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Pathophysiology - Diseases > GI diseases pt 2 > Flashcards

GI diseases pt 2 Flashcards

1
Q

how do diseases of intestines manifest?

A

diarrhea
constipation
changes in stool characteristics
secondary diseases that arise as a result of poor nutrition

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2
Q

What is appendicitis?

A

acute and painful inflammation of the appendix

most common in males before puberty to age 25

location of appendix at cecum makes it a trap for fecal material which contains bacteria (particularly Escherichia coli)

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3
Q

s/s of appendicitis?

A

appendix to become swollen, red and covered with inflammatory exudate

possible to develop gangrene (become green and black)

walls of appendix may thin and rupture causing fecal material to spill into peritoneal cavity = peritonitis

nausea, vomiting, fever of btwn 99F and 102F and elevated WBC count

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4
Q

how to diagnose appendicitis?

A

physical exam (pain begin in mid abd and shifting to the RLQ)

pt may walk or lie bending over and draw R leg up to abd to seek pain relief

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5
Q

What is malabsorption syndrome?

A

inability to absorb fat or other substance from the small intestines

main cuase is defective mucosal cells in small intestine (also hindered if intestinal enzymes and chemicals r not propelry assisting digestive process), disease pancres or blocked pancreaticduct, reduced secretion of bile (caused by hepatic disease or bile duct obsrtuction), also prevents lipid digestion, hyperparathyroid and diabetes mellitus, severe parasitic and worm infestiaions

often occurs with other types of diseases and disorders

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6
Q

diseased pancreas + malabsorption syndrome

A

disease pancreas/ obstructed pancreatic duct deprives small intestine of lipase and amylase = fat cant be digested or absorbed

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7
Q

s/s of malabsorption syndrome?

A

bleeding bc vitamin K essential to blood clotting cant be absorbed
lack of energy
inability to maintain weight
fat in stool (fatty, pale stool with a foul odor, stool floats)
abd discomfort
bloating with gas
chronic diarrhea
abnormal bowel movement
anemia
SOB

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8
Q

how to diagnose treat malabsorption?

A

diagnose w/ several blood tests, lab analysis of stool samples, biopsy of small bowel

treat - depends on cause, diet is carefully controlled and supplements of fat-soluble vitamins A, D, E and K and high-protein, high cal

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9
Q

What is Celiac disease + other names?

A

aka gluten enteropathy and celiac sprue

disease of small intestine, characterized by malabsorption, gluten intolerance, damage to lining of intestine

affects 2 million ppl or 1 in 133 ppl

caused by toxic or an immunologic reaction to component of gluten, genetic, 2x more in females

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10
Q

risk factors of celiac disease?

A

seems to be genetics
immune dysfunction
affects twice as many females as males
more common in European ancestry

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11
Q

s/s of celiac disease?

A

dermatitis herpetiformis (skin rash of pruritic papulovesiclve on extremities and over trunk, scalp and neck)
recurrent diarrhea
gas
abd cramps
systemic signs of malnutrition due to low caloric intake and poor absorption of vitamins
wt loss
anorexia
duarrgea
fkatulence
abd distention
intestinal bleeding
weakness
muscle wasting
large, pale, greasy, foul-smelling stools

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12
Q

how to diagnose and treat celiac disease?

A

diagnose - positive serologic testing, biopsy of small intestine showing changes or destruction in mucosal lining ((atrophy and flattening of intestinal villi), improvement while on a gluten-free diet, blood tests for WBC, platelets, albumin, PT, glucose tolerance, upper GI and small bowel radiographic studies

treatment - elimination of gluten from diet, fluid replacement and vitamin supplements, corticosteroids for refractory sprue

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13
Q

What are Diverticula + etiology & s/s?

A

little pouches or sacs formed when the mucosal lining pushes through the underlying muscle layer of the intestinal wall (called diverticulosis) which become diverticulitis when these acs become impacted fecal material and bacteria and become inflamed

  • colonic diverticla may vary in size, from a few mm to several centimeters and in number from 1 to several dozen
  • sometimes pt expresses nonspecific bd distress, such as pain and flatulence, difficulty in defacation, alternating constipation and diarrhea and even blood in stool
  • cause is unknown, thought to be caused by diet that contains inadequate roughage and excessive amounts of highly refined food (lack of roughage = small-caliber, drier stools)
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14
Q

Where is diverticular disease most prevalent?

A

in western industrialized nations where fiber consumption is the lowest

50% of older adults develop diverticulosis

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15
Q

what are the risk factors for diverticulitis?

