Lecture 2 Flashcards
1
Q
Dysphagia
A
difficulty swallowing Causes: Esophageal stenosis or stricture Esophageal diverticula Esophageal tumors Stroke Cerebral damage
2
Q
Dysphasia
A
difficulty speaking
3
Q
Emesis
A
vomitus
4
Q
Hematemesis
A
blood in the vomit
Has a characteristic “coffee grounds” appearance resulting from protein in the blood being partially digested
Blood is irritating to the gastric mucosa
Upper GI bleeding is often the cause
5
Q
Colic
A
pain in the abdomen, usually caused by gas
6
Q
Leukocytosis
A
increased white blood cells in blood
7
Q
Jaundice
A
yellowing of tissues due to increased levels of bilirubin
8
Q
“Frank” Blood
A
obvious blood
9
Q
Occult Blood
A
“hidden” blood, not obvious
10
Q
Melena
A
black “tarry” feces from blood
11
Q
Exudate
A
drainage produced from infection or inflammation
12
Q
Gangrene
A
death of body tissue
13
Q
sepsis
A
infection in the blood
14
Q
Ascites
A
fluid collection in the abdomen
15
Q
Steatorrhea
A
high fat content in the feces
16
Q
Hepatic
A
of the liver
17
Q
Peritoneum
A
space around abdominal organs
18
Q
Stenosis
A
narrowing
19
Q
Peristalsis
A
movement of colonic smooth muscle
20
Q
Intrathoracic
A
inside the chest
21
Q
Carcinoma
A
cancerous
22
Q
Atrophic
A
wasting of body tissue
23
Q
Epigastric
A
upper central region of abdomen
24
Q
Perforation
A
a hole made by “piercing”
25
Arthralgia
joint pain
26
Calculi
stone in the body
27
Autoimmune
abnormal immune response to the body’s own tissues
28
Hyperplasia
increase in tissue cell production
29
Percutaneous
through the skin
30
Permucosa
through the muscosa
31
Fibrosis
excessive formation of connective tissue
32
Encephalopathy
brain disease
33
"Chole"
of the gallbladder
34
Malabsorption
poor absorption
35
Gastrointestinal System
Consumes, digests, and eliminates food
Includes
Upper Division: oral cavity, pharynx, esophagus, and stomach
Lower Division: small intestine, large intestine, and anus
Hepatobiliary System: liver, gallbladder, and pancreas
36
Four Layers
mucosa, submucosal(contains blood vessels, nerve), muscle, serosa
37
Peritoneum
large serous membrane that lines the abdominal cavity – IS STERILE!
38
Peritoneal cavity
space between the two layers
39
Gastric motility
Peristalsis
40
Small intestinal motility
Segmentation and peristalsis
41
Colonic motility
Haustrations and propulsive mass movement
42
Oral phase
| swallowing
voluntary
43
Pharyngeal phase
involuntary; prevents from food entering the nasopharynx when a patient is eating
44
Esophageal phase
involuntary
Initiates peristalsis
Primary versus secondary
45
The mesentery contains the intestine’s blood supply.
True
46
Bilirubin
is the byproduct of the breakdown and release of hemoglobin from old red blood cells becomes unconjugated bilirubin.
47
Liver
links unconjugated bilirubin in blood to glucuronide --> conjugated bilirubin--> bile
48
Excess unconjugated bilirubin in blood
bilirubinemia--> jaundice
49
What causes jaundice?
