Lesson 9 Gastrointestinal Systems

Question 1

A major disorder of upper GI tract, is diagnosed if a person has esophagitis more than a few times a week. most commonly in infants and in persons older than age 40 years.

Answer 1

gastroesophageal reflux disease (GERD)

Question 2

This disease is associated with esophogitis and GERD, and if left untreated there is the possibility of acute GI bleeding.

Answer 2

peptic ulcer disease (PUD)

Question 3

How is the lower esophageal sphincter (LES) affected in GERD patients?

Answer 3

a functional or mechanical problem that decreases muscular tone: Relaxation of the LES allows for regurgitation of stomach contents into the esophagus

Question 4

This is the delayed emptying of gastric contents into the duodenum

Answer 4

Gastroparesis

Question 5

Why is gastroparesis problematic for GERD patients?

Answer 5

causes increased gastric distention that leads to increased pressure within the stomach against the LES. (lower esophageal sphincter)

Question 6

How can GERD progress to a serious illness?

Answer 6

esophageal epithelial cells are not able to withstand the acidity of the refluxed stomach contents. The gastric acid can quickly erode the protective mucosal epithelial layer and lead to ulceration of the esophagus. Repeated injury to the epithelial layer commonly causes metaplasia, the change of esophageal epithelial cells into stomachlike columnar epithelium.

Question 7

What is the metaplastic cellular change at the gastroesophageal junction called?

Answer 7

Barrett’s esophagus, is a precancerous change of cells

Question 8

Which factor determines the seriousness of an upper GI bleed?

Answer 8

(can’t find a distinct answer in the book)
An acute UGIB can quickly develop into hypovolemic shock.
a large blood loss causes sudden hypotension and hypovolemia.
Hematemesis is vomitus with bright-red, bloody streaks or a dark, coffee-ground appearance. The presence of bright-red blood indicates a current bleed.

Question 9

This is the presence of blood in the stool that is not visible

Answer 9

occult blood

Question 10

PUD, esophageal varices, Mallory–Weiss syndrome, Boerhaave syndrome, esophageal cancer, and hemorrhagic gastritis, can cause what?

Answer 10

upper GI bleed

Question 11

This is is associated with a rupture, tear, or perforation in the esophageal or gastric lining, resulting in blood loss. large blood loss causes sudden hypotension and hypovolemia. rapid onset of anxiety, dizziness, weakness, shortness of breath, or change in mental status. Tachycardia and tachypnea will occur because of decreased cardiac output. The skin will be pale and clammy as a result of the body’s effort to shut down peripheral blood flow.

Answer 11

Acute Upper GI bleed

Question 12

This is the result of a small tear or opening in the GI tract that causes a gradual, small amount of blood loss. causes complaints of fatigue, low hemoglobin, and low iron levels

Answer 12

Chronic upper GI bleed

Question 13

This is treated primarily with PPIs such as omeprazole (PrilosecR) for 4 to 8 weeks.

Answer 13

chronic upper GI bleed

Question 14

This is treated with rapid fluid replacement, insertion of a nasogastric tube to prevent abdominal distention from accumulation of blood, and administration of blood transfusions. might need endoscopy, coagulation, or surgical repair

Answer 14

Acute Upper GI bleed

Question 15

What are the two major causes of peptic ulcer disease (PUD)?

Answer 15

the bacterium H. pylori and the use of NSAIDs or aspirin.

Question 16

This is inflammatory erosion in the stomach or duodenal lining. The incidence of this disease is equal in males and females.

Answer 16

Peptic ulcer disease (PUD)

Question 17

What is the most significant risk factor for developing PUD?

Answer 17

the presence of H. pylori

Question 18

Why do NSAIDs and aspirin cause PUD?

Answer 18

They counteract prostaglandin E secretion, the major stimulant of gastric mucus production, and diminish the stomach’s protective layer.

Question 19

Hydrochloric acid (HCl) is normally found in the stomach. How can HCl disorder
contribute to PUD?

Answer 19

Hypersecretion of HCl can lead to erosion of the mucus membrane in the stomach or duodenum, which permits the diffusion of HCl into the stomach wall and blood vessels=inflammatory response=release of protaglandins and histamine=stomach cells triggered to release more mucus and bicarbonate to neutralize, but the parietal cells keep releasing histamine and HCl=continued damage

Question 20

What are complications of PUD?

