GI Flashcards
(303 cards)
1
Q
Explain the structure and function of the digestion system
A
Digestion begins in the mouth with chewing which breaks down food mechanically and mixes it with saliva. Swallowing propels chewed food through the esophagus to the stomach, where acids and stomach motility liquefy it further. Next the liquefied food enters the small intestine, where secretions of the intestinal walls, liver, gallbladder, and pancreas digest it into absorbable nutrients. Nutrients are absorbed through intestinal walls, and unabsorbed wastes enter the large intestines (colon), where fluids are removed. Solid wastes then enter the rectum and leave the body through the anus.
2
Q
Explain the structure and function of the digestion system
A
Digestion begins in the mouth with chewing which breaks down food mechanically and mixes it with saliva. Swallowing propels chewed food through the esophagus to the stomach, where acids and stomach motility liquefy it further. Next the liquefied food enters the small intestine, where secretions of the intestinal walls, liver, gallbladder, and pancreas digest it into absorbable nutrients. Nutrients are absorbed through intestinal walls, and unabsorbed wastes enter the large intestines (colon), where fluids are removed. Solid wastes then enter the rectum and leave the body through the anus.
3
Q
Digestion begins in the __ and what is the function?
A
mouth with chewing which breaks down good mechanically and mixes it with saliva.
4
Q
Swallowing propels ___ ___ through the ___ to the ____ and has what function?
A
chewed foods, esophagus, stomach
where acids and stomach motility liquefy it further
5
Q
Liquefied food enters the __ ___ and has what function?
A
where secretions of the intestinal walls, liver, gallbladder, and pancreas digest it into absorbable nutrients.
6
Q
Nutrients are absorbed through _____ ____ and unabsorbed wastes enter the ___ ___ where ___ are removed.
A
small intestines large intestines (colon) liquids
7
Q
Solid wastes then enter the ____ and leave the body through the ____.
A
rectum and leave the body through the anus
8
Q
Sites of absorptions of major nutrients: Stomach
A
Water
alcohol
9
Q
Sites of absorptions of major nutrients: duodenum (S SIP CF WVM)
A
iron, calcium, fats, sugars, water, proteins, vitamins, magnesium, sodium
10
Q
Sites of absorptions of major nutrients: Jejunum
A
Sugars, Proteins
11
Q
Sites of absorptions of major nutrients: Ileum
A
bile salts, vitamin B12, chloride
12
Q
Sites of absorptions of major nutrients: Colon
A
water, electrolytes
13
Q
In the stomach, do you absorb water or lose water?
A
both
14
Q
In the stomach, do you absorb water or lose water? Why
A
If some fluid is hypotonic (sports drinks) , the stomach will get rid of some water to make the stomach fluid isotonic and if something makes the fluid in the stomach hypertonic (saltines) then the stomach will absorb more water to make the fluid isotonic.
15
Q
What are the 3 main categories of diseases of the esophagus?
A
anatomical and motor disorders
esophagitis
esophageal cancer
16
Q
Esophagus: anatomical and motor disorders
A
hiatal hernia
achalasia
esophageal varices
17
Q
Esophagus: esophagitis
A
GERD (reflux esophagitis
Barret esophagus
18
Q
Esophagus: esophageal cancer
A
Squamous cell carcinoma
- alcohol, tobacco, achalasia, very hot tea
Adenocarcinoma
- barret esophagus
19
Q
What is the most common type of hiatal hernia?
A
sliding
20
Q
What are the two types of hiatal hernia?
A
sliding and hiatial paraesophageal hernia (rolling)
21
Q
Hiatus means?
A
break
22
Q
What is a break in the diaphragm where the esophagus goes through?
A
hiatial paraesophageal hernia (rolling)
23
Q
The stomach goes through this type of hernia?
A
hiatial hernia
24
Q
Achalasia and the hiatal hernias have these s/s…
A
heartburn, regurgitation
25
heartburn, regurgitation are associated with ...
achalasia and hiatal hernia
26
regurgitation is more associated with (~95%)
sliding hernia
27
Achalasia has the loss of
intrinsic inhibitory innervation of LES
28
Achalasia has the loss of intrinsic inhibitory innervation of LES: _____, ___ ____ of LES, ___ ___ ___ of LES
Aperistalis, incomplete relaxation of LES, increased resting tone of LES
29
Achalasia: problems
dysphagia, mucosal inflammation and ulceration, squamous cell carcinoma (5%)
30
What happens in achalasia?
the lower esophageal sphincter fails to relax
31
When you bite off a normal sized amount of food but the lower esophageal sphincter doesn't open appropriately, the bolus will get stuck due to the lower esophageal sphincter failing to relax. This describes?
