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Anatomy and Physiology-DNP > Alterations of Digestive System > Flashcards

Alterations of Digestive System Flashcards

1
Q

Referred pain

A
  • visceral pain that’s felt at some distance from the diseased or infected organ
  • Referred pain develops as visceral pain increases
  • Ex. gallbladder is inflamed and pain is felt between the shoulder blades. Pain begins as a vague pain but worsens as the inflammation worsens
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2
Q

GI dysfunction and biochemical mediators

A
  • biochemical mediators of the inflammatory response

- -histamine, bradykinin, and serotonin stimulate organic nerve endings producing abd. pain

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3
Q

Upper GI bleed

A
  • Esophagus, stomach, duodenum

- Caused by ulcer disease, varices, or cancer

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4
Q

Lower GI bleeding

A
  • below the ligament of Treitz or bleeding from the jejunum. ileum, colon, or rectum
  • Diverticulitis, polyps, diverticulitis, inflammatory disease, cancer, hemorrhoids
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5
Q

GI bleeding

A
  • upper GI bleeding
  • lower GI bleeding
  • hematemesis
  • hematochezia
  • melena
  • occult bleeding
  • Change in HR, BP, and CO are best measures for blood loss.
  • If significant blood loss then blood is shunted to vital organs
  • Low UOP b/c blood is shunted away from the kidney to the heart and brain
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6
Q

Disorders of motility

A
  • Dysphagia
  • GERD (reflux of chyme from stomach to esophagus)
  • Hiatal hernia
  • Pyloric obstruction
  • intestinal obstruction and ileus
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7
Q

GERD

A
  • Conditions that increase abd. pressure can contribute to GERD
  • S/S heartburn, regurg of chyme, upper abd pain w/in 1 hour of eating, worsen laying down
  • LES maintains the high pressure to prevent GERD-gerd pressure is lower
  • TX: PPI or H2 blocker, increase HOB, wt. reduction, stop smoking.
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8
Q

Pyloric obstruction

A
  • blocking or narrowing of the opening between the stomach and the duodenum
  • Can be aquired or congenital
  • epigastric pain and fullness, n/v, and w/ prolonged obstruction, malnutrition, dehydration and extreme debilitation
  • Vomiting is a cardinal sign-copious
  • If due to ulcerative issues-conservative measure: NGT, use PPI, may need electrolyte replacement
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9
Q

Intestinal obstruction

A
  • an ileus is an obstruction of the intestines
  • s/s: colicky pain, vomiting, distention, hypovolemia, metabolic acidosis
  • small intestine more commonly obstructed
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10
Q

Simple obstruction

A

-mechanical obstruction or blockage by a lesions (adhesions are common)

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11
Q

Functional obstruction

A

-failure of motility (paralytic ileus): common after GI/Abd surgery. Anaesthesia, opioids, and hyperactivity of the parasympathetic nervous system

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12
Q

Large intestinal obstruction

A

-seen w/ malignancy, twisting, stricture, diverticulitis

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13
Q

Gastritis

A
  • inflammatory disorder of the gastric mucosa
  • acute gastritis (H pylori, NSAIDS)
  • Chronic gastritis
  • affects antrum, fundus of stomach or both
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14
Q

Peptic ulcer disease

A
  • a break or ulceration in the protective mucosal lining of the lower esophagus, stomach or duodenum
  • Acute or chronic ulcers
  • Superficial (erosions)
  • Deep (true ulcers)
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15
Q

Chronic NSAID use

A

-suppresses prostaglandin synthesis resulting in decreased bicarb secretion and mucin production increasing levels of HCL

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16
Q

Duodenal ulcers

A
  • most common of the peptic ulcers
  • H Pylori infection, hypersecretion of stomach acid and pepsin, use of NSAIDs, high gastrin levels, acid production by smoking
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17
Q

Symptoms of duodenal ulcers

A
  • chronic, intermittent pain, 30min-2hours after eating, pain is caused by sensineural stimulation by acid or muscle spasm.
  • Symptoms relieved w/ food or antacids
  • Can heal or may recur
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18
Q

Eval/Tx of duodenal ulcer

A
  • Endoscopic
  • Eval H pylori test
  • Antacids (help neutralize the gastric contents, eval pH, inactivate pepsin and relieve pain).
  • H2, PPI inhibit acid secretion
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19
Q

Gastric ulcer

A
  • tends to develop in antral region of the stomach, adjacent to the acid-secreting mucosa of the body
  • Patho: primary defect is an increase mucosal permeability to hydrogen ions
  • Gastric secretion is normal or less than normal
  • S/S: similar to duodenal ulcers, pain is relieved w/ food, may see anorexia, vomiting
  • Tx: PPI
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20
Q

Stress ulcer

A
  • stress ulcer is a peptic ulcer that’s related to severe illness, neural injury or systemic trauma
  • ischemic ulcers
  • cushing ulcers (from burn injuries)
  • s/s bleeding.
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21
Q