Answer 20

bleeding and perforation

Question 21

this occurs when part of the stomach pushes up through the opening in the diaphragm and protrudes into the thoracic cavity. This allows acid from the stomach to reflux back up into the esophagus.

Answer 21

hiatal hernia

Question 22

How can gastroenteritis pathogens cause watery diarrhea?

Answer 22

These microorganisms cause diarrhea by adherence to the mucosa, invasion into the mucosal layer, or toxin production. The end result of most microbial infections is increased fluid to shift into the lumen of the intestine, to a point where the excessive fluid cannot be adequately reabsorbed. This fluid shift results in watery, small intestinal contents that pass into the large intestine and are then excreted as diarrhea.

Question 23

This is a protrusion of a section of the small intestine through a weakened abdominal wall muscle

Answer 23

Hernia

Question 24

This occurs from an irritation to the lining of the stomach, small intestine, or large intestine by a pathogen or toxin. The disease can occur from a virus, bacteria, parasite, or chemical toxin. It is transmitted from person to person or can be a waterborne or foodborne illness.

Answer 24

Gastroenteritis

Question 25

This type of diarrhea occurs because of an increase in the osmotic load presented to the intestinal lumen because of diminished absorption.

Answer 25

osmotic diarrhea

Question 26

This type of diarrhea occurs when the mucosal lining of the intestine is inflamed, edematous, and unable to reabsorb fluid or nutrients.

Answer 26

inflammatory diarrhea

Question 27

This type of diarrhea occurs when an organism stimulates the intestine to secrete fluid and mucus.

Answer 27

Secretory diarrhea

Question 28

This type of diarrhea is caused by intestinal neuromuscular disorders.

Answer 28

motility diarrhea

Question 29

Which individuals are most at risk for viral or bacterial gastroenteritis?

Answer 29

individuals who are in close contact with others, such as those in nursing homes, day-care centers, cruise ships, and dormitories

Question 30

What is the primary clinical presentation of gastroenteritis?

Answer 30

nausea, vomiting, abdominal cramping, and diarrhea.

Question 31

What are the clinical signs or red flags that may indicate a need for hospitalization in patients with acute gastroenteritis?

Answer 31

• Severe volume depletion/dehydration
• Abnormal electrolytes or renal function
• Bloody stool/rectal bleeding
• Weight loss
• Severe abdominal pain
• Prolonged symptoms (more than 1 week)
• Hospitalization or antibiotic use in the past 3 to 6 months
• Age 65 or older
• Comorbidities (e.g., diabetes mellitus, immunocompromised)
• Pregnancy

Question 32

What specifically named diet is recommended for someone with gastroenteritis?

Answer 32

The BRAT diet (bananas, rice, applesauce, and toast)

Question 33

This is also known as sprue and gluten-sensitive enteropathy, is a condition that occurs from a hypersensitivity reaction to gluten, a by-product of wheat, barley, and rye. The cause is unknown, but it is considered an autoimmune disease.

Answer 33

Celiac Disease

Question 34

What is the etiology of Celiac disease?

Answer 34

a gluten-derived peptide called gliadin damages the intestinal mucosa in persons with genetic predisposition to this disease. The exact etiology is unknown, but T cells predominate in an autoimmune inflammatory reaction against intestinal villi.

Question 35

In celiac disease, what does the inability to digest carbs lead to?

Answer 35

a buildup of gases within the intestinal system, causing abdominal bloating and diarrhea

Question 36

This is the name for the loss of fat in stool, which causes it to be light colored and soft.

Answer 36

Steatorrhea

Question 37

What are the initial symptoms of celiac disease? what is seen as the disease progresses?

Answer 37

fatigue, abdominal pain, bloating, and steatorrhea. As the disease progresses, symptoms associated with vitamin deficiencies will present, including anemia, high incident of fractures or bone pain, abnormal growth, bruising, poor skin turgor, and dehydration.

Question 38

How is celiac disease treated?

Answer 38

aimed at making dietary changes, identify and eliminate gluten products in the diet. The patient frequently needs vitamin replacement. If the immune response is extreme, corticosteroids may be prescribed.

