GI Flashcards
1
Q
list the functions of the GI system
A
- Breaks down food
- Obtain and absorb nutrients
- Chemical breakdown
- Excrete waste products
2
Q
the GI tract extends from the ____ ____ to the _____
A
oral cavity to anus
3
Q
what are the layers of the GI tract?
A
- Mucosa
- Submucosa
- Muscularis externa
- Serosa
4
Q
which layer is considered the visceral peritoneum?
A
the serosa
5
Q
what is a mesentery?
A
a double layer of visceral peritoneum (serosa)
6
Q
which layer of the GI system contains pain receptors for sensory organs?
A
the serosa
7
Q
which omentum hangs from the lesser curvature of the stomach to the liver?
A
lesser omentum
8
Q
which omentum hangs from greater curvature of stomach?
A
greater omentum
9
Q
which omentum is considered the “fatty” omentum?
A
the greater omentum
10
Q
T or F: the omenta have blood vessels, lymphatics, and nerves?
A
true
11
Q
what happens if inflammation affects the omenta?
A
fibrotic tissue can form, which can contract and limit the movement of digestive organs
12
Q
what are the accessory organs of the gi system?
A
salivary glands
liver
gallbladder
pancreas
13
Q
what are the primary salivary glands? are they paired or unpaired?
A
parotid, sublingual, and submandibular
all are paired
14
Q
what are the organs of the upper GI tract?
A
oral cavity
esophagus
stomach
15
Q
what is mechanical breakdown of food in the oral cavity known as?
A
mastication
16
Q
_____ _____ is responsible for the enzymatic breakdown of ______ in the oral cavity
A
salivary amylase, carbs
17
Q
what secretes salivary amylase?
A
the major salivary glands (parotid, sublingual, and submandibular)
18
Q
as the tongue begins to push food into the pharynx, what cranial nerves are stimulated? what does this cause?
A
cranial nerves V (trigeminal) and IX (glossopharyngeal) stimulate deglutition (swallowing)
19
Q
what is deglutition
A
swallowing
20
Q
explain step 1 of swallowing (what nerves are stimulated and what physically occurs?)
A
- as bolus of food enters the pharynx, CN V, IX, X, and XII are stimulated
- soft palate blocks off nasal cavity
- epiglottis folds down to cover airways
- tongue blocks off oral cavity
21
Q
explain step 2 of swallowing
A
peristaltic waves push bolus down into upper esophageal sphincter (this is aided by gravity)
22
Q
explain step 3 of swallowing (hint: what reflex is stimulated?)
A
vagovagal reflex is stimulated - the sensory vagus branch stimulates the motor branch so both can work together to stimulate primary peristalsis
primary peristalsis moves food through the lower esophageal sphincter into relaxed stomach
if vagus realizes not all food is pushed through, secondary peristalsis will be stimulated
23
Q
where is the swallowing center located?
A
in the medulla
24
Q
how many layers are there in the muscularis externa of the stomach? how many are there normally?
A
there are 3 in the stomach, normally there are 2 layers everywhere else in GI
25
what does the extra/3rd layer of muscularis externa in the stomach do?
it allows strong churning and mixing to create chyme
26
what is the pH of the stomach? what is this maintained by?
1.5 to 3.5 pH
parietal cells in the fundus and body of stomach secrete HCl
27
what do parietal cells in the stomach create?
HCl and intrinsic factor
28
what is HCl needed for?
Hint: 3 things
1. to maintain low stomach pH
2. to kill microbes
3. converts pepsinogen to pepsin for protein digestion
29
what is intrinsic factor needed for?
binds to vitamin B12 for absorption in small intestine
30
what do chief cells secrete? where are they?
chief cells secrete pepsinogen in the fundus and body of the stomach
31
explain how pepsinogen is turned to pepsin?
1) chief cells secrete pepsinogen
2) parietal cells secrete HCl
3) HCl activates pepsinogen to turn it into pepsin for protein digestion
32
what secretes mucus in the stomach? why is this mucus important?
glands in the cardiac and pyloric region of the stomach secrete mucus to coat the stomach for protection against HCl and digestive enzymes
33
what do enteroendocrine cells secrete? what are these cells also called? what is the product important for?
secrete hormone gastrin
enteroendocrine cells = G cells
gastrin activates parietal cells so they can produce HCl
34
what stimulates chief cells?
the presence of food
35
what quadrant is the liver located in?
upper right quadrant
36
what are cells of the liver called?
hepatocytes
37
what do hepatocytes absorb?
1. nutrients for storage – folic acid, vits A, B6, B12, D & K, C, copper, iron
2. amino acids
38
what is absorption of amino acids in the liver important for?
production of plasma proteins (albumin) and clotting factors
39
what 3 process are conducted in the liver?
glycogenesis, glycogenolysis, and gluconeogenesis
40
why does the liver produce cholesterol?
for steroid hormone production
41
what does the liver degrade for excretion?
alcohol, ammonia (goes to urea for excretion) and hormones
42
what does the liver produce that is important for digestion?
bile
43
what are bile salts/bile acids important for?
bile salts emulsify fats for lipase degradation
44
T or F: the liver produces bile every day
FALSE - 90% of bile is recycled so the liver does not need to produce it every day
45
what is included in bile? hint: 4 things
bile salts/bile acids
bilirubin
cholesterol
electrolytes
46
what is responsible for the pigment in bile?
