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Pathophysiology > Abdominal + Digestive Disorders > Flashcards

Abdominal + Digestive Disorders Flashcards

1
Q

Describe the location of the abdomen

A
  • anterior portion of the body between thorax and pelvis
  • contains abdominal cavity
  • separated from chest by diaphragm
  • lined with peritoneum membrane
  • contains stomach, large + small intestines, liver, spleen, pancreas, kidneys, gallbladder, urinary bladder and other structures
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2
Q

What are the nine regions of diagnosis and examination of the abdomen?

A
  • right + left hypochondrium
  • right + left lumbar
  • right + left iliac
  • epigastric
  • umbilical
  • hypogastrium/supra pubic
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3
Q

What is contained in the right hypochondriac region?

A
  • liver
  • right kidney
  • gallbladder
  • large/small intestine
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4
Q

What is contained in the left hypochondriac region?

A
  • liver’s tip
  • stomach
  • pancreas
  • left kidney
  • spleen
  • large/small intestine
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5
Q

What is contained in the epigastric region?

A
  • liver
  • stomach
  • spleen
  • duodenum
  • adrenal glands
  • pancreas
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6
Q

What is contained in the right lumbar region?

A
  • ascending colon
  • small intestine
  • right kidney
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7
Q

What is contained in the left lumbar region?

A
  • descending colon
  • small intestine
  • left kidney
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8
Q

What is contained in the umbilical region?

A
  • duodenum
  • small intestine
  • transverse colon
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9
Q

What is contained in the right iliac region?

A
  • appendix
  • caecum
  • ascending colon
  • small intestine
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10
Q

What is contained in the left iliac region?

A
  • sigmoid colon
  • descending colon
  • small intestine
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11
Q

What is contained in the hypogastric/supra pubic region?

A
  • bladder
  • sigmoid colon
  • small intestine
  • reproductive organs
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12
Q

Provide a definition of the gastrointestinal system

A
  • ingestion of food is acted upon by physical and chemical means
  • provides the body with absorbable nutrients
  • excretes waste products
  • in animals the system includes the alimentary canal extending from mouth to anus, the hormones and enzymes assisting digestion
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13
Q

What are the cardinal questions of the gastrointestinal system?

A
  • do you have Abdominal pain?
  • are you nauseous?
  • are you vomiting blood?
  • are you vomiting?
  • do you have constipation, diarrhoea or faecal incontinence?
  • is there blood in your stool?
  • do you have anorectal pain?
  • do you have any masses around your anus?
  • do you have the sensation of incomplete emptying?
  • has your weight changed unintentionally?
  • do you believe your skin to be of a yellow colour?
  • do you have problems swelling (Dysphagia)
  • do you have pain on swallowing (odnophagia)
  • do you have indigestion?
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14
Q

What are the signs and symptoms of GI Disorders?

A
  • Dysphagia (difficulty swallowing)
  • bleeding
  • bloating
  • constipation/diarrhoea
  • heartburn/GERD
  • incontinence
  • nausea and vomiting
  • pain in the abdomen
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15
Q

What is Dysphagia?

A
  • defined as difficulty swallowing
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16
Q

Why is Dysphagia a serious symptom that requires investigation?

A
  • to exclude neoplasm
  • can lead to malnutrition
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17
Q

If the patient experiences a lump in the throat when they are not swallowing, what is the likely diagnosis?

A
  • anxiety, so called Globus Hystericus
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18
Q

What are the causes of dysphagia?

A
  • malignant stricture
  • benign strictures
  • extrinsic pressure
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19
Q

What are the malignant strictures of dysphagia?

A
  • oesophageal cancer
  • gastric cancer
  • pharyngeal cancer
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20
Q

What are the benign strictures of dysphagia?

A
  • oesophageal web/ring
  • peptic stricture
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21
Q

What are the extrinsic pressures (outside growing in) of dysphagia?

