GI Flashcards
Explain the structure and function of the digestion system
Digestion begins in the mouth with chewing which breaks down food mechanically and mixes it with saliva. Swallowing propels chewed food through the esophagus to the stomach, where acids and stomach motility liquefy it further. Next the liquefied food enters the small intestine, where secretions of the intestinal walls, liver, gallbladder, and pancreas digest it into absorbable nutrients. Nutrients are absorbed through intestinal walls, and unabsorbed wastes enter the large intestines (colon), where fluids are removed. Solid wastes then enter the rectum and leave the body through the anus.
Explain the structure and function of the digestion system
Digestion begins in the mouth with chewing which breaks down food mechanically and mixes it with saliva. Swallowing propels chewed food through the esophagus to the stomach, where acids and stomach motility liquefy it further. Next the liquefied food enters the small intestine, where secretions of the intestinal walls, liver, gallbladder, and pancreas digest it into absorbable nutrients. Nutrients are absorbed through intestinal walls, and unabsorbed wastes enter the large intestines (colon), where fluids are removed. Solid wastes then enter the rectum and leave the body through the anus.
Digestion begins in the __ and what is the function?
mouth with chewing which breaks down good mechanically and mixes it with saliva.
Swallowing propels ___ ___ through the ___ to the ____ and has what function?
chewed foods, esophagus, stomach
where acids and stomach motility liquefy it further
Liquefied food enters the __ ___ and has what function?
where secretions of the intestinal walls, liver, gallbladder, and pancreas digest it into absorbable nutrients.
Nutrients are absorbed through _____ ____ and unabsorbed wastes enter the ___ ___ where ___ are removed.
small intestines large intestines (colon) liquids
Solid wastes then enter the ____ and leave the body through the ____.
rectum and leave the body through the anus
Sites of absorptions of major nutrients: Stomach
Water
alcohol
Sites of absorptions of major nutrients: duodenum (S SIP CF WVM)
iron, calcium, fats, sugars, water, proteins, vitamins, magnesium, sodium
Sites of absorptions of major nutrients: Jejunum
Sugars, Proteins
Sites of absorptions of major nutrients: Ileum
bile salts, vitamin B12, chloride
Sites of absorptions of major nutrients: Colon
water, electrolytes
In the stomach, do you absorb water or lose water?
both
In the stomach, do you absorb water or lose water? Why
If some fluid is hypotonic (sports drinks) , the stomach will get rid of some water to make the stomach fluid isotonic and if something makes the fluid in the stomach hypertonic (saltines) then the stomach will absorb more water to make the fluid isotonic.
What are the 3 main categories of diseases of the esophagus?
anatomical and motor disorders
esophagitis
esophageal cancer
Esophagus: anatomical and motor disorders
hiatal hernia
achalasia
esophageal varices
Esophagus: esophagitis
GERD (reflux esophagitis
Barret esophagus
Esophagus: esophageal cancer
Squamous cell carcinoma
- alcohol, tobacco, achalasia, very hot tea
Adenocarcinoma
- barret esophagus
What is the most common type of hiatal hernia?
sliding
What are the two types of hiatal hernia?
sliding and hiatial paraesophageal hernia (rolling)
Hiatus means?
break
What is a break in the diaphragm where the esophagus goes through?
hiatial paraesophageal hernia (rolling)
The stomach goes through this type of hernia?
hiatial hernia
Achalasia and the hiatal hernias have these s/s…
heartburn, regurgitation
heartburn, regurgitation are associated with …
achalasia and hiatal hernia
regurgitation is more associated with (~95%)
sliding hernia
Achalasia has the loss of
intrinsic inhibitory innervation of LES
Achalasia has the loss of intrinsic inhibitory innervation of LES: _____, ___ ____ of LES, ___ ___ ___ of LES
Aperistalis, incomplete relaxation of LES, increased resting tone of LES
Achalasia: problems
dysphagia, mucosal inflammation and ulceration, squamous cell carcinoma (5%)
What happens in achalasia?
the lower esophageal sphincter fails to relax
When you bite off a normal sized amount of food but the lower esophageal sphincter doesn’t open appropriately, the bolus will get stuck due to the lower esophageal sphincter failing to relax. This describes?
Achalasia
The first s/s you will notice with achalasia is
dysphagia
The second s/s you will notice with achalasia is
mucosal inflammation and ulceration
dysphagia (1st)
iF ACHALASIA goes on long enough you will develop…
squamous cell carcinoma
dysphagia (1st)
mucosal inflammation and ulceration (2nd)
Esophageal Varices is what?
dilated submucosal veins (varices)
What is the cause of esophageal varices?
impaired hepatic portal blood flow
Esophageal Varices: Impaired hepatic blood flow is associated with __ ___ and ~2/3 of ___ patients
alcoholic cirrhosis, cirrhosis
What is the problem with Esophageal varices?
rupture
Esophageal Varices: Problems
hematemesis,
20-30% die on each episode
70% recurrence rate
What is the recurrence rate with esophageal varices?