Question 39

What is inflammation of a vestigial part of the intestine-can lead to perforation if not diagnosed promptly?

Answer 39

appendicitis

Question 40

what are segmental mixing or kneading movements that shuffle the contents back and forth among the haustra in the large intestine? and what is its purpose?

Answer 40

Haustrations: increases the contact time with the mucosa to facilitate the absorption of water and electrolytes and allow time for bacteria to accumulate. The circular muscles contract and relax at different sites, creating a shuffling effect.

Question 41

what are the movements that generally occur after meals? A large segment of the colon (longer than 20 cm) contracts as one unit, moving fecal contents forward. A series of these movements lasts approximately 10 to 30 minutes and occurs several times per day.

Answer 41

Propulsions

Question 42

What increases the membrane permeability to sodium, and it increases both the diffusion of sodium into cells and its active transport into interstitial fluid in the large intestine?

Answer 42

Aldosterone

Question 43

How much of the bulk of solid feces is bacteria?

Answer 43

1/3

Question 44

Commonly used drugs, particularly those with which kind of side effects can interfere with intestinal motility?

Answer 44

anticholinergic

Question 45

What can chronic use of laxatives lead to?

Answer 45

lack of natural colonic motility. Excessive laxative use is defined as more than three times per week for at least 1 year.
-also: serious medical consequences, such as fluid and electrolyte imbalance, steatorrhea, protein-losing gastroenteropathy, osteomalacia, and vitamin and mineral deficiencies.

Question 46

This is the anatomical and physiological change in the colon that occurs with chronic use of stimulant laxatives.

Answer 46

Cathartic colon

Question 47

This occurs when hard stool that cannot be passed is lodged in the sigmoid colon and rectum.

Answer 47

fecal impaction

Question 48

This is the urge to defecate but there is no passage of stool, liquid, or gas from the colon.

Answer 48

Obstipation

Question 49

What is the difference between IBS (irritable bowel syndrome) and IBD (inflammatory bowel disease)?

Answer 49

IBS= frequent episodes of abdominal pain, bloating, and abdominal distention. no pathological change within the interior of the bowel, and etiology is unclear.
IBD= caused by pathological changes in the wall of the colon. UC and Crohn’s disease, both types of IBD, cause severe abdominal pain, diarrhea, bloody stools, and weight loss. The bowel mucosa is friable, edematous, ulcerated, scarred, and bleeding.

Question 50

This is an inflammatory disorder of the colon, caused by weak areas that form pouches off the wall of the large intestine. Commonly, these pouches become filled with stagnant intestinal contents, leading to obstruction and inflammation of the bowel wall.

Answer 50

Diverticulitis

Question 51

Right lower quadrant (RLQ) tenderness is commonly caused by what?

Answer 51

Appendicitis

Question 52

LLQ tenderness is commonly associated with what?

Answer 52

Diverticulitis

Question 53

Upper right quadrant (URQ) tenderness elicited by palpation is called what? What does this indicate?

Answer 53

Murphy’s sign
Cholecystitis: gallbladder inflammation

Question 54

What additional examination do women need with abdominal pain and why?

Answer 54

pelvic examination and pregnancy test to rule out ectopic pregnancy.

Question 55

This is a surgical procedure in which the healthy end of the intestine is brought out of the abdomen through an incision in the anterior abdominal wall.

Answer 55

Ileostomy: small intestine
colostomy: large intestine

Question 56

This is a chronic, transmural, inflammatory process of the bowel that often leads to fibrosis and obstructive symptoms; it can affect any part of the GI tract from the mouth to the anus. The most common location is the terminal ileum and ascending right colon.

Answer 56

Crohn’s disease

Question 57

What is the cause of Crohn’s disease?

Answer 57

No known cause
theories= genetic, immunological, infectious, and environmental influences that contribute to an overactive inflammatory response to unknown triggers.

Question 58

What are the risk factors for Crohn’s disease?

Answer 58

genetic predisposition, ethnicity, and cigarette smoking. (caucasians more likely, urban living, mutations of genes, consuming refined sugars and saturated fats, stress factors)

Question 59

What are the complications of Crohn’s disease?

