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Exam 1 Flashcards

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1
Q

Where the gastroesophageal junction together with teh stomach move above the diaphragm

A

Sliding hernia

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2
Q

Alpha cells pancreas

A

Secrete glucagon which increases glucose in the blood

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3
Q

When a peptic ulcer develops close to the pylorus, it may becomes stenotic due to development of ___ causing the pylorus to undergo ____

A

Fibrous tissue
Shrinkage and deformity

Pyloric stenosis

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4
Q

Differential diagnosis hiatal hernia

A

Ischemic heart disease (chest pain)
GERD (heartburn)
Lung diseases (shortness of breath)

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5
Q

Usually GERD happens because

A

The LES opens at the wrong time or does not close properly

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6
Q

In the stomach there is also absorption of

A

Alcohol
Medications
Water

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7
Q

The small intestine wall also contains 2 layers of smooth muscles, rhythmical contractions of which

A

Move products of digestion through the intestine (peristalsis)

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8
Q

When the symptoms of benign tumors are present, their severity and clinical outcomes depend on

A

The tumor size
Location
Complications (bleeding, ulceration)

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9
Q

Signs and symptoms of GERD

A 
Heartburn
Regurgitation
Dysphagia
Increased salivation
Nausea
Chest pain (radiating to arms and neck)
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10
Q

When a neoplasma has extended below the submucosa into the muscular wall

A

Advanced gastric carcinoma

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11
Q

The head of the pancreas lies

A

In the C loop of duodenum

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12
Q

Early clinical manifestations of malignant tumors

A

Heartburn
Loss of appetite, especially for meat
Abdominal discomfort or irritability
Darkness of the skin, frequently locating in axilla and groin
Tripe palms
Sudden eruption of multiple seborrheic keratosis

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13
Q

Adenocarcinoma has direct correlation with

A

GERD
Barrett esophagus
Scleroderma
Zollinger-Ellison syndrome

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14
Q

The first of the 3 parts of the small intestine and is directly attached to the pylorus of the stomach

A

Duodenum

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15
Q

Signs and symptoms of chronic gastritis depend on

A

The form

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16
Q

Treatment malignant tumors esophagus

A

Surgery
Chemotherapy
Radiotherapy

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17
Q

5-10% of upper gastrointestinal bleeding episodes

A

Mallory-weiss syndrome

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18
Q

Starving pain 6-7 hours after meal is characteristic for

A

Duodenal peptic ulcer

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19
Q

Neutralization of acidic gastric content due to function of

A

Brunner’s glands

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20
Q

Saliva contains

A 
98% water
Mucus
Salivary amylase
Electrolytes
Proteins
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21
Q

Other stomach benign tumors

A

Cystic

Inflammatory pseudotumors

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22
Q

Etiology of barrett esophagus

A

GERD
Central obesity
Smoking - most common

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23
Q

Bilirubin + albumin =

A

Unconjugated (indirect, non-H2O soluble) - blood - liver - albumin and bilirubin+glucuronic acid = conjugated direct H2O soluble - to gallbladder

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24
Q

Acquired pyloric stenosis

A

Scarring of stomach peptic ulcer or duodenal bulb

Tumors (stomach, pancreatic, etc)

