Term
|
Definition
| Inflammation causing reversible pancreatic parenchymal injury. |
|
|
Term
| Clinical features of acute pancretitis. |
|
Definition
pain is constant & varies from mild to incapacitating. Referred pain to the upper back & left shoulder.
Often accompanied by anorexia, nausea, & vomiting |
|
|
Term
| How do you diagnose acute pancretitis? |
|
Definition
elevated plasma levels of amylase and lipase
exclusion of other causes of abdominal pain
imaging of inflamed (fatty or necrotic) pancreas contributes to diagnosis |
|
|
Term
| How do you treat acut pancreatitis? |
|
Definition
It is a medical emergency
stop food intake & give IV support
5% of acute cases die |
|
|
Term
| Is acute pancreatitis a dangerous illness? |
|
Definition
yes; it is a medical emergency
5% of cases of acute pancreatitis die |
|
|
Term
| 80% of cases of acute pancreatitis occur in women with _________________ or men with ________________ |
|
Definition
biliary tract disease
alcoholism |
|
|
Term
| Risk factors for acute pancreatitis |
|
Definition
biliary tract disease (mostly in women)
alcoholism (mostly in men)
(these 2 account for 80% of acute pancretitis)
drugs
infection (esp. mumps)
trauma
genetic problems
metabolic disease
ischemia
obstructions
10% idiopathic |
|
|
Term
| 35-65% of people with acute pancreatitis have _____________ |
|
Definition
|
|
Term
| What are some alterations in the pancreas caused by acute pancreatitis? |
|
Definition
1. microvascular leakage causing edema
2. necrosis of fat by lipolytic enzymes
3. acute inflammation
4. proteolytic dstruction of pancreatic parenchyma
5. destruction of blood vessesl & subsequent interstitial hemorrhage
there is a lot of variation in the alterations that acute pancreatitis causes to the pancreas, from trivial inflammation to necrosis & hemorrhage |
|
|
Term
| How does acute pancreatitis lead to pancreatic damage? |
|
Definition
| The pancreas produces a variety of digestive enzymes. In acute pancreatitis, these enzymes back up in the pancreas and some (especially trypsin) digest the pancreas, which causes the pain & complications of pancreatitis |
|
|
Term
|
Definition
| inflammation causing irreversible exocrine damamge, fibrosis, and later endocrine damage |
|
|
Term
| Clinical features of chronic pancreatitis |
|
Definition
attacks of abdominal pain
mild fevar
jaundice
weight loss
edema
patient may also present with diabetes mellitus, with its attendant signs & symptoms |
|
|
Term
| What may serum tests show in chronic pancreatitis? |
|
Definition
mild-to-moderate elevates of serum amylase
elevated serum alkaline phosphatase
low albumin
hyperglycemia (due to development of diabetes mellitus) |
|
|
Term
| What may visualization (such as ultrasound) or biopsy show in chronic pancreatitis? |
|
Definition
destruction of acinar cells
calcification within the pancreas
eosinophilic dilated duct
areas of destroyed architecture and residual islets & ducts |
|
|
Term
| What changes will you see in a biopsy of a pancreas with chronic pancreatitis? |
|
Definition
fibrosisi
reduced number & size of acini with relative sparing of islets of Langerhans, which become embedded in slcerotic tissue & may fuse & appear enlarged
variable dialtion of the pancreatic ducts
chronic inflammatory infiltrate around lobules & ducts
ductal epithelium may be atrophied or hyperplastic
the gland is hard
ducts are dilated and eosinophilic
visible calcified concretions |
|
|
Term
| Who is most liekly to get chronic pancreatitis? |
|
Definition
| middle-aged male alcoholic with previous acute pancreatic episodes |
|
|
Term
| Risk factors for chronic pancreatitis |
|
Definition
alcoholic
previous acute pancreatitic episodes
middle-aged male
long obstruction of the pancreatic duct by pseudocyts
calculi (stones)
trauma
neoplasms
pancreatic divisum (a congenital anomaly in the anatomy of the ducts of the pancreas in which a single pancreatic duct is not formed, but rather remains as two distinct dorsal and ventral ducts)
tropical pancreatitis (seen in Africa & Asia)
PRSS1 or SPINK1 genetic mutations (associated with acute pancreatitis, chronic pancreatitis, nad pancreatic cancer)
CFTR gene mutations (cystic fibrosis)
40% have no prdisposing factors |
|
|
Term
|
Definition
| a congenital anomaly in the anatomy of the ducts of the pancreas in which a single pancreatic duct is not formed, but rather remains as two distinct dorsal and ventral ducts |
|
|
Term
|
Definition
| special type of chronic pancreatitis that is seen mainly in tropical countries (primarily Africa & Asia); cause is unknown, but mutations such as the SPINK1 gene mutation and environmental factors are likely causes |
|
|
Term
| The genetic mutations _________ and __________ are associated with acute and chronic pancreatitis and panreatic cancer. |
|
Definition
|
|
Term
| What is the main difference between congenital true cysts in the pancreas & pseudocysts? |
|
Definition
true cysts have an epithelial lining (cuboidal epithelium in pancreas)
pseudocysts do not have an epithelial lining |
|
|
Term
| Risk factors for pseudocysts of the pancreas |
|
Definition
chronic alcoholic pancreatitis (most imp!)
