DOC. ANDAL - GIT part2 Flashcards by Shiela Micah Gascon

FREQUENTLY AFFECTED BY INFECTIOUS AND INFLAMMATORY DISORDERS

SMALL INSTESTINE
COLON

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MOST COMMONLY INVOLVED IN INSTESTINAL OBSTRUCTION

SMALL INTESTINE

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4 TYPES OF INSTESTINAL OBSTRUCTION

[H-A-V-I]
1. HERNIAS
2. ADHESIONS
3.VOLVULUS
4. INTUSSUCEPTION

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CC: ABDOMINAL PAIN NOT RELIEVED BY ANY MEDICATION

INSTESTINAL OBSTRUCTION

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INSTESTINAL OBSTRUCTION PRESENTATION

[A-A-V-C]
1. ABD. PAIN
2. ABD. DISTENTION
3. VOMITING
4. CONSTIPATION

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WEAKNES OR DEFECT IN ABD. WALL
PROTRUSION OF SEROSA-LINED POUCH

HERNIAS

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MC FREQUENT CAUSE OF INSTESTINAL OBSTRUCTION WORLWIDE
SMALL BOWEL TYPICALLY INVOLVED

HERNIAS

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TYPE OF HERNIA THAT TYPICALLY OCCUR ANTERIORLY

ACQUIRED HERNIAS

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MOST OFTEN ACQUIRED TO BE CONGENITAL IN MOST CASES
FROMSURGICAL PROCEDURES (ENDOMETRIOSIS)

ADHESIONS

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TWISTING OF BOWEL LOOPS
RESULT IN LUMINAL AND VASCULAR COMPROMISE
MC IN SIGMOID COLON

VOLVULUS

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MC CAUSE OF INTESTINAL OBSTRUCTION IN CHILDREN YOUNGER THAN 2YEARS OLD
OTHER CAUSE: VIRAL INFXN, ROTAVIRUSVACCINE
RARE IN CHILDREN AND ADULT
“TELESCOPING”

INTUSSUSCEPTION

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+ COMPLICATION OF INFERIOR MESENTERIC ARTERY
DISTAL COLON MIGHT DIE

ISCHEMIC BOWEL DISEASE

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NO DEPER THAN MUSCULARIS MUCOSAE

MUCOSAL INFARCTION

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INVOLVE MUCOSA AND SUBMUCOSA

MURAL INFARCTION

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INVOLVES ALL 3 LAYERS
TYPICAL CAUSE: ACUTE VASCULAR OBSTRUCTION

TRANSMURAL INFARCTION

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ONSET OF VASCULAR COMPROMISE
MIN. DAMAGE TO EPITHELIAL CELLS LININGIN THE INTESTINE

HYPOXIC INJURY

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INITIATED BY RESTORATION OF BLOOD SUPPLY
LEAKAGE OF GUT LUMEN
NORMAL OR HYPERPROLIFERATIVE CRYPTS

REPERFUSION INJURY
INSCHEMIC INTESTINAL DISEASE

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SEGMENTAL AND PATCHY
HEMORRHAGIC AND ULCERATED MUCOSA AND MUSCULARIS PROPRIA
THICKENED BOWEL WALL
CONGESTED AND DUSKY TO PURPLE RED

ISCHEMIC BOWEL DISEASE

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S/S:
SUDDEN ONSET ODF CRAMPING
LEFT LOWER ABD. PAIN
DESIRE TO DEFECATE
BLOODY DIARRHEA

ISCHEMIC BOWEL DISEASE

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MORTALITY IS DOUBLED IN PATIENTS WITH RIGHT-SIDED COLONIC DISEASE

ISCHEMIC BOWEL DISEASE

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ACUTE RADIATION ENTERITIS
MANIFEST AS: ANOREXIA, ABD. CRAMPS & MALABSORPTIVE DIARRHEA
+RADIATION FIBROBLAST

RADIATION ENTEROCOLITIS

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ACUTE DISORDER OF SI AND LI RESULT TO TRANSMURAL NECROSIS
MC GI EMERGENCY IN NEONATES
PRESENT WHEN ORAL FEEDING

NECROTIZING ENTEROCOLITIS

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MALFORMED SUBMUCOSALAND MUCOSAL BLOOD VESSELS
MC LOCATION : CECUM AND RIGHT COLON

ANGIODYSPLASIA

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ECTATIC NEST OF TORTOUS VEINS, VENULES AND CAPILLARIES

ANGIODYSPLASIA

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PRESENTS MC AS CHRONIC DIARRHEA

