Exam 1 Ch. 14 Oral And GI Flashcards Preview

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Flashcards in Exam 1 Ch. 14 Oral And GI Deck (247):
1

What is the general name for an apthous ulcer

Canker sore

2

If a patient has a painful ulceration in their mouth characterized by a white exudate and red rim what do they have

An aphthous ulcer

3

How much of the population is affected by an apthous ulcer

40%

4

Who is most likely to get an aphthous ulcer

Females less than 20 years old (reproductive age) and those with celiac disease/IBD

5

What is also known as the extreme version of an apthous ulcer

Behcet disease

6

What are 3 things that increase the likelihood of an aphthous ulcer

-trauma/foods
-nsaids/corticosteriods
-vitamin B12

7

What is HSV-1

Oral herpes

8

Childhood HSV infection are usually symptomatic or asymptomatic?

80% asymptomatic

9

Most adults have what relationship with HSV

60% are carriers

10

Where is HSV dormant in adults

Trigeminal ganglion (CN v)

11

Reactivation of HSV in adults is known as what

Recurrent herpetic stomatitis

12

Childhood HSV can present itself as symptomatic and known as what?

Acute herpetic gingivostomatitis

13

Does location indicate type of HSV

No!

14

What are major symptoms of HSV

Grouped vesicles resulting in itching/burn, with HA, sore throat

15

Is there a cure for HSV

No, antiviral drugs decrease replication reducing recurrence

16

If HSV spreads to the CNS what is it known as

Herpesviral encephalitis (life threatening/HSV-1)

17

What is also known as thrush

Oral candidiasis

18

What is the occurrence of thrush in new borns

About 40%

19

What is the characteristic of oral candidiasis

Gray/white pseuodmembranes that can be scraped off

20

In what ways is oral candidiasis opportunistic

Decreases immune status, broad spectrum antibiotics, diabetes

21

How do physicians make diagnosis of the oral candidiasis

Leukoplakia, candidemia, oral CA

22

What are the two types of an oral proliferative lesion

Fibroma and pyogenic granuloma

23

Where is a fibroma most commonly found

Along the bite line

24

What is a characteristic of a fibroma

A nodular mass following chronic irritation

25

What is another name for a pyogenic granuloma

Pregnancy tumor

26

Why are pregnant women and children likely to get pyogenic granuloma

Hormonal factors, irritation, rapid growth

27

What are characteristicsof a pyogenic granuloma

Hemangioma on gingiva, red/purple

28

What is the treatment of a pyogenic granuloma

Remove irritant or excision

29

What is the difference between thrush and leukoplakia

Thrush can be scraped off, leukoplakia cannot

30

What are characteristics of leukoplakia

Raised white patch that can’t be scraped off due to epithelial hyperplasia/keratosis

31

Who is most likely to get leukoplakia

Males (2x) age 40-70 years

32

What are the risks of leukoplakia

Inflammation, tobacco, alcohol, candidiasis

33

How is leukoplakia diagnosed

Rule out cancer through biopsy, 25% are precancerous

34

If a leukoplakia is precancerous what kind is it

Squamos cell carcinoma

35

What is erythoroplakia

Red oral lesion with irregular borders

36

Who is most likely to get an erythroplakia

Males age 40-70

37

What increases risk of erythroplakia

Tobacco use, >50% transition into cancer

38

What type of cancer is about 2x more common among males

Oral cancer

39

What mutations are common in oral cancer

TP53 mutations from sites of dysplasia

40

Are multiple primary tumors common in squamos cell carcinomas

Yes

41

What is the prognosis of those with squamos cell carcinoma

Poor <50% long term survival, early detection best, pain/dysfunction = advanced stages

