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Final From Material Flashcards

1
Q

Difficulty in the digestion or absorption of nutrients from food in teh small intestine

A

Malabsorption syndrome

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2
Q

Etiology malabsorption syndrome

A 
Infections
Structural defects
Postsurgery
Mucosal abnormalities
Systemic diseases
Enzyme deficiencies
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3
Q

Malabsorption syndrome

Infectious

A

Bacteria (E. Coli, whipple disease, TB)
Virus (HIV)
Parasites (Giardia lamblia)

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4
Q

Malabsorption syndrome
Etiology
Structural defects

A 
IBD (crohn’s disease)
Autoimmune diseases (SLE)
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5
Q

Malabsorption syndrome
Etiology
Postsurgery

A

Gastroectomy
Weight loss surgery
Short bowel syndrome (resection of small intestine)

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6
Q

Malabsorption syndrome
Etiology
Mucosal abnormalities

A

Celiac disease

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7
Q

Malabsorption syndrome
Etiology
Systemic diseases

A

Diabetes mellitus

Addison’s disease

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8
Q

Malabsorption syndrome
Etiology
Enzyme deficiencies

A

Lactose intolerance

Pancreatic insufficiency

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9
Q

Signs and symptoms malabsorption syndrome

A

Chronic diarrhea with steatorrhea
Abdominal bloating
Signs of malnutrition

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10
Q

Signs of malnutrition

A

Edema anywhere in the body (protein deficiency)
Muscle cramping
Osteomalacia, osteoporosis (vit D and calcium deficiency)
Anemia (vit B12, folic acid, iron deficiencies) - megaloblastic
Bleeding tendencies
Weight loss (deficiency of all nutrients)

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11
Q

Diagnosis malabsorption syndrome

Blood tests

A

Signs of anemia
Hypoalbuminemia
Decreased amount of pancreatic enzymes

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12
Q

Malabsorption syndrome
Diagnosis
Stool tests

A

Identification of bacteria
Identification of protozoa
Presence and concentration of fat

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13
Q

Malabsorption syndrome

Diagnosis

A 
Blood tests
Stool tests
Schilling test
Lactose intolerance test
CT or MRI
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14
Q

Malabsorption syndrome
Diagnosis
Schilling test

A

To establish vit B12 deficiency

Urine test - distal portion ilium absorption test

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15
Q

Diagnosis malabsorption syndrome CT or MRI

A

Only for ruling out structural abnormalities

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16
Q

Malabsorption syndrome treatment

A

Depends on etiological factors

Restoration of nutrients, vitamins, minerals, enzymes

Gluten and lactose free diet

Bromamine - decrease inflammation

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17
Q

Celiac disease aka

A

Celiac sprue
Non-tropcial sprue
Gluten enthesopathy
Gluten intolerance

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18
Q

Autoimmune disorder that occurs in all age people with genetically predisposed damage of the small intestine villi

A

Celiac disease

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19
Q

The problem associated with presence of unexpected antigen on chromosome 6

A

Celiac disease

AMHC type 1 and 2 human leukocyte antigen

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20
Q

Celiac disease is often associated with

A

Diabetes mellitus type 1
Autoimmune thyroiditis (aka hasimoto’s disease)
SLE
Rheumatoid arthritis

Abnormal chormosome 6 MHC type 2

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21
Q

Celiac disease etiology

A

Gluten which is found in

Wheat
Rye
Barley
Oat 
Triticale
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22
Q

Risk factors celiac disease

A

Severe emotional stress
Pregnancy
After surgery

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23
Q

Pathophysiology celiac disease

A

Zonulin works like the traffic conductor

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24
Q

Celiac disease signs and symptoms

A 
Abdominal pain and cramping
Bloating
Chronic diarrhea and steatorrhea
Lactose intolerance
Weight loss
Fat-soluble vitamin deficiencies
Osteomalacia, osteoporosis
Recurrent painful mouth ulceration (aphthous stomatitis)
Dermatitis herpetiformis
Unexplained anemia (iron-deficiient or megaloblastic)
Joint pain
Numbness and tingling in feet and hands
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25
Q

Dermatitis herpetiformis

A

Itchy rash on the elbows
Knees
Buttocks
Scalp

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26
Q

Diagnosis celiac disease

A

TTGA-test - Ig
A anti-tissue transglutaminase antibodies - 90% specificity for celiac disease

Endoscopy of small intestine, especially with biopsy of descneidng duodenum

Hypoalbuminemia

Low levels of iron, vitamins (B12, 9,6), calcium, fat soluble vitamins

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27
Q

Gold standard for diagnosis of celiac disease

A

Endoscopy of small intestine, especially with biopsy of descneidng duodenum

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28
Q

Treatment celiac disease

A

No contraindication for adjustments
Lactose-free diet
Gluten free diet life-time requirement

Absolute avoidance of products with
Wheat, barley, rye, oat, triticale

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29
Q

Strong diet could result in healing of small intestine in celiac disease

A

3-6 months in children

Several years in adults

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30
Q

Whipple disease aka

A

Intestinal lipodystrophy

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31
Q

Infectious systemic disease, most likely caused by gram-positive bacterium tropheryma whipplei

A

Whipple disease

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32
Q

This disease affects small intestine, joints, CNS, cardiovascular ssytem

A

Whipple disease

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33
Q

The characteristic pathomorphological sign of whipple disease is

A

Thickening of intestinal wall

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34
Q

Whipple disease etiology

A

Gram-positive bacillus tropheryma whipplei

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35
Q

Whipple is most common in

A

Male 30-40 years old

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36
Q

Source of tropheryma whipplei

A

Soil

Animals

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37
Q

Whipple disease ____ transmitted from person to person

A

Is not

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38
Q

Signs and symptoms of whipple disease

A

Joint pain - usually initial symptom
Joints - knee elbow fingers
Joint involvement without joint deformity
GI tract manifestations several years after joint involvement - malabsorption - diarrhea/steatorrhea, weight loss, abdominal pain, peripheral edema due to hypoalbuminemia

