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111 Cards in this Set
- Front
- Back
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What are five unique facts about the GI tract? |
(1)Open ended, (2)Mucosal layer is important for protecting the body, (3)GI tract is a tube and can thus be obstructed and dilate, (4)GI tract diseases can cause a large number of issues, (5) Movement of intestines depends on autonomic contraction of smooth muscles, (6)Large blood supply to GI tract, (7)Exposure to carcinogens in food |
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What makes the open ended GI tract unique? |
Readily accessible to bacteria and allergens. Normal intestinal flora – protective – destroyed by antibiotics (changes with age). Pathologic pathogens ex. Vibrio cholerae (Cholera). |
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What makes the mucosal layer of the GI tract important? |
Chancers. Ulcers. |
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What makes the shape of GI tract important? |
Mega colon (Hirshsprung’s)/mega esophagus (achalasia – spasm of the LES) |
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What are three diseases the GI tract can cause? |
(1)Loss of teeth, (2)Scleroderma causing dysphagia, (3)Malabsorption |
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How does the smooth muscle of the GI tract contract? |
Requires neural and hormonal control |
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Describe the blood supply to the GI tract. |
Arteries prone to atherosclerosis. Prone to hemorrhage or ischemia. |
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Upper GI bleeds – melena = |
Black tarry stool
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Rectal bleeding = |
Hematochezia
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What is a result of carcinogens in food? |
Carcinomas are common |
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What are general signs & symptoms gastric distress? |
(1)Nausea & Vomiting, (2)Anorexia, (3)Dysphagia, (4)Achalasia, (5)Heartburn, (6)Diarrhea, (7)Constipation, (8)Fecal incontinence, (9)Pain, (10)Pain |
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What is dysphagia? |
difficulty or discomfort in swallowing |
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What is achalasia? |
failure to relax smooth muscles of GI tract, esp LES contraction -- esoph dilation/dysphagia |
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What are four features of diarrhea? |
(1)Osmotic, (2)secretory, (3)exudative, (4) Increased transit time |
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What is hematemesis? |
vomiting bright red blood (esophageal laceration, GU) |
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What is hematochezia? |
fresh rectal blood (hemorrhoid, colon or rectal bleeding, cancer) |
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What is melena? |
black, tarry stool dt digested blood (upper GI) |
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What is a cleft lip? |
Congenital abnormality. Lack of fusion of the fetal nasal and maxillary processes that form the upper lip. |
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What parts of the GI tract can oral cancer affect? |
Lips, tongue, soft palate and/or any structure of the mouth |
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What are three risk factors for oral cancer? |
(1)Smoking, (2)Chewing tobacco, (3)Chronic alcoholism
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How does oral cancer present? |
Lasting more than 14 days: Leukoplakia - White, elevated plaque, Erythroplakia - Red plaque – different from surrounding mucosa, Ulcer, Crater, Nodule |
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What are three typical symptoms of esophageal diseases? |
(1)Dysphagia, (2)Esophageal pain, (3)Aspiration and regurgitation |
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What is dysphagia? |
Difficulty swallowing |
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Describe esophageal pain. |
Spontaneous muscular spasm. Retrosternal burning – heartburn. |
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What is congenital atresia? |
Developmental esophageal disease. Lack of lumen. Can also present with fistula to trachea (Abnormal connection between the esophagus and trachea). Food cannot pass into the stomach. Babies constantly vomit ingested milk (Constant hunger, Aspiration pneumonia) |
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What is a hiatal hernia? |
Displacement of cardiac portion of the stomach into the thoracic cavity through the diaphragmatic hiatus. Causes reflux of gastric juice into esophagus. |
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A hiatal hernia is the most common cause of: |
Gastroesophageal Reflux Disease |
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What is Gastroesophageal Reflux Disease? |
GERD. Inflammation of esophagus dt backflow of gastric contents. |
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What are six causes/risk factors for GERD? |