MALABSORPTION

HALLMARKOF MALABSORPTION

STEATORRHEA

4 PHASES OF NUTRIENT ABSORPTION

1. INTRALUMINAL DIGESTION 2. TERMINAL DIGESTION 3. TRANSEPITHELIAL TRANSPORT 4. LYMPHATIC TRANSPORT OF ABSORBED LIPIDS

INCREASE IN STOOL MAS, FREQUENCY OR FLUIDITY GREATER THAN 200g PER DAY

DIARRHEA

ABSENCE OF EPITHELIAL CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULATOR (CFTR) DEFECT IN CHLORIDE AND BICARBONATE ION SECRETION

CYSTIC FIBROSIS

AKA CELIAC SPRUE OR GLUTEN SENSITIVE ENTEROPATHY TRIGGERED BY INGESTION OF GLUTEN CONTAINING FOODS (WHEAT, RYE OR BARLEY)

CELIAC DISEASE

INCREASED # OF INTRAEPITHELIAL CD8+ T LYMPHOCYTES, CRYPT HYPERPLASIA AND VILLOUS ATROPHY

CELIAC DISEASE

+ SEROLOGY AND VILLOUS ATROPHY WITHOUT SYMPTOMS

SILENT CELIAC DISEASE

+ SEROLOGY - VILOUS ATROPHY

LATENT CELIAC DISEASE

BETWEEN 6 & 24 MONTHS INTRODUCTION OF GLUTEN

PEDIATRIC CELIAC DISEASE

NON INVASIVE SEROLOGIC TEST FOR CELIAC DISEASE

1. IgA ANTIBODIES AGAINTS TRANSGLUTAMINASE (MOST SENSITIVE) 2. IgA ANTI-ENDOMYSIAL ANTIBODIES 3. ABSENCE OF HLA-DQ2 & HLA-DQ8

MC CELIAC DISEASE-ASSOCIATED CANCER

ENTEROPATHY ASOCIATED T-CELL LYMPHOMA

AKA TROPICAL ENTEROPATHY AKA TROPICAL SPRUE POPULATIONS WITH POOR SANITATION AND HYGIENE

ENVIRNMENTAL ENTEROPATHY

UNKNOWN CAUSE DEFECTIVE INTESTINAL BARRIER, CHRONIC EXPOSURE TO FECAL PATHOGENS REPEATED BOUTS OF DIARRHEA 1ST 2 OR 3 YEARS OF LIFE

ENVIRONMENTAL ENTEROPATHY

X LINKED DIOSRDER SEVERE PERSISTENT DIARHEA AUTOIMMUNE DISEASE IN YOUNG CHILDREN

AUTOIMUNE ENTEROPATHY

GERMLINE LOSS OF FUNCTION MUTATION IN THE FOXP3 GENE AND IPEX (IMMUNE DYSREGULATION, POLYENDOCRINOPATHY, ENTEROPATHY, & X LINKAGE)

AUTOIMUNE ENTEROPATHY

IMUNOSUPPRESSIVE DRUGS IN AUTOIMUNE ENTEROPATHY

CYCLOSPORINE

MUTATION IN GENE ENCODING LACTASE RARE AR DISORDER EXPLOSIVE DIARHEA WITH WATERY,FROTHY STOOLS & ABD. DISTENTION UPON MILK INGESTION

CONGENITAL LACTASE DEFIECIENCY

DOWNREGULATION OF LACTASE GENE EXPRESSION ABD. FULLNESS & DIARRHEA, + FLATULENCE

ACQUIRED LACTASE DEFICIENCY

MYO5B GENE AKA DAVIDSON DISEASE AR DISORDER OF VEHICULAR TRANSPORT THAT LEADS TO DEFIECIENT BRUSH BORDER ASSEMBLY

MICROVILLUS INCLUSION DISEASE

COMMA SHAPED GRAM - BACTERIA RAPIDLY GROW AT WARM TEMP SHELLFISH, MUSSELS, CONTAMINATED WATER

CHOLERA VIBRIO CHOLERA

VIRULENT FACTORS OF CHOLERA

1.FLAGELLAR PROTEINS 2. HEMAGGLUTININ

ASYMPTOMATIC RICE WATER WITH FISH ODOR

CHOLERA

TRAVELER’S DIARRHEA INGESTION IMPROPERLY COOKED CHICKEN, UNPASTEURIZED MILK OR CONTAMINATED WATER -FOOD POISONING

CAMPYLOBACTER ENTEROCOLITIS

PATHOGENESIS OF C. ENTEROCOLITIS

[M-A-T-I] MOTILITY ADHERENCE TOXIN INVASION

CAN RESULT IN REACTIE ARTHRITIS IN HLA-B27PATIENTS 40% GUILLAIN-BARRE SYNDROME

CAMPYLOBACTER ENTEROCOLITIS

GRAM - BACTERIA UNENCAPSULATED - ENTEROBAC FAMILY FECAL ORAL ROUTE AFFECT CHILDREN IN DAYCARE

SHIGELLOSIS

RESISTANT TO HARSH ACIDIC ENVIRONMENT OF STOMACH S. DYSENTERIAE SEROTYPE 1 RELEASE:

SHIGATOXIN STX

MOST PROMINENT ON LEFT COLON ILEUM CAN BE INVOLVED MUCOSA - HEMORHAGIC ULCERATED AND PSEUDOMEMBRANES TROPISM FOR M CELLS

SHIGELLOSIS

INITIAL WATERY DIARRHEA PROGRES TO DYSENTERIC PHASE

SHIGELLOSIS

TRIAD OF: 1. REACTIVE ARTHRITIS 2. URETHRITIS 3. CONJUNCTIVITIS - HEMOLYTIC UREMIC SYNDROME (HUS) - ENTEROHEMORRHAGIC E.COLI (EHEC)

SHIGELLOSIS

PEAK INCIDENCE IN SUMMER CAUSEFOOD POSIONING INGESTION OF CONTAMINATED FOOD, RAW AND UNDERCOOKED MEAT, POULTRY, EGGS AND MILK

SALMONELLA

POSSES VIRULENCE GENES ENCODE TYPE 3 SECRETION TRANSFER BACTERIAL PROTEINS INTOM CELLS AND ENTEROCYTES

SALMONELLA

LOOSE STOLS TO CHOLERA LIKE PROFUSE DIARHEA TO DYSENTERY ORGANISMS SHED IN THE STOOL SELFLIMITED RISK FX - MALIGNANCIES, IMUNOSUPPRESSION, ALCOHOLISM, CARDIOVASCULAR DYSFUNCTION

SALMONELLA

ENTERIC FEVER SALMONELLA ENTERICA HUMANS ARE THE SOLE RESERVOIR GALLBLADDER COLONIZATION

TYPHOID FEVER

ENLARGEMENT OF PEYER PATCHES IN THE TERMINAL ILEUM PLATEAU LIKE ELEVATIONS UP TO 8CM INDIAMETER

TYPHOID FEVER

ROSE SPOTS IN CHEST AND ABDOMEN

TYPHOID FEVER

INGESTION OF PORK, RAW MILK ANDCONTAMINATED WATER USES ADHESINS TO BIND TO HOST B1 INTEGRINS TO INVADE M CELLS MC IN ILEUM, APPENDIC & RIGHT COLON APTHOUS LIKE EROSIONS MIMIC ACUTE APPENDICITIS

