Path 2: Digestive System

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JennieF
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228755
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Path 2: Digestive System
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2013-07-31 15:55:27
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pathology digestive system
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Pathology 2: Digestive System Quiz
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  1. Common Classes of Symptoms
    • Abdominal or Chest Px: aka angina pectoris
    • Altered Ingestion of Food: Crohn's, food not absorbed properly
    • Altered Bowel Movements: constipation, diarrhea
    • Gastrointestinal Bleeding: Blood in stool, ulcers
  2. The Esophagus: Clinical Manifestations
    1. Dysphagia
    2. Retrosternal Px
    3. Hematemesis
    • 1. Dysphagia: difficulty swallowing
    • 2. Retrosternal Px: "Retro" means behind/ behind the sternum - heartburn can cause retrosternal px
    • 3. Hematemesis: vomiting blood
  3. The Esophogus: Congenital Disorders
    1. Tracheoesophageal Fistula / Atresia
    • Tracheoesophageal Fistula: most common congenital disorder, occasionally the trachea & esophagus do not completely separate & become the same tube. This opening allows anything swallowed into the pharynx to enter the lungs. Another possible outcome is atresia
    • Atresia: no lumen / lumen is a channel or tube in body
  4. The Esophagus: Motor Disorders
    1. Achalasia
    2. Scleroderma
    • 1. Achalasia: Absence of peristalsis, failure of the cardiac sphincter to relax, leads to a functional obstruction of the esophagus
    • 2. Scleroderma: overproduction of collagen within the wall of esophagus, the added collagen affects the function of the sphincters & interferes with peristalsis
  5. The Esophagus: Reflux Esophagitis
    • Injury to the esophagus caused by regurgitation of the gastric contents
    • Pathogenesis: triggers include chocolate, alcohol, fatty foods, caffeine & cigarettes, all of which can decrease the tone of the cardiac sphincter, allowing reflux of gastric contents into the esophagus
    • Clinical manifestations: presents as a burning chest px, "heartburn" especially @ night when supine
  6. The Esophagus: Hiatal Hernia
    • Herniation of the stomach through an enlarged esophageal hiatus in the diaphragm
    • Sliding hernia: excess abdominal pressure, comes and goes
    • Paraesophageal hernia: not sliding, it can get stuck
  7. The Esophagus: Esophageal Varices
    • can be caused by coughing up blood
    • varicose veins in the esophagus - caused by increased hydrostatic pressure
  8. The Esophagus: Neoplasms
    Leiomyomas is a benign smooth muscle tumor
  9. The Stomach: Clinical Manifestations
    • Pain & dyspepsia: px in the stomach /upset stomach ("pep" refers to stomach)
    • Loss of appetite
    • Bleeding: ulcer
    • Gastric mass
  10. The Stomach: Acute Erosive Gastritis
    • The presence of focal necrosis of the mucose in an otherwise normal stomach
    • Erosion: epithelial and some of the tunica mucosa / shallow: affects just the inside layers
    • Ulcer: full thickness of the tunica mucosa / affects all the layers of the stomach
    • *The distinction between an erosion & an ulcer is based on depth
  11. Pathogenesis of Acute Erosive Gastritis
    drugs
    stress ulcers
    trauma to the CNS
    hypersection of gastric acid
    • drugs: aspirins, NSAID's, coricosteroids & cigarettes
    • stress ulcers: trauma, burns, emotional stress, surgery
    • trauma to the CNS: not as clearly linked to acute erosive gastritis
    • hypersection of gastric acid: not as clearly linked to acute erosive gastritis
  12. Pathology & Clinical Manifestations of Acute Erosive Gastritis
    • Pathology: hemorrhaging leads to sloughing of dead tissue and further injury to the stomach wall
    • Clinical Manifestations: anything from a vague discomfort to hemorrhaging
  13. The Stomach: Peptic Ulcer Disease
    • deeper injury than acute erosive gastritis
    • breaks in the mucosa of the stomach & small intestine but can occur anywhere in the GI tract that is exposed to acidic gastric juice
  14. Peptic Ulcer Disease Pathogenesis
    • Hypersecretion of acid
    • Decreased mucosal resistance: same drugs as erosion; aspirins, NSAID's, coricosteroids, & cigarettes
    • Helicobacter pylori infection: found in almost all patients with duodenal ulcers. However, not all people with H. pyolri have ulcers - the mechanism is unclear. Fecal: oral route of infection
  15. Clinical Manifestations of Peptic Ulcer Disease
