Chapter 20: Digestive System Disorders Flashcards
What is a Bolus?
A round mass of food ready to be swallowed.
What is a Cholecystectomy?
Removal of the Gall Bladder.
What is Cholecystitis?
Inflammation of the Gall Bladder.
What is a Gastrectomy?
Removal of the stomach.
What is Hematemesis?
Vomiting blood.
What is Hyperbilirubinemia?
Excessive bilirubin in the blood.
What is Steatorrhea?
Fatty, bulky stool resulting from malabsorption.
What is Anorexia?
Lack of appetite
What does N & V stand for?
Nausea and vomiting
What is Hematemesis?
Vomiting blood
What is Melena?
Black, tarry stools; feces containing digested blood
What is Hematochezia?
Passage of fresh, bright red blood from the rectum
What is Occult Blood?
Detection of hidden blood in the feces
What is an Upper Gastrointestinal (UGI) test?
X-ray images of esophagus, stomach, and small intestine obtained after administering barium by mouth
What is Barium Swallow?
The study of the esophagus this test is to determine why the patient is experiencing difficulty swallowing, abdominal pain
What is a Barium Enema?
AKA lower gastrointestinal series X-ray images of the colon and rectum obtained after injection of barium into the rectum. Radiologists inject barium, a contrast by enema into the rectum.
What is a Small Bowel Series?
A test to look at the small bowel part of the digestive tract between the stomach and the colon.
What is Gastric Analysis?
Series of tests used to analyze the contents of the stomach. Collecting residual gastric fluid from a fasting patient. Collecting basal secretions every 15 minutes for four hours. Intramuscular administration of a drug that stimulates gastric acid output. Collecting stomach secretions every 15 minutes for 90 minutes.
What is an Ultrasound?
Sound waves beamed into the abdomen produce an image of abdominal viscera.
What is an Esophagoscopy?
Visual examination of the esophagus
What is an Esophagogastroduodenoscopy (EGD)
Visual examination of the esophagus, stomach, and duodenum.
What is a Colonoscopy?
Visual examination of colon
What is a Cholangiopancreatopgraphy (ERCP)?
X-ray examination. Contrast medium injected via catheter (tube) through the mouth, esophagus, stomach, duodenum and then into the bile ducts
What is Esophageal Cancer?
Primarily squamous cell carcinoma Most commonly in distal esophagus Significant dysphagia in later stages Poor prognosis due to late manifestations Associated with chronic irritation due to Chronic esophagitis Achalasia Hiatal hernia Alcohol abuse, smoking
What is GERD?
Gastroesophageal Reflux Disease
Reflux of gastric contents into the esophagus causing esophagitis.
Caused by incompetent esophageal sphincter- a circular band of muscle that closes the few centimeters of esophagus and prevents the backward flow of stomach contents.
S&S: heartburn usually severe
DX: UGI, EGD with Bravo (pH test)-measures the amount of esophageal reflux you have
Trx: antacids, H2 antagonists. i.e.: Zantac, Tagament, PPI drugs, i.e.: Prilosec, Nexium, Prevacid, avoid coffee, tea, and smoking elevate Head above Bed (HOB)
What is Acute Gastritis?
Gastric mucosa is inflamed. May be ulcerated and bleeding May result from Infection by microorganisms Allergies to foods Spicy or irritating foods Excessive alcohol intake Ingestion of aspirin or other NSAIDs Ingestion of corrosive or toxic substances Radiation or chemotherapy
What are the basic signs of Gastrointestinal Infection?
Anorexia, nausea, vomiting may develop
Hematemesis due to bleeding
Epigastric pain, cramps or general discomfort
With infection, diarrhea may develop.
Acute Gastritis is usually_______?
self-limiting.
Complete regeneration of gastric mucosa
Supportive treatment with prolonged vomiting
May require treatment with antimicrobial drugs
What is Chronic Gastritis?
Inflammation of the stomach mucosa
H. Pylori- type of bacteria called helicobacter pylori that infects your stomach usually during childhood.
Often seen in patients with chronic peptic ulcers, those who abuse alcohol and the elderly.
S&S
Mild epigastric discomfort
Anorexia
Intolerance for certain foods usually spicy or fatty foods
Increased risk for peptic ulcers and gastric carcinoma
What is Barrett’s Esophagitis?
Chronic reflux esophagitis leading to dysplasia and cancer. This is a serious complication of GERD. Barrett’s does not have any specific symptoms, patients may have symptoms related to GERD.
What are the causes of a Peptic Ulcer (Gastric and Duodenal)?
Causes:
- Imbalance between acid/pepsin
- Inability of the gastric mucosal barrier to resist destruction (alcohol)
- H. Pylori bacteria in 90% of ulcers. Usually occurs during childhood, a common cause of peptic ulcers.