Answer 59

small bowel obstruction due to chronic inflammation, stricture or spasm in the intestine=narrowed lumen, impactions, adhesions after surgery, microperforations, localized peritonitis or abscess, high risk for venous thrombo and PE.

Question 60

This disease affects the entire thickness of the bowel wall and all layers of the submucosa. The mucosa is chronically inflamed and contains a high number of immunoglobulins, T cells, and macrophages. T cells attract nonspecific inflammatory cells, especially neutrophils, which play a major role in tissue damage. This response produces cytokines, growth factors, antibodies, and proteases, which all contribute to continual tissue destruction.

Answer 60

Crohn’s disease

Question 61

The lesions are visible as edematous, reddish-purple areas in a segmental pattern. There are areas of disease separated by healthy areas, referred to as what?

Answer 61

skip lesions

Question 62

In crohn’s disease the bowel mucosa develops granulomas; this is exhibited as an effect called what?

Answer 62

cobblestoning

Question 63

This is the extreme dilation of a segment of the diseased colon, commonly the transverse colon. It causes complete obstruction and impaired absorption of fluids and electrolytes. Life-threatening perforation and peritonitis can result. Occurs in Crohn’s disease

Answer 63

Toxic megacolon

Question 63

What are the intestinal symptoms of Crohn’s disease?

Answer 63

abdominal tenderness, increased bowel sounds, steady progressive weight loss, anorexia, nausea, vomiting, diarrhea, pallor, and, in acute exacerbations, fever. Severe bouts can cause intestinal obstruction with accompanying signs of borborygmi (hyperactive bowel sounds), abdominal distention, and tympany on percussion.

Question 64

What systemic symptoms can Crohn’s disease cause?

Answer 64

arthritis, uveitis, cheilitis, and dermatological problems
Cheilitis= inflam lesion of lips
uveitis=inflam of middle layer of eye–> retinal detatchment
hepatic or bile duct inflam can occur

Question 65

Why are colonoscopy and biopsy the best diagnostic tools to distinguish Crohn’s
from ulcerative colitis?

Answer 65

Crohn’s= any part of GI tract from mouth to anus
UC= only large intestine
Crohn’s= affects GI with skip lesions=healthy tissue interrupted by areas of dieased
UC= affects from rectum to continually upward into colon
Crohn’s= affects whole thickness of intestinal wall
UC=only upper layers (mucosa and submucosa)
Crohn’s= cobblestoning
UC=pseudopolyps
Crohn’s= anal fistula and anal fissures
UC=No fistuals or fissures
Crohns= does not predispose to cancer
UC= predisposes to colon cancer

Question 66

This is thought to be an autoimmune disease of the colon. It affects the mucosal layer of the large intestine, is more likely to present with blood in the stool and a colonoscopy will show pseudopolyps. It is also more likely to lead to cancer.

Answer 66

Ulcerative colitis

Question 67

LBO (large bowel obstruction) has a high mortality rate if diagnosis and treatment are not commenced within the first how many hours?

Answer 67

24 hours

Question 68

This type of large bowel obstruction physically blocks the movement of material through the intestines. may be caused by scar tissue from prior surgery (adhesions), benign or malignant tumors, abdominal hernia, a swallowed foreign body, a gallstone that migrated into the intestine, bolus of undigested food, intussusception, volvulus, stricture, fecal impaction, or diverticula.

Answer 68

mechanical obstruction

Question 69

This type of large bowel obstruction stem from certain intestinal conditions, such as a disruption of the peristalsis caused by weakness of muscles of the intestinal wall (dysmotility syndrome or pseudo-obstruction) or paralysis of the bowel wall (paralytic ileus).

Answer 69

Nonmechanical

Question 70

What is the pathophysiology of a mechanical large bowel obstruction?

Answer 70

an obstruction that causes the bowel to become dilated proximal to the obstruction. This distention of the bowel results in an increase in peristalsis in an effort to excrete intestinal contents through the obstruction. As the distention progresses and pressure rises within the bowel, the bowel’s ability to absorb fluids is impaired, and blood flow to the bowel is decreased, causing ischemia.
if not resolved= perforation=spilling of fecal material into the peritoneal cavity, causing peritonitis.

Question 71

What is the pathophysiology of nonmechanical LBO?

