GI SYSTEM Flashcards
1
Q
Abdominal pain
A
Most common symptom of GI disorders
2
Q
Anorexia
A
-Lack of appetite
-Common symptom of GI disorder
-May be due to non-intestinal conditions (psychological, widespread cancer, kidney failure, med side effect
3
Q
Common manifestations of GI Disorders
A
-abdominal pain
-anorexia
-nausea and vomiting
-changes in bowel habits (diarrhea, constipation)
-dysphagia
4
Q
Nausea and vomiting may indicate…
A
Stomach or duodenal disorder
5
Q
Stimuli for nausea and vomiting
A
-GI irritation (common)
-Stomach distension (common)
-Unpleasant sights or smells
-General anesthesia
-Dizziness
-Certain drugs
6
Q
Nausea
A
-Unpleasant sensation with an urge to vomit
7
Q
Vomiting
A
-forcible expulsion of stomach and sometimes duodenal contents through the mouth
8
Q
Neuro system and vomiting
A
-Protective reflex regulated by chemoreceptor trigger zone and vomiting centre located in medulla oblongata
9
Q
How vomiting happens
A
-Involves squeezing the stomach between the diaphragm and abdominal muscles and expelling the contents though open esophageal sphincters
10
Q
Vomitus containing undigested food
A
-May be an obstruction near pyloric sphincter
11
Q
Yellow or green vomitus
A
Indicates presence of duodenal bile
12
Q
Brown colitis
A
May indicate intestinal obstruction
13
Q
Bloody vomitus
A
-hematemesis
-may indicate damage to GI wall
14
Q
Consequences of Vomiting
A
Water loss = dehydration
Electrolyte imbalance = hyponatremia, hypokalemia, hypochloremia = metabolic alkalosis
15
Q
Hypochloremic Metabolic Alkalosis
A
-Characterized by low chloride and potassium levels in the blood and high bicarbonate levels
16
Q
Mallory-Weiss Syndrome
A
-Frequent and violent episodes of vomiting may tear the esophagus and cause bleeding
-More common in individuals who misuse alcohol
17
Q
Electrolyte imbalance and vomiting: hyponatremia
A
-Gastric juice contains Na, loss of Na without replacement leads to hyponatremia
18
Q
Electrolyte imbalance and vomiting: Hypokalemia
A
-Secondary to hyponatremia
-Low Na stimulates Na reabsorption and K excretion in the kidneys
19
Q
Electrolyte imbalance and vomiting: Alkalosis
A
-Gastric juice contains H, loss of H leads to high bicarbonate levels in the blood and metabolic alkalosis
20
Q
Definition of Diarrhea
A
-Passage of loose watery stools 3+ times per day
21
Q
Diarrhea pathophysiology
A
-infection
-inflammation
-food intolerances
-allergies
-certain drugs
22
Q
Diarrhea mechanisms
A
-increased water secretion
-decreased water reabsorption
-normally small intestine absorbs most of the water and electrolytes in the intestinal tract and large intestine absorb the remainder leaving formed stool
23
Q
3 types of diarrhea
A
Osmotic, secretory, motility
24
Q
Osmotic diarrhea
A
-Occurs when solute concentrations in intestinal lumen is higher than in body fluids
-causes influx of water into intestines leading to diarrhea
-undigested or unabsorbed material draws water into lumen
25
Common causes of osmotic diarrhea
-lactose intolerance
-over use of bulk forming or osmotic laxatives (psyllium fibre, polyethylene glycol)
26
Secretory diarrhea
-due to increased water and electrolyte secretion into the intestinal lumen
27
Causes is secretory diarrhea
-Usually caused by infection or inflammation of intestinal mucosa
-Ecoli infection
-food allergies
-inflammatory bowel disease
28
Motility diarrhea
-Occurs when intestinal motility is disrupted and stool moves too quickly through intestines = decreased water absorption
29
Causes of motility diarrhea
-intestinal surgery
-irritable bowel syndrome
-over use of peristalsis stimulating laxatives (bisacodyl)
30
Consequences of diarrhea
Water loss = dehydration
Electrolyte imbalance = hyponatremia, hypokalemia, acidosis
-hypernatremia is a rare consequence of osmotic diarrhea where only water not sodium is secreted into the intestinal lumen
31
Diarrhea and acidosis
-due to loss on anions (organic acids and HCO3)
32
Osmotic diarrhea and electrolyte imbalance
