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Pathophysiology Exam 3 > GI > Flashcards

GI Flashcards

1
Q

Explain the structure and function of the digestion system

A

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.

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2
Q

Explain the structure and function of the digestion system

A

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.

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3
Q

Digestion begins in the __ and what is the function?

A

mouth with chewing which breaks down good mechanically and mixes it with saliva.

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4
Q

Swallowing propels ___ ___ through the ___ to the ____ and has what function?

A

chewed foods, esophagus, stomach

where acids and stomach motility liquefy it further

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5
Q

Liquefied food enters the __ ___ and has what function?

A

where secretions of the intestinal walls, liver, gallbladder, and pancreas digest it into absorbable nutrients.

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6
Q

Nutrients are absorbed through _____ ____ and unabsorbed wastes enter the ___ ___ where ___ are removed.

A 
small intestines
large intestines (colon) 
liquids
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7
Q

Solid wastes then enter the ____ and leave the body through the ____.

A

rectum and leave the body through the anus

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8
Q

Sites of absorptions of major nutrients: Stomach

A

Water

alcohol

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9
Q

Sites of absorptions of major nutrients: duodenum (S SIP CF WVM)

A

iron, calcium, fats, sugars, water, proteins, vitamins, magnesium, sodium

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10
Q

Sites of absorptions of major nutrients: Jejunum

A

Sugars, Proteins

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11
Q

Sites of absorptions of major nutrients: Ileum

A

bile salts, vitamin B12, chloride

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12
Q

Sites of absorptions of major nutrients: Colon

A

water, electrolytes

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13
Q

In the stomach, do you absorb water or lose water?

A

both

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14
Q

In the stomach, do you absorb water or lose water? Why

A

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.

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15
Q

What are the 3 main categories of diseases of the esophagus?

A

anatomical and motor disorders
esophagitis
esophageal cancer

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16
Q

Esophagus: anatomical and motor disorders

A

hiatal hernia
achalasia
esophageal varices

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17
Q

Esophagus: esophagitis

A

GERD (reflux esophagitis

Barret esophagus

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18
Q

Esophagus: esophageal cancer

A

Squamous cell carcinoma
- alcohol, tobacco, achalasia, very hot tea
Adenocarcinoma
- barret esophagus

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19
Q

What is the most common type of hiatal hernia?

A

sliding

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20
Q

What are the two types of hiatal hernia?

A

sliding and hiatial paraesophageal hernia (rolling)

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21
Q

Hiatus means?

A

break

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22
Q

What is a break in the diaphragm where the esophagus goes through?

A

hiatial paraesophageal hernia (rolling)

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23
Q

The stomach goes through this type of hernia?

A

hiatial hernia

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24
Q

Achalasia and the hiatal hernias have these s/s…

A

heartburn, regurgitation

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25
Q

heartburn, regurgitation are associated with …

A

achalasia and hiatal hernia

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26
Q

regurgitation is more associated with (~95%)

A

sliding hernia

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27
Q

Achalasia has the loss of

A

intrinsic inhibitory innervation of LES

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28
Q

Achalasia has the loss of intrinsic inhibitory innervation of LES: _____, ___ ____ of LES, ___ ___ ___ of LES

A

Aperistalis, incomplete relaxation of LES, increased resting tone of LES

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29
Q

Achalasia: problems

A

dysphagia, mucosal inflammation and ulceration, squamous cell carcinoma (5%)

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30
Q

What happens in achalasia?

A

the lower esophageal sphincter fails to relax

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31
Q

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?

A

Achalasia

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32
Q

The first s/s you will notice with achalasia is

A

dysphagia

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33
Q

The second s/s you will notice with achalasia is

A

mucosal inflammation and ulceration

dysphagia (1st)

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34
Q

iF ACHALASIA goes on long enough you will develop…

A

squamous cell carcinoma
dysphagia (1st)
mucosal inflammation and ulceration (2nd)

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35
Q

Esophageal Varices is what?

A

dilated submucosal veins (varices)

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36
Q

What is the cause of esophageal varices?

A

impaired hepatic portal blood flow

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37
Q

Esophageal Varices: Impaired hepatic blood flow is associated with __ ___ and ~2/3 of ___ patients

A

alcoholic cirrhosis, cirrhosis

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38
Q

What is the problem with Esophageal varices?

A

rupture

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39
Q

Esophageal Varices: Problems

A

hematemesis,
20-30% die on each episode
70% recurrence rate

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40
Q

What is the recurrence rate with esophageal varices?

A

70%

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41
Q

Reflex esophagitis: GERD is what?

A

LES opening allowing reflux of liquid and contents into the esophagus

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42
Q

What are the contributing causes to gerd?