    • Px esp @ night
    • Hemorrhage: affects 20% of patients. Most common complication
    • Perforation: a hole / the leaking of gastric contents into abdominal cavity poses a risk of serious infection
    • Pyloric Obstruction: ulcers adjacent to the pyloric sphincter may lead to spasm of the pyloric sphincter
  16. The Stomach: Bezoars
    • foreign bodies in stomach altered by digestive process
    • Phytobexoar: food
    • Trichobezoar: giant hair balls / usually goes along with some kind of mental disease / can become malnourished / causes obstruction
  17. The Small Intestine Clinical Manifestations
    • Malabsorption
    • Obstruction (failure of peristalsis)
    • Intestinal perforation (hole)
    • Intestinal hemorrhage (bleeding)
    • Diarrhea (doesn't absorb properly)
    • Dysentry (a type of diarrhea with blood & mucus @ times)
  18. The Small Intestine: Congenital Disorders
    • Atresias: complete occlusion (blocked off) of the lumen
    • Stenonsis: incomplete stricture (blockage), narrows but does not occlude the lumen
    • Duplications: extra section that may or may not communicate with main passageway. / Retained material may rot & lead to an infection w/serious consequences
  19. The Small Intestine: Ischemia
    • Decreased blood flow to the intestines from any cause can lead to ischemic bowel disease
    • secondary to atherosclerosis
  20. The Small Intestine: Malabsorption
    less than optimal absorption of any basic nutrients
  21. The Small Intestine: Mechanical Obstruction Etiology (3 causes of mechanical obstruction)
    A (1) luminal mass, an (2) intrinsic lesion of the bowel wall, or (3) extrinsic compression
  22. The Small Intestine: Mechanical Obstruction: 4 Different Types
    • 1. Intussusception: telescoping of the bowel into itself / vascular supply may also be compromised leading to ischemia
    • 2. Volvulus: segment of the bowel twists on its mesentry /primary affects blood flow
    • 3. Adhesions: arise from fibrous scar caused by previous surgery or peritonitis, kinking, manipulating, or compressing
    • 4. Hernias: loops of small bowel passing through unintended openings
  23. The Small Intestine: Enteritis (food poisoning)
    Bacteria: common ones is E. Coli, Salmonella
  24. The Large Intestine: Congenital Megacolon
    • Colonic dilatation secondary to defective innervation
    • failure of the complete development of the nervous system within the gut leading to a failure of peristalsis
  25. The Large Intestine: Diverticular Disease
    • acquired herniation of the mucosa and submucosa through the muscular layer of the colon
    • Diverticulosis: the presence of diverticula / vegetarians are 3x less likely to develop the disease than meat eaters - red meat & a ow fiber diet increase intraluminal pressure
    • Diverticulitis: inflammation at the base of the diverticulum secondary to reatined fecal material leading to necrosis
  26. The Large Intestine: Polyps in the Colon
    • a tumorous mass that protrudes into the gut
    • Non-neoplastic polpys: represent 90% of all cases & occur in >50% of patients > 60 years
    • Neoplastic polyps (adenomas): occur w/increasing frequency as age increases
  27. The Appendix: Apppendicitis
    • Affects 10% of the population w/a peak incidence inthe 20's and 30's
    • Acute Appendicitis: obstruction of the appendix /
    • 50-80% of the time w/a fecalith, but may be a gallstone, tumor, or ball of worms. /
    • If appendix ruptures the contents are released into the peritoneal cavity rapidly leading to sepsis and death
  28. The Appendix: Cirrhosis
    • Among the top 10 causes of death in the western world.
    • Alcohol abuse is the leading cause
    • Pathogenesis: progressive fibrosis that ultimately destroys the entire architecture of the liver
  29. The Appendix: Hepatitis
    inflammation of the liver
  30. Biliary Tract: Cholelithiasis (gallstones)
    • 100,000 new cases per year
    • affecting 10% of adults in the northern hemisphere
    • 1,000 deaths per year due to gallstone disease or complications of surgery
    • stones may be found in the gallbladder or biliary tract
    • pathogenesis: too much cholesterol
  31. Biliary Tract: Cholecystitis
    inflammation of the gall bladder secondary to prolonged blockage of the cystic duct
  32. Biliary Tract: Pancreatitis Acute & Chronic
    • Glandular organ
    • Acute: leakage of prancreatic enzymes into pancreatic and peripancreatic tissue, often secondary to gall stones
    • Chronic: irreversible parenchymal destruction

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