Digestive Flashcards
Diaphragmatic hernia
Protrusion of any abdominal structure through the hiatus in the diaphragm.
Hiatus hernia: Causes/risk factors
Idiopathic
Age, obesity, smoking
Diaphragmatic hernia: cause/risk factors
Idiopathic
Older than 50, overweight (especially women), smoking
Other types may be congenital
Sliding hiatus hernia
Junction between stomach and esophagus, and portion of stomach, protrude above diaphragm.
Paraesophageal hiatus hernia
Gastro-esphogeal junction in its normal place; portion of stomach pushed above hiatus and lies beside esophagus
Sliding hiatus hernia: Sx
Sometimes asymptomatic
Symptoms minor, related to reflux (indigestion, especially when lying down or eating, leaning forward, straining, bun in oven)
Hiatus hernia
Protrusion of a portion of the stomach across the opening of the diaphragm
Strangulation
Complication of paresophageal hernia
When the herniated segment gets pinched or trapped by diaphragm and loses blood supply.
Medical emergency
Hiatus hernia: Dx
X-ray, often barium
Hiatus hernia: Tx
Sliding: symptomatic of required
Paresophageal: surgery
Reflux Esophagitis
GERD
Stomach acid and enzyme flow backwards through stomach into stomach
Problem with lower esophageal sphincter
Reflux esophalgitis: risk factors
Anticholinergic drugs – inhibit ACh – beta blockers, progesterone, nitrates.
Weight, fatty foods, chocolate, alcohol, caffeine, smoking.
Reflux esophagitis: complications
Bleeding may lead to vomiting blood to to melena.
Esophageal ulcers
Narrowing (structure) of esophagus – may make swallowing difficult.
Barrets esophagus
Reflux esophagitis: Tx
Antacids
Proton pump inhibitors (most effective)
Hepatitis
Inflammation of the liver
Commonly viral; can also be due to alcohol, drugs, etc.
Acute or chronic.
Acute viral hepatitis
Inflammation of the liver caused by Hep A,B,C,DE virus (A and B two most common respectively)
Sudden, short duration
Symptoms can range from nonexistent to severe
Poor appetite, nausea, vomiting, fever, pain in upper right abdomen, jaundice
Most prevalent liver disease globally
Acute viral hepatitis
Alcoholic Hepatitis
Inflammation of the liver caused by chronic alcohol use
Three types of damage caused by prolonged alcohol use
Steatosis
Hepatitis
Cirrhosis
Steatosis
Fatty liver
Chronic hepatitis
Inflammation of the liver lasting more than 6 months.
Less common than acute
Commonly caused by Hep B and C (60-70% of cases) viruses, drugs, non-alcoholic fatty liver, alcoholic hepatitis, and liver cancer. Hep D also implicated
Chronic hepatitis: Sx
Usually asymptomatic until liver has been severely scarred, although 1/3 cases occur after a bout of acute hepatitis.
Malaise, anorexia, fatigue.
Complications may include: ascites enlarged spleen spiderlike blood vessels redness of palms
Alpha-fetoprotein
Protein normally produced in fetal liver cells. Also produced by some tumour (ie liver) cells
Hepatitis A
Primarily oral-fecal transmission
Usually asymptomatic, but can lead to acute hepatitis.
Does not lead to “carrying”; does not become chronic
Hepatitis B
Most often transmitted through fluids
Can be mild or severe; coinfection with Hep D increases severity
Symptoms usually disappear after 40-120 days, but 5-7% of acute cases progress to chronic
Wheals
Hives. More common in Hep B than other hep infections
Chronic Hep B can lead to
Cancer
If coinfected with D, can also lead to cirrhosis
Chronic Hep C can lead to
Cirrhosis
If cirrhosis develops may lead to cancer
Three stages of Hep B infection
- Preicteric (weakness nausea vomiting)
- Icteric (jaundice)
- Convalescent
Hepatitis C
Transmitted by fluids, most commonly shared needles
1/5 people with alcoholic steatosis also have Hep C
Infection can me mild and asymptomatic – not as bad as Hep B – but becomes chronic in 75% of cases, with 20-30% developing cirrhosis.
