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Syst Path 600 > Digestive > Flashcards

Digestive Flashcards

1
Q

Diaphragmatic hernia

A

Protrusion of any abdominal structure through the hiatus in the diaphragm.

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2
Q

Hiatus hernia: Causes/risk factors

A

Idiopathic

Age, obesity, smoking

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3
Q

Diaphragmatic hernia: cause/risk factors

A

Idiopathic

Older than 50, overweight (especially women), smoking

Other types may be congenital

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4
Q

Sliding hiatus hernia

A

Junction between stomach and esophagus, and portion of stomach, protrude above diaphragm.

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5
Q

Paraesophageal hiatus hernia

A

Gastro-esphogeal junction in its normal place; portion of stomach pushed above hiatus and lies beside esophagus

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6
Q

Sliding hiatus hernia: Sx

A

Sometimes asymptomatic

Symptoms minor, related to reflux (indigestion, especially when lying down or eating, leaning forward, straining, bun in oven)

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7
Q

Hiatus hernia

A

Protrusion of a portion of the stomach across the opening of the diaphragm

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8
Q

Strangulation

A

Complication of paresophageal hernia

When the herniated segment gets pinched or trapped by diaphragm and loses blood supply.

Medical emergency

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9
Q

Hiatus hernia: Dx

A

X-ray, often barium

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10
Q

Hiatus hernia: Tx

A

Sliding: symptomatic of required

Paresophageal: surgery

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11
Q

Reflux Esophagitis

A

GERD

Stomach acid and enzyme flow backwards through stomach into stomach

Problem with lower esophageal sphincter

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12
Q

Reflux esophalgitis: risk factors

A

Anticholinergic drugs – inhibit ACh – beta blockers, progesterone, nitrates.

Weight, fatty foods, chocolate, alcohol, caffeine, smoking.

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13
Q

Reflux esophagitis: complications

A

Bleeding may lead to vomiting blood to to melena.

Esophageal ulcers

Narrowing (structure) of esophagus – may make swallowing difficult.

Barrets esophagus

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14
Q

Reflux esophagitis: Tx

A

Antacids

Proton pump inhibitors (most effective)

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15
Q

Hepatitis

A

Inflammation of the liver

Commonly viral; can also be due to alcohol, drugs, etc.

Acute or chronic.

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16
Q

Acute viral hepatitis

A

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

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17
Q

Most prevalent liver disease globally

A

Acute viral hepatitis

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18
Q

Alcoholic Hepatitis

A

Inflammation of the liver caused by chronic alcohol use

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19
Q

Three types of damage caused by prolonged alcohol use

A

Steatosis
Hepatitis
Cirrhosis

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20
Q

Steatosis

A

Fatty liver

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21
Q

Chronic hepatitis

A

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

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22
Q

Chronic hepatitis: Sx

A

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
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23
Q

Alpha-fetoprotein

A

Protein normally produced in fetal liver cells. Also produced by some tumour (ie liver) cells

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24
Q

Hepatitis A

A

Primarily oral-fecal transmission
Usually asymptomatic, but can lead to acute hepatitis.

Does not lead to “carrying”; does not become chronic

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25
Q

Hepatitis B

A

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

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26
Q

Wheals

A

Hives. More common in Hep B than other hep infections

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27
Q

Chronic Hep B can lead to

A

Cancer

If coinfected with D, can also lead to cirrhosis

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28
Q

Chronic Hep C can lead to

A

Cirrhosis

If cirrhosis develops may lead to cancer

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29
Q

Three stages of Hep B infection

A
  1. Preicteric (weakness nausea vomiting)
  2. Icteric (jaundice)
  3. Convalescent
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30
Q

Hepatitis C

A

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.

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31
Q

Cirrhosis

A

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

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32
Q

Cirrhosis: Sx

A

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)

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33
Q

Liver can carry on as normal even with what degree of damage?

