GI system disorders Flashcards
1
Q
What makes up the upper GI tract
A
- mouth,
- esophagus
- stomach
- duodenum
2
Q
What makes up the lower GI tract
A
- small and large intestines
3
Q
What are the effects of aging on the GI tract
A
- tooth decay/loss
- lose motility in GI tract = constipation
4
Q
S&S of GI disease
A
- nausea&vomiting (upper GI)
- abdominal pain
- Diarrhea, constipation and fecal incontinence (lower GI)
- achalasia: difficulty with esophageal emptying (autoimmune or innervation)
- GI bleeding (typically found in the stool)
- Dysphagia: difficulty swallowing
- anorexia and anorexia-cachexia
5
Q
Hiatal Hernias
A
- when the esophageal hiatus of diaphragm becomes enlarged it allows the stomach to pass through into the thoracic cavity
- can be congenital or acquired
- acquired can be sliding or paraesophogeal
6
Q
How do sliding hiatal hernias form
A
- there is widening of the hiatal tunnel around esophagus
- increased abdominal pressure such as straining, acid reflux, vomiting can allow the gastoresophageal junction to pass above diaphragm
7
Q
How do paraesophageal hernias develop
A
- secondary due to surgery or trauma
- associated with laxity of gastrophrenic and gastrocolic ligaments
8
Q
What are lower abdomen hernias
A
- indirect inguinal: most common, congenital or acquired, intestine protrudes into the inguinal canal
- direct inguinal: acquired from lifting or straining; goes through inguinal ligament
- Femoral: loop of intestine goes through the femoral ligament
- umbilical: Goes through the abdominal muscle
- incisional: goes through an incision
9
Q
Signs and symptoms of hernias
A
- heart burn
- difficulty swallowing
- treatment is to stay elevated especially after eating
10
Q
Gastritis:
A
- inflammation of the stomach
- diagnosis of exclusion of other conditions
- often follows infection
11
Q
Gastritis: pathophysiology/S&S
A
- Inflammation of the stomach lining
- acute or chronic
- associated with H pylori, ulcers and cancers
- epigastric pain with feeling of distention
- loss of appetite
- nausea
12
Q
Gastritis: management
Dx/Tx
A
- H pylori breath test
- blood teat
- stool test
- upper endoscopy
- Upper GI test
- Tx: depends on the cause
13
Q
Peritonitis:
A
- peritoneum
- can be caused if appendicitis ruptures
14
Q
Peritonitis: pathophysiology/S&S
A
- inflammation of serous membrane lining walls of abdominal cavity
- forms adhesions and causes destruction
- decreases intestinal motility and causes intestinal distention with gas
- initially presents with fatigue and generalized abdominal pain
- progress to acute abdomen and severe abdominal pain
15
Q
Peritonitis: management
Diganosis and treatment
A
- abdominal exam
- blood test
- paracentesis
- tx: antibiotics surgical drainage and debridement and supportive measures
16
Q
Appendicitis: S&S
A
- abdominal pain (RLQ) with anorexia
- nausea/vomiting
- low-grade fever
- RLQ point tenderness at McBurney’s point
- pinch inch test: for peritonitis if pain when skin fold strikes the peritoneum
- elevated WBC >20,000 mm3 suggests rupture
17
Q
Appendicitis: management
A
- US
- CT scan
- Tx: surgery
18
Q
Cholecystitis
A
- inflammation of the gallbladder
19
Q
Cholecystitis: pathophysiology/Symptoms
A
- gallstones
- tumor
- blockage of bile duct
- infection
- illness
Symptoms
- serere pain in your upper right of center abdomen or right shoulder of back
- tenderness over your abdomen when its touched
- nausea/vomiting
- fever
20
Q
Cholecystitis management
A
- US
- CT scan
- HIDA scan: tip the person and take a scan
- tx: weight loss, diet, surgery
21
Q
Esophageal cancer S&S
A
- dysphagia with or without pain
- weight loss
- scapular pain
- more common with those with GI history
22
Q
esophageal cancer incidence
A
- one of the lowest cure rates
- 5 yr survival 10%
- median survival <10 months
23
Q
esophageal cancer linked to
A
- linked to H pylori
- squamous cells (90% worldwide)
- adenocarcinoma
24
Q
Gastric adenocarcinoma S&S
A
- weight loss
- abdominal pain
- early satiety
- hurts to eat
25
Q
Gastric adenocarcinoma management/survival rate
A
- endoscopic screening (not done unless you have symptoms)
- 5 year survival rate 31%
- most common
26
Q
Gastric adenocarcinoma: associated with
A
- H. pylori
- epstein barr virus
27
Q
Colorectal cancer risk factors
A
- 1st degree relative had it
- cigarette smoking
- alcohol consumption
- age
- male gender
- H/O polyps
- polyps take 10-15 years to become cancerous
28
Q
Colorectal cancer survival
A
- 4 leading cancer deaths
- 5 year survival
- 64% overall
- 90% with early detection
29
Q
colorectal pathophysiology
A
- begins as a polyp
- takes 10-15 years to become cancerous-
30
Q
GERD
A
- gastroesophogeal reflux disease
- esophagitis
31
Q
Causes of GERD
A
- chocolate
- peppermint
- fatty foods
- citrus products
- spicy foods
- coffee
- carbonated drinks
- alcohol
- caffeine
- nicotine
- CNS depressants
- prolonged vomtiing
- pregnancy (last trimester)
32
Q
GERD symptoms
A
- 30-60 minutes after a meal
- heartburn
- reflux
- belching
- dysphagia
- painful swallowing
- burning sensation that may move up and down back, neck, jaw (mimics MI)
33
Q
Complications of GERD
