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MED CON II > GI FUNCTION AND DISORDERS > Flashcards

GI FUNCTION AND DISORDERS Flashcards

1
Q

Functions of the GI tract (4)

A

digestion

absorption

excretion

host defense

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2
Q

Digestion def

A

– Physical breakdown & chemical alterations of food stuffs to allow
absorption along GI tract

– Involves GI motility, pH changes, biological detergents and
enzymes

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3
Q

absorption definition

A

Directed movement of nutrients across the intestinal lining

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4
Q

excretion definition

A

Food residue, hydrophobic molecules (e.g.: drugs, bacteria and dead cells)

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5
Q

host defense definition

A

– GI system is the largest lymphoid organ in the body with extensive surface area

– Gut microbiota (gut microbiome)

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6
Q

Esophagus characteristics

A

-fibromusucular tube connecting the throat with the stomach (about 25 cm; 9-10” long, <1” diameter)

-peristaltic contractions to pass food

upper esophageal sphincter

lower esophageal sphincter

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7
Q

What is abnormal swallowing called?

A

aspiration

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8
Q

What patient population is a barium swallow often used in ?

A

patients with stroke

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9
Q

GERD

A

-Reflux of gastric contents (acid; pepsin; bile from duodenum) into the esophagus
-the lower esophageal sphincter is not closing off very well

FACTORS:
-impaired LES
-impaired gastric emptying
-hiatal hernia
-alcohol abuse
-more common in children with developmental delays

-can cause inflammation of the lungs due to contents from the esophagus getting into the lungs

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10
Q

What complications can happen with GERD?

A

-regurgitation/malnutrition
-esophagitis

-Barrett’s Esophagus: Transformation of the normal esophageal squamous epithelium to columnar epithelium … “pre-malignant” —> increase risk for developing esophageal cancer
—may require esophagectomy

-respiratory compromise
—> associated with asthma and COPD (due to esophageal breakdown getting into lungs)

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11
Q

Functions of the stomach:

A

Reservoir- release of chyme to small intestine
–can hold up to 2-4 liters of fluid/food

Mechanical digestion
—peristalsis: occurs due to many muscle layers of the stomach (in 3 diff directions)
—controlled by the enteric nervous system
—the inner lining has many pits –> which have different glands and epithelial cells (where HCl comes from too)

Chemical digestion - performed by digestive enzymes
–pepsin for protein
–lipase for fats

HCl
-role in chemical digestion in the stomach

Intrinsic Factor (IF)- helps with the absorption of nutrients in the small intestine

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12
Q

Functions of HCl in the stomach

A

-chemical digestion
-activates digestive enzymes (pepsin)
-immune defense ** –> helps to kill bacteria

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13
Q

Functions of Intrinsic factor in the stomach

A

-binds vitamin B12 for absorption in the small intestine (ileum)
-Deficiency leads to pernicious anemia

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14
Q

pernicious anemia

A

Pernicious anemia is a relatively rare autoimmune disorder that causes diminishment in dietary vitamin B12 (cobalamin) absorption, resulting in B12 deficiency and subsequent megaloblastic anemia. It affects people of all ages worldwide, particularly those over 60.

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15
Q

Why doesn’t our stomach self digest? How does it protect itself?

A

The gastric glands of the stomach also produce mucus that helps to protect the inner lining of the stomach from being broken down by acidic contents

The stomach can take bicarbonate from the bloodstream –> helps to neutralize some of the stomach acid

PROTECTIVE BARRIER FUNCTION
-compact epithelial cell lining
-mucus covering
-bicarbonate ions (buffers H+)
-blood flow –> less blood to stomach if on mechanical ventilation –> can lead to anemia and gastritis

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16
Q

Gastritis

A

Inflammation of the inner lining of the stomach (the mucosa)

ACUTE
1.) Excessive acid production greater than gastric defense: NSAIDs, ASA, ETOH

2.) Stress-induced- common in critically ill patients –> esp those on mechanical ventilation

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17
Q

PUD- peptic ulcer disease

A

PATHOGENESIS:
-Increased acid secretions and
digestive enzymes erode gastric mucosa
-H pylori infection (>70%) –> requires antibiotic use

COMPLICATIONS
-hemorrhage, perforation peritonitis (medical emergency), scarring

-defined by the site of origin

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18
Q

what is an ulcer?

