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NS374—Pathophysiology > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

gastroparesis

A

delayed gastric emptying w/o mechanical gastric outlet obstruction

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2
Q

melena

A

dark tarry stools

upper GI bleed

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3
Q

hematochezia

A

frank blood in stool

lower GI bleed

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4
Q

Worldwide, 2nd preventable leading cause of death in children <5

A

diarrhea

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5
Q

acute vs persistent diarrhea

A

acute <14 days

persistent >14 days

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6
Q

large volume diarrhea

A

excessive water/secretions

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7
Q

small volume diarrhea

A

excessive intestinal motility

frequent BMs throughout day

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8
Q

4 major mechanisms of diarrhea

A
  • Osmotic - extra solutes in LI pull water in - lactose intolerance
  • Secretory - electrolytes w/i stool pull water in - cholera; gastroenteritis
  • Motility - hypermotility - SI (extra solutes pull water in) or LI (water not absorbed)
  • Inflammatory - dysentery; IBD
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9
Q

secondary condition constipation caused by…

A

diet (↓ fiber, ↓ water)

meds (opioids)

disorders

aging (↓ peristalsis)

decreased mobility

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10
Q

5 malapsorption problems/disorders/diseases

A

bariatric surgery

increased motility

enzyme deficiencies

lactose intolerance

celiac disease

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11
Q

CELIAC DISEASE

etiology

explanation

s/s

tx

A
  • Genetic, autoimmune
  • Gluten ingestion damages villi in SI - ↓ surface area for absorption
  • s/s - malabsorption; diarrhea; steatorrhea; growth problems in children; cramping precipitated by eating gluten
  • Tx - avoid gluten (wheat)
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12
Q

GASTRITIS

explanation

etiology (acute vs chronic)

s/s

A
  • Inflammation of stomach lining
  • Acute - caused by injury to protective mucosal barrier
  • Chronic - H. pylori
  • s/s - n/v; indigestion; heartburn; fullness feeling; belching; localized epigastric pain; possibly referred pain to shoulder, abd that worsens with swallowing (how it can be differentiated from cardiac pain)
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13
Q

2 types of chronic gastritis

A
  • Fundal gastritis - Type A, immune
  • Antral gastritis - Type B, nonimmune
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14
Q

causes referred pain to shoulder, abdomen that worsens with swallowing

A

gastritis

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15
Q

GASTROENTERITIS

explanation

r/f

s/s

A
  • Inflammation of stomach & intestines - results from viral or bacterial infection
  • “Stomach flu”
  • r/f - unclean water
  • s/s - watery diarrhea; n/v; stomach pain; cramping; fever; h/a
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16
Q

OROPHARYNGEAL CANCER

etiology

r/f

s/s

A
  • Etiology - HPV (most common); tobacco
  • r/f - white; middle age; male; tobacco use; HPV
  • s/s - painless lesions on floor of mouth, side of tongue
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17
Q

painless lesions on floor of mouth, side of tongue

A

oropharyngeal cancer

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18
Q

GERD

explanation

etiology

r/f

s/s

complications

dx test

A
  • Reflux of acid, pepsin into esophagus causing esophagitis - dysfunction of lower esophageal sphincter (LES) - resting tone of LES lower than normal
  • Etiology - conditions that ↑ abd pressure; delayed gastric emptying
  • r/f - obesity; pregnancy (↑ pressure OR ↑ progesterone in 1st tri); ascites; gastroparesis; hiatal hernia; connective tissue disorders
  • s/s - heartburn; acid regurgitation; belching; dysphagia; chronic cough; asthma attacks; laryngitis; upper abd pain w/i 1 hr of eating
    • Resp sx caused by inhalation of acid when it gets high enough
  • Complications - chronic esophagitis; Barrett’s esophagus (precancer); esophageal cancer (metaplasia caused by acid)
  • Test - endoscopy
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19
Q