bilirubin
47
T or F: the pancreas is both an exocrine and endocrine organ
TRUE
48
what is the exocrine function of the pancreas? endocrine?
exocrine = digestion
endocrine = islets of langerhans
**dont ask me what this means bc i dont know lol she just said it so here it is
49
what is in pancreatic juice? where is this released into?
enzymes
bicarbonate
water
released into the first part of the small intestine (duodenum)
50
what enzymes are included in pancreatic juice?
trypsin, chymotrypsin, carboxypeptidase, amylase, and lipase
51
which enzyme(s) in pancreatic juice are responsible for the breakdown of proteins?
trypsin, chymotrypsin, and carboxypeptidase
52
which enzyme(s) in pancreatic juice are responsible for break down of carbohydrates?
amylase
53
which enzyme(s) in pancreatic juice are responsible for break down of lipids?
lipase
54
what organs are part of the lower GI tract?
small intestine and large intestine
55
where does majority of absorption take place?
the small intestine
56
where does digestion end?
the small intestine
57
what does the small intestine produce?
mucus and enzymes
58
where is mucus in the small intestine secreted from?
from goblet cells
needed to neutralize stomach acid (chyme) that is entering
59
what enzymes are produced in the small intestine? what are these needed for?
peptidases, lipases, sucrases, maltases, and lactases - all needed to break down to the smallest nutrients
60
what 3 things does the large intestine absorb?
water, electrolytes, and vitamin K that is produced by own bacteria in large intestine
61
what is "mass movement"?
long, slow, powerful contractions in the large intestine that moves feces into end of large intestine
62
why is fiber important?
increases strength of mass movement
63
what happens when feces enter the rectum?
stretch receptors are stimulated to activate the defecation reflex
stretch receptors send information to the sacral spinal cord which sends parasympathetic motor impulse back to begin peristalsis to allow relaxation of the internal anal sphincter for fecal movement into the anal canal
64
the internal anal sphincter is ____ muscle, while the external anal sphincter is ____ muscle
internal = smooth (involuntary)
external = skeletal (voluntary)
65
the parasympathetic system is controlled through CN ___
CN X (vagus) controls the rest and digest system
66
what is the cephalic phase?
the beginning of secretions and motility
it is triggered by the thought, sight, and smell of food (before you even eat anything)
67
what are 3 important true hormones?
Gastrin
CCK
Secretin
68
what is gastrin, where does it come from, and what does it do?
Gastrin = true hormone secreted from stomach and duodenum
1. stimulates parietal cells (increases secretion of HCl)
2. increases motility
3. relaxes pyloric sphincter
4. relaxes iliocecal valve
69
what is CCK, where does it come from, and what does it do?
CCK (cholecystokinin) = true hormone produced by jejunum and duodenum (SI)
1. inhibits gastric emptying (too much chyme at a time can be harmful to SI)
2. contracts gallbladder
3. stimulates pancreas
70
what is secretin, where does it come from, and what does it do?
secretin = true hormone from duodenum
1. inhibits gastric emptying
2. stimulates pancreatic and biliary bicarbonate
71
what is histamine, where does it come from, and what does it do?
histamine = paracrine from mast cells in GI system
stimulates gastric acid secretion by binding to parietal cells to produce HCl
72
the GI tract absorbs things into ______ cells of mucosa
epithelial cells
73
explain transcellular absorption
absorption through cells
74
explain paracellular absorption
absorption between cells
75
explain transcytosis
peptides are absorbed by being encapsulated
76
explain how amino acids are absorbed
they are co-transported with sodium
77
explain how di- and tripeptides are absorbed
they are co-transported with hydrogen ions and will be converted to amino acids once they are inside the cell
78
how is water absorbed?
through aquaporins
79
what is the most common congenital oral defect?
cleft lip
80
what is a cleft lip? when does it begin forming?
a congenital defect that occurs during the second or third month of gestation when the maxillary processes dont fuse with nasal structures or when the upper lip does not fuse together
81
is a cleft lip multifactorial?
yes
82
do cleft lips occur bilaterally or unilaterally?
can be either
83
explain cleft palate
a congenital disorder that occurs when soft and hard palates do not fuse - nothing separates the oral cavity from the nasal cavity
84
what two things do babies with cleft palates need?
they need a device to feed to ensure milk does not enter the nasal cavity
they need surgical repair
85
what are aphthous ulcers?
inflammatory lesions of small, shallow ulcerations that can be painful - also known as canker sores
86
what causes aphthous ulcers
fever and spicy/hot foods
87
where are aphthous ulcers commonly found?
on the inner cheeks, palate, and lateral or tip of tongue
88
how are apthous ulcers treated?
they will resolve on their own
89
T or F: the oral cavity is subject to opportunistic infection
TRUE
90
what 3 opportunistic infections can occur from resident oral flora?
