Gastrointestinal Disease Flashcards
Gastroesophageal Reflux Disease
inflammation of the esophagus due to backflow of stomach acids and other stomach content (pepsin and bile). most likely caused by intermittien relaxation of lower esphageal sphincter
- Symptoms
- heartburn
- reflux
- p! swallowing
- bitter taste in mouth
- chest pain *differentiate from MI*
- Complications:
- aspiration pneumonia
- esophagitis
- asthma
- Barrett’s Esophagus (cancer)
- Treatment
- antacids Mylanta, Maalox, Tums, Rolaids
- H2 receptor blockers, Tagamet, Zantac, Pepcid reduce acid production
- proton pump inhibitors: prilosec, prevacid, nexium
- PT
- avoid high caloric foods prior to exercise
- modification of positioning
- heads up = reduces abdominal pressure
- left side lying = prevents regurgitation and aspiration
Gastritis
inflammation of the lining of the stomach limited to the mucosa, classified as acute or chronic. Develops in association with serious illnessor various medications such as aspirin or other NSAIDs (> 3mo)
- Etiology
- acute gastritis associated with stress
- chronic gastritis H. pylori
- Symptoms
- epigastric pain w/ abdominal distention
- loss of appetite
- Nausea
- Treatment
- avoid irritating substances
- caffiene, nicotine, alcohol
- avoid irritating substances
Peptic Ulcer Disease
loss of the lining of the lower esophagus, stomach, and duodenum, most likely caused by infection w/ H. Pylori or chronic use of NSAIDs, causing stomach ulcers. Can be life threatening if ulcer perforates the stomach
- symptoms
- epigastric pain “heartburn”
- burning
- gnawing
- cramping
- back pain (comes in waves)
- presence of food increases pain (stomach)
- inbetween meals in creased pain (duodenum)
- Treatment
- antibiotics for tx of H. Pylori and acid suppressing drugs
- Complications
- hemorrhage and perforation (bright red or coffee ground vomitus)
- dark tarry stools (melena)
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Malabsorption Syndrome
a complex of disorders characterized by problems in intenstinal absorption of nutrients.
Short gut syndrome, crohn’s dx, chronic pancreatitis and pernicious anemia
- Symptoms
- anorexia
- weight loss
- abdominal bloating
- pain and cramps
- indigestion
- steatorrhea
- chronic explosive diarrhea
Inflammatory Bowel Disease
2 related chronic inflammatory intestinal disorders Crohn’s Dx (skip pattern) and Ulcerative Colitis (20+ stools/day) - both result in inflammation of the bowel and are characterized by remissions and exacerbations
- symptoms
- abdominal pain (R lower quad)
- frequent attacks of diarrhea
- fecal urgency
- weight loss
- relief of p! after passing BM
Irritable Bowel Syndrome
abnormally increased motility of the small and large intestines. Associated with emotional stress and certain foods (high fat content, roughage or lactose intolerance)
- Symptoms
- persistent or recurrent abdominal pain that is relieved by defecation
- constipation
- diarrhea
- bloating
- abdominal cramps/pain (L lower quad)
- flatulence
- nausea and anorexia
- Treatment
- stress reduction
- medications to reduce anxiety
- regular physical activity
Diverticular Disease
characterized by pouch like herniations of the mucosal layer of the colon through the muscularis layer - especially sigmoid.
- symptoms
- miniman, rectal bleeding
- lack of dietary fiber
- diverticulitis
- pain and cramping in lower left quadrant
- nausea vommiting
- elevated WBC
- COmplications
- bowel obstruction
- perforation with peritonitis and hemorrhage
- Exercise is important part of treatment
Appendicitis
inflammation of the veriform appendix. as the condition progresses, the appendix becomes swollen, gangrenous, and perforated. perforation can be life threatening and lead to peritonitis
- symptoms
- pain abrupt at onset
- localized to the epigastric or periumbulical
- rebound tenderness (Blumberg’s sign)
- point tenderness at McBurney’s point
- elevations in WBC > 20k = surgery
Peritonitis
inflammation of the peritoneum, the serous membrane lining the walls of the abdominal cavity
results from bacterial invasion and infection: E. Coli, Bacteroides, Fusobacterium and strep
- symptoms
- abdominal distention
- severe abdominal pain
- rigidity from reflex guarding
- rebound tenderness
- decreased or absend bowel sounds
- nausea
- vommiting
- tachycardia
- elevated WBC, fever, electrolyte imbalance and hypotension are common
- Complications
- can lead to toxemia and shock
- circulatory failure
- respiratory distress
- Treatment
- controlling inflammation/infection
- restoring fluids/electrolytes
- maybe surgery
Hemorrhoids (piles)
varicosities in the lower rectum or anus cause by congestion of the veins in the hemorrhoidal plexus. Internal or external
- Symptoms
- local irritation
- pain
- rectal itching
- prolong bleeding = anemia
- increased risk w/ pregnancy
- Treatment
- topical medications to shrink the hemorrhoid
- dietary changes
- sitz baths
- local cold/hot compresses
- litigation or surgical excision
GI Pain Pattern Referrals AKA Red Flags
- Visceral p! from esophagus = midback
- Midthoracic spine pain (nerve root p!) = esophageal pain
- Visceral p! from liver, diaphragm, or pericardium = shoulder pain
- Visceral p! from gall bladder, stomach, pancreas or small intestine = midback and scapular regions
- Visceral p! from colon, appendix, or pelvic viscera = pelvis, low back or sacrum
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Red Flags: GERD
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- Atypical pain may present as head and neck pain
- Chest pain sometimes mistaken for MI
- Respiratory symptoms can occur including
- Wheezing
- Chronic cough (microaspiration)
- Laryngeal injury
- Vagul mediated bronchospasm
- Hoarsness 2ndary to inflammation of vocal chords
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Red Flags: Gastritis
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Patients taking NSAIDs for a long time should be monitored carefully for stomach pain, bleeding and N/V
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Red Flags: Peptic Ulcer Disease
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- Stress and anxiety may increased gastric secretions and pain
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Red Flags: Malabsorption Syndromes
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- Easy bruising and bleeding due to lack of vitamin K
- Muscle weakness and fatigue due to lack of protein, iron, folic acid, and vitamin B
- Bone loss, pain and predisposition to develop fractures from lack of calcium, phosphate and vitamin D
- Neuropathy including tetany, parasthesias, numbness, and tingling from lack of calcium, vit B, vit D, magnesium and potassium
- Muscle spasms from electrolyte imbalance and lack of calcium
- Peripheral edema
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