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¼³»ç¿Í º¯ºñ ´ëÀå°æ Á¤¸®

1. HUS¸¦ ÀÏÀ¸Å°´Â ´ëÇ¥ÀûÀÎ ±Õ 2°¡Áö: Shigella, EHEC(O157:H7)

2. toxigenic bacteria¿¡ ÀÇÇÑ ¼³»ç´Â watery diarrheaÀÌ¸ç ¹ß¿­ÀÌ µ¿¹ÝµÇÁö ¾Ê°í ´ëº¯ÀÇ

¹éÇ÷±¸µµ °üÂûµÇÁö ¾Ê´Â´Ù.

3. ´ëº¯¿¡¼­ mononuclear leukocyte°¡ º¸À̰í, enteric fever(¼³»ç, ¹ß¿­)¸¦ ÀÏÀ¸Å°´Â

±Õ 2°¡Áö : S. typhi, Yersinia enterocolitica

4. fecal osmolar gap = ÃøÁ¤ - °è»ê osmolality

= ÃøÁ¤ - [Na + K] ¡¿ 2

>50 mosm/L : osmotic diarrhea

5. pseudodiarrhea°¡ ÀϾ ¼ö ÀÖ´Â Áúȯ 3°¡Áö: IBS, proctitis, hyperthyroidism

6. ¼ÒÈ­±â Áúȯ¿¡¼­ octreotide°¡ »ç¿ëµÉ¼ö ÀÖ´Â °æ¿ì

1) GI bleeding: varix, portal hypertensive gastropathy

2) hormone secreting tumor: carcinoid tumor, VIPoma, insulinoma, glucagonoma,

gastrinoma

3) dumping syndrome

4) fistula: pancreatic, enteric, Crohn's disease

5) diarrhea: short-bowel syndrome, ileostomy, diabetic neuropathy, AIDS

7. secretory diarrheaÁß cAMP¿Í °ü·ÃÀִ°ä

1) enterotoxin-producing bacteria(V. cholera, E. coli)

2) methyxanthine(caffeine, theophylline)

3) PG, VIP, dihydroxy bile acid

8. º¯ºñȯÀÚ¿¡¼­ ½ÃÇàÇÏ´Â °Ë»çÁ¾¸ñ

colonoscopy or barium enema, colon transit time, anorectal manometry, defecography

9. bacterial food poisoningÁß 1-6½Ã°£ incubation

S. aureus, Bacillus cereus

10. melanosis coli: lipofuscin pigment°¡ lamina propria³ª muscularis mucosa¿¡

anthracene laxative»ç¿ë ½ÃÀÛÈÄ 4°³¿ù Á¤µµ¸é ¹ß»ý°¡´ÉÇÏ°í ²÷ÀºµÚ 4-12°³¿ù³»¿¡

»ç¶óÁø´Ù.

cf. diphenolic laxative(phenolphthalein, bisacodyl)´Â ÀÏÀ¸Å°Áö ¾ÊÀ½

11. nontyphoidal salmonellosis¿¡¼­ Ç×»ýÁ¦ Åõ¿©°¡ ÇÊ¿äÇÑ °æ¿ì

i) immunosuppressive disease: lymphoma¿Í °°Àº malignancy, AIDS, sickle cell disease

ii) glucocorticoid¿Í °°Àº ¸é¿ª¾ïÁ¦Á¦ Åõ¿©

12. µ¶¼Ò

µ¶¹ö¼¸ - amatoxin, º¹¾î - tetrodotoxin, amnesic shellfish - domoic acid

diarrheal shellfish - okadaic acid & pectenotoxin

13. PMC¸¦ Àß ÀÏÀ¸Å°´Â Ç×»ýÁ¦: cephalosporin, penicillin, clindamycin

PMC¸¦ Àß ÀÏÀ¸Å°Áö ¾Ê´Â Ç×»ýÁ¦: vancomycin, aminoglycoside

14. PMC´Â ´ëºÎºÐ Ç×»ýÁ¦¸¦ Åõ¿©ÇÑÁö 4-10ÀÏÈÄ¿¡ ¹ß»ýÇÏÁö¸¸ ¿øÀξàÁ¦¸¦ ²÷°í 6ÁÖ±îÁöµµ

»ý±æ¼ö ÀÖ´Ù.

15. PMC Ä¡·á: metronidazole PO or IV, vancomycin PO

Àç¹ß : 15-30%

16. radiation colitis·Î ÀÎÇÑ rectal bleedingÀÇ medical tx

i) endoscopic cauterization with Nd:YAG laser

ii) bipolar electrocoagulation

iii) rectal irrigation with formalin solution

17. cholera¿¡¼­ ¿©·¯ virulence geneÀÇ Ç¥Çö¿¡ °ü¿©ÇÏ´Â gene: tox R gene

18. choleraÀÇ Áø´Ü: dark field microscopy/stool culture(TCBS media)

19. El tor cholera

°íÀüÇüº¸´Ù ȯ°æ¿äÀο¡ ´õ ÀúÇ×·ÂÀÌ ÀÖ°í ÀüÆÄ¼Óµµ°¡ ´õ ºü¸£´Ù.

