Ch. 36 Flashcards
1
Q
Digestive tract layers
Deep to superficial
A
- Mucosa
- Submucosa
- Muscularis Externa
- Serosa
2
Q
Digestive tract wall is the same
A
from esophagus to anus
3
Q
Mucus layer
A
provides level of epithelial (Mucosa protection)
-varies in different areas of the digestive tract
4
Q
Mucosa layer in the small intestine
A
1 layer
5
Q
mucosa layer in the large intestine
A
2 layers, inner and outer layers
6
Q
Gastro-intestinal dysorders
A
disrupt one or more of its functions
7
Q
structural and neural abnormalities
A
-obstruct, slow/accelerate intestinal contractions
8
Q
inflammatory and ulcerative conditions disrupt
A
-secretions
-motility
-absorption
9
Q
problems with accessory organs
A
alter metabolism
10
Q
Greek word for vommiting
A
Emesis
11
Q
Vommiting/emesis
A
-forceful emptying stomach/intestinal contents through mouth
12
Q
what is the vomiting center
A
medulla oblongota
13
Q
retching
A
muscular event of vomiting without vomitous expulsion
14
Q
projectile vomiting
A
-spontaneous vomiting that does not follow nausea or retching
15
Q
cause of projectile vomiting
A
direct stimulation of vomit center (medulla oblongota)
16
Q
Process of vomiting
(1)
A
Severe pain, distention of stomach/duodenum
17
Q
Process of vomiting
(2. initiation)
A
deep inhalation and glottis closes
18
Q
Process of vomiting
(3)
A
abdominal muscles create pressure from stomach to throat
19
Q
Process of vomiting
(4)
A
duodenum and stomach antrum spasm forcing chyme into esophagas
20
Q
Process of vomiting
(5)
A
upper esophageal sphincter stays closed = contents can’t enter mouth
21
Q
Process of vomiting
(5)
A
abdominal muscles relax and contents return to the stomach
22
Q
Process of vomiting
(6)
A
process is repeated several times
23
Q
Process of vomiting
(7)
A
parasympathetic system relaxes both esophageal sphincters
24
Q
Process of vomiting
(8)
A
abdominal muscles contract = force diaphragm high into thoracic cavity = stomach chyme forced out of mouth
25
normal defecation range
1-3/day to 1/week
26
constipation
difficult/infrequent defecation
27
primary constipation
impaired, infrequent, and straining colonic movement
28
secondary constipation
neural pathways are altered/colon transit time delayed
29
opiate constipation
-codeine especially
-inhibit bowel movement
30
a change in constipation can indicate
colorectal cancer
31
manifestations of constipation
straining to evacuate stool may cause hemorrhoids
32
diagnosis of constipation
-assess sphincter tine and detect anal lesions
-colonoscopy (direct lumen view)
33
constipation Tx
-OTC laxatives (RestoraLAX)
-enemas
-surgery
34
enemas used to
establish bowel routine but should not be used habitually
35
surgery for constipation treatment
colectomy (remove part of the colon) is a last resort
36
Diarrhea
loose watery stools
37
acute diarrhea
24h or less
38
persistent diarrhea
14-28 days
39
chronic diarrhea
longer than 4 weeks
40
osmotic diarrhea
non-absorbable substance in intestine draws excess water to intestine
41
secretory diarrhea
excessive mucosal secretion of fluid and electrolytes
42
secretory diarrhea cause
-viruses, bacterial toxins
-Rotavirus: RNA virus (enteritis)
43
enteritis
inflammation of intestinal system
44
motility diarrhea
excessive motility = decreased transit time
= decreased fluid reabsorption = diarrhea
45
Diarrhea tx
-restoration of fluid and electrolytes
-anti-motility or water absorbent medication
46
abdominal pain cause
-mechanical, inflammatory, or ischemic
-organs stretch/distend = activation of pain receptors
47
Types of abdominal pain
-parietal pain
-visceral pain
48
parietal abdominal pain
pain from parietal peritoneum
-localized and intense
49
visceral abdominal pain
-distension, inflammation, ischemia of abdominal organs
-poorly localized with radiating pattern
50
Upper gastro-intestinal bleeding
-esophagus, stomach, duodenum
-bright pink or dark bleeding (affected by stomach acids)
51
Upper gastro-intestinal bleeding cause