Increase in bilirubin levels
50
Liver
Main functions
1. Metabolize carbohydrates, protein, and fats
2. Metabolize medications to prepare them for excretion
3. Synthesize glucose, protein (Albumin), cholesterol, triglycerides, and clotting factors.
4. Detoxify blood of potentially harmful chemicals
5. Maintain intravascular fluid volume – Colloidal ONCOTIC PRESSURE (Albumin)!
6. Produce bile
7. Remove damaged or old erythrocytes to recycle iron and protein (this cycle produces the waste product bilirubin).
8. Serve as a blood reservoir-VERY VASCULAR
51
Pancrease
Exocrine functions: produces enzymes (lipase, amylase, protease), electrolytes, sodium bicarbonate, and water necessary for digestion
Endocrine function: produces hormones to help regulate blood glucose (glucagon, insulin, amylin) – key organ in blood glucose regulation
52
Gall Bladder
stores bile produced by the liver
Lower GI tract
Continues digestion
Absorbs nutrients and water
53
Cleft lip and Palate
Common congenital defects of the mouth and face
Apparent at birth and vary in severity
Usually develop in the 2nd or 3rd month of gestation
Multifactoral in origin
Can affect the one’s appearance
May lead to problems with feeding, speech, ear infections, and hearing problems
May occur separately or together
Cleft palate results from failure of the hard and soft palate to fuse in development
Teeth and nose malformations may also be present
54
Cleft lip and palate treatment
```
Temporary measures (e.g., special nipples or dental appliances)
Surgical repair, cosmetic plastic surgery,
Speech therapy, orthodontist consultation, and multidisciplinary case management
```
55
Pyloric Stenosis
Narrowing and obstruction of the pyloric sphincter.
May be present at birth or develop later in life
The exact cause of pyloric stenosis is unknown
Most common in Caucasians and males
56
Pyloric Stenosis Manifestations
```
Dysphagia: difficulty swallowing
A hard mass in the abdomen,
Regurgitation,
Projectile vomiting,
Wavelike stomach contractions,
Small and infrequent stools,
Failure to gain weight,
Dehydration
```
57
Dysphagia
```
Sensation of food being stuck in the throat
Choking
Coughing
“pocketing” food in the cheeks
Difficulty forming a food bolus
Delayed swallowing
```
58
Vomiting
Involuntary or voluntary forceful ejection of chyme from the stomach up through the esophagus and out the mouth
59
Vomiting causes
protection, reverse peristalsis, increased intracranial pressure, and severe pain
60
Involuntary vomiting sequ
A deep breath is taken.
The glottis closes and the soft palate rises.
Respirations cease to minimize the risk of aspiration.
The gastroesophageal sphincter relaxes.
Abdominal muscles contract, squeezing the stomach against the diaphragm and forcing the chyme upward into the esophagus.
Reverse peristaltic waves eject chyme out of the mouth.
61
Involuntary vomiting sequence
A deep breath is taken.
The glottis closes and the soft palate rises.
Respirations cease to minimize the risk of aspiration.
The gastroesophageal sphincter relaxes.
Abdominal muscles contract, squeezing the stomach against the diaphragm and forcing the chyme upward into the esophagus.
Reverse peristaltic waves eject chyme out of the mouth.
62
Yellow or green colored vomitus
Usually indicates the presence of bile
| GI tract obstruction
63
A deep brown colored vomitus
May indicate content from the lower intestine
64
Undigested food vomitus
Caused by conditions that impair gastric emptying
65
Hiatal Hernia
A stomach section protrudes upward through an opening in the diaphragm toward the lung
66
Hiatal Hernia Causes
```
Weakening of the diaphragm muscle
Increased intrathoracic pressure
Increased intra-abdominal pressure
Trauma
Congenital defects
```
67
Hiatal Hernia Manifestations
Include: indigestion, heartburn, frequent belching, nausea, chest pain, strictures, dysphagia, and soft upper abdominal mass (protruding stomach pouch)
Worsen with recumbent (flat in bed) positioning, eating (especially after large meals), bending over, and coughing
68
Gastroesophageal Reflux Disease (GERD)
Chyme periodically backs up from the stomach into the esophagus
Bile can also back up into the esophagus
69
GERD Causes
```
Certain food (e.g., chocolate, caffeine, carbonated beverages, citrus fruit, tomatoes, spicy or fatty foods, and peppermint)
Alcohol consumption
Smoking
Hiatal hernia
Obesity
Pregnancy
Certain medications
Delayed gastric emptying
```
70
GERD manifestations
heartburn, epigastric pain (usually after a meal or when recombinant), dysphagia, dry cough, laryngitis, pharyngitis, regurgitation of food, and sensation of a lump in the throat
71
Why does GERD feel like a burn?
