Patho: Digestive System Disorders

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Patho: Digestive System Disorders
2012-11-11 09:47:22
pathophysiology south university chapter 20 Digestion Digestive System

Covers chapter 20 of Pathophysiology for Health Sciences
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  1. define gastroentiritis
    Inflammation of the mucous membrane of the stomach and intestines.
  2. Signs of gastroentiritis
    • vomiting
    • diarrhea
    • elevated temperature
  3. symptoms of gastroentiritis
    • nausea
    • abdominal cramps
    • fever
    • malaise
  4. cause of gastroenteritis
    • microorganisms transmitted by fecally contaminated food and water
    • most infections are self-limiting
    • epidemics of viral gastroenteritis common in daycares
  5. treatment and prevention for gastroentiritis
    • infections are usually self-limiting
    • might be necessary to replenish fluids and electrolytes
    • careful hand washing and food handling can reduce outbreaks
  6. define peptic ulcer
    • A lesion of the skin or a mucous membrane such as the one lining the stomach or duodenum that is accompanied by formation of pus and necrosis of surrounding tissue, usually resulting from inflammation or ischemia.
    • can be called duodenal ulcer or gastric ulcer, depending on where it is located
  7. signs of peptic ulcers
    • heartburn
    • nausea
    • vomiting--esp. after intake of alcohol or irritating foods
    • weight loss
    • weight gain--after patient realizes more food intake is relieving
    • iron-deficiency anemia
    • presence of blood in the stool
  8. symptoms of peptic ulcers
    • epigastric burning or aching pain, usually 2-3 hrs after a meal
    • relief in eating more frequently
  9. cause of peptic ulcers
    • infection with Helicobacter pylori in most cases
    • genetics can influence
    • more common in: blood type O, seniors, those with scar tissue, those who take ucerogenic anti-inflammatory medications (aspirins or NSAIDS), and more in men than women
    • a combination of all of the above
  10. treatment and prevention for peptic ulcers
    • drug therapy, including two or three antimicrobial drugs and medication to reduce secretion
    • reducing exacerbating factors such as coffee
    • vagotomy
    • surgery: partial gastrectomy or pyloroplasty
  11. signs of stress ulcer
  12. cause of stress ulcer
    • severe trauama, such as burns or head injury
    • serious systemic problems such as hemorrhage or sepsis
  13. Curling's ulcer
    stress ulcers in the presence of burns
  14. Cushing's ulcers
    stress ulcers in the presence of head injury
  15. ischemic ulcers
    stress ulcers everywhere except burns and head injury
  16. pathophysiology of stress ulcer
    • multiple ulcers, usually gastric, form within hours of the precipitating event due to decreased blood flow to the mucosa-->reduced secretion of mucus and epithelial regenration
    • the mucosal barrier is lost-->acid diffuses into the mucosa
    • with Cushing's, increased vagal stimulation of acid secretion
  17. treatment and prevention of stress ulcers
    prophylactic medication are usually administered ASAP to minimize the risk of ulcer development
  18. adenocarcinoma
    A malignant tumor originating in glandular tissue.
  19. signs of gastric cancer
    • anorexia
    • weight loss
    • tests could reveal blood in stool or iron-deficiency anemia
  20. symptoms of gastric cancer
    • feelings of indigestion or epigastric discomfort
    • fatigue
    • feeling of fullness after eating
  21. cause of gastric cancer
    • Helicobacter pylori is associated with a higher risk of gastric carcinoma
    • food preservatives such as nitrates or nitrites and smoked foods
    • genetics
    • blood group A
    • presence of chronic atrophic gastritis or polyps
  22. pathophysiology of gastric cancer
    • primarily in the mucous glands
    • most tumors can occur in the antrum or pyloric area
    • some tumors affect lesser curvature of stomach or cardia
    • adenocarcinoma occurs most frequently
    • early is confined to mucosa and submucosa--> spreads to the muscularis layer--> lymph nodes (regional and supraclavicular)--> liver and ovaries
  23. treatment of gastric cancer
    • surgery
    • chemotherapy
    • radiation
    • vit. b12 injections post gastrectomy 
  24. define cholecystitis
    inflammation of the gallbladder and cystic duct
  25. signs of cholecystitis
    • severe waves of pain in the URQ of the abdomen or epigastric area, often radiating to the back and right shoulder
    • vomiting
    • intolerance to fatty foods
    • excessive belching
    • bloating
    • epigastric discomfort
    • elevated temperature
    • test results indicate leukocytosis
  26. symptoms of cholecystitis
    • pain
    • nausea
    • fever
  27. cause of cholecystitis
    • cholesterol gallstones that tend to develop in individuals with high cholesterol levels in bile
    • high risk factors: obesity, high cholesterol intake, multiparity, the use of oral contraceptives or estrogen supplements
    • women at higher risk than men