70%
Reflex esophagitis: GERD is what?
LES opening allowing reflux of liquid and contents into the esophagus
What are the contributing causes to gerd?
obestity
hiatal hernia
vagal nerve abnormalities
What are the problems with GERD?
heartburn, Barret’s esophagus
What is the cause of Barret’s esophagus?
GERD
What is the problem with Barret’s esophagus?
Adenocarcinoma
What are the two types of tissues in Barret’s esophagus?
normal stratified squamous mucosa
Columnar epithelium
Barret esophagus: Replacement of normal __ __ __ with metaplastic __ __ with __ __
stratified squamous mucosa with metaplastic columnar epithelium with goblet cells
Goblet cells do protect the lining from?
gastric contents
Esophageal cancer: what two tissues are associated with it?
squamous cell carcinoma
Adenocarcinoma
Esophageal cancer: Squamous cell carcinoma occurs where at in the esophagus?
higher up
Esophageal cancer: Squamous cell carcinoma occurs from?
tobacco, alcohol, achalasia, very hot tea >65 degrees Celsius
Esophageal cancer: Adenocarcinoma is more common in the
USA
Esophageal cancer: Adenocarcinoma: cause
barret’s esophagus
S/S of esophageal cancer and occur when in cancer progression?
dysphagia and obstruction
occur late in cancer progression
Esophageal cancer: Adenocarcinoma: occurs where in the esophagus?
lower part near the opening of the stomach
What are the 3 main diseases associated with the stomach?
gastritis, gastric ulceration, stomach cancer
Stomach: Gastritis: types
Chronic (H. Pylori)
Acute
Stomach: Gastric Ulceration: Types
Peptic ulcers, Acute gastric ulceration
Stomach: Stomach cancer: types
gastric carcinoma
Chronic gastritis will lead to
peptic ulcers
Acute gastritis will lead to
acute gastric ulceration
The stomach is __ and __. It wants a lot of __ __ b/c __ __ will only act at surface area. The duodenum raises the __. If the pH is not high enough, it will tell the stomach to __ __ and is basically controlling __ __.
The stomach is muscular and resilient. It wants a lot of surface area b/c digestive enzymes will only act at surface area. The duodenum raises the pH. If the pH si not high enough, it will tell the stomach to slow down and is basically controlling stomach emptying.
Of the stomach mucosa, what are the most important cells?
Gastric glands: mucous neck cells, parietal cells, chief cells, endocrine cells
Gastric pits are __ in teh ___ lining of the stomach. At the __ of each pit is one or more __ __ __. __ __ produce the enzymes of __ __, and __ __ produce __ __.
Gastric pits are depressions in the epithelial lining of the stomach. At the bottom of each pit is one or more tubular gastric glands. Chief cells produce the enzymes of gastric juice, and parietal cells produce stomach acid.
Hydrocholric acid secretion by parietal cell:
What are the three main elements in the blood?
CO2, HCO3-, Cl-
Hydrocholric acid secretion by parietal cell: What are the three main elements in the stomach lumen?
K+, H+, Cl-
Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens when CO2 from the blood enters the cell?
CO2 -> CO2 + H20 -> H2CO3
I I
V V
HCO3 (blood) H2O
Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens when HCO3- from the blood enters the cell?
HCO3 goes back into the blood via a (HCO3-/Cl-) transporter
Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens when Cl- from the blood enters the cell?
Cl- goes into the cell via a( HCO3-/Cl-) transporter and then goes straight to the stomach lumen
Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens with H20?
H2O I \ V V OH- H+(exits p.cell into stomach lumen via k+/h- transpor I V H2O
Most common chronic problem is in the?
stomach
Digestion begins in the __ and what is the function?
mouth with chewing which breaks down good mechanically and mixes it with saliva.
Swallowing propels ___ ___ through the ___ to the ____ and has what function?
chewed foods, esophagus, stomach
where acids and stomach motility liquefy it further
Liquefied food enters the __ ___ and has what function?
where secretions of the intestinal walls, liver, gallbladder, and pancreas digest it into absorbable nutrients.
