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Pathophsiology - OMED 1397 > The Digestive System > Flashcards

The Digestive System Flashcards

1
Q

What Organs are in the Right Upper Quadrant?

A

Right lobe of Liver
Gallbladder
Pylorus
Duodenum
Head of Pancreas
Upper Right Kidney

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2
Q

What Organs are in the Left Upper Quadrant?

A

Left Lobe of Liver
Spleen
Stomach
Left Kidney
Body of Pancreas
Splenic Flexion of Colon

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3
Q

What Organs are in the Right Lower Quadrant?

A

Lower Right Kidney
Caecum
Appendix
Ascending Colon
Right Fallopian Tube/Right Ovary
Right Ureter/Distended Bladder

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4
Q

What Organs are in the Left Lower Quadrant?

A

Descending Colon
Sigmoid Colon
Left Fallopian Tube
Left Ovary
Left Ureter/Distended Bladder

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5
Q

What are the Function of the GI Tract?

A

Ingestion
Propulsion (Voluntary and Involuntary)
Digestion (Mechanical and Chemical)
Absorption
Secretion
Excretion (or Defecation)

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6
Q

What are Disorders of the GI Tract?

A

Disorders of the Digestive System will result in One or more of these Function being Disrupted.
Example: Diarrhoea due to infection results in increased involuntary propulsion, reduces digestion of food, reduced absorption of nutrients and water and increased defaecation.

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7
Q

What is the General Pathology of the Oesophagus?

A

Obstruction
Gastric Acid Reflux
Oesophagitis
Oesophageal Varices
Tumours

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8
Q

What is Meant by Gastric Acid Reflux?

A

Acid and Stomach Contents rise back up into the Esophagus after the stomach contracts in the opposite direction.

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9
Q

What is Oesophageal Varices?

A

Oesophageal Varices are dilations of the Oesophageal Veins, usually caused by liver disease/portal hypertension.
Since dilated veins are more Fragile and these are under high pressure, they can rupture causing severe oesophageal bleeding.
If a varix bleeds, the patent will vomit undigested blood as it has not reached the stomach.
Likely to result in Hypovolaemic shock if carries on.

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10
Q

What can cause an Obstruction of the Oesophagus?

A

When the Oesophagus is Narrowed by Tumour Scarring it can cause an obstruction.

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11
Q

What is Oesophagitis?

A

Inflammation of the Esophagus.
Can cause painful, difficult swallowing and chest pain.

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12
Q

What is the General Pathology of the Stomach?

A

Gastric Ulcers
Outlet Obstruction
Gastritis
Tumours
Pernicious Anaemia

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13
Q

What is a Gastric (Peptic) Ulcer?

A

Peptic Ulcers may lead to bleeding or perforation, emergency situations.

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14
Q

What is a Gastro Outlet Obstruction?

A

Clinical syndrome that can manifest with a Variety of symptoms including abdominal pain, postprandial vomiting, early satiety and weight loss. Caused by either a benign or malignant mechanical obstruction or a mobility disorder interfering with gastric emptying.

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15
Q

What is Gastritis?

A

When the Stomach becomes Inflamed.
Symptoms include:
Indigestion, Tummy Pain and feeling or being sick.
Causes include:
Bacterial Infections

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16
Q

What is a Gastric Tumour?

A

Disease in which Malignant (Cancer) cells form in the Lining of the Stomach. Age, Diet and Stomach Disease can affect the risk of developing gastric cancer.

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17
Q

What is a Hiatus Hernia?

A

Occurs when a defect in the Diaphragm permits a portion of the Stomach to pass through the diaphragmetic opening.
Some people asymptomatic, where others experience reflux, heartburn and chest pain.
Occurs most commonly in Women than Men
Muscle weakening which allows the Stomach to herniate is common with Ageing
May also be secondary to oesophageal cancer, kyphoscoliosis, trauma.

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18
Q

What are the Signs and Symptoms of a Hiatus Hernia?

A

Heartburn occurring 1-4 hours after eating, aggravated by reclining and belching and may be accompanied by regurgitation or vomiting.
Retrosternal or Substernal pain, occurring usually after meals or at bedtime.
Dysphagia
Bleeding due to Oesophagitis
Severe pain and such when the hernia becomes strangulated.

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19
Q

What is Pernicious Anaemia (Vitamin B12 Deficiency)?

A

Vitamin B12 is important for metabolism, the formation of Red Blood Cells and the Maintenance of the Central Nervous System, which includes the Brain and Spinal Cord.

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20
Q

What is the General Pathology of the Small Intestine?

