Chapter 1 Flashcards
1
Q
define digestion
A
the breakdown and absorption of nutrients, electrolytes and water
2
Q
Name two methods of digestion
A
mechanical and chemical
3
Q
where does the initial site of digestion occur?
A
the mouth
4
Q
How does food move through the digestive system.
A
- gravity,
2. peristalsis
5
Q
What is another name for the gastroesophageal junction (GE junction)
A
Z-line, d/t zig zag appearance
6
Q
What is the major function of the stomach
A
mechanical grinding of the food bolus, and to enhance the chemnical process of digestion.
7
Q
What are the 2 enzymes found in the stomach that digest food and the one protein produced that aids in the absorption of vit B12
A
Hydrochloric acid (HCL)
pepsin
—————————————
Intrinsic factor
8
Q
What is the name of the muscular chanel between the stomach and the duodenum
A
pylorus
9
Q
Name the common opening that empties the digestive enzymes produced by the pancreas and bile from the liver.m into the duodenum
A
ampulla or papilla of vater
10
Q
what food component is broken down in the duodenum?
A
proteins, carbohydrates and fats. This is done by the bile/enzyme mixture along with locally-produced pH neutralizing bicarbonate.
11
Q
Name the 3 parts of the small intestine
A
duodenum, jejunum, illium
12
Q
what do you call the projections of mucosa that absorb nutrients?
A
villi.
13
Q
What is the name of the valve that seperates the sillium and the cecum?
A
ileocecal valve
14
Q
What are the major funcitons of the large intestine?
A
- to reabsorb water and electrolytes secreted by the small intestine
- control elimination of the digestive water materia
15
Q
The large bowel contains bacteria for what purpose?
A
to aid in the production of Vit K.
16
Q
Oral cancer is usually found in what form?
A
Squamous cell carcinoma.
17
Q
Name some systemic diseases that have associated oral lesions
A
- apthous ulcers- associated with crohns and systemic lupis
2. thrush associated with AIDS or inhaling steroids
18
Q
Esophageal disorders can occur as a results of what?
A
- primary esophageal motor abN
- CNS diseases
- strictures
- masses.
19
Q
What is dysphagia?
A
difficulty swallowing
20
Q
what is pain associated with dysphagia
A
odynophagia, described as retrosternal and occurs while swallowing.
21
Q
what is esophageal manometry
A
pressure monitoring of the esophagus
22
Q
How would you determine/diagnose an esophageal disease?
A
- dx through esophageal manometry and barium x-ray studies
23
Q
What is a typical tx for dysphagia
A
- promotility medication metoclopramide
- antisoasmodic agents
- nitroglycerin.
24
Q
how would you dilate the esophagus?
A
use of fiberoptic intrusments (endoscopes)
25
What is Achalasia, how is it tx'ed?
failure of the lower esophageal sphincter to relax- tx'ed with endoscopic ballon dilation/surgery
26
When does GERD occur?
idiopathically
| associated with hiatal hernia
27
What is the medical term for heartburn?
pyrosis
28
Chronic inflammation of the esophagus can lead to what?
normal > suqamous mucosa > glandular gastric mucosa -- metaplasia----> intestinal cells. Also called barrett's esophagus.
29
How is Barrett's esophagus diagnosis confirmed?
visual: pink mucus appearance of what should be white
| biopsy
30
How can Barrett's Esophagus be tx'ed?
```
endoscopic therapy (radifrequency ablation + photodynamic therapy)
- surveillance is required.
```
31
How is GERD tx'ed?
1. diet
2. timing of indigestion (prior to reclining)
3. raising the head of the bed
4. weight loss
5. medication
6. surgery
32
What is the name of the surgery they use to tx GERD
they wrap the lower esophagus around the stomach- Nissan fundoplication- performed by laparoscope.
33
Esophageal cancer is usually found in which two forms?
Squamous cell carcinoma
| adenocacinoma- associated with B.E
34
What is a hiatal hernia and how is it detected?
>when the stomach pushes up through the diaphragm into the chest.
>X-rays or endoscopies
35
Name two types of hiatal hernias
1. Sliding or axial hiatal hernia
| 2. paraesophageal hernia.
36
What is a common cause of gastric and duodenal inflammation and ulceration?
