GI module 3b Flashcards
What are the two forms of pyloric obstruction?
Infantile hypertrophic pyloric stenosis (IHPS) (congenital)
Adult/acquired pyloric obstruction (Acquired)
signs and symptoms of IHPS (congenital PS)
Infant 2-3 weeks begins projectile vomiting (several feet) for no reason
Pathophysiology of IHPS
hypertrophied pyloric sphincter
etiology of IHPS
unknown - ? hormones
TX for IHPS
Pyloromyotomy
Cause of Acquired Pyloric Obstruction?
severe peptic ulcer or tumor in area
s/s of acquired pyloric obstruction?
epigastric discomfort/fullness w/ eating that progresses to severe
tx for acquired pyloric obstruction
address cause of obstruction
What are the 5 different kinds of mechanical obstruction?
Adhesions Herniation Intussusception Volvulus Tumor growth
Define obstructive adhesions
Fibrous scar tissue adheres to intestinal loops
What is the MC type of mechanical SI obstruction?
Adhesions
What is the 2nd MC type of Mechanical SI obstruction?
Herniation
What is most commonly a bowel obstruction of infants and young children?
Intussusception-more common in ileocecal area
What is the definition of a volvulus
intestine twists upon itself
What is the MC cause of LI obstruction?
Tumor growth
What is one functional obstruction (physiological obstruction)
Paralytic ileus
Define paralytic ileus
Obstruction that results when peristalsis stops
What are possible causes of an ileus?
Narcotics HTN meds ABD, spine, joint surgery Injury/trauma Infection/peritonitis MI Imbalance of lytes D/o of muscle function Mescenteric ischemia
TX strategies for ileus?
NG tube decompress pressure in GI
Address underlying cause
Surgery if conservative tx unsuccessful
What is the other name for Congenital Aganglionic Megacolon?
Hirschsprung’s Disease
Etiology of Hirschsprung’s dz?
Birth defect -ganglionic cells of the LI fail to develop
What is the functional result of Hirschsprung’s Dz?
Impaired motility of colon - poor coordination/ability to contract muscle
Impacted/trapped stool, infection, inflammation, constipation
Name the 2 different kinds of Hirschsprungs dz
Short-segment-rectosigmoid colon
Long segement-regions proximal to rectosigmoid also involved
Tx for Hirschsprung’s dz
Decompress colon - serial rectal irrigation-surgical removal of involved intestinal segment
What are the 2 different forms of IBD?
Ulcerative colitis
Crohn Dz
Peak onset of Crohn’s
15-25 and then again up to age 40
Pathophys of Crohns
Inflammation extends through all layers of intestinal wall
Granulomatous inflammation occurs
Skip lesions may occur
can effect entire GI system
Pharaceutical tx of crohns
Antiinflammatory drugs Salyscylate Corticosteroids Infliximabe Immune suppressors ABX
Surgical tx.
Intestinal resection
colostomy/ileostomy
What is different about the inflammation of UC as compared to crohns
UC inflammation only extends mucosa-not through all layers like Crohn’s
UC always involves rectum and proximally to contiguous sections of colon-Crohn’s can effect ANYWHERE along the GI tract
What are the 3 common regions of UC?
Ulcerative proctitis
Proctosigmoiditis
Pancolitis
What percent of pt’s with diverticulitis are asymptomatic?
85%
Pathophys of diverticulosis
Colonic muscle wall weak where vessels penetrate
Multiple diverticuli present
Most common in sigmoid
Tx of Diverticulosis
High fiber diet
Avoid high residue foods (anecdotal studies)
What is the difference between diverticulosis and diverticulitis
Diverticulosis is just out pockets of the intestinal wall, Diverticulitis is inflammation of colonic diverticula!
What is the most common etiology of colorectal cancer?
Adenomatous polyp
Why is colorectal cancer so easy to detect early.
It is easy to assess with scope
Slow growth down the star toward deeper layer of mucosa
RF for colorectal ca
AGE over 50
PMH of inflammatory dz
Family hx
lifestyle related risks
