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what are some possible disorders of the esophagus?
- atresia
- hiatal hernia
- achalasia
- diverticula
- esophageal varices
- reflux esophagitis
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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
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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
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what are sliding hiatal hernias?
traction from scarred or congenitally shortened esophagus pulls the cardia of stomach thru esophageal hiatus
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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.
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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
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what are clinical manifestations of esophageal achalasia?
- dysphasia (difficulty swallowing)
- food regurgitation
- aspiration pneumonia
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what is esophageal diverticula?
Developmental or acquired outpouching of esophagus wall
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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
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what are esophageal varices?
- tortuous distended veins beneath the esophageal mucosa
- caused by vascular disorder due to hepatic portal HTN (usually related to cirrhosis)
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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
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what is reflux esophagitis?
Inflammation of esophagus related to injury due to regurgitation of gastric contents- may be associated with hiatal hernia
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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)
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what are complications related to reflux esophagitis?
Approx 10% of patients will develop adenocarcinoma
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what are some possible stomach disorders?
- pyloric stenosis
- gastritis
- acute peptic ulceration
- chronic peptic ulceration
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what are the two types of pyloric stenosis?
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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.
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what causes congenital pyloric stenosis?
hypertrophy of pyloric circular muscle that may be palpated as a mass in the newborn having projectile vomiting
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what is acquired pyloric stenosis?
- post-inflammation scarring that may lead to pyloric obstruction
- ulcer -> inflammation->scarring.
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what is gastritis?
- an inflammatory disease of the gut
- can be
- -- acute (erosive)
- -- chronic (non-erosive)
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what is acute gastritis?
- inflammation of gut
- mucosal erosions by
- -- aspirin
- -- toxins
- -- alcohol
- -- stress
- -- CNS trauma
- -- hypersecretion of gastric acid
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what are the symptoms of acute gastritis?
range from abdominal discomfort to massive, life-threatening hemorrhages & gastrical perforation
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what are the characteristics of chronic gastritis?
- No erosions
- chronic inflammatory changes leading eventually to gastric mucosa atrophy & possibly carcinoma
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what are the two types of chronic gastritis?
- Type A (autoimmue)
- Type B (non-immune, more common)
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what is type A chronic gastritis?
- autoimmune origin
- associated with pernicious anemia (lack of B12- decreased RBCs can’t fully develop & mature)
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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
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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
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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
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what is the pathogenesis of acute peptic ulceration?
uncertain since acid concentration is not increased
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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
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what are the two types of chronic peptic ulcers?
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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
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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
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what are possible intestinal disorders?
- hemorrhoids
- acute appendicitis
- ulcerative colitis
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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)
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what are the symptoms of hemorrhoids?
pain, itching, and rectal bleeding but often not symmptomatic
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what is an acute appendicitis?
Inflammatory disease initiated by obstruction of mucous drainage leading to distension, infection, neutrophil emigration, fibrinopurulent exudation, suppurative & gangrenous necrosis
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how does an acute appendicitis present clinically?
- abdominal discomfort in right lower quadrant, nausea, vomiting
- requires immediate surgery upon rupture
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what are the complications associated w/ an acute appendicitis?
- rupture
- peritonitis
- sepsis
- death
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what is ulcerative colitis?
Acute or chronic inflammation of unknown etiology (possibly infections or autoimmunity) causing extensive ulcerations of the mucosal surface of colon
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what is the progression of ulcerative colitis?
begins as mucosal hemorrhages, abscesses & ulcerations in the rectum that spreads proximally & extend to muscular layer
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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
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what are common disorders of the liver?
- hepatitis A, B, C, D
- cirrhosis
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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
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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
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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.
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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
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what is the progression of Hepatitis B?
- incubation period of up to 6 months.
- ((Rest lying down, so BFthru liver increases by ~40%))
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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
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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
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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
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what is liver cirrhosis?
- necrosis, fibrosis and disruption of normal liver architecture
- two types: Laennec's (alcholic) cirrhosis & Postnecrotic (macronodular) cirrhosis
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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.
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what is the progression and symptoms of Laennec's cirrhosis?
Cirrhosis may develop over decades w/symptoms of weight loss, nausea, vomiting, jaundice.
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what are complications associated w/ Laennec's cirrhosis?
Patients may develop ascites, esophageal varices, gastritis, & death usually occurs with hepatic failure.
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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.
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what is the progression of postnecrotic cirrhosis?
When symptoms occur, they are often the result of liver failure or portal HTN.
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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
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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
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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.
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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.)
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what causes obesity?
- possible genetic disposition
- excessive calorie intake > calorie expenditure
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what are complications related to obesity?
- increases the risk of
- - type II diabetes
- - hypertension
- - atherosclerosis
- - cholelithiasis
- - varicose veins
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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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