Achalasia
32
The first s/s you will notice with achalasia is
dysphagia
33
The second s/s you will notice with achalasia is
mucosal inflammation and ulceration
| dysphagia (1st)
34
iF ACHALASIA goes on long enough you will develop...
squamous cell carcinoma
dysphagia (1st)
mucosal inflammation and ulceration (2nd)
35
Esophageal Varices is what?
dilated submucosal veins (varices)
36
What is the cause of esophageal varices?
impaired hepatic portal blood flow
37
Esophageal Varices: Impaired hepatic blood flow is associated with __ ___ and ~2/3 of ___ patients
alcoholic cirrhosis, cirrhosis
38
What is the problem with Esophageal varices?
rupture
39
Esophageal Varices: Problems
hematemesis,
20-30% die on each episode
70% recurrence rate
40
What is the recurrence rate with esophageal varices?
70%
41
Reflex esophagitis: GERD is what?
LES opening allowing reflux of liquid and contents into the esophagus
42
What are the contributing causes to gerd?
obestity
hiatal hernia
vagal nerve abnormalities
43
What are the problems with GERD?
heartburn, Barret's esophagus
44
What is the cause of Barret's esophagus?
GERD
45
What is the problem with Barret's esophagus?
Adenocarcinoma
46
What are the two types of tissues in Barret's esophagus?
normal stratified squamous mucosa
| Columnar epithelium
47
Barret esophagus: Replacement of normal __ __ __ with metaplastic __ __ with __ __
stratified squamous mucosa with metaplastic columnar epithelium with goblet cells
48
Goblet cells do protect the lining from?
gastric contents
49
Esophageal cancer: what two tissues are associated with it?
squamous cell carcinoma
| Adenocarcinoma
50
Esophageal cancer: Squamous cell carcinoma occurs where at in the esophagus?
higher up
51
Esophageal cancer: Squamous cell carcinoma occurs from?
tobacco, alcohol, achalasia, very hot tea >65 degrees Celsius
52
Esophageal cancer: Adenocarcinoma is more common in the
USA
53
Esophageal cancer: Adenocarcinoma: cause
barret's esophagus
54
S/S of esophageal cancer and occur when in cancer progression?
dysphagia and obstruction
| occur late in cancer progression
55
Esophageal cancer: Adenocarcinoma: occurs where in the esophagus?
lower part near the opening of the stomach
56
What are the 3 main diseases associated with the stomach?
gastritis, gastric ulceration, stomach cancer
57
Stomach: Gastritis: types
Chronic (H. Pylori)
| Acute
58
Stomach: Gastric Ulceration: Types
Peptic ulcers, Acute gastric ulceration
59
Stomach: Stomach cancer: types
gastric carcinoma
60
Chronic gastritis will lead to
peptic ulcers
61
Acute gastritis will lead to
acute gastric ulceration
62
The stomach is __ and __. It wants a lot of __ __ b/c __ __ will only act at surface area. The duodenum raises the __. If the pH is not high enough, it will tell the stomach to __ __ and is basically controlling __ __.
The stomach is muscular and resilient. It wants a lot of surface area b/c digestive enzymes will only act at surface area. The duodenum raises the pH. If the pH si not high enough, it will tell the stomach to slow down and is basically controlling stomach emptying.
63
Of the stomach mucosa, what are the most important cells?
Gastric glands: mucous neck cells, parietal cells, chief cells, endocrine cells
64
Gastric pits are __ in teh ___ lining of the stomach. At the __ of each pit is one or more __ __ __. __ __ produce the enzymes of __ __, and __ __ produce __ __.
Gastric pits are depressions in the epithelial lining of the stomach. At the bottom of each pit is one or more tubular gastric glands. Chief cells produce the enzymes of gastric juice, and parietal cells produce stomach acid.
65
Hydrocholric acid secretion by parietal cell:
| What are the three main elements in the blood?
CO2, HCO3-, Cl-
66
Hydrocholric acid secretion by parietal cell: What are the three main elements in the stomach lumen?
K+, H+, Cl-
67
Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens when CO2 from the blood enters the cell?
CO2 -> CO2 + H20 -> H2CO3
I I
V V
HCO3 (blood) H2O
68
Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens when HCO3- from the blood enters the cell?
HCO3 goes back into the blood via a (HCO3-/Cl-) transporter
69
Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens when Cl- from the blood enters the cell?
Cl- goes into the cell via a( HCO3-/Cl-) transporter and then goes straight to the stomach lumen
70
Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens with H20?
```
H2O
I \
V V
OH- H+(exits p.cell into stomach lumen via k+/h- transpor
I
V
H2O
```
71
Most common chronic problem is in the?
stomach
72
Digestion begins in the __ and what is the function?
mouth with chewing which breaks down good mechanically and mixes it with saliva.
73
Swallowing propels ___ ___ through the ___ to the ____ and has what function?
chewed foods, esophagus, stomach
| where acids and stomach motility liquefy it further
74
Liquefied food enters the __ ___ and has what function?
where secretions of the intestinal walls, liver, gallbladder, and pancreas digest it into absorbable nutrients.
75
Nutrients are absorbed through _____ ____ and unabsorbed wastes enter the ___ ___ where ___ are removed.
