Gastrointestinal System Disorders Flashcards
Beginning and ending of GI tract = ?
GI System Disorders
GI Tract:
- Is a long tube, beginning at esophagus and ending at rectum.
(a) Upper GI includes = ?
(b) Middle GI includes = ?
(c) Lower GI includes = ?
(stomach, jejunum, cecum…etc.)
GI System Disorders
Accessory GI organs include = ?
GI System Disorders
Accessory organs:
- Salivary glands
- Liver
- Pancreas
Function of GI wall structure = ?
GI System Disorders
GI Wall Structure:
- Digestion
- Absorption.
Layers of GI Wall Structure:
- Mucosa = ?
- Submucosa = ?
- Muscularis = ?
- Serosa = ?
GI System Disorders
Layers of GI Wall Structure:
(a) Mucosa:
- Made of epithelium
- Secrete mucus, enzymes, and hormones, absorption.
- Think
- Inflammatory Bowel Disease (IBD) = Crohn’s disease, ulcerative colitis
- Peptic Ulcer Disease: Ulceration of the mucosal lining, often caused by prolonged NSAID use.
(b) Submucosa:
- Thin connective tissue layer that has nerves, glands and blood vessels.
- Think =
- Gastroesophageal Reflux Disease (GERD), Submucosal inflammation due to chronic exposure to gastric acid reflux.
- Irritable Bowel Syndrome (IBS): Submucosal alterations and neuroimmune dysregulation
(c) Muscularis:
- Smooth muscle cells- facilitate the movement of contents of GI tract
- Think =
- Gastric Motility Disorders (gastroparesis)
- Intestinal Obstruction: Impaired muscularis function
(c) Serosa:
- Serous membrane
- Consist of simple squamous epithelium and connective tissue (also known as visceral peritoneum).
- Think =
- Diverticulitis: Inflammation and infection involving the serosa layer.
- Peritonitis: Infection or inflammation of the serosal membrane covering the abdominal cavity.
Signs and symptoms of GI diseases = ?
GI System Disorders
- Nausea
- Vomiting
- Diarrhea
- Anorexia
- Abdominal pain
- Referred pain
- Arthralgia (joint stiffness)
- Dysphagia (difficulty swallowing)
- Weight loss
- GI bleed
Heart burn - Epigastric pain
- Felt in midline below sternum
- Cause: acidic contents of stomach move backward into esophagus
Fecal incontinence (inability to control bowel movements):
- Psychological cause
- Neuro sensory motor impairment (stroke, SCI)
- Anal distortion - secondary to traumatic childbirth, sexual assaults
GI Bleed:
- Coffee ground emesis (coffee or dark brown vomitus, granular material, resemblescoffee ground)
- Hematemesis (bright red blood)
- Melena (black tarry sticky stools)
- Hematochezia (maroon coloredstools).
Signs and symptoms of GI dieases:
- Constipation = ?
- Neurogenic = ?
- Metabolic and/or Endocrine = ?
- Mechanical = ?
- Drugs = ?
GI System Disorders
Signs and Symptoms of GI diseases - Constipation:
- Pressure on sacral nerves from stored fecal content (aching in sacrum, buttocks andthighs).
- Acute / chronic diseases of GI
Neurogenic:
- MS
- Parkinson’s
- SCI
Metabolic / Endocrine Defects:
- Hyperparathyroidism
- Hypothyroidism
- Severe malnutrition.
Mechanical:
- Bowel obstruction, cancer, diverticulitis, pregnancy,pelvic floor andanal sphincter dysfunction (analsphincter contracts instead of relaxing)
- Dehydration, prolonged bed rest, emotional stress
- People with mechanical low back pain can develop constipationbecause ofmuscleguarding and splinting- reduced bowel motility
Drugs and diet:
- Anesthetic agents, antacids, antidepressants, antipsychotics, antihistamine, cancer chemotherapy, iron compounds, narcotics, lack of dietary fiber.
