gi

Question 1

upper GI anatomy

Answer 1

esophagus, stomach, beginning of SI
esophageal issues = GERD, hiatal hernia
inflam of stomach = gastritis, acute gastroenteritis, PUD

Question 2

lower GI anatomy

Answer 2

SI, colon (LI), rectum/anus

Question 3

dysphagia

Answer 3

difficulty swallowing: solids -> liquids (progress)
causes: mechanical and NM dysF, trach, intubated
mechanical: stenosis/stricture, diverticula (in esophagus), tumors (block)
NM dysF: CVA, achalasia, (LES doesn’t open properly, LES connects esophagus to stomach)

Question 4

GERD

Answer 4

upper GI, esophagus
LES doesnt close properly, backflow of stomach contents into esophagus (highly acidic) pass through and cause s/s of heart burn

Question 5

gerd: etiology

Answer 5

sphincter strength altered or abd P increases
ex: fatty foods, spicy, tomato based, citrus, caffeine, large amount of OH, cig smoking, sleep position, obesity, preg, pharm agents

Question 6

GERD: cm

Answer 6

heart burn (pyrosis), dyspepsia, regurgitation, chest pain, dysphagia, pulm S, hot burps
tooth decay, gingivitis, bad breath
chronic cough, worsening asthma, recurrent pna
abd bloating, belching
earache
hoarseness, chronic sore throat, throat clearing, laryngitis, lump in throat, post nasal drip

Question 7

gerd: complications

Answer 7

ulcerations, scaring, strictures
barret’s esophagus (dev of abn metaplastic tissue premalignant) -> 3x increase risk of adenocarcinoma of esophagus
not really treatment - just control gerd

Question 8

GERD: tm

Answer 8

not really pharm for complications, prevention, treat gerd and avoid triggers

Question 9

hiatal hernia

Answer 9

diaphragm defect that allows part of stomach to pass into throax
types: sliding, paraesophageal (rolling), mixed (more severe, type 3 + 4)

Question 10

hitatal hernia: sliding

Answer 10

type 1
small, no treatment, peritoneum intact and restrains size of hernia

Question 11

hiatal hernia: paraesophageal

Answer 11

type 2
part of stomach pushes through diaphragm and stays there
peritoneum membrane is thinner so sac sits above diaphragm and expand into thoracic
peritoneum becomes thin, enters into intrathoracic P = becomes larger

Question 12

hiatal hernia: patho

Answer 12

exact cause unknown, age related, injury or other damage to weaken diaphragm muscle, repeated P around stomach (severe cough, v, c and straining for BM, smoking, obesity
rf = age, smoke, obesity

Question 13

hitatal hernia: cm

Answer 13

asymp, belching, dysphagia, chest or epigastric pain
GERD coexist -> bc LES is weak

Question 14

hitatal hernia: tm

Answer 14

conservative
small and freq meals, dont lay down after eating
no tight clothes and or abd support
weight control (for obese)
antacid for gerd S
sx of other tm dont work (usually due to noncompliance)

Question 15

gastritis

Answer 15

stomach inflam

Question 16

gastritis: acute

Answer 16

temp, not intestines - just stomach
2-10 days
irritating substances (OH), drugs - ex:
NSAIDs - inhibit prostaglandins and therefore diminish protective coating
infectious agents - H. pylori + others

Question 17

gastritis: chronic

Answer 17

progressive, wks - yrs
immune (attack on parietal cells) or non immune (H. pylori)
complications: PUD, bleeding ulcers, anemia, gastric cancers

Question 18

gastritis: H. pylori

Answer 18

gram -
thrives in acid, destructive when overgrown, persistent inflam which leads to chronic gastritis, PUD, stomach cancer
transmitted via saliva, fecal matter, v, contaminated food or water

Question 19

gastritis: cm

Answer 19

same for acute or chronic
asymp or anorexia, n/v, postprandial discomfort, intestinal gas, hematemesis, tarry stools, anemia

Question 20

acute gastroenteritis

Answer 20

stomach and SI
1-3 days, up to 10
viral infections = norovirus, rotovirus
bacterial = E. coli, salmonella, campylobacter
parasitic
mostly let it play out, prevent dehyd, abx, see provider if last >48-72 hr

Question 21

acute gastroenteritis: cm

Answer 21

diff btw gastritis (not just upper GI issues)
watery d (bloody if bacteria), abd pain, n/v, fever, malaise
complication = FVD!

