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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
Q

What is GERD (Gastroesophageal Reflux)

A

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)

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26
Q

What can Chronic GERD result in

A

strictures (from scarring = spasm, and edema) OR

Barrett’s esophagus (squamous epithelial cells replaced by columnar and high risk for esophageal cancer)

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27
Q

How do you treat GERD

A 
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
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28
Q

What are the 2 major causes of Gastric Irritation and Ulcer Formation

A

Aspirin or NSAIDS (irritate mucosal lining in stomach)

H. pylori infection (loves acid environments in the stomach)

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29
Q

What are the types of Gastritis and what do they do

A

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

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30
Q

What are 2 other names for Acute and Chronic Gastritis

A 
Acute = EROSIVE
CHRONIC = INVASIVE
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31
Q

How do you detect H. pylori infection

A

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

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32
Q

What is Peptic Ulcer Disease

A

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

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33
Q

Gastric ulcers

A

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
Q

Predisposing factors of gastric ulcers

A

use of steroids, NSAIDS, alcohol and hx of gastritis or H. pylori infection

35
Q

How do you assess gastric ulcers

A

gnawing, sharp pain in left midepigastric region 1-2 hours after eating
Nausea and vomiting
Hematemesis

36
Q

Duodenal Ulcers

A

break in the mucosa of the duodenum (same as gastric except in the duodenum)

37
Q

What are predisposing factors of duodenal ulcers

A

steroids, NSAIDS, alcohol, caffiene, stress, H. pylori

38
Q

How do you assess duodenal ulcers?

A

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
Q

Complications of Peptic Ulcers?

A

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
Q

Risk factors for Stress Ulcers

A 
Trauma
Burns
Sepsis
Liver failure
Major surgical procedures

**Body physiologically stressed from all of these and can develop an ulcer.

41
Q

Zollinger-Ellison Syndrome

A

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
Q

Gastric Cancer Assessment

A

abnormal, malignant growth of stomach

anorexia
weight loss
palpabe mass
ascites
anemia/fatigue
43
Q

Risk Factors for Gastric Cancer

A 
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
Q

Vit B12 deficiency

A

inadequate intake of bit B12 or lack of absorption of ingested B12 (no intrinsic factor to absorb it)

45
Q

What is a result of Vit B12 deficiency

A 
Pernicious anemia (bc no intrinsic factor for intestinal absorption of B12)
** can lead to neurological issues
46
Q

Vit B12 Assessment

A

severe pallor
fatigue
SMOOTH BEEFY RED TONGUE
paresthesias of the hands and feet

47
Q

Dumping Syndrome

A

rapid emptying of the gastric contents into the small intestine

48
Q

Assessment of Dumping Syndrome

A 
**symptoms occur 30 min after eating
nausea and vomiting
abdominal cramping
tachycardia
perspiration
weakness and dizziness
diarrhea
49
Q

Irritable Bowel Syndrome (IBS)

A

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
Q

What are the 2 types Irritable Bowel Disease (IBD)

A 
Crohn's (affects any part of the GI tract) 
Ulcerative colitis (only affects the colon)
51
Q

Crohn’s Disease (aka Regional Enteritis)

A

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
Q

Assessment of Crohn’s disease

A 
Fever
cramplike pain after meals (recurrent)
abdominal distention
electrolyte imbalances
weight loss
53
Q

Ulcerative Colitis

A

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
Q

Assessment of Ulcerative Colitis

A 
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
Q

What are the 2 most common bacterial infections in the intestine?
Protozoal?

A

Clostridium Difficile Colitis (D-diff)
E.coli

E. histolytica (contaminated H2O)

56
Q

Diverticulosis

A

Outpounches/herniations of the intestinal mucosa (mainly sigmoid colon)

57
Q

Diverticulitis

A

when one of the out pouching areas becomes inflamed/painful

possibly d/t lowe fiber/genetic weakness

58
Q

Assessment of diverticulitis

A 
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
Q

Hemorrhoids

A

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
Q

Appendicitis

A

inflammation of the appendix - becomes inflamed and can rupture = spilling everything into the peritoneum

61
Q

Peritonitis

A

SERIOUS surgical emergency
inflammation of the peritoneum (sterile area)
abdominal distention and pain (very firm “surgical” abdomen)
pallor and right guarding of abdomen

62
Q

Causes of Peritonitis

A

Ruptured appendix
Perforated peptic ulcer or diverticulum
Abdominal trauma/sounds

63
Q

Types of diarrhea

A

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
Q

Four causes of diarrhea

A

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
Q

Increased Secretion diarrhea

A

WATERY STOOL:
cholera toxin
clostridium
carcinoid syndrome

66
Q

Increased osmotic load

A

BULKY GREASY STOOL:
SORBITOL INGESTION (sugar free candy)
Lactose deficiency
Dumping syndrome

67
Q

Inflammation diarrhea

A

BLOODY STOOL W OR W/O LEUKOCYTES
Ulcerative colitis
Crohn’s disease
Invasive microbial gastroenteritis

68
Q

Altered intestinal motility diarrhea

A

Thyrotoxicosis
IBS
Neurologic disease (DM)

69
Q

Common causes of Constipation

A

Failure to respond to the urge to defecate
Low fiber in diet
Not taking in enough fluids
Inactivity/Bedrest

70
Q

Mechanical Bowel Obstruction

A

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
Q

Intestinal Obstruction

A

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
Q

Assessment of Intestinal Obstruction

A

ABSOLUTE CONSTIPATION - nothing is getting through
Pain
Abdominal distention
visible peristalsis

73
Q

Celiac Disease

A

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
Q

Celiac in babies

A

Failure to thrive
Diarrhea
Abdominal distention

75
Q

Symptoms of Malabsorption

A

Steatorrhea
Weight Loss and Abdominal Distension
Diarrhea/Constipation
Bloating/Cramps/Abdominal Pain

76
Q

Intestinal Tumors

A

s/sx usually all over the place
malignant lesions in bowel wall or polyps in colon/rectum
Metastasis occurs via lymphatics

77
Q

Colorectal Cancer

A

2nd in cancer mortalitiy
Prevention = screening early
Incidence rises after age 40 and significally increases after age 55

78
Q

Etiology of Colorectal Cancer

A

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
Q

Adenomas

A

neoplastic lesions of glandular epithelium that display abnormal cellular differentiation and vary in size and shape (tubular, tubulovillous, villous)

80
Q

Risk Factors of Colorectal Cancer

A 
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
Q

Advanced Sx of Colorectal Cancer

A 
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
Q

Screening for Colorectal Cancer

A

Stool Occult Blood Tests
Xray with barium
DRE
colonoscopy

Patho Exam 3 (4 decks)

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