```
small intestines
large intestines (colon)
liquids
```
76
Solid wastes then enter the ____ and leave the body through the ____.
rectum and leave the body through the anus
77
Sites of absorptions of major nutrients: Stomach
Water
| alcohol
78
Sites of absorptions of major nutrients: duodenum (S SIP CF WVM)
iron, calcium, fats, sugars, water, proteins, vitamins, magnesium, sodium
79
Sites of absorptions of major nutrients: Jejunum
Sugars, Proteins
80
Sites of absorptions of major nutrients: Ileum
bile salts, vitamin B12, chloride
81
Sites of absorptions of major nutrients: Colon
water, electrolytes
82
In the stomach, do you absorb water or lose water?
both
83
In the stomach, do you absorb water or lose water? Why
If some fluid is hypotonic (sports drinks) , the stomach will get rid of some water to make the stomach fluid isotonic and if something makes the fluid in the stomach hypertonic (saltines) then the stomach will absorb more water to make the fluid isotonic.
84
What are the 3 main categories of diseases of the esophagus?
anatomical and motor disorders
esophagitis
esophageal cancer
85
Esophagus: anatomical and motor disorders
hiatal hernia
achalasia
esophageal varices
86
Esophagus: esophagitis
GERD (reflux esophagitis
| Barret esophagus
87
Esophagus: esophageal cancer
Squamous cell carcinoma
- alcohol, tobacco, achalasia, very hot tea
Adenocarcinoma
- barret esophagus
88
What is the most common type of hiatal hernia?
sliding
89
What are the two types of hiatal hernia?
sliding and hiatial paraesophageal hernia (rolling)
90
Hiatus means?
break
91
What is a break in the diaphragm where the esophagus goes through?
hiatial paraesophageal hernia (rolling)
92
The stomach goes through this type of hernia?
hiatial hernia
93
Achalasia and the hiatal hernias have these s/s...
heartburn, regurgitation
94
heartburn, regurgitation are associated with ...
achalasia and hiatal hernia
95
regurgitation is more associated with (~95%)
sliding hernia
96
Achalasia has the loss of
intrinsic inhibitory innervation of LES
97
Achalasia has the loss of intrinsic inhibitory innervation of LES: _____, ___ ____ of LES, ___ ___ ___ of LES
Aperistalis, incomplete relaxation of LES, increased resting tone of LES
98
Achalasia: problems
dysphagia, mucosal inflammation and ulceration, squamous cell carcinoma (5%)
99
What happens in achalasia?
the lower esophageal sphincter fails to relax
100
When you bite off a normal sized amount of food but the lower esophageal sphincter doesn't open appropriately, the bolus will get stuck due to the lower esophageal sphincter failing to relax. This describes?
Achalasia
101
The first s/s you will notice with achalasia is
dysphagia
102
The second s/s you will notice with achalasia is
mucosal inflammation and ulceration
| dysphagia (1st)
103
iF ACHALASIA goes on long enough you will develop...
squamous cell carcinoma
dysphagia (1st)
mucosal inflammation and ulceration (2nd)
104
Esophageal Varices is what?
dilated submucosal veins (varices)
105
What is the cause of esophageal varices?
impaired hepatic portal blood flow
106
Esophageal Varices: Impaired hepatic blood flow is associated with __ ___ and ~2/3 of ___ patients
alcoholic cirrhosis, cirrhosis
107
What is the problem with Esophageal varices?
rupture
108
Esophageal Varices: Problems
hematemesis,
20-30% die on each episode
70% recurrence rate
109
What is the recurrence rate with esophageal varices?
70%
110
Reflex esophagitis: GERD is what?
LES opening allowing reflux of liquid and contents into the esophagus
111
What are the contributing causes to gerd?
obestity
hiatal hernia
vagal nerve abnormalities
112
What are the problems with GERD?
heartburn, Barret's esophagus
113
What is the cause of Barret's esophagus?
GERD
114
What is the problem with Barret's esophagus?
Adenocarcinoma
115
What are the two types of tissues in Barret's esophagus?
normal stratified squamous mucosa
| Columnar epithelium
116
Barret esophagus: Replacement of normal __ __ __ with metaplastic __ __ with __ __
stratified squamous mucosa with metaplastic columnar epithelium with goblet cells
117
Goblet cells do protect the lining from?
gastric contents
118
Esophageal cancer: what two tissues are associated with it?
squamous cell carcinoma
| Adenocarcinoma
119
Esophageal cancer: Squamous cell carcinoma occurs where at in the esophagus?
higher up
120
Esophageal cancer: Squamous cell carcinoma occurs from?
tobacco, alcohol, achalasia, very hot tea >65 degrees Celsius
121
Esophageal cancer: Adenocarcinoma is more common in the
USA
122
Esophageal cancer: Adenocarcinoma: cause
barret's esophagus
123
S/S of esophageal cancer and occur when in cancer progression?
dysphagia and obstruction
| occur late in cancer progression
124
Esophageal cancer: Adenocarcinoma: occurs where in the esophagus?
lower part near the opening of the stomach
125
What are the 3 main diseases associated with the stomach?
gastritis, gastric ulceration, stomach cancer
126
Stomach: Gastritis: types
Chronic (H. Pylori)
| Acute
127
Stomach: Gastric Ulceration: Types
Peptic ulcers, Acute gastric ulceration
128
Stomach: Stomach cancer: types
gastric carcinoma
129
Chronic gastritis will lead to
peptic ulcers
130
Acute gastritis will lead to
acute gastric ulceration
131
The stomach is __ and __. It wants a lot of __ __ b/c __ __ will only act at surface area. The duodenum raises the __. If the pH is not high enough, it will tell the stomach to __ __ and is basically controlling __ __.