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25
Behind the sternum, with radiation to neck or arms can be extremely painful, gest worse after eating
Chest pain with achalasia
26
Pain in midback on the level of T5-7 around right scapula sometimes mimics gallbladder disease
Postbulbar area peptic ulcer
27
Benign tumors of the stomach
Epithelial Mesenchymal Other
28
Esophagus ends at
Cardia of the stomach - T11
29
The stomach consists of four major regions
``` Stomach Fundus Cardia Stomach body Pylorus ```
30
Signs and symptoms of perforation complication of peptic ulcer
Stabbing upper abdominal pain 10/10 Extreme tenderness of the abdomen Pain by radiate to the right shoulder and back Sudden weakness, dizziness, breathes shallowly Chills, tachycardia
31
GI tract
Food - G-cells - gastrin - HCl - pepsinogen (non-active enzyme) - pepsin (active enzyme) - digestion of proteins
32
There is absorption of glucose, water, some medications
Oral cavity
33
The prognosis of malignant tumors of esophagus is generally
Poor
34
Indigestion is characterized by
Severe pain or bruning feeling in the right upper abdomen | May be also accompanied by nausea, abdominal bloating, belching, vomiting
35
This route is generally typical for carcniomas
Lymphatic system
36
Risk factors benign tumors
Chronic h. Pylori infection of the stomach Autoimmune gastritis Radiation gastritis Genetic abnormalities Long term medication use antacids - proton pump inhibitors (PPIs)
37
Has only parasympathetic fibers and provides secretor innervation to the mucosa nearest the lumen of the gut - production of normal mucoas
Meissner’s plexus
38
Is an exophytic (projectile) tumor
Intestinal-type adenocarcinoma
39
Signs and symptoms chronic gastritis all forms
Cramping Nausea, vomiting Weakness Intolerance of spicy food
40
The ascending part of duodenum runs
Cranially along the left side of the vertebral column
41
Complications peptic ulcer
``` Bleeding or hemorrhages Perforation Penetration Pyloric stenosis Malignancy of stomach ulcer Stomach deformity ```
42
Bird’s beak or rat’s tail sign
Achalasia
43
Suppress production of prostaglandins which inhibit secretion of gastrin Etiology peptic ulcer
Corticosteroid hormones and nonsteroidal antiinflammatory drugs
44
A chronic syndrome resulting in mucosal damage caused by stomach acid coming up from the stomach into the esophagus
GERD - gastroesophagel reflux disease
45
On some types of food like meat and bread
Dysphagia - benign tumors of esophagus
46
Final digestion of proteins takes place
Small intestine
47
A breach in the mucosa of the alimentary tract that extends into the submucosa and deeper
Ulcers of alimentary tract
48
The esophagus is surrounded at the top and bottom by two muscular rings
The upper esophageal sphincter | The lower esophageal sphincter
49
Most common benign tumors of esophagus
Leiomyomas
50
This complication develops as a result of peptic ulcer healing, with development of scar tissue - so called hourglass stomach
Stomach deformity
51
Protein digestion in small intestine enzymes from the pancreas = _____
Chymotrypsin Trypsin Carboxypeptidase Elastase Break down short-chain peptides to AA
52
Gastric carcinoma is generally ____ until late in its course
Asymptomatic
53
The body’s cells in stomach secretes
Pepsinogen | HCl
54
Diagnosis of achalasia
X-ray | Upper endoscopy
55
Narrowing (stenosis) of the pylorus due to hypertrophy of the sphincter muscle, or scarring of the tissue surrounding the opening from the stomach to duodenum
Pyloric stenosis
56
The submucosa secretes mucus from ___ which aids the passage of food down the esophagus
Mucous glands
57
Diagnosis benign tumors
Upper endoscopy with multiple biopsy CT-scan Endoscopic ultrasonography for submucosal tumors
58
Treatment malignant tumors of stomach
Surgery Chemotherapy Radiation therapy
59
Recommendation by chiropractor acute gastritis
Avoid alochol, caffeine, tobacco Hydration Check for subluxation in neck and dorsal spine
60
Fat digestion in small interstine
Bile from liver and gallbladder emulsifies fats then lipase from the pancreas breaks down fat to fatty acids and glycerol
61
Diagnosis chronic gastritis
Clinical manifestations | Upper endoscopy with biopsy
62
Live size depends on
Age, sex, body size
63
During development, the liver size increases with increasing age, averaging
5cm span at 5 years and attaining adult size by age 15
64
Although an ulcer can be found anywhere in GI tract, the peptic ulcers develop only in
Organs which have exposure to the stomach pepsin and stomach acidity Stomach Duodenum Esophagus
65
In the large intestine there is absorption of
Water Electrolytes Eliminates drier residues as feces
66
Exocrine enzymes produced by pancreas
``` Chymotrypsin Trypsin Carboxypeptidase Elastase Amylase Lipase ```
67
Peritonitis could also develop in
Peptic ulcer
68
Nausea, vomiting, regurgitation of food esophageal cancer due to
Disruption of normal peristalsis
69
Has known predisposing factors
Intestinal-type adenocarcinoma
70
Benign tumors of esophagus typically occur in the age between ____ abnd have ___ gender predominance
20-50 yo | No
71
Late clinical manifestations malignant tumors
``` Upper abdominal pain Weight loss Nausea and vomiting Diarrhea or constipation Bleeding (hematemesis, melena) Signs of anemia Dysphagia ```
72
Common signs and symptoms of benign tumors
Abdominal pain Nausea Weight loss Acute or chronic bleeding
73
The descending part and rest of duodenum lies
Retroperitoneally
74
Neurogenic
Neurinoma aka schwannoma aka neurilemmoma
75
H. Pylori Bile reflux In chronic gastritis affect the ___ part of teh stomach
