Chapter 29: Disorders of GI function Flashcards
Describe Mallory-Weiss Syndrome.
It is longitudinal tearing in the mucosal layer of the esophageal sphincter because related to it not relaxing during retching
What are the (2) RF of Mallory-Weiss Syndrome?
ETOH
Hiatus Hernia
What are the (2) manifestations of Mallory-Weiss Syndrome?
Hematemesis
Coffee-ground stools
What is Hiatus Hernia?
it is the herniation of the upper stomach through the esophageal hiatus of the diaphragm
What are the two (2) types of Hiatus Hernia?
Sliding
Rolling or Paraesophageal
What is the most common type of Hiatus Hernia?
Sliding
Compare the anatomy that occurs in Sliding and Rolling (Paraesophageal).
SLIDING: gastroesophageal junction and part of stomach moves above the diaphragm
ROLLING (PARAESOPHAGEAL): part of stomach moves through the gastroesophageal junction and lies next to esophagus
What percentage of people with Sliding Hiatus Hernia are over the age of fifty?
> 50 percent
List the (2) causes of hiatus hernia.
Increased abdominal pressure
Hereditary
List a few things that could increase abdominal pressure.
Constipation Heavy lifting Violent cough, sneeze, vomiting Pregnancy/delivery Obesity Sitting to defecate
What is gastritis? Describe the characteristics of its manifestations (rate of onset, duration)
inflammation of the grastric mucosa
Manifestations are slow to abrupt in onset and often self-limiting but depends on cause (ex food poisoning)
List 4 acute causes of gastritis
Things that are local irritants:
ASA/NSAIDS
alcohol
bacterial toxins
corticosteroids
List the (4) manifestations of gastritis.
Heartburn (chest)
Sour Stomach (abdomen)
Vomiting
Hematemesis
What is the most common cause of bacterial gastritis?
Helicobacter Pylori
Describe the characteristics of Helicobactor Pylori as it relates to gastritis.
Shape allows it to burrow into the mucosal layer by chemotaxis (moves away from acid chemical gradient)
Secretes Urease which causes
Urea -> CO2 + NH3
NH3 is ammonia (a base)
Produces enzymes/toxins that cause continuous gastritis
How is Helicobacter Pylori transmitted?
Oral to Oral
or
Fecal to Oral
Describe the characteristics of H. Pylori Gastritis manifestations and list 3
Often asymptomatic and highly variable
Nausea
Abdominal discomfort
Pain
What are the (2) conditions that H. Pylori Gastritis predisposes you to.
Peptic ulcer disease
Gastric adenocarcinoma
Describe what Peptic Ulcer Disease is.
it is acid ulceration of the mucosa/smooth muscle.
Heals to a scar
Remissions are common
What part of the digestive tract does Peptic Ulcer Disease most commonly affect?
The duodenum
List some causes and risk factors that lead to Peptic Ulcer Disease
H. Pylori
NSAIDS (ASA)
RF: age, warfarin, coritcosteroids, h/o peptic ulcer, smoking
List the (2) manifestations of Peptic Ulcer Disease.
Abdominal discomfort (dyspepsia)
Pain
Describe the pain manifestation associated with peptic ulcer disease.
1) burning, cramping, rhythmic
2) midline pain that may radiate down/back
3) Occurs on empty stomach and often relieved with food
List and describe the (3) complications of peptic ulcer disease
HEMORRHAGE:
if it erodes into a artery/vein
PERFORATION & PERITONITIS:
perforates stomach wall and enters peritoneum
GASTRIC OUTLET OBSTRUCTION:
scarring and structure changes in the pylorus hinder its opening causing food obstruction and distended stomach
Describe what IBS (Irritable Bowel Syndrome) is.
It is inflammation of the intestines with no known organic or biochemically normal findings
What is the prevalence of IBS
1/5 adults
List the (4) risk factors of IBS
Woman > Men
Stress
Age
Lactose intolerance
List the (9) manifestations of IBS
Lower intermittent abdominal pain (relieved by defecation and at night)
Mucousy BM Altered BM frequency Bloating Flatulence Nausea Vomiting Anxiety Depression
Describe the (3) treatments for IBS.
STRESS MANAGEMENT
DIETARY COUNCELLING:
inc fiber and avoid fat, alcohol, and caffeine
PHARMACOLOGY:
1) antispasmatics
2) antacids
3) analgesics
What are the two types of inflammatory bowel disease?