trauma to the pancreas
aucte pancreatitis |
|
|
Term
| What do pesudocysts in the pancreas look like? |
|
Definition
uusually solitary
in the pancreas or retroperitoneum
lack epithelial lining (imp!)
2-30 cm in diameter
pseudocysts are walled off areas of peripancreatic hemorrhagic fat necrosis
composed of central nerotic-hemorrhagic material rich in pancreatic enzymes surrounded by non-epithelial-lined fibrous walls of granulation |
|
|
Term
| What happens to pseudocysts in the pancreas? |
|
Definition
often, they spontaneously resolve
may become secondarily infected
larger pseudocysts may comprss or even perforate into adjacent structures |
|
|
Term
| What age and gender is most likely to get serous cystadenoma? |
|
Definition
|
|
Term
| Serous cystadenoma of the pancreas |
|
Definition
| a benign, cystic neoplasm of the pancreas |
|
|
Term
| What does serous cystadenoma of the pancreas look like? |
|
Definition
| glycogen-rich cuboidal cells surrounding 1- 3mm cysts containing clear, thin, straw-colored fluid |
|
|
Term
| Clinical features of serous cystadenoma. |
|
Definition
ambdominal pain
often a palpable mass |
|
|
Term
| Treatment for serous cystadenoma. |
|
Definition
|
|
Term
| How likely is serous cystadenoma to become malignant? |
|
Definition
| very, very rarely; usually stays benign & grows slowly |
|
|
Term
| Pancreatic mucinous cystadenoma |
|
Definition
| A grouping of cystic neoplasms that arise from the pancreas. They may be benign, malignant or in between. The cysts are filled with thick mucin |
|
|
Term
| 95% of pancreatic mucinous cystadenoma occurs in which gender? |
|
Definition
|
|
Term
| Is pancreatic mucinous cystadenoma benign or malignant? |
|
Definition
it may be either, or borderline
it is (or is associated with) invasive adenocarcinoma in 1/3 of patients |
|
|
Term
| Describe the appearance of pancreatic mucinous cystadenom. |
|
Definition
larger than serous cystadenomas
lined with columna mucin-producing epitheliam
cyst is filled with thick mucin
associated with dense, ovarian-like stroma |
|
|
Term
| How do you know if a pateint has benign cystadenoma or mlaignant adenocarcinoma of hte pancreas? |
|
Definition
| must surgically remove the neoplasm & send to pathology |
|
|
Term
| Where in the pancreas does pancreatic mucinous cystadenoma occur? |
|
Definition
|
|
Term
| Clinical features of pancreatic mucinous cystadenoma. |
|
Definition
usually no clinical features unless that mass can be palpated
it is a painless, slow-growing mass in the body or tail of the pancreas |
|
|
Term
| Intraductal Papillary Mucinous Neoplasm (IPMN) occurs mostly in which gender? |
|
Definition
|
|
Term
| Where does Intraductal Papillary Mucinous Neoplasm (IPMN) occur? Is there usually just one focus, or is it multi-focal? |
|
Definition
in the head of the pancreas
usually one focus, but 10-20% are multifocal |
|
|
Term
| How does Intraductal Papillary Mucinous Neoplasm (IPMN) differ from Pancreatic mucinous cystadenoma? |
|
Definition
IPMN occurs more in men than women
Pancreatic Mucinous Cystadenoma is associated with dense, ovarian stroma, while IPMN is not
IPMN tends to involve larger pancreatic ducts |
|
|
Term
| How do you know if Intraductal Papillary Mucinous Neoplasm (IPMN) is benign or malignant |
|
Definition
| diagnosed post-surgically by tissue invasion |
|
|
Term
|
Definition
| a medical condition in which a part of the intestine has invaginated into another section of intestine, similar to the way in which the parts of a collapsible telescope slide into one another |
|
|
Term
| Where does intussusception most commonly occur? |
|
Definition
|
|
Term
| What problems can intussusception cause? |
|
Definition
obstruction, GI bleeding, and episodes of intense abdominal pain
not immediately life-threatening, but it may become a medical emergency (ex., if the bowel becomes necrotic or perforates) |
|
|
Term
| In pateints, greater than 3 years old, intussusception is usually associated with: |
|
Definition
mechanical etiology (ex., Meckel's diverticulum, polyps, foreign bodies, hemoatomas from trauma, etc.)
