Gastro 2 Flashcards
The two main types of Oesophageal cancer are……
Squamous cell carcinoma
Adenocarcinoma
Describe squamous cell carcinoma…
Cancer of the epithelial cells, upper oesophagus.
What is Adenocarcinoma?
Cancer of epithelial cells of the glands, lower oesophagus.
Oesophageal cancer has a high mortality rate compared to incidence, and can metastasise rapidly.
True or False?
Why?
True.
Because there is no serosa around the oesophagus, so the cancer invades local lymph tissue easily.
GORD can result in cell type change which can lead to Adenocarcinoma.
True or False?
True
What factors increase the risk of squamous cell carcinoma of the oesophagus?
Age
Alcohol
Smoking
Possibly even drinks that are too hot.
Adenocarcinoma is associated with a condition called ………… , Where chronic irritation of the oesophageal mucosal lining occurs.
GORD. Gastro-oesophageal reflux disease.
What occurs in ‘Barrett’s Oesophagus’?
Normal squamous cell lining is replaced with columnar cells (like in stomach), which is a pre-malignant mucosal change, Adenocarcinoma becomes higher risk.
The change from squamous cells to columnar cells in the oesophagus is also known as…….
Metaplasia
When cells change from squamous to columnar in patients with GORD, it IS possible for the cells to revert back to normal.
True or False?
True
Clinical features of oesophageal cancer include…….
Dysphagia
Heart burn
Weight loss
Bleeding
Treatment for oesophageal cancer includes…..
Oesophagectomy is most common
Radiation
Chemo
Microvilli is otherwise known as……
What happens here?
Brush border.
Enzymes break down carbs, proteins and fats.
Digestion requires……….
Pancreatic enzymes
Bile from liver
Enzymes within epithelial cells of mucosa.
Malabsorption syndromes describes the inability to…….
Absorb nutrients from the small intestine.
Malabsorption syndromes occur due to impaired digestion. List reasons why impaired digestion may occur.
Lack of enzymes, eg. Lactose intolerance.
Pancreatic cancer
Cystic fibrosis
Surgical resection following small intestine cancer.
Lack of bile salts, eg. Liver cirrhosis, gall stones.
Malabsorption syndromes can occur through impaired mucosal function. Why might this happen?
Damage to small intestine due to coeliac disease or chemotherapy
How does coeliac disease relate to malabsorption?
Gluten flattens the villi; loss of villi means loss of surface area to absorb nutrients.
Why does cystic fibrosis cause malabsorption?
Because thick mucus blocks the ducts of the glands, enzymes get ‘stuck’ in the ducts and are not released for digestion
Clinical features of malabsorption syndromes include…..
Diarrhoea
Steatorrhoea
Abdominal distension (bloating, farts!)
Weight loss
What is steatorrhoea?
Fat in the stool due to poor fat absorption
Reduced absorption of Iron, B12 and folate, and calcium can lead to………
Anaemia
Osteoporosis
What is the main role of the large intestine?
To reabsorb water
Chronic inflammatory bowel disease describes ………. And ……….
Crohn’s disease, And
Ulcerative colitis
Chronic abnormal immune and inflammatory responses result in inflammation and ulceration of the wall of the intestine….. What is this describing?
Chronic inflammatory bowel disease.
What complications can occur from chronic inflammatory bowel disease?
Damage to intestinal mucosa and reduced absorption of nutrients can occur.
Leading to malnutrition, vitamin and nutrient deficiencies and steatorrhoea.
Crohn’s disease involves the small AND large intestine and involves all 4 layers of intestinal wall.
True or false?
True
Ulcerative colitis involves only the mucosal layer of the intestine.
True or false?
True
Which parts of the large intestine are mainly affected by ulcerative colitis?
Sigmoid colon
Rectum
Does malabsorption occur in ulcerative colitis?
No. Very rare.
Does malabsorption occur in Crohn’s disease?
Yes.
Skip lesions occur in Crohn’s disease but not in ulcerative colitis.
True or false?