Answer 71

motility through the intestine is impaired. This can be caused by weakness of intestinal peristalsis, also known as paralytic ileus. Ileus can result from neurological disease, acute colonic pseudo-obstruction, metabolic disturbances, ischemia of the bowel, or infection of an abdominal organ.

Question 72

This is an inflammation of a blind-ended, pouchlike area that protrudes from the cecum, where the small intestine meets the large intestine.

Answer 72

Appendicitis

Question 73

What is the cause of appendicitis?

Answer 73

It is hypothesized that appendicitis results from a nearby blockage, commonly caused by stool or fecalith (calcified feces). Blockage of the appendix often occurs when neighboring mesenteric lymph nodes become inflamed in response to a viral or bacterial infection and compress the appendix. the protective mucosa layer of the appendix becomes compromised as luminal bacteria multiply and attack the wall of the appendix, causing inflammation. This inflammation, in combination with tissue ischemia, leads to necrosis and perforation of the appendix.

Question 74

Typical manifestations of appendicitis include abdominal pain that originates in the umbilical region radiating to the RLQ, also known as

Answer 74

McBurney’s point
(rebound tenderness is also apparent)

Question 75

The examiner deeply palpates the abdomen; upon release of the hand, the patient feels intense pain.

Answer 75

Rebound tenderness

Question 76

Examiner asks the supine patient to actively flex the right thigh at the hip. If abdominal pain results, this is positive for?

Answer 76

Psoas sign

Question 77

The examiner palpates the LLQ of the abdomen. If pain in the patients RLQ develops, this is positive for ?

Answer 77

Rovsing’s sign

Question 78

Internal and external rotation of the patient’s flexed right hip causes pain in the RLQ.

Answer 78

obturator sign

Question 79

What are the treatments for appendicitis?

Answer 79

surgical removal and ABX (in acute)
Some pts with non-perforated can be treated with ABX alone

Question 80

This is a GI disorder characterized by abdominal pain and altered bowel activity in the absence of specific pathology. No specific motility or structural disorders of the intestine or bowel are seen. Lay terms for it are colitis, irritable colon, or spastic colon

Answer 80

IBS (irritable bowel syndrome)

Question 81

These causes of acute abdominal pain will show pain in which quadrant?
Gastric ulcer, ruptured spleen, aortic aneurysm, pancreatitis

Answer 81

LUQ

Question 82

These causes of acute abdominal pain will show pain in which quadrant?
Hepatitis, duodenal ulcer, acute cholecystitis

Answer 82

RUQ

Question 83

These causes of acute abdominal pain will show pain in which quadrant?
Hernia, appendicitis, ovarian cyst, kidney stone, pyelonephritis, ectopic pregnancy, salpingitis, mesenteric adenitis, Meckel’s diverticulitis, bowel obstruction/perforation/ischemia, inflamm bowel disease

Answer 83

RLQ

Question 84

These causes of acute abdominal pain will show pain in which quadrant?
hernia, diverticulitis, ovarian cyst, kidney stone, pyelonephritis, ectopic pregnancy, bowel obstruction/perforation/ischemia, inflamm bowel disease

Answer 84

LLQ

Question 85

These causes of acute abdominal pain will show pain where in the body?
esophagitis, pancreatitis, perforated ulcer, acute cholecystitis, myocardial infarction

Answer 85

Epigastric

Question 86

What appears to be the causative factor in irritable bowel syndrome?

Answer 86

The patient commonly reports a stressor in his or her life.

Question 87

How do complications and variations of gastrointestinal disorders
and injuries affect the body?

Answer 87

(my general thought based on review of the text): it affects absorption of vitamins, minerals, proteins, carbs, fats, etc, the building blocks our bodies need. When disturbances happen in the GI system it will affect the rest of our body.

Question 88

These are the functional cells of the liver that are capable of regeneration, excrete metabolic substances into small channels called canaliculi.

Answer 88

Hepatocytes

Question 89

These are specific macrophages of the liver, line the sinusoids and protect the body by detoxifying the bloodstream.

Answer 89

Kupffer cells

Question 90

How does the liver aid in digestion?

Answer 90

manufactures bile and secretes it into the hepatic duct, which enters the common bile duct and, in turn, empties into the intestine for digestion of fats.

