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Dr. Seva Visceral GI
Dr. Seva's Visceral Pathology GIT
| Question | Answer |
|---|---|
| What are congenital esophageal problems? (3) | 1. trachea-esophageal fistula 2. esophageal (Zenker's) diverticulum 3. esophageal web/ring |
| What is a trachea-esophageal fistula? | A communiation b/w trachea and esophagus can give aspiration pneumonia in infant. |
| What is esophageal diverticulum? | An outpouching in esophagus causes halitosis. |
| What is esophageal web/ring? | A thickening of an area in esophagus that can cause a ringlike appearance; dysphagia; associated w/ iron deficiency anemia. |
| What do dysfunction of striated m. of upper esophagus, skeletal m. disorders, neuro. disorders and peripheral neuropathy cause? | dysphagia: motor dysfunction of the esophagus = difficulty swallowing |
| What is achalasia? | Impaired lower esophageal sphincter - failure to relax w/ absence of peristalsis in upper esophagus. Food is retained and esophageal dilation is proximal to LES. |
| What is achalasia associated with? | Loss or absence of ganglion cells in the esophageal myenteric (Auerbach's) plexus; "rat tailed" or "beak" appearance in barium x-ray. |
| What is scleroderma of esophagus? | Fibrosis in esophagus along w/ the dermis. |
| What is a hiatal hernia? | Herniation of stomach through esophageal hiatus in the diaphragm. |
| What are the 2 types of hiatal hernia? | Sliding hernia and paraesophageal hernia. |
| What is sliding hernia? | Upward herniation of the gastric mucosa above the diaphragm |
| What is paraesophageal hernia? | Upward herniation of the stomach by the side of esophagus. |
| What are clinical factors of hiatal hernia? | heartburn, dysphagia, gastroesophageal reflex (GERD) |
| What is reflex esophagitis? | Caused by regurgitation of gastric contents; "acid burn" |
| What agents decrease the pressure of the lower esophageal sphincter leading to GERD? | alcohol, chocolate, fatty foods, cigarettes, pregnancy, estrogen therapy |
| What is candidal esophagitis? | A fungal infection of esophagus found in immunocompromised patients like DM, HIV/AIDS, etc. |
| What are clinical factors of candidal esophagitis? | dysphagia and odynophagia (painful swallowing) |
| What is chemical esophagitis? | Occurs in accidental or intentional poisoning by lye or strong acids. |
| What is Barrett's esophagus? | A result of chronic GE reflux normal strat. squamous epithelium of lower esophagus is replaced by columnar epithelium of the stomach (metaplasia). Can later form adenocarcinoma. |
| What are esophageal varices? | Varicosity of esophageal veins at the lower third; dilated, congested veins thinner mucosa, blood in lumen, -> hematemesis. |
| What are esophageal varices related to? | Hallmark of portal HTN and history of cirrhosis. |
| What is mallory weiss syndrome? | Severe wretching at the GE junction associated w/ alcohol use; linear tear of esophagus at gastroesophageal junction. |
| What is diffuse esophageal spasm? | Muscular thickening causes spasm - "rosary esophagus" or cork-screw esophagus in barium meal series. |
| What are tumors of esophagus? | Benign: leiomyoma (uncommon); Malignant: squamous cell Ca worldwide but in US adenocarcinoma |
| What are risk factors for tumors of esophagus? | smoking and alcohol for squamous cell carcinoma and barrette's esophagus for adenocarcinoma. |
| What are clinical features of tumors of the esophagus? | dysphagia and cachexia |
| What is congenital pyloric stenosis and who is more likely to get it? | Concentric enlargement of the pyloric sphincter and narrowing of the pylorus; more common in first born white male. |
| What is seen w/ congenital pyloric stenosis, what are clinical factors and treatment? | Visible peristalsis fromleft to right and palpable olive-like mass in the abdomen; non-bilious projectile vomiting; surgery. |
| What is acute gastritis and what is it also called? | Inflammation of the stomach; acute hemorrhagic (erosive) gastritis. |
