GI dysfxn Flashcards
- Nausea Common symptoms:
hypersalivation and tachycardia
Steatorrhea
fat in the stools
iochemical mediators of the inflammatory response
histamine, bradykinin, and serotonin
o Upper GI bleeding location
Esophagus, stomach, or duodenum
o Lower GI bleeding locations
Below the ligament of Treitz, or bleeding from the jejunum, ileum, colon, or rectum
o Sliding hiatal hernia
stomach usually only protrudes into chest cavity on swallowing
o Paraesophageal hiatal hernia
stomach bulge protrudes into chest cavity beside esophagus
o An intestinal obstruction is any condition that
prevents the flow of chyme through the intestinal lumen or failure of normal intestinal motility in the absence of an obstructing lesion
o An ileus is an obstruction of the
intestines
o Functional obstruction
loss of function or paralysis commonly seen after surgery, opioids
o Small intestinal obstruction vs Large bowel obstruction s/s
pain in cramps and spasms with short (minutes) duration
widespread lower abdominal pain, spasms last longer
Most common of the peptic ulcers
Duodenal ulcers
Duodenal ulcers patho
H. pylori infection - Toxins and enzymes that promote inflammation and ulceration
Hypersecretion of stomach acid and pepsin
High gastrin levels
NSAIDs, Acid production by cigarette smoking
Gastric Ulcer: * Tends to develop in the _region of the stomach, adjacent to the acid-secreting mucosa of the body
antral
Gastric Ulcer patho
primary defect is an increased mucosal permeability to hydrogen ions
o Gastric secretion is normal or less than normal
Ulcers that develop due to increased intracranial pressure which stimulates vagal nerve and triggers increased gastric acid secretion
Cushing’s ulcers
Ulcers that develop as a result of a burn injury
o Curling’s ulcers
- Pancreatic insufficiency main problem
o Fat maldigestion is the main problem, so the person will exhibit fatty stools and weight loss
- Bile salt deficiency
o Poor intestinal absorption of lipids causes fatty stools, diarrhea, and loss of fat-soluble vitamins (A, D, E, K)
o Conjugated bile salts are synthesized from _in the _
cholesterol, liver
- Fat-soluble vitamin deficiencies A
Night blindness
Fat-soluble vitamin deficiencies E
Uncertain
- Fat-soluble vitamin deficiencies D
Decreased calcium absorption, bone pain, osteoporosis, fractures
- Fat-soluble vitamin deficiencies K
Prolonged prothrombin time, purpura, and petechiae
Ulcerative Colitis: * Chronic inflammatory disease that causes ulceration of the colonic mucosa
- Sigmoid colon and rectum
- Increased colon cancer risk demonstrated
ulcerative colitis
Crohn Disease
- Idiopathic inflammatory disorder; affects any part of the digestive tract, from mouth to anus. * Causes “skip lesions”, which can be seen as lesion in some haustra but not others. * Ulcerations can produce longitudinal and transverse inflammatory fissures that extend into the lymphatics
Crohn Disease can cause malabsorp of
vitamin B12 and folic acid
Asymptomatic diverticular disease
- Diverticulosis
Herniations of mucosa through the muscle layers of the colon wall, especially the sigmoid colon
- Diverticula
Appendicitis s/s
Epigastric and RLQ pain, rebound tenderness. Nausea, vomiting, fever, leukocytosis
Appendicitis most serious complication
peritonitis
- Blood supply to the stomach and intestine
o Celiac axis
o Superior and inferior mesenteric arteries
how many arteries required to cause vascular insufficiency
o Two of three must be compromised to cause ischemia
- Obesity Body fat index
> 30
- Leptin resistance
Failure of hypothalamus to react to released leptin
- Anorexia nervosa o In females, characterized by
absence of three consecutive menstrual periods
ANOREXIA - Person can lose _to _% of ideal body weight due to fat and muscle depletion
25-30%
- Bulimia nervosa
Two binge-eating episodes per week for at least 3 months
o Short-term starvation
Glycogenolysis, Gluconeogenesis
Marasmus
Protein energy malnutrition seen in absolute food deprivation. Results in dry skin, elimination of fat deposits, irritable behavior
Kwashiorkor
Protein deprivation with carbohydrate ingestion. Swollen, bloated abdomen secondary to decreased albuminemia, muscle atrophy, diarrhea.
HEPATITIS B: * Maternal transmission if the mother is infected during
the third trimester
- Responsible for most cases of post-transfusion hepatitis
Hepatitis C
- 50% to 80% of hepatitis C cases result in
chronic hepatitis
Depends on hepatitis B for replication
- Hepatitis D
- Hepatitis E transmission
Fecal-oral
- Acute hepatic failure
Acetaminophen overdose
- Irreversible inflammatory disease that disrupts liver function and even structure
- Decreased hepatic function from nodular and fibrotic tissue synthesis (fibrosis)
- Biliary channels become obstructed and cause portal hypertension; due to the hypertension, blood shunted away from the liver, and a hypoxic necrosis develops
Cirrhosis
o Cirrhosis begins in
bile canaliculi and ducts
Cleft Lip and Cleft Palate are developmental anomalies of the
first brachial arch
Cleft Lip Is caused by the incomplete fusion of the nasomedial or intermaxillary process during the
fourth week of development.
