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Patho > GI system > Flashcards

GI system Flashcards

1
Q

What parts of the GI system is considered the “upper portion”?

A
  1. Mouth
    2 Esophagus
  2. Stomach
  3. Duodenum
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2
Q

Name the parts of the “Lower GI” unit and its functions

A
  1. Small Intestine: digestion and nutrient absorption

2. Large Intestine: absorption of water and electrolytes; storing and eliminating waste.

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3
Q

Define Achalasia

A

Failure to relax the lower esophageal sphincter. This is usually preceded by dysphagia.

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4
Q

Define Hematemesis

A

A type of GI bleeding. Characterized by vomiting “frank blood” (bright, red). This usually constitutes bleeding in the esophagus or mouth.

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5
Q

Define Hematochezia

A

A type of GI bleeding. Characterized of passing stools that resemble “Frank blood” (bright, red). This can be due to bleeding hemorrhoids or possibility of colon cancer.

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6
Q

Define Melena

A

A type of GI bleeding. Characterized by stools that are black-tarry. This is indicative of bleeding in GI system below the stomach. This is the MOST SERIOUS condition.

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7
Q

Define Coffee Grindemesis

A

A type of GI bleeding. Characterized by coughing up particles that resemble coffee grinds. This usually occurs due to blood mixing with stomach acids.

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8
Q

What spinal levels are usually affected by GI pathology?

A

T4 - T12

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9
Q

In which quadrant will you find the liver, gallbladder, and transverse colon?

A

Right upper quadrant (RUQ)

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10
Q

In which quadrant will you find the stomach, and portions of transverse and descending colon?

A

Left upper quadrant (LUQ)

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11
Q

In which quadrant will you find the cecum and appendix?

A

Right lower quadrant (RLQ)

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12
Q

In which quadrant will you find the sigmoid colon and portions of descending colon?

A

Left lower quadrant (LLQ)

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13
Q

What are some aging effects on the GI system?

A
  1. Appetite depression due to oral changes, diminished taste and smell, and decreased salivary secretion
  2. Macronutrients, minerals, and vitamins are absorbed more slowly
  3. Decreased gastric acid secretion
  4. Decrease in intrinsic factor production
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14
Q

Decrease in intrinsic factor production can lead to ….

A
  1. Pernicious Anemia
  2. Numbness/ tingling in extremities
  3. Anemia
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15
Q

Why is intrinsic factor production important?

A

B12 is necessary for RBC formation, neuron health, and DNA replication. Intrinsic factor is necessary for B12 absorption

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16
Q

Define Gastroesophageal reflux disease (GERD)

A

Lower esophageal sphincter does not close properly and stomach contents reflux into the esophagus.

CHRONIC heartburn that occurs >2x/wk is considered GERD.

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17
Q

What are the MAJOR risk factors for GERD?

A
  1. Decreased pressure of lower esophageal sphincter
  2. Increased gastric pressure
  3. Gastric contents near gastroesophageal junction
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18
Q

Describe the pathogenesis of GERD

A

Acidic gastric contents contact the walls of the esophagus, causing inflammation in mucosal walls

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19
Q

How is GERD diagnosed?

A
  1. Usually by history
  2. Barium X-ray
  3. Endoscopy
  4. Esophageal pH testing
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20
Q

What are the clinical presentations for GERD?

A
  1. Heartburn
  2. Dysphagia
  3. Coughing
  4. Wheezing
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21
Q

Symptoms of GERD are aggravated by:

A
  1. Bending over
  2. Recumbency
  3. Meals
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22
Q

Symptoms of GERD are alleviated by:

A
  1. Antacids
  2. Standing
  3. Fluids
  4. Avoidance of predisposing factors
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23
Q

What are the treatment options for GERD?

A
  1. Lifestyle modifications
  2. Medications
  3. Surgery
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24
Q

What lifestyle modifications can be made to treat GERD?

A
  1. Avoid caffeine, smoking, alcohol, NSAIDs
  2. Remain upright 3 hours after eating
  3. Eat small meals
  4. Drink fluid between meals
  5. Elevate HOB
  6. Avoid strenuous exercise right before bed
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25
Q

In regards to GERD, what side is beneficial to lay on when sleeping?

A

LEFT sidelying

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26
Q

in regards to GERD, what will elevating HOB help to do?

A

Prevent nocturnal reflux

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27
Q

What are the drug medication classes and their functions for treating GERD?

A
  1. Antacids = neutralize stomach acid
  2. Histamine blockers (Pepcid, Tagamet) = prevent acid secretion
  3. Proton-pump inhibitors (Prilosec, Prevacid)
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28
Q

Can GERD present without symptoms?

A

Yes, sxs could include excessive clearing throat, change/loss of voice, problems with swallowing, feeling that food is stuck in throat, burning in mouth, or chest pain.

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29
Q

Explain exercise-related GERD

A

More common in athletes. Strenuous exercise INHIBITS gastric and small intestine emptying.

