Gastrointestinal Disorders

Question 1

What are the crucial functions of the gastrointestinal system?

Answer 1

• Absorption
• Processing of nutrients (digestion, secretion, motility and absorption)

Question 2

What’s the upper gastrointestinal tract composed of?

Answer 2

1) Mouth
2) Esophagus
3) Stomach

Question 3

What’s the lower gastrointestinal tract composed of?

Answer 3

1) Small intestine (duodenum, jejunum and ileum).

2) Large intestine (cecum, ascending colon, transverse colon, descending colon , sigmoid colon and rectum).

3) Anus

Question 4

What are other organs that compose the gastrointestinal system?

Answer 4

Liver, pancreas, gallbladder and salivary glands.

Question 5

What’s the gastroesophageal reflux disease?

Answer 5

It is charaterised by passage of gastric contents into the esophagus.
May occur in healthy individuals. However, it can lead to gastroesophageal reflux disease when it presents uncomfortable clinical manifestations.

Can be divided into gastroesophageal reflux:
- Without esophageal erosion (~70% of patients)
-With esophageal erosion = reflux esophagitis (30%)

Question 6

What’s cardia relaxation?

Answer 6

Cardia relaxation refers to the relaxing of the cardiac sphincter, which is the muscle that separates the esophagus from the stomach.
This relaxation allows food and liquids to pass from the esophagus into the stomach.

Question 7

GERD can involve 2 main phenomena. What are they?

Answer 7

1) Gastroesophageal junction dysfunction: increased frequency of cardia relaxations and reflux associated with them; mechanical dysfunction of the cardia (hiatal hernia, neoplasia); increased intragastric pressure (pregnancy, obesity, delayed gastric emptying).

2) Decreased acid elimination: decreased saliva secretion (due to smoking, for example) and decreased peristalsis.

Question 8

What are the 5 main causes of GERD?

Answer 8

1) Foods (spicy, alcohol, fatty, junk foods)
2) Smoking
3) Dysphagia
4) Hypertension
5) Delayed gastric emptying

Question 9

Amlodipine treats high blood pressure. What’s its effect on the lower esophageal sphincter (LES)?

Answer 9

It is a calcium blocker that relaxes the LES.

Question 10

How does dealyed gastric emptying cause GERD?

Answer 10

Gas builds up in the stomach and there is an increase of the pressure on the cardia.

Pressure receptors indirectly stimulate the vagus nerve, which, in turn, stimulates LES relaxation, leading to an excessive or prolonged transient lower esophageal sphincter relaxation.

Question 11

What’s Barret’s esophagus?

Answer 11

Barrett’s esophagus is a change in the cellular structure of your esophagus lining.

Question 12

Repeated damage to the esophagus can cause mechanical dysphagia. True or False?

Answer 12

True

Question 13

Repeated damage to the esophagus can cause normal squamous epithelium to be replaced with columnar cells (metaplasia). True or False?

Answer 13

True

Question 14

Barrett’s esophagus can be considered a precancerous lesion. True or False?

Answer 14

True

Question 15

Heart Burn always disappears after GERD treatment. True or False?

Answer 15

False. It may persist despite treatment (NERD - non-erosive reflux disease).

Question 16

What’s water regurgitation (water brash)?

Answer 16

Water brash, also known as acid brash, is a symptom of gastroesophageal reflux disease (GERD) where excess saliva mixes with stomach acid in the throat.

Question 17

What are the consequences of water regurgitation?

Answer 17

• Aspiration of acid into the larynx and lungs.
• Irritation of the upper respiratory tract.
• Chronic cough (especially at night), asthma, hoarse voice.

Question 18

What are the most common clinical manifestations (7) of GERD?

Answer 18

1) Epigastric pain with a burning feeling
2) Regurgitation
3) Dysphagia
4) Odynophagia (painful swallowing)
5) Sialorrhea (salivação excessiva)
6) Halitosis
7) Teeth damage

Question 19

What are some less common clinical manifestations (6) of GERD?

