alterations in GI function Flashcards
1
Q
what cells make up the walls of the sinusoids
A
endothelial cells
2
Q
what are kupffer cells
A
specialized macrophages
3
Q
lipocytes?
A
fat-storing cells involved in vitamin A metabolism
4
Q
where do lipocytes lie in the liver
A
btwn hepatocytes and endothelial cells
5
Q
what cells are part of the reticuloendothelial cell network of the liver
A
endothelial cells, kupffer cells, lipocytes
6
Q
Reticuloendothelial cells are bigger/smaller than hepatocytes
A
smaller
7
Q
functions of reticuloendothelial cells?
A
secretion of cytokines
communication with each other and with hepatocytes
8
Q
what does dysfunction of Reticuloendothelial cells cause
A
hepatocyte necrosis in acute liver disease
hepatic fibrosis in chronic liver disease
9
Q
will patients recover well if they have fulminant hepatic failure with massive hepatocellular death?
A
yes
10
Q
are cells in the miver undergoing mitosis
A
no
11
Q
how do hepatocytes regenerate and proliferate
A
unknown
12
Q
cirrhosis?
A
irreversible inflammatory disease that disrupts liver function and structure
13
Q
why is there decreased hepatic function in cirrhosis
A
from nodules and fibrosis
14
Q
what becomes obstructed in cirrhosis? what does this cause
A
biliary channels become obstructed and cause portal HTN
15
Q
when portal HTN occurs in the liver, what occurs
A
blood is shunted away from the liver and hypoxic necrosis develops
16
Q
alcoholic cirrhosis?
A
oxidation of alcohol destroys hepatocytes
17
Q
where does biliary/bile canaliculi cirrhosis begin
A
bile canaliculi and ducts
18
Q
primary biliary cirrhosis is…
A
autoimmune
19
Q
secondary biliary cirrhosis is caused by…
A
obstruction such as gallstones
20
Q
what is postnecrotic cirrhosis caused by
A
chronic disease
21
Q
what liver enzymes are commonly measured in serum
A
alanine aminotransferase (ALT) and aspartate aminotransferase (AST)
Alkaline phosphatase
Gamma-glutamyl transpeptidase (GGT)
5’-nucleotidase
Lactate dehydrogenase (LDH)
22
Q
what is jaundice aka
A
icterus
23
Q
what type of jaundice is hemolytic jaundice
A
prehepatic
24
Q
hemolytic jaundice?
A
Excessive hemolysis of red blood cells or absorption of a hematoma
25
what type of obstruction is obstructive jaundice
Extrahepatic obstruction or Intrahepatic obstruction
26
where is bilirubin excreted
bile and urine
27
what is responsible for the yellow color of bruises, urine, and the yellow discoloration in jaundice?
bilirubin
28
where does most bilirubin come from (75%)
hemoglobin of senescent red blood cells
29
normal levels of bilirubin?
250-350 mg
30
where is bilirubin phagocytosed by PMN
spleen
31
is bilirubin soluble
no
32
since bilirubin isnt soluble, what does it need
carrier protein, albumin
33
what is conjugated bilirubin catabolized by
bacteria
34
what is stercobilinogen aka
fecal urobilin
35
what is responsible for the color of feces
stercobilinogen/fecal urobilin
36
how is urobilin excreted
feces and urine
37
plasma bilirubin levels when jaundice is clinically obvious?
over 50 mol/L
38
Hyperbilirubinemia?
imbalance btwn production and excretion of bilirubin
39
3 main causes of jaundice?
prehepatic, intrahepatic, and posthepatic
40
what is prehepatic jaundice caused by
excess production of bilirubin from hemolysis, or a genetic abnormality in the hepatic uptake of unconjugated bilirubin
41
hemolysis is commonly a result of...