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39
Q

Systemic manifestations of whipple disease

A 
Fever, chills
Uveitis
Bacterial endocarditis
Lymphadenopathy
Darkness or grey color of the skin
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40
Q

More advanced stage of whipple disease

A

CNS involvement

Oculomasticatory myorythmia - highly characteristic of whipple disease

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41
Q

Eye movmenet disturbances and rapidly repetitive movements of the facial muscles

A

Oculomasticatory myorythmia

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42
Q

CNS involvement whipple disease

A 
Vision problems
Memory problems or personality changes
Dementia
Facial numbness
Headaches
Msucle weakness or twitching
Difficulty walking
Hearing loss or ringing in the ears
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43
Q

Whipple disease diagnosis

A

Duodenal endoscopy with biopsy, which reveals presence of bacteria

PCR

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44
Q

Highly sensitive test that amplifies the DNA of the tropheryma whipplei from tissue samples

A

PCR - polymerase chain reaction

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45
Q

Treatment whipple disease

A

Long-term antibioticotherapty (1-2 years)

If the disease is untreated, mortality is 100%

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46
Q

A true congenital diverticulum, is a slight bulge in the small intestine present at birth, and represents a remnant of incompletely obliterating omphalomesenteric duct (also called the viteline duct)

A

Meckel’s diverticulum

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47
Q

The omphalomesenteric duct normally undergoes obliteration at

A

7-8 week of gestation

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48
Q

The most common congenital abnormality of the small intestine

A

Meckel’s diverticulm

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49
Q

Meckel diverticulum is characterized by

A

Blind end
True diverticulum that contains all layers of the wall
Usually found in the ileum (distal 3rd)
Tip of the diverticulum is free in 75% of cases or is attacehd to the anterior abdominal wall

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50
Q

In the case of diverticulum’s attachment to the anterior abdominal wall the following anomalies could be found in meckel’s diverticulum

A

Fibrous cord
Umbilicoileal fistula
Umbilical sinus
Fluid-filled cysts located either intra-abdominally or just below the umbilical skin

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51
Q

Characteristics of meckel’s diverticulum (rule of 2’s)

A

Occurs in 2% of the population
Male-to-female ratio is 2:1
Peak age of presentation is 2 years old
Locates 2 feet from ileocecal junction (distal portion of ileum)
2cm in diameter
2in in length
2 types of common ectopic tissue (gastric and pancreatic)

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52
Q

The majority of people with a meckel’s diverticulum are

A

Asymptomatic (silent meckel’s diverticulum

Symptoms often occur during the first few years of life

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53
Q

Clinical manifestations of meckel’s diverticulum come to the clinical attention in teh form of complications

A

Bleeding
Obstruction
Diverticulitis
Tumors

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54
Q

Meckel’s diverticulum

Bleeding is more common among ___ occurs when acid secreted from ____ in the diverticulum ulcerates the adjacent ileum

A

Young children less than 5

Ectopic gastric mucosa

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55
Q

Repeated episodes of painless rectal bleeding which is usually not severe enough to cause shock
Stools are birght red like currany jelly or black and tarry

Adults may also bleed in form of melena

A

Meckel’s diverticulum

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56
Q

Meckel’s diverticulum

Intestinal obstruction can occur at ____ but is more common in ___

A

Any age

Older children and adults

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57
Q

Intestinal obstruction is manifested by

A

Cramping abdominal pain
Abdominal tenderness
Nausea, comiting
Severe or complete constipation

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58
Q

Later intestinal obstruction is manifested by

A

Acute peritoneal signs due to intestinal ischemia or infarction

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59
Q

Acute meckel’s diverticulum can occur at ___ but is more common in ____

A

Any age

Older children

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60
Q

Acute meckel’s diverticulum is characterized by

A

Either focal or diffuse abdominal pain and tenderness
Pain typically localized in epigastric or periumbilical regions
The pain is similar to one typical for appendicitis (but not same location!!!!!_)

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61
Q

Persistence of periumbilical pain or a history of bleeding from rectum may be helpful in distinguishing this entity from appendicitis

A

Meckel’s diverticulum

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62
Q

Meckel’s diverticulum

Tumors

A

Rare and occur mainly in adults

Benign = leiomyoma, angioma, neuroma, lipoma

Malignant = carcinoid, sarcoma, adenocarcinoma

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63
Q

Routine laboratory findings are ___ helpful in establishing the diagnosis of meckel diverticulum

A

Not

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64
Q

tests necessary for meckel’s diverticulum

A

CBC

Stool

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65
Q

CBC meckel’s

A

Hemoglobin and hematocrit (low)

Signs of iron def anemia and signs of megaloblastic anemia can be seen

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66
Q

Stool test meckls

A

For occult blood

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67
Q

Technetium-99m (99mTc) scan

A

Aka meckel scan

Investigation of choice to diagnose meckel’s diverticulum

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68
Q

99mTc can detect ____ since approx 50% of symptomatic meckel’s diverticula have ectopic gastric or pancreatic cells locating within them, they are displayed as a spot on the scan distant from the stomach itself

A

Gastric mucosa

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69
Q

In children, the meckel scan is

A

Highly accurate
Noninvasive
95% specificity and 85% sensitivity

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70
Q

In adults meckel sca is

A

9% specific and 62% sensitive

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71
Q

Diagnosis GI bleeding meckel’s diverticulum

A

Screening colonoscopy

Angiography

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72
Q

Diagnosis intestinal obstruction meckel’s diverticulum

A

Plain -xray of abdomen may reveal evidence of signs of air or air-fluid levels or perforation

US could demonstrate the omphaloenteric duct remnants or cyst

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73
Q

Diagnosis nonbleeding or bleeding or inflammatory complications meckel’s

A

CT scan - blind ended and inflamed structure in the mid-abdominal cavity which is not an appendix

