GI Flashcards
(106 cards)
1
Q
Diseases of the GI tract can be classified as:
(5)
A
– Developmental disorders
– Inflammatory diseases
– Functional disorders
– Circulatory disturbances
– Neoplastic diseases
2
Q
Important Clinical Symptoms and
Signs Relating to the GI System
(8)
A
- Dysphagia
- Vomiting
- Hematemesis
- Hematochezia
- Melena
- Diarrhea
- Constipation
- Odynophagia
3
Q
- Dysphagia –
A
difficulty in swallowing
4
Q
- Hematemesis –
A
vomiting of fresh, red blood
5
Q
- Hematochezia –
A
bright, red blood in stool
6
Q
- Melena –
A
black, tarry feces
7
Q
- Odynophagia –
A
painful swallowing
8
Q
- Gastroenterology –
A
a subspecialty
of Internal Medicine
9
Q
- Esophagogastroduodenoscopy
(EGD) –
A
upper GI endoscopy
10
Q
- Colonoscopy –
A
lower GI endoscopy
11
Q
Clinical Symptoms and Signs of
Esophageal Disease
(4)
A
- Dysphagia
- Odynophagia
- Heartburn –a burning behind the sternum
- Acid regurgitation into the mouth
12
Q
- Dysphagia –
A
difficulty in swallowing
13
Q
- Odynophagia –
A
pain on swallowing
14
Q
- Heartburn –
A
a burning behind the sternum -
GERD
15
Q
- Acid regurgitation into the mouth –
A
a sign of
GERD
16
Q
Achalasia –a Functional (Motor)
Disorder
(2)
A
- Dysfunction of ganglion cells of myenteric plexus (Auerbach plexus) prevents proper relaxation of lower esophageal sphincter - a motility disorder
- Dysphagia, regurgitation, halitosis and proximal dilation
17
Q
Plummer-Vinson Syndrome
(Paterson-Kelly Syndrome)
(5)
A
- Scandinavian, Northern European women
- Severe Fe-deficiency anemia
- Mucosal atrophy - atrophic glossitis
- Esophageal webs - dysphagia
- Increased risk for squamous cell carcinoma
18
Q
- Increased risk for squamous cell carcinoma
(3)
A
– Esophagus
– Oropharynx
– Posterior Oral Cavity
19
Q
Esophageal Varices
A
- Portal hypertension
produces venous
dilation
20
Q
- Rupture leads to
A
hematemesis and massive upper GI bleed
21
Q
- Rupture of a varix is associated with
A
high mortality
22
Q
- Rupture of a varix accounts for half of the deaths in
A
advanced cirrhosis
23
Q
Mallory-Weiss Syndrome
* Mallory-Weiss tears are
seen in
A
chronic
alcoholics, where
violent retching causes
esophageal lacerations
and hemorrhage
24
Q
Hiatal Hernia
* Diaphragmatic hernia -
A
widened diaphragmatic hiatus allows protrusion of the stomach through the diaphragm
25
Hiatal Hernia
* Gastroesophageal junction pulled into thorax causing
GERD, heartburn and dysphagia
26
Barrett Esophagus
(3)
* Gastric metaplasia of lower esophageal mucosa - columnar epithelium replaces stratified squamous epithelium
* Odynophagia, ulceration, hemorrhage
* Adenocarcinoma
27
Esophageal Cancer
(3)
* Squamous cell
carcinoma
* Adenocarcinoma -
Barrett esophagus
* Dysphagia due to
narrowing of lumen or
interference with
peristalsis
28
Esophageal Squamous Cell Carcinoma
(4)
* Older adults, geographical variation,
poor prognosis
* Squamous cell carcinoma most
common world-wide, but
adenocarcinoma of esophagus is
more common in the United States
* Most common in middle third
* Alcohol and tobacco, Plummer-
Vinson syndrome, diet influence
incidence
29
Esophageal Squamous Cell Carcinoma
(4)
* Older adults, geographical variation,
poor prognosis
* Squamous cell carcinoma most
common world-wide, but
adenocarcinoma of esophagus is
more common in the United States
* Most common in middle third
* Alcohol and tobacco, Plummer-
Vinson syndrome, diet influence
incidence
30
Esophageal Adenocarcinoma
(3)
* Lower segment
