Exam 1 Flashcards
Where the gastroesophageal junction together with teh stomach move above the diaphragm
Sliding hernia
Alpha cells pancreas
Secrete glucagon which increases glucose in the blood
When a peptic ulcer develops close to the pylorus, it may becomes stenotic due to development of ___ causing the pylorus to undergo ____
Fibrous tissue
Shrinkage and deformity
Pyloric stenosis
Differential diagnosis hiatal hernia
Ischemic heart disease (chest pain)
GERD (heartburn)
Lung diseases (shortness of breath)
Usually GERD happens because
The LES opens at the wrong time or does not close properly
In the stomach there is also absorption of
Alcohol
Medications
Water
The small intestine wall also contains 2 layers of smooth muscles, rhythmical contractions of which
Move products of digestion through the intestine (peristalsis)
When the symptoms of benign tumors are present, their severity and clinical outcomes depend on
The tumor size
Location
Complications (bleeding, ulceration)
Signs and symptoms of GERD
Heartburn Regurgitation Dysphagia Increased salivation Nausea Chest pain (radiating to arms and neck)
When a neoplasma has extended below the submucosa into the muscular wall
Advanced gastric carcinoma
The head of the pancreas lies
In the C loop of duodenum
Early clinical manifestations of malignant tumors
Heartburn
Loss of appetite, especially for meat
Abdominal discomfort or irritability
Darkness of the skin, frequently locating in axilla and groin
Tripe palms
Sudden eruption of multiple seborrheic keratosis
Adenocarcinoma has direct correlation with
GERD
Barrett esophagus
Scleroderma
Zollinger-Ellison syndrome
The first of the 3 parts of the small intestine and is directly attached to the pylorus of the stomach
Duodenum
Signs and symptoms of chronic gastritis depend on
The form
Treatment malignant tumors esophagus
Surgery
Chemotherapy
Radiotherapy
5-10% of upper gastrointestinal bleeding episodes
Mallory-weiss syndrome
Starving pain 6-7 hours after meal is characteristic for
Duodenal peptic ulcer
Neutralization of acidic gastric content due to function of
Brunner’s glands
Saliva contains
98% water Mucus Salivary amylase Electrolytes Proteins
Other stomach benign tumors
Cystic
Inflammatory pseudotumors
Etiology of barrett esophagus
GERD
Central obesity
Smoking - most common
Bilirubin + albumin =
Unconjugated (indirect, non-H2O soluble) - blood - liver - albumin and bilirubin+glucuronic acid = conjugated direct H2O soluble - to gallbladder
Acquired pyloric stenosis
Scarring of stomach peptic ulcer or duodenal bulb
Tumors (stomach, pancreatic, etc)
Behind the sternum, with radiation to neck or arms can be extremely painful, gest worse after eating
Chest pain with achalasia
Pain in midback on the level of T5-7 around right scapula sometimes mimics gallbladder disease
Postbulbar area peptic ulcer
Benign tumors of the stomach
Epithelial
Mesenchymal
Other
Esophagus ends at
Cardia of the stomach - T11
The stomach consists of four major regions
Stomach Fundus Cardia Stomach body Pylorus
Signs and symptoms of perforation complication of peptic ulcer
Stabbing upper abdominal pain 10/10
Extreme tenderness of the abdomen
Pain by radiate to the right shoulder and back
Sudden weakness, dizziness, breathes shallowly
Chills, tachycardia
GI tract
Food - G-cells - gastrin - HCl - pepsinogen (non-active enzyme) - pepsin (active enzyme) - digestion of proteins
There is absorption of glucose, water, some medications
Oral cavity
The prognosis of malignant tumors of esophagus is generally
Poor
Indigestion is characterized by
Severe pain or bruning feeling in the right upper abdomen
May be also accompanied by nausea, abdominal bloating, belching, vomiting
This route is generally typical for carcniomas
Lymphatic system
Risk factors benign tumors
Chronic h. Pylori infection of the stomach
Autoimmune gastritis
Radiation gastritis
Genetic abnormalities
Long term medication use antacids - proton pump inhibitors (PPIs)
Has only parasympathetic fibers and provides secretor innervation to the mucosa nearest the lumen of the gut - production of normal mucoas
Meissner’s plexus
Is an exophytic (projectile) tumor
Intestinal-type adenocarcinoma
Signs and symptoms chronic gastritis all forms
Cramping
Nausea, vomiting
Weakness
Intolerance of spicy food
The ascending part of duodenum runs
Cranially along the left side of the vertebral column
Complications peptic ulcer
Bleeding or hemorrhages Perforation Penetration Pyloric stenosis Malignancy of stomach ulcer Stomach deformity
Bird’s beak or rat’s tail sign
Achalasia
Suppress production of prostaglandins which inhibit secretion of gastrin
Etiology peptic ulcer
Corticosteroid hormones and nonsteroidal antiinflammatory drugs
A chronic syndrome resulting in mucosal damage caused by stomach acid coming up from the stomach into the esophagus
GERD - gastroesophagel reflux disease
On some types of food like meat and bread
Dysphagia - benign tumors of esophagus
Final digestion of proteins takes place
Small intestine
