Gastrointestinal Flashcards
(87 cards)
1
Q
What type of secretions do these salivary glands secrete?
- Parotid
- Sublingual
- Submandibular
A
Parotid: serous
Sublingual: mucous
Submandibular: mixed
2
Q
Symptoms of salivary gland inflammatory lesions
A
dry mouth–xerostomia
gland swelling
w/pain
3
Q
examples of inflammatory salivary gland lesions
A
sialoliths
mumps
sarcoidosis
4
Q
when is most common to see swelling and tenderness in an obstructive salivary gland lesion
A
before meals
5
Q
another name for inflammatory lesions of the salivary glands
A
sialendenitis
6
Q
what is sialolithiasis? what is affected in this disease? diagnose and tx?
A
an inflammatory salivary gland lesion
affects the submandibular duct
common disease
diagnose with occlusal films and sialoendoscopy
7
Q
what is sialolithiasis? what is affected in this disease? diagnose and tx?
A
an inflammatory salivary gland lesion
affects the submandibular duct
common disease
diagnose with occlusal films and sialoendoscopy
8
Q
What is sjogren’s disease
A
an autoimmune disease causing intense lymphocytic infiltrate into salivary glands
9
Q
who is mostly affected by sjogren’s
A
females in 5th decade
10
Q
what are the symptoms of sjogren’s and what is the main concern for these patients
A
symptoms: xerostomia and kerato-conjunctivitis sica (dry eyes)
Concern: increase incidence of developing lymphomas
11
Q
Sjogren’s clinical manifestations
A
bilateral parotid enlargement
xerostomia, cheilitis
keratoconjunctivitis sicca
50% other immune mediated diseases such as rheumatoid arthritis and lupus
12
Q
which gland is most commonly involved in salivary gland tumors
A
parotid gland; most benign
13
Q
what happens to the parotid gland in a salivary gland tumor…what if its malignant?
A
can become enlarged and if malignant can involve the facial n causing pain, paralysis, numbing
14
Q
pleomorphic adenoma
- ->what is it
- ->benign or malignant?
- ->where does it occur most
- ->what does it feel like
A
mixed tumor of salivary gland (epithelial and mesenchymal) usually benign 60% occur in the parotid gland 10% recurrence firm on palpation
15
Q
what is the most common neoplasm
A
pleomorphic adenoma
16
Q
warthins tumor
- ->what is it
- ->what does it usually affect
- ->benign or malignant
- ->recurrence
- ->who does it affect
- ->what cells are involved
- ->how does it present
A
salivary gland tumor usually affects the parotid gland usually benign 10% recurrence firm yet cystic mass oncocytes, lymphocytes males
17
Q
mucoepidermoid carcinoma
- ->what is it
- ->how does it present
- ->benign or malignant
- ->what cells
- ->what does it affect
- ->prognosis
A
salivary gland tumor (makes up 15% of all of them)
bluish in color
malignant in nature
squamous and mucous cells present
usually affects the parotid and minor glands (palate)
grade determines behavior
18
Q
esophageal disease can occur by (3)
A
obstruction
functional problems
esophageal varices
19
Q
esophageal varices
A
result of portal hypertension (high pressured vessels in bottom of esophagus)
asymptomatic but can rupture causing hemorrhage/death
20
Q
obstruction of the esophagus can be cause by
A
mechanical stimulus
such as post inflammatory stenosis
21
Q
functional problems affecting the esophagus include
A
dis coordinated contraction
muscle spsms
22
Q
external agents causing esophagitis
A
acids
akalis
heavy smoking
pill lodging
23
Q
iatrogenic causes of esophagitis
A
chemotherapy
radiation
graft vs host disease
24
Q
infectious agents causing esophagitis
A
fungal-candidiasis
more common in immune suppressed
25
can viruses develop from esophagitis?
YES
| CMV, HSV, fungal esophagitis
26
what is reflux esophagitis
| -->complication?