Nutrients are absorbed through _____ ____ and unabsorbed wastes enter the ___ ___ where ___ are removed.
small intestines large intestines (colon) liquids
Solid wastes then enter the ____ and leave the body through the ____.
rectum and leave the body through the anus
Sites of absorptions of major nutrients: Stomach
Water
alcohol
Sites of absorptions of major nutrients: duodenum (S SIP CF WVM)
iron, calcium, fats, sugars, water, proteins, vitamins, magnesium, sodium
Sites of absorptions of major nutrients: Jejunum
Sugars, Proteins
Sites of absorptions of major nutrients: Ileum
bile salts, vitamin B12, chloride
Sites of absorptions of major nutrients: Colon
water, electrolytes
In the stomach, do you absorb water or lose water?
both
In the stomach, do you absorb water or lose water? Why
If some fluid is hypotonic (sports drinks) , the stomach will get rid of some water to make the stomach fluid isotonic and if something makes the fluid in the stomach hypertonic (saltines) then the stomach will absorb more water to make the fluid isotonic.
What are the 3 main categories of diseases of the esophagus?
anatomical and motor disorders
esophagitis
esophageal cancer
Esophagus: anatomical and motor disorders
hiatal hernia
achalasia
esophageal varices
Esophagus: esophagitis
GERD (reflux esophagitis
Barret esophagus
Esophagus: esophageal cancer
Squamous cell carcinoma
- alcohol, tobacco, achalasia, very hot tea
Adenocarcinoma
- barret esophagus
What is the most common type of hiatal hernia?
sliding
What are the two types of hiatal hernia?
sliding and hiatial paraesophageal hernia (rolling)
Hiatus means?
break
What is a break in the diaphragm where the esophagus goes through?
hiatial paraesophageal hernia (rolling)
The stomach goes through this type of hernia?
hiatial hernia
Achalasia and the hiatal hernias have these s/s…
heartburn, regurgitation
heartburn, regurgitation are associated with …
achalasia and hiatal hernia
regurgitation is more associated with (~95%)
sliding hernia
Achalasia has the loss of
intrinsic inhibitory innervation of LES
Achalasia has the loss of intrinsic inhibitory innervation of LES: _____, ___ ____ of LES, ___ ___ ___ of LES
Aperistalis, incomplete relaxation of LES, increased resting tone of LES
Achalasia: problems
dysphagia, mucosal inflammation and ulceration, squamous cell carcinoma (5%)
What happens in achalasia?
the lower esophageal sphincter fails to relax
When you bite off a normal sized amount of food but the lower esophageal sphincter doesn’t open appropriately, the bolus will get stuck due to the lower esophageal sphincter failing to relax. This describes?
Achalasia
The first s/s you will notice with achalasia is
dysphagia
The second s/s you will notice with achalasia is
mucosal inflammation and ulceration
dysphagia (1st)
iF ACHALASIA goes on long enough you will develop…
squamous cell carcinoma
dysphagia (1st)
mucosal inflammation and ulceration (2nd)
Esophageal Varices is what?
dilated submucosal veins (varices)
What is the cause of esophageal varices?
impaired hepatic portal blood flow
Esophageal Varices: Impaired hepatic blood flow is associated with __ ___ and ~2/3 of ___ patients
alcoholic cirrhosis, cirrhosis
What is the problem with Esophageal varices?
rupture
Esophageal Varices: Problems
hematemesis,
20-30% die on each episode
70% recurrence rate
What is the recurrence rate with esophageal varices?
70%
Reflex esophagitis: GERD is what?
LES opening allowing reflux of liquid and contents into the esophagus
What are the contributing causes to gerd?
obestity
hiatal hernia
vagal nerve abnormalities
What are the problems with GERD?
heartburn, Barret’s esophagus
What is the cause of Barret’s esophagus?
GERD
What is the problem with Barret’s esophagus?
Adenocarcinoma
What are the two types of tissues in Barret’s esophagus?
normal stratified squamous mucosa
Columnar epithelium
Barret esophagus: Replacement of normal __ __ __ with metaplastic __ __ with __ __
stratified squamous mucosa with metaplastic columnar epithelium with goblet cells
Goblet cells do protect the lining from?
gastric contents
Esophageal cancer: what two tissues are associated with it?
squamous cell carcinoma
Adenocarcinoma
Esophageal cancer: Squamous cell carcinoma occurs where at in the esophagus?
higher up
Esophageal cancer: Squamous cell carcinoma occurs from?
tobacco, alcohol, achalasia, very hot tea >65 degrees Celsius
Esophageal cancer: Adenocarcinoma is more common in the
USA
Esophageal cancer: Adenocarcinoma: cause
barret’s esophagus
S/S of esophageal cancer and occur when in cancer progression?
dysphagia and obstruction
occur late in cancer progression
Esophageal cancer: Adenocarcinoma: occurs where in the esophagus?
lower part near the opening of the stomach
What are the 3 main diseases associated with the stomach?
gastritis, gastric ulceration, stomach cancer
Stomach: Gastritis: types
Chronic (H. Pylori)
Acute
Stomach: Gastric Ulceration: Types
Peptic ulcers, Acute gastric ulceration
Stomach: Stomach cancer: types
gastric carcinoma
Chronic gastritis will lead to
peptic ulcers
Acute gastritis will lead to
acute gastric ulceration
The stomach is __ and __. It wants a lot of __ __ b/c __ __ will only act at surface area. The duodenum raises the __. If the pH is not high enough, it will tell the stomach to __ __ and is basically controlling __ __.