The stomach is muscular and resilient. It wants a lot of surface area b/c digestive enzymes will only act at surface area. The duodenum raises the pH. If the pH si not high enough, it will tell the stomach to slow down and is basically controlling stomach emptying.
132
Of the stomach mucosa, what are the most important cells?
Gastric glands: mucous neck cells, parietal cells, chief cells, endocrine cells
133
Gastric pits are __ in teh ___ lining of the stomach. At the __ of each pit is one or more __ __ __. __ __ produce the enzymes of __ __, and __ __ produce __ __.
Gastric pits are depressions in the epithelial lining of the stomach. At the bottom of each pit is one or more tubular gastric glands. Chief cells produce the enzymes of gastric juice, and parietal cells produce stomach acid.
134
Hydrocholric acid secretion by parietal cell:
| What are the three main elements in the blood?
CO2, HCO3-, Cl-
135
Hydrocholric acid secretion by parietal cell: What are the three main elements in the stomach lumen?
K+, H+, Cl-
136
Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens when CO2 from the blood enters the cell?
CO2 -> CO2 + H20 -> H2CO3
I I
V V
HCO3 (blood) H2O
137
Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens when HCO3- from the blood enters the cell?
HCO3 goes back into the blood via a (HCO3-/Cl-) transporter
138
Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens when Cl- from the blood enters the cell?
Cl- goes into the cell via a( HCO3-/Cl-) transporter and then goes straight to the stomach lumen
139
Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens when K+ from the stomach lumen enters the cell?
nothing. it just enters the cell
140
Hydrocholric acid secretion by parietal cell: In the parietal cell, what happens with H20?
H2O
141
Most common chronic problem is in the?
stomach
142
Chronic gastritis and peptic ulceration is basically
chronic mucosal inflammation
143
Chronic gastritis and peptic ulceration is caused by
H Pyloric
144
Chronic gastritis and peptic ulceration is usually
aymptomatic
145
Chronic gastritis and peptic ulceration problems:
upper abdominal discomfort
n/v
ulcers
146
Gastric mucosa: Damaging influences
```
Helicobacter pylori
- urease, toxins
Gastric acidity
Peptic enzymes
Drugs
```
147
Chronic gastritis causes
atrophy
intestinal metaplasia
lymphoid aggregrates
neutrophil inflitrates
148
Peptic ulceration: has what 4 layers
necrotic debris
inflammatory layer
granulation tissue
fibrous scar
149
Peptic ulcers are __ lesions that occur ___ in the __ tract that is exposed to acid-peptic juices. 98% are in the __ __ and __ (4:1)
peptic ulcers are chronic lesions that occur anywhere in the GI tract that is exposed to acid-peptic juices. 98% are in the proximal duodenum and stomach (4:1)
150
Peptic ulcers: H pyloric is present in 70-90% __ ulcers and 70% __ ulcers
duodenal and gastric
151
What is the percentage of ppl that actually get peptic ulcers?
ns10-20%
152
What are the aggragavating causes of peptic ulcers?
NSAIDS, SMOKING, ALCOHOL, CORTIOCOSTEROIDS, high stress personality
153
Peptic ulcers: problems
epigastric pain, N/V, hemorrhage and perforation
| generally do NOT progress to cancer
154
Peptic ulcers are more often impair the __ __ __ rather than shorten it
quality of life
155
Spicy foods make an ulcer worse but does NOT
cause it
156
Acute mucosal inflammation that is usually transient is
acute gastritis
157
Acute gastritis: casues
```
HEAVY NSAID (aspirin)
excessive alcohol use
heavy smoking
cancer chemotherapy
uremia
systemic infection
severe stress
ischemia and shock
ingestion of caustic agents
mechanical trauma
```
158
Acute gastritis: problem
epigastric pain with n/v
| hematemesis and or melena
159
Acute gastric ulcers aka
stress ulcers
160
Acute gastric ulcers aka stress ulcers: __, acute gastric mucosal __ resulting from __ __.
focal, acute gastric mucosal defects resulting from severe stress
161
Acute gastric ulcers aka stress ulcers: Causes
severe trauma,
extensive burns
trauma to CNS
gastric irritants
162
Why have stomach cancer rates fallen?
food storage and refrigeration
163
Gastric Carcinoma:
| accounts for __ of stomach cancers
>90%
164
Gastric Carcinoma: Causes (intestinal type adenocarcinoma)
| these have DECREASED in frequency
```
nitrites/nitrates (perservatives in meat)
smoked food
pickled food
excessive salt
DECREASED BY FRUIT AND VEG. CONSUMPTION
chronic gastritis
H pylori infection
```
165
Gastric Carcinoma: Causes (diffuse carcinoma)
| these have NOT decreased in frequency
risk factors are poorly understood but H pylori is often absent
166
Gastric carcinoma is the __ leading causes of __ ___ worldwide.
gastric carcinoma is the 2nd leading cause of cancer death worldwide
167
What are the 7 most common disorders of the small and large intestines?
