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pathophysiology > 2 - gastrointestinal > Flashcards

2 - gastrointestinal Flashcards

1
Q

clinical manifestation of GI dysfunction

A
  • anorexia
  • nausea
  • vomiting
  • abdominal pain
  • changes in bowel sounds
  • constipation
  • diarrhea
  • GI bleeding
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2
Q

Diarrhea in children

A
  • very dangerous
  • have lower fluid reserves than adults
  • need to be monitored closely for dehydration
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3
Q

diarrhea and fluid replacement

A

must be with osmotically balanced products

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4
Q

GI bleeding

A
  • hematemesis
  • melena
  • occult
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5
Q

hematemesis

A
  • vomiting of blood
  • bright red
  • dark grainy “coffee grounds”
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6
Q

melena

A

dark, sticky, fowl smelling stool

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7
Q

occult

A

hidden loss of blood

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8
Q

what are the implications of GI bleeding? (slow and rapid)

A
  • slow: iron deficient anemia

- rapid: hypovolemic shock

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9
Q

congenital structural anomalies

A
  • cleft lip and palate

- esophageal & tracheal malformations

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10
Q

cleft lip and cleft palate

A
  • fetal developmental anomalies
  • caused by multifactorial inheritance (maternal alcohol, tobacco use or diabetes)
  • failure of fusion between 6 and 12th week of gestation
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11
Q

cleft lip

A
  • incomplete fusion during 2nd moth of development
  • commonly occurs under one nostril
  • can be bilateral, symmetric and asymmetric
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12
Q

cleft palate

A
  • commonly associated with cleft lip but can occur without it
  • results from an incomplete fusion of the palate
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13
Q

cleft lip and cleft palate - clinical manifestations

A

difficulty feeding

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14
Q

cleft lip and cleft palate - complications

A
  • sinus infection
  • ear infection
  • formation of teeth
  • speech impediment
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15
Q

cleft lip and cleft palate - repair

A
  • surgery
  • start at 4 months
  • could be staged depending on severity
  • lip can be repaired earlier than palate
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16
Q

esophageal malformations

A
  • esophageal atresia
  • tracheoesophageal fistula
  • can happen together
  • below the epiglottis
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17
Q

esophageal atresia

A
  • condition in which esophagus ends in blind pouch
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18
Q

tracheoesophageal fistula (TEF)

A
  • abnormal connection between the trachea and the esophagus
  • various forms
  • allows for food and air to combine
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19
Q

esophageal malformations - manifestations

A
  • excessive drooling
  • cyanosis
  • choking and coughing
  • milk return through the mouth and nose
  • abdominal distention
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20
Q

esophageal malformations - complications

A

pneumonia

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21
Q

esophageal malformations - repair

A

must be surgically repaired right after birth (usually a few days)

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22
Q

functional obstruction

A

function is abnormal

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23
Q

mechanical obstruction

A

something is structurally blocking flow

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24
Q

intestinal obstruction

A
  • regardless of type of obstruction you will eventually end up with an accumulation of fluid and gas
  • loss of blood supply to the bowel and eventually loss of function in tissue
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25
Q

bowel sound if obstruction is in the area distal (past) to the obstruction

A

hypoactive

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26
Q

bowel sound if obstruction is in the area proximal (before) to the obstruction

A

hyperactive because it will be trying to squeeze through

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27
Q

functional obstruction types

A
  • paralytic ileus

- hirschsprung disease

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28
Q

paralytic ileus

A
  • when your bowel stops working although there might not be anything wrong with it
  • mobility helps restore gut function
  • common after surgery (more common after bowel surgery)
  • usually last from 3-5 days
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29
Q

hirschsprung disease

A
  • aganglionic megacolon
  • born with lack of bundle of nerve intervation in the colon
  • noted by babies not having any bowel movements
  • missing a part of the PNS
  • surgically repaired
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30
Q

mechanical obstructions

A
  • pyloric stenosis
  • hernias
  • volvulus
  • intussusception
  • adhesions
  • impacted feces
  • tumors
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31
Q

pyloric stenosis

A
  • narrowing of the pyloric

- at the end of the stomach is closed

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32
Q

hernias

A
  • bowel protrudes through weakening in abdominal wall ligament
  • unusual flow and compressed blood flow
  • surgical repair
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33
Q

volvulus

A
  • kink and twissting of the bowel

- “our puppy volvy”

