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5 Pathology > L5 GI Disorders > Flashcards

L5 GI Disorders Flashcards

1
Q

Upper Gi

A

ingestion and digestion of food
mouth to duodenum

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2
Q

Lower GI

A

small intestine to anus

small = digestion and nutrient absorption
large = absorption of water and electrolytes

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3
Q

Red Flags of Systemic Pathology

A

nausea/vomiting
diarrhea
malaise
fever
night sweats
pallor/diaphoresis
dizziness

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4
Q

Nausea/Vomiting

A

irritation of nerves, pain, GI disorders, ADR of meds

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5
Q

Diarrhea

A

abnormal frequency or volume of watery stools

tube feeding, antibiotics, increased caffeine intake

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6
Q

Constipation

A

infrequent bowel movements b/c they are too hard. Decreased fiber, dehydration, low PA

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7
Q

Anorexia

A

aversion to food. Cancer, chemotherapy

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8
Q

Dysphagia

A

obstruction in esophagus neuro condition

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9
Q

Achalasia

A

failure of esophageal spinchter to relax leads to dysphagia. neuro disease, stress, anxiety

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10
Q

Heartburn/dyspepsia

A

midline burning pain. Esophageal reflux

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11
Q

GI Bleeding

A

Hematemesis = vomiting blood, esophagus + up

Melena = black tarry stools. stomach to rectum

Hematochexia = bright red blood in stool. Local bleeding

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12
Q

Fecal incontinence

A

unable to hold poop. CNS injury

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13
Q

Pain in GI

A

T4-T12 depends on structure

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14
Q

RUQ

A

liver and gallbladder
duodenum
transverse and ascending colon
1/2 pancreas

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15
Q

LUQ

A

left liver lobe
stomach
1/2 pancreas
transverse and descending colon

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16
Q

RLQ

A

cecum
appendix
ascending colon

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17
Q

LLQ

A

sigmoid colon
portion of descending colon

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18
Q

Normal aging effects on GI system

A

appetite depression

vitamins, macronutrients due to slow absorption

decreased gastric acid

Decrease in intrinsic factor production, can lead to anemia

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19
Q

B12

A

needed for RBC, neurons, DNA. HCL breaks B12 bond so it can be used. then it is bound to intrinsic factor so it can be used

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20
Q

Gastroesophageal reflux disease (GERD)

A

Chronic heartburn >2x a week

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

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21
Q

Epidemiology GERD

A

Extremely common in american adults, 2/3 will experience it

peaks at 50 years of age
75% of individuals experience reoccurrence

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22
Q

RF of GERD

A

decreased pressure of lower esophageal sphincter

increased gastric pressure, pushes food back up

gastric contents near gastroesophageal junction

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23
Q

Common heartburn triggers

A

fatty/fried foods, alcohol, carbonated drinks, spicy foods, garlic, NSAIDs, caffeine, chocolate, etc

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24
Q

GERD Patho and Dx

A

Patho: acidic gastric contents contact the walls of the esophagus causing inflammation in mucosal walls

Dx: usually by history

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25
Q

CP of GERD

A

heartburn, midline burning pain
dysphagia
coughing wheezing
bending over, laying down makes it worse

antacids, standing, fluids make it better

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26
Q

GERD Referral of Pain

A

can present without heartburn
symptoms could include excessive clearing of throat, change in voice, problems swallowing

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27
Q

TX GERD

A

Lifestyle modifications –> avoid caffeine/personal triggers, remain upright 3 hours after eating, eat small meals, drink fluids between meals

Drugs to decrease acid–> antacids, histamine blockers, proton pump inhibitors

surgery

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28
Q

Sleeping positions for GERD

A
  1. put risers under bedposts at head of bed
  2. use bolster for reading
    3.Left sidelying is better b/c is kinks the esophageal sphincter
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29
Q