1. oral candidiasis "thrush" (C. albicans)
2. herpes simplex type 1
3. syphilis
91
what is oral candidiasis? who is at risk?
an opportunistic infection that can occur from C. albicans
those on long-term antibiotics and the immunocompromised (chemotherapy) are at risk
92
is syphilis contagious?
yes - during the first and second stages
93
explain stage 1 syphilis
painless ulcer on tongue, palate, or lip that will resolve in a week or two
94
explain stage 2 syphilis
erythematous, papular lesions on palate that will resolve without treatment in a week or two
95
what are caries?
cavities
96
what causes cavities/caries?
metabolism of sugars in food produce lactic acid which can erode teeth, causing a cavity
97
what is included in peridontium?
gingiva, periodontal ligament, and cementum around teeth
98
what is the socket called that holds teeth in place?
alveoli (like the lungs!)
99
what is the general definition of peridontitis? include what kind of bacteria are involved (G+ or G-, aerobic or anaerobic, and name)
more serious form of peridontal disease where G- anaerobic bacteria become more active.
Porphyromonas gingivalis – secretes toxins and enzymes
100
peridontitis is an infection of _____ and ____ causing....
infection of ligament and bone causing teeth to become loose and fall out
101
what is peridontitis aggravated by?
smoking and poor oral hygiene
102
what is gingivitis?
inflammation of the gums/gingiva due to plaque buildup where they become red, swollen, soft, and begin to bleed
103
what is plaque? (in the oral cavity)
debris and bacteria that stick to teeth by secretions from bacteria
104
what is calculus/tartar? (in the oral cavity)
calcified plaque
105
what causes gingivitis?
brushing teeth too hard can cause pits and grooves in enamel, increasing the risk of gingivitis and plaque formation
106
what is gingival hyperplasia?
overgrowth of gingiva over teeth
107
what can cause gingival hyperplasia?
antiseizure medications and pregnancy
108
what is hyperkeratosis/leukoplakia
epidermal thickening (dental problem)
109
what can hyperkeratosis/leukoplakia progress into?
squamous cell carcinoma
110
what causes hyperkeratosis/leukoplakia? is it painful?
idiopathic - not painful
111
what is the most common cancer of the oral cavity?
squamous cell carcinoma
112
who is most likely to develop squamous cell carcinoma in the oral cavity?
those over 40 years old and smokers
113
where is oral squamous cell carcinoma typically found?
floor of mouth or lateral tongue
114
what is the prognosis like for oral squamous cell carcinoma?
poor prognosis - it metastasizes very quickly to lymph nodes in the neck
115
what is sialadenitis?
inflammation of the salivary glands
116
what is inflammation of the parotid gland called? what type of disease is this?
parotitis (is a type of sialadenitis)
117
what is another name for infectious parotitis?
mumps
118
what type of infection is mumps?
viral infection of a myxovirus
119
is parotitis painful?
very!
120
what is responsible for the rise of mumps?
anti-vaxers choosing to not vaccinate their children
121
what is the main issue with mumps that caused a large push for vaccine?
men will become infertile as they age (moves to testes in 50% of men)
122
what is dysphagia?
difficulty swallowing
123
what are causes of dysphagia? hint: there are 8
infection
stroke
brain damage
achalasia
congenital atresia
stenosis of esophagus
diverticula
esophageal tumors
124
what is achalasia?
when the lower esophageal sphincter does not open/opens slowly, food will accumulate in the esophagus, causing an inflammatory process and dysphagia
125
what is congenital atresia?
separation of upper and lower esophagus causing dysphagia (requires immediate surgery)
126
what is stenosis of the esophagus?
congenital or acquired scar tissue from chemo/inflammation that contracts and causes a smaller lumen causing dysphagia
126
does stenosis of the esophagus require surgery?
depends on width of the lumen
127
what is diverticula?
outpouchings/outgrowth of a wall
128
explain diverticula of the esophagus.
pouches form in the wall of the esophagus which can accumulate food causing dysphagia and inflammation, which can eventually lead to fibrosis and stenosis
129
what are signs of diverticula in the esophagus?
regurgitating or aspirating food that is stuck in diverticulum
hoarse voice
frequent coughing
feeling as though you are not swallowing food
130
do internal or external esophageal tumors cause dysphagia? explain.
both can create narrowing of the lumen
131
what can cause esophageal cancer?
inflammation
hiatal hernias (common cause because it causes long-term inflammation)
alcohol abuse
132
what is a hiatus?
opening in the diaphragm (i eat apples at 8 10 and 12!!!!!!!!!)
133
what causes hiatal hernias?
increased abdominal pressure (pregnancy)
congenitally short esophagus
134
what are signs and symptoms of hiatal hernias?
heart burn
dysphagia
sour taste in mouth (from reflux)
135
what are the two types of hiatal hernias?
sliding hiatal hernia
paraoesophageal/rolling hernia
136
what is the most common type of hiatal hernia?
a sliding hiatal hernia
137
explain a sliding hiatal hernia
a sliding hiatal hernia occurs when the cardiac sphincter and part of the stomach slides through the diaphragm
it will slide back into place as the patient lies supine
138
explain a paraoesophageal/rolling hernia
a paraoesophageal/rolling hernia occurs when majority of the fundus of the stomach is above the diaphragm. it will not slide back into place
139
what does GERD stand for?
gastroesophogeal reflux disease
140
what causes GERD?
hiatal hernias
decrease in lower esophageal pressure
increase in abdominal pressure
141
what are irritants that can cause a decrease in lower esophageal sphincter pressure which can aggravate GERD?
caffeine
smoking
fatty foods
142
how quickly can irritants cause reflux?
within an hour
143
with GERD, what can happen?
