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Patho Exam 3 > GiI Disorders > Flashcards

GiI Disorders Flashcards

1
Q

What are risk factors for GI disorders

A

PREVIOUS ABDOMINAL SURGERY OR TRAUMA
Family History
Chronic Laxative Use/alcohol/tobacco use
Long term GI conditions (ulcerative colitis can predispose one to colorectal cancer)

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2
Q

Barium Swallow (upper GI)

A

examines upper GI under fluoroscopy performed after the client drinks barium sulfate
Abstain from foods and fluids prior to test
Post Procedure- laxative; 6-8 glasses of water a day for 2 days; monitor for passage of chalky white stool

**don’t want barium to stay in you; if it does it will get hard and stiffen and body can’t expel it

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3
Q

Barium enema (lower GI)

A

fluoroscopic and radiographic exam of the lg intestine
pre procedure - laxatives to get everything out of systems and a liquid diet 1 day in advance
post procedure - increased fluid intake for 2 days; mild laxatives to get rid of barium

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4
Q

Gastroscopy

A

insertion of a scope through the esophagus and into the stomach and upper portion of small intestine - looks at the lining to see if any bleeding, mass, tumors etc.
**must have gag reflex return before they can start eating agian

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5
Q

Sigmoidoscopy

A

endoscopic visualization of the sigmoid colon (go in through the butt)

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6
Q

Colonoscopy

A

GOLD STANDARD
up through the rectum - examine the lining of the Large intestine
Want to make sure that it’s cleaned out (laxatives)
Best procedure because if they see a poll up they can remove them

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7
Q

Gall bladder Studies

A

HIDA Scan
Ultrasound
CT scan
Cholangiography

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8
Q

HIDA scan

A

radioactive material is injected into vein and taken up by the gallbladder (want to see if ti’s taken up to know how well it’s functioning)

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9
Q

Cholangiography

A

percutaneous or endosopic
scope goes down through the esophagus and into the gall bladder rather than the stomach - shoot dye into it to show the bile ducts and can shoot dye into the pancreas to see pancreas and liver function

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10
Q

Liver Biopsy

A

a needle is inserted through the abdominal wall to the liver to obtain a tissue sample for microscopic examination

**make sure that the b4 the procedure is done that the person is able to clot; want to know this bc the liver produces coagulation factors

Can place client on right side for 1-2 hours to decrease risk of hemorrhage and to put pressure to stop the liver from bleeding

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11
Q

Paracentesis

A

transabdominal removal of fluid from the peritoneal cavity
to examine electrolytes, RBCs, WBCs, bacteria and viruses

** Want to measure abdominal girth to make sure you didn’t puncture anything when you went in (look for hematuria)
Dry sterile dressing

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12
Q

Stool Specimens

A

examining stool for the presence of occult blood; take the tongue depressor and smash stool on 2 card; flip it over and put stool on other card (2 sep specimens); sent to the lab where they put hydrogen peroxide on it

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13
Q

Liver and Pancreas Tests include

A 
Alkaline Phosphatase
Prothrombin Time (PT)
Serum Ammonia
Liver Enzymes  (AST and ALT)
Cholesterol
Bilirubin
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14
Q

Alkaline Phosphatase

A

released during liver damage or biliary obstruction (damage = increased value)

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15
Q

Prothrombin Time

A

time it takes body to clot; if liver damage = decreased PT

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16
Q

Serum Ammonia

A

Assesses the ability of the liver to dominate protein by products; if Liver failure = ammonium levels rise

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17
Q

Liver Enzymes

A 
Aspartate Aminotransferase (AST)
Alanine Aminotransferase (ALT)

these are the 2 most common enzymes and they are important for liver function tests

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18
Q

Cholesterol tests

A

tell us whats going on with the pancreas - increase can indicate pancreatitis or biliary obstruction

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19
Q

Bilirubin

A 
Increase indicates liver damage or biliary obstruction
Biliary Direct (conjugated) 
Biliary Indirect (unconjugated)
** 2 different stages in making bile
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20
Q

