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Medical Phys II > GI Patho > Flashcards

GI Patho Flashcards

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USMLE® Step 1 flashcards
1
Q

Why does GERD happen?

A

lower esophageal sphincter may spontaneously relax 1-2 hours after eating which allows regurg

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2
Q

What is Reflux esophagitis

A

factors cause injury and inflammatory response to reflux

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3
Q

What is a protrusion of the upper part of the stomach through the diaphragm into the thorax?

A

Hiatal hernia

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4
Q

What are the names of the two types of hiatal hernias? Which is the most common?

A

Sliding (direct) (most common)

Paraesophageal (rolling)

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5
Q

What happens during a sliding hernia?

A

Stomach slides or moves into the thoracic cavity through the esophageal hiatus when supine

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6
Q

What are two problems associated with a hiatal hernia?

A

GERD

Esophagitis

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7
Q

WHat happens during a paraesophageal (rolling) hiatal hernia?

A

Herniation of the greater curvature of the stomach through a secondary opening in the diaphragm (entire stomach can pass into thorax)

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8
Q

In which type of hernia is there less of a chance of developing reflux?

A

Paraesophageal (rolling)

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9
Q

What is bleeding due to tear in mucosa or submucosa of lower esophagus?

A

Mallory-Weiss Syndrome

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10
Q

What can a tear in mallory-weiss syndrome be caused by?

A

forceful or prolonged vomiting

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11
Q

What are the clinical symptoms of Mallory-Weiss Syndrome

A

Vomiting blood and blood passed rectally after vomitting, pain

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12
Q

What causes esophageal varices?

A

Portal hypertension
Cirrhosis
Schistosoma infection

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13
Q

How many of cirrhotic patients have esophageal varices?

A

50%

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14
Q

What is an inflammatory disorder of gastric mucosa?

A

Gastritis

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15
Q

In acute gastritis, what are the erosions like?

A

Superficial, affects surface epithelium in diffuse or localized pattern

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16
Q

What are the two types of gastritis?

A

A- chronic fundal, autoimmune, more severe

B- non-immune, pyloric

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17
Q

Why do elderly get gastritis?

A

Due to thinning of stomach wall with atrophy of gastric epithelium

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18
Q

What is inflammation of stomach and small intestines?

A

Gastroenteritis

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19
Q

What is chronic gastroenteritis due to?

A

Another GI disorder

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20
Q

Is acute gastroenteritis normally self-limiting?

A

Yes

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21
Q

What is the break or ulceration in protective mucosal lining of lower esophagus, stomach or duodenum?

A

Peptic ulcer disease

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22
Q

What does a peptic ulcer expose the submucosa to?

A

Gastric secretions

Autodigestion

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23
Q

True peptic ulcers extend through the….

A

muscularis mucosae

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24
Q

What is the ulcer with the greatest frequency?

A

Duodenal

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25
Q

What is the major cause of a duodenal ulcer?

A

Infection with H. Pylori

Hypersecretion of acid and pepsin contribute

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26
Q

When does pain from a duodenal ulcer occur?

A

30 minutes to 2 hours after eating

pain in middle of night- gone by morning

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27
Q

What can make pain from a duodenal ulcer better?

A

Eating

pain-food-relief

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28
Q

Are duodenal ulcers asymptomatic?

A

Can be- first symptoms is often hemorrhage or perforation

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29
Q

Where is a gastric ulcer normally found?

A

Antral region

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30
Q

What is the primary defect in a gastric ulcer?

A

abnormality that increases the mucosal barrier’s permeability to hydrogen ions

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31
Q

What is a gastric ulcer often associated with?

A

chronic gastritis

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32
Q

When does pain occur with a gastric ulcer?

A

Immediately after eating

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33
Q

What allows hydrogen ions to diffuse in a gastric ulcer?

A

Bile salts disrupt gastric mucosa- (disrupt permeability and cellular structure)

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34
Q

Do gastric ulcers tend to be acute or chronic?

A

Chronic

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35
Q

What is a stress ulcer an acute form of?

A

Peptic ulcer

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36
Q

What are two types of stress related mucosal disease?

A 
Ischemic ulcers (ex: Curling ulcer) 
Cushing ulcer
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37
Q

What is an ulcer that develops within hours of event that causes ischemia of stomach and duodneal mucosa?

