Gastrointestinal Flashcards
Constipation that involves difficulty expelling stool because of failure of the pelvic floor muscles or anal sphincter to relax with defecation
Pelvic floor dysfunction or outlet dysfunction
Diarrhea where a nonabsorbale substance in the intestine draws water into the lumen by osmosis and increases stool weight and volume producing large volume diarrhea
osmotic diarrhea
The rapid emptying of hypertonic chyme from the surgically created, residual stomach into the small intestine 10 to 20 minutes after eating
Dumping syndrome
Which type of diarrhea is usually caused by an inflammatory disorder of the intestine such as ulcerative colitis, Crohn disease or microscopic colitis
Small-volume diarrhea
Diarrhea caused by resection of the small intestine (short bowel syndrome), surgical bypass of an area of the intestine, fistula formation between loops of intestine, irritable bowel syndrome
motility diarrhea
this pain arises from the parietal peritoneum, is more localized and intense
Parietal pain
This pain arises from a stimulus acting on mechanical and chemical nociceptors of abdominal organs
Visceral pain
this pain is felt at some distance form a diseased or affected organ and is well localized
Referred pain
Bleeding in the esophagus, stomach, or duodenum and is characterized by frank, bright red bleeding in emesis or dark grainy digestedd blood “coffee grounds” in stool
Upper gastrointestinal bleeding
Bleeding from the jejunum or ileum of the small intestine, colon or rectum and can be caused by polyps, inflammatory bowel disease, diverticular disease, cancer, mucosal vascular ectasias, or hemorrhoids
Lower gastrointestinal bleeding
Bleeding caused by slow chronic blood loss. Is not obvious and results in iron deficiency anemia
Occult bleeding
What are the best indicators of massive blood loss in the gastrointestinal tract
Changes in blood pressure and heart rate
Why are hematocrit and hemoglobin values not the best indicator of acute GI bleeding?
Because plasma and red cell volume are lost proportionately
Symptoms of severe GI blood loss may include?
Light headedness, loss of vision, tachycardia, hypovolemic shock, decreased urine output
Bloody vomitus; either fresh, bright red blood or dark, grainy, digested blood with “coffee grounds” appearance
Hematemesis
Black, sticky, tarry, foul-smelling stools caused by digestion of blood in the GI tract
Melena
Fresh, bright red blood passed from the rectum
Hematochezia
Trace amounts of blood in normal appearing stools or gastric secretions; detectable with a guaiac test
Occult bleeding
Difficulty swallowing or preception of obstruction during swallowing
Dysphagia
This type of dysphagia originates outside the esophogeal lumen and narrow the esophagus by pressing inward on the esophageal wall
Extrinsic mechanical obstruction dysphagia
A rare disorder related to the loss of inhibitory neurons in the myenteric plexus with smooth muscle atrophy in the middle and lower portions of the esophagus causing functional obstruction of the lower esophagus. Food accumulates above the obstruction, distends the esophagus, and causes dysphagia. Ad hydrostatic pressure increases food is slowly forced past the obstruction into the stomach
Achalasia
Heartburn, chronic cough, asthma attacks, laryngitis, sinusitis, upper abdominal pain within 1 hour of eating. Symptoms worsen if the individual lies down or if intra-abodminal pressure increases
GERD
A rare idiopathic inflammatory disease of the esophagus characterized by esophageal infiltration of eosinophils associated with atopic disease including asthma and fool allergies.
Eosinophilic esophagitis
A type of diaphragmatic hernia with protrusion of the upper part of the stomach through the diaphragm and into the thorax
hiatal hernia
Delayed gastric emptying in the absence of mechanical gastric outlet obstruction and is associated with DM, surgical vagotomy, or fundoplication
Gastroparesis
The narrowing or blocking of the opening between the stomach and the duodenum
Pyloric obstruction (gastric outlet obstruction)
Rolling or jarring of the abdomen produces a sloshing sound called
succusion splash
Why is the small intestine more commonly obstructed
Because of its narrower lumen
The mechanical blockage of the lumen by a lesion, but blood flow is preserved
simple obstruction
Blood flow is compromised, leading to intestinal iscehmia and if left untreated necrosis and perforation
strangulated obstruction
A failure of GI motility after intestinal or abdominal surgery, acute pancreatitis or hypokalemia
paralytic ileus
If the GI obstruction is at the pylorus or high in the small intestine the patient will develop
metabolic alkalosis
If the GI obstruction is prolonged or lower in the intestine the patient will develop
metabolic acidosis
Which electrolyte imbalance is likely to occur during obstruction?
