Exam 1 Flashcards
Stomach protrudes into the thorax
hiatal hernia
pg 59
Types of hiatal hernia
1) axial (sliding)
2) non-axial (rolling)
pg 59
Most common type of hiatal hernia
axial (sliding) 95%
pg 59
Type of hiatal hernia with a “bell-shaped” dilation
axial (sliding)
pg 59
Type of hiatal hernia where a separate portion of the stomach protrudes and is prone to strangulation or obstruction
non-axial (rolling)
pg 59
Population most affected by hiatal hernias
> 70 years
pg 61
Hiatal hernia are commonly asymptomatic, but when symptomatic they present like…
GERD-like esophagitis
possible perforation, hemorrhage
pg 61
Esophageal metaplasia
Barrett Esophagus
pg 63
In Barrett Esophagus stratified squamous transitions into what cell type?
columnar epithelia
pg 63
Risk factors for Barrett Esophagus
caucasians (30-100x), males (4x), obesity, family hx, 40-60 years
pg 63
What % of symptomatic GERD patients have Barrett Esophagus?
10%
pg 63
An endoscopic look at Barrett Esophagus would have what appearance?
red, velvety mucosa, bands (tongues), pre-cancerous lesions
pg 67
Complications of Barrett Esophagus
1) esophageal adenocarcinoma
2) ulceration and strictures
pg 68
Types esophageal tumors
1) leiomyoma
2) adenocarcinoma
3) squamous cell carcinoma
pg 69
Type of esophageal tumor: Benign, smooth muscle tumor
leiomyoma
pg 69
Type of esophageal tumor: 50% of esophageal cancers in the US
adenocarcinoma
pg 69
Risks for esophageal adenocarcinoma
US, GERD, Barrett esophagus, Caucasians, males (7x), obesity, irradiation, tobacco
pg 69
Type of esophageal tumor: most common worldwide
squamous cell carcinoma (90%)
pg 69
Late stage features of adenocarcinomas
obstruction, vomiting, cachexia, fatigue, weakness
pg 70
Prognosis of esophageal adenocarcinoma
poor <25% 5 year survival
(early lymphatic spread)
pg 70
Most common location of esophageal adenocarcinoma
distal 1/3 of the esophagus
pg 71
Risks for squamous cell carcinoma
> 45 years, males (4x), African American(6x), irritation, rural/underdeveloped, poverty, achalasia
pg 72
Features of squamous cell carcinoma
dysphagia, odynophagia, cachexia
pg 72
Prognosis of squamous cell carcinoma
very poor, <10% 5 year survival
(lymphatic mets)
pg 72
Most common location of squamous cell carcinoma
middle 1/3 of the esophagus
pg 73
Melena
black, “tarry” feces
pg 75
Types of gastric inflammatory diseases
1) acute gastritis
2) chronic gastritis
pg 78
Common risk factors for gastric inflammatory diseases
alcohol, NSAIDs, chemotherapy, irradiation, increased age
pg 78
Type of gastric inflammatory disease with a sudden onset that is often transient
acute gastritis
pg 79
Risk associated with acute gastritis with possible erosion/ulceration
hemorrhage
acute erosive hemorrhagic gastritis
pg 79
Risks for acute gastritis
NSAIDs, alcohol, smoking, physical trauma, irradiation, chemotherapy
pg 79
Symptoms of acute gastritis
epigastric pain, nausea, vomiting, anorexia, hematemesis, melena
pg 80
Small/shallow ulceration in the stomach/duodenum
acute peptic ulceration
pg 83
Causes of acute peptic ulceration
severe physiological stress, high doses of NSAIDs, intracranial disease
83
Type of gastric inflammatory disease that is less intense but more prolonged
chronic gastritis
pg 84
Symptoms of chronic gastritis
nausea & upper abdominal discomfort
pg 84
Possible causes of chronic gastritis
helicobacter pylori, increased age, other stressors
pg 84
Chronic gastritis may lead to…
peptic ulcer disease or gastric adenocarcinoma
pg 84
What % of those with chronic gastritis have H. pylori infections?
70-90%
pg 86
Chronic gastritis leading to gastric atrophy
autoimmune gastritis
pg 86
Antibodies against parietal cells in autoimmune gastritis
pernicious anemia
pg 86
Solitary “punched-out” lesion
peptic ulcer disease
pg 87
Most common location of peptic ulcer disease
proximal duodenum(4x) pg 87
Common locations of peptic ulcer disease
proximal duodenum(4x)gastric antrum pg 87
What % of those with peptic ulcer disease have an H. pylori infection?
