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N361: Pathophysiology II > Module 10 - Control and Disorders of Gastrointestinal Function > Flashcards

Module 10 - Control and Disorders of Gastrointestinal Function Flashcards

1
Q

Functions of the GI System

A

Process food substances—dismantle & reassemble food

Produce enzymes and hormones for digestion

Absorb the products of digestion—nutrients, vitamins, minerals, electrolytes, and water

Store and synthesize vitamins

Provide an environment for microorganisms to synthesize nutrients, such as vitamin K

Collect and eliminate wastes

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2
Q

Digestion and absorption requires what two things

A

an intact and healthy GI epithelial lining that can resist the effects of its own digestive secretions

the presence of enzymes for the digestion and absorption of nutrients

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3
Q

Digestion and Absorption involves…

A

the movement of materials through the GI tract at a rate that facilitates absorption

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4
Q

Dumping

A

movement through the GI tract that is too fast to allow digestion and absorption

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5
Q

What are the sections of the digestive system

A

Upper part

middle portion

lower segment

fourth part - accessory organs

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6
Q

What does the upper part of the digestive system consist of and what does it do?

A

the mouth, esophagus and stomach

they act as an INTAKE source and receptacle through which food passes and in which INITIAL DIGESTIVE processes take place

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7
Q

What does the middle portion of the digestive system consist of and what does it do?

A

the small intestine: duodenum, jejunum, ileum

Most digestion and absorption processes occur here in the small intestine

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8
Q

What does the lower segment of the digestive system consist of and what does it do?

A

The cecum. colon, and rectum

Serves as a storage channel for the efficient elimination of waste and the large intestine allows for some fluid reabsorption

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9
Q

What is the fourth part of the digestive system and what does it do?

A

It is the accessory organs like the salivary gland, liver, and pancreas

They produce digestive enzymes that help dismantle food and regulate the use and storage of nutrients

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10
Q

What are the important anatomical portions of the mouth

A

Lips
Cheeks
Palate
Tongue
Teeth (Mastication)
Salivary Glands (Lubrication)
Muscles
Maxillary Bones

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11
Q

Saliva contains the enzyme ___ (___) that aids in digestion of ___

A

amylase (ptylain); starches

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12
Q

Esophagus

A

collapsible muscular tube (a transportation tube)

about 10 inches long

carries food from the pharynx to the stomach

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13
Q

What are the sections of the stomach?

A

the cardia, fundus, body, and pylorus

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14
Q

The Cardia

A

The portion of the stomach directly connected and closest to the esophagus

contains the cardiac opening

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15
Q

The Pyloris

A

The area at the bottom of the stomach closest to the duodenum of the small intestine

has the pyloric sphincter

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16
Q

Stomach Body and Fundus

A

the body is the largest mid portion while the fundus is the top portion above the level of the cardia or on the same level

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17
Q

Cardiac Opening

A

An opening into the stomach - not really a sphincter since stomach contents can get back out

opens and closes in the cardia

prevents reflux back into the esophagus

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18
Q

What is the pH of the esophagus compared to the stomach

A

esophagus pH of 8

stomach pH of 1-2

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19
Q

Pyloric Sphincter

A

sphincter near the end of the stomach leading to the duodenum

regulates the rate of stomach emptying into the small intestine

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20
Q

What does the stomach have that the esophagus does not which allows regeneration and protection from stomach acid

A

prostaglandins

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21
Q

Barret’s Esophagus

A

a condition of cellular change in the esophagus from stomach content reflux

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22
Q

What protects the stomach from enzymes and acids?

A

Gastric Mucosal Protection consisting of water soluble mucus and water insoluble mucus

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23
Q

Water Soluble Mucus

A

A gastric mucosal protection

It is washed from the mucosal surface and mixes with luminal contents

Its viscid nature makes it a lubricant to prevent MECHANICAL damage to the stomachs mucosal surface

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24
Q

Water Insoluble Mucus

A

A gastric mucosal protection

forms a thin and stable gel that adheres to the gastric mucosa surface

It gives protection from the proteolytic actions of pepsin

Forms an unstirred layer that traps bicarbonate thus forming an interface between the luminal contents of the stomach and its mucosal surface

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25
Q

What gastric mucosal protection form is more stable?

A

Insoluble

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26
Q

Small intestine

A

Duodenum –> Jejunum –> Ileum –> Cecum –> Colon (not part)

It is the major area of absorption of nutrients that is occurring

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27
Q

Duodenum

A

first part of the small intestine

contains the openings of the bile and pancreatic ducts

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28
Q

Jejeunum

A

second part of the small intestine

about 8 feet long

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29
Q

Ileum

A

the third part of the small intestine

about 12 feet long

terminates at the cecum

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30
Q

If there is a J tube or ileostomy bringing waste directly out of the small intestine, what would that look like and why?

A

It would be much more watery and loose since the large intestine is the one absorbing most of the water

Because of this the feces is more full of nutrients that are unabsorbed, electrolytes, and water that we need to monitor for with imbalances

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31
Q

Cecum

A

area where the small and large intestine meet

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32
Q

What quadrant is the cecum/where the small and large intestine meet?

A

Right Lower Quadrant

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33
Q

What is the GI wall structure like?

A

Inner Mucosal Layer

Submucosal Layer

Muscularis Layer with Circular and Longitudinal Muscle Layers

Outer serosal layer/Peritoneum

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34
Q

Inner Mucosal Layer

A

part of GI wall

cells produce mucus here that lubricates and protects the INNER surface of the alimentary canal

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35
Q

Submucosal Layer

A

part of GI wall

consists of connective tissues to keep GI sections where they belong

contains blood vessels, nerves, and structures responsible for secreting digestive enzymes

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36
Q

Muscularis Layer

A

part of GI wall

has a circular and longitudinal muscle layer

facilitates movement of the contents of the GI tract (peristalsis)

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37
Q

Outer Serosal Layer/Peritoneum

A

loosely attached layer to the outer wall of the intestine (the peritoneal layer attaching to abdomen wall)

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38
Q

Mucus is a ___ and ___

A

lubricator and protector

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39
Q

What is the layers of the GI tract from outermost to innermost?

