GI Flashcards
Foregut structures and blood supply
Week 3 of development
Top portion supplied by celiac artery, gives rise to liver, gallbladder, pancreas, esophagus, stomach, duodenum, spleen
What structures are in Midgut and what is the blood supply?
Supplied by superior mesenteric artery and vitelline duct
3rd & 4th sections of duodenum, jejunum, ileum, cecum, appendix, ascending colon, and proximal 2/3 of transverse colon
Physiologic herniation through umbilical ring
Hindgut
Distal 1/3 transverse colon, descending colon, sigmoid colon, and upper part of anal canal
Microscopic anatomy of gallbladder (inside to outside)
Mucosa contains epithelium (simple columnar cells, highly folded) and lamina propria (dense irregular connective tissue, immune cells, and capillaries)
Tunica muscularis (bundles of smooth muscle randomly oriented
External adventitia connects to the liver and is dense irregular connective tissue
External serosa not attached to liver and made up of loose irregular connective tissue w/ lymphatic vessels, blood vessels, adipocytes, and mesothelium on outside
Microscopic anatomy of esophagus (inside to outside)
Mucosa: Epithelium (stratified squamous non-keratinized cells), Lamina propria (dense irregular connective tissue, and Muscularis mucosa (longitudinal smooth muscle)
Submucosa: dense collagenous connective tissue w/ elastin, blood vessels, lymphatic vessels, nerves, and mucosal glands in lower 1/3
Muscularis Propria: inner circular layer and outer longitudinal layer of muscle, 1/3 upper skeletal, middle 1/3 skeletal & SM, Auerbach plexus
Adventitia: connective tissue attach nearby structure
Serosa: last 1-2 cm simple squamous epithelium
Stomach microscopic anatomy
Cardia:
Mucosa: simple columnar epithelium that form gastric pits w/ cardiac glands secrete mucus and muscularis mucosa consisting of thin layer of SM
Submucosa: dense irregular CT
Muscularis propria: 3 layers of S muscle inner oblique, circular, and longitudinal
Serosa: loose connective tissue
Fundus:
Mucosa: rugae w/ parietal cells (isthmus, secrete gastric acid and Intrinsic factor), mucous neck cells, chief cells (secrete pepsinogen found in base), and G cells that secrete gastrin)
Submucosa: dense irregular CT
Muscularis propria: 3 layers of S muscle inner oblique, circular, and longitudinal
Serosa: loose connective tissue
Pylorus:
Mucosa: gastric pits 1/2, pyloric glands secrete mucus are shorter, small number G, parietal, and stem cells
Submucosa: dense irregular CT
Muscularis propria: 3 layers of S muscle inner oblique, circular, and longitudinal
Serosa: loose connective tissue
Small Intestine microscopic anatomy
All share submucosa (dense irregular CT, meissner’s plexus), muscularis propria (circular, myenteric plexus, and longitudinal), and serosa (loose connective tissue)
Duodenum
Mucosa: long tall villi, enterocytes (simple columnar cells w/ microvilli and goblet cells that secrete mucus), lamina propria (loose connective tissue), crypts of Lieberkuhn (stem cells -> epithelial cells, paneth cells prevent against pathogens), muscularis mucosa
Submucosa: burnner’s glands secrete alkaline mucus
Jejunum
Mucosa: same as duodenum
Ileum
Mucosa: short broader villi, Peyer’s patches within lamina propria, lacteals w/in cores of villi that absorb fat,
Colon Microscopic Anatomy
Mucosa: epithelium (enterocytes simple columnar cells w/ microvilli that absorb water and goblet cells secret mucus), lamina propria (plasma cells, lymphocytes, eosinophils, macrophages), crypts of Lieberkuhn, and muscularis mucosa
Submucosa: dense irregular connective tissue, meissner’s plexus, lymphatic vessels, and blood vessels
Muscularis propria: circular, myenteric plexus, longitudinal, tinea coli
Serosa
Liver Microscopic Anatomy
HEPATOCYTES: Perform metabolic, synthetic, storage, catabolic and excretory functions. Apical surface of hepatocytes face bile canaliculi. Basolateral surface faces sinusoids.
KUPFFER CELLS: Macrophages, form the lining of sinusoids.. Protect against infection and circulating toxins (e.g., endotoxin), but with higher efficiency. Activated Kupffer cells also release cytokines, such as TNF-α, interleukins, interferons and TGFs α and β
STELLATE CELLS: (Ito cells) have specialized storage capacities. Contain fat, vitamin A and other lipid-soluble vitamins. Secrete extracellular matrix components, including collagens, laminin and proteoglycans. In disease states, can make in great excess, leading to hepatic fibrosis and eventually cirrhosis.
Pancreas Microscopic Anatomy
Exocrine: Acini contain secretory cells (pyramid-shaped with rough ER at base and zymogens at apices), centroacinar cell, intercalated duct (simple cuboidal epithelium)
Intralobular duct: stratified cuboidal cells and thicken connective tissue
capsule
Intralobular duct: epithelium that could be simple columnar, stratified columnar, or stratified cuboidal and large CT
Interlobular ducts: epithelium (simple columnar cells, or stratified columnar, or stratified cuboidal) connective tissue
Endocrine: islets of Langerhans (fenestrated capillaries, beta cells, alpha cells, delta cells, and pp cells)
Mastication (mechanism, regulation, and factors)
Mechanism: Food gets broken down via masseter, temporalis, medial pterygoid, and lateral pterygoid. Salivary glands secrete saliva that contains salivary amylase, mineral salts, and mucus. Tongue moves side to side pushing between teeth for extra grinding.
Factors: food in mouth, sight of food
Deglutination (mechanism)
Mechanism: Starts with voluntary movement of the tongue pushing bolus to oropharynx then mechanoreceptors, thermoreceptors, and taste receptors in upper esophagus detect food -> sensory info via trigeminal, glossopharyngeal, and vagus nerve to the medulla -> motor info via vagus->
soft palate and uvula moves up -> epiglottis covers larynx -> upper esophageal sphincter relaxes-> upper esophageal sphincter closes-> vagus -> peristalsis -> lower esophageal sphincter relaxes
Salivary gland (embryology, location, function, innervation, circulation)
Embro: ectoderm
Location:
Parotid- below external acoustic meatus/zygomatic arch, behind masseter, in front of SCM, along angle of mandible, contain facial nerve, retromandibular vein, external carotid artery, superficial temporal artery, facial nerve, parotid duct
Submandibular gland- posterior half of mandible, inferior/deep to body of mandible and superficial/deep to mylohyoid muscle
Function: secrete saliva, keep mouth mucosa hydrated, makes swallowing easier, digestion of starch
Innervation: parasympathetic via glossopharyngeal nerve, sympathetic via superior cervical ganglion
Esophagus (innervation, circulatory pathway,)
Innervation: parasympathetic control peristalsis via vagus nerve, sympathetic vis sympathetic trunk from greater splanchnic nerve T5 to T9
Circulatory pathway: inferior thyroid arteries/vein, thoracic aorta/left gastric vein/esophageal veins, left gastric artery
Pharynx (embryo, circulatory pathway, innervation)
Embryo: pharyngeal pouch
Circulatory: facial artery, maxillary artery, inferior thyroid artery, and superior thyroid artery
Innervation: pharyngeal plexus, pharyngeal branch of vagus nerve, glossopharyngeal
Liver (circulatory pathway and innervation)
Circulatory: hepatic artery and hepatic portal vein
Innervation: hepatic nervous plexus, sympathetic celiac plexus, and parasympathetic from vagal trunk
Pancreas ( circulatory pathway and innervation)
