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Drug Action II > Block 1: Upper and Lower GI Pathophys > Flashcards

Block 1: Upper and Lower GI Pathophys Flashcards

1
Q

What is the function of the digestive system?

A

Prepares ingested foods for absorption or elimination

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2
Q

What are GI tract components?

A
  1. Mouth
  2. Esophagus
  3. Stomach
  4. Duodenum
  5. Small intestine
  6. Large intestine
  7. Rectum
  8. AnusWh
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3
Q

What are the accessory organs of digestion?

A
  1. Tongue
  2. Salivary glands
  3. Liver
  4. Pancreas
  5. Gall bladder
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4
Q

What is the upper GI system’s function?

A

Secretes mucus, water, and enzymes to aid in mechanisms nicad and chemical digestion

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5
Q

What is the lower? GI system’s function?

A
  1. Absorbs nutrients and fluids
  2. Eliminates wastes
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6
Q

What are the cardinal signs and symptoms of GI disorders?

A
  1. Pain
  2. Altered ingestion
  3. Altered motility
  4. Bleeding
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7
Q

What is the most common esophageal symptom?

A

Heart burn

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8
Q

What is the difference between heart burn and esophageal chest pain?

A

Heart burn: discomfort behind the sternum and epigastrium common experienced after eating or exercise

Esophageal chest pain: pressure sensation in the mid chest similar to a cardiac chest pain that radiates in back, arms, and jaw due to the same nerve plexus (gastroesophageal reflux)

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9
Q

What is the uncomfortable feels asscoiated with pathophys of upper GIT?

A

Dyspesia: bloating, nausea, fullness

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10
Q

What is the pain caused by swallowing?

A

Odynophagia

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11
Q

What is the sensation of fullness or lumping in throat?

A

Globus sensation

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12
Q

What are the types of pain and sensations of GI disorders?

A
  1. Heart burn
  2. Esophageal chest pain
  3. Dyspepsia
  4. Odynophagia
  5. Globulus sensation
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13
Q

What is the difference between regurgitation and vomiting?

A

Regurgitation: Effortless return of food and fluid without retching
Vomiting: Forceful evacuation of gastric contents usually preceded by nausea

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14
Q

What types of maneuvers provoke regurgitation?

A
  1. Overdistending the stomach
  2. Bending
  3. Belching
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14
Q

What are the s/s of regurgitation?

A
  1. Burning in throat
  2. Sour taste
  3. Undigested food return
  4. Halitosis
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15
Q

What is reflux?

A

Backwards movement of GI contents; involuntary

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16
Q

What is dysphagia?

A

Difficulty swallowing food and liquids; sticking to throat

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17
Q

What is dysphagia for solids an indicator for?

A

Obstructive lesion in the esophagus

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18
Q

What is dysphagia for solids and liquids an indicator for?

A

Motor disorder:
1. Upper: striated muscle dysmotility (graves and stroke)
2. Lower: smooth muscle dysmotility (achalasia)

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19
Q

What are the types of altered ingestion of GI disorders?

A
  1. Regurgitation
  2. Reflux
  3. Vomiting
  4. Dysphagia
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20
Q

What is diarrhea?

A

Increase in stool, volume, and weight and evacuation frequency of stool per day

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21
Q

Infrequent vs frequent bowl elimination patterns?

A

Infrequent: 1/week
Frequent: 2-3/day

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22
Q

What is large volume diarrhea and indicator for?

A

Increase in volume of stool majorly osmotic or secretory

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23
Q

What is small volume diarrhea and indicator for?

A

Increased intestinal motility from inflammatory bowel and motility causes

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24
Q

What is constipation?

A

Difficult or infrequency of stoll passage resulting in hard stool commonly in wome, young children, and older adults

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25
Q

What are the primary causes of constipation and identify its effect?

A

Normal transit: normal rate but difficulty with elimination due to low fiber diet
Slow trnasit: impaired colonic motot activity with infrequent evaculations
Pelvic floor dysfunction: impariment in pelvic floor muscle preventing stool evacuation

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26
Q

What are the secondary causes of constipation and identify its effect?

A

Neurgonic: stroke, spinal cord injury
Pharmacologic: opioids
Endocrine: hypothyroidism, DM
Mechanical: weakness, failness, pain

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27
Q

What are types of altered motility?

A
  1. Diarrhea
  2. Constipation
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28
Q

Where does upper GI bleeding occur and what are the types of bleeds within that area?

A

Esophagus, stomach, duodenum:
Hematemesis: blood in vomit both undigested (bright red) and digested blood (dark, grainy)
Melena: Blood in stool (black, tarry) from digestion of blood

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29
Q

Where does lower GI bleeding occur and what are the types of bleeds within that area?

