gastro u world Flashcards
acute pancreatitis : def
inflammation and hemorrhage of the pancreas , due to auto digestion of pancreatic parenchyma by pancreatic enzymes that results in liquefactive hemorrhagic necrosis of the pancreas and fat necrosis of the peri pancreatic fat
acute pancreatitis causes :
mot commonly due to alcohol (decrease drainage by contracting the sphincter of oddi ) and gallstones ( block )
trauma (automobile accident in children )
acute pancreatitis clinical features (5)
1-epigastric abdominal pain
2-nausea and vomiting
3-periumbilical and Flank hemorrhage
4-elevated lipase specific
5-hypocalcemia in severe cases ( calcium is used for saponification in fat necrosis )
acute pancreatitis :complications
1-shock
2-pancreatic pseudocyst
3-pancreatic abscess due to E.coli
4-DIC and ARDS
acute pancreatitis : physiopathologie
pancreatic zymogens are normally converted into their active form by trypsin in the duodenal lumen
in AP , begins with either a toxic or ischemic injury to the acinar cells that leads to premature activation of trypsin that activates the other enzymes and Starts auto digestion
lipase
hydrolyzes triglycerides into fatty acids and glycerol
specific enzyme to acute pancreatitis
lipase
causes the formation of characteristic calcium soap deposit ( fat necrosis )
gilbert syndrome
jaundice during stress , during an infection , NOT CLINICALLY significant
high UCB
UDP glucuronosyltransferase
form unconjugated bilirubine to conjugated bilirubine
intestinal beta glucuronidase
its a bacterial enzyme in the colon , that deconjugate the conjugated bilirubine
begnin neonatal hyperbilirubinemia
caracteristics and physiopathology
- high bilirubin production due to physiologic breakdown of high RDC in the newborn
-low bilirubin clearance due to low UDP glucuronyltransferase result in high UCB
-high enteropatic circulation and absence of bacterial enzyme
-2 to 5 days
traitement to begin neonatal hyperbilirubinemia
phototherapy that makes UCB water soluble
complication of begin neonatal hyperbilirubinemia
UCB is fat soluble and can deposit in the basal ganglia (kernicterus ) and lead to neurological defects and death
biliary atresia def
failure to form or early destruction = fibrous obliteration of extra hepatic biliary tree
biliary atresia clinical features
1/ biliary obstruction within the first 2 months of life —> elevated CB
2/acholic stools, dark urine and jaundice
3/may present cirrhosis
biliary atresia : anatomic caracteristics
-absent or abnormal gall bladder
-atretic : cystic duct, common hepatic duct , bile duct
-fibrosis
portal tract edema and inflammation
biliary atresia treatment
cannot be treated by medication
the surgeon will create a path so the bile can flow directly into the intestines
and removes the damage ducts
= hepatoportoenterestomy
carcinoid tumor
malignant proliferation of neuroendocrine cells , low grade malignancy
the tumor cells are positive for *chromogranin *
can ariseanywhere along the gut , in the small bowel commonly , also rectum , appendix
NOT carcinoid syndrome
carcinoid tumor biological marker
secretes serotonin into the portal circulation that is metabolized by liver monoamine oxidase into 5-HIAA that is excreted into urine
carcinoid syndrome
def
metastasis of the cracionoid tumor , the serotonin bypass the liver metabolism and leaks into the systemic circulation via hepatic systemic shunts
carcinoid syndrome characteristics
-bronchospasme
-diarrhea
-flushing of skin
-symptoms that can be triggered by alcohol or emotional stress that stimulate the serotonin release
metastases of carcinoid tumor
carcinoid syndrome (liver metastase ) and then carcinoid heart
carcinoid heart disease
is characterized by right-sided vascular fibrosis leading to tricuspid regurgitation and pulmonary valve stenosis , left sided valvular lesions are not seen due to presence of monoamine oxidase in the lung
carcinoid tumors
composition
are composed of island or sheets of uniform cells with eosinophilic cytoplasm and oval-to round stippled nuclei
appendix
acute inflammation of the appendix most common cause of acute abdomen
appendix clinical featrures
1/periumbilical pain (due to irritation of the parietal peritoneum ) and right lower quadrant ,(Mcburney point : tenderness ) and we can have pain with hip extension and intern rotation
2/fever
3/nausea
-rupture results in peritonitis
complication of appendix
periappendiceal abscess
peptic ulcer disease
solitary mucosal ulcer involving proximal duodenum (90%) or distal stomach (10%)
duodenal ulcer causes :
-mostly due to Hpylori 95%
-due to ZE syndrome (gastrinoma)
duodenal ulcer clinical features
-epigastric pain that improves with meals
-hypertrophy of Brunner Glands
-usually arises in anterior duodenum
-if present in posterior duodenum : rupture may lead to bleeding from gastroduodenal artery or acute pancreatitis
duodenal ulcer in posterior duodenum complication
rupture that may cause bleeding of the gastroduodenal artery or acute pancreatitis
gastric ulcer causes
-due to Hpylori 75%
-NSAIDs
-bile reflux
gastric ulcer clinical features
-epigastric pain that worsens with meal
-ulser is usually located in the lesser curvature of the stomach (between the gastric corps and antrum )
-rupture carries risk of bleeding from left gastric artery
risk of gastric ulcer
rupture with bleeding of the left gastric artery because they usually occurs in the lesser curvature
diferential diagnosis of duodenal ulcers
duodenal carcinoma that are extremely malignant
benign peptic ulcers and malignant ulcers differences :
-benign : small <3cm , punched out , radiating folds of mucosa
-malignant : large , irregular , heaped up margins
–biopsy is required
necrotizing enterocolitis
-frequent gastrointestinal emergencies affecting new borns , *preterm * infants secondary to gastrointestinal and immunologic maturity
(bacteria proliferate excessively causing inflammation and ischemic necrosis of the terminal ileum and colon)
pneumatosis intestinalis
= air in the bowel wall
-X RAY : thin curvilinear areas of lucency that parallel the lumen
-infant with abdominal distension and bloody stools : this finding is diagnostic for necrotizing enterocolitis
necrotizing enterocoliti clinical features :
-preterm infants /newborn
-bloody stools
-abdominal distension
-pneumatosis intestinalis
volvulus
twisting of bowel along its mesentery
common location : sigmoid colon for elderly , cecum for young adults
obstruction and disruption of the blood supply
volvulus clinical features
-abdominal distension, pain, vomiting, constipation, and bloody stools , inability to pass gazs
The onset of symptoms may be insidious or sudden.
-The most sensitive radiographic signs : absence of rectal gas and distended sigmoid loop with an inverted-U appearance , coffee bean sign
pyloric stenosis
congenital hypertrophy of pyloric snooty muscle , more common in males
-presents *2weeks after birth *
pyloric stenosis clinical features
2 weeks after birth :
- projecting non bilious vomiting
-visible peristaltis
-olive like mass in the abdomen
traitement of pyloric stenosis
myotomy : cut away the excess of muscle
duodenal atresia
congenital failure of duodenum to canalize , associated with Down syndrome
clinical features of duodenal atresia (3)
- polyhydramnios
-distension of stomach and blind loop of duodenum : double bubble sign
-bilious vomiting shortly after birth
crhon disease
cholelithiasis
ulcerative colitis
irritable bowel syndrome
symtoms
-relapsing abdominal pain with bloating , flatulence and change in bowel habits (diarrhea or constipation ) , IMPROVES with defecation
-seen in middle aged women
-increased dietary fibers may improve symptoms
irritable bowel syndrome
cause
related to disturbed intestinal motility , no identifiable pathologic changes
