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Med Con II > GI Disorders > Flashcards

GI Disorders Flashcards

1
Q

Function of the GI tract (4)

A

Digestion
o physical breakdown and chemical alterations of food stuff to allow absorption along GI tract
o Involves GI motility, pH changes, biological detergents and enzymes
Absorption
o Direct movement of nutrients across the intestinal lining
Excretion
o Food residue, hydrophobic molecules (drugs bacteria and dead cells)
Host defense
o Largest lymphoid organ in the body with extensive surface area
o Gut microbiome
o

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2
Q

Function of the esophagus

A

-Fibromuscular tube connecting the throat with the stomach
-Food passes by peristaltic contractions
Sphincters: bundles of muscle that control entry/exit
o Upper esophageal sphincter
o Lower esophageal sphincter

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3
Q

Explain GERD and contributing factors

A

Reflux of gastric contents into the esophagus causes heartburn
contributing factors:
1. incompetent lower esophageal sphincter
2. impaired gastric emptying
3. Hiatal hernia
4. Alcohol abuse
more common in children with developmental delays

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4
Q

Complications of GERD

A
  1. Regurgitation/malnutrition
  2. Esophagitis- inflammation of the esophagus
  3. Barretts Esophagus
    -Transformation of the normal esophagus squamous epithelium to columnar epithelium “pre malignant”
    -Increased risk of developing esophageal cancer
  4. Respiratory compromise: Associated with asthma and COPD
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5
Q

Function of the Stomach

A
  1. Reservoir function: controlled release of chyme into small intestine
  2. mechanical digestion: gastric motility peristalsis
  3. chemical digestion: digestive enzymes continue digestion of protein and fats
  4. Hydrochloric acid: chemical digestion activates digestive enzymes; immune defense
  5. Intrinsic Factor (IF): binds vitamin b12 for absorption
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6
Q

If there is an issue with intrinsic factor in the stomach what happens? Where is intrinsic factor produced

A

individual will become vitamin b12 deficient
intrinsic factor is produced in the parietal cells

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7
Q

Cell types within the stomach allow for what?

A

alot of cell types in the stomach secrete mucus to protect the stomach from its own acidity

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8
Q

Define Gastritis and acute causes

A

Gastritis: inflammation of the inner lining of the stomach
excessive acid production> gastric defense
ex: NSAID, ASA, ETOH
Stress induced
ex: common in critical illness

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9
Q

Define Peptic Ulcer Disease

A

increased acid secretion and digestive enzymes that erode the gastric mucosa
Helicobacter pylori infection: infection leading to PUD

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10
Q

Complications of PUD

A

Hemorrhage, peroration, peritonitis, scarring
defined by site of origin

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11
Q

15% of long term ___ users develop peptic ulcer disease

A

NSAID
Asprin, ibuprofen and cox2 inhibitors

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12
Q

What are the risk with NSAID/Asprin

A

pain relief with GI bleeding risk blocks both COX1 and COX2

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13
Q

What are the risks with COX2 inhibitors

A

pain relief with decreased GI bleed risk but Increased MI/CVA risk

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14
Q

GI Bleed Red Flags

A
  1. Syncope (passing out)
  2. hypotension
  3. pallor
  4. diaphoresis
  5. Tachycardia
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15
Q

Coffee ground emesis/ black tarry stools indicate what type of GI bleed

A

UGIB
not good

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16
Q

Blood in stool indicates what type of GI bleed

A

LGIB

17
Q

What examination items would you include for a pt who has a PMH including GIB

A

review the H & H values- look for trends slow decrease in value recognize that the blood volume is less and less oxygen carrying capacity
normal RBC around 13-17 male
female 12-15

18
Q

Function of the small intestine

A
  1. mixes and grinds (segmentation) and propels (peristalsis) contents
  2. digests and absorbs nutrients
  3. secretes regulatory hormones

mainly absorbs nutrients!!!!