A

Peritoneum –> longitudinal muscle –> circular muscle –> submucosal layer –> inner mucosal layer/mucous membrane –> lumen of the gut

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40
Q

Peritoneum

A

serous membrane lining the abdomen and the abdominal organs

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41
Q

Parietal Peritoneum

A

The serous membrane that lines the abdominal cavity

Lines the walls of the abdomen

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42
Q

Visceral Peritoneum

A

serous membrane that forms the mesentery (folds of the visceral peritoneum) which supports the intestines and blood supply

covers the abdominal organs

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43
Q

Peritoneal Fluids

A

several mL of fluid that moisten the surface of the peritoneal layers

The membranes are able to then glide smoothly over each other as the intestinal tract changes shape during digestion

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44
Q

Paracentesis

A

If someone has low plasma proteins, low oncotic pressure, or ascites/fluid build up from something like liver disease we can use a needle to remove some fluid

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45
Q

Where are the female reproductive parts located

A

in the peritoneal area

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46
Q

Where are the kidneys located

A

retroperitoneal (behind)

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47
Q

Disgestion

A

Process by which food is broken down mechanically and chemically in the GI to convert into an absorbable form

chewing + enzymes

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48
Q

What are some processes of digestion

A

hydrolysis

enzyme cleavage

fat emulsification

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49
Q

Absorption

A

uptake of water, FAs, monosaccharides, amino acids, vitamins and minerals from the lumen of the gut into the capillary networks and lacteals (lymph capillaries) of the villi

reusing the broken down parts

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50
Q

Absorption occurs primarily in the …

A

small intestine

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51
Q

Where does carbohydrate digestion start?

A

Digestions of starch begins in the mouth with amylase

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52
Q

Brush Border Enzymes

A

enzymes in the small intestine that convert disaccharides to monosaccharides

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53
Q

What breaks down fats?

A

gastric and pancreatic lipase

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54
Q

Bile Salts act as …

A

a carrier system

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55
Q

When does protein break down begin

A

in the stomach with the action of pepsin - it will then further break down via pancreatic enzymes

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56
Q

Pepsin is the reason what is important?

A

the mucosal protection of the layers of the stomach

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57
Q

What are some GI secretions that are important

A

Salivary (1200 mL)

Gastric (2000 mL)

Pancreatic (1200 mL)

Biliary (700 mL)

Intestinal (2000 mL)

total =7100 mL

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58
Q

What functions does saliva provide?

A

protection and lubrication and a mucus coating of food

antimicrobial action via lysozyme

initiation of digestion of starches via ptyalin and amylase

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59
Q

Mucus Secreting Cells are located…

A

throughout the stomach

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60
Q

Oxyntic (Gastric) Glands

A

located in the body and fundus of the stomach

These include parietal cells and chief cells

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61
Q

Parietal Cells

A

gastric cells that secrete HCl and intrinsic factor

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62
Q

Chief Cells

A

gastric cells that release pepsinogen for protein digestion

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63
Q

Pyloric Glands

A

glands found in the antrum that secrete mucus, some pepsinogen and gastrin in the stomach

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64
Q

Bile Salts

A

biliary product

it can emulsify and help in the absorption of fats and fat soluble vitamins

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65
Q

Fat Soluble Vitamisn

A

ADEK

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66
Q

Brunner’s Glands

A

intestinal glands

located where the stomach empties and secretes large amounts of alkaline mucus

protects the duodenum from acidic chyme and digestive enzymes

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67
Q

Crypts of Lieberkuhn

A

intestinal gland

secrete serous alkaline fluids

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68
Q

Peptidases

A

surface enzymes that aid in absorption in the small intestine

split amino acids

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69
Q

Disaccharidases

A

surface enzymes that aid in absorption in the small intestine

split sugars

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70
Q

Enzymes used in the digestion of carbohydrates

A

lactase

sucrase

amylase

maltase

alpha dextranase

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71
Q

The end product of the enzymes that convert carbohydrates via digestion is…

A

glucose (and maybe some other stuff)

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72
Q

Pancreatic Enzymes that break down proteins in the Small Intestine

A

Trypsin

Chymotrypsin

Carboxypeptidase

Elastase

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73
Q

The end product of the enzymes in the small intestine that convert proteins via digestion is…

A

always amino acids (maybe some other byproduct)

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74
Q

3 Levels of Control of Secretory Functions

A

Local

Humoral

Neural Influences

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75
Q

Local Control of Secretory functions

A

pH

Osmolality

Chyme

They act as stimuli for neural and humoral mechanisms

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76
Q

Neural Influences of Secretory Functions

A

Mediated with the ANS

Increased with parasympathetic stimulation

Inhibited with sympathetic activity

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77
Q

___ nervous system causes more digestion

A

parasympathetic

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78
Q

___ nervous system causes less digestion

A

Sympathetic

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79
Q

Autonomic Neural Control: Sympathetic

A

Controlled via spinal nerves

Inhibits smooth muscle contractions

Vasoconstriction occurs

The last two are why SNS stops digestion

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80
Q

Autonomic Neural control: Parasympathetic

A

Controlled via the vagus and pelvis nerves

Promotes smooth muscle contraction

Vasodilation occurs

Leads to secretion of enzymes like pepsin

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81
Q

What receptors and neurotransmitter help with PNS and peristaltic activity

A

muscarinic receptors and acetylcholine (helps increase peristalsis and vasodilation in the GI system)

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82
Q

What does the enteric/intrinsic system do for neural control of the GI system

A

it controls motility of GI smooth muscles and secretion of blood flow via stretch of the wall

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83
Q

Auerback’s (Mesenteric Plexus)

A

Enteric/Intrinsic

Located in the muscular layer and primarily controls motility of GI smooth muscle

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84
Q

Meissner’s (Submucosal Plexus)

A

enteric/intrinsic

located in the submucosa and primarily controls secretion and blood flow to GI region

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85
Q

Gastrointestinal Movements

A

Tonic Movements

Rhythmic Movements

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86
Q

Tonic Movements

A

continuous movements that last for minutes or even hours in the GI system

contractions occur AT SPHINCTERS

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87
Q

Rhythmic Movements

A

intermittent contractions responsible for mixing and moving food along the digestive tract

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88
Q

What kind of GI movements are peristaltic movements?

A

RHYTHMIC (propulsive) movements

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89
Q

Important GI Hormones

A

Cholecystokinin

Secretin

Gastrin

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90
Q

Cholecystokinin

A

stimulates contraction of the gall bladder (helps move bile)

Stimulates secretion of pancreatic enzymes

slows gastric emptying

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91
Q

Secretin

A

stimulates secretion of bicarbonate containing solution by pancreas and liver

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92
Q

Gastrin

A

stimulates secretion of gastric acid and pepsinogen

increases gastric blood flow

stimulates gastric smooth muscle contraction

stimulates growth of gastric, small intestine, and colon mucosa

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93
Q

Food must be ___ ___ and absorbed

A

broken down

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94
Q

What forms must carbohydrates be in for absorption

A

Monosaccharides (single sugars)

ex: Fructose - facilitated diffusion (no energy need)

ex: Glucose and galactose - Na dependent carrier system that requires ATP

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95
Q

What forms must fats be in for absorption

A

formation of MICELLES (action of bile salts) and transported to villi for absorption

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96
Q

Where does the absorption of fat primarily occur

A

in the upper jejunum

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97
Q

What are MCT and LCT and why is MCT better absorbed

A

they are middle and long chain triglycerides and it is easier to absorb the middle chain like coconut oil due to size

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98
Q

Water can follow ___ or ___

A

glucose or sodium

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99
Q

How big must proteins be for absorption?

