buds
Saliva from salivary glands lubricates food, contains immunoglobulins to fight microbes and amylase to digest starch
Esophagus: hollow muscular tube transporting food bolus from the oropharynx to the stomach. Swallowing occurs in three phases.
Site of primary and secondary peristalsis.

Digestive System Function

Breakdown of large macromolecules into smaller absorbable molecules.
Secretion of enzymes, mucus, and ions by accessory organs directly into the canal.
Motility involves contraction of smooth muscle in the canal wall to crush, mix and propel contents.
Absorption of water, ions, and nutrients across the canal's epithelial wall into blood vessels for systemic circulation.

The Stomach

J-shaped pouch connecting the esophagus to the small intestine
Regions: cardia, fundus, body, and antrum, pylorus
Cardia: the superior portion where the esophagus enters
Fundus: superior, dome-like portion that receives the food bolus, undergoes receptive and adaptive relaxation.
Body: major portion of the J' that contains most of the gastric glands. These glands secrete acid and enzymes.
Antrum: portion connecting the body to the pyloric region.
Pylorus: portion that connects the body to the pyloric region that propels chyme into the duodenum via the pyloric valve.

Salivary Glands

Parotids: secrete watery saliva, lubricates food, contains immunoglobulins to fight microbes, and amylase to digest starches (complex carbohydrates).
Submandibulars: secrete viscous saliva containing glycoprotein, mucin, to lubricates the food bolus.
Sublinguals: secrete a mucin rich saliva that also contains buffering substances.

Small Intestine

Sections: duodenum, jejunum, ileum
Duodenum: receives food bolus from stomach and digestive enzymes from the liver, pancreas, and gallbladder
Jejunum: most functionally significant division, bile salts from liver and gallbladder, pancreatic enzymes complete the digestion of proteins, fats, carbohydrates.
Ileum: absorbs vitamin B12, bile salts, and other nutrients. Undigested matter passed to the large intestine.

Large Intestine

Cecum: collects and begins to compress the ileum contents.
Colon: ascending, transverse, and descending colon remove water and compress waste products into fecal matter in colon.
Sigmoid colon: muscular final portion that moves stool into the rectum
Rectum: holds feces until nervous stimulation leads to expulsion via the anus.

Liver Structure & Function

Large organ in right upper quadrant, four lobes (right, left, quadrate, caudate)
Mechanical filtering, detoxification, synthetic, metabolic, immunologic, storage, and digestive functions
Major digestive role is producing bile and metabolizing nutrients

Liver Digestive Functions

Bile produced in the liver, secreted into the hepatic duct. Passes into duodenum to participate in the metabolism of lipids
All nutrients absorbed from the small intestine are transported to the liver via the portal vein

Pancreas Structure & Function

Slender, elongated organ behind the stomach and adjacent to the duodenum
Divided into head, body, and tail regions.
Pancreatic duct joins common bile duct to empty pancreatic secretions into the duodenum via ampulla of Vater.
Composed of acini (grape-like clusters of acini) and islets of Langerhans (clusters of specialized cells).
Acinar cells secrete digestive enzymes.
Islets of Langerhans synthesize and secrete hormones (insulin, glucagon, somatostatin)

Pancreatic Digestive Enzymes

Proteases: trypsin and chymotrypsin complete protein digestion that began in the stomach (proteases made as inactive proenzymes).
Lipase: digests triglycerides into monoglycerides and free fatty acids (absorbed into bloodstream)
a-amylase: digests starch into disaccharides, trisaccharides, and fragments (secreted mainly by pancreas and salivary glands).

Duodenal Cell Secretions

Bicarbonate is secreted from acinar cells and bicarbonate/water by duct epithelial cells into ductal lumen.
Secretin (hormone secreted by s-cells in duodenal mucosa) is in response to low pH and protein digestion products, increasing bicarbonate/water secretion.

Pancreatic Endocrine Control

Cholecystokinin (CCK): secreted from endocrine cells in the duodenum, in response to fats and partially digested proteins; stimulates acinar cells to stimulate synthesis and secretion of digestive enzymes.
Secretin: secreted from endocrine cells in the duodenum in response to low pH fluid and partially digested protein, stimulates acinar and ductal cells to secrete bicarbonate and water into the ductal lumen to flush pancreatic enzymes.
Gastrin: secreted in large amounts by the stomach in response to distention & irritation; stimulates acid secretion by parietal cells and stimulates acinar cells to secrete digestive enzymes.

Neural Control of Pancreatic Exocrine Secretions

Parasympathetic nerve fibers (vagus nerve) provide low-level stimulation and hormonal secretion in anticipation of a meal.
Sympathetic stimulation inhibits pancreatic secretions.
Hormonal stimulation predominates over the lower-level neural stimulation.

Sphincter of Oddi

Located at the second portion of the duodenum
Smooth circular muscle around the common channel formed by the pancreatic and bile duct.
Rhythmic contractions create a pressure greater than that in the common bile and pancreatic ducts.
Prevents flow of pancreatic juice and bile into the duodenum between meals.
CCK and Motilin stimulate acinar secretion and gallbladder contraction.
Backflow of secretions is prevented in between duodenal contractions when sphincter relaxes to allow flow.

