Alterations of Digestive Function 1 Flashcards
what is anorexia associated with?
a) nausea
b) abdominal pain and indigestion
c) diarrhea
what is vomiting a result of?
reverse peristalsis in duodenum/stomach
what is vomiting?
forceful contraction of abdominal mm.
what is vomiting usually preceded by?
by N/V
how is vomiting initiated?
a) various drugs
b) trauma or torsion to ovaries, testes, uterus, bladder, kidney, GI or brain
c) activation of medullary centre
what is constipation d/t?
a) personal habits
b) various disorders
c) drugs
d) inadequate fluid intake
e) mm. weakness
what may constipation lead to?
hard stools and difficult evacuations
what is fecal impaction?
retention of hardened stool in rectum or colon causing bowel obstruction
in which populations is fecal impaction more common in?
a) elderly
b) immobilized
c) prolonged bed rest
if a patient is experiencing fecal impaction, what is there usually a hx of?
watery diarrhea/fecal incontinence
a sigmoidoscope is used for what?
treating fecal impaction
what is large volume diarrhea d/t?
excessive water and/or secretions in intestines
what is small volume diarrhea d/t?
increase intestinal motility
what is parietal abdominal pain?
localized and intense
what is visceral abdominal pain?
diffuse and vague
what is visceral abdominal pain closely connected to?
ANS. will see pallor, sweating, N/V
what is referred abdominal pain?
well localized (more than parietal abdominal pain), felt in skin/deeper tissues
what is hematemesis?
bloody vomit.
can either be frank or coffee-ground in colour
what is melena?
tarry, foul-smelling stool d/t digested blood
what is hematochezia?
frank blood from rectum
what is occult blood?
trace amounts of blood in stool or gastric secretions (detected in lab)
what does acute severe GI bleeding cause?
HR/BP changes
what can happen if there is blood accumulation in the GI tract?
vomiting & diarrhea
what is dysphagia d/t?
a) lack of salivary glands
b) esophageal obstruction
c) neural or muscular disorders (impaired esophageal motility)
the term used to describe when the lower esophageal sphincter fails to relax is _______.
achalasia
what is a hiatal hernia?
protrusion of upper part of stomach INTO thoracic cavity through esophageal hiatus
which type of hiatal hernia is common and considered okay in asymptomatic patients?
sliding hiatal hernia
which type of hiatal hernia progressively enlarges and may lead to the entire stomach herniating into the thorax?
paraesophageal hernia
what can hiatal hernias lead to although often symptomatic?
a) GER
b) esophagitis
c) dysphagia
d) regurgitation
what is gastroesophageal reflux?
backwards movement of gastric contents into esophagus
what can GER lead to?
a) esophagitis
b) cancer
c) asthma attack
d) strictures
e) esophageal spasm
f) decreased esophageal motility
when does GER turn into GERD (gastroesophageal reflux disease)?
when regurgitation of chyme into esophagus becomes persistent
what can GERD lead to?
a) upper abdominal pain w/in 1 hour of eating
b) heartburn
how can symptoms of GERD worsen?
lying down or increased intra-abdominal pressure
what is GERD associated with?
a weak gastroesophageal sphincter
what is inflamed in gastritis?
gastric mucosa (usually superficial erosions)
what is acute gastritis d/t?
mucosal injury d/t drugs, chemicals or bacterial toxins
what erodes in acute gastritis?
surface epithelium in diffuse or localized patterns
list the manifestations of acute gastritis (3)
- vague abdominal discomfort
- epigastric tenderness
- bleeding (ocasional hematemesis)
in acute gastritis, inflammation is usually ____ and heals ______ w/in a few days.
in acute gastritis, inflammation is usually transient and heals spontaneously w/in a few days.
what is chronic gastritis?
a) thinning and degeneration of stomach lining
b) absence of visible erosions
c) presence of chronic inflammatory changes leading to atrophy of glandular epithelium
which population does chronic gastritis usually affect?
the elderly
list 3 signs of chronic gastritis
- anorexia
- nausea
- pain
list causes of chronic gastritis (3)
- H. Pylori (most common)
- autoimmune
- chemicals (NSAIDs or secretions/bile)
why does auto-digestion occur in peptic ulcer disease?
breaks/ulcerations (from pepsin and acid) exposes submucosal tissue to gastric secretions
what type of ulcerations erode the mucosa but do not penetrate it?
superficial ulcerations/erosions
what are true ulcers?
ulcers that extend through muscularis and damages blood vessesls
why would an ulcer lead to the complication of bleeding?
because the ulcer has penetrated to the submucosa or deeper
what can happen if slow bleeding occurs in PUD?
iron deficiency anemia
why would an ulcer lead to the complication of perforation?
because the ulcer has extended through the entire stomach wall
what else can happen if an ulcer perforates?
peritonitis
gastric juices enters the peritoneal cavity
where do gastric ulcers usually occur?
antrum
what age range do gastric ulcers usually occur?