A

1,2, or 3 amino acids long

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100
Q

How are proteins transported in absorption

A

by facilitated diffusion and ATP dependent sodium linked processes (no energy and energy)

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101
Q

Water in absorption is linked to absorption of osmotically active particles like…

A

glucose and sodium

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102
Q

Large Intestine

A

about 5 feet long

absorbs water and eliminates wastes

Manufactures vitamins including B vitamins and vitamin K

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103
Q

Pernicious Anemia

A

a megaloblastic macrocytic anemia

occurs without intrinsic factor from parietal cells

can be autoimmune

there is a neurologic deficit without B12 that takes time to manifest

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104
Q

Large intestine only secretes ___

A

mucus

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105
Q

What are the areas of the large intestine

A

Ascending Colon (right lower quadrant)

Transverse

Descending

Sigmoid

Rectum

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106
Q

Rectum

A

part of the large intestine

has valves and an internal and external sphincter

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107
Q

Ileocecal valve

A

valve in the rectum/large intestine that prevents contents of the large intestine from entering the ileum

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108
Q

Anal Sphincters

A

guard the anal canal

internal and external

we cannot see the internal but we can see the external

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109
Q

Internal Anal Sphincter

A

several CM long circular thickening of smooth muscle that lies inside the anus

cannot be viewed by use outside

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110
Q

External Anal Sphincter

A

composed of striated voluntary muscle surrounding the internal sphincter

Controlled by nerve fibers in the pudendal nerve (part of the somatic NS under voluntary control)

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111
Q

The largest gland in the body weight 3-4 pounds is the ___

A

liver

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112
Q

Kupffer’s Cells

A

tissue macrophages in the liver

remove bacteria in the portal venous blood

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113
Q

The liver is a ___

A

detoxifier

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114
Q

The liver will remove excess…

A

glucose and AA from portal blood

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115
Q

The liver synthesizes…

A

glucose, amino acids, and fats

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116
Q

The liver aids in the digestion of…

A

carbohydrates, proteins, and fat

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117
Q

The liver can do what 2 things to blood

A

store and filter it (200-400 mL of blood)

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118
Q

High First Pass

A

Metabolism

If a drug passes through the liver it will go from an active form to inactive

This may be why we do drugs IM IV or SQ

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119
Q

What, other than blood, can the liver store?

A

Vitamin A

Vitamin D

Vitamin B12

Iron

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120
Q

The liver secretes ___ the emulsify fats (500-1000 mL a day!)

A

Bile

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121
Q

What about the liver delays pernicious anemia

A

the fact it stores vitamin B12 there

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122
Q

The liver and gallbladder share …

A

common ducts

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123
Q

Hepatic means

A

liver

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124
Q

Renal means

A

kidney

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125
Q

What duct comes directly off the liver

A

Hepatic Duct

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126
Q

what duct comes directly off the gallbladder

A

the cystic duct

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127
Q

The hepatic duct and cystic duct merge into the…

A

common bile duct

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128
Q

The common bile duct and pancreatic duct merge into the …

A

ampulla of vater and sphincter of oddi

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129
Q

Where does the sphincter of oddi open up to

A

the duodenum

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130
Q

Location of a ___ determines what organ will be affected

A

block (ex: if the cystic duct is blocked only the gallbladder is effected)

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131
Q

The sphincter of oddi prevents..

A

reflux of intestinal contents into the common bile duct and pancreatic duct

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132
Q

What are not included in the secretions in the pancreatic duct?

A

insulin and glucagon

these go directly into the blood

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133
Q

Gallbladdar

A

stores and concentrates biles

can contract to force bile into the duodenum during fat digestion

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134
Q

How does the presence of fatty materials stimulate the release of bile

A

presence of fatty materials in duodenum stimulates cholecystokinin to release which leads to gall bladder contraction and relaxation of the sphincter of oddi

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135
Q

Exocrine

A

secreted into a duct

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136
Q

Endocrine

A

secreted into the blood

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137
Q

The pancreas as an exocrine gland does what

A

secretes sodium bicarbonate to neutralize the acidity of the stomach contents as they enter the duodenum

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138
Q

What is in pancreatic exocrine juices

A

pancreatic juices contain enzymes for digesting carbohydrates, fats, and proteins

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139
Q

The pancreas as an endocrine gland does what

A

Insulin secretion

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140
Q

Insulin secretion is produced by

A

the islets of langerhans cells in the pancreas

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141
Q

Insulin is secreted…

A

into the blood stream

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142
Q

Insulin is important for ___ metabolism

A

carbohydrate

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143
Q

Risk Factors for GI Disorders

A

Family Hx

Chronic laxative, alcohol, tobacco use

Chronic high stress levels

Allergic reactions to food or meds

Long term GI conditions like ulcerative colitis may predispose someone to colorectal cancer

Previous abdominal surgery or trauma leading to adhesions

Neuro disorders impairing movement, particularly with chewing or swallowing

Cardiac, respiratory, and endocrine disorders can lead to constipation

DM may predispose someone to oral candida infections

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144
Q

How does nicotine cause GI disorders

A

it stimulate muscarinic receptors and can lead to consipation

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145
Q

Adhesions

A

like scar tissue forming between the mucosa of the GI tract and wall of the abdomen leading to pleura or bowel pieces sticking together

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146
Q

What to look for on an abdominal assessment (in order)

A

Inspect - skin color, abnormalities, contour, tautness, distension

Auscultate - bowel sounds

Percuss - air or solids

Palpate - tenderness

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147
Q

Borborygmi

A

a rumbling or gurgling noise made by the movement of fluid and gas in the intestines

148
Q

What needs to be done before percussion and palpation?

A

auscultation (in all 4 quadrants)

149
Q

Normal bowel sounds occur ___ to __ times a minute or __ to ___ seconds

A

5 to 34 times

5-15 seconds

150
Q

If you are not hearing any bowel sounds how long must you listen in each quadrant

A

5 minutes

151
Q

Upper GI Barium Swallow

A

An examination of the upper GI tract under fluoroscopy performed after the client drinks barium sulfate

Requires fasting from foods and fluids overnight prior to the study

152
Q

Post Barium Swallow what must the patient do?

A

drink 6-8 cups of water x2 days to pass the barium (since it can cause issues and constipation)

May need a laxative to help

153
Q

What will stool look like when passing barium

A

chalky

154
Q

Lower GI Barium Enema

A

A fluoroscopic and radiographic exam of the large intestine after rectal instillation of barium sulfate

May be done with or without air

Requires laxative evening prior and morning of procedure and liquid diet the day before the procedure

155
Q

After a barium enema, what must be done

A

increase fluids or use a laxative to monitor for passage of the barium

156
Q

Gastroscopy

A

Insertion of an endoscopic instrument through the esophagus into the stomach and upper portion of the small intestine to visualize the mucosal lining

look for lesions that need removal or wall ulceration

157
Q

Important considerations for Gastroscopy

A

no fluids until gag reflex returns

after procedure monitor resp, cardiac, and neuro status

important to monitor VS before and after

158
Q

What to monitor for after gastroscopy?

