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Pathophysiology I > Chapter 29: Disorders of GI function > Flashcards

Chapter 29: Disorders of GI function Flashcards

1
Q

Describe Mallory-Weiss Syndrome.

A

It is longitudinal tearing in the mucosal layer of the esophageal sphincter because related to it not relaxing during retching

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2
Q

What are the (2) RF of Mallory-Weiss Syndrome?

A

ETOH

Hiatus Hernia

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3
Q

What are the (2) manifestations of Mallory-Weiss Syndrome?

A

Hematemesis

Coffee-ground stools

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4
Q

What is Hiatus Hernia?

A

it is the herniation of the upper stomach through the esophageal hiatus of the diaphragm

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5
Q

What are the two (2) types of Hiatus Hernia?

A

Sliding

Rolling or Paraesophageal

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6
Q

What is the most common type of Hiatus Hernia?

A

Sliding

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7
Q

Compare the anatomy that occurs in Sliding and Rolling (Paraesophageal).

A

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

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8
Q

What percentage of people with Sliding Hiatus Hernia are over the age of fifty?

A

> 50 percent

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9
Q

List the (2) causes of hiatus hernia.

A

Increased abdominal pressure

Hereditary

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10
Q

List a few things that could increase abdominal pressure.

A 
Constipation
Heavy lifting
Violent cough, sneeze, vomiting
Pregnancy/delivery
Obesity
Sitting to defecate
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11
Q

What is gastritis? Describe the characteristics of its manifestations (rate of onset, duration)

A

inflammation of the grastric mucosa

Manifestations are slow to abrupt in onset and often self-limiting but depends on cause (ex food poisoning)

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12
Q

List 4 acute causes of gastritis

A

Things that are local irritants:

ASA/NSAIDS
alcohol
bacterial toxins
corticosteroids

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13
Q

List the (4) manifestations of gastritis.

A

Heartburn (chest)
Sour Stomach (abdomen)
Vomiting
Hematemesis

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14
Q

What is the most common cause of bacterial gastritis?

A

Helicobacter Pylori

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15
Q

Describe the characteristics of Helicobactor Pylori as it relates to gastritis.

A

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

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16
Q

How is Helicobacter Pylori transmitted?

A

Oral to Oral

or

Fecal to Oral

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17
Q

Describe the characteristics of H. Pylori Gastritis manifestations and list 3

A

Often asymptomatic and highly variable

Nausea
Abdominal discomfort
Pain

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18
Q

What are the (2) conditions that H. Pylori Gastritis predisposes you to.

A

Peptic ulcer disease

Gastric adenocarcinoma

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19
Q

Describe what Peptic Ulcer Disease is.

A

it is acid ulceration of the mucosa/smooth muscle.

Heals to a scar
Remissions are common

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20
Q

What part of the digestive tract does Peptic Ulcer Disease most commonly affect?

A

The duodenum

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21
Q

List some causes and risk factors that lead to Peptic Ulcer Disease

A

H. Pylori
NSAIDS (ASA)

RF: age, warfarin, coritcosteroids, h/o peptic ulcer, smoking

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22
Q

List the (2) manifestations of Peptic Ulcer Disease.

A

Abdominal discomfort (dyspepsia)

Pain

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23
Q

Describe the pain manifestation associated with peptic ulcer disease.

A

1) burning, cramping, rhythmic
2) midline pain that may radiate down/back
3) Occurs on empty stomach and often relieved with food

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24
Q

List and describe the (3) complications of peptic ulcer disease

A

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

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25
Q

Describe what IBS (Irritable Bowel Syndrome) is.

A

It is inflammation of the intestines with no known organic or biochemically normal findings

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26
Q

What is the prevalence of IBS

A

1/5 adults

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27
Q

List the (4) risk factors of IBS

A

Woman > Men
Stress
Age
Lactose intolerance

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28
Q

List the (9) manifestations of IBS

A

Lower intermittent abdominal pain (relieved by defecation and at night)

Mucousy BM
Altered BM frequency
Bloating
Flatulence
Nausea
Vomiting
Anxiety
Depression
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29
Q

Describe the (3) treatments for IBS.

