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Pathophysiology Exam 3 > GI and Liver > Flashcards

GI and Liver Flashcards

1
Q

Gastrin

A

stimulates gastric acid, blood flow

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2
Q

Cholecystokinin (CCK)

A

Contraction of gallbladder and secretion of pancreatic enzymes

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3
Q

Secretin

A

inhibits gastric acid secretion; stimulates secretion of water from the pancreas

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4
Q

Ghrelin

A

peptide hormone stimulates food intake and digestive function (appetite)

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5
Q

Digestion and Absorption

A

Requires hydrolysis, enzyme cleavage, fat emulsification

Absorption: moving nutrients from external intestinal lumen to internal environment.

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6
Q

Clinical Manifestations of GI Dysfunction

A 
Anorexia: lack of appetite
Vomiting (emesis)
Constipation 
Diarrhea 
Abdominal Pain 
GI Bleeding 
Melena in Lower GI (bloody/dark stool)
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7
Q

GERD

A

Reflux of gastric contents into esophagus as a result of
Reduction in lower esophageal sphincter tone
Delayed gastric emptying
Increase gastric acid secretion
Irritation of esophageal mucosa

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8
Q

S/S of GERD

A 
Pyrosis (heartburn) cardinal symptom 
Belching 
Atypical Symptoms
Esophageal pain referred to the neck, mid-back, upper abdomen
Chest pain
Chronic cough, wheezing, Hoarseness
Chronic sore throat, dysphagia
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9
Q

GERD Risk Factors

A 
Factors which reduce LES tone
Aging
Obesity
Pregnancy (hormones_
High fat meals
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10
Q

Peptic Ulcer Disease

A

A group of ulcerative disorders that occur in areas of the upper gastrointestinal tract that are exposed to acid-pepsin secretions
Erosion of the gastric membrane
Gastric ulcers
Duodenal ulcers
Stress ulcers- Curling’s ulcer stimulates acid production in stomach
Duodenal ulcers are more popular then gastric

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11
Q

PUD Risk Factors

A

Helicobacter pylori (H-Pylori) infection
90-95% of patients with duodenal ulcers
60-70% of patients with gastric ulcers

NSAIDs
Aspirin: blocks prostaglandins in stomach, this takes away from the stomach’s mucus lining

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12
Q

PUD S/S

A

Burning, gnawing, cramp-like
Frequently when stomach empty
Midline epigastric, near xiphoid…may radiate to back or right shoulder
Relieved by foods or antacids

Periodicity: daily for weeks, then remits until next occurrence

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13
Q

PUD Complications

A 
Bleeding 
Hematemesis (blood)
Coffee ground emesis 
Hematochezia (blood stool)
Melena (foul/dark bloody stool)
Occult bleeding

Gastric Outlet Obstruction
Caused by edema, spasm, scar tissue

Perforation
Peritonitis: inflammation from bacteria throughout GI

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14
Q

Inflammatory Bowel Disease (IBD)

A

Idiopathic chronic disorders of the GI tract distinguished by the recurrent inflammatory involvement of intestinal segments.

Two main types:
Crohn’s disease
Ulcerative colitis (UC)
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15
Q

Crohn’s Disease

A

Granulomatous inflammatory lesions of the GI tract.
Peak age of onset 20-30’s (Crohn’s), and 30’s (UC)
Family history
Genetic predisposition – triggered by dietary antigen or microbial agent

Location: Mouth to anus. Mostly small intestine & proximal colon. Smoker’s and Jews are mostly affected

Pattern: “Cobblestone” inflammatory appearance of submucosal layer 
Skip lesions (healthy mucosa) if multiple

Manifestations
Intermittent diarrhea, steatorrhea, colicky pain (cramping), weight loss, F/E imbalances, nutritional deficiencies, malaise, low-grade fever.

Complications: anal & perianal fistulas, abscesses, intestinal obstruction

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16
Q

Diagnosis for Crohn’s Disease

A

Sigmoidoscopy & Colonoscopy with biopsy: inflammation; biopsy often reveals granulomatous inflammation
X-rays
CT scan
Sedimentation rate: elevated shows inflammation
Complete Blood Count: possible anemia
Electrolytes: imbalances (Potassium)

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17
Q

Treatment for Crohn’s Disease

A 
Gastroenterologist referral 
Corticosteroids
Immunosuppressants
Antibiotics- Metronidazole (Flagyl)
Nutritious diet; residue free/bulk free to allow bowel rest
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18
Q

Ulcerative Colitis

A

Inflammatory condition confined to the mucosal layer of the rectum and colon

Starts in rectum and spreads proximally through colon

Confluent inflammatory pattern (no “skip” lesions)
Lead to pinpoint mucosal hemorrhages; may develop into crypt abscesses; may become necrotic & ulcerate
Pseudopolyps of mucosal layer (obstruction of bowels)

Manifestations
Bloody diarrhea, nocturnal diarrhea, mild abdominal cramping
Complications: Colon cancer risk; toxic megacolon in severe fulminant type