inflammatory process can cause ulcers, fibrotic tissue, and cancer in the esophagus
144
what is gastritis?
inflammation of the gastric mucosa
145
what is acute/erosive gastritis?
mucos becomes inflamed, edemetous, and will have shallow ulcerations (only in mucosa)
146
what causes acute/erosive gastritis?
infection
radiation/chemo
aspirin use
overusage of nonsteroidals
alcohol
147
what are signs of acute/erosive gastritis?
nausea and vomiting
pain
148
how is acute/erosive gastritis resolved?
once the trigger is taken away, it will heal
149
what is chronic/atrophic gastritis?
atrophy of all mucosal layers that causes loss of chief, parietal, and G cells, resulting in no digestion
150
T or F: chronic/atrophic gastritis is thought to be an autoimmune disease
TRUE
151
what is gastroenteritis?
inflammation of intestines due to infection
152
how is gastroenteritis transmitted?
through food and water
153
if gastroenteritis is in the stomach, what are signs and symptoms?
nausea and vomitting
154
if gastroenteritis occurs in the intestines, what are the signs and symptoms?
diarrhea
155
who is gastroenteritis common for?
common for children in daycare
156
can gastroenteritis cause mortality?
for children in 3rd world countries yes
157
how is gastroenteritis resolved?
if mild - will run its course or need IV fluids
if from E. coli - is more serious
158
Enterotoxigenic E. coli (ETEC) causes....
traveler's diarrhea
159
Enteroinvasive E. coli (EIEC)...
penetrates and destroys epithelial cells of colon causing severe fever and diarrhea
160
Enteroaggregative E. coli (EAggEC) causes....
mild diarrhea (usually in children)
161
are peptic ulcers more common in men or women?
men
162
where are gastric peptic ulcers located?
in the antrum of stomach or lesser curvature near cardiac region
163
what is the general cause of gastric peptic ulcers?
breakdown of mucosal barrier
164
what can cause breakdown in mucosal barrier ultimately leading to gastric peptic ulcers?
1. blood supply decrease to epithelial cells causing cell death
2. chronic gastritis
3. medications - aspirin, NSAIDs, etc.
4. H. pylori
165
where do duodenal peptic ulcers occur?
the proximal duodenum
166
what is the general cause of duodenal peptic ulcers?
overproduction of HCl
167
what is a peptic ulcer?
a single, round erosion with smooth margins
168
T or F: peptic ulcers can penetrate submucosa and muscle layer
TRUE
169
what can increase HCl eventually leading to a duodenal peptic ulcer
1. congenitally can be born with more parietal cells which will secrete more HCl
2. increase in gastrin will trigger more parietal cells
3. issue with pyloric sphincter will allow faster stomach emptying into the duodenum *duodenum cannot secrete enough bicarbonate fast enough*
4. alcohol and caffeine abuse
170
how does H. pylori cause a peptic ulcer?
bacteria can release cytokines and enzymes to break down stomach
171
how can you treat a peptic ulcer caused by H. pylori?
antibiotics
172
how can you treat a peptic ulcer?
1. medications that decrease acid productions
2. coating agents
3. surgery for bleeding ulcer or peritonitis
173
how can you confirm a peptic ulcer?
endoscopy or barium x-rays
174
how can a peptic ulcer develop into a bleeding ulcer?
if it erodes into the blood vessel it becomes a bleeding ulcer
175
what is peritonitis?
stomach contents emptying into the peritoneum
176
what are signs and symptoms of peptic ulcers
1. pain (2-3 hours after a meal or at night)
2. nausea
177
what causes stress ulcers?
major burns, brain damage/head injury
178
what is a stress ulcer?
body compensates by shunting blood to other areas that need compensation. the blood shunt is so drastic and complete, the epithelial cells lose blood supply, and the ulcer forms
179
what is a curling ulcer from?
major burns (3rd degree)
180
what is a cushing's ulcer from?
head injury
181
where are the 3 most common areas that gastric carcinoma occur?
pyloric region
lesser curvature area of stomach
duodenum
182
T or F: gastric carcinomas are on the decline in the US
true - we have been able to catch them earlier
183
what is the most common gastric carcinoma?
adenocarcinoma
184
what is the difference in appearance between ulcers and adenocarcinoma?
margins on ulcers are smooth, whereas adenocarcinoma's are not
185
explain the early stage of gastric adenocarcinoma
it only affects mucosa and submucosa
186
if caught in the early stage, what is the survival rate of adenocarcinoma?
78%
187
explain the late stages of gastric adenocarcinoma?
it can rupture through the serosa, metastasize to lymphnodes, and can spread to ovaries in women
188
if caught in the late stage, what is the survival rate of gastric adenocarcinoma?
8%
189
what are signs and symptoms of gastric adenocarcinoma?
nausea, heartburn, feeling full after a meal
190
what are risk factors for gastric adenocarcinoma?
