GI System Flashcards
Diseases of the GI tract can be classified as what 5 ways?
– Developmental disorders – Inflammatory diseases – Functional disorders – Circulatory disturbances – Neoplastic diseases
The following diseases affect what portion of the GI system? – Hiatal hernia – Reflux esophagitis – Barrett esophagus – Achalasia – Esophageal varices – Esophageal cancer
Esophagus
The following diseases affect what portion of the GI system? – Acute gastritis – Chronic gastritis – Peptic ulcer disease – Stomach cancer
Stomach
The following diseases affect what portion of the GI system? – Meckel diverticulum – Bowel obstruction – Herniation – Adhesions – Intussusception – Volvulus – Adenocarcinoma – Carcinoid tumor
Small intestine
The following diseases affect what portion of the GI system? – Pseudomembraneous colitis – Diverticulosis – Crohn disease – Ulcerative colitis – Adenomatous polyps – Colon cancer
Large Intestine
–difficulty in swallowing
• Dysphagia
–expulsion of stomach contents through the mouth
• Vomiting
–vomiting of fresh, red blood
• Hematemesis
–bright, red blood in stool
• Hematochezia
–black, tarry feces
• Melena
–frequent, loose, watery bowel movements
• Diarrhea
–hard feces that are difficult to eliminate
• Constipation
–painful swallowing
• Odynophagia
Clinical Symptoms and Signs of \_\_\_\_\_\_ Disease • Dysphagia –difficulty in swallowing • Odynophagia –pain on swallowing • Heartburn –a burning behind the sternum - GERD • Acid regurgitation into the mouth –a sign of GERD
Esophageal
–a Functional (Motor)
Disorder
• Dysfunction of ganglion cells of myenteric plexus (Auerbach plexus) prevents proper relaxation of lower esophageal sphincter - a motility disorder
• Dysphagia, regurgitation, halitosis and proximal dilation
Achalasia
• Scandinavian, Northern European women • Severe Fe-deficiency anemia • Mucosal atrophy - atrophic glossitis • Esophageal webs - dysphagia • Increased risk for squamous cell carcinoma – Esophagus – Oropharynx – Posterior Oral Cavity
Plummer Vinson Syndrome
• Portal hypertension
produces venous
dilation in Esophagus
• Rupture leads to hematemesis and massive upper GI bleed
• Rupture of a varix is associated with high mortality
• Rupture of a varix accounts for half of the deaths in advanced cirrhosis
Esophageal varices
\_\_\_\_\_\_ syndrome tears are seen in chronic alcoholics, where violent retching causes esophageal lacerations and hemorrhage
• Mallory-Weiss Syndrome
- Diaphragmatic hernia - widened diaphragmatic hiatus allows protrusion of the stomach through the diaphragm
- Gastroesophageal junction pulled into thorax causing GERD, heartburn and dysphagia
Hiatal hernia
- Gastric metaplasia of lower esophageal mucosa - columnar epithelium replaces stratified squamous epithelium
- Odynophagia, ulceration, hemorrhage
- Adenocarcinoma
Barrett esophagus
• Squamous cell carcinoma • Adenocarcinoma - Barrett esophagus • Dysphagia due to narrowing of lumen or interference with peristalsis
Esophagus cancer
• Older adults, geographical variation, poor prognosis • Squamous cell carcinoma most common world-wide, but adenocarcinoma of esophagus is more common in the United States • Most common in middle third • Alcohol and tobacco, Plummer- Vinson syndrome, diet influence incidence
Esophageal SCC
- Lower segment
- Barrett esophagus is a risk factor
- More common than squamous carcinoma in United States
Esophageal Adenocarcinoma
Epithelial cells of the \_\_\_\_\_\_ • Mucous cells • Parietal cells - hydrochloric acid, intrinsic factor • Chief cells - pepsin • Endocrine cells - G-cells - gastrin
Stomach
• Inflammation of the gastric mucosa • Acute gastritis – erosive, due to irritants and NSAIDs • Chronic gastritis – erosive or non-erosive –infectious or autoimmune
Gastritis
• Epigastric burning, pain, nausea, vomiting • Shallow erosions • Asprin, NSAIDs, alcohol, stress, shock, sepsis • One of the major causes of hematemesis in alcoholics
Acute Erosive Gastritis
• Infectious –the most common form of is due to infection by Helicobacter pylori • Autoimmune – autoantibodies to parietal cells
Chronic Gastritis
• Gram negative s-shaped rods • Biopsy and silver stain • Urea breath test • Antibody test -Responsible for gastritis
H Pylori
• Autoantibodies against gastric parietal cells, • Gastric mucosal atrophy • No intrinsic factor, low serum vitamin B12, pernicious anemia
Autoimmune (Atrophic) Gastritis
• Deeper than erosions, may extend to muscularis • Severe stress - ICU patients (shock, trauma, burns, sepsis)
Gastric stress ulcers
Where are peptic ulcers usually located 98% of time?