Antral part
76
Malignant tumors can also send metastases to the
Pancreas and lungs
77
Squamous cell carcinoma has direct correlation with
Celiac disease Hot tea with increased concentration of tannins Tylosis (palmar/plantar hyperkeratosis)
78
Digestion in liver due to production of
Bile
79
Whereby the shallow or deeply erosive crater is present in the wall of the stomach
Excavated
80
Enteroendocrine cells (G-cells) secrete
Hormone gastrin
81
Leiomyomas originate from
The smooth muscle cells
82
Unusual hoarseness, coughing for cancer of esophagus due to
Involving of the recurrent laryngeal nerve
83
Signs and symptoms of zenker’s diverticulum
Food regurgitation in the absence of dysphagia, can be complicated by aspiration pneumonia
84
Exophytic
With protrusion of tumor into the lumen
85
Small intestine enzymes for carb digestion
Maltase Sucrase Lactase
86
Signs and symptoms penetration peptic ulcer
Pain from upper abdomen radiates to the back Pain gets worse in teh night Pain could be relieved by intake of antacids
87
Similar to intestinal lymphomas
Gastric lymphomas
88
About 25-35 cm long (12 fingers’ length) C-shaped Located in upper abdomen
Duodenum
89
Forms of acute gastritis
Based on degree of mucosal damage Erosive Nonerosive
90
The potentials for malignancy of benign tumors of esophagusl are
Extremely low
91
Carbohydrate digestion in small intestine
Pancreatic amylase finishes the breaking down of carbohydrates to simple sugars
92
Pancreas length
15 cm (6 in)
93
Neck of the pancreas lies
Between the body and head, anterior to the superior mesenteric artery and vein
94
Treatment esophageal diverticuli
Surgery
95
Treatment esophageal varicies
Life-threatening situation requires immediate hospitalization - NEVER ADJUST THIS PATIENT
96
It is associated with predominate venous blood flow from GI tract organs to Maliganant tumor
Portal vein
97
Diagnosis esophageal diverticuli
X-ray with contrast fluid | Upper endoscopy
98
Zenker’s diverticulum aka
Pharyngoesophagel diverticulum
99
20% of peptic ulcer develops in the
Stomach
100
Esophageal varices appear in ___ of patients with liver cirrhosis
65%
101
Forms of achalasia
Primary achalasia | Secondary achalasia
102
In over 40% of patients, __ are the first sign of an undiagnosed cancer
Tripe palms
103
Midesophageal diverticulum aka
Traction diverticulum
104
Pathogenesis peptic ulcer
Aggressive forces - weaken mucous barrier (Defensive forces) - peptic ulcers
105
Diagnosis hiatal hernia
X-ray with liquid barium salt | Upper endoscopy
106
Tratment pyloric stenosis
Surgery
107
Signs and symptoms acute gastritis
``` Constant or sporadic pain in epigastric area (achy, burning, sharp, dull) Nausea Vomiting Fever, chills Belching, bloating ```
108
The duodenum may be subdivided into 4 sections
Superior part Descending part Horizontal part Ascending part
109
Liver storage function
Vitamins A, D, B12, K, E Glycogen Iron Copper
110
Mallory may develop
Metabolic acidosis
111
Gastrin - ____ - inc production of HCl
Parietal cells
112
Etiology benign tumors
Unkown
113
Sodium, potassium, chloride, phosphate, bicarbonate ions
Electrolytes in salivary glands
114
Cholecystokinin
Bile from liver and gallbladder and pancreatic enzymes
115
Lower GI tract
Mid-transverse colon to anus Hindgut
116
Reduces rate at which food is absorbed from teh content of the intestines Regulates/sotps alpha and beta cell functions
Somatostatin
117
Etiological factors of chronic gastritis cause ____ damages of the stomach mucosa
Multiple focal
118
Sucrase
Breaks down sucrose to glucose and fructose
119
Polyps are usually composed of
A combincation of fibrous, vascular or adipose tissue, covered by an intact mucosa
120
Signs and symptoms mallory-weiss syndrome
Episodes of vomiting with bright blood
121
Achalasia is characterized by
Incomplete relaxation of LES Its increased tone Lack of peristalsis of esophagus
122
Esophagus enters the diaphragm at
T10
123
Tail of pancreas ends
Abutting teh spleen
124
Etiology peptic ulcer
``` H. Pylori Corticosteroid hormones and nonsteroidal antiinflammatory drugs Cigarette smoking Zollinger-Ellison syndrome Stressful lifestyle Genetic predisposition ```
125
Immediately above the lower esophageal sphincter diverticulum
Epiphrenic diverticulum
126
Pain in left upper quadrant and retrosternal area - mimics heart problem like hiatal hernia or esophagitis
Area of cardia peptic ulcer
127
The pancreatic duct and common bile duct enter the descending duodenum, through the ____
Major duodenal papilla - hepatopancreatic ampulla | = ampulla of Vater
128
2 ducts of pancreas
The main pancreatic duct | The accessory pancreatic duct
129
Middle GI tract
Duodenal papilla to mid-transverse colon Midgut
130
Usually occurs in the distal third of esophagus or gastro-esophageal junction
Adenocarcinoma
131
Hiccups tumors of esophagus
Phrenic nerve involvement
132
In peptic ulcer there is a strong casual association with ___ infection
H. Pylori
133
Chief (zymogen) cells secrete
Pepsinogen
134
Most commonly locates in distal 2/3 of the esophagus, usually they are multiple
Leiomyomas - benign tumors
135
The epithelial surface of plicae is further folded to form
Villi
136
Immunity function of liver
Contains Kupffer cells - a type of fixed macrophages
137
Majority of nutrients are absorbed in the
Jejunum
138
Immediately above the upper esophageal sphincter | False diverticulum
Zenker’s diverticulum/pharyngoesophageal diverticulum
139
In the small intestine there is also absorption of
``` Iron Vitamins A and B1 Calcium Glycerol Fatty acids, monoglycerides AA Monosaccharides and disacchariddes are absorbed in the duodenum ```
