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Patho > GI Emergencies > Flashcards

GI Emergencies Flashcards

1
Q

What are common manifestations of GI emergencies?

A

-Abdominal pain
-Anorexia
-Nausea
-Vomiting
-Diarrhea
-Constipation

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2
Q

What is anorexia?

A

-Decreased appetite
-Many factors can stimulate hunger (regulated by the hypothalamus) and many things can cause anorexia (fear, depression, disease, drugs)

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3
Q

What is referred pain?

A

Perceived pain at a site different from its point of origin but innervated by the same spinal segment

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4
Q

What is hematemesis?

A

-Blood in emesis
-Can be bright red (fresh) or dark and appear like coffee grounds (older)

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5
Q

What is melena?

A

Black, tarry stool associated with upper GI tract hemorrhage

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6
Q

What questions are important to ask regarding GI complaints?

A

-Bowel movements (regularity, quality, consistency)
-Urinary habits (frequency, pain, odorous, consistency)
-Pain (OPQRST, isolate area - pinpoint vs vague)
-Nausea, vomiting, anorexia
-Change in diet, exercise, or medication
-Chronic complaint, flareups, compare
-Females - OBS questions

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7
Q

What is esophageal varices?

A

-Common complication of portal hypertension and liver cirrhosis
-Almost always associated with alcoholism
-Thin-walled veins that have become very superficial in the submucosa of the esophagus
-They are very prone to rupture and can cause catastrophic hemorrhage and airway
compromise

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8
Q

What is esophagitis?

A

-Inflammation of the esophagus
-Caused by reflux of stomach contents, infectious process, food allergies, medications or medical procedures
-Most common cause is GERD
-Can produce difficulty swallowing and chest discomfort

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9
Q

What is Gastroesophageal Reflux?

A

-The backward movement of gastric contents into the esophagus
-Probably the most common GI disorder
-Produces heartburn and regurgitation
-Lower esophageal sphincter typically prevents reflux of gastric contents
-Many stimuli can cause relaxation of the LES including gastric distension and fatty meals

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10
Q

What is Gastroesophageal Reflux Disease (GERD)?

A

-A more serious and long lasting form of GER
-Symptoms of mucosal damage produced by chronic abnormal reflux of gastric contents into the esophagus
-Commonly occurs 30-60 minutes after eating and can be made worse by bending at the
waist and lying supine. May also be nocturnal.
-Symptoms may include: excessive gas (burping) and chest pain (often epigastric or retrosternal that radiates up the throat) that is often described as burning

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11
Q

What is gastritis?

A

-Inflammation of the gastric mucosa - acute or chronic
-Acute - acute mucosal inflammatory process often associated with emesis, pain and
occasionally hemorrhage and ulcers
-Can be caused by overuse of alcohol, NSAIDs or bacterial toxins
-Chronic - visible erosions and chronic inflammatory changes leading to the eventual
atrophy of the glandular epithelium of the stomach
-Can be caused by a bacterium (H. pylori), autoimmune disorder or reflux of duodenal
contents into the stomach

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12
Q

What is peptic ulcer disease?

A

-Group of ulcerative disorders that occur in areas of the upper GI tract that are exposed to acid-pepsin secretions
-A peptic ulcer may penetrate one or all layers of the stomach and may occasionally penetrate the outer wall of the stomach or duodenum
-Healing of the muscular layer may produce scar tissue and regeneration of the covering tissues becomes more prone to repeat ulcers

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13
Q

What is an ulcer?

A

an excavation of the surface of an organ or tissue, which results from necrosis that accompanies some inflammatory or infectious process

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14
Q

What are the clinical manifestations of peptic ulcer disease?

A

-Epigastric pain (burning, cramping) on an empty stomach - uncomplicated peptic ulcer
-Hemorrhage - disruption of healing tissue or ulceration into a vein or artery
-Significant and life threatening hemorrhage may occur and present as hematemesis or melena
-Perforations - ulceration erodes through all layers of the stomach or duodenum allowing for a leakage of gastric contents into the peritoneum causing peritonitis - sepsis may occur!

