Exam 3 - alterations of digestive system Flashcards
1
Q
Anorexia is characterized as a…
A
loss of appetite
2
Q
What is responsible in the brain for vomiting?
A
medulla oblongata
3
Q
What can committing lead to?
A
fluid, electrolyte, and acid-base disturbances
4
Q
what types of medications can be taken for nausea and vomiting?
A
antiemetic medications
5
Q
What are 5 clinical manifestations of GI dysfunction?
A
- nausea
- retching
- projectile vomiting
- constipation
- diarrhea
6
Q
What are 2 common symptoms associated with nausea?
A
- hypersalivation
2. tachycardia
7
Q
define retching
A
vomiting without the expulsion of vomitus
8
Q
define projectile vomiting
A
spontaneous vomiting that does not follow nausea or retching
9
Q
define constipation
A
infrequent or difficult defecation
10
Q
What kind of constipation is characterized by normal rate of stool passage, but difficulty with stool evacuation from low-residue, low-fluid diet?
A
normal transit constipation
11
Q
What kind of constipation is characterized by impaired colonic motor activity with infrequent bowel movements and straining?
A
slow-transit constipation
12
Q
What is failure of pelvic floor muscles or anal sphincter to relax with defecation:
A
pelvic floor dysfunction
13
Q
what does secondary constipation come from?
A
from an actual disease process or condition
14
Q
what is fecal impaction?
A
hard, dry stool retained in rectum
15
Q
What are some treatments for constipation?
A
bowel retraining, moderate exercise, increased fluid and fiber intake, enemas (should not be habitually used), biofeedback, drugs (stool softeners and laxatives).
16
Q
How many bowel movements do you have a day with diarrhea?
A
three or more per day
17
Q
What are 3 systemic manifestations of diarrhea?
A
- acute bacterial or viral infection (fever, with or without vomiting or cramping pain)
- inflammatory bowel disease (fever, cramping pain, bloody stools)
- malabsorption syndromes (steatorrhea (fat in the stools), bloating, and diarrhea)
18
Q
What kind of diarrhea is characterized by a nonabsorbable substance in the intestine drawing water into the lumen by osmosis, causing large-volume diarrhea?
A
osmotic diarrhea
19
Q
What kind of diarrhea is characterized by large-volume diarrhea caused by excessive mucosal secretion of chloride or bicarbonate-rich fluid or the inhibition of net sodium absorption?
A
secretory
20
Q
What kind of diarrhea is characterized by excessive motility decreases transit time, mucosal surface contact, and opportunities for fluid absorption?
A
motility diarrhea
21
Q
What are 4 clinical manifestations of diarrhea?
A
- dehydration
- electrolyte imbalance (hyponatremia, hypokalemia)
- metabolic acidosis
- weight loss
22
Q
What is a symptom of a number of GI disorders?
A
abdominal pain
23
Q
Where does parietal (somatic) pain occur?
A
in the peritoneum
24
Q
Where does visceral pain occur?
A
in the organs themselves
25
Where does referred pain occur?
felt in another area, usually the back
26
What are 3 biochemical mediators of the inflammatory response?
1. histamine
2. bradykinin
3. serotonin
27
What do biochemical mediators stimulate?
organic nerve endings producing abdominal pain
28
Where does upper GI bleeding occur?
from the esophagus, stomach, or duodenum
29
What does upper GI bleeding look like?
Frank, bright red bleeding in emesis or digested blood (coffee grounds) in stool
30
Where does lower GI bleeding occur?
from the jejunum, ileum, color, or rectum
31
define hematemesis:
blood vomit
32
define hematochezia:
bloody stools
33
define melena:
black, tarry stools
34
define occult bleeding:
not visible
35
define dysphagia
difficult swallowing
36
What are 2 types of dysphagia?
