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Questions and Answers
A patient presents with right upper quadrant pain, pale yellow skin, and caviar-like gallstones found during imaging. Which of the following most likely contributes to the formation of these gallstones?
A patient presents with right upper quadrant pain, pale yellow skin, and caviar-like gallstones found during imaging. Which of the following most likely contributes to the formation of these gallstones?
- Decreased gallbladder motility due to estrogen. (correct)
- Increased production of urobilinogen.
- Elevated levels of pancreatic lipase.
- Rapid emptying of the gallbladder.
A patient with a history of gallstones presents with clay-colored stools. This symptom suggests a blockage in which location?
A patient with a history of gallstones presents with clay-colored stools. This symptom suggests a blockage in which location?
- Common bile duct, preventing bile from reaching the duodenum. (correct)
- Hepatic duct, impairing bile production in the liver.
- Pancreatic duct, obstructing pancreatic enzyme secretion.
- Cystic duct, preventing bile flow from the gallbladder.
Which of the following is the MOST likely initial treatment goal for a patient presenting with acute pancreatitis?
Which of the following is the MOST likely initial treatment goal for a patient presenting with acute pancreatitis?
- Providing pancreatic enzyme supplements.
- Initiating a high-fat diet to stimulate pancreatic function.
- Administering antibiotics to prevent infection.
- Hemodynamic stabilization to address potential shock. (correct)
A patient with chronic pancreatitis is evaluated. Which lab finding would MOST strongly support this diagnosis?
A patient with chronic pancreatitis is evaluated. Which lab finding would MOST strongly support this diagnosis?
A patient diagnosed with Primary Sclerosing Cholangitis (PSC) should be evaluated for which of the following co-existing conditions?
A patient diagnosed with Primary Sclerosing Cholangitis (PSC) should be evaluated for which of the following co-existing conditions?
A patient presents with difficulty swallowing and is diagnosed with a fistula connecting the esophagus and trachea. What is the primary concern associated with this condition?
A patient presents with difficulty swallowing and is diagnosed with a fistula connecting the esophagus and trachea. What is the primary concern associated with this condition?
A patient is diagnosed with achalasia. Which physiological process is most directly affected by this condition?
A patient is diagnosed with achalasia. Which physiological process is most directly affected by this condition?
A patient is diagnosed with a Type 1 hiatal hernia. What is the key characteristic of this type of hernia?
A patient is diagnosed with a Type 1 hiatal hernia. What is the key characteristic of this type of hernia?
A patient presents with severe heart burn and is diagnosed with a hiatal hernia. An endoscopy reveals that the upper part of the stomach has protruded through the esophageal hiatus, but the gastroesophageal junction remains in its normal anatomical location. Which type of hiatal hernia is the patient most likely experiencing?
A patient presents with severe heart burn and is diagnosed with a hiatal hernia. An endoscopy reveals that the upper part of the stomach has protruded through the esophageal hiatus, but the gastroesophageal junction remains in its normal anatomical location. Which type of hiatal hernia is the patient most likely experiencing?
A patient reports experiencing pain in the left upper quadrant (LUQ). Which condition is most likely associated with this symptom?
A patient reports experiencing pain in the left upper quadrant (LUQ). Which condition is most likely associated with this symptom?
An infant presents with persistent projectile vomiting. Diagnostic imaging reveals a thickened pyloric sphincter obstructing the passage of food from the stomach to the duodenum. Which condition is most likely the cause of these symptoms?
An infant presents with persistent projectile vomiting. Diagnostic imaging reveals a thickened pyloric sphincter obstructing the passage of food from the stomach to the duodenum. Which condition is most likely the cause of these symptoms?
A patient is diagnosed with a peptic ulcer caused by H. pylori. What enzymatic activity of H. pylori contributes to its survival in the stomach's acidic environment?
A patient is diagnosed with a peptic ulcer caused by H. pylori. What enzymatic activity of H. pylori contributes to its survival in the stomach's acidic environment?
A patient is diagnosed with an H. pylori infection. The patient has a known penicillin allergy. Which combination of medications would be most appropriate for treating this patient's infection?
A patient is diagnosed with an H. pylori infection. The patient has a known penicillin allergy. Which combination of medications would be most appropriate for treating this patient's infection?
A patient with cirrhosis develops splenomegaly. Which of the following mechanisms is the MOST direct cause of this condition?
A patient with cirrhosis develops splenomegaly. Which of the following mechanisms is the MOST direct cause of this condition?
A patient with cirrhosis is prescribed lactulose. What is the MOST likely rationale for this medication order?
A patient with cirrhosis is prescribed lactulose. What is the MOST likely rationale for this medication order?
A male patient with cirrhosis develops gynecomastia. Which of the following BEST explains the pathophysiology behind this condition?
