GI System Flashcards
1
Q
Diseases of the GI tract can be classified as what 5 ways?
A
– Developmental disorders – Inflammatory diseases – Functional disorders – Circulatory disturbances – Neoplastic diseases
2
Q
The following diseases affect what portion of the GI system? – Hiatal hernia – Reflux esophagitis – Barrett esophagus – Achalasia – Esophageal varices – Esophageal cancer
A
Esophagus
3
Q
The following diseases affect what portion of the GI system? – Acute gastritis – Chronic gastritis – Peptic ulcer disease – Stomach cancer
A
Stomach
4
Q
The following diseases affect what portion of the GI system? – Meckel diverticulum – Bowel obstruction – Herniation – Adhesions – Intussusception – Volvulus – Adenocarcinoma – Carcinoid tumor
A
Small intestine
5
Q
The following diseases affect what portion of the GI system? – Pseudomembraneous colitis – Diverticulosis – Crohn disease – Ulcerative colitis – Adenomatous polyps – Colon cancer
A
Large Intestine
6
Q
–difficulty in swallowing
A
• Dysphagia
7
Q
–expulsion of stomach contents through the mouth
A
• Vomiting
8
Q
–vomiting of fresh, red blood
A
• Hematemesis
9
Q
–bright, red blood in stool
A
• Hematochezia
10
Q
–black, tarry feces
A
• Melena
11
Q
–frequent, loose, watery bowel movements
A
• Diarrhea
12
Q
–hard feces that are difficult to eliminate
A
• Constipation
13
Q
–painful swallowing
A
• Odynophagia
14
Q
Clinical Symptoms and Signs of \_\_\_\_\_\_ Disease • Dysphagia –difficulty in swallowing • Odynophagia –pain on swallowing • Heartburn –a burning behind the sternum - GERD • Acid regurgitation into the mouth –a sign of GERD
A
Esophageal
15
Q
–a Functional (Motor)
Disorder
• 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
A
Achalasia
16
Q
• Scandinavian, Northern European women • Severe Fe-deficiency anemia • Mucosal atrophy - atrophic glossitis • Esophageal webs - dysphagia • Increased risk for squamous cell carcinoma – Esophagus – Oropharynx – Posterior Oral Cavity
A
Plummer Vinson Syndrome
17
Q
• Portal hypertension
produces venous
dilation in Esophagus
• Rupture leads to hematemesis and massive upper GI bleed
• Rupture of a varix is associated with high mortality
• Rupture of a varix accounts for half of the deaths in advanced cirrhosis
A
Esophageal varices
18
Q
\_\_\_\_\_\_ syndrome tears are seen in chronic alcoholics, where violent retching causes esophageal lacerations and hemorrhage
A
• Mallory-Weiss Syndrome
19
Q
- Diaphragmatic hernia - widened diaphragmatic hiatus allows protrusion of the stomach through the diaphragm
- Gastroesophageal junction pulled into thorax causing GERD, heartburn and dysphagia
A
Hiatal hernia
20
Q
- Gastric metaplasia of lower esophageal mucosa - columnar epithelium replaces stratified squamous epithelium
- Odynophagia, ulceration, hemorrhage
- Adenocarcinoma
A
Barrett esophagus
21
Q
• Squamous cell carcinoma • Adenocarcinoma - Barrett esophagus • Dysphagia due to narrowing of lumen or interference with peristalsis
A
Esophagus cancer
22
Q
• 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
A
Esophageal SCC
23
Q
- Lower segment
- Barrett esophagus is a risk factor
- More common than squamous carcinoma in United States
A
Esophageal Adenocarcinoma
24
Q
Epithelial cells of the \_\_\_\_\_\_ • Mucous cells • Parietal cells - hydrochloric acid, intrinsic factor • Chief cells - pepsin • Endocrine cells - G-cells - gastrin
A
Stomach
25
```
• Inflammation of the
gastric mucosa
• Acute gastritis –
erosive, due to irritants
and NSAIDs
• Chronic gastritis –
erosive or non-erosive
–infectious or
autoimmune
```
Gastritis
26
```
• Epigastric burning, pain,
nausea, vomiting
• Shallow erosions
• Asprin, NSAIDs, alcohol,
stress, shock, sepsis
• One of the major causes
of hematemesis in
alcoholics
```
Acute Erosive Gastritis
27
```
• Infectious –the most
common form of is due to infection
by Helicobacter pylori
• Autoimmune –
autoantibodies to parietal
cells
```
Chronic Gastritis
28
```
• Gram negative s-shaped rods
• Biopsy and silver stain
• Urea breath test
• Antibody test
-Responsible for gastritis
```
H Pylori
29
```
• Autoantibodies against
gastric parietal cells,
• Gastric mucosal
atrophy
• No intrinsic factor, low
serum vitamin B12,
pernicious anemia
```
Autoimmune (Atrophic) Gastritis
30
```
• Deeper than erosions,
may extend to
muscularis
• Severe stress - ICU
patients (shock,
trauma, burns, sepsis)
```
Gastric stress ulcers
31
Where are peptic ulcers usually located 98% of time?
