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151 Cards in this Set

  • Front
  • Back
what is the most common type of esophagitis?
reflux esophagitis
what infections can cause esophagitis (2)?
1) candida; 2) HSV
in what systemic illnesses can esophagitis arise (3)?
1) pemphigoid; 2) GVHD; 3) Crohn's
what else can cause esophagitis (2)?
1) prolonged intubation; 2) ingestion of irritants (alkali, acid, hot tea in Iran)
what is gastroesophageal reflux disease?
abnormal degree of gastroesophageal reflux (regurgitation of acid-peptic gastric content into esophagus) with sympotoms or tissue damage
what is reflux esophagitis?
inflammation and other objective evidence of injury to the esophageal mucosa from GERD
what are four causative factors of reflux esophagitis/GERD?
1) decreased efficacy of esophageal anti-reflux mechanisms (LES tone); 2) sliding hiatal hernia; 3) ninadequate or slow esophageal clearance of refluxed material; 4) action of gastric juices
in severe cases, what can be refluxed?
bile from duodenum
what are the two most important clinical features of reflux esophagitis?
1) heartburn (substernal burning pain); 2) regurgitation (reflux of sour/bitter material into mouth)
what type of extraesophageal manifestations occur?
pulmonary symptoms
what are other symptoms in clinical presentation (3)?
1) dysphagia; 2) odynophagia; 3) hemorrhage
what inflammatory cells are involved (2)?
1) eosinophils; 2) neutrophils
what hyperplastic changes occur in the epithelium (2)?
1) basal cell hyperplasia; 2) elongated papillae
what complications must we know for reflux esophagitis (3)?
1) ulcer; 2) stricture; 3) Barrett esophagus
what is Barrett Esophagus a complication of?
long standing gastroesophageal reflux
what % of symptomatic GERD patients get it?
what happens in response to injury?
the distal squamous mucosa is replaced by metaplastic columnar epithelium
what criteria are used to diagnose?
columnar mucosa with intestinal metaplasia (goblet cells)
what is there an increased risk for, and how much is risk increased?
adenocarcinoma of the esophagus (30 to 40 fold increase rate over general population)
what should be done to these patients?
periodic surveillance every 1 or 2 years with endoscopic biopsy to detect dysplasia and early cancer
what is 5 years survival rate for esophageal adenocarcinoma after surgery, and how does this differ for early cancer?
less than 20% survival after surgery, but 80% for early cancer
what is the most common esophageal carcionma?
squamous cell carcinoma (90% worldwide, 50% in USA)
what causes most adenocarcinoma?
Barrett esophagus
what is the highest incidence area in the world for squamous cell carcinoma?
Central China, followed by Iran and South Africa
what race and sex is most likely to get squamous cell carcinoma of the esophagus?
blacks > whites, male > female
what are major etiological factors in the USA and Europe (2)?
1) heavy smoking; 2) chronic drinking
what are factors in China and South Africa (3)?
1) fungus-contaminated food; 2) nitrosamine containing food; 3) deficiencies in vitamins/metals
what else can be etiological factors (2)?
1) genetic alterations; 2) chronic injury to esophageal mucosa (lye stricture, achalasia, diverticuli, Plummer-Vinson)
what are clinical manifestations of squamous cell carcinoma of the esophagus (3)?
1) dysphagia; 2) gradual obstruction; 3) aspiration pneumonia
why may there be aspiration pneumonia?
tracheoesophageal fistula
where in the esophagus is the most common location, and what % occur there?
middle third - 50%; lower third - 30%; upper third - 20%
what is the most common morphological form, and what are two other forms?
fungating - 60%; ulcerated - 25%; flat - 15%
what is the five year survival rate for all patients with squamous cell carcinoma of the esophagus?
what groups have higher survival rates (2), and what is the 5 year survival rate for each?
1) patients who undergo "curative" for advanced disease - 25%; 2) patients with superficial disease - 75%
what is hiatal hernia?
herniation of the stomach through an enlarged esophageal hiatus in the diaphragm
what are the two basic types (2) and which is most common?
1) sliding hernia (95%); 2) paraesophageal hernia
what is a sliding hernia (location, part of stomach)
supradiaphragmatic herniation of portion of the cardia
how common is it (what % of otherwise normal individuals)?
4-7% of otherwise normal individuals
what are symptoms referable to?
GE reflux
what is a paraesophageal hernia (location, part of stomach)?
herniation of portion of gastric fundus alongside the esophagus through a defect in the diaphragm
what is the clinical course usually like in paraesophageal hernia?
what symptoms may occur (2)?
1) strangulation; 2) infarction
what is Mallory-Weiss syndrome (lesion, location)?
longitudinal tears at esophageal junction
who is this syndrome most common in and why?
alcoholics - attributed to episodes of excessive vomiting
where in the bowel does this disease affect, and what does the area affected depend on?
may be restricted to small or large intestine, or may affect both, depending on particular vessels affected
what are three types of ischemic bowel disease?
1) transmural; 2) mural; 3) mucosal
what causes transmural IBD?
mechanical compromise of major mesenteric blood vessels
what causes mural IBD?
hypoperfusion (acute or chronic)
what causes mucosal IBD?
hypoperfusion (acute or chronic)
what are four categories of predisposing factors for IBD (other miscellaneous causes exist)?
1) arterial thrombosis; 2) arterial embolism; 3) venous thrombosis; 4) nonocclusive ischemia
what are some causes of arterial thrombosis (list)?
severe atherosclerosis, systemic vasculitis, dissecting aneurysm, angiography, oral contraceptives
what are some causes of arterial embolism (list)?
cardiac vegetations, aortic atheroembolism
what are some causes of venous thrombosis (list)?
hypercoagulable states, oral contraceptives, postoperative state, intraperitoneal sepsis, invasive neoplasms, cirrhosis, abdominal trauma
what are some causes of nonocclusive ischemia (list)?
cardiac failure, shock, dehydration, vasoconstrictive drugs
what are some miscellaneous causes of IBD (4)?
