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127 Cards in this Set
- Front
- Back
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What are the categories of esophageal diseases?
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Anatomic and Motor Disorders
Esophagitis Barrett Esophagus Esophageal Carcinomas |
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What are the signs and symptoms of esophageal diseases?
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Dyphagia
Heartburn - regurgitiation Hematemesis Melena |
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What are the Anatomic and Motor disorders of the esophagus?
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Hiatal Hernia
Achalasia Esophageal Lacerations Esophageal varices |
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What is the definition of Hiatal hernias?
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a defect in the diaphragm allowing the stomach to pouch through
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What percent of the population has hiatal hernias?
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1-20% (incidence increases with age)
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What are the types of hiatal hernias? describe the incidence and description of each?
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Sliding hiatal hernia (95%) - the whole cardiac portion goes throught the sphincter
Paraesophageal (rolling) hernia (5%) - a small portion comes up laterally through the sphincter |
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What are the symptoms of a hiatal hernia? What causes the symptoms to be worse?
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symptoms are associated with gastic reflux
obesity, reclining after large meals make it worse |
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What is another name for achalasia?
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megaesophagus
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What is the definition of achalasia?
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failure of the cardiac sphincter to relax which leads to FUNCTIONAL obstruction
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What are the mechanisms of achalasia?
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1) aperistalsis
2) incomplete sphincter relaxation with swallowing 3) increased resting tone of the sphincter |
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What is the major symptom of achalasia?
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progressive dysphagia with possible retrosternal chest pain
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What are complications of achalasia?
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nocturnal regurgitation with risk of aspiration and a 5% increased risk of squamous cell carcinoma
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What is another name and the definitions for esophageal lacerations?
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Mallory-Weiss syndrome
definition = longitudinal tears in the esophageal mucosa |
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What percent of upper GI bleeds does Mallory-Weiiss syndrome account for
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5-10%
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What causes esophageal laceration?
who is esophageal lacerations more common in? What % of patients who have this have a hiatal hernia? |
caused by severe vomiting
more common in chronic alcoholism 75% have hiatal hernia |
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What is the major symptom of esophageal lacerations?
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hematemesis - rarely life-threatening
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What is the definition of esophageal varices?
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dilated and tortuous veins in the submucosa of the lower esophagus. They are characterized by venous congestion and possibly high venous pressures
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What % of hematemesis does esophageal varices account for?
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50% --> more common than tears
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What is the mechanism of esophageal varices?
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portal hypertension due to liver cirrhosis (2/3 of cirrhosis patient develop esophageal varices)
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What are the symptoms of esophageal varices?
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massive hematemesis
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How do you treat the bleeding form esophageal varices?
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with sclerosing agents and/or balloon tamonade. 50% stop bleeding on their own.
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What is the mortality rate on the first episode of rupture with esophageal varices? How many rebleed within the first year?
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20-30%
70% |
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Define these:
Stenosis Atresia Webs and rings Diverticula |
Stenosis - constriction of the esophageal lumen
Atresia - developmental anomaly where esophagus, or portion thereof, fails to form Webs and rings - folds of mucosa that protrude into the lumen (eg. plumber vincen syndrome - increased risk of GI cancer due to iron deficiency.) Diverticula - an outpouching of mucosa through muscular wall of gut - very rare doesn't really cause problems |
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What is the definition of esophagitis?
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mucosal injury with subsequent inflammation of the esophagus
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Who is mostly affected by esophagitis?
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middle-aged adults
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What is the most common mechanism of mucosal injury in the U.S.?
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chronic gastric reflux
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What is the clinical term for symptomatic disease of esophagitis?
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Gastroesophageal reflux disease (GERD)
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What % of the population has GERD and what is the major symptom?
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.5% and the major symptom is recurrent heartburn
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What are the possible complications of esophagitis?
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Barrett esophagus (transformation of epithelium with increased risk for adenocarcinoma)
Bleeding strictures - fibrotic narrowing of the esophagus Increased risk of adenocarcinoma of the esophagus |
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What is the definition of Barrett Esophagus?
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the replacement of the normal stratified squamous epithelium of the distal esophagus by metaplastic columnar epithelium containing goblet cells
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Is the metaplasia that occurs in the Barrett Esophagus reversible?
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YES!
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Why does Barrett Esophagus develop?
