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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
What is constipation?
Difficult or infrequency of stoll passage resulting in hard stool commonly in wome, young children, and older adults
25
What are the primary causes of constipation and identify its effect?
**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
26
What are the secondary causes of constipation and identify its effect?
**Neurgonic:** stroke, spinal cord injury **Pharmacologic:** opioids **Endocrine:** hypothyroidism, DM **Mechanical:** weakness, failness, pain
27
What are types of altered motility?
1. Diarrhea 2. Constipation
28
Where does upper GI bleeding occur and what are the types of bleeds within that area?
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
29
Where does lower GI bleeding occur and what are the types of bleeds within that area?
Small intestine, large intestine, colon, rectum: **Hematochezia:** bright red blood in stool
30
What is occult blood? How is it diagnosed?
Slow, chronic bleeding that is not detectable in routine stool or gastric secretions Diagnosed by guaiac test that uses stool samples
31
What are cardinal sx are present in esophagus disorders?
1. Pain 2. Alteration in ingestion 3. Bleeding
32
What is esophagitis and what are the types?
Irritation or inflammation of esophagus tissue: 1. Infectious 2. Radiation 3. Corrosion 4. Pill
33
What is infectious esophagitis caused by?
1. Parasites, virus, fungi, bacteria 2. HSV/AIDS 3. CMV 4. Candida
34
What is radiatio esophagitis caused by?
Iatrogenic injury from medical exams or treatments: 1. Irradiation of chemo (thoracic cancer) 2. Chemo agents
35
What is corrossive esophagitis caused by?
Mechanical injury by ingestion of strong alkaline or acidic substances
36
What is pill esophagitis caused by?
Mechanical injury caused by medication lodging in throat
37
Sx of infectious esophagitis?
1. Dysphagia 2. Chest pain 3. Odynophagia 4. Signs of infection
38
Sx of radiation and corrosive esophagitis?
1. Dysphagia 2. Chest pain 3. Odynophagia 4. Esophageal bleeding or perforation
39
Sx of pill esophagitis?
1. Sudden chest pain 2. Odynophagia
40
What is GERD?
Constellation of esophageal and extraesophageal sx
41
What is reflux esophagitis?
Esophagitis from reflux of gastric contents
42
What are the risk factors of GERD?
1. LES tone decrease 2. Vagotomy 3. Gastrin decrease 4. Pregnancy 5. Obesity 6. Impaired esophageal motility
43
Patients with GERD may also be diagnosed with ___?
1. Asthma 2. A fib 3. Low systolic BP
44
Where is the location of GERD?
Gastroesophageal junction (GEJ)
45
What is the normal function of the LES? How does GERD differ?
1. LES relaxes allow substance to pass 2. LES tightens to allow contents to digest and prevent reentrance Mechanical failure
46
What are the s/s of GERD?
1. erosion and ulceration from acid ligering in esophagus 2. Ulcer (damage to mucosal layer of GIT)
47
What are the factors of chronic failute of LES?
1. Transient LES relaxation 2. Acid pocket 3. Obesity 4. Ineffective esophageal clearance
48
What is TLESR?
Stomach venting execcive gas triggering vagal afferents and diaphragm
49
TLESR is twice as common in ____ patients than ___ patients?
GERD; healthy
50
What is an acid pocket?
Pocket of gastric acid that floats on top of ingested meals
51
GERD patients have ___ and ___ acid pockets compared to healthy patients?
larger and closer
52
____ is a major component of refluxed contentes in GERD?
Acid
53
How does obesity contribute to GERD?
1. Increaed abdominal pressure 2. LES pressure gradient
54
What facotrs affect relux clearance?
1. SUpine position 2. Reduced saliva 3. Decreased secondary peristalsis 4. Disorders of esophageal motility
55
What are the sx of GERD?
1. Heartburn 2. Epigastric pain 3. Regurgitation 4. Dysphonia (difficulty speaking)
56
What are the complications of increased gastric content exposure?
1. Erosive esophagitis 2. Barrett esophagus 3. Peptic strictures 4. Esophageal cancer
57
What are the sx of GERD in infants?
1. Vomiting or regurgitation 2. Dough 3. Failure to thrive 4. SLeep disturbances 5. Irratibility 6. Difficulty feeding
58
What are the sx of GERD in older children?
1. Abdominal pain 2. Heartburn like 3. Regurgitation 4. Cough
59
What is barrett esophagus?
Metaplastic change in lining of esophageal mucosa (Barrett metaplasia)
60
What causes Barret esophagus?
Long-standing GERD from injury to mucosa leadign to dysplasia and carcinoma
61
What are the sx of Barret esophagus?
1. Gastric like cells grow up in esophagus 2. Reflux tolerated 3. May be asymptomatic 4. Heatburn 5. Regurgitation
62
What are the cardinal GI sx of stomach disorders?
1. Pain 2. Altered ingestion 3. Altered digestion 4. GIT bleed
63
What balances gastric acids?
1. Feedback mechanism 2. Protective barriers in gastric lining
64
What are the esophagus disorders?
1. Esophagitis 2. GERD 3. Barrett esophagus
65
What is the pH of HCl?
1.5-3.5
66
What is PUD caused by?
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
What are the types of PUD?
1. Imbalances in gigestive agents (HCl, pepsin) 2. Imbalances in protective mucosal barriers in GI lining
68
What are the types of mucosal erosions found in PUD?
**Inflammation and erosion:** affecting layers **Ulceration:** penetrate the mucosal layers and begin eroding the mucosal layers **Perforated:** GIT wall is eroded through entirely
69
What are the risk factors of PUD?