A

Monitor for signs of bleeding, as evidenced by hypotension, pallor, and tachycardia

Monitor for perforation as evidenced by pain, tachypnea, and rales

159
Q

Sigmoidoscopy

A

Endoscopic visualization of the sigmoid colon using a sigmoidoscope

does not go far in but does need a clear GI tract to see

160
Q

Sigmoidoscopy is invasive so…

A

it requires informed consent

161
Q

What sort of diet should be done before a sigmoidoscopy

A

a full liquid diet and laxatives because they must have diarrhea and empty the GI tract for a clear sigmoid colon

162
Q

What can be done following the sigmoidoscopy

A

Normal activities and diet may be resumed post procedure but notify provider if fever >101° F, difficulty breathing, stomach pain, or bright red rectal bleeding occurs

there is risk for perforation and infection

163
Q

Colonoscopy

A

A fiberoptic endoscopic study in which the lining of the large intestine is visually examined

Requires informed consent - invasive

looks at entire colon

164
Q

Preparation for colonoscopy

A

clear liquid diet

bowel preparation

*all to clear colon

165
Q

Post procedure colonoscopy

A

client returns to normal activities and diet

monitor for signs of colon perforation, AEB abdominal pain or distention, malaise, fever, purulent rectal drainage, or lower GI bleeding

166
Q

How must stool run before a colonoscopy

A

run clear or light yellow with no stool particles

167
Q

Gallbladder Series

A

Oral cholecystography to study the dye-filled gallbladder by radiographic film

168
Q

What is important to tell the client about regarding the dye for a gallbladder series?

A

Instruct client to go to the emergency department if a rash, itching or hives, or difficulty in breathing occurs after taking the tablets

the dye can be painful to micturate

169
Q

What must be done before a gallbladder series

A

a low fat supper before the test then fasting after midnight the night prior

170
Q

After a gallbladder series what sort of diet should be done

A

a high fat meal to help with dye elimination from the gall bladder

171
Q

___ is common since gallbladder series dye is excreted in urine

A

Dysuria (painful or difficult urination)

172
Q

Liver Biopsy

A

A needle is inserted through the abdominal wall to the liver to obtain a tissue sample for biopsy and microscopic examination

173
Q

What to do pre procedure for a liver biopsy

A

Obtain informed consent

Assess hematological laboratory results

Administer sedative as prescribed

NPO after midnight on the day prior to the test

Note that the client is placed in the supine or left lateral position during the procedure

174
Q

What to do post procedure for a liver biopsy

A

Assess vital signs frequently (every 15 minutes for an hour after)

Assess biopsy site for bleeding

Monitor for peritonitis

Maintain bedrest for 24 hours

Place client on the right side for 1 to 2 hours to decrease the risk of hemorrhage

175
Q

The liver is on the __ side of the body

A

right

176
Q

How big is the needle for a liver biopsy

A

14-18 gauge (huge and thick)

177
Q

Liver biopsy comes with a huge risk for waht

A

bleeding since the liver is so vascularized - could cause bleeding all over the peritoneum

178
Q

Why does the patient lie on the left side for the liver biopsy and then the right side after

A

to allow access to the liver during and then put pressure on the site afterward

179
Q

Paracentesis

A

Transabdominal removal of fluid from the peritoneal cavity for the analysis of electrolytes, red blood cells and white blood cells, bacterial and viral cultures, and cytology studies

Obtain informed consent

180
Q

What must be done prior to start of paracentesis

A

Void prior to the start of procedure to empty bladder and to move bladder out of the way of paracentesis needle

Measure abdominal girth, weight, and baseline vital signs

181
Q

What position is the patient in during paracentesis

A

the client is positioned sitting on the edge of the bed with the back supported and the feet resting on a stool, or lying prone during the procedure

182
Q

What to do post paracentesis

A

Monitor for hematuria due to bladder trauma

Instruct client to notify physician if the urine becomes bloody, pink, or red

Possibility to nick the bladder is why we watch for hematuria

183
Q

Stool Specimens

A

Examination of stool for the presence of occult bleeding

184
Q

What to do pre stool specimen procedure

A

Instruct client to avoid aspirin, NSAIDs, red meat, poultry, and fish for 3 days prior to the collection

These things can contribute to further occult bleeding or cause false positives

185
Q

Occult Bleeding

A

bleeding that cannot be seen with the naked eye

goes on a specimen card in with a reagent and will light up blue if positive for occult blood

186
Q

Liver and Pancreas Lab Studies can look at levels of what things

A

Alkaline Phosphatase

Prothrombin time (PT)

Serum Ammonia

Liver Enzymes (Transaminase Studies)

Cholesterol

Bilirubin

Amylase and Lipase

*these can alert us to liver damage

187
Q

Alkaline Phosphatase

A

released during liver damage or biliary obstruction

high amount above 13-120 or 0.5-2.0 can indicate liver damage

188
Q

Prothrombin time

A

prolonged PT time with liver damage (coagulation time)

above 12.5 seconds indicates damage

The increase in PT means a greater risk of bleeding d/t decreased clotting factors

189
Q

Serum Ammonia

A

Assesses the ability of the liver to deaminate protein by products

if the liver cannot turn ammonia into urea, an increased ammonia amount means it is secondary to cirrhosis or hepatitis leading to confusion, sleepiness, hand tremors, or coma

190
Q

What else could lead to a false high serum ammonia

A

high protein diet

191
Q

Transaminase Studies (Liver Enzymes)

A

elevated levels with liver damage

AST, ALT, and LDH (Aspartate Aminotransferase, Alanine Aminotransferase, Lactic Dehydrogenase) levels increase

192
Q

Cholesterol Studies

A

increase can indicate pancreatitis or biliary obstruction (normal value under 200 mg/dL)

193
Q

Bilirubin Studies

A

increases indicate liver damage or biliary obstruction

can be direct, indirect, or total kind

comes from recycled heme during the breakdown of RBC

indirect is water soluble with direct fat soluble and we find indirect from the total and direct together

194
Q

All liver and pancreas lab studies are done using __ blood

A

venous

195
Q

Amylase and Lipase Studies

A

Elevations indicate pancreatitis / pancreas damage

196
Q

S/S Common to GI Disorders

A

Anorexia

Nausea

vomiting or emesis

GI bleeding

197
Q

What 2 ways can nausea be stimulated

A

unpleasant subjective sensation from stimulation of the vomiting center in the medulla

may be stimulated by duodenum distension

198
Q

___ leads to nausea and vomiting

A

Hypoxia

199
Q

Vomiting involves what areas of the brain to trigger

A

medulla vomiting center and the CTZ (chemoreceptor trigger zone)

