DIG PATHO Flashcards
- What does GERD stand for?
Gastroesophageal reflux disease
- Describe the development of GERD, its most frequent clinical manifestation and in what the long-term inflammation involved in GERD can result.
Return of stomach contents in esophagus (because of relaxation of the lower esophageal sphincter) can occur spontaneously, the gastric contents are usually neutralized and cleared within minutes
Heartburn
Lead to fibrosis and precancerous lesions
- Define dyspepsia and gastroparesis.
Painful digestion with possible feelings of bloating, nausea and heartburn
Slowing of movement of food from the stomach
- Be familiar with factors that increase the likelihood of GERD.
Infancy – positional and reduced sphincter tone
Increased intra-abdominal pressure (obesity, pregnancy)
Smoking
Certain foods relax LES (fat, coffee, alcohol)
Lupus
- What is a peptic ulcer?
Is a break in the protective mucosal lining of the lower esophagus, stomach or duodenum
- Define melena and hematemesis (know that these can be complications of peptic ulcer disease).
Hematemesis: vomiting of blood, either bright red or “coffee ground” appearing (slightly digested blood)
Melena: black foul smelling stools from digestion of blood
- Describe three other complications of peptic ulcer disease (other than melena and hematemesis).
Perforation (ulcer erodes through wall and contents enter peritoneal cavity)
Penetration (same, but erosion is into another organ (liver))
Gastric/duodenal outlet obstruction (from edema or scarring)
- Identify and describe the pathophysiology behind the effects of the two high risk factors for the development of peptic ulcers.
Helicobacter pylori: passes through the mucus layer that protects the stomach: Stomach acid keeps mucin lining of epithelial cell layer in a spongy gel-like state. This consistency is impermeable to H. pylori however the bacterium releases urease which neutralizes the stomach acid causing the mucin to liquefy, and the bacterium can now penetrate it and reach epithelial cells inducing inflammation
NSAIDS interfere with prostaglandin synthesis: This blocks production of mucus and bicarbonate, and increases acid production, making the stomach vulnerable to injury from acid and enzymes
- What are two similarities between duodenal ulcers and gastric ulcers?
Caused by H. pylori and NSAIDS
Clinical manifestations include intermittent pain in epigastric region
- What are three differences between duodenal ulcers and gastric ulcers? (include the pattern of pain)
Gastric ulcers: 25% as common as duodenal ulcers, Tend to develop in order people (55-65), Frequently occurs immediately after eating, Gastric tend to be chronic, Hard to treat
Duodenal ulcers:
Occur with greater frequency than other types, Tend to develop in younger people (commonly in males), Pain begins 2-3 hours after eating, Have periods of remission Can be relieved by ingestion of food
- What are the main treatments for peptic ulcers?
Eradicate H. pylori with antibiotics
Reduce acidity (antiacids, proton pump inhibitors, histamine 2 receptor)
Minimally invasive surgical resection if ulcers are bleeding or have perforated the GI wall
- What are the two diseases that make up inflammatory bowel disease?
Ulcerative colitis & Crohn’s disease
- Describe and differentiate between these two diseases, including: a. Typical age range affected b. Regions of the bowel affected and the nature of the inflammatory process c. The appearance of the inflamed tissues d. Risk factors e. Clinical manifestations f. Possible complications
Ulcerative colitis: 20-40 & Crohn’s: 20-30
Ulcerative: colonic mucosa, most commonly in the rectum and sigmoid colon & Crohn’s: both large and small intestine
Crohns: inflammation of entire width (serous to mucosa) skip lesions & Ulcerative: inflammation of mucosa, continuous
Ulcerative: age, family history & Crohns: family history
Crohns: Most common symptom is diarrhea (not as commonly bloody as with UC) (with tenesmus), accompanied by weight loss and abdominal pain (usually in lower right quadrant & Ulcerative: c inflammatory disease that causes ulceration of the colonic mucosa, most commonly in the rectum and sigmoid colon. Usually beginning in the rectum, the ulceration spreads in a continuous manner. Condition can be sporadic in time
Crohns: fistula, strictures, perianal abscesses & ulcerative: cancer
- What is toxic megacolon?
An abrupt increase in diameter of colon (within one to a few days) that could rupture
- What is celiac disease?
Malabsorptive disease where the mucosa fails to absorb digested nutrients
- Describe the development of celiac disease.
T-cell mediated autoimmune disorder: persons with the disease show an intense immune reaction to gluten (gliadin), the protein components of cereal grains. The inflammation brought on by the immune reaction damages small intestinal villous epithelium, interfering with absorption of macro and micronutrients
- Describe the clinical manifestations of celiac disease and the consequences of malabsorption of nutrients in childhood and adulthood.
End result is loss of ability of intestine to absorb nutrients, Childhood, this produces a failure to thrive, Abdominal pain, Diarrhea with fatty stools
Malabsorption:
osteoporosis, seizures/tetany, from lack of calcium
Anemia from lack of iron
Short stature, when it develops in childhood, from general malnutrition
Pregnancy: miscarriage, neural tube defects (due to lack of folic acid, and other nutrients)
- Define portal hypertension and its cause.
Abnormally high blood pressure in the hepatic portal venous system
Caused by disorders that obstruct blood flow through the portal venous system or vena cava, including thrombosis of hepatic veins, severe right-sided heart failure, alcoholic cirrhosis