Question 91

The liver manufactures most of the body’s ___________. Proteins are broken down (referred to as deamination) into ammonia, which is then absorbed into the bloodstream and excreted in urine.

Answer 91

Albumin

Question 92

How is the liver involved in carb metabolism?

Answer 92

Glucose builds up in the liver, which is stored in the form of glycogen (glycogenesis). There is also breakdown of glycogen by the liver when the body needs it (glycogenolysis).

Question 93

What does the liver synthesize using vitamin K?

Answer 93

coagulation factors ( fibrinogen and coagulation factors I, II, VI, IX, and X for clotting. With the exception of factor VIII, all of the elements of clotting are made by the hepatocytes. Prothrombin is produced by the liver with the assistance of vitamin K and bile. )

Question 94

How is the liver involved in detoxification?

Answer 94

The portal vein brings all substances absorbed by the GI system into the liver, which then detoxifies substances through biotransformation and first-pass effects.

Question 95

This vital organ in the body stores vitamin A, D, B12, iron, and copper, produces B lymphocytes, synthesizes angiotensinogen, synthesizes thrombopoietin, which stimulates platelet production in bone marrow.

Answer 95

Liver

Question 96

How is the liver involved with the recycling of worn out RBCs?

Answer 96

conjugates bilirubin into bile (bilirubin is a yellow-colored compound, is derived from the breakdown of aged red blood cells (RBCs). Hemoglobin in the RBCs breaks down into heme and globin)

Question 97

This is yellowing of the skin and sclera, is the key symptom of liver disease

Answer 97

jaundice

Question 98

What three specific etiologies can cause Hyperbilirubinemia?

Answer 98

• Excessive RBC hemolysis
• Hepatocellular injury
• Bile duct obstruction

Question 99

What type of jaundice happens when there is a large amount of hemolysis, bilirubin levels can overwhelm the liver, and some bilirubin can go into the bloodstream without being conjugated, which is why prolonged hemolysis increases both conjugated and unconjugated bilirubin concentrations?

Answer 99

Prehepatic jaundice

Question 100

What type of jaundice happens when the liver is having problems conjugating the bilirubin, resulting in only a portion becoming conjugated?

Answer 100

intrahepatic jaundice

Question 101

What type of jaundice happens in bile duct obstruction, the liver can conjugate the bilirubin, but the bile duct does not allow its excretion, resulting in increased levels of conjugated bilirubin circulating in the bloodstream?

Answer 101

Posthepatic jaundice

Question 102

What are the most common viruses that infect the liver?

Answer 102

hepatitis virus A, B, C, D, and E. Other viruses include cytomegalovirus and Epstein–Barr virus (EBV)

Question 103

This occurs when the liver is affected by drugs or toxic substances. What is the most common cause?

Answer 103

toxic hepatitis, Acetaminophen

Question 104

A patient with this often reports extreme fatigue, abdominal pain, weakness, anorexia, nausea, vomiting, abdominal bloating, changes in bowel habits, and weight loss. Interestingly, smokers often lose their taste for tobacco.

Answer 104

liver disfunction

Question 105

These are fine capillaries that fan out from a central point on the skin’s surface that can indicate liver disfunction

Answer 105

spider angioma

Question 106

This is a common cause of long-term, chronic liver disease. With chronic inflammation, stellate cells within the liver are stimulated to synthesize collagen and fibrotic tissue. Other classic histological features of the disease include bile duct damage, lymphoid follicles or aggregates, and macrovesicular steatosis. Steatosis is the infiltration of fat in the liver. Fatty liver is a characteristic change.

Answer 106

Alcohol abuse

Question 107

How are viruses that affect the liver diagnosed?

Answer 107

A hepatitis serology panel is done that includes specific laboratory data regarding hepatitis A, B, C, D, or E

Question 108

How is Hep A transmitted?

Answer 108

caused by ingestion of contaminated food or water or contracted from person to person by the fecal–oral route. The virus is able to live on surfaces at room temperature, but is killed by cooking food thoroughly.

Question 109

Which liver virus is the only DNA virus?

Answer 109

Hep B

Question 110

What are two different characteristics that distinguish HBV and HCV?

