1. what are some possible disorders of the esophagus?
    • atresia
    • hiatal hernia
    • achalasia
    • diverticula
    • esophageal varices
    • reflux esophagitis
  2. what is atresia of the esophagus?
    • esophagus has incompletely developed
    • -- disconnected, hypertrophied upper segment
    • -- lower segment connected to trachea
    • usually at level of tracheal bifurcation
    • easy surgical fix
  3. what is a hiatal hernia?
    • protrusion of part of the gut into the throax above the diaphragm
    • most are asymptomtic but 10% of patients will have reflux esophagitis & heart burn
    • can be misdiagnosed for an MI
  4. what are sliding hiatal hernias?
    traction from scarred or congenitally shortened esophagus pulls the cardia of stomach thru esophageal hiatus
  5. what are rolling (paraesophageal) hernias?
    • part of gastric fundus protrudes thru a defect (weak muscle) in the esophageal hiatus
    • may be accentuated by increased intraabdominal pressure.
  6. what is achalasia of the esophagus?
    • "lazy esophagus": lack of expansion and contraction
    • failure of gastroesophageal sphincter to relax so food remains within esophagus prox to gastroesophageal sphinter
  7. what are clinical manifestations of esophageal achalasia?
    • dysphasia (difficulty swallowing)
    • food regurgitation
    • aspiration pneumonia
  8. what is esophageal diverticula?
    Developmental or acquired outpouching of esophagus wall
  9. what causes esophageal diverticula?
    • 1. increased intraluminal pressure occuring on posterior wall (over accum of food)
    • 2. inflammation outside the esophagus w/ fibrosis that creates distortion
  10. what are esophageal varices?
    • tortuous distended veins beneath the esophageal mucosa
    • caused by vascular disorder due to hepatic portal HTN (usually related to cirrhosis)
  11. what are the symptoms and problems w/ esophageal varices?
    • generally asymptomatic
    • rupture occurs when varices reach size grtr than 5 mm in diameter - causes massive hematemesis
  12. what is reflux esophagitis?
    Inflammation of esophagus related to injury due to regurgitation of gastric contents- may be associated with hiatal hernia
  13. what is the clinical presentation of reflux esophagitis?
    • epithelial necrosis
    • peptic ulcers
    • submucosal inflammation
    • All present in distal 1/3 of esophagus leading to fibrosis & metaplasia (replacement of squamous by columnar epithelium- Barret esophagus)
  14. what are complications related to reflux esophagitis?
    Approx 10% of patients will develop adenocarcinoma
  15. what are some possible stomach disorders?
    • pyloric stenosis
    • gastritis
    • acute peptic ulceration
    • chronic peptic ulceration
  16. what are the two types of pyloric stenosis?
    • congenital
    • acquired
  17. what is congenital pyloric stenosis?
    • Congenital narrowing of pyuloric canal
    • 4:1 predominant for males
    • most common indication for abdominal surgery in 1st 6 months of life.
  18. what causes congenital pyloric stenosis?
    hypertrophy of pyloric circular muscle that may be palpated as a mass in the newborn having projectile vomiting
  19. what is acquired pyloric stenosis?
    • post-inflammation scarring that may lead to pyloric obstruction
    • ulcer -> inflammation->scarring.
  20. what is gastritis?
    • an inflammatory disease of the gut
    • can be
    • -- acute (erosive)
    • -- chronic (non-erosive)
  21. what is acute gastritis?
    • inflammation of gut
    • mucosal erosions by
    • -- aspirin
    • -- toxins
    • -- alcohol
    • -- stress
    • -- CNS trauma
    • -- hypersecretion of gastric acid
  22. what are the symptoms of acute gastritis?
    range from abdominal discomfort to massive, life-threatening hemorrhages & gastrical perforation
  23. what are the characteristics of chronic gastritis?
    • No erosions
    • chronic inflammatory changes leading eventually to gastric mucosa atrophy & possibly carcinoma
  24. what are the two types of chronic gastritis?
    • Type A (autoimmue)
    • Type B (non-immune, more common)
  25. what is type A chronic gastritis?
