GI tract

Question 1

Function of the gut

Answer 1

digestion and absorption

Question 2

What propels food through the gut

Answer 2

peristalsis - muscular contraction

Question 3

What does the stomach lining produce

Answer 3

acid and pepsin (breaks down protein)

Question 4

Where does most of the digestion occur

Answer 4

duodenum

Question 5

What does the pancreas release in the duodenum

Answer 5

digestive enzymes

Question 6

What does the liver release into the duodenum and what is it good for?

Answer 6

Bile produced by the liver is also released into the duodenum, and is important in the absorption of fat.

Question 7

What is the entire small bowel important in

Answer 7

absorption of digested food

Question 8

The role of the large bowel

Answer 8

absorb water and electrolytes, producing formed stools

Question 9

General signs and symptoms of diseases of the gut

Answer 9

Diseases of the gut may be silent (asymptomatic) or produce the following signs and symptoms: loss
of appetite, nausea, vomiting, diarrhea, pain, bleeding, obstruction.

Question 10

What is hematenesis

Answer 10

vomiting of blood

Question 11

if the bleeding is from the stomach or duodenum, what color is the stool? why?

Answer 11

black (melena) because of the action of acid and digestive enzymes on the blood.

Question 12

What happened if stool is red colored

Answer 12

Bleeding from the rest of the small and large bowel (hematochezia)

Question 13

When is bleeding said to be occult?

Answer 13

if the amount is too small to be seen with the naked eye, but can still be detected by a chemical test for blood.

Question 14

Cancer of the _____ account for 6% of GI tract cancers

Answer 14

esophagus

Question 15

About ___% of esophageal cancers are adenocarcinomas and ___% squamous cell carcinomas. Who is incidence highest in?

Answer 15

60, 40 - males >50 y.o

Question 16

How do Adenocarcinoma and squamous cell carcinoma of the esophagus differ? What do these patients usually present with

Answer 16

In pathogenesis –> dysphagia

Question 17

Longstanding gastroesophageal reflux may result in the following sequence of events in the lower esophagus:

Answer 17

intestinal metaplasia (known as Barrett esophagus) –> dysplasia –> adenocarcinoma.

Question 18

The major risk factors for squamous cell carcinoma in Canada are…

Answer 18

alcohol and tabacco

Question 19

How can Esophageal tumors cause harm and how do they spread

Answer 19

Esophageal tumors can cause harm by local obstruction and spread due to the proximity to several important structures, e.g. the trachea, the large vessels of the heart.

Question 20

What is the problem with symptoms associated with esophageal tumors

Answer 20

Unfortunately, by the time that the tumor causes symptoms, it is often not curable by surgery due to invasion through the wall of the esophagus and spread to lymph nodes.

Question 21

What is Adenocarcinoma 5 year survival rate

Answer 21

5-10%

Question 22

What is a peptic ulcer

Answer 22

a break in the mucosal lining of the gastrointestinal tract produced by the action of gastric secretions (i.e. acid and pepsin).

Question 23

what is the structure of a normal mucosa

Answer 23

an impermeable epithelial cell covering and layer of mucus.

Question 24

When do peptic ulcers result

Answer 24

when the mucosa is damaged, leaving it susceptible to breakdown by gastric acid and pepsin.

Question 25

Where are most peptic ulcers

Answer 25

stomach and duodenum

Question 26

What % of the population is affected by peptic ulcers

Answer 26

10%

Question 27

Which is more common, duodenal ulcers or gastric ulcers

Answer 27

Duodenal ulcers are 4 times more common than gastric ulcers

Question 28

What age are duodenal and gastric ulcers most common

Answer 28

most frequent around age 20 and gastric ulcers around age 40

Question 29

What sex is more likely to get duodenal ad gastric ulcers

Answer 29

duodenal - male | gastric - equal

Question 30

Two main causes for peptic ulcers

Answer 30

Helicobacter pylori and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ASA and ibuprofen.

Question 31

HP is the cause of ___% of gastric ulcers and ___% of duodenal ulcers

Answer 31

80 90

Question 32

What is HP? it is found in the stomach of ___% of people

Answer 32

a bacteria, 20% of people under 40 y.o 50% over the age 50

Question 33

What do we know about how one acquires HP? Where has HP been identified in?

Answer 33

The infection is usually acquired in early childhood by transmission from mother to child, and the bacteria may remain in the stomach for the rest of the person’s life. HP has been identified in saliva, feces, and vomitus.

Question 34

What does HP always result in? Will it always eventually result in an ulcer?

Answer 34

Although HP infection always results in inflammation of the stomach lining, most people are asymptomatic and only 10-15% will develop an ulcer at some time during their life.

Question 35

What is it thought that ulceration is due to?

Answer 35

It is thought that ulceration is due to increased gastric acid production

Question 36

what determines the outcome of the infection

Answer 36

The strain of the organism and a variety of host factors determine the outcome of the infection

Question 37

how can HP infections be diagnosed

Answer 37

HP infection can be diagnosed by antibody tests, by identifying the organism in endoscopic biopsies, or by a noninvasive breath test that identifies bacterial production of an enzyme in the stomach.

Question 38

Of the gastric and duodenal ulcers not caused by HP infection, most are due to _______ which block ______________ __________. What are important in maintaining an intact mucosal barrier

Answer 38

NSAIDs which block prostaglandin synthesis Prostaglandins produced by the gastric mucosa are important in maintaining an intact mucosal barrier

Question 39

most common symptom of peptic ulcers

Answer 39

upper abdominal pain, although a significant number, especially the elderly, are asymptomatic.

Question 40

how can peptic ulcers be ruled out as cancer

Answer 40

biopsy

Question 41

complications of peptic ulcers | treatment of peptic ulcers

Answer 41

bleeding (occult or massive and life threatening), obstruction due to formation of scar tissue, and perforation with peritonitis. Medical treatment includes antacids and drugs inhibiting acid secretion, and antibiotics to eradicate Helicobacter pylori (if present). Surgery is performed when drug therapy fails, or to treat complications.

Question 42

lifetime risk of appendicitis (%)

Answer 42

10%

Question 43

what is the most common acute abdominal condition needing surgery

Answer 43

appendicitis

Question 44

In 50-80% of cases of acute appendicitis, the _______ is obstructed, usually by a _______ (hard piece of stool)

Answer 44

lumen, fecalith

Question 45

once the lumen is obstructed in acute appendicitis, what happens next

Answer 45

Mucus continues to be produced in the obstructed appendix, leading to an increase in intraluminal pressure, compression of veins, and ischemic injury. Bacterial proliferation in the presence of obstruction and ischemia increases the inflammatory reaction. In the cases without obstruction, the etiology/ pathogenesis is unknown