Chapter 14 (2) Flashcards
- In the stomach, generalized paths like benign gastritis may include epigastric pain, nausea, vomiting
- ______ is the MC cause of infection
helicobacter pylori
With MUCOSAL ULCERATIONS that can lead to hemorhage in the stomach, a pt may have vomiting like “COFFEE GROUNDS” aka: _______, or ________ which are black tarry feces
hematemesis (vomitting of blood)
melena
Two MC risks of GASTRIC INFLAMMATORY DISEASES (acute & chronic)
alcohol
nsaids
_________ has an onset that follows TRANSIENT mucosal inflammation pattern, with multifactorial pathogenesis. The pH is close to _____
- EPIGASTRIC PAIN, nausea, vomit, anorexia
- Hematemesis associated with ALCOHOLICS
- Dose-dep assoc w/ NSAIDs
acute gastritis
1 (strongly acidic)
- Multiple small shallow ulcers in STOMACH & DUODENUM due to severe PHYSIOLOGICAL stress and NSAIDs
- INTRACRANIAL DISEASE, aka _________, vomiting up of COFFEE GROUND HEMATEMESIS
acute peptic ulceration
Cushing ulcer
- _______ gastritis is LESS SEVER but MORE PROLONGED and is associated w/ peptic ulcers, HELICOBACTER PYLORI (70-90%), and combines w/ other injuries
- Increased acid prod
- POOR CHILDHOOD SANITATION/HYGIENE
- May complicate into gastric _______ bc its inflam (5x)
chronic
adenocarcinoma
Gastritis type MC in elderly females, DECREASED B12 ABSORPTION, can cause PERNICIOUS ANEMIA
(CHRONIC gastritis)
autoimmune gastritis (CHRONIC gastritis)
_________ disease develops in highly acidic areas, in the PROXIMAL DUODENUM (4x) and cuases a solitary “PUNCHED OUT” lesion
- Perforation/hemorrhage possible -> med emergency
- 10% male 4% female lifetime risk
peptic ulcer
PEPTIC ULCER DISEASE is the result of chronic/recurrent gastritis and/or hyperacidity, and like gastritis, two risk factors are _________
helicobacter pylori (MC, 70-90%) nsaids
Peptic ulcer disease is MC at night 1-3 hrs ____ (after eating) and is relieved by ___ substances
postprandial
alkaline
_______ PEPTIC ULCER DISEASE have immediate postprandial RELEIF (dairy) while _______ ulcers are worse on EMPTY STOMACH or POSTPRANDIAL (after eating), and have less predictable features
- Both are relief w/ alkaline, worse at night, inconsistent pain patterns
duodenal (dairy-duodenal)
gastric
Mass PROJECTING FROM MUCOSA into gastric lumen that is associated w/ chronic gastritis
gastric polyps
- GASTRIC POLYPS are MC (75%) appears as ______ & ______ post biopsy, and is unlikely to transition into CA.
- _______ are LEAST common but 30% transition into adenocarcinomas
- Biopsy required to determine
inflammatory & hyperplastic
gastric adenomas
(GASTRIC POLPYS)
- > 90%* of all gastric CA are GASTRIC ____, which are dx late and are already advanced, as symptoms develop late
- RESEMBLES chronic gastritis
- 5 yr survival:
adenocarcinomas
JAPAN
Used to take an esophageal biopsy of polyps
EGD (esophagogastroduodenoscopy)
MC occurring in the ______ intestine, INTESTINAL OBSTRUCTIONS present with pain, distention, constipation, and are 80% of all mechanical obstructions
small
CONGENITAL, BLIND ENDED OUTPOUCHING of the SI that occurs in 2% of all births (common), is 2x mc in males, and is MC asymptomatic (2% symptomatic)
meckel diverticulum
(small intestine)
(Rule of 2: 2% symptomatic, males 2Xs)
CONGENITAL GANGLIONIC MEGACOLON that occurs in the RECTUM or SIGMOID colon, LACKS neurologic ganglia in the DISTAL INTESTINES and obstructs the proximal bowl
hirschsprung disease
A ______ is an intestinal obstruct that is secondary to an abdominal wall defect while _______ start as inflammation –> fibrosis and cause adherent intestinal segments
herniation
adhesions
AKA: Ischemic bowel disease: that tend to have OCCLUDED arteries, ischemia from occlusion, and mucosal INFARCTION
ischemic colitis
IBD
______ is an intestinal obstruct with telescoping of the prox bowel into the distal segment while a _____ occurs with a twisting loop of bowel and poss infarction
intussusception
volvulus
- Hirschsprung disease is dx by a FAILURE to _____
- MC in _______, more SEVERE in _______
pass meconium
males
females
Ischemic bowel disease that tend to have OCCLUDED arteries, ischemia from occlusion, and mucosal INFARCTION
ischemic colitis
_______ causes occlusion secondary to atherosclerosis, while _____ involves myocardial infarction, and ______ ischemia involves heart failure, hemorrhage, shock etc.