200
Q

What can act as neuromediators for vomiting

A

dopamine

serotonin

opioids

201
Q

Vomiting serves a __ function

A

protective

*it forcefully expels contents that may harm you

202
Q

Vomitus

A

Emesis = Vomiting

203
Q

Hematemesis

A

blood in the vomitus

may be bright red or have a coffee ground appearance

204
Q

Hematochezia

A

Passage of bright red blood in the stool

Usually indicates bleeding is from the lower bowel

Coating of stool with bright red blood is associated with hemorrhoids

always concerning/frightening

205
Q

Bright red bleeding in the stool usually means bleeding comes from …

A

the lower bowel (or hemorrhoid)

206
Q

Melena

A

Black tarry stool caused by digestion of blood in the GI tract

Usually indicates bleeding above ileocecal valve

May increase BUN due to absorption of nitrogenous end products from digestion of blood

207
Q

The ileocecal valve is in what quadrant

A

the right lower quadrant

208
Q

Melena indicates bleeding where

A

above the ileocecal valve- so small intestine and before

209
Q

Occult Blood (Hidden) must be detected by and are usually caused by ?

A

Must be detected by chemical testing & usually caused by gastritis, peptic ulcer, or lesions of the small intestine

210
Q

Swallowing mechanism

A

depends on the coordinated action of the tongue and pharynx

211
Q

The tongue and pharynx (therefore swallowing) is innervated by what cranial nerves

A

V

IX

X

XII

212
Q

Strictures

A

narrowing of the esophagus

213
Q

What causes swallowing disorders or alterations in swallowing

A

altered nerve function or strictures

214
Q

What are some swallowing issues?

A

Dysphagia

Odynophagia

Achalasia

Increased risk for aspiration!

215
Q

Dysphagia

A

difficulty swallowing

216
Q

Odynophagia

A

painful swallowing

217
Q

Achalasia

A

lower esophageal sphincter fails to relax and food stays in the lower esophagus

painful

218
Q

Esophageal Diverticulum

A

outpouching of the esophageal wall leading to retention of food

219
Q

Common s/s of esophageal diverticulum

A

gurgling

belching

coughing

foul smelling breath

220
Q

Mallory Weiss Syndrome

A

longitudinal tears in the esophagus

Infection here can lead to inflammatory ulcer or mediastinitis

221
Q

What is Mallory Weiss Syndrome etiology associated with?

A

chronic alcoholism or severe retching or vomiting

222
Q

Gastroesophageal Reflux (GERD)

A

Backward movement of gastric contents into the esophagus resulting in heartburn

Reflux of gastric contents results in irritation & erosion of the lower esophageal mucosa

223
Q

GERD is thought to be associated with …

A

Thought to be associated with weak or incompetent lower esophageal sphincter that allows reflux to occur

224
Q

What is NOT a good indicator of extent of mucosal injury in GERD?

A

severity of heartburn

225
Q

GERD pain is ___ or ___ and may radiate to what areas?

A

epigastric or retrosternal

radiates to throat, shoulder, back

226
Q

GERD can produce what S/S

A

respiratory symptoms like wheezing, chronic cough, hoarseness

chronic persistent reflux can cause strictures from scarring, spasms, and edema

Barret’s esophagus

227
Q

Barrets esophagus can lead to ___ ___

A

esophageal cancer

228
Q

GERD can be mistook for…

A

something more serious like a heart attack

229
Q

Treatments for GERD

A

Avoiding large meals

Avoiding alcohol use and smoking

Eating meals sitting up

Avoiding recumbent position several hours after a meal

Avoiding bending for long periods

Sleeping with the head elevated

Losing weight if overweight

Sit up for several hours as well after meals

Avoid bending if overweight or have tight clothing

230
Q

Major Causes of gastric irritation and ulcer formation

A

Aspiring or non steroidal anti inflammatory drugs (NSAIDS)

infection with H Pylori

also compounds with stress

231
Q

How does NSAIDS cause gastric irritation and ulcer formation

A

irritates the gastric mucosa and inhibits prostaglandin synthesis (which allows the stomach to be attacked by its own secretions - prostaglandins release from damaged cells and cause fever and damage cell walls further usually but also help protect the stomach)

232
Q

Why do H Pylori cause ulcer formation

A

they thrive in acidic environments like the stomach

disrupts the mucosal barrier that protects the stomach from harmful effects of its digestive enzymes

233
Q

To avoid NSAID GI harm always do what

A

take them with food

234
Q

Types of Gastritis

A

Acute

Chronic

Infective

Erosive

235
Q

Acute Gastritis

A

A transient inflammation of the gastric mucosa

Most commonly associated with local irritants such as bacterial endotoxins, alcohol, and aspirin

236
Q

Chronic Gastritis

A

Characterized by the absence of grossly visible erosions and the presence of chronic inflammatory changes

Leads eventually to atrophy of the glandular epithelium of the stomach

Caused by H pylori gastritis, autoimmune gastritis, multi focal atrophic gastritis, chemical gastropathy

237
Q

What may cause erosive gastritis

A

person who ingested ASA and had an acute lesion

238
Q

How to detect H Pylori infection

A
  1. C Urea Breath test using a radioactive carbon isotope
  2. stool antigen test
  3. endoscopic biopsy for urease testing
  4. blood tests to obtain serologic titers of H pylori antibodies
239
Q

What does H Pylori produce that we can detect to diagnose infection

A

Urea

240
Q

Peptic Ulcer Disease

A

An ulceration in the mucosal wall of stomach, pylorus, or duodenum in portions that are accessible to gastric secretions - holes in the stomach

Erosion may extend through the muscle to the peritoneum

241
Q

The most common peptic ulcers are ___ and ___ ulcers

A

gastric and duodenal

242
Q

Gastric Ulcers

A

Involves ulceration of the mucosal lining that extends to the submucosal layer of the stomach

sharp stomach ulcer

243
Q

Predisposing Factors for Gastric Ulcers

A

stress

smoking

use of steroids

NSAIDS

alcohol

hx of gastritis

infection with H Pylori

244
Q

What exactly is gastritis

A

a group of GI issues involving stomach lining inflammation

245
Q

things seen on assessment of a gastric ulcer

A

gnawing sharp pain in or left of the mid epigastric region 1 to 2 hours after eating

nausea and vomiting

hematemesis

246
Q

Duodenal Ulcers

A

a break in the mucosa of the duodenum

similar to gastric ulcer but a different pain pattern

247
Q

Risk factors for Duodenal Ulcers

A

alcohol intake

smoking

stress

caffeine

use of ASA

corticosteroids

NSAIDS

H pylori infection

248
Q

What is seen on assessment of Duodenal Ulcers

A

burning pain in the mid epigastric region area 2 to 4 hours after eating and during the night

pain that is often RELIEVED BY EATING

melena

249
Q

Complications of Peptic Ulcers

A
  1. Hemorrhage (from granulation tissue or from erosion of an ulcer into an artery or vein)
  2. Obstruction (edema, spasm, contraction of scar tissue and interference with the free passage of gastric contents through the pylorus or areas nearby)
  3. Perforation (when an ulcer erodes through all the layers of the stomach or duodenum wall)
250
Q