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15
Q

What are symptoms of an upper GI bleed?

A

-Hematemesis - bright red coloring indicates fresh blood vs. Dark black/brown “coffee grounds” emesis indicates blood that has coagulated and reacted with the stomach acid (not fresh)
-Melena - black tarry stool - blood becomes darker because it gets “digested” in the intestines before becoming feces

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16
Q

What are symptoms of a lower GI bleed?

A

Bright red or clotted blood in stool. Occasionally melena.

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17
Q

What is an intestinal/bowel obstruction?

A

Any blockage of the lower GI tract preventing the passage of food/stool

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18
Q

What are the mechanical causes of a bowel obstruction?

A

Impacted stool, Stricture, Intussusception, Volvulus, Inguinal Hernia

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19
Q

What is impacted stool?

A

Retention of hardened or putty like stool in the rectum and colon

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20
Q

What is stricture?

A

An abnormal temporary or permanent narrowing of the lumen or a duct, canal or passage

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21
Q

What is intussusception?

A

Intussusception - telescoping of the bowel into the adjacent section. More common in young children

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22
Q

What is a volvulus?

A

Complete twisting of the bowel

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23
Q

What is an Inguinal Hernia?

A

intestine, peritoneum and other abdominal tissues protrude into the scrotum

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24
Q

What are the paralytic causes of a bowel obstruction?

A

-Neurogenic or muscular impairment of peristalsis
-Postoperative, inflammatory bowel diseases, back/spinal injuries

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25
Q

What are the clinical manifestations of a bowel obstruction?

A

-Abdominal distension/pain (can be severe) - stagnant contents and gases
-Strangulation of the bowel - interrupted blood flow (severely painful)
-Bowel perforation - contents cause extensive inflammation and sepsis

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26
Q

What is inflammatory bowel disease?

A

Refers to two related inflammatory intestinal disorders:
-Crohn’s Disease
-Ulcerative Colitis
Both diseases:
-Produce inflammation of the bowel
-Lack evidence of a proving causative agent
-Have a pattern of familiar occurrence
-Can be accompanied by systemic manifestations

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27
Q

What does Crohn’s effect?

A

commonly affects the distal small intestine and proximal colon

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28
Q

What does ulcerative colitis effect?

A

the colon and rectum

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29
Q

What is Crohn’s disease?

A

-A recurrent and exaggerated inflammatory response that can affect any area of the GI
tract (most commonly the distal small intestine and proximal colon)
-Most commonly presents itself in a patient’s early 20s or 30s
-A characteristic feature is isolated granulomatous lesions surrounded by normal appearing mucosal tissue - when the lesions are multiple, they are referred to as skip lesions
-The lesions affect all layers of the GI tract and, with multiple recurrences, may become scarred and ineffective

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30
Q

What are the clinical manifestations of Crohn’s disease?

A

-Involves period of exacerbations and remissions with symptoms being related to the location of the lesions
-Symptoms include: diarrhea, abdominal pain, weight loss, fluid and electrolyte imbalance, malaise, occasional fevers
-The absorption of the affected lesions becomes disrupted and nutritional deficiencies are common
-Common complications include: fistulas (alternate pathway), abscess formation, intestinal obstruction and surgical removal of bowel segments

31
Q

How is Crohn’s disease treated?

A

-Treatment is targeted at reducing inflammation, promoting healing, maintaining adequate nutrition and treating acute complications as they arise
-Surgical resection of damaged bowel, drainage of abscesses or repairing fistulas are commo

32
Q

What is ulcerative colitis?