Cirrhosis
Irreversible replacement of a large amount of normal liver tissue with nonfunctioning scar tissue.
Most commonly results from alcoholism and hepatitis. Can also be caused by nonalcholic steatohepatitis or metabolic problems like hemochromatosis
Third most common cause of death between 45 and 65
Cirrhosis: Sx
1/3 asymptomatic
Symptoms can include malaise, fatigue, clubbing of the fingertips, jaundice, itchiness, small yellow nodules, especially around eyelids.
Also atrophy, palmar erythema, Dupuytren’s contracture, spider veins, peripheral neuropathy, gynecomastia, ascites
Portal vein hypertension, varices, hepatic encephalopathy
Osteoporosis
Anemia (low vitamin K –> easy bleeding; enlarged spleen may trap platelets)
Liver can carry on as normal even with what degree of damage?
85%
Portal Hypertension
Abnormally high blood pressure in branches of portal vein
Caused by:
1. increased blood volume
2. increased resistance to blood flow through the liver
In the west, most commonly due to cirrhosis
Consequences of portal hypertension
Enlarged spleen
Ascites
Development of collateral veins –> varices
Hepatic encephalopathy
Most common location of portal hypertension-related varices
Lower esophagus
Upper stomach
Rectal
Caput medusae
Enlarged and distended superficial epigastric veins radiating from umbilicus
Consequence of portal hypertension
Hepatic encephalopathy
AKA portal system encephalopathy, liver encephalopathy, hepatic coma
Deterioration of brain function resulting from a build up of toxic substances in blood and brain
Hepatic encephalopathy can be ameliorated by reducing what dietary component?
Protein (decreased protein –> decreased nitrogen –> decreased ammonia)
Hepatic encephalopathy: Sx
Cognitive, behavioural shift Sleep disturbances Musty, sweet breath Asterixes Disorientation
Asterixes
Tremor of the hand when the wrist is extended
“Liver flap”
Often results from hepatic encephalopathy
Hepatoma
Most common primary liver cancer
Chance increased by Hep B or C, alcohol consumption
Poor prognosis
Choleocystitis
Inflammation of the gallbladder, usually resulting from blocked cystic duct
Pain in upper right abdomen; can refer to right shoulder blade
Acute choleocystitis
Sudden, sever pain in upper abdomen
95% result from gallstones
Initial inflammation without infection, but can develop infection
Acalculous choleocystitis
Choleocystitis without gallstones. Serious – usually related to trauma or sepsis
Chronic choleocystitis
Long term damage
Biliary colic
Biliary colic
Recurrent pain caused by choleocystitis
Cholelithiasis
Gallstones
Usually formed from cholesterol, but can also be from calcium and bilirubin
Can block cystic duct, common bile duct, or ampulla of vader
Acute Pancreatitis
Sudden inflammation of the pancreas that may be mild or life threatening but that usually subsides.
Most frequently caused by gallstones and/or alcohol abuse. More common in women
Upper abdominal pain most predominant symptom
Usually requires hospitalization
Acute Pancreatitis: Pathogenesis
Blockage of pancreatic ductules/increased pressure/overstimulation of pancreatic acinar cells
–> activation of digestive enzymes –> liquifaction of pancreatic tissue, fat necrosis
- possible peritonitis
Chronic pancreatitis may lead to:
Calcification of the pancreas
Exocrine pancreatic insufficiency
Endocrine pancreatic insuffiency
Cystic Fibrosis and the Pancreas
Pancreatic secretions become thick and viscous.
Pancreas becomes scarred/
15% of people with CF develop diabetes because of insufficient insulin
Exocrine pancreatic insufficiency
Destruction of acinar cells –> reduction in digestive enzymes
Malabsorption, steatorrhea, ADEK vitamin deficiency
Chronic pancreatitis
Carcinoma of the pancreas
95% adenocarcinomas (malignant epithelial neoplasm), usually in head of pancreas
Usually fatal
Smoking, chronic pancreatitis, diabetes
Symptoms of pancreatic cancer
Blockage of pancreatic duct –> jaundice
Deposit of bile salts under skin –> itchiness
Head of pancreas may obstruct duodenum –> vomiting
Of tail and body, usually asymptomatic until too late.