-peptic ulcers
-tearing of esophageal gastric junction caused by severe retching
52
lower gastro-intestinal bleeding
-jejunum, ileum, colon, rectum
53
lower gastro-intestinal bleeding cause
-polyps
-inflammatory disease
-hemorrhoids
54
occult bleeding
-slow chronic blood loss
-not obvious
-results in iron deficiency (anemia)
55
presentation of GI bleeding
-trace amounts of blood in diarrhea or stools
-bp reduction
-compensating tachycardia
-vision loss
56
dysphagia
difficulty swallowing
57
mechanical obstruction (dysphagia)
obstruction in esophageal wall (tumors, herniations)
58
Functional dysphagia
-neural/muscular disorders interfere with swallowing
59
Achalasia
rare form of dysphagia
60
achalasia cause
smooth muscle neurons of middle/lower esophagus attacked by immune response
61
result of achalasia
-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
LES
lower esophageal sphincter
63
GERD
gastroesophageal reflux disease
64
Reflux
acid/pepsin or bile salts into esophagus causes esophagitis
65
GERD/reflux cause
-abnormalities in LES (low reset tone)
-delayed gastric emptying of chyme
66
severe esophageal damage depends on
composition and duration of reflux
67
increased acidic chyme exposure causes
mucosal injury and inflammation
68
persistent GERD/reflux
fibrosis thickening, precancerous lesions
69
GERD/reflux diagnosis
-endoscopy
-tissue biopsy
70
GERD/Reflux tx
-laparoscopic fundoplication to tighten junction between esophagus and stomach to prevent acid reflux
71
hiatal hernia
protrusion (herniation) of superior aspect of stomach through diaphragm hiatal into thorax
72
sliding hiatal herniation
stomach moves into thorax though esophageal hiatus (opening in diaphragm)
-GERD association
73
paraoesophageal hiatal herniation
stomach moves into thorax alongside esophageal
-leads to gastritis and ulcer formation
74
risk of hiatal hernation
strangulation of hernia = medical emergency
75
diagnosis
radiology with barium swallow
76
hiatal herniation tx
-sleeping with your head up
-laparoscopic fundoplication
77
intestinal obstruction
any condition that prevents normal flow of chyme through intestinal lumen
78
paralytic ileus
(functional obstruction)
failure of intestinal motility due to dysfunctional neural activity after surgery
79
large bowel obstruction (LBO)
-less common/ often related to cancer
80
LBO s+s
abdominal distension
vomiting
81
Small bowel obstruction (SBO) cause
-post-op adhesions/herniations which lead to distensions (enlargement)
82
SBO results
-distension
-systemic ECF osmotically moves into lumen
-intestinal lumen becomes acidic
-leakage of pathogens
83
SBO distension
impaired absorption and increased secretion = accumulation of fluid, gas, and solutes into lumen
84
SBO systemic ECF osmolarity moves into lumen causes
-decreased ECF
-dehydration/tachycardia and possibly shock
85
SBO leakage of pathogens
- always present in intestine leak into systemic circulation (sepsis) causes immune response with possible remote organ failure
86
gastritis
inflammatory disorder of gastric mucosa
87
acute gastritis
erosion of protective stomach mucosal barrier by Helicobacter pylori and NSAIDs
88
NSAIDs
inhibit prostaglandin synthesis which normally stimulates goblet cell secretion of mucus
89
H. Pylori
burrows into mucus layer and disrupts function of mucosal layer and triggers immune response which further destroys mucosal layer
90
acute gastritis symptoms
-pain
-vomiting
91
how long does acute gastritis take to heal
a few days
92
chronic gastritis
occurs in older adults
causes chronic inflammation and mucosal atrophy
93
Chronic nonimmune (antral gastritis)
-in the antrum
-caused by H. pylori
-high levels of hydrochloric acid secretion = increased risk of duodenal ulcers
94
chronic immune (fundal gastritis)
-affects body and fundus
-associated with loss of Tcell tolerance resulting in gastric mucosa being extensively degenerated in stomach fundus and body
95
peptic ulcer disease