upper abd pain w/i 1 hr of eating

A

GERD

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20
Q

HIATAL HERNIA

explanation

etiology

r/f

s/s

complication

dx tests

A
  • Upper part of stomach herniates through opening in diaphragm, entering thoracic cavity
  • Etiology - consistent, intense pressure on surrounding muscles; congenital (large diaphragm hole)
  • r/f - congenital; obesity; pregnancy; chronic cough
  • s/s - asymptomatic; GERD; intense pain with strangulation; constant epigastric/chest pressure
  • Complication - strangulation - ischemia, necrosis
  • Tests - radiology; endoscopy
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21
Q

constant epigastric/chest pressure

A

hiatal hernia

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22
Q

PYLORIC STENOSIS

explanation

r/f

s/s

complication

A
  • Enlarged pylorus blocks chyme from entering SI - multifactorial genetic condition
  • r/f - firstborn; males; first 6 months of life
  • s/s - projectile vomiting followed by hunger; FTT (failure to thrive); change in bowel patterns; dehydration; jaundice (not enough feces created to get bilirubin out of body)
  • Complications - inability to grow/gain wt
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23
Q

projectile vomiting followed by hunger in infants

A

pyloric stenosis

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24
Q

PEPTIC ULCER DISEASE

etiology

A
  • Etiology - H. pylori - fecal oral, mouth to mouth - requires several medications for extended periods
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25
Q

DUODENAL ULCERS

etiology

s/s

tx

A
  • Most common
  • Etiology - H. pylori; hypersecretion of stomach acid & pepsin; use of NSAIDs (especially aspirin)
  • s/s - intermittent epigastric pain, rapidly relieved by foods or antacids (“feed an ulcer” - pyloric sphincer closes, less acid in duodenum); melena
  • Tx - relieving hyperacidity; preventing complications
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26
Q

GASTRIC ULCERS

location

etiology

s/s

complication

A
  • Antral region, adjacent to acid-secreting mucosa
  • Etiology - ↑ mucosal permeability to H+ (gastric secretion is normal or less than normal)
  • Pain is worsened by eating
  • Complication - perforation through stomach wall & infection, acid w/i peritoneum
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27
Q

2 types of inflammatory bowel disease

A

Crohn’s disease

ulcerative colitis

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28
Q

ULCERATIVE COLITIS

explanation

r/f

s/s

complications

A
  • Long-lasting inflammation & ulcers in colon
  • Continuous superficial lesions beginning at rectum - extent up through colon varies
  • r/f - family hx; teens or twenties; white
  • s/s - very bloody diarrhea; abd pain; rectal bleeding; wt loss; fatigue
  • Complications - severe bleeding; diarrhea; perforated bowel; dehydration; liver disease; osteoporosis; colon cancer (especially with 7-8yr hx of UC); scarring (shortens and narrows colon)
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29
Q

CROHN’S DISEASE

explanation

r/f

s/s

complications

A
  • Idiopathic inflammatory disorder
  • Affects any part of GI tract, from mouth to anus
  • r/f - family hx; NSAID use; teens or twenties; white
  • s/s - bloody diarrhea, melena (depends on location of lesions); “skipping” lesions; lesions on only one side of intestinal wall; penetration through tract wall (more likely than in UC)
  • Compilations - anemia; fissures that extend into lymphatics; ↑ risk of infection
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30
Q

continuous GI lesions beginning at anus

A

UC

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31
Q

skipping GI lesions anywhere along tract

A

Crohn’s

32
Q

IRRITABLE BOWEL SYNDROME

explanation

2 types

r/f

s/s

complications

dx tests

tx

A
  • Idiopathic common disorder of LI - no obvious structutal problem
    • IBS-D - diarrhea problems
    • IBS-C - constipation problems
  • r/f - current smoking; frequent alcohol; younger age; psych & physical stress
  • s/s - varied; abd pain; gas; mucus in stool; bowel sounds; sx relieved with defecation
  • Associated with anxiety, depression, reduced quality of life
  • Tests - must rule out everything else first
  • Tx - no cure; individualized
33
Q

GI disease causing anxiety, depression, quality of life problems

A

IBS

34
Q

DIVERTICULITIS

explanation

what is a diverticula?

what is diverticulosis?