True
What is haematochezia?
Red blood in stool due to bleeding from the lower GI tract.
Clinical features of chronic inflammatory bowel disease include…..
Abdominal pain, cramping.
Haematochezia
Diarrhoea
Weight loss
Treatment for chronic inflammatory bowel disease includes…..
Modify diet
Reduce stress
Anti-inflammatory drugs
Surgical resection of the large intestine is possible for ulcerative colitis, but not Crohn’s disease.
True or false
True
Changes to the structure of the GIT can be seen in irritable bowel syndrome.
True or false?
False.
No apparent changes are present.
Irritable bowel syndrome is related to what 3 contributing factors?
Psychological stressors
Diet
Abnormal gut motility
Pain and discomfort, change in stool form and frequency, and discomfort that improves after defecation need to occur ….. days over …. months for irritable bowel syndrome to be diagnosed.
3
3
Diarrhoea and/or constipation
Chronic abdominal pain
And bloating are clinical features of what condition?
Irritable bowel syndrome.
There is a cure for irritable bowel syndrome.
True or false?
False.
Treatment must be individualised
Colorectal cancer usually occurs from ……….. of the colon.
Adenocarcinoma
How does colorectal cancer usually develop?
From benign polyps
Adenomatous polyps are malignant.
True or false?
False
They are benign
List risk factors for colorectal cancer.
Age over 50
Family history of polyps or colorectal cancer
Genetic syndrome
Inflammatory bowel disease
Can lifestyle factors contribute towards colorectal cancer?
What might they be?
Physical inactivity Low fruit and veg intake Low fibre and high salt diet Obesity Alcohol consumption Smoking
Do adenomatous polyps arise from all layers of the colon or just the mucosal layer?
Mucosal layer only. They can be removed by colonoscopy before they have the opportunity to grow and spread within the layers of the colon
Once adenoma spreads to the ……….. layer, it becomes an …………… which is a ……… tumour.
Submucosal
Adenocarcinoma
Malignant
What can occur when adenoma spreads to the submucosal layer of the colon?
Metastasis
Difficulty in treating
Stage I colorectal cancer is limited to the ……… and …………..
What is the 5 year survival rate?
Mucosa and submucosa
90%
Stage II colorectal cancer has spread to the …….. ……….
What is the 5 year survival rate?
Muscularis externa
87%
Stage III colorectal cancer has spread to the …….. and ……. ……..
What is the 5 year survival rate?
Serosa and lymph nodes
57%
Stage IIII colorectal cancer has spread to ……. ……. (……….)
What is the 5 year survival rate?
Other organs (metastasised) 10%
What does the 5 year survival rate actually mean?
The % of patients that are still alive after 5 years of treatment
Clinical features of colorectal cancer become apparent very rapidly.
True or false?
False.
Few symptoms show until advanced stage
Symptoms of colorectal cancer depend on location of cancer and can include……
Change in bowel habit
Abdominal pain, bloating
Occult blood
Unexplained tiredness
What would explain increased tiredness in a patient with colorectal cancer?
Depletion of red blood cells due to the chronic slow bleed.
What is occult blood?
Traces of blood in stool usually due to bleeding from the lower GI tract.
Why has screening been introduced for colorectal cancer?
No early warning signs.
Remains confined for long period before invading bowel wall and other organs.
Treatment more successful if detected early.
At what age should you commence the National bowel screening program?
How is this done?
50, then every 5 years thereafter.
Faecal occult blood test (FOBT)
Early stage treatment of colorectal cancer is ……….. or ………….
If not reached muscularis externa, will cure ….. % of cases.
Polypectomy or surgery
90%
If colorectal cancer penetrates wall and/or spreads to lymph nodes, how should it be treated?
Surgery and chemotherapy
List some age-related changes that may lead to anorexia, impaired absorption, malnutrition and constipation in the elderly.
Loss of teeth Decline in taste bud numbers Sense of smell lessens Saliva secretion decreases Dysphagia Gastric secretions decrease Decreased liver function Decreased GIT motility
