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Advanced Patho UC > GI Alterations > Flashcards

GI Alterations Flashcards

1
Q

lack of desire to eat despite physiologic stimuli that would normally produce hunger

nonspecific symptom that is often associated with nausea, abdominal pain, diarrhea, and psychologic distress

A

anorexia

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2
Q

_____ is a subjective experience, and associated symptoms are tachycardia and hypersalivation

A

nausea

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3
Q

metabolic consequences of vomiting

A

hyponatremia, hypokalemia, hypochloremia, and metabolic alkalosis

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4
Q

projectile vomiting is spontaneous vomiting that ____ follow nausea or retching and what is the cause?

A

does not follow nausea or retching

cause by direct stimulation of the vomiting center (medulla oblongata) by neurologic lesions – increased ICP, tumors, brain stem aneurysms – neuro problems

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5
Q

different types of constipation

A

normal transit (functional) constipation: normal function but decreased evacuation d/t low-residue (low fiber), low-fluid diet

slow-transit constipation: impaired colonic motor activity

pelvic floor dysfunction: failure of the pelvic floor muscles or anal sphincter to relax with defecation (pelvic floor dyssynergia or animus)

secondary: from an actual disease process, condition, or med

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6
Q

Diagnosis of constipation

A

Two of the following for at least 3 months
• Straining with defecation at least 25% of the time
• Lumpy or hard stools at least 25% of the time
• Sensation of incomplete emptying at least 25% of the time
• Manual maneuvers to facilitate stool evacuation for at least 25% of defecations
• Fewer than three bowel movements per week

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7
Q

large volume diarrhea cause

A

volume of feces is increased – caused by excessive amounts of water or secretions or both in the intestines

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8
Q

small volume diarrhea cause

A

volume of feces is not increased - result of increased intestinal motility

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9
Q

systemic effects of diarrhea

A

dehydration, electrolyte imbalance, metabolic acidosis (loss of sodium bicarb), and weight loss

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10
Q

_____ and ______ are common signs of malabsorption syndromes

A

diarrhea and steatorrhea (fat in stool)

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11
Q

types of diarrhea - osmotic, secretory, motility

A

osmotic draws water in by osmosis (non-absorbable substance like with lactose deficiency, magnesium sulfate, magnesium phosphate)

secretory forms large volume diarrhea caused by excessive mucosal secretion of chloride or bicarb-rich fluid or the inhibition of net sodium absorption (bacterial enterotoxins like E.coli)

motility - excessive motility decreases transit time, mucosal surface contact, and opportunities for fluid absorption (resection of SI, short bowel syndrome, abnormal fistula)

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12
Q

black, tarry stools could be d/t

A

upper GI bleed, pepto bismol intake, increased iron intake

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13
Q

frothy, fatty, pale (steatorrhea)

A

problems w/fat digestion, children w/CF, adults with pancreatic disease or cholecystitis – indicates loss of bile needed for fat digestion

remember that light or clay-colored stools due to decrease in conjugated bilirubin and bile (gallbladder or liver disease)

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14
Q

parietal (somatic) pain

A

in the peritoneum

localized, intense, sharp

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15
Q

mechanical obstruction of the esophagus

A

intrinsic - in wall of the esophageal lumen (tumors, strictures, diverticular herniations)

vs extrinsic - outside esophageal lumen and narrow esophagus by pressing inward (tumors)

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16
Q

clinical manifestations of dysphagia…difficulty beginning with both solids and liquids

A

neuromotor function loss

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17
Q

resting tone of the lower sphincter LES tends to be lower than normal from transient relaxation or weakness

A

GERD

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18
Q

risk factors for GERD

A

H.pylori, obesity

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19
Q

GERD that does not cause symptoms - LES relaxes and regurgitation of gastric contents into esophagus - acid is neutralized and cleared by peristaltic action in esophagus in 1-3 minutes

A

physiologic reflux

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20
Q

symptoms of reflux disease but no visible mucosal injury

A

nonerosive reflux (NERD)

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21
Q

combination of factors causes injury and inflammation

A

reflux esophagitis

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22
Q

clinical manifestations of GERD

A

heartburn, regurgitation of acidic chyme, and upper abdominal pain w/i 1 hour of eating

s/sx worse if person lies down or it intra-abd pressure is increased (vomiting, coughing)

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23
Q

association with GERD and:

A

laryngitis, asthma, and chronic cough

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24
Q

Acute gastritis associated with, and cause what symptoms?

