Ch36 GI

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Ch36 GI
2015-03-14 22:08:31
patho GI

final review
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  1. Dysphagia
    • difficulty in swallowing 
    • inability to initiate swallowing; sensation that swallowed solids/liquids 'stick' in esophagous 
    • may have pain with swallowing
  2. Dysphagia 
    Type 1 
    • problems in delivery of food/fluid into esophagus 
    • causes: R/T neuromuscular incoordination and normal sequence is altered/absent
  3. Dysphagia Type I 
    • may cough and expel ingested food/fluids thru mouth/nose
    • aspirate when attempt to swallow 
    • worse with liquids
  4. Dysphagia Type II
    problems in transport of bolus down esophagus
  5. Dysphagia Type II 
    • outpouching of one or more layers (diverticula)
    • disorder of smooth muscle functio (achalasia) 
    • interference of peristaltic activity (neoplasms, strictures)
  6. Dysphagia Type II 
    • sensation food is struck behind sternum
    • may have impaired passage of liquids
  7. Dysphagia Type III
    Problems in bolus entry into stomach
  8. Dysphagia Type III 
    Cause: lower esophageal dysfunction/lesion obstruction 

    Symptoms: tightness or pain in substernal area during swallowing process
  9. Esophageal pain
    Heartburn (pyrosis)/Chest pain (esophageal distention/obstruction)
  10. Esophageal pain 
    Heart burn
    • reflux of gastric contents into esophagus 
    • ---high acidic contents are irritant to sensory afferent nerve endings in mucosa 
    • ---causes spasms of esophageal muscle
  11. Esophageal pain 
    substernal burning sensation that may radiate to neck/throat
  12. Esophageal pain 
    chest pain 
    • similar to angina pectoris (radiates to neck, shoulder, arm, and jaw) 
    • brought on by swallowing
  13. What is the first sign of GI tract disorder
    Abdominal pain
  14. What are the 3 abdominal pains
    • visceral pain
    • somatic pain
    • referred pain
  15. Visceral pain 
    • stretching/distending an abdominal organ
    • inflammation
  16. visceral pain 
    • diffuse, poorly localized 
    • gnawing, burning, or cramping
  17. Somatic pain 
    injury to abdominal wall, parietal peritoneum, root of mesentery of the diaphragm
  18. somatic pain 
    • sharp, intense pain 
    • well localized to area of irritation
  19. Referred pain
    • felt at location distant from source of pain 
    • ex: in same dermatome/neurosegment
  20. Referred pain 
    • sharp and well localized 
    • may be felt in skin or deeper tissues
  21. Acute abdominal pain
    • instantaneous organ 
    • perforated ulcer or ruptured organ
  22. Chronic Abdominal pain
    • Diverticulitis 
    • Ulcerative colitis
  23. Vomiting
    • forceful expulsion of gastric contents thru mouth 
    • then comes nausea
  24. intestinal gas
    results from altered motility or lack of digestive enzymes 

    ex: belching - eructation of swallowed air
  25. Belching 
    • swallowing of air
    • bacterial and digestive action on intestinal contents 
    • diffusion from blood 
    • neutralization of acids by bicarbonate in upper GI tract
  26. Abdominal distention 
    also intestinal gas 

