Chapter 36- Digestion Flashcards
1
Q
What are the four layers of the digestive tract?
A
- Mucosa
- Submucosa
- Muscularis
- Serosa
2
Q
What layer of the digestive tract is protected by a layer mucus?
A
Mucosa
3
Q
How many layers of mucus protect the small intestine?
A
Single layer
4
Q
How many layers of mucus protect the large intestine?
A
2 layers
-Inner and outer layer
5
Q
What do GI tract disorders disrupt?
A
One or more of the GI tract’s functions
6
Q
What can structural and neural abnormalities do?
A
Obstruct and Slow/accelerate intestinal contents
7
Q
What do Inflammatory and ulcerative conditions disrupt?
A
Secretion
Motility
Absorption
8
Q
What is the Greek word for vomiting?
A
Emesis
9
Q
What is vomiting?
A
Forceful emptying of the stomach or intestinal contents through the mouth
10
Q
Where is the vomiting centre?
A
Medulla oblongata
11
Q
What is retching?
A
Muscular event of vominiting without vomitus expulsion
12
Q
What is projectile vomiting?
A
Spontaneous vomiting that does not follow nausea or retching
13
Q
What causes projectile vomiting?
A
Direct stimulation of vomit centre
14
Q
What are symptoms of vomiting?
A
Severe pain
Distention of stomach/duodenum
15
Q
What initiates vomiting?
A
Deep inhalation and glottis closes
16
Q
Once vomiting is initiated, what do the abdominal muscles do?
A
Create pressure from stomach to throat
17
Q
What parts of the GI tract spasm to force chyme into the esophagus?
A
Duodenum
Stomach antrum
18
Q
During vomiting, what must occur for contents to not be able to enter the mouth?
A
Upper oesophageal sphincter has to stay closed
19
Q
During vomiting if abdominal muscles relax what happens?
A
Contents (in the esophagus) return to the stomach
20
Q
What finally relaxes both oesophageal sphincters?
A
parasympathetic nervous system
21
Q
During vomiting, what happens when abdominal muscles contract?
A
Diaphragm is forced into thoracic cavity and chyme is forced out of the mouth
22
Q
What is constipation?
A
Difficult/infrequent defecation
23
Q
Why is constipation individually determined?
A
Because there is a wide normal defection range
24
Q
What is the normal defecation range?
A
1-3/day to 1/wk
25
What is primary constipation?
Impaired, infrequent, and straining colonic movement
26
What is secondary constipation?
Neural pathways are altered causing colon transit time to be delayed
27
What inhibits bowel movement?
Opiates specifically, codeine
28
A notable change in constipation can be indicative of what?
Colorectal cancer
29
What can straining to defacate (constipation) lead to?
Haemorrhoids
30
How is constapation diagnosed?
Spincter tone assessed
Anal lesions detected
Colonoscopy (direct lumen view)
31
How is constipation treated?
OTC laxatives (RestoraLAX)
Enemas
Surgery (colectomy)
32
Should enemas be used habitually?
No they should only be used to determine a bowel routine
33
What surgery is is used to treat constipation as a last resort?
Colectomy
-removing part of the colon
34
What is diarrhoea?
Loose watery stools
35
What is acute diarrhoea?
24 hrs or less
36
What is persistent diarrhoea?
14-28 days
37
What is chronic diarrhoea?
longer than 4 weeks
38
Who has higher rates of morbidity/mortality of diarrhoea?
Children younger than 5 years old
39
What is osmotic diarrhoea?
Non-absorbable substance in intestine draws excess water to intestine
40
What is secretory diarrhoea?
Excessive mucosal secretion of fluid and electrolytes
41
What causes secretory diarrhoea?
Viruses and bacterial toxins
42
What virus causes diarrhoea and enteritis?
Rotavirus
-RNA virus
43
What is enteritis?
Inflammation of intestinal system
44
What is motility diarrhoea?
Excessive motility causing decreased transit time and decreased fluid absorption leading to diarrhoea
45
What causes motility diarrhoea?
Surgical bypass of area of intestine
46
How is diarrhoea treated?
Restoration of fluid and electrolyte balance
Anti-motility or water absorbent medication
47
What are the 3 types of diarrhoea?
Osmotic
Secretory
Motility
48
What can cause abdominal pain?
mechanical, inflammatory or ischemic causes
49
What leads to the feeling of abdominal pain?
