Patho Test 3

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ilikepinkeverything
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136280
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Patho Test 3
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2012-02-22 10:40:20
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Patho Test
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Test 3
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  1. Clinical manifestations of GI dysfunction
    • Anorexia
    • Vomiting
    • nausea
    • constipation
    • diarrhea
    • abdominal pain
  2. Bleeding that occurs in esophagus, stomach or duodenum
    upper GI bleeding
  3. Bleeding that occurs in jejunum, ileum, colon, or rectum
    Lower GI bleeding
  4. Causes of Upper GI bleed
    • Ulcers
    • varices
    • tears
  5. Causes of Lower GI bleeding
    • Polyps
    • iflammatory disease
    • hemorrhoids
    • cancer
  6. Bloody vomitus
    hematemesis

    may be bright red or coffee groun appearance
  7. Bright red blood from rectum
    Hematochezia
  8. Black sticky foul smelling stools
    Melena
  9. Trace blood detected
    occult bleeding

    Hemoccult test detects
  10. Best indicators of gi bleed
    • BP
    • Heart rate
  11. Difficulty swallowing d/t mechanical obstruction or impaired esophageal motility
    Dysphagia
  12. painful swallowing
    odynophagia
  13. Lower esophageal sphincter fails to relax
    achalasia
  14. clinical manifestations of dysphagia
    • discomfort w/swallowing
    • regurgitation
    • unpleasant taste
    • vomiting
    • weight loss
    • aspiration
    • nutritional deficiencies
  15. dysphagia may be d/t
    • tumors
    • strictures
    • diverticula
    • CVA
    • parkinsons
  16. ________________ is weak or incompetent. Increases in abdominal pressure contribute to reflux eophagitis. as a result, inflammatory responses are initaited. Edema, fibrosis and hyperplasia may occur. Metaplastic changes (barrett's esophagus) may occur.
    Lower Esophageal sphincter in Gastroesophageal reflux
  17. Clinical manifestations of GER
    • heartburn
    • regurgitation of acidic chyme w/in 1hr of eating
    • symptoms worsen w/lying down or increased intraabdominal pressure
    • respiratory-chronic cough, wheezing, hoarseness, asthma
  18. Protursion of upper portion of stomach thru diaphragm into thorax
    hiatal hernia
  19. 2 types of hiatal hernias
    sliding-stomach slides or moves into thoracic cavity through esophageal hiatus

    Paraesophageal-greater curvature of stomach herniates thru secondary opening in diaphragm and lies alongside the esophagus
  20. clinical manifestations of hiatal hernia
    • reflux
    • dysphagia
    • heartburn
    • epigastric pain
    • substernal discomfort
  21. Accounts for 1% of all new cancers
    Cancer of esophagus
  22. Who is at greater risk for cancer of esophagus?
    Males
  23. Squamous cell types in cancer of esophagus d/t:
    • alcohol
    • tobacco
  24. Adenocarcinomas in cancer of esophagus d/t
    Barrett's esophagus-assoc w/GER
  25. Pathogenesis of cancer of esophagus
    esophageal dysfunction-food/drink prolonged contact

    ulceration and metaplasia from reflux

    chronic exposure to alcohol and tobacco

    obesity
  26. clinical manifestations of esophageal cancer
    • dysphagia
    • chest pain
    • heartburn-#1

    dysphagia may be late sign:1st w/bulky, then soft, then liquid
  27. Can be caused by any condition that prevents normal flow of chyme thru intestinal lumen
    intestinal obstruction
  28. Mechanical blockage of lumen by lesion
    adhesions
    hernias

    are all examples of:
    Simple intestinal obstruction
  29. Failure of motility
    paralytic ileus

    are examples of:
    Functional Intestinal obstruction
  30. Intestinal obstructions occur where?
    Can occur in either small or large intestines

