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Applied pathophysiology > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

what is the treatment for ulcerative colitis

A

anti-inflammatory medication

removal of the colon

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2
Q

how can you diagnose ulcerative colitis

A

colonscopy- camera up your bum

ct scan, mri

xray

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3
Q

what causes ulcerative colitis

A

an autoimmune conditon that causes t-cells to destroy cells that line the walls of the large intestine

it affectsthe large intestine function

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4
Q

what is ulcerative colitis

A

condition that tends to form ulcers on the inner surface of the lumun in the large intestine

only happens in the large intestine

form of inflamtion bowel diesease

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5
Q

what are symptoms of inflammation bowel disease

A

pain in the right lower quadrant

diarrhea

blood in stool

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6
Q

what is the cause of inflammation bowel disease

A

gentics

gene mutation

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7
Q

explain the pathophysiology of inflammation bowel disease

A

a pathogen enters the body (epithelial cells are defected in inflammation bowel disease letting pathogens in easily)

the t-helper cells reassess a chemical that stimulates an inflammation response

this in inflammation bowel disease is a process with a dysfunction therefor their is a LOT of inflammation and immune response

this destroys healthy cells

the immune repsone contiunes to attack healthy cells leading to ulcers to form

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8
Q

what is the difference between chron’s disease and ulcerative colitis

A

chron’s disease affect anywhere in the go tract not just the large instestine

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9
Q

what are the two conditions that fall under inflammation bowel disease

A

chron’s disease

ulcerative colitis

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10
Q

what are the signs and symptoms of irritable bowel syndrome

A

Intermittent cramping abdo pain, often lower usually relieved by defecation

o Altered bowel function

o Flatulence, bloating, nausea

o Often accompanied by anxiety and depression

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11
Q

how to diagnose irritable bowel syndrome

A

criteria often continuous or recurrent symptoms of at least 12 weeks of abdo symptoms with two of three symptoms

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12
Q

explain the pathophysiology of irritable bowel syndrome

A

its a functional disorder- no physical changes but the bowel doesn’t work effectively with the communication between the gt and the central feverous system

this causes to hypersensitive where the brain tells the large intestine to move after or slower effecting how much water is absorbed

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13
Q

what is irritable bowel syndrome

A

chronic or recurrent abdominal pain with changes in bowel habits

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14
Q

how can you diagnose acute choleytitis

A

xray

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15
Q

what are the symptoms of a acute choleystits

A

pain in the epigastric area

nausea and vomiting

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16
Q

explain the pathophysiology of acute cholecystitis

A

individual has gallstones in the gallbalder

when the gallbladder is singled to contract and realise bile to help with digestion it loges one of the gallstones in the cystic duct

this blocked the bile flow- this irritates the mucus linning leading to it producing enzymes that promote inflammation

their is eventually a pressure build up, as well as this bacteria starts to grow causing an infection

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17
Q

what is the cystic duct

A

leaves the gallbladder and connects to the common bile duct

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18
Q

what is acute cholecystitis

A

inflammation of the gallbladder- due to gallstones being loved in the cystic duct

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19
Q

how can you diagnose gallstones

A

x-ray

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20
Q

what are the two types of gallstones

A

cholesterol stones- due to cholesterol breaking away from the bile this is due to high construction of bile

bilirubin stones- made when to much bilirubin is in the bile

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21
Q

what is the job of the gallbladder

A

store bile

send the small intestine bile to break down fatty foods

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22
Q

what is gallstones

A

hard solid masses formed in the gallbladder

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23
Q

can a diverticular be aysmptamitc

A

yes

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24
Q

what is diverticulitis

A

inflammation of a small bulges in the large intestine

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25
Q

explain the pathophysiology of diverticulitis

A

The outermost layer of colon tissue is made up of fibrous bands of muscle rapped around one another.

· The muscles become weakened with age, and the increased pressure of muscle spasms can cause the inner layers of tissue, the mucosa and submucosa, to herniate through the opening, forming diverticula.

