Gastrointestinal System Flashcards
1
Q
diseases of the GI tract can be classified as:
A
- developmental disorders
- inflammatory diseases
- functional disorders
- circulatory disturbances
- neoplastic diseases
2
Q
what are the pathologies of the esophagus
A
- hiatial hernia
- reflux esophagus
- achalasia
- esophageal varices
3
Q
what are the conditions of the stomach
A
- acute gastritis
- chronic gastritis
- peptic ulcer disease
- stomach cancer
4
Q
what are the conditions f the small intenstine
A
- meckel diverticulum
- bowel obstruction
- herniation
- adhesions
- intussesception
- volvulus
- adenocarcinoma
- carcinoid tumor
5
Q
what are the conditions of the large intestine
A
- pseudomembranenous colitis
- diverticulosis
- chron disease
- ulcerative colitis
- adenomatous polyps
- colon cancer
6
Q
what are the layers of the GI system
A
- mucosa
- submucosa
- muscularis
7
Q
what makes up the mucosa in the GI system
A
- epithelium
- lamina propria
- muscularis mucosa
8
Q
what are the types of muscularic propria
A
- circumferential
- longitudinal
9
Q
what is dysphagia
A
difficulty swallowing
10
Q
what is hematesis
A
vomiting of fresh red blood
11
Q
what is hematochezia
A
bright red blood in stool
12
Q
what is melena
A
balck tarry feces
13
Q
what is diarrhea
A
frequent, loose, watery bowel movements
14
Q
what is constipation
A
hard feces that are difficult to eliminate
15
Q
what is odynophagia
A
painful swallowing
16
Q
what is gastroenterology
A
a subspecialty of internal medicien
17
Q
what is esophagogastroduodenoscopy
A
upper GI endoscopy
18
Q
what is a colonoscopy
A
lower GI endoscopy
19
Q
what is odynophagia
A
pain on swallowing
20
Q
what is heartburn
A
a burning behind the sternum - GERD
21
Q
what are clinical symptoms and signs of esophageal disease
A
dysphagia
- odynophagia
- heartburn
- acid regurgitation into mouth
22
Q
what is achalasia
A
- a functional motor disorder
- dysfunction of ganglion cells of myenteric plexus (auerbach plexus) prevents proper relaxation of lower esophageal sphincter- a motility disorder
23
Q
what are the symptoms in achalasia
A
- dysphagia
- regurgitation
- halitosis
- proximal dilation
24
Q
describe plummer- vinson symdrom (paterson- kelly syndrome)
A
- scandanavian , norther european women
- severe iron deficiency anemia
- mucosal atrophy - atrophic glossitis
- esophageal webs- dysphagia
- increased risk for squamous cell carcinoma in esophagus, oropharynx and posterior oral cavity
25
what are esophageal varies caused by
portal hypertension produced venous dilation
26
describe rupture of esophageal varices
- rupture leads to hematesis and massive upper GI bleed
- rupture of a varix is associated with high mortality
- rupture of a varix accounts for half of the deaths in advanced cirrhosis
27
what are mallory weiss syndrome seen in and what is it
- seen in chronic alcoholics, where violent retching causes esophageal lacerations and hemorrhage
28
what is a hiatal hernia
- diaphragmatic hernia- widended diaphragmatic hiatus allows protrusion of the stomach through the diaphragm
- gastroesophageal junction pulled into thorax
29
what is barrett esophagus
- gastric metaplasia of lower esophageal mucosa- columnar epithelium replaces stratified squamous epithelium
- odynophagia, ulceration and hemorrhage
- risk of developing adenocarcinoma
30
describe esophageal canccer
- squamous cell carcinoma
- adenocarcinoma- barret esophagus
- dysphagia due to narrowing of lumen or interference with peristalsis
31
describe esophageal squamous cell carcinoma
- older adults, geographical variation, poor prognosis
- most common world wide but adenocarcinoma of esophagus is more common in US
- most common in middle third
- alcohol and tobacco, plummer vinson syndrome, diet influence incidence
32
describe esophageal adenocarcinoma
