Chapter 37 Disorders of Gastrointestinal Function Flashcards
1
Q
What is the definition of anorexia?
A
loss of appetite
2
Q
What is emesis?
A
vomiting
3
Q
What are some signs and symptoms of GI disorders?
A
anorexia, nausea, vomiting, diarrhea…
4
Q
What are the 2 centers that need to be stimulated in order to vomit?
A
the vomiting center and the chemoreceptor trigger zone (CTZ)
5
Q
____ is a protective mechanism to remove noxious agents from the GI tract
A
vomiting
6
Q
What monitors for noxious substances in the GI tract?
A
chemoreceptors
7
Q
Where does the vomiting center receive input from?
A
the GI tract, cerebral cortex, thalamus, vestibular apparatus
8
Q
What area is responsible for car/sea sickness?
A
vestibular apparatus
9
Q
____ is the tube that connects the oropharynx with the stomach
A
the esophagus
10
Q
What is the oropharynx?
A
part of the throat that is behind the mouth and nasal cavity
11
Q
Swallowing involves the coordinated action of what 2 things?
A
the tongue and the pharynx
12
Q
Which cranial nerves innervate swallowing?
A
V, IX, X, and XII
13
Q
What is the main function of swallowing?
A
the passage of food from pharynx to stomach
14
Q
What is dysphagia?
A
difficulty swallowing
15
Q
What are some possible causes of dysphagia?
A
Lack of saliva, weakening muscles, disorders that involve narrowing of the esophagus, stroke, cancer, or scarring
16
Q
Why can a stroke cause dysphagia?
A
Damage to the innervating nerves that are responsible for swallowing
17
Q
What is odynophagia?
A
painful swallowing
18
Q
How can dysphagia impact a patients overall health?
A
If the patient is unable to swallow they are unable to consume foods that give them nutrients and energy, can lead to starvation. At higher risk for aspirations.
19
Q
What is achalasia?
A
failure of the lower esophageal sphincter to relax
20
Q
What can cause achalasia?
A
disorders that cause the narrowing of the esophagus
21
Q
What is the treatment plan for achalasia?
A
Potentially physio, surgery, or mechanical dilation of the esophagus
22
Q
____ is the outpouching of the esophageal wall caused by weakness in the muscularis layer
A
esophageal diverticulum
23
Q
What causes esophageal diverticulum?
A
weakness in the muscle layer
24
Q
Explain what can occur with esophageal diverticulum
A
Weakness in the muscle layer causes an outpouching of the esophagus where food can be retained and ferment causing gurgling, belching, coughing and foul smelling breath
25
If esophageal diverticulum is left untreated what can it progress into?
esophagitis and ulceration
26
what is the treatment for esophageal diverticulum?
surgery
27
What are longitudinal tears?
tears in the mucosal layer at the junction of the esophagus and stomach that occurs with severe bouts of vomiting
28
What is a hiatal hernia?
hernia of the stomach through the esophageal hiatus of the diaphragm
29
what is a hernia?
when part of an organ protrudes through the wall of the cavity containing it
30
can a hiatal hernia be asymptomatic?
yes
31
what are the 2 anatomic patterns of hiatal hernias?
axial/sliding hiatal hernia and nonaxial/paraoesophageal hernia
32
what is a paraoesophageal hernia?
an anatomic pattern type of a hiatal hernia where a portion of the stomach enters the thorax
33
what is a sliding hiatal hernia?
bell shaped protrusion of the stomach above the diaphragm
34
which of the 2 anatomical pattern types of hiatal hernias are most common?
axial/sliding hiatal hernia
35
What is the treatment for a hiatal hernia? Describe the process
Surgery to push the stomach back down below the diaphragm
36
What are the risk factors that could lead to the development of a hernia and why?
people over 40 because the muscles start to weaken, and being overweight because the adipose tissue pushes on the stomach
37
What is GERD?
gastroesophageal reflux disease
38
What is gastroesophageal reflux?
the backward movement of gastric contents into the esophagus
39
What are signs/symptoms of gastroesophageal reflux?
heartburn, backwash of sour liquid/fluid in the throat, chest pain, trouble swallowing, ongoing cough, worsening asthma
40
If persistent reflux occurs what can happen to the gastroesophageal structures?
it can lead to mucosal damage which can in turn lead to hyperemia, edema, and Barrett esophagus
41
What is Barrett esophagus?
When the lining of the esophagus becomes damaged by acid reflux which causes the cell type to change and the lining to thicken and become red. Associated with an increased risk for esophageal cancer.