Crohn’s Disease
Ulcerative Colitis
What is the prevalence of people with IBD?
1/150 canadians
Is there an obvious cause for IBD?
no, but many risk factors
List some risk factors for IBD
Genetics (south asia immigrants more likely)
More common in NA, Europe, Australia
Dietary link (especially to changes)
Microbe
Vit D deficiency
Abx use at young age
Smoking (for Crohn’s)
How does appendicitis affect the risk of ulcerative colitis?
decreases risk
List the (6) systemic complications of IBD that are shared by both types.
Arthritis
Eye inflammation (urveitis)
Skin lesions (mouth and mucous membranes)
Anemia
Hypercoagulability
Bile duct inflammation (sclerosing cholangitis)
What is inflammation of the eye called?
urveitis
What is inflammation of the bile duct called?
Sclerosing Cholangitis
What regions of the digestive tract does Crohm’s Disease affect?
distal small intestine and proximal colon
What age/gender is the most at risk for Crohn’s disease?
Women ages 20-30
Describe Chrohn’s disease
1) well defined granuloma (skip lesions)
2) usually sub-mucosal, but can involve all layers
3) fibrosis results in thickening and stiffness
4) adjacent structures become inflamed
5) lymph nodes can enlarge
List the (7) manifestations of Crohn’s Disease. (2 general ones, 5 with a general theme)
LRQ pain (b/c of location of distal small intestine and proximal colon)
Low grade fever
Inflammation leads to dmg of wall leading to malabsorption
- diarrhea
- steatorrhea
- fluid and electrolyte imbalances
- wt loss
- malaise
List (2) complications of Crohn’s Disease.
FISTULAS:
openings into other areas
OBSTRUCTION:
b/c of granulomas
Describe the 3 treatments for Crohn’s Disease.
1) DIET ALTERATIONS:
high cal, vitamin, proteins
avoid fats, bulk
TPN if needed
2) MEDICATION:
anti-inflammatories, corticosteroids, etc
3) SURGERY:
not a cure, remission is common
What is TPN? Why is it used in Crohn’s Disease?
it is total parenteral nutrition
used to bypass the gut to meet the nutritional needs
What region of the digestive tract does ulcerative colitis affect?
The rectum and the colon
List the names and locations of the three types of ulcerative colitis
1) Ulcerative Proctitis (rectum only)
2) Prostosigmoiditis (rectum and sigmoid)
3) Pancolitis (entire colon)
Describe (2) characteristics of ulcerative colitis (besides location in the tract)
Usually mucosal layer only
Lesions in Crypts of Lievberkuhn (intestinal glands)
- inflammation to hemorrhage to absess to necrosis
- pseudopolyps can form and trap feces
List the (6) manifestations of ulcerative colitis
1) Diarrhea with blood and or mucous (hematochezia)
2) mild abd cramping
3) hyperactive bowel sounds
4) anorexia
5) weakness
6) fatigue
What is fresh blood in the stool called?
Hematochezia
How long does ulcerative colitis last?
can last for days, weeks, or months
remissions and recurrences are common
Ulcerative Colitis varies from mild, moderate, severe, and fulminant. Describe the criteria for each.
MILD: 4 stools/day, minimal signs of infection
SEVERE: >6 bloddy stools/day with toxicity
(fever, tachycardia, anemia, elevated ESR)
FULMINANT: >10 stools/day, continuous bleeding, anemia. (fever, abdominal tenderness/distension
What are the (2) complications of Ulcerative Colitis
1) Toxic Megacolon
- abnormal dilation of colon, systemic toxicity
2) Colon Ca
What are the signs of toxic megacolon?
paralytic ileus (no movement of the bowels), pain, infection
How is Ulcerative Colitis diagnosed? When is this method contraindicated?
Colonoscopy
Contraindicated with sever disease
Describe the three treatment methods for ulcerative colitis.
1) Dietary restrictions and fiber
2) Pharmacology
3) Surgical Removal
(ileostomy, ileoanal anastomosis)
Describe what diverticular disease is. Describe what diverticulosis is.
It is a disease that involves single or multiple herniation of “pouches” through the muscle layer.
