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107 Cards in this Set

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Crohn Dse
-Discontinouse involvement of the intest. mucosa visualized as a "String Sign" on x-ray
Persistent projectile vomiting usually appearing in the 2nd-3rd wk of life
Congenital Hypertrophic Pyloric Stenosis
Difficulty swallowing due to increased tone of the lower esophageal sphincter
-can be caused by destruction of the myenteric plexus in Chagas disease
Right lower quadrant pain, nausea, fever, and an elevated WBC
Acute Appendicitis
Serotinin elaboration causing flushing, diarrhea, bronchospasm, and right heart damage
Carcinoid Syndrome
-carcinoid tumors of the appendix & rectum rarely metastasize
Increased CEA(Carcinoembryonic Antigen)
Carcinoma of the colon
-risk factor includes low fiber diet
Barrett esophagus is the only recognized precursor
Esophageal Adenocarcinoma
-Barrett esophagus=squamous to columnar metaplasia(specialized, intestinal type epitheliun)in the distal esophagus
Fatigue,weakness,& iron deficiency anemia in the older males
Carcinoma of the right colon
Presents early as obstruction & crampy dicomfort
Carcinoma of the rectosigmoid colon
Malabsorption that resolves upon withdrawal of wheat gliadins from the diet
Celiac Sprue
-Histologically characterized as flattening of the mucosal villi w/ inflammatory infiltrate
Weakness in the peritoneal wall allowing protrusions of bowel segments
Can rupture producing massive hemorrhage into the esophageal lumen
Esophageal Varices
-often assoc. w/ portal hypertension, as in cirrhosis
Cobblestone appearance of the bowel mucosa
Crohn disease
-caused by inflammation & thickening of all 3 layers of the GI wall
Small sac-like outpouchings of the colon through the muscular wall, common in the elderly
-most commonly asymptomatic
Signet Ring Cells
Gastric carcinoma, diffuse variant
-extensive infiltration of malignant cells can lead to linitis plastica or "leather bottle stomach"; matastasis bilaterally to the ovaries results in Krukenburg tumors
100% chance of colon cancer by midlife
Familial polyposis syndromes
-caused by autosomal dominant mutations in the APC gene w/ hundreds of adenomatous polyps carpeting the intestines
Pseudomembranes consisting of fobrin, mucin, & inflamatory debris covering the colonic mucosa
Pseudomembranous Colitis
-caused by elaboration of exotoxins by Clostridium difficile
Congenital absence of ganglion cells in the muscular or submucosal layers of the GI wall
Hirschsprung disease(congenital megacolon)
-absence of ganglion cells is in the nondilatedregion of the colon
Telescoping of one intestinal segment into another, usaully in children
Most common & innocuous congenital abnormality in the GI
Meckel diverticulum
-failure of involution of the vitelline duct
Sharply punched out lesions in the stomach or duodenum
Peptic Ulcer
-assoc. w/ NSAID use & Helicobacter pylori
Autosomal dominant disorder w/ multiple benign hamartomatous polyps & melanin pigmentation of the oral mucosa, hands, & genitals
Peutz-Jegher Synd.
Recurs often & is difficult to completely resect bec. of proximity of the facial nerve
Pleomorphic adenoma(mixed tumor of the salivary gland)
-most common salivary tumor
Toxic megacolon is a complication
Ulcerative colitis
-destruction of the neural plexus leading to massive dilation, gangrene, & imminent rupture of colon
Ulcerative Colitis
-regenerating mucosal areas in the ulcerated mucosa & submucosa
Absorption of H2O
Secondary to solute absorption, isosmotic in small intestine & gallbladder(similar to renal proximal tubule)
Secretion of electroytes & H2O by the intestine
Crypts(secretory mech.) & Villi(absorptive mech.); Cl-(primary ion secreted)is transported via Cl channels regulated by cAMP~Na+ passively follows Cl-~H2O follows NaCl to maintain isosmotic condition
Mech. of action of Vibrio cholera(cholera toxin) in causing diarrhea
Cholera toxin binds to luminal memb. receptors(crypt cells)~activates adenylate cyclase(basolateral memb.)~ inc. cAMP~opening of Na channels in luminal memb.~Na & H2O follow Cl(secretory diarrhea)
Digestion & absorption of lipids
In stomach(mixing,lingual lipase digestion, gastric emptying slowing by CCK)~in small intestine(emulsification of lipids by bile acids,pancreatic lipase digestion,solubilization of hydrophobic lipids in micelles by bile acid)~diffusion of F.A,monoglycerides, cholesterol(except glycerol) into the cell~reesterification back to original form~w/ apoprotein form chylomicrons~ transported to lymph vessels
Funct. & innervation of the extrinsic(parasympathetic & sympathetic NS) system on the GI tract
Parasym.:excitatory via the vagus (esophaghus,stomach,pancreas,upperlarge intest.)& pelvic nerve(lower large intest.,rectum,anus); Symp:inhibitory, T8-L2,preganglionic cholinergic synapse in prevertebral ganglia, postganglionic adrenergic synapse in myenteric & submucosal plexus.