    • CAuses: 
    • failure to adequately digest nutrients such as lactose
    • excess gas resulting from defect in intestinal motility
  27. Flatus 
    increased amt of gas produced by action of bacteria on gas-producing nutritional substrates (legumes, veggies)
  28. Bowel pattern alterations are ...
    • constipation
    • diarrhea
  29. Constipation
    small, infrequent, or difficult bowel movements
  30. Constipation 
    • dietary (low in fiber) 
    • lack of exercise 
    • pathologic conditions (diverticulities, obstruction
  31. Diarrhea
    increased frequency and fluidity of bowel movements caused by decreased transit time in SI
  32. Acute diarrhea
    • acute infection 
    • emotional stress 
    • leakage of stool around impacted feces
  33. Chronic diarrhea
    • chronic GI tract infection 
    • Alter in motility/integrity of GI 
    • malabsorption
    • certain endocrine disorder 
    • food allergy 
    • ingestion of irritants
    • caffeine
  34. Stomatitis
    inflammation of the oral mucosa
  35. Stomatitis 
    • pathogenic org.
    • trauma
    • chemical irritants 
    • chemotherapy, radiation 
    • nutritional deficiencies
  36. Acute herpetic stomatitis
    cold sores
  37. Acute herpetic stomatitis 
    [signs and symptoms]
    • fever 
    • pharyngitis 
    • prodromal tingling and itching 
    • vesicles on erythematous base that rupture, leaving painful ulcer
  38. Acute herpetic stomatitis 
    • adequate oral hygiene 
    • meds: antiviral meds (famciclovir, valacyclovir)
  39. GERD - Gastroesophageal reflex disease
    • backflow of gastric contents into esophagus thru LES 
    • inflammation caused by reflux of highly acidic material 
    • progression = ulceration, fibrotic scarring, strictures, Barrett esophagus
  40. GERD
    • anything that alters closure strength of LES or increaes abdominal press. 
    • fatty foods 
    • caffeine
    • large amt of alkie 
    • smoking 
    • sleeping position 
    • pharmacologic aents 
    • anatomic features (hiatal hernia)
  41. Esophagitis
    Barrett esophagus
  42. Barrett esophagus
    • complication when columnar tissue replaces normal squamous epithelium of distal esophagus 
    • may be risk for esophageal cancer
  43. Hiatal hernia
    • defect in diaphragm when portion of the stomac passes thru diaphragmatic opening into thorax
    • increases with age 
    • women more than men
    • life threatening, if large portion of stomach becomes caught above diaphragm and becomes incarcerated
  44. hiatal hernia 
    [signs and symptoms]
    • similar to GERD 
    • heartburn
    • chest pain
    • dysphagia
  45. What are 3 types of hiatal hernia
    • sliding hermia - most common 
    • paraesophageal hernia - rolling 
    • mixed
  46. sliding hernia
    portion of stomach and gastroesophageal junction slip up into thorax above diaphragm
  47. paraesophageal
    part of greater curvature of stomach rolls thru the diaphragmatic effect
  48. Mallory-Weiss syndrome
    • bleeding caused by tear in mucosa/submucosa of the cardia or lower portion of esophagus 
    • tear is longitudinal
  49. Mallory-Weiss syndrome 
    forceful or prolonged vomiting
  50. Esophageal varices
    complication of portal hypertension resulting from alcoholic or posthepatitis cirrhosis
  51. Acute gastritis
    • precipitated by ingestion of irritating substances 
    • ex: alkie and aspirin
  52. Acute gastritis 
    [signs and symptoms]
    • anorexia
    • nausea
    • vomiting 
    • postprandial discomfort 
    • Hematemesis
  53. Chronic gastritis
    H. pylori - always a factor
  54. Chronic Gastritis 
    • peptic ulcer disease 
    • atrophic gastritis 
    • gastric adennocarcinoma 
    • mucosa-associated lymphoid tissue lymphoma
  55. Gastroenteritis
    inflammation of stomach and small intestine
  56. Gastroenteritis
    • Acute: direct infection of tract by pathogenic virus/bacterial toxin 
    • maybe imbalance in normal bacterial flora by intro of travelling bacteria
  57. Gastroenteritis
    [signs and symptoms]
    • diarrhea
    • abdominal discomfort and pain 
    • nausea 
    • vomit
    • fever
    •  malaise
  58. Gastroenteritis 
    replace fluid and electrolytes
  59. Peptic ulcer disease 
    • H. pylori
    • stress
    • smoking
    • alkie
    • spicy foods
    • genetic
  60. Peptic ulcer disease 
    • H. pylori - antibiotics 
    • H2 antagonists 
    • proton pump inhibitors 
    • sucralfate 
    • cease smoking 
    • avoid ASA and NSAIDS, caffeinated drinks, alkie and irritating foods
  61. Ulcerative colitis
    large ulcers form in mucosal layer of colon and rectum
  62. Ulcerative colitis 
    [hallmark symtpoms]
    • blood diarrhea 
    • lower abdominal pain
  63. Ulcerative colitis 
    • corticosteroids 
    • salicylate analogs 
    • immunomodulating agents: Azathioprine & Mercaptopurine
  64. Antibiotic-associated colitis (AAC)
    • aka pseudomembranous enterocolitis
    • type of enterocolitis 
    • acute inflammation and necrosis of small and large intestine
  65. AAC
    by C. difficile due to exposure to antibiotics
  66. AAC
    [signs and symtpoms]
    • Diarrhea (often bloody)
    • abdominal pain
    • fever
    • colonic perforation (rare)
  67. AAC 
    • stop current antibiotic (if possible)
    • treat ischeia
    • oral antibiotics (metronidazole/vancomycin)
  68. Necrotizing enterocolitis (NEC)
    occurs in premature infants <34wks and low birth wt <5lbs

