exam 3 - GI - week 5 content Flashcards
Upper GI distress
what 2 drugs Increase protective factors
o Antacids
o Sucralfate
upper GI or Lower GI=
- Esophagus
- Stomach
- Beginning of small intestines
- Small intestines
- Colon (large intestines)
- Rectum/anus
Upper GI
- Esophagus
- Stomach
- Beginning of small intestines
Lower GI
- Small intestines
- Colon (large intestines)
- Rectum/anus
s/s of what UGI issue
- Pyrosis – heartburn
- Dyspepsia – indigestion
- Regurgitation
- Chest pain
- Dysphagia
- Pulmonary symptoms
GERD
Gastro esophageal reflux disease
s/s
- abdominal distension
- fullness
- flatulence
- bloating
- intermittent abdominal pain exacerbated by stress and relieved by BM
- bowel urgency
- intolerance to certain food – sorbitol, lactose, gluten
- non-bloody stool that may contain mucus
Irritable bowel syndrome
what develops when the GI tract is exposed to acid and H pylori (when the aggressive factors outweigh the defensive factors)?
ulcers
Peptic ulcer disease PUD
s/s differences in duodenal ulcer vs gastric/peptic ulcer
- ________ ulcer timing = 2-4 hours after eating
- __________ulcer timing = 1-2 hours after eating
duodenal ulcer timing
= 2-4 hours after eating
gastric/peptic ulcer timing = 1-2 hours after eating
and that makes sense bc food passes through the stomach (gastric) area before it passes through the small intestine (duodenum)
Complications from GERD
- Ulceration
- Scarring
- Strictures
- Barrett esophagus
ALL
Barrett esophagus – development of abnormal metaplastic tissue, increased risk of development into cancer
Characterized by
- Chronic inflammation of the intestines
- Exacerbation and remissions
IBD or IBS?
Inflammatory bowel disease
A group of life changing, chronic illnesses
- Crohn’s disease
- Ulcerative colitis
Development or presence of diverticula – small pouches in lining of colon that bulge outward through weak spots
- Location – descending colon
Diverticulosis
- appendicitis
- peritonitis
- Irritable bowel disorder
- Inflammatory bowel disorder
- Crohns ulcerative colitis
- Diverticulosis/Diverticulitis
lower GI or upper GI issues?
lower GI
A group of life changing, chronic illnesses
- Crohn’s disease
- Ulcerative colitis
Chronic condition
Characterized by alterations in bowel pattern due to changes in intestinal motility
- chronic and frequent constipation
OR
- chronic and frequent diarrhea
Inflammatory bowel disease or Irritable bowel syndrome?
Irritable bowel syndrome
Chronic condition
Characterized by alterations in bowel pattern due to changes in intestinal motility
- chronic and frequent constipation = IBSC
- chronic and frequent diarrhea = IBSD
Inflammatory bowel disease
A group of life changing, chronic illnesses
- Crohn’s disease
- Ulcerative colitis
Complications
- Perforation
- Peritonitis
- Obstruction
Diverticulitis
Patho/cause of ________
- Idiopathic
- Age related
- Injury/damage may weaken the diaphragm muscle
- Constantly too much pressure on the muscles around the stomach
o Severe coughing
o Vomiting
o Constipation and straining to have a BM
hiatal hernia
s/s of ______
- asymptomatic
- n/v
- anorexia
- weight loss
- bleeding
- burning pain – in middle abdomen or back , worse when stomach is empty
- cramping
- gas like pain
PUD
complications of acute or chronic gastritis?
- PUD
- Bleeding ulcers
- Anemia
- Gastric cancers
chronic gastritis
- lasts weeks to years
s/s
- Abdominal pain
- Bloody diarrhea
- Weight loss
- Fatigue
- Anorexia
- Fever
- crypts of lieberkuhn affected
s/s
- LRQ pain
- LRQ mass – palpable
- Cramps
- Watery diarrhea
- Weight loss
- Fatigue
- Anorexia
- Fever
- Malabsorption of nutrients
- Mouth ulcers
- s/e fistula
Crohn’s or UC?