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74
Q

Treatment meckel’s diverticulum

A

No symptoms = no treatment required
Symptoms = surgery to remove diverticulum
Blood loss = iron therapy or blood transfusion to replace lost blood

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75
Q

Group of idiopathic autoimmune inflammatory conditions of the small intestine and colon with genetic predisposition

A

Inflammatory bowel diseases

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76
Q

Two major types of IBD

A

Crohn’s disease

Ulcerative colitis

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77
Q

Crohn’s disease aka

A

Regional enteritis

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78
Q

An idioptahic chronic systemic autoimmune inflammatory disease which can involve any segment of GI tract from teh mouth to the anus, as well as other systems

A

Crohn’s disease

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79
Q

Typical age of onset for crohn’s

A

13-30 yo

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80
Q

Crohn’s disease is characterized by

A

Inflammation and ulceration of all layers of involved GI tract wall

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81
Q

A classic feature of crohn’s disease is

A

The sharp demarcation of diseased segments fro adjacent uninvolved part

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82
Q

Abrupt transition between unaffected tissue and the ulcer - characteristic sign of crohn’s known as

A

Skip lesions

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83
Q

When multiple segments are involved the intervening part is essentially

A

Normal

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84
Q

Risk factors for crohn’s disease

A

Smoking (high risk factor)
Increased intake of animal proteins, milk proteins
Emotional stress or surgery

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85
Q

Crohn’s etiology

A

Unknown but these could contribute:
Genetic predisposition
Abnormal host immunoreactivitiy
Infection (mycobacterium paratuberculosum

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86
Q

Signs and symptoms crohn’s disease

A

Chronic recurring periods of flare-ups and remissions
Abdominal pain due to inflammation and ulcerations, predominately in lower right side of abdomen
Diarrhea from mild to severe bowel movements (5-20 a day)
Sometiems stool contains mucus, blood, pus
Weight loss and fatigue due to malabsorption diarrhea
Fever
Dysphagia or upper abdominal pain due to ulceration of esophagus or stomach
Aphthous ulcers

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87
Q

Aphthous ulcers

A

Non-helaing sores if the mouth is involved

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88
Q

Crohn’s disease has an increased risk for formation of

A

Gallstones

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89
Q

Gallstone risk is due to

A

Decrease in bile acid reabsorption in the ileum and the bile gest excreted in the stool which causes the cholesterol/bile ratio to increase in the gallbladder an dinc risk for gallstones

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90
Q

Systemic manifestations crohn’s

A 
Seronegative spondyloarthritis
Eye involvement
Skin involvement
Thrombosis
Anemias
Nervous system involvment
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91
Q

Seronegative spondyloarthris crohn’s disease

A

Infalmmation of one or more joints and/or AS

Chromosome 1

HLA-B27

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92
Q

Eye involvment crohn’s

A

Uveitis (iridocyclitis)

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93
Q

Uveitis characterized by

A

Inflammation of iris, acocmpanying by eye pain, photofobia

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94
Q

Skin involvment crohn’s

A

Erythema nodosum - due to inflammation of subcutaneous tissue

Pyoderma gangrenosum - painful ulcerating nodules

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95
Q

Thrombosis crohn’s

A

Of lower extremity veins which could result in pulmonary embolism and lung infarction

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96
Q

Anemias crohn’s

A

B12-def anemia due to involvement of ileum
B9 def anemia due to involvment of jejunum
Iron def anemia due to blood loss or dec iron absoprtion in duodenum
Autoimmune immunohemolytic anemia

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97
Q

Nervous system involvement crohn’s

A

Peripheral neuropathy due to malabsorption of group B vitamins
Depression and headache

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98
Q

Diagnosis crohn’s

A

Endoscopy and colonoscopy with biopsy (in 50% of cases the granulomas of GI wall are found)

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99
Q

Aggregations of macrophages most specific for crohn’s disease

A

Granulomas

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100
Q

Granulomas in crohn’s do not show a ___ appearance on microscopic examination

A

Cheese-liek

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101
Q

Other diagnosis for crohn’s

A

Capsule endoscopy because small intestine difficult to access

CT or MRI for complicated areas

CBC for diagnostics of anemia, leukocytosis

Stool test for presence of blood or bacteria

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102
Q

Complications crohn’s

A

Bowel obstruction due to development of bowel stricture

Fistula to adjacent organs or perforation

Colorectal cancer

Malnutrition disorders - osteoporosis, osteomalacia, gallstones

Internal bleeding

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103
Q

Management crhon’s

A

Quit smoking
Avoid: alcohol, high fiber food, nuts and seeds, raw fruits and vegetables, soft drinks, coffee, chocolate, butter and mayo
High calorie liquid diet
Probiotics

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104
Q

Treatment crohn’s

A

Medical treatment is mandatory

Corticosteroids
Aminosalicylates (sulfasalazine)
Immunomodulators
Antibiotics

Surgery could be necessary

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105
Q

Chronic idiopathic autoimmune inflammatory ulcerative disease affecting superficial inner lining of teh colon and rectum

A

Ulcerative colitis

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106
Q

This disease always starts in the rectum and then moves up, diffusely involving all other parts of the colon

No skip lesions

A

Ulcerative colitis

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107
Q

Etiology ulcerative colitis

A

Unkown

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108
Q

Risk factors ulcerative colitis

A

Northern european white people
Genetic predisposition
Viral or bacterial infection of the colon
Physical and/or emotional stress

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109
Q

Unlike crohns disease ____do not predispose to ulcerative colitis

A

Smoking and food

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110
Q

Peaks of age ulcerative colitis

A

15-30 and between 50-70

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111
Q

Signs and sypmtoms of ulcerative coitis depend on whether the disease

A

Is restricted by rectum or involves other parts of the colon

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112
Q

The farther from the rectum ulcerative colitis

A

The more severe the clinical manifestations are

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113
Q

Signs and symptoms ulcerative colitis

A 
Bloody diarrhea
Tenesmus
Left abdominal pain
Fever
Weight loss
Fatigue, loss of energy
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114
Q

