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Medical Conditions II > GI System > Flashcards

GI System Flashcards

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USMLE® Step 1 flashcards
1
Q

S/Sx GI Disease

A
  • N/V
  • diarrhea
  • anorexia
  • constipation
  • dysphagia
  • achalasia
  • heartburn
  • abdominal pain
  • GI bleeding
  • Bowel incontinence
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2
Q

Achalasia

A
  • inability to relax smooth muscles of GI tract

- feeling of fullness in sternal region

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3
Q

hematemesis

A

-spitting up blood

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4
Q

melena

A

black stool

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5
Q

hematochezia

A

bloody stool

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6
Q

Causes of Diarrhea

A
  • neurogenic: IBS
  • Muscular: alcohol, muscular incompetence
  • Mechanical: obstruction
  • Other: diet, meds, infection, strenuous exercise
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7
Q

Causes of Constipation

A
  • neurogenic: IBS, MS, PD
  • Muscular: inactivity, back pain
  • mechanical: obstruction
  • Other: diet, meds
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8
Q

Aging and GI

A
  • constipation, incontinence, diverticular disease
  • wear/tear dental components
  • decreased sensation and salivation
  • decrease gastric motility, volume/acid content
  • decreased blood flow and nutrient absorption
  • decreased production of intrinsic factor (IF)
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9
Q

GI is an ____ organ

A

-endocrine

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10
Q

GI produces and secretes _____

A

hormones

-travel through portal system to organ of influence

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11
Q

Intrinsic Innervation

A
  • enteric nervous system
  • myenteric plexus
  • submucsal plexus
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12
Q

Extrinsic Innervation

A

-parasympathetic and sympathetic nervous systems

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13
Q

Parasympathetic Innervation of GI

A
  • from sacral segments of SC
  • thoracic ganglia
  • celiac, superior mesenteric, inferior mesenteric ganglia
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14
Q

Sympathetic Innervation of GI

A

-nonadrenergic fibers from prevertebral sympathetic ganglia

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15
Q

Vagus Nerve

A

-sensory and motor fibers

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16
Q

Gastrointestinal conditions: Esophagus

A
  • hiatal hernia
  • GERD
  • Scleroderma Esophagus
  • Neoplasms
  • Varices
  • Tracheoesophageal Fistula
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17
Q

Hiatal Hernia

A
  • enlargement of cardiac sphincter

- stomach protrudes thru opening into diaphragm into thoracic cavity

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18
Q

Hiatal Hernia may cause:

A
  • midline/sternal pain (heartburn) 30 min after eating

- pain/difficulty with swallowing

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19
Q

Treatment of Hiatal hernia

A
  • antacids
  • elevating upper body in supine position
  • avoid full supine
  • avoid valsalva
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20
Q

GERD

A
  • gastroesophageal reflux disease

- result of reflux of irritating fluids

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21
Q

GERD Treatment

A
  • acid-suppressing inhibitor drugs (PPIs)
  • antacids or histamine blockers
  • lifestyle modifications
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22
Q

GERD PT Management

A
  • exercise may aggravate
  • decreased Sx with less strenuous exercise
  • avoid supine
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23
Q

Esophageal Neoplasms

A
  • 2 types: squamous cell and adenocarcinoma
  • more in middle aged white men
  • squamous more in blacks
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24
Q

GERD may increase the risk of:

A

-adenocarcinoma via Barrett’s esophagus (precancerous)

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25
Q

_____ mades esophageal mucosa more vulnerable to neoplastic changes

A

-vitamin A and zinc deficiencies

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26
Q

Food/drink remaining in esophagus may lead to _____

A

-ulceration/metaplasia

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27
Q

Sx of esophageal neoplasm

A
  • dysphagia w/ or w/o pain
  • heartburn in supine
  • enlarged painless lymphnodes
  • anorexia
  • weight loss
  • hoarseness
  • cough/recurrent pneumonia
  • bleeding
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28
Q

