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Clin Med 2 > GI Path and Phys > Flashcards

GI Path and Phys Flashcards

1
Q

What is the function of the stomach?

A

storage, grinding, mixing, digestions, acid secretion

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2
Q

What is the function of the exocrine pancreas?

A

digestions, HCO3- buffer

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3
Q

What is the function of the liver?

A

metabolism, detox

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4
Q

What is the function of the small intestine?

A

ABSORPTION

digestions

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5
Q

What is the function of the large intestine?

A

water reabsorption

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6
Q

What is the function of the gallbladder?

A

stores bile

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7
Q

For embryologic development, which structures arise from the foregut?

A

pharynx
esophagus
stomach
respiratory tract

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8
Q

For embryologic development, which structures arise from the midgut?

A

small intestine

primordium of live and pancreas

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9
Q

For embryologic development, which structures arise from the hindgut?

A

colon

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10
Q

What does the salivary gland produce and what is its function?

A

amylase

-digestion of starch

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11
Q

What does the stomach produce and what is its function?

A

pepsin
HCL
-digestion of proteins

Gastrin
Intrinsic Factor
-mediates absorption of vitamin B12

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12
Q

What does the small intestine produce and what is its function?

A

enterokinase
-activates pancreative enzymes

cholecystokinin
-stimulates GB contraction and pancreatic secretion of bicarbs

secretin
-stimulates secretion of pancreatic trypsin and chymotrypisin

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13
Q

Sialadenitis: infectious

A

infectious (viral or bacterial)
stap or strep viridans
obstruction

mumps (paramyoxviridae) - most common viral; children > adults

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14
Q

Sialadenitis: autoimmune

A

sjogren’s disease

xerostomia (dry mouth) and xerophthalmia (dry eyes) with enlargement of the salivary glands

destruction of the parenchymal cells affects their function and results in decreased production of saliva and tears

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15
Q

Salivary gland Neoplasms epi

A

W > M
all age groups –peak incidence in 6th - 7th decade of life

MC parotid gland –epithelial origin

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16
Q

What is the most common salivary gland to get neoplasms?

A

parotid gland

majority of salivary gland neoplasms are of epithelial origin, representing 80% to 90% of all neoplasms

75% benign

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17
Q

What is the most common benign neoplasms of the salivary glands?

A

pleomorphic adenoma

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18
Q

What is the most common malignant tumors of the salivary glands?

A

mucoepidermoid carcinoma

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19
Q

Which salivary glands are more likely to be benign and which ones are more likely to be malignant?

A

major salivary gland neoplasms –mc benign

minor salivary gland neoplasms – mc malignant

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20
Q

How long is the human esophagus?

A

25cm long

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21
Q

What is considered a definitive anatomic landmark for the tubular esophagus?

A

identification of a squamous duct and submucosal mucous glands

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22
Q

Achalasia

A

spasm of lower esophagus sphincter with esophageal dilation proximal to the site of spasm

pts present with dysphagia

typically idiopathic

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23
Q

What is the most common esophagitis?

A

reflux of gastric juice (“peptic esophagitis”), with pepsin and HCl leading to ulcerations and epithelial metaplasia