| What causes acute gastritis? | Drug (NSAID) and stress ulcers; occur in severely burned persons giving a curling ulcer in the mucosa of the stomach. |
| What are clinical features of acute gastritis? | Vague abdominal discomfort or massive, life-threatening hemorrhage (coffee colored vomit) or clinical manifestations of gastric perforation (through all layers). |
| What are the 6 types of chronic gastritis? | 1. Autoimmune atrophic gastritis 2. Environmental or multifocal atrophic gastritis 3. Helicobactor gastritis 4. Granulomatous gastritis 5. Chemical or reactive gastropathy 6. Menetrier DZ: hyperplastic hypersecretory gastropathy. |
| What is associated w/ autoimmune atrophic gastritis? | Pernicious (megaloblastic) anemia which is caused by malabsorption of vitamin B12 d/t intrinsic factor deficiency. |
| What does autoimmune atrophic gastritis exhibit? | 1. Diffuse atrophic gastritis in the body & fundus of the stomach 2. Antibodies to parietal cells & intrinsic factor 3. Reduced (hypochlorhydria) or absence of gastric secretion (achlorhydria) 4. G cell hyperplasia & increased serum gastrin (may -> Ca) |
| What is Environmental or multifocal atrophic gastritis? | The stomach mucosa is replaced by intestinal mucosa. This metaplastic change is a risk factor for gastric adenocarcinoma. More risk for those w/ pernicious anemia and cancer is common in gastric antrum. |
| What causes environmental or multifocal atrophic gastritis and what is it associated w/? | Unknown etiology; involves antrum; more common than autoimmune; associated w/ hypochlorhydria. |
| What is helicobactor gastritis associated w/? | helicobactor pylori -> ulcer: pain, may bleed -> anemia |
| When diagnosing anemia what must be ruled out for males and females? | Males: must r/o ulcer and prostate and colon cancer; Females: child bearing age r/o from anemia from cycle |
| What is granulomatous gastritis associated w/? | TB, sarcoidosis, crohn's disease or idiopathic. |
| Who gets chemical or reactive gastropathy? | Patients who use NSAIDs chronically; bleeding inside -> anemia and losing blood in feces. |
| What is a finding in menetrier disease: hyperplastic hypersecretory gastropathy? | Gastric mucosa is characterized by enlarged brain like convolutions (rugae) and protein loss from altered gastric mucosa. |
| What are clinical features for menetrier disease? | Postprandial pain w/ pedal edema, ascities & cachexia. Considered pre-cancerous. |
| What is peptic ulcer disease and where is it common? | Focal mucosal destruction caused by the action of gastric secretions; Common in distal stomach and proximal duodenum. |
| Describe a person w/ a gastric ulcer. | 25% of ulcers; common in elderly people; immediate pain after eating; more pain standing; blood in vomit; afraid to eat; thin |
| Describe a person w/ a duodenal ulcer. | 75% of ulcers; common in young males; pain 1-2 hours after eating; more pain lying down; blood in fecal matter = melena (black/tar like); eat constantly, think pain from hunger; obese. |
| What are risk factors for peptic ulcers? | cigarettes, NSAID, people w/ O blood type, epithelial injury by H. pylori |
| What are clinical features for peptic ulcers? | Dyspepsia (indigestion), epigastric pain; hour glass and teapot stomach w/ barium meal studies. |
| What are complications of peptic ulcers? | Hemorrhage, obstruction (d/t fibrous tissue), perforation, peritonitis. |
| What are benign and malignant neoplasms that appear in the stomach? | Benign: tubular adenoma (uncommon); Malignant: gastric adenocarcinoma |
| What gives increased risk for gastric neoplasm? | diet: nitrasamine; most common among people who eat large amounts of starch, smoked fish and meat and pickled vegetables; blood type A |
| What is seen macroscopically in gastric cancers (3 groups)? | 1. Fungating mass (growth in fundus) 2. Malignant ulcer w/ raised everted edges 3. Diffused type - linitis plastica (stomach shrunk w/ thick wall) |
