Chapter 13: GI Flashcards
- an inflammation of the oral cavity
1) caused by irritants: ______, ______, and stress
2) caused by infectious agents: - ______ (HSV-1): vesicles involving oral mucosa that rupture and results in shallow, painful, ______. primary infection occurs in ______. ______ heal, but virus remains dormant in ______ of the ______ nerve. stress and hormonal changes cause reactivation of the virus, leading to ______ on the lips (cold sores).
- oral candidiasis (______), is a local white, membranous lesion caused by ______. it occurs most commonly in infants and children, ______, and ______ patients
stomatitis alcohol tobacco herpes virus red ulcers childhood lesions ganglia trigeminal vesicles thrush candida albicans immuno-compromised diabetes
- classified as squamous cell carcinomas
- often related to ______
- ______ of the mouth is common location
- oral ______ and ______ are precursor of lesions
- morphologically present as the following:
- ______: white plaque which cannot be scraped away represents squamous cell dysplasia
- ______: red plaque (______) represents squamous cell dysplasia
oral cancer tobacco smoking floor leukoplakia erythroplakia leukoplakia erythroplakia vascularized
- ______: infectious or autoimmune. clinically presents as swelling of glans by ______
- prevented by ______ vaccine
- neoplasms (greatest in women 20-40 years old)
- most common localization of the ______ glands
- most common tumor is ______ adenoma (benign)
salivary gland disease sialadenitis MUMPS MMR parotid pleomorphic
- upper end of the esophagus is intact but ends in a blind pouch
- ______: lower part of the esophagus is normal but it ______ at the proximal end which communicates with trachea
- clinical symptoms: fetus can not swallow ______ and neonates appear to be healthy. but, when fluids are administered they come out via ______, mouth causing ______
- treatment: ______
esophageal atresia tracheo-esophageal atresia with fistula tappers amniotic fluid nose respiratory distress surgery
- disorder with esophageal motility with inability to relax the lower esophageal sphincter (LES)
- the condition is caused by a loss of ______ in the ______, which leads to the progressive dilation of the ______. one important source (principally in south america) is ______ (parasite) infection in Chagas disease. in other cases, ganglion cells are lost for reasons that are not known.
- clinical characteristics include difficulty in ______
- achalasia can lead to ______ cell carcinoma in about 5%
diseases of the esophagus: achalasia ganglion cells myenteric plexus esophagus trypanosoma cruzi swallowing squamous
______: protrusion of the abdominal contents through abdominal wall to thoracic cavity
______: above the diaphragm (90%)
______: below the diaphragm origin but rolls alongside the distal esophagus
hiatal hernia
sliding hernia
paraesophageal or rolling type
- hernia protrudes through the inguinal canal and extends into the scrotum is known as ______
- hernia occurs through the femoral canal in the groin is also known as ______
inguinal hernia
femoral hernia
dilated sub-mucosal esophageal veins that occur secondary to portal hypertension can result in upper gastrointestinal hemorrhage
diseases of the esophagus: esophageal varices
- reflux of gastric juice into esophagus
- characteristics usually include ______ pain relieved by ______. manifestations often include substernal pain (______)
- most commonly, associated with conditions include incompetent lower esophageal sphincter and ______ hernia. GERD is also associated with excessive use of ______ and ______
- ______ and ______ esophagus are late complications
gastroesophageal reflux disease (GERD) burning antacids heartburn hiatal alcohol tobacco ulceration barrett
- lower portion of the esophagus is affected by this disorder. the ______ cell lining is replaced by ______. most aggressive form of ______.
- common cause is ______ where the glandular ______ happens die to the acid injury.