A

obestity
hiatal hernia
vagal nerve abnormalities

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43
Q

What are the problems with GERD?

A

heartburn, Barret’s esophagus

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44
Q

What is the cause of Barret’s esophagus?

A

GERD

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45
Q

What is the problem with Barret’s esophagus?

A

Adenocarcinoma

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46
Q

What are the two types of tissues in Barret’s esophagus?

A

normal stratified squamous mucosa

Columnar epithelium

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47
Q

Barret esophagus: Replacement of normal __ __ __ with metaplastic __ __ with __ __

A

stratified squamous mucosa with metaplastic columnar epithelium with goblet cells

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48
Q

Goblet cells do protect the lining from?

A

gastric contents

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49
Q

Esophageal cancer: what two tissues are associated with it?

A

squamous cell carcinoma

Adenocarcinoma

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50
Q

Esophageal cancer: Squamous cell carcinoma occurs where at in the esophagus?

A

higher up

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51
Q

Esophageal cancer: Squamous cell carcinoma occurs from?

A

tobacco, alcohol, achalasia, very hot tea >65 degrees Celsius

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52
Q

Esophageal cancer: Adenocarcinoma is more common in the

A

USA

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53
Q

Esophageal cancer: Adenocarcinoma: cause

A

barret’s esophagus

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54
Q

S/S of esophageal cancer and occur when in cancer progression?

A

dysphagia and obstruction

occur late in cancer progression

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55
Q

Esophageal cancer: Adenocarcinoma: occurs where in the esophagus?

A

lower part near the opening of the stomach

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56
Q

What are the 3 main diseases associated with the stomach?

A

gastritis, gastric ulceration, stomach cancer

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57
Q

Stomach: Gastritis: types

A

Chronic (H. Pylori)

Acute

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58
Q

Stomach: Gastric Ulceration: Types

A

Peptic ulcers, Acute gastric ulceration

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59
Q

Stomach: Stomach cancer: types

A

gastric carcinoma

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60
Q

Chronic gastritis will lead to

A

peptic ulcers

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61
Q

Acute gastritis will lead to

A

acute gastric ulceration

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62
Q

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 __ __.

A

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.

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63
Q

Of the stomach mucosa, what are the most important cells?

A

Gastric glands: mucous neck cells, parietal cells, chief cells, endocrine cells

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64
Q

Gastric pits are __ in teh ___ lining of the stomach. At the __ of each pit is one or more __ __ __. __ __ produce the enzymes of __ __, and __ __ produce __ __.

A

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.

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65
Q

Hydrocholric acid secretion by parietal cell:

What are the three main elements in the blood?

A

CO2, HCO3-, Cl-

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66
Q

Hydrocholric acid secretion by parietal cell: What are the three main elements in the stomach lumen?

A

K+, H+, Cl-

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67
Q

Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens when CO2 from the blood enters the cell?

A

CO2 -> CO2 + H20 -> H2CO3
I I
V V
HCO3 (blood) H2O

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68
Q

Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens when HCO3- from the blood enters the cell?

A

HCO3 goes back into the blood via a (HCO3-/Cl-) transporter

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69
Q

Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens when Cl- from the blood enters the cell?

A

Cl- goes into the cell via a( HCO3-/Cl-) transporter and then goes straight to the stomach lumen

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70
Q

Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens with H20?

A 
H2O
   I    \
  V    V
OH-  H+(exits p.cell into stomach lumen via k+/h- transpor
  I
 V
H2O
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71
Q

Most common chronic problem is in the?

A

stomach

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72
Q

Digestion begins in the __ and what is the function?

A

mouth with chewing which breaks down good mechanically and mixes it with saliva.

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73
Q

Swallowing propels ___ ___ through the ___ to the ____ and has what function?

A

chewed foods, esophagus, stomach

where acids and stomach motility liquefy it further

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74
Q

Liquefied food enters the __ ___ and has what function?

A

where secretions of the intestinal walls, liver, gallbladder, and pancreas digest it into absorbable nutrients.

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75
Q

Nutrients are absorbed through _____ ____ and unabsorbed wastes enter the ___ ___ where ___ are removed.

A 
small intestines
large intestines (colon) 
liquids
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76
Q

Solid wastes then enter the ____ and leave the body through the ____.

A

rectum and leave the body through the anus

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77
Q

Sites of absorptions of major nutrients: Stomach

A

Water

alcohol

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78
Q

Sites of absorptions of major nutrients: duodenum (S SIP CF WVM)

A

iron, calcium, fats, sugars, water, proteins, vitamins, magnesium, sodium

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79
Q

Sites of absorptions of major nutrients: Jejunum

A

Sugars, Proteins

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80
Q

Sites of absorptions of major nutrients: Ileum

A

bile salts, vitamin B12, chloride

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81
Q

Sites of absorptions of major nutrients: Colon

A

water, electrolytes

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82
Q

In the stomach, do you absorb water or lose water?