70-90%
pg 90
What % of those with an H. pylori infection have peptic ulcer disease?
5-10%
pg 90
Symptoms of peptic ulcer disease
nausea/vomiting, bloating cachexia, fatigue, epigastric pain
pg 92
What time(s) are the symptoms for peptic ulcer disease most common?
night and 1-3 hrs postprandial
pg 92
Which type of peptic ulcer disease is typically relived by eating?
duodenal
pg 93
Which type of peptic ulcer disease is typically worsened by eating?
gastric
pg 93
Most common type of gastric polyp
inflammatory and hyperplastic polyps (75%)
pg 96
Second most common type of gastric polyp
Fundic gland polyp (15%)
pg 96
Least common gastric polyp
gastric adenomas (10%) pg 96
What % of gastric adenomas become adenocarcinomas?
30%
pg 96
90% of all stomach cancers
gastric adenocarcinomas
pg 100
Hpertrophy/narrowing of the pyloric sphincter
pyloric stenosis
pg 102
How common is pyloric stenosis?
1:~400
pg 102
Classic symptom of pyloric stenosis
projectile vomiting
pg 102
Risks for pyloric stenosis
family hx, Caucasians, males(4x), Turner syndrome
Most common location of intestinal obstructions
small intestine
pg 106
What % of intestinal obstructions are mechanical?
80%
pg 106
Examples of mechanical obstructions
hernia, adhesions, intussusception, volvulus
pg 106
Abdominal wall defect, allows a segment of intestine to protrude
hernia
pg 106
Inflammation leading to fibrosis
adhesions
pg 106
A proximal segment telescopes into a distal segment
intussusception
pg 106
Twisting a loop of bowel
volvulus
pg 106
Congenital out pouching of the small intestine
Meckel Diverticulum
pg 112
What % of Merkel Diverticulum are symptomatic?
2%
pg 112
Lack of neurologic ganglia in rectum
Hirschsprung disease
pg 114
How is Hirschsprung disease usually dx’ed?
failure to pass meconium
severe dilation of proximal bowels
pg 114
Hirschsprung disease is more common in ____(males or females)
males
pg 114
Lessened blood flow to the large intestine
ischemic bowel disease
pg 117
Arteries involved in ischemic bowel disease
superior mesenteric, inferior mesenteric, celiac
pg 117
Causes of ischemic bowl disease
thrombosis, arterial, embolism, non-occlusive ischemia(heart failure, hemorrhage, shock), volvulus, dissecting aneurysm, scarring/stricture
pg 118
Types of ischemic bowel disease
1) chronic
2) acute
pg 119
Which type of ischemic bowel disease is the most dangerous?
acute
risk for septic or hypovolemic shock, 50% mortality
pg 119
Risks for ischemic bowel disease
elderly, cardiovascular disease
pg 119
Vascular lesion, submucosal & mucosal vessels are tortuous/dilated
angiodyplasia
pg 121
Most common location for angiodyplasia
cecum
pg 121
Angiodyplasia is the cause of what % of lower intestinal bleeds
20%
pg 121
Dilated hemorrhoidal venous plexus
hemorrhoids
pg 122
Most common GI vascular disorder
hemorrhoids (5% of adults)
pg 122
Risks for hemorrhoids
> 50 years, increased intraabdominal pressure, liver cirrhosis
pg 122
Types of hemorrhoids
1) internal
2) external
pg 123
How do you distinguish a internal from external hemorrhoid?
Internal hemorrhoids are about the anorectal line, external are below
pg 123
Common causes of malabsorption in the US
1) celiac disease
2) crohn disease
3) pancreatic insufficiency
pg 124
Excessive fat in feces
steatorrhea
pg 125
Characteristics of steatorrhea
bulky, frothy, greasy, yellow/gray diarrhea
pg 125
Bloody diarrhea
dysentery
pg 125
Features of malabsorption
weight loss, muscle wasting, abdominal distension, borborygmus, flatulence, anorexia
pg 126
Consequences of malabsorption
vitamin deficiencies, iron-deficiency anemia, osteopenia, tetany, amenorrhea, impotence, infertility, hyperkeratosis, edema, peripheral neuropathies
pg 126
Immune-mediated reaction to gliadin
celiac disease
pg 127
Gluten breaks into what two components?
gliadin and glutenin
pg 127
Common population with celiac disease
Caucasians, 30-60 years
pg 128
