GI Flashcards
1
Q
Define digestion, absorption, and deglutition
A
Digestion - physical and chemical breakdown of food into absorbable substances
Absorption - transfer of end products of digestion across the intestinal wall to circulation, involves villi
Deglutition - swallowing, mechanical
2
Q
How does the pharynx assist in swallowing?
A
secretes mucous which aids in swallowing
3
Q
What does the epiglottis cover during swallowing?
A
The larynx
4
Q
The LES remains contracted except during?
A
Swallowing, belching, and vomiting
5
Q
Where does digestion begin?
A
The mouth
6
Q
What is the role of the stomach in digestion?
A
It stores food, secretes digestive juices, and empties the chyme into the small intestine
7
Q
Which macronutrient(s) is primarily digested in the stomach? What is required?
A
Protein digestion begins and the digestion of starches and fats is minimal
Pepsinogen is transferred into pepsin
8
Q
Where is digestion completed? What three things are necessary in the GI tract to complete digestion?
A
Digestion is completed in the small intestine
- Enzymes from the pancreas
- Bile from the liver
- intestinal secretions and alkaline pancreatic secretions
9
Q
How do alkaline pancreatic secretions assist in digestion?
A
They neutralize the acidity of the chyme
10
Q
Where is the predominant region for water and electrolyte absorption in the GI tract?
A
The large intestine
11
Q
What 5 things are feces made up of?
A
- Water
- Bacteria
- Food residue
- Unabsorbed GI secretions
- Desquamated epithelial cells
12
Q
What is the valsalva maneuver?
A
Contraction of the chest muscles, closed glottis, and contracted abdominal muscles that increases intra-abdominal pressure
13
Q
Which patients are we most concerned with in regard to the valsalva manuever
A
Cardiac and head trauma
14
Q
What organ metabolizes RBCs and in turn creates bilirubin:?
A
The liver
15
Q
What organ is both an endocrine and exocrine gland?
A
Pancreas
16
Q
What is xerostomia?
A
Dry mouth/decreased saliva production
17
Q
What is hypochlorhydria?
A
Decreased HCl secretions
18
Q
Where is the appetite centre of the brain located?
A
Hypothalamus
19
Q
What are 4 factors that may affect appetite?
A
Hypoglycemia, empty stomach, decrease in body temp, and input from higher brain centres
20
Q
What is H. pylori? Where is it typically present?
A
H. pylori is bad bacteria that may cause infection and damage the GI tract, specifically the upper GI (stomach and small intestine)
21
Q
Describe an ALT, ALP, AST, and GGT
A
o ALT – elevated in liver damage and inflammation
o ALP – elevated when excretion is impaired as a result of an obstruction in the biliary tract
o AST – elevated in liver damage and inflammation
o GGT – elevated in hepatitis and alcoholic liver disease
22
Q
Bilirubin is?
A
the product of old RBC breakdown
23
Q
What is amylase? Where is it secreted from? It is important in diagnosing?
A
Digestive protein, excreted from the pancreas, will identify acute pancreatitis
24
Q
Where is lipase excreted from?
A
The pancreas
25
What is an occult blood sample/match book? How many samples does it require?
Testing for red blood cells in the GI tract
3 samples of stool - want to see across a period of days
26
What diagnostic test/blood test will identify H. pylori?
culture and sensitivity
27
What is the difference between a gastroscopy and colonoscopy?
gastroscopy - scope of the entire stomach
colonoscopy - scope of the entire colon
28
What is an ERCP? What is one thing you must be aware of prior to sending the patient for this test?
A scope inserted down the esophagus that views the back of the liver and pancreas
It uses contrast medium - must be careful of allergies to shellfish
29
What is a barium swallow? What is the difference between an upper and lower?