UC s/s
- Abdominal pain
- Bloody diarrhea
- Weight loss
- Fatigue
- Anorexia
- Fever
- crypts of lieberkuhn affected
Crohn’s
s/s
- LRQ pain
- LRQ mass – palpable
- Cramps
- Watery diarrhea
- Weight loss
- Fatigue
- Anorexia
- Fever
- Malabsorption of nutrients
- Mouth ulcers
- s/e fistula
acute ___________
temporary inflammation of the stomach lining only (intestines are not affected)
- lasts 2-10 days
chronic ___________
progressive disorder with chronic inflammation in the stomach
- lasts weeks to years
acute _____________
inflammation of stomach and small intestine
- lasts 1-3, or 10 days
acute gastritis
temporary inflammation of the stomach lining only (intestines are not affected)
- lasts 2-10 days
chronic gastritis
progressive disorder with chronic inflammation in the stomach
- lasts weeks to years
acute gastroenteritis
inflammation of stomach and small intestine
- lasts 1-3, or 10 days
Risk factors for what UGI issue?
- Age
- Smoking
- Obese
hiatal hernia
Ulcerative disorder of the upper GI tract
Peptic ulcer disease PUD
Treatment for GERD
SATA
- Avoid triggers
- Prevent complications
- Some meds
- surgery
- Avoid triggers
- Prevent complications
- Some meds
X- surgery
Difficulty swallowing
- Begins with solids and progresses to liquids
Dysphagia
Etiology of _______
- H pylori
- Injury causing substances – daily use of NSAIDS, ASA, alcohol
- Excess secretion of acid
o Stress – increased gastric acid is secreted with body’s stress response
- Smoking
- Family hx
PUD
_________________
o H pylori
o NSAIDS
o Acid
o Pepsin
o Smoking
______________
o Mucus
o Bicarbonate
o Blood flow
o Prostaglandins
which factors cause ulcers and which factors protect against ulcers?
- Aggressive factors
o H pylori
o NSAIDS
o Acid
o Pepsin
o Smoking - Defensive factors
o Mucus
o Bicarbonate
o Blood flow
o Prostaglandins
s/s
- LLQ pain
- Fever
- Increase WBC
- Constipation or diarrhea
- Acute – passage of large quantity of frank blood
Diverticulitis
- Elastic reservoir for food, mixing, and initial digestion of proteins
- Lined with epithelium/gastric glands, which secrete HCl, IF – intrinsic factor, and gastrin
Stomach
- Perforated ulcer
- Pancreatitis
- Ruptured gallbladder, spleen, bladder, appendix
cause ________
Peritonitis
- Esophageal disorders like
o GERD
o Hiatal hernia - Inflammatory disorders of the stomach like
o Gastritis
o Acute gastroenteritis
o PUD
upper or lower GI problems?
Upper GI problems
Membrane wall = plicae circulares
Fingers on membrane wall = intestinal villi
Fingers on the fingers = microvilli
These all give larger surface area for digestion
small or large intestine?
small
Backflow of gastric acid from the stomach into esophagus
- Occurs via the lower or upper esophagus sphincter?
- Highly acidic material
GERD
Gastro esophageal reflux disease
“heart burn”
Backflow of gastric acid from the stomach into esophagus
- Occurs via the LES
- Highly acidic material
PUD Classification
_____________
o Most common
o Age any, early adulthood
_____________
o Age 50-70 peak
o b/c increased use of NSAIDS, corticosteroids, anticoagulants and more likely to have serious systemic illnesses
Gastric/peptic ulcer or Duodenal ulcer ?
Classification
- Duodenal ulcer
o Most common
o Age any, early adulthood
- Gastric/peptic ulcer
o Age 50-70 peak
o b/c increased use of NSAIDS, corticosteroids, anticoagulants and more likely to have serious systemic illnesses
s/s of acute gastroenteritis
- watery diarrhea – bloody if bacterial
- abdominal pain
- n/v
- fever
- malaise
complications =
FVD
__________ intestine
Includes appendix, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum
- No villi and no digestive enzymes
- Cells absorb water and electrolytes
- Goblet cells produce mucus
- Endocrine cells produce hormones
Large
- Fatty foods
- Spicy foods
- Tomato based foods
- Citrus foods
- Caffeine
- Alcohol
- Smoking
- Sleep position
- Obesity
- Pregnancy
- Pharmacologic agents
cause what upper GI issue?