A

85%

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34
Q

Portal Hypertension

A

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

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35
Q

Consequences of portal hypertension

A

Enlarged spleen
Ascites
Development of collateral veins –> varices
Hepatic encephalopathy

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36
Q

Most common location of portal hypertension-related varices

A

Lower esophagus
Upper stomach
Rectal

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37
Q

Caput medusae

A

Enlarged and distended superficial epigastric veins radiating from umbilicus

Consequence of portal hypertension

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38
Q

Hepatic encephalopathy

A

AKA portal system encephalopathy, liver encephalopathy, hepatic coma

Deterioration of brain function resulting from a build up of toxic substances in blood and brain

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39
Q

Hepatic encephalopathy can be ameliorated by reducing what dietary component?

A

Protein (decreased protein –> decreased nitrogen –> decreased ammonia)

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40
Q

Hepatic encephalopathy: Sx

A 
Cognitive, behavioural shift
Sleep disturbances
Musty, sweet breath
Asterixes
Disorientation
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41
Q

Asterixes

A

Tremor of the hand when the wrist is extended
“Liver flap”
Often results from hepatic encephalopathy

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42
Q

Hepatoma

A

Most common primary liver cancer
Chance increased by Hep B or C, alcohol consumption

Poor prognosis

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43
Q

Choleocystitis

A

Inflammation of the gallbladder, usually resulting from blocked cystic duct

Pain in upper right abdomen; can refer to right shoulder blade

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44
Q

Acute choleocystitis

A

Sudden, sever pain in upper abdomen
95% result from gallstones
Initial inflammation without infection, but can develop infection

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45
Q

Acalculous choleocystitis

A

Choleocystitis without gallstones. Serious – usually related to trauma or sepsis

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46
Q

Chronic choleocystitis

A

Long term damage

Biliary colic

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47
Q

Biliary colic

A

Recurrent pain caused by choleocystitis

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48
Q

Cholelithiasis

A

Gallstones
Usually formed from cholesterol, but can also be from calcium and bilirubin
Can block cystic duct, common bile duct, or ampulla of vader

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49
Q

Acute Pancreatitis

A

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

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50
Q

Acute Pancreatitis: Pathogenesis

A

Blockage of pancreatic ductules/increased pressure/overstimulation of pancreatic acinar cells
–> activation of digestive enzymes –> liquifaction of pancreatic tissue, fat necrosis

  • possible peritonitis
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51
Q

Chronic pancreatitis may lead to:

A

Calcification of the pancreas
Exocrine pancreatic insufficiency
Endocrine pancreatic insuffiency

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52
Q

Cystic Fibrosis and the Pancreas

A

Pancreatic secretions become thick and viscous.
Pancreas becomes scarred/
15% of people with CF develop diabetes because of insufficient insulin

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53
Q

Exocrine pancreatic insufficiency

A

Destruction of acinar cells –> reduction in digestive enzymes

Malabsorption, steatorrhea, ADEK vitamin deficiency

Chronic pancreatitis

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54
Q

Carcinoma of the pancreas

A

95% adenocarcinomas (malignant epithelial neoplasm), usually in head of pancreas

Usually fatal

Smoking, chronic pancreatitis, diabetes

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55
Q

Symptoms of pancreatic cancer

A

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.

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56
Q

Diaphragmatic hernia

A

Protrusion of piece of intestine through hole or weakening in the diaphragm

57
Q

Possible complications of diaphragmatic hernia

A

Incarceration
Strangulation
Perforation

58
Q

Hiatus hernia

A

Diaphragmatic hernia the bulges through the opening the esophagus usually passes through.

59
Q

Pyloric Stenosis

A

Blockage of pylorus due to hypertrophy of pyloric muscle

Occurs in infancy. Causes projectile vomiting, failure to thrive, dehydration

More often Dx in boys

60
Q

Gastritis

A

Inflammation of the stomach lining

61
Q

Acute gastritis

A

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.

62
Q

Acute stress gastritis

A

Caused by sudden illness or injury, even if not to the stomach

63
Q

Ulcers

A

Can develop due to many types of gastritis.

Deeper than erosions

May bleed, resulting in hematemesis, melena. May also perforate wall, causing peritonitis.

64
Q

Hematemesis

A

Vomiting blood

65
Q

Melena

A

Black tarry stools resulting from blood in GI tract.

66
Q

Chronic gastritis

A

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

67
Q

Autoimmune meta plastic atrophic gastritis

A

When antibodies attack the stomach lining.

