2 - gastrointestinal Flashcards
clinical manifestation of GI dysfunction
- anorexia
- nausea
- vomiting
- abdominal pain
- changes in bowel sounds
- constipation
- diarrhea
- GI bleeding
Diarrhea in children
- very dangerous
- have lower fluid reserves than adults
- need to be monitored closely for dehydration
diarrhea and fluid replacement
must be with osmotically balanced products
GI bleeding
- hematemesis
- melena
- occult
hematemesis
- vomiting of blood
- bright red
- dark grainy “coffee grounds”
melena
dark, sticky, fowl smelling stool
occult
hidden loss of blood
what are the implications of GI bleeding? (slow and rapid)
- slow: iron deficient anemia
- rapid: hypovolemic shock
congenital structural anomalies
- cleft lip and palate
- esophageal & tracheal malformations
cleft lip and cleft palate
- fetal developmental anomalies
- caused by multifactorial inheritance (maternal alcohol, tobacco use or diabetes)
- failure of fusion between 6 and 12th week of gestation
cleft lip
- incomplete fusion during 2nd moth of development
- commonly occurs under one nostril
- can be bilateral, symmetric and asymmetric
cleft palate
- commonly associated with cleft lip but can occur without it
- results from an incomplete fusion of the palate
cleft lip and cleft palate - clinical manifestations
difficulty feeding
cleft lip and cleft palate - complications
- sinus infection
- ear infection
- formation of teeth
- speech impediment
cleft lip and cleft palate - repair
- surgery
- start at 4 months
- could be staged depending on severity
- lip can be repaired earlier than palate
esophageal malformations
- esophageal atresia
- tracheoesophageal fistula
- can happen together
- below the epiglottis
esophageal atresia
- condition in which esophagus ends in blind pouch
tracheoesophageal fistula (TEF)
- abnormal connection between the trachea and the esophagus
- various forms
- allows for food and air to combine
esophageal malformations - manifestations
- excessive drooling
- cyanosis
- choking and coughing
- milk return through the mouth and nose
- abdominal distention
esophageal malformations - complications
pneumonia
esophageal malformations - repair
must be surgically repaired right after birth (usually a few days)
functional obstruction
function is abnormal
mechanical obstruction
something is structurally blocking flow
intestinal obstruction
- 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
bowel sound if obstruction is in the area distal (past) to the obstruction
hypoactive
bowel sound if obstruction is in the area proximal (before) to the obstruction
hyperactive because it will be trying to squeeze through
functional obstruction types
- paralytic ileus
- hirschsprung disease
paralytic ileus
- 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
hirschsprung disease
- 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
mechanical obstructions
- pyloric stenosis
- hernias
- volvulus
- intussusception
- adhesions
- impacted feces
- tumors
pyloric stenosis
- narrowing of the pyloric
- at the end of the stomach is closed
hernias
- bowel protrudes through weakening in abdominal wall ligament
- unusual flow and compressed blood flow
- surgical repair
volvulus
- kink and twissting of the bowel
- “our puppy volvy”
intussusception
- like a telescope that has collapsed in
- cannot see through so you must stretch it forward
bowel obstruction - manifestations
- nausea and vomiting
- colicky abdominal pain
- distention
- dehydration
- perforation
- necrosis
- sepsis
neoplasia of the GI tract
- esophagus
- stomach
- colon and rectum
- gallbladder
- pancreas
- liver
cancer of the colon - incidence
remains somewhat high
cancer of the colon - mortality rate
decreased
cancer of the colon
- one of the leading causes of cancer death in men and women (2nd in men, 3rd in women)
- 5 yr survival is caught early
cancer of the colon - risk factors
- age 50+ (rare in children)
- genetic
- low finer diet (because bowel stays in longer)
- smoking
- obesity
- chronic inflammation (ulcerative colitis)
cancer of the colon - manifestations
depending on where the disease is located
ascending colon
- 25%
- pain, mass, change in bowel habits, anemia
transverse colon
- 15%
- pain, obstruction, chnage in bowel habits, anemia
descending colon