19
Q

Explain Small Intestine segmentation

A

mixes and grinds breaks down food

20
Q

Explain small intestine peristalsis

A

propels food bowel forward

21
Q

Function of Large Intestine

A

main function of large intestine is reabsorption of water along with ions and some vitamins

22
Q

What is the same and different about crohns disease and ulcerative colitis

A

Crohns Disease: inflammation that involves the entire bowel wall
pain in the lower right abdomen
Ulcerative Colitis: involves inflammation of the inner most lining of the bowel wall
pain is common in the lower left abdomen

Both involve joint pain and the medication taken suppresses the immune system thus these individuals are at a higher risk of infection

23
Q

Common presentation of Crohns and Ulcerative Colitis

A

abdominal cramping, pain, diarrhea, obstruction, fatigue, malabsorption, leading to weight loss and malnutrition

24
Q

What is IBS

A

o Disturbed bowel function without structural abnormalities
o Spasmodic motility pattern
o Malabsorption
o Nutrient deficiency and loose stools
o Etiology is unknown but IBS is believed to be related to colonic sensitivity
o Diagnosis of exclusion

25
Q

Celiac Disease

A

Autoimmune disorder genetic predisposed people where ingestion of gluten damages the small intestine
can lead to malabsorption and symptoms of bloating, diarrhea, gas and fatigue

other issues include anemia, osteoporosis

26
Q

Describe Hernia

A

Protrusion of an organ through the wall of the cavity that normally contains it

Can lead to necrotic tissue or ischemia to the protruding tissue
Doesn’t necessarily need surgery

27
Q

Describe Acute Abdomen/ Peritonitis and the Physical Exam

A

Sudden severe abdominal pain <24 hrs in duration
often a medical emergency
causes: appendicitis, cholecystitis, pancreatitis, ischemic bowel, AAA

Physical Exam:
identify location, palpation reveals rigidity; rebound tenderness; bowel sounds are usually diminished or absent

28
Q

Colorectal Cancers

A

Progression often starts with benign polyp
early detection; Colonoscopy
common symptoms: bleeding; pressure/pain with deification; change in elimination
associated with: family history, diet, age, exercise

3rd most common cancer 3rd leading cause of death

29
Q

Common post operative compliations and what the PT role is?

A

pain
pulmonary complications
bleeding
infection
ileus: decrease motility/paralysis of the bowel
bowel leakage: sepsis

pt needs to be aware of pt changes in presentaion

30
Q

Explain Pancreatitis

A

acute inflammation of the pancreas
leads to inflammation and auto-digestion
Causes: Alcohol abuse and gall stones

31
Q

Common Signs and Symptoms of Pancreatitis

A

Severe abdominal pain, often radiating to the back
nausea/vomiting
symptoms worsen after eating foods
relief with forward leaning
can mimic LBP

32
Q

Explain the importance of the liver in portal circulation

A

all GI veins go to the liver
Thus if there is an issue with the liver and its function the veins will back up and increase in pressure causing portal hypertension causing the veins to expand leading to varices

Varices can burst leading to Upper GI bleed

33
Q

Explain the liver and its role in the first pass effect

A

The liver plays a role in detoxifying noxious compounds found in chemicals and drugs thus all the things pass by the liver for detoxification

34
Q

Why does a pt with a liver disorder look swollen

A

If there is dysfunction of the liver then the liver is unable to produce albumen which makes it so that water isn’t readily pulled into the capillaries as much so the water is pushed out into the intersitum. however the patient is actually extremely dehydrated and hypovolemic and hypotensive because the water was pushed out. pt should not be on a diuretic

35
Q

Signs and Symptoms of Liver Dysfunction

A

Jaundice: excessive deposition of bile pigments
Ascites: abdominal swelling/fluid in the peritoneum
due to portal HTN and hypoalbuminemia

36
Q

What is the difference between an aneurysm and a dissection?

A

aneurysm: ballooning/weakening of vessel wall
ppl can have stable aneurysm for years

Dissection: tear in the intimal layer
medical emergency–> sharp pain
instant blood accumulation

37
Q

Clinical Presentation of ruptured/dissecting AAA

A
  1. sudden abdominal or back pain
  2. hypotension and tachycardia; sweating; clamminess; dizziness
  3. N/V
  4. Pulsating mass in abdomen
38
Q

What are the Risk Factors and Complications of AAA

A

age, family hx, HTN, CAD, smoking, high cholesterol, male

Complications
thrombosis
distal embolism
dissection and rupture

39
Q

Should a patient with a known aneurysm exercise?

A

high blood pressure–> pushing on already weakened walls

typically yes but with restrictions
HR: 90 bpm
BP: SBP 150
duration and size of aneurysm

Med Con II (8 decks)

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