Cleft Palate * Results from the incomplete fusion of the primary palatal shelves during the
third month of gestation.
tends to cause repeated infections of the paranasal sinuses and middle ear.
o Cleft palate
Tracheoesophageal fistulas o Defective differentiation as the trachea separates from the esophagus during the
fourth to sixth weeks of embryonic development
Tracheoesophageal fistulas Associated with
polyhydramnios (excessive amniotic fluid)
Pyloric Stenosis risk factors
o Increased gastrin secretion by the mother in the last trimester
o Overproduction of gastric secretions in the infant that may be caused by stress-related factors in the mother
o Exogenous administration of prostaglandin E
o Colon remains in the upper right quadrant
Intestinal Malrotation
Meconium Ileus common in newborns with
cystic fibrosis
another one a/w cystic fibrosis
Distal Intestinal Obstruction Syndrome
- Most common congenital malformation of the gastrointestinal tract
Meckel Diverticulum
Meckel Diverticulum rule of 2
o Occurs in approximately 2% of the population.
o Two percent develop complications usually before 2 years of age.
o Two types of common ectopic tissue (gastric and pancreatic) have been identified.
o Is located within 2 feet of the ileocecal valve.
Meckel Diverticulum - Most common symptom
Painless rectal bleeding
Meckel Diverticulum Develops when the _duct fails to obliterate
omphalomesenteric
Congenital Aganglionic Megacolon Hirschsprung disease: * Functional obstruction of the colon caused by an absence of the_ with inadequate motility by PSNS
enteric ganglia (Meissner and Auerbach plexuses)
first sign of hirschsprung
Diarrhea
currant jelly stool sign
intussusception
most common scenario of intussusception
Ileum invaginating into the cecum
in newborns, reflux is
normal
Cystic Fibrosis mutation of
long arm of chromosome 7
Cystic Fibrosis * Classic triad
o Deficiency of pancreatic enzyme - beta cell damage to DM
o Overproduction of mucus in the respiratory tract
o Abnormally elevated sodium and chloride concentrations
o 72-hour stool fat measurements: Determines the extent of pancreatic function
o Carbon-13 (13C) mixed triglyceride breath test: Simple, noninvasive way of assessing the need for pancreatic enzyme supplementation in children
Cystic Fibrosis eval
o Causes T cell–mediated autoimmune injury to the intestinal epithelial cells.
Gluten-Sensitive Enteropathy (Celiac Sprue or Disease)
- Dermatitis herpetiformis
specific cutaneous manifestation of gluten-sensitive enteropathy.
o Involves transglutaminase 3 immunoglobulin A (IgA) autoantibodies.
o IgA autoantibodies circulate to the skin and interact with antigens produced by keratinocytes.
o Antigen-antibody complex activates neutrophils in the papillary dermis, causing blister formation.
kwashiorkor vs marasmus
- Presence of subcutaneous fat, hepatomegaly, and fatty liver
Failure to Thrive eval
Falls below the third percentile on the growth curve or falls off a previously established growth curve
most common gastrointestinal emergency of the newborn.
Necrotizing Enterocolitis
Necrotizing Enterocolitis: The more, the greater the risk
premature
Necrotizing Enterocolitis: s/s
o Abdominal pain, unstable temperature, bradycardia, apnea
Necrotizing Enterocolitis:tx
o Cessation of feeding formula milk
o Avoidance of H2-receptor antagonists
o Initiation of enteral feeding started as soon as possible
o Gastric suction: To decompress the intestines
o Maintenance of fluid and electrolytes
o Administration of antibiotics: To control sepsis
leading cause of severe diarrhea in infants and young children worldwide.
rotavirus
- Chronic diarrhea
Lasts longer than 2 weeks.
o Zinc supplements and children
Not used in children younger than 6 months of age
o Most common cause of jaundice in newborn
Hemolytic disease of the newborn
- Kernicterus
Chronic bilirubin encephalopathy
Physiologic Jaundice of the Newborn EVAL
Total serum bilirubin greater than 20 mg/dl or Indirect bilirubin greater than 15 mg/dl
- Primary clinical manifestation of biliary atresia
Jaundice
o Main cause of portal hypertension in children
most common sign
Obstruction of the portal vein
splenomegaly
Wilson disease genetics
autosomal recessive . loss of ATP7B gene expression located on chromosome 13.
Kayser-Fleischer rings
Accumulation of copper in the limbus of the cornea, causing a greenish-yellow ring
Wilson Disease ABNORM
toxic levels of copper to accumulate in the liver, brain, kidneys, and corneas. Failure to insert copper into ceruloplasmin, which is a glycoprotein that transports copper in the blood ( Low ceruloplasmin levels)
Only therapy for Wilson disease
o Liver transplantation
ALOSETRON
only approved serotonin antagonist for last chance in women with IBS
