mod 7 Flashcards
What does GERD stand for? Development and most frequent clinical manifestation.
gastroesophageal reflux disease.
development: stomach returns its contents to the esophagus - due to relaction of the lower esophageal sphincter.
- can be spontaneous, neutralized cleared in minis - esophagitis can occur.
longterm: fibrosis and pancreatic lesions
manifestations- increase gastric volume and pressure
Dyspepsia
upset stomach
Gastroparesis
slowing of food movement in the stomach “paresis” = slowing.
What increases the likely-hood of GERD?
infancy - positional + reduced sphincter (colic)
^ intra-abdominal pressure (obesity + prego)
smoking
foods that relaxes LES (eg. after dinner, coffee, alcohol and fats)
people with lupus have more issues
what is a peptic ulcer?
A break in the protective mucosal lining of the lower esophagus, stomach or duodenum.
could be multi, acute, chronic, superficial or deep.
Describe melena
black foul smelling stool from digestion - has blood.
“coffee grounds” lower gi
describe hematemesis + complications
vomiting of blood - lower gi tract
what are the 3 other complications of peptic ulcers
hemorrhage: causes hematemesis or melena
perforation: ulcer erodes thru call to the peritoneum.
penetration: same, not erosion into another organ (eg. liver)
Identify and describe the pathophysiology of peptic behind the effects of the two risk factors that develop peptic uclers
Helicobacter Pylori - passes through the mucosal lining of the stomach.
- neutralizes the gastric juices in the stomach, causes the thick mucosal lining
to “liquify” and then it is able to penetrate through.
NSAIDS - interfere with prostaglandin synthesis
- prostaglandins inhibit acid secretion + stimulate mucus + bicarbonate secretions. The NSAIDS can decrease the prostaglandins synthesis and decrease these effects which can lead to the acid touching the layer, causing ulceration.
Two similarities between duodenal ulcers and gastric ulcers?
Gastric: occurs in the stomach common in older folks (55-65) 1/4
- h.pylori and NSAIDS (chronic)
- more chronic than duodenal ulcers and duration.
- pain immediate after eating
Duodenal: duodenum
- greater frequency w/ other types (young folks, most common in male)
- mainly h.pylori and NSAIDS
- pain 2-3 hours after eating
What are the main treatments for peptic ulcers?
antibiotics
reduce acidity
- antacids
- proton pump inhibitor (interferes with H_ secretion from the parietal cells)
- h2 receptor antagonists (block action of histamine which HCL secretes)
minimally invasive surgical resection of uclers.
Two diseases that make up inflammatory bowel disease
Ulcer Colitis
Chron’s disease
Typical ages of ulcer colitis vs crohn’s
Regions of the bowel affected by ulcer colitis vs crohn’s
ulcer: large intestine
crohn’s: anywhere in the gi tract (mouth to anus)
The appearance of inflammed tissues: crohn’s vs ulcer colitis
ulcer: inner most layer
crohn’s: any part
risk factors of crohn’s
NSAIDS obesity smoking age ethnicity genetics
risk factors of ulcer colitis
smoking
contraceptive
being white
clinical manifestations of crohn’s
clinical manifestations of ulcer colitis
define tenesmus
feeling of passing stool even though it is empty
toxic megacolon
defines seriousness of a condition
common cause of croup?
laryngealtrachbronchitis ltb
What is retraction
Funky looking dents from ab cavity mf
What is celiac disease?
A malabsorbptive disease where the mucosa fails to absorb digestive nutrients
- sprue or gluten-sensitive enteropathy
What is the development of celiac disease
T cell mediated immune disorder
- person with it can show an intense immune reaction to gluten protein of cereal grains.
- The inflammation brought on by immune reaction damages small intestinal villous epithelium, interfering with the absorption of macro and mico-nutrients.
Appears early on during infantry, can develop in older adults.
clinical manifestations of celiac disease
failure to thrive ab pain diarrhea w/fatty acids malabsorption of nutrients leading to - ostoporosis, seizures, anemia, short statue, pregnancy
primary: remove gluten from diet
Liver disorders - define portal hypertension and its causes
abnormally high bp in the portal venous system
- caused by disorders that obstruct blood flow, thru portal or vena cava and thrombosis of hepative beings, severe r sided heart failure, alcoholic cirrhosis etc.