Risk factors for stress ulcers

A

Large surface-area burns

Trauma

Sepsis

Acute respiratory distress syndrome

Severe liver failure

Major surgical procedures

psychological stress

not just psych stress, but physical as well

251
Q

Zollinger Ellison Syndrome

A

Highly malignant type of GI cancer caused by a gastrin secreting tumor (gastrinoma)

More than 2/3 are malignant

252
Q

Where is the zollinger ellison syndrome tumor usually found?

A

in the pancreas but may be in the submucosa of the stomach or the duodenum

253
Q

What may assessment of Zollinger Ellison Syndrome show

A

diarrhea

impaired fat digestion

elevated serum gastrin

decrease in intestinal pH

254
Q

Gastric Cancer

A

abnormal malignant growth in the stomach

255
Q

S/S of Gastric Cancer

A

Anorexia

Nausea and vomiting

Indigestion and epigastric discomfort

A sensation of pressure

Dysphagia

Weight loss

Palpable mass

Fatigue

Anemia

Ascites

Sensation of pressure is due to the growth

256
Q

Risk factors for Gastric cancer

A

Genetic predisposition

Carcinogenic factors in the diet

Diet high in starch and salt and low in fresh, green leafy vegetables and fresh fruits

Smoking & alcohol

History of gastric ulcers

Presence of Helicobacter pylori

Autoimmune gastritis

Gastric adenomas or polyps

257
Q

Gastric Polyp

A

abnormal growth on the lining inside the stomach

258
Q

Vitamin B12 Deficiency Results from either..

A
  1. inadequate VB12 intake
  2. Lack of absorption of ingested VB12 from the intestinal tract
  3. not making intrinsic factors
  4. receptors for the complex cannot detect
259
Q

S/S of Vitamin B12 Deficiency

A

Severe pallor

Fatigue

Weight loss

Smooth, beefy red tongue

Slight jaundice

Paresthesia of the hands and feet

Disturbances with gait and balance

260
Q

One of the biggest concerns of VB12 deficiency is

A

neurological disorders

261
Q

Dumping Syndrome

A

rapid emptying of the gastric contents into the small intestine

occurs following a gastric resection

tonic and rhythmic movements are supposed to keep it moving at the right rate but this stops them somewhat

262
Q

S/S of Dumping Syndrome

A

Symptoms occurring 30 minutes after eating

Nausea and vomiting

Abdominal cramping

Feelings of fullness

Diarrhea

Palpitations

Tachycardia

Perspiration

Weakness and dizziness

Borborygmi

263
Q

Altered Intestinal Function includes what things

A

Irritable bowel syndrome

Inflammatory bowel disease

Diverticulitis

Appendicitis

Alterations in bowel motility

Malabsorption syndrome

Cancer of the colon and rectum

264
Q

Irritable Bowel Syndrome (IBS)

A

persistent or recurrent symptoms of abdominal pain

265
Q

IBS S/S

A

altered bowel function

varying complains of flatulence and bloatedness

Nausea

anorexia

constipation

diarrhea (may be a ton in 2 hours)

anxiety or depression (can cause IBS or vice versa)

266
Q

What treats both diarrhea and constipation and why?

A

FIBER

It can make diarrhea less watery and it adds bulk to move constipation

267
Q

Inflammatory Bowel Diseases (IBDs)

A

Crohn’s Disease

Ulcerative Colitis

268
Q

Chrohn’s Disease (regional enteritis)

A

IBD

a recurrent, granulomatous type of inflammatory response that can affect any area of the gastrointestinal tract from the mouth to the anus

can look like canker sores

if serious enough can cause need for colon resectioning/removal

269
Q

Ulcerative Colitis

A

A nonspecific inflammatory condition of the colon

IBD

270
Q

Where does Crohn’s Disease most likely occur

A

the terminal ileum

271
Q

What does Crohn’s Disease often lead to

A

thickening and scarring

a narrowed lumen

fistulas

ulcerations

abscesses

272
Q

Crohn’s Disease is characterized by __ and __

A

remissions and exacerbations

273
Q

S/S of Crohn’s Disease

A

Fever

Cramplike pain after meals

Diarrhea semisolid and may contain mucus, pus, and blood

Abdominal distention

Anorexia, nausea, and vomiting

Weight loss

Anemia (poor iron and B1`2 absorption)

Dehydration

Electrolyte imbalances

274
Q

Fistulas

A

communications from one part of the bowel to another or to another organ

275
Q

Ulcerative Colitis

A

Ulcerative and inflammatory disease of the bowel results in poor absorption of nutrients

loss of elasticity and ability to absorb nutrients occur

276
Q

What is the difference between ulcerative colitis and Crohns disease

A

UC is limited to the colon

277
Q

Ulcerative colitis commonly begins in and spreads to?

A

begins in the rectum and spreads upward toward the cecum

278
Q

What happens to the colon during ulcerative colitis

A

it becomes edematous and may develop bleeding lesions and ulcers

these ulcers may lead to perforation

279
Q

what causes the loss of elasticity and ability to absorb nutrients in UC

A

scar tissue development

280
Q

UC is characterized by ..