A

age
diet low in fiber
family history

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16
Q

What does diverticulitis cause?

A

causes low, cramping pain in left side of abt and lumen of intestine to narrow and obstruct

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17
Q

how to diagnose and treat diverticulitis?

A

diagnose - CT scan and endoscopy

Treat - antibiotic therapy with controlled diet

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18
Q

What is regional enteritis + etiology?

A

aka Crohn’s disease, inflammatory disease of intestine that frequently affects the upper colon and sometimes the distal end of the ileum

caused by allergies, immune disorders or stress

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19
Q

risk factors of crohn’s disease?

A

affects white adults age 20-40

2-3 times more common among Ashkenazi Jews

family history

autoimmune disease

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20
Q

s/s of crohn’s disease?

A
  • peroianal fissures and fistulas
  • related to the inflammation
  • intestinal walls become thick and rigid
  • lumen narrows and develops a chronic obstruction
  • resembles appendicitis
  • malaise, fever, abd fullness, blood in stool
  • crappy, intermittent abdominal ain, often in RLQ abdomen
    severe diarrhea, constipation and melena
  • anorexia, nausea and vomiting leading to wt loss
  • inflammation can manifest as RA, hemorrhage or perforation
  • complications include deep ulcerations, symptoms of bowel obstruction, adhesions, abscesses, mimin small intestine bacterial overgrowth (SIBO)
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21
Q

how to diagnose and treat Crohn’s disease?

A

diagnose - CT, endoscopy, enteroscopy, test for elevated level of WBC, low levels of potassium, calcium and magnesium, biopsy

treat - anti-inflammatory meds and immunosuppressive agents, antibioitcs, sterois, anticholinergics, narcotics, surgery to correct complications like obstruction, perforation or massive hemorrhage (may need ileostomy), dietary supplements of vitamins, minerals, proteins and calories, iv nutrition

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22
Q

What is chronic ulcerative colitis + etiology?

A

type of chronic inflammatory bowel disease that affects mucosa and submucosa of rectum and colon

serious inflammation of the colon characterized by extensive ulceration of the colon and rectum

may be caused by autoimmunity, E. coli infection, stress or hypersensitivity to certain foods (familial tendency)

higher occurance in white ppl of Jewish descent (usually occurs betwn 15 and 30)

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23
Q

What are the typical s/s of chronic ulcerative colitis?

A

teesmus
bloody diarrhea
urgency to defecate
mucoid stools
pus blood, and mucus in the cramplike pain in the lower abdomen
anemia
cramps and rectal pressure
weight loss
fever
malaise
periods of remission and exacerbation

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24
Q

how to diagnose chronic ulcerative colitis?

A

diagnose - clinical symptoms, reduced Hgb level and leukocytosis, electrolyte abnormalities, plain film radiograph, stool cultures, colonscopy and CT in which colon looks like it doesnt have normal pouchlike markings of the colon (appears straight and rigid - pipestem colon), barium enema studies, biopsy

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25
Q

how to treat chronic ulcerative colitis?

A

aimed to reduce symptoms, rpelace nutruents, stop blood loss and prevent complications

reducing stress, eliminate triggering food (low in fat and bulk and high in protein, vitamins and calories), adrenal corticosteroids (prednisone and hydrocortisone for autoimmunity), anticholinergic drugs, Anti-TNF (antibodeis to TNF)

colostomy, preoctocolectomy (surgery to remove colon and rectum) followed by ileostomy or ileoanal anastomosis

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26
Q

What is the cancer of the colon and rectum (___ leading cancer COD + risk factors)?

A

4th leading cancer cause of death in US

chance of getting it is increaed by longstanding ulcerative colitis and familial polyposis, a diet high in red meat and low in dietary fiber, diabetes mellitus, Crohn disease, first-degree relative with colorectal cancer, cigarette smoking, obesity, higher intake of fruits and vegetables, aspirin, NSAIDs

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27
Q

what is familial polyposis?

A

heredity disease in which numerous polyps develop in the intestinal tract (no symptoms unless malignagcy)

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28
Q

S/s of colon and rectum cancer

A

ascites
cachexia
lymphadenopathy
hepatomegaly
change of bowel habits
diarrhea
constipation is symptomatic
abd discomfort and pressure
blood in stool
blood loss from tumor = anemia
weakness
wt loss
iron deficiency
abdomen distention
pallor

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29
Q

how to diagnose and treat colorectal cancer?

A

digital rectal exam and CT, colonsocpy, fecal occult blood test, double-contrast barium enema, EUS, level of carcinoembryonic antigen (CEA)

treat with chemo, radiation therapy, and surgery (may need colostomy) (if matastatic then treatment is amined at palliation of symptoms)

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30
Q

where are most malignancies of large intestine?