Diaphragmatic hernia
Protrusion of piece of intestine through hole or weakening in the diaphragm
Possible complications of diaphragmatic hernia
Incarceration
Strangulation
Perforation
Hiatus hernia
Diaphragmatic hernia the bulges through the opening the esophagus usually passes through.
Pyloric Stenosis
Blockage of pylorus due to hypertrophy of pyloric muscle
Occurs in infancy. Causes projectile vomiting, failure to thrive, dehydration
More often Dx in boys
Gastritis
Inflammation of the stomach lining
Acute gastritis
AKA erosive gastritis
Self-limiting
Involves inflammation and erosion of stomach lining
Characterized by erosions – mucosal defects limited to the upper layers of epithelium
Results from Circulatory disturbances (cause ischemia in gastric mucosa, causing erosions) or exogenous irritants (aspirin, NSAIDs).
Also Crohns, infection, viral infection.
Acute stress gastritis
Caused by sudden illness or injury, even if not to the stomach
Ulcers
Can develop due to many types of gastritis.
Deeper than erosions
May bleed, resulting in hematemesis, melena. May also perforate wall, causing peritonitis.
Hematemesis
Vomiting blood
Melena
Black tarry stools resulting from blood in GI tract.
Chronic gastritis
Results from chronic mucosal inflammation.
Usually presents as Atrophic gastritis – stomach lining thins, loses the cells that produce acids and enzymes.
Can also present as hyperplasia. May or may not have metaplasia.
May occur when antibodies attack the stomach lining, or from H pylori infection.
Increase risk of gastric cancer
Autoimmune meta plastic atrophic gastritis
When antibodies attack the stomach lining.
Reduced intrinsic factor production –> reduced B12 absorption –> pernicious anemia, neurological Sx
Peptic Ulcer
Chronic multifaceted disease characterized by sharply defined round ulcerations of the GI mucosa, most often stomach or duodenum.
Common
Usually a combination of increased acid, decreased protection against avid, and H pylori. Also drugs (like aspirin)
Marginal ulcers
Peptic ulcers forming where part of the stomach has been surgical removed.
Stress ulcers.
Peptic ulcers that result from physical stress (trauma, burn).
Complications of peptic ulcers
Penetration (penetrates through wall to adjacent organ)
Perforation (into abdominal cavity)
Hemorrhage
Cicatrizarion (excessive scarring; can lead to:)
Obstruction
Cancers (3-6 x if H pylori present; no increase otherwise)
Carcinoma of the stomach
95% adenocarcinomas
7th most common cause of cancer death.
Often starts at site of inflammation; may be strongly correlated to H pylori.
Stomach cancer: Sx
Early stages resembles peptic ulcers.
Later anemia, weight loss. Possible melena, hematemesis
Celiac Disease
AKA sprue
Intolerance to gluten, which causes changes in the stomach lining. Reversible.
Antibodies flatten out intestinal villi.
Some hereditary component.
Celiac Disease: Sx
Diarrhea, weight loss, malnutrition.
Occasionally rashes with small blisters
Symptoms of specific nutritional deficiencies. Anemia, edema, nerve damage
Crohn’s Disease
AKA Regional enteritis, granulomatous ileitis, iliocolitis
Chronic inflammation, most often of the intestinal wall, but that can affect any part of the digestive tract (mouth to anus)
Immune malfunction most likely.
Chron’s disease: Sx
Chronic diarrhea, cramps, fever, loss of appetite, weight loss.
Chron’s disease: common presentation
Most commonly affects ileum and large intestine.
Skip lesions
May affect full thickness of bowel
During flare up: arthritis, episcleritis, aphthous stomatitis, erythema nodosum, pyoderma gangrenosum.
