Gastro - Final Exam review

What is Meckel's diverticulum a remnant of?

vitelline duct; connected the developing gut to the yolk sac

Is Meckel's diverticulum symptomatic or asymptomatic?

Usually asymptomatic, and incidental finding

What is the AKA for Hirschsprung's Dx?

congenital megacolon

Hirschsprung's Dx is a congenital disorder of _______ of a portion of the intestinal tract usually the rectum, and possibly sigmoi

aganglionosis

The different ways a person can get an acquire megacolon include:

Chagas dx

Organic obstruction (neoplasm)

Toxic megacolon due to ulcerative colitis or chron's

Functional psychosomatic disorder

What is diarrhea?

abnormally frequent discharge of semisolid or fluid fecal matter

What is dysentery?

low-volume, painful, and bloody diarrhea

_________ diarrhea occurs when intestinal fluid secretions lead to output >500ml/day, which is isotonic with plasma and persists with fasting

secretory

___________ diarrhea occurs when excessive osmotic forces by luminal solutes lead to >500ml stool/day, which abates during fasting

osmotic

___________ mucosal destruction leads to output of purulent bloody stools, persist with fasting

Exudate disease

___________ aberrant neuromuscular function

produce variable patterns of increased stool volume

deranged motility

___________ abnormal absorption produces

voluminous, bulky stool with fat (steatorrhea) usually abates with fasting

malabsorption

What is the MC viral infection that causes diarrhea in children?

Rotavirus

What is the MC viral infection that causes diarrhea in the general population?

Norovirus

What bacteria can cause diarrhea?

• E-coli

• Salmonella

• clostridium

• Campylobacter

• shigella

What is an enteroinvasive bacteria?

penetrates into the cell and kills it

What is an enterocigenic bacteria?

toxin produced by bacteria that leads to digestion problems

What are the AKAs to celiac disease?

Celiac sprue

Gluten-sensitive enteropathy

What is celiac disease?

Mucosal lesion of small intestine and impaired nutrient absorption, improves if gluten is removed from diet

Who mostly gets celiac's Dx

Caucasians

What is Tropical Sprue?

Celiac-like disease that occurs almost exclusively in people

of the tropics

What do patients with tropical sprue usually present with?

folate or vit B12 deficiency

What is Whipple disease caused by?

tropheryma whippelii

What malabsorption syndrome can cause arthropathy, polyarthritis, lymphadenopathy and hyperpigmentation?

whipple dx

lactose intolerance can lead to __________

osmotic diarrhea

Is lactose intolerance usually acquired or congenital ?

usually acquired; congenital is rare

What is adult onset of lactose intolerance associated with?

viral & bacterial enteric infections of the gut

What are the AKAs for Crohn's Dx?

Terminal ileitis

Regional enteritis

Granulomatous colitis

What is Crohn's dx pathologically characterized by?

Transmural involvement of the bowel

Presence of noncaseating granulomas

Fissuring with formation of fistulae

Mesentery is granular and gray, with fat wrapping around bowel (creeping fat)

Intestinal wall is rubbery and thick, as a consequence of edema, inflammation, fibrosis, and hypertrophy of the muscularis propria

Lumen is narrowed (String sign on X-ray)

Skip lesions- clear demarcation of diseased bowel from uninvolved areas

If the small intestine is involved in crohn's dx, what can it lead to?

malabsorption issues ie. Vit B12 - pernicious anemia, bile salts -

steatorrhea

Extraintestinal involvement of Crohn's Dx includes:

Polyarthritis

Sacroilitis

AS

Clubbing of fingertips

Ulcerative colitis affects the ________ and on the mucosa and submucosa

colon

What is ulcerative colitis associate with?

Polyarthritis

Sacroiliitis

AS

Uveitis

Hepatic involvement

Broad ulceration of the mucosa in fully developed ulcerative colitis, with isolated islands of regenerated mucosa bulging upwards that create ___________

pseudopolyps

Only in severe cases of both CD and UC toxic damage to the __________ and __________ will cause it to shut down. It progressively swells and becomes gangrenous (___________)

muscularis externa; neural plexus; toxic megacolon

What is a long term complication of ulcerative colitis?

cancer

A ___________ is a weakness or defect in the wall of the abdominal cavity which may allow for a protrusion or sac

hernia

Usual areas for hernias are:

inguina/femoral canals and umbilicus

The trapped contents with a hernia may cause further swelling, which will lead to permanent trapping "____________________"

incarceration

____________ could lead to adhesions developing between bowel segments, and/or abdominal wall

Peritonitis (inflammation of peritoneum)

__________________ is described as a telescoping of a bowel segment into the immediate distal segment

Intussusception

What is intussusception a result of?

peristaltic wave

What can intussusception cause?

Could cause infarction due to vasculature compromise.

A _____________ described as a twisting of a loop of bowel

volvulus

What does a volvulus usually invovle?

the sigmoid, cecum, small intestine, stomach and rarely the transverse colon

Cancer (tumors of the small intestine), represent what % of GI tumors?

3-6%

Most benign tumors of the small intestine are what? (2 things)

Adenomas and mesenchymal tumors

Adenomas of the small intestine occur where?

At the ampulla of Vater

In what age group are tumors of the small intestine usually seen?