Ineffective painful urge to defecation altough bowels are empty

A

Tenesmus

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115
Q

In a case of the entire colon involvement ulcerative colitis (pancolitis aka fulminant colitis) the clinical manifestations develop in the following order

A

Severe diarrhea with blood and pus
Severe abdominal pain due to severe inflammation and pus formation
High fever with night sweat
Dehydration due to fever, diarrhea, lack of water absorption
Shock could develop

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116
Q

Systemic manifestations ulcerative colitis

A

Oligoarthritis
AS
Mouth ulceration due to depletion of B vitamins
Skin ulceration, predominately of low extremities
Iron def anemia
Sclerosing cholangitis

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117
Q

Disease of the bile ducts that causes inflamamtion and subsequent obstruction of bile ducts both at a intrahepatic and extrahepatic levels

A

Sclerosing cholangitis

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118
Q

Diagnosis ulcerative colits

A

Colonoscopy with bopsy presence of continuous ulceration
Anti-neutrophil anti-cytoplasmic autoantiboidies - p-ANCA ONLY in UC
CBC - anemia neutrophilia
Stool specimens - to exclude infection and parasites
Blood in stool
CT, MRI, x-ray with liquid barium

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119
Q

Inflammation may devlep anywhere in GI tract

A

Crohn’s (CD)

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120
Q

Patholgoical process may extend thorugh entire thickenss of wall of GI tract organ

A

CD

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121
Q

Characterized by patchy areas of inflammation - skip lesions

A

CD

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122
Q

Inflammation limited to large intestine

A

UC

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123
Q

Pathological process occurs in teh superficial lingin gof large intestine wall

A

UC

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124
Q

Always starts in rectum and characterized by continuous area of inflammation

A

UC

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125
Q

Diarrhea may or may not be bloody

A

CD

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126
Q

Smoking is always a high risk of the disease development

A

CD

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127
Q

Pain is commonly presented in the right side of abdomen RLQ

A

CD

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128
Q

Diarrhea Is always bloody

A

UC

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129
Q

Smoking is risky just in 30%

A

UC

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130
Q

Pain is common in left part of abdomen LLQ

A

UC

131
Q

Fistulas and stenosis are common

A

CD

132
Q

Tenesmus may present

A

CD

133
Q

Colon wall may be thickend and may have granulomas

A

CD

134
Q

Fistulas and stneosis are rare

A

UC

135
Q

Tenesmus are more common

A

UC

136
Q

Colon wall is thinner and shows continuous inflammation

A

UC

137
Q

Complications of ulcerative colitis

A

Colon rupture
Osteoporosis
Hypovolemic shock
Colon cancer

138
Q

Treatment ulcerative colitis

A

Diet - high calorie diet but eliminate raw fruits, vegetables, nuts and seeds, sugar, high fiber food

Hydration - drink small portions frequently

Probiotics

Pig whipwomr therapy duration 12 weeks

Corticosteroids

Antibiotics if needed
Aminosalicylates

139
Q

In cases of serious complications ulcerative colitis

A

Surgery is necessary

140
Q

Any mass of tissue that arises from the bowel wall and protrudes into the lumen

A

Colon/rectal polyps

141
Q

Etiology colon/rectal polyps

A

Unkown

142
Q

Risk factors colorectal polyps

A

Stronly associated with increasing age

Age over 50
African-americans
Strong family history
Lifestyle (smoking, low fiber meal and fatty meal)

143
Q

Morphologically the colorectal polyps are divided into 2 groups

A

Pedunculated

Sessile

144
Q

Attached to intestinal wall by a stalk

A

Pedunculated

145
Q

Grow directly from intestinal wall broad based

A

Sessile

146
Q

Histologically the colorectal polyps are divided into 3 groups

A

Benign (hyperplastic polyps)
Premalignant (tubular adenoma)
Malignant (colorectal adenocarcinoma)

147
Q

Colorectal polyps divided into 4 groups

A

Hyperplastic polys
Serrated polyps
Adenomatous (neoplastic) polyps
Inflammatory (pseudoinflammatory) polyps

148
Q

Usually do not develop into colon cancer

A

Hyperplastic polyps

149
Q

Having a notched edge or saw-like teeth - lesss common but may develop into colon cancer over time

A

Serrated polyps

150
Q

May devleop into colon cancer over time

A

Adenomatous polyps

151
Q

Usually small and on the left side of hte colon

Polyps that do not carry a risk of developing into cancer

Large ones on the right are ofconcern and should be removed

A

Hyperplastic polyps

152
Q

Rarely malignant
Usually less than .5cm in diameter
Occurs in recto sigmoid region

A

Small serrated polyps

153
Q

Precancerous

Typically flat more tahn .5cm in diameter

Difficult to detect, they locate in the right upper colon

A

Large serrated polyps

154
Q

About 2/3 of all polyps

Can be benign premalignant or malignant

Only a small percentage of them actually become cancerous

Nearly all malignant polyps are this

A

Adenomatous polyps (neoplastic polyps)

155
Q

These polyps are associated with IBD

Having ulcerative colitis or crohn’s disease increases overall risk of colon cancer

A

Inflammatory (pseudoinflammatory) polyps

156
Q

Signs and symtpoms colorectal polyps

A

Not usually associated with symptoms

First sign could be rectal bleeding or bloody stool

Later the manifestations may include fatigue (due to iron def anemia), diarrhea (large villous adenomas), abodminal pain, bowel obstruction with severe constipation, nausea and vomiting

157
Q

The larger the poly

A

The higher probability of its malignancy

158
Q

Diagnosis colorectal polyps

A 
Fecal occult blood test
Stool DNA test
Digital rectal exam
Flexible sigmoidoscopy
Colonoscopy
159
Q

Treatment colorectal polyps

A

The polyps can be removed during a colonoscopy or sigmoidoscopy

160
Q

FAP

A

Familial adenomatous polyposis

161
Q

A genetic condition, when a person develops multiple (more than 100) noncancerous (benign) adenomatous colon polyps

