Exam 2 - Gastro-Intestinal System Flashcards
Cancers of the mucous membranes of the mouth and lips account for what % of cancer in US
5%
White plaque-keratin precursors that appear in mucus membranes
Leukoplakia
Precancerous lesions include (2)
Leukoplakia Dysplasia (10% cases)
Contributing factors of cancers of mucous membranes of mouth and lips (3)
Physical injury
Chemical (tobacco)
Chronic thrush (candida)
Most common location of cancer of the mucous membranes of mouth and lips
Exposed portions of lower lip (38%)
What cancer of the mucous membranes of mouth and lips has the poorest prognosis
Tongue (33% cases)
5 year survival
Sjogren syndrome is
A rare chronic inflammatory disease of salivary and lacrimal glands. Some cases may be associated with systemic collagen vascular disease
Xerostomia is
Dry mouth
What are general conditions that cause enlargement of salivary glands
Inflammation (e.g. mumps, hypersensitivity rxn)
Obstruction of ducts
Neoplasms e.g. pleomorphic adenoma
Pleomorphic adenoma s are most common in what gland
Parotid (65-80%)
In the esophagus, where are common locations of pathological lesions
Cricoid, tracheal bifurcation, esophageal hiatus
Note: common points of narrowing
Dysphagia
Difficulty in swallowing
Subjective condition
Odynophagia is
Painful swallowing
“Odyno-” is Greek for pain. Literal meaning “that which eats or consume”
What are symptomatic manifestations of esophagus disease (3)
Dysphagia
Heart burn
Odynophagia
Achalasia
Motor dysfunction
The lower esophageal sphincter (LES) is a muscular ring that closes off the esophagus from the stomach. If you have achalasia, your LES fails to open up during swallowing, which it’s supposed to do. This leads to a backup of food within your esophagus.
Trypanosoma cruzii leads to what disease
Chaga’s disease
What are the causes of hiatal hernia and what is the overall incidence
Causes uncertain but may include congenital shortening of esophagus, scarring, trauma, obesity and aging
4-10%
What percentage of hernia population gets a sliding hernia?
90%
What is a sliding hernia
Gastroesophageal junction shifted upward above hiatus
What is paraesophageal hernia and what percentage of hernia population gets it?
Also called “rolling” hernia
Portion of fundus is reflected upward alongside esophagus
50 % or less
Inflammatory scarring, bleeding, ulcers, erosions of the esophagus is called
Esophagitis
What is a chronic esophagitis called that includes mucosal inflammation, erosions, ulcers and columnar cell metaplasia?
Barrett’s esophagus
What part of the esophagus does Barrett’s esophagus appear in?
Lower esophagus
Esophageal varicosities pathogenesis
Portal hypertension (blood is diverted through gastric-esophageal venous anastomoses, esophageal veins enlarge and protrude into lumen)
Where does carcinoma of the esophagus happen most?
Iran 10-25x higher than US
South Africa, parts of China
What sex & age generally gets carcinoma of the esophagus?
Males (4x more often than F)
>50 yo
Risk factors of esophageal carcinoma (4)
- Alcohol
- Smoking
- Dietary nitrosamines and aflatoxins, smoked foods
- Dietary lack of fresh fruits and veggies
What kind of cell is implicated in carcinoma of esophagus?
Squamous cell
Barrett’s esophagus presents with adenocarcinoma
What are contributing mechanisms to developing erosive and ulcerative diseases
- Hyperacidity
- Reduced mucosal resistance to peptic juices (because of alterations in mucin or ischemic injury)
Helicobater pylori
Secretes enzymes that degrade mucin and produce ammonia
And the associated alkalinity stimulates HCl secretion
Delayed gastric emptying
Stomach ulcers
“Premature” emptying
Duodenal ulcers
List 3 motility disorders of the GI tract
1- Delayed gastric emptying (stomach ulcers)
2- “Premature” emptying (duodenal ulcers)
3- Exposure to bile - duodenal reflux
Gastritis is
A broadly defined term that includes discomfort, indigestion, vomiting, other symptoms
Is acute gastritis reversible?
Yes, generally
What risks are likely to lead to acute gastritis (8)
- Caustic chemicals
- NSAIDs
- Alcohol
- Heavy smoking
- Chemotherapy
- Infections (salmonella)
- Irritation
- Mucosal ischemia
What symptoms does gastritis present with?
Variable
“Vague,” discomfort, epigastric pain, severe bleeding, vomiting, etc.