A

Small intestine, large intestine, colon, rectum:
Hematochezia: bright red blood in stool

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30
Q

What is occult blood? How is it diagnosed?

A

Slow, chronic bleeding that is not detectable in routine stool or gastric secretions

Diagnosed by guaiac test that uses stool samples

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31
Q

What are cardinal sx are present in esophagus disorders?

A
  1. Pain
  2. Alteration in ingestion
  3. Bleeding
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32
Q

What is esophagitis and what are the types?

A

Irritation or inflammation of esophagus tissue:
1. Infectious
2. Radiation
3. Corrosion
4. Pill

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33
Q

What is infectious esophagitis caused by?

A
  1. Parasites, virus, fungi, bacteria
  2. HSV/AIDS
  3. CMV
  4. Candida
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34
Q

What is radiatio esophagitis caused by?

A

Iatrogenic injury from medical exams or treatments:
1. Irradiation of chemo (thoracic cancer)
2. Chemo agents

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35
Q

What is corrossive esophagitis caused by?

A

Mechanical injury by ingestion of strong alkaline or acidic substances

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36
Q

What is pill esophagitis caused by?

A

Mechanical injury caused by medication lodging in throat

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37
Q

Sx of infectious esophagitis?

A
  1. Dysphagia
  2. Chest pain
  3. Odynophagia
  4. Signs of infection
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38
Q

Sx of radiation and corrosive esophagitis?

A
  1. Dysphagia
  2. Chest pain
  3. Odynophagia
  4. Esophageal bleeding or perforation
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39
Q

Sx of pill esophagitis?

A
  1. Sudden chest pain
  2. Odynophagia
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40
Q

What is GERD?

A

Constellation of esophageal and extraesophageal sx

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41
Q

What is reflux esophagitis?

A

Esophagitis from reflux of gastric contents

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42
Q

What are the risk factors of GERD?

A
  1. LES tone decrease
  2. Vagotomy
  3. Gastrin decrease
  4. Pregnancy
  5. Obesity
  6. Impaired esophageal motility
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43
Q

Patients with GERD may also be diagnosed with ___?

A
  1. Asthma
  2. A fib
  3. Low systolic BP
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44
Q

Where is the location of GERD?

A

Gastroesophageal junction (GEJ)

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45
Q

What is the normal function of the LES? How does GERD differ?

A
  1. LES relaxes allow substance to pass
  2. LES tightens to allow contents to digest and prevent reentrance

Mechanical failure

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46
Q

What are the s/s of GERD?

A
  1. erosion and ulceration from acid ligering in esophagus
  2. Ulcer (damage to mucosal layer of GIT)
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47
Q

What are the factors of chronic failute of LES?

A
  1. Transient LES relaxation
  2. Acid pocket
  3. Obesity
  4. Ineffective esophageal clearance
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48
Q

What is TLESR?

A

Stomach venting execcive gas triggering vagal afferents and diaphragm

49
Q

TLESR is twice as common in ____ patients than ___ patients?

A

GERD; healthy

50
Q

What is an acid pocket?

A

Pocket of gastric acid that floats on top of ingested meals

51
Q

GERD patients have ___ and ___ acid pockets compared to healthy patients?

A

larger and closer

52
Q

____ is a major component of refluxed contentes in GERD?

A

Acid

53
Q

How does obesity contribute to GERD?

A
  1. Increaed abdominal pressure
  2. LES pressure gradient
54
Q

What facotrs affect relux clearance?

A
  1. SUpine position
  2. Reduced saliva
  3. Decreased secondary peristalsis
  4. Disorders of esophageal motility
55
Q

What are the sx of GERD?

A
  1. Heartburn
  2. Epigastric pain
  3. Regurgitation
  4. Dysphonia (difficulty speaking)
56
Q

What are the complications of increased gastric content exposure?

A
  1. Erosive esophagitis
  2. Barrett esophagus
  3. Peptic strictures
  4. Esophageal cancer
57
Q

What are the sx of GERD in infants?

A
  1. Vomiting or regurgitation
  2. Dough
  3. Failure to thrive
  4. SLeep disturbances
  5. Irratibility
  6. Difficulty feeding
58
Q

What are the sx of GERD in older children?

A
  1. Abdominal pain
  2. Heartburn like
  3. Regurgitation
  4. Cough
59
Q

What is barrett esophagus?

A

Metaplastic change in lining of esophageal mucosa (Barrett metaplasia)

60
Q

What causes Barret esophagus?

A

Long-standing GERD from injury to mucosa leadign to dysplasia and carcinoma

61
Q

What are the sx of Barret esophagus?

A
  1. Gastric like cells grow up in esophagus
  2. Reflux tolerated
  3. May be asymptomatic
  4. Heatburn
  5. Regurgitation
62
Q

What are the cardinal GI sx of stomach disorders?

