Term
|
Definition
Benign epithelial tumors—polyps (e.g., hyperplastic, tubular, villous)
Benign stromal tumors (e.g., leiomyoma)
Malignant tumors
Adenocarcinoma (most common)
Lymphoma |
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|
Term
| Diseases of the Esophagus—Clinical Presentations |
|
Definition
Dysphagia
Esophageal (retrosternal) pain
Aspiration or regurgitation |
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Term
| Diseases of the Esophagus |
|
Definition
Developmental abnormalities—atresia with or without esophageal-tracheal fistula
Esophagitis
Hernia
Achalasia
Varices |
|
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Term
|
Definition
Reflux of gastric juice (“peptic esophagitis”)
Infection—viruses, fungi (immunosuppressed persons), and bacterial superinfection
Chemical irritants—exogenous chemicals or drugs |
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Term
| Carcinoma of the Esophagus |
|
Definition
Accounts for 4% of all cancers—8000 cases per year in the United States
Higher incidence in Asia and Africa than in the United States and Europe
Correlates with alcohol and tobacco abuse
More common in men than in women
More common in blacks than in whites
Poor prognosis—average survival, 2 years |
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Term
| Carcinoma of the Esophagus |
|
Definition
Squamous cell carcinoma in upper or lower esophagus
Adenocarcinoma in lower esophagus developing in Barrett’s esophagus |
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Term
| Diseases of Stomach and Duodenum—Symptoms |
|
Definition
Pain—midline, upper abdomen
Vomiting
Bleeding—acute with hematemesis or chronic with melena
Dyspepsia
Systemic consequences—e.g., iron deficiency anemia caused by chronic blood loss, vitamin B12 malabsorption–related megaloblastic anemia |
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|
Term
| The Most Important Developmental Abnormality |
|
Definition
|
|
Term
|
Definition
Acute (erosive)—stress related, shock, food, exogenous chemicals and drugs
Erosions
Ulcerations
Chronic atrophic gastritis with or without intestinal metaplasia
Helicobacter pylori related
Autoimmune (with pernicious anemia) |
|
|
Term
| Peptic Ulcer—Etiology and Pathogenesis |
|
Definition
Multifactorial!
Contributing factors include:
Gastric juice—HCl, pepsin
Mucosal barrier defects—stress, shock, NSAIDs, smoking reduce resistance
Helicobacter pylori—found in most patients |
|
|
Term
| Complications of Peptic Ulcer Disease |
|
Definition
Hemorrhage (most common)—hematemesis, melena, iron deficiency anemia
Penetration into the pancreas—acute pancreatitis
Perforation—peritonitis
Cicatrization—stenosis |
|
|
Term
|
Definition
Benign epithelial tumors—polyps (e.g., hyperplastic, tubular, villous)
Benign stromal tumors (e.g., leiomyoma)
Malignant tumors
Adenocarcinoma (most common)
Lymphoma |
|
|
Term
|
Definition
| This common form of cancer affects 25,000 persons and causes 14,000 deaths in the United States yearly. It is eight times more common in Japan and Chile. The incidence of this has decreased over the past 70 years in the United States. The etiology is unknown—suspect nitrosamines in food and maybe H. pylori. |
|
|
Term
| Gastric Carcinoma—Gross Pathology |
|
Definition
Macroscopic forms
Superficial
Polypoid
Ulcerated
Diffusely infiltrating (“linitis plastica”)
Histology
Adenocarcinoma |
|
|
Term
| Diseases of the Intestines |
|
Definition
Developmental abnormalities—Hirschsprung’s disease, congenital diverticula (e.g., Meckel’s)
Diverticulosis, obstructions, and hernias
Vascular disorders
Inflammatory bowel disease
Infections, including peritonitis
Malabsorption syndrome
Neoplasms |
|
|
Term
| Intestinal Vascular Diseases |
|
Definition
Hemorrhoids
Angiodysplasia
Ischemic bowel disease
Chronic ischemia
Acute thrombosis of mesenteric arteries and veins
Nonocclusive intestinal infarcts |
|
|
Term
| Inflammatory Bowel Disease |
|
Definition
Crohn’s disease—incidence is 70 to 150 per 100,000 persons per year in the United States
Ulcerative colitis—incidence is 20 to 40 per 100,000 persons per year in the United States
Cause unknown but may be familial