A

both

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83
Q

In the stomach, do you absorb water or lose water? Why

A

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.

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84
Q

What are the 3 main categories of diseases of the esophagus?

A

anatomical and motor disorders
esophagitis
esophageal cancer

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85
Q

Esophagus: anatomical and motor disorders

A

hiatal hernia
achalasia
esophageal varices

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86
Q

Esophagus: esophagitis

A

GERD (reflux esophagitis

Barret esophagus

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87
Q

Esophagus: esophageal cancer

A

Squamous cell carcinoma
- alcohol, tobacco, achalasia, very hot tea
Adenocarcinoma
- barret esophagus

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88
Q

What is the most common type of hiatal hernia?

A

sliding

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89
Q

What are the two types of hiatal hernia?

A

sliding and hiatial paraesophageal hernia (rolling)

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90
Q

Hiatus means?

A

break

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91
Q

What is a break in the diaphragm where the esophagus goes through?

A

hiatial paraesophageal hernia (rolling)

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92
Q

The stomach goes through this type of hernia?

A

hiatial hernia

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93
Q

Achalasia and the hiatal hernias have these s/s…

A

heartburn, regurgitation

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94
Q

heartburn, regurgitation are associated with …

A

achalasia and hiatal hernia

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95
Q

regurgitation is more associated with (~95%)

A

sliding hernia

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96
Q

Achalasia has the loss of

A

intrinsic inhibitory innervation of LES

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97
Q

Achalasia has the loss of intrinsic inhibitory innervation of LES: _____, ___ ____ of LES, ___ ___ ___ of LES

A

Aperistalis, incomplete relaxation of LES, increased resting tone of LES

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98
Q

Achalasia: problems

A

dysphagia, mucosal inflammation and ulceration, squamous cell carcinoma (5%)

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99
Q

What happens in achalasia?

A

the lower esophageal sphincter fails to relax

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100
Q

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?

A

Achalasia

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101
Q

The first s/s you will notice with achalasia is

A

dysphagia

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102
Q

The second s/s you will notice with achalasia is

A

mucosal inflammation and ulceration

dysphagia (1st)

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103
Q

iF ACHALASIA goes on long enough you will develop…

A

squamous cell carcinoma
dysphagia (1st)
mucosal inflammation and ulceration (2nd)

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104
Q

Esophageal Varices is what?

A

dilated submucosal veins (varices)

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105
Q

What is the cause of esophageal varices?

A

impaired hepatic portal blood flow

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106
Q

Esophageal Varices: Impaired hepatic blood flow is associated with __ ___ and ~2/3 of ___ patients

A

alcoholic cirrhosis, cirrhosis

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107
Q

What is the problem with Esophageal varices?

A

rupture

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108
Q

Esophageal Varices: Problems

A

hematemesis,
20-30% die on each episode
70% recurrence rate

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109
Q

What is the recurrence rate with esophageal varices?

A

70%

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110
Q

Reflex esophagitis: GERD is what?

A

LES opening allowing reflux of liquid and contents into the esophagus

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111
Q

What are the contributing causes to gerd?

A

obestity
hiatal hernia
vagal nerve abnormalities

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112
Q

What are the problems with GERD?

A

heartburn, Barret’s esophagus

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113
Q

What is the cause of Barret’s esophagus?

A

GERD

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114
Q

What is the problem with Barret’s esophagus?

A

Adenocarcinoma

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115
Q

What are the two types of tissues in Barret’s esophagus?

A

normal stratified squamous mucosa

Columnar epithelium

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116
Q

Barret esophagus: Replacement of normal __ __ __ with metaplastic __ __ with __ __

A

stratified squamous mucosa with metaplastic columnar epithelium with goblet cells

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117
Q

Goblet cells do protect the lining from?

A

gastric contents

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118
Q

Esophageal cancer: what two tissues are associated with it?

A

squamous cell carcinoma

Adenocarcinoma

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119
Q

Esophageal cancer: Squamous cell carcinoma occurs where at in the esophagus?

A

higher up

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120
Q

Esophageal cancer: Squamous cell carcinoma occurs from?

A

tobacco, alcohol, achalasia, very hot tea >65 degrees Celsius

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121
Q

Esophageal cancer: Adenocarcinoma is more common in the

A

USA

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122
Q

Esophageal cancer: Adenocarcinoma: cause

A

barret’s esophagus

123
Q

S/S of esophageal cancer and occur when in cancer progression?