The stomach is muscular and resilient. It wants a lot of surface area b/c digestive enzymes will only act at surface area. The duodenum raises the pH. If the pH si not high enough, it will tell the stomach to slow down and is basically controlling stomach emptying.
Of the stomach mucosa, what are the most important cells?
Gastric glands: mucous neck cells, parietal cells, chief cells, endocrine cells
Gastric pits are __ in teh ___ lining of the stomach. At the __ of each pit is one or more __ __ __. __ __ produce the enzymes of __ __, and __ __ produce __ __.
Gastric pits are depressions in the epithelial lining of the stomach. At the bottom of each pit is one or more tubular gastric glands. Chief cells produce the enzymes of gastric juice, and parietal cells produce stomach acid.
Hydrocholric acid secretion by parietal cell:
What are the three main elements in the blood?
CO2, HCO3-, Cl-
Hydrocholric acid secretion by parietal cell: What are the three main elements in the stomach lumen?
K+, H+, Cl-
Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens when CO2 from the blood enters the cell?
CO2 -> CO2 + H20 -> H2CO3
I I
V V
HCO3 (blood) H2O
Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens when HCO3- from the blood enters the cell?
HCO3 goes back into the blood via a (HCO3-/Cl-) transporter
Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens when Cl- from the blood enters the cell?
Cl- goes into the cell via a( HCO3-/Cl-) transporter and then goes straight to the stomach lumen
Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens when K+ from the stomach lumen enters the cell?
nothing. it just enters the cell
Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens with H20?
H2O
Most common chronic problem is in the?
stomach
Chronic gastritis and peptic ulceration is basically
chronic mucosal inflammation
Chronic gastritis and peptic ulceration is caused by
H Pyloric
Chronic gastritis and peptic ulceration is usually
aymptomatic
Chronic gastritis and peptic ulceration problems:
upper abdominal discomfort
n/v
ulcers
Gastric mucosa: Damaging influences
Helicobacter pylori - urease, toxins Gastric acidity Peptic enzymes Drugs
Chronic gastritis causes
atrophy
intestinal metaplasia
lymphoid aggregrates
neutrophil inflitrates
Peptic ulceration: has what 4 layers
necrotic debris
inflammatory layer
granulation tissue
fibrous scar
Peptic ulcers are __ lesions that occur ___ in the __ tract that is exposed to acid-peptic juices. 98% are in the __ __ and __ (4:1)
peptic ulcers are chronic lesions that occur anywhere in the GI tract that is exposed to acid-peptic juices. 98% are in the proximal duodenum and stomach (4:1)
Peptic ulcers: H pyloric is present in 70-90% __ ulcers and 70% __ ulcers
duodenal and gastric
What is the percentage of ppl that actually get peptic ulcers?
ns10-20%
What are the aggragavating causes of peptic ulcers?
NSAIDS, SMOKING, ALCOHOL, CORTIOCOSTEROIDS, high stress personality
Peptic ulcers: problems
epigastric pain, N/V, hemorrhage and perforation
generally do NOT progress to cancer
Peptic ulcers are more often impair the __ __ __ rather than shorten it
quality of life
Spicy foods make an ulcer worse but does NOT
cause it
Acute mucosal inflammation that is usually transient is
acute gastritis
Acute gastritis: casues
HEAVY NSAID (aspirin) excessive alcohol use heavy smoking cancer chemotherapy uremia systemic infection severe stress ischemia and shock ingestion of caustic agents mechanical trauma
Acute gastritis: problem
epigastric pain with n/v
hematemesis and or melena
Acute gastric ulcers aka
stress ulcers
Acute gastric ulcers aka stress ulcers: __, acute gastric mucosal __ resulting from __ __.
focal, acute gastric mucosal defects resulting from severe stress
Acute gastric ulcers aka stress ulcers: Causes
severe trauma,
extensive burns
trauma to CNS
gastric irritants
Why have stomach cancer rates fallen?
food storage and refrigeration
Gastric Carcinoma:
accounts for __ of stomach cancers
> 90%
Gastric Carcinoma: Causes (intestinal type adenocarcinoma)
these have DECREASED in frequency
nitrites/nitrates (perservatives in meat) smoked food pickled food excessive salt DECREASED BY FRUIT AND VEG. CONSUMPTION chronic gastritis H pylori infection
Gastric Carcinoma: Causes (diffuse carcinoma)
these have NOT decreased in frequency
risk factors are poorly understood but H pylori is often absent
Gastric carcinoma is the __ leading causes of __ ___ worldwide.