_________________________________
Note: Symptoms may overlap, and in 20% of cases, it is impossible to tell them apart. |
|
|
Term
| Features of Crohn’s Disease and Ulcerative Colitis |
|
Definition
|
|
Term
| Gastrointestinal Infections |
|
Definition
Food poisoning—bacterial toxins
Viral infections
Infectious diarrhea
Small intestinal infection—E. coli, Vibrio cholerae, Giardia lamblia, rotavirus
Large intestinal infection—E. coli, Shigella, Norwalk virus, Entamoeba |
|
|
Term
| Comparison of Diarrhea Caused by Small and Large Intestinal Disease |
|
Definition
|
|
Term
| Etiology and Pathogenesis of Acute Infectious Peritonitis |
|
Definition
Rupture of stomach
Spread of infection from fallopian tubes
Rupture of an abscess
Infection of preexisting ascites |
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|
Term
| Etiology and Pathogenesis of Acute Sterile (Noninfectious) Peritonitis |
|
Definition
Acute pancreatitis
Rupture of the gallbladder
Postsurgical peritonitis by talc or chemicals used during surgery |
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|
Term
| Causes of Intestinal Obstruction |
|
Definition
Paralytic ileus
Mechanical (obstructive) ileus
Atresia or stenosis
Stricture
Intussusception
Volvulus
Hernia
Adhesions
Neoplasms |
|
|
Term
| Pathogenesis of Malabsorption |
|
Definition
Malabsorption results from abnormalities involving:
Intraluminal digestion of food
Uptake and processing of nutrients within intestinal cells
Transport of the nutrients from intestine to the liver |
|
|
Term
| Malabsorption Resulting from Defective Intraluminal Digestion |
|
Definition
Deficiency of gastric juices—postgastrectomy conditions, atrophic gastritis
Deficiency of bile—biliary obstruction, liver disease, Crohn’s disease
Deficiency of pancreatic juices—chronic pancreatitis
Bacterial overgrowth—Giardia lamblia |
|
|
Term
| Malabsorption Resulting from Defective Uptake of Nutrients |
|
Definition
Celiac sprue
Tropical sprue
Infectious enteritis (e.g., E. coli, rotavirus)
Crohn’s disease
Whipple’s disease
Congenital abetalipoproteinemia
Short bowel syndrome (after surgical resection) |
|
|
Term
| Malabsorption Resulting from Defective Transport of Nutrients |
|
Definition
Gastrointestinal lymphoma
Congestive heart failure with intestinal ischemia
Scleroderma
Amyloidosis |
|
|
Term
|
Definition
Colon most often affected
May be sporadic or familial (S:F = 8:2)
May be benign or malignant (B:M = 3:1)
May be solitary or multiple
May be primary or secondary (P > S)
Epithelial tumors (adenomas and carcinomas)—account for 90% of all tumors and are more common than lymphomas or mesenchymal tumors (benign soft tissue tumor, e.g., lipoma and leiomyoma, or sarcomas) |
|
|
Term
| Large Intestinal Carcinoma |
|
Definition
Third most common cancer of internal organs
Affects 190,000 person per year in the United States |
|
|
Term
|
Definition
Etiology unknown in most cases
Genetic factors (play important role)
Familial polyposis coli
Gardner’s syndrome
Hereditary nonpolyposis colorectal cancer
Dietary factors (“Western diet”—low fiber and high carbohydrate and fat content)
Interaction of carcinogens and oncogenes and tumor suppressor genes (e.g., p53) |
|
|
Term
| Classification of Intestinal Tumors |
|
Definition
Non-neoplastic polyps—hyperplastic polyp, inflammatory polyp, juvenile polyp, Peutz-Jeghers polyp, lymphoid polyp
Benign neoplasms—tubular adenoma, villous adenoma, tubulovillous adenoma, benign stromal tumors (e.g., leiomyoma)
Malignant neoplasms—adenocarcinoma, carcinoid, lymphoma, sarcoma |
|
|
Term
| Gastrointestinal Carcinoids |
|
Definition
Ninety percent occur in the intestines
Appendix the most common site of origin
If smaller than 2 cm, benign; larger ones can metastasize
May be multiple, especially in terminal ileum and stomach
Composed of neuroendocrine cells that contain granules visible by electron microscopy and polypeptide hormones |
|
|
Term
| Gastrointestinal Carcinoids—Clinical Features |
|
Definition
Small tumors (<2 cm) are benign; larger ones metastasize—low-grade malignancy.
Tumors secrete serotonin and polypeptide hormones, which cause diarrhea and hypermotility of intestines.
