Gastrointestinal Module #3 Flashcards
What is pyloric obstruction?
Narrowing of the pylorus (junction between stomach and duodenum)
What are the 2 forms of pyloric obstructive?
Acquired
Congenital
What is infantile hypertrophic pyloric stenosis (IHPS)?
Congenital narrowing of pylorus
What are the signs and symptoms of infantile hypertrophic pyloric stenosis?
Infant @ 2-3 weeks begins to vomit for no apparent reason
**projectile vomitting –> several feet
What happens to the sphyncter that makes it stenotic in infantile hypertrophic pyloric stenosis?
Hypertrophy
What is the treatment for infantile hypertrophic pyloric stenosis?
Surgery: Pyloromyotomy
What causes adult/acquired pyloric obstruction?
Severe peptic ulcer or tumor in pyloric area
What are the signs/symptoms of adult/acquired pyloric obstruction?
Vague symptoms:
epigastric discomfort/fullness w/ eating –> progresses to severe (gastric distention, nausea, –> vomitting and acute distress)
What is the treatment of adult/acquired pyloric obstruction?
Address the cause of the obstruction
What are the different mechanical obstructions?
Adhesions
Herniation
Intussusception
Volvulus (torsion)
Tumor Growth
What are intestinal adhesions?
Fibrous “scar tissue” adheres to intestinal loops
What causes intestinal adhesions?
Usually common complication of abdominal surgeries
What is an intestinal herniation?
Intestine protrudes through abdominal wall
may strangulate through opening
What is intestinal intussusception?
Telescoping of one part of an intestine on another portion
What is the most common area to have intestinal intussusception?
Ileocecal area
Who is most likely to have an intestinal intussusception?
Young kids
What is intestinal volvulus (torsion)?
Intestine twist upon itself
Messentary twists around strangulating the blood supply to the intestine
Who do you usually see with intestinal volvulus (torsion)?
Elderly
What is the most common cause of large intestine obstruction?
Colon/rectal cancer
What is a paralytic ileus?
Obstruction that results when peristalsis stops –> functional/physiological obstruction
What causes paralytic ileus?
Certain drugs –> narcotic pain drugs or high BP meds
What is hirschsprung’s disease (congenital aganglionic megacolon)?
Birth defect in which ganglion (nerve) cells of the colon (large intestine) fails to develop
How common is hirschsprung’s disease?
1:5,000 newborns
25% of all infant obstructions
Does hirschsprung’s disease affect males or females more?
Males
What will biopsy show in hirschsprung’s disease?
Absent Meissener’s (submucosal)
Absent Auerbach’s (myenteric) plexus
etc.
What does hirschsprung’s disease result in functionally?
Impaired motility of colon d/t poor coordination/ability to contract intestinal musculature
Impacted/trapped Stools
Infection
Inflammation
Constipation
What are the 2 categories of Hirschsprung’s disease?
Short segment
Long segment
What regions of the colon are affected in short segment hirschsprung’s disease?
Rectosigmoid colon
What regions of the colon are affected in long segment Hirschsprung’s disease?
Rectosigmoid colon and regions proximal to it
**severe cases can involve entire colon
Which type of Hirschsprung’s is the more mild type?
Short segment
What is the treatment for Hirschsprung’s disease?
Decompress the colon (serial rectal irrigation)
Surgical removal of involved intestinal segment
Mild to moderate cases (short-segment) = myotomy or resection
Severe cases (enterocolitis) = temporary or permanent colostomy
What is Inflammatory Bowl Disease (IBD)?
Chronic autoimmune inflammatory dz that damages/ulcerates GI tract
What are the 2 forms of Inflammatory Bowl Disease?
Crohn’s Disease
Ulcerative Cholitis
Where does Crohn’s disease common occur?
End of ileum (small intestine)
Cecum of large intestine
What does stress do to people with Crohn’s disease?
Exacerbate symptoms
**NOT A CAUSE OF CHRON’S!
In Crohn’s are women or men affected more?
Women
**usually family Hx (2-4x higher risk w/ first degree relative)
Which layers of the intestinal wall are affected in Crohn’s disease?
All layers
**chronic granulomatous inflammation
What is a granuloma?
Cluaster of cells that form in area of inflammation
What are skip lesions?
2+ inflamed areas w/ healthy bowel in between
What is the pharmaceutical treatment for Crohn’s Disease?
**Depends on severity
Anti–inflammatory drugs:
Salicylate (5-ASA) –> mild to
moderate
Corticosteroids –> mod. to severe
Infliximab
Immune Suppressors –> mod. to severe
Antibiotics –> fistulas and other infectous complications
What are the indications for surgergy to treat Crohn’s disease?
Not responding to meds
To correct complications from dz
- obstruction
- perforation
- abscess
What are the surgical procedures done for Crohn’s disease?