Chron’s disease: complications
Scarring –> obstruction
Abscesses
Fistulas
Increase chance of cancer
Cracks and fistula around anus
Gallstones, UTIs, malabsorption, amyloidosis.
Episcleritis
Inflammation of the white of the eyes
May occur during a flare up of Chron’s disease.
Aphthous stomatitis
Mouth sores.
May occur during acute Chron’s attack
Erythema nodosum
Inflamed skin modules on arms and legs.
May be seen during acute Chron’s flare up.
Pyoderma gangrenosum
Blue-red, pus-filled sores on the skin. May present during Chron’s flare up.
Uveitis
Inflammation inside the eye
Sometimes occurs with Chron’s (even when in remission)
Primary sclerosing cholangitis
Inflammation of the bile duct.
Can occur with Chron’s disease, even when not acute.
Malabsorption syndrome
Any of a number of disorders which impair absorption of nutrients in the small intestine.
Inadequate enzymes, decreased bile, micro biota imbalance
Diarrhea, weight loss, bulky smelly poo
Calcium deficiency: Sx
Bone pain and deformities
Muscle spasms
Osteoporosis, osteopenia
Tooth discolouration
Folate deficiency: Sx
Fatigue and weakness (anemia)
Iron deficiency: Sx
Fatigue and weakness
Magnesium deficiency: Sx
Muscle spasms
Niacin deficiency: Sx
Pellagra
Diarrhea, dementia, dermatitis, death
Protein deficiency: Sx
Edema, dry skin, hair loss
Vit A deficiency: Sx
Night blindness
Vit B1 deficiency: Sx
Beriberi
Pins & needles, especially in feet.
Heart failure
(Seen in alcoholics)
Vit B2 deficiency: Sx
Sore tongue, cracks at edge of mouth
Vit B12 deficiency: Sx
Anemia
Pins & needles
Confusion
Vit C deficiency: Sx
Weakness
Bleeding gums
Vitamin D deficiency: Sx
Bone thinning, bone pain
Vit K deficiency; Sx
Tendency to bruise and bleed.
Ulcerative colitis
Chronic inflammation of large intestine, causing ulceration, bloody diarrhea, cramps, fever.
Flare ups and remission.
Ulcerative colitis: pathogenesis
Usually start between 15-30 (or 50-70), at rectum/sigmoid colon, and spreads proximally.
Does not affect full thickness of wall.
Idiopathic.
Ulcerative proctitis
Common and benign form of ulcerative colitis confined to the rectum.
Cigarette smoke and Ulcerative colitis
Decreases risk.
Ulcerative colitis: complications
Bleeding (anemia)
Toxic colitis
Toxic megacolon
Colon cancer
Extraintestinal (rare): arthritis, episcleritis, erythema nodosum, pyoderma gangrenosum.
Ulcerative colitis: Tx
Dietary restrictions Antidiarrheal drugs Anti inflammatory drugs Corticosteroids Surgery
“Lead Pipe”
X Ray sign for ulcerative colitis
Irritable Bowel Syndrome
Idiopathic syndrome affecting entire digestive tract
Affects 10-15% of the population
Functional disorder (no structural abnormalities)
Irritable Bowel Syndrome: Sx
Variable, but may include:
Lower abdominal pain (relieved by defecation) Change in stool frequency/consistency Distention Mucus in stool Sensation of incomplete emptying
Also bloating, gas, headaches, fatigue, depression, anxiety, inattention
Irritable Bowel Syndrome: Tx
Normal diet, perhaps lower fat. Smaller, frequent meals.
Symptomatic approach
Ischemic Bowel Syndrome
Category of disorders that compromise blood flow through segments of the intestine
Can be classified as occulsive or nonocclusive, transmural or limited to mucosa, or chronic or acute.
Often results of athersclerosis (especially of superior mesenteric artery)
Occlusive Ischemic Bowel Syndrome
Caused by thrombi or emboli
Nonocclusive Ischemic Bowel Syndrome
Caused by atherosclerotic narrowing of the arteries.