-osmotic diarrhea represents the loss of electrolyte free water
-large volume osmotic diarrhea can generate hypernatremia
33
Definition of constipation
Difficult or infrequent defecation
34
Primary constipation
Caused by colonic or pelvic floor dysfunction
35
Categories of primary constipation
-normal transit (functional)
-slow transit
-outlet (dyssynergia)
36
Secondary constipation
-due to other disease processes or medications
37
Categories of secondary constipation
-neurological disorders
-myogenic disorders
-endocrine disorders
-medication side effects
38
Secondary constipation: Neurological disorders
-affect nerves and muscles of digestive system
-Parkinson’s disease, multiple sclerosis, spinal cord injuries
-disrupt normal functioning of the colon
39
Secondary constipation: medications
-Opioids, anticholinergics, and calcium channel blockers
-Cause constipation by slowing down colonic transit or reducing the strength of colonic contractions
40
Normal transit (functional) constipation
-most common
-involves normal rate of stool passage but difficulty with stool evacuation
-rate is normal, movement from point a to b is normal
41
Risk factors for normal transit/functional constipation
-Low fibre diet
-Low fluid intake
-Sedentary lifestyle
42
Slow transit constipation
Involves impaired smooth muscle activity in the colon
-more time for water reabsorption
43
Slow transit constipation cause
-decreased colonic motility may be due to enteric nerve plexus dysfunction
44
Slow transit constipation results in
Increased water absorption and hardened stool
45
Outlet constipation (dyssynergia)
-involves skeletal muscle activity of the pelvic floor during bowel evacuation
46
Outlet constipation (dyssynergia) cause
-normally pelvic floor relaxes during defecation but with dyssynergia the pelvic floor contracts during defecation making it difficult to empty the rectum
47
Potential complications of constipation
-Fecal impaction
-Hemorrhoids
-Anal fissures
-Rectal prolapse
-Alkalosis
48
Chronic constipation and metabolic alkalosis
-Chronic constipation sometimes causes alkalosis due to increased HCO3 absorption
49
Submucosa
-contains glands for secretions
50
Muscularis
-smooth muscle
-helps with mechanical digestion and moving food forward to anus
-under control of ANS
51
Proximal meaning
In front of
52
Dysphagia
-Difficulty swallowing
-Can be caused by structural or functional obstruction of the esophagus
53
Causes of esophageal dysphagia
-GERD
-Achalasia
-Diffuse esophageal spasm
-Esophageal cancer
-Scleroderma
-Esophageal stricture
54
Structural Dysphagia
-Caused by a physical obstruction of the esophagus
-eg. esophageal tumor and esophageal stricture
55
Functional Dysphagia
-Impairment of esophageal motility due to neural or muscular disorder
-Eg. stroke, Parkinson’s disease, MS, muscular dystrophy, achalasia
56
Achalasia is caused by
Loss of esophageal innervation
57
GI Disorders 3 Broad Categories
1. Altered GI tract motility disorders
2. Altered GI tract integrity disorders
3. Maldigestion and malabsorption disorders
58
Altered motility disorders patho physiological characteristics
-Due to obstruction or peristaltic dysfunction
59
Examples of altered motility disorders
-GERD
-Mechanical obstruction
-Functional obstruction
60
Altered integrity disorders pathophysiological characteristics
-Damage to GI tract wall due to infection, inflammation, or structural change
61
Example of altered integrity disorders
-Gastritis
-PUD
-IBD
-Diverticular disease
62
Maldigestion and Malabsorption disorder pathophysiological characteristics
-Poor digestion and absorption of intestinal contents; often secondary to altered motility or integrity
63
Maldigestion and Malabsorption Disorder examples
-Digestive enzyme deficiency
-Bile salt deficiency
-Celiac disease
64
Motility and GI system
-coordinated smooth muscle contractions of the muscularis propel food and secretions through the digestive tract
-The GI tracts capability to mix and move material along its length is called motility
65