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34
Q

intussusception

A
  • like a telescope that has collapsed in

- cannot see through so you must stretch it forward

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35
Q

bowel obstruction - manifestations

A
  • nausea and vomiting
  • colicky abdominal pain
  • distention
  • dehydration
  • perforation
  • necrosis
  • sepsis
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36
Q

neoplasia of the GI tract

A
  • esophagus
  • stomach
  • colon and rectum
  • gallbladder
  • pancreas
  • liver
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37
Q

cancer of the colon - incidence

A

remains somewhat high

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38
Q

cancer of the colon - mortality rate

A

decreased

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39
Q

cancer of the colon

A
  • one of the leading causes of cancer death in men and women (2nd in men, 3rd in women)
  • 5 yr survival is caught early
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40
Q

cancer of the colon - risk factors

A
  • age 50+ (rare in children)
  • genetic
  • low finer diet (because bowel stays in longer)
  • smoking
  • obesity
  • chronic inflammation (ulcerative colitis)
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41
Q

cancer of the colon - manifestations

A

depending on where the disease is located

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42
Q

ascending colon

A
  • 25%

- pain, mass, change in bowel habits, anemia

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43
Q

transverse colon

A
  • 15%

- pain, obstruction, chnage in bowel habits, anemia

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44
Q

descending colon

A
  • 15%

- pain, change in bowel habits, bright red, blood in stool, obstruction

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45
Q

rectum

A
  • 45%

- blood in stool, change in bowel habits, rectal discomfort

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46
Q

bowel habits

A
  • shape

- frequency

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47
Q

cancer of the colon: stage 0

A
  • carcinoma in situ

- mucosa

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48
Q

cancer of the colon: stage 1

A

though muscle layer

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49
Q

cancer of the colon: stage 2

A

involves serosa

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50
Q

cancer of the colon: stage 3

A

lymph nodes involved

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51
Q

cancer of the colon: stage 4

A

metastasis

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52
Q

cancer of the colon - warning signs

A

polyp

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53
Q

cancer of the pancreas

A
  • incidence increases with age

- mortality almost 100% due to late diagnosis

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54
Q

cancer of the pancreas - risk factors

A
  • smoking
  • obesity
  • chronic pancreases
  • diabetes mellitus
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55
Q

cancer of the pancreas - manifestations

A
  • pain (typically late)

- very vague

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56
Q

inflammatory GI disorders

A
  • common
  • exposure of unprotected GI mucous membrane to acid
  • infection
  • autoimmunity
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57
Q

inflammatory GI disorders - esophagus

A
  • acid reflux

- gastroesophageal reflux disease

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58
Q

inflammatory GI disorders - stomach and duodenum

A
  • gastritis

- peptic ulcer disease

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59
Q

inflammatory GI disorders - bowel

A
  • diverticulitis
  • appendicitis
  • inflammatory bowel disease
60
Q

acid reflux

A

“heart burn”

61
Q

gastroesophageal reflux disease

A

chronic, ore severe from of reflux

62
Q

gastroesophageal reflux disease - risk factors

A
  • fatty foods
  • coffee, chocolate
  • obesity
  • alcohol
  • smoking
  • hiatal hernia
63
Q

gastritis

A
  • inflammatory disorder of the mucosa of the stomach

- acute or chronic

64
Q

stomach - antrum

A

non-immune

65
Q

stomach - fundus

A

auto-immune

66
Q

peptic ulcer disease

A
  • a break or ulceration int he protective mucosal lining
  • stomach or duodenum
  • superficial or deep
67
Q

peptic ulcer disease - superficial

A

erosions

68
Q

peptic ulcer disease - deep

A

true ulcers

69
Q

peptic ulcer disease - risk factors

A
  • helicobacter pylori
  • NSAIDS
  • alcohol
  • smoking
  • age
  • chronic disease
70
Q

stress ulcer

A
  • a tyro of peptic ulcer that is related to severe illness, neural injury or systemic trauma
  • stress in internal
71
Q

ischemic ulcers

A

decrease blood flow

72
Q

crushing ulcers

A

associated with severe head injury or brain surgery

73
Q

stress ulcers - most at risk

A
  • people who are in critical care units

- neurological patients

74
Q

diverticulosis

A
  • sigmoid colon
  • western society
  • low finer diet
  • small, bulging pouches (diverticula) develop in your digestive tract
75
Q

diverticulitis

A
  • one or more of these pouches become inflamed or infected
76
Q

appendicitis

A
  • exact mechanism is unclear except for inflammation and infection
77
Q

appendicitis - manifestations

A
  • pain: periumbilical then RQL
  • nausea and vomitting
  • fever
  • elevated WBC
78
Q

appendicitis - treatment

A
  • antibiotics

- surgery

79
Q

spot where appendicitis pain takes place*****

A

McBurney’s point

80
Q

inflammatory bowel disease (IBD)

