Ch 36- Alteration in Digestive Function Flashcards
1
Q
T or F: Digestive tract wall has same structure form esophagus to anus.
A
True
2
Q
What are the four layers to digestive tract?
A
From deep to superficial:
- Mucosa
- Submucosa
- Muscularis externa
- Serosa
3
Q
The ____ layer provides levels of ____ (mucosa) protection
A
mucus; epithelial
4
Q
T or F: GI tract disorders disrupt one or more of its functions.
A
True
5
Q
____ & ____ abnormalities can obstruct, slow/accelerate intestinal contents.
A
structural; neural
6
Q
Inflammatory and ulcerative condtions disrupt _____, _____ & _____
A
secretion; motility; absorption
7
Q
What are the accessory organs that can alter metabolism?
A
liver, pancreas and gallbladder
8
Q
What is the Greek word for vomiting?
A
emesis
9
Q
What is vomiting?
A
forceful emptying stomach/intestinal contents through the mouth
10
Q
Where is the center of vomiting lies?
A
medulla oblongata
11
Q
What is retching?
A
muscular event of vomiting without vomitus expulsion
12
Q
What is the cause of projectile vomiting?
A
direct stimulation of vomit center
13
Q
What is projectile vomiting?
A
spontaneous vomiting that does not follow nausea or retching
14
Q
What is the initiation of vomiting?
A
deep inhalation & glottis closes
15
Q
During vomiting, ____ and stomach ____ spasm forcing chyme into esophagus
A
duodenum; antrum
16
Q
T or F: During vomiting, abdominal muscles creates pressure from stomach to throat.
A
True
17
Q
T or F: During vomiting, there is no pain and distension of stomach/ duodenum
A
False; there is a sever pain, distension of stomach/ duodenum
18
Q
T or F: During vomiting, upper esophageal sphincter stays open = contents can enter mouth.
A
False; upper esophageal sphincter stays closed = contents can’t enter mouth
19
Q
T or F: During the process of vomiting, abdominal muscles does not relax = contents return to stomach.
A
False; abdominal muscles relax = contents return to stomach
20
Q
T or F: Vomiting process are repeated several times.
A
True
21
Q
During the process of vomiting, the _______ system relaxes ____ esophageal sphincters
A
parasympathetic; both
22
Q
When abdominal muscles contract, what happens to the diaphragm during the process of vomiting?
A
force diaphragm high into thoracic cavity
23
Q
When the diaphragm is force high into thoracic cavity, what happens to the stomach chyme?
A
the stomach chyme is forced out of mouth
24
Q
What is constipation?
A
difficult/infrequent defecation
25
Constipation must be ____ determined.
individually
26
What is the wide normal defacation range?
1-3 days to 1 week
27
Primary or Secondary constipation: Which is associated with neural pathways are altered/ colon transit time delayed.
secondary constipation
28
Primary or Secondary constipation: Which is associated with impaired, infrequent and straining colonic movement.
primary constipation
29
What opiate inhibit bowel movement?
codeine
30
T or F: Notable change in constipation can be indicative of colorectal cancer.
True
31
What is the manifestations for constipation?
pushing too hard to poop can cause hemorrhoids
32
What are some diagnosis for constipation?
- assess sphincter tone and detect anal lesions.
- colonoscopy = direct lumen view.
33
What do you assess and detect when diagnosing constipation?
sphincter tone & anal lesions
34
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
35
What is the final resort of treatment for constipation?
colectomy, which is removing part of colon
36
What is diarrhea?
loose watery stools
37
What is the time frame for acute diarrhea?
24 hrs or less
38
What is the time frame for persistent diarrhea?
14-28 days
39
What is the time frame for chronic diarrhea?
longer than 4 weeks
40
In children, there is a high rates of _____/____ for children younger than ___ years old
morbidity/mortality; 5
41
What is osmotic diarrhea?
non-absorbable substance in intestine draws excess water to intestine.
42
What is secretory diarrhea?
excessive mucosal secretion of fluid & electrolytes.
43
What is the cause of secretory diarrhea?
viruses & bacterial toxins.
44
What is the rotavirus that causes diarrhea?
RNA virus
45
What does RNA virus cause? & which disease leads to this virus?
It causes enteritis; diarrhea
46
What is enteritis?
inflammation of intestinal system.
47
What is motility diarrhea?
excessive motility, which decreased transit time which decreased fluid reabsoprtion.
