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;
127 Cards in this Set
- Front
- Back
|
what injurs gastric mucosa |
1. corticosteroids, ASA,
2. PGE defecit, NSAIDS 3. chemo- 4. alkalinization |
|
|
what organism is associated with peptic ulcers of...
1. Duodenum 2. stomach 3. chronic gastritis 4. gastric neoplasm |
H pylori
|
|
|
tell me about H pylori disease progression and time line
|
1. infected as a kid and get chronic gastritis
2. as an adult you get duodenal ulcer or interstitial metaplasia 3. by the time you are an old timer you get MALT lymphoma, Gastric carcinoma, Gastric ulcer |
|
|
name ALL of the disease H pylori is associated with
|
1. ulcers, duodenal (early) and stomach (late)
2. chronic gastritic 3. gastric carcinoma, MALT lymphoma |
|
|
are you more or less likely to be infected with H pylori as you age
|
MORE
|
|
|
alright, we know H pylori can lead to chronic gastritis, duodenal ulcer, MALT lymphoma, gastric ulcer. whats the micro?
|
spiral bacilli
common with poverty, crowding, developing country ORAL ORAL or ORAL fecal Gastritis is initially antral, pangastritic --> atrophy --> decreased acid --> increased risk of adenocarcinoma |
|
|
how does H pylori lead to increased risk of adenocarcinoma
|
1. gastritis is antral --> atrophy --> decreased acid --> increased risk of cancer
|
|
|
what are some of the virulence factors associated with H pylori
|
urease, local increase in pH
CagA+ peptic ulcer, cancer incite B/T cell response |
|
|
whats Cag A
|
virulence assoc with H pylori --> peptic ulcer and cancer
Tx H pylori with PPI and AB |
|
|
your pt has complaints of epigastric pain, and a + CLO test. What are some confirmatory labs, what are you worried about
|
H pylori
CLO test is the rapid urease test DNA by PCR serology for AB fecal AG breath test for urea Afraid of: chronic gastritis if a young person, duodenal ulcer if older. Cancer and stomach ulcer if even older Tx with PPI and AB |
|
|
what are the first and second most common places for peptic ulcers
|
1. duodenum- 1st part
2. Stomach- lesser curvature near antrum |
|
|
what are some common locatinos and causes of peptic ulcers
1. duodenum 2. stomach, antrum 3. Gastroesophageal junction 4. Multiple near duodenum, stomach, jejunum |
1. duodenum- mid h pylori infection
2. stomach- late h pylori 3. GE Junct- reflux 4. duodenum, stomach, jejunum- zollinger Ellison |
|
|
if your pt has ulcers in the duodenum and stomach how might to ID H pylori infection from Zollinger Ellison
|
Zollinger Ellison will also have ulcer in jejunum
H pylori: fecal AG, serum AB, DNA by PCR, rapid CLO urease and breath urease. |
|
|
what causes gastric ulcer
what causes duodenal ulcer |
1. Gastric: h pylori, cigs, ASA
2. Duodenal: H pylori (almost always caused by H pylori) |
|
|
where will the ulcer be when its cause by...
1. H pylori 3. Cigs 4. ASA what are 3 more things tht cause peptic ulcer ** |
1. duodenal > gastric
2. gastric > duodenal 3. gastric > duodenal **hyperacidity, NSAIDS, CORTICOSTEROIDS |
|
|
This 76 y/o female presented with iron
deficiency anemia, Hct 24% (normal 40% ) Test for fecal occult blood positive. • Rx 1 enteric coated aspirin daily for RA . • After receiving packed RBCs, endoscopy was performed. The aspirin was removed from the ulcer by forceps. Aspirin discontinued Review question: How does aspirin cause peptic ulceration? |
??
|
|
|
What does the cell do?
