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Pathophysiology > GI > Flashcards

GI Flashcards

1
Q

What makes up the GI tract?

A

Oral cavity

esophagus

stomach

small intestine

large intesting

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2
Q

What does the stomach acid do?

What else happens in the stomach?

A

Denatures proteins and kills most pathogens

adds or removes water until bolus is isotonic

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3
Q

What are the anatomical and motor disorders of the esophagus?

A
  • Hiatal hernia
  • achalasia
  • esophageal varices
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4
Q

What is a hiatal hernia?

A
  • stomach protrudes up into diaphragm
    • sliding- food enters stomach from esophagus and gets caught in the pouch above the diaphragm
  • symptoms:
    • Heart burn
    • regurgitation
    • **can cause barrets esophagus and then cancer
  • increases with age
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5
Q

Achalasia

A
  • Food gets stuck in your esophagus
    • food that sits there then starts to errode the esophagus
  • lower esophageal sphinctor doesn’t open properly
    • or has increased resting tone
  • usually happens more to older people
  • symptoms
    • dysphagia
    • mucous membrane errosion
    • barrets esophagus –>squamus cell carcinoma
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6
Q

What are esophageal varices?

What is the big problem with these?

A
  • Varicose veins in esophagus
  • caused by impaired hepatic portal blood flow
    • associated with alcoholic cirrhosis (~2/3 of cirrhosis patients)
  • big problem is rupture
    • hematemesis- vomiting blood
    • 20-30% die on each episode of rupture
    • 70% recurrence rate
    • *often also have coagulopathies related to liver disease
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7
Q

What is Mallory-Weiss Syndrome?

A

severe and prolonged (traumatic) vomiting can cause tears in esophagus

*usually not a huge problem because if they dont have cirrhosis, then they will not have coagulophathies and will stop bleeding.

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8
Q

Reflux esophagitis

A
  • When the lower esophageal sphinctor doesnt close properly
    • causes heartburn and barret esophagus
  • contributing factors
    • obesity
    • hiatal hernia
    • vagal nerve abnormalities
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9
Q

What is barrett esophagus?

A
  • replacement of normal stratified squamus mucosa with metaplastic columnar epithelium with goblet cells
  • Can lead to cancer
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10
Q

What are the two esophageal cancers?

A
  • Squamous cell carcinoma- occurs where you have normal esophageal tissue (no barretts)
    • caused by tobacco, alcohol, achalasia, very hot tea (>65 C)
  • Adenocarcinoma
    • caused by barrett esophagus
    • symptoms: dysphagia and obstruction
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11
Q

What is Zenker’s Diverticulum?

A
  • part of food bolus gets trapped in the pouch
  • more common in pts over 60
  • symptoms
    • dysphagia
    • regurgitation
    • cough
    • halitosis (food rots in the pouch, causing bad breath)
    • usually painless
    • may cause infection and perforation (rare)
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12
Q

What is Chronic gastritis?

A
  • Usually caused by H. pylori
    • will start to errode stomach lining
    • usually asymptomatic
      • maybe stomach discomfort, N/V
  • Can continue to becme peptic ulceration
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13
Q

What are peptic ulcers?

A
  • Chronic lesions that can be anywhere in GI tract but 98% are in proximal duodenum and stomach (4:1)
    • H. pylori is involved in 70-90% of duodenal ulcer and 70% of gastric ulcers
  • Only 10-20% of ppl w/ H. Pylori get ulcers
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14
Q

What aggravates peptic ulcers?

A
  • NSAIDS
  • smoking
  • alcohol
  • corticosteroids
  • high stress personality??
  • gastrinoma (zollinger-ellison syndrome)
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15
Q

What problems do peptic ulcers cause?

A
  • epigastric pain
  • nausea and vomiting
  • hemorrhage and perforation
  • generally do NOT progress to cancer
  • ** usually just impair quality of life rather than shorten it
    • 15,000 deaths/year attributed to complications of peptic ulcers
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16
Q

Why do NSAIDS exacerbate ulcers?

A

decrease prostaglandins which decreases mucous layer

(prostaglandins stimulate mucousal production)

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17
Q

What is a gastrinoma?

A

a hormone producing tumor

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18
Q

What is acute (stress) gastritis?

A
  • Completely different from chronic and does not progress to chronic
  • Causes:
    • heavy NSAID use
    • excessive alcohol
    • heavy smoking
    • chemo
    • uremia
    • systemic infections
    • severe stress (trauma, burn, surgery)
    • ischemia and shock
    • ingestion of caustic agents (acids or bases)
    • mechanical trauma (nasogastric intubation)
  • Problems:
    • epigastric pain with N/V
    • Hematemesis and/or melena (bloody stool)
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19
Q

How did we cure stomach cancer?

A

refrigeration

*before refrigerators ppl ate all smoked or pickled foods for winter

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20
Q

What are the two types of stomach cancers?

A
  • Intestinal-type adenocarcinoma (the type of cancer cured with refrigeration)
    • caused by nitrites, preservatives
    • smoked food
    • excessive salt
    • decreased fruit and veg consumption
    • chronic gastritis
    • H. pylori
  • Diffuse carcinoma
    • risk factors poorly understood; we have not cured this type
21
Q

What is the third leading cause of cancer death worldwide?

A

gastric carcinoma

1st- lung

2nd- liver

22
Q

How are carbohydrates, proteins, and fats digested?

(chart)

A
23
Q

What part of GI tract is most at risk for ischemia if there is a shortage (shock)?

A

splenic flexure

24
Q

What is Hirschsprung disease?