(1)weakened lower esophageal sphincter (LES), (2)gastric pressure or presence of gastric contents near gastroesophageal junction, (3)hiatus hernia (most common cause), (4)age, (5)diet, (6)abdominal pressure |
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What is the pathogenesis of GERD? |
Exposure of esophagus to stomach contents -- erosion and ulceration of mucous lining of esophagus -- inflammation(esophagitis). Can lead to Barrett’s esophagus |
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What are eight clinical manifestations of GERD? |
(1)A burning sensation in the chest (heartburn), sometimes spreading to throat, along with a sour taste in mouth, (2)Chest pain, (3)Difficulty swallowing (dysphagia), (4)Dry cough, (5)Hoarseness or sore throat, (6)Regurgitation of food or sour liquid (acid reflux), (7)Sensation of a lump throat, (8)Usually worse if lying supine or after large meal |
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What is Barrett’s Esophagus? |
Metaplasia. Abnormal change to lower esophagus – considered pre-cancerous (Stratified squamous epithelium changes to columnar epithelium with goblet cells). Risk factor for cancer --metaplasia of the normal squamous epithelium -- damage to DNA -- dysplasia -- adenocarcinoma of the esophagus |
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What is a risk factor for Barrett's esophagus? |
Chronic exposure to acid from the stomach - GERD |
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What are four signs/symptoms of Barrett's esophagus? |
(1)Frequent, long bouts of heartburn, (2)Dysphagia, (3)Vomiting blood (hematemesis), (4)Retrosternal pain |
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What is esophageal varices? |
Dilated sub-mucosal veins. Presents as copious hematemesis. |
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What are two causes of esophageal varices? |
(1)Cirrhosis of the liver, (2)Portal hypertension |
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What is Mallory-Weiss syndrome? |
Laceration of the small blood vessels at the gastroesophageal junction caused by tears in the mucosa that occur during strenuous vomiting. Most commonly in alcoholics. |
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What are the two types of gastritis? |
(1)Acute – erosive gastritis, (2)Chronic – non-erosive gastritis |
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What is erosive gastritis? |
Self limiting, short lived. Shallow mucosal defects in upper layer of epithelium. |
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What are five causes of erosive gastritis? |
(1)Shock – lack of blood flood -- ischemic mucosa -- susceptible to gastric juices, (2)Stress ulcers, (3)Drugs, alcohol, chemicals, (4)Aspirin, NSAIDS, (5)Bacteria (Helicobacter Pylori) (deterioration of the protective mucosal lining of the stomach -- erosion -- inflammation) |
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What are eight signs/symptoms of erosive gastritis? |
(1)appetite loss, (2)Indigestion, (3)black stools, (4)Nausea, (5)Vomiting, (6)bloody vomit that looks like used coffee grounds, (7)pain in the upper part of the abdomen, (8)a full feeling in the upper abdomen after eating. |
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What is non-erosive gastritis? |
Atrophic. Cause is unknown – sometimes immune mediated. Often in elderly. |
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What are six signs/symptoms of non-erosive gastritis? |
(1)upper abdominal pain, (2)indigestion or bloating, (3)nausea and vomiting, (4)Belching, (5)loss of appetite or weight loss, (6)Loss of intrinsic factor in immune cases (pernicious anemia) |
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What is a peptic ulcer? |
Chronic ulceration of the mucosa. Extends through entire epithelial layer and into muscularis. Can occur anywhere along GI tract. |
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What are the two most common places for a peptic ulcer? |
Stomach and duodenum. Duodenal 4x more common than stomach ulcers. |
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What is the etiology of a peptic ulcer? |
Exposure to gastric juices – decreased mucosal protection. Smoking and alcohol. Stress. H. pylori infection. NSAIDs. |
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What is the pathology of a peptic ulcer? |
Round, punched out ‘holes’ in the mucosa and deeper. No necrotic tissue as HCl keeps it ‘clean’. Sharp margins. Complications of chronic ulcers: hemorrhage, penetration – can erode the walls of duodenum and penetrate the pancreas, perforation – passage of intestinal contents into peritoneal cavity. |
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What are eight clinical features of a peptic ulcer? |
(1)Pain immediately after food (stomach); pain1-3 hours after a meal (duodenal), (2)Night pain, (3)Gnawing pain w/ cramping in epigastric area radiating to back, (4)Patient can point to site of max pain, (5)Pain alleviated by alkaline agents, (6)Nausea, vomiting, loss of appetite, (7)Melena, (8)Iron deficiency anemia |