A

H. pylori, NSAIDS, drugs, chemicals

vague abdominal discomfort, epigastric tenderness, and bleeding

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25
Q

Chronic gastritis: Fundal (upper) gastritis

A

Immune, type A

autoantibodies against parietal cells and intrinsic factor causes atrophy and pernicious anemia

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26
Q

chronic gastritis: antral (lower) gastritis

associated with?

A

nonimmune, type B

associated with H.pylori and NSAIDS (also w/acute)

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27
Q

2 basic causes of peptic ulcer disease (PUD)

A
  1. decreased mucosal protection (NSAIDS block prostaglandins which are involved in mucous production, stress ulcers, tobacco and EtOH)
  2. increased acid production - Zollinger-Ellison syndrome -gastroma – increases gastrin which increases acid secretion
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28
Q

Deep PUD

A

true ulcers extend through muscularis mucosae and damage blood vessels causing hemorrhage or perforate the GI wall

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29
Q

most common of PUDs and tends to develop in younger people d/t H.pylori infection

-cause chronic intermittent epigastric pain that begins 30 minutes to 2 hours after eating when stomach is empty - can occur during night and disappear by morning

A

relieved by ingestion of food or antacids - “pain-food-relief” pattern

duodenal ulcers

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30
Q

Gastric ulcers - location typically? causes? clinical manifestations?

A

tend to develop in the antral region (bottom of the stomach) where most of the acid secreting cells are

causes are often from H.pylori - primary defect is an increased mucosal permeability to hydrogen ions and gastric secretion tends to be normal or less than normal

similar to duodenal - pain-food-relief pattern - pain also occurs immediately after eating - tends to be chronic rather than intermittent
*causes more anorexia, n/v, and weight loss than duodenal ulcers

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31
Q

types of stress ulcers

A

ischemic: within hours of trauma, hemorrhage, sepsis, burns (curling ulcers)

Cushing: as a result of brain injury – decreased mucosal blood flow and hypersecretion of acid caused by overstimulation of the vagal nerve

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32
Q

Clinical manifestations of pyloric obstruction

A

epigastric pain, fullness, nausea

Succession SPLASH: sloshing sound in abdomen: at this stage vomiting is cardinal sign - copious and occurs several hours after eating - contains undigested food but NO bile (no way for bile to enter)

*with prolonged obstruction, malnutrition, dehydration, electrolyte abnormalities, and extreme dehydration can occur

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33
Q

Developmental factors of early dumping syndrome

A

loss of gastric capacity, emptying control, and feedback control by the duodenum when it’s removed

plasma volume decreases – vasomotor responses – tachycardia, hypotension, weakness, pallor, diaphoresis, dizziness – rapid distention of the intestine produces feeling of epigastric fullness, cramping, n/v/d

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34
Q

late dumping syndrome

A

occurs 1-3 hours after eating

35
Q

higher concentration of conjugated bilirubin

A

this means that the liver is able to conjugate the bilirubin but has a problem with secretion into bile

this could occur with biliary obstruction, or hepatitis

36
Q

higher concentration of unconjugated bilirubin

A

means breakdown of RBC before reaching liver releases bilirubin or inability of liver to conjugate

ex. missing enzyme (congenital), hemolytic anemia

37
Q

upper GI bleeding location and what does it look like?

A

esophagus, stomach, or duodenum

causes include bleeding peptic ulcers

Frank? Bright red blood in emesis (hematemesis), or digested blood (coffee-grounds emesis)

Melena: dark, tarry stools

38
Q

Lower GI bleeding location and what does it look like? Causes?

A

Below ligament of treitz, jejunum, ileum, colon, rectum – causes: polyps, diverticulosis, cancer, hemorrhoids

Hematochezia: bright red or burgundy blood from rectum
Occult bleeding: slow, non-obvious blood loss that results in iron-deficiency anemia

39
Q

GI bleeding causes what?

A

accumulation of blood in the intestinal tract leads to irritation - increased peristalsis - diarrhea

BUN will increase if blood has been digested - breakdown of RBCs - proteins increase serum urea

hgb and hct are not good indicators of immediate blood loss

40
Q

failure of the chemical processes of digestion

A

maldigestion

41
Q

failure of the intestinal mucosa to absorb (transport) the digested nutrients. common causes?