42

What are the risks of squamos cell carcinoma

Alcohol, tobacco, >30 years old, HPV-16

43

What are characteristics of oral squamos cell carcinomas

Raised firm lesion of white or red with irregular borders

44

What are the 2 most common places of oral squamos cell carcinoma

Ventral (inferior) tongue and floor of the mouth

45

Where is oral squamo cell carcinoma most likely to invade or metastasize

Cervical nodes

46

HPV associated oral squamos cell carcinoma is most likely located where

Base of tongue and tonsillar crypts

47

Where are primary salivary gland pathologies found

Rare but MC in parotid glands

48

What is indicated by dry mouth due to decreased saliva production

Xerostomia

49

What is an autoimmune attack on salivary AND lacrimal glands

Sjogren syndrome

50

What happens to the tongue from xerostomia

It can fissure and ulcerate creating risk for cadidiasis

51

What is sialadenitis

Inflammation and enlargement of salivary glands

52

What are two causes of sialadenitis

Viral and bacterial

53

Viral sialadenitis is mc caused from what

Mumps virus infection

54

What can viral sialadenitis create in adults

Pancreatitis and orchitis

55

What causes bacterial sialadenitis

MC staph. Aureus infection with dehydration being a risk

56

What is it called when saliva collects within tissue creating an inflamed cyst

Mucocele follows ductal obstruction

57

What is the liklihood of cancers ratio to salivary gland size

Smaller salivary glands tumors are less common but are greater cancer risk and vice versa for larger glands

58

Who is mostly impacted by salivary gland neoplasms

MC females 60-80 years old

59

What is the mc impacted gland from salviary gland neoplasms

Parotid

60

What is a pleomorphic adenoma

Mc a benign tummor that is painless and encapsulated

61

What is an invasive, affixed form of a parotid gland neoplasms that is aggressive

Carcinoma ex pleomorphic adenoma

62

What is Zenker’s diverticulum

Lower esophageal outpouching

63

What causes Zenker’s diverticulum and what does it affect

From increased pressure in the pharynx creating uncoordinated swallowing and cricopharyngeus muscle spasm

64

Why is halitosis associated with zenker’s diverticulum

A bolus accumulates within the lower esophageal outpouching

65

How is zenker’s diverticulum diagnosed

Through barium swallowing and video fluoroscopy

66

Which esophageal lesion is associated with atresia, tracheal fistula, stenosis that produces regurgitation

Mechanical esophageal lesion

67

Which esophagial lesion is produced from achalasia resulting in aperistalsis

Functional esophageal lesions

68

What happens in ectopia esophageal lesion

Mostly asymptomatic that is an ectopic gastric mucosa (inlet patch ) located in the upper 1/3

69

What does esophageal varices of esophageal lesions follow

Follows portal HTN

70

What is achalasia

Failure to relax due to functional esophageal obstruction

71

What are the 3 causes of achalasia

Incomplete LES relaxation, increased LES tone, esophageal aperistalsis

72

How is achalasia treated

Dialation or injection of botulinium toxin

73

Dilated esophagus from achalasia produces what

Dysphagia, regurgitation, “heart burn” producing weight loss sometimes

74

How is achalasia diagnosed

Barium swallowing producing “bird beak sign”

75

What is the most common type of achalasia

Primary that is due to loss of inhibitory innervation to LES (idiopathic)

76

What causes secondary achalasia

Co-morbidity impairing LES funx

77

What are common co-morbidities causing secondary achalasia

Chagas disease, diabetes, polio, inflammation near Auerbach’s plexus

78

What causes esophageal varices

Portal venous congestion producing portal HTN

79

What are 2 causes of portal venous congestion in esophageal varices

Blood in esophageal venous plexus making it dilated/tortuous, or cirrhosis from alcohol/flatworm

80

When are esophageal varices at risk for severe hemorrhage

When its asymptomatic

81

How does advanced cirrhosis affect the CNS

Liver failure produces toxins into CNS producing hepatic encephalopathy

82

What are 2 main symptoms of esophagitis

Odynophagia and dysphagia

83

What is GERD

Gastroesophageal reflux disease = idiopathic LES dysfunction

84

What is the most common cause of esophagitis

GERD

85

What is the MC GI complaint

GERD

86

What are some symptoms of GERD

Dysphagia, heartburn, “sour brash”

87

What are major risks of esophagitis

Obesity and increased gastric volume

88

What are some treatments/managements of GERD

Sleep at angle, weight loss, PPI, not laying down within 2 hours of eating, no carbonated drinks

89

What causes chemical esophagitis

Acute, pill induced, chemo, irradiation

90

Who is most likely impacted by infectious esophagitis

Debilitated and immunosupressed

91

When is infectious esophagitis most likely to hhappen

After an ulcer from microbes (fungal/viral)

