Chapter 1 Flashcards
Food is passed to the esophagus through the ________ ______process of swallowing.
Neurologically mediated process
Once food enters the esophagus, how is it forced downward?
By gravity and rhythmic contractions (peristalsis) if the muscles that make up the outer two layers of the esophagus.
What is the name for the rhythmic contractions that push fois from the esophagus to the stomach?
Peristalsis
What is another name for the gastroesophageal junction (GE junction)?
Z-line
Because of it’s zigzag appearance
What is the major function of the stomach?
To continue the mechanical grinding of the food bolus and to enhance the chemical process of digestion
How is the chemical process of digestion done
Through hydrochloride acid (HCL) and pepsin.
Does the stomach absorb nutrients?
Not for the most part, but it does absorb alcohol
What is the other role of the stomach?
Production of intrinsic factor, a protein that is necessary for the absorption of vitamin B12.
Where is food passed after stomach
Through pylorus
Into first part of small intestine (duodenum)
Where are digestive enzymes produced
Pancreas
Where is bile produced
Liver
Bile and digestive enzymes empty into the duodenum through a common opening known as the _________
Ampulla or papilla of Vater
As nutrients pas through the rest of the small intestine, they are absorbed through multiple projections of the mucosa called the ____
Villi
How long is the small intestine
Average 22 feet
Where does the residual solution that is not absorbed by the small intestine go
Passes through the ileocecal valve into the cecum
The last 15 cm of the colon is called the _____
Rectum
The structure that controls the fecal outflow is called the ___\
Anus
What is the major function of the large intestine
Reabsorb water and electrolytes passing from the small intestine and to control the elimination of the digestive waste material
The large bowel is host to many bacteria that aid in the production of ______
Vitamin K
Oral cancer is usually what type
SCC and it tends to recur and has high mortality rate
What is the name for pain that is associated with dysphasia
Odynophagia
What is esophageal manometry
Pressure monitoring of the esophagus
What meds are often used to treat primary motor disorder (e.g. Esophageal spasm)
Metoclopramide/reglan
Nifedipine/procardia
NTG
What is achalasia
Failure of the lower esophageal sphincter to relax, resulting in significant dilatation if the esophagus
What is name for heartburn
Pyrosis
What is metaplasia and Barrett’s
Chronic inflammation such as from GERD can cause a transition of the normal squamous esophageal mucosa into glandular gastric mucosa. Further changes to the mucosa (metaplasia) a using it to resemble intestinal cells (intestinal Izard on) is Barrett’s esophagus
How does Barrett’s appear endoscopically
Pink areas of mucosa in an esophagus that is a pearly white color
Barrett’s - over time, the newly transformed, intestinalized cells become dysplastic. what does dysplastic mean?
pre-malignant, and the dysplasia can be low grade or high grade
how can Barrett’s be treated
radio frequency ablation and photodynamic therapy, but would still require close surveillance to watch for recurrence
what is the most common surgery for GERD
Nissan fundoplication (laparoscopic)
is SCC or adenocarcinoma from Barrett’s more common?
SCC used to be the most common, but now adenocarcinoma from Barrett’s has become more common.
is the mortality rate from esophageal cancers low or high?
high
describe esophageal hernia
stomach normally lies in and cavity with gastroesophageal junction being just below the level of the diaphragm. when the stomach pushes up through the diaphragm into the chest, it is called esophageal or hiatal hernia
what % of gastric ulcers are malignant
about 1%
what type of lymphoma can h pylori be associated with
MALT - mucosa-associated lymphoid tissue lymphoma
what does the pancreas produce
insulin and pancreatic enzymes
what are the possible causes of pancreatitis
alcohol, blockage by gallstones (gallstone pancreatitis), meds, infection, autoimmune disease, hyperTG with TG levels >1000, and idiopathic.
does acute pancreatitis have high or low mortality rate?