- lower segment
- barrett esophagus is a risk factor
- more common than squamous carcinoma in US
33
what are the epithelial cells of the stomach and what do they do and where are they found
- mucous cells- secrete mucous, in cardia
- parietal cells- located in body, secretes hydrochloric acid, and intrinsic factor
- chief cells- located in body, pepsin
- endocrine cells- G cells- gastrin
34
describe gastritis
-inflammation of the gastric mucosa
- acute gastritis- erosive, due to irritants and NSAIDSs
- chronic gastritis- erosive or non erosive- infectious or autoimmune
35
describe acute erosive gastritis
- epigastric burning, pain , nausea , vomiting
- shallow erosions
- aspirin, NSAIDs, alcohol, stress, shock , sepsis
- one of the major causes of hematemesis in alcoholics
36
describe chornic gastritis
- infectious- the most common form of chronic gastritis is due to infection by helicobacter pyloris
- autoimmune- autoantibodies directed against parietal cells
37
what do H pyloris cause
- peptic ulcer disease
- adenocarcinoma
- MALT lymphoma
38
describe H pylori
- gram negative s-shaped rods
- biopsy and silver stain
- urea breath test
- antibody test for H pylori
39
describe autoimmune gastritis
- autoantibodies against gastric parietal cells
- gastric mucosal atrophy
- no IF, low serum vitamin B12, pernicious anemia
40
describe gastric stress ulcers
- deeper than erosions may extend to muscularis
- severe stress- ICU patietns - shock, trauma, burns, sepsis
41
describe peptic ulcer ddisease
most peptic ulcers are generally solitary lesions
- most occur in the duodenum - 98% are located in duodenum or stomach
42
what are characteristics of peptic ulcers
- sharply demarcated ulcer with a clean, smooth base
- chronic lesions may exhibit puckering due to fibrosis
43
what is the clinical course pf peptic ulcer disease
- acute/chronic blood loss
- nausea, vomiting, hematemesis, melena
- perforation- major cause of death in PUD
44
what does immediate pain in peptic ulcer mean
gastric ulcer
45
what does delayed pain in peptic ulcer mean
duodenal ulcer
46
what is etiology of peptic ulcers
- mutlifactorial disease, decreased mucosal resistance
- infection by H pyloris
- drugs- aspiriin - NSAIDs
- neuroendocrine- hormonal hypersecretion syndromes
- cushing syndromes- corticosteroids
- zollinger ellision syndrome- gastrin
47
what are the complications of peptic ulcer disaese
- minor hemorrhage- melena, iron defiency, anemia
- major hemorrhage- hematemesis
- perforation- peritonitis
- stenosis and obstruciton
- penetration into pancreas
48
describe zollinger ellison syndrom
- gastrin secretion tumor in pancreas of duodenum ( gastrinoma
- hypergastrinemia causes hypersecretion of gastric acid
- severe peptic ulcer disease with multiple ulcers in unusual locations
49
describe gastric adenocarcinoma
- older individuals- poor prognosis
- smoked fish - nitrosamines
- predisposition to gastric cancer
- h. pylori infection
- chronic atrophic gastritis
- gastric adenomatous polyps
- less curve of antro- pyloric region
50
what are the types of gastric adenocarcinoma and describe each
- intestinal type- bulky tumors composed of glandular structures
- diffuse type- infiltrative growth of poorly differentiated cells (linitis plastica)
51
what is a krukenberg tumor
- metastatic adenocarcinoma to ovaries
- bilateral ovarial metastases
- frequently of gastric origin- mucus producing cells
52
describe gastrointestinal tract lymphoma
- non- hodgkin lymphoma
- primary lymphomas- MALT-omas and other NHLs
- secondary lymphomas- extranodal spread
53
what is a gastric MALT lymphoma
- stomach- most common site for extranodal lymphomas
- MALT lymphomas- B cell lymphomas of mucosa associated lymphoid tissue
- associated with helicobacter pylori infection - may regress with H pylori treatment
54
