patho test 4 GI

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patho test 4 GI
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2012-12-04 22:19:56
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GI
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  1. difficulty swallowing
    dysphagia
  2. mechanical obstructions causing dysphagia
    strictures
  3. dysorders of skeletal muscle of upper 1/3 of esophogus
    functional dysphagia
  4. neural or muscular disorder that affects the lower 2/3 of esophogus
    achalasia
  5. the reflux of chyme from the stomach to the esophagus
    GERD
  6. 2 risk factors of GERD
    • hiatal hernia
    • delayed gastric emptying
  7. most common type of hiatal hernia
    sliding
  8. what 2 cells does the fundus contain
    • parietal cells
    • chief cells
  9. what are the parietal cells responsible for
    • HCl
    • intrinsic factor
  10. what are the chief cells responsible for
    pepsinogens
  11. 4 triggers of GERD
    • vomiting
    • coughing
    • lifting
    • bending
  12. pyrosis
    heartburn
  13. dysphagia is associated with
    • asthma, laryngitis, and chronic cough
    • you are aspirating more
  14. etiologies of GERD
    • LES relaes 1-2 hr /p meal, permitting gastric contents to regurgitate into the esophagus
    • acid is usually neutralized and contents may return to the stomach, sphincter tone restored
  15. GERD with symptoms of inflammation
    reflux esophagitis
  16. the narrowing or blocking of the opening between the stomach and duodenum
    pyloric obstruction
  17. when is pyloric obstruction more distressing
    after eating and later in the day
  18. initial clinical manifestations of pyloric obstructions
    vague epigastric fullnes
  19. later clinical manifestations of pyloric obstructions
    • anorexia
    • weight loss
  20. lack of muscle tone and motility
    atony
  21. stomach sloshing if jarred
    succusion splash
  22. cardinal sign of pyloric obstructions
    vomiting
  23. 7 treatments for pyloric obstructions
    • drain gastric contents
    • PPI
    • rehydrate
    • correct electrolytes
    • surgery
    • parenteral hyperalimentation of malnourished
    • NOT BARIUM
  24. mechanical blockage of the lumen by a lesion
    simple obstruction
  25. most common type of simple obstruction
    in the small intestine due to adhesions
  26. obstruction type with a failure of motility (paralytic ileus)
    functional obstructions
  27. 7 causes of intestinal obstruction
    • herniation
    • intussusception
    • torsion
    • diverticulosis
    • tumor
    • paralytic ileus
    • fibrous adhesions
  28. main cause of small bowel obstructions
    adhesions 2ndary to abdominal surgery
  29. main cause of large bowel obstructions
    colorectal cancer
  30. second leading cause of small bowel obstructions
    hernia's
  31. ovarian cysts are relatively common and usually disappear without treatment, but can cause what
    adhesions
  32. lower bowel obstructions can lead to
    metabolic acidosis, b/c bicarbonate from pancreatic and bile cannot be reabsorbed
  33. as the condition of distension worsens what happens
    hypokalemia becomes severe promoting acidosis and atony of intestinal wall
  34. cardiac symptoms of intestinal obstructions
    • colicky pain (initially)
    • followed by vomiting
  35. autonomic responses of intestinal obstruction
    sweating, nausea, hypotension
  36. S & S of intestinal obstruction if strangulation
    pain less colicky, more constant and severe as ischemia progresses to necrosis, or perforation
  37. if distension pushes up on the diaphragm what can occur
    atelactasis and pneumonia
  38. 3 treatments for intestinal obstructions
    • decompress lumen with suction
    • replace fluids and electrolytes
    • surgery if strangulation or complete obstruction
  39. inflammatory of disorder of the gastric mucosa
    gastic ans stress ulcers
  40. 4 risk factors of gastritis and stress ulcers
    • drugs (NSAIDS, alcohol, histamine, digitalis)
    • chemicals
    • metabolic disorders (uremia)
    • helicobacter pylori
  41. erodes the surface epithelium in a diffuse or localized  pattern
    erosions are usually superficial
    can occur as bleeding, stress-related gastritis in seriously ill ICU patients
    acute gastritis
  42. causes thinning and degeneration of stomach wall
    chronic gastritis
  43. atrophic gastritis
    most rare and severe
    decrease
        chief & parietal cells
        pepsinogen
        HCl
        intrinsic factor --> pernicious anemia-->carcinoma
    increase
        elevated plasma gastrin
    auto immune
    fundal chronic gastritis
  44. H. pylori is a major causative factor
    bile reflux can contribute
    antral chronic gastritis
  45. 4 risk factors for peptic ulcer disease
    • smoking
    • H. pylori infection
    • habitual use of NSAIDS or alcohol
    • certain chronic diseases
    •    emphysema
    •    rhematoid arthritis
    •    cirrhosis
    •    stress
  46. often located in antral area of stomach or duodenum
    H. pylori
    high prolonged gastrin levels
    rapid gastric dumping
    peptic ulcer disease
  47. occurs in the middle of the night when the stomach is empty
    relieved byeating or antacid medications
    dull gnawing ache
    occurs 2 to 3 hrs after a meal
    PUD
  48. tx of PUD
    • antacids
    • H2 antagonists
    • PPIs
    • antibiotics for H. pylori
  49. acute form of peptic ulcer
    multiple sites of injury in stomach or duodenum
    superficial lesion of epithelium
    stress ulcer
  50. decreased mucosal blood flow
    mucosal lining degenerates
    allows stomach acid to diffuse back to mucosa
    inflammation, ulceration
    stress ulcer
  51. what is absent from a peptic ulcer that is seen in stress ulcers
    scaring and thickening of blood vessels
  52. 2 types of stress ulcers
    • ischemic
    • cushings
  53. stress ulcer that has rapid development
    ischemic
  54. stress ulcer associated with severe head injury
    high incidence of perforation
    cushings
  55. ulcer developed of ischemia after a burn
    curlings
  56. is H. pylori involved with a stress ulcer
    no
  57. the most common surgical emergency of the abdomen and affects 7-12% of the population
    most common age 20-30 yo
    appendicitis
  58. localized pain
    rebound tenderness RLQ
    obstruction with 2ndary distension and bacterial invasion of the wall
    1/2 of the cases are not obstructed
    appendicitis
  59. wound infection is the most common post-op complication
    surgery and antibiotics
    appendicitis
  60. mucosal hypoxia
    ulcerations
    bacterial or other pathogens invade
    inflammation and edema
    thrombosis of luminal blood vessels
    gangrene
    perforation
    peritonitis
    appendicitis
  61. S&S
    localized pain
    increase WBC cound
    increase C-reactive protein
    appendicitis
  62. 3 arteries supplying the intestines and stomach
    • celiac axis
    • superior mesenteric artery
    • inferior mesenteric artery
  63. atherosclerotic lesions
    thrombi
    emboli
    chronic mesenteric insufficiency
    vascular insufficiency
  64. cardinal symptoms of mesenteric insufficiency: colicky abdominal pain after eating
    mortality is high in accute occlusion
    vascular insufficiency
  65. bowel ischemia
    vascular insufficiency
  66. complication is abdominal angina
    vascular insufficiency

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