A
  • Neural crest cells don’t make it all the way to the end of the colon (caudal migration) during fetal formation leaving an aganglionic segment
  • distal colon lacks both meissner and auebach myenteric plexus
    • no peristalsis past where there are no nerves
  • Problems
    • obstruction
    • enterocolitis
    • perforation
  • Fixed by removing the aganglionic segment
25
Q

What is ischemic bowel disease?

A
  • acute occlusion or hypoperfusion can result in infarction
  • Mucosal- not a big deal, make for mucous
  • mural- More severe, but not the worst
  • Transmural infarction- Goes all the way through the intestinal wall
    • becomes friable- easy to perforate, like trying to suture a wet tissue; whatever was in the lumen is now in the abdomen
      *
26
Q

What are the causes of ischemic bowel?

A
  • arterial thrombosis
  • arterial embolism
  • venous thrombosis
  • nonocclusive ischemia
    • cardiac failure, shock, dehydration, vasoconstrictive drugs
  • mechanical obstruction
    • volvulus, stricture, herniation
27
Q

What is the mortality of transmural bowal infarction?

A

90%!

They were probably already sick when the bowel infarcted

28
Q

What causes hemorrhoids?

A
  1. straining during defecation- strain causes increased venous pressure
  2. pregnancy- later in pregnancy
  3. portal hypertension- similar to esophageal varices
29
Q

What causes cholera?

A
  • Secretory (cholera)- produces toxin that causes chloride to leak into lumen, prevenitn Na from being reabsorbed. Water goes to lumen. Difficult to keep this person hydrated
30
Q

What are osmotic causes of diarrh

A
  • Gut lavage- goal to clean out the GI tract
    • too much golytely causes dehydration with some kind of electrolyte imbalance
31
Q

What are all the major causes of diarrhea?

A
  • Secretory- cholera
  • osmotic- golytely
  • exudative- IBD (crohn’s and UC)
  • Infectious- shigella, salmonella, campylobacter, C.diff
    • C.diff can take over after antibiotics
  • Malabsorption- defective absorption (lactose, gluten)
  • Deranged motility- surgery, hyperthyroidism
32
Q

What is irritable bowel syndrom?

A
  • chronic “crummy tummy”
  • IBD is WAY worse than IBS
33
Q

Where does UC start?

A
  • Ulcers in colon
  • Starts at the anus and goes back from there. Amount of colon involved depends on extent of disease
  • Pseudopolys- part of tissue wall stays forward as all the neighboring tissue becomes ulerated and errodes back
34
Q

What part of the bowel does crohn’s disease affect?

A
  • some parts are affected, others are normal (skip lesions)
  • causes deep fissures that go through mucosal layer and can even cause fistulas from lumen of intestine to abdomen
  • structures form, making intestine walls thicker
35
Q

What are the different smptoms of Crohn’s vers UC?

(chart)

A
36
Q

What are the common symptoms between Crohn’s and UC?

A

Diarrhea

loss of appetite

painful bowel movement

frequent bowel movement

weight loss

fatigue

37
Q

Whats this?

A
  • The hook worm!! A possible cure for crohn’s?!?
  • causes hemorrhagic anemia with no bleeding
  • the hook worm “turns off” the pts immune system so that it can survive
38
Q

What is the lifecycle of the hookworm?

A
  • lives in intestines, sucks blood, lays eggs
  • eggs come out of body in feces, get into soil and hatch
  • larva bore into the ground and then bore into a person’s foot when they walk over that ground
  • the larva make their way into person’s lungs, get coughed up in sputum and then swallowed into GI tract to start cycle again
39
Q

What is the other high yuck factor medical treatment discussed in class?

A
  • Fly maggots
  • eat dead flesh but not live tissue
  • can be sprinkled on a necrotic wound and a few days later it is nice and clean
  • alternative to amputation
40
Q

What is diverticulosis/diverticulitis?

What causes it?

Where does it usually occur?

symptoms?

prevention?

A
  • Diverticulosis- pouches that protrude out of the bowel
    • occur in about 50% of ppl over 50 years old and increase with age
  • diverticulitis- inflammation of the pouches
  • occurs mostly in descending colon where the stool is very thick and difficult to move along
  • Left lower quadrant pain
  • prevent by eating more fiber, avoid food with small seeds
41
Q

What are the different types of mechanical bowel obstructions?

A
  • hernias- intestine seeps through inguinal canal; bolus can’t get through easily and neither can blood
  • adhesions- scar tissue binds bowel together so it cant move as well
  • intussusception
  • vulvulus- twisting
42
Q

What are some pseudo obstructions?

A
  • paralytic ileus- bowel doesnt work so content just builds up
  • bowel infarction- muscle damage prevents peristalsis
  • myopathies and neuropathies (herschsprung)
43
Q

Which intestine has the greater occurance of cancer?

A

large intestine

44
Q

Definitions:

polyp

pedunculated

sessile

A
  • polyp- a tumorous mass protruding into the lumen
  • pedunculated- having a stalk
  • sessile- not having a stalk
45
Q

adenoma

A

neoplastic polyp arising from epithelial proliferation and dysplasia

46
Q

adenocarcinoma

A
  • cancer arrising from adenomatous polyps (98% of colorectal cancers)
47
Q

Carcinoid tumor

A

tumors of neuroendocrine cells, found in stomach, intestines, and lung

48
Q

What are the differences between a cancer on the right side vs left side?

A
  • right- fatigue, weakness
    • iron deficient anemia
    • blood on guiac, but wont see it in stool
  • Left- no anemia because pt will see blood in stool and will get checked

Pathophysiology (26 decks)

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