A

dysphagia and obstruction

occur late in cancer progression

124
Q

Esophageal cancer: Adenocarcinoma: occurs where in the esophagus?

A

lower part near the opening of the stomach

125
Q

What are the 3 main diseases associated with the stomach?

A

gastritis, gastric ulceration, stomach cancer

126
Q

Stomach: Gastritis: types

A

Chronic (H. Pylori)

Acute

127
Q

Stomach: Gastric Ulceration: Types

A

Peptic ulcers, Acute gastric ulceration

128
Q

Stomach: Stomach cancer: types

A

gastric carcinoma

129
Q

Chronic gastritis will lead to

A

peptic ulcers

130
Q

Acute gastritis will lead to

A

acute gastric ulceration

131
Q

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 __ __.

A

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.

132
Q

Of the stomach mucosa, what are the most important cells?

A

Gastric glands: mucous neck cells, parietal cells, chief cells, endocrine cells

133
Q

Gastric pits are __ in teh ___ lining of the stomach. At the __ of each pit is one or more __ __ __. __ __ produce the enzymes of __ __, and __ __ produce __ __.

A

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.

134
Q

Hydrocholric acid secretion by parietal cell:

What are the three main elements in the blood?

A

CO2, HCO3-, Cl-

135
Q

Hydrocholric acid secretion by parietal cell: What are the three main elements in the stomach lumen?

A

K+, H+, Cl-

136
Q

Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens when CO2 from the blood enters the cell?

A

CO2 -> CO2 + H20 -> H2CO3
I I
V V
HCO3 (blood) H2O

137
Q

Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens when HCO3- from the blood enters the cell?

A

HCO3 goes back into the blood via a (HCO3-/Cl-) transporter

138
Q

Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens when Cl- from the blood enters the cell?

A

Cl- goes into the cell via a( HCO3-/Cl-) transporter and then goes straight to the stomach lumen

139
Q

Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens when K+ from the stomach lumen enters the cell?

A

nothing. it just enters the cell

140
Q

Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens with H20?

A

H2O

141
Q

Most common chronic problem is in the?

A

stomach

142
Q

Chronic gastritis and peptic ulceration is basically

A

chronic mucosal inflammation

143
Q

Chronic gastritis and peptic ulceration is caused by

A

H Pyloric

144
Q

Chronic gastritis and peptic ulceration is usually

A

aymptomatic

145
Q

Chronic gastritis and peptic ulceration problems:

A

upper abdominal discomfort
n/v
ulcers

146
Q

Gastric mucosa: Damaging influences

A 
Helicobacter pylori
  - urease, toxins
Gastric acidity
Peptic enzymes
Drugs
147
Q

Chronic gastritis causes

A

atrophy
intestinal metaplasia
lymphoid aggregrates
neutrophil inflitrates

148
Q

Peptic ulceration: has what 4 layers

A

necrotic debris
inflammatory layer
granulation tissue
fibrous scar

149
Q

Peptic ulcers are __ lesions that occur ___ in the __ tract that is exposed to acid-peptic juices. 98% are in the __ __ and __ (4:1)

A

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)

150
Q

Peptic ulcers: H pyloric is present in 70-90% __ ulcers and 70% __ ulcers

A

duodenal and gastric

151
Q

What is the percentage of ppl that actually get peptic ulcers?

A

ns10-20%

152
Q

What are the aggragavating causes of peptic ulcers?

A

NSAIDS, SMOKING, ALCOHOL, CORTIOCOSTEROIDS, high stress personality

153
Q

Peptic ulcers: problems

A

epigastric pain, N/V, hemorrhage and perforation

generally do NOT progress to cancer

154
Q

Peptic ulcers are more often impair the __ __ __ rather than shorten it

A

quality of life

155
Q

Spicy foods make an ulcer worse but does NOT

A

cause it

156
Q

Acute mucosal inflammation that is usually transient is

A

acute gastritis

157
Q

Acute gastritis: casues

A 
HEAVY NSAID (aspirin)
excessive alcohol use
heavy smoking
cancer chemotherapy
uremia
systemic infection
severe stress
ischemia and shock
ingestion of caustic agents 
mechanical trauma
158
Q

Acute gastritis: problem

A

epigastric pain with n/v

hematemesis and or melena

159
Q

Acute gastric ulcers aka

A

stress ulcers

160
Q

Acute gastric ulcers aka stress ulcers: __, acute gastric mucosal __ resulting from __ __.

A

focal, acute gastric mucosal defects resulting from severe stress

161
Q

Acute gastric ulcers aka stress ulcers: Causes

A

severe trauma,
extensive burns
trauma to CNS
gastric irritants

162
Q

Why have stomach cancer rates fallen?