What are the manifestations of Peptic Ulcers?
Epigastric pain when stomach is empty and relieved with food or antacids
What are the Diagnoses and goals of treatment for Peptic Ulcers?
Dx: History, gastroscopy, UGI Goals of Treatment: 1. Decrease or neutralize HCL 2. Increase resistance of mucosal layer 3. Promote Healing
What are the treatments for Peptic Ulcers?
Trx: Relieve stress/anxiety, dietary management, medications to buffer or decrease secretions(H2 histmaine 2 Zantac & Tagamet) (PPI proton pump inhibitors- Nexium and Protnix), Bismuth, Tetracycline or Amoxicillin, Metronidazole
Surgical Trx: Vagotomy, gastrectomy, pyloroplasty
What are complications of Peptic Ulcers and their treatments?
- Hemorrhage 10-15% of patients, hematemesis and melena
- Obstruction-edema, scarring
- Perforation-erodes all 3 layers of the gastric mucosa causes peritonitis
Trx: Gastroduodenostomy, hemigastrectomy, gastrojejunostomy
What is Gastric Cancer?
Incidence: generally found in 50-70 y.o.
15% have a 5 year survival rate
An adenocarcinoma, 50% in pyloric region
S&S: back pain, epigastric pain, wt. loss, n&v
Dx: gastroscopy with biopsy, UGI
Trx: surgery-gastrectomy or hemigastrectomy, gastrojejunostomy, PEG or PEJ tube, chemotherapy of 5-FU or carmustine
What is Irritable Bowel Syndrome?
GI symptoms of bloating, diarrhea, constipation, gas with no organic pathology (spastic colon)
Dx: r/o other diseases
Trx: Dietary changes-increase fiber, stop diary products, relieve stress, drugs: miralax, librax, anti-anxiety drugs, anti-depressants
What are two examples of Inflammatory Bowel Disease?
Crohn’s disease and Ulcerative Colitis are chronic inflammatory bowel diseases, the causes of which are unknown
What is the incidence rate for Inflammatory Bowel Diseases?
15-35 y.o.
What is Ulcerative Colitis?
edema, ulcers, congestion of the colon with exacerbations and remissions, In severe acute episodes, a serious complication, toxic megacolon, may develop, as inflammation impairs peristalsis, leading to obstruction and dilation of the colon. Patients have an increase risk of colorectal carcinoma
What are the manifestations, diagnoses and treatments for Ulcerative Colitits?
S&S: recurrent bloody diarrhea 10-25 per day, abdominal pain, n&v, wt. loss, fatigue
Dx: hx, stool specimen, colonoscopy with bx
Trx. Azulfidine, corticosteroids(enemas, suppositories, oral initial trx) Remicade, education, decrease stress, Surgery Colectomy
What is Crohn’s Disease?
Recurrent inflammation and granulomatous disease of the terminal ileum and colon
S&S: fever, abdominal pain (RLQ), diarrhea (35x/day), slow onset
Dx: Colonoscopy, small bowel x-ray
Trx: reduce stress, dietary changes, humira, remicade, Imuran, Corticosteroids-initial, resection of the distal ileum with ileostomy, Vitamin B-12, TPN (Total Parenteral Nutrition)-how to obtain nutrition
What is Diverticulosis?
Condition of having small out-pouchings in the colon (diverticula, diverticulum)
Diverticulitis: Inflammation and infection of the diverticula
S&S: pain in the LLQ, low grade fever, constipation, diarrhea, n&v
Dx: CT scan, colonoscopy, barium enema
What is Colorectal Cancer?
Incidence: Found in those over the age of 40
80% survival rate rectal cancer
85% survival rate colon cancer
Causes: low fiber, high fat diet, family hx, polyps, ulcerative colitis
What are the manifestations, diagnoses and treatments for Colorectal Cancer?
S&S: Locational: Right side- cramping and pressure
Left side- Pressure and Rectal Bleed
Dx: Rectal exam, stools with occult blood, BA enema, CEA-tumor marker, ultrasound, colonoscopy with bx
Trx: Right hemicolectomy (cecum/ascending colon) Right colectomy (proximal & middle transverse colon) Sigmoid colectomy (sigmoid) or abdominoperineal resection with sigmoid colostomy (lower rectum) initial trx is surgery
Chemotherapy: 5-FU
What are Bowel Obstructions?
Mechanical:
Volvulus: twisted intestine
Intussusception: telescoping of intestine upon its self (kids under the age of 2)
S&S: acute onset of abdominal pain
Dx: Physical exam, flat plate x-ray of abdomen or CT Scan
Trx: Emergency surgery
What is Paralytic Ileus?
Diagnostic tests that are completed for bowel obstruction are also done to determine if the patient has paralytic ileus.