high
how is pancreatitis diagnosed
elevated serum amylase
elevated lipase
ultrasound, CT, MRI, MRCP
what other problems can chronic pancreatitis cause
inadequate insulin production (diabetes)
inadequate digestive enzyme production (pancreatic insufficiency)
name 2 meds for pancreatic insufficiency
Creon, pancrease (oral digestive enzymes)
name 3 categories of pancreatic tumors (solid)
benign, malignant, hormone-producing (endocrine)
what is most common pancreatic tumor
pancreatic adenocarcinoma, with very high mortality rate
what are the 3 most common pancreatic endocrine tumors
gastronomes (collinger-ellison syndrome, cause ulcers)
insulinomas (cause hypoglycemia)
vasoactive intestinal peptide producing tumors (VIPomas) that cause watery diarrhea
what tests are done to determine if a pancreatic cystic lesion is benign or malignant
ERCP, CT, MRI
what pancreatic cystic lesions of no malignant potential
pseudocyst, lymphoepithelial cyst, retention cyst, congenital cyst, cystic lymphangioma, cavernous hemangioma, serous cystic adenoma
what pancreatic cystic lesions have malignant potential
intraductal papillary mutinous neoplasm, mutinous cystic neoplasm,
intraductal tubular carcinoma
what pancreatic cystic lesions are malignant
cystic ductal adenocarcinoma, cystic neuroendocrine tumor, solid pseudo papillary neoplasm, cystic pancreatoblastoma, cystic acinar cystoadenocarcinoma, mature cystic teratoma
what are the causes of inadequate absorption of nutrients
insufficient breakdown of food (pancreatic insufficiency)
disruption of the intestinal lining
too rapid of passage of food through the intestines
in what disease is disruption or destruction of the villous surface of the small intestine seen
celiac disease
what is Chron’s disease and what is another name for it
also known as granulomatous or regional enteritis.
inflammatory process that can affect any part of the GI tract but most commonly the distal third of the small intestine (ileum) and the colon. possible autoimmune basis.
what part does ulcerative colitis affect
only the large intestine
which always involves the rectum - chron’s or UC?
UC always involves the rectum and is continuous to some proximal part of the large intestine.
which can have skip lessons - UC or Chron’s?
Chron’s can affect the bowel in a non-continuous pattern, creating skip lesions, with areas of severe inflammation with intervening normal mucosa
which has increased risk of colon cancer- chron’s, UC or both?
Both.
how many years after onset of Chron’s or UC is there steady, significant, increased risk of developing cancer?
8-10 years
what other factor is risk of colon cancer dependent upon
extent of disease (how far up colon it has spread)
ulcerative proctitis can go how far up the colon?
distal 15 cm, which is limited to rectum
how far up colon can ulcerative proctosigmoiditis go
up 10 25 cm
do ulcerative proctitis and ulcerative proctosigmviditis have smaller or larger cancer risk
small increased cancer risk
what is the etiology of chron’s
unknown. possibly autoimmune
how often should someone with chron’s x 10 to more years have colonoscopy?
every 1-2 years
if scope for chron’s finds dysplasia what is treatment
total colectomy, which is not curative for chron’s
what are meds for chron’s
abx, steroids, immunosuppressive agents such as imuran, sulfasalazine, with goal to put into remission
what are meds for UC
abx, sulfasalazine, pentasa, asacol, canasa, rowasa, steroids, DMARDs used to avoid prolonged need for steroids
From underwriting perspective, what is chron’s disease mortality associated with?
bleeding, malabsorption, complications of the meds used to treat the disease, late cancer risk, obstructive, infectious, and surgical complications
From underwriting perspective, what is UC mortality associated with?
risk of acute disease causing bleeding, acute dilatation (toxic megacolon), and perforation of colon. when acute symptoms are not severe, mortality most significantly affected by the increased risk of cancer
what extra intestinal complications are associated with chron’s and UC
ankylosing spondylitis, arthritis, iritis, pyoderma gangrenous, erythema nodosum
elevated LFTs from Chron’s are felt to be secondary to what?
nonspecific inflammation around the microscopic bile ducts, and felt to be of little clinical significance
abnml LFTs from UC can be result of what, and what is the risk
usually Alk phos and GGT
can be primary sclerosing cholangitis (PSG)
bile ducts become scarred and narrowed, obstructing bile flow, eventually leading to cirrhosis and death
this persists even after colectomy
is rectal bleeding more common with UC or Chron’s
UC - common
chron’s - occassional
is abdominal pain more common with UC or Chron’s
UC- uncommon
Chron’s - common
is rectal involvement more common with UC or Chron’s
UC- almost 100%
chron’s - 50%
is fistula formation more common with UC or Chron’s
UC - No
Chron’s - common
is stricture, obstruction more common with UC or Chron’s
UC - No
Chron’s- common
is perianal, perirectal abscess more common with UC or Chron’s
UC - uncommon
chron’s - common
what type of involvement is there with UC vs Chron’s
UC - continuous
chron’s - discontinuous (skip areas)
what is the depth of involvement with UC vs chron’s
UC - mucosa and submucosa
chron’s - transmural
is bowel involvement more common with UC or Chron’s
UC - not involved
chron’s - often involved
is there greater risk of malignancy with UC or chron’s
UC.- greatly increased
chron’s - moderately increased
what is IBD
Chron’s and UC
IBS
disorder of the motor function of the GI tract, creating areas of spasm and pain. doesn’t cause inflammation, bleeding, or obstruction
what are the symptoms of IBS
diarrhea, abd pain, bloating and/or constipation. psychological stress can influence
what symptoms don’t appear with IBS
almost never any weight loss, usually doesn’t occur during sleep
what tests can dx IBS?