- Misc causes of ischemic bowel disease involve scarring/stricture
thrombosis
arterial embolism
non-occlusive
______ ischemic bowel disease has episodic bloody diarrhea and mimics ibd while _______ has sudden/severe abdom pain, nausea, frank blood in stool
- Elderly at risk for both, CVD
chronic
acute
_____ features include weight loass, cachexia, abdom distention, etc and consequences including vitamin deficiencies, anemia, peripheral neuropathies
- Can transition to ________
malabsorption
cystic fibrosis
TORTUOUS VESSELS, MALFORMED DILATIONS MC in CECUM or ASCENDING colon with idiopathic cause (poss mech stress)
angiodysplasia
- _______ are thin walled VARICES MC vasc d/o of GI TRACT
- > 50 increased risk, increased intraabdominal pressure (VALSALVA’S)
- Can develop in advanced _______ causing portal HTN
hemorrhoids
liver cirrhosis
Hemorrhoids can range from asympt to v painful, as it irritates surrounding tissues, causes perianal _____ and frank blood in stool. Patients may be EMBARRASSED
Internal hemorrhoids: _______ anorectal line
External hemorrhoids: _______ anorectal line
pruritis
above
below
Top THREE malabsorption diarrheal diseases in the US, caused by intestinal inflammation (in ORDER)
pancreatic insufficiency
celiac disease
chrohn disease
Malabsorption manifests as CHRONIC DIARRHEA from DEFECTIVE ABSORPTION, and can be _____ (chronic), with excessive fat in feces or ______, bloody diarhhea
steatorrhea
dysentery
_____ features include weight loass, cachexia, abdom distention, etc and consequences including vitamin deficiencies, anemia, peripheral neuropathies
malabsorption
NON-INFECTIOUS MALABSORPTION reaction to GLIADIN in grains such as wheat barley and rye, that causes VILLOUS ATROPHY
celiac disease
- 1% of US & Europe population has celiac disease, and the MC patients are ______ (race and age)
- Symptoms range STEATORRHEA, BLOATING, ABDOMINAL DISTENTION
caucasians 30-60 yo
Pruritic blisters on limbs, buttocks, found in 10% of CELIAC DISEASE patients
- Similar appearance to HERPES VESICLES
dermatitis herpetiformis
- AKA tropical sprue, inflam cycle beginning with DIARRHEA, steatorrhea, weight loss then MALAISE and NUTRITIONAL DEFICIENCIES that will cause stunted growth
- MC in CHILDREN 2-3 yrs old
environmental enteropathy
Environmental enteropathy can either be _________ which RESPONDS TO ANTIBIOTICS or ________ which causes VILLUS FLATTENING
infectious
autoimmune
Lactase deficiency can either be _______ MC in young adulthood or ________
- Dx via breath hydrogen test, unremarkable biopsy
acquired
congenital
- Major GLOBAL health problem where MICROBIAL INFECTIONS cause inflam and diarrhea
- 12k children die each day
infectious enterocolitis
Cholera is caused by _______ which releases a CHOLERA TOXIN that causes massive CHLORIDE ION secretion into the GI tract which causes abrupt vomiting & RICE WATER STOOL, HYPOTENSION, SHOCK
vibrio cholerae
- MC bacterial enteric path in US, caused by contaminated chicken and is MC non invasive but enterotoxins can invade
- Can be ACUTE SELF-LIMITED and last less than a month
campylobacter enterocolitis
In acute self limited colitis, campylobacter jejuni presents with an accum of neutrophils & _______, while e. coli has neutrophils and _________
crypt abscess
normal crypt architecture
AKA ANTIBIOTIC ASSOCIATED COLITIS, as antibiotics disrupt microbiota and causes a CLOSTRIDIUM DIFFICILE overgrowth, build up of neutrophils
- HOSPITALIZATION increases risk, leukocytosis occurs
pseudomembranous colitis
- 1/2* of all gastroenteritis is _______, presents with nausea, vomiting, abdom pain, diarrhea
- Children: ________
- Adults: ________
viral
rotavirus
norovirus