The lining of your esophagus is more delicate than the lining of your stomach. So, the acid in your esophagus causes a burning sensation in your chest.
72
Gastritis
Inflammation of the stomach’s mucosal lining
73
Acute gastritis
Can be a mild, transient irritation, or it can be a severe ulceration with hemorrhage
Usually develops suddenly and is likely to be accompanied by nausea and epigastric pain
74
Chronic gastritis
Develops gradually
| May be asymptomatic, but usually accompanied by a dull epigastric pain and a sensation of fullness after minimal intake
75
Gastroenteritis
Inflammation of the stomach and intestines usually because of an infection or allergic reaction
76
Helicobacter pylori
Most common cause of chronic gastritis
77
Gastritis other causes
Organisms transmitted through food and water contamination
Medications that irritate the gastric mucosa
Excessive alcohol use
Severe stress
Autoimmune conditions.
78
Gastritis manifestations
```
Indigestion,
Heartburn
Epigastric pain
Abdominal cramping
Nausea
Vomiting
Anorexia
Dark Tarry Stools
```
79
Peptic Ulcer Disease
```
Lesions affecting the lining of the stomach or duodenum
Risk factors:
Male
Increased age
GI irritating medications
H. pylori infections
Gastric tumors
Those for GERD (e.g., smoking and alcohol use)
```
80
Peptic Ulcer Disease Manifestations
```
Complications:
GI hemorrhage
Obstruction
Perforation
Peritonitis
Manifestations:
Epigastric or abdominal pain
Abdominal cramping
Heartburn
Indigestion
Nausea and vomiting
```
81
Disorders of the Gallbladder
Cholelithiasis (gallstones)
Acute and chronic cholecystitis
Choledocholithiasis
Cholangitis
82
Cholangitis
Inflammation of the common bile duct
83
Choledocholithiasis
Stones in the common bile duct
84
Acute and chronic cholecystitis
Inflammation caused by irritation due to concentrated bile
85
Cholelithiasis (gallstones)
Cholesterol, calcium salts, or mixed
86
Cholelithiasis (gallstones)
Cholesterol, calcium salts, or mixed
Common condition that affects both genders and all ethnic groups relatively equally.
Usually the gall stones lodge in the common bile duct.
Manifestations:
biliary colic, abdominal distension, nausea, vomiting, jaundice, fever, and leukocytosis
risk factor- advancing age
87
Cholestasis
Bile flow in the liver slows down.
Bile accumulates and forms plugs in the ducts.
Ducts rupture and damage liver cells
Alkaline phosphatase released into blood
The liver is unable to continue processing bilirubin.
Increased bile acids in blood and skin
Pruritus (itching)
88
Cholecystitis
Inflammation or infection caused my calculi
May vary in severity according to size
May obstruct the bile flow and cause gallbladder rupture
89
Hepatitis
```
Inflammation of the liver
Causes:
Infections (usually viral)
Alcohol
Liver toxic medications
Autoimmune disease
Can be acute, chronic, or fulminant
Can be active or non-active
```
90
Hepatitis nonviral
Usually recover
May develop liver failure, liver cancer, or cirrhosis
Not contagious
91
Hepatitis viral
Contagious
Usually recovers with no residual damage
Advancing age and comorbidity increase the likelihood that liver failure, liver cancer, or cirrhosis will develop
92
Liver Function Tests (Labs)
Aminotransferases [alanine aminotransferase (ALT) and aspartate aminotransferase (AST)
ALT is primarily found in the liver.