Tumors that metastasize to the liver cause carcinoid syndrome and adversely affect the right-sided heart valves. |
|
|
Term
|
Definition
Jaundice syndromes
Hepatitis
Toxic/metabolic hepatic injury
Cirrhosis
Diseases of the extrahepatic bile ducts and gallbladder
Tumors |
|
|
Term
|
Definition
Prehepatic
Hepatic
Posthepatic |
|
|
Term
|
Definition
Hemolysis
Hematoma
Gilbert’s disease |
|
|
Term
|
Definition
Viral hepatitis
Alcoholic liver disease
Drug-induced liver disease
Chronic hepatitis due to various causes
Cirrhosis |
|
|
Term
|
Definition
Gallstones in common bile duct
Carcinoma of the head of the pancreas
Carcinoma of the common bile duct
Carcinoma of the gallbladder (late symptom) |
|
|
Term
| Causes of Acute Viral Hepatitis |
|
Definition
Common
Hepatitis viruses—A, B, C, D, E
Rare
Epstein-Barr virus
Cytomegalovirus
Herpesvirus
Viruses causing childhood viral diseases
Yellow fever virus (in tropics) |
|
|
Term
|
Definition
Alcohol
Hepatitis viruses (B, C, D)
Hereditary metabolic diseases—Wilson’s disease, hemochromatosis, alpha1-antitrypsin deficiency
Autoimmune diseases—primary biliary cirrhosis, primary sclerosing cholangitis, autoimmune hepatitis
Biliary obstruction
Drugs
Cryptogenic (unknown causes) |
|
|
Term
|
Definition
Fatty liver
Alcoholic hepatitis
Alcoholic cirrhosis |
|
|
Term
| Distant and Systemic Complications of Cirrhosis |
|
Definition
Bleeding tendency—reduced clotting factors and thrombocytopenia
Hematemesis and exsanguination from bleeding esophageal varices
Hyperestrinism—spider nevi, palmar erythema, gynecomastia, testicular atrophy
Hepatic encephalopathy
Hepatorenal syndrome |
|
|
Term
| Laboratory Findings in Patients with Cirrhosis |
|
Definition
Liver cell injury—serum transaminases (ALT and AST) elevated
Loss of liver cell function—hypoalbuminemia, prolonged prothrombin time (bleeding tendency)
Loss of detoxification function—blood ammonia elevated |
|
|
Term
| Complications of Portal Hypertension |
|
Definition
Ascites
Splenomegaly
Anastomoses between portal and systemic circulation
Hemorrhoids
Esophageal varices
Caput medusae |
|
|
Term
|
Definition
Reduced production of albumin—hypoalbuminemia, reduced oncotic pressure of the plasma
Portal hypertension—increased transudation of fluid into the abdomen
Hyperaldosteronism—sodium and water retention in the kidneys |
|
|
Term
| Drug-Induced Liver Injury |
|
Definition
Predictable (dose related)
Necrosis
Fatty change
Unpredictable
Viral hepatitis–like
Cholestasis
Chronic hepatitis–like
Granulomas
Tumors |
|
|
Term
| Hereditary Liver Diseases |
|
Definition
Gilbert’s disease—benign recurrent jaundice with unconjugated bilirubin
Hemochromatosis—excessive accumulation of iron in many organs, cirrhosis
Wilson’s disease—excessive accumulation of copper (liver, eye, central nervous system), cirrhosis
Alpha1-antitrypsin deficiency—accumulation of AAT, cirrhosis |
|
|
Term
|
Definition
Autoimmune hepatitis—occurs in young women; associated with other autoimmune diseases (antibodies in serum—ANA, ASM)
Primary biliary cirrhosis—occurs in middle-aged women; chronic jaundice, hypercholesterolemia (antibodies in serum—AMA)
Primary sclerosing cholangitis—occurs in men younger than 40 years; associated with ulcerative colitis (no specific antibodies) |
|
|
Term
| Routes of Bacterial Infection of the Liver |
|
Definition
Ascending through biliary ducts
Blood-borne through portal vein
Blood-borne through hepatic artery
Direct inoculation through wounds
Direct extension from adjacent organs, anatomic structures, or peritoneal cavity |
|
|
Term
| Gallstones (Cholelithiasis) |
|
Definition
Cholesterol stones
Pigmentary stones
Black stones
Brown stones |
|
|
Term
|
Definition
Benign liver tumors
Hemangioma
Hepatocellular adenoma
Malignant tumors
Hepatocellular carcinoma
Cholangiocellular carcinoma of the liver
Carcinoma of extrahepatic bile ducts
Gallbladder carcinoma |
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