Exam 3: chapter 38

Question 1

general clinical manifestations of the digestive function

Answer 1

vomiting
nausea
anorexia
constipation
diarrhea
abdominal pain

Question 2

what is the difference between retching and projectile vomiting?

Answer 2

retching: non productive vomiting
projectile vomiting: spontaneous vomiting that does not follow nausea or retching

Question 3

define nausea and anorexia

Answer 3

○ Nausea
■ A subjective experience that is associated with a number of conditions
○ Anorexia
■ A lack of a desire to eat despite physiologic stimuli that would normally produce hunger

Question 4

describe primary and secondary constipation

Answer 4

■ Primary condition
● Normal transit
○ Normal rate of stool passage but there is difficulty with evacuation
○ Stress, sedentary lifestyle, low-residue diet, low fluid intake
● Slow transit
○ Impaired colonic motor activity with infrequent bowel movements, straining to defecate, mild abdominal distension and palpable stool in the sigmoid colon
● Pelvic floor or outlet dysfunction
○ Inability or difficulty expelling stool
■ Secondary condition
● Caused by many different factors such as diet, medications, various disorders, aging

Question 5

constipation manifestations

Answer 5

● Straining with defecation
● Hard stools
● Sensation of incomplete emptying
● Fewer than three bowel movements per week

Question 6

define diarrhea

Answer 6

■ Presence of loose, watery stools
● Acute vs persistent
■ Large-volume diarrhea
● Caused by excessive amounts of water or secretions, both in the intestines
■ Small-volume diarrhea
● Volume of feces is not increased, usually results from excessive intestinal motility
■ Major mechanics
● Osmotic
○ Excess water is drawn into the intestine and increases stool weight and volume (excess sugar)
● Secretory
○ Excessive mucosal secretion of F/E produces large volume stool (infectious in origin)
● Motility
○ Due to resection of the small intestine (short bowel syndrome)
■ Systemic effects
● Dehydration
● Electrolyte imbalance
● Weight loss
■ Treated
● Fluid restoration, antimotility or water-absorbent medications (imodium)

Question 7

describe the different types of pain

Answer 7

■ Parietal pain
● From the parietal peritoneum (localized and intense)
■ Visceral pain
● From the organ (distention, inflammation, ischemia; poorly localized, diffuse, vague)
■ Referred pain
● Visceral pain felt at some distance from a diseased or affected organ; well localized, felt in the skin dermatomes of deeper tissue that share a central pathway with the affected organ

Question 8

gastrointestinal bleeding

Answer 8

■ Upper gastrointestinal bleeding
● Esophagus, stomach, or duodenum
■ Lower gastrointestinal bleeding
● Jejunum, ileum, colon, or rectum
■ Occult bleeding - slow, chronic bleed that’s not visually obvious
● Could result in anemia

Question 9

define osmotic, secretory, motility disorders

Answer 9

○ Osmotic
■ Excess water is drawn into the intestine and increases stool weight and volume (excess sugar)
○ Secretory
■ Excessive mucosal secretion of F/E produces large volume stool (infectious in origin)
○ Motility
■ Due to resection of the small intestine (short bowel syndrome)

Question 10

define occult bleeding and how to recognize it

Answer 10

○ Occult bleeding - slow, chronic bleed that’s not visually obvious
■ Could result in anemia
■ Fecal occult blood test (FOBT)
■ Iron-deficiency anemia

Question 11

how does achalasia lead to dysphagia?

Answer 11

food accumulates above the obstruction, distends the esophagus, and causes dysphagia

Question 12

what are the manifestations of achalasia

Answer 12

■ Stabbing pain at the level of obstruction
■ Regurgitation of undigested food
■ Vomiting
■ Aspiration
■ Weight loss

Question 13

GERD pathophysiology manifestations and treatment

Answer 13

○ Reflux of acid and pepsin from the stomach to the esophagus that causes esophagitis
○ Manifestations
■ Heartburn
■ Acid regurgitation
■ dysphagia
○ Treatment
■ PPIs for controlling symptoms and healing esophagitis (not as effective in children)

Question 14

GERD manifestations

Answer 14

§ Heartburn
§ Acid regurgitation
§ Dysphagia
§ Chronic cough
§ Asthma attacks
§ Laryngitis
§ Upper abdominal pain within 1 hour of eating

Question 15

what is the drug of choice for controlling symptoms and healing esophagitis that is not as effective in children?

Answer 15

PPI

Question 16

GERD pathophysiology

Answer 16

• Gastroesophageal reflux disease (GERD)
  
  • Reflux of acid and pepsin from the stomach to the esophagus that causes esophagitis
  • Resting tone of the LES tends to be lower than normal (weakened)
    Conditions that increase abdominal pressure or delay gastric emptying can contribute to the development of reflux esophagitis

Question 17

what is pyloric obstruction

Answer 17

• Pyloric obstruction
  ○ The blocking or narrowing of the opening between the stomach and the duodenum
  ○ Can be acquired or congenital (pyloric stenosis)
  ○ Manifestations
  § Epigastric pain and fullness
  § Nausea
  § Vomiting-cardinal sign of obstruction
  □ Usually projectile
  □ Contains undigested food, but no bile
  § With a prolonged obstruction, malnutrition, dehydration, and extreme debilitation
  ○ May do okay with conservative management but may need surgical repair

Question 18

what is an intestinal obstruction?