92

What cases esophageal lacerations

Trauma from coughing or vomiting

93

What type of tear is most likely a part of esophageal laceration

Mallory weiss tear

94

Where is a longitudinal tear located at in a mallory weiss tear

Gastroesophageal jxn

95

Mallory weiss tear is associated with how many upper GI bleeds

50%

96

What is a hiatal hernia

Stomach protrudes to thorax widening esophageal hiatus

97

What are the characteristics of axial hiatal hernia

“Sliding” it is the MC and it is bell shaped

98

What are the characteristics of non axial hiatal hernia

“Rolling” and part of the stomach protrudes causing stragulation and obstruction

99

Who is mostly affected by hiatal hernia

70% are greater than 70 years old

100

What hiatal hernia is symptomatic

Non axial which mimics GERD causing possible perforation/hemorrhage

101

What is Barret esophagus

Metaplastic columnar epithelium replaces the stratified squamos epithelium after stomach acid damage

102

Where does barret esophagus take place

The distal esophagus

103

Who is most at risk for barrett esophagus

Caucasian males that are obese and 40-60 years old

104

What symptom of barret esophagus prompts an evaluation

GERD

105

What are some complications from barrett esophagus

Esophageal adenocarcinoma, ulcerations, strictures

106

How do you diagnose barrett esophagus

Esophagoscopy and biopsy under regular surveillance

107

How do you treat barrett esophagus

Stop irritants or meds (PPI’s, surgery)

108

What are the 3 types of esophageal tumors

Leiomyoma, adenocarcinoma, squamos cell carcinoma

109

Which esophageal tumor is MC in the US and which is MC worldwide

Adenocarcinoma = MC in US and squamos cell carcinoma = MC worldwide

110

What are the risks for an adenocarcinoma esophageal tumor

Similar to GERD

111

What is an adenocarcinoma esophageal tumor caused by

Esophageal metaplasia/dysplasia

112

Which esophageal tumor makes up 90% of all esophageal CA

Squamos cell carcinoma

113

What are indicators of an advanced adenocarcinoma

Obstruction = dysphagia/odynophagia

114

What are some symptoms of an advanced adenocarcinoma

Vomit, cachexia, fatigue

115

Which esophageal tumor has early lymphatic invasion and what is the prognosis

Adenocarcinoma, poor <25% at 5 years

116

How do you diagnose an adenocarcinoma

Esophagoscopy, endoscopy = if abnormal image shown then biopsy taken

117

What are 3 characteristics of a diffuse infiltration of an esophageal adenocarcinoma

Flat/raised, exophytic, ulceration

118

Who is most at risk for a squamos cell carcinoma esophageal tumor

African american males older than 45 years with alcoholism, HPV, or taking nitrosamines

119

Where is squamos cell carcinoma going to be impacting most, geographically

Rural

120

Why do those with squamos cell carcinoma (esophageal) have a poor prognosis <10% at 5 years

Due to lymphatic mets

121

What does a cardio-pulmonary invasion with an esophageal squamos cell carcinoma cause

Possible fistula

122

What can also result from a squamos cell carcinoma (esophageal)

Strictures, hemorrhage

123

Mucosal ulcerations can produce hemorrhages producing what

Hematemesis and melena

124

What is the cause of the most common infection of the stomach

Helicobacter pylori

125

What is an inflammation of gastric mucosa

Gastritis

126

What are the 2 forms of the gastric inflammatory diseases

Acute and chronic gastritis

127

Are neutrophils associated with acute or chronic gastritis

Acute gastritis

128

What can cause the acute erosive hemorrhagic gastritis

Hemorrhage that is from possible erosion/ulceration

129

Acute gastritis is dose dependent with what

Nsaids

130

What meds are associated with acute gastritis

PPI’s, H2 receptor antagonists = decrease gastric acidity

131

Hematemsis with acute gastritis is associated with who

Alcoholics

132

Acute peptic ulcerations can cause what type of hemorrhage

Hematemesis

133

What are 3 causes of acute peptic ulceration

1. Severe physiological stress
2. High dose of NSAIDS
3. Intracranial disease(vagal nerve)

134

What is rare with chronic gastritis

Hematemesis

135

What are the multifactorial causes of chronic gastritis

-helibacter pylori
-increased age
-other stressors

136

What can follow chronic gastritis

-peptic ulcer disease
-gastric adenocarcinoma

137

What are the risks of chronic gastritis

Poor childhood sanitation/hygeine

138

Dysplasia/metaplasia from chronic gastritis produces what

Carcinogenic = gastric adenocarcinoma, MALT lymphoma

139

Who is most commonly affected by autoimmune gastritis

Elderly about 60 years old

140

What antibodies are released from autoimmune gastritis

Parietal cells and I.F.