NSAIDS use.
alcohol
cigarettes (inhibits healing)
gastric cancer
37
What is the main complication of inflammation and ulceration of the stomach and duodenum, and how is it detected??
bleeding and perforation.
endoscopies or xray
38
How do you treat gastritis, duodenitis, and ulcer disease?
medications used to reduce acid content of the stomach.
| - antacids, H2blockers, proton pump inhibitors.
39
What is H. Pylori, how is it detected and how is it treated?
Bacterium
biopsy or serum antibody testing, stool testing, breath test
antibiotics
40
What does H pylori cause?
atrophy of stomach lining
^ risk of adenocarcinoma
MALT lymphoma ( tumor)
41
what is pancreatitis, and how is it dx?
inflammation of the pancreas
| serum amuylase and lipase levels, or imaging studies
42
What causes pancreatitis?
```
alcohol
blockage by gallstomes
Rx
infection
autoimmune disease
hypertriglyceridemia
idiopathy
```
43
What is pseudocyst?
cyst like mass in the pancrease
44
chronic pancreatitis can lead to what?
diabetes and inadequate digestive enzyme productions.
| tx'ed with insulin /digestive enzyme pills
45
What is the most common tumor of the pancreas?
pancreatic adenocarcinoma
| high mortality rate
46
What are the 3 most common endocrine tumors and sxs?
1. gastrinomas (Zollinger-Ellison synfrome)- ulcers
2. insulinomas- hypoglycemia
3. VIPomas- watery diarrhea
47
How can you determine the nature of a pancreatic cystic lesion? (ie is is malignant?)
ERCP
CT
MRI
biopsy
48
Blockage of the bile flow into the duodenum by tumors, stones or strictures interfere with the absorption of what?
fats and fat-soluble vits
49
What is a common example of a mild form of insufficient intestinal enzyme production?
lactase deficiency, causing inability to digest the milk sugar, lactose
50
What can cause the Blunting of the villous surface of the small intestine?
infection (viral or bacterial gastroenteritis) or an immune or allergen-mediated destruction, such as celiac sprue.
51
What are some physiological symptoms of malabsorption?
```
bloating
diarrgea
weight loss
abdo pain
anemia
low serum albumin
osteoporosis
Vit Dif. sxs
```
52
What are some tx options for celiac sprue?
often gluten free diet, but also may need steroids.
53
What is another name for crohns, and what part of the colon does it affect?
1. granulomatous or regional enteritis
| 2. distal 3rd of the small intestine- ileum and colon.
54
What part of the colon is affected by U.C?
large intestine
55
What is difference between crohns and uc besides size
1. crohns is non-continuous pattern- skip lesions
| 2. UC always involves recum and is continuous until some part of the lare intestine
56
Crohns affects which layers of the bowel?
All, and can be complicated by strictures, fistulas and absecess
57
UC affects which layers of the bowel?
mucosa.
58
Which disorder Crohns or UC reveals micoscopic granulomas
crohns
59
UC that is limited to 15 cm up and 25 cm up is called what?
Ulcerative proctitis
| ulcerative proctosigmoiditis
60
How often should people with 10 yrs of crohns or UC be getting c-scopes
1-2 yrs, and getting random biopsies
61
How do you tx crohns?
Put them in remission
1. abx
2. steroids
3. immunosuppressive agents
4. sulfasalazines
62
How do you tx UC
1/ abx
2. sulfasalazines or derivatives
3. steroids
Sulfasalazine if often used to maintain remission and prevent relapse
63
What are DMARS?
biologic-disease modifying agents. New drug used to avoid prolonged used of steroids/
they gave an increase risk of infection and lymphoma.
they are IV or injected
64
What is an ileostomy?
procedure that connects the terminal ileum to an opening in the skin in the right Lower quadrant of the abdo with an external bag to collect the fluid.
65
What is ileoanal anastomosis?
procedure that attaches the ileum to the anus with the creation of an internal pouch.
66
What is pouchitis?
complication of ileo-surgery which is inflammation of the about- and can be refractory to tx
67
Crohns disease mortality is associated with what?
bleeding,
malabsorption
complications of the Rx used
late cancer risk (increases with depth of disease and yrs had)
obstructive + infectious and surgical complications
68
What are the mortality risks associated with UC?
bleeding
acute dilation (toxic megacolon)
perforation of colon
-increased risk of cancer
69
What are some extra intestinal complications associated with crohns and UC?