Malabsorptive disorder in lipids due to lack of apoprotein B w/c results in inability to transport chylomicrons out of the intestinal cell
Mech. of action of hypersecretion of gastrin & bact. overgrowth in causing malabsorption of lipids
Gastrin hypersecretion(low duodenal pH inactivates pancreatic lipase); Bact. overgrowth(deconjugation of bile acids leading to early absorption in the upper small intestine~depleting the availability of bile acids to aid in lipid absorption
Most common neoplasm of the western world occuring often in 6th-7th decades w/c provide a "model of tumor progression"
Adenocarcinoma of colon & rectum
-assoc w/ inc. CEA(useful for following the course of the dse. rather than for diagnosis)
Four mech. in Na+ is absorbed into the intestinal cells,across the luminal memb.,& down its electrical gradient
1)passive diffusion(colon;inc. by aldosterone) 2)Na-glucose or Na-A.A cotransport(small intestine) 3)Na-Cl cotransport 4)Na-H exchange(small intest.)
-Na+ is transported out of cell via Na-K pump
Absorption & secretion of K+
Absorbed by passive diffusion via paracellular route in the small intestine; secreted in colon
-aldosterone & diarrhea(flow rate dependent mech) inc. K+ secretion
1 of 5 pancreatic protease enzymes (trypsin,chymotrypsin,elastase, carboxypeptidase A,carboxypeptidase B) w/c is 1st activated by enterokinase to its active form, then is used to convert the other 4 enzymes
Trypsinogen to trypsin
-after the enzymes are finished digesting, they degrade each other & are absorbed along w/ the dietary proteins
Predisposing factors of Adenocarcinoma of the colon & rectum
Adenomatous polyps,inherited mutiple polyposis synd.,long-standing ulcerative colitis,genetic factors,low fiber & high animal fat diet
Funct. & innervation of the intrinsic(enteric nervous system)system
Coordinates & relays inf. from the extrinsic innervation to the GI tract; uses local reflexes to relay inf. w/in the GI tract;controls motility(Myenteric plexus,Auerbach's plexus) & secretion(Submucosal plexus,Meissner's plexus) even in the absence of extrinsic innervation
Four GI hormones released from the endocrine cells in the GI mucosa
Gastrin(G cells), Cholecystokinin(I cells of duedenum & jejunum), Secretin(S cells of duedenum), GIP(duedenum & jejunum)
Effect of your gastric hormones (gastrin,CCK,secretin,GIP)
Gastrin(inc. H+ secretion & growth of gastric mucosa),CCK(stimulate gallbladder contraction,relaxation of sphincter of oddi,inc. pancreatic enzyme & HCO3 secretion,inc. exocrine pancreas/gallbladder growth,inhibit gastric emptying),Secretin(inc. pancreatic & biliary HCO3 secretion, dec. gastric H+ secretion),GIP(inc. insulin secretion,dec. gastric secretion)
Stimulus for secretion of the gastric hormones(gastrin,CCK,secretin,GIP)
Gastrin(peptides & A.A,distension of the stomach,vagus via GRP,ihibited by H+ in stomach),CCK(peptides & A.A,F.A), Secretin(H+ & F.A in duedenum),GIP(F.A,A.A,oral glucose)
Most potent stimuli for gastrin secretion
Phenylalanine & Tryptophan
Two types of paracrine hormones w/c are released from endocrine cells in the GI mucosa over short distances to act on tardet cells
Somatostatin(secreted in resp. to H+, inhibited by vagal stimulation, inhibits release of all GI hormone)
Histamine(secreted by mast cells,inc. gastric H+ secretion)
Enzyme w/c degrades lactose-glucose & galactose, trehalose-glucose, & sucrose-glucose & fructose
-degradation of disaccharide to monosaccharides
3 types of neurocrine hormones produced in neurons in GI tract w/c move down the axon accross the synaptic cleft to a target cell
Vasoactive intest. peptide(homologous to secretin,relaxes GI smooth muscle, stimulate pancreatic HCO3 secretion, inhibit gastric H+ secretion,mediates pancreatic cholera);GRP-bombesin(stimulates gastrin release); Enkephalins(stimulate GI contraction, inhibit intest. secretion,usefull in opiate tx. of diarrhea)
Difference betw. phasic & tonic contraction in the GI tract
Phasic(occurs in eophagus,gastric antrum,small intest.;contract & relax periodically);Tonic(occur in LES,orad stomach,ileocecal & iinternal sphincter)
The swallowing reflex is coordinated by what area of the brain?
