Ch 36- Alteration in Digestive Function Flashcards
T or F: Digestive tract wall has same structure form esophagus to anus.
True
What are the four layers to digestive tract?
From deep to superficial:
- Mucosa
- Submucosa
- Muscularis externa
- Serosa
The ____ layer provides levels of ____ (mucosa) protection
mucus; epithelial
T or F: GI tract disorders disrupt one or more of its functions.
True
____ & ____ abnormalities can obstruct, slow/accelerate intestinal contents.
structural; neural
Inflammatory and ulcerative condtions disrupt _____, _____ & _____
secretion; motility; absorption
What are the accessory organs that can alter metabolism?
liver, pancreas and gallbladder
What is the Greek word for vomiting?
emesis
What is vomiting?
forceful emptying stomach/intestinal contents through the mouth
Where is the center of vomiting lies?
medulla oblongata
What is retching?
muscular event of vomiting without vomitus expulsion
What is the cause of projectile vomiting?
direct stimulation of vomit center
What is projectile vomiting?
spontaneous vomiting that does not follow nausea or retching
What is the initiation of vomiting?
deep inhalation & glottis closes
During vomiting, ____ and stomach ____ spasm forcing chyme into esophagus
duodenum; antrum
T or F: During vomiting, abdominal muscles creates pressure from stomach to throat.
True
T or F: During vomiting, there is no pain and distension of stomach/ duodenum
False; there is a sever pain, distension of stomach/ duodenum
T or F: During vomiting, upper esophageal sphincter stays open = contents can enter mouth.
False; upper esophageal sphincter stays closed = contents can’t enter mouth
T or F: During the process of vomiting, abdominal muscles does not relax = contents return to stomach.
False; abdominal muscles relax = contents return to stomach
T or F: Vomiting process are repeated several times.
True
During the process of vomiting, the _______ system relaxes ____ esophageal sphincters
parasympathetic; both
When abdominal muscles contract, what happens to the diaphragm during the process of vomiting?
force diaphragm high into thoracic cavity
When the diaphragm is force high into thoracic cavity, what happens to the stomach chyme?
the stomach chyme is forced out of mouth
What is constipation?
difficult/infrequent defecation
Constipation must be ____ determined.
individually
What is the wide normal defacation range?
1-3 days to 1 week
Primary or Secondary constipation: Which is associated with neural pathways are altered/ colon transit time delayed.
secondary constipation
Primary or Secondary constipation: Which is associated with impaired, infrequent and straining colonic movement.
primary constipation
What opiate inhibit bowel movement?
codeine
T or F: Notable change in constipation can be indicative of colorectal cancer.
True
What is the manifestations for constipation?
pushing too hard to poop can cause hemorrhoids
What are some diagnosis for constipation?
- assess sphincter tone and detect anal lesions.
- colonoscopy = direct lumen view.
What do you assess and detect when diagnosing constipation?
sphincter tone & anal lesions
What are some treatments for constipation?
-over the counter laxatives.
- enemas can be used to establish bowel routine but should not be used habitually
- surgery: colectomy – final resort
What is the final resort of treatment for constipation?
colectomy, which is removing part of colon
What is diarrhea?
loose watery stools
What is the time frame for acute diarrhea?
24 hrs or less
What is the time frame for persistent diarrhea?
14-28 days
What is the time frame for chronic diarrhea?
longer than 4 weeks
In children, there is a high rates of _____/____ for children younger than ___ years old
morbidity/mortality; 5
What is osmotic diarrhea?
non-absorbable substance in intestine draws excess water to intestine.
What is secretory diarrhea?
excessive mucosal secretion of fluid & electrolytes.
What is the cause of secretory diarrhea?
viruses & bacterial toxins.
What is the rotavirus that causes diarrhea?
RNA virus
What does RNA virus cause? & which disease leads to this virus?
It causes enteritis; diarrhea
What is enteritis?
inflammation of intestinal system.
