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Patho > Lecture 5 & 6 - GI Disorders > Flashcards

Lecture 5 & 6 - GI Disorders Flashcards

1
Q

what is GORD?

A

Gastro-oesophageal reflux disease
Acid from the stomach leaks up into the oesophagus which can result in oesophageal mucosal injury

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2
Q

what is the main cause of GORD?

A

Occurs as a result of the lower oesophageal sphincter at the bottom of the oesophagus becoming weakened

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3
Q

what things may exacerbate GORD?

A
  1. Hiatus hernia - displacement of oesphageal junction
  2. central obesity - increases pressure gradient between abdomen and thorax thus increasing reflux
  3. impaired gastric clearance - slows movement of material down tract
  4. stress - aggravated by diet and lifestyle
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4
Q

what is the best management for GORD?

A

small amounts of food, regularly
delay lying down post meal
positioning after meal
antacids - temporary relief

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5
Q

what is the treatment for GORD?

A

PPIs such as omeprazole taken 30-60 minutes before food

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6
Q

what are red flags of GORD?

A

dysphagia - peptic stricture could be suspected (damage to oesophagus from narrowing)

odynophagia - pain swallowing

haematemesis - vomiting blood could be gastric bleed if it looks like coffee grounds

unexplained weight loss

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7
Q

what are complications of GORD?

A

erosive oesophagitis - damage to lining
Barrett’s oesophagus - thickened lining
Peptic stricture - narrowing of oesophagus
oesophageal adenocarcinoma - cancer of oesophagus

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8
Q

what are surgical interventions for GORD?

A

Fundoplication - fundus is folded and sewn around the lower esophageal sphincter

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9
Q

what is helicobacter pylori and what effect does it have on the stoamach?

A

Bacteria in stomach that damages stomach mucosa by inducing chronic inflammatory response.

Destroys protective layers and reduces mucosal blood flow

increased release of gastrin and decrease in somatostatin results in hypersecretion of acid

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10
Q

what findings would be likely if h.pylori were present?

A

FBC may reveal anaemia
bacteria may be present in breath, blood or stool
endoscopy may find eroded gastric mucosa
melena may be present in stool
vomit may reveal hematemesis

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11
Q

what are the management options for H. pylori?

A

antibiotics
antisecretory agents
nutritional supplements

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12
Q

what is malabsorption characterized by?

A

loss of mucosal tissue resulting in decreased absorptive area of the gut and availability of intestinal enzymes

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13
Q

what are the common signs and symptoms of malabsorption?

A

Ds and Vs
steatorrhea - fat in stool
abdominal distention and pain
anorexia
glossitis - inflammation of tongue
malnutrition
electrolyte imbalance
anaemia

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14
Q

what factors can lead to malabsorption?

A

hepatic inflammatory conditions
gall bladder inflammation and obstructions
bowel resection or inflammatory conditions
duct obstructions
pancreatic inflammatory conditions

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15
Q

what does lactose intolerance result in?

A

lactase deficiency which results in fermentation of lactose in large bowel flora = large amount of gas production = increase in gut osmotic pressure from undigested lactose

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16
Q

what is celiac disease?

A

autoimmune disease resulting from improper immune response to storage of gluten (protein found in wheat, barley and rye)

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17
Q

how does celiac disease impact the body?

A

produces antibodies against gliadin and antitransglutaminase

results in enterocyte destruction, villous atrophy, mucosal flattening, malabsorption

damages villi so unable to absorb nutrients

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18
Q

how is celiac disease diagnosed?

A

folate and vit B12 deficiency
stool collection - steatorrhea
barium swallow and endoscopy (identify mucosal changes)
mucosal flattening

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19
Q

how is celiac disease managed?

A

nutritional support
correction of anaemia (folic acid, B12 and iron supplements)
antibiotics

20
Q

what is dumping syndrome?

A

rapid gastric emptying
food moves too quickly from stomach to duodenum

21
Q

what are some signs and symptoms of dumping syndrome?

A

nausea
Ds and Vs
abdo pain and cramps
bloating
sweating
weakness
dizziness
flushing of face
rapid/irregular heart beat

22
Q

what is appendicitis?

A

when appendix becomes inflammed and edematous due to kink or occluded by fecalith

23
Q

what happens when appendix becomes inflammed?

A

reduced blood flow to tissue
bacteria multiplies = immune system cant attack = pus fills = pressure in lumen increases = reduce venous drainage

24
Q

what can happen is appendicitis goes untreated?