Amylase and Lipase

A

Elevations indicated pancreatitis

*** We will draw these two enzymes

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21
Q

What are some s/sx of common GI disorders

A

Anorexia and Nausea
Vomiting (protective function)
Hematemesis (blood vomit
Hematochezia (passage of red blood in stool)
Melena (black tarry fatty stool)
Occult - must be detected by chemical testing and usually caused by gastritis, ulcer, or lesions on the small intestine

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22
Q

Hematemesis

A

vomiting up blood
may be red = person probably bleeding from stomach/esophagus
may be coffee color = old blood from below

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23
Q

Esophageal Diverticulum and it’s s/sx

A

out pouching of the esophageal wall leading to the retention of food
s/sx gurgling, belching, coughing, foul smelling breath

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24
Q

Mallory-Weiss Syndrome

A

Longitudinal tears in the esophagus
Associated with chronic alcoholism or severe vomiting
Infection may lead to an ulcer or mediastinitis (inflammation of the tissues of the mid chest)

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25
What is GERD (Gastroesophageal Reflux)
Backward movement of gastric contents into the esophagus resulting in heartburn possibly d/t weak/incompetant lower esophageal sphincter ***THE SEVERITY OF THE HEARTBURN IS NOT INDICATIVE OF THE EXTENT OF THE MUCOSAL INJURY Pain can radiate to throat, shoulder, or back and can also produce respiratory problems (wheezing, cough, hoarseness)
26
What can Chronic GERD result in
strictures (from scarring = spasm, and edema) OR | Barrett's esophagus (squamous epithelial cells replaced by columnar and high risk for esophageal cancer)
27
How do you treat GERD
``` Avoid large meals Decrease alcohol use and NO smoking Sit up while eating and don't resume the recumbent position until several hours after meals Sleep with head elevated If overweight - lose some weight ```
28
What are the 2 major causes of Gastric Irritation and Ulcer Formation
Aspirin or NSAIDS (irritate mucosal lining in stomach) | H. pylori infection (loves acid environments in the stomach)
29
What are the types of Gastritis and what do they do
Acute = TRANSIENT inflammation of the gastric mucosa bacterial endotoxins, alcohol, and ASA) ex. too much alcohol or ate something that was bad Chronic = CHANGES in inflammation that is characterized by the absence of grossly visible erosions; leads to atrophy of the glandular epithelium of the stomach (ex. H. pylori, chemical gastropathy) **This is lower level damage
30
What are 2 other names for Acute and Chronic Gastritis
``` Acute = EROSIVE CHRONIC = INVASIVE ```
31
How do you detect H. pylori infection
Measure the Carbon in the breath (C urea breath test) Stool antigen test Endoscopic biopsy for urease testing Blood tests to obtain serologic titers of H. pylori antibodies
32
What is Peptic Ulcer Disease
ulceration of the stomach, pylorus, or duodenum (portions must be accessible to gastric secretions) Erosion may extend through the muscle to the peritoneum Most common peptic are GASTRIC and DUODENAL
33
Gastric ulcers
ulceration of the mucosal lining that extends to the submucosal layer of the stomach **PAIN starts right after you eat d/t digestive enzymes irrigating the area
34
Predisposing factors of gastric ulcers
use of steroids, NSAIDS, alcohol and hx of gastritis or H. pylori infection
35
How do you assess gastric ulcers
gnawing, sharp pain in left midepigastric region 1-2 hours after eating Nausea and vomiting Hematemesis
36
Duodenal Ulcers
break in the mucosa of the duodenum (same as gastric except in the duodenum)
37
What are predisposing factors of duodenal ulcers
steroids, NSAIDS, alcohol, caffiene, stress, H. pylori
38
How do you assess duodenal ulcers?
