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106 Cards in this Set

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Define deglutition
swallowing
Define peristalsis
wave like motions that help the food along
Define dysphagia
difficulty swallowing
Define mastication
chewing
Define odynophagia
painful swallowing
Define hematochezia
blood in stools - frank red blood
Define borborygmus
bowel sounds
Define eructation
gas, beltches, farts, exloding mushroom clouds
Define melena
dark tary stools
Define steatorrhea
oily fatty stools
Define achalasia
No opening.
Define hernia
protrusion of a part or structure thru the tissues normally containing it. So, when your brains spill onto the pages of your objectives, is that a herniated or eviscerated brain?
Define lysis
destruction or death of via lysin: eg; enzymatic, immune, etc.
Define fistula
diminutive form of fissure; a small fissure or cleft
GI
GI
Define emesis
vomiting
define lysis
destruction
define pepsia
a cola drink when I'm tired or digestion
define phagia
swallowing
define plasty
repair
define rrhagia
heavy bleeding
define rrhaphy
suture
define stasis
stagnant, stop
define stenosis
tightening
define tresia
opening
define bucc/o
cheek
define chol/o
bile
define cholangi/o
bile duct
define cholecyst/o
gallbladder
define colon/o
large bowel
Define duoden/o
duodenum
define enter/o
intestine
define gastr/o
stomach
define herni/o
hernia
define ile/o
ilium
define jejun/o
jejunum
define lithiasis
stone
define sialaden/o
salivary gland
define steat/o
fat
define stomat/o
mouth - is a stomatopedis a foot in the mouth?
Define “reflux esophagitis” (a.k.a.: gastroesophageal reflux disease, or GERD)
most common disease affecting esophagus. contact between esophageal mucosa & gastric acid resting lower esophageal sphincter (LES) pressure is mainly responsible for preventing reflux
Describe the symptoms of “heartburn” and identify it as the most common symptom of reflux
feeling of substernal burning often radiating to the neck. Caused by reflux of acid or rarely alkaline material into esophagus. is highly specific for esophageal reflux disease
identify the general significance of odynophagia
usually reflects severe erosive disease. is commonly associated with infectious esophagitis due to candida, herpesviruses, or cytomegalovirus especially in immunocompromised patients
identify the general significance of transfer dysphagia
trouble transferring food from pharynx to esophagus. 80% neuromuscular, 20% localized inflammation
identify the general significance of transport dysphagia
trouble tranporting the food bolus from teh esophagus to stomach. 85% obstructive disease, 15% motor disease
Describe a plan of medical therapy for reflux esophagitis
goal: symptomatic relief, heal esophagitis, prevent complications. Avoid lying down 3 hours post meal. Elevate head/bed 6in. avoid acidic, fatty food. No ETOH, smoking. Weight loss. Antacids for rapid relief. H2 blockers or PPI long term relief but require 30min.
Define “achalasia”
loss of peristalsis in the distal two-thirds (smooth muscle) of the esophagus and impaired relaxation of the lower esophageal sphincter.
describe typical clinical presentation of achalasia
increase incidence in age, gradual dysphagia, substernal discomfort or fullness after eating, regurgitaion common. PE unhelpful
Describe the syndrome of “diffuse esophageal spasm” and recognize its place in the differential diagnosis of chest pain and possible coronary heart disease
simultaneous contractions, spasms peristalsis, or failed peristalsis. can be found on barium esophagography. may experience anterior chest px easily confused with angina pectoris. CAD must be r/o 1st
Describe the typical presentation of patients with cancer of the esophagus
Most present with advanced incurable disease. dysphagia Odynophagia weight loss, tumor into tracheobronchial tree may result in tracheoesophageal fistula, characterized by coughing, swallowing or pneumonia
Describe role of alcohol and smoking as risk factors for cancer of the esophagus
Chronic alcohol and tobacco use are strongly associated with an increased risk of squamous cell carcinoma
What population is generally effected by esophageal cancer and what are the histological types
50-70, men:women 3:1 histologic types: squamous cell carcinoma & adenocarcinoma. In U.S. squamous cell caner more common in blacks than whites
Identify potential causes of dysphagia
esophageal rings and diverticuli
List or recognize several diseases that predispose patients to candidiasis, herpes simplex, or CMV infection of the esophagus
Patients with AIDS, solid organ transplants, leukemia, lymphoma, and those receiving immunosuppressive drugs
Define and describe the Mallory-Weiss syndrome
non penetrating mucosal tear at gastroesophageal junction. thought to be caused from sudden increase in transabdominal pressure like: lifting retching or vomiting. Alcoholism is strong predisposing factor
Define "hiatus hernia."
