diverticul/o

diverticulum, or blind pouch, extending from a hollow organ

varices

veins that are enlarged or swollen

Hiatal/hiatus

opening

hernia

referring to a protrusion of a tissue through the wall of the cavity in which it is normally contained

epi

above

gastro

stomach

pylor/o

pylorus (opening between the stomach and duodenum)

sten/o

narrow; contracted; constriction

pept/o

digestion, digestive

volvulus

Abnormal twisting of a portion of the gastrointestinal tract, usually the intestine, which can impair blood flow

Lith

Stone

chole

bile, gall

megaly

enlargement

peritoneum

the serous membrane lining the cavity of the abdomen and covering the abdominal organs.

hepta

liver

cyst/o

urinary bladder, cyst, sac of fluid.

atresia

absence or abnormal narrowing of an opening or passage in the body.

alcoholic gastritis

inflammation of stomach lining caused by alcohol

bacterial(phlegmonous) gastritis

inflammation of the stomach lining caused by bacterial infection

chronic atrophic gastritis

(nonerosive) refers to severe mucosal atrophy(wasting) that causes thinning and a relative absence of mucosal folds, with the fundus or entire stomach having a bald appearance.

chyme

gastric contents that have become mixed with hydrochloric acid and the proteolytic enzyme pepsin, resulting in a milky white product

colonic ileus

selective or disproportionate gaseous distention of the large bowel without an obstruction

constipation

extra water is absorbed from the fecal Mass to produce a hardened stool

corrosive gastritis

inflammation of the stomach caused by corrosive agents

deglutition

swallowing

diarrhea

results from increased motility of the small bowel, which floods the colon with an excessive amount of water that cannot be completely absorbed

diarrheagenic islet cell tumors

reduce the wdha syndrome

emulsifier

a substance that acts like soap by dispersing the fat into very small droplets that permit it to mix with water

epiphrenic diverticulum

outpouching found in the distal 10 cm of the esophagus

gastrinomas

a tumor usually in the pancreas or duodenum (the first segment of the small intestine) that produces excessive levels of the hormone gastrin, which stimulates the stomach to secrete acid and enzymes, causing peptic ulcers.

glycogen

excess glucose absorbed is stored as

hepatitis

inflammatory disease of the liver

infectious gastritis

inflammation of the stomach lining caused by microorganism

infiltrating

spreading into surrounding tissues

insulinoma

hormone secreting neoplasm most frequently in the tail of the pancreas, usually benign

localized ileus

isolated distended loop of small or large bowel

Mallory Weiss syndrome

subsequent inflammation of the distal esophagus due to laceration associated with bleeding and mediastinal penetration caused by severe retching and vomiting

mastication

chewing

pancreatitis

an inflammatory process in which protein and lipid digesting enzymes become activated within the pancreas and begin to digest the organ itself

peristalsis

worm-like movement by which the alimentary canal or other tubular organ propels its contents

polypoid

resembling a polyp

pyloric stenosis

also known as infantile hypertrophic pyloric stenosis, occurs when two muscular layers of the pylorus become hyperplastic and hypertrophic

traction

process of placing tension between two structures

ulceration

destruction of tissue creating an opening within a structure

ulcerogenic islet cell tumors (gastrinoma)

tumor found in pancreas and duodenum that is associated with peptic ulcers

villi

finger-like projections of the small bowel to increase the inner surface area

zenker's diverticulitis

outpouching that arises from the posterior wall of the upper esophagus

what is the basic function of the gastrointestinal system dependent on?

• Secretions of the endocrine and exocrine glands
• Controlled movement of ingested food through the
  tract so absorption can occur

what is the basic function of the gastrointestinal system?