A

STRESS MANAGEMENT

DIETARY COUNCELLING:
inc fiber and avoid fat, alcohol, and caffeine

PHARMACOLOGY:

1) antispasmatics
2) antacids
3) analgesics

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30
Q

What are the two types of inflammatory bowel disease?

A

Crohn’s Disease

Ulcerative Colitis

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31
Q

What is the prevalence of people with IBD?

A

1/150 canadians

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32
Q

Is there an obvious cause for IBD?

A

no, but many risk factors

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33
Q

List some risk factors for IBD

A

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)

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34
Q

How does appendicitis affect the risk of ulcerative colitis?

A

decreases risk

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35
Q

List the (6) systemic complications of IBD that are shared by both types.

A

Arthritis

Eye inflammation (urveitis)

Skin lesions (mouth and mucous membranes)

Anemia

Hypercoagulability

Bile duct inflammation (sclerosing cholangitis)

36
Q

What is inflammation of the eye called?

A

urveitis

37
Q

What is inflammation of the bile duct called?

A

Sclerosing Cholangitis

38
Q

What regions of the digestive tract does Crohm’s Disease affect?

A

distal small intestine and proximal colon

39
Q

What age/gender is the most at risk for Crohn’s disease?

A

Women ages 20-30

40
Q

Describe Chrohn’s disease

A

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

41
Q

List the (7) manifestations of Crohn’s Disease. (2 general ones, 5 with a general theme)

A

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
42
Q

List (2) complications of Crohn’s Disease.

A

FISTULAS:
openings into other areas

OBSTRUCTION:
b/c of granulomas

43
Q

Describe the 3 treatments for Crohn’s Disease.

A

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

44
Q

What is TPN? Why is it used in Crohn’s Disease?

A

it is total parenteral nutrition

used to bypass the gut to meet the nutritional needs

45
Q

What region of the digestive tract does ulcerative colitis affect?

A

The rectum and the colon

46
Q

List the names and locations of the three types of ulcerative colitis

A

1) Ulcerative Proctitis (rectum only)
2) Prostosigmoiditis (rectum and sigmoid)
3) Pancolitis (entire colon)

47
Q

Describe (2) characteristics of ulcerative colitis (besides location in the tract)

A

Usually mucosal layer only

Lesions in Crypts of Lievberkuhn (intestinal glands)

  • inflammation to hemorrhage to absess to necrosis
  • pseudopolyps can form and trap feces
48
Q

List the (6) manifestations of ulcerative colitis

A

1) Diarrhea with blood and or mucous (hematochezia)
2) mild abd cramping
3) hyperactive bowel sounds
4) anorexia
5) weakness
6) fatigue

49
Q

What is fresh blood in the stool called?

A

Hematochezia

50
Q

How long does ulcerative colitis last?

A

can last for days, weeks, or months

remissions and recurrences are common

51
Q

Ulcerative Colitis varies from mild, moderate, severe, and fulminant. Describe the criteria for each.

A

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

52
Q

What are the (2) complications of Ulcerative Colitis

A

1) Toxic Megacolon
- abnormal dilation of colon, systemic toxicity

2) Colon Ca

53
Q

What are the signs of toxic megacolon?

A

paralytic ileus (no movement of the bowels), pain, infection

54
Q

How is Ulcerative Colitis diagnosed? When is this method contraindicated?

A

Colonoscopy

Contraindicated with sever disease

55
Q

Describe the three treatment methods for ulcerative colitis.

A

1) Dietary restrictions and fiber
2) Pharmacology

3) Surgical Removal
(ileostomy, ileoanal anastomosis)

56
Q

Describe what diverticular disease is. Describe what diverticulosis is.

