GI & Reproductive Mega-Review

Exam Logistics (Final Overview)

• Total questions: $100$
  • Gastrointestinal (GI): $10$
  • Reproductive (Genito-Urinary): $10$
  • Modules $1\text{–}12$ review: $80$
• GI + Reproductive content from Weeks $13\text{–}14$ absolutely testable.

Esophagus & Stomach

• Cellular anatomy
  • Esophagus: stratified squamous cells
  • Stomach: simple columnar cells
  • Metaplasia → dysplasia → Barrett’s esophagus (precancerous “mish-mash cells”).

Hiatal Hernia

• Lower esophageal sphincter (LES) displaced → impaired closure
• Risk ↑ for GERD.

Gastro-Esophageal Reflux Disease (GERD)

• Patho: intermittent reflux of gastric acid past LES.
• Classic S/S
  • Heartburn = dyspepsia
  • Epigastric pain
  • Chronic cough, sore throat, morning “bitter taste.”
• Risk factors
  • ↑ Intra-abdominal pressure: obesity, pregnancy, large meals near bedtime, gastroparesis, hiatal hernia
  • Diet: fatty food, caffeine, alcohol
  • Drugs: oral contraceptives, sedatives
• Complications: aspiration, esophagitis, ulcers, stenosis, Barrett’s esophagus, esophageal cancer.

Esophagitis / Strictures / Ulcers

• Inflammation (acid) → bright-red bleeding, ulcers, chronic scarring → narrowing → dysphagia.

Upper GI Bleed

• Hematemesis (bright-red) = esophageal source
• “Coffee-ground” emesis = gastric source
• Melena (black tarry stool) = upper GI bleed beyond pylorus
• Causes: ruptured varices, peptic ulcers, esophagitis/gastritis, cancer, NSAIDs/ASA/steroids.

H. pylori & Peptic Ulcer Disease (PUD)

• \text{#1 cause of PUD} = H.\,pylori (circle/underline!)
• Gastric vs Duodenal Ulcer
  • Gastric: pain ↑ with food; vomiting possible; link to gastric CA
  • Duodenal (most common): pain ↑ when empty; food relieves; tarry stool; perforation risk.

Gastritis

• Inflammation types: erythematous, erosive, hemorrhagic, atrophic, hypertrophic, nodular.
• Causes: NSAIDs, alcohol, smoking, NG tubes, H. pylori.

Gastric Cancer

• 3rd most deadly (after lung & colorectal).
• RF: smoking (primary), H. pylori, male, >50, family hx, smoked/pickled foods, obesity.

Small & Large Intestine

Normal lengths

$\text{Small intestine}=9\text{–}16\,\text{ft}\quad\text{Large intestine}=5\,\text{ft}$

Gastroenteritis

• Causes: viral (Norovirus #1—“cruise ship”), bacterial (E. coli, Salmonella, Shigella, Campylobacter), parasitic.
• S/S: watery non-bloody diarrhea, vomiting; self-limited ≈ 1 week.

Celiac Disease

• Autoimmune gluten-triggered villous atrophy.
• Flattened/eroded villi ↓ surface area → malabsorption of fat-soluble vitamins (A, D, E, K).
• S/S: bloating, flatulence, diarrhea, weight loss, steatorrhea (greasy, floating stool).
• Tx: strict gluten-free diet.

Short Bowel Syndrome (<$7$ ft functional)

• Etiology: surgery (Crohn’s, trauma, bypass) or non-functional segments.
• Consequences: malabsorption, diarrhea, steatorrhea, dehydration, weight loss.
• Mgmt: small frequent meals, vitamin/mineral replacement, TPN if severe.

Inflammatory Bowel Disease (IBD)

Crohn’s Disease

• “Cobblestone,” patchy, affects anywhere mouth → anus, full-thickness.
• High fistula, abscess, perforation risk.
• S/S: severe watery diarrhea, abd pain, bloating.