42
Are children and infants likely to outgrow gastroesophageal reflux?
yes
43
What would be clear signs of a patient that is experiencing GERD?
heartburn 30-60 minutes after eating
44
What is the recommended treatment for GERD?
eat smaller meals, avoid alcohol and smoking
45
Is esophageal cancer more common in women or men?
men
46
What are the 2 types of esophageal cancer?
squamous cell carcinoma and adenocarcinoma
47
What is squamous cell carcinoma of the esophagus?
cancer of the esophagus, attributed to alcohol and tobacco use, mucus membranes have become damaged leading to new cell type growth of the lining
48
What is adenocarcinoma of the esophagus?
cancer of the esophagus, linked to gastroesophageal reflux and Barrett's esophagus. It is cancer of the mucus glands of the esophagus
49
What is dysplasia?
disordered cell growth, cells have changed from normal mucosal cells to cancerous cells
50
what does the gastric mucosal barrier do?
it produces mucus and bicarbonate ions that buffers the acid so it doesn't ruin the lining of the stomach
51
what is the gastric mucosal barrier made of?
it is made of impermeable epithelial cells
52
What can cause gastric irritation?
NSAID and aspirin use, infection of H. pylori
53
how does an infection of H. pylori affect the gastric tract?
H. pylori disrupts the mucosal barrier that protects the stomach from digestive enzymes.
54
____ produces ammonia which buffers stomach acid that can damage the stomach barrier
h pylori
55
_____ is inflammation of the gastric mucosa
gastritis
56
What is the difference between acute and chronic gastritis?
Acute is transient inflammation that is associated with irritants and is usually short term and self limiting. Chronic has the absence of visible erosions and the presence of chronic inflammatory changes that can lead to atrophy of the glandular epithelium.
57
What are the 3 common types of chronic gastritis?
1. caused by h pylori
2. autoimmune gastritis and multifocal atrophic gastritis
3. chemical gastrophy
58
What is peptic ulcer disease?
ulcerative disorder that occurs in the upper GI tract (stomach and duodenum) that are exposed to acid-pepsin secretions
59
What type of ulcers are more common in the GI tract? Why?
duodenal ulcers are 4 times more common than peptic ulcers because the duodenum is not designed to handle acid like the stomach is so it is more susceptible to getting ulcers
60
What is one common thing that can relieve ulcers of the GI tract?
Food, food buffers the acid and raises the pH
61
what are the 2 main causes of peptic ulcer disease?
h. pylori infection and NSAID/aspirin use
62
How does Aspirin/NSAIDS cause gastric irritation?
they irritate the mucosa and inhibit prostaglandin synthesis which are involved in maintaining the lining of the stomach
63
A patient suffering with peptic ulcer disease comes into the hospital. How would they present?
discomfort, stomach pain that frequently occurs between meals, belching, heartburn, nausea. If the ulcers are bleeding the pt can be vomiting blood, having dark tarry stools, feeling dizzy or fainting...
64
What is the treatment for peptic ulcer disease?
If caused by H. pylori then getting rid of the infection, avoiding irritation from NSAIDs, drug treatment to help heal the ulcers
65
What interventions would encourage the healing of peptic ulcers?
acid neutralizing/acid inhibiting drugs, mucosal protectives, antacids, and proton pump inhibitors
66
What are possible complications for peptic ulcer disease?
hemorrhage, obstruction, perforation, hematemesis, melena
67
what is hematemesis?
vomiting blood - can either be bright red or look like coffee grounds
68
what is melena?
blood in the stool, appears bright red or black and tarry
69
What is zollinger-ellison syndrome?
a gastrin secreting tumor that causes gastric levels to be so high that ulcers are inevitable
70
True or False?
You can't get ulcers from stress
False
You can get stress ulcers
71
what is a curling ulcer?
a stress ulcer that occurs from trauma and burns. Results from necrosis
72
What is a cushing ulcer??
happens in people with intercranial trauma or surgery - caused by the hypersecretion of gastric acid due to stimulation of the vagal nuclei by the intercranial pressure
73
what is the treatment for stress ulcers?
drugs to reduce acid production
74
In regard to stress ulcers, does the problem lie with the stomach secreting acid?
No the problem lies with stimulation elsewhere in the body that triggers the stomach to produce more acid
75
What are some risk factors involved with stomach cancer?
genetic predisposition, carcinogenic factors in the diet, chronic gastritis, gastric adenomas, polyps.
76
Is stomach cancer asymptomatic?
Generally starts as asymptomatic or starts as symptoms that you would contribute to other things first like anorexia, indigestion, weight loss...
77
what is the treatment for stomach cancer?
surgery - gastrectomy
78
What is IBS?
