Gastrointestinal Health Flashcards
What are the different parts of the GI Tract?
- Esophagus
- Stomach
- Small Bowel
- Large Bowl
What are the different parts of the Esophagus?
- Proximal
- Mid
- Distal
What are the different parts of the Stomach?
- Cardia
- Antrum
- Fundus
- Pylorus
What are the different parts of the Small Bowel?
- Duodenum
- Jejunum
- ileum
What are the different parts of the Large Bowel? (6)
- Cecum (+ appendix)
- Ascending colon
- Transverse colon
- Descending colon
- Sigmoid colon
- Rectum
What connects the Esophagus to the Stomach?
The lower esophageal sphincter, also known as the Gastroesophageal Junction
What connects the Stomach to the Small Bowel?
Pyloric Valve
What connects the Small Bowel to the Large Bowel?
Ileocecal valve
What does the Upper GI tract consist of?
- Esophagus
- Stomach
- First part of the small bowel
What does the Lower GI tract consist of?
- rest of the small bowel
- large bowel
Where does Gastroesophageal Reflux or GERD occur most often?
Distal Esophagus
Where does infections by Helicobacter Pylori tend to occur first?
The antral part of the stomach
Where does Crohn’s disease commonly occur?
Terminal Ileum
Where does Ulcerative Colitis commonly occur?
The Rectum and then moves proximally into the colon
What is the Lumen?
The hollow space in the GI tract where food passes through
What is the Mucosa?
The inner lining, the layer closest to the lumen and has contact with contents that pass through
What is the Muscularis?
- the muscle layer
- contents move through GI tract through coordinated wave-like contractions (peristalsis)
What are the different layers of the GI Tract?
- Lumen
- Mucosa
- Muscularis
What is the Peritoneal Cavity?
- Continuous membrane that forms the lining of the abdominal cavity
- can involve diseases of the GI tract
- Can fill with fluid (ascites), or become inflamed (peritonitis)
What are the functions of the GI Tract?
- Digestion
- Absorption
- Excretion
What is Digestion?
Breaking down food components into smaller constituents
- Enzymes/acids break down food and specific components
- occurs mainly in stomach and duodenum
What is Absorption?
taking up nutrients and/or water for use
- nutrient absorption occurs in small bowel
- water and electrolyte absorption occur in large bowel
What is Excretion?
expelling waste products of digestion
What are possible Signs and Symptoms of GI diseases? (10)
- pain
- nausea
- vomiting
- loss of appetite
- diarrhea
- constipation
- distention
- fatigue
- fever
- bleeding
What is a GI bleed?
- possible indication of a GI tract pathology
- Range of possible sources and causes
- Characterizing the bleed important clinically
What is Hematemesis?
vomiting of blood
What is Coffee Ground Emesis?
Dark and granular vomitus due to effects of stomach acid on hemoglobin
What is Hematochezia?
Bright red blood in stool
- indicates “fresh” bleed, commonly from lower GI tract
What is Melena?
Dark, black, tarry stool
- stool colour due to digestion of blood, most commonly from upper GI tract
What is Occult Bleeding?
Blood that is not visible, typically found in stool
What tests are done to determine Occult blood?
- Screening stool tests (Fecal blood tests)
- Bloodwork (Iron deficiency anemia)
What can Infections of the GI tract be caused by?
- Viruses
- Bacteria
- Parasites
What is Appendicitis?
Inflammation of the appendix
What is the Pathogenesis of Appendicitis?
Often associated with fecalith obstruction (Ischemia) = ulceration = secondary infection
What is Ischemia?
Obstruction of blood flow
What are the risk factors of Appendicitis?
- Extremes of age
- Family history
- more common in males than females
What are the Signs and Symptoms of Appendicitis?
- Abdominal pain (RLQ/McBurney’s point), Rebound tenderness
- Nausea/vomiting
- Fever
What are complications that could occur with Appendicitis?
Can lead to appendiceal rupture (perforation) = leading to peri-appendiceal abscess or inflammation of the peritoneal cavity (peritonitis)
What is treatment of Appendicitis?
Surgical treatment is most common treatment for acute cases
What is Helicobacter pylori (H. pylori)?
A Gram-negative bacteria, that most commonly colonizes stomach
- estimated 50% prevalence worldwide, higher in developing countries
What are the signs and symptoms of Helicobacter pylori?
- often asymptomatic
- abdominal pain (mid-upper)
- nausea
- bloating
What are some complications of H. pylori and Peptic Ulcer Disease?
- Peptic/duodenal ulcers in 10-15% of cases = leading to bleeding and perforation
- chronic inflammation = increased risk of lymphoma and cancer
How do you diagnose H. pylori infection and Peptic Ulcer Disease?
- Via endoscopy + biopsies
- bloodwork
- urea breath test
What is the treatment for H. pylori infections and Peptic Ulcer Disease?