A

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

57
Q

List the (3) RF of diverticulosis

A

1) lack of fiber
2) dec physical activity
3) aging

58
Q

list the (2) complications of diverticulitis

A

1) fistulas

2) perforation (leads to peritonitis and paralytic ileus)

59
Q

List the (6) manifestations of diverticulosis

A

1) abd discomfort
2) pain
3) diarrhea
4) constipation
5) bloating
6) flatulence

60
Q

What can be said about the symptoms of diverticulosis and their relief?

A

They vary from asymptomatic to mild complaint

Improved with dietary changes.

61
Q

Describe the condition of appendicitis

A

Inflammation of the appendix d/t fecal obstruction or twisting of structure

62
Q

When does appendicitis usually present?

A

early adulthood or younger

63
Q

List the (3) manifestations of appendicities

A

1) Epigastric pain (abrupt and increasing)
2) Nausea
3) Rebound tenderness to R quadrant

64
Q

List the (3) complications of Appendicitis

A

1) peritonitis
2) abscess
3) septicemia

65
Q

Where do acute intestinal obstructions usually occur?

A

in the small intestine

66
Q

What are the 2 types of acute intestinal obstruction?

A

Mechanical (inguinal hernia)

Non-Mechanical (paralytic ileus, accumulation of gasses/fluid

67
Q

What are the 4) complications of Mechanical Acute Intestinal Obstruction.

A

Intussusception (folding)
Vovulus (twisting)
Post Op adhesions
Strictures/tumors

68
Q

What are the risk factors for paralytic ileus causing non-mechanical acute intestinal obstruction.

A

Surgery
Infection
Back injuries

69
Q

What (4) things can cause accumulation of gases/fluids leading non-mechanical acute intestinal obstruction?

A

toxins
infection
strangulation
gangrene

70
Q

List the (9) manifestations of Acute Intestinal Obstruction.

A

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

71
Q

List the 4 complications of acute intestinal obstructions.

A

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

72
Q

Describe what compartment syndrome is

A

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

73
Q

Describe what peritonitis is

A

Inflammation of the serous membrane lining abd cavity and covering visceral organs

74
Q

What are 2 causes of peritonitis?

A

leakage from abd organs

trauma

75
Q

What are the (9) manifestations of peritonitis?

A

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

76
Q

List the six ways that peritonitis is treated.

A

1) NG tube
2) NPO
3) abx
4) fluid and electrolyte therapy
5) narcotics
6) surgery

77
Q

Describe what Celiac Disease is.

A

It is an autoimmune disease causing inflammation in the vili of the small intestine causing poor absorption

Problems with grains

78
Q

What are the 6 RF for Celiac Disease

A 
Genetic predisposition
Women > men
Type 1 diabetes
Other autoimmune
Family hx
Turner syndrome
79
Q

List the 4 general manifestations of Celiac disease that occur at all ages

A

Diarrhea
Abd discomfort
Distension
Malnutrition (FTT)

80
Q

What are the 3 manifestations of celiac disease that increase with age.

A

1) Anemia
2) Dental enamel defects
3) Constipation

81
Q

What are the 3 manifestations of celiac disease that occur in adult populations?

A

1) Iron deficiency
2) Osteoporosis
3) IBS

82
Q

What is the complication that arises with long term use of the gluten free diet?

A

inc risk of malignancy

83
Q

What are the 4 RF of colorectal Ca?

A

1) family hx of Ca
2) Crohn’s and Ulcerative Colitis
3) Adenomatous polyposis of colon (high risk)
4) High fat/sugar diet

84
Q

What reduces the risk of colorectal Ca?

A

fiber, vitamins, ASA

85
Q

List the 5 manifestations of colorectal Ca

A

1) hematochezia
2) diarrhea
3) constipation
4) incomplete emptying
5) pain

86
Q

What is a possible complication of diverticulosis?

A

DIVERTICULITIS:

inflammation of the herniated pouches

87
Q

List the 4 manifestations of diverticulitis

A

1) LLQ pain
2) N and V
3) fever
4) elevated WBC

Pathophysiology I (16 decks)

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