* Barrett esophagus is a risk factor
* More common than squamous carcinoma in United States
31
Epithelial Cells of the Stomach
(4)
* Mucous cells
* Parietal cells -
* Chief cells -
* Endocrine cells -
32
* Parietal cells -
hydrochloric acid,
intrinsic factor
33
* Chief cells -
pepsin
34
* Endocrine cells -
G-cells
- gastrin
35
Gastritis
* Inflammation of the
gastric mucosa
36
* Acute gastritis –
erosive, due to irritants
and NSAIDs
37
* Chronic gastritis –
erosive or non-erosive
–infectious or
autoimmune
38
Acute Erosive Gastritis
(4)
* Epigastric burning, pain,
nausea, vomiting
* Shallow erosions
* Asprin, NSAIDs, alcohol,
stress, shock, sepsis
* One of the major causes
of hematemesis in
alcoholics
39
Chronic Gastritis
* Infectious –
* Autoimmune –
the most
common form of chronic
gastritis is due to infection
by Helicobacter pylori
autoantibodies to parietal
cells
40
the most
common form of chronic
gastritis is due to infection
by Helicobacter pylori
(3)
* Peptic ulcer disease
* Adenocarcinoma
* MALT Lymphoma
41
--- is a potential human carcinogen
H. pylori
42
H. pylori
(4)
* Gram negative s-shaped rods
* Biopsy and silver stain
* Urea breath test
* Antibody test for H. pylori
43
Autoimmune (Atrophic) Gastritis
(3)
* Autoantibodies against
gastric parietal cells,
* Gastric mucosal
atrophy
* No intrinsic factor, low
serum vitamin B12,
pernicious anemia
44
Gastric Stress Ulcers
(2)
* Deeper than erosions,
may extend to
muscularis
* Severe stress - ICU
patients (shock,
trauma, burns, sepsis)
45
Peptic Ulcer Disease
(2)
* Most peptic ulcers are generally solitary lesions
* Most occur in the duodenum - 98% are located in the duodenum and stomach
46
Characteristics of Peptic Ulcers
(2)
* Sharply-demarcated ulcer with a clean, smooth base
* Chronic lesions may exhibit puckering due to fibrosis
47
Clinical Course of Peptic Ulcer Disease
(3)
* Acute/chronic blood loss
* Nausea, vomiting, hematemesis, melena
* Perforation - major cause of death in PUD
48
Melena –
Hematocheza –
black, tarry stool
red blood in stool
49
Immediate pain –
Delayed pain -
gastric ulcer
duodenal ulcer
50
Etiology of Peptic Ulcers
(4)
* Multifactorial disease, decreased mucosal resistance
* Infection by H. pylori
* Drugs –aspirin, NSAIDs
* Neuroendocrine –hormonal hypersecretion syndromes
51
* Neuroendocrine –hormonal hypersecretion syndromes
– Cushing Syndrome –
– Zollinger-Ellison Syndrome –
corticosteroids
gastrin
52
Complications of Peptic Ulcer Disease
(5)
* Minor hemorrhage –melena, iron deficiency anemia
* Major hemorrhage -hematemesis
* Perforation - peritonitis
* Stenosis and obstruction
* Penetration into pancreas
53
Zollinger-Ellison Syndrome
(3)
* Gastrin-secreting tumor in pancreas or duodenum (“gastrinoma”)
* Hypergastrinemia causes hypersecretion of gastric acid
* Severe peptic ulcer disease with multiple ulcers in unusual locations
54
Gastric Adenocarcinoma
(3)
* Older individuals, poor
prognosis
* Smoked fish –nitrosamines
* Predispostion to gastric
cancer
55
* Predispostion to gastric
cancer
(3)
– H. pylori infection
– Chronic atrophic gastritis
– Gastric adenomatous polyps
56
Gastric Adenocarcinoma
* Lesser curve of --- region
* Intestinal type -
* Diffuse type -
antro-
pyloric
bulky
tumors composed of
glandular structures
infiltrative growth of
poorly-differentiated
cells (linitis plastica)
57
Krukenberg Tumor
(3)
* Metastatic
adenocarcinoma to
ovaries
* Bilateral ovarian
metastases
* Frequently of gastric