G Parietal Cheif |
G cell: gastrin
Parietal: acid Chief: pepsin |
|
|
What types of injury lead to Ulcers
|
1. H pylori
2. NSAID 3. ASA 4. Cigs 5. EtOH 6. Too much stomach acid 7. Duadonel gastric reflux ulcer can also be from decreased defense: 1. Ischemia 2. Delayed gastric emptying 3. Host factors |
|
|
What are the causes of relative polycythemia
|
dehydration
|
|
|
What are the 2 types of gastric ulcers
|
1. Acute “stress” 2 Chronic, Peptic
|
|
|
What are the morphological features of acute ulcers
|
1 can be shallow to deep 2. Located anywhere in stomach, multiple areas involved 3. Stained by acid digested blood. Margins show NO fibrosis, scarring or vascular thickening
|
|
|
Name 2 types of acute ulcer and describe the clinical situations for each
|
Acute "stress"
extension of acute gastritis NSAIDS complication shock, sepesis, trauma curling- burns cushings- CNS trauma, involve stomach esophagous and duodenum, high risk of perforation |
|
|
What is a breech in the muscularis mucosa of ailementary tract and can extend through the muscularis mucosa into submucosa or deeper
|
ulcer (acute or chronic)
|
|
|
What are ulcers associated with
|
1. Acute gastritis
2. NSAIDS 3. Shock, sepsis, trauma 3. Burns 4. Cushing ulcer with CNS trauma- stomach esophagous, duodenum, high risk for perforation |
|
|
What ulcer is associated with esophagous, stomach and duodenum and is a high risk for perforation
|
cushing, associated with CNS trauma
|
|
|
Does the margin of an ulcer show fibrosis, scarring or vascular thickening
|
nope. Can be anywhere in stomach and there can be multiple blood stained areas involved
|
|
|
A 23 y/o woman with frequent, recurrent migraine headaches and no other significant past medical history comes to the ER complaining of severe epigastric pain, nausea, and hematemesis. A gross image similar to her gastric mucosa is shown (several darkened areas, some look to perforate through mucosa). Which of the following is the most likely cause of this patient’s symptoms? A. Amyloidosis
B. Helicobacter pylori infection C. Nonsteroidal anti‐inflammatory drugs‐ (NSAIDs) D. Prednisone E. Uremia |
H pylori
|
|
|
what does COPD have to do with peptic ulcers
what does Ca levels have to do with peptic ulcers wht does live disease (cirrhosis) have to do with ulcers |
1. a 1 antitrypsin def--> duodenal ulcers
2. anthing the increases Ca stim gastrin to increase acid 3. duodenal ulcers |
|
|
causes of duodenal ulcers in general
gastric causes of duodenal ulcers duodenal causes of duodenal ulcers |
1. COPD, a1antitrypsin deficit
2. cirrhosis of liver 3. Blood type O 4. H pylori Gastric Causes: fast emptying H pylori parietal cells secrete too much acid/hyperplasia increased vagal activity Duodenal Causes: decreased HCo3, increased Acid mucosal sensitivity to acid decreased retrograde motility impairs neutralization by pancreatic alkaline secretions |
|
|
causes of gastric ulcers
|
1. uremia
2. ASA 3. Cigs |
|
|
whats the morphology of peptic ulcers
|
single (multiple with acute gastric)
punched out with straight walls, surrounded by thick scarred wall (no fibrosis or thickening with acute gastric ulcer) mucosa can radiate from crater |
|
|
what kind of ulcer shows thick scarred wall and is punched out with straight walls
what kind of ulcer shows multiple affected areas with no fibrosis or scarring or vascular thickening |
peptic ulcers, single
acute gastric ulceration, can heal |
|
|
what are the 4 layers of peptic ulcer disease
**recall its a single lesion with thickened fibrotic edges |
1. Fibrinoid debis in ulcer base
2. acute non specific inflammation 3. granulation tissue 3. fibrosis/scar **there is chronic gastritis in surrounding mucosa and hyperplastic mucosa surrounding the crater |
|
|
