Chapter 36: Gastrointestinal Disorders

Question 1

Dysphagia

Answer 1

• Difficulty in swallowing
• Inability to initiate swallowing
• Sensation that swallowed solids/liquids “stick” in esophagus
• Pain with swallowing (odynophagia) may occur

Question 2

Esophageal Pain (Heartburn/Pyrosis)

Answer 2

• cause is a reflux of gastric contents into the esophagus (produces high acidic contents that are an irritant to sensory afferent nerve endings in mucosa, and causes spasms of the esophageal muscle)
• Clinical manifestations include substernal burning sensations that may radiate to neck or throat

Question 3

Esophageal Pain (Chest Pain)

Answer 3

• Causes include esophageal distention or powerful esophageal contractions. May also arise from esophageal obstruction or a condition called diffuse esophageal spasm.
• Clinical Manifestations include those similar to angina pectoris (radiates to neck, shoulder, arm, and jaw). Also includes Odynophagia brough on by swallowing

Question 4

Abdominal Pain

Answer 4

• may be the first sign of GI tract disorder or many other disorders
• Visceral Pain (diffuse, poorly localized gnawing, burning, or cramping from inflammation or disteneded abdominal region)
• Somatic Pain (sharp, intense pain; well localized to area of irritation from injury)
• Referred Pain (felt at location distant from the source of the pain, in the same deramtome or neurosegmant; sharp and well localized; may be felt in skin or deeper tissues

Question 5

Ulcerative Colitis

Answer 5

• Chronic inflammatory disease of the mucosa of the rectum and colon
• Large ulcers form in mucosal layer of colon and rectum
• Begins as inflammation at base of crypts of Lieberkühn; damage results; abscess formation in crypts; abscesses begin to coalesce, large ulcerations develop in epithelium
• Associated with increased cancer risk after 7 to 10 years of disease
• Have exacerbations and remissions
• Hallmark clinical manifestations are bloody diarrhea and lower abdominal pain

Question 6

Treatment of Ulcerative Colitis

Answer 6

• Corticosteroids (MAINSTAY for acute)
• Broad spectrum antibiotic
• Salicylate analogs (similar to asprin, decreases inflammation)
• Immunomodulating agents (Azathioprine & Mercaptopurine)
• Intravenous followed by oral cyclosporine for
  refractory
• Infliximab (Remicade) for refractory

Question 7

Chron’s Disease

Answer 7

• Also called regional enteritis or granulomatous colitis
• Affects proximal portion of the colon or terminal ileum
• Chronic inflammation of all layers of intestinal wall resulting from blockage and inflammation of lymphatic vessels
• Suggestive findings are ulcerations, strictures, fibrosis, and fistulas

Question 8

Clinical Manifestations of Chron’s DIsease

Answer 8

Intermittent bouts of fever, diarrhea, if bloody, not as severe as ulcerative colitis; constant, chronic RLQ pain, may have RLQ mass, tenderness

Question 9

Treatment of Chron’s Disease

Answer 9

• Alleviating and reducing inflammation
• Smoking cessation
• Drugs similar to ulcerative colitis
• No cure
• Prednisone and sulfasalazine
• Antibiotics: metronidazole
• Azathioprine, 6-mercaptopurine, methotrexate, and biologic therapies (refractory)
• Anti–tumor necrosis factor agents infliximab, adalimulab, and certolizumab (refractory)

Question 10

Antibiotic-Associated Colitis (Pseudomembranous Enterocolitis)

Answer 10

• Acute inflammation and necrosis of large intestine
• Caused by Clostridium difficile (exposure to antibiotics)
• Mediated by bacterial
• Clinical manifestations include Diarrhea (such a distinct and horrible smell that you will know immediately)(often bloody), abdominal pain, fever, leukocytosis, sepsis, colonic perforation (rare)

Question 11

Treatment of Antibiotic-Associated Colitis (Pseudomembranous Enterocolitis)

Answer 11

• Stop current antibiotic (if possible)
• Treat ischemia
• Treat contributing conditions
• Oral antibiotics: metronidazole or vancomycin
• Recurrence common
• Rare: fecal transplant (transfer of fecal material from another healthy person to the source patient via enema or gastric tube) or colectomy

Question 12

Diverticular Disease

Answer 12

• Presence of diverticula (herniations) in the colon: diverticulosis
• Results from low intake of dietary fiber and results in high intraluminal pressure
• Clinical manifestations include Diverticulosis (asymptomatic) and Diverticulitis (inflamed diverticuli) which shows fever, acute lower abdominal pain, leukocytosis
• Treatments include Antibiotics, and surgery for abscess