A
  • lung cancer
  • retrosternal goitre - usually anteriorly C5/T1
  • mediastinal cancers
  • pharyngeal pouch
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22
Q

What does the word stricture mean?

A
  • narrowing
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23
Q

What are the causes of dysphagia?

A
  • Achalasia = failure of smooth muscle fibres to relax
  • diffuse oesophageal spasm
  • myasthenia gravis = long term neuromuscular function disease
  • syringomyelia = neurological disorder in which a fluid-filled cyst (syrinx) forms within the spinal cord
  • systemic sclerosis = hardening and tightening of the skin
  • bulbar palsy = bilateral impairment of cranial nerves IX - XII
  • oesophagitis
  • infection (candida, herpes)
  • reflux oesophagitis
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24
Q

What key questions should you ask for differential diagnosis of dysphagia?

A
  • do you have difficulty swallowing liquids and soldes from the start (can’t swallow liquids = significant restriction => referral to A&E)
  • is it difficult to make the swallowing movement?
  • is swallowing painful?
  • is the dysphagia intermittent or is it constant and getting worse?
  • does the neck bulge or gurgle on drinking?
25
Q

What is GERD?

A

Gastro esophageal reflux disease is a chronic + severe form of acid reflux

26
Q

What is heartburn?

A

A symptom of acid reflux and GERD

27
Q

What are the symptoms of GERD?

A
  • chronic acid reflux
  • painful burning sensation in the upper stomach, chest and throat
  • dry coughing
  • nocturnal cough
  • nocturnal wheeze
  • dysphagia (trouble swallowing)
  • burning retrosternal discomfort from epigastrium to throat; worsens on stooping, lying, having a hot drink and relieved by antacids
28
Q

What us the physiological cause of GERD?

A
  • relaxation of the lower oesophageal sphincter (LES)
  • if incompetent, then acid from stomach contents comes through LES into oesophagus, serosa tissue doesn’t have any protection against hydrochloric acid
29
Q

What are the risk factors/causes of GERD (environmental/biomechanical)?

A
  • smoking
  • alcohol
  • fat
  • coffee
  • obesity
  • tight clothes
  • big meals
  • hiatus hernia
  • medication
  • systemic sclerosis
  • nutritional allergies
30
Q

What are the complications of GERD?

A
  • oesophagitis
  • ulcer
  • anaemia
  • Barrett’s oesophagus (cells in the lining of the oesophagus start to change -> cancer)
31
Q

What is another name for a peptic ulcer?

A
  • stomach ulcer
32
Q

What are the two different types of peptic ulcers?

A
  • duodenal ulcer
  • gastric ulcer
33
Q

What is the most likely presenting symptom of a peptic ulcer?

A
  • dyspepsia (indigestion)
34
Q

What are the causes of duodenal ulcers?

A
  • significant association with helicobacter pylori (90%)
  • the rest are NSAID related
35
Q

What is the relieving factor of a duodenal peptic ulcer?

A
  • relieved by eating
36
Q

Where do gastric ulcers most likely occur?

A
  • lesser curvature of the stomach
37
Q

What sign is associated with a gastric ulcer?

A
  • weight loss
38
Q

What aggravates a gastric ulcer?

A
  • worsened by food
39
Q

What are the complication of peptic ulcers?

A
  • haemorrhage (loss of blood from a damaged blood vessel)
  • perforation (lining of stomach splits open)
  • pyloric stenosis (narrowing between stomach and small intestine)
  • penetration through the serosa (erosion through bowel wall without perforation; contents leak into peritoneal cavity)
40
Q

Which 2 diseases are encompassed by Inflammatory Bowel Disease (IBD)?

A
  • Ulcerative colitis (UC)
  • Crohn’s disease
41
Q

Which medical syndrome should IBD not be confused with?

A
  • irritable bowel syndrome
42
Q

What is the definition of Ulcerative colitis (UC)?