gastric carcinoma is the 2nd leading cause of cancer death worldwide
What are the 7 most common disorders of the small and large intestines?
developmental anomalies vascular disorders diarrheal diseases idiopathic inflammatory bowel disease colonic diverticulosis bowel obstruction tumors of the colon
small and large intestines: developmental anomalies
hirschsprung disease: congenital megacolon
small and large intestines: vascular disorders
ischemic bowel disease
hemorrhoids
small and large intestines: diarrheal diseases
infectious enterocolitis
malabsorption syndromes
small and large intestines: idiopathic IBD
crohn disease, ulcerative colitis
Small and large intestines: tumors of the colon
colorectal carcinoma
What are the two layers of the GI tract?
circular and horizontal
GI tract wall: the serosa is continuous with a fold of serous membrane called the …
mesentery
What is your friend when you need to absorb something?
surface area
more surface area =
more diffusion
small and large intestines: developmental anomalies: hirschsprung (congenital megacolon)
Caudal migation of __ __ __ fails to reach the __ leaving an __ segment of the __ __ lacking both __ and __ __ __
caudal migration of neural crest cells fails to reach the anus leaving an agnaglioic segment of the distal colon lacking both Meissneer and Auerback myenteric plexuses
small and large intestines: developmental anomalies: problems
obstruction
enterocolitis
perforation
small and large intestines: developmental anomalies: Hirschsprung (congenital megacolon) is fixed by
removal of aganglionic segment
Small and large intestines: vascular disorders: Ischemic bowel disease is what
Acute occlusion or hypo-perfusion can result in infarction
Ischemic bowel disease: causes
arterial thrombosis arterial embolism venous thrombosis nonocclusive ischemia -cardiac failure, shock, dehydration, vasoconstrictive drugs mechanical obstruction -volvulus, stricture, herniation
what is the mortality rate for transmural bowel infarction?
90%
Small and large intestines: vascular disease: Hemorrhoids: are persistently ___ ___ ___ in the hemrroidal plexus causes variceal dilation
are persistently elevated venous pressure in the hemorrhoidal plexus causes variceal dilation
Small and large intestines: vascular disease: Hemorrhoids: causes
straining during defecation
pregnancy
hepativ portal hypertension- similar to eso varices
Small and large intestines: Diarrhea: Major causes
Secretory osmotic exudative malabsorption deranged motility
Small and large intestines: Diarrhea: Secretory
Vibrio cholerae (Cholera)
bacteria causes the cells to dump choride into lumen of GI tract
you will have lots of watery diarrhea (liter an hour - nonstop)
tends to live in lakes, rivers, bays
Vibrio cholerae (Cholera)
bacteria causes the cells to dump choride into lumen of GI tract
you will have lots of watery diarrhea (liter an hour - nonstop)
tends to live in lakes, rivers, bays
This describes what?
Secretory diarrhea
Small and large intestines: diarrhea: osmotic
gut lavage
see a lot of polyethaline glycol- molecule we dont absorb so we hold the water in the lumen and the water has to go somewhere so it goes out and cleans everything out.
colonscopy
gut lavage
see a lot of polyethaline glycol- molecule we dont absorb so we hold the water in the lumen and the water has to go somewhere so it goes out and cleans everything out.
colonscopy
describes what?
osmotic diarrhea
Small and large intestines: diarrhea: exudative - destruction of epithelial layer
shigella
salmonella
campylobacter
kill mucosal cells that line the GI tract in the lumen acting as osmotic agents holding water in GI tract and out it goes
shigella
salmonella
campylobacter
kill mucosal cells that line the GI tract in the lumen acting as osmotic agents holding water in GI tract and out it goes
exudative
Small and large intestines: diarrhea: malabsorption
giardia, lymphatic obstruction, defective absorption lactose intolerance gas bloating end up with diarrhea
giardia, lymphatic obstruction, defective absorption lactose intolerance gas bloating end up with diarrhea`
malabsorption
Small and large intestines: diarrhea: deranged motility
surgery, hyperthyroidism,
surgery will normally cause an ileus (stopping of gi tract)
hyperthyroidism: diarrhea moving too fast to absorb all the water
Small and large intestines: idiopathic inflammatory bowel disease (IBD): crohn disease
can affect anywhere from mouth to anus
deep chasms that is transmural inflammation - through wall of intestine
Small and large intestines: idiopathic inflammatory bowel disease (IBD): Ulcerative Colitis (UC)
ulcers in colon, continous, starts at rectum and goes backwards,
pesudopolyps: something that doesn’t stick out but looks like it sticks out bc it is surrounded by ulcers
Small and large intestines: idiopathic inflammatory bowel disease (IBD): crohn disease: s/s
fever, abdominal tenderness, abd. mass, abd. pain, fistulas
rectal bleeding - occurs in 1/2 of pts
Small and large intestines: idiopathic inflammatory bowel disease (IBD): UC s/s
rectal bleeding (ulcers)
Common s/s for both UC and crohn’s disease
diarrhea, loss of appetite, painful bowel mvmts, frequent bowel mvmt, weight loss, fatigue
Diverticulosis/diverticulitis are __ protuding out of the __. These occur in __ of people over __ y.o. in the __ and __ with age.