A

Ischemic ulcers

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38
Q

What type of ulcer occurs with burns?

A

Curling ulcer

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39
Q

What is a cushing ulcer associated with?

A

Severe head trauma or brain surgery

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40
Q

What causes a cushing ulcer?

A

Decreased mucosal blood flow and hypersecretion of acid; overstimulation of vagal nuclei

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41
Q

What are two types of IBD (inflammatory bowel disease) ?

A

Ulcerative colitis

Crohn Disease

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42
Q

What is an inflammatory bowel disease?

A

Chronic relapsing inflammatory bowel diseases of unknown origins

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43
Q

Where does ulcerative colitis occur?

A

Mucosa of colon

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44
Q

Where does crohn disease occur?

A

Any part of the GI tract

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45
Q

Where does inflammation begin in ulcerative colitis?

A

Base of crypt

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46
Q

In what type of ulcerative colitis is mucosa hyperemic, edematous, dark red and velvety?

A

Mild ulcerative colitis

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47
Q

In what type of ulcerative colitis does mucosa become hemorrhagic, small erosions and ulcers?

A

Severe ulcerative colitis

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48
Q

What may narrow the lumen in ulcerative colitis?

A

Edema and thickening of muscularis mucosae

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49
Q

What develops from regenerating epithelium in ulcerative colitis?

A

Pseudopolyps

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50
Q

What are some symptoms of ulcerative colitis?

A

Large volume of watery diarrhea

Bleeding, cramping, urge to defecate

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51
Q

These are all part of what : Granulomatous colitis, ileocolitis, regional enteritis

A

Crohn Disease

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52
Q

Where does inflammation begin in Crohn Disease?

A

Submucosa- then moves to mucosa and serosa

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53
Q

What is the pattern of spread in Crohn disease?

A

Inflammation that can skip some haustra- create pattern of skip lesions

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54
Q

What type fissures do ulcerations produce in Crohn Disease?

A

Longitudinal and transverse fissures

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55
Q

What is the only symptoms of Crohn Disease?

A

Irritable bowel for several year, diarrhea

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56
Q

What is herniations of mucosa

A

Diverticula

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57
Q

What is asymptomatic diverticular disease?

A

Diverticulosis

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58
Q

What is inflammation of diverticula?

A

Diverticulitis

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59
Q

Where does diverticulitis occur?

A

Anywhere- sigmoid colon is most common

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60
Q

What forms with diverticulosis?

A

Pockets

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61
Q

What are 5 disorders that cause alteration of GI tract mobility?

A 
Irritable bowel syndrome
Intestinal obstruction
Volvulus
Intussusception
Megacolon
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62
Q

What are the symptoms of Irritable Bowel Syndrome?

A

Alternating diarrhea and constipation accompanied by abdominal cramping pain in the absence of any identifiable pathological process in GI tract

63
Q

What is a mechanical blockage by a lesion?

A

Simple intestinal obstruction

64
Q

What is a functional intestinal obsrtuction due to?

A

Failure of motility (paralytic ileus)

65
Q

What is the most common cause of simple obstructions?

A

Fibrous adhesions

66
Q

What accumulates proximal to a small intestine obstruction?

A

Fluid and gas in lumen, distention

67
Q

When can metabolic alkalosis happen with an intestinal obstruction?

A

When it is in the pylorus or higher- due to hydrogen ions not being reabsorbed later in small intestine

68
Q

When can metabolic acidosis occur with an intestinal obstruction?

A

In a lower obstruction

Bicarbonate from pancreas and bile can’t be reabsorbed

69
Q

When does ischemia happen in an intestinal obstruction?

A

Intraluminal pressure exceeds capillary pressure

70
Q

What are the cardinal symptoms of an intestinal obstruction?

A

Colicky pain due to distention followed by vomiting

Pain may diminish with distention

71
Q

When is pain with an intestinal obstruction constant and severe?

A

Strangulation of the insteine can lead to necrosis and perf

72
Q

What are symptoms with an pyloric intestinal obstruction?

A

Early profuse vomiting of clear fluid

73
Q

What are symptoms of a proximal small intestinal obstruction?

A

Mild distention and vomiting of bile-stained fluid

74
Q

What symptoms are associated with a lower small intestinal obstruction?