55-65 years
list the major causes of gastric ulcers (4)
- H. Pylori
- NSAIDs (decrease PGs)
- hyper/hyposecretion of acid/bicarbonate
- stress/chemicals
describe the manifestation of gastric ulcers and how can one relieve this?
chronic intermittent pain (burning, gnawing, cramping) that occurs SHORTLY after meals
can be relieved by antacids
how do gastric ulcers heal?
fibrosis w/in 6-8 weeks
gastric ulcerations is an _______ condition
gastric ulcerations is an episodic condition
do duodenal ulcers have more anorexia, vomiting, and weight loss than gastric ulcers?
no. gastric ulcers have more anorexia, vomiting, and weight loss.
how is irritable bowel syndrome (IBS) characterized?
by persistent and recurrent intestinal manifestations in the absence of structural abnormalities
list the manifestations of IBS (7)
- abdominal pain
- diarrhea/constipatino
- urgency
- bloating
- nausea
- anorexia
- anxiety
what is the IBS hallmark?
abdominal pain that is relieved by defecation
list the treatments for IBS (3)
- anti-diarrheals
- increase fibre
- probiotics
name the 2 diseases classified under inflammatory bowel diseases
- ulcerative colitis
2. chron’s disease
what is ulcerative colitis?
chronic inflammation of colon mucosa
where do you typically see ulcerative colitis?
rectum and sigmoid colon
describe ulcerative erosions
they are small erosions that form in the mucosal layer. they can merge to form ulcers that bleed and become necrotic.
what are pseudopolyps?
ulcerated tissue separated by islands of raise, inflamed mucosa
what likes between pseudopolyps?
the only remaining muscularis
in ulcerative colitis, what happens to the lumen?
edema and thickening of muscularis narrows it
what will a patient w/ ulcerative colitis experience?
frequent diarrhea (large volume) w/ passage of small amounts of blood, purulent mucous and cramping
what happens if the entire colon is suffering from ulcerative colitis?
a) fever
b) increased pulse rate
c) urgency
d) frequent, bloody diarrhea
e) continuous crampy pain
name the treatments used for ulcerative colitis?
- avoid caffeine, lactose, spicy or gas-forming food
- increase fibre intake
- anti-inflammatories
- immunosuppressive drugs
- surgical resection/colostomy (if other therapies fail)
does UC increase risk of colon cancer?
yes
what is chron’s disease and what does it affect?
it is recurrent granulomatous inflammation that beings in submucosa w/ hyperemia.
it affects the distal 10-20 cm of ileum, rarely affects colon
in chron’s disease, what do you call portions of the bowel that are unaffected?
skip lesions
name the IBD that has a greater familial predisposition
chron’s disease
what can happen to the ileum?
WBC infiltration -> fibrosis -> rigidity like a lead pipe
manifestations of chron’s disease
- weight loss
- lower abdominal pain
- malaise
- low grade fever
what can happen if the ileum is involved in chron’s disease?
anemia d/t malabsorption of vitamin B12
what is infectious enterocolitis?
infection to the small or large intestine that leads to inflammation
how does infectious enterocolitis commonly manifest?
rapidly w/ low grade fever, vomiting, abdominal pain, and watery diarrhea
name the virus that can cause infectious enterocolitis
norwalk virus
name the bacteria that can cause infectious enterocolitis
- staph
- salmonella
- c. diff
- e. coli
how does c diff proliferate?
when broad-sprectrum antibiotics wipe out mucosal bacteria
what does e. coli do?
produces toxins that lead to local inflammation (diarrhea), damage the kidneys and other structures if systemic
what is diverticular disease?
multiple herniations of mucosa through muscularis externa
where do you see diverticular disease usually?
sigmoid colon
describe the surface of the colon suffering from diverticular disease
hyperemic
what can happen to the erosion from the stool in the diverticula?
it can become inflamed and hemorrhage
in which population is diverticular disease most common?
in the elderly and young people w/ low dietary fibre
what is inflammation of diverticula usually d/t?
infection from an accumulation of fecal matter
when not asymptomatic, what symptoms will you see with diverticular disease?
- cramping
- distension
- constipation
- flatulence
how can you relieve diverticular disease?
from increasing dietary fibre
what will you observe if inflammation occurs in diverticular disease?
- LLQ pain
2. rectal bleeding
how do you treat diverticular disease?
- antibiotics
2. bowel rest
fecalith, tumour and foreign bodies all can cause _____ by?
appendicitis by obstructing lumen of appendix resulting in bacterial infection or torsion
manifestations of acute appendicitis
- gastric/periumbilical pain of incresing intensity over 2-12 hrs –> pain will focus in the RLQ once serosa is involved
name the complications of appendicitis
- abcess formation
2. gangrene -> performation -> peritonitis
how can an intestinal obstruction occur?
by any condition that prevent normal flow of chyme through intestinal lumen
types of intestinal obstructions
- simple (mechanical blockage by lesion or motility issue)
- acute or chronic
- intrinsic
- extrinsic
list 4 major causes of intestinal obstruction
- herniation
- adhesion
- intussusception
- volvulus
clinical manifestations of intestinal obstruction
- intermittent pain with peristalsis
- constipation w/ peristaltic noises
- sweating
- N/V
- abdominal distention