Diverticulosis is a type of this disease and involves the mucosal and submucosal layers only
List the (3) RF of diverticulosis
1) lack of fiber
2) dec physical activity
3) aging
list the (2) complications of diverticulitis
1) fistulas
2) perforation (leads to peritonitis and paralytic ileus)
List the (6) manifestations of diverticulosis
1) abd discomfort
2) pain
3) diarrhea
4) constipation
5) bloating
6) flatulence
What can be said about the symptoms of diverticulosis and their relief?
They vary from asymptomatic to mild complaint
Improved with dietary changes.
Describe the condition of appendicitis
Inflammation of the appendix d/t fecal obstruction or twisting of structure
When does appendicitis usually present?
early adulthood or younger
List the (3) manifestations of appendicities
1) Epigastric pain (abrupt and increasing)
2) Nausea
3) Rebound tenderness to R quadrant
List the (3) complications of Appendicitis
1) peritonitis
2) abscess
3) septicemia
Where do acute intestinal obstructions usually occur?
in the small intestine
What are the 2 types of acute intestinal obstruction?
Mechanical (inguinal hernia)
Non-Mechanical (paralytic ileus, accumulation of gasses/fluid
What are the 4) complications of Mechanical Acute Intestinal Obstruction.
Intussusception (folding)
Vovulus (twisting)
Post Op adhesions
Strictures/tumors
What are the risk factors for paralytic ileus causing non-mechanical acute intestinal obstruction.
Surgery
Infection
Back injuries
What (4) things can cause accumulation of gases/fluids leading non-mechanical acute intestinal obstruction?
toxins
infection
strangulation
gangrene
List the (9) manifestations of Acute Intestinal Obstruction.
DISTENSION
PAIN: continuous and slight variation with paralytic ileus, severe and steady with strangulation
VOMITING
HIGH-PITCHED PERISTALSIS (silent in paralytic ileus)
VISIBLE PERISTALSIS
ANXIETY
PERSPIRATION
WEAKNESS
CONSTIPATION
List the 4 complications of acute intestinal obstructions.
1) Fluid and electrolyte imbalance (from vomiting)
2) Distension: fluids moving into intestines and gas accumulating proximal to obstruction
3) Toxemia: toxins build up and are not excreted
4) Compartment syndrome
Describe what compartment syndrome is
It is attempted expansion inside a membrane that meets resistance and can’t expand.
blood vessels and nerves become compressed leading to ischemia and necrosis
Describe what peritonitis is
Inflammation of the serous membrane lining abd cavity and covering visceral organs
What are 2 causes of peritonitis?
leakage from abd organs
trauma
What are the (9) manifestations of peritonitis?
1) Pain/tenderness over site
2) Avoidance of movement
- including shallow resp
3) Vomiting
4) Abd guarding/rigidity
5) Signs of infection
6) Hypotension
7) Tachycardia
8) Paralytic ileus
9) Distension
List the six ways that peritonitis is treated.
1) NG tube
2) NPO
3) abx
4) fluid and electrolyte therapy
5) narcotics
6) surgery
Describe what Celiac Disease is.
It is an autoimmune disease causing inflammation in the vili of the small intestine causing poor absorption
Problems with grains
What are the 6 RF for Celiac Disease
Genetic predisposition Women > men Type 1 diabetes Other autoimmune Family hx Turner syndrome
List the 4 general manifestations of Celiac disease that occur at all ages
Diarrhea
Abd discomfort
Distension
Malnutrition (FTT)
What are the 3 manifestations of celiac disease that increase with age.
1) Anemia
2) Dental enamel defects
3) Constipation
What are the 3 manifestations of celiac disease that occur in adult populations?
1) Iron deficiency
2) Osteoporosis
3) IBS
What is the complication that arises with long term use of the gluten free diet?
inc risk of malignancy
What are the 4 RF of colorectal Ca?
1) family hx of Ca
2) Crohn’s and Ulcerative Colitis
3) Adenomatous polyposis of colon (high risk)
4) High fat/sugar diet
What reduces the risk of colorectal Ca?
fiber, vitamins, ASA
List the 5 manifestations of colorectal Ca
1) hematochezia
2) diarrhea
3) constipation
4) incomplete emptying
5) pain
What is a possible complication of diverticulosis?
DIVERTICULITIS:
inflammation of the herniated pouches
List the 4 manifestations of diverticulitis
1) LLQ pain
2) N and V
3) fever
4) elevated WBC
