Patho of GI Diseases Flashcards
Components of Upper GI
–Esophagus
–Stomach
–Beginning of small intestines
Components of Lower GI
–small intestines
–colon (large intestines)
–rectum/anus
Esophageal disorders
–GERD
–Hiatal Hernia
Inflammatory disorders of the stomach (Upper GI)
–gastritis
–acute gastroenteritis
–PUD
dysphagia
difficulty swallowing
how does dysphagia progress?
begins with solids and progresses to liquids
common causes of dysphagia
–mechanical obstruction
–neuromuscular dysfunction
–intubation
–tracheostomy
examples of mechanical obstruction
–stenosis and stricture
–diverticula
–tumors
examples of neuromuscular dysfunction
–CVA
–achalasia
achalasia
lower esophageal sphincter can’t open properly
GERD
gastro esophageal reflux disease
GERD aka ________
heartburn
GERD definition
–backflow of gastric acid from stomach into esophagus
–occurs via LES
what triggers GERD?
–anything that alters closure strength of LES or increases abdominal pressure
–fatty foods
–spicy foods
–tomato based foods
–citrus foods
–caffeine
–large amounts of alcohol
–cigarettes
–sleep position
–obesity
–pregnancy
–pharm agents
clinical manifestations of GERD
–heartburn (pyrosis)
–dyspepsia
–regurgitation
–chest pain
–dysphagia
–pulmonary symptoms
complications of GERD
–ulceration
–scarring
–strictures
–Barrett’s esophagus
Barrett’s esophagus
development of abnormal metaplastic tissue–premalignant
treatment for Barrett’s esophagus
prevention, no treatment
risk associated with Barrett’s esophagus
three-fold increased risk of developing adenocarcinoma of the esophagus
Hiatal Hernia
a defect in the diaphragm that allows part of the stomach to pass into the thorax
two main types of hiatal hernias
–sliding hernia
–paraesophageal hernia
sliding hernia
usually small and often do not need treatment
paraesophageal hernia
part of the stomach pushes through the diaphragm and stays there
causes of hiatal hernia
–exact cause is unknown
–increased age
–injury or other damage may weaken the diaphragm muscle
–repeatedly putting too much pressure on the muscles around the stomach
examples of mechanisms that can cause a hiatal hernia
–severe coughing
–vomiting
–constipation and straining to have a bowel movement
clinical manifestations of hiatal hernias
–asymptomatic
–belching
–dysphagia
–chest or epigastric pain
–weaker LES
risk factors for hiatal hernias
–age
–obesity
–smoking
GERD and hiatal hernias
common for these to coexist
treatment of hiatal hernias
–conservative treatment
–surgery if conservative treatments don’t work
–antacids for the GERD/esophagitis syndrome
teaching for hiatal hernias
–small, frequent meals
–avoid lying down after eating
–avoid tight clothing and abdominal supports
–weight control for obese individuals
acute gastritis
temporary inflammation of the stomach lining only (intestines not affected)
duration of acute gastritis
generally lasts 2-10 days
etiology of acute gastritis
–irritating substances (alcohol)
–drugs (NSAIDs)
–infectious agents
infectious agent involved with acute gastritis
H. pylori
chronic gastritis
progressive disorder with chronic inflammation in the stomach
duration of chronic gastritis
can last weeks to years
complications of chronic gastritis
–PUD
–bleeding
–ulcers
–anemia
–gastric cancers
PUD
peptic ulcer disease
etiologies of chronic gastritis
–autoimmune (attacks parietal cells)
–H. pylori infection
H. pylori
helicobacter pylori bacterium
where does H. pylori thrive?
in acidic environments
how does H. pylori work?
destructive pattern of persistent inflammation
how is H. pylori transmitted?
