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Pathophysiology > Chapter 36 - Alteration In Digestive Function > Flashcards

Chapter 36 - Alteration In Digestive Function Flashcards

1
Q

Four layers of the digestive tract

A
  1. Mucosa
  2. Submucosa
  3. Muscularis externa
  4. Serosa
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2
Q

Small intestine (A) epithelial mucosa protection

A

Single layer

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3
Q

Large intestine (B) epithelial mucosa protection

A

Inner and outer layers

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4
Q

Structural and neural abnormalities can

A

Obstruct, slow, accelerate intestinal contents

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5
Q

Inflammatory and ulcerative conditions disrupt

A

Secretion, motility and absorption

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6
Q

Effects of accessory organs (liver pancreas and gallbladder) can alter

A

Metabolism

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7
Q

Emesis is Greek for

A

Vomiting

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8
Q

Vomiting

A

-forceful emptying stomach/intestinal contents through the mouth

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9
Q

Where is the vomiting center

A

Medulla oblong at a

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10
Q

Retching

A

Muscular event of vomiting without vomitus expulsion

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11
Q

Projectile vomiting

A

Spontaneous vomiting that does not follow nausea or retching

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12
Q

projectile vomiting is caused by

A

Direct stimulation of vomit center

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13
Q

Invitation of vomiting

A

Deep inhalation and glottis closes

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14
Q

Abdominal muscles create

A

Pressure from stomach to throat

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15
Q

Duodenum and stomach antrum

A

Spasm forcing chyme into esophagus

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16
Q

Upper esophageal sphincter stays closed =

A

Contents can’t enter mouth

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17
Q

Abdominal muscles relax =

A

Contents return to stomach

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18
Q

What replaces both esophageal sphincters

A

Parasympathetic

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19
Q

Abdominal muscles contract =

A

Force diaphragm high into thoracic cavity causing stomach chyme forced out of mouth

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20
Q

Constipation must be

A

Individually determined

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21
Q

Wide normal defecation range :

A

1-3 day to 1 week

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22
Q

Primary constipation

A

Impaired, infrequent and straining colonic movement

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23
Q

Secondary constipation

A

Neural pathways are altered, colon transit time delayed

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24
Q

Opiates (codeine)

A

Inhibit bowel movement

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25
Q

Notable change in constipation can be indicative of

A

Colorectal cancer

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26
Q

Manifestations of constipation

A

Straining to evacuate stool may cause hemorrhoids

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27
Q

Diagnosis of constipation

A

Assess sphincter tone and detect anal lesions
-colonoscopy to help direct lumen view

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28
Q

Treatment for constipation

A

-restoraLAX
-enemas to establish bowel routine
-collectomy

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29
Q

Colectomy

A

Remove part of the colon

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30
Q

Acute diarrhea

A

24 hours or less

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31
Q

Persistent diarrhea

A

14-28

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32
Q

Chronic diarrhea

A

Longer than 4 weeks

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33
Q

Osmotic diarrhea

A

Non absorbable substance in intestine draws excess water to intestine

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34
Q

Secretory diarrhea

A

Excessive mucosal secretion of fluid and electrolytes
-virus, bacterial toxins, rotavirus

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35
Q

Children and diarrhea, have high rates of

A

Morbidity and mortality
-younger than 5 years

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36
Q

Motility diarrhea

A

Excessive motility, causing decreased transit time, and decreased fluid reabsorption

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37
Q

Motility diarrhea is caused by

A

Surgical bypass of area of intestine

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38
Q

Treatment for diarrhea

A

-restoration of fluid and electrolyte balance
-anti motility or water absorbent medication

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39
Q

Rotavirus

A

RNA virus
-causing enteristis

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40
Q

Enteritis

A

Inflammation of intestinal system

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41
Q

Abdominal pain is caused by

A

Mechanical, inflammatory or ischemic
-abdominal organs stretching/distension = activation of pain receptors

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42
Q

Parietal pain

A

From parietal peritoneum
-localized and intense

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43
Q

Visceral pain

A

Distension, inflammation, ischemic of abdominal organs
-poorly localized with radiating pattern

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44
Q

Upper gastrointestinal intestinal bleeding is found in

A

Esophagus, stomach and duodenum

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45
Q

Upper gastrointestinal bleeding

A

Mostly Bright red or dark bleeding
-affected by stomach acids

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46
Q

Upper gastrointestinal bleeding is caused by

A

Peptic ulcers, tearing of esophageal gastric junction (due to severe retching)