- 15%
- pain, change in bowel habits, bright red, blood in stool, obstruction
rectum
- 45%
- blood in stool, change in bowel habits, rectal discomfort
bowel habits
- shape
- frequency
cancer of the colon: stage 0
- carcinoma in situ
- mucosa
cancer of the colon: stage 1
though muscle layer
cancer of the colon: stage 2
involves serosa
cancer of the colon: stage 3
lymph nodes involved
cancer of the colon: stage 4
metastasis
cancer of the colon - warning signs
polyp
cancer of the pancreas
- incidence increases with age
- mortality almost 100% due to late diagnosis
cancer of the pancreas - risk factors
- smoking
- obesity
- chronic pancreases
- diabetes mellitus
cancer of the pancreas - manifestations
- pain (typically late)
- very vague
inflammatory GI disorders
- common
- exposure of unprotected GI mucous membrane to acid
- infection
- autoimmunity
inflammatory GI disorders - esophagus
- acid reflux
- gastroesophageal reflux disease
inflammatory GI disorders - stomach and duodenum
- gastritis
- peptic ulcer disease
inflammatory GI disorders - bowel
- diverticulitis
- appendicitis
- inflammatory bowel disease
acid reflux
“heart burn”
gastroesophageal reflux disease
chronic, ore severe from of reflux
gastroesophageal reflux disease - risk factors
- fatty foods
- coffee, chocolate
- obesity
- alcohol
- smoking
- hiatal hernia
gastritis
- inflammatory disorder of the mucosa of the stomach
- acute or chronic
stomach - antrum
non-immune
stomach - fundus
auto-immune
peptic ulcer disease
- a break or ulceration int he protective mucosal lining
- stomach or duodenum
- superficial or deep
peptic ulcer disease - superficial
erosions
peptic ulcer disease - deep
true ulcers
peptic ulcer disease - risk factors
- helicobacter pylori
- NSAIDS
- alcohol
- smoking
- age
- chronic disease
stress ulcer
- a tyro of peptic ulcer that is related to severe illness, neural injury or systemic trauma
- stress in internal
ischemic ulcers
decrease blood flow
crushing ulcers
associated with severe head injury or brain surgery
stress ulcers - most at risk
- people who are in critical care units
- neurological patients
diverticulosis
- sigmoid colon
- western society
- low finer diet
- small, bulging pouches (diverticula) develop in your digestive tract
diverticulitis
- one or more of these pouches become inflamed or infected
appendicitis
- exact mechanism is unclear except for inflammation and infection
appendicitis - manifestations
- pain: periumbilical then RQL
- nausea and vomitting
- fever
- elevated WBC
appendicitis - treatment
- antibiotics
- surgery
spot where appendicitis pain takes place*****
McBurney’s point
inflammatory bowel disease (IBD)
- chronic, relapsing inflammatory bowel disorders of unknown origin
- genetics
- alterations of epithelial barrier functions
- immune reaction to intestinal flora
- abnormal T cell response
IBD - types
- ulcerative colitis
- crown’s disease
IBD - incidence
north american, specifically canada has one of the highest rates
remission relapsing
worse better lose better
IBD - manifestations
- crampy pain
- frequent diarrhea
crohn’s disease
- can occur anywhere in bowel (large and small intestine)
- patchy areas (walls look like stone - cobblestone)
- skipped lesions
crohn’s disease - fistulas
- connection that shouldn’t be there
- due to mal absorption of nutrients
- foods and stress trigger flare ups
- autoimmune therefore more common in females
crohn’s disease - manifestations
mal absorption/mal nutrition
ulcerative colitis
- affects large intestine
- continuous inflammation with pinpoint hemorrhages
ulcerative colitis - manifestations
blood in stool
ulcerative colitis - complications
- short term
- long term
ulcerative colitis - treatment
- anti-inflammatory/ anti-immune medications
- surgery
liver dieases
- hepatitis
- end-stage liver disease
end-stage liver disease
- cirrhosis
- portal hypertension
manifestations of liver disease
- jaundice
- ascites
- hepatorenal syndrome
- hepatorenal encephalopathy
ascites
- accumulation of fluid in the peritoneal cavity
- reduced albumin levels
- sodium/water retention
- late stage manifestations
obstructive jaundice
obstruction of bio flow
hemolytic jaundice
break down of a lot of red blood cells and creates an increase in billirubin