Question 22

PUD

Answer 22

ulcerative disorder of upper GI
esophageal, stomach -> stomach ulcers, duodenum -> peptic ulcer in 1st part of SI
when GI tract exposed to too much acid and H. pylori
natural body defenses: mucus, bicarb, BF, prostaglandins

Question 23

PUD: etiology

Answer 23

H. pylori, injury causing substances (NSAIDs - decrease prostaglandins, ASA, OH), excessive acid, smoking, fam hx, stress -> increase gastric acid secretion (not cause but can worsen)
rf: age, high NSAID dose, hx of PUD, corticosteroids and anticoags, serious systemic disorders, H. pylori infection

Question 24

PUD: patho

Answer 24

mucosa damage, histamine secreted (increase acid and pepsin secretion - more damage, vasodilate - edema), blood vessels destroyed = bleeding!

Question 25

PUD: classify

Answer 25

duodenal ulcer: most common, any age (early adulthood) gastric/peptic ulcer: 50-70 yo -> high NSAIDs, corticosteroids, anticoags, more likely to have serious systemic illness

Question 26

PUD: cm

Answer 26

none n/v, anorexia, weight loss, bleed (if BV involved), mid abd burning (worse when stomach empty) gastric = burning, cramp, gas; epigastrium, back; 1-2 hrs after eating duodenal = same except 2-4 hrs after eating

Question 27

PUD: complications

Answer 27

HOP hemorrhage - if BV involved obstruction - scar tissue and strictures perforation and peritonitis

Question 28

appendicitis

Answer 28

inflam of appendix etiology: obstructed, leads to inflam complications cause biggest issues - gangrene, abscess, peritonitis classic RLQ pain in periumbilical area - begins dull and steady and progress rapidly over 4-6 hrs; rebound pain, sudden relief - rupture = peritonitis cm: low grade fever, n, anorexia, elevated wbc

Question 29

peritonitis

Answer 29

serious membrane that covers abd cavity and visceral organs inflam, fluid shifts and 3rd spacing (hypovolemic shock, sepsis), decreased peristalsis, paralytic ileus and intestinal obstruction -> bc gut shuts down and doesnt digest food treat cause and anti inflam

Question 30

appendicitis: dx

Answer 30

s/s, elevated wbc, abd sonogram (US), exploratory lap

Question 31

peritonitis: causes

Answer 31

perforated ulcer, ruptured gallbladder, pancreatitis, ruptured spleen, ruptured bladder, ruptured appendix

Question 32

peritonitis: cm

Answer 32

sudden/severe - cant move/talk/hard to breathe, abd pain!, tender, rigid abd, n/v, fever, elevated wbc, increase HR and decreased BP d/t SNS and fluid shift

Question 33

irritable bowel s

Answer 33

chronic condition, alteration in bowel pattern d/t change in intestinal motility constipation or diarrhea -> chronic and freq almost never the result of psych distress -> can exacerbate, cyclic cause is unknown but triggered by stress, food, hormone changes, GI infections, menses

Question 34

IBS: cm

Answer 34

vary by individual abd distention, fullness, flatus, bloat intermittent abd pain exacerbated by stress and relieved by defecation bowel urgency intol to certain foods (sorbitol, lactose, gluten) non bloody stool with excessive mucus

Question 35

inflammatory bowel disease

Answer 35

chron's and ulcerative colitis characterized by chronic inflam of intestines, exacerbations and remission (periods) group of lifechanging chronic illness rf: white, F, jewish, smoke autoimmune activated by infection

Question 36

chron's

Answer 36

lymph structures of GI tract blocked, tissue becomes engorged and inflammed, deep linear fissues and ulcers develop in patchy patterns in bowel wall (skip lesions - specific to chron's, cobblestone appearance)

Question 37

chron's: complications

Answer 37

malN -> anemia scar tissue and obstructions fistulas - 2 structures connected innappropriately cancer

Question 38

chron's: cm

Answer 38

crampy RLQ, watery d systemic = weight loss, fatigue, no appetite, fever, malabs of nutrients palpable abd mass, mouth ulcers, s/s fistulas -> depend on location granulomas increased r/o VTE

Question 39

ulcerative colitis

Answer 39

inflam of mucosa of rectum and colon 3rd decade rf: white (european descent), jewish, occassionally AA, asian rare

Question 40

ulcerative colitis: patho

Answer 40

inflam begins in rectum and extends in continuous segment that may involve entire colon, large ulcerations, necrosis of epithelial tissue result in crypt abscesses colon and rectum try to repair damage with new granulation tissue (fragile, bleed easily)

