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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
Describe what IBS (Irritable Bowel Syndrome) is.
It is inflammation of the intestines with no known organic or biochemically normal findings
26
What is the prevalence of IBS
1/5 adults
27
List the (4) risk factors of IBS
Woman > Men Stress Age Lactose intolerance
28
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 ```
29
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
30
What are the two types of inflammatory bowel disease?
Crohn's Disease Ulcerative Colitis
31
What is the prevalence of people with IBD?
1/150 canadians
32
Is there an obvious cause for IBD?
no, but many risk factors
33
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)
34
How does appendicitis affect the risk of ulcerative colitis?
decreases risk
35
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)
36
What is inflammation of the eye called?
urveitis
37
What is inflammation of the bile duct called?
Sclerosing Cholangitis
38
What regions of the digestive tract does Crohm's Disease affect?
distal small intestine and proximal colon
39
What age/gender is the most at risk for Crohn's disease?
Women ages 20-30
40
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
41
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
42
List (2) complications of Crohn's Disease.
FISTULAS: openings into other areas OBSTRUCTION: b/c of granulomas
43
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
44
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
45
What region of the digestive tract does ulcerative colitis affect?
The rectum and the colon
46
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)
47
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
48
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
49
What is fresh blood in the stool called?
Hematochezia
50
How long does ulcerative colitis last?
can last for days, weeks, or months remissions and recurrences are common
51
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
52
What are the (2) complications of Ulcerative Colitis
1) Toxic Megacolon - abnormal dilation of colon, systemic toxicity 2) Colon Ca
53
What are the signs of toxic megacolon?
paralytic ileus (no movement of the bowels), pain, infection
54
How is Ulcerative Colitis diagnosed? When is this method contraindicated?
Colonoscopy Contraindicated with sever disease
55
Describe the three treatment methods for ulcerative colitis.
1) Dietary restrictions and fiber 2) Pharmacology 3) Surgical Removal (ileostomy, ileoanal anastomosis)
56
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
57
List the (3) RF of diverticulosis
1) lack of fiber 2) dec physical activity 3) aging
58
list the (2) complications of diverticulitis
1) fistulas | 2) perforation (leads to peritonitis and paralytic ileus)
59
List the (6) manifestations of diverticulosis
1) abd discomfort 2) pain 3) diarrhea 4) constipation 5) bloating 6) flatulence
60
What can be said about the symptoms of diverticulosis and their relief?
They vary from asymptomatic to mild complaint Improved with dietary changes.
61
Describe the condition of appendicitis
Inflammation of the appendix d/t fecal obstruction or twisting of structure
62
When does appendicitis usually present?
early adulthood or younger
63
List the (3) manifestations of appendicities
1) Epigastric pain (abrupt and increasing) 2) Nausea 3) Rebound tenderness to R quadrant
64
List the (3) complications of Appendicitis
1) peritonitis 2) abscess 3) septicemia
65
Where do acute intestinal obstructions usually occur?
in the small intestine
66
What are the 2 types of acute intestinal obstruction?
Mechanical (inguinal hernia) Non-Mechanical (paralytic ileus, accumulation of gasses/fluid
67
What are the 4) complications of Mechanical Acute Intestinal Obstruction.
Intussusception (folding) Vovulus (twisting) Post Op adhesions Strictures/tumors
68
What are the risk factors for paralytic ileus causing non-mechanical acute intestinal obstruction.
Surgery Infection Back injuries
69
What (4) things can cause accumulation of gases/fluids leading non-mechanical acute intestinal obstruction?
toxins infection strangulation gangrene
70
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
71
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
72
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
73
Describe what peritonitis is
Inflammation of the serous membrane lining abd cavity and covering visceral organs
74
What are 2 causes of peritonitis?
leakage from abd organs trauma
75
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
76
List the six ways that peritonitis is treated.
1) NG tube 2) NPO 3) abx 4) fluid and electrolyte therapy 5) narcotics 6) surgery
77
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
78
What are the 6 RF for Celiac Disease
``` Genetic predisposition Women > men Type 1 diabetes Other autoimmune Family hx Turner syndrome ```
79
List the 4 general manifestations of Celiac disease that occur at all ages
Diarrhea Abd discomfort Distension Malnutrition (FTT)
80
What are the 3 manifestations of celiac disease that increase with age.
1) Anemia 2) Dental enamel defects 3) Constipation
81
What are the 3 manifestations of celiac disease that occur in adult populations?
1) Iron deficiency 2) Osteoporosis 3) IBS
82
What is the complication that arises with long term use of the gluten free diet?
inc risk of malignancy
83
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
84
What reduces the risk of colorectal Ca?
fiber, vitamins, ASA
85
List the 5 manifestations of colorectal Ca
1) hematochezia 2) diarrhea 3) constipation 4) incomplete emptying 5) pain
86
What is a possible complication of diverticulosis?
DIVERTICULITIS: | inflammation of the herniated pouches
87
List the 4 manifestations of diverticulitis
1) LLQ pain 2) N and V 3) fever 4) elevated WBC

Pathophysiology I (16 decks)

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