but no one really knows what causes intussusception |
|
|
Term
| In what age group does intussuception most often occur? |
|
Definition
|
|
Term
| Clinical presentation of intussusception |
|
Definition
early symptoms:
nausea & vomiting
sudden paroxysms of abdominal pain (last ~5 minutes & occurs 10-20 minutes apart) in a previously healthy child
children draw their knees up to their chese & cry during these episodes
Later signs:
rectal bleeding ("red currant jelly" stool--stool mixed with blood & mucus)
lethargy
fever is not typical of intussusception, but can develop if bowel becomes necrotic, whic may lead to bowel perforation & sepsis |
|
|
Term
| How do you diagnose intussusception? |
|
Definition
history
physical exam
ultrasound |
|
|
Term
| Radiographic findings of intussusception |
|
Definition
| "sausage mass" is usually identified by ultrasound |
|
|
Term
| Microscopic findings from biopsy of intussusception. |
|
Definition
swollen, edematous bowel
possible necrosis & acute inflammation |
|
|
Term
| What is the first line of treatment for intussusception? |
|
Definition
enema
confirm diagnosis
reduce the intussusception in >80% of cases |
|
|
Term
| If an enema doesn't fix an intussusception, what do you do next? |
|
Definition
| surgery to manually reduce or remove infected bowel |
|
|
Term
| Necrotizing enterocolitis |
|
Definition
| acute, necrotic inflammation of the bowel that occurs in premature neonates or those of low birthweight |
|
|
Term
| The most common GI emergency in newborns |
|
Definition
| necrotizing enterocolitis |
|
|
Term
| 6-7% of neonates with _____________________ get necrotizing enterocolitis. |
|
Definition
|
|
Term
| _____________ increases risk of necrotizing enterocolitis compared to _______________ infants. |
|
Definition
formula feeding
breast fed |
|
|
Term
| Most common area affected by necrotizing enterocolitis. |
|
Definition
|
|
Term
| Clinical presentation of necrotizing enterocolitis. |
|
Definition
variable depending on severity
tender belly, anorexia, constipation
vomiting, melena or hematochezia
low or unstable body temperature
little activity |
|
|
Term
| How do you diagnose necrotizing enterocolitis? |
|
Definition
clinical features
diagnostic imaging modalities |
|
|
Term
| Radiographic findings of necrotizing enterocolitis |
|
Definition
dilated bowel loops
"fixed loop" (unaltered gas-filled loop of bowel)
pneumatosis intestinalis (free air within the bowel wall not the lumen)
pneumoperitoneum ("free air" outside the bowel within the abdomen) |
|
|
Term
| Microscopic features of necrotizing enterocolitis. |
|
Definition
| microscopic evidence of edema, hemorrhage, and necrosis of bowel (small or large intestine) |
|
|
Term
| How do you treat necrotizing enterocolitis? |
|
Definition
mostly supportive care (IV fluids, prophylactic antibiotics, etc.) if NEC is mild
usually need surgery to resect significantly necrotic or perforated bowel |
|
|
Term
| What is the prognosis of necrotizing enterocolitis? |
|
Definition
if it is mild & doesn't require surgery, then good prognosisi
if it requires surgery, then 20-30% mortality risk |
|
|
Term
|
Definition
| neoplasms arising from the small bowel (duodenum to terminal ileum) |
|
|
Term
| About what fraction of small bowel neoplasms are benign? About what fraction are malignant? |
|
Definition
|
|
Term
| What are some types of benign small bowel neoplasms? |
|
Definition
leimyomas
lipomas
neurofribromas
fibromas |
|
|
Term
| What are some types of malignant small bowel neoplasms? |
|
Definition
adenocarcinomas
carcinoids
sarcomas / GastroIntestinal Stromal Tumors (GISTs)
Lymphomas |
|
|
Term
| Are small bowel neoplasms common? |
|
Definition
No; they are rare
