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Patho Summer Test #1 > Gastrointestinal Module #3 > Flashcards

Gastrointestinal Module #3 Flashcards

1
Q

What is pyloric obstruction?

A

Narrowing of the pylorus (junction between stomach and duodenum)

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2
Q

What are the 2 forms of pyloric obstructive?

A

Acquired

Congenital

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3
Q

What is infantile hypertrophic pyloric stenosis (IHPS)?

A

Congenital narrowing of pylorus

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4
Q

What are the signs and symptoms of infantile hypertrophic pyloric stenosis?

A

Infant @ 2-3 weeks begins to vomit for no apparent reason

**projectile vomitting –> several feet

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5
Q

What happens to the sphyncter that makes it stenotic in infantile hypertrophic pyloric stenosis?

A

Hypertrophy

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6
Q

What is the treatment for infantile hypertrophic pyloric stenosis?

A

Surgery: Pyloromyotomy

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7
Q

What causes adult/acquired pyloric obstruction?

A

Severe peptic ulcer or tumor in pyloric area

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8
Q

What are the signs/symptoms of adult/acquired pyloric obstruction?

A

Vague symptoms:

epigastric discomfort/fullness w/ eating –> progresses to severe (gastric distention, nausea, –> vomitting and acute distress)

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9
Q

What is the treatment of adult/acquired pyloric obstruction?

A

Address the cause of the obstruction

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10
Q

What are the different mechanical obstructions?

A

Adhesions

Herniation

Intussusception

Volvulus (torsion)

Tumor Growth

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11
Q

What are intestinal adhesions?

A

Fibrous “scar tissue” adheres to intestinal loops

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12
Q

What causes intestinal adhesions?

A

Usually common complication of abdominal surgeries

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13
Q

What is an intestinal herniation?

A

Intestine protrudes through abdominal wall

may strangulate through opening

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14
Q

What is intestinal intussusception?

A

Telescoping of one part of an intestine on another portion

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15
Q

What is the most common area to have intestinal intussusception?

A

Ileocecal area

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16
Q

Who is most likely to have an intestinal intussusception?

A

Young kids

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17
Q

What is intestinal volvulus (torsion)?

A

Intestine twist upon itself

Messentary twists around strangulating the blood supply to the intestine

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18
Q

Who do you usually see with intestinal volvulus (torsion)?

A

Elderly

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19
Q

What is the most common cause of large intestine obstruction?

A

Colon/rectal cancer

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20
Q

What is a paralytic ileus?

A

Obstruction that results when peristalsis stops –> functional/physiological obstruction

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21
Q

What causes paralytic ileus?

A

Certain drugs –> narcotic pain drugs or high BP meds

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22
Q

What is hirschsprung’s disease (congenital aganglionic megacolon)?

A

Birth defect in which ganglion (nerve) cells of the colon (large intestine) fails to develop

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23
Q

How common is hirschsprung’s disease?

A

1:5,000 newborns

25% of all infant obstructions

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24
Q

Does hirschsprung’s disease affect males or females more?

A

Males

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25
Q

What will biopsy show in hirschsprung’s disease?

A

Absent Meissener’s (submucosal)

Absent Auerbach’s (myenteric) plexus

etc.

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26
Q

What does hirschsprung’s disease result in functionally?

A

Impaired motility of colon d/t poor coordination/ability to contract intestinal musculature

Impacted/trapped Stools

Infection

Inflammation

Constipation

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27
Q

What are the 2 categories of Hirschsprung’s disease?

A

Short segment

Long segment

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28
Q

What regions of the colon are affected in short segment hirschsprung’s disease?

A

Rectosigmoid colon

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29
Q

What regions of the colon are affected in long segment Hirschsprung’s disease?

A

Rectosigmoid colon and regions proximal to it

**severe cases can involve entire colon

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30
Q

Which type of Hirschsprung’s is the more mild type?

A

Short segment

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31
Q

What is the treatment for Hirschsprung’s disease?

A

Decompress the colon (serial rectal irrigation)

Surgical removal of involved intestinal segment

Mild to moderate cases (short-segment) = myotomy or resection

Severe cases (enterocolitis) = temporary or permanent colostomy

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32
Q

What is Inflammatory Bowl Disease (IBD)?

A

Chronic autoimmune inflammatory dz that damages/ulcerates GI tract

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33
Q

What are the 2 forms of Inflammatory Bowl Disease?

A

Crohn’s Disease

Ulcerative Cholitis

34
Q

Where does Crohn’s disease common occur?

A

End of ileum (small intestine)

Cecum of large intestine

35
Q

What does stress do to people with Crohn’s disease?

A

Exacerbate symptoms

**NOT A CAUSE OF CHRON’S!

36
Q

In Crohn’s are women or men affected more?

A

Women

**usually family Hx (2-4x higher risk w/ first degree relative)

37
Q

Which layers of the intestinal wall are affected in Crohn’s disease?

A

All layers

**chronic granulomatous inflammation

38
Q

What is a granuloma?

A

Cluaster of cells that form in area of inflammation

39
Q

What are skip lesions?

A

2+ inflamed areas w/ healthy bowel in between

40
Q

What is the pharmaceutical treatment for Crohn’s Disease?

A

**Depends on severity

Anti–inflammatory drugs:
Salicylate (5-ASA) –> mild to
moderate
Corticosteroids –> mod. to severe
Infliximab

Immune Suppressors –> mod. to severe

Antibiotics –> fistulas and other infectous complications

41
Q

What are the indications for surgergy to treat Crohn’s disease?