A

various periods of remissions and exacerbations

281
Q

Acute UC results in…

A

vascular congestion

hemorrhage

edema

ulceration of the bowel mucosa

282
Q

Chronic UC results in …

A

muscular hypertrophy

fat deposits

fibrous tissue

bowel thickening

shortening

narrowing

283
Q

S/S of Ulcerative Colitis

A

Anorexia

Weight loss

Malaise

Abdominal tenderness and cramping

Severe diarrhea that may contain blood and mucus

Dehydration and electrolyte imbalances

Anemia

Vitamin K deficiency

284
Q

Why is there Vit K deficiency in UC

A

it is impacting an area (colon) with a lot of the bacteria that make Vitamin K

285
Q

What sort of areas are impacted with Crohn’s disease v UC

A

Crohns - anywhere along the small and large intestine

UC: more in the descending sigmoid colons and rectum

286
Q

Crohns Disease takes on a ___ appearance from edema and inflammation

A

cobblestone

287
Q

Ulcerative colitis is __ looking and in an ascending pattern

A

angry

288
Q

Crohn’s Disease v Ulcerative Colitis: Location

A

CD - entire GI tract, sm. intestine and colon

UC: Limited to the colon

289
Q

Crohn’s Disease v Ulcerative Colitis: Level of Penetration

A

CD: primarily submucosal

UC: primarily mucosal

290
Q

Crohn’s Disease v Ulcerative Colitis: Rectal Involvement

A

CD: often spared

UC: almost always involved

291
Q

Crohn’s Disease v Ulcerative Colitis: Hx

A

CD: abdominal pain, weight loss

UC: bloody diarrhea

292
Q

Crohn’s Disease v Ulcerative Colitis: Colonoscopy

A

CD: skip lesions, cobblestone mucosa

UC: continuous involvement, pseudopolyps

293
Q

Crohn’s Disease v Ulcerative Colitis: Complications

A

CD: bowel obstruction, fistulas, and strictures

UC: Colon cancer

294
Q

What does skip lesions mean in Crohn’s Disease

A

areas of ulcer, healthy area, ulcer, health y area, etc (this isn’t in UC, that has continuous)

295
Q

Why is Crohn’s disease more likely to have fistulas?

A

it goes through the surface and muscle layers so it can tunnel to different areas and the strictures can close off the openings that open up

296
Q

Infections of the Intestine

A

Viral (rotavirus)

Bacterial (c difficile colitis, E coli)

Protozoal (E histolytica)

297
Q

Diverticulosis

A

Outpouching or herniations of the intestinal mucosa

They can occur in any part of the intestine but are most common in the sigmoid colon

298
Q

Diverticulitis

A

Inflammation of one or more diverticuli

Results when a diverticulum perforates, with local abscess formation

A perforated diverticulum can progress to intra-abdominal perforation with generalized peritonitis

299
Q

S/S of Diverticulitis

A

Left lower quadrant abdominal pain that increases with coughing, straining, or lifting

Elevated temperature

Nausea and vomiting

Flatulence

Cramplike pain

Abdominal distention and tenderness

Palpable, tender rectal mass

Blood in stools

Slight fever

Elevated WBC count

300
Q

The sigmoid colon is in what quadrant

A

Left lower quadrant

301
Q

Hemorrhoids

A

dilated varicose veins of the anal canal

302
Q

Hemorrhoids can be ___ ___ or ___

A

internal external or prolapsed

303
Q

Internal Hemorrhoids lie where?

A

above the anal sphincter and cannot be seen upon inspection of the perianal area

304
Q

External hemorrhoids lie where?

A

below the anal sphincter and can be seen on inspection of the perianal area

305
Q

Prolapsed hemorrhoids can become…

A

thrombosed or inflamed

306
Q

What can cause hemorrhoids?

A

portal HTN

straining

irritation

increased venous or abdominal pressure

labor and delivery

pressures on the body in jobs like carpentry

307
Q

How does portal HTN cause hemorrhoids

A

you get a nodular liver and blood backs up since it cannot get through and it backs up into the intestines and causes esophageal varices and hemorrhoids

308
Q

S/S of Hemorrhoids

A

bright red rectal bleeding

rectal mucus discharge

pain associated with thrombosis

rectal itching

309
Q

Appendicitis

A

inflammation of the appendix

when the appendix becomes inflamed or infected rupture may occur within a matter of hours leading to peritonitis or sepsis

310
Q

S/S and Assessment of Appendicitis

A

Pain in periumbilical area that descends to the right lower quadrant

Abdominal pain that is most intense at McBurney’s point

Rebound tenderness and abdominal rigidity

Low-grade fever

Elevated WBC count

Anorexia, nausea, and vomiting

Client in side-lying position with abdominal guarding
and legs flexed

Constipation or diarrhea

311
Q

Pain from appendicitis occurs in what quadrant

A

Right lower quadrant

312
Q

Appendicitis is most intense at ___point

A

McBurney’s

313
Q

Peritonitis

A

inflammation of the peritoneum

infection of lining and can be life threatening

314
Q

S/S of Peritonitis

A

Increased fever and chills

Progressive abdominal distention and abdominal pain

Right guarding of abdomen

Tachycardia and tachypnea

Pallor

Restlessness

315
Q

Types of Diarrhea

A
  1. Large volume (osmotic and secretory - OS)
  2. Small volume (inflammatory bowel disease, infectious disease, irritable colon - iii)
316
Q

We normally have how much stool a day?

A

150 g/day

317
Q

Diarrhea

A

an increase in volume of stool

often it is an increase in stool fluid content and frequency

318
Q

What are the 4 basic pathophysiologic causes of Diarrhea

A
  1. Increased secretion of electrolytes and water in bowel lumen (INCREASED SECRETION)
  2. Increased osmotic load within the intestine –> water retention in the bowel lumen (INCREASED OSMOTIC LOAD)
  3. Inflammation –> exudation of protein and fluid from intestinal mucosa (INFLAMMATION)
  4. altered intestinal motility –> rapid transit times (ALTERED INTESTINAL MOTILITY)
319
Q

What things can cause increased secretion leading to diarrhea?

A

Cholera toxin

Clostridium endotoxin

Non-invasive microbial gastroenteritis

Carcinoid syndrome

Vasoactive intestinal peptide-secreting tumor

Villous adenoma

320
Q

What things can cause increased osmotic load leading to diarrhea?

A

Sorbitol ingestion “sugar-free candy diarrhea”

Bile salt malabsorption

Lactase deficiency “lactose intolerance”

Malabsorption – celiac sprue

Post-antrectomy rapid gastric emptying “dumping syndrome”

Magnesium containing laxatives

321
Q

Sorbitol

A

an ingredient in sugar free candy that can cause increased osmotic load and cause diarrhea

322
Q

What can cause the inflammation leading to diarrhea?

A

Ulcerative colitis

Crohn’s disease

Radiation-induced enteritis

Invasive microbial gastroenteritis

323
Q

What can cause the altered intestinal motility leading to diarrhea

A

Thyrotoxicosis

Irritable bowel syndrome

Neurologic disease (enteropathy in DM)

324
Q

things to gather during the Hx for Diarrhea

A
  1. Is it acute or chronic
  2. What is the nature of stool: watery (secretory), bulky and greasy (osmotic), blood w or w/o leukocytes (inflammatory)
  3. Medications (antibiotics, laxatives, antihypertensive, anti inflammatory, diuretics)
  4. Other things like fever, abdominal pain, flatulence, extraintestinal sx like arthritis rashes weight loss and edema, and association with meals or fasting
325
Q

What does secretory caused diarrhea look like

A

watery

326
Q

what does osmotic caused diarrhea look like

A

bulky and greasy

327
Q

What does inflammatory caused diarrhea look like

A

bloody with or without leukocytes

328
Q

What to check on physical exam for diarrhea?