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What is a gastric neoplasm? |
Carcinoma of the Stomach. 90% of all malignant stomach tumours. |
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What is the etiology of a gastric neoplasm? |
Nitrosamines – nitrates found in foods and other products that change form in acidic conditions (Beer, cheeses, pickling products, smoked foods, tobacco smoke, chewing tobacco) |
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What is the pathology of a gastric neoplasm? |
Most carcinomas are found at the distal stomach – all gastric cancers areadenocarcinomas. Begin as a mucosal lesion. Irregular shape, fuzzy margins with central ulcer. Metastasis to regional lymph nodes -- liver. |
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What are seven clinical features of a gastric neoplasm? |
(1)Nonspecific symptoms, (2)Often not diagnosed until advanced stage, (3)Inoperable, (4)Weight loss, anemia, weakness, (5)Vomiting, (6)Dysphagia, (7)Melena |
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What is a pyloric stenosis? |
Idiopathic narrowing or obstruction of pyloric sphincter |
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What is the cause of a pyloric stenosis? |
Can be congenital; in adults MCC = ulcer disease |
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What are the risks of pyloric stenosis? |
white males 4:1; family hx; stress in pregnant mom |
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What is the pathogenesis of a pyloric stenosis? |
hypertrophy & hyperplasia -- form nodule -- narrowed lumen -- partial obstruction of pyloric canal -- inflammation + edema -- complete obstruction |
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What are four signs/symptoms of a pyloric stenosis? |
(1)projectile vomiting & symptoms of malnutrition/electrolyte depletion, (2)lethargy, (3)weakness, (4)wasting |
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What is diverticulosis? |
Formation of diverticula – outpouchings of the intestinal wall. Solitary or multiple. Congenital or acquired. |
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Where is diverticulosis most common? |
Constipation
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What are five risk factors for diverticulosis? |
(1)Age – 40+, (2)Constipation, (3)Diet low in dietary fibre, (4)Connective tissue disorders that weaken colon wall, (5)Genetics |
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What is the pathology of diverticulosis? |
Weakening of intestinal wall. Chronic straining from constipation. Outpouchings are often obstructed with fecal matter. Bleeding. Perforation of diverticula. |
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What is a clinical manifestation of diverticulosis? |
usually asymptomatic, increased urge to defecate |
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What is diverticulitis? |
Inflamed diverticula. Pouches can trap food or feces – become infected. Usually sigmoid colon. |
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What is a clinical manifestation of diverticulitis? |
Severe abdominal pain in LLQ (s/t mid abdomen), radiates into back, constipation alternating with diarrhea, increased’d gas, painless rectal bleeding, may be fever. Eventual anemia |
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What are hemorrhoids? |
Aka. Piles. Varicosities of the anal and perianal region. |
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What are four risk factors of hemorrhoids? |
(1)Congenital and heredity predisposition, (2)Chronic constipation, (3)Prolonged sitting, (4)Portal hypertension |
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What are two clinical features of hemorrhoids? |
Rectal bleeding with bowel movement – note-normal coloured stool. Painful – especially external. |
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What is ischemic bowel disease? |
Includes several disorders that compromise blood flow through segments of the intestine. Chronic – d/t atherosclerosis – usually undiagnosed. Acute – high mortality (Thrombosis of the mesenteric arteries (usually also atherosclerosed) – transmural infarction) |
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What are six signs/symptoms of ischemic bowel disease? |
(1)pain/cramping in your abdomen, (2)blood in stool, (3)an urgent need to have a bowel movement, (4)diarrhea, (5)vomiting, (6)tenderness in the abdomen |
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What is inflammatory bowel disease? |
Crohn’s Disease and Ulcerative Colitis. Recurrent, chronic inflammation of the intestines. Ulcerative Colitis is 2x more common. |
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What is the pathology of inflammatory bowel disease? |
Both affect the same populations – most common in Caucasians. Peak diagnosis between 20-30 years old. Familial predisposition. Often similar mucosal changes, but many differences too. |