(only 1-5% of GI tumors; about 5k cases in the US annually) |
|
|
Term
| Clinical presentation of small bowel neoplasms. |
|
Definition
typically asymptomatic until advanced stage
50% of patients have nausea, vomiting, & intestinal obstruction
less common symptoms: abdominal pain, weight loss, GI bleeding |
|
|
Term
| How do you diagnose a small bowel neoplasm? |
|
Definition
radiographic imagine study shows a mass
biopsy of lesion(s) is necessary for diagnosis |
|
|
Term
| What will you see if you look at a patient with a small bowel neoplasm with a plain abdominal x-ray film? |
|
Definition
|
|
Term
| What will you see if you look at a patient with a small bowel neoplasm with an upper GI endoscopy with small bowel enteroscopy? |
|
Definition
| may be able to see the tumor |
|
|
Term
| What will you see if you look at a patient with a small bowel neoplasm with an abdominal CT? |
|
Definition
| may show site and extent of tumor, including presence or absence of liver metastases |
|
|
Term
| How do you treat small bowel neoplasms? |
|
Definition
|
|
Term
| What kind of small bowel neoplasm has the worst prognosis? |
|
Definition
|
|
Term
| Diverticular Disease (DD) |
|
Definition
| conditions that involve the development of small sacs or pockets in the walls of the colon |
|
|
Term
|
Definition
| multiple small sacs or pockets outpouching in the colon |
|
|
Term
|
Definition
| GI bleed due to bleeding diverticula |
|
|
Term
|
Definition
| a condition with one or more infected or inflamed diverticular pouches |
|
|
Term
| 10-25% of people with diverticulosis will develop: |
|
Definition
|
|
Term
| In America, about 10% of people over the age of ________,and about 50% of people over the age of _________ have diverticulosis |
|
Definition
|
|
Term
| What causes diverticulosis? |
|
Definition
develop from increased luminal pressure on weakened spots of the intestinal walls by gas, waste, or liquid
results while straining during a bowel movement, such as from constipation |
|
|
Term
| Where are diverticula most common? |
|
Definition
|
|
Term
| Clinical presentation of diverticulosis. |
|
Definition
usually asymptomatic
diverticular bleeding usually presents with hematochezia or, less commonly, melena |
|
|
Term
| Clinical presentation of diverticulitis. |
|
Definition
varies
mild attacks of discomfort to a more serious presentation needingg hospitalization (fever, diarrhea or constipation, severe LLQ abdomnial pain) |
|
|
Term
| How is diverticulosis usually diagnosed? |
|
Definition
often incidentally found
if symptomatic (diverticular bleeding or diverticulitis), often diagnosed by radiographic studies or endoscopic findings |
|
|
Term
| Radiographic findings with diverticulosis. |
|
Definition
| X-rays, CT scans, & ultrasound testing can all detect diverticula by observing small pouches |
|
|
Term
| How does diverticulosis appear in a colonoscopy? |
|
Definition
| A colonoscopy sees lesions from luminal surface (small “holes” in the bowel wall). |
|
|
Term
| How do diverticulosis and diverticulitis appear on microscopy of a biopsy of the colon wall? |
|
Definition
Microscopically, a diverticulum will show all the layers of the bowel except for “thinner” muscularis propria.
Diverticulitis will show acute inflammation that extends throughout the bowel wall. |
|
|
Term
| How do you treat diverticulosis and diverticulitis? |
|
Definition
Asymptomatic diverticulosis not treated.
Bleeding diverticular disease and diverticulitis treated by surgical resection |
|
|
Term
| How do you prevent diverticulosis? |
|
Definition
high fiber diet
avoidance of straining during bowel movements
drinking enough water. |
|
|
Term
|
Definition
Non-specific term to refers to inflammation of the large intestine.
