GI Diseases Flashcards

Question

Tropical Sprue

Answer 1

Similar to celiac sprue Affects small bowel Responds to antibiotics Recent visitors to tropics Can cause diarrhea, steatorrhea, weight loss, weakness, and vitamin and mineral deficiencies

Answer 2

Infection with tropheryma whipplei (gram+) PAS+ Foamy macrophages in intestinal lamina propria, mesenteric nodes, Cardiac symptoms, arthralgias, and neurologic symptoms Most often in older men Treat with antibiotics Can cause diarrhea, steattorrhea, weight loss, weakness, and vitamin and mineral defeiciencies

Answer 3

decreased synthesis of apolipoprotein B leading to inability to generate chylomicrons leading to decreased secretion of cholesterol, VLDL into bloodstream leading to fat accumulation in enterocytes clear or foamy cytoplasm Presents in early childhood with failure to thrive, steatorrhea, acanthocytosis, ataxia, night blindness LOF of MTP gene (functions as chaperone proteins of proper folding of apoB)

Answer 4

Acute inflammation of appendix due to obstruction by fecalith (in adults) or lymphoid hyperplasia (children) nematodes, carcinoids, foreign bodies Retained mucus causes appendicular wall to distend leading to impaired venous outflow which causes hypoxia and bacterial invasion Initial periumbilical pain migrates to McBurney point nausea, fever, may peforate leading to peritonitis +obturator, psoas and Rovsing signs Differential: diverticulitis (elderly), ectopic pregnancy (use B-hCG) Treatment: appendectomy

Answer 5

Blind pouch protruding from the alimentary tract that communicates with the lumen of the gut Most diverticula are acquired and are false (lack or have attenuated musscularis externa) Most often in sigmoid colon Due to increased intraabdominal pressure due to straining during constipation

Answer 6

Many false diverticula of the colon, commonly sigmoid Common >60 y.o. Caused by increased intaluminal pressure with focal weakness in colonic wall Associated with low fiber diets Asymptomatic or vague discomfort Common cause of hematochezia

Answer 7

Inflammation of diverticula causing LLQ pain, fever, leukocytosis May peforate leading to peritonitis, abscess formation or bowel stenosis Give antibiotics Stool occult blood is common with or without hematochezia May cause colovescial fistula (fistula within bladder) leading to pneumaturia

Answer 8

Pharyngoesophageal false diverticulum Herniation of mucosal tissue at Killian triangle between the thyropharyngeal and cricopharygneal parts of the inferior pharyngeal constrictor Due to cricopharyngeal muscle dysfunction occurs due to diminshed relaxation of pharyngeal muscles during swallowing More force needed to move bolus downward more intense contraction increase pressure leading to herniation Presents with: dysphagia, obstruction foul breath from trapped foods, recurrent pneumonia palpated lateral neck muscles Common in elderly males

Answer 9

Telescopin of bowel segment into distal segment, commonly at ileocecal junction Compromised blood supply leads to intermittent abdominal pain often with currant jelly stools (blood and mucus) Can cause ischemia and subsequent necrosis majority in children (idiopathic or associated with enteric or respiratory infection) Abdominal emergency Diagnosis: barium enema

Answer 10

Twisting of portion of bowel around its mesentery Can lead to obstruction and infarction Can occur throughout GI tract Midgut volvulus more common in infants and children Sigmoid volvulus more common in elderly

Answer 11

Atresia: lumen is completely occluded Stenosis: lumen is narrowed Failed recanalization or ischemia Clinical: polyhydramios and billous vomiting (proximal) Normal amniotic fluid levels, abdominal distension, later vomiting and failure to pass meconium (distal)

Answer 12

Third portion of duodenum compressed due to decreased angle between SMA and aorta Occurs due to decreased mesenteric fat (bariatric surgery, anorexia), severe burns, prolonged bed rest, pronounced lordosis, dehabilitating illness, scoliosis surgery High pitched bowel sounds and billous vomiting

Answer 13

Pain is greater with meals H. Pylori in 70% Mechanism: Decreased mucosal protection against gastric acid Other causes: NSAIDs High risk of MALT lymphoma or gastric adenocarcinoma Often occurs in older patients