140
Forms chronic gastritis
``` Hypertrophic Hyperplastic Erosive Antral Atrophic ```
141
Head of pancreas rests within
The concavity of the duodenum
142
Is found behind the stomach, with the head surrounded by duodenum
Pancrea
143
The esophagus passes close to the ___ and the ___ side of the heart
Trachea | Left
144
Represents 50-80% of esophageal cancer in USA
Adenocarcinoma
145
More complex arterial arcades Shorter vasa recta Less plicae circulares, thinner less folded Fat present in mesentery
Ileum
146
Backflow of undigested food
Regurgitation
147
In which there is no obvious tumor mass within the mucosa
Flat or depressed
148
Benign tumors of esophagus
``` Leiomyomas Polyps Fibromas Lipomas Hemangiomas Neurofibromas Squamous papillomas ```
149
An outpouching of the alimentary trat organ wall that contains all visceral layers
Diverticulum
150
The tissue of adjacent organ undergoes digestion, which is potentially also very dangerous and may result in death
Penetration peptic ulcer
151
The wall of the small intestine is lined with a ____ with certain modifications for each section of the intestine
An absorptive type of mucosa
152
The 1st place where digestion and absorption start
Oral cavity
153
Signs and symptoms epiphrenic diverticulum
Gives rise to nocturnal regurgitation
154
Treatment peptic ulcer
Physical and emotional rest Anti-helicobacter therapy Antacids Diet modification
155
Erosive acute gastritis
Mucosal damage Superficial Deep Hemorrhagic
156
Aspirationo f food or liquid - possible development fo aspiration pneumonia
Achalasia
157
Metastases malignant tumors of esophagus
Regional lymph nodes Aorta Liver and lungs Mediastinum
158
Etiology of GERD
Failure of the lower esophageal sphincter Sliding hernia Obesity H. Pylori infection Some visceral diseases (SLE, asthma, gallbladder stones, laryngitis)
159
Here the salivary amylase starts to digest carbs
Oral cavity
160
Bleeding from longitudinal tears in the mucosa (not muscular layer) at the esophagogastric juinction
Mallory-weiss syndrome (lacerations)
161
Differential diagnosis peptic ulcer
``` Acute or chronic gastritis Esophagitis Pancreatitis Cholecystitis Angina pectoris/heart attack ```
162
Diagnosis barrett esophagus
Upper endoscopy with biopsy
163
Diagnosis esophageal varicies
Upper endoscopy | CT scan
164
Peyer’s patches provide
Local immunological protection
165
Most common area of stomach with cancer
Lesser curvature
166
Less complex arterial arcades Longer vasa recta More plicae circulares, thicker, more highly folded No fat in mesentery
Jejunum
167
In the case of heart attack it is very important to remember that indigestion is ___ to eating
Unrelated
168
Gamma cells pancreas - endocrine role
Secrete pancreatic polypeptide
169
Complications benign tumors
Malignancy Bleeding Ulcerations Pyloric canal obstruction
170
Microscopically the gastric carcinomas are classified to
Early gastric carcinoma | Advanced gastric carcinoma
171
Pain in epigastric area, without radiation
Lesser curvature peptic ulcer
172
Clinical manifestations for both cancers of esophagus are
``` Dysphagia Weight loss/dec appetite Pain Unusual hoarseness, coughing Hiccups Nausea, vomiting Bleeding, hematemesis ```
173
Esophagus starts
Around level of C6 behind cricoid cartilage
174
When the stomach or duodenal wall is perforated, the stomach content spreads into teh peritoneal cavity, resulting in
Peritonitis
175
Chest pain in heart attack
Lasts for more than a few minutes Increases in intensity Is not relieved by rest or by taking nitroglycerin
176
Squamous cell carcinoma arises from
The squamous epithelium
177
The stomach wall contains
Parietal cells Chief cells G-cells
178
Benign tumors of esophagus bleeding or hematemesis result from
Ulceration or necrosis of benign tumors. | These manifestations are extremely rare.
179
Parietal cells secrete
HCl and | Intrinsic factor
180
Stomach carcinomas give metastases predominantly through ___ primarily to regional lymphatic nodes
Lymphatic system
181
Diagnosis acute gastritis
CBC Upper endoscopy Stool sample for presence of blood Pregnancy test
182
Less common is pain while swalloing - usually is retrosternal
Benign tumors of esophagus
183
Has a seasonal characteristic usually in spring or fall for
Stomach, dudodenum peptic ulcer
184
This complication develops only in the stomach, and usually when peptic ulcer locates on greater curvature
Malignancy of stomach ulcer
185
Diagnosis GERD
X-ray with liquid Barium salt | Upper endoscopy - the best
186
Lactase
Breaks down lactose to glucose, and galactose
187
Young children, sometimes congenital
Primary achalasia
188
From gallbladder - in intestine
Direct bilirubin - stercobilinigen - stercobilin - excretion with feces Direct bilirubin - reabsorption to blood (urobilinogen) - liver and kidneys - urobilin - excretion with urine
189
Midesophageal diverticulum usually results from
Mediastinal lymphadenitis (as from tuberculosis)
190
Provides motor innervation to both layers of the muscular layer, having both parasympathetic and sympathetic input
Auerbach’s plexus (myenteric plexus)
191
Most common complication of peptic ulcer, manifested by
``` Hematemesis and/or Melena (tarry feces) Weakness Orthostasis Syncope Thirst Sweating caused by blood loss ``` May result in anemia
192
Hollow muscular tube that transports saliva, liquids, and foods from the mouth to the stomach
Esophagus
193
3 pairs of salivary glands secrete up to 1 L of saliva a day
Parotid glands Submandibular glands Sublingual glands
194
Close association with chronic gastiritis due to intestinal metaplasia and H. Pylori infection