Multiple etiologies (ischemic, radiation-induced, infectious, IBD, etc.). |
|
|
Term
| What are the 4 bacteria that most commonly cause infectious colitis? |
|
Definition
campylobacter
shigella
e. coli
salmondella |
|
|
Term
|
Definition
| lack of oxygen (due to lack of blood supply) induces inflammation and necrosis at site of injury |
|
|
Term
| Clinical presentation of ischemic colitis. |
|
Definition
abdominal pain
fever
bloody bowel movements |
|
|
Term
| Treatment for ischemic colitis. |
|
Definition
| surgical resection of the necrotic bowel |
|
|
Term
|
Definition
| damage to colon (including acute inflammation, possibly with necrosis) due to radiation treatment of tumors |
|
|
Term
| Treatment for radiation colitis. |
|
Definition
supportive
surgical resection of necrotic bowel |
|
|
Term
| Clinical features common to all types of colitis. |
|
Definition
GI bleeding
diarrhea
possible abdominal pain |
|
|
Term
| How do you diagnose colitis? |
|
Definition
workup includes medical history, physcial exam, lab tests (CBC, electrolytes, stool culture, stool ova & parasites test, etc.)
endoscopic findings & biopsy |
|
|
Term
| What would you see in the colonoscopy of a person with colitis? |
|
Definition
colonic mucosal erythema (redness of inner surface of the colon)
ulcers
bleeding |
|
|
Term
| what will you usually see microscopically in a biopsy from a person with colitis? |
|
Definition
| Microscopy will show granulocytes (mostly neutrophils) that are scattered throughout the mucosa with infiltration of the crypts (called cryptitis), crypt abscesses formation, and presence in the lamina propria. Ulceration and hemorrhage can also be present. |
|
|
Term
| 2 most common causes of upper GI bleed |
|
Definition
peptic ulcer disease (55%)
portal hypertension (15%) |
|
|
Term
| What test might you do to see if a GI bleed is from an upper GI source? |
|
Definition
nasogastric lavage
if, when you pull it out, it is covered in blood or coffee-ground bile, then the bleed is upper GI
If it is clean, then the pyloric valve is closed & the bleed may be lower GI, may be intermittent/stopped, or may be behind the closed pyloric valve.
If it comes back covered in bile, but no visible signs of blood, then the pyloric valve is open and the bleeding may be lower GI, intermittent/stopped, or occul) |
|
|
Term
|
Definition
| An autosomal dominant hereditary intestinal polyposis syndrome characterized by the development of benign hamartomatous polyps in the gastrointestinal tract and hyperpigmented macules on the lips and oral mucosa |
|
|
Term
| International Normalized Ratio (INR) |
|
Definition
A normalized prothrombin time.
INR = (PT of the test/PT of normal)^(international sensitivity index of the testing materials)
The result (in seconds) for a prothrombin time performed on a normal individual will vary depending on what type of analytical system it is performed. This is due to the differences between different batches of manufacturer's tissue factor used in the reagent to perform the test. The INR was devised to standardize the results. |
|
|
Term
| blood urea nitrogen (BUN, pronounced "B-U-N") test |
|
Definition
| a measure of the amount of nitrogen in the blood in the form of urea, and a measurement of renal function. Urea is a by- product from metabolism of proteins by the liver, which is removed from the blood by the kidneys. |
|
|
Term
| What does elevated Blood Urea Nitrogen (BUN) indicate? |
|
Definition
| An elevated BUN most often indicates renal dysfunction If creatinine level in the urine is normal and BUN is moderately elevated, that may inidicate an upper GI bleed. The nitrogenous compounds from the blood are resorbed as they pass through the rest of the GI tract and then broken down to urea by the liver. Enhanced metabolism of proteins will also increase urea production, as may be seen with high protein diets, patients on total parenteral nutrition, steroid use, burns, or fevers. |
|
|
Term
| 2 types of endoscopic therapy for esophageal varices |
|
Definition
esophageal variceal banding
endoscopic variceal sclerotherapy |
|
|
Term
| Clinical hallmarks of visceral pain |
|
Definition
unreliable localization; generally deep & diffuse, with generalized localization to body regions (not to specific organs of origin)
pain often accompanied by nausea, diaphoresis (excessive sweating), piloerection, dyspnea
visceral pain produces negative emotions, which causes more visceral pain, in a positive feedback loop |
|
|
Term
| Visceral Pain Hypersensitivity |
|
Definition
a painful response to normally non-painful visceral stimulation of non-diseased structures due to emotional components of visceral disease