· The diverticula then trap small amounts of faecal material, especially undigested seeds, etc, the trapped faeces can allow bacteria to grow and result in infection.

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26
Q

what are the treatments for diverticulitis

A

Diet
GP recommends to stick to fluid only diet for a few days
When recovering you should eat very low fibre diet
Medicine:
Treated at home with antibiotics prescribed from the GP.
More serious cases may need hospital treatment of IV and antibiotics.
Surgery – In rare cases surgery may be needed in certain cases which involves removing the infected section of the large intestines. This is known as colectomy

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27
Q

what are the complications of diverticulitis

A

If tears become large enough they can spill bowel consents into the abdominal lining leading to infection called peritonitis.

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28
Q

what are the signs and symptoms of diverticulitis

A 
Normally unnoticeable
Symptoms normally develop after the age of 40 and include…
Diarrhoea 
Constipation
Fever
Chills
Abdominal tenderness in illac fossa/ hypogastric regions (mainly in the left lower side of abdomen. 
Blood in stool
Rectal bleeding
Inflammation
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29
Q

explain the pharyngeal phase of swallowing

A

epiglottis closes the airway and upper oesophageal spinchtor relaxes to allow food to move into the oesophagus

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30
Q

explain the oral phase of swallowing

A

food is prepared into a bolus and acts of swallowing occur where food safely enters the oropharynx

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31
Q

what is somatic pain

A

Sharp pain caused when the somatic nervous system detects stimuli such as touch, temperature, or bodily fluids such as blood, pus or gastrointestinal contents.

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32
Q

explain the pathophysiology of referred pain

A

Pain that is felt at a site away from the pain stimulus.
This is due to the convergence of many different nerve fibres from wide areas of the body into small areas of the spinal cord.

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33
Q

explain the pathophysiology of visceral pain

A

These pain signals travel along nerves which enter the spinal column at various levels, meaning that visceral pain usually is not localised to any one specific area
As the pathology progresses, this pain may become parietal in nature
The body responds to this vague pain with sympathetic stimulation that causes nausea and vomiting, diaphoresis (sweating) and tachycardia.

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34
Q

explain the pathophysiology of somatic pain

A

The pain signals travel along definite neural routes to the spinal column, meaning that the pain identified as being from a particular region or area.

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35
Q

what causes oesophageal dysphia

A

internal obstruction

forgien bodies

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36
Q

what is oesophageal dysphia

A

able to do the first process of swallowing but feel discomfort in the mid and lower stream

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37
Q

what is the management of dyspina

A

treating underlying causes
dietary changes
swallowing exercises

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38
Q

what are the causes of oropharyngeal dysphia

A

tremor in tonsils
peritonsillar obscess

or

stroke
ms
Parkinson’s disease

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39
Q

what is oropharyngeal dysphia

A

pt unable to transfer food to upper oesophagus by swallowing

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40
Q

what is the two types of dysphagia

A

oropharyngeal and oesophageal and can either be structural or neurological

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41
Q

what is the oesophageal phases of swallowing

A

oesophagus relaxes to receive the food and is helped by the peristalsis wave

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42
Q

what are the three process of swallowing

A

oral phase and pharyngeal phases and oesophageal phase

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43
Q

what is swallowing

A

process that food transported from mouth to the stomach

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44
Q

what is dysphasia

A

difficulty and abnormality of swallowing

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45
Q

what are the factors the causes heartburn

A 
large meals 
coughing 
allchol 
medication 
previous surgery
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46
Q

what causes symptoms of oesphagitis

A

back flow of gastric acid into oesophagus due to an incompetent barrier

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47
Q

what Is oesophagitis

A

heartburn

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48
Q

musclualis mucosa

A

Smooth muscle that contracts and breakdown food

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49
Q

what is a lamina propria

A

made of blood and lymph tissues

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50
Q

what is the epithelial layer

A

absorbs and recreates mucus and digestive enzymes

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51
Q

what is a peptic ulcer

A

a break in the membrane in the stomach

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52
Q

what are the causes of peptic ulcers

A

infection from h.pylori bacteria- due to it colonising at the gastric mucusa causing damage which over time gets deeper and deeper causing ulcers