Altered GI motility refers to
-abnormal speed or
-abnormal direction material moves though GI tract
66
Abnormal Speed
-If motility is too fast, the GI tract does not have enough time to digest and absorb nutrients or reabsorb water = often associated with diarrhea
-If motility is too slow then GI tract may reabsorb too much water which causes constipation
-No movement at all can be caused by an obstruction like a tumour
67
Abnormal direction
-If GI motility is reversed, material in GI tract moves forward towards the mouth instead of the anus (acid reflux and vomiting)
68
Examples of motility issues
-Hiatal hernia
-GERD
-Pyloric obstruction
-Intestinal obstruction
69
Hiatal Hernia
-Occurs when a section of the stomach protrudes upward into the thoracic cavity through the diaphragms esophageal hiatus
70
Risk factors for hiatal hernia
-Any condition that weakens the diaphragm
-Aging (muscles/diaphragm weaken)
-Increased intrabdominal pressure (obesity, pregnancy, coughing, straining during BM) can weaken diaphragm
-Increased intrathoracic pressure (COPD, asthma, mechanical ventilation) can weaken diaphragm
-Nicotine weakens muscle and diaphragm
71
Potential symptoms of hiatal hernia
-often asymptomatic on its own, clinical manifestations reflect damage and inflammation of the esophagus and stomach due to acid reflux
-heartburn
-regurgitation
-dysphagia
-chronic cough
72
Two types of hiatal hernia
1. Sliding hiatal hernia
2. Paraesophageal hiatal hernia
73
Sliding hiatal hernia
-most common type
-gastroesophageal junction and portion of the stomach slide up into the chest through the esophageal hiatus
-gastroesophageal junction moves up and down within the chest with respiration and swallowing
74
Paraesophageal hiatal hernia
-Less common, more severe
-portion of stomach pushes though the esophageal hiatus next to the esophagus and stays in the chest cavity
-in severe cases the herniated stomach can twist upon itself and cut off its blood supply leading to a medical emergency =gastric Volvulus
75
Gastric volvulus
When the stomach twists upon itself and cuts off blood supply
76
Gastroesophageal Reflux Disease (GERD)
-chronic regurgitation of stomach contents through the lower esophageal sphincter (LES) into the esophagus
77
GERD and reflux esophagitis
-Repeated exposure to acid and enzymes irritates the esophageal mucosa and causes reflux esophagitis
78
GERD causes
-reflux esophagitis
-relatively common, 1 in 6 Canadians
79
GERD caused by
Weakening of LES
80
GERD risk factors
-Hiatal hernia (protrusion of stomach through diaphragm) weaker LES
-Obesity increased pressure on stomach, weakens LES
-Pregnancy, hormonal changes during pregnancy relax LES
-Smoking (nicotine) weakens LES and increases stomach acid production
-Alcohol and caffeine consumption relaxes LED and increased stomach acid production
81
General Pathogenesis and Complications of GERD
-Some condition weakens LES —> Stomach contents reflux into esophagus —> refluxuate irritates and erodes esophageal mucosa —> esophageal inflammation (reflux esophagitis)—> esophageal fibrosis = esophageal obstruction AND esophageal mucosal dysplasia —> Barrett esophagus = esophageal cancer
82
Barret Esophagus
Esophageal mucosal dysplasia which can lead to precancerous Barrett esophagus
-approx 15% of Canadians with GERD develop Barrett esophagus
-primary risk factor for esophageal cancer
83
Clinical Manifestations of GERD
-heartburn (most common)
-regurgitation
-dysphagia
-n/v
-chronic cough d/t refluxate damage to the larynx
84
Heart burn
-burning sensation in chest that often occurs after eating or lying down
-pain can be severe and be mistaken for heart attack
85
Pyloric obstruction
-Condition in which the opening between the stomach and small intestine (pylorus) becomes narrowed or blocked
-Can be congenital (infantile hypertrophic pyloric stenosis) more cases are acquired
-Thickened pyloric muscle narrows the pyloric canal making it difficult for food to pass through from the stomach to small intestine
