EXAM 1 Flashcards
1
Q
A
2
Q
Where does the esophagus enter the diaphragm?
A
T10
3
Q
Where does the Esophagus end?
A
At cardia of the stomach, T11
4
Q
The esophagus passes close to ______
A
The trachea and left side of heart
5
Q
Can problems with the esophagus cause problems with the heart?
A
YES - Eating something too hot can sometimes feel like pain close to or in the heart or throat
6
Q
The esophagus is surrounded at the top and bottom by 2 muscular rings, what are they?
A
The upper esophageal sphincter and lower
7
Q
What lines the esophagus ?
A
Has a nonkeratinized stratified squamous epithelial lining which protects the esophagus from trauma
8
Q
What does the submucosa of the esophagus secrete?
A
Mucus from mucous glands which aids the passage of food down the esophagus
9
Q
What is the lumen of the esophagus surrounded by?
A
Layers of muscle
10
Q
The lumen of the esophagus has muscles, what types of muscles are in these?
A
- Voluntary in TOP 1/3rd (striated) - Involuntary in the BOTTOM 1/3rd (smooth muscle) - The MIDDLE 1/3rd containing a mixture of BOTH
11
Q
What shape is the stomach?
A
J-Shaped with 2 openings 1). Esophageal 2). Duodenal
12
Q
What are the 4 major regions of the stomach?
A
Fundus, Cardia, Stomach Body, Pylorus
13
Q
What does the fundus collect?
A
Digestive gases
14
Q
What does the body of the stomach secrete?
A
Pepsinogen and Hydrochloric acid
15
Q
The pylorus is responsible for _____
A
Production of mucus, hormone gastrin, and pepsinogen secretion
16
Q
The glandular tissue within the stomach mucosa account for secretion of various substances, what are they?
A
1). Parietal cells 2). Chief (zymogen) cells 3). Enteroendocrine cells (G cells)
17
Q
What do parietal cells secrete?
A
Hydrochloric acid and intrinsic factor
18
Q
What do chief (zymogen) cells secrete?
A
Pepsinogen
19
Q
What do enteroendocrine cells (G-cells) secrete?
A
Hormone gastrin
20
Q
The stomach wall contains 3 layers of involuntary smooth muscles which aid digestion by physically breaking up the food particles, what are they?
A
- Inner oblique layer 2. Circular layer 3. Outer longitudinal layer
21
Q
What are the 5 major functions of the stomach?
A
- Preliminary digestion of protein with pepsin 2. Temporary food storage 3. Control of the rate at which food enters the duodenum 4. Acid secretion and antibacterial action 5. Fluidsation of stomach content
22
Q
What are the 3 main sections of the small intestine?
A
- Duodenum 2. Jejunum 3. Ileum
23
Q
The small intestine is the site where the most of _____ is carried out?
A
Chemical and mechanical digestion and where virtually all of the absorption of useful material is carried out
24
Q
What is the wall of the small intestine lined with?
A
An absorptive type of mucosa, with certain modifications of each intestine
25
What does the wall of the small intestine have as far as muscles?
2 layers of smooth muscles, rhythmical contractions of which move products of digestion through the intestine (peristalsis)
26
The duodenum is the \_\_\_\_\_
FIRST of 3 parts of the intestine
27
What is the duodenum attached to?
The pylorus of the stomach
28
How long is the Duodenum?
25-30 cm long (12 fingers length), C - Shaped, and is located in upper abdomen
29
What lies in the C shape of the duodenum?
Pancreas
30
What are the 4 subdivisions of the duodenum?
1. Superior part 2. Descending part 3. Horizontal part 4. Ascending part
31
Where does the superior part of the duodenum lie?
It lies intraperitoneally and is enlarged proximally (duodenal bulb)
32
The descending part and the rest of the duodenum is \_\_\_\_\_\_
Retroperitoneally
33
How do the pancreatic duct and common bile duct enter the descending duodenum through the \_\_\_\_\_
Major duodenal papilla - Hepatopancreatic ampulla (= ampulla of Vater)
34
The second part (descending) of the duodenum also can contain the \_\_\_\_\_
Minor duodenal papilla
35
What is the entrance for the accessory pancreatic duct?
The minor duodenal papilla (Papilla of Santorini)
36
Where does the Horizontal part of the duodenum pass?
In front of the inferior vena cava, abdominal aorta and the vertebral column, runs from right to left.
37
Where does the horizontal duodenum locate?
Retroperitoneally
38
How does the Ascending part of the Duodenum run?
Cranially along the left side of the vertebral column
39
What is special about the ascending part of the duodenum?
It joins with the jejunum
40
Where is the ascending part of the duodenum located?
Retroperitoneally
41
What are the main functions of the duodenum?
- neutralizing of acidic gastric content - further digestion - absorption of nutrients - regulation of the rate of gastric emptying
42
How does the duodenum neutralize acidic gastric content?
Brunner’s glands
43
Where are Brunner’s glands?
They are found in the duodenum only, locate in its submucosa.
44
What do Brunner’s glands secrete?
An alkaline mucus which neutralizes the chyme and protects the surface of the duodenum
45
What are the jejunum and ileum?
The greatly coiled parts of the small intestine, and together are about 4-6 meters long
46
What is special about the mucosa of the jejunum and ileum?
It is highly folded (folds are called plicae) and increase surface area for absorption
47
What are the characteristics of the Jejunum?
- Less complex arterial arcades - Longer Vasa Recta - More plicae circulares, thicker, more highly folded - No fat in mesentery
48
What are the characteristics of the Ileum?
- More complex arterial arcades - Shorter Vasa Recta - Less Plicae circulates, thinner less folded - Fat present in mesentery
49
In the jejunum and ileum, the epithelial surface of plicae is further folded to form \_\_\_\_\_\_
Villi
50
In the Jejunum and ileum the surface of each villus is covered by what?
MICROVILLI, to maximize surface area, and thus area available for absorption
51
The mucosa of the large intestine consists of 2 types of epithelial cells, what are they?
