Pathophysiology 2 Flashcards
inflammation of the mucosal lining of the stomach and small bowel
gastroenteritis
[pathophysiology] gastroenteritis
- Gastritis due to NSAIDS, alcohol, steroids, stress, trauma, viral/fungal infections, smoking, H. pylori
- Salmonella enteritis - contaminated poultry, meat, egg, dairy - diarrhea from mild mucosal ulcerations
[s/s] gastroenteritis
mild feverr
vomiting
watery diarrhea
[Dx] gastroenteritis
UGIS/ SIS
DC - slit-like collection of Ba surrounded by radiolucent halos; thickened mucosal folds
[Tx] gastroenteritis
antibiotics
fluid management
remove causative agent
chronic condition where parts of the digestive system become inflamed.
a type of a condition called inflammatory bowel disease (IBD).
Crohn’s Disease
Crohn’s Disease occurs in [..]
GI tract (lower ileum and cecum)
Crohn’s Disease [poi occurrence percentage]
SB 30%
Colon 30%
Combination 40-50%
Crohn’s Disease [bimodal distrib]
14-24 and 50-60 yrs old
[pathophysiology] Crohn’s Disease
-involves all bowel layers which may lead to fistulas and abscess
-rectal sparring 50%
-may affect mouth to anus
-NOD2/CARD15 gene increases susceptibility
-unreg intestinal immune response to envi factors
-crypt cells inflammation and abcess
-small ulcers-thickened bowel wall
[s/s] Crohn’s Disease
-similar to appendicitis or acute bowel
obstruction
-periods of exacerbation and inactivity
-abdo pain and cramping , blood in stool, diarrhea, fever, fatigue, mouth sores, reduced appetite and wt loss
[s/s] Crohn’s Disease
-similar to appendicitis or acute bowel
obstruction
-periods of exacerbation and inactivity
-abdo pain and cramping , blood in stool, diarrhea, fever, fatigue, mouth sores, reduced appetite and wt loss
[Dx] Crohn’s Disease
UGIS/SIS
SBFT
Endoscopy
BaE
CT/MR Enterography
Sonography
HMPAO Leukoscintigraphy
[Dx] Crohn’s Disease - useful for characterizing length of involvement
SBFT
[Dx] Crohn’s Disease - SBFT Characteristic Findings: (5)
abscess/fistula
mucosal nodularity
narrowed lumen
string sign
ulceration
[Dx] Crohn’s Disease -SBFT sign
“String sign” - appears w/ small ulcers and thickened bowel wall, narrowing of lumen, reversible
-caused by incomplete filling as a result of irritability/spasms assoc. w/ ulceration
[Dx] Crohn’s Disease - preferred initial examination, when ulceration is severe
[appearance]
Endoscopy
Cobble Stone appearance
[Dx] Crohn’s Disease - for unsuccessful colonoscopies
BaE
[Dx] Crohn’s Disease -shows promise for initial dx
CT/MR Enterography
[Dx] Crohn’s Disease - CT/MR Enterography -sign
“comb sign” - increased no of visible vessels on mesenteric side of affected segments of SB
-found in CD or LUPUS ENTERITIS (SLE MESENTERIC VASCULITIS)
[Dx] Crohn’s Disease - Sonography signs
bowel wall thickening (4-5mm)
“target sign”
[Dx] Crohn’s Disease - monitor and assess disease activity
HMPAO Leukoscintigraphy
[Cx] Crohn’s Disease
Mechanical bowel obstruction – fibrotic
scarring
Increased risk for bowel carcinoma
abscess, cancer, fistula, obstruction, perianal disease
[Tx] Crohn’s Disease
drug therapy, surgery 70%
recurrence is common
rarely cured but rarely fatal
long term condition where colon and rectum become inflamed
ulcerative colitis
[incidence] Ulcerative Colitis
15-25 yr olds; 4x more common in whites
[pathology] Ulcerative Colitis
-inflammation of mucosa only (exudate of pus, blood and mucus from the “crypt abscess”)
-always start in rectum (up to 1/3 dont progress)
-limited to colon and rectum
[s/s] Ulcerative Colitis
diarrhea w/ blood or pus, mucus, rectal bleeding, abdo pain and cramping, urgency by inability to defacate. wt loss and fatigue
[dx] Ulcerative Colitis
colonoscopy
BaE
[dx] Ulcerative Colitis - primary means
colonoscopy
[dx] Ulcerative Colitis - support dx, assess progression
BaE
[dx] Ulcerative Colitis BaE sign
LEAD PIPE SIGN - loss of haustrations + mucosal edema
PSEUDOPOLYPS
(islands of normal mucosa surrounded by affected mucosa
[diagnosis] Ulcerative Colitis
-continuous lesions
-rare
-lead pipe app due to chronic scarring and subsequent retraction and loss of haustra
