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151 Cards in this Set
- Front
- Back
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What are 3 tests that can be used to dx H. Pylori?
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-blood test
-breath test -tissue tests |
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The esophagus is a hollow muscular tube that is how long?
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25 cm
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What helps to prevent reflux and regurgitation of stomach contents thru contraction and relaxes to allow food to pass when swallowing?
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LES or lower esophageal sphincter
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GERD consists of an injury to what?
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esophageal mucos and subsequent inflammation
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In GERD, damage to mucosa depends on the level of what refluxed back into the esophagus?
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level of pH
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GERD can be caused by decreased efficacy of antireflex mechanisms, especially the LES. What can cause this weakness?
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-pregnancy
-smoking -alcohol -fat -chocolate -caffeine -scleroderma like diseases |
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Hiatal Hernia is a potential cause of what?
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GERD
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What can be seen on endoscopy for GERD?
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spontaneous reflux to mid-esophagus, mucosal erythema and erosion of the mucosa
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What can the gross pathology show in GERD?
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-disruption of the mucosa ranging from erosion to ulceration, but no malignant changes will be seen
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What are 3 broad tx for GERD?
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1-elevate the head of bed
2-weight loss 3-avoid fatty foods, smoking, alcohol |
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What are some pharmacology for GERD?
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-PPIs
-H2 blockers -Antacids -Reglan |
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Explain the surgery that can be done to tx GERD
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fold and wrap the fundus of the stomach aroudn the lower end of the esophagus to reduce size of teh lumen and the potential for reflux
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What are som ebossiple complications of GERD?
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-bleeding
-stricture formation -tendency to develop Barrett's esophagus -Hiatal Hernia |
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Wht are some clinical features of GERD?
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-heart burn
-CP -postural reflux |
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Barrett's esophagus occurs with what?
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metaplasia of the distal esophageal squamous epithelium into an intestinal glandular epithelium with goblet cells
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Barrett's Esophagus is a risk factor for what?
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esophageal adenocarcinoma
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What are 4 possible dx tests used to dx Barrett's Esophagus?
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-endoscopy
-barium esophagram -esophageal manometry -esophageal pH monitoring |
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Endoscopy is used in what pts?
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Those with persistent reflux symptoms or frequent relapses after H2 blocker therapy to assess the possible presence of esophagitis or other complications of GERD
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What is the most sensitive test for the direct visualization of esophageal mucosal damage?
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Endoscopy
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What is the first dx test that is done in pts with dysphagia?
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Barium esophagram
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Esophageal manometry is usually used for the dx of what?
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achalasia
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What is the most reliable method for the dx of GERD?
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esophageal pH monitoring
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Squamous cell carcinoma can remain asymptomatic for how long?
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a long time
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The tumors of squamous cell carcinoma is what?
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large, moderate to well-differentiated and locally invasive
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The esophagus lacks a ______layer and is instead surrounded by what?
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serosal layer
-surrounded by an adventia that blends with the CT of the thoracic cavity |
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Squamous cell carcinoma is at high risk of spread to where?
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mediastinal structures, trachea and regional lymph nodes
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Squamous cell carcinoma has the highest incidence rate in what populations?
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Asian populations
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What are some dietary factors that can contribute to the development of squamous cell carcinomas?
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N-nitroso compounds and betelnut chewing
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What are some other risk factors for the development of squamous cell carcinomas of the esophagus?
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-smoking
-alcohol use -achalasia |
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Achalasia is a defect in the esophageal peristalsis due to what?
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loss of ganglion cells in Auerbach's plexus and impaired relaxation of the lower esophageal sphincter during swallowing
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For adenocarcinomas, who are at highest risk?
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men and caucasions
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Does alcohol play a role in adenocarcinomas of the esophagus?
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NO
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Where are the majority of adenocarcinomas of the GI system located?
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gastro-esophageal junction and is associated with evidence of Barrett's esophagus
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What are some key findings on esophageal cancer?
