GI Disorders Flashcards by Nishan Pressley

What is the Z-line?

Transition from stratified squamous epithelium of esophagus to simple columnar epithelium in stomach

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What controls peristalsis in the esophagus?

Auerbach’s plexus

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This is a decrease in LES pressure, causing it to open + gastric contents to reflux into esophagus when supine (laying down)

GERD

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This is when herniation of a portion of the stomach goes into thoracic cavity through diaphragm

Hiatal hernia

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If GERD is untreated, it may lead to what 2 issues?

Metaplasia = Barrett’s

2. Dysplasia = Neoplasia

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What are the 4 tests for GERD?

Barium swallow
Upper GI series
Monitor esoph. PH
Upper endoscopy (test of choice)

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This is an adaptive replacement (metaplasia) of esophageal squamous epithelium with columnar found in stomach and intestine. Complication of GERD

Barrett’s Esophagus/epithelium

- 1% are malignant

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This presents late with dysphagia; not diagnosed until after metastasis; Tp53 found in 50% of scc

Esophageal cancer

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What are the 2 types of esophageal cancer?

Squamous cell

2. Adenocarcinoma

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This causes pepsinogen to convert to pepsin in low pH; enyzyme that hydrolyzes protein to polypeptides

Chief cells

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This secretes HCL acid + intrinsic factor

Parietal cells

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These cells secrete mucus in the stomach

Cardiac glands + mucus neck cells

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These cells contain gastrin that stimulates secretion of HCl, Pepsin, Intrinsic factor, histamine type 2

G cells

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What 4 things control stomach acid secretion?

Gastrin
Vagus nerve
Histamine 2 from amst cells in mucosa
Proton pumps in parietal cells

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What inhibits stomach acid secretion

Prostaglandins

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This is the inflammation + breakdown of gastric mucosal barrier leading to edema and erythema

Gastritis

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This is an erosion or ulcer where acid-pepsin are exposed to mucosa

Peptic Ulcer Disease

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What is the most common drug that causes PUD?

NSAIDs (decreases prostaglandin synthesis which decreases mucus and bicarbonate)

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What’s the most common infectious cause of PUD?

H. Pylori

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This is a type of peptic ulcer (20% of PUD); found more in men; >50-60yo; main cause is H. Pylori; patients vomit blood

Gastric Ulcers

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90% of gastric ulcers are found where? Can they become malignant?

Antrum and lesser curvature, anterior

- yes 4% become cancer

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This is a type of peptic ulcer (80%), found = in men and women; ~40 yos; H. pylori was main cause; patients poop blood

Duodenal Ulcers

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90% of duodenal ulcers occur where? are they cancerous?

in duodenal bulb

- almost never malignant

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What are the main risk factors of duodenal ulcers?

Cirrhosis of liver

2. Type O blood

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What is the triple therapy to treat H. Pylori?

1. Amoxicillin 2. H-2 blocker 3. Metronidazole (Flagyl)

Patients with what blood type and descent are at a high risk for gastric cancer?

- Blood type A | - asian descent

90% of gastric cancers are?

adenocarcinomas

What are the 2 functions of the small intestine?

Digestion | Absorption

This is a malabsorption disease; found in 1% of population, induced by gluten intake; villi become flattened; found early or after 20 yo

Celiac Disease

If a patient has a celiac crisis, what is the treatment?

corticosteroids to aid in the inflammation

The lack of lactase enzyme leads to inability to break down lactose in dairy products.

Lactose deficiency

This is known as the post-surgery lack of stomach space, reduced pancreatic output, stasis, rapid transmit time leads to malabsorption

Postgastrectomy malabsorption

Pancreatic enzyme deficiency which leads to malabsorption

cystic fibrosis

This is a common disease in western society, not enough fiber in diet, spasm of musculature and increase in pressure causes mucosal outpouchings

Diverticular disease

Small pounches in diverticular disease?

Diverticula

Outpouching/herneation of mucosa through muscle layers of the colonic wall

Diverticulosis - asymptomatic

Inflammation of diverticula

Diverticulitis

What's the most common site for involvement of diverticular disease?

sigmoid colon (90%)

What is the treatment for diverticular disease?

High fiber diet

Inflammatory bowel disease consist of what 2 diseases?

1. Chron's disease | 2. Ulcerative colitis

What leukocyte antigen is associated with IBD?

HLA-B27

What ocular manifestations are first seen in IBD?

Nongranulomatous Anterior Uveitis

This disease affects all layers of bowel (small intestine, 40%); skip lesions are classic findings (cobblestone); affects more young adult females

Chron's disease

This is a recurrent granulomatous inflammatory response with sharply demarcated lesions surround by normal bowels.

Chron's disease

This disease is more common than Chron's; begins at 30; always causes colon cancer; originates in rectum

Ulcerative colitis

Bloody,mucus filled diarrhea often with rectal bleeding, abdominal pain, fatigue anorexia = hallmark of this disease?

Ulcerative colitis

This causes dilation of colon and systemic toxicity

Toxic megacolon

This is abdominal pain relieved by defecation; alternating diarrhea w/ constipation; no known cause

Irritable bowel syndrome

T/F: Polyps + Tubular adenomas are common; most are benign. Villous adenoma is more likely to be malignant

True

This disease causes entire colon to be filled with polyps, its genetic via chromosome 5; pt will get cancer by 40 yo

Familial adenomatous polyposis (FAP)

This is the 3rd most common cause of cancer death in the US. What's the most common malignancy?

Colorectal cancer | - adenocarcinoma is most common malignancy

Acute pancreatitis is mostly related to what 2 things?

1. binary tract disease (passed gallstone) | 2. heavy alcohol intake

What's the most common type of hepatitis in the US? How is it spread? is there a vaccine?

Hepatitis A - spread among children in daycare - yes vaccine

Hepatitis B disease can cause what 2 diseases?

1. Acute fulminant hepatitis | 2. chronic hepatitis

Hepatitis B is found mainly in who?

IV drug users (there's a vaccine)

Hepatitis C is mostly caused from IV drug use. Is there a vaccine available?

In chronic persistent hepatitis, most patients recover. What about chronic active hepatitis?

Death in 5 years - mostly found in hep C patients

This is the liver's inability to eliminate copper. What ocular findings are present ?

1. Wilson's disease | 2. Kayser-Fleischer rings

These are the risk factors for what disease? Female, fertile, obesity, rapid weight loss, hypertriglyceridemia, insulin resistance, NSAIDS

Cholelithiaisis (gallstones)

What are gallstones composed of?

Bile salts and cholesterol

This is when a cystic duct is blocked by stone, inflammation develops behind stone; associated with gallstones 90% of the time

Cholecystitis

How is hepatitis A transmitted?

Fecal oral route

How is hepatitis B/C transferred?

Mainly by blood and body fluids