DISORDERS OF THE DIGESTIVE SYSTEM Flashcards
Motor dysfunction of smooth muscle of the individual parts of the digestive system -
Aperistalsis refers to a lack of propulsion
Indigestion of food and absorption of nutrients -
malabsorption syndrome
hemorrhoids, peptic ulcers, tears or
inflammation in the esophagus, diverticulosis and diverticulitis, ulcerative colitis and Crohn’s
disease, colonic polyps, or cancer in the colon, stomach or esophagus.
Bleeding into the individual parts of the digestive tract –
Perforation of the wall of the digestive system with subsequent leakage of the contents to the
peritoneal cavity
- appendicitis and diverticulitis
Obstruction in moving of the contents of one part of the digestive system to the next section
- hernias; colon cancer; diverticulitis, Crohn’s disease
- is the forceful emptying of stomach and intestinal contents through the mouth
Vomiting
the vomiting center lies in the ___ and includes the reticular formation and
tractus solitarius nucleus
medulla oblongata
stimulation of the vomiting center occurs
directly by irritants or indirectly.
the sudden expansion of the stomach and duodenum in the sudden accumulation of contents
VOMITING
irritation of the stomach mucosa by toxic substances
- Direct -
reflex response to intense pain - trauma of ovary, testis, uterus, bladder and kidneys or stimulating the vomiting center, for example. metabolic acidosis or brain lesions
- Indirect -
(malfunction of digestion)
. Dyspepsia
- frequently it is ___ dyspepsia
functional (non-ulcer)
- dyspepsia similar to ulcer symptomatology:
pain predominates
- dyspepsia similar to dysmotility symptomatology:
nausea, vomiting, bloating
non-absorbable substance in the intestine draws water into the lumen by osmosis
osmotic diarrhea
DISEASES IN DYSPEPSIA: (2)
peptic ulcer
long-lasting reflux of stomach contents into the esophagus
gastritis
an increase in the frequency of defecation and the fluid content, volume, and weight of feces.
DIARRHEA
(fat in the stools)
Steatorrhea
− caused by an inflammatory disorder of the intestine, such as ulcerative colitis, Crohn disease, or
microscopic colitis
Small-volume diarrhea
lactose, milk sugar, is not digested by the intestine => high osmotic activity => binds water => increase
in the intestine volume content
lactase deficiency
− caused by resection of the small intestine (short bowel syndrome), surgical bypass of an area of
the intestine
Motility diarrhea
(large-volume diarrhea)
Osmotic diarrhea and secretory diarrhea
− caused by excessive mucosal secretion of chloride- or bicarbonate-rich fluid or inhibition of net
sodium absorption
Secretory diarrhea (large-volume diarrhea)
- difficult or infrequent defecation
- it is associated with difficulty emptying of solid stool, which is usually painful
Constipation
Bleeding in the upper GIT parts
(esophagus, stomach, duodenum
Bleeding in the lower GIT
(jejunum, ileum, colon, rectum)
sudden and intense bleeding in the GIT is ___ and manifests the presence of blood in the
stool or vomit
life threatening
presence of blood in vomit, in the form of fresh blood or blood precipitates
Hematemesis
blood in vomit in the form of
“coffee grounds”
blood flows more slowly in the stomach - it’s time for him to digest it - hemoglobin converts to
acidic hematin (black)
dark stool caused by digested blood
Melena
chronically recurrent losses of small amounts of blood that usually results in anemia due to iron losses
Occult bleeding
interfere with nutrient absorption
malabsorption syndromes
-failure of the chemical processes of digestion (intestinal lumen)
-caused by deficiencies of enzymes (__, __)
inadequate secretion of __ and inadequate reabsorption of __ in the __
maldigestion
pancreatic lipase, intestinal lactase
bile salts
bile in the ileum
-failure of the intestinal mucosa to absorb (transport) the digested nutrients
-result of ___
malabsorption
mucosal disruption
– malabsorption of proteins
Celiac
excretes certain digestive enzymes and is also the most important area for the absorption of nutrients
Small intestine
___ area depends on the construction of normal mucosa, which is shaped into the ___
Resorption
villi
malabsorption of sugar
Lactase Deficiency
__ and __ are considered to be primary diseases of malabsorption in our geographical area.
- celiac and lactose intolerance
- caused by the the allergic response in the small intestine to gluten
celiac
- lack of activity - enzyme which degrades lactose (milk sugar)
- Lactase
lactose is decomposed by
results in
intestinal bacteria to gas
abdominal cramps, bloating and diarrhea often
is characterized as ___ disorders, which may be due to __, or __ that impairs esophageal motility
Dysphagia
swallowing
mechanical obstruction of the esophagus
functional disorder
_____
- intrinsic -
- extrinsic -
The most common cause of extrinsic mechanical obstruction is ____
- Mechanical obstruction
tumor, strictures
originate outside the esophageal lumen and narrow the esophagus by pressing inward on
the esophageal wall.
tumor
- caused by neural or muscular disorders that interfere with ___ or ___.
