Sys Med 2 (GI Disorders)

What ocular findings is associated with vitamin A deficiency?

night blindness and Bidot spot

What ocular findings is associated with vitamin B12 deficiency?

optic neuropthy

What ocular findings is associated with jaundice?

scleral icterus

What ocular findings is associated with inflammatory bowl disease?

associated with uveitis or episcleritis

What ocular findings is associated with iron deficiency anemia?

pale conjunctiva

What ocular findings is associated with fat-soluble vitamin deficiencies?

ocular surface dryness

What is atresia?

incomplete development

What is agenesis?

absence of an organ

What is caused by the disruption of elongation and separation of esophagus and trachea during embryogenesis?

esophageal atresia

What are the symptoms associated with esophageal atresia?

choking, cyanosis, excessive drooling

What is the most common form of congenital intestinal atresia?

imperforated anus

What is the cause of an imperforated anus?

failure of the cloacal diaphragm to involute

What is the most common site of fistulization in the GI tract?

esophagus

When does a diaphragmatic hernia occur?

when incomplete formation of the diaphragm allows the abdominal viscera to herniate into the thoracic cavity

What can a hiatal hernia cause if severe?

pulmonary hypoplasia

What are signs and symptoms of a hiatal hernia?

heartburn, epigastric pain, volvulus, strangulation and perforation of the organ

What is characterized by an outpouching of the esophagus just above the upper esophageal sphincter caused by a weakening of the muscle wall?

Zenker's diverticulum

What are symptoms of Zenker's diverticulum?

dysphagia, aspiration, regurgitation of food eaten hours earlier

Plummer Vinson syndrome has ______________________________________ manifestations.

hematologic, GI, and mucocutaneous

Who is Plummer Vinson syndrome more commonly seen in?

women 40-70 yo

What is Plummer Vinson syndrome often associated with?

chronic iron deficiency

What are the oral manifestations of Plummer Vinson syndrome?

dysphagia, iron deficient anemia, atrophic glossitis, angular stomatitis, and koilonychia

What is diagnostic for Plummer Vinson syndrome?

Barium swallow which will reveal a web in the post-cricoid region

Which cancer is Plummer-Vinson syndrome considered a precursor to?

post-cricoid carcinoma

What is the treatment for Plummer-Vinson syndrome?

esophageal dilation

Which condition is defined as an incomplete relaxation of the lower esophageal sphincter (LES) in response to swallowing?

achalasia

What is the triad associated with achalasia?

esophageal aperistalsis, partial or incomplete relation of LES, and increased resting tone of LES

Achalasis carries an increased risk of which malignancy?

squamous cell carcinoma

What is diagnostic for achalasis?

manometry ("bird's beak")

What is Mallory Weiss syndrome characterized by?

longitudinal mucosal tears at the esophagogastric junction

What is Boerhaave syndrome characterized by?

full thickness esophageal tear

Who is Mallory Weiss syndrome commonly seen in?

alcoholics and bulimics

What causes esophagitis?

reflux, irritants, fungal infections, malignancy and intubation

What is characterized as a chronic condition where stomach acid frequently flows back into the esophagus due to dysfunction of the lower esophageal sphincter (LES)?

GERD (gastroesophageal reflux disease)

What are laboratory findings of GERD?

anemia on CBC (if chronic or acute bleeding), barium swallow can reveal some barium regurgitation, upper endoscopy

What is characterized by the replacement of the normal esophageal squamous mucosa by metaplastic columnar epithelium due to prolonged injury?

Barrett's esophagus

What is Barrett's esophagus a precursor lesion for?

esophageal adenocarcinoma (30-40x risk)

How does Barrett's esophagus appear on endoscopy?

velvety pink columnar mucosa instead of normal pearly-white squamous mucosa

What are less common and benign neoplasms of the GI tract?

squamous papilloma and leiomyoma

What are more common and malignant neoplasms of the GI tract?

squamous cell carcinoma and adenocarcinoma

What is the most common malignant neoplasm of the GI tract globally?

squamous cell carcinomas

What is the most common malignant neoplasm of the GI tract America?

adenocarcinoma

Who is most commonly effected by squamous cell carcinoma?

African American males >45yo who smoke and drink alcohol

What do patients with squamous cell carcinoma of the GI tract present with?

dysphagia, odynophagia (pain when swallowing), or obstruction (pt with subconsciously alter their diet to liquids slowly)

Which congenital condition presents with projectile vomiting, palpable epigastric mass and visible peritalasis?

pyloric stenosis

Who is pyloric stenosis most common in?

first male child

How is pyloric stenosis treated?

myotomy

What causes acute gastritis?

NSAIDs, excessive alcohol, severe stress, smoking, ischemia, shock

What are peptic ulcers?

chronic solitary lesions that occur in any part of the GI tract exposed to aggressive gastric acid

What causes majority of peptic ulcers?

