Exam 1: GI Cont. Flashcards by Rachel Smith

MC stomach infection

H. Pylori

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Normal stomach defenses

Bicarbonate
Mucus
Mucus blood flow
Epithelial regeneration

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NSAIDs inhibit what secretion

Bicarbonate

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Inflammation of gastric mucosa

Gastritis

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Significant bleeding caused by acute gastritis

Acute erosive hemorrhagic gastritis

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3 typical NSAIDs

Aspirin
Ibuprofen
Naproxen

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Symptoms of acute gastritis

Epigastric pain 
N + V
Anorexia 
Hematemesis 
Melena

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Acute peptic ulceration aka

Stress-related mucosal Disease

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Small shallow ulcerations MC in stomach and duodenum, with symptoms of N + V, coffee-ground hematemesis

Stress-relelated mucosal disease

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Caused of acute peptic ulceration

Severe physiologic stress
High NSAID dose
Intracranial disease

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___ is rare in chronic gastritis

Hematemesis

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Potential causes of chronic gastritis

H pylori

Increase age

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Chronic gastritis can lead to

Peptic ulcer disease

Gastric adenocarcinoma

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70-90% of all cases of chronic gastritis positive for ____

H pylori infection

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Risks for developing H pylori gastritis

Poor childhood sanitation/ hygiene

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Autoimmune gastritis involves antibodies against

Parietal cells and Intrinsic factor

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Autoimmune gastritis MC in what population

> 60 yo

Females

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Autoimmune gastritis can cause what form of anemia

Pernicious

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2 types of ca H pylori gastritis can cause

Gastric adenocarcinoma

MALT lymphoma

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Autoimmune gastritis complicates ___

Erythropoiesis

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Solitary “punched out” ulceration with pin point pain indicative of

PUD

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PUD MC in what locations

Proximal duodenum

Gastric antrum

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PUD contain what tissue

Granulation

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Freq of PUD in population

10% males

4% females

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Risks for PUD

H pylori NSAIDs Smoking Alcohol

5-10% of everyone with H pylori will develop

PUD

Symptoms of PUD

N/V Bloating Cachexia Epigastric pain (1-3 hrs postprandial)

Shared features of gastric and duodenal ulcers

Eating influences pain Relieved by alkaline substances Worse at night

Duodenal ulcers classic presentation

Postprandial relief (dairy)

Gastric ulcer classic presentation

Worse postprandial

Risk for gastric polyps

Chronic gastritis

___ makes up 75% of gastric polyps

Inflammatory and hyperplastic Polyps

___ makes up 15% of gastric polyps

Fundic gland polyp

___ makes up 10% of gastric polyps

Gastric adenomas

Gastric adenomas MC in __

Males (older age)

1/3 of gastric adenomas transition to

Adenocarcinomas

90% stomach cancer

Adenocarcinoma

10% stomach cancer

Lymphomas and carcinoid tumors

Stomach cancer MC ___ age ___, and ___ ethnicity

Males 55 Japanese

Advanced symptoms of stomach cancer

``` Gastritis Altered bowels Nausea Anorexia Weight loss Hemorrhage Anemia ```

Hypertrophy/ narrowing of pyloric sphincter

Pyloric stenosis

Freq of pyloric stenosis

1 in 400 births

Risks for pyloric stenosis

History Caucasian Males Turner syndrome

Symptoms of pyloric stenosis

Hyperperistalsis Projectile vomiting w/o bile Dehydration Irritable

Small and large intestine disorders commonly causes ___ and ___

Malabsorption and diarrhea

Intestinal obstructions MC in ____

Small intestine

4 common mechanical obstructions in intestine

Hernia Adhesion Intussusception Volvulus

Hernia

Abdominal wall defect | Allows segment of intestine to protrude

Adhesion

Chronic inflammation due to adherent segments

Intussusception

Proximal segment telescopes into distal segment Infants Frank blood

Volvulus

Twisting loop of bowel Frank blood

MC GI vascular disorder

Hemorrhoids 5% adults

Dilated hemorrhoidal venous plexus risks

>50 yo Pregnancy Constipation Liver cirrhosis

Internal hemorrhoids

Above anorectal line

External hemorrhoids

Below anorectal line

Recurrence of hemorrhoids is

5-50%

Vascular lesion MC in cecum or ascending colon

Angiodysplasia

20% of lower intestinal bleeds

Angiodysplasia

Ischemic bowel disease can occur due to occlusion of which arteries

Superior mesenteric Inferior mesenteric Celiac

Chronic ischemic bowel disease

Mimics IBD

Acute ischemic bowel disease

Severe abdominal pain | N and V

Acute ischemic bowel disease is a risk for ___ and prognosis is ___

Septic or hypovolemic shock 50% mortality

malabsorption conditions in US due to

Celiac Crohn’s Pancreatic insufficiency

Chronic diarrhea decreases absorption of which nutrients

``` Fats Carbs Proteins Vit ADEK Minerals Electrolytes Water ```

Steatorrhea

Excessive fat in feces Frothy, greasy, yellow

Dysentery

Bloody diarrhea following infection

Features of malabsorption

``` Weight loss Muscle wasting Flatulence Anorexia Abnormal distention ```

Consequences of malabsorption

``` Iron deficiency anemia Osteopenia Tetany (low calcium) Amenorrhea Infertility Neuropathies (low Vit b12) ```

Immune mediated reaction to gliadin

Celiac disease

In celiacs, lymphocytes cause _____ primarily in duodenum and jejunum

Villous atrophy

Genes associated with celiacs

HLA DQ2 | HLA DQ8

Gluten can be broken down into

Gliadin | Glutenin

Congenital outpouching of SI

Meckel’s diverticulum

Characteristics of Meckel’s

2 in long 2% pop 2X risk males 2% asymptomatic

MC cause of acute abdomen

Acute appendicitis

Freq of acute appendicitis

7% US population

Early symptoms of acute appendicitis

Periumbilical/ epigastric discomfort

Late signs of acute appendicitis

RLQ | Deep, sharp, constant pain

Leukocytosis is characteristic of

Acute appendicitis

Acute appendicitis MC in

Adolescents Young adults Males

Common cause of acute appendicitis

Obstruction

MC tumor of appendix

Carcinoid

MC form of gastric Ca

Adenocarcinoma

Sigmoid diverticulitis risks

Age (50% >60 yo) | Low fiber

Tenesmus is ___ and is common in ____

Sensation of inadequate bowel movements Sigmoid diverticulitis

Celiac freq

1% US and Europe Age 30-60

Untreated celiacs can increase risk of

Intestinal adenocarcinoma

Diagnosis of celiac

Duodenal biopsy IgA tissue transglutaminase IgG deaminated gliadin

Additional tests that can be performed for celiacs

DEXA | Nutritional tests

Celiac disease manifesting on skin

Dermatitis herpetiformis

10% of celiac patients develop ___, which appear as ____

Dermatitis herpetiformis ``` Itchy Small blisters (arms, elbows, legs, buttocks) ```

Environmental enteropathy aka

Tropical sprue

Tropical sprue common in

Children 2-3 yo Tropics

Environmental enteropathy includes cycles of

Mucosal injury Malnutrition Inflammation

Hypotheses for tropical sprue

Autoimmune causing villus flattening + Infectious component

MC form of lactose intolerance

Acquired

Lactose intolerance is rarely congenital, which is due to ___

Autosomal recessive disorder

Diagnosis for lactose intolerance

Breath hydrogen test