A

Stomach ulcers (gastric ulcers) are open sores that develop on the lining of the stomach.

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19
Q

NSAIDs and their influence on the GI system:

A

– Acetylsalicylic acid (ASA = aspirin; e.g., Bayer, Ecotrin)
–block COX-1 and COX-2
–prevention of blood clotting–> increases bleeding risk
– Traditional NSAIDs (e.g., Ibuprofen, Naproxen)—> also block cox 1 and cox 2

– COX-2 Inhibitors (e.g., Celebrex, Vioxx)
–decreased inflammation and pain relief with decreased GI bleeding but increase in CVA/MI risk
–The amount of blood clotting increases due to the lack of inhibition of COX-1

-15% of long-term NSAID users develop peptic ulcer disease

-

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20
Q

What lab values would you check for GI bleeding?

A

hemoglobin
hematocrit

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21
Q

What part of the GI tract does most GI bleeding occur in?

A

75% UPPER TRACT
20-25% LOWER TRACT - ileum, colon, rectum

-50% of bleeding is due to NSAID use in the elderly –> more in females than males

-Continued bleeding and re-bleeding are high predictors of mortality and morbidity in older patients

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22
Q

RED flags for GI bleeding

A
  • Syncope
  • Hypotension (orthostasis)
  • Pallor
  • Diaphoresis
  • Tachycardia
  • Fatigue & weakness
  • Shortness of breath
  • Abdominal discomfort

-Hematemesis- coffee ground emesis indicative of upper gi bleed

-decreased H & H

-Melena: black, tarry stool
–UGIB or LGIB
–lab test: + test for microscopic blood (occult GI bleed)

*Occult gastrointestinal bleeding is defined as gastrointestinal bleeding that is not visible to the patient or physician, resulting in either a positive fecal occult blood test, or iron deficiency anemia with or without a positive fecal occult blood test.

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23
Q

Functions of the small intestine

A
  • Mixes/ grinds (segmentation)
    & propels (peristalsis) contents
  • Digests & absorbs nutrients
  • Secretes regulatory hormones

CHEMICAL DIGESTION
-Endocrine (hormonal) cells and exocrine (digestive enzyme) function
-Hormones regulate gastric, pancreatic & gall bladder
function.–> When chyme enters the duodenum hormone CCK is released –> increases pancreatic enzyme and bile release to aid in digestion

ABSORPTION
-villi and microvilli of SI
-impaired ^ in celiac disease
-The large number of microvilli increases the surface area for absorption of nutrients
–lacteals (lymphatic capillaires) are for fat absorption (chyle)

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24
Q

Two types of propulsion in the small intestine

A

segmentation - localized contractions of circular muscle of the GI tract

peristalsis- When food or fluids enter your GI tract, nerves trigger the muscles to initiate a series of wave-like contractions. These muscle contractions automatically move food and fluids forward until they reach their exit at your anus or urethra.

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25
Q

Functions of the large intestine

A

-ferment carbs, produce B vitamins, vitamin K

-bacterial action

-mucus secretion

-no enzymes secreted

-Main role of colon is re-absorption of water along with ions and some vitamins
–> reab. of salts by epithelial cells
–water flows by osmosis

26
Q

Crohn’s disease

A
  • Patchy inflammation that may occur anywhere along the digestive tract
  • Involves entire bowel wall
  • Pain is commonly experienced in the lower right abdomen

RLQ

-can cause malabsorption

27
Q

ulcerative colitis

A
  • Inflammation is continuous throughout affected large intestine (colon)
  • Involves the innermost lining (mucosa)
  • Pain is common in the lower left part of the abdomen

-often malabsorption is involved

LLQ

28
Q

Common presentation of Crohn’s and Ulcerative Colitis

A

Abdominal cramping & pain; diarrhea; obstruction; fatigue;
malabsorption leading to weight loss & malnutrition

joint pain; anemia - lower than normal number of RBC

29
Q

Medical management of crohn’s and ulcerative colitis

A

MEDS –> can depress the immune system
* Immunosuppressants: Azathioprine (Imuran)
* Biologics: Infliximab (Remicade), adalimumab (Humira)
* Anti-inflammatory agents: steroids

