Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
101 Cards in this Set
- Front
- Back
|
Difficulty in swallowing
|
dysphagia
|
|
|
retrosternal burning pain, regurgitation of gastric contents
|
heartburn
|
|
|
blood in stools
|
melena
|
|
|
vomiting of blood
|
hematamesis
|
|
|
lower gi bleeds
|
hematochezia
|
|
|
dilated tortous veins protrude into esophagus
|
esophageal varices
|
|
|
esophageal varices is result of what?
|
portal hypertension and chronic alcoholism
|
|
|
injury to the esophageal mucosa with subsequent inflammation.
|
esophagitis
|
|
|
esophagitis has been correlated strongly with this
|
esophageal carcinoma
|
|
|
narrow of esophagus
|
stricture
|
|
|
due to chronic GI reflux, this is the replacement of normal distal stratified squamous mucosa by metaplastic columnar epithelium containing goblet cells
|
barrett esophagus
|
|
|
significant clinical outcome of barrett esophagus
|
dev. of adenocarcinoma, thus screening recommended
|
|
|
90% of esophageal cancers but in US not so much.
|
Squamous cell carcinoma
|
|
|
dominant esophageal cancer in US
|
adenocarcinoma
|
|
|
only recognized precursor to esophageal adenocarcinoma
|
barret esophagus
|
|
|
1. iron deficiency anemia
2. atrophic glossitis (bald tongue) 3. dysphagia (dif. swallowing) |
plummer-vinson syndrome, common in swedish women who also have atrophic gastritis and esophageal webs.
|
|
|
chronic inflammation of stomach
|
atrophic gastritis
|
|
|
overused term, inflammation of the gastric mucosa
|
gastritis
|
|
|
chronic mucosal inflammatory changes leading to muscosal atrophy and epi. dysplasia
|
chronic gastritis
|
|
|
most important etiologic association for chronic gastritis
|
H. pylori
|
|
|
autoantibodies to the gastric gland parietal cells
|
autoimmune gastritis
|
|
|
name two types of chronic gastritis
|
1. H. Pylori
2. autoimmune |
|
|
h. pylori induced proliferations of lymphoid tissue w/in gastric mucosa can lead to
|
gastric lymphomas
|
|
|
patients with peptic ulcer often have what?
|
h. pylori infection
|
|
|
acute mucosal inflammatory process of transient nature
|
acute gastritis (NOT ASSOCIATED WITH H. PYLORI)!!
|
|
|
major cause of hematameses (throwing up blood), complicated by NSAID use
|
acute gastritis (NOT ASSOCIATE WITH H. PYLORI)!!
|
|
|
breach in epi. of mucosa only.
|
erosion
|
|
|
a breach in the mucosa of the GI that extends through the musc. mucosa into the submucosa or deeper.
|
ulcer
|
|
|
chronic, usually solitary lesions that occur in any portion of the GI exposed to the aggressive action of acid-peptic juices.
|
peptic ulcers
|
|
|
ratio of peptic ulcers in duodenum to stomach
|
4:1
|
|
|
remitting, relapsing lesions with no racial or genetic influence
|
peptic ulcers
|
|
|
name the two key facts regarding peptic ulcers
|
1. fundamental requisite is mucosal exposure to gastric acid and pepsin
2. strong causal assoc. w/ H. Pylori (70% of cases) |
|
|
Other major cause of peptic ulcers (besides H. pylori)
|
NSAIDs, ^ w/ age, dose of NSAID & prolonged usage. Suppression of prostaglandin synthesis is key to nsaid indused peptic ulceration
|
|
|
extremely common condition in peptic ulcer disease patients
|
chronic gastritis
|
|
|
what do NSAID associated peptic ulcer disease pts + H. pylori results in
|
Chronic gastritis, without H. Pylori, won't have chron. gastritis
|
|
|
Multiple peptic ulcerations in the stomach, duodenum and even jejunum due to excess gastrin by a tumor (a paraneoplastic syndrome)
|
Zollinger-Ellison Syndrome
|
|
|
focal, acutely developing gastric mucosal defects due to stresses
|
Acute Gastric Ulcerations
|
|
|
acute gastric ulcerations due to trauma defined as:
|
major surgery, sepsis
|
|
|
ulcers due to extensive burns
|
Curling ulcers
|
|
|
ulcers due to trauma or surgical injury to the CNS or intracerebral hemorrhage
|
Cushing ulcers
|
|
|
final type of acute gastric ulcerations, do to irritants:
|
NSAIDs and corticosteroids, typically.
