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PHAR 123* > GI Pathophysiology > Flashcards

GI Pathophysiology Flashcards

1
Q

What is esophagitis?

A

It is the inflammation or infection in the esophagus

The most common cause of esophagitis is GERD

Patients with immunodeficiencies are most likely to experience infections

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2
Q

What drugs can cause esophagitis?

A

Bisphosphonates can irritate the esophagus if the patient does not remain upright after administration

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3
Q

Are swallowing disorders caused by esophagitis?

A

No, they actually represent a lack of neuromuscular coordination of the voluntary or involuntary muscles associated with swallowing

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4
Q

What is globus?

A

The feeling of something stuck in the throat, often related to anxiety

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5
Q

What happens in GERD?

A

The contents of the stomach spill into the esophagus due to a a weak lower esophageal (cardiac) sphincter.

The esophagus lacks a protective lining, so GERD can mimic chest pain that is usually experienced in a heart attack

Eventually inflammatory changes can occur, causing metaplasia

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6
Q

What are some non-pharmacological GERD treatments?

A

Weight loss

Extra pillow for sleep

Earlier supper

Avoiding trigger foods

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7
Q

What are some pharmacological treatments for GERD?

A

H2 receptor antagonists (antihistamines)

Proton pump inhibitors

Antacids (ex. Tums)

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8
Q

How do H2 antihistamines treat GERD?

A

These drugs bind to the H2 receptor in gastric parietal cells, reducing H+/K+ ATPase activity (inhibiting a precursor step to the release of protons)

Ex. Ranitidine, famotidine, cimetidine, nizatidine

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9
Q

How do proton pump inhibitors (PPIs) treat GERD?

A

They bind to H+/K+ ATPase of the gastric parietal cell, directly preventing the movement of protons into the stomach (acid secretion)

Ex. Pantoprazole, omeprazole, rabeprazole, esomeprazole, lansoprazole

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10
Q

Are proton pump inhibitors intended for long-term use?

A

No, they are designed for short-term treatment (6 weeks), but many patient have been taking PPIs chronically.

Chronic use of PPI = chronic elevation of stomach pH. This reduces digestive ability, pathogen elimination, absorption of certain minerals.

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11
Q

What are some good probing questions in patients who report stomach pain?

A

How frequently and how much they are taking

Have they seen an MD

Patient eating habits and schedule

Any triggers of GERD

Fatigue or paleness (loss of blood via ulcers)

Involvement of other body systems

Presence of angina

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12
Q

What is gastritis?

A

It is an infection or inflammation of the stomach

It is usually due to an H.pylori or NSAID overuse

Other etiology:

Alcohol

Atrophy of old age

Major stress (surgery, major burns, severe illness)

Autoimmune (pernicious anemia with B12 anemia)

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13
Q

What are the symptoms of gastritis?

A

Pain

Bloating

Burning sensation

Heavy feeling in stomach

Belching or flatulence

Nausea/vomiting

Blood in vomit (coffee-ground emesis)

Blood in stool (presence of blood that has passed through the entire GI tract)

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14
Q

How are the different etiologies that cause gastritis managed?

A

H. Pylori infection: (triple antibiotic therapy and a PPI)

NSAID use: Take with food

Alcohol: avoid excessive use of alcohol + smoking

Major stress (surgery, major burns, and severe illness): H2 antagonists and PPIs

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15
Q

What are the exact details of treatment of gastric ulcers?

A
  1. Usually given one or two antibiotics, choice dependent on allergies and sensitivity
  2. Bismuth (coating agent)
  3. H2 receptor antagonists

Surgery only if perforated or treatment has been ineffective

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16
Q

What are some commonalities seen in countries that have higher incidence of gastric cancer?

A

They all have high rates of H. Pylori infection, and a high diet in salt and smoked foods

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17
Q

What is the treatment of gastric cancer?

A

Most are adenocarcinomas

Treatment is surgery in the early stages, plus radiation and chemotherapy for later stages

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18
Q

What are some functions of the pancreas?

A

The pancreas has three parts; tail, body, and head

The pancreas also has endocrine and exocrine functions. Its exocrine functions involve the production and secretion of bicarbonate and digestive enzymes

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19
Q

What are the consequences of cancer in the head of the pancreas?

A

Cancer of the head of the pancreas can impinge on the ducts that could normally secrete bicarbonate and digestive enzymes. This will likely cause digestive problems

20
Q

What is acute pancreatitis?

A

Acinar cell injury and duct obstruction that causes the leakage of activated digestive enzymes and subsequent auto digestion of pancreatic tissues

There is a spectrum of severity from self-limiting (mild disease) to fatal hemorrhagic pancreatitis

21
Q

What are some symptoms associated with acute pancreatitis?

A

Severe epigastric pain that radiates to the upper back, nausea, and vomiting

Acute pancreatitis can be monitoring with elevated serum amylase and lipase levels.

Pancreatitis can complicate by becoming infected

22
Q

What is chronic pancreatitis?

A

Chronic pancreatitis (80% due to alcoholism) presents as recurrent or epigastric pain with signs of pancreatic insuffiency

Alcohol is a pancreatic secretagogue, so it stimulates release of digestive enzymes, but these enzymes can clog up pancreatic ducts (causing obstruction)

23
Q

What is pancreatic insufficiency?

A

Poor digestion, pain upon eating, greasy/smelly stools, malnutrition

24
Q

What are some factors that increase GI secretions and motility?