we are looking through an endoscope and see a white nasty lesion with pus. We take a biopsy and look in the lab and it shows areas of chronic gastritis in surrounding mucosa and hyperplastic mucosa right near the lesion. The lesion itself shows a layer of fibrinoid debris, acute non specific inflammation, granulation tissue and even scarring. what did we biopsy
|
peptic ulcer
|
|
|
what are hte sx of peptic ulcer disease,
whats the clinical course of PUD whats the complications of PUD |
Sx: epigastric burning/aching pain, radiates to back on L. Worse at night. Occurs 1-3 hrs after meals. Occult fecal blood, GI hemorrhage, NV, bloating, weight loss
Course: chronic, recurring. slow to heal w/o therapy. heals in weeks with therapy. Complications: bleeding, perforation, Gastric outlet obstruction. NOT CANCER |
|
|
ok so we had a pt with epigastric pain 1-3 hrs after eating, worse at night and fecal occult blood and weight loss. Endoscope showed a single lesion with fibrinous debris and thickening and scarring. the leiosn looked punched out. What are some complications this pt might encounter
|
PUD
Bleed, perforation, gastric outlet syndrome, NOT cacner **this will be chronic and recurring. its slow to heal if you dont treat with PPI, AB, and H2 blockers |
|
|
your pt has had these sx on and off for the past 7 years. whats the disease, whats the tx and whats the complications
epigastric burn/aching pain- radiates to back (t5-T9) L side, worse at night and 3 hrs after meals. Better with food or alkinalizer (TUMS). Fe deficit anemia, NV, bloat, belch, weight loss |
1. disease PUD
1. Tx: PPI, AB, H2 inhibitor 3. GI bleed, perforation, gastric outlet obstruction., NOT cancer **associated with fibrosis |
|
|
are PUD releived with food? does it increase cancer
|
YESS! also alkinalizers
NO increase in cancer risk **associated with fibrosis |
|
|
62 y/o with history of peptic ulcer disease for all of his adult life presents with nausea, vomiting and inability to keep food down for 3 days was admitted with a diagnosis of
gastric outlet obstruction. He had episodes of acute abdominal pain at approx. 8 mon. intervals. He had been hospitalized for GI bleeds, 10 and 20 yrs. earlier. Seven years earlier, he suffered a perforation that was repaired by a patch. On EGD, esophagitis, esophageal stricture and marked obstruction of the gastric outlet were noted. He was held NPO with gastric decompression by nasogastric tube and given total parenteral nutrition. 2 days later wire dilation of the gastric outlet was attempted w/o success. He was taken to surgery for distal gastric resection with gastro‐duodenostomy. There was an active penetrating ulcer of the duodenum with hypertrophy of the gastric wall at the pylorus and marked narrowing of the lumen due to outlet obstruction. There were perigastro‐duodenal adhesions with abundant pancreatic tissue in the adhesive mass. Patient developed postoperative pancreatitis and died. What are the complications of peptic ulceration ? |
1. Bleeding: common
2. perfoation: more likely than bleed to be fatal. super high death rate with gastric perforation 3. Gastric Outlet Obstruction: pyloric channel/duodenal ulcer. Crampy pain and vomit- tx with surgery. Cancer is not a common complication |
|
|
what are the clinical and morphologic features of Menetriers disease
|
brain stomach!!! its emlargement of rugal folds
PRECANCER uncommon, idiopathic- excess TGFa makes mucous cells grow. parietal cells atrophy Males more than females |
|
|
what are the 2 things that can cause brain stomach (hypertrophic gastopathy)
|
1. Menetrier Disease- protein loss, parietal cell atrophy, increase mucous cells, PRECANCER
2. Hyperplasia 2 to Zollinger Ellison- gastrin secreting tumor of pancreas or duodenum --> too much acid and recurrent ulcers in weird places and brain stomach |
|
|
what is Zollinger Ellison syndrom
|
tumor in pancreas or duodenum that secretes gastrin, this leads to TOO MUCH ACID. the stomach looksl ike a brain and you get recurrent ulcers in weird places (jejunum)