H. pylori
eating foods with preservatives
blood group A
191
what are treatments for gastric adenocarcinoma?
gastric resection
chemo and radiation
192
what is cholethiasis?
gallstones
193
what is the primary cause of gallbladder disease?
cholethiasis (gallstones)
194
is cholethiasis asymptomatic?
usually - if they are small
195
what is cholecystitis?
inflammation of gallbladder and cystic duct
196
what is cholangitis?
inflammation and infection of bile duct
197
what are signs and symptoms of gallbladder disease?
nausea post meal
severe RUQ pain (with inflammation and infection)
198
what is choledocholithiasis?
gallstones blocking entire billiary tract
199
what are risk factors for gallbladder disease?
female, over age of 40
diets high in fatty foods
previous pregnancy
200
what are white gallstones comprised of?
cholesterol with or without calcium
201
what are brown or black gallstones comprised of?
cholesterol with or without calcium and contain BILIRUBIN
202
what is the average size of a gallstone?
around the size of a small pebble
203
where can gallstones/colelithiasis form?
in the gallbladder, cystic duct, and bile ducts
204
how can gallstones cause pancreatitis?
if it blocks the pancreatic duct or sphincter of oddi
205
what can cause gallstones? (hint 2 things)
1. decreased contraction will cause bile to not be excreted. this will concentrate the bile, causing precipitation and forming gallstones
2. high cholesterol diet
206
what is the function of the gallbladder?
to store and concentrate bile
207
what is the treatment for gallstones?
cholecystectomy - remove the gallbladder (microscopic surgery)
208
T or F: jaundice/icterus is a disease itself
FALSE: it is not a disease itself, it is an indicator something else is wrong in the body
209
what is bilirubin a product of?
breakdown product of heme
210
how is jaundice/icterus caused?
an accumulation of bile not excreting from body
211
visually, how can you tell if someone has jaundice/icterus?
yellow discoloration of the skin and/or sclera of the eyes
212
prehepatic jaundice is also known as...
hemolytic jaundice
213
what is prehepatic/hemolytic jaundice caused from?
breaking down of RBC - like from a bad transfusion or hemolytic anemia
214
in prehepatic/hemolytic jaundice, is there something wrong with the liver?
no, but the liver cannot deal with the excess bilirubin
215
what is intrahepatic jaundice caused from?
due to liver disease (like hepatitis) which destroys the hepatocytes so bile cannot be made, and bilirubin will accumulate
216
what is another term for posthepatic jaundice?
obstructive jaundice
217
what causes posthepatic/obstructive jaundice
gallstones block ducts, causing obstruction and bile accumulation in the liver
218
when will you see steatorrhea? what is it?
fatty stools (light color) will be seen when fats cannot be emulsified aka when no bile is produced or released as seen in posthepatic/obstructive jaundice
219
what happens in posthepatic/obstructive jaundice that causes pruritis?
obstruction of bile duct will cause bile to back up in the liver. As this happens, excess bile will be released into the tissues, aggravating the integumentary system, causing itching
220
what is the treatment for jaundice?
UV light treatment converts bile into water soluble isomers so it can be excreted quicker
also - find and treat the cause!
221
what is acute hepatitis?
severe inflammation of the liver, causing death of hepatocytes by necrosis or apoptosis
222
what causes acute hepatitis?
1. idiopathic
2. drugs
3. poisons
4. virus (most common)
223
what viruses cause acute hepatitis?
1. CMV - cytomegalo virus
2. epstein-barr
3. Hep A, B, C, D, and E (most common)
224
when someone is infected with hepatitis, how does it damage the body?
the virus directly targets hepatocytes, and the body's immune response also damages hepatocytes
225
how can hepititis cause jaundice?
loss of hepatocytes can cause the liver to swell and can cause loss of function, so the bile cannot leave and will accumulate in the liver
226
what is fulminant hepatitis?
when acute hepatitis progresses to massive necrosis and liver failure
227
can hepatocytes regenerate if acute hepatitis resolves?
yes! if not, scar tissue will eventually block hepatic ducts
228
what is another name for hepatitis A?
infectious hepatitis
229
is hepA an RNA or DNA virus?
RNA
230
how does hepA affect the liver? (hint is it direct or not?
it directly destroys hepatocytes which stimulates a cell mediated immune response
231
how is HepA transmitted?
through the fecal/oral route from infected water or shellfish
232
how long is the incubation period for Hep A?
2-6 weeks
233
what are symptoms like in HepA?
mild
234
what antibodies spike first and second with HepA?
IgM first, then IgG
235
what is another name for Hep B?
serum hepatitis
236
what is the second most common hepatitis virus?
HepB
237
how is HepB so easily transmitted?
80% are asymptomatic allowing easy transmission
238
is HepB an RNA or DNA virus?
DNA
known as dane particle - idk what this means lol she just said it
239
which hepatitis is very complex and needs 3 antigens? what are these antigens?
hepatits B needs 3 antigens - HBcAg, HBeAg, and HBsAg
C, E, S
240
how long is the incubation period in hepatitis B?
8-10 week long incubation period
241
how is HepB transmitted?
sexual contact, blood, and other bodily fluids
242
how does Hep B destroy the liver? (hint is it direct or not?
the body's immune response destroys hepatocytes (not direct)
243
which hepatitis is most common?
Hep C
244
which hepatitis is second most common?
Hep B
245
which hepatitis commonly develops into chronic hepatitis?
in hepatitis C, 60-85% will develop into chronic hepatitis
246
how is Hep C transmitted?
by blood and bodily fluids
247
which hepatitis runs a high risk for liver cancer?
Hep C
248
is Hep C an RNA or DNA virus?
RNA
249
what is Hep D also known as?
the Delta agent
250
which Hep is known as an incomplete RNA virus?
