Pathology debby exam 3(elise)

With advanced cirrhosis, do you increase or decrease your kVp?

increase because it is additional fluid in the abdomen

Is an increased or decreased kVp needed in patients with suspected obstruction of the larger or small bowel?

decreased because of the excessive amount of gas in the abdominal cavity

What kVp setting is recommended to penetrate barium-filled structures for single-contrast studies?

110-120

what kVp range can be used in double contrast studies to demonstrate both positive and negative agents within and around organs?

90-100

what kVp range should be used when using iodinated, water-soluable contrast media?

80-90

What are the major modalities for the pancreas and biliary tract?

ultrasound and CT

what modality is useful when screening for hepatic metastases?

MRI

What is used for direct visualization of the esophagus, stomach, and duodenum?

endoscopy

What procedure is done to visualize the large intestine?

colonoscopy

What is the basic function of the digestive system?

to alter the chemical and physical composition of food so it can be absorbed and used by body cells

What is the chemical breakdown of food?

mastication

What is a complex process that requires the coordination of many muscles in the head and neck and the precise opening and closing of esophageal sphincters?

deglutition (swallowing)

Where does the greatest amount of digestion occur?

duodenum

Where is bile secreted?

liver

where is bile stored?

gallbladder

where does bile enter the duodenum through?

common bile duct

what is a substance that acts like soap by dispersing the fat into very small droplets that permit it to mix with water

an emulsifier.

When digestion is complete, what happens to the nutrients?

it is absorbed through the intestinal mucosa into blood capillaries and lymph vessels of the wall of the small bowel

What is the inner surface area of the small bowel is increased by the formation of numerous finger-like projections

villi

What is it when the contents of the lower colon and rectum move at a rate that is slower than normal, extra water is absorbed from the fecal mass to produced hardened stool

constipation

What results from an increased motility of the small bowel, which floods the colon with an excessive amount of water that cannot be completely absorbed

diarrhea

Where does the vermiform (worm-shaped) appendix arise from?

the inferomedial aspect of the cecum approximately 3 cm below the ileocecal valve

What is the largest gland in the body?

liver

approximately how much bile does the liver secrete each day?

1 pint

What does bile consist of?

a greenish liquid consisting of water, bile salts, cholesterol, and bilirubin

what is the major site of synthesis of the enzymes necessary for various cellular activities throughout the body

the liver

What are the essential proteins required for blood clotting?

fibrogen and prothrombin

What happens when the level of circulating glucose falls below normal?

the liver breaks down glycogen and releases glucose into the bloodstream

What is a pear-shaped sac lying on the undersurface of the liver

the gallbladder

What is the function of the gallbladder?

to store bile

How does the pancreas control the level of circulating blood glucose?

by secreting insulin and glucagon in the islets of langerhans

What result from the failure of a satisfactory esophageal lumen to develop completely separate from the trachea

congenital tracheoesophageal fistulas

What is the most common congenital tracheoesophageal fistula?

type 3 TE fistula

50% of acquired fistulas between the esophagus and trachea are caused by what?

malignancy of the mediastinum

What are any symptomatic condition or structural changes caused by reflux of the stomach contents into the esophagus

Gastroesophageal reflux disease

what develops when the lower esophageal sphincter fails to act as an effective barrier to the entry of gastric acid contents into the distal esophagus

reflux esophagitis

What is a condition related to severe reflux esophagitis, in which the normal squamous lining of the lower esophagus is destroyed and replaced by columnar epithelium similar to that of the stomach

Barrett esophagus

What are the organisms most responsible for infectious esophagitis, which usually occurs in patients with widespread malignancy who are receiving radiation therapy, chemotherapy, corticosteroids, or other immunosuppressive agents

candida (fungal) and herpesvirus

The ingestion of alkaline or acidic corrosive agents produces acute inflammatory changes in the esophagus

Ingestion of Corrosive agents

Progressive difficulty in swallowing (dysphagia) in a person older than 40 years must be assumed to be caused by cancer until demonstrated otherwise

esophageal cancer

what are common lesions that either contain all layers of the wall or are composed of only mucosa and submucosa herniating through the muscular layer

Esophageal Diverticula

what arise from the posterior wall of the upper (cervical) esophagus and can occasionally become so large that they almost occlude the esophageal lumen

Zenker diverticula

what arise in the distal 10 cm of the esophagus and are associated with incoordination of esophageal peristalsis and sphincter relaxation, which increases the intraluminal pressure in this segment

Epiphrenic diverticula

what are dilated veins in the wall of the esophagus that are most commonly the result of increased pressure in the portal venous system, which is in turn usually a result of cirrhosis of the liver.

Esophageal Varices

What is the radiographic appearance of esophageal varices

a wavy border and thickening of folds

What is the most common abnormality detected on upper GI examinations? (occurs in 50% of the population)

Hiatal Hernia

What is a functional obstruction of the distal section of the esophagus with proximal dilation caused by incomplete relaxation of the lower esophageal sphincter?

Achalasia

Where are foreign bodies usually located?

in the esophagus, usually in the cervical esophagus at or just above the level of the thoracic inlet

What is the most common cause of Perforation of the esophagus?

vomiting

What is an increase in intraluminal and intramural pressures associated with vomiting (severe retching) after an alcoholic bout causes superficial mucosal lacerations or fissures near the esophagogastric junction, producing severe hemorrhage

Mallory-Weiss syndrome

What is inflammation of the stomach?

gastritis

What is also known as infantile hypertrophic pyloric stenosis (IHPS), and occurs when the two muscular layers of the pylorus become hyperplastic and hypertonic?