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24
Q

Esophageal atresia

A

lack of lumen, with or without esophagotracheal fistula

babies vomit ingested milk

without repair, babies die of hunger or aspiration PNA

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25
What are the 2 types of hiatal hernias?
sliding vs paraesophageal
26
What is the most common cause of hiatal hernia?
reflux esophagitis tone of LES can decrease d/t smoking and caffeine; pregnancy
27
What is a chemical cause of esophagitis?
Lye in suicide attempts | pts taking NSAIDs and not drinking water
28
What is the common cause of esophageal varices?
liver cirrhosis or any disease causing portal HTN among MC causes of UGI bleeds
29
What is a common cause of UGI bleeds?
esophageal varices
30
What is Mallory Weiss syndrome?
laceration of small vessels at GE junction during strenuous vomiting MC in EtOHers
31
Who is more likely to have Mallory Weiss Syndrome?
pts with hx of severe vomiting EtOHers
32
What is Barrett's Esophagus?
characterized by the conversion of normal squamous epithelium of the esophagus into metaplastic columnar epithelium
33
What is the most common cause of Barrett's esophagus?
chronic GERD familial predispositions forBE and esophageal adenocarcinoma (EAC) has been documented in familial clusters
34
Epi of esophagus carcinoma
accounts for 4% of all cancers M > W correlates with EtOH + tobacco bad survival
35
At dx of esophageal carcinoma, where is the tumor?
most have spread through adventitia to lymph nodes and adjacent organs "locally invasive"
36
What is the most important developmental abnormality?
congenital pyloric stenosis appears during neonate periods M > F projectile vomiting
37
What are causes of acute gastritis?
stress, shock, food, exogenous chemicals, drugs (aspirin)
38
What is peptic ulcer?
related to an underlying chronic gastritis (typically caused by H. pylori)
39
What does an H2 blocker do?
inhibits gastric sections and promotes healing in peptic ulcer pts
40
"Punched out round defects of the mucosa extending into deep layers"
macroscopic features of peptic ulcers
41
What are complications of peptic ulcer diseases?
hemorrhage (most common): hematemesis, melena, iron deficiency anemia penetration into the pancreas: acute pancreatitis perforation: peritonitis cicatrization: stenosis after healing of ulcers leads to scaring
42
Where are peptic ulcers most common?
duodenal 4x more common than gastric
43
What age group presents with peptic ulcers?
depends on the type gastric - >40 age duodenal - any age
44
When/how do peptic ulcers present?
pain 1-3 hrs after a meal or during the night nausea, vomiting, weight or appetite loss, Melena, iron deficiency
45
What are the clinical features of gastric carcinoma?
nonsepcific sxs - weight loss, anemia, weakness, vomiting, loss of appetite, dysphagia, bleeding
46
Hirschsprung's Disease
developmental abnormality in the innervation of the rectum and sigmoid colon intramural ganglion cells don't develop making the colon in permanent spams and thus fecal matter can't pass --> megacolon tx. resection and end-to-end anastomosis
47
Atresia
developmental abnormality complete obstruction of the lumen of the intestine tx. end-to-end anastomosis
48
Congenital diverticula
out pouchings of the intestine | the best known one is MECKEL'S DIVERTICULUM
49
Meckel's Diverticulum
a congenital diverticula incompletely obliterated omphalomesenteric duct --connection between small intestine and umbilicus sxs similar to acute appendicitis but w/ LLQ pain instead
50
older pts with chronic constipation
think diverticulosis
51
Where are the most significant diverticuli?
sigmoid colon commonly occur at point of arterial entry through muscle
52
Hemorrhoids
varicosities of the anal and perianal region | 5% of adults
53
What determines if a hemorrhoid is internal or external?
the anorectal line above = internal below = external i think you can have internal hemorrhoids protrude outside of the anus
54
Hemorrhoids are associated with what?
lower extremity varicose veins some hereditary component of looseness of connective tissue commonly seen in pregnant pts
55
Angiodysplasia
localized vascular lesion of the colon (cecum and ascending colon MC) in elderly pt
56
unexplained rectal bleeding