Protrusion into the lower esophagus, that can lead to increased reflux or acid accumulation
List common risk factors for peptic ulcer disease.
Men > Women, 30 – 55 years, Smokers, patients taking NSAIDS
Discuss dyspepsia and prescribe a reasonable work-up for this symptom.
Hx, PE helpful but not conclusive. Check for peptic ulcer disease, H. Pylori infection, pancreatic disease, biliary tract disease, DM, thyroid disease, renal insufficiency, intra-abdominal malignancy, gastric volvulus or paraesphogeal hernia, pregnancy
Identify criteria for patients in whom a definitive diagnosis must be made by imaging procedures or endoscopy.
Gastpduodenal ulcers by upper endoscopy, patients with weight loss, dysphagia, recurrent vomiting, evidence of bleeding, or anemia
Discuss the pros and cons of upper GI x-rays versus endoscopy in working up patients with gastroduodenal disorders.
Pros: less invasive, costs less, Cons: Endoscopy sees more and is indicated for gastric cancer or other serious disease
Describe general goals of treatment for gastric and duodenal ulcer, including patient education and lifestyle modifications that are (or are not) necessary—e.g., smoking, diet, and alcohol.
General goals are to heal the ulcer while relieving pain and preventing complications and recurrence. Warn against alcohol use, tobacco, asa, and other nsaids, and foods that upset stomach
Describe the role of helicobacter pylori testing in a patient with dyspepsia.
may help to cure the patients dyspepsia. A dual abx plus ppi has 80-90% cure rate for dyspepsia if its the cause. H.Pylori can also lead to other dyspeptic conditions
Describe in broad, general terms the pros and cons of of the following ulcer treatments: Antacids
Pros- In chewable form or liquid, over the counter,
Cons- can cause constipation, or diarrhea
Describe in broad, general terms the pros and cons of of the following ulcer treatments: H2 antagonists
Pros– work well for long periods, show ulcer repair, over the counter. Cons- Continuos use is needed
Describe in broad, general terms the pros and cons of of the following ulcer treatments: PPI’s
Pros- Heal ulcers better than h2’s, over the counter. Cons- continuos use is needed
Describe in broad, general terms the pros and cons of of the following ulcer treatments: Sucralfate
Pros- Can be used by persons intolerant to H2’s. Cons- Constipation, laryngospasm, and decreases other drugs absorption (digoxin, fluoroquinolones, ketaconazole, phenytion)
Describe in broad, general terms the pros and cons of of the following ulcer treatments: ABX for H.Pylori
Pros- Effectice in treating bacterium. Cons- Multiple drugs, costly, sometimes associated with significant side effects
Describe typical features of Crohn's disease
obstruction fistula formation, abscess, px, Chronic inflammatory disease, Intestinal obstruction, Perianal disease,
Describe complications of Crohn's disease
Abscess, Obstruction, Fistulas, Perianal Disease, Carcinoma, Hemorrhage Malabsorption
Describe the typical presentation of a patient with ischemic colitis.