origin - mucus-
producing cells
58
Gastrointestinal Tract Lymphoma
Non-Hodgkin Lymphoma
* Primary lymphomas -
* Secondary lymphomas
MALT-omas and other
NHLs
- extranodal spread
59
Gastric MALT Lymphoma
* Stomach –
most common site for
extranodal lymphomas
60
Gastric MALT Lymphoma
* MALT lymphomas -
B cell
lymphomas of
Mucosa-Associated Lymphoid
Tissue
61
Gastric MALT Lymphoma
* Associated with Helicobacter
pylori infection –
may regress with H. pylori
treatment
62
Meckel Diverticulum
(2)
* Developmental defect of ileum - a blind pouch containing all layers
* “Left-sided appendix” -may produce symptoms similar to appendicitis
63
Herniation
(5)
Weakness in peritoneum
* Inguinal
* Femoral
* Umbilicus
* Incisional
64
Adhesions
(3)
* Fibrotic bridges of
peritoneum
* May trap and kink
bowel segments
* They are usually
sequelae of prior
surgery or infection
65
Intussusception
(2)
* Small intestine
invaginates into itself -
intussusceptum
becomes necrotic
unless everted
* Small pedunculated
tumors carried by
peristalsis may pull
forward the loop to
which it is attached
66
Volvulus
(3)
* Rotation of a loop of intestine about
its own mesenteric root
* Most common in small intestine and
sigmoid colon
* Volvulus undergoes necrosis
67
Carcinoid Tumor
(3)
* A low-grade malignancy of
neuroendocrine cells, appearing as
mucosal nodules
* May occur throughout gastrointestinal
tract but are most common in appendix
* May produce hormones, such as
serotonin
68
Carcinoid Syndrome
(2)
* Caused by a serotonin-
producing carcinoid tumor
that is asymptomatic until
metastasis to the liver
* The serotonin that is no
longer metabolized by the
liver causes cramping,
diarrhea, flushing and
bronchospasm
69
Colon
(2)
* Enteric nervous system
* Colonized by non-pathogenic strains
of bacteria
70
* Enteric nervous system -
myenteric
(Auerbach) and submucosal plexus
(Meissner)
71
Hirschprung Disease –
Congenital Megacolon
(3)
* Developmental defect
of enteric nervous
system - agangliosis of
terminal colon
(myenteric plexus)
* Chronic constipation,
proximal dilation
* Resection of
aganglionic segment
72
Diverticulosis
(3)
* Consist of out-pouchings of
mucosa and submucosa through
muscular layer of colon
* Associated with a low bulk diet,
straining during defecation
* May become inflamed
(diverticulitis)
73
Intestinal Polyps
* Neoplastic polyps
(adenomatous polyps,
adenomas)
(2)
– Tubular adenoma
– Villous adenoma
74
Intestinal Polyps
* Non-neoplastic polyps
(2)
– Hyperplastic polyp –most
common
– Hamartomatous polyp -
Peutz-Jeghers Syndrome
75
Hyperplastic Polyp
(2)
* Non-neoplastic
hyperplasia of
epithelium, most
common
* Not pre-malignant
76
Hamartomatous Polyp
(4)
* Large, pedunculated
polyp, consisting of all
layers of the mucosa
* May be associated with
Peutz-Jeghers
syndrome
* Risk for intussusception
* No malignant change
77
Peutz-Jegher Syndrome
(4)
* Autosomal dominant
* Pigmented macules of oral mucosa and
perioral skin
* Hamartomatous polyps of bowel
* Increased risk for adenocarcinoma outside GI
tract - pancreas, breast, lung, ovary, uterus
78
Adenomatous Polyps –Adenomas
–Neoplastic Polyps
(2)
* Tubular adenomas - tubular
glands, frequently
pedunculated
* Villous adenomas - villous
projections, frequently
sessile
79
Tubular Adenoma
(3)
* Most common
neoplastic polyp
* <5% malignant
transformation
* Endoscopic
polypectomy curative
80
Villous Adenoma
(3)
* Least common
neoplastic polyp
* 50% malignant
transformation