A

rectum or sigmoid colon

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31
Q

What are intestinal obstructions?

A

classified as:
organic - material bloackage
paralytic or functional - decrease in peristalsis (prevent the propulsion of intestinal contents)

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32
Q

Type of intestinal obstructions?

A

tumor (physical obstruct intestine)
hiatal and inguinal hernias (intestine pinches as it protrudes through muscle of body wall)
volvulus (intestine twists on itself)
adhesions (linking of 2 surfgaces by fibrous scars; occurs after surgery or inflammation)
intussusception (segment of intestine telescopes into the part forward to it)

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33
Q

What is flatus?

A

gas

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34
Q

what does an acute organic obstruction cause?

A

sever pain, abd becomes distended and vomiting occurs, complete constipation - no flatus

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35
Q

how to remove organic obstruction?

A

suction tube or surgery

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36
Q

what is strangulated hernia obstruction?

A

protrusion of intestine through abd wall, surgery is needed because strangulated segment can become gangreous

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37
Q

what is a paralytic obstruction?

A

results from peritonitis

if a loop of small intestine is surrounded by pus from infection smooth muscle cant contract so sphincters can go into spams and fail ot open bc of intense pain

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38
Q

What are hemorrhoids?

A

varicose veins in the lining of the rectum near the anus

internal or external

often painless but could be rectal pain, itching, protrusion, or bleeding, esp after defecation, mucous discharge from rectum, sensation of incomplete evacuation, difficulty cleaning the anal area

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39
Q

how to observe internal and external hemorrhoids?

A

internal - proctoscope (hollow tube with a lighted ended)

external - handheld mirror

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40
Q

cause of hemorrhoids?

A

heredity
poor dietary habits
inadequate fiber
overuse of laxtatives
lack of exercise
constipation
straining
pregnancy
any condition that increases pressure on veins

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41
Q

What can straining to have a bowel movement cause?

A

bleeding, hemorrhoid to proplase (come through anal opening)

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42
Q

when do hemorrhoids frequently occur?

A

during pregnancy bc of pressure from an enlarged uterus

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43
Q

diagnose and treatment of hemorrhoids?

A

diagnose - visual insepciton of anal area, proctoscopy, low Hgb and RBC count

treat - adding fiber and water to diet, stool softeners to reduce straining and subsequent inflammation, may take medicated suppositories and anorectal creams for pain and reduce inflammation, warm sitz baths along with topical anesthetic ointment or witch hazel compresses, sclerotherapy injections to induce scar formation, band ligation, cryosurgery, photocoagulation, electrocoagulation, thermocoagulation, stapled hemorrhoidectomy

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44
Q

What is spastic colon?

A

aka irritible bowel syndrome (occurs in 20% of am adults, more women than men)

functional bowel disorder cahracterized by chronic abdominal pai or discomfort, bloating, erratic dysfuct=ion of bowel habits

cause of IBS is unknown but incidence of developing IBS increases after actue GI infection which suggests an immune or neuroimmune contribution (pt may report other chronic pain disorders such as fibromyalgia, lactose intolerance, back pain, urinary symptoms, anxiety and depression)

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45
Q

s/s of IBS

A

episodes of cramping or aching abdominal pain typically relieved by defectation
- change of bowel habits with predominant diarrhea or constipation
- bloating and abdominal distention r commonly experiences
- tenesmus
- Gastroesophageal reflux
- nausea
- feeling of lump in throat
- abd pain and gas

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46
Q

diff btwn spastic/ irritable colon and other diseases?

A

no lesion, tumor or ulceration

functional disorder of motility (movement of colon most likely caused by colon muscle spasms)

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47
Q

risk factors for IBS?

A

abuse of laxatives
consumption of certain foods and beverages,
particularly caffeine, alcohol, spicy foods, fatty
foods, and concentrated orange juice that can irritate the bowel
age 20-40 and primarily female gender predominace

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48
Q

what to avoid if you have IBS?

A

beans and cabbage (have carbs that ferment by colon bacteria to promote gas)

laxatives

emotional stress

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49
Q

What is dysentry?

A

infectious disease with acute inflammation of the colon

uncommon in US but occurs in places where food or water sanitation

caused by bacteria, parasitic worms and other microorganisms

50
Q

what is the leading cause of death from infectious idsease in young children?

A

dysentery

51
Q

risk factors for dysentery?

A

poor sanitation, being under 6 over age 65, having immune deficiency

52
Q

What is Entamoeba histolytica?

