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Pathophysiology > alterations in GI function > Flashcards

alterations in GI function Flashcards

1
Q

what cells make up the walls of the sinusoids

A

endothelial cells

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2
Q

what are kupffer cells

A

specialized macrophages

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3
Q

lipocytes?

A

fat-storing cells involved in vitamin A metabolism

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4
Q

where do lipocytes lie in the liver

A

btwn hepatocytes and endothelial cells

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5
Q

what cells are part of the reticuloendothelial cell network of the liver

A

endothelial cells, kupffer cells, lipocytes

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6
Q

Reticuloendothelial cells are bigger/smaller than hepatocytes

A

smaller

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7
Q

functions of reticuloendothelial cells?

A

secretion of cytokines

communication with each other and with hepatocytes

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8
Q

what does dysfunction of Reticuloendothelial cells cause

A

hepatocyte necrosis in acute liver disease

hepatic fibrosis in chronic liver disease

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9
Q

will patients recover well if they have fulminant hepatic failure with massive hepatocellular death?

A

yes

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10
Q

are cells in the miver undergoing mitosis

A

no

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11
Q

how do hepatocytes regenerate and proliferate

A

unknown

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12
Q

cirrhosis?

A

irreversible inflammatory disease that disrupts liver function and structure

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13
Q

why is there decreased hepatic function in cirrhosis

A

from nodules and fibrosis

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14
Q

what becomes obstructed in cirrhosis? what does this cause

A

biliary channels become obstructed and cause portal HTN

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15
Q

when portal HTN occurs in the liver, what occurs

A

blood is shunted away from the liver and hypoxic necrosis develops

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16
Q

alcoholic cirrhosis?

A

oxidation of alcohol destroys hepatocytes

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17
Q

where does biliary/bile canaliculi cirrhosis begin

A

bile canaliculi and ducts

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18
Q

primary biliary cirrhosis is…

A

autoimmune

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19
Q

secondary biliary cirrhosis is caused by…

A

obstruction such as gallstones

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20
Q

what is postnecrotic cirrhosis caused by

A

chronic disease

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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)

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22
Q

what is jaundice aka

A

icterus

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23
Q

what type of jaundice is hemolytic jaundice

A

prehepatic

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24
Q

hemolytic jaundice?

A

Excessive hemolysis of red blood cells or absorption of a hematoma

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25
Q

what type of obstruction is obstructive jaundice

A

Extrahepatic obstruction or Intrahepatic obstruction

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26
Q

where is bilirubin excreted

A

bile and urine

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27
Q

what is responsible for the yellow color of bruises, urine, and the yellow discoloration in jaundice?

A

bilirubin

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28
Q

where does most bilirubin come from (75%)

A

hemoglobin of senescent red blood cells

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29
Q

normal levels of bilirubin?

A

250-350 mg

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30
Q

where is bilirubin phagocytosed by PMN

A

spleen

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31
Q

is bilirubin soluble

A

no

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32
Q

since bilirubin isnt soluble, what does it need

A

carrier protein, albumin

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33
Q

what is conjugated bilirubin catabolized by

A

bacteria

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34
Q

what is stercobilinogen aka

A

fecal urobilin

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35
Q

what is responsible for the color of feces

A

stercobilinogen/fecal urobilin

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36
Q

how is urobilin excreted

A

feces and urine

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37
Q

plasma bilirubin levels when jaundice is clinically obvious?

A

over 50 mol/L

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38
Q

Hyperbilirubinemia?

A

imbalance btwn production and excretion of bilirubin

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39
Q

3 main causes of jaundice?

A

prehepatic, intrahepatic, and posthepatic

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40
Q

what is prehepatic jaundice caused by

A

excess production of bilirubin from hemolysis, or a genetic abnormality in the hepatic uptake of unconjugated bilirubin

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41
Q

hemolysis is commonly a result of…

A

immune disease, structurally abnormal red cells, breakdown of extravasated blood

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42
Q

can conjugated and unconjugated bilirubin be distinguished

A

yes

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43
Q

who is intrahepatic jaundice common in

A

neonates due to immaturity of enzymes controlling bilirubin conjugation

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44
Q

what is posthepatic jaundice caused by

A

obstruction of the biliary tree

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45
Q

what liver enzyme levels are measured in intraheptatic jaundice

A

AST and ALT

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46
Q

what liver enzyme levels are measured in postheptatic jaundice

A

ALP and y glutamyl transferase

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47
Q

what type of bilirubin is increased in prehepatic jaundice?

