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GI julia Flashcards

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1
Q

MC congenital fistula

A

Tracheoesophageal Fistula
- feeding issues: bind pouch and food accumulates -> vomit
- breathing complication: as baby breathes, the air enters the lower part of esophagus to stomach + stomach inflates

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2
Q

Achalasia: definition and sx

A
  • inability to relax LES = increased LES tone and APERISTALSIS
  • mostly uncertain etiology

sx:
- dysphagia
- regurgitation
- chest pain

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3
Q

Hiatal hernia: definition and sx

A
  • diaphragmatic muscular defect
  • WIDENING of space through which the lower esophagus passes through to stomach
  • hiatal hernias are ABOVE the stomach
  • associated with reflux
  • can lead to ulceration, bleeding, perforation, strangulation
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4
Q

Schatzki ring: definition, what is it found with

A

circular band of mucosal tissue at DISTAL esophagus
- causes narrowing

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5
Q

Diverticula of the esophagus: location and true diverticula def

A

Zencker – usually high/proximal
Traction – usually mid esophagus
Epiphrenic – usually distal esophagus/low

true diverticula: have all 4 layers in the

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6
Q

Mallory-Weiss tear

A

severe secondary to severe vomiting: alcoholics, bulimia
– mucosal tears is LONGITUDINAL on lower esophagus

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7
Q

Esophageal varices: common areas portal/caval anastomoses (where portal and systematic connects)

A

Definition: Dilated submucosal veins in the lower esophagus
- secondary to portal hypertension (90% of cirrhosis pts)
- can lead to MASSIVE, sudden and fatal hemorrhage

Three common areas of portal/caval anastomoses (where portal and systematic connects)
- Esophageal
- Umbilical
- Hemorrhoidal

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8
Q

esophagitis causes

A
  • GERD/reflux -> leads to barretts
  • barretts

chemical:
- lye: suicide attempts with strictures
- alcohol
- hot drinks
- chemo

infectious:
- CANDIDA esophagitis: immunocompromised patients (e.g. AIDS) – white, creamy coating
- Herpes esophagitis: can cause ULCERS

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9
Q

GERD definition and what can be seen histologically for dx

A

definition: Reflux of acid from the stomach due to reduced LES tone
- reflux esophagitis
- main sx: heartburn
- slowed reflux clearing and delayed gastric emptying
- complication: Barrett’s esphagus

Dx: inflammatory cells
- EOSINOPHILS
- neutrophils
- lymphocytes

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10
Q

Barrett’s esophagus: definition, cause, and major complication

A

Definition: Metaplasia of lower esophageal mucosa from stratified squamous epithelium to
columnar epithelium with GOBLET cells
- metaplastic to protect itself from acid reflux
– intestinal mucosa produces MUCIN which helps neutralize acid (goblet cells)
- Long standing metaplasia -> dysplasia-> esophageal ADENOCARCINOMA**

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11
Q

Esophageal tumors: benign types

A

leiomyomas (smooth muscle tumor) - often found in uterus**

others: lipoma, condylomas (HPV), fibrovascular polyps, “granulation tissue”

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12
Q

Esophageal tumors: malignant types and their risk factors

A

SCC MC
- risk factors: TOBACCO, ALCOHOL, nitrites in fungi, Betel nuts
– progression is usually from DYSPLASIA of squamous cells to squamous cell carcinoma-in-situ to infiltrative/invasive cancer

Adenocarcinoma = Barrett’s esophagus major risk factor
- usually occurs distally

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13
Q

Pyloric stenosis presentation and risk factors

A

Presentation:
- congenital hypertrophy of pyloric smooth muscle
- projectile vomiting in infants
- presence of palpable mass in epigastrium “olive”
- M > F
- risk factors: whites, premature birth, fam hx, smoking during pregnancy

Tx: myotomy

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14
Q

Acute gastritis definition and risk factors and what does it cause on histology

A

definition: Acidic damage to the stomach mucosa
- causes HEMORRHAGE and EROSIONS + NEUTROPHILS (inflammatory response)

Risk factors
- NSAIDS
- alcohol, smoking
- chemotherapy
- severe stress: trauma, burn, surgery, shock

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15
Q

Chronic gastritis: how does it compare to acute gastritis

A

Chronic:
- no erosions, no hemorrhage
– mucosal changes: intestinal metaplasia, atrophy (thinning of mucosa), dysplasia
- LYMPHOCYTES present (chronic inflammation)

acute:
- neutrophils
- hemorrhage
- erosions

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16
Q

Chronic gastritis: what are the types of gastritis

A

Chronic H pylori gastritis * (90%):