48
What is the cause of motility diarrhea?
surgical bypass of area of intestine.
49
What is the treatment for diarrhea?
- restoration of fluid and electrolyte balance.
- anti-motility or water absorbent medication
50
What is the cause of abdominal pain?
mechanical, inflammatory or ischemic.
51
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.
52
What are the types of abdominal pain?
parietal pain & visceral pain
53
What type of abdominal pain is associated with pain localized and intense and its from parietal peritoeum?
parietal pain
54
What type of abdominal pain is associated with distention, inflammation, ischemia of abdominal organ?
visceral pain
55
T or F: Parietal pain is poorly localized with a radiating pattern.
False; visceral pain
56
What are the organs involved with upper gastro-intestinal bleeding?
esophagus, stomach and duodenum
57
Which gastro-intestinal bleeding is associated with bright-red or dark bleeding?
upper gastro-intestinal bleeding
58
Upper gastro-intestinal bleeding is caused by _____ ulcers/ tearing of esophageal gastric ____ caused by severe ______
peptic; junction; retching
59
The bright-red or dark bleeding in upper gastro-intestinal is affected by stomach ______
acids
60
What organs are associated with lower gastro-intestinal bleeding?
jejunum, illeum, colon and rectum
61
What is the cause of lower gastro-intestinal bleeding?
polyps, inflammatory disease, & hemorrhoids
62
What type of bleeding is cause by slow chronic blood loss, not obvious and results in iron deficiency?
occult bleeding
63
What is the result in deficiency of occult bleeding?
iron -- anemia
64
What are some presentation of gastrointestinal bleeding?
-trace amounts of blood in diarrhea or stools
- blood pressure reduction/ compensating tachycardia/ vision loss
65
What is dysphagia?
difficulty swallowing
66
What is mechanical obstruction?
obstruction in esophageal wall
67
What can lead due to mechanical obstruction?
tumors and herniations
68
What is functional dysphagia?
neural/muscular disorders interfere with swallowing
69
Functional dysphagia is a ______/_____ disorders interfere with swallowing
neural/muscular
70
Mechanical obstruction is the obstruction in _______ wall
esophageal
71
What is the rare form of dysplasia?
achalasia
72
When the person has achalasia, _____ muscle neurons of middle/______ esophagus attacked immune response.
smooth; lower
73
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
74
What is GERD?
Gastroesophageal Reflux Disease
75
What is the cause of GERD?
- Ab in LES function -- LES resting tone is lower than normal
- Delayed gastric emptying of chyme can contribute
76
What does reflux of acid/pepsin or bile salts into esophagus leads to?
esophagitis
77
When the person has GERD, the severity of esophageal damage depends on the _____ and ______ of reflux
composition; duration
78
T or F: An increased acidic chyme exposure = mucosal injury and inflammation.
True
79
Persistent GERD causes fibrosis thinning, precancerous lesions.
False; thickening
80
What is the diagnosis for GERD?
esophageal endoscopy/ tissue biopsy
81
What is the treatment for GERD?
laparoscopic fundoplication
82
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
83
Which disease is associated with protrusion of superior aspect of stomach through diaphragm hiatal into thorax?
hiatal hernia
84
What are the two types of hiatal hernia?
Sliding hiatal hernia & paraesophageal hiatal hernia
85
Which type of hiatal hernia is associated with stomach moves into thorax through esophageal hiatus (opening of diaphragm)
sliding hiatal hernia
86
Which type of hiatal hernia is associated with stomach moves into thorax alongside esophageal?
paraesophageal hiatal hernia
87
Which types of hernia hiatal is associated with GERD?
sliding HH
88
Which type of hiatal hernia (HH) leads to gastritis and ulcer formation?
paraesophageal HH
89
The risk for HH is ________ of hearnia leading to medical emergency
strangulation
90
What is the diagnosis for HH?
radiology with barium swallow
91
Treatment for HH?
sleeping with your head up (1)
laparoscopic fundoplication (2)
92
Which obstruction is associated with any condition that prevents normal flow of chyme through intestinal lumen?
intestinal obstruction
93
Which type of obstruction is associated with failure of intestinal motility du to dysfunctional neural activity after surgery?
paralytic illeus (PI)
94
T or F: Large bowel obstruction is more common and often related to diabetes.
