Week 11 - Terms; Gastrointestinal Health

Question 1

List the components of the large bowel

Answer 1

a. Cecum (+ appendix)
b. Ascending colon
c. Transverse colon
d. Descending colon
e. Sigmoid colon
f. Rectum

Question 2

List the components of the stomach

Answer 2

a. Cardia, Antrum, Fundus, Pylorus
b. Pyloric valve

Question 3

List the components of the small bowel

Answer 3

a. Duodenum, Jejunum, Ileum
b. Ileocecal valve

Question 4

Describe the general structure of the GI tract

Answer 4

• Lumen: hollow space in the GI tract
• Mucosa: inner lining
  o Varies by site depending on function
• Muscularis: muscle layer
  o Contents move through GI tract through coordinated wave-like contractions (peristalsis)

Question 5

Describe the peritoneal cavity

Answer 5

-Continuous membrane that forms the lining of the abdominal cavity
-Diseases of the GI tract can involve the peritoneal cavity
-Can fill with fluid (ascites), or become inflamed (peritonitis)

Question 6

What are the functions of the GI tract?

Answer 6

1. Digestion
   2.Absorption – taking up nutrients and/or water for use
   a. Nutrient absorption occurs in small bowel
   b. Water and electrolyte absorption occur in large bowel
2. excretion

Question 7

Define hematemesis

Answer 7

vomiting of blood; “Coffee grounds emesis” – dark and granular vomitus due to effects of stomach acid on hemoglobin

Question 8

Define hematochezia

Answer 8

Indicates “fresh” bleed, commonly from lower GI tract

Question 9

Hematochezia is a common finding in what?

Answer 9

ulcerative colitis

Question 10

Define melena

Answer 10

Dark, black, tarry stool; Stool colour due to digestion of blood, most commonly from upper GI tract

Question 11

Define occult bleeding

Answer 11

Blood that is not visible in stool; May be picked up on screening stool tests (fecal blood tests/FIT tests)

Question 12

FIT test is a common screening tool for what?

Answer 12

colorectal cancer; to detect occult blood. Positive results - patients may have iron deficient anemia (blood work) and/or be sent for colonoscopy

Question 13

Infections of the GI tract can be caused by what and can occur where?

Answer 13

• Can be caused by viruses, bacteria and/or parasites, and can occur in any segment of the GI tract

Question 14

Define appendicitis

Answer 14

Inflammation of the appendix

Question 15

What is the pathogenesis of appendicitis?

Answer 15

Often associated with fecalith obstruction (obstruction of blood flow (ischemia)
leading to ulceration and secondary infection)

Question 16

What are the risk factors for appendicitis?

Answer 16

o Extremes of age
o Family history
o Male sex (M>F)

Question 17

What are the signs and symptoms of appendicitis?

Answer 17

o Abdominal pain (RLQ/McBurney’s point)
 Rebound tenderness
o Nausea/vomiting
o Fever

Question 18

What are the complications of appendicitis?

Answer 18

o Can lead to appendiceal rupture (perforation) leading to peri-appendiceal abscess or inflammation of the peritoneal cavity (peritonitis)

Question 19

What is the treatment for appendicitis?

Answer 19

surgery is most common in acute cases - appendectomy

Question 20

Describe H. pylori (helicobacter pylori)

Answer 20

• Helicobacter pylori (H. pylori) is a Gram-negative bacterium, mostly commonly colonizes stomach
• Estimated prevalence 50% worldwide, higher in developing countries

Question 21

What are the signs and symptoms of H. pylori?

Answer 21

o Often asymptomatic
o Common symptoms: abdominal pain (mid-upper), nausea, bloating

Question 22

What are the complications of H. pylori infection?

Answer 22

o Peptic/duodenal ulcers in 10-15% of cases (disintegration of the epithelial lining) which can lead to bleeding and perforation
o Chronic inflammation leading to increased risk of lymphoma and cancer

Question 23

How do you diagnose H. pylori infection?

Answer 23

• Diagnosis of H. pylori infection/peptic ulcer disease via endoscopy + biopsies, bloodwork, and/or urea breath test

Question 24

What is the treatment for H. pylori infection?

Answer 24

Triple-therapy (antibiotics and protein-pump inhibitors)

Question 25

What is the typical age for onset of inflammatory bowel disease?

Answer 25

15-35

Question 26

What are the two types of IBD

Answer 26

crohn's disease and ulcerative colitis

Question 27

What are the common symptoms of IBD

Answer 27

o Diarrhea (+/- blood - only in UC) and urgency o Abdominal pain o Fever o Weight loss/fatigue o +/- extraintestinal problems (liver, joints, skin, eyes)

Question 28

What are the sites of involvement in Crohn's disease?

Answer 28

* - Ileum and colon * - Can involve any part of GI tract * - Patchy involvement

Question 29

What are the sites of involvement in ulcerative colitis?