- Cells specializing for water absorption - Mucus producing goblet cells (they also locate in the small intestine)
52
The large intestine contains areas of lymphoid tissue called \_\_\_\_\_\_
Peyer’s patches
53
What do Peyer’s patches do?
They are also found in the distal part of ileum. - Peyer’s patches provide local immunological protection
54
What is the 2nd largest organ in the human body?
LIVER
55
During development, what does the liver do?
The liver size increases with increasing age, averaging 5 cm span at 5 years and attaining adult size by age 15
56
What does the liver’s size depends on?
Several factors: age, sex, body size
57
How much does a liver have to be to be considered abnormal?
2 - 3 cm larger or smaller
58
What are the 4 distinct lobes of the liver?
- Left - Right - Caudate - Quadrate
59
What is the Pancreas?
An endocrine organ that lies in the specifically the upper left abdomen
60
Where is the pancreas?
It is found behind the stomach, with the head of the pancreas surrounded by the duodenum
61
How long is the Pancreas?
About 15 cm (6in) long
62
What is the Pancreas divided into, anatomically?
- head - body - tail - neck
63
Where is the head of the Pancreas?
Rests within the con cavity of the duodenum
64
Where does the body of the Pancreas lie?
Lying behind base of stomach
65
Where does the tail of the Pancreas lie?
Which ends abutting the spleen
66
Where does the neck of the pancreas lie?
Lies between the body and the head, anterior to the superior mesentery artery and vein
67
What are the 2 ducts of the pancreas?
The main pancreatic duct, and the accessory pancreatic duct
68
What are the 2 roles of the Pancreas?
1. Internal Hormonal Role (endocrine) 2. External Digestive Role (Exocrine)
69
What are the 4 main cells in the islets of the Pancreas (Internal Hormonal Role)?
1. A (alpha) cells 2. B (beta) cells 3. Delta cells 4. Gamma cells
70
What do alpha cells of the pancreas secrete?
Glucagon (increases glucose in blood)
71
What do Beta cells of the pancreas secrete?
Insulin (decreases glucose in blood)
72
What do Delta cells secrete?
Somatostatin (regulates function of alpha and beta cells)
73
What do gamma cells secrete?
Pancreatic Polypeptide
74
What does the Pancreas secrete?
Pancreatic fluid that contains digestive enzymes
75
What do the external pancreas enzymes do?
Enzymes help to further break down the carbohydrates, proteins, and lipids in the chyme
76
How many pairs of salivary glands are there?
3, and they secrete up to ONE liter of saliva a day
77
What are the 3 Salivary glands?
1. Parotid - Lie just below and in front of the ear near the jaw 2. Submandibular 3. Sublingual
78
What does Saliva contain?
- 98% water - mucus - salivary amylas - electrolytes - the proteins, mucin, lysozyme, and IgA
79
What does the stomach wall contain?
- Parietal cells - Chief cells - G cells
80
What do Parietal cells produce?
Hydrochloric acid and intrinsic factor
81
What do chief cells secrete?
Pepsinogen
82
What do G cells secrete ?
Gastrin
83
What is the flow of GI tract Stomach phys?
1. Food 2. G-cells 3. Gastrin 4. Hydrochloric Acid 5. Pepsinogen (non active) 6. Pepsin (active) 7. Digestion of proteins
84
What are the substances the stomach absorbs?
Alcohol, meds, and water
85
What are the main things the small intestine digests?
Carbs, proteins, fats
86
What do Duodenal mucosal cells do in the small intestine?
Produce and release hormones secretin and cholecystokinin
87
What is secretin associated with?
Pancreatic juice
88
What is cholecystokinin associated with?
Bile from liver and gallbladder and pancreatic enzymes
89
What are the enzymes from the small intestine that digest protein?
- Chymotrypsin - Trypsin - Carboxypeptidase - Elastase (Breaks down short chain peptides to AA)
90
How does fat digestion in the small intestine occur?
Bile from the liver and gallbladder emulsifies fat, and then lipase (from pancreas) breaks down fat to fatty acids and glycerol
91
What is the sequence of fat digestion in the small intestine?
1. Liver and Gallbladder 2. Bile 3. Fat 4. Emulsification 5. Pancreas 6. Lipase 7. Emulsified fat 8. Free fatty acids and glycerol
92
What is the process of carb digestion in small intestine?
Pancreatic amylase finishes the breaking down of carbs to simple sugars
93
What are the small intestine enzymes?
Maltese, Sucrase, Lactase
94
What does Maltese break down into?
2 glucose molecules
95
What does sucrase break down to?
glucose and fructose
96
What does lactase break down to?
Glucose and galactose
97
What are the substance absorbed in the Duodenum of small intestine?
- Iron - Vitamins A and B1 - Calcium - Glycerol - Fatty acids, monoglycerides - Amino acids - Monosaccharides and disaccharides
98
Where are most of the nutrients absorbed?
Jejunum
99
Where is vit B12 and bile salts absorbed ?
Terminal ileum
100
Large intestine absorbs \_\_\_\_\_
Water and electrolytes (The large intestine eliminates drier residues as feces)
101
What does the liver produce?
- Bile - Albumins - Lipoprotiens - Clotting factors (prothrombin and fibrinogen) - Angiotensinogen
102
What is the normal Bilirubin Pathway?
1. RBC 2. Spleen (lysis) 3. Globulin and Heme 4. Iron and Porphyrin Ring 5. Biliverdin 6. Bilirubin 7. Bilirubin + Albumin = Unconjugated (indirect, non-H2O soluble) 8. Blood 9. In Liver 10. Albumin and Bilirubin + Glucuronic acid - Conjugated (direct, H20 soluble) 11. To gallbladder
103
Does the Liver digest?
Yes, due to the production of bile
104
What is bile?
A mixture of water, bile salts, cholesterol, the pigment bilirubin
105
What does the Liver store?