    • Characterized by diffuse or patchy intestinal
    • necrosis with sepsis 

    signs: distended abdomen and stomach, intestinal perforation 

    tx: surgical with antibiotics
  69. Appendicitis
    • type of entercolitis 
    • obstruction by fecalith, inflammation
  70. appendicitis
    [signs and symptoms]
    • RLQ pain (McBurney's point 
    • nausea
    • vomiting
    • fever 
    • diarrhea
    • RLQ tenderness
    • systemic signs of inflammation
  71. Appendicitis 
    immediate surgical removal
  72. Diverticular disease (diverticulosis)
    • presence of diverticula in colon 
    • results in low intake of dietary fiber
  73. diverticulosis 
    [signs and symptoms]
    • diverticulosis: asymptomatic 
    •  diverticulitis - fever, acute lower abdominal pain
  74. Diverticular disease 
    antibiotics and surgery for complicated diverticulitis
  75. Irritable bowel syndrome 
    • Chronic >3 mos 
    • fluctuations in stool frequency and consistency
  76. Irritable bowl syndrome 
    • unclear but slow wave activity of bowel in increased 
    • -associated with anxiety/depression 
  77. Irritable bowel syndrome 
    [signs and symptoms]
    diarrhea/constipation or alteration of both; abdominal cramping pain, mucus in stool, nausea, bloating 
  78. Irritable bowel syndrome 
    • antidiarrheal agents
    • antispasmodic meds
    • increased fiber in diet 
  79. Intestinal obstruction 
    mechanical: adhesions, hernia, tumors, impacted feces, volvulus, intussusception 

    functional: conditions that inhibit peristalsis such as narcotics, anesthesia, surgery, peritonitis, hypokalemia, spinal cord injuries 
  80. intestinal obstruction 
    [signs and symptoms]
    depend on site and duration: dehydration, vomit, electrolyte depletion, constipation, abdominal distention 
  81. intestinal obstruction 
    • surgical intervention/decompression with intestinal tube 
    • left uncorrected, can cause edema, ischemia, and necrosis leading to bowel gangrene, sepsis, and shock 
  82. Volvulus
    • Twisting of bowel on itself 
    • causes intestinal obstruction and blood vessel compression (ischemia) 

    results from anomaly of rotation, ingested foreign body, or adhesion (cant always determine)

    impedes blood flow to bowel = gangrene, necrosis, and perforation 

    life threatening condition 
  83. Common site for Volvulus
    cecum and sigmoid colon
  84. Volvulus 
    [signs and symptoms]
    depnds on site and duration: dehyrdation, vomit, electrolyte depletion 
  85. Volvulus 
    varies according to severity and location; surgical intervention/decompression 
  86. Intussusception
    telescoping/invagination of a portion of bowel into adjacent (distal) bowel causing intestinal obstruction 
  87. Intussusception 
    [signs and symptoms]
    increased bowel sounds, abdominal pain, varies 
  88. Intussusception 
    surgical treatment 
  89. Hirschsprung disease 
    familial, congenital disorder of large intestine in which autonomic ganglia are reduced or absent 

    common in infants and children 
  90. Hirschsprung disease 
    [signs and symptoms]
    profuse diarrhea, hypovolemic shock, intestinal perforation 
  91. Hirschsprung disease 
    colonic lavage, surgical intervention 
  92. Malabsorption disorders 
    failure of GI tract to absorb or normally digest one or more dietary constituents 
  93. malabsorption disorders 
    • enzyme abnormalities 
    • infection 
    • radiation enteritis 
  94. Malabsorption disorders 
    [signs and symptoms]
    • diarrhea
    • passage of inappropriately processed intestinal contents 
  95. Types of malabsorption disorders 
    • Celiac disease 
    • tropical sprue 
  96. Celiac disease (celiac spruce) 
    • a malabsorption disorder 
    • familial intolerance of gluten-containing foods
    • leads to inflammation and atrophy of the intestinal villi 