cause: H. pylori, NSAIDs
result: break or ulceration in protective mucosal lining
96
3 disorders of peptic ulcer disease
1. duodenal ulcers
2. gastric ulcers
3. stress-related mucosal disease
97
duodenum ulcers
-most frequent
-cause: H. pylori, NSAIDs
98
duodenum ulcers causative factors
-alone or together acid and pepsin concentrations penetrate mucosal barrier cause ulceration
99
duodenum ulcers host response
-T + B cells, neutrophils combat H. pylori but damage gastric epithelium with cytokine release
100
duodenum ulcers H. pylori function
release toxin resulting in apoptosis of epithelial cells
101
gastric ulcers
-1/4 as common as duodenal ulcers
-cause: h. pylori, NSAIDs
102
where does gastric ulcers develop
gastric antrum (next to acid-producing gastric body)
103
gastric ulcers defect is an
increase in mucosal barriers permeability to hydrogen ions
104
gastric ulcers hydrogen ions
disrupt mucosal permeability and structure
105
gastric ulcers resulting cycle
damaged mucosa liberates histamine = increased HCL and pepsin production = mucosal destruction
106
Stress related mucosal disease
-acute peptic ulcer
-follows stress, illness, or major trauma
-many ulcer sites in stomach or duodenum
107
Stress related mucosal disease types
1. ischemic ulcers
2. curling ulcers
3. crushing ulcers
108
ischemic ulcers
develop within hours of events such as hemorrhage, heart failure, sepsis
109
curling ulcers
develop because burn injury
110
crushing ulcers
develop because of brain trauma/surgery
111
inflammatory bowel disease
environmental factors or infections that alter mucosal epithelium barrier
112
Inflammatory bowel disease result
-loss of body ability to discriminate harmful pathogens from commensal MO
113
Commensal
association between two organisms in which one benefits and the other derives neither benefit or harm
114
loss of ability to discriminate in inflammatory bowel disease means
activation of immune system production of proinflammatory cytokines
-intestinal epithelial damage
115
three inflammatory bowel diseases
1. ulcerative colitis
2. chron's disease
3.irritable bowel syndrome
116
ulcerative colitis
chronic inflammatory disease causes ulcers in colonic (colon) mucosa
117
ulcerative colitis pathophysiology (1)
disease begins in rectum and may extend to entire colon
118
ulcerative colitis pathophysiology (2)
small erosions coalesce into ulcer = necrosis
119
ulcerative colitis pathophysiology (3)
thickening of muscularis mucosa narrows lumen = reduces transit time in colon
120
ulcerative colitis pathophysiology (4)
mucosal destruction and inflammation causes bleeding and urge to defecate
121
ulcerative colitis signs
frequent watery diarrhea with small amounts of blood and mucus (10-20 stools/d)
122
ulcerative colitis lasts
for intermitted periods of remission and exacerbation
123
ulcerative colitis diagnosis
endoscopy and biopsies
124
ulcerative colitis tx
steroids, medication, surgery for severe disease
125
Chron's disease
idiopathic inflammatory disorder
-affects any part of the digestive tract from mouth to anus
126
Chron's disease pathophysiology (1)
inflammation begins in intestinal submucosa and spreads discontinuous or transmural
127
discontinuous
skip lesions
128
transmural
across entire wall of organ
129
Chron's disease common sites
1. ascending and transverse colon
2. large and small intestine
130
Chron's disease ulcerations
can produce fissures (fistulae) that extend inflammation into lymphoid tissue
131
increased risk of Chron's disease from
smoking, also causes poor response to treatment
132
Chron's disease diagnosis
-endoscopy and biopsies
133
Chron's disease tx
steroids, medication, surgery for severe disease
134
fistulae
an abnormal opening or passage between two organs
135
peri-anal area fistulae
area around anus can be extended into bladder, rectum, or vagina
136
Irritable bowel syndrome (IBS)
abdominal pain with altered bowel habits (alternate constipation and diarrhea)
137