Exercise-related GERD

A

strenuous exercise inhibits gastric emptying

condition is more common in athletes who have non-exercise tendency for GERD

Advice: eat smaller meals before training, dilute sports drinks, avoid exercises that increases abdominal pressure

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30
Q

Hiatal Hernia Pathogenesis

A

b/c of enlarged lower esophageal spinchter, the stomach moves into and past the diaphragm. Pressure on sphincter is reduced, allowing sphincter to open at the wrong time, causing stomach contents and acid to flow into esophagus

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31
Q

Hiatal hernia

A

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

relatively common, incidence increases with age. More common in female

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32
Q

DX of Hiatal Hernia

A

barium x-ray
endoscopy

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33
Q

RF of Hiatal Hernia

A

anything that weakness the diaphragm

increases in intra-abdominal pressure
(lifting, forceful cough, pregnancy, obesity)

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34
Q

CP of Hiatal hernia

A

heartburn 30-60 min after meals, exacerbated with tight clothing or supine position

possible difficulty in swallowing

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35
Q

Tx in Hiatal Hernia

A

antacids and elevating head of bed

surgical repair for some cases

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36
Q

Abdominal Precautions

A

logrolling, avoid twisting
no lifting >10 lbs
No bending or squatting
avoid valsalva maneuver
wear abdominal binder

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37
Q

Hiatal Hernia tips for PTs

A

avoid supine exercises
avoid exercises that increase intra-abdominal pressure
teach proper breath control
instruct proper body mechanics

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38
Q

Peptic ulcer disease

A

break in mucosal lining of stomach, upper small intestine or esophagus, exposing submucosal areas to gastric secretions

1/2 million new cases a year

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39
Q

Penetrating ulcer

A

gone through stomach, is now penetrating another organ

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40
Q

RF for Peptic ulcer disease

A

Helicobacter pylori infection
Aging
Chronic use of NSAIDs

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41
Q

Pathogenesis of peptic ulcer disease

A

90% are caused by h.pylori (bacteria)
common cause is NSAIDs

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42
Q

CP of Peptic ulcer disease

A

Burning, cramping pain is most common. Near epigastric location, lasts few min-hrs

Worse when stomach is empty, common flare ups at night, can be relieved by acid reducing meds

Dx includes history or H. pylori test

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43
Q

Tx of Peptic Ulcer disease

A
  1. ABX
  2. REduce level of acid in digestive system with histamine, PPIs, antacids
  3. Prevent recurrence by stopping smoking, limit alcohol, avoid NSAIDs
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44
Q

PT Tip for Peptic Ulcer Disease

A

many people do not report classic S/S, but present with pain after a perforation or hemorrhage

Referred pain with complications, mid thoracic region to R shoulder

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45
Q

Gastric Cancer

A

malignant cells form in the gastric mucosa

2nd most common cause of cancer death in the world. Significant decline in incidence over most of the century, mainly due to improved sanitation and decreased transmission of H pylori

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46
Q

RF for Gastric Cancer

A

chronic h pylori infection
male
>50 year old, median age at dx is 70

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47
Q

Gastric Cancer Patho and Dx

A

Patho: multifactorial, often begins with h. pylori infection. Duodenal reflux, decreased gastric acid secretion

Dx: upper endoscopy and biopsy

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48
Q

CP of Gastric Cancer

A

Early: asymptomatic, indigestion, stomach discomfort, heartburn, nausea

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

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49
Q

Tx and Prognosis of Gastric Cancer

A

Tx: surgery is a treatment of choice in 1/3 of cases. Chemo therapy and radiation

Prognosis: 2/3 of patients are diagnosed in advnaced stages, with metastatic stage is incurable.