Using barium as a contrast medium to see the movement of the solution through the GI tract after being swallowed
Upper - determines dysphagia/swallow process
Lower - out pouches in the small intestine
30
Define GERD
GERD is a syndrome, not a disease
Reflux of gastric acid contents into the lower esophagus
31
What is the primary cause of GERD?
There is no single cause, it occurs when the defences of the lower esophagus are overwhelmed by the reflux of stomach acid
32
What are six potential causes of GERD? Briefly define each
1. Hiatal hernia - out pouch of the stomach into the abdominal cavity, area of increased pressure
2. Incompetent LES
3. Decreased esophageal clearance - inability to clear liquids/food from esophagus into stomach
4. impaired esophageal motility
5. decreased gastric emptying
6. certain foods and medications
33
Does inflammation occur with GERD?
Yes
34
What are five clinical manifestations of GERD?
1. Pyrosis - heart burn
2. Resp. symptoms - wheezing, coughing, dyspnea
3. Otolaryngological symptoms - hoarseness, sore throat, and globus sensation
4. Regurgitation - small amounts of throw up
5. gastric symptoms - early satiety, bloating, nausea, vomiting
35
What are 7 complications of GERD?
1. esophagitis
2. scar tissue formation
3. Barrett's esophagus
4. bronchospasms
5. laryngospasms
6. cricopharyngeal spasm
7. dental erosion
36
What is the most concerning complication of GERD?
Barrett's esophagus - type of cancer that results from GERD
37
What are four diagnostic studies that would be appropriate for GERD?
1. Barium swallow
2. Endoscopy
3. Biopsy
4. Cytology
38
What are three lifestyle modifications that could be useful for GERD
1. Avoidance of triggers (diet/medications)
2. weight loss
3. smoking cessation
39
What specific dietary/food choices are imperative for GERD?
Avoid fatty foods, chocolate, peppermint, caffeinated beverages, milk
40
What 3 nutritional behaviours are important for GERD management?
1. small, frequent meals
2. avoid late evening meals
3. fluids taken between meals
41
What are the four generic goals of medication therapy for GERD?
Focus is to improve LES function, increase esophageal clearance, decrease the volume and acidity of reflux, and protect esophageal reflux
42
What are cryotherapy and ablation therapy for GERD?
Cryo - uses cold to scar and kill the tissue
Ablation - uses heat to scar and kill the tissue
43
Define peptic ulcer disease
Erosion of the GI mucosa from digestive action of HCl acid and pepsin - it can be acute or chronic
44
What are the three characteristics of acute PUD?
1. Superficial and minimal inflammation
2. short duration
3. resolves quickly once cause is identified and removed
45
What are the two characteristics of chronic PUD
1. long duration
2. erode through muscular wall, fibrous tissue forms (scar tissue – area of the stomach that is prone to weakness)
46
Which type of PUD is 4 times more common than the other?
Chronic
47
What two medical interventions do we need to be cautious of to the exacerbation of ulcers?
NSAIDs may cause the formation of an ulcer
NG tubes
48
What is auto digestion? What can it cause? What is the body's protective mechanism against it?
Stomach begins to eat itself - this may cause an ulcer
Protected from this by the gastric mucosal barrier
49
How does increased blood flow increase risk of PUD?
It increases the congestion in the stomach
50
Where are gastric ulcers typically located?
Found on the lesser curvature of the stomach
51
What is the least common type of ulcer?
Gastric
52
What type of ulcer is more prevalent in women?
Gastric
53
Which type of ulcer has the greatest mortality rate? Why?
Gastric ulcers - due to them effecting older individuals more often than other ulcers
54
What are the six causes of a gastric ulcer?
H. pylori, smoking, medications (i.e., NSAID, ASA, and corticosteroids), alcohol, chronic gastritis, bile reflux gastritis
55
What three types of medications can cause ulcers?
NSAIDs, ASA/aspirin, and corticosteroids
56
What type of ulcer makes up 80% of all ulcers
Duodenal
57
What type of ulcer effects men more than women?