Abdominal organs stretch or distend and activate pain receptors
50
What are the 2 types of abdominal pain?
Parietal pain
Visceral pain
51
What is parietal pain?
from parietal peritoneum
-Pain is localised and intense
52
What is visceral pain?
Distention, inflammation, schema of abdominal organ
-Pain is poorly localised and radiates
53
What part of GI tract is affected by upper gastrointestinal bleeding?
Esophagus
stomach
duodenum
54
Upper gastro-intestinal bleeding: Appearance?
Bright red or dark (is affected by stomach acids)
55
What causes upper gastro-intestinal bleeding?
Peptic ulcers
Tearing of oesophageal drastic junction caused by severe retching
56
What part of GI tract is affected by lower gastrointestinal bleeding?
jejunum
ileum
colon
rectum
57
What causes lower gastro-intestinal bleeding?
Polyps
Inflammatory disease
Hemorrhoids
58
What is occult gastrointestinal bleeding?
Slow, chronic blood loss that is not visible/obvious to the patient or physician
59
What does occult bleeding cause?
Anemia
60
How does gastrointestinal bleeding present itself?
Trace amounts of blood in diarrhoea or stool
Blood pressure reduced
Compensatign tachycardia
Vision loss
61
What are some disorders of motility?
Dysphagia
GERD
Hiatal hernia
Intestinal obstruction (IO)
Paralytic Ileum (PI)
62
What is Dysphagia?
Difficulty swallowing
63
What are the kinds od dysphagia?
Mechanical obstruction
Functional dysphagia
Achalasia
64
What is mechanical obstruction dysphagia?
Obstruction in oesophageal wall like tumours or herniations that make it difficult to swallow
65
What is functional dysphagia?
Neural/muscular disorders that interfere with swallowing
66
What is a rare kind of dysphagia?
Achalasia
67
What causes achalasia?
Smooth muscle neurons of middle/lower esophagus are attacked by immune response
68
What is the result of achalasia?
-Altered oesophageal peristalsis
-Failure of LES to relax (obstruction)
-Cough and aspiration bc food is is forced past LES
69
What is GERD?
Gastroesophageal Reflux Disease
70
What is reflux?
Reflux of acid/pepsin or bile salts into oesophagus causing esophagitis
71
What causes GERD?
Abnormalities in LES function
LES resting tone lower than normal
Delayed gastric emptying of chyme
72
What does the severity of oesophageal damaged caused by GERD depend on?
Composition and duration of reflux
73
What does increased acidic chyme exposure because of GERD lead to?
Mucosal injury and inflammation
74
If GERD becomes persistent what is the result?
Fibrosis thickening and precancerous lesions
75
How is GERD diagnosed?
Esophageal endoscopy
Tissue biopsy
76
How is GERD treated?
Laparoscopic fundoplication to tighten junction between esophagus and stomach to prevent acid reflux
77
What is a Hiatal hernia?
Protrusion (herniation) of superior aspect of stomach through diaphragm hiatal into thorax
78
What are the 2 kinds of hiatal hernias?
Sliding
Paraesophageal
79
What is a sliding hiatal hernia?
Stomach moves into thorax through oesophageal hiatus (opening in diaphragm)
80
What is Paraesophageal hiatal hernia?
Stomach moves into thorax alongside esophagus
81
What hiatal hernia is GERD associated with?
Sliding hiatal hernia
82
What can paraesophageal hiatal hernias lead to?
Gastritis
Ulcer formation
83
What is a risk associated with hiatal hernias?
If the Hernia is strangulated it is a medical emergency
84
How are hiatal hernias diagnosed?
Radiology with barium swallow
85
How are hiatal hernias treated?
Sleeping with your head up
Laparoscopic fundoplication
86
What is an intestinal obstruction (IO)?
Any condition that prevents normal flow of chyme through intestinal lumen
87
What is paralytic Ileus (functional obstruction)?
Failure of intestinal motility due to dysfunctional neural activity after surgery
88
What is a LBO?
Large Bowel Obstruction
-Less common obstruction
89
What are LBO's often related to?
Cancer
90
Signs and symptoms of LBO?
Abdominal distention and vomiting
91
What causes a SBO (Small bowel obstruction)?
Post-operative adhesions or herniations which lead to distensions/enlargement
92
IO and PI's result in distention, distension causes?
Impaired absorption and increased secretion causing gas, fluid and solutes to accumulate in the lumen
93
What causes dehydration and tachycardia and possibly shock (IO)?
