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Gastrointestinal II Exam #1 > Anus, Peritoneum and Gallbladder > Flashcards

Anus, Peritoneum and Gallbladder Flashcards

1
Q

What causes hemorrhoids?

A

Increased venous pressure within the hemorrhoidal plexus

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2
Q

What 3 predisposing conditions/diseases can cause hemorrhoids?

A

Straining at the toilet due to constipation

Pregnancy

Portal HTN

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3
Q

What is the difference between internal and external hemorrhoids?

A

Internal - painless and can be treated without anesthesia (above the pectinate line)

External - very painful and require anesthesia (below pectinate line)

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4
Q

What are the 3 zones of the anal canal and what are the epithelium types?

A

Upper zone: columnar epithelium

Middle zone: transitional epithelium

Lower zone: stratified squamous epithelium

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5
Q

What are cancers below the pectinate line typically?

Above the pectinate line?

A

Below the pectinate line: squamous cell carcinomas (basal cell carcinoma and melanoma) - HPV-16 association

Above the pectinate line: adenocarcinomas

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6
Q

Which lymph nodes does anal cancers most often spread?

A

Superficial inguinal LNs

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7
Q

Appendicitis is most common in which patients?

A

Younger patients, M>F

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8
Q

What is on the DDx for acute appendicitis? (5)

A 
Yersinia infection (mesenteric lymphadenitis)
Acute salpingitis
Ectopic pregnancy
Mittelschmerz
Meckel diverticulum
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9
Q

What initiates an appendicitis?

A

Progressive increases in intraluminal pressure that compromises venous outflow

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10
Q

What processes lead to inflammation in an appendicitis?

A

50-80% occur due to overt luminal obstruction, usually due to a small piece of stool, fecalith or, less commonly, a gallstone or mass of worms.

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11
Q

How does stasis affect the inflammatory process in an appendicitis?

A

It increases the risk for infection and triggers inflammatory responses and ischemia, along with a neutrophilic infiltrate to the surrounding tissues.

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12
Q

What are symptoms of appendicitis?

A

RLQ pain, followed by nausea, vomiting, low-grade fever and mildly elevated WBC ct.

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13
Q

A diagnosis of appendicitis requires what?

A

Neutrophilic infiltrate of the muscularis propria

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14
Q

What is the most common tumor of the appendix?

A

Well-differentiated neuroendocrine (carcinoid) tumor

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15
Q

What is an appendix mucocele? What causes it? (2)

A

A dilated appendix filled with mucin, which might be due to an obstructed appendix containing mucous, or as a consequence of mucinous cystadenoma.

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16
Q

What can occur as a result of` mucinous cystadenoma?

A

Invasion through the appendiceal wall

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17
Q

What causes a pseudomyxoma peritonei?

A

Mucinous cystadenoma causes the abdomen to fill with semisolid mucin and leads to pseudomyxoma peritonei and follows a fatal course

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18
Q

What can cause peritoneal inflammation?

A

Bacterial invasion or chemical irritation

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19
Q

List 7 causes of peritoneal inflammation

A

Leakage of bile and pancreatic enzymes, producing sterile peritonitis

Perforation or rupture of the biliary system, which can be complicated by a secondary bacterial infection

Acute hemorrhagic pancretitis - leakage of pancreatic enzymes and fat necrosis

Foreign material

Endometriosis

Ruptured dermoid cyst

Perforation of abdominal viscera

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20
Q

What causes a peritoneal infection?

A

Bacteria from the GI lumen are released into the abdominal cavity, most commonly following a perforation

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21
Q

What 5 bacteria are most often implicated in peritonitis?

A

E. coli

Streptococci

S. aureus

Enterococci

C. perfringens

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22
Q

What characterizes sclerosing retroperitonitis?

A

Dense fibrosis that may extend to involve the mesentery

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23
Q

What group of diseases is sclerosing retroperitonitis in?

What structure is most commonly affected?

A

IgG4-related disease

Ureters

24
Q

What is the most common malignancy of the peritoneum? What is the most common sub-type?

A

Mesotheliomas - most commonly, the desmoplastic small round cell tumors, which occur in kids and young adults

25
Q

What is the most common congenital anomaly of the Gb?

A

A phyrgian cap, due to a folded fundus

26
Q

What are the 2 types of choleliths?

A

Cholesterol stones and Pigment stones

27
Q

What ethnicities are associated with Cholesterol stones and Pigment stones?

A

Cholesterol stones: Northern Europeans, North and South Americans, NA, Mexicans

Pigment stones: Asians, rural>urban

28
Q

What are some risk factors for cholesterol stones? (4)

A

Increased age

Female sex hormones (OCs and pregnancy)

Obesity and metabolic syndrome

Rapid weight loss

29
Q

What 3 structural/anatomical changes can increase the risk for cholesterol stones?