86
Causes of Pyloric Obstruction
-Congenital
-Duodenal ulcers
-Gastric ulcers
-Tumors
87
Gastric ulcers/ duodenal ulcers and pyloric obstruction
-main cause of acquired pyloric obstruction are peptic ulcers (both)
-Tissue damage and chronic inflammation leads to scarring and thickening of the pylorus
-duodenal ulcers more likely to cause obstruction than gastric ulcers
88
Potential symptoms of pyloric obstruction
-Nausea and vomiting (stomach becomes distended with food)
-sometimes projectile vomiting
-dehydration
-hypochloremic alkalosis (d/t prolonged vomiting) and prolonged obstruction causing stomach to secrete more acid further exacerbating metabolic alkalosis (also increased risk for gastric ulcers d/t this)
-Weight loss
89
Intestinal Obstruction
-Occurs when intestinal blockage partially or completely interrupts flow of intestinal contents
-Small bowel more common than large bowel obstruction because of its narrower lumen
90
2 types of intestinal obstruction
Mechanical, functional
91
Mechanical Intestinal Obstruction
-Occurs when there is a physical blockage of the intestines
-More common
92
Functional Intestinal obstruction
-Occurs when intestinal muscles are unable to move contents through the digestive tract
-Eg. paralytic ileus caused by decreased or complete absence of intestinal motility
93
Causes of Mechanical Obstruction (SBO)
-Adhesions
-Hernia
-Intussusception
-Crohn Disease
94
Main Causes of Mechanical Obstruction (LBO)
-Tumour
-Volvulus
-Diverticular Disease
-Ulcerative Colitis
95
Adhesions
-SBO
-bands of scar tissue that form between intestinal loops often because of prior abdominal surgery
-leading cause of small bowel obstruction
96
Hernia
-SBO
-protrusion of small intestine through a weak spot in the abdominal wall or inguinal ring
97
Tumour
-LBO
-eg. Colorectal cancer
-Leading cause of large bowel obstruction
98
Intussusception
-SBO
-When one part of the small intestine telescopes into another part causing a blockage
99
Volvulus
-LBO
-occurs when a portion of the small or large intestine twists around itself causing a blockage
100
Diverticular Disease
LBO
-inflammation or infection of small pouches called diverticula in large intestine wall can cause blockage
101
Crohn’a disease/ulcerative colitis
-aka Inflammatory bowel disease
-crohns = SBO, ulcerative colitis = LBO
-can cause inflammation and narrowing of the intestine
102
Pathogenesis of mechanical obstruction
Intestinal obstruction —> air and gas —> intestinal distension proximal to obstruction —> intestinal perforation/peritoneal transudation—> bacterial migration —> peritonitis and sepsis ALSO intestinal distension proximal to obstruction —> loss of intestinal absorption —> intestinal fluid sequestration —> fluid and electrolyte imbalance
103
General Pathogenesis and complications other format
1. Intestinal lumen becomes obstructed
2. Proximal (above) the obstruction the intestinal contents accumulate, distal to the blockage the intestine compresses as its contents pass towards the anus
3. Swallowed air and gas from bacteria fermentation can accumulate adding to bowel distension
4. As the bowel distends, normal absorptive function is lost and fluid is sequestered into the bowel lumen which can cause fluid and electrolyte imbalance
5. There may also be transudative loss of fluid from the intestinal lumen into the peritoneal cavity
6. Gut bacteria may also pass into the into the peritoneal cavity during the transudative process which can lead to peritonitis and sepsis
7. Obstruction eventually may lead to strangulation, gangrene and perforation of bowel, peritonitis and sepsis
104
Potential symptoms of mechanical obstruction
-Severe colicky pain
-Absolute constipation
-Abdominal distension
-Nausea and vomiting (SBO)
105
Potential consequences of mechanical obstruction
-Fluid and electrolyte losses
-Hypovolemic shock
-Alkalosis (SBO)/ Acidosis (LBO)
-Intestinal necrosis and perforation
-Peritonitis and sepsis
106
Metabolic alkalosis more like associated with..
