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Patho 2 > Gestrointestinal > Flashcards

Gestrointestinal Flashcards

1
Q

Coleithiasis

A

Gall Stones

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2
Q

3 types of choleithiasis (gall stones)

A

Cholesterol: 70-80% cholesterol

Pigmented black gallstones: chronic liver disease

Brown gallstones: Biliary stasis, bacterial infections, biliary parasites

Mixed

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3
Q

Cholecystitis

A

Obstruction from gallstones in cystic duct. Causes gallbladder to become distended and inflamed.

Risk for acute pancreatitis

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4
Q

Which form of hepatitis is transmitted by fecal-oral route? (contaminated food/water)

A

A and E

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5
Q

Projectile Vomiting

A

Vomiting without nausea.

Stimulation of vomiting centre by tumours, ICP, aneurysms

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6
Q

Emesis

A

Forceful emptying of stomach contents. Usually preceded by nausea

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7
Q

Consequences of nausea and vomiting

A

Fluid and Electrolyte imbalance, hyponatrenia, hypokalemia, hypochloremia, metabolic alkalosis

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8
Q

Primary constipation vs secondary constipation

A

Primary: Directly caused by bowel dysfunction of transit or evacuation (local cause)

Secondary: Caused by outside factors such as medications, diet, endocrine or neurogenic disorders, pregnancy

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9
Q

Osmotic Diarrhea

A

nonabsorbable substance in the intestine draws excess water into intestine (sugars)

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10
Q

Secretory Diarrhea

A

Excessive mucosal secretion (c.diff can cause)

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11
Q

Motility Diarrhea

A

decreased transit time = decreased reabsorption time

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12
Q

Small intestine absorbs most of..

A

carbs
fats
minerals
protein
vitamins
water (90%)

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13
Q

large intestine absorbs most of

A

water
vitamins

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14
Q

Malabsorption syndrome signs

A

fat in stools
bloating
diarrhea

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15
Q

IBD signs

A

Cramping
Fever
Bloody stools

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16
Q

Perietal Abdominal Pain

A

perietal peritoneum - precisely localized and intense - aggrivated by movement - usually caused by infection

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17
Q

Visceral Abdominal pain

A

arise from stimulus acting on organ caused by damage or disruption.

Poorly localized, vague

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18
Q

Upper GI Bleeds

A

Emesis of frank blood and/or grainy digested blood

Causes:
Esophageal varices
peptic ulcer
tear from extreme retching

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19
Q

Lower GI bleeds

A

Malena (black tarry stool)
Or bright red stool passed from rectum

Causes:
Digestion of blood in GI tract
polyps
diverticulitis
IBD
cancer
hemorrhoids

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20
Q

Acid Reflux

A

Lower esophageal sphincter weak and doesn’t properly close, allowing acid to back up.

Feeling of chest pressure that’s worse when lying down, sour taste, feeling of food “stuck” in throat

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21
Q

GERD

A

Severe form of acid reflux. Chronic.

Reflux of pepsin and acid or bile salts from stomach into esophagus.

Causes:
•Resting tone of LES lower than normal

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22
Q

Simple (mechanical) intestinal obstruction

A

Most common

•Blockage by lesions most common
•Hernia blockage
•More common in men
•Adhesions
•Volvulus (intestines twisted)
•Intussusception

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23
Q

Functional Intestinal Obstruction

A

Paralytic ileus: inability for section of intestine to conduct peristalsis

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24
Q

Signs/Symptoms of obstruction in small intestine

A

colicky pain
distention
nausea
vomiting

25
Q

Signs/symptoms of obstruction in ileum

A

more pronounced distension
Vomiting is late sign
Constipation (rarely diarrhea)
Increased bowel sounds

26
Q

Signs/symptoms of obstruction in large intestine

A

Hypogastric pain
Abdominal distension
Pain varies depending on ischemia
Vomiting is late sign

27
Q

Gastritis

A

Inflammation of gastric mucosa

Acute: vague abd discomfort, epigastric tenderness. Spontaneous recovery. H2 receptor agonists for healing

Chronic: seen in older adults. mucosal atrophy, epithelia metaplasia

28
Q

Immune gastritis

A

Example: Fundal gastritis.
Leads to gastric atrophy, which diminishes acid and intrinsic factor, causing pernicious anemia (Poor vit B12 absorption)

29
Q

non-immune gastritis (chronic)

A

Involves antrum only - follows acute gastritis

30
Q

Gastric Ulcer vs Duodenal Ulcer

A

Gastric
Ulceration of stomach linine

Duodenal
Ulceration of upper part of small intestine

S&S:
Nausea, vomiting, bloating, 75% have no symptoms

Causes: H.pylori, medication

Risk factors: >70, alcohol, smoking, injury/trauma

31
Q

Gastric Ulcer vs Duodenal Ulcer symptom comparison

A

Gastric
Normal secretion of acid
Pain 1-2 hr after meal
Food aggravates pain
Vomiting common
More likely to hemorrhage