Age 30-60 with occult blood loss

What are polyps?

Tumorous mass that protrudes into the lumen. Usually start as sesile (broad base to it) but with traction will become pedunculated (an elongated stalk of tissue)

Polyps may form as a result of what?

Abnormal mucosal maturation, inflammation or architecture (non-neoplastic)

Polyps that arise from proliferation and dysplasia are called what?

Adenomatous polyps precursor of carcinoma

Hamartomatous polyps and peutz-jeghers are also examples of what?

Non-neoplastic polyps

Colorectal carcinoma peak incidences occur around what age?

60-80

What are the 5 main risks for colorectal cancer?

1) Excess dietary caloric intake

2) low content of veggie fibers

3) high content of refined carbs

4) red meat (BOOOOOO)

5) Decreased intake of protective micronutrients

Decreased stool bulk, increased fecal transit time, and altered bacterial flora are caused by?

reduced fiber

Iron-deficient anemia is usually observed in whom?

An older male with colorectal cancer, due to bleeding

T/F with early detection of colorectal carcinoma, chances of survival go up?

True

Detection of [what] is key for detection of colorectal carcinoma?

Polypoid tumors

Irritable bowel syndrome has what symptoms?

1) abdominal pain or discomfort reported as cramping, bloating, gas, diarrhea and/or constipation

2) affects the colon

T/F Irritable bowel syndrome is a disease?

False. It's a functional disorder.

Doctors aren't sure what causes it.

T/F Irritable bowel syndrome doesn't damage the bowel?

True. It's painful, but it doesn't damage the bowel or lead to other health problems.

How are symptoms of Irritable bowel syndrome relieved?

A bowel movement

other helps can be found with Diet changes (ADD FIBER) medicine, and stress relief may help too! Eating smaller meals may also help.

What are some "other symptoms" of Irritable Bowel Syndrome?

Whitish mucus in stool,

swollen abdomen

The feeling that you may not have finished a movement

T/F woman have more symptoms of irritable bowel syndrome when they're on their period?

True

What foods should you avoid with irritable bowel syndrome?

Fatty foods

milk products

chocolate

alcohol

caffeine

carbonated beverages

What medicines can help with Irritable bowel syndrome?

Laxatives (constipation)

Antispasmodics (colon spasms)

Antidepressants (stress/depression)

T/F Liver and Gallbladder are accessory glands?

True

The liver produces [what] for export to the duodenum?

Bile

Which side of the abdomen does the liver mostly reside?

Right side

What are the 4 lobes of the liver called?

Right

Left

Caudate (back)

Quadrate (front) - next to gallbladder

Which ligament is a mesentery found between the rt and lt lobe on the front attaching to the anterior abdominal wall?

Falciform ligament

*divides liver into 2

Which ligament is found inferiorly on the falciform lig?

The round ligament of the liver

The remnant of the "fetal umbilical v" is called what?

The round ligament of the liver

Which ligament attaches the liver to the diaphragm?

The coronal ligament

*at very Rt and Lt there's a stretching that forms triangular ligaments

The right and left hepatic ducts leave the liver, join together to form what?

The common hepatic duct

Cystic and common hepatic duct join together and become what?

Common Bile Duct

The liver is formed of what?

Hexogonal structural units called "liver lobules"

*size of a sesame seed

T/F Plates of hepatocytes are located within the liver lobules?

True

What does the portal triad consist of and where is it located?

It's at each of the six corners of the liver lobule.

Includes: Bile Duct, Portal artery, and portal vein

The liver sinusoids pass between where?

Between the plates

Blood from the hepatic AA and the portal VV travel through the sinusoids to what?

The Central Vein, which goes on to the interlobular vein!

The interlobular vv eventually dumps where?

into the hepatic vv, which dump into the inferior vena cava.

Kupffer cells are found where and what do they do?

in the walls of the sinusoids

They remove bacteria and dead blood cells

Bile within the liver, flows through where?

Through bile canaliculi (aka canal of hering) that runs between the hepatocytes toward the bile ducts in the triad

What's the space between the sinusoids and hepatocytes called?

Space of disse

The space of Disse contains what?

Quiescent stallate cells, which store Fat and fat soluble vitamins

Quiescent stallate cells store what?

Fat and fat soluble vitamins (ADEK)

What is the general composition of bile?

Yellow-green alkaline solution containing bile salts, pigments, cholesterol, fat and lecithin

Bile salts facilitate absorption of what?

Fat and cholesterol

Bile salts are reabsorbed by what?

Enterohepatic circulation (at ileum)

Liver produces how much bile a day?

500-1000ml/day

General composition of the gall bladder?

Thin green walled musculature sac about 4 inches long

Where does the gallbladder reside?

Under liver inferior to right lobe

What does the gallbladder do?

Stores bile that is produced by the liver when it's not immediately needed.

What happens to bile in the gallbladder?

It will concentrate from absorption of water and ions

T/F Liver has a dual blood supply?

True

*the hepatic aa (300 ml/min) and the hepatic portal vv (1050ml/min)

The hepatic portal vv brings blood to liver from where?

The gut, spleen and pancreas

The liver holds how much (%) of body's total volume?

10%

The blood leaves the liver via what/to where?

The hepatic veins to the inferior vena cava