PATH 375 Gastrointestinal

Question 1

Gastrointestinal fn

Answer 1

absorb nutrients

excrete waste

Question 2

Gastrointestinal structure

Answer 2

4 layered tube: mucosa (epith, LP, muscularis mucosae), submucosa, muscularis propria, serosa (peritoneum)

blood vessels, lymphatics, nerves (ANS)

MALT

Question 3

Cleft lip and palate

• def
• factors, severity

Answer 3

congenital anomalies of lip and palate
due to failure of fusion of facial processes

multifactorial disorders, varying severities

Question 4

Dental caries
- B.

• complications

Answer 4

bacterial erosion of tooth
Strep mutans thrives in sugar with saliva

plaque promotes attachment

complications: pulpitis, apical abcess, periapical granuloma, radicular cyst

Question 5

Periodontitis

• inflamm of_
• most common cause of_

Answer 5

inflamm of periodontal recesses (gingiva, periodonal memb, alveolar bone)

most common cause of tooth loss

Question 6

Stomatitis

causes (infectious and noninfectious)

Answer 6

inflamm of mouth (oral mucosa)

infectious causes: virus (herpes), B., fungi (candida)
non-infectious causes: aphthous ulcers, immunologic

Question 7

Leukoplakia

Erythrplakia

Answer 7

persistent white/red lesion

Question 8

Malignant oral neoplasm

• arise from_
• risk
• present
• loc
• mets
• Tx

Answer 8

arise from epith in oral cavity
usu squamous cell carcinoma (95%)

risk: tobacco, alcohol

present: leukoplakia
loc: anterior 2/3 tong, lower lip

mets to regional lymph nodes

Tx: surgery and radiation 5yr 45%

Question 9

Sialedenitis

• causes
  Sjorgren

Answer 9

inflamm of salivary gland (usu parotid)

infectious causes: viral (mumps), bacterial (Staph aureus)
autoimmune causes: Sjogren’s syndrome: immune med inflamm of salivary and lacrimal glands

Question 10

Pleomorphic adenoma

Answer 10

benign, epith and stromal elements

most common salivary gland tumor

req proper excision, may recur

Question 11

Esophagitis

Answer 11

inflamm of epith lining of esophagus

causes

infectious: viral (Herpes), fungal (Candida)
chemical: GERD

Question 12

GERD

• due to
• Barrett’s

Answer 12

inflamm due to reflux of gastric contents allowed by relaxed tone of LES

Barrett’s esophagus: metaplastic intestinal type epith in lower esophagus

• incr risk of adenocarcinoma
• req regular evaluations

Question 13

Hiatus hernia

2 types

Answer 13

displacemt of portion of stomach above diaphragm

• sliding hernia (90%)
• paraesophageal hernia (10%) portion protrudes, outpouching

Question 14

Achalasia

Answer 14

incr resting tone of LES

no food enters stomach

Question 15

Esophageal varices

Answer 15

dilation of submucosal veins of distal esophagus

• usu due to portal hypertension 2º to hepatic cirrhosis
• if rupture, significant morbidity and mortality

Question 16

Malignant esophageal neoplasms
2 types

• loc
• present

Answer 16

usu carcinomas
usu lower portion of esophagus

present: ulceration or mass
- lymphatic invasion

1. squamous cell carcinoma risks: tobacco, alcohol
2. adenocarcinoma risks: Barrett’s

Question 17

Acute gastritis

Answer 17

acute erosive inflamm of mucosal lining of stomach

• stress
• drugs (aspirin)
• alcohol

Question 18

Chronic gastritis

2 causes and their assoc complications

Answer 18

chronic inflamm of mucosa with acute exacerbations

cause:
A) H. pylori infection: B. survives in acid, assoc with increased inc of gastic adenocarcinomas and lymphomas
B) autoimmune: destroy parietal cells in stomach, assoc with incr risk of gastic adenocarcinoma

Question 19

Peptic ulcer disease

• def
• factors (3)
• complications (3)

Answer 19

localized chronic ulceration of gastic or duodenal mucosa due to acid on weakeend gastric ur duodenal mucosa

factors: H. pylori, stress, hormones

complications:
a. hemorrhage (melena, Fe def anemia, hematemesis)
b. perforation (peritonitis)
c. scarring (stenosis, obstruction)