Duodenal
58
What is the average age range of duodenal ulcers?
35-45 years
59
What type of secretions are duodenal ulcers associated with?
High HCl secretions
60
What is the cause of duodenal ulcers 90-95% of the time?
H. pylori
61
What causes stress-related mucosal disease? What type of illness is it?
Major physiological insult (trauma or surgery)
Type of erosive gastritis/ulcer
62
Are ulcers often accompanied by pain?
No, often have no pain or symptoms
63
What are the three clinical manifestations of duodenal ulcers?
Burning/cramp-like, mid-epigastric region beneath the xiphoid process, may present with back pain
64
What are the three clinical manifestations of gastric ulcers?
pain high in epigastrium, 1-2 hours following meals, and burning or gaseous type pain/symptoms
65
What are the three complications associated with PUD?
1. Hemorrhage
2. Perforation - spillage into the peritoneal cavity
3. Gastric outlet obstruction
66
What is the most common complication of PUD? Which type of ulcer does it typically effect most?
Hemorrhage, duodenal
67
What is the most lethal complication of PUD? What are the symptoms associated with it?
Perforation
Spontaneous onset of symptoms – sudden, severe abdominal pain, rigid and broad-like abdomen, shallow and rapid respirations, and absent bowel sounds
68
What are the gastric outlet obstruction symptoms?
Belching, self-induced vomiting, swelling in upper abdomen, increased bowel sounds (high-pitched), visible peristalsis
69
What is the immediate intervention for a gastric outlet obstruction
NG tube
70
Why would we want to order CBCs for PUD?
RBCs will indicate the presence of blood and WBCs will indicate infection
71
What is the most important lifestyle behaviour to change for PUD management?
Smoking cessation
72
What is the average healing time of ulcers?
3-9 weeks - pt should be seen frequently throughout this time
73
What is absolutely imperative for medication therapy of PUD?
Strict adherence is necessary, as recurrence is frequent
74
What foods should be eliminated in PUD management?
Hot, spicy, pepper, alcohol, carbonated beverages, tea, coffee, meat extract broth, food with high roughage, decrease protein, avoid milk
75
Why would we want to limit protein consumption in PUD patients>
It takes a long time to digest
76
What types of macronutrients are suggested for PUD? Why?
Fats and carbs because they are less stimulating to the GI system
77
What type of disease is inflammatory bowel disease? What are the types?
It is an autoimmune disease
Crohn's and ulcerative colitis
78
What are the three main considerations that are often related to/causes of IBD?
o Genetics
o Altered dysregulated immune response
o Altered response to gut organisms
79
What ages is IBD common in?
Teenage years and early adulthood, with a second peak for ages 50-70
80
What populations is IBD common in?
It is common in industrialized regions, higher incidence in white individuals of Jewish descent, Scandinavian descent, and in family members, temperate regions
81
What country has the highest incidence of IBD?
Canada
82
Describe the pathophysiology of Ulcerative colitis
o Inflammation and ulceration of the rectum and the colon
o Inflammation is diffuse (spread out), involves mucosa and submucosa
o Begins in the rectum, and spreads proximally along the colon in a continuous fashion
o Red and edematous in affected areas, multiple abscesses develop, these abscesses break and develop into ulcerations, leading to bleeding and diarrhea, blood loss through stool
Abscesses may lead to pus, which may be present in the stool
o Pseudo (fake) polyps can develop
Outgrowths will develop, but they will not be cancerous and are not physiologically formed the same way cancerous polyps are
o Granulation tissue develops, mucosa becomes thickened, shortens the colon
Granulation tissue is good, as it begins the healing process, but it never has a chance to rest due to continuous motion of the GI tract
83
What are pseudo polyps?
Outgrowths that develop, but they will not be cancerous and are not physiologically formed the same way cancerous polyps are
84
What are three generic clinical manifestations of ulcerative colitis?
bloody diarrhea and abdominal pain, and toxic megacolon or acute perforations
85
What is the mild disease presentation of ulcerative colitis?
