Alterations Of Digestive Function

Question 1

Constipation

Answer 1

Difficult or frequent defecation

Question 2

Normal transit constipation

Answer 2

Normal rate of stool passage, but difficulty of evacuation

Causes: sedentary lifestyle, low fiber diet, low fluid intake

Question 3

Slow transit constipation

Answer 3

Slow rate of stool passage caused by impaired colon peristalsis
Causes: again, neurogenic disorders, medications that slow bowel movement, or other GI diseases

Question 4

Hirschsprung disease

Answer 4

This is a disease caused by the absence or partial absence of of the enteric nervous system and reduces peristalsis

Question 5

Diarrhea

Answer 5

Presence of loose or watery stools

Question 6

Osmotic diarrhea

Answer 6

Substance in the lumen of the large intestine attract water, producing large volumes of diarrhea
Causes: lactose intolerant, pancreatic enzyme deficiency

Question 7

Secretory diarrhea

Answer 7

Intestinal epithelium secretes large volumes of fluid; many cases are due to infection
Chrons disease and ulcerative colitis can cause it

Question 8

Motility diarrhea

Answer 8

Insufficient water absorption in intestines

Cause: bowel resection, fistula formation, hyperthyroidism and laxative abuse

Question 9

Steatorhea

Answer 9

Fat in the stools

Cause: pancreatic enzyme insufficiency

Question 10

Gastroesophageal reflux disease

Answer 10

Reflux of hydrochloride acid and gastric enzymes through the lower esophageal sphincter in to the esophagus

Question 11

Risk factors for GRD

Answer 11

Hiatal hernia
Foods
Pregnancy
Pyloric stenosis obstruction

Question 12

Hiatal hernia GRD

Answer 12

Weakening of the connection between the diaphragm and the wall of the esophagus leading to instability of the LES

Question 13

Pyloric stenosis obstruction GRD

Answer 13

Hypertrophy of the pyloric valve leads to delayed gastric emptying and increased volume of gastric contents

Question 14

Patho of GRD

Answer 14

Decreased LES tone and increased intrabdominal pressure resulting in the reflux of hydrochloride acid and pepsin into the lower esophagus

Question 15

Lower esophageal strictures

Answer 15

Scare tissue formation in the wall of the distal esophagus leading to a narrowing of the esophagus and obstruction of the food passage

Question 16

Barrett’s esophagitis

Answer 16

Dysplastic changes of the esophageal epithelium occurring in 10-15% of individuals with GERD

Question 17

Esophageal cancer

Answer 17

Adenocarcinoma that develops in dysplastic tissue

Question 18

Peptic ulcer disease

Answer 18

Ulceration in the mucosal lining of the stomach or duodenum

Primary cause: H. Pyloric-a spiral shaped, gram negative bacteria that can survive in highly acidic environments

Question 19

Patho of PUD

Answer 19

Each bacterium has a flagellum that drills a hole in the mucus creating a space for the organism to burrow into
H. Pylori secretes an enzyme that neutralizes hydrochloride acid in the stomach, allowing the bacteria to survive, mucous layer is weakend allowing. The HCL and pepsin back flow

Question 20

Other causes of PUD

Answer 20

Non-steroidal anti-inflammatory medications NSAIDs: inhibit prostaglandins which leads to decreased gastric/duodenal mucus production
Many NSAIDs also have anticoagulant properties

Psychological stress

Excessive use of tobacco

Question 21

Intestinal vascular insufficiency

Answer 21

Ischemia of the intestines also known as me sent Eric vascular insufficiency or ischemic bowel disease

Question 22

Types of IVI

Answer 22

Transmural infarct
Complete cessation of blood flow to a section of the GI tract
Causes: arterial thrombus or thromboembolism in the superior or inferior mesenteric artery
Severe ischemia causes cramping and bowel wall necrosis

Question 23

Nonocclusive hypoperfusion

Answer 23

Chronic hypo-perfusion of the intestines

Causes: non-occlusive atherosclerosis, LVF

Question 24

Ulcerative colitis

Answer 24

Autoimmune, chronic inflammatory disease of the colon mucosa. Age of onset 15-30 years. Causes: include genetic and environmental factors

