Exam 3: chapter 38 Flashcards
general clinical manifestations of the digestive function
vomiting
nausea
anorexia
constipation
diarrhea
abdominal pain
what is the difference between retching and projectile vomiting?
retching: non productive vomiting
projectile vomiting: spontaneous vomiting that does not follow nausea or retching
define nausea and anorexia
○ 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
describe primary and secondary constipation
■ 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
constipation manifestations
● Straining with defecation
● Hard stools
● Sensation of incomplete emptying
● Fewer than three bowel movements per week
define diarrhea
■ 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)
describe the different types of pain
■ 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
gastrointestinal bleeding
■ 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
define osmotic, secretory, motility disorders
○ 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)
define occult bleeding and how to recognize it
○ Occult bleeding - slow, chronic bleed that’s not visually obvious
■ Could result in anemia
■ Fecal occult blood test (FOBT)
■ Iron-deficiency anemia
how does achalasia lead to dysphagia?
food accumulates above the obstruction, distends the esophagus, and causes dysphagia
what are the manifestations of achalasia
■ Stabbing pain at the level of obstruction
■ Regurgitation of undigested food
■ Vomiting
■ Aspiration
■ Weight loss
GERD pathophysiology manifestations and treatment
○ 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)
GERD manifestations
§ Heartburn
§ Acid regurgitation
§ Dysphagia
§ Chronic cough
§ Asthma attacks
§ Laryngitis
§ Upper abdominal pain within 1 hour of eating
what is the drug of choice for controlling symptoms and healing esophagitis that is not as effective in children?
PPI
GERD pathophysiology
- 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
what is pyloric obstruction
- 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
what is an intestinal obstruction?
○ An intestinal obstruction is any condition that prevents the flow of chyme through the intestinal lumen
§ Simple obstruction
- Mechanical blockage of the lumen
define functional obstruction (paralytic ileus)
§ Failure of intestinal motility
§ Often occurs after intestinal or abdominal surgery, pancreatitis, or hypokalemia
clinical manifestations of intestinal obstruction and paralytic ileus
○ Clinical Manifestations of small intestinal obstruction
§ Colicky pains
§ Nausea
§ Bilious Vomiting- cardinal sign
○ Clinical Manifestations of large intestine obstruction
- Hypogastric pain and abdominal distention
define gastritis and differentiate between chronic gastritis and acute gastritis
- 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
what is peptic ulcer disease? what causes it? and what are the risk factors?
- 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
define duodenal ulcers
- 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
define gastric ulcer
- 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
list the different malabsorption syndromes
- Maldigestion
○ Failure of the chemical processes of digestion - Malabsorption
○ Failure of the intestinal mucosa to absorb digested nutrients - Maldigestion and malabsorption frequently occur together
ulcerative colitis: what is it and what are some of the symptoms?
- 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
chron’s disease: what is it
- 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
what are the different types of hepatitis
- 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
pancreatitis exocrine insufficiency
○ 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
define lactase deficiency
Inability to break down lactose (milk sugar) into monosaccharides and therefore prevent lactose digestion and absorption
fat-soluble vitamin deficiencies
■ Vit A
● Skin issues
■ Vit D
● Bone pain
● Decreased calcium absorption
● fractures
■ Vit K
● Prolonged prothrombin time
■ Vit E
● Immune system role
