GI Module 3B

Question 1

What is infantile hypertrophic pyloric stenosis?

Answer 1

• Congenital narrowing of pylorus
• Infant at 2-3 wks begins to vomit for no apparent reason
• Hormones to allergic reactions MAY be a cause
• Tx is pyloromyotomy

Question 2

What is an adult pyloric obstruction?

Answer 2

• Aka gastric outlet obstruction

- Usually caused by severe peptic ulcer or tumor in area

Question 3

What are adhesions?

Answer 3

• Mechanical intestinal obstruction
• Fibrous scar tissue adheres to intestinal loops
• Common complication of abdominal surgeries

Question 4

What is a herniation?

Answer 4

• Mechanical intestinal obstruction

- Intestine protrudes through abdominal wall

Question 5

What is an intussusception?

Answer 5

• Mechanical intestinal obstruction
• Telescoping of 1 part of an intestine on another portion
• MC in ileocecal area

Question 6

What is the MC bowel obstruction in infants/young children?

Answer 6

Intussusception

Question 7

What is a volvulus?

Answer 7

• Mechanical intestinal obstruction
• Intestine twists upon itself (torsion)
• MC in LI in elderly population

Question 8

What is the MC cause of LI obstructions?

Answer 8

Colon/rectal cancer

Question 9

What is a paralytic ileus?

Answer 9

• Functional intestinal obstruction

- Obstruction that results when peristalsis stops

Question 10

What is Hirschsprung’s disease?

Answer 10

• Megacolon
• Birth defect (ganglion cells of colon fail to develop)
• Causes 25% of all infant obstructions
• Impaired motility of colon

Question 11

What are the types of Hirschsprung’s disease?

Answer 11

• Short Segment (rectosigmoid colon, milder)

- Long Segment (regions proximal to rectosigmoid as well)

Question 12

What is IBD?

Answer 12

• Chronic inflammatory disease that damages/ulcerates GI tract
• Abnormal response to immune system
• Two forms (Crohn’s, ulcerative colitis)

Question 13

Crohn’s disease location

Answer 13

• Can affect any part of GI tract

- Though commonly at terminal end of ileum and in cecum of LI

Question 14

When is the peak onset of Crohn’s? Males or females?

Answer 14

15-25 yo

Females more than males

Question 15

Pathophys of Crohn’s

Answer 15

• Inflammation extends through all layers of intestinal wall

- Chronic granulomatous inflammation

Question 16

What are skip lesions?

Answer 16

2 or more inflamed areas in Crohn’s with healthy bowel in between

Question 17

What is a stricturoplasty?

Answer 17

Surgical tx option for chronic narrowing of intestinal lumen

Question 18

What is ulcerative colitis?

Answer 18

• Chronic inflammatory disease that affects LI
• Inflammation extends to mucosa ONLY
• Always involves rectum

Question 19

What are the different regional patterns of LI in ulcerative colitis?

Answer 19

• Ulcerative proctitis (distal 12 cm of colon)
• Proctosigmoiditis (rectum to splenic flexure)
• Pancolitis (rectum to cecum, “everything”)

Question 20

What is a total colectomy and ileorectal anastamosis?

Answer 20

• Colon is removed except last 5 inches of rectum

- SI is then surgically joined to upper rectum

Question 21

What is a colectomy with ileoanal pouch?

Answer 21

• Aka restorative proctocolectomy
• Colon and rectum removed
• “New rectum” is made from SI and attached to anal canal
• Sometimes an ileostomy is created and then closed later on

Question 22

What is an ileostomy (or stoma)?

Answer 22

• Temporary opening in abdomen

- After operation has healed, it is closed to restore normal bowel function

Question 23

What is a proctocolectomy and ileostomy?

Answer 23

• Both colon and rectum removed
• Permanent ileostomy
• Recommended for pts with rectal cancer or who cannot have other operations

Question 24

Is obstruction MC in Crohn’s or ulcerative colitis?

Answer 24

Crohn’s

Question 25

Are abscesses and fistulas MC in Crohn's or ulcerative colitis?

Answer 25

Crohn's

Question 26

Are bloody stools MC in Crohn's or ulcerative colitis?

Answer 26

Ulcerative colitis

Question 27

What is diverticulosis?

Answer 27

- Weakening of intestinal wall - Out pockets created - 85% pts are asymp

Question 28

Where are diverticuli MC found?

Answer 28

Sigmoid colon

Question 29

How to treat diverticulosis?

Answer 29

- High fiber diet | - Avoid high residue foods (seeds, corn, nuts)

Question 30

What is diverticulitis?

Answer 30

- Inflammation of colonic diverticula - Impacted w/fecal material - Perforations d/t inflammation

Question 31

What is simple diverticulitis?

Answer 31

Inflammation is contained in intestinal wall

Question 32

What is complicated diverticulitis?

Answer 32

Inflammation penetrates into peritoneal space

Question 33

How do most colorectal cancers develop?

Answer 33

From adenomatous (glandular) polyp

Question 34

What is the screening tool for colorectal cancer?

Answer 34

Colonoscopy

Question 35

Which is more thorough - colonoscopy or sigmoidoscopy?

Answer 35

Colonoscopy

Question 36

What is hepatitis and what is its pathology?

Answer 36

- Inflammation of the liver - Virus or agent - Kupffer cell hyperplasia

Question 37

What is fulminating hepatitis?

Answer 37

- Rare complication of hepatitis | - Massive hepatic cell death and liver failure

Question 38

What is cirrhosis?

Answer 38

- Irreversible inflammatory condition of liver | - Hepatic cell death causes diffuse scarring of liver

Question 39

What is the pathology of cirrhosis?

Answer 39

- Dependent on cause - Hepatic tissue becomes nodular and fibrotic - Liver may expand or shrink in size

Question 40

What is alcoholic cirrhosis?

Answer 40

- Enlarged liver | - Initially fatty accumulation in hepatocytes (reversible)

Question 41

How does the chronic metabolism of alcohol cause cirrhosis?

Answer 41

- Produces acetaldehyde which disrupts hepatocyte function/metabolism - Inflammatory response and necrosis - Fibrotic accumulation/scarring

Question 42

Define fatty liver, fibrosis, and cirrhosis in terms of reversibility

Answer 42

Fatty liver = reversible Fibrosis = reversible w/scarring Cirrhosis = irreversible

Question 43

What is primary biliary cirrhosis?

Answer 43

- Autoimmune disease | - Attacks small intrahepatic bile ducts

Question 44

What is secondary biliary cirrhosis?

Answer 44

- Chronic obstruction of biliary flow | - Leads to fibrotic changes