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PGHY 350 > GI 4 > Flashcards

GI 4 Flashcards

1
Q

what 4 general causes can elicit intestinal obstruction?

A
  1. mechanical
  2. developmental
  3. inflammatory
  4. tumour
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2
Q

what are the three mechanical obstructions of the intestine?

A
  1. intussusception
  2. volvulus
  3. adhesions

strangulation is sometimes also considered a mechanical obstruction of the intestine

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3
Q

Explain intussusception

A

intussusception occurs when a part of the intestine folds in over an adjacent section –> like a compression. This occurs due to ‘loose’ mucosa’
80% of cases occur in children 2 years or younger
impacts blood flow - ischemia, hypoxia, pain, vomiting
relatively easy to fix

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4
Q

Explain Volvulus

A

volvulus occurs when there is a twist in the gut which may cause a knot or dilation. There may be a congenital predisposition involved but not always.

small twistings can be fixed by the mesentery regaining organization –> in volvulus this fails

horses and dogs are predisposed to this

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5
Q

explain adhesions

A

adhesions are inappropriate extra-intestinal connects of the intestine to an adjacent part of the intestine or to another organ. These are outside of the intestine obstructions.

  • involves the mesentery, and the serosa
  • obstructs the movement of gut or dilation of gut
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6
Q

what may cause an adhesion?

A

healed or ongoing inflammation - connections via scar tissue?

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7
Q

explain strangulation

A
  • nothing is wrong with the intestine
  • part of the abdominal muscle is herniated
  • if the intestine moves through this muscle, and then the muscle contracts, it pinches off the intestine.

this is the 0.5 mechanical obstruction

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8
Q

congenital issues: explain Atresia

A

atresia is a congenital abnormality in which the intestinal tube fails to form a contiguous lumen. i.e. =====| |======= –> there should not be a gap.

this is very rare and has very early diagnosis

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9
Q

what is Hirschsprung’s disease aka congenital aganglionosis

A

congenital aganglionosis (Hirschsprung’s) is the failure of a certain section of the ENS to develop in the colon! This region becomes non-propulsive and obstructs the fetuses large intestine.

typically affects the most distal region of the colon

upstream of the band of constriction causes intestinal distention and risk of toxicity

histology: the absence of intramural ganglia

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10
Q

how do we fix Hirschsprung’s disease?

A

surgical excision of the non-functional colon region and reattachment of two functional regions. the joining of two entities in medicine = anastomosis

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11
Q

t or f, the ENS has redundancy

A

true - explains why resection of some of the colon is fine for curing congenital aganglionosis

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12
Q

what are the two types of pain in the GI tract

A
  1. colic - on/off cramping pain
  2. unremitting pain - non-stop pain
    signs of GI problems
    usually arise from muscles contracting against objects that will not move
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13
Q

the progression of a mechanical obstruction has many consequences… what are they? (6)

A

pain and vomiting
upstream contractions above the obstruction will increase intra-luminal pressure
vascular supply compromised - ischemia
no downstream water/ion resorption
lack of motility (ileus) –> this allows bacterial overgrowth which can cause perforation and peritonitis.

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14
Q

what is ileus?

A

functional paralysis (loss of motility) in the intestine

  • it can lead to obstruction
  • or associated with disease
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15
Q

when does ileus commonly occur?

A

after surgery of the intestine

- spontaneous reversal occurs

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16
Q

true or false ileus is not associated with colic pain. It is also not associated with any reflex contractions

A

true - also no bowel sounds

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17
Q

true or false - ileus is a major cause of ICU cases

A 
true - long ileus is associated with 
bacterial overgrowth
perforation
sepsis
peritonitis 
shock 
etc
18
Q

what is the peritoneum?

A

a thin layer that lines the abdominal and pelvic cavities. It responds to and plays a role in inflammation

it is thin, highly vascularised and highly innervated

it can be involved in adhesions

19
Q 
what are the 
parietal peritoneum 
visceral peritoneum 
mesentary 
omentum
A

parietal peritoneum –> the portion that actually lines the abdominal and visceral cavities (peritoneal cavity)
visceral peritoneum –> covers external surfaces of intestinal tract
mesentery –> this connects the intestine to the abdomen
omentum –> this is a loose sheet which can mobilize. it plays an important role in sealing off abscesses.

20
Q

what is peritonitis?

A

inflammation of the peritoneal cavity

  • often omentum then mobilizes to the site of inflammation
  • peritonitis can lead to perforations
21
Q

what two things can cause perforations?

A

chemical irritants

bacterial perforitis

22
Q

what is the guarding reflex?

A

omentum mobilization to seal off peritonitis

23
Q 
ascites 
guarding
ileus 
systemic infection 
signs of?
A

bacterial peritonitis

no infection - chemical peritonitis

24
Q

what are the two kinds of peritonitis?

A

a. chemical peritonitis
- caused by hemorrhage and blood
- caused by perforated ulcer
- caused by rupture of any organ

b. bacterial peritonitis

25
Q

t or f, originally, chemical peritonitis may arise. this however causes increased permeability of vessels/lumen –> bacteria leak into the peritoneal cavity –> now we have a bacterial peritonitis.

A

true

26
Q

t or f, the omentum can seal of peritonitis which can cause an abscess (collection of pus/fluid) –> this can lead to fibrosis, scarring, adhesions –> obstruction

A

true

27
Q

t or f, ileus causes obstruction

A

false –> ileus can lead to obstruction due to food blockage but it does not cause obstruction

28
Q

what are mastication and deglutition

A

chewing and swallowing

29
Q

t or f, the oral cavity / pharynx represents the transition between voluntary control and involuntary control

A

true

30
Q

what are canker sores (aphthous ulcer’s) and oral thrush?

A

aphthous ulcers are sores inside the mouth
oral thrush is a yeast infection inside the mouth

brushing teeth prevents opportunistic infection

31
Q

what is the periodontium?

A

important tissues surrounding the teeth

32
Q

poor oral hygiene can lead to?

A

infection of the periodontium and gingivitis - gum inflammation

33
Q

true or false, vagal and extrinsic innervation stimulate swallowing (deglutition)

A

false,

vagal and intrinsic innervation do

34
Q

what is dysphagia?

A

difficulty swallowing

35
Q

what is achalasia?

A

failure with esophageal propulsion and LES relaxation

36
Q

what may cause achalasia? 2

A

a. defects in smooth muscle - LES stays contracted

b. failures with the intrinsic inhibitory innervation via the ENS

37
Q

esophageal atresia?

A

developmental tube defect leading to one end being a blind tube - recall this may also occur congenitally in the intestine

very rare

38
Q

what is gastro-esophageal reflux disease (GERD)?

A

Acid reflux into the lower esophagus through the LES causing inflammation and deterioration of the esophagus. This can cause an ulcer.

the pain feeling is aka heartburn

39
Q

what 3 things may cause GERD?

A
  1. relative relaxed LES
  2. excessive Acid production
  3. hernia of the abdomen
40
Q

what is a hiatal hernia?

A

this is when there is an abdominal hernia. then the stomach may squeeze through a section of this and become pinched off –> pooling of acids and GERD

41
Q

GERD treatment?

A

antacids
proton pump blockers
endoscopic sewing

42
Q

what danger can GERD lead to?

A

Barrett’s esophagus –> a pre-malignant condition (cancer) due to prolonged GERD. Functional cell changes occur - e.g. metaplasia which can lead to CA

PGHY 350 (10 decks)

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