NSAID’s anti inflammatory drugs

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53
Q

what does prostaglandin do

A

increases mucus and bicarbonate production in the stomach

inhibits acid secretion in the stomach

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54
Q

why does nsaid’s anti inflammatory drugs causes peptic ulcers

A

the inhibit the cox-1 which produces prostaglandin this causes it to become reduced

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55
Q

explain what causes a GI obstruction

A

Blockages of the hollow space, or lumen, within the small and large intestines.

Bowel obstruction is either due to a mechanical blockage (adhesions, intussusception, tumour / faeces, hernia, volvulus) or due to other factors that affect the muscular wall of the bowel (myopathy) or the nerve supply to the bowel (neuropathy) which would affect its ability to perform peristalsis.

The end result of either cause is the food gets stuck and then the problems start.

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56
Q

explain what causes a GI obstruction

A

Blockages of the hollow space, or lumen, within the small and large intestines.

Bowel obstruction is either due to a mechanical blockage (adhesions, intussusception, tumour / faeces, hernia, volvulus) or due to other factors that affect the muscular wall of the bowel (myopathy) or the nerve supply to the bowel (neuropathy) which would affect its ability to perform peristalsis.

The end result of either cause is the food gets stuck and then the problems start.

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57
Q

why can a Gi obstruction be dangerous

A
  • Bacteria in the gut will multiply when food gets stuck because of the extra nutrition available to them.
  • They produce gas which accumulates in the bowel causing distension
  • Pressure on the bowel wall reduces its blood supply
  • Cells begin to die in the bowel wall and it can perforate causing peritonitis
  • The bacteria can enter the blood and cause sepsis
  • Fluids leak from the bowel causing hypotension
  • Brain initiates vomiting to shift the blockage which adds to fluid loss and Hypotension
  • Shock can result from sepsis and/or hypovolaemia = death
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58
Q

what is. ulcerative colitis

A

chronic inflammatory disorder that starts in the rectum and spreads proximally in a continuous manner effecting the mucosa manifesting in inflammation and ulceration with no segments of normal tissue

this leads to damage epithelial barrier leads to increased permeability due to the reduction and alteration of the surfactant and increases the permeability of the mucosa leading to the immue system mistaking good bacteria for bad causing an immune response leading to ulcerations.

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59
Q

what is a volvulus

A

• A volvulus is when a loop of intestine twists around itself resulting in a bowel obstruction

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60
Q

what is an abdominal hernia

A
  • Abdominal hernia occurs when bowel passes through a weakening in the muscle wall that enclose the abdominal cavity.
  • The intestine/bowel that bulges through the weak area may be at risk of ‘strangulation’ and become ischaemic
61
Q

what is a intussusception

A
  • Part of the intestine slides into an adjacent part of the intestine. This “telescoping” often causes obstruction.
  • Can cut off the blood supply to the bowel (ischaemia)
  • Can result in perforation or tissue death
62
Q

what is bowel adhesions

A

common after surgery

bands of fibrous tissues form between the abdominal tissues causing them to stick together

63
Q

how does a GI obstruction occur

A

sequestration of fluids and gas proximal to obstruction

dilation of bowel and abdominal distension

fluid shifts out of bowel into peritoneum

irritation occurs in the peritoneum

vascular shift into peritoneal cavity

hypovolaemia, dehydration, shock

64
Q

what is the signs and symptoms for ulcerative colitis

A 
Diarrhoea that can contain blood, mucus or pus
Abdominal pain
Need to empty bowels frequently
Extreme fatigue
Loss of appetite
Weight loss
65
Q

what are the factors that can play a role in who gets ulcerative colitis

A

Genes.You may inherit a gene from a parent that increases your chance.
Other immune disorders.If you have one type ofimmune disorder, your chance for developing a second is higher.
Environmental factors.Bacteria

66
Q

what is the cause of ulcerative colitis

A

overactive immune system

67
Q

what is ulcerative colitis

A

that theimmune system mistakes “friendly bacteria” in the colon, which aid digestion, as a harmful infection, leading to the colon and rectum becoming inflamed.