Esophageal Neoplasm Treatment

A
  • surgery
  • radiation
  • chemo

poor prognosis/rapid metastasis

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29
Q

Esophageal Varices

A
  • dilation of veins in lower 1/3 of esophagus

- liver disease–>portal HTN–>varices

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30
Q

Variceal bleeding usually manifests as ____

A

painless but massive hematemesis with or w/o melena

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31
Q

Esophageal Varices S/Sx

A
  • postural tachycardia
  • profound shock
  • melena
  • hematemesis
  • asterixis
  • ascitis
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32
Q

Esophageal Varices Treatment

A
  • pharmacologic
  • endoscopic
  • liver transplant
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33
Q

Esophageal varices PT management

A
  • avoid valsalva
  • watch for asterixis
  • assess fluid retention (ankles) and ascites
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34
Q

Stomach Conditions

A
  • Gastritis
  • Peptic Ulcer Disease (PUD)
  • Gastric Cancer
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35
Q

Gastritis

A
  • inflammation of stomach lining (gastric mucosa)–not whole wall
  • most common stomach disorder
  • 2 types: A and B
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36
Q

Gastritis Type A

A
  • associated with pernicious anemia

- less common

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37
Q

Gastritis Type B

A
  • bacterial infection
  • more common

(Helicobacter pylori)

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38
Q

Acute Gastritis

A

-often with serious illness (physiologic stress) or meds (NSAIDs)

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39
Q

Risk factors with NSAID use:

A
  • > 65
  • Hx of ulcer disease
  • NSAIDs >3 months
  • high dose of multiple NSAIDs
  • concurrent corticosteroid therapy
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40
Q

S/Sx Acute Gastritis

A
  • epigastric pain
  • abdominal distention
  • appetite loss
  • nausea
  • occult GI Bleeds
  • heartburn
  • low-grade fever
  • vomiting
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41
Q

S/Sx Chronic Gastritis

A
  • asymptomatic

- pain/indigestion after eating

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42
Q

Acute Gastritis PT Management

A
  • watch for Gastritis in people taking NSAIDs

- edu about side effects, risks, proper use of NSAIDs

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43
Q

PUD

A
  • peptic ulcer disease

- break in gastric mucosa or duodenal mucosa

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44
Q

Pepsin

A
  • proteolytic enzyme
  • principle component of gastric juice
  • catalyst in chemical breakdown of protein
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45
Q

S/Sx of PUD

A
  • symptomless until perforation/hemorrhage occur
  • epigastric pain (burning, gnawing, cramping, aching)
  • nausea
  • appetite loss
  • weight loss
  • occur in waves
  • radiate to back (steady T6-T10 pn with duodenal perforation)
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46
Q

Risk factor of PUD

A
  • Helicobacter pylori infection (90% of all ulcers)

- NSAIDs

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47
Q

S/Sx PUD related to:

A

-secretion of acid presence of food in stomach

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48
Q

PUT Treatment Goals

A
  • relief of Sx
  • promote healing
  • prevent complications
  • prevent recurrence
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49
Q

_____ ulcers heal faster than _____ ulcers

A

duodenal faster than gastric ulcers

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50
Q

PUD Treatment

A
  • antimicrobials for H. pylori
  • antacids, PPIs, histamine blockers
  • diet mod
  • surgery for perforation
  • ex’s to decrease risk of GI bleeding (moderate)
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51
Q

Signs of GI bleed

A
  • pallor
  • activity intolerance
  • fatibue level
  • vital signs: RR, HR increased
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52
Q

Most Common Gastric Cancer

A
  • adenocarcinoma

- (90% of all malignant tumors of stomach)

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53
Q

Gastric Cancer Risk Factors

A

-H. pylori

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54
Q

Treatment of Gastric Cancer

A

-surgical

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55
Q

S/Sx Gastric Cancer

A
  • epigastric pn
  • back pain
  • paraneoplastic acanthosis
  • left supraclavicular lymph node enlarged (Virchow’s)
  • umbilical nodule
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56
Q

