GI Flashcards
upper GI problems occur in the……
Esophagus, Stomach, Beginning of small intestines
lower GI problems occur in the…….
Small intestines, colon (large intestines), rectum/anus
define dysphagia
Difficulty swallowing.
Begins with solids and progresses to liquids
dysphagia: common causes
- Mechanical obstruction: Stenosis or stricture, Diverticula, Tumors
- Neuromuscular dysfunction: CVA, Achalasia – LES can’t open properly
GERD
Backflow of gastric acid from the stomach into esophagus.
Occurs via the lower esophageal sphincter (LES).
Highly ACIDIC material!
GERD: Etiology
Anything that alters closure strength of LES or increases abdominal pressure
GERD: Clinical Manifestations
Heartburn (pyrosis)
Dyspepsia
Regurgitation
Chest pain
Dysphagia
Pulmonary symptoms
GERD: Complications
ulceration
scarring
strictures
Barrett esophagus- most severe.
define Hiatal Hernia
A defect in the diaphragm that allows part of the STOMACH to pass into the THORAX
Hiatal Hernia: Pathophysiology
Exact cause is unknown.
Age related.
Injury or other damage may weaken the diaphragm muscle.
Repeatedly putting too much pressure on the muscles around the stomach: Severe coughing, Vomiting, Constipation and straining to have a bowel movement.
2 types of Hiatal Hernia
Sliding hernia – usually small and often do not need treatment.
Paraesophageal hernia- part of the stomach pushes through the diaphragm and stays there.
Hiatal Hernia: risk factors
Age
Obesity
Smoking
Hiatal Hernia: clinical manifestations
Asymptomatic
Belching
Dysphagia
Chest or epigastric pain
Hiatal Hernia: treatment
Mostly a conservative treatment
Teaching: small, frequent meals, avoid lying down after eating
Avoid tight clothing and abdominal supports
Weight control for obese individuals
Antacids for the GERD/esophagitis symptoms
Surgery if the conservative treatments do not work
define Gastritis
Inflammatory condition of the stomach
define acute gastritis
TEMPORARY inflammation of the STOMACH lining only (intestines NOT affected)
how long does acute gastritis last?
Generally last from 2-10 days
Acute Gastritis Etiology
Irritating substances (alcohol)
Drugs (NSAIDs)
Infectious agents- H.Pylori
define chronic gastritis
PROGRESSIVE disorder with chronic inflammation in the stomach
how long can chronic gastritis last?
Can last weeks to years
Chronic Gastritis: etiology
- Autoimmune: Attacks parietal cells
- H. pylori infection
Chronic Gastritis: complications
PUD, bleeding ulcers, anemia, gastric cancers
What is H. pylori?
Helicobacter pylori bacterium.
Acidic environment.
Destructive pattern of persistent inflammation: Can cause chronic gastritis, PUD, and stomach cancer
how is H.Pylori transmitted?
Person to person via saliva, fecal matter, or vomit
Contaminated food or water
Acute or Chronic Gastritis: Clinical Manifestations
Sometimes none
Anorexia
N/V
Postprandial discomfort
Intestinal gas
Hematemesis
Tarry Stools
Anemia
define Acute Gastroenteritis
Inflammation of stomach & SMALL INTESTINE
Acute Gastroenteritis: etiology
Viral infections: Norovirus and rotavirus
Bacterial infections: E. col, salmonella, campylobacter
Parasitic infections
how long does Acute Gastroenteritis last?
Usually lasts 1-3 days but may last as long as 10 days
Acute Gastroenteritis: clinical manifestations
Watery Diarrhea: May be bloody if bacterial.
Abdominal pain
N/V
Fever, malaise
Acute Gastroenteritis: complications
fluid volume deficits
Peptic Ulcer Disease (PUD)
Ulcerative disorder of the upper GI tract
Esophageal
Stomach: gastric ulcers
Duodenum: peptic ulcer in the first part of the small intestine
Develops when the GI tract is exposed to acid and h. pylori.
PUD: Etiology
H. pylori
Injury-causing substances: NSAIDs, ASA, alcohol.
Excess secretion of acid
Smoking
Family history
Stress - remember there is increased gastric acid secreted with the stress response
Risk factors: NSAID-Induced Peptic Ulcer Disease
Age
Higher doses of NSAIDs
History of PUD
Use of corticosteroids and anticoagulants
Serious systemic disorders
H. pylori infection
PUD: Pathogenesis
Mucosa is damaged
Histamine is secreted, resulting in: Increase in acid and pepsin secretion- causes further tissue damage, Vasodilation– causes edema.
If blood vessels are destroyed, this results in BLEEDING.
PUD: Classification
Duodenal ulcer Most common type, Age – any; early adulthood
Gastric/peptic ulcer: Age – peak 50 - 70; Why? Increased use of NSAIDS, corticosteroids, anticoagulants and more likely to have serious systemic illnesses
PUD: Clinical Manifestations
Sometimes none
N/V, anorexia
Weight loss
Bleeding
Burning Pain: in middle of abdomen that is usually worse when the stomach is empty
gastric ulcers: characteristics, location, timing
characteristics: burning, cramping, gas-like
location: epigastrium, back
timing: 1-2 hours after eating
duodenal ulcers: characteristics, location, timing
characteristics: burning, cramping, gas-like
location: epigastrium, back
timing: 2-4 hours after eating
PUD: Complications
“HOP” Complications
H – Hemorrhage
O – Obstruction
P – Perforation and Peritonitis
name 5 lower GI problems
appendicitis
peritonitis
irritable bowel disorder
inflammatory bowel disorder: crohns, ulcerative colitis.
diverticulosis/diverticulitis.
define Appendicitis
Inflammation of the appendix
Appendicitis: etiology
Appendix is OBSTRUCTED
Leads to INFLAMMATION
Appendicitis: complication
Gangrene
Abscess formation
PERITONITIS
Appendicitis s/s
Classic Pain: RLQ in periumbilical area.