A
  • recurrent inflammatory disease of large bowel which always involves the rectum
  • never spreads beyond the ileocaecal valve
43
Q

Which is more common UC or Crohn’s Disease?

A
  • UC
44
Q

In what population is UC more common?

A
  • non-smokers
45
Q

What are the symptoms of UC?

A
  • bloody diarrhoea
  • dehydration
  • abdominal pain
  • rectal bleeding
  • weight loss
  • fever
46
Q

What are the complications of UC?

A
  • haemorrhage (rupture of a blood vessel)
  • dehydration
  • toxic dilation and perforation (toxic megacolon => deep inflammation disables the muscles in your colon => substances (food and gas) to build up in your colon while the walls weaken, stretch and widen (dilate) => build up of toxins inside your colon => leak through the weakened walls into your bloodstream => this causes systemic toxicity)
  • colon cancer
47
Q

What is Crohn’s Disease?

A
  • chronic inflammatory disease affecting any part of the gut from mouth to anus
48
Q

What are unaffected areas between bowel areas of active disease called?

A
  • skip lesions
49
Q

What are the signs + symptoms of Crohn’s Disease?

A
  • diarrhoea
  • malabsorption
  • cramping abdominal pain
  • rectal bleeding
  • weight loss
  • fever
50
Q

What are the complications of Crohn’s Disease?

A
  • strictures/GI obstruction
  • fistulas (abnormal passage way in the GI tract)
  • renal disease
  • large and small bowel cancer
51
Q

You are taking a case history from your seventy eight year old new patient when she mentions that she has difficulty swallowing … what further questions would you ask to determine whether she is appropriate for osteopathic care?

A
  • did you have difficulty swallowing liquids and solids from the start?
  • is it difficult to make the swallowing movement?
  • is swallowing painful?
  • is the dysphagia intermittent or is it constant and getting worse?
  • does the neck bulge or gurgle on drinking?
52
Q

You are taking a case history from your seventy eight year old new patient when she mentions that she has difficulty swallowing … what tests/examinations would you perform in your practice?

A
  • palpation of the area distally first and then proximally (feeling for obstruction)
  • ask patient to swallow and observe movement
  • ausculate throat, trachea and lungs to hear for any obstruction
  • cranial nerve test
53
Q

Name three differences between UC and Crohn’s disease

A
  • Crohn’s disease can affect anywhere between the mouth and the anus, UC does not go past the ileocecal valve
  • UC symptoms include dehydration, Crohn’s disease does not
  • UC can result in haemorrhage and toxic megacolon, Crohn’s disease can result in fistulas, renal disease, strictures/GI obstruction
54
Q

Why would GERD cause a nocturnal cough or wheeze?

A
  • while lying flat the LES relaxes and opens, resulting in stomach content coming into the Oesophagus => natural reflex to cough
55
Q

Which parts of the digestive system are in the epigastric region of the abdomen?

A
  • liver
  • pancreas
  • duodenum
  • stomach
  • adrenal glands
  • spleen
56
Q

Explain the terms Achalasia, oesophageal web/ring and Bulbar palsy

A
  • Achalasia => oesophageal muscles don’t contract properly (almost like a bulging area in the oesophagus) => ‘not’ + ‘relaxation’
  • Oesophageal web/ring => smooth muscle extensions of the oesophagus that can result in dysphagia as liquid/solids become trapped (more likely around postcricoid area)
  • Bulbar palsy => bilateral impairment of lower cranial nerves from 9-12 due to lower motor neuron lesion
57
Q

How would Achalasia lead to dysphagia?

A
  • fluid gets caught in the oesophageal area where the Achalasia is; if this is above the LES, it results in the sphincter being on ‘tension’ all the time and not able to empty content into stomach => back up of contents up the oesophagus
58
Q

How would oesophageal ring/web lead to dysphagia?

A
  • narrowing of oesophageal wall, resulting in a blockage where food cannot be swallowed

Pathophysiology (12 decks)

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