Answer 14

Pain decreases with meals-weight gain H. Pylori infection in 100% Mechanism: decreased mucosal protection or increased gastric acid secretion Other causes: Zollinger-Ellison syndrome, NSAIDs Generally benign Hypertrophy of brunner glands Treat with: metronidazole, tetracycline, amoxacillin, or clarithromycin with proton pump inhibitor

Answer 15

Diagnosis: at least 12 weeks total time in preceding 12 months with pain/discomfort that has 2/3 of 1. Relieved with defecation 2. Onset associated with change in frequency in stool 3. Onset associated with change in appearance of stool Clinical: diarrhea, constipation or both Visceral hypersensitivity Symptoms that support diagnosis: 1. Abnormal stool frequency 2. Abnormal stool form 3. Abnormal stool passage 4. Passage of mucus 5. Bloating or feeling of abdominal distention Patyhophys: changes in 5- hydroxytryptamin signaling (overactivity) Overactivation of anterior cingulate cortex, PFC and amygdala in response to rectal distension (involved in attentional processes, threat perception and response selection) Enterochromafffin cell release 5HT in GI tract SERT clears serotining from synpases in the brain (low SERT expression in IBS) Stress exacerbates IBS

Answer 16

internal hemorrhoids-not painful due to visceral innervation arterial supply from superior rectal artery (branch of IMA) Venous drainage is superior rectal vein leading to inferior mesenteric vein then to portal system Lymphatic drainage to deep nodes Adenocarcinoma also here

Answer 17

receive somatic innervation via inferior rectal branch of pudendal nerve and are painful arterial supply via inerior rectal artery (branch of pudendal artery) venous drainage via inferior rectal vein leading to internal pudendal vein leading to internal iliac vein then to IVC squamous cell carcinoma also happens here

Answer 18

tear in anal mucosa below the pectinate line pain while pooping, blood on toilet paper, located midline posteriorly due to poor perfusion associated with constipation and low fiber diets May have skin tag

Answer 19

abdominal structures enter the thorax-in infants as a result of defective development of pleuroperitoneal membrane most commonly a hiatal herniates upward through the esophageal hiatus

Answer 20

most common gastroespogeal junction is displaced above (hourglass stomach)

Answer 21

gastrogesophageal junction is normal fundus protrudes into the thorax

Answer 22

goes through internal (deep ring) then external (superficial ring) and into scrotum lateral to inferior epigastric artery occurs in infants due to failure of processes vaginalis to close ( can form hydrocele) or due to internal inguinal ring to close lower border=inguinal ligament medial border=inferior epigastric vessels covered by all 3 layers of spermatic fascia

Answer 23

Protrudes through the inguinal (hesselback triangle) bulges directly through abdominal wall medial to inferior epigastric artery Goes through external (superficial) inguinal ring only Covered only by external spermatic fascia (external oblique) Caused by weakness of transversalis fascia lower border=inguinal ligament medial border=rectus abdominus muscle lateral border=inferior epigastric muscles

Answer 24

protrudes below inguinal ligament through femoral canal below and lateral to pubic tubercle femoral canal becomes lax with age Upper thigh, groin or pelvic discomfort Leading cause of bowel incarceration (leading to nausea, vomiting, abdominal pain) medial border: pubic tubercle and lacunar ligament lateral border: femoral artery, vein and nerve posterior border: Cooper's ligament

Answer 25

Non peristaltic esophageal contractions Can be painful Corkscrew esophagus on barium esphogogram Symptoms: intermittent dysphagia and occasional chest pain Chest pain associated with exertion and not relieved by rest

Answer 26

Gastric hypertrophy with protein loss, parietal cell atrophy, and increased mucous cells Precancerous Rugae of stomach are so hypertrophied they look like brain gyri

Answer 27

Hemorrhage: gastric=posterior lesser curvature of stomach-bleeding from left gastric artery posterior wall of duodenum=gastroduodenal artery Duodenal=anterior Perforation: duodenal may see free air under the diaphragm with pain referred to shoulder

Answer 28

Abdominal pain and distension Fever, diarrhea and shock (decrease BP and increase HR) Due to complete cessation of neuromuscular activity is first step in pathogenesis Can perforate leading to death Barium contrast and colonscopy are CI due to risk of perforation