visceral pain produces negative emotions, which causes more visceral pain, in a positive feedback loop |
|
|
Term
|
Definition
| serves to distinguish between structures that have pain fibers that travel with the sympathetics (above the pain line) and those that travel with the parasympathetics (below the pain line). |
|
|
Term
| Structures located above the pelvic pain line have pain fibers that travel with the __________ fibers |
|
Definition
|
|
Term
| Structures located below the pelvic pain line have pain fibers that travel with the __________ fibers |
|
Definition
|
|
Term
| What is an anatomical explanation for referred pain? |
|
Definition
the spinal dorsal horn neurons receive multiple, convergent inputs from various viscera, joints, muscle, and cutaneouos structures
Thus, pain from one source may be misinterpreted as pain from another, more commonly stimulated source |
|
|
Term
| What is different about the pathway of pain neurons from viscera, joints, and muscle when the enter the spinal dorsal horn, and pain neurons with exclusively cutaneous input(especially from non-hairy, or glabrous skin). |
|
Definition
Neurons from viscera, joins, muscle, and some cutaneous structures converge their inputs onto a single spinal neuron
neurons with exclusively cutaneous input(especially from non-hairy, or glabrous skin) tend to have a designated pathway all the way up, so pain from skin is more easily located |
|
|
Term
| Under normal conditions, the viscera contain a large number of "silent" afferents, which are not activated by distention. Under what circumstances can these silent afferents be activated? |
|
Definition
inflammation
ischemia
purinergic chemical messengers such as ATP |
|
|
Term
| What 3 places does the medial pain pathway end in the brain, and what happens in those places? |
|
Definition
forward projection to prefrontal cortex--overall evaluation of pain
upward projection to the cingulate cortex--aversive emotional evaulation (I want this to stop)
projection to the amygdala--fear |
|
|
Term
| Glycogen is a highly branched polymer of glucose molecules primarily linked by ____________ bonds, but linked by _____________ bonds at branch points |
|
Definition
α-1,4 glycosidic bonds.
α-1,6 glycosidic bonds. |
|
|
Term
| Glycogen is a highly branched polymer of __________ molecules |
|
Definition
|
|
Term
|
Definition
initiates de novo glycogen chain formation if no pre-existing glycogen is present (serves as a primer).
• the glycogenin end of the glycogen chains is the reducing end
• the opposite end (where the new glucose is added) is the non-reducing end |
|
|
Term
| What happens to glycogen in fed, fasting, & starved states? |
|
Definition
fed (within 2-4 hours of a meal)--synthesis of glycogen
fasting (2-4 hours after a meal)--breakdown of glycogen
starved (3-5 days of fasting)--no more glycogen |
|
|
Term
|
Definition
| a transmembrane carrier protein that is the primary glucose transporter between hepatocytes and the blood |
|
|
Term
|
Definition
| an insulin-regulated transmembrane carrier protein that is the primary glucose transporter between the blood and adipose tissue, skeletal and cardiac muscle. |
|
|
Term
| Phosphorylation of glucose by __________ (liver) and ____________ (other tissues) prevents glucose from leaving the cell. |
|
Definition
|
|
Term
| von Gierke's (Type I) glycogen storage disorder |
|
Definition
a deficiency in glucose-6-phosphatase
in the liver,
G-6-P--(glucose-6-phosphatase)-->glucose
without glucose-6-phosphatase, liver can't release glucose back into the blood & is forced to store it as fat or glycogen
this disorde does not affect skeletal muscle because skeletal muscle doesn't release glucose back into the bloodstream anyway |
|
|
Term
| What is the cutoff between acute and chronic abdominal pain |
|
Definition
|
|
Term
| What is a urine HCG test looking for |
|
Definition
pregnancy
(human chorionic gonadotropin is a hormone produced during pregnancy) |
|
|
Term
| What are the 3 main categories of extra-abdominal causes of acute abdominal pain in the adult non-elderly (18-64), non-traumatic, non-pregnnat patient? |
|
Definition
Cardiothoracic
toxic/metabolic
neurogenic/ psychiatric |
|
|
Term
| Where in the abdomen can pain from MI refer? |
|
Definition
|
|
Term
| On palpation, what are some peritoneal signs with suggest an abdominal source for abdominal pain? |
|
Definition
Shaking tenderness (pain elicited or worsened when the examiner lightly bump’s patient’s bed or stretcher)
Tenderness elicited to light percussion and light palpation
Rebound tenderness (pain upon removal of pressure rather than application of pressure to the abdomen which represents aggravation of the parietal layer of peritoneum by stretching or moving).
