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Patho > Week 11: GI, Liver & Pancreas > Flashcards

Week 11: GI, Liver & Pancreas Flashcards

1
Q

Define dysphagia

A

difficulty swallowing

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2
Q

Causes of dysphagia (4)

A
  • Disorders that produce a narrowing of the esophagus
  • obstructions d/t tumors inside or outside the esophagus
  • Lack of salivary secretion
  • Impaired esophageal motility
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3
Q

External causes of dysphagia (5)

A

compression of the esophagus by:

  1. enlargement of the L atrium of the heart
  2. aortic aneurysm
  3. abnormally formed blood vessels
  4. abnormal thyroid gland
  5. bony outgrowth from spine or cancer
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4
Q

Define esophagitis

A

inflammation of esophagus

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5
Q

Causes of esophagitis (3)

A
  • Eosinophilic
  • Infection - candida albicans, herpes simplex virus, CMV
  • Erosive: chronic acid reflux
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6
Q

Define Barrett’s esophagus, what does it usually lead to

A

intestinal metaplasia in the esophagus

typically leads to adenocarcinomas

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7
Q

Define hiatal hernia

S/S related to hiatal hernia (5), causes (4)

A

protrusion or herniation on the upper part of the stomach into the thorax through a tear or weakness in the diaphragm
S/S: chest pain, SOB, heart palpitations, discomfort swallowing food, acid reflux/heartburn
Causes: obesity, constipation, smoking, pregnancy

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8
Q

Define GERD

S/S related to GERD (2), causes (6)

A

backflow of gastric or duodenal contents or both into the esophagus past the LES
S/S: acute epigastric pain, heartburn
Causes: food/alcohol/cigarettes, hiatal hernia, increased abdominal pressure, medications, NG intubation, weak LES

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9
Q

How does smoking increase the risk of developing GERD? How does obesity?

A

Smoking: relaxes the LES
Obesity: increased abdominal pressure

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10
Q

Define gastritis, causes (5), s/s (5)

A

inflammation of the stomach
Causes: infection, stress, injury, drugs, immune disorders
S/S: abdominal pain, indigestion, bloating, N/V, pernicious anemia

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11
Q

Identify: exposure (2); infection; and genetic disorder (2) related to gastritis.

A

Exposure: gastric banding surgery, trauma
Infection: H.pylori
Genetic disorder: Type I diabetes, Hashimoto’s

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12
Q

Define gastroenteritis; identify two causative agents; and explain the role of inflammation in this process. What are indicators of inflammation; and what are typical clinical consequences of gastroenteritis?

A

inflammation of the GI tract, mostly within small intestine, also of the stomach
Causative agents: bacterial or viral infections - rotavirus, e. coli and campylobacter jejuni
Indicators of inflammation: evidence of blood in the stool
Clinical consequences: dehydration

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13
Q

Define irritable bowel syndrome

A

non-inflammatory type disorder, also known as spastic colon or spastic colitis, disorder of entire digestive tract causes recurring abdominal pain and constipation or diarrhea

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14
Q

Underlying cause of IBS
Prevalence
Triggers
Benign or Malignant?

A

unknown, may involve motor disturbances and reaction to distension irritants or stress
Prevalence: common, twice as common in women as men
Triggers: A variety of substances and emotional factors
Benign - no anatomic abnormality

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15
Q

Define inflammatory bowel disease

Patho

A

general term for chronic inflammation of the GI tract

Patho: chronic inflammation results in neutrophil infiltration, ulceration, development of fibrosis

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16
Q

Causes of inflammatory bowel disease
Sx (3)
Tx (1)

A

unknown, associated with genetic, infectious, immunological or psychological factors
Sx: bloody diarrhea, abdominal pain, weight loss (due to malabsorption)
Tx: termination of inflammatory response/promotion of healing

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17
Q

Define Crohn’s disease, what layers are affected?

What is a complication that can occur?

A

regional enteritis or granulomatous colitis, chronic inflammatory process that can affect any part of the GI tract

affected layers: affects all layers

Complication: fistula or abscess formation and intestinal obstruction

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18
Q

What disease process are skip lesions and cobblestone associated with?
Define each

A

Crohn’s
Skip lesions: demarcated granulomatous lesions that are surrounded by normal-appearing mucosal tissue

Cobblestone: fissures and crevices cause a cobblestone appearance to the surface of the mucosal layer

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19
Q

Define Ulcerative Colitis, what layers are affected?

What is a complication that can occur (3)?