A breach in the mucosa of the alimentary tract that extends into the submucosa and deeper
Ulcers of alimentary tract
The esophagus is surrounded at the top and bottom by two muscular rings
The upper esophageal sphincter
The lower esophageal sphincter
Most common benign tumors of esophagus
Leiomyomas
This complication develops as a result of peptic ulcer healing, with development of scar tissue - so called hourglass stomach
Stomach deformity
Protein digestion in small intestine enzymes from the pancreas = _____
Chymotrypsin
Trypsin
Carboxypeptidase
Elastase
Break down short-chain peptides to AA
Gastric carcinoma is generally ____ until late in its course
Asymptomatic
The body’s cells in stomach secretes
Pepsinogen
HCl
Diagnosis of achalasia
X-ray
Upper endoscopy
Narrowing (stenosis) of the pylorus due to hypertrophy of the sphincter muscle, or scarring of the tissue surrounding the opening from the stomach to duodenum
Pyloric stenosis
The submucosa secretes mucus from ___ which aids the passage of food down the esophagus
Mucous glands
Diagnosis benign tumors
Upper endoscopy with multiple biopsy
CT-scan
Endoscopic ultrasonography for submucosal tumors
Treatment malignant tumors of stomach
Surgery
Chemotherapy
Radiation therapy
Recommendation by chiropractor acute gastritis
Avoid alochol, caffeine, tobacco
Hydration
Check for subluxation in neck and dorsal spine
Fat digestion in small interstine
Bile from liver and gallbladder emulsifies fats then lipase from the pancreas breaks down fat to fatty acids and glycerol
Diagnosis chronic gastritis
Clinical manifestations
Upper endoscopy with biopsy
Live size depends on
Age, sex, body size
During development, the liver size increases with increasing age, averaging
5cm span at 5 years and attaining adult size by age 15
Although an ulcer can be found anywhere in GI tract, the peptic ulcers develop only in
Organs which have exposure to the stomach pepsin and stomach acidity
Stomach
Duodenum
Esophagus
In the large intestine there is absorption of
Water
Electrolytes
Eliminates drier residues as feces
Exocrine enzymes produced by pancreas
Chymotrypsin Trypsin Carboxypeptidase Elastase Amylase Lipase
Peritonitis could also develop in
Peptic ulcer
Nausea, vomiting, regurgitation of food esophageal cancer due to
Disruption of normal peristalsis
Has known predisposing factors
Intestinal-type adenocarcinoma
Benign tumors of esophagus typically occur in the age between ____ abnd have ___ gender predominance
20-50 yo
No
Late clinical manifestations malignant tumors
Upper abdominal pain Weight loss Nausea and vomiting Diarrhea or constipation Bleeding (hematemesis, melena) Signs of anemia Dysphagia
Common signs and symptoms of benign tumors
Abdominal pain
Nausea
Weight loss
Acute or chronic bleeding
The descending part and rest of duodenum lies
Retroperitoneally
Neurogenic
Neurinoma aka schwannoma aka neurilemmoma
H. Pylori
Bile reflux
In chronic gastritis affect the ___ part of teh stomach
Antral part
Malignant tumors can also send metastases to the
Pancreas and lungs
Squamous cell carcinoma has direct correlation with
Celiac disease
Hot tea with increased concentration of tannins
Tylosis (palmar/plantar hyperkeratosis)
Digestion in liver due to production of
Bile
Whereby the shallow or deeply erosive crater is present in the wall of the stomach
Excavated
Enteroendocrine cells (G-cells) secrete
Hormone gastrin
Leiomyomas originate from
The smooth muscle cells
Unusual hoarseness, coughing for cancer of esophagus due to
Involving of the recurrent laryngeal nerve
Signs and symptoms of zenker’s diverticulum
Food regurgitation in the absence of dysphagia, can be complicated by aspiration pneumonia
Exophytic
With protrusion of tumor into the lumen
Small intestine enzymes for carb digestion
Maltase
Sucrase
Lactase
Signs and symptoms penetration peptic ulcer
Pain from upper abdomen radiates to the back
Pain gets worse in teh night
Pain could be relieved by intake of antacids
Similar to intestinal lymphomas
Gastric lymphomas
About 25-35 cm long (12 fingers’ length)
C-shaped
Located in upper abdomen
Duodenum
Forms of acute gastritis
Based on degree of mucosal damage
Erosive
Nonerosive
The potentials for malignancy of benign tumors of esophagusl are
Extremely low
Carbohydrate digestion in small intestine
Pancreatic amylase finishes the breaking down of carbohydrates to simple sugars
Pancreas length
15 cm (6 in)
Neck of the pancreas lies
Between the body and head, anterior to the superior mesenteric artery and vein
Treatment esophageal diverticuli
Surgery
Treatment esophageal varicies
Life-threatening situation requires immediate hospitalization - NEVER ADJUST THIS PATIENT
It is associated with predominate venous blood flow from GI tract organs to
Maliganant tumor
Portal vein
Diagnosis esophageal diverticuli
X-ray with contrast fluid
Upper endoscopy
Zenker’s diverticulum aka
Pharyngoesophagel diverticulum
20% of peptic ulcer develops in the
Stomach
Esophageal varices appear in ___ of patients with liver cirrhosis
65%