AST is found in many tissues (e.g., skeletal muscle, heart, kidney, brain).
ALT is more sensitive and specific than AST for liver damage.
93
Other lab tests
```
Bilirubin
Albumin
Partial Tissue Thromboplastin (PTT)
Prothrombin Time (PT)
Alkaline Phosphatase (ALK), and
Gamma-glutamyl-transferase (GGT).
```
94
Acute hepatitis
has three phases
95
Chronic hepatitis
Hepatic disease lasting longer than 6 months
Symptom severity and disease progression varies depending on degree of liver damage
Can quickly deteriorate with declining liver function
96
Fulminant hepatitis
An uncommon, rapidly progressing form that can quickly lead to liver failure, hepatic encephalopathy, or death within 3 weeks
97
Cirrhosis
Chronic, progressive, irreversible, diffuse damage to the liver resulting in decreased liver function
Scar tissue partially blocks sinusoids and bile canaliculi
Causes:
Hepatitis and all those factors that can lead to hepatitis
Chronic alcohol abuse is the most frequent cause of cirrhosis in the United States
Hepatitis is the most common etiology in developing countries
98
Stages of liver damage
1. Healthy
2. Fatty liver(steatosis): fat deposits cause liver enlargement
3. Liver fibrosis: scar tissue forms
4. Cirrhosis: connective tissue growth destroys cells
99
Alcoholic hepatitis
Liver inflammation and liver cell failure
100
Veins Draining Into the Hepatic Portal System
Portal hypertension causes pressure in these veins to increase.
Collateral channels and shunts develop.
Organs engorge with blood.
101
End Stage Liver Disease
```
common symptoms:
Anorexia
Weakness
Nausea/Vomiting
Abdominal Pain
```
```
common signs:
Hepatomegaly
Splenomegaly
Ascites
Jaundice
Spider Angiomas
Encephalopathy
```
102
Hematologic disorders
Anemia, thrombocytopenia, coagulation defects, leukopenia
103
End Stage Liver Disease
```
common symptoms:
Anorexia
Weakness
Nausea/Vomiting
Abdominal Pain
```
```
common signs:
Hepatomegaly
Splenomegaly
Ascites
Jaundice
Spider Angiomas
Encephalopathy: confusions
```
104
Endocrine disorders
Fluid retention, hypokalemia, disordered sexual functions (build up in body).
105
Skin disorders
Jaundice, red palms, spider nevi
106
Hepatorenal syndrome
Azotemia, increased plasma creatinine, oliguria
107
Hepatic encephalopathy
Asterixis (hand flapping tremor), confusion, coma, convulsions
108
Cirrhosis Manifestations
```
sparse body hair
muscle wasting
spider angioma
jaundice
dilated vessels
confusion
```
109
Pancreatitis
Inflammation of the pancreas leading to autodigestion of the pancreas and surrounding tissue.