pouches protruding out of the bowel. These occur in ~50% of ppl over 50 years old in the USA and increase with age
Diverticulosis/diverticulitis: problems
lower left quadrant discomfort
bleeding
perforations
fistula formation (following perf)
Diverticulosis/diverticulitis: treatment and prevention
eat more fiber
Bowel obstruction: mechanical obstructions (types)
hernias
adhesions
intussusception
volvulus
Bowel obstruction: pseudo-obstructions
paralytic ileus (post op)
bowel infarction
myopathies and neuropathies (hirschsprung)
Tumors of the colon (types)
polyp pedunculated sessile hyperplatic non neoplastic neoplastic adenoma adenocarcinoma
Tumors of the colon: polyp
a tumorous mass protruding into the lumen
Tumors of the colon: pedunculated
having a stalk
tumors of the colon: sessile
not having a stalk
Tumors of the colon: hyperplastic
increased number of cells - not cancer
Tumors of the colon: non-neoplastic
not cancerous
Tumors of the colon: neoplastic
abnormal disorganized growth - can be cancer
Tumors of the colon: adenoma
neoplastic polyps arising from epithlial proliferation and dysplasia
Tumors of the colon: adenocarcinoma:
cancer arising from adenomatous polyps (~98% colorectal cancers)
Tumors of the colon: Colorectal carinoma \_\_\_ cases/year \_\_ deaths (USA) lifetime risk : \_\_ incidence, \_\_ death remains \_\_\_\_ for year
~150,000 cases/year, ~50,000 deaths (USA)
lifetime risk; 6% incidence, 2% death
remains asymptomatic for a year
Tumors of the colon: Colorectal carinoma: Common s/s
pain
obstruction
changes in bowel habits
Tumors of the colon: Colorectal Carcinoma: left s/s
descending colon, sigmoid colon, rectum
visible blood in stool
LLQ discomfort
Tumors of the colon: Colorectal carcinoma: Right s/s
cecum, ascending colon
fatigue, weakness
iron deficient anemia
Initials for colon caner staging:
TNM
tumor nodes metastasis
Tumor: types Tis, T1, T2, T3, T4
Tis - earliest stage, only mucosa
T1- ca grown thru muscularis mucosa and extends into submucosa
T2- ca grown thru submucosa and extends into muscularis propria (outer muscle layer)
T3 - ca grown thrn muscularis propria and into subserosa but not to any neighboring organs or tissues
T4 - grown thru the wall of the colon or rectum and into nearby tissues or organs
Tumor: grown thru the wall of the colon or rectum and into nearby tissues or organs
T4
Tumor: a grown thrn muscularis propria and into subserosa but not to any neighboring organs or tissues
T3
Tumor: ca grown thru submucosa and extends into muscularis propria (outer muscle layer)
T2
Tumor: ca grown thru muscularis mucosa and extends into submucosa
T1
Tumor: earliest stage, only mucosa
Tis
Nodes: (N0,N1,N2)
N0- no lymph node involvement is found
N1- ca cells found in 1-3 nearby lymph tissues
N2 - ca cells found in 4+ lymph tissues
Metastasis (M0, M1)
M0 - NO DISTANT SPREAD IS SEEN
m1 - distant spread in seen
Peptic ulcers: H pyloric is present in 70-90% __ ulcers and 70% __ ulcers
duodenal and gastric
What is the percentage of ppl that actually get peptic ulcers?
ns10-20%
What are the aggragavating causes of peptic ulcers?