- Vitamins A, D, B12, K, and E - Glycogen - Iron - Copper
106
What does the Liver do to Detox?
- Converts ammonium to urea - breaks down insulin and other hormones - breaks down toxic substances
107
Does the Liver function to help with Immunity?
Yes, it contains Kupffer cells
108
What are Kupffer cells, and what do they do?
A fixed type of macrophage They play an important role by capturing and digesting bacteria, fungi, parasites, worn out blood cells, and cellular debris (Clean the large volumes of blood very fast)
109
What are the exocrine enzymes produced by the pancreas?
- Chymotrypsin - Trypsin - Carboxypeptidase - Elastase - Amylase - Lipase
110
What are the hormones the Pancreas produces?
- Insulin, Amylin - Glucagon - Somatostatin - Pancreatic Polypeptide
111
What are the actions of Amylin?
- Inhibits the secretion of glucagon - Slows emptying of the stomach - Sends a satiety signal to the brain
112
What does Glucagon do?
Increases glucose in blood, acts principally on the liver where it stimulates the conversion of: - Glycogen in glucose - Fat and protein into glucose
113
What are the functions of Somatostatin?
- Reduces the rate at which food is absorbed from the content of the intestines - regulates/stops alpha and beta functions
114
Pancreatic polypeptide ________ appetite?
REDUCES
115
What is Achalasia? (Cardiospasm)
An esophageal motility disorder involving the smooth muscle layer of the esophagus, and the lower esophageal sphincter (LES)
116
What is Achalasia characterized by?
- Incomplete relaxation of LES - It’s increased tone - Lack of peristalsis of esophagus
117
What is Primary Achalasia?
MC\*\* Characterized by failure of distal esophageal inhibitory neurons - The Auerbach’s plexus (myenteric plexus)
118
What does the Auerbach’s plexus (or myenteric plexus) provide?
Motor innervation to both layers of the muscular layer, having both para and sympathetic output
119
What is special about Meissner’s plexus?
It has ONLY parasympathetic fibers and provides secretor innervation to the mucosa nearest the lumen of the gut
120
What could secondary Achalasia result from?
Cancer of esophagus or upper stomach
121
What else could Secondary Achalasia result from?
Infection with Protozoa (Trypanosoma Cruzi) which causes destruction of the myenteric plexus of the esophagus with its dilation
122
Achalasia caused by Tripansoma cruzi is known as \_\_\_\_\_
\*\*\*Chaga’s Disease SECONDARY ACHALASIA
123
What are the signs and symptoms of Achalasia?
1. Dysphasia 2. Regurgitation 3. Chest pain 4. Coughing 5. Aspiration of food or liquid
124
What is “Dysphagia” associated with Achalasia?
Difficulty in swallowing of solid or liquid food
125
What is “Regurgitation” associated with Achalasia?
Backflow of undigested food
126
Why would you have chest pain with Achalasia?
BEHIND THE STERNUM With radiation to the neck or armS\* (NOT JUST ONE ARM) Can be extremely painful and gets worse AFTER eating
127
Why would there be “Coughing” with Achalasia ?
Cough when you’re in a HORIZONTAL position especially at night
128
What will you see on X- Ray with Achalasia?
Use contrast liquid swallowing shows the narrowing of the distal part of esophagus
129
What is the radiographic sign apparent with Achalasia?
“Bird’s Beak” or “Rat’s Tail” sign\*\* Along with dilation above
130
How is there a diagnosis of Achalasia?
Upper Endoscopy (Gastroscopy)
131
What are the 3 complications of Achalasia?
1. Aspiration pneumonia or airway obstruction 2. Lower esophageal diverticulum 3. Esophageal Cancer (in 5% of patients)
132
What do you recommend to patients with Achalasia ?
- Eat slowly - Avoid eating near bed time - Avoid ketchup, citrus, chocolate, caffeine - Physician consultation
133
What is a Hiatal Hernia of the esophagus?
Protrusion of the upper part of stomach into thorax through the space between the muscular Curran’s of the diaphragm (hiatus)
134
What are the different forms of Hiatal Hernia?
1. Sliding MC\* 2. Rolling or Paraesophageal
135
What happens during a Sliding Hernia?
Where the gastroesophageal junction together with the stomach move above the diaphragm
136
What type of dilation do you see with a sliding hernia?
Bell Shaped\* MC form of hiatal hernia
137
What is a rolling or paraesophageal hernia?
When a separate portion of the stomach, usually along the greater curvature, enters the thorax through the widening foremen
138
What is condition can be an etiology of Hiatal Hernia?
Kyphoscoliosis
139
What are the etiologies associated with Hiatal Hernia?
- Increased pressure within the abdominal cavity - Congenital diaphragmatic weakness - Obesity, trauma
140
Hiatal Hernia is known as
Great mimic disease
141
What do most cases of Hiatal Hernia do?
Does not cause any symptoms or specific symptoms
142
Signs and Symptoms of the Hiatal hernia:
- Dull pain in chest - Shortness of breath - Heartburn (typical for sliding hernia) - Heart Palpitation (tachycardia)
143
How do you diagnose Hiatal Hernia?
X ray with liquid Barium salt, or upper endoscopy
144
What are the differential diagnosis of the Hiatal Hernia?
- Ischemic heart disease (chest pain) - GERD because of heartburn - Lung disease (short breath)
145
Ulcer in the esophagus is a complication of what disease?
Hiatal Hernia
146
What is there a stricture of in the complication of a Hiatal Hernia?
Stricture of esophagus
147
What can the complication of Rolling Hernia be?
Development of venous infarction due to its possible strangulation by the diaphragm \*\*\* EMERGENCY \*\*\*
148
What are the recommendations by the chiropractor with Hiatal hernia?
- Restrict activities that raise intra abdominal pressure - Avoid eating near bed time - Diet modification: small frequent bland food
149
What is Gastroesophageal Reflux Disease (GERD)?
A chronic syndrome resulting in mucosal damage caused by stomach acid coming up from the stomach into the esophagus
150
Why does GERD usually happen?