A

FAP

162
Q

Etiology FAP

A

Passed from generation to generation in a family

APC gene (tumor supressor gene) is linked to FAP

163
Q

A mutation in the APC gene gives a person an increased lifetime risk of developing

A

Colorectal cancer or other cancers of the GI tract

164
Q

Familial adenomatous polyposis may begin to develop in the colon

A

As early as teenage years

165
Q

More than 95% of people with FAP will have multiple colon polyps by age

A

35

166
Q

The average age at which an individual develops colon cancer in classic familial adenomatous polyposis is

A

39-40 yo

167
Q

Symptoms FAP early stages

A

None

168
Q

Symptoms of FAP as condition progresses

A

Blood in the stool (iron def anemia)
Diarrhea (mucous drainage)
Abdominal pain
Intestinal obstruction

169
Q

FAP always affects the ____ but the mutation is present in every cell int he body and other organs are affected

A

Colon

170
Q

As a reult of other organs being affected, tumors are sometimes found in other places of the body with FAP

A

Stomach (usually NOT precancerous)
Duodenum (precancerous)
Bones, skin, brain, teeth (may cause jaw pain)

171
Q

Three subtypes of classic FAP

A

Attenuated FAP (AFAP)
Gardner syndrome
Turcot syndrome

172
Q

Multiple adenomatous colon polyps, and polyps and cancer of the stomach and small intestines

A

Attenuated FAP

173
Q

Multiple adenomatous colon polyps typical of FAP, along with benign tumors in many different organs (osteomas - most commonly on the skull and mandible, dental problems, soft tissue tumores), and sometimes carcinomas

A

Gardner syndrome

174
Q

Multiple adenomatous colon polyps, an increased risk of colorectal cancer, and an increased risk of brain cancer

A

Turcot syndrome

175
Q

Diagnosis colorectal polyps

A

Genetic test to detect an APC mutation gene

Flexible sigmoidoscopy or colonoscopy every 1-2 years

Fecal occult blood tests

US, CT or MRI of abodmen

176
Q

Tests to diagnose colorectal polyps should be performed starting at age

A

10-12

177
Q

Complications of FAP

A

GI hemorrhage

GI obstruction

Colorectal cancer

178
Q

If FAP is not recognized and treated, there is almost a 100% cahnce that a person will develop _____ by age 40

A

Colorectal cancer

179
Q

Treatment colorectal polyps

A

Prophylactic surgery may be recommended before the age of 25

NSAIDs have been shown to significantly decrease the number of polyps

180
Q

Malignant tumor that grows from uncontrolled cells of the large intestine

A

Colorectal cancer

181
Q

Etiology colorectal cancer

A

Unkown

182
Q

Predisposing factors colorectal cancer

A

Neoplastic adenomatous polyps

Right side colon hyperplastic polyps

Multiple polyposis (FAP)

IBD

Alcohol abuse

Fatty food

Age after 50

Family hisotry of colorectal cancer

183
Q

Two types of colorectal cancer depending on its location

A

Right side cancer in ascending colon

Left side cancer in descending colon

184
Q

Right side cancer characterized by

A

Ascending colon

Exophytic shape of the tumor

Development of anemia

185
Q

Left side cancer characterized by

A

Descending colon

Tendency to be circumferential

High frequency of the bowel obstruction

186
Q

Types of colorectal cancer depending on histology

A

Adenocarcinoma

Lymphoma

Squamous cell carcinoma

187
Q

Adenocarcinoma colorectal cancer

A

Originates from goblet or endocrine cells

188
Q

Lymphoma colorectal cancer originates from

A

Peyer’s patches

189
Q

Squamous cell carcinoma originates from

Colorectal cancer

A

Epithelial cells

190
Q

Signs and symptoms colorectal cancer early stages

A

Blood in stool (bright or very dark)

Change in bowel habits (constipation change to diarrhea)

Worsening constipation**

Stool is narrower than usual

Frequent gas or cramps

191
Q

Worsening constipation is classic sign

A

Colorectal cancer

192
Q

In terminal stages of colorectal cancer, patients demonstrate

A 
Fatigue
Night perspiration
Unexplained weight loss - 10 lb a month
Abdominal pain
Pelvic pain, back pain
Unexplained anemia
193
Q

More than 80% of colorectal cancer arises from ____ making this cancer amenable to screening

A

Adenomatous polyps

194
Q

Diagnosis of colorectal cancer through screening tends to occur

A

2-3 years before the first manifestations of cancer

195
Q

Screening tests have the potentials to reduce colorectal cancer death by

A

60%

196
Q

Diagnosis colorectal cancer

A 
Fecal occult blood test
DNA screening stool test (cologuard)
Blood tests (CBC)
Tumor markers
Flexible sigmoidoscopy with biopsy
Colonoscopy
Virtual colonoscopy via a CT-scan
CT-scan of chest, abdomen and pelvis
PET and MRI
197
Q

For invisible blood in the stool

Should be done every year in the age after 40

A

Fecal occult blood test - colorectal cancer

198
Q

could indicate cancer or pre-cancer of a large intestine

Should be done every year starting at age 50

A

DNA screening stool test (cologuard)

199
Q

Blood test colorectal cancer

A

CBC - ESR increased, IDA

200
Q

Tumor markers colorectal cancer

A

Carcinoembryonic antigen CEA - colorectal**

CA-19-9 - pancreas**, colorectal, liver

CA 125 - ovarian cancer**, breat, colorectal, liver

CA 27.29 - breast***, colorectal, liver

201
Q

The most accurate way to detect polyps should be done every 3-5 years in age after 50 with biopsy

A

Colonoscopy

202
Q

In teh process of ____ and _____ the polyps can be removed immediately

A

Sigmoidoscopy

Colonoscopy

203
Q

Appears as good as standard colonoscopy for detecting cancers and large adenomatous polys