A

food storage and refrigeration

163
Q

Gastric Carcinoma:

accounts for __ of stomach cancers

A

> 90%

164
Q

Gastric Carcinoma: Causes (intestinal type adenocarcinoma)

these have DECREASED in frequency

A 
nitrites/nitrates (perservatives in meat)
smoked food
pickled food
excessive salt
DECREASED BY FRUIT AND VEG. CONSUMPTION
chronic gastritis 
H pylori infection
165
Q

Gastric Carcinoma: Causes (diffuse carcinoma)

these have NOT decreased in frequency

A

risk factors are poorly understood but H pylori is often absent

166
Q

Gastric carcinoma is the __ leading causes of __ ___ worldwide.

A

gastric carcinoma is the 2nd leading cause of cancer death worldwide

167
Q

What are the 7 most common disorders of the small and large intestines?

A 
developmental anomalies
vascular disorders
diarrheal diseases
idiopathic inflammatory bowel disease
colonic diverticulosis
bowel obstruction
tumors of the colon
168
Q

small and large intestines: developmental anomalies

A

hirschsprung disease: congenital megacolon

169
Q

small and large intestines: vascular disorders

A

ischemic bowel disease

hemorrhoids

170
Q

small and large intestines: diarrheal diseases

A

infectious enterocolitis

malabsorption syndromes

171
Q

small and large intestines: idiopathic IBD

A

crohn disease, ulcerative colitis

172
Q

Small and large intestines: tumors of the colon

A

colorectal carcinoma

173
Q

What are the two layers of the GI tract?

A

circular and horizontal

174
Q

GI tract wall: the serosa is continuous with a fold of serous membrane called the …

A

mesentery

175
Q

What is your friend when you need to absorb something?

A

surface area

176
Q

more surface area =

A

more diffusion

177
Q

small and large intestines: developmental anomalies: hirschsprung (congenital megacolon)
Caudal migation of __ __ __ fails to reach the __ leaving an __ segment of the __ __ lacking both __ and __ __ __

A

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

178
Q

small and large intestines: developmental anomalies: problems

A

obstruction
enterocolitis
perforation

179
Q

small and large intestines: developmental anomalies: Hirschsprung (congenital megacolon) is fixed by

A

removal of aganglionic segment

180
Q

Small and large intestines: vascular disorders: Ischemic bowel disease is what

A

Acute occlusion or hypo-perfusion can result in infarction

181
Q

Ischemic bowel disease: causes

A 
arterial thrombosis
arterial embolism
venous thrombosis
nonocclusive ischemia 
-cardiac failure, shock, dehydration, vasoconstrictive drugs
mechanical obstruction 
-volvulus, stricture, herniation
182
Q

what is the mortality rate for transmural bowel infarction?

A

90%

183
Q

Small and large intestines: vascular disease: Hemorrhoids: are persistently ___ ___ ___ in the hemrroidal plexus causes variceal dilation

A

are persistently elevated venous pressure in the hemorrhoidal plexus causes variceal dilation

184
Q

Small and large intestines: vascular disease: Hemorrhoids: causes

A

straining during defecation
pregnancy
hepativ portal hypertension- similar to eso varices

185
Q

Small and large intestines: Diarrhea: Major causes

A 
Secretory 
osmotic
exudative
malabsorption
deranged motility
186
Q

Small and large intestines: Diarrhea: Secretory

A

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

187
Q

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?

A

Secretory diarrhea

188
Q

Small and large intestines: diarrhea: osmotic

A

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

189
Q

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?

A

osmotic diarrhea

190
Q

Small and large intestines: diarrhea: exudative - destruction of epithelial layer

A

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

191
Q

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

A

exudative

192
Q

Small and large intestines: diarrhea: malabsorption

A 
giardia, lymphatic obstruction, defective absorption
lactose intolerance
gas
bloating
end up with diarrhea
193
Q 
giardia, lymphatic obstruction, defective absorption
lactose intolerance
gas
bloating
end up with diarrhea`
A

malabsorption

194
Q

Small and large intestines: diarrhea: deranged motility

A

surgery, hyperthyroidism,
surgery will normally cause an ileus (stopping of gi tract)
hyperthyroidism: diarrhea moving too fast to absorb all the water

195
Q

Small and large intestines: idiopathic inflammatory bowel disease (IBD): crohn disease

A

can affect anywhere from mouth to anus

deep chasms that is transmural inflammation - through wall of intestine

196
Q

Small and large intestines: idiopathic inflammatory bowel disease (IBD): Ulcerative Colitis (UC)

A

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

197
Q

Small and large intestines: idiopathic inflammatory bowel disease (IBD): crohn disease: s/s

A

fever, abdominal tenderness, abd. mass, abd. pain, fistulas

rectal bleeding - occurs in 1/2 of pts

198
Q

Small and large intestines: idiopathic inflammatory bowel disease (IBD): UC s/s

A

rectal bleeding (ulcers)

199
Q

Common s/s for both UC and crohn’s disease

A

diarrhea, loss of appetite, painful bowel mvmts, frequent bowel mvmt, weight loss, fatigue

200
Q

Diverticulosis/diverticulitis are __ protuding out of the __. These occur in __ of people over __ y.o. in the __ and __ with age.