| What is seen microscopically in gastric cancers? | All have signet ring cells (not Ca w/o) |
| What are clinical symptoms of gastric cancers? | weight loss, anorexia, hematemesis, anemia, left clavicular lymph node enlargement (Virchow's node) |
| What are the 3 A's (symptoms) of GIT cancer? | 1. Anorexia 2. Anemia 3. Asthemia (ill, tired) |
| What are tricobezoars? | Foreign bodies (gum or hair) altered by the digestive process. Mass of hairball usually seen in long haired girls who eat their own hair as nervous habit. |
| What are congenital anomalies of small and large intestine? | 1. Atresia 2. Stenosis 3. Mickel's diverticulum |
| What is atresia? | Complete occlusion of (small) intestinal lumen |
| What is stenosis w/ intestinal congenital anomalies? | Incomplete stricture which narrows but does not occlude the lumen. |
| What is Meckel's diverticulum w/ intestinal congenital anomalies? | Outpouching of ileum d/t persistent vitelline duct. Mostly asymptomatic but may -> a number of complications: peptic ulceration, intestinal obstruction, diverticulitis, perforation and peritonitis. |
| What is enterocolitis? | Small and large intestine inflammation; diarrhea: sudden onset of bowel frequency associated w/ abdominal cramp. |
| What is secretory diarrhea d/t? | Cholera toxin, celiac disease, lactose intolerance, laxitives. |
| What is exudative diarrhea and what is it d/t? | Blood and mucus in the stool; ulcerative colitis and Crohn's Dz. |
| What is hypermotility dirrhea? | d/t increased motility: hyperthyroidism, diabetic neuropathy |
| What is inflammatory diarrhea? | Damage to mucosal lining by bacteria, virus, etc. |
| What is dysentery? | Not diarrhea but is visible in the stool d/t bowel tissue invasion from shigella and salmonella. |
| What is Pseudomembranous colitis? | Antibiotic associated diarrhea: developed following the use of any antibiotic in the first few days. Causative organism is clostridium difficile. |
| What causes chronic diarrhea? | Ulcerative colitis, chron's Dz, carcinoma of the colon; also a symptom in HIV patients. |
| What is intestinal ischemia and infarction? | Decreased blood flow to the intestine d/t any cause (sup. mesenteric a. thrombosis or acute MI); may range from mucosal necrosis to transmural infarction. |
| What are clinical features of intestinal ischemia and infarction? | Adynamic ileus (absence of peristalsis) may lead to peritonitis and sepsis (dead area of intestine gangrenous need surgery to remove), no bowel sounds, vomit constantly |
| What are the 3 types of malabsorption syndrome? | Common symptoms: diarrhea and steatorrhea 1. Celiac sprue 2. Tropical sprue (postinfection sprue) 3. Whipple's Dz |
| What is celiac sprue? | Damage to the small intestinal mucosa d/t abnormal senstivity to gluten. Microscopically: villous atrophy |
| What is tropical sprue? | Common after visiting south east Asia or Caribbean; long standing contamination of bowel w/ e. coli, or associated w/ B12 and B9 deficiency. No villous atrophy. |
| What is Whipple's Dz? | Lamina propria contains macrophages w/ the organisms; mucosal damage and lymphatic obstruction. Will also have fever and joint pain in addition to diarrhea. |
| What are the 2 idiopathic inflammatory bowel diseases? | 1. Ulcerative colitis 2. Chrohn's Dz: regional ileitis |
| What is ulcerative colitis? | chronic inflammation of the large intestine (rectum, sigmoid colon); continuous lesion and superficial inflammation (ulcers); colonoscopy shows inc. mucosal friability, thick inflam. exudates. |
| What symptoms are sen w/ ulcerative colitis? | Recurrent hematochezia (fresh blood in feces) w/ pus/mucus; higher risk of colon adenocarcinoma. |
| What is Crohn's Dz: regional ileitis? | Prevalent in young adults (20-40) and 2-3x more common in Jews; Chronic inflammation of small intestine (ileum) |
| What is seen in Crohn's Dz? | Intermittent lesions and transmural inflammation; edematous mucosa presents "cobble-stone" appearance. Intestinal lumen narrows b/c edema and fibrosis and non-caseating granulomas. |
