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EXAM 3: Pathophysiology > GI disorders > Flashcards

GI disorders Flashcards

Differentiate between the causes and manifestations of selected disorders of the esophagus (dysphagia, GERD, hiatal hernia), stomach (peptic ulcer disease, acute and chronic gastritis), and small and large intestines (constipation and diarrhea). Discuss nutritional disorders and their relationship to the GI system. Differentiate the pathophysiology, etiologies, and manifestations of obstructive (intestinal obstruction), inflammatory (Crohn disease vs ulcerative colitis, appendicitis, peritonitis

1
Q

What are common manifestations of GI disorders?

4

A

Anorexia
nausea
retching
vomiting

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2
Q

esophageal

causes of GERD

A

weak/incompetent lower esophageal sphincter (LES)
delayed gastric emptying.

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2
Q

esophageal

What are the symptoms of dysphagia?

A

difficulty swallowing
risk of aspiration.

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2
Q

esophageal

What are the causes of dysphagia?

A

neuromuscular (can’t move food down, CN 5,9,12)
structural issues (lesions/scars)

leading to a narrowed airway

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3
Q

esophageal

What is a hiatal hernia and how does it present?

A

Protrusion of the stomach through diaphragm

Often asymptomatic but may mimic GERD, may cause bleeding or strangulation.

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3
Q

esophageal

symptoms of GERD

A

heartburn (retrosternal, 30 -60 min after food)
regurgitation
mucosal injury
aspiration (asthma + chronic cough)
belching
CP
INFANTS: poor weight gain, crying/irritable

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3
Q

esophageal

what is GERD?

A

symptoms priduced by abnormal reflux of gastric contents into esophagus, oral cavity ot lungs from stomach

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3
Q

what is dysphagia?

A

difficulty swallowing

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3
Q

what causes a hiatal hernia?

A

weak diaphragm
esophagus hiatus is larger than normal

may strangulate = ischemic

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3
Q

what is gastritis?

A

inflammation of the gastric mucosa

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3
Q

what causes chronic diarrhea?

A

increased fluid retion in intestines
increased intestinal secretory processes
inflammatory conditons
infectious processes

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4
Q

What differentiates acute from chronic gastritis?

A

Acute: from local irritants (NSAIDs, alcohol), rapid onset, self-limiting.

Chronic: often due to H. pylori, leads to mucosal atrophy and PUD, ongoing symptoms

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4
Q

What is the difference between acute and chronic diarrhea?

A

Acute: less than 2 wks, from infectious agents (viral/bacterial), short duration.

Chronic: lasts >4 weeks, related to inflammation or secretory disorders.

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4
Q

`

what is peptic ulcer disease?

A

ulcerative disorders in the upper GI tract that are exposed to acid-pepsin secretions

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4
Q

cause of PUD

A

H pylori and NSAID
zollinger-ellison syndrome (gastrin secreeting tumor)
age/smoking/ETOH

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4
Q

what are the manifestations of PUD?

A

pain/discomfort (cramp/burn/gnaw/rhythmic, when stomach is empty)
gaurding

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4
Q

what are possible complications of PUD?

A

hemorrhage
perforation
penetration
gastric outlet obstruction

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5
Q

manifestations of non-inflammatory diarrhea

A

cramping (ard belly button)
bloating
NV
large volume, loose, watery stools
*dehydration risk + hypokalemia

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6
Q

manifestations of inflammatory diarrhea

A

fever
bloody, frequent, small stools
LLQ pain
feel like they need to poop but there is none

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7
Q

what is constipation?

A

infrequent, incomplete, or difficult passage of stools

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8
Q

what is the etiology of constipation?

A

primary: d/t inside of body
secondary: d/t side effects of meds, or another disease

inactive
pregnancy
narcotic use
spinal cord injury
peds: kids don’t want to
inaqdequate fiber/hyrdration

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9
Q

what is obesity?

A

having excess body fat accumulation with multiple organ specific pathologic consequences

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10
Q

BMI:
overweight
obese

A

overweight: over 25
obese: over 30

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11
Q

causes of obesity

A

energy imbalance (kcals > burned)
genetics
environment (available, fam eating)
culture/socioeconomic status

