Diseases of Organ Systems GI - 34% Flashcards
What is diabetes mellitus type 1? signs? Who gets it?
Insulin dependent DM due to insulting deficiency cause by beta cell destruction. Associated antibodies to beta cells of the pancreas
- weight loss, more prone to diabetic ketoacidosis
- common in children and teens. HLA DR3 or 4 genetic predisposition
What is diabetes mellitus type 2? Who?
Insulin insensitivity. Non-insulting dependent DM. Insulin levels may even be elevated.
- common in obese adults, many have family history of diabetes
What are signs of DM type 2?
- polyuria, polydipsia, polyphagia, prone to hyperosmolar non-ketoacidosis coma
- Cause narrowing of small and medium-size vessels
- premature cataracts and retinopathy may be related to accumulation of sorbitol
What is MODY type
Mature onset diabetes in the young
- not dependent on insulin, no antibodies, not obese
- <25 years
What is gestational diabetes?
Occurs in 4% of pregnancies, usually revolves with the end of pregnancy. Some may progress to type 2 DM
What is carcinoid syndrome? Signs?
How many metastize? How many are multiple?
Tumors of the neuroendocrine cells in the gut.
Results in recurrent diarrhea, cutaneous flushing and bronchial wheezing
1/3 metastasize, 1/3 are multiple
What is insulinoma?
Pancreatic beta-islet cell tumor. Hypoglycemia relieved by food
What is gastrinoma?
Excess gastrin from GI tumor. Recurrent peptic ulcer disease. Aka Zollinger-Ellison syndrome. May be part of MEN type 1
What is Zollinger-Ellison syndrome?
Gastrinoma causing excess gastrin from GI tumor
What is MEN type 1?
Multiple Endocrine Neoplasia
Wermer’s Syndrome - 3 P’s
- pituitary adenoma, parathyroid adenoma, pancreas adenoma
What is MEN type 2a?
Multiple Endocrine Neoplasia
Sipple’s syndrome - 2Ps + 1M
- medullary thyroid cancer, pheochromocytoma, parathyroid hyperplasia
What is MEN type 2b?
Multiple endocrine neoplasia
1P + 3Ms
- marfanoid features, medullary thyroid cancer, mucosal neuromas, pheochromocytoma
Achalasia
Failure of LES to relax, dysphagia for fluids not solids
Hiatal hernia
Protrusion of stomach into the chest through the diaphragm
Esophageal varices
Dilated veins in the lower esophagus seen in portal hypertension
GERD
Chronic inflammation of lower esophagus due to acid regurgitation
Barrett’s esophagus
Premalignant metaplastic change in lower esophagus due to GERD
Esophageal cancer? Risks?
Squamous cell carcinoma
excess nitrosamines in the diet and smoking.
Adenocarcinoma after Barrett’s esophagus
Mallory-Weiss syndrome
Linear tear in lower esophagus due to prolonged vomiting and retching
Peptic ulcer disease due to? Where?
H.Pylori infection, ulcer along lesser curvature of stomach (70%) or duodenum (95%)
How can you tell the difference between gastric and duodenal ulcers based on sx?
Epigastric pain is greater with meals in gastric ulcer and duodenal is pain after meals
Congenital pyloric stenosis
Young male infants >6 weeks, projectile vomiting, hypertrophic pyloric
Atrophic gastritis due to? Predisposes to?
H. Pylori infection; predisposition to pernicious anemia and cancer
Gastric carcinoma due to
H. Pylori infection, high nitrosamines in diet, smoked meats
Gastric carcinoma sx
Unexplained weight loss and Troisier’s node
What is Troisier’s sign?
