MT M 6.4 Common Digestive System Medical Procedures/Conditions Flashcards
Dyspepsia
Dyspepsia is commonly called “indigestion”. It refers to pain in the upper abdomen that can be acute or chronic. When chronic, it typically has been present for at least 1 month. It can be caused by eating too fast, eating high-fat foods, eating during times of high stress, or taking in too much alcohol or caffeine. It is a common side effect of several medications, including antibiotics, anti-inflammatory drugs, opioids, and anti-depressants. Dyspepsia is commonly associated with heartburn, which will be discussed later. It is treated with lifestyle changes or medications that decrease the amount of acid produced in the stomach.
Upper Gastrointestinal Bleeding
Bleeding from the upper GI tract, including the esophagus, stomach, and beginning of the small intestine, is a common disorder and a frequent cause of hospitalization within the United States. There are many conditions that can lead to upper GI bleeding.
Ulcers
Upper Gastrointestinal Bleeding
Ulcers located in the stomach or duodenum can bleed.
Esophageal varices
Upper Gastrointestinal Bleeding
Esophageal varices, dilated veins in the lower esophagus due to portal hypertension, are superficial and prone to bleeding.
Mallory-Weiss tears
Upper Gastrointestinal Bleeding
Mallory-Weiss tears are lacerations of the gastroesophageal junction that cause bleeding. These tears can be associated with excessive alcohol intake or vomiting.
Tumors in the stomach
Upper Gastrointestinal Bleeding
Tumors in the stomach can bleed.
Vascular abnormalities
Upper Gastrointestinal Bleeding
Vascular abnormalities located in the upper GI tract can also cause bleeding.
Hematemesis
Patients will present with either hematemesis or melena. Hematemesis is the condition of vomiting with blood. Hematemesis can be bright red blood or referred to as “coffee ground emesis”, which is brown.
angiectasias
Upper Gastrointestinal Bleeding.
Vascular abnormalities
The most common vascular abnormalities are angiectasias. These are vessels, located in the submucosa of the GI tract, that become dilated and are prone to bleeding due to obstructions in the vascular system.
Melena
Melena is stool that has blood that has been “digested” in the small and large intestines. It has a distinct odor and appears black and tarry.
significant blood loss
Patients with significant blood loss will be tachycardic and hypertensive. They may require stabilization with fluids and blood transfusions.
esophagogastroduodenoscopy (EGD)
Patients with significant blood loss. Patients will undergo an esophagogastroduodenoscopy (EGD) to identify where the bleeding is occurring. The term explains which parts of the GI tract the scope will examine: esophag/o refers to the esophagus, gastr/o refers to the stomach, and duoden/o refers to the duodenum of the small intestine.
EGD examining the stomach
During an esophagogastroduodenoscopy (EGD) areas that are actively bleeding can be cauterized, clipped, or injected with medication to stop the bleeding. After identifying the source of the bleeding, patients may also require medications to control underlying diseases, such as acid inhibitors or medications to control portal hypertension.
Lower Gastrointestinal Bleeding
Lower GI bleeding occurs primarily in the large intestine. It can range in severity from mild anorectal bleeding to massive blood loss called hematochezia.
Hematochezia
Lower GI bleeding
Hematochezia is the passage of large volumes of bloody stool. It is different from melena, as the appearance is not black or tarry. The sources of bleeding in the lower GI tract are infectious colitis, anorectal disease including hemorrhoids or anal fissures, and inflammatory bowel disease, including ulcerative colitis. Bleeding can also occur from diverticulosis, angiectasias, or tumors located in the colon.
colonoscopy
Lower GI bleeding
The source of bleeding in stable patients is identified through colonoscopy, seen in Figure 6.12. This is a scope that is inserted into the anus to examine the colon after completion of a proper bowel preparation. Areas of active bleeding can be addressed similarly to an EGD.
Gastroesophageal reflux disease (GERD)
Gastroesophageal reflux disease (GERD) is a condition where stomach contents reflux into the esophagus and cause symptoms and damage to the surface of the esophagus. It is a common medical condition that affects 20% of all adults. Patients will complain of heartburn and regurgitation, belching, chest pain, and cough. The lower esophageal sphincter is either weak or relaxes inappropriately and allows the stomach contents to reflux. Reflux can also occur with increases in abdominal pressure, seen in pregnant patients or in patients with abdominal obesity.
hiatal hernia
GERD can also be caused by a hiatal hernia, seen in Figure 6.14, which is where a portion of the stomach protrudes through the diaphragm and into the thoracic cavity.
Mild symptoms of GERD
Mild symptoms of GERD are treated with lifestyle changes, such as decreasing high acid foods in the diet, weight loss, and smoking cessation. Patients are also instructed to not lay down for 3 hours after eating. Medications can be used to reduce the amount of acid produced in the stomach.
Peptic ulcer disease
Peptic ulcer disease is a condition where ulcers develop within the stomach and duodenum. Stomach juices are highly acidic and can start to break down the mucosal surface of the stomach and duodenum.
