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or hypochlorhydria refers to states where the production of gastric acid in the stomach is absent or low, respectively.
- The slowing of the body's basal metabolic rate associated with hypothyroidism
- Autoimmune disorders where there is antibody production against parietal cells which normally produce gastric acid.
- The use of antacids or drugs that decrease gastric acid production (such as H2-receptor antagonists) or transport (such as proton pump inhibitors).
- A symptom of rare diseases such as mucolipidosis (type IV).
- A symptom of Helicobacter pylori infection which neutralizes and decreases secretion of gastric acid to aid its survival in the stomach.
- A symptom of pernicious anemia, atrophic gastritis or of stomach cancer.
- Radiation therapy involving the stomach.
- Gastric bypass procedures such a duodenal switch and RNY, where the largest acid producing parts of the stomach are either removed, or blinded.
- VIPomas (vasoactive intestinal peptides) and somatostatinomas are both islet cell tumors of the pancreas.
- Pellagra, caused by niacin deficiency.
(also termed canker sores, recurrent aphthous stomatitis, RAS, recurring oral aphthae and recurrent aphthous ulceration) is a common cause of benign and non-contagious mouth ulcers (canker sores). This condition is characterized by the repeated formation of ulcers on the mucous membrane of the oral cavity (the lining of the mouth), in otherwise healthy individuals. Symptoms range from a minor nuisance to interfering with eating and drinking. The cause is not completely understood, but may involve a T cell mediated immune response which is triggered by a variety of factors. Different people may have different triggers, including nutritional deficiencies, local trauma, stress, hormonal influences, allergies and a genetic predisposition. The condition is very common, affecting about 20% of the general population. There is no cure, and treatments are aimed at reducing pain and speeding the healing process. Often, the onset of the condition is during childhood or adolescence and usually lasts for several years before gradually disappearing, with or without any form of treatment.
gastroenterological term for an accumulation of fluid in the peritoneal cavity. The medical condition is also known as peritoneal cavity fluid, peritoneal fluid excess, hydroperitoneum or more archaically as abdominal dropsy. Although most commonly due to cirrhosis, severe liver disease or metastatic cancer, its presence can portend other significant medical problems. Diagnosis of the cause is usually with blood tests, an ultrasound scan of the abdomen, and direct removal of the fluid by needle or paracentesis (which may also be therapeutic). Treatment may be with medication (diuretics), paracentesis, or other treatments directed at the cause.
(also called the flapping tremor, or liver flap) is a tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings. This motor disorder is characterized by jerking movements (as of the outstretched hands) and is associated with various encephalopathies due especially to faulty metabolism.[
a neurological sign consisting of lack of voluntary coordination of muscle movements. Ataxia is a non-specific clinical manifestation implying dysfunction of the parts of the nervous system that coordinate movement, such as the cerebellum. Several possible causes exist for these patterns of neurological dysfunction.
collapse or closure of the lung resulting in reduced or absent gas exchange. It may affect part or all of one lung. It is a condition where the alveoli are deflated, as distinct from pulmonary consolidation.It is a very common finding in chest x-rays and other radiological studies. It may be caused by normal exhalation or by several medical conditions. Although frequently described as a collapse of lung tissue, atelectasis is not synonymous with a pneumothorax (abnormal collection of air or gas in the pleural space that separates the lung from the chest wall and which may interfere with normal breathing), which is a more specific condition that features atelectasis. Acute atelectasis may occur as a post-operative complication or as a result of surfactant deficiency. In premature neonates, this leads to infant respiratory distress syndrome.
Buildup of abnormally high levels of nitrogen-containing compounds, such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds in the blood.
- Normal BUN:Cr is equal to 15
- BUN:Cr in prerenal azotemia is greater than 20
- BUN:Cr in renal azotemia is less than 15
- BUN:Cr in postrenal azotemia is >15.[
The plantar reflex is a reflex elicited when the sole of the foot is stimulated with a blunt instrument. The reflex can take one of two forms. In normal adults the plantar reflex causes a downward response of the hallux (flexion). An upward response (extension) of the hallux is known as Koch sign, Babinski response or Babinski sign, named after Joseph Babinski (1857–1932), a French neurologist of Polish origin. The presence of the Babinski sign can identify disease of the spinal cord and brain in adults, and also exists as a primitive reflex in infants.
includes a variety of procedures performed on people who are obese. Weight loss is achieved by reducing the size of the stomach with a gastric band or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestines to a small stomach pouch (gastric bypass surgery).