Ischemic ulcers

A
  • develop within hours of event-hemorrhage, trauma, burn; can be seen at multiple sites
  • can be seen related to shock, anorexia, sympathetic response to decrease blood flow-causes ischemia of the stomach and duodenal mucosa
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22
Q

Cushing ulcer

A

-result in burn injury; associated w/ severe head trauma/brain surgery; results from decreased blood flow to the mucosa and hypersecretion of acid produced by vagal nuclei

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23
Q

Dumping syndrom

A
  • rapid emptying of hypoertonic chyme from surgically created residual stomach into small intestine
  • complication of partial gastrectomy or pyloroplasty surgery
  • s/s: 10-20minutes after eating, loss of gastric emptying can lead to tachycardia, hypotension, weakness, pallor, sweating, cramping, fullness, N/V
  • Tx: manage w/ well dietary management, small frequent meals high in protein and low carbs
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24
Q

Postgastrectomy syndrimes

A
  • alkaline reflux gastritis
  • Afferent loop obstruction
  • diarrhea, wt loss, anemia
25
Q

Malabsorption syndromes

A
  • inadequate digestion
  • pancreatic insufficiency
  • Lactase deficiency
  • Bike salt deficiency
  • Gluten-sensitive enteropathy
26
Q

Pancreatic insufficiency: malabsorption syndromes

A
  • insufficient pancreatic enzyme production (lipase, amylase, trypsin, or chymotrypsin)
  • causes: pancreatitis, pancreatic carcinoma, pancreatic resection, and cystic fibrosis
  • Fat maldigestion is main problem-fatty stools and wt. loss
27
Q

Bile salt deficiency: malabsorption syndromes

A
  • Conjugated bile salts needed to emulsify and absorb fats
  • Conjugated bile salts are synthesized from cholesterol in the liver
  • result from liver disease and bile obstructions
  • Poor intestinal absorption of lipids causes fatty stools diarrhea, and loss of fat-soluble vitamins (A,D,E,K)
  • Tx: vitamin supplement and increase medium chain triglycerides in the diet
28
Q

Fat soluble vitamins

A
  • Vit A-night blindness
  • Vit D
  • Vit K
  • Vit E
29
Q

Inflammatory bowel diseases

A
  • chronic, relapsing inflammatory bowel disorders unknown origin
  • Crohn, UC
  • Genetics, alterations of epithelial barrier functions
  • immune reactions to intestinal flora
  • abnormal T cell responses
30
Q

Ulcerative Colitis

A
  • chronic inflammation disease that causes ulcerations of the colonic mucosa (sigmoid colon, and rectum)
  • suggested causes: infectious, immune (anticolon antibodies), dietary, genetic)
  • Extends from rectum to colon
  • s/s diarrhea (10/20 a day)-blood stools, cramps, dehydration, anemia, wt. loss
  • Tx: broad-spectrum abx, immunosuppressive agents, surgery
  • increased colon cancer risk
  • Remission and exacerbations
  • Low hgb, low albumin, low K
31
Q

Crohn disease

A
  • granulomatous colits, ileocolitis, or regional enteritis
  • idiopathic inflammatory disorder, affects any part of the digestive tract from mouth to anus
  • difficult to differentiate from UC.
  • Distal small intestine, and proximal large intestine
  • “skip lesions”
  • Ulcerations and inflammation can involve multiple layers and into lymphatics
32
Q

Diverticula

A

-diverticula (herniations of mucosa through muscle layers of colon wall. esp. sigmoid colon.

33
Q

Diverticulosis

A
  • asymptomatic diverticular disease

- Uknown cause may relate to decrease deitary and increase intracolonic pressure

34
Q

diverticulitis

A
  • inflammatory stage of diverticulosis
  • s/s: low abd. pain, diarrhea, constipation, fever, leukocytosis
  • Eva/tx: Abd CT, US, sigmoidoscopy, barium enema
  • Increase fiber, abx and surgery
35
Q

Appendicitis

A
  • inflammation of vermiform appendix
  • causes: obstruction, ischemia, increase intraluminal pressure, infection, ulceration
  • s/s: epigastric and RLQ pain, rebound tenderness, N/V, fever leukocytosis
  • Most serious complication: peritonitis
  • EVAL/TX: CBC, WBC, CRP, CT scan. US
  • Surgery/appendectomy, abx
36
Q

Vascular insufficiency

A
  • blood supply to stomach and intestine
  • Mesenteric venous thrombosis
  • acute occlusion of mesenteric artery blood flow
37
Q

Acute occlusion of mesenteric artery blood flow

A
  • reduction in mucosal blood flow from the arteries supplying the large and small intestine.
  • Ischemia and necrosis can alter membrane permeabilty.
  • Ischemia leads to decreased motility and distention.
  • fluid loss 2/2 mucosal alteration which can lead to hypovolemia and shock.
  • Bacteria invade the nectoic intestinal wall causing gangrene and peritonitis.
38
Q