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it is a complication of long-standing gastroesophageal reflux
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What % of GERD patients have Barrett Esophagus?
What is the ratio of men to women that have Barrett Esophagus? |
10%
4:1 |
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How much of an increased risk for adenocarcinoma of the esophagus occurs with Barrett Esophagus?
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30-40 fold increased risk
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What are the 2 types of esophageal carcinomas?
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Adenocarcinoma
Squamous Cell Carcinoma |
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What type of esophageal cancer is the most common in the U.S.?
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adenocarcinoma
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What is the age and gender predilection for adenocarcinoma?
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>50 years men
M:F = 3:1 |
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What part of the esophagus is adenocarcinoma more common in?
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distal 1/3
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What esophageal carcinoma accounts for 90% of esophageal carcinomas world-wide?
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squamous cell carcinoma
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What part of the esophagus does squamous cell carcinoma usually occur in?
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the middle 1/3
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What are the risk factors for squamous cell carcinomas?
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slowed passage of foods
tobacco and alcohol use nitrosamines in the diet vitamen and mineral defiencies Plummer-Vinson syndrome |
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What are the clinical signs and symptoms of esophageal carcinomas?
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late symptoms
dysphagia - usually 1st symptom anorexia and weight loss fatigue Pain - late finding |
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What esophageal carcinoma has the worst prognosis?
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Squamous cell carcinoma
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What esophageal carcinoma is not associated with metaplasia?
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squamous cell carcinoma
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What is the treatment for esophagea carcinomas?
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surgery, radiation and chemotherapy
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What is the prognosis for esophageal carcinomas?
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5% 5 year survival rate
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What are the signs and symptoms of stomach disorders?
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Heartburn
Epigastric pain Hematemeisis - "coffee grounds" Melena |
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What are the diseases of the stomach
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Gastritis
Gastric ulcerations Tumors |
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What is the definition of Gastritis?
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inflammation and erosion of the stomach lining
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What are the types of gastritis?
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Chronic gastritis
Acute gastritis |
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What is the definition of chronic gastritis?
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chronic inflammation of the stomach mucosa leading to mucosal atrophy and epithelial intestinal metaplasia
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What % of adults who have a biopsy have histological evidence of chronic gastritis?
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50%
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What is the etiology of chronic gastritis?
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Heliocbactor pylori (50% of adults older than 50 have this)
Autoimmune gastritis - pernicious anemia |
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What is the morphology of chronic gastritis?
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Chronic inflammation - lymphocytes and plasma cells
Mucosal atrophy - loss of parietal cells (only in pernicious anemia) intestinal metaplasia Metaplastic epithelium may become dysplastic = 5x increase risk for carcinoma Proliferation of lymphoid tissue - increases risk of gastric lymphoma |
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What are the signs and symptoms of chronic gastritis?
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usually asymptomatic*!*!
symptoms if present are upper abdominal discomfort, nausea and vomiting |
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What is the definition of acute gastritis?
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transient acute inflammation of stomach mucosa
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What are the mechanisms of acute (erosive) gastritis?
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1) decreased mucus layer
2)increased acid 3)decreased bicarb 4) decreased mucosal blood flow 5) injury to epithelium 6)possibly H. pylori infection (not usually) |
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What are contributing factors to acute gastritis?
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NSAIDS, alcohol, heavy smoking, cancer, chemo, uremia, systemic infections (salmonella), sever stress, ischemia and shock, consumption of strong acids or alkalis, intubation and reflux of bile)
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What is the morphology of acute gastritis?
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1) acute inflammation - neutrophils with mucosal edema and erosion
2) erosion of the epitheium may occur 3) hemorrhage may be present |
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What are the symptoms of acute gastritis?
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1) may be asymtomatic
2) possible symptoms are epigastric pain, nausea, vomiting, hematemesis, melena 3) acute gastritis is a common cause of hematemesis in alcoholics |
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What is the definition of gastric ulcerations?
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a breach in the mucosa, extending through the muscularis mucosae and into the submucosa. Most occur in the stomach and duodenum
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What is the life-time risk of peptic ulcer disease?
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10% in the U.S.
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Where is the site of predilection of peptic ulcers?
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98% occur in the first portion of the duodenum
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What are the clinical signs and symptoms of peptic ulcers?