describe meckel diverticulum
- developmental defect of ileum- a blind pouch containing all layers
- left- sides appendix- may produce symptoms similar to appendicitis
55
what are the types of bowel obstruction
- herniation
- intussuscpetion
- adhesions
- volvulus
56
what are herniations
weakness in peritoneum
57
where can herniations occur
- inguinal
- femoral
- umbilicus
- -incisional
58
what are adhesions
- fibrotic bridges of peritoneum
- may trap and link bowel segments
- they are usually sequelae of prior surgery or infection
59
what is intussusception
- small intestine invaginates into itself- intussusceptum becomes necrosis unless everted
- small pedunculated tumors carries by peristalsis may pull forward the loop to which it is attached
60
what is volvulus
- rotation of a loop of intestine about its own mesenteric root
- most common in small intestine and sigmoid colon
- volvulus undergoes necrosis
61
what is the prevalence of adenocarcinoma of small intestine
rare
62
describe carcinoid tumor
- a low grade malignancy of neuroendocrine cells, appearing as mucosal nodules
- may occur throughout gastrointestinal tract but are most common in appendix
- may produce hormones such as serotonin
63
describe carcinoid syndrom
- caused by a serotonin- producing carcinoid tumor that is asymptomatic until metastasis to the liver
- the serotonin that is no longer metabolized by the liver causes cramping, diarrhea, flushing and bronchospasm
64
describe the colon
- enteric nervous system- myenteric (auerbach) and submucosal plexus (Meissner)
- colonized by non pathogenic strains of bacteria
65
what is hirschprung disease- congenital megacolon
- developmental defect of enteric nervous system- agangliosis of terminal colon (myenteric plexus)
- chronic constipation proximal dilation
- resection of aganlionic segment
66
what is the characteristic histology of the large intestine
crypts
67
what is the characteristic histology of the small intestine
villi
68
what is diverticulosis
- consist of out- pouchings of mucosa and submucosa through muscular layer of colon
- associate with a low bulk diet, straining during defecation
- may become inflamed- diverticultis
69
what are the types of intestinal polyps and describe each
- neoplastic polyps (adematous polyps, adenomas): tubular adenoma and villous adenoma
- non-neoplastic polyps: hyperplastic polyp- most common
- hamartomatous polyp- Peutz- Jeghers Syndrome
70
describe hyperplastic polyp
- non-neoplastic hyperplasia of epithelium, most common
- not pre- malignant
71
describe hamartomatous polyp
- large- pedunculated polyp, consisting of all layers of the. mucosa
- may be associated with peutz- jeghers syndrome
- risk for intussusception
- no malignant change
72
describe Peutz- Jegher Syndrome
- autosomal dominant
- pigmented. macules of oral mucosa and perioral skin
- hamartomatous polyps of bowerl
- increased risk for adenocarcinoma outside GI tract- pancreas, breast, lung, ovary, uterus
73
describe adematous polyps- adenomas- neoplastic polyps
- tubular adenomas- tubular glands, frequently pedunculated
- villous adenomas- villous projections, frequently sessile
74
describe a tubular adenoma
- most common neoplastic polyp
- less than 5% malignant transformatino
- endoscopic polypectomy curative
75
describe villous adenoma
- least common neoplastic pulp
- 50% malignant transformation
- endoscopic removal often not possible
76
describe colonic adenocarcinoma
- third most common cause of cancer death - lung, breast/prostate, colon
- older adults, unless predisposing condition (ulcerative colitis, hereditary colon cancer syndrome, gardner syndrome)
- dietary risk factors- high caloric intake, high fat, red meat, high refined carbohydrates, low fiber
77
adenoma carcinoma sequence:
- normal colon -> mucosa at risk -> adenomas -> carcnoma