Burning pain in the midepigastric area 2-4 hours after eating and during the night Melena **PAIN IS OFTEN RELIEVED BY EATING - d/t acids and digestive enzymes working on the food rather than your ulcer
39
Complications of Peptic Ulcers?
Hemorrhage Obstruction - d/t edema, spasm, or contraction of scar tissue that interferes with passage of gastric contents through the pylorus Perforation - ulcer erodes through all the layers of the stomach/duodenum
40
Risk factors for Stress Ulcers
``` Trauma Burns Sepsis Liver failure Major surgical procedures ``` **Body physiologically stressed from all of these and can develop an ulcer.
41
Zollinger-Ellison Syndrome
body is making too much acid typically d/t gastrin secreting tumor (in pancreas or submucosa of stomach) 2/3 are malignant Assessment = diarrhea, impaired fat digestion, elevated serum gastrin, decreased intestinal pH **typically in ppl with lots of gastric ulcers
42
Gastric Cancer Assessment
abnormal, malignant growth of stomach ``` anorexia weight loss palpabe mass ascites anemia/fatigue ```
43
Risk Factors for Gastric Cancer
``` Genetics/hx of Gastric Ulcers Carcinogenic factors in the diet (very charred foods) High starch and salty diet Smoking and alcohol Gastric adenomas or polyps ```
44
Vit B12 deficiency
inadequate intake of bit B12 or lack of absorption of ingested B12 (no intrinsic factor to absorb it)
45
What is a result of Vit B12 deficiency
``` Pernicious anemia (bc no intrinsic factor for intestinal absorption of B12) ** can lead to neurological issues ```
46
Vit B12 Assessment
severe pallor fatigue SMOOTH BEEFY RED TONGUE paresthesias of the hands and feet
47
Dumping Syndrome
rapid emptying of the gastric contents into the small intestine
48
Assessment of Dumping Syndrome
``` **symptoms occur 30 min after eating nausea and vomiting abdominal cramping tachycardia perspiration weakness and dizziness diarrhea ```
49
Irritable Bowel Syndrome (IBS)
FUNCTIONAL disorder (more common in women than men) persistent symptoms of abdominal pain altered bowel function with complaints of flatulence/bloatedness Constipation and/or diarrhea possibly d/t anxiety, depression or stress
50
What are the 2 types Irritable Bowel Disease (IBD)
``` Crohn's (affects any part of the GI tract) Ulcerative colitis (only affects the colon) ```
51
Crohn's Disease (aka Regional Enteritis)
can affect any area from the mouth to the anus (typically adolescents or people who smoke) *often occurs in the terminal ileum and it LEADS TO thickening and scarring narrowed lumen fistulas ulcerations abscessess
52
Assessment of Crohn's disease
``` Fever cramplike pain after meals (recurrent) abdominal distention electrolyte imbalances weight loss ```
53
Ulcerative Colitis
confined to the colon and is STRUCTURAL inflammatory disease that results in poor absorption of nutrients Begins in rectum and spreads upward to cecum Edemouys colic may develop bleeding lesions = scarring/scar tissue = loss of elasticity and can't absorb nutrients ***remissions and exacerbations
54
Assessment of Ulcerative Colitis
``` VITAMIN K DEFICIENCY (bleeding ulcers and now can't clot so bleed more) Bloody diarrhea abdominal tenderness and cramping electrolyte imbalances weight loss ``` ***COULD RESULT IN COLON CANCER
55
What are the 2 most common bacterial infections in the intestine? Protozoal?
Clostridium Difficile Colitis (D-diff) E.coli E. histolytica (contaminated H2O)
56
Diverticulosis
Outpounches/herniations of the intestinal mucosa (mainly sigmoid colon)
57
Diverticulitis
when one of the out pouching areas becomes inflamed/painful possibly d/t lowe fiber/genetic weakness
58
Assessment of diverticulitis
``` Left lower quadrant abdominal pain (pain increases with coughing, straining or lifting) Elevated teamp nausea/vomiting abdominal distention and tenderness palpable tender RECTAL mass ```
59
Hemorrhoids
dilated varicose veins in the anal canal can be internal, external, or prolapsed (internal and then spill out) caused by portly HTN, straining, irritation, and increased venous/abdominal pressure