Circulatory: (head and uncinate) superior pancreaticoduodenal artery, inferior pancreaticoduodenal artery, and pancreatic artery (body and tail)
Innervation: parasympathetic vagus, sympathetic greater and lesser splanchnic nerves (T5-T12)
Mastication regulation
Regulation: muscles are innervated by trigeminal nerve, salivary glands are innervated by glossopharyngeal and facial nerve via parasympathetic activation, mechanoreceptors in periodontal ligaments, taste receptors on tongue, salivatory nuclei in brainstem
Mastication factors
Factors: food in mouth, sight of food
Deglutination regulation
Regulation: swallowing center in medulla via vagus and glossopharyngeal
Pancreas function
endocrine: regulate blood sugar levels,
exocrine: pancreatic amylase to breakdown carbs, trypsin & chymotrypsin breakdown proteins, and lipase breakdown lipids, ductal cells secrete NaK and ClHCO3
Liver function
detoxify harmful substances, normal blood glucose level, store Vit A, D, E, K, B12, iron, copper, remove amine group from amino acids, albumin, coagulation factors, regulate lipid metabolism, make VLDL, HDL,), bile synthesis
Pharynx (Micro anatomy)
buccopharyngeal fascia, muscular layer (circular and longitudinal part
Pharynx (location)
cranial base to the inferior border of the cricoid cartilage anteriorly and the inferior border of the C6 vertebra posteriorly
Pharynx (function)
carries air, carries food and fluid for throat
Gallbladder (circulatory pathway and innervation)
Circulatory: cystic artery, segmental portal veins
Innervation: hepatic plexus, vagus nerve
Gallbladder function
reservoir for bile
Stomach innervation, artery, vein
Nerve: parasympathetic from anterior vagal trunk and posterior vagal trunk, sympathetic celiac plexus (T5-T12)
Artery: gastric arteries, gastroomental artery, posterior gastric arteries, gastroduodenal artery
Vein: gastric vein, gastroomental vein, posterior gastric vein, and gastroduodenal vein
Stomach function
chemical and mechanical digestion of ingested food
Duodenum nerve, artery, vein
Nerve: sympathetic greater splanchnic and parasympathetic vagus nerve
Artery: gastroduodenal artery, anterior/posterior/inferior pancreaticoduodenal artery
Vein: duodenal vein
Duodenum Function
dilute and neutralise digestive juices, digest and process chyme passed on from the stomach, receive pancreatic enzymes and bile, as well as absorb various nutrients
Jejunum function
digestion of nutrient
absorption of lipophilic nutrients and water
Ileum nerve, artery, vein
Nerve: coeliac plexus, superior mesenteric plexus, vagus nerve
Artery: straight arteries
Vein: superior mesenteric
Ileum function
Enzymatic digestion of nutrient
absorption of vitamin B12, fats, and bile salts
immunological function
Colon nerve, artery, vein
Nerve: superior mesenteric plexus, vagus nerve, inferior mesenteric plexus, pelvic splanchnic nerve
Artery; colic and sigmoid arteries
Rectum micro anatomy
Mucosa: simple columnar enterocytes, goblet cells, and turns into transitional zone stratified squamous non-keratinized
Lamina propria: CT, blood, lymph, muscle layer
Submucosa: loose CT, blood vessels, lymph follicles, meissner’s plexus,
Muscularis: circular extends to sphincter ani externus muscle, longitudinal muscle etends to corrugator cutis ani muscle, Auerbach’s plexus,
Rectum nerve, artery, vein
Nerve: symp inferior mesenteric plexus and para pelvic splanchnic nerve and inferior hypogastric plexs
Artery: superior, middle, inferior rectal arteries
Vein: superior, inferior, middle rectal veins
Rectum function
absorption of water and electrolytes and feces storage
Anus micro anatomy
Colorectal: simple columnar epithelium, folds
Transitional: simple columnar epithelium and stratified squamous epithelium, crypts of Morgagni, anal glands
Anoderm: stratified squamous non-keratinized epithelium, sensory neurons
Cutaneous: stratified squamous keratinized epithelium, pigmented, sweat glands, sebaceous glands, Pacinian corpuscles, and hair follicles
Anus nerve, artery, vein
Nerve: above dentate line (symp inferior mesenteric plexus, para pelvic splanchnic nerve and inferior hypogastric plexus) below ( pudendal)
Artery: above dentate line (superior rectal artery) below (middle/inferior rectal arteries)
Vein: above dentate line (superior rectal vein) below (middle and inferior rectal viens)
Anus function
absorption of water and electrolytes and defecation
Colon Function
absorption of water from stool
absorbs Na, K, Cl
secrets K
intestinal flora: decomposing indigestible foods, producing Vit K, promoting intestinal peristalsis, supporting immune
Intraperitoneal Organs
Stomach, 1st part of duodenum, jejunum, ileum, cecum, appendix, transverse colon, sigmoid colon, liver, gallbladder, tail of pancreas, spleen
Retroperitoneal Organs
Suprarenal (adrenal) glands Aorta, IVC Duodenum Pancreas Ureters Colon Kidney Esophagus (lower 2/3) Rectum SAD PUCKER
Retroperitoneal Organs
Suprarenal (adrenal) glands Aorta, IVC Duodenum Pancreas Ureters Colon Kidney Esophagus (lower 2/3) Rectum SAD PUCKER
Gastrin (source)
Source: G Cells in antrum of stomach, duodenum
Gastrin Action
↑ Gastric H+ secretion
↑ Growth of gastric mucosa
↑ Gastric motility
Stimulates the release of histamine from enterochromaffin-like cells
Stimulates H+ and gastric mucosa (gastric motility)
Gastrin Regulation
↑ By stomach distention/alkalinization, amino acids, peptides, vagal stimulation via gastrin-releasing peptide (GRP)
↓ pH < 1.5
Somatostatin source
D Cells
Pancreatic islets, GI mucosa
Somatostatin action
↓ Gastric acid secretion ↓ Pepsinogen secretion ↓ Pancreatic secretion ↓ Small intestine fluid secretion ↓ Gallbladder contraction ↓ Insulin + glucagon release
Somatostatin regulation
↑ By acid
↓ By vagal stimulation
Cholecystokinin source
I Cells
Duodenum, jejunum
Cholecystokinin action
↑ Pancreatic secretion
↑ Gallbladder contraction
↓ Gastric emptying
↑ Sphincter of Oddi relaxation (leading to release of pancreatic enzymes + bicarbonate)
Cholecystokinin regulation
↑ By fatty acids, amino acids
Acts on neural muscarinic pathways to cause pancreatic secretion
Secretin source
S Cells
Duodenum
Secretin Action
↑ Pancreatic HCO3- secretion
↓ Gastric H+ secretion
↑ Bile acid secretion in liver
pancreatic enzymes to function
Secretin Regulation
↑ By acid, fatty acids in lumen of duodenum
low pH of food mixture from the stomach
Glucose-dependent insulinotropic peptide S
K Cells
Duodenum, jejunum
Glucose-dependent insulinotropic peptide A
Exocrine:
↓ Gastric H+ secretion
Endocrine:
↑ Insulin release
Glucose-dependent insulinotropic peptide R
↑ By fatty acids, amino acids, oral glucose
Motilin Source
Small intestine
Motilin Action
Produces migrating motor complexes (MMCs)
Motilin Reg
↑ In fasting state
Vasoactive intestinal polypeptide Source
Parasympathetic ganglia in sphincters, gallbladder, small intestine
Vasoactive intestinal polypeptide action
↑ Insteinal water and electrolyte secretion
↑ Relaxation of intestinal smooth muscle and sphincters
Vasoactive intestinal polypeptide reg
↑ By distention and vagal stimulation
↓ By adrenergic input
Nitric Oxide source
smooth muscle relaxing and vasodilation
Nitric Oxide A
↑ Smooth muscle relaxation, including lower esophageal sphincter (LES)
Pathology associated with Vasoactive intestinal polypeptide
VIPoma (non-a, non-B islet cell pancreatic tumor that secretes VIP) Associated with Watery Diarrhea, Hypokalemia, Achlorhydria (WDHA syndrome)
What pathology is associated with Gastrin?