Answer 19

1) Eructation (burping)
2) Bloating
3) Nausea
4) Halitosis
5) Anorexia
6) Chronic cough

Question 20

What conditions can make the symptoms of GERD escalate?

Answer 20

• Lying down after meals or at night.
• Bending over.
• Intake of fluid with meals.
• Intake of certain foods and drinks (e.g.: caffein, alcohol, fatty foods or spicy foods).
• Smoking.

Question 21

What are the 6 complications of GERD?

Answer 21

• Ulcer on the esophagus
• Scarring and narrowing of the esophagus
• Esophagitis
• Changes in the esophagus cells linen (ex.: Barrett’s esophagus)
• Asthma
• Esophagus carcinoma

Question 22

What are the exams employed to diagnose GERD?

Answer 22

• Physical examination and anamnesis
• Biochemical blood tests
• Endoscopy
• Esophagram (X-ray generally using barium enema for contrast and better visualisation of the pathology)
• Esophageal pH test esophagus (24h registry of the pH at the esophagus)
• Esophageal manometry (examines motility)
• Computed tomography (CT) or Magnetic Resonance Imaging (MRI) (generally using barium enema for contrast and better visualisation of the pathology)

Question 23

What is a peptic ulcer?

Answer 23

It is a lesion characterised by open sores in the inner lining of the gastric or duodenal mucosa with a minimum diameter of 0.5 cm and that penetrates the muscularis mucosa layer.

Question 24

20% of peptic ulcers are gastric ulcers. True or False?

Answer 24

False. 20% of peptic ulcers are duodenal ulcers.

Question 25

Gastric ulcers typically appear in the lesser curvature, at the _________________ transition.

Answer 25

body-antrum

Question 26

Duodenal ulcers appear both at the anterior or ______________ wall.

Answer 26

posterior

Question 27

Between 5% and 10% of people worldwide will develop ___________ _________ disease in their lifetimes. It can develop at any age, though it’s more common in _____________ adults. It’s also more common in ___________.

Answer 27

peptic ulcer; middle-aged; males

Question 28

What are the 3 main causes of peptic ulcers?

Answer 28

- Infection by H- Pylori (associated with 95% of duodenal ulcers; and with 70-80% of gastric ulcers) - Medications (NSAIDs, corticosteroids and alcohol) - Others (Zollinger-Ellison syndrome; acute stress; malignancy; Crohn's)

Question 29

How does H. pylori act?

Answer 29

It colonises epithelial cells and decreases the production of mucus.

Question 30

In a normal gastrointestinal tissue, what are some of its protective factors?

Answer 30

1) Surface mucus secretion 2) Bicarbonate secretion into mucus 3) Mucosal blood flow 4) Epithelial barrier function 5) Epithelial regenerative capacity 6) Elaboration of prostaglandins

Question 31

Peptic ulcers are always symptomatic. True or False?

Answer 31

False. 70% of the patients are asymptomatic.

Question 32

What are the most often (5) seen symptoms in peptic ulcers?

Answer 32

- Epigastric pain with a burning sensation - Indigestion - Bloated stomach - Burping - Nausea and vomiting.

Question 33

What are the symptoms of peptic ulcers associated with bleeding?

Answer 33

1) Palor 2) Melena 3) Dizziness

Question 34

In gastric ulcer, symptoms might worsen after food intake and felling night pain is common. Why?

Answer 34

Food increases acid production, which directly contacts the already damaged stomach lining.

Question 35

In duodenal ulcer, symptoms might actually improve after food intake, and night pain is not as often. Why?

Answer 35

Food stimulates bicarbonate and mucus secretion from the pancreas and duodenum. This neutralises stomach acid entering the duodenum.

Question 36

What are the complications of peptic ulcers?

Answer 36

1) Bleeding (most common) 2) Perforation (life-threatening) 3) Fistulation 4) Malignant evolution

Question 37

What exams are performed to diagnose peptic ulcers?

Answer 37

- Physical examination and anamnesis - Biochemical blood tests - Endoscopy - Esophagram (barium enema) - H. pylori tests

Question 38

What is an inflammatory bowel disease?