Chronic autoimmune gastritis * (10%): antibodies against parietal cells and intrinsic factor (pernicious anemia + B12 deficiency)

others:
- toxins: alcohol/smoking
- post-surgical: bile reflux
- radiation
- Crohn’s: granulomatous
- eosinophilic esophagitis: middle aged women
- allergic gastritis: children
- lymphocytic gastritis: diffuse

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17
Q

H. pylori can lead to what illnesses

A
  • chronic gastritis
  • peptic ulcers: 80% of gastric peptic ulcers, 100% of duodenal peptic ulcers
  • adenocarcinoma of stomach
  • MALT lymphoma of stomach

tx: triple therapy abx

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18
Q

Peptic ulcers: MCC and other causes; main sx and complication

A

MCC: H. pylori
- 80% of gastric peptic ulcers
- 100% of duodenal peptic ulcers.

others: NSAIDS, stress

sx:
- burning, aching
- epigastric pain
- iron deficiency anemia
- main complications: perforate, acute hemorrhage, obstruction from edema/scarring

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19
Q

peptic ulcers: complication

A

bleeding: 15-20% of pts
- MC complication
- first indication of ulcer

perforation:
- radiation to back, chest, LUQ
- 2/3 of ulcer deaths
- rarely first indication of ulcer

obstruction from edema:
- 2% of pts
- incapacitating crampy ab pain
- rare: total obstruction with intractable vomit

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20
Q

Acute ulcers

A

usually small < 1cm, superficial, multiple

Due to : NSAIDS or stress

Stress: endogenous steroids vs exogenous steroids
- endogenous: release of stress hormones during burns, shock, massive trauma, sepsis
- exogenous: high dose corticosteroid tx, cushing ulcer

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21
Q

Hypertrophic gastropathies: main sx/presentation and what are the pain gastropathies

A

stomach rugae are prominent* (cerebriform)
- usually no inflammation
- marked hyperplasia of mucosa

main types:
- Menetrier’s disease
- Zollinger-Ellison syndrome
- hypertrophic -hypersecretory gastropathy

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22
Q

Zollinger-Ellison syndrome vs Menetrier’s disease

A

Menetrier’s disease:
- hyperplasia of surface mucus cells
- associated with: elevation of TGF-alpha

Zollinger-Ellison syndrome:
- gastric gland hyperplasia secondary to excessive gastrin secretion from a gastrinoma (pancreas tumor)

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23
Q

Stomach tumors: benign

Study These Flashcards
A

leiomyomas: smooth muscle
polyps (hyperplastic vs adenomatous)
- PPI pts tend to get polyps
lipomas: adipose tissue

24
Q

stomach tumor: malignant vs potentially malaignant

Study These Flashcards
A

malignant:
- adenocarcinoma MCC (H. pylori); SIGNET RING CELLS
- lymphoma: MC = B cell type MALToma -> can treat by tx H. pylori

potentially malignant:
- GIST: gastrointestinal stromal tumor, SPINDLE CELLS, CELLS OF CAJAL, c-KIT
- carcinoid tumor (neuroendocrine

