7 (to match lecture #)

inflammation of the esophagus

esophagitis

esophagitis can occur 3 ways

through infectious agents (candida - fungus, herpes - viral)

eosinophilic esophagitis

reflux (gastric) acid contents

eosinophilic esophagitis

allergic reaction to the things we eat

what is the most common way to get esophagitits

reflux of acid

infectious agents for esophagitits

Candida - white patch

CMV/Herpes - ulcer

reflux of acid is due to the failure of the lower _____ ___

esophageal sphincter

the sphincter can become incompetent with increased ____-_____ pressure

intra-abdominal

lifting, obesity, pregnancy

the esophageal sphincter can become incompetent with direct ____

injury

alcohol, tobacco

the esophageal sphincter can become incompetant from some _____

foodstuffs

Barretts esophagus develops in some patietns with chronic ____ _____

refluc esophagitis

it is metaplasia in the esophagus - adaptive response to chronic injury

with Barretts esophagus, ____ mucosa is replaced by _____ mucosa with ____ ____

squamous

glandular

goblet cells

Barretts esophagus is at risk to develop _____ and then _____

dysplasia

cancer (adenocarcinoma)

does all barretts esophagus go to cancer?

no

most will get dysplactic

esophageal carcinoma is usually ____

lethal

esophageal carcinoma usually presents one of 2 ways

adenocarcinoma

squamous carcinoma

adenocarcinoma arises out of _____ metaplasia

Barretts

squamous carcinoma is related to ____ and ____ abuse

tobacco and alcohol

squamous carcinoma is most common in _____ countries

developing

inflammation of the stomach

gastritis

gastritis can be ___ or ____

acute or chronic

acute gastritis is caused by _____ and ____ in large amounts

alcohol and aspirin

acute gastritis is usually severely ____ and life-threatening

hemorrhagic

chronic gastrits is ____ common

very

what are the 3 causes of chronic gastritis

chemical gastropathy

autoimmune

helicobacter pylori - bacteria

helicobacter pylori predisposes the stomach to ____

ulcers

helicobacter pylori predisposes you to _____ and ____

carcinoma and lymphoma

reactive (chemical) gastropathy is caused by ____ and ___ ____

drugs (NSAIDs)

bile reflux - bile comes up the pyloric sphincter and gets into the stomach where it does not belong

reactive (chemical) gastropathy can result in ____

ulcers

reactive (chemical) gastropathy affects the ____

antrum

Autoimmune gastritis

auto-antibodies attack ____ ___ in the gastric ____/_____

parietal cells

body/fundus

autoimmune gastritis results in loss of ___ ____ and loss of ____ ___

stomach acid

intrinsic factor (leads to B12 deficiency “pernicious anemia”

autoimmune gastritis leads to increased risk of ______

carcinoma

helicobacter pylori is a huge player in (3)

gastritis

peptic ulcer disease

malignancy (gastric carcinoma and gastric lymphoma)

this is an imbalance of acid and defense mechanisms

peptic ulcer disease

peptic ulcer disease in the stomach leads to failure of ____ ____

defense mechanisms

peptic ulcer disease in the duodenum excess _____ is usually the problem

acid (not built to handle acid)

helicobacter decreases ____ _____ and increases ____ ____, leadin to gastric and duodenal _____

defense mechanisms

acid production

ulcers

complications of gastric peptic ulcers

bleeding

perforation

Gastrointestinal bleeding

coffee ground colored vomit

hematemesis

bleeding from an upper GI site

GI bleeding

dark tarry stools

melena

also bleeding from upper GI - means you didnt throw it up, you digested and pooped it out

GI bleeding

bright red blood in the stool is related to ____ GI sites

upper - usually colon

Colon adenoma, colon cancer, hemorrhoids, others

GI bleeding

this is blood you cannot see, identified only when tested for chemically. Small amounts from anywhere in GI

occult bloof

upper GI ulcers or cancer, colon inflammation, adenoma, colon cancer, red meat in diet, etc

tumors of the stomach

adenocarcinoma

gastric adenocarcinoma early invasion is not beyond the ______

submucosa

only 10% of cases - 90% survival

gastric adenocarcinoma advances invasion beyond ____

submucosa

90% of cases - only 15% survival

the surface epithelium of the small bowel has a ____ ____ due to microvilli

brush border

absorptive cells of the small intestie _____ in number distally

decrease

goblet cells of the small intestine_____ in number distally

decreased

food needs greased up to move onto the colon

maldigestion occurs due to insufficient _____ or ____

enzymes or bile

malabsorption is due to insufficient effective ______ ______ due to small intestine ______

surface area

damage

what 2 things can cause small intestine damage

celiac disease

giardia

what causes celiacs disease

genetic predisposition

immune mediated damage triggered by the ingestion of gluten

many people with autoimmune disease have it

celiacs disease may be associated with other ____ ____

autoimmune disease

ie: children with type I diabetes

celiac disease is tested for by finding ______

antibodies

celiac disease pathology

_____ and proximal _____ are the most affected areas

duodenum and jejunum

exposed to the highest conc of dietary gluten

the first jey finding of celiacs disesase in increased intraepithelial ______

lymphocytes (CD8 T cells)

2nd finding of celiacs disease is crypt _______, and villous _____

hyperplasia

atrophy

villi will disappear and crypts will get huge

celiacs disease leads to loss of ____ and ____ ___ surface area which leads to ______

mucosal

brush border

malabsorption

celiacs disease is usually in what age group

30-60 years

symptoms of celiacs disease

anemia

chronic diarrhea

bloating

chronic fatigue

celiacs disease - pediatric symptoms

failure to thrive

weight loss

muscle wastin

infection enterocolitis list of potential organisms

– Viral – rotovirus, norovirus, adenovirus, etc

– Bacterial – Salmonella, Shigella, E. coli, Campylobacter,

Clostridium difficile, etc

– Fungal – histoplasmosis, etc

– Protozoan – Cryptosporidium, Entamoeba histolytica, etc

– Parasitic – Giardia, etc

infectious enterocolitis is found in ____ countries

developing

Giardiasis is common in the _____

midwest

giardiasis comes from ______ ____

contaminated water

cool, clear stream , well water

can giardiasis be spread person to person

yes

are small intestine tumors more common than those of the esophagus, stomach, or colon

no

the appendix is a small growth off the _____

cecum (large intestine)

what age can appendicitis occur

any age

most common in adolescence and young adults

in apedicitis, pain starts periumbilically and then localizes to the ____ ____ quadrant

lower right

symptoms of apendicitis

Nausea/vomiting, low-grade fever, and a mildly elevated peripheral white cell count

treatment for apendicitis

surgical removal

tumors of the appendix

low grade neuroendocrine tumor - ______ most common

carcionoid

usually incidental finding in the tip of the appendix, almost always benign

tumors of the appendix

____ and _______ can also occur

adenomas and adenocarcinomas

a dilated appendix filled with mucin (greases)

mucocele

occurs when appendix obstructed

can be from a neoplastic process

REVIEW:
_______ _____ is an allergic reaction to food

eosinophilic esophagitis

REVIEW

Reflux esophagitis is common and in some leads to _____ _____

Barrett’s metaplasia

REVIEW

Barrett’s metaplasia is at risk for developing _____ of the esophagus

adenocarcinoma

REVIEW

____ _____ is an important cause of gastritis/ulcers

H. pylori

REVIEW

Celiac disease is common and _____ treatable

“easily”

REVIEW

• Acute appendicitis is treated _____

surgically