A

-A nonspecific inflammatory condition of the colon
-Inflammation is limited to the mucosa and submucosa and is generally isolated to the colon and rectum
-The disease typically starts in the rectum and spreads proximally
-Unlike Crohn’s, the disease tends to be continuous instead of skipping areas
-The inflamed areas often develop pinpoint mucosal hemorrhages which fester and
develop into abscesses
-Ulcers often develop tongue-like projections similar to polyps (pseudopolyps)
-The bowel wall thickens over time due to repeated episodes of colitis and results in a
loss of flexibility and function

33
Q

What are the clinical manifestations of ulcerative colitis?

A

-Typically presents as relapses marked by episodes of diarrhea which may persist for
days, weeks or even months
-The remission periods may last for months to years
-Due to the affected location (mucosal layers) the stool often contains mucous and blood
-Mild abdominal cramping, anorexia and weakness are also common
-Other symptoms and comorbidities vary with the severity of the disease

34
Q

What is diverticulosis?

A

-A diverticulum is an out-pouching of a hollow structure in the body.
-Diverticulosis is the condition of having diverticula in the colon that are not inflamed
-Most commonly affects the distal descending and sigmoid colon
-Most cases of diverticulosis are asymptomatic and aproblematic however abdominal

35
Q

What is diverticulitis?

A

-Diverticulitis is a complication of diverticulosis in which there is inflammation and/or perforation of the diverticulum
Clinical Manifestations:
-Pain and tenderness (usually LLQ)
-Nausea, vomiting, fever (+/-)
Serious Complications include:
-Perforation of diverticula with peritonitis
-Abscess, hemorrhage
-Bowel obstruction

36
Q

What is gangrene?

A

localized death and decomposition of body tissue, resulting from obstructed circulation or bacterial infection

37
Q

What is appendicitis?

A

-Acute inflammation of the appendix - can become swollen, gangrenous and often perforates if
not treated promptly
-Usually caused by intraluminal obstruction with feces, gallstones, tumors, parasites or lymphatic tissue
-Onset of appendicitis is usually very abrupt and must be treated quickly
-Perforation of the appendix can be a serious complication resulting in significant peritonitis
and sepsis

38
Q

What are the clinical manifestations of appendicitis?

A

-Initially vague epigastric or periumbilical pain (referred) that progresses to severe over 2-12 hours - pain is often colicky (intermittent/waves)
-Once pain and inflammation has worsened, the pain usually involves the LRQ
-Nausea, pallor, diaphoresis, and fever (+/-)
-Rebound tenderness is a common telltale sign
-Pain when pressure is removed rather than applied

39
Q

What is gastroenteritis?

A

-Inflammation of the stomach and intestinal lining, commonly referred to as the “stomach flu”
-May be viral, bacterial or parasitic - most common cause is norovirus
-Symptoms include: Fever, Abdominal cramping, Nausea, Vomiting, Diarrhea
-Treatment is targeted at fluid and nutrient replenishment and waiting for the pathogen to run its course

40
Q

What is cholelithiasis/gallstones?

A

-Precipitation of substances contained in bile (mainly cholesterol and bilirubin)
-Contributing factors include: Increased cholesterol, stasis of bile, women on oral contraceptives
-Stones get lodged in the common bile duct and produce indigestion, biliary colic (URQ or
epigastric pain) and jaundice due to the buildup of bilirubin - may have referred pain to the upper right back/shoulder
-Symptoms usually follow a large, fatty meal
-Nausea and vomiting also typically associated

41
Q

What is cholecystitis?

A
  • Diffuse inflammation of the gallbladder usually secondary to obstruction of the flow of bile
    -Most commonly caused by gallstones but can also be due to sepsis, trauma or infection of the gallbladder
    -Can be acute or chronic (recurring episodes of gallstones and cholecystitis) leading to varying
    degrees of chronic inflammation and decreased function
42
Q

What are the clinical manifestations of cholecystitis?

A

-URQ/Epigastric pain
-Fever
-Anorexia
-Jaundice
-Nausea
-Vomiting

43
Q

What is acute pancreatitis?