A

necrosis and gangrene
perforation

25
Q

what are some clinical manifestations of appendicitis?

A

right lower quadrant pain
fever, nausea, vomiting
tenderness at McBurneys point when pressure applied
rebound tenderness
rovsings sign - touch at lower left causes pain in lower right

26
Q

how is appendicitis diagnosed?

A

FBC - showing elevated WBC and neutrophils
x-ray, ultrasound or CT scan
pregnancy test to rule out ectopic pregnancy
CRP - shows sign of bacterial infection

27
Q

what nursing interventions are important when dealing with appendicitis?

A

monitor S&S of worsening condition that may indicate
- perforation
- abscess
- peritonitis

notify if pain suddenly ceases (perforation)

comfort position - semi-fowlers post surgery

do not give analgesics/antipyretics to mask fever before diagnosis

do not give laxatives as the may cause rupture

manage fluid loss

manage AB therapy to prevent infection

28
Q

what surgical management is required before going in for surgery with appendicitis?

A

correction or prevention of fluid and electrolyte imbalance and dehydration (ABs or IV)

analgesics after diagnosis

surgery = appendectomy, laparotomy or laproscopy

29
Q

what is the main cause of mechanical intestinal obstruction?

A

adhesions - bands of granulation and scar tissue that develop as a result of inflammation, encircle intestine and constrict lumen

30
Q

what is a paralytic ileus

A

nonmechanical obstruction of intestine - failure of perstalic contractions

31
Q

what are clinical manifestations of a paralytic ileus?

A

vomiting
constant discomfort
diarrhoea
abdominal distention
abdominal rigidity

32
Q

how are bowel obstructions diagnosed?

A

CT useful
X-ray - distention of loops of intestine
presence of free air in abdomen - perforation

33
Q

how is a paralytic illeus managed?

A

NBM
NG tube
enemas
fluid and electrolytes
ice chips
monitor I&Os
mobilize

34
Q

what are consequences of reduced liver function?

A

Failure of liver gluconeogenesis – leading to hypoglycemia

Reduced ability to convert ammonia to urea (from deamination of amino acids)

Reduced albumin production – leads to oedema

Reduced production of clotting proteins

Failure to produce bile components

35
Q

what are 4 complications of liver cirrhosis?

A

Oedema - reduced albumin production
Excessive bleeding - reduced clotting protein
heaptic encephalopathy - (NS disorder) reduced ammonia processing
gynecomastia in males - abnormal breast development

36
Q

what is portal hypertension?

A

flow of blood from the portal vein through the sinusoids of the lover impeded = pressure rise in vein

37
Q

what can portal hypertension lead to?

A

development of extra blood vessels that bypass portal vein

hepatic encephalopathy - brain damage

varicose veins in stomach/esophagus/rectum

gastric and esophageal varices can rupture

hormonal, metabolic and kidney abnormalities

cause ascites

38
Q

what are ascites and what are the causes?

A

fluid accumulation in the abdomen
caused by increased capillary pressure and obstruction to venous flow through liver

liver cannot metabolise aldosterone = increase in sodium and water by kidneys

39
Q

in portal hypertension, why does heaptic encephalopathy occur?

A

ammonia from L. intestine not converted in urea properly and can travel to brain = brain damage

40
Q

in portal hypertension, why does splenomegaly occur?

A

back pressure in venous tributaries of portal vein causes spleen enlargement

41
Q

in portal hypertension, why does formation of oesophageal varices occur?

A

blood vessels draining from portal vein into oesophagus become congested and distend = rupture

42
Q

what are spider Nevi?

A

vascular abnormalities caused by dilated blood vessels

43
Q

what is ascending cholangitis?

A

inflammation of bile duct from stone blocking normal passage of bile which backs up fluid causing infection

44
Q

what are the clinical manifestations of ascending cholangitis?

A

Fever
chills
abdo pain
jaundice

45
Q

what is the treatment for ascending cholangitis?

A

ABs
analgesics
intervention to relieve blockage

46
Q

what is the difference between cholelithiasis and choledocholithiasis?

A

cholelithiasis is gallstones in the gall bladder choledocholithiasis is gallstones in the common bile duct

47
Q

what is a polyp?

A

protrusion in the lumen of a hollow organ
hyperplastic polyps most common in L. intestine

Patho (10 decks)

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