Gastrointestinal

What is stomatitis? What are three common causes?

- inflammation of the oral mucosa

- herpesvirus

- Candida albicans infection (thrush)

- Aphthous stomatitis (canker sores)

What causes mouth and genital herpes in the US?

- HSV1

- HSV2

Most oral cancers are what type of cancer? What are two common risk factors? How fast does oral cancer grow?

- squamous cell carcinoma

- tobacco smoking and chronic alcohol use

- grows very rapidly

What are two precancerous lesions of the mouth? Which is more likely to turn into cancer?

- leukoplakia (white plaque)

- erythroplakia (red plaque, more likely to turn into cancer)

What are 4 morphological presentations of oral cancer?

- plaque

- ulcer

- crater

- nodule

What is sialadenitis? What is the most common immunological cause? What are the symptoms?

- infectious or autoimmune salivary gland disease

- Sjorgren's syndrome

- swelling of glands, xerostomia, sialorrhea

How common are salivary gland neoplasms? What percentage is benign? What is the most common tumor?

- very rare and slow growing

- over 60% are benign

- pleomorphic adenoma

What are three general presentations of esophageal disease?

- dysphagia

- esophageal (retrosternal) pain

- aspiration or regurgitation

What is esophageal atresia? How prevalent is it?

- Congenital condition in which the esophagus ends in a blind pouch

- most common developmental issue of the esophagus

What are the two types of hiatal hernia? Which is more common? Which is more serious? Hiatal hernias are the most common cause of what condition?

- sliding, paraesophageal

- sliding is more common

- paraesophageal is more serious (strangulation, infection risk)

- GERD

What is achalasia?

motor disorder of the esophagus characterized by impaired relaxation of the lower esophageal sphincter (LES), stenosis of the sphincter

What is a common cause of esophageal varices? What can it cause (3)?

- cirrhosis that causes portal vein HTN

- upper GI bleed (melena), hematemesis, iron-deficiency anemia

What are four causes of esophagitis?

- reflux of gastric juice (peptic esopagitis)

- infection (viruses, fungi, bacterial infection)

- chemical irritants (exogenous chemicals or drugs)

- iatrogenic (feeding tube)

Carcinoma of the esophagus accounts for what percentage of all cancers?

- 4%

What places have higher incidence of esophageal cancer?

Asia and Africa

What are 3 risk factors for esophageal cancer? What is the prognosis?

- alcohol and tobacco use

- more common in men than women

- race: more common in black people than white people

- poor prognosis: 2 yr avg survival rate

What are 5 symptoms of disease of the stomach of duodenum?

- pain: midline/upper abdomen

- vomiting

- bleeding

- dyspepsia

- systemic symptoms: iron def. anemia, vit B12 malabsorption (megaloblastic anemia)

What is the most common developmental abnormality of the stomach? What group is most affected?

- congenital stenosis of the pyloric sphincter

- 4 x more common in males

What are three causes of acute (erosive) gastritis? What two things result?

- circulatory disturbances

- food

- exogenous chemicals and drugs

- erosions and ulcerations

What are two things that cause chronic atrophic gastritis?

- Helicobacter pylori

- autoimmune (with pernicious anemia)

What are three things that contribute to peptic ulceration?

- gastric juice: HCl, pepsin

- mucosal barrier defects: stress, shock, NSAIDs, smoking

- Helicobacter pylori: found in most pts with ulcers

What is the first and second most common sites for peptic ulcers? How are their symptoms different?

- duodenum: food relieves

- stomach: food causes pain

What are 4 possible complications of peptic ulcer disease?

- hemorrhage (most common): hematemesis, melena, iron def. anemia

- penetration into pancreas -> acute pancreatitis

- perforation -> peritonitis

- cicatrization (hardening) -> stenosis, decreases peristalsis

What are polyps?

benign epithelial gastric tumors

What is a leiomyoma?

benign stromal gastric tumor

What are two malignant tumors of the stomach and which is most common? Most malignant tumors of the stomach are primary or secondary? What percentage of tumors in the stomach are cancerous?

- adenocarcinoma (most common)

- lymphoma

- primary

- 90%

Carcinoma of the stomach is 8 x more common in which countries?

Japan and Chile

How has the incidence of gastric cancer changed in the US over the past 70 years? What are two possible etiologies for gastric cancer?

- decreased

- nitrosamines in food and maybe H. pylori

What are two developmental diseases of the intestines?

- Hirschsprung's disease (missing nerve cells in colon, can't move stool)

- Meckel's: congenital diverticula

What is diverticulosis? How can you get it? What is diverticulitis?