    • autoimmune origin
    • associated with pernicious anemia (lack of B12- decreased RBCs can’t fully develop & mature)
  26. what is type B chronic gastritis?
    • nonimmune origin
    • more common
    • can be
    • -- hypersecretory: antral gastritis related to duodenal ulcer
    • -- environmental: multifocal related to gastric ulcer & carcinoma
  27. what is an acute peptic ulceration?
    • aka a stress ulcer
    • extension of acute erosive gastritis where mucosal erosions penetrate the muscle mucosa
    • appear 24hrs after severe trauma (acid concentration does NOT inc)
    • cause bleeding & do not progress to chronic ulcers
  28. what is the progression of acute peptic ulceration?
    • Start in proximal part but multiple ulcers may involve whole stomach.
    • Appear within 24 hours after severe trauma, acute brain damage, severe medical illness, surgery, steroid therapy & aspirin abuse
  29. what is the pathogenesis of acute peptic ulceration?
    uncertain since acid concentration is not increased
  30. what are chronic peptic ulcers?
    • result from acid-pepsin digestion of mucosa as solitary lesions
    • bacteria is the main cause
    • can treat w/ antibiotics
    • affects 5-10% of mid adult population
  31. what are the two types of chronic peptic ulcers?
    • duodenal
    • gastric
  32. what causes duodenal ulcers?
    • (a type of chronic peptic ulcer)
    • genetic predisposition (men, type O blood) who smoke & drink,
    • high acid secretion
    • patients with gastric ulcer
  33. what causes gastric ulcers?
    • (a type of chronic peptic ulcer)
    • more related to alteration of gastric mucosal resistance than to increased acid secretion & usually is extension of chronic gastritis
  34. what are possible intestinal disorders?
    • hemorrhoids
    • acute appendicitis
    • ulcerative colitis
  35. what are hemorrhoids?
    • variocose veins at the bottom of the colon
    • associated w/chronic constipation, portal HTN & pregnancy
    • can be internal (beneath rectal mucosa) or external (beneath anal mucosa)
    • unusual for those under 30y.o. (except if preg)
  36. what are the symptoms of hemorrhoids?
    pain, itching, and rectal bleeding but often not symmptomatic
  37. what is an acute appendicitis?
    Inflammatory disease initiated by obstruction of mucous drainage leading to distension, infection, neutrophil emigration, fibrinopurulent exudation, suppurative & gangrenous necrosis
  38. how does an acute appendicitis present clinically?
    • abdominal discomfort in right lower quadrant, nausea, vomiting
    • requires immediate surgery upon rupture
  39. what are the complications associated w/ an acute appendicitis?
    • rupture
    • peritonitis
    • sepsis
    • death
  40. what is ulcerative colitis?
    Acute or chronic inflammation of unknown etiology (possibly infections or autoimmunity) causing extensive ulcerations of the mucosal surface of colon
  41. what is the progression of ulcerative colitis?
    begins as mucosal hemorrhages, abscesses & ulcerations in the rectum that spreads proximally & extend to muscular layer
  42. what are the symptoms of ulcerative colitis?
    • a recurrent disease manifested in adulthood as abdominal pain, cramps & bloody diarrhea
    • exp: chron's disease
    • not much in way of tx
  43. what are common disorders of the liver?
    • hepatitis A, B, C, D
    • cirrhosis
  44. what is hepatitis?
    • a viral liver inflammatory disease
    • may occur as an inapparent infection or a varying disorder from mild and brief to prolonged, severe, necrotic
    • can be acute or chronic
    • no cure, but can support liver throughout life
  45. what is Hepatitis A?
    • RNA virus liver infection acquired by ingestion of fecally-contaminated food & water
    • damage can be confirmed by rise in serum aminotransferase activity
    • vaccine available
  46. what is the progression and symptoms of hepatitis A?
    • incubation period of 2-6 wks
    • patients develop nonspecific symptoms like fever, malaise, & liver damage
    • jaundice appears 5-10 days later.
