Gastroenterology Flashcards
Functions of the GI tract
- mechanical and chemical breakdown of food
- passage of food by peristalsis
- immunological protection
- absorption of water and minerals
- excretion of waste
Oral Cavity
- salivary and mucus glands
- teeth
- tongue
- soft and hart palate=Uvula
- tonsil Immunological function)
what does salivary and mucus glands do in the mouth
- soften food
- lubricate food
- formation of bolus
- lipase and amylase begin digestion
- antibodies
pharynx
- connects the nasal/oral cavity to the esophagus
- passage of food and air
epiglottis
- cartilaginous flap at the entrance of the larynx
- this covers over the larynx during swallowing protecting the airways
esophagus
- muscular tube with mucus membrane
- this is passage by peristalsis
- has an upper and lower sphincter (upper is always active)
stomach
- has a churning and grinding motility
- releases gastric acid
- releases different enzymes
- intrinsic factor is released
- has a protective mucus layer and bicarbonate section
what does gastric acid do?
- activates digestive enzymes (pepsinogen and gastric lipase)
- immunological function
- contains HCL
Small Intestine
- mixes and moves chyme
- enzymatic breakdown using different enzymes
- lots of absorption occurs here
- large surface area due to Villi and microvilli
what are the three sections of the small intestine?
- duodenum (where bile and pancreatic juices enter)
- jejunum
- ileum (vit B12 and bile acids are reabsorbed)
Large Intestine (colon)
- important in the absorption of water
- storage of waste
- has about 3 peristaltic waves per day
- bacterial breakdown
What is absorbed in the large intestine?
- water
- vitamin K
- other nutrients
what is the purpose of the anus?
storage of feces
rectum
- has two sphincters (one is voluntary control and one Is not)
- allows for the removal of waste
what are the accessory organs of the digestive tract?
- liver
- pancreas
- appendix
what does the liver do?
- recieves nutrient rich blood from the GI track (first pass of metabolism)
- produces bile
- detoxifys blood
- makes red blood cells in babies
- makes clotting factors
- carb, protein, and lipid metabolism
- breakdown of ammonia
describe the importance of bile production?
- bile is released into the duodenum
- it allows for the absorption of fat soluble vitamins
- bile salts emulsify fat droplets for better absorption
- without you will have fatty feces (will look white)
endocrine functions of the pancreas
-release of insulin and glucagon
Exocrine functions of the pancreas
- releases pancreatic juices into the duodenum
- releases enzymes that assist in digestion (precursor enzymes)
- peptidase and lipase and amylase
- high bicarb content to neutralize pH of the Chyme from stomach
what does it mean to be a precursor enzyme?
this means that it is released in an inactive form and then gets activated by cleavage or a specific environmental conditions (ex. pH)
Peritoneum
the lining of the abdominal cavity
- serous membrane
- lining of the abdominal cavity
- support of abdominal organs
- nerves, blood, and lymphatic vessels pass through
describe the layers of the lining of the small intestine
outer most layer: serosa
- tunica muscularis
- submucosa
- mucosa (touches the lumen of the small intestine)
describe the importance of the mucosa
- this is what allows for motility
- this is the layer that has villi and microvilli
- white spots are goblet cells (release mucus for lubrication)
the top left of the patients abdomen is:
left hypochondriac region
the middle left of the patients abdomen is:
left lumbar region
the bottom left of the patients abdomen is:
left iliac region
the top right of the patients abdomen is:
right hypochondriac region
the middle right of the patients abdomen is:
right lumbar region
the bottom right of the patients abdomen is:
right iliac region
the top middle of the patients abdomen is:
epigastric region
the middle middle of the patients abdomen is:
umbilical region
the bottom middle of the patients abdomen is:
hypogastric region
Abdominal examination
- inspection
- auscultation
- palpation
- percussion
- DRE
- gynecological examination
What does inspection refer to when doing an abdominal examination?
- general condition (color, can they stand, cleanliness?)
- vital parameters
- look for scars or herniation
- check if it is a moving or still patient (could be peritonitis)
why Is it important to check for auscultation?
you want to listen to the intestinal sounds
- you can hear normal sounds of stomach rumbling
- you can hear metallic/high pitched tinkling sounds
- you might hear no sound
when would you hear metallic/high-pitched tinkling sounds
- mechanical Ilius
- this is when something is trapped in the intestine and it is something that is holding down the intestine that wants to move
when would you not hear any sound coming from the abdomen?
- this could be a paralytic ilius
- this means the blood supply of the intestine is compromised and then the pain will go away because the tissue tied
- *should hear movement at least once a minute otherwise something is wrong
what are you looking for when you palpate the abdomen?