GERD
Gastro esophageal reflux disease
anything that alters closure/strength of LES or increases abdominal pressure
complications of _______
Fluids Shifting
1. Third spacing: fluids leave blood vessel and accumulate in the abdomen or pleural cavity.
2. This can lead to hypovolemia and Hypovolemic shock: If fluid loss is significant
3. Sepsis: infection
Decreased Peristalsis
1. Paralytic ileus: intestines stop moving
2. Intestinal obstruction: intestines become completely blocked
associated with which lower GI issue
Peritonitis
obstruction that causes Appendix inflammation
Appendicitis
complications of PUD
H –
O –
P –
complications of PUD
H – hemorrhage – if blood vessels are damaged
O – obstruction – scar tissues
P – perforation and peritonitis
Crypts of lieberkuhn – secrete fluid
Goblet cells and brunner glands – make mucus for protection against acid
small or large intestine?
small
- _________ esophageal sphincter – prevents food and fluids from aspirating into lungs (top of esophagus)
- _______ esophageal sphincter or “cardiac sphincter” – separates the esophagus from the stomach, prevents acidic content of the stomach from entering back into the esophagus (bottom of esophagus)
– upper
– lower (LES)
_____________ is a chronic inflammatory bowel disease (IBD) that can affect any part of the digestive tract, from the mouth to the anus.
________ is a chronic inflammatory bowel disease (IBD) that causes inflammation of the mucosa of the rectum and colon
Crohn’s disease
ulcerative colitis
which layer of the stomach
contains:
- G-cells – produce gastrin which facilitates production of HCl
- Parietal cells – produce HCl to help break down food, and produce IF to protect mucosa
- Chief cells – secrete pepsin
- epithelial cells – secrete bicarbonate-rich solution to protect mucosa
- blood vessels
Mucosa layer - Inner layer
Cause
- Autoimmune activated by an infection
causes IBS or IBD?
Inflammatory bowel disease
A group of life changing, chronic illnesses
- Crohn’s disease
- Ulcerative colitis
s/s of ________
- Asymptomatic
- Belching
- Dysphagia
- Chest or epigastric pain
hiatal hernia
Complications of what lower GI issue
- Gangrene
- Abscess formation
- Peritonitis
Appendicitis
Inflammation of one or more of the pouches (diverticula)
- May resolve spontaneously
Diverticulitis
s/s
- Sudden and severe
- Abdominal pain
- Tenderness
- Rigid board like abdomen
- n/v
- fever
- elevated WBC
- increased HR – r/t pain and fluid shifts
- decreased BP – r/t pain and fluid shifts
Peritonitis
Patho for crohn’s disease
1. Lymph structures in the GI tract are _______
2. Tissue becomes engaged and ________
3. Skip lesions - Deep linear fissures and ulcers develop in a patchy pattern in the bowel wall, _________ appearance
Patho
1. Lymph structures in the GI tract are blocked
2. Tissue becomes engaged and inflamed
3. Skip lesions - Deep linear fissures and ulcers develop in a patchy pattern in the bowel wall, cobblestone appearance
A group of life changing, chronic illnesses
- Crohn’s disease
- Ulcerative colitis
Inflammatory bowel disease
Patho of PUD
1. ______ is damaged
2. _________ secreted
3. ___crease in acid and pepsin secretion = causes further tissue damage
4. Vaso____tion = causes edema
5. Destroyed blood vessels = bleeding ulcers
Patho
1. Mucosa (lining of the stomach) is damaged
2. Histamine secreted
3. Increase in acid and pepsin secretion = causes further tissue damage
4. Vasodilation = causes edema
5. Destroyed blood vessels = bleeding ulcers
s/s
- Asymptomatic
- Accidentally discovered or with presentation of acute diverticulitis
Diverticulosis
is it Common for GERD and hiatal hernia to coexist ?