A

transmitted in feces-contaminated food and water, causes amebiasis (amoebic dysentery)

invades wall of colon and causes numerous ulceration, which account for the pus and blood in the stools

treated with amebicides

53
Q

s/s of of dysentry?

A

diarrhea containing pus, blood and mucus accompanied by severe abd pain

54
Q

what is bacillary dysentry caused by?

A

various species of gram-neg bacteria in genus Shigella

treated with antibiotics

55
Q

What is diarrhea?

A

unformed watery stool that is result of contents of smal intestine rushe through large intestine

mild or severe, acute or chronic

cause dehydraton and electrolyre imbalanace

severe or prolonged diarrhea can produce metabolic acidosis

pt may be lethargic and may hyperventilaite

s.s include intestinal cramping, wakenss, nausea, irritabilty and fever

stool passage may become painful

sign not disease

large intestine cant reabsrob water from feces bc peristalsis in intestine is intensified

56
Q

What impairs water absorption by mucosal cells?

A

intestinal infections and food poisoning

57
Q

What is constipation?

A

inability to eliminate feces from color and feces become hard and dry

caused by poor habits of elimination, dehydration, low-fiber diets

58
Q

what happens if defecation doesnt occur when defaction relexes r strong?

A

feces remain too long in colon , excess water reabsoprtion - feces become dry, making elimination difficult

59
Q

What does it mean if blood in stool is bright red?

A

bleeding from distal end of colon (rectum)

may indicate bleeding hemorrhoids

can indicate cancer of rectum

60
Q

What does dark blood mean in stool?

A

gives melena dark,tarry appearance

originated from stomach or duodenum (altered as it passed through digestive tracts)

bleeding ulcer of cancer of stomach

can be caused by certain meds (like those with iron)

61
Q

What is occult blood?

A

blood not present to naked eyye but a chemical test shows presence

indicates bleeding ulcers or a malignancy in digestive tract

62
Q

What does stool that is large and pale mean?

A

appears greasy, floats in water means they contain fat

symptom of malabsorption syndrome

diseases liver, gallbladder or pancreas

63
Q

How does liver disease manifest?

A

inflammation or when chronic damge to liver cells

64
Q

What is jaundice?

A

aka icterus, yellow or orange discoloration of the skin, tissues and whites of eyes

associated with liver disease

caused by buildup of bilirubin (yellow pigment from breakdwon of hemoglobin - normal excreted in bile and urine)

65
Q

What diseases cause jaundice?

A

cirrhosis, hepatitis, inflammation of gallbladder or bile ducts, gallstones or hemolyic anemia

66
Q

What is viral hepatitis?

A

systemic infection that causes inflammation of liver to destruction of hepatic cells

caused by hepatitis virus A (move through the fecal-oral router), B, C (B and C r bloodborne), and D (E is uncommon in the US)

67
Q

What is hepatitis A + diagnose and treat?

A
  • formerly called ifnectious hepatitis
  • least serious form
  • develop as isolate or epidemic case
  • incubation period is 2-6 weeks from exposure
  • caused by contaminated water or food
  • mild in children and more severe in adults
  • only viral hepatitis causing spiking fevers
  • diangose wit hblood tests for elevate ALT, AST, liver function studies, prolonged PT time, serum bilirubin level, bilirubinuria, antibody to HAV in serum
  • treat with rest, symptom control, inrtamuscular administration of Ig, isolation, meds to control nausea and pain, low-ft, high carb and restriction of physical activity
68
Q

s/s hepatitis A?

A

anorexia, nausea and mild fever, urine is darker in color, jaundince, liver may be enlarged and tender

69
Q

What provides temp protections agaisnt hepatitis virus A?

A

Immunoglobulin injections

70
Q

What is hepatitis virus B + diagnose and treat?

A

aka serum hepatitis

more serious and common disease

1.25 milllion american r chronically infected with hepatitis B (25% will die from cirrhosis)

aminotransferase levels r higher than in HAV infection, liver inflammation causes destruction of liver cells and necrosis, abnormal results of liver profile studies

sudden onset and progresses rapidly

delirium is followed by coma and death

diagnose with detection of hepatitis B surface antigen in blood (if in blood for over 6 months, chronic)

treat with oral antiviral therpay in chronic, usually general medical managemetn as it is self-limiting, interferon, hepatitis B Ig

71
Q

How is heptatis virus B spread?

A

donating blood, serum transfusions that contain virus, sexual transmission, sharing contaminated needles or syringes

72
Q

What is hepatitis C + s/s and diagnose?