Basic function of the gastrointestinal system is to alter the chemical and physical composition of food so it can be absorbed and used by body cells.

digestion most occurs in the

duodenum

what is the purpose of bile?

emulsifier; it is essential for the digestion and absorption of dietary fat and fat-soluble vitamins

what is the largest gland in the body?

liver

list functions of the liver

• Bile production and excretion
• Excretion of bilirubin, cholesterol, hormones, and drugs
• Metabolism of fats, proteins, and carbohydrates
• Enzyme activation
• Storage of glycogen, vitamins, and minerals
• Synthesis of plasma proteins, such as albumin, and clotting factors
• Blood detoxification and purification

appearance of the gallbladder

pear-shaped sac that lies on the undersurface of the liver

function of the gallbladder

to store bile that enters by way of the hepatic and cystic ducks in to concentrate the Bayou by absorbing water. in response to the presence of dietary fat in the small bowel, the gallbladder contracts and ejects the concentrated bile into the duodenum.

function of the pancreas

the pancreas controls the level of circulating blood glucose by secreting insulin and glucagon in the islets of langerhans... necessary for the breakdown of proteins, carbohydrates, and fats.

tracheoesophageal fistula Congenital form results from?

result from the failure of the esophageal lumen to develop completely separate from the trachea

Most common type of Congenital tracheoesophageal fistula

Type III

tracheoesophageal fistula acquired type causes

caused by cancer (50%), infection, trauma, instrumentation perforation

Most common complication of tracheoesophageal fistula

Aspiration Pneumonia

Esophageal Atresia

The lack of the development of the esophageal lumen resulting in a blind pouch

What is the acute form of esophagitis most commonly the result of?

Acute form of esophagitis is most commonly the result of reflux of stomach contents into distal esophagus.

most common type of esophagitis

GERD – gastroesophageal reflux disease

Chronic esophagitis may result in?

Chronic esophagitis may result in strictures or Barrett’s esophagus.

What condition increases the likelihood of esophagitis?

patients with sliding Hiatal hernias

Barrett’s esophagus

a condition related to severe reflux esophagitis in which the normal squamous lining of the lower esophagus is destroyed and replaced by columnar epithelium similar to that of the stomach

esophagitis may also be caused by infection:(2)

• Herpes virus
• Candida

ingestion of corrosive agents produce

Produces acute inflammatory changes in the esophagus

Superficial penetration of the toxic agent results?

results in only minimal ulceration

What does deeper penetration of ingested corrosive agents result in?

Deeper penetration of the submucosa and muscular layers causes sloughing of destroyed tissue and deep ulceration

most common cell type of esophageal cancer

Most are squamous cell type

most common site for esophageal cancer

Most common site is esophagogastric junction

what is esophageal cancer associated with?

Associated with excessive alcohol intake and smoking

what does esophageal cancer cause to occur late in the disease?

Dysphagia(difficulty swallowing) occurs late in the disease

Best Imaging procedure to diagnose esophageal cancer

double-contrast barium swallow

Best Imaging procedure to stage esophageal cancer

CT

Esophageal Diverticula

Outpouchings of the esophageal wall

True or traction esophageal diverticula

Involve all layers of the wall

False or pulsion esophageal diverticula

Composed of only mucosa and submucosa herniating through the muscular layer

zenker's diverticulum

Arises from the posterior wall of the cervical esophagus

epiphrenic diverticulum

arises in the distal 10 cm of the esophagus

Esophageal Varices

Dilated veins in the distal esophagus

esophageal varices caused

Caused by portal hypertension

Portal hypertension is usually caused by?

cirrhosis

esophageal varices complication

may hemorrhage

esophageal varices best shown on?

Best shown on a double contrast barium
swallow

Hiatal Hernia

Protrusion of a portion of the stomach into the thoracic cavity through the esophageal hiatus in the diaphragm

hiatal hernia commonly cause

Commonly causes GERD

how is hiatal hernia commonly found?

Most common abnormality found on UGI

Achalasia

Functional obstruction of the distal esophagus with proximal dilation

achalasia caused by?

Caused by incomplete relaxation of the lower
esophageal sphincter

Foreign bodies may be _______ or ________.

radiopaque or radiolucent.

Radiopaque is seen with/without the aid of contrast.

Radiopaque is often seen without the aid of contrast.

Radiolucent is seen with/without the aid of contrast.

Radiolucent is best seen with the aid of barium swallow.

Why is an AP and lateral required for a foreign object?

Two projections 90 degrees from each other required to truly determine where the object is lodged in esophagus.

Perforation of the Esophagus may be a complication of:

• Esophagitis
• Peptic ulcer
• Neoplasm
• External trauma
• Instrumentation

perforation of the esophagus may result from?