Because the LES opens at the wrong time or does not close properly
151
Failure of the lower esophageal sphincter can be due to:
- CNS depressants - Hypothyroidism - Pregnancy - Alcohol or Tobacco exposure
152
Sliding hernia might be etiology for:
GERD
153
What are some visceral things that are an etiology of GERD?
SLE, asthma, gallbladder stones, and laryngitis
154
What infection is an etiology of GERD?
Helicobacter Pylori
155
Does obesity cause GERD?
YES
156
What are the signs and symptoms of GERD?
- Heartburn - Regurgitation - Dysphagia - Increased salivation - Nausea - Chest pain (radiates to arms and neck)
157
How do you diagnose GERD?
- X-ray with liquid Barium salt - Upper endoscopy
158
What is a differential diagnosis of GERD?
- Heart diseases (chest pain) - Hiatal Hernia
159
What is a major complication of GERD?
Reflux esophagitis necrosis (ulcer near the junction between stomach and esophagus)
160
Is esophageal stricture complication of GERD?
YES
161
What are the 3 complications of GERD?
- Barrett Esophagus - Aspiration Pneumonia - Esophageal Cancer
162
What are life style modifications for GERD?
- Eating not later than 3-4 hours before going to bed - Avoid coffee, alcohol, chocolate, sour, and spicy food - Increased fluid intake - Ginger tea
163
What is Barrett Esophagus?
An abnormal change (metaplasia) in the cells of the lower portion of esophagus
164
What happens to the cells in Barrett Esophagus?
The squamous epithelial cells of the esophageal mucosa are replaced by columnar epithelial cells with \*\*Goblet mucus producing cells
165
What is the etiology of Barrett Esophagus?
- GERD - Central Obesity - Smoking
166
What are the signs and symptoms with Barrett Esophagus?
- Heartburn - Hematemesis - Painful eating - Dysphagia (in case of complication by stricture)
167
How do you diagnose Barrett Esophagus?
Upper endoscopy with biopsy
168
What are complications of Barrett Esophagus?
Bleeding, stricture, and frank esophageal adenocarcinoma
169
How is treatment done with Barrett Esophagus ?
ONLY MEDICAL
170
What is Mallory Weiss Syndrome?
Lacerations - Bleeding from longitudinal tears in the mucosa (not muscular layer) at the esophagogastric junction
171
5-10% of Mallory-Weiss Syndrome have:
Upper GI bleeding episodes
172
What is the pathogenesis of Mallory Weiss Syndrome?
Inadequate relaxation of the musculature of the lower esophageal sphincter during vomiting, with stretching and tearing of the esophageal junction during propulsive expulsion of gastric contents
173
What is the MC etiology of Mallory Weiss Syndrome?
Alcoholism, after frequent severe retching and vomiting
174
What are the different etiologies of Mallory-Weiss Syndrome?
- Hiatal Hernia - Overdose of NSAIDs - Severe vomiting in pregnancy
175
What are signs and symptoms of Mallory Weiss Syndrome?
Episodes of vomiting with bright blood
176
What is the Diagnosis method for Mallory Weiss Syndrome?
Upper Endoscopy
177
What are the complications of Mallory Weiss Syndrome?
- Severe bleeding - Esophageal Rupture (known as BOERHAAVE SYNDROME\*\*\*)
178
Action of Mallory Weiss Syndrome in an office =
CALL 911
179
What is an esophageal Varicies?
Extremely dilated submucosa veins in the low 1/3rd of the esophagus
180
What is the Etiology of Esophageal Varicies?
Portal Hypertension
181
What does Portal Hypertension cause?
1. Posthepatic (suprahepatic) 2. Hepatic (Intrahepatic) 3. Prehepatic (Infrahepatic)
182
What is Post Hepatic (suprahepatic) associated with?
- Chronic right sided heart failure - Budd-Chiari Syndrome
183
What is Budd Chiari Syndrome?
Endophlebitis of the liver veins, or obstruction of the hepatic vein
184
What is Hepatic (Intrahepatic) associated with?
- Liver cirrhosis (MC) - Liver tumors - Amyloidosis
185
Prehaptic (infrahepatic) is associated with,
- Portal vein thrombosis - Portal vein sclerosis - Portal vein congenital stenosis or atresia
186
Esophageal Varicies appear in 65% of patients with \_\_\_\_\_\_
Liver cirrhosis
187
What are manifestations of Esophageal Varicies?
- Varicies produce no symptoms until they rupture, and the hemorrhage develops (hematemesis)
188
What is the diagnosis of Esophageal Varicies?
Upper Endoscopy and CT scan
189
What is the treatment for Esophageal Varicies?
This is life threatening situation and requires immediate hospitalization
190
What is an esophageal diverticuli?
A Diverticulum is an outpouching of the alimentary tract organ wall that contains all visceral layers
191
What are the forms of Esophageal Diverticulum?
1. Zenker’s Diverticulum aka Pharyngoesophageal Diverticulum 2. Midesophageal, aka Traction Diverticulum 3. Epiphrenic Diverticulum
192
What is Zenker’s Diverticulum aka Pharyngoesophageal Diverticulum?
Immediately above the upper esophageal sphincter (FALSE Diverticulum)
193
Midesophageal aka Traction Diverticulum =
Near the midpoint of the esophagus
194
What does Midesophageal aka Traction Diverticulum results from:
Mediastinal Lymphadenitis (as from TB)
195
Where is Epiphrenic Diverticulum?
Immediately above the lower esophageal sphincter
196
What are the signs and symptoms of Esophageal Diverticuli ?
1. Zenker’s diverticulum 2. Traction diverticulum 3. Epiphrenic diverticulum
197
What is Zenker’s Diverticulum?
Food regurgitation in the absence of Dysphagia, can be complicated by aspiration pneumonia
198
What is Traction Diverticulum?
Usually asymptomatic
199
What is Epiphrenic Diverticulum?
