Gastrointestinal Disorders- Notes from Slideshow (Quiz 4) PART 2 Flashcards
Impermeable epithelial cell surface
Gastric Mucosal Barrier
Function of the Gastric Mucosal Barrier
Mechanisms for selective transport of hydrogen & bicarbonate ions
What protects the gastric mucosa?
Mucus
What types of mucus are there?
- water insoluble
- water soluble
Thin, stable gel that adheres to gastric mucosal surface
water insoluble mucus
What is the function of water insoluble mucus?
protection from proteolytic (protein-digesting) pepsin
How does insoluble mucus protect from pepsin?
- Forms unstirred layer
- traps bicarbonate
- forms an alkaline interface b/w luminal contents of stomach & its mucosal surface
Where does water soluble mucous come from
washed from mucosal surface
What makes up water soluble mucous?
luminal contents
What is the function of water soluble mucous?
prevents mechanical damage to mucosal surface
How does water soluble mucous prevent damage?
- viscid nature
- lubricant
Major causes of Gastric Irritation & Ulcer Formation
- NSAIDS/asparin
- H. Pilori
How do NSAIDS/asparin cause gastric iratation and ulcers?
- Irritate gastric mucosa
- inhibit prostaglandin synthesis
What do prostaglandins produce?
Hcl
How does H. Pylori cause gastric irritation and ulcers?
- Thrives in acidic environment of stomach
- Disrupts mucosal barrier that protects stomach from harmful effects of its digestive enzymes
Pathophysiology of H. Pylori in stomach
- Low Hcl lowers pH
- Mucin forms gel
- Mucin transitions from gal to solid
- H. Pylori can then swim freely through mucus
- Attaches to epithelia cells
Types of Gastritis
- Acute
- Chronic
Transient inflammation of gastric mucosa
Acute gastritis
What causes Acute gastritis?
Local irritants such as
- bacterial endotoxins
- alcohol
- aspirin
Absence of grossly visible erosions & presence of chronic inflammatory changes
Chronic Gastritis
Complication of Chronic Gastritis
atrophy of glandular epithelium of stomach
Types of Chronic Gastritis
- H. pylori
- Autoimmune
- Multifocal atrophic
- Chemical gastropathy
Symptoms of Chronic Gastritis
- abdominal pain with gnawing sensation
- pain often made worse w empty stomach
- night time pain
- poor apatite
- weight loss
- heart burn
- dyspepsia
- belching
- N&V
- blood in stool
What is dyspepsia
indigestion
Disorders of the small and large intestine
- Irritable Bowel Syndrome
- Inflammatory Bowel Disease
- Crohn’s & UC
- Appendicitis
- Infectious Enterocolitis
- Viral, Bacterial, Protozoan
- Diverticular Disease
- Intestinal Motility
- Malabsorption Syndrome
- Celiac Disease (Celiac Sprue)
- Adenomatous Polyps
Normal anatomy of the large intestine- be able to identify location
- Appendix
- cecum
- where small intestine attaches
- taenia
- hepatic flexure
- diverticula
- splenic flexure
- haustra
- ascending colon
- transverse colon
- descending colon
- sigmoid colon
Intestinal disorder causing functional issues but no structure abnormality defined by symptoms.
IBS
Cause of IBS
- isn’t well understood
- can be caused by abnormal contractions in muscular layer of bowel
How is diagnosis of IBS made?
based on symptoms
Symptoms of IBS
- Abdominal pain (persistent, intermittent, cramps)
- Altered bowel function
- Flatulence
- Bloating
- Nausea
- Anorexia
- Constipation
- Diarrhea
- Mucus in stool
- Anxiety/Depression
How common is IBS?
1 in 5
Are male or females more likely to get IBS? How much more likely?
- women
- 2-3 times more likely
Treatment for IBS
- Medications
- Diet
- Exercise
- Psychotherapy
- Stress release
What medications are used to treat IBS?
- laxatives
- antispasmodics
- tricyclic antidepressants
- serotonin antagonists
- serotonin agonists
What can be used in the diet to improve IBS?
prune juice
Are irritable bowel syndrome and inflammatory bowel disease the same thing?
No
Major types of inflammatory bowel disease
- Ulcerative Colitis (UC)
- Crohn disease (CD)
What is the major difference between UC and CD?
UC- colonic mucosa only
CD- any segment of the GI (mouth to the anus)
Defining characteristics of CD
- skip lesions
- transmural
UC vs CD: location
UC: begins in rectum and continues continuously toward cecum
CD: most common in terminal ileum w/ patches through all layers of bowel
UC vs CD: etiology
UC: unknown
CD: unknown
UC vs CD: peak age
UC: 15-25 and 55-65
CD: 15-40
UC vs CD: number of stools
UC: 10-20
CD: 5-6
UC vs CD: consistency of stool
UC: liquid
CD: loose
UC vs CD: blood in stool
UC: yes
CD: no
UC vs CD: complications
UC: hemorrhage
CD: fistula
UC vs CD: nutritional deficiency
UC: yes
CD: yes
UC vs CD: surgery
UC: infrequent
CD: frequent
An inflammation of the digestive tract, involving enteritis of the small intestine and colitis of the colon.
Infectious Enterocolitis
How is Infectious Enterocolitis classified?
By type of organism causing the infection
What are the different types of Infectious Enterocolitis?
- Viral
- Bacterial
- Protozoan
Which virus often causes Infectious Enterocolitis?
Rotavirus
Which bacteria often causes Infectious Enterocolitis?