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iron def. anemia and positive occult blood in stool
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The tx of esophageal cancer includes what?
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surgery, chemotherapy, and radiation therapy
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What is hepatic encephalopathy?
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high ammonia levels that can cause delerium
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Spider angiomas are seen in who and it is normal?
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healthy children and pregnant women
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Numerous spider angiomas are more common in what pts?
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-chronic liver disease
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Acute gastritis is defined as what?
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self-limited inflammation of the gastric mucosa
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When you get an imbalance btw aggressive forces and defensive forces of the stomach you get what?
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gastritis
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Name some aggresive forces of the stomach?
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-gastric acid
-digestive enzymes |
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What are some defensive forces of the stomach?
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-mucus
-bicarb -prostalgandins -epithelial regeneration |
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What are some things that can increase aggression of the stomach?
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-H. plylori
-NSAIDS -cigarettes -alcohol |
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What are some common symptoms of gastritis?
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-dyspepsia
-nausea -vomiting -epigatric pain |
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What is the tx for gastritis?
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-tx underlying cause
-antacids, sucralfate, PPI, and H2 receptor blockers |
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What is IF?
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-protein released by parietal cells and is needed for absorption of B-12 in distal illeum
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Chronic gastritis is associated with what 6 things?
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1-NSAIDS
2-ethanol ingestion 3-radiation 4-smoking 5-pernicious anemia 6-H. Pylori |
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Pernicious anemia is assoicated with what?
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atrophic gastritis
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Pts with chronic gastritis have an increased risk of what?
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gastric ulcers and gastric carcinomas
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Cheif cells of the stomach produce pepsinogen, which breaks down what?
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proteins
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Endocrine cells of the stomach produce what enzyme?
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gastrin
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Endocrine cells of the stomach produce what enzyme?
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gastrin
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Endocrine cells of the stomach produce what enzyme?
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gastrin
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Parietal cells of the stomach produce what?
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IF and HCl
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Parietal cells of the stomach produce what?
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IF and HCl
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Parietal cells of the stomach produce what?
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IF and HCl
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What are peptic ulcers?
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chronic, remitting and relapsing, usually solidary lesions that extend through the muscularis propria into the submucosal layer and possibly deeper
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What are peptic ulcers?
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chronic, remitting and relapsing, usually solidary lesions that extend through the muscularis propria into the submucosal layer and possibly deeper
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What are peptic ulcers?
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chronic, remitting and relapsing, usually solidary lesions that extend through the muscularis propria into the submucosal layer and possibly deeper
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Where are some common locations for peptic ulcers?
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near lesser curvature and at the border of the body of the stomach and the duodenum
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Where are some common locations for peptic ulcers?
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near lesser curvature and at the border of the body of the stomach and the duodenum
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Where are some common locations for peptic ulcers?
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near lesser curvature and at the border of the body of the stomach and the duodenum
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What are the 2 major risk factors for peptic ulcers?
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H. Pylori and NSAIDS
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What are the 2 major risk factors for peptic ulcers?
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H. Pylori and NSAIDS
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What are the 2 major risk factors for peptic ulcers?
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H. Pylori and NSAIDS
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What are some other potential risk factors for peptic ulcers?
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-hyperacidity
-low mucosal blood flow -delayed gastric emptying -poor epithelial repair -smoking -alcohol use -high dose corticosteroids |
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What are some other potential risk factors for peptic ulcers?
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-hyperacidity
-low mucosal blood flow -delayed gastric emptying -poor epithelial repair -smoking -alcohol use -high dose corticosteroids |
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Which is more likely to cause cancer, gastric or duodenal ulcers?
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gastric ulcers
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What are some other potential risk factors for peptic ulcers?
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-hyperacidity
-low mucosal blood flow -delayed gastric emptying -poor epithelial repair -smoking -alcohol use -high dose corticosteroids |
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Which is more likely to cause cancer, gastric or duodenal ulcers?
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gastric ulcers
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What causes 70% of gastric ulcers?
