patho exam 3 Flashcards
what is the major function of the GI tract?
digestion and absorption of nutrients
what are the 4 major activities of the GI tract?
motility
secretions
digestion
absorbtion
what does the GI system consist of?
GI tract:
mouth
esophagus
stomach
small intestines
large intestines
rectum
accessory glands:
pancreas
liver
gallbladder
what are the four layers of the wall of GI tract?
muscosa
submucosa
muscularis externa
serosa
describe the mucosa
inner most layer
mucous membrane - secrete enzymes
lamina propria - CT layer
muscularis mucosae - contract into folds to stir contents
describe the submucosa
helps wall to not be damaged due to stretching
describe muscularis externa
motility, propel food and mix with secretions
circular muscle decreases diameter of lumen
longitudinal muscle shortens GI tract
what happens if gestational diabetes is untreated?
developmental abnormalities like spina bifida
heart defects
large body size of baby
describe serosa
outermost layer
structural support
what happens at the beginning of GI tract? (mouth to stomach)
food is chewed to decrease size and mix with saliva
propelled by tongue to pharynx
esophagus can easily stretch and takes food from pharynx to stomach
upper esophageal sphincter
ring of skel muscle surrounding esophagus at upper end
lower esophageal sphincter
ring of smooth musc that regulates flow of food into stomach
prevents contents of stomach which are acidic from entering esophagus
what is the stomach?
j shaped sac that secretes gastric juice from gastric glands
what happens in the stomach?
smooth mus pulverizes food into smaller particles and mixes with gastric juices forming chyme
what are the three regions of stomach?
fundus
body
antrum
what is gastric emptying?
contraction of antrum to propel chyme from stomach into small intestine
what makes up gastric juice?
mucus, pepsinogen, hydrogen ions
what is the small intestine?
3 ft long coiled tube
what is the primary site of digestion of all nutrients in food?
small intestine
other than digestion, what is the other function of the small intestine?
its high absorptive capacity
what are the three major regions of the small intestine?
duodenum: adds pancreatic juice to chyme and receives bile form liver
jejunum
ileum: joins to the colon
what do villi do?
in small intestine, increase surface area
make a brush border of microvilli
what does the large intestine consist of?
cecum
colon
rectum
what happens in the large intestine?
material that is not reabsorbed enters destined for excretion - feces
what are the four regions of colon their functions?
ascending - absorb water and ions
transverse - absorb water and ions
descending- absorb water and ions
sigmoid - storage for what remains after absorption
what happens in rectum?
fecal contents stored
what does the ileocecal sphincter do?
prevents reflux into ileum from cecum
where is the pyloric sphincter?
between stomach and duodenum
what are the two types of mature bone?
compact - outer shell
cancellous - lattice patterns
what is lamellar bone?
strong mature bone that is highly organized
what is an osteocyte?
mature bone cells
what is a lacuna?
space filled with ECF
what is woven bone?
low tensile strength bone
what types of stem cells does bone marrow contain?
hematopoeitic: RBCs, WBCs, platelets
stromal: adipose, cartilage, bone
what is bone tissue comprised of?
type 1 collagen
proteins
lipids
inorganic salts
bone cells
what are osteoprogenitor cells?
differentiate into osteoblasts
what do osteoblasts release?
alkaline phosphatase
helps precipitation of calcium and phosphorous
what is bone remodeling?
skeletal maintenance
maintains strength and integrity of skeleton
replaced = resorbed
in what disorders is there more bone formation than resorption?
hyperostosis - widening of cortical bone
osteosclerosis - increased density
in what disorders is there more bone resorption that formation?
osteopenia - decreased density
osteoporosis - severe form of osteopenia
disorders of reduced bone mineralization
osteomalacia
rickets
disorders of increased bone mineralization
metabolic soft tissue mineralization
what is osteopenia?
reduction in bone mass greater than expected
what are the pathologies that cause of osteopenia?