FALSE; less common and often related to cancer
95
What are some signs/symptoms of LBO?
vomiting and abdominal distension
96
What does small bowel obstruction cause (SBO)?
post-operative adhesions/ herniations lead to distentions (enlargement)
97
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.
98
What disease is an inflammatory disorder of gastric mucosa?
gastritis
99
What type of gastritis is associated with erosion of protective of stomach mucosal barrier by Helicobacter pyloris and NSAIDs?
acute gastritis
100
What are the symptoms of acute gastritis
pain, vomiting
101
T or F: when the person has acute gastritis, healing generally occurs within a few days.
true
102
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
103
What does NSAIDs do?
inhibit prostaglandins synthesis which stimulates goblet cell secretion of mucus
104
Which type of gastritis occurs in older adults, which causes chronic inflammation and mucosal atrophy?
chronic gastritis
105
What type of chronic gastritis occurs in antrum?
chronic non-immune or antral gastritis
106
T or F: Chronic non-immune is involves body and fundus.
False; Chronic immune or fundal gastritis
107
Which type of chronic gastritis is caused by H. pylori?
Chronic non-immune or antral gastritis
108
T or F: When the person has antral gastritis, there is high levels of HCL secretion which increased risk of duodenal ulcers.
true
109
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
110
What is the cause of peptic ulcer?
H. Pylori & NSAIDs (1) and the breaking or ulceration in protective mucosal lining (2)
111
What are the three disorders of peptic ulcer?
duodenal ulcers (1), gastric ulcers (2) & stress-related mucosal disease (3)
112
T or F: Gastric ulcers are more frequent than other peptic ulcers.
false; duodenal ulcers
113
Which type of peptic ulcers cause acid and pepsin concentrations to penetrate mucosal barrier and cause ulceration?
duodenal ulcers
114
In duodenal ulcers, H. pylori releases _____ resulting in _____ of epithealial cells
toxin; apoptosis
115
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
116
T or F: Gastric ulcers is one-fourth as common as duodenal ulcers.
true
117
Where does gastric ulcers develop?
gastric antrum
118
T or F: In gastric ulcers, H+ ions disrupts mucosal permeability to hydrogen ions
True
119
Which type of ulcer is associated with an increase in mucosal barrier's permeability to hydrogen ions
gastric ulcers
120
The result cycle of gastric ulcer is that damaged mucosa liberates ____ which ____ HCL and pepsin production which leads to mucosal destruction.
histamine; increased
121
What is an acute form of peptic ulcer?
Stress related mucosal disease
122
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
123
Stress related mucosal disease is accompanies physiological stress, _______, or major trauma
illness
124
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
125
Which disease is associated with environmental factors or infections that alter mucosal epithelium barrier?
Inflammatory bowel disease (IBD)
126
What is commensal?
association between 2 organisms in which one benefits and other derives neither benefit nor harm
127
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
128
What are the three IBDs?
Ulcerative colitis (1), chron's disease (2) & irritable bowel syndrome (3)
129
What is ulcerative colitis?
chronic inflammatory disease, which causes ulcers in colonic mucosa
130
What are the symptoms of ulcerative colitis?
diarrhea (10-20 tools a day)
131
What is the diagnosis for ulcerative colitis and Chron's disease (CD)?
endoscopy and biopsies
132
What are the tx for ulcerative colitis & chron's disease (CD)?
- steriods
- meds
- surgery for severe disease
133
T or F: Ulcerative colitis only affects large intestine
True
134
What is the result of small erosions coalesce into ulcers for ulcerative colitis?
necrosis
135
Ulcerative colitis result in thickening of ________ mucosa which narrows lumen, thus reduces ______ time in colon
muscularis; transit
136
Which IBDs is associated with idiopathic inflammatory disorder?
CD
137
T or F: CD affects any part of digestive tract, from mouth to anus.
True
138
What is the most common sites of disease for CD?
ascending and transverse colon
139
What is transmural? Which type of IBD is transmural associated?
across entire wall of organ involvement; CD
140
T or F: Transmural disease may not result in penetration or fistula formation
False; it may result in penetration or fistula formation
141
What is fistula?
an abnormal opening or passage between two organs.
142
Fistulae may form in ____-____ (area around anus) or extend into _____, rectum or vagina
peri-anal; bladder
143
What are some risks for people to get CD?
smoking increases risk of dev severe disease & may cause poor response to tx
144
CD ulcerations can produce ______ that extend inflammation into ______ tissue.
fissures; lymphoid
145
Which type of IBD is characterized by abdominal pain with altered bowel habits?