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What is Crohn’s disease? |
Inflammation (Terminal ileum and colon, Appendix). Segmental - May have areas of inflammation with areas of healthy tissue between. Shallow ulcers that overlie Peyer’s patches. Inflammation extends through the entire intestinal wall (formation of granulomas, fibrosis of muscularis and serosa). Thick and rigid intestinal wall. Mucosa has a cobblestone appearance. |
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What are five clinical features of Crohn's disease? |
(1)Diarrhea, (2)Abdominal pain, (3)Weight loss, (4)Constipation – later in disease progression, (5)Vitamin deficiency, anemia |
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What is ulcerative colitis? |
Inflammation (large intestine, diffuse, does not extend into the ilium). Limited to mucosa (looks like sandpaper, prone to bleeding, becomes pitted – pigskin on a football. Large ulcerations occur later in disease process (eave little healthy mucosa tissue) |
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What are eight clinical features of ulcerative colitis? |
(1)abdominal pain, (2)increased abdominal sounds, (3)bloody stools, (4)Diarrhea, (5)Fever, (6)rectal pain, (7)weight loss, (8)malnutrition |
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Four features of Crohn's disease vs. ulcerative colitis. |
(1)Skipped areas vs. Diffuse Inflammation (2)Entire thickness of intestine vs. limited to mucosa (3)Granulomas vs no Granulomas (4)Cobblestone appearance vs. wide ulcers and pigskin appearance |
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What is irritable bowel syndrome (IBS)? |
Most common disorder of the GI tract. Chronic non-inflammatory motility disorder affecting entire GI tract; women much more common than men. Aka: nervous indigestion, functional dyspepsia, spastic/nervous/irritable colon. |
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What are four risk factors for irritable bowel syndrome (IBS)? |
(1)emotional stress, (2)alcohol, (3)smoking, (4)certain foods can trigger |
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What is the pathology of irritable bowel syndrome (IBS)? |
“functional bowel disorder” -- no identifiable abnormality of the bowel (poss imbalance between SNS and PNS activity, abnormal intestinal contractions) |
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What are five clinical manifestations of irritable bowel syndrome (IBS)? |
(1)Abdominal pain or cramping – relieved by defecation, (2)A bloated feeling, (3)Gas, (4)Diarrhea or constipation — sometimes alternating bouts of constipation and diarrhea, (5)Mucus in stool |
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What is the cause of bacterial diarrhea? |
Bacterial toxins, colonization of bacteria or invasive bacteria -- tissue destruction |
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What is pseudomembranous colitis? |
Infectious disease with pseudomembranes on the surface of the intestinal mucosa |
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What is the cause of pseudomembranous colitis? |
Clostridium dificile d/t antibiotic use |
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What is the pathology of pseudomembranous colitis? |
Abx eradicate normal flora -- overgrown C. difficile -- toxin -- foci of necrosis and superficial ulcers |
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What is a clinical feature of pseudomembranous colitis? |
Acute diarrhea with blood |
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What is viral gastroenteritis? |
Usually mild – rarely reported. “Stomach Flu”. Common isolated viruses – Norovirus, Rotovirus. Viral gastroenteritis typically presents with short prodrome, with mild fever and vomiting, followed by 1-4 days of non-bloody, watery diarrhea. Viral gastroenteritis is usually self-limited. |
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What are four signs of a bacterial infection of viral gastroenteritis? |
(1)High fever, (2)bloody diarrhea, (3)severe abdominal pain, (4)more than6 BMs in 24 hours
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What is acute appendicitis? |
Acute inflammation of the vermiform appendix, with peritonitis |
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What is the cause of acute appendicitis? |
Enterogenic bacteria that become pathogenic after obstruction of the lumen of the appendix d/t feces, worms or enlarged lymph node |
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What are three risk factors for acute appendicitis? |
(1)poor hygiene, (2)low fibre diet, (3)men in 20’s & 30’s |
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What is the pathogenesis of acute appendicitis? |
obstruction of appendix -- bacterial multiplication -- ulceration of appendix wall -- inflammation -- ischemia and necrosis -- rupture and peritonitis |
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What are six clinical features of acute appendicitis? |