|
|
|
leading gastric cancer, has intestingal and diffuse types
|
Gastric carcinoma
|
|
|
malignancy that arises from gastric mucous cells having undergone metaplasia due to chronic gastritis. Well differentiated, form neoplastic intestinal glands, declining in US
|
Intestinal type gastric carcinoma
|
|
|
arrises de novo from native gastric mucous cells, not assoc. w/ chronic gastritis, poorly differentiated, no glands, permeate mucosa and infiltrative growth pattern, 1/2 of GC in the US
|
Diffuse type gastric carcinoma
|
|
|
metastasis involving supraclavicular lymph node
|
Virchow's node
|
|
|
metastatic invasion to ovaries
|
Krukenberg tumor
|
|
|
predisposing factors to adenocarcinoma:
|
1.chronic gastritis associated w/ H. Pylori
2. diet |
|
|
distension of colon greater than 6-7 cm, congenital and acquired disorder
|
Hirschsprung disease, congenital megacolon
|
|
|
cause of hirschsprung/megacolon
|
caudad migration of neural crest-derived cells along GI arrests before reaching anus
|
|
|
variceal dilations of anal and perianal submucosal venous plexuses
|
hemorrhoids (straining or chronic constipation or pregnancy)
|
|
|
increased stool mass, frequency or fluidity
|
diarrheal disease
|
|
|
viral, bacterial, parasitic or protozoal GI infection
|
enterocolitis
|
|
|
bacterial diarrhea due to toxins
|
bacterial enterocolitis, an example of a toxin would be C. Botulinum
|
|
|
enteric pathogen that adheres to mucosal epi.
|
bacterial enterocolitis, incubation of several hours to days before onset
|
|
|
suboptimal absorption of any or all ocmponents of normal diet
|
malabsorption syndromes
|
|
|
defective intraluminal digestion
|
pancreatic insufficiency, undigested nutrients ^ osmotic pressure, result in diarrhea
|
|
|
mucosal cell abnormalities
|
lactose intolerance, a deficiency of disaccharidase
|
|
|
reduced small intestinal surface area
|
gluten sensitive enteropathy, aka celiac disease
|
|
|
prototypical noninfectious malabsorption due to reduced absorptive surface area
|
celiac disease
|
|
|
sensitivity to gliadin
|
celiac disease, leads to total flattening of mucosal villi and loss of absorptive surf. area due to immune response
|
|
|
malabsorption due to intestinal infection
|
tropical sprue
|
|
|
Crohn disease an dulcerative colitis, collectively known as
|
idiopathic inflammatory bowel disease
|
|
|
affects any level of GI, mouth to anus, mostly small intestine and colon. a systemic inflammatory diesaes w/ predominant GI involvement.