Forms of achalasia
Primary achalasia
Secondary achalasia
In over 40% of patients, __ are the first sign of an undiagnosed cancer
Tripe palms
Midesophageal diverticulum aka
Traction diverticulum
Pathogenesis peptic ulcer
Aggressive forces - weaken mucous barrier (Defensive forces) - peptic ulcers
Diagnosis hiatal hernia
X-ray with liquid barium salt
Upper endoscopy
Tratment pyloric stenosis
Surgery
Signs and symptoms acute gastritis
Constant or sporadic pain in epigastric area (achy, burning, sharp, dull) Nausea Vomiting Fever, chills Belching, bloating
The duodenum may be subdivided into 4 sections
Superior part
Descending part
Horizontal part
Ascending part
Liver storage function
Vitamins A, D, B12, K, E
Glycogen
Iron
Copper
Mallory may develop
Metabolic acidosis
Gastrin - ____ - inc production of HCl
Parietal cells
Etiology benign tumors
Unkown
Sodium, potassium, chloride, phosphate, bicarbonate ions
Electrolytes in salivary glands
Cholecystokinin
Bile from liver and gallbladder and pancreatic enzymes
Lower GI tract
Mid-transverse colon to anus
Hindgut
Reduces rate at which food is absorbed from teh content of the intestines
Regulates/sotps alpha and beta cell functions
Somatostatin
Etiological factors of chronic gastritis cause ____ damages of the stomach mucosa
Multiple focal
Sucrase
Breaks down sucrose to glucose and fructose
Polyps are usually composed of
A combincation of fibrous, vascular or adipose tissue, covered by an intact mucosa
Signs and symptoms mallory-weiss syndrome
Episodes of vomiting with bright blood
Achalasia is characterized by
Incomplete relaxation of LES
Its increased tone
Lack of peristalsis of esophagus
Esophagus enters the diaphragm at
T10
Tail of pancreas ends
Abutting teh spleen
Etiology peptic ulcer
H. Pylori Corticosteroid hormones and nonsteroidal antiinflammatory drugs Cigarette smoking Zollinger-Ellison syndrome Stressful lifestyle Genetic predisposition
Immediately above the lower esophageal sphincter diverticulum
Epiphrenic diverticulum
Pain in left upper quadrant and retrosternal area - mimics heart problem like hiatal hernia or esophagitis
Area of cardia peptic ulcer
The pancreatic duct and common bile duct enter the descending duodenum, through the ____
Major duodenal papilla - hepatopancreatic ampulla
= ampulla of Vater
2 ducts of pancreas
The main pancreatic duct
The accessory pancreatic duct
Middle GI tract
Duodenal papilla to mid-transverse colon
Midgut
Usually occurs in the distal third of esophagus or gastro-esophageal junction
Adenocarcinoma
Hiccups tumors of esophagus
Phrenic nerve involvement
In peptic ulcer there is a strong casual association with ___ infection
H. Pylori
Chief (zymogen) cells secrete
Pepsinogen
Most commonly locates in distal 2/3 of the esophagus, usually they are multiple
Leiomyomas - benign tumors
The epithelial surface of plicae is further folded to form
Villi
Immunity function of liver
Contains Kupffer cells - a type of fixed macrophages
Majority of nutrients are absorbed in the
Jejunum
Immediately above the upper esophageal sphincter
False diverticulum
Zenker’s diverticulum/pharyngoesophageal diverticulum
In the small intestine there is also absorption of
Iron Vitamins A and B1 Calcium Glycerol Fatty acids, monoglycerides AA Monosaccharides and disacchariddes are absorbed in the duodenum
Forms chronic gastritis
Hypertrophic Hyperplastic Erosive Antral Atrophic
Head of pancreas rests within
The concavity of the duodenum
Is found behind the stomach, with the head surrounded by duodenum
Pancrea
The esophagus passes close to the ___ and the ___ side of the heart
Trachea
Left
Represents 50-80% of esophageal cancer in USA
Adenocarcinoma
More complex arterial arcades
Shorter vasa recta
Less plicae circulares, thinner less folded
Fat present in mesentery
Ileum
Backflow of undigested food
Regurgitation
In which there is no obvious tumor mass within the mucosa
Flat or depressed
Benign tumors of esophagus
Leiomyomas Polyps Fibromas Lipomas Hemangiomas Neurofibromas Squamous papillomas
An outpouching of the alimentary trat organ wall that contains all visceral layers
Diverticulum
The tissue of adjacent organ undergoes digestion, which is potentially also very dangerous and may result in death
Penetration peptic ulcer
The wall of the small intestine is lined with a ____ with certain modifications for each section of the intestine
An absorptive type of mucosa
The 1st place where digestion and absorption start
Oral cavity
Signs and symptoms epiphrenic diverticulum
Gives rise to nocturnal regurgitation
Treatment peptic ulcer
Physical and emotional rest
Anti-helicobacter therapy
Antacids
Diet modification
Erosive acute gastritis
Mucosal damage
Superficial
Deep
Hemorrhagic
Aspirationo f food or liquid - possible development fo aspiration pneumonia
Achalasia
Metastases malignant tumors of esophagus
Regional lymph nodes
Aorta
Liver and lungs
Mediastinum
Etiology of GERD
Failure of the lower esophageal sphincter
Sliding hernia
Obesity
H. Pylori infection
