Chapter 29 Gastro Flashcards
What is the patho and manifestation of esophageal laceration
Patho
- Mallory-Weiss syndrome is longitudinal lacerations in the esophagus
- inadequate relaxation relaxation of the esophageal sphincter during vomiting, with stretching and tearing of the esophageal junction during propulsive expulsion of gastric contents.
Manifestation
- hematemesis
- coffee-ground stools
What is the patho and manifestation of hiatus hernia
-herniation of upper stomach through esophageal hiatus of diaphragm
Sliding (most common) = gastroesophageal junction and part of the stomach moves above the diaphragm
->50% of people over 50 years of age
Rolling (paraesophageal)
-part of the stomach move through the gastroesophageal junction and lies next to the esophagus
Cause
-increase ABD pressure:
constipation, heavy lifting, coughing, delivery, obesity, sitting to defecate
Treatment
- surgical for “rolling” if symptomatic
- elevate HOB, weight loss, stress reduction
Describe acute gastritis causes and manifestation
-inflammation of gastric mucosa
Cause:
-local irritant (ASA/NSAIDS, alcohol, bacterial toxins, corticostreroids
Manifestation
- heart burn/ sour stomach
- alcohol = gastric distress, vomiting, hemetemesis
- abrupt (toxins) to slow onset
- self-limiting
Describe chronic gastritis causes and manifestation
Causes
- h.pylori bacteria
- oral to oral, fecal to oral, sprea from the environment
- secretes urease to buffer acidity of stomach = produce ammonia
- produces enzymes/toxins that cause continuous inflammatory response in mucosa
MANIFESTATION
- variable
- nausea, abdominal discomfort/pain
- predisposition to peptic ulcer, pastric adenocarinoma
Describe role of H pylori in the development of peptic ulcer and manifestation and complication
- involves one or more layers of stomach lining (usually in duodenum)
- acidic ulceration of mucosa and smooth muscle
causes
- H.pylori infection
- NSAIDS and aspirin
- age, warfarin, corticosteroid, h/o peptic ulcer, smoking
Manifestation
- ABD discomfort “indigestion”
- pain (burning, cramping, rhythmic) in midline, may radiate down to back, and occurs on an empty stomach; RELIEF WITH FOOD
COMPLICATION
-hemorrhage (erosion into artery/vein) fast and insidious
- perforation & peritonitis
- gastric outlet obstruction
State the diagnostic criteria, risks, manifestations and proposed treatment for irritable bowel syndrome
DIAGNOSTIC CRITERIA
-continuous or recurrent symptoms of at least 12 weeks’ duration of ABD discomfort or pain in the preceding 12 months with two or three accompanying features: relief with defecation, onset associated with a change in bowel frequency, and associated with a change in form of stool.
RISK
- women > men
- stress
- age
- lactose intolerance
MANIFESTATION
-*lower ABD pain (intermittent, cramping) relieved by defecation. Relief at night
- Bowel movements are mucous and altered number
- bloating, flatulence, nausea, vomiting
- anxiety and depression
TREATMENT
- stress management
- dietary counseling, fiber, avoiding fat, alcohol, caffeine
antispasmodics
antacids
analgeisc
What are characteristics of Crohn’s disease
-granulomatous type of inflammatory response, usually small intestine and proximal colon
Risk: women, 20-30 years of age
- well-defined granuloma (skip lesions)
- usually sub-mucosal but can involve all layers
- fibrosis resulting in thickening and stiffness
- adjacent structures can become inflamed
- lymph nodes can enlarge
MANIFESTATION
- intermittent diarrhea & steatorrhea
- due to malabsorption
- with resulting fluid and electrolyte imbalance
- LRQ pain
- fever
COMPLICATION
- fistulas
- obstruction
TREATMENT
- high calories, vitamins, proteins
- avoid fat
- TPN
- antiinflammatories, corticosteroids, antibiotics, immunesuppresants
surgery to remove but will not cure
What are characteristics of ulcerative colitis
-inflammation of the rectum. then colon
ulcerative proctitis=rectum only
proctosigmoiditis= rectum & sigmoid
pancolitis = entire colon
characteristics
- usually mucosal layer
- lesions in crypts of liberkuhn
- inflammation to hemorrhage to abscess to necrosis
- psuedopolyps form
MANIFESTATION
- diarrhea with blood or mucous
- hematochezia (flesh blood from anus)*
- mild adb cramping
- hyperactive bowel sound
- anorexia, weakness
COMPLICATIONS
- risk for toxic megacolon
- abnormal dilatation of colon
- systemic toxicity
- signs include paralytic ileus, pain, infections
- risk for cancer of colon
DIAGNOSIS AND TREATMENT -colonoscopy contraindicated with severe disease TREATMENT -dietary restrictions + fiber -pharmacology -surgical
Relate the use of a high-fiber diet in the treatment of diverticular disease to the etiologic factors and manifestations for the condition
-use of high-fiber promotes regular defecation and increases colonic contetns and colon diameter, thereby decreasing intraluminal pressure.