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19
Q

Ulcerative Colitis Diagnosis and Treatment

A

Diagnosis: History & Physical/Colonoscopy

Treatment: Diet modifications, Fiber reduces diarrhea
Avoid caffeine, lactose, spicy, and gas-producing foods
Corticosteroids, Immunosuppressants, Surgery

20
Q

DIVERTICULAR DISEASE

A

Diverticulum/Diverticula – saclike protrusions of the mucous membrane that herniates outward through muscular layer. (outpouches or outpocketings)
Diverticulosis – the presence of diverticula
Diverticulitis – diverticula become inflamed and may perforate (undigested food, fecal matter, and bacteria become trapped forming fecalith: stone of feces)

21
Q

Diverticular Disease Risk Factors

A 
Increases dramatically with age
More common in North America, Australia, and Europe
Affects men and women equally
Risk Factors
Low fiber diet
↓strength of colon musculature
↓physical activity (strengthens ALL muscles!)
Poor bowel habits
22
Q

ACUTE DIVERTICULITIS

A 
LLQ ABDOMINAL PAIN (93-100%)
Tender palpable mass in Left Lower Quadrant
Fever
Mild to moderate leukocytosis 
Nausea, vomiting, and anorexia
Constipation/Diarrhea
23
Q

APPENDICITIS

A

Inflammation of the vermiform appendix
Can lead to gangrene and perforation (peritonitis)

Cause: Intraluminal obstruction w/ fecalith
Signs and Symptoms
Initially: vague epigastric or periumbilical pain
Nausea, vomiting, anorexia
Follow onset of pain
RLQ McBurney’s point rebound tenderness
75% have leukocytosis 10-18,000/mm3
Fever
Psoas sign: extend leg/check for pain by stretching muscle
Obturator test: rotating ankle, leg for pain

24
Q

DIAGNOSIS/TREATMENT for Appendicitis

A 
Emergency Department
History & Physical 
CT scan** (or U/S)
Appendectomy (surgical)
IV Antibiotics
Complications 
Peritonitis
Abscess formation
Septicemia
25
Q

Intestinal Obstruction

A

Mechanical vs. Paralytic

Mechanical (feces, stricture, edema):
Hernias, adhesions, strictures, tumors, foreign bodies, intussusception (part of bowel breaks off), volvulus (twisting of bowel)
Severe colicky pain (cramping)
Borborygmy (bowel sounds rapidly present)

Paralytic (failure of motility from NS innervation):
“adynamic”: not moving
Neurogenic or muscular impairment of peristalsis
Paralytic ileus
Absent bowel signs

S/S:
Abdominal distention, pain, constipation, vomiting, Fluid & Electrolyte disturbances.

26
Q

COLORECTAL CANCER

A

Uncontrolled growth of malignant cells in the large intestine
Risk Factors - >40-50 age, polyps, family history, DM, Tobacco, diets rich in fats and red meats, ethnicity
S/S – Change in bowel habits, occult blood, bloating, anorexia
Pain/weight loss is a LATE sign!
Diagnosis – Colonoscopy, CoreoEmbryonic Antigen
Treatment – Surgery, chemo, radiation
Screening recommendations: every 2 years for polyps, colonoscopy every 10 years

27
Q

Peritonitis

A

Inflammatory response of the peritoneal membrane
Causes:
Bacterial or chemical irritation
Perforated ulcers, diverticulum, appendix
Gangrenous bowel or gallbladder

28
Q

S/S of Peritonitis

A 
Pain & tenderness 
Rigid/board-like, distended, guarded abdomen 
Shallow respirations 
Nausea/Vomiting 
Fluid losses; Dehydration 
Fever
↑WBC count
Tachycardia 
Hypotension

Complications: Paralytic ileus, Hypovolemia, Sepsis
Shock

29
Q

VIRAL HEPATITIS

A

Viral infection affecting the liver
Five viral causative agents: A,B,C,D,E
Hepatitis B, C, and D can cause chronic infections

Risk Factors:
HAV & HEV
Transmitted via fecal-oral route
Travel to endemic areas
Ingestion of contaminated food, water, milk, or shellfish
IgM anti-HAV, IgG anti-HAV
Hep A vaccine available
30
Q

Heptatitis B and C RISK FACTORS

A 
HBV, HCV –blood/body fluids
Shared needles
Multiple sexual partners
Tattoo recipients; body piercings
Health care workers
Can cause chronic hepatitis & cirrhosis
All adolescents are considered high-risk for HBV
Risk for hepatocellular CA w/ HCV
HBV vaccine available
31
Q

SIGNS AND SYMPTOMS of Hep B and C

A

Many are asymptomatic
Nausea, vomiting, anorexia, RUQ abdominal pain, liver enlargement
Malaise, fever
Sclera become yellow (icteric)
Jaundice, dark urine, clay-colored stools
Elevated ALT, AST, bilirubin levels