Erosive gastritis
Acute gastritis
Non-erosive gastritis
Chronic gastritis
Erosive vs non-erosive gastritis
Acute: acute inflammation associated with variable levels of injury and, when severe, hemorrhage and mucosal erosion (sloughing) occur
Chronic: generally varying stages of mucosal atrophy that may be patchy or diffuse and becomes more common with advancing age that is (generally) non-hemorrhagic. Levels of severity exist.
What are the levels of severity for chronic (non-erosive) gastritis listed from the most mild to the most severe
Mild - Superficial gastritis
Moderate - Atrophic gastritis
Severe - Gastric gastritis
What are the 2 classifications of chronic gastritis and which one is most common
Fundic: Type A-
Antral gastritis: type B
Type B is most common 80%
What type of chronic gastritis is associated with pernicious anemia (PA)
Type A-
What type of chronic gastritis is associated with Helicobacter pylori
Type B
In which type of chronic gastritis do you get ulcers?
Type B
Fundic, Type A- vs Antral, Type B
Fundic: type A-
- loss of parietal cells in peptic regions and pernicious anemia
- no ulcer but risk for gastric cancer increases
Antral: type B most common
- dyspepsia
- increased risk for ulcer and gastric cancer
Ulcers appear in portions of GI tract exposed to
Peptic acid
Cushing’s is associated with ulcers because
Increased HCl
Chronic peptic ulcer are characterized by
“Punched out” mucosal defects with smooth margins and with repair, scarring deformities are common
Meckel’s diverticulum is a leftover
remnant of yolk sac stalk located in distal ileum
When’s chronic peptic ulcer is seen on the jejunum (which is RARE) its likely associated with
Zollinger-Ellison syndrome
What is more common: benign or malignant tumors of the GI?
Malignant is 95% more common
_______ account for >95% of gastric malignancies
Adenocarcinomas
50% of malignant tumors of the GI tract are localized in (2)
Antrum and pylorus
What is the prognosis of early and advanced malignant GI tumors?
Early - respond well to treatment
Advanced - poor prognosis
There are 3 types of advanced tumors of the GI tract
Fungating
Ulcerative
Infiltrating (2-3 cm thick)
Symptoms of malignant tumor of GI includ
Weight loss, abdominal pain, nausea, blood loss, etc
What is congenital pyloric stenosis
Hypertrophy of pylorus leads to obstruction with projectile vomiting after meals
What is the incidence of inflammatory bowel disease (IBD) in the US
500,000 - 2 mil
Symptoms of crohn’s disease
Diarrhea, mild fever, weight loss (because malabsorption), abdominal pain, rectal bleeding
What is more common: crohn’s disease or ulcerative colitis
Ulcerative colitis about 2-3x more common
Where is ulcerative colitis found?
Recto-sigmoid region 10-20%
Left colon 40%
Entire colon 40%
Into the ileum 10-20%
Manifestations of ulcerative colitis
May lead to hemorrhage, perforations and (when healed) strictures
Symptoms of ulcerative colitis
Episodes of acute, bloody, mutinous diarrhea and abdominal pain
Diseases of the stomach, small intestine, liver and pancreas affect
Digestion and uptake of nutrients from GI tract
When there is malabsorption from disease of GI tract, how to patients present?
Diarrhea, bulky stools, weight loss, fatigue and vitamin and mineral deficiencies
What is characterized by atrophy of villi and columnar cells of small intestine and malabsorption
Celiac disease
Gluten-sensitive enteropathy, ‘non-tropical’ sprue
Celiac disease
Gliadin
Glycoproteins found in gluten, an element of wheat, barley and rye
What malabsorption disease, found in tropical regions, usually begins as an acute intestinal illness secondary to bacterial infection?
Tropical sprue
Note: certain strains of E.coli
Symptoms of Tropical sprue improve with
Antibiotics and folic acid
Intestinal lipodystrophy
Whipple’s disease
What is a rare multisystem disorder that occurs most commonly in males?
Whipple’s disease (intestinal lipodystrophy)
What are 6 symptoms of Whipple’s disease (intestinal lipodystrophy)
Polyarthritis CNS disease Abnormal skin pigmentation Lymphadenopathy Disease of heart, liver or lungs
Evidence implies that Tropheryma whipplei is responsible and its suggested that macrophages in subjects with _______ disease lack an enzyme that results in an inability to kill ingested bacteria. (As a result, what do you see?)