Duodenal
Hyper-secretion of acid
Pain 2-4 hr after meal
Food relieves pain
Vomiting not common
Less likely to hemorrhage
(Malena if it does bleed)

32
Q

Stress Ulcer

A

Acute peptic ulcer that forms due to physiological stress of severe illness or trauma

ischemic ulcer
due to trauma such as hemorrhage, multisystem trauma, heart failure, sepsis

Curling ulcer: Burn injury

Cushing ulcer: Brain injury

Primary sign of stress ulcer is bleeding

33
Q

Dumping Syndrome

A

Rapid emptying of residual stomach - cramping, nausea, vomiting, diarrhea, weakness, pallor, hypotension

34
Q

Anemia causes

A

Duodenal removal
Decreased acid secretion
Supplements

35
Q

Alkaline reflux gastritis

A

inflammation caused by reflux of bile and pancreatic secretions

Nausea, vomiting bile, epigastric pain,

36
Q

Ulcerative Colitis

A

•Form of IBD
•Affects large intestine only
•Ulcerations in mucosa of the colon
•Chronic condition

-Peak occurrence age 20-40 then 50-70. More men.
-possible due to abnormal immune response of GI tract
-Not caused by stress, but stress can make worse
-Smoking seems to be a protective factor (unknown why)
-Remission and exacerbation
-Severe=entire colon, abd pain, fever, tachycardia, diarrhea, bloody stool

Malabsorption
Chronic Anemia

37
Q

Crohn’s Disease

A

Idiopathic (unknown cause)
Affects ANY part of digestive tract from mouth to anus.

“Skip lesions” - skips from place to place

Ulcers can cause fistulas that extend into lymphatics. Can form in perianal area, between loops of bowels, extend into vagina or bladder.

Anemia from malabsorption of vit B12 and folic acid.

Signs/Symptoms:
Can be asymptomatic for years. S&S similar to ulcerative colitis. Diarrhea major symptom. Also weight loss and abdominal pain.

If crohns in ileum, can have malabsorption of folic acid and vitamin D

38
Q

Ulcerative colitis vs Crohn’s symptoms

A

Ulcerative Colitis
Pain lower left abdomen
Bleeding common
Inflammation in colon only
Continuous inflammation
Colon wall thinning
No granulomas
Ulcers in mucus lining (colon)
Fewer complications
Non-smokers
mucosal and submucosal wall

Crohn’s
Pain lower right abdomen
Bleeding uncommon
Inflammation anywhere
Inflammation in patches
Cobblestone appearance
Thickened GI wall
Granulomas present
Ulcers in colon are deeper
Complications more common
Smoking worsens it
•”transmural” - affects full thickness of wall

39
Q

Diverticulosis

A

Asymptomatic herniations or saclike outpouching of mucosa and submucosa

Diverticulitis: Inflammation of the outpouching

Idiopathic - related to increased intracolonic pressure, abnormal neuromuscular function, alterations in intestinal motility

Anywhere in GI tract - weak points in colon wall

Complications: obstruction, fistula, abscess, bleed, perforation

Predisposing factors: Older age, genetic predisposition, obesity, smoking, diet, sedentary lifestyle, meds such as aspirin and NSAIDS

S&S: cramping lower abd, diarrhea, constipation, distended, flatulence

Diverticulitis S&S: fever, increased WBC, tenderness lower left abd

40
Q

Most dangerous complication of appendicitis

A

Peritonitis

Due to perforation causing contents to spill into abdominal cavity

41
Q

Obesity BMI

A

> 30

42
Q

Accessory GI organs

A

pancreas
liver
portal vein
gall blader

43
Q

Types of cirrhosis

A

Alcoholic liver disease
*More common in middle aged men but woman develop more serious injury
*Most prevalent form
*25% of alcoholics

3 stages:

1. Steatosis
*Fat deposits in liver. Lipids from adipose tissue or dietary intake contribute to fat accumulation
*Can be caused by low volumes alcohol
*Reversible if pt stops drinking

2. Fibrosis
*Increased hepatic storage of fat
*Inflammation and degeneration leads to necrosis of hepatocytes
*Stimulates irreversible fibrous characteristics

3. Cirrhosis
*Caused by chronic alcoholism and malnutrition
*Cell damage initiates an inflammatory response that results in excessive collagen formation
*Fibrosis and scarring alter structure of liver which obstructs biliary and vascular channels
*Irreversible

44
Q

Viral Hepatitis

A

Systemic disease that primarily affects the liver

Inflammatiry process of liver can damage and obstruct bile capillaries, leading to bile obstruction and obstructive jaundice.