Intestinal-type adenocarcinoma
195
Somatostatin also secreted by
Hypothalamuc and the intestine
196
An endocrine organ that lies in the specifically upper left abdomen
Pancreas
197
In barrett esophagus, The squamous epithelial cells of the esophageal mucosa are replaced by
Columnar epithelial cells with goblet mucus-producing cells
198
Forms of esophageral diverticuli
Zenker’s diverticulum Midesophageal diverticulum Epiphrenic diverticulum
199
This disease is also known as gastrinoma with overproduction of gastrin
Zollinger-Ellison syndrome
200
No association with chronic gastritis and H. Pylori infection
Diffuse gastric carcinoma
201
Most common area for blood
Duodenal bulb
202
Treatment benign tumors of stomach
Laparoscopic or endoscopic surgery
203
Signs and symptoms depend on degree of
Tumor progression
204
Hepatic (intrahepatic) portal hypertension assocaited with
Liver cirrhosis - most common Liver tumors Amyloidosis
205
Difficulty in swallowing of solid and liquid food
Dysphagia
206
Achalasia aka
Cardiospasm
207
Pancrease external digestive role - exocrine
Secretes pancreatic fluid that contains digestive enzymes which help to further break-down the carbohydrates, proteins and lipids in the chyme
208
Leser-trelat sign
Sudden eruption of multiple seborrheic keratosis
209
Second largest organ in the human body
Liver
210
J-shaped organ with two openings
Stomach
211
When a lesion confined to the mucosa and submucosa carcinoma
Early gastric carcinoma
212
Etiology pyloric stenosis
Congenital | Acquired
213
The superior part of duodenum lies
Intraperitoneally and is enlarged proximally (duodenal bulb)
214
Proteins in salivary glands
Mucin Lysozyme IgA
215
Pain in epigastric area and right upper quadrant
Pylorus and duodenum peptic ulcer
216
The horizontal duodenum runs ___ and is located ____
From right to left | Retroperitoneally
217
Delta cells pancreas endocrine role
Secrete somatostatin (regulates functioin of alpha and beta cells)
218
Most patients benign tumors are
Asymptomatic for long period of time
219
Causes portal hypertension
Posthepatic (suprahepatic) Hepatic Prehepatic (infrahepatic)
220
Same as perforation, but because the involved wall is bound to an adjacent organ (liver, pancreas, greater omentum) the stomach content does not enter the peritoneal cavity
Penetration
221
X-ray diagnosis of achlasia
Contrast liquid swallowing shows the narrowing of the distal part of the esophagus (bird’s beak or rat’s tail sign) and its dilatation above
222
Most cases of does not cause any symptoms or specific symptoms
Hiatal hernia
223
Diet modification peptic ulcer
Avoid: | Alcohol, coffee, sour food, spicy food, bubble water, broccoli, orange juice, hot food
224
Stomach cancer arises from any part of the stomach, but a favored location is the
Lesser curvature of the antrum-pyloric region
225
Kupffer cells
Clean the large volumes of blood very fast
226
All complications of peptic ulcer are considered as
Emergency medical situations
227
Pain of peptic ulcer can be
Diffuse, achy, acute or dull and is associated with mealtime
228
Prehepatic (infrahepatic) portal hypertension associated with
Portal vein thrombosis Portal vein sclerosis Portal vein congenital stenosis or atresia
229
They are suually asymptomatic, silent, and undetected | More than 5 cm in diameter can come to clinical attention
Benign tumors of the esophagus
230
Etiology esophageal varicies
Portal hypertension
231
This last part (ascending duodenum) joins it with the ___. And is located ___
Jejunum | Retroperitoneally
232
Carcinomas occur when the DNA of a cell is ____ or ____ and the cell begins to grow uncontrollably and become malignant
Damaged | Altered
233
Late peptic ulcer
1.5-2 hours after the meal | Typical for duodenal peptic ulcer
234
The pancreas is a secretory structure with
Internal hormonal role (endocrine) | External digestive role (exocrine)
235
Forms of hiatal hernia
Sliding hernia | Rolling or paraesophageal hernia
236
In hypertrophic pyloric stenosis in babies
First symptoms appear in the first 2-6 weeks of the life | There is progressive vomiting with partially digested food after each or few feedings
237
For esophageal motility studies
X-ray with barium liquid
238
The most common malignant esophageal tumors are
Squamous cell carcinoma | Adenocarcinoma
239
Great mimic disease
Hiatal hernia
240
Acts principally on the liver where it stimulates conversion of glycogen to glucose and fat and protein to glucose
Glucagon
241
Usually makes the pyloric canal such a narrow that the bolus cannot move from the stomach to duodenum
Pyloric stenosis
242
Insulin ___ glucose in the blood
Decreases
243
Site where the most of the chemical and mechanical digestion is carried out and where virtually all of the absorption of useful materials is carried out as well
Small intestine
244
Most common form of hiatal hernia
Sliding hernia
245
Duodenal mucosal cells produce and release
Secretin | Cholecystokinin
246
On embryologic ground, teh GI tract should be divided into
Upper Middle Lower
247
The esophagus has a ____ lining which protects the esophagus from ___
Nonkeratinized stratifies squamous epithelial lining | Trauma
248
Muscles in middle portion of esophagus
Smooth
249
Most important for evaluation of inflammation
Upper endoscopy (gastroscopy)
250
Stomach polyps could undergo malignancy in ___ of cases
4-30% | Hyperplastic polyps and adenomas
251
Complications barrett esophagus
Bleeding Stricture due to healing or improper healing Frank esophageal adenocarcinoma - goblet cells
252
Risk factors are undefined
Diffuse gastric carcinoma
253