A
  1. Pain
  2. Altered ingestion
  3. Altered digestion
  4. GIT bleed
63
Q

What balances gastric acids?

A
  1. Feedback mechanism
  2. Protective barriers in gastric lining
64
Q

What are the esophagus disorders?

A
  1. Esophagitis
  2. GERD
  3. Barrett esophagus
65
Q

What is the pH of HCl?

A

1.5-3.5

66
Q

What is PUD caused by?

A

Chronic erosion and destruction in the lining of the stomach caused by ulcers in the stomach lining and duodenum

H. pylori infection or NSAIDs

67
Q

What are the types of PUD?

A
  1. Imbalances in gigestive agents (HCl, pepsin)
  2. Imbalances in protective mucosal barriers in GI lining
68
Q

What are the types of mucosal erosions found in PUD?

A

Inflammation and erosion: affecting layers
Ulceration: penetrate the mucosal layers and begin eroding the mucosal layers
Perforated: GIT wall is eroded through entirely

69
Q

What are the risk factors of PUD?

A
  1. Smoking
  2. Excessive alcohol
  3. Drug use
  4. Emotional stress
  5. Psychological factors
70
Q

How does H. pylori cause PUD?

A

Bacteria secretes urease → alkaline environment → release of inflammatory cytokines → mucosal inflammation → hypochlorhydria or hyperchlorhydria

71
Q

What is hypochlohydria?

A

Decreased parietal cell acid secretion from:
1. Decreased H-K ATPase
2. Decreased gastrin secretion
3. Increased somatostatin secretion
4. Gastric ulcers, loss appetite, weight loss

72
Q

What is hyperchlohydria?

A

Increased parietal cell acid secretion:
1. Increased H-K ATPase
2. Increased gastrin secretion
3. Decreased somatostatin secretion
4. Duodenal ulcers, eating, weight gain

73
Q

How do NSAID cause PUD?

A

Inhibits COX enzymes → GI bleeding

74
Q

What are the sx of PUD?

A
  1. Epigastric pain
  2. Dyspepsia
75
Q

What are the complications of PUD?

A
  1. GI bleed
  2. Perforation
  3. GI obstruction
76
Q

What is the difference between gastritis and gastropathy?

A

Gastritis: Irritation and injury of gastric mucosal
Gastropathy: Any gastric disorder that doesn’t produce inflammation

77
Q

What are the types of gastritis?

A
  1. Acute
  2. Ulcerohemorrhagic gastritis/Stress-related mucosal disease (SRMD)
  3. Drug induced
78
Q

What is acute gastritis caused by?

A

H. pylori

79
Q

What is Ulcerohemorrhagic gastritis/SRMD caused by?

A

Critical ill patients who experience physiologic stress and ischemic changes

80
Q

What drug can induce gastritis?

A
  1. NSAIDs
  2. Steroids
  3. Chemo
  4. Alcohol
  5. Iron
81
Q

What are causes of chronic gastritis?

A
  1. Infection
  2. Chemical and caustic agents
  3. Radiation
  4. Autoimmune disease
82
Q

What occurs during the stages of gastritis?

A

Superficial: early stage with limited inflammation of mucosa surface
Atrophic: inflammation changes extend deeper into mucosa damaging gastric secretory glands (pernicious anemia and decreased acid production)
Gastric: gastric glandular structures lost that become metaplasia leading to gastric cancer

83
Q

What are the sx of gastritis?

A

Asymptomatic or mild dyspepsia

84
Q

What are the disorders of the stomach?

A
  1. PUD
  2. Gastritis
85
Q

What are the cardinal signs of small, large intestine and rectum disorders?

A
  1. Altered motility
  2. Pain
  3. Bleeding
86
Q

What are the causes motility failure?

A
  1. Malabsorption
  2. Malnutrition
  3. Dehydration
87
Q

What is IBD? Types?

A

Chronic inflammatory disorder involving GIT:
1. Ulcerative colitis
2. Crohn disease

88
Q

What is ulcerative colitis?

A

Inflammation limited to the sub and mucosal layers, can be pancolitis

Changes in bowel include:
1. Epithelial damage
2. Inflammation
3. Crypt abscesses
4. Loss of goblet cells

89
Q

What is Crohn disease?

A

Transmural inflammation of the bowel (ileum and proximal oon)

Skip lesion that are not continuous

Changes in bowel include:
1. Wall thickening
2. Ulcerations
3. Submucosal thickening
4. Cobblestone patterns of mucosa

90
Q

What are factors that affect IBD?

A
  1. Environment
  2. Microbial imbalance
  3. Genetics
  4. Inappropriate immune response
91
Q

What is active vs remitting IBD?