A

Malabsorption Syndromes
Obstruction
Tumours

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21
Q

What is Crohn’s Disease?

A

Inflammatory Bowel Disease that may affect any segments of the Gastrointestinal Tract. Symptoms include abdominal pain, diarrhoea, fever, abdominal distension and weight loss. Chronic Inflammation.

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22
Q

What is Meant by Melanoma of the Small Intestines?

A

Cancer that is on the Small Intestines. Causes fat build up on external surface of SI.

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23
Q

What is Mesenteric Ischaemia?

A

Due to a suddent decline in blood flow throughout the mesenteric vessels. When narrowed or blocked arteries restrict blood flow to Small Intestines. Decreased blood flow can permanently damage the Small Intestines.

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24
Q

What is the General Pathology of the Large Intestines?

A

Diarrhoea
Constipation
Obstruction
Colitis
Tumours

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25
Q

What are Causes of Diarrhoea?

A

Colonic Causes:
Inflammatory Bowel Disease
Infective Colitis - Bacterial, Viral
Left Sided Colon Malignancy
Ischaemic Colitis
Overflow Diarrhoea secondary to Constipation
Small Bowel Causes:
Coeliac Disease
High - Output e.g. Post small bowel resection
Terminal Ileitis e.g. TB or Crohns.

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26
Q

What is a Large Intestine Obstruction?

A

When the Large intestines is blocked or obstructed by an object or mass such as a tumour. Occurs when a tumour, scar tissue or something else blocks the Large Intestines. Gas and Stool build up and the intestines may rupture.

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27
Q

What is Ulcerative Colitis?

A

Abnormal reactions of the immune system cause inflammation and ulcers on the inner lining of your large intestines.

28
Q

What is Appendicitis?

A

Inflammation accompanies the ulceration and temporarily obstructs the appendix.
Mucus outflow is blocked, which distends the Organ.
Pressure within the Appendix increases and the Appendix contracts.
Bacteria multiply and inflammation and pressure continue to increase, affecting the Blood flow to Organ and causing severe abdominal pain.
Inflammation can lead to infection, clotting, tissue decay and perforation of the Appendix.
If the Appendix ruptured or perforates, the infected contents spill into the abdominal cavity causing peritonitis, the most common and dangerous complication.

29
Q

What are the Signs and Symptoms of Appendicitis?

A

First symptom of pain is Vague epigastric pain, sometimes describes as a cramping sensation.
Over time the pain becomes more localised, moving to the right lower abdominal area.
If appendix is in the back of caecum or in the pelvis, the patient may have flank tenderness, instead of abdominal tenderness.
Anorexia
Nausea and Vomiting
Low Grade Pyrexia
Rebound tenderness on Palpation.

30
Q

What is Constipation?

A

Delayed movement of Intestinal Content through the Large Bowel.
Stool are too hard, too small, too difficult to expel, too infrequent (The FOUR TOOS)
Defined by straining 25% of the Time
Hard Stools at least 25% of the Time
Sensation of Incomplete emptying 25% of the Time.
Two or Fewer Bowel Movements a Week.

31
Q

What are the Signs and Symptoms?

A

Abdominal Fullness or Distension
Cramping abdominal pain
Flatus
Loss of Appetite
Excessive Straining
Haemorrhoids

32
Q

What are the Causes of Constipation?

A

Inadequate Dietary Fibre
Poor Fluid intake
Lifestyle issues (like being Sedentary)
Ignoring the call to stool
Environmental factors (Lack of Privacy)
Disease processes like tumours
Clients who have had surgical interventions
Clients on medication that slows gastric motility.

33
Q

What is Diarrhoea?

A

Condition in which faeces are discharged frequently from the bowels and in a liquid state.
Urgency - a sudden and irresitible need to have a bowel movement.
Abdominal Pain
Perineal Discomfort
Faecal incontinance
Increased fluid content of the stool (may be soft i.e. formed, or loose i.e. unformed - these are not the same)

34
Q

What are the Causes of Diarrhoea?

A

Often of unknown cause (Self Limiting)
Infection (Bacterial and Viral)
Allergy/Food Intolerance
Dietary Indiscretion
Malabsorption Disorders
Inflammatory Bowel Disease (Crohn’s and Ulcerative Colitis)
Intestinal Obstruction (inc Overflow)
Hormonal (inc part of Fight or Flight Response)

35
Q

What is Meant by Nausea?

A

Sensation that leads to the urge to vomit

36
Q

What is meant by Retching?