Small bowel obstruction d/t copious vomiting
107
Metabolic acidosis more likely associated with …
-large bowel obstruction d/t failure to reabsorb HCO3
108
Integrity disorders
-Any breakdown in the guts wall structure may lead to altered GI tract integrity
-Infectious, inflammatory and erosive disorders are the root of most examples of altered GI tract integrity
109
Examples of altered GI tract integrity and one outlier
1. Gastritis
2. Peptic ulcer disease
3. inflammatory bowel disease
4. Inflammatory bowel syndrome (not actually integrity, but is motility disorder and not associated with inflammation)
5. Diverticular disease
6. Appendicitis
110
Integrity disorders: Gastritis
-Inflammation of the stomachs lining due to breakdown of the mucosal barrier
-mucosal barrier protects the stomach from injury by hydrochloric acid (HCL) and digestive enzymes found in gastric juice = d/t thick layer of mucus secreted onto its surface
111
Causes of Gastritis
-H.pylori infection
-NSAID overuse (irritate gastric mucosa and reduce mucus secretion by inhibiting prostaglandin synthesis)
-Alcohol, smoking, drugs (such as cocaine damage mucosa)
-Acute stress (causes release of certain hormones such as cortisol which can reduce blood flow to stomach and increase acid production)
-Immune dysfunction (immune system may attack and damage gastric mucosa eg. Gastritis more common in people with hashimoto disease and type 1 diabetes)
112
Gastritis complications
-Regardless of cause, mucosal damage to stomach leads to inflammation which results in
-abdominal pain
-anorexia
- nausea and vomiting
113
Gastritis complications
-If left untreated
-gastric ulcers
-GI bleeding
-stomach cancer
114
Helicobacter Pylori Infection
-Infection of the stomach and is most common cause of gastritis
-In Canada 8 to 10 million people are infected, people with Type O blood @ greater risk
-Bacteria secretes enzymes and toxins that break down stomachs mucus barrier allowing HCL to damage the gastric mucosa
115
Type O blood and H pylori
-May be at further risk because they exhibit enhanced mucosal binding of the bacteria and increased inflammatory response both of which cause more mucosal damage
116
Diseases associated with h pylori
Gastritis
Peptic ulcers
Stomach cancer (WHO considers it a carcinogen d/t increased risk of gastric cancer)
117
Integrity Disorders: Peptic Ulcers
-Circumscribed area of mucosal inflammation and ulceration of the esophagus, stomach, or duodenum
-Like gastritis, develops when the mucosal barrier is eroded
-can be single or multiple, acute or chronic, deep or superficial
118
Causes/Etiology of Peptic ulcers
-Similar etiology as gastritis
-H. Pylori (usual cause)
-NSAID overuse (usual cause)
-alcohol use, smoking, certain drugs
-stress
-advanced age
-chronic disease
119
Peptic Ulcers: Erosions
Superficial ulcers of the gastric mucosa that do not extend into the submucosa
120
Peptic Ulcers: True ulcers
-Extend into the submucosa, damage blood vessels, cause bleeding and may even perforate the GI wall leading to peritonitis and sepsis
121
Gastric vs Duodenal Ulcers: Location
Gastric: Stomach
Duodenal: Duodenum
122
Gastric Vs Duodenal Ulcers: Prevalence
Gastric: less common
Duodenal: More common (because does not have mucus barrier = easy for h. Pylori and acid erosion
123
Gastric vs Duodenal Ulcers : Cause
Gastric: more likely d/t NSAID overuse
Duodenal: more likely d/t h. Pylori infection (duodenum doesn’t have mucus barrier, straight shot for h. Pylori)
124
Gastric vs Duodenal Ulcers: Mechanism
Gastric: Gastritis
Duodenal: Mucosal damage from stomach acid (duodenal damage is result of increased acid secretion and emptying of stomach but gastric damage not usually associated with increased acid secretion)
125
Gastric vs Duodenal Ulcers: Pain
Gastric: Higher in abdomen
Duodenal: Lower in abdomen
126
Gastric vs Duodenal Ulcers: Timing of pain
Gastric: tends to occur when stomach is full/after eating
Duodenal: Tends to occur when stomach is empty typically between meals and at night (when stomach full gastric juices not entering duodenum, busy with food in stomach) = may be relieved by eating or drinking which dilutes or buffers acid in duodenum
127
