Test #3 GI and Liver path Flashcards
What causes chemical esophagitis?
-Irritants to squamous mucosa (like medications)
What causes infectious esophagitis?
- Usually immunosuppressed
- Herpes
- Candida
- Cytomegalovirus
What virus affects the entire GI tract?
-Cytomegalovirus
What virus may be associated with irritable bowel disease?
-Cytomegalovirus
What do you see with herpes simplex esophagitis?
-Small ulcers
Where is CMV most likely found in?
- Glandular epithelium
- Endothelial cells
What are the symptoms of Reflux Esophagitis?
- Burning
- Excessive salivation
- Choking
What is reflux esophagitis?
-Relaxation (or malfunction) of gastroesophageal sphincter combined with reflux of gastric acid - can reflux into sinuses or mouth
What are aggravating factors of reflux esophagitis?
- Obesity
- Pregnancy
- Alcohol/Tobacco use
- Caffeine
- Nicotine
- Many prescription drugs
What is the medical treatment of reflux esophagitis?
- Antacids
- H2 blockers
- Proton Pump inhibitors
- Lose weight
- Stop smoking/drinking
What are the complications of reflux esophagitis?
- Ulceration
- Stricture
- Barrett esophagus (frequently becomes adenocarcinoma)
What is barrett’s esophagus?
- Continual irritation and long tongues of extended columns of epithelium cells into esophagus
- Lining takes on a small intestine appearance due to chronic irritation
- Metaplasia goes to dysplasia and becomes adenocarcinoma
What does the esophageal lining take the appearance of in barrett’s esophagus?
-Small intestine
What is reactive (erosive) Gastropathy induced by?
- Alcohol
- NSAIDs
- Iron
- Stress
- Bile reflux
What is acute gastritis
-Asymptomatic to erosion and ulceration with possible significant blood loss
What can cause acute peptic ulcerations?
- Nausea
- Vomiting
- NSAIDs
- Stress
What do you see with H pylori gastritis?
- Dueodenal and pyloric ulcers
- May lead to cancer
What are types of chronic gastritis?
- H pylori gastritis
- Autoimmune gastritis
- Peptic ulcer disease
What is causative of Peptic Ulcer Disease?
- H pylori
- NSAIDs
What happens to acid in peptic ulcer disease?
-Increases
What do the ulcers look like in peptic ulcer disease?
-Punched out ulcers giving potential for perforation and hemorrhage
What can peptic ulcer disease lead to?
- Gastric ulcer
- Dysplasia
- Eventuall adenocarcinoma
What can you treat H pylori with?
-Antibiotics
Gastric polyps that are hyperplastic are a response to what?
-Gastric injury around ulcers
T/F Gastric polyps that are hyperplastic may contain some dysplasia
True
The intestinal type of gastric adenocarcinoma forms what?
-Glands
The diffuse type of gastric adenocarcinoma have what type of cell morphology?
-Signet
What usually causes intestinal obstruction?
-Mechanical such as hernia or postsurgical adhesions
What percent of intestinal obstructions are mechanical
80%
What percent of intestinal obstructions are neoplasms and infarctions?
-20%
What is Hirschprung disease?
- Congenital defect
- Lack ganglia cells to stimulate smooth muscle
- Can’t pass meconium at birth (need to remove section of colon that can’t contract)
Where do 80% of peptic ulcers frequently occur in?
-Duodenum
What are four diarrheal diseases?
- Celiac sprue
- Irritable bowel syndrome
- Infectious self limiting colitis
- Pseudomembranous colitis
What are the oral effects of celiac sprue?
- Enamel defects
- Delayed eruptions
- Recurrent aphthous ulcers
What is celiac sprue triggered by?
- Gluten
- Metabolite causes tissue damage (especially in small bowel)
What happens to the villi in celiac sprue?
-It gets blunted
T/F Celiac sprue is unique because it is not immune mediated
False
-It is immune mediated
What symptoms do you have with Irritable bowel syndrome?
- Relapsing pain
- Bloating
- Constipation
- Diarrhea
What can cause irritable bowel syndrome?
- Diet
- Abnormal motility
- Stress
What diarrheal disease has no gross microscopic abnormalities associated with it?
-Irritable bowel syndrome
What causes infectious self limiting colitis?
- E. coli
- Salmonella
What is the most common nosocomial infection in older adults?
-Pseudomembranous colitis
What usually causes pseudomembranous colitis?
-Clostridium difficile (heat resistant and hard to destroy)
Can pseudomembranous colitis spread and how?
-Yes via person to person from C diff
T/F Pseudomembranous colitis often follow antibiotic therapy
True
What do the toxins from C diff cause?
- Pseudomembranous formation
- Fluid secretions
- Ulcerations
- May cause perforation of intestinal wall
What percent of neonates are carries of C diff?
-50%
What other disease is Crohns disease similar to?
-Ulcerative colitis
Where does Crohns disease affect?
-Mainly the lower GI tract (rectum) but can also affect the upper
T/F Crohns disease can lead to cancer
True
T/F Crohns disease doesn’t have transmural lesions
False
-It does have transmural lesions
What type of inflammatory bowel disease has fistulas and peranal disease as well as granulomas?
-Crohn disease
What inflammatory bowel disease has skipped areas that are non-lesioned and has intermediate strictures?
-Crohn disease
What inflammatory bowel disease is more continuous especially in colon and has no strictures and is also found more superficial?
-Ulcerative colitis
Do hyperplastic colon polyps have malignant potential?
-No
What are the types of inflammatory bowel disease?
- Crohns disease
- Ulcerative colitis
Can a colon polyp adenoma become malignant?
-yes
What percent of cancer death in the US is a result of invasive colonic adenocarcinoma?
15%
Do you find ulcerative colitis in the upper GI tract?
No
What are some dietary factors that can lead to invasive colonic adenocarcinoma?
- Low vegetable soluble fiber
- High fat/carbohydrate diet
Malabsorption is typically due to nutrients not being absorbed by what segment of the GI tract?
-Small intestine
What can malabsorption be associated with?
-Steatorrhea (high fat content in stools)
How do you detect pernicious anemia?
-Shilling test
What does Zollinger-Ellison syndrome cause?
-Causes tumors in duodenum and ulcers
what patients does cytomegalovirus typically affect?
elderly or immunocompromised
cytomegalovirus affects the entire GI tract. how does it typically present?
multiple discrete, well-circumscribed superficial ulcers
what is reactive (erosive) gastropathy?
damage to protective epithelial layer
which type of chronic gastritis is usually genetic, does not have ulcers, and is characterized by generalized metaplasia?
autoimmune atrophic gastritis
what gets destroyed in autoimmune atrophic gastritis?
- parietal and chief cells
- destroyed by antibodies
what vitamin deficiency is commonly associated with autoimmune atrophic gastritis, and what can it lead to?
vit B12, which can lead to adenocarcinoma
what part of the GI does peptic ulcer disease affect?
lower stomach and proximal duodenum
A variety of colitis-related disorders are ___-based and cause ___
- inflammatory
- diarrhea
what are characteristics of the bowels in irritable bowel syndrome?
they are functional, without the typical structural correlates
is inflammatory bowel disease chronic or acute? is it contageous?
- chronic
- not contageous
do patients with inflammatory bowel disease have oral lesions?
some may
what are the oral manifestations of crohn’s disease are typically associated with?
typically associated with rectal changes to mucosal layers
what are some prognostic features of invasive colonic adenocarcinoma?
- depth of invasion and lymph node involvement
- the deeper the involvement, the more likely to metastasize