A
  • leading viral cuase of chronic liver disease and cirrhosis
  • most common reason for liver transplants and bloodborne infection
  • incubation period varies from 2 weeks to 6 months
  • s/s resemble hepatitis A, less severe and sometimes without jaundice, results in radual, insidious liver disease, necrosis, fibrosis, and cirrhosis
  • 4+ million Americans have Hep C currently
  • diagnose with ultrasonography of liver, lab findings include elevated serum levels of liver enzymes, elevated serum bilirubin, bilirubinuria, circuliating virus in blood (HCV ribonucleid acid serum test) + postivie blood test result for presence of anti-HCV antibodies
73
Q

About __% of those infected with hepatitis C
develop cirrhosis, and a number of these cases
can lead to end-stage liver disease

A

20

74
Q

how is hepatitis C transmitted?

A

mostly through blood transfusions, IV drug use, kidney dialysis, organ transplant, secual contact w/ someone with hepatitis, wokringin healthcare, illegal drugs

75
Q

how to treat hepatitis C?

A

interferon injections and oral ribavirin, Sofosbuvir (Sovaldi) s the 1st treatment bleieved to cure hepatitis C in conjucntion wsith ribavirin or peginterferon, and ribavirin, gamma globulin, antiviran agent interfereoin- a, glucocorticoids

may need liver transplant

76
Q

What is hepatitis D virus?

A

defective virus bc it can only reproduce if cell is also infected with hepatitis B

more serious and more frequently progresses to chornic liver disease

77
Q

What is hepatitis E?

A

v. rare i nUS

worldwide iti s the leading cause of epidemics of infectious hepatitis

major epidemics occur in Africa, Asia and Mexico

transmitted through fecal-contaminated drinking water

78
Q

What is cirrhosis of liver?

A

chronic destruction of liver cells and tissue with nodular, bump regeneration (replacement of normal liver cells with hard, fibrous, scar tissue known as hbnail liver)

12th leading cause of death in US (kills abt 26k yrly)

alc cirrhosis is most common (other causes r malnutriotion, hepatitis, paraxsites, toxic chemicals, CHF, Wilson disease, hemochromatosis)

79
Q

other names for alc cirrhosis?

A

portal, Laennec, or fatty nutritional
cirrhosis (an accumulation of fat often develops
within the liver)

80
Q

What occurs to a cirrhotic liver?

A

loses highly organized arrangement of cells, bv and bile ducts

liver cells r repalced by fibrous connective tissue and scar tissue (no liver cell function)

liver starts enlarged due to regenration but becomes smaller as the fibrous connective tusse

has nodular appearance (hobnailed liver)

81
Q

What happens to rest of abd due to cirrhosis?

A

high bp in vessels of abd and other areas

esophageal veins swell = esophageal varices

spleen, pancrease and sotmach swell

these organs and vessels may hemorrhage

may lead to hematemesis

82
Q

what is a characterisistic symptom (among others) of cirrhosis?

A

distention of abd caused by accumulation of fluid in the peritoneal cavity (fluid is called ascites, develops as a result of liver failure)

pressure in obstructed veins forces plasma into abd cavity

at first smypomt r vague and mild (pt experiences loss of appetite and wt, nausea and vomiting, indigestion, edema, tend to bruise and bleed more easily, frequently nosebleed, skin appears jaundiced and dry with pruritus, small, red, spidery marks on face and body, testicular atrophy, gunectomastia, loss of chest hair in male), impaired memory, confusion and droswiness

83
Q

What does the disorganization of the liver due to cirrhosis cause?

A

blackage of the bile ducts

= bile in blood = jaundice bc bile is not secreted in duodenum = clay colored stool and dark color to urine

84
Q

impact of cirrhosis on men?

A

liver inactivates estrogen produces in adrenal glands but if liver doesnt do that then men have feminizing effect, boobies enlargen (gynecomastia), palms become red, hair on chest is lost, female type distribtion of hair, atrophy of testicles

85
Q

effect of cirrhosis on blood?

A

liver cant detoxify so ammonia and poisonous substance in blood

86
Q

what can elevated ammonia cause

A

neurological disorders (confusion, disorientation, stupor, asterixis, abn sleeiness and hepatic coma)

87
Q

other causes for cirrhosis?

A

severe chronic hepatitis, chronic inflammation of bile ducts, certain drugs and toxins that = necrosis of lier cells r first step in developing cirrhosis

88
Q

diagnose and treatment for cirrhosis?