- treatments for GERD or peptic ulcer: a) ______ are not a permanent solution. b) ______ blockers like zantac blocks the ______ which in terms inhibit ______ secretion. c) acid pump reducer drugs like nexium which decrease the ______ production via acid pump
- ______ in upper or lower esophagus
- ______ in lower esophagus developing in Barrett’s esophagus
barretts esophagus squamous columnar epithelium adenocarcinoma GERD (gastro esophageal reflux disease) metaplasia antacids H-2 histamine gastric acid acid squamous cell carcinoma adenocarcinoma
diseases of the stomach: clinical symptoms
- pain- ______, upper abdomen
- ______
- bleeding
- ______: upset stomach
- ______ consequences: e.g., iron deficiency anemia caused by chronic ______, vitamin ______ malabsorption- related to ______ anemia
midline vomiting dyspepsia systemic blood loss b12 megaloblastic
diseases of stomach: developmental abnormality
- ______: congenital hypertrophy of pyloric smooth muscle; more common in ______. seen in two weeks of birth
- prevents ______ of the stomach and results in ______
- ______ of the contracted muscle
congenital stenosis of pylorus males emptying projectile vomiting surgical incision
- acidic damage to the stomach
- in most cases, self-limited, of short duration
- may be associated with ______, with bleeding
- risk factors: ______, aspirin, ibuprofen, ______, heavy ______ consumption, severe ______ patients (______ ulcer: hypovolemia leads to decrease blood supply), increased intracranial pressure (______ ulcer): increased stimulation of vagal nerve resulting in acid production
- treatment: ______ blocker or ______ reducer (proton pump inhibitor)
acute gastritis mucosal ulceration NSAIDS naproxen alcohol burn curling cushing H2 acid pump
- is characterized by chronic mucosal inflammation and ______ of the mucosal glands. two types:
- ______: autoimmune gastritis is associated with the presence of antibodies to ______ cells (and sometimes to ______), lack of gastric acid secretion, ______ anemia, and other autoimmune diseases, such as chronic thyroiditis and ______ disease. it is also associated with aging, gastric ______ and gastric ______
- ______: caused by ______ bacteria and common form of chronic gastritis. H. pylori is also strongly associated with ______ and ______ peptic ulcers and is thought to play a role in the development of ______ of the stomach and gastric lymphoma of the mucosa-asociated lymphoid (MALT) type
- treatment: ______ (antibiotic) to treat H. pylori. negative ______ breath test and lack of ______ antigen confirm eradication of H. pylori
chronic gastritis atrophy type A parietal cells intrinsic factor pernicious Addison ulcer carcinoma type B helicobacter pylori gastric duodenal adenocarcinoma triple therapy urea stool
- Most often, the stomach ulcer (punch out margins) occurs at or near the ______ curvature, in the ______ and ______ regions with hypertrophy of Brunner glands.. Caused by ______ (95 %)
- The ulcer is not a precursor lesion of carcinoma of the stomach
- Unlike peptic ulcer that occurs elsewhere, peptic ulcer of the stomach is not dependent on increased ______ secretion; however, acid and ______ are believed to play a role.
- Presents with ______ that improves with meals. Rupture causes the risk of ______ from gastric arteries.
peptic ulcer: duodenal lesser antral pre-pyloric H. pylori gastric acid pepsin epigastric pain bleeding
- ______ ulcer is mediated by H. pylori, in which bacterial ureases and proteases break down ______ in gastric mucus, thus interfering with ______ protection.
- Increased permeability of the ______ to ______ ion, resulting in back diffusion of hydrogen ion with injury to the gastric mucosa.
- Bile-induced gastritis leading to gastric ______.
- Treatment: same as ______.
- Note a precursor to gastric ______
peptic ulcer: gastric gastric glycoproteins epithelial gastric mucosa hydrogen ulceration GERD carcinoma
Complications of Peptic Ulcer Disease
-______ (most common)—______ (vomiting of blood), ______ (black stool), iron deficiency anemia
Hemorrhage
hematemesis
melena
-Malignant proliferation of surface epithelial cells (adenocarcinoma). Carcinoma of the stomach is most common after ______ years of age, with an increased incidence in men. It occurs more frequently in persons with blood group ______, suggesting a ______ predisposition. Incidence varies greatly from one geographic area to another, with incidence much higher in Japan, Finland, and Iceland. The incidence is decreasing in the US. Two main types:
-1) ______ (more common) presents as a large, irregular ulcer with heaped up margins; most commonly involves the ______ of the ______ (similar to
gastric ulcer).
-2) ______ is characterized by ______ cells that diffusely infiltrate the gastric wall (leather bottle stomach).
-Causative factors:
-______ is a high suspect
-______ from dietary amines and nitrites used as food preservatives may play a role. Incidence of the disease is greatly increased in populations who eat large amounts of ______ and ______ and pickled vegetables.
-Increased incidence is also associated with excessive ______ intake and a diet low in fresh fruits and vegetables
-Chronic gastritis with or without ______
-Treatment: ______ with or without ______.
gastric carcinoma 50 A genetic Intestinal type lesser curvature antrum Diffuse type signet ring H. pylori Nitrosamines smoked fish meat salt pernicious anemia Surgical resection perioperative chemotherapy
Developmental abnormalities: Congenital diverticula (e.g., Meckel’s diverticulum) mimics the symptoms of appendicitis but pain \_\_\_\_\_\_ corner of \_\_\_\_\_\_. \_\_\_\_\_\_ of all three layers of the \_\_\_\_\_\_ wall.
left
abdomen
Outpouching
bowel
______ (marked dilation of large intestine) is notable proximal to the narrowing of the rectum. Due to congenital failure of ______ (neural crest-derived) to descend into ______ and ______ plexus. Clinical features include failure to pass ______, or chronic ______ with abdominal bloating early in life, may present as acute enterocolitis with watery/foul smelling stool or rupture of the ______.