Some visceral diseases (SLE, asthma, gallbladder stones, laryngitis)
Here the salivary amylase starts to digest carbs
Oral cavity
Bleeding from longitudinal tears in the mucosa (not muscular layer) at the esophagogastric juinction
Mallory-weiss syndrome (lacerations)
Differential diagnosis peptic ulcer
Acute or chronic gastritis Esophagitis Pancreatitis Cholecystitis Angina pectoris/heart attack
Diagnosis barrett esophagus
Upper endoscopy with biopsy
Diagnosis esophageal varicies
Upper endoscopy
CT scan
Peyer’s patches provide
Local immunological protection
Most common area of stomach with cancer
Lesser curvature
Less complex arterial arcades
Longer vasa recta
More plicae circulares, thicker, more highly folded
No fat in mesentery
Jejunum
In the case of heart attack it is very important to remember that indigestion is ___ to eating
Unrelated
Gamma cells pancreas - endocrine role
Secrete pancreatic polypeptide
Complications benign tumors
Malignancy
Bleeding
Ulcerations
Pyloric canal obstruction
Microscopically the gastric carcinomas are classified to
Early gastric carcinoma
Advanced gastric carcinoma
Pain in epigastric area, without radiation
Lesser curvature peptic ulcer
Clinical manifestations for both cancers of esophagus are
Dysphagia Weight loss/dec appetite Pain Unusual hoarseness, coughing Hiccups Nausea, vomiting Bleeding, hematemesis
Esophagus starts
Around level of C6 behind cricoid cartilage
When the stomach or duodenal wall is perforated, the stomach content spreads into teh peritoneal cavity, resulting in
Peritonitis
Chest pain in heart attack
Lasts for more than a few minutes
Increases in intensity
Is not relieved by rest or by taking nitroglycerin
Squamous cell carcinoma arises from
The squamous epithelium
The stomach wall contains
Parietal cells
Chief cells
G-cells
Benign tumors of esophagus bleeding or hematemesis result from
Ulceration or necrosis of benign tumors.
These manifestations are extremely rare.
Parietal cells secrete
HCl and
Intrinsic factor
Stomach carcinomas give metastases predominantly through ___ primarily to regional lymphatic nodes
Lymphatic system
Diagnosis acute gastritis
CBC
Upper endoscopy
Stool sample for presence of blood
Pregnancy test
Less common is pain while swalloing - usually is retrosternal
Benign tumors of esophagus
Has a seasonal characteristic usually in spring or fall for
Stomach, dudodenum peptic ulcer
This complication develops only in the stomach, and usually when peptic ulcer locates on greater curvature
Malignancy of stomach ulcer
Diagnosis GERD
X-ray with liquid Barium salt
Upper endoscopy - the best
Lactase
Breaks down lactose to glucose, and galactose
Young children, sometimes congenital
Primary achalasia
From gallbladder - in intestine
Direct bilirubin - stercobilinigen - stercobilin - excretion with feces
Direct bilirubin - reabsorption to blood (urobilinogen) - liver and kidneys - urobilin - excretion with urine
Midesophageal diverticulum usually results from
Mediastinal lymphadenitis (as from tuberculosis)
Provides motor innervation to both layers of the muscular layer, having both parasympathetic and sympathetic input
Auerbach’s plexus (myenteric plexus)
Most common complication of peptic ulcer, manifested by
Hematemesis and/or Melena (tarry feces) Weakness Orthostasis Syncope Thirst Sweating caused by blood loss
May result in anemia
Hollow muscular tube that transports saliva, liquids, and foods from the mouth to the stomach
Esophagus
3 pairs of salivary glands secrete up to 1 L of saliva a day
Parotid glands
Submandibular glands
Sublingual glands
Close association with chronic gastiritis due to intestinal metaplasia and H. Pylori infection
Intestinal-type adenocarcinoma
Somatostatin also secreted by
Hypothalamuc and the intestine
An endocrine organ that lies in the specifically upper left abdomen
Pancreas
In barrett esophagus, The squamous epithelial cells of the esophageal mucosa are replaced by
Columnar epithelial cells with goblet mucus-producing cells
Forms of esophageral diverticuli
Zenker’s diverticulum
Midesophageal diverticulum
Epiphrenic diverticulum
This disease is also known as gastrinoma with overproduction of gastrin
Zollinger-Ellison syndrome
No association with chronic gastritis and H. Pylori infection
Diffuse gastric carcinoma
Most common area for blood
Duodenal bulb
Treatment benign tumors of stomach
Laparoscopic or endoscopic surgery
Signs and symptoms depend on degree of
Tumor progression
Hepatic (intrahepatic) portal hypertension assocaited with
Liver cirrhosis - most common
Liver tumors
Amyloidosis
Difficulty in swallowing of solid and liquid food
Dysphagia
Achalasia aka
Cardiospasm
Pancrease external digestive role - exocrine
Secretes pancreatic fluid that contains digestive enzymes which help to further break-down the carbohydrates, proteins and lipids in the chyme
Leser-trelat sign
Sudden eruption of multiple seborrheic keratosis
Second largest organ in the human body
Liver
J-shaped organ with two openings
Stomach
When a lesion confined to the mucosa and submucosa carcinoma