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H. Plyori
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Which is more likely to cause cancer, gastric or duodenal ulcers?
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gastric ulcers
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What causes 70% of gastric ulcers?
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H. Plyori
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What causes 70% of gastric ulcers?
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H. Plyori
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In gastric ulcers pain is ______ with meals, but in duodenal ulcers pain is ______ with meals
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-gastric-pain greater with meals
-duodenal-pain is decreased with meals |
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In gastric ulcers pain is ______ with meals, but in duodenal ulcers pain is ______ with meals
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-gastric-pain greater with meals
-duodenal-pain is decreased with meals |
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What causes 100% of duodenal ulcers?
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H. Pylori
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In gastric ulcers pain is ______ with meals, but in duodenal ulcers pain is ______ with meals
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-gastric-pain greater with meals
-duodenal-pain is decreased with meals |
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What causes 100% of duodenal ulcers?
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H. Pylori
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What causes 100% of duodenal ulcers?
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H. Pylori
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Gastric ulcers are due to a decreased what?
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mucosal protection against gastric acid
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Duodenal ulcers are due to an increased what?
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gastric acid secretion or decreased mucosal protection
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Gastric Ulcers are associated with the use of what?
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NSAIDS
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Duodenal ulcers are associated with hypertrophy of what?
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Brunner's gland
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What are some complications to peptic ulcers?
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-bleeding
-perforation -obstruction -pain |
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What are some possible lab findings consistent with peptic ulcers?
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-+ h.pylori
-+ occult blood -possible anemia -slightly low hematocrit -hemoglobin |
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In peptic ulcers, the depth usually extends from the mucosa to where?
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the mucularis propria
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Does size differentiate between benign peptic ulcers and malignant ulcers in ulcerating gastric adenocarcinomas?
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NO
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Tx for H.pylori includes what?
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2 antibiotics and either a PPI or H2 receptor blocker or bismuth salicylate
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Early adenocarcinoma of the stomach is defined as what?
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lesion confined to the mucosa and the submucosa
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Advanced gastric carcinoma is a tumor that has what?
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spread into the muscular wall or that has metastisized to regional or distant lymph nodes
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What is a common metastasis for gastric carcinoma?
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suprclavicular node (Virchow's node)
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What are some risk factors for gastric carcinoma?
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-chronic atrophic gastritis
-pernicious anemia -partial gastrectomy -smoking -alcohol -poor diet -high Na intake |
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What is the male to female ratio for gastric adenocarcinoma?
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2:1
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Common locations for stomach cancer to arise are where?
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pylorus, the antrum and the lesser curvature
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Perforation of ulcers are associated with what?
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emptying of gastric contents into adjacent organs or the peritoneal cavity
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Ulcers perforating through the anterior antral surface empty into where?
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greater sac
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Air in the peritoneal cavity as a result of perforation may by visualized it what position?
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erect or sitting position
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Ulcers perforating through the doudenal cap may empty into where?
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the lesser or greater sac or may erode into the pancreas
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Abdominal cancers may metastazsize to the left supraclavicular lymph node via what?
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thoracic duct
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Cirrhosis of the liver is often associated with what?
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splenomegaly and low platelets
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What is the MCC of upper GI bleed?
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duodenal ulcer
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What is gastroparesis?
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disorder in which the stomach takes too long to empty its contents
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What causes gastroparesis?
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when nerves to the stomach are damaged or stop working
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What nerve controls the movment of food through the digestive tract?
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vagus
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What happens if the vagus nerve is damaged?
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the muscles of the stomach and intestines do not work normally and movement of food is slowed or stopped
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What are some symptoms of gastroparesis?
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-feeling of fullness when eating
-N/V -weight loss -abdominal bloating and discomfort |
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What are some acute causes of gastroparesis?
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-drugs
-viruses -post surgery |
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What is a chronic cause of gastroparesis?
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DM
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What is the tx for gastroparesis?
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Reglan and erythromyocin
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What is achalasia?
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absent peristalsis with increased LES tone
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In achalasia, what happens to the esophagus and the LES?
