306- GI Alterations

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306- GI Alterations
2012-09-13 20:50:56
306 GI Alterations

Exam 1
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  1. A lack of a desire to eat despite physiologic
    stimuli that would normally produce hunger
  2. *The forceful emptying of the stomach and intestinal contents through the mouth

    (Several types of stimuli initiate the vomiting reflex)
  3. *A subjective experience that is associated with a number of conditions...the common symptoms of vomiting are hypersalivation and tachycardia
  4. Non-productive Vomitting
  5. Spontaneous vomiting that does not follow nausea or retching 
    Projectile Vomitting
  6. *Infrequent or difficult defecation
  7. Pathophysiology of Constipation
    oNeurogenic disorders, functional or mechanical conditions, low-residue diet, sedentary lifestyle, excessive use of antacids, changes in bowel habits
  8. *Increased frequency of bowl movements
    *Increased volume, fluidity, weight of the feces
  9. Mechanisms of Diarrhea:
    • -Osmotic diarrhea
    • -Secretory diarrhea
    • -Motility diarrhea
  10. Motility Diarrhea
    *controlled by the parasympathetic nervous system...when the amount of fluid and electrolytes entering the large intestine exceed 8liters of fluid
  11. Abdominal Pain
    • Abdominal pain is a symptom of a number of gastrointestinal disorders
    • Parietal pain
    • Visceral pain
    • Referred pain
    • **when assessing for abdominal pain, always visualize what is underneath the surface
  12. Gastrointestinal Bleeding:
    • *Upper gastrointestinal bleeding
    • Esophagus, stomach, or duodenum

    • *Lower gastrointestinal bleeding
    • Below the ligament of Treitz, or bleeding from the jejunum, ileum, colon, or rectum...
    • Hematemesis
    • Hematochezia
    • Melena
    • Occult bleeding --> blood in the stool
  13. Difficulty Swallowing
  14. Types of Dysphagia
    • -Mechanical obstructions (something anotomically prohibiting the swallowing of food)
    • -Functional obstructions (neurological (ex: stroke) problem that prevents swallowing of food)
  15. Denervation of smooth muscle in the esophagus and lower esophageal sphincter relaxation
  16. Major Symptom of Achalasia:
    Acid Reflux
  17. GER (Gastroesophogeal Reflux)
    • **GER is the reflux of chyme from the stomach to the esophagus
    • **If GER causes inflammation of the esophagus, it is called reflux esophagitis
    • **A normal functioning lower esophageal sphincter maintains a zone of high pressure to prevent chyme reflux
  18. Major Cause of GER
    • *Increased abdominal pressure
    •    -Pregnancy
    •    -Ascites
    •    -Obesity
    •    -Hernia
  19. Manifestations of GER
    *Heartburn, regurgitation of chyme, and upper abdominal pain within 1 hour of eating
  20. Disorders of Motility
    • GER
    • Hiatial Hernia
    • Pyloric Obstruction
    • Internal Obstruction
    • Ileus
  21. Seen around diaphragm, protruding through a muscle wall (can be pushed back in)
    *can cause necrosis and gangrene if it is not treated
    Sliding Hiatial Hernia
  22. Blocking or narrowing of the opening between the stomach and the duodenum...can be acquired or congenital
    Pyloric Obstruction
  23. Manifestations of Pyloric Obstruction
    *Epigastric pain and fullness, nausea, succussion splash, vomiting, and with a prolonged obstruction, malnutrition, dehydration, and extreme debilitation
  24. Any condition that prevents the flow of chyme through the intestinal lumen or failure of normal intestinal motility in the absence of an obstructing lesion
    Internal Obstruction
  25. Obstruction of the intestines from small bowel obstruction or past surgery ((nothing is moving through))
  26. Obstruction that requires putting patient on regularized diet plan
    Simple Obstruction
  27. Removing part of the intestine
  28. Situation in which an anatomical problem is causing the obstruction
    Functional Obstruction
  29. **Inflammatory disorder of the gastric mucosa (stomach)