think about angiodysplasia (these can rupture) | especially if the pt is older
57
Mesenteric thrombosis
MC in elderly pts thrombosis of mesenteric vessels - MC superior mesenteric artery frequently a complication of atheroscleorsis
58
Common infectious pathogens of the small-intestine
E. coli vibrio cholerae giardia lambila rotavirus
59
Common infectious pathogens of the large-intestine
E. coli shigella Norwalk virus Entamoeba
60
How does the diarrhea differ between small and large intestine?
small intestine - large volume - watery appearance - rarely ever blood large intestine - small volume - mucoid appearance - commonly blood - +/- leukocytes - + proctoscopy
61
What is the MC pathogen causing pseudomembranous colitis?
>90% of cases = C. difficile
62
What causes the diarrhea in pseudomembranous colitis?
the c.diff bacteria makes exotoxin that acts on epithelial cells causes necrosis and superficial ulcers
63
Strawberry gallbladder
cholesterolosis d/t cholesterol
64
What are the 4 Fs of cholelithiasis?
``` risk factors Female Fat Fertile Forties ```
65
What can cholelithiasis cause?
cholecystitis pancreatitis gall bladder carcinoma
66
What is the most common composition of gallstones?
cholesterol
67
pigment stones
derived from hemoglobin/bilirubin
68
Rokitansky-Aschoff sinuses
hallmark of chronic cholecystitis
69
Lipase
produced exclusively by the pancreas used to breakdown fat
70
Common causes of acute pancreatitis?
EtOH Gallstones Idiopathic
71
Hallmark of acute pancreatitis
necrosis (not fat necrosis)
72
What is the vast majority of lesions in the pancreas?
pseudocysts
73
Pancreatic Neoplasms
most are malignant | more commonly exocrine derived from the ductal system
74
What is the 4th major cause of cancer death in men and women?
adenocarcinoma of pancreas
75
Epi of adenocarcinoma of pancreas
rare before age of 40 incidence increases with age 4th major cause of cancer death in men and women prognosis is poor (most die within 2 years)
76
Where are ductal adenocarcinoma most common?
60-70% in the head (upper half)
77
Courvoisier
painless jaundice tumor in the head seen with ductal adenocarcinoma
78
How do you dx ductal adenocarcinoma?
ERCP | endoscopic retrograde cholangiopancreatography
79
What predicts the survival of adenocarcinoma?
``` size site stage margins recurrence ```
80
Acinar cell carcinoma
``` very rare (more rare than ductal carcinoma) worse prognosis --present metastatic typically ``` 7th generation M >> F
81
Where do pancreatic endocrine neoplasms arise from?
arise from the ducts
82
What is the 6th leading cause of death?
diabetes
83
When does gluconeogenesis occur?
once glycogen stores are depleted--synthesized from amino acids
84
What produces insulin?
Beta cells in the pancreatic islets as pro-insulin when needed they are cleaved into insulin and inactive C-peptide
85
What is the half life of insulin?
4 minutes
86
Which type of diabetes has sweet urine?
DM
87
Type 1 vs Type 2 DM?
Type 1 - insulin dependent | Type 2 - non-insulin dependent
88
What is the pathophys behind type 1 DM?
autoimmune destruction of islets so no production of insulin
89
How does glucose get into the cell?
with the help of insulin
90
How does glucose leave the cell?
glucagon, epinephrine, cortisol, growth hormone
91
What age group is most common for type 2 DM?
>40 years
92
Honeymoon period
in adult pt dx with type 1 have this period in which they are still producing insulin, and might not need insulin for a few years
93
Amyloid deposition
can be seen with DM type 2
94
Family history is more prominent with type 1 or type 2 DM?
Type 2 surprisingly
95
How does the speed of onset differ between type 1 and type 2 DM?
Type 1 is sudden onset while 2 is gradual
96
Antibodies to islet cells
seen in DM type 1
97
Gestational Diabetes
hyperglycemia developing during pregnancy leads to neonate hypoglycemia and bigger birth weights these babies have a 50/50 chance of developing DM type 2 later in life
98
What should a random glucose reading be?
<200 mg/dL
99
What should a normal fasting glucose reading be?
<126 mg/dL
100
What is a normal hemoglobin A1c?
<6.5%
101
_____ is required for fat absorption?
Emulsification
102
What enzyme is produced in the intestinal mucosa?
enteropeptidase/ enterokinase substrate: trypsinogen

Clin Med 2 (13 decks)

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