Patho Exam 4

cardio gi and respiratory

cheiloplasty

surgical correction of cleft lip/palate

cleft lip can be repaired

soon after birth

cleft palate can be repaired

after 1 to 2 years of age, requiring speech therapy

temporary deciduous teeth

20

permanent teeth

32

tetracycline

antibiotic harmful to enamel formation causing permanent discoloration in crowns

dental plaque

sticky film formed from bacteria mixing with saliva

dental caries

tooth decay from plaque combined with bacterial action

dental cavity

loss of tooth structure from bacterial action

patients with xerostoma have a higher incidence of cavities because

saliva buffers bacterially produced acid

periodontal disease

inflammation in tissues supporting teeth forms pockets of infection between teeth and gums

stomatitis

inflammation of oral cavity

stomatitis caused by iritamts

alcohol, tobacco, hot and spicy foods

stomatitis caused by infectious agents

herpes virus, candida albicans fungus, bacteria responsible for trench mouth

oral cavity carciomas

arise from squamous epithelium

location of oral cavity carcinomas

lips, cheeks, tongue, palate, back of throat

elderly oral cavity carcinomas

alcohol tobacco use, bad prognosis

young people oral cavity carcinomas

HPV from oral sex, better prognosis

cardiac sphincter

gastroesophageal, the lower sphincter

tears at gastroesophageal junction

from repetitive vigorous contractions increasing intrabdominal pressure

cardiospasm

cardiac sphincter fails to open, malfunction of nerve plexus, esophagus dilated from food retention

incompetent cardiac sphincter

sphincter remains open letting gastric juice into esophagus

complications of incompetent cardiac sphincter

reflux esophagitis, ulceration and scarring, Barrett esophagus

Barret Esophagus

glandular metaplasia change from squamous to columnar epithelium, increasing risk for cancer

tracheoesophageal fistula

carcinoma of esophagus invades trachea

food impaction of esophagus

occurs in distal part

stricture of esophagus

from scar tissue due to necrosis and inflammation from corrosive chemicals such as lye

gastric mucosal tears

linear tears caused by vomiting leading to blood vomit

acute gastritis

inflamed gastric lining from NSAIDS or alcohol

NSAIDS that inhibit cyclooxygenase enzyme (cox)

aspirin, ibuprofen, naproxen

Cox-1

promotes synthesis of prostaglandin that protects gastric mucosa

cox-2

promotes synthesis of prostaglandin that mediates inflammation

drugs that inhibit cox 2

increase risk of heart attack and stroke

alcohol

gastric irritant stimulating gastric acid and secretion

H Pylori gastritis

gram negative organisms colonize surface of gastric mucosa, producing urease and breaking down mucus layer

urease

decomposes urea into ammonia, neutralizing gastric acid and allowing organisms to flourish

H pylori gastritis increases risk of

mucosa associated lymphoid tissue MALT

H pylori gastritis progression

increases with age

peptic ulcer

increased acid secretion digests mucosa, H pylori associated

peptic ulcer common locations

distal stomach or proximal duodenum

peptic ulcer complications

hemorrhage, perforations, peritonitis, obstruction from scarring

peptic ulcer treatment

antacids, antibiotics, surgery

carcinoma of stomach

upper abdomen discomfort and iron deficiency anemia, diagnosed through biopsy

carcinoma of stomach treatment

surgical resection of affected area, long term survival relatively poor

acute enteritis

common intestinal infection causing nausea, vomiting, abdominal discomfort and loose stools

chronic enteriris

less common and more difficult to treat

Regional enteritis or Crohn disease

chronic scattered inflammation and ulceration of mucosa with thickening and scarring of bowel wall

treatment of enteritis

drugs, possible surgical resection

antibiotic associated colitits

broad spectrum antibiotics destroy normal intestinal flora allowing growth of C diff

symptoms of colitis

diarrhea, abdominal pain, fever

diagnosis of colitis

stool culture, toxin in stool

treatment of colitis

stop antibiotics. give vancomycin or metronidazole

drugs that prolong colitis

drugs that decrease intestinal mobility

Meckel Diverticulum

congenital outpouching in the small intestine, located near the junction of the small and large intestines. It can cause abdominal pain or bleeding.

food intolerance

crampy abdominal pain, distension, flatulency, loose stools

lactose intolerance

Condition where the body can't digest lactose, a sugar found in milk. Symptoms include bloating, diarrhea, and gas after consuming dairy products.