141

Why does autoimmune gastritis complicate erythropoiesis

Pernicious anemia

142

What are two identifiers of peptic ulcer disease

Pin point pain (granulation tissue), and hemorrhage

143

Where doe peptic ulcer disease affect

Proximal duodenum(4x) and gastric antrum

144

Who is more at risk from peptic ulcer disease

Males

145

What factors contribute to peptic ulcer disease

Increase acidity (ulcerogenic), nsaids (decrease gastric protection), h. Pylori

146

Why can peptic ulcer disease be a medical emergency

Possible perforation/hemorrhage

147

What is a major symptom of peptic ulcer disease

Epigastric pain 1-3 hours postprandial

148

Which type of peptic ulcer disease is releived postprandial and which type worsens postprandial

Duodenal = releif, gastric= worse

149

What are 3 types of gastric polyps and which is MC

Inflammatory and hyperplastic polyps (MC), fundic gland polyp, gastric adenomas

150

Who is most commonly afffected by a gastric adenoma

Males age 50-60

151

What is associated with 90% of all stomach cancers

Gastric adenocarcinomas

152

Who mostly gets gastric adenocarcinomas

Males age 55

153

Males from which country are more likley to get gastric adenocarcinomas

Japan

154

What is pyloric stenosis

Hypertrophy/narrowing of pyloric sphincter

155

What is a characteristic of pyloric stenosis in newborns

Non bile stained projectile vomiting

156

Who is most likely to get pyloric stenosis

White males, turner syndrome

157

What treatment is associated with pyloric stenosis

Pyloromyotomy

158

Intestinal obstructions are most commonly found where

In SI

159

What is an abdominal wall defect allowing the intestine to protrude =inflammation

Hernia

160

What is an intestinal obstruction with adherent segments

Adhesions producing inflammation = fibrosis

161

What is a proximal segment telescoping into a distal segment

Intussusception

162

What is a twisting loop of bowel

Volvulus, possible infarction

163

What is a congenital outpouching of the SI

Meckel diverticulum

164

What is a lack of neurologic ganglia in the rectum

Hirschsprung disease

165

What causes hirschsprung disease

Defective neural crest cell migration

166

Who is impacted more by hirschsprung disease

Females

167

What arteries are impacted by ishemic bowel disease

Superior mesenteric, inferior mesenteric, celiac

168

Ischemia in ischemic bowel disease causes what

Hypotension/occlusion, mucosal infarction

169

What are 3 types of ischemic bowel disease

Thrombosis, arterial embolism, non occlusive ischemia

170

What are characteristics of chronic ischemic bowel disease

Episodic bloody diarrhea mimicking IBD

171

What are characteristics of actue ischemic bowel disease

Abdominal pain, frank blood in stool, risk for septic shock = 50% mortality rate

172

What is angiodysplasi

Vascular lesion

173

Where are angiodysplasias commonly found

MC in cecum, or ascending colon

174

What are angiodysplasias hypothesized to develop following what

Mechanical stress (constipation)

175

What are the two types of hemorrhoids

Internal = above anorectal line, external = below anorectal line

176

When hemorrhoids irritates surrounding tissues what happens

Perianal itching, frank blood in stool

177

What are the top 3 malabsorption diseases in the US

Celiac, crohn, pancreatic insufficiency

178

What is excessive fat in feces called

Steatorrhea

179

What is bloody diarrhea

Dysentery

180

What is celiac disease

Immune mediated reaction to gliadin

181

What produces villous atrophy and what disease is it associated with

B and t cells damaged within celiac disease

182

Where does celiac disease impact

Duodenum and jejunum

183

What is dermatitis herpetiformis

Celiac disease manifesting on the skin

184

What disease is associated with cycles of mucosal injury, malnutrition, inflammm.

Environmental enteropathy

185

Autoimmune environmental enteropathy involves what

Villus flattenin

186

When is lactos intolerance acquired

In young adulthood MC

187

What is an indication of traveler’s disease

>3 unformed or loose stools within 24 hours

188

What is the mc bacterial enteric pathogen in the US

Campylobacter jejuni

189

Campylobacter jejuni may initiate what

Reactive arthritis

190

How long does acute self limited colitis last

<1 month

191

What is pseudomembranous colitis

Antibiotics disrupts flora (antibiotic associated colitis)