Stomach or Duodenum
Clinical Course of \_\_\_\_\_\_ • Acute/chronic blood loss • Nausea, vomiting, hematemesis, melena • Perforation - major cause of death in PUD Immediate pain – gastric Delayed pain - duodenal
Melena –black, tarry stool
Hematocheza –red blood in stool
Peptic Ulcer Disease
• Multifactorial disease, decreased mucosal resistance
• Infection by H. pylori
• Drugs –aspirin, NSAIDs
• Neuroendocrine –hormonal hypersecretion syndromes
– Cushing Syndrome –corticosteroids
– Zollinger-Ellison Syndrome –gastrin
Peptic ulcers
Complications of \_\_\_\_\_\_ • Minor hemorrhage –melena, iron deficiency anemia • Major hemorrhage -hematemesis • Perforation - peritonitis • Stenosis and obstruction • Penetration into pancreas
Peptic Ulcer Disease
- Gastrin-secreting tumor in pancreas or duodenum (“gastrinoma”)
- Hypergastrinemia causes hypersecretion of gastric acid
- Severe peptic ulcer disease with multiple ulcers in unusual locations
Zollinger-Ellison Syndrome
• Older individuals, poor prognosis • Smoked fish –nitrosamines • Predispostion to gastric cancer – H. pylori infection – Chronic atrophic gastritis – Gastric adenomatous polyps • Lesser curve of antro- pyloric region • Intestinal type - bulky tumors composed of glandular structures • Diffuse type - infiltrative growth of poorly-differentiated cells (linitis plastica)
Gastric Adenocarcinoma
• Metastatic adenocarcinoma to ovaries • Bilateral ovarian metastases • Frequently of gastric origin - mucus- producing cells
Krukenberg Tumor
Non-Hodgkin Lymphoma • Primary lymphomas - MALT-omas and other NHLs • Secondary lymphomas - extranodal spread
Gastrointestinal Tract Lymphoma
\_\_\_\_\_\_ • Stomach –most common site for extranodal lymphomas • MALT lymphomas - B cell lymphomas of Mucosa-Associated Lymphoid Tissue • Associated with Helicobacter pylori infection – may regress with H. pylori treatment
Gastric MALT Lymphoma
- Developmental defect of ileum - a blind pouch containing all layers
- “Left-sided appendix” -may produce symptoms similar to appendicitis
Meckel diverticulum
Weakness in peritoneum • Inguinal • Femoral • Umbilicus • Incisional
Herniation
• Fibrotic bridges of peritoneum • May trap and kink bowel segments • They are usually sequelae of prior surgery or infection
Adhesions
• Small intestine invaginates into itself - intussusceptum becomes necrotic unless everted • Small pedunculated tumors carried by peristalsis may pull forward the loop to which it is attached
Intussusception
• Rotation of a loop of intestine about its own mesenteric root • Most common in small intestine and sigmoid colon • Volvulus undergoes necrosis
Volvulus
• A low-grade malignancy of neuroendocrine cells, appearing as mucosal nodules • May occur throughout gastrointestinal tract but are most common in appendix • May produce hormones, such as serotonin
Carcinoid Tumor
• Caused by a serotonin- producing carcinoid tumor that is asymptomatic until metastasis to the liver • The serotonin that is no longer metabolized by the liver causes cramping, diarrhea, flushing and bronchospasm
Carcinoid syndrome
• Enteric nervous system - myenteric (Auerbach) and submucosal plexus (Meissner) • Colonized by non-pathogenic strains of bacteria
Colon
• Developmental defect of enteric nervous system - agangliosis of terminal colon (myenteric plexus) • Chronic constipation, proximal dilation • Resection of aganglionic segment
Hirschprung Disease –
Congenital Megacolon
• Consist of out-pouchings of mucosa and submucosa through muscular layer of colon • Associated with a low bulk diet, straining during defecation • May become inflamed (diverticulitis)
Diverticulosis
• Neoplastic polyps (adenomatous polyps, adenomas) – Tubular adenoma – Villous adenoma • Non-neoplastic polyps – Hyperplastic polyp –most common – Hamartomatous polyp - Peutz-Jeghers Syndrome
