Gastrointestinal Disorders Flashcards
what is gastroesophageal reflux disease (GERD)? etiology? patho? CM?
-backflow of acidic gastric contents through lower esophageal sphincter (LES)
-15% people have heartburn and/or regurgitation at least once a week and 7% daily
-progression can lead to ulceration, fibrotic scarring, strictures, Barrett esophagus
Etiology:
Anything altering closure strength of LES or increasing abd. pressure
* High-fat diet
* Hiatal hernia
* Pregnancy
* Obesity
* Excess intake of caffeine
* Congenital defects
* Gastroparesis—delayed emptying
* Vomiting
* Coughing
* Lifting
* Bending
* Smoking
* Acidic foods
* Alcohol
* Intubation
Pathogenesis:
Pressure difference between the lower esophageal sphincter (LES) and the stomach is compromised. Normally, the LES acts like a valve, keeping stomach contents from flowing back up into the esophagus. However, if the LES weakens, either temporarily or for a prolonged period, it allows stomach acid to flow back into the esophagus, irritating its lining and causing inflammation. Epithelial cells are damaged and muscle layer of esophagus eroses.
CM:
* Belching (increased pressure in the stomach due to swallowed air or gas produced by the breakdown of food)
* Dyspepsia (discomfort or pain in the upper abdomen d/t acid)
* Sour taste in mouth (regurgitation of acid)
* Pain after eating (eating triggers acid production)
* Pain when lying down (gravity)
* Increased salivation
* Flatulence (from increased gas production)
* H/o high stress level (can exacerbate = more acid)
what is a hiatal hernia? etiology? CM?
Increased intra-abdominal pressure pushes portion of stomach through diaphragmatic opening into thorax.
Two types:
1. sliding (most common)
2. paraesophageal
Etiology:
increase intra-abdominal pressure
* Obesity
* Pregnancy
* Tight clothing
* Straining
* Coughing
* Abdominal surgery (support systems are weak)
* Aging (diaphragm weakens)
* Sudden physical exertion
CM:
* Heartburn (stomach acid refluxing into the esophagus)
* Chest pain (irritation and inflammation of the esophageal lining)
* Dysphagia (narrowing = difficulty swallowing)
* GERD (weakened LES)
what is gastritis? CM?
inflammation of stomach lining
1. acute: ingestion of irritating substances such as ETOH and ASA
2. chronic: thinning of the stomach lining and reduced production of stomach acid (HCl) and intrinsic factor, a substance needed for absorbing vitamin B12.
-often associated with the bacteria H. pylori
CM:
-anorexia (acid can cause discomfort)
-diarrhea
-vomiting
-abdominal pain
what is gastroenteritis? CM?
Inflammation of stomach & small intestine
- Usually result of another GI disorder
1. Acute: Direct infxn of tract by pathogenic virus or bacterial toxin
- May be caused by imbalance in normal bacterial flora by introduction of
unusual bacteria (travel)
2. Chronic due to GI disorder
CM:
-Diarrhea
-abdominal pain
-NV
-fever & malaise
what is peptic ulcer disease? etiology? patho? CM? major complications?
Disorders of upper GI tract caused by acid, results in ulcers esophagus, stomach, or duodenum
* Acute or chronic.
* Superficial or deep.
* 70% associated with NSAID use or H. pylori infection.
Etiology:
* Excessive stress (increases acid production)
* Helicobacter pylori (weakens protective mucous layer)
* Excessive use of NSAIDS (irritates lining)
* Trauma to lining
* Smoking (since it goes to GI)
* ETOH consumption
* Spicy foods
* Genetic
Patho:
1. Gastric: Breakdown of protective mucous layer causes diffusion of acids into gastric epithelia d/t chronic irritations: ASA, NSAIDs, ETOH & bile acids
2. Duodenal: Inappropriate excess secretion of acid
CM:
-fullness after eating
-NV
-bloating
-anorexia, weight gain/loss
-hematemesis (vomiting blood)
-melena (black stools)
Major complications: Perforation & bleed
1. Duodenal Ulcer: Epigastric burning pain 2-3hrs after meal. Relieved by further food ingestion or antacids.
2. Gastric Ulcer: Pain occurs on empty stomach but may present soon after a meal; food does not relieve the pain
what is Crohn’s disease? etiology? patho?