    Simple obstructions of small is most common
  31. obstruction in ___________ causes more pronounced distention
    lower
  32. obstruciton that can cause diarrhea or constipation
    Partial
  33. Causes of intestinal obstruction
    • hernia
    • intussusception
    • volvulus
    • diverticulosis
    • tumor
    • ileus
    • adhesions
  34. patho effects of intestinal obstruction
    • F&E loss
    • Acid base imbalance
    • Distention d/t gas and fluid accumulation
    • can lead to strangulation, gangrene, perforation, bacterial growth
  35. clinical manifestations of intestinal obstruction
    • colicky pain followed by vomiting (cardinal)
    • sweating
    • nausea
    • hyptension
    • distention
    • atelectasis and pneumonia
  36. rumbling heard w/mechanical obstruction trying to propel thru obstruction
    borboygmus
  37. inflammatory disorder of gastric mucosa
    gastritis
  38. Erodes surface epithelium and causes superficial erosions of gastric mucosa
    acute gastritis
  39. causes of acute gastritis
    • NSAIDs
    • chemicals
    • alcohol
    • histamine
    • digitalis
    • uremia-toxic waste in blood-kidney failure
  40. clinial manifestations of acute gastritis
    • abdominal discomfort
    • epigastric tenderness
    • bleeding
  41. chronic inflammation changes lead to eventual atrophy of glandular epithelium of stomach. may progress to dysplasia
    chronic gastritis
  42. who's at risk for chronic gastritis?
    • elderly
    • alcohol
    • smokers
    • chronic nsaid users
  43. major causative factor of chronic gastritis?


    Other cause?
    h. pylori

    Autoimmune
  44. Vit B12 deficiency -lacking intrinsic factor leading to B12 malasorption
    Pernicious enemia
  45. clinical manifestation of chronic gastritis
    • anorexia
    • fullness
    • nausea
    • vomiting
    • epigastric pain
    • gastric bleeding
  46. break or ulceration in protective mucosal lining of lower esophagus, stomach, or duodenum that are exposed to acid-pepsin secretions.
    peptic ulcers

    acute,chronic, superficial or deep
  47. risk factrs of peptic ulcers
    • smoking
    • advanced age
    • habitual use of nsaids
    • alcohol
    • chronic disease-emphysema, ra, cirrohosis, diabetes
    • infection of gastric and duodenal mucosa w/h pylori
  48. most common type of ulcer
    duodenal ulcers
  49. Risk factors of duodenal ulcers
    • younger persons
    • type o blood-more conducive, lacking a and b antigens and less mucousal protection
  50. major causes of duodenal ulcers
    • h pylori
    • nsaids
  51. Patho of peptic ulcers
    • increased parietal cells
    • increased gastric acid levels
    • rapid gastric emptying
    • h pylori destruction of mucousal epith cells and release of toxins
    • use of nsaids and inhibit prostoglandins
    • acid producation r/t smoking
  52. clinical manifestations of ulcers
    • pain 2-3 hrs after eating when empty
    • pain at night
    • pain food relief pattern
    • chronic intermittent epigastric discomfort
    • constant unremitting pain-obstruction or perforation
  53. 1/4 as common as duodenal ulcers
    gastric ulcers

    • occur equally in males and females
    • 55-65 yrs old

    major cause-nsaids and h pylori
  54. clinical manifestations of gastric ulcers
    • pain food relief pattern
    • may occur immediately after eating
    • cause more anorexia, vomiting and weight loss
  55. result of burn injury
    curling ulcer
  56. result of head injury, brain surgery
    cushing ulcer
  57. major factors of stress ulcer formation
    • decreased mucousal blood flow
    • ischemia

    may develop hours after stressful event such as hemorrhage, trauma, burn, sepsis, and heart failure
  58. clinical manifestations of stress ulcers
    primary-bleeding


    assess: color, vs changes, lab values
  59. risk factors of cancer of stomach
    • h pylori
    • heavily salted and preserved foods
    • low intake of fruits and veggies
    • use of tobacco and alcohol
    • males>females
    • family hx
    • blood type A
    • pernicious anemia

    May be asymptomatic until late
  60. chronic inflammatory disease that causes ulceration of colonic mucosa
    ulcerative colitis
  61. most common sites for ulcerative colitis
    colonic mucosa, left colon, usually rectum and sigmoid
  62. risk factors of ulcerative colitis
    • 20-40 yrs of age
    • family hx
    • jewish
    • whites
    • autoimmune
  63. patho:inflammation at base of crypt of lieberkuhn, primarily in left colon
    ulcerative colitis

    inflammatory products cause tissue damage and small erosions and ulcers can form. abcesses, necrosis and edema may occur.