can be due to MEN1 (multiple endocrine neoplasia) Menetriers is precacner and associated with parietal cell atrophy and mucous cell hypertrophy |
|
|
what is the precancer that shows gastric hypertrophy (brain looking!), parietal cell atrophy, mucous cell hypertrophy
|
menetriers
M>F idiopathic, increased TGFa |
|
|
ok so we know menetriers is precancer, gastric hypertrophy that affects M > F. what are the sx
|
1. bleeding, epigastric pain, diarrhea, weight loss
2. protein loss --> hypoalbuniemina --> edema 3. peptic ulcers 4. risk for gastric carcinoma |
|
|
what disease is associated with gastric hypertrophy secondary to gastrin producing tumor
|
zollinger ellison
Gastrinoma- gastrin producing carcinoid tumor in pancreas or duodenum. can be due to MEN1 (multiple endocrine neoplasia) Gastrin stim too much acid! recurrent peptic ulcers, **ulcers at unusual locations: jejunum, |
|
|
whats the tx for gastroma carcinoid tumor in pancreas or duodenum
|
acid suppression to control ulcers in weird places
remove the tumor **this is Zollinger Ellison caused by MEN1 |
|
|
what are the 4 types of gastric polyps
|
1. inflammatory.hyperplastic polyps
2. gastritis cystica 3. fundic gland polyps 4. gastric adenomas |
|
|
gastric vs duodenal ulcer
pain related to meals risk of cancer |
gastric: Greater pain with meals, increased risk of carcinoma,
Duodenal: Decreased pain with meals, increased risk of cacner |
|
|
gastric mucosal polyps
inflammatory fundic adenomatous what are the risk factors and association with gastric adenocarcinoma |
the adenomatous are the only ones assoicated with cancer
|
|
|
inflammatroy & hyperplatic gastric mucosal polyp
|
most common
associated with H pylori gastritis, NOT associated with cacner |
|
|
fundic gland gastric polyp
|
benign, increasing frequency bc of PPI use
can occur in familial adenomatous polyposis |
|
|
what syndromes are assoicated with hamartomatous gastric mucosal polyp
|
cowden syndrome
peutz Jeghers syndrome |
|
|
whats peutz jeghers syndrome
|
associated with hamartomous gastric polyp, benign
AD- LKB1 germline mutation buccal mucosa gets pigmented |
|
|
tell me about gastric adenomas
|
ALWAYS arise with chronic gastritis, atrophy, intestinal metaplasia
increased incidence in FAP PREMALIGNANT get intestinal columnar epithelium pedunculated poyp |
|
|
what is a pedunculated polyp
|
its a gastric adeno polyp, can develop into adenocarcinoma
*8the only gastric polyp with risk of cacner development |
|
|
adenoma of the stomach is also called what
|
adenocarcinoma = GASTRIC CARCINOMA
most common can be: 1. intestinal type 2. diffuse, signet ring, type |
|
|
what are 4 types of gastric cancer
|
1. gastric carcinoma= adenocarcinoma. most common. can be intestinal type of diffuse (signet ring) type
2. MALT lymphoma 3. GIST- GI stromal tumor 4. Carcinoids and more |
|
|
where is gastric carcinoma common
|
in japan, chile, costa rica, russia
low in US |
|
|
what is the pathogenesis of gastric adenocarcinoma, the intestinal type
|
1. H pylori
2. Diet- nitrates, salted means, pickled veggies 3. cigs 4. low acids **overall is not super common in US, more common in china areas * |
|
|
what genes are associated with...
1. diffuse gastric carcinoma 2. intestinal type gastric carcinoma 3 |
1. diffuse: BRCA2, E cadherin
2. intestinal: APC gene (FAP), microsatellite instability, TGFb mutation H pylori also will cause it |
|
|
tell me about prognosis of gastric adenocarcinoma
|
1. depth of invasion
|
|
|
whats the macroscopic morphology of gastric adenocarcinoma
|
1. depth of invasion (tells about prognosis more than any other)
- Early: wont invade muscularis - Late: through submucosa into mm |
|
|
where is gastric carcinoma located
|
lesser curvature
classified based on how DEEP |
|
|
A 62 y/o has had persistent nausea for 5 yrs.