r/f

s/s

complications

A
  • Inflamed diverticula - something gets stuck in diverticula
  • Diverticula - herniations of mucosa through muscle layers of colon wall - especially in sigmoid
  • Diverticulosis - asymptomatic diverticular disease
  • r/f - aging; obesity; smoking; standard American diet; meds that slow motility
  • s/s - vague pain; n/v; LLQ tenderness; constipation; very rigid stomach with peritonitis
  • Complications - abscess; fistula; obstruction (can lead to death due to colon rupture); impaction; bleeding; perforation (can lead to peritonitis)
35
Q

vague LLQ tenderness

A

diverticulitis

36
Q

APPENDICITIS

explanation

etiology

r/f

s/s

what if severe pain is suddenly relieved?

complications

dx tests

A
  • Inflammation of vermiform appendix
  • Etiology - obstruction; foreign bodies; infection
  • r/f - family hx; younger age; male
  • s/s - vague periumbilical pain; migrates to RLQ pain; McBurney’s point between umbilicus and top of hip; fever; n/v
    • If severe pain is suddenly relieved, this indicates the appendix has ruptured
  • Complications - peritonitis; sepsis
  • Tests - rebound (McBurney’s); left side referred rebound (Rovsing’s sign); psoas; obturator signs; CT; barium enema
37
Q

RLQ pain; rebound tenderness

A

appendicitis

38
Q

MESENTERIC VASCULAR INSUFFICIENCY

explanation

complication

etiology

s/s

A
  • Obstruction of vascular supply to intestines (not duodenum; separate supply)
    • Dead bowel impairs functioning of peristalsis, causing problems for the rest of the bowel
  • Etiology - thrombus; embolus
  • s/s - usually upper abd pain
39
Q

what is cirrhosis?

A

final pathological result of various chronic liver disease - normal hepatocytes replaced with nonfunctional scar tissue

40
Q

5 stages of liver damage

A
  1. Healthy liver
  2. Hepatic steatosis
  3. Steatohepatitis
  4. Liver fibrosis
  5. Liver cirrhosis
41
Q

etiology of cirrhosis

A
  • Chemicals
    • Alcohol - converted to acetaldehyde causing hepatocellular damage
    • Non-alcoholic fatty liver disease
    • Medications (acetaminophen; halothane; tetracycline…)
  • Infection with hepatitis
  • Toxic metals
    • Excessive iron in liver - hemochromatosis
    • Copper hepatotoxicosis (Wilson’s disease)
  • Autoimmune
42
Q

complications of cirrhosis

A

esophageal varices

hepatic encephalopathy

hepatocarcinoma

kidney failure

43
Q

ESOPHAGEAL VARICES

explanation

etiology

r/f

s/s

A
  • Enlarged veins in esophagus
  • Caused by obstructed blood flow through hepatic portal vein
  • r/f - portal HTN; alcohol; cirrhosis; infection; excessive vomiting
  • s/s - vomiting large amts of blood; black/tarry stools; lightheadedness; loss of consciousness
44
Q

HEPATIC ENCEPHALOPATHY

onset

explanation

s/s

associated with…

A
  • Onset - rapid during fulminant hepatitis, OR slowly during course of liver disease
  • Neurpsychiatric toxicity & encephalopathy r/t liver’s inability to detoxify ammonia - unmetabolized ammonia accumulates
  • s/s - subtle personality changes; memory loss; irritability; disinhibition; lethargy; sleep disturbances; confusion; disorientation; tremors; bradykinesia; stupor; convulsion; coma
  • Associated with hepatitis & Reye’s syndrome
45
Q

neuro sx of cirrhosis

A

hepatic encephalopathy → peripheral neuropathy; asterixis (liver stops turning ammonia into urea, ammonia accumulates)

46
Q

CV sx of cirrhosis

A

ascites, peripheral edema (portal vein HTN)

47
Q

GI sx of cirrhosis

A

anorexia

dyspepsia

n/v

change in bowel habits

dull abd pain

fetor hepaticus (liver can no longer remove toxins)

esophageal, umbilical vein, and hemorrhoidal varices leading to bleeding, which may lead to death (portal vein HTN)

hematemesis (esophageal varices)

congestive gastritis

48
Q

integ sx of cirrhosis

A

intrahepatic jaundice (buildup of bilirubin, byproduct of hemolysis)

palmar erythema, spider angiomas (↑ estrogen)

purpura, petechiae (liver cannot build clotting factors)

caput medusae (umbilical varices)