Question 25

Patho of UC

Answer 25

Autoimmune reaction epithelial cells lining the inside of the colon Infiltration of inner layer of the colon by B and T lymphocytes Extensive erosions colon’s mucosal lining leading to loss of surface area for absorption in colon Colon necrosis and abscesses can develop

Question 26

Clinical manifestations UC

Answer 26

Periods of exacerbation and remissions. Can occur in mild and severe forms Cramping abdominal pain Lots of diarrhea, lower GI bleed, anal fissures and abscesses

Question 27

Crohn disease

Answer 27

Autoimmune, chronic inflammatory disease of the digestive tract wall affecting all layers and the entire length Causes: include genetic and environmental factors

Question 28

Patho of Crohn’s disease

Answer 28

Gene mutation stimulates an overactive response to the GI bacteria leading to an auto immune reaction similar to UC Inflammation, which affects the entire wall of the intestine Mucosal injury occurs in skip lesions from the mouth to the anus

Question 29

Clinical manifestations and consequences of CD

Answer 29

Diarrhea Malnutrition leading to weight loss Bowel obstruction Intestinal and anal fissures and abscesses

Question 30

GI bleed risk factors

Answer 30

Use of anti inflammatory medications | Liver cirrhosis

Question 31

Liver cirrhosis

Answer 31

Decreased clotting factor production | Portal hypertension and esophageal varices

Question 32

Causes of Uppper GI bleed

Answer 32

Esophagus: cancer or varices Stomach: cancer or ulcers Duodenum: ulcers

Question 33

Causes of lower GI bleed

Answer 33

Jejunum, ileum: diverticulitosis, Chiron disease Colon: cancer, ulcerative colitis Rectum: cancer, haemorrhoids

Question 34

Clinical manifestations of Acute GI bleed

Answer 34

``` Hematemesis Hematochezia(blood in stool) Melena (dark bloody stool) Orthostatic hypotension Hypovolemia shock ```

Question 35

CF of chronic GI bleed

Answer 35

Trace amounts of blood in stool or GI secretions | Decreased hemoglobin/hematocrit with decreased plasma ferritin

Question 36

Consequences of liver disorders

Answer 36

Decreased to convert unconjugated bilirubin into conjugated bilirubin Decrease production of albumin leading to reduced plasma oncotic pressure Decreased production of inflammatory proteins

Question 37

Patho of portal hypertension

Answer 37

Obstruction to hepatic portal vein blood flow through liver Varices form in tributaries to the hepatic portal vein. Splenomegaly

Question 38

As cites

Answer 38

Accumulation of fluid in the peritoneal cavity

Question 39

Causes of ascites

Answer 39

Portal hypertension Hypoalbuminemia Fluid overload Abdominal cancers

Question 40

Patho of ascites

Answer 40

Portal hypertension leads to increased hydrostatic pressure in the GI caps Decreased plasma albumin due to liver failure also leads to decreased plasma oncotic pressure Fluid leaks out of digestive. Capillaries and seeps into the peritoneal cavity

Question 41

Clinical consequences of ascites

Answer 41

Abdominal distinction Hypovolemia and hypotension Hypoxemia and hypercapnea leading to dysplastic

Question 42

Hepatic encephalopathy

Answer 42

Neurological syndrome caused by elevated plasma ammonia levels from advances liver disease

Question 43

Patho of HE

Answer 43

Normally ammonia is liberated during the process of protein breakdown Hepatocyte injury/death leads to a buildup of ammonia in the blood Ammonia leaks into the bloodstream and reaches the cerebral circulation

Question 44

Alcoholic cirrhosis

Answer 44

Diffuse inflammatory and fibrotic disease of the liver caused by chronic and excessive alcohol consumption

Question 45

Patho of alcoholic cirrhosis

Answer 45

In hepatocytes, alcohol is matbolyzed to form acetaldehyde which interferes with cell function Leads to inflammation Scar tissue Portal hypertension

Question 46

Acute pancreatitis

Answer 46

Characterized by acute inflammation and injury to the pancreas