```
developmental anomalies
vascular disorders
diarrheal diseases
idiopathic inflammatory bowel disease
colonic diverticulosis
bowel obstruction
tumors of the colon
```
168
small and large intestines: developmental anomalies
hirschsprung disease: congenital megacolon
169
small and large intestines: vascular disorders
ischemic bowel disease
| hemorrhoids
170
small and large intestines: diarrheal diseases
infectious enterocolitis
| malabsorption syndromes
171
small and large intestines: idiopathic IBD
crohn disease, ulcerative colitis
172
Small and large intestines: tumors of the colon
colorectal carcinoma
173
What are the two layers of the GI tract?
circular and horizontal
174
GI tract wall: the serosa is continuous with a fold of serous membrane called the ...
mesentery
175
What is your friend when you need to absorb something?
surface area
176
more surface area =
more diffusion
177
small and large intestines: developmental anomalies: hirschsprung (congenital megacolon)
Caudal migation of __ __ __ fails to reach the __ leaving an __ segment of the __ __ lacking both __ and __ __ __
caudal migration of neural crest cells fails to reach the anus leaving an agnaglioic segment of the distal colon lacking both Meissneer and Auerback myenteric plexuses
178
small and large intestines: developmental anomalies: problems
obstruction
enterocolitis
perforation
179
small and large intestines: developmental anomalies: Hirschsprung (congenital megacolon) is fixed by
removal of aganglionic segment
180
Small and large intestines: vascular disorders: Ischemic bowel disease is what
Acute occlusion or hypo-perfusion can result in infarction
181
Ischemic bowel disease: causes
```
arterial thrombosis
arterial embolism
venous thrombosis
nonocclusive ischemia
-cardiac failure, shock, dehydration, vasoconstrictive drugs
mechanical obstruction
-volvulus, stricture, herniation
```
182
what is the mortality rate for transmural bowel infarction?
90%
183
Small and large intestines: vascular disease: Hemorrhoids: are persistently ___ ___ ___ in the hemrroidal plexus causes variceal dilation
are persistently elevated venous pressure in the hemorrhoidal plexus causes variceal dilation
184
Small and large intestines: vascular disease: Hemorrhoids: causes
straining during defecation
pregnancy
hepativ portal hypertension- similar to eso varices
185
Small and large intestines: Diarrhea: Major causes
```
Secretory
osmotic
exudative
malabsorption
deranged motility
```
186
Small and large intestines: Diarrhea: Secretory
Vibrio cholerae (Cholera)
bacteria causes the cells to dump choride into lumen of GI tract
you will have lots of watery diarrhea (liter an hour - nonstop)
tends to live in lakes, rivers, bays
187
Vibrio cholerae (Cholera)
bacteria causes the cells to dump choride into lumen of GI tract
you will have lots of watery diarrhea (liter an hour - nonstop)
tends to live in lakes, rivers, bays
This describes what?
Secretory diarrhea
188
Small and large intestines: diarrhea: osmotic
gut lavage
see a lot of polyethaline glycol- molecule we dont absorb so we hold the water in the lumen and the water has to go somewhere so it goes out and cleans everything out.
colonscopy
189
gut lavage
see a lot of polyethaline glycol- molecule we dont absorb so we hold the water in the lumen and the water has to go somewhere so it goes out and cleans everything out.
colonscopy
describes what?
osmotic diarrhea
190
Small and large intestines: diarrhea: exudative - destruction of epithelial layer
shigella
salmonella
campylobacter
kill mucosal cells that line the GI tract in the lumen acting as osmotic agents holding water in GI tract and out it goes
191
shigella
salmonella
campylobacter
kill mucosal cells that line the GI tract in the lumen acting as osmotic agents holding water in GI tract and out it goes
exudative
192
Small and large intestines: diarrhea: malabsorption
```
giardia, lymphatic obstruction, defective absorption
lactose intolerance
gas
bloating
end up with diarrhea
```
193
```
giardia, lymphatic obstruction, defective absorption
lactose intolerance
gas
bloating
end up with diarrhea`
```
malabsorption
194
Small and large intestines: diarrhea: deranged motility
surgery, hyperthyroidism,
surgery will normally cause an ileus (stopping of gi tract)
hyperthyroidism: diarrhea moving too fast to absorb all the water
195
Small and large intestines: idiopathic inflammatory bowel disease (IBD): crohn disease
can affect anywhere from mouth to anus
| deep chasms that is transmural inflammation - through wall of intestine
196
Small and large intestines: idiopathic inflammatory bowel disease (IBD): Ulcerative Colitis (UC)
ulcers in colon, continous, starts at rectum and goes backwards,
pesudopolyps: something that doesn't stick out but looks like it sticks out bc it is surrounded by ulcers
197
Small and large intestines: idiopathic inflammatory bowel disease (IBD): crohn disease: s/s
fever, abdominal tenderness, abd. mass, abd. pain, fistulas
| rectal bleeding - occurs in 1/2 of pts
198
Small and large intestines: idiopathic inflammatory bowel disease (IBD): UC s/s
rectal bleeding (ulcers)
199
Common s/s for both UC and crohn's disease
diarrhea, loss of appetite, painful bowel mvmts, frequent bowel mvmt, weight loss, fatigue
200
Diverticulosis/diverticulitis are __ protuding out of the __. These occur in __ of people over __ y.o. in the __ and __ with age.