↑ Chronic PPI use
↑ In chronic atrophic gastritis (eg, H. pylori)
↑↑ In Zollinger-Ellison syndrome (gastrinoma)
Ghrelin S
Stomach
Ghrelin A
↑ Appetite (“ghrowlin’ stomach”)
Ghrelin R
↑ In fasting state
↓ By food
Ghrelin Patho associated
↑ In Prader-Willi syndrome
↓ After gastric bypass surgery
Intrinsic Factor S
Parietal cells
Stomach
Intrinsic Factor A
Vit B12 binding protein
Required for B12 uptake in terminal ileum
Intrinsic Factor patho
Autoimmune destruction of parietal cells > Chronic gastritis + pernicious anemia
Gastric Acid S
Parietal cells
Stomach
Gastric Acid A
↓ Stomach pH
Gastric Acid R
↑ By histamine
↑ Vagal stimulation (ACh)
↑ Gastrin
↓ By somatostatin
↓ GIP
↓ Prostaglandin
↓ Secretin
Pepsin S
Chief cells
Stomach
pepsinogen to pepsin
Pepsin A
Protein digestion
Pepsin R
↑ By vagal stimulation (ACh)
↑ Local acid
triggered by presence of H
Bicarbonate S
Mucosal cells - Stomach, duodenum, salivary glands, pancreas, trapped in mucus that covers the gastric epithelium
Brunner glands - Duodenum
Bicarbonate A
Neutralizes acid
Bicarbonate R
↑ By pancreatic and biliary secretion with secretin
Gluconeogenesis
Rate limiting: fructose-1,6-bisphosphate 1 Start: pyruvate End: glucose Cofactors: biotin, ATP, GTP, Mg, NADH, Location: Mitochondria, cytosol,
Beta-oxidation
Rate limiting: carnitine acyltransferase 1 Location: mitochondria Start: fatty acid End: acetyl CoA Cofactors: FAD, NAD
Lipid digestion
Fatty acids form globule gets turned in the stomach -> bile salts from liver break up globule -> lipase in saliva, stomach, and pancreas break down into monoglycerides and free fatty acids -> assemble into mixed micelles -> travel to intestinal lumen to enterocytes -> release fatty acids in enterocytes-. resemble into triglycerides -> package into chylomicron (phospholipids, protein, triglyceride, cholesterol, Vit A, D, E,K) -> enters lacteal -> thoracic duct -> dumped into blood -> release fatty acids and monoglycerides into muscle, adipose
Protein digestion
Protein reaches stomach-> HCl denatures protein, pepsin cleaves into oligopeptide chains -> move into duodenum where digestive enzyme from pancreas stimulated by CCK break them into tripeptides, dipeptides, and individual amino acids -> peptidases attach them to external surface -> intestine cells di & tri get converted into amino acids -> can be transported via specific transporter -> blood stream to tissues
Fat Soluble Vitamin digestion
Location: small intestine
incorporated into micelles along w/ products of lipid digestion and absorbed into enterocytes
Protein Structure
Chain of amino acids (central C, amino group, carboxylic acid group, and side chain) -> folded and then different changes might be added
Carb Structure
Glucose: 6 carbon, one double bound w/ O, 6 O molecules Fructose: 6 carbon, Galactose: 6 carbon Lactose: glucose +galactose beta 1-4 Sucrose: fructose+ glucose alpha 1-2 Maltose: glucose+ glucose alpha 1-4 monosaccharide: one sugar di/oligo/poly-Saccharide: when they linked together via glyosidic bonds Starches: oligosaccharide w/ branches
Lipid Structure
glycerol (3 carbon backbone) and fatty acid (chain carbon and hydrogen)
Large polysaccharides digestion
Amylase breaks down large polysaccharides into small units in mouth and duodenum
Lactose digestion
Lactase breaks β-1,4-glycosidic bond between galactose and glucose
Sucrose digestion
Sucrase breaks down into fructose and glucose
Fructose -> 2 3 carbon-> glycolysis
glucose move into blood-> ↑ insulin -> ↑ glucose into tissues -> glycogen or use
Maltase digestion
Malatse breaks down into glucose x2
Glucose move into blood-> ↑ insulin -> ↑ glucose into tissues -> glycogen or use
How much carbs do you need in diet?
45-65 % calories
Unsaturated Fatty acid
single bond, only H, straight line, can pack down, solid at room temp
Saturated Fatty acid
double bond, don’t pack, liquid at room temp
Triglyceride structure
3 sets of glycerol and fatty acid
How many carbons do short chain fatty acids
2-5 carbons
How many carbons in medium chain fatty acids
6-12 carbons
How many carbons in long chain fatty acids
> 13
Which amino acids are nonessential?
alanine, asparagine, aspartic acid, glutamic acid, serine
Which amino acids are conditionally essential?
arginine, cysteine, glutamine, glycine, proline, tyrosine
Which amino acids are essential?
PVT TIM Hall
histidine, isoleucine, leucine, methionine, phenylamine, threonine, tryptophan, valine
How much protein do adults need?
0.8 g/kg of body weight
Water-Soluble Vitamins Digestion
Location: ileum
cotransport w/ sodium
B12 digestion
ingestion -> stomach acidity releases B12 from food -> free B12 binds to haptocorrin (R protein) secreted by salivary glands -> pancreatic proteases degrade R protein in duodenum -> B12 binds to intrinsic factor -> intrinsic factor B12 complex resistant to degradation from pancreatic enzymes -> absorbed in ileum
Iron absorption
Location: Small intestine
ferric -> reduced to ferrous -> binds to apoferritin in enterocytes -> transported across basolateral membrane -> binds to transferrin in blood -> transferrin carries to liver
Calcium Absorption
cholecalciferol -> 25-hydroxycholecalciferol in liver -> 1,25-dihydroxycholecaliferol in kidney -> synthesizes calbindin D-28K -> promote calcium absorption in ileum and duodenum
Bilirubin Metabolism
RBC -> macrophage eat RBC -> breakdown hemaglobin into heme and globin -> heme converted into iron and protoporphyrin -> protoporphyrin converted into unconjugated bilirubin -> unconjugated bilirubin + albumin go to liver -> hepatocytes take it in and conjugate via UGT w/ glucuronic acid -> sent to gallbladder for storage as bile
Gastroschisis
extrusion of abdominal contents through abdominal wall defect, guts not covered by peritoneum or amnion
Omphalocele
herniation of abdominal contents through umbilicus covered by peritoneum and amnion, trisomies 13 and 18
Congenital umbilical hernia
failure of umbilical ring to close after physiological herniation of midgut, protrudes w/ intra-abdominal pressure
Parotitis etiology
Staph aureus, mumps, herpes, EBV
DM, tumors, stones, dental issues, HIV, Viral, TB, Sjorgen syndrome, sarcoidosis
Parotitis risk factors
close contact w/ mumps, cystic fibrosis, dehydration, HIV/AIDS, medications, not being immunized w/ MMR vaccine, poor oral hygiene, Sjorgen syndrome
Parotitis complication
massive swelling, obstruction respiratory dysfunctions, septicemia, facial bone osteomyelitis, septic jugular thrombophlebitis
Parotitis clinical characteristics
bacterial: painful swelling, fever
viral: pain, swelling, malaise, anorexia, fever
HIV: nonpainful swelling
TB: nontender swelling
Acute pancreatitis etiology
gallstones, hypertriglyceridemia, idiopathic, drug-induced, post-procedural, ampullary stenosis, autoimmune, infection, trauma, congenital anomalies, genetics, hypercalcemia, renal disease, toxins, vasculitis
Acute pancreatitis complication
Sepsis Necrotic pancreas Hemorrhagic pancreatitis Acute respiratory distress syndrome Renal failure Pancreatic duct disruption Pseudocysts Infected pancreatic necrosis Pancreatic abscess
Acute pancreatitis pathophys
Pancreatic juice enters tissues of pancreas, triggers auto-digestion of gland, inflammation, edema. May lead to hemorrhage and necrosis. Premature activation of trypsinogen to trypsin (digestion mode)
Zymogen
inactive enzyme, pH, chemoreceptor, or mechanoreceptor trigger release
GLUT 5
fructose transport
GLUT 2
cell to blood
Gastric zymogens
pepsinogen to pepsin activated via low pH
Pancreas zymogens
chymotrypsinogen
trypsinogen
procarboxypeptidase
proelastase
Bile salt
amphipathic molecule that come from cholesterol and are made in the liver and secreted by gallbladder in response to CCK
bind to lipids to make them more soluble
simulate micelle formation
Absorption of fatty acids
transported into intestinal cells by fatty-acid binding protein on membrane of intestinal cells -> moved to smooth ER via FABP-> triglycerides are resynthesized -> associated w/ protein, small amount of phospholipid and cholesterol are formed in the lumen of smooth ER -> chylomicrons are formed
Amylase
cleaves 1,4- bonds of carbohydrates to di and tri-saccharides
Stomach acid
gastric proton pump (H/K ATPase) on cell lining of the stomach
A-glucosidase
digests maltose and maltotriose
Regulatory substance of stomach
gastrin ghrelin gastric acid intrinsic factor pepsin bicarbonate somatostatin
Regulatory substance of Small Intestine
gastrin cholecystokinin secretin glucose-dependent insulinotropic peptide motilin vasoactive intestinal peptide bicarbonate
Regulatory substance of pancreas
a-amylase lipase proteases trypsinogen somatostatin
Intrinsic Factor Reg
↑ histamine or vagal input via Ach, gastrin
↓ By somatostatin, GIP, prostaglandin, secretin
Nitric oxide patho
loss of NO secretion implicated in increased tone of achalasia
Acute Pancreatitis clinical
Severe epigastric pain (dull, boring, steady, radiates to back) Worse eating, better fasting Abdominal tenderness/distention N/V Loss of appetite Fever, chills, Tachycardia Jaundice Malabsorption (steatorrhea, diarrhea)
Chronic pancreatitis etiology
Chronic alcoholism, gallstones, autoimmune disease, tumors, genetics, congenital anomalies, idiopathic
Chronic Pancreatitis pathophy
loss and injury to acinar, islet, and ductal cells w/ fibrosis and loss of pancreatic function
Chronic pancreatitis RF
alcohol, smoking, obesity, diabetes, FH
Chronic pancreatitis Complication
malabsorption, diabetes, pancreatic pseudocyst, mechanical obstruction of bile/duodenum, pancreatic ascites, pleural effusion, gastric varices, splenic vein thrombosis, pancreatic adenocarcinoma
Chronic pancreatitis clinical
Upper abdominal pain worse after eating, better fasting Steatorrhea Vitamin malabsorption Weight loss Diabetes
Chronic pancreatitis def
continuing inflammatory disease of the pancreas w/ irreversible morphological changes
Acute pancreatitis def
inflammation of pancreas
Parotitis def
inflammation of parotid gland
Cholestasis def
decrease in bile flow due to impaired secretion by hepatocytes or to obstruction of bile flow through intra-or extrahepatic bile ducts
Cholestasis cause
gallstones, cysts, tumor, acute hepatitis, alcoholic liver disease, primary biliary cholangitis, drugs, pancreatitis, pregnancy
Cholestasis pathophy
impairment of bile formation or impedance of bile flow
Cholestasis RF
FH, alcohol
Cholestasis complication
mineral bone disease, dyslipidemia, and fat-soluble vitamin deficiency
The pocketlike sacs of the large intestine are called
a. teniae coli
b. haustra
c. epiploic appendages
d. cecae
haustra
the esophageal hiatus is found on this organ
a. esophagus
b. stomach
c. diaphragm
d. pharynx
diaphragm
Which histological layer of the alimentary canal is also known as the visceral peritoneum?