Chronic inflammatory disease of bowel. Affects proximal portion of colon or terminal ileum.
* Inflammation of all layers of intestinal wall
* Suggestive findings are ulcerations, strictures & fistulas
Etiology:
* infectious process
* allergy
* immune disorder
* dietary
* hormonal
* environmental factors
Patho:
* Long ulcers with areas of strictures may occur from mouth to anus.
* Lesions are local & involve all layers of intestinal wall.
* Some areas of bowel but not all (skip lesions)
* Cobblestone tissue appearance.
* Bowel wall congested, thickened; may develop abscesses, fistulas & scar tissue,
with resulting malabsorption.
CM:
* nausea
* vomiting
* flatulence
* malaise
* weight loss
* localized pain in RLQ
* intermittent 5-10 stools per day
* mucus/blood in stools
* fluid & electrolyte imbalance
* dehydration
* fever
* elevated WBC
* iron-deficiency anemia
* fistulas
* hypoalbuminemia
* urge to defecate at night
what is ulcerative colitis? patho? CM?
Chronic inflammatory disease of mucosa of rectum & colon
* Increased CA risk after 7-10yrs
* Exacerbations & remissions
Patho:
* Large ulcers form & erode mucosa of rectum & colon
* Abscesses form d/t inflammatory damage, coalesce & larger ulcers develop.
* Lesions have hemorrhages & abscesses.
* Bowel wall becomes fibrotic
CM:
* chronic, bloody diarrhea mixed with mucus
* fever
* wt loss
* Abd pain & cramping
* nausea & vomiting
* urge to defecate
* bloody diarrhea and lower abdominal cramps
what is enterocolitis? etiology? CM?
Acute inflammation & necrosis of small & large intestine
Etiology: Broad spectrum abx (Clostridium difficile)
Manifestations: Diarrhea, abd pain, fever, rectal bleeding, & perforation.
Necrotizing enterocolitis: In premature infants: Intestinal necrosis with sepsis, bowel ischemia manifested by abd distention
what is appendicitis? etiology? patho? CM?
Inflammation d/t obstruction by fecal matter.
* Common in young; 10-30 yrs.
* Males>females
Etiology: idiopathic
Patho:
-Occlusion leads to ischemia & hypoxic tissue with potential for developing Gangrene
CM:
* periumbilical/RLQ pain
* anorexia, nausea
* vomiting/diarrhea
* rebound tenderness
* fever
* malaise
* systemic signs of inflammation–elevated WBC
what is diverticulosis? CM?
- Inflamed or infected pouches that protrude from walls of colon
- Common >60yrs with a low fiber diet.
CM:
1. Diverticulosis: usually asymptomatic
2. Diverticulitis: fever, acute lower L sided abd pain, leukocytosis, constipation, rectal
what is irritable bowel syndrome?
- Chronic (>3mos) functional disorder with no identifiable pathology: alternating diarrhea & constipation/abd cramping.
- Etiology unclear but slow wave activity of bowel is increased
- Perceived abd distention, bloating, pain.
- Often associated with anxiety or depression
what is intestinal obstruction? CM?
Partial or complete block of small or large bowel: Intestinal contents unable to progress.
Fluid, gas, H20, & electrolytes accumulate in bowel.
Mechanical: d/t condition that decreases patency of the bowel: adhesions, hernia,
tumors, volvulus, intussusception
Functional: d/t neurogenic or muscular impairment hindering peristalsis
CM:
* Depend on site & duration
* Mechanical: increased BS initially, accompanied by abd pain, nausea & vomiting
* Functional: absence of BS
* Vomiting, dehydration
what is paralytic ileus?
- Pseudo obstruction—no blockage
- Occurs when peristalsis stops.
- May cause S/S of intestinal obstruction.
- Intestines cannot move food & fluid smoothly through digestive tract.
- Can effect any part of the GI tract.
- Risk factors include abdominal surgery, drugs, abdominal infection
what is intussusception? CM?
- Telescoping/invagination of portion of bowel into adjacent bowel causing intestinal obstruction
- Most often in infants: males>females
- Manifestations: increased BS, abd pain
what is volvulus?
- Sudden, tight twisting of bowel on itself causing obstruction & blood vessel compression
(ischemia/gangrene, necrosis & perforation). - D/t anomaly of rotation, ingested foreign body, or adhesion; cannot always be determined