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1) symptoms tend to be relapsing and remitting.
2) gnawing epigastric pain, possible burning or boring pain (worse 1-3 hours after meals and at night) 3) nausea, vomiting, bloating 4) complication include perforation with bleeding and possilbe peritonitis 5) Not associated with malignant transformation |
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how long does it take peptic ulcers to spontaneously heal?
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15 years
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What is the mechanism of disease of peptic ulcer disease?
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1) aggressive acid, pepsin exposure
2) Helicobacter pylori infection - 70-90% of patients 3) decreased mucoal defenses |
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How does helicobacter pylori cause peptic ulcer disease?
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it produces toxins that injure epithelium, breaks down mucus, elitics dramatic inflammatory response, increases gastric acid production, decreases bicarbonate production, induces metplasia, and induces immunogenic Band T cell responses.
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What is the treatment for peptic ulcer disease?
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antibiotics and antacids (with bismuth)
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What are the causes of acute gastric ulceration?
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1) severe stress or trauma
2) extensive burns 3) CNS injury or surgery 4) chronic drug exposure - NSAIDS, corticosteroid |
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What is the morphology of acute gastric ulcerations?
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1) ulcers are usually in the stomach
2) measure up to 1 cm diameter 3) ulcers are usually multiple 4) depth of ulceration is variable, but most do not penetrate the muscularis |
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What are the clinical signs and symptoms of acute gastric ulcerations?
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usually asymptomatic; may cause pain and bleeding
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How is the prognosis of acute gatric ulcerations?
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recovery is rapid once underlying cause is eliminated
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What % of gastric cancers does gastric carinomas account for?
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90-95%
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What % of of cancer deaths in the U.S. does gastric carcinoma account for?
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2%
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Where is the hightest incidence of gastric carcinoma occur?
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Japan and South Korea
declining in the U.S. |
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What % of gastric cancers does gastric carinomas account for?
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90-95%
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What % of of cancer deaths in the U.S. does gastric carcinoma account for?
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2%
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Where is the hightest incidence of gastric carcinoma occur?
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Japan and South Korea
declining in the U.S. |
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What are the types of gastric carcinomas? And what is the incidence of each?
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Intestinal type - 50% (decreasing)
diffuse type - 50% (increasing) |
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What type of gastric carcinoma arises from metaplastic epithelium in the setting of chronic gastritis?
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intestinal type
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What is the age and gender predilection of the intestinal type of gastric carcinoma?
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occurs after 50; M:F = 2:1
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What are the risk factors for intestinal type of gastric carcinoma?
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Diet - nitrites, smoked and pickled foods, salty foods, lack of fresh vegetables and fruits
Chronic gastritis - H. pylori infection, pernicious anemia |
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What causes diffuse type of gastric carcinomas?
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UNK - arises de novo form gastric cells - tumor cells are poorly differentiated
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T or F: diffuse type of gastric carcinoma is associated gastritis?
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F
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What are the clinical signs and symptoms of gastric carcinomas?
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symptoms do not develop til late
symptoms are anorexia, epigastric pain, wight loss and bleeding |
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what is the prognosis for gastric carcinomas?
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5 year survival rate is <20%
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What are the categories of the small intestine?
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1) developmental anomalies
2) ischemic bowel disease 3) Malabsoption syndromes 4) Neoplasms |
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What are the developmental anomalies of the small intestine
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1) atresia or stenosis
2) duplication -?? 3) Meckel diverticulum 4) omphalocele |
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What is the most common developmental problem of the small bowl?
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meckel diverticulum
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What causes meckel diverticulum?
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when the omphalomesenteric duct does not involute during embryogenesis
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Where is meckel diverticulum located?
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in the distal ileum
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What is the definition of omphalocele?
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a membranous abdominal wall that balloons out and contains abdominal viscera
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What developmental anomaly is associated with fetal demise?
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omphalocele
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What is the definition of ishemic bowel disease?
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bowel infarction due to inadequate blood supply. May involve the small bowel or large bowel. Occlusion may involve celiac artery, superior mesenteric artery, or inferior mesenteric artyer
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What are the predisposing clinal condition for ishemic bowel disease?