Paraneoplastic Acanthosis

A
  • diffuse thickening of skin with grey/brown/black pigmentation
  • found in body folds
57
Q

Virchow’s Node

A
  • left supraclavicular lymph node

- commonly involved with gastric cancer

58
Q

Intestinal Conditions

A
  • malabsorption syndrome
  • intestinal ischemia
  • botulism
  • inflammatory bowel disease (IBD)
  • irritable bowel syndrome (IBS)
  • diverticular disease
  • neoplasms
  • obstructive disease
59
Q

Malabsorption Syndrome

A

-group of syndromes marked by decreased intestinal absorption/excessive loss of nutrients in stool

60
Q

Causes of Malabsorption Syndrome

A
  • Celiac Disease
  • Cystic Fibrosis
  • Crohn’s Disease
  • Chronic Pancreatitis or Pancreatic Carcinoma
  • Pernicious Anemia
  • Short-Gut Syndrome
61
Q

Maldgestion

A

-failure of chemical process of digestion

62
Q

Malabsorption

A

-failure of intestinal mucosa to absorb digested nutrients

63
Q

Digestive Defects

A
  • Cystic Firbosis: absent pancreatic enzymes

- Lactase Deficiency

64
Q

Absorptive Defects

A
  • primary (celiac disease)

- secondary (inflammatory disease bowel)

65
Q

Types of Malabsorption Conditions Seen in PT

A
  • gastroenteritis due to NSAID use
  • Fibrosis due to progressive systemic sclerosis or radiation
  • exocrine deficiency of pancrease due to DM
  • Short-gut syndrome following extensive resection of bowel
66
Q

Early Symptoms of Malabsorption Syndrome

A
  • weight loss
  • fatigue
  • depression
  • abdominal bloating
  • steatorrhea
  • nocuria
  • dermatitis herpetiformis
67
Q

Common Symptoms of Malabsorption Syndrome

A
  • explosive &/or chronic diarrhea
  • abdominal cramps
  • indigestion
  • flatulence
68
Q

Later Symptoms of Malabsorption Syndrome

A
  • muscle wasting
  • bone mineral density changes
  • low BP
  • abdominal distention
  • pernicious anemia
  • clubbed fingers
69
Q

Malabsorption Syndrome can result in:

A

-pernicious anemia

poor uptake of Vit B12

70
Q

Aging of GI system can result in:

A
  • decreased Intrinsic factor (IF) which promotes B12 absorption
  • pernicious anemia
71
Q

malabsorption of Calcium, vitamin D and proteins can cause:

A
  • osteoporosis
  • bone pain from compression Fx
  • skeletal deformities
72
Q

electrolyte imbalance and low Ca++ can cause

A

Mm spasms

73
Q

Intestinal Ischemia caused by:

A
  • embolic occlusions of abdominal aorta visceral branches

- arteriosclerotic changes

74
Q

Intestinal Ischemia usually presents with:

A
  • crampy or steady epigastric or periumbilical pain

- can refer to thoracolumbar junction with exertion

75
Q

PT management of intestinal ischemia

A
  • screen back pain pts for:
  • -CAD risk factors
  • -PVD/PAD
  • -recent surgeries
  • -Hx of blood clots
76
Q

Botulism result from indigestion of:

A
  • E. coli
  • Camplyobacter listeria
  • salmonella
77
Q

GI Symptoms of Botulism

A
  • prolonged bloody diarrhea
  • dehydration
  • wt loss
  • fever
  • nausea
  • severe abdominal pain
78
Q

Neurologic Sx of Botulism

A
  • motor weakness
  • paresthesias
  • CN palsies
79
Q

Treatment of Botulism

A

-antitoxin

80
Q

IBD

A
  • inflammatory bowel disease

- 2 types (Crohn’s disease, ulcerative colitis)

81
Q

CD

A
  • Crohn’s Disease

- affects all layers of intestine with normal areas between (skip areas)

82
Q

UC

A
  • ulcerative colitis

- affects mucosa and submucosa in continuous pattern (no skips)