Reduced intrinsic factor production –> reduced B12 absorption –> pernicious anemia, neurological Sx

68
Q

Peptic Ulcer

A

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)

69
Q

Marginal ulcers

A

Peptic ulcers forming where part of the stomach has been surgical removed.

70
Q

Stress ulcers.

A

Peptic ulcers that result from physical stress (trauma, burn).

71
Q

Complications of peptic ulcers

A

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)

72
Q

Carcinoma of the stomach

A

95% adenocarcinomas
7th most common cause of cancer death.

Often starts at site of inflammation; may be strongly correlated to H pylori.

73
Q

Stomach cancer: Sx

A

Early stages resembles peptic ulcers.

Later anemia, weight loss. Possible melena, hematemesis

74
Q

Celiac Disease

A

AKA sprue

Intolerance to gluten, which causes changes in the stomach lining. Reversible.

Antibodies flatten out intestinal villi.

Some hereditary component.

75
Q

Celiac Disease: Sx

A

Diarrhea, weight loss, malnutrition.

Occasionally rashes with small blisters

Symptoms of specific nutritional deficiencies. Anemia, edema, nerve damage

76
Q

Crohn’s Disease

A

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.

77
Q

Chron’s disease: Sx

A

Chronic diarrhea, cramps, fever, loss of appetite, weight loss.

78
Q

Chron’s disease: common presentation

A

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.

79
Q

Chron’s disease: complications

A

Scarring –> obstruction
Abscesses
Fistulas

Increase chance of cancer

Cracks and fistula around anus

Gallstones, UTIs, malabsorption, amyloidosis.

80
Q

Episcleritis

A

Inflammation of the white of the eyes

May occur during a flare up of Chron’s disease.

81
Q

Aphthous stomatitis

A

Mouth sores.

May occur during acute Chron’s attack

82
Q

Erythema nodosum

A

Inflamed skin modules on arms and legs.

May be seen during acute Chron’s flare up.

83
Q

Pyoderma gangrenosum

A

Blue-red, pus-filled sores on the skin. May present during Chron’s flare up.

84
Q

Uveitis

A

Inflammation inside the eye

Sometimes occurs with Chron’s (even when in remission)

85
Q

Primary sclerosing cholangitis

A

Inflammation of the bile duct.

Can occur with Chron’s disease, even when not acute.

86
Q

Malabsorption syndrome

A

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

87
Q

Calcium deficiency: Sx

A

Bone pain and deformities
Muscle spasms
Osteoporosis, osteopenia
Tooth discolouration

88
Q

Folate deficiency: Sx

A

Fatigue and weakness (anemia)

89
Q

Iron deficiency: Sx

A

Fatigue and weakness

90
Q

Magnesium deficiency: Sx

A

Muscle spasms

91
Q

Niacin deficiency: Sx

A

Pellagra

Diarrhea, dementia, dermatitis, death

92
Q

Protein deficiency: Sx

A

Edema, dry skin, hair loss

93
Q

Vit A deficiency: Sx

A

Night blindness

94
Q

Vit B1 deficiency: Sx

A

Beriberi
Pins & needles, especially in feet.
Heart failure

(Seen in alcoholics)

95
Q

Vit B2 deficiency: Sx

A

Sore tongue, cracks at edge of mouth

96
Q

Vit B12 deficiency: Sx

A

Anemia
Pins & needles
Confusion

97
Q

Vit C deficiency: Sx

A

Weakness

Bleeding gums

98
Q

Vitamin D deficiency: Sx

A

Bone thinning, bone pain

99
Q

Vit K deficiency; Sx

A

Tendency to bruise and bleed.

100
Q

Ulcerative colitis

A

Chronic inflammation of large intestine, causing ulceration, bloody diarrhea, cramps, fever.

Flare ups and remission.

101
Q

Ulcerative colitis: pathogenesis

A

Usually start between 15-30 (or 50-70), at rectum/sigmoid colon, and spreads proximally.

Does not affect full thickness of wall.

Idiopathic.

102
Q

Ulcerative proctitis

A

Common and benign form of ulcerative colitis confined to the rectum.

103
Q

Cigarette smoke and Ulcerative colitis

A

Decreases risk.

