Pathology Test: Gastrointestinal Disorders PDF

Dysphagia-Difficulty Swallowing -​ Connection: esophagus is for food, trachea is for air; Fistula creates an abnormality which connects them -​ Diverticulum: a pouch (food is not supposed to be stuck and can cause necrosis) -​ Peristalsis: the contractions of muscles to move through t...

Dysphagia-Difficulty Swallowing -​ Connection: esophagus is for food, trachea is for air; Fistula creates an abnormality which connects them -​ Diverticulum: a pouch (food is not supposed to be stuck and can cause necrosis) -​ Peristalsis: the contractions of muscles to move through the system -​ Achalasia: no peristalsis in the system -​ Below the Esophagus: if people have tumours in this location, it can be esophageal cancer or lung cancer if it is on the outside -​ Neurological Aspects: runs through the cranial nerves (ie: strokes; CNS damage) -​ Cranial Nerve 5: trigeminal; helps chew -​ Cranial Nerve 10: Vagus; helps swallow Gastric Disorders Hiatal Hernia -​ Hernia is when there is a protrusion/poking in an area it does not belong in -​ Lower esophageal sphincter is effected -​ If pushed above the diaphragm, type 1 (no longer in line with the diaphragm; ~90% of cases) -​ Type 2: sphincter is in the right place, the upper part of the stomach is through the top opening (~5% of cases) -​ M/F: heartburn/acid reflux, pyrosis, risk for esophageal cancer -​ Dx: endoscopy -​ Tx: laparoscopic surgery to push it down (T1), surgical removal; since stomach will become necrotic due to twisting it will be removed (T2) -​ E/T: crush injury, heimlich maneuver, being pregnant Gastritis -​ Inflammation of the stomach lining -​ E/T: spicy food, alcohol, medications -​ Pain: reported in LUQ Pyloric Stenosis -​ Narrow opening between stomach and duodenum -​ Thickened pyloric sphincter, if food cannot get through it will either decompose or will be vomited Peptic Ulcer -​ Stomach or duodenal ulcer -​ Caused by H. pylori, or overuse of NSAIDs (Ibuprofen, Naproxen) H. pylori Pathogenesis -​ Person to person (gastro oral transmission) (from the stomach) (ie: sharing food) -​ This bacteria created urease which neutralizes the acid in the stomach, converts urea into NH3 (ammonia, alkaline) -​ Dx: fast tests, non-invasive: -​ Urea breath test: presence of carbon 13 -​ Stool sample: easier in children -​ Both tests are very similar (use either or) -​ Mx: Triple therapy; Clarithromycin, Amoxicillin, Pantoprazole (Metronidazole is used in place of Penicillin/Amoxicillin [allergy]), Bismuth (Pepto Bismol) is another option for quadruple therapy Dumping Syndrome -​ Gastric bypass: Tx of obesity to aid in losing weight -​ Patho: accelerated gastric emptying -​ M/F: extreme form of diarrhea (risk for dehydration, extreme volume of water and electrolytes) -​ NO sugar on an empty stomach; sugar is a water magnet IBS (Irritable Bowel Syndrome) -​ Sporadic abnormal contractions -​ Vagus nerve controls -​ M/F: 15% of people, change in bowel habits, pain/discomfort relieved w/BM  -​ P/F: stress (brain-gut axis), gut microbiome imbalances (e/t; antibiotics, food sensitivity), 5-HT imbalance (serotonin) -​ Splenic Flexure Syndrome: back pressure pressing on the spleen, where the large intestine kinks downwards Intestinal Obstructions Inguinal Hernia -​ Small intestine poking through the abdominal wall, more common in males Volvulus -​ Part of the intestine is twisted on itself -​ Causes ischemia and has to be fixed to avoid necrosis (sepsis will occur w/necrotic tissue because it allows bacteria from large intestine to escape into the body) Telescoping (Intussusception) -​ One component is sliding into another Internal Tumour -​ Intestinal cancer -​ Tumour is on the inside Diverticulitis -​ Diverticulum filled with feces -​ Causes inflammation Inflammatory Bowel Disease Crohn’s Disease -​ Onset: 15-35 y/o, 55-70 y/o -​ s/s: abdominal pain, diarrhea, weight loss, fatigue -​ May have bloody stools -​ Colonoscopy will reveal patchy inflamed tissue (skipped lesion), deep in tissue (fissures) -​ Can affect small and large intestine -​ Complications: -​ Fistula because lesions can erode the wall of one which can go through the thing that's next (touching it) (distends the colon creating a toxic megacolon; must be treated surgically; risk for sepsis if it rips) -​ Rectovaginal Fistula: is a possibility (feces will come out of the vagina) -​ Enterovesical Fistula: is a possibility (males: feces will come out of bladder Ulcerative Colitis -​ Onset: 15-35, 55-70 -​ s/s: stool urgency, fatigue, increased bowel