    • Bile pigment stones precipitated in people with  hemolytic anemia, alcoholic cirrhosis, or biliary tract infections
  28. pathophysiology of cholecystitis
    • gallstones tend to form when bile contains high concentration of a component such as cholesterol or in deficit of bile salts
    • inflammation or infection in the biliary structures may provide a focus for stone formation or may alter the solubility of the constituents-->development of calculus
    • secondary infections by Escherchia coli or enterocci may occur
  29. cholelithiasis
    formation of gallstones
  30. gallstones
    masses of solid material or caculi that form in the bile
  31. cholangitis
    inflammation usually related to infection of the bile ducts
  32. choledocholithiasis
    pertains to obstruction by gallstones of the biliary tract
  33. multiparity
    having several children
  34. general types of hepatitis
    • Viral 
    • Toxic or Nonviral
  35. Three stages of hepatitis signs and symptoms
    • 1. preicteric or prodromal stage
    • 2. icteric or jaundice stage
    • 3. posticteric or recovery stage
  36. Signs of Hepatitis: Preicteric Stage
    • anorexia
    • nausea
    • elevated temperature
    • headache
    • serum levels of liver enzymes are elevated ( aspartate aminotransferase [AST], alanine aminotransferase [ALT])
  37. Symptoms of preicteric stage
    • fatigue
    • malaise
    • general muscle aching
    • fever
    • headache
    • distaste for cigarettes
    • mild URQ discomort
  38. Signs of Hepatitis: Icteric stage
    • onset of jaundice as serum bilirubin rises
    • light color stools
    • dark urine
    • pruritic skin
    • liver is tender and enlarged (hepatomegaly)-->mild aching pain
    • blood clotting prolonged
  39. Signs of Hepatitis: Posticteric stage
    • reduction in signs 
    • recovery
  40. cause of hepatitis A
    • aka infectious hepatitis
    • small RNA virus: hepatitis A virus, or HAV
    • transmitted primarily by oral-fecal route, often from contaminated water or shellfishoutbreaks in daycares and homosexual populations
    • HAV causes an acute but self-limiting infection
    • serum markers: anti-HAV IgM + anti-HAV IgG
    • no carrier or chronic state
  41. cause of hepatitis B
    • caused by small DNA partially double-stranded  hepatitis B virus, HBV
    • transmitted primarily by infected blood but can also be found in other body secretions
    • high risk: intravenous drug abusers, hemodialysis, healthcare workers, fetus during pregnancy, tattooing
    • HBV has carrier and chronic states
  42. cause of hepatitis C
    • single-stranded RNA virus HCV
    • transmitted by blood transfusions
    • increases the risk of hepatocellular carcinoma
    • may exist in carrier state and chronic state
  43. cause of hepatitis D
    • defective/incomplete RNA virus, HDV, aka delta virus
    • requires the presence of hepatitis B virus to replicate and product active infection
    • usually increases severity of HBV infection
    • transmitted by blood-->high risk for intravenous drug abusers
    • may exist in chronic state
  44. cause of hepatitis E
    • HEV, single-stranded RNA virus
    • spread by oral-fecal route
    • similar to HAV and lacks chronic or carrier state
    • high mortality rate in pregnant women in Africa
  45. treatments and preventions of viral hepatitis
    • no method of destroying the viruses
    • supportive measures include rest and diets high in protein, carbs, and vitamins
    • Chronic Hep. B + C can be improved with medications that reduce viral replication, but only works in 30-40% of cases
    • and HBV vaccine available for long-term protection for high risk groups, esp healthcare professionals and now administered to children
    • HBV globulin available as temporary measure
  46. pancreatitis
    • an inflammation of the pancrease resulting from autodigestion of the tissues
    • may occur in acute or chronic form
    • acute is considered a medical emergency
  47. Signs of pancreatitis
    • may follow intake of a large meal or a large amount of alcohol
    • sever epigastric or abdominal pain radiating to the back, increases in supine position
    • signs of shock: low BP, pallor and sweating, and a rapid but weak pulse
    • inflammation and hemorrhage-->hypovolemia
    • high temperature
    • abdominal distention and decreased bowel sounds (peritonitis--> decreased peristalsis and paralytic ileus
    • tests show elevated serum amylase within first 12-24 hrs and fall after 48 hrs
    • serum lipase levels also elevated
    • hypocalcemia
    • leukocytosis
  48. symptoms of pancreatitis
    • sever epigastric or abdominal pain radiating to the back, increases in supine position
    • fever
  49. treatment of pancreatitis
    • oral intake stopped
    • bowel distention relieved to reduce pancreatic stimulation
    • shock and electrolyte imbalances treated
    • analgesics for pain relief (never morphine)
  50. jaundice
    • aka icterus or hyperbilirubinemia
    • Yellowish discoloration of the whites of the eyes, skin, and mucous membranes caused by deposition of bile salts in these tissues.
