gi disorders Flashcards
Upper and lower GI :
Upper : Esophagus, Stomach, Beginning of small intestines
Lower GI: Small intestines, colon (large intestines), rectum/anus
upper GI problems
esophageal:
- GERD
- Hiatial Hernia
Inflammatory disorders of stomach:
- gastritis
- acute gastroenteritis
- PUD
dysphagia definition
Defined: Difficulty swallowing
Begins with solids and progresses to liquids
Common Causes:
- Mechanical obstruction
- Stenosis or stricture
- Diverticula
- Tumors - Neuromuscular dysfunction, intubation or trach
- CVA
- Achalasia
– LES (lower esophageal sphincter) can’t open properly
what is GERD?
- gastroesophageal reflux disease
- upper GI problem
- esophageal disorder
- Backflow of gastric acid from the stomach into the esophagus
- Occurs via the lower esophageal sphincter (LES)
- Highly ACIDIC material!
gerd etiology
Anything that alters closure strength of LES or increases abdominal pressure Examples: Fatty foods Spicy foods Tomato based foods Citrus foods Caffeine Large amounts of alcohol Cigarette smoking Sleep position Obesity Pregnancy Pharmacologic agents
gerd clinical manifestations
Heartburn (pyrosis) Dyspepsia - indigestion Regurgitation Chest pain Dysphagia Pulmonary symptoms
gerd complications
Complications:
ulceration
scarring
strictures
Barrett esophagus (development of abnormal metaplastic tissue - premalignant)
**Three-fold increased risk of developing adenocarcinoma of the esophagus
Overall survival only 17%
**longterm GERD = increased risk esophageal
hiatal hernia
A defect in the diaphragm that allows part of the STOMACH to pass into the THORAX
Two Main Types:
1. Sliding hernia – usually small and often do not need treatment** less severe
2. Paraesophageal hernia- part of the stomach pushes through the diaphragm and stays there- peritonial becomes thin
**more severe
3-4. mix of type 1 & 2 and increase with severity
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
**obesity increases risk
risk factors hiatal hernia
age
obesity
smoking
clinical manifestations hiatal hernia
Asymptomatic
Belching
Dysphagia
Chest or epigastric pain
**common for hiatal hernia and GERD to coexist
hiatal hernia tx
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
what is gastritis
inflammatory condition of the stomach
acute gastritis
Defined: TEMPORARY inflammation of the STOMACH lining only (intestines NOT affected)
Generally last from 2-10 days
Etiology:
Irritating substances (**alcohol
Drugs (NSAIDs) - stop prostaglandin secretion in stomach
Infectious agents - h. pylori
chronic gastritis
PROGRESSIVE disorder with chronic inflammation in the stomach
Can last weeks to years
Complications: PUD, bleeding ulcers, anemia, gastric cancers
Two main etiologies:
Autoimmune - Attacks parietal cells
H. pylori infection - acute or chronic
what is h. pylori
Helicobacter pylori bacterium- gram negative spiral bacteria
Acidic environment
Destructive pattern of persistent inflammation
- Can cause chronic gastritis, PUD, and stomach cancer
How is it transmitted?
- Person to person via saliva, fecal matter, or vomit
- Contaminated food or water
clinical manifestations acute/chronic gastritis?
Sometimes none Anorexia N/V Postprandial (after eating) discomfort Intestinal gas Hematemesis Tarry Stools Anemia
what is acute gastroenteritis
Inflammation of stomach & SMALL INTESTINE
Etiology:
Viral infections: Norovirus and rotavirus
Bacterial infections: E. col, salmonella, campylobacter
Parasitic infections
Usually lasts 1-3 days but may last as long as 10 days
clinical manifestations and complications acute gastroenteritis
Clinical manifestations
*Watery Diarrhea
May be bloody if bacterial
Abdominal pain
N/V
Fever, malaiseComplication: fluid volume deficits
** decreased fluid = increased dehydration
what is peptic ulcer disorder (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
what are factors that influence healthy GI balancing?
aggressive factors (causing ulcers)
- h. pylori
- NSAIDs
- acid
- pepsin
- smoking
defensive factors
- mucus
- bicarbonate
- increased blood flow
- prostaglandins
peptic ulcer disease etiology
H. pylori
Injury-causing substances
**NSAIDs, ASA, alcohol
Excess secretion of acid
SmokingFamily history
Stress - remember there is increased gastric acid secreted with the stress response
**can worsen the response not the actual cause tho
risk factors NSAIDs PUD
**inhibits prostaglandin synthesis and decreases mucus protection in stomach
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
describe gastric ulcers
burning, cramping, gas-like
epigastric, back
1-2 hours after eating
describe duodenal ulcers
burning, cramping, gas-like
epigastrium, back
***2-4 hours after eating
how to best decipher btw gastric and duodenal PUD?