* Endoscopic removal
often not possible
81
Third most common cause of cancer death –
Colonic Adenocarcinoma
lung, breast/prostate, colon
82
Colonic Adenocarcinoma
Older adults, unless
predisposing condition (ulcerative colitis, hereditary colon cancer syndrome –Gardner syndrome)
83
Colonic Adenocarcinoma
Dietary risk factors-
high caloric intake, high fat, red meat, high refined carbohydrates, low fiber
84
Adenoma - Carcinoma Sequence
* Accumulation of mutations in tumor
supressor genes and proto-oncogenes
85
Colonic Adenocarcinoma
* Sigmoid colon most
common site
86
Colonic Adenocarcinoma
* Left side -
circumferential,
napkin-ring lesion
producing narrowing of
lumen
87
Colonic Adenocarcinoma
* Right side -
exophytic,
polypoid, crater-like
ulcerations with rolled
borders
88
Staging of Colon Cancer
* --- is most important prognostic indicator
Stage
89
Hereditary Colonic Cancer Syndromes
–Autosomal Dominant
* Familial Adenomatous Polyposis Coli (FAP) -multiple tubular adenomas, 100% malignant transformation
– Gardner syndrome –a variant of FAP with multiple supernumerary teeth, jaw bone densities, multiple osteomas, fibromatosis, epidermal inclusion cysts
90
Hereditary Colonic Cancer Syndromes
–Autosomal Dominant
* Hereditary Non-Polyposis Colorectal Cancer (HNPCC) - colonic cancer unrelated to adenomas
– Increased risk of endometrial and ovarian cancers
91
Inflammatory Bowel Disease
(4)
* Two chronic, relapsing
inflammatory disorders of
unknown etiology
* Crohn Disease
* Ulcerative Colitis
* Exaggerated and
unregulated local immune
respose in genetically
susceptable individuals
92
Crohn Disease
(4)
* Any level of GI tract, mouth
to anus, most often distal
ileum and colon
* Transmural inflammation,
thickened intestinal wall
* Sarcoid-like non-caseating
granulomas
* Pain, diarrhea, fissure and
fistula formation
93
Crohn Disease –
Perianal Fistula Formation
* Fistula –
an abnormal channel
between two hollow organs or
between a hollow organ and the skin
surface
94
Oral Manifestations of Crohn Disease
(3)
* Aphthous-like lesions
* Granulomatous nodules
* Malabsorption, vitamin K-dependent clotting factor deficiency, bleeding diathesis
95
Ulcerative Colitis
(3)
* Chronic inflammatory disease with
increased risk of malignancy
* Thinning of intestinal wall, limited to
colon and rectum
* Relapsing diarrhea, pain
96
* Inflammation limited to mucosa –
not transmural
97
* Crypt abscesses-
accumulation of neutrophils within colonic crypts are signs of active inflammation
98
Ulcerative Colitis - Pseudopolyps
* Remnants of colonic mucosa surrounded by ulceration
99
Pyostomatitis Vegetans
(2)
* Oral lesions of
ulcerative colitis
* Small, yellow
superficial pustules
100
Appendicitis
(2)
* An acute bacterial
infection of appendix
* Complications may
include rupture and
peritonitis
101
Appendicitis –Obstruction of Lumen
(3)
* Fecalith
* Reactive lymphoid
hyperplasia
* Neoplasm
102
* Fecalith -
inspissated
fecal material
103
* Reactive lymphoid
hyperplasia –
response
to viral infection
104
* Neoplasm –
carcinoid
tumor
105
Acute Appendicitis
(6)
* Acute inflammation,
mucosal ulceration
* Transmural
inflammation
* Serositis
* Peritonitis
* Right lower quadrant
pain, rebound
tenderness
* Leukocytosis, fever,
nausea, vomiting
106
Hemorrhoids
(2)
* Varicose dilation of
hemorroidal venous
plexus at anorectal
junction
* Increased venous
pressure may be
associated with
pregnancy, chronic
constipation, portal
hypertension