What is motility diarrhea?
excessive motility, which decreased transit time which decreased fluid reabsoprtion.
What is the cause of motility diarrhea?
surgical bypass of area of intestine.
What is the treatment for diarrhea?
- restoration of fluid and electrolyte balance.
- anti-motility or water absorbent medication
What is the cause of abdominal pain?
mechanical, inflammatory or ischemic.
T or F: When the person is experiencing abdominal pain, the abdominal organs are stretching/ distension = there no activation of pain receptors.
False; there is activation of pain receptors.
What are the types of abdominal pain?
parietal pain & visceral pain
What type of abdominal pain is associated with pain localized and intense and its from parietal peritoeum?
parietal pain
What type of abdominal pain is associated with distention, inflammation, ischemia of abdominal organ?
visceral pain
T or F: Parietal pain is poorly localized with a radiating pattern.
False; visceral pain
What are the organs involved with upper gastro-intestinal bleeding?
esophagus, stomach and duodenum
Which gastro-intestinal bleeding is associated with bright-red or dark bleeding?
upper gastro-intestinal bleeding
Upper gastro-intestinal bleeding is caused by _____ ulcers/ tearing of esophageal gastric ____ caused by severe ______
peptic; junction; retching
The bright-red or dark bleeding in upper gastro-intestinal is affected by stomach ______
acids
What organs are associated with lower gastro-intestinal bleeding?
jejunum, illeum, colon and rectum
What is the cause of lower gastro-intestinal bleeding?
polyps, inflammatory disease, & hemorrhoids
What type of bleeding is cause by slow chronic blood loss, not obvious and results in iron deficiency?
occult bleeding
What is the result in deficiency of occult bleeding?
iron – anemia
What are some presentation of gastrointestinal bleeding?
-trace amounts of blood in diarrhea or stools
- blood pressure reduction/ compensating tachycardia/ vision loss
What is dysphagia?
difficulty swallowing
What is mechanical obstruction?
obstruction in esophageal wall
What can lead due to mechanical obstruction?
tumors and herniations
What is functional dysphagia?
neural/muscular disorders interfere with swallowing
Functional dysphagia is a ______/_____ disorders interfere with swallowing
neural/muscular
Mechanical obstruction is the obstruction in _______ wall
esophageal
What is the rare form of dysplasia?
achalasia
When the person has achalasia, _____ muscle neurons of middle/______ esophagus attacked immune response.
smooth; lower
The result of having achalasia are altered esophageal ____ (wave like muscle contraction to move food down)(1), failure of lower esophageal sphincter (LES) to ______ which leads to _____ (2), and cough & ______ can occur with increased pressure food is forced past LES (3)
peristalsis; relax, obstruction; aspiration
What is GERD?
Gastroesophageal Reflux Disease
What is the cause of GERD?
- Ab in LES function – LES resting tone is lower than normal
- Delayed gastric emptying of chyme can contribute
What does reflux of acid/pepsin or bile salts into esophagus leads to?
esophagitis
When the person has GERD, the severity of esophageal damage depends on the _____ and ______ of reflux
composition; duration
T or F: An increased acidic chyme exposure = mucosal injury and inflammation.
True
Persistent GERD causes fibrosis thinning, precancerous lesions.
False; thickening
What is the diagnosis for GERD?
esophageal endoscopy/ tissue biopsy
What is the treatment for GERD?
laparoscopic fundoplication
What does laparoscopic fundoplication do? Which disease does this tx apply?
LF tighten junction between esophagus and stomach to prevent acid reflux; GERD & hiatal hernia
Which disease is associated with protrusion of superior aspect of stomach through diaphragm hiatal into thorax?
hiatal hernia
What are the two types of hiatal hernia?