Answer 38

It is a chronic inflammation of several sections of the gastrointestinal tract, resulting from the immunological action on the intestinal mucosa.

Question 39

IBD often presents with recurrent episodes (with phases of _____________ and ____________) of ____________ _______________ diarrhea and abdominal pain. It differs from other infectious pathologies in that it does not present ______________ culture results for known microbial agents and does not respond to ____________ treatments.

Answer 39

exacerbation; remission; bloody mucopurulent; positive; antibiotic

Question 40

IBD affects men and women equally. True or False?

Answer 40

True

Question 41

What are the 2 more evident age incidence peaks of IBD?

Answer 41

15-30 and 60-80

Question 42

IBD can be ulcerative colitis. What are some of the basic characteristics of this disease?

Answer 42

Mainly limited to the descending colon, rectum and anus. It mainly affects the most superficial/inner layer of the intestinal wall (mucosa).

Question 43

What are the most basic characteristics of Crohn's disease?

Answer 43

- It can appear in any part of the gastrointestinal tract (from the mouth to the anus). - It has a transmural character (that is, it affects the entire intestinal wall: mucosa, submucosa, muscularis propria and serosa). - Autoimmune disease

Question 44

What is diverticular disease?

Answer 44

It is characterised by the presence of dilations in the mucosa that form a type of balloon-shaped sac, the diverticula. The presence of diverticula is particularly significant in the sigmoid colon, although it may exist in other locations, such as Meckel's diverticulum in the small intestine. The presence of diverticula is called diverticulosis, a condition that tends to appear during middle age.

Question 45

When inflammation of the diverticula occurs, it is a condition called ________________.

Answer 45

diverticulitis

Question 46

Populations with diets richer in fiber appear to be ________ predisposed to developing diverticula.

Answer 46

less

Question 47

Diverticulosis is associated with sedentary lifestyle, smoking habits and certain eating habits, and with ___________ _________ __________ (the inner layer of the wall is pushed through weak spots in the muscular wall, leading to the formation of diverticula).

Answer 47

muscle layer spasms

Question 48

The closing of the _____________ opening by ________ can lead to its infection and inflammation. Diverticulitis is also considered in light of the existence of small __________ in the wall of the diverticulum that allow the entry of microbial agents that trigger an ______________ process.

Answer 48

diverticulum; feces; holes; inflammatory

Question 49

Diverticulosis is usually ________________ but is sometimes associated with complaints of _______________ discomfort/pain (in the lower ______ quadrant) that is relieved by defecation. There are also reports of diarrhea, cramping, changes in bowel habits and occasionally rectal _______________.

Answer 49

asymptomatic; abdominal; left; bleeding

Question 50

What can diverticulitis lead to?

Answer 50

- Abdominal pain/tenderness - Fever and chillls - Change in bowel habits - Nausea and vomiting

Question 51

What are the complications (7) of diverticular disease?

Answer 51

- Bowel obstruction - Intestinal stenosis and necrosis - Fistulas - Abscesses - Peritonitis - Inflammation of adjacent organs - Intestinal bleeding (more evident in elderly people)

Question 52

What is the irritable bowel syndrome (IBS)?

Answer 52

This is a disorder of the digestive tract, in which the muscular tissue of the intestine is more sensitive and reacts more intensely to stimuli. Affects bowel movement, consequently altering the frequency, shape and/or consistency of stools.

Question 53

IBS affects more women than men. True or False?

Answer 53

True

Question 54

IBS is most often diagnosed in ____________ ___________________.

Answer 54

young adulthood

Question 55

IBS is associated with eating habits; ______________ __________ syndromes; emotional and/or ________________ disorders and other gastrointestinal disorders.

Answer 55

somatic pain; psychiatric

Question 56

IBS is associated with a _____________ intestinal peristalsis.

Answer 56

decreased

Question 57

IBS is associated with changes in the sensitivity of ___________ pathways intrinsic or extrinsic to the ________________ (with neuron necrosis), which can lead to exaggerated sensations of _________ (__________________) and/or changes in secretion/absorption and intestinal ___________.