A

pouches protruding out of the bowel. These occur in ~50% of ppl over 50 years old in the USA and increase with age

201
Q

Diverticulosis/diverticulitis: problems

A

lower left quadrant discomfort
bleeding
perforations
fistula formation (following perf)

202
Q

Diverticulosis/diverticulitis: treatment and prevention

A

eat more fiber

203
Q

Bowel obstruction: mechanical obstructions (types)

A

hernias
adhesions
intussusception
volvulus

204
Q

Bowel obstruction: pseudo-obstructions

A

paralytic ileus (post op)
bowel infarction
myopathies and neuropathies (hirschsprung)

205
Q

Tumors of the colon (types)

A 
polyp
pedunculated
sessile
hyperplatic
non neoplastic
neoplastic
adenoma
adenocarcinoma
206
Q

Tumors of the colon: polyp

A

a tumorous mass protruding into the lumen

207
Q

Tumors of the colon: pedunculated

A

having a stalk

208
Q

tumors of the colon: sessile

A

not having a stalk

209
Q

Tumors of the colon: hyperplastic

A

increased number of cells - not cancer

210
Q

Tumors of the colon: non-neoplastic

A

not cancerous

211
Q

Tumors of the colon: neoplastic

A

abnormal disorganized growth - can be cancer

212
Q

Tumors of the colon: adenoma

A

neoplastic polyps arising from epithlial proliferation and dysplasia

213
Q

Tumors of the colon: adenocarcinoma:

A

cancer arising from adenomatous polyps (~98% colorectal cancers)

214
Q 
Tumors of the colon: Colorectal carinoma 
\_\_\_ cases/year 
\_\_ deaths (USA)
lifetime risk : \_\_ incidence, \_\_ death
remains \_\_\_\_ for year
A

~150,000 cases/year, ~50,000 deaths (USA)
lifetime risk; 6% incidence, 2% death
remains asymptomatic for a year

215
Q

Tumors of the colon: Colorectal carinoma: Common s/s

A

pain
obstruction
changes in bowel habits

216
Q

Tumors of the colon: Colorectal Carcinoma: left s/s

descending colon, sigmoid colon, rectum

A

visible blood in stool

LLQ discomfort

217
Q

Tumors of the colon: Colorectal carcinoma: Right s/s

cecum, ascending colon

A

fatigue, weakness

iron deficient anemia

218
Q

Initials for colon caner staging:

A

TNM

tumor nodes metastasis

219
Q

Tumor: types Tis, T1, T2, T3, T4

A

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

220
Q

Tumor: grown thru the wall of the colon or rectum and into nearby tissues or organs

A

T4

221
Q

Tumor: a grown thrn muscularis propria and into subserosa but not to any neighboring organs or tissues

A

T3

222
Q

Tumor: ca grown thru submucosa and extends into muscularis propria (outer muscle layer)

A

T2

223
Q

Tumor: ca grown thru muscularis mucosa and extends into submucosa

A

T1

224
Q

Tumor: earliest stage, only mucosa

A

Tis

225
Q

Nodes: (N0,N1,N2)

A

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

226
Q

Metastasis (M0, M1)

A

M0 - NO DISTANT SPREAD IS SEEN

m1 - distant spread in seen

227
Q

Peptic ulcers: H pyloric is present in 70-90% __ ulcers and 70% __ ulcers

A

duodenal and gastric

228
Q

What is the percentage of ppl that actually get peptic ulcers?

A

ns10-20%

229
Q

What are the aggragavating causes of peptic ulcers?