A

inflammatory disease of the colon and rectum, produces edema and ulcerations

affected layers: usually affects mucosa only

Complications: perforation of the colon, fatal peritonitis and toxemia, increased r/f colon cancer

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20
Q

Characteristics of ulcerative colitis

A
  • Inflammation is consistent and confluent across the surface
  • May see small, focal crypt abscesses that become necrotic and ulcerate
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21
Q

Causes, Sx, Tx of Ulcerative colitis

A

Causes: unknown, may be r/t abnormal immune response in colon
Sx: constant diarrhea mixed with blood
Tx: reduce acute manifestations, prevent recurrence, avoid irritants

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22
Q

Define nausea vs. vomiting

A

Nausea: urge to vomit that may occur independently of vomiting or may precede or accompany it

Vomiting: forceful expulsion of gastric contents, increases intra-abdominal pressure along with relaxation of LES causes return of stomach contents to the esophagus and mouth

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23
Q

Define anorexia

A

loss of appetite or lack of desire for food
Nausea, abdominal pain and diarrhea may accompany it
May result from dysfunction of GI system or other cause

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24
Q

Distinguish between: osmotic and secretory diarrhea and identify one cause of each

A

Osmotic: Hyperosmotic luminal contents whereby a nonabsorbable substance in GI tract shifts the osmotic balance so that water is drawn into the GI tract - lactose intolerance

Secretory diarrhea: secretory processes increased - Zollinger-Ellison syndrome

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25
Q

Define constipation and explain how: dehydration, lack of exercise, medications can cause constipation.

A

define: infrequent, incomplete or difficult passage of stools

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26
Q

Define normal-transit vs. slow-transit constipation

A

Normal-transit: perceived difficulty in defecation, usually responds to increased fluid and fiber intake

Slow-transit: characterized by infrequent bowel movements and is often associated with alterations in intestinal innervation

27
Q

What typically causes disorders of defecation?

A

Causes: dysfunction of the pelvic floor or anal sphincter

28
Q

Define intestinal obstruction and explain/give an example of mechanical (1) and non-mechanical obstructions (3).

A

Intestinal obstruction: partial or complete blockage of the lumen of the small or large bowel

Mechanical: foreign bodies such as fruit pits, gallstones or worms

Non-mechanical: paralytic ileus, electrolyte imbalances, toxicity

29
Q

What is the connection between adhesions; strangulation; and tumors and intestinal obstruction?

A

○ Adhesions and strangulated hernias usually cause small bowel obstructions

Tumors: carcinomas usually cause large bowel obstructions

30
Q

How can obstruction result in shock?

A

can occur if obstruction is untreated

31
Q

Define diverticulosis and identify two causes.

A

inflammation of diverticular or herniation within the wall of the intestinal tract, accompanied by an inflammatory response usually in sigmoid colon

Causes: - intraluminal pressure: chronic constipation, obesity
- Inflammation: bacterial infection and undigested food

32
Q

Define peritonitis and explain GI causes (5) and GU causes.

A

inflammatory response of the serous membrane lining the abdominal cavity and covering internal visceral organs

GI causes: perforated peptic ulcer, ruptured appendix, perforated diverticulum, gangrenous bowel or gallbladder

GU causes: PID

33
Q

Define malabsorption syndrome

A

alteration of ability of intestine to absorb nutrients

34
Q

How are each of the following related to malabsorption: cystic fibrosis; celiac disease; inflammatory bowel disease

A

CF: thick mucus surrounding organs can lead to poor absorption

Celiac disease: immune-mediated disorder triggered by ingestion of gluten-containing grains

Inflammatory bowel disease: inflamed mucosa more difficult to properly absorb nutrients

35
Q

How can malabsorption cause anemia; steatorrhea; and edema?

A

anemia: decreased B12, iron, folic acid), steatorrhea: decreased fat absorption
edema: decreased protein absorption

36
Q

Definition/causes/sx of Upper GI bleed
Definition/sx of Lower GI bleed
Definition: occult bleeding

A

Upper GI bleed: esophagus, stomach, duodenum
Causes: bleeding varices, PUD, esophageal tea
Sx: hematemesis, melena (dark, tarry stools)

Lower GI bleed: jejunum, ileum, colon or rectum
Sx: hematochezia (frank bleeding from rectum)

Occult bleeding: usually slow chronic blood loss

37
Q

Define jaundice and explain the differences between pre-hepatic; hepatic; and post-hepatic jaundice and give one example of each type of jaundice.

A

Jaundice: yellow or greenish pigmentation of the skin, sclerae and mucous membranes caused by hyperbilirubinemia

Pre-hepatic: may be caused by genetic diseases including sickle cell anemia, thalassemia, glucose-6-phosphate dehydrogenase deficiency, hemolytic uremic syndrome

Hepatic: dysfunction of the liver’s ability to process bilirubin for elimination; commonly caused by hepatitis or cirrhosis

Post-hepatic: problems related to passage of bile through bile ducts that results in obstructive jaundice; commonly caused by gallstones or pancreatitis/pancreatic cancer

38
Q

How does neonatal jaundice occur?

A

Neonatal jaundice caused by impaired uptake/conjugation of bilirubin as enzymes not present at birth

39
Q

What is the normal role of the liver in biotransformation; what generally happens in phase I and phase II reactions?

A

Biotransformation: detoxification of drugs or alcohol, reactions that convert lipid-soluble or nonpolar molecules into water-soluble or polar substances to facilitation excretion and elimination from the body

Phase I: chemical modifications - cytochrome P450 system

Phase II: conjugation with glutathione

40
Q

Define hepatitis, causes (4)

A

Hepatitis: inflammation of the liver

Causes: infection, alcohol abuse, drug intoxication, autoimmune processes

41
Q

What is the most common cause of drug-induced liver damage?