A male patient with cirrhosis develops gynecomastia. Which of the following BEST explains the pathophysiology behind this condition?
A patient with a history of alcohol abuse is admitted with hematemesis and diagnosed with esophageal varices. What is the MOST immediate life-threatening risk associated with esophageal varices?
A patient with a history of alcohol abuse is admitted with hematemesis and diagnosed with esophageal varices. What is the MOST immediate life-threatening risk associated with esophageal varices?
Which of the following is NOT typically a direct cause of cirrhosis?
Which of the following is NOT typically a direct cause of cirrhosis?
What is the primary physiological mechanism behind dumping syndrome following a gastric bypass procedure?
What is the primary physiological mechanism behind dumping syndrome following a gastric bypass procedure?
Why is the consumption of sugar on an empty stomach particularly problematic for individuals experiencing dumping syndrome?
Why is the consumption of sugar on an empty stomach particularly problematic for individuals experiencing dumping syndrome?
Which of the following is a key characteristic of Irritable Bowel Syndrome (IBS)?
Which of the following is a key characteristic of Irritable Bowel Syndrome (IBS)?
Which factor is thought to play a significant role in the pathophysiology of Irritable Bowel Syndrome (IBS)?
Which factor is thought to play a significant role in the pathophysiology of Irritable Bowel Syndrome (IBS)?
What is the primary risk associated with a volvulus?
What is the primary risk associated with a volvulus?
In the context of Inflammatory Bowel Disease (IBD), what is a fistula, and why is it a significant complication?
In the context of Inflammatory Bowel Disease (IBD), what is a fistula, and why is it a significant complication?
What is a key differentiating factor between Crohn's disease and ulcerative colitis in terms of the location and nature of inflammation?
What is a key differentiating factor between Crohn's disease and ulcerative colitis in terms of the location and nature of inflammation?
What is the potential consequence of a rectovaginal fistula in a female patient with Crohn's disease?
What is the potential consequence of a rectovaginal fistula in a female patient with Crohn's disease?
In Celiac disease, what is the primary target of the antibodies produced by the body?
In Celiac disease, what is the primary target of the antibodies produced by the body?
What is the primary consequence of villi deterioration in the intestinal lumen due to Celiac disease?
What is the primary consequence of villi deterioration in the intestinal lumen due to Celiac disease?
A patient is suspected of having Celiac disease but has a low IgA level. Which of the following tests would be MOST appropriate as a first-line screening test?
A patient is suspected of having Celiac disease but has a low IgA level. Which of the following tests would be MOST appropriate as a first-line screening test?
Why are individuals with IgA deficiency more susceptible to infections?
Why are individuals with IgA deficiency more susceptible to infections?
Which of the following is LEAST likely to cause acute appendicitis?
Which of the following is LEAST likely to cause acute appendicitis?
A 67-year-old male on warfarin presents with bloody emesis and black stools. Which lab value most directly explains these symptoms?
A 67-year-old male on warfarin presents with bloody emesis and black stools. Which lab value most directly explains these symptoms?
A 67-year-old male with osteoarthritis and atrial fibrillation on warfarin presents with bloody emesis, black stools, and decreased urination. Which medication is MOST likely contributing to his current gastrointestinal issue?
A 67-year-old male with osteoarthritis and atrial fibrillation on warfarin presents with bloody emesis, black stools, and decreased urination. Which medication is MOST likely contributing to his current gastrointestinal issue?
Based on the lab results provided for a 67-year-old male, which result indicates potential kidney dysfunction?
Based on the lab results provided for a 67-year-old male, which result indicates potential kidney dysfunction?
A client presents with orthostatic hypotension, bloody stools, and a history of regular naproxen and warfarin use. Which of the following is the MOST likely underlying cause of the orthostasis?
A client presents with orthostatic hypotension, bloody stools, and a history of regular naproxen and warfarin use. Which of the following is the MOST likely underlying cause of the orthostasis?
A client with a suspected upper GI bleed has an elevated urea level. Which statement BEST explains the relationship between GI bleeding, decreased kidney perfusion, and elevated urea?
A client with a suspected upper GI bleed has an elevated urea level. Which statement BEST explains the relationship between GI bleeding, decreased kidney perfusion, and elevated urea?
A patient is being treated for a GI bleed related to NSAID use and warfarin. After discontinuing warfarin and naproxen, which intervention is MOST important for immediate stabilization?
A patient is being treated for a GI bleed related to NSAID use and warfarin. After discontinuing warfarin and naproxen, which intervention is MOST important for immediate stabilization?
During the management of a patient with a significant upper GI bleed, at what hemoglobin (Hb) level would a blood transfusion be MOST clearly indicated, assuming the patient is also symptomatic for anemia?