Systemic ECF fluid osmotically moving into the lumen causing decreased ECF
94
During intestinal obstructions what happens to the intestinal lumen when ECF moves into it?
Lumen becomes acidic and pathogens leak into circulation causing Sepsis and immune response with possibility of remote organ failure
95
What is Gastritis?
Inflammatory disorder of gastric mucosa
96
What is acute gastritis?
Erosion of protective stomach mucosal barrier by H. pylori and NSAIDS
97
How do NSAIDS cause acute gastritis?
Inhibit prostaglandin synthesis which normally stimulates goblet cells to secrete mucus
98
How does H. pylori cause acute gastritis?
Bacteria burrows into mucus layer, disrupts function of mucosal layer and tiggers immune response which further destroys mucosal layer
99
What are symptoms of gastritis?
Pain
Vomiting
100
How long does it to take to heal from gastritis?
Normally within a few days
101
What is chronic gastritis?
Chronic inflammation of gastric mucosa and mucosal atrophy
102
Who is affected by chronic gastritis?
Older adults
103
What are the 2 kinds of chronic gastritis?
Chronic non-immune antral
Chronic immune fundal
104
What part of stomach is affected by chronic non-immune gastritis?
Antrum
aka Antral gastritis
105
What causes chronic non-immune gastritis?
H. pylori
106
What does antral gastritis cause?
Increased hydrochloric acid secretion which leads to increased risk of duodenal ulcers
107
What part of the stomach is affected by chronic immune gastritis?
Body and fundus
aka Fundal gastritis
108
What is chronic immune gastritis?
loss of Tcell tolerance resulting in gastric mucosa being extensively degenerated in stomach fundus and body
109
What causes peptic ulcers?
H. pylori
NSAIDS
110
What is a peptic ulcer?
Break or ulceration in protective mucosal lining
111
What are the 3 disorders of peptic ulcers?
Duodenal ulcers
Gastric ulcers
Stress-related mucosal disease
112
What kind of peptic ulcers occur more frequently?
Duodenal ulcers
113
How are duodenal ulcers caused?
Causative factors cause acid and pepsin concentrations to penetrate mucosal barrier and cause ulceration
114
How does the host respond to H. pylori penetrating mucosa?
T and B cells, neutrophils combat H. pylori which causes the release of cytokines that damage the gastric epithelium
115
What does H. pylori release to cause ulceration?
Toxin that causes apoptosis of epethial cells
116
How common are Gastric ulcers?
1/4th as common as duodenal ulcers
117
Where do gastric ulcers develop?
In the Gastric antrum (next to acid-producing gastric body)
118
What happens when there is a defect in the mucosal barrier's permeability? (Gastric ulcers)
Allows hydrogen ions (H⁺) to penetrate, compromising the protective layer of the stomach.
119
Describe the resulting cycle of damaged mucosa in the stomach caused by gastric ulcers?
When the mucosa is damaged, it liberates histamine, leading to increased production of hydrochloric acid (HCl) and pepsin, which further destructs the mucosal lining.
120
What kind of ulcer is formed by stress related mucosal disease?
Acute form of peptic ulcer
121
What accompanies stress related mucosal disease?
Physiological stress
Illness
Major trauma
122
Where are ulcers caused by stress related mucosal disease located?
Multiple ulcers located in stomach or duodenum
123
What are the three types of ulcers caused by stress related mucosal disease?
Ischemic
Curling
Cushing
124
What are ischemic ulcers?
Develop within hours of events such as haemorrhage, heart failure, sepsis
125
What are curling ulcers?
Develop because of burn injury
126
What are Cushing ulcers?
Develop because of brain trauma/surgery
127
How do environmental factors or infections affect the mucosal epithelium barrier?
Alter the mucosal epithelium barrier, leading to a loss of the body's ability to discriminate harmful pathogens from commensal microorganisms.
128
What is commensal?
ssociation between two organisms in which one benefits and the other derives neither benefit nor harm
129
What is the consequence of the loss of the body's ability to discriminate harmful pathogens from commensal microorganisms?
activation of the immune system and the production of proinflammatory cytokines, which results in damage to the intestinal epithelium
130
What are 3 inflammatory bowel diseases?
1. Ulcerative colitis
2. Chron's disease
3. Irritable bowel syndrome
131
What is Ulcerative colitis?