a. submucosa
b. muscularis
c. serosa
d. mucosa
serosa
Which reflexes are we able to voluntarily control in GI system?
defecation reflex
Which hormone relaxes the hepatopancreatic sphincter?
CCK
simple columnar epithelium is found in which histological layer of the alimentary canal?
mucosa
Function of large intestine
absorption of water and electrolytes, elimination of waste, absorption of vitamins produced by bacteria
The membrane that lines the body wall of the abdominal cavity is the
parietal peritoneum
Alcoholic Liver Disease def
damage to liver and its function due to alcohol
Alcoholic Liver Disease cause
alcohol
Alcoholic Liver Disease pathophys
excessive alcohol in hepatocytes activates alcohol dehydrogenase which requires NAD -> ↑ NAD ↑fat production -> deposition of fat in liver -> alcoholic fatty liver
alcohol also ↑ ROS
↑ acetaldehyde bind to macromolecules -> acetaldehyde adducts -> neutrophils infiltrate -> damage to cells-> alcoholic hepatitis -> cirrhosis
Alcoholic Liver Disease RF
Sustained, long-term consumption of alcohol
Alcoholic Liver Disease complication
portal hypertension, varices, ascites, hepatic encephalopathy, infection, liver cancer, bleeding
Alcoholic Liver Disease pathophys
excessive alcohol in hepatocytes activates alcohol dehydrogenase which requires NAD -> ↑ NAD ↑fat production -> deposition of fat in liver -> alcoholic fatty liver
alcohol also ↑ ROS
↑ acetaldehyde bind to macromolecules -> acetaldehyde adducts -> neutrophils infiltrate -> damage to cells-> alcoholic hepatitis -> cirrhosis
Non-Alcoholic Fatty Liver Disease def
excess fat build up in liver
Non-Alcoholic Fatty Liver Disease cause
insulin resistance, hyperlipidemia, obesity
Non-Alcoholic Fatty Liver Disease pathophys
insulin resistance -> liver to ↑ fat storage & synthesis & uptake of free fatty acids ↓ fatty acid oxidation and secretion of fatty acids into bloodstream -> ↑ fat in hepatocytes -> fatty acids degrade -> cell death -> NASH ->
Non-Alcoholic Fatty Liver Disease RF
Metabolic syndrome (insulin resistance) Obesity HTN DM Hypertriglyceridemia Hyperlipidemia
Non-Alcoholic Fatty Liver Disease complication
May cause fibrosis leading to cirrhosis
HCC
Non-Alcoholic Fatty Liver Disease pathophys
insulin resistance -> liver to ↑ fat storage & synthesis & uptake of free fatty acids ↓ fatty acid oxidation and secretion of fatty acids into bloodstream -> ↑ fat in hepatocytes -> fatty acids degrade -> cell death -> NASH ->
Cirrhosis cause
Alcohol (60-70%), nonalcoholic steatohepatitis, chronic viral hepatitis, AI hepatitis, biliary disease, genetic/metabolic disorders
Cirrhosis pathogen
Diffuse bridging fibrosis (via stellate cells) and regenerative nodules
Disrupt normal architecture of liver
Cirrhosis RF
alcohol, hepatitis infx, metabolic disease, genetic, HTN,
Cirrhosis def
liver damage lading to remodeling, permanent damage, and loss of function
Cirrhosis clinical
Weight loss, weakness, fatigue Jaundice Asterixis (tremors) Increased estrogen - gynecomastia, spider angiomas, testicular atrophy, palmar erythema Confusion
Gilbert syndrome def
benign intertied metabolic disorder causng reccuring unconjugated hyperbilirubinemia jaundice,
Gilbert syndrome pathogen
autosomal recessive
Genetic mutation in promoter region of UGT gene -> structurally normal enzyme -> impaired genetic expression of hepatic UGT w/ decreased activity -> decreased conjugation of bilirubin
Gilbert syndrome def
benign intertied metabolic disorder causing recurring unconjugated hyperbilirubinemia jaundice,
Gilbert syndrome cause
genetics
Gilbert syndrome clinical
jaundice
Hepatitis def
inflammation of the liver that occurs suddenly and can lead to liver failure
Hepatitis cause
medications, drugs, alcohol, toxins, autoimmune, metabolic, hemochromatosis, wilson’s disease
Portal Hypertension def
Increased pressure in the portal venous system
> 5-10mmHg
Portal Hypertension comp
Hepatic encephalopathy
Most common cause of esophageal varices
Bacterial peritonitis (with ascites)
Build up of ammonia in the blood
Hepatitis cause
medications, drugs, alcohol, toxins, autoimmune, metabolic, hemochromatosis, wilson’s disease, Autoimmune Hepatitis, A1-antitrypsin Deficiency
Hepatitis pathogen
causative agent causing inflammation or immune complexes attacking liver tissue
Hepatitis RF
alcohol, drugs, genetic
Hepatitis comp
Liver failure
Hepatitis clinical
Abdominal pain
Joint pain
Fever
Fatigue
Portal Hypertension cause
Pre-hepatic: Vascular obstruction (eg, portal vein thrombosis)
Intrahepatic: Cirrhosis (most common in western countries), Schistosomiasis, and Sarcoidosis
Post-hepatic: R sided HF, Constrictive pericarditis, and Budd-Chiari syndrome
Portal Hypertension pathogen
↑ pressure -> blood is diverted away from portal system -> ↓ blood to liver -> build up of ammonia
Portal Hypertension pathogen
↑ pressure -> blood is diverted away from portal system -> ↓ blood to liver -> build up of ammonia
Portal Hypertension clinical
Ascites Bleeding GI Caput medusa (veins on abdomen) Diminished liver function Enlarged spleen
Cholecystitis def
inflammation of gallbladder
Cholecystitis cause
gallstone, bacterial infx in bile duct, tumor, reduced blood supply to gallbladder, gallbladder sludge
Cholecystitis pathogen
obstruction of biliary outflow tract by stone -> gb tries to squeeze -> bile causes mucosal wall to secrete mucus and inflammatory enzymes -> causing inflammation -> E coli, enterococci, Bacteroides fragilis, clostridium can build up in GB/wall -> stone fall or stays stuck -> cell death
Cholecystitis RF
age 40 female hormonal changes obesity DM FHx
Cholecystitis comp
Cell death Rupture Sepsis Infection Jaundice
Cholecystitis clinical
RUQ pain radiate to right scapula or shoulder
N/V
Fever
Cholecystitis comp
Cell death Rupture Sepsis Infection Jaundice gallbladder adenocarcinoma
Cholelithiasis def
presence of gallstone in GB
Cholelithiasis cause
cholesterol: obesity, pregnancy, gallbladder stasis, drugs, genetics
Black: sickle cell anemia, hereditary spherocytosis, beta-thalassemia,
brown: intraductal stasis, bacteria, postsurgical biliary strictures, choledochal cysts
Cholelithiasis path
cholesterol, bilirubin, calcium, heme in bile are present in concentrations that approach the limit of their solubility causing them to form crystals
Cholelithiasis comp
acute cholecystitis
overgrowth of bacteria
fibrosis of GB
gallbladder adenocarcinoma
Cholelithiasis RF
Fat
Female
Fertile
Forty
Cholelithiasis comp
acute cholecystitis overgrowth of bacteria fibrosis of GB gallbladder adenocarcinoma double duct sign
Cholelithiasis clinical
biliary colic epigastrium or RUQ pain indigestion dyspepsia belching bloating
Achlorhydria cause
pernicious anemia, ant secretory meds, H. pylori, gastric bypass, VIPomas, hypothyroidism, radiation to stomach, gastric cancer
Achlorhydria path
parietal cells or K channels on apical membrane get damaged
Achlorhydria RF
>60 autoimmune disease prior gastric surgery h. pyloir infection hypergastrinemia gastric carcinoid
Achlorhydria comp
Iron deficiency
Vitamin-B12 deficiency
Vitamin-D and calcium deficiency leading to osteoporosis and bone fracture
Gastric adenocarcinoma