Whipple’s disease
So “foamy’ macrophages containing PAS-positive bacteria-containing granules 🦠 are observed in many locations
Mucosal injury and circulatory obstruction within the ______ with ischemia contributes to bacterial invasions (usually E.coli)
Appendix
What is the morphology of acute appendicitis (3 stages)
Early
Acute suppurative (pus)
Acute gangrenous
With intestinal obstruction, a “high location” leads to __ while a “low location” means ___
High location: Vomiting
Distal location: typically characterized by decreased bowel activity, abdominal distention, etc
In a functional (physiologic) obstruction, what do you notice about peristalsis?
It is decreased
What are 3 reasons for functional obstruction?
Vascular disease
Congenital megacolon (Hirschsprung’s disease)
Adynamic (paralytic) ileus
Adynamic ileus is also known as
Paralytic ileus
Contributing causes: peritonitis and other severe infections, abdominal surgery, shock and ulcerative colitis
Congenital megacolon is also a problem of ____ disease
Hirschsprung’s disease
Peristalsis is absent in affected segments
Risk for intestinal vascular insufficiency are significantly higher in
Diabetics
What are 5 mechanical (anatomical) intestinal obstructions?
- Hernia (incarceration and strangulation)
- Strictures and adhesions of intestinal segments
- Volvulus (loop of intestine twists around itself)
- Intussusception (segment of intestine “slides” into adjacent intestine)
- Other: impacted gallstones, tumors, etc
a loop of intestine twists around itself; contributing causes include detached (intraperitoneal) cecum and enlarged sigmoid colon, persistent yolk sac stalk and intestinal adhesions
Volvulus
Pockets in wall of GI tract
Diverticula
Meckel’s diverticulum
Remnant of yolk sac stalk located in distal ileum (at apex of developmental mid-gut ‘loop’)
What is “true” vs “false” diverticulum
Congenital “true” diverticulum - when the wall of pouch contains all layers of GI tract. Mecke’s diverticulum (remnant of yolk sac stalk located in distal ileum)
Acquired “false” diverticulum or “diverticula disease” - when the mucosa herniates out through muscular layers
Where is acquired “false” diverticula disease commonly found
Colon, esp sigmoid region
What is lower left abdominal quadrant pain often due to acute infection; may give rise to abscesses and bleeding (in some)?
Is this “Diverticulitis” or “diverticulosis”?
Diverticulitis
What is a non-specific diverticular disease, symptoms may be mild or absent; long-term effects
include fibrosis and thickening of affected segments
Is this “Diverticulitis” or “diverticulosis”?
Diverticulosis
Small intestine tumors are uncommon and account for _____% fo GI tumors
5%
What is a small intestine carcinoma in “slow motion” called
Carcinoid
Usually slowly progressive growth with late metastasis
Carcinoid of the small intestine is _______ cell origin
Argentaffin cell origin
Most common carcinoid location:
Appendix, followed by ileum but may occur anywhere including lungs
A carcinoid may secrete (5)
5-HT Kinin peptides Histamine Gastrin Catecholamines
What occurs with metastasis or when in extra-intestinal site and may include cardiovascular disturbances, intestinal hypermobility, asthma, etc
Carcinoid syndrome
Large intestine tumors show up in 2 ways (which one produces symptoms?)
1 - 90% pedunculated (tubular adenoma)
2 - 10% villous adenoma (sessile)** more likely to produce symptoms (bleeding, albuminous secretions, etc)
Tumor with a raspberry-like head with narrow stalk
Pedunculated (tubular adenoma)
Tumor with a complex structure with numerous villous-like projections
Villous adenoma (sessile)
Autosomal dominant inheritance
Multiple familial polyposis
Begin to appear by 10-20 years of age
Cancer eventually appears in virtually all untreated subjects of what kind of large intestine polyps
Multiple familial polyposis
Colectomy is necessary to prevent malignancy
Colon carcinoma risk factor (1) & etiology (4)
- > 50 yo
- High animal fat
- Low fiber (from fresh fruit, vegetables)
- Deficient in protective nutrients (vit A, C, E, selenium, cruciferous veggies)
- Nitrosamines
Common location of colon carcinoma
Recto-sigmoid 50%
Descending colon 5-10%
Transverse colon 15-20%
Ascending colon 20-25%
Clinical features of colon carcinoma
- Chronic bleeding = iron-deficiency anemia melena
- left side cancer: altered bowel activity, decreased caliber of stool, lower left quadrant pain or cramps, possible bleeding
- right side cancer: usually silent symptoms
- Systematic manifestations when advanced: weight loss, malaise, weakness, hepatomegaly
iron-deficiency anemia melena causes
Stool discoloration