[Cx] Ulcerative Colitis
cancer
megacolon
perforation
stricture
[Cx] Ulcerative Colitis
cancer
megacolon
perforation
stricture
[Tx] Ulcerative Colitis
dietary restrictions, steroids
Surgery – for obstruction or neoplasm
Resection – ileorectal/anal anastomosis
Inflammation of the vermiform appendix due to obstruction by a fecalith or neoplasm (rare)
appendicitis
[incidence] Appendicitis
late teens and 20s
M=F
[pathophysiology] Appendicitis
Obstruction – inflammation + distention –
compromised blood flow – increased
susceptibility to infection (E. coli bacteria) –
gangrene, perforation, rupture
[s/s] Appendicitis
Persistent RLQ pain
Nausea and vomiting – reflex symptom (stomach and appendix innervated by Vagus nerve)
Low grade fever, elevated WBC
[dx] Appendicitis
CT
Radiography + Contrast (BaE)
Sonography
[dx] Appendicitis - golden standard, most accurate for pts who do not have a clear clinical dx
CT
[dx] Appendicitis - follow-up to investigate other RLQ pain causes
Radiography + contrast (BaE)
[dx] Appendicitis - effective as CT if done by experienced […]
Sonography
[Cx] Appendicitis
Gangrenous/perforated appendicitis
because of delayed dx – rupture –
generalized peritonitis – death
[Tx] Appendicitis
Surgical removal of the appendix
Varicose veins
Abnormally lengthened and dilated
superficial veins
Esophageal Varices
Varicose veins
Abnormally lengthened and dilated
superficial veins
Esophageal Varices
[pathophysiology] Esophageal Varices
Portal hypertension – conditions that cause
resistance to the normal blood flow thru the
liver (ex. Cirrhosis) – increased blood flow
to the collateral veins (esophageal and
gastric) – dilatation
[s/s] Esophageal Varices
vomiting blood, black/blood stools, lighthead, loss of consciousness, jaundice, easy bleeding, ascites
[dx] Esophageal Varices
Thin Ba Swallow - rec pos’n, serpentine/wormlike filling defects
[Cx] Esophageal Varices
rupture and hemorrhage - massive often fatal
[Tx] Esophageal Varices
Endoscopic Sclerotherapy
Banding Ligation
Vasopressin
Balloon Tamponade
“Transjugular intrahepatic portosystemic shunt” (TIPPS)
[Tx] Esophageal Varices - redirect blood flow, assessed by Doppler
“Transjugular intrahepatic portosystemic shunt” (TIPPS)
protrusion of bowel loops (usually in the abdominal wall)
Hernia
[patho] Hernia
due to anatomic weakness - bowel loop herniates (along with peritoneum)
[types] hernia
inguinal - m only
femoral
umbilical
weakness of the esophageal hiatus causing portions of stomach to herniate into the thoracic cavity
hiatal hernia
[incidence] Hiatal Hernia
occur in half the popu over the age 50
[patho] Hiatal Hernia
early stages - reducible
chronic herniation - assoc. w/ GERD
[types] Hiatal Hernia
direct/sliding - eso and top of stomach slides w/in diaphragm, GEJ and stomach portions above diaphragm
rolling/paraesophageal - portion of stomach herniates above diaphragm, GEJ remains below diaphragm may result in intrathoracic stomach
[s/s] Hiatal Hernia
mostly asymptomatic
reflux
[dx] Hiatal Hernia
UGIS - Schatski Ring (luminal ring related to reflux) -direct/sliding
[tx] Hiatal Hernia
conservative management (minimize discomfort)
interruption of normal peristalsis of SB and LB due to lesions
Bowel Obstruction
[types] Bowel Obstruction
mechanical/physical -physical blockage
paralytic/non-mechanical/adynamic/ functional - ab peristalsis
[patho] Small BO
adhesive secondary to prev abdo surgeries: 50-70%
hernia: 20-25%
tumors: 10%
mesenteric ischemia: 3-5%
[patho] Large BO
colon/rectal CA: 90%
volvulus: 4-5%
diverticular d.: 3%
luminal occlusion by physical means - hernia, tumor, volvulus, intussusception, post op adhesion (most common)
mechanical bo
[types] Mechanical BO
Simple Obstruction - does not involve blood supply
Strangulating Obstruction- impairment of blood flow resulting to bowel edema then necrosis
[types] Mechanical BO
Simple Obstruction - does not involve blood supply
Strangulating Obstruction- impairment of blood flow resulting to bowel edema then necrosis
volvulus is usually in [..]
sigmoid or ileocecal area
volvulus is usually in [..]