1. mechanical obstructions of esophagus
| 2. functional obstructions of esophageal motility
37
define achalasia with dysphagia:
denervation of smooth muscle in the esophagus and lack of lower esophageal sphincter relaxation
38
What is the treatment of achalasia:
dilation or surgical myomotomy of the lower esophageal sphincter
39
define hiatal hernia
protrusion of the upper part of the stomach through the diaphragm and into the thorax
40
What kind of hernia is hernia I?
sliding
41
What is the most common hernia?
hernia I (sliding)
42
What kind of hernia is characterized by the proximal stomach portion moving into the thoracic cavity through an opening in the diaphragm for the esophagus and vagus nerves?
hernia I (sliding)
43
Which type of hernia is also called a rolling hiatal hernia?
hernia II (paraesophageal)
44
What kind of hernia is characterized by herniation of the greater curvature
of the stomach is through a secondary opening in the diaphragm?
hernia II (paraesophageal)
45
What kind of hernia is hernia III?
Mixed (a combo of hernia I and II)
46
What is a pyloric obstruction?
blocking or narrowing of the opening between the stomach and duodenum
47
What does a pyloric obstruction feel like?
1. epigastric pain and fullness
2. nausea
3. succussion splash
4. vomiting
5. if prolonged, malnutrition and dehydration
48
What is any condition that prevents the flow of chyme through the intestinal lumen or failure of normal intestinal motility in the absence of an obstructing lesion?
intestinal obstruction
49
What is an ileus?
an obstruction of the intestines
50
What are symptoms of a small intestine obstruction?
1. colicky pains caused by intestinal distention
2. nausea
3. vomiting
51
What are symptoms of a large intestine obstruction
1. hypogastric pain
| 2. abdominal distention
52
What can type of vomitus indicate in terms of obstruction?
location of obstruction
53
What type of vomitus is associated with pylorus obstruction?
early, profuse vomiting of clear gastric fluid
54
What type of vomitus is associated with proximal small intestine obstruction?
mild distention and vomiting of bile-stained fluid
55
what type of vomitus is associated with lower in small intestine obstruction?
1. more pronounced distention because a greater length of intestine is proximal to the obstruction.
2. vomiting may not occur or may occur later and contain fecal material.
56
What is the most common cause of small intestine obstructions?
fibrous adhesions
57
What are the most common causes of large intestine obstructions?
1. colorectal cancer
2. volvulus (twisting)
3. strictures related to diverticulitis
58
What is acute colonic pseudo-obstruction also called?
ogilvie syndrome
59
What is acute colonic pseudo-obstruction?
massive dilation of the large bowel
60
When does acute colonic pseudo-obstruction occur?
in patients who are critically ill and older adults who are immobilized
61
define gastritis
inflammatory disorder of the gastric mucosa
62
What is acute gastritis associated with?
1. H. pylori
2. nonsteroidal antiinflammatory drugs (NSAIDs)
3. drugs
4. chemicals
5. metabolic disorders
63
What is chronic fundal gastritis?
Immune Type A
64
What is chronic fundal gastritis associated with?
autoantibodies to parietal cells and intrinsic factor
65
What does chronic fundal gastritis result in?
gastric atrophy and pernicious anemia
66
What is chronic astral gastritis?
Non immune, Type B
67
What is chronic astral gastritis associated with?
H. Pylori and NSAIDS
68
Finish the sentence: Signs and symptoms of chronic gastritis often do not what?
correlate with the severity of the disease
69
Define peptic ulcer disease:
break or ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum
70
What is characteristic of peptic ulcer disease?
acute and chronic ulcers
71
what are risk factors of peptic ulcer disease?
1. Genetic predisposition
2. H. pylori infection
3. habitual use of NSAIDs
4. excessive alcohol
smoking
5. acute pancreatitis
6. COPD
7. obesity
8. cirrhosis
9. socioeconomic status
10. over 65 years of age
72
What is superficial in relation to peptic ulcer disease?
erosions
73
What is deep in relation to peptic ulcer disease?
true ulcers
74
What are the most common peptic ulcers?
duodenal ulcers
75
What are stress ulcers?
peptic ulcers related to severe illness, multi system organ failure, or major trauma
76
When do ischemic ulcers develop?
within hours of an event
77
When do curling ulcers develop?
after a burn from ischemia
78
When do cushing ulcers develop as a result of?
as a result of head trauma or brain injury from hyper secretion of hydrochloric acid from the vagal nuclei
79
What is the most common clinical manifestation of stress ulcers?
bleeding
80
What is a treatment option for stress ulcers?
prophylactic therapy
81
What are the 4 pancreatic enzymes associated with pancreatic insufficiency?
