PHCP - WEEK 3 Flashcards by Xei Lee

Digestion and
assimilation of nutrients
from food

Intestine

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acts as a reservoir,
emptying intermittently by
bolus movements.
– allows time for salvage of
fluids, electrolytes,
nutrients

Distal ileum

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-Segmented
– compartmentalizes the
colon
– facilitates mixing, retention
of residue, and formation
of solid stools.

Haustra

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-Segmented
– compartmentalizes the
colon
– facilitates mixing, retention
of residue, and formation
of solid stools.

Haustra

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Tonic contraction of the puborectalis muscle, which forms a sling around
the rectoanal junction, is important to maintain continence;
during ______, sacral parasympathetic nerves relax this muscle,
facilitating the straightening of the rectoanal angle

Defecation

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Increase in fluidity,
frequency, or volume of
stool output
* Often a symptom of an
underlying disease

Mechanisms
– Dec sodium abs/inc
Chloride secretion
– Inc intestinal motility
– Inc tissue hydrostatic
pressure

Diarrhea

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Diarrhea <2weeks

Acute

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Diarrhea 2-4weeks

Persistent

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Diarrhea >4weeks

Chronic

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Ingested, poorly
absorbable, osmotically
active solutes draw
enough fluid into the
lumen to exceed the
reabsorptive capacity of
the colon
* Fecal output increases in
proportion to such a
solute load
* Ceases with fasting or
discontinuation of
causative agent

Osmotic Diarrhea

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Fat malabsorption
* Greasy, foul smelling,
difficult-to-flush
* Associated with weight
loss and nutritional
deficiencies
– Concominant
malabsorption of amino
acids and vitamins

Steatorrheal Diarrhea

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Discharge of mucus,
proteins or blood into
the gut

Exudative Diarrhea

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delay the transit of
intraluminal content or increase gut capacity, prolonging
contact and absorption. The limitations of the opiates
are addiction potential (a real concern with long-term
use) and worsening of diarrhea in selected infectious
diarrheas.

Opiates and opioid derivatives

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often recommended for managing acute
and chronic diarrhea. Diarrhea lasting 48 hours beyond
initiating ___ warrants medical attention

*Loperamide

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are used for
symptomatic relief (see Table 23–4). _______are
nonspecific in their action; they adsorb nutrients, toxins,
drugs, and digestive juices. Coadministration with other
drugs reduces their bioavailability

Adsorbents

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is often used for
treatment or prevention of diarrhea (traveler’s
diarrhea) and has antisecretory, antiinflammatory, and antibacterial effects. Bismuth
subsalicylate contains multiple components that
might be toxic if given in excess to prevent or
treat diarrhea.

Bismuth subsalicylate

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is intended to replace
colonic microflora. This supposedlyrestores
intestinal functions and suppresses the growth of
pathogenic microorganisms. However, a dairy
product diet containing 200 to 400 g of lactose or
dextrin is equally effective in recolonization of
normal flora.

Lactobacillus preparation

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Empirical Treatment
– Severely ill patients with febrile dysentery

Quinolones, Ciprofloxacin (500mg bid for 3-5d)

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Empirical Treatment
- Suspected giardiases

Metronidazole (250mg qid for 7d)

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persistent, difficult, infrequent, or seemingly
incomplete defecation

Constipation

Reflux of gastric acid
and pepsin
– Necrosis of esophageal
mucosa
– Causes erosions and
ulcers
– Often excessive and with
impaired clearance of
refluxed gastric juice

Gastroesophageal
Reflux Disease

A circumscribed loss of the mucous membrane of
the GIT system exposed to gastric juices
containing acid and pepsin.

Peptic Ulcer Disease

Characterized by gnawing, burning or aching pain
(worsen at night), N/V, belching and weight loss

Peptic Ulcer Disease

Excessive secretion of gastric acid - stomach

Gastric Ulcer

Excessive secretion of gastric acid - duodenum

Duodenal Ulcer

Excessive secretion of gastric acid - Esophagus

Esophageal Ulcer

Excessive secretion of gastric acid - Esophagus

Esophageal Ulcer

Age 25-75 yrs – Gnawing or burning upper abdomen pain relieved by food but reappears 1-3 hrs after meals. – Worse pain when stomach is empty – Bleeding occurs with deep erosion * Hematemesis * Melena

Duodenal Ulcers

Age 55-65 yrs – Relieved by food but pain may persist even after eating – Anorexia, wt loss, vomiting – Infrequent or absent remissions – Small % become cancerous – Severe ulcers may erode through stomach wall

Gastric Ulcers

More often in duodenum – Often superficial – Less severe GI bleeding

Ulcers associated with H. Pylori

More often in stomach – Often deep – More severe GI bleeding – Sometimes asymptomatic

Ulcers associated with NSAIDs

Secreted from the PARIETAL CELLS in the body of the stomach

Hydrochloric acid

Meal Stimulated Acid Secretion

Gastrin

Basal Stimulated Acid Secretion

Acetylcholine

Vomiting or vomiting blood — which may appear red or black * Dark blood in stools, or stools that are black or tarry * Trouble breathing * Feeling faint * Nausea or vomiting * Unexplained weight loss * Appetite changes

Peptic Ulcer Disease

subjective feeling of a need to vomit

Nausea

oral expulsion of GI contents due to gut contraction

Vomiting/emesis

Three consecutive phases

Nausea, retching, vomiting

-Self-limiting, resolves spontaneously -Px complaint of queasiness or discomfort -none

Simple N/V

Not relieved after administration of antiemetics, progressive deterioration of px secondary to fluidelectrolyte imbalance Weight loss, fever, abdominal pain Serum electrolyte conc, upper/lower GI evaluation

Complex N/V

AKA infectious hepatitis

Hepatitis A

Self-limiting, rarely fatal * Vaccine preventable Caused by RNA virus – Picornaviridae – 85C to inactivate

Hepatitis A

Long-term (Chronic infxn) * Only have DNA virus * Results to liver cirrhosis and HCC Etiology – DNA Virus – Hepadnaviridae

Hepatitis B

Clinical presentation – HCV RNA (1-2 weeks exposure) – ALT = hepatic injury and cell necrosis – 85% chronic HCV infxn – Defined as persistently detectable HCV RNA for 6 mos or more

Hepatitis C

Mucosal inflammatory condition confined to the rectum and colon -continuous colonic involvement, beginning in rectum

Ulcerative Colitis (UC)

– Transmural inflammation that may occur in any part of the GI tract -Skip lesions

Crohn Disease

Inflammation of the pancreas with upper abdominal pain and pancreatic enzyme elevations

* Acute Pancreatitis

– Progressive disease, long standing inflammation leading to loss of pancreatic exocrine and endocrine function

Chronic Pancreatitis