Triple-therapy (antibiotics and protein-pump inhibitors)
What is Inflammatory Bowel Disease (IBD)?
A disease of unknown etiology, characterized by inflammation of the bowel
- age onset typically 15-35
What are the common symptoms of IBD? (5)
- diarrhea (+/- blood) and urgency
- abdominal pain
- Fever
- Weight loss/fatigue
- +/- extra-intestinal problems (liver, joints, skin, eyes)
What are the two types of IBD?
- Crohn’s Disease
- Ulcerative Colitis
What are the distinguished characteristics of Crohns’s Disease? (4)
Sites of Involvement:
- Ileum and colon
- Can involve any part of GI tract
- patchy involvement
Hematochezia:
- uncommon
Complications:
- Abscesses, strictures, fistulas, and perianal disease more common
Degree of Inflammation:
- Transmural with fissuring ulcers
What are the distinguished characteristics of Ulcerative Colitis? (4)
Sites of involvement:
- starts at rectum + moves proximally
- Limited to colorectum
- continuous involvement
Hematochezia:
- Common
Complications:
- greater risk of colon cancer
Degree of Inflammation:
- Superficial
Pseudopolyps more common
What are the treatment options for Crohns and Ulcerative Colitis?
- medications to reduce inflammation (anti-inflammatories, immune system modulators, biologics)
- nutritional support to help relief stool symptoms
- Surveillance endoscopy
What are the surgery options for Crohn’s and Ulcerative Colitis?
Crohn’s disease: removal of damaged sections, management of abscesses/fistulas
Ulcerative Colitis: removal of colon/rectum
What is a Diverticulum?
Outpouching of bowel wall
What is Diverticular Disease?
Presence of Diverticula
Where is Diverticular Disease most common?
Sigmoid Colon in North America, and in the Right Colon in Asia
What is the cause of Diverticular Disease?
Increased luminal pressure (low fiber, high fat diets) + weak points in gut wall
What is Diverticulitis?
Inflammation of Diverticula
What are the symptoms of Diverticulitis?
- fever
- worsening abdominal pain (LLQ)
What are the complications of Diverticulitis?
- Abscess formation
- perforation
- strictures
- fistulas
What is the treatment for Diverticulitis?
- Antibiotics
- surgery (depending on severity)
What is a Bowel Obstruction?
- Blockage that prevents the passage of food/liquids
- Can occur across all age groups, with a variety of causes
What are the common signs and symptoms of bowel obstruction?
- abdominal distention
- vomiting
- constipation
What is a Herniation?
bowel obstruction that is a pouch-like protrusion of the peritoneum
What are Adhesions?
bowel obstruction that is a fibrosis/scar tissue forming between loops of bowel
Commonly seen in pts who’ve had multiple surgeries
What is a Volvulus?
Bowel obstruction that is the twisting of the bowel on itself + mesentery
What is an Intussusception?
Bowel obstruction that is the telescoping of the bowel into adjacent segment
In children, the most common site is at the ilioceal valve
What is the third most commonly diagnosed cancer in Canada?
Colorectal Cancer
What is the most common type of colorectal cancer?
Adenocarcinoma
What are the different stages of Colorectal Cancer?
- Stage I + II = confined to bowel
- Stage III = metastasis to local lymph nodes
- Stage IV = metastasis to distant organ/sites
What is the Pathogenesis of Colorectal Cancer?
- mutations in the bowel mucosa may result in pre-cancerous lesions = polyps
- Additional mutations may accumulate that result in local invasion or metastasis (cancer)
- not all polyps result in cancer transformation
What are the symptoms of Colorectal Cancer? (6)
- Rectal/stool bleed
- change in bowel habits
- abdominal discomfort
- weakness
- fatigue
- weight loss
What are the risk factors for Colorectal Cancer? (7)
- family history/known familial syndromes
- age
- inflammatory bowel disease
- Diet
- Obesity
- Smoking
- exercise
What are the different screening types for Colorectal Cancer?
- Fecal immunochemical test (FIT): stool test to detect blood
- Endoscopy: procedure to directly examine the bowel and identify premalignant or malignant lesions
What is the most common Esophageal Cancer in Canada?
Adenocarcinoma
What is the most common Esophageal Cancer worldwide?
Squamous cell carcinoma
Where is the most common place that Esophageal Cancer occurs?
Distal third of the esophagus
What is the Pathogenesis of Esophageal Adenocarcinoma? (3)
- often arises in a background of chronic GERD
- 10% patients with symptomatic GERD, develop Barrett’s esophagus
- Greater risk of developing dysplasia and maligancy
What are the signs and symptoms of Esophageal Adenocarcinoma?
- pain or dysphagia
- weight loss
- chest pain
- vomiting
What are the risk factors of Esophageal Adenocarcinoma?
- GERD
- Tobacco use
- Obesity
- Radiation