Chronic inflammatory disease that causes ulcers in colonic mucosa
132
Where does ulcerative colitis disease begin?
In the rectum but may extend to the entire colon
133
How does ulcerative colitis cause necrosis?
Small erosions coalesce into ulcers causing necrosis
134
How does ulcerative colitis reduce transit time in the colon?
Muscularis mucosa thickens narrowing the lumen
135
Ulcerative colitis causes the urge to what?
Defecate
136
How does ulcerative colitis cause the urge to defecate?
Mucosal destruction and inflammation causes bleeding and the urge to defecate
137
How does ulcerative colitis stool appear?
Water diarrhea (frequently) with small amounts of blood and mucus
138
Ulcerative colitis causes intermittent periods of what?
Remission and exacerbation
139
What is a symptom of ulcerative colitis?
Diarrhea
10-20 stools/day
140
How is ulcerative colitis diagnosed?
Endoscopy and biopsies
141
How is ulcerative colitis treated?
Steroids, Medication
Surgery for severe disease
142
What is Chron's disease?
Idiopathic (unknown cause) inflammatory disorder
143
What does Chron's disease affect?
Any part of the digestive tract from mouth to anus
144
where does inflammation begin in Chron's disease?
In intestinal submucosa
145
How does inflammation spread in Chron's disease?
Discontinuous ("skip lesions")
Transmural (across entire wall of organ)
146
Chron's disease inflammation VS Ulcerative colitis inflammation?
Chron's: Discontinuous, transmural
Ulcerative colitis: Continuous, only mucosal and submucosal layers affected
147
What are the most common sites of disease for Chron's?
Ascending and transverse colon
-But both large and small intestines are common
148
How does Chron's disease affect the lymphoid tissue?
CD ulcerations can produce fissures/fistulae that extend inflammation into lymphoid tissue
149
What increases the risk of developing Chron's disease and may cause a poorer response to treatment?
Smoking
150
How is CD diagnosed/treated?
Similar to ulcerative colitis
151
What is fistulae?
An abnormal opening or passage between 2 organs
-May form in peri-anal area or extend into bladder, rectum or vagina
152
What is IBS?
Characterized by abdominal pain with altered bowel habits (alternating constipation and diarrhea)
153
What is the cause of IBS?`
It is idiopathic (unknown cause) with no specific biomarkers for disease
154
What does IBS target?
Altered gut microflora
155
IBS is more common in who?
Women (1.5 to 3 times greater than in men)
-Higher prevalence during youth and middle age
156
How does IBS manifest?
Lower abdominal pain or discomfort and bloating
157
What are the symptoms of IBS?
Usually relived with defecation
Does not interfere with sleep
158
Is IBS curable?
No cure
159
How is IBS treated?
Treatment is individualized
160
What is Appendicitis?
Inflammation of the appendix
161
What is the hypothesized function of the appendix?
It contains lymphoid tissue which provides a safe house for commensal bacterium for repopulation of intestinal system
162
What is the most common surgical emergency of the abdomen?
Appendicitis surgery
-Appendectomy
163
What age does Appendicitis usually occur?
10-19 years old
-can occur at any age tho
164
How does appendicitis manifest?
Mild pain increases to intense pain in 3-4 hours
Nausea
Vomiting
165
How is appendicitis treated?
Laparoscopic surgery
-Surgical procedure that allows access to viscera without creating a large incision
166
What is the common hypothesis of appendicitis?
Obstruction of the appendix lumen blocks drainage of the appendix.
167
What happens when the lumen of the appendix is obstructed?
mucosal secretions continue, leading to increased intraluminal pressure
168
What is the consequence of increased intraluminal pressure in the appendix?
Reduced blood flow causes the appendix to become hypoxic and leads to ulceration
169
How does ulceration affect the appendix in appendicitis?
Ulceration promotes bacterial invasion, triggering an immune response and inflammation.
170
What serious complication can develop in the appendix due to prolonged inflammation?
Gangrene
171
What are the four main disorders of the liver?
1. Hepatic Encephalopathy
2. Jaundice (Icterus)
3. Cirrhosis
4. Viral Hepatitis
172
What is encephalopathy?
Brain disease that alters brain function or structure
173
What is Hepatic encephalopathy?
A complex neurological syndrome characterized by impaired behavioural, cognitive and motor function
174
How does Hepatic encephalopathy affect neurotransmission and brain function?