Gastric Vs Duodenal Ulcers: Progression
Gastric: Usually heal slowly and are chronic
Duodenal: Tend to heal spontaneously and exhibit a pattern of exacerbation-remission
128
Gastric vs Duodenal Ulcers: Complications
-both can lead to bleeding or perforation
-Gastric: more likely to bleed and are associated with a higher risk of developing stomach cancer than duodenal
-Duodenal: More likely to cause obstruction and intestinal perforation
129
Stress Ulcers
-An acute form of peptic ulcer associated with severe illness or trauma (NOT caused by stress)
130
Types of Stress Ulcers
-Ischemic ulcers
-Curling Ulcers
-Cushing ulcers
131
Stress Ulcers: Ischemic
-Can be caused by any disorder that significantly reduces GI tract blood supply
132
Stress ulcers: Curling ulcers
-Develops because of burn injuries, reduced plasma volume leads to ischemia and necrosis of gastric mucosa
133
Stress Ulcers: Cushing
-associated with brain trauma, caused by increased gastric acid secretion resulting from brain stem compression and vagal nerve overstimulation
134
Inflammatory Bowel Disease (IBD)
-Designates two related inflammatory intestinal disorders: ulcerative colitis (UC), Crohn’s disease (CD)
-Canadians have highest incidence in the world (Manitoba the worst)
135
IBD etiology
-probably multifactoral
-environmental
-infectious agent
-autoimmune predisposition
-environmental factors and infection agents may damage the mucosal barrier and illicit an autoimmune response against an individuals own intestinal mucosa
136
IBD: UC and CD common/shared Pathogenesis
-Produce bowel inflammation
-Involve abnormal immune response to intestinal cells
-Are characterized by remissions and exacerbations of diarrhea, fecal urgency, and weight loss
-Are associated with increased risk for intestinal obstruction and colon cancer
137
Ulcerative Colitis
-A chronic relapsing bowel disease characterized by inflammation and ulceration of the colonic mucosa
138
Ulcerative colitis etiology/cause
-complex and multifactoral
-Genetics
-Environmental (diet, infection, NSAIDs)
-altered immune response to intestinal microflora may play a role in the development of UC
139
Ulcerative Colitis: Pathogenesis
-Immune “confusion” —> inflammation —> ulceration
-UC centres on an inappropriate immune response against gut microbes in genetically susceptible pts
-intestinal immune system becomes overly active causing immune cells to attack harmless gut bacteria and mucosal cells = results in release of inflammatory cytokines and recruitment of immune cells to the colonic mucosa leading to chronic inflammation
-over time inflammation leads to the characteristic features of UC including mucosal ulcerations, drivability and crypt abscesses
140
Ulcerative colitis: manifestations
-Depend on severity
-Mild UC involves less muscosa do frequency of BM, bleeding and pain is minimal
-Severe UC involves more mucosa and is characterized by pain, fever, elevated pulse, frequent diarrhea, and bloody stools
-dehydration, weight loss and anemia may occur
141
Ulcerative Colitis: Complications
-related to chronic nature of inflammatory disease
-scarring can causes narrowing of colon (stricture) and obstruction of
-severe inflammation can extent deeper into colonic wall leading to perforations, abscesses, fistulas
-long term inflammation also increases risk for colorectal cancer
-chronic inflammation and immune system direction can also result in systemic effects affecting joints skin and eyes
142
Crohns Disease
-Chronic relapsing bowel disease characterized by submucosa inflammation and granuloma formation (beginning in colons submucosa)
143
Crohn’s disease: etiology/cause
-same as UC
-genetic predisposition, environmental factors, and altered immune response
144
Crohn’s disease: Pathogenesis
-Like UC
-abnormal immune response in gut
-immune system mistakenly identifies harmless gut bacteria triggers an immune response that breads to chronic inflammation
-unlike UC inflammation begins in the submucosa and spreads with discontinuous transmural involvement (skip lesioning)
-over time inflammation leads to characterized features of UC includinging submucosa granulomas and cobble stone appearance of mucosa
145
Crohn’s disease manifestations
