Gastrointestinal Disorders Flashcards
Dysphagia
difficulty swallowing
Achalasia
Spastic condition of the lower esophageal sphincter which can produce a functional partial dysfunction causing dysphagia and pain
Esophageal Diverticula
Out pouching of the wall of the esophagus. extremely rare
Esophageal Varices
occurs with hepatic (liver) failures like cirrhosis. These are similar to varicose veins in appearance (distended) except they appear in the esophagus.
What causes Esophageal Varices?
Portal Hypertension from liver disease (cirrhosis of the liver)
Why are esophageal varices especially dangerous if they rupture?
because these are caused by liver problems which means that the liver wont be able to produce vitamin K (which is a clotting factor) so an already bad situation is made worse because of the inability to clot efficiently
What is a Mallory Weiss Tear?
mucosal tearing/rupture/laceration that can be life threatening if it ruptures. Seen with bulimics because of the chronic irritation from stomach acid being in the esophagus
What dysfunctions are seen in the Esophagus?
Dysphagia Achalasia Diverticula Varices Lacerations - Mallory Weiss Tear Esophageal cancer
What is GERD?
aka: Acid Reflux
will cause mucosal damage either permanent if chronic or temporary damage GERD is not chronic
What concerns do we have for patients with GERD?
chronic irritation of the esophagus from HCl can lead to cell abnormalities in the esophageal lining (turn into stomach cells) which can lead to cancer
What can chronic GERD cause?
Scaring and narrowing of the esophagus which could lead to dysphagia. Also could eventually lead to Esophageal cancer
What is Adenocarcinoma?
- cancer
- found in the distal esophagus
- increased incidence associated with Barrett Esophagus
Squamous Cancer of the Esophagus
most are attributed to alcohol and tobacco use
Barrett Metaplasia
- painful
- can cause bleeding and narrowing b/c of fibrous scar (stricture)
- increased risk of esophageal adenocarcinoma
What are some common disorders of the Stomach?
Ulcer disease (gastric/duodenal)
Gastritis
Peptic Ulcer Disease (PUD)
Stomach Cancer
Gastric and Duodenal Ulcers
- “stress ulcers”
- Superficial ulcerations on gastric mucosal
- often associated w/ severe trauma, sepsis, major surgery, grave illnesses, alcohol abuse, extensive burns, CNS trauma/surgery, chronic exposure to NSAIDs or corticosteroids
- H. Pylori (bacteria) has been found to cause gastric ulcers
Acute Gastritis
-transient (comes and goes) inflammation of the gastric mucosa
- associated with local irritants
- bacterial endotoxins (bacteria poop)
- aspirin
- alcohol abuse
Chronic Gastritis
-chronic inflammatory changes leading to atrophy of the epithelium of the stomach
Causes
- unchecked H. Pylori
- Autoimmune gastritis
- Chemical gastropathy (NSAIDs etc.)
Why do we patients in the hospital H2 blockers or PPI like Pepcid and Prevacid even if they don’t have GERD?
because medications can irritate the stomach lining/esophagus and cause ulcerations/bleeding. By giving patients this we can prevent these from developing.
Peptic Ulcer Disease (PUD)
-Deep ulceration of the stomach wall, may burrow into/through the muscular wall
Associated with…
- atrophic gastritis,
- exposure to gastric juices
- H. Pylori infection
Helicobacter Pylori (H. Pylori)
Major cause of Ulcers
-damages stomach lining with toxins which leads to ulcers
-increased risk of gastric cancer
Stomach Cancer
- 2nd most common cancer world wide
- majority of the time occurs in the PYLORIC region
Symptoms are usually vague
- indigestion
- weight loss
- vague Epigastric pain
- vomiting
What are the top two causes of gastric irritation and ulcer formation?
#1 = H. Pylori #2= aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
What are manufacturers now doing to Aspirin?
-coating it so that it doesn’t begin to get broken down until it’s in the intestines. this decreased the side effects associated with aspirin to the intestinal lining. DO NOT CRUSH coated pills because then that defeats the purpose of the coating
T/F A peptic ulcer affects only a single layer of the stomach or duodenum.
False. could be superficial to deep and affect all the layers
What are the disorders of the small and large intestines?
Irritable Bowel Syndrome
Inflammatory Bowel Disease (Crohn’s & UC)
Infectious Enterocolitis
Diverticular disease
IBS (Irritable Bowel Syndrome)
- symptom based diagnosis
- no known cause
S/S
- chronic pain/discomfort
- Bleeding
- altered bowel habits
No Cure - Treatment includes:
- dietary change
- medications
- psychiatric interventions
What are two theories of the cause of IBS even though there is no definite cause?
