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Patho Summer Test #1 > Gastrointestinal Module #3 > Flashcards

Gastrointestinal Module #3 Flashcards

(81 cards)

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1
Q

What is pyloric obstruction?

A

Narrowing of the pylorus (junction between stomach and duodenum)

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2
Q

What are the 2 forms of pyloric obstructive?

A

Acquired

Congenital

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3
Q

What is infantile hypertrophic pyloric stenosis (IHPS)?

A

Congenital narrowing of pylorus

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4
Q

What are the signs and symptoms of infantile hypertrophic pyloric stenosis?

A

Infant @ 2-3 weeks begins to vomit for no apparent reason

**projectile vomitting –> several feet

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5
Q

What happens to the sphyncter that makes it stenotic in infantile hypertrophic pyloric stenosis?

A

Hypertrophy

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6
Q

What is the treatment for infantile hypertrophic pyloric stenosis?

A

Surgery: Pyloromyotomy

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7
Q

What causes adult/acquired pyloric obstruction?

A

Severe peptic ulcer or tumor in pyloric area

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8
Q

What are the signs/symptoms of adult/acquired pyloric obstruction?

A

Vague symptoms:

epigastric discomfort/fullness w/ eating –> progresses to severe (gastric distention, nausea, –> vomitting and acute distress)

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9
Q

What is the treatment of adult/acquired pyloric obstruction?

A

Address the cause of the obstruction

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10
Q

What are the different mechanical obstructions?

A

Adhesions

Herniation

Intussusception

Volvulus (torsion)

Tumor Growth

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11
Q

What are intestinal adhesions?

A

Fibrous “scar tissue” adheres to intestinal loops

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12
Q

What causes intestinal adhesions?

A

Usually common complication of abdominal surgeries

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13
Q

What is an intestinal herniation?

A

Intestine protrudes through abdominal wall

may strangulate through opening

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14
Q

What is intestinal intussusception?

A

Telescoping of one part of an intestine on another portion

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15
Q

What is the most common area to have intestinal intussusception?

A

Ileocecal area

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16
Q

Who is most likely to have an intestinal intussusception?

A

Young kids

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17
Q

What is intestinal volvulus (torsion)?

A

Intestine twist upon itself

Messentary twists around strangulating the blood supply to the intestine

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18
Q

Who do you usually see with intestinal volvulus (torsion)?

A

Elderly

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19
Q

What is the most common cause of large intestine obstruction?

A

Colon/rectal cancer

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20
Q

What is a paralytic ileus?

A

Obstruction that results when peristalsis stops –> functional/physiological obstruction

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21
Q

What causes paralytic ileus?

A

Certain drugs –> narcotic pain drugs or high BP meds

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22
Q

What is hirschsprung’s disease (congenital aganglionic megacolon)?

A

Birth defect in which ganglion (nerve) cells of the colon (large intestine) fails to develop

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23
Q

How common is hirschsprung’s disease?

A

1:5,000 newborns

25% of all infant obstructions

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24
Q

Does hirschsprung’s disease affect males or females more?