| What are symptoms and complications of Crohn's Dz? | Severe abdominal pain, diarrhea and fever; intestinal obstruction and fistulas |
| What are 3 types of Bowel obstructions and diverticulosis? | 1. Adhesions 2. Intussception 3. Volvulus |
| What is adhesions in bowel obstruction and diverticulosis? | Post surgical adhesions (fibrous bands) b/w tissues/organs may cause small bowel obstruction and strangulations. |
| What is intussuception in bowel obstruction and diverticulosis? | Telescoping one segment of the intestine into another segment like stacking glasses; common in children |
| What are the 4 cardinal effects of intussuception in bowel obstruction and diverticulosis? | 1. Colicky abdominal pain 2. Vomiting 3. Currant jelly stools (mix of blood and mucus) 4. Tender, palpable sausage shaped abdominal mass. |
| What is volvulus in bowel obstruction and diverticulosis? | Twisting of intestine at least 180 degrees on its mesetery, resulting in blood vessel compression and ischemia. |
| What are clinical features of volvulus in bowel obstruction and diverticulosis? | vomiting and rapid, marked abdominal distension followed by sudden onset of severe abdominal pain. |
| What is appendicitis? | common in young adults; appendix obstructed by fecalith (fecal stone) |
| What are clinical features of appendicitis? | anorexia, nausea, vomiting, periumbilical pain (McBurney's poing), rebound tenderness, leukocytosis |
| What are complications of appendicitis? | necrosis-gangrene-perforation-peritonitis |
| What is diverticulosis? | Outpouching of mucus membrane of the intestine; common in sigmoid colon; aka left sided appendicitis |
| What causes diverticulosis? | Decreased fiber in diet; if inflamed diverticulitis; pouch opp. of polyp. |
| What are clinical features, complications and x-ray findings of diverticulosis? | Moderate left abdominal pain and vomiting; perforation, stricture, fibrosis; saw teeth appearance |
| What is polyps of colon and rectum? | Mass that protrudes into lumen of the gut; can be benign or malignant; asymptomatic but some are precancerous |
| What is familial adenomatous polyposis? | 1000 or more polyps in the colon; autosomal dominant; if colectomy not done all patients dev. adenocarcinoma of the colon by 40 y/o |
| What are benign tumors of the large intestine? | tubular, villous or tubulovillous (MC) adenomas. Tubular (stalk and smooth surface) common in US; small flat adenomas may be missed in colonoscopy and have high chance becoming malignant; male predominance more in blacks; commonly in rectosigmoid region |
| What are risk factors of colorectal adenocarcinoma? | Familial, high animal fat diet, low fiber diet, ulcerative colitis; diet associated w/ slower transit of fecal contents through the colon. |
| How does colorectal adenocarcinoma appear? | As an ascending polypoid messes or nvolve the whole circumference ("apple core appearance") and constrict the lumen or ulcers w/ everted edges |
| What are clinical features of colorectal adenocarcinoma? | Altered bowel habits, abdominal palpable mass, abdominal pain, weight loss, anemia, hemetochezia; Staging done by Duke's staging method. |
| What is cirrhosis of the liver and steps this pathology takes? | End stage of chronic liver disease; 1. necrosis 2. fibrosis 3. Vascular destruction & derangement 4. Regenerative nodules 5. Destruction of normal liver architecture 6. Diffuse involvement of whole liver |
| What is the etiology of cirrhosis of the liver? | alcohol, viral, biliary diseases, hemochromatosis; is irreversible, progressive and premalignant. |
| What are clinical features of cirrhosis of liver? | Loss of functional liver parenchyma causes: hypoalbuminemia (-> edema, ascites), clotting abnormalities, jaundice, risk of infection, portal HTN, endocrine abnormalities, primary hepatocellular carcinoma |
