GI Tract

Question 1

Define hiatus hernia.

Answer 1

A diaphragmatic hernia where the stomach passes through the diaphragm into the thoracic cavity

Two types: sliding hernia (90% of cases) and rolling (paraesophageal) hernia.

Question 2

What is gastroesophageal reflux disease (GERD)?

Answer 2

Reflux of gastric juices and contents through the lesser esophageal sphincter (LES)

Symptoms include heartburn and dysphagia.

Question 3

List the signs and symptoms of nausea. (6)

Answer 3

• Unpleasant sensation preceding vomiting due to;
• Nerve ending irritation
• Intense pain
• Strong emotions
• Systemic disorders
• Drugs and excessive alcohol intake

Nausea can be caused by various factors.

Question 4

What are the effects of excessive vomiting? (7)

Answer 4

• Dehydration
• Fluid and electrolyte imbalance
• Loss of hydrochloric acid
• Aspiration into lungs
• Tear or rupture of esophageal wall
• Malnutrition
• Damage to teeth

Excessive vomiting can lead to serious health issues.

Question 5

Define diarrhea.

Answer 5

Frequent, watery stools with poor absorption of nutrients and water

Causes include malabsorption, infections, and mechanical issues.

Question 6

What causes anorexia? (4)

Answer 6

• Loss of appetite
• Aversion to food
• Associated with nausea, vomiting, diarrhea
• Can be due to cancer, heart disease, renal disease, or psychological factors

Anorexia can lead to malnutrition and weight loss.

Question 7

What is dysphagia?

Answer 7

Difficulty swallowing

Causes include neurological conditions, local trauma, and obstructions.

Question 8

Define constipation.

Answer 8

Slow, difficult, or infrequent bowel movements (fewer than 3 per week)

Causes include dehydration, drugs, and mechanical obstructions.

Question 9

What is heartburn?

Answer 9

Burning sensation in the esophagus due to acidic contents regurgitated

Often associated with hiatal hernia and certain foods.

Question 10

What are the types of peptic ulcers?

Answer 10

• Gastric ulcer
• Duodenal ulcer
• Stress ulcers

Peptic ulcers result from a break in the protective mucosal lining.

Question 11

What is the most common cause of chronic gastritis?

Answer 11

Chronic Helicobacter pylori infection

Type A gastritis may be autoimmune and associated with pernicious anemia.

Question 12

What are the clinical manifestations of acute gastritis? (5)

Answer 12

• Epigastric pain
• Abdominal distension
• Anorexia
• Nausea
• Possible fever and vomiting

Acute gastritis is often associated with serious illness or drug use.

Question 13

What is the incidence of peptic ulcers?

Answer 13

Common, up to 10% of Americans; duodenal ulcers are the most common

Peak incidence occurs in mid-30s for duodenal ulcers and 60s for gastric ulcers.

Question 14

What are the clinical manifestations of stomach cancer?

Answer 14

• Dysphagia
• Anorexia
• Weight loss
• Hoarseness

Esophageal cancer is uncommon but has significant risk factors.

Question 15

True or false: Scleroderma esophagus is common in people with progressive systemic sclerosis.

Answer 15

TRUE

It leads to impaired motility and reflux esophagitis.

Question 16

What is malabsorption syndrome?

Answer 16

A condition where the intestine cannot absorb nutrients properly

Associated with conditions like celiac disease and Crohn’s disease.

Question 17

What are the symptoms of ischemic bowel disease? (3)

Answer 17

• Abdominal pain
• Diarrhea
• Weight loss

Caused by reduced blood flow to the intestines.

Question 18

What is diverticulitis?

Answer 18

Inflammation of diverticula in the colon

Can lead to complications like abscesses or perforation.

Question 19

What is appendicitis?

Answer 19

Inflammation of the appendix

Symptoms include abdominal pain and fever.

Question 20

What is peritonitis?

Answer 20

Inflammation of the peritoneum

Can be caused by infection or perforation of abdominal organs.

Question 21

What is the difference in pain occurrence between gastric ulcers and other types of pain?

Answer 21

• Pain occurs between meals
• Gastric ulcer pain is felt with food in stomach

Gastric ulcers may also have systemic symptoms such as nausea, vomiting, and loss of appetite.

Question 22

What are the systemic symptoms that may occur with gastric ulcers?

Answer 22

• Nausea
• Vomiting
• Loss of appetite

Symptoms may not appear until perforation and hemorrhage occurs, leading to melena stools or hematemesis.

Question 23

What is the most common type of stomach cancer?

Answer 23

Gastric Adenocarcinoma

In 90% of cases, malignant neoplasms arise from gastric mucosa.

Question 24

What factors are associated with an increased risk of stomach cancer?