SURGERY
-surgical resection of the affected part of the bowel

30
Q

IBS characteristics

A

NO structural abnormalities —> diagnosis of exclusion

disturbed bowel function

spasmodic motility pattern

malabsorption

nutrition deficiency and loose stools

etiology is unknown, but may be related to colonic sensitivity

31
Q

Celiac disease

A

Autoimmune disorder that occurs in genetically predisposed people where the ingestion of gluten (protein found in wheat, barley & rye) leads to damage in the small intestine

-leads to malabsorption and bloating, diarrhea, gas, fatigue

-can lead to anemia (dec iron absorption, dec vitamin b12 absorption), and osteoporosis (dec absorption of calcium and vitamin d)

32
Q

Hiatal vs ventral vs inguinal hernia

A

Hiatal- The gastro-esophageal
junction moves above the
diaphragm with some of the
stomach.

Ventral- An incision-related hernia where abdominal contents protrude through the linea alba

Inguinal- protrusion of abdominal cavity contents through the inguinal canal

33
Q

Acute abdomen (“peritonitis”)

A
  • May also be referred to as “peritonitis”
  • Refers to a sudden, severe abdominal pain (< 24 hours
    duration)
  • Often a medical emergency
    *extremely painful

CAUSES: appendicits, cholecystitis, pancreatitis, ischemic bowel, AAA

Physical exam:
-identify location, palpate for rigidity
-often rebound tenderness on palpation
-bowel sounds are usually diminished/absent

34
Q

Colorectal cancers

A

often starts with benign polyp –> should be getting colonoscopy >50 years old

common symptoms: bleeding; pressure/pain with defecation; change in elimination

RISKS:
-age, family history; diet; exercise
-ulcerative colitis/crohn’s disease

3rd most common CA & 3 rd leading cause of death

35
Q

ileectomy:

A

resection of the small intesntine

36
Q

colecteomy:

A

resection of the large intestine

37
Q

ostomy

A

surgically created opening in the body for the
discharge of body wastes.

-sometimes after healing the ostomy may be removed

-PT has a role in teaching patients how to mobilize with their ostomy bag

38
Q

stoma

A

-is the end of the small or large intestine that is protruding through the abdominal wall
-The bowel may have to be rerouted through an artificially created hole (stoma) in the abdomen so that faeces can still leave the body. A colostomy is an operation that connects the colon to the abdominal wall, while an ileostomy connects the last part of the small intestine (ileum) to the abdominal wall.

-A colostomy is an operation to divert 1 end of the colon (part of the bowel) through an opening in the tummy. The opening is called a stoma. A pouch can be placed over the stoma to collect your poo (stools).

39
Q

3 types of bariatric surgical procedures and benefits

A

A) Roux-en-Y gastric bypass
B) Vertical Sleeve Gastrectomy
C) Laparoscopic Adjustable Gastric Band

-often carried out by psychiatry departments

BENEFITS:
* Weight loss
* Remission of Type 2 DM
* Improvement in CV risk factors and CV health
–improved lipid profiles
–reduced BP/decrease HTN
* Improvements in mental health such as reduced depression
* better sleep –> decrease in obstructive sleep apnea
* decreased joint pain- hip and knee
* improved fertility

40
Q

Post op complications for GI - not just bariatric surgery

A

-pain
-pulmonary complications –> atelectasis; desat; PNA; PE; respiratory failure
-bleeding, infection

-ileus –> temporary decreased motility/paralysis of the bowel, leads to constipation/discomfort, N&V

-bowel leakage that can lead to sepsis

-post-surgical adhesions –> scar tissue that can lead to strangulation

41
Q

What is a big concern with a hernia?

A

if the hernia becomes strangulated –> can lead to necrosis of gastrointestinal tissue

42
Q

GERD medical interventions / lifestyle modifications and other GI MEDS

A

LIFESTYLE
* Eliminate ETOH & smoking; weight reduction

  • Elevate head of bed (GERD; PUD); Eliminate bedtime
    snacks & food that increases reflux (e.g.: fatty foods)

MEDS
-Antacids: drugs that decrease acid secretion by gastric
parietal cells
–> proton pump inhibitors (omeprazole (Prilosec), esomeprazole (Nexium, lansoprazole (Prevacid))
–> H2-Receptor Blockers (e.g.: cimetidine (tagamet),
famotidine (Pepcid), ranitidine (Zantac))

OTHER GI MEDS

-antibiotic therapy (PUD/H pylori)
-anti inflammatory agents
-anti-emetics
-laxatives: short term relief of constipation by increasing water content of stool
-antidiarrheal meds

-surgery

43
Q

Does an upper or lower abdominal surgery have more risk of creating post-operative pulmonary complications ?