During the management of a patient with a significant upper GI bleed, at what hemoglobin (Hb) level would a blood transfusion be MOST clearly indicated, assuming the patient is also symptomatic for anemia?
Which of the following is NOT typically considered a risk factor for developing cholelithiasis?
Which of the following is NOT typically considered a risk factor for developing cholelithiasis?
A patient experiencing biliary colic from cholelithiasis would MOST likely report pain in which location, with potential radiation to which area?
A patient experiencing biliary colic from cholelithiasis would MOST likely report pain in which location, with potential radiation to which area?
In managing a patient with cholecystitis, what is the PRIMARY goal of using an NG tube with intermittent suctioning?
In managing a patient with cholecystitis, what is the PRIMARY goal of using an NG tube with intermittent suctioning?
Which type of gallstone has the STRONGEST association with chronic hemolytic conditions?
Which type of gallstone has the STRONGEST association with chronic hemolytic conditions?
Flashcards
Gallstones
Gallstones
Solid particles in the gallbladder formed from bile components, often cholesterol.
Acute Pancreatitis
Acute Pancreatitis
Sudden inflammation of the pancreas, often triggered by gallstones, alcohol, or high fat diet.
Chronic Pancreatitis
Chronic Pancreatitis
Long-term inflammation of the pancreas leading to scarring and enzyme dysfunction.
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Endoscopic Retrograde Cholangiopancreatography (ERCP)
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Cirrhosis
Cirrhosis
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Dumping Syndrome
Dumping Syndrome
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Irritable Bowel Syndrome (IBS)
Irritable Bowel Syndrome (IBS)
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Vagus Nerve Role
Vagus Nerve Role
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Splenic Flexure Syndrome
Splenic Flexure Syndrome
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Intestinal Obstruction
Intestinal Obstruction
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Inguinal Hernia
Inguinal Hernia
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Crohn's Disease
Crohn's Disease
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Ulcerative Colitis
Ulcerative Colitis
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Dysphagia
Dysphagia
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Achalasia
Achalasia
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Hiatal Hernia
Hiatal Hernia
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Type 1 Hiatal Hernia
Type 1 Hiatal Hernia
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Gastritis
Gastritis
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Pyloric Stenosis
Pyloric Stenosis
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H. Pylori Transmission
H. Pylori Transmission
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Triple Therapy for H. Pylori
Triple Therapy for H. Pylori
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Portal Circulation
Portal Circulation
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Celiac Disease
Celiac Disease
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Gliadin
Gliadin
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Tissue Transglutaminase (TTG)
Tissue Transglutaminase (TTG)
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Esophageal Varices
Esophageal Varices
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IgA deficiency
IgA deficiency
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Hepatic Encephalopathy
Hepatic Encephalopathy
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Acute Appendicitis
Acute Appendicitis
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Asterixis
Asterixis
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Fecalith
Fecalith
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Hematocrit (Hct)
Hematocrit (Hct)
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INR
INR
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Peptic Ulcer
Peptic Ulcer
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Orthostasis
Orthostasis
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Melena
Melena
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Cholelithiasis
Cholelithiasis
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Biliary Sludge
Biliary Sludge
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Cholecystitis
Cholecystitis
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Biliary Colic
Biliary Colic
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Cholecystectomy
Cholecystectomy
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Study Notes
GI Tract Disorders
- Dysphagia: Difficulty swallowing
- Esophagus connects to the trachea; fistula is an abnormal connection
- Food should not be stuck in the diverticulum (pouch) as this can lead to necrosis
- Peristalsis are muscle contractions for moving food; a lack of it is achalasia
- Tumours in this area can show up as esophageal or lung cancer
Hiatal Hernias
- Hernia: a protrusion/bump of an organ into an area it is not supposed to be
- Lower esophageal sphincter is crucial
- Type 1: the stomach slides above the diaphragm (most common type)
- Type 2: the stomach is thrust above the diaphragm (less common)
- Symptoms include heartburn, acid reflux (pyrosis), and an increased risk of esophageal cancer
Gastric Disorders
-
Gastritis: inflammation of the stomach lining, symptoms include pain in the upper left quadrant (LUQ) caused by spicy food, alcohol, and medications
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Pyloric Stenosis: narrowing of the opening between the stomach and duodenum; the thickened sphincter prevents food passage, causing vomiting and/or decomposition of food material stuck in the stomach.
-
Peptic Ulcers: ulcers in the stomach or duodenum caused by H. pylori or overuse of NSAIDs (ibuprofen, naproxen)
Pathogenesis of H. Pylori
- H. Pylori is transmitted through gastro-oral route
- Bacteria produce urease for neutralizing stomach acid converting urea into ammonia.