-Treatment: resection of the involved ______; ______ are present in the bowel proximal to the diseased segment
Hirschsprung’s disease Megacolon ganglion cells myenteric submucosal meconium constipation colon bowel ganglion cells
- Out pouching of colonic mucosa through weak areas in wall (diverticulum) causing ______. most frequently involve the ______ colon. They are almost always multiple. Diverticula are most common in older persons. Chronic ______ and ______ diet predisposes to this condition.
- Most diverticula are ______, but occasionally problems arise.
- When bits of fecal material become trapped within the pouches and incite inflammation, this reaction is called ______. Complications: inflammation, ______, and ______ rectal bleeding.
- Treatment: High ______ diet and ______ (diverticulitis)
diverticulosis sigmoid constipation low-residue asymptomatic diverticulitis perforation bright red fiber antibiotic
hemorrhoids:
-pathophysiology:
– Mass of swollen ______ in ______ or ______
– Idiopathic
– ______ (veins of the lower rectum) and predispose to ______.
– ______ (veins of the anal region) and may or may not ______.
– Constipation and increased ______ predispose to development
-signs and symptoms:
– Limited ______ bleeding and painful stools
– Consider ______ bleeding
-Treatment : ______, high ______ diet and rectal ointment.
veins anus rectum Internal bleeding External bleed straining bright red lower GI Stool softener fiber
other intestinal vascular diseases:
- ______: localized vascular lesion in colon and ______ in old people.
- ______: decrease blood flow in the intestine (acquired malformation of mucosal layer) due to the ______ of at least two of the major ______ vessels.
angiodysplasia unexplained bleeding Ischemic bowel disease atherosclerotic occlusion mesenteric
IBD is sometimes confused with IBS, which stands for irritable bowel syndrome. Both conditions can cause chronic digestive problems, but there are significant differences between the two. People with IBD have ______, ______, and other damage visible inside the digestive tract. In contrast, there is no damage in IBS, despite symptoms such as ______, ______, and constipation. IBS is much more common but ______ serious than IBD.
inflammation ulcers cramping diarrhea less
-Pathogenesis: inflammation of the distal ileum (small intestine) which affects the ______ side of the abdomen.
-______ in appearance and inflammation may skip area.
-Ulceration of the ______ and scaring of the ______ intestine.
-Presence of ______, fistula and ______(string sign). String sign on X-ray after ______ (narrowed bowel lumen).
-______ and related to ______ gene
-Causes: Idiopathic and may flare
up with ______
-Treatment: Cortisol, ______, Remicade (______).
chron's disease Right Patchy mucosal layer small granuloma stenosis barium Autoimmune HLA stress/food Humira DMARDs
- Pathogenesis: recurrent chronic inflammation of the large intestine and affects ______ side of the abdomen.
- No skipped area of ______ and involves the whole area (______).
- Presence of ______ and ______ (not cancerous).
- Deep linear ulceration and mucosal layer is red and ______.
- Cause:Idiopathic. Patients with ulcerative colitis have a much higher risk of developing ______.
- Treatment: ______, cortisol and immunosuppressants (______).
ulcerative colitis Left inflammation transmural megacolon pseudopolyps granular colorectal adenocarcinoma Anti-diarrheals DMRADs
gastrointestinal infections
- Food poisoning—bacterial toxins (______)
- Viral infections
- ______ (small intestine): E. coli (Traveler’s diarrhea, Vibrio cholerae, Giardia lamblia, rotavirus
- Large intestinal infection— Shigella, ______ (cruise ship fever).
Staph
Infectious diarrhea
Norwalk virus
- Pathophysiology:
- Inflammation of the appendix
- Frequently affects ______ children and ______ adults.
- Lack of treatment can cause ______ and subsequent ______
- signs and symptoms:
- ______, vomiting, and ______ fever.
- Pain localizes to ______ (______ point).
- treatment: ______
Appendicitis older young rupture peritonitis Nausea low-grade RLQ McBurney’s surgery
intestinal obstructions
-adhesions: ______
-______: (twisting of a portion of the gastrointestinal tract about itself), often causing bowel obstruction
-______: Telescoping of proximal segment of bowel forward into distal segment Telescoped segment is pulled forward by ______ which results in obstruction and disruption of ______ with ______.
Cause: ______
tumors volvulus intussusception peristalsis blood supply infarction Tumor
mal absorption Resulting from Defective Digestion
- Deficiency of ______
- Deficiency of bile—______ obstruction, ______ disease.