Answer 18

○ An intestinal obstruction is any condition that prevents the flow of chyme through the intestinal lumen
§ Simple obstruction
- Mechanical blockage of the lumen

Question 19

define functional obstruction (paralytic ileus)

Answer 19

§ Failure of intestinal motility
§ Often occurs after intestinal or abdominal surgery, pancreatitis, or hypokalemia

Question 20

clinical manifestations of intestinal obstruction and paralytic ileus

Answer 20

○ Clinical Manifestations of small intestinal obstruction
§ Colicky pains
§ Nausea
§ Bilious Vomiting- cardinal sign
○ Clinical Manifestations of large intestine obstruction
- Hypogastric pain and abdominal distention

Question 21

define gastritis and differentiate between chronic gastritis and acute gastritis

Answer 21

• Nonspecific inflammatory disorder of the gastric mucosa
• Acute gastritis
  ○ Caused by injury of the protective mucosal barrier
  ○ Drugs (NSAIDs), H. pylori infection, alcohol, physiologic stress…
• Chronic gastritis
  ○ Tends to occur in older adults
  ○ Causes chronic inflammation
  Types depend on the location and pathogenesis of the lesions

Question 22

what is peptic ulcer disease? what causes it? and what are the risk factors?

Answer 22

• A break or ulceration in the protective mucosal lining
• Usually in the stomach and proximal duodenum
• Can also be found in the esophagus
• Ulcers develop when mucosal protective factors are overcome by erosive factors
  ○ Caused by NSAIDs and H. Pylori infection
• Acute and chronic ulcers
• Risk factors: H. Pylori infection, chronic use of * NSAIDs, alcohol, smoking, advanced age, Psychological stress

Question 23

define duodenal ulcers

Answer 23

• Duodenal ulcers
  ○ Most common of the peptic ulcers
  ○ Developmental factors:
  § Helicobacter pylori infection
  § Use of NSAIDs
  ○ Cause hypersecretion of stomach acid and pepsin
  ○ Characterized by chronic intermittent pain in the epigastric area
  § Begins 2 to 3 hours after eating, when the stomach is empty
  § Relieved rapidly by ingestion of food or antacids
  ○ Management aimed at relieving the causes and effects of hyperacidity and preventing complications

Question 24

define gastric ulcer

Answer 24

• Ulcers of the stomach
• Tend to develop in the antral region of the stomach, adjacent to the acid-secreting mucosa of the body
• Pathophysiology
  ○ The primary defect is an increased mucosal permeability to hydrogen ions
  ○ Gastric secretion tends to be normal or less than normal
• Manifestations and treatment similar to duodenal ulcers except food causes pain

Question 25

list the different malabsorption syndromes

Answer 25

• Maldigestion
  ○ Failure of the chemical processes of digestion
• Malabsorption
  ○ Failure of the intestinal mucosa to absorb digested nutrients
• Maldigestion and malabsorption frequently occur together

Question 26

ulcerative colitis: what is it and what are some of the symptoms?

Answer 26

• Chronic inflammatory disease that causes ulceration of the colonic mucosa (mucosal an submucosal layer only)
  ○ Commonly in the sigmoid colon and rectum
  ○ Begins in the rectum and may extend proximally to the entire colon
  ○ Intermittent periods of remission and exacerbation
• Symptoms:
  ○ Diarrhea (10 to 20/day)
  ○ Urgency
  ○ Bloody stools
  Cramping

Question 27

chron’s disease: what is it

Answer 27

• Granulomatous colitis, ileocolitis, or regional enteritis
  
  • Idiopathic inflammatory disorder; affects any part of the digestive tract, from mouth to anus
  • Affects entire/ full thickness of intestinal/bowel wall in a discontinuous way
  • Ulcerations can produce fissures that extend into the lymphatics
  • Symptoms similar to ulcerative colitis
  • Anemia may result from malabsorption of vitamin B12 and folic acid
    Treatment similar to ulcerative colitis

Question 28

what are the different types of hepatitis

Answer 28

• Systemic viral disease that primarily affects the liver
• 5 types (A, B, C, D, and E)
• Spectrum of manifestations ranges from absence of symptoms to fulminating hepatitis, with rapid onset of liver failure and coma

Question 29

pancreatitis exocrine insufficiency

Answer 29

○ Pancreatic exocrine insufficiency
■ Insufficient pancreatic enzyme production
● Lipase, amylase, tryspin, or chymotrypsin
■ Causes:
● Pancreatitis
● Cystic fibrosis
■ Fat maldigestion is the main problem, patient will exhibit fatty stools and weight loss

Question 30

define lactase deficiency

Answer 30

Inability to break down lactose (milk sugar) into monosaccharides and therefore prevent lactose digestion and absorption

Question 31

fat-soluble vitamin deficiencies

Answer 31

■ Vit A
● Skin issues
■ Vit D
● Bone pain
● Decreased calcium absorption
● fractures
■ Vit K
● Prolonged prothrombin time
■ Vit E
● Immune system role