Exam 1 Flashcards by Emma Hervat

Stomach protrudes into the thorax

hiatal hernia

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Types of hiatal hernia

1) axial (sliding)
2) non-axial (rolling)
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Most common type of hiatal hernia

axial (sliding) 95%

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Type of hiatal hernia with a “bell-shaped” dilation

axial (sliding)

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Type of hiatal hernia where a separate portion of the stomach protrudes and is prone to strangulation or obstruction

non-axial (rolling)

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Population most affected by hiatal hernias

> 70 years

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Hiatal hernia are commonly asymptomatic, but when symptomatic they present like…

GERD-like esophagitis
possible perforation, hemorrhage
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Esophageal metaplasia

Barrett Esophagus

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In Barrett Esophagus stratified squamous transitions into what cell type?

columnar epithelia

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Risk factors for Barrett Esophagus

caucasians (30-100x), males (4x), obesity, family hx, 40-60 years
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What % of symptomatic GERD patients have Barrett Esophagus?

10%

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An endoscopic look at Barrett Esophagus would have what appearance?

red, velvety mucosa, bands (tongues), pre-cancerous lesions

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Complications of Barrett Esophagus

1) esophageal adenocarcinoma
2) ulceration and strictures
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Types esophageal tumors

1) leiomyoma
2) adenocarcinoma
3) squamous cell carcinoma
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Type of esophageal tumor: Benign, smooth muscle tumor

leiomyoma

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Type of esophageal tumor: 50% of esophageal cancers in the US

adenocarcinoma

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Risks for esophageal adenocarcinoma

US, GERD, Barrett esophagus, Caucasians, males (7x), obesity, irradiation, tobacco
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Type of esophageal tumor: most common worldwide

squamous cell carcinoma (90%)

pg 69

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Late stage features of adenocarcinomas

obstruction, vomiting, cachexia, fatigue, weakness

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Prognosis of esophageal adenocarcinoma

poor <25% 5 year survival
(early lymphatic spread)
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Most common location of esophageal adenocarcinoma

distal 1/3 of the esophagus

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Risks for squamous cell carcinoma

> 45 years, males (4x), African American(6x), irritation, rural/underdeveloped, poverty, achalasia
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Features of squamous cell carcinoma

dysphagia, odynophagia, cachexia

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Prognosis of squamous cell carcinoma

very poor, <10% 5 year survival
(lymphatic mets)
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Most common location of squamous cell carcinoma

middle 1/3 of the esophagus | pg 73

Melena

black, "tarry" feces | pg 75

Types of gastric inflammatory diseases

1) acute gastritis 2) chronic gastritis pg 78

Common risk factors for gastric inflammatory diseases

alcohol, NSAIDs, chemotherapy, irradiation, increased age | pg 78

Type of gastric inflammatory disease with a sudden onset that is often transient

acute gastritis | pg 79

Risk associated with acute gastritis with possible erosion/ulceration

hemorrhage acute erosive hemorrhagic gastritis pg 79

Risks for acute gastritis

NSAIDs, alcohol, smoking, physical trauma, irradiation, chemotherapy pg 79

Symptoms of acute gastritis

epigastric pain, nausea, vomiting, anorexia, hematemesis, melena pg 80

Small/shallow ulceration in the stomach/duodenum

acute peptic ulceration | pg 83

Causes of acute peptic ulceration

severe physiological stress, high doses of NSAIDs, intracranial disease 83

Type of gastric inflammatory disease that is less intense but more prolonged

chronic gastritis | pg 84

Symptoms of chronic gastritis

nausea & upper abdominal discomfort | pg 84

Possible causes of chronic gastritis

helicobacter pylori, increased age, other stressors | pg 84

Chronic gastritis may lead to...

peptic ulcer disease or gastric adenocarcinoma | pg 84

What % of those with chronic gastritis have H. pylori infections?

70-90% | pg 86

Chronic gastritis leading to gastric atrophy

autoimmune gastritis | pg 86

Antibodies against parietal cells in autoimmune gastritis

pernicious anemia | pg 86

Solitary "punched-out" lesion

peptic ulcer disease | pg 87

Most common location of peptic ulcer disease

``` proximal duodenum(4x) pg 87 ```

Common locations of peptic ulcer disease

``` proximal duodenum(4x)gastric antrum pg 87 ```

What % of those with peptic ulcer disease have an H. pylori infection?