Some perforations may result from severe vomiting (the most common cause) or coughing, often from dietary or alcoholic indiscretion.

gastritis

is defined as inflammation of the stomach mucosa.

gastritis caused by irritants including:

• Alcohol
• Corrosive agents
• Infection

what infection can cause chronic gastritis that may lead to peptic ulcer disease?

Helicobacter pylori can cause chronic gastritis that may lead to peptic ulcer disease.

what does gastritis change?

It changes the normal surface pattern of the gastric mucosa.

Pyloric stenosis is also known as

infantile hypertrophic pyloric stenosis (IHPS).

pyloric stenosis causes:

Causes are thought to be a combination of environmental and hereditary factors.

pyloric stenosis demonstrates as:

• Lengthening of the gastric antrum and pyloric
  canal
• Edematous and thickened mucosa

pyloric stenosis causes the two muscular layers of the pylorus to become

hyperplastic and hypertrophic

pyloric stenosis can cause

obstruction (incomplete or complete), preventing food from entering into the duodenum.

pyloric stenosis modality of choice

ultrasound

when pyloric stenosis is palpated what is it described as?

is often described as a mobile hard "olive."

peptic ulcer disease

is a group of inflammatory processes involving the stomach and duodenum

Peptic Ulcer Disease caused by

by the action of acid and the enzyme pepsin secreted by the stomach.

peptic ulcer disease most common location

Most common location is the lesser curvature.

peptic ulcer disease Spectrum

Disease spectrum varies from small and shallow superficial erosions to huge ulcers that may perforate.

peptic ulcer disease major complication:

• Hemorrhage
• Gastric outlet obstruction
• Perforation

peptic ulcer disease is the most common cause of

most common cause of acute upper gastrointestinal bleeding

most common manifestation of PUD

Duodenal ulcer is the most common manifestation

most common location of PUD

majority occur in the duodenal bulb

Cancer of the stomach is rare in _________

the United States.

where is stomach cancer prevalent?

It is prevalent in Japan, Chile, and parts of Eastern Europe.

why does a stomach cancer diagnosis often occur late?

Pain is not an early symptom, so diagnosis usually occurs late stage.

where does stomach cancer most occur?

Most occur in the distal stomach.

stomach cancer prognosis? how is it staged?

Prognosis is poor – staged by CT.

Predisposing risk factors of stomach cancer:

-Atrophic gastric mucosa, as in pernicious anemia
-10 to 20 years after a partial gastrectomy for
peptic ulcer disease.

lymphomas of the stomach

Lymphoma is a malignancy of the of the lymphoreticular system

gastric lymphoma often seen as?

often is seen as a large, bulky polypoid mass, usually irregular and ulcerated.

gastric lipomas may be indistinguishable from?

It may be indistinguishable from a carcinoma.

Crohn's disease (Regional Enteritis)

is an idiopathic, chronic, inflammatory disorder.

what does Crohn's disease most often affect?

It most often involves the terminal area of the ileum. It can affect any part of the GI tract.

cause of Crohn's Disease?

Cause is unknown, but stress or emotional upsets are frequently related to the onset or relapse of the disease.

most common causes of small bowel obstruction

Most often caused by fibrous adhesions from
previous surgery
Second most common cause is hernias

Adynamic ileus

also termed paralytic ileus, It is a common disorder of intestinal motor activity. Fluid and gas do not progress normally through a nonobstructed small and large bowel.

what factors can trigger reflexes that impede intestinal motility?

Neural, hormonal, and metabolic factors can trigger reflexes that impede intestinal motility.

who does adynamic ileus normally happen to?

It occurs in almost every patient who undergoes abdominal surgery.

other causes for adynamic ileus:

• Peritonitis
• Medications that decrease intestinal peristalsis
  (those with an atropine-like effect),
• Electrolyte and metabolic disorders
• Trauma

Intussusception

Intussusception is the telescoping of one part of the intestinal tract into another because of peristalsis. It forces the proximal segment of bowel to move distally within the outer portion.

What does this cause in children?