25
Malignant – Adenocarcinoma of stomach risk factors types and major cell type found in that cancer type
Risk factors: - H. pylori - geographic and socioeconomic factors - nitrites - smoked and pickled foods - chronic gastritis - smoking - fam hx Types: - intestinal type: usually presents as a mass – different forms - linitis plastica (“leather bottle”): diffuse infiltration of stomach walls by malignant SIGNET cells, poor prognosis
26
GIST – gastrointestinal stromal tumor
Solitary, circumscribed fleshy mass - Size and location important for prognosis - Small lesions do better and don’t usually recur cell type: - SPINDLE CELLS: look like smooth muscle or nerve tissue - derived from Interstitial cells of Cajal (innervated network of intestinal pacemaker cells for gut peristalsis) - cKit positive chemo marker!!!! can give IMATINIB - tyrosine kinase inhibitor
27
Congenital problems of small/large intestine: list
- duplication of segments in GI tract - malrotation: increase volvulus risk - atresia/stenosis: partial or complete blockage (atresia) or narrowing (stenosis) of the gastrointestinal lumen - Omphacele: ventral wall defect where the intestines, liver, and sometimes other organs remain outside the abdomen, contained WITHIN A SAC - Gastroschisis : infant’s intestines protrude out of the body through an opening near the UMBILICAL CORD, WITHOUT covered by protective sac, paraumbilical - Meckel’s diverticulum: MC congenital - Hirschsprung’s disease
28
Meckel’s diverticulum: definition, causes, presentation
Outpouching of all three layers of the bowel wall = true diverticulum: - cause: failure of the vitelline duct to obliterate – usually in terminal ileum on antimesenteric side rule of 2s: - 2% of population (MC congenital anomaly of the GI tract!!!) - 2 inches long and located in the small bowel within 2 feet of the ileocecal valve - often clinically silent - When symptomatic: abdominal pain or sx of GI or bowel obstruction.
29
Hirschsprung’s disease: major sx, cause, complication
cause: absence of GANGLION cells in segment of bowel = aperistalsis - usually infant fails to pass meconium - Most prominent symptom is CONSTIPATION in first 2 months of life - May also present with vomiting, abdominal pain, distention, diarrhea, poor weight gain, and slow growth Complications: - enterocolitis - megacolon - bowel obstruction - intestinal perforation
30
Celiac disease
immune-mediated damage of small bowel villi due to gluten exposure!!!! - gluten: present in wheat and grains, oats, barley; its most pathogenic component is gliadin - T lymphocytes are immobilized - histology: villous flattening (atrophy) in duodendum - malabsoprtion sx due to no villi: bloating, greasy stool, flatulence Tx: no gluten diet.
31
Whipple’s disease
infectious disease caused by Tropheryma whipplei (rod-shaped bacilli) - Dx: SI biopsies detecting PAS-positive foamy macrophages in the lamina propria - dense accumulation of distended, foamy macrophages into SI lamina propria --> contains periodic acid (Schiff (PAS)-positive) in granules Rare multisystem inflammatory disease - first sx: malabsorption in small intestine - stearrhea - affects the joints, central nervous system, and cardiovascular system
32
celiac ds: increased risk of what
- increased risk of malignancy!! - MC cancer: enteropathy associated T cell lymphoma
33
tropical sprue
Celiac ds in tropical regions - Acquired - Unsure etiology but epidemic - not related to gluten
34
Whipple’s disease
Systemic tissue damage characterized by macrophages loaded with Tropheryma whippelii organisms (rod-shaped bacilli)**** - rare multisystem inflammatory disease: joints, CNS, and cardiovascular system - distended macrophages in lamina propria - risk factor: Occupational exposure to soil or animals - white farmers Villi are full of tropheruyma whipplei -> lymphatic obstruction -> MALABSORPTION SX - triad: diarrhea, wt loss, arthralgia
35
Disaccharidase deficiencies: what type of diarrhea
lactose is most common, causes osmotic diarrhea - acquired not congenital
36
Abetalipoproteinemia
- autosomal recessive - inability to make chylomicrons from free fatty acids and monoglycerides -> cannot absorb adek fat soluble vitamins + fat malabsoprtion - Infant presents with failure to thrive, diarrhea, steatorrhea.
37
viral entrocolitis: MCC
MC: rotovirus – the virus infects and destroys mature enterocytes in small intestine
38
Bacterial enterocolitis
Bacterial enterocolitis – ingestion of bacterial toxins (Staph., Vibrio, Clostridum), ingestion of bacteria which produce toxins (e.g. E. coli), infections by enteroinvasive bacteria (enteroinvasive E. coli, Shigella, C. difficile). E. coli – many subtypes, may produce toxins, invasive; usually watery diarrhea, some types cause hemorrhage. Salmonella – food borne Shigella – hemorrhagic, not usually food borne, person-to-person contact Campylobacter – toxins, invasive, food borne Yersinia – food, invasive, lymphoid reactions Vibrio – non-invasive, watery, enterotoxin C. difficile – cytotoxin, nosocomial (usually antibiotic related), aka pseudomembranous colitis