1. Smoking 2. Excessive alcohol 3. Drug use 4. Emotional stress 5. Psychological factors
70
How does *H. pylori* cause PUD?
Bacteria secretes urease → alkaline environment → release of inflammatory cytokines → mucosal inflammation → hypochlorhydria or hyperchlorhydria
71
What is hypochlohydria?
**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
What is hyperchlohydria?
**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
How do NSAID cause PUD?
Inhibits COX enzymes → GI bleeding
74
What are the sx of PUD?
1. Epigastric pain 2. Dyspepsia
75
What are the complications of PUD?
1. GI bleed 2. Perforation 3. GI obstruction
76
What is the difference between gastritis and gastropathy?
**Gastritis:** Irritation and injury of gastric mucosal **Gastropathy:** Any gastric disorder that doesn't produce inflammation
77
What are the types of gastritis?
1. Acute 2. Ulcerohemorrhagic gastritis/Stress-related mucosal disease (SRMD) 3. Drug induced
78
What is acute gastritis caused by?
*H. pylori*
79
What is Ulcerohemorrhagic gastritis/SRMD caused by?
Critical ill patients who experience physiologic stress and ischemic changes
80
What drug can induce gastritis?
1. NSAIDs 2. Steroids 3. Chemo 4. Alcohol 5. Iron
81
What are causes of chronic gastritis?
1. Infection 2. Chemical and caustic agents 3. Radiation 4. Autoimmune disease
82
What occurs during the stages of gastritis?
**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
What are the sx of gastritis?
Asymptomatic or mild dyspepsia
84
What are the disorders of the stomach?
1. PUD 2. Gastritis
85
What are the cardinal signs of small, large intestine and rectum disorders?
1. Altered motility 2. Pain 3. Bleeding
86
What are the causes motility failure?
1. Malabsorption 2. Malnutrition 3. Dehydration
87
What is IBD? Types?
Chronic inflammatory disorder involving GIT: 1. Ulcerative colitis 2. Crohn disease
88
What is ulcerative colitis?
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
What is Crohn disease?
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
What are factors that affect IBD?
1. Environment 2. Microbial imbalance 3. Genetics 4. Inappropriate immune response
91
What is active vs remitting IBD?
**Active:** Depends on segment (mild to severe) **Remission:** Sx may decrease or even disappear
92
What are the sx of UC? Risks?
1. Bloody diarrhea 2. Tenesmus (sense of incomplete cowel evacuation) 1. Increased stomach cancer risk 2. Toxic megacolan (dilation of colon and excessive episodes of bloody diarrhea)
93
What are the sx of Crohn disease?
1. Pain with defecation 2. N/V/D 3. Abdominal pain
94
What are the complications of CD?
1. Bowel strictures and obstructions 2. Bowel perforations 3. Intra-abdominal abscesses May require surgical interventions
95
What is appendicitis? Is it dangerous?
Infectious process that inflames appendix caused by obstruction (fecalith) Rupture may caus peritonitis or death
96
What is the differecne between simple and complicated appendicitis?
**Simple:** w/o complications **Complicated:** w/ complications
97
What are the sx of appendicitis?
1. Cramping 2. Tenderness 3. N/V 4. Increased WBC 5. Low-grade fever
98
What is ileus?
Blockage of ileum or part of intestine
99
What are the types of bowel obstructions?
1. Small 2. Low-grade 3. High-grade 4. Functional
100
What are adhesions?
Scar tissue that forms between tissues and organs commonly after abdominal surgery
101
What are the causes of SBO?
**H**ernia **A**dhesions **N**eoplasm/tumor **G**allstone **I**ntussusception **V**olvulus
102
What are the sx of bowel obstruction?
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
What are the physical presentation of bowel obstruction?
Hyperactive bowel sounds or absent
104
What is IBS? How is it typed?
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
What is the cause of motility in IBS?
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
What are the sx of IBS?
1. N 2. Lethargy 3. Backache 4. Bladder sx
107
What is diverticula?
Small out pouching or herniation of colonic mucosa through muscle layers of the colon wall
108
What is the difference between diverticulosis and diverticulitis?
Diverticulosis: w/o inflammation Diverticulitis: w/ inflammation
109
Where does diverticular disease occur?
Primarily in descending colon
110
What causes diverticular disease?
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
What occurs during uncomplicated diverticulosis?
1. Herniation of mucosa 2. Chronic low-grade inflammation
112
What occurs during complicated diverticulosis?
Inflammation and formation of abscess → bleeding or perforation
113
Diverticulitis are diverticula with ___?
1. Obstruction 2. Stasis 3. Altered local bacteria
114
What are the sx of Diverticular disease?
1. Sudden and constant abdominal pain in left lower quadrant 2. Fever 3. Tachycardia 4. Hypotension
115
What are the hemorrhoidal cushions?
**Hemorrhoids:** Abnormal enlargements of these cushions. **Internal hemorrhoids:** Originate above the dentate line. **External hemorrhoids:** Originate below the dentate line
116
What are the causes of hemorhoids?
1. Engorgement and straining leading to prolapse of tissue into anal canal 2. Vasodilation from downward displacement of cushion → swelling and prolapse
117
What are the grades of internal hemorrhoid?
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
What are the sx of hemorrhoidal disease?
1. Hematochezia 2. Bleeding Large hemorrhoids → rectal fullness and incomplete evacuation
119
What is hematochezia?
Passage of fresh blood through the anus, usually in or with stools
120

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