A

NSAIDS, SMOKING, ALCOHOL, CORTIOCOSTEROIDS, high stress personality

230
Q

Peptic ulcers: problems

A

epigastric pain, N/V, hemorrhage and perforation

generally do NOT progress to cancer

231
Q

Peptic ulcers are more often impair the __ __ __ rather than shorten it

A

quality of life

232
Q

Spicy foods make an ulcer worse but does NOT

A

cause it

233
Q

Acute mucosal inflammation that is usually transient is

A

acute gastritis

234
Q

Acute gastritis: casues

A 
HEAVY NSAID (aspirin)
excessive alcohol use
heavy smoking
cancer chemotherapy
uremia
systemic infection
severe stress
ischemia and shock
ingestion of caustic agents 
mechanical trauma
235
Q

Acute gastritis: problem

A

epigastric pain with n/v

hematemesis and or melena

236
Q

Acute gastric ulcers aka

A

stress ulcers

237
Q

Acute gastric ulcers aka stress ulcers: __, acute gastric mucosal __ resulting from __ __.

A

focal, acute gastric mucosal defects resulting from severe stress

238
Q

Acute gastric ulcers aka stress ulcers: Causes

A

severe trauma,
extensive burns
trauma to CNS
gastric irritants

239
Q

Why have stomach cancer rates fallen?

A

food storage and refrigeration

240
Q

Gastric Carcinoma:

accounts for __ of stomach cancers

A

> 90%

241
Q

Gastric Carcinoma: Causes (intestinal type adenocarcinoma)

these have DECREASED in frequency

A 
nitrites/nitrates (perservatives in meat)
smoked food
pickled food
excessive salt
DECREASED BY FRUIT AND VEG. CONSUMPTION
chronic gastritis 
H pylori infection
242
Q

Gastric Carcinoma: Causes (diffuse carcinoma)

these have NOT decreased in frequency

A

risk factors are poorly understood but H pylori is often absent

243
Q

Gastric carcinoma is the __ leading causes of __ ___ worldwide.

A

gastric carcinoma is the 2nd leading cause of cancer death worldwide

244
Q

What are the 7 most common disorders of the small and large intestines?

A 
developmental anomalies
vascular disorders
diarrheal diseases
idiopathic inflammatory bowel disease
colonic diverticulosis
bowel obstruction
tumors of the colon
245
Q

small and large intestines: developmental anomalies

A

hirschsprung disease: congenital megacolon

246
Q

small and large intestines: vascular disorders

A

ischemic bowel disease

hemorrhoids

247
Q

small and large intestines: diarrheal diseases

A

infectious enterocolitis

malabsorption syndromes

248
Q

small and large intestines: idiopathic IBD

A

crohn disease, ulcerative colitis

249
Q

Small and large intestines: tumors of the colon

A

colorectal carcinoma

250
Q

What are the two layers of the GI tract?

A

circular and horizontal

251
Q

GI tract wall: the serosa is continuous with a fold of serous membrane called the …

A

mesentery

252
Q

What is your friend when you need to absorb something?

A

surface area

253
Q

more surface area =

A

more diffusion

254
Q

small and large intestines: developmental anomalies: hirschsprung (congenital megacolon)
Caudal migation of __ __ __ fails to reach the __ leaving an __ segment of the __ __ lacking both __ and __ __ __

A

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

255
Q

small and large intestines: developmental anomalies: problems

A

obstruction
enterocolitis
perforation

256
Q

small and large intestines: developmental anomalies: Hirschsprung (congenital megacolon) is fixed by

A

removal of aganglionic segment

257
Q

Small and large intestines: vascular disorders: Ischemic bowel disease is what

A

Acute occlusion or hypo-perfusion can result in infarction

258
Q

Ischemic bowel disease: causes

A 
arterial thrombosis
arterial embolism
venous thrombosis
nonocclusive ischemia 
-cardiac failure, shock, dehydration, vasoconstrictive drugs
mechanical obstruction 
-volvulus, stricture, herniation
259
Q

what is the mortality rate for transmural bowel infarction?

A

90%

260
Q

Small and large intestines: vascular disease: Hemorrhoids: are persistently ___ ___ ___ in the hemrroidal plexus causes variceal dilation

A

are persistently elevated venous pressure in the hemorrhoidal plexus causes variceal dilation

261
Q

Small and large intestines: vascular disease: Hemorrhoids: causes

A

straining during defecation
pregnancy
hepativ portal hypertension- similar to eso varices

262
Q

Small and large intestines: Diarrhea: Major causes

A 
Secretory 
osmotic
exudative
malabsorption
deranged motility
263
Q

Small and large intestines: Diarrhea: Secretory

A

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

264
Q

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?

A

Secretory diarrhea

265
Q

Small and large intestines: diarrhea: osmotic

A

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

266
Q

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?