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47
Q

Lower gastrointestinal bleeding is found in

A

Jejunum, ileum, colon, rectum

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48
Q

Lower gastrointestinal bleeding is caused by

A

Polyps, inflammatory disease, hemorrhoids

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49
Q

Occult bleeding is caused by

A

Slow chronic blood loss, not very obvious

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50
Q

Occult bleeding results in

A

Iron deficiency
-anemia

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51
Q

Presentation of gastrointestinal bleeding

A

-trace amount of blood in diarrhea or stools
-bp reduction
-compensating tachycardia
-vision loss

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52
Q

Dysphagia

A

Difficulty swallowing

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53
Q

Mechanical obstruction

A

Obstruction in esophageal wall
-tumours or herniating

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54
Q

Functional dysphagia

A

Neural and muscular disorders that interfere with swallowing

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55
Q

Achalasia

A

Rare form of dysphagia
-smooth muscle neurons of middle/lower esophagus are attacked by immune response

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56
Q

Result of achalasia

A

Altered esophageal peristalsis
-failure of LES to relax which causes obstruction

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57
Q

What can occur in achalasia

A

Cough and aspiration can occur
-since there is increased pressure of food being forced past LES

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58
Q

GERD

A

Gastroesophageal reflux disease

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59
Q

GERD is the reflux of

A

Acid/pepsin or bile salts into esophagus causing esophagitis

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60
Q

GERD is caused by

A

Abnormalities in LES function
-resting tone is lower than normal

+delayed gastric emptying of chyme

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61
Q

Severity of esophageal damage depends on

A

Composition and duration of reflux

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62
Q

Increased acidic chyme exposure =

A

Mucosal injury and inflammation

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63
Q

(GERD) Persistent =

A

Fibrosis thickening and precancerous lesions

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64
Q

Diagnosis of GERD

A

Esophageal endoscopy, tissue biopsy

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65
Q

TX GERD

A

Laparoscopic fundoplication to tighten junction between esophagus and stomach to prevent acid reflux

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66
Q

Hiatal hernia

A

Protrusion of superior aspect of stomach through diaphragm hiatal into thorax

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67
Q

Sliding hiatal hernia

A

So teach moves into thorax through esophageal hiatus
-via opening in diaphragm

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68
Q

Paraesophageal hiatal hernia

A

Stomach moves into thorax alongside esophageal

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69
Q

Paraesophageal hiatal hernia leads to

A

Gastritis and ulcer formation

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70
Q

Which type of hernia is GERD associated with

A

Sliding hiatal hernia

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71
Q

risk of hiatal hernia

A

Strangulation of hernia causing a medical emergency

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72
Q

Diagnosis of hiatal hernia

A

Radiology with barium swallow

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73
Q

TX for hiatal hernia

A

Sleeping with your head up, laparoscopic fundoplication

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74
Q

Intestinal obstruction

A

Any condition that prevents normal flow of chyme through the intestinal lumen

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75
Q

Paralytic ileus

A

Causes failure of intestinal motility due to dysfunctional neural activity after surgery

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76
Q

Paralytic ileus is a ____ obstruction

A

Functional

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77
Q

Large bowel obstruction

A

Less common
-related to cancer

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78
Q

S/s of large bowel obstruction

A

Abdominal distension and vomiting

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79
Q

Cause of small bowel obstruction

A

Postoperative adhesions
-herniation which lead to distension (enlargement)

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80
Q

Small bowel obstruction results in

A

Distension, causing impaired absorption and increased secretion —> accumulation of fluid, gas, solutes in lumen

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81
Q

Systemic ECF fluid osmotically moves into lumen causing

A

Decreased ECF —> tachycardia, dehydration and possible shock

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82
Q

Intestinal lumen becomes acidic and leaks..

A

Pathogens, into systemic circulation —> sepsis
-immune response with possibility of remote organ failure

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83
Q

Adhesions

A

Organs attacking to each other

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84
Q

Gastritis

A

Inflammatory disorder of gastric mucosa

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85
Q

acute gastritis

A

Erosion of protective stomach mucosal barrier by H. Pylori and NSAIDs

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86
Q

NSAIDs inhibit

A

Prostaglandin synthesis —> which normal stimulates global cell secretion of mucus

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87
Q

H.pylori

A

Burrows into mucus layers and disrupts function of mucosal layer—> triggers immune response which further destroys mucosal layer