Composed of neoplastic intestinal glands
Intestinal-type adenocarcinoma
254
GERD recommendations by chriopractor
Life style modifications: Eating not later than 3-4 hours before sleep Avoid coffee, alcohol, chocolate, sour and spicy food Increaesed fluid intake Ginger tea
255
The large intestine contains areas of lymphoid tissue called
Peyer’s patches - also found at distal part of ileum
256
Normal bilirubin pathway
RBC - spleen lysis - globulin and heme - heme into iron and porphyrin ring - biliverdin - bilirubin
257
Chronic mucosal inflammatory changes in the stomach wall that eventually result in mucosal atrophy and mucosal (intestinal) metaplasia
Chronic gastritis
258
The mucosa of jejunum and ileum is highly folded (folds are called plicae) which dramatically increases
The surface area available for absorption
259
In females the stomach carcinoma could sometimes metastasize thorugh the abdominal cavity, giving rise to development of secondary ovarian cancer called
Krukenberg tumors
260
Has short latent period
Diffuse gastric carcinoma
261
Vitamin B12 and bile salts are absorbed in the
Terminal ileum
262
Detoxification liver function
Converts ammonium to urea Breaks down insulin adn other hormones Breaks down toxic substances
263
Etiology of hiatal hernia
Kyphoscoliosis Increased pressure within the abdominal cavity Congenital diaphragmatic weakness Obesity, trauma
264
In the liver there is production of
``` Bile Albumins Lipoproteins Clotting factors Angiotensinogen ```
265
There are 3 main sections of the small intestine
Duodenum Jejunum Ileum
266
Most common carcinoma of the stomach
Intestinal-type adenocarcinoma | Diffuse stomach carcinoma
267
Treatment barrett esophagus
ONLY medical treatment
268
Upper GI tract
Mouth to major papilla in duodenum Foregut
269
Usually occurs in the proximal 2/3 of esophagus
Squamous cell carcinoma
270
The manifestations of chronic gastritis are ____ and do not push a patient to attend a phsyician
Vague, not severe, non-specific
271
The second part of the duodenum also can contain the ___, the entrance for the accessory pancreatic duct
Minor duodenal papilla | =paillia of santorini
272
Hyperproduction of ____ leads to vasoconstriction of the stomach wall arteries. It affects ___ thus weakens ___
Catecholamines Stomach mucosal blood flow Mucous barrier
273
Cigarette smoking leads to impairment of ____ thus weakening the ____ Etiology peptic ulcer
Stomach mucosal blood flow | Mucous barrier
274
Flat advanced gastric carcinoma is also known as
Linitis plastica
275
Treatment benign tumors of esophagus
Removal of polyps thorugh endoscopy | Surgery
276
Two openings of the stomach
Esophageal | Duodenal
277
The lumen of the esophagus is surrounded by layers of muscle
Voluntary in top 1/3 - striated Involuntary in the bottom 1/3 - smooth Mixture of voluntary and involuntary in the middle 1/3
278
Leiomyoma occupies 2nd position in frequency after
Polyps
279
Etiology acute gastritis
``` Food poisoning/food infection Severe alcohol consumption Heavy smoking NSAIDs, especially aspirin Extreme stress (severe trauma, burns, surgery, etc) ```
280
Is a flat tumor
Diffuse gastric carcinoma
281
Heart attack could be manifested by GI symptoms called ___ which also known as upset stomach or dyspepsia
Indigestion
282
posthepatic (suprahepatic) portal hypertension assocaited with
Chronic right-sided cardiac failure | Budd-chiari syndrome
283
The ___ within the stomach mucosa accounts for secretions of various active substances
Glandular tissue
284
Muscles in upper portion of esophagus
Skeletal striated muscles
285
Problem with auerbach’s plexus
Achalasia
286
The pylorus is responsible for
Production of mucus, hormone gastrin, and pepsinogen secretion
287
Stomach carcinomas also give metastases to a lymphatic node in the left supraclavicular fossa
Virchow’s node
288
Endophelbitis of the liver veins or obstruction ofhte hepatic vein
Budd-Chiari syndrome
289
In 50% of peptic ulcer patients
Constipation
290
Diagnosis benign tumors of esophagus
Upper endoscopy with biopsy Ultrasound endoscopy CT scan X-ray with barium liquid
291
Signs and symptoms pyloric stenosis
``` Severe worsening vomiting Weight loss Dehydration Constant hunger Visible or palpable peristaltic waves ```
292
Early peptic ulcer
30 min to 1 hour after the meal - typical for stomach peptic ulcer
293
Heartburn (in 30-80%) may be the only peptic ulcer symptom Nausea Vomiting (relieves the pain) Belching with sour taste
Dyspepsia
294
Near the midpoint of the esophagus diverticuli
Midesophageal aka traction diverticulum
295
Recommendations by chiropractor hiatal hernia
To restrict activities that raise the intra-abdominal pressure Avoid eating near bed-time Diet modification - small frequent bland meal
296
Has relatively long latent period
Intestinal-type adenocarcinom
297
Diagnosis mallory-weiss syndrome
Upper endoscopy
298
Maltase
Breaks down maltose to 2 glucose
299
Diagnosis malignant tumors of esophagus
Endoscopy with biopsies Ultrasound endoscopy CT-scan of chest, abdomen and pelvis (esp for metastasis) PET X-ray with barium liquid for esophageal motility studies
300
Begins the chemical digestion of carbs in the mouth
Salivary amylase
301
Complications mallory-weiss syndrome
``` Severe bleeding Esophageal rupture (known as Boerhaave syndrome) ```
302
Most common benign tumors of the stomach
Polyps
303
H. Pylori is found in ___ of duodenal peptic ulcer and ____ of stomach peptic ulcer
100% | 70%
304
The junction between jejunum and ileum is
Not well-defined
305
In late stages of carcinoma prognosis is often
Poor
306
Diagnosis peptic ulcer