104
Q

Ulcerative colitis: complications

A

Bleeding (anemia)
Toxic colitis
Toxic megacolon
Colon cancer

Extraintestinal (rare): arthritis, episcleritis, erythema nodosum, pyoderma gangrenosum.

105
Q

Ulcerative colitis: Tx

A 
Dietary restrictions 
Antidiarrheal drugs
Anti inflammatory drugs
Corticosteroids
Surgery
106
Q

“Lead Pipe”

A

X Ray sign for ulcerative colitis

107
Q

Irritable Bowel Syndrome

A

Idiopathic syndrome affecting entire digestive tract

Affects 10-15% of the population

Functional disorder (no structural abnormalities)

108
Q

Irritable Bowel Syndrome: Sx

A

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

109
Q

Irritable Bowel Syndrome: Tx

A

Normal diet, perhaps lower fat. Smaller, frequent meals.

Symptomatic approach

110
Q

Ischemic Bowel Syndrome

A

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)

111
Q

Occlusive Ischemic Bowel Syndrome

A

Caused by thrombi or emboli

112
Q

Nonocclusive Ischemic Bowel Syndrome

A

Caused by atherosclerotic narrowing of the arteries.

113
Q

Acute mesenteric ischemia

A

Sudden blockage of blood flow to part of the intestines
May lead to gangrene and perforation
Occlusive

Less common than chronic; more deadly

114
Q

DiverticulOsis

A

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

115
Q

Diverticulosis: Sx

A

Usually asymptomatic; sometimes bleediing, cramps, bowel movement disturbances.

Sometimes thickening of muscular layer of intestine

116
Q

Diverticulosis: Tx

A

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

117
Q

Diverticulitis

A

When something gets caught in a diverticulum and infected

118
Q

Appendicitis

A

Inflammation and infection of the appendix

Often caused by blockage

119
Q

Appendicitis: Sx

A

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

120
Q

Appendicitis: Tx

A

Surgery

121
Q

Peritonitis

A

Inflammation of the peritoneal cavity

Caused by any inflammatory condition but most serious cause GI perforation

122
Q

Family (Adenomatous) Polyposis Coli

A

Autosomal dominant disorder causing numerous colonic polyps and resulting in colon carcinoma by age 40.

Tx: colectomy

123
Q

Atresia

A

Complete obstruction of the lumen. Can occur at any part of the intestine

Congenital.

Treated with surgical resection

124
Q

Hirschsprung’s Disease

A

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

125
Q

Toxic enterocolitis

A

Inflammation of the small and large intestine.

Possible consequence of Hirschsprung’s Disease.

May cause fever, distension, and explosive and/or bloody diarrhea.

126
Q

Mackel’s Diverticulum

A

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.

127
Q

Intussuption

A

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 (!)

128
Q

What condition can be diagnosed with an air enema (!)

A

Intussuption

129
Q

“Red currant jelly” stool is typical of what condition?

A

Intussuption

130
Q

Volvulus

A

Twisting of a loop of the intestine around its mesenteric attachment. –> infarction

Most often involves small intestine or sigmoid colon

131
Q

Strangulation

A

Blood supply cut off to intestine

132
Q

Three main causes of intestinal strangulation

A

Strangulated hernia
Volvulus
Intussuption

133
Q

Bacterial Diarrhea may be caused by the following:

A 
Bacterial toxins (food poisoning, botulism)
Lytic action of bacteria (traveler's diarrhea, shigella, salmonella)
134
Q

Viral Gastroenteritis

A

Most frequently rotavirus (kids) and Norwalk (adults)

135
Q

Protozoal Enteritis

A

parasitic infections of intestine

Giardia lambia (beaver fever)

Ambiasis (entamoeba histolyica)

136
Q

Colorectal Cancer

A

Most often adenocarcinoma
Slow growing

2nd leading cause of cancer death.
Metastasizes easily because blood is carried to liver

137
Q

Colorectal Cancer: Sx

A

Bleeding during defecation; fatigue; weakness

Bleeding may be occult (undetected)

138
Q

Colorectal Cancer: risk factors

A 
Family history
Ulcerative colitis
Crohn's disease 
High fat/low fibre diets
Environmental exposure
139
Q

Colorectal Cancer: Stages

A

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 (

Syst Path 600 (5 decks)

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