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88
Q

Symptoms/ healing of gastritis

A

Pain, vomiting
-healing occurs within a few days

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89
Q

Chronic gastritis

A

Occurs in older adults
-chronic inflammation and mucosal atrophy

90
Q

Chronic non immune antral gastritis is caused by

A

-involves only antrum and is caused by H.pylori

91
Q

Chronic non immune antral gastritis

A

High levels of hydrochloric acid secretion = inc risk of duodenal ulcers

92
Q

Sections of the stomach diagram

93
Q

chronic immune fundal gastritis

A

-body and fungus
Associated with loss of T cell tolerance resulting in gastric mucosa being extensively degenerated in stomach fungus and body

94
Q

Peptic ulcer is caused by

A

H.pylori and NSAIDs

95
Q

peptic ulcer

A

Break or ulceration in protective mucosal lining

96
Q

Duodenal ulcers

A

More frequent
-caused by H.pylori and NSAIDs

97
Q

Causative factors of duodenal ulcers

A

Singly or in combination cause acid pepsin concentrations to penetrate mucosal barrier and cause ulceration

98
Q

Host response (duodenal ulcers)

A

T and B cells, neutrophils to combat H. Pylori = damage to gastric epithelium by released cytokines

99
Q

H. Pylori in duodenal ulcers

A

Releases toxin resulting in apoptosis of epithelial cells

100
Q

Gastric ulcers

A

1/4 as common and caused by H. Pylori and NSAIDS

101
Q

Gastric ulcers develop in

A

Gastric antrum
-next to acid producing gastric body

102
Q

Defect of gastric ulcers

A

Increase in mucosal barriers permeability to hydrogen ions

103
Q

H+ ions disrupts

A

Mucosal permeability and structure

104
Q

Resulting cycle of gastric ulcers

A

Damaged mucosa liberates histamine causing inc HCL and pepsin production leading to mucosal destruction

105
Q

Stress related mucosal disease

A

Acute from of peptic ulcer
-tends to accompany physiological stress, illness or major trauma

106
Q

Where are Stress related mucosal disease found

A

Multiple sites of ulcers in stomach or duodenum

107
Q

(Stress related mucosal disease) ischemic ulcers

A

Develop within hours of events
-hemorrhage, heart failure, sepsis

108
Q

(Stress related mucosal disease) curling ulcers

A

Develop because of burn injury

109
Q

(Stress related mucosal disease) Cushing ulcers

A

Develop because of brain trauma/surgery

110
Q

Inflammatory bowel disease

A

Environmental factors or infections alter mucosal epithelium barrier

111
Q

Result of Inflammatory bowel disease

A

-loss of body’s ability to discriminate harmful pathogens from commensal microorganism

112
Q

Commensal

A

Association between two organisms in which one benefits and other derives neither benefit nor harm

113
Q

Loss of ability to discriminate causes (three things)

A
  1. Activation of immune system
  2. Production of pro inflammatory cytokines
  3. Intestinal epithelium damage
114
Q

Ulcerative colitis

A

Chronic inflammatory disease causing ulcers in colonic mucosa

115
Q

Ulcerative colitis: disease begins in

A

Rectum and may extend to entire colon

116
Q

Ulcerative colitis: small erosions coalesce into ulcers causing

117
Q

Ulcerative colitis: necrosis results in

A

Thickening of muscularis mucosa, which narrows lumen and reduces transit time in colon

118
Q

Ulcerative colitis: mucosal destruction and inflammation causes

A

Bleeding and urge to defecate

119
Q

Ulcerative colitis causes

A

Frequent watery diarrhea with small amounts of blood and mucus

120
Q

Ulcerative colitis has an intermittent period of

A

Remission and exacerbation

121
Q

Symptoms of Ulcerative colitis

A

Diarrhea roughly 10-20 times a day

122
Q

diagnosis of Ulcerative colitis

A

Endoscopy and biopsies

123
Q

TX for Ulcerative colitis

A

Steroids, medication and surgery

124
Q

Chrons disease

A

idiopathic inflammatory disorder

125
Q

Chrons disease affects what area of the digestive tract

A

Any part, from mouth to anus

126
Q

Chrons disease: inflammation begins in

A

Intestinal submucosa and spreads with discontinuous and transmural

127
Q

Discontinuous

A

Skip lesions

128
Q

Transmural

A

Across entire wall of organ

129
Q

Most common sites of Chrons disease

A

Ascending and transverse colon
-but both large and small intestines are common

130
Q

Chrons disease vs ulcerative colitis

A

C: discontinuous patchy inflammation + mucosal and submucosal layers

U: continous inflammation + transmural

131
Q

Chrons disease ulcerations can produce

A

Fissures that extend inflammation into lymphoid tissue

132
Q

Risks of Chrons disease

A

Smoking increases risk of developing serve disease and may cause a poorer response to treatment

