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hlsc 222 > Ch. 36 > Flashcards

Ch. 36 Flashcards

1
Q

Digestive tract layers

Deep to superficial

A
  1. Mucosa
  2. Submucosa
  3. Muscularis Externa
  4. Serosa
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2
Q

Digestive tract wall is the same

A

from esophagus to anus

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3
Q

Mucus layer

A

provides level of epithelial (Mucosa protection)
-varies in different areas of the digestive tract

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4
Q

Mucosa layer in the small intestine

A

1 layer

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5
Q

mucosa layer in the large intestine

A

2 layers, inner and outer layers

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6
Q

Gastro-intestinal dysorders

A

disrupt one or more of its functions

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7
Q

structural and neural abnormalities

A

-obstruct, slow/accelerate intestinal contractions

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8
Q

inflammatory and ulcerative conditions disrupt

A

-secretions
-motility
-absorption

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9
Q

problems with accessory organs

A

alter metabolism

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10
Q

Greek word for vommiting

A

Emesis

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11
Q

Vommiting/emesis

A

-forceful emptying stomach/intestinal contents through mouth

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12
Q

what is the vomiting center

A

medulla oblongota

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13
Q

retching

A

muscular event of vomiting without vomitous expulsion

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14
Q

projectile vomiting

A

-spontaneous vomiting that does not follow nausea or retching

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15
Q

cause of projectile vomiting

A

direct stimulation of vomit center (medulla oblongota)

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16
Q

Process of vomiting
(1)

A

Severe pain, distention of stomach/duodenum

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17
Q

Process of vomiting
(2. initiation)

A

deep inhalation and glottis closes

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18
Q

Process of vomiting
(3)

A

abdominal muscles create pressure from stomach to throat

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19
Q

Process of vomiting
(4)

A

duodenum and stomach antrum spasm forcing chyme into esophagas

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20
Q

Process of vomiting
(5)

A

upper esophageal sphincter stays closed = contents can’t enter mouth

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21
Q

Process of vomiting
(5)

A

abdominal muscles relax and contents return to the stomach

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22
Q

Process of vomiting
(6)

A

process is repeated several times

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23
Q

Process of vomiting
(7)

A

parasympathetic system relaxes both esophageal sphincters

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24
Q

Process of vomiting
(8)

A

abdominal muscles contract = force diaphragm high into thoracic cavity = stomach chyme forced out of mouth

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25
Q

normal defecation range

A

1-3/day to 1/week

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26
Q

constipation

A

difficult/infrequent defecation

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27
Q

primary constipation

A

impaired, infrequent, and straining colonic movement

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28
Q

secondary constipation

A

neural pathways are altered/colon transit time delayed

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29
Q

opiate constipation

A

-codeine especially
-inhibit bowel movement

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30
Q

a change in constipation can indicate

A

colorectal cancer

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31
Q

manifestations of constipation

A

straining to evacuate stool may cause hemorrhoids

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32
Q

diagnosis of constipation

A

-assess sphincter tine and detect anal lesions
-colonoscopy (direct lumen view)

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33
Q

constipation Tx

A

-OTC laxatives (RestoraLAX)
-enemas
-surgery

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34
Q

enemas used to

A

establish bowel routine but should not be used habitually

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35
Q

surgery for constipation treatment

A

colectomy (remove part of the colon) is a last resort

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36
Q

Diarrhea

A

loose watery stools

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37
Q

acute diarrhea

A

24h or less

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38
Q

persistent diarrhea

A

14-28 days

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39
Q

chronic diarrhea

A

longer than 4 weeks

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40
Q

osmotic diarrhea

A

non-absorbable substance in intestine draws excess water to intestine

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41
Q

secretory diarrhea

A

excessive mucosal secretion of fluid and electrolytes

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42
Q

secretory diarrhea cause

A

-viruses, bacterial toxins
-Rotavirus: RNA virus (enteritis)

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43
Q

enteritis

A

inflammation of intestinal system

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44
Q

motility diarrhea

A

excessive motility = decreased transit time
= decreased fluid reabsorption = diarrhea

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45
Q

Diarrhea tx

A

-restoration of fluid and electrolytes
-anti-motility or water absorbent medication

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46
Q

abdominal pain cause

A

-mechanical, inflammatory, or ischemic
-organs stretch/distend = activation of pain receptors

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47
Q

Types of abdominal pain

A

-parietal pain
-visceral pain

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48
Q

parietal abdominal pain

A

pain from parietal peritoneum
-localized and intense

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49
Q

visceral abdominal pain

A

-distension, inflammation, ischemia of abdominal organs
-poorly localized with radiating pattern

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50
Q

Upper gastro-intestinal bleeding

A

-esophagus, stomach, duodenum
-bright pink or dark bleeding (affected by stomach acids)