Gives rise to nocturnal regurgitation
200
How do you diagnose Esophageal Diverticuli?
- X-ray with contrast liquid - Upper endoscopy
201
What is the treatment of Esophageal Diverticuli?
Surgery
202
What are the different types of Benign tumors of Esophagus?
1. Leiomyomas 2. Polyps 3. Fibromas 4. Lipomas 5. Hemangiomas 6. Neurofibromas 7. Squamous Papillomas
203
What are benign tumors of esophagus?
Mostly mesenchymal in origin and usually lie within the esophageal wall
204
What is a leiomyoma?
MC benign tumor of esophagus, originates from smooth muscle cells
205
Where do Benign tumors most commonly locate ?
Distal 2/3rd of the esophagus, usually they are multiple
206
What are Polyps?
Usually composed of a combination of fibrous, vascular, or adipose tissue, covered by an intact mucosa
207
What age/gender do Benign tumor of esophagus occur?
Occur between 20-50, and have NO gender preference \*\*The potential for malignancy for these tumors is very low
208
What is the rule for signs and symptoms of benign tumors of esophagus?
They are usually asymptomatic, silent, and undetected - Their size is more than 5 cm in diameter, they can come to the clinical attention
209
What are the signs and symptoms of Benign tumors of the Esophagus?
1. Dysphagia (meat and bread) 2. Pain while swallowing (less common) 3. Food regurgitation 4. Bleeding or hematemesis
210
When does bleeding or hematemesis of Benign tumor result from?
Bleeding or hematemesis result from ulceration or necrosis of benign tumors (These manifestations are very rare)
211
What is the diagnosis for Benign tumor of esophagus ?
- Upper endoscopy with biopsy - Ultrasound endoscopy - CT scan - X-ray with Barium liquid
212
How do you treat Benign tumors of Esophagus?
- Removal of polyps through endoscopy - Surgery
213
What are the MC malignant esophageal tumors?
Squamous cell carcinoma and adenocarcinoma
214
Squamous cell Carcinoma represents ______ of esophageal cancer world wide
90-95%
215
Where does squamous cell carcinoma arise from?
The squamous epithelium
216
Adenocarcinoma represents ______ of esophageal cancer in the US?
50-80%
217
What does Adenocarcinoma arise from?
Metaplastic columnar epithelium
218
Where does squamous cell carcinoma usually occur?
In the proximal 2/3rd of esophagus
219
Where does Adenocarcinoma usually occur?
In the distal 1/3rd of esophagus or gastroesophageal junction
220
What is squamous cell carcinoma in direct correlation with?
- Celiac disease - Hot tea with increased concentration of tannins - Tylosis (palmar/plantar hyperkeratosis)
221
What is adenocarcinoma in direct correlation with?
- GERD - Barrett Esophagus - Scleroderma - Zollinger-Ellison syndrome
222
What are the risk factors for both cancers of esophagus ?
- Tobacco smoking and chewing - Alcohol overconsumption - Age after 60-65 y/o - male:female 5:1
223
What are the clinical manifestations for both cancers of esophagus?
- Dysphagia - Weight loss
224
Why is there pain with Malignant tumors of esophagus?
Usually more late symptom, the pain locates behind sternum or epigastrium, could be severe, and is worsened by swallowing of any food
225
Why is there coughing with Malignant esophageal tumors?
Unusual hoarseness, due to involving of the recurrent laryngeal nerve
226
Why are there hiccups of Malignant tumors of esophagus?
Phrenic nerve involvement
227
What are the more severe manifestations of malignant tumors of esophagus?
- Nausea, vomiting, regurgitation of food - due to disruption of normal peristalsis - Bleeding, hematemesis
228
How do you diagnose malignant tumors of esophagus?
Endoscopy with biopsies - Ultrasound endoscopy
229
What are the 3 special imaging choices for Malignant tumors of esophagus?
1. CT scan of chest, abdomen and pelvis, especially if looking for METS 2. PET (Positron Emission Tomography) for estimation of stage, Mets of the cancer 3. Xrays with Barium liquid for esophageal motility studies
230
Where do malignant tumors of the esophagus metastasize to?
- Regional lymph nodes - Aorta - Liver and lungs - Mediastinum
231
What is the treatment for Malignant tumors of the esophagus?
- Surgery - Chemotherapy - Radiotherapy
232
What is Pyloric Stenosis?
A 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
233
What are the etiologies of Pyloric Stenosis?
Congenital and Acquired
234
What is Congenital Pyloric Stenosis?
Hypertrophic pyloric stenosis
235
What is the gender/prevalence in Hypertrophic Pyloric Stenosis (Congenital)?
Male:Female = 4:1 - Prevalence 2-4 per 1,000 newborns
236
What happens with Acquired Pyloric Stenosis?
Scarring of stomach peptic ulcer or duodenal bulb
237
What is the etiology of acquired Pyloric Stenosis?
Tumors (stomach, Pancreatic, etc.)
238
What are the signs and symptoms of Pyloric Stenosis?
- Severe worsening vomiting - Weight loss - Dehydration - Constant Hunger - Visible or palpable peristaltic waves
239
In Hypertrophic Pyloric stenosis (congenital), when do symptoms appear?
In the first 2-6 weeks of life
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In Hypertrophic Pyloric stenosis (congenital), what are the symptoms to appear?
THere is progressive vomiting with partially digested food after each or few feedings
241
How would you diagnose Pyloric Stenosis?
Ultrasound (visualizes the thickened pylorus) Upper Endoscopy
242
What signs do you see from imaging a Pyloric Stenosis?
String sign or “Railroad track sign”
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What blood test would you do for Pyloric Stenosis?
Hypochloremic, metabolic alkalosis with hypokalemia
244
What is treatment for Pyloric Stenosis ?
Surgery
245
What is Acute Gastritis?
Sudden Inflammation of the lining of the stomach
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What are the common etiologies of Acute Gastritis?