reflux of gastric juices
GERD: gastroesophageal reflux disorder
associated w/ mucosal injury
complication: barrett esophagus
27
symptoms of reflux esophagitis
dysphagia
heartburn
regurgitation of gastric contents
odynophagia: pain on swallowing
28
barrett esophagus
intestinal metaplasia within the esophagus squamous mucosa
complication of GERD
increased risk of adenocarcinoma
most people w/barrett esophagus do not develop tumors of the esophagus
29
diagnostic features for barrett esophagus
extension of abnormal mucosa above gastro-esophageal junction
demonstration of squamous metaplasia
30
what is the first pass effect
when oral medications are administered and the material is absorbed from the GI tract to the liver where it is metabolized before reaching the inferior vena cava and entering circulation
31
oral manifestations of GI reflux
erosion of the enamel
32
benign lesions of esophagus
leiomyomas- smooth mm tumors
squamous papillomas
lipomas- tumor of fat
33
esophageal adenocarcinoma is associated with what
GERD
34
esophageal adenocarcinoma occurs in what gender more frequently
males (7:1)
35
where does esophageal adenocarcinoma most commonly develop
distal third of esophagus
36
survival rate of esophageal adenocarcinoma
w/ advanced disease very poor survival
37
squamous cell carcinoma
- presentation
- age affected
- gender frequency
- risk factors
- where in the body does it develop
- prognosis
MOST COMMON ESOPHAGEAL MALIGNANCY WORLDWIDE
- presents as a polypoid, fungating mass
- 45 yrs old, adults
- more common in males (4:1)
- risk factors: alcohol, tobacco, hot beverages, caustic esophageal injuries
- occurs in the middle third of the esophagus
- poor prognosis
38
two types gastritis
Acute: abrupt, transient
Chronic: longer duration
both AUTOIMMUNE
- loss parietal cells
- decrease intrinisc factor and B12
- result in pernicious anemia
39
acute gastritis symptoms and complications
asymptomatic or painful (variable)
may see ulceration, erosion, hemorrhage
nausea and vomitting
40
acute gastritis etiology
- cigarettes
- alcohol
- stress
- ischemia
- NSAID's and aspirin
- infection
41
acute gastritis pathology
- punctate hemorrhage/erosion
- edema
- acute inflammation
42
chronic gastritis etiology
autoimmune
-e.g. pernicious anemia
infection, chemical
43
chronic gastritis
- what bacteria is the culprit?
- most common affected population
primarily caused by infection with H. Pylori in patients w/ H. Pylori autoimmune-gastritis
-most commonly acquired in childhood
44
chronic gastritis--Treatment
antibiotics and proton pump inhibitors
45
chronic gastritis--Pathology
```
flat epithelium
chronic inflammation
atrophy
intestinal metaplasia
can get ulceration
cancer risk 2-4%
```
46
H pylori most commonly seen in what disease
chronic gastritis
47
H pylori see in what age
colonizes in 50% of people over the age of 50
48
H pylori morphology
S shaped gram negative rods
| flagellated
49
H pylori present in which ulcers
65% of gastric ulcers
| 85-100% of duodenal ulcers
50
H pylori tx
antibiotics, proton pump inhibitors
51
what is a peptic ulcer and what causes it
- where are they found most
- healing?
- lifetime risk?
loss of continuity of epithelial or epidermal lining
- caused by acid--peptic juices
- 98% found in duodenum or stomach
- intermittent healing, recurrent
- 10% lifetime risk
52
peptic ulcer complications
painful
cause bleeding (15-20%; 1/4 deaths)
perforations in 5%; 2/3 deaths
ostructions: edema, scarring in 2%
53
stomach neoplasia (benign)
hyperplastic, fundic gland polyps, adenomas and inflammatory polyps
54
gastric adenomas
increased in Familial Adenosis Polyposis (FAP) patients and most frequently arise in background of atrophy and intestinal metaplasia
55
gastric adenocarcinoma
- 90% of gastric cancers are adenocarcinomas
- overall decrease of incidence in US because decreased use of smoked and salt-cured meat
- association w/ GERD
- Linitis plastica "leather bottle appearance" (thickened stomach wall)
- aggressive and deadly form of stomach cancer
56
gastric adenocarcinoma
| -risk factors
- hereditary
- smoke and salt cured meat
- GERD
- pernicious anemia (B12 deficiency)
- atrophic gastritis (intestinal metaplasia)
- pre existing adenomatous polyp
57
in addition to neoplasia what else can develop in the stomach
lymphoma
58
celiac disease
gluten sensitivity
hypersensitivity to gliadin
involves SI malabsorption
59
SI morphology in celiacs disease
blunted villi
| inflammatory infiltrate
60
treat celiacs disease
withdrawl of wheat gliadin and related grain proteins from the diet
61
infectious enterocolitis
"travelers diarrhea"
| SI affected
62
SI-reactive, non neoplastic conditions
celiac disease
infectious enterocolitis
viral gastroenteritis/parasitic enterocolitis
inflammatory bowel disease
63