Answer 24

• Men over 40
• Chronic gastritis
• Chronic H. pylori infection
• Pernicious anemia
• Type A blood
• Gastric polyps
• Smoked fish and salt preserved foods

High incidence is noted in Japan, parts of South America, and Eastern Europe.

Question 25

What is the **pathogenesis** of stomach cancer?

Answer 25

* Most common site: glands of stomach mucosa in distal portion of stomach on lesser curvature of the pre-pyloric antrum * Duodenal reflux destroys mucosal barrier * Insufficient acid secretion creates an alkaline environment allowing bacteria to convert nitrates to nitrosamines ## Footnote This process can damage DNA of the mucosal cells, promoting metaplasia.

Question 26

What are the **clinical manifestations** of stomach cancer?

Answer 26

* Early asymptomatic or vague symptoms * Dyspepsia * Anorexia * Weight loss ## Footnote Clinical presentation varies based on tumor characteristics such as infiltration, ulceration, obstruction, or metastasis.

Question 27

What is **pyloric stenosis**?

Answer 27

Obstruction at the pyloric sphincter due to hypertrophy of the sphincter ## Footnote It is one of the most common surgical disorders of early infancy.

Question 28

What are the **incidence and etiology** factors for pyloric stenosis?

Answer 28

* Unknown cause for congenital * Genetic predisposition * More common in white males (4:1 females) * More likely in full-term infants than premature infants * Associated with congenital anomalies ## Footnote Increased gastric secretion in the mother during the 3rd trimester may increase likelihood.

Question 29

What are the **clinical manifestations** of pyloric stenosis in infants?

Answer 29

* Projectile vomiting 2–4 weeks after birth * Progressive dehydration * Lethargy * Malnutrition * Weakness * Electrolyte imbalances * Palpable mass at sphincter ## Footnote Adults may experience persistent nausea, vomiting, epigastric pain, weight loss, and anorexia.

Question 30

What are the two components of **malabsorption syndrome**?

Answer 30

* Maldigestion * Malabsorption ## Footnote Maldigestion refers to the inability to chemically digest nutrients, while malabsorption refers to the inability to absorb nutrients.

Question 31

What are some **causes** of malabsorption syndrome?

Answer 31

* Celiac disease * Crohn’s disease * Ulcerative colitis * Cystic fibrosis * Chronic pancreatitis * Pancreatic carcinoma * Pernicious anemia ## Footnote These conditions lead to decreased absorption of various nutrients.

Question 32

What are the **clinical manifestations** of malabsorption syndrome?

Answer 32

* Progressive weight loss * Fatigue * Depression * Bloating * Changes in feces (bulky, malodorous, fatty) * Diarrhea * Cramps * Flatulence ## Footnote Late symptoms may include muscle wasting, low blood pressure, and abdominal distention.

Question 33

What is **celiac disease**?

Answer 33

Sensitivity to gluten leading to damage of the intestinal mucosa ## Footnote It is also known as gluten-induced enteropathy or celiac sprue.

Question 34

What are the **four characteristics** of celiac disease?

Answer 34

* Steatorrhea (fat in feces) * General malnutrition * Abdominal distention * Secondary vitamin deficiencies ## Footnote It is second to cystic fibrosis as a cause for childhood malabsorption.

Question 35

What are the two conditions included in **Inflammatory Bowel Disease (IBD)**?

Answer 35

* Crohn’s disease * Ulcerative colitis ## Footnote IBD is likely autoimmune and often accompanied by other conditions like SLE or fibromyalgia.

Question 36

What are the **clinical manifestations** of Crohn's disease?

Answer 36

* Right lower quadrant abdominal mass * Severe anorexia and weight loss * Abdominal pain * Bloody stools * Diarrhea ## Footnote It can affect any region from mouth to anus.

Question 37

What are the **clinical manifestations** of Ulcerative Colitis?

Answer 37

* Severe chronic diarrhea with blood * Abdominal pain * Possible joint pain * Skin rashes ## Footnote It primarily affects the mucosa and submucosa of the large intestine and/or rectum.

Question 38

What is **Irritable Bowel Syndrome (IBS)**?

Answer 38

A group of disorders involving abnormal motility of the intestines without inflammation ## Footnote It is the most common disorder of the gastrointestinal tract.

Question 39

What are the **clinical manifestations** of IBS?

Answer 39

* Intermittent symptoms * Altered bowel habits (diarrhea and constipation) * Abdominal cramps or deep aching pain * Nausea * Vomiting * Anorexia * Flatulence ## Footnote Women, especially young women, are more likely affected.

Question 40

What is **ischemic bowel disease**?

Answer 40

Condition due to inadequate blood supply to the intestines ## Footnote It can be acute or chronic, often associated with embolism or atherosclerosis.