Abdominal wall rigidity (involuntary guarding of abdominal musculature) |
|
|
Term
| If you palpate a pulsatile mass in the abdomen, what might that suggest? |
|
Definition
| abdominal aortic aneurysm |
|
|
Term
| What might free air suggest in an abdominal x-ray? |
|
Definition
|
|
Term
| Why would you want to do an EKG on a patient with abdominal pain? |
|
Definition
| to rule out a heart attack |
|
|
Term
| What do air-fluid levels (areas with a air above & fluid below a straight line) suggest? |
|
Definition
|
|
Term
| Why would you want to do an upright chest x-ray on a patient with abdominal pain? |
|
Definition
| to rule out cadriothoracic causes of abdominal pain, like pneumonia |
|
|
Term
| clinical features of perforated GI viscera |
|
Definition
| Severe abdominal pain, rigidity, fever, diaphoresis (sweating) |
|
|
Term
| clinical features of intestinal obstruction |
|
Definition
| Pain with nausea, vomiting (bilious or feculent), obstipation (severe constipation that results in prevention of passage of stool and gas) and increased abdominal distension |
|
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Term
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Definition
| a loop of bowel that has twisted on itself, causing intestinal obstruction |
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Term
| What are 2 common causes of intestinal obstruction in adults? |
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Definition
intestinal adhesions
volvulus (a loop of twisted bowel) |
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Term
| Clinical presentation of abdominal pain suggestive of inflammatory or infectious cause |
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Definition
| Pain that is crampy, diffuse and is associated with vomiting and diarrhea |
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Term
| Clinical presentation of abdominal pain that suggests a ruptured or rupturing abdominal aoritc aneurysm |
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Definition
| Sudden onset of pain that may radiate to the back with hypotension, diaphoresis |
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Term
| Clinical presentation of abdominal pain that suggests mesenteric ischemia or infarction |
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Definition
| sudden onset of pain out of proportion ot physical exam |
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Term
| guaiac positive stool contains |
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Definition
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Term
| What are the 4 tunics of the GI tract? |
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Definition
• Mucosa = mucous membrane
• Submucosa (elastic connective tissue)
• Muscularis externa (2 or 3 layers)
• Adventicia (fibrous connective tissue; serosa within peritoneal cavity) |
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Term
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Definition
an invagination of mucosa in the small intestine and colon
it functions as a gland, secreting various enzymes
also, the base of the crypt consists of stem cells which constantly replace the intestinal epithelium as it is worn away by passing food |
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Term
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Definition
| Large circular folds of mucosa and submucosa projecting from the lumen of the small intestine |
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Term
|
Definition
| small, finger-like protrusions of mucosa only in the small intestine |
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Term
|
Definition
| evagination of apical domain of enterocytes, which are found throughout the intestines |
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Term
| What 2 things does the adventitia of the GI tract consist of? |
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Definition
fibrous connective tissue
serosa (serous membranes) within the peritoneal cavity |
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Term
| Describe the villi of the duodenum |
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Definition
| ‘leaf-like’ – relatively broad and short. |
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Term
| Describe the adventicia of the duodenum |
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Definition
| the adventicia is extensive, but the serosa (serous membranes) is incomplete |
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Term
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Definition
| cells found in the base of the crypts of Lieberkuhn throughout the small intestine. Their purpose is unknown, but they can excrete lysozymes, so they are believed to have an immune function |
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Term
|
Definition
a lymphatic capillary that extends into a villus in the jejunum & absorbs dietary fats
• so-called because the mix of lymph and fat looks milky |
|
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Term
| describe the villi of the jejunum |
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Definition
| long ‘finger-like’ villi, with well-developed core lymph and a lacteal (a lymph capillary that extends into a villus & absorbs dietary fats). |
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Term
| Where do Brunner's glands occur? |
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Definition
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Term
| Describe the villi of the ileum |
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Definition
| shorter ‘finger-like’ villi |
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Term
| Where do Peyer's patches occur? |