Answer 29

* - Starts at rectum and moves proximally * - Limited to colorectum * - Continuous involvement

Question 30

Hematochezia is common in which IBD?

Answer 30

ulcerative colitis; uncommon in crohn's disease

Question 31

What is the degree of inflammation for Crohn's disease?

Answer 31

Transmural - involving the entire bowel wall

Question 32

What is the degree of inflammation for ulcerative colitis?

Answer 32

superficial

Question 33

Which IBD leads to a greater risk of colorectal cancer

Answer 33

ulcerative colitis

Question 34

How are IBDs treated and surveilled?

Answer 34

- Medications to reduce inflammation (anti-inflammatories, immune system modulators, biologics) - Symptom relief for stools, nutritional support - Surveillance endoscopy - Surgery o Crohn’s disease: removal of damaged sections, management of abscesses/fistulas o Ulcerative colitis: removal of colon/rectum

Question 35

Define diverticulum

Answer 35

outpouching of bowel wall

Question 36

Define diverticular disease

Answer 36

presence of diverticula in the bowel

Question 37

What is thought to be the cause of diverticula

Answer 37

increased luminal pressure (low fiber, high fat diets) and weak points in gut wall

Question 38

Define diverticulitis

Answer 38

inflammation of diverticula

Question 39

What are the symptoms of diverticulitis?

Answer 39

fever, worsening abdominal pain (LLQ)

Question 40

What are the complications of diverticulitis

Answer 40

abscess formation, perforation, strictures, fistulas

Question 41

What is the treatment for diverticulitis

Answer 41

antibiotics, surgery (depending on severity)

Question 42

What are the four common causes of bowel obstruction

Answer 42

1. Herniation: Pouch-like protrusion of peritoneum 2. Adhesions: Fibrosis/scar tissue forming between loops of bowel 3. Volvulus: Twisting of bowel on itself and mesentery 4. Intussusception: Telescoping of bowel into adjacent segment

Question 43

In children, where does bowel obstruction most commonly occur?

Answer 43

ileocecal valve

Question 44

What are the common signs and symptoms of bowel obstruction?

Answer 44

o Abdominal distention o Vomiting o Constipation

Question 45

Describe bowel obstruction

Answer 45

- Blockage that prevents the passage of food/liquids - Can occur across all age groups, with a variety of causes

Question 46

What is the third most commonly diagnosed cancer in Canada?

Answer 46

colorectal cancer

Question 47

What is the most common type of colorectal cancer?

Answer 47

adenocarcinoma

Question 48

Describe the pathogenesis of colorectal cancer

Answer 48

Mutations in the bowel mucosa may result in pre-cancerous (pre-malignant) legions called polyps - Additional mutations may accumulate that result in local invasion or metastasis (cancer) - Not all polyps result in cancer transformation

Question 49

What are the signs and symptoms of colorectal cancer?

Answer 49

o Rectal/stool bleed o Change in bowel habits o Abdominal discomfort o Weakness, fatigue, weight loss (unintentional)

Question 50

What are the risk factors for colorectal cancer?

Answer 50

o Family history/known familial syndromes o Age o Inflammatory bowel disease o Diet, obesity, smoking, (lack of) exercise

Question 51

What are the risk factors for esophageal cancer?

Answer 51

- GERD - Tobacco use - Obesity - Radiation

Question 52

What is the most common type of esophageal cancer in Canada?

Answer 52

adenocarcinoma; worldwide it is squamous cell carcinoma

Question 53

Where does esophageal cancer most commonly occur?

Answer 53

In the distal portion of the esophagus

Question 54

Which GI cancer is more common (colorectal or esophageal)?

Answer 54

Colorectal cancer

Question 55

What are the signs and symptoms of esophageal cancer?

Answer 55

(often at late stage) - Pain or difficulty swallowing (dysphagia) - Weight loss - Chest pain - Vomiting

Question 56

Describe the pathogenesis of esophageal cancer

Answer 56

- Often arises in a background of chronic gastroesophageal reflux disease (GERD)  acid reflux from stomach - In approx. 10% of symptomatic GERD, the esophageal mucosa undergoes intestinal metaplasia (Barrett’s esophagus) - Greater risk of developing dysplasia and malignancy - Patients with Barrett’s esophagus may get PPIs and surveillance endoscopies

Question 57

Someone presents with abdominal discomfort, fatigue, weight loss, and bloody stool, what is the likely diagnosis?

Answer 57

colorectal cancer; send for more testing though

Question 58

What is the difference between diverticular disease and diverticulitis?

Answer 58

In diverticular disease, small bulges or pockets (diverticula) develop in the lining of the intestine. Diverticulitis is when these pockets become inflamed or infected.

Question 59

Define dsyphagia

Answer 59

dysphagia - difficulty swallowing.

Question 60

Define fistula

Answer 60

an abnormal duct or passage connecting an abscess, cavity or hollow organ to the body surface or to another hollow organ.