YERSINIA

GRAM - BACILI COLONIZING THE GI TRACT

ESCHERICHIA COLI

TRAVELLERS DIARHEA HEAT LABILE TOXIN HEAT STABLE TOXIN

ETEC

ACTIVATE ADENYLATE CYCLASE = INCREASED cAMP

LT TOXIN

BIND TO GUANYLATE CYCLASE = INCREASED cGMP

ST TOXIN

ENDEMIC DIARHEA OUTBREAKS IN <2 Y/O ATTACHING AND EFFACING LESIONS

EPEC

E. COLI 0157:H7 & NON-O157:H7 INADEQUATELY COKED GROUND BEEF PROD. SHIGA LIKE TOXIN

EHEC

SIMILAR TO SHIGELLA YOUNG CHILDREN & DEVELOPING COUNTIRES

EIEC

UNIQUE PATTER ADHERANCE FIMBRAIE NON BLOODY DIARRHEA - INDIVIDUALS WITH AIDS

EAEC

AGENT: C. DIFFICILE ABX-ASSOCIATED COLITIS

PSEUDOMEMBRANOUS COLITIS

FORMATION OF PSEUDOMEMBRANES SUPERFICIAL DAMAGED CRYPTS

PSEUDOMEMBRANOUS COLITIS

TX FOR PSEUDOMEMBRANOUS COLITIS

METRONIDAZOLE VANCOMYCIN

RARE, MULTIVISCERAL CHRONIC DIASEASE G+ ACTINOMYCETE (TROPHERYMA WHIPPELI) MALABSORPTIVE DIARHEA

WHIPPLE DISEASE

HALLMARK: FOAMY MACROPHAGES IN SI AT LAMINAPROPRIA

WHIPLE DISEASE

sSRNA GENOME MC IN ALL POPULATION

NOROVIRUS

MC IN PEDIATRIC PATIENTS

ROTAVIRUS

dSRNA GENOME MC PEDIATRIC DIARHEA

ADENOVIRUS

Ascaris lumbricoides

GIANT ROUNDWORM

Strongyloides stercoralis

LARVAE PERIPHERAL EOSINOPHILIA

Necator duodenale and Ancylostoma duodenale

HOOKWORMS

Enterobius vermicularis

PINWORM D-SHAPED EGGS

Trichuris trichiura

WHIPWORM

Schistosomiasis

SNAIL BLADDER

Intestinal Cestodes

TAPEWORM CAUSE: TAENIASIS

Entamoeba histolytica

AMEABIASIS FLASK-SHAPED ULCER

Giardia lamblia

GIARDASIS LAMBLIASIS PEAR-SHAPED OLD MANS FACE DECREASE IN LACTASE

Cryptosporidium

SPOROZOITES CHRONICDIARHEA

CHRONIC, RELAPSING ABDOMINAL PAIN MICROSCOPIC - NORMAL

IRITABLE BOWEL SYNDROME

ABDOMINAL DISCOMFORT OR PAIN AT LEAST 3 DAYS/ MONTHS OVER 3 MONTHS POORLY DEFINED

IRRITABLE BOWEL SYNDROME

2 PROTOTYPES CROHNS DISEASE OR ULCERATIVE COLITIS

INFLAMMATORY BOWEL DISEASE

ILEUM +/- COLON SKIP LESIONS + STRICTURE THICK WALL TRANSMURAL INFLAMMATION MODERATE PSEUDOPOLYPS DEEP KNIFE LIKE ULCERS

CROHNS DISEASE

COLON ONLY DIFUSE RARE STRICTURE NORMAL WALL MUCOSA INFLAMMATION MARKED PSEUDOPOLYPS SUPERFICIAL, BROAD BASED ULCERS

ULCERATIVE COLITIS

NOD2 POLYMORPHISM ATG16L1 10X IN:

CROHNS DISEASE

COBBLESTONE APPEARANCE

CROHNS DISEASE

NON CASEATING GRONULOMA SERPENTINE ULCER NORMAL & ABNORMAL MUCOSA (SKIPING)

CROHNS DISEASE

NO SKIPPING LESIONS COLON AND RECTUM

ULCERATIVE COLITIS

OUTPOUCHING MUCOSA AND SUBMUCOSA MC IN SIGMOID CIRCULARIS LAYER HYPERTROPHY

SIGMOID DIVERTICULA

PATHOLOGIC AND CLNICAL OVERLAP OF CC & UC 75% WITH PANCA

INTERMEDIATE COLITIS

MC CANCER IN THE WORLD 2ND MC CAUSE OF CANCER DEATH

COLON CA

MORE RISK OF DEVELOPING COLON CA

ULCERATIVE COLITIS

NEOPLASTIC ADENOMAS RED MEAT, SATUIRATED FAT, REFINED CARBS, ALCOHOL

COLORECTAL POLYPS

o Familial adenomatous polyposis (FAP) o Hereditary nonpolyposis colon cancer (HNPCC)

FAMILIAL CANCER (HEREDITARY COLORECTAL CANCER) - HCC

MUTATION OF APC

FAMILIAL ADENOMATOUS POLYPOSIS

MC THAN FAP MUTATION OF THE MISMATCH REPAIR GENE

HEREDITARY NON-POLYPOSUS COLORECTAL CANCER (HNPCC) AKA. LYNCH SYNDROME

LYNCH SYNDROME OR HNPCC CRITERIA

1. 1ST DEGREE RELATIVE 2. 2 SUCCESIVE GENERATIONS 3. 3 RELATIVED WITH HNPCC 4. FAP 5. DX BEFORE AGE 50 6. PATHO EXAMINATION

APCG MUTATION KRAS P53 MIN PATHWAYS (BETTER PROGNOSIS)

GASTRIC ADENOCARCINOMA

SIGNS OF METSADENOCARCINOMA

CACHEXIA (LOSS OF WT.) LOSS OF APETITE HEPATOMEGALY BONE PAIN

MC IN ADENOCARCINOMA

RECTUM ( 38%)

TEST FOR ADENOCARCINOMA

FOB -GUAIAC TEST (HEMATOCRIT) - 50% SENSITIVITY IMMUNOLOGICAL TEST STOOL DNA DOUBLE CONTRAST BRAIUM ENEMA - 82.9 SENSITIVITY COLONOSCOPY/SIGMOIDOSCOPY - 5mm CT COLONOGRAPHY - 92 % SENSITIVITY

BLOOD TEST TUMOR MARKER ADENOCARCINOMA

CEA

ADENOCARCINOMA

+METS = STAGE 4 ADJUVANT CHEMOTHERAPY = BEFORE OPERATION