inflammatory bowel disease etiology
due to inappropriate mucosal immune activation
64
two types of inflammatory bowel disease
1. ulcerative colitis
| 2. crohn disease
65
ulcerative colitis
severe ulcerating inflammatory disease limited to colon and rectum
extends to mucosa and submucosa
66
crohn disease
regional enteritis
may involve any area of GI tract
frequently transmural
"skip lesions"-->non caseating granulomas
67
crohns and ulcerative colitis frequency
- age
- gender
- etiology
- complication
teens and early 20s
females
etiology: not autoimmune; results from combination of deficits entailing host interactions and GI microflora; intestinal epithelial dysfunction and averrant mucosal immune responses
-increase risk for neoplasia
68
malabsorption effects
anemia: iron, pyridoxine, folate, b12 deficiency, bleeding from vit K deficiency
osteopenia, tetany: from defective Ca, Mg, Vit D and protein absorption
amenorrhea, impotence, infertility: from generalized malnutrition
purpura, petechia
peripheral neuropathy, nyctalopia: decrease vitamin A and B12
69
oral manifestations of malabsorption
atrophic glossitis (bald red tongue)-->pernicious anemia
---can be patchy or involve entire dorsum
tongue lesions--sore; burning sensation (glossopyrosis)
predisposition to angular cheilitis
70
tumors of SI
less than 5% of GI tumors
benign: leiomyoma
malignant: adenocarcinoma, carcinoid tumors, lymphoma
71
adenocarcinoma of the colon
MOST COMMON MALIGNANCY OR GI TRACT
related to dietary factors: low intake of absorbable vegetables, high intake of refine carbs and fat
genetic component: increased incidence in FAP patients
most arise within pre existing adenomas
colonoscopies are effective screening tools
72
colon presents with more tumors than the SI
True or False
True
even though the SI makes up 75% of the length of GI tract
73
what is second to lung cancer in causing cancer deaths in the US
colorectal cancer (15% of cancer deaths)
74
whats most important to predict malignant change in colon polyps
size
75
FAP extraintestinal manifestations
- dental
- tumors
- skin
- thyroid
- desmoid
dental: unerupted teeth
tumors: osteomas of the jaw/skull, supernumerary teeth, dentigerous and mandibular cysts
skin: epidermal inclusion cysts, lipomas, fibromas, nasopharyngeal, angiofibromas
thyroid: soft tissue tumors, brain tumors
desmoid: neurofibroma, trichepitheliomas
76
FAP
mutation of APC gene; most common polyposis syndrome of GI tract
risk of developing cancer if untreated is 100%
adenomas throughout colorectum--onset 16 yrs
if extraintestinal lesions present-->gardners syndrome
77
gardners syndrome
- oral manifestations
- other lesions
- how many polyps need to diagnose
FAP+ extraintestinal lesions
oral manifestations: unerupted teeth, supernumerary teeth, dentigerous and mandibular cysts, increased risk for odontomas
benign skin lesions
need >100 polyps to diagnose as FAP
78
peutz jegher syndrome
- presentation
- age
- second most common polyposis syndrome
- GI hamartomatous polyps and pigmented macules of mucous memranes and skin
- melanin deposits around nose, lips, buccal mucosa, hands, feet, genitalia, and perianal region
average age: 23-26 yrs
79
ulcerative colitis
severe ulcerating inflammatory disease limited to colon and rectum
extends to mucosa and submucosa
not transmural inflammation
80
crohn disease
regional enteritis
may involve any area of GI tract
frequently transmural
"skip lesions"-->non caseating granulomas
noncaseating granulomatous inflammation
persistant and remit and relapse over the years
transmural inflammation
81
crohns and ulcerative colitis frequency
- age
- gender
- etiology
- complication
teens and early 20s
females
etiology: not autoimmune; results from combination of deficits entailing host interactions and GI microflora; intestinal epithelial dysfunction and aberrant mucosal immune responses
-increase risk for neoplasia
82
peutz jegher syndrome
- presentation
- age
- second most common polyposis syndrome
- GI hamartomatous polyps and pigmented macules of mucous memranes and skin
- melanin deposits around nose, lips, buccal mucosa, hands, feet, genitalia, and perianal region
average age: 23-26 yrs
83
crohn's disease location
frequently spares the rectum
84
crohn's disease oral manifestations
mucosal thickening
85
ulcerative colitis clinical manifestations
diarrhea
tenesmus
colicky lower abdominal pain
risk for development of carcinoma
86
ulcerative colitis location
begins at rectosigmoid area and extends proximally
continuous involvement
small to large ulcerations, crypt abscesses
greater risk of dysplasia and adenocarcinoma
associated with primary sclerosing cholangitis (PSC)
87
ulcerative colitis oral manifestations
scattered or linearly oriented pustules on mucosa
| 10% of patients develop arthritis of TMJ