68
Q

what are the complications of diverticulitis

A

If tears become large enough they can spill bowel consents into the abdominal lining leading to infection called peritonitis.
Bowel obstruction

69
Q

what are the symptoms of diverticulitis

A 
Normally unnoticeable
Symptoms normally develop after the age of 40 and include…
Diarrhoea 
Constipation
Fever
Chills
Abdominal tenderness in illac fossa/ hypogastric regions (mainly in the left lower side of abdomen. 
Blood in stool
Rectal bleeding
Inflammation
70
Q

what causes diverticulitis

A

by perforation of one of sacs in the sigmoid colon.

Mainly painful when stool can’t pass through the colon

71
Q

what is diverticulitis

A

Diverticular disease is the general name for a common condition that involves small bulges or sacs called diverticula that form from the wall of the large intestine (colon).

72
Q

where is diverticulitis found

A

Diverticulitis is mainly found in the sigmoid colon but can be present throughout the large and small bowel.

73
Q

What’s the name for the movement of stuff along the digestive tract

A

Peristalsis

74
Q

What is peristalsis

A

A series of wave like muscles contraction that moves food through the digestive tract

75
Q

Where can you find Segmental mixing movement

A

Small intestine

76
Q

What is intussuspetion

A

Part of the intestine slides inside itself causing an obstruction

77
Q

What does intussusuption lead to

A

Can lead to iscemia and tissue death which can cause a perforation

78
Q

What age is intussusception common in

A

Children below age 3

79
Q

How can you tell if someone has intussusception

A

Still like red current jelly

80
Q

What are the signs and symptoms of a bowel obstruction

A 
Nausea and vomiting (bile and fractal vomit)
Fever and tachycardia 
Loss of appetite and weight loss 
Abdominal pain 
Constipation 
Distended abdomen 
Diarrhoea 
Bloody stool
81
Q

Why does a bowl obstruction lead to diarrhoea

A

Only the liquid with go around the blockage as the food the is being digested

Due to an overflow of fluids

82
Q

Describe the appendix

A

Blind ended worm shaped tubed, about 9cm long. Attached to your cacum

83
Q

What is your cacum

A

A pouch that form the first part of your large intestine

84
Q

What is a appendicitis

A

Due to the appendix swelling

inflammation of the wall in the appendix.

85
Q

What is the common age for a appendicitis

A

Males more common

Common in age 20-30

86
Q

What causes a appendicitis

A

Blockage of the appendix

87
Q

What is a Lymphoid hyperplasia

A

Buick growth and multiplication of the lymphoid cells

88
Q

What causes a appendix

A

Lymphoid hyperplasia
Infection
Feacalities
Tumour

89
Q

what causes an appendicicites

A

the tube connecting to the appendices can get twisted

90
Q

what is the lymphoid hyperplasia

A

essential to the appendicitis, it is the quick growth or multiplication of normal lymphocytic cells that look like lymph tissues

91
Q

Why does an infection in the appendix cause an appendicitis

A

The infection causes swelling in the appendix leading to a preferartion

92
Q

What is a faecalities

A

Poo stones

Fractal matter gets compacted and as it’s passing through the cucem and breaks away and dropped in the appendix

93
Q

What is the most common cause of a surgical emergency

A

Appendicitis

94
Q

What’s the first sign and symptoms to a appendicitis

A

Vague epicanthic area

Can be described a cramping then overtime pain becomes more localised and moves to the right lower quadrant

95
Q

What are the signs and symptoms of appendicitis

A 
Flank tenderness 
Nausea and vomiting 
Diarrhoea 
Low grade fever (not above 39) 
Rebound tenderness
96
Q