- most common theory is that there is a linkage between the brain (emotions, psychological) and the GI tract
- another is abnormality of the flora in the intestines that allows for inflammation/infection
What is the hallmark of IBS?
patient stating that their abdominal pain is relieved with defecation
How do you tell the difference between if a Gastric Bleed is coming from the Upper GI or the Lower GI?
Upper GI will present with black, tarry stools (blood goes through digestion process)
Lower GI will present with bright red blood in the stools
Crohn’s Disease
- Granulomatous type of inflammatory response that can affect any area of the GI tract from the mouth to the anus
- progressive disabling disease
- granulomatous lesions that are surrounded by normal appearing mucosal tissue
Ulcerative Colitis
- nonspecific inflammatory condition of the colon
- confined to the rectum and colon
- characterized by lesions (polyps) that form in the base of the mucosal layer
- lesions may become necrotic and ulcerate
- colon only involvement and associated with carcinoma of the colon
What are some local complications of Ulcerative Colitis?
- mostly concerned with perforation
- toxic megacolon
- colonic carcinoma
- hemorrhage
What are some systemic complications of Ulcerative Colitis?
- Uveitis (eyes)
- spinal arthritis
- sclerosing cholangitis
- malnutrition
- erythema nodosum (red spots on skin)
- arthritis
- pyoderma gangenosum
Which inflammatory bowel disease can involve the whole GI tract?
Crohn’s
Which inflammatory bowel disease only involves the colon and rectum/anus?
Ulcerative Colitis
Which inflammatory bowel disease has areas of normal bowel (inflammation is skipped)?
Crohn’s
Which inflammatory bowel disease does not have areas of normal bowel?
ulcerative colitis is continuous
Which inflammatory bowel disease is characterized by pseudopolyps?
Ulcerative colitis
which inflammatory bowel disease is characterized by granulomatous inflammation?
crohn’s
Which type of inflammatory bowel disease is characterized by deep transmural inflammation of the intestinal wall?
crohn’s
Which type of inflammatory bowel disease is characterized by superficial mucosa inflammation?
ulcerative colitis
_______ is a common characteristic of both ulcerative colitis and Crohn’s disease?
Diarrhea (frequent BM) - can cause decrease in electrolytes, water and nutrients which can result in dehydration, fatigue, headache and bleeding
Bacterial Enterocolitis
-caused by bacteria invasion of intestines / contaminated food or drink
Why don’t we give medication to bacterial Enterocolitis patients to stop their diarrhea/frequency of BM?
because we want the bacteria to be flushed out
What is the difference between inflammatory diarrhea and non inflammatory diarrhea?
inflammatory diarrhea comes from an infection. non inflammatory diarrhea does not
Rotavirus
- viral infection that causes Enterocolitis
- most common cause worldwide of acute enterocolitis
Clostridium Difficile Colitis
- pseudomembranous colitis with colonic overgrowth of C. Diff
- often resistant to treatments
- presents with unique smelling frothy diarrhea
- highly contagious
E. Coli infection
- an enterohemorrhagic strain of the bacterium Escherichia Coli
- cause of illness through food ingestion
- infection may lead to hemorrhagic diarrhea and to kidney failure
- transmission : fecal to oral route
Colonic Diverticulosis
-area of the intestinal wall that is thin and has outpouched. composed of mucosa and submucosa only. no muscle is present
What is a problem that Colonic Diverticulosis can cause?
food particles get stuck in pouches and can lead to ulcerations which can become inflamed and bleed and erode
What is the difference between diverticulosis and diverticulitis?
diverticulosis - just the pouches
diverticulitis - inflammation, infection of the diverticula
Chronic diverticulosis is uncommon with a diet rich in…
fiber
Diverticulosis is often seen in those who have diets consisting of…
low fiber, high fat
diverticulosis is the hallmark of a low fiber diet
A patient with diverticulitis will express pain where?
LLQ
Neoplastic Polyps (adenomas)
colon cancer comes from these polyps. screening can prevent death from colon cancer. These polyps grow extremely slow.
What is the treatment for colon cancer?
-surgical removal of the infected colon piece
Do S/S show up early in colon cancer?
NO! they don’t show up until the cancer is very advanced
Does polyp removal during a colonoscopy hurt?
no b/c 1. there is not a lot of nerves in the colon and 2. they give you medicine to knock you out