A

-A reversible inflammatory process of the pancreatic acini caused by premature activation
of pancreatic enzymes
-Pancreatic enzymes are released in their inactive forms and become activated once they reach the duodenum
-Inflammation and autodigestion can spread beyond the pancreas resulting in a systemic
inflammatory response syndrome (SIRS) and subsequent sepsis
-Commonly caused by gallstones and alcohol

44
Q

What are the clinical manifestations of acute pancreatitis?

A

-Epigastric or periumbilical pain that may radiate to the back, chest or flank
-Fever (+/-), tachycardia, abdominal tenderness/distension, hypotension/respiratory
distress (severe cases)
-Fluid shifting into the retroperitoneal cavity
-May result in hyperglycemia (more common in chronic pancreatitis)

45
Q

What is chronic pancreatitis?

A

-Characterized by progressive destruction of the exocrine pancreas.
-May progress to complete destruction of the exocrine cells
-Similar factors that cause acute pancreatitis by the main difference is chronic pancreatitis creates irreversible damage
-The main cause of chronic pancreatitis involves alcoholism

46
Q

What are the clinical manifestations of chronic pancreatitis?

A

-Persistent and recurrent episodes
of epigastric/LUQ pain precipitated by alcohol abuse and overeating
-May eventually cause diabetes

47
Q

What is cirrhosis?

A

-End-stage chronic liver disease in which much of the functional liver tissue has been replaced with fibrous tissue
-Most commonly associated with alcoholism
-The fibrous tissue can disrupt blood flow and biliary ducts
-The disruption of blood flow often leads to portal hypertension and all of its complications
-The obstruction of biliary ducts leads to bile stasis, destruction of hepatocytes and eventually liver failure

48
Q

What are the clinical manifestations of cirrhosis?

A

-Manifestations are variable depending on the severity and spread of the fibrous tissue -symptoms don’t usually arise until the disease is advanced
-Hepatomegaly - abnormal enlargement of the liver (may be asymptomatic or produce
abdominal pain - URQ/epigastric)
-Weight loss, weakness, anorexia, jaundice
-Diarrhea or constipation (abnormal bowel activity)
-Late complications - splenomegaly, ascites, portosystemic shunts, bleeding (decreased
clotting factors), thrombocytopenia, gynecomastia (testosterone atrophy), spider angiomas, palmar erythema, encephalopathy

49
Q

What is portal venous blood flow?

A

Venous blood from the abdominal organs travels through the liver, via the portal vein, before entering the vena cava

50
Q

What is portal hypertension?

A

increased resistance to blood flow in the portal venous system and sustained portal vein pressure

51
Q

What is pre-hepatic portal hypertension?

A

obstruction of the portal vein before it enters the liver (thrombosis, tumours, trauma)

52
Q

What is post-hepatic portal hypertension?

A

any obstruction to blood flow through the hepatic veins beyond the liver (thrombosis, right sided heart failure)

53
Q

What is intra-hepatic portal hypertension?

A

obstruction of blood flow within the liver (fibrous tissue distorts the liver architecture and increases resistance to flow)

54
Q

What are the complications of portal hypertension?

A

ascites, splenomegaly, hepatic encephalopathy, and portosystemic shunt

55
Q

What is ascites?

A

excessive fluid build up in the peritoneal cavity due to liver damage and/or portal hypertension

56
Q

What is splenomegaly?

A

-progressive enlargement of the spleen caused by the shunting (backflow) of blood into the splenic vein
-This leads to decreased levels of all formed elements and diminished lymphatic immunity

57
Q

What are portosystemic shunts?

A

-collateral channels open up between the portal vein and systemic circulation
-involved in hemorrhoids, esophageal varices, caput medusae (dilated veins around the umbilicus)

58
Q

What is liver failure?