```
ankylosing spondylitits
arthritis
orotos
pyoderma gangernosum
eruthema nodosum
^ LFTS
```
70
What is the name of the disease where bile ducts throughout the liver become scarred and narrows causing obstruction of bile flow? its detected by abN Alk phos and GGT.
PSC
| primary sclerosing cholangitis
71
What is IBS, and what are the sxs
disorder of the motor function of the gastrointestinal tract, creating spasm and pain.
diarrhea, abdo pain, constipathion
72
how is IBS dx'ed and what are the tx?
usually by exclusion, based on hx and absence of findings on endoscopic or xray test.
fiber products, antispasmodics, antidiarrhheal agents, and anticonstipation agents
73
is mortality affected by IBS?
no but there are sig morbidity issues.
74
What do you call a polyp that is broad-based and on that is on a stalk?
sessile
| pedunculated
75
Name 3 kinds of pre-malignant adenoma polyps
tubular adenomas
villous adenoma
tubulovillous adenomas
76
What do you call a benign polyp with no malignancy potential- 3 names
hyperplastic
inflammatory
juvenile polyps
77
How do you tx polyps?
polypectomy. Preformed during a c-scope
78
What is the average age for colonoscopic screening
50 in average risk
40 in increase risk
repeat every 3-5 yrs with premalignant polyps or 10 o/w
79
What is a CT colonography. And name 4 other less sensititve methods of screening
a noninvasive , readiographic technique for a colon screening. its not as reliable,
FIT, occult blood, barium enema, flex sigmoidoscopy, and DNA of Stool
80
What are diverticula
out pouchings of the colon. (L side usually)
81
When diverticulosis presents with sxs, it does so in which two ways?
1. lower intestinal hemorrhage
| 2. diverticulitis
82
What is diverticulitis and what are the sxs and tx?
1. when diverticula become inflamed or infected.
2. abdo pain and fever.
3. without perforation just rest and abs o/w surgery
83
What would prompt an evaluation for small volume gartrointestinal bleeding?
1. Fe deficient anemia on CBC
| 2. microscopic quantities of blood detected through Hemoccult cards.
84
What are some causes for slow gastrointestinal bleeding?
1. esophagitis
2. gastritis
3. duodenitis
4. IBD
5. vascular abN6. gastric and duodenal ulcers
6. malignant and benign tumors throughout GI tract.
85
What are hemmorhoids
dilations of the rectal veins
86
What other sxs would be present with Large volume acute GI blood loss of the upper GI ?
usually presents with vomiting of blood (hematemesis) and or melena (black tinny stools)
87
What are the most common sources of large volume upper GI bleeding?
1. esophageal varices
2. ulcers
3. severe gastritis
4. Mallory Weiss tear
88
What other sxs would be present with large volume acute GI blood loss of the lower GI
bright red blood per rectum, (hematochezia)- caused by
1. diverticulosis
2. AVMS
3. polyps
4. cancer
89
What is the impairment of concern in view of its high incidence and high mortalitiy risk in terms of GI bleedin of Older vs younger age groups?
1. older cancer
| 2. inflammation
90
What are the most common weight loss surgery operations?
1. gastric bypass
2. sleeve gastrectomy
3. adjustable gastric band
91
what is gasrtric bypass?
dividing the stomach so that a smaller reservoir is created and connecting it to a part of the small intestine so that it empties further down the intestine.
- causes intended malabsorption
92
What is sleeve gastectomy
removing the pouch-like portion of the stomach, creating a narrow "sleeve-like" shaped stomach
93
What is lap ban?
a silicone ring that is placed around the outside of the upper stomach, connected to an injectable port that is placed under the skin. This allows for ban adjustments
94
how long does it take to lose 60-120lbs following each of the bariatric surgeries? And what is the expected regain weight over time?
12-18 mo- gastric bypass and sleeve
24 mo with lap ban
10% regain
95
What are some long term complications related to bariatric surgery?
```
esophageal reflux
stenosis of anastromosis sites
ulceration and bleeding
Vit and Mineral deficiencies
intestinal obstructions
```
