Exam 6: GI Disorders Flashcards
gastric parietal cells
secrete hydrochloric acid and intrinsic factor -> necessary for the absorption of vitamin B12 in the small intestine
gastric goblet cells
secrete mucus and prostaglandin E2 (PGE2), a lipid-rich molecule, which exerts a strong protective effect. PGE2 stimulates gastric mucus production and bicarbonate secretion, which reduce the effects of HCL
GERD
Epi: most common GI disorder
Patho: Decreased closure of the LES, which allows acidic gastric contents to reflux up into the esophagus. Acid of the stomach damages the esophageal epithelium.
Two types: erosive or non-erosive (difference in damage to esophageal mucosa)
CM: Frequent heartburn = pyrosis, reflux (regurgitation) with bitter taste gastric contents into mouth, dysphagia, chest pain, chronic cough, hoarseness, wheezing
Complication: metaplasia of cells at the gastroesophageal junction = Barrett’s esophagus = can lead to esophageal cancer
Diagnosis: S/S, endoscopy, pH testing, biopsy
Hiatal hernia
Protrusion or herniation of the stomach through the esophageal hiatus of the diaphragm
Sliding hiatal hernia is common, non-significant in asymptomatic people
With GERD and large hiatal hernia can cause further irritation/pain requiring intervention
Peptic ulcer disease (PUD)
Inflammatory erosion in the stomach or duodenal lining. Ulceration occurs four times more often in the duodenum than in the stomach.
Etiology: H. Pylori & NSAIDS. Advanced age, prior PUD
Patho: exact process not clearly known. H. Pylori induce inflammation release cytokines to continue to mucosal damage. NSAIDS like aspirin thought to inhibit prostaglandin synthesis.
CM: epigastric pain, burning/gnawing, b/t meals, comes and goes
Diagnosis: endoscopy, biopsy for H. Pylori
Complications: Can lead to perforation (peritonitis), hemorrhage (acute abdominal pain), penetration
Upper GI bleed
bleeding in the esophagus, stomach, or duodenum (from lesion, erosion, ulceration, varicosed vein)
CM: Hematemesis, coffee ground emesis, melena
Slow chronic bleed -> iron deficiency anemia, fatigue, lethargy
Acute large GI bleed -> anxiety, dizziness, weakness, shortness of breath, tachycardia, tachypnea, pallor
Diagnostic: CBC, Endoscopy, positive FOBT
Pyloric stenosis
Constriction of the pyloric sphincter that impairs the movement of gastric contents into the small intestines
Etiology: build up of thick muscularis layer or fibrous tissue from PUD
CM: Delayed emptying of the gastric contents causes distension, can develop into pyloric obstruction
Bowel obstruction
Etiology: mechanical physical obstruction (adhesions, hernia, neoplasms) or nonmechanical which is reduced or absent peristalsis. (Paralytic ileus, Crohn’s, gallstones, intussusception, volvulus)
CM: vary depending on severity -> Abdominal pain, distention distal to site, N/V, hyperactive bowel sounds. Pain occurs in waves with peristalsis. partial = liquid diarrhea.
Diagnosis: Abdominal X-Ray -> excessive gas proximal to obstruction, CT & US
Complications: ischemic bowel, perforation, shock, infection, death. Can have fluid and electrolyte imbalances *small bowel absorbs a lot of water
Small bowel obstruction
post-surgery adhesions (bond sections of intestine together) -> typically requires surg intervention
Large bowel obstruction
colon cancer, diverticular disease, volvulus
generally in the stigmoid colon
high mortality if not caught early
Celiac disease
autoimmune disease w/ genetic component triggered from environmental (gluten)
patho: destroys intestinal villi from inflammation, flattens intestinal wall and reduces absorption
CM: excessive gas, muscle wasting, steatorrhea, weight loss, concern for anemias from lack of absorption of protein
diagnosis: serology celiac panel (immune) -> positive antibody titer of IgA, upper endoscopy
Irritable bowel syndrome (IBS)
Altered bowel activity and S/S w/ no pathological change
Experience periods of frequent abdominal pain, bloating, constipation/diarrhea, mucus in stools
Inflammatory bowel disease (IBD)
Pathological changes to the GI track
Failure of immune regulation
Ulcerative colitis
Crohn’s disease
Crohn’s disease
unclear etiology (genetics, autoimmune, environment)
entire bowel wall and all layers affected - any area of GI tract, chronic inflammation -> large immune response,
**skip lesions (patchy through small & large). risk for fistulas or abscesses
CM: abdominal pain, diarrhea, fatigue, weight loss
Diagnosis: colonscopy/endoscopy, biopsy, anemia labs
Ulcerative colitis
unclear etiology
episodes of inflammation in colon and rectum (inc in T, B, plasma IgG & IgE)
**continuous inflammation large bowel only
risk for colorectal cancer
CM: diarrhea, abd pain, melena
Diagnosis: scopy (psuedopolyps seen)