A

Gb stasis

Inborn errors of bile acid metabolism

Hyperlipidemia syndromes

30
Q

What are 3 causes of pigment stones?

A

Chronic hemolytic syndromes

Biliary infections

GI disorders: CD, ileal resection/bypass, CF with pancreatic insufficiency

31
Q

Cholesterol stones occur when…

A

Cholesterol concentrations exceed the solubilizing capacity of bile (supersaturation)

32
Q

Which stones are exclusively in the Gb?

A

Cholesterol stones

33
Q

What do cholesterol stones look like?

A

Pale yellow, round to ovoid and have a fine/granular, hard external surface

Multiple stones develop often

34
Q

What causes Pigment stones?

A

Increased unconjugated bilirubin

35
Q

What 3 infections are implicated in pigment stones?

A

E. coli

Ascaris lumbricoides

C. sinensis

36
Q

What is the appearance of pigment stones? Where are they found?

A

Black stones: found in sterile Gb bile

Brown stones: found in large infected bile ducts

37
Q

What is the major symptom of gallstones?

A

Biliary colic - RUQ pain following a fatty meal

Many may exist asymptomatically for years and remain that way

38
Q

What are complications of gallstones? (5)

A 
Empyema
Perforation
Fistulas
Inflammation of biliary tree
Inflammation of the pancreas
39
Q

Acute cholecystitis is precipitated by what?

A

Precipitated by obstruction of the neck or cystic duct by a stone

40
Q

What are some symptoms of acute cholecystitis?

A

RUQ pain for 6 hrs.

-mild fever, anorexia, tachycardia, sweating, N/V

41
Q

Which type of cholecystitis does not often cause jaundice?

A

Acute cholecystitis does not cause jaundice

42
Q

What lab abnormalities are seen in acute cholecystitis?

A

Mild leukocytosis and mild elevation of serum alkaline phosphatase

43
Q

What is the pathophysiology of acute calculous cholecystitis?

A

Chemical irritation and inflammation of the Gb obstructed by a stone - occurs in the absence of bacterial infection

44
Q

What patients are most likely to have acute calculous cholecystitis?

A

Diabetics with symptomatic gallstones

45
Q

What is the cause of acute acalculous (w/o stone involvement) cholecystitis?

A

Thought to be from ischemia

46
Q

What is the morphology of the Gb in acute chgolecystitis?

A

Gb is enlarged and tense in acute cholecystitis

47
Q

Define the following:

Gb empyema

Gangrenous cholecystitis

Acute emphysematous cholecystitis

A

Gb empyema: occurs when the Gb fills with fibrin and pus in calculous cholecystitis

Gangrenous cholecystitis: when the Gb is transformed into a green-necrotic organ

Acute emphysematous cholecystitis: when there is invasion of gas-forming organisms

48
Q

What is the most common cause of chronic cholecystitis?

A

It is often asequel to repeated bouts of mild to severe acute cholecystitis, but can also be without precipitating cause

49
Q

Chronic cholecystitis is associated with what?

A

Gallstones in 90% of cases

50
Q

What 2 bugs can be cultured in 1/3 of chronic cholecystitis cases?

A

E. coli and enterococci

51
Q

What may exist morphologically in chronic cholecystitis? (3)

A

Subserosal fibrosis

Rokitansky-Aschoff sinuses - outpouchings of mucosal epithelium through the wall

In rare cases - extensive dystrophic calcification within the Gb, which yields a “porcelain Gb” and increases the risk of cancer

52
Q

What is Xanthogranulomatous cholecystitis?

A

Occurs in chronic cholecystitis when the Gb has a massively thickened wall and is shrunken, inflamed and necrotic

53
Q

What is hydrops of the gallbladder?

A

Occurs in atrophic, chronically obstructed, often dilated Gb that contains clear secretions

54
Q

What patient population is most commonly affected by Gb carcinoma?

A

> 2x more common in females, especially in NA, Hispanic and Latin ethnicities

55
Q

What is the most important risk for Gb cancer?

What is the most common cancer?

A

Gallstones

Adenocarcinomas

56
Q

What is the prognosis of Gb cancers?

A

Hard to say - by the time they’ve been found, they have often metastasized to the liver and invaded the cystic duct and nearby bile ducts and portal-hepatic lymph nodes

57
Q

What are the 2 patterns of growth in Gb cancer? What is their appearance?

A

Infiltrating pattern - more common and appears as a poorly defined area of diffuse mural thickening and induration

Exophytic pattern - grows into tge lumen as irregular “cauliflower mass”, but also invades the underlying wall

Gastrointestinal II Exam #1 (19 decks)

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