GERD = ?
GI System Disorders
Gastroesophageal reflux disease (GERD):
- GERD can lead to mucosal damage.
- Backward flow of stomach contents and acids like pepsin/bile into the esophagus or beyond like larynx, a phenomenon called acid reflux.
- Normally high pressure zone exist around the gastroesophageal sphincter, which permits passage of food and liquids and prevents reflux.
- Reduction in pressure of LES (lower esophageal sphincter) or increased gastric pressure or gastric contents can lead to esophageal reflux.
- GER that occurs more than 2 times/ week for a few weeks can lead to GERD.
- HCL / gastric/ duodenal contents containing bile acid and pancreatic juice come in contact with walls of esophagus.
- Reflux esophagitis (most common type of esophagitis), defined as inflammation of esophagus.
- Mucosal ulcerations - that may bleed
Granulation / healing- scarring- esophageal strictures.
Narrow the esophagus making swallowing difficult.
Complications:
- Vocal cord inflammation, asthma, esophageal cancer
Causes GERD = ?
GI System Disorders
(a) Decreased pressure of lower esophageal sphincter
- Chocolate, fatty foods, citrus products, coffee, alcohol, carbonated drinks, cigarette smoking
- Medications like morphine, calcium channel blockers, tricyclic antidepressants, estrogen therapy
- Pregnancy, last semester: increased progesterone relaxes the sphincter
(b) Increased gastric pressure
- Pregnancy: increased gastric pressure
- Obesity
- Tight clothing: spandex
(c) Gastric contents near junction
- Recumbency
- Increased intra-abdominal pressure
Clinical manifestations of GERD = ?
GI System Disorders
Clinical manifestations - GERD:
- Heart burn: Burning sensation in the retrosternal area (Often at night)
- Pain: located in the epigastric area / retrosternal area, may radiate to neck, jaw, back.
Notes:
- Occurs 30-60 minutes after a meal
- Sour taste - acid regurgitation (perception of flow of refluxed gastric contents into the mouth)
- Made worse by bending at waist and recumbancy, relieved by sitting upright
- Severe reflux; reaches pharynx and mouth
- Laryngitis and morning hoarseness
- Cough
- Asthma
- Pulmonary aspiration in neurologically impaired
- Recurrent pulmonary aspiration- aspiration pneumonia.
Clinical manifestations of GERD:
- Complications = ?
GI System Disorders
Complications:
(a) Barret’s esophagus:
- Metaplasia: squamous lining of lower esophagus to columnar epithelium
- Can become cancerous
(b) Cause:
- Cycle of mucosal damage that leads to erosion, edema, scar tissue.
- Dysphagia (edema, spasm and scars)
- Painful swallowing
How to diagnose GERD = ?
GI System Disorders
diagnose GERD:
(a) History
(b) Esophagoscopy:
- Allows visualization of lumen of upper GI tract.
- Permits performance of biopsy.
(c) pH monitoring
GERD Management:
- Drugs = ?
- Lifestyle modifications = ?
GI System Disorders
Drugs:
- Proton pump inhibitors: cut acid production (E.g. Prilosec).
- Histamine 2 receptor blocker: reduces acid production (E.g. Zantac)
- Antacids: neutralize and reduce stomach acid (E.g. Tums)
- Prolonged use cause body’s phosphate levels to reduce.
Lifestyle modifications / PT:
- Avoid food that reduce the lower esophageal sphincter tone: caffeine, nicotine, NSAIDS, chocolate, fried and fatty foods.
- Acidic foods like orange juice, wine, tomatoes may irritate the inflamed esophagus.
- Avoid alcohol and smoking
- Keeping food diary: identify triggers
- Remaining upright after meals for several hours, avoiding large meals near bedtime.
- Elevation of head of bed at least 6 inches to reduce nocturnal reflex.
- Excess abdominal fat puts pressure on stomach - weight loss.
Inflammation of vermiform appendix= ?