glucose intolerance

chronic diarrhea impairing absorption of fats and nutrients, weight loss, and vitamin deficiencies

Irritable Bowel Syndrome

spastic/mucous colitis, excessive mucus secreted by colonic mucosal glands, alternating diarrhea and constipation

IBS manifestations

episodes of crampy abdominal discomfort, loud gurgling bowel sounds and disturbed bowel function without structural or biochemical abnormalities

IBS diagnosis

exclude pathogenic infections, food intolerance, and inflammatory conditions

IBS treatment

reduce emotional tension and improve intestinal ability

Appendicitis

most common inflammatory lesion of the bowel

appendicitis pathogensis

appendix plugged with fecal material, secretions drain poorly, creating pressure and compressing blood supply, or bacteria invade causing inflammation

appendicitis manifestations

abdominal pain in RLQ, rebound tenderness, rigidity

ulcerative colitits

large intestine and rectal mucosa inflamed without bowel thickening

ulcerative colitis complications

bleeding, bloody diarrhea, perforation, cancer of colon or rectum

ulcerative colitis treatment

supportive measures, antibiotics, corticosteroids, immunosuppressive drugs, surgical resection

intestinal obstructions

a serious condition blocking normal passageway of intestinal contents, severity depends on location and interference with blood supply

high intestinal obstruction

sever, crampy abdominal pain from vigorous peristalsis, vomiting with loss of H2O and electrolytes causing dehydration

low intestinal obstruction

symptoms less acute, mild, crampy abdominal pain, moderate distension of abdomen

common causes of intestinal obstruction

adhesions, hernia, tumor, volvulus, intussusception

intestinal adhestions

adhesive bands of connective tissue, may cause loop of bowel to become kinked, compressed, twisted, causes obstruction proximal to site of adhesion

hernia

protrusion of loop of bowel through a small opening, usually in abdominal wall, herniated loop pushes through peritoneum to form herniated sac

inguinal hernia

common in men, loop of small bowel protrudes through a weak area in inguinal ring and descends downward into scrotum

umbilical and femoral hernia common in

both sexes

umbilical hernia

loop of bowel protrudes through umbilucus through defect in abdominal wall

femoral hernia

loop of intestine extends under inguinal ligament along course of femoral vessels into the groin

reducible hernia

herniated loop of bowel can be pushed back into abdominal cavity

incarcerated hernia

herniated loop of bowel can not be pushed back into abdominal cavity

strangulated hernia

loop of bowel tightly constricted, obstructing the blood supply to the herniated bowel; requires prompt surgical intervention

volvulus

rotary twisting of bowel impairing blood supply; common site is sigmoid colon

intussception

telescoping of segment of bowel into adjacent segment; from vigorous peristalsis or tumor, common site is terminal ileum

mesenteric thrombosus

thrombosus of superior mesenteric artery, extensive bowel infarction

diverticulosis

outpouching or diverticula of colonic mucosa through weak area areas in muscular wall of large intestine

predisposes to diverticulosis

low residue diet, because increased intralumenal pressure must be generated to propel stools through colon

diverticulitis

inflammation incited by bits of fecal material trapped within outpouchings

diverticulitis complications

inflammation, perforation, bleeding, scarring, abcess

benign pedunculated polyps of colon

frequent, tip may erode causing bleeding, removed during colonoscopy

types of carcinoma of colon

cecum and right ½ of colon or left half of colon

tumor of cecum and right ½ of colon

does not cause obstruction because caliber is large and bowel contents are relatively soft. tumor can ulcerate and bleed leading to chronic iron deficiency anemia, weakness and fatigue

tumor of left ½ of colon

causes obstruction and symptoms of lower intestinal obstruction

diagnosis of colon carcinoma

narrowed colon on barium enema

change from normal colon to small benign polyp

loss of APC gene

change of small benign polyp to large benign polyp

oncogenic mutation in Ras gene

change of large benign polyp to invasive malignant colon cancer

mutation or loss of p53 function

imperforate anus

congenital abnormality where colon fails to acquire a normal opening, two types

easily treated by incising tissue covering anal opening

rectum and anus normally formed and extends to level of skin just without an anal orifice

corrected surgically, more technically difficult with less satisfactory results

entire distal rectum fails to develop with associated abnormalities of urogenital and skeletal system

hemorrhoids

varicose veins of hemorrhoidal venous system that drains rectum and anus

predisposal to hemorrhoids

constipation and straining