A

Virtual colonoscopy via CT-scan

204
Q

Disadvantages to virtual colonoscopy via CT-scan

A

Expensive

Associated iwth radiation exposure

Cannot remove abnormal growth and polyps like standard colonoscopy can

205
Q

CT-scan determines ___ for colorectal cancer

A

Metastases

206
Q

Colorectal cancer spreads first to ____ of the peritoneum

A

Lymphatic nodes

207
Q

Colorectal cancer spread to lymphatic nodes of peritoneum may be manifested by

A

Bloating
Swollen belly
Feeling of fullness
Loss of appetite

208
Q

Colorectal cancer also spreads to the

A

Liver

209
Q

Liver spread from colorectal cancer can be manifested by

A

Pain in upper right side of the abdomen
Bloating
Loss of appetite
Feeling of fullness

210
Q

Colorectal cancer also spreads to the lungs which can be manifested by

A

Cough
Blood in sputum
Hard time breathing

211
Q

Colorectal cancer also spreads to bones especially to the spine, hips, and pelvis. Can be manifested by

A

Constant bone pain which can awaken a patient in the night

Back pain

212
Q

Colorectal cancer also spreads to the brain. It may cause problems with

A

Memory
Concentration
Ataxia
Movements

213
Q

If colorectal cancer is diagnosed early then ____ can be curative

A

Surgery

214
Q

In addition to surgery treatment for colorectal cancer may include

A

Chemotherapy

Radiation therapy

215
Q

Congenital abnormality of distal part of large intestine characterized by lack of ganglion cells resulting in functional obstruction and dilation of proximal part of affected colon

A

Hirschprung’s disease

216
Q

Hirschprung’s disease aka

A

Congenital aganglionic megacolon

Congenital megacolon

217
Q

Hirschprung’s disease often coexists with

A

Down’s syndrome

218
Q

Hirschprungs boys vs girls

A

Boys more often affected 5:1

219
Q

Most common segment in boys hirschprung’s disease

A

Short aganglionic segment of colon

220
Q

Most common segemnet girls hirschprung’s disease

A

Long aganglionic segment

221
Q

Hirschprung’s disease etiology is unclear. It is not caused by

A

Nything the mother did while being pregnant

222
Q

Possible genetic predisposition is found for hirschprung’s disease

A

Several genes and specific regions of chromosomes have been shown to be associated with hirschprung’s disease

223
Q

Pathogenesis of hirschprung’s disease

A

During normal fetal development between 7-12 weeks the cells from the neural crest migrate into the muscular layer of the large intestine to form the networks of nerves called Auerbach’s and Meissner’s plexus

224
Q

Normally auerbach’s and meissner’s plexus ganglion cells account for _____ which plays a significant role in peristalsis

A

Relaxation of smooth muscle cells in the GI tract

225
Q

Pathomorphologically in hirschprung’s disease these ganglion cells in the affected colon

A

Are absent

226
Q

Due to absence of ganglion cells the affected segment of the colon

A

Cannot relax and pass stool through the colon

227
Q

The absence of ganglion cells without the reciprocal relaxation results in a ___ in the affected regions leading to spasm of affected colon smooth muscles, creating an obstruction

A

Overstimulation of nerves

228
Q

Usually hirschprungs diseaase affects the part of the colon ____ but sometimes more regions could be involved

A

Near the anus

229
Q

Signs and symptoms hirschprungs in a newborn birth-1month

A

First manifestation occurs usually in first 24-48 hours after birth because a baby fails to pass meconium and first stool

If stool does not occur baby may develop vomiting with green or brown color vomiting masses within first 24 hours after birth

Swelling of the abdomen which may cause baby to breathe fast

After the stool pass, baby may have watery diarrhea

Constipation - no regular bowel movement

230
Q

Signs and symptoms hirschprung’s disease 1 motnh -1 year of age

A

Slow than expected weight gain
Constipation - bowel movement once every 3-5 days
Swollen abdomen
Episodes of vomiting and diarrhea due to intoxication from delayed feces

231
Q

Signs and symptoms hirschprung’s children 1 year and older

A 
Severe chronic constipation (stool 1x/5-7 days)
Malnutrition
Easy palpable fecal masses
Abdominal distention
Emotional instability
Delayed physical development
232
Q

Complications hirschprung’s disease

A

Perforation or rupture of intestine
Electrolyte imbalance
Enterocolitis due to overgrowth of opportunistic bacteria (e. Coli)
Toxic megacolon

233
Q

Diagnosis hirschprung’s disease

A

X-ray with liquid barium for children older than 3 months

If only a small anal part is involved x-ray won’t reveal signs of the disease

Colonoscopy with biopsy of rectum

CT-scan of abdomen

234
Q

Gold standard for hirschprung’s disease

A

Colonoscopy with biopsy of rectum

235
Q

Treatment hirschprung’s disease

A

Corrective surgery, I.e. removal of aganglionic segment of colon

236
Q

Chronic functional disorder of large intestine without inflammation or morphological changes in bowel tissue (without organic basis of disease) - all cells and tissues normal

A

IBS - irritable bowel syndrome

237
Q

IBS aka

A

Spastic colon
Irritable colon
Mucous colitis

(Prolonged spasm)

238
Q

IBS ___ cause more serious conditions such as colorectal cancer or IBD

A

Does NOT

239
Q

IBS is more common

A

In young than elderly

Females 2:1

240
Q

People over age 50 are less likely to develop IBS for the first time in life, so it is more likely that similar symptoms may be caused by

A

Another problem

241
Q

Etiology IBS

A

Not known
Often results from combination of physical and stress related factors
Genetic predisposition is possible

242
Q

Chriopractor is super helpful for

A

IBS

243
Q

Risk factors for IBS

A

Abnormality of innervations of large intestine
Abnormally decreased serotonin level
Pscyhological/psychosomatic factors (anxiety, depression, fibromyalgia, stressful lifestyle)
Change of hormonal level (females before menses)
Abnormalities in gut flora (overgrowth of opportunistic bacteria, decrease in bifidobacteria and lactobacteria - good bactera)
After long-term therapy with antibiotics (more than 2 weeks)