pouches protruding out of the bowel. These occur in ~50% of ppl over 50 years old in the USA and increase with age
201
Diverticulosis/diverticulitis: problems
lower left quadrant discomfort
bleeding
perforations
fistula formation (following perf)
202
Diverticulosis/diverticulitis: treatment and prevention
eat more fiber
203
Bowel obstruction: mechanical obstructions (types)
hernias
adhesions
intussusception
volvulus
204
Bowel obstruction: pseudo-obstructions
paralytic ileus (post op)
bowel infarction
myopathies and neuropathies (hirschsprung)
205
Tumors of the colon (types)
```
polyp
pedunculated
sessile
hyperplatic
non neoplastic
neoplastic
adenoma
adenocarcinoma
```
206
Tumors of the colon: polyp
a tumorous mass protruding into the lumen
207
Tumors of the colon: pedunculated
having a stalk
208
tumors of the colon: sessile
not having a stalk
209
Tumors of the colon: hyperplastic
increased number of cells - not cancer
210
Tumors of the colon: non-neoplastic
not cancerous
211
Tumors of the colon: neoplastic
abnormal disorganized growth - can be cancer
212
Tumors of the colon: adenoma
neoplastic polyps arising from epithlial proliferation and dysplasia
213
Tumors of the colon: adenocarcinoma:
cancer arising from adenomatous polyps (~98% colorectal cancers)
214
```
Tumors of the colon: Colorectal carinoma
___ cases/year
__ deaths (USA)
lifetime risk : __ incidence, __ death
remains ____ for year
```
~150,000 cases/year, ~50,000 deaths (USA)
lifetime risk; 6% incidence, 2% death
remains asymptomatic for a year
215
Tumors of the colon: Colorectal carinoma: Common s/s
pain
obstruction
changes in bowel habits
216
Tumors of the colon: Colorectal Carcinoma: left s/s
| descending colon, sigmoid colon, rectum
visible blood in stool
| LLQ discomfort
217
Tumors of the colon: Colorectal carcinoma: Right s/s
| cecum, ascending colon
fatigue, weakness
| iron deficient anemia
218
Initials for colon caner staging:
TNM
| tumor nodes metastasis
219
Tumor: types Tis, T1, T2, T3, T4
Tis - earliest stage, only mucosa
T1- ca grown thru muscularis mucosa and extends into submucosa
T2- ca grown thru submucosa and extends into muscularis propria (outer muscle layer)
T3 - ca grown thrn muscularis propria and into subserosa but not to any neighboring organs or tissues
T4 - grown thru the wall of the colon or rectum and into nearby tissues or organs
220
Tumor: grown thru the wall of the colon or rectum and into nearby tissues or organs
T4
221
Tumor: a grown thrn muscularis propria and into subserosa but not to any neighboring organs or tissues
T3
222
Tumor: ca grown thru submucosa and extends into muscularis propria (outer muscle layer)
T2
223
Tumor: ca grown thru muscularis mucosa and extends into submucosa
T1
224
Tumor: earliest stage, only mucosa
Tis
225
Nodes: (N0,N1,N2)
N0- no lymph node involvement is found
N1- ca cells found in 1-3 nearby lymph tissues
N2 - ca cells found in 4+ lymph tissues
226
Metastasis (M0, M1)
M0 - NO DISTANT SPREAD IS SEEN
| m1 - distant spread in seen
227
Peptic ulcers: H pyloric is present in 70-90% __ ulcers and 70% __ ulcers
duodenal and gastric
228
What is the percentage of ppl that actually get peptic ulcers?
ns10-20%
229
What are the aggragavating causes of peptic ulcers?
