Exam 2 Flashcards
Constitutional GI Symptoms
Nausea Vomiting Diarrhea Malaise Fatigue Fever Night sweats Pallor Diaphoresis Dizziness
GI signs and symptoms associated with strenuous exercise
Fecal urgency, diarrhea Abdominal cramps Belching Nausea and vomiting Heartburn
GI changes with aging
GI problems: constipation, incontinence, and diverticular disease
Oral: tooth enamel and dentin wear increasing tooth decay
Sensory changes: decreased taste buds and diminished sense of smell resulting in altered sense of taste
Salivary Secretion: decreases, leads to dry mouth
Alimentary organs (esophagus, stomach, small intestine, and colon) lose tone
Alimentary tract: decreased gastric motility, blood flow, nutrient absorption, gastric juice volume and acid content
Hiatal Hernia
Lower esophageal sphincter becomes enlarged, allowing stomach to pass through the diaphragm into the thoracic cavity
Congenital: from failure of formation/fusion of the multiple developmental components of the diaphragm
Acquired: penetrating wounds, shot, knife, trauma, surgery, empyema
Manifestations: sliding hernia (heartburn after eating); rolling hernia (difficult and painful swallowing)
Implications: avoid flat supine and valsalva, avoid intra-abdominal pressure, slow return to function
GERD (Esophagitis)
Inflammation of esophagus, may be result of reflux of infectious agents, chemical irritants, physical agents, or gastric juice
Heartburn or acid indigestion are common (but not term for GERD)
Reflux esophagitis is the most common (return of stomach/small intestine contents into esophagus)
Clinical Manifestations: Heartburn, reflux, belching, dysphagia, and painful swallowing, in older adults (dysphagia, vomiting, respiratory difficulties, weight loss, anemia, anorexia, with/without heartburn)
Can cause Barret’s Esophagus (damaged esophagus heals abnormally, lining develops cell found in intestine that’s more resistant but can be cancerous)
Implications: exercise is important (excess puts pressure on stomach), some PA can worsen symptoms, reflux degree worse in body agitation (running), supine before meals, strengthen muscles around esophageal sphincter, sleep on left side for nocturnal reflux
Mallory-Weiss Syndrome
Mucosal laceration of lower end of esophagus with bleeding (alcohol abuse, eating disorders, viral syndrome)
Increased transabdominal pressure in exercise/lifting can cause a tear
Scleroderma Esophagus
Abnormal functioning of the smooth muscle of the esophagus common in people with progressive systemic sclerosis
Symptoms: dysphagia to solids/liquids in recumbent position, heartburn and regurgitation in GERD/esophagitis
No effective treatement
Neoplasm
Squamous (most) and adenocarcinoma
H pylori predisposes people to peptic ulceration and gastric neoplasms, but protective effect against esophageal cancer
Barret’s esophagus: precursor of esophageal adenocarcinoma
Gasto reflux = increased risk of adenocarcinoma
Clinical Manifestations: dysphagia (predominant) pain presenting as pressure (may radiate between scapulae); many with GERD have no symptoms so progression to Barrett’s and then adenocarcinoma goes unnoticed
Esophageal cancer metastasizes quickly
Implications: lymphatic vessels are continuous with mediastinal structures, may see changes in nodes
Esophageal Varices
Dilated sub-mucosal veins in the lower esophagus (presence of portal hypertension secondary to cirrhosis of liver)
Rupture is common when varices reach greater than 5mm
Implications: avoid rupture, proper lifting techniques, avoid activities that increase abdominal pressure
Transesophageal Fistulas
Congenital defect; occurs when the esophagus fails to develop as a continuous passage and abnormal communication between the lower portion of the esophagus and trachea occurs
Most common esophageal anomaly, often combine with form of esophageal atresia (blind pouch)
Manifestations: pouch overflows into pharynx, leading to excess drooling or aspiration
Gastritis
Inflammation of the lining of the stomach, Type A or B (most common)
Manifestations: epigastric pain with abdominal distention, loss of appetite, nausea, painless GI hemorrhage, heartburn, low-grade fever, vomiting, chronic may be asymptomatic
Implications: NSAIDs lead to it, encourage steroids from doctor to reduce irritation, avoid aspirin
Peptic Ulcer Disease
Mucosal eruption of an area of the gastrointestinal tract, e.g., the stomach or the duodenum
DUs are more likely
Lifestyle/psychologic stress can aid in development, along with long-term NSAIDs
Manifestations: epigastric pain described as burning, gnawing, cramping, aching near xiphoid, nausea, loss of appetite, weight loss, hemorrhaging
Implications: check for SBP under 100, pulse greater than 100 bpm, drops in DBP more than 10, can cause back pain, exercise helps reduce to aid in healing
Gastric Cancer
Primary: No common
Adenocarcinoma: malignant neoplasms arise from gastric mucosa, chronic gastritis with intestinal metaplasia (strong factor), most common site in stomach glands
Manifestations: depend on size, location, metastasis, present with Trousseau’s syndrome, dermatomyositis, acanthosis nigricans, abnormal lymphnodes (left supraclavicular region/umbilical region)
After surgery: change positions after 2 hours, breathe deeply, cough to avoid pulmonary complications
Pyloric Stenosis
Sphincter at distal opening of stomach is obstructed
Congenital (hypertrophic PS, most common surgical disorders early infancy) or in adults with ulcer disease
Risks: increased third-trimester gastric secretion with maternal stress-related factors; turner’s syndrome, trisomy 18, intestinal malrotation, esophageal/duodenal atresia and anorectal anomalies
S/S: projectiel vomiting around 2-4 weeks after birth, dehydration, malnutrition, weakness, weight loss, lethargy