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30
Q

Advice for exercise-related GERD

A
  1. Eat smaller meals > 1 hour before training
  2. Dilute sports drinks
  3. Avoid/minimize exercise that increase intra-abdominal pressure
  4. Avoid strenuous training before sleeping/ lying down
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31
Q

Define Hiatal (diaphragmatic) hernia

A

Lower esophageal sphincter becomes enlarged, allowing stomach to pass through diaphragm into thoracic cavity.

32
Q

Describe the pathogenesis of hiatal hernia

A

With a hiatal hernia, the stomach moves into and past the diaphragm, pressure on sphincter is reduced. This allows sphincter to OPEN at the wrong time, causing stomach contents and acid to flow into esophagus.

33
Q

What are the risk factors for a hiatal hernia?

A
  1. Anything that WEAKENS the diaphragm
  2. Anything that INCREASES intra-abdominal pressure
    - lifting activities
    - chronic or forceful coughing
    - pregnancy
    - obesity
    - CHF
    - Low-fiber diet
    - Constipation
    - Vigorous exercise
34
Q

Describe the clinical presentation of hiatal hernia

A
  1. Heartburn 30 - 60 min after meals - exacerbated with tight clothing or supine position
  2. Possible difficulty in swallowing
35
Q

Treatment options for hiatal hernia

A
  1. Symptomatic control : antacids and elevating HOB

2. Surgical repair

36
Q

What are the abdominal precautions?

A

NO BLTs

  1. No twisting - logrolling
  2. No lifting > 10 lbs
  3. No bending over or squatting
  4. Avoid Valsalva maneuver
  5. Wear abdominal binder, only if indicated by surgeon
37
Q

What tips would be useful for patients with hiatal hernias or GERD?

A
  1. Avoid supine exercises - use wedges
  2. Avoid exercises that increase intra-abdominal pressures
  3. Teach proper breath control - No Valsalvas
  4. Instruct in proper body mechanics/ lifting
38
Q

Define Peptic ulcer disease

A

Break in mucosal lining of stomach, upper small intestine (duodenum), or esophagus, exposing submucosal areas of gastric secretions

39
Q

What are the risk factors for peptic ulcer disease?

A
  1. H. pylori infection - bacterial
  2. Aging - Gastric and/or duodenal ulcers
  3. Chronic use of NSAIDs
40
Q

What is the clinical presentation for peptic ulcer disease?

A
  1. Burning, wave- like pain is the most common symptom
    a. epigastric location
    b. WORSE when stomach is empty
    c. Flare-ups at night
    d. Temporarily relieved by acid-reducing medications

**Many people report sxs ONLY when complications (ie hemorrhage, perforation) have arisen.

41
Q

Treatment options for peptic ulcer disease

A
  1. ABX to kill the bacteria
  2. Reduce level of acid in digestive system to relieve pain and encourage healing. (ie histamine blockers, antacids)
  3. Prevent recurrence: quit smoking, limit alcohol intake, avoid NSAIDs
42
Q

What is the referred pain pattern for peptic ulcer disease?

A
  1. Midthoracic region

2. Right shoulder

43
Q

Define Gastric cancer

A

Malignant cells form in gastric mucosa (innermost layer of tissue)

44
Q

What are the risk factors for gastric cancer?

A
  1. Chronic H. pylori infection
  2. Male
  3. > 50 yrs old (media age is 70)
  4. Being non-white
  5. Family history of gastric cancer
  6. Smoking
  7. Alcohol abuse
  8. Pernicious anemia
  9. Diet: excessive salty, smoky, pickled foods; low intake of fruits and vegetables
45
Q

What is the pathogenesis of gastric cancer?

A
  1. Often begins with H. pylori infection
  2. Duodenal reflux
  3. Decreased gastric acid secretion
46
Q

What is the clinical presentation of gastric cancer?

A

Early stages: asymptomatic. However, could have indigestion, stomach discomfort, heartburn, nausea, loss of appetite, tired

Later stages: blood in stool, bloated feeling after eating, vomiting, unexplained weight loss, stomach pain

47
Q

How is gastric cancer diagnosed?

A
  1. Upper endoscopy and biopsy

2. Staging done by abdominal imaging and biopsy of lymph nodes

48
Q

What is the treatment for gastric cancer?

A
  1. Surgery is the treatment of choice

2. Chemo or radiation therapy in conjunction with surgery

49
Q

Define Inflammatory Bowel Disease (IBD)

A

chronic inflammatory diseases of GI tract of unknown etiology

  1. Crohn’s disease
  2. Ulcerative collitis
50
Q

What is the pathogenesis of IBD?

A

Crohn’s disease: Inflammation occurs discontinuously, most often in lower part of small intestine or colon; involves all bowel layers.

Ulcerative collitis: Inflammation occurs uniformly beginning in rectum, extends proximally and abruptly stops; involves mucosa and submucosa.

51
Q

What layers of the GI system does Crohn’s disease affect?

A

All bowel layers

52
Q

What layers of the GI system does ulcerative collitis disease affect?

A

The mucosa and submucosa

53
Q

What does chronic inflammation of the bowels cause?

A

ULCERATIONS

54
Q

What initiates the inflammation with IBD?