Gastric carcinoid tumor
Small intestinal bacterial overgrowth syndrome
Achlorhydria clinical
Epigastric pain Weight loss Heartburn Nausea Bloating Diarrhea Abdominal pain Acid regurgitation Early satiety Vomiting Postprandial fullness Constipation Dysphagia Glossitis Decreased position and vibration sense
Gluten-Sensitive Enteropathy (Celiac disease) def
inability to digest certain proteins
Gluten-Sensitive Enteropathy (Celiac disease) path
intestinal inflammation d/o gliadin, glutenin, and secalin not being able to be broken down -> damage to intestinal epithelial cells in jejunum -> inability to absorb other nutrients
Gluten-Sensitive Enteropathy (Celiac disease) cause
genetics (HLA DQ2 and DQ8)
Gluten-Sensitive Enteropathy (Celiac disease) path
gliadin, glutenin, and secalin go to lumen of SMI-> get into lamina propria of these cells -> tissue transglutaminase cuts of amide -> deaminated gluten proteins are eaten by macrophages and presented on MHC class II -> T cells release TNF and Interferon gamma -> B cells make anti-tTG and anti-gliadin antibodies -> CD8 T kill cells
Gluten-Sensitive Enteropathy (Celiac disease) RF
infectious gastroenteritis (viral or non-viral)
Gluten-Sensitive Enteropathy (Celiac disease) comp
GI cancers, fractures,
Gluten-Sensitive Enteropathy (Celiac disease) clinical
Asymptomatic
Bloating, chronic diarrhea, constipation, gas and bloating, N/V, abdominal pain, anemia, Dermatitis herpetiformis, osteoporosis, ataxia
Lactase Deficiency def
being unable to break down lactose
Lactase Deficiency cause
genetics, congenital autosomal recessive, damage to small intestine
Lactase Deficiency path
downregulation of lactase production -> lactose doesn’t get broken down -> in colon gut flora break down lactose
Lactase Deficiency RF
African, Asian, Hispanic, and American Indian descent, premature birth
Lactase Deficiency clinical
diarrhea
gas
bloating
Appendicitis def
inflammation of appendix
Appendicitis cause
fecalith, undigested seeds, pinworm infection, lymphoid follicle,
Appendicitis path
obstruction -> fluid and mucus builds up -> ↑ pressure causing nerves to be compressed -> E coli or Bacteroides fragilis can multiply -> immune system calls WBC forming pus in appendix ->
Appendicitis Rf
FH, cystic fibrosis
Appendicitis comp
Cell death Rupture Peritonitis Peri-appendiceal abscess Subphrenic abscess
Appendicitis clinical
Fever, N/V, RLQ pain, abdominal guarding P- pain A- anorexia, N/V T- tenderness E- elevated temperature L- leukocytosis L- lying still A- asleep
Barrett Esophagus def
metaplasia of cells lining lower esophagus
Barrett Esophagus cause
GERD
Barrett Esophagus path
Chronic acid exposure -> reflux esophagitis -> Specialized intestinal metaplasia - replacement of nonkeratinized stratified squamous epithelium in distal esophagus (replaced with nonciliated columnar epithelium- goblet cells).
Z-line and gastroesophageal junction
Barrett Esophagus RF
Chronic GERD Bulimia Previous chemical damage Smoking Hiatal hernia
Barrett Esophagus comp
Esophageal adenocarcinoma
Barrett Esophagus clinical
Asymptomatic or Heartburn, Dysphagia, Regurgitation Hematemesis Epigastric pain Weight loss
achalasia def
esophageal SM fibers fail to relax so lower esophageal sphincter remains closed
achalasia cause
idiopathic autoimmune triggered by infx, genetic, neurodegenerative disease
esophageal cancer, Chagas disease
achalasia patho
progressive degeneration of ganglion cells in mesenteric plexus w/in esophageal wall -> lower esophageal sphincter fails to relax -> loss of peristalsis in distal esophagus
lack noradrenergic noncholinergic, inhibitory ganglion cells -> imbalance excitation and relaxation -> incomplete LES relaxation, increase LE tone, lack of esophageal peristalsis
achalasia RF
genetics, autoimmune, herpes simplex
achalasia comp
aspiration pneumonia, esophageal perforation, esophageal cancer
Adynamic ileus def
when food or drink do not pass through bowel due to loss of peristaltic movement
Adynamic ileus cause
stress response from abdominal or pelvic surgery, gastroenteritis, pancreatitis, peritonitis, diverticulitis, electrolyte imbalances, vascular/neural impairment, meds
Adynamic ileus path
surgery activates stress response that immobilize the digestive tract
Adynamic ileus RF
long surgery
Adynamic ileus comp
toxic megacolon
rupture
Adynamic ileus clinical
asymptomatic
abdominal discomfort, bloating, constipation, N/V, abdominal tenderness
Hernia def
abdominal organ protrudes through the abdominal wall
Types: epigastric, umbilical, inguinal, femoral
Hernia cause
surgery, congenital (indirect inguinal), weakening due to age (direct inguinal),
Hernia path
↑ pressure in abdominal cavity can lead abdominal organs pas through the tissue
Hernia path
↑ pressure in abdominal cavity can lead abdominal organs passing through the tissue
Hernia comp
strangulation- redness, N/V
Hernia clinical
asx or pain, visible, palpable budge,
Intussusception def
part of the intestine folds into another part of the intestine, most common children
Intussusception cause
idiopathic
adult: polyp, tumor
babies: lymphoid hyperplasia
Meckel’s diverticulum
Intussusception path
A: growth due to peristalsis gets grabbed and pulled ahead of itself leading to the ileum folding into the cecum
B: infection enlarges lymph nodes (roto or norovirus) become a lead point that grabs ileum into cecum
Intussusception RF
having one previously, having sibling w/ one, having intestinal malrotation
Intussusception comp
Death of tissue - blood, mucus, intestinal mucosa into stool
Sepsis
volvulus
Intussusception clinical
intermittent abdominal pain worsen w/ peristalsis
Vomiting
hard, sausage-like mass in abdomen
red currant jelly stool
Volvulus def
obstruction caused by a loop in the intestine that twists around itself and its mesentery
Volvulus cause
sigmoid: pregnancy, chronic constipation, Hirschsprung disease, abdominal adhesions
cecal: congenital
Midgut: abnormal intestinal development
Volvulus path
anything that can act as pivot point allowing the colon to twist and pinch the lumen shut causing bowel obstruction
Volvulus RF
Hirschsprung disease, intestinal malrotation enlarged colon, pregnancy, abdominal adhesions
Volvulus comp
Death to intestinal wall
Sepsis
Volvulus clinical
Cramping abdominal pain Distention Obstipation Constipation N/V Constant abdominal pain
Megacolon def
abnormal dilation of colon that is not cause by mechanical obstruction
Megacolon cause
infection (Clostridium difficile, Salmonella, Shigella, Campylobacter, Trypanosoma cruzi and Entamoeba histolytica), meds, Hirschsprung’s disease, surgery, diabetic neuropathy, Parkinson disease, muscular dystrophies, scleroderma, SLE, idiopathic
Megacolon patho
damage to ANS, reduced SM activity due to inflammation leading severely decreased intestinal motility causes a buildup of feces, air, and intestinal secretions in the colon, which presents as dilation of the colon.
Megacolon patho
damage to ANS, reduced SM activity due to inflammation leading severely decreased intestinal motility causes a buildup of feces, air, and intestinal secretions in the colon, which presents as dilation of the colon.