immune disease, structurally abnormal red cells, breakdown of extravasated blood
42
can conjugated and unconjugated bilirubin be distinguished
yes
43
who is intrahepatic jaundice common in
neonates due to immaturity of enzymes controlling bilirubin conjugation
44
what is posthepatic jaundice caused by
obstruction of the biliary tree
45
what liver enzyme levels are measured in intraheptatic jaundice
AST and ALT
46
what liver enzyme levels are measured in postheptatic jaundice
ALP and y glutamyl transferase
47
what type of bilirubin is increased in prehepatic jaundice?
unconjugated
48
what type of bilirubin is increased in intrahepatic jaundice?
unconjugated and conjugated
49
what type of bilirubin is increased in posthepatic jaundice?
conjucated
50
is hemoglobin high or low in preheptatic jaundice
low... they also have anemia
51
in complete obstruction of posthepatic jaundice, what is absent in urine
urobilinogen and urobilin
52
what is cholelithiasis?
when cholesterol stones form in bile are supersaturated with cholesterol
53
causes of cholelithiasis
enzyme defect, decreased secretion or resorption of bile acids, gallbladder smooth muscle hypomotility, genetic
54
what is asymptomatic in cholelithiasis
gallstones
55
symptoms of cholelithiasis
nausea or abdominal discomfort after eating fatty or fried foods, severe RUQ or midepigastric abdominal pain, and jaundice.
56
typical pt with cholelithiasis is...
female, high fat intake, 40's, prior pregnancies
57
is cholelithiasis progressive or acute
progressive
58
what hormone is important in gallstone formation
estrogen
59
what are gallstones made of
cholesteron with or without calcium deposits or bilirubin
60
how many gallstones do ppl with cholelitiasis usually have
few large individual stones or many small stones
61
sludge?
thick gel from bile that is prone to formation of stones
62
Cholecystitis?
inflammation of the gallbladder
63
acute cholecystitis can progress to what...
acute pancreatitis
64
what occurs in acute cholesystitis
stone travels down the common bile duct but fails to clear the sphincter of Oddi which blocks the pancreatic duct
65
what can happen ultimately to an inflamed gallbladder
it can become infected or infarction/necrosis leading to systemic sepsis
66
2 types of cholesystitis
acute or chronic
67
what other clinical disorders is pancreatitis associated with
alcohol intake and cholelithiasis
68
what is pancreatitis caused by
injury or damage to pancreatic cells and ducts where pancreatic enzymes leak into the pancreatic tissue
69
what do pancreatic enzymes leaking into the pancreatic tissue cause
autodigestion of pancreatic tissue
70
clinical manifestations of pancreatitis
Epigastric pain radiating to the back, Fever, leukocytosis, Hypotension, hypovolemia, increased vascular permeability, inc. serum amylase levels
71
what is chronic pancreatitis related to
chronic alcohol abuse
72
anorexia?
A lack of desire to eat despite physiologic stimuli that would normally produce hunger
73
vomiting?
The forceful emptying of the stomach and intestinal contents through the mouth
74
symptoms during nausea?
hypersalivation and tachycardia
75
retching?
nonproductive vomiting
76
projectile vomiting?
Spontaneous vomiting that does not follow nausea or retching
77
normal pooping times?
Two or three per day to one per week
78
constipation?
Infrequent or difficulty defecation
79
normal transit/functional constipation?
Normal rate of stool passage, but difficulty with stool evacuation from low-residue, low-fluid diet
80
Slow-transit constipation?
Impaired colonic motor activity with infrequent bowel movements and straining
81
Pelvic floor dysfunction (pelvic floor dyssynergia or anismus)?
Failure of the pelvic floor muscles or anal sphincter to relax with defecation
82
secondary constipation?
from disease process or condition
83
diarrhea?
increased frequency, volume, fluidity, or weight of feces
84
3 types of diarrhea?
Osmotic diarrhea
Secretory diarrhea
Motility diarrhea
85
osmotic diarrhea?
Nonabsorbable substance in the intestine draws water into the lumen by osmosis, causing large-volume diarrhea
86
secretory diarrhea?
Form of large-volume diarrhea caused by excessive mucosal secretion of chloride or bicarbonate-rich fluid or the inhibition of net sodium absorption
87
motility diarrhea?