Very painful
Can be acute or chronic
110
acute pancreatitis
Considered a medical emergency
Mortality increases with advancing age and comorbidity
```
Causes:
Cholelithiasis
Alcohol abuse
Biliary dysfunction
Trauma
Renal failure
Endocrine disorders
Pancreatic tumors
```
111
Manifestations of acute pancreatitis
Upper abdominal pain that radiates to the back
Nausea and vomiting
Mild jaundice
Low-grade fever
Blood pressure and pulse changes – severe hypovolemia
Steatorrhea for chronic pancreatitis
112
Pancreatitis history
Recent operative or other invasive procedures
Family history of hypertriglyceridemia
Previous biliary colic and binge alcohol consumption (major causes of acute pancreatitis)
113
Pancreatitis physical findings
```
Fever
Tachycardia
Hypotension
Abdominal tenderness
Muscular guarding
Abdominal distention
Diminished or absent bowel sounds
```
114
Unusual signs-may indicate a complication: Pancreatitis
Jaundice (28%)
Dyspnea (10%); tachypnea; basilar rales, especially in the left lung
In severe cases, hemodynamic instability (10%) and hematemesis or melena (5%); pale, diaphoretic, and listless appearance
Occasionally, extremity muscular spasms secondary to hypocalcemia
115
Pancreatitis complications
```
Diabetes mellitus (why?): mainly occurs due to the destruction of islet cells by pancreatic inflammation
Infection
Shock
Renal failure
Malnutrition,
Pancreatic cancer
```
116
Chronic Pancreatitis and Pancreatic Cancer
Have signs and symptoms similar to acute pancreatitis
Often have:
Digestive problems because of inability to deliver enzymes to the duodenum
Glucose control problems because of damage to the islets of Langerhans
Signs of biliary obstruction because of underlying bile tract disorders or duct compression by tumors
117
Diarrhea (symptom)
Change in bowel pattern characterized by an increased frequency, amount, and water content of the stool
Acute diarrhea
Often caused by viral or bacterial infections or certain medications (e.g., antibiotics, antacids, and laxatives)
Chronic diarrhea
Last longer than 4 weeks
Causes: inflammatory bowel diseases, endocrine disorders, chemotherapy, and radiation
118
Diarrhea
Originating in the small intestine
Stools are large, loose, and provoked by eating
Originating in the large intestine
Stools are small and frequent
Acute diarrhea is generally infectious and accompanied by cramping, fever, chills, nausea, and vomiting
Fluid, electrolyte, and pH imbalances
119
Constipation (symptom)
```
Change in bowel pattern characterized by infrequent passage of stool in reference to the individual’s typical bowel pattern
Causes:
Low-fiber diet
Inadequate physical activity,
Insufficient fluid intake,
Delaying the urge to defecate,
Laxative abuse
Stress
Travel
Bowel diseases
Chronic constipation also greatly increases the patient’s risk of colon cancer!
```
120
Constipation manifestations
pain during the passage of a bowel movement,
inability to pass stool after straining or pushing for more than 10 minutes,
no bowel movements for more than 3 days,
decreased bowel sounds from decreased peristalsis.
121
Constipation treatment
increasing dietary fiber
increase in hydration
increasing physical activity (this increases peristalsis)
defecating when initial urge is sensed
taking stool softeners
digitally removing impaction (yes, this is the nurse’s job )
122
Intestinal Obstruction
Blockage of intestinal contents in the small intestine or large intestine.
Causes
Mechanical obstructions: foreign bodies, tumors, hernias, intussusception, Crohn’s disease, diverticulitis, and fecal impaction
Functional obstructions (also called paralytic ileus):
Neurologic impairment
Intra-abdominal surgery complications
Electrolyte disturbances
Intra-abdominal infections
Abdominal blood supply impairment
123
Intestinal Obstruction manifestations
```
Abdominal distension
Abdominal cramping
Pain
Nausea
Vomiting
Constipation
Diarrhea
Decreased or absent bowel sounds
```
124
Pancreatitis complications
```
Diabetes mellitus (why?): mainly occurs due to the destruction of islet cells by pancreatic inflammation
Infection
Shock
Renal failure
Malnutrition,
Pancreatic cancer
```
125
Chronic Pancreatitis and Pancreatic Cancer
Have signs and symptoms similar to acute pancreatitis
Often have:
Digestive problems because of inability to deliver enzymes to the duodenum
Glucose control problems because of damage to the islets of Langerhans
Signs of biliary obstruction because of underlying bile tract disorders or duct compression by tumors
126
Diarrhea (symptom)
Change in bowel pattern characterized by an increased frequency, amount, and water content of the stool
Acute diarrhea
Often caused by viral or bacterial infections or certain medications (e.g., antibiotics, antacids, and laxatives)
Chronic diarrhea
Last longer than 4 weeks
Causes: inflammatory bowel diseases, endocrine disorders, chemotherapy, and radiation
127
Diarrhea
Originating in the small intestine
Stools are large, loose, and provoked by eating
Originating in the large intestine
Stools are small and frequent
Acute diarrhea is generally infectious and accompanied by cramping, fever, chills, nausea, and vomiting
Fluid, electrolyte, and pH imbalances
128
Constipation (symptom)
```
Change in bowel pattern characterized by infrequent passage of stool in reference to the individual’s typical bowel pattern
Causes:
Low-fiber diet
Inadequate physical activity,
Insufficient fluid intake,
Delaying the urge to defecate,
Laxative abuse
Stress
Travel
Bowel diseases
Chronic constipation also greatly increases the patient’s risk of colon cancer!