    • Acute gastritis
    • Chronic gastritis    
    •      Chronic fundal gastritis   
    •       Chronic antral gastritis
  30. Losing of GI mucosa, no bleeding yet, beginning symptoms of heartburn
  31. Wearing away through the mucosa, muscle, sub-mucosa

    **Long term medications and diet alterations
    True Ulcer
  32. oA break or ulceration in the protective
    mucosal lining of the lower esophagus, stomach, or duodenum

    oAcute and chronic ulcers


    -True ulcers
    Peptic Ulcer Disease
  33. Most common of Peptic Ulcers
    Duodenal Ulcers
  34. Developmental factors of an Ulcer
    • *Helicobacter pylori infection
    •     -Toxins and enzymes that promote inflammation and ulceration

    • oHypersecretion of stomach acid and pepsin
    • oUse of NSAIDs (ex: ibruproferens)
    • oHigh gastrin levels
    • oAcid production by cigarette smoking
  35. Gastric ulcers tend to develop in the _____ region of the stomach, adjacent to the acid-secreting mucosa of the body
  36. Pathophysiology of an Ulcer
    *The primary defect is an increased mucosal permeability to hydrogen ions

    *Gastric secretion tends to be normal or less than normal
  37. Peptic ulcer that is related to severe illness, neural injury, or systemic trauma
    Stress Ulcer
  38. Examples of Stress Ulcers
    • Ischemic ulcers
    •    -problem with the blood flow, necrosis to those areas, requires surgical intervention
    • Cushing ulcers
    •    -Ulcers that develop as a result of a burn injury
  39. Post-gastectomy Symptoms
    oDumping syndrome

    oAlkaline reflux gastritis

    oAfferent loop obstruction


    oWeight loss

  40. Type of condition commonly seen in patients with gastectomy:
    B12 Anemia (pernicious anemia)
  41. The rapid emptying of chyme from a surgically created residual stomach into the small intestine 

    Clinical complication of partial gastrectomy or pyloroplasty surgery
    Dumping Syndrome
  42. Developmental Factors of Dumping Syndrome
    -Loss of gastric capacity, loss of emptying control, and loss of feedback control by the duodenum when it is removed 
  43. Failure of the chemical processes of digestion
  44. Failure of the intestinal mucosa to absorb digested nutrients
  45. What is the primary problem with pancreatic disorders?
    Fat Malabsorption (steatorrhea)
  46. Pancreatic Insufficiency
    • -Insufficient pancreatic enzyme production
    • oLipase, amylase, trypsin, or chymotrypsin

    -Causes include pancreatitis, pancreatic carcinoma, pancreatic resection, and cystic fibrosis

    -Fat maldigestion is the main problem, so the patient will exhibit fatty stools and weight loss
  47. Lactase Deficiency
    -Inability to break down lactose into monosaccharides and therefore prevent lactose digestion and monosaccharide absorption

    -Fermentation of lactose by bacteria causes gas (cramping pain, flatulence, etc.) and osmotic diarrhea
  48. Bile Salt Deficiency
    Conjugated bile salts needed to emulsify and absorb fats

    Conjugated bile salts are synthesized from cholesterol in the liver

    Can result from liver disease and bile obstructions

    Poor intestinal absorption of lipids causes fatty stools, diarrhea, and loss of fat-soluble vitamins (A, D, E, K)
  49. Fat Soluble Vitamin Deficiencies
    • *Vitamin A
    • oNight blindness

    • **Vitamin D
    • oDecreased calcium absorption, bone pain, osteoporosis, fractures

    • ***Vitamin K
    • oProlonged prothrombin time, purpura, and petechiae

    • Vitamin E
    • oUncertain 
  50. People with vitamin K deficiencies are more prone to.....