244
Q

Food intolerance for IBS

A 
Chocolate
Sugar
Alcohol
Vegetables
High fiber fruits like mango
Chewing gums with sweeteners
Coffee
245
Q

IBS appears to reflect motor disturbances of the ____ in response to stimuli

A

Entire colon

246
Q

The contraction of the bowel wall in IBS

A

Can be stronger and lasts longer than normal

247
Q

Contraction of gallbladder and stimulation of smooth muscle

A

Cholecystokinin

248
Q

The patient may be hypersensitive to hormones ___ and ____ which result in hypercontraction of the bowel smooth muscles in IBS

A

Gastrin

Cholecystokinin

249
Q

The abnormal decreased produciton of serotonin by brain and IG cells is associated with

A

Abnormal digestive function and mood

250
Q

Biochemically derived from tryptophan

A

Serotonin

251
Q

Primarily found in GI tract - 90% - used to regulate intestinal movements

A

Serotonin

252
Q

Serotonin is found in and stored in

A

Platelets

253
Q

Neurotransmitter of the CNS - regulation of mood, appetite, sleep (melatonin)

A

Serotonin

254
Q

IBS-D

A

Predominately characterized by diarrhea

255
Q

IBS-C

A

Predominately characterized by constipation

256
Q

IBS-A

A

Predominately characterized by pain or alternating stool patterns

257
Q

Signs and symptoms IBS

A 
Abdominal discomfort or pain lower than bellybutton occurs 1 hour after meal or stress
Association with diarrhea or constipation (no blood or pus)
Presence of mucous in the stool
Fatigue
Headaches
Depression in 60% of patients
Unpleasant taste in the mouth
Backache
Insomnia
Heart palpitation
258
Q

IBS pain disappears after

A

Bowel movement and passage of gas

259
Q

IBS close to age

A

40

260
Q

Diagnosis IBS

A

Non-specific and based on ruling out of other more serious disaeses

Blood tests - rule out celiac disease
CBC - rules out inflammation, allergy, cancer
Stool microscopy and culture - rule out infection
Stool for parasites
Fecal occult test
Thyroid functional test - rule out thyroid diseases (myxedema)
Colonoscopy - rule out IBD - only over 40
X-ray with liquid barium

261
Q

Cancer ESR level

A

High with more than 40 ml/hr

262
Q

Treatment IBS

A

No single type of treatment works best for everyone. Treatment is individual and basaed on IBS form

Adjustments are super helpful

263
Q

IBS-D treatment

A 
Fructose free diet (no honey, apples, pears, corn, corn syrup, dry figs, grapes, red sweet pepper, mango, maple syrup)
Lactose free diet
Avoid artifical sweeteners
Avoid alcohol
Avoid coffee and fried foods
264
Q

IBS-C treatment

A

Soluble fibers 20 g per day
Non-soluble fibers will worsen symptoms (cellulose, lignins, cereal grains)
Regular exercises may help reduce constipation (swimming, biking, walking)
Recommend raw or steamed vegetables - steamed is best, olive oil, hydration

265
Q

IBS-A treatment

A

Avoid foods that increase gas production

Beans, cabbage, uncooked cauliflowers, broccoli

266
Q

Recommended for all forms IBS treatment

A

Chiropractic
Meditation
Normalize serotonin with Vit B 1,3,6,9; calcium, magnesium, sunlight exposure not less than 30 min/day, 7-8 hours of sleep

267
Q

Medications for IBS

A

Antidiarrhea or laxative meds
Antidepressants
Probiotics (bifidobacteria and lactobacteria) - 20-60mg
Antispasmodic meds (peppermint oil)

268
Q

Outpocketing of colonic mucosa and submucosa through weakness of muscle layers in the colon wall

A

Diverticular disease

269
Q

Diverticular disease is most prevalent in

A

Men over age 40

270
Q

Most common site for diverticula is in the

A

Sigmoid colon

271
Q

Diverticula may develop in

A 
Esophagus
Stomach - usually precursor of peptic or neoplastic diseases of stomach
Duodenum near hepatopancreatic ampulla
Jejunum
Ileum - meckel’s - congenital anaomaly
272
Q

Etiology diverticular disease

A

Unkown

273
Q

Risk factors diverticular disease

A

Increasing age - 50% of people 70 or over have this
Chronic constipation
A high fiber diet and inc frequency of bowel movement
Connective tissue disorders that may cause weakness in the colon wall (marfan’s syndrome)
Genetic predisposition
Physical inactivity

274
Q

Clinical forms diverticular disease

A

Diverticulosis

Diverticulitis

275
Q

Diverticulum is present but asymptomatic, no inflammation

A

Diverticulosis

276
Q

Inflamed diverticula may cause potentially complications - fatal obstruction, bleeding, abscess, perforation, fistula to adjacent organs, peritonitis

A

Diverticulitis

277
Q

Diverticula probably result from ___ on an area of weakness in GI wall where blood vessels enter

A

High intraluminal pressure

278
Q

In ___ the fecal masses and bacteria accumulate in the diverticular sac. They affect blood supply to the thin wall of the sac making them more susceptibel to attack by colonic bacteria

A

Diverticulitis

279
Q

Signs and symptoms of diverticulosis

A

80% of patients are asymptomatic

20% of patients experience irregular defecation or bloating

280
Q

Signs and symptoms of acute diverticulitis

A 
Characterized by triad - sudden left lower quadrant pain worsening with movement, chills and fever, leukocytosis
Nausea, vomiting
Diarrhea or constipation
Tenderness in the lower abdomen
Feeling of fullness
281
Q

Signs and symptoms of chronic diverticulitis

A 
Constipation
Ribbon-like stool
Abdominal rigidity and pain
Diminished bowel sound (normal is 5-35, less than 5 is constipation)
Nausea, vomiting
282
Q