A

Pronounced distention

Possibly no vomiting or vomit with fecal material

75
Q

With a partial obstruction what are symptoms?

A

Diarrhea or constipation

76
Q

With complete intestinal obstruction there will only be…..

A

constipation

77
Q

What is difficulty swallowing or can result from mechanical obstruction or disorders that impair esophageal motility?

A

dysphagia

78
Q

What is pyrosis?

A

Heartburn; caused by gastric reflux into esophagus

79
Q

What is chest pain caused by esophageal distention or powerful esophageal contractions?

A

Esophageal pain

80
Q

What is abdominal pain usually associated with?

A

Tissue injury

81
Q

Are abdominal organs sensitive to mechanical stimuli other than stretch and distention?

A

NO

82
Q

What causes stretching with abdominal pain?

A

Edema and vascular congestion

83
Q

What is forceful emptying of stomach and intestinal contents through mouth?

A

Vomiting

84
Q

What are two things associated with nausea?

A

Hypersalivation and tachycardia

85
Q

What happens with retching?

A

Deep inspriation
Glottis closes, intrathoracic pressure falls
LES opens and abdominal muscles contract

86
Q

What is interstinal gas normally from?

A

Swallowed air, bacterial and digestive action, diffusion from blood, neutralization of acids

87
Q

What is difficult or infrequent defecation?

A

Constipation

88
Q

What are the two types of diarrhea?

A

Large volume and small volume

89
Q

What is large volume diarrhea due to?

A

Large volume of feces caused by excessive amounts of water or secretions (or both) in intestines

90
Q

What is small volume diarrhea due to?

A

Excessive intestinal motility

91
Q

What is when non-absorbable substance in intestine draws water
into lumen - causes large volume diarrhea?

A

Osmotic diarrhea

92
Q

What is when large volume diarrhea caused by excessive
mucosal secretion of chloride or bicarbonate rich fluid, or inhibition of net
sodium absorption?

A

Secretory diarrhea

93
Q

What are the signs and symptoms of hepatic disease attributed to?

A

Loss of hepatocellular function or disruption of blood flow through the liver

94
Q

What is jaundice due to?

A

Hepatocellular failure which leads to hyperbilirubinemia

95
Q

What causes hyperbilirubinemia?

A

Excessive hemolysis of RBCs or obstructive disorder of the bile ducts or liver cells

96
Q

What symptoms are associated with jaundice?

A

Darkedned urine, light color-ed stools, fever, chills, pain, anorexia, fatigue

97
Q

What is abnormally high bood pressure in portal venous system?

A

Portal hypertension

98
Q

What can long term portal hypertension lead to?

A

Varices
Splenomegaly
ascites
hepatic encephalopathy

99
Q

What is hepatic encephalopathy?

A

Complex neuropsychiatric syndrome

100
Q

What are symptoms of hepatic encephalopathy?

A

Mild confusion and lethargy; can progress to stupor and coma

Asterixis (liver flip)

101
Q

What causes hepatic encephalopathy?

A

Shunting of blood around liver during fulminant hepatic failure

102
Q

What is the degree of hepatic encephalopathy correlated with?

A

Ammonia levels in the arterial blood

103
Q

What is brain swelling that often develops w/ heaptic encephalopathy?

A

Cerebral edema

104
Q

What is accumulation of fluid in the peritoneal cavity?

A

Ascites

105
Q

What is the twisting of bowel on itself?

A

Volvulus

106
Q

In what part do volvulus typically occur?

A

Sigmoid colon and Cecum

107
Q

What is the telescoping of invagination of part of bowel into adjacent distal portion?

A

Intussusception

108
Q

What happens to the area of invaginated bowel in intussuscpetion?

A

Becomes edematous

Venous engorgement w/ hemorrhage

109
Q

What is the abnormal dilation of the colon not caused by mechanical obstruction?

A

Megacolon

110
Q

Most type of colon cancer develops from…

A

Adenomatous polyps

111
Q

When does an adenoma become invasive and malignant?

A

When it crosses muscularis mucosae

112
Q

What are the two types of polyps?

A

Pedunculated adenomatous polyps (mushroom)

Sessile (papillary or villous) adenomas (square)

113
Q

When does an adenoma become invasive and malignant?

A

When it crosses muscularis mucosae

114
Q

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?