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1) arterial embolism
2) arterial thrombosis 3) venous thrombosis 4) non0occlusive ishemia- cardiac failure, shock dehydration 5) bowel resection, volvulus, torsion |
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What are the clinical signs and symptoms of ischemic bowel disease?
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1) sudden onset severe abdominal pain
2) may have bloody diarrhea 3) progresses rapidly to shock |
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What is the prognosis for ishemic bowel disease?
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90% mortality rate - usually due to perforation and peritonitis
- prognosis is better if not transmural |
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When does malabsorption syndrome occur?
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when there is inadequate tranport of dietary nutrients across the gut wall
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What are the complications of malabsorption syndromes?
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1) hematologic - anemia and bleeding problems
2) musculoskeletal - osteopenia and tetany 3) endocrine - hyerparathyroidism, amenorrhe, impotence 4) Skin - purpura and petechiae, edema, dermatitis 5) Nervous system - peripheral neuropathy |
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What are the types of malabsorption syndromes?
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1) defective intraluminal digestion
- cystic fibrosis, bile obstruction 2) Primary mucosal cell abnormalities - lactose intolerance 3) Reduced small intestine surface area - celiac disease, short gut syndrome, Crohn disease 4) Infection - tropical sprue, Whipple disease |
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What causes celiac disease and what is the incidence?
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it is caused by immunologic reaction to gluten in wheat, rye, oats and barley. The immulogic damage causes flattening of villi, and significant loss of surface area for absorption.
It occurs in 1:300 people in the US |
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What genes are affected in celiac disease?
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the HLA-DQ2 or HLA-DQ8
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What histologic changes are seen with celiac disease?
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the mucosa is infiltrated by lymphocytes
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What are the symptoms for celiac disease?
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diarrhea, and malnutrition
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Is there an increased risk for cancer with celiac disease?
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yeas 2x risk for intestinal lymphoma and other cancers
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What is the etiology for tropical sprue?
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thought to be caused by an infection but causal organism is unkonwn
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Who gets tropical sprue?
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people living or visiting the tropics
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What are the symptoms of tropical sprue and how is it treated?
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presents as acute diarrheal disease, similar to celiac disease. Treated with broad-spectrum antibiotics
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What cuases Whipple disease?
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Tropheryma whippleii (a gram positive culture-resistance actinomycete)
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What organs does whipple disease affect?
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lymph nodes, spleen, heart, liver, kidneys, muscle, CHS and especially small intestines
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What is the histological presentation of whipple disease?
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has numerous PAS+ macrophages in the affected organs
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Who is affected by Whipple disease?
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men 30-50
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What are the symptoms of Whipple disease?
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diarrhea, lymphadenopathy, polyarthritis, and hyperpigmentation of skin
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How is Whipple disease treated?
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with antibiotics
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What % of GI tumors occur in the small intestine?
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3-6%
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What is the most common cancer in the small intestine?
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Adenocarcinoma
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Which cancer accounts for almost 1/2 of small bowel cancers?
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carcinoid tumors
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What small bowel cancer is derived from endocrine cells?
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carcinoid tumors
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What are the sites (in order) for carcinoid tumors?
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appendix, small gut, rectum and sigmoid, lung and other sites
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What type of small bowel cancer produces biologically active substances? And what does it produce?
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carcinoid tumor (agrentaffinoma)
- histamine, serotonin, kinins - hormones - gastrin, ACTH, somatostatin, insulin |
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What is the morphological appearance of carcinoid tumors?
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may be benign or malignant. Solitary or multiple
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What are the idiopathic inflammatory bowel diseases?
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Crohn disease (reginal enteritis)
Idiopathic Ulcerative Colitis |
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What is the definition of idiopathic inflammatory bowel disease?
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inappropriate activation and persistent activation of mucosal immune system resulting in chronic inflammation of the bowels
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What causes idiopathic inflammatory bowel disease?
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UNK
1)Possibly genetic * Ulcerative colitis HLA-DR2 * Crohn disease - HLA-DR1 and Dqw5 2) Immunologic factors - dysregulation of T-cell responses 3) Microbial factors - trigger an immune response |
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What is the symptom of idiopathic inflammatory bowel disease?
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diarrhea
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What immune cells are involved in idiopathic inflammatory bowel disease?
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dysregulation of T-cell responses
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Which is more common Crohns disease or idopathic ucerative colitis?
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idiopathic ucerative colitis
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