Treatment for HH
1. Teaching
o meals =
o don’t _____ after eating
o _____- tight clothes and abdominal supports
o ________ if obese
o _______ meds for GERD symptoms
2. surgery if other treatment doesn’t work
Treatment
1.Teaching
o Small frequent meals
o don’t lie down after eating
o avoid tight clothes and abdominal supports
o weight control if obese
o antacids for GERD symptoms
2. surgery if other treatment doesn’t work
s/s
- RLQ pain
- Rebound pain – severe pain after release of palpating hand over RLQ
- Sudden pain relief = rupture (peritonitis)
Appendicitis
o CVA-stroke
o Achalasia – LES cant open properly
o Common in intubated people
resulting in dysphagia
cause is….
Mechanical obstruction (structure issue) or Neuromuscular dysfunction (brain issue)?
Neuromuscular dysfunction (brain issue)
Risk factors for _______ induced PUD
- older Age
- Higher doses of NSAIDS – inhibit prostaglandin, lose protective mucus coating
- Hx of PUD
- Use of corticosteroids long term and anticoagulants
- Serious systemic disorders – autoimmune
- H pylori infection
NSAID
2 types of hernia - - Paraesophageal hernia
and Sliding hernia
________
o Usually small
o Doesn’t need treatment
o Less severe
__________
o Part of the stomach pushes through the diaphragm and stays there
o More severe
2 types
- Sliding hernia
o Usually small
o Doesn’t need treatment
o Less severe
- Paraesophageal hernia
o Part of the stomach pushes through the diaphragm and stays there
o More severe
There are types 3 and 4 and they are a mixture and worse
psychosocial stress and IBS
T/F
- emotional stress doesn’t cause IBS
- emotional stress doesn’t make IBS worse
- IBS doesn’t cause emotional stress
T/F
Causes of IBS
- Idiopathic
- Triggered by stress
- Triggered by food
- Triggered by hormone changes
- Triggered by GI infections
- Triggered by menses
- autoimmune activated by an infection
- emotional stress doesn’t cause IBS
X - emotional stress can make IBS worse
X - IBS can cause emotional stress - Idiopathic
- Triggered by stress
- Triggered by food
- Triggered by hormone changes
- Triggered by GI infections
- Triggered by menses
X- autoimmune activated by an infection = IBD
___________ __________
- Normally closed at rest
- Prevent the movement of food backwards
Esophageal sphincters
Complications of ______
- Malnutrition and anemia
- Scar tissue and obstructions
- Fistulas – inappropriate connections
- Cancer
Complications of ________
- Hemorrhage
- Perforation
- Cancer
- Malnutrition
- Anemia
- Strictures
- Colon, rectal and/or Anal Fissures
- Colon, rectal and/or Anal abscesses
- Toxic megacolon – rapid dilation of the large intestine that can be life threatening
- Colorectal carcinoma
- Liver disease – from inflammation and scarring of the bile ducts
- F&E and pH imbalances
Crohn’s or UC?
crohn’s Complications
- Malnutrition and anemia
- Scar tissue and obstructions
- Fistulas – inappropriate connections
- Cancer
UC Complications
- Hemorrhage
- Perforation
- Cancer
- Malnutrition
- Anemia
- Strictures
- Colon, rectal and/or Anal Fissures
- Colon, rectal and/or Anal abscesses
- Toxic megacolon – rapid dilation of the large intestine that can be life threatening
- Colorectal carcinoma
- Liver disease – from inflammation and scarring of the bile ducts
- F&E and pH imbalances
etiology of _______:
- irritating substances – like alcohol
- drugs – like NSAIDS
- infectious agents – like H pylori
2 main etiology of ______:
- Autoimmune – attacks parietal cells (produce HCl to help break down food, and produce IF to protect mucosa)
- H pylori infection
etiology of ________:
- viral – noro and rota
- bacterial – E.coli, salmonella, campylobacter
- parasitic infection
acute gastroenteritis, acute gastritis, or chronic gastritis?
etiology acute gastritis
- irritating substances – like alcohol
- drugs – like NSAIDS
- infectious agents – like H pylori
2 main etiology chronic gastritis
- Autoimmune – attacks parietal cells (produce HCl to help break down food, and produce IF to protect mucosa)
- H pylori infection
etiology acute gastroenteritis
- viral – noro and rota
- bacterial – E.coli, salmonella, campylobacter
- parasitic infection
___________
- Tube for food and fluids
- Connects throat to stomach
- Mucus and muscles help move food
Esophagus
gastroenteritis vs gastritis?