The two main causes of peptic ulcer disease
Peptic ulcer disease
The two main causes of peptic ulcer disease are an excessive intake of anti-inflammatory medications, such as ibuprofen, and an infection with H pylori. Patients present with epigastric pain that is dull, aching, or gnawing. The pain may improve with eating or by taking an antacid but typically returns within 2-4 hours. Ulcers are diagnosed through an EGD and H pylori testing. They are treated with antibiotics for the bacterial infection and medications to decrease the production of acid within the stomach. Figure 6.15 shows ulcers in the stomach and duodenum due to increased secretion of stomach acid.
Cholelithiasis
Cholelithiasis is a condition where stones develop within the gallbladder. It is commonly called gallstones. Gallstones are more common in women and can be seen on an ultrasound. Gallstones generally do not cause symptoms.
As seen in Figure 6.16, gallstones can be present in the gallbladder. They also can be present within the biliary tree. When gallstones migrate out of the gallbladder, they can cause symptoms and may need to be addressed.
Cholecystitis
Cholecystitis is inflammation of the gallbladder, and when it occurs, it is frequently associated with gallstones. Cholecystitis occurs when a gallstone obstructs the cystic duct and inflammation develops behind the obstruction. Patients will complain of pain in the right upper quadrant, fever, and vomiting. Patients may appear jaundice, which is a yellowing of the skin and whites of the eyes. Acute episodes of cholecystitis will likely resolve. Indications for a cholecystectomy, surgical removal of the gallbladder, are repeated episodes of cholecystitis leading to chronic inflammation, necrosis of the gallbladder due to ischemia, and choledocholithiasis, stones within the common bile duct.
appendix
The appendix is attached to the cecum of the large intestine. It is a worm-like diverticulum or pouch that hangs from the large intestine. It can be seen in Figure 6.6.
Appendicitis
Appendicitis is a condition of inflammation of the appendix that occurs when the entrance to the appendix is obstructed by a fecalith, inflammation, foreign body, or tumor.
fecalith
A fecalith is a hard mass of stool.
Appendicitis
typically occurs
Appendicitis typically occurs between the ages of 10 to 30.
Appendicitis
symptoms
When the appendix becomes obstructed, the pressure within the large intestine increases. This can cause infection and damage to the blood vessels.
Patients will complain of pain in the right lower quadrant that is constant and worse with standing or coughing. They will have nausea, vomiting, and fever. A typical physical exam finding is point tenderness at McBurney’s point,
Appendicitis
diagnosed
Appendicitis is diagnosed via an abdominal ultrasound or abdominal CT scan.
appendectomy
Appendicitis
Patients will require an appendectomy, which is surgical removal of the appendix by a general surgeon.
laparoscope
Appendicitis surgery
This surgery is commonly performed with a laparoscope, a minimally invasive surgical approach with a scope fitted with tools used to remove the appendix, rather than with a large incision
Inflammatory bowel disease
Inflammatory bowel disease includes ulcerative colitis and Crohn’s disease.
Both diseases are chronic, recurrent, and cause inflammation of the mucosal surface of the GI tract. The difference is in the location of the inflammation. Ulcerative colitis is inflammation of the lining of the colon only, while Crohn’s disease can involve any portion of the GI tract.
Patients with Crohn’s disease
Patients with Crohn’s disease have intermittent episodes of fever, diarrhea, and right lower quadrant pain. It is common for patients to have inflammation in the terminal ileum of the small intestine, ileitis, and the ascending colon, ileocolitis. Inflammation in these areas can cause a palpable mass in the right lower quadrant, obstruction of the intestines, and fistulas between the small and large intestines.
perianal disease
Crohn’s disease can also cause
Crohn’s disease also can cause perianal disease with painful skin tags, anal fissures, perianal abscesses, and fistulas. An anal fissure is a deep crack around the anus. A **fistula **is an abnormal passage between two areas that should not be connected.
Ulcerative colitis
Inflammatory Bowel Diseases
Ulcerative colitis is inflammation of the mucosal surface of the colon. Frequent bloody diarrhea is a common symptom, as well as abdominal pain.
Inflammatory bowel disease
Patients are treated with
Inflammatory bowel disease is a lifelong disease that does not have a cure. Patients are treated with steroids and aminosalicylates to decrease inflammation in acute flare-ups. Immunomodulators are medications used in severe disease to help maintain remission. Patients also may require surgery to remove sections of their bowel that are resistant to medications.
Diverticulosis
Disease of the Colon
Diverticulosis is a condition where pouches form within the walls of the colon, as seen in Figure 6.19. Development of these diverticula is a common result of aging. The pouches themselves do not cause any symptoms and are generally uncomplicated.
Diverticulitis
Disease of the Colon
Diverticulitis is inflammation of one or more diverticula and does cause symptoms. Patients will complain of abdominal pain, nausea, vomiting, and fever. They may also have blood in their stool. Diverticulitis is diagnosed with a CT scan of the abdomen. Treatment involves antibiotics and a liquid diet for 2-3 days. If their symptoms do not resolve, they may need hospitalization for IV fluids and IV antibiotics. Surgical management is reserved for patients with severe disease