bouts of crampy lower abd px and mild often bloody diarrhea. May be indistinguishable from inflammatory bowel disease without colonoscopy
Describe the typical presentation of a patient with diverticulitis
intra-abdominal infection with either abscess or generalized peritonitis. mild-moderate aching abd px, in LLQ. Constipation or loose stools. N/V frequent. PE:low-grade fever, LLQ tenderness, palpable mass. Stool occult blood common
Describe complications of diverticulitis including such as perforation, abscess formation, and fistula
Fistula formation may involve bladder ureter vagina uterus bowel & abd wall, stricturing of colon with partial or complete obstruction
List and discuss common causes of acute lower GI bleeding
Pt's < 50 most common causes: infectious colitis anorectal disease inflammatory bowel disease. >50: significant hematochezia is most often seen with diverticulosis, vascular ectasias, malignancy, or ischemia. In 20% of acute bleeding episodes, no source of bleeding can be identified
Describe the clinical presentation, diagnostic workup
abd discomfort px >3 mo that has 2/3 features: (1) relieved with defecation, (2) onset associated with change in frequency of stool (3) onset associated with change in form of stool
Describe management for irritable bowel syndrome
education, support, diet - 0 caffeine fat, rx reserved for moderate - severe IBS
What premalignant precursors account for 95% + of most colorectal cancers
It is currently believed that the majority of colorectal cancers arise from malignant transformation of an adenomatous polyp
Identify major risk factors in the etiology of colorectal cancer
age, fam hx, IBS, race (higher in blks than whites, high fat and red meat diets,
Describe typical signs and symptoms of left vs. right colon cancer, and rectal cancer
R: Chronic blood = iron def anemia, L: obstructive sx's with colicky abd px, change in bowel habits. Rectal CA: tenesmus, urgency, hematochezia. PE usually normal except in advanced disease. mass may be palpable in abd. check for hepatomegaly
Describe the typical workup in making the diagnosis of colorectal cancer in the symptomatic patient
Labs: CBC for anemia, LFT, Carcinoembryonic antigen(CEA) barium enema, CT colonography colonoscopy to biopsy and confirm
Describe guidelines for screening asymptomatic patients for colorectal neoplasms 50 yrs old +
Annual fecal occult blood testing, sigmoidoscopy every 5 yrs, Colonoscopy every 10 years, Barium enema every 5 years
describe guidelines for screening individuals with a family history of a first-degree member with colorectal neoplasia
if dx relative > 60 yrs: screening age 40. Screening guidelines same as average-risk individual. < 60 yrs, screening at 40 or 10 years younger than age at dx of affected relative whichever comes 1st. colonoscopy every 5 yrs
Describe the typical signs and symptoms, and basic approach to therapy for:
hemorrhoids, including thrombosed external hemorrhoids
precipitated by coughing, heavy lifting, straining. acute onset px, tense and bluish perianal nodule covered with skin up to several centimeters in size. Tx: warm sitz baths, analgesics, and ointments.
Describe the typical signs and symptoms, and basic approach to therapy for:
internal hemorrhoids
confined to anal canal but can eventually come out to play. Typically not painful. Tx high fiber diet, increase fluid intake, reduce straining, sclerotherapy, rubber band ligation, electrocoagulation
Describe the typical signs and symptoms, and basic approach to therapy for:
anal fissure
linear or rocket-shaped ulcers <5 mm. arise from trauma anal canal during defecation, straining, constipation, high internal sphincter tone. Tx: Fiber, sitz baths, ointments
Describe the typical signs and symptoms, and basic approach to therapy for: abscess and fistula
throbbing, continuous perianal px Erythema, fluctuance, swelling in perianal area or ischiorectal fossa on digital rectal examination. Tx: I&D
Describe the typical signs and symptoms of each of the following STD's of the anorectum: condyloma accuminata (vs. condyloma lata)
Caused by HPV. no sx or itching, bleeding, and pain. The warts may form a confluent mass that may obscure anal opening
Describe the typical signs and symptoms of each of the following STD's of the anorectum: gonococcal & chlamydial proctitis
fever, bloody diarrhea, painful perianal ulcerations, anorectal strictures and fistulas, inguinal adenopathy (buboes). Dx by serology, culture of rectal discharge or rectal biopsy
Describe the typical signs and symptoms of each of the following STD's of the anorectum: Anal syphilis
asymptomatic, perianal px and discharge. Primary: chancre may mimic fissure at anal margin or ulcer. Proctitis or inguinal lymphadenopathy may be present. secondary: condylomata lata (pale-brown, flat verrucous lesions), secretion of foul-smelling mucus. Dx: dark-field microscopy of scrapings from chancre or condylomas
Describe the typical signs and symptoms of each of the following STD's of the anorectum: Herpes simplex virus
common cause of anorectal infection. Sx's occur 4–21 days after exposure, severe pain, itching, constipation, tenesmus, urinary retention, radicular px. Small vesicles or ulcers may be seen in perianal area or anal canal.
List and be able to describe several diseases that may affect nutrient absorption in the small bowel.