``` X-ray with liquid barium (ulcer crater aka nicha) Upper endoscopy with biopsy tests for H. Pylori Ultrasound CBC, UA, liver tests Urea breath test for H. Pylori Stool culture for H. Pylori antigen PCR blood tests for H. Pylori DNA CBC, UA, liver tests Fecal occult blood test (FOBT) CT ```
307
Recommendations of chiropractor for achalasia
To eat slowly Avoid eating near bed-time (3-4 hours) Avoid ketchup, citrus, chocolate, caffeine Physician’s consultation
308
Congenital pyloric stenosis
Hypertrophic pyloric stenosis Male:female = 4:1 Prevalence 2-4 per 1,000 newborns
309
Macroscopic growth patterns of gastric carcinomas
Exophytic Flat or depressed Excavated
310
Complications hiatal hernia
Ulcer in the esophagus | Stricture of the esophagus with possible achalasia
311
By percussion the liver size is
6 cm for women | 12 cm for men
312
Diffuse stomach carcinoma is a typical example of ____ cancer
Scirrhous aka scirr
313
Greatly coiled parts of the small intestine, and together are about 4-6 meters long
Jejunum and ileum
314
5 major functions of the stomach
Preliminary digestion of protein with pepsin Temporary food storage Control of the rate at which food enters the duodenum Acid secretion and antibacterial action Fluidisation of stomach content
315
Beta cells pancreas endocrine role
Secrete insulin - decreases glucose in the blood
316
Atrophic form chronic gastritis signs and symptoms
Heaviness in epigastrium and left upper abdominal area Fullness in the stomach after small amount of meal Diarrhea Signs of pernicious anemia
317
Signs and symptoms of achalasia
``` Dysphagia Regurgitation Chest pain Coughing Aspiration of food or liquid ```
318
Fundus does what
Collects digestive gases
319
Etiology chronic gastritis
NSAIDs Autoimmune diseases (autoimmune chronic gastritis, SLE) Allergic response
320
Are found in the duodenum ONLY, located in its submucosa, secrete an alkaline mucus which neutralizes the chyme and protects the surface of the duodenum
Brunner’s glands
321
Mesenchymal
Leiomyoma Lipoma Neurogenic Vascular
322
Benign tumors of esophagus are mostly ____ in origin and usually lie within the ____
Mesenchymal | Esophageal wall
323
Major digestion of carbs take place
Small intestine
324
Ulcer near the junction between stomach and esophagus
Reflux esophagitis necrosis
325
Signs and symptoms of benign tumors of esophagus
Dysphagia Pain while swallowing Food regurgitation Bleeding or hematemesis
326
Darkness of skin frequently locating in axilla and groin known as
Acanthosis nigricans
327
Body of pancreas lies
Behind the base of the stomach
328
Usually more late syptom, the pain located behind sternum or epigastrium could be severe and is worsened by swallowing of any food
Tumors of esophagus
329
Complications GERD
``` Reflus esophagitis necrosis Esophageal stricture Barrett esophagus Aspiration pneumonia Esophageal cancer ```
330
Amylin actions
Inhibits secretion of glucagon Slows emptying of the stomach Sends a satiety signal to the brain
331
Squamous cell carcinoma represents ___ of esophageal cancer worldwide
90-95%
332
Acanthosis palmaris Skin condition in which teh skin of the palm becomes thick and velvety hyperpigmentation with pronounced folds in the lines of the hand
Tripe palms
333
Malignant tumors of the stomach
Carcinomas (90-95% of all stomach malignant tumors) Lymphomas Carcinoids Sarcoma
334
The horizontal part of duodenum passes
In front of the inferior vena cava, abdominal aorta and the vertebral column,
335
Genetic predisposition - more common in children | Etiology peptic ulcer
Type O blood (30% risk of duodenal ulcer) Hypersecretion of HCl, pepsinogen Familial tendencies
336
Etiology of GERD - failure of the LES due to
CNS depressants Hypothyroidism Pregnancy Alcohol or tobacco exposure
337
Risk factors for both cancers of esophagus are
Tobacco smoking and chewing Alcohol overconsumption Age after 60-65 yo Male:female = 4-5:1
338
A liver span 2-3 cm larger or smaller than normal is considered to be
Abnormal
339
Etiology mallory-weiss syndrome
Alocholism, after frequent severe retching and vomiting (most common cause) Hiatal hernia Overdose of NSAIDs Severe vomiting in pregnancy
340
Leather bottle stomach aka ____ aka _____
Linitis plastica | Diffuse stomach carcinoma
341
For estimation of stage, metastases of the cancer
PET - positron emission tomography
342
Four main cells exist in the islets of pancreas for internal hormonal role - endocrine role
Alpha Beta Delta Gamma
343
Bile is a mixture of
Water Bile salts Cholesterol Pigment bilirubin
344
Diagnosis pyloric stenosis
Ultrasound examination Upper endoscopy X-ray (string sign) or railroad track sign
345
Indigestion in heart attack could be accompanied by
Shortness of breath Sweating Pain radiating to the left jaw, left part of the neck, or left arm Chest pain Experience severe abdominal pressure that feels like an elephant sitting on stomach
346
Creates a bell-shaped dilation
Sliding hernia
347
80% of peptic ulcer develops in the
Duodenum
348
An abnormal change (metaplasia) in the cells of the lower portion of the esophagus
Barrett esophagus
349
The stomach wall contains 3 layers of involuntary smooth muscles which aid digestion by physically breaking up the food particles
Inner oblique layer Circular layer Outer longitudinal layer
350
Etiology chronic gastritis
H. Pylori (in 90%) | Bile reflux
351
Complications of achlasia
Aspiration pneumonia or airway obstruction Lower esophageal diverticulum Esophageal cancer - in 5% of patients
352
Vascular
Glomus tumors
353
Nonerosive
Focal | Pangastritis (diffuse)
354
The pancreas also produces hormones