Hep D
251
how is hepatitis D transmitted? who is it common among?
easily transmitted by blood - seen among drug users
252
if Hep D does not have HbS antigen, it will not be _______
infectious
253
is Hep E an RNA or DNA virus?
RNA virus
254
how is Hep E spread?
fecal/oral route
255
which hepatitis is dangerous to pregnant woman, causing liver failure?
Hep E
256
what are the 3 stages of acute hepatitis?
1. prodromal/pre-icteric stage
2. icteric stage
3. convalescent/post-icteric stage
257
how long is the prodromal/pre-icteric stage of acute hepatitis?
3-4 days
258
what are the symptoms of prodromal/pre-icteric stage of acute hepatitis?
fatigue, fever, headaches, joint pain
259
what liver enzyme levels increase within 24 hours during the prodromal/pre-icteric stage of acute hepatitis?
AST and ALT
260
how long is the icteric stage of acute hepatitis?
1-4 weeks
261
which stage of acute hepatitis does jaundice occur?
the icteric stage
262
in the icteric stage, what accumulates?
bilirubin, bile, and bile salts
263
what 4 things can happen during the icteric stage?
1. when bile doesnt flow, steatorrhea occurs
2. when bile salts accumulate, pruritis occurs
3. hepatomegaly
4. splenomegaly
264
what occurs during the convalescent/post-icteric stage of acute hepatitis?
gradual decrease in signs and symptoms
265
what are the 3 treatments for acute hepatitis?
rest, good nutrition, and interferon A
266
what is interferon A, and what is it used to treat? does it work?
treats hepatitis B and C to decrease how fast the virus replicates
only works in 40% of patients
267
how does chronic hepatitis occur?
occurs when Hep B, C, and D create continuous inflammation and necrosis of the liver for more than 6 months causing the liver to become fibrotic
268
what are 2 high risk diseases with chronic hepatitis?
cirrhosis of liver and liver cancer
269
what is toxic hepatitis?
inflammation and necrosis of liver due to certain chemicals and drugs
270
how does toxic hepatitis affect the liver? (hint: is it direct or not?)
Toxic hep directly destroys hepatocytes and inflammation destroys hepatocytes (direct and indirect)
271
which 2 medications have warning for liver damage (toxic hepatitis)? what must you do if a patient is on one of these medications long-term?
acetaminophen and tetracycline
monitor liver enzymes!
272
what is cirrhosis of the liver?
progressive liver destruction - extremely chronic liver disease
273
is cirrhosis progressive?
yes
274
which disease causes 80-90% of the liver to be destroyed, resulting in liver failure?
cirrhosis
275
what physical changes occur to the liver with cirrhosis?
1. lobules become destroyed
2. nodules form (nodular liver),
3. the fibrosis destroys the blood vessels
4. hepatomegaly, then the liver becomes smaller
276
what 2 things can cause cirrhosis?
chronic hepatitis and alcohol
277
what can chronic alcohol usage lead to?
alcohol liver disease
278
chronic overuse of alcohol can cause destruction of _________
hepatocytes
279
how many stages are there in alcohol liver disease?
3
280
explain stage 1 of alcohol liver disease. include duration
fat infiltrates the liver causing "fatty liver", which can eventually lead to hepatomegaly.
can continue for months
281
if alcohol consumption is stopped during stage 1 of alcohol liver disease, can the liver repair itself?
yes
282
explain stage 2 of alcohol liver disease
inflammation, necrosis, and irreversible fibrosis occurs
this is when the patient becomes symptomatic
283
explain stage 3 of alcohol liver disease
this is end stage cirrhosis where there is no liver function left
284
cirrhosis cause decreased bile excretion. what will this do to digestion?
fat will not be able to be digested
285
cirrhosis can cause decreased detoxification of _____ and ______
drugs and alcohol
286
cirrhosis causes decreased production of ______ ______ and ______ _______
plasma proteins and clotting factors
287
cirrhosis will cause decrease in ____ _______ ______ absorption
fat soluble vitamin
288
cirrhosis will cause decreased storage of ____ and ______
iron and glycogen
289
the liver is supposed to convert ammonia to urea for excretion. with cirrhosis, the increase of ammonia will cause what?
will affect the CNS, causing hepatic encephalopathy
290
what will happen when cirrhosis causes hepatic encephalopathy?
tremors and confusion are likely
291
what can happen if cirrhosis causes fibrosis that obstructs bile ducts and blood vessels? (hint: 4 things. think about which veins will be affected!)
1. blood accumulation in hepatic portal vein will cause portal hypertension
2. blood accumulating and moving into the splenic vein can cause splenomegaly
3. fluid can infiltrate the peritoneum causing ascites
4. blood will flow back into superficial esophageal veins causing varicose veins/esophageal varices
292
as food passes through the esophagus in someone with esophageal varices, what can happen?
it can cause rupture and bleeding, which can lead to hypotensive shock. this is a surgical emergency.
293
T or F: cirrhosis allows the individual to be subject to infection
true
294
what are the beginning signs of cirrhosis?
fatigue
diarrhea
dull ache in RUQ
295
what are progressive signs of cirrhosis?
ascites causing large abdomens
edema
jaundice
ruptured varices
tremors
confusion
296
how can cirrhosis cause an enlarged abdomen?
blood will move backwards and build up causing pressure and forcing fluid to move into the peritoneum which can enlarge the abdomen
297
what are the treatments for cirrhosis?