NSAIDS, SMOKING, ALCOHOL, CORTIOCOSTEROIDS, high stress personality
230
Peptic ulcers: problems
epigastric pain, N/V, hemorrhage and perforation
| generally do NOT progress to cancer
231
Peptic ulcers are more often impair the __ __ __ rather than shorten it
quality of life
232
Spicy foods make an ulcer worse but does NOT
cause it
233
Acute mucosal inflammation that is usually transient is
acute gastritis
234
Acute gastritis: casues
```
HEAVY NSAID (aspirin)
excessive alcohol use
heavy smoking
cancer chemotherapy
uremia
systemic infection
severe stress
ischemia and shock
ingestion of caustic agents
mechanical trauma
```
235
Acute gastritis: problem
epigastric pain with n/v
| hematemesis and or melena
236
Acute gastric ulcers aka
stress ulcers
237
Acute gastric ulcers aka stress ulcers: __, acute gastric mucosal __ resulting from __ __.
focal, acute gastric mucosal defects resulting from severe stress
238
Acute gastric ulcers aka stress ulcers: Causes
severe trauma,
extensive burns
trauma to CNS
gastric irritants
239
Why have stomach cancer rates fallen?
food storage and refrigeration
240
Gastric Carcinoma:
| accounts for __ of stomach cancers
>90%
241
Gastric Carcinoma: Causes (intestinal type adenocarcinoma)
| these have DECREASED in frequency
```
nitrites/nitrates (perservatives in meat)
smoked food
pickled food
excessive salt
DECREASED BY FRUIT AND VEG. CONSUMPTION
chronic gastritis
H pylori infection
```
242
Gastric Carcinoma: Causes (diffuse carcinoma)
| these have NOT decreased in frequency
risk factors are poorly understood but H pylori is often absent
243
Gastric carcinoma is the __ leading causes of __ ___ worldwide.
gastric carcinoma is the 2nd leading cause of cancer death worldwide
244
What are the 7 most common disorders of the small and large intestines?
```
developmental anomalies
vascular disorders
diarrheal diseases
idiopathic inflammatory bowel disease
colonic diverticulosis
bowel obstruction
tumors of the colon
```
245
small and large intestines: developmental anomalies
hirschsprung disease: congenital megacolon
246
small and large intestines: vascular disorders
ischemic bowel disease
| hemorrhoids
247
small and large intestines: diarrheal diseases
infectious enterocolitis
| malabsorption syndromes
248
small and large intestines: idiopathic IBD
crohn disease, ulcerative colitis
249
Small and large intestines: tumors of the colon
colorectal carcinoma
250
What are the two layers of the GI tract?
circular and horizontal
251
GI tract wall: the serosa is continuous with a fold of serous membrane called the ...
mesentery
252
What is your friend when you need to absorb something?
surface area
253
more surface area =
more diffusion
254
small and large intestines: developmental anomalies: hirschsprung (congenital megacolon)
Caudal migation of __ __ __ fails to reach the __ leaving an __ segment of the __ __ lacking both __ and __ __ __
caudal migration of neural crest cells fails to reach the anus leaving an agnaglioic segment of the distal colon lacking both Meissneer and Auerback myenteric plexuses
255
small and large intestines: developmental anomalies: problems
obstruction
enterocolitis
perforation
256
small and large intestines: developmental anomalies: Hirschsprung (congenital megacolon) is fixed by
removal of aganglionic segment
257
Small and large intestines: vascular disorders: Ischemic bowel disease is what
Acute occlusion or hypo-perfusion can result in infarction
258
Ischemic bowel disease: causes
```
arterial thrombosis
arterial embolism
venous thrombosis
nonocclusive ischemia
-cardiac failure, shock, dehydration, vasoconstrictive drugs
mechanical obstruction
-volvulus, stricture, herniation
```
259
what is the mortality rate for transmural bowel infarction?
90%
260
Small and large intestines: vascular disease: Hemorrhoids: are persistently ___ ___ ___ in the hemrroidal plexus causes variceal dilation
are persistently elevated venous pressure in the hemorrhoidal plexus causes variceal dilation
261
Small and large intestines: vascular disease: Hemorrhoids: causes
straining during defecation
pregnancy
hepativ portal hypertension- similar to eso varices
262
Small and large intestines: Diarrhea: Major causes
```
Secretory
osmotic
exudative
malabsorption
deranged motility
```
263
Small and large intestines: Diarrhea: Secretory
Vibrio cholerae (Cholera)
bacteria causes the cells to dump choride into lumen of GI tract
you will have lots of watery diarrhea (liter an hour - nonstop)
tends to live in lakes, rivers, bays
264
Vibrio cholerae (Cholera)
bacteria causes the cells to dump choride into lumen of GI tract
you will have lots of watery diarrhea (liter an hour - nonstop)
tends to live in lakes, rivers, bays
This describes what?
Secretory diarrhea
265
Small and large intestines: diarrhea: osmotic
gut lavage
see a lot of polyethaline glycol- molecule we dont absorb so we hold the water in the lumen and the water has to go somewhere so it goes out and cleans everything out.
colonscopy
266
gut lavage
see a lot of polyethaline glycol- molecule we dont absorb so we hold the water in the lumen and the water has to go somewhere so it goes out and cleans everything out.
colonscopy
describes what?