This is a major cause of obstruction in children.

malabsorption disorders

refers to a multitude of conditions in which there is defective absorption of carbohydrates, proteins, and fats from the small bowel.

what is malabsorption results in?

steatorrhea—the passage of bulky, foul-smelling, high-fat-content stools that float.

appendicitis

is the inflammation of the appendix.

causes of appendicitis

Obstruction of fluid flow by fecalith or scarring

complications of appendicitis

• Gangrene
• Abscess
• Perforation

appendicitis is most common in what age group?

Appendicitis is more common in children.

appendicitis modality of choice

CT

diverticulosis

is outpouchings that are acquired herniations of mucosa and submucosa through the muscular layers at points of weakness in the bowel wall.

incidence of diverticulosis increases with?

Incidence increases with age

where does diverticulosis most commonly occur?

It occurs most commonly in the sigmoid portion.

diverticulitis

defined as necrosing inflammation in the diverticula.

why does diverticulitis occur?

Diverticulitis is a complication of diverticulosis.

diverticulitis complications:

• Perforation
• Abscess
• Fistulas to adjacent organs

What is ulcerative colitis? What is a characteristic feature?

Ulcerative colitis is an idiopathic inflammatory disease of the bowel.
It may have an autoimmune or psychogenic factor (stress exacerbates condition). A characteristic feature is alternating periods of remission and relapse.

Crohn’s Colitis

is the second major cause of inflammatory bowel disease. It is identical to Crohn’s disease in the small bowel.

What portion of the colon does Crohn's Colitis usually affect?

It most commonly affects the proximal colon. Most also have disease of the terminal ileum. Rarely affects the rectum.

What is ischemic colitis characterized by?

Ischemic colitis is characterized by the abrupt onset of lower abdominal pain and rectal bleeding.

symptoms of ischemic colitis?

Diarrhea is common. It is often accompanied by abdominal tenderness.

who is ischemic colitis most common in?

It is most common in those over 50 years old.

what do most people have who have ischemic colitis have history of?

Most have a history of cardiovascular disease.

irritable bowel syndrome(IBS)

refers to several conditions that have an alteration in intestinal motility as the underlying pathophysiologic abnormality.

most common symptoms of irritable bowel syndrome

are alternating periods of constipation and diarrhea.

What is the third leading cause of cancer death in the United States?

cancer of the colon

Most common primary colon cancer

Most typical primary colon cancer is annular.

who is colon cancer most common in?

Peak age incidence is 50 to 70 years old.

It is twice as common in men

predisposing factors of colon cancer:

• Long-term ulcerative colitis
• Familial polyposis

large bowel obstruction results primarily from what?

About 70% of large bowel obstructions result from primary colonic carcinoma.

Diverticulitis and volvulus account for most other cases.

large bowel obstruction vs small bowel obstruction

It is usually less acute than small bowel obstructions.
Symptoms develop more slowly.
Fewer fluid and electrolyte disturbances are produced.

Volvulus of the colon refers to?

Volvulus of the colon refers to a twisting of the bowel on itself. May cause obstruction.

Most common sites of volvulus of the colon:

Cecum
Sigmoid

hemorrhoids and symptoms

Hemorrhoids are varicose veins of the distal
rectum. Symptoms include pain, itching, and bleeding.

causes of hemorrhoids

Caused by increased venous pressure, such as with:

• Constipation
• Pelvic tumor
• Pregnancy

Two major types of gallstones:

• Cholesterol – predominant type in the United States.
• Pigment

predispositions of gallstones:

• Family history
• Over age 40
• Overweight
• Female

modality of choice to diagnose gallstones

ultrasound

Acute Cholecystitis

is acute inflammation of the gallbladder.

cause of Acute Cholecystitis

It is usually caused by cystic duct obstruction by a gallstone.

Emphysematous cholecystitis

Emphysematous cholecystitis is a rare condition that occurs when stasis, ischemia, and cystic duct obstruction (stones) allow the growth of gas-forming organisms in the gallbladder.

who does emphysematous cholecystitis most commonly occur in?