A

diagnose - physical exam (liver appears enlarged, firm to hard, palpable blunt edge, abd radiographs show enlargement, blood studies for elevated liver enzyme and bilirubin levels, CT, ultrasonography needle biopsy) cant reverse liver damage but can try preventing further damage by treating alcoholism or liver infection

treat - symptoms, ex: treat edem with diuretics, portal hypertension is fixed with beta blockers to reduce bp, vitamin and mineral supplements, anaticds, diuretics (prevents edema, ascites), paracentesis, only solution is liver transplant

89
Q

What is hepatocarcinoma + demographics and etiology?

A

cancer of the liver, rare malignancy of liver, high mortality rate, 1% of all cancer (6& in men 2% in women)

most prevaent in men over 60

usually arises in setting of chronic lvier disease

90
Q

what is most cancer in lvier?

A

secondary that metasised from ther orgnas, esp colon, rectum, sotomahc, pancreas, esophagus, lungs or breat

91
Q

causes for liver cancer

A

primary - viral hepatitis and cirrhosis, HBV, exposure to aflaxtoxins, mostly in Africa and Asia

other causes r aflatoxin (toxin from mold that grow on peanuts and rice)

92
Q

s/s of hepatocarcinoma?

A

depends on site of tumor

if in portal vein ascites in abd cavity + cirrhosis

if fluid has blood than malignancy

tumor blocking bile duct = jaundice

wt loss, abd mass, pain in RUQ

early satiety, upper abd pain

thrombocytopenia, elevated bilirubin, low albumin, electrolyte abnormalities

elevated serum alphafetoprotein (AFP), protein secreted by neopalstic liver cells

93
Q

How to diagnose and treat liver cancer?

A

serum levels of enzymes that arise from diseases liver tissue, mainly needle biopsy or open biopsy, AFP level greater than 500 g/L, ultrasonographym CT, MRI, liver biopsy (risky in pt with cirrhosis)

prognosis is poor

treat - surgical resection (partial hepatectomy), radiofrequency ablation, percutaneous ethanol injection

94
Q

What is cholelithiasis + s/s and etiolgy
?

A

aka gallstones

precipitated bile components in gallbladder and bile ducts

stones r created when bile composition changes, gallblader msucle activity reduces, pregnancy , use of oral contraceptives, diabetes mellitus, obesity, cirrhosis and pancreatitis, high cal, high cholesterol diet, ileal disease, alcohol cirrhosis

asymptomtic until bile ducts become obstucutred by stones, cockly pain (or biliary colic) signal obstruction, pain in epigastric or RUP, oten radiation ot right upper back in area of scapula, N^V, typically severe pain, flatulence, clay-colored stool jaundice (transient elevations of bilirubin and alkaline phosphate, AST, and ALT)

95
Q

stats for gallstones?

A

affects 1 million americans

affects 2x women than men

risk factors r gender, obesity, age and family history

96
Q

what are gallstones composed of?

A

aka biliary calculi, are madeof cholesterol, bilirbin and calcium

small sontes r caled gravel (can enter common bile duct and cause obstruciton = pain)

97
Q

How to diagnose and treat gallstones?

A

ultrasound and xray, elevated serum bilirbuin

treat with cholecystectomy (ligate cystic duct and examine common bile duct for stones), endoscopic retrograde cholangiopancreatography (ERCP) to identify and remove stones in common bile dusct, bile acids to dissolve stones, extracorporeal shokck wave lithotripsy (ESWL)

cant administer solubilizing agen t through catheter in bile duct to dissolve remaining stones

98
Q

What is cholecystits?

A

inflammation of the gallbladder, usually associated with gallstones (cholelithiasis) (can be assocaited with trauma or otherinsult ot gallbaldder, includign infection)

most common in middle age

risk factors r age, being female and having gallstones

diagnose with clinical picture, ultrasonogrpahy, radioisotope gallbladder study (hepatobiliary iminodiacetic acid (HIDA) scan), elevated WBC count and increased serum bilirubin level

treat with dietary modification, nasogastric tube, IV solution to replace fluids and electolytes, cholecystectomy

99
Q

s/s of cholecystitis?

A

swelling of the gallbladder

pain under R rib cage radiating to right shoulder

gallbladder can be paplated

chills

fever

N&V

belching

indigestion (esp after fatty foods)

guardig URQ muscles

shallw respiration

jaundice

clay-colored stools

dark urine

pruritius

ruptured gallbladder

100
Q

why pain with cholecystitis?

A

when eating fat duodenum stimulates gallbaldder to contract = pain (prolonged inflammation = walls of gallbladder to contract = pain)

101
Q

complications of cholecystits?