Intestinal polyps
• Non-neoplastic hyperplasia of epithelium, most common • Not pre-malignant
Hyperplastic polyp
• Large, pedunculated polyp, consisting of all layers of the mucosa • May be associated with Peutz-Jeghers syndrome • Risk for intussusception • No malignant change
Hamartomatous Polyp
• Autosomal dominant
• Pigmented macules of oral mucosa and
perioral skin
• Hamartomatous polyps of bowel
• Increased risk for adenocarcinoma outside GI
tract - pancreas, breast, lung, ovary, uterus
Peutz Jegher syndrome
• Tubular adenomas - tubular glands, frequently pedunculated • Villous adenomas - villous projections, frequently sessile
Adenomatous Polyps –Adenomas
–Neoplastic Polyps
• Most common neoplastic polyp • <5% malignant transformation • Endoscopic polypectomy curative
Tubular Adenoma
• Least common neoplastic polyp • 50% malignant transformation • Endoscopic removal often not possible
Villous Adenoma
- Third most common cause of cancer death –lung, breast/prostate, colon
- Older adults, unless predisposing condition (ulcerative colitis, hereditary colon cancer syndrome –Gardner syndrome)
- Dietary risk factors- high caloric intake, high fat, red meat, high refined carbohydrates, low fiber
Colonic Adenocarcinoma
• Sigmoid colon most common site • Left side - circumferential, napkin-ring lesion producing narrowing of lumen • Right side - exophytic, polypoid, crater-like ulcerations with rolled borders
Colonic adenocarcinoma
____ is most important prognostic indicator of colon cancer
Stage
-multiple tubular adenomas, 100% malignant transformation
• Familial Adenomatous Polyposis Coli (FAP)
Gardner syndrome –a variant of FAP with multiple supernumerary teeth, jaw bone densities, multiple osteomas, fibromatosis, epidermal inclusion cysts
Gardner syndrome
- colonic cancer unrelated to adenomas
– Increased risk of endometrial and ovarian cancers
Hereditary Non-Polyposis Colorectal Cancer (HNPCC)
• Two chronic, relapsing inflammatory disorders of unknown etiology • Crohn Disease • Ulcerative Colitis • Exaggerated and unregulated local immune respose in genetically susceptable individuals 104
Inflammatory bowel disease
• Any level of GI tract, mouth to anus, most often distal ileum and colon • Transmural inflammation, thickened intestinal wall • Sarcoid-like non-caseating granulomas • Pain, diarrhea, fissure and fistula formation
Crohns disease
–an abnormal channel
between two hollow organs or
between a hollow organ and the skin
surface
Fistula
Oral Manifestations of _______:
• Aphthous-like lesions
• Granulomatous nodules
• Malabsorption, vitamin K-dependent clotting factor deficiency, bleeding diathesis
Crohn Disease
• Chronic inflammatory disease with
increased risk of malignancy
• Thinning of intestinal wall, limited to
colon and rectum
• Relapsing diarrhea, pain
• Inflammation limited to mucosa –not transmural
• Crypt abscesses- accumulation of neutrophils within colonic crypts are signs of active inflammation
• Pseudopolyps: Remnants of colonic mucosa surrounded by ulceration
Ulcerative colitis
• Oral lesions of
ulcerative colitis
• Small, yellow
superficial pustules
Pyostomatitis Vegetans
Where can UC be found vs Crohns?
UC: Colon only
Crohns : Ileum and colon
• An acute bacterial infection of appendix • Complications may include rupture and peritonitis • Fecalith - inspissated fecal material • Reactive lymphoid hyperplasia –response to viral infection • Neoplasm –carcinoid tumor
Appendicitis
• Acute inflammation, mucosal ulceration • Transmural inflammation • Serositis • Peritonitis • Right lower quadrant pain, rebound tenderness • Leukocytosis, fever, nausea, vomiting
Acute Appendicitis
• Varicose dilation of hemorroidal venous plexus at anorectal junction • Increased venous pressure may be associated with pregnancy, chronic constipation, portal hypertension
Hemorrhoids