Damage most severe in hepatitis B and C

S&S:
Range from asymptomatic to liver failure and coma

Prodromal phase: 2 weeks after exposure, ends with appearance of jaundice - fatigue, anorexia, malaise, nausea, vomiting, headache, cough, fever

Icteric phase: 1-2 weeks after prodromal. Lasts 2-6 weeks. Jaundice, dark urine, clay stools, enlarged liver, tender

Recovery phase: resolution of jaundice, liver remains large and tender, return of normal liver function 2-12 weeks after jaundice

Chronic B, C and D may not become jaundiced and may not be diagnosed - can become carriers

45
Q

Portal hypertension

A

High blood pressure in portal venous system

Causes:
pre-hepatic: any disease that obstructs blood flow

Hepatic: Cirrhosis of liver or viral hepatitis that cause inflammable or fibrosis

Post-hepatic: Cardiac disorders that impair pumping ability of the right side of the heart

Hematemesis is most common sign of portal hypertension due to esophageal varices rupture.

Caused by liver dysfunction si can have hx of jaundice and hepatitis, alcoholism, cirrhosis

46
Q

Liver disease complications

A

Ascites: fluid buildup in abdomen. trapped fluid in peritoneal space. Biggest cause is cirrhosis but can also happen from heart failure, abdominal malignancies, nephrotic syndrome, malnutrition

Decreased synthesis of albumin in liver with portal hypertension will cause capillary hydrostatic pressure to exceed capillary osmotic pressure, pushing water into peritoneal cavity

Hepatic Encephalopathy
Decline in brain function due to liver disease. Impaired behavioural, cognitive, and motor function. Can develop quickly in hepatitis or slowly in cirrhosis. Toxins normally removed by liver eventually travel to brain.

47
Q

Cholelithiasis

A

Gall stones.

Formed from impaired metabolism of cholesterol, bilirubin, and bile acids.

Three types:
1. Cholesterol (70-80%)
2. Black (rare. chronic liver disease, hemolytic disease)
3. Brown (biliary stasis, bacterial infection, biliary parasites)

S&S: Can be asymptomatic, epigastric and right upper quadrant pain. Intolerance for fatty foods manifested as heartburn, flatulence, epigastric discomfort and food intolerance

48
Q

Cholecystitis

A

Inflammation

Can be acute or chronic. Caused by gall stones lodged in cystic duct. Obstruction causes gall bladder to become distended and inflamed. Pressure against distended wall of gall gladder can cause decreased blood flow, ischemia, necrosis and perforation

S&S: Fever, leukocytosis (high WBC), rebound tenderness, abdominal muscle guarding

49
Q

Pancreatitis

A

Equal between men and women. More likely in black individuals

Risk factors: cholethiasis, alcoholism, peptic ulcers, obesity, trauma, dyslipidemia, hypercalcemia, smoking, genetics

Acute: Obstruction of the outflow of pancreatic digestive enzymes - bile and pancreatic duct obstruction. Can also result from alcohol, meds, viral infections

Chronic: Progressive fibrotic destruction of pancreas. Chronic alcohol abuse most common cause. May also come from gallstones, smoking, genetics

50
Q

Esophageal cancer

A

More common in males

Risk: malnutrition, alcohol, tobacco

S&S: chest pain, dysphagia

51
Q

Stomach Cancer

A

More common in males

Risk: Salty food, red meat, nitrates

S&S: Anorexia, weight loss, vomiting occult blood, RUQ pain

52
Q

Colorectal Cancer

A

More common in males

Risk: Polyps, IBD, Diverticulitis, high fat, low fiber

S&S: Pain, mass, anorexia, bloody stool, distension

53
Q

liver cancer

A

more common in males

risk: hepatitis B, C, D, Cirrhosis

S&S: pain, anorexia, weight loss, ascites, jaundice

54
Q

Pancreatic cancer

A

More common in females

Risk: chronic pancreatitis, smoking, alcohol, diabetes

S&S: weight loss, weakness, nausea, vomiting, abd pain, depression, jaundice

55
Q

Hyperplastic (in colorectal cancer) meaning

A

Benign growth. starts from mucosal epithelium

56
Q

Pyloric Stenosis

A

In infants

Most common cause of postprandial vomiting (vomiting several hr after eating)

Unknown cause

Muscle fibers thicken so pyloric sphincter becomes enlarged and inflexible. Extra effort to force gastric contents. Stomach muscles can become hypertrophied

S&S:
•Occurs 2-8 wks after birth
•Forceful, non-bilious vomiting after feeding
•Needs to be refed
•Constipation (fluid doesn’t reach intestine)

57
Q

Functional Obstructions in pediatrics

A

Hirschsprung’s disease
•Most common cause of colon obstruction 1/3 of all obstructions in infants

Causes:
•Absence of nerve cells in PART of colon
•Causes decreased peristalsis and distention to proximal colon
•”megacolon”

Intussusception
•Telescoping of proximal segment of intestine into a distal segment, causing obstruction (functional). Most common cause of small bowel obstruction in children. age 5-7 months.

58
Q

Mechanical obstructions in pediatrics

A

Hernias
Bowel protrudes through weakening in abdominal wall ligament

Patho 2 (6 decks)

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