36 GI Disorders Flashcards
common manifestations of GI tract disorders
- pain
- vomiting
- intestinal gas
- bowel pattern alterations (const/diarrh)
pathophysio mechanism of bowel pattern alterations
1 osmotic
2 secretory
3 exudative (muc, bld, prtein)
4 diarrhea r/t motility disturbances
dysphagia
difficulty swallowing
3 types
Type I Dysphagia
problem w delivery of food/fluid into esophagus
-cough, aspirate, worse w liquids than solids
Type II Dysphagia
problem w transport of bolus down esophagus
-sensation food is “stuck” behind sternum, first w solid, may progress to fluid
Type III Dysphagia
problems in bolus entry to stomach
-tight/pain in substernal area during swallowing
GastroEsophageal Reflux Disease [GERD]
blackflow of gastruc contents into esophagus thru LES
GastroEsophageal Reflux Disease [GERD]
causes
any conditin that alters closure strength of LES or incr ab pressure
1 fatty food 2 caffein 3 lrg amt of alcohol 4 cig smoking 5 pregnancy 6 anatomic features like hiatal hernia
GastroEsophageal Reflux Disease [GERD]
s/s
1 hrt burn
2 regurgutation
3 chest pain
4 dysphalgia
GastroEsophageal Reflux Disease [GERD]
treatment
histamine H2-blocking for occasional GERD
proton pump inhibitors [PPI] for chronic GERD
GastroEsophageal Reflux Disease [GERD]
complications
- Barrett esophagus
- ulceration/fibrotic scarring
- esophageal strictures
- pilmonary symptoms
Barrett esophagus
columnar tissue replaces norm squamous epithelium of distal esophagus
-carries risk for esophageal cancer
complication of GERD
Gastritis
inflammation of stomach lining
Acute Gastritis
precipitated by ingestion of irritating substances
—alcohol + aspirin, NSAIDs, viral, bacterial, autoimmune
Chronic Gastritis
peptic ulcer>gastriic adenocarcinoma
-decr intrinsic factor>decr HCl acid
most common cause of chronic gastritis
Helicobacter Pylori
diseases of inflammation of stomach + intestines
1 acute gastritis
2 chronic gastritis
3 peptic ulcer disease
Peptic Ulcer Disease
disorder of upper GI tract caused by action of ACID + PEPSIN
Peptic Ulcer Disease
cause
- no relation w diet
- NSAID, stress/GLUCOCORTICOIDS, smoking, generics
- H.pylori
H. pylori
promotes gastric + duodenal ulcer formation
- thrives in acidic conditions
- clearance of H pylori promotes ulcer healing
- common cause of chronic gastritis + peptic ulcer disease
pain of ____ typically occurs on an empty stomach but may present soon after a meal
GASTRIC ULCERS
pain of ____ classically occurs 2-3 hrs after a meal and is relieved by further food ingestion
DUODENAL ULCER
Peptic Ulcer Disease
diagnosis
gastric ulcers should be visualized w ENDOSCOPY + BIOPSY to rule out malignancy
Peptic Ulcer Disease
treatment
- reduce gastric acidity
- H.pylori antibiotics
- H2 antagonist
- PPI
- sucralfate
- smoking cessation
- avoidance of ASA + NSAID
- stress reduction
- avoid irritating foods (caffeine,alcohol)
inflammatory bowel diseases
1 Ulcerative Colitis
2 Crohn Diseased
Ulcerative Colitis
chronic inflammatory disease of MUCOSA of rectum + colon (lower end)
-assoc w incr cancer risk
Ulcerative Colitis
s/s
bloody diarrhea + lower abdominal pain
Ulcerative Colitis
treatment
- corticosteroid
- broad spect antibiotic
- salicylate analog
- immunomodulating agents (azarthioprine + mercaptopurine)
- IV followed by oral cyclosporine for refractory
- Infliximab (remicade)
Crohn Disease