Blood Supply of the GI Tract

Arterial Supply: detailed description of major arteries and blood vessels supplying the GI tract.
Venous Drainage: details about venous drainage of the GI tract.

Abdominal Cavity

Peritoneum : serous membrane surrounding abdominal and pelvic organs, analogous to pericardium and pulmonary pleura. Visceral and parietal layers.
Omentum: intra-abdominal organ of adipose tissue (fat storage and organ protection)
Mesentery: serous fold of peritoneum that lines the abdominal cavity that covers most abdominal organs, providing conduit for lymphatics and blood vessels; Mechanical support and allows for movement of abdominal viscera.

Vomiting

Forceful expulsion of GI contents (usually gastric or proximal small bowel) through the mouth.
Nausea: reduced gastric motility and reverse peristalsis.
Retching: spasmodic respiratory movements with intermittent glottis closure and abdominal muscle and stomach contraction.
Vomiting: Stomach contracts via closed glottis and contraction of diaphragm & abdominal muscles. Opening of esophageal sphincters enables vomiting.
Chemoreceptor Trigger Zone (CTZ): area in medulla oblongata for vomiting stimulus

Emesis Management

Center for vomiting lies in the medulla oblongata which are stimulated by: Chemoreceptor Trigger Zone (blood-borne input), Extra GI Viscera (stones, cardiac ischemia), and Extra Medullary Centers (odors, fears).
Stimulation of the Emetic Center results in physical mechanisms of vomiting (vomiting).
Many antiemetic medications inhibit vomiting by acting on the CTZ.

Constipation

Decrease in frequency or increased difficulty in passing stool causing abdominal distension, possibly obstruction.
Low residue/fiber diets, dehydration, lack of exercise, repeated suppression of urge to defecate, decreased colonic/anal motility, neurologic diseases, narcotics, antacids, pregnancy, aging/pain, IBS, and endocrine disease.

Diarrhea

Increased frequency, volume, and/or consistency of stool.
Osmotic diarrhea (undigested substance drawing excess fluid into bowel).
Secretory diarrhea (mucosal secretion of chloride).
Motility diarrhea (decreased transit time & digestion).

Clostridium Difficile (C.Diff)

Gram-positive bacteria; common cause of antibiotic-associated diarrhea
Produces toxins A & B
Risk factors include antibiotic use, advanced age, proton pump inhibitors, chronic liver/renal disease, malnutrition.
Symptoms range from asymptomatic/watery diarrhea to toxic megacolon/bowel perforations.
Diagnosis: 3 or more loose stools in 24 hours w/o other explanation; C. diff antigen & toxin.
Treatment: oral vancomycin/fidaxomicin, IV metronidazole.

Gastrointestinal Bleeding (GI bleed)

Bleeding within the GI tract (mouth to anus)
Pathophysiology: breakdown of mucosa and exposure of submucosa and vessels to erosive HCL acid.
Manifestations: Hypovolemia, shock, anemia, malnutrition, elevated BUN, aspiration pneumonia.

Upper GI Bleeding

Erosive gastritis, duodenal ulcers, gastric/esophageal varices, Mallory-Weiss tears, tumors, and dental injury/perforation.
BUN greater and elevated over creatinine. Prolonged slow loss of chronic blood in the stool (hematochezia) in presence of melena (dark tarry and foul smelling stool) if acute blood loss has occurred.

Lower GI Bleeding

Causes: polyps, diverticulosis, ulcerative colitis, malignancies, ulcers, hemorrhoids, aorto-enteric fistula.
Symptoms include melena, dark stools containing blood from upper GI bleeding or hematochezia (bright red blood per rectum) from lower GI bleeding.

GI Bleed Diagnosis

Occult blood (slow chronic loss, visible only by testing), CT, MRI, X-ray.
Endoscopy/Colonoscopy. Capsule endoscopy. Bleeding scan. Barium swallow (UPR GI). Barium enema (lower).
Lab tests: CBC, metabolic panel, coagulation studies.

Bowel Obstruction

Results in partial or complete failure of food, gas, and fluids to pass through the small and/or large intestine.
Mechanical etiologies: adhesions, intussusception, tumor, hernia, volvulus
Paralytic ileus: functional bowel obstruction from arrest or loss of peristalsis in portion. Common in abdominal surgery/ trauma, narcotics, hypokalemia, peritonitis, spinal cord injury, pneumonia, neuropathies, and myopathies.

Treatment Algorithm for Bowel Obstruction

Initial steps: aggressively treat underlying conditions, discontinue implicated medications, NG tube for swallowed air, correct hydration/electrolytes.
Neostigmine IV for paralyzed ileus.
Decompression via colonoscopy if possible and repeat as needed.
Surgical therapy (cecostomy or colectomy if perforation/ischemia)

Irritable Bowel Syndrome (IBS)

Characterized by lower abdominal pain, diarrhea, constipation/alternation between both, nausea, bloating, and fecal urgency.
Often associated with anxiety and depression.
Pathophysiology: visceral hyperalgesia, abnormal intestinal permeability, motility, and secretion, post-infectious symptoms, overgrowth of intestinal flora, food allergies, or emotional stress.
Treatment: symptom control via laxatives, diet, probiotics, and antimotility agents, selective serotonin reuptake inhibitors (SSRI's).