A
  • chronic, relapsing inflammatory bowel disorders of unknown origin
  • genetics
  • alterations of epithelial barrier functions
  • immune reaction to intestinal flora
  • abnormal T cell response
81
Q

IBD - types

A
  • ulcerative colitis

- crown’s disease

82
Q

IBD - incidence

A

north american, specifically canada has one of the highest rates

83
Q

remission relapsing

A

worse better lose better

84
Q

IBD - manifestations

A
  • crampy pain

- frequent diarrhea

85
Q

crohn’s disease

A
  • can occur anywhere in bowel (large and small intestine)
  • patchy areas (walls look like stone - cobblestone)
  • skipped lesions
86
Q

crohn’s disease - fistulas

A
  • connection that shouldn’t be there
  • due to mal absorption of nutrients
  • foods and stress trigger flare ups
  • autoimmune therefore more common in females
87
Q

crohn’s disease - manifestations

A

mal absorption/mal nutrition

88
Q

ulcerative colitis

A
  • affects large intestine

- continuous inflammation with pinpoint hemorrhages

89
Q

ulcerative colitis - manifestations

A

blood in stool

90
Q

ulcerative colitis - complications

A
  • short term

- long term

91
Q

ulcerative colitis - treatment

A
  • anti-inflammatory/ anti-immune medications

- surgery

92
Q

liver dieases

A
  • hepatitis

- end-stage liver disease

93
Q

end-stage liver disease

A
  • cirrhosis

- portal hypertension

94
Q

manifestations of liver disease

A
  • jaundice
  • ascites
  • hepatorenal syndrome
  • hepatorenal encephalopathy
95
Q

ascites

A
  • accumulation of fluid in the peritoneal cavity
  • reduced albumin levels
  • sodium/water retention
  • late stage manifestations
96
Q

obstructive jaundice

A

obstruction of bio flow

97
Q

hemolytic jaundice

A

break down of a lot of red blood cells and creates an increase in billirubin

98
Q

hepatocellular jaundice

A

liver isn’t working

99
Q

bilirubin

A

makes skin itchy

100
Q

hepatorenal syndrome

A
  • renal dysfunction secondary to advanced liver disease
  • kidney failure that happens with liver failure (if you were to place kidney in someone else w/o liver failure it would work)
  • kidney appears to be normal
  • ?? changes to blood supply, vessel tone
101
Q

hepatic encephalopathy

A
  • a neurologic syndrome of impaired cognitive function, flapping tremor and EEG changes
  • develops rapidly during fulminant hepatitis or slowly during chronic liver disease
  • shaking hands (tremors)
102
Q

hepatitis

A
  • inflammation caused by exposure to drugs or other chemicals or by viral infections
  • acute or chronic
  • exposure to drugs, chemicals, viruses
103
Q

viral hepatitis: mild and short-lived infections

A

A, D, E

104
Q

viral hepatitis: severe and chronic liver function

A

B, C

105
Q

viral hepatitis: varied mode of transmission

A
  • fecal and oral (A and E)

- parenteral or sexual blood and body fluids (B, C, D)