- Regional &TRANSMURAL inflammation that causes fissues, skip lesions, granulomas, strictures and is 1:500
- Risk for GI adenocarcinoma 8-10 yr post dx
crohn disease
IBD
- MC parasitic infection that RESISTS COLD AND CHLORINE, stems from fecal, water contam and alters SI enzymes
- AKA: giardiasis, BEVER FEVER
giardia lamblia
SUPERFICIAL MUCOSAL ULCERATIONS that begins in RECTUM, moves proximal, presents as PSEUDOPOLYPS, is 1:5000 in patients 20-25 yrs
- _________ is INHIBITORY
ulcerative colitis (IBD) smoking
Sigmoid ________ is active and inflamed, while colonic ________ indicates a simple presence, non inflammatory
diverticulitis
diverticulosis
________ are defects in the colon wall (95% sigmoid), can lead to INFECTION, possible PERFORATION and HEMORRHAGE
- Increased risk with AGE, constipation, decreased fiber
acquired diverticulum
50% people ______ get SIGMOID DIVERTICULITIS, 20% are SYMPTOMATIC, which includes TENESMUS
- Tx: INCREASE FIBER
> 60 yrs old
ALTERED BOWEL HABITS, DIARRHEA, CONSTIPATION, chronic & relapsing ABDOMINAL PAIN MC between 20-40 yrs females with NO CELLULAR INFLAMMATION abnormalities
irritable bowel SYNDROME
Abnormal local immune response that is idiopathic
- Crohn: MC in _______, TRANSMURAL
- Ulcerative colitis: RECTUM –> DISTAL COLON, ________
inflammatory bowel DISEASE
ileum
mucosa/submucosa
- Regional & TRANSMURAL inflammation that causes fissues, skip lesions, granulomas, strictures and is 1:500
- Risk for GI adenocarcinoma 8-10 yr post dx
crohn disease
MC location for chron disease symptoms (3)
terminal ileum
ileocecal valve
cecum
SUPERFICIAL MUCOSAL ULCERATIONS that begins in RECTUM, moves proximal, presents as PSEUDOPOLYPS, is 1:5000 in patients 20-25 yrs
- _________ is INHIBITORY
ulcerative colitis
smoking
- Ulcerative colitis as an _______ onset of TENESMUS, FEVER, ABDOMINAL PAIN and presents with GROSSLY BLOODY and MUCOID STOOL
- Increased adenocarcinoma risk with dysplasia
insidious
POLYP is a mass that protrudes into lumen of colon, can be inflam (min risk), hamartomas (min risk), or ________, which is piled up epithelia resembling benign dyslplasia
hyperplastic
________ polyp is a neoplastic mass that is DYSPLASTIC, PREMALIGNANT, and can become adenocarcinoma
adenomatous
50% of ALL US ADULTS > 50 yrs, onset >40 yrs have _________, benign tumors but with dysplasia pose risk of aggressive adenocarcinomas
- MALIGNANT UNTIL PROVEN BENIGN
- Larger = greater CA risk
adenomas
____________ is a rare autosomal dominant mutation that has a 100% chance of CA, MC by 30 yo
- Detected by fecal occult blood, tx by PROPHYLACTIC COLECTOMY
familial adenomatous polyposis
Tumors of the colon are the MC carcinoma: _______% of US pop develops colorectal CA, _____% LETHAL, and ______% of CA-RELATED DEATH
5
40
15
55k deaths from ________, the MC MALIGNANCY of GI tract, MC dx from age 50-70, w/ a HIGHLY PROCESSED DIET of low fiber and high carbs (USA has highest rate obvs)
- _____ % of ALL CA-related mortality
colorectal adenocarcinoma
15%
Early on, colorectal adenocarcinoma is __________ but progresses insidiously to alter BM, fatigue, weakness, and can mets via regional lymph & hematopoietic, MC to ________
asymptomatic
liver
- Neoplasms of the SI are rare, only 1% of GI MALIGNANCIES, and are MC in the ____
- 50% ADENOCARCINOMAS, 50% CARCINOID TUMORS
- Dx when advanced (asymp early), shows ABDOMINAL PAIN/CRAMPING
duodenum
MC ACUTE ABDOMINAL CONDITION that presents with RLQ TENDERNESS, deep/constant pain, ANOREXIA, NAUSEA, VOMITING
acute appendicitis
________ MC cause of APPENDICITIS (50-80%), ischemia –> inflammation
- High morbidity & mortality when PERFORATED due to peritonitis, sepsis potential
obstruction
MC tumor of the appendix is _______, possible adenocarcinoma but it is rare
carcinoid