A

unconjugated

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48
Q

what type of bilirubin is increased in intrahepatic jaundice?

A

unconjugated and conjugated

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49
Q

what type of bilirubin is increased in posthepatic jaundice?

A

conjucated

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50
Q

is hemoglobin high or low in preheptatic jaundice

A

low… they also have anemia

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51
Q

in complete obstruction of posthepatic jaundice, what is absent in urine

A

urobilinogen and urobilin

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52
Q

what is cholelithiasis?

A

when cholesterol stones form in bile are supersaturated with cholesterol

53
Q

causes of cholelithiasis

A

enzyme defect, decreased secretion or resorption of bile acids, gallbladder smooth muscle hypomotility, genetic

54
Q

what is asymptomatic in cholelithiasis

A

gallstones

55
Q

symptoms of cholelithiasis

A

nausea or abdominal discomfort after eating fatty or fried foods, severe RUQ or midepigastric abdominal pain, and jaundice.

56
Q

typical pt with cholelithiasis is…

A

female, high fat intake, 40’s, prior pregnancies

57
Q

is cholelithiasis progressive or acute

A

progressive

58
Q

what hormone is important in gallstone formation

A

estrogen

59
Q

what are gallstones made of

A

cholesteron with or without calcium deposits or bilirubin

60
Q

how many gallstones do ppl with cholelitiasis usually have

A

few large individual stones or many small stones

61
Q

sludge?

A

thick gel from bile that is prone to formation of stones

62
Q

Cholecystitis?

A

inflammation of the gallbladder

63
Q

acute cholecystitis can progress to what…

A

acute pancreatitis

64
Q

what occurs in acute cholesystitis

A

stone travels down the common bile duct but fails to clear the sphincter of Oddi which blocks the pancreatic duct

65
Q

what can happen ultimately to an inflamed gallbladder

A

it can become infected or infarction/necrosis leading to systemic sepsis

66
Q

2 types of cholesystitis

A

acute or chronic

67
Q

what other clinical disorders is pancreatitis associated with

A

alcohol intake and cholelithiasis

68
Q

what is pancreatitis caused by

A

injury or damage to pancreatic cells and ducts where pancreatic enzymes leak into the pancreatic tissue

69
Q

what do pancreatic enzymes leaking into the pancreatic tissue cause

A

autodigestion of pancreatic tissue

70
Q

clinical manifestations of pancreatitis

A

Epigastric pain radiating to the back, Fever, leukocytosis, Hypotension, hypovolemia, increased vascular permeability, inc. serum amylase levels

71
Q

what is chronic pancreatitis related to

A

chronic alcohol abuse

72
Q

anorexia?

A

A lack of desire to eat despite physiologic stimuli that would normally produce hunger

73
Q

vomiting?

A

The forceful emptying of the stomach and intestinal contents through the mouth

74
Q

symptoms during nausea?

A

hypersalivation and tachycardia

75
Q

retching?

A

nonproductive vomiting

76
Q

projectile vomiting?

A

Spontaneous vomiting that does not follow nausea or retching

77
Q

normal pooping times?

A

Two or three per day to one per week

78
Q

constipation?

A

Infrequent or difficulty defecation

79
Q

normal transit/functional constipation?

A

Normal rate of stool passage, but difficulty with stool evacuation from low-residue, low-fluid diet

80
Q

Slow-transit constipation?

A

Impaired colonic motor activity with infrequent bowel movements and straining

81
Q

Pelvic floor dysfunction (pelvic floor dyssynergia or anismus)?

A

Failure of the pelvic floor muscles or anal sphincter to relax with defecation

82
Q

secondary constipation?

A

from disease process or condition

83
Q

diarrhea?

A

increased frequency, volume, fluidity, or weight of feces

84
Q

3 types of diarrhea?

A

Osmotic diarrhea

Secretory diarrhea

Motility diarrhea

85
Q

osmotic diarrhea?

A

Nonabsorbable substance in the intestine draws water into the lumen by osmosis, causing large-volume diarrhea

86
Q

secretory diarrhea?

A

Form of large-volume diarrhea caused by excessive mucosal secretion of chloride or bicarbonate-rich fluid or the inhibition of net sodium absorption

87
Q

motility diarrhea?