Hypokalemia
This type of obstruction is less common and often related to carcinoma
Large Bowel obstruction
A rare functional, massive dilation of the large bowel that is related to excessive sympathetic motor input or decreased parasympathetic motor input with absence of mechanical obstruction and occurs in people who are critically ill and immobilized older adults
Acute colonic pseudo-obstruction (Ogilvie Syndrome)
Protrusion of the intestine through the abdominal muscles or through the inguinal ring
Herniation
Telescoping of one part of the intestine into another, causing strangulation of blood supply, more common in ileocecal area in infants 10-15 months of age
Intussusception
Twisting of the intestine on its mesenteric pedicle, with occlusion of the blood supply, often associated with fibrous adhesions in the small intestine; occurs most often in the large intestine in older adults
torsion
Inflammed saccular herniations of the mucosa and submucosa through the tunica muscularis of the colon; diverticular are interspersed between thick circular fibrous bands; most common in obese individuals older than 60
Diverticulitis
Peritoneal irritation from surgery or trauma leads to formation of fibrin and adhesions that attach to intestine, omentum, or peritoneum and cause traction and obstruction usually in the small intestine
Fibrous adhesions
inflammatory disorder of the gastric mucosa
Gastritis
A break or ulceration in the protective mucosal lining of the lower esophagus, stomach or duodenum
Peptic ulcer
A superficial ulceration that erode the mucosa but do not penetrate the muscularis mucosae
Erosions
A rare syndrome also associated with peptic ulcers caused by a gastrin-secreting neuroendocrine tumor or multiple tumors of the pancreas or duodenum
Zollinger-Ellison syndrome
An acute form of erosive inflammatory peptic ulcers that tends to accompany the physiologic stress of severe illness, multisystem organ failure; or major trauma, including severe burns or head injury
stress-related mucosal disease (stress ulcer)
This type of stress ulcer develops within hours of an event such as hemorrhage, multisystem trauma, severe burns, heart failure, or sepsis
Ischemic ulcers
Stress ulcers that result due to burn injury are often called
Curling ulcers
A stress ulcer associated with severe head trauma or brain surgery
cushing ulcer
This gastritis is caused by reflux of bile and alkaline pancreatic secretions containing proteolytic enzymes that disrupt the mucosal barrier in the remnant stomach
Alkaline reflux gastritis
This disease is characterized by intermittent periods of remission and exacerbation, loss of absorptive mucosal surface, large volume watery diarrhea, bleeding, cramping pain, and an urge to defecate might have
Ulcerative colitis
An idiopathic inflammatory disorder that affects ANY part of the GI tract from the mouth to the anus and involves “skip lesions” with inflamed areas mixed with uninflamed areas, noncaseating granulomas, fistulas, and deep penetrating ulcers.
Crohn disease
Which gene mutation has the strongest association with Chron’s disease?
CARD15/NOD2
A complication of Chron’s disease treatment involving a surgical resection of the small intestine that results in malabsorption, diarrhea, and nutritional deficiencies.
short bowel syndrome
A disorder of the brain gut interaction characterized by abdominal pain with altered bowel habits, more common in women, with higher prevalence in youth and middle age
Irritable bowel syndrome
A relatively common cause of chronic watery diarrhea. Risk factors include age 50 years or older, female sex, weight loss, absence of abdominal pain, use of PPI’s or NSAIDS.