osteoporosis
osteomalacia
malignancy
hyperPT
hyperT
what is osteoporosis
porous bone
combo of decres bone mass/density and micro-damage
causes of osteoporosis
postmenopausal estrogen deficient
age
medications
malnutrition
alcoholism
risk factors of osteoporosis
age
female
white
small bone structure
family history
low peak bone mass
aluminum antacids
anticonvulsants
heparin
diabetes
clinical manifestations of osteoporosis
loss of trabeculae
minimal stress causes fracture
diagnosis of osteoporosis
history
drugs
bone mineral density -2.5 or lower
x rays
management of osteoporosis
treatment of underlying
prevention: nutrition, PA, eliminate tobacco, vitamin D
bisphosphonates
hormonal therapy
calcitonin
what is osteomalacia?
inadequate mineralization of new bone resulting in softening of bone
causes of osteomalacia
lack of dietary calcium / vit D
insuff calcium absorption
phosphate deficiency
risk factors of osteomalacia
older
intestinal malabsorption
long term use of drugs
diet deficient in vit d
pathogenesis of osteomalacia
decrease in calcified matrix and increase of uncal matrix
failure of calcium salts to be deposited in osteoid - leaving it not matured
clinical manifestations of osteomalacia
generalized aching and fatigue
weight loss
bone pain
muscle weakness and softening = postural deformities
diagnosis of osteomalacia
bone radiograph
bone biopsy
blood test
urine analysis
treatment of osteomalacia
correct primary disease
adequate nutrition - cal, vit d
what is paget’s disease?
osteitis deformans
abnormal bone remodeling
extensive unorg new bone formation
lacks structural stability
incidence of paget’s
genetic
pathogenesis of paget’s
rapid clastic resorption
hectic formation with chaotic depositing
poor quality, fibrous bone
fractures
bone marrow replaced with progenitors and blood vessels
clinical manifestations of paget’s
present long before detected
bone pain with deformities
hypercalcemia
fatigue
loss of appetite
abdominal pain
constipation
headache
tinnitus, vertigo
1/3rd of skeleton involved, increased in Q
common sites of paget’s
skull
pelvis
humerus
ribs
spine
femur
tibia
diagnosis of paget’s
alkaline phosphate - 10-20 x higher
bone scan
radiographs:
spine - picture frame
bowing of bones
skull - cotton wool appearance
treatment of paget’s
drugs to inhibit clastic activity
NSAIDs
adequate dose of calcium, vitamin D
surgery to decompress nerves
general signs and symptoms of GI disease
nausea, vomiting, diarrhea, anorexia
abdominal pain
dysphagia, weight loss, GI bleed
heart burn
fecal incontinence
GI bleed
constipation
what are the indicators of a GI bleed?
coffee ground emesis
hematemesis
melena - black tarry sticky stool
hematochezia - maroon colored stools
mechanical causes of constipation
bowl obstruction
cancer
diverticulitis
pregnancy
what is GERD?
backward flow of stomach contents called acid reflux
occurs more than 2 times/week for a few weeks
symptoms of GERD
reflux esophagitis
mucosal ulcerations
granulation
narrowing of esophagus
vocal cord inflammation
asthma
eso cancer
causes of GERD
decreased pressure of lower eso sphincter
increased gastric pressure
gastric contents near junction
clinical manifestations of GERD
heart burn at night
pain in epigastric area
sour taste from acid
sever reflux - morning hoarseness
cough asthma
pulmonary aspiration
barret’s esophagus
what is barret’s esophagus
metaplasia - squamous to columnar
mucosal damage
can become cancerous
dysphagia
diagnosis of GERD
history
esophagoscopy to look for changes
pH monitoring - will be more acidic
drugs to manage GERD
proton pump inhibitors
histamine 2 receptor blocker
antacids
lifestyle mods to manage GERD
avoid food that reduces sphincter tone
avoid acidic food
avoid alcohol and smoking
keep food diary to id triggers
remain upright after meals
elevations of HOB
weight loss
what is appendicitis?
