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GI Domain > GI Diseases > Flashcards

GI Diseases Flashcards

1
Q

Achalasia

A

failure of lower esophageal sphincter to relax due to loss of myenteric (Auerbach) plexus
High LES opening pressure and uncoordinated peristatlsis leads to progressive dysphagia to solids and liquids

Presents with: progressive dysphagia, chest pain, food regurgitation, aspiration (can lead to bronchopneumonia), bad breath
Alcohol may relieve due to relaxation of LES

Smaller valley in LES tone on monometry

Barium swallow shows dilated esophagus with distal stenosis

Increased risk of esophageal squamous cell carcinoma

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2
Q

Sjogren Syndrome

A

Autoimmune disorder characterized by destruction of exocrine glands (lacrimal and salivary)
Predominantly females of 40-60 years old

Findings: Xerophatlamia (decreased tear production and corneal damage)
Xerostomia (decreased saliva production)
Peresence of Anti-Ro and or anti-La (SS-A and B) Abs
Bilateral parotid enlargement

Complications: dental carries, MALT-lymphoma

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3
Q

Barretts Espohagus

A

Chronic GERD characterized by intestinal metaplasia (nonciliated columnar with goblet cells-G cells needed for diagnosis) replacing esophageal squamous mucosa
Endoscpic abnormality also needed for diagnosis

Complicated with ulcerations, stricture and bleeding

Increased risk of adenocarcinoma-more common in males and caucasians (atypia)

Higher esophageal/gastric junction

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4
Q

GERD

A

Symptoms: Heartburn, water brash, chest pain, postural related symptoms, nocturnal coughing, wheezing/asthma, Anemia (iron deficiency), GI bleeding, Dysphagia, painful swallowing

Pathogenesis: Decrease in lower esophageal sphincter tone
Transient: belching
Constant: hypotensive LES-caffeine, chocolates, fatty foods, alcohol, smoking, peppermint, gastric distension, drugs
Increased abdominal pressure

Histo: basal zone hyperplasia, elongation of lamina propria pappillae (upper 1/3 of epithelium), and inflammatory cells (eosinophils, neutrophils)
Hyperemia,

Treatment:
Mild symptoms: raise head in bed, avoid late night snacks, chewing gum, avoid tight clothing, lose weight, restriction of alcohol and elimination of smoking, antacids, H2 blockers

Severe symptoms: H2 Blockers or PPIs, metoclopramide, surgery (Nissen fundoplication)

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5
Q

Eosinophilic Esophagitis

A

Dysphagia
Children and infants have feeding difficulties

Do not respond to PPIs

History of Atopy: allergies, asthma, blood eosinophilia, food senstivities, allergic rhinitis

Endoscopy: linear furrowing and stacked circular rings

Eosinophils on histology

Treatment: elimination diets, topical glucocorticoids, esophageal dilatation

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6
Q

Esophagitis

A

irritants: corrosie chemicals, pills-doxycycline, hot liquids, heavy smoking, alcohol

Infectious: immunocompromised
Candida: psyodmembrane (yeast buds and hyphae)
HSV: punhced out ulcers
CMV: linear ulcers

Iatrogenic: cytotoxic chemotherapy, radiation, graft versus host disease

Crohns disease

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7
Q

Boerhaave syndrome

A

Transmural esophagitis
Distal esphageal rupture due to violent retching: surgical emergency

Esophageal air fluid leakage into mediastinal/pleura

Chest pain, fever, dyspnea and septic shock

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8
Q

Mallory-Weiss Syndrome

A

Mucosal lacerations at gastroesophageal junction due to severe vomiting (metabolic alkalosis),

Leads to hematemesis, epigastic pain

Alcoholics and bulimics

Associated with hiatal hernias

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9
Q

Chagas disease

A

Caused by trypanosoma cruzi-South America
dilated cardiomyopathy, megacolon, megaesophagus (achalasia)

Transmission: Reduviid bug, feces, deposited in painless bite

Diagnosis: blood smear

Treatment: benznidazole or nifuritimox

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10
Q

lactase deficiency

A

Malabsoprtion of lactose leads to bacterial fermentation and gas distension (H2, CO2 and methane)

Leads to osmotic diarrhea

Lactase functions on brush border

Primary: age dependent decline after childhood, common in Asian, African and Native American descent
Secondary: loss of brush border due to gastroenteritis (rotavirus), autoimmune,
Congenital: rare due to defective gene

