Lower GI Flashcards
Appendicitis
Inflammation of the appendix after an obstruction
Complications of appendicitis
Abscess, gangrene, peritonitis
CM of appendicitis
RLQ pain in periumbilical area, rebound tenderness, dull, steady pain in periumbilical area, progressive over 4-6h to RLQ, low fewer, N, anorexia
Peak incidence for appendicitis
10-12Y
Sudden relief of pain with appendicitis
CONCERN - BURST - risk of peritonitis
Appendicitis dx
US or laporotomy
Peritonitis
Inflammation of the peritoneum from stuff in the stomach getting outside the gut; serous membrane that lines the abdominal cavity and covers the visceral organs
Risks with peritonitis
Get fluid shifts (3rd spacing) that lead to hypovolemia and sepsis; dec peristalses and paralytic ileus
Causes of peritonitis
Perforated ulcers, ruptured gallbladder, pancreatitis, ruptured spleen, ruptured appendix
CM of peritonitis
Sudden abdominal pain, tender, rigid, board-like abdomen, N/V, fever, inc WBCs, inc HR, dec BP
Peritonitis patho
Pain and fluid shifts causing SNS action
tx for peritonitis
Anti-inflammatory, fixing the cause
IBS
change in bowel pattern with changes in intestinal motility; includes IBSC (constipation) and IBSD (diarrhea)
Sx of IBS
Vary by person
- ab distention, fullness, bloat, flatulence
- intermittent ab pain exac by stress and relieved with pooping
- bowel urgency
- food intolerances (lactulose, gluten, sorbitol)
- non-bloody stool containing mucus
Can stress cause IBS?
No but it can exacerbate IBS
Cause of IBS
Unknown, triggered by food, stress, hormonal changes, GI infection, menses
Inflammatory bowel disease
UC and Crohn’s
- life-changing chronic illness
- chronic inflam of intestines and exac and remissions
- autoimmune activated by infx
Risk factors for IBD
women, white, Jewish, smokers
Crohn’s
- lymphatic structures of GI tract are blocked
- tissues engage and inflam
- deep liver fissure and ulcer dev in “patchy” pattern on bowel wall (skip lesions aka cobblestone look)
Sx of Crohn’s
Anemia, scar tissue, fistula, inc risk of cancer, RLQ cramp, watery diarrhea, wt loss, fatigue, fever, malabsorption of nutrients, palpable ab mass, mouth ulcer
What is Crohn’s associated with?
Granulomas
UC
inflammation of mucosa in the rectum and colon
Risk fx for UC
white euro descent, esp ashkenazi jews, some Black, rare in asians
- often dev in 3rd decade of life
UC patho
Inflam begins in rectum and extends into continuous segment that might involve the whole colon
- inflam leads to big ulcers
- necrosis of epithelial tissue (crypt abscesses)
- colon and rectum try to fix w/ new granulated tissue (tissues fragile, bleed easy)
Sx of UC
bleeding, diarrhea, wt loss, fatigue, anorexia, fever
Complications of UC
hemorrhage, perforation, cancer (colon carcinom), malnutrition, anemia, strictures, fissures and abscesses, liver disease from scarred bile ducts, VTE and DVT, F&E, pH imbalance
V dangerous risk of UC
Toxic megacolon - rapid dilation of L intestine–life threatening
Diverticular disease
Develop diverticula - small pouches in the lining of the colon that bulge out thru weak spots (often in the descending colon)
Is diverticular disease congenital or acquired?
BOTH
Diverticulosis
w/o inflam
Diverticulitis
with inflam
Cause of diverticular disease
May be from low fiber diet resulting with chronic constipation
Risk fx of diverticulosis
chronic constipation
CM for diverticular disease
Often asymptomatic, diagnosed accidentally or with acute -litis exac
Patho of diverticulitis and CM
Inflamed pouch from retained fecal material
- LLQ ab pain, fever, inc WBCs, constipation or diarrhea, large frank bleed
- may resolve spontaneous
Complications of diverticular disease
Perforation, obstruction, peritonitis
- depends on severity, if they pop
GI tx
Often diet, sometimes surg
- may r/t constipation
Treating H. pylori
Need several abx, gastric acid inhibition
- combo drugs to dec resistance, like acid
- need 10-14d tx
- very $$$ so adherence is prob
Pharm target for GI
dec gastric acid production
- Block H2 receptors (which produce GA) or inhibit proton pump (pump makes gastric acid)
- occur in parietal cells of stomach