hepatocellular jaundice
liver isn’t working
bilirubin
makes skin itchy
hepatorenal syndrome
- 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
hepatic encephalopathy
- 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)
hepatitis
- inflammation caused by exposure to drugs or other chemicals or by viral infections
- acute or chronic
- exposure to drugs, chemicals, viruses
viral hepatitis: mild and short-lived infections
A, D, E
viral hepatitis: severe and chronic liver function
B, C
viral hepatitis: varied mode of transmission
- fecal and oral (A and E)
- parenteral or sexual blood and body fluids (B, C, D)
viral hepatitis: pathophysiology
inflammation and some scaring of the liver
viral hepatitis: sequence
- prodromal phase
- icteric phase
- recovery phase
prodromal phase
pre jaundice phase
icteric phase
jaundice - yellow and itchy
recovery phase
some go on to develop chronic active hepatitis
viral hepatitis: chronic active hepatitis
increased vulnerability to cirrhosis and cancer
cirrhosis of the liver
- chronic, irreversible, inflammation
- scarring of the bile canaliculi
- common causes like hepatitis, ETOH, idiopathic
portal hypertension
- 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)
portal hypertension: consequences
- varicose veins (varices)
- lower esophagus, stomach, rectum
- can rupture and bleed profusely
- splenomegaly
gall bladder: cholecystitis
- due to cholelithiasis (gallstones)
- prevalent in developed countries
- caused by abnormalities in bile composition, bile stasis and or inflammation of gallbladder
cholecystitis - risk factors
- fat
- female
- fertile
- forty
- first nation
pathogenesis of cholecystitis #1
- supersaturated bile
- formation of crystals
- formation of microstones/stones
pathogenesis of cholecystitis #2
obstruction of cystic duct
pathogenesis of cholecystitis #3
inflammation of gallbladder
cholecystitis
- obstruction of cystic duct and inflammation
- stones in gallbladder
cholecystitis - manifestations
- asymptomatic or vague symptoms
- heartburn
- food intolerances
- epigastric pain
- biliary colic
cholecystitis and fatty foods
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
biliary colic
pain that starts in the upper right quadrant and radiates pain to the shoulder blade
cholecystitis - treatment
- prevention
- pain management
- antibiotics
- removal of stone via scope
- cholecystectomy
cholecystectomy 2 types
- laparoscopic or open
- depending on number
pancreatitis
- acute or chronic inflammation
acute pancreatitis: cause
- associated with several other clinical disorders
- *gallstones
- *alcoholism
acute pancreatitis
- 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)
chronic pancreatitis
- related to chronic alcohol abuse as well as smoking
- structural changes
- complications
- scaring narrowing and decreased functions
chronic pancreatitis can lead to (2)
- pancreatic cancer
- diabetes
malnutrition
- BMI
- deficit
BMI > 35
- associated with increased risk of morbidity and mortality
central obesity
- abdominal/visceral fat
- associated with increased morbidity, mortality
- diabetes, cardiovascular disease, cancer
obesity - causes
- imbalances between caloric intake and energy expenditure
- dysregulation of hypothalamus and other hormones that control appetite and weight
- neonatal exposure to calories
BMI
also associated with higher mortality
normal BMI
30-35
deficit
- eating disorder
- a problem of access to food
eating disorders
- characterized by abnormal eating behavior, weight regulation and disturbed attitudes toward body weight, body shape and size
- affect both genders (females more likely)
anorexia nervosa
- 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
bulimia nervosa
- body weight remains near normal but with aspirations for weight loss
- recurrent cycles of binge eating followed by forced vomiting
starvation
- decrease caloric intake leading to weight loss
- short-term or long term
short term starvation
- glycogenolysis
- glyconeogenesis
long-term starvation
- marasmus
- kwashiorkor
- more risk for younger children
marasmus
- deficiency of all nutrients
- younger children
kwahiorkor
- severe protein deficiency, related to high CHO intake
- usually after weaning from breast
- presence of subcutaneous fat
ascites