GI System Disorders
Appendicitis:
- Inflammation of vermiform appendix.
- Occurs in adolescents and young adults.
- Cause blockage, infections
- Appendix becomes obstructed, inflamed and infected, rupture may occur leading to peritonitis, medical emergency
- Peritonitis (membrane lining the cavity of the abdomen and covering the abdominal organs)
- Pain (begins in umbilical region and localizes to right lower quadrant), nausea, vomiting, low grade fever
- Pain could be referred to thigh
- Pain in groin/ testicular area in young males
- Pain comes in waves, becomes steady, aggravated by movement causing client to bend over or draw the legs up to relieve abdominal muscle tension.
Appendicitis:
- Rebound tenderness = ?
- Rovsing’s sign = ?
GI System Disorders
Appendicitis:
Rebound Tenderness:
- Press your fingers gently and deeply over right lower quadrant for 14-30 secs, palpating hand is then quickly removed.
- Pain is induced by quick withdrawal,pain from rapid movement of inflamed peritoneum, pain on the side of inflammation.
Rovsing’s sign:
- Palpation of left lower quadrant of abdomen increases pain felt in the right lower quadrant.
McBurney’s Point = ?
GI System Disorders
Appendicitis - McBurney’s Point:
- Inflammation of peritoneum in acute appendicitis or from other inflammatory infectious causes.
- Client in fully supine position
- Palpate ASIS and umbilicus, tenderness on palpation halfway between the umbilicus and ASIS.
- Can be very painful when positive, so do pinch an inch test first
Pinch an Inch Test = ?
GI System Disorders
Appendicitis - Pinch an Inch Test:
- To avoid the discomfort of the classic rebound tenderness test, the pinch-an-inch test is recommended to assess for appendicitis or generalized peritonitis.
(B) Test:
- To perform the test, a fold of abdominal skin over McBurney’s point is gently grasped and elevated away from the peritoneum.
- The skin is then allowed to recoil back against the peritoneum quickly.
- If the individual has increased pain when the skin fold strikes the peritoneum (upon release of the skin), the test is positive for possible peritonitis.
Psoas Sign = ?
GI System Disorders
Psoas Sign:
- Performed when abdominal pain is possible cause of hip or thigh pain, when abscess forms on the iliopsoas muscle from an inflamed / perforated appendix, inflamed peritonitis, osteomyelitis of ileum / vertebrae or septic arthritis of SI joint, direct extension of intra-abdominal infections like diverticulitis, Crohn’s disease, kidney infection.
- Fever, lower abdominal, pelvic and back pain, or referred pain to hip, medial thigh and groin
- Antalgic gait - functional hip contracture
- Pain with hip extension
- Tender mass can be palpated in the groin.
- In the supine position, have the client activelyperform a straight leg raise; apply resistance to the right distal thigh as the clienttries to hold the leg up or side lying and right hip extension.
- Increased abdominal,flank, or pelvic pain constitutes a positive sign,suggesting irritation of the psoas muscle, inflamed appendix orperitoneum.
Inflammatory bowel disease
GI System Disorders
Inflammatory bowel disease:
- Refers to chronic inflammatory condition, commonly in large and small intestine, can occur anywhere along the GI tract from mouth to anus.
Most common forms include
- Crohn’s disease
- Ulcerative colitis
Peak incidence:
- 15-35 years
Over 1 million in US
No proven cause
Genetic suggested
Etiology and Pathogenesis - Inflammatory Bowel Disease:
- Genetic susceptibility = ?
- Environmental triggers= ?
- Systemic manifestations = ?
GI System Disorders
(a) Unregulated and exaggerated immune response.
(b) Genetic susceptibility
- First degree relatives of people diagnosed have 30-100 times greater incidence
- Largest genetic association study employed genetic wide association data for over 75000 people with IBD- 163 susceptible loci for IBD
(c) Environmental trigger
- Smoking- 2-fold risk
(d) Systemic manifestations:
- Arthritis in spine and sacroiliac joints inflammatory conditions of eye, skin lesions, autoimmune anemia
Crohn’s disease = ?