Screening helps to detect 40% of tumors early

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50
Q

Inflammatory Bowel Disease

A

chronic inflammatory diseases of GI tract of unknown etiology. Includes chrohns and ulcerative colitis

about 1 million cases

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51
Q

RF for IBD

A

15-35 years old at peak
caucasian
females
living in N. america or europe
family history

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52
Q

Pathogenesis of IBD

A

UC: inflammation uniformly in rectum, extends proximally and stops. Involves mucosa and submucosa

CD: inflammation is discontinuous, most often in small intestine or colon. Involves all bowel layers

Chronic inflammation causes ulcerations. The inflammation is caused by genetics and environment, NOT By diet and stress alone

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53
Q

CP of IBD

A

remissions and exacerbations
abdominal pain, diarrhea, bloody stools, abdominal mass, anorexia, weight loss

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54
Q

DX of IBD

A

medical hx
colonoscopy (very sensitive test)

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55
Q

TX of IBD

A

goal is to reduce inflammation that triggers S/S

drugs: anti inflammatory, ABX

surgery, resections

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56
Q

CD is

A

incurable, chronic, debilitating
most patients require surgery

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57
Q

UC is

A

curable, by colon resection

58
Q

PT Tips and IBD

A

QOL is generally lower in CD b/c of recurrences
IBD takes a emotional toll
Educate pts to take a part of support groups

59
Q

Irritable Bowl Syndrome

A

collection of S/S that are not attributed to identifiable bowel abnormality. IBS is a functional GI disorder

Most common disorder of GI, 1/5 american adults

60
Q

RF for IBS

A

female
usually begins 20 years of age

61
Q

CP of IBS

A

intermittent s/s with variable periods of remission
Diarrhea and/or constipation
abdominal pain/cramping in LLQ
bloating
gas
mucus in stool

62
Q

Pathogenesis of IBS

A

no single or specific cause identified

63
Q

IBS Dx

A

remains one of exclusion
use history, sigmoidoscopy, lactose intolerance test

64
Q

TX of IBS

A

focus in on symptom relief

drugs–> antidepressants, antidiarrheals, antispasmodics
Lifestyle changes–> dietary changes (increased fiber and probiotics), stress reduction

65
Q

Diverticulitis

A

DIVERTICULOSIS: condition of having diverticula, small mucosal blind pouches in wall of colon

DiverticuLITIS is the inflammation of >1 diverticula

66
Q

RF of Diverticulitis

A

aging
low fiber diet

67
Q

Diverticula development

A

come about in weaker places in colon
most common is in sigmoid colon
often occur due to straining during bowel movements over years

68
Q

Diverticulitis patho

A

diverticuli fill with fecal material, leading to infection and inflammation

localized abscess forms in limited area around wall of colon

if performation develops in a pouch, can cause fistula or peritonitis infection within abdominal caivty

69
Q

CP of Diverticulitis

A

pain is severe, abrupt, localized to LLW, worsens over time

fever, nausea, vomiting

dx with enema, CT, WBC count

70
Q

Tx of Diverticulitis

A

Depends on severity
MILD: ABX and liquid/low fiber diet

Recurrent/Severe: surgery. Primary bowel resection or bowel resection w/colosotomy

71
Q

Primary bowel resection

A

removal of diseased segment with reconneciton to healthy segements

72
Q

Bowel resection with colostomy

A

chosen if significant inflammation in colon makes it impossible to rejoin colon and rectum

opening made in abdomnal wall and unaffected part of colon is connected to stoma. Waste passes into a bag. Can be temporary or permanent

73
Q

Referral of pain diverticulitis

A

LLW pain or pain in back

assess for presence of abscesses: iliopsoas muscle palpation and test, rebound tenderness

74
Q

Exercise for Diverticulitis

A

avoid exercises that increase intra-abdominal pressure
aerobic exercise promotes GI motility

75
Q

Abdominal Hernias

A

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

76
Q

Types of abdominal hernias

A

inguinal
femoral
umbilical
incisional

77
Q

RF for Hernias

A

Muscular weakness
family or personal hx
certain medical conditions and smoking
chronic constipation
excess weight
c-section/pregnancy
activities (standing for long periods)
premature birth

78
Q

Reducible hernia

A

when contents of hernial sac can be replaced into abdominal cavity by manual manipulation