1-2 semi-formed stools (snake like), containing small amounts of blood per day
86
What is the moderate disease presentation of ulcerative colitis?
increase in stool output (4-5 per day), increased bleeding, systemic symptoms (fever, malaise, anorexia)
87
What is the severe disease presentation of ulcerative colitis?
Bloody diarrhea with mucous, 10-20 times per day, fever, malaise, weight loss (greater than 10%), anemia, tachycardia, and dehydration
88
What are four intestinal complications of ulcerative colitis?
hemorrhage, perforation, toxic megacolon, colonic dilation
89
What is metastatic Crohn's disease?
Complications that arise in the mouth, eyes, hepatobiliary, and GU from ulcerative colitis
90
What are the six goals of ulcerative colitis treatment?
1. Rest the bowel
2. Control inflammation
3. Manage fluid and nutrition
4. Manage patient stress
5. Provide education
6. Provide symptom relief
91
What condition has 80-85% remission with conservative management?
Ulcerative colitis
92
When is surgery indicated for ulcerative colitis?
patient fails to respond, if exacerbations are frequent and debilitating, massive bleeding, perforation, strictures, or obstruction, tissue changes, or carcinoma occurs
93
What condition requires a food diary, where one food is introduced at a time?
Ulcerative colitis
94
What type of diet/macronutrients will an ulcerative colitis patient be on?
High calorie, high protein, low residue with vitamins and iron
95
What is the biggest difference between ulcerative colitis and Crohn's
Ulcerative colitis only effects the rectum and colon, whereas Crohn's can affect any part of the GI tract
96
Describe the characteristics of Crohn's
inflammation involves all layers of the bowel, ulcerations are deep and longitudinal, cobblestone appearance, stricture development, abscesses and fistulas
97
What are the clinical manifestations of Crohn's? How does it typically start presenting?
Starts with non-specific symptoms - diarrhea, fatigue, abdominal pain, weight loss, fever
Diarrhea is non-bloody, pain is severe, intermittent, or constant, abdominal cramping/tenderness, abdominal distention, fever, and fatigue
98
What condition may be confused with appendicitis initially due to RLQ symptoms?
Crohn's
99
What are 4 intestinal complications of Crohn's
1. strictures and obstruction
2. fistulas
3. inflammation of intestines
4. impaired absorption, nutritional abnormalities, fat malabsorption (ADEK), and intolerance of gluten
100
What condition may result in an intolerance to gluten?
Crohn's
101
What are six extra intestinal complications of Crohn's
Systemic arthritis, liver disease, cholelithiasis, ankylosing spondylitis (abnormal curvature to the spine begins), uveitis (inflammation of the eye), nephrolithiasis (kidney stones)
102
What is appropriate diet for a Crohn's patient?
Elemental diets (high calories, high nitrogen, fat-free, no residue), maybe no milk and/or milk products, vitamin supplements and PN
103
What are diverticulum?
Out pouching of the mucosa through the circular smooth muscle
Feces gets trapped in the holes, hardens and gets infected
104
Where can diverticulitis occur? Where is it most common?
Can occur at any point of the GI tract, but most common in sigmoid colon
105
Do men or women have a higher rate of complications from diverticulitis?
men
106
What is diverticulitis often associated with?
Low fibre intake
107
What is high intraluminal pressure and fecalith? What pathology is it associated to?
Intraluminal - the lumen narrows and the stool decreases in bulk which increases pressure
Fecalith - dry feces compacted in the out pouches
108
What is the difference between diverticulosis and diverticulitis?
Diverticulosis – multiple non-inflamed diverticula are present
Diverticulitis – inflammation of the diverticula occurs
109
What are the three main clinical manifestations of diverticulitis?
Majority are asymptomatic!