GI System Disorders
Crohn’s disease:
- Chronic, recurrent lifelong disorder, characterized by granulomatous inflammatory process.
- Can be found anywhere along the GI tract, but small intestine and ascending colon are more commonly affected.
- Characterized by diseased area of intestine with normal intestine in-between (skip lesions).
- Periods of exacerbation and remission.
- Common in 20’s and 30’s , slightly more common in women.
Crohn’s Disease:
- Layer most affected = ?
- Damage to villi = ?
GI System Disorders
Crohn’s Disease:
- All the layers are involved, submucosal layer is affected the most
- Inflammation - granuloma inflammation
- Edema / fissures - cobblestone appearance
- Fibrosis, bowel obstruction - life threating emergency
- Ulcerations - deep - penetrate through layers and form fistula, base of fistula can have abscess.
- Damage to villi = impairs absorptive capacity, malnutrition.
Fever with acute inflammation, diarrhea, abdominal pain, weight loss, fluid and electrolyte disorders are signs and symptoms of = ?
GI System Disorders
Crohn’s Disease:
- Periods of exacerbation and remission, symptoms related to location of lesion.
- Fever with acute inflammation, diarrhea, abdominal pain, weight loss, fluid and electrolyte disorders.
- Terminal Ilium:Pain in the periumbilical region with possible referred pain to the corresponding segment of the low back pain.
- Nutritional deficiencies- in childhood- retardation of growth
Complications:
- Fistula formation, abdominal abscess.
- This condition comes and goes with the disease process and may precede repeat episodes of bowel symptoms by 1-2 weeks.
- Anti-inflammatory& Nutritious diet(avoid fat).
Ulcerative Colitis = ?
GI System Disorders
Ulcerative Colitis:
- Chronic inflammatory disorder of mucosa primarily and submucosa of the rectum/colon.
- Confined large intestine: rectum and colon; begins in rectum and spreads proximally.
- No skip lesions
- 15-25 years of age
- Mucosa bleeds, erythema, can form abscess.
- Inflammation causes pseudo polyps.
- Cells atrophy
- Metaplasia: High risk of colorectal cancer.
Ulcerative Colitis:
- Clinical manifestations= ?
GI System Disorders
Ulcerative Colitis - Clinical manifestations:
- Diarrhea
- Rectal bleeding
- Nausea
- Vomiting
- Anorexia
- Weight loss
- Fever
Rare:
- Anemia
- Clubbing of fingers
- Extra-intestinal manifestations
(a) Diarrhea:
- <4 to 10 or more stools/ day
- Persist for days, weeks or months and then subside to reoccur later
(b) Rectal bleeding: stool contain blood
Pathophysiology:
- Crohn’s and Ulcerative Colitis
GI System Disorders
Crohn’s Disease:
- Location = Small intenstine and ascending colon.
- Pattern = Skip lesions
- Depth = Primarily submucosal
- Diarrhea = Watery
- Abdominal pain = Yes
- Bowel obstruction = Comon
- Cancer risk = Increased
Ulcerative Colitis:
- Location = Descending colon
- Pattern = Continuous
- Depth = Primarily mucosal
- Diarrhea = Bloody
- Abdominal pain = Yes
- Bowel obstruction = Uncommon
- Cancer risk = Higher risk than with Crohn’s
Diverticulosis = ?
GI System Disorders
Diverticulosis:
- Diverticulum: Outpouching in the wall of the colon, without inflammation.
- Develops at the site of weakness in the intestinal wall.
- More than one diverticulum is called diverticula.
- Presence of diverticula is called diverticulosis.
Diverticulitis = ?
GI System Disorders
- When food particle/ feces become trapped, pockets become inflamed.