–person to person via saliva, fecal matter, or vomit
–contaminated food or water
clinical manifestations of acute/chronic gastritis
–sometimes none
–anorexia
–N/V
–postprandial discomfort
–intestinal gas
–hematemesis
–tarry stools
–anemia
acute gastroenteritis
inflammation of stomach and small intestine
etiology of acute gastroenteritis
–viral infections: norovirus and rotavirus
–bacterial infections: E. coli, salmonella, campylobacter
–parasitic infections
duration of acute gastroenteritis
usually lasts 1-3 days, but many last as long as 10 days
clinical manifestations of acute gastroenteritis
–watery diarrhea (bloody if bacterial)
–abdominal pain
–N/V
–fever, malaise
complication of acute gastroenteritis
fluid volume deficits (dehydration)
treatment for acute gastroenteritis
let virus run its course (>72 hours = see PCP)
peptic ulcer disease (PUD)
ulcerative disorder of the upper GI tract
body parts affected by PUD
–esophageal
–stomach
–duodenum
PUD term in stomach
gastric ulcers
PUD term in duodenum
peptic ulcer
when does PUD develop?
when GI tract is exposed to acid and h. pylori
aggressive factors for GI health
–H. pylori
–NSAIDs
–acid
–pepsin
–smoking
defensive factors for GI health
–mucus
–bicarbonate
–blood flow
–prostaglandins
PUD etiology
–H. pylori
–injury-causing substances
–NSAIDs, ASA, alcohol
–excess secretion of acid
–smoking
–family history
–stress
how does stress affect PUD?
remember there is increased gastric acid secreted with the stress response
risk factors for PUD
–age
–higher doses of NSAIDs
–hx of PUD
–use of corticosteroids and anticoags
–serious systemic disorders
–H. pylori infection
pathogenesis of PUD
–mucosa is damaged
–histamine is secreted, resulting in (1) increase in acid and pepsin secretion - tissue damage, (2) vasodilation - causes edema
–bleeding if BV destroyed
duodenal ulcer
–most common type
–age - any; early adulthood
gastric/peptic ulcer age and causes
–age: peak 50-70
–increased use of NSAIDs, corticosteroids, anticoagulants, more likely to have serious systemic illnesses
clinical manifestations of PUD
–sometimes none
–N/V, anorexia
–weight loss
–bleeding
–burning pain in middle of abdomen that is usually worse when stomach is empty
symptomatic characteristics of gastric ulcer
–burning
–cramping
–gas-like
location of gastric ulcer
epigastrium, back
timing of gastric ulcer
1-2 hours after eating
symptomatic characteristics of duodenal ulcer
burning, cramping, gas-like
location of duodenal ulcer
epigastrium, back
timing of duodenal ulcer
2-4 hours after eating
PUD complications
H – hemorrhage
O – obstruction
P – perforation and peritonitis
lower GI disorders
–appendicitis
–peritonitis
–IBS (Crohn’s, UC)
–IBD
–diverticulosis/diverticulitis
etiology of appendicitis
–appendix is obstructed
–leads to inflammation
complications of appendicitis
–gangrene
–abscess formation
–peritonitis
types of pain with appendicitis
–classic pain (RLQ in periumbilical area)
–rebound pain
–sudden pain relief
what might sudden pain relief indicate in appendicitis?
may indicate rupture – peritonitis
peak incidence of appendicitis
10-12 years
symptoms of appendicitis
–low grade fever
–nausea
–anorexia
–rebound pain or tenderness at McBurney’s point (RLQ)
diagnosis of appendicitis
–clinical signs and symptoms
–increased WBC
–abdominal sonogram
–exploratory lap
peritonitis
inflammation of peritoneum
peritoneum
serous membrane that lines abdominal cavity and covers visceral organs
what happens to the peritoneum in peritonitis?