A combination of biochemical alterations
175
What causes liver dysfunction associated with Hepatic encephalopathy?
The development of collateral vessels that shunt blood around liver to systemic circulation
176
What is the consequence of blood being shunted around the liver in hepatic encephalopathy?
Shunt permits toxins absorbed from the GI tract (normally removed by the liver) to circulate to the brain.
177
How do toxins affect the brain in hepatic encephalopathy?
Toxins alter cerebral energy metabolism, interfere with neurotransmission, and cause edema.
178
Which toxin is most hazardous in hepatic encephalopathy?
Ammonia
179
What are the effects of ammonia circulating the brain due to Hepatic encephalopathy?
Astrocytes swell, alter the blood-brain barrier and promote cerebral edema
180
What is Jaundice?
Yellowing pigmentation of the skin
181
What is the cause of Jaundice?
Hyperbillirubinemia
-Increased plasma bilirubin concentration
182
What is bilirubin?
A component of Hb breakdown that is normally removed from blood by the liver
183
Increased plasma bilirubin concentration indicates what?
Liver damage
184
What are the 2 types of jaundice/icterus?
Obstructive jaundice
Hemolytic jaundice
185
What is obstructive jaundice?
Occlusion of common bile duct by gall stones, tumor, etc.
186
How does obstructive jaundice lead to increased plasma [bilirubin] (cause jaundice)?
The blockage prevents bilirubin from flowing to the duodenum and it accumulates in the liver, which then enters the bloodstream
187
What is Hemolytic jaundice?
Excessive production of bilirubin from excessive hemolysis of RBC
188
How does hemolytic jaundice lead to increased plasma [bilirubin] (cause jaundice)?
Plasma [bilirubin] exceeds the liver's ability to process it and increases
189
How does Jaundice manifest?
-Darkened urine (noticeable several days before)
-Bacterial infections
-Yellowing of sclera of eye (first yellowing of the skin that appears)
190
What is Cirrhosis?
Irreversible fibrotic scarring of liver in response to inflammation and tissue damage
191
Liver cirrhosis is the final step of what diseases?
Chronic liver diseases
192
What does the scar tissue caused by fibrosis cause?
Blood flow obstruction
193
When liver blood flow is obstructed by Cirrhosis what happens?
Jaundice
Increased portal hypertension
Cellular dysfunction
194
How does Cirrhosis lead to liver failure?
Regeneration of the liver is disrupted by hypoxia causing necrosis and atrophy
195
How does Cirrhosis manifest?
The liver gets a cobbly appearance and is hard upon palpitation
196
What are the types of Cirrhosis?
Alcoholic cirrhosis
Non-alcoholic fatty liver disease
Biliary cirrhosis
197
What is Alcoholic cirrhosis?
Toxic effects of alcohol on the liver causing immune alterations
198
How does alcohol cause alcoholic cirrhosis?
Alcohol is transformed into acetaldehyde which activates hepatic stellate cells. Stellate cells are hyperactivated resulting in collagen formation causing fibrosis and scarring
199
The damage caused by alcohol on the liver/stellate cells results in what?
Translocation of gut microbiota
200
What is Non-alcoholic fatty liver disease?
Infiltration of hepatocytes with triglycerides
201
What is non-alcoholic fatty liver disease commonly associated with?
Obesity
High blood triglyceride concentration
High cholesterol levels
202
What is biliary cirrhosis?
Damage and inflammation leading to cirrhosis begins in bile ducts rather than hepatocytes
203
What are the two kinds of biliary cirrhosis?
Primary
Secondary
204
What is primary biliary cirrhosis caused by?
Chronic, autoimmune liver disease
-T cells and anti-mitochondrial antibodies
205
How is the bile duct obstructed in primary biliary cirrhosis?
Bile ducts are damaged causing fibrosis which obstructs the bile duct
206
What causes secondary biliary cirrhosis?
Caused by obstruction of common bile ducts by gallstones, tumours, etc.
207
What is Viral hepatitis?
Common systemic disease that primarily affects the liver
208
What are the 5 types of Hepatitis?
A, B, C, D, E
209
All 5 types of Hepatitis can cause what?
Jaundice
210
How does Hepatitis affect the liver?
The invasion of pathogens causes hepatic cell necrosis and scarring
211
How is further cell injury promoted by Hepatitis?
Immune response
212
What types of hepatitis produce the most severe damage?
