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dysphasia difficulty swallowing
heartburn retrosternal burning
hematemesis vomiting blood
melena blood in stool
esophageal varices dilated veins that protrude into esophagus from portal hypertension that reverts blood to azygous system; especially in alcoholics and risk for rupture
esophagitis injury and inflammation to esophageal mucosa; leads to esophageal carcinoma and Barrett esophagus
Barrett esophagus seen in longterm GERD; stratified squamous epi replaced by columnar epic with goblet cells -increase risk of adenocarcinoma
esophageal carcinoma can be squamous cell carcinoma (most common, Plummer-Vinson) or adenocarcinoma (Barrett esophagus)
cardia region of stomach that is lined by foveolar cells that secrete mucin
fundus region of stomach that is lined with endocrine G cells that secrete gastrin
body and antrum regions of stomach that have chief cells to secrete pepsin
gastritis inflammation of gastric mucosa, {majority of cases are chronic gastritis}
acute gastritis usually transient in longterm NSAID/aspirin users
chronic gastrits chronic mucosal inflammation that leads to mucosal atrophy and metaplasia; due to chronic infection of {Helicobacter pylori}
autoimmune gastritis from autoantibodies to parietal cells; loss of intrinsic factor then leads to pernicious anemia
intestinal metaplasia replacement of gastric epithelium with columnar epithelium with goblet cells -leads to gastric adenocarcinoma
gastric lymphoma proliferation of lymphoid tissue in gastric mucosa from H. pylori
gastric ulceration breaches of mucosa to submucosa or deeper
acute gastric ulceration ulcers mainly in stomach and duodenum -{stress ulcers}- severe trauma and sepsis -{Curling ulcers}- extensive burns -{Cushing ulcers}- injury to CNS -chronic NSAIDs or steroid use
peptic ulcer disease (PUD) solitary, relapsing lesions in response to excess acid -{the two most common causes are H. pylori and NSAID use}
Zollinger-Ellison syndrome multiple peptic ulcers from {excess gastrin secretion} by a tumor; a paraneoplastic syndrome
gastric adenocarcinoma first nodal involvement is seen in supraclavicular node {Virchow's node}
intestinal type type of gastric adenocarcinoma that arises from gastric mucous cells having undergone metaplasia from chronic gastritis; differentiated
diffuse type type of gastric adenocarcinoma that arises from gastric mucous cells not associated with chronic gastritis; poorly differentiated in infiltrative growth pattern
linitus plastica stiffening of gastric wall from tumor; has leather bottle appearance
Krukenberg tumor intraperitoneal spread of gastric adenocarcinoma in females to both ovaries
risk factors for gastric adenocarcinoma 1. H. pylori infection 2. Epstein-Barr virus 3. chronic atrophic gastritis
Hirschsprung disease -aka congenital megacolon; distention of colon due to lack of neural crest cell migration so some segments aganglionic and obstructions occur
hernia weakness in peritoneal cavity that forms serosa-lined pouch
intestinal adhesions caused by peritoneal inflammation and these develop during healing between bowel segments and abdominal wall
intussusception telescoping of bowel into distal segment
volvulus twisting of a loop of bowel about its attachment constricting venous outflow
colonic diverticulosis blind pouch off the alimentary tract lined by mucosa, most commonly in colon -seen in refined, low-fiber diets in Western societies
hemorrhoids vatical dilation of anal and perianal submucosal venous plexuses
diarrhea increase in stool mass, frequency, or fluidity
bacterial/infectious enterocolitis common when traveling with diarrhea; can ingest preformed toxin or enteric pathogen
most common malabsorption syndromes 1. pancreatic insufficiency 2. celiac disease 3. Crohn disease
defective intraluminal digestion failure to break down proteins, carbs, and fats; seen in {pancreatic insufficiency}
defective terminal digestion classic example is {lactose intolerance}, a deficiency of lactase; inherited form is rare but acquired form is very common
defective transepithelial transport {celiac disease} or gluten-sensitivity enteropathy is example of this
celiac disease reduction of small intestine absorptive surface area leading to defective transepithelial transport of nutrients; sensitivity to protein gliadin -increased risk of T-cell lymphoma and intestinal adenocarcinoma
tropical sprue malabsorption from an intestinal infection
Crohn disease (regional enteritis) can affect any level of alimentary tract; deep {transmural} involvement with {skip lesions} and {non-caseating granulomas} -higher risk for colonic carcinoma
ulcerative colitis in colon and limited to mucosa and submucosa; no granulomas or skip lesions -much much higher risk for carcinoma
polyps tumorous mass that protrudes into lumen of the gut; can be neoplastic and non-neoplastic
hyperplastic polyp most common type; multiple and small in rectum and left colon
hamartomatous polyp includes juvenile and Peutz-Jeghers polyps
juvenile polyps hamartomatous proliferation in children under 5 but also in adults
adenomatous polyps aka colorectal adenomas; {neoplastic polyps} that appear to be familial and predispose to colorectal adenocarcinomas
sessile serrated adenoma looks histologically like a hyperplastic polyp but has the malignant potential of an adenoma
familial polyposis syndrome autosomal dominantly inherited diseases with greater chance for malignancies
familial adenomatous polyposis (FAP) 500-2500 colonic adenomas that carpet mucosal surface; {due to a mutation of the tumor suppressor gene APC} with 100% risk of colon cancer
Gardner syndrome extra intestinal tumors present, especially craniofacial; mutation on APC gene
Peutz-Jegher syndrome small intestine hamartomatous polyps and melanotic pigmentations; increase cancer risk
Cowden syndrome hamartomatous polyps in GIT; increased risk for breast and ovarian cancer
APC/β-Catenin pathway pathway of colorectal carcinogenesis; {evolution of cancer occurs through morphologically identifiable stages} and follows the {adenoma-carcinoma sequence}
MSI (microsatellite instability) pathway pathway of colorectal carcinogenesis with no clear morphologic correlates; due to inactivation of a DNA mismatch repair gene
Hereditary Nonpolyposis Colon Carcinoma Syndrome (Lynch syndrome) inherited mutation of one of five DNA mismatch repair genes; example of MSI pathway
clinical stage single most important prognostic indicator of colorectal carcinoma; determined by depth of invasion and presence or absence of lymph node metastasis
carcinoid tumors arise from enterochromaffin cells of the gut; asymptomatic except affects of secretory products -tumors of the appendix are usually this type
Cushing syndrome paraneoplastic syndrome with excess ACTH hormone produced
Carcinoid syndrome seen with GIT carcinoids that have metastasized to liver; symptoms due to excess serotonin production
gastrointestinal lymphoma H. pylori > B-cell, celiac disease > T-cell
McBurney's sign/point pain or tenderness between belly button and iliac spine on the right side
Created by: aharnold