A

-Occurs when 80-90% of hepatic functional capacity is lost
-Typically by the time this occurs, the patient has developed a plethora of other associated
comorbidities (sepsis, electrolyte imbalances, GI bleeds/obstructions, heart disease/failure

59
Q

What are the clinical manifestations of liver failure?

A

-Anemia
-Thrombocytopenia (low platelet count)
-Coagulation defects (decreased clotting factors)
-Leukopenia
-Menstrual irregularities
-Loss of libido
-Atrophy of the testes
-Gynecomastia
-Spider angiomas
-Palmar erythema (red palms)
-Hepatorenal syndrome (renal failure caused by liver failure)
-Hepatic Encephalopathy - various nervous system complications caused by liver failure -
decreased LOA, convulsions, coma, various personality changes, axterixis - “flapping”
tremor in the hands

60
Q

What are spider angiomas?

A

tiny red superficial blood vessels - related to hormone metabolism

61
Q

What is liver cancer?

A

-The two main types: liver tumours and cancer of the bile ducts
-Symptoms may be insidious at onset (malaise, indigestion, loose stools, abdominal discomfort) and eventually progress to any number of liver and gallbladder related symptoms
-Primary liver cancer is when the cancer originates in the liver, when it has spread from another source it is referred to as secondary liver cancer
or liver metastasis

62
Q

What is an aneurysm?

A

an abnormal localized dilation of a blood vessel

63
Q

What is an abdominal aortic aneurysm (AAA)?

A

commonly found below the level of the renal artery. A pulsating mass may be palpated
in some circumstances, but they usually aren’t detected until rupture

64
Q

What is a ruptured AAA?

A
  • a significant life threat with a high mortality rate
    -characterized by excruciating abdominal pain (may be described as tearing), restlessness, pallor, diaphoresis, tachycardia, and hypotension
65
Q

What is hepatitis?

A

-Inflammation of the liver primarily caused by a viral infection
-May also be caused by an autoimmune mechanism, reaction to drugs/toxins, secondary to
another disorder

66
Q

What are the known hepatotropic viruses (causing viral hepatitis)?

A

-Hepatitis A
-Hepatitis B
-Hepatitis B-D
-Hepatitis C
-Hepatitis E
-All of these viruses cause viral hepatitis, but they differ in their mode of transmission, incubation period, liver damage, and ability to evolve

67
Q

What are the two mechanisms of liver injury?

A

direct cellular injury and induction of immune
response against viral antigens

68
Q

What are the clinical manifestations of hepatitis?

A

Early:
-General malaise
-Myalgia (muscle aches)
-Arthralgia (joint pain)
-Fatigue
-Anorexia
-Nausea
-Vomiting
-Diarrhea
-Fever
7-14 days:
-URQ tenderness
-Mild weight loss
-Spider angiomas
-Jaundice

69
Q

What is Hep A?

A

-Usually benign and self-limiting but rarely can be fatal
-Transmitted by the fecal-oral route but can also be contaminated in food
-Immunization exists

70
Q

What is Hep B?

A

-Can produce any severity level of the disease
-Transmitted in bodily fluids including blood
-Common amongst IV drug users and during unprotected sex
-Immunization exists

71
Q

What is Hep C?

A

-Often results in chronic hepatitis and eventual liver failure
-Blood borne transmission and unprotected sex
-No immunization exists

72
Q

What is Hep D?

A

-Can cause acute or chronic hepatitis
-Transmitted in bodily fluid
-No vaccine, however, HepB vaccine strongly protects against D

73
Q

What is Hep E?

A

-Typically benign and self-limiting, similar to HepA
-Fecal-oral transmission. No vaccine

74
Q

What is chronic hepatitis?

A

-Defined as a chronic inflammatory reaction of the liver of more than 3- 6 months
-Principal cause of chronic liver disease, cirrhosis and hepatocellular cancer
-Caused by B, C and D with C being the most common cause

Patho (9 decks)

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