Microscopic colitis
Herniations or saclike outpouchings of mucosa through the muscle layers of the colon wall
Diverticula
Asymptomatic diverticular disease
Diverticulosis
Inflammation of the diverticula
diverticulitis
Portal hypertension is the elevation of hepatic venous pressure above
5 mmHg
The accumulation of fluid in the peritoneal cavity and is a complication of portal hypertension.
ascites
This ascites theory is the most accepted theory and proposes that circulating nitric oxide and carbon monoxide cause splanchnic vasodilation.
Peripheral arterial vasodilation theory or forward theory
This disorder occurs due to liver dysfunction and collateral vessels that shunt blood around the liver to the systemic circulation permitting neurotoxins and other substances absorbed from the GI tract to accumulate and circulate freely to the brain
Hepatic encephalopathy
A rare chronic, progressive autoimmune inflammatory liver disease that affects genetically susceptible individuals usually women and children?
Autoimmune hepatitis
This type of hepatitis can be recovered from feces, bile, and sera of infected individuals. The usual mode of transmission is fecal-oral route, but can be spread by infected blood and by men having sex with men
Hepatitis A (HAV)
This type of hepatitis is a parenterally and sexually transmitted virus with 8 genotypes. Those who are at highest risk are immunosuppressed, receive hemodialysis, multiple blood transfusions, use immunosuppressive drugs, have multiple sex partners, share needles/syringes, and infants born to infected mothers.
Hepatitis B (HBV)
This type of hepatitis is a parenterally transmitted flavivirus with 10 genotypes and a significant number of cases involve IV drug users with 80% developing chronic liver disease
HCV
This type of hepatitis is a defective, single strand RNA virus and occurs as a co-infection with hepatitis B
HDV
This type of hepatitis is most common in Asian and African countries, is transmitted via fecal-oral route from contaminated water or uncooked meat, domestic pigs, wild boars, deer, mongoose, and rabbits are all reservoirs for it.
HEV
Fibrosis in cirrhosis is a consequence of
Kupffer cell activation
This disease differs from alcoholic cirrhosis in that damage and inflammation leading to cirrhosis begin in bile canaliculi and bile ducts, rather than in hepatocytes
Biliary cirrhosis
What is the hall mark of primary biliary cirrhosis?
Antimitochondrial antibody
This disease can be chronic or acute but both forms are almost always caused by the lodging of a gallstone in the cystic duct causing the gallbladder to become distended and inflamed
cholecystitis
The mutation of which gene is an early event in esophageal cancer?
TP53
A patient presenting with loss of appetite (especially meat), malaise, indigestion, unexplained weight loss, upper abdominal pain, vomiting, change in bowel habits and anemia caused by occult bleeding probably has
Stomach cancer
why is a stomach cancer prognosis generally poor?
Because it is asymptomatic until it has distant metastases
This cancer is rare but occurs more frequently in familial adenomatous polyposis and Crohn disease.
Small intestine carcinoma
The third most common cause of cancer and cancer death in the United States.
Colorectal cancer (CRC)
Familial adenomatous polyposis, HNPCC or Lynch Syndrome are both high risk factors for
CRC
A mass or finger like projection arising from the intestinal mucosal epithelium
polyp
What two medication have been shown to prevent and treat colorectal cancer?
aspirin and NSAIDS
Tumors that occur up to 15 cm from the anal opening.
rectal carcinoma
Why is screening so important for CRC?
Because polyps and early stage tumors are asymptomatic
The leading cause of cancer death worldwide and is highest in Eastern and Southeastern Asia
Liver Cancer
This develops in the hepatocytes and can be nodular, massive, or diffuse.
Hepatocellular carcinoma
This is a rare but lethal disease associated with gallstones, advancing age, female sex, anomalous pancreaticobiliary ductal junction and obesity
Gallbladder cancer
Risk factors for this cancer include use of tobacco, heavy alcohol use, family history, DM type 2, chronic pancreatitis, and non O blood group
pancreatic cancer
This is a rare autoimmune fibroinflammatory disorder of the pancreas that mimics radiologic and clinical symptoms of pancreatic cancer and must be differentiated
autoimmune pancreatitis
What tumor marker is useful for diagnosis and response to treatment of pancreatic cancer?
CA19-9