Answer 110

HBV=DNA virus
HCV=RNA virus
HBV=Major mode of transmission is sexual contact
HCV= Transmission is via blood, as in IV drug use
HBV=infected people carry it for life
HCV= can be considered cured with agressive treatment

Question 111

Fatty liver develops in every individual who consumes more than how much alcohol per day?

Answer 111

60 grams of alcohol per day

Question 112

What does chronic ingestion of alcohol inhibit in the liver?

Answer 112

oxidation of fatty acids
Fat accumulates in and around hepatocytes as constant alcohol use occurs, and this fat accumulation within the hepatocyte disrupts the integrity of the organelles. Nuclear disruption causes death of the hepatocytes. Disrupting the mitochondria leads to free radical release and inflammation.

Question 113

When the liver demonstrates fibrosis and scar tissue, the disorder is referred to as what?(often is a silent and gradual disease; most patients remain asymptomatic until a late stage of liver impairment marked by ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, or variceal bleeding from portal hypertension. )

Answer 113

cirrhosis

Question 114

Patients with acute alcoholic hepatitis typically present with what symptoms?

Answer 114

mild, nonspecific symptoms of RUQ pain, nausea, malaise, and low-grade fever. Jaundice and darkened urine may be present because of liver dysfunction and bilirubin accumulation in the bloodstream. The liver is usually enlarged, often with mild hepatic tenderness.

Question 115

individuals with severe alcoholic hepatitis are at high risk of?

Answer 115

death

Question 116

What are symptoms of alcohol withdrawl?

Answer 116

restlessness, mood disturbance, tremors called delirium tremens, and, possibly, seizures.

Question 117

What are increased risks for patients with alcohol abuse and why?

Answer 117

risk of bleeding esophageal varices and subdural hematoma in head injury due to Decreased synthesis of coagulation factors

Question 118

This is an elevated pressure within the portal vein, is a key pathophysiological change associated with cirrhosis. (cirrhosis is causing restricted blood flow of the portal vein through the liver, which causes back up of pressure to GI system)

Answer 118

Portal hypertension

Question 119

What are the consequences of portal hypertension?

Answer 119

Increased venous pressure builds within the vascular beds of the GI system, producing splenomegaly, esophageal varices, rectal varices, and eventually ascites. The esophageal veins and rectal veins are fragile submucosal veins that are prone to rupture; ruptured esophageal veins can cause vomiting of blood (hematemesis), whereas ruptured rectal veins can cause rectal bleeding.

Question 120

Dilated, superficial veins become visible around the umbilicus, a sign referred to as what?

Answer 120

caput medusa

Question 121

what is the purpose of bile?

Answer 121

emulsifies fats and facilitates absorption of fat-soluble vitamins. It also carries waste products for elimination (such as bilirubin)

Question 122

The purpose of this organ is to produce the digestive enzymes lipase, which digests fats, and amylase, which digests carbohydrates. Trypsin and chymotrypsin, other enzymes also manufactured by it, digest proteins. It also produces bicarbonate, which is a natural antacid.

Answer 122

Pancreas

Question 123

These are the most common stones formed in the gallbladder

Answer 123

Cholesterol stones

Question 124

These are small, hard gallstones composed of calcium bilirubinate and inorganic calcium salts. it’s related to alcoholic liver disease, chronic hemolysis and aging

Answer 124

Black pigment stones

Question 125

These are composed of calcium salts of unconjugated bilirubin, with small amounts of cholesterol and protein. They are often located in the bile ducts and cause obstruction and inflammation.

Answer 125

Brown pigment stones

Question 126

This is a syndrome of spasmodic pain associated with irritation of the gallbladder, commonly secondary to gallstones.

Answer 126

Biliary Colic

Question 127

The pain of cholecystitis commonly radiates to where?

Answer 127

right shoulder or posterior thoracic region at the scapula. called Collin’s sign

Question 128

is an invasive procedure that uses an endoscope with a camera to inspect the anatomy of the biliary tract. In addition to visualization, it can be used to remove obstructive gallstones from the common bile duct.

Answer 128

Endoscopic retrograde cholangiopancreatography (ERCP)

Question 129

If the patient has pancreatitis, and the goal is to rest the GI system and pancreas, what should the patient’s diet be free from?