    impaired nutrient absorption: reduced SA & decreased brush border enzymes 
  97. Celiac disease 
    • intestinal biopsy
    • anti-tissue transglutaminase antibody (anti-ttg)
    • IgA endomysial antibody
  98. Celiac disease 
    • gluten-free diet 
    • supplemental Fe, folate, B12, fat-soluble vitamins (A, D, E, K) 
  99. Tropical sprue 
    • malabsorptive syndrome of unknown cause 
    • adults more than children 
  100. Tropical sprue 
    Mucosa of small intestine atrophies resulting in malabsorption along with B12 and folic acid deficiency 
  101. Tropical sprue 
    [signs and symptoms]
    severe diarrhea with blood-tinged stools, abdominal distention, steatorrhea 
  102. Tropical sprue 
    • predictability depends on area 
    • antidiarrheals, prolonged antimicrobial therapy 
  103. dumping syndrome 
    • dumping of stomach contents into small intestine due to impaired gastric emptying 
    • common after gastrectomy
    • increased bowel motility 
    • rapid absorption of large amt of glucose leads to excessive rise in plasma insulin 
  104. dumping syndrome 
    [signs and symptoms]
    • diarrhea, abdominal pain 
    • rapid fall in blood glucose level 1-3 hr after meal (rebound hypoglycemia) 
  105. dumping syndrome 
    • eating small meals thru-out day
    • carbohydrate restriction
    • meds to reduce bowel motility 
  106. What are the malabsorption disorders after a surgical intervention 
    • dumping syndrome 
    • short-bowel syndrome 
  107. short-bowel syndrome 
    • severe diarrhea and significant malabsorption 
    • after surgical removal of large portion of SI 
    • rapid transit time and reduced SA
    • diminished ability to absorb H2O, electrolytes, protein, fat, carbohydrates, vitamins, and trace elements 
  108. Short bowel syndrome 
    [signs and symptoms]
    diarrhea and malabsorption 
  109. short bowel syndrome 
    temporary or indefinite intravenous nutritional support 
  110. Esophageal cancer 
    risk factors 
    • genetic 
    • diet high in nitrosamine content
    • chronic severe reflux (Barrett esophagus) 
    • environmental 
    • smoking
    • alkie 
  111. Esophageal cancer 
    • poor; spreads extensively to surrounding organs 
    • high degree of metasis
  112. Esophageal cancer 
    • stent placement,
    • tumor ablation thru heat probe and laser 
  113. Gastric carcinoma 
    [risk factors]
    • H. pylori infection 
    • genetic 
    • dietary habits
    • environmental factors 
    • smoking 
  114. Small intestinal neoplasms 
    • benign/malignant
    • unusual 
    • causes partial/complete obstruction (depends on extend and type) 
  115. Small intestinal neoplasms 
    [signs and symptoms]
    depends on type and extent; partial/complete obstruction of small bowel may occur 
  116. small intestinal neoplasms 
    surgical removal of tumor and affected portion of SI 
  117. Colonic polyps
    • any protrusion into the lumen of the GI tract 
    • can be benign or malignant 
  118. Colonic polyps 
    [signs and symptoms]
    usually none; may cause occult or gross bleeding, abdominal pain 
  119. Colonic polyps 
    varies according to size, type, and location 
  120. Colon cancer 
    risk factor
    • increases after 40
    • high fat, low fiber diet 
    • poly, chronic irritation/inflammation 
  121. Colon cancer 
    [warning signs]
    • black, tarry, pencil shaped stool 
    • change in bowel habits 
    • urgent need to defecate in once awake 
    • alternate constipation and diarrhea 
    • sensation of rectal fullness 
    • dull ache may be felt in rectum/sacral region 
  122. Colon cancer 
    depnds on extent of tumor invasion, cell type, degree of dysplasia, tumor genetics, presence/absence of metastasis 
  123. Colon cancer 
    • surgical removal 
    • chemotherapy, radiation, or both