    ***Stop anticoagulants, NO aspirin, limit physical activity, make very cautious judgments because bruises and bumps may lead to bleeding...Monitor patient diet [leafy green vegetables promote bleeding])
  51. Inflammatory Bowel Disease
    Chronic, relapsing inflammatory bowel disorders of unknown origin

    • -Genetics --> family hx
    • -Alterations of epithelial barrier functions 
    • -Immune reactions to intestinal flora
    • -Abnormal T cell responses
  52. Chronic inflammatory disease that causes ulceration of the colonic mucosa

    Sigmoid colon and rectum
    Ulcerative colitis
  53. Suggested Causes of Ulcerative Colitis
    • Infectious, immunologic (anticolon antibodies), dietary, genetic
    • (supported by family studies and identical twin studies)
  54. Symptoms of Ulcerative Colitis
    Diarrhea (10 to 20/day), bloody stools, cramping
  55. Treatment of Ulcerative Colitis
    Broad-spectrum antibiotics and steroids

    -Immunosuppressive agents

  56. People with Ulcerative Colitis are at risk for ________?
  57. Granulomatous colitis, ileocolitis, or regional enteritis

    Idiopathic inflammatory disorder; affects any part of the digestive tract, from mouth to anus

    Difficult to differentiate from ulcerative colitis
    **Similar risk factors and theories of causation as ulcerative colitis
    Crohn's Disease
  58. Effects of Crohn's Disease
    • oCauses
    • “skip lesions”

    -Ulcerations can produce longitudinal and transverse inflammatory fissures that extend into the lymphatics

    • -Anemia may result from malabsorption of vitamin B12 and
    • folic acid

    **Treatment is similar to ulcerative colitis
  59. *Out-pouching of the colon
    *Herniations of mucosa through the muscle layers of the colon wall, especially the sigmoid colon
  60. *Asymptomatic diverticular disease
  61. *The inflammatory stage of diverticulosis
  62. *Inflammation of the vermiform appendix 
  63. Possible causes of Appendicitis:
    *Obstruction, ischemia, increased intraluminal pressure, infection, ulceration, etc.
  64. Pain and Complications associated with appendicitis
    • -Epigastric and RLQ pain
    • -Rebound tenderness
    • **The most serious complication is peritonitis (can quickly turn into sepsis if not found and treated quickly)
  65. Vascular Insuffieciency
    • -Blood supply to the stomach and intestine
    •      Celiac axis
    •      Superior and inferior mesenteric arteries
    •      Two of three must be compromised to cause ischemia
    • -Mesenteric venous thrombosis (blood clot in mesentary)
    • -Acute occlusion of mesenteric artery blood flow
    • -Chronic mesenteric arterial insufficiency
  66. Increase in body fat mass
    Body mass index greater than 30
    A major cause of morbidity, death, and increased health care costs
    Risk factor for many diseases and conditions
  67. What part of the brain can impact obesity
  68. Hormones that control appetite and weight:
    • *Insulin, ghrelin, peptide YY, leptin, adiponectin, and resistin
    • (it takes A LOT of testing to identify hormone related obesity)
  69. What factors are associated with Obesity
    • Leptin resistance
    • Hyperleptinemia
  70. Characterized by abnormal eating behavior, weight regulation, and disturbed attitudes toward body weight, body shape, and size
    Anorexia & Bulimia nervosa
  71. Anorexia facts
    -A person has poor body image disorder and refuses to eat

    -Anorexic patients can lose 25% to 30% of their ideal body weight as a result of fat and muscle depletion

    -Can lead to starvation-induced cardiac failure

    -In women and girls, anorexia is characterized by the absence of three consecutive menstrual periods

    -Binge eating/purging anorexia nervosa
  72. Bulimia Facts
    -Body weight remains near normal but with aspirations for weight loss


    -Recurrent episodes of binge eating

    -Self-induced vomiting

    • -Two binge-eating episodes per week for at least 3
    • months

    -Fasting to oppose the effect of binge eating, or excessive exercise

    • -Continual vomiting of acidic chyme can cause pitted teeth,
    • pharyngeal and esophageal inflammation, and tracheoesophageal fistulas

    -Overuse of laxative can cause rectal bleeding
  73. -Decreased caloric intake leading to weight loss
  74. A state of ill health, malnutrition, and wasting that may occur in many chronic diseases, malignancies, and infections
  75. Short Term Starvation activates:
    • Glycogenolysis
    • Gluconeogenesis
  76. Long term Starvation leads to:
    • oMarasmus ---> general wasting and lack of sc fat
    • oKwashiorkor ---> protein/albumin deficiency...EDEMA