Crampy, LLQ where pain is relieved by flatus or BMs, alternating constipation and diarrhea, and a palpable mass may be present
110
What illness pain is often relieved by flatus or BM?
Diverticulitis
111
What are six complications of diverticulitis?
1. Perforation
2. Peritonitis
3. Abscess and fistula
4. Bowel obstruction - feces will move out the mouth
5. urethral obstruction
6. bleeding
112
What two diagnostic studies should not be used in the acute phase of diverticulitis? Why?
Barium enema and colonoscopy - may cause a puncture or perforation
113
What diet adjustment is imperative for diverticulitis?
High fibre diet
114
What type of IV fluid would be administered to an acute diverticulitis pt?
Isotonic
115
What are broad spectrum antibiotics for diverticulitis treatment?
Prophylactic treatment
116
What is cholecystitis? What usually causes it?
Inflammation of the gall bladder
Most often associated with obstruction caused by stones or biliary sludge
117
How does the gall bladder present in cholecystitis?
Gall bladder edematous, hyperemic (more blood than usual going to the organ), distended with bile or pus
118
What is cholelithiasis?
Gall stones
119
Do individuals with cholethiasis usually present with symptoms?
80% present with no symptoms
120
What age, sex, and lifestyle factors influence gall stones?
Higher in women, multiparous (multiple pregnancies), post-menopausal on estrogen, young women on oral contraceptives
People older than 40
Sedentary, family history, and obesity
121
What are the clinical manifestations of cholelithiasis?
- Severe symptoms or none
- Spasms
- biliary colic (pain that comes and goes but is constant)
- pain can be excruciating, with tachycardia, diaphoresis, and prostration (doubled over in pain – bending over stretches the ducts longer, making pain decrease)
- residual RUQ tenderness
122
What are the four clinical manifestations of cholecystitis
1. Indigestion to moderate/severe pain (gassy, bloated, feeling full)
2. Fever, jaundice
3. RUQ tenderness, right shoulder pain
4. Acute pain with nausea and vomiting
123
What are 7 complications of cholelithiasis/cholecystitis?
1. Gangrenous cholecystitis (necrotizing gall bladder)
2. Subphrenic abscess (pus)
3. Acute pancreatitis
4. Cholangitis (inflamed ducts)
5. Biliary cirrhosis
6. Fistulas
7. Rupture of the gall bladder
124
Where is the first and second stage of jaundice?
First - skin
Second - sclera
125
What are 4 conservative therapies for cholecystitis?
Pain control, infection control, maintain fluid and electrolytes, and NG tube
126
What are three conservative therapies for cholelithiasis
Meds to dissolve stones, ERCP, or shock wave therapy
127
What is transhepatic biliary catheter?
Bile drains to the external environment - may be used for palliative settings, preop, and hepatic dysfunction r/t obstructive jaundice
128
What are four dietary/nutritional changes for cholelithiasis
1. Smaller, more frequent meals with some fat
2. Reduced calorie with obesity
3. Low in sat fats
4. High in calcium and fibre
129
What is the primary GI requirement for someone with liver cirrhosis to manage ammonia
The pt needs to be pooping at least 4-6 times per day (loose BMs) - likely will be put on laxatives
130
What is liver cirrhosis?
A condition of chronic liver inflammation, regenerative nodules, impaired perfusion, scar tissue
131
How do nodules develop on the liver through cirrhosis?
Liver attempts to repair itself, leading to scar tissue and nodules
132
What is the primary cause of liver cirrhosis?
Alcoholism
133
What is compensated liver cirrhosis?
Liver can functional normally and blood tests will come back as normal
134
What are the five clinical manifestations of decompensated cirrhosis?
1. Jaundice
2. Skin lesions
3. Hematological conditions
4. Endocrine disturbances
5. Peripheral neuropathy
135
Why does jaundice present in liver cirrhosis?
cannot excrete bilirubin, mild-severe, pruritus (patient is trying to process bilirubin and ammonia, making the body itching)
136
What are spider angiomas and palmar erythema? What condition are they associated with?