- typical causes of functional dysphagia in the ___
- __ (a muscle disease) and neurologic impairments caused by stroke, MS, PD, ALS
Functional dysphagia
swallowing or peristalsis
upper esophagus
dermatomyositis
___ is a primary esophageal motility disorder characterized by an inability of the ____ to relax and is constantly ___
Achalasia
lower esophageal sphincter
contracted
MANAGEMENT of dysphagia
- Esophageal dilation
- Surgery
- Medications (antacids, antibiotics)
Management of achalasia
- eat slowly, drink with fluids with meals
- Calcium channel blockers and nitrates
- botulinum toxins (botox)
- pneumatic dilation
- surgical myotomy
__ & __ are taken by mouth ___ a meal.
For people with achalasia, these medications relax the muscles of the ___, allowing food and liquid to pass more easily into the stomach.
Calcium channel blockers and nitrates
10 to 30 minutes before
lower esophageal sphincter
__ administration of botulinum toxin acts at the neuromuscular junction to cause __
botulinum toxin (Botox)
muscle paralysis
___ is an endoscopic therapy for achalasia.
An ____ disrupts the muscle fibers of the lower esophageal sphincter, which is __in patients with achalasia.
Pneumatic dilation
air-filled cylinder-shaped balloon
too tight
- __ This procedure ___ the muscles at the ___, allowing the __ between the ___ and ___ to remain open.
Surgical myotomy
destroys
gastroesophageal junction
valve
esophagus and stomach
__ is the opening in the ___ through which the esophagus passes becomes enlarged, part of
the upper stomach moves up into the lower portion of the thorax
HIATAL HERNIA
diaphragm
There are two main types of hiatal hernias:
sliding and paraesophageal.
__ occurs when all or part of the stomach pushes through the diaphragm beside the esophagus.
- IT IS further classified as types __ __ __ , depending on the extent of herniation.
- Large hiatal hernias may lead to __ ,__ , __
- __, __ ,__ can occur with any type of hernia.
A paraesophageal hernia
II, III, or IV
intolerance to food, nausea, and vomiting.
Hemorrhage, obstruction, and strangulation
occurs when the upper stomach and the gastroesophageal junction are displaced upward and slide in and out of the thorax.
The patient with a sliding hernia may have __ ,__ ,__
Sliding, or type I, hiatal hernia
pyrosis, regurgitation, and dysphagia.
Diverticula may occur in one of the three areas of the esophagus—
- pharyngoesophageal (upper),
- midesophageal (middle), or
- epiphrenic (lower)
__ is an out-pouching of mucosa and submucosa that protrudes through a weak portion of the musculature of the esophagus.
An esophageal diverticulum
Getting rid of excess air. ___ is commonly known as burping.
Belching
when the patient assumes a recumbent position, undigested food is regurgitated
- Coughing
ESOPHAGEAL DIVERTICULUM
ASSESSMENT AND DIAGNOSTIC FINDINGS
* Barium swallow
* Manometric studies
___ senses the pressure and constriction of muscles in the esophagus as you swallow.
* ___ is contraindicated
* ___ of an NG tube should be avoided
The manometry test
Esophagoscopy
Blind insertion
MANAGEMENT OF ESOPHAGEAL DIVERTICULUM
- ___ of the cricopharyngeal muscle
- Postoperative: evidence of leakage from the esophagus, developing ___.
- Food and fluids are withheld until ___ show ____ at the surgical site
- Diverticulectomy
Myotomy
fistula
x-ray studies
no leakage
___ a surgical emergency may result from iatrogenic causes (endoscopy or intraoperative injury, forceful vomiting or severe straining, foreign-body ingestion, trauma, and malignancy)
ESOPHAGEAL PERFORATION
Perforation can occur at the __, __ , ___ of the esophagus
cervical, thoracic, or abdominal portion
- ___ means you have a high white blood cell count.