Excessive motility decreases transit time, mucosal surface contact, and opportunities for fluid absorption
88
clinical manifestations of acute bacterial or viral infection of diarrhea
fever, with or without cramping
89
clinical manifestations of IBD diarrhea
Fever, cramping pain, bloody stools
90
clinical manifestations of malabsorption syndrome diarrhea
steatorrhea (fat in stools)
91
what causes abdominal pain
stretching, inflammation, or ischemia
92
Biochemical mediators of the inflammatory response
histamine, bradykinin, and serotonin
93
where does upper GI bleeding come from
esophagus, stomach, or duodenum
94
what does upper GI bleeding look like
bright red bleeding in emesis or digested blood (“coffee grounds”) in stool
95
where does lower GI bleeding come from
jejunum, ileum, colon, or rectum
96
hematemesis?
the vomiting of blood that's bright red, or similar to coffee grounds
97
hematochezia?
the passage of fresh blood, per anus
98
melana?
black, tarry stool
99
occult bleeding?
blood instool you cant see
100
dysphagia?
difficulty swallowing; Distention and spasm of esophagus after swallowing, regurgitation of undigested food
101
Achalasia
Denervation of smooth muscle in the esophagus and lack of lower esophageal sphincter relaxation
102
trmt for achalasia
Dilation or surgical myomotomy of the lower esophageal sphincter
103
what causes dysphasia
esophageal obstruction, impaired esophageal motility, or achalasia
104
GERD?
The reflux of chyme from the stomach to the esophagus
105
reflux esophagitis?
inflammation of esophagus from GERD
106
Vomiting, coughing, lifting, bending, or obesity can contribute to what disease
GERD
107
clinical manifestations of GERD
Heartburn, regurgitation of chyme, and upper abdominal pain within 1 hour of eating, chronic cough, laryngitis
108
diagnosis of GERD?
biopsy to see dysplastic changes/ barrett esophagus
109
trmt for GERD
Proton pump inhibitors, Histamine type 2 (H2) receptor antagonists, prokinetic agents, and antacids, Elevate head of the bed 6 inches; reduce weight; stop smoking, Laparoscopic fundoplication/ surgery
110
hiatal hernia?
Protrusion of the upper part of the stomach through the diaphragm and into the thorax
111
3 types of hernias
sliding, paraesophageal, mixed
112
sliding hernia?
stomach moves through the diaphragm into the esophagus
113
MC hernia type?
sliding
114
paraesophageal/rolling hernia?
Herniation of the greater curvature
| of the stomach is through a secondary opening in the diaphragm
115
causes of hiatal hernia
short esophagus, Trauma, Weak diaphragmatic muscles, Increased abdominal pressure
116
Pyloric/gastric outlet obstruction
Blocking or narrowing of the opening between the stomach and duodenum
117
clinical manifestations of Pyloric/gastric outlet obstruction
Epigastric pain and fullness, nausea, vomiting; if prolonged, malnutrition and dehydration
118
Intestinal obstruction
Any condition that prevents the flow of chyme through the intestines or failure of normal intestinal motility in the absence of an obstructing lesion
119
Colicky pains caused by intestinal distention, followed by nausea and vomiting are symptoms of what
SI obstruction
120
Hypogastric pain and abdominal distention are symptoms of what
LI obstruction
121
if the vomitus is Early, profuse vomiting of clear gastric fluid, where is the obstruction?
pylorus
122
if the vomitus is Mild distention and vomiting of bile-stained fluid, where is the obstruction?
proximal small intestines
123
if the vomitus has fecal matter, where is the obstruction
lower SI
124
what does a simple obstruction indicate
presence of lesion
125
what does a functional obstruction/ paralytic ileus indicate
failure of motility
126
MC small intestinal obstruction
fibrous adhesion
127
MC large intestinal obstruction
Colorectal cancer, volvulus (twisting), and strictures related to diverticulitis
128
Acute colonic pseudo-obstruction (Ogilvie syndrome)
Massive dilation of the large bowel; patients who are critically ill and older adults who are immobilized
