Exam 1 - Intestinal Pathologies Flashcards
What are the two types/population of Obstructive Pyloric disorders?
- Infantile Hypertrophic Pyloric Stenosis
2. Adult/Acquired Pyloric Obstruction
What causes Pyloric Obstructions?
Narrowing of Pylorus (junction between stomach and duodenum)
Is Infantile Hypertrophic Pyloric Stenosis congenital or acquired?
Congenital
What are the signs/symptoms of Infantile Hypertrophic Pyloric Stenosis? Due to what? Treatment?
S/S: At 2-3 weeks projectile vomiting of several feet.
Cause: Hypertrophied pyloric sphincter. Unk etiology (hormones?).
Tx: Pyloromyotomy is treatment.
What are the signs/symptoms, cause, and treatment of Adult/Acquired Pyloric Obstruction?
S/S: Vague to severe epigastric discomfort with eating. Gastric distention, nausea/vomiting, to acute distress.
Cause: Severe peptic ulcer or tumor in area.
Tx: Address cause of obstruction
What are the two types of Intestinal Obstructions?
- Mechanical
2. Functional (physiological obstruction)
Adhensions, Herniations, Intussusception, Volvulus, and Tumor Growth are examples of what type of Intestinal Obstruction?
Mechanical Intestinal Obstruction
What is the most common cause of SI obstructions? What causes it?
Adhesions (mechanical intestinal obstruction).
Fibrous “scar tissue” adheres to intestinal loops, often complication of abdominal surgery.
What kind of obstruction is a Hernia and how does it present?
Mechanical intestinal obstruction.
Intestine protruding through abdominal wall. May stangulate through opening. Hiatial hernia, inguinal hernia, umbilical ring hernia.
What kind of obstruction is an Intussuspection and how does it present? Where is it most common?
Mechanical intestinal obstruction.
Telescoping/folding back/invagination of one part of intestine on another. Most common in ileocecal area.
What kind of obstruction is a Volvulus (torsion) and how does it present? Who gets it most common?
Mechanical intestinal obstruction.
Intestine twisting in on itself from mesentary twisting in on itself and strangulating blood supply to intestine. Most common in elderly.
Tumor Growth is most common cause of what? How does it present?
Mechanical intestinal obstruction.
Most common cause of LI obstruction. Colon/rectal cancer.
Paralytic Ileus is what type of intestinal obstruction?
Functional/physiological obstruction
Paralytic Ileus causes an obstruction due to what….? Causes and tx?
Physiological/functional. Obstruction that occurs when peristalsis stops.
Causes: Narcotics pain meds, HTN meds, injury, trauma, infx, MI, electrolyte imbalance, dz of muscles, low blood supply to mesentery
Tx: NG tube to decompress, address underlying cause, surgery
Hirschsprung’s Disease (Congenital Aganglionic Megacolon) is what type of defect and what is the functional result?
Birth defect where ganglion nerve cells of colon fail to develop.
Impaired mobility of colon due to poor coordination/ability to contract intestinal musculature. Results in impacted/trapped stool, infx, inflammation, constipation.
Inflammatory Bowel Disease types and what is generally is caused by and does
Chronic autoimmune inflammatory disease that damages/ulcerates GI tract.
- Chron’s Disease
- Ulcerative Colitis
Where does Chron’s IBD commonly affect and present?
Most commonly distal ileum and cecum/proximal colon but can be any part of GI tract. Inflammation through all layers of intestinal wall. Forms “granulomas” and “skip lesions”.
What are granulomas and skip lesions in Chron’s IBD?
Granulomas=cluster of cells that form in an area of inflammation
Skip Lesions=Two or more inflamed areas with healthy bowel in-between
Who gets Chron’s IBD and what is the Etiology?
Etiology unknown. (Genetics, autoimmune, environmental?)
15-20 y/o, women more than men, 2-4x risk when 1º relative.
How is Chron’s IBD classified and subtyped?
Based on anatomical locations.
Subtypes=Acute, inflammatory, fistulizing/perforating.
What are five pharamceutical treatments for Chron’s IBD?
Based on severity.
- Aminosalicylates (5-ASA)
- Corticosteroids
- Immunomodulators
- Antibiotics
- Biological therapies
When is surgery used for Chron’s IBD? Indications?
As a last resort. 65-75% of PTs require surgery at some point. Commonly require several surgeries.
Indication=Don’t respond to meds, obstruction/perforation/abscess.
What is the “last resort” surgery in Chron’s IBD?
Colostomy/Ileostomy
Can a woman with Chron’s IBD get pregnant? Will the Chron’s get worse?
Yes, considered safe. Some women get better, some worse. GI and OB need to team up.
What is Ulcerative Colitis IBD, etiology, and how is differs from Chron’s IBD? Inflammation?