NSAIDS, SMOKING, ALCOHOL, CORTIOCOSTEROIDS, high stress personality
Peptic ulcers: problems
epigastric pain, N/V, hemorrhage and perforation
generally do NOT progress to cancer
Peptic ulcers are more often impair the __ __ __ rather than shorten it
quality of life
Spicy foods make an ulcer worse but does NOT
cause it
Acute mucosal inflammation that is usually transient is
acute gastritis
Acute gastritis: casues
HEAVY NSAID (aspirin) excessive alcohol use heavy smoking cancer chemotherapy uremia systemic infection severe stress ischemia and shock ingestion of caustic agents mechanical trauma
Acute gastritis: problem
epigastric pain with n/v
hematemesis and or melena
Acute gastric ulcers aka
stress ulcers
Acute gastric ulcers aka stress ulcers: __, acute gastric mucosal __ resulting from __ __.
focal, acute gastric mucosal defects resulting from severe stress
Acute gastric ulcers aka stress ulcers: Causes
severe trauma,
extensive burns
trauma to CNS
gastric irritants
Why have stomach cancer rates fallen?
food storage and refrigeration
Gastric Carcinoma:
accounts for __ of stomach cancers
> 90%
Gastric Carcinoma: Causes (intestinal type adenocarcinoma)
these have DECREASED in frequency
nitrites/nitrates (perservatives in meat) smoked food pickled food excessive salt DECREASED BY FRUIT AND VEG. CONSUMPTION chronic gastritis H pylori infection
Gastric Carcinoma: Causes (diffuse carcinoma)
these have NOT decreased in frequency
risk factors are poorly understood but H pylori is often absent
Gastric carcinoma is the __ leading causes of __ ___ worldwide.
gastric carcinoma is the 2nd leading cause of cancer death worldwide
What are the 7 most common disorders of the small and large intestines?
developmental anomalies vascular disorders diarrheal diseases idiopathic inflammatory bowel disease colonic diverticulosis bowel obstruction tumors of the colon
small and large intestines: developmental anomalies
hirschsprung disease: congenital megacolon
small and large intestines: vascular disorders
ischemic bowel disease
hemorrhoids
small and large intestines: diarrheal diseases
infectious enterocolitis
malabsorption syndromes
small and large intestines: idiopathic IBD
crohn disease, ulcerative colitis
Small and large intestines: tumors of the colon
colorectal carcinoma
What are the two layers of the GI tract?
circular and horizontal
GI tract wall: the serosa is continuous with a fold of serous membrane called the …
mesentery
What is your friend when you need to absorb something?
surface area
more surface area =
more diffusion
small and large intestines: developmental anomalies: hirschsprung (congenital megacolon)
Caudal migation of __ __ __ fails to reach the __ leaving an __ segment of the __ __ lacking both __ and __ __ __
caudal migration of neural crest cells fails to reach the anus leaving an agnaglioic segment of the distal colon lacking both Meissneer and Auerback myenteric plexuses
small and large intestines: developmental anomalies: problems
obstruction
enterocolitis
perforation
small and large intestines: developmental anomalies: Hirschsprung (congenital megacolon) is fixed by
removal of aganglionic segment
Small and large intestines: vascular disorders: Ischemic bowel disease is what
Acute occlusion or hypo-perfusion can result in infarction
Ischemic bowel disease: causes
arterial thrombosis arterial embolism venous thrombosis nonocclusive ischemia -cardiac failure, shock, dehydration, vasoconstrictive drugs mechanical obstruction -volvulus, stricture, herniation
what is the mortality rate for transmural bowel infarction?
90%
Small and large intestines: vascular disease: Hemorrhoids: are persistently ___ ___ ___ in the hemrroidal plexus causes variceal dilation
are persistently elevated venous pressure in the hemorrhoidal plexus causes variceal dilation
Small and large intestines: vascular disease: Hemorrhoids: causes
straining during defecation
pregnancy
hepativ portal hypertension- similar to eso varices
Small and large intestines: Diarrhea: Major causes
Secretory osmotic exudative malabsorption deranged motility
Small and large intestines: Diarrhea: Secretory
Vibrio cholerae (Cholera)
bacteria causes the cells to dump choride into lumen of GI tract
you will have lots of watery diarrhea (liter an hour - nonstop)
tends to live in lakes, rivers, bays
Vibrio cholerae (Cholera)
bacteria causes the cells to dump choride into lumen of GI tract
you will have lots of watery diarrhea (liter an hour - nonstop)
tends to live in lakes, rivers, bays
This describes what?
Secretory diarrhea
Small and large intestines: diarrhea: osmotic
gut lavage
see a lot of polyethaline glycol- molecule we dont absorb so we hold the water in the lumen and the water has to go somewhere so it goes out and cleans everything out.
colonscopy
gut lavage
see a lot of polyethaline glycol- molecule we dont absorb so we hold the water in the lumen and the water has to go somewhere so it goes out and cleans everything out.
colonscopy
describes what?