    mucousal destruction occurs
  64. clinical manifestations of ulcerative colitis
    • remissions and exacerbations
    • diarrhea (10-20)
    • stool w/blood and mucous
    • cramping
    • anorexia
    • weakness and fatigue
  65. recurrent, granulomatous type of inflammatory response that can affect both large and small intestines
    crohns disease

    aka-regional enteritis
  66. risk factors of crohns
    • family hx
    • similiar to ulcerative colitis
    • altered immune response
  67. Most common site of crohns
    ascending and transverse
  68. multiple lesions interspersed b/t normal bowel layers
    skip lesions

    crohns
  69. clinical manifestations of crohns
    • diarrhea
    • lower abdominal pain
    • weight loss
    • f/e disorders
    • less bloody than ulcerative colitis
  70. herniation or saclike outpouching of mucosa thru muscle layers
    diverticula
  71. asymptomatic diverticular disease
    diverticulosis
  72. inflammation of pouchings
    diverticulitis
  73. most frequent site for diverticulitis
    sigmoid colon
  74. patho for diverticula
    form at weak points in colon wall, usually where arteries penetrate tunica mucularis to nourish mucosal layer. colonic mucosa herniates through smooth muscle layers. muscle hypertrophy and contraction occurs
  75. risk factors of diverticula
    • age
    • diet of refined foods
  76. clinical manifestations of diverticula
    • may be vague or absent
    • cramping
    • diarrhea, constipation, distention, flatulence
    • inflammation and abcesses may occur
    • fever, leukocytosis tenderness, LLQ
  77. inflammation of vermiform appendix. obstruction of lumen w/stool, tumors, foreigh occurs w/bacterial infection, inflammation. obstruction results in decreased mucosal blood flow, hypoxia, inflammation and edema. gangrene and perforation can occur
    appendicitis
  78. most common surgical procedure of abdomen
    appendicitis

    20-30 yrs of age most common
  79. clinical manifestations of appendicitis
    • epigastric or periumbilical pain
    • vague at first w/increased intensity
    • may shift to RLQ-rebound tenderness
    • mcburney's point
    • n/v/d
    • anorexia
    • increased wbc w/increased neutorphils
  80. variable combination of chronic and recurrent intestinal symptoms not explained
    irritable bowel syndrome
  81. IBS more common in:
    women
  82. clinical manifestations of IBS
    • abd pain
    • n/v
    • flatus
    • bloated
    • change in stools
  83. mass that protrudes into lumen of gut. benign neosplasm
    adenomatous polyp
  84. raised mucosal nodules of adenomatous polyp
    sessile
  85. attached by stalk of adenomatous polyp
    pedunculated
  86. most common site of adenomatous polyp
    rectosigmoid colon
  87. 3rd most common cause of cancer and cancer death in us for men and women

    most begin with adenomatous polyp

    > 50 years of age
    colorectal cancer
  88. risk factors of colorectal cancer
    • family hx
    • ulcerative colitis
    • high fat, lowfiber diet
    • alcohol
    • sedentary lifestyle
    • smoking
  89. clinical manifestations of colorectal cancer
    • depends on site
    • bleeding
    • change in bowel habits
    • pain is late sign
  90. abnormally high accumulation of bilirubin

    billi > 2.5-3.0
    jaundice (icterus)

    may see 1st in sclera
  91. abnormally high pressure in portal venous system > 10 mm Hg
    portal hypertension

    normal is 3 mm Hg

    d/t obstruction, thrombosis, inflammation, cirrhosis
  92. patho of viral hepatitis
    hepatic cell necrosi, scarring, hyperplasia, cellular injury, inflammatory response can damage bile canaliculi
  93. begins _____ wks after exposure and ends with appearance of jaundice

    highly infectious

    fatigue, anorexia, n/v, ruq pain, weight loss, malaise, ha, hyperalgia, cough, low grade fever
    2 wks

    Prodromal (preicterus) phase- 1st phase
  94. begins about ________ wks after prodromal phase and lasts 2-6 wks.

    juandice, dark urine, clay colored stools, liver enlarged and tender. actual phase of illness.
    icteric phase
  95. begins with resolution of jaundice after approx 6-8 wks. liver function tests return to normal w/in 2-12 wks after onset of jaundice.

    symptoms diminish. liver remains large and tender
    convalescent (recovery) phase

    • chronic hepatitis may persist. abn liver fx tests for > 6 mo
    • B,C,D infections
  96. functional liver tissue replaced by fibrous tissue. fibrous replaces normally functioning liver tissue and forms constrictive bands that disrupt flow in vascular channels and iliary duct systems of liver
    cirrhosis
  97. cirrhosis usually assoc with _____________ but can develop from other disorders
    alcoholism