Celiac disease, Whipple’s disease, Bacterial Overgrowth, Short Bowel Syndrome,
Describe Celiac disease:
S/S wt loss, chronic diarrhea, steatorrhea, abdominal distention, weakness, muscle wasting, or growth retardation. Atypical symptoms: dermitis, herpetiformis, iron deficiency anemia, osteoporosis-Dx- abnormal small bowel biopsy- TX: gluten free diet
Describe Whipple’s disease:
multisystem disease- S/S fever, lymphadenopathy, arthralgias, malabsorption, weight loss, chronic diarrhes-Dx-duodenal biopsy with periodic acid-Schiff (PAS)-positive macrophages with characteristic bacillus. TX: antibiotic therapy x 1 yr
Describe Bacterial Overgrowth:
causes: many Sx: abd distention, weight loss, steatorrhea, culture jejunal secretion >105 organisms/mL. TX: correct defect, ABX 1-2 weeks effective against enteric aerobes and anaerobes
Describe Short Bowel Syndrome
malabsorptive condition secondary to removal of significant segments of the small intestine. The type and degree of malabsorption depend upon the length and site of the resection and the degree of adaptation of the remaining bowel
Describe the presentation, laboratory findings and treatment of Celiac Sprue (A.K.A. gluten enteropathy, celiac disease).
Sx: wt loss, chronic diarrhea, steatorrhea, abdominal distention, weakness, muscle wasting, or growth retardation. Labs: sudan stain, IgA, bowel biopsy. Tx: gluten free diet
Explain gluten deficiency (seliac disease) as a common diet related cause of malabsorption symptoms
caused by immune reactions against gluten, a mixture of proteins found in wheat, rye, barley. most common in Europeans. children more likely to have anemia, nonspecific chronic disease, or short stature.
Explain lactose deficiency as a common diet related cause of malabsorption symptoms
nausea, bloating, cramps, and osmotic diarrhea after ingesting milk products. Weight loss and steatorrhea absent or mild; appetite remains good. Avoidance of milk products terminates the symptoms.
Describe the conditions that affect iron absorption and how these nutrients may be affected by small intestinal diseases, leading to specific anemias
Most iron originates from diet, which is converted to ferrous after ingestion and absorbed in duodenum and jejunum. usually caused by malabsorption, inadequate diet, or blood loss
Describe the conditions that affect vitamin B-12 absorption and how these nutrients may be affected by small intestinal diseases, leading to specific anemias
autoimmune mechanism where antibodies attack intrinsic factor and parietal cells impair or damage B12 uptake. surgical resection of the ileum will interfere with uptake sites.
Define “steatorrhea,” and identify lab test used for it and what it may indicate.
bulky, light-colored fatty feces caused by failure to digest & absorb. Lab: suden stain which may indicate malabsorption
Describe the typical syndrome of viral gastroenteritis
incubation period 48-72 hrs, sx's begin abruptly: diarrhea, NV, HA, low-grade fever, abd cramps, and malaise. Norwalk virus is predominant in older children & adults, Rotavirus in young children.
Learn the associations between the following bacterial pathogens causing vomiting and /or diarrhea and their sources: Staph aureus
(food poisoning) NV abd cramps, diarrhea 2-8 hrs after food eaten. Affects any animal product left above 40* for more than 2 hours
bacterial pathogens causing vomiting and /or diarrhea and their sources: Shigella
infected food handlers: infection produces an invasive diarrheal illness. Transmission by fecal-oral route.
bacterial pathogens causing vomiting and /or diarrhea and their sources: Salmonella
(eggs, poultry also typhoid fever)species cause diarrhea by invading the bowel wall. Initial presentation is indicative of watery diarrhea, cramps, nausea, vomiting, and fever
bacterial pathogens causing vomiting and /or diarrhea and their sources: E. coli
traveler’s diarrhea, hemorrhagic colitis: usually passed by contaminated meat (typically hamburger) that is undercooked. mild crampy, nonbloody diarrhea to life-threatening hemorrhagic colitis complicated by hemolytic-uremic syndrome
bacterial pathogens causing vomiting and /or diarrhea and their sources: Clostridium difficile
antibiotic therapy – causes pseudomembranous colitis: pathogen responsible for antibiotic-associated colitis and diarrhea. Is common cause of nosocomial infections