affects all layers of intestinal wall of the proximal portion of the colon or terminal ileum
Crohn Disease
s/s
- interminent fevers
- diarrhea (may be blood but not as severe as ulcerative colitis)
- chronic RLQ pain
- RLQ mass/tenderness
Enterocolitis Disorders
1 Antibiotic-Associated Colitis
2 Appendicitis
3 Diverticular Disease
Antibiotic-Associated Colitis aka Pseudomembranous Enterocolitis
acute inflammation + necrosis of lrg intestines
Antibiotic-Associated Colitis aka Pseudomembranous Enterocolitis
cause
Clostridium difficile
Antibiotic-Associated Colitis aka Pseudomembranous Enterocolitis
s/s
diarrhea (often bloody) abdominal pain fever leukocytosis sepsis colonic perforation
Antibiotic-Associated Colitis aka Pseudomembranous Enterocolitis
diagnosis
HISTORY IS CRITICAL
Antibiotic-Associated Colitis aka Pseudomembranous Enterocolitis
treatment
- stop current antibiotic
- treat ischemia
- treat contributing conditions
- oral antibiotics: metronidazole or vancomycin
- recurrence common
- rare: fecal transplant
Appendicitis
inflammation of the vermiform appendix
-obstruction by a fecalith
Appendicitis
s/s
- RLQ pain “McBurney’s Point”
- rebound tenderness
- n/v
- fever
- diarrhea
Appendicitis
treatment
- immediate surgical removal
- antibiotics w fluid/electrolyte replacement
Motility Disorders
1 Irritable Bowel Syndrome
2 Volvolus
3 Intussusception
Irritable Bowel Syndrome
alternating diarrhea + constipation
- accompanied by abdominal cramping pain
- no ID pathologic process in GI tract
Irritable Bowel Syndrome aka
Spastic Colitis
Irritable Colon Syndrome
Irritable Bowel Syndrome
s/s
- diarrhea/constipation
- —or alternating pattern of both
- abdomincal pain
- mucus in stool
- nasusea
Volvulus
twisting of bowel on itself causing intestinal obstruction + blood vessel compression (ISCHEMIA)
Motility Disorders
1 Intussusception
2 Celiac Disease
Intussusception
telescoping/invagination of a portion of bowel into adjacent bowel causing intestinal obstruction
- most often in infants
- more often in males more than females
Celiac Disease
-malabsorption disorder
familial intolerance of gluten-containing foods leading to inflammation and atrophy of the intestinal villi
Celiac Disease
treatment
- gluten-free diet
- supplemental Fe, folate, B12
- fat soluble vitamins (A,D,E,K)
- oral corticosteroids or other immunomodulating agents for refractory
Neoplasms of GI Tract
1 Esophageal Cancer 2 Gastric Carcinoma 3 Small Intestinal Neoplasms 4 Colonic polyps 5 Colon Cancer
Neoplasms of GI Tract
1 Esophageal Cancer 2 Gastric Carcinoma 3 Small Intestinal Neoplasms 4 Colonic polyps 5 Colon Cancer
Esophageal Cancer
accounts for 1-2% of all cancer
- men 3x more than women
- poor prognosis
- V high degree of metastasis
Esophageal Cancer
risk factors
- genetic
- diet high in NITROSAMINE content
- chronic severe reflux “BARRETT ESOPHAGUS”
- environmental
- smoking
- alcohol
Gastric Carcinoma
- prevalence in Japan
- Men less than 30yrs
Gastric Carcinoma
risk factors
H. pylowri
epstein barr virus
Small Intestinal Neoplasms
- benign or malignant
- account for <5% GI tumors
- 50 yrs or older
Colonic Polyps
- any protrusion into the GI lumen
- major precursor lesion in dvlpt of colon cancer
Colon Cancer
-second only to lung cancer as a cause of cancer deaths
Colon Cancer
risk factors
- 40+ years old
- high-fat, low-fiber diet
- polyps
- chronic irritation or inflammation
- hereditary