none so far. dx of exclusion
what is treatment for IBS
fiber, antispasmodics, antidiarrheal agents and/or anticonstipation agents
what is the risk with IBS
no mortality risk
can be significant morbidity issues
which part of the GI tract is most often affected by neoplasms?
large intestine
describe types of colon polyps (shapes)
sessile - broad-based
pedunculate - on a stalk
what determines the malignancy potential of a colon polyp
the histology
type of pre-malignant polyps
adenomas (tubular adenomas, villouss adenomas, tubulovillous adenomas)
serrated polyps or serrated adenomas
are adenomas low or high grade in dysplasia
low-grade dysplastic, but the larger or more villous the polyp is, the higher the malignant potential
what term describes benign polyps with no malignant potential
hyperplastic, inflammatory, or juvenile polyps
polyposis syndromes
FAP, Gardner’s syndrome, Turcot syndrome, MYH polyposis, HNPCC or Lynch syndrome, Peutz-Jeghers syndrome, juvenile polyposis
colon polyps and cancer occur more frequently after what age?
50
what age does colonoscopy screening start?
age 50 for avg risk individuals
age 40 for those with family hx of colon polyps
what is the repeat colonoscopy interval
in 3-5 yrs if hx of premalignant polyps or family hx
in 8-10 yrs for all others
describe in situ vs invasive colon cancer and where mets most frequently occur
in situ is confined to the superficial layer of the bowel
invasive spreads beyond that
mets most frequently to liver, lung, brain
where do diverticula most commonly occur
lt side of the colon
what are the most common sources of large volume upper GI bleed
esophageal varices, ulcers, severe gastritis, mallory-weirs tear (tear of lower esophagus usually after vomiting)
large volume lower GI bleeding (hematochezia) is most commonly caused by:
diverticulosis, AVMs, polyps, cancers
what are the mortality risks with GI bleed
mortality is a/w the underlying cause, acute complications a/w rapid blood volume loss ( syncope, shock, and MI), and risks of the therapy needed to control and treat bleeding (surgery and transfusions). the cause of the bleeding is the key to determining mortality risk.
what is the major impairment of concern in older age groups
colon cancer
what is the major impairment of concern is younger age groups
inflammatory causes and they concomitant mortality risk
what are the causes of intestinal obstruction
- blockages in small or large intestine by tumors, polyps or foreign bodies
- bowel twisting on itself (volvulus)
- adhesions from prior surgery or prior intrabdominal infection causing tethering of the bowel and obstruction
- telescoping of the bowel on itself (intussusception)
- herniation of the bowel through the abd wall, inguinal ligament or diaphragm
(last 4 can also cut off blood supply to the intestine and result in ischemia or infarction with gangrene and risk of perforation)
what is intestinal ischemia
disruption of blood flow to the intestines
what are the causes of intestinal ischemia
adhesions, intussusception, herniation, volvulus, clotting of intestinal arteries d/t atherosclerosis, clot or embolism. sudden drop in BP can also result in ischemia of the bowel
is bariatric surgery usually done laparoscopically or open?
laparoscopically
what is the weight reduction typical after bariatric surgery
45-80% of excess weight loss, corresponding to 60-120 lbs over 12-18 months with bypass or 24 months with gastrectomy/lap band, with 10% regain over time
what is the mortalityy risk with bariatric surgery
small post mortality of <0.5%
what are possible long term probs after bariatric surgery
esophageal reflux, stenosis of the anastomosis sites, ulceration, bleeding, vitamin and mineral deficiencies, intestinal obstruction
what obesity related illness improve or resolve after bariatric surgery and after how long?
DM2, HTN, HLD, NAFLD, OSA, within first 12 months. cancer rates also decrease long term after surgery
what is the long term overall decrease in mortality after bariatric surgery?
mortality improves 40% by 7 years and persists up to 20 years when compared to those who didn’t have the surgery