39
parasitic enterocolitis
Nematodes (Roundworms) such as Ascaris, Strongyloides, etc. Cestodes (tapeworms), Giardia (G. lamblia) infection by cyst of single-cell organism, worldwide prevalence.
40
Diarrhea types and main causes
- secretory: viral damage to mucosa, bacterial endotoxin, laxatives - osmotic: disaccharidase deficiencies, too. much solutes in lumen - exudative: bacterial damage to mucosa, IBD - malabsorptive: celiac, whipple, steorrhea - motility
41
Inflammatory Bowel Disease – Crohn’s versus ulcerative colitis and which has greater cancer risk
Crohn: - can form fistulas -> fecal madder in urine - Terminal ileum: B12 malabsorption - Skip areas - transmural inflammation - GRANULOMAS UC: - Just mucosa NOT transumural - No malabsorption - Not terminal ilium - No skip areas just colon -> more risk for colon cancer adenocarcinoma - crypt abscesses on microscope* - pseudopolyps*: represent regenerating mucosa
42
Ischemia/infarct of bowel: what is the main hallmark, common presentation, causes
hallmark: Hemorrhagic Necrosis!!! - mucosal necrosis -> transmural - may see pseudomembranes histologically (similar to C. difficile colitis) common presentation: - elderly who have cardiovascular problems because cause is usually thrombus to vessel supplying intestine - pt presents with severe, sudden abdominal pain with rigid abdomen other causes: - shock - CHF: decreased perfusion - arterial thrombus/emboli - venous thrombus - mechanical
43
IBD: common features of UC vs crohns
44
Angiodysplasia: def and main issue
NOT dysplasia – twisted, dilated submucosal vessels which may RUPTURE – similar to AVM (arteriovenous malformation) - Rupture classically presents as hematochezia in an older adult
45
Hemorrhoids
due to chronically elevated increased submucosal venous pressure, increased abdominal pressure - ex: valsalva
46
Diverticulosis/diverticulitis definition, associated factors
full thickness (all 4 layers) outpocketings related to wall stress: -Associated with increased luminal pressure - older age - decreased fiber in diet - weakening in wall - In Japan, diverticulosis is more common on the right side due to higher fiber diets, while in Western countries it often affects the left side.
47
diverticulosis/Diverticulitis complications
- impaction - inflammation - perforation -> peritonitis - bleeding: silent or fatal - obstruction
48
Formation of Colonic Diverticula
- Vessels are very close to diverticula - Resemble hernias of the colonic wall: form at the entry points of mucosal arteries through the muscularis. - Represents weak spots that develop due to high colonic intraluminal pressure, often related to a low-fiber diet.
49
Obstructions in small and large intestine
caused by adhesions, impaction, hernias, volvulus (twisting), intussusception, tumors, IBD volvulus: sigmoid colon (elderly) and cecum (young adults) - hx of ab surgery, hernia repair INTUSSUSCEPTION: - Telescoping of proximal segment of bowel forward into distal segment - kids: MC location in terminal ilium with lymphoid hyperplasia -> lymphatic tissue to fight infections
50
Intestinal tumors – Colonic polyps types, which are more cancerous
- hyperplastic: non-neoplastic, SERRATED appearance on histo - adenomatous: dysplastic -> could lead to cancer - sessile > pedunculated: more risk of cancer -> flat on top of mucosa - pedunculated: on stalk, can snip it off - villous > tubular: VILLOUS MORE CANCEROUS biggest risk of adenoma to cancer: sessile, villous, over 2 cm
51
Colon adenocarcinoma: genetic causes
loss of APC gene: tumor suppressor k-RAS mutations: oncogene loss of p53: tumor suppressor activation of telomerase: infinite replication
52
Colon adenocarcinoma risk factors and pathogenesis/growth pattern
risk factors: - family history - age: over 50 - low fiber, high meat, refined carbs diet pathogenesis: - from pre-existing adenomatous polyp : dysplasia -> infiltration -> metastasis -or can arise de-novo - growth pattern: polypoid, annular (constricting), diffuse
53
Anal canal cancer: MCC and type
usually SCC related to HPV!!! - worse prognosis
54
Mucocele and major complication
cyst in appendix filled with mucus!! - may rupture and lead to pseudomyxoma peritonei (spread of mucinous material throughout the peritoneal cavity) (mucinous cystadenoma and mucinous cystadenocarcinoma can also cause pseudomyxoma peritonei )
55
appendicitis/ other appendiceal lesions
- may have obstruction by fecalith - NEUTROPHILS are present microscopically in muscularis to make diagnosis - May perforate leading to peritonitis Other appendiceal lesions: - mucocele - mucinous cystadenoma - mucinous cystadenocarcinoma (last two are rare)

pathophysiology (14 decks)

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