A

lack of blood flow bc of obstruction = swelling = infarction = gangrene (may need surgical removal)

102
Q

what is biliary cirrhosis?

A

necrosis and fibrosis of lvier cells lining bile ducts when bile accumuilates in the bile ducts in the liver

103
Q

What is acute pancreatitis + etiology?

A

serious, painful inflammation of the pancreas

more prevanelnt nin women and usually occurs after 40

thought to be caused by “escape” of activated pancreatic enzymes from acinar cells into surrounding tissue (could be cause by alcholism, biliary tract disease, trauma, infection, structural anomalies, greatly elevated calcium level in blood, hemorrhage, hyperlipidemia, drug may cause pancreatic, gallstones)

104
Q

What is pancreatitis associated with in men and women (seperately)?

A

men - associated with alcoholism or perptic ulcers (v. poor prognosis)

women - gallbladdder disease (good prognosis)

105
Q

s/s pancreatitis?

A

local swelling, necrosis, hemorrhage or trauma

sudden severe, steady abd pain (back and resembles sharp pain of perforated ulcer)

N&V

epigastric pain is often worsened by walkign and lying supine or improved by sitting and leaning forward

acutely ill, diaphoretic, tachycardic with shallow, rapid respirations (B{ falls and body temp rises)

Jaundice (if swelling blocks common bile duct)

greasy stool with foul odor(no lipid enzymes from pancrease)

secondary malabsorption syndrome

protein and lipid digesting enzyme become activated in pancrrease and digest the organ itself - necrosis and edema

severe internal bleedign and shock (acute hemorrhagic pancreatitis)

105
Q

s/s of chronic pancreatitis?

A

ANOREXIA
constipation
flatulence
weight loss
organ becomes fibrotic
signs of malabsorption and diabetes mellitus
psychiatric disturbances (including depression and anxiety)
N&V

106
Q

How to diagnose and treat pancreatitis?

A

diagnose - blood and urine tests for elevated pancreatic enzymes such as lipase and amylase, elevatedWBC, and hyperglycemia , may test stool for foat, abd CT or ultrasound, radiography and ultrasonography for stones, CT w/ oral or IV contrast

treatment - hospitalization, few days of fasting, IV fluids, analgesics, no smoking, drinking alc and good hydration, pain meds (usually narcotic), monitor electrolytes, serum amylase and lipase, Hct, glucose and serum calcium

107
Q

What is cancer of the pancreas`?

A

adenocarcinoma

more frequent in males btwn 35-70

malignancy in head of pancrease can block common bile duct (=jaundince and impaired digestion = malabsorption of fat and clay-colored stool, sufficient nutrients and cal and wt loss, great pain)

can get v. advanced before discovered

most of neoplasms arise from exocrine cells of pancreas wherease 1-2% involve endocrine cells

108
Q

risk factors for adenocarcinoma?

A

cigarette smoking
high-protein and -fat diets
food additives
exposure to industrial chemicals such as
beta-naphthalene, benzidine, and urea
Chronic alcohol abuse
chronic pancreatitis
diabetes mellitus
obesity
mutations in cancer susceptibilty genes BRCA1, BRCA2 and STK11

109
Q

how to diagnose and treat adenocarcinoma?

A

diagnose - laparoscopic biopsy and ultrasound, CT, dilated bile ducts, mass in pancreas, CA 19-9 serum tumor marker, tissue diagnosis by EUS fine-needle aspiration biopsy of mass and lymph nodes, staging laparoscopy (bc of location pancreas is inaccessible to palpation and insensitive to many diagnstic techniques)

treatment - prognosis is poor so death is relatively short, treatment is surgerical resection (only viable for pt with disease confined to pancreas and peripancreatic nodes) (only 15-20% of pt are canddates for surgery), stents, control of pain and treatment of depression, weight loss, malabsorption, chemo and radia,tionation

110
Q

Age related sdiseases of mouth and esophagus?

A

dental caries (cavities) r more prevalent in children

as you get older risk for gingivitis and periodontal disease increase

periodontal disease and osteoporosis = tooth loos in older adults

number of taste buds, saliva secretion lessen = decreased appetitie

esophageal cancer is high for those over 60

111
Q

Age related sdiseases of GI tract?

A

infectious diarrheal diseases r leading cause of death in children worldwide (cant tolerate loss of enormous amt of water, elctrolytes and nutrients)

hiatal hernia, hemorrhage r greater in older adults

colon cancer icnreases after 45

diverticula is most common in older adults

intestinal motility is slsightly decreased

112
Q

Age related sdiseases of liver and gallbladder?