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51
Q

Upper gastro-intestinal bleeding cause

A

-peptic ulcers
-tearing of esophageal gastric junction caused by severe retching

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52
Q

lower gastro-intestinal bleeding

A

-jejunum, ileum, colon, rectum

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53
Q

lower gastro-intestinal bleeding cause

A

-polyps
-inflammatory disease
-hemorrhoids

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54
Q

occult bleeding

A

-slow chronic blood loss
-not obvious
-results in iron deficiency (anemia)

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55
Q

presentation of GI bleeding

A

-trace amounts of blood in diarrhea or stools
-bp reduction
-compensating tachycardia
-vision loss

56
Q

dysphagia

A

difficulty swallowing

57
Q

mechanical obstruction (dysphagia)

A

obstruction in esophageal wall (tumors, herniations)

58
Q

Functional dysphagia

A

-neural/muscular disorders interfere with swallowing

59
Q

Achalasia

A

rare form of dysphagia

60
Q

achalasia cause

A

smooth muscle neurons of middle/lower esophagus attacked by immune response

61
Q

result of achalasia

A

-altered esophageal peristalsis
-failure of lowers esophageal sphincter to relax =obstruction
-cough and aspiration can occur/ with less increased pressure food is forced past LES

62
Q

LES

A

lower esophageal sphincter

63
Q

GERD

A

gastroesophageal reflux disease

64
Q

Reflux

A

acid/pepsin or bile salts into esophagus causes esophagitis

65
Q

GERD/reflux cause

A

-abnormalities in LES (low reset tone)
-delayed gastric emptying of chyme

66
Q

severe esophageal damage depends on

A

composition and duration of reflux

67
Q

increased acidic chyme exposure causes

A

mucosal injury and inflammation

68
Q

persistent GERD/reflux

A

fibrosis thickening, precancerous lesions

69
Q

GERD/reflux diagnosis

A

-endoscopy
-tissue biopsy

70
Q

GERD/Reflux tx

A

-laparoscopic fundoplication to tighten junction between esophagus and stomach to prevent acid reflux

71
Q

hiatal hernia

A

protrusion (herniation) of superior aspect of stomach through diaphragm hiatal into thorax

72
Q

sliding hiatal herniation

A

stomach moves into thorax though esophageal hiatus (opening in diaphragm)
-GERD association

73
Q

paraoesophageal hiatal herniation

A

stomach moves into thorax alongside esophageal
-leads to gastritis and ulcer formation

74
Q

risk of hiatal hernation

A

strangulation of hernia = medical emergency

75
Q

diagnosis

A

radiology with barium swallow

76
Q

hiatal herniation tx

A

-sleeping with your head up
-laparoscopic fundoplication

77
Q

intestinal obstruction

A

any condition that prevents normal flow of chyme through intestinal lumen

78
Q

paralytic ileus
(functional obstruction)

A

failure of intestinal motility due to dysfunctional neural activity after surgery

79
Q

large bowel obstruction (LBO)

A

-less common/ often related to cancer

80
Q

LBO s+s

A

abdominal distension
vomiting

81
Q

Small bowel obstruction (SBO) cause

A

-post-op adhesions/herniations which lead to distensions (enlargement)

82
Q

SBO results

A

-distension
-systemic ECF osmotically moves into lumen
-intestinal lumen becomes acidic
-leakage of pathogens

83
Q

SBO distension

A

impaired absorption and increased secretion = accumulation of fluid, gas, and solutes into lumen

84
Q

SBO systemic ECF osmolarity moves into lumen causes

A

-decreased ECF
-dehydration/tachycardia and possibly shock

85
Q

SBO leakage of pathogens

A
  • always present in intestine leak into systemic circulation (sepsis) causes immune response with possible remote organ failure
86
Q

gastritis

A

inflammatory disorder of gastric mucosa

87
Q

acute gastritis

A

erosion of protective stomach mucosal barrier by Helicobacter pylori and NSAIDs

88
Q

NSAIDs

A

inhibit prostaglandin synthesis which normally stimulates goblet cell secretion of mucus

89
Q

H. Pylori

A

burrows into mucus layer and disrupts function of mucosal layer and triggers immune response which further destroys mucosal layer

90
Q

acute gastritis symptoms

A

-pain
-vomiting

91
Q

how long does acute gastritis take to heal

A

a few days

92
Q

chronic gastritis

A

occurs in older adults
causes chronic inflammation and mucosal atrophy

93
Q

Chronic nonimmune (antral gastritis)

A

-in the antrum
-caused by H. pylori
-high levels of hydrochloric acid secretion = increased risk of duodenal ulcers

94
Q

chronic immune (fundal gastritis)