Question 20

Gastric carcinoma

• risk
• types
• prognosis
• spread

Answer 20

adenocarcinomas
decr inc in N.A.

risk: nitrosamines, Japanese, H. pylori

types:
gross appearance- polypoid, fungating, ulcerating, diffuse
histology- intestinal, signet cell

poor prognosis
lymphatic spread (Virchow node)

Question 21

Lymphoma

cause

Answer 21

extra-nodal malignant lymphomas often occur in stomach

MALToma: low grade lymphoma due to chronic H. pylori

Question 22

Meckel’s diverticulum

Answer 22

develpmental disorder
presistence of omphalomesenteric (vitelline) duct

2% of pop, 2 ft from ileocecal valve, 2% ectopic gastric mucosa, 2% dev symptoms

Question 23

Malabsorption

Answer 23

inability to absorb nutrients (maldigestion, decr absorption, impaired transport)

Celiac disease: hypersens rxn to gluten (wheat prtn) damage small bowel mucosa => malabsorption

Tx: gluten free diet

Question 24

Small bowel infections

Answer 24

Giarda (parasite, beaver fever)

Question 25

Small bowel neoplasms

2 types

Answer 25

rare

cacinoids: low grade malignant, neuroendocrine cells
may prod carcinoid syndrome: diarrhea, flushing, bronchospasm

lymphomas

Question 26

Crohn disease

• present
• loc
• complications (3)

Answer 26

present: skip lesions, transmural inflamm, granulomas

may affect any pt of GI tract

complications:
- fissures, strictures, fistulas, adhesions
- dysplasia less common than ulcerative carcinoma
- extra colonic: arthritis, eye, 1º sclerosing cholangitis, skin lesions

Question 27

Ulcerative colitis

• loc
• complications (3)

Answer 27

inflamm confined to mucosa
rectum proximal to cecum
small bowel not involved

complications:
- toxic megacolon
- dysplasia
- extra-colonic: arthritis, eye, 1º sclerosing cholangitis, skin lesions

Question 28

Hirschprung disease

Answer 28

congenital absence of colonic nerve ganglia
no peristalsis in portion of colon

dilation of colon proximal to aganglionic segment

Question 29

Divericular disease

• def
• complications (3)

Answer 29

outpouchings of colonic mucosa (pseudodiverticulum)
usu elderly

diverticulosis: diverticula present
diverticulitis: inflamm of diverticulum

complications

• pericolonic abscess
• peritonitis
• colonic stenosis

Question 30

Inflamm of large bowel

3 types

Answer 30

A. infectious
pseudomembranous colitis: due to C. difficile toxin, due to use of broad spectrum antibiotic

B. inflamm bowel disease

C. ischemic bowel disease: watershed areas susceptible to ischemia, may result from atherosclerosis

Question 31

Hemorrhoids

Answer 31

variceal dilation of veins in submucosa of anorectal area

Question 32

Polyps

3 types

Answer 32

A. hyperplastic: most common colonic polyp, not malignant

B. hamartomatous: in kids, Peutz-Jeghers syndrome (autosomal dom, multiple hamartomatous polyps and pigmented lesions on lips, peri-oral skin), incr risk of malignancy

C. adenomatous: benign, incr risk of carcinoma if villous or high grade dysplasia
i. tubular
ii. villous
iii. tubulovillous
familial adenomatous polyposis (autosomal dom tumor syndrome)

Question 33

Colonic carcinoma

• 3rd most common_
• peak inc
• risk
• type
• how to stage
• loc
• Dx

Answer 33

• 3rd most common malignant tumor in N.A.
• 3rd most common cause of cancer-related death

peak inc 60-80 yo, rare <40 yo unless predisposed

risk: FAP, IBD

adenocarcinoma, mets via lymph/blood
stage: penetration, nodes, mets
usu distal colon
digital rectal exam pt of routine physical exam

Question 34

Appendicitis

Answer 34

acute B. infection 2º to luminal obstruction

• fecolith
• lymphoid hyperplasia
• pinworms

present: abdnominal pain (McBurney’s pt, rebound tenderness), systemic features, leukocytosis

rupture => peritonitis

Question 35

Appendiceal neoplasms

Answer 35

cacinoid: most common neoplasm of appendix

may have adenocarcinomas