CAUSE
-resulting from the unique structure and elevated luminal pressures.
Diverticulosis: mucosa and submucosa only
-single or multiple herniation of “pouches” through musle layers
RISK
-lack of fiber, decrease physical activity, aging
MANIFESTATION
- asymptomatic to mild complaints
- ABD pain
- diarrhea, constipation, bloating, flatulence
Discuss the complication of diverticulosis
- perforation with peritonitis,hemorrhage, and bowel obstruction = paralytic ileus
- fistulas, involving bladder, skin. or perianal area
describe the rationale for the symptoms and possible complications associated with appendicitis
-inflammation of appendix d/t fecal obstruction or twisting of structure
MANIFESTATION
- abrupt onset of epigastric pain caused by stretching of appendix
- nausea cause of increase pain
- rebound tenderness lower R quadrant because inflammatory process has extended to involve the serosal layer of the appendix and the peritoneum.
COMPLICATION
-peritonitis, abscess, septicemia
differentiate between mechanical and paralytic intestinal obstruction in terms of cause and manifestation
Mechanical can be intrinsic and extrinsic.
- cause by hernia: inguinal, femoral, and umbilical
- Intussusception (d/t pressure)
- Volvulus (twisting)
- Post-operative adhesions
- Strictures/Tumors
Non-mechanical
-caused by Paralytic intestinal which is a neurogenic or muscular impairment of the peristalsis
MANIFESTATION
- distention
- pain (Paralytic = continuous) (strangulation = severe and steady)
- vomiting
- constipation
- borborygum (rumbling sound made by gas)
- anxiety
With mechanical obstruction, the pain is severe and colicky, in contrast with the continuous pain and silent abdomen of paralytic ileus
Discuss possible complication of acute intestinal obstruction
Vomiting => fluid and electrolyte loss
Fluids collect in intestine
Gas accumulates proximal to blockage
Distension of bowel
Anaerobic bacteria produce endotoxi -> toxemia
Compartment syndrome -> ischemia, necrosis
Describe the characteristics of peritonitis, including the causes, pathophysiology, manifestations, and possible treatments.
Peritonitis is an inflammatory response of the serous membrane that lines the abdominal cavity and covers the visceral organs.
CAUSE
-It can be caused by bacterial invasion or chemical irritation.
–perforated peptic ulcer, ruptured appendix, perforated diverticulum, gangrenous bowel, pelvic inflammatory disease, and gangrenous gallbladder. Other causes are abdominal trauma and wounds.
PATHO
-enteric bacteria enter the peritoneum because of a break in the wall of one of the abdominal organs.
MANIFESTATION -Pain/tenderness over site Avoidance of movement Shallow respirations Vomiting Abdominal guarding/rigidity Signs of infection CVS: hypotension, tachycardia GI: paralytic ileus, distension Signs of fluid loss
TREATMENT -Nasogastric tube NPO Antibiotics Fluid replacement Electrolyte balance Narcotics Surgical intervention for cause
Describe celiac disease in regards to the etiology, patho, manifestations, diagnosis, primary treatment and complication
Cause
- immune-mediated disorder triggered by ingestion of gluten-containing grains (wheat, barley, and rye).
PATHO
-immune response produce an intense inflammatory reaction that results in loss of absorptive villi from the small intestine. Proteins, carbs, fats, vitamines, minerals.
MANIFESTATION
-Diarrhea, abdominal discomfort/distension
Malnutrition, failure to thrive
With increased age
Anemia, dental enamel defects, constipation
Adults
Iron deficiency, osteoporosis, IBS
Treatment
-gluten-free diet
Complication
-malignancies after being on diet long-term
