GI Patho Flashcards
Why does GERD happen?
lower esophageal sphincter may spontaneously relax 1-2 hours after eating which allows regurg
What is Reflux esophagitis
factors cause injury and inflammatory response to reflux
What is a protrusion of the upper part of the stomach through the diaphragm into the thorax?
Hiatal hernia
What are the names of the two types of hiatal hernias? Which is the most common?
Sliding (direct) (most common)
Paraesophageal (rolling)
What happens during a sliding hernia?
Stomach slides or moves into the thoracic cavity through the esophageal hiatus when supine
What are two problems associated with a hiatal hernia?
GERD
Esophagitis
WHat happens during a paraesophageal (rolling) hiatal hernia?
Herniation of the greater curvature of the stomach through a secondary opening in the diaphragm (entire stomach can pass into thorax)
In which type of hernia is there less of a chance of developing reflux?
Paraesophageal (rolling)
What is bleeding due to tear in mucosa or submucosa of lower esophagus?
Mallory-Weiss Syndrome
What can a tear in mallory-weiss syndrome be caused by?
forceful or prolonged vomiting
What are the clinical symptoms of Mallory-Weiss Syndrome
Vomiting blood and blood passed rectally after vomitting, pain
What causes esophageal varices?
Portal hypertension
Cirrhosis
Schistosoma infection
How many of cirrhotic patients have esophageal varices?
50%
What is an inflammatory disorder of gastric mucosa?
Gastritis
In acute gastritis, what are the erosions like?
Superficial, affects surface epithelium in diffuse or localized pattern
What are the two types of gastritis?
A- chronic fundal, autoimmune, more severe
B- non-immune, pyloric
Why do elderly get gastritis?
Due to thinning of stomach wall with atrophy of gastric epithelium
What is inflammation of stomach and small intestines?
Gastroenteritis
What is chronic gastroenteritis due to?
Another GI disorder
Is acute gastroenteritis normally self-limiting?
Yes
What is the break or ulceration in protective mucosal lining of lower esophagus, stomach or duodenum?
Peptic ulcer disease
What does a peptic ulcer expose the submucosa to?
Gastric secretions
Autodigestion
True peptic ulcers extend through the….
muscularis mucosae
What is the ulcer with the greatest frequency?
Duodenal
What is the major cause of a duodenal ulcer?
Infection with H. Pylori
Hypersecretion of acid and pepsin contribute
When does pain from a duodenal ulcer occur?
30 minutes to 2 hours after eating
pain in middle of night- gone by morning
What can make pain from a duodenal ulcer better?
Eating
pain-food-relief
Are duodenal ulcers asymptomatic?
Can be- first symptoms is often hemorrhage or perforation
Where is a gastric ulcer normally found?
Antral region
What is the primary defect in a gastric ulcer?
abnormality that increases the mucosal barrier’s permeability to hydrogen ions
What is a gastric ulcer often associated with?
chronic gastritis
When does pain occur with a gastric ulcer?
Immediately after eating
What allows hydrogen ions to diffuse in a gastric ulcer?
Bile salts disrupt gastric mucosa- (disrupt permeability and cellular structure)
Do gastric ulcers tend to be acute or chronic?
Chronic
What is a stress ulcer an acute form of?
Peptic ulcer
What are two types of stress related mucosal disease?
Ischemic ulcers (ex: Curling ulcer) Cushing ulcer
What is an ulcer that develops within hours of event that causes ischemia of stomach and duodneal mucosa?
Ischemic ulcers
What type of ulcer occurs with burns?
Curling ulcer
What is a cushing ulcer associated with?
Severe head trauma or brain surgery
What causes a cushing ulcer?
Decreased mucosal blood flow and hypersecretion of acid; overstimulation of vagal nuclei
What are two types of IBD (inflammatory bowel disease) ?
Ulcerative colitis
Crohn Disease
What is an inflammatory bowel disease?
Chronic relapsing inflammatory bowel diseases of unknown origins
Where does ulcerative colitis occur?
Mucosa of colon
Where does crohn disease occur?
Any part of the GI tract
Where does inflammation begin in ulcerative colitis?
Base of crypt
In what type of ulcerative colitis is mucosa hyperemic, edematous, dark red and velvety?
Mild ulcerative colitis
In what type of ulcerative colitis does mucosa become hemorrhagic, small erosions and ulcers?
Severe ulcerative colitis
What may narrow the lumen in ulcerative colitis?
Edema and thickening of muscularis mucosae
What develops from regenerating epithelium in ulcerative colitis?
Pseudopolyps
What are some symptoms of ulcerative colitis?
Large volume of watery diarrhea
Bleeding, cramping, urge to defecate
These are all part of what : Granulomatous colitis, ileocolitis, regional enteritis
Crohn Disease
Where does inflammation begin in Crohn Disease?