Sliding hiatal hernia & paraesophageal hiatal hernia
Which type of hiatal hernia is associated with stomach moves into thorax through esophageal hiatus (opening of diaphragm)
sliding hiatal hernia
Which type of hiatal hernia is associated with stomach moves into thorax alongside esophageal?
paraesophageal hiatal hernia
Which types of hernia hiatal is associated with GERD?
sliding HH
Which type of hiatal hernia (HH) leads to gastritis and ulcer formation?
paraesophageal HH
The risk for HH is ________ of hearnia leading to medical emergency
strangulation
What is the diagnosis for HH?
radiology with barium swallow
Treatment for HH?
sleeping with your head up (1)
laparoscopic fundoplication (2)
Which obstruction is associated with any condition that prevents normal flow of chyme through intestinal lumen?
intestinal obstruction
Which type of obstruction is associated with failure of intestinal motility du to dysfunctional neural activity after surgery?
paralytic illeus (PI)
T or F: Large bowel obstruction is more common and often related to diabetes.
FALSE; less common and often related to cancer
What are some signs/symptoms of LBO?
vomiting and abdominal distension
What does small bowel obstruction cause (SBO)?
post-operative adhesions/ herniations lead to distentions (enlargement)
The result of having SBO are, distention = impaired _____ and increased _____, which leads to accumulation of ___, gas and ____ in lumen (1), systemic ECF fluid osmotically moves into lumen which _____ ECF which leads to dehydration/ ______ will result of possible ______ (2), intestinal lumen becomes ______ (3) & leakage of ____ into systemic circulation leads to immune response with possibility of remote _____ failure (4).
absorption, secretion, fluid, solutes; decreased, tachycardia, shock; acidic; pathogens, organ.
What disease is an inflammatory disorder of gastric mucosa?
gastritis
What type of gastritis is associated with erosion of protective of stomach mucosal barrier by Helicobacter pyloris and NSAIDs?
acute gastritis
What are the symptoms of acute gastritis
pain, vomiting
T or F: when the person has acute gastritis, healing generally occurs within a few days.
true
Which bacteria burros into mucus layer and disrupts function of mucosal layers and triggers immune system which destroys mucosal layer?
Helicobacter pylori or H. Pylori
What does NSAIDs do?
inhibit prostaglandins synthesis which stimulates goblet cell secretion of mucus
Which type of gastritis occurs in older adults, which causes chronic inflammation and mucosal atrophy?
chronic gastritis
What type of chronic gastritis occurs in antrum?
chronic non-immune or antral gastritis
T or F: Chronic non-immune is involves body and fundus.
False; Chronic immune or fundal gastritis
Which type of chronic gastritis is caused by H. pylori?
Chronic non-immune or antral gastritis
T or F: When the person has antral gastritis, there is high levels of HCL secretion which increased risk of duodenal ulcers.
true
T or F: Antral gastritis is associated with loss of T cell tolerance resulting in gastric mucosa being extensively degenerated in stomach fundus and body.
False; Chronic immune or fundal gastritis
What is the cause of peptic ulcer?
H. Pylori & NSAIDs (1) and the breaking or ulceration in protective mucosal lining (2)
What are the three disorders of peptic ulcer?
duodenal ulcers (1), gastric ulcers (2) & stress-related mucosal disease (3)
T or F: Gastric ulcers are more frequent than other peptic ulcers.
false; duodenal ulcers
Which type of peptic ulcers cause acid and pepsin concentrations to penetrate mucosal barrier and cause ulceration?
duodenal ulcers
In duodenal ulcers, H. pylori releases _____ resulting in _____ of epithealial cells
toxin; apoptosis
T or F: When the person has duodenal ulcer, T, and B cells, neutrophils combat H. pylori which lead to damage to gastric epithelium by the release by cytokines
true
T or F: Gastric ulcers is one-fourth as common as duodenal ulcers.
true
Where does gastric ulcers develop?
gastric antrum
T or F: In gastric ulcers, H+ ions disrupts mucosal permeability to hydrogen ions
True
Which type of ulcer is associated with an increase in mucosal barrier’s permeability to hydrogen ions
gastric ulcers
The result cycle of gastric ulcer is that damaged mucosa liberates ____ which ____ HCL and pepsin production which leads to mucosal destruction.
histamine; increased
What is an acute form of peptic ulcer?