with occasional vomiting. On upper gastrointestinal endoscopy, a small area of gastric mucosa is noted in the fundus, which has loss of rugal folds. A biopsy reveals a welldifferentiated adenocarcinoma confined to the mucosa. Upper GI endoscopy 5 yrs. previously showed gastritis with presence of Helicobacter pylori. Which of the following best characterizes this patient’s neoplasm? A. Following resection, a 5 year survival rate of greater than 90%. B. High incidence in the United States C. Characterized by linitis plastica D. Metastases limited to regional lymph nodes E. On light microscopy, a signet ring pattern |
on light microscopy there is a signet ring pattern
Linitis plastica: ADVANCED intramuscular growth prodiced rigid leather bottle **diffuse gastric carcinoma |
|
|
a gastric carcinoma has NOT penetrated the muscularis, is this early or late or can you not tell
|
early
**depth of invasion is MOST important factor to determine prognosis **late infection does affect muscularis |
|
|
linitis plastica
|
ADVANCED intramuscular growth of gastric carcinoma, prodices a rigid "leather bottle"
recall the depth of invasion detemines prognosis, its late when it gets into mucsularis flat or depressed area in advanced gastric cancer |
|
|
A 62 y/o has had persistent nausea for 5 yrs.
with occasional vomiting. On upper gastrointestinal endoscopy, a small area of gastric mucosa is noted in the fundus, which has loss of rugal folds. A biopsy reveals a welldifferentiated adenocarcinoma confined to the mucosa. Upper GI endoscopy 5 yrs. previously showed gastritis with presence of Helicobacter pylori. Which of the following best characterizes this patient’s neoplasm? 61 A. Following resection, a 5 year survival rate of greater than 90%. B. High incidence in the United States C. Characterized by linitis plastica D. Metastases limited to regional lymph nodes E. On light microscopy, a signet ring pattern |
**signet ring
linitis plastica penetrates past mucosa into muscularis |
|
|
compare signet ring gastric carcinoma and intestinal pattern
|
Intestinal Type: mucin in lumen of malignant glands, M>W, 55 yo. Arises in chronic gastritis like H pylori
Signet ring: infiltrating SINGLE cells, no glands. Mucin in CYTOPLASM. M=F, <50 yo. de novo, NO gastritis or H pylori, decreased E cadherin, aggressive |
|
|
does this describe intestinal type or signet ring type gastric carcinoma
forms glands with mucin M>F 55 yo arises in chronic gastritis/H pylori |
intestinal type
malignant type |
|
|
does this describe intestinal or signet ring type gastric carcinoma
M=F, <50 yo, NO previous H pylori or gastritis, infiltrating single cells, MUCIN in cytoplasm decreased E cadherin, aggressive |
signet ring cell
normal glands recall the intestinal was M>F, mucin in glands, happens after H pylori or chrinic gastrits |
|
|
how does gastric carcinoma spread
what are the sites of distant METS |
mucosa --> invation into muscularis, serosa --> mets to regional nodes --> duodenum, pancreas, retroperitoneum,
mets to peritoneal seeding and mets to liver and lungs |
|
|
whats the prgonisis of gastric carcinoma
|
METS to liver and lungs
|
|
|
BA is a 50 y/o female underwent a partial
gastrectomy in June for adenocarcinoma of the stomach. It was signet ring cell type, invasive through the muscularis with metastases to one lymph node • Prior to surgery she had chronically taken Zantac for symptoms of dyspepsia. Preoperative weight was 300 pounds. • Symptomatic improvement following surgery was brief. She developed emesis in September consisting of food w/o bile. She eventually vomited after every meal; lost 65# by Nov. • Gastric outlet obstruction due to ulcerated recurrent gastric adenocarcinoma was diagnosed by endoscopy. • Liver metastases were seen on CT. Patient survived less than 1 month. • What was her stage at surgery and how did that impact her clinical course? |
mets to 1 LN- stage ??