Acute mesenteric ischemia
Sudden blockage of blood flow to part of the intestines
May lead to gangrene and perforation
Occlusive
Less common than chronic; more deadly
DiverticulOsis
Presence of multiple balloon-like sacs, usually in the large intestine, most commonly sigmoid colon
Believed to be caused by spasms of the muscular layer of the intestine
Idiopathic; related to low fibre diet
Diverticulosis: Sx
Usually asymptomatic; sometimes bleediing, cramps, bowel movement disturbances.
Sometimes thickening of muscular layer of intestine
Diverticulosis: Tx
High fibre diet, increased hydration, to reduce spasm
If uncomplicated, bleeding usually stops on its own.
May perform colonoscopy to stop bleeding
Giant diverticulum (up to 15 cm) usually require surgery – likely to be infected and to rupture
Diverticulitis
When something gets caught in a diverticulum and infected
Appendicitis
Inflammation and infection of the appendix
Often caused by blockage
Appendicitis: Sx
Fewer than 50% experience stereotypical Sx: upper abdominal/umbilical pain, waxing/waning nausea, pain moving to lower right.
In many people, pain widespread not localized
Appendicitis: Tx
Surgery
Peritonitis
Inflammation of the peritoneal cavity
Caused by any inflammatory condition but most serious cause GI perforation
Family (Adenomatous) Polyposis Coli
Autosomal dominant disorder causing numerous colonic polyps and resulting in colon carcinoma by age 40.
Tx: colectomy
Atresia
Complete obstruction of the lumen. Can occur at any part of the intestine
Congenital.
Treated with surgical resection
Hirschsprung’s Disease
Congenital megacolon
Section of large intestine missing the nerve network that control contractions. Cannot contract normally.
Symptoms of intestinal obstruction
Can lead to toxic enterocolitis
Toxic enterocolitis
Inflammation of the small and large intestine.
Possible consequence of Hirschsprung’s Disease.
May cause fever, distension, and explosive and/or bloody diarrhea.
Mackel’s Diverticulum
Most well know congenital diverticula
Incompletely obliterated embryonic connection between intestine and umbilicus
Usually asymptomatic; if symptoms do appear often resemble acute appendicitis except its lower left rather than lower right.
Intussuption
When one segment of the intestine “telescopes” into another. Most common cause of intestinal blockage between 3 months and 3 years.
Obstructs the bowel and blocks blood flow.
Sx: pain and vomiting. Current-jelly poo. Fever
Dx: air enema (!)
What condition can be diagnosed with an air enema (!)
Intussuption
“Red currant jelly” stool is typical of what condition?
Intussuption
Volvulus
Twisting of a loop of the intestine around its mesenteric attachment. –> infarction
Most often involves small intestine or sigmoid colon
Strangulation
Blood supply cut off to intestine
Three main causes of intestinal strangulation
Strangulated hernia
Volvulus
Intussuption
Bacterial Diarrhea may be caused by the following:
Bacterial toxins (food poisoning, botulism) Lytic action of bacteria (traveler's diarrhea, shigella, salmonella)
Viral Gastroenteritis
Most frequently rotavirus (kids) and Norwalk (adults)
Protozoal Enteritis
parasitic infections of intestine
Giardia lambia (beaver fever)
Ambiasis (entamoeba histolyica)
Colorectal Cancer
Most often adenocarcinoma
Slow growing
2nd leading cause of cancer death.
Metastasizes easily because blood is carried to liver
Colorectal Cancer: Sx
Bleeding during defecation; fatigue; weakness
Bleeding may be occult (undetected)
Colorectal Cancer: risk factors
Family history Ulcerative colitis Crohn's disease High fat/low fibre diets Environmental exposure
Colorectal Cancer: Stages
0: limited to inner layer (lining) covering the polyp (95% survival)
1: spread to space between inner layer and muscular layer (90%)
2: muscle layer and outer layer of colon (55-85%)
3: Beyond colon to lymph nodes (20-55%)
4: metastasis (