sigmoid or ileocecal area
[dx] volvulus
rad’phy - collection of air in the dilated bowel
[dx] volvulus
rad’phy - collection of air in the dilated bowel
[dx] volvulus
rad’phy - collection of air in the dilated bowel
[dx] volvulus
rad’phy - collection of air in the dilated bowel
[patho] intussusception
imbalance b/w longit and radial smooth muscle forces of intestine that maintain normal struc
**[s/s] intussusception
stool w/ blood and mucus, vomiting, lump in belly, weakness, diarrhea
[dx] intussusception
BaE - spring-like app
a gallstone erodes the gb and creates a fistula w/ SB
gallstone ileus
[patho] Gallstone Ileus
obstruction occurs when gs reaches ileocecal valve
[dx] Gallstone Ileus
Clinical Radiograph (supine and erect)
CT - 90% accuracy for high grade SBO w/o cont (limited for low grade, needs multiformat recon)
CT enterography - detecting lumen obliterating ab
MRI- for low grade SBO
neuromuscular ab
failure of the lower esophageal sphincter to relax leading to dysphagia
achalasia
[incidence] achalasia
m=f
20-40 yrs old
[patho] achalasia
motility disorder, absence of esophageal peristalsis
[s/s] achalasia
slow progressive dysphagia, regurgitation, wt loss, chest pain
[dx] achalasia
barium swalllow -upper dilater, lower constricted w/ little/absent peristalsis
[tx] achalasia
nitrates, calcium channel blockers, botulinum toxin, esophageal dilation, myotomy
variable sized sac/pouch occurring normally or created by herniation of the mucosal membrane thru the muscle wall
diverticulum
herniation of the mucosa due to motility disorders of the eso frequent in the upper and lower thirds
pulsion diverticulum
[types] pulsion diverticulum
zenker
killian-jamieson
epiphrenic
pulsion diverticulum - zenker
posterior, upper eso (pharyngoesophageal junction)
pulsion diverticulum - killian-jamieson
lateral, upper eso
pulsion diverticulum - killian-jamieson
lateral, upper eso
pulsion diverticulum- epiphrenic
lower eso, above diaphragm
[dx] pulsion diverticulum
Ba swallow - rounded w/ narrow neck
involves all layers of eso
from pulling off adjacent scar tissue
traction diverticulum
traction diverticulum frequently in [..]
middle third carina
[s/s] traction diverticulum
asymptomatic if small
causes obstruction, aspiration pneumonia if large (food retention)
[dx] traction diverticulum
Ba Swallow -triangle
presence of 2 or more diverticula w/o inflammation
diverticulosis
diverticulosis is frequently in the [..]
sigmoid colon 95%
[incidence] diverticulosis
adults over 40 yrs
[patho] diverticulosis
-assoc. w/ hypertrophy of muscle layer
-occur where mesenteric vessel branches pierce bowel wall
-pressure gradient b/w lumen and serosa
-sigmoid narrowest
occurs in 10-20% of pts w/ diverticulosis, exacerbated by lodged feces
diverticulitis
[s/s] diverticulitis
LLQ pain and tenderness
fever
increased WBC
[dx] diverticulitis
CT -gs
BaE
Sonography
Endovaginal Sonography
[dx] diverticulitis - CT
80-90% sensitivity, ability to detect extraluminal patho (detect other diseases that mimic diverticulitis)
-pericolonic adenopathy adjacent -thickened colonic wall seg
[dx] diverticulitis- BaE
poor extraluminal imaging
[dx] diverticulitis -sonography
high sensi and speci but dep on skill and pt habitus
[dx] diverticulitis - endovaginal sono
rule out ectopic pregnancy or PID
[cx] diverticulitis
abscesses, fistulas, obstructions, perforations
[tx] diverticulitis
antibiotics/anti-inflammatory drugs
CT/UTS guided percutaneous drainage of abscess
surgical resection
benign tumors are almost always [..]
leiomyomas (smooth muscle usually incidental findings)
[dx] benign tumors
Ba Swallow -intramural defects
CT-gs - exact location of homo st mass
[stats] malignant tumor
7% GI cancers - poor prognosis
<10% 5 yr survival rate
[dx] malignant tumors
endoscopic biopsy
CT for TNM staging
Endoscopic UTS
forms in thin, flat cells lining in esophagus
squamous cell carcinoma
[s/s] squamous cell carcinoma
chronic irritation (smoking, alcohol, reflux)
dysphagia (50-75% circum reduced)
metastatic spread to LN and mediastinal strucs
[dx] squamous cell carcinoma
mucosal destruction, ulceration, narrowing, sharp demarcation b/w normal and malignant tissue
[tx] squamous cell carcinoma
excision, chemo/rad’n
cancers that start in gland cells or bottom of eso lower portion
95%mucosal
adenocarcinoma
[s/s] adenocarcinoma
Barrett Esophagus
[dx] adenocarcinoma
plaquelike or sessile polyps, infiltrating lesions w/ irregular luminal narrowing (abrupt, asymmetric)
[localization of ulcers] gastric adenocarcinoma
lesser curvature, pyloric and antral regions
[stats] gastric adenocarcinoma
5x more in Japan
5 yr survival rate - 71% localized
<4% metastatic
[patho] gastric adenocarcinoma
alter in p53 tumor suppressor gene, cell cycle regulators, cell adhesion mole, DNA repair genes
H. pylori -3-6x increased risk
[s/s] gastric adenocarcinoma
non specific symp at early stages, diagnosed late
persistent GI pain, bleeding, vomiting, loss of appetite, wt. loss, early satiety
[dx] gastric adenocarcinoma
UGIS
upper gi endoscopy w/ biopsy
CT
gastric adenocarcinoma - UGIS
rigid peristalsis and filling defects
gastric adenocarcinoma-CT
polypoid tumors, staging
[tx] gastric adenocarcinoma
subtotal gastrectomy + gastrojejunostomy
rad’n/chemo-less effective