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12
types of obesity
Upper body (apple shape): more common in men, intra-abdominal fat, ↑ cardiovascular risk. Lower body (pear shape): more common in women, subcutaneous fat in hips/thighs
13
What GI consequences can obesity have?
GERD, gallbladder disease, fatty liver disease, increased risk for certain GI cancers
14
What is Marasmus and what causes it?
A form of PEM due to calorie **AND** protein deficiency.
14
What are general symptoms of PEM?
Muscle wasting weakness immune dysfunction frequent infections fatigue
15
What is protein-energy malnutrition?
A depletion of lean body mass and fat stores due to starvation or catabolic stress.
15
What are manifestations of Marasmus?
* Wasted" appearance * Muscle loss * protruding abdomen * Stunted growth * Diarrhea and recurrent infections * Dry, thin skin and hair
16
What causes Kwashiorkor?
Severe protein deficiency with adequate calorie intake, often seen after weaning ## Footnote more severe than marasmus
16
What are signs of Kwashiorkor?
Edema (especially in legs/face) Enlarged liver (fatty infiltration) Dermatitis and hyperpigmented skin Hair discoloration (flag sign) Apathy and irritability ## Footnote more severe wasting
17
What changes in metabolism occur during trauma or illness?
Accelerated protein breakdown Impaired protein synthesis Loss of protein from liver, heart, GI tract, kidneys decrease in immune cells (Inc infection risk)
18
What are potential complications of malnutrition in illness?
GI: mucosal atrophy, poor absorption Cardiac: decreased contractility Respiratory: reduced diaphragm strength Immunosuppression
19
What are two types of PEM related to illness?
Kwashiorkor-like: from stress (e.g., trauma, sepsis) Marasmus-like: from chronic disease or cachexia
20
What psychiatric disorders often accompany eating disorders?
Mood disorders anxiety personality disorders
21
what is anorexia?
psychologial and physiological disorder of self-starvation failure to maintain minimum weight w fear of being overweight determined dieting/purging + compulsive exercise = sustained low weight
22
what is the patho of anorexia?
decrease in body weight = depletion of body fat and protein
23
What are key features of anorexia nervosa?
Intense fear of gaining weight Self-starvation Amenorrhea Compulsive exercise Body weight less than 85% of expected
24
What physiological changes occur in anorexia?
Low estrogen/testosterone Electrolyte imbalances (e.g., hypokalemia) Bradycardia, hypotension hypothyroidism: Cold intolerance, dry skin, brittle hair Renal failure and anemia in severe cases ketoacidosis
25
What behaviors define bulimia nervosa? ## Footnote 4
Recurrent binge eating (2x/week for 3 months) Inappropriate compensatory behaviors (vomiting, laxatives, exercise) Concern with body weight/shape Normal or near-normal body weight
25
What complications can occur from bulimia?
Dental erosion, esophagitis (high acid content of vomit) Hypokalemia (d/t GI losses) Metabolic alkalosis (vomiting) or acidosis (laxative abuse)
26
How is binge eating disorder diagnosed?
Recurrent episodes (2+ days/week for 6 months) with ≥3 behaviors: * Eating rapidly * Eating when not hungry * Eating alone out of embarrassment * Eating until uncomfortably full * Feelings of guilt or disgust after eating
27
What is an intestinal obstruction?
A blockage that prevents normal movement of intestinal contents through the bowel in a "head-to-toe" direction
28
Who is most at risk for intussusception?
Children under 2 years old.
28
What are the two main types of intestinal obstruction?
Mechanical Obstruction (physical blockage) Paralytic (Functional) Obstruction (loss of peristalsis)
29
What are common causes of mechanical obstruction?
Intussusception: Telescoping of a bowel segment into another Volvulus: Twisting of the intestine Adhesions: Scar tissue that causes narrowing or kinking of the bowel Hernias or tumors may also obstruct the lumen
30
What is a volvulus and why is it dangerous?
A complete twisting of the intestine, which can compromise blood supply and cause ischemia and necrosis.
31
What are adhesions and how do they form?
Bands of scar tissue that form after abdominal surgery or infection, causing the bowel to stick together abnormally.
32
What is paralytic ileus?
A functional obstruction caused by loss of peristalsis in the bowel without any physical blockage.
33
What causes paralytic obstruction?
Abdominal surgery Infections (e.g., peritonitis) Electrolyte imbalances (e.g., hypokalemia) Medications (e.g., opioids)
34
what is the patho of a bowel obstruction? ## Footnote 4
* Accumulation of gas and fluid above the blockage * Increased intraluminal pressure * Impaired absorption * Risk of bowel perforation, peritonitis, and sepsis
35
what is more common SBO or LBO?
small
36
37
What symptoms are common in intestinal obstruction? ## Footnote 7
Cramping abdominal pain Abdominal distention Nausea and vomiting Complete constipation (no passage of stool or gas) Dehydration and electrolyte imbalances Hypoactive or absent bowel sounds (in paralytic ileus) High-pitched bowel sounds (in mechanical obstruction)
38
# * How do symptoms differ depending on location of the obstruction?
Small intestine: Rapid onset of vomiting, less distention Large intestine: Gradual onset, marked distention, late vomiting
39
What are serious complications of untreated obstruction?
Bowel perforation Sepsis Hypovolemic shock Strangulation (especially with volvulus or incarcerated hernia)
