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2010-10-18 19:57:43

ch. 34
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  1. Clinical Manifestations of GI dysfunction include:
    • anorexia
    • vomiting
    • nausea
    • projectile vomiting
    • consstipation
    • diarrhea
    • abdominal pain
    • GI bleeding
    • hematemesis
    • hematochezia
    • melena
    • occult bleeding
  2. Anorexia:
    a lack of desire to eat
  3. Vomiting:
    the forceful emptying of the stomach and intestinal contents through the mouth
  4. Nausea:
    • a subjective experience that is associated with a number of conditions
    • retching (dry heave)
    • nonproductive vomiting
  5. Projectile vomiting:
    spontaneous vomiting
  6. Constipation:
    infrequent or difficult defecation
  7. Diarrhea:
    • increased frequency of bowel movements
    • increased volume, fluidity, weight of the feces
    • 3 mechanisms of diarrhea=
    • --osmotic
    • --secretory
    • --motility
  8. Abdominal pain:
    • parietal pain
    • visceral pain
    • referred pain
  9. Parietal Pain:
    localized intense
  10. Visceral Pain:
    poorly localized, diffuse, vague
  11. Referred Pain:
    well localized
  12. Gastrointestinal Bleeding:
    • upper GI or lower GI
  13. Upper GI bleeding:
    esophagus, stomach, or doudenum
  14. Lower GI bleeding:
    jejunum, ileum, colon, rectum
  15. Hematemesis:
    • bloody vomitus
    • (bright red blood or coffee grounds)
  16. Hematochezia:
    bright red stools
  17. Melena:
    blakc or tarry stools
  18. Occult Bleeding:
    trace amounts of blood in stool (detectable only with guaiac test)
  19. Disorders of Motility include:
    • Dysphagia
    • Achalasia
    • GER
    • NERD
    • Hiatal Hernia
    • Pyloric Obstruction
    • Intestinal Obstruction
  20. Dysphagia:
    • difficulty swallowing
    • types: mechanical or functional obstructions
    • Causes: stroke, esophageal cancer, and scleroderma
    • S/S: choking, coughing, c/o food sticking to throat when swallowing
  21. Achalasia:
    • Denervation of smooth muscle in the eesophagus and lower esophageal sphincter relaxation (sphincter fails to relax)
    • food has difficulty passing into the stomach; esophagus above sphincter becomes enlarged
  22. Gastroesophageal Reflux (GER)
    • reflux of chyme from stomach to esophagus
    • (backward movement of gastric contents into esophagus, causing heartburn)
    • the LES relaxes spontaneously after eating and allows gastric contents to regurgitate
    • Most common disorder originating in the GI tract
    • conditions that increase abdominal pressure can contribute to GER (coughing, vomiting, straining at stool)
  23. reflux esophagitis:
    inflammation of the esophagus cause by GER
  24. Manifestations of GER
    • Heartburn (most frequent) occuring 30-60 minutes after eating; worse by bending over; relieved by sitting straight up
    • Acid regurgitation
    • upper abdominal pain within 1 hour of eating
    • dysphagia
    • belching
    • wheezing, chronic cough and hoarseness (resp. s/s)
  25. GER is exacerbated by:
    nicotine, caffeine, fatty foods, chocolate, coffee
  26. Nonerosive Reflux Disease (NERD)
    heartburn symptoms without mucosal injury and inflammation
  27. Hiatal Hernia:
    • development of an abnormal gap around the wall of the esophagus
    • leads to herniation of stomach into the thoracic cage
  28. Two Type of Hiatal Hernias:
    • Sliding Hiatal Hernia
    • Paraesophageal Hiatal Hernia
  29. Hiatal Hernias often occur with these other diseases:
    • reflux esophagitis
    • peptic ulcer
    • cholecystitis
    • cholelithiasis
    • chronic pancreatitis
    • diverticulosis
  30. Pyloric Obstruction
    • the blocking or narrowing of the opening between the stomach and the duodenum
    • can be acquired or congenital
  31. Manifestations of Pyloric obstruction:
    • epigastric pain and fullness
    • nausea
    • succusion splash (rolling or jarring of abd.)