It occurs most commonly in elderly men and in patients with poorly controlled diabetes mellitus.

what is porcelain gallbladder? what is porcelain gallbladder caused by? what does porcelain gallbladder cause?

refers to calcification of the gallbladder walls. It is caused by chronic cholecystitis. Walls become fibrous, then calcified.

what is the most prevalent inflammatory disease of the liver?

hepatitis

common causes of hepatitis:

• Viral infection
• Reaction to drugs and toxins

The viral types of hepatitis include:

• Hepatitis A virus (HAV)
• Hepatitis B virus (HBV)
• Hepatitis C virus (HCV)
• Hepatitis E virus (HEV)

Healthcare workers are at risk of HBV exposure. how is it transmitted? what helps protect healthcare workers and the public from getting HBV?

It is transmitted through contaminated blood and blood products and sexual contact.
Vaccine is available and often required for employment.

cirrhosis

Cirrhosis refers to the chronic destruction of liver cells and structure, with nodular regeneration of liver parenchyma and fibrosis. It is an end-stage liver disease.

major cause of cirrhosis

The major cause is chronic alcoholism (i.e., 10 to 20 years of alcohol abuse).

other causes of cirrhosis:

• Postnecrotic viral hepatitis
• Hepatotoxic drugs and chemicals
• Biliary cirrhosis
• Hemochromatosis

common complication of cirrhosis? what do they do for cirrhosis?

Most characteristic symptom or complication– ascites
Fluid accumulation in the abdomen Incurable and irreversible

technical factors of cirrhosis

in normal individuals, the liver always appears brighter than the spleen, whereas in patients with cirrhosis of the liver is much darker because of the amount of fat. The portal veins appear as high-density structures surrounded by a background of low-density caused by hepatic fat; this is the opposite of a normal pattern of the portal veins, which are low-density channels on non-contrast scans.

What is hepatocellular carcinoma? Who is hepatocellular carcinoma most common in?

is primary liver cell cancer. It is most common in those with cirrhosis.

what is the modality of choice for hepatocellular carcinoma?

CT

What is hepatic metastasis? What is the prognosis?

is the most common malignancy of the liver. Prognosis is very poor

hepatic metastasis diagnosed via:

• CT
• US
• MRI
• NM

acute pancreatitis

is an inflammatory process in which protein- and lipid-digesting enzymes become activated within the pancreas and begin to digest the organ itself.

most common cause of acute pancreatitis

Excessive alcohol consumption

other causes of acute pancreatitis

Gallstones obstructing bile flow

what causes chronic pancreatitis?

results when frequent injury to the pancreas causes scar tissue.

what usually causes recurring episodes of chronic pancreatitis?

Recurring episodes usually result from chronic alcohol abuse. It causes the gland to lose its ability to produce digestive enzymes, insulin, and glucagon.

3 symptoms of chronic pancreatitis:

• Pain
• Malabsorption causing weight loss
• Diabetes

Pancreatic pseudocyst

is defined as walled-off fluid collections.

Why does Pancreatic pseudocyst occur?

occur due to inflammation, necrosis, or hemorrhage.

pancreatic pseudocyst causes:

• Acute pancreatitis
• Trauma

what is the most common type of pancreatic cancer?

Most common type of cancer of the pancreas is adenocarcinoma.

• Usually advanced at time of diagnosis.
• Prognosis is poor.

most common site for pancreatic cancer

Most common site is the head of the pancreas.

modality of choice for pancreatic cancer:

CT

Pneumoperitoneum

is defined as free air in the peritoneal cavity.

Pneumoperitoneum causes:

• Perforation of a gas-containing viscus (surgical
  emergency)
• Abdominal, gynecologic, intrathoracic, or
  iatrogenic causes (does not require operative
  intervention)

splenomegaly

is enlargement of the spleen.

splenomegaly is associated with numerous conditions, including:

• Infections (subacute bacterial endocarditis,
  tuberculosis, infectious mononucleosis, malaria)
• Connective tissue disorders
• Neoplastic hematologic disorders (lymphoma,
  leukemia)
• Hemolytic anemia
• Hemoglobinopathies
• Portal hypertension (cirrhosis)

what is the most common cause of splenic rupture? what does splenic rupture usually require?

Most common cause of splenic rupture is trauma. Rapid blood loss usually requires immediate surgery.

splenic rupture may be a complication of

may be a complication of the palpation of a spleen enlarged by infection (especially infectious mononucleosis) or leukemia.