192

What causes pseudomembranous colitis

Clostridium difficile overgrows = enterotoxins= inflammation/cell death

193

Who is most susceptible to pseudomembranous colitis

Old age, hospitilization, decreased immunity

194

What are psuedomembranes

Cellular debris and leukocytes

195

What is viral gastroenteritis

Infection that leads to superficial injury to the stomach/SI

196

1/2 of all gastroenteritis is associated with what

Viral gastroenteritis

197

What causes viral gastrroenteritis in children

Rotavirus

198

What causes viral gastroenteritis in adults

Norovirus

199

How does one get viral gastroenteritis

Direct viral contact via contaminated food/H2O

200

What is treatment for viral gastroenteritis

Self limiting, fluid replacement

201

What type of parasitic disease affect greater than 1/2 the world

Ascaris lumbricoides

202

What is a flagellated protozoa that resists cold and chlorine

Giardia lamblia

203

What is giardia lamblias affect on the body

Its non-invasive and alters the SI enzymes

204

What is another name for giardiasis

Beaver fever

205

What is giardiasis

Malabsorption = diarrhea, anorexia, cramps

206

What is sigmoid diverticulitis

Acquired diverticulum usually within the sigmoid colon

207

What increases risk of sigmoid diverticulitis

Age and refined foods, decreased fiber = increase strain/pressure

208

What is another possible cause of sigmoid diverticulitis

Possible infection = perforation = hemorrhage

209

Who is most susceptible to sigmoid diverticulitis

50% of people > 60

210

What is the sensation of inadequate BM and what is it usually associated with

Tenesmus with sigmoid diverticulitis

211

What are main treatments for sigmoid diverticulitis

Increased fiber = decresed exaggerated peristalsis= reduce intraluminal pressure

212

When does irritable bowel syndrome usually occur

Mc females 20-40 years old, psychological stress

213

What is inflammatory bowel disease

Abnormal GI immune response = chronic/relapsing

214

What are the 2 types of inflammatory bowel disease

Crohn disease and ulcerative colitis

215

Where does crohns disease affect

Entire GI, MC in ileum

216

Where does ulcerative colitis usually affect

Rectum/distal colon within the mucosa/submucosa

217

What is the body’s reaction during inflammatory bowel disease

Microbiota, epithelial dysfunction, aberrant immune response

218

What happens in crohns disease

Regional inflammation/fissures/ creeping fat

219

What type of mediated reaction is with crohns disease

T cell mediated

220

What does crohns disease open up the GI up to

Risk for adenocarcinoma

221

What is ulcerative colitis

Superficial inflammation = mucosal ulcerations

222

Where does ulcerative colitis start

Always begins in rectum to proximally

223

Who is most likley to get ulcerative colitis

20-25 years old

224

What is inhibitory to ulcerative colitis

Smoking

225

What is ulcerative colitis associated with

Toxic megacolon = polyarthritis, AS, eye irritation

226

What do relapsing episodes of ulcerative colitis look like

Stool is grossly bloody/mucoid

227

What can ulcerative colitis lead to

Adenocarcinoma

228

What is an autosomal dominant cancer syndrome

Familial adenomatous polyposis

229

What does familial adenomatous polyposis affect

APC gene on chromosome 5

230

How many people develop cancer from familial adenomatous polyposis

100% mc before age 30

231

What is common in the stool. Of those with familial adenomatous polyposis

Occult blood with possible anemia

232

How is familial adenomatous polyposis diagnosed

>100 adenomas

233

What is lynch syndrome

Hereditary cancer syndrome

234

How does one get lynch syndrome

Inherited mutations alter DNA mismatch repair

235

What is the most common type of tumor of the colon

Adenocarcinomas next is carcinoid tumors

236

What is the mc malignancy of the GI tract

Colorectal adenocarcinoma

237

Who is mc affected with colorectal adenocarcinoma

Ages 50-70 males in developed nations with highly processed diets

238

What dietary risks are associated with colorectal adenocarcinomas

Low fiber=low stool bulk, low antioxidants, high fat/carbs,

239

Where is colorectal adenocarcinoma mc mets to

Liver

240

What are the two types of small intestine tumors

1/2=adenocarcinomas, 1/2=carcinoids

241

Where are most of the tumors of the SI

Duodenum

242

What is the mc cause of acute abdomen

Acute appendicitis

243

How does early compare to late acute appendicitis

Early=periumbilical/epigastric discomfort
Late=RLQ tender/deep constant pain progress to sharp

244

Who is mc affected by acute appendicitis

Male adolescents

245

What is a common cause of acute appendicitis

Obstruction = ischemia = inflammation

246

If acute appendicitis results in a rupture what happens

High morbidity/mortality or sepsis

247

What is the mc tumor of the appendix

Carcinoid possible site for mucocele