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Patho 2 > GI > Flashcards

GI Flashcards

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1
Q

Diverticular disease: etiology/risks

A

Lack of fibre in diet
Inactivity
Poor bowel patterns
Aging (80% > 85yo)

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2
Q

Diverticulitis

A

Inflammation of diverticula

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3
Q

Diverticular Disease Dx?

A

CT scan

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4
Q

Diverticulosis

A

Formation of Diverticula
Asymptomatic
Usually found during imaging for other purposes or screening/occult blood

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5
Q

Diverticular Disease: Tx?

A

Depending on severity and intended to prevent complications;
Tx of symptoms;
Sx if perforated or obstructed

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6
Q

Irritable Bowel Syndrome: Et? (Theories)

A

Unclear;
1- Malabsorption of polyols and fermented CHO
2-Alteration in regulation of motor and sensory GI functions
3-Molecular signalling defective for serotonin

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7
Q

IBS: Tx?

A

Antispasmodics
Antidiarrheals (if diarrhea)
Laxative (if constipation)
Antibiotics (with caution)

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8
Q

Diverticular Disease: manifestations?

A

LLQ local dull pain
Abdominal discomfort
Fever (usually indication of infection)
Nausea + vomiting (d/t pain when severe)

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9
Q

IBS: manifestations?

A 
Diarrhea / Constipation
Abdominal discomfort/pain (relieves with defecating and at night)
Mucoid stools
Flatulence
Bloating
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10
Q

Peritonitis: Etiology?

A

Bacterial invasion/infection
(acute inflm ruptured appendix/ perforated peptic ulcer/trauma/PID/ruptured diverticulum)
Chemical irritation (bile)

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11
Q

Peritonitis: Patho?

A

Causative agent impacts peritoneum > Inflammation

Disadvantage:
Highly vascularized + inflammatory vasodilation > rapid absoption & spread of bacteria/toxins

Well adapted for inflammation/Advantage:

1) Production of thick and sticky exudate > seals off perforated viscus & aids localization of inflammation
2) Localization stimulates a sympathetic response that limits intestinal motility > decreased peristalsis

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12
Q

Peritonitis: Manifestations?

A

cardinal signs of inflammation (erythema, swelling, heat, pain, loss of fx)
severe:
> fluid shift into bowel & abdominal cavity > 3rd spacing
> blood shunt to site of inflammation > hyperemia
> Pain > vomiting
> Dyspnea d/t fluid buildup exerting pressure on thoracic cavity > Ascites

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13
Q

Peritonitis: Tx?

A 
NPO
Antibiotics IV
NG suction
Fluids & electrolytes
Pain meds (narcotics)
Sx > if perf ulcer/inflm appendix
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14
Q

Appendicitis: Et?

A

Idiopathic
Theories:
1) Intraluminal obstruction by Fecalith (hard piece of stool)
2) Twisting of appendix or bowel

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15
Q

Appendicitis: Patho?

A

Lumen becomes obstructed
Drainage from cecum increases luminal pressure in the appendix
Excess venous pressure leads to venous stasis and impedes perfusion > ischemia and necrosis
Bacteria invade appendix’s wall & perforate?

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16
Q

Appendicitis: manifestations?

A

abrupt onset
acute epigastric & periumbilical pain at first - referred pain
nausea & vomiting - severe pain
increasing pain - colicky & localized on RLQ over 12h
Fever
WBC

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17
Q

Appendicitis: Dx?

A

Hx & Px
Ultrasound
CT (if US not adequate to dx)

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18
Q

Appendicitis: Tx?

A

NPO
Antibiotics
IV Fluids & electrolytes
Sx

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19
Q

IBD

A

Inflammatory Bowel Disease
> Crohn’s Disease
> Ulcerative Colitis

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20
Q

IBD: Etiology?

A

Complex trait
> genetic susceptibility
> environmental - infective trigger

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21
Q

IBD: Patho

A

Mucosal immune system responds against ingested pathogens, but is unresponsive to the normal intestinal microflora

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22
Q

Crohn’s Disease: Patho?

A

Affects submucosal layer in terminal ileum - other areas can be affected;
Granulomatous, skip lesions (cobblestone pattern)
Slower Progression compared to Ulcerative Colitis
Chronic

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23
Q

Crohn’s: Manifestations?