Inflammatory Bowel Disease (IBD)

Chronic inflammation of bowel with relapsing and remitting patterns.
Common pathology: intestinal epithelial cells (IEC).
Types include: ulcerative colitis and Crohn's disease

Ulcerative Colitis (UC) vs. Crohn's Disease (CD)

Ulcerative colitis begins in rectum and extends to the colon and affected areas are contiguous. Inflammation is superficial (mucosal).
Crohn's disease can affect any part of the GI tract. Inflammation is patchy throughout the intestinal walls (transmural). Skip lesions or areas of normal bowel within affected areas are common.

Acute Cholecystitis

Inflammation of the gallbladder, often associated with gallstones (bilirubin, cholesterol).
Manifestations: fever, leukocytosis, rebound tenderness, right upper quadrant (RUQ) pain radiating to the right shoulder, colicky pain after eating.

Chronic Cholecystitis

Chronic inflammation of the gallbladder, caused by gallstones.
Manifestations: similar to acute cholecystitis, but chronic.
Treatment: IV fluids, analgesia, NPO, antibiotics, cholecystectomy (surgical removal of the gallbladder)

Acute Pancreatitis

Inflammation of the pancreas, often caused by duct obstruction or acinar cell injury.
Manifestations: pain, fever, leukocytosis, nausea, vomiting, paralytic ileus, SIRS, ARDS, and/or renal failure.
Treatment: analgesia, Demerol, IV fluids, respiratory support, vasopressors, J-tube feeding, surgical resection.

Chronic Pancreatitis

Repeated episodes of acute pancreatitis, often caused by alcohol abuse.
Results in destruction of acinar and islet of Langerhans cells, replaced by fibrous tissue, calcification, and duct obstruction.
Cysts develop as walled-off, necrotic debris, pancreatic juice, and blood accumulate.
Increased risk of diabetes mellitus (DM) and pancreatic cancer.
Treatment: analgesia, pancreatic enzymes, low-fat diet, alcohol cessation, insulin, cyst drainage

Liver Structure

Large organ in the upper right quadrant, divided into four lobes (right, left, quadrate, caudate)
Blood circulation: hepatic artery brings oxygenated blood, portal vein brings blood from digestive tract, hepatic veins drain blood to inferior vena cava.
Internal anatomy includes hepatocytes, biliary system. Portal triad (hepatic artery, portal vein, and bile duct).

Liver Function

Transamination: amino acid metabolism using aminotransferase enzymes (ALT & AST).
Deamination: removes ammonia groups from amino acids.
Protein synthesis: albumin, clotting factors, plasma protein carriers.
Bile production: makes bile salts for lipid emulsion.
Carbohydrate metabolism: glycogenesis (glucose to glycogen), glycogenolysis (glycogen to glucose), gluconeogenesis (pyruvate to glucose).
Lipid metabolism: production of lipids and lipoproteins, phospholipids and cholesterol.

Liver Injury

Acute liver injury: reversible but can lead to large-scale hepatocyte necrosis/acute or fulminant liver failure
Chronic liver injury: irreversible, prolonged injury, leading to intermediate stage of cirrhosis or chronic liver failure.

Acute or Fulminant Liver Failure

Acute loss of hepatocellular function within days/weeks due to necrosis.
Manifestations: jaundice, encephalopathy, coagulopathy.
Treatment: supportive care, identify cause for failure.

Acetaminophen Toxicity

Produces a toxic metabolite NAPQI through oxidation.
The liver also produces glutathione, an antioxidant, to inactivate the metabolite.
Severe OD leads to depletion of glutathione stores, NAPQI accumulation, and hepatocyte necrosis.
Treatment with N-acetylcysteine (NAC) to provide cysteine for glutathione synthesis.

Liver Cirrhosis

Chronic liver disease that progresses to compensated cirrhosis, then decompensated cirrhosis, and on to chronic liver failure.
Causes: chronic hepatitis B/C, alcoholic/non-alcoholic fatty liver disease, Wilson's disease.
Fibrosis involves diffuse scarring.
Complications: portal hypertension, ascites, splenomegaly, varices, infection, jaundice, encephalopathy, renal failure, increased risk of liver cancer.

Chronic Liver Failure Management

MELD score (model for end-stage liver disease) assess severity of liver failure to determine urgency.
Surveillance and monitoring of complications (ascites, varices, hepatic encephalopathy,)
Regular assessment for hepatocellular carcinoma is essential.

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Description

Test your knowledge on gastrointestinal disorders in this quiz, which covers acute cholecystitis, pancreatitis, irritable bowel syndrome, and more. Whether you are a medical student or just interested in understanding digestive health, this quiz is designed to challenge your understanding of key concepts and symptoms.