Diagnosis diverticulosis is occasional finding while performing

A

Plain x-ray of the abdomen with liquid Barium
CT-scan
MRI
Colonoscopy (gold standard)

283
Q

Diagnosis acute diverticulitis contraindications

A

Colonoscopy and plain x-ray with liquid barium because could result in perforation of colon

284
Q

Diagnosis acute diverticulitis

A

CT-scan
MRI
US

285
Q

Complications diveticular disease

A

More common in patients taking NSAIDS esp long-term (over 6 months, over age 70)

Bleeding
Abscess
Rupture of colon
Perforation of colon
Fistula to adjacent organs
Peritonitis
Sepsis
286
Q

First time bleeding from the rectum especially in patients over 40 yo requires ruling out of

A

Colorectal cancer
Inflammatory bowel diseases
Colon polyps

287
Q

In uncomplicated diverticular disease there is no specific treatment it is recommended

A

Adjust

Decrease consumption of nuts, sunflower seeds, popcorn, pumpkin seeds

288
Q

In complicated diverticular disease only ___ and ___ are indicated for treatment

A

Antibioticotherapy

Surgery

289
Q

Inflammation of the appendix

A

Appendicitis

290
Q

Untreated cases of acut appendicitis have

A

High mortality rate

291
Q

Appendicitis is classified as

A

Medical emergency

292
Q

Location of appendix

A

Base of appendix at 2cm below ileocecal valve, tip of appendix can vary from being retrocecal (74%) to being in the pelvis to being extraperitoneal

293
Q

There are some rare congenital variations of appendix

A

Agenesis
Duplication
Triplication
Situs inversus

294
Q

Etiology appendicitis

A

Lymphoid hyperplasia

Obstruction of appendix

295
Q

Appendicitis
Etiology
Lymphoid hyperplasia due to

A

Viral infection (measles, mono, respiratory viral infeciton)
Crohn’s disease
Bacterial enterocolitis
Amebiasis

296
Q

Lymphoid hyperplasia etiology is more typical for

A

Children, young people before age 20

297
Q

Appendicitis
Etiology
Obstruction of appendix due to

A

Foreign bodies
Constipation with fecal stasis
Parasites
Neoplasms

More typical for adults age 25 and older

298
Q

Clinical forms appendicitis

A

Acute - typical, atypical

Chronic - aka rumbling or recurrent appendicitis

299
Q

Signs and symptoms acute appendicitis appear in strict sequence

A

Pain
Vomiting, nausea
Fever

300
Q

Acute appendicitis

The first symptom is ___

A

Sudden mild pain in upper epigastric area or around the umbilicus lasting 4-6 hours

301
Q

after first symptoms acute appendicits

A

The pain gets more sharp, severe, constant and goes down towards RLQ (typical) LLQ or RUQ (atypical)

302
Q

Pain characteristic depending on locations of tip of appendix

A

Flank or back pain (retro/paracecal) - could mimic kidney stone migration
Crampy pain associated with diarrhea (paraileal)
Suprapubic pain associated with increased urinary frequency (pelvic) - mimics bladder inflammation

303
Q

In children before 8 yo acute appendicitis the pain localizes around

A

The umbilicus

304
Q

The pain is reduced when the patient being in supine or side position flex the hips and draw their knees up toward the chest right side

A

Fetal position

305
Q

Acute appendicitis

The second manifestations are

A

Nausea, vomiting, reduced appetite

306
Q

Acute appendicits

The third manifestation is

A

The fever from low to high degrees

307
Q

Acute appendicitis after 12-20 hours the following symptoms usually come to the clinical attention

A

Chills
Constipation
High fever
Severe constant pain

308
Q

If after first three manifestations the sudden relief of pain occurs within next 2-4 hours, it could indicate

A

Rupture of appendix

309
Q

If after few hours the pain becomes significantly worse, the development of ___ might be suspected

A

Peritonitis

310
Q

Chronic appendicitis develops rare, usually in ___ never in ___

A

Age 16 and over

Children

311
Q

All patients with chronic appendicitis have experienced before

A

One or more episodes of acute appendicitis

312
Q

Chornic appendicitis is characterized by

A

Fibrotic thickening or scaring of the appendix wall as a result of previous acute inflammation

313
Q

Pain characteristics chronic form

A

Pain in RLQ or lower abdomen for 3 or more weeks of duration

Pain intensity from mild to moderate, it gets worse within one to more weeks

If pain gest severe and constant, it indicates the rupture of appendix

314
Q

Nausea and vomiting are not always present in

A

Chronic appendicitis (unlike acute form)

315
Q

Fever chronic appendicitis

A

Is NOT present

If develops, the peritonitis must be suspected

316
Q

In pregnancy the appendix migrates in CCW direction towards

A

The right kidney, rising above the iliac crest

317
Q

RLQ pain and tenderness dominate in

A

First trimester of pregnancy

318
Q

After 20 weeks of pregnancy the pain may present in RUQ or right flank, and could mimic the

A

Kidney or gallbladder problems

319
Q

Complications appendicitis

A

Gangrenous appendicits with local peritonitis
Diffuse peritonitis
Sepsis
Death

320
Q

Diagnosis appendicits most specific physical findings are

A

Pain on percussion of abdomen
Rebound tenderness - Rowsing sign
Psoas sign
Obturator sign

321
Q

The most specific physical findings of appendicitis are

A

Rigidity and guarding of abdominal muscles in RLQ
Positive dunphy sign (sharp pain in RLQ with coughing)
Positive sitkovsky sign (an increase of pain in the RLQ when a patient lies on left side)
Positive blumberg sign - indicates the development of peritonitis

322
Q

Diagnosis appendicits

A

CBC - leukocytosis acute, neutrophilia acute, normal blood chronic

Urinalysis to rule out UTI is normal

US - esp in children and chronic cases

CT-scan only for chronic form

323
Q

Treatment appendicitis

A

Surgery ASAP

GE (5 decks)

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