- Foodpoisoning/food infection - Severe alcohol consumption - Heavy smoking - NSAIDs, especially Aspirin - Extreme stress (severe trauma, burns, surgery etc.)
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What are the signs and symptoms of Acute Gastritis?
- Constant or sporadic pain in epigastric area (achy, burning, sharp, dull) - Nausea - Vomiting - Fever, chills - Belching, bloating
248
What are the forms of Acute Gastritis, and what is it based on?
\* Based on degree of mucosal damage \* 1. Erosive (mucosal damage) 2. Non erosive 3. Focal 4. Pan Gastritis (diffuse)
249
What is erosive Acute Gastritis?
- Superficial - Deep - Hemorrhagic
250
How do you diagnose Acute Gastritis?
- CBC - Upper Endoscopy - Stool sample for presence of blood - Pregnancy test
251
What is a recommendation by chiropractor for Acute Gastritis?
Avoid alcohol, caffeine, tobacco, hydrate, and check subluxation in neck and dorsal spine
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What is Chronic Gastritis?
Chronic mucosal inflammatory changes in the stomach wall that eventually result in mucosal atrophy and mucosal (intestinal) metaplasia
253
What is the etiology of Chronic Gastritis?
- Helicobacter Pylori (90% !!) - Bile reflux
254
What does Helicobacter Pylori affect in the stomach?
The Antral Part of the stomach
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What is an important predisposing factor for Intestinal type Adenocarcinoma (Stomach cancer) ?
Intestinal (mucosal) metaplasia
256
What are the less common etiologies of Chronic Gastritis ?
- NSAIDs - Autoimmune Diseases (autoimmune chronic gastritis, SLE) - Allergic Response
257
What do etiological factors do for Chronic Gastritis?
Cause multiple focal damages of stomach mucosa
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What are the forms of Chronic Gastritis?
- Hypertrophic - Hyperplastic - Erosive - Antral - Atrophic
259
What are the signs and symptoms of Chronic Gastritis?
- Vague, not severe, non-specific, and do not push a patient to attend physician \*\* DEPENDS ON FORM
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What are the signs and symptoms of Hypertrophic, Erosive, and Antral forms of chronic gastritis ?
- Acute pain in epigastrium and left upper abdominal area - This pain is local, without radiation - Usually this pain develops in 30-60 minutes after the meal
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What are the common symptoms of Hypertrophic, erosive and Antral forms of Chronic Gastritis?
- Heartburn - Belching - COnstipation
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What are the signs and symptoms of the Atrophic form of Chronic Gastritis ?
- Heaviness in epigastrium and left upper abdominal area - Fullness in the stomach after SMALL amount of meal - Diarrhea - Signs of megaloblastic/pernicious anemia
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What can Atrophic form of chronic gastritis be ?
Asymptomatic
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What do ALL forms have of chronic Gastritis?
- Cramping - Nausea, vomiting - Weakness - Intolerance of spicy food
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How do you diagnose Chronic Gastritis?
- CLinical manifestations - Upper endoscopy with biopsy
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What is a peptic ulcer defined as?
A breach in the mucosa of the alimentary tract that extends into the submucosa and deeper
267
Where do peptic ulcers develop?
Only in organs which have exposure to the stomach pepsin and stomach acidity - Stomach duodenum and esophagus
268
What % of peptic ulcers develop in duodenum, what about stomach?
80% Duodenum 20% Stomach
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In Peptic Ulcer, there is a strong causal association with \_\_\_\_\_\_
Helicobacter Pylori infection
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Where is Helicobacter Pylori found in?
100% of duodenal peptic ulcer And 70% of stomach peptic ulcer
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What is a common Etiology of Peptic Ulcer?
Corticosteroid Hormones and Nonsteroidal antiinflammatory drugs (They suppress the production of PG’s which inhibit secretion of Gastrin)
272
What is the sequence of Gastrin?
Gastrin -\> Parietal cells -\> Increased production of HCl
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What can Cigarette smoke lead to?
Peptic Ulcer (Leads to impairment of stomach mucosal blood flow, thus weakening the mucous barrier)
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What is Zollinger-Ellison Syndrome an etiology of?
Peptic Ulcer
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What is Zollinger Ellison Syndrome also known as?
Gastrinoma with overproduction of Gastrin
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Can stressful lifestyle have an effect on the Stomach or Duodenum?
Yes! It can cause peptic ulcer
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How can a stressful lifestyle cause a peptic ulcer?
Hyper production of Catecholamines leads to vasoconstriction of the stomach wall arteries. It affects stomach mucosal blood flow, thus weakens the mucous barrier
278
Is there a Genetic predisposition to Peptic Ulcer?
YES, but it’s more common in children
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What are the risk factors for genetic predisposition for peptic ulcer?
- Type O blood (30% risk of duodenal ulcer) - Hypersecretion of hydrochloric acid, pepsinogen - Familial tendencies
280
What is the pathogenesis of Peptic Ulcer?
Aggressive forces -\> Weaken the mucus barrier (defense forces) -\> Peptic Ulcers
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How does pain normally distribute with Peptic Ulcers?
It can be diffuse, achy, acute, dull, and is associated with mealtime
282
What are the 2 types of pain for peptic ulcers?
- Early (30 min - 1 hour after the meal) typical for stomach peptic ulcer - Late (1.5 - 2 hours after the meal) - typical for duodenal peptic ulcer
283
“Starving” pain (6-7 hours after the meal) is characteristic for ________ peptic ulcer?
Duodenal
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Night pain (at 4-5 am) is characteristic for ______ Peptic Ulcer
Duodenal
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What are the “Seasonal” characteristic of Peptic Ulcers?
Usually in spring or fall for BOTH stomach and duodenal peptic ulcer
286
What does pain distribution tell you about pain With peptic ulcer?
Lesser curvature or Pylorus and Duodenum
287
What kind of pain will you have with peptic ulcer in the lesser curvature?
Epigastric area, without radiation
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What kind of pain do you see with Pylorus and Duodenum with peptic ulcers?