(1)Sudden onset of abdominal pain with anorexia, (2)N/V, (3)fever, (4)pain is constant and within 12 hours will shift to Right Lower Quadrant, (5)rebound tenderness at McBurney’s point, (6)Very high WBC |
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What is peritonitis? |
Inflammation of the serous membrane (peritonium) lining the walls of the abdominal cavity |
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What is the cause of peritonitis? |
Anything that introduces microorganisms into the peritoneal cavity (a normally sterile env’t) |
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What is the pathogenesis of peritonitis? |
inflammation/perforation -- fibrinopurulent exudate covers the peritoneal surface -- fibrotic adhesions & obstructions -- incr'd blood to area to fight infection & peristalsis stops -- circulatory alterations, fluid shifts and respiratory problems -- critical fluid and electrolyte imbalances |
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What are six symptoms of peritonitis? |
(1)“acute abdomen” w/ severe abdominal pain and distension, (2)abdominal tenderness and rigid guarding, (3)Dcr'd or absent peristalsis, (4)N&V, (5)high fever, (6)shock |
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What is gastric volvulus? |
Rotation of the intestine around the mesenteric attachment site. Leads to twisting of the arteries and veins -- infarction of the rotated intestinal loop (strangulation). M/C in loops of SI or the sigmoid colon. |
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What is malabsorption syndrome? |
Malabsorption syndromes are characterized by the inability of the intestines to absorb nutrients from food, result from abnormalities involving: Intraluminal digestion of food, Uptake and processing of nutrients with the intestinal cells, Transport of the nutrients from the intestine to the liver |
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What are 13 clinical manifestations of malabsorption syndrome? |
(1)malnutrition, (2)wt loss, (3)muscle wasting, (4)failure to thrive, (5)fatigue, (6)malaise, (7)depression, (8)Sx of various nutritional deficiencies (eg. pernicious anemia,) (9)(GI) abdominal distension, (1)cramps/bloating, (11)diarrhea, (12)flatulence, (13)steatorrhea (fatty) |
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What is celiac disease (Gluten sensitive enteropathy)? |
A digestive and autoimmune disorder that results in damage to the lining of the small intestine when foods with gluten are eaten. |
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What is the pathogenesis of celiac disease? |
Gluten triggers the immune system to form antibodies to gluten -- attack the intestinal lining -- inflammation in the intestines and damages the villi of the small intestine |
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What are seven symptoms of celiac disease? |
(1)Digestive problems (abdominal bloating, pain, gas, diarrhea, pale stools, and weight loss), (2)A severe skin rash called dermatitis herpetiformis, (3)Iron deficiency anemia (low blood count), (4)Musculoskeletal problems (muscle cramps, joint and bone pain), (5)Growth problems and failure to thrive (in children), (6)Aphthous ulcers (sores in the mouth), (7)Small intestine biopsy shows flattened villi |
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What are four types of intestinal neoplasms? |
(1)Non-neoplastic polyps, (2)Benign tumours, (3)Malignant tumours, (4)Familial adenomatous polyposis coli |
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What is a non-neoplastic polyps? |
Polyp = Any growth or mass protruding into the intestinal lumen from any part of the mucous membrane. Non-neoplastic = composed of normal glandular or stromal cells. |
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What is a benign intestinal tumour? |
Neoplastic polyps = composed of neoplastic epithelium with no differentiation. Benign adenomatous polyps may be a Risk Factor for colorectal cancer – usually removed |
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What is a malignant intestinal tumour? |
Mainly adenocarcinoma (colorectal cancer) |
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What is a familial adenomatous polyposis coli? |
Autosomal dominant condition where colon shows multiple adenomas which evolve into carcinomas |
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What is adenocarcinoma? |
Colorectal cancer |
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What are six risk factors of colorectal cancer? |
(1)age (>40), (2)male, (3)low fiber/high animal fat & protein diets (especially red meat cooked on a grill), (4)polyps, (5)UC/Crohn’s, (6)other cancer Hx,, sedentary lifestyle, obesity, immuno def. |
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What is the pathology of colorectal cancer? |
Long, slow-growing, malignant conversion of benign polyps |
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What are four clinical features of colorectal cancer? |
(1)Few early warning signs (esp on Right), (2)Bright red blood (Hematochezia), (3)Persistent stomach pain, diarrhea or constipation, (4)Thin stools (pencil) |