1) radiation; 2) volvulus; 3) stricture; 4) herniation
if the small bowel is involved, what part is normally affected?
substantial portion of total length
if the colon is involved, what part is normally affected?
the splenic area (the watershed between the distribution of superior and inferior mesenteric arteries)
what is seen microscopically if there is infarction or acute ischemia (2)?
1) coagulative necrosis; 2) hemorrhage (minimal inflammatory reaction)
what is seen microscopically if there is chronic ischemia (3)?
1) chronic inflammation; 2) fibrosis; 3) stricture
what is the most serious form of IBD, and what is the mortality?
transmural infarction - uncommon but grave disorder (mortality 50-75%)
what will the patient present with, in transmural IBD?
severe pain and tenderness
what will stool be like (2)?
1) bloody diarrhea; 2) grossly melanotic
what will patients complain of in mucosal and mural infarction (2)?
1) nonspecific abdominal complaints; 2) intermittent bloody diarrhea
what is the normal cause?
C. difficile overgrowth secondary to broad-spectrum antibiotics
what is this acute colitis characterized by?
formation of an adherent layer of inflammatory cells and debris (pseudomembrane) overlying sites of mucosal injury
what is the pathogenesis (2 things caused by C. difficile, and 2 results)?
C. difficile produces toxin A and toxin B which: 1) induce cytokine production; 2) cause host cell apoptosis
what does C. difficile enterocolitis look like grossly?
raised yellowish plaques (1-2 mm)
what is the appearance microscopically?
"volcano or mushroom like" pseudomembrane
what are the clinical symptoms (4)?
1) fever; 2) pain; 3) leukocytosis; 4) diarrhea
what tools are used to diagnose (3)?
1) C. difficile toxin in stool; 2) endoscopy/biopsy; 3) clinical history of antibioti use
what is the treatment (2)?
1) metronidazole; 2) vancomycin
what type of lesion occurs, and where?
mucosal lesion, small intestine
what cells increase in number?
intraepithelail lymphocytes
what antibodies can be found in serology (3)?
1) anti-gliadin; 2) andi-endomysial; 3) TTG (tissue transglutaminase)
what is there a small long-term increased risk for (3)?
malignant diseases including: 1) intestinal lymphoma; 2) small intestinal adenocarcinoma; 3) esophageal squamous cell carcinoma
who does collagenous colitis predominantly affect (age, sex)?
middle-aged and elderly women
what is seen on colonoscopic examination?
what is the clinical symptom?
chronic watery diarrhea
what alteration is the cause?
markedly thickened subepithelial collagen layer
who usually gets acute apendicitis?
adolescents and young adults (but can occur in any age group)
what is pain like, in location and progression?
at first periumbilical, but then localizing to right lower quadrant
what are other pesentations (4)?
1) nausea/vomiting; 2) abdominal tenderness (appendix region); 3) mild fever; 4) leukocytosis
what is regrettable about classic presentation?
more often absent than present
what is acute appendicitis associated with in 50-80% of cases?
obstruction (fecalith, tumor, worm)
what is diagnostic for acute appendicitis?
neutrophilic infiltration of the muscularis
what are complications of acute appendicitis (3)?
1) perforation; 2) liver abscess; 3) bacteremia
what error commonly occurs among highly competent surgeons?
false positive diagnosis (20-25%)
what is angiodysplasia?
tortuous dilatations of submucosal and mucosal blood vessels
where is this most often seen (2)?
1) cecum; 2) right colon
at what age is angiodysplasia seen?
usually only after sixth decade of life
what is the main symptom?
lsignificant ower intestinal bleeding
what % of significant lower intestinal bleeding is angiodysplasia responsible for?
what may be involved in pathogenesis (2 - remains speculative)?
1) mechanical factors/congenital malformation; 2) vascular degenerative changes related to aging
what are the two main categories of obstruction?
1) mecahnical; 2) pseudo-obstruction
what is the most common cause of mechanical obstruction?
what are other causes of mechanical obstruction (list)?
hernias, intussusception, tumors, inflammatory strictures, volvulus, obstructive gallstones, fecaliths, foreign bodies, congenital strictures, atresia, congenital bands, meconium in mucoviscidosis (cystic fibrosis), imperforate anus
what are causes of pseud-obstruction (4)?
1) paralytic ileus (e.g. post-operative); 2) vascular (bowel infarction; 3) myopathies; 4) neuropathies
what are hernias?
weakness or defect in wall of peritoneal cavity
what are four types of hernias?
1) incisional; 2) inguinal; 3) femoral; 4) umbilical
what are two problems caused by hernias?
1) incarceration (trapping); 2) strangulation
who does intussusception most often occur in?
infants, children
what happens in intussusception?
telescoping of one part of the intestine into the immediately distal segment of bowel
what region of the intestine does this most commonly occur in?
iliocecal region
what problem can this cause besides obstruction?
what is the underlying pathology in childhood?
lymphoid hyperplasia related to rotavirus infection
what is the underlying pathology in adulthood?
usually associated with intraluminal mass
what is the treatment for early/uncomplicated cases, and what is the treatment for late cases?
1) barium enema (early); 2) surgery with manual reduction ore resection (late)
what is volvulus?
torsion or twisting of intestine (causing obstruction)
where does volvulus occur (3)?
1) sigmoid colon; 2) cecum; 3) small intestine
what problem can this cause besides obstruction?
what are predisposing conditions (3)?
1) redundant loop; 2) peritoneal adhesions; 3) congenital long mesentery