    • never progresses to chronic hepatitis & infection provides lifelong immunity.
  47. what is Hepatitis B?
    • DNA virus-acute & chronic liver condition- may be asymptomatic or exceedingly fulminant
    • virus is transmitted by blood products or contaminated
    • needles
  48. what is the progression of Hepatitis B?
    • incubation period of up to 6 months.
    • ((Rest lying down, so BFthru liver increases by ~40%))
  49. what are the different types of Hepatitis B?
    • Acute, self-limited: symptoms appear 2-3 months after exposure. Complete recovery & lifelong immunity.
    • Fulminant: massive liver necrosis, failure & death
    • Chronic carrier state: patients do not develop antigens, infection persists
  50. what is Hepatitis C?
    • RNA virus- acute or chronic liver infection.
    • Clinical symptoms similar to Hepatitis B.
    • Result of transfusion of contaminated blood but may be spread by fecal-oral route.
    • Can live a normal life if this stays dormant, if not, person will need liver transplant
  51. what is Hepatitis D?
    • RNA delta (defective) virus
    • Liver infection that requires help from coexisting Hep B virus infection.
    • Clinical cause similar to Hep B along w/ Hep C exposure
  52. what is liver cirrhosis?
    • necrosis, fibrosis and disruption of normal liver architecture
    • two types: Laennec's (alcholic) cirrhosis & Postnecrotic (macronodular) cirrhosis
  53. what is Laennec's (alcoholic) cirrhosis?
    • Common type in U.S.
    • Causes decreases in liver size with fine nodularity
    • Advanced stages: liver develops fibrotic consistency & dark color.
  54. what is the progression and symptoms of Laennec's cirrhosis?
    Cirrhosis may develop over decades w/symptoms of weight loss, nausea, vomiting, jaundice.
  55. what are complications associated w/ Laennec's cirrhosis?
    Patients may develop ascites, esophageal varices, gastritis, & death usually occurs with hepatic failure.
  56. what is postnecrotic (macronodular) cirrhosis?
    • not related to alcohol abuse
    • 10-30% of total cases of cirrhosis.
    • May follow a single episode of viral hepatitis or chronic hepatitis, or drug-related hepatotoxicity which results in a marked degree of acute necrosis.
    • most frequently associated w/liver carcinoma.
  57. what is the progression of postnecrotic cirrhosis?
    When symptoms occur, they are often the result of liver failure or portal HTN.
  58. what is the most frequently seen complication of cirrhosis?
    • portal hypertension
    • results in a backup of blood increasing pressure in the portal vein which can lead to
    • -- ascites
    • -- esophageal varices
    • -- hemorrhoids
  59. what is a common disorder of the gallbladder and biliary tract?
    • cholelithiasis (gallstones)
    • more often seen in women, increase in incidence w/age, & are related to obesity & high caloric diets
  60. what is the composition of gallstones?
    • Cholesterol: most common, w/size from small up to 6 cm in diameter & egg-shell, movement of bile to liver not possible, bile backs bilirubin & blood back up
    • Calcium bilirubinate: less common, related to excessive production of bilirubin, 80% of all biliary calculi.
    • Calcium carbonate: rare, mixed stones account for 80% of all biliary calculi.
  61. what is obesity?
    • an accumulation of body fat above a particular standard
    • (If standard is 20% above the mean adiposity, then 20% of middle-aged man and 40% woman are obese in US.)
  62. what causes obesity?
    • possible genetic disposition
    • excessive calorie intake > calorie expenditure
  63. what are complications related to obesity?
    • increases the risk of
    • - type II diabetes
    • - hypertension
    • - atherosclerosis
    • - cholelithiasis
    • - varicose veins
  64. what is the definition of malnutrition?
    • 20% below normal body weight, (if falls 40% it is marasmus).
    • loss of fat w/ catabolism of tissue proteins: thinning of the skin, dec muscle mass and dec serum proteins
    • (if protein deprivation is greater than calorie reduction like in carbohydrate diet it is kwashiorkor)
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clinical medicine gastrointestinal liver