```
129
Constipation manifestations
pain during the passage of a bowel movement,
inability to pass stool after straining or pushing for more than 10 minutes,
no bowel movements for more than 3 days,
decreased bowel sounds from decreased peristalsis.
130
Constipation treatment
increasing dietary fiber
increase in hydration
increasing physical activity (this increases peristalsis)
defecating when initial urge is sensed
taking stool softeners
digitally removing impaction (yes, this is the nurse’s job )
131
Intestinal Obstruction
Blockage of intestinal contents in the small intestine or large intestine.
Causes
Mechanical obstructions: foreign bodies, tumors, hernias, intussusception, Crohn’s disease, diverticulitis, and fecal impaction
Functional obstructions (also called paralytic ileus):
Neurologic impairment
Intra-abdominal surgery complications
Electrolyte disturbances
Intra-abdominal infections
Abdominal blood supply impairment
132
Intestinal Obstruction manifestations
```
Abdominal distension
Abdominal cramping
Pain
Nausea
Vomiting
Constipation
Diarrhea
Decreased or absent bowel sounds
```
133
Appendicitis
```
Inflammation of the vermiform appendix
Most often caused by an infection
Complications:
Abscesses
Peritonitis
Gangrene
Death
```
134
Appendicitis Manifestations
Sharp abdominal pain develops, gradually intensifies (over about 12–18 hours) and becomes localized to the lower right quadrant of the abdomen (McBurney point)
Pain will temporarily subside if the appendix ruptures, and then the pain will return and escalate
Nausea, vomiting, and bowel pattern changes (mild usually)
Indications of inflammation and infection (e.g., fever, chills)
135
Peritonitis
Medical Emergency! May lead to sepsis!
Inflammation of the peritoneum – usually from sterile GI contents spilling into the normally sterile retroperitoneal space
Causes include direct organism invasion (e.g., appendicitis rupture, colonic rupture, peptic ulcer perforation)
136
Peritonitis Manifestations
Usually sudden and severe
Classical manifestation = abdominal rigidity (hardening)
Abdominal tenderness and pain
Large volumes of fluid leak into the peritoneal cavity
Nausea and vomiting
Decreased peristalsis
Intestinal obstruction
Indicators of infection (e.g., fever, malaise, and leukocytosis)
Indications of sepsis and shock
137
Loss of fluid in the GI Tract
Turnover of fluid in the bowel is large; about 9 to 10 liters
of fluid enter the gut each day:
```
Water Turnover in the Bowel
Water from diet
2000-3000 mls/day
Saliva
1000-2000
Gastric juice
1000-2000
Bile
500-1000
Pancreatic juice
1000-2000
Intestinal secretions
1000-2000
```
138
Inflammatory Bowel Disease (IBD)
Chronic inflammation of the GI tract, usually the intestines
Includes Crohn’s disease and ulcerative colitis
Exacerbations and remissions
Thought to be caused by a genetically associated autoimmune state that has been activated by an infection
Fluid, electrolyte, and pH imbalances develop
Can be painful, debilitating, and life threatening
Cause malabsorption of nutrients, leading to multiple problems
139
Crohn’s Disease
Insidious, slow-developing, progressive condition
Often develops in adolescence
Manifestations:
Abdominal cramping and pain (typically in the right lower quadrant)
Diarrhea
Constipation
Abdominal mass
Melena
Anorexia and weight loss
Indications of inflammation (e.g., fever, fatigue, arthralgia, and malaise)
Strictures, fissures, abscesses occur
140
Ulcerative Colitis