s/s
- asymptomatic
- anorexia
- n/v
- postprandial pain – after eating
- intestinal gas
- hematemesis
- tarry stool
- anemia
s/s
- watery diarrhea – bloody if bacterial
- abdominal pain
- n/v
- fever
- malaise
gastritis
s/s
- asymptomatic
- anorexia
- n/v
- postprandial pain – after eating
- intestinal gas
- hematemesis
- tarry stool
- anemia
gastroenteritis
s/s
- watery diarrhea – bloody if bacterial
- abdominal pain
- n/v
- fever
- malaise
o Stenosis or stricture
o Diverticula
o Tumor
resulting in dysphagia
cause is….
Mechanical obstruction (structure issue) or Neuromuscular dysfunction (brain issue)?
- Mechanical obstruction – structure issue
Cause _______
- Congenital or acquired
- Low fiber diet = chronic constipation
Diverticulosis
Small intestine
1st
2nd
3rd
jejunum
ileum
duodenum
Small intestine
1st duodenum
2nd jejunum
3rd ileum
Peritoneum inflammation – serous membrane that lines the abdominal cavity and covers visceral organs
Peritonitis
Chronic condition
Characterized by alterations in bowel pattern due to changes in intestinal motility
- chronic and frequent constipation
OR
- chronic and frequent diarrhea
Irritable bowel syndrome
- chronic and frequent constipation = IBSC
- chronic and frequent diarrhea = IBSD
complications of _______
H – hemorrhage – if blood vessels are damaged
O – obstruction – scar tissues
P – perforation and peritonitis
complications of PUD
H – hemorrhage – if blood vessels are damaged
O – obstruction – scar tissues
P – perforation and peritonitis
G – granulomas
A – all
L – layers
S – skip lesions
Crohn’s disease of ulcerative colitis?
Crohn’s disease
H pylori causes
________ and ________ and ___________
SATA
- Bacteria or virus?
- Acidic environment
- Persistent inflammation
- Transmission
o person to person via saliva, feces, or vomit
o contaminated food/water
chronic gastritis
PUD
stomach cancer
- Bacteria
- Acidic environment
- Persistent inflammation
- Can cause chronic gastritis, PUD, and stomach cancer
- Transmission
o person to person via saliva, feces, or vomit
o contaminated food/water
Defect in the diaphragm that allows part of the stomach to pass into the thorax
Hiatal hernia
bacteria or virus causes acute gastroenteritis?
bacteria or virus causes chronic gastritis?
acute gastroenteritis
- viral – noro and rota
- bacterial – E.coli, salmonella, campylobacter
- parasitic infection
chronic gastritis
Bacteria = H pylori
also autoimmune
IBD or IBS
More common in
- Women
- White
- Jewish
- Smokers
Inflammatory bowel disease
A group of life changing, chronic illnesses
- Crohn’s disease
- Ulcerative colitis
Small intestine sphincter
is called __________ sphincter
where food passes from small intestines to large intestines
- Distention allows passage and prevents reflux back onto ileum
Ileocecal sphincter
Peptic ulcer disease PUD
- Esophageal – ulcer in the _________
- Gastric ulcer – ulcer in the __________
- Duodenum ulcer – ulcer in the ___________
esophagus
stomach
first part of the small intestine
Patho of UC
1. Begins in_______and extends in a continuous segment that may involve the entire colon
2. Inflammation = large ulcerations
3. _____ abscesses - Necrosis of the epithelia tissue can cause abscesses
4. Colon and rectum try to repair the damage with new _________ tissue – which is problematic b/c it is fragile and bleeds easy
Patho
1. Begins in rectum and extends in a continuous segment that may involves the entire colon
2. Inflammation = large ulcerations
3. Crypt abscesses - Necrosis of the epithelia tissue can cause abscesses
4. Colon and rectum try to repair the damage with new granulation tissue – which is problematic b/c it is fragile and bleeds easy
which quadrant
diverticulitis =
appendicitis =
crohns =
Left LQ (descending colon)
Right LQ
Right LQ (mouth to anus)