Chronic inflammatory dz that affects LI (Chron’s IBD can affect entire GI tract from mouth to anus). Inflammation extends to mucosa only, always involved rectum to contiguous sections of colon
What are the three regional patterns of Ulcerative Colitis IBD?
- Ulcerative Proctitis
- Proctosigmoiditis
- Pancolitis
What are the pharmaceutical interventions for Ulcerative Colitis IBD?
Like Chron’s IBD.
5-ASA, Cortico, Immunomodulators, Antibiotics, Biologics
What are the two surgical options for Ulcerative Colitis IBD?
- Total Proctocolectomy (Brooke Ileostomy)=total colorectal mucosa excised
- Ileal Pouch Anal Anastomosis=PT maintains anal function and continence
What is IBS?
Irritable Bowel Syndrome
What is difference between IBS and IBD?
IBS=syndrome with no specific pathology
IBD=specific pathology; chron’s and colitis
What are the two types of Diverticular Disease?
- Diverticulosis
2. Diverticulitis
What is Diverticulosis and what causes it? Treatment?
“Out-pockets” anywhere intestinal wall most commonly in Sigmoid Colon. Weakness in wall where vessels penetrate. 85% asymptomatic; 15% colicky symptoms.
Tx= High fiber diet, avoid high residue foods (seeds, nuts, corn)
What is Diverticulitis and what causes it? Types?
Inflammation of colonic diverticuli impacted with fecal material. Most often in Sigmoid Colon.
Simple Diverticulitis=contained in intestinal wall
Complicated Diverticulitis=through intestinal wall
What causes perforations in Diverticulitis? Does it penetrate the intestinal wall?
Perforations may or may not penetrate intestinal wall.
Simple Diverticulitis=contained in intestinal wall
Complicated Diverticulitis=through intestinal wall
What is an Adenoma? Is it cancerous?
Glandular tumor. Not malignant/cancerous.
What is an Adenocarcinoma? Cancerous?
Adenoma that develops into malignancy/cancer.
Do all Adenomas become malignant/cancerous?
No, but all Colorectal Cancer (CRC) is from an Adenoma that does become malignant/cancerous.
What is the origin of Colorectal Cancer?
An Adenoma that becomes cancerous/malignant and becomes an Adenocarcinoma.
Adenoma aka?
Polyp, found in colon.
Initial mutant cancer cell develops within the…..?
Polyp
Is the cancerous growth on a polyp fast or slow?
Slooowwwww
Growth on polyps progress toward…?
Deeper layers of mucosa
If cancer from poly penetrates into submucosa it can reach what…?
Lymphatic/BV pathways
If a cancer from polyp penetrated into submucosa it can become ____ _____.
Highly malignant
What is critical in CRC prevention?
Early identification/screening for and removal of polyps
What are the two types of non-neoplastic polyps? Which is majority of polyps?
- Hyperplastic Polyps, majority of polyps in colon
2. Inflammatory Polyps (Pseudo-polyps)
Do Hyperplastic Polyps become cancerous?
No, except if there are a large number present called Hyperplastic Polyposis Syndrome.
What is Hyperplastic Polyposis Syndrome?
Large number of Hyperplastic Polyps present that can become cancerous.
What is cause of Inflammatory Polyps (Pseudo-polyps)? Becomes cancerous? Secondary do what?
Polyp-like shape when inflammatory ulcers heal. Not a “true” polyp. Secondary to IBD.
Does IBD increase risk of CRC?
Yes
What is a Neoplastic Polyp and the three types?
Potential to develop into malignant cancer.
- Adenomatous Polyp (adenomas)
- Carcinomatous (malignant) Polyps
- Serrates Polyps
Adenomatous Polyps (adenomas) are precursors for what two cancers and what should be done with them?
- Invasive Colon Cancer
- Rectal Cancer
Remove them!
What are the three architectural types of Adenomatous Polyps? Which most likely to become cancer?
- Villous Adenomas=Flat, sessile (no stalk). Most likely to become CA.
- Tubulovillous Adenoma=Tube-like. Middle likely go become CA.
- Tubular Adenoma=Pedunculated, stalk. Least likely to become CA.
What and where are Carcinomatous Polyps?
Malignant adenomas that have spread to the submucosal or lymph layer
Sessile Serrates Adenomas and Traditional Serrated Adenomas have features of what? Become CA?
Features of Hyperplastic Adenomas and Adenomatous Polyps. Rare but definite risk of becoming CA. Must be removed.
What are some CRC risk factors?
Over 50 y/o; location, size, number of polyps; IBD, gallbladder surgery; pelvic irradiation; family history; lifestyle related risk factors (tobacco, BMI over 35-40).
What is the most thorough screening tool for CRC? How often done?
Colonoscopy. Every ten years from 50 y/o.