|
|
|
ok so gastric cancer spreads to liver and lings. what are the other distant mets
|
1. Virchows Node- mets to supraclavicular node
2. Sister Mary Joseph- mets to periumbilical 3. Krukenberg- metastatic signet ring adenocarcinoma to ovaries. usually from gastric primary |
|
|
what can be the first sign of gastric cancer
|
the mets to supraclavicular area, Virchows node
Sister mary Joesph- mets to periumbilical Krukenberg- mets of signet ring to ovaries |
|
|
Virchows
Sister Mary Joesph Krukenberg |
distant areas of gastric carcinoma METS
Virchows- mets to supraclavicular node Sister Mary Joesph- mets to periumbilical Krukenberg- signet ring mets to ovary |
|
|
what is gastric cancer mets to the belly button called
|
sister mary joesph nodule
virchow- supraclavicular krukenberg- ovaries |
|
|
what are the sx of gastric cancer
|
1. insidious onset
2. anemia, blood loss, Fe deficit 3. Epigastric pain/Back pain 4. weight loss 5. NV anorexia 6. change in bowel |
|
|
your pt comes in with insidious onset of epigastric pain, weight loss, NV anorexia, changes in bowel, anemia
|
gastric carcinoma
|
|
|
is MALT lymphoma common
|
ya, stomach is a common site of extranodal lymphoma
|
|
|
whats the immunophenotype of gastric MALT lymphoma
|
B cell lymphoma, associated with H pylori
treat with AB but the MALToma is unresponssive to AB **1 of 3 translocations, can progress to large B cell lym CD19 Cd20 NO Cd5 or CD10 |
|
|
what does gastric MALT lymphoma look like, gross and micro
|
its a B cell lymphoma
lots of B cell infiltrate |
|
|
what is gastric MALToma associated with
|
h pylori
treat with AB but it wont help the MALToma |
|
|
what type of gastric cancer is assoicated with CD19 CD20 and NO Cd5 or CD10
|
maltoma
|
|
|
how does MALToma present
|
dyspnea, epigastric pain
hematemesis, melena, Fe deficit anemia, fever, chills, weight loss |
|
|
what are the causes of gastric perforation
|
1. dilations can perforate (dilate bc of outlet obstruction, paralytic ileus)
2. spontaneous- newborns, severe vomit, resucitation, carbonated beverages |
|
|
what is a bezoar
|
ball of foerign material that was awallowed
|
|
|
A previously healthy 18‐y/o woman c/o
5‐mon. history of pain in the LUQ of the abdomen, abdominal distention, postprandial emesis, and weight loss of 18 kg. PE revealed a firm, tender, epigastric mass but was otherwise unremarkable. CT showed a large gastric mass extending from the fundus to the antrum (Panel A, arrow), with no indication of obstruction of the gastric outlet. On questioning, the patient stated that she had a habit of eating her hair for many years a condition called trichophagia. Owing to the large size of the trichobezoar (37.5 by 17.5 by 17.5 cm), it was removed surgically. She regained 9 kg and stopped eating hair. |
trichobezoar
dont eat foerign objects |
|
|
A 4 y/o girl with intermittent bilious emesis
for 2 wks. • No weight loss; change in bowel or bladder habits. • She was noted to frequently pull at and eat her hair. • PE: Firm mass RUQ of abdomen, • Upper GI series was ordered. |
bezoar occupies stomach
trichobezoar- hair ball |
|
|
retroperitoneal organs
sad pucker |
Suprarenal glands
Aorta Duodenum Pancreas Uterus Colon Kidney Esophagous Rectum |
|
|
what odes this BV supply
1. Celiac 2. SMA 3. IMA |
1, celiac- duodenum
2. SMA- prox jejunum to prox transverse colon 3. IMA- distal transverse colon to midrectum *lots of anastamoses |
|
|
what does this supply
1. Superior Hemorrhoidal Artery 2. Inferior Hemorrhoidal 3. collaterals |
1. Sup hemorrhoidal- branch of IMA, supplies upper rectum
2. Inferior hemorrhoidal- branch of pudendal, supplies lower rectum 3. Collaterals- mesenteric to celiac superiorly, mesenteric to pudendal inferiorly |
|
|
WHAT SUpplies the upper and lower rectum, waht are they branches of
|
1. Upper- superior hemrrhoid, branch of IMA
2. Lower- inferior hemorrhoidal, branch of pudendal |