70-90% | pg 90

What % of those with an H. pylori infection have peptic ulcer disease?

5-10% | pg 90

Symptoms of peptic ulcer disease

nausea/vomiting, bloating cachexia, fatigue, epigastric pain | pg 92

What time(s) are the symptoms for peptic ulcer disease most common?

night and 1-3 hrs postprandial | pg 92

Which type of peptic ulcer disease is typically relived by eating?

duodenal | pg 93

Which type of peptic ulcer disease is typically worsened by eating?

gastric | pg 93

Most common type of gastric polyp

inflammatory and hyperplastic polyps (75%) | pg 96

Second most common type of gastric polyp

Fundic gland polyp (15%) | pg 96

Least common gastric polyp

``` gastric adenomas (10%) pg 96 ```

What % of gastric adenomas become adenocarcinomas?

30% | pg 96

90% of all stomach cancers

gastric adenocarcinomas | pg 100

Hpertrophy/narrowing of the pyloric sphincter

pyloric stenosis | pg 102

How common is pyloric stenosis?

1:~400 | pg 102

Classic symptom of pyloric stenosis

projectile vomiting | pg 102

Risks for pyloric stenosis

family hx, Caucasians, males(4x), Turner syndrome

Most common location of intestinal obstructions

small intestine | pg 106

What % of intestinal obstructions are mechanical?

80% | pg 106

Examples of mechanical obstructions

hernia, adhesions, intussusception, volvulus | pg 106

Abdominal wall defect, allows a segment of intestine to protrude

hernia | pg 106

Inflammation leading to fibrosis

adhesions | pg 106

A proximal segment telescopes into a distal segment

intussusception | pg 106

Twisting a loop of bowel

volvulus | pg 106

Congenital out pouching of the small intestine

Meckel Diverticulum | pg 112

What % of Merkel Diverticulum are symptomatic?

2% | pg 112

Lack of neurologic ganglia in rectum

Hirschsprung disease | pg 114

How is Hirschsprung disease usually dx'ed?

failure to pass meconium severe dilation of proximal bowels pg 114

Hirschsprung disease is more common in ____(males or females)

males | pg 114

Lessened blood flow to the large intestine

ischemic bowel disease | pg 117

Arteries involved in ischemic bowel disease

superior mesenteric, inferior mesenteric, celiac | pg 117

Causes of ischemic bowl disease

thrombosis, arterial, embolism, non-occlusive ischemia(heart failure, hemorrhage, shock), volvulus, dissecting aneurysm, scarring/stricture pg 118

Types of ischemic bowel disease

1) chronic 2) acute pg 119

Which type of ischemic bowel disease is the most dangerous?

acute risk for septic or hypovolemic shock, 50% mortality pg 119

Risks for ischemic bowel disease

elderly, cardiovascular disease | pg 119

Vascular lesion, submucosal & mucosal vessels are tortuous/dilated

angiodyplasia | pg 121

Most common location for angiodyplasia

cecum | pg 121

Angiodyplasia is the cause of what % of lower intestinal bleeds

20% | pg 121

Dilated hemorrhoidal venous plexus

hemorrhoids | pg 122

Most common GI vascular disorder

hemorrhoids (5% of adults) | pg 122

Risks for hemorrhoids

>50 years, increased intraabdominal pressure, liver cirrhosis pg 122

Types of hemorrhoids

1) internal 2) external pg 123

How do you distinguish a internal from external hemorrhoid?

Internal hemorrhoids are about the anorectal line, external are below pg 123

Common causes of malabsorption in the US

1) celiac disease 2) crohn disease 3) pancreatic insufficiency pg 124

Excessive fat in feces

steatorrhea | pg 125

Characteristics of steatorrhea

bulky, frothy, greasy, yellow/gray diarrhea | pg 125

Bloody diarrhea

dysentery | pg 125

Features of malabsorption

weight loss, muscle wasting, abdominal distension, borborygmus, flatulence, anorexia pg 126

Consequences of malabsorption

vitamin deficiencies, iron-deficiency anemia, osteopenia, tetany, amenorrhea, impotence, infertility, hyperkeratosis, edema, peripheral neuropathies pg 126

Immune-mediated reaction to gliadin

celiac disease | pg 127

Gluten breaks into what two components?

gliadin and glutenin | pg 127

Common population with celiac disease

Caucasians, 30-60 years | pg 128

Exam 1 Flashcards

(94 cards)