| What is icterus? | Jaundice; yellow discoloration of conjunctiva and mucosa membrane; hyperbilirubinemia & pruritus (itching). |
| What are the 3 types of jaundice? | 1. Hemolytic J (pre-hepatic) 2. Hepatic J 3. Obstructice J (post-hepatic J) |
| What is hemolytic J? | Hemolytic anemia. Increased bilirubin in serum but not in urine; urine color normal. |
| What is hepatic J? | cirrhosis; Increased bilirubin in serum and bilirubin present in urine; dark urine. |
| What is Obstructive J? | Cholestasis: e.g. gallbladder Dz; increased bilirubin in serum, dark urine; pale stool. |
| What is neonatal jaundice? | Physiological J: mild jaundice from 2nd to 8th day after birth d/t result of immaturity of the liver enzyme system. |
| What is Kernicterus? | Neonatal pathological jaundice; a severe neurological condition associated w/ very high levels of unconjugated bilirubin in the blood & brain causing cerebral dysfunction |
| What are clinical features of kernicterus? | lethargy, convulsions, hearing loss, mental retardation. |
| What is Gilbert syndrome? | an inherited, mild, chronic unconjugated hyperbilirubinemia that is d/t impaired clearance of bilirubin in the absence of any detectable functional or structural liver disease. |
| What is Dubin-Johnson syndrome? | An inherited, mild, chronic conjugated hyperbilirubinemia that is caused aby impaired clearance of bilirubin w/ deposition of melanin like pigments in the liver (black-liver). |
| What are clinical features of Dubin-Johnson syndrome? | Mild intermittent jaundice w/ dark urine. |
| What is Rotor syndrome? | Familial conjugated hyperbilirubinemia but w/o liver pigments. |
| What is benign recurrent intrahepatic cholestasis? | Familial; self-limited periodic episodes of malaise and itching d/t bile stasis in the bile canaliculi. |
| What is cholestasis of pregnancy? | Characterized by pruritus & cholestatic jaundice during the last trimester of pregnancy which disappears after delivery. |
| What are complications of cholestasis of pregnancy? | Fetal distress, prematurity or stillbirth |
| What is always associated with increased bile in the body? | Pruritis |
| What is fulminant hepatitis? | Hepatic encephalopathy. High levels of ammonia in the blood and brain, may die w/in a week. |
| What is autoimmune hepatitis? | Idiopathic, chronic hepatitis w/ autoantibodies and increased serum immunoglobulins |
| What is primary sclerosing cholangitis? | Idiopathic; chronic cond'n; inflammation and fibrosis narrows and eventually obstructs the bile duct |
| What is hereditary hemochromatosis? | Excessive absorption and toxic accumulation of iron in hepatocytes, pancreas, joint cavities, heart and skin. Autosomal dominant. |
| What are clinical features of hereditary hemochromatosis? | Will affect at least 3 of these tissues: Cirrhosis, cardiomegaly (d/t iron pigment), skin pigmentation (metallic brown), arthropathy and diabetes mellitus (secondary b/c iron in pancreas). |
| What is secondary hemochromatosis? | In sickle cell anemia and thalassemia and dietary iron overload. |
| What is hepatolenticular disease: Wilson's Dz? | Autosomal recessive; excessive copper deposition in liver and brain. |
| What are clinical features of Wilson's Dz? | Jaundice, tremors, dysarthria, Kayser-Fleischer ring in the eyes and spontaneous bone fractures and osteoporosis. |
| What is and what causes hepatotoxicity? | Drug induced liver Dz; acetaminophen, NSAID, some herbal remedies; natural or synthetic still goes through liver. |
| What is hepatic pyogenic abscess? | high fever w/ right quadrant pain, rapid weight loss and hepatomegaly. |
| What are benign hepatic tumors? | Hepatic Adenoma Hepatic Hemangiomas |
| What is hepatic adenoma? | Common in women of reproductive age w/ oral contraceptive Hx; mostly solitary and sharply demarcated masses. |
| What is Hepatic hemangioma? | Most common in young children. Asymptomatic or right hypochondrial pain. (BVs undergo benign changes) |
