Gastrointestinal Sytem Flashcards by Nikolas Leventis

Hiatal hernia

enlargement of lower esophageal sphincter

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Hiatal hernia prevelance

common, 5/1000

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Hiatal hernia risks

Advanced aging
Women
Can be congenital or acquired

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Type 1 Hiatal Hernia

Sliding hernia (most common)
Stomach and gastroesophageal junction are displaced upward into thorax

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Type 2 Hiatal Hernia

Rolling “paraesophageal” hernia (higher risk)
gastroesophageal junction stays below diaphragm, but all or part of the stomach pushes through into thorax

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Hiatal Hernia Clinical manifestations

Many asymptomatic
Heartburn
Chest pain
Dysphagia

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Sliding Hernia clinical manifestations

Heartburn 30-60 minutes after a meal, especially in supine
substernal pain

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Rolling hernia clinical manifestations

difficult and painful swallowing

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Hiatal hernia diagnosis

Barium swallow
xray
upper endoscopy

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Hiatal hernia treatment

antacid
potential surgery

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GERD

backward flow of gastric contents into esophagus

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GERD Clinical manifestations

heartburn
dysphagia
edema and spasm

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Chronic GERD can lead to

Barrett’s esophagus

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GERD diagnosis

History
Endoscopy
Barium radiography
H. plyori
Esophageal monitoring
Medications

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Gastritis

injury and inflammation of stomach mucosa

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etiology of gastritis

aspirin/NSAIDS and chemotherapy
physiologic stress
hospitalization for severe illness

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gastritis clinical manifestations

epigastric pain
abdominal distention
anorexia and los of appetite
nausea
indigestion
painless GI bleeding

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gastritis diagnosis

history
upper GI endoscopy to rule out ulcer our tumor

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gastritis treatment

avoid irritants
acid suppressors and anitbiotics

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gastritis prognosis

good if predisposing factor removed
chronic gastritis increases risk of stomach cancer

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esophageal cancer types

squamous cell carcinoma
adenocarcinoma

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squamous cell carcinoma

majority of esophageal cancer
middle of esophagus
african americans
alcohol/tobacco use

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adenocarcinoma

distal esophagus
middle aged white men
GERD, barrets esophagus
obesity

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esophageal cancer clinical manifestations

dysphagia and pain swallowing
anorexia
heartburn, chest pain (spread of tumor)
cough and pneumonia

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hoarseness of voice from esophageal cancer suggests involvement of which nerve?

recurrent laryngeal nerve

esophageal cancer treatment

surgical resection chemo

esophageal cancer prognosis

poor, bc 50 percent are detected at advances stage high morbidity and mortality metastasizes rapidly

Peptic Ulcer

open sores that develop on the stomach lining or small intestine that can lead to perforations and GI bleed

Peptic ulcer (Gastric)

affects lining of stomach

Peptic ulcer (Duodenal)

affects duodenum

Protection of Stomach Lining (mucus)

secreted by cells in mucosa and coats lining

Protection of Stomach Lining (bicarbonate)

secreted by epithelial cells of GI neutralizes gastric acid

Protection of Stomach Lining (adequate blood flow)

nourishes mucosa

Protection of Stomach Lining (prostaglandins)

stimulate mucus and bicarbonate secretion

Cause of peptic ulcer disease (H. plyori)

most common cause hides between mucus and epithelial cells

Cause of peptic ulcer disease (NSAIDS)

Inhibit prostoglandins

Cause of peptic ulcer disease (Gastric Acid)

Injure mucosa cells and activate pepsin

Cause of peptic ulcer disease (smoking and alcohol)

increase GA reduce bicarbonate prod. delay healing

Best diagnosis for PUD

endoscopy

PUD prognosis

good unless massive hemorrhage or perforations

IBS (Crohn Disease) locations and pain

anywhere in GI tract, including mouth RLQ pain

IBS (Crohn Disease) lesions

Skip lesions

IBS (Crohn Disease) symptoms

weight loss, fecal urgency, pain relieved by farting, joint arthritis, abdominal pain

IBS (Ulcerative Colitis) locations and pain

occur in large intestine and rectum LLQ pain

IBS (Ulcerative Colitis) lesions

continous

IBS (Ulcerative Colitis) symptoms

weight loss, fecal urgency, rectal pain, bleeding, bloody diarrhea with mucus/pus

IBS CD prognosis

chronic, incurable, debilitating

IBS UC prognosis

possible by colon resection

General IBS prognosis

Increased risk of GI cancer mortality risk low, but increases with durations and severity of disease

Implications for PTs (CD IBS)

may present as LBP may cause psoas abscesses (fever, LAP, referred pain) +ve psoas signs dehydrations psychological issues

Diverticulum

asymptomatic outpouching in the colonic mucosa from weakness affects sigmoid colon

Diverticulitis

inflammation of a diverticulum

Diverticulitis Risk Factors

Advanced age >85 Chronic constipation low fiber low exercise obesity smoking NSAIDs and immunosuppressants prior episodes

Diverticulitis Pathogenesis

due to blocked diverticulum, leading to proliferation of bacteria and inflammation

Diverticulum Symptoms

asymptomatic

Diverticulitis Symptoms

Abdominal pain in LLQ, often with back pain fever change in bowel habits nausea, vomiting, anorexia

Diverticulitis Treatment

prevent with high fiber smoking cessation bowel rest antibiotics surgery

Colorectal cancer risk factors

age male poor diet IBD family history obesity

Prevention of colorectal cancer

screening, colonoscopy, removal of polyp

Colorectal cancer clinical manifestations

blood from rectum blood loss melena weight loss change in bowel habits

colorectal cancer prognosis

5 year survival for all stages is combined 64%

Appendix

hollow muscular closed ended tube 10 cm in length unclear function

appendicitis risk

young men peak 15-19 year olds but can occur at any age

appendicitis etiology

50% has no known cause infection, distention, ischemia of obstruction that forms abscess and perforates

appendicitis clinical manifestations

RLQ pain peri-umbilical McBurney's point fever nausea and vomiting

Signs of perforation in appendicitis

WBC of 20,0000/mm3 or greater tense or rigid abdomen elevated temperature (102°F)

appendicitis implications for PTs

early recognition and referral is important may present as right thigh pain, groin/testicular pain, pelvic or referred hip pain

Peritonitis

inflammation of peritoneum

Peritonitis clinical manifestations

Severe AP Abdominal rigidity and distention nausea/vomiting diarrhea and fever can lead to septic shock and cardiopulmonary collapse

hemmorrhoids

varicose veins in peri-anal region (internal and external)

hemorrhoids are associated with

increased IAP

Hemmorrhoids can also be caused by

PH pregnancy prolonged sitting standing or heavy lifting low fiber diets with constipation obesity diarrhea

hemorrhoid treatment

remove factors sitz baths high fiber surgery