Question 41

What are the **symptoms** of acute ischemic bowel?

Answer 41

* Acute onset of cramping or steady epigastric or periumbilical pain ## Footnote Emergency surgery is often required to reestablish blood flow.

Question 42

What is a **hernia**?

Answer 42

Protrusion of the intestine through a weak point in the abdominal musculature ## Footnote Common types include inguinal, femoral, and umbilical hernias.

Question 43

What are the **symptoms** of a hernia?

Answer 43

* Lump * Pain (persistent or intermittent) ## Footnote Strangulated hernias present with persistent pain, fever, tachycardia, vomiting, and abdominal distention.

Question 44

What is **diverticulosis**?

Answer 44

Presence of outpouchings of the intestinal wall called diverticula ## Footnote It is usually asymptomatic and can be complicated by diverticulitis.

Question 45

What are the **risk factors** for developing diverticulosis?

Answer 45

* Inherited weakness of muscularis * Obesity * Chronic constipation * Low fiber diet ## Footnote These factors lead to increased intraluminal pressure and straining during defecation.

Question 46

What are the **symptoms** of diverticulitis?

Answer 46

* Abdominal pain in left quadrant or midabdominal region * Fever * Diarrhea or constipation * Sudden, painless rectal bleeding * Anemia due to chronic blood loss ## Footnote Treatment may involve a high fiber diet, antibiotics, and possible surgery.

Question 47

What is **gastroenteritis**?

Answer 47

Inflammation of the stomach and intestines often due to infection ## Footnote It can be caused by bacterial, viral, or protozoan pathogens.

Question 48

What are the **symptoms** of gastroenteritis?

Answer 48

* Diarrhea * Vomiting * Fever * Dehydration ## Footnote Bacterial gastroenteritis can be caused by intoxication or infection, while viral gastroenteritis is often due to replication of viruses in mucosal cells.

Question 49

What is **gastroenteritis** commonly associated with?

Answer 49

* Rotavirus in infants and children * Norwalk virus in adults * Severe vomiting * Small epidemics (e.g., cruise ships) * Major complication: dehydration ## Footnote Gastroenteritis is often not reported and can occur alongside enteroviruses and adenoviruses affecting the respiratory tract.

Question 50

What are the **two forms** of protozoan enteritis?

Answer 50

* Giardia lamblia (beaver fever) * Entamoeba histolytica (amoebiasis) ## Footnote Both forms exhibit inactive cysts that live in fecally contaminated water.

Question 51

What is the role of **intestinal polyps**?

Answer 51

* Growth or mass from mucous membranes * Can be non-neoplastic or adematous * More than 2/3 of population over age 65 has at least one * Asymptomatic until large enough to cause obstruction ## Footnote Larger adematous polyps are precancerous lesions of adenocarcinoma.

Question 52

What is the most common type of **colorectal cancer**?

Answer 52

Adenocarcinoma of the colon and rectum ## Footnote It accounts for 15% of all cancer deaths and incidence increases with age.

Question 53

What are some **risk factors** for colorectal cancer?

Answer 53

* Family history of colorectal cancer * Family history of breast cancer * Familial polyposis coli * Ulcerative colitis * Crohn's disease ## Footnote Increased fiber in diet does not reduce the risk.

Question 54

What are the **clinical manifestations** of colorectal cancer?

Answer 54

* Changes in bowel habits * Bright red blood in feces (hematochezia) * Complications: obstruction, anemia, ascites ## Footnote Metastases to the liver are most common, but can also occur in lungs, brain, and bone.

Question 55

What is the **diagnosis** process for colorectal cancer?

Answer 55

* Test for blood in stool (FOB) * Abdominal and rectal exam * Colonoscopy, sigmoidoscopy, biopsy * Barium enema, ultrasound, CT scan ## Footnote Early detection through screening for adenomatous polyps is crucial.

Question 56

What is **appendicitis** primarily caused by?

Answer 56

Bacterial infection of the appendix due to obstruction ## Footnote Inflammation can lead to progressive edema, ulceration, and possible rupture.

Question 57

What are the **signs and symptoms** of appendicitis?

Answer 57

* Sudden fever * Leukocytosis * Abdominal pain (starts around umbilicus, localizes to right lower quadrant) * Rebound tenderness ## Footnote Pain is typically localized at McBurney’s point.

Question 58

What is **peritonitis**?

Answer 58

Inflammation of the peritoneum due to microorganisms ## Footnote It can be caused by ruptured organs, chemical irritation, or perforated gut wall.

Question 59

What are the **clinical manifestations** of peritonitis?

Answer 59

* Acute abdominal pain * Rebound tenderness * Muscle guarding * Nausea and vomiting * High fever ## Footnote Symptoms can escalate quickly, leading to shock and complications.