movements, mucus in stool, nocturnal bowel movements, abdominal pain -​ Bloody stool is common -​ Continuous inflammation (continuous lesions), surface level (occurs in mucosa) -​ Can effect large intestine Celiac disease -​ Autoimmune -​ Gluten binds to Gliadin that binds to Tissue Transglutaminase (people w/celiac will create antibodies) -​ Antibodies will attack Tissue Transglutaminase (TTG) and Gliadin  -​ Intestinal Lumen villi will begin to deteriorate through inflammatory response; meaning there will be malabsorption causing weight issues (cannot absorb nutrients) Labs: IgA LOW TTG IgA NEGATIVE (first line screen) Endomysial Antibody (EMA-IgA) NEGATIVE (confirmatory) IgA deficiency: TTG IgG POSITIVE (1st line) Deamidated Gliadin Peptide IgG POSITIVE (confirmatory) (DGP-IgG) IgA deficient people are prone to infections due to antibodies Acute Appendicitis -​ 1. General periumbilical pain -​ 2. Localized: severe RLQ pain, deep tenderness -​ 3. Rupture: pain decreases, spills content into peritoneal cavity -​ 4. Peritonitis: severe pain as infection spreads -​ E/T: little nugget of appendix gets obstructed, which cuts off circulation caused by fecal stone (Fecaliths, calculi, infections (gastro), neoplasm (new growth; tumour), ozempic use -​ s/s: pain in RLQ and belly button, upon percussion will be firm and hard, distention may be present Liver and Pancreatic Functions Cholelithiasis -​ Gallstones: hard, pebble like, made from cholesterol or bilirubin -​ Risk factors: obesity, females, sedentary lifestyle, HTN, age, fair skinned, fertility, over 40 -​ Biliary Sludge: viscous small particles from bile (cholesterol, calcium salts, bilirubin), is a result of bile staying in the gallbladder for too long Cholestasis -​ Gallstones: can be caused by oral contraceptives (Estrogen and progesterone) -​ Estrogen slows movement of your gallbladder causing bile to collect and create stones -​ Located in RUQ -​ Stones: yellow (cholesterol), caviar like, pale yellow -​ Stones can get stuck in the cystic duct (bile will be able to move) or get stuck in the common bile duct (bile will not reach duodenum -​ M/F: common bile duct (clay coloured stool) since the bile is stuck, there is no stercobilin being made, bilirubin backs up into GI tract and gets excreted -​ Stones can also get stuck in pancreatic duct Acute Pancreatitis -​ #1 trigger is gallstones, alcohol, high triglycerides (fat [too much in diet will overstimulate enzymes], mumps virus, medications [ozempic], post endoscopic retrograde cholangiopancreatography, biliary sludge, pregnancy -​ Enzymes: hypovolemic shock when enzymes leak into circulation causing vasodilation, neurogenic shock, Disseminated Intravascular Coagulation, Acute Respiratory Distress Syndrome -​ Septic shock, peritonitis (look for tenderness of inner wall of abdomen) -​ Tx: hemodialysis stabilization Endoscopic Retrograde Cholangiopancreatography -​ Camera gets snaked down esophagus to duodenum -​ Can irritate pancreatic tissue Chronic Pancreatitis -​ Long Term inflammation can turn into scarring (fibrosis) -​ LABS: low fecal elastase in stool -​ E/T: Alcohol abuse, smoking, gallstones, recurrent acute pancreatitis, AiP (autoimmune pancreatitis [labs: IgG4 antibodies]), Cystic fibrosis (thick mucus everywhere) -​ M/F: abdominal pain, N/V, weight loss (no appetite due to pain, can't digest enzymes/food), steatorrhea (fat in the stool; not breaking fat down), Secondary DM (pancreas stops making insulin) Cirrhosis -​ Primary Biliary Cholangitis (PBC): Autoimmune destruction of intrahepatic bile ducts -​ Primary Sclerosing Cholangitis (PSC): Immune-mediated damage to intra- and extrahepatic bile ducts, often linked to UC. -​ Hep C,B,D [chronic and most common to lead to cirrhosis] -​ Autoimmune: Autoimmune Hepatitis (AiH) -​ other: Fe overload (hereditary hemochromatosis), Cu overload (Wilson's disease), a1 antitrypsin deficiency -​ Resistance to BF through fibrotic liver Hepatocytes can't do what they're supposed to Portal Circulation -​ AKA: liver circulation -​ 1: scar tissue obstructs BF through liver (shrinks and tightens)[tried to take blood back to the heart but has a back up effect; high portal hypertension {lots of pressure in the portal vein}] -​ 2: high pressure in anal area (causes hemorrhoids) -​ 3: will not be able to absorb nutrients correctly -​ 4: Back up of blood into the spleen (splenomegaly) -​ 5: bulging esophageal varices (bulge in lumen in esophagus; risk for aspiration, perforation, bleeding from vomiting) -​ Cirrhosis will shut down all organs unless eligible for transplant