- Associated conditions include gastritis, peptic ulcer disease, gastric adenocarcinoma, and lymphoma
- Diagnosis via Urea breath test (presence of carbon 13) or Stool sample (easier for children)
Dumping Syndrome
- Gastric Bypass: surgery for obesity
- Symptoms: severe diarrhea (high risk of dehydration), high volume of water and electrolytes, NO SUGAR (sugar is a water magnet) on an empty stomach after the procedure.
IBS
- Irritable Bowel Syndrome
- Sporadic, abnormal bowel contractions
- Vagus nerve controls the bowel
- Often causes pain or discomfort relieved by bowel movements
- Factors include stress, gut microbiome imbalances, antibiotics, food sensitivities, and serotonin imbalance.
- Can include splenic flexure syndrome, where increased pressure is present.
Intestinal Obstructions
- Inguinal Hernia: small intestine protrudes through the abdominal wall.
- Volvulus: twisting of the intestine
- Intussusception: one part of the intestine slides into another
- Internal Tumour: intestinal cancer
- Diverticulitis: inflammation of the diverticulum (pouch).
IBD
- Inflammatory Bowel Disease: suspected autoimmune disease; triggered by gut microbiome
- Crohn's disease: lesions cause one part of the colon to connect to another causing a megacolon (must be surgically repaired to avoid septic shock) Possible complications include fistula formation (between the bowel and vagina for females or bladder in males), leading to fecal leakage through the affected area.
- Ulcerative Colitis: continuous inflammation in the large intestine leads to urgency, fatigue, increased bowel movements, and mucous/blood in stool.
Celiac Disease
- Celiac disease: autoimmune disease with gluten as a trigger.
- Gluten binds to gliadin and then to tissue transglutaminase creating antibodies. These antibodies attack tissue transglutaminase and gliadin causing villus deterioration. leading to malnutrition and weight loss (malabsorption of nutrients)
- Diagnosis via blood tests such as IgA levels.
Acute Appendicitis
- Periumbilical pain that increases in severity and localizes as the inflamed appendix becomes distended/larger.
- Deep tenderness in the right lower quadrant (LRQ)
- Possible rupture: pain decreases temporarily, contents enter peritoneal cavity; leading to peritonitis.
- Triggered by fecal stones, other infections, or neoplasms.
Case Study of Patient with GI-Renal Connection
- Patient: 67-year old man with osteoarthritis taking naproxen.
- Symptoms: vomiting blood (hematemesis), black stool (melena), and decreased urination.
- Medical History: Atrial fibrillation and Warfarin.
- Lab Values: Low Hct, Hb, elevated INR (2.9), elevated Urea (14 mmol/L) and elevated Creatinine.
- Pathophysiology: Possible peptic ulcer (due to naproxen) causing upper GI bleeding, decreased renal perfusion due to blood loss and/or warfarin side effects.
Cholelithiasis
- Gallstones (risk factors include: fair-skinned females, Indigenous people, oral contraceptives (estrogen and progesterone)), causing bile sludge.
- Cholecystitis: inflammation of the gallbladder.
- Gallstones can be cholesterol or pigment based and can get stuck in the cystic duct or common bile duct leading to blocked bile flow and potential stercobilin disruption in liver functions, and excretion to produce the clay-colored stool. The stones can also affect the pancreatic duct causing further digestive or pain issues
Acute Pancreatitis
- Inflammation of the pancreas triggered by activation of pancreatic enzymes, mostly from autodigestion (trypsin, peptidase, elastase, amylase, lipase)
- Symptoms: Severe abdominal pain, often radiating to the back, nausea, vomiting
- Enzyme leaks into the circulation can cause complications such as vasodilation, neurogenic shock, DIC (disseminated intravascular coagulation), septic shock, peritonitis
- Treat with hemodynamic stabilization (treat symptoms to support vitals)
Chronic Pancreatitis
- Long-term inflammation of the pancreas leading to scar tissue (fibrosis)
- Symptoms include abdominal pain, nausea, vomiting, weight loss, malabsorption of nutrients, steatorrhea (fat in stool)
- Possible causes include alcohol abuse, smoking, gallstones, recurring acute pancreatitis, autoimmune pancreatitis, and cystic fibrosis
Cirrhosis
- Fibrosis (scarring) of the liver from chronic liver injury
- Can be caused by toxins, infections, or autoimmune diseases and other predispositions/genetics.
- Dysfunction associated with liver insufficiency due to compromised liver cells and architecture leading to issues with hepatic vasculature and other functions (bile production, detoxification, nutrient conversion, hormone production)
Portal Circulation
- Liver circulation, scar tissue obstruction to blood flow and high portal pressure.
- Portal hypertension causes: esophageal varices (bulging veins), short gastric veins, splenomegaly, and hemorrhoids.
- High pressure leads to esophageal varices (potential for rupture and bleeding), which may require surgical intervention, and potential for infection.
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