A

Degree of hydration

Presence of abdominal tenderness

Rectal mass or blood

Character of bowel sounds

Indicate –> etiology & severity of illness

329
Q

Common Causes of Constipation

A

Failure to respond to the urge to defecate

Inadequate fiber in the diet (to add water to stool)

Inadequate fluid intake

Weakness of the abdominal muscles

Inactivity and bed rest

Pregnancy

Hemorrhoids

330
Q

Mechanical Bowel Obstruction Issues

A

Adhesions

Intussusception

Volvulus

Incarcerated Inguinal Hernia

331
Q

Adhesions

A

parts of the bowel fuse together

332
Q

Intussusception

A

When the bowel slips on to itself

333
Q

Volvulus

A

bowel twists

334
Q

Incarcerated Inguinal Hernia

A

when intestine descends through area tested go through and it gets pinched off and lacks of blood supply

335
Q

Intestinal Obstruction can be caused by what:

A

mechanical obstruction

paralytic ileus

abdominal distention

loss of fluids and electrolytes (hypokalemia)

336
Q

Paralytic Ileus

A

intestinal obstruction

neurogenic or muscular impairment

often occurs after abdominal surgery

337
Q

What can cause abdominal distention leading to intestinal obstruction

A

Gases (swallowed air) and fluids

Distention moves proximally

338
Q

Intestinal Obstruction can lead to what

A

strangulation

gangrenous changes

perforation of the bowel

339
Q

Intestinal Obstruction increases… leading to…

A

increases pressure leading to compromises of blood flow and leads to necrosis

340
Q

Assessment of Intestinal Obstruction may show S/S like…

A

Pain

Absolute constipation

Abdominal distention

Vomiting

Borborygmi

Visible peristalsis

Extreme restlessness, weakness, perspiration, anxiety

341
Q

Risk factors for Paralytic Ileus

A

physical manipulation of the bowel

Hypokalemia (potassium needed for good GI function)

they have not eaten well

neuro or muscular impairment

common after abdominal surgery to check for bowel sounds

342
Q

If there is intestinal obstruction, then what may happen?

A
  1. the need for surgery
  2. need to have something come out someway, even vomiting
343
Q

Causes for Peritonitis

A

Perforated peptic ulcer

Ruptured appendix

Perforated diverticulum

Gangrenous bowel

Pelvic inflammatory disease

Gangrenous gallbladder

Abdominal trauma and wounds

344
Q

Celiac Disease

A

Immune-mediated disorder triggered by ingestion of gluten-containing grains (wheat, barley, rye)

Inappropriate T-cell response in genetically predisposed individuals

May impair absorption of macro- & micro-nutrients

may need blood test

345
Q

The gall bladder is in what quadrant

A

upper right quadrant

346
Q

Classic Form of Celiac Diseas presents in ___ and manifests as…

A

infancy

presents as: FTF, diarrhea, abdominal distention, occasionally severe malnutrition

347
Q

Symptoms of Intestinal malabsorption

A

Diarrhea or constipation

Steatorrhea

Flatulence

Bloating

Abdominal pain

Belching

Cramps

Weakness, muscle wasting

Weight loss and abdominal distention

348
Q

Intestinal Tumors

A

Malignant lesions that develop in the cells lining the bowel wall or develop as polyps in the colon or rectum

Colonoscopies can detect these

349
Q

Complications of intestinal tumors include…

A

Complications include bowel perforation with peritonitis, abscess and/or fistula formation, frank hemorrhage, and complete intestinal obstruction

350
Q

Metastasis of Intestinal tumors occurs via…

A

the circulatory or lymphatic system or by direct extension to other areas in the colon or other organs

351
Q

The intestinal tract is very vascular and deeply involves with..

A

the lymph system (Peyers Patches) and nodes

352
Q

S/S of Intestinal Tumor

A

Blood in stools

Abnormal stools

Anorexia, vomiting, weight loss

Malaise

Anemia

Ascending colon tumor: diarrhea

Descending colon tumor: constipation or some diarrhea, or flat ribbon-shaped stool due to a partial obstruction

Rectal tumor: alternating constipation and diarrhea

Guarding or abdominal distention

Abdominal mass (a late sign)

Cachexia (a late sign)

353
Q

Ribbon stools indicate ___

A

obstruction

354
Q

Cachexia

A

wasting syndrome

with decreased weight muscle atrophy fatigue weakness and very little appetite

355
Q

Colorectal cancer is __ in cancer incidence and __ in cancer morality

A

3rd in incidence and 2nd in mortality

356
Q

Etiology of Colorectal Cancer

A

Most arise from pre-existing benign adenomatous polyps that undergo sequential malignant transformation (only ~5% develop into cancer)

Adenomas

factors associated w malignant transformation (DNA damage, ras oncogene, inactivation of tumor suppressor gene, increasing size and histology)

the deeper it is the worse it is

357
Q

Adenomas

A

neoplastic lesions of glandular epithelium that display abnormal cellular differentiation & are of varying architecture, sizes & shapes

(tubular, tubulovillous, villous)

358
Q

If colorectal cancer is confined to the mucosa,,,

A

it is in situ (but it can progress to submucosa, muscularis propria and adjacent tissue - metastasis)

359
Q

Colorectal cancer that is invasive …

A

can spread to regional lymph nodes and distance sites

360
Q

Recurrence of rectal cancer is more common…

A

after re-sectioning

361
Q

Risk Factors for Colorectal cancer

A

Hx of adenomatous polyps

familial disorders (familial polyposis)

personal hx of another malignancy or cancer

family hx of colon cancer in a first degree relative

diet and lifestyle

362
Q

Diet and Lifestyle risk factors for colo rectal cancer

A

High animal fat consumption (red meat)

Low fiber consumption (lack of fruits & veggies)

Obesity

Ethanol

Refined sugar

Cigarette smoking

363
Q

What are the benefits and downfalls of ASA in the GI system

A

It can lower incidence of colorectal cancer (and heart attack) but increases risk for GI bleed (NOT A CURE FOR CANCER THO)

364
Q

What things can be seen on H&P of colorectal cancer

A

Asymptomatic - but Sx in advanced disease occur

There are few px specific findings

mass may be found on external palpation of the abdomen or on DRE but that is uncommon

365
Q

What are some advanced disease symptoms in colorectal cancer

A

GI bleeding (occult, anemia)

Change in bowel habits (narrow caliber stool, chronic diarrhea, constipation)

Abdominal pain

Anorexia and weight loss (late)

366
Q

Colorectal cancer is often considered a…

A

silent killer

367
Q

Screenings for Colorectal Cancer

A

Stool occult blood tests

Digital rectal examination

X ray studies using barium (ex: barium enema)

Flexible sigmoidoscopy and colonoscopy

May need a barium enema, and regular sigmoidoscopy and colonoscopies at a younger age

N361: Pathophysiology II (20 decks)

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