Early gastric carcinoma
Etiology pyloric stenosis
Congenital
Acquired
The superior part of duodenum lies
Intraperitoneally and is enlarged proximally (duodenal bulb)
Proteins in salivary glands
Mucin
Lysozyme
IgA
Pain in epigastric area and right upper quadrant
Pylorus and duodenum peptic ulcer
The horizontal duodenum runs ___ and is located ____
From right to left
Retroperitoneally
Delta cells pancreas endocrine role
Secrete somatostatin (regulates functioin of alpha and beta cells)
Most patients benign tumors are
Asymptomatic for long period of time
Causes portal hypertension
Posthepatic (suprahepatic)
Hepatic
Prehepatic (infrahepatic)
Same as perforation, but because the involved wall is bound to an adjacent organ (liver, pancreas, greater omentum) the stomach content does not enter the peritoneal cavity
Penetration
X-ray diagnosis of achlasia
Contrast liquid swallowing shows the narrowing of the distal part of the esophagus (bird’s beak or rat’s tail sign) and its dilatation above
Most cases of does not cause any symptoms or specific symptoms
Hiatal hernia
Diet modification peptic ulcer
Avoid:
Alcohol, coffee, sour food, spicy food, bubble water, broccoli, orange juice, hot food
Stomach cancer arises from any part of the stomach, but a favored location is the
Lesser curvature of the antrum-pyloric region
Kupffer cells
Clean the large volumes of blood very fast
All complications of peptic ulcer are considered as
Emergency medical situations
Pain of peptic ulcer can be
Diffuse, achy, acute or dull and is associated with mealtime
Prehepatic (infrahepatic) portal hypertension associated with
Portal vein thrombosis
Portal vein sclerosis
Portal vein congenital stenosis or atresia
They are suually asymptomatic, silent, and undetected
More than 5 cm in diameter can come to clinical attention
Benign tumors of the esophagus
Etiology esophageal varicies
Portal hypertension
This last part (ascending duodenum) joins it with the ___. And is located ___
Jejunum
Retroperitoneally
Carcinomas occur when the DNA of a cell is ____ or ____ and the cell begins to grow uncontrollably and become malignant
Damaged
Altered
Late peptic ulcer
1.5-2 hours after the meal
Typical for duodenal peptic ulcer
The pancreas is a secretory structure with
Internal hormonal role (endocrine)
External digestive role (exocrine)
Forms of hiatal hernia
Sliding hernia
Rolling or paraesophageal hernia
In hypertrophic pyloric stenosis in babies
First symptoms appear in the first 2-6 weeks of the life
There is progressive vomiting with partially digested food after each or few feedings
For esophageal motility studies
X-ray with barium liquid
The most common malignant esophageal tumors are
Squamous cell carcinoma
Adenocarcinoma
Great mimic disease
Hiatal hernia
Acts principally on the liver where it stimulates conversion of glycogen to glucose and fat and protein to glucose
Glucagon
Usually makes the pyloric canal such a narrow that the bolus cannot move from the stomach to duodenum
Pyloric stenosis
Insulin ___ glucose in the blood
Decreases
Site where the most of the chemical and mechanical digestion is carried out and where virtually all of the absorption of useful materials is carried out as well
Small intestine
Most common form of hiatal hernia
Sliding hernia
Duodenal mucosal cells produce and release
Secretin
Cholecystokinin
On embryologic ground, teh GI tract should be divided into
Upper
Middle
Lower
The esophagus has a ____ lining which protects the esophagus from ___
Nonkeratinized stratifies squamous epithelial lining
Trauma
Muscles in middle portion of esophagus
Smooth
Most important for evaluation of inflammation
Upper endoscopy (gastroscopy)
Stomach polyps could undergo malignancy in ___ of cases
4-30%
Hyperplastic polyps and adenomas
Complications barrett esophagus
Bleeding
Stricture due to healing or improper healing
Frank esophageal adenocarcinoma - goblet cells
Risk factors are undefined
Diffuse gastric carcinoma
Composed of neoplastic intestinal glands
Intestinal-type adenocarcinoma
GERD recommendations by chriopractor
Life style modifications:
Eating not later than 3-4 hours before sleep
Avoid coffee, alcohol, chocolate, sour and spicy food
Increaesed fluid intake
Ginger tea
The large intestine contains areas of lymphoid tissue called
Peyer’s patches - also found at distal part of ileum
Normal bilirubin pathway
RBC - spleen lysis - globulin and heme - heme into iron and porphyrin ring - biliverdin - bilirubin
Chronic mucosal inflammatory changes in the stomach wall that eventually result in mucosal atrophy and mucosal (intestinal) metaplasia
Chronic gastritis
The mucosa of jejunum and ileum is highly folded (folds are called plicae) which dramatically increases
The surface area available for absorption
In females the stomach carcinoma could sometimes metastasize thorugh the abdominal cavity, giving rise to development of secondary ovarian cancer called
Krukenberg tumors
Has short latent period
Diffuse gastric carcinoma