Question 41

ulcerative colitis: cm

Answer 41

abd pain, bloody d - v common systemic: weight loss, fatigue, no appetite, fever complications: hemorrhage, perforation, cancer, increased r/o VTE, malN, anemia, strictures, fissures abscesses, colorectal carcinoma, toxic mega colon -> rapid dilation of LI, can be life threatening; liver disease - from inflam and scarring of bile ducts, F+E and pH imbalances

Question 42

diverticular disease - diverticulosis: patho

Answer 42

development of diverticula -> small pouches in lining of colon that bulge outward through weak spots congenital or acquired though to be caused by low fiber diet with resulting chronic c usually descending colon inflammation of 1+ pouches (diverticula) -> retained fecal material

Question 43

diverticular disease - diverticulitis: cm

Answer 43

LLQ pain, fever, elevated wbc, c/d (abn bowel pattern), acute (pass large quantity of frank blood), may resolve spont usually asymp discovered accidentally or with presentation of acute diverticulitis complications: perforation, peritonitis, obstruction; depends on how inflammed, if they rupture, how many are there

Question 44

GI system: structure

Answer 44

GI tract and related solid organs of digestion 7m 4th wk GA

Question 45

GI system: function

Answer 45

provide nutrients for body with propulsive and mixing movements secretion of digestive juices abs of nutrients

Question 47

esophageal sphincters

Answer 47

food is prevented from movement backwards by 2 sphincters (bundles of muscle) normally closed at rest UES prevents food and fluid from being aspirated into lungs LES: cardiac sphincter, separates esophagus from stomach, prevents acidic contents of stomach from entering back into esophagus

Question 48

stomach

Answer 48

elastic reservoir for food, mixing and initial digestion of proteins capacity: 1000 - 1500 mL lined with columnar epithelium containing millions of gastric glands these glands contain special cells that secrete HCl, IF, and gastrin

Question 49

stomach layers

Answer 49

mucosa layer: inner layer made up of special cells - G cells, parietal, chief, epithelial; also contain BV 2 muscle layers help propel food to SI serosa: outer, act as covering

Question 50

gastric cells in mucosa

Answer 50

G cells parietal cells chief cells epithelial cells

Question 51

G cells

Answer 51

produce gastrin - hormone that facilitates production of HCl

Question 52

parietal cells

Answer 52

produce HCl to breakdown food produce IF to protect mucosa

Question 53

chief cells

Answer 53

secrete peptin

Question 54

epithelial cells

Answer 54

secrete bicarbonate rich solution to coat and protect mucosa

Question 55

SI: length

Answer 55

approximately 5-6m duodenum: 22cm jejunum: 2m ileum: remainder

Question 56

SI

Answer 56

entire inner wall has circular folds of a mucous membrane called plicae circulares these are permanent ridges that contain millions of fingerlike projections - intestinal villi each vilus has its own microscopic projections called microvilli combined effect of circular folds, villi, and microvilli increase SA for digestion x600

Question 57

special cells of SI

Answer 57

crypts of liberkuhn: intestinal glands that secrete about 2L of fluid per day into lumen of intestine, flui quickly reabs by villi goblet cells and brunner glands: secrete large amounts of mucus to protect SI from damage of acidic gastric juices SI cells have rapid turnover (58-72 hrs), one of fastest turnover rates in body

Question 58

SI sphincter

Answer 58

ileocecal - area where food passes from SI to LI distention of terminal ileum causes relaxation to allow contents to enter LI distention of cecum prevents reflux back into ileum

Question 59

LI: length

Answer 59

1.5m long, muscular tube that forms a frame around SI 6.5 cm in diameter, > than diameter of SI includes appendix, ascending colon, transverse colon, descending colon, sigmoid colon, rectum

Question 60

cells of LI

Answer 60

mucosa does not have villi and does not produce digestive enzymes absoprtive cells absorb H2O and electrolytes goblet cells produce mucous endocrine cells are present and produce hormones but their function is not really understool turnover is 3-8 days

Question 61

GI tract motility

Answer 61

due to contractions of 2 layers of SM (longitudinal and circular) 2 types: propulsive (peristalsis) and mixing (segmental) regulated by enteric NS, autonomic NS, and hormones

Question 62

esophagus - function

Answer 62

transport food

Question 63

stomach - function

Answer 63

stores and chums food pepsin digests protein HCl activates enzymes, breaks up food, kills germs mucus protects stomach wall limited abs

Question 64

SI - function

Answer 64

completes digestion, mucus protects gut wall abs nutrients, most water peptidase digests P sucrases digest sugars amylase digests polysaccharides

Question 65

LI - function

Answer 65

reabs some water and ions forms and stores feces

Question 66

rectum - function

Answer 66

store and expel feces