A

Likely interaction between immune systems, environment, genes. It is NOT initiated by diet and stress. They can, however, exacerbate IBD.

55
Q

What are the complications of chronic inflammation of IBD?

A

INCREASED risk of colon CA; toxic megacolon, bowel obstruction, ulcers, fistulas, malnutrition, etc

56
Q

What is the clinical presentation of IBD?

A

Abdominal pain, diarrhea, bloody stool (UC) abdominal mass (CD), anorexia, weight loss, skin rash, arthralgias

57
Q

What are possible treatment options for IBD?

A

Treatment is directed toward reducing inflammation that triggers signs/ symptoms.

  1. Use of anti-inflammatories, immune system suppressors, ABX.

CD: Incurable, chronic, debilitating.
UC: can be cured by colon resection

58
Q

Define Irritable bowel syndrome?

A

Collection of signs/ symptoms that are NOT attributed to an identifiable bowel abnormality. AKA spastic colon or nervous colon

59
Q

Risk factors for IBS

A
  1. Female

2. Usually begins around 20 yrs of age

60
Q

What are the treatment options for IBS?

A

Treatment is focused on symptom relief

  1. Antidiarrhetics
  2. Antispasmodics (anticholinergic)
  3. Antidepressants
  4. Serotonin-modulators

5 Reduce stress

61
Q

Define Diverticulitis

A

Diverticulosis- condition of having diverticula - small mucosal “blind” pouches in wall of colon.

Diverticulitis- inflammation of >1 diverticula

62
Q

Pathogenesis of Diverticulitis

A

Diverticuli fill with stagnant fecal material or undigested food particles, leading to infection and inflammation.
If infection is limited to area around wall of colon when diverticula are inflamed, localized abscess can develop.

OR if perforation develops in an infected pouch, can cause fistula or peritonitis.

63
Q

Pathogenesis of Diverticula

A

Develops under pressure in weaker places in colon. Most common and numerous in sigmoid colon. And this often occurs due to straining during bowel movements over years.

64
Q

Describe the clinical presentation of Diverticulitis

A

Pain is severe, abrupt in onset, localized to the LLQ (left lower abdominal quadrant), worsens steadily over time.

Pain may radiate to low back, pelvis, left leg.

Fever, nausea/vomiting, and constipation

65
Q

Describe the treatment options for Diverticulitis

A
  1. If mild, ABX and liquid low fiber diet for a few days. This will help the colon calm down for healing. Then slowly increase high-fiber food in diet.
  2. If severe or recurrent, surgery options:
    a. Primary bowel resection: removal of diseased segment
    b. Bowel resection with colostomy
66
Q

Define colostomy

A

Opening (stoma) made in abdominal wall and unaffected part of colon is connected to stoma. Waste passes through the opening into a bag. Colostomy may be temporary or permanent.

67
Q

When would a PT perform an abdominal examination with rebound tenderness technique?

A

When there is suspicion of diverticulitis. Positive sign with this test is a general sign of peritoneal inflammation.

68
Q

What are appropriate exercise prescriptions for individuals with diverticulitis?

A
  1. Exercise is good in general as it improves gut motility

2. Avoid exercises that INCREASE intra-abdominal pressures

69
Q

Define abdominal hernias

A

Acquired or congenital abnormal protrusion of abdominal contents through a weak point or tear in muscular wall of the abdomen.

70
Q

Name the different types of abdominal hernias

A
  1. Inguinal
  2. Femoral
  3. Umbilical
  4. Incisional
71
Q

Define Reducible, Irreducible, and Strangulated in regards to Abdominal Hernias.

A
  1. Reducible - when contents of hernial sac can be replaced into abdominal cavity by manual manipulation
  2. Irreducible - hernias that can’t be replaced by manipulation
  3. Stangulated - when protruding organ is constricted to extent that CIRCULATION IS IMPAIRED
72
Q

Describe the pathogenesis of Inguinal hernias

A

2 types: Direct and Indirect, can appear as a bulge in inguinal crease.

Indirect (most common): may protrude into scrotum

Direct: Herniation above inguinal ligament where abdominal wall is slightly thinner.

73
Q

Describe pathogenesis of Femoral hernias

A

Herniation of abdominal contents through enlarged femoral ring/canal, causes a bulge below inguinal crease.

More common in multiparous women.

Has high risk of becoming irreducible and strangulated

74
Q

Describe pathogenesis of umbilical hernia

A

Opening in abdominal wall does not close completely. If small, it usually closes in a few year. If bigger, will need surgery.

75
Q

Even when umbilical hernias close at birth, why would they still appear later in life.

A

Because that particular area remains weaker.

76
Q

What are the treatment options for Hernias?

A
  1. Wait and watch for minimally symptomatic inguinal hernias
  2. Curative surgical hernia repair
  3. Acutely irreducible hernias need emergency treatment because of risk of strangulation.
77
Q

Why do acutely irreducible hernias need emergency treatment?

A

Because of risk of strangulation. If the intestinal contents of hernia have their blood supply cut off, GANGRENOUS BOWEL is possible in 6hrs!

Patho (5 decks)

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