A

uncommon in children

in adulthood liver function diminsished w/ increasing age = persistence of high blood lvels of med or toxins, levels of clotting factors decline, cholelithiasis is highest in those over 80

113
Q

Age related sdiseases of pancreas?

A

pancreatic disorder r uncommon in children except for Type 1 diabetes

type 2 (known as adult-onset diabetes) is starting to occur in children as a result of obesity

pancreatic cancer peaks in 60s and most common on older men

acute pancreatitis is common in older adults (in younger ppl acute pancreatitis is associated with alcholism while odler adults get acute pancreatistis from gallstones blocking pancreatic duct)

114
Q

How to diagnose and treat diarrhea/

A

DIAGNOSE - since it’s a sign not disease clinician seeks to determine degree, cuase and fluid electrolute status of pt w/ specific hsitory of onset and severity of symptoms, lab blood testing, stool cultures and analyis of stools

treat - monitor fluid electrolute balaance, frequency, color, consistency and genreal composition of stool, oral intake restruction, appropriate antibiotcs, IV fluid and electrolyte therapy

115
Q

What is vomiting?

A
  • ejection of stomach contents through mouth
  • range from mild ergurgitation to projectile expulsion
  • distneted abd, irritable, often fever
  • aspiration of vomitus into lungs can result in pneumonia
  • possible dehydration
  • more common in infants for reasons such as overfeeding, food lalergy, gastric irritation, infection, drug poisoning, elevated intracranial pressure, defect and habitual voluntary vomiting
  • diabogse w/ physical, history, monitoring wt, nutriotnal status, fluid and electrolute balance and radiographi sutdy of itnesitna ltract
  • treat w/ withhelding food, change in technique or intake of food for infatns, medical or surgical intervetion
116
Q

how to diagnose and treat IBS?

A

diagnose - history, physical, test, physical symptoms, involve excluding other conditions with similar symptoms, colonoscopy or double-contrast barium enema with sigmoidoscopy (age > 50 years)

treat - no cure, soluble fiber supplements, stool softeners, laxatives for constipation-dominant, diarrea-dominant IBS = antidiarrheal, ondansetron has been show to block, tricyclic antidepressants, antispasmodic drugs, nonabsorbed antibiotics, guanylate cyclase-c agonists

117
Q

how to diagnose and treat IBS?

A

diagnose - history, physical, test, physical symptoms, involve excluding other conditions with similar symptoms, colonoscopy or double-contrast barium enema with sigmoidoscopy (age > 50 years)

treat - no cure, soluble fiber supplements, stool softeners, laxatives for constipation-dominant, diarrea-dominant IBS = antidiarrheal, ondansetron has been show to block, tricyclic antidepressants, antispasmodic drugs, nonabsorbed antibiotics, guanylate cyclase-c agonists

118
Q

how to diagnose and treat IBS?

A

diagnose - history, physical, test, physical symptoms, involve excluding other conditions with similar symptoms, colonoscopy or double-contrast barium enema with sigmoidoscopy (age > 50 years)

treat - no cure, soluble fiber supplements, stool softeners, laxatives for constipation-dominant, diarrea-dominant IBS = antidiarrheal, ondansetron has been show to block, tricyclic antidepressants, antispasmodic drugs, nonabsorbed antibiotics, guanylate cyclase-c agonists

119
Q

What is hepatoblastoma?

A
  • childhood cancer that arises in an otherwise normal liver
  • more common in children with a history of prematurity or with certai ngenetic syndromes such as Beckwith-Wiedemann syndrome or familial colonic polyposis - (if hepatoblastoma cna be treated with chemo, surgical resection or lvier transplant)
120
Q

s/s of adenocarcinoma?

A
  • abdominal pain
  • wt loss
  • jaundice
  • N&V
  • acholic (without bile) stools
    = steatorrhea
  • ascites
  • abdominal tenderness
  • palpable gallbladder
  • glucose intolerance
  • increasing weakness
  • fatigue
  • diarrhea
  • elevated bilirbuin and alkaline phospatease conncentration
121
Q

What is motion sickness?

A
  • loss of equilibrium experienced during motion
  • during episode of motion sickness, pt experiences N&V when riding in motor vehicle, boat, airplane (air hunger, excessive salivation, pallor, sweating, dizziness, or headache may precede nausea and vomiting)
  • results from disturbance in sense of balance (fluid in semicircular canals of ear becomes dislocated bc of motion)
  • to prevent sit in spot w/ least amt of motion and where u can see orizon, avoid food and liquid before traveling, only small amts, anti emetics

Pathophysiology - Diseases (22 decks)

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