40
What is the underlying cause of many inflammatory GI disorders?
patho: An exaggerated immune or inflammatory response in the GI tract cause: genetic predisposition or environmental trigger (smoking).
41
What are the two main types of IBD?
Crohn Disease Ulcerative Colitis
42
What are shared manifestations of IBD?
Diarrhea Fecal urgency Weight loss Abdominal pain Skin lesions and systemic inflammation
43
What part of the GI tract does Crohn disease affect?
Any part of the GI tract (mouth to anus), most commonly the terminal ileum and proximal colon.
44
What are key pathological features of Crohn disease?
Transmural inflammation (affects all layers) “Skip lesions” (patchy areas) Cobblestone appearance of mucosa Granuloma formation
45
What complications are associated with Crohn disease?
Fistulas Strictures Abscesses Malabsorption (especially B12 and fat-soluble vitamins)
46
What part of the GI tract does UC affect?
Only the colon and rectum. ## Footnote may move upward
47
What are key pathological features of UC?
Continuous inflammation starting from the rectum Affects only the mucosa and submucosa Formation of crypt abscesses
48
What are common symptoms of UC?
Bloody, mucousy diarrhea Abdominal cramping Fecal incontinence Tenesmus (feeling of incomplete evacuation)
49
# * What is a major complication of UC?
Increased risk of colorectal cancer (especially with longstanding disease)
50
What is appendicitis and what causes it?
Inflammation of the appendix, commonly caused by intraluminal obstruction (fecalith, lymphoid hyperplasia).
51
What are symptoms of appendicitis?
Abrupt onset of RLQ pain (McBurney’s point) Rebound tenderness Nausea, vomiting Low-grade fever Pain may start peri-umbilical and then localize
52
What are potential complications of appendicitis?
Perforation Peritonitis Sepsis
53
what is the etiology of appendicitis?
intraluminal obstruction
54
what is the patho of appendicitis?
obstruction prevents appendix from draining and it becomes inflamed
55
What is peritonitis?
Inflammation of the peritoneum, the membrane lining the abdominal cavity.
55
What causes peritonitis?
Bacterial infection (e.g., bowel perforation, appendicitis, PID) Chemical irritation (e.g., bile, pancreatic enzymes)
56
What are clinical signs of peritonitis?
Severe abdominal pain and tenderness Guarding and rigidity Rebound tenderness Nausea/vomiting Fever Decreased bowel sounds (ileus may develop)
57
How can you differentiate Crohn’s from UC clinically?
Crohn’s: patchy inflammation, can affect any GI segment, deeper ulcers, more likely to form fistulas. UC: continuous inflammation in colon/rectum, more superficial, higher risk of bleeding and colon cancer.
58
What are ischemic GI disorders?
Conditions caused by reduced or interrupted blood flow to parts of the gastrointestinal tract, leading to tissue injury.
59
What are potential complications of ischemic GI disorders?
Bowel necrosis Perforation Sepsis Death if not treated promptly
60
What are common causes of intestinal ischemia?
Arterial embolism or thrombosis Low-flow states (e.g., shock, heart failure) Volvulus or strangulated hernias Intussusception (can also cause ischemia due to bowel compression)
61
What is colorectal cancer?
A malignancy of the colon or rectum, typically arising from adenomatous polyps.
62
What are risk factors for colorectal cancer?
Age > 50 Family history (especially with genetic syndromes like FAP or Lynch syndrome) Inflammatory bowel disease (especially UC) High-fat, low-fiber diet Smoking and alcohol use Obesity
63
What are later symptoms of colorectal cancer?
Visible blood in stool Abdominal pain or cramping Unexplained weight loss Fatigue Sensation of incomplete evacuation
64
What is the pathophysiology of colorectal cancer development?
Begins as a benign adenomatous polyp → progresses to carcinoma over years due to genetic mutations (APC, p53, KRAS, etc.)
65
What is the difference between diverticulosis and diverticulitis?
Diverticulosis: Presence of non-inflamed diverticula (outpouchings) in the colon. Diverticulitis: Inflammation or infection of one or more diverticula.
66
What causes diverticular disease?
Low-fiber diet → decreased stool bulk Increased intraluminal pressure in the colon Weak points in the bowel wall where vessels penetrate
67
What are symptoms of diverticulosis?
Often asymptomatic May have mild abdominal discomfort, bloating, irregular bowel habits
68
What are symptoms of diverticulitis?
LLQ pain (most common) Fever Nausea, vomiting Change in bowel habits (constipation or diarrhea) Possible complications: abscess, perforation, peritonitis
69
what is the patho of diverticular disease?
less feces produced = decreased colon diameter = increase in colon wall pressure
70
What is irritable bowel syndrome?
A chronic functional GI disorder with recurrent abdominal pain and altered bowel habits without an organic cause.
71
What causes IBS?
Exact cause unknown Likely related to gut-brain axis dysregulation, stress, gut microbiome changes, and abnormal motility
72
What are hallmark symptoms of IBS?
Abdominal pain relieved by defecation Bloating and gas Constipation and/or diarrhea (or alternating) Sensation of incomplete bowel emptying
73
What are the subtypes of IBS?
IBS-C: Constipation-predominant IBS-D: Diarrhea-predominant IBS-M: Mixed IBS-U: Unclassified
74
What aggravates IBS symptoms?
Stress and anxiety Certain foods (FODMAPs) Menstrual cycle in females

EXAM 3: Pathophysiology (8 decks)

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