- pain (diet pain, indirect pain,[always begin away from pain])
- increased size of liver or spleen or pain in these
- masses
- hernias or defects in abdominal wall
- Psoas sign
- torsio testes
what is Psoas sign?
when you pull up on the leg and try to activate the poses muscle and it hurts
what is torso testes
twisting of the testicles that cause pain in the abdomen
- this is common in young men
- the testicle could be twisted and lose blood flow
- if you cannot untwist you need to have surgery
what are different types of sounds you could hear with percussion
- tympanitic sounds: air in hollow viscera
- dull: organ or mass or fluid (bladder)
- painful: peritoneal reaction (gallstones/cholecystitis/kidney stones)
what is DRE
digital rectal excitation
- looking for painful areas, masses, and blood on your glove
- *should always be preformed on patients with abdominal pain
what is acute abdomen
- pain in the abdomen for less than a week
- can have nausea, vomiting, and changes in stool consistency and color
How common is acute abdomen
- very common
- about 10% of all visits to hospitals
- one in three are admitted
- most between the ages of 19-29 years old
- half are discharged with unspecific abdominal pain
what is RARELY done to the abdomen?
CAT scans because it causes so much radiation and the tissues of the abdomen absorb it
anamnesis
the is the patients account of their medical history
what could lack of bowel movements mean for acute abdomen?
this could mean they have an ilius
What is important to ask about if there is blood or melena in feces?
ask about I they take iron supplements because they could look similar
what are some preclinical tests performed for acute abdomen?
-blood test
-blood type
-hemoculture
-arterial blood gas
-imaging
ECG
Urinestix
Gastroenteritis
inflammation of the gastrointestinal tract
- abdominal pain
- diarrea
- nausa
- vomiting
- fever
treatment for gastroenteritis
- no antibiotic!!!
- sometimes hospitalization (if they are extremely dehydrated or old and fragile)
- treatment with fluids and electrolytes
- if severe stool and blood samples for microorganisms.
why don’t we want antibiotics for gastroenteritis
- because we don’t know if it is bacteria or virus
- this will also kill our natural flora which is there to help the issue
- only give antibiotics to those who absolutely need it!!
appendicitis Acuta
- most often for 10-30 years of age
- sick for less than two days
- slight or moderate fever
- localized peritoneal pain
treatment: surgical or antibiotics
Gallstones
-fat
-female
-forty
might be more common in females due to metabolism?
describe gallstone attack episodes:
- episodes with constant pain: can last a few hours
- intense pain episodes: duration a few minutes
- often localized under the right curvature
- few symptoms between episodes
- diagnosed via ultrasound
differences in simple vs. complicated gallstones:
Simple: pain management until the episode is over
Complicated: Infection in the gall bladder, long duration of pain, many episodes, obstruction of duct into the small intestine, liver infections
treatment: surgical removal of gallbladder/removal of stone from bile duct
Constipation
Deficating 2 or fewer times a week
- incomplete emptying
- pain
- hard stools
- most often women and elderly
- predisposing Factors:
- bad toilet habits
- inactivity
- fiber poor diet
- low fluid intake
why is it important to be weary of Diarrhea for constipation?
the large intestine is so full that the water and material moves through without being about to be absorbed at all and they have constant diarrhea
Treatment for diarrhea:
- laxatives and lavament
- change of habits
- prophylactic daily
describe and uncomplicated gastric ulcer:
- usually greater than 40 year old
- dyspepsia/upper GI pain/area tender with palpation
- alleviated by food or antacids
- often sparse clinical findings
- caused by a bacteria and use an NSAID (anti-inflammatory drug)
what is the urea breath test?
- this is used because the bacteria is able to convert urea into ammonia and CO2
- if positive, eradicate with AB and proton pump inhibitor
- always stop treatment with NSAID
- referral to gastroscopy + biopsy at a later time
what does it mean for perforation with a gastric ulcer?
- sudden onset of intense pain and peritoneal reaction
- laparoscopy and surgical closure
- must be treated in a hospital
pancreatitis acuta
- alcohol abuse
- pain in the umbilical and hypogastric area
- sometimes radiation to the left shoulder
- patient are most often leaning forward
- very painful
- increased enzymes that are spilling into the bloodstream and the surrounding area causing necrosis
treatment for pancreatitis acuta
- hospitalization +CT+ultrasound to exclude gallstone
- pain management
Ileus
this means obstruction
Name some common things that can be signs of an Ileus
-hernia (issues with the lining of the stomach
-often previous abdominal surgery
-episodes of intense pain
-fecal vomiting
-no intestinal sounds if paralytic ileum
metallic high pitched tingling sounds in mechanical ileum
treatment for Ileus
- emergency surgery with resection of necrotic tissues and removal of obstruction/strangulation
- antibiotics