1. lipase
2. amylase
3. trypsin
4. chymotrypsin
82
What is the primary problem with pancreatic insufficiency
fat maldigestion
83
what are 2 common signs of pancreatic insufficiency?
1. fatty stools (steatorrhea)
| 2. weight loss
84
what is the treatment of pancreatic insufficiency?
lipase supplements
85
What is the cause of lactase deficiency?
congenital defect in the lactase gene
86
Lactase deficiency is associated with an inability to break down what?
lactose into monosaccharides and thus prevent lactose digestion and monosaccharide absorption
87
What does lactase deficiency cause?
1. cramping pain, flatulence
| 2. osmotic diarrhea
88
What are 2 treatments for lactase deficiency?
1. avoid milk products
| 2. maintenance of adequate calcium intake to decrease risk of osteoporosis
89
What is bile salt deficiency the result of?
1. liver disease
| 2. bile obstructions
90
What does bile salt deficiency cause?
1. fatty stools
2. diarrhea
3. loss of fat-soluble vitamins (A, D, E, K)
91
What are 4 fat-soluble vitamins?
A, D, E, K
92
What can a deficiency in vitamin A cause?
night blindness
93
What can a deficiency in vitamin D cause?
decreased calcium absorption, bone pain, osteoporosis, fractures
94
What can a deficiency in vitamin K cause?
1. prolonged prothrombin time
2. purpura
3. petechiae
95
What can a deficiency in vitamin E cause?
1. testicular atrophy
| 2. neurologic defects in children
96
define ulcerative colitis
chronic inflammatory disease that causes ulceration of the colonic mucosa
97
What are suggested cause of ulcerative colitis?
1. infectious
2. immunologic (anticolon antibodies)
3. dietary
4. genetics
98
What is the pathophysiology of ulcerative colitis?
lesions are continuous with no skipped lesions, are limited to the mucosa, and are not transmural
99
What are characteristics of ulcerative colitis?
1. large volumes of watery diarrhea
2. bloody stools
3. cramps
4. pain
5. urge to defecate
100
People who have ulcerative colitis are at an increased risk for what?
colon cancer
101
What does crohn disease cause?
skip lesions
102
What does crohn disease look like?
produces "cobblestone" appearance
103
What does crohn disease feel like?
abdominal pain and diarrhea
104
Where is the location of lesions in ulcerative colitis?
colon and rectum; no "skip" lesions
105
Where is the location of lesions in crohn's disease?
all of GI tract - mouth to anus; "skip" lesions common
106
What is the area affected in ulcerative colitis?
mucosal layer
107
What is the area affected in crohn's disease?
entire intestinal wall
108
What is granuloma with ulcerative colitis?
rare
109
What is granuloma with crohn's disease?
common "cobblestone" appearance
110
What is abdominal pain like with ulcerative colitis?
occasional
111
What is abdominal pain like with crohn's disease?
common
112
What are bloody stools like with ulcerative colitis?
common
113
What are bloody stools like with crohn's disease?
less common
114
What is steatorrhea like with ulcerative colitis?
rare
115
What is steatorrhea like with crohn's disease?
common
116
What is antineutrophil cytoplasmic antibody like in ulcerative colitis?
common
117
what is antineutrophil cytoplasmic antibody like in crohn's disease?
rare
118
what is antisaccharomyces cerevisiae antibody like in ulcerative colitis?
rare
119
What is antisaccharomyces cerevisiae antibody like in crohn's disease?
common
120
define irritable bowel syndrome:
functional gastrointestinal disorder with no specific structural or biochemical alterations
121
What are 4 clinical manifestations of IBS?