Chronic mesenteric insufficiency

A
  • nonocclusive mesenteric insufficiency, can develop 2/2 atherosclerosis, CHF, MI, hemorrhage, or thrombus formation.
  • May see abdominal angina after meals given lack of proper blood flow.
39
Q

Manifestations of liver disease

A
  • portal hypertension
  • ascites
  • hepatic-encephalopathy
  • jaundice
  • hepatorenal syndrome
40
Q

Portal hypertension

A
  • abnormally high BP in portal venous system due to resistance to portal blood flow
  • caused by disorders that obstruct or impede blood flow
  • most common cause is obstruction caused by cirrhosis of liver
41
Q

Portal HTN consequences

A
  • varices (lower esophagus, stomach, rectum)
  • splenomegaly
  • ascites
  • hepatic encephalopathy
  • Abd distention, SOB, wt. gain, hyponatremia,
  • Tx: parecentesis, send fluid for Cx,
42
Q

Varices from portal HTN

A

-prolonged elevation of pressure in the collateral veins-causes transformation into varices, especially in the lower esophagus and stomach.

43
Q

Splenomegaly from portal HTN

A

-increased pressure in the splenic vein which branches from the portal vein. Thrombocytopenia is the most common manifestation and can contribute to increased bleeding.

44
Q

Ascitis from portal htn

A
  • accumulation of fluid between the visceral and parietal peritoneum
  • increase pressure in the mesenteric tributaries of the portal vein.
  • Hydrostatic pressure forces water out of the vessels and into the peritoneal cavity. Fluid trapped in the third space.
  • W/ cirrhosis see both portal HTN, and decreased albumin w/ both cause ascites
45
Q

Overfill theory

A

proposes that renal sodium retention is stimulated by portal hypertension with intravascular hypervolemia and overflow into the peritoneal cavity.

46
Q

hepatic encaphalopathy

A
  • impaired cognitive dysfunction, flapping tremor, EEG changes. -
  • Liver dysfunction and collateral vessels that shunt blood around the liver to the systemic circulation permit neurotoxins and other harmful substances absorbed from the GI tract to circulate freely to the brain. Most harmful end product of intestinal protein digestion is ammonia.
47
Q

Hepatorenal syndrome (HRS)

A

-renal failure-oliguria, Na, water retention, hypotension, peripheral vasodilation due to advanced liver disease

48
Q

Renal failure r/t liver failure

A

-hypovolemia, hotn, decreased renal bf, intrarenal vasoconstriction, decreased GFR, and UO

49
Q

Viral hepatitis

A
  • hep A (infectious hep)
  • Hep B (serum hep)
  • Hep C, D, E, G
  • Co infection of HBV, HIV, HCV, HDV
50
Q

Hep A

A
  • can be found in feces, bile, and sera of infected individuals
  • fecal oral route transmission
51
Q

Hep B

A
  • transmitted through contact w/ infected blood, body fluids, contaminated needles
  • maternal transmission during 3rd trimester
  • Hep B vaccine
52
Q

Hep C

A
  • Responsible for most cases of post transfusion hep

- hep C cases result in chronic hepatitis most times

53
Q

Hepatitis

A
  • Hep D (depends on B)
  • Hep E (fecal oral transmission), developing countries)
  • Hep G (recently discovered, patenterally and sexually transmitted)
54
Q

Cirrhosis

A
  • Irreversible inflammatory disease that disrupts liver function and structure
  • Decreased hepatic function from nodular and fibrotic tissue synthesis (fibrosis)
  • Biliary channels become obstructed and cause portal hypertension; due to the hypertension, blood shunted away from the liver, and a hypoxic necrosis develops
55
Q

Cirrhosis types

A
  • Alcoholic (oxidation of alcohol damages hepatocytes)
  • Biliary
  • Postnecrotic
56
Q

Disorders of gallbladder

A

-Cholectytitis
-Gallstones
-ERCP: Endoscopic retrograde cholangiopancreatography; is one way to look for stones.
Tx with laparoscopic cholecystectomy.

57
Q

Disorders of pancreas

A
  • Pancreatitis
  • These enzymes cause autodigestion of pancreatic tissue and leak into the bloodstream to cause injury to blood vessels and other organs
  • Inflammation of the pancreas
  • Associated with several clinical disorders (alcohol intake and cholelithiasis)
58
Q

Pancreatitis

A

-Epigastric pain radiating to the back Fever and leukocytosis Hypotension and hypovolemia
-Enzymes increase vascular permeability/dilate vessels
-Characterized by an increase in a patient’s serum amylase level
-Chronic pancreatitis
Related to chronic alcohol abuse
–Eval/Tx: see elevated amylase/lipase levels. Get US or Abd CT to help r/o other disorders or issues that may occur.
-Goal is to stop the process of autodigestion and prevent systemic complications. Pain medications, NGT, IVF, PPI to decrease gastric acid

Anatomy and Physiology-DNP (18 decks)

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