49
Q

3 types of jaundice

A

Prehepatic (excessive hemolysis)

intrahepatic (hepatocyte dysfunction)

posthepatic (obstruction of biliary drainage)

50
Q

JAUNDICE

r/f

s/s

A
  • r/f - liver inflammation; inflammation or destruction of bile duct; hemolytic anemia
  • s/s - yellowing of skin and sclera; pale skin; dark urine; fatigue; abd pain; n/v; wt loss
51
Q

hematologic sx of cirrhosis

A

anemia, thrombocytopenia, leukopenia, coagulation disorders (liver cannot supply vitamins, minerals to create blood components)

hepatosplenomegaly developing prior to ascites (portal vein HTN)

52
Q

metabolic cirrhosis sx

A

hypokalemia

hyponatremia

hypoalbuminemia

53
Q

reproductive sx of cirrhosis

A

amenorrhea (females)

testicular atrophy, gynecomastia, impotence (males)

(↑ estrogen, liver can no longer break it down)

54
Q

HAV

source, route

duration

prevention

A
  • Fecal source; fecal-oral route
  • Acute
  • Prevented by pre/post exposure immunization; early vaccination
55
Q

HBV

source, route

duration

complication

prevention

significance

A
  • Blood & blood-based bodily fluid derived; percutaneous and permucosal route
    • More sexually transmitted
  • Chronic & acute forms
    • Chronic form related to hepatocarcinoma in adults & children
  • Prevented by pre/post exposure immunization; newborn vaccination, 3-shot series
  • Leading cause of liver disease worldwide
56
Q

HCV

source, route

duration

complication

prevention

significance

A
  • Blood & blood-based bodily fluid derived; percutaneous and permucosal route
    • More transmission by shared needles, tattoos
  • Chronic & acute forms
    • Pts with mild cases may not realize they have it
    • May manifest as GI illness
    • Chronic form related to hepatocarcinoma
  • Prevented by behavior modification; blood donor screening; no vaccine
  • Leading cause of liver disease in US
57
Q

HDV

source, route

duration

prevention

A
  • Blood & blood-based bodily fluid derived; percutaneous and permucosal route
    • Only possible to get Hep D if you are infected with Hep B
  • Chronic
  • Prevented by pre/post exposure immunization; behavior modification
58
Q

HEV

source, route

duration

prevention

significance

A
  • Fecal source; fecal-oral route
  • Acute
  • Prevented with clean drinking water
  • More common in other areas of the world than Hep A
59
Q

causative agents of hepatitis other than the hepatitis viruses

A
  • Canine adenovirus type 1
  • Helicobacter
  • Herpesvirus
  • Leptospirosis (Leptospira)
60
Q

PHYSIOLOGIC/INFANT JAUNDICE

explanation

etiology

A
  • Lack of maturity of bilirubin uptake and conjugation in babies
  • Etiology - ↑ breakdown of fetal erythrocytes; low hepatic excretory capacity
61
Q

CHOLECYSTITIS

explanation

what is cholelithiasis? caused by?

etiology

s/s

r/f

dx test

A
  • Inflammation of gallbladder
  • Cholelithiasis - gallstone formation - ↑ elevated cholesterol or bilirubin in the bile
  • Etiology - gallstone lodged in cystic duct; bile duct problems; tumors; serious illness; certain infections
  • s/s - RUQ pain; radiation to rt shoulder; fever; leukocytosis; intolerance of fatty food
  • r/f - obesity; middle age; female; American Indian ancestry; gallbladder disease
  • Murphy’s sign - patient takes deep breath in, then you push on the RUQ to elicit pain
62
Q