Vitamin B12 and bile salts are absorbed in the
Terminal ileum
Detoxification liver function
Converts ammonium to urea
Breaks down insulin adn other hormones
Breaks down toxic substances
Etiology of hiatal hernia
Kyphoscoliosis
Increased pressure within the abdominal cavity
Congenital diaphragmatic weakness
Obesity, trauma
In the liver there is production of
Bile Albumins Lipoproteins Clotting factors Angiotensinogen
There are 3 main sections of the small intestine
Duodenum
Jejunum
Ileum
Most common carcinoma of the stomach
Intestinal-type adenocarcinoma
Diffuse stomach carcinoma
Treatment barrett esophagus
ONLY medical treatment
Upper GI tract
Mouth to major papilla in duodenum
Foregut
Usually occurs in the proximal 2/3 of esophagus
Squamous cell carcinoma
The manifestations of chronic gastritis are ____ and do not push a patient to attend a phsyician
Vague, not severe, non-specific
The second part of the duodenum also can contain the ___, the entrance for the accessory pancreatic duct
Minor duodenal papilla
=paillia of santorini
Hyperproduction of ____ leads to vasoconstriction of the stomach wall arteries. It affects ___ thus weakens ___
Catecholamines
Stomach mucosal blood flow
Mucous barrier
Cigarette smoking leads to impairment of ____ thus weakening the ____
Etiology peptic ulcer
Stomach mucosal blood flow
Mucous barrier
Flat advanced gastric carcinoma is also known as
Linitis plastica
Treatment benign tumors of esophagus
Removal of polyps thorugh endoscopy
Surgery
Two openings of the stomach
Esophageal
Duodenal
The lumen of the esophagus is surrounded by layers of muscle
Voluntary in top 1/3 - striated
Involuntary in the bottom 1/3 - smooth
Mixture of voluntary and involuntary in the middle 1/3
Leiomyoma occupies 2nd position in frequency after
Polyps
Etiology acute gastritis
Food poisoning/food infection Severe alcohol consumption Heavy smoking NSAIDs, especially aspirin Extreme stress (severe trauma, burns, surgery, etc)
Is a flat tumor
Diffuse gastric carcinoma
Heart attack could be manifested by GI symptoms called ___ which also known as upset stomach or dyspepsia
Indigestion
posthepatic (suprahepatic) portal hypertension assocaited with
Chronic right-sided cardiac failure
Budd-chiari syndrome
The ___ within the stomach mucosa accounts for secretions of various active substances
Glandular tissue
Muscles in upper portion of esophagus
Skeletal striated muscles
Problem with auerbach’s plexus
Achalasia
The pylorus is responsible for
Production of mucus, hormone gastrin, and pepsinogen secretion
Stomach carcinomas also give metastases to a lymphatic node in the left supraclavicular fossa
Virchow’s node
Endophelbitis of the liver veins or obstruction ofhte hepatic vein
Budd-Chiari syndrome
In 50% of peptic ulcer patients
Constipation
Diagnosis benign tumors of esophagus
Upper endoscopy with biopsy
Ultrasound endoscopy
CT scan
X-ray with barium liquid
Signs and symptoms pyloric stenosis
Severe worsening vomiting Weight loss Dehydration Constant hunger Visible or palpable peristaltic waves
Early peptic ulcer
30 min to 1 hour after the meal - typical for stomach peptic ulcer
Heartburn (in 30-80%) may be the only peptic ulcer symptom
Nausea
Vomiting (relieves the pain)
Belching with sour taste
Dyspepsia
Near the midpoint of the esophagus diverticuli
Midesophageal aka traction diverticulum
Recommendations by chiropractor hiatal hernia
To restrict activities that raise the intra-abdominal pressure
Avoid eating near bed-time
Diet modification - small frequent bland meal
Has relatively long latent period
Intestinal-type adenocarcinom
Diagnosis mallory-weiss syndrome
Upper endoscopy
Maltase
Breaks down maltose to 2 glucose
Diagnosis malignant tumors of esophagus
Endoscopy with biopsies
Ultrasound endoscopy
CT-scan of chest, abdomen and pelvis (esp for metastasis)
PET
X-ray with barium liquid for esophageal motility studies
Begins the chemical digestion of carbs in the mouth
Salivary amylase
Complications mallory-weiss syndrome
Severe bleeding Esophageal rupture (known as Boerhaave syndrome)
Most common benign tumors of the stomach
Polyps
H. Pylori is found in ___ of duodenal peptic ulcer and ____ of stomach peptic ulcer
100%
70%
The junction between jejunum and ileum is
Not well-defined
In late stages of carcinoma prognosis is often
Poor
Diagnosis peptic ulcer
X-ray with liquid barium (ulcer crater aka nicha) Upper endoscopy with biopsy tests for H. Pylori Ultrasound CBC, UA, liver tests Urea breath test for H. Pylori Stool culture for H. Pylori antigen PCR blood tests for H. Pylori DNA CBC, UA, liver tests Fecal occult blood test (FOBT) CT
Recommendations of chiropractor for achalasia
To eat slowly
Avoid eating near bed-time (3-4 hours)
Avoid ketchup, citrus, chocolate, caffeine
Physician’s consultation
Congenital pyloric stenosis
Hypertrophic pyloric stenosis
Male:female = 4:1
Prevalence 2-4 per 1,000 newborns
Macroscopic growth patterns of gastric carcinomas
Exophytic
Flat or depressed
Excavated
Complications hiatal hernia
Ulcer in the esophagus