|
|
what veins drain to portal circulation
|
SMV
IMV |
|
|
1. gastrochisis
2. omphalocele 3. heterotopia, ex 4. atresia, common location 5 congenital pyloric stenosis 6. imporforate anus |
1. gastrochisis- intestine stick out of umbilical cord
2. omphalocele- abd wall mm fails, herniation of guts into membranous sac 3. heterotopia, ex. right tissue, wrong place. pancreas and gastric mucosa is common 4. atresia, common location. complete obstruction. duodenum 5 congenital pyloric stenosis: male, new onset regurg and projectile vomit, palpable olive 6. imporforate anus- failure of cloacal membrane to rupture |
|
|
heterotopia
hamartoma |
heterotopia- right stuff, wrong place
hamartoma- right place, wrong configuration |
|
|
whats the embryo, morph and complications of meckel diverticulum
|
embryo: failure of involution of vitiline duct
2-2-2: 2 inches, 2 feet from ileocecal, 2% OF ppl heterotopias are common true diverticulum: all layers affected |
|
|
what is a failure of involution of vitelline duct
|
meckles diverticulum
*2% of pop, 2 feet from ileocecal valve, 2inches *true diverticulum |
|
|
what is the micro of meckles diverticulum
|
gastric
|
|
|
what are some clinical features of meckle diverticulum
|
1. incidental finding during other surgery
2. appendix on teh Left side 3. peptic ulcers- bleed, perforation 4. intussusception, volvulus 5. fistula to umbilicus |
|
|
A two year old boy y y was admitted to the ER c/o
abdominal pain and vomiting. There had been no bowel movements for more than 48 hours. • There was fever and tachycardia. The abdomen was distended and tympanic to percussion and there were no bowel sounds • Flat plate x‐ray of the abdomen revealed gasfilled dilated loops of intestine. • Before abdominal exploration could be scheduled, the child died. What is the underlying pathology? |
megaclon- no innervation to the sigmoid colon
|
|
|
what are hte clinical features of aganglionic megacolon
|
aka hirschprung disease
*no ganglion cells in the colon, fx obstruction and dilation proximal to obstructed area M>F, failure of neural crest migration |
|
|
what is hirsprung disease
|
aganglionic megacolon
**no ganglion cells so you have a blocked segment, and dilated proximal to this M>F, common in Downs failure of neuroal crest migration |
|
|
what is the pathogensis of aganglionic megacolon (hirsprung)
|
ffailure of neural crest migration
RET gene mutation **common to have constipation and NO meconium **more commin in kids with downs syndrome |
|
|
a kid who never passed meconium and is constipated has an embryonic failure of what
|
neural crest migration
**absent ganglion cells, affected segment is narrow, megacolon refers to the proximal part of colon that dilates- this megacolon HAS ganglion cells |
|
|
what are some clinical features of aganglionic megacolon
|
can be a short or long segment
failure to pass meconium, constipation with intermittent diarrhea. abd distension complications- toxin megacolon, enterocolitis **no ganglion in the affected segment but the other segments do have ganglion. failure of neural crest to migrate (RET gene) |
|
|
what are the causes of acquired megacolon
|
acquired- secondary cause
1. Chagas, also causes cardiomyopathy 2. mechanical obstruction 3. drugs 4. toxic megacolon- due to inflammation or infection of colonic wall |
|
|
what does chagas lead to
|
1. cardiomyopathy
2. acquired megacolon |
|
|
what is toxic megacolon
|
complication of megacolon, associated with infection/inflammation
causes: UC, chrons, Infective enterocolitis, narcotics *colon dilates >6cm |
|
|
UC, chrons (colonic) and infective enterocolitis can cause what
|
toxic megacolon
|
|
|
whats ileus
|
bowel obstruction, sm intest common
abd pain, distension, vomit, constipation/obstipation, wont fart |
|
|
what causes mechanical ileus, what are the consequences
|