Irritable bowel syndrome (IBD)
146
What does altered bowel habits mean?
alternating constipation and diarrhea.
147
What are the symptoms of IBD?
relieved with defacation & does not interfere with sleep
148
T or F: Pathophysiology of IBS is idiopathic with no specific biomarkers for disease.
True
149
What are some manifestations for IBS?
lower abdominal pain or discomfort and bloating
150
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
151
There has been an increasing evidence that IBS targets altered gut _______
microflora
152
What are some tx for IBS?
no cure; treatment is individualized.
153
What is appendicitis?
inflammation of appendix
154
T or F: Appendicitis is the most common surgical emergency of abdomen.
True
155
What age does appendicitis occurs?
Between 10-19 yrs; tho can occur at any age.
156
What are some manifestation of appendicitis?
mild pain increases to intense pain in 3-4 hours; nausea; vomiting
157
Tx for appendicitis?
laparoscopic surgery
158
What organ is considered as a safe house for commensal bacterium for repopulation of intestinal system?
appendix
159
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
160
What does ulceration in appendix promotes?
bacterial invasion which leads to inflammation
161
What are the 4 main disorders of the liver?
hepatic encephalopathy (1), jaundice (2), cirrhosis (3), viral hepatitis (4)
162
What is the brain disease that alters brain function or structure?
encephalopathy
163
What disorder of liver is associated with the complex neurological syndrome characterized by impaired behavioral, cogntive and motor function?
hepatic encephalopathy
164
What does astrocyte swelling do in the body?
alter blood-brain barrier which promote cerebral edema
165
What leads to astrocyte swelling?
ammonia
166
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
167
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
168
What are some underlying changes when the person has hepatic encephalopathy?
combination of biochem alterations that affect neurotransmission and brain function
169
What is jaundice?
pigmentation of skin
170
What is the cause of jaundice?
hyperbilirubinemia - increased plasma (bilirubin) -- a component of Hb breakdown.
171
T or F: Bilirubin is waste product normally remove from blood by gall bladder.
False; removed from blood by liver
172
T or F: Increased plasma (bilirubin) indicates pancreas damage.
False; liver damage
173
What is another term for jaundice?
icterus
174
What are some manifestations of jaundice?
- noticeable darkened urine several days before onset of jaundice
- bacterial infections
175
What is the first yellowing skin that indicates jaundice?
yellow discoloration of sclera of eye
176
What are the two different forms of jaundice?
obstructive jaundice & hemolytic jaundice
177
What is obstructive jaundice?
occlusion of common bile duct by gall stones, tumor (1) & bilirubin can't flow to duodenum which accumulates in liver.
178
What is the result of obstructive jaundice?
bilirubin enters blood stream causing jaundice
179
What is hemolytic jaundice?
excessive production of bilirubin from excessive hemolysis (destruction of RBC)
180
What is the result of hemolytic jaundice?
plasma (bilirubin) exceeding liver ability to process, thus there is an increased plasma bilirubin jaundice
181
What liver disease is the irreversible fibrotic scarring of liver in response to inflammation and tissue damage?
cirrhosis
182
What is the final step of various chronic liver diseases?
liver cirrhosis
183
The pathophysiological hallmark of cirrhosis is the development of _____ _____ due to fibrosis.
scar tissue
184
What are some manifestations for cirrhosis?
liver acquires a cobbly appearance and is hard upon palpitation
185
Tissue regeneration of someone with cirrhosis is disrupted by ____ which leads to necrosis then atrophy, resulting in ___ failure
hypoxia; liver
186
What are the 3 types of cirrhosis?
(1) alcohol cirrhosis, (2) non-alcoholic fatty liver disease (3) biliary cirrhosis
187
which type of cirrhosis is associated with the damage and inflammation leading to cirrhosis begins in bile ducts rather than hepatocytes?
biliary cirrhosis
188
Which type of biliary cirrhosis is caused by a chronic, autoimmune liver disease (e.g., T cells and antimitochondrial antibodies)?
primary biliary cirrhosis
189
In primary biliary cirrhosis, damage to bile ducts = _____ = bile duct _____
fibrosis; obstruction
190
Which type of biliary cirrhosis is caused by obstruction of common bile duct by gallstones, tumours?
secondary biliary cirrhosis
191
What are the damage result of alcoholic cirrhosis?
translocation of gut microbiota
192
What is alcoholic cirrhosis?
toxic effect of alcohol on liver/ immune alterations.