32
Q

DIAGNOSIS for Hep B and C

A

Liver function tests
ALT, AST – hepatic injury
ALT – Think Hepatitis B
AST – Alcohol, Statins, Tylenol
PT/albumin (low) – measure synthetic activity of liver. Long time to clot
Increased Bilirubin – measure of excretory function of liver

33
Q

CIRRHOSIS

A 
End stage chronic liver disease 
Irreversible inflammatory disease
Disrupts liver structure and function
Inflammation causes structural fibrotic changes
Disruption of blood flow…portal HTN
Obstruction of biliary system…jaundice
34
Q

S/S of Cirrhosis

A 
Most common: Weight loss (masked by ascites fluid), Weakness, Anorexia, Ascites, Diarrhea, Jaundice
Abdominal pain (epigastric or RUQ)
If portal HTN & liver failure: esophageal varices, bleeding, encephalopathy (confusion and ammonia in blood), splenomegaly.
35
Q

The Fate of Bilirubin

A

The liver converts bilirubin into conjugated bilirubin
Bilirubin passes on to the intestine
Bacteria convert it to urobilinogen
Some is lost in feces
Most is reabsorbed into the blood via portal circulation
Returned to the liver to be reused
Filtered out by the kidneys urine

36
Q

Why would a man with liver failure develop jaundice?

A

Bilirubin elevation

37
Q

Liver Failure Leads To…

A

Hematologic disorders: Anemia, thrombocytopenia (low platelet), coagulation defects, leukopenia (WBC)

Metabolic disorders: Fluid retention, hypokalemia, disordered sexual functions

Skin disorders: Jaundice, red palms, spider nevi (spider veins)

Hepatorenal syndrome: Azotemia, increased plasma creatinine, oliguria

Hepatic encephalopathy: Asterixis, confusion, coma, convulsions
Ammonia not converted to urea

38
Q

Disorders of the Gallbladder

A 
Cholelithiasis (gallstones)
Cholesterol, calcium salts, or mixed
Acute and chronic cholecystitis
Inflammation caused by chemical irritation due to concentrated bile. Can result in ischemia from mucosal swelling 
Choledocholithiasis
Stones in the common bile duct
Cholangitis 
Inflammation of the common bile duct
39
Q

Cholecystitis

A

Gall bladder disease
Acute – Complete or partial obstruction of the cystic or common bile ducts.
Inflammation caused by chemical irritation from the concentrated bile, mucosal swelling and ischemia.
Bacterial infection
Mucosal necrosis gangrene perforation

Risk Factors
The Five F’s: Females, Fat, Fair-skinned, Family history, 40’s

40
Q

SIGNS AND SYMPTOMS of Cholecystitis

A

RUQ pain that radiates to the tip of the right scapula
Murphy’s sign: palpating (pain), can’t take a breath
Excessive belching
Flatus
Nausea and vomiting
Low-grade fever
Elevated WBC count
Worsening symptoms after ingesting fried foods.

41
Q

Exocrine Pancreas

A 
Acini produce:
Inactive digestive enzymes
Trypsin inactivator
These are sent to the duodenum
In the duodenum, the digestive enzymes are activated
42
Q

Biliary Reflux

A
  1. Gallbladder contracts
  2. Bile is sent down common bile duct
  3. Blockage forms in ampulla of Vater: bile cannot enter duodenum
  4. Bile goes up pancreatic duct
  5. Bile in pancreas disrupts tissues; digestive enzymes activated
43
Q

ACUTE PANCREATITIS

A

Rapidly developing, potentially fatal, inflammatory disease of the pancreas
Escape of pancreatic enzymes cause autodigestion of the pancreas and fat necrosis
Causes:
Gall stones/Alcohol/GI surgery

44
Q

Autodigestion of the Pancreas

A

Activated enzymes begin to digest the pancreas cells
Severe pain results
Inflammation produces large volumes of serous exudate hypovolemia
Elevated enzymes (amylase, lipase) appear in the blood
Areas of dead cells undergo fat necrosis
Calcium from the blood deposits in them
Hypocalcemia

45
Q

Acute Pancreatitis S/S

A

Severe abrupt abdominal pain that may radiate to the back.
Pain worse in supine position
N/V
Hyperglycemia
Hypotension & tachycardia
Fever
Elevated pancreatic enzymes – Amylase, Lipase,

Tx – aggressive hydration, antibiotics, NPO, NGT, pain management, surgery. Grey Turner’s Sign: blood in pancreas, by back. Cullen’s sign: bruising near ubilical area

46
Q

Chronic Pancreatitis and Pancreatic Cancer

A

Have signs and symptoms similar to acute pancreatitis
MOST common cause: ETOH (alcohol)
Permanent destruction of exocrine function and later stages also endocrine fxn destruction
Often have:
Digestive problems because of inability to deliver enzymes to the duodenum
Glucose control problems because of damage to islets of Langerhans
Signs of biliary obstruction because of underlying bile tract disorders or duct compression by tumors

Pathophysiology Exam 3 (6 decks)

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