A

Acetaminophen

42
Q

What is nonalcoholic fatty liver disease?

What are underlying conditions associated with NAFLD (4); and a common mechanism that underpins these conditions?

A

Nonalcoholic fatty liver disease: fatty liver disease that has the potential to progress to cirrhosis and ESLD arising from causes other than alcohol abuse

Associated underlying conditions: Type 2 diabetes, obesity, metabolic syndrome, hyperlipidemia

Common mechanism: unknown, appear at least in part related to insulin resistance

43
Q

What are the liver function tests that can be done and what do they indicate?

A

ALT, AST indicate liver cell injury or death

44
Q

Define liver failure and hepatorenal syndrome and discuss how this occurs in the terminal stages of liver failure?

A

Liver failure: results when 80-90% of liver function is lost

Hepatorenal syndrome: terminal stages of liver failure with ascites, includes azotemia, increased creatinine and oliguria

45
Q

Define cholelithiasis

A

formation of gallstones that obstruct a bile duct

46
Q

Explain how gallstones are formed; what precipitates from the bile to form gallstones?

A

Gallstone formation: caused by precipitation of bile components including cholesterol and bilirubin, crystals form into gallstones

Usually cholesterol, calcium salt of bilirubin or calcium carbonate precipitate from bile

47
Q

What is cholecystitis and the relationship to obstruction and infection.

A

Cholecystitis: inflammation of the gallbladder

Obstruction: causes accumulation of bile in the gallbladder and increased pressure

48
Q

How can perforation of the gallbladder result in fever, shock, and jaundice?

A

Causes systemic inflammatory response

49
Q

Define/distinguish: acute and chronic pancreatitis.

A

Acute: reversible inflammatory process of pancreatic acini brought on by premature activation of pancreatic enzymes

Chronic: progressive and permanent destruction of the exocrine pancreas, fibrosis and later stages destruction of the endocrine pancreas

50
Q

What are major causes of acute pancreatitis (2) and how can this be life-threatening?

A

Causes: alcohol abuse and cholelithiasis

obstruction that limits drainage of pancreatic fluid, damages multiple body systems

51
Q

Fx of pancreatitis on GI system (2)

A

GI: inflammation causes premature activation of enzymes, fluid losses can lead to hypovolemic shock

52
Q

What are underlying causes (2) of chronic pancreatitis and how can this cause type 1 diabetes?

A

Causes - chronic alcohol abuse, cholelithiasis

Progressive loss of pancreas parenchyma leads to pathology including Type 1 diabetes

53
Q

Where does oral cancer occur and what are risk factors?

A

Oral cancer: lips, pharynx, tongue, soft palate, uvula

Risk factors: tobacco/alcohol use

54
Q

Why is the liver a common site of secondary tumors?

A

common site of secondary tumors as liver is responsible for blood filtration to other organs

55
Q

Define benign vs. malignant liver tumors

A

Benign: liver cell adenoma, bile duct adenoma

Malignant: arise from hepatocytes (hepatocellular carcinoma or hepatoma) or bile duct epithelium (cholangiocarcinoma)

56
Q

Complications of esophageal cancer (3) and what are risk factors (3)

A

causes dysphagia, obstruction, usually in lower two-thirds of esophagus; causes pulmonary complications
Risk factors: tobacco use, alcohol use, diet

57
Q

Characteristics of stomach cancer (2) and what are symptoms (4)?

A

gastric changes, adenocarcinoma

sx: weakness, weight loss, loss of appetite, gastric pain

58
Q

Characteristics of intestinal cancer, risk factors, sx?

A

adenocarcinomas, usually in large intestine
risk factors: diet, other diseases
Sx: rectal bleeding

59
Q

Gallbladder cancer: Ranking in GI cancers, prognosis, sx?

A

5th most common GI cancer, poor prognosis 1% 5 year survival rate
sx: cholecystitis

60
Q

Pancreatic cancer:
Ranking in causes of death from cancer
Prognosis
Are benign or malignant more common? Which is more life-threatening?

A

pancreatic cancer is the 4th leading cause of death from cancer in the US, 90% die within 1st year of diagnosis, 4-5% 5-year survival rate

Malignant more common and more life-threatening

61
Q

Fx of pancreatitis on cardiovascular system (2)

A

CV: trypsin activates kallidrein, causing vasodilation and increased vascular permeability

62
Q

Fx of pancreatitis on clotting (2)

A

Clotting: pancreatic inflammation interferes with vitamin K absorption, resulting in reduced clotting factors; DIC may result

63
Q

Fx of pancreatitis on immune system (1)

A

Immunity: infection of pancreas may occur and purulent drainage can erode the retroperitoneum into bowel and pleural space and promote sepsis

64
Q

Fx of pancreatitis on respiratory system (2)

A

Respiratory: severe pain can interfere with breathing, resulting in PNA; pancreatic enzymes can enter circulation and damage pulmonary vessels, resulting in pleural effusion

Patho (14 decks)

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