Hepatitis B and C
213
What virus can Hepatitis co-infect with?
HIV
214
Why can a co-infection of Hepatitis and HIV occur?
Because the viruses share the same route of transmission (contact between infected body fluids)
215
A co-infection promotes what?
Rapid progression of Liver disease
216
How is Hepatitis diagnosed?
Based upon the presence of viral antibodies
217
How is Hepatitis treated?
Viral replication suppression
218
Is Hepatitis preventable?
Yes Hep B vaccine is available for all age groups
219
What are some common gallbladder disorders?
Obstruction
Inflammation
220
What are gallstones?
Aggregates of bile
221
WHat causes gallbladder inflammation?
Gallstones block flow of bile in and out of the gallbladder
222
What is the term for gallstone formation?
Cholelithiasis
223
What is the term for gallbladder inflammation?
Cholecystitis
224
What happens in obstructive pancreatic disease?
There is a backup of pancreatic secretion, leading to the release and activation of pancreatic enzymes within acinar cells.
225
What is the result of enzyme activation within acinar cells in the pancreas?
The enzymes cause autodigestion of pancreatic cells and tissues, leading to inflammation.
226
What are the consequences of autodigestion in the pancreas?
Vascular damage
Necrosis
Pseudocysts formation
227
What are pseudocysts?
Walled-off collections of pancreatic secretions
228
What is the main cause of further developments in pancreatic disease?
Alcohol abuse
229
How does alcohol abuse affect the pancreas?
Acinar cells metabolize ethanol into toxic metabolites that release acinar digestive enzymes.
230
What is the impact of chronic alcohol consumption on the pancreas?
Chronic alcohol consumption leads to the destruction of acinar cells, which causes tissue destruction that is replaced with fibrosis, leading to pancreatic cysts.
231
How is Pancreatic obstructive disease treated?
Alcohol cessation
232
What are some cancers affecting the GI Tract?
Cancer of the Esophagus
Cancer of the Stomach
Cancer of the Colon and Rectum
233
What cancer forms in esophageal cancer?
Carcinoma and adenocarcinoma of epithelium
234
Where do adenocarcinomas initiate?
Epithelial glandular cells
235
Where do carcinomas initiate?
Epethilial squamous cells
236
How does cancer of the esophagus manifest?
Dysphagia (swallowing difficulties) and chest pain
237
What makes you more at risk to getting cancer of the esophagus?
Alcohol combined with smoking or chewing tobacco
238
What cancer forms in Stomach cancer?
Gastric adenocarcinoma associated with H. pylori
239
What promotes the development of stomach cancer?
Heavily salted and preserved foods
240
How does salt enhance the development of stomach cancer?
Salt enhances the conversion of nitrates to carcinogenic nitrosamines
241
What is the most common form of cancer?
Carcinoma
-Adenocarcinoma = subtype of carcinoma
242
What cancer forms in colon and rectum cancer?
Colon adenocarcinoma associated with pre-existed polyps
243
How does colon and rectal cancer manifest?
Pain, bloody stool and change in bowel habits
244
Where do rectal carcinomas occur?
Close to anus
-Spread to female vagina and male prostate
245
What are some cancers of accessory digestive organs?
Cancer of the Liver
Cancer of the Gallbladder
Cancer of the Pancreas
246
What is the leading cause of world-wide cancer deaths?
Liver cancer
247
What are primary liver cancers associated with?
Chronic liver disease
-Hepatitis and Cirrhosis
248
What form of cancer develops in liver cancer?
hepatocellular carcinomas
Cholangiocellular carcinomas
249
What do hepatocellular carcinomas arise from?
Hepatocytes
250
What are cholangiocellular carcinomas?
A rare form of cancer that develops in bile ducts
251
Does liver cancer metastasize?
yes, can metastasize to many other organs
252
When is gallbladder cancer most common?
between age 50-60
253
What is the most common cancer form causing Gallbladder cancer?
Adenocarcinoma
254
Does gallbladder cancer metastasise?
Yes to lymph vessels
255
When does metastasis of gallbladder cancer often occur?
Before diagnosis
-prognosis is poor if it metastasizes
256
What is the fourth leading cause of cancer death in Canada?
Pancreatic cancer
257
What cancer forms in pancreatic cancer?
Adenocarcinoma in the exocrine component of the pancreas
258
When does metastasis of pancreatic cancer often occur?
Before diagnosis