inflammation of vermiform appendix
occurs in adolescents and young adults
medical emergency
what is peritonitis?
inflam of membrane lining the cavity
where does pain refer to with appendicitis?
thigh
what is rebound tenderness?
press finger over lower quadrant and quickly remove hand. pain indicated appendicitis
what is rovsing’s sign?
palpation of left lower quadrant increases the pain in right LQ. indicator of appendicitis
what is mcburney’s point?
palpate halfway between ASIS and umbilicus
tenderness indicated appendicitis
what is pinch an inch test?
pinch skin over mcburney’s. allow to recoil quickly
increased pain is positive for peritonitis
what is psoas sign?
abdominal pain is possible cause of hip or thigh pain
pain with hip extension
have client perform straight leg raise, resistance applied to distal thigh
increased pain is positive but not specific to peritonitis
what is inflammatory bowel disease?
chronic inflam in large and small intestine
no proven cause
what are the two most common forms of IBD?
crohn’s
ulcerative colitis
cause of IBD
unregulated and exaggerated immune response
genetic
environmental trigger
systemic manifestations
what is crohn’s disease
granulomatous inflam process
20-30 yo women
small intestine and colon most affected
exacerbation and remission
skip lesions
cobblestone appearance
fat wrapping
ulcerations
obstruction
damage to villi
what layer of GI is most affected in crohn’s
submucosal
manifestations of crohn’s
exacerbation and remission
fever, diarrhea, abdo pain, weight loss
electrolyte disorders
nutritional deficiencies
fistula formation
treatment of crohn’s
anti-inflammatory
nutritious diet: high cal, vit, protiens, avoid fat
may need feeding tube
what is UC?
inflam disorder of mucosa of rectum and colon
spreads proximally from rectum
no skip lesions
15-25 yo
clinical manifestations of UC
diarrhea 4-10 stools/day
rectal bleeding
nausea, vomiting, weight loss, anorexia, fever
anemia and clubbing of fingers are rare
ankylosing spondylitis
location of uc and crohn
crohn - small intestine and ascending colon
uc - descending colon and rectum
pattern of uc and crohn
crohn - skip lesions
uc - continous
depth of uc and crohn
crohn - submucosal
us - mucosal
diarrhea in uc and crohn
crohn - watery
uc - bloody
abdo pain in uc and crohn
both - yes
bowl obstruction in uc and crohn
crohn - common
uc - uncommon
cancer risk in uc and crohn
crohn - increased
uc - higher than crohn
what is diverticular disease?
decreased motility
obstruction
impaired perfusion
what is a diverticulum
outpouching in wall of colon
develops at site of weakness
plural: diverticula
presence: diverticulosis
what is diverticulitis?
particle trapped in pockets becomes inflammed
pain and tender LQ
nausea, slight fever, elevated WBCs
complications of diverticulitis
herniation
perforation
hemorrhage
inflammation
risk factors of diverticulitis
low fiber diet
chronic constipation
weak bowel muscle
obesity
weak pelvic floor muscles
NSAID use
immediate treatment of diverticulitis
control infection
rest the bowl
clear liquid diet for 2-3 days
LT treatment of diverticulitis
high fiber, low fat diet
avoid foods like banana and rice
fluid intake of 2L/day
daily exercise
anti-biotic, anti-inflam
surgery for perforations
bowel resections or removal
colostomy
red flags for UC
blood diarrhea
nausea and vomiting
anorexia
weight loss
fever
chronic abdo pain
family hx of IBD’s
rectal bleeding
PT for UC
low to mod intensity
walking
cycling
simple HEP
higher activity have better outcomes
PT for crohn’s
hydration during
activities limited by severity of symptoms
light to mod exercise recommended
implications to PT with crohn’s
low bone mineral density
increased risk of osteoporosis - corticosteroid use
tendency for arthritis in lower back
abscesses can form on hip due to skip lesions