-depends on severity and location
-often no symptoms early in disease
-abdominal pain, fever, diarrhea common
-occasionally bloody diarrhea
-reduced nutrient absorption occurs if the ileum is affected which can lead to weight loss, malnutrition, and vitamin deficiency
-nutritional diarrhea is most common symptom
146
Crohn’s disease complications
-like UC
-strictures, obstructions, fistulas, and increased risk for colorectal cancer
-given transmural nature of CD, perforations are more common
-may also be associated with extra intestinal complications of joints skin and eyes
147
UC vs CD: Cause
-UC: family history less common, smoking decreases disease severity
-CD: Family history more common, smoking increases disease severity and risk
148
UC vs CD: Location of inflammation
UC: rectum and distal colon (descending) usually
CD: ileum and proximal (ascending) colon usually but can affect any part Of GI from mouth to anus
149
UC vs CD: Pattern of inflammation
UC: continuous and affects uniform areas typically starting at rectum and extending proximal in a continuous fashion
CD: skip lesions, patchy with healthy tissue between affected areas
150
UC vs CD: Depth of inflammation
UC: usually limited to mucosa
CD: usually below mucosa, can be transmural (involve entire thickness of intestinal wall)
151
UC vs CD: Microscopic features
UC: mucosal ulcerations, friable appearance of mucosa, diffuse inflammation and ulceration of colonic mucosa with crypt abscesses and crypt distortion
CD: submucosal granulomas, cobblestone appearance to mucosa, skip lesions, transmural inflammation
152
UC vs CD: Manifestations
UC: bloody diarrhea more common, malabsorption less common
CD: bloody diarrhea less common, malabsorption more common, weight loss/malnutrition and vitamin deficiency more common
153
Inflammatory bowel syndrome
-Functional disorder of colonic smooth muscle (effects colon contractions causing abdominal issues)
-Unlike IBD no structural changes like inflammation or damage to GI mucosal lining ( NOT an integrity disorder)
-more of a motility disorder
154
IBS potential causes
-exact cause unknown
-stress, diet, and genetics may place role
155
IBS manifestations
-pain
-gas and bloating
-constipation or diarrhea
156
Diverticular Disease
-Condition that occurs when small pouches (diverticula) form in the outer wall of the colon
-Pouches vary in size and number
157
Diverticulosis vs Diverticulitis
Diverticulosis: Diverticula with no associated manifestations
Diverticulitis: infected or inflamed diverticula
-Diverticula are often found in older adults and are usually asymptomatic (diverticulosis)
158
Diverticulitis manifestations
-abdominal pain, bloating, constipation, diarrhea, rectal bleeding
159
Diverticular disease risk factors
-older age, obesity, smoking, poor diet, lack of physical activity, medication use (aspirin and nsaids)
160
Diverticula and polys
NOT THE SAME
-polyps is an abnormal tissue growth that protrudes from the mucous membrane lining of a hallow organ into its lumen
-polyps are often discovered during colonoscopies of other diagnostic procedures
-most polyps are benign but some can be precancerous or cancerous
161
Appendicitis
-most common surgical emergency of the abdomen
162
Appendicitis Pathogenesis
-lumen obstruction —> increased lumen pressure —> inflammation —> ischemia —> perforation/peritonitis/sepsis (complications)
163
Pancreatic insufficiency
-causes malabsorption associated with insufficient amounts of enzymes that digest protein, carbohydrates, and fats into components that can be absorbed by the intestine
164
Deficient lactase productions
In the brush border of the small intestine inhibits breakdown of lactose which prevents lactose absorption and causes osmotic diarrhea
165
Bile salt deficiency
Causes fat malabsorption including fat soluble vitamins, steatorrhea
-can result from inadequate secretion of bile, excessive bacterial deconjugation of bile or impaired reabsorption of bile salts caused by ileal disease
166
Upper GI bleed causes
-peptic ulcer disease
-erosive gastritis/esophagitis
-esophageal varices
167
Lower GI bleed causes
-Diverticulosis
-Ischemic/infectious colitis
-inflammatory bowel disease
-hemorrhoids