osmotic diarrhea
Small and large intestines: diarrhea: exudative - destruction of epithelial layer
shigella
salmonella
campylobacter
kill mucosal cells that line the GI tract in the lumen acting as osmotic agents holding water in GI tract and out it goes
shigella
salmonella
campylobacter
kill mucosal cells that line the GI tract in the lumen acting as osmotic agents holding water in GI tract and out it goes
exudative
Small and large intestines: diarrhea: malabsorption
giardia, lymphatic obstruction, defective absorption lactose intolerance gas bloating end up with diarrhea
giardia, lymphatic obstruction, defective absorption lactose intolerance gas bloating end up with diarrhea`
malabsorption
Small and large intestines: diarrhea: deranged motility
surgery, hyperthyroidism,
surgery will normally cause an ileus (stopping of gi tract)
hyperthyroidism: diarrhea moving too fast to absorb all the water
Small and large intestines: idiopathic inflammatory bowel disease (IBD): crohn disease
can affect anywhere from mouth to anus
deep chasms that is transmural inflammation - through wall of intestine
Small and large intestines: idiopathic inflammatory bowel disease (IBD): Ulcerative Colitis (UC)
ulcers in colon, continous, starts at rectum and goes backwards,
pesudopolyps: something that doesn’t stick out but looks like it sticks out bc it is surrounded by ulcers
Small and large intestines: idiopathic inflammatory bowel disease (IBD): crohn disease: s/s
fever, abdominal tenderness, abd. mass, abd. pain, fistulas
rectal bleeding - occurs in 1/2 of pts
Small and large intestines: idiopathic inflammatory bowel disease (IBD): UC s/s
rectal bleeding (ulcers)
Common s/s for both UC and crohn’s disease
diarrhea, loss of appetite, painful bowel mvmts, frequent bowel mvmt, weight loss, fatigue
Diverticulosis/diverticulitis are __ protuding out of the __. These occur in __ of people over __ y.o. in the __ and __ with age.
pouches protruding out of the bowel. These occur in ~50% of ppl over 50 years old in the USA and increase with age
Diverticulosis/diverticulitis: problems
lower left quadrant discomfort
bleeding
perforations
fistula formation (following perf)
Diverticulosis/diverticulitis: treatment and prevention
eat more fiber
Bowel obstruction: mechanical obstructions (types)
hernias
adhesions
intussusception
volvulus
Bowel obstruction: pseudo-obstructions
paralytic ileus (post op)
bowel infarction
myopathies and neuropathies (hirschsprung)
Tumors of the colon (types)
polyp pedunculated sessile hyperplatic non neoplastic neoplastic adenoma adenocarcinoma
Tumors of the colon: polyp
a tumorous mass protruding into the lumen
Tumors of the colon: pedunculated
having a stalk
tumors of the colon: sessile
not having a stalk
Tumors of the colon: hyperplastic
increased number of cells - not cancer
Tumors of the colon: non-neoplastic
not cancerous
Tumors of the colon: neoplastic
abnormal disorganized growth - can be cancer
Tumors of the colon: adenoma
neoplastic polyps arising from epithlial proliferation and dysplasia
Tumors of the colon: adenocarcinoma:
cancer arising from adenomatous polyps (~98% colorectal cancers)
Tumors of the colon: Colorectal carinoma \_\_\_ cases/year \_\_ deaths (USA) lifetime risk : \_\_ incidence, \_\_ death remains \_\_\_\_ for year
~150,000 cases/year, ~50,000 deaths (USA)
lifetime risk; 6% incidence, 2% death
remains asymptomatic for a year
Tumors of the colon: Colorectal carinoma: Common s/s
pain
obstruction
changes in bowel habits
Tumors of the colon: Colorectal Carcinoma: left s/s
descending colon, sigmoid colon, rectum
visible blood in stool
LLQ discomfort
Tumors of the colon: Colorectal carcinoma: Right s/s
cecum, ascending colon
fatigue, weakness
iron deficient anemia
Initials for colon caner staging:
TNM
tumor nodes metastasis
Tumor: types Tis, T1, T2, T3, T4
Tis - earliest stage, only mucosa
T1- ca grown thru muscularis mucosa and extends into submucosa
T2- ca grown thru submucosa and extends into muscularis propria (outer muscle layer)
T3 - ca grown thrn muscularis propria and into subserosa but not to any neighboring organs or tissues
T4 - grown thru the wall of the colon or rectum and into nearby tissues or organs
Tumor: grown thru the wall of the colon or rectum and into nearby tissues or organs
T4
Tumor: a grown thrn muscularis propria and into subserosa but not to any neighboring organs or tissues
T3
Tumor: ca grown thru submucosa and extends into muscularis propria (outer muscle layer)
T2
Tumor: ca grown thru muscularis mucosa and extends into submucosa
T1
Tumor: earliest stage, only mucosa
Tis
Nodes: (N0,N1,N2)
N0- no lymph node involvement is found
N1- ca cells found in 1-3 nearby lymph tissues
N2 - ca cells found in 4+ lymph tissues
Metastasis (M0, M1)
M0 - NO DISTANT SPREAD IS SEEN
m1 - distant spread in seen
