PATH 375 Gastrointestinal Flashcards
Gastrointestinal fn
absorb nutrients
excrete waste
Gastrointestinal structure
4 layered tube: mucosa (epith, LP, muscularis mucosae), submucosa, muscularis propria, serosa (peritoneum)
blood vessels, lymphatics, nerves (ANS)
MALT
Cleft lip and palate
- def
- factors, severity
congenital anomalies of lip and palate
due to failure of fusion of facial processes
multifactorial disorders, varying severities
Dental caries
- B.
- complications
bacterial erosion of tooth
Strep mutans thrives in sugar with saliva
plaque promotes attachment
complications: pulpitis, apical abcess, periapical granuloma, radicular cyst
Periodontitis
- inflamm of_
- most common cause of_
inflamm of periodontal recesses (gingiva, periodonal memb, alveolar bone)
most common cause of tooth loss
Stomatitis
causes (infectious and noninfectious)
inflamm of mouth (oral mucosa)
infectious causes: virus (herpes), B., fungi (candida)
non-infectious causes: aphthous ulcers, immunologic
Leukoplakia
Erythrplakia
persistent white/red lesion
Malignant oral neoplasm
- arise from_
- risk
- present
- loc
- mets
- Tx
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%
Sialedenitis
- causes
Sjorgren
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
Pleomorphic adenoma
benign, epith and stromal elements
most common salivary gland tumor
req proper excision, may recur
Esophagitis
inflamm of epith lining of esophagus
causes
infectious: viral (Herpes), fungal (Candida)
chemical: GERD
GERD
- due to
- Barrett’s
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
Hiatus hernia
2 types
displacemt of portion of stomach above diaphragm
- sliding hernia (90%)
- paraesophageal hernia (10%) portion protrudes, outpouching
Achalasia
incr resting tone of LES
no food enters stomach
Esophageal varices
dilation of submucosal veins of distal esophagus
- usu due to portal hypertension 2º to hepatic cirrhosis
- if rupture, significant morbidity and mortality
Malignant esophageal neoplasms
2 types
- loc
- present
usu carcinomas
usu lower portion of esophagus
present: ulceration or mass
- lymphatic invasion
- squamous cell carcinoma risks: tobacco, alcohol
- adenocarcinoma risks: Barrett’s
Acute gastritis
acute erosive inflamm of mucosal lining of stomach
- stress
- drugs (aspirin)
- alcohol
Chronic gastritis
2 causes and their assoc complications
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
Peptic ulcer disease
- def
- factors (3)
- complications (3)
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)
Gastric carcinoma
- risk
- types
- prognosis
- spread
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)
Lymphoma
cause
extra-nodal malignant lymphomas often occur in stomach
MALToma: low grade lymphoma due to chronic H. pylori
Meckel’s diverticulum
develpmental disorder
presistence of omphalomesenteric (vitelline) duct
2% of pop, 2 ft from ileocecal valve, 2% ectopic gastric mucosa, 2% dev symptoms
Malabsorption
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
Small bowel infections
Giarda (parasite, beaver fever)
Small bowel neoplasms
2 types
rare
cacinoids: low grade malignant, neuroendocrine cells
may prod carcinoid syndrome: diarrhea, flushing, bronchospasm
lymphomas
Crohn disease
- present
- loc
- complications (3)
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
Ulcerative colitis
- loc
- complications (3)
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
Hirschprung disease
congenital absence of colonic nerve ganglia
no peristalsis in portion of colon
dilation of colon proximal to aganglionic segment
Divericular disease
- def
- complications (3)
outpouchings of colonic mucosa (pseudodiverticulum)
usu elderly
diverticulosis: diverticula present
diverticulitis: inflamm of diverticulum
complications
- pericolonic abscess
- peritonitis
- colonic stenosis
Inflamm of large bowel
3 types
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
Hemorrhoids
variceal dilation of veins in submucosa of anorectal area
Polyps
3 types
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)
Colonic carcinoma
- 3rd most common_
- peak inc
- risk
- type
- how to stage
- loc
- Dx
- 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
Appendicitis
acute B. infection 2º to luminal obstruction
- fecolith
- lymphoid hyperplasia
- pinworms
present: abdnominal pain (McBurney’s pt, rebound tenderness), systemic features, leukocytosis
rupture => peritonitis
Appendiceal neoplasms
cacinoid: most common neoplasm of appendix
may have adenocarcinomas