Lack of peristalsis in Ileum, intestinal muscles must be so inactive that it presents the passage of food and leads to a functional blockage of the intestine.
Causes: Surgery or Trauma
S&S: Vomiting
Dx: Bowel sounds- hear a high pitched tinkling sound
Trx: N/G tube to suction, IV’s NPO, will resolve on its own
What is Cholecystitis/Cholelithiasis?
S&S: Pain in the RUQ or in the back after a fatty meal, fever, biliary colic
Dx: Ultrasound, oral cholecystogram, IV Cholangiogram, HIDA scan- imaging test that helps track the production and flow of bile from the liver to the small intestine. Bile is a fluid produced by the liver that helps the digestive system break down fats in the foods you eat.
Trx: Cholecystectomy (laparoscopic) with common bile duct exploration (for choledocholithiasis) EGD- with injection of chenodeoxycholic acid to dissolve stones
What is Pancreatitis?
Autodigestion of the pancreas by lipase and amylase
Cause: alcoholism, trauma, peptic ulcers, gall bladder disease
S&S: Pain in the back, n&v
Dx: serum amylase & lipase, H&P
Trx: Demerol/mophine, IV therapy, insulin,
Complications: Abscesses, peritonitis
What is Cirrhosis?
Chronic degenerative disease of liver. Cirrhosis is commonly the result of chronic alcoholism and often malnutrition, hepatitis, or other causes. Lobs of the liver become covered with fibrous tissue, hepatic cells degenerate and the liver is infiltrated with fat.
What are the causes, manifestations, diagnoses and treatments for Cirrhosis?
Causes:
1. Post Necrotic- Hepatitis
2. Biliary- Gall Bladder Disease
3. Alcoholic- Turns yellow-orange with fat deposits and scarring
S&S: wt. loss, hepatomegaly, jaundice, anorexia, esophageal varices, diarrhea, bleeding disorders, ascites, telangiectasis (spider angiomas) benign vascular lesion these lesions are found on the cheeks, neck and arms
Dx: History of Alcohol intake, hepatitis, palpation of liver, liver bx., CT scan, abdominal x-ray, liver enzymes
Trx: stop drinking alcohol! Vitamins, low Na diet, restricted fluids, abdominocentesis for ascites
End Result is hepatic coma and death
What is Hepatitis?
Inflammation of the liver
Causes: Drugs, toxins, infections, malaria, salmonella
What is Hepatitis A?
Viral hepatitis caused by the hepatitis A virus (HAV). It is a benign disorder spread by contaminated food or water and characterized by slow onset of symptoms. Complete recovery is expected.
Infectious, Shell Fish, Fecal Matter
What is Hepatitis B?
caused by the hepatitis B virus (HBV) and is transmitted by blood transfusions, sexual contact, or the use of contaminated needles or instruments. Severe infection can cause destruction of liver cells, cirrhosis, or death. A vaccine that provides immunity is available and recommended for persons at risk for exposure.
What is Hepatitis C?
caused by the hepatitis C virus (HCV) and is transmitted by blood transfusions or needles (drug users sharing needles) The acute illness may progress into chronic hepatitis. C occurs most frequently in prison. Good hand washing techniques should be practiced.
What is Hepatitis D?
aka delta virus it is a serious liver disease caused by infection with the hepatitis D (HDV) which is an RNA virus structurally unrelated to the Hepatitis A,B,C viruses. D can be acute or chronic is uncommon in the US. It is transmitted through percutaneous or mucosal contact with infections blood and can be acquired either as a coinfection with HBV . There is no vaccine for Hepatitis D.
What is Hepatitis E?
a serious liver disease caused by the Hepatitis E virus (HEV) that usually results in an acute infection. It does not lead to a chronic infection. Type E is rare in the US. Transmission: Ingestion of fecal matter, even in microscopic amounts, outbreaks are usually associated with contaminated water supply in countries with poor sanitation. No vaccination available.
Which type of Hepatitis is least threatening?
Type A
Which types of Hepatitis are the most common?
B and C
What is the pathology, manifestations, diagnoses and treatments for Hepatitis?
Pathology-diffuse or patchy hepatocellular necrosis
S&S:
Pre-icterus stage- myalgia, arthralgia, anorexia, n&v, malaise
Icterus stage- jaundice, RUQ pain, hepatomegaly, fever, elevated bilirubin
Convalescent stage- recovery stage can take 2-3 weeks or up to 16 weeks
Dx: Serum hepatitis screening, bilirubin, liver enzyme
Trx: bedrest, IV Therapy, No Alcohol, Interferon
What is Chronic Hepatitis?
Symptoms for more than 6 months
Chronic persistent-few symptoms
Chronic active- progressive liver failure, cirrhosis and death
Drugs: Antivirals, interferon