A

Excessive motility decreases transit time, mucosal surface contact, and opportunities for fluid absorption

88
Q

clinical manifestations of acute bacterial or viral infection of diarrhea

A

fever, with or without cramping

89
Q

clinical manifestations of IBD diarrhea

A

Fever, cramping pain, bloody stools

90
Q

clinical manifestations of malabsorption syndrome diarrhea

A

steatorrhea (fat in stools)

91
Q

what causes abdominal pain

A

stretching, inflammation, or ischemia

92
Q

Biochemical mediators of the inflammatory response

A

histamine, bradykinin, and serotonin

93
Q

where does upper GI bleeding come from

A

esophagus, stomach, or duodenum

94
Q

what does upper GI bleeding look like

A

bright red bleeding in emesis or digested blood (“coffee grounds”) in stool

95
Q

where does lower GI bleeding come from

A

jejunum, ileum, colon, or rectum

96
Q

hematemesis?

A

the vomiting of blood that’s bright red, or similar to coffee grounds

97
Q

hematochezia?

A

the passage of fresh blood, per anus

98
Q

melana?

A

black, tarry stool

99
Q

occult bleeding?

A

blood instool you cant see

100
Q

dysphagia?

A

difficulty swallowing; Distention and spasm of esophagus after swallowing, regurgitation of undigested food

101
Q

Achalasia

A

Denervation of smooth muscle in the esophagus and lack of lower esophageal sphincter relaxation

102
Q

trmt for achalasia

A

Dilation or surgical myomotomy of the lower esophageal sphincter

103
Q

what causes dysphasia

A

esophageal obstruction, impaired esophageal motility, or achalasia

104
Q

GERD?

A

The reflux of chyme from the stomach to the esophagus

105
Q

reflux esophagitis?

A

inflammation of esophagus from GERD

106
Q

Vomiting, coughing, lifting, bending, or obesity can contribute to what disease

A

GERD

107
Q

clinical manifestations of GERD

A

Heartburn, regurgitation of chyme, and upper abdominal pain within 1 hour of eating, chronic cough, laryngitis

108
Q

diagnosis of GERD?

A

biopsy to see dysplastic changes/ barrett esophagus

109
Q

trmt for GERD

A

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
Q

hiatal hernia?

A

Protrusion of the upper part of the stomach through the diaphragm and into the thorax

111
Q

3 types of hernias

A

sliding, paraesophageal, mixed

112
Q

sliding hernia?

A

stomach moves through the diaphragm into the esophagus

113
Q

MC hernia type?

A

sliding

114
Q

paraesophageal/rolling hernia?

A

Herniation of the greater curvature

of the stomach is through a secondary opening in the diaphragm

115
Q

causes of hiatal hernia

A

short esophagus, Trauma, Weak diaphragmatic muscles, Increased abdominal pressure

116
Q

Pyloric/gastric outlet obstruction

A

Blocking or narrowing of the opening between the stomach and duodenum

117
Q

clinical manifestations of Pyloric/gastric outlet obstruction

A

Epigastric pain and fullness, nausea, vomiting; if prolonged, malnutrition and dehydration

118
Q

Intestinal obstruction

A

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
Q

Colicky pains caused by intestinal distention, followed by nausea and vomiting are symptoms of what

A

SI obstruction

120
Q

Hypogastric pain and abdominal distention are symptoms of what

A

LI obstruction

121
Q

if the vomitus is Early, profuse vomiting of clear gastric fluid, where is the obstruction?

A

pylorus

122
Q

if the vomitus is Mild distention and vomiting of bile-stained fluid, where is the obstruction?

A

proximal small intestines

123
Q

if the vomitus has fecal matter, where is the obstruction

A

lower SI

124
Q

what does a simple obstruction indicate

A

presence of lesion

125
Q

what does a functional obstruction/ paralytic ileus indicate

A

failure of motility

126
Q

MC small intestinal obstruction

A

fibrous adhesion

127
Q

MC large intestinal obstruction

A

Colorectal cancer, volvulus (twisting), and strictures related to diverticulitis

128
Q

Acute colonic pseudo-obstruction (Ogilvie syndrome)

A

Massive dilation of the large bowel; patients who are critically ill and older adults who are immobilized

Pathophysiology (17 decks)

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