Megacolon types
Toxic: systemic toxicity,
chronic: permanent dilation of colon, congenital, neuro/msk, CT
acute: acute dilation, post surgery
Megacolon comp
blood loss sepsis perforation shock death
Megacolon clinical
constipation, bloating, abdominal pain or tenderness, hard fecal mass,
might have fever, tachycardia, shock
Diverticulosis def
small pouches, or sacs, form and push outward through weak spots in the wall of colon
Diverticulosis RF
genetics, low fiber, low physical activity, NSAIDs, obesity, smoking, aging, male, FH, obesity, marfan syndrome, ehlers-danlo syndrome, ADPKD,
Diverticulosis comp
Blood vessels weaken
Diverticulitis
Segmental colitis
Diverticulosis clinical
no symptoms, stomach pain, altered bowel habits, rectal bleeding
Diverticulitis def
small pouches, or sacs, form and push outward through weak spots in the wall of colon that become inflamed or infected
Diverticulitis cause
fecalith
erosion of diverticula
Diverticulitis path
increased intraluminal pressure -> erosion -> inflammation, focal necrosis -> macro perforation
Diverticulitis RF
diverticula present
Diverticulitis comp
fistula, stricture, intestinal obstruction, perforation, abscess, peritonitis
Diverticulitis clinical
fever, diarrhea, constipation, abdominal pain LLQ, urinary urgency, freq, dysuria
Enteritis def
Inflammation of the small intestine
Enteritis cause
contaminated food or water, Crohn disease, NSAIDs, cocaine, radiation therapy, celiac disease, tropical sprue, Whipple disease
Enteritis RF
recent travel, exposure to unclean water, recent stomach flu
Enteritis path
bacteria or virus multiples in the sm intestine causing immune system recruitment and inflammatory cytokines plus tissue destruction
Enteritis comp
Dehydration
Enteritis clinical
abdominal pain, diarrhea, loss of appetite, vomiting, blood in stool
Enteritis Organisms
Campylobacter E coli Salmonella Shigella Staph aureus
Esophageal Ulcers def
mucosal damage to the esophagus
Esophageal Ulcers cause
GERD, bulimia nervosa, Candida species, Herpes simplex, and cytomegalovirus, NSAIDs, bisphosphonates, some antibiotics, acidic foods
Esophageal Ulcers path
excessive reflux of acid and pepsin result in necrosis of surface layers of esophageal mucosa
Esophageal Ulcers clinical
pyrosis, regurgitations, dysphagia, Globus sensation, odynophagia, nausea, vomiting, weight loss, hematemesis, coffee ground emesis, substernal chest pain radiating to the back
Esophageal Ulcers comp
upper gastrointestinal bleeding, in rare cases
recurrent peptic ulcers
esophageal strictures that narrow the esophagus
esophageal cancer
excessive weight loss due to appetite loss and difficulty swallowing
esophageal rupture
death in the rare cases of ulcer hemorrhage or perforation
Peptic Ulcer Disease def
chronic mucosal ulceration of stomach/duodenum that extends into muscularis mucosa
Peptic Ulcer Disease def
chronic mucosal ulceration of stomach/duodenum that extends into muscularis mucosa, gastric or duodenal
Peptic Ulcer Disease path
↑ acid secretion ↓protective mechanisms -> mucosal damage -> ulceration
Peptic Ulcer Disease path
↑ acid secretion ↓protective mechanisms -> mucosal damage -> ulceration
Peptic Ulcer Disease comp
“An Outstanding Physician Prevents Catastrophe” Anemia/hemorrhage Obstruction Penetration Perforation Carcinoma in a gastric ulcer
Peptic Ulcer Disease clinical
asymptomatic or epigastric pain after meal, worse at night, relieved by food/antacids radiates to back, chest, LUQ/RUQ N/V, coffee ground emesis bloating weight loss
Gastric Ulcers def
sores that develop on lining of stomach
Gastric Ulcers cause
H pylori, NSAIDs, acidic food
Gastric Ulcers path
↑ acid secretion ↓protective mechanisms -> mucosal damage -> ulceration
Gastric Ulcers RF
NSAIDs, FH, alcohol, smoking,
Gastric Ulcers comp
In lesser curvature > can erode into L gastric artery and cause upper GI bleed
Malignant gastric ulcers:
Gastric MALT lymphoma
Gastric adenocarcinoma
Hemorrhage, obstruction
Gastric Ulcers clinical
Epigastric pain worse 30 mins after meal > Anorexia > weight loss
heartburn, indigestion
Duodenal Ulcers def
chronic mucosal ulceration of duodenum that extends into muscularis mucosa,
Duodenal Ulcers cause
H pylori, Zollinger-Ellison Syndrome
Duodenal Ulcers path
H. pylori colonization and persistent inflammation lead to the weakening of the mucosal surface layer causing it to be vulnerable to exposure to gastric acid
SAIDs causes a significant and persistent decrease in prostaglandins leading to susceptibility to mucosal injury
Duodenal Ulcers RF
alcohol, h. pylori, radiation, NSAIDs, stress, tobacco
Duodenal Ulcers comp
Hemorrhage, obstruction,
Perforation
Duodenal Ulcers clinical
Pain improves with eating
Weight gain
Esophagitis (Non-infectious) def
Inflammation of esophagus
Esophagitis (Non-infectious) cause
GERD, pill induced, eosinophilic, radiation
Esophagitis (Non-infectious) cause
GERD, pill induced (NSAIDS, doxycycline, potassium chloride, bisphosphonate), caustic (strong acid or basic) eosinophilic, radiation
Esophagitis (Non-infectious) RF
Caffeine, alcohol, smoking, Antihistamines, Ca2+ channel blockers
Obesity, pregnancy, Zollinger-Ellison Syndrome, FH, asthma, climate, older age
Esophagitis (Non-infectious) comp
scarring or narrowing of esophagus
Barrett’s esophagus
cancer
Tearing
Esophagitis (Non-infectious) comp
scarring or narrowing of esophagus
Barrett’s esophagus
cancer
Tearing/perforation
Acute Gastritis def
Inflammation of gastric mucosa
Acute Gastritis def
Inflammation of gastric mucosa
Acute Gastritis patho
causative agent causing decrease in defensive mechanism, inflammation, erosion to the mucosa lining
Acute Gastritis patho
causative agent causing decrease in defensive mechanism, inflammation, erosion to the mucosa lining with neutrophil infiltration
Acute Gastritis clinical
Epigastric pain, N/V,
Chronic gastritis def
Chronic inflammation of gastric mucosa leading to gastric atrophy and metaplasia or dysplasia
Chronic gastritis cause
Type a: Autoimmune: body and fundus
Type B: H. Pylori antrum
Chronic gastritis path
A: type IV hypersensitivity to H/K ATPase and intrinsic factor on parietal cells, chief are lost
B: inflammation decreases # of delta cells, decrease pH
Chronic gastritis RF
old age, stress, alcohol, autoimmune,
Chronic gastritis comp
Neuroendocrine tumors
Gastric adenocarcinoma
gastric MALT lymphoma
Chronic gastritis clinical
Asx
Epigastric pain
N/V
GERD def
stomach acid flows back into esophagus
GERD path
reflux -> inflammation, edema, erosion and remodeling -> wall thickens & lumen is smaller
GERD RF
Caffeine, alcohol, smoking
Antihistamines, Ca2+ channel blockers
Obesity, pregnancy, Zollinger-Ellison Syndrome, fatty food, hiatal hernia , scleroderma
GERD comp
Esophagitis Esophageal strictures Barrett’s esophagus Esophageal adenocarcinoma Pulmonary fibrosis laryngitis asthma Pneumonia
GERD clinical
Retrosternal chest pain
Heartburn
Regurgitation
Dysphagia
All worse after eating, bending down, leaning over
Acidic taste in mouth, sore throat, chronic cough, hoarseness
In mouth: Damage tooth enamel
Crohn Disease def
inflammation and destruction anywhere along the GI tract, terminal ileum and colon
Crohn Disease def
inflammation and destruction anywhere along the GI tract, terminal ileum and colon with areas that are unaffected
Crohn Disease path
infection by mycobacterium paratuberculosis, pseudomonas, listeria activates immune system via antigen presentation -> unregulated th1 and cytokines -> macrophages, free radicals, proteases, platelet-activating factor -> lots of tissue destruction
Crohn Disease RF
Black pts, genetics
Crohn Disease comp
malabsorption/malnutrition colorectal cancer fistulas phlegmon/abscesses strictures perianal disease
Crohn Disease clinical
Diarrhea w/or w/o blood
pyoderma gangrenous, erythema nodosum, uveitis, episcleritis, oral ulceration, arthritis
Crohn Disease clinical
Diarrhea w/or w/o blood
pyoderma gangrenous, erythema nodosum, uveitis, episcleritis, oral ulceration, arthritis
Ulcerative Colitis def
inflammation of the colon forming ulcers in mucosa and submucosa along the lumen, circumferential and continuous from rectum to colon
