GI Disorders Flashcards
What are 4 etiology/risk factors for diverticular disease?
Poor diet (low fibre), poor bowel habits (constipation), inactivity, and ageing.
What is the patho for diverticular disease?
Normal weak points in gut for BV entry into gut & increased intraluminal pressure (from RF) results in mucosa herniating through muscularis externa causing a bowel protrusion (out pouch)
Where abouts in the GIT is diverticulosis most common?
Sigmoid colon
What is diverticulosis?
Formation of non-inflamed out pouchings.
What is diverticulitis?
Inflamed out-pouching as a result from strangulation.
Do manifestations occur in diverticulosis or litis? What are the 3 manifestations?
Diverticulitis. Dull pain, N and V, low grade fever.
What are the four treatments for diverticular disease?
Addressing risk factors, anti-inflm, pain meds, Sx for complications (perforation or obstruction).
IBS is a GI _____ disorder
Motility
What is the etiology for IBS?
Unclear, but triggers are related to diet, stress, and smoking.
What are the 5 manifestations of IBS?
Abdominal pain and discomfort, diarrhea/constipation, flatulence, nausea, and mucoid stools.
What are the two theories for the patho of IBS?
1st theory - malabsorption of fermentable CHO and polyols leads to gut flora processing and flatulence.
2nd theory - alteration in CNS regulation of GI sensory/motor fx results in a molecular signalling defect of serotonin.
What are the 4 functions of serotonin?
Pain, secretion, perfusion, motility.
How is IBS diagnosed?
Exclusion of organic disease and sigmoidoscopy.
What are the 5 treatments for IBS?
Eliminate triggers, reduce stress, antispasmodic drug (Modulon), antidiarrheal/laxative, abx with caution to reduce normal flora and reducing flatulence.
What is peritonitis?
Inflammation of the peritoneum.
What is the etiology of peritonitis?
Bacteria (E.coli) or chemical irritation (HCl, bile, pancreatic juice).
In what two ways can the etiologic factor in peritonitis enter the abdominal cavity?
Perforated ulcer or ruptured appendix.
What is the patho of peritonitis?
Etiologic agent impacts peritoneum leading to inflammation.
The peritoneum is highly vascularized, why is this negative?
Quick absorption of bacteria toxins.
The peritoneum is a large structure, what is negative about this?
The agent of injury spreads easily.
What forms as a result of inflammation to the peritoneum? Is this beneficial?
Thick exudate. Beneficial because is localizes the inflammatory process, seals perforations and limits the spread of the agent of injury.
How does the body compensate for peritonitis? What happens?
The SNS limits GI motility and an ileus forms.
What are the 4 manifestations of severe peritonitis?
Dyspnea (due to pain of diaphragm pushing against abdominal cavity), mucoid stools, ileus, hyperemia (altered perfusion, blood shunting and vasodilation)
What is the biggest concern with peritonitis? (Complication)
Hypovolemic shock due to massive fluid shift.
What are the 5 STAT treatments for peritonitis?
IV abx, anti-inflm, IV fluids, pain meds, surgery if necessary.
Appendicitis is acute inflammation of the _________
Appendix wall.
What is the etiology for appendicitis? 2 possibilities?
Idiopathic. Fecalith obstruction of cecum or twisting of bowel or appendix.
What is the patho for appendicitis?
Appendix lumen obstruction blocks drainage and blocks cecum which results in mucus being secreted into lumen and increases intraluminal pressure. Intraluminal pressure exceed venous and eventually arterial pressure. Then tissue becomes ischemic and eventually necrotic. Bacteria then enters wall from fecal matter and causes infection and inflammation.
How does pain progress throughout appendicitis?
Acute epigastric pain moves to periumbilical region, it increases and then becomes colicky over 12 hours and localizes to LRQ and becomes rebound pain.
What 4 manifestations are there for appendicitis?
Inc WBC, inc temp, N and V, severe pain.
How is appendicitis diagnosed?
US, CT, Px.
What are the 5 treatments for appendicitis?
IV abx, IV fluids, pain meds, anti inflm, and appendectomy (if necessary must be done within 24-48 hours)
What 2 conditions comprise IBD?
Chrons and ulcerative colitis
What are the 2 etiologic factors for IBD?
Genetic susceptibility + environmental trigger = complex trait, IR against normal gut flora (not autoimmunity).
What is the patho for IBD if the etiologic factor is an inappropriate IR toward normal gut flora?
IR targets bacteria on gut lining resulting in inflammation which also destructs gut lining.
Which disease is this? Terminal ileum most commonly affected, granulomatous skip lesions present, submucosa primarily affected.
Chron disease.
Which disease is this? Begins in rectum and spreads proximally. Primarily involves mucosa of colon and rectum. Continuous lesions.
Ulcerative colitis.
What happens to the inflamed tissue in ulcerative colitis?
It becomes thickened and hardened.
Development of cancer, and rectal bleeding/bloody diarrhea are common in UC or CD?
Ulcerative colitis.
Fistulas, strictures, and perianal abcesses are common in UC or CD?
Chrons disease.
What are 3 manifestations of Chron disease?
Weight loss (due to decrease absorptive area), intermittent abdominal pain, and diarrhea (increased peristalsis and exudate in lumen)
What are 3 manifestations of ulcerative colitis?
Bloody diarrhea, intermittent abdominal pain, weight loss (decreased appetite)
What 4 important diagnostics/diagnostic considerations are there for IBD?
Exclude viral/bacterial/parasitic/fungal GI infection, colonoscopy, sigmoidoscopy, biopsy.
If IBD is mild, what might a possible treatment be?
Diet modification.
If IBD is moderate-severe, what treatment will be done? What treatment will be done if pt is non-responsive to one of the previous treatment? What treatment might slow the progression of BD? What is a final treatment option if pt is not responsive to any drugs?
Sulfasalazine (anti-inflm). Steroids. Methotrexate. Surgery.
What two things must be in place for herniation to occur?
Weakened retaining structure (via injury, ageing, congenital defect) and increased intra abdominal pressure (via pregnancy or obesity).
Sliding hiatial hernia: what portion of stomach enters TC? Where is the GEJ? What are the 3 manifestations?
Upper part of stomach and GEJ enter TC. Pain (organ constriction), heart burn, reflux.
Rolling/paraesophageal hernia: what portion of stomach enters TC? Where is the GEJ? What are 2 manifestations?
Non-upper part of stomach in TC. GEJ is below diaphragm. Chest pain (impacting lung) and fullness after eating small meals.
What are 3 treatment options for symptomatic hernias?
Lifestyle modifications, behavioural modifications, diet modifications, drugs for reflux (antacid, PPI, H2RA), surgery.
What 2 things does fundoplication accomplish?
- Increases the GEJ size so it cannot move upward and 2. wraps fundus around GEJ which fortifies cardiac sphincter.
What is an inguinal hernia?
Weakening of aperture in which vas deferens, BVs and others pass through.