A

periods of exacerbation & remission
symptoms related t the location of the lesions
- intermittent diarrhea
- abdominal pain (colicky usually RLQ)
Weight loss d/t absorptive layer is compromised
Fluid & electrolyte disorders imbalance d/t water loss
low grade fever

Complications:

  • fistulas
  • abdominal abscesses
  • bowel obstruction
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24
Q

Ulcerative Colitis

A

Non-specific inflammatory condition of the colon
Confined to rectum & colon - begins in the rectum & spreads proximately affecting the mucosal layer - can extend to submucosa
Continuous lesions

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25
Ulcerative Colitis: Patho?
- bleeding occurs d/t ulceration & inflammation - thickened, inflamed areas > scarring tissue - edema & congestion of gut content & exudate in the gut - crypt abscesses - pseudopolyps
26
Ulcerative Colitis: manifestations?
bloody diarrhea | abdominal cramping
27
Ulcerative Colitis: Dx?
Hx & Px (exclude other conditions) Sigmoidoscopy, colonoscopy, biopsy Labs to exclude GI infection
28
Ulcerative Colitis: Tx?
Address inflammatory symptoms - anti-inflammatories (sulfasalazine) - steroids (if non responsive or flareups) - immunomodulator (methotrexate) ? antibiotics (with caution to control overgrowth of normal flora) ? Sx (necrotic bowel sections if required) Diet Alteration
29
Herniation
- Organ protrusion through retaining structure | - Usually in abdominal cavity
30
Herniation Patho?
-Weakened retaining structure (eg: muscles) Etiology: - Acquired or Congenital - Increased intra-abdominal pressure (pregnancy, obesity)
31
Hernias: Types?
1) Hiatal: - axial/sliding (95%) - parasophageal/nonaxial (rolling) 2) Inguinal - direct (through the abdominal wall) - indirect (through the inguinal canal)
32
Hiatal Hernia: Patho?
- Hiatus enlarges | - part of stomach protrudes into thoracic cavity
33
Axial/Sliding (95%): description + manifestations?
- GEJ and upper part of stomach protrude into TC - 50% asymptomatic, of symptomatic: - reflux (d/t increased gastric acid in esophagus) - heartburn pain (d/t being adjacent to heart)
34
Paraesophageal/Nonaxial (rolling): description + manifestations?
- non-upper part of stomach enters TC - GEJ remains below diaphragm - pain - dyspnea (limited lung expansion d/t hernia) - fullness (reduced stomach volume) - no reflux (gastric content is pushed into the pouch, therefore no acid in esophagus)
35
Hiatal Hernia: Tx?
- modify lifestyle (avoid caffeine, alcohol & smoking) - behavioural changes (avoid bending, drinking fluids @HS, raise HOB) - drugs (reflux): antacids, H2RA, PPIs - Sx (~15%) fundoplication for hiatal hernia - if affecting breathing
36
Inguinal Hernia: Types + Tx?
- direct (through body structure - abdominal wall) - indirect (through inguinal canal) Peritoneum forms hernial sac > contains intestine & omentum Sx required to avoid complications (strangulation of bowel)
37
Direct Hernia
projection through abdm wall
38
Indirect Hernia
projection through inguinal canal
39
Peptic Ulcer Disease: describe?
- Ulcerative disorder of the lining of the stomach (20%) or duodenum (80%) - Affects mucosa (can penetrate) > can lead to peritonitis - Spontaneous remissions and exacerbations
40
Peptic Ulcer: Et/Risk Factors? Aggressive components that facilitate the formation of ulcers or compromises the protection of the lining
- Aspirin & NSAIDs use - Helicobacter pylori - HCl & biliary acid - Chronic gastritis - Smoking, alcohol & caffeine
41
Peptic Ulcer: Patho?
Unclear: H pylori > not part of the normal flora, but survives low pH. - ability to colonize stomach *& duodenum lining - adhesion ability with the production of urease which converts urea into CO2 + NH3 > creating a microniche that neutralizes gastric acid and promotes growth > H pylori induce inflammation & stimulate the release of cytokines and other inflammatory mediators that contribute to the damage of the mucosa. > Hypergastrinemia - increase release of gastrin by the G cells which promotes the secretion of HCl by the parietal cells > Risk factors impede protection and defence of the lining INFECTION > INFLAMMATION > INCR. ACID > COMPROMISED PROTECTION > TISSUE DAMAGE > ULCER > PERFORATION?
42
Peptic Ulcer: manifestations?
- abdominal pain - burning - cramping - N+V Complications: Perforation > Peritonitis > Life Threatening! Hemorrhage Obstruction d/t edema, spasm & scar tissue contraction