133
Q

Chrons disease TX and diagnosis `

A

D: endoscopy and biopsies

TX: steroids, medication or surgery

134
Q

Fistulae

A

Abnormal opening or passage between two organs

135
Q

Where are fistulae found

A

May form in peri anal area, or extend into bladder, rectum or vagina

136
Q

IBS

A

-abdominal pain with altered bowel habits
-idiopathic with no specific bio markers for disease

137
Q

IBS is more common in

A

Women, especially during youth and middle age

138
Q

Manifestation of IBS

A

Lower abdominal pain or discomfort and bloating

139
Q

Symptoms

A

Usually relieved with defecation and does not interfere with sleep

140
Q

Appendicitis

A

Inflammation of appendix

141
Q

Appendix hypothesis

A

That it contains lymphoid tissue which may provide a safe house for commensal bacterium for repopulation of intestinal system

142
Q

What is the most common surgical emergency of abdomen

A

Appendicitis

143
Q

Most common age appendicitis occurs

A

10 to 19 years

144
Q

Manifestation of appendicitis

A

Mild pain, inc to intense pain in 3 to 4 hours
-nausea, vomiting

145
Q

TX for appendicitis

A

Laparoscopic surgery
-allowing access to viscera without creating a large incision

146
Q

Appendicitis: obstruction of appendix lumen causing

A

Block in the drainage of appendix

147
Q

Appendicitis: as mucosal secretions continue

A

Intraluminal pressure inc

148
Q

Appendicitis: inc pressure reduces blood flow

A

Appendix is hypoxia and ulcerative

149
Q

Appendicitis: ulceration promotes bacterial invasion

A

Immune response and inflammation
-gangrene

150
Q

Hepatic encephalopathy

A

A complex neurological syndrome characterized by impaired behavioural cognitive and motor function

151
Q

Encephalopathy

A

Brain disease that alters brain function or structure

152
Q

Hepatic encephalopathy: combination of biochemical alterations that affect

A

Neurotransmission and brain function

153
Q

Liver dysfunction causes (Hepatic encephalopathy)

A

Development of collateral vessels that shunt blood around liver to systemic circulation

154
Q

Hepatic encephalopathy: shunt permits

A

Toxins absorbed from GI tract to circulate to brain
-the toxins are usually removed by liver

155
Q

Hepatic encephalopathy: toxins will alter

A

Cerebral energy metabolism, interfere with neurotransmisison and cause edema

156
Q

Hepatic encephalopathy: most hazardous is

A

Ammonia causing astrocyte swelling
-alter BBB and promote cerebral edema

157
Q

Jaundice

A

Yellowing pigmentation of skin

158
Q

Jaundice is caused by

A

Hyperbilirubienmia which inc plasma

159
Q

Bilirubin is normally

A

Removed from blood by liver

160
Q

Inc plasma indicates

A

Liver damage

161
Q

Obstructive jaundice

A

Occlusion of common bile duct by gall stones, tumour etc
-bilirubin cannot flow to duodenum and accumulates in liver

162
Q

Obstructive jaundice results in

A

Enters blood stream causing jaundice

163
Q

Hemolytic jaundice

A

Excessive production of bilirubin from excessive hemolysis of RBC

164
Q

Hemolytic jaundice results in

A

Plasma exceeding liver ability to process = inc plasma bilirubin = jaundice

165
Q

Manifestations of jaundice

A

-darkened urine, several days before onset
-bacterial infections may occur
-yellow discolouration of sclera followed by inc yellowing of skin

166
Q

Cirrhosis

A

Irreversible fibrotic scarring of liver in response to inflammation and tissue damage

167
Q

Liver cirrhosis is

A

Final step of various chronic liver diseases

168
Q

Pathophysiology cal hallmark of cirrhosis

A

Development of scar tissue due to fibrosis

169
Q

Chaotic fibrosis

A

Obstructus blood flow and produces jaundice, inc portal hypertension and cellular dysfunction

170
Q

Cirrhosis regeneration is disrupted by

A

Hypoxia = necrosis= atrophy= liver failure

171
Q

Manifestation of cirrhosis

A

Liver acquires a cobble appearance and is hard upon palpitation

172
Q

Alcoholic cirrhosis

A

Toxic effects of alcohol on liver, and immune alterations

173
Q

Alcoholic cirrhosis: alcohol is transformed into

A

Acetaldehyde which activates hepatic Stellate cells

174
Q

Alcoholic cirrhosis: hyperactivation of stellate cells results in

A

Collagen formation = fibrosis scarring

175
Q

Alcoholic cirrhosis: damage results in

A

Translocation of gut microbiota

176
Q

Non alcoholic fatty liver disease

A

Infiltration of hepatocutes with triglycerides
-obesity, high blood triglycerides and cholesterol