Ulcerative Colitis (UC)

• Large intestine only, continuous spread upward, mucosa & submucosa.
• S/S: bloody diarrhea, ↑ colon cancer risk.

Appendicitis

• Inflamed/obstructed appendix → risk rupture/peritonitis.
• S/S: migrating pain to RLQ, McBurney’s point, Rovsing sign, psoas/obturator signs, rebound tenderness, fever, ↑ WBC.

Abdominal Hernias

• Weak abdominal wall → protrusion of bowel.
• Types: inguinal (direct/indirect common), umbilical, incisional, femoral, epigastric.
• Reducible vs incarcerated/strangulated (ischemia).
• Classic presentation: bulge with heavy lifting/coughing + nausea.

Bowel Obstruction

• Small bowel causes: adhesions (post-op), hernia strangulation, intussusception, volvulus, ischemia.
• Large bowel: colon cancer (must memorize).
• S/S
  • Small: colicky cramps, profuse vomiting (looks like food).
  • Large: persistent pain, minimal vomit but feculent if present, severe distension.

Peritonitis

• Sterile peritoneum → contamination (secondary most common: perforated ulcer/appendix, bowel leak).
• S/S: rigid or distended “board-like” abdomen, severe pain, fever, ↑HR/↑BP.
• Primary (rare): hematogenous spread.
• Tx: broad IV antibiotics, fluids, surgery.

Diverticular Disease

• Diverticulosis = mere presence of out-pouchings (LLQ sigmoid).
  • RF: ↑ age, low-fiber/high-fat diet, constipation.
• Diverticulitis = inflammation/ infection of pouches
  • S/S: fever + LLQ pain, nausea, leukocytosis.
  • Complications: abscess, perforation → peritonitis.

Hemorrhoids

• Engorged anal vessels (internal painless bright-red bleed; external painful, itchy).
• RF: constipation, pregnancy, chronic sitting, coughing, heavy lifting.

Irritable Bowel Syndrome (IBS)

• Functional brain–gut disorder; diarrhea-predominant, constipation-predominant, or mixed.
• Triggered by stress, certain foods, infections.
• S/S: bloating, abd pain, altered bowel habit, no structural disease.

Hepatobiliary

Hepatitis

• Acute (<$6$ mo) vs chronic (≥$6$ mo).
• Common early S/S: anorexia, N/V, RUQ pain, malaise.
• Late S/S: jaundice, pruritus, edema, confusion (hepatic encephalopathy).

Viral Types (Mnemonic)

Jaundice

• Patho: accumulation of bilirubin (RBC breakdown by-product).
• Pre-hepatic (hemolysis), hepatic (hepatitis, cirrhosis), post-hepatic (obstruction).

Cirrhosis

• Chronic injury → fibrosis replaces hepatocytes.
• Major causes: alcohol, chronic HBV/HCV, NASH.
• Late hallmark: jaundice.
• Complications
  • Portal HTN → ascites, splenomegaly, esophageal varices
  • Hepatorenal syndrome, encephalopathy, coagulopathy (bleeding).
• Portal HTN: ↑ pressure in portal vein → collateral veins (“Caput Medusae”).

Gallbladder & Pancreas

Cholelithiasis → Biliary Disorders

1. Cholelithiasis
   • Stones inside GB, often asymptomatic.
2. Biliary Colic
   • Stone transiently blocks cystic duct → RUQ pain, N/V.
3. Cholecystitis
   • Stone impacted in cystic duct → persistent pain, fever, ↑WBC.
4. Choledocholithiasis
   • Stone in common bile duct → obstructive jaundice; may trigger pancreatitis/hepatitis.

• RF (“4 F’s”): Female, Forty, Fat, Fertile (multiple pregnancies), high-cholesterol diet, TPN, obesity.

Pancreatitis

• Premature activation of enzymes → auto-digestion of pancreas.
• Acute causes: alcohol (men), gallstones (women).
• Labs: ↑ amylase, ↑ lipase, ↑ WBC, hyperglycemia, ↓ Ca/Mg.
• Chronic: persistent inflammation ⇒ malabsorption, steatorrhea.