RUQ pain that radiates to the right shoulder

A

cholelithiasis

63
Q

PANCREATITIS

explanation

duration

etiology

s/s

r/f

A
  • Inflammation of pancreas as a result of autodigestion due to obstruction of outflow of pancreatic digestive enzymes
  • Acute or chronic
    • Acute pancreatitis ↑ risk for chronic
  • Etiology - gallstones; alcohol; hypertriglyceridemia (>500); infections; medications
  • s/s - severe, visceral, gnawing pain in back/epigastric area (pancreas sits further back in abd cavity) - pain is better if pt sits up & leans forward
  • r/f - excessive alcohol; smoking; obesity; family hx
64
Q

epigastric/back pain that is relieved when the patient sits up/leans forward

A

pancreatitis

65
Q

ILEUS

explanation

r/f

s/s

tx

A
  • Peristalsis stops in one region of bowel
  • r/f - anesthesia; open abd surgery
  • s/s - watery stools; hypoactive bowel sounds in one region; abd distension; pain at site of obstruction
  • Tx - none; just wait until peristalsis begins again
66
Q

OBESITY

dx criteria

associated with…

etiology

tx

A
  • ↑ body fat mass; BMI >30
  • Associated with higher mortality, disease development, hospital costs
  • Etiology - caloric intake > caloric expenditure; genetic variations; other causes (peripheral & central pathways; cytokines; hormones; neurotransmitters)
  • Tx - bariatric surgery most effective for ↓ morbidity, especially for pts with comorbidities
67
Q

fat localized around abd, upper body

less healthy, risk for heart disease

A

visceral obesity/central adiposity

68
Q

fat is extraperitoneal, distributed around thighs and buttocks

lower risk

A

peripheral obesity

69
Q

someone with a normal BMI with >30% body fat

A

normal weight obesity

70
Q

high BMI, but no associated complications

↓ risk for mortality & morbidity

A

metabolically healthy obesity

71
Q

ESOPHAGEAL CANCER

prevalence

r/f

s/s

prognosis

A
  • 4.7 cases/100,000
  • r/f - chronic alcohol use; tobacco; hot & irritant drinks; food containing nitrosamines (beer, bacon, cured meat); achalasia (LES fails to open during swallowing); Barrett’s esophagus
  • s/s - wt loss; chest pain; dysphagia; feeling like food is getting stuck
  • Often leads to metastasis - poor prognosis
72
Q

STOMACH CANCER

prevalence

r/f

s/s

A
  • 6.6-20 cases/100,000
  • r/f - atrophic gastritis; male; H. pylori; smoking; diet; genetic disorders
  • s/s - chronic n/v; gastritis; family hx; anorexia; heartburn; wt loss; bloating; pain
73
Q

COLON CANCER

prevalence

r/f

s/s

significance

prevention

A
  • 38.6 cases/100,000
  • r/f - older age; IBD; family hx; obesity; smoking; DM; alcohol; diet
  • s/s - change of bowel habits; rectal bleeding; abd pain; wt loss; fatigue
  • After lung cancer, kills more people in US than any other
  • At age 50, recommend all men & women have colonoscopies
74
Q

RECTAL CANCER

etiology

s/s

A
  • Mostly caused by HPV
  • Not necessary to have receptive anal intercourse - HPV can migrate from genitals
  • s/s - rectal bleeding, especially painless; pencil stools
75
Q

LIVER CANCER

prevalence

r/f

s/s

A
  • 5.1-14.3 cases/100,000
  • r/f - HBV (children) or HCV; alcohol; DM; genetics; fatty liver disease
  • s/s - wt loss; abd pain; n/v; fatigue; jaundice; white chalky stools
76
Q

GALLBLADDER CANCER

prevalence

r/f

s/s

A
  • 0.8-1.4 cases/100,000
  • r/f - gallstones; female; older age
  • s/s - wt loss; fever; abd pain; jaundice; n/v
77
Q

PANCREATIC CANCER

prevalence

r/f

s/s

prognosis

A
  • 4-5.5 cases/100,000
  • r/f - smoking; DM; obesity; pancreatitis; older age; family hx
  • s/s - vague abd/back pain; jaundice; light colored stool; dark urine; DM; wt loss; blood clots; fatigue
  • Very poor prognosis - often advanced at diagnosis

NS374—Pathophysiology (18 decks)

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