Submucosa- then moves to mucosa and serosa
What is the pattern of spread in Crohn disease?
Inflammation that can skip some haustra- create pattern of skip lesions
What type fissures do ulcerations produce in Crohn Disease?
Longitudinal and transverse fissures
What is the only symptoms of Crohn Disease?
Irritable bowel for several year, diarrhea
What is herniations of mucosa
Diverticula
What is asymptomatic diverticular disease?
Diverticulosis
What is inflammation of diverticula?
Diverticulitis
Where does diverticulitis occur?
Anywhere- sigmoid colon is most common
What forms with diverticulosis?
Pockets
What are 5 disorders that cause alteration of GI tract mobility?
Irritable bowel syndrome Intestinal obstruction Volvulus Intussusception Megacolon
What are the symptoms of Irritable Bowel Syndrome?
Alternating diarrhea and constipation accompanied by abdominal cramping pain in the absence of any identifiable pathological process in GI tract
What is a mechanical blockage by a lesion?
Simple intestinal obstruction
What is a functional intestinal obsrtuction due to?
Failure of motility (paralytic ileus)
What is the most common cause of simple obstructions?
Fibrous adhesions
What accumulates proximal to a small intestine obstruction?
Fluid and gas in lumen, distention
When can metabolic alkalosis happen with an intestinal obstruction?
When it is in the pylorus or higher- due to hydrogen ions not being reabsorbed later in small intestine
When can metabolic acidosis occur with an intestinal obstruction?
In a lower obstruction
Bicarbonate from pancreas and bile can’t be reabsorbed
When does ischemia happen in an intestinal obstruction?
Intraluminal pressure exceeds capillary pressure
What are the cardinal symptoms of an intestinal obstruction?
Colicky pain due to distention followed by vomiting
Pain may diminish with distention
When is pain with an intestinal obstruction constant and severe?
Strangulation of the insteine can lead to necrosis and perf
What are symptoms with an pyloric intestinal obstruction?
Early profuse vomiting of clear fluid
What are symptoms of a proximal small intestinal obstruction?
Mild distention and vomiting of bile-stained fluid
What symptoms are associated with a lower small intestinal obstruction?
Pronounced distention
Possibly no vomiting or vomit with fecal material
With a partial obstruction what are symptoms?
Diarrhea or constipation
With complete intestinal obstruction there will only be…..
constipation
What is difficulty swallowing or can result from mechanical obstruction or disorders that impair esophageal motility?
dysphagia
What is pyrosis?
Heartburn; caused by gastric reflux into esophagus
What is chest pain caused by esophageal distention or powerful esophageal contractions?
Esophageal pain
What is abdominal pain usually associated with?
Tissue injury
Are abdominal organs sensitive to mechanical stimuli other than stretch and distention?
NO
What causes stretching with abdominal pain?
Edema and vascular congestion
What is forceful emptying of stomach and intestinal contents through mouth?
Vomiting
What are two things associated with nausea?
Hypersalivation and tachycardia
What happens with retching?
Deep inspriation
Glottis closes, intrathoracic pressure falls
LES opens and abdominal muscles contract
What is interstinal gas normally from?
Swallowed air, bacterial and digestive action, diffusion from blood, neutralization of acids
What is difficult or infrequent defecation?
Constipation
What are the two types of diarrhea?
Large volume and small volume
What is large volume diarrhea due to?
Large volume of feces caused by excessive amounts of water or secretions (or both) in intestines
What is small volume diarrhea due to?
Excessive intestinal motility
What is when non-absorbable substance in intestine draws water
into lumen - causes large volume diarrhea?
Osmotic diarrhea
What is when large volume diarrhea caused by excessive
mucosal secretion of chloride or bicarbonate rich fluid, or inhibition of net
sodium absorption?
Secretory diarrhea
What are the signs and symptoms of hepatic disease attributed to?
Loss of hepatocellular function or disruption of blood flow through the liver
What is jaundice due to?
Hepatocellular failure which leads to hyperbilirubinemia
What causes hyperbilirubinemia?
Excessive hemolysis of RBCs or obstructive disorder of the bile ducts or liver cells
What symptoms are associated with jaundice?
Darkedned urine, light color-ed stools, fever, chills, pain, anorexia, fatigue
What is abnormally high bood pressure in portal venous system?
Portal hypertension
What can long term portal hypertension lead to?
Varices
Splenomegaly
ascites
hepatic encephalopathy
What is hepatic encephalopathy?
Complex neuropsychiatric syndrome
What are symptoms of hepatic encephalopathy?
Mild confusion and lethargy; can progress to stupor and coma
Asterixis (liver flip)
What causes hepatic encephalopathy?