20. intestinal amebiasis¶§ PMNÀº °ÅÀÇ º¸ÀÌÁö ¾Ê´Â´Ù.

21. IBS Áø´Ü¿¡ À־ ²À ÇÊ¿äÇÑ ÀÓ»óÁõ»ó

abdominal discomfort or pain

22. IBS¿ÜÀÇ ´Ù¸¥ ¿øÀÎÀ» »ý°¢ÇØ¾ß ÇÒ Áõ»ó

blood in stool, wt loss, fever, ¼ö¸é½Ã ÅëÁõ ¶Ç´Â ¼³»ç

23. IBSÀÇ ´ëÀå¿îµ¿

- Á¤»óÀο¡¼­´Â high-amplitude peristaltic contraction ÀÌ ÇÏ·ç¿¡ 6-8ȸ °üÂûµÈ´Ù.

- high amplitude peristaltic contractionÀº ¹èº¯½Ã ÈçÈ÷ °üÂûµÈ´Ù.

- Á¤»óÀο¡¼­´Â ½ÄÈÄ Áõ°¡µÈ ´ëÀå¿îµ¿ÀÌ 50ºÐ À̳»·Î Á¡Â÷ »ç¶óÁø´Ù.

- IBS¿¡¼­´Â ½ÄÈÄ ´ëÀå¿îµ¿ÀÌ delayed peak¸¦ º¸ÀδÙ(½ÄÈÄ¿£ °¨¼Ò).

24. diarrhea & painÀÌ µ¿¹ÝµÈ IBSÀÇ Ä¡·á: alosetron(5-HT3 antagonist), TCA

25. colon transitÀ» °áÁ¤ÇÏ´Â °ÍÀº pressure gradientÀÌ´Ù.

proximal descending colon°ú splenic flexure´Â ³»¿ë¹°À» ¼¯´Â ¿ªÇÒÀ» Çϰí,

T-colonÀº ÀúÀåÀÌ ÁÖ·Î ÀϾ´Ù.

26. rapid colon transitÀ» º¸ÀÌ´Â Áúȯ

functional diarrhea, bile salt diarrhea, surreptitious abuse of laxative

27. functional abdominal painÀÇ 3°¡Áö type

IBS, non-ulcer dyspepsia(ulcer-like type), chronic intractable abdominal pain

28. cisapride¿Í º´¿ë½Ã ½É°¢ÇÑ QT prolongationÀ» ÀÏÀ¸Å°´Â ¾àÁ¦

1) QT prolongationÀ» ÀÏÀ¸Å°´Â ¾àÁ¦¿Í º´¿ë½Ã

IA(quinidine, disopyramide, procainamide), III(amiodarone, sotalol)

TCA, phnothiazine

2) erythromycin(clarithromycin), antifungal agent

29. À§Àå°üÀÇ ¿©·¯ºÎÀ§¿¡ Á¸ÀçÇÏ¸ç ¿îµ¿À» Á¶ÀýÇÏ´Â pacemaker·Î spontaneously active

cell·Î ÀÛ¿ëÇÏ´Â ¼¼Æ÷ÀÇ À̸§? Interstitial cell of Cajal

ÀÌ ¼¼·ÎÀÇ Á¸À縦 ¾Ë°Ô ÇØ ÁÖ´Â À¯ÀüÀÚ·Î tyrosine kinase receptor¸¦ codeÇÏ´Â

proto-oncogene˼? proto-oncogene c-kit

30. Àå¿îµ¿¿¡ °ü¿©ÇÏ´Â brain stem³»ÀÇ nucleus 2°¡Áö

: NTS(nucleus tractus solitarius), DMN(dorsal motor nucleus)

»ó±â nucleus¿¡¼­ inputÀ» ¹Þ´Â afferent neuronÀÇ ½Å°æÀý À̸§? prevertebral ganglion

31. rectal prolapseÀÇ ÈçÇÑ ¿øÀÎÀº aging process¶§¹®ÀÌ¸ç °Ë»ç·Î´Â Á÷Àå°æ°ú B.E°¡ ÇÊ¿ä

ÇÏ´Ù. Ç×¹®ÀÇ Àü¹æ¿¡¼­ ÃËÁöµÇ¸ç ¼ö¼úÀû Ä¡·á(excision or fixation procedure)°¡

ÇÊ¿äÇÏ´Ù.