Midterm Ch.14 Part 2 Flashcards
What is the MC cause of esophagitis
Reflux aka GERD
25-40% of U.S. adults
Idiopathic LES dysfunction
What is associated with a “sour brash”
GERD
Thx. Antacids, dietary modification
MC G.I. Compliant
Infectious esophagitis MC develops following an
Ulcer
Also microbes
Fungal= Candida esophagitis
Viral- HSV, CMV
What is Mallory Weiss tear
Longitudinal esophageal tear
From forceful vomiting
Hematemesis
1/2 of all upper G.I. Bleeds
What is the MC hiatal hernia
Axial 95%
” bell shaped” dilation
AKA sliding
What is Non axial hiatal hernia
AKA rolling
Separate potion of stomach protrudes
Prone to strangulation or obstruction
Who’s is most at risk for hiatal hernia
70% occur in adults 70+
90% are asymptomatic
MC with non axial type
What is Barrett esophagus
Esophageal metaplasia at distal end
Pre-neoplastic lesion
10% of symptomatic GERD patients
Risks White ppl 30-100x, males 4x
Age 40-60
What are found in Barrett esophagus
Goblet cells
Get red velvety mucosa aka “tongues”
What is a leiomyoma
Benign smooth muscle tumor in the esophagus
Adenocarcinoma in the esophagus is
50% of esophageal cancers
Risks GERD, white, male, fat, tobacco
What is the MC esophageal tumor
Squamous cell carcinoma
MC world wide 90%
Adenocarcinoma with ealrly lymphatic invasion results in
Poor prognosis <25% 5 yr survival
Esophageal adenocarcinoma may have
Exophytic (raised lesion)
Flat or raised patches
Distal 1/3
Risks for squamous cell carcinoma
> 45yr old, males, black, HPV
Esophageal squamous epithelium cell carcinoma MC affects
Middle 1/3
What is melena
black “tarry” feces
What is MC infxn. Of stomach
Helicobacter pylori
What is acute gastritis
Neutrophils will be present
Acute erosive hemorrhagic gastritis
Pathogensis is multipfactorial
May be asymptomatic
Acute peptic ulceration occurs from
Severe PHYSIOLOGICAL stress
High douses of NSAIDs
Intracranial disease
“Coffee ground” throw up
Chronic gastritis involves
Upper abdominal discomfort
Hematemesis is RARE
H. Pylori, old age, stressors
Risk for producing peptic ulcer disease
Gastric adenocarcinoma
Chronic gastritis results in
H. Pylori
Increased acid production
Epithelial metaplasia
Autoimmune gastritis is
mc in elderly
Pernicious anemia= antibodies against parietal cells
What is a “punched out” lesion
Peptic ulcer disease
Where is peptic ulcer disease MC located
Proximal duodenum
Gastric antrum
MC in men
When is peptic ulcer disease MC
At night 1-3 hours after eating
If perforation or hemorrhage happens MEDICAL emergency
Presentation of duodenal and gastric
Peptic ulcer disease
Duodenal= postprandial relief
Gastric= worse postprandial
Eating does influence pain
What is the MC gastric polyp
Inflammatory Hyperplastic polyps 75%
1cm age 50-60 H. Pylori
Funding gland polyp
15% of cases
PPI use or FAP
Gastric adenomas
10% of gastric polyps
Males 3x, age 50-60
30% are adenocarcinoma
Dysplasia adenomas are
90% of all stomach cancers
MC in males around 55
Japan 20X risk
5yr survival early 90% vs. advanced 20%
What is pyloric stenosis
Hypertrophy/ narrowing of pyloric sphincter
Dx. Shortly after birth
1 per 400 births
Projectile vomiting
Vomiting from pyloric stenosis is
Fluid is NOT bile stained
Males, whites at risk, Turner syndrome
Where is MC intestinal obstructions
Small intestine
What is intussusception
A proximal segment telescopes into a distal segment
What is a volvulus
Twisting a loop of bowel
Possible infarction
What is Hirshsprung disease
Forms from defective neural crest cell migration
Lack of neurologic ganglia in rectum
Dx. Failure to pass meconium (48hrs)
Sever dilation of proximal bowels
Hirschsprung disease MC in
Males, but MORE SEVERE when in females
Chronic ischemic bowel disease
Mimics IBD, insidious, episodic bloody diarrhea
Acute ishemic bowel disease has
Severe abdominal pain, nausea, vomiting, frank blood in stool
50% mortality
Risk for septic or hypocalcemia shock
Risks= elderly, cardiovascular disease
What is angiodysplasia
Vascular lesion
MC in cecum or ascending colon
20% of lower GI bleeds melena
Risk increases with age
Hypothesized development following constipation
What is the MC G.I. vascular disorder
Hemorrhoids
What is pruritus
Perinatal itching