Shunting of blood around liver during fulminant hepatic failure
What is the degree of hepatic encephalopathy correlated with?
Ammonia levels in the arterial blood
What is brain swelling that often develops w/ heaptic encephalopathy?
Cerebral edema
What is accumulation of fluid in the peritoneal cavity?
Ascites
What is the twisting of bowel on itself?
Volvulus
In what part do volvulus typically occur?
Sigmoid colon and Cecum
What is the telescoping of invagination of part of bowel into adjacent distal portion?
Intussusception
What happens to the area of invaginated bowel in intussuscpetion?
Becomes edematous
Venous engorgement w/ hemorrhage
What is the abnormal dilation of the colon not caused by mechanical obstruction?
Megacolon
Most type of colon cancer develops from…
Adenomatous polyps
When does an adenoma become invasive and malignant?
When it crosses muscularis mucosae
What are the two types of polyps?
Pedunculated adenomatous polyps (mushroom)
Sessile (papillary or villous) adenomas (square)
When does an adenoma become invasive and malignant?
When it crosses muscularis mucosae
Tumors that are polyploid lesions along one wall, often have a pain and palpable mass along with dark blood in the stool without an obstruction.. where are they found?
Tumors on right (ascending colon)
Where are colon cancer tumors that growth circumferentially, commonly cause an obstruction, cause bright red streaks on stools.
Tumors on left (descending colon)
What is gallstone formation?
Cholelithiasis
What is the inflammation of gallbaldder or cystic duct?
Cholecystitis
What are the two type of gallstones?
Cholesterol
Pigmented(cirrhosis)
What causes cholecystitis?
When stones become lodged in the cystic duct
What is inflammation of the pancreas?
Pancreatitis
What happens in acute pancreatitis?
Pancreatic enzymes are leaked out and activated
Autodigestion and acute pancreatitis occurs
Can cause injury to vessels and other organs
Can acute pancreatitis lead to myocardial depression?
Yes- due to vasoactive peptide release
What is chronic pancreatitis due to?
Structural or functional impairment of the pancreas
Most common- chronic alcohol abuse
What can the lack of endocrine function in chronic pancreatitis cause?
Type 1 DM
How many strains of hepatitis are there, and what are their names?
6 strains
A, B, C, D,E, G
What types of hepatitis are common found with HIV?
B, C, D
What is hepatitis A caused by?
Ingestion of food or water contaminated with fecal matter
Spreads in crowded unsanitary conditions
How is Hep B transmitted?
Contact with infected blood, body fluids, STD
What type of hepatitis will cross the placenta?
B
What causes Hep C and what is their a risk for with it?
Post transfusion and IV drug use
Risk factor for liver disease
In order to have Hep D, what other type of hep must you have?
B
What causes Hep E?
Fecal to oral contaminated by water
What is the pre-icteric phase of hepatitis that ends with the appearance of jaundice?
Prodromal phase
What are the phases of hepatitis?
Incubation phase
Prodromal phase
Icteric phase
Recovery phase
How long does the icteric phase last?
2-6 weeks
what is the icteric phase caused by?
Hepatocellular destruction and intrahepatic bile stasis
When does the recovery of hepatitis phase involve?
Resolution of jaundice
What types of Hep can lead to chornic hepatitis?
HBV HCV
In chronic hepatitis, how long are liver function tests abnormal?
> 6 months
Chronic hepatitis gives a predisposition to…
Cirrhosis
Primary hepatocellular carcinoma
What are causes of fulminant hepatitis?
HCV and HBV (with HDV) - toxic drug reactions, congenital disorders
What does fulminant hepatitis cause?
Severe impairment or necrosis of liver
What is cirrhosis?
Scarring of liver
Irreversible inflammatory disease that disrupts liver structure and function
What are the two main components of cirrhosis
Diffuse fibrosis
Nodular regeneration
What disease is a precursor to cirrhosis?
Alcoholic hepatitis (alcoholic liver disease)
Where are Mallory bodies (red stained) found?
injured hepatocytes
What does alcohol become in the liver?
Acetaldehyde
What does excessive acetaldehyde in the liver do?
Induces lipid peroxidation
Disrupts cellular function
What other functions are inhibited by alcoholic liver disease?
MItrochondria- reduced oxidation of fatty acids
Protein export, vitamin metabolism
What type or cirrhosis begins in the bile canaliculi and bild ducts?
Biliary cirrhosis
What type of biliary cirrhosis is autimmune and caused by the destruction of small intrahepatic bile ducts?
Primary biliary cirrhosis
What causes secondary biliary cirrhosis?
Prolonged partial or complete obstruction of common bile duct
What is postnecrotic cirrhosis the consequence of?
Many severe liver diseases
HCV, drug and toxin injury