78
in adenoma carcinomas there are accumulation os mutations in:
tumor supressor genes and proto oncogenes
79
describe colonic adenocarcinoma
- sigmoid colon most common site
- left side- circumferential, napking- ring lesion producing narrowing of lumen
- right side- exophystic, polypoid, crater- like ulcerations with rolled borders
80
what is the most prognostic indicator for colon cancer
stage
81
what is hereditary colonic cancer syndromes
- autsomal dominant
- familial adenomatous polyposis cali (FAP) - multiple tubular adenomas, 100% malignant transformation
- gardner syndrome- a variant of FAP with multiple supernumerary teeth, jaw bone densities, mulitple osteomas, fibromatosis, epidermal inclusion cysts
- hereditary non polyposis colorectal cancer (HNPCC)- colonic cancer unrealted to adenomas: increased risk of endometrial and ovarian cancers
82
describe IBS
- two chronic relapsing inflammatory disorders of unknwon etiology
- crohn disease
- ulcerative colitis
- exaggerated and unregulated local immune response in genetically susceptable individuals
83
describe chron disease
-any level of GI tract, outh to anus, most often distal ileum and colon
- transmural inflammation, thickened intestinal wall
- sarcoid like non- caseating granulomas
- pain, diarrhea, fissure and fistula formation
84
what is a fistula
an abnormal channel between hollow orgnas or between a hollow organ and the skin surface
85
what are oral manifestations of crohn disease
- apthous like lesions
- granulomatous nodules
- malabsorption vitamin K dependent clotting factor deficiency, bleeding diathesis
86
describe ulcerative colitis
- chronic inflammatory disease with increased risk of malignancy
- thinning of intestinal wall, limited to colon and rectum
- relapsing diarrhea and pain
87
where is inflammation limited to in ulcerative colitis
mucosa- not transmural
88
what are crypt abscesses and what disease are they seen with
- accumulation of neutrophils within colinic crypts are signs of active inflammation
- ulcerative colitis
89
what are pseudopolyps and what disease are these seen with
remnants of colonic mucosa surrounded by ulceration
90
what is pyostomatitis vegetans
- oral lesions of ulcerative colitis
- small, yellow superficial pustules
91
what are the differences between crohn disease and ulcerative colitis
- crohn disease skips lesions
- ulcerative colitis is continuous colinic involvement beginning in rectum
92
what is the region of crohn disease? ulcerative colitis?
- ileum and colon
- colon only
93
what is the wall of crohn disease? ulcerative colitis?
- thickened
- thin
94
what is the inflammation of crohn disease? ulcerative colitis?
- transmural
- mucosa
95
what is the ulcers of crohn disease? ulcerative colitis?
- deep, linear
- superficial
96
what is the granulomas of crohn disease? ulcerative colitis?
- yes
- no
97
are there fistulae in crohn disease? ulcerative colitis?
- yes
- no
98
is there malabsorption in crohn disease? ulcerative colitis?
- yes
- no
99
is there malignant risk in crohn disease? ulcerative colitis?
- low
- high
100
describe appendicitis
- an acute bacterial infection of appendix
- complications may include rupture and peritonitis
101
what are the types of appendicits- obstruction of lumen
- fecalith- inspissated fecal material
- reactive lymphoid hyperplasia- resopnse to viral infection
- neoplasm- carcinoid tumor
102
describe acute appendicitis
- acute inflamamtion, mucosal ulceration
- transmural inflammation
- serositis
- peritonitis
- right lower quadrant pain, rebound tenderness
- leukocytosis, fever, nausea, vomiting
103
what are hemorrhoids
- varicose dilation of hemorroidal venous plexus at anorectal junction
- increased venous pressure may be associated with pregnancy, chronic constipation, portal HTN
104