H. pylori

How is H. pylori diagnosed?

urea breath test

What does the prognosis of gastric adenocarcinoma depend on?

depth of invasion and nodal status

What is a Krukenberg tumor?

ovarian metastasis of gastric adenocarcinoma

What is Virchow's lymph node?

supraclavicular lymph node metastasis of gastric adenocarcinoma

What is a Sister Mary Joseph nodule?

periumbilical metastasis of gastric adenocarcinoma

What congenital condition is characterized as a ring of pancreatic tissue that completely encircles the duodenum?

annular pancreas

What is the pathophysiology of acute pancreatitis?

autodigestion of pancreatic parenchyma by pancreatic enzymes

What is the most common cause of acute pancreatitis?

duct obstruction due to gallstones and alcoholism

What is seen in the first 24hrs of acute pancreatitis?

raised amylase levels

What is seen in the within 72-96 hrs of acute pancreatitis?

raised lipase levels

What sign is characterized by the purple discoloration of the flank in acute pancreatitis?

Grey Turner's sign

What sign is characterized by the periumbilical purple discoloration in acute pancreatitis?

Cullen's sign

What is Whipple's triad associated with insulinoma?

signs/symptoms of hypoglycemia, hypoglycemia relieved by intake of glucose, low blood glucose levels

What is Meckel's diverticulum a result of?

incomplete involution of vitelline duct

What are characteristics of Meckel's diverticulum?

2% of normal population, within 2ft of ileocecal valve, 2inch long, 2 types of tissue, 2 years old, 2:1 male:female ratio

Where are changes associated with celiac disease more marked?

2nd part of the duodenum

What are characteristics of Celiac disease?

marked atrophy and loss of villi, increase intraepithelial lymphocytes, elongated and hyperplastic crypts

True or False. Changes in celiac disease reverse after gluten free diet.

True

Where do intestinal obstruction most commonly occur?

in the small intestine

What is the most common cause of an intestinal obstruction?

extramural/mechanical

What causes extramural intestinal obstruction?

peritoneal disease, intussusception, volvulus, hernia

What peritoneal diseases can cause extramural intestinal obstruction?

bands, tumors, peritoneal adhesions

What is intussusception?

telescoping

What is volvulus?

twisting of the bowel

Where is tenderness associated with acute appendicitis located?

McBurney's point

True or False. Pain initially is periumbilical then localizes to the RLQ in acute appendicitis.

True

What are complications of acute appendicitis?

perforation, peritonitis, peri-appendiceal abscess, liver abscess, bacteremia

What is the most common cause of congenital intestinal obstruction?

Hirschprung's disease

Hirschprung's disease is seen in 10% of ____________ patients.

trisomy 21

What is effected in Hirschprung's disease?

absence of ganglion Meissner and Aurbach's splexus

How is Hirschprung's disease diagnosed?

rectal biopsy

Colitis =

diarrhea

What are common causes of colitis?

infections, C. Diff, ischemic colitis

What are conditions are considered inflammatory bowl diseases?

Crohn's and Ulcerative colitis

What are characteristics of inflammatory bowl diseases?

chronic relapsing, bloody mucoid diarrhea, flare ups with physical and mental stress, vitamin deficiency symptoms

What are ocular manifestations of IBD?

acute non-granulomatous anterior uveitis, conjunctivitis, episcleritis, retinal vasculitis, peripheral ulcerative keratitis

What is condition is characterized by ulcers and inflammatory disease limited to the colon which affect the mucosa and submucosa and extends in a continuous fashion?

ulcerative colitis

What is ulcerative colitis associated with?

primary sclerosing cholangitis (PSC)

Which lab do 50% of patients with ulcerative colitis test positive for?

pANCA

What are signs and symptoms associated with ulcerative colitis?

cryptitis, basal lymphoplasmacytosis, isolated islands of regenerating mucosa bulge between ulcers (pseudopolyps), backwash ileitis

What is the most common treatment for ulcerative colitis and Crohn's disease?

total colectomy

What are pharmacologic treatments for UC and Crohn's disease?

ASA preparations (sulfasalazine), immunosuppressants, infliximab

What condition is characterized by skip lesions and transmural involvement with non-caseating granulomas giving rise to a cobblestone appearance to the small intestine most commonly?

Crohn's disease

What sign is associated with Crohn's disease?

radiographically-string sign

What is Crohn's disease also known as?

terminal ileitis, regional enteritis, granulomatous colitis

How is IBS diagnosed?

diagnosis of exclusion (symptom based)

How does a patient with IBS present?

normal bowl structure with no inflammation but have abnormal function of motility or peristalsis

What procedures are done to diagnose IBS?

look for spasm, distention or mucus accumulation in the intestine

True or False. There is no medical treatment for IBS but it can be managed through nutrition.

True