    • It occurs as a sign of various types of disorders, such as hepatitis, that affect the processing of bile.
  51. the jaundice disorder groups
    • 1. Prehepatic: results from excessive destruction of RBCs and is characteristic of hemolytic anemias or transusion reactions. Live function is normal but unable to handle additional bilirubin
    • 2. Intrahepatic: occurs i nindividuals with liver disease such as hepatitis or cirrhosis. Related to impaired uptake of bilirubin from the bloodand decreased conjugation of bilirubin by hepatocytes
    • 3. Posthepatic: caused by obstruction of bile flow into the gallbladder or duodenum and subsequent backup o bile into bile-->congenital atresia of bile ducts, obstruction caused by cholelithiasis, inflammation of liver, tumors, skin pruritis
  52. Signs of appendicitis
    • general periumbilical pain
    • nausea 
    • vomiting
    • increased severe pain in LRQ of abdomen
    • tenderness in LRQ
    • after rupture pain subsides but then recurs as peritonitis develops
    • elevated temperature and leukocytosis
    • inflammation
    • onset of peritonitis include a rigid boardlike abdomen, tachycardia, and hypotension
  53. symptoms of appendicitis
    • general periumbilical pain
    • increased  and severe pain in LRQ
    • pain subsides then recurs
    • fever
  54. causes of appendicitis
    • obstruction of appendiceal lumen by a fecalith, gallstone, or foreign material
    • fluid builds up inside the the appendix and microorganism proliferate
    • the appendiceal wall becomes inflamed and purulent exudent forms-->swollen appendix and compressed BVs
    • increasing congestion ad prssure within the appendix leads to ischemia and necrosis of the wall--> increased permeability
  55. treatment of appendicitis
    surgical removal and administration of antimicrobial drugs
  56. define cirrhosis
    • A chronic disease of the liver characterized by the replacement of normal tissue with fibrous tissue and the loss of functional liver cells. It can result from alcohol abuse, nutritional deprivation, or infection especially by the hepatitis virus.
    • end result of many chronic liver diseases
  57. Signs of cirrhosis
    • Initial: fatigue, anorexia, weightloss, anemia, diarrhea, dull aching pain in URQ of abdomen
    • ascities and peripheral edema
    • esophogeal varices form
    • jaundice
    • encephalopathy
    • imbalance in sex hormones--> spider nevi in skin, testicular atrophy, impotence, gynecomastia, irregular menses
    • complications-->reptured varices, hemorrhage, circ. shock, an acute hepatic encephalopathy
    • frequent infections due to inability to diffuse nutrients in body
  58. Encephalopathy
    • any degenerative disease of the brain, often associated with toxic conditions
    • acute manifests as asterixis, a "hand-flapping" tremor, and confusion, disorientation, convulsions, coma
    • chronic characterized by personality changes, memory lapses, irritability, and disinterest in personal care
  59. define colitis
    • inflammation of the colon: a Chronic Inflammatory Bowel Disease
    • aka colonitis
  60. Signs and Symptoms of ulcerative colitis
    • diarrhea marked by presence of blood and mucus and cramping pain
    • during severe exacerbations, blood and mucus alone may be passed frequently accompanied by tenesmus
    • recal bleeding which leads to iron-deficiency anemia
    • fever
    • weight loss
  61. tenesmus
    an ineffective painful straining to empty the bowels in response to the sensation of a desire to defecate, without producing a significant quantity of feces
  62. Cause of colitis
    • idiopathic
    • genetic factors b/c prevalent in Ashknaz Jews
  63. Treatment of colitis
    • remove physical or emotional stressors that act as exacerbators
    • anti-inflammatory medications
    • antimotility agents
    • nutritional supplements, diet low in fat
    • antimicrobials (for secondary infections)
    • surgical resection
  64. diarrhea
    • an excessive frequency of stools, usually of loose or watery consistency, and may be acute or chronic.