106
Q

viral hepatitis: pathophysiology

A

inflammation and some scaring of the liver

107
Q

viral hepatitis: sequence

A
  • prodromal phase
  • icteric phase
  • recovery phase
108
Q

prodromal phase

A

pre jaundice phase

109
Q

icteric phase

A

jaundice - yellow and itchy

110
Q

recovery phase

A

some go on to develop chronic active hepatitis

111
Q

viral hepatitis: chronic active hepatitis

A

increased vulnerability to cirrhosis and cancer

112
Q

cirrhosis of the liver

A
  • chronic, irreversible, inflammation
  • scarring of the bile canaliculi
  • common causes like hepatitis, ETOH, idiopathic
113
Q

portal hypertension

A
  • abnormally high blood pressure in the portal venous system
  • back pressure causes congestion of veins that drain into portal system (esophagus, stomach, spleen and rectum)
114
Q

portal hypertension: consequences

A
  • varicose veins (varices)
  • lower esophagus, stomach, rectum
  • can rupture and bleed profusely
  • splenomegaly
115
Q

gall bladder: cholecystitis

A
  • due to cholelithiasis (gallstones)
  • prevalent in developed countries
  • caused by abnormalities in bile composition, bile stasis and or inflammation of gallbladder
116
Q

cholecystitis - risk factors

A
  • fat
  • female
  • fertile
  • forty
  • first nation
117
Q

pathogenesis of cholecystitis #1

A
  • supersaturated bile
  • formation of crystals
  • formation of microstones/stones
118
Q

pathogenesis of cholecystitis #2

A

obstruction of cystic duct

119
Q

pathogenesis of cholecystitis #3

A

inflammation of gallbladder

120
Q

cholecystitis

A
  • obstruction of cystic duct and inflammation

- stones in gallbladder

121
Q

cholecystitis - manifestations

A
  • asymptomatic or vague symptoms
  • heartburn
  • food intolerances
  • epigastric pain
  • biliary colic
122
Q

cholecystitis and fatty foods

A

they would have an intolerance to fatty foods because the gallbladder store bile and bile helps us digest fat. So this can trigger pain when digesting fatty foods

123
Q

biliary colic

A

pain that starts in the upper right quadrant and radiates pain to the shoulder blade

124
Q

cholecystitis - treatment

A
  • prevention
  • pain management
  • antibiotics
  • removal of stone via scope
  • cholecystectomy
125
Q

cholecystectomy 2 types

A
  • laparoscopic or open

- depending on number

126
Q

pancreatitis

A
  • acute or chronic inflammation
127
Q

acute pancreatitis: cause

A
  • associated with several other clinical disorders
  • *gallstones
  • *alcoholism
128
Q

acute pancreatitis

A
  • blockage of outflow of pancreatic
  • enzymes cause autosuggestion of pancreatic tissue
  • leak into bloodstream to cause injury to vessels and other organs
  • can become extremely sick (nausea, vomitting, fever and elevated WBC)
129
Q

chronic pancreatitis

A
  • related to chronic alcohol abuse as well as smoking
  • structural changes
  • complications
  • scaring narrowing and decreased functions
130
Q

chronic pancreatitis can lead to (2)

A
  • pancreatic cancer

- diabetes

131
Q

malnutrition

A
  • BMI

- deficit

132
Q

BMI > 35

A
  • associated with increased risk of morbidity and mortality
133
Q

central obesity

A
  • abdominal/visceral fat
  • associated with increased morbidity, mortality
  • diabetes, cardiovascular disease, cancer
134
Q

obesity - causes

A
  • imbalances between caloric intake and energy expenditure
  • dysregulation of hypothalamus and other hormones that control appetite and weight
  • neonatal exposure to calories
135
Q

BMI

A

also associated with higher mortality

136
Q

normal BMI

A

30-35

137
Q

deficit

A
  • eating disorder

- a problem of access to food

138
Q

eating disorders

A
  • characterized by abnormal eating behavior, weight regulation and disturbed attitudes toward body weight, body shape and size
  • affect both genders (females more likely)
139
Q

anorexia nervosa

A
  • a person has a disorder of body image

- may lose 25% - 30% of their ideal body weight as a result of fat and muscle depletion

140
Q

bulimia nervosa

A
  • body weight remains near normal but with aspirations for weight loss
  • recurrent cycles of binge eating followed by forced vomiting
141
Q

starvation

A
  • decrease caloric intake leading to weight loss

- short-term or long term

142
Q

short term starvation

A
  • glycogenolysis

- glyconeogenesis

143
Q

long-term starvation

A
  • marasmus
  • kwashiorkor
  • more risk for younger children
144
Q

marasmus

A
  • deficiency of all nutrients

- younger children

145
Q

kwahiorkor

A
  • severe protein deficiency, related to high CHO intake
  • usually after weaning from breast
  • presence of subcutaneous fat
    ascites

pathophysiology (16 decks)

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