timing!!
gastric - 1-2 hrs after eating
duodenal - 2-4 hrs after eating
PUD complications (HOP)
“HOP” Complications H – Hemorrhage O – Obstruction - scarring tissue bondage P – Perforation and Peritonitis
what are the lower GI disorders
appendicitis
peritonitis
irritable bowel disorder
inflammatory bowel disorder
- Crohn’s and ulcerative colitis
diverticulosis/diverticulitis
appendicitis
Inflammation of the appendix
**RLQ pain
Etiology
Appendix is OBSTRUCTED
Leads to INFLAMMATION
Complications
Gangrene
Abscess formation
**PERITONITIS
appendicitis and pain
Classic Pain: RLQ in periumbilical area
Rebound Pain
Sudden pain relief may indicate rupture
- Peritonitis
Rebound Pain = Pain is SEVERE after release of palpating hand over the RLQ
what is peritonitis
Inflammation of the PERITONEUM (abdominal cavity)
Serous membrane that lines abdominal cavity & covers visceral organs (like the pleura for lungs)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
causes peritonitis
perforated ulcer ruptured gallbladder pancreatitis ruptured spleen ruptured bladder ruptured appendix non-asepsis during peritoneal dialysis
clinical manifestations peritonitis
Usually sudden and severe Abdominal pain* severe ***Tenderness Rigid “board-like” abdomen **hard to touch** N/V
Others: Fever Elevated WBC HR \_\_\_\_\_increased\_\_\_\_ BP \_\_\_\_decreased\_\_\_\_\_
lower GI problems
irritable bowel syndrome (IBS)
inflammatory bowel disease (IBD)
IBS - 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)
symptoms IBS
Symptoms: vary by individual
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
stress and IBS
IBS is almost never the result of primarily psychological causes
“Emotional stress did not cause my illness”
IBS can be exacerbated by stress
“Emotional stress can make my illness worse.”
IBS can cause stress and psychological problems
“My IBS is stressful to live with and may cause me to have emotional problems.”
Cause UNKNOWN but thought to be “triggered” by stress, food, hormone changes, GI infections, menses
inflammatory bowel disease - 2 types?
A group of life-changing, chronic illnesses
TWO SEPARATE DISORDERS:
Crohn’s disease
Ulcerative colitis
Characterized by:
Chronic inflammation of the intestines
Exacerbation and remissions
More common in WOMEN, Caucasians, persons of Jewish descent, and smokers
Etiology? Genetically
AUTOIMMUNE activated by an infection
crohn’s disease - pathogenesis
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
Complications: Malnutrition Anemia Scar tissue and obstructions Fistulas- connections btw 2 structure that's not normal 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 - location dependent
granulomas and skip lesions*
ulcerative colitis definition
Inflammation of the mucosa of the RECTUM AND COLON
Usually develops in the third decade of life
More common in white people of European descent, esp. Ashkenazi Jewish descent
Occasionally in Black/African Americans
Rare in Asians
ulcerative colitis pathogenesis**crypt abscesses
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
Why is this a problem? Tissue is fragile and bleeds easily
ulcerative colitis clinical manifestations
Abdominal pain
***Bloody diarrhea - not typical with crohns
Systemic:
Weight loss, fatigue, no appetite, fever
complications ulcerative colitis
Hemorrhage - bc of new granulation tissue Perforation Cancer Malnutrition Anemia Strictures FISSURES ABSCESSES - rectal, colon, anal 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
-increase risk vte/dvt
diverticular disease pathogenesis
Development of diverticula:
Small pouches in lining of colon that bulge outward through weak spots
May be CONGENITAL or ACQUIRED
Thought to be caused by low fiber diet with resulting chronic constipation
Usual location: DESCENDING COLON
diverticulosis vs diverticulitis
diverticulosis - not inflamed
diverticulitis - inflammed
diverticulosis clinical manifestations
Usually asymptomatic
Discovered accidently or with presentation of acute diverticulitis
diverticulitis
INFLAMMATION of one or more of the pouches (diverticula) Usually from retained fecal material Clinical manifestations Abdominal pain – LLQ Fever WBC’s \_\_increased_ Constipation or diarrhea Acute – passage large quantity of frank blood May resolve spontaneously
Complications
Perforation
Peritonitis
Obstruction
pyrosis?
heartburn
dyspepsia?
indigestion