A

malabsorption

*bile salt deficiencies, enzyme deficiencies, bacterial infections, disruption of mucosal lining, disturbed lymphatic and vascular circulation, loss of gastric or intestinal surface area

42
Q

pancreatic insufficiency primary problem and most common signs? what causes?

A

insufficient enzyme production – lipase, amylase, typsin, chymotrypsin

43
Q

lactase deficiency

A
  • Congenital defect in the lactase gene
  • Inability to break down lactose into monosaccharides and thus prevent lactose digestion and monosaccharide absorption
  • Fermentation of lactose by bacteria, causing gas (cramping pain, flatulence) and osmotic diarrhea
44
Q

bile salt deficiency results from? causes?

A

Conjugated bile salts are needed to emulsify
and absorb fats and are synthesized from
cholesterol in the liver.
• Is the result of liver disease and bile
obstructions.
• Poor intestinal absorption of lipids causes
fatty stools, diarrhea, and loss of fat-soluble
vitamins (A, D, E, K).

45
Q

vitamin A deficiency

A

night blindness

46
Q

vitamin D deficiency

A

decreased calcium absorption, bone pain, osteoporosis, fractures

47
Q

vitamin K deficiency

A

prolonged PT time, purpura, petechiae

48
Q

vitamin E deficiency

A

testicular atrophy, neuro defects in children

49
Q

obstruction of the intestines - usually more common in the small intestine d/t narrower structure

A

ileus

50
Q

small intestine obstruction (think blockage of chyme passage = intestinal obstruction) s/s

A

colicky pains caused by intestinal distention followed by n/v

51
Q

large intestine obstruction s/s

s/s, consequences r/t?,

A

hypogastric pain and abdominal distention

consequences related to the competence of the ileocecal valve

52
Q

acute colonic pseudo-obstruction - massive dilation of large bowel that occurs in critically ill patients and immobilized older adults - characterized by dilation of the cecum and absence of mechanical obstruction

A

Ogilvie syndrome

53
Q

location of obstruction and vomit

pyloric, proximal SI, lower in SI

A

pyloric: early, profuse vomiting of clear gastric fluid

proximal SI: mild distension and vomiting of bile-stained fluid

lower SI: more pronounced distension bc a greater length of intestine is proximal to the obstruction; vomiting may or may not occur

54
Q

chronic inflammatory disease that causes ulceration of the colonic mucosa of sigmoid colon and rectum

lesions are…

clinical manifestations

A

ulcerative colitis

lesions are continuous with NO SKIP lesions - limited to mucosa - not transmural

clinical manifestations: diarrhea 10-12 times/day, BLOODY stools, crampy lower abd pain relieved by defecation - remissions and exacerbations

55
Q

idiopathy inflammatory disorder affecting any part of the digestive tract but most often affecting the SI and proximal colon

patho, clinical manifestations

A

Patho: SKIP lesions - inflammation affects some segments but not others – ulcerations produce longitudinal and transverse inflammatory fissures that extend into lymphoid tissue “cobblestone” - GRANULOMA

clinical manifestations: abd pain and diarrhea >5/day with passage of blood and mucus (not as much blood as UC), RLQ tenderness and wt loss

anemia may result from vit B12 and folic acid; bone disease from malabsorption of calcium; protein loss leads to hypoalbuminemia

56
Q

functional gastrointestinal disorder with no specific structural or biochemical alterations characterized by recurrent abdominal pain and discomfort associated with altered bowel habits that present as diarrhea or constipation or both

symptoms relieved with?

A

IBS

*symptoms are relieved by defecation and do not interfere with sleep

57
Q

overweight BMI

A

> 25

58
Q

obese BMI

A

> 30

59
Q

molecules that stimulate eating

A

orexins

(hypocretins [from the hypothalamus], a
peptide family that act as neurotransmitters for
stimulating eating)

60
Q

molecules that inhibit eating

A

anorexins

61
Q

visceral obesity

A

intra-abdominal, central, apple shaped obesity

62
Q

peripheral obesity

A

gluteal-femoral, subcutaneous, pear shape

63
Q

patho of appendicitis

A

obstruction by inflammatory process, foreign body, or neoplasm

normally polymicrobial process

obstruction of the lumen leads to increased pressure, ischemia, and inflammation of the appendix

64
Q

formed in sterile environment and primarily composed of caclium bilirubinate polymer from hyperbilirubinbilia

A

black pigmented gallstone

65
Q

associated with bacterial infection of the bile ducts with formation of stone that is composed of calcium soaps, unconjugated bilirubin, cholesterol, fatty acids, and mucin

A

brown stones gallstones

66
Q

remember that if a gallstone gets lodged in the common bile duct this can cause what s/s

A

jaundice

67
Q

gallstone complication

A

pancreatitis

68
Q

clinical manifestations of cholecystitis

A

fever, leukocytosis, rebound tenderness, abdominal muscle guarding

pain increases after fatty meal when bile is trying to be secreted

69
Q

acute pancreatitis resolves how? clinical manifestations?