Leukocytosis
- The esophagus is located in the center of your chest in an area called the ____.
mediastinum
ASSESSMENT AND DIAGNOSTIC FINDINGS FOR ESOPHAGEAL PERFORATION
(3)
- X-ray studies
- Fluoroscopy by either a barium swallow or esophagram (a noninvasive test)
- Chest CT scan
MANAGEMENT
- Postoperative nutritional status is a major concern
(__, __)
NPO 7 days, parenteral nutrition
___ is the reflux of acid and pepsin from the stomach to the esophagus that causes esophagitis.
GERD
___ - induce mucosal inflammation, erosion and ulceration
HCl, pepsin and bile
____ is a burning feeling in the chest caused by stomach acid travelling up towards the throat (acid reflux).
− symptoms may worsen if the individual ____, or in the case of increasing intra-abdominal pressure (as a result of coughing, vomiting, or of hard stool)
− heartburn can be seen as ___, which requires the exclusion of cardiac ischemia
− alcohol or foods that contain acid (___) can cause discomfort and worsen the symptoms
Heartburn
lies down
chest pain
citrus fruits
is used to evaluate the degree of acid reflux
Ambulatory 12- to 36-hour esophageal pH monitoring
(inflammation of the gastric or stomach mucosa) is a common GI problem.
It may be __ or __
Gastritis
acute, lasting several hours to a few days, or chronic, resulting from repeated exposure
to irritating agents or recurring episodes of acute gastritis
_____
- _____—a person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms.
- Pharmacologic - overuse of ___ or ____
Acute gastritis
dietary indiscretion
aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol intake,
_____
- benign or malignant ulcers
- bacteria ___
- Autoimmune diseases such as pernicious anemia;
- dietary factors such as caffeine;
- the use of medications such as NSAIDs or bisphosphonates (eg, alendronate [Fosamax],
risedronate [Actonel], ibandronate [Boniva]); - alcohol;
- smoking; or
- chronic reflux of pancreatic secretions and bile into the stomach
Chronic gastritis
Helicobacter pylori
is defined as a feeling of lethargy or a lack of mental or physical energy.
Lassitude
are involuntary contractions of the diaphragm. (which can last from a few hours to a few days)
Hiccups
Patients with ____ gastritis from vitamin deficiency usually have evidence of malabsorption of
vitamin ____ caused by the production of antibodies that interfere with the binding of vitamin __ to
___ factor.
chronic
B12
B12
intrinsic
- Acute gastritis
- refrain from ___ and food until symptoms subside.
- a ___ diet is recommended.
- If the symptoms persist, ___ fluids may need to be administered.
- is caused by ingestion of strong acids or alkalis,
To neutralize acids, commo ____ (eg, aluminum hydroxide) are used;
to neutralize an alkali, ___ or ___ is used.
- If corrosion is extensive or severe, ___ or ___ are avoided because of the danger of perforation and damage to the esophagus.
alcohol
nonirritating
intravenous (IV)
antacids
diluted lemon juice or diluted vinegar
emetics and lavage
- Chronic gastritis
- modifying the patient’s ___,
- promoting __,
- reducing ,
- recommending avoidance of __ or __, and
- initiating pharmacotherapy
diet
rest
stress
alcohol and NSAIDs
is a result of imbalance between the mucosal defense mechanisms in the esophagus, stomach and
duodenum, and gastric mucosa-damaging mechanisms
relates to digestion of mucous membrane and lower parts of the stomach, duodenum, and lower
esophagus by ___ and ___
PEPTIC ULCER
HCl and pepsin
Type of Peptic Ulcers:
- quickly heal by the mucosa regeneration
acute
- traumatic origin, or after surgery CNS (irritation of n. Vagus -> hypersecretion HCl)
Cushing
- penetrate deeper into the tissue, healing takes several weeks or months
chronic
- traumatic origin, after burns (↑ levels of histamine -> hypersecretion HCl)
Curling
- Ellison Syndrome - ↑ production of gastrin -> stimulates the secretion of HCl)
Zollinger
- mucosal perfusion defect
Stress ulcers
a burning sensation in the midepigastrium or the back.
- Pain is usually relieved by __ , because food neutralizes the ___, or by taking __; however, once the stomach has emptied or the ___’s effect has decreased, the pain returns.
- Sharply localized tenderness can be elicited by applying gentle pressure to the ___ at or slightly to the ___ of the midline.
eating
acid
alkali
alkali
epigastrium
right
Serologic testing for antibodies against the __
H. pylori antigen,
surgery to remove part of your vagus nerve.
- Vagotomy
- lower part of the stomach (pylorus) surgery
- Pyloroplasty
- more than two times their ideal body weight or
- BMI exceeds 40kg/m2
- more than 100 pounds greater than ideal body weight
Morbid Obesity
- main nerves of your parasympathetic nervous system. This system controls specific body functions such as your digestion
VAGUS NERVE
is the resection, or surgery, of the main stomach referred to as antrum.
