GI Flashcards
Compare/Contrast Crohns Dz and UC
Both are inflammatory bowel dz. Crohns likes Anus, UC lieks Rectum.
Crohns causes fistulas anf fissures of anus. Likes to jump around, transmural.
UC likes rectum and NEVER terminal ileum and producing bloody diarrhea. Doesnt jump around and always involves mucosa/submucosa. NON-CASEATING GRANULOMAS.
ileocecal valve, ascending colon, terminal ileum- there is transmural inflammation with very narrow lumen- therefore presentation will be COLICKY, RLQ PAIN, diarrhea in YOUNG person.
Crohns dz
Pt can take down liquids but not solids.. whats going on?
due to OBSTRUCTION, can be esophageal cancer
Pt can’t take down liquids or solids… whats going on?
due to PERISTALSIS problems, which is really bad. If it involves upper 1/3 (which is all striated muscle) it is myasthenia gravis. If it’s lower 1/3 (smooth muscle) it’s due to scleroderma (AKA progressive systemic sclerosis and CREST syndrome) and achalasia (muscles of lower part of esophagus fail to relax).
Pt presents with a peristalsis problem, what is going on with the esophagus? What causes LES to relax?
problem with relaxation of Lower esophageal sphincter (LES). Vasointestinal peptide (VIP) helps LES relax.
Pt presents with a lesion in esophagus, dysphagia of solids but not liquids, lesion is noted in distal esophagus.
Since it is in DISTAL esophagus it is adenocarcinoma, and the precursor lesion is Barretts Esophagus.
Describe Barretts esophagus. What do you expect to see in a Bx?
Ulcerated mucosa of the DISTAL esophagus. Bx shoes glandular metaplasia, see GOBLET cells and MUCOUS cells (which shouldn’t be there). These are here because the esophagus cannot protect itself from esophageal injry.
Describe esophageal varices
DILATED SUBMUCOSAL ESOPHAGEAL VEINS of lower third. Pt has CIRRHOSIS, is an ALCOHOLIC and has PORTAL HYPERTENSION. Left gastric vein is involved (which drains the distal esophagus and proximal stomach).
Describe the portal venous system
directs blood from the GI tract to the liver for processing before continuing to the heart. extends from lower third of esophagus to anal canal and includes spleen and pancreas.
hematemesis
vomiting blood
hemoptysis
coughing blood
hematochezia
blood pouring out of anus.
alcoholic trying to vomit but nothing coming out causing tremendous pressures, leading to tear and hematamesis or puncture. Describe this syndrome
Mallory Weiss syndrome- Tear in esophago-gastric jxn. Dz of esophagus If puncture is called BORHAVES- where air gets into pleural cavity leads to HAMANS crunch of anterior mediastinum.
ie 50 year old male, alcoholic, dysphagis, cannot swallow solids but can swallow liquirds. Dx?
Esophageal cancer- squamous cell carcinoma of MID esophagus.
Whats the mechanism of NSAID ulcers in the stomach
NSAIDS block PGE2 (resp. for mucous membrane barrier of the stomach, vdilation of vessels, and secretion of micarb into mucous barrier). When you take NSAIDS over period of time leads to multiple ulcers and significant blood loss.
why don’t we ever get duodenal bx?
they are never malignant. gastric ulcers have a chance of becoming malignant you take gastric bx NOT duodenal bx.
Why do you get melena (blood in stool) with upper GI bleeds?
Acid converts Hb to hematin which is a black pigment. If you have black tarry stools, its 95% chance its upper GI bleed – duodoneal ulcer (vs. gastric ulcer).
Three branches of celiac trunk
Left gastric, splenic, common hepatic
Portosystemic anastomoses
Esophageal varices, caput medusae, hemorrhoid
Describe characteristics of esophageal cancer..
AABCDEFFGH. Achalasia, alcohol, barrets esophagus, cigarettes, diverticula, esophageal web, familial, fat, GERD, hot liquids
Where iron, folate, B12 absorbed?
Duodenum, jejunum and ileum, terminal ileum along with bile acids. Requires intrinsic factor.
Describe esophageal pathology
Boerhaave syndrome( transmural distal esophageal future due to retching). Esophageal varices (painless bleeding primary to 1/3 eso and secondary portal hypertension) Mallory Weiss syndrome (mucosal lacerations assoc with alcoholics and bullemics)
Describe malabsorption syndromes
“TWCDAP” tropical spruce, whipple in a CAN, celiac, disaccharide, abet.., pancreatitis.
Describe irritable bowel dz
Pain improves with defecation, change stool frequency, change appearance.
Diff kinds fo diverticulum..meckels, intersusception, volvulus
Meckels the five 2’s (2 in long, 2 ft from ileocecal, 2% population, 2 yrs of life, 2 types of epithelium gastric/pancreatic). Intersusception- current jelly stool in children. Volvulus-twisting of bowel around mesentery.
Describe colorectal cancer
“AK53” loss of Apc gene, loss of Kras gene, loss of P53
Describe hereditary hyperbilirubinemia
Gilbert - bili uptake, criger najj-conjugation (causing severe jaundice in children), Dublin- excretion, rotor- mild conjugated.
Wilson and hemochromatosis
Wilson COPPER is Hella BAD. Where copper in brain etc. Hemolytic anemia, basal ganglia degeneration, atresia, dementia, dysphasia, dysarthria
Describe acute pancreatitis
GET SMASHED
Gallstones, ethanol, trauma, steroids, murmur, autoimmune, scorpion, hypercalcemia, ERCP, drugs