It can result in complications such as ascites, splenomegaly _ portosystemic shunts w/ accompany esophageal varices
What is ascites and two causes
It is accumulation of fluid in the perineal cavity
caused by portal hypertension and release serum protein production by the liver, decrease osmotic pressure of capillaries, more retention of fluid in tissues that seeps into the peritoneal cavity fluid in abdominal cavity pushes on the diaphragm - causes breathing issues.
how can ascites be treated and what could happen if moved too quickly
by paracentesis (drainage of the abdominal cavity using a needle)
it relieves breathing
- collapse lungs
Development of carices associated with the portal system and most common clniical manifestation
veins drain directaly back to the v.c and hepatic protal vein
if pressure becomes greater, there is a increase resistance for the blood to flow from esophagus into the portal syste,
collateral veins will develop between
Where are two other places where collateral shunts can occur due to portal hypertension? Name the varices that result
Between veins on abdominal wall caput medusae (varices) and/or hemorrhoids (rectum)
Hepatic encephaolopahty development and clinical manifestations
Liver dysfunctions + collateral vessels that shunt blood past the liver to allow toxins to remain in the blood stream and reach the brain
ammonia - urea most hazardous and the neurotransmission is affected
may display personality changes, memory loss, confusion, coma and asterixis
Define asterixis
Flapping of hands
Define icterus and describe its two causes that are related to GI organs
It is jaundice
RBC are broken down in the spleen and liver - breakdown bilirubin, liver can excrete into bile.
- Excess bilirubin
Green/yellow tinge on skin caused by hyperbilirubinemia
3 causes
- too many rbc being broken down, obstruction (common_ and prcoess disruption
Why are feces clay colored and urine dark with jaundice
The bilirubin is excreted into feces and passes through, it goes everywhere.
Where does jaundice often occur first
The sclera of the eye then skin
Why does splenomegaly occur with liver disorders and how blood cell numbers can be affected
spleen enlargement due to portal hyper tension (shunting to splenic vein)
formed elements take longer to filter thru enlargement of spleen, leads to increase the rate of removal (increase time to remove)
result = anemia, thrombocytopenia, leukopenia
Define aute hepatitis and outline its common causes and diagnostic features
Hep A(infectious), B(serum), C, D, E - all can cause HBV AND HCV can cause chronic liver diseases and liver cancer - causes destruction of hepatocytes, scarring + hyperplasia of hepative macrophages 0if intra-hepatic ducts are damaged, obstruction and jaundice can occur (most damage with hcv and hbv)
Damage done by acute hepatitis to the liver
done by contamination + body fluids
- more rapid progression with hbv, hcb, hdv and hiv
The stages of typical acute viral hepatitis infection
Prodromal stage - viral inflammatory effect
- 2 weeks after exposure, ends with jaundice (urine and feces changes)
- marked by fatigue, vomiting, headache, cough, low grade fever. Disease = very infectious during this stage.
Icteric Stage - Live effects
- 2-6 weeks
- jaundice, dark urine, clay coloured stool, liver is enlarged + tender - palpation causes pain
Convalescent Stage - healing and repair
- begins with resolution - 6-8 weeks after exposure
- liver remains large and tender. Live returns to normal function.
- 2-12 weeks after onset of jaundice
Define and describe chronic hepatitis, causitive organism and possible result
persistent of clinical manifestations
- remain abnormal for longer than 6 months (HBV/HCV surface antigen persists.
- virus persists in hepatocytes providing a prolonged immune response, extending liver damage.
Define cirrhosis + cause and 3 disorders that can lead to it
It is irreverisble infallmatory, fibrotic liver disease
0caused b direct damage and inflammation
from man disorders (HBV, HCV, excessive alcohol consumption, prolonged exposure to drugs + toxins, hepatoxin.
It can lead to hepatomegagly, splenomegagly, ascites, portal hypertension, hepatic encephaolpathy and esophageal varices.
Define hepatotocin
Toxins that can affect the liver
Disorders that result from cirrhosis
Fibrosis - release of inflammatory mediators by leukocytes + activation of fibroblasts
Describe two types of alterations that occur in the liver during the development of cirrhosis
liver metabolism and structur
What is the “treatment” for cirrhosis
No treatment
- rest,
- vitamin
- good nutrition
Define liver failure
inability to perform normal function of the liver
- may need a liver transplant
Name and describe the clinical manifestations of liver failure
- Fetor hepaticus - chronic musty odor of breath
anemia, thrombocytopenia, leukopenia (clotting factor loss that leads to purpural, petechiae, spider angioma, and epistaxis - hemolysis - changes in rbc lipid membrane
- hepatorenal syndome (kidney failure, oliguria decrease bv thru bleeding)
- hepative encephaolopathy