Irritable bowel syndrome
79
Does a person with IBS have structural or biochemical alterations different from a person without IBS?
no there are no changes to enzyme levels or mucosa
80
What are the signs/symptoms of IBS?
lower abdominal pain that is made better by pooping, gas, bloating, nausea
81
what are the 3 types of IBS?
diarrhea predominant, constipation dominant, alternating constipation and diarrhea
82
What are the current treatments for IBS?
no cure, treat pain constipation or diarrhea, stress management, self management through diet, medications to slow the movement of food through the gut
83
What are the 2 types of IBD?
Crohns and ulcerative colitis
84
How would a pt present if they are suffering with Crohns?
abdominal pain, diarrhea, weight loss, malaise, fistula formation, malnutrition, periods of exacerbation and remission
85
What is Crohns disease?
recurrent granulomatous inflammatory disorder that causes lesions, fissures and crevasses
86
How would the bowel of someone with Crohns appear?
like cobblestone
87
What is ulcerative colitis?
chronic inflammatory disease that causes ulceration of the colon and rectum
88
how would a pt with ulcerative colitis present?
abdominal pain, malaise, diarrhea, ulcers in the colon and rectum
89
how is ulcerative colitis graded?
on the number of bowel movements a day - 4 to more than 10 a day
90
What distinguishes ulcerative colitis from Crohns?
ulcerative colitis' lesions are continuous and limited to the mucosa where Crohns can have skip lesions where there are lesions on part of the bowels, followed by healthy tissue, then followed again with lesions.
91
What is the treatment for ulcerative colitis?
anti-inflammatories, steroids, immunosuppressive agents, or surgery to resect part of the colon, or a colostomy bag
92
What is Diverticulosis?
herniation of mucosa through the muscle layers of the colon wall
93
What causes diverticulosis?
muscles weaken in the intestine and then food/material doesn't move through as fast and causes pressure and herniation
94
How would a patient with Diverticulosis present?
pain, nausea, vomiting, most cases are asymptomatic though
95
If diverticulosis progresses what does it turn into?
Diverticulitis: inflammation of the diverticulum
96
What is the treatment for diverticulosis?
increase dietary fiber, antibiotics if needed, decrease of intracolonic pressure
97
What is appendicitis?
Inflammation of the appendix
98
What is appendicitis thought to be related to?
intraluminal obstruction
99
What is the treatment for appendicitis?
antibiotics or surgery
100
What is considered to be a disorder of motility?
Diarrhea, constipation, and intestinal obstructions
101
What is the difference between acute and chronic diarrhea?
Acute: less than 2 weeks and usually from infectious agents.
Chronic: longer than 4 weeks and due to inflammatory conditions
102
Inflammatory diarrhea means there will be what?
damage to the mucosa
103
what is osmotic diarrhea?
diarrhea caused by an increase in osmolarity of the contents - it attracts water to the intestine
104
What is an example of osmotic diarrhea?
lactose intolerance
105
What are the treatments for diarrhea?
usually self limiting but you can use meds to slow down the bowel and electrolyte replacement
106
What is normal transit constipation caused by?
low fiber and low fluid in the diet
107
What is the difference between normal transit and slow transit constipation?
Normal transit: caused by low fiber and low fluid where slow transit is caused by impaired colonic motor activity usually from nerve injury, drugs or defecatory disorders
108
What is the treatment for constipation?
fluids, fiber, and exercise
stool softeners or laxatives
109
What are the types of intestinal obstructions?
mechanical obstructions, paralytic obstructions, twists.
110
What is a mechanical obstruction of the intestine?
post operative adhesions, tumors, hernias
111
What is a paralytic obstruction of the intestine?
neurogenic or muscular impairment from injury or surgery
112
Can people with intestinal obstructions suffer from necrosis?
yes if the obstruction goes untreated
113
How do you treat intestinal obstructions?
suction or surgery
114
What is an example of intestinal absorption syndromes?
celiac disease
115
A person suffering from malabsorption syndrome will be experiencing what symptoms?
diarrhea, bloating, pain, steatorrhea, weight loss, neuropathy, anemia
116
what is steatorrhea?
fatty stool
117
Celiac disease is an ____ mediated disorder
immune
118
What are neoplasms?
abnormal growth of cells in the body
119
What are adenomatous polyps?
benign neoplasms that arise from the mucosal epithelium of the intestine - a mass of colonic epithelium protrudes into the lumen
120
More than half of adenomatous polyps are in the _____
rectosigmoid colon
121
What are risk factors for colorectal cancer?
over 50 years of age, family history, IBD, diet
122