Epigastric area and RUQ
289
If there is pain in the area of cardia with a peptic ulcer, where will you feel this?
LUQ and retrosternal area
290
If there is pain with a peptic ulcer in the Postbulbar area, where will you feel pain?
Mid back on the level of T5-T7 around right scapula
291
What are the signs and symptoms of Peptic Ulcer
1. Pain 2. Dyspepsia 3. Constipation 4. Emotional Instability
292
What may be the ONLY symptom with a peptic Ulcer?
Heartburn (30-80%)
293
What are the signs of peptic ulcer under Dyspepsia?
- Heartburn - Nausea - Vomiting - Belching
294
What will vomiting do in patients with peptic ulcers?
Relieve pain
295
What will belching feel like with Peptic Ulcers?
Sour Taste
296
What are the complications of Peptic Ulcer?
- Bleeding or Hemorrhage - Perforation - Penetration - Pyloric Stenosis - Malignancy of stomach ulcer - Stomach Deformity
297
What is bleeding or hemorrhage of peptic ulcer manifested by?
- Hematemesis (dark color vomiting) - Melena (tarry feces)
298
What can bleeding or hemorrhages of peptic ulcers cause ?
- Weakness - Orthostatic hypotension - Syncope - Thirst - Sweating \*\* POSSIBLE ANEMIA
299
What is Perforation associated with Peptic Ulcer?
When the stomach or duodenal wall is perforated, the stomach or duodenal content spreads into the peritoneal cavity, resulting in peritonitis
300
What are the signs and symptoms of Perforation Associated with Peptic ulcer?
\*\*\* Stabbing upper abdominal pain (10/10) - Pain by radiate to the right shoulder and back - chills and tachycardia - shallow breathing
301
What will you see on X ray with Peptic Ulcer?
Air under diaphragm clearly visible (suggestive of perforated, duodenal ulcer)
302
What is Penetration, associated with Peptic Ulcer?
Same as perforation, but because the involved wall is bound to an adjacent organ (liver, pancreas, greater omenum) the stomach content does not enter the peritoneal cavity.
303
What are “Penetration” signs and symptoms in Peptic Ulcer?
- Pain from upper abdomen radiates to the back \*\*\* - Night pain - Pain CANNOT be relieved by ANTACIDS\*\*
304
What is Pyloric Stenosis in regard to peptic ulcer?
When a peptic ulcer develops close to the pylorus, it may become Stenosis due to development of fibrous tissue causing the pylorus to undergo shrinkage and deformity
305
When can a peptic ulcer become malignant?
This complication develops ONLY in the stomach (stomach ulcer) and usually when peptic ulcer locates on greater curvature\*\*
306
How does the stomach deform with Peptic ulcer?
Peptic ulcer HEALING, with development of scar tissue, so called, “HOURGLASS STOMACH”
307
How do you diagnose Peptic Ulcer?
X ray with liquid barium (ulcer crater, aka hicha) - Upper endoscopy with biopsy tests for H pylori, rapid Urease test in the tissue sample - Ultra sound
308
What is the main infection associated with Peptic Ulcer?
H pylori CBC, Urine analysis, PCR, liver
309
What is a specific diagnosis method for Peptic Ulcer?
Fecal Occult blood test FOBT
310
Why is CT important for Peptic Ulcer diagnosis?
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
311
What is the differential diagnosis for Peptic Ulcer?
- Acute or chronic gastritis - Esophagitis - Pancreatitis - Cholecystitis - Angina Pectoris/Heart attack
312
If heart attack is a differential diagnosis with Peptic Ulcer, what would cause this diagnosis?
Heart attack could be manifested by GI symptoms called Indigestion, which also known as upset stomach or dyspepsia
313
In the case of a heart attack, it is very important to remember that indigestion is \_\_\_\_\_\_\_
Unrelated to eating
314
What is indigestion with peptic ulcer characterized by?
- Severe pain or burning feeling in the upper abdomen - May be also accompanied by: nausea, vomiting, abdominal bloating, belching
315
Indigestion in heart attack (associated with Peptic Ulcer) could be accompanied by:
- Shortness of breath - Pain radiating to left Jaw, Left part of neck or left arm - Chest pain
316
Chest pain in heart attack (unstable angina):
- Lasts for more than a few minutes - Increases in intensity - Is not relieved by rest or by taking Nitroglycerin
317
What’s the treatment of Peptic Ulcer?
- Physical and emotional rest - Anti Helicobacter therapy - Antacids - Diet Modification
318
When can chiropractic help?
Chiropractic spinal manipulation may benefit some people with uncomplicated gastric or duodenal ulcer
319
What are the 3 benign bone tumors of the stomach?
1. Epithelial 2. Mesenchymal 3. Other
320
What are the most common benign tumors of the stomach?
Polyps
321
Stomach Polyps could undergo malignancy in \_\_\_\_\_\_
4-30% of cases (hyperplastic polyps and Adenomas)
322
What is the category of benign tumors under Mesenchymal derived stomach tumors?
Leiomyoma , occupies 2nd position in frequency after polyps
323
What are the 4 types of Mesenchymal benign stomach tumors?
- Leiomyoma - Lipoma - Neurogenic (neurinoma aka schwannoma, aka neurilemmoma) - Vascular (glomus tumors)
324
What are the subcategories under “Other” section of benign stomach tumors?
- Cystic - Inflammatory pseudo tumors
325
What is the Etiology of benign stomach tumors?
Unknown
326
What are the risk factors of benign stomach tumors?
- Chronic H Pylori infection of the stomach - Autoimmune gastritis - Radiation Gastritis - Genetic abnormalities - Long term medication use antacids (proton pump inhibitors PPI)
327
Do patients have symptoms or no with Benign Stomach Tumors?
Most patients are asymptomatic for long period of time
328
When symptoms are present with benign stomach tumors, what do they depend on?