What is rosving sign

A

When you palpate left lower quadrant and they feel pain in the right lower quadrant

97
Q

What are the atypical presentation of an appendicitis to consider

A

Appendic can move with pregnancy
Males can get testicular pain and urinary symptoms
Appendix may be in a different place due to developing differently

98
Q

What is a grumbling appendix

A

A chronic appendicitis and isn’t a surgical emergency

They are also different in pain, pain gradually increased and is not a sudden onset of pain. It’s mild and occurs gradually

99
Q

What organs are in the abdomen

A 
Stomach 
Liver 
Kidneys 
Pancreas’s 
Small and large bowl 
Appendix 
Gall bladder 
Spleen
100
Q

What are the three types of abdo pain

A

Visceral pain
Parietal / somatic pain
Referred pain

101
Q

What is visceral pain

A

A vague, centralising pain which can be caused by inflammation

102
Q

What is ingestion

A

The process of taking food or drink by swallowing or absorbing

103
Q

What is peristalsis

A

The involuntary constriction and relaxation of muscles in the intestine

104
Q

What is Digestion

A

Chemical and mechanical break down of food

105
Q

What is absorption

A

The process by which one thing absorbs/state of being engrossed

106
Q

What is Defecation

A

Discharge of feaces from the body

107
Q

How long is the oesophagus

A

25cm Long

108
Q

What part of the spine is the oesophagus parallel too

A

C6-t11 and passes through the diaphragm at t10

109
Q

Has 3 narrowing points

A

Aortic arch
Left main bronchus
Diaphragm

110
Q

What is Gastro-oesophageal reflux

A

Heart burn

111
Q

How does Gastro-oesophageal reflux happen

A
  1. Relaxed lower oesophageal sphincter
  2. gastric contents enter oesophagus
  3. Irritation of mucosal lining
112
Q

What can Gastro-oesophageal reflux lead too

A

Oesophagitis
Ulcerations
Barrett’s oesophagus

113
Q

What is a Weiss tear

A

Accounts for 3-15% of all patients GI bleeds

It’s a tear of a tissue(mucous membrane) or lower oesophagus which leads to bleeding

114
Q

Causes of a Weiss tear

A

Violent coughing, retching, vomiting or straining (common)
Healed hernia(rare)
Childbirth(rare)

115
Q

Signs and symptoms of a Weiss tear

A 
Vomiting of bright red or coffee ground blood 
Melena(stools with blood)
Dysphasia(painful swallowing)
Anemia 
Fatigue,dizziness,faintness 
Shortness of breath
Chest pain or abdo pain
116
Q

Diagnosis of a weiss tear

A

Signs and symptoms
Stool test
Upper GI endoscopy

117
Q

What is a Hiatus hernia

A

A small part of the stomach moves up from a small opening in the diaphragm into the chest

Estimated 1/3 of people over 50 have a Hiatus hernia

118
Q

Risk factors of a hiatus hernia

A 
Age related factors- changes in diaphragm 
Pregnancy 
Obesity 
Exercising and heavy weight lifting 
Persistent and intense pressure on surrounding muscles 
Coughing 
Vomiting 
Straining
119
Q

Types of hiatus hernia

A

Sliding hiatus hernia-moves up and down in and out of the chest
More then 80% of cases
Paracosophegeal hiatus hernia- oesophagus and stomach stay in the same location however part of the stomach pushes through the hole and ends up next to the oesophagus

120
Q

Signs and symptoms of hiatus hernia

A 
Heartburn 
Shortness of breath 
Regurgitation of food 
Burping and feeling bloated 
Feeling full when eating 
Nausea and vomiting 
Difficulty swallowing 
Vomiting blood 
Black stools
121
Q

