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Patho 2 > 2 - GI Patho > Flashcards

2 - GI Patho Flashcards

1
Q

What is achalasia?

A

lower esophageal sphincter fails to relax during swallowing

Food can’t get from the esophagus into the stomach

Caused by denervation of the myenteric plexus in the lower 2/3 of the esophagus

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2
Q

What is megaesophagus?

A

When achalasia is severe, the esophagus becomes distended and can hold up to one liter

food becomes putrid and infected while waiting to pass into the stomach

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3
Q

Loss of stomach secretions in individuals with chronic gastritis leads to ____ and ____

A

achlorhydria

pernicious anemia

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4
Q

What is achlorhydria

A

Stomach fails to secrete hydrochloric acid

A lack of acid also means pepsin is not secreted, and even if it is it isn’t activated into pepsinogen

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5
Q

How much Vitamin B12 is absorbed without intrinsic factor?

A

1/50th of the normal amount!

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6
Q

What is the usual cause of a peptic ulcer?

A

imbalance between rate of gastric secretion and degree of intestinal wall protection

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7
Q

What percentage of people with gastric ulcers have H. Pylori infections?

Why?

A

75%

bacteria burrows its way through the gastric barrier and releases ammonium that liquefies the barrier and stimulates secretion of hydrochloric acid

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8
Q

How long does an H. Pylori infection last?

A

A lifetime

Requires ABX treatment

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9
Q

What are three big modifiable factors that predispose people to peptic ulcers?

A

Smoking

Alcohol

Aspirin and NSAIDs

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10
Q

What are extreme measures that are used to stop ulcerative bleeding?

A

Removing portions of the stomach

Cutting the vagus nerves that supply PS stimulation to the gastric glands

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11
Q

What is the most common cause of pancreatitis?

What is the second?

A

Alcohol

Blockage of the papilla of Vater by a gallstone

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12
Q

What is Sprue?

A

Any disease that causes malabsorption in the SI mucosa

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13
Q

Compare tropical and non-tropical sprue

A

Tropical: caused by some sort of bacteria, but no one is sure which one

Non-tropical: celiac’s etc

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14
Q

What is steatorrhea?

A

Fatty stools

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15
Q

Sprue leads to fatty stools that are almost entirely composed of salts of fatty acids. What does this mean?

A

The problem isn’t in digesting fat. The bile salts are still doing their job, and the fats are still being broken down

they just aren’t being reabsorbed

that’s why sprue is a disease of malabsorption, not digestion

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16
Q

What is one cause of Hirschprung’s Disease?

A

lack of or deficiency of ganglion cells in the myenteric plexus in a segment of the sigmoid colon

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17
Q

How can patients with severed spinal cords control their bowel movements

A

Giving an enema at a specified time of day (in the morning) creates stimuli that will trigger the cord defecation reflex, and they can have a bowel movement

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18
Q

What is antiperistalsis?

A

Peristalsis up the GI tract (vomiting)

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19
Q

In the large intestine, what generates most of the gases?

A

Bacterial action

CO2

Methane

hydrogen

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20
Q

What is anorexia?

A

Lack of desire to eat despite physiologic stimuli that would normally produce hunger

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21
Q

What substances trigger vomiting in the CTZ?

A

Dopamine

Opioids

Ach

Substance P

serotonin

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22
Q

What is projectile vomiting?

A

Not preceded by nausea or retching

caused by direct stimulation of the vomiting center by neurologic lesions

OR

gastric outlet obstruction

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23
Q

What are the three main mechanisms of diarrhea?

A

osmotic

secretory

motility

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24
Q

Small volume diarrhea is usually caused by:

A

inflammatory disorder of the intestines (Crohn’s, UC, microscopic colitis)

Irritation and inflammation causes increased motility

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25
Q

What is motility diarrhea?

A

caused by resection of the SI,

surgical bypass,

fistula formation,

IBS,

diabetic neuropathy

laxative abuse

hyperthyroidism

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26
Q

Compare and contrast parietal and visceral pain

A

parietal pain arises from the peritoneum, visceral pain arises from the organs themselves

parietal is more localized and intense than visceral, which is diffuse and vague

parietal lateralizes and follows dermatomes, visceral may b e referred or nonspecific

parietal pain comes from A delta fibers, visceral comes from polymodal C fibers

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27
Q

Gallbladder pain sometimes is referred to the right shoulder. This is an example of ______ pain

A

visceral

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28
Q

What is a Mallory-Weiss tear?

A

tear at esophageal-gastric junction

caused by severe retching

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29
Q

What drugs put people at risk for GERD?

A

Ones that relax the lower esophageal sphincter:

anticholinergics

nitrates

calcium channel blocker

nicotine

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30
Q

What is eosinophilic esophagitis?

A

rare idiopathic inflammatory disease that causes infiltration of esinophils in the esophagus

manifestations look a little similar to GERD

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31
Q

What is a hiatal hernia?

A

protrusion of the upper stomach through the diaphragm into the thorax

Often asymptomatic except for GERD

Severe symptoms arise if strangulation occurs

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32
Q

Gastroparesis is most commonly associated with:

A

diabetes (form of neuropathy involving the vagal nerve and cells of cajal)

surgical vagotomy

fundoplication

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33
Q

What generally causes acquired pyloric obstruction?

A

PUD or nearby carcinoma

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34
Q

Why is prostaglandin inhibition such a problem for the stomach?

A

Prostaglandin usually stimulate the secretion of mucu and suppress inflammation

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35
Q

What is a curling ulcer?

What is a cushing ulcer?

A

From burns

From brain surgery/injury

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36
Q

What is dumping syndrome?

A

rapid emptying of hypertonic chyme from the fakey stomach into the SI 10-12 min after eating

Since the chyme is so extremely hypertonic, it pulls water into the lumen creating systemic dehydration

Causes rapid distention of the intestines, leading to pain and cramping, N/V

leads to diarrhea

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37
Q

What kinds of meals are ideal to prevent dumping syndrome?

A

frequent, small meals

high in protein

low in carbs

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38
Q

What are the four fat soluble vitamins?

A

A

D

K

E

39
Q

Vitamin A deficiency results in:

A

night blindness

40
Q

Vitamin D deficiency results in:

A

decreased calcium absorption/osteoporosis etc

41
Q

Vitamin K deficiency results in

A

prolonged prothrombin

42
Q

Vitamin E deficiency results in

A

testicular atrophy

neurologic defects in children

43
Q

Conditions that decrease the production or secretion of bile include:

A

advanced liver disease (decreased production)

bile duct obstruction (decreased secretion)

intestinal stasis (permits overgrowth of bacteria that deconjugate bile salts)

resection/disease of the ileum (prevents reabsorption and recycling of bile salts)

44
Q

_________ and _______ are chronic, relapsing idiopath inflammatory bowel disease

A

Ulcerative Colitis

Crohn’s Disease

45
Q

What are the PRIMARY histological differences between UC and Crohn’s?

A

Crohn’s is transmural (full thickness), while UC is mucosal

Crohn’s effects portions of the entire bowel via skip lesions. UC is in the sigmoid colon and rectum

46
Q

What are the most common sites of Crohn’s lesions?

A

ascending and transverse colon

47
Q

What’s the difference between diverticulosis and diverticulitis?

A

Diverticulosis is asymptomatic presence of diverticula

Diverticulitis is inflammatory diverticula

48
Q

Where in the GI tract do diverticuli occur?

A

can occur anywhere

most commonly in the left colon (western countries) and right colon (asian countries)

49
Q

Where do diverticula form?

A

at weak points in the colon wall, where arteries penetrate the tunica muscularis to reach the mucosa

50
Q

How does Laplace’s Law relate to diverticulitis?

A

Consuming a low-fiber diet results in reduced fecal bulk

This means the lumen of the intestines is smaller, which increases wall tension

Pressure can increase enough within the narrow lumen to cause bowel ischemia

51
Q

What is the typical pain associated with appendicitis?

A

Epigastric or periumbilical pain!

The rebound RLQ pain is actually from inflammation of the surrounding tissues (the peritoneum)

52
Q

Why is the small intestine more often the victim of acute mesenteric ischemia than the large?

A

The superior mesenteric artery has a more direct line of flow from the aorta

emboli enter it more readily than they enter the inferior branch, causing ischemia and necrosis of the SI

53
Q

What happens when the intestines lose perfusion?

A

increased motility, N/V, diarrhea, distention

eventually mucosa can’t produce enough mucus to protect itself and start autodigesting

loss of fluid into the bowels

bacteria invade the necrotic intestinal wall, causing gangrene and peritonitis

54
Q

What is normal portal blood pressure?

What is considered HTN?

A

3-5 mmHg

> 5 mmHg

55
Q

What causes portal hypertension?

A

Anything that impedes blood flow through the liver:

Prehepatic (thrombosis/narrowing of portal vein)

Intrahepatic (vascular remodeling, fibrosis, hepatitis etc)

Posthepatic (R sided heart failure)

56
Q

Hepatopulmonary Syndrome (HPS) is associated with:

Portopulmonary Hypertension (PPH) is associated with:

Both are respiratory complications caused by liver disease.

A

pulmonary vasodilation, shunting, and hypoxia

pulmonary vasoconstriction, vascular remodeling

57
Q

What medications are used in preventing variceal bleeding?

A

nonselective beta blockers

58
Q

Name five disease associated with ascites

A
  1. Liver Cirrhosis (most common)
  2. R heart failure
  3. Abdominal malignancies
  4. nephrotic syndrome
  5. malnutrition
59
Q

What are three causes of jaundice?

A
  1. Obstructive (doesn’t pass from liver to intestine)
  2. Hepatocellular (not conjugated in the liver)
  3. Hemolytic (escessive destruction of RBCs)
60
Q

What causes hepatorenal syndrome?

A

arterial vasodilation of the splanchnic vasculature reduces effective blood volume

also, renal vasoconstriction with advanced liver failure and portal hypertension

less fluid, and narrower afferent arteriole = decreased GFR

61
Q

What is the incidence of gallstones in Native Americans?

A

60-70%!!!!!

it’s 15% in white adults

62
Q

list some risk factors for gallstones

A

obesity, but also obese persons who have rapidly lost weight

Middle aged females

using contraceptives

63
Q

What causes gallstones?

A

impaired metabolism of cholesterol, bilirubin, and bile acids

64
Q

What are the three types of gallstones, and how common are they?

A
  1. Cholesterol 70-80%
  2. Pigmented
  3. Mixed
65
Q

Cholesterol gallstones form in bile that is high in ______ and low in ______

A

cholesterol

bile acids and phospholipids

66
Q

Pigmented gallstones are formed from:

A

calcium bilirubinate

fatty acid soaps

these bind with calcium

67
Q

Pigmented gallstones are associated with:

A

biliary stasis

bacterial infections

biliary parasites

68
Q

In obese persons, gallstones are usually caused by______

In nonobese persons, gallstones are usually caused by _____

A

cholesterol over-synthesis

decreased secretion of bile acids

69
Q

When does biliary colic occur?

A

30 minutes after eating a fatty meal

70
Q

What almost always causes cholecystitis?

A

A gallstone in the cystic duct

71
Q

Cholelithiasis is a risk factor for developing _______

A

pancreatitis

72
Q

Why is alcoholism related to pancreatitis?

A

pancreatic acinar cells metabolize ethanol and generate toxic metabolites that injure the acinar cells

Chronic alcoholism can also cause protein plugs in pancreatic duct and Oddi spasms

73
Q

What is the most common cause of chronic pancreatitis?

A

Chronic alcohol abuse and smoking

74
Q

Cleft ____ is more common in males

Cleft ____ is more common in females

A

lip

palate

75
Q

Esophageal atresia is usually accompanied by:

A

a tracheoesophageal fistula

76
Q

Which two syndromes are assoiated with esophageal atresia?

A

CHARGE

VACTERL

77
Q

Increased secretion of ______ during the last trimester increases the incidence of pyloric stenosis

A

gastrin

78
Q

What is the most common cause of intestinal obstruction in infants?

A

Pyloric Stenosis

79
Q

Is pyloric stenosis more common in term or preterm infants?

A

term

80
Q

How long after birth does pyloric stenosis manifest?

A

2-3 weeks after birth

forceful, non-bilious vomiting immediately after feeding

81
Q

In the intestines, an atresia will cuase what?

A

a complete blockage

82
Q

What is the most common congenital anomaly of the small intestine?

A

Intestinal malrotation

83
Q

What is the other name for Hirschsprung disease?

A

Congenital Aganglionic Megacolon

84
Q

What causes Hirschsprungs?

A

absence of PNS ganglia in the meissner and auerbach plexuses of the colon

85
Q

What is the usual manifestation of Hirschsprung?

A

constipation or watery diarrhea 24-72 hours after birth

86
Q

What causes a meconium ileus?

A

Formation of meconium in utero that is abnormally sticky

most common in children with CF d/t abnormal pancreatic enzymes

cause is usually unknown if not d/t CF

87
Q

What is the most common cause of SBO in children?

A

Intussusception

88
Q

Cystic fibrosis is caused by a dysfunction in which transmembrane receptor?

A

CFTR

89
Q

What is the role of the CFTR protein in the epithelium?

A

regulates chloride and sodium ion channels

90
Q

What is Kwashiorkor?

A

edematous malnutrition

usually occurs in infants or children 1-4 years old

high starch, protein deficient diet

91
Q

What is marasmus?

A

starvation from lack of protein and carbs

can occur at any age, but more common in children <1 year

Often caused by early weaning to overdiluted commercial formula

92
Q

Kwashiorkor and Marasmus are collectively referred to as:

A

Protein-Energy Malnutrition (PEM)

93
Q

What is usually the underlying medical condition in infants with FTT?

A

80% of the time there isn’t one

Patho 2 (24 decks)

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