Stricture of the esophagus with possible achalasia
By percussion the liver size is
6 cm for women
12 cm for men
Diffuse stomach carcinoma is a typical example of ____ cancer
Scirrhous aka scirr
Greatly coiled parts of the small intestine, and together are about 4-6 meters long
Jejunum and ileum
5 major functions of the stomach
Preliminary digestion of protein with pepsin
Temporary food storage
Control of the rate at which food enters the duodenum
Acid secretion and antibacterial action
Fluidisation of stomach content
Beta cells pancreas endocrine role
Secrete insulin - decreases glucose in the blood
Atrophic form chronic gastritis signs and symptoms
Heaviness in epigastrium and left upper abdominal area
Fullness in the stomach after small amount of meal
Diarrhea
Signs of pernicious anemia
Signs and symptoms of achalasia
Dysphagia Regurgitation Chest pain Coughing Aspiration of food or liquid
Fundus does what
Collects digestive gases
Etiology chronic gastritis
NSAIDs
Autoimmune diseases (autoimmune chronic gastritis, SLE)
Allergic response
Are found in the duodenum ONLY, located in its submucosa, secrete an alkaline mucus which neutralizes the chyme and protects the surface of the duodenum
Brunner’s glands
Mesenchymal
Leiomyoma
Lipoma
Neurogenic
Vascular
Benign tumors of esophagus are mostly ____ in origin and usually lie within the ____
Mesenchymal
Esophageal wall
Major digestion of carbs take place
Small intestine
Ulcer near the junction between stomach and esophagus
Reflux esophagitis necrosis
Signs and symptoms of benign tumors of esophagus
Dysphagia
Pain while swallowing
Food regurgitation
Bleeding or hematemesis
Darkness of skin frequently locating in axilla and groin known as
Acanthosis nigricans
Body of pancreas lies
Behind the base of the stomach
Usually more late syptom, the pain located behind sternum or epigastrium could be severe and is worsened by swallowing of any food
Tumors of esophagus
Complications GERD
Reflus esophagitis necrosis Esophageal stricture Barrett esophagus Aspiration pneumonia Esophageal cancer
Amylin actions
Inhibits secretion of glucagon
Slows emptying of the stomach
Sends a satiety signal to the brain
Squamous cell carcinoma represents ___ of esophageal cancer worldwide
90-95%
Acanthosis palmaris
Skin condition in which teh skin of the palm becomes thick and velvety hyperpigmentation with pronounced folds in the lines of the hand
Tripe palms
Malignant tumors of the stomach
Carcinomas (90-95% of all stomach malignant tumors)
Lymphomas
Carcinoids
Sarcoma
The horizontal part of duodenum passes
In front of the inferior vena cava, abdominal aorta and the vertebral column,
Genetic predisposition - more common in children
Etiology peptic ulcer
Type O blood (30% risk of duodenal ulcer)
Hypersecretion of HCl, pepsinogen
Familial tendencies
Etiology of GERD - failure of the LES due to
CNS depressants
Hypothyroidism
Pregnancy
Alcohol or tobacco exposure
Risk factors for both cancers of esophagus are
Tobacco smoking and chewing
Alcohol overconsumption
Age after 60-65 yo
Male:female = 4-5:1
A liver span 2-3 cm larger or smaller than normal is considered to be
Abnormal
Etiology mallory-weiss syndrome
Alocholism, after frequent severe retching and vomiting (most common cause)
Hiatal hernia
Overdose of NSAIDs
Severe vomiting in pregnancy
Leather bottle stomach aka ____ aka _____
Linitis plastica
Diffuse stomach carcinoma
For estimation of stage, metastases of the cancer
PET - positron emission tomography
Four main cells exist in the islets of pancreas for internal hormonal role - endocrine role
Alpha
Beta
Delta
Gamma
Bile is a mixture of
Water
Bile salts
Cholesterol
Pigment bilirubin
Diagnosis pyloric stenosis
Ultrasound examination
Upper endoscopy
X-ray (string sign) or railroad track sign
Indigestion in heart attack could be accompanied by
Shortness of breath
Sweating
Pain radiating to the left jaw, left part of the neck, or left arm
Chest pain
Experience severe abdominal pressure that feels like an elephant sitting on stomach
Creates a bell-shaped dilation
Sliding hernia
80% of peptic ulcer develops in the
Duodenum
An abnormal change (metaplasia) in the cells of the lower portion of the esophagus
Barrett esophagus
The stomach wall contains 3 layers of involuntary smooth muscles which aid digestion by physically breaking up the food particles
Inner oblique layer
Circular layer
Outer longitudinal layer
Etiology chronic gastritis
H. Pylori (in 90%)
Bile reflux
Complications of achlasia
Aspiration pneumonia or airway obstruction
Lower esophageal diverticulum
Esophageal cancer - in 5% of patients
Vascular
Glomus tumors
Nonerosive
Focal
Pangastritis (diffuse)
The pancreas also produces hormones
Insulin, amylin - beta cells
Glucagon - alpha cells
Somatostatin - delta cells
Pancreatic polypeptide - gamma cells
Hypertrophic erosive and antral forms chronic gastritis signs and symptoms
Acute pain in epigastrium and left upper abdominal area
Local pain without radiation
Usually pain develops in 30-60 min after meal