–inflammation
–third spacing
–decreased peristalsis
what can third spacing lead to?
can lead to hypovolemic shock and sepsis
what can peritonitis lead to?
paralytic ileus and intestinal obstruction
causes of peritonitis
–perforated ulcer
–ruptured gallbladder
–pancreatitis
–ruptured spleen
–ruptured bladder
–ruptured appendix
s/s of peritonitis
–sudden and severe
–abdominal pain
–tenderness
–rigid “board-like” abdomen
–N/V
–fever
–elevated WBC
–HR increased
–BP decreased
treatment of peritonitis
–antiinflammation
–treat the cause
causes of increased HR and decreased BP in peritonitis
SNS activation from pain; fluid shifts
lower GI problems
–inflammatory bowel syndrome
–inflammatory bowel disease
irritable bowel syndrome
–chronic condition
–alterations in bowel pattern due to changes in intestinal motility
types of irritable bowel syndrome
–chronic and frequent constipation (IBSC)
–chronic and frequent diarrhea (IBSD)
symptoms of IBS
varies by individual
potential symptoms of IBS
–abdominal distention, fullness, flatus, and bloating
–intermittent abdominal pain exacerbated by stress and relieved by defecation
–bowel urgency
–intolerance to certain foods
–non-bloody stool that may contain mucous
psychosocial stress and IBS
–almost never the result of primarily psychological causes
–can be exacerbated by stress
–can cause stress and psych problems
cause of IBS
unknown, but thought to be “triggered” by stress, food, hormone changes, GI infections, menses
inflammatory bowel disease
(1) Crohn’s disease
(2) Ulcerative colitis
what is IBD characterized by?
–chronic inflammation of the intestines
–exacerbation and remissions
who is IBD most common in?
–women
–Caucasians
–Jewish people
–smokers
etiology of IBD
genetically autoimmune; activated by an infection
pathogenesis of Crohn’s disease
–lymph structures of GI tract are blocked
–tissue becomes engorged and inflamed
–deep linear fissures and ulcers develop in “patchy” pattern along the bowel wall (skip lesions, cobblestone)
complications of Crohn’s disease
–malnutrition
–scar tissue and obstructions
–fistulas
–cancer
clinical manifestations of Crohn’s disease
–crampy lower abdominal pain (RLQ)
–watery diarrhea
–systemic (weight loss, fatigue, no appetite, fever, malabsorption of nutrients)
–palpable abdominal mass (RLQ)
–mouth ulcers
–s/s of fistulas
what are specific to Crohn’s disease?
–skip lesions
–granulomas
complications of Crohn’s disease
VTE/DVT
ulcerative colitis
inflammation of the mucosa of the rectum and colon
development of UC
third decade of life
who gets UC?
white people of European descent (Ashkenazi Jewish)
–occasionally in AA
–rare in Asians
UC patho
–inflammation in rectum and extends in continuous segment that may involve the entire colon
–inflammation = large ulcerations
–colon and rectum try to repair the damage with new granulation tissue
crypt abscesses
necrosis of the epithelial tissue can result in abscesses
symptoms of UC
–abdominal pain
–bloody diarrhea
–systemic (weight loss, fatigue, no appetite, fever)
complications of UC
–hemorrhage
–perforation
–cancer (colorectal carcinoma)
–malnutrition
–anemia
–strictures
–fissures
–abscesses
–toxic megacolon
–liver disease
–F/E, pH imbalances
significance of bloody diarrhea
only happens with UC, not Crohn’s
toxic megacolon
rapid dilation of large intestine that can be life-threatening
diverticulosis
–development of diverticula
–may be congenital or acquired
–thought to be caused with low fiber diet with resulting chronic constipation
usual location of diverticulosis
descending colon
diverticula
small pouches in lining of colon that bulge outward through weak spots
diverticulitis vs. diverticulosis
diverticulitis = with infection or inflammation
diverticulosis = without inflammation
symptoms of diverticulosis
–asymptomatic
–discovered accidentally or with presentation of acute diverticulitis
diverticulitis
inflammation of one or more of the pouches (usually from retained fecal matter)
symptoms of diverticulitis
–abdominal pain (LLQ)
–fever
–WBCs increased
–constipation or diarrhea
–acute passage of large quantity of frank blood
–may resolve spontaneously
complications of diverticulitis
–perforation
–peritonitis
–obstruction
