Unit 11 Flashcards
two distinct medullary centers for vomiting
vomiting and chemoreceptor trigger zone
emesis
vomiting
hypoxia exerts direct effect on
vomiting center
what are some neurotransmitters that work on chemoreceptors for the vomiting
dopamine, serotonin, opioid
do we want excess or little of dopamine, serotonin, opioids
we want little
why do we want to attack dopamine, serotonin, opioid
to prevent nausea
where is the