Ulcerative Colitis cause
autoimmune, stress, diet
Ulcerative Colitis path
t cells destroying the cells lining the large intestine
Ulcerative Colitis RF
women, FH, white
Ulcerative Colitis comp
toxic megacolon, perforation, fulminant colitis, malabsorption, malnutrition, colorectal cancer
Ulcerative Colitis clinical
Attacks of bloody, mucousy diarrhea
Abdominal pain
pyoderma gangrenous, erythema nodosum, uveitis, episcleritis, oral ulceration, arthritis
Esophageal Atresia def
esophagus doesn’t develop
Esophageal Atresia cause
congenital
Esophageal Atresia path
defective lateral separation of foregut into the esophagus and trachea
Esophageal Atresia RF
diaphragmatic hernia, duodenal atresia, imperforate anus, congenital heart problems, Trisomy 13, 18, or 21
Esophageal Atresia comp
esophageal stricture, GERD, recurrent pneumonia, obstructive and restrictive ventilatory defects, and airway hyperreactivity
Esophageal Atresia clinical
choking, respiratory distress, or cyanotic episodes during feeding
Esophageal Webs and Rings def
thin structures that partially occlude the esophageal lumen
Esophageal Webs and Rings cause
Plummer-Vinson syndrome
Eosinophilic esophagitis
Sliding hiatal hernia
Chronic reflux
Plummers enter sliding crevasse
Esophageal Webs and Rings path
congenital or inflammation irritating esophageal wall
Esophageal Webs and Rings RF
Plummer-Vinson syndrome
Esophageal Webs and Rings comp
food impaction, perforation by solid food/esophageal probe insertion
Esophageal Webs and Rings clinical
Asx Dysphagia Food getting stuck odynophagia retrosternal pain
Meckel Diverticulum def
abnormal pouch on antimesenteric side of ileum
Meckel Diverticulum cause
congenital
Meckel Diverticulum path
incomplete obliteration of the omphalomesenteric duct in the developing embryo
Meckel Diverticulum RF
other congenital anomalies
Meckel Diverticulum comp
diverticulitis, ulcers, perforation, food impaction, lithiasis, peritonitis, peritoneal adhesions, intussusception, volvulus, neoplasm
Meckel Diverticulum clinical
asymptomatic or abdominal pain, distention, melena, vomiting, constipation
Pyloric Stenosis def
narrowing of the opening bw the stomach and duodenum
Pyloric Stenosis cause
genetics
Pyloric Stenosis path
SM of pyloric antrum undergoes hypertrophy and hyperplasia causing a blockage
Pyloric Stenosis RF
boys, macrolide antibiotics
Pyloric Stenosis comp
dehydration
jaundice
failure to thrive
Pyloric Stenosis clinical
olive in RUQ
peristalsis felt or seen
vomiting
Ascites def
fluid collects in the spaces w/in the abdomen
Ascites cause
cirrhosis (most common), heart failure, kidney failure, cancer, infection
Ascites path
portal hypertension and increased activity of RAAS leads to fluid accumulation
Ascites RF
alcohol, obesity, hepatitis infection, metabolic disease
Ascites comp
peritonitis
Ascites clinical
asymptomatic, weight gain, abdominal discomfort
Peritonitis def
peritonitis inflammation of the peritoneum
Peritonitis cause
bacteria, leakage of GI contents, foreign material, endometriosis, peritoneal dialysis, adhesions form surgery
Peritonitis path
inflammation causing neutrophilic infiltration, formation of fibrinopurulent exudate
Peritonitis RF
liver cirrhosis, appendicitis, Crohn’s disease, stomach ulcers, diverticulitis and pancreatitis
Peritonitis comp
enterocutaneous fistula, abdominal compartment syndrome, and enteric insufficiency
Peritonitis clinical
Fever, chills, tachycardia, ascites, abdominal distention, abdominal rigidity, spider angiomata, jaundice, anorexia, N/V, diarrhea, encephalopathy, delirium, confusion, cognitive decline
Esophageal varices def
dilated submucosal distal esophageal veins connecting the portal and systemic circulations
Esophageal varices cause
portal hypertension, cirrhosis
Esophageal varices path
↑ pressure -> blood is diverted away from portal system -> ↓ blood to liver -> build up of ammonia -> remodeling and dilation of blood vessels
Esophageal varices RF
alcohol
Esophageal varices comp
Variceal rupture
Esophageal varices clinical
Hematemesis, melena, or hematochezia, Weight loss, Anorexia, Abdominal discomfort, Jaundice, Pruritus
Hemorrhoids def
swollen veins in anus
Hemorrhoids cause
straining during BM, constipation
Hemorrhoids path
increased pressure causes veins to swell
Hemorrhoids RF
constipation, strenuous defecation, diarrhea, prolonged sitting, aging, increased intra-abdominal pressure, pregnancy, intra-abdominal mass, ascites, portal hypertension
Hemorrhoids comp
bleeding w/ BM, prolapsing, incarceration, strangulation, and itching
bleeding, acute thrombosis, itching, hygiene difficulties
Hemorrhoids clinical
itching, bleeding w/ BM, pain, mucous discharge, perianal mass
Infarction def
reduced blood supply to GI tract
Infarction cause
Thrombus, thromboembolism, tumor, hernia, volvulus, intussusception, hypovolemia, after MI
Infarction path
reduced blood supply to GI tract -> lack of oxygen -> cell death
Infarction RF
atherosclerosis, age, smoking, COPD, meds, blood clot disorders,
Infarction comp
Sepsis
Infarction clinical
abdominal pain, vomiting, bloody diarrhea, distension
Esophageal Adenocarcinoma RF
Obesity, smoking, achalasia, chronic GERD, Barrett’s esophagus, age >60, male
Esophageal Adenocarcinoma clinical
Dysphasia, first solids then liquids
odynophagia, pyrosis, pain in chest/back, vomiting, weight loss
Esophageal Squamous Cell Carcinoma def
cancer arising from the squamous epithelium of the esophagus, all along esophagus
Esophageal Adenocarcinoma def
cancer arising from columnar glandular epithelium
Esophageal Adenocarcinoma path
chronic aid exposure -> intestinal metaplasia -> mutation in tumor suppressor gene/proto-oncogenes -> tumor
Esophageal Adenocarcinoma comp
obstruction, fistula
Esophageal Squamous Cell Carcinoma cause
alcohol and smoking
Esophageal Adenocarcinoma cause
GERD
Barrett’s esophagus
Esophageal Squamous Cell Carcinoma RF
alcohol, smoking, hot fluids, age >60, achalasia, caustic strictures, plummer-vinson syndrome, palmoplantar keratoderma
Esophageal Squamous Cell Carcinoma comp
Fistula, obstruction
Esophageal Squamous Cell Carcinoma clinical
Dysphasia, first solids then liquids, odynophagia, pyrosis, pain in chest/back, vomiting, weight loss
Gastric Adenocarcinoma def
cancer originating in the columnar glandular epithelium
Gastric Adenocarcinoma cause
H. pylori or mutation in CDH1 gene
Gastric Adenocarcinoma path
h. pylori releases cagA goes into the epithelium and cause damage -> immune system detects damage causing inflammation -> chronic infection leads to more inflammation, damage, and repair -> metaplasia develops -> mutations in tumor suppressor/ proto-oncogenes > cancer
CDH1 cause cells to not stick together and divide
Gastric Adenocarcinoma comp
metastasis
paraneoplastic syndrome (keratinocytes inc)
polyarteritis nodosa (inflammation/necrosis of medium ateries)
thrombosis
pseudoachalasia syndrome
Gastric cancer types
lymphomas: lymphocytes in MALT due to chronic h. pylori
carcinoid: neuroendocrine cells, g cells, polyp
leiomyosarcoma: smooth muscles cells
Gastric cancer RF
FH, smoking, alcohol, obesity, older
Gastric Adenocarcinoma RF
male, h. pylori, type A blood, diet high in nitrates, salt, smoked foods, autoimmune gastritis,
Gastric cancer clinical
malaise, loss of appetite, dyspepsia, epigastric pain, N/V, weight loss, anemia, hematemesis, melena
Gastrinoma def
neuroendocrine tumor that secretes gastrin
Gastrinoma cause
MEN1 gene mutation
Gastrinoma path
uncontrolled division and replication of G cells
Gastrinoma RF
chronic pancreatitis, FH, alcohol
Gastrinoma comp
metastases, bleeding
Gastrinoma clinical
abdominal pain, chronic diarrhea, dyspepsia, gastroesophageal reflux, gastrointestinal bleeding, and weight loss
Liver cancer types
Hepatocellular carcinoma
Angiosarcoma
Cavernous hemangioma
Hepatic adenoma
Hepatocellular carcinoma def
cancer in hepatocytes
Hepatocellular carcinoma cause/RF
alcoholic hepatitis, hemochromatosis, primary biliary cirrhosis, alpha 1- antitrypsin deficiency, chronic hep B and C, aflatoxins,