A
- esophagitis
- barrets esophagus
- strictures: constant inflammation leads to fibrous tissue = narrowing of esophagus = cancer
- adenomcarcinoma
34
Q
Barrett’s esophagus
A
- esophagus becomes damaged due to prolonged acid exposure
- esophagus starts to fill with stomach cells that are abnormally being laid down
35
Q
Management of GERD
A
- antacids: magnesium hydroxide, aluminum hydroxide (taking too many = make sure they are seeing their doc)
- histamine 2 blockers: block release of acid into stomach
- proton pump inhibitors: omeprazole, Prilosec, aciphex, prevailed, Nexium (blocks release of acid into stomach)
36
Q
Peptic ulcer disease
A
- break in mucosal lining exposing submucosal area to gastric sections
- gastric ulcer = lining of stomach often relieved by eating g
- duodenal ulcer - duodenum = feels better 45 minutes after eating
- stress (secondary ulcers)
37
Q
Meds for peptic ulcers
A
- drugs that reduce intragastric ulcers: antacids, H2 receptor blockers, Proton pump inhibitors, antimuscarinic drugs
- drugs that promote mucosal defense against acid erosion: bismuth compounds (pesto, kaopectate)
- Drugs that eradicate the bacterium (helicobacter pylori, antibiotics)
- avoid spicy foods
38
Q
Prokinetic meds for the GI system: how they stimulate motor function
A
- lower esophageal sphincter pressure
- improve gastric emptying
- stimulate small intestine
- accelerate colonic transition
39
Q
Clinical indications for prokinetic meds
A
- GERD
- gastroparesis: paralysis of stomach
- post-op ileus
- constipation
40
Q
Other meds for GI system
A
- antidiarrheals: lopermide, bile salt binding resins
- constipation: (opioids can cause) laxatives, stool softener (usually given with opioids), osmotic laxatives
- antispasmodics (anticholinergics): ADRS, used infrequently
- 50HT3 receptor antagonists
41
Q
Irritable Bowel Syndrome
signs and symptoms
A
- > 3 months of abdominal pain with at least 3 other symptoms
- abdominal bloating or distention
- passage of muscus
- changes in stool form
- changes in frequency
- difficulty passing a movement
42
Q
Irritable bowl syndrome
- pathophysiology
A
- altered GI motor activity
- visceral hypersenitivity
- altered processing of info by nervous system,
- altered intestinal microflora
- increased intestinal permeability
43
Q
Irritable bowl syndrome
Treament
A
- TCA
- serotonin-modulating agents possible
- treat symptoms
44
Q
Celiac disease
What is it?
A
- malabsorptive disorder
- immune mediated disorder that is trigger by gluten
45
Q
Celiac disease
clinical manifestations
A
- vary
- diarrhea
- bloating
- indigestion
- flatulence
- weight loss
- abdominal cramping
- dermatitis herpetiformis
46
Q
Celiac disease
management
A
- gluten free diet
- IgA indicates this as well as some other proteins
- adverse effects: coagulation and infertility
47
Q
Crohns disease
what is it
A
- inflammatory bowl disease
- any segment can be affected (large intestine)
- presents earlier in life
- all layers of intestinal wall can be involved
48
Q
Crohns disease: pathophysiology
A
- granulomas
- thickened bowl wall
- narrow lumen
- fissures and fistulas
49
Q
Crohns disease: clinical manifestations
A
- abdominal pain
- right lower quadrant mass
- severe anorexia and weight loss
- skin rashes
- joint pain
- marked retardation of growth (peds)
- remission and exacerbations
50
Q
Ulcerative colitis: what is it
A
- doesnt typically occur until lateral on
- inflammatory bowel disease
- Rectum and colon affected
- muosal layers and submucosal layers
51
Q
Ulcerative colitis: clinical manifestations
A
- abdominal pain
- diarrhea and blood stool
- mild-moderate anorexia and weight loss
- skin rases
- joint pain
- remissions and exacerbations
- cancer is common
52
Q
Inflammatory bowel disease meds
A
- aminosalicylates
- clucocorticoids
- methotrexate
- purine analogs
- anti-TNF agents
- monoclonal antibiodies
53
Q
Diverticular disease
A
- diverticulosis: uncomplicated
- diverticulitis: inflammatory
- most common in signmod colon
- littel pouches in the colon where things can get stuck
54
Q
Diverticular disease: clinical manifestations
A
- pain in LLQ (differentiate between iliopsoas)
- can cause a systemic infection (peritonitis)
- things do not digest well as they get stuck in the pouches
55
Q
Intestinal ischemia: what is it and types
A
- decrease blood supply to bowel
- Acute mesenteric: life threatening
- chronic mesenteric: aka intestinal angina/followed and managed
- colonic ischemia
56
Q
Intestinal ischemia: clinical manifestations
A
- abdominal pian
- things get stuck and can get infected
57
Q
Rectal fissure
A
- a cut
- ulceration or tear of lining in the anal canal
- childbirth of large hard bowl movement can cause it
- heal iwthin a month or two
58
Q
Rectal abscess and fistulas
A
infected anal gland, fissure or prolasped hemorrhoid
59
Q
Hemorrhoids
A
- can be hereditary
- varicose veins just beneath the mucous membrane lining the rectum and anus
- caused by anything that increases intraabdominal pressure
- internal - lower rectum; blood in stool, caused by straining
- external: under skin around anus; bleed in injured or ulcerated; painful