Hormone w/c is a mediator for contracions(migrating myoelectric complex) during fasting
Type of food product in the stomach w/c may inc. gastic emptying time
High fat diet
-by stimulating release of CCK
GI disorder w/c occurs in periods of stress resulting in constipation(inc. segmentation contractions) or diarrhea(decr. segmentation contractions)
Irritable bowel Synd.
GI disorder charact. by absence of the colonic enteric nervouse system resulting in constriction of involved segment,marked dilatation & accumulation of intest. contents proximal to constriction, & constipation
Megacolon(Hirschsprungs's Dse)
Major charact. & fxn. of saliva
Fxn.(starch & triglyceride digestion, lubrication,protection); Charact.(high HCO3&K+,hypotonic,alpha-amylase(ptyalin)for starch digest.,lingual lipase for triglyceride digest.)
Parasympathetic(CN VII & IX) regulation of salivary secretion
Transport of ACH to muscarinic recptors on acinar & ductal cells~ activation of second messanger(IP3 & inc. intracellular Ca+)
-inhibited by atropin
Sympathetic regulation of salivary secretion
Release of NE to Beta-receptors~avtivation of second messanger(cAMP)
3 major glands w/c produce saliva
Submaxillary,Parotid,Sublingual glands
One of the 4 types of enzymes(endopeptidase,exopeptidase,pepsin, pancreatic protease)w/c degrade proteins for absorption & is only effective in the stomach w/ a pH of 1-3
-secreted as pepsinogen from chief cells & activ. to pepsin by H+
Mech. for gastric H+ secretion in the parietal cells
CO2=H2O--H2CO3--(H+)+HCO3~secretion of H+ via H,K-ATPase into the stomach w/ Cl-,HCO3 absorb into the bloodstream via Cl-HCO3 exchange;omeprazole blocks H+ secretion by inhibiting H,K-ATPase
Mech. of action in metabolic alkalosis caused by vomitting
Gastric H+ never arrives in the small intestine to stimulate pancreatic HCO3 secretion causing art. bld to become alkaline
Stimulation of of gastric H+ secretion via direct pathway
Vagus nerve innervates parietal cells via ACh on muscarinic receptors~ activation of second messsanger (IP3,Ca+)~stimulation of H+ secretion
-inhibited by atropine
Stimulation of gastric H+ secretion via indirect pathway
Vagus nerve innervates G cells~gastrin secretion~activation of neurotransmitter(GRP)~H+ secretion
-vagotomy eliminates both direct & indirect pathways
Stimulation of gastric H+ secretion by Histamine
Released from mast cells~stimulation of H2 receptors on parietal cells~ activation of 2nd mess.(cAMP)~H+ secretion
-Cimitidine inhibit H+ secretion by blocking H2 receptor
Neg. feefback mech. w/c inhibit the secretion of H+
Low ph(<3) in the stomach; Chyme in the doudenum via GIP(due to F.A in the duodenum) & secretin(due to H+ in the duedenum)
Gastrin secreting tumor of the pancrease w/c causes inc. H+ secretion
Zollinger-Ellison Synd.
-inc. H+ has no neg. feedback effect on the pancreatic tumor
Composition & formation of pancreatic secretion
Composition(high HCO3 conc.,isotonic, lipase,amylase,protease,Na & Cl- at low flow rates,Na & HCO3 at high flow rates); Formation(prod. by acinar cells of exocrine pancreas;later modified by ductal cells)
Regulation of pancreatic secretion
Secretin(S cells of duodenum) in response to H+ in duodenum~inc. HCO3 secretion from pancreatic ductal cells; CCK(I cells of duodenum) in response to peptides,A.A,F.A in duodenum~inc. secretion of amylase,lipase,proteases; potentiates secretin secretion of HCO3; ACh(via vagovagal reflex)stimulated by H+,peptide,A.A,F.A in duodenum~ stimulate acinar enzyme secretion; potentiate secretin HCO3 secretion
Pancreatic secretion disorder resulting in a defective Cl- channel w/c results from a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR)
Cystic fibrosis
-def. of pancreatic enzymes resulting in malabsorption & steatorrhea
Component in bile w/c is amphipathic helping it aid in the digestion & digestion of lipids by emulsifying & solubilizing them into micelles
Bile salts
Formation of bile
In hepatocytes, primary bile acids(cholic acid,chenodeoxycholic acid) synthesized from cholesterol~in intestine,converted to secondary bile (deoxycholic acid,lithocolic acid) by bact.~conjugated w/ glycine&taurine to form bile salt~added w/ electrolytes & H2O in gallbaladder & concentrated
Mech. in w/c ileal resection results in steatorrhea
Occur due to bile acid not being able to absorbed & recirculated back to the liver depleting the bile acid pool impairing fat reabsorption
Products of Carb.,protein,lipids in w/c they can be absorbed through the small intest.