Rebound Pain= Pain is SEVERE after release of
palpating hand over the RLQ.
Sudden pain relief may indicate rupture: Peritonitis.
low grade fever, Nausea, anorexia
define Peritonitis
Inflammation of the PERITONEUM.
Serous membrane that lines abdominal cavity & covers visceral organs.
Peritonitis: What happens to the peritoneum?
INFLAMMATION
Fluid shifts – THIRD SPACING, Can lead to hypovolemic shock and sepsis.
DECREASED PERISTALSIS.
Can lead to paralytic ileus and intestinal obstruction.
Peritonitis: Causes
Perforated ulcer
Ruptured gallbladder
Pancreatitis
Ruptured spleen
Ruptured bladder
Ruptured appendix
Peritonitis: Clinical Manifestations
Usually sudden and severe
Abdominal pain*
Tenderness
Rigid “board-like” abdomen
N/V
Fever
Elevated WBC
HR increased
BP decreased
define Irritable Bowel Syndrome
Chronic condition characterized by: alterations in bowel pattern due to changes in intestinal motility,
Chronic and frequent constipation (IBSC)
Chronic and frequent diarrhea (IBSD)
Irritable Bowel Syndrome: Symptoms
Abdominal distension, fullness, flatus, and bloating.
Intermittent abdominal pain exacerbated by stress and RELIEVED BY DEFECATION.
Bowel urgency.
Intolerance to certain foods (sorbitol, lactose, gluten).
Non-bloody stool that may contain mucous.
Psychosocial Stress and IBS
is almost never the result of primarily psychological causes.
can be exacerbated by stress
can cause stress and psychological problems
causes of IBS
Cause UNKNOWN but thought to be “triggered” by stress, food, hormone changes, GI infections, menses
define Inflammatory Bowel Disease (IBD)
A group of life-changing, chronic illnesses
IBD Characterized by:
Chronic inflammation of the intestines.
Exacerbation and remissions.
TWO SEPARATE DISORDERS of IBD
Crohn’s disease
Ulcerative colitis
etiology for IBD
Genetically AUTOIMMUNE activated by an infection
IBD is most common in
WOMEN, Caucasians, persons of Jewish descent, and smokers
Crohn’s DiseasePathogenesis
Lymph structures of the GI tract are blocked.
Tissue becomes engorged and inflamed.
Deep linear FISSURES and ULCERS develop in a ”patchy” pattern in the bowel wall.
SKIP LESIONS
COBBLESTONE APPEARANCE
Crohn’s Disease: complications
Malnutrition: Anemia
Scar tissue and obstructions
Fistulas
Cancer
Crohn’s Disease: Clinical Manifestations
Crampy lower Abdominal pain (RLQ).
Watery diarrhea
SYSTEMIC: Weight loss, fatigue, no appetite, fever, malabsorption of nutrients.
Palpable abdominal mass (RLQ).
Mouth ulcers.
S/S of fistulas.
Ulcerative Colitis: define
Inflammation of the mucosa of the RECTUM AND COLON. Usually develops in the third decade of life.
Ulcerative Colitis is most common in…
white people of European descent, esp. Ashkenazi Jewish descent
Occasionally in Black/African Americans
Rare in Asians
Ulcerative colitis: pathogenesis
Inflammation begins in the rectum and extends in a CONTINUOUS segment that may involve the ENTIRE colon.
Inflammation leads to large ulcerations.
Necrosis of the epithelial tissue can result abscesses – CRYPT ABSCESSES.
Colon and rectum try to repair the damage with new granulation tissue.
Ulcerative Colitis:Clinical Manifestations
Abdominal pain
Bloody diarrhea
Systemic: Weight loss, fatigue, no appetite, fever
ulcerative colitis: complications
*Hemorrhage
*Perforation
*Cancer
Malnutrition
Anemia
Strictures
*FISSURES
*ABSCESSES
*TOXIC MEGACOLON – a rapid dilation of the large intestine that can be life-threatening
COLORECTAL CARCINOMA
Liver Disease – from inflammation and scarring of bile ducts
Fluid, electrolyte and PH imbalances
Diverticulosis: Pathogenesis
Small pouches in lining of colon that bulge outward through weak spots.
May be CONGENITAL or ACQUIRED
causes of Diverticulosis
low fiber diet with resulting chronic constipation
Diverticulosis: usual location
DESCENDING COLON
Diverticulosis: Clinical Manifestations
Usually asymptomatic
Discovered accidentally or with presentation of acute diverticulitis.
define Diverticulitis
INFLAMMATION of one or more of the pouches (diverticula)
Usually from retained fecal material.
Diverticulitis: Clinical manifestations
Abdominal pain – LLQ
Fever
WBC’s increased
Constipation or diarrhea
Acute – passage large quantity of frank blood.
May resolve spontaneously
Diverticulitis: complications
Perforation
Peritonitis
Obstruction