    • vomiting
  32. Prolonged pyloric obstructions:
    malnutrition, dehydration, and extreme debilitation
  33. Intestinal Obstructions:
    • simple obstruction: mechanical blockage
    • Functional obstruction: failure of motility
  34. Paralytic ileus:
    failure of motility (often occurs after surgery)
  35. Manifestations of Intestinal Obstruction:
    • abdominal distention
    • loss of fluid and electrolytes
    • distention
    • CARDINAL SX: colicky pain followed by vomiting
  36. Inssusception
    • cause of obstruction
    • most common in children under 2; telescoping of the terminal ileum into the right colon most common
  37. Gastritis:
    • inflammatory disorder od the gastric mucosa
    • Acute or chronic gastritis
  38. Acute Gastritis:
    • erodes epithelium surface (mucosal barrier)
    • superficial erosions
    • associated with local irritants
    • --bacterial enterotoxins
    • --alcohol
    • --aspirin
    • Aspirin causes heartburn or sour stomach
    • Excessive alcohol consumption causes transient gastric distress, vomiting, bleeding and hematemesis
    • Staphylococcal enterotoxins manifest with abrupt and violent onset usually 5 hours after ingestion of contaminated food source
  39. Chronic Gastrits:
    • causes thinning and degeneration of stomach wall
    • absence of grossly visible erosions
    • presence of chronic inflammatory changes
    • atrophy of the glandular epithelium of the stomach
    • H-pylori gastritis-most common non-erosive gastritis
  40. Peptic Ulcer Disease:
    • a break or ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum
    • acute and chronic ulcers
    • superficial (erosions)
    • deep (true ulcers)
  41. Peptic Ulcer Disease(cont.):
    • duodenal and gastric
    • major causes: H. pylori infection
    • treated with NSAIDs
    • duodenal ulcers occur more frequently and typically seen in early adulthood
    • gastric ulcers affect the older older population (55-65)
  42. Duodenal Ulcers:
    • most common of peptic ulcers
    • early adulthood
  43. Developmental Factors of Duodenal Ulcers:
    • toxins and enzymes that promote inflammation and ulceration
    • hypersecretion of stomach acis and pepsin
    • use of NSAIDs
    • high gastrin levels
    • acid production by cigarette smoking
  44. Complications of Duodenal Ulcers
    • Bleeding
    • Perforation (duodenal wall destruction)
    • Obstruction (edema, scarring)
  45. Gastric Ulcers:
    • develop in the antral region of the stomach, adjacent to acid-secreting mucosa of body
    • Patho:
    • primary defect=increased mucosal permeability to hydrogen ions
    • gastric secretions=normal or less than normal
  46. Manifestations of PUD:
    • Discomfort and pain(burning, gnawing, or cramp-like) usually rhythmic and frequently occurs when the stomach is empty
    • Midline near the xiphoid and may radiate below the costal margins into the back or rarely to the right shoulder
    • Pain is relieved by food or antacids (but food may cause pain immediately after eating)
  47. Gastric Ulcers cause more:
    anorexia, vomiting, and weight loss than duodenal ulcers
  48. Stress Ulcers:
    • peptic ulcer related to severe illness, neural injury, or systemic trauma
    • -ischemic-burn injury
    • -cushing-head trauma or brain injury
  49. Postgastrectomy Syndromes:
    • Dumping Syndrome
    • Alkaline reflux gastritis
    • afferent loop obstruction
    • diarrhea
    • weight loss
    • anemia
    • bone disorders
  50. Dumping Syndrome:
    • the rapid emptying of chyme from a surgically created residual stomach into the small intestine
    • a clinical complication of partial gastrectomy or pyloroplasty
    • S/S: cramping pain, nausea, vomiting, osmotic diarrhea, weakness, pallor, hypotension