A

Not responding to meds

To correct complications from dz

    - obstruction
    - perforation
    - abscess
42
Q

What are the surgical procedures done for Crohn’s disease?

A

Intestinal Resection –> small portion of the intestine is removed

Stricturoplasty –> done for chronic narrowing of intestine

Colostomy/ileostomy

43
Q

What are the complications of intestinal resection?

A

Adhesions/scarring –> create obstructions

44
Q

What is ulcerative cholitis?

A

Chronic inflammatory disease that affects the large intestine

45
Q

Which areas of the intestines are usually affected in ulcerative cholitis?

A

ALWAYS involves rectum

Extends proximally to contiguous sections of the colon

46
Q

Which layers of the intestine are affected w/ ulcerative cholitis?

A

Mucosa only (doesn’t penetrate deeper lyaers)

47
Q

What are the regional patterns of the large intestine seen with ulcerative colitis?

A

Ulcerative proctitis

Ulcerative proctosigmoiditis

Ulcerative pancolitis

48
Q

What are the Surgical procedures done for ulcerative cholitis?

A

Total colectomy and ileorectal anastamosis

Total proctocolectomy (Brooke ileostomy)

Ileal pouch anal anastomosis

49
Q

Describe the total colectomy and ileorectal anastamosis procedure

A

Colon removed except last 5 in from rectum

Small intestine/ileum is surgically joined to upper rectum

**pt has normal bowel function after procedure

50
Q

Describe the total proctocolectomy (Brooke ileostomy) procedure

A

Entire colorectal mucosa is excised

New rectum is made from small intestine and attached to anal canal

May have to make a stoma (opening to poop) until new rectum has healed

51
Q

What is diverticulosis?

A

Out pockets in the intestinal wall

**85% = asymptomatic
15% develop colicky symptoms

52
Q

Where is diverticulosis commonly found?

A

Sigmoid colon

53
Q

What happens to cause diverticulosis?

A

Vessel penetrates through weak colonic muscle wall

54
Q

What is the treatment for diverticulosis?

A

High fiber diet

Avoid high residue foods (seeds, nuts, corn)

55
Q

What is diverticulitis?

A

Inflammation of diverticuli (colonic diverticula)

56
Q

Which area of the intestines is most often involved w/ diverticulitis?

A

Sigmoid colon

57
Q

What happens with diverticulitis?

A

Impacted w/ fecal material (fecalith)

Colon perforations d/t inflammation

58
Q

What is simple diverticulitis?

A

Inflammation is contained in the intestinal wall

59
Q

What is complicated diverticulitis?

A

Inflammation penetrates into peritoneal space

60
Q

What do most colorectal cancers develop from?

A

Adenomatous polyp

**initial mutant cancer cell develops in polyp

61
Q

How fast does the cancer grow on the polyp and where does it grow towards?

A

Slow growth down stalk towards deeper layers of mucosa

62
Q

What happens is colorectal cancer penetrates into the submucosa?

A

Reach lymphatic/BV pathways and become highly malignant

63
Q

What is critical for the prevention of colorectal cancer?

A

Screening

Removal of polyps

64
Q

Which age population are the @ higher risk factors for colorectal cancer?

A

> 50 yo

65
Q

Which past medical history puts you at greater risk of colorectal cancer?

A

IBD

Adenomatous polyps > 5 mm

Gall bladder surgery (cholecystectomy)

Pelvic irradiation

66
Q

Which family history puts you at greater risk of colorectal cancer?

A

first degree relative w/ colorectal cancer

67
Q

What lifestyle risks are associated w/ colorectal cancer?

A

Tobacco abuse

Obesity (BMI > 35 - 40)

68
Q

What is the screening tool of choice for colorectal cancer?

A

Colonoscopy

69
Q

How often should average risk patients > 50 yo be screened for colorectal cancer?

A

Colonoscopy every 10 yrs

Digital rectal exam and fecal occult blood every year

**higher risk pts should be screened more frequently

70
Q

What are the different types of hepatitis?

A

A

B

C

D

E

G

71
Q

What is the pathophys of hepatitis?

A

Hepatic cell death/scarring

Kupffer cell hyperplasia

Inflammation may disrupt canaliculi

72
Q

Which types of viral hepatitis has more severe hepatic cell damage?

A

B

C

73
Q

What is fulminating hepatitis?

A

Rare complication in which massive hepatic cell death and liver failure occur

**rapid/severe onset

74
Q

What is cirrhosis?

A

Irreversible inflammatory condition –> hepatic cell death causes diffuse scarring of the liver

75
Q

What is the general pathophysiology of cirrhosis?

A

Hepatic tissue becomes nodular/fibrotic

Size of liver may expand or shrink

76
Q

What is the initial phase of alcoholic cirrhosis?

A

Fatty accumulation develops w/ in hepatocytes

77
Q

What is produced by the metabolism of alcohol which disrupts hepatocyte function/metabolism?

A

Acetaldehyde

78
Q

What does the damage from the acetaldehyde do in the liver?

A

Initiates inflammatory response/necrosis

Promotes excessive collagen synthesis and fibrotic accumulation/scarring

79
Q

What does the fibrosis eventually do in the liver during cirrhosis?

A

Alter biliary and vascular drainage

Liver function declines

Portal HTN

GI Bleeding

Varicose Veins

Ascities

Hepatomegaly

Spleenomegaly

80
Q

What is primary biliary cirrhosis?

A

Autoimmune disease that attacks small intrahepatic bile ducts (canaliculi)

81
Q

What is secondary biliary cirrhosis?

A

Develops as result of chronic obstruction of biliary flow –> inflammation –> fibrotic changes

Patho Summer Test #1 (8 decks)

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