A

upper

44
Q

PT interventions for GI disorders/post op:

A

-pain and pain control
-log roll
-valsalva maneuver
-lab values and volume status
-rectal tubes and feeding tubes

45
Q

Function of the pancreas

A

-has both an exocrine and endocrine function

EXOCRINE:
-duct cells secrete aqueous NaHCO3 solution
-acinar cells secrete digestive enzymes into ducts

ENDOCRINE:
-hormones insulin and glucagon from the pancreas into the blood
-islets of langerhans secrete insulin and glucagon –> to blood

46
Q

exocrine vs endocrine substances

A

The key difference between the two types is that, whereas exocrine glands secrete substances into a ductal system to an epithelial surface, endocrine glands secrete products directly into the bloodstream [1].

47
Q

pancreatitis

A

-can be acute or chronic
-pancreatic enzymes (especially trypsin) are activated in the pancreas instead of the small intestine –> inflammation and auto-digestion

** usually enzymes are activated in the small int.

90% cases caused by:
-alcohol abuse
-gallstones

  • Severe abdominal (epigastric)
    pain, often radiating to the back
    -Nausea/Vomiting
    – Symptoms worsen with
    eating (especially fatty foods)
    – Relieved somewhat with
    forward leaning
    -dehydration can lead to hypotension
    -severe pain–> hypertension and tachycardia
48
Q

Cystic fibrosis

A
  • Enzyme synthesis & secretion is normal
  • Inability to secrete bicarbonate & water which limits the amount of enzymes released into the intestinal lumen
  • If they reach lumen often inactive as not enough
    alkaline to neutralize gastric acid
  • Treatment: enzyme supplements & antacids

** PANCREATIC INSUFFICIENCY

In digestion in people with CF, the small tubes that transport these enzymes out of the pancreas become blocked with mucus. The enzymes build up in the pancreas instead of reaching the digestive system (specifically, the lumen of the gut), causing the pancreas to become inflamed.

49
Q

Circulation to the liver:

A

hepatic artery - 20-40%: O2 enriched blood from aorta

portal vein - 60-80%: nutrient enriched blood

hepatic vein

-everything that goes through the GI tract has to go through the liver via the first pass effect

The liver has a dual blood supply. The portal vein (which is rich in nutrients and relatively high in oxygen) provides two thirds of blood flow to the liver. The hepatic artery (which is oxygen-rich) supplies the rest. The hepatic veins drain the liver into the inferior vena cava.

50
Q

Liver anatomy and functions:

A

ANATOMY

-in RUQ
-percussion dullness in midclavicular line is used to determine liver span
– Upper border: 5th-7th intercostal space
– Lower border: usually ends at costal border
-2-3 cm below costal margin may indicate enlargement (hepatomegaly)

FUNCTIONS - synthetic, excretory, metabolism, detoxification
-synthetic: produced plasma proteins and coagulation factors
-synthetic: synthesizes triglycerides and cholesterol and carbs
-excretory: production of bile for the digestion of fats
-metabolism: glycogen storage
-metabolism: protein catabolism and synth of urea that is transported to the kidney for excretion (blood urea nitrogen)
-metabolism:breaks down RBCs and removes excess bilirubin
-detoxifies noxious compounds found in chemicals and drugs (1st pass effect)

51
Q

BUN measures what?

A

The BUN test measures the amount of urea nitrogen in your blood. Urea nitrogen is a waste product that your kidneys remove from your blood. Higher than normal BUN levels may be a sign that your kidneys aren’t working well. People with early kidney disease may not have any symptoms.