    • the presence of blood, mucus, or pus in the stoll may be helpful in diagnosing or monitoring a disease
    • frequently accompanied by nausea and vomiting when infection or inflammation occurs alone
    • accompanied by cramping pain
    • severe or prolonged diarrhea-->dehydration, electrolyte imbalance, acidosis, and malnutrition
  65. classifications of diarrhea
    • large volume diarrhea
    • small-volume diarrhea
    • steatorrhea
    • blood
    • gas
  66. large-volume diarrhea
    • can be secretory or osmotic
    • leads to watery stool
    • related to infections or a short transit time which limits reabsorption, or increased osmotic pressure of intestinal contents, causing them to retain water
    • common causes: lactose intolerance
  67. small-volume diarrhea
    • common in people with IBD
    • stool may contain blood, mucus, or pus
    • may be accompanied by abdominal cramps and urgency
  68. steatorrhea
    • fatty diarrhea
    • mared by frequent, bulky, greasy, foul-odored loose stools
    • characteristic of malabsorption syndromes like celiac disease
    • abdomen often dstended because of bulk remaining in intestines
    • malnutrition manifested in other tissues unless disguised by edema from hypoproteinemia
  69. squamous cell carcinoma
    • common cancer of the oral cavity
    • more common in age >40, smokers, preexisting leukoplakia, history of alcohol abuse
    • malginanat tumors are hidden and painless
    • common sites: floor of the mouth and lateral borders of the tongue
    • intraoral cancer spreads first to the regional lymph nodes and nodes in the neck
  70. Kaposi sarcoma
    • may occur in patients with AIDS
    • typical lesion is  brownish or purple macular lesion, usually on the palate, becomes a nodular mass
  71. esophogeal cancer
    • primarily squamous cell carcinoma
    • commonly found int he sital esophagus
    • tmors form curcumferenctial strictures or grow out into the lumen of the esophogus-->dysphagia
    • associated with chronic irritation (ie chronic esophogitis, achalasia, hiatal hernia, alcohol abuse, smoking
    • poor prognosis
  72. hiatal hernia
    part of the stomach protrudes though the opening in the diaphragm into thoracic cavity
  73. causes of liver cancer
    • secondary more common than primary
    • most common primary tumor is hepatocellular carcinoma, developing in cirrhotic livers, other causes: prolonged exposure to carcinogenic chemicals
    • secondary or metastaticcancer often arises from areas served by the hepaticportal veins or that spread along the peritoneal membranes
  74. signs of liver cancer
    • similar to other liver diseases
    • anorexia and vomiting
    • fatigue
    • weight loss
    • hepatomegaly
    • portal hypertension
    • splenomegaly
    • Paraneoplastic syndromes, with tumor cells producing substances similar to erythropoietin, estrogen, or insulin
  75. treatment of liver cancer
    • usually advanced by the time it's diagnosed
    • chemotherapy is usual
    • lobectomy or radiofrequency when tumor is localized
  76. pancreatic cancer
    • risk factor: cigarrette smoking,pancreatitis, and dietary factors
    • common form is adenocarcinoma which arises from epithelial cells in the ducts
    • 95% mortality rate
    • liver failure from hepatobiliary obstruction, often cause of death
  77. signs and symptoms of pancreatic cancer
    • weight loss and jaundice caused by obstruction of biliary and pancreatic flow due to tumor at the head of pancreas
    • asymptomatic if in the body or tail until it is well advanced and affecting other nearby organs, causing severe pain
  78. Pathophysiology of Chron's disease
    • mostly affects the small intestine and ascending colon
    • inflammation occurs in "skip lesions" segments of inflammation then segments of normal tissue
    • initial inflammation occurs in mucosal layer with shallow ulcers
    • progressive inflammation leads to thick "rubber hose" wall--> narrow lumen--> obstruction
    • granulomas present in walls and regional lymph nodes
    • inflammation stimulates quick motility with malabsorption--> hypoproteinemia, avitaminosis, malnutrition, steatorrhea
  79. signs and symptoms of Crohn's disease
    • diarrhea with cramping abdominal pain
    • soft semi-formed stool
    • melena
    • pain and tenderness in LRQ
    • anorexia
    • weight loss
    • anemia
    • fatigue
    • in children, delayed growth and sexual maturation due malabsorption of vit. A and D
  80. colorectal cancer
    a malignant tumor of the colon; early symptom is bloody stools
  81. pathophysiology of colorectal cancer
    • most malignant neoplasms develop from adenomatous polyps
    • polyps distributed equally in the ascending, descending, and distal sigmoid colon and rectum
  82. cause of colorectal cancer
    • primarily in persons >55
    • western hemisphere
    • genetics
    • diets high in fat, sugar, and red meat, and low in fiber
  83. signs and symptoms of colorectal cancer
    • mostly asymptomatic until well advanced
    • vague cramping, small flat pellets or ribbon stool, feeling of incomplet emptying-->annular legion in rectosigmoid area
    • general systemic signs fatigue, weight-loss, iron-deficiency anemia--> ascending colon
    • unexplained change in bowel habits such as alternating diarrhea and constipation
    • bleeding indicated by occult blood or melena
    • blood or mucus on surface of stool