gastro after quiz 4 material

aka for Crohn's disease

terminal ileitis, regional enteritis, granulomatous colitis

why is crohn's called terminal ileitis

thought to only involve the terminal ileum when first discovered

what are sharply delineated affected areas with intervening unaffected areas and what are they associated with

skip lesions

Crohn's

what is involvement of the bowerl in Crohn's

transmural involvement

full thickness of GI tract

what type of granulomas are present in Crohn's

noncaseating granulomas

Crohn's is characterized by fissuring with formation of ______

fistulae

how is the mesentery affected in Crohn's

granular and grey with fat wrapping around bowel

what is fat wrapping around the bowel in Crohn's

creeping fat

how is the intestinal wall affected by Crohn's

-rubbery and thick

-resulting from edema, inflammation, fibrosis, and hypertrophy of muscularis propria

how is the lumen affected by Crohn's

narrowed

what is the name sign for a narrowed lumen on x-ray

string sign

what age group is commonly affected by Crohn's

13-30 years old with a bump in 50-60s

what are symptoms of Crohn's in the initial phase

diarrhea, right lower abdominal pain, fever

what are chronic complications of Crohn's

fibrosing strictures and formation of fistulas

what parts of the intestines are affected by Crohn's

can affect both small intestine and large intestine

what part of the large intestine is not usually affected by Crohn's

distal part

what is the result of small intestine involvement in Crohn's

malabsorption issues

what would malabsorption of vitamin B12 as a result of Crohn's lead to

pernicious anemia

what would malabsorption of bile salts as a result of Crohn's lead to

streatorrhea since bile slats are essential for fat emulsification and absorption

what is extraintestinal involvement of Crohn's

polyarthritis

sacroilitiis

ankylosing spondylitis

clubbing of fingertips

what part of the intestines is affected by ulcerative colitis

large intestine only

what is ulcerative colitis

ulceroinflammatory disease that affects the colon and only the mucosa and submucosa

where does ulcerative colitis usually start

rectum and moves proximally

what is ulcerative colitis associated with

polyarthritis

sacroilitis

ankylosing spondylitis

ureitis

hepatic involvement

when is onset of ulcerative colitis seen

between 2nd and 3rd decade

younger people

how is the mucosa affected in fully developed ulcerative colitis

broad ulceration

isolated islands of regenerated mucosa bulging upwards creates pseudopolyps

how is ulcerative colitis different that Crohn's

serosal surfaces appear normal in ulcerative colitis (damage happens within)

how do severe cases of Crohn's and ulcerative colitis cause toxic megacolon

damage to muscularis externa and neural plexus cause it to shut down --> swelling and becomes gangrenous

what leads to carcinoma in ulcerative colitis

dysplasia of the epithelial cells

what are the clinical features of ulcerative colitis

-relapsing attacks of bloody mucoid diarrhea which persists for days, weeks, or months and then subsides

-lower abdominal pain relieved by defecation

what does the outlook of ulcerative colitis depend on

severity of active disease and duration

what is the long term complication of ulcerative colitis

cancer

what is a hernia

weakness or defect in the wall of the abdominal cavity which allows for protrusion or sac

what are usual areas for hernias

inguinal and femoral canals

umbilicus

how are hernias formed

-pressure at neck may block vascular flow and chyme

-trapped contents cause further swelling --> permanent trapping (incarceration)

-strangulation and infarction of the trapped segment

what are adhesions

bands of scar tissue

what could cause formation of adhesions between bowel segments and/or abdominal wall

peritonitis

what is the danger of adhesions in the bowel segments

creates a closed loop through which a segment of bower could slide through and become trapped

what is an internal hernia considered

adhesion

what is intussusception

-telescoping of a bowel segment into the immediate distal segment

-at neck of herniation

what causes an intussusception

peristaltic wave

-pulls the mesentery in along with the segment

what is the risk of intussusception

infarction due to vasculature compromise

what is volvulus

twisting of a loop of bowel

what areas does volvulus affect

suspending areas (not retroperitoneal)