Stress related mucosal disease
T or F: With stress related mucosal disease, only one single site of ulcer is affected in stomach or duodenum
False; multiple sites of ulcers are involved
Stress related mucosal disease is accompanies physiological stress, _______, or major trauma
illness
What are the three types of stress related mucosal disease? Describe each of them.
Ischemic ulcers – developing within hours of event; hemorrhage, heart failure and sepsis
Curling ulcers – develop bec of burn injury
Cushing ulcers – develop bec of brain trauma/ surgery
Which disease is associated with environmental factors or infections that alter mucosal epithelium barrier?
Inflammatory bowel disease (IBD)
What is commensal?
association between 2 organisms in which one benefits and other derives neither benefit nor harm
When the person has IBD, there is a loss of body’s ability to discriminate _____ pathogens from ______ microorganisms (1) & loss of ability to discriminate, meaning there is an activation of immune system, production of _________ cytokines which results in intestinal ________ damage (2)
harmful, commensal; proinflammatory epithelium
What are the three IBDs?
Ulcerative colitis (1), chron’s disease (2) & irritable bowel syndrome (3)
What is ulcerative colitis?
chronic inflammatory disease, which causes ulcers in colonic mucosa
What are the symptoms of ulcerative colitis?
diarrhea (10-20 tools a day)
What is the diagnosis for ulcerative colitis and Chron’s disease (CD)?
endoscopy and biopsies
What are the tx for ulcerative colitis & chron’s disease (CD)?
- steriods
- meds
- surgery for severe disease
T or F: Ulcerative colitis only affects large intestine
True
What is the result of small erosions coalesce into ulcers for ulcerative colitis?
necrosis
Ulcerative colitis result in thickening of ________ mucosa which narrows lumen, thus reduces ______ time in colon
muscularis; transit
Which IBDs is associated with idiopathic inflammatory disorder?
CD
T or F: CD affects any part of digestive tract, from mouth to anus.
True
What is the most common sites of disease for CD?
ascending and transverse colon
What is transmural? Which type of IBD is transmural associated?
across entire wall of organ involvement; CD
T or F: Transmural disease may not result in penetration or fistula formation
False; it may result in penetration or fistula formation
What is fistula?
an abnormal opening or passage between two organs.
Fistulae may form in ____-____ (area around anus) or extend into _____, rectum or vagina
peri-anal; bladder
What are some risks for people to get CD?
smoking increases risk of dev severe disease & may cause poor response to tx
CD ulcerations can produce ______ that extend inflammation into ______ tissue.
fissures; lymphoid
Which type of IBD is characterized by abdominal pain with altered bowel habits?
Irritable bowel syndrome (IBD)
What does altered bowel habits mean?
alternating constipation and diarrhea.
What are the symptoms of IBD?
relieved with defacation & does not interfere with sleep
T or F: Pathophysiology of IBS is idiopathic with no specific biomarkers for disease.
True
What are some manifestations for IBS?
lower abdominal pain or discomfort and bloating
T or F: IBS is more common in men with higher prevalence during adolescence.
FALSE; more common in women (1.5 to 3x greater than men) with a higher prevalence during youth and middle age
There has been an increasing evidence that IBS targets altered gut _______
microflora
What are some tx for IBS?
no cure; treatment is individualized.
What is appendicitis?
inflammation of appendix
T or F: Appendicitis is the most common surgical emergency of abdomen.
True
What age does appendicitis occurs?
Between 10-19 yrs; tho can occur at any age.