- out-pouchings of the haustra, diverticula

- congenital or acquired

- when the out-pouchings get inflammed

What are hemorrhoids?

varicose veins in rectum

What is angiodysplasia?

localized vascular lesion in the colon caused by HTN -> bleeding

What are the symptoms of chronic ischemic bowel disease? What causes it?

- caused by atherosclerosis

- vague symptoms of abdominal discomfort

What happens in acute ischemic bowel disease?

complete blockage, necrosis, need surgery

Features of Crohn's vs ulcerative colitis:

familial incidence

peak age

immune disturbances

extraintestinal complications

treatment

Features of Crohn's vs ulcerative colitis:

Distribution of lesions

transmural

granuloma

fistula

megacolon

cancer

What are three GI infections that cause bacterial diarrhea?

- food poisoning (bacterial toxins)

- travelers diarrhea (E. coli)

- salmonella

How does viral gastroenteritis compare to bacterial?

more mild

What is the most common cause of viral gastroenteritis in vaccinated kids, unvaccinated, and adults?

- rotavirus in unvacc

- norovirus in vacc and adults

What causes acute appendicitis?

The opening of the appendix is obstructed leading to stagnation of contents and inflammation. Bacteria may colonize the appendix and infection occurs that may cause rupture.

What are 4 causes of acute infectious peritonitis?

- rupture of stomach

- spread of infection from fallopian tubes

- rupture of abscess

- infection of preexisting ascites

What are three causes of acute sterile peritonitis?

- acute pancreatitis

- rupture of gallbladder

- postsurgical peritonitis by talc or chemicals used during surgery

What are two general causes of intestinal obstruction?

- paralytic ileus (motor activity impaired without physical obstruction)

- mechanical ileus

What are causes of mechanical ileus?

- atresia/stenosis/stricture

- intussusception (folds on self)

- volvulus (twisting)

- hernia

- adhesions

- neoplasms

Malabsorption results from abnormalities involving what three processes?

- intraluminal digestion of food

- uptake and processing of nutrients within intestinal cells

- transport of the nutrients from intestine to liver

What are 4 ways defective intraluminal digestions can cause malabsorption?

- deficiency of gastric juices: postgastrectomy conditions, atrophic gastritis

- deficiency of bile or brush border enzymes: biliary obstruction, liver disease, Crohn's disease, short bowel syndrome

- deficiency of pancreatic juices: chronic pancreatitis, CF

- overgrowth of microorganisms: Giardia lamblia

What are 5 conditions that damage the absorptive surface of the intestine?

- Celiac sprue

- Tropical sprue

- infectious enteritis (ex: E. coli)

- Crohn's

- Whipple's (rare, bacterial, similar symptoms to Crohn's)

What is short bowel syndrome?

malabsorption and diarrhea resulting from extensive bowel resection

What are three ways malabsorption can result from defective transport of nutrients?

- Lymphatic obstruction (gastrointestinal lymphoma)

- Intestinal ischemia (congestive heart failure)

- inadequate lipoprotein synthesis (congenital abetalipoproteinemia)

What part of the GI is most commonly affected by intestinal neoplasms?

colon

What proportion of intestinal neoplasms are benign and malignant? Is primary or secondary more common?

3:1 B:M

primary

What is the most common type of intestinal neoplasm?

epithelial (90%)

What are three classes of intestinal tumors?

- non-neoplastic polyps (hyperplastic polyp, inflammatory polyp etc)

- benign neoplasms (adenomas, benign stromal tumors)

- malignant neoplasma (carcinomas and sarcoma)

What is the third most common cancer of internal organs? How can you prevent it?

- large intestine

- regular colonoscopies and getting benign polyps removed

What are three genetic colon cancers and how are they inherited?

- familial polyposis coli (AR)

- Gardner's syndrome (AD)

- Hereditary nonpolyposis colorectal cancer (tumors in all epithelial tissue)

What about the Western diet contributes to colon cancer?

- low fiber, high carb and fat

Gastrointestinal carcinoids occur where? Where do you usually find multiple? Which type tend to metastasize? What are they composed of?

- 90% in intestines, appendix most common site

- terminal ileum and stomach

- large ones can metastasize

- neuroendocrine cells that contain granules visible by electron microscopy

How do gastrointestinal carcinoids compare to carcinomas in terms of malignancy? What do they secrete? What can these secretions cause? Tumors that metastasize to the liver cause what?

- not as malignant as carcinoma

- polypeptide hormones that are locally active

- diarrhea and hypermotility of intestines

- carcinoid syndrome: facial blushing, bronchial wheezing, heart valve damage