-sigmoid, cecum, small intestine, stomach

what part does volvulus rarely affect

transverse colon

what does volvulus lead to

intestinal obstruction and infarction

what cancer represents only 3-6% of GI tumors

tumors of small intestine

what are most benign tumors of the small intestine

adenomas and mesenchymal tumors

where do adenomas in the small intestine occur

ampulla of vater

who is most affect by tumors of fthe small intestine

30-60 year olds with occult blood loss (blood in stool not noticed)

what are signs of tumors of the small intestine

abnormal digestion

inflammation

what are polyps

tumorous mass that protrudes into the lumen

how do polyps usually start and what do they become

start as sessile and become pedunculated

what causes polyps to form

genetic mutation (juvenile polyp; peutz jeuger)

inflammation (inflammatory pseudopolyps; Crohn's)

architecture (hyperplastic polyps)

juvenile polyps, inflammatory pseudopolyps, hamartomatous polyps, and hyperplastic polyps are _____

non-neoplastic but monitored

what are polyps that arise from proliferation and dysplasia

adenomatous polyps --> precursor of carcinoma

what are the 4 most common cancers

1: breast

2: prostate

3: lung

4: colorectal carcinoma

what is the second leading cause of death by cancer

colorectal carcinoma

what is the peak incidence of colorectal carcinoma

60-80

what are the risk factors of colorectal cancer

-excess dietary caloric intake

-low content of vegetable fiber

-high content of refined carbs

-red meat

-decreased intake of protective micronutrients

what region is colorectal cancer seen in females

colon (besides rectum)

what region is colorectal cancer seen in males

rectum

how does reduced fiber lead to colorectal carcinoma

decreased stool bulk, increased fecal transit time, and altered bacterial flora

what is seen in older male with colorectal cancer due to bleeding

iron deficient anemia

how to increase survival rate of colorectal carcinoma

early detection

yearly stool tests

detection of polypoid tumors

what is stage 1 cancer

one layer of tissue affected

what is stage 2 cancer

multiple layers of tissue or in lymph

what is stage 3 cancer

larger and can spread to adjacent tissues

what is stage 4 cancer

distal metastasis

what is irritable bowel syndrome

syndrome with abdominal pain or discomfort reported as cramping, bloating, gas, diarrhea, and/or constipation

what part of the GI tract does irritable bowel syndrome affect

colon

is irritable bowel syndrome a disease

no, it is a functional disorder

what does overly sensitive nerves and muscles in IBS cause

more contraction than necessary or nerves may be overactive with stretching of bowel

does IBS cause damage

no it does not cause damage to the bowel or lead to other health problems

what causes pain in IBS

stretching either from fecal matter or gas

what are other symptoms of IBS besides pain

-whitish mucus in the stool

-swollen abdomen

-tenesmus: feeling that you may not have finished a movement

when do women have more symptoms of IBS

during menstrual period

is there a cure of IBS

no but it can be managed with diet changes, medicine, and stress relief

what foods should be avoided with iBS

fatty foods, milk products, chocolate, alcohol, caffeine, carbonated beverages

what can help with IBS

increasing fiber and eating smaller meals

what diet is recommended for IBS

low FODMAP (sugars)

what medicines are recommended for IBS

laxatives for constipation

antispasmodics for colon spasms

antidepressants for stress

what does the liver produce

bile

where is bile exported

duodenum

where is the liver located

right side of abdomen

what are the 4 lobes of the liver

right, left, caudate, quadrate

which lobes of the liver are located on the inferior part

caudate and quadrate

which ligament of the liver is a mesentery found between the right and left lobe on front

falciform

which ligament of the liver connects it to the anterior abdominal wall

falciform

which ligament of the liver is found inferiorly on the falciform ligament and is a remnant of fetal umbilical vein

round ligament

when does the umbilical vein usually degenerate

once umbilicus is cut

which ligament of the liver attaches the liver to the diaphragm

coronary

what creates the triangular ligament of the liver

stretching of the coronary ligament

what is the bare area of the liver

-top of liver

-sits below diaphragm

-not covered by visceral peritoneum

what ducts leave the liver and what do they join together to form

right and left hepatic ducts leave the liver and form the common hepatic duct

which duct from the gallbladder joins the common hepatic duct to form the common bile duct

cystic duct

what are the sulcus in the liver from

IVC

vascularity

what are the hexagonal structural units of the liver

liver lobules (size of sesame seed)

what is found within the liver lobules

hepatocytes

how are hepatocytes organized in the liver lobule

radiate outward from a central vein