Treatment for Hiatus hernias

A

Life style changes
Changing eating habits
Stop smoking
Keyhole surgery

122
Q

Diagnosis for hiatus hernia testing

A

X-ray and endoscopy

123
Q

What is Mechanical digestion

A

Churning movement

124
Q

What is Chemical digestion

A

Gastric juices

125
Q

What is absorption

A

Very little absorption takes place in the stomach

Coverts the bolis to a semi liquid mass called chyme

126
Q

What is the role of gastric mucosal barrier

A
  1. Luminal membrane impermeable to hydrochloric acid
  2. Tight junctions towards epithelial cells
  3. Mucas layer
127
Q

What is a peptic ulcer

A

Can occur in oesophagus,stomach or duodenum
Weakness in gastric mucosal barrier
Gastritis
Pepsin and hydrochloric acid erode the stomach wall
90% are caused by acid resistant bacterial

128
Q

What is Gastric mortality dysfunction

A

Paralysis of the stomach, fails to empty into the intestine

129
Q

Causes of gastric mortality dysfunction

A

Diabetes
Neurological disorders such as MS
Connective tissue disorder
Post surgical complications

130
Q

Signs and symptoms of gastric mortality dysfunction

A 
Stomach/abdo pain 
Bloating 
Heartburn 
Nausea and vomiting 
Malnutrition 
Weight loss
131
Q

Diagnosis of gastric mortality dysfunction

A

Gastric emptying study
Upper endoscopy
X-ray
Wireless motility capsules

132
Q

gastric mortality dysfunction treatments

A

Dietary changes
Medication to increase motility
Symptom management medications
Surgery’s

133
Q

How many lobes make up the Liver structure

A

Left lobe
Right lobe
Canidate lobe- behind right lobe
Quartlate lobe- behind left lobe

134
Q

What is the liver functional unit called

A

Lobule

135
Q

What does each hexagonal liver lobe contain in its structures

A

Hepatic artery branch
Hepatic portal vein branch
Bile duct branch

136
Q

What is the functions of the liver

A 
Breakdown of old erythrocytes 
Iron storage 
Protection of bile 
Removal of bacteria by kipffer cells 
Synthetics of clotting fibres 
Lipid metabolism 
Carbs storage 
Detoxification
137
Q

Blood supply to the liver

A

Blood enters through the hepatic vein(carry’s oxygen and supports liver growth)
Blood also enters through the portal vein( this carrier blood and nutrientes from the intestine and deliver them to the liver cells (hepatocytes) which performs specific liver functions

138
Q

How does blood leave the liver

A

The blood leaves through the hepatic vein, bile from the liver transferred to the gall bladder and duodenum through the bile duct

139
Q

What shape are the lobiles

A

Hexagonal

140
Q

What is Jaundice

A

Elevated levels of bilirubin in plasma

It is deposited in tissues causing discolouration

141
Q

Causes of jaundice

A

Pre hepatic
Hepatic
Post hepatic

142
Q

Hepatic jaundice

A

Due to liver tissue damage

Unable to deal with Normal levels of bilirubin

143
Q

Possible causes of jaundice

A

Viral hepatitis- mild/severe damage to hepatic cells
Toxic hepatis-abuse over exposure of drugs or Alcohol
Cirrhosis-permanent damage to liver cells which replaced by fibrosis tissues

144
Q

Gallstone process

A

Bile leaves the liver via the common hepatic duct which fuses with the cystic duct from the gallbladder
Secreted pancreatic enzymes into small intestine(amalyse,protease,liapase)

145
Q

What is Gastritis

A

Sudden inflammation of the stomach lining

146
Q

Pathphyisiology of gastritis

A

Disruption to protective mechanism of the stomach—>leads to epiphilium, cells in direct contact with substances i stomach eg acids—>inflammation occurs(attracting white blood cells)—>if damage is severe it can cause erosion damage—>permanent damage to protective mechanisms

147
Q

Causes of gastritis

A

Infection
Alcohol
Smoking
Food allergies

148
Q

Signs and symptoms of gastritis

A

Burning sensation
Epigastric pain
Nausea and vomiting
Bloating and bleaching

Complications: can lead to a GI bleed

Diagnosis:endoscope and stool samples

Applied pathophysiology (8 decks)

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