Intestinal Resection –> small portion of the intestine is removed
Stricturoplasty –> done for chronic narrowing of intestine
Colostomy/ileostomy
What are the complications of intestinal resection?
Adhesions/scarring –> create obstructions
What is ulcerative cholitis?
Chronic inflammatory disease that affects the large intestine
Which areas of the intestines are usually affected in ulcerative cholitis?
ALWAYS involves rectum
Extends proximally to contiguous sections of the colon
Which layers of the intestine are affected w/ ulcerative cholitis?
Mucosa only (doesn’t penetrate deeper lyaers)
What are the regional patterns of the large intestine seen with ulcerative colitis?
Ulcerative proctitis
Ulcerative proctosigmoiditis
Ulcerative pancolitis
What are the Surgical procedures done for ulcerative cholitis?
Total colectomy and ileorectal anastamosis
Total proctocolectomy (Brooke ileostomy)
Ileal pouch anal anastomosis
Describe the total colectomy and ileorectal anastamosis procedure
Colon removed except last 5 in from rectum
Small intestine/ileum is surgically joined to upper rectum
**pt has normal bowel function after procedure
Describe the total proctocolectomy (Brooke ileostomy) procedure
Entire colorectal mucosa is excised
New rectum is made from small intestine and attached to anal canal
May have to make a stoma (opening to poop) until new rectum has healed
What is diverticulosis?
Out pockets in the intestinal wall
**85% = asymptomatic
15% develop colicky symptoms
Where is diverticulosis commonly found?
Sigmoid colon
What happens to cause diverticulosis?
Vessel penetrates through weak colonic muscle wall
What is the treatment for diverticulosis?
High fiber diet
Avoid high residue foods (seeds, nuts, corn)
What is diverticulitis?
Inflammation of diverticuli (colonic diverticula)
Which area of the intestines is most often involved w/ diverticulitis?
Sigmoid colon
What happens with diverticulitis?
Impacted w/ fecal material (fecalith)
Colon perforations d/t inflammation
What is simple diverticulitis?
Inflammation is contained in the intestinal wall
What is complicated diverticulitis?
Inflammation penetrates into peritoneal space
What do most colorectal cancers develop from?
Adenomatous polyp
**initial mutant cancer cell develops in polyp
How fast does the cancer grow on the polyp and where does it grow towards?
Slow growth down stalk towards deeper layers of mucosa
What happens is colorectal cancer penetrates into the submucosa?
Reach lymphatic/BV pathways and become highly malignant
What is critical for the prevention of colorectal cancer?
Screening
Removal of polyps
Which age population are the @ higher risk factors for colorectal cancer?
> 50 yo
Which past medical history puts you at greater risk of colorectal cancer?
IBD
Adenomatous polyps > 5 mm
Gall bladder surgery (cholecystectomy)
Pelvic irradiation
Which family history puts you at greater risk of colorectal cancer?
first degree relative w/ colorectal cancer
What lifestyle risks are associated w/ colorectal cancer?
Tobacco abuse
Obesity (BMI > 35 - 40)
What is the screening tool of choice for colorectal cancer?
Colonoscopy
How often should average risk patients > 50 yo be screened for colorectal cancer?
Colonoscopy every 10 yrs
Digital rectal exam and fecal occult blood every year
**higher risk pts should be screened more frequently
What are the different types of hepatitis?
A
B
C
D
E
G
What is the pathophys of hepatitis?
Hepatic cell death/scarring
Kupffer cell hyperplasia
Inflammation may disrupt canaliculi
Which types of viral hepatitis has more severe hepatic cell damage?
B
C
What is fulminating hepatitis?
Rare complication in which massive hepatic cell death and liver failure occur
**rapid/severe onset
What is cirrhosis?
Irreversible inflammatory condition –> hepatic cell death causes diffuse scarring of the liver
What is the general pathophysiology of cirrhosis?
Hepatic tissue becomes nodular/fibrotic
Size of liver may expand or shrink
What is the initial phase of alcoholic cirrhosis?
Fatty accumulation develops w/ in hepatocytes
What is produced by the metabolism of alcohol which disrupts hepatocyte function/metabolism?
Acetaldehyde
What does the damage from the acetaldehyde do in the liver?
Initiates inflammatory response/necrosis
Promotes excessive collagen synthesis and fibrotic accumulation/scarring
What does the fibrosis eventually do in the liver during cirrhosis?
Alter biliary and vascular drainage
Liver function declines
Portal HTN
GI Bleeding
Varicose Veins
Ascities
Hepatomegaly
Spleenomegaly
What is primary biliary cirrhosis?
Autoimmune disease that attacks small intrahepatic bile ducts (canaliculi)
What is secondary biliary cirrhosis?
Develops as result of chronic obstruction of biliary flow –> inflammation –> fibrotic changes