Stomach or Duodenum
32
```
Clinical Course of ______
• Acute/chronic blood loss
• Nausea, vomiting, hematemesis, melena
• Perforation - major cause of death in PUD Immediate pain – gastric
Delayed pain - duodenal
```
Melena –black, tarry stool
Hematocheza –red blood in stool
Peptic Ulcer Disease
33
• Multifactorial disease, decreased mucosal resistance
• Infection by H. pylori
• Drugs –aspirin, NSAIDs
• Neuroendocrine –hormonal hypersecretion syndromes
– Cushing Syndrome –corticosteroids
– Zollinger-Ellison Syndrome –gastrin
Peptic ulcers
34
```
Complications of ______
• Minor hemorrhage –melena, iron deficiency anemia
• Major hemorrhage -hematemesis
• Perforation - peritonitis
• Stenosis and obstruction
• Penetration into pancreas
```
Peptic Ulcer Disease
35
* Gastrin-secreting tumor in pancreas or duodenum (“gastrinoma”)
* Hypergastrinemia causes hypersecretion of gastric acid
* Severe peptic ulcer disease with multiple ulcers in unusual locations
Zollinger-Ellison Syndrome
36
```
• Older individuals, poor
prognosis
• Smoked fish –nitrosamines
• Predispostion to gastric
cancer
– H. pylori infection
– Chronic atrophic gastritis
– Gastric adenomatous polyps
• Lesser curve of antro-
pyloric region
• Intestinal type - bulky
tumors composed of
glandular structures
• Diffuse type -
infiltrative growth of
poorly-differentiated
cells (linitis plastica)
```
Gastric Adenocarcinoma
37
```
• Metastatic
adenocarcinoma to
ovaries
• Bilateral ovarian
metastases
• Frequently of gastric
origin - mucus-
producing cells
```
Krukenberg Tumor
38
```
Non-Hodgkin Lymphoma
• Primary lymphomas -
MALT-omas and other
NHLs
• Secondary lymphomas
- extranodal spread
```
Gastrointestinal Tract Lymphoma
39
```
______
• Stomach –most common site for
extranodal lymphomas
• MALT lymphomas - B cell
lymphomas of
Mucosa-Associated Lymphoid
Tissue
• Associated with Helicobacter
pylori infection –
may regress with H. pylori
treatment
```
Gastric MALT Lymphoma
40
* Developmental defect of ileum - a blind pouch containing all layers
* “Left-sided appendix” -may produce symptoms similar to appendicitis
Meckel diverticulum
41
```
Weakness in peritoneum
• Inguinal
• Femoral
• Umbilicus
• Incisional
```
Herniation
42
```
• Fibrotic bridges of
peritoneum
• May trap and kink
bowel segments
• They are usually
sequelae of prior
surgery or infection
```
Adhesions
43
```
• 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
```
Intussusception
44
```
• Rotation of a loop of intestine about
its own mesenteric root
• Most common in small intestine and
sigmoid colon
• Volvulus undergoes necrosis
```
Volvulus
45
```
• 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
```
Carcinoid Tumor
46
```
• 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
```
Carcinoid syndrome
47
```
• Enteric nervous system - myenteric
(Auerbach) and submucosal plexus
(Meissner)
• Colonized by non-pathogenic strains
of bacteria
```
Colon
48
```
• Developmental defect
of enteric nervous
system - agangliosis of
terminal colon
(myenteric plexus)
• Chronic constipation,
proximal dilation
• Resection of
aganglionic segment
```
Hirschprung Disease –
| Congenital Megacolon
49
```
• 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)
```
Diverticulosis
50
```
• Neoplastic polyps
(adenomatous polyps,
adenomas)
– Tubular adenoma
– Villous adenoma
• Non-neoplastic polyps
– Hyperplastic polyp –most
common
– Hamartomatous polyp -
Peutz-Jeghers Syndrome
```
Intestinal polyps
51
```
• Non-neoplastic
hyperplasia of
epithelium, most
common
• Not pre-malignant
```
Hyperplastic polyp
52
```