The client who has had a Billroth II procedure is at risk for dumping syndrome. The client should lie down after eating and avoid drinking liquids with meals to prevent this syndrome. The client should be placed on a dry diet that is high in protein, moderate in fat and low in carbohydrates. Frequent small meals are encouraged, and the client should avoid concentrated sweets.
The Billroth II is often indicated in refractory peptic ulcer disease. Billroth's operation II, is an operation in which the greater curvature of the stomach is connected to the first part of the jejunum in a side-to-side manner. This often follows resection of the lower part of the stomach (antrum). The antrectomy (resection of the stomach antrum) is not part of the originally described procedure. The surgical procedure is called gastrojejunostomy.
BMI (body mass index)
= (lb / height(in)^2) x 703
= kg / height(meters)^2
BSA (body surface area)
= sqrt((lb x height(in)) / 3131)
= sqrt((kg x height(cm)) / 3600)
most abundant catecholamines are epinephrine (adrenaline), norepinephrine (noradrenaline) and dopamine, all of which are produced from phenylalanine and tyrosine. Release of the hormones epinephrine and norepinephrine from the adrenal medulla of the adrenal glands is part of the fight-or-flight response.
a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules (lumps that occur as a result of a process in which damaged tissue is regenerated), leading to loss of liver function. Cirrhosis is most commonly caused by alcoholism, hepatitis B and hepatitis C, and fatty liver disease, but has many other possible causes. Some cases are idiopathic (i.e., of unknown cause).
- Compared to Hepatitis:
- In comparison, cirrhosis and hepatitis share common causes, and features of hepatitis lie on the road leading to cirrhosis. The management in both the conditions is supportive, and the diseases can be prevented by vaccinating against infective organisms. Cirrhosis is a late stage disease, and hepatitis is an early stage disease. Hepatitis A is a cause of hepatitis, but it will never cause cirrhosis. Features of hepatitis are generalized, with scattered early features of biliary blockage, but cirrhotic will have features of decompensated liver disease with complications like ascites, haematemesis, spontaneous bacterial peritonitis and renal failure. The outcome of a patient with cirrhosis is very poor, whereas a patient with hepatitis is good. Liver transplantation is a necessity in cirrhosis, whereas in hepatitis not so much.
paroxysmal abdominal pain or cramping that is manifested by loud crying and drawing the legs up to the abdomen. Treatment of colic may involve a change in infant feeding practices, correction of a stressful environment, behavior modification, and support of the parent. Medications such as antispasmodics or mild sedatives may decrease symptoms in some infants. Perhaps the most important nursing intervention (once the diagnosis of colic is established) is reassuring parents that they are not doing anything wrong and that the infant is not experiencing any physical or emotional harm.
Commonly used in medicine, the word decubitus is used to mean "lying down".
Right lateral decubitus would mean that the patient is lying on his or her right side. Another example is angina decubitus, (chest pain while lying down)
the symptom of difficulty in swallowing. Sufferers are sometimes unaware of their dysphagia. It may be a sensation that suggests difficulty in the passage of solids or liquids from the mouth to the stomach, a lack of pharyngeal sensation, or various other inadequacies of the swallowing mechanism.
medical term for a subcutaneous purpura larger than 1 centimeter or a hematoma, commonly, but erroneously, called a bruise. That is, a bruise is caused by trauma whereas ecchymoses, a type of purpura is not caused by trauma. A more generic definition of ecchymosis is as: the escape of blood into the tissues from ruptured blood vessels. The term ecchymosis also applies to the subcutaneous discoloration resulting from seepage of blood within the contused tissue.
secretes its essential product without the use of a duct directly into the bloodstream or else by diffusion into its surrounding tissue (paracrine signaling) where it often affects only target cells near the release site.
Examples of endocrine glands include the adrenal glands, located atop the kidneys and responsible for the secretion of certain hormones such as adrenaline, cortisol and others. The testes, sing: testicle, in males and ovaries in females are not only gonads, organs which generate male and female germ cells respectively, but are also endocrine glands in that they produce various androgens and estrogens together known as steroidal sex hormones.
(or oesophageal varices) are extremely dilated sub-mucosal veins in the lower third of the esophagus. They are most often a consequence of portal hypertension, commonly due to cirrhosis; patients with esophageal varices have a strong tendency to develop bleeding.
excretes its essential product by way of a duct to some environment external to itself, be it either inside the body or on a surface of the body.
Examples of exocrine glands include the sweat glands, salivary glands, mammary glands, pancreas and liver.