What are some manifestation of appendicitis?
mild pain increases to intense pain in 3-4 hours; nausea; vomiting
Tx for appendicitis?
laparoscopic surgery
What organ is considered as a safe house for commensal bacterium for repopulation of intestinal system?
appendix
What is the cause of appendicitis?
obstruction of appendix lumen leads to the blockage drainage of appendix. Mucosal secretion continues, thus intraluminal pressure increases. Increase pressure reduces blood flow, appendix becomes hypoxic = ulceration
What does ulceration in appendix promotes?
bacterial invasion which leads to inflammation
What are the 4 main disorders of the liver?
hepatic encephalopathy (1), jaundice (2), cirrhosis (3), viral hepatitis (4)
What is the brain disease that alters brain function or structure?
encephalopathy
What disorder of liver is associated with the complex neurological syndrome characterized by impaired behavioral, cogntive and motor function?
hepatic encephalopathy
What does astrocyte swelling do in the body?
alter blood-brain barrier which promote cerebral edema
What leads to astrocyte swelling?
ammonia
How does liver dysfunction affect the body?
the creation of extra blood vessels that bypass (aka shunt) the liver and carry blood directly back to the body
Under HE, what does shunt do in the body?
permits toxins absorbed from GI tract (normally removed by liver) to circulate to brain.
- Toxins alter cerebral energy metabolism, interfere with neurotransmission and cause edema
What are some underlying changes when the person has hepatic encephalopathy?
combination of biochem alterations that affect neurotransmission and brain function
What is jaundice?
pigmentation of skin
What is the cause of jaundice?
hyperbilirubinemia - increased plasma (bilirubin) – a component of Hb breakdown.
T or F: Bilirubin is waste product normally remove from blood by gall bladder.
False; removed from blood by liver
T or F: Increased plasma (bilirubin) indicates pancreas damage.
False; liver damage
What is another term for jaundice?
icterus
What are some manifestations of jaundice?
- noticeable darkened urine several days before onset of jaundice
- bacterial infections
What is the first yellowing skin that indicates jaundice?
yellow discoloration of sclera of eye
What are the two different forms of jaundice?
obstructive jaundice & hemolytic jaundice
What is obstructive jaundice?
occlusion of common bile duct by gall stones, tumor (1) & bilirubin can’t flow to duodenum which accumulates in liver.
What is the result of obstructive jaundice?
bilirubin enters blood stream causing jaundice
What is hemolytic jaundice?
excessive production of bilirubin from excessive hemolysis (destruction of RBC)
What is the result of hemolytic jaundice?
plasma (bilirubin) exceeding liver ability to process, thus there is an increased plasma bilirubin jaundice
What liver disease is the irreversible fibrotic scarring of liver in response to inflammation and tissue damage?
cirrhosis
What is the final step of various chronic liver diseases?
liver cirrhosis
The pathophysiological hallmark of cirrhosis is the development of _____ _____ due to fibrosis.
scar tissue
What are some manifestations for cirrhosis?
liver acquires a cobbly appearance and is hard upon palpitation
Tissue regeneration of someone with cirrhosis is disrupted by ____ which leads to necrosis then atrophy, resulting in ___ failure
hypoxia; liver
What are the 3 types of cirrhosis?
(1) alcohol cirrhosis, (2) non-alcoholic fatty liver disease (3) biliary cirrhosis
which type of cirrhosis is associated with the damage and inflammation leading to cirrhosis begins in bile ducts rather than hepatocytes?
biliary cirrhosis
Which type of biliary cirrhosis is caused by a chronic, autoimmune liver disease (e.g., T cells and antimitochondrial antibodies)?
primary biliary cirrhosis
In primary biliary cirrhosis, damage to bile ducts = _____ = bile duct _____
fibrosis; obstruction
Which type of biliary cirrhosis is caused by obstruction of common bile duct by gallstones, tumours?
secondary biliary cirrhosis
What are the damage result of alcoholic cirrhosis?
translocation of gut microbiota
What is alcoholic cirrhosis?
toxic effect of alcohol on liver/ immune alterations.