1. decrease fat in diet
2. liver transplant (ethical question)
3. diuretics (to decrease ascites)
4. antibiotics
298
what is the most common primary liver tumor?
hepatocellular carcinoma
299
is liver cancer more likely to be due to secondary or primary tumors?
more common as secondary tumors
300
what is hepatocellular carcinoma caused from?
cirrhosis
301
______megaly can occur with hepatocellular carcinoma
splenomegaly
302
what is the treatment for liver cancer?
chemo
303
what is acute pancreatitis?
pancreas destroys itself by autodigestion of tissues
304
is acute pancreatitis a medical emergency?
yes
305
during acute pancreatitis, _______ are activated in the pancreas instead of the duodenum. this causes _____ of pancreatic tissue
proenzymes, erosion
306
In acute pancreatitis, erosion of pancreatic tissue can be so bad, it can digest the thin ______ surrounding the pancreas. What does this cause?
capsule
this can allow enzymes to escape into the peritoneum which can digest other organs
307
what can inflammation cause in acute pancreatitis?
1. peritonitis
2. vasodilation and increased capillary permeability which will allow blood to leave the capillaries, causing hypovolemia (can lead to hypovolemic shock)
308
what are 2 common risk factors for acute pancreatitis?
alcohol consumption and biliary tract obstruction by gallstones
309
how can alcohol consumption cause acute pancreatitis?
alcohol increases enzymes produced by the pancreas
310
how can biliary tract obstruction by gallstones cause acute pancreatitis?
gallstones block pancreatic duct, causing build up of enzymes in the pancreas as they cannot leave
311
what are signs and symptoms of acute pancreatitis? what is usually the first to occur?
1. severe radiating pain into back (first)
2. low grade fever
3. hypotension
4. amylase levels are very high within 24 hours
312
what are the treatments for acute pancreatitis? how must it be administered?
fluids to escape hypovolemia
must all be by IV - nothing by mouth
find and treat cause!
313
what is the leading cause of pancreatic cancer?
cigarette smoking
314
what is the most common type of pancreatic cancer?
adenocarcinoma
315
if a tumor is in the head of the pancreas, what will be blocked? what does this cause?
the bile duct will be blocked, blocking pancreatic flow and pancreatic enzymes
this causes an issue with digestion
316
if a tumor is in the tail or body of the pancreas, what can happen?
the patient will usually be asymptomatic until metastasis has occurred
317
where will a tumor in the tail or body of the pancreas likely metastasize to?
the liver (quickly), and the stomach
318
is pain severe or dull with pancreatic cancer
severe
319
if pancreatic adenocarcinoma is found early, what can be done for treatment?
remove the tumor
320
why is mortality rate 95% for pancreatic adenocarcinoma?
symptoms usually develop after metastasis, making detection too late
321
what is celiac disease also known as? (two other names)
celiac sprue or gluten enteropathy
322
what causes celiac disease?
its genetic - they lack the enzyme that digests gliadin
323
what is gliadin?
breakdown product of gluten that is not digested in celiac disease
324
what physical changes occur to the intestine with celiac disease? what does this physical change cause?
vili atrophy causing loss of digestive enzymes and surface area for digestion and absorption
this leads to malabsorption and malnutrition
325
when is celiac disease usually recognized? (hint - when will it first be noticed by parents?)
around 4-6 months of age when weening from breast milk to real food
326
what symptoms may parents notice in their child that can indicate celiac disease?
1. failure to thrive - their child will not gain adequate weight
2. irritability
3. vomiting
4. muscle wasting
327
how may celiac disease be diagnosed?
1. antibodies in serum
2. duodenal biopsy
328
what is the treatment for celiac disease?
1. gluten free diet
2. will need to use corn and rice instead of cereal and wheat/gluten
329
if the correct diet is followed for celiac disease, can the intestinal vili return?
yes
330
what two diseases are included in chronic inflammatory bowel disease?
ulcerative colitis and Chron's
331
explain the genetic component associated with chronic inflammatory bowel diseases
many patients have antibodies and cytokine interleukin against their mucosa
332
T or F: patients with UC or Chron's usually have another disease - such as arthritis or ankylosing spondylitis - combined with their chronic inflammatory bowel disease
TRUE
333
what is ankylosing spondylitis?
arthritis in the spine
334
do chronic inflammatory bowel diseases affect both men and women?
yes
335
how do chron's and UC differ in terms of when they usually begin to present?
Chron's shows up in teen years, while UC shows up between 20 and 40
336
T or F: Chron's and UC are known for having periods of remission and stress triggered exacerbation
true
337
what are 2 other names for Chron's disease?
regional ileitis or regional enteritis
338
where is Chron's disease usually located?
the ilium or lower colon
339
explain skip lesions seen in Chron's disease
diseased areas and normal tissue are next to each other/alternate continually
340
where does inflammation begin in chron's disease? (hint: which layer?)
the mucosa
341
when multiple Chron's disease ulcers combine and degrade down into tissue, what does that create?
fistulas
342
explain the cobblestone effect seen in Chron's disease.
thick and normal areas are both apparent next to each other
343
if all layers of the intestine are affected in Chron's disease, what will happen? (hint: one word!)
obstruction
344
can lymph nodes become damaged in Chron's disease?
yes
345
digestion and absorption are decreased with chron's disease, what can this cause?
malnutrition and anemia which lead to weight loss and growth delay
346
what causes diarrhea with cramping and tenderness with chron's disease?
increased motility
347
T or F: melena will not occur with Chron's disease
false! bleeding ulcers can cause blood in stool
348
where does inflammation begin and progress to in UC?