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Definition
| in the mucosa of the jejunum (lower density) and ileum (higher density) |
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Term
Explain the following mnemonic:
dudoenum (longest word)
jejunum (middle word)
ileum (shortest word) |
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Definition
The 3 parts of the intestine are arranged from the longest word to the shortest word:
duodenum
jejunum
ileum |
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Term
| Peyer's patches occur in the highest density in the __________, and in a lwoer density in the ______________. |
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Definition
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Term
| Clinical features of c. jejuni, including incubation period. |
|
Definition
incubation period: 2-5 days
diarrhea--up to 10 stools/day, can be bloody; lasts one week
cramping
abdominal pain (often only on one side; can occur in RLQ & mimic appendicities)
nausea & vomiting |
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Term
| C. fetus can be deadly for: |
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Definition
fetuses
(no! would never have guessed!) |
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Term
| What are some illnesses that c. fetus can cause? |
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Definition
endocarditis
septic thrombophlebitis (phlebitis--inflammation of a vein)
bacteremia
septic arthritis
septic abortion
meningoencephalitis
spontaneous peritonities |
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Term
| What protein is a virulence factor for C. fetus, and what does it do? |
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Definition
S-protein
provides resistance to killing by complement |
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Term
|
Definition
|
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Term
| How are campylobacter species transmitted? |
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Definition
| zoonotic--particularly through food (poultry, raw milk, contaminated water) |
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Term
| From what animal do humans most often catch C. fetus? |
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Definition
|
|
Term
| Frm what animal do humans most often catch C. upsalienses. |
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Definition
|
|
Term
| What age group is most likely to catch Campylobacter? |
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Definition
|
|
Term
| In what season is one most likely to catch Campylobacter? |
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Definition
|
|
Term
|
Definition
| a group of diseases characterized by insufficient antibodies |
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Term
| Who is particularly likely to have a prolonged campylobacter infection? |
|
Definition
hypogammaglobulinemic people
Hypogammaglobulinemia—a group of diseases characterized by insufficient antibodies |
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Term
| Where are you more likely to have a milder disease from a Campylobacter infection? |
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Definition
| in areas where the disease is endemic |
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|
Term
bipolar flegalla
unipolar flagella |
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Definition
Bipolar flagella—having a flagellum or cluster of flagella at both ends
Unipolar flagella—having a flagellum or cluster of flagella at only one end |
|
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Term
| What shape is H. pyloric? |
|
Definition
comma or "gull wing" with 3 unipolar flagella (that is, 3 flagella at one end of the bacterium)
Unipolar flagella—having a flagellum or cluster of flagella at only one end |
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Term
|
Definition
spiral shapped with one flagellum at each end (bipolar flagella)
Bipolar flagella—having a flagellum or cluster of flagella at both ends |
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Term
| What are some diseases that H. pylori is associated iwth? |
|
Definition
gastritis
peptic ulcers
gastric adenocarcinoma
gastric mucosa associated lymphoid tissue B-cell lymphomas |
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Term
| What kind of disease does C. jejuni cause? |
|
Definition
|
|
Term
| Where does H. pylori cause pain? |
|
Definition
| upper abdomen (epigastric region) |
|
|
Term
| Where does C. jejuni cause pain? |
|
Definition
diffuse, non-localized abdominal pain
(could be in abdominal cavity, pelvis, retroperitoneum, and/or abdominal wall) |
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|
Term
At what temperature does C. jejuni grow best?
1. cold
2. room temp
3. normal body temp
4. Houston in August at 4pm
5. very hot |
|
Definition
| Houston in August (42 degrees C; 108 degrees F) |
|
|
Term
At what temperature does C. fetus grow best?
1. cold
2. room temp
3. normal body temp
4. Houston in August at 4pm
5. very hot |
|
Definition
| normal body temp (37 degrees C; 98.6 degrees F) |
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Term
| Where does C. jejuni cause damage & disease? |
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Definition
| mucosal surfaces of jejunum (causes bacterial gastroenteritis) |
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|
Term
| Where does C. fetus cause damage & disease? |
|
Definition
| throughout the body; particularly intravascularly |
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Term
| What are 2 serious sequelae of C. jejuni? |
|
Definition
Guillain-Barre sydnrome
Reactive arthritis |
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