A

Active: Depends on segment (mild to severe)
Remission: Sx may decrease or even disappear

92
Q

What are the sx of UC? Risks?

A
  1. Bloody diarrhea
  2. Tenesmus (sense of incomplete cowel evacuation)
  3. Increased stomach cancer risk
  4. Toxic megacolan (dilation of colon and excessive episodes of bloody diarrhea)
93
Q

What are the sx of Crohn disease?

A
  1. Pain with defecation
  2. N/V/D
  3. Abdominal pain
94
Q

What are the complications of CD?

A
  1. Bowel strictures and obstructions
  2. Bowel perforations
  3. Intra-abdominal abscesses

May require surgical interventions

95
Q

What is appendicitis? Is it dangerous?

A

Infectious process that inflames appendix caused by obstruction (fecalith)

Rupture may caus peritonitis or death

96
Q

What is the differecne between simple and complicated appendicitis?

A

Simple: w/o complications
Complicated: w/ complications

97
Q

What are the sx of appendicitis?

A
  1. Cramping
  2. Tenderness
  3. N/V
  4. Increased WBC
  5. Low-grade fever
98
Q

What is ileus?

A

Blockage of ileum or part of intestine

99
Q

What are the types of bowel obstructions?

A
  1. Small
  2. Low-grade
  3. High-grade
  4. Functional
100
Q

What are adhesions?

A

Scar tissue that forms between tissues and organs commonly after abdominal surgery

101
Q

What are the causes of SBO?

A

Hernia
Adhesions
Neoplasm/tumor
Gallstone
Intussusception
Volvulus

102
Q

What are the sx of bowel obstruction?

A

Bowel dilates proximal to blockage → swallowed gas can’t pass → body pull fluid to lumen of the bowel → can lead to vomiting → hypovolemia and metabolic alkalosis

103
Q

What are the physical presentation of bowel obstruction?

A

Hyperactive bowel sounds or absent

104
Q

What is IBS? How is it typed?

A

Abdominal discomfort associated with altered bowel habits:
1. IBS with constipation (IBS-C)
2. IBS with diarrhea (IBS-D)
3. IBS with mixed constipation and diarrhea (IBS-M)
4. Unclassified (IBS-U)

105
Q

What is the cause of motility in IBS?

A
  1. Abnormal gut motor and sensory activity
  2. Central neural dysfunction
  3. Psychologic disturbances
  4. Mucosal inflammation
  5. Stress
  6. Luminal factors

No pathognomonic abnormalities

106
Q

What are the sx of IBS?

A
  1. N
  2. Lethargy
  3. Backache
  4. Bladder sx
107
Q

What is diverticula?

A

Small out pouching or herniation of colonic mucosa through muscle layers of the colon wall

108
Q

What is the difference between diverticulosis and diverticulitis?

A

Diverticulosis: w/o inflammation
Diverticulitis: w/ inflammation

109
Q

Where does diverticular disease occur?

A

Primarily in descending colon

110
Q

What causes diverticular disease?

A
  1. Increased intraluminal pressure
  2. Weakness of bowel wall

Diverticula typically occur at any point where a feeder artery penetrates muscle or breaks colonic wall integrity

111
Q

What occurs during uncomplicated diverticulosis?

A
  1. Herniation of mucosa
  2. Chronic low-grade inflammation
112
Q

What occurs during complicated diverticulosis?

A

Inflammation and formation of abscess → bleeding or perforation

113
Q

Diverticulitis are diverticula with ___?

A
  1. Obstruction
  2. Stasis
  3. Altered local bacteria
114
Q

What are the sx of Diverticular disease?

A
  1. Sudden and constant abdominal pain in left lower quadrant
  2. Fever
  3. Tachycardia
  4. Hypotension
115
Q

What are the hemorrhoidal cushions?

A

Hemorrhoids: Abnormal enlargements of these cushions.
Internal hemorrhoids: Originate above the dentate line.
External hemorrhoids: Originate below the dentate line

116
Q

What are the causes of hemorhoids?

A
  1. Engorgement and straining leading to prolapse of tissue into anal canal
  2. Vasodilation from downward displacement of cushion → swelling and prolapse
117
Q

What are the grades of internal hemorrhoid?

A
  1. No prolapse, just prominent blood vessels
  2. Prolapse upon bearing down, spontaneous reduction
  3. Prolapse and manual reduction
  4. Prolapse with inability to manually reduced
118
Q

What are the sx of hemorrhoidal disease?

A
  1. Hematochezia
  2. Bleeding
    Large hemorrhoids → rectal fullness and incomplete evacuation
119
Q

What is hematochezia?

A

Passage of fresh blood through the anus, usually in or with stools

120
Q
A

Drug Action II (28 decks)

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