Hepatocellular carcinoma path
mutation in a hepatocytes to chronic conditions that cause damage and repair
Hepatocellular carcinoma comp
metastases
death
Hepatocellular carcinoma clinical
asymptomatic
abdominal pain and fever
Oral cancer types
squamous cell carcinoma
adenocarcinoma
melanoma
lymphoma
Leukoplakia def
white flat raised patch in mouth that is precancerous
Leukoplakia RF
tobacco use, alcohol
Leukoplakia comp
squamous cell carcinoma
Leukoplakia clinical
white raised patches
Oral Squamous cell Carcinoma def
cancer from stratified squamous epithelium
Oral Squamous cell Carcinoma path
mutation to proto-oncogenes or tumor suppressor genes
Oral Squamous cell Carcinoma RF
tobacco smoke, alcohol, chewing betel quid's/ paan UV radiation exposure to metal dust or chemicals vitamin and mineral deficiencies immune deficiencies HPV 16
Oral Squamous cell Carcinoma clinical
numbness or change in sensation, hoarse voice, pain or difficulty w/ chewing or swallowing, painless & painful lumps, sores, or discolorations
Pancreatic cancer types
Adenocarcinoma
Acinar
Cystadenocarcinoma
Pancreatic Adenocarcinoma def
cancer arising from the epithelial cells of exocrine gland
Pancreatic Adenocarcinoma comp
metastasis
obstructive common bile duct
Pancreatic Adenocarcinoma clinical
nausea, vomiting, fatigue, weight loss, mid-epigastric pain, trousseau sign, gallbladder enlarged
Pancreatic cancer type
VIPoma Gastrinoma Glucagonoma Insulinoma Acinar cystadenocarcinoma
Colorectal cancer types
adenocarcinoma
Colorectal adenocarcinoma def
cancer of epithelial cells in colon
Colorectal adenocarcinoma cause
mutations, adenomatous polyposis coli gene (APC)
Colorectal adenocarcinoma path
APC -> mutated cells don’t die and divide/replicate (polyp) -> more replication/mutations -> adenocarcinoma
Colorectal adenocarcinoma RF
elder, male, APC mutation, IBD, smoking, red meat, lack of fiber, obesity, Familial adenomatous polyposis, hereditary nonpolyposis
Colorectal adenocarcinoma comp
metastasis
Colorectal adenocarcinoma clinical
ascending: abdominal pain, weight loss, anemia
descending: lumen narrowing, colicky abdominal, hematochezia
Esophagitis def
inflammation of esophagus due to
Esophagitis def
inflammation of esophagus due to
Esophagitis cause
Candida
Herpes Simplex Virus
Cytomegalovirus
Human Immunodeficiency Virus
Esophagitis RF
immunocompromised states, AIDS, diabetes
Esophagitis clinical
fever, dysphagia or difficulty in swallowing, odynophagia or painful swallowing, and retrosternal chest pain
Candida: small white raised plaques
HSV: small rounded vesicles, lesions in mouth
CMV: large superficial ulceration
HIV: large ulcerations
Gastroenteritis def
inflammation of the gastrointestinal tract that involves the stomach and small intestine
Gastroenteritis cause
rotavirus (kids), norovirus, astrovirus, adenoviruses
Gastroenteritis path
viruses -> epithelium damage
Gastroenteritis RF
children, elderly, immunocompromised individual, daycare center, cruise ship, contaminated food/water
Gastroenteritis comp
server dehydration
Gastroenteritis clinical
watery diarrhea, N/V, abdominal cramp, pain, fever, malaise, dry lips, skin turgor, tachycardia
Gingivitis def
inflammation of gums
Periodontitis def
inflammation and destruction of structures around the teeth
Gingivitis/Periodontitis cause
Prevotella intermedia, alpha-hemolytic streptococci, Actinomyces species
Gingivitis/Periodontitis cause
lack of competition or ineffective immune response, fusobacterium nucleatum, preuotella intermedia, porphyromonas gingivalis
Gingivitis/Periodontitis RF
poor oral care, smoking, older age, dry mouth, poor nutrition, dental restorations that don’t fit properly
Gingivitis/Periodontitis comp
tooth loss
Gingivitis/Periodontitis clinical
no sx, redness, swelling, bleeding
Oral thrush def
infection of the oral mucosal membrane by candida spp
Oral thrush cause
Candida albicans
Oral thrush RF
young age, dentures, xerostomia, antibiotics, DM, malnutrition, immunosuppression due to chemo, corticosteroids, HIV/AIDS
Oral thrush path
Overgrowth of yeast on the oral mucosa leads to desquamation of epithelial cells and accumulation of bacteria, keratin, and necrotic tissue
Stomatitis def
swelling and redness of the oral mucosa or discrete, painful ulcers
Stomatitis cause
Recurrent aphthous stomatitis herpes simplex and herpes zoster Candida albicans and bacteria Trauma Tobacco or irritating foods or chemicals Chemotherapy and radiation therapy Systemic disorders
Stomatitis path
T cell mediated immune dysfunction, neutrophil, and mast cell-mediated destruction of the mucosal epithelium
Stomatitis RF
Poor oral hygiene. Smoking. Alcohol. Trauma. Psychological stress. H. pylori. Sensitivity to food. Nutritional abnormalities.
Stomatitis comp
Meningoencephalitis, recurrent skin and mouth infections, dissemination of the infection, and teeth loss
Stomatitis clinical
red patches, blisters, swelling of the mouth, oral dysaesthesia, ulcers,
Hepatitis A def
inflammation of liver parenchyma due to hepatitis A
Hepatitis A cause
Fecal-oral route shellfish
Personal contact
Sexual contact
Illicit drug use
Hepatitis A def
inflammation of liver parenchyma due to hepatitis A
Hepatitis A RF
traveling to endemic areas
chronic liver disease or clotting factor disorders
MSM
Hepatitis A clinical
Jaundice, Fever/chills, Fatigue/weakness, Headache, Myalgias, RUQ
Phase II: Anorexia, N/V, Arthralgia, Malaise, Urticaria, Dark urine, Hepatomegaly
Phase III: Dark urine, Pale-colored stools, Gastrointestinal sx, Malaise, Hepatomegaly/ splenomegaly
Hepatitis E def
inflammation of liver parenchyma due to hepatitis E
Hepatitis E cause
Transfusion of infx blood
fecal-oral route
Hepatitis E def
inflammation of liver parenchyma due to hepatitis E
Hepatitis E RF
contamination of water supplies, poor sanitation, ingestion of undercooked meat and shellfish, travel to regions where HEV is endemic, and chronic liver disease.
Hepatitis E clinical
Jaundice Malaise Anorexia N/V Abdominal pain Fever Hepatomegaly
Hepatitis E comp
fulminant hepatitis in pregnant women
Hepatitis E comp
fulminant hepatitis in pregnant women
chronic in immunocompromised
Hepatitis B def
inflammation of liver parenchyma due to hepatitis B
Hepatitis B RF
IV drug users, needle stick accidents, dialysis, blood transfusion
Hepatitis B comp
chronic hepatitis (90% in children) fulminant hepatitis
Hepatitis B clinical
Prodrome: malaise, fever, arthralgias, lymphadenopathy, pruritis, rash
Hepatitis B comp
chronic hepatitis (90% in children), cirrhosis fulminant hepatitis, aplastic anemia, membranous glomerulonephritis, membranoproliferative glomerulonephritis
Hepatitis B clinical
Prodrome: malaise, fever, arthralgias, lymphadenopathy, pruritis, rash
HBsAG -> IgM -> total anti-HBs -> anti-HBs surface antigen antibody 6 month
Hepatitis D def
inflammation of liver parenchyma due to hepatitis D, coinfection w/ HBV
Hepatitis D path
cytotoxic killing of hepatocytes -> inflammation -> liver damage
Hepatitis D clinical
Sx 3-7 wks after infxn Fever Fatigue Anorexia N/V Abdominal pain Dark urine Clay-colored stool Joint pain Jaundice
Hepatitis D RF
Injection drug users.
Persons with hemophilia.
Infants/children of immigrants from areas with high rates of HBV infection.
Household contacts of chronically infected persons.
Persons with multiple sex partners or diagnosis of a sexually transmitted disease.
Men who have sex with men.
Hepatitis D comp
cirrhosis, liver failure, and liver cancer, chronic hepatitis
Hepatitis C def
inflammation of liver parenchyma due to hepatitis C
Hepatitis C cause
hepatitis c
Hepatitis C cause
hepatitis c, childbirth, sex
Hepatitis C RF
IV drugs, sexual contact, from mother to child in neonatal period, chronic hemodialysis
Hepatitis C comp
cirrhosis, hepatocellular carcinoma, renal dysfunction
Hepatitis C clinical
low grade fever, malaise, lethargy, anorexia, fatty stool, dark urine, jaundice, hepatomegaly, icterus, pruritus
Which hepattitis can become chronic?
B, C, D, E
Which hepatitis can become chronic?
B, C, D, E
Where is the quadrate lobe located between?
bw left lobe and gallbladder
