GI Flashcards
What are the cell types in each GI mucosa layers?
Upper GI: Squamos epithelium
Stomach to Anus: Cuboidal glandular epithelium
Anus to external skin: Squamos epithelium
What defines a true ulcer?
It is a chronic ulcer; extends through the muscular mucosa (begins bleeding, damages blood vessels)
What type of cancer occurs in the upper GI? Stomach to anus? Anus outward?
Squamous cell carcinoma; adenocarcinoma; squamous cell carcinoma
What is in the upper GI tract?
- Mouth
- Pharynx
- Esophagus
- Stomach
- Duodenum
What is in the lower GI tract?
- Small Intestine (SI)
- Ileum = last part of SI, common site of Crohn’s Disease also in LI - Large Intestine (LI)
- Appendix
- Rectum
- Anus
An inherited congenital abnormality that is more prevalent in some families. More common in males.; Results from a lack of fusion of the fetal nasal and maxillary processes that form the upper lip
Cleft lip
Often associated with cleft lip; A condition in which a fissure forms between the mouth and the nasal cavity; roof of the mouth posterior to the teeth
Cleft palat
Results from inflammation of the teeth; begins after bacteria form plaque on the surface of the tooth erode the enamel
Dental caries
An inflammatory condition of the gums and tissue surrounding the tooth; Inflammation is in response to colonized pockets of periodontal bacteria; Bacteria will further invade the tooth socket and the root canal and result in loosening and loss of the tooth; Massive inflammation of the gums with production of pus is called pyorrhea
Periodontal disease
Why is periodontal disease related to joint replacement?
bacteria that enters through opening can enter blood stream and set in the new joint
What are the causes of oral cancer?
- Smoking
- Especially Pipe Smoking
- Chronic Alcoholism
What are the signs of oral cancer?
- Leukoplakia
- Erythroplasia
- Ulcers
- Craters
- Nodules or Plaque
What type of cancer is most oral cancers?
Squamous cell carcinoma (tend to metastasize in local lymph nodes in the neck)
What is prognosis of oral cancer?
Good in early aggressively treated lesions with radiation or surgery. Old lesions, poor prognosis, 5-year survival only 25%
What are common symptoms of diseases of the esophagus
- Dysphagia (difficulty swallowing)
- Pain
- Aspiration and regurgitation (food comes up from stomach and enters lower respiratory tract)
What are 3 diseases of the esophagus?
- Esophagitis
- Circulatory Disturbances
- Neoplasms
Infection by viruses or fungi in the immunosupressed or debilitated persons; Bacterial infections are not common in the normal esophagus
Esophagitis
Most common condition that results in gastroesophageal reflux; defect in lower esophageal sphincter; part of the stomach herniates into esophageal area
Hiatal Hernia
Characterized by foci of esophageal mucosa composed of metaplastic epithelium which is changing from squamous to glandular; Metaplastic tissue resembles the glandular columnar epithelium of the stomach; risk factor for cancer (tissue undergoing change)
Barrett’s esophagus
Hiatal hernia type: Lower esophageal sphincter slides above the diaphragm; can cause reflux & heartburn 30 – 60 minutes after the meal
Sliding hiatal hernial (causes heartburn)
Hiatal hernia type: lower esophageal sphincter stays at the level of the diaphragm
Paraesophageal hernia (AKA rolling hernia)
Circulatory disturbances of the esophagus where dilation of veins in the esophagus that can hemorrhage resulting in hematemesis or vomiting of blood; caused by diseases with portal hypertension like cirrhosis of the liver
Esophageal varices
What is the incidence of esophageal carcinomas? Mortality rate?
accounts for 4-7% of malignant neoplasms; 95% die within 2 years of dx
What are S and S of carcinoma of the esophagus?
- Dysphagia (difficulty swallowing)
- Pain
- Bleeding
- Changes in cervical, internal jugular, and supraclavicular lymph nodes
- Bad breath
Where are peptic ulcers found?