    • manifestions:
    • weakness
    • fatigue
    • anorexia
    • hepatomegaly
    • jaundice
  98. one of main effects of alcohol is accumulation of fat in hepatocytes (steatosis) liver becomes yellow and enlarges owing to excessive fat accumulation
    fatty liver
  99. inflammation and necrosis of liver cels. intermediate stage b/t fatty changes and cirrhosis
    alcoholic hepatitis
  100. liver changes occur d/t toxic effects of chronic, excessive alcohol intake, acetyladehye formed by alcohol metabolism damages hepatocytes. cellular damage initiates an inflammatory response that results in necrosis and excessive collagen formation. bands of fibrosis and scarring disrupt stucture of liver
    • alcoholic cirrhosis
    • laennec cirrhosis

    liver becomes fatty d/t deposits of triglycerides w/in liver
  101. damage and inflammation leading to cirrhosis begin in bile canaliculi and bile ducts, rather than in hepatocytes
    biliary cirrhosis
  102. d/t autoimmune disease that destroys small intrahepatic ducts
    primary biliary cirrhosis
  103. d/t prolonged partial or complete obstruction of common bile duct or its branches
    secondary biliary cirrhosis
  104. etiologic agents:
    chronic viral hepatitis
    cirrhosis
    chemical agents
    cancer of liver
  105. clinical manifestations of cancer of liver
    • insidious onset
    • weakness
    • fatigue
    • abdominal fullness
    • ascites
    • jaundice
    • hepatomegaly
    • elevated alpha fetoprotein
  106. risk factors of cholelithiasis include:
    • obesity
    • middle age
    • female
    • native american
    • gallbladder disease
    • pancreas and leal disease
    • rapid weight loss
    • genetics
  107. factors contributing to gallstones
    1.abnormalities in composition of bile

    2. stasis of bile

    3. inflammation of gallbladder
  108. form in bile that is supersaturated with cholesterol produced by liver. supersaturation promotes crystalization into stones. may lay in gallbladder or become lodged in cystic or bile duct
    cholesterol gallstones
  109. form from increased levels of unconjugated bilirubin which binds with calcium
    pigmented stones
  110. cardinal signs of cholelithiasis


    other signs
    abd pain and jaundice

    epigastric, ruq pain, intolerant of fatty foods, heartburn, flatus
  111. biliary colic d/t:_________________________
    gallstones in cystic or common duct

    may c/o ruq pain that radiates to back ,right shoulder, right scapula, midscapular region
  112. what does jaundice indicate in cholelithiasis
    stone blocking CBD(common bile duct)- post hepatice jaundice
  113. acute or chronic cholecystitis d/t:
    lodging of gallstone in cystic duct

    gallbladder becomes distended and inflamed with potential for ischemia, necrosis, and perforation. Fever, leukocytosis, rebound tenderness, and guarding may be present.

    bilirubin and alkaline phosphatse levels may elevate
  114. most common causes of acute pancreatitis
    alcoholism and stones
  115. develops as result of injury or disruption of pancreatic ducts or acini, permitting leakage of enzymes into tissue. leaked enzymes activated, initiating autodigestion
    acute pancreatitis

    amylase and lipase are enzymes that break down
  116. most common initial symptom of acute pancreatitis
    sever epigastric and abdominal pain that radiates into back
  117. clinical manifestations of pancreatitis
    • fever
    • leukocytosis
    • n/v
    • abdominal distention
    • cullen's
    • turners
    • elevated amylase and lipase
  118. why is person at risk for hyptension
    plasma volume is lost d/t release of enzymes and kinins that increase vascular permeability and dilate vessels
  119. complications of acute pancreatitis
    • acute resp distress syndrome (ards)
    • acute tubular necrosis-kidneys
    • hypocalcemia
    • increased wbcs and glucose
  120. client may complain of continuous or intermittent abdominal pain, which intensifies after meals. enzyme deficiency may cause steatorrhea (fatty stools) or a malabsorption
    chronic pancreatitis
  121. chronic alcohol abuse is most common cause of:
    chronic pancreatitis

    complications include fibrosis, strictures, inflammation, cysts

    risk for pancreatic cancer
  122. smoking is a major risk factor of
    cancer of pancreas

    • other risks include:
    • diet
    • obesity
    • diabetes
    • chronic pancreatitis
  123. clinical manifestations of cancer of pancreas
    • asymptomatic at first
    • vague back pain
    • jaundice
    • weight loss
    • malabsorption

    • most panc cancers metastasized by time of diagnosis
    • 5 year survival < 5%

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