Progressive condition of the rectum and colon mucosa
Usually develops in the 2nd or 3rd decade of life
Manifestations:
Diarrhea (usually frequent [as many as 20 daily]
Watery stools with blood and mucus
Abdominal cramping
Nausea and vomiting
Weight loss
Indications of inflammation (e.g., fever, fatigue, arthralgia, and malaise)
141
Stages of stomach cancer
Stage 0-4
142
Irritable Bowel Syndrome (IBS) manifestations
Stress and mood disorders often worsen symptoms
Abdominal distension, fullness, flatus, and bloating
Intermittent abdominal pain exacerbated by eating and relieved by defecation
Chronic and frequent constipation or diarrhea, usually accompanied by pain
Non-bloody stool that may contain mucus
Bowel urgency
Emotional distress
Anorexia
143
Diverticular Disease
Conditions related to the development of diverticula, outwardly bulging pouches of the intestinal wall that occur when mucosa sections or large intestine submucosa layers herniate through a weakened muscular layer
144
Diverticulosis
Asymptomatic diverticular disease - chronic
| Usually there are multiple diverticula present
145
Diverticulitis
acute inflammation of the chronic condition
Diverticula have become inflamed, usually because of retained fecal matter
Often asymptomatic until the condition becomes serious
146
Diverticular Disease manifestations
abdominal cramping followed by passing a large quantity of frank blood
Low-grade fever
Abdominal tenderness (usually left lower quadrant)
Abdominal distension
Nausea and vomiting
Leukocytosis
147
Colorectal Cancer (CRC) manifestations
```
lower abdominal pain and tenderness,
blood in the stool,
diarrhea, constipation,
intestinal obstruction,
narrow stools,
unexplained anemia (usually iron deficiency), and unintentional weight loss
```
148
Gastric Cancer
Occurs in several forms, but adenocarcinoma (an ulcerative lesion) is the most frequent type
```
manifestations:
Abdominal pain
Abdominal fullness
Epigastric discomfort
Palpable abdominal mass
Dark stools
Melena
Dysphagia
Excessive belching
Anorexia
Nausea and vomiting
Hematemesis
Premature abdominal fullness after meals
```
149
Pernicious Anemia
Vitamin b12 deficiency anemia
150
Pancreatic Cancer
Aggressive malignancy that can quickly metastasize
Risk factors:
Family history, obesity, chronic pancreatitis, long-standing diabetes mellitus, cirrhosis, alcohol abuse, and tobacco use
151
Pancreatic cancer manifestations
progressive upper abdominal pain that may radiate to the back,
jaundice,
dark urine,
clay-colored stools, indigestion,
anorexia,
weight loss, malnutrition, and hyperglycemia
152
Colorectal Cancer (CRC)
Most often develops from an adenomatous polyp
Very common and fatal in the US and worldwide
Incidence and mortality highest among men and African Americans
153
Intestinal Obstruction
partial or complete blockage of the lumen of the small or large intestine causing an interruption in the normal flow of intestinal contents along the intestinal tract
block may be complete or incomplete, may be mechanical or paralytic, and may or may not compromise the vascular supply.
154
Bowel Obstruction manifestations
```
mechanical blockage or paralytic lleus
higher the obstruction, the quicker the symptoms
abdominal distension
constipation with failure to pass flatus
bowel sounds: increased to silent
high pitched at first then silent
vomiting, hypovolemia, electrolytes
```
155
myenteric
controls the motility along the length of the gut
156
steatorrhea
fatty stools