A

Strong attempt to vomit without brining anything up

37
Q

What is Vomiting?

A

Defined as involuntary expulsion of stomach contents via the mouth. Unlike Diarrhoea and constipation which are alteracations to normal gut function, vomiting is abnormal.
Bloodborne molecules and sensory impulses stream to the Emetic Centre in the Medulla, where they initiate a group of Motor Responses.
Before Vomiting an individual typically feels nauseated, is pale and salivates excessively.
A Deep inspiration preceded vomiting, the diaphragm and abdominal wall muscles contract, increasing intra abdominal pressure, the cardiac sphincter relaxes and the soft palate rises to close off the nasal passages.
As a result stomach (and perhaps duodenal) contents are forced upwards through the oesophagus and pharynx and out of the mouth.

38
Q

What is Consider Excessive Vomiting?

A

Hyperemesis or excessive vomiting can cause dehydration and severely distrust the body’s electrolyte and acid-base balance, especially pregnant women, the elderly and young children.
Since large amounts of HCL (Hydrochloric Acid) are lost in vomitus, the blood becomes alkaline as the stomach attempts to replace its lost acid.

39
Q

What is the Regulation of Gastric Emptying?

A

Stomach usually empties within 4 hours after meal.
The Larger the Meal (greater stomach distension) and more liquid its contents, the faster the stomach empties.
Fluids pass quickly through the stomach, solids linger until well mixed with gastric juiced and converted to liquid.
Stomach and duodenum act in tandem. As Chyme enters the duodenum, chemical and stretch receptors in its wall inhibitory gastric secretion and prevent duodenal filling by reducing the force of pyloric contractions.
Carbohydrate rich meal moves through duodenum quickly, but fats form an oily layer on top of chyme and slows down digestion. Fatty food may remain in the stomach for 6 hours or more.

40
Q

What is an Acute Abdomen?

A

Abdominal Emergencies usually present with:
- Acute Abdominal Pain
- Vomiting
- Shock
- Altered Bowel Habit
- Abdominal Distension

41
Q

What is Abdominal Distension?

A

Common, but non-specific symptom
If associated with severe colicky pain, vomiting and absolute constipation, it is probably an intestinal obstruction.

42
Q

What is the Peritoneum?

A

Large membrane in the abdominal cavity which houses the abdominal organs. Kidneys sit within the retroperitoneum.

43
Q

What is the Abdominal Cavity?

A

Extends from the Diaphragm to the Pelvis. Upper abdominal organs are partly in the lower thorax and lie under the lower ribs, therefore fractures to the lower ribs may damage abdominal structures such as the Liver and the Spleen.

44
Q

What is the Pelvis?

A

Contains the Bladder, Lower part of Large Intestines and in a Female, the Uterus and Ovaries.

45
Q

What is the Retroperitoneal Area?

A

Lies against the posterior abdominal wall and contains the Kidneys, Ureters and Abdominal Aorta.

46
Q

What is Meant by Acute Cholecystitis?

A

Inflammation of the Gallbladder (an organ that sits below the Liver and stores bile that is Secreted by the Liver; Bile helps with digestion after a fatty meal). Typically presents with Sharp pain in upper right quadrant, especially on palpation (positive Murphy’s Sign) and referred pain to the right shoulder tip, as well as Nausea and Vomiting.

47
Q

What is Acute Pancreatitis?

A

Inflammation of the Pancreas. (A digestive Endocrine Organ - secreted hormones such as insulin and glucagon). Secondary cause of Diabetes Mellitus. Constant epigastric and/or back pain with Nausea, Vomiting, Dehydration and a History of Alcohol abuse or Gallstones in the most common presentation.

48
Q

What is an Abdominal Aortic Aneurysm?

A

Tear in the Intimal layer of the Aortic Wall, allowing blood flow between the intima and media. Patients can present with sudden severe chest pain, abdominal pain or back pain, describes as sharp, ripping or tearing in nature. AAA rupture is a catastrophic event with a High Mortality Rate.

49
Q

What is Diverticular Disease?

A

Inflammation of Diverticula in the Large Intestines. Generalised Lower Left Quadrant Abdominal pain with altered bowel habit, bloating, nausea and vomiting.

50
Q

What is an Ectopic Pregnancy?

A

Pregnancy that implants in the Fallopian tube instead of the Uterus. Lower Abdominal, pelvic of back pain, missed period or vaginal bleeding, GI symptoms, UTI Symptoms, dizziness/feeling faint and referred shoulder tip pain. TIME CRITICAL.

51
Q

What is Gastritis?