In alcoholic cirrhosis, alcohol transformed into ____ which activates hepatic stellate cells
acetaldehyde
What happens if there is a hyperactivation of stellate cells?
results in collagen formation
In alcoholic cirrhosis, collagen formation results in?
fibrosis and scarring
What is non-alcoholic fatty liver disease?
infiltration of hepatocytes with triglycerides
Non-alcoholic fatty liver disease is associated with _____, high blood, and ____ cholesterol levels
obesity; high
What is viral hepatitis?
common systemic disease that primarily affects the liver.
What is the diagnosis for viral hepatitis?
presence of viral antibodies
What is the tx for viral hepatitis?
viral replication suppression (1), hepatitis B vaccine
What are the 5 types of viral hepatitis?
A, B, C, D, E
T or F: Not all 5 types of viral hepatitis can cause jaundice.
False; all can types can cause jaundice
Among the 5 types of viral hepatitis, which are the most severe damage?
Hepatitis B & C
When there is a co-infection in viral hepatitis, there is a _____ progression of liver disease
rapid
In viral hepatitis, co-infection of _____ and _____ occurs because virus’ share same _____ of transmission. That is the contact between infected body ____
hepatitis; HIV; rout; fluids
What are the common gallbladder disorders?
obstruction and inflammation
What blocks the flow of bile in and out of gallbladder?
gallstones
What is the cause of gallstones blocking the bile in and out of gallbladder?
gallbladder inflammation
What do you call to the gallstone formation?
choleilithiasis
What do you call to gallbladder inflammation?
cholecystitis
Treatment for pancreatic disorder?
alcohol cessation
When there is an obstructive disease in pancreas, there is a backup pancreatic secretion which release and activate pancreative enzyme within ______ cells.
acinar
Chronic alcohol = destruction of _____ cells.
acinar
What causes pancreatic cysts?
tissue destruction replaces fibrosis
What is autodigestion?
vascular damage, necrosis, and pseudocysts formation (walled-off collections of pancreatic secretions
What does acinar cell metabolizes that leads to toxic metabolites release acinar digestive enzymes?
ethanol
What are the cancer of the esophagus?
carcinoma & adenocarcinomas of epithelium
Where does adenocarcinoma initiates?
epithelial glandular cells.
Where does carcinoma initiates?
epithilial squamous cells.
What are the manifestations of the cancer of the esophagus?
dysphagia and chest pain
What is dysphagia?
difficulty of swallowing
What are the risk of esophagus cancer?
alcohol combined with smoking & chewing tobacco
Gastric adenocarcinoma is associated with what pathogen? What organ focuses on gastric adenocarcinoma?
H. pylori; stomach cancer
What contributes to gastric adenocarcinoma?
heavily salted and preserved foods
What does slat converts nitrates?
carcinogenic nitrosamines
What are highly associated with colon adenocarcinoma?
pre-existing polyps
What are some manifestations of colon and rectum cancer?
pain, bloody stools and a change in bowel habits
Rectal carcinomas occurs close to ____ and/or spread to female _____ and male _____
anus; vagina, prostate
What is the leading cause of world-wide cancer deaths?
liver cancer
Primary cancers are associated with _____ liver disease like cirrhosis and hepatitis ___
chronic; B
Where does hepatocellular carcinomas arise from?
hepatocytes
Where does cholangiocellular develops?
bile ducts
T or F: Cholangiocellular carcinomas are common
False; rare
T or F: Liver cancer metastisizes to many other organs
True
Gallbladder cancer is most common between ages…
50-60
What type of cancer is the most common type for gallbladder?
adenocarcinoma
Gallbladder cancer mestastases to _____ vessels/ metastases often occurs _____ diagnosis
lymph; before
T or F: When gallbladder mestastisize, the prognosis is poor.
True
What is the fourth cancer death in Canada?
cancer of the pancreas
Adenocarcinoma occurs in _____ component of pancreas.
exocrine
Cancer of the pancreas: mestastisizes often ______ diagnosis.
before