Associated with liver cirrhosis
Spider angiomas - breaking of veins
Palmar erythema - blanching and redness of the palm
137
Why do endocrine disturbances occur in liver cirrhosis? What are some results/symptoms of it?
The liver processes and metabolizes hormones, especially estrogen
gynecomastia (men developing breasts), loss of armpit and pubic hair, testicular atrophy, impotence, amenorrhea, vaginal bleeding, sodium and water retention along with potassium loss
138
What are five complications of liver cirrhosis?
1. portal hypertension - impaired blood flow through the portal and hepatic veins; may result in collateral circulation that can lead to varicosities
2. esophageal and gastric varices - valsalva maneuver may burst these
3. peripheral edema and ascites
4. hepatic encephalopathy
5. hepatorenal syndrome
139
Why does peripheral edema and ascites occur in liver cirrhosis?
decreased colloidal oncotic pressure
140
What is hepatic encephalopathy? What condition does it occur in?
Liver cirrhosis
Neural toxic effects of ammonia - graded, asterixis (flapping tremors) and fetor hepaticas (musty, sweet breath - due to ammonia)
141
What is fector hepaticas?
Musty, sweet breath due to ammonia accumulation
142
Will LFTs come back critically high or low in liver cirrhosis pt?
They will come back critically high
143
How do we treat ascites in liver cirrhosis?
Sodium restriction, diuretics, fluid removal (paracentesis)
144
What is the primary goal for someone who has esophageal and gastric varies?
prevention of bleeding
145
Why would we administer lactulose to a liver cirrhosis pt?
Lactulose is a laxative - administer it to increase BMs to rid the body of ammonia
146
What is the goal of medication therapy for liver cirrhosis? What do we need to keep in mind with med administration?
Treating the symptoms not the cirrhosis
Need to be concerned of dosage amounts and continuous monitoring of toxic effects of medications
147
What type of diet would a liver cirrhosis pt be on?
High in calories and carbohydrates, low in fat and protein
Watch sodium intake for water retention
148
What 7 factors may lead to colorectal cancer?
Diet high in red/processed meat, obesity, physical inactivity, alcohol use, long-term smoking, low intake of fruits and vegetables, genetics/family history
149
What age is at highest risk for colorectal cancer?
Increases slightly after age 50 and then rapid rise in following decades of life
150
How does colorectal cancer begin?
Begins as a polyp, the cancer moves down the tip of the polyp into the mucosa, and then travels to the vascular system
151
What are the clinical manifestations of colorectal cancer?
o Rectal bleeding is the most common symptom
o Alternate constipation and diarrhea
o Abdominal cramps, bloating/gas, change in stools (ribbon like), loss of appetite, early fullness, weight loss, lethargy, feeling of incomplete BMs (may be due to the presence/feeling of a tumor in the GI tract)
152
What is the most common symptom in colorectal cancer?
Rectal bleeding
153
What is the difference between an FOBT and FIT?
o FOBT
3 days prior the patient cannot have any red meat, no NSAIDs or ASA, as the test will pick up the byproducts and give a false positive
Requires 3 stool samples, chemicals test the stool for blood
o FIT
No restrictions prior to testing
1 sample required, antibodies test for blood in the stool, used as a screening tool
FOBT or FIT should be done every 2 years for screening
154
What is a CEA test (carcinoembryonic antigen)?
This only tells you if the antigen is present, but does not determine if it is definitively colorectal cancer
155
How long are NG tube feeds good for? How often should they be flushed and with how much fluid?
NG tubes are commonly used for short-term feeding (less than 4 weeks)
All tube feeds should be flushed with 30mL of warm tap water every 4 hours
Tubes must be flushed before and after eating, between medications, and after all medications are administered