osmotic diarrhea
267
Small and large intestines: diarrhea: exudative - destruction of epithelial layer
shigella
salmonella
campylobacter
kill mucosal cells that line the GI tract in the lumen acting as osmotic agents holding water in GI tract and out it goes
268
shigella
salmonella
campylobacter
kill mucosal cells that line the GI tract in the lumen acting as osmotic agents holding water in GI tract and out it goes
exudative
269
Small and large intestines: diarrhea: malabsorption
```
giardia, lymphatic obstruction, defective absorption
lactose intolerance
gas
bloating
end up with diarrhea
```
270
```
giardia, lymphatic obstruction, defective absorption
lactose intolerance
gas
bloating
end up with diarrhea`
```
malabsorption
271
Small and large intestines: diarrhea: deranged motility
surgery, hyperthyroidism,
surgery will normally cause an ileus (stopping of gi tract)
hyperthyroidism: diarrhea moving too fast to absorb all the water
272
Small and large intestines: idiopathic inflammatory bowel disease (IBD): crohn disease
can affect anywhere from mouth to anus
| deep chasms that is transmural inflammation - through wall of intestine
273
Small and large intestines: idiopathic inflammatory bowel disease (IBD): Ulcerative Colitis (UC)
ulcers in colon, continous, starts at rectum and goes backwards,
pesudopolyps: something that doesn't stick out but looks like it sticks out bc it is surrounded by ulcers
274
Small and large intestines: idiopathic inflammatory bowel disease (IBD): crohn disease: s/s
fever, abdominal tenderness, abd. mass, abd. pain, fistulas
| rectal bleeding - occurs in 1/2 of pts
275
Small and large intestines: idiopathic inflammatory bowel disease (IBD): UC s/s
rectal bleeding (ulcers)
276
Common s/s for both UC and crohn's disease
diarrhea, loss of appetite, painful bowel mvmts, frequent bowel mvmt, weight loss, fatigue
277
Diverticulosis/diverticulitis are __ protuding out of the __. These occur in __ of people over __ y.o. in the __ and __ with age.
pouches protruding out of the bowel. These occur in ~50% of ppl over 50 years old in the USA and increase with age
278
Diverticulosis/diverticulitis: problems
lower left quadrant discomfort
bleeding
perforations
fistula formation (following perf)
279
Diverticulosis/diverticulitis: treatment and prevention
eat more fiber
280
Bowel obstruction: mechanical obstructions (types)
hernias
adhesions
intussusception
volvulus
281
Bowel obstruction: pseudo-obstructions
paralytic ileus (post op)
bowel infarction
myopathies and neuropathies (hirschsprung)
282
Tumors of the colon (types)
```
polyp
pedunculated
sessile
hyperplatic
non neoplastic
neoplastic
adenoma
adenocarcinoma
```
283
Tumors of the colon: polyp
a tumorous mass protruding into the lumen
284
Tumors of the colon: pedunculated
having a stalk
285
tumors of the colon: sessile
not having a stalk
286
Tumors of the colon: hyperplastic
increased number of cells - not cancer
287
Tumors of the colon: non-neoplastic
not cancerous
288
Tumors of the colon: neoplastic
abnormal disorganized growth - can be cancer
289
Tumors of the colon: adenoma
neoplastic polyps arising from epithlial proliferation and dysplasia
290
Tumors of the colon: adenocarcinoma:
cancer arising from adenomatous polyps (~98% colorectal cancers)
291
```
Tumors of the colon: Colorectal carinoma
___ cases/year
__ deaths (USA)
lifetime risk : __ incidence, __ death
remains ____ for year
```
~150,000 cases/year, ~50,000 deaths (USA)
lifetime risk; 6% incidence, 2% death
remains asymptomatic for a year
292
Tumors of the colon: Colorectal carinoma: Common s/s
pain
obstruction
changes in bowel habits
293
Tumors of the colon: Colorectal Carcinoma: left s/s
| descending colon, sigmoid colon, rectum
visible blood in stool
| LLQ discomfort
294
Tumors of the colon: Colorectal carcinoma: Right s/s
| cecum, ascending colon
fatigue, weakness
| iron deficient anemia
295
Initials for colon caner staging:
TNM
| tumor nodes metastasis
296
Tumor: types Tis, T1, T2, T3, T4
Tis - earliest stage, only mucosa
T1- ca grown thru muscularis mucosa and extends into submucosa
T2- ca grown thru submucosa and extends into muscularis propria (outer muscle layer)
T3 - ca grown thrn muscularis propria and into subserosa but not to any neighboring organs or tissues
T4 - grown thru the wall of the colon or rectum and into nearby tissues or organs
297
Tumor: grown thru the wall of the colon or rectum and into nearby tissues or organs
T4
298
Tumor: a grown thrn muscularis propria and into subserosa but not to any neighboring organs or tissues
T3
299
Tumor: ca grown thru submucosa and extends into muscularis propria (outer muscle layer)
T2
300
Tumor: ca grown thru muscularis mucosa and extends into submucosa
T1
301
Tumor: earliest stage, only mucosa
Tis
302
Nodes: (N0,N1,N2)
N0- no lymph node involvement is found
N1- ca cells found in 1-3 nearby lymph tissues
N2 - ca cells found in 4+ lymph tissues
303
Metastasis (M0, M1)
M0 - NO DISTANT SPREAD IS SEEN
| m1 - distant spread in seen