|
Regional Enteritis (Crohn Disease)
|
|
|
skip lesions
|
sharply delimited and typically transmural involvement of the bowel by an inflammatory process with mucosal damage (Crohn Disease)
|
|
|
Granulomas in alimentary tract
|
presence of non-caseating granuloma in 40-50% of cases of Crohn Disease
|
|
|
fistula formation
|
the 3rd characteristic of CD
|
|
|
ulceroinflammatory disease affecting the colon but limited to the mucosa and submucosa except in the most sever cases. Begins in rectum and extends proximally in continuous fashion
|
Ulcerative colitis
|
|
|
well formed granulomas are absent
|
UC
|
|
|
no skip lesions
|
UC
|
|
|
mucosal ulcers rarely extend below submucosa and serosal surface typically normal
|
UC
|
|
|
much greater risk for carcinoma than Crohn Disease
|
Ulcerative Colitis - think inflammation = predisposition to cancer
|
|
|
blind pouch leading off GI tract
|
colonic diverticulosis
|
|
|
most common location for diverticula
|
colon
|
|
|
2 causes of diverticula
|
1. exaggerated peristaltic contractions with abnormal elevation of intraluminal pressure
2. focal defects peculiar to the normal musculature of colonic wall |
|
|
weakness or defect in wall of peritoneal cavity, protrusion of pouch like sac of peritoneum
|
hernial sac
|
|
|
adhesions between bowel segments or abdominal wall, often post surgery
|
intestinal adhesions
|
|
|
telescoping of proximal segment of bowel into immediately distal segment
|
intussusception
|
|
|
twisting of a loop of bowel about its base or attachment
|
volvulus
|
|
|
tumorous mass that protrudes into lumen of gut
|
polyps
|
|
|
90% of all epi. polyps, no malig. potential
|
non-neoplastic polyps
|
|
|
most common type of non-neoplastic polyp, small and multiple
|
hyperplastic polyps
|
|
|
normal tissue, all jumbled around
|
hamartoma
|
|
|
juvenile or peutz-jeghers
|
examples of hamartomatous polyps
|
|
|
hamartomatous proliferation occurs most freq in kids
|
juvenile polyps
|
|
|
a familial polyposis syndrome, hamartomatous polyps. does not develop colonic carcinomas but is assoc. w/ ^ risk of malignancy
|
Peutz-Jephers Syndrome
|
|
|
500 to 2500 colonic adenomas that carpet mucosa, due to mutation in APC gene. min of 100 polyps for dx. colonic cancer 100% by midlife
|
familial adenomatous polyposis FAP
|
|
|
APC mutation, has several extraintestinal tumors, hundreds of thousands of adenoma, colon cancer 100% by midlife
|
Gardener's syndrome
|
|
|
Two polyp syndrome related to mutated APC gene
|
Familial adenomatous polyposis (FAP) and Gardener's Syndrome
|
|
|
hamartomatous polyps in GI, does not develop colonic carcinomas, but is associated with ^ risk of malignancy
|
Cowden syndrome
|
|
|
Two syndromes, both w/ hamartomatous polyps, don't becme carcinomas, but are associated w/ ^ risk of malignancy
|
1. Peutz-Jephers Syndrome
2. Cowden Syndrome |
|
|
2 pathways for colon cancer development
|
1. APC/Beta catenin pathway
2. MSI microsatellite instability pathway |
|
|
loss of APC tumor supressor gene is believed to be the earliest event in the formation of adenomas. Chromosomal instability.
|
APC/Beta Catenin pathway *most colon cancers*
|
|
|
germline mutations in APC gene giving rise to hundreds of adenomas that progress to form cancers
|
adenoma-carcinoma sequence, part of APC/b catenin pathway
|
|
|
defective *DNA repair* caused by inactivation of DNA mismatch repair genes
|
MSI microsatellite instability. *non polyps*
|
|
|
MSI pathway gives rise to this type of cancer
|
hereditary nonpolyposis colon carcinoma
|
|
|
unique tumor from enterochromaffin cells of gut
|
Carcinoid tumors, mainly small intestine
|
|
|
problem with GI carcinoids
|
often have secratory products, ex: zollinger-ellison (excess gastrin) cushing syndrome (ACTH secretion).
|
|
|
GI carcinoids that have metastasized to liver
|
Carcinoid Syndrome
|
|
|
w/ GI carcinoids, what must be present for development of syndrome?
|
hepatic dysfunction due to metastases from other sites.
|
|
|
chronic gastritis and H. Pylori predispose to what lymphatic cancer?
|
gastrointestinal lymphoma
|
|
|
result of fecalith
|
acute appendicitis.
|