Answer 129

fat, caffeine, and alcohol.

Question 130

Pancreatic cancer commonly requires surgery called what?

Answer 130

Whipple procedure.

Question 131

Because epigastric pain with radiation to the shoulder is a common symptom, many patients can mistake an episode of acute cholecystitis for what?

Answer 131

Cardiac chest pain

Question 132

The inflammatory process associated with acute cholecystitis can also occur because of bacterial infection that can progress to a purulent effusion of the gallbladder, called what?

Answer 132

empyema

Question 133

The patient presents with the following symptoms: abdominal pain in the RUQ, anorexia, nausea, vomiting, eructations, heartburn, feeling full after eating, and, perhaps, fever, Murphy’s sign, Collins’s sign. Although the pain may initially be described as spasmodic or colicky, it becomes constant in many cases.

Answer 133

acute cholecystitis

Question 134

What is the treatment of choice for symptomatic cholelithiasis and cholecystitis?

Answer 134

Laparoscopic cholecystectomy

Question 135

When there is concern that stones may have moved into the common bile duct, what may also be performed during surgery?

Answer 135

intraoperative cholangiography and choledochoscopy (This allows full exploration of the common bile duct. )

Question 136

When a patient has acute cholecystitis and the patient has acute pain that is transient and followed by relief of pain, what could this indicate?

Answer 136

Rupture of an acutely inflamed gallbladder as contents are released from the distended, perforated gallbladder into the abdomen. It is critical to report this finding immediately to avoid sepsis.

Question 137

Why is dilauded the pain medication of choice for acute cholecystitis patients?

Answer 137

morphine and codeine are contraindicated because they can cause spasm of the sphincter of Oddi. Dilaudid does not cause spasm of the sphincter of Oddi

Question 138

How can gallstones affect the pancreas?

Answer 138

obstruction of the pancreatic duct by a gallstone or other cause, with release of digestive enzymes that back up into the pancreatic gland parenchyma, followed by autodigestion.

Question 139

The classic symptom associate with this disease is severe abdominal pain, which is dull, penetrating, and steady. pain is sudden in onset and gradually intensifies. Mostly in epigastric region and radiates straight into the back. Nausea, vomiting, and diarrhea with anorexia. Fever, tachycardia, and hypotension commonly accompany the pain. Dyspnea and tachypnea may also occur because of irritation of the diaphragm.

Answer 139

Acute pancreatitis

Question 140

is a dark-blue discoloration around the umbilicus that resembles a bruise resulting from blood in the peritoneal cavity because of hemorrhagic pancreatitis.

Answer 140

Cullen sign

Question 141

is a dark-blue discoloration resembling bruises along the flanks resulting from retroperitoneal blood dissecting along tissue planes

Answer 141

Grey Turner sign

Question 142

how is acute pancreatitis treated?

Answer 142

no proven therapy that directly ameliorates pancreatic inflammation. The main treatment goal for acute pancreatitis is to provide supportive care and minimize pancreatic stimulation.
Pain meds, may need surgical intervention

Question 143

What should be suspected in patients who have moderate-to-severe acute pancreatitis; who have worsening symptoms after initial improvement; and who develop new fever, marked by leukocytosis, positive blood cultures, or other evidence of sepsis.

Answer 143

Infected pancreatic necrosis

Question 144

What are the systemic complications of acute pancreatitis?

Answer 144

cardiovascular, renal, and respiratory failure. Cardiovascular complications include profound hypotension.

Question 145

This is defined as inflammation of the pancreas that does not heal and that leads to permanent damage. it occurs when digestive enzymes attack the pancreas and nearby tissues, causing episodes of pain.

Answer 145

chronic pancreatitis

Question 146

What is the most common cause of chronic pancreatitis?

Answer 146

long-term, heavy alcohol use and can be triggered by one acute attack that damages the pancreatic duct.

Question 147

What is the treatment for chronic pancreatitis?

Answer 147

commonly requires hospitalization for pain management, IV hydration, and nutritional support. Nasogastric feedings may be necessary for several weeks if the person continues to lose weight. When a normal diet is resumed, synthetic pancreatic enzymes may be prescribed if the pancreas does not secrete enough of its own.