Carb.(monosccharides:glucose,galactose, fructose), proteins(A.A,dipeptides, tripeptides), lipids(F.A, monoglycerides, cholesterol)
Vascular dse. of the colon w/c is a common cause of unexplained lower bowel bleeding
-tortuous dilatation of small vesels spanning the intestinal mucosa or submucosa often involving the cecum or ascending colon
Inflammatory bowel dse. limited to the large intest. affecting the mucosa & submucosa w/ neutrophil infiltrates in the crypts of Lieberkuhn(crypt abscess) presenting as chronic bloody diarrhea w/ mucus
Ulcerative colitis
-complicated w/ toxic megacolon, perforation & carcinoma
Inflamatory disorder of the colon due to Entamoeba histolytica infection
Amebic colitis
-result in flask shape ulcers
Most common type of intest. adenomatous polyp w/c are small,pedunculated w/c may contain a malignant foci
Tubular Adenomas
-greater % of malignancy w/ larger polyps
An intestinal adenomatous polyp w/ the highest potential for malignancy(>30%)
Villous Adenomas
-10% of adenomatous polyps charact. by large #'s of finger-like villi
3 types of Multiple polyposis synd. w/c are assoc w/ greatly inc. risk of malignant transformation
Familial polyposis(almost 100% risk of malignant transformation), Garder Synd.(adenomatous polyps w/ osteomas & soft tissue tumors), Turcot Synd.(adenomatous polyps w/ tumors of CNS)
An autosomal dominant neoplasia charact. by pituitary,thyroid, parathyroid,adrenal cortical, & pancreatic islet cell adenomas or hyperplasia assoc. w/ hypergastrinemia & peptic ulcer
Multiple Endocrine Neoplasia(MEN)Type I(Wermer synd)
Vit. deficiency w/c may result from a gastrectomy
Vit. B12 def.
-instrinsic factor(released from parietal cells) is needed for vit.B12 absorption in the ileum; leads to pernicious anemia
Vit. produced in the kidney needed for absorption of Ca+ in the small intestine
Vit.D(1,25 dihydroxycholecalciferol)
-Vit.D def. or chronic renal failure results in inadequate Ca+ absorption~ rickets(children) & osteomalacia(adults)
Absorption of Iron
Absorbed as heme iron or free Fe+ in small intestine~heme is degraded to release free Fe+~free Fe+ binds to apoferritin & transported into bld. circulation~binds to transferrin w/c transport free Fe+ to storage sites(liver)~transported to bonemarrow for hemoglobin synthesis
Severe gingival infl. occuring in immune compromised px. due to symbiotic bact. infection (Fusobacterium & Borrelia vincentii)
Acute necrotizing ulcerative gingivitis(trench mouth,Vincent infection, fusospirochetosis)
Most common benign epithelial tumor of the oral mucosa(tongue,lips,gingivae, buccal mucosa)
Most common odontogenic tumor; a hamartoma derived from odontogenic epithelium & odontoblastic tissue
Malignant tummor,commonly squamous cell carcinoma, w/c involves the tongue 50% of cases & is assoc. w/ tobacco & alcohol abuse
Oral cancer
An autoimmune dse. of the salivary gland characterized by keratoconjuctivitis sicca,xerostomia, assoc. w/ a connective tissue dse.(rheumatoid arthritis)
Sjögren Synd.
-assoc. w/ inc. incidence of malignant lymphoma
Most common variant of tracheoesophageal fistula w/c leads to copious salivation assoc. w/ choking, coughing, & cyanosis during food intake
Lower portion of esophagus communicates w/ trachea near the tracheal bifurcation;uppeer esophagus ends in a blind pouch
-assoc w/ polyhydramnios
3 locations for an esophageal diverticula(pulsion-false or traction-true)
Above the upper esophageal sphincter(Zenker diverticulum); midpoint of the esophagus; above the lower esophageal sphincter(Epiphrenic diverticulum)
3 important causes of upper GI hemorrhage
Esophageal varices(dilated submucosal veins due to portal HPN), bleeding peptic ulcer,Mallory-Weiss Synd.(bleeding from esophagogastric laceration due to severe retching
A columnar metaplasia of esophageal squamous epithelium due to long standing gastroesophageal reflux
Barret Esophagus
-precursor of esophageal adenocarcinoma
A chronic inflammatory condition of unknown etiology affecting the distal ileocecum,small intest.,or colon often people in there 2nd-3rd decade of life
Crohn dse
-can lead to carcinoma of the small intest. or colon(although more common in ulcerative colitis
Morphology of Crohn dse.