A

Tumors on right (ascending colon)

115
Q

Where are colon cancer tumors that growth circumferentially, commonly cause an obstruction, cause bright red streaks on stools.

A

Tumors on left (descending colon)

116
Q

What is gallstone formation?

A

Cholelithiasis

117
Q

What is the inflammation of gallbaldder or cystic duct?

A

Cholecystitis

118
Q

What are the two type of gallstones?

A

Cholesterol

Pigmented(cirrhosis)

119
Q

What causes cholecystitis?

A

When stones become lodged in the cystic duct

120
Q

What is inflammation of the pancreas?

A

Pancreatitis

121
Q

What happens in acute pancreatitis?

A

Pancreatic enzymes are leaked out and activated
Autodigestion and acute pancreatitis occurs
Can cause injury to vessels and other organs

122
Q

Can acute pancreatitis lead to myocardial depression?

A

Yes- due to vasoactive peptide release

123
Q

What is chronic pancreatitis due to?

A

Structural or functional impairment of the pancreas

Most common- chronic alcohol abuse

124
Q

What can the lack of endocrine function in chronic pancreatitis cause?

A

Type 1 DM

125
Q

How many strains of hepatitis are there, and what are their names?

A

6 strains

A, B, C, D,E, G

126
Q

What types of hepatitis are common found with HIV?

A

B, C, D

127
Q

What is hepatitis A caused by?

A

Ingestion of food or water contaminated with fecal matter

Spreads in crowded unsanitary conditions

128
Q

How is Hep B transmitted?

A

Contact with infected blood, body fluids, STD

129
Q

What type of hepatitis will cross the placenta?

A

B

130
Q

What causes Hep C and what is their a risk for with it?

A

Post transfusion and IV drug use

Risk factor for liver disease

131
Q

In order to have Hep D, what other type of hep must you have?

A

B

132
Q

What causes Hep E?

A

Fecal to oral contaminated by water

133
Q

What is the pre-icteric phase of hepatitis that ends with the appearance of jaundice?

A

Prodromal phase

134
Q

What are the phases of hepatitis?

A

Incubation phase
Prodromal phase
Icteric phase
Recovery phase

135
Q

How long does the icteric phase last?

A

2-6 weeks

136
Q

what is the icteric phase caused by?

A

Hepatocellular destruction and intrahepatic bile stasis

137
Q

When does the recovery of hepatitis phase involve?

A

Resolution of jaundice

138
Q

What types of Hep can lead to chornic hepatitis?

A

HBV HCV

139
Q

In chronic hepatitis, how long are liver function tests abnormal?

A

> 6 months

140
Q

Chronic hepatitis gives a predisposition to…

A

Cirrhosis

Primary hepatocellular carcinoma

141
Q

What are causes of fulminant hepatitis?

A

HCV and HBV (with HDV) - toxic drug reactions, congenital disorders

142
Q

What does fulminant hepatitis cause?

A

Severe impairment or necrosis of liver

143
Q

What is cirrhosis?

A

Scarring of liver

Irreversible inflammatory disease that disrupts liver structure and function

144
Q

What are the two main components of cirrhosis

A

Diffuse fibrosis

Nodular regeneration

145
Q

What disease is a precursor to cirrhosis?

A

Alcoholic hepatitis (alcoholic liver disease)

146
Q

Where are Mallory bodies (red stained) found?

A

injured hepatocytes

147
Q

What does alcohol become in the liver?

A

Acetaldehyde

148
Q

What does excessive acetaldehyde in the liver do?

A

Induces lipid peroxidation

Disrupts cellular function

149
Q

What other functions are inhibited by alcoholic liver disease?

A

MItrochondria- reduced oxidation of fatty acids

Protein export, vitamin metabolism

150
Q

What type or cirrhosis begins in the bile canaliculi and bild ducts?

A

Biliary cirrhosis

151
Q

What type of biliary cirrhosis is autimmune and caused by the destruction of small intrahepatic bile ducts?

A

Primary biliary cirrhosis

152
Q

What causes secondary biliary cirrhosis?

A

Prolonged partial or complete obstruction of common bile duct

153
Q

What is postnecrotic cirrhosis the consequence of?

A

Many severe liver diseases

HCV, drug and toxin injury

Medical Phys II (16 decks)

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