Stool: decreased pH and breath shows increased H content with lactose tolerance test

Normal mucosa in biopsy

Symptoms: bloating, cramps, flatulence, osmotic diarrhea

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11
Q

hartnup Disease

A

Autosomal recessive disorder
Deficiency of neutral amino acid transporters in proximal renal tubular cells and on enterocytes

Leads to neutral aminoaciduria and decreaed absorption from the gut

Results in: photosensitivity, skin rashes, ataxia (wax and wane), Niacin (Vit. B3 deficiency)-pellagra like sypmtoms

Treat with: high protein diet, and nicotinic acid

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12
Q

Celiacs disease

A

Immune mediated damage of small bowel villi due to gluten exposure
Associated with HLA-DQ2 and DQ8

Gluten present in wheat and grains-gliadin is pathogenic
Gliadin is deaminated by tissue transglutaminase and presented to MHC class II cells leading to helper T cell damage

Clinical:
children: abdominal distension, diarrhea, and failure to thrive, delayed puberty, growth failure
Adults: chronic diarrhea and bloating, anemia, difficulty gaining weight
Small herpes like vesicles on skin (dermatitis hepetiformis)
Due to IgA deposition at the tips of the dermal papillae

labs:
IgA Abs to endomysium, tTG, or gliadin
Duodenal biopsy reveals flattened villi, hyperplasia of crypts, and increased interaepithelial lymphocytes
Damage is most prominent in duodenum and jejunum

Small bowel carcinoma and T cell lymphoma are late complications

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13
Q

Crohn’s Disease

A

Chronic inflammation of transmural layers of intestine (any part mostly ileum and colon) and skip lesions

Symptoms: right lower abdominal pain, fevers, weight loss
Inflammation can lead to abscesses, fistula, scarring/obstruction and rectal fissures, peri anal disease, non caseating granulomas, palpable mass, leukocytosis

Endoscopy: apthous ulcers, longitudinal ulcers, cobble-stoning, fat creeping, colon and small bowel obstruction

Complications: malabsorption of fats and gallstones (don’t reasorb bile salts)

Systemic manifestations: migratory polyarthritis, erythema nodosum, ankylosing spondylitis, pyoderma gangrenosum, uveitis, oxalate kidney stones, anemia, gallstones

Smoking may cause disease, appendectomy my be risk, oral contraceptives slightly increase risk, more genetic

Treatment: Corticosteroids, azothioprine, methotrexate, infliximab, adalimumab
Responds to antiobiotics and recurs after surgery

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14
Q

Ulcerative Colitis

A

Chronic and continuous Inflammation of the mucosal layer of the COLON

Involves the RECTUM with no skip lesions

Symptoms: abdominal pain, tenesmus, passage of mucus and gross bloody diarrhea

Endoscopy: mucosal friability and distorted vascular pattern, pesuodpolyps formed from islands of remaining regenerating mucosa, loss of haustra

Complications: pyoderma gangrenosum, erythema nodosum, primary sclerosing cholangitis, ankylosing spodnyltis, apthous ulcers, uveitis

Increased colon cancer and toxic megacolon risk

Smoking may prevent disease, appendectomy may be protective

Treatment: ASA perparations (sulfasalazine), 6-mercaptopurine, infliximab, colectomy

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15
Q

Osmotic Diarrhea

A

Little or no passive electrolyte absorption in gut, cannot sustain osmotic gradient

3.5 ml water retained in lumen for each additional mOsm

Increased stool osmotic gap=290-2(Na+K)
Greater than 50 mOsm/kg

Causes:
Laxatives: Mg, SO4, PO4, PEG
Non-absorbable sweeteners: mannitol sorbitol, aspartame, erythritol (sugar free products)
CHO maldigestion: disaccharidase deficiency, pancreatic exocrine insufficiency
Malabsorption: celiacs

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16
Q

Non inflammatory secretory diarrhea

A

mechanism: enterotoxin, adherence of superficial invasion

Location: proximal small bowel

Illness: watery diarrhea

Stool exam: no leukocytes

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17
Q

Exudative (inflammatory) diarrhea

A

Mechanism: invasion, cytotoxin

Location: colon

Illness: dysentery/inflammatory diarrhea

Stool exam: fecal leukocytes (PMNs),, sometimes RBCs

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18
Q

Entamoeba histolytica

A 
Ameboe
Bloody diarrhea (dysentery), liver abscess with exudate, RUQ pain

Histology shoes flask shaped ulcer if submucosal abscess of colon ruptures

Transmission: cysts in water

Diagnosis: serology and/or trophozoites (with RBCs in the cytoplasm) or cysts with up to 4 nuclei in stool