Transmural involvement,thickening of involve segment,linear ulceration, cobblestone appearance,skip lesions, noncaseating granulomas,submucosal fibrosis
Clinical manifestation of Crohn dse
Abd. pain,diarrhea,malabsorption,fever, obstruction due to fibrous stricture, fistulas betw. loops of intestine & betw. the intest.,bladder,vagina,skin
Malabsorption synd. most commonly affecting the small intest. w/ arthralgia,cardiac,neurologic sympt. showing PAS-positive macrophages in intest. mucosa
Whipple Dse.
-visualization of Tropherma whippelii bacilli on electron microscopy
Common types of malabsorption synd.
Celiac Dse(gluten sensitivity),Tropical sprue(infectious origin),Whipple Dse(PAS-positive macrophage in intest.mucosa),Disaccharidase def.(lactase def. most common), Abetalipoproteinemia(def.apoprotein B), Intestinal lymphangiectasia(protein loss~hypoproteinemia & edema)
Common malignant tumors of the small intest.
Adenocarcinoma(common primary tumor), Carcinoid(most common in the appendix), Lymphoma(present in malabsorption)
2 most common affected areas in ischemic bowel dse. resulting in mucosal,mural,transmural infarction often caused by atherosclerotic occlusion of atleast 2 major mesenteric vesels
Splenic flexure & rectosigmoid junction
-both lie in watershed areas(poor vascularized regions)
In carcinoma of the esophagus(adenocarcinoma & squamous cell),w/c type occurs most frequently in the upper middle 3rd of the esophagus?
Squamous cell
-as compared to lower 3rd(adenocarcinoma) w/c may also arise from barret esophagus;diffuse by local extension(trachea,bronchi,aorta)
Dse. of the stomach caused by hypertrophy of pylorus resulting in a palpable mass,gastric outlet obstruction(resulting in projectile vomitting at 1st 2weeks of life)
Congenital pyloric stenosis
-common in boys;corrected by surgery
An acute gastric ulcer assoc. w/ severe burns
Curling ulcer
-as compared to Cushing ulcer(assoc. w/ brain surgery)
Most common form of chronic gastritis assoc. w/ inc.gastric acid prod., gastric & duodenal ulcer,carcinoma of the stomach & gastric lymphoma of the mucosa-assoc. lymphoid tissue(MALT)type
Helicobacter pylori-assoc. gastritis
Dse. of the stomach characterized by hypertrophy of the gastric rugae & loss of plasma proteins from the altered mucosa
Ménétrier dse(giant hypertrophic gastritis)
Etiopathogenic mech. of gastric peptic ulcer are
1)H.pylori-mediated ulcer(bact. ureas & proteases break down epthelial protection in gastric mucosa); 2)Inc. H+ permeability resulting of back diffusion of H+ leading to injury; 3)Bile-induced gastritis leading to gastric ulceration
Malignant tumor of the stomach w/c occours often in males in there 50's, have bld. grp.A & are suspected of H.pylori inf., high nitrosamine diet,excessive salt & low fruit-veg. diet
Carcinoma of the stomach
-predisposed by achlorhydria & chronic gastritis
Characteristics of carcinoma of the stomach
Almost always adenocarcinoma;often involves the distal stomach;aggessive spread to adjacent organs & lymphatic metastasis(Virchow node-involvement of supraclavicular lymphnode;Krukenberg tumor-bilateral involvement of the ovaries,charact. by signet-ring cells)
Morphologic variant in carcinoma of the stomach assoc w/ H.pylori infxn. resulting in ulcers w/ irregular necrotic base & firm,raised margins
Intestinal type
-differentiated from peptic ulcer based on shape of ulcer;manifest as polypoid(fungating)carcinoma
Morphologic variant of carcinoma of the stomach not assoc. w/ H.pylori, charact. by thickened, rigid stomach wall, caused by diffuse infiltration of tumor cells w/ accompanying extensive fibrosis
Infiltrating or Diffuse carcinoma(linitis plastica,leather-bottle stomach)
Most common appendiceal neoplasm