Male Reproductive Disorders

Testicular Torsion

• Twisting of spermatic cord ⇒ ischemia.
• Teen boys, sudden unilateral scrotal pain + vomiting; surgical emergency (<$6$ h).

Hydrocele & Varicocele

• Hydrocele: fluid-filled scrotal sac, painless → enlarging discomfort.
• Varicocele: dilated pampiniform veins, “bag of worms,” worse with standing; fertility risk.

Epididymitis

• Inflammation (often chlamydia/gonorrhea, or UTI).
• Tender scrotum, dysuria, discharge, fever.

Cryptorchidism

• Undescended testis (right > left); usually descends by $1$ yr.
• Uncorrected ↑ testicular CA risk.

BPH (Benign Prostatic Hyperplasia)

• Nodular enlargement → outflow obstruction.
• S/S triad: reduced stream, hesitancy, nocturia in older male.

Balanitis (Candida)

• Fungal infection of glans penis, especially uncircumcised; burning/itching, vesicular rash; treat topical azoles.

Erectile Dysfunction

• Inability to maintain erection sufficient for intercourse.
• Physical RF: CVD, DM, obesity, hyperlipidemia, meds.
• Psychological: stress, anxiety, depression.

Female Reproductive Disorders

Menstrual Terminology

• Amenorrhea – no menses
• Hypomenorrhea – scanty
• Oligomenorrhea – infrequent
• Polymenorrhea – frequent
• Menorrhagia – heavy
• Metrorrhagia – inter-period bleeding
• Menometrorrhagia – heavy + irregular.

Pelvic Inflammatory Disease (PID)

• Ascending infection (often gonorrhea, chlamydia).
• RF: multiple partners, no condoms, IUD insertion, douching, prior PID.
• S/S: lower abd pain, foul discharge, irregular menses, dyspareunia, fever.

PCOD vs PCOS

• PCOD: polycystic ovarian disease—multiple cysts, enlarged ovaries, hyperandrogenism, irregular cycles.
• PCOS: syndrome—metabolic–endocrine disorder with insulin resistance, obesity, hirsutism, infertility; broader systemic impact.

Ectopic Pregnancy

• Implantation outside uterus (90% tubal).
• S/S: unilateral pelvic pain, spotting → rupture = life-threatening hemorrhage; can mimic appendicitis (right tube).

Cervical Cancer

• Primary cause: HPV infection (types 16/18).
• Early asymptomatic; advanced: vaginal discharge/bleeding.
• Prevention: HPV vaccine, Pap screening.

Endometriosis

• Functional endometrial tissue outside uterine cavity.
• Cyclic pain (dysmenorrhea), dyspareunia, dyschezia, infertility.

Menopause

• Defined: $\ge 12$ consecutive months amenorrhea (avg age $\approx 51$).
• Estrogen drop → hot flashes, insomnia, ↓ libido, mood change, weight gain, osteoporosis.

Ethical & Practical Connections

• Lifestyle counseling (diet, weight, alcohol, smoking) cuts across GERD, PUD, liver disease, BPH, ED, gallstones.
• Screenings: HPV vaccine & Pap (cervical CA), colonoscopy (IBD, diverticulitis complications, colon CA), testicular self-exam (torsion vs CA), hepatitis panels for needle exposure.
• Chronic untreated “benign” conditions (GERD, hemorrhoids) can evolve into serious pathology (Barrett’s, variceal bleed).
• Inter-system links: portal HTN ↔ esophageal varices ↔ GI bleed; biliary stones ↔ pancreatitis.

High-Yield Numerical & Formula Reminders

• $\text{Exam breakdown}=80\%\;\text{old}+10\%\;\text{GI}+10\%\;\text{Repro}$
• <7\,\text{ft} small bowel ⇒ Short Bowel Syndrome.
• Upper vs lower GI tract anatomical divide: ligament of Treitz (roughly).