An antrectomy
A prosthetic device is used to restrict oral intake by creating a small pouch of 10 to 15 mL that empties through the narrow outlet into the remainder of the stomach.
Gastric banding.
A vertical row of staples along the lesser
curvature of the stomach creates a new, smaller stomach pouch of 10 to 15 mL.
gastroplasty
A horizontal row of staples across the fundus of the stomach creates a pouch with a capacity of 20 to 30 mL. The jejunum is divided distal to the ligament of Treitz and the distal end is anastomosed to the new pouch. The proximal segment is anastomosed to the jejunum.
Roux-en-Y gastric bypass.
Half of the stomach is removed, leaving a small area that holds about 60 mL. The entire jejunum is excluded from the rest of the gastrointestinal tract. The duodenum is disconnected and sealed off. The ileum is divided above the ileocecal junction and the distal end of the jejunum is anastomosed to the first portion of the duodenum. The distal end of the biliopancreatic limb is anastomosed to the ileum.
Biliopancreatic diversion with duodenal switch.
- is an inflammation of the vermiform appendix, which is a projection from the apex of the cecum
APPENDICITIS
Clinical manifestation:
- pain is initially diffuse and poorly localizable (___), later when the inflammation transit to the parietal peritoneum, patients localize the pain in the right hypogastrium (____)
- the pain may be vague at ___, increasing in intensity over ___
- ______ is associated with extension of the inflammation to the surrounding tissues
visceral pain
somatization visceral pain
first
3 to 4 hours
right lower quadrant pain
sign – referred pain
- Rovsing sign
- elicited by having the patient lie on his or her left side while the right thigh is flexed backward
- Psoas sign
The exact cause of appendicitis is ___
- ___ obstruction of the lumen with stool, tumors, or foreign bodies with consequent increased intraluminal pressure, ischemia, bacterial infection, and inflammation is a common theory
controversial.
- Fecalit
in appendicitis, complete blood cell count - elevated ___
white blood cell count with an elevation of the neutrophils.
Appendicitis with perforation management??
(Laparotomy)
___ & ___ are chronic, relapsing inflammatory bowel diseases (IBDs) of unknown origin both diseases are associated with ____, alterations in epithelial cell barrier functions, immunopathology related to abnormal ___ reactions to microflora and other luminal antigens,
and varying phenotypes
Ulcerative colitis and Crohn disease
genetic factors
T-cell
Crohn’s disease
- any part of the ____
- the most common - terminal part of the ___
- inflammatory process affects all layers of the wall of the digestive tract -> ____ in the wall, the formation of ___ and ___
digestive tract
ileum
ulcerations
fistulas and abscesses
Ulcerative colitis
- affects __ and __
- the process of fibrosis is not __
colon and rectum
intensified
Transmural thickening
Deep, penetrating granulomas
Crohn’s disease
- Mucosal ulceration
- Minute, mucosal ulcerations
Ulcerative colitis
- is a serious condition that can have many causes
- __ disorders, ___ diseases, spinal cord injury
- this happens very ___
ILEUS -
metabolic
parathyroid
rarely
- ___ - obstruction in the lumen of the intestine and leads to compression of the wall
- intussusception,
- polypoid tumors and neoplasms,
- adhesions,
- hernias,
mechanical obstruction
- ___ - due to the “paralysis” of the intestinal muscles
functional obstruction
- ____ - strangulation of blood vessel due to thrombosis or embolism
vascular obstruction
- in paralysis, intestinal immobility, intestine vasculature failure, CNS disorders
- Paralytic ileus
- there is a long spasm of various segments of the intestine
- Spastic ileus
ileus management
Management
* Decompression of the bowel through a nasogastric tube
CLINICAL MANIFESTATIONS
- constipation may be the only symptom for months.
- the stool is altered as it passes the obstruction that is gradually increasing in size.
- Blood loss in the stool may result in iron deficiency anemia. (___)
- The patient may experience weakness (____)
- weight loss, and
- anorexia
- the abdomen becomes markedly distended,
- crampy lower abdominal pain.
- fecal vomiting develops (____)
- Symptoms of shock may occur.
(Large Bowel Obstruction)
hematochezia
Asthenia
copremesis
CLINICAL MANIFESTATIONS
* may be colic pain (obstruction of the lumen)
* vomiting and
* abdominal distension
(Small Bowel Obstruction)
__ may be performed if removal of the entire large bowel is necessary (_)
- An ileoanal anastomosis
proctocolectomy
in which a surgical opening is made into the cecum,
- A temporary or permanent ___ may be necessary.
A cecostomy,
colostomy
