Chapter 5: Gastrointestinal System
an abnormal connection between two hollow spaces
diverticulum, or blind pouch, extending from a hollow organ
veins that are enlarged or swollen
referring to a protrusion of a tissue through the wall of the cavity in which it is normally contained
pylorus (opening between the stomach and duodenum)
narrow; contracted; constriction
Abnormal twisting of a portion of the gastrointestinal tract, usually the intestine, which can impair blood flow
the serous membrane lining the cavity of the abdomen and covering the abdominal organs.
urinary bladder, cyst, sac of fluid.
absence or abnormal narrowing of an opening or passage in the body.
inflammation of stomach lining caused by alcohol
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.
gastric contents that have become mixed with hydrochloric acid and the proteolytic enzyme pepsin, resulting in a milky white product
selective or disproportionate gaseous distention of the large bowel without an obstruction
extra water is absorbed from the fecal Mass to produce a hardened stool
inflammation of the stomach caused by corrosive agents
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
a substance that acts like soap by dispersing the fat into very small droplets that permit it to mix with water
outpouching found in the distal 10 cm of the esophagus
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.
excess glucose absorbed is stored as
inflammatory disease of the liver
inflammation of the stomach lining caused by microorganism
spreading into surrounding tissues
hormone secreting neoplasm most frequently in the tail of the pancreas, usually benign
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
an inflammatory process in which protein and lipid digesting enzymes become activated within the pancreas and begin to digest the organ itself
worm-like movement by which the alimentary canal or other tubular organ propels its contents
resembling a polyp
also known as infantile hypertrophic pyloric stenosis, occurs when two muscular layers of the pylorus become hyperplastic and hypertrophic
process of placing tension between two structures
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
finger-like projections of the small bowel to increase the inner surface area
outpouching that arises from the posterior wall of the upper esophagus
what is the basic function of the gastrointestinal system dependent on?
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
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?
list functions of the liver
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
tracheoesophageal fistula acquired type causes
caused by cancer (50%), infection, trauma, instrumentation perforation
Most common complication of tracheoesophageal fistula
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
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)
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
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
Arises from the posterior wall of the cervical esophagus
arises in the distal 10 cm of the esophagus
Dilated veins in the distal esophagus
esophageal varices caused
Caused by portal hypertension
Portal hypertension is usually caused by?
esophageal varices complication
esophageal varices best shown on?
Best shown on a double contrast barium
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
Functional obstruction of the distal esophagus with proximal dilation
achalasia caused by?
Caused by incomplete relaxation of the lower
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:
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.
is defined as inflammation of the stomach mucosa.
gastritis caused by irritants including:
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:
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
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:
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
Second most common cause is hernias
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:
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.
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.
is the inflammation of the appendix.
causes of appendicitis
Obstruction of fluid flow by fecalith or scarring
complications of appendicitis
appendicitis is most common in what age group?
Appendicitis is more common in children.
appendicitis modality of choice
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.
defined as necrosing inflammation in the diverticula.
why does diverticulitis occur?
Diverticulitis is a complication of diverticulosis.
What is ulcerative colitis? What is a characteristic feature?
Ulcerative colitis is an idiopathic inflammatory disease of the
It may have an autoimmune or psychogenic factor (stress exacerbates condition). A characteristic feature is alternating periods of remission and relapse.
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:
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:
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:
Two major types of gallstones:
predispositions of gallstones:
modality of choice to diagnose gallstones
is acute inflammation of the gallbladder.
cause of Acute Cholecystitis
It is usually caused by cystic duct obstruction by a gallstone.
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?
common causes of hepatitis:
The viral types of hepatitis include:
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
Vaccine is available and often required for employment.
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:
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?
What is hepatic metastasis? What is the prognosis?
is the most common malignancy of the liver. Prognosis is very poor
hepatic metastasis diagnosed via:
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:
is defined as walled-off fluid collections.
Why does Pancreatic pseudocyst occur?
occur due to inflammation, necrosis, or hemorrhage.
pancreatic pseudocyst causes:
what is the most common type of pancreatic cancer?
Most common type of cancer of the pancreas is adenocarcinoma.
most common site for pancreatic cancer
Most common site is the head of the pancreas.
modality of choice for pancreatic cancer:
is defined as free air in the peritoneal cavity.
is enlargement of the spleen.
splenomegaly is associated with numerous conditions, including:
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.