Virchow’s node in left supraclavicular fossa. Metastatic spread from intra-abdominal cancer
Crohn’s disease
(Regional ileitis)
Non-caseous granulomas, cobblestone terminal ileum, skip lesions and fistula
Meckel’s diverticulum
Remnant of vitelline duct: 2” long, 2’ from ileocecal valve, 2% of people
Celiac disease
Celiac spruce - small intestine disorder
Gluten sensitivity causing malabsorption in small intestine, vomiting, diarrhea
Whipple’s disease
Tropical sprue Trophermya whipplei (Gram +rod) infection of small intestine causes steatorrhea and arthritis
Steatorrhea
Oily stool
Appendicitis
Inflammation of appendix following blockage of its lumen by fecalith
Periumbilical pain radiation to the RLQ with tenderness at McBurney’s point
Diverticulosis
Condition of numerous outpouchings of the large bowel-older people
Diverticulitis
Inflammation of the diverticulum in the bowel
- causes left lower quadrant pain and blood in the stool in an older patient
Intussusception
Telescoping of the proximal part of bowel into a distal segment
Presents with abdominal pain and intestinal obstruction in a child
Hirschsprung’s disease
Arrested neural crest cell migration, congenital aganglionosis of the colon
Presents with chronic constipation in a child
Ulcerative colitis
Chronic ulcerative inflammation mainly confined to the rectum
Presents with bloody diarrhea, toxic megacolon and an increased risk of colon cancer
Carcinoma of the colon? How common? Sx?
Third most common cancer in both sexes
Unexplained weight loss and change of bowel habits in the older population
What is the third most common cancer in both sexes?
Carcinoma of the colon
Volvulus
Twisting part of the bowel on itself; more common in sigmoid colon and in blacks. Presents with intestinal obstruction and abdominal pain
Peutz-Jegher syndrome
Oral pigmentation and multiple intestinal polyps
IBS
Spastic colon of unknown cause
Presents with pain relieved cry defecation, bloating, diarrhea and/or constipation
What is hepatitis?
Inflammation of liver caused by viral infections, alcohol or drugs
What is the difference between Hep A, B and C?
A- fecal/oral transmission; water borne infection
B - intravenous drug use and sexually transmitted; chronic carrier state
C - used to be the most common cause of post-transfusion hepatitis
Nutmeg liver
Chronic passive venous congestion
Seen in congestive heart failure
Cirrhosis
Chronic liver condition with damage, fibrosis and regurgitation nodules: presents with portal hypertension and caput medusae
Portal hypertension
Obstruction to portal blood flow to the liver due to fibrosis
Causes ascites
May also be due to decrease protein and increased aldosterone levels
Caput Medusae
Dilated varicose veins radiating from umbilicus due to portal hypertension
Reye’s syndrome
Rare cause of childhood hepatoencephalopathy caused by the use of aspirin in children with some febrile illnesses-chickenpox and influenza
Hepatocellular carcinoma causes? Sx?
Aka malignant hepatoma
- Liver cancer associated with Hep B and C cirrhosis, raised alpha-fetoprotein
- may be associated with fungal (aspergillosis) aflotoxins
- may present with painful hepatomegaly, anorexia, fatigue and weight loss
Cholescystitis: inflammation of gallbladder
Fair, fat, fertile, flatulent females over 40 with right upper quadrant pain
95% is caused by gallstones
Cholelithiasis
gallstones
Cholesterol, pigment or mixed stones
- 70-80% of people with gallstone are asymptomatic
Pancreatitis causes? Sx?
Inflammation of the pancreas caused by alcohol, gallstones, trauma, steroids, mumps and hypercalcemia
- swollen pancreas with leakage of pancreatic enzymes into the abdominal cavity
- severe abdominal pain radiation through the back, nausea and vomiting, bluish discoloration (Cullen’s sign) around umbilicus or in the flanks (Grey Turner’s sign)
Pancreatic cancer
Malignancy arise from the pancreatic ducts (adenocarcinoma)
- painless jaundice, clay-colored stool if the cancer is in the head of the pancreas, weight loss due to malabsorption and anorexia; very poor prognosis