43
Peptic Ulcer: Dx?
- Hx - Serology - Stool sample - UBT (Urea Breath Test) - Barium Swallow (contrast) - Endoscopy
44
Peptic Ulcer: Tx? Aim to eradicate bacteria
- Antiacids to manage manifestations - Triple regimen >PPI (H2RA) + Amoxyl + Biaxin >PPI (H2RA) + Flagyl + Biaxin > continued PPI to assist ulcer healing - Sx if complications
45
Hepatitis
Inflammation of the Liver
46
Hepatitis: Etiology?
- Microbes (viruses mostly; fungi, bacteria, parasites) - Autoimmunity - Drugs (hepatotoxicity)
47
Viral Hepatitis
ABC - most common forms DE FG (not severe)
48
Viral Hepatitis: differences?
Virus & transmission mode Incubation period Severity Carrier state
49
Hepatitis A
mild, acute form orofecal transmission route HAV antibodies measured & IgM 28 days - 1 month incubation period
50
Hepatitis B
``` more severe 10-15% chronic or acute state carrier state? cirrhosis?? > complication transmission mode is broad: > oral > blood > body fluids > sexual ``` 3 antibodies: anti-HBs, anti-HBc, anti-HBe
51
Hepatitis C | worst form
``` 80% chronic > cirrhosis & hepatocellular CA? via infected blood - IV use - high risk sex practices antibodies & viral testes for Dx ```
52
Hepatitis: Patho?
2 mechanisms cause decrease liver fx: > IR: inflammation & necrosis > viral injury > necrosis Damage to vasculature & ducts ~4 months to heal
53
Hepatitis: Manifestations?
Prodromal - lethargy, myalgia - fever, abdominal pain - anorexia, N+V Clinical - manifestations worsen - hepatomegaly, tender liver on palpation - jaundice, pruritus Full recovery in ~16 weeks > when lab values are normal
54
Viral Hepatitis Tx
Bed Rest to decrease metabolic demand and workload on Liver Modify diet - small meals Refrain from alcohol and hepatotoxic drugs Symptom management ~pruritus Vaccines for Hep A and B New direct acting antiviral DAA for Hep C Adjunct drug ~interferon
55
Autoimmune Hepatitis Et
Complex trait ~Environmental triggers viral & chemical agents ~HLA genes and MHC on Chr. 6
56
Autoimmune Hepatitis Type 1
More common ~80% in women ANA & anti smooth muscle antibodies Usually have other autoimmune conditions associated
57
Autoimmune Hepatitis Type 2
2-14 yo | Antibodies against cytosol & microsomes
58
Autoimmune Hepatitis Manifestations and Dx
Mnfts vary, usually asymptomatic to those of Liver Failure ``` Dx Exclude other liver disease - viral hepatitis Increase of gamma globulins ANA tests Biopsy ```
59
Autoimmune Hepatitis Tx
Immunosuppressants | Transplant if non responsive to immunotherapy
60
Cirrhosis
Cirr - yellow- jaundice ``` Final stage of chronic liver disease Life threatening Leading cause of death Aka Liver Failure Complication ```
61
Cirrhosis Et
``` Alcoholism 60-70% Hepatitis Biliary disease - low prevalence when compared to ETOH Metabolic disorders - Wilson disease Drugs Cryptogenic Etiology - aka unknown ```
62
Cirrhosis Patho
Hepatocytes necrosis Cells regenerate bound by fibrous tissue - nodular appearance Vessel Constriction Impeded perfusion leads to Portal HTN - fluids shifts resulting in ascites Biliary duct constriction leads to bile stasis Increased waste d/t decreased metabolic waste clearance Liver Failure —— GAME OVER!! LOL!
63
Cirrhosis Manifestations
Vary, based on stage & underlying cause Anorexia, weakness, Wt loss are common Hepatomegaly Jaundice - depending on what is causing liver failure Complications - Portal HTN - Ascites - Varices -rupture could result in hemorrhage - usually esophageal & hemorrhoidal veins - Splenomegaly - vessels become congested
64
Cirrhosis Tx Think- Goal is to facilitate regeneration and reduce liver workload
- diet modification - smaller meals - refrain from ETOH - prevent complications
65
Portal HTN
Increased pressure in Hepatic Portal System HPS Greater than 12mmHg Normal P - 5-10mmHg Et Pre- Post - Intra- Et depending on what is causing it Mostly caused by Cirrhosis & Ascites Ruptured Varix - major complication Portosystemic shunts - colaterization of vessels to decrease pressure from Liver resulting in shunting of blood to other vessels
66
Ascites
Fluid accumulation in Peritoneal Cavity Et+patho - Cirrhosis - Portal HTN - Fluid retention d/t increased hydrostatic pressure
67
Ascites Mnfts
Dyspnea | Abdominal distension
68
Ascites Tx