Inflammation begins at anal rectal junction and progresses proximally
349
UC differs from Chron's in that with UC only the ____ is affected
mucosa
350
high levels of _____ are found throughout the epithelial cells of mucosa in UC
neutrophils
351
in UC, there is a decrease in absorption of ____ and _____
water and electrolytes
352
what is a toxic megacolon seen in UC
decreased peristalsis and motility cause feces to accumulate in the transverse colon
toxic from feces
megacolon from swelling
353
what are 3 symptoms of UC
diarrhea
cramping
anemia (from decreased absorption)
354
what are the treatments for UC?
1. treat trigger
2. colonostomy
3. ileostomy
4. anti-inflammatories or immunosuppressives (azathioprine -Imuran)
5. antidiarrheals and antibiotics
355
azathioprine (imuran) is used to treat....
UC - it is an immunosupressive
356
who is IBS most commonly seen in?
young and middle-aged women
357
what is the cause of most GI doctor visits in the US?
IBS
358
what are signs and symptoms of IBS?
diarrhea, constipation, and abdominal pain with no reason for it
359
what are causes of IBS?
1. Enteric nervous system in GI that becomes overactive/oversensitive
2. Linked to stress
3. Increase in T cells
4. Food allergies
360
how is IBS diagnosed?
exclusion
361
what are the treatments for IBS?
antidiarrheals and laxatives
analgesics if abdominal pain is severe
362
what is appendicitis?
inflammation of vermiform appendix at the distal end of colon
363
who is appendicitis common for?
children/the very young
364
how does appendicitis begin?
Begins with obstruction of appendix by feces or spasms that twists appendix
spasms more common in children
365
when the appendix is blocked off by feces, what happens?
it will fill with fluid and cause an overgrowth of microorganisms
366
what can inflammation from appendicitis lead to?
edema, erythema, pustular exudate, and compromised blood vessels
367
how does appendicitis cause ischemic and gangrenous tissue?
inflammation can compromise the blood vessels, decreasing blood flow
368
if inflammation causes increased permeability from appendicitis, what will occur? what other organ can this damage?
permeability allows for fecal bacteria to leak out, causing it to enter the peritoneum (peritonitis). this can even damage the liver!
369
if a patient has appendicitis and dies, what is it likely that they ultimately died from?
the peritonitis, not the appendicitis itself
370
what is typically the first sign of peritonitis?
hard abdomen - like a board
371
list the symptoms of appendicitis
1. Periumbilical pain
2. Nausea and vomiting
3. Diarrhea
4. Fever
5. Pain will migrate to RLQ
6. First sign of peritonitis – hard abdomen (like a board)
7. Leukocytosis
8. Tachycardia
9. Hypotensive
372
why may someone with appendicitis have a sudden relief in pain? does this relief last?
When it ruptures, will have short relief of pain, but will become worse again from peritonitis
373
what are 2 treatments for appendicitis?
antibiotics and surgery
374
is diverticular disease in intestines congenital or acquired?
can be either
375
where is 95% of diverticular disease in the intestines located?
the descending and sigmoid colon
376
what is diverticulosis?
multiple diverticula
377
is diverticulosis in the intestines asymptomatic?
yes
378
what is diverticulitis of the intestines?
inflammation from feces becoming trapped in diverticula
379
where will diverticula occur in the intestines?
in the weakest part of the wall - anywhere near the taeniae coli
380
what is the taeniae coli of the intestines?
three separate longitudinal ribbons of smooth muscle on the outside of the colon
381
what is constipation caused from?
low fiber diet
382
how can constipation affect the intestines?
it will cause pressure, muscle hypertrophy, and eventually herniation
383
T or F: most people do not develop bleeding associated with diverticulitis of the intestines
FALSE
384
what are symptoms of diverticular disease in the intestines?
LLQ pain
nausea
vomiting
385
what are treatments for diverticular disease of the intestines?
increase fiber in diet
if bleeding - will need hospitalization
386
what is the second leading cause of cancer death in the US?
colorectal cancer
387
what age group is more likely to develop colorectal cancer?
those over 50
388
what physical characteristics are presented with colorectal cancer? what can this lead to?
multiple polyps which can protrude into and block the large intestine
389
where is colorectal cancer most commonly seen? (what part of the intestines?)
ascending, descending, and sigmoid colon, and colon
390
T or F: colorectal cancer can grow into and obstruct the lumen
TRUE
391
what are causes of colorectal cancer
1. Genetic factor
2. UC
3. Red meat eaters
4. High sugar diet
5. Low fiber diet
392
colorectal cancer symptoms depend on _____
location
393
T or F: symptoms of colorectal cancer are extreme in the beginning
FALSE: symptoms may be vague, but will increase when cancer advances
394
what are the treatments for colorectal cancer?
1. Colon removal
2. Colostomy bag to collect feces
3. Chemo and radiation