Extrapyramidal symptoms (EPS)
Also known as extrapyramidal side-effects (EPSE), such as akinesia (inability to initiate movement) and akathisia (inability to remain motionless).
Extrapyramidal symptoms (EPS) are various movement disorders such as acute dystonic reactions, pseudoparkinsonism, or akathisia suffered as a result of taking dopamine antagonists, usually antipsychotic (neuroleptic) drugs, which are often used to control psychosis. It can also be a symptom of a metabolic disease. Extrapyramidal syndrome (EPS) is due to the blockade of dopamine receptors in the basal ganglia, leading to Parkinson-like symptoms such as slow movement (bradykinesia), stiffness, and tremor.
A fecaloma, also called fecalith, fecolith and coprolith, i.e., a "stone" made of feces, is a hardening of feces into lumps of varying size inside the colon, which may appear whenever chronic obstruction of transit occurs, such as in megacolon and chronic constipation. They may be the obstruction that initiates apendicitis. Some diseases, such as Chagas disease, Hirschsprung's disease and others damage the autonomic nervous system in the colon's mucosa (Auerbach's plexus) and may cause extremely large or "giant" fecalomas, which must be surgically removed (disimpaction).
an abnormal connection or passageway between two epithelium-lined organs or vessels that normally do not connect. It is generally a disease condition, but a fistula may be surgically created for therapeutic reasons.
any event or process that occurs suddenly and quickly, and is intense and severe to the point of lethality.
expectoration (coughing up) of blood or of blood-stained sputum from the bronchi, larynx, trachea, or lungs (e.g., in tuberculosis or other respiratory infections or cardiovascular pathologies).
vomiting of blood. The source is generally the upper gastrointestinal tract. Patients can easily confuse it with hemoptysis (coughing up blood), although the latter is more common.
Hematocrit versus Hemoglobin
With blood loss anemia and macrocytic (larger volume RBCs than normal) anemia's the X3 rule applies meaning:
HgB X 3 = HCT
i.e. with a HCT of 30%, you would expect a Hgb of 10g/dL
With an iron deficiency anemia though the proportion of RBCs may still be HCT=30%, the HgB would be less than 10g/dL becauase each RBC does not have a full compliment of iron and therefore HgB.
Inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ.
The condition can be self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis.
protrusion (or herniation) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm.
Jaundice is a yellowish pigmentation of the skin and other mucous membranes caused by hyperbilirubinemia (increased levels of bilirubin in the blood).
When it also affects the conjunctival membranes over the sclerae (whites of the eyes) it is called icterus.
This hyperbilirubinemia subsequently causes increased levels of bilirubin in the extracellular fluid. Concentration of bilirubin in blood plasma is normally below 1.2 mg/dL (<25µmol/L). A concentration higher than 2.5 mg/dL (>50µmol/L) leads to jaundice. The term jaundice comes from the French word jaune, meaning yellow.
of unknown cause
commonly defined simply as bowel obstruction.
However, authoritative sources define it as decreased motor activity of the GI tract due to non-mechanical causes. In such sense, this does not include motility disorders that result from structural abnormalities, and, therefore, some mechanical obstructions are misnomers, such as gallstone ileus and meconium ileus, and are not true examples of ileus.
Inflammatory bowel disease (IBD)
a group of inflammatory conditions of the colon and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis.
Although very different diseases, both may present with any of the following symptoms: abdominal pain, vomiting, diarrhea, rectal bleeding, severe internal cramps/muscle spasms in the region of the pelvis and weight loss. Anemia is the most prevalent extraintestinal complication of inflammatory bowel disease
Irritable bowel syndrome (IBS)
or spastic colon) is a symptom-based diagnosis characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits. As a functional bowel disorder, IBS has no known organic cause. Diarrhea or constipation may predominate, or they may alternate.
There is no rectal bleeding as in IBD, and no consequent anemia.
refers to the black, "tarry" feces that are associated with gastrointestinal hemorrhage. The black color is caused by oxidation of the iron in hemoglobin during its passage through the ileum and colon.