52
Q

Signs of liver dysfunction

A

JAUNDICE
-bile pigments—> excessive deposition
-hyperbilirubinemia > 1.3 mg/dL

ASCITES
– Abdominal swelling/fluid in
the peritoneum
– Due to portal HTN &/ or
hypoalbuminemia
-can impact breathing
-due to altered starling forces in portal vessels (low oncotic pressure due to hypoalbuminemia)
-increased portal venous pressure
-can lead to overstretched abdominal muscles

-INTERVENTION:
–diuresis and Na restriction
–paracentesis: fluid removal from ab. cavity

53
Q

Influence of ascites on lung volumes

A

can elevate diaphragm –> reduce lung volume

LEADS TO:
-rapid, shallow breathing
-resembles “restrictive” lung pathology
-hypoxemia –> low level o2 in blood

54
Q

Hepatopulmonary syndrome

A

-watch out for oxygen
desaturation/ ↓ SpO2; especially with movement & sitting
upright

CAUSE: may be due to shunt physiology: Q> V

** Alveolar ventilation (V) is the amount of air that reaches alveoli in the lungs, measured in liters/minute (L/min); and perfusion (Q) is the pulmonary blood flow, or cardiac output, that reaches the arteries, and specifically the capillaries, surrounding the alveoli, also measured in L/min.
* shunt is perfusion of poorly ventilated alveoli. Physiologic dead space is ventilation of poor perfused alveoli

55
Q

Varices - sign of liver dysfunction

A
  • Portal hypertension causes congestion in the spleen, stomach and esophagus.
  • Collateral vessels develop which become distended and varicose (stomach &
    esophagus).
  • Varices may burst, leading to upper GI bleeding/ hematemesis
56
Q

Hepatic encephalopathy

A

A reversible decrease in neurologic function due to shunting of blood away from the portal circulation

Hepatic encephalopathy is caused when toxins that are normally cleared from the body by the liver accumulate in the blood, eventually traveling to the brain.

Associated with hepatic failure resulting in the accumulation
of noxious metabolic by-products
–> increased serum ammonia (NH3+)
-normal ammonia : 15-56 microgram/dl

SIGNS:
-Asterixis: “liver flap” looks kind of like a tremor; Alternating flexion-extension of the hands observed when the patient is asked to dorsiflex the wrist with the arms extended

STAGES:
-stages 0-4
-0- asymptomatic loss of cognitive abilities and no neuromuscular dysfunction
-4- coma and dilated pupils, oculocephalic or oculovestibular reflexes, decerebrate posturing

57
Q

CLINICAL FEATURES OF HEPATIC DYSFUNCTION

A

look at slide 68

58
Q

aneurysm vs dissection

A

ANEURYSM:
-ballooning/weakening of the vessel wall
-ppl can live for decades with a stable aneurysm
-can have abdominal aortic aneurysm or thoracic aortic aneurysm

DISSECTION: Tear in the intimal layer of vessel wall –> EMERGENT
-tear in the deepest layer of the blood vessel

59
Q

Presentation of ruptured/dissecting AAA and risks

A

– Sudden abdominal or back pain (“tearing” sensation)
– Hypotension & tachycardia: sweating; clamminess, dizziness
– N/V
-Pulsatile mass in abdomen (often obscured due to obesity)
—-> if <5 cm in diameter, not usually detected by routine physical exam

RISKS
- Age, family hx; HTN, CAD/atherosclerosis,
smoking, high cholesterol, male gender

COMPLICATIONS
-thrombosis
-distal embolization
-dissection and rupture
>7 cm aneurysm: 20-30% yearly rupture rate, and >90% risk over 5 years

60
Q

Open vs endovascular aneurysm repair

A

OPEN

A large incision is made in the abdomen to directly visualize the abdominal aorta and repair the aneurysm.
A cylinder-like tube called a graft may be used to repair the aneurysm.

ENDOVASCULAR
Endovascular repair uses a much smaller incision than open surgery. Because of this, it has a lower risk of complications. It may benefit older adults who have a higher risk of complications. It can also lead to faster recovery.
-inserting a graft within the aneurysm through small groin incisions using X-rays to guide the graft into place.
-does not require incision in the abdomen

RISKS:
-period of circulation loss
-NM changes

61
Q

Anatomy of the liver

A

consists of two main lobes, both of which are made up of eight segments, the segments are made up of 1000 lobules

62
Q

Bleeding risk associated with liver dysfunction

A

The liver plays a central role in the clotting process, and acute and chronic liver diseases are invariably associated with coagulation disorders due to multiple causes: decreased synthesis of clotting and inhibitor factors, decreased clearance of activated factors, quantitative and qualitative platelet defects, hyperfibrinolysis, and accelerated intravascular coagulation

MED CON II (2 decks)

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