A

Food

Nervous System (Enteric and PNS)

Activity (promotes GI motility, reducing transit time)

Disease (peripheral neuropathy, vessel damage can affect GI tract motility and function)

25
Q

What are some factors that can decrease GI secretions and motility?

A

Lower food intake (carbs pass through GI tract faster than fats)

SNS stimulation (fight or flight)

Low activity increases GI transit time (affects older adults vs. active and younger people

26
Q

What are some intestinal vascular diseases?

A

Hemorrhoids (swollen vein or group of veins in the anus)

Ischemic bowel disease (clot affecting a large bowel artery)

Chronic ischemia (ex. Heart failure)

Acute thrombosis of mesenteric arteries and veins (blood clot)

Non-occlusive intestinal infarction (tissue death)

Hernia (strangulation of tissue and subsequent ischemia)

27
Q

Describe the flow of blood in the intestines?

A

The bowels are closely attached to the a rich supply of blood from arteries accompanied by the mesenteric veins.

When the blood reaches the intestines, it will absorb nutrients and other substances from the small intestines. This nutrient-rich blood is sent to the liver for processing and detoxification

Once the substances from the small intestines have been processed and detoxified, it is allowed to enter systemic supply

28
Q

What are some things that are associated diarrhea?

A

Excessive motility

Loss of fluids due to high water content in faeces

Usually caused by infections or toxic agents due to epithelial disruption

29
Q

What are some treatments for diarrhea?

A

Rehydration

Bulking agents

Anti-motility drugs (loperamide)

30
Q

What are some things associated with constipation?

A

Inadequate mobility (acute/chronic)

Harder stool (more difficult to pass)

Impactions (could lead to hospitalization)

Discomfort

Enteric nervous system disruption

31
Q

What are some treatments for constipation?

A

Motility agents (sennosides, bisacodyl, PEG)

Fluids

Bulking agents (fiber)

Stool softners (docusate)

32
Q

What are some characteristics of gastrointestinal infections?

A

Bacterial infections are usually associated with travel and are food-borne

Most common pathogens: (Salmonella, Campylobacter, Shigella, Shiga toxin-producing E. coli)

33
Q

What are the two types of gastrointestinal infections?

A

Non-inflammatory: usually less severe but still can cause dehydration

Inflammatory: associated with bloody diarrhea and presence of fecal leukocytes more likely, and more severe illness

34
Q

How can diarrhea be managed by the patient?

A

Rehydration

Rest

Loperamide to reduce symptom duration

Simethicone for gas and cramping

Hygiene

Healthy diet

35
Q

When should a case of diarrhea be referred to an MD?

A

Bloody diarrhea

Diarrhea has lasted over 7 days

Travel-associated

Immunocompromised

Fever, severely ill, debilitated

Complex patients

Extremes of age

36
Q

What are some causes of intestinal obstruction?

A

Mechanical:
Stenosis

Stricture (due to inflamed surrounding tissue)

Intussusception (telescoping intestine)

Volvulus (twisting around itself)

Hernia (bulging through)

Adhesions

Neoplasms (rarely large enough to obstruct the lumen)

37
Q

Describe intestinal neoplasms in detail?

A

Third most common cancer of internal organs (affects more than 200,000 people every year)

Adenoids and carcinomas account for 90% of intestinal neoplasms

Colon most often affected

Sporadic of familial (8:2)

Benign or malignant (3:1)

May be solitary or multiple

Primary or secondary (P>S)

38
Q

What is the consequence of a intestinal neoplasm that is partially obstructing the lumen?

A

Constipation

Changes in bowel movement

Bleeding

Bloating

Weight loss

39
Q

What is inflammatory bowel disease (IBD)?

A

Chronic inflammation of portions of the GI tract. Usually diagnosed in adolescence or early adulthood

Can cause complications such as malnutrition, colon cancer, intestinal fistulas and ruptures

40
Q

What are the two main types of inflammatory bowel disease (IBD)?

A

Crohn’s disease

Ulcerative colitis

41
Q

What are the causes of inflammatory bowel disease (IBD)?

A

Very complex etiology, with genetic, environmental and autoimmune factors result in inflammation in the gut and in other tissues

Risk factors: smoking, family history, fatty diet, hormonal medications,, stress, environmental pollution

42
Q

What are some symptoms associated with inflammatory bowel disease (IBD)?

A

Abdominal pain

Mouth/stomach ulcers

Diarrhea

Rectal bleeding

Loss/change in appetite

Fever

Weight loss

Fatigue

Change/loss of menstrual cycle

43
Q

What are some long-term complications of inflammatory bowel disease (IBD)?

A

Malnutrition and malabsorption

Anemia

Perforated bowel

Fistula, strictures, andabcess

Joint pain

Increases risk of colon cancer

44
Q

What structural chnages occur in patients with Crohn’s disease?

A

Small intestine lumen wall:
Irregular nodular presentation with hyperaemia (looks red due to increased perfusion) and focal ulceration

45
Q

Describe ulcerative colitis

A

It is family common (affects about 500,000 Canadians)

Redness, pain, and swelling in the colon are some symptoms associated with ulcerative colitis

46
Q

What is the main difference between Crohn’s disease and ulcerative colitis?

A

Crohn’s disease tends to be more involved in the GI tract tissue

Ulcerative colitis is more surface associated

47
Q

Are biologic drugs ineffective in inflammatory bowel disease?

A

No, they are effective

Anti-TNF BIologics

a2b7 Integrin blockers

Antibodies to p40 subunit of IL-12 and IL-23

PHAR 123* (11 decks)

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