60
Appendicitis
inflammation of the appendix - becomes inflamed and can rupture = spilling everything into the peritoneum
61
Peritonitis
SERIOUS surgical emergency inflammation of the peritoneum (sterile area) abdominal distention and pain (very firm "surgical" abdomen) pallor and right guarding of abdomen
62
Causes of Peritonitis
Ruptured appendix Perforated peptic ulcer or diverticulum Abdominal trauma/sounds
63
Types of diarrhea
Large Volume - H2O pulled into GI tract very fast d/t infection/lactose deficiency (osmotic) or organism secreting toxins (secretory Small Volume = Inflammatory bowel disease, infections, irritable colon **peristaltic activity is faster
64
Four causes of diarrhea
Increased secretion of electrolytes and water in bowel lumen Increased osmotic load within intestine = water retention in bowel of lumen Inflammation Altered intestinal motility = rapid transit times
65
Increased Secretion diarrhea
WATERY STOOL: cholera toxin clostridium carcinoid syndrome
66
Increased osmotic load
BULKY GREASY STOOL: SORBITOL INGESTION (sugar free candy) Lactose deficiency Dumping syndrome
67
Inflammation diarrhea
BLOODY STOOL W OR W/O LEUKOCYTES Ulcerative colitis Crohn's disease Invasive microbial gastroenteritis
68
Altered intestinal motility diarrhea
Thyrotoxicosis IBS Neurologic disease (DM)
69
Common causes of Constipation
Failure to respond to the urge to defecate Low fiber in diet Not taking in enough fluids Inactivity/Bedrest
70
Mechanical Bowel Obstruction
Volvulus - twisting Adhesions - sticking of tubes together Intussusception - part of intestines slides into adjacent parts of the intestines Incarcerated inguinal hernia - area of intestines slides through a weaker area and causes an obstruction
71
Intestinal Obstruction
Can develop ischemia d/t blockage and O2 can't even get through Abdominal distention Loss of fluids and electrolytes (hypokalemia) Can lead to strangulation, gangrenous changes, and perforation of the bowel Increased pressure = necrosis
72
Assessment of Intestinal Obstruction
ABSOLUTE CONSTIPATION - nothing is getting through Pain Abdominal distention visible peristalsis
73
Celiac Disease
Immune disorder triggered by ingestion of grains (wheat, barley, rye) Inappropriate response of T cells (go wild and attack) Can impair absorption bc you can lose the absorptive villi to the point where you can't absorb anymore The small intestine thickens so nutrients can't get across (malabsoprtion)
74
Celiac in babies
Failure to thrive Diarrhea Abdominal distention
75
Symptoms of Malabsorption
Steatorrhea Weight Loss and Abdominal Distension Diarrhea/Constipation Bloating/Cramps/Abdominal Pain
76
Intestinal Tumors
s/sx usually all over the place malignant lesions in bowel wall or polyps in colon/rectum Metastasis occurs via lymphatics
77
Colorectal Cancer
2nd in cancer mortalitiy Prevention = screening early Incidence rises after age 40 and significally increases after age 55
78
Etiology of Colorectal Cancer
mainly from pre-existing benign adenomatous polyps that undergo malignant transformation (hence why they are removed in colonoscopy) Confined to the mucosa, but may progress to the submucosa and adjacent tissue Invasive = spreads to lymph nodes
79
Adenomas
neoplastic lesions of glandular epithelium that display abnormal cellular differentiation and vary in size and shape (tubular, tubulovillous, villous)
80
Risk Factors of Colorectal Cancer
``` Hx of adenomatous polyps IBD (ulcerative > risk) Family hx of colon cancer High fat diet or Low fiber or both ***Use of ASA may lower incidence ```
81
Advanced Sx of Colorectal Cancer
``` GI bleeding (occult or anemia) Change in bowel habits = NARROW CALIBER STOOL Anorexia/Weight loss Mass may be found on external palpation or Digital Rectal Exam ```
82
Screening for Colorectal Cancer
Stool Occult Blood Tests Xray with barium DRE colonoscopy

Patho Exam 3 (4 decks)

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