Duodenum (first receives pancreatic juices)
What region of the stomach are most carcinomas found?
Antrum and pylorus (60%)
What are causes of peptic ulcers?
NSAIDS, Prolonged Psychological Stress, Use of alcohol, and smoking breaks down the normal mucosal barrier to gastric juices
What ages get peptic ulcers?
Gastric = >50 years Duodenal = any age
What are S and S of peptic ulcers?
- Pain 1-3 hours after meal or during night
2. Pt can localize site of maximum pain, usually in midline of epigastric region
How do you treat peptic ulcers?
- Antacids and diet
- H pylori bacteria
- suppression of gastric acid (Cimetidine)
What are warnings of malignant tumors in the stomach?
polyps (benign epithelial tumors)
Where do stomach cancers metastasize?
- Liver through thoracic duct
- Supraclavicular lymph nodes (Virchow nodes)
- Lungs
What are Virchow nodes classic signs of? what side are they usually on?
Gastric carcinoma and pancreatic cancer; left side
What are the S and S of stomach cancer? Prognosis?
weight loss, anemia, general weakness, gastric irritation, vomiting, loss of appetite (anorexia), & dysphagia; 5 year survival rate is 10-15%
Disease of small and large intestine: a complete obstruction of the lumen which can occur in any part of the intestine – usually surgically resected & repaired
Atresia
Disease of small and large intestine: Loss of nerve innervation to the rectum & sigmoid colon resulting in permanent spasm to the denervated segment of intestine
Hirschsprung’s disease
Hirschsprung’s disease results in:
- An obstruction preventing the passing of feces
- Dilatation of the large intestine proximal to the obstruction
- Surgery usually relieve all the symptoms
Protrusions of the mucosa & submucosa through a hole in the weakened wall of the large intestine into the pelvic cavity; Can be congenital or acquired; Can occur in all parts of the GI tract; The most clinically important are outpouchings in the Sigmoid colon
Diverticula
Fecal matter causes bleeding & inflammation in outpouchings of the intestinal wall
Diverticulitis
Recurrent inflammation of the intestines with chronic unpredictable daily course for the patient
Inflammatory Bowel Diseases (churn’s and ulcerative colitis)
Which IBS is more common?
Ulcerative colitis
Where can Chron’s disease occur?
Ilium (small intestine), large intestine, and rectum
What is specific to Chron’s disease?
early arthritis occurrence seems to be related
Disruption of innervation of the smooth muscle of the intestine, a neuromuscular paralysis; Common in acute peritonitis & patient with spinal cord injury
Adynamic Ileus (a.k.a. Paralytic Ileus)
Caused by:
- intraluminal material – gall stones, fecal concretion
- Hernia’s – Inguinal Hernia, Femoral Hernia, Periumbilical Hernia, & Hiatal Hernia
Obstructive Ileus
Abdominal contents herniate through the internal inguinal ring and are the most common type
Indirect hernia
Abdominal contents herniate through the external ring only
Direct Hernia
A protrusion of the abdominal contents through the abdominal wall
Hernia
What are the types of hernia and commonality?
- Indirect inguinal (most)
- Direct inguinal (less)
- Femoral (least)
- Umbilical (more common in women)
- Incisional (affects men and women after surgical repair of hernia)
What are S and S of common indirect inguinal hernia?
- Pain with straining
- Increased intraabdominal pressure causes sharp pain (coughing, sneezing)
- Standing increases pain which is relieved when lying down
- Sharp pain in the groin awakes patient at night
- Genitofemoral nerve pain
What are S and S of colon cancer?
- Overt Rectal bleeding
- Alteration in bowel habits, especially associated with abdominal pain
- Iron deficiency anemia
- Dull aching back pain
When do colonoscopy’s begin and how often do they screen?
Start at age 50, every 10 years
> 95% of colon cancers are ______ in origin. Most occur in the _____.
epithelial; Large (only 1% in small)