Treatment: metronidazole, iodoquinol for asymptomatic cyst passers

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19
Q

Chronic Mesenteric Ischemia

A

Predominantly involving the small intestine
Involves clot in SMA (a. fib), atherosclerosis or low flow state

Postprandial epigastric pain and food aversion
pain due to lack of blood supply with mucosal celsl most susceptible followedc by submucosa and muscularis (total infarction of bowel in 4-6 hours if no collateral)
preservation of crypts where stem cells can initiate regeneration of mucosa

In embryo leads to atresia
In adult leads to atrophy

Incarcerated: trapped
Strangulate: no flow or no movement

Diagnosis: arteriogram

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20
Q

Ischemic enteritis/colitis

A

Loss of sufficient blood for good function but not enough decrease in flow to cause tissue death (but often doesn’t)

Symptoms: pain over affected site and bloody diarrhea

Most common sites:
Splenic flexure and sigmoid colon due to watershed areas relying on circulation through marginal arteries

Cure: increase flow

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21
Q

Reperfusion injury

A

If flow restored before death of cells than further injury generated by free radical production and may result in multiorgan failure

Generation of free oxygen radicals and release of inflammatory mediators including complement and TNF

22
Q

Acute Gastritis

A

Disruption of mucosal barrier leads to inflammation

Can be caused by stress, NSAIDs (decrease PGE2 leading to decreased gastric mucosa protection) alcohol, uremia, burns (decreased plasma volume sloughing of gastric mucosa-Curling ulcer) and brain injury (increased vagal stimulation leading to Increased ACh and increased H+-Cuhsing ulcer)
stress: shock, extensive burns, sepsis, severe trauma, and intracranial injury/surgery

Neutrophil infiltrate with multiple defects in stomach

23
Q

Chronic Gastritis-Type A

A

In fundus/body
Autoimmune disorder characterized by autoAbs to parietal cells (upper glandular layer)
Pernicious anemia: fatigue, lower extremity parasthesias, megaloblastic RBCs
Acholrhydia

Associated with other autoimmune disorders

24
Q

Chronic gastritis-Type B

A

In antrum
Most common type
Caused by H. Pylori infection

Increase risk of MALT lymphoma and gastric adenocarcinoma
Decreased somatostatin producing cells (delta cells) leads to increased acidity not matched by duodenum leading to duodenal ulceration and gastric metaplasia

25
Q

Tropical Sprue

A

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

26
Q

Whipple disease

A

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

27
Q

Abetalipoproteinemia

A

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)

28
Q

Appendicitis

A

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

29
Q

Diverticulum

A

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

30
Q

Diverticulosis

A

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

31
Q

Diverticulitis

A

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

32
Q

Zenker Diverticulum

A

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

33
Q

Intussusception

A

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

34
Q

Volvulus

A

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

35
Q

Intestinal atresia and stenosis

A

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)

36
Q

SMA syndrome

A

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

37
Q

Gastric Ulcer

A

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

38
Q

Duodenal Ulcer

A

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

39
Q

Irritable Bowel Syndrome

A

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

40
Q

above pectinate line hemorrhoids

A

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

41
Q

Below pectinate line hemorrhoids

A

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

42
Q

Anal fissure

A

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

43
Q

diaphragmatic hernia

A

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

44
Q

Sliding hiatal hernia

A

most common

gastroespogeal junction is displaced above (hourglass stomach)

45
Q

Paraesophageal hernia

A

gastrogesophageal junction is normal

fundus protrudes into the thorax

46
Q

indirect inguinal hernia

A

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

47
Q

Direct inguinal hernia

A

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

48
Q

Femoral hernia

A

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

49
Q

Diffuse Esophageal Spasm

A

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

50
Q

Menetrier disease

A

Gastric hypertrophy with protein loss, parietal cell atrophy, and increased mucous cells

Precancerous

Rugae of stomach are so hypertrophied they look like brain gyri

51
Q

Ulcer Complications

A

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

52
Q

Toxic megacolon

A

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

GI Domain (3 decks)

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