79
Q

Irreducible hernia

A

hernias that cannot be replaced by manipulation

80
Q

Strangulated hernia

A

when protruding organ is constricted to extent that circulation is impaired

81
Q

Clinical Presentation of Hernia

A

initially is an intermittent or persistent bulge that may be painless and easily reducible

as pressure increases and pushes more abdominal contents out through the weakened wall, bulge size increases, accompanied by intermittent or persistent pain

pain depends on structures involved though usually localized. Sharp, aggraved by increases in pressure, relieved by cessation, radiation

82
Q

Inguinal hernia Indirect patho

A

most common
herniation through inguinal ring, may protrude into scrotum
may occur at any age, more common males <1 year and 16-20 yr
pain with straining

83
Q

Direct Inguinal Hernia

A

herniation above inguinal ligament where abdominal wall is slightly thinner

occurs most often in men >40 yr, rarely protrudes into the scrotum

usually painful

84
Q

Distinguishing between direct and indirect hernia is

A

not that important because both are treated the same

85
Q

Femoral hernia

A

herniation of abdominnal contents through enlarged femoral ring/canal, causing bluge below inguinal crease

more common in women with more children

rare, high risk of becoming irreducible and strangulated

86
Q

Umbilical hernia

A

opening in abdominal wall does not close completely. Usually close 2-3 years of age, unless large and need surgery

even if closed at birth, umbilical hernias may appear later because that area remains weaker

87
Q

Tx Options of Hernias

A

wait and watch for minimally symptomatic hernias
curative surgical repair

acutely irreducible need emergency tx because of risk of strangulation

if the intestinal contents of hernia have blood supply cut off, gangrenous bowel possible in 6 hr

88
Q

Tips for PTs with Hernias

A

PTs may be key players in recognition of hernias

in pts with chronic cough, pregnancy ,or other RF, ask about the presence of a known hernia

PT should encourage body mechanics, postural education, weight management, encourage smoking cessation

89
Q

Appendicitis

A

inflammatio of vermiform appendix (blind ended tube that connects to cecum)

occurs with 7% of US population, mainly from 15-20 yrs of age

90
Q

Pathogenesis of Appendicitis

A

1/2 of all cases have no known cause
obstruction of appendix lumen leads to distension of appendix b/c of fluid accumulation

ineffective drainage allows bacterial invasion of wall of appendix

in advanced cases, perforation and spillage of infected fluid into peritoneal cavity can occur

91
Q

Perforation

A

can occur in 24 to 48 hr and causes peritonitis, which is an emergency

92
Q

CP of Appendicitis

A

Anorexia, periumbilical pain, nausea, RLQ pain, vomiting

migration of pain from periumbilical area to RLQ is the most discriminating feature of pts history

OLDER ADULTS frequently have few to no symptoms until perforation occurs

93
Q

Dx of Appendicitis

A

careful history to rule out ectopic prevnancy, right sided ovarian cysts, kidney stone, Crohns disease

palpate mcburney’s point, pinch an inch test

WBC count

94
Q

Appendicitis and PT

A

there may be non-classic history of appendicitis pain

perform palpation exam
positive cough test (deep cough causes pain)

if appendicitis is suspected, immediate MD attention is necssary

95
Q

Appendicitis Tx and Prognosis

A

Tx: removal of appendix asap

Prognosis: usually good with surgery. If untreated, appendix can perforate, leading to serious complications. Greater likelihood of perforation in <2 yr old and >60yr

96
Q

Colorectal Cancer

A

adenocarcinoma of colon or rectum

3rd most common cancer in USA
rate of new cases decreasing due to screening and changes in risk factors

in people <50, rates increasing since mid 90s

97
Q

Risk Factors Colorectal Cancer

A

increasing age >50 year of age comprise >90% of those with CRC
overweight/obesity
sedentary lifestyle
alcohol use

98
Q

Pathogenesis of Colorectal cancer

A

Preinvasive: exaggerated growth may cause precancerous polyps in intestinal lining. The polyps can metaastasize to nearby lymph nodes.

