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. ¼Òȱâ 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¿¡ ÀÖ¾î¼ 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.