A

-affects body and fundus
-associated with loss of Tcell tolerance resulting in gastric mucosa being extensively degenerated in stomach fundus and body

95
Q

peptic ulcer disease

A

cause: H. pylori, NSAIDs
result: break or ulceration in protective mucosal lining

96
Q

3 disorders of peptic ulcer disease

A
  1. duodenal ulcers
  2. gastric ulcers
  3. stress-related mucosal disease
97
Q

duodenum ulcers

A

-most frequent
-cause: H. pylori, NSAIDs

98
Q

duodenum ulcers causative factors

A

-alone or together acid and pepsin concentrations penetrate mucosal barrier cause ulceration

99
Q

duodenum ulcers host response

A

-T + B cells, neutrophils combat H. pylori but damage gastric epithelium with cytokine release

100
Q

duodenum ulcers H. pylori function

A

release toxin resulting in apoptosis of epithelial cells

101
Q

gastric ulcers

A

-1/4 as common as duodenal ulcers
-cause: h. pylori, NSAIDs

102
Q

where does gastric ulcers develop

A

gastric antrum (next to acid-producing gastric body)

103
Q

gastric ulcers defect is an

A

increase in mucosal barriers permeability to hydrogen ions

104
Q

gastric ulcers hydrogen ions

A

disrupt mucosal permeability and structure

105
Q

gastric ulcers resulting cycle

A

damaged mucosa liberates histamine = increased HCL and pepsin production = mucosal destruction

106
Q

Stress related mucosal disease

A

-acute peptic ulcer
-follows stress, illness, or major trauma
-many ulcer sites in stomach or duodenum

107
Q

Stress related mucosal disease types

A
  1. ischemic ulcers
  2. curling ulcers
  3. crushing ulcers
108
Q

ischemic ulcers

A

develop within hours of events such as hemorrhage, heart failure, sepsis

109
Q

curling ulcers

A

develop because burn injury

110
Q

crushing ulcers

A

develop because of brain trauma/surgery

111
Q

inflammatory bowel disease

A

environmental factors or infections that alter mucosal epithelium barrier

112
Q

Inflammatory bowel disease result

A

-loss of body ability to discriminate harmful pathogens from commensal MO

113
Q

Commensal

A

association between two organisms in which one benefits and the other derives neither benefit or harm

114
Q

loss of ability to discriminate in inflammatory bowel disease means

A

activation of immune system production of proinflammatory cytokines
-intestinal epithelial damage

115
Q

three inflammatory bowel diseases

A
  1. ulcerative colitis
  2. chron’s disease
    3.irritable bowel syndrome
116
Q

ulcerative colitis

A

chronic inflammatory disease causes ulcers in colonic (colon) mucosa

117
Q

ulcerative colitis pathophysiology (1)

A

disease begins in rectum and may extend to entire colon

118
Q

ulcerative colitis pathophysiology (2)

A

small erosions coalesce into ulcer = necrosis

119
Q

ulcerative colitis pathophysiology (3)

A

thickening of muscularis mucosa narrows lumen = reduces transit time in colon

120
Q

ulcerative colitis pathophysiology (4)

A

mucosal destruction and inflammation causes bleeding and urge to defecate

121
Q

ulcerative colitis signs

A

frequent watery diarrhea with small amounts of blood and mucus (10-20 stools/d)

122
Q

ulcerative colitis lasts

A

for intermitted periods of remission and exacerbation

123
Q

ulcerative colitis diagnosis

A

endoscopy and biopsies

124
Q

ulcerative colitis tx

A

steroids, medication, surgery for severe disease

125
Q

Chron’s disease

A

idiopathic inflammatory disorder
-affects any part of the digestive tract from mouth to anus

126
Q

Chron’s disease pathophysiology (1)

A

inflammation begins in intestinal submucosa and spreads discontinuous or transmural

127
Q

discontinuous

A

skip lesions

128
Q

transmural

A

across entire wall of organ

129
Q

Chron’s disease common sites

A
  1. ascending and transverse colon
  2. large and small intestine
130
Q

Chron’s disease ulcerations

A

can produce fissures (fistulae) that extend inflammation into lymphoid tissue

131
Q

increased risk of Chron’s disease from

A

smoking, also causes poor response to treatment

132
Q

Chron’s disease diagnosis

A

-endoscopy and biopsies

133
Q

Chron’s disease tx

A

steroids, medication, surgery for severe disease

134
Q

fistulae

A

an abnormal opening or passage between two organs

135
Q

peri-anal area fistulae

A

area around anus can be extended into bladder, rectum, or vagina

136
Q

Irritable bowel syndrome (IBS)

A

abdominal pain with altered bowel habits (alternate constipation and diarrhea)

137
Q
A

hlsc 222 (9 decks)

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