1. lower abdominal pain
2. diarrhea-predominant, constipation-predominant, or alternating diarrhea and constipation
3. gas, bloating
4. nausea
122
define diverticula
herniation of mucosa through the muscle layers of the colon walls
123
define diverticulosis
asymptomatic diverticular disease
124
define diverticulitis
inflammatory stage of diverticulosis
125
what are possible causes of appendicitis
1. obstruction
2. ischemia
3. increased intraluminal pressure
4. infection
5. ulceration
126
What are symptoms of appendicitis?
1. epigastric and periumbilical pain
2. rebound tenderness
3. nausea, vomiting, fever, anorexia
127
define portal hypertension
abnormally high blood pressure in the portal venous system primarily caused by resistance to portal blood flow
128
What are causes of portal hypertension?
1. pre hepatic
2. intrahepatic
3. posthepatic
129
What are clinical manifestations of portal hypertension?
1. ascites
| 2. vomiting blood from bleeding esophageal varices
130
define ascites
accumulation of fluid in the peritoneal cavity
131
What are clinical manifestation of ascites?
1. abdominal distention
2. increased abdominal girth
3. weight gain
132
define hepatic encephalopathy
accumulation of toxins related to liver failure, causing disruption of neurotransmission
133
What are clinical manifestations of hepatic encephalopathy
1. Personality changes
2. Confusion, irritability, lethargy
3. Memory loss, sleep disturbances
4. Flapping tremor (asterixis)
5. Stupor, coma, death
134
define acute liver failure
severe impairment or necrosis of liver cells without preexisting liver disease or cirrhosis
135
What are clinical manifestations of acute liver failure?
1. anorexia
2. vomiting
3. abdominal pain
4. progressive jaundice
136
define viral hepatitis:
systemic viral disease that primarily affects the liver
137
What is the sequence of viral hepatitis?
1. incubation phase
2. prodromal phase
3. icteric phase
4. recovery phase
138
Which phase of viral hepatitis varies depending upon the virus?
incubation phase
139
When does the prodromal phase begin?
2 weeks after exposure
140
During which phase is viral hepatitis is it highly transmittable?
prodromal phase
141
What is the actual phase of viral hepatitis?
icteric phase
142
What are the clinical manifestations of the icteric phase?
1. jaundice
2. hyperbilirubinemia
3. fatigue
4. abdominal pain
143
What phase of viral hepatitis begins with the end of jaundice?
recovery phase
144
Hepatitis A can be found in the what of the infected individual?
feces, bile, and sera
145
How is hep A transmitted?
by the fecal-oral route
146
What are 2 risk factors of Hep A?
1. crowded, unsanitary conditions
| 2. food and water contamination
147
How can you prevent hep A?
1. hand washing
2. administration of immunoglobulin before exposure or early in the incubation period
3. administration of vaccines
148
How is Hep B transmitted?
transmitted through contact with infected blood, body fluids, contaminated needles (parenterally and sexually transmitted)
149
How can Hep B also be transmitted during pregnancy?
maternal transmission if the mother is infected during the third trimester
150
What does the Hep B vaccine prevent?
transmission and development of Hep B
151
What does Hep B immunoglobulin provide?
post-exposure prophylaxis against hep B
152
which Hep is responsible for most cases of post-transfusion hepatitis?
Hep C
153
Co-infection of Hep C and what other Hep is common?
Hep C
154
Approximately 80% of those with Hep C develop what?
chronic liver disease
155
Is there a vaccine available for Hep C?
No
156
What is administered with hep C?
antiviral meds
157
What is dependent on hep B for replication?
hep D
158
What is the treatment for Hep D?
pegylated interferon alpha
159
How is Hep E transmitted?
fecal-oral transmission
160
what can cause Hep E?
contaminated water or uncooked meat
161
Where is Hep E most common?
Asian and african countries
162
Where is a vaccine available for Hep E?
china, but not other countries
163
define cirrhosis
an irreversible inflammatory fibrotic disease that disrupts liver function and even liver structure
164
What are the most common causes of cirrhosis?
1. alcohol abuse
| 2. HCV
165
What is the 3rd most common cause of cancer death in the US for men and women?
cancer of the colon and rectum
166
How does cancer of the colon and recutum develop from?
adenomatous polyps - a mass or fingerlike projection arising from the intestinal mucosal epithelium