Their severity and clinical outcomes depend on the tumor size, location, and complications (bleeding, ulceration)
329
What are common signs and symptoms of Benign stomach tumors?
- Abdominal Pain - Nausea - Weight Loss - Acute or Chronic bleeding
330
How do you diagnose benign stomach tumor?
- Upper endoscopy with multiple biopsy - CT scan - Endoscopic ultrasonography for submucosa tumors
331
What are complications of benign stomach tumors?
- Malignancy - Bleeding - Ulcerations - Pyloric Canal obstruction
332
How do you treat benign stomach tumors?
Laparoscopic or endoscopic surgery
333
What are Malignant tumors of the stomach?
1. Carcinomas (90-95% of all stomach malignant tumors) 2. Lymphomas 3. Carcinoids 4. Sarcoma
334
Carcinoma is a type of cancer that develops from \_\_\_\_\_
Epithelial cells
335
When do carcinomas occur?
Carcinomas occur when the DNA of a cell is damaged or altered and the cell begins to grow uncontrollably and become malignant
336
\*\* Microscopically, the Gastric Carcinomas are classified to:
- Early gastric carcinoma - Advanced gastric carcinoma
337
What is Early gastric carcinoma?
When a lesion confined to the mucosa and submucosa
338
What is Advanced gastric carcinoma?
When a neoplasm has extended below the submucosa into the muscular wall
339
What are the Macroscopic growth patterns of Gastric Carcinoma?
- Exophytic - Flat or Depressed - Flat advanced (Linitis Pastica) - Excavated
340
What is Exophytic Macroscopic growth pattern?
With protrusion of tumor into the lumen
341
What is Flat or Depressed Macroscopic growth patterns of Gastric Carcinoma?
In which there is no obvious tumor mass within the Mucosa
342
Flat advanced gastric carcinoma is also known as \_\_\_\_\_
Linitis Plastica
343
What is Excavated macroscopic growth patterns of Gastric Carcinoma ?
Whereby the shallow or deeply erosive crater is present in the wall of the stomach
344
What are the 2 most most common carcinomas that are malignant?
- Intestinal Type Adenocarcinoma - Diffuse Stomach Carcinoma
345
What is Intestinal type Adenocarcinoma composed of?
Neoplastic intestinal glands
346
What is Diffuse Gastric Carcinoma composed of?
Gastric - type mucous cells
347
What type of tumor is Intestinal type Adenocarcinoma ?
Exophytic (Projectile) \*
348
What type of tumor is Diffuse Gastric Carcinoma?
A flat tumor
349
What is the latent period of Intestinal Type Adenocarcinoma ?
Relatively LONG latent period
350
What is the latent period of Diffuse Gastric Carcinoma?
Has SHORT latent period \*
351
What are the risk factors of Diffuse Gastric Carcinoma?
UNDEFINED
352
What is the association that is with Intestinal type Adenocarcinoma ?
Close association with chronic gastritis (due to intestinal metaplasia) and Helicobacter Pylori infection
353
What is the association that is Diffuse Gastric Carcinoma ?
THere is NO association with chronic gastritis and Helicobacter Pylori infection
354
Diffuse stomach carcinoma is a typical example of \_\_\_\_\_
Scirrhous cancer (aka scirr) \*\*
355
What is Diffuse stomach carcinoma also known as?
Leather bottle stomach and Linitis Plastica
356
What represents 5% of all gastric malignancies?
Gastric Lymphomas
357
Gastric carcinoma is generally \_\_\_\_\_
Asymptomatic until late in its course
358
Stomach cancer arises from any part of the stomach, but \_\_\_\_\_
A favored location is the lesser curvature of the antrum-pyloric region
359
What are 3 early clinical manifestations of Malignant stomach tumors?
- Heartburn - Loss of appetite, especially for meet - Abdominal discomfort or irritability
360
What is a unique sign of malignant stomach tumor?
Darkness of the skin, frequently locating in the axils and groin, known as ACANTHOSIS NIGRICANS\*\*
361
What do you see with the extremities with Stomach malignant tumors?
Tripe palms (aka ACANTHOSIS PALMARIS) \*\*
362
What is Tripe Palms (aka ACANTHOSIS palmaris)?
A skin condition in which the skin of the palm becomes thick and velvety hyperpigmentation with pronounced folds in the lines of the hand \*\* In over 40% of patients, tripe palms are the 1st sign of undiagnosed cancer
363
What is visible on chest and back in early manifestations of Malignant stomach tumors?
Sudden eruption of multiple Seborrheic Keratosis (Leser-Trelat sign)
364
What are 2 advanced clinical manifestation IN ADDITION to early symptoms and signs of Malignant tumors?
1. Weakness and fatigue 2. Bloating of the stomach, usually after meal
365
What are late clinical manifestations of Malignant tumors?
1. Upper abdominal pain 2. Weight loss 3. Nausea and vomiting 4. Diarrhea or constipation
366
What are very severe late clinical manifestations of malignant tumors?
1. Bleeding (hematemesis, melena) 2. Signs of anemia 3. Dysphagia
367
How does Carcinoma generally metastasize?
Stomach carcinomas give metastasis predominantly through lymphatic system, primarily to regional lymphatic nodes
368
Stomach carcinomas give met to a lymphatic node in the left supraclavicular fossa known as \_\_\_\_
Virchow’s node
369
Where is Virchow’s node?
Left supraclavicular fossa
370
Mets of malignant stomach tumors can send to \_\_\_\_
The liver via the blood
371
What is blood in the liver associated with Mets with stomach tumors, associated with?
It is associated with predominate venous blood flow from GI tract organs to portal vein
372
Where can METS of stomach tumors also send Mets?
To the pancreas and lungs
373
In females, the stomach carcinoma could sometimes metastasize through the abdominal cavity, giving rise to development of secondary ovarian cancer called \_\_\_\_\_\_\_
Krukenberg Tumors
374
What is treatment of Malignant stomach tumors?
- Surgery - Chemotherapy - Radiation Therapy