| What is the etiology of hepatocellular carcinoma? | Hepatitis B & C, alcoholic dirrhosis and hemochromatosis |
| What are clinical features of hepatocellular carcinoma? | Jaundice, painful hepatomegaly, cachexia |
| What is cholangiocarcinoma? | Cancer arising from intrahepatic bile ducts. |
| What are clinical features of cholangiocarcinoma? | In older adults, 60+ y/o; jaundice, weight loss, itching |
| What is hemangiosarcoma and the etiology? | Multiple hemorrhagic nodules; exposure to vinyl chloride, inorganic arsenic |
| What are clinical features of hemangiosarcoma? | Hepatomegaly, jaundice, ascites; secondary liver cancer normally from GIT -> many masses; secondary liver cancer more common than primary. |
| What is cholelithiasis? | bile stone in duct (-lithiasis = stone) cholesterol in whites and pigment stones in other races. |
| How does one feel w/ gall stones and how are they seen? | Asymptomatic and biliary colic (feel full, pain in muscular tube, not continuous, spasmodic); visible by ultrasound, not radiopaque. |
| What are the 5 F's of gall stones? | Female Forty Fat Fertile (multiparous) Fair |
| What is the etiology of gall stones in white people? | high cholesterol or decreased bile salts or decreased gall bladder motility for cholesterol stones |
| What is the etiology of gall stones for other races? | sickle cell anemia and parasitic infestation |
| What is choledocholithiasis? | Gall stones in the common bile duct? |
| What is acute cholecystitis? | GB inflammation; edematous enlarged gall bladder |
| What are the etiology and s/s of cholecystitis? | Cholelithiasis or bacterial; pain at Murphy's point radiating to right shoulder, fever w/ chills, leukocytosis. |
| What are complications of cholecystitis? | Empyema bladder (filled w/ pus, chills, high fever), perforation and peritonitis |
| What is chronic cholecystitis? | Persistent inflammation of gall bladder associated w/ gall stones or repeated attacks of acute cholecystitis; thick, firm and contracted gall bladder, the wall may become calcified (porcelain gall bladder) |
| What are symptoms of chronic cholecystitis? | nonspecific vague abdominal symptoms. |
| What is a papilloma? | Most common benign tumor of GB |
| What is cholangio adenocarcinoma? | common in women, porcelain gall bladder is prone to become cancer of the gall bladder |
| What are the 2 main causes of pancreatic pathology? | Alcohol or idiopathic |
| What is cystic fibrosis? | Mucoviscidosis (thick mucus); a congenital disease, abnormal mucus secretion of the exocrine glands throughout the body. |
| What are s/s of cystic fibrosis/mucoviscidosis? | Recurrent pulmonary infections and pancreatic insufficiency lead to failure to thrive (thinner, small for age) |
| What causes acute pancreatitis? | Gall stones, alcohol, mumps (paramyxo virus) |
| What happens in acute pancreatitis? | Pancreas releases its lytic enzymes causing necrosis of its own tissue and surrounding tissue |
| What are clinical features of acute pancreatitis? | Sudden onset of severe boring abdominal pain, radiating to the back, nausea and vomiting. Cullen's sign, turner's sign; serum amylase greatly elevated -> hypotension and shock. |
| What is Cullen's sign? | Subcutaneous (internal) bleeding around umbilicus |
| What is Turner's sign? | Subcutaneous bleeding on back |
| What causes chronic pancreatitis? | chronic alcoholism, gall stone, cystic fibrosis |
| How does chronic pancreatitis look? | Shrinkage of pancreas d/t fibrosis and atrophy of the acinar structures. |
| What are clinical features of chronic pancreatitis? | Steatorrhea, endocrine insufficiency |
| Describe carcinoma of the pancreas. | adenocarcinoma w/ CFs of weight loss, midepigastric and back pain, jaundice w/ clay colored stool. |
| What is Zollinger Ellison's syndrome (Gastrinoma)? | Malignant islet cell tumor from G cells produce excess of gastrin - hyper acidity and peptic ulcer Dz w/ clinical features of diarrhea and abdominal pain. |
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