177
Q

Biliary cirrhosis

A

Damage and inflammation leading to cirrhosis begins in bile ducts rather than hepatocytes

178
Q

Primary biliary cirrhosis

A

Caused by chronic autoimmune liver disease
-damage bile ducts = fibrosis = bile duct obstruction

179
Q

Secondary biliary cirrhosis is caused by

A

Caused by obstruction of common bile ducts by gallstones, tumours etc

180
Q

Viral hepatitis

A

Common systemic disease that primarily affects the liver
-ABCDE

181
Q

Viral hepatitis

A

-all cause jaundice
-infiltration of pathogens = hepatic cell necrosis/scarring

182
Q

Further cellular injury is promoted by

A

Immune response

183
Q

Most severe damage (hepatitis)

A

Hep B and C

184
Q

Co infection fo hep and hiv occurs because

A

Virus share same route of transmission
-contact between infected body fluids

185
Q

Diagnosis of viral HEP

A

Presence of viral antibodies

186
Q

TX for viral HEP

A

Directed at viral replication suppression and HEP B vaccine

187
Q

Common gallbladder disorders

A

Obstruction and inflammation

188
Q

Gallstones

A

Block flow of bile in and out of gallbladder
-causes inflammation

189
Q

Cholelithaiasis

A

Gallstone formation

190
Q

Cholecystitis

A

Gallbladder inflammation

191
Q

Obstructive pancreas disease

A

Causes backup of pancreatic secretion, release and activation of pancreatic enzymes within acinar cells

192
Q

Enzymes causes (pancreas)

A

Autodigestion of pancreatic cells and tissues = inflammation

193
Q

Autodigestion of pancreas causes

A

Vascular damage, necrosis and pseudocysts formation

194
Q

Pseudocysts

A

Walled off collections of pancreatic secretions

195
Q

Alcohol abuse is the

A

Main cause of further developments in pancreas
-acinar cell metabolizes ethanol = toxic metabolites that release acinar digestive enzymes

196
Q

Chronic alcohol to pancreas =

A

Destruction of acinar cells = tissue destruction replaced with fibrosis = pancreatic cysts

197
Q

treatment for pancreas

A

Alcohol cessation

198
Q

Cancer of the esophagus

A

Carincoma and adenocarinomas of epithelium

199
Q

Adenocarcinoma initiates in

A

Epithelial glandular cells

200
Q

Carcinoma initaiates in

A

Epithelial squamous cells

201
Q

Manifestations of esophageal cancer

A

Dysphagia and chest pain

202
Q

Risk for cancer of esophagus

A

Alcohol combined with smoking or chewing tobacco

203
Q

Gastric adenocarcinoma is associated with

204
Q

Cancer of the stomach inc risk by

A

Heavily salted and preserved foods
-salt enhances conversions of nitrates to carcinogenic nitrosamines

205
Q

Most common form of cancer

A

Carcinoma
-imitates in epithelial tissue of skin or internal organs

206
Q

Adenocarcinoma

A

Is a subtype of carcinoma that initiates in glands

207
Q

Pre existing polyps are highly associated

A

With colon adenocarcinoma

208
Q

Manifestations of cancer in colon and rectum

A

Pain, bloody stools and change in bowel habits

209
Q

Rectal carcinomas occur close to

A

Anus
-spread to vaginal and prostate

210
Q

Leading cause of world wide cancer deaths

A

Cancer of the liver

211
Q

Cancers of the over are associated with

A

Chronic liver diseases
-cirrhosis and HEP b

212
Q

Hepatocellular carcinomas arise from

A

Hepatocytes

213
Q

cholangiocellular carcinomas

A

Rare and develop in bile ducts

214
Q

Liver cancers have high risk of

A

Metastasizing to other organs

215
Q

Msot common cancer between 50 and 60 years of age

A

Cancer of gallbladder

216
Q

Most common type within gallbladder cancer

A

Adenocarcinoma

217
Q

Cancer of gallbladder metastases to

A

Lymph vessels and usually occurs before diagnosis

218
Q

What is the fourth leading cause of cancer death in Canada

A

Cancer of pancreas

219
Q

Adrencarinoma in pancreas cancer occurs in

A

Exocrine component of pancreas

220
Q

Cancer of pancreas often metastasizes before

Pathophysiology (20 decks)

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