A

spontaneously

epigastric or midabdominal pain, n/v, fever, leukocytosis

elevated amylase 3x normal (amylase P is more specific)

lipase elevated and remains high

70
Q

clinical manifestations of chronic pancreatitis

A

continuous or intermittent pain associated with increased intraductal pressure, increased tissue pressure, ischemia, neuritis, ongoing injury, and changes in central pain perception

weight loss, steatorrhea, DM accompanies disease progression

71
Q

patho of acute liver failure

leading cause?

A

occurs in the absence of liver disease or cirrhosis

leading cause is acetaminophen overdose

patho: hepatocytes become edematous - patchy areas of necrosis and inflammatory cell infiltrates disrupt the parenchyma - hepatic necrosis is irreversible

72
Q

irreversible inflammatory fibrotic disease that disrupts liver function and structure

A

cirrhosis

73
Q

causes of cirrhosis

A

viral hepatitis and alcohol abuse

74
Q

patho of cirrhosis

A

fibrosis occurs and biliary channels become obstructed and cause portal HTN - portal HTN causes blood to be shunted away from the liver - hypoxic necrosis develops

75
Q

alcoholic liver disease caused by and what does it cause?

A

oxidation of alcohol causing damage to hepatocytes

impairs the hepatocytes’ ability to oxidize fatty acids, synthesize enzymes and proteins, degrade hormones, and clear portal blood of ammonia and toxins

76
Q

stages of alcoholic liver disease

A

Stages:
Steatosis (alcoholic fatty liver) Is the mildest form.
Is reversible if drinking is stopped.

Alcoholic hepatitis (steatohepatitis)
•Is characterized by inflammation.
•Degeneration and necrosis of the hepatocytes occur.

Alcoholic cirrhosis (fibrosis)
•Toxic effects of alcohol metabolism on the liver, immunologic alterations,
oxidative stress from lipid peroxidation, and malnutrition occur.

77
Q

clinical manifestations of alcoholic liver disease

A

anorexia, nausea, fever, abdominal pain, jaundice

78
Q

primary biliary cirrhosis vs secondary biliary cirrhosis

A

primary (autoimmune): t-lymph mediated and antibody mediated destruction of the small intrahepatic bile ducts

secondary biliary cirrhosis: common bile duct obstruction; resolved w/removal

79
Q

portal hypertension regions affected

A

pre hepatic (portal vein): caused by thrombosis or narrowing of the portal vein

intrahepatic (within the liver): from vascular remodeling with intrahepatic shunts, thrombosis, inflammation, or fibrosis of the sinusoids

posthepatic (hepatic vein): occur from hepatic vein thrombosis or cardiac disorders (RHF or pericarditis) that impair pumping of R heart

80
Q

most common clinical manifestation of splenomegaly from hepatic HTN

A

thrombocytopenia - increased tendency to bleed

81
Q

jaundice from extra hepatic obstruction to bile flow

A

gallstones

82
Q

intrahepatic obstruction - jaundice - from what?

A

from cirrhosis or hepatitis

83
Q

prehepatic obstruction - jaundice

A

excessive production of bilirubin from excessive hemolysis of RBCs

84
Q

stages of hepatitis

A

incubation

prodromal (pre-icteric): begins approx 2 weeks after exposure; ends with appearance of jaundice
-clinical manifestations: fever, malaise, anorexia, hepatomegaly, tenderness; HIGHLY TRANSMISSIBLE

icteric phase: actual phase of illness
-jaundice, hyperbilirubinemia, fatigue, abdominal pain, increased bilirubin in serum, PT prolonged

recovery phase: begins with resolution of jaundice
-symptoms resolve after several weeks - chronic or chronic active hepatitis may develop

Advanced Patho UC (14 decks)

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