Insulin, amylin - beta cells Glucagon - alpha cells Somatostatin - delta cells Pancreatic polypeptide - gamma cells
355
Hypertrophic erosive and antral forms chronic gastritis signs and symptoms
Acute pain in epigastrium and left upper abdominal area Local pain without radiation Usually pain develops in 30-60 min after meal Heartburn Belching Constipation
356
Sudden inflammation of the lining of the stomach
Acute gastritis
357
Signs and symptoms peptic ulcer
PAIN Dyspepsia Constipation Emotional instability
358
Carcinomas are a type of cancer that develops from
Epithelial cells
359
Duodenum main functions are
Neutralization of the acidic gastric content Further digestion Absorption of nutrients Regulation of the rate of gastric emptying
360
Coughing when lying in horizontal position especially at night
Achlasia
361
For assessing a patient with acute abdominal pain, and in some settings may be able to identify the site of bleeding or perforation prior to endoscopy
CT
362
Chronic atrophic gastritis may often be
Asymptomatic
363
Anatomically the pancreas is divided into
Head Body Tail Neck
364
Extremely dilated submucosal veins in low third of the esophagus
Esophageal varices
365
Signs and symptoms barrett esophagus
Heartburn Hematemesis Painful eating Dysphagia (in case of complication by stricture)
366
Pathogenesis mallory-weiss syndrome
Inadequate relaxation of the musculature of the lower esophageal spincter during vomiting, with stretching and tearing of the esophageal junction during propulsive expulsion of gastric contents
367
Glucagon ___ glucose in the blood
Increases
368
Rolling hernia can be complicated by development of
Venous infarction due to it’s possible strangulation by the diaphragm - this is EMERGENCY situation
369
Characterized by failure of distal esophageal inhibitory neurons - the auerbach’s plexus (myenteric plexus)
Primary achalasia
370
Typanosoma cruzi causes
Destruction of the myenteric plexus of the esophagus with its dilation
371
Problems with the esophagus, such as eating something too hot, can sometimes feel like a pain
Close to or in the heart or throat
372
Varicies produce no symptom until
They rupture, and the hemorrhage develops (hematemesis)
373
Diagnosis malignant tumors tumor markers
CEA elevated in 45-50% of cases CA 19-9 elevated in 20% of cases CBC
374
Parotid glands lie
Just below and in front of the ear near the jaw
375
First digestion of fat takes place
Small intestine
376
Achalasia most common etiological factor
Incomplete relaxation of LES
377
An esophageal motility disorder involving the smooth muscle layer of the esophagus, and the lower esophageal sphincter (LES)
Achalasia (cardiospasm
378
Gastric lymphomas represent ___ of all gastric malignancies
5%
379
Signs and symptoms of hiatal hernia
Dull pain in the chest Shortness of breath Heartburn (typical for sliding hernia) Heart palpitation (tachycardia)
380
Both submandibular and sublingual glands lie
On the floor of the mouth
381
The also are able to send metastases to the ___ via blood Malignant tumors
Liver
382
Differential diagnosis GERD
``` Heart diseases (chest pain) Hiatal hernia ```
383
The liver consists of 4 distinct lobes
Left Right Caudate Quadrate
384
Secretin
Pancreatic juice
385
Most of the liver’s mass is located
On teh right side of the body where it descends inferiorly toward the right kidney
386
Diagnosis malignant tumors
Tumor markers Endoscopic ultrasonography with biopsy PET, CT, or MRI of chest, abdomen, and pelvis
387
More advanced clinical manifestations malignant tumors
Weakness and fatigue | Bloating of the stomach, usually after meal
388
Composed of gastric-type mucous cells
Diffuse gastric carcinoma
389
Each villus has its own
Blood supply
390
The surface of each villus is covered by
Small microvilli to maximize surface area and thus area available for absorption
391
The mucosa of the large intestine consists of two types of epithelial cells
Cells specialized for water absorption | Mucus-producing goblet cells - also located in small intestine
392
Kupffer cells play an important role by ____ and ___ bacteria, fungi, parasites, worn-out blood cells, and cellular debris
Capturing and digesting
393
Villi further increase
The surface area of the small intestine
394
Very important predisposing factor for development of one of the most common stomach cancers - intestinal-type adenocarcinoma
Intestinal (mucosal) metaplasia
395
Most common cancer
Adenocarcinoma
396
Obesity as adult Trauma as a child Marfan’s sydrome - congenital diaphragmatic weakness
Hiatal hernia
397
Action in chiro office mallory-weiss syndreom
Call 911
398
Traction diverticulum signs and symptoms
Usually asymptomatic
399
Achalasia caused by trypanosoma cruzi is known as
Chagas’ disease
400
When a separate portion of the stomach, usually along the greater curvature, enters the thorax through the widening foramen
Rolling or paraesophageal hernia
401
Protrusion of the upper part of the stomach into thorax through the space between the muscular crura of the diaphragm (the hiatus)
Hiatal hernia
402
Arises from metaplastic columnar epithelium
Adenocarcinoma
403
Night pain at 4-5am is characteristic for
Duodenal peptic ulcer
404
Chiropractic spinal manipulation may benefit some people with ____ gastric or duodenal ulcer
Uncomplicated
405
Secondary achlasia could result from
Cancer of esophagus or upper stomach | Infeciton with a protozoa Trypanosoma cruzi - Chagas disease
406
Pancreatic polypeptide
Reduces appetite
407
Functions of liver
``` Production Digestion Storage Detoxification Immunity ```

GE (5 decks)

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