clinicalMedGIAndLiverSystem

• atresia
• hiatal hernia
• achalasia
• diverticula
• esophageal varices
• reflux esophagitis

• esophagus has incompletely developed
• -- disconnected, hypertrophied upper segment
• -- lower segment connected to trachea
• usually at level of tracheal bifurcation
• easy surgical fix

• 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

traction from scarred or congenitally shortened esophagus pulls the cardia of stomach thru esophageal hiatus

• part of gastric fundus protrudes thru a defect (weak muscle) in the esophageal hiatus
• may be accentuated by increased intraabdominal pressure.

• "lazy esophagus": lack of expansion and contraction
• failure of gastroesophageal sphincter to relax so food remains within esophagus prox to gastroesophageal sphinter

• dysphasia (difficulty swallowing)
• food regurgitation
• aspiration pneumonia

Developmental or acquired outpouching of esophagus wall

• 1. increased intraluminal pressure occuring on posterior wall (over accum of food)
• 2. inflammation outside the esophagus w/ fibrosis that creates distortion

• tortuous distended veins beneath the esophageal mucosa
• caused by vascular disorder due to hepatic portal HTN (usually related to cirrhosis)

• generally asymptomatic
• rupture occurs when varices reach size grtr than 5 mm in diameter - causes massive hematemesis

Inflammation of esophagus related to injury due to regurgitation of gastric contents- may be associated with hiatal hernia

• 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)

Approx 10% of patients will develop adenocarcinoma

• pyloric stenosis
• gastritis
• acute peptic ulceration
• chronic peptic ulceration

• congenital
• acquired

• Congenital narrowing of pyuloric canal
• 4:1 predominant for males
• most common indication for abdominal surgery in 1st 6 months of life.

hypertrophy of pyloric circular muscle that may be palpated as a mass in the newborn having projectile vomiting

• post-inflammation scarring that may lead to pyloric obstruction
• ulcer -> inflammation->scarring.

• an inflammatory disease of the gut
• can be
• -- acute (erosive)
• -- chronic (non-erosive)

• inflammation of gut
• mucosal erosions by
• -- aspirin
• -- toxins
• -- alcohol
• -- stress
• -- CNS trauma
• -- hypersecretion of gastric acid

range from abdominal discomfort to massive, life-threatening hemorrhages & gastrical perforation

• No erosions
• chronic inflammatory changes leading eventually to gastric mucosa atrophy & possibly carcinoma

• Type A (autoimmue)
• Type B (non-immune, more common)

• autoimmune origin
• associated with pernicious anemia (lack of B12- decreased RBCs can’t fully develop & mature)

• nonimmune origin
• more common
• can be
• -- hypersecretory: antral gastritis related to duodenal ulcer
• -- environmental: multifocal related to gastric ulcer & carcinoma

• 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

• 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

uncertain since acid concentration is not increased

• 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

• duodenal
• gastric

• (a type of chronic peptic ulcer)
• genetic predisposition (men, type O blood) who smoke & drink,
• high acid secretion
• patients with gastric ulcer

• (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

• hemorrhoids
• acute appendicitis
• ulcerative colitis

• 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)

pain, itching, and rectal bleeding but often not symmptomatic

Inflammatory disease initiated by obstruction of mucous drainage leading to distension, infection, neutrophil emigration, fibrinopurulent exudation, suppurative & gangrenous necrosis

• abdominal discomfort in right lower quadrant, nausea, vomiting
• requires immediate surgery upon rupture

• rupture
• peritonitis
• sepsis
• death

Acute or chronic inflammation of unknown etiology (possibly infections or autoimmunity) causing extensive ulcerations of the mucosal surface of colon

begins as mucosal hemorrhages, abscesses & ulcerations in the rectum that spreads proximally & extend to muscular layer

• a recurrent disease manifested in adulthood as abdominal pain, cramps & bloody diarrhea
• exp: chron's disease
• not much in way of tx

• hepatitis A, B, C, D
• cirrhosis

• 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

• RNA virus liver infection acquired by ingestion of fecally-contaminated food & water
• damage can be confirmed by rise in serum aminotransferase activity
• vaccine available

• 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.

• DNA virus-acute & chronic liver condition- may be asymptomatic or exceedingly fulminant
• virus is transmitted by blood products or contaminated
• needles

• incubation period of up to 6 months.
• ((Rest lying down, so BFthru liver increases by ~40%))

• 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

• 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

• 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

• necrosis, fibrosis and disruption of normal liver architecture
• two types: Laennec's (alcholic) cirrhosis & Postnecrotic (macronodular) cirrhosis

• Common type in U.S.
• Causes decreases in liver size with fine nodularity
• Advanced stages: liver develops fibrotic consistency & dark color.

Cirrhosis may develop over decades w/symptoms of weight loss, nausea, vomiting, jaundice.

Patients may develop ascites, esophageal varices, gastritis, & death usually occurs with hepatic failure.

• 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.

When symptoms occur, they are often the result of liver failure or portal HTN.

• portal hypertension
• results in a backup of blood increasing pressure in the portal vein which can lead to
• -- ascites
• -- esophageal varices
• -- hemorrhoids

• cholelithiasis (gallstones)
• more often seen in women, increase in incidence w/age, & are related to obesity & high caloric diets

• 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.

• 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.)

• possible genetic disposition
• excessive calorie intake > calorie expenditure

• increases the risk of
• - type II diabetes
• - hypertension
• - atherosclerosis
• - cholelithiasis
• - varicose veins

• 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)