Small Volume - diuretics - Na Restriction - Fluids and lytes Large Volume exceeds 5L - paracentesis - volume expander - albumin - to prevent further fluid leaving vasculature
69
Liver Failure
Acute or Chronic Loss of Functional capacity - 80% ~50% mortality
70
Liver Failure Et
Several - toxic liver damage - fulminant hepatitis - cirrhosis
71
Colorectal CA: Et
Unknown Incidence increases with: -age -family hx (crohn's or ulcerative colitis) -diet (fat intake, refined sugar intake, fibre intake)
72
Colorectal CA: Mnfts
Usually present for a long time before producing s+s Bleeding Change of bowel patterns (diarrhea or constipation); sense of urgency or incomplete emptying
73
Colorectal CA: Stages
Stage 1: limited to invasion of mucosal and submucosal layers Stage 2: tumour infiltrates into, but not through the muscularis externa Stage 3: invasion of the serosal layer and lymph node involvement Stage 4: metastatic tumour penetrates serosa or adjacent organs - poor prognosis!
74
Colorectal CA: screening and Dx
Early Dx improves prognosis ``` Detection methods: -digital rectal examination -fecal occult blood test X-Ray Colonoscopy and sigmoidoscopy ```
75
Colorectal CA: Tx
Sx - removal Preoperatively radiation therapy Postoperative adjuvant chemotherapy
76
Liver Failure
Acute or chronic Loss of functional capacity - greater than 80% to present failure s+s ~50%
77
Liver Failure: Et
Several ~toxic liver damage ~Fulminant hepatitis ~Cirrhosis
78
Liver Failure: Patho
``` Hepatic Insufficiency - multiorgan failure 1-Hematology 2-Metabolism 3-Hepatorenal syndrome 4-Encephalopathy ```
79
Liver Failure: Tx
Address underlying cause and reverse cause Purgative - potent laxative to clear toxins eg. Ammonia Non absorbable Antibiotics - replace normal flora Transplant if non responsive
80
Cholelithiasis: Et
Bile stasis Altered bile composition ~Eg high cholesterol dec bile salts Genetics
81
Cholelithiasis: Patho
Debris - nuclei for stone formation | Precipitation of bile content - stone
82
Cholelithiasis: Types
Cholesterol stones 80% Pigment stones 20% Mixed - bilirubin, Ca salts, Phosp
83
Cholelithiasis: manifestations
Colic - intermittent and radiating pain | Nausea and vomitting
84
Cholelithiasis: Dx
Hx Px US Nuclear scans
85
Cholelithiasis: Tx
``` Pain management Dissolving agents - Actigal drug - less invasive Sx if required US to blast the stones Retrograde endoscopy Tx complications such as Pancreatitis ```
86
Acute Pancreatitis:
inflammation of the Pancreas due to Auto Digestion
87
Acute Pancreatitis: Et
Alcohol abuse Cholelithiasis Idiopathic Other: trauma, drugs...
88
Liver CA: Primary?
- Hepatocarcinoma (most common >80%); mnfts often masked by underlying liver damage; poor prognosis - Cholangiocarcinoma arises from epithelial of bile duct
89
Liver CA: Secondary?
Metastasis from colon, lung and breast
90
Liver CA: Primary > Et?
- Chronic Liver disease > eg. Hep C | - Toxins (arsenic)
91
Liver CA: Tx
Very poor prognosis Supportive & palliative If Tx fails > 2-3 months prognosis & cause of death is liver failure Debulking Sx- to remove malignancy as much as possible
92
Pancreatic CA: Et?
Unclear Risk Factors: - Smoking - Age (>50yo) - DM, Chronic Pancreatitis, Poor diet
93
Pancreatic CA: mnfts?
``` Very aggressive Very fast Jaundice (unclear why?) Wt loss Abdominal pain ```
94
Pancreatic CA: Dx
US CT Mets at Dx- usually too late when found
95
Pancreatic CA: Tx
Pain management | Primary approach -Sx resection then palliative care
96
Cleft Lip
Genetic Congenital ~ 1 in 700 live births Structural anomaly Incomplete fusion of maxilla and nasal structures - uni or bilateral d/t TERATOGENS - smoking during pregnancy, viral infection, folic acid deficiency
97
Cleft palate
Incomplete fusion of palatine structures - malformed nasal structures Linked to smoking during pregnancy - Teratogens ~1 in 2000 live births - Problems with speech, swallowing, nutrition and breathing
98
Hirschsprung disease
~1 in 5000 live births RET gene in Chr 10- genetics problem Areas of colon lack parasympathetic ganglia - NO PERISTALSIS Tx: Resection Sx
99
Intussusception
Intestine invaginates in adjoining part - ileocecal valve region mechanical problem & increased pressure Can cause Obstruction and inflammation Invagination > Obstr > inflamm & edema > ischemia Complications: necrosis, perforation, peritonitis

Patho 2 (7 decks)

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