83
Q

Cause of CD and UC

A

-idiopathic

84
Q

CD and UC affect:

A

-GI tract’s ability to distinguish foreign entities from body’s antigens

85
Q

Etiology of IBD

A
  • genetic link
  • immunologic mechanism
  • run in families
86
Q

Treatment of IBD

A
  • diet/nutrition
  • palliative
  • medication
  • surgical excision
87
Q

IBD PT management

A
  • watch for referred pn to LS
  • screen all pt with low back/hip/SI pn with unknown origin
  • aware of low bone mineral content/osteoporosis
  • watch for dehydration/vascular depletion
88
Q

Antibiotic-Associated Colitis

A

-long courses of antibiotics can decrease colonies of normal GI bacteria–>colonization of yeasts, molds and C. diff–>damage of intestinal mucosa

89
Q

Symptoms of Antibiotic-Associated Colitis

A
  • voluminous watery diarrhea
  • abdominal cramps/tenderness
  • fever
90
Q

Clinical Complication of Antibiotic-Associated Colitis

A
  • easily spread to other pts

- hand washing (C. diff)

91
Q

Treatment of Antibiotic-Associated Colitis

A
  • stop antibiotics
  • use of meds
  • IV fluids
  • antibiotics just for C. diff
  • probiotics
  • immunoglobulins
92
Q

Antibiotic-Associated Colitis: watch for

A

-reactive arthritis

93
Q

reactive arthritis

A
  • acute, aseptic inflammatory arthropathy after infectious process
  • at site remote from primary infection
94
Q

IBS

A
  • Irritable bowel SYNDROME
  • group of symptoms
  • most common disorder of entire GI
  • No inflammation
95
Q

IBS Cause

A
  • abnormal intestinal contractions
  • stress/serotonin levels
  • women>men
96
Q

IBS Treatment

A
  • lifestyle/dietary changes

- medications

97
Q

IBS Symptoms

A

=/>3 months

-relieved by bowel movement

98
Q

IBS PT Management

A
  • exercise (decrease stress and assist bowel function

- proper breathing/relaxation techniques

99
Q

Diverticulosis

A

-uncomplicated disease

100
Q

Diverticulitis

A

-disease with inflammation

101
Q

Diverticula

A
  • outpocketing in intestinal wall

- muscosa/submucosa herniates through muscular layers

102
Q

Diverticular Disease Symptoms

A
  • 80% asymptomatic
  • passing fresh blood/clots
  • urgency in defecation
  • severe abdominal pain (left quadrant, mid-abdominal region-refer to back, pelvic pain)
  • alternating constipation/diarrhea
  • increase flatus
  • fever
  • anemia (due to blood loss)
103
Q

Diverticular Disease Treatment

A
  • dietary changes
  • laxatives
  • exercise
  • may require antibioticcs
  • NG Tube
  • parenteral feedings
104
Q

Neoplasms

A
  • intestinal polyps

- adenocarcinoma

105
Q

Intestinal polyps

A
  • growth protruding into intestinal lumen from mucosa
  • may be neoplastic (tumor) or non-neoplastic
  • malignant or benign
106
Q

Adenocarcinoma

A

-most relevant in colon and rectum

107
Q

Adenocarcinoma Cardinal Sign

A

-bright-red blood from rectum

differentiate from diverticulosis

108
Q

Adenocarcinoma Symptoms

A
  • persistent stomach pain
  • diarrhea
  • constipation
  • sometimes asymptomatic until metastasis occurs
109
Q

Adenocarcinoma Prevention

A
  • regular colonoscopy after 50 years
  • decrease risk factors
  • exercise
  • daily aspirin/NSAID use >20 year
  • sigmoidoscopy
  • healthy diet
  • no smoking/alcohol
110
Q

Adenocarcinoma Treatment

A
  • surgical removal of tumor (or portion of colon)

- radiation

111
Q

Spread of cancer to prostate can refer pn to:

A
  • sacral/lumbar spines

- vague, dull, achy

112
Q

PT management of Adenocarcinoma

A
  • simultaneous or alternating abdominal pain at same level as back pain
  • associated GI symptoms
113
Q

Adenocarcinoma Risk Factors

A
  • age
  • men
  • adenomatous polyps
  • UC/CD
  • cancer elsewhere
  • Family Hx
  • Immunodeficiency disease
  • sedentary
  • tobacco
  • low-fiber/high-fat/high-protein diets
114
Q

Obstructive Disease Causes

A
  • organic (ulcer, gallstone, viral infection, neoplasm)
  • mechanical (actual block)
  • functional (peristalsis, drug, electrolyte imbalance)
115
Q

Obstructive Disease Progression

A

-obstruction–>distention–>constipation

116
Q

Symptoms of Obstructive Disease

A
  • cramping pain/tenderness in periumbilical area
  • costitutional symptoms
  • dehydration
  • hypovolemia
  • metabolic acidosis (w/n 24 hours of obstruction)
117
Q

Paralytic Ileus

A
  • functional obstruction

- after anterior lumbar fusion/abdomina surgery/immobilization

118
Q

Obstructive Disease PT management

A

-get moving (within limitations by surgeon)

119
Q

mechanical obstruction

A
  • adhesions
  • intussusception
  • volvulus
  • hernia
120
Q

adhesions

A

-fibrous bands after abdominal surgery

121
Q

intussusception

A

-telescoping of bowel in on itself

122
Q

volvulus

A

-torsoin of an intestinal polyp, twisted on it’s mesentery

123
Q

hernia

A

-abnormal protursion of part of an organ/tissue through structure normally containing it

124
Q

Types of Hernias

A
  • inguinal (direct/indirect) [sports hernia]
  • femoral
  • umbilical
  • incisional (ventral)
125
Q

Symptoms of Hernias

A
  • intermittent/persistent bulge
  • interm/persistent pain
  • pn increases with change in position, valsalva maneuver, physical exertion
  • pn relieved by stopping atcitity
  • fever, tachycardia, vomiting, abdominal distention
126
Q

Treatment of Hernias

A

-surgical repair (herniorrhaphy)

127
Q

Appendicitis

A
  • inflammation of vermiform appendix

- may progress to necrosis, perforation–>peritonitis

128
Q

Cause of Appendicitis

A
  • 1/2 are idipathic
  • 1/3 due to obstruction
  • infection elsewhere
  • IBD (CD/UC)
  • tuberculous enteritis
129
Q

Symptoms of Appendicitis

A
  • abdominal pain
  • anorexia
  • nausea
  • vomiting
  • low-grade fever (higher in children)
  • TTP over McBurney’s point
  • agg by valsalva, bend over
130
Q

Treatment of Appendicitis

A

-surgical removal

131
Q

PT management of Appendicitis

A
  • refer to right hip, thigh, groin
  • screening: palp of McBurney’s Point
  • Blumberg Sign (rebound pn)
  • local pn on coughing/valsalva
132
Q

Peritonitis

A

-inflam of serous membrane lining abdominal cavity

133
Q

Primary Peritonitis

A

-spontaneous

134
Q

Secondary Peritonitis

A

-due to trauma, surgery, ulceration (contam by bowel contents)

135
Q

Symptoms of Peritonitis

A
  • rigid/board-like abdomen
  • severe abdominal pn
  • high fever
  • nausea
  • vomiting
  • Blumberg Sign (rebound pn)
136
Q

Treatment of Peritonitis

A
  • surgical drainage/repair
  • antibiotics
  • supportive measures to correct fluid, electrolyte and nutritional disorders
137
Q

Kehr’s sign

A
  • left shoulder pain with splenic irritation

- associated with peritonitis due to blood, infectious fluids in abdominal cavity contacting spleen

138
Q

Spleen refers to

A

-left shoulder

139
Q

Liver refers to

A

-right shoulder

Medical Conditions II (34 decks)

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