Pyloric stenosis

What is caused by the action of acid and the enzyme pepsin secreted by the stomach and occurs most frequently on the lesser curvature?

Peptic ulcer disease

What is the most common manifestation of peptic ulcer disease?

Duodenal Ulcer

Where do gastric ulcers usually occur?

lesser curvature of stomach

most carcinomas of the stomach occur in the _________ and are __________ in nature.

distal stomach, adenomatous

What diagnosis can be made if there is evidence of gas bubbles (produced by the bacteria) in the stomach wall?

infectious gastritis

What changes the normal surface pattern of the gastric mucosa?

Gastritis

What refers to severe mucosal atrophy (wasting) that causes thinning and relative absence of the mucosal folds, with the fundus or entire stomach having a bald appearance?

Chronic atrophic gastritis

when a pyloric stenosis is palpated what does it feel like

a mobile hard "olive"

What is the imaging modality of choice for pyloric stenosis?

Ultrasound

what are some major complications of peptic ulcer disease?

hemorrhage, gastric outlet obstruction, and perforation

What is the most common cause of upper GI bleeding?

peptic ulcer disease

How does a gastric ulcer appear?

a persistent collection of barium surrounded by a halo of edema (the ulcer collar)

What modality is of major value in the staging of gastric carcinoma?

CT

What is a chronic inflammatory disorder of unknown cause that most often involves the terminal area of the ileum but can effect any part of the GI tract?

Crohn's Disease

What age group is Crohns most common in?

young adults

What accounts for almost 75% of all small bowel obstructions?

Fibrous adhesions caused by previous surgery of peritonitis

Distended loops of small bowel containing gas and fluid can usually be recognized within how many hours of the onset of complete obstruction?

3-5 hours

What is a common disorder of intestinal motor activity in which fluid and gas do not progress normally through a non-obstructed small and large bowel

Adynamic ileus

What are the two major variants of adynamic ileus?

localized ileus and colonic ileus

what refers to an isolated distended loop of small or large bowel (the sentinel loop), which is often associated with an adjacent acute inflammatory process?

localized ileus

What refers to selective or disproportionate gaseous distention of the large bowel without an obstruction?

colonic ileus

What is the telescoping of one part of the intestinal tract into another because of peristalsis, which forces the proximal segment of bowel to move distally within the ensheathing outer portion?

Intussusception

How does intussusception appear radiographically?

a classic coiled-spring appearance

What refers to a multitude of conditions in which there is defective absorption of carbohydrates, proteins, and fats from the small bowel

Malabsorption disorders

is a colonoscopy or a barium enema more accurate in detecting polyps, cancers, and colitis?

colonoscopy

What develops when the neck of the appendix becomes blocked by fecalith or by post inflammatory scaring that creates a closed-loop obstruction within the organ?

appendicitis

What are outpouchings that represent acquired herniations of mucosa and submucosa through the muscular layers at points of weakness in the bowel wall?

Diverticulosis

What has the radiographic appearance of "outpouchings"

diverticulosis

What is a compilation of diverticular disease of the colon, especially in the sigmoid region, in which perforation of the diverticulum leads to the development of a peri diverticular abscess?

diverticulitis

What are the two major inflammatory bowel diseases?

ulcerative colitis and Crohn colitis

What age group does ulcerative colitis primarily affect?

young adults and is highly variable in severity, clinical course, and ultimate prognosis

What refers to sharply defined finger-like indentions along the margins of the colon wall?

thumbprinting (ischemic colitis)

What comprises several conditions that have an alteration in intestinal motility as the underlying pathophysiologic abnormality?

Irritable bowel syndrome

What is the third leading cause of death from cancer in the united states?

carcinoma of the colon and rectum

What percent of large bowel obstructions result from primary colon carcinoma?

70 %

What refers to a twisting of the bowel on itself that may lead to intestinal obstruction?

Volvulus

What are varicose veins of the lower end of the rectum that cause pain, itching, and bleeding?

hemorrhoids

What is a long redundant loop of sigmoid colon that can undergo a twist on its mesenteric axis and form a closed- loop obstruction

sigmoid volvulus

What are the two major types of gallstones?

cholesterol and pigment

What occurs after obstruction of the cystic duct by an impacted gallstone?

Acute cholecystitis

What is a rare condition in which the growth of gas-forming organisms in the gallbladder is facilitated by stasis and ischemia caused by cystic duct obstruction

Emphysematous Cholecystitis

What refers to extensive calcification in the wall of the gallbladder, which forms an oval density corresponding to the size and shape of the organ?

porcelain gallbladder

What is the most prevalent inflammatory disease of the liver?

hepatitis

What refers to the chronic destruction of liver cells and structure, with nodular regeneration of liver parenchyma and fibrosis, it is an end-stage liver disease.

Cirrhosis of the liver

What are the most common malignant tumors of the liver?

Metastases

What is an inflammatory process in which protein and lipid digesting enzymes become activated within the pancreas and begin to digest the organ?

Acute pancreatitis

What results when frequent intermittent injury to the pancreas causes increasing damage that produces scar tissue?

Chronic pancreatitis

What are loculated fluid collections arising from inflammation, necrosis, or hemorrhage associated with acute pancreatitis or trauma?

Pancreatic Pseudocyst