- Melena vs. hematochezia
- Bleeds that originate from the lower GI tract (such as the sigmoid colon and rectum) are generally associated with the passage of bright red blood, or hematochezia, particularly when brisk. Only blood that originates from a high source (such as the small intestine), or bleeding from a lower source that occurs slowly enough to allow for enzymatic breakdown is associated with melena. For this reason, melena is often associated with blood in the stomach or duodenum (upper gastrointestinal tract), for example by a peptic ulcer. A rough estimate is that it takes about 14 hours for blood to be broken down within the intestinal lumen; therefore if transit time is less than 14 hours the patient will have hematochezia, and if greater than 14 hours the patient will exhibit melena. One often-stated rule of thumb is that melena only occurs if the source of bleeding is above the ligament of Treitz although, as noted below, exceptions occur with enough frequency to render it unreliable
a nasoenteric tube that is used to decompress the intestine and correct a bowel obstruction. Nausea should subside as decompression is accomplished. Although bowel sounds will be abnormal in the presence of obstruction, the presence or absence of bowel sounds is not associated with the location of the tube. The end of the tube should be located in the intestine (below the pylorus). The pH ofthe gastric fluid is acidic, and the pH of the intestinal fluid is alkaline (7 or higher). Location of the tube can also be determined by radiographs.
simply the contact between teeth.
More technically, it is the relationship between the maxillary (upper) and mandibular (lower) teeth when they approach each other, as occurs during chewing or at rest.
painful swallowing, in the mouth (oropharynx) or esophagus. It can occur with or without dysphagia, or difficulty swallowing. Odynophagia often results in inadvertent weight loss. It can be caused by many conditions, including very hot or cold food or drink, drugs, ulcers and mucosal destruction, upper respiratory tract infections, immune disorders, epiglottitis, cancers, and motor disorders.
inflammation of the pancreas which requires immediate medical attention and hospitalization during an attack that has multiple causes and symptoms. It occurs when pancreatic enzymes (especially trypsin) that digest food are activated in the pancreas instead of the small intestine.
a form of body fluid sampling procedure, generally referring to peritoneocentesis (also called laparocentesis - "cent" means "pierce") in which the peritoneal cavity is punctured by a needle to sample peritoneal fluid.
Simply the absense of peristalsis.
Commonly defined simply as bowel obstruction. However, authoritative sources define it as decreased motor activity of the GI tract due to non-mechanical causes. In such sense, this does not include motility disorders that result from structural abnormalities, and, therefore, some mechanical obstructions are misnomers, such as gallstone ileus and meconium ileus, and are not true examples of ileus.
Paroxysmal attacks or paroxysms are a sudden recurrence or intensification of symptoms, such as a spasm or seizure.
For example: Infants with colic have paroxysmal abdominal pain or cramping manifested by episodes of loud crying.
a myeloproliferative blood disorder in which the bone marrow makes too many red blood cells. It may also result in the overproduction of white blood cells and platelets. Most of the health concerns associated with polycythemia vera are caused by the blood being thicker as a result of the increased red blood cells. It is more common in the elderly and may be symptomatic or asymptomatic. Common signs and symptoms include itching (pruritus), and severe burning pain in the hands or feet that is usually accompanied by a reddish or bluish coloration of the skin. Patients with polycythemia vera are more likely to have gouty arthritis. Treatment consists primarily of phlebotomy.
region of the stomach that connects to the duodenum (the beginning of the small intestines). It is divided into two parts: the pyloric antrum, which connects to the body of the stomach and the pyloric canal, which connects to the duodenum.
is the condition of urine containing pus. Defined as the presence of 6-10 or more neutrophils per high power field of unspun, voided mid-stream urine. It can be a sign of a bacterial urinary tract infection. Pyuria may be present in the septic patient, or in an older patient with pneumonia.
commonly called palm healing or hands on healing as a form of alternative medicine and is sometimes classified as oriental medicine by some professional medical bodies.
Through the use of this technique, practitioners believe that they are transferring universal energy (i.e., reiki) in the form of qi (Japanese: ki) through the palms, which they believe allows for self-healing and a state of equilibrium.
Reduced blood flow to kidneys cause them to produce Renin.
Renin causes angiotensinogen to split off angiotensin I, which is converted by an enzyme in the lungs to form angiotensin II, which is both a strong vasoconstrictor as well as the controlling mechanism for aldosterone release.
Aldosterone causes the kidney tubules to reabsorb sodium, which in turn inhibits fluid loss.
Aldosterone also causes potassium to be excreted by the kidneys, so as sodium is retained, potassium is lost leading to possible hypokalemia @ < 3.2 mEq/L
a potentially fatal disease that has numerous detrimental effects to many organs, especially the brain and liver, as well as causing a lower than usual level of blood sugar (hypoglycemia). The classic features are a rash, vomiting, and liver damage. The exact cause is unknown and, while it has been associated with aspirin consumption by children with viral illness, it also occurs in the absence of aspirin use.The disease causes fatty liver with minimal inflammation and severe encephalopathy (with swelling of the brain). The liver may become slightly enlarged and firm, and there is a change in the appearance of the kidneys. Jaundice is not usually present. Early diagnosis is vital; although most children recover with supportive therapy, it may lead to severe brain injury and death.