A

Inflammation of the Stomach Lining, which can be causes by alcohol, drugs such as aspiring or NSAIDs, H/ Pylori bacterial infection or stress. Epigastric Pain or lower Chest Pain.

52
Q

What is Gastroenteritis?

A

Viral Infection which causes a sudden onset of Diarrhoea, with or without vomiting. Caused by consumption of food or water contaminated with bacteria, toxins, parasites, viruses or chemicals (food poisoning). Prevent/treat dehydration and advice should be focused on preventing transmission of infection.

53
Q

What is an Ischaemic Bowel?

A

Reduced Blood Flow and potential infarction of the Intestines. Result from thrombus. Generalised severe abdominal pain, nausea, vomiting, rectal bleeding and signs of Peritonitis.

54
Q

What is a Myocardial Infarction?

A

Ischaemic Death of myocardial tissue associated with atherosclerotic disease of the Coronary Arteries. Sudden reduction in blood flow to the Heart causes by Rupture of atherosclerotic plaque and formation of blood clot.

55
Q

What is Pelvic Inflammatory Disease?

A

Infection of the Upper Genital Tract. Due to Sexually Transmitted Disease.

56
Q

What is Peritonitis?

A

Inflammation of the Peritoneum causes by Infection. Can result from Ruptured Appendix, Stomach Ulcer, Pancreatitis Surgery, trauma to the Abdomen, Crohn’s Disease, Diverticulitis. Can lead to sepsis from perforation. Abdominal Distention, Guarding, absent/decreased bowel sounds, severe pain and refusal/inability to walk.

57
Q

What is a Peptic Ulcer?

A

Erosion of the Lining of the Stomach or Small intestine forming an Ulcer. Perforation can occur which may lead to burning epigastric pain and haematemesis.

58
Q

What is a Strangulated Hernia?

A

Hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. Surgical emergency as it cuts off blood supply to intestines or tissues with abdomen. May be Palpable mass and associated with severe localised pain.

59
Q

What is a Testicular Torsion?

A

Testicle Rotates and Twists the spermatic cord which supplied blood to the testes. Surgical Emergency. Sudden onset of severe pain in lower abdominal region or scrotum and nausea and vomiting may occur.

60
Q

What is an Ovarian Torsion?

A

Twisting of the ovary around its ligamentous supports. May result in loss of blood supply to both the Ovary and Fallopian tube. Surgical Emergency.

61
Q

What is Meant by Trauma to the Abdomen?

A

Any traumatic disruption to abdominal organs.

62
Q

What are the 4 Different Types of Pain?

A

Parietal - caused by inflammation of parietal peritoneum. Wall of abdominal cavity. Sharp pain.
Visceral - caused by distension of hollow organs. Dull Pain.
Referred - felt away from site of pain due to nerve pathways.
Red Flags - Time critical presentations that are high risk and life threatening. Red flags for abdominal pain are:
- Suspected Leaking or Ruptured abdominal aortic aneurysm, ectopic pregnancy, sepsis resulting from perforation, testicular torsion or trauma to abdomen.

63
Q

What are the 4 Steps of Abdominal Physical Assessments?

A

Inspection, Ausculation, Palpation and Percussion.

64
Q

What is Meant by Inspection?

A

Pt lying flat - inspect their abdomen for signs of:
Injury, Scars, Bruising, Abdominal Distension, Swelling, Hernias, Pulsatile mass suggest AAA, Ascites (Abnormal Fluid Accumulation in the Peritoneum most commonly caused by liver cirrhosis).

65
Q

What is Meant by Auscultation?

A

Listen with Stethoscope for Bowel sounds. Normal Bowel sounds will sound like gurgling. Reduced or absent bowel sounds may indicate malfunction of peristalsis or obstruction. Hyperactive Bowel sounds may indicate diarrhoea, build up of flatulence, hunger or recent oral intake.

66
Q

What is Meant by Palpation?

A

Lightly palpate and note abdominal tenderness, masses and guarding (involuntary tensing of abdominal muscles associated with peritonitis, appendicitis, diverticulitis and traumatic abdominal injury). Deeper palpation can be explored and specific signs such as Murphy’s sign can help to identify presence of Cholecystitis.
DO NOT PALPATE A PULSATING MASS

67
Q

What is meant by Percussion?

A

Percuss all Quandrants. Hyper-Resonance indicated air or hollow organs, Hypo-Resonance indicated possible obstruction, solid organs, ascites (shifting dullness), faeces, tumour.

Pathophsiology - OMED 1397 (8 decks)

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