- Deficiency of pancreatic juices—______
- Protozoa overgrowth—______
- Worm infection like ______ worm or ______ worm
gastric juices biliary liver chronic pancreatitis Giardia lamblia tape round
- hypersensitivity to dietary grain (gliadin or gluten), It is more common in patients with ______. Diagnosis involves documentation of ______, small intestinal biopsy demonstrating blunting of small intestinal ______, the presence of ______ and anti-tissue ______ (Anti-TTG antibodies), and clinical improvement and restoration of normal intestinal morphology on a gluten-free diet. Incidence increases in association with human leukocyte antigens (HLAs) ______ and ______
- Presence of antibodies directed against ______ (a glycoprotein component of gluten) These antibody tests may also be used for screening prior to definitive diagnosis by biopsy.
- Clinical symptoms: ______ (fat in stool), chronic diarrhea and ______.
celiac sprue Type I diabetes mellitius malabsorption villi IgA transglutaminase HLA-B8 HLA-DW3 gliadin Steatorrhoea bloating
other diseases by mal absorption
-______: ______ (bacteria). Results in fat malabsorption and steatorrhea. Systemic tissue damage characterized by ______ loaded with this bacteria.
-______: Damage to small bowel villi due to an unknown organism resulting in mal absorption.
Occurs in ______ regions. Responds to ______.
Whipple’s disease Tropheryma whippelii macrophages Tropical sprue tropical antibiotics
- ______ are outgrowths of rapidly dividing mucosal cells into the ______ of the ______ (and rarely the small intestine).
- ______ polyps occur anywhere along the length of the bowel and have no significance clinically.
- Inflammatory polyps consist of ______ and are most commonly caused by the inflammation that occurs with the ______.
Polyps lumen colon Hyperplastic granulation tissue inflammatory bowel diseases
hamartomatous polyps
- ______: These occur most often in children (no surprise according to the name). They can affect both the large and small bowel, but the most frequent site of occurrence is the ______. large numbers of juvenile polyps increase the risk of progression to ______.
- ______: In this ______ dominant syndrome hamartomatous polyps can be found in the ______ and ______ bowel. Along with polyps in the ______ tract, are seen on the hands, mouth, lips, and on the genitals. Increased risk for colorectal, breast, and gynecologic cancer.
Juvenile Polyps rectum carcinoma Peutz-Jeghers Polyps (Peutz-Jegher syndrome) autosomal small large gastrointestinal
adenomatous Polyps
- There are 3 different configurations of adenomatous polyps. The polyps themselves are not ______, but depending upon the ______, there is an increased potential to develop into a malignancy. They are considered true ______. Symptoms range from being asymptomatic to ______.
- ______ : This is the most common configuration and appears small and ______ (mass coming out of the membrane). There is a slightly increased risk of developing malignancy, but the malignant potential is low.
- ______: This configuration includes 5-10% of adenomatous polyps and appears similar to tubular adenomas; however, their surface is covered by ______. They are of ______ malignant potential.
- ______ : This configuration comprises 1% of adenomatous polyps and appears somewhat ______ surface. They have the ______ associated malignant potential of the three types, with approximately ______ transforming into malignancy.
malignant configuration neoplasms rectal bleeding Tubular Adenoma peduncular Tubulovillous Adenoma finger-like projections intermediate Villous Adenoma flattened highest 30%
- Carcinoma arising from colonic or rectal mucosa; 3rd most common site of cancer. Peak incidence is 60-70 years of age.
- ______ mutation, mismatch repair genes in DNA, Colorectal carcinoma arises ______ (not from adenomatous polyps) at a relatively early age; usually ______, Screening for colorectal carcinoma occurs via ______ and fecal occult blood testing; begins at 50 years of age. Goal is to remove ______ before carcinoma develops and to detect cancer early (before clinical symptoms arise).
- Carcinoma can develop anywhere along entire length of ______.
- Left-sided carcinoma usually grows as a ______ lesion, left lower quadrant pain, and blood- streaked stool.
- Right-sided carcinoma usually grows as a ______; presents with ______ anemia (occult bleeding) and vague pain. An older adult with iron deficiency anemia has colorectal carcinoma until proven otherwise.
Colorectal (Colon) Carcinoma P53 de novo right-sided colonscopy adenomatous polyps colon 'napkin- ring' raised lesion iron-deficiency
Colorectal (Colon) Carcinoma: Staging
- ______—depth of invasion; tumors limited to the mucosa.
- ______—spread to regional lymph nodes
- ______—distant spread; most commonly involves the liver
- Lab test for ______ (serum tumor marker) which is useful for assessing treatment response and detecting recurrence; for screening (not useful)
- Treatment: Surgery and ______
T N M CEA Chemotherapy (5-FU)
Gastrointestinal carcinoids
- Ninety percent occur in the ______
- ______ the most common site of origin
- If smaller than ______, benign; larger ones can ______
- May be ______, especially in terminal ileum and stomach
- Composed of ______ that contain granules visible by electron microscopy and ______
intestines Appendix 2 cm metastasize multiple neuroendocrine cells polypeptide hormones