Heartburn
Belching
Constipation
Sudden inflammation of the lining of the stomach
Acute gastritis
Signs and symptoms peptic ulcer
PAIN
Dyspepsia
Constipation
Emotional instability
Carcinomas are a type of cancer that develops from
Epithelial cells
Duodenum main functions are
Neutralization of the acidic gastric content
Further digestion
Absorption of nutrients
Regulation of the rate of gastric emptying
Coughing when lying in horizontal position especially at night
Achlasia
For assessing a patient with acute abdominal pain, and in some settings may be able to identify the site of bleeding or perforation prior to endoscopy
CT
Chronic atrophic gastritis may often be
Asymptomatic
Anatomically the pancreas is divided into
Head
Body
Tail
Neck
Extremely dilated submucosal veins in low third of the esophagus
Esophageal varices
Signs and symptoms barrett esophagus
Heartburn
Hematemesis
Painful eating
Dysphagia (in case of complication by stricture)
Pathogenesis mallory-weiss syndrome
Inadequate relaxation of the musculature of the lower esophageal spincter during vomiting, with stretching and tearing of the esophageal junction during propulsive expulsion of gastric contents
Glucagon ___ glucose in the blood
Increases
Rolling hernia can be complicated by development of
Venous infarction due to it’s possible strangulation by the diaphragm - this is EMERGENCY situation
Characterized by failure of distal esophageal inhibitory neurons - the auerbach’s plexus (myenteric plexus)
Primary achalasia
Typanosoma cruzi causes
Destruction of the myenteric plexus of the esophagus with its dilation
Problems with the esophagus, such as eating something too hot, can sometimes feel like a pain
Close to or in the heart or throat
Varicies produce no symptom until
They rupture, and the hemorrhage develops (hematemesis)
Diagnosis malignant tumors tumor markers
CEA elevated in 45-50% of cases
CA 19-9 elevated in 20% of cases
CBC
Parotid glands lie
Just below and in front of the ear near the jaw
First digestion of fat takes place
Small intestine
Achalasia most common etiological factor
Incomplete relaxation of LES
An esophageal motility disorder involving the smooth muscle layer of the esophagus, and the lower esophageal sphincter (LES)
Achalasia (cardiospasm
Gastric lymphomas represent ___ of all gastric malignancies
5%
Signs and symptoms of hiatal hernia
Dull pain in the chest
Shortness of breath
Heartburn (typical for sliding hernia)
Heart palpitation (tachycardia)
Both submandibular and sublingual glands lie
On the floor of the mouth
The also are able to send metastases to the ___ via blood
Malignant tumors
Liver
Differential diagnosis GERD
Heart diseases (chest pain) Hiatal hernia
The liver consists of 4 distinct lobes
Left
Right
Caudate
Quadrate
Secretin
Pancreatic juice
Most of the liver’s mass is located
On teh right side of the body where it descends inferiorly toward the right kidney
Diagnosis malignant tumors
Tumor markers
Endoscopic ultrasonography with biopsy
PET, CT, or MRI of chest, abdomen, and pelvis
More advanced clinical manifestations malignant tumors
Weakness and fatigue
Bloating of the stomach, usually after meal
Composed of gastric-type mucous cells
Diffuse gastric carcinoma
Each villus has its own
Blood supply
The surface of each villus is covered by
Small microvilli to maximize surface area and thus area available for absorption
The mucosa of the large intestine consists of two types of epithelial cells
Cells specialized for water absorption
Mucus-producing goblet cells - also located in small intestine
Kupffer cells play an important role by ____ and ___ bacteria, fungi, parasites, worn-out blood cells, and cellular debris
Capturing and digesting
Villi further increase
The surface area of the small intestine
Very important predisposing factor for development of one of the most common stomach cancers - intestinal-type adenocarcinoma
Intestinal (mucosal) metaplasia
Most common cancer
Adenocarcinoma
Obesity as adult
Trauma as a child
Marfan’s sydrome - congenital diaphragmatic weakness
Hiatal hernia
Action in chiro office mallory-weiss syndreom
Call 911
Traction diverticulum signs and symptoms
Usually asymptomatic
Achalasia caused by trypanosoma cruzi is known as
Chagas’ disease
When a separate portion of the stomach, usually along the greater curvature, enters the thorax through the widening foramen
Rolling or paraesophageal hernia
Protrusion of the upper part of the stomach into thorax through the space between the muscular crura of the diaphragm (the hiatus)
Hiatal hernia
Arises from metaplastic columnar epithelium
Adenocarcinoma
Night pain at 4-5am is characteristic for
Duodenal peptic ulcer
Chiropractic spinal manipulation may benefit some people with ____ gastric or duodenal ulcer
Uncomplicated
Secondary achlasia could result from
Cancer of esophagus or upper stomach
Infeciton with a protozoa Trypanosoma cruzi - Chagas disease
Pancreatic polypeptide
Reduces appetite
Functions of liver
Production Digestion Storage Detoxification Immunity