mechanical ileus: 1. ischemia --> perforation/bacterial invasion of ischemic bowel --> peritonitis, septicemia, septic shock, death
can also have pseudo obstruction: after surgery, infarct, neruopathies like hirchsprung |
|
|
what is teh constellation of abd pain and distension, vomit, constipation/ostipation, and no gas pass called
|
ileus
can be an obstruction or pseudo-obstruction |
|
|
what are 4 causes of intestinal obstruction
|
1. hernia
2. adhesions 3. intususseption 4. volvulus recall obstruction causes ileus (pain, distension, vomit, constipation) ileus causes ischemia, ischemia leads to bowel infection and perforation |
|
|
A 64-year-old woman who had no known medical conditions or
surgical history presented with a 2-day history of epigastric fullness and vomiting. Abdominal radiography showed a hyperdense lesion with calcified margins in the right upper quadrant (Panel A, arrow).Upper gastrointestinal series was performed with the use of barium contrast material. It showed a fistulous communication between the gallbladder and the duodenum, with multiple filling defects in the jejunum (Panel B, arrows). What are the symptoms of intestinal obstruction? |
gall stone illeus
abd pain, distension, vomit, no pooping or gas things that block: intusussception, hernia, volvulus, adhesion, gallstones The patient underwent surgery with successful cholecystectomy, closure of the cholecystoduodenal fistula, and removal of three gallstones in the jejunum. She had an uneventful recovery with no complications |
|
|
• A 56 y/o man seeks medical attention for
inguinal “achiness”. He states that it has been present for 3 months. The gross appearance is illustrated Bowel sounds are auscultated over the area of bulging. • What is the diagnosis? • Is this direct or indirect? |
hernia, indirect ingunal hernia
|
|
|
A 40 y/o man has a 2 day history of nausea,
vomiting and left lower quadrant pain. On PE, his abdomen is distended with high pitched bowel sounds. Pain is elicited on palpation of the left inguinal region. His lower abdominal CT is shown. • What is your Dx? • What is the pathogenesis? • What complications can occur? |
abd hernia
|
|
|
whats an abd hernia
where is it common what are the complications |
PERITONEUM lined hernia through abd wall
location: inguinal, femoral, umbilicus, surgical scar, sm intestine is common complication: incarceration (in jail), strangulation, infarct, perforation |
|
|
is an inguinal hernia abdominal
|
yep, peritoneum lined
|
|
|
what are the causes and complications of adhesions
|
1. after surgery, peritonitis perforated viscus, endometriosis
consequences: herniation, obstruction, strangulation |
|
|
can you have a small bowel obstruction with infarct from a surgery tht was a long time ago
|
OH YA!
|
|
|
what is intususseption
what are the complications and clinical features tx |
gut is swallowed INTO adjacent piece of bowel
spontantous in kids, rotavirus, lipoma of ileocecal valve, adenocarcinoma (cancers) cause: obstruction, infarction, red currant stool. enema can reduce it can be colocolic or ileocolic tx with surgry or BE |
|
|
is intusucception always a surgical abdomen? what does x ray look like
|
nope, an enema can pull it out
looks like a hole |
|
|
you pt has a known ileocecal valve, they now have red currant jelly stool. what happened
|
got intussucption
|
|
|
what tpye of ileus is associated with cancer
|
cancers can cause intussuception which leads to ileus
|
|
|
whats volvulus
where is it common what are the complications |
volvus: complete twisting of bowels at mesenteric base
common: sigmoid, cecum, small intestine complications: intestinal obstruction, infarction |
|
|
what are all of the causes of intestinal perforation
what are the consequences of peforation |
causes:
foerign body, ulcers/inflammation: appendicitis, diverticulitis, ischemia- infarct, volvulus, strangulated hernia tumor megacolon trauma/surgery consequence: PERITONITIS |