- Pain and tenderness in the lower left quadrant (sigmoid colon), accompanied by nausea and vomiting, slight fever and elevated WBC’s.
Complications:
- Herniation
- Perforation
- Hemorrhage
- Inflammation.
- The presence of diverticula is known as diverticulosis.
- When one or more of the pouches become inflamed, and in some cases infected, that condition is known as diverticulitis.
Diverticular disease:
- Etiology & risk factors
GI System Disorders
Diverticular Disease - Etiology & Risk factors:
- Primary risk factor, low fiber diet which decreases stool bulk - predisposing to constipation.
- Chronic constipation
- Atrophy/weak bowel muscle
- Obesity
- Weak pelvic floor muscles (constipation)
- Inherited defect in the muscular wall of intestine
- NSAIDS, acetaminophen - associated with diverticular disease
Diverticular disease:
- Treatment
GI System Disorders
Diverticular disease - Treatment:
- Immediate: control of infection, resting of bowel, prevention of complications
- Acute dietary management: clear liquid diet for 2- 3 days until symptoms resolve
Diet and lifestyle to prevent constipation
- Diet high in fiber and low in fat
- Avoidance of foods like banana and rice
- Fluid intake, 2 L/day
- Daily exercise
Pharmacotherapy:
- Anti-biotic & anti-inflammatory
Surgical:
- Surgery for perforations
- Bowel resections or removal of portion of large intestines.
- Colostomy: establishment of an artificial opening of the large intestine externally on the abdomen until the colon is healed)
Diverticular Disease - Primary pain:
Pain at #1 = ?
GI System Disorders
(1)
- Stomach
- Duodenum
Diverticular Disease - Primary pain:
Pain at #2 = ?
GI System Disorders
(2)
- Liver
- Gallbladder
- Common bile duct
Diverticular Disease - Primary pain:
Pain at #3 = ?
GI System Disorders
(3) Small intestine
Diverticular Disease - Primary pain:
Pain at #4 = ?
GI System Disorders
(4) Appendix
Diverticular Disease - Primary pain:
Pain at #5 = ?
GI System Disorders
(5) Esophagus
Diverticular Disease - Primary pain:
Pain at #6 = ?
GI System Disorders
(6) Pancreas
Diverticular Disease - Primary pain:
Pain at #7 = ?
GI System Disorders
(7)
- Large intestine
- Colon
Referred Pain
Pain at #1 = ?
GI System Disorders
(1)
- Liver
- Gallbladder
- Common bile duct
Referred Pain
Pain at #2 = ?
GI System Disorders
(2) Appendix
Referred Pain
Pain at #3 = ?
GI System Disorders
(3) Pancreas
- The exocrine pancreas produces enzymes that help to digest food, particularly protein.
- The endocrine pancreas makes the hormone insulin, which helps to control blood sugar levels.
Referred Pain
Pain at #4 = ?
GI System Disorders
(4) Pancreas
Referred Pain
Pain at #5 = ?
GI System Disorders
(5) Small intestine
Referred Pain
Pain at #6 = ?
GI System Disorders
(6) Colon
Referred Pain
Pain at #7 = ?
GI System Disorders
(7) Esophagus
Referred Pain
Pain at #8 = ?
GI System Disorders
(8)
(a) Stomach
- Primary function is to break down food both mechanically (through muscular contractions) and chemically (through the action of gastric juices), turning it into a semi-liquid substance known as chyme.
(b) Duodenum
- First part of the small intestine, situated immediately after the stomach.
- Plays a crucial role in digestion, where the chyme from the stomach mixes with bile from the liver and digestive enzymes from the pancreas.
- Bile aids in the breakdown of fats, while pancreatic enzymes help further digest proteins, carbohydrates, and fats.
Referred Pain
Pain at #9 = ?
GI System Disorders
(9)
- Liver
- Gallbladder
- Common bile duct
Referred Pain
Pain at #10 = ?
GI System Disorders
(10)
- Stomach
- Duodenum