Answer 57

nerve; pain; hyperalgesia; motility

Question 58

IBS is not correlated with dysbiosis intestinal (unfavorable imbalance of the intestinal microbiota). True or False?

Answer 58

False.

Question 59

What are the clinical manifestations (7) of IBS?

Answer 59

- Diarrhea alternating with constipation - Changes in intestinal transit - Presence of mucus in the stool - Abdominal pain - Abdominal distension (due to excess gas) - Flatulence - Nausea, reflux and early satiety

Question 60

Psychological evaluation exams are not common in the diagnosis of IBS. True or False?

Answer 60

False

Question 61

What are the complications of IBS (5)?

Answer 61

- Malnutrition and dehydration (electrolyte dysregulation and avoidance of certain foods) - Anxiety disorders and depression - Hemorrhoids (in patients with recurrent constipation) - Sleep perturbations - Impact on quality of life

Question 62

What factors contribute to the appearance of Crohn's disease?

Answer 62

1) Immune dysregulation 2) Diet and stress 3) Genetic factors (HLA-B27 gene) 4) Age (< 30), smoking, appendicectomy, stress and geographical factors

Question 63

It is believed that Crohn's disease may be triggered by a viral or bacterial infection that leads to an inflammatory response. However, this inflammatory response does not cease, and the inflammatory process continues, leading to ________________ inflammation. Strong inflammatory response has been correlated with hyperactivity of ________ lymphocytes. This process leads to a ________________ of the walls of the gastrointestinal tract, which become weakened.

Answer 63

granulomatous; Th-17; thickening

Question 64

What are the main signs and symptoms (6) of Crohn's disease?

Answer 64

- Abdominal pain and cramps - Chronic diarrhea - Blood in the stool - Mouth ulcers - Loss of appetite and weight - Pain around the anus.

Question 65

What are some symptoms (5) outside the gastrointestinal system?

Answer 65

* Fatigue * Fever * Joint pain/arthritis * Eye inflammation (e.g. uveitis and episcleritis) * Osteoporosis

Question 66

What are the complications (9) of Crohn's disease?

Answer 66

1) Intestinal occlusion 2) Ulcers (mouth, anus and genital region) 3) Fistulas 4) Abscesses 5) Malnutrition (lack of vitamin D and B12) 6) Anemia (blood loss and poor absorption of iron and vitamin B12) 7) Skin problems (hidradenitis suppurativa) 8) Artritis 9) Colon cancer

Question 67

Biopsies are not performed for Crohn's disease diagnosis. True or False?

Answer 67

False

Question 68

Ulcerative colitis shares the same risk factors with Crohn's disease. True or False?

Answer 68

True

Question 69

Typically, the inflammation that may lead to ____________ ___________ begins in the anorectal area and extends _______________. Inflammation is generally limited to the mucosa and foci of ________________ and ________________ may be seen.

Answer 69

Ulcerative colitis; proximally; ulceration; abscesses

Question 70

What are the main signs and symptoms (5) of ulcerative colitis?

Answer 70

* Abdominal pain and cramps * Diarrhea with blood, pus and/or mucus * Urgency to defecate, but unable to do so * Pain when defecating * Loss of appetite and weight

Question 71

What are some symptoms (4) of ulcerative colitis outside the GI system?

Answer 71

* Fatigue * Fever * Joint pain/arthritis * Eye inflammation (e.g. uveitis and episcleritis).

Question 72

What are the complications (4) of UC?

Answer 72

- Severe bleeding - Sudden perforation of the colon (may lead to fistulas and/or peritonitis). - Osteoporosis - Lithiasis (kidney stones) - Colon cancer

Question 73

Fistulas are often seen in UC. True or False?

Answer 73

False. They are often seen in Crohn's disease.

Question 74

Granulomas are not common in UC. True or False?

Answer 74

True. They are very common in Crohn's disease (25-50%).

Question 75

Distinguish Crohn's disease from UC in terms of injury regularity.

Answer 75

CD: The intestinal wall is asymmetrically affected and irregular. UC: The intestinal wall is affected symmetrically and continuously.