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esophagus dilates and the tone of the LES increases
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In Achalasia, most of the nerves responsible for relaxation are lost, which results in what?
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a shift in the balance towards contraction, hence the failure of the LES to relax or open up with swallowing
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What are some S/S for achalasia?
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-dysphagia to both solids and liquids
-CP -odynophagia -weight loss |
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Dysphagia to solids is more likely what?
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tumor in esophagus
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Dysphagia to liquids is more likely what?
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a neuro reason
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Why might achalasia be associated with a nocturnal cough?
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because of overflow aspiration or with recurrent aspiration pneumonia
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What is one major complication to achalasia?
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16 fold increase in the risk for squamous carcinoma of the esophagus
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On a cine-esophagram, what indicates achalasia?
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dilate fluid filled esophagus
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If you see a simultaneous, noncoordinated contractions on a cine-esophagus, what does it indicate?
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DES
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A person with achalasia usually has history of what?
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-dysphagia
-halitosis -recurrent chest infections |
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What is more effective than medical therapy for the tx of achalasia?
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pneumatic dilatation
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What is the surgical option for achalasia?
What does it increas the risk of? |
-Heller's myotomy
-postoperative reflux |
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Diffuse esophageal spasm (DES) is aka what?
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Nut cracker esophagus
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DES causes the esophagus to do what?
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spasm in an uncorrdinated fashion that prevents food that is swallowed from reaching the stomach
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What are some S/S of DES?
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-CP
-dysphagia -Heartburn -regurgitation |
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DES is related to the motor abnormality of what?
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the esophagus
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What is the diagnostic tool of choice for DES?
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esophagram
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What are your options for the tx of DES?
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-medications-may not help
-surgery |
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An acid peptic stricture has what kind of dysphagia?
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solids dysphagia
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What is Schatzki's Ring?
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a narrow ring of benign fibrou tissue constricting the lower esophagus
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What disease is basically Achalasia of the bowel?
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Hirschsprung's disease
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Hirschsprungs disease is more accurately known as what?
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congenital aganglionic megacolon
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Hirschsprungs disease develops when what happens?
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neural crest tissue fails to migrate to a segment of the large intestine, so the embryo has no nerve plexeses in this part of the colon
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How does a child present who has Hirschsprungs disease?
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absent bowel movements and abdominal distention
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How is the dx of Hirschsprungs disease made?
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biopsy, which shows lack of ganglion cells in the gut wall
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What is the tx of Hirschsprungs disease?
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surgical removement of affected segment
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The entire luminal surface of the small intestine has what?
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villi which are small projections of mucosa
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The villi are lined with what?
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simple columnar epithelial cells also called enterocytes
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Duodenal villli are _______, while jejunum and ileum villi are ______/
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-leaf-like
-finger-like |
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Goblet cells contain what?
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apical mucin droplets
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Mucin droplets secrete to do what?
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protect and lubricate the lumen
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Perianal fistulas are common in what disease?
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Crohn's Disease
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Crohn's is a __________ disease?
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granulomas disease
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What is Crohn's disease?
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chronic non-infectious gastrointestinal inflammation
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What are some extra intestinal manifestations can be seen such as what?
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-arthritis
-ankylosing spondylitis -sclerosing cholangitis -uveitis -oral ulcers -erythema nodosum |
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What are some possible complications associated with Crohn's disease?
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-cancer
-malabsorption -Torsades -Fibrious adhesions -absess formation -fissures -fistulas |
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What are some S/S of toxic megacolon?
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-pain
-fever -tachycardia -lower abdominal tenderness -possibly hypotension |
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What are some lab findings in Crohn's disease?
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-magaloblastic anemia
-leukocytosis -heme positive stool |
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What is the test of choice for Crohn's disease?
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colonoscopy with ileoscopy
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What drugs do you want to avoid in Crohn's pts?
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-anti-diarrhea drugs (toxic megacolon)
-glucocorticoids-can exacerbate symptoms |