Systemic inflammatory response syndrome (SIRS) is an inflammatory state affecting the whole body, frequently a response of the immune system to infection, but not necessarily so. It is related to sepsis, a condition in which individuals both meet criteria for SIRS and have a known or highly suspected infection.
Criteria for SIRS were established in 1992 as part of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. The conference concluded that the manifestations of SIRS include, but are not limited to:
- → Body temperature less than 36°C(96.8°F) or greater than 38°C(100.4°F)
- → Heart rate greater than 90 beats per minute
- → Tachypnea (high respiratory rate), with greater than 20 breaths per minute; or, an arterial partial pressure of carbon dioxide less than 4.3 kPa (32 mmHg)
- → White blood cell count less than 4000 cells/mm³ (4 x 109 cells/L) or greater than 12,000 cells/mm³ (12 x 109 cells/L); or the presence of greater than 10% immature neutrophils (band forms)
SIRS can be diagnosed when two or more of these criteria are present.
is an inflammation of the mucous lining of any of the structures in the mouth, which may involve the cheeks, gums, tongue, lips, throat, and roof or floor of the mouth. The inflammation can be caused by conditions in the mouth itself, such as poor oral hygiene, dietary protein deficiency, poorly fitted dentures, or from mouth burns from hot food or drinks, toxic plants, or by conditions that affect the entire body, such as medications, allergic reactions, radiation therapy, or infections.
- Severe iron deficiency anemia can lead to stomatitis. Iron is necessary for the upregulation of transcriptional elements for cell replication and repair. Lack of iron can cause the genetic downregulation of these elements, leading to ineffective repair and regeneration of epithelial cells, especially in the mouth and lips. This condition is also prevalent in people who have a deficiency in vitamin B2 (Riboflavin), B3 (Niacin), B6 (Pyridoxine), B9 (folic acid) or B12 (cobalamine).
Parietal and Chief cells are located only in the Fundic area of the stomach.
fainting due to global cerebral hypoperfusion (low blood flow to the brain) that most often results from hypotension (low blood pressure).
the feeling of constantly needing to pass stools (or, in the less common sense, urine), even if the bowels (or bladder) are already empty. It can involve pain, straining, and cramping.
(Rectal) tenesmus is a clinical sign of inflammatory bowel disease, irritable bowel syndrome, and colorectal cancer. Other causes include amoebic and bacillary dysentery.
Thrombotic thrombocytopenic purpura (TTP)
a rare disorder of the blood-coagulation system, causing extensive microscopic clots to form in the small blood vessels throughout the body. These small blood clots, called thromboses, can damage many organs including the kidneys, heart and brain. In the era before effective treatment with plasma exchange, the fatality rate was about 90%. With plasma exchange, survival at six months is around 80%. Immunosuppressants, such as glucocorticoids, rituximab, cyclophosphamide, vincristine, or cyclosporine may also be used if there is relapse or recurrence following plasma exchange.
The mortality rate is approximately 95% for untreated cases, but the prognosis is reasonably favorable (80-90% survival) for patients with idiopathic TTP diagnosed and treated early with plasmapheresis.
Toxic shock syndrome (TSS) is a potentially fatal illness caused by a bacterial toxin.
Different bacterial toxins may cause toxic shock syndrome, depending on the situation.
The causative bacteria include Staphylococcus aureus and Streptococcus pyogenes.
In either case, diagnosis is based strictly upon CDC criteria modified in 1981 after the initial surge in tampon-associated infections.
Body temperature > 38.9 (102.2 )
Systolic blood pressure < 90 mmHg
Diffuse rash, intense erythroderma, blanching with subsequent desquamation, especially of the palms and soles
Involvement of three or more organ systems:
Gastrointestinal (vomiting, diarrhea)
Mucous membrane hyperemia (vaginal, oral, conjunctival)
Renal failure (serum creatinine > 2 times normal)
Hepatic inflammation (AST, ALT > 2 times normal)
Thrombocytopenia (platelet count < 100,000 / mm3)
CNS involvement (confusion without any focal neurological findings)
Failure to pass stools or gas. Severe constipation includes obstipation