193
In alcoholic cirrhosis, alcohol transformed into ____ which activates hepatic stellate cells
acetaldehyde
194
What happens if there is a hyperactivation of stellate cells?
results in collagen formation
195
In alcoholic cirrhosis, collagen formation results in?
fibrosis and scarring
196
What is non-alcoholic fatty liver disease?
infiltration of hepatocytes with triglycerides
197
Non-alcoholic fatty liver disease is associated with _____, high blood, and ____ cholesterol levels
obesity; high
198
What is viral hepatitis?
common systemic disease that primarily affects the liver.
199
What is the diagnosis for viral hepatitis?
presence of viral antibodies
200
What is the tx for viral hepatitis?
viral replication suppression (1), hepatitis B vaccine
201
What are the 5 types of viral hepatitis?
A, B, C, D, E
202
T or F: Not all 5 types of viral hepatitis can cause jaundice.
False; all can types can cause jaundice
203
Among the 5 types of viral hepatitis, which are the most severe damage?
Hepatitis B & C
204
When there is a co-infection in viral hepatitis, there is a _____ progression of liver disease
rapid
205
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
206
What are the common gallbladder disorders?
obstruction and inflammation
207
What blocks the flow of bile in and out of gallbladder?
gallstones
208
What is the cause of gallstones blocking the bile in and out of gallbladder?
gallbladder inflammation
209
What do you call to the gallstone formation?
choleilithiasis
210
What do you call to gallbladder inflammation?
cholecystitis
211
Treatment for pancreatic disorder?
alcohol cessation
212
When there is an obstructive disease in pancreas, there is a backup pancreatic secretion which release and activate pancreative enzyme within ______ cells.
acinar
213
Chronic alcohol = destruction of _____ cells.
acinar
214
What causes pancreatic cysts?
tissue destruction replaces fibrosis
215
What is autodigestion?
vascular damage, necrosis, and pseudocysts formation (walled-off collections of pancreatic secretions
216
What does acinar cell metabolizes that leads to toxic metabolites release acinar digestive enzymes?
ethanol
217
What are the cancer of the esophagus?
carcinoma & adenocarcinomas of epithelium
218
Where does adenocarcinoma initiates?
epithelial glandular cells.
219
Where does carcinoma initiates?
epithilial squamous cells.
220
What are the manifestations of the cancer of the esophagus?
dysphagia and chest pain
221
What is dysphagia?
difficulty of swallowing
222
What are the risk of esophagus cancer?
alcohol combined with smoking & chewing tobacco
223
Gastric adenocarcinoma is associated with what pathogen? What organ focuses on gastric adenocarcinoma?
H. pylori; stomach cancer
224
What contributes to gastric adenocarcinoma?
heavily salted and preserved foods
225
What does slat converts nitrates?
carcinogenic nitrosamines
226
What are highly associated with colon adenocarcinoma?
pre-existing polyps
227
What are some manifestations of colon and rectum cancer?
pain, bloody stools and a change in bowel habits
228
Rectal carcinomas occurs close to ____ and/or spread to female _____ and male _____
anus; vagina, prostate
229
What is the leading cause of world-wide cancer deaths?
liver cancer
230
Primary cancers are associated with _____ liver disease like cirrhosis and hepatitis ___
chronic; B
231
Where does hepatocellular carcinomas arise from?
hepatocytes
232
Where does cholangiocellular develops?
bile ducts
233
T or F: Cholangiocellular carcinomas are common
False; rare
234
T or F: Liver cancer metastisizes to many other organs
True
235
Gallbladder cancer is most common between ages...
50-60
236
What type of cancer is the most common type for gallbladder?
adenocarcinoma
237
Gallbladder cancer mestastases to _____ vessels/ metastases often occurs _____ diagnosis
lymph; before
238
T or F: When gallbladder mestastisize, the prognosis is poor.
True
239
What is the fourth cancer death in Canada?
cancer of the pancreas
240
Adenocarcinoma occurs in _____ component of pancreas.
exocrine
241
Cancer of the pancreas: mestastisizes often ______ diagnosis.
before
242