• Large, pedunculated
polyp, consisting of all
layers of the mucosa
• May be associated with
Peutz-Jeghers
syndrome
• Risk for intussusception
• No malignant change
```
Hamartomatous Polyp
53
• 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
Peutz Jegher syndrome
54
```
• Tubular adenomas - tubular
glands, frequently
pedunculated
• Villous adenomas - villous
projections, frequently
sessile
```
Adenomatous Polyps –Adenomas
| –Neoplastic Polyps
55
```
• Most common
neoplastic polyp
• <5% malignant
transformation
• Endoscopic
polypectomy curative
```
Tubular Adenoma
56
```
• Least common
neoplastic polyp
• 50% malignant
transformation
• Endoscopic removal
often not possible
```
Villous Adenoma
57
* Third most common cause of cancer death –lung, breast/prostate, colon
* Older adults, unless predisposing condition (ulcerative colitis, hereditary colon cancer syndrome –Gardner syndrome)
* Dietary risk factors- high caloric intake, high fat, red meat, high refined carbohydrates, low fiber
Colonic Adenocarcinoma
58
```
• Sigmoid colon most
common site
• Left side - circumferential,
napkin-ring lesion
producing narrowing of
lumen
• Right side - exophytic,
polypoid, crater-like
ulcerations with rolled
borders
```
Colonic adenocarcinoma
59
____ is most important prognostic indicator of colon cancer
Stage
60
-multiple tubular adenomas, 100% malignant transformation
• Familial Adenomatous Polyposis Coli (FAP)
61
Gardner syndrome –a variant of FAP with multiple supernumerary teeth, jaw bone densities, multiple osteomas, fibromatosis, epidermal inclusion cysts
Gardner syndrome
62
- colonic cancer unrelated to adenomas
| – Increased risk of endometrial and ovarian cancers
Hereditary Non-Polyposis Colorectal Cancer (HNPCC)
63
```
• Two chronic, relapsing
inflammatory disorders of
unknown etiology
• Crohn Disease
• Ulcerative Colitis
• Exaggerated and
unregulated local immune
respose in genetically
susceptable individuals
104
```
Inflammatory bowel disease
64
```
• 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
```
Crohns disease
65
–an abnormal channel
between two hollow organs or
between a hollow organ and the skin
surface
Fistula
66
Oral Manifestations of _______:
• Aphthous-like lesions
• Granulomatous nodules
• Malabsorption, vitamin K-dependent clotting factor deficiency, bleeding diathesis
Crohn Disease
67
• Chronic inflammatory disease with
increased risk of malignancy
• Thinning of intestinal wall, limited to
colon and rectum
• Relapsing diarrhea, pain
• Inflammation limited to mucosa –not transmural
• Crypt abscesses- accumulation of neutrophils within colonic crypts are signs of active inflammation
• Pseudopolyps: Remnants of colonic mucosa surrounded by ulceration
Ulcerative colitis
68
• Oral lesions of
ulcerative colitis
• Small, yellow
superficial pustules
Pyostomatitis Vegetans
69
Where can UC be found vs Crohns?
UC: Colon only
| Crohns : Ileum and colon
70
```
• An acute bacterial
infection of appendix
• Complications may
include rupture and
peritonitis
• Fecalith - inspissated
fecal material
• Reactive lymphoid
hyperplasia –response
to viral infection
• Neoplasm –carcinoid
tumor
```
Appendicitis
71
```
• Acute inflammation,
mucosal ulceration
• Transmural
inflammation
• Serositis
• Peritonitis
• Right lower quadrant
pain, rebound
tenderness
• Leukocytosis, fever,
nausea, vomiting
```
Acute Appendicitis
72
```
• Varicose dilation of
hemorroidal venous
plexus at anorectal
junction
• Increased venous
pressure may be
associated with
pregnancy, chronic
constipation, portal
hypertension
```
Hemorrhoids