A

osmotic diarrhea

267
Q

Small and large intestines: diarrhea: exudative - destruction of epithelial layer

A

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

268
Q

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

A

exudative

269
Q

Small and large intestines: diarrhea: malabsorption

A 
giardia, lymphatic obstruction, defective absorption
lactose intolerance
gas
bloating
end up with diarrhea
270
Q 
giardia, lymphatic obstruction, defective absorption
lactose intolerance
gas
bloating
end up with diarrhea`
A

malabsorption

271
Q

Small and large intestines: diarrhea: deranged motility

A

surgery, hyperthyroidism,
surgery will normally cause an ileus (stopping of gi tract)
hyperthyroidism: diarrhea moving too fast to absorb all the water

272
Q

Small and large intestines: idiopathic inflammatory bowel disease (IBD): crohn disease

A

can affect anywhere from mouth to anus

deep chasms that is transmural inflammation - through wall of intestine

273
Q

Small and large intestines: idiopathic inflammatory bowel disease (IBD): Ulcerative Colitis (UC)

A

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

274
Q

Small and large intestines: idiopathic inflammatory bowel disease (IBD): crohn disease: s/s

A

fever, abdominal tenderness, abd. mass, abd. pain, fistulas

rectal bleeding - occurs in 1/2 of pts

275
Q

Small and large intestines: idiopathic inflammatory bowel disease (IBD): UC s/s

A

rectal bleeding (ulcers)

276
Q

Common s/s for both UC and crohn’s disease

A

diarrhea, loss of appetite, painful bowel mvmts, frequent bowel mvmt, weight loss, fatigue

277
Q

Diverticulosis/diverticulitis are __ protuding out of the __. These occur in __ of people over __ y.o. in the __ and __ with age.

A

pouches protruding out of the bowel. These occur in ~50% of ppl over 50 years old in the USA and increase with age

278
Q

Diverticulosis/diverticulitis: problems

A

lower left quadrant discomfort
bleeding
perforations
fistula formation (following perf)

279
Q

Diverticulosis/diverticulitis: treatment and prevention

A

eat more fiber

280
Q

Bowel obstruction: mechanical obstructions (types)

A

hernias
adhesions
intussusception
volvulus

281
Q

Bowel obstruction: pseudo-obstructions

A

paralytic ileus (post op)
bowel infarction
myopathies and neuropathies (hirschsprung)

282
Q

Tumors of the colon (types)

A 
polyp
pedunculated
sessile
hyperplatic
non neoplastic
neoplastic
adenoma
adenocarcinoma
283
Q

Tumors of the colon: polyp

A

a tumorous mass protruding into the lumen

284
Q

Tumors of the colon: pedunculated

A

having a stalk

285
Q

tumors of the colon: sessile

A

not having a stalk

286
Q

Tumors of the colon: hyperplastic

A

increased number of cells - not cancer

287
Q

Tumors of the colon: non-neoplastic

A

not cancerous

288
Q

Tumors of the colon: neoplastic

A

abnormal disorganized growth - can be cancer

289
Q

Tumors of the colon: adenoma

A

neoplastic polyps arising from epithlial proliferation and dysplasia

290
Q

Tumors of the colon: adenocarcinoma:

A

cancer arising from adenomatous polyps (~98% colorectal cancers)

291
Q 
Tumors of the colon: Colorectal carinoma 
\_\_\_ cases/year 
\_\_ deaths (USA)
lifetime risk : \_\_ incidence, \_\_ death
remains \_\_\_\_ for year
A

~150,000 cases/year, ~50,000 deaths (USA)
lifetime risk; 6% incidence, 2% death
remains asymptomatic for a year

292
Q

Tumors of the colon: Colorectal carinoma: Common s/s

A

pain
obstruction
changes in bowel habits

293
Q

Tumors of the colon: Colorectal Carcinoma: left s/s

descending colon, sigmoid colon, rectum

A

visible blood in stool

LLQ discomfort

294
Q

Tumors of the colon: Colorectal carcinoma: Right s/s

cecum, ascending colon

A

fatigue, weakness

iron deficient anemia

295
Q

Initials for colon caner staging:

A

TNM

tumor nodes metastasis

296
Q

Tumor: types Tis, T1, T2, T3, T4

A

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

297
Q

Tumor: grown thru the wall of the colon or rectum and into nearby tissues or organs

A

T4

298
Q

Tumor: a grown thrn muscularis propria and into subserosa but not to any neighboring organs or tissues

A

T3

299
Q

Tumor: ca grown thru submucosa and extends into muscularis propria (outer muscle layer)

A

T2

300
Q

Tumor: ca grown thru muscularis mucosa and extends into submucosa

A

T1

301
Q

Tumor: earliest stage, only mucosa

A

Tis

302
Q

Nodes: (N0,N1,N2)

A

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

303
Q

Metastasis (M0, M1)

A

M0 - NO DISTANT SPREAD IS SEEN

m1 - distant spread in seen

Pathophysiology Exam 3 (2 decks)

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