- C-diff
- E. Coli
Characteristics of C-diff colitis
- infectious diarrhea
- pseudomembranous colitis
Pathophysiology of C-diff colitis
- toxin-induced cytokines
- cause inflammatory response
Symptoms of C-diff
- fever
- increase WBCs
- bandemia
- abdominal pain
- can have diarrhea but not always
How high are WBCs in C-diff colitis?
often as high as 50,000 or more
Too many white blood cells being released by bone marrow into the bloodstream
bandemia
What causes C-diff colitis?
- The elimination of normal flora
- Allowing C-diff to grow
What often causes the elimination of normal flora that causes C-diff colitis?
Antibiotics
How long after antibiotic therapy does it take for C-diff colitis to occur?
Up to 8 weeks after therapy
Number one risk factor for C-diff colitis
ANTIBIOTICS
Which antibiotics most commonly cause C-diff colitis?
- penicillin
- clindamycin
- cephalosporins
Other risk factors for C-diff colitis
- prolonged hospital stay
- infected roommate
- repeated enemas
- prolonged NG tube
- GI tract surgery
Why is the C-diff colitis WBC count significant?
Most infectious/inflammatory conditions do not typically elevate WBCs over 25,000
Symptoms of Rotavirus
- severe watery diarrhea
- vomiting
- fever
- abdominal pain
Transmission of Rotavirus
- fecal-oral route
- enters mouth by feces contaminated hands, surfaces or objects
Complications of Rotavirus
can become severely dehydrated and die
Who gets rotavirus?
Most common in infants and children
When are infants and children most likely to get Rotavirus?
6-24 mo
Is Rotavirus still relevant today?
Yes, it is still a significant cause of death
How many are hospitalized by Rotavirus worldwide?
2 million
How can Rotavirus be prevented?
Rotavirus vaccine by mouth
A condition in which small, bulging pouches develop in the digestive tract.
Diverticular Disease
Types of Diverticular Disease
- Diverticul(OSIS)
- Diverticul(ITIS)
What is the difference between diverticulosis and diverticulitis?
diverticulosis-small, bulging pouches (diverticula) develop in the digestive tract
diverticulitis-when one or more of these pouches become inflamed or infected
Symptoms of Diverticular Disease
- Pain LLQ
- N&V
- tenderness in LLQ
- Slight fever
- Elevated WBCs
When appendix becomes inflamed, swollen, & gangrenous, and can eventually perforate if not treated
Appendicitis
What causes Appendicitis
- intraluminal obstruction with a fecalith
- gallstones
- tumors
- parasites
- lymphatic tissue
hard piece of stool
fecalith
Symptoms of Appendicitis
- loss of appetite
- flatulence
- fever
- pain in rectum
- RLQ pain
- diarrhea
- constipation
- bloating
- N&V
Types of Intestinal Obstruction
- Mechanical
2. Paralytic/adynamic
absence of force
adynamic
Difference between mechanical and paralytic/adynamic intestinal obstruction
- Mechanical: result from post-op cause (ex: external hernia, postop adhesions)
- Paralytic/adynamic: results from neurogenic or muscular impairment of peristalsis
Symptoms of Intestinal Obstruction
- fecal smelling/malodorous vomit
- abdominal distention
- constipation w/ failure to pass flatus
Complications of intestinal obstruction r/t vomiting
- hypovolemia
- loss of of electrolytes
Bowel sounds with intestinal obstruction
increased to silent:
-high pitched at fist then they go silent
Inflammation of the membrane lining the abdominal wall and covering the abdominal organs.
peritonitis
Severity of peritonitis
Severe and often life threatening
Cause of peritonitis
Usually caused by bacterial infection via
- blood
- after rupture of an abdominal organ
In what situation would an abdominal organ rupture causing peritonitis
- perforated peptic ulcer
- ruptured appendix
- perforated diverticulum
- gangrenous bowel
- pelvic inflammatory disease
- abdominal trauma/wounds
What surface is inflamed in peritonitis
serosal surfaces
Characteristics of peritonitis
Throughout abdomen
- fecal matter
- purulent material
Pathophysiology of peritonitis
- rapid absorption of bacterial toxins
- causes spreading of contaminants
- causes inflammatory response
Autoimmune disorder that can occur in genetically predisposed people where ingestion of gluten leads to damage in small intestine
Celiac Disease
What is another name for Celiac Disease
Celiac Sprue
How common is Celiac Disease worldwide?
1 in 100
How many Americans go undiagnosed with Celiac Disease?
2.5 mil
Why is it bad to go undiagnosed for Celiac Disease?
risk for long-term health complications
Pathophysiology of Celiac Disease
- ingestion of gluten
- immune response that attacks small intestines’
gluten
protein found in
- wheat
- rye
- barley
Complications of autoimmune response in Celiac Disease
- damage/atrophy of the villi
- nutrients cannot be absorbed properly
Who gets Celiac Disease?
-hereditary
Risk factor for Celiac Disease if in family
-Pts with first degree relative have a 1 in 10 risk
first degree relative
family member who shares about 50 percent of their genes with a particular individual in a family
Who do we share about 50 percent of out genes with?
- parents
- offspring
- siblings
Symptoms of Colon Cancer
Change in BM habits:
- diarrhea
- constipation
- stool consistency change
Bleeding:
- rectal bleeding
- blood in the stool
Persistent abdominal discomfort:
- cramps
- gas
- pain
- Feeling of bowel not emptying completely
- Weakness/fatigue
- Weight loss
How long does diarrhea or constipation or a change in the consistency of the stool last to be considered for colon cancer?
> 4 weeks
Characteristics of Symptoms of colon cancer
- many have no symptoms with early stages
- when symptoms appear, they vary (depending on the cancer size & location)