A

Males

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25
What will biopsy show in hirschsprung's disease?
Absent Meissener's (submucosal) Absent Auerbach's (myenteric) plexus etc.
26
What does hirschsprung's disease result in functionally?
Impaired motility of colon d/t poor coordination/ability to contract intestinal musculature Impacted/trapped Stools Infection Inflammation Constipation
27
What are the 2 categories of Hirschsprung's disease?
Short segment Long segment
28
What regions of the colon are affected in short segment hirschsprung's disease?
Rectosigmoid colon
29
What regions of the colon are affected in long segment Hirschsprung's disease?
Rectosigmoid colon and regions proximal to it **severe cases can involve entire colon
30
Which type of Hirschsprung's is the more mild type?
Short segment
31
What is the treatment for Hirschsprung's disease?
Decompress the colon (serial rectal irrigation) Surgical removal of involved intestinal segment Mild to moderate cases (short-segment) = myotomy or resection Severe cases (enterocolitis) = temporary or permanent colostomy
32
What is Inflammatory Bowl Disease (IBD)?
Chronic autoimmune inflammatory dz that damages/ulcerates GI tract
33
What are the 2 forms of Inflammatory Bowl Disease?
Crohn's Disease Ulcerative Cholitis
34
Where does Crohn's disease common occur?
End of ileum (small intestine) Cecum of large intestine
35
What does stress do to people with Crohn's disease?
Exacerbate symptoms **NOT A CAUSE OF CHRON'S!
36
In Crohn's are women or men affected more?
Women **usually family Hx (2-4x higher risk w/ first degree relative)
37
Which layers of the intestinal wall are affected in Crohn's disease?
All layers **chronic granulomatous inflammation
38
What is a granuloma?
Cluaster of cells that form in area of inflammation
39
What are skip lesions?
2+ inflamed areas w/ healthy bowel in between
40
What is the pharmaceutical treatment for Crohn's Disease?
**Depends on severity Anti--inflammatory drugs: Salicylate (5-ASA) --> mild to moderate Corticosteroids --> mod. to severe Infliximab Immune Suppressors --> mod. to severe Antibiotics --> fistulas and other infectous complications
41
What are the indications for surgergy to treat Crohn's disease?
Not responding to meds To correct complications from dz - obstruction - perforation - abscess
42
What are the surgical procedures done for Crohn's disease?
Intestinal Resection --> small portion of the intestine is removed Stricturoplasty --> done for chronic narrowing of intestine Colostomy/ileostomy
43
What are the complications of intestinal resection?
Adhesions/scarring --> create obstructions
44
What is ulcerative cholitis?
Chronic inflammatory disease that affects the large intestine
45
Which areas of the intestines are usually affected in ulcerative cholitis?
ALWAYS involves rectum Extends proximally to contiguous sections of the colon
46
Which layers of the intestine are affected w/ ulcerative cholitis?
Mucosa only (doesn't penetrate deeper lyaers)
47
What are the regional patterns of the large intestine seen with ulcerative colitis?
Ulcerative proctitis Ulcerative proctosigmoiditis Ulcerative pancolitis
48
What are the Surgical procedures done for ulcerative cholitis?
Total colectomy and ileorectal anastamosis Total proctocolectomy (Brooke ileostomy) Ileal pouch anal anastomosis
49
Describe the total colectomy and ileorectal anastamosis procedure
Colon removed except last 5 in from rectum Small intestine/ileum is surgically joined to upper rectum **pt has normal bowel function after procedure
50
Describe the total proctocolectomy (Brooke ileostomy) procedure
Entire colorectal mucosa is excised New rectum is made from small intestine and attached to anal canal May have to make a stoma (opening to poop) until new rectum has healed
51
What is diverticulosis?
Out pockets in the intestinal wall **85% = asymptomatic 15% develop colicky symptoms
52
Where is diverticulosis commonly found?
Sigmoid colon
53
What happens to cause diverticulosis?
Vessel penetrates through weak colonic muscle wall
54
What is the treatment for diverticulosis?
High fiber diet Avoid high residue foods (seeds, nuts, corn)
55
What is diverticulitis?
Inflammation of diverticuli (colonic diverticula)
56
Which area of the intestines is most often involved w/ diverticulitis?
Sigmoid colon
57
What happens with diverticulitis?
Impacted w/ fecal material (fecalith) Colon perforations d/t inflammation
58
What is simple diverticulitis?
Inflammation is contained in the intestinal wall
59
What is complicated diverticulitis?
Inflammation penetrates into peritoneal space
60
What do most colorectal cancers develop from?
Adenomatous polyp **initial mutant cancer cell develops in polyp
61
How fast does the cancer grow on the polyp and where does it grow towards?
Slow growth down stalk towards deeper layers of mucosa
62
What happens is colorectal cancer penetrates into the submucosa?
Reach lymphatic/BV pathways and become highly malignant
63
What is critical for the prevention of colorectal cancer?
Screening Removal of polyps
64
Which age population are the @ higher risk factors for colorectal cancer?
> 50 yo
65
Which past medical history puts you at greater risk of colorectal cancer?
IBD Adenomatous polyps > 5 mm Gall bladder surgery (cholecystectomy) Pelvic irradiation
66
Which family history puts you at greater risk of colorectal cancer?
first degree relative w/ colorectal cancer
67
What lifestyle risks are associated w/ colorectal cancer?
Tobacco abuse Obesity (BMI > 35 - 40)
68
What is the screening tool of choice for colorectal cancer?
Colonoscopy
69
How often should average risk patients > 50 yo be screened for colorectal cancer?
Colonoscopy every 10 yrs Digital rectal exam and fecal occult blood every year **higher risk pts should be screened more frequently
70
What are the different types of hepatitis?
A B C D E G
71
What is the pathophys of hepatitis?
Hepatic cell death/scarring Kupffer cell hyperplasia Inflammation may disrupt canaliculi
72
Which types of viral hepatitis has more severe hepatic cell damage?
B C
73
What is fulminating hepatitis?
Rare complication in which massive hepatic cell death and liver failure occur **rapid/severe onset
74
What is cirrhosis?
Irreversible inflammatory condition --> hepatic cell death causes diffuse scarring of the liver
75
What is the general pathophysiology of cirrhosis?
Hepatic tissue becomes nodular/fibrotic Size of liver may expand or shrink
76
What is the initial phase of alcoholic cirrhosis?
Fatty accumulation develops w/ in hepatocytes
77
What is produced by the metabolism of alcohol which disrupts hepatocyte function/metabolism?
Acetaldehyde
78
What does the damage from the acetaldehyde do in the liver?
Initiates inflammatory response/necrosis Promotes excessive collagen synthesis and fibrotic accumulation/scarring
79
What does the fibrosis eventually do in the liver during cirrhosis?
Alter biliary and vascular drainage Liver function declines Portal HTN GI Bleeding Varicose Veins Ascities Hepatomegaly Spleenomegaly
80
What is primary biliary cirrhosis?
Autoimmune disease that attacks small intrahepatic bile ducts (canaliculi)
81
What is secondary biliary cirrhosis?
Develops as result of chronic obstruction of biliary flow --> inflammation --> fibrotic changes

Patho Summer Test #1 (8 decks)

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