99
Q

Colonoscopy

A

screening for prevention of CRC by identifying and removing any polyps

100
Q

CP of CRC

A

change in bowel habits like diarrhea, constipation, narrow stools
-blood in stool
-frequent gas pains
-unintended weight loss
-may be asymptomatic

101
Q

Dx and Tx of Colorectal Cancer

A

Dx: physical exam, blood test, biopsy

Tx: surgery is the most common, chemotherapy, radiation, rehab

102
Q

CRC Prognosis and Prevention

A

Prognosis: survival related to stage at diagnosis, most present with advanced disease. Higher survival rate if limited to the bowel

Prev.: increase activity level, lose excess weight, decrease alcohol intake, decrease consumption of red meat and processed meat

103
Q

CRC Screening

A

people of average risk should start screening at AGE 45 and continue until 76

average risk means no family hx, personal hx, IBD, pain radiation

104
Q

How often should a colonscopy happen?

A

every 10 years
(sigmoid is every 5 yrs)

105
Q

Functions of the liver

A

carbohydrate metabolism
protein metabolism
lipid metabolism

metabolism of drugs
removal of waste
storage of glycogen, fats, vitamins
Activation of Vit D
phagocytosis
endocrine functions
aids blood clotting
digestive functions

106
Q

Common S/S of hepatic disease

A

GI S/S
RUQ pain
edema
dark urine
skin changes
neuro involvement
musculoskeletal pain
heaptic osteodystrophy

107
Q

Ascites

A

edema within the peritoneal cavity

108
Q

Jaundice

A

yellow color in skin, mucous membranes and/or eyes
yellow pigment is from bilirubin, a byproduct of old RBCs

109
Q

Hepatitis

A

acute or chronic liver inflammation caused by a virus, chemical, drug reaction, or alcohol abuse

hepatitis from ANY cause produces similar symptoms

alcohol and drug intake can make any liver disease worse

110
Q

Vaccine availability for viral hepatitis

A

A: yes
B: yes
C: NO
D: no
E: yes

111
Q

Hepatitis A

A

liver disease caused by hep A virus

waves both in the nation and within communities. 1/3 of americans have a evidence of past infection

Usually spread by putting the mouth that has been contaminated with stool

112
Q

RF of Hep A

A

household or sexual contact with infected person
living in ares with high HAV rates
persons traveling to countries where HAV is common
homosexual men who are active sexually
illicit drug users

113
Q

Prev of Hep A

A

active vaccine is best
immune globulin can be given for short term
hand washing!

114
Q

CP of Hep A

A

jaundice, fatigue, loss of appetite, abd pain
nausea, diarrhea, fever

115
Q

Tx and Long Term Effects of Hep A

A

Tx: primarily symptomatic, bed rest
Long term: once you have it, you can’t get it again. Most heal within 1-2 months

116
Q

Hep B

A

can cause lifelong infection, cirrhosis of liver, liver CA, liver failure, death

1.25 million americans are chronically infected

Transmitted through blood/bodily person

117
Q

RF and PRevention of Hep B

A

RF: multiple sex partners, sexually active homosexual men, injecting drugs, work in healthcare

Prevention: Hep B vaccinne is the best production

118
Q

CP and TX of Hep B

A

CP: jaundice, fatigue, loss of appetite, abd pain, nausea, vomiting, joint pain

TX: alpha interfern and lamivudine are 2 drugs that can be used

119
Q

Hep C

A

liver disease caused by hep C virus, can lead to liver failure, cirrhosis, liver cancer

accounts for 60 to 70% of chronic hepatitis. Infections are increasing after a period of downfall

120
Q

Transmission and Prevention of Hep C

A

Trans: BLOOD BORNE route
Prevention: No vaccine available!!! Use standard precautions and don’t share personal hygiene items

121
Q

CP of Hep C

A

80% have NO S/S
jaundice, fatigue, loss of appetite, abdominal pain, nausea, dark urine

122
Q

TX of Hep C

A

possible pill
liver transplant

PX: chronic infection will develop if untreated, and can increase risk of liver cancer

123
Q

Pancreatitis

A

inflammation of pancreas due to alcohol abuse (40%), gallstone (40%), idiopathic causes (20%), can be acute or chronic

124
Q

Acute pancreatitis

A

abrupt onset, lasts for a few days
can have repeated episodes and recover fully

125
Q

Chronic Pancreatitis

A

gradual development and persists over years
destroys pancreas and nearby tissues, although it may be years before S/S appear

less common than acute

126
Q

RF for Pancreatitis

A

Heavy alcohol use
gallstones
male, black american

127
Q

Pathogenesis of Pancreatitis

A

primary causes are heavy alcohol ingestion and gallstones

END RESULT: pancreatic digestive enzymes move into pancreas itself, causing potentially severe damage

128
Q

Alcohol and pancreatitis

A

causes digestive ensymes to be released sooner
increased permeability of ducts, allows digestive enzymes to leak into pancreatic tissue
leads to formation of protein plugs that block parts of pancreatic duct

129
Q

Gallstones and Pancreatitis

A

leave gallbladder and lodge/obstruct pancreatic duct

130
Q

Exocrine Pancreas

A

most cells in pancreas
releases enzymes though ducts

131
Q

CP Of Pancreatitis

A

Mild to severe mid epigastric and LUQ pain that is nearly constant

1/2 of patients have pain radiating to back

pain aggravated by eating, alcohol, walking, lying supine

severe: dehydration, low BP, internal bleeding shock

Chronic: weight loss, oily stools, diabetes

132
Q

Dx and Tx of Pancreatitis

A

DX: Blood test, increased WBC, increased liver enzymes, stool test, endscopic test

TX: pain control, IV fluids, NPO. Removal of gallstones, decrease alcohol dependency

133
Q

PT Tips and Pancreatitis

A

PT may be consulted for pain relief
position for comfort like sidelying, fetal position
Relaxation techniques

134
Q

Cholelithiasis

A

gallstones, which are deposits of cholesterol or caclium salts

135
Q

Cholecystitis

A

inflammation of gallbladder or cystic duct, due to impaction of gallstone in cystic duct

136
Q

Epidemiology of Cholecystitis/Cholelithiasis

A

Gallstones are VERY common
incidence increases with age
most common in obese females >40 yr of age

137
Q

RF of Cholecystitis/Cholelithiasis

A

Increasing age
female
high bile cholesterol
high fat diet
decreased PA

138
Q

Pathogenesis of Cholecystitis/Cholelithiasis

A

1.Gallstones form when bile in gallbladder becomes oversaturated with cholesterol
2. high cholesterol and decreased gallbladder motility results in production of cholesterol crystals and formation of gallstones
3. If obstruction of cystic duct occurs, gallbladder distends, while muscles in duct wall contract to expel stone

139
Q

CP of Cholecystitis/Cholelithiasis

A

30% cause symptoms
Biliary colic or gallbladder attack
RUQ abdominal pain, pain may radiate between scapulae, right shoulder or neck

pain frequently abrupt onset and gradually subsides
nausea, vomiting, anxiety, fear

140
Q

Dx and TX of Cholecystitis/Cholelithiasis

A

Dx: ULTRASOUND
Tx: ERCP to remove stones, cholecystectomy, bile salt tablets

141
Q

PTs and Cholecystitis/Cholelithiasis

A

in treating patients for MSK pain between scapulae, right shoulder, neck associated with RUQ pain

GI screaning questions, should contact MD

Cholecystitis may occur without formation of gallstones

142
Q

Increasing levels of PA activity ____ the risk of _____ cancers and other conditions

A

LOWERS, 13

Endometrial, breast, colon, rectum
Diverticulitis, gallstones

5 Pathology (9 decks)

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