8 - GI Tract, Liver, Biliary Tract and Pancreas Flashcards
What is the most common craniofacial malformation of the newborn?
Cleft lip and/or palate
The etiology of cleft lip is multifactorial. What can contribute to it?
- Genetic factors
- Environmental factors
What is the most well-known cleft lip/palate syndrome? What causes it?
DiGeorge Syndrome
22q11 deletion
5 Risk factors of dental carries?
- poor oral hygiene
- anything that promotes plaque formation
- sugar
- lack of saliva
- possibly genetics
What is pulpitis
Painful cavities because erosion is so bad it reaches the pulp, which is the innermost layer of the tooth where the nerves are
What is periodontitis and what three things does it cause
Severe gingivitis
- tooth falls out
- bad breath
- infections spreads to jaw bone
What is stomatitis?
Inflamed/sore mouth
What is the difference between aphthous stomatitis and infectious stomatitis?
Aphthous = canker sores
- unknown cause
Infectious = herpes “cold sore”
- cause = candida fungus
Name two immune system diseases that can result from stomatitis
Behcet syndrome
Inflammatory Bowel disease
What is the main type of oral cavity neoplasm? What are the two main causes? What are 3 other causes?
Squamous cell carcinoma/squamous dysplasia
- alcohol and tobacco
- HPV
- therapeutic radiation
- immunosuppression
- UV exposure on lips
What is the term for persistent white patch and persistent red patch? What are they both associated with etiologically?
leukoplakia
erythroplakia
alcohol and tobacco
Treatment of oral cavity neoplasms?
surgical resectioning and radiation therapy
What are two infectious and three non-infectious causes of sialadenitis?
Infectious:
1. bacteria (S. aureus)
2. virus (mumps)
Non-infectious:
1. autoimmune (Sjogren syndrome)
2. stones in salivary glands (Sialolithiasis)
3. therapeutic radiation
Name a benign and malignant oral sialadenitis neoplasm
Benign: pleomorphic adenoma
Malignant: mucoepidermoid carcinoma
What is a hiatus hernia? What is a sliding hernia and paraesophageal hernia?
Hiatus: when part of stomach protrudes out from diaphragm. Two exampels are sliding and paraesophageal hernia
Sliding: ‘sliding’ of gastroesophageal junction and cardia out of the stomach
Paraesophageal: part of stomach protrudes upwards and forms a pocket besides the esophagus
What is achalasia?
degeneration of ganglion cells in myenteric plexus causes LES to contract, leading to dysphagia (difficulty swallowing) and food build up in esophagus
Primary and secondary causes of achalasia?
Primary: unknown
Secondary: parasitic infections (T. cruzi aka Chagas disease), or diseases that infiltrate esophagus (amyloidosis, sarcoidosis)
What is varicies? Common cause? Treatment?
Varicies: dilation of submuscoal veinsin the esophagus -> rupture -> life-threatening bleeding
Common cause: hepatic cirrhosis (portal HTN)
Treatment: banding, medications, liver transplant
What is one main example of esophagitis? What are some risk factors?
Gastroesophageal Reflux Disease (GERD)
- reflux of gastric contents into esophagus
- due to pressure buildup in stomach and insufficient LES tone
- risk factors: alcohol, drugs, pregnant, obese, xs caffeine
What are 4 other causes of esophagitis besides GERD?
- infectious: virus (HSV), candida
- ingestion of irritating substance
- allergies and inflammation
- autoimmune diseases
What exactly is Barrett esophagus and how can it go from bad to worse?
Complication of GERD
Squamous mucosa -> columnar mucosa (intestinal metaplasia) -> dysplasia -> esophageal adenocarcinoma
4 signs and symptoms of malignant esophageal neoplasms?
- occult GI bleeding (anemia)
- Unintentional weight loss
- dysphagia (difficulty swallowing)
- odynophagia (painful swallowing)
What is gastropathy?
Injury to stomach lining without inflammation, but can be severe enough to cause stomach lining erosion or ulceration
3 causes of gastropathy?
Causes:
- chemical injury (alcohol, NSAIDs)
- vascular injury (ischemia, portal HTN)
- physiological injury: trauma, burn, sepsis
Difference btwn acute and chronic gastritis? Talk about type of WBC present and causes.
Acute
- neutrophils present
- drugs, alcohol, severe physiologic stress
Chronic
- lymphocytes present
- autoimmune conditions, H. pylori
What is peptic ulcer diseaes?
ulceration of gastric or duodenal mucosal lining from either acute or chronic gastritis
3 risk factors of peptic ulcer disease? 4 complications?
Risk Factors:
1. H. pylori
2. reduced mucosal barrier
3. drugs
Complications:
1. hemorrhaging
2. perforation -> peritonitis
3. penetration into the pancreas
4. scarring
How does H. pylori cause gastritis? What are some symptoms of helicobacter gastritis? What happens if left untreated?
Gram-neg bacteria hides in mucosal lining to avoid stomach acid and releases urease
Usually asymptomatic but can cause abdominal discomfort (dyspepsia)
Can lead to MALT lymphoma, mucosal atrophy, and intestinal metaplasia
What are the functions of parietal, chief, and G cells in normal gastric function?
Parietal: releases HCl for stomach acid and intrinsic factors for B12 absorption
Chief: release pepsinogen which digests protein
G: releases gastrin which tells parietal to make more HCl
What happens to the three gastric function cells during autoimmune gastritis?
Parietal cells and chief cells get destroyed. Lack of HCl causes G cells to produce more gastrin.
What are the three consequences to autoimmune gastritis and solutions to each?
-
Inability to absorb B12
- parietal cells dead so no IF and thus no absorption of B12
- leads to megaloblatic anemia and possible chronic nerve dmg
SOLUTION: early detection and lifelong injection of B12 -
Increased risk of gastric adenocarcinoma
- due to G cells making too much gastrin
- longstanding chronic inflammation, atropy, and intestinal metaplasia
SOLUTION: early detection and biopsy screening -
Increased risk of gastric well-differentiated neuroendocrine tumor
- due to G cells making too much gastrin
- leads to endocrine cell proliferation which can end up as a tumor
SOLUTION: endoscopic screening and resectioning
Name two stomach neoplasms
Gastric adenocarcinoma
Lymphoma (MALT)
Gastric adenocarcinoma: What are some of its risk factors? Why does it have such a poor prognosis?
H. pylori gastritis, autoimmune gastritis
Poor prognosis due to metasis to lymph nodes (Virchow supraclavicular lymph node) and ovaries (Krukenberg tumor)
MALT lymphoma: main characteristic (e.g. grade and progressive speed), major cause, and treatments
Main characteristic: slow-progressing, low-grade lymphoma
Major cause: H. pylori infection
Treatment: treat H. pylori, but if it still persists even when bacteria is gone, radiation or chemotherapy
What is Meckel’s diverticulum? What is the rule of 2?
Developmental disorder involving the persistene of vitelline duct staying partially open even after birth
- 2% of population
- 2% develop symptoms
- presents after 2 yo
- 2 ft proximity to ileocecal valve
- 2 in long
- 2 types of ectopic tissue (gastric, pancreatic)
Three mechanisms of malabsorption (small bowel pathology)?
- inadequate intraluminal digestion
- primary mucosal absorptive defect
- impeded transport of nutrients
What is celiac disease? Pathogenesis of it? Treatment?
What it is: gluten allergy HSR IV
Pathogenesis: breakdown of gluten triggers immune sys and causes small bowel disease. Malabsorption also causes dmg
Treatment: lifelong gluten-free diet
What is intraepithelial lymphocytosis? Anti-tissue transglutaminase?
Too many lymphocytes in epithelium, result of malabsorption of gluten in small bowel
Antibodies produced when malabsorption of gluten in small bowel
What are 6 similarities between CD and UC?
- both affect young ppl
- more common in caucasians and has familial predisposition
- similar extra-intestinal manisfestations (arthritis, skin lesions, liver involvement)
- affects upper GI (more common in CD)
- predisposes to dysplasia and carcinoma (more so in UC)
- treated with anti-inflammatory drugs
What is Hirschsprung’s disease and how is it treated
Congenital absence of colonic ganglion cells = no peristalsis and thus remains in permanent spasm (creating obstruction)
Treated by resecting the agangliaonic segment
What is diverticular disease? What’s an example?
Acquired disease involving formation of tiny pouches especially on the sigmoid colon
Meckel Diverticulum
Difference between diverticulosis and diverticulitis (what it is and treatment)?
Diverticulosis: many diverticula
- wall of bowl is thin and can easily bleed
- treat with colonscopy or resection
Diverticulitis: inflammation of diverticula
- if uncomplicated, treat with antibiotics
- if complicated, pouches are obstructure and are very painful because it becomes trapped with bacteria
- treate with surgical resection
What causes hemorrhoids? Possible treatments (6)?
Dilation of veins in submucosa of anorectal area, caused by increased venous pressure in area (obesity, pregnancy), can be painful and bleed
High fiber diet, stool softener, steroid cream, band ligation, sclerotherapy, local resection
What are the three types of serrated polyps
hyperplastic polyp
sessile serrated lesion
traditional serrated adenoma
What exactly are adenomatous polyps?
Polyps that protrude and thus are easier to detect and completely remove
What is familial adenomatous polyposis (FAP)?Why can’t you simply resect it
Autosomal dominant hereditary tumor syndrome with so many adenomatous polyps that cannot resect; requires total colectomy
What are hamartomatous polyps? Example of a disease characterized by these?
Usually low to no malignant potential and involves benign disorganized growth of polyps
Peutz-Jeghers syndrome, an autosomal dom diseaese with hamartomatous colon polyps
What is colorectal adenocarcinoma? Whys is it considered one of the top killer cancers in both men and women? How is it diagnosed?
The most common form of colon cancer, often associated with IBD or genetics (Lynch, FAP) but risk factors can come into play.
Metastasizes via lymphatics and bloodstream
Screening of fecal occult blood, goal is to find colon polyps
What causes appendicitis? What do symptoms look like? How can it be treated?
Acute bacterial infection of appendix secondary to luminal obstruction
Symptoms: Abdominal pain, nausea/vomit/anorexia, elevated WBC, can rupture and lead to peritonitis/sepsis
Treatment: resection or antibiotics (similar to diverticulitis)
What causes jaundice?
hyperbilirubinemia, which is buildup of bilirubin, a breakdown product of hemoglobin
What are the three classifications of jaundice/hyperbilirubinemia
Pre-hepatic: e.g. hemolysis of RBC
Hepatic: e.g. severe hepatitis or cirrhosis
Post-hepatic: e.g. cancer at pancreas head
What is glucuronide?
The thing bilirubin binds to when conjugated in the liver before being excreted into bile
What are the 4 main classifications of liver disease?
- Hepatitis
- Drug-induced liver disease
- Autoimmune diseaes
- Metabolic diseases (fatty liver disease, hemochromatosis, Wilson’s disease, Alpha-1 antitrypsin deficiency)
What are the three main metabolic liver diseases and how do they harm the body?
Hemochromatosis
- AR disorder preventing liver from regulating iron in body
- results in iron buildup leading to scarring/cirrhosis, possibly to hepatocellular carcinoma
Wilson’s disease
- AR disorder preventing liver from excreting xs copper into bile
- results in liver cirrhosis and other abnormalities
Alpha-1 antitrypsin
- AR disorder causing misfolding of alpha-1 antitrypsin
- misfolded protein accmulation in hepatocytes causes scarring/cirrhosis
- lack of the protein in blood can cause problems with inflammation
What are two drugs/toxins that can induce hepatitis
Acetaminophen (Tylenol) and alcohol
What are five other liver diseases caused by microorganisms?
Hepatic Abscess (bacteria or amoeba)
Hydatid disease (echinococcus spp; parasite-filled cysts)
Schistosomiasis (schistosoma spp; lays eggs in your veins, may cause portal HTN)
Ascariasis (Ascaris lumbricoides; obstruction of bile ducts, looks like earth worms)
Fascioliasis (Fasciola hepatica or gigantica; liver flukes that lead to inflammation and scarring)
What are three immunologic disorders related to biliary pathology (Hint: APP)?
Autoimmune hepatitis (AIH)
- causes chronic hepatitis
Primary biliary cholangitis (PBC)
- disease of unknown etiology characterized by destruction of SMALL intra-hepatic bile ducts
Primary sclerosing cholangitis (PSC)
- disease of unknown etiology characterized by destruction of LARGE intra-hepatic bile ducts
What are two examples of benign liver neoplasms? Three malignant neoplasms?
Benign:
Cavernous hemangioma (endothelium)
Hepatocellular adenoma (neoplasm of hepatocytes)
Malignant:
Hepatocellular carcinoma (HCC)
Metastatic malignancy
Cholangiocarcinoma (adenocarcinoma of the bile ducts)
How would you treat hepatocellular carcinoma (HCC)? (3)
Embolization, direct thermal ablation, resection
What are the three types of stones in gallstones (cholelithiasis)
- cholesterol (caused by xs cholesterol secretion by liver)
- pigment stones
- mixed stones
What is cholelithiasis
Gallstones
What are 4 complications with cholelithiasis
- cholecystitis
- choledocholithiasis (stones block bile duct) => obstructive jaundice, ascending cholangitis
- gallstone ileus (obstruction of bowel)
- risk factor for gallbladder cancer
Difference btwn acute (2) and chronic (4) pancreatitis?
Acute:
- due to release of pancreatic enzymes
- alcohol and gallstones primarily responsible
Chronic:
- persistence of infection even after causative agent removed
- CF is an imporant factor, alcohol too
- progressive and irrev fibrosis
- may result in exocrine/endocrine insufficiency
6 complications of acute pancreatitis?
- abscess
- pseudocyst
- peritonitis
- chronic pancreatitis
- diabetes
- high mortality
Differences btwn PDAC (2) and WDNETs (3)
Pancreatic ductal adenocarcinoma:
- poor prognosis
- difficult to detect early cuz asymptomatic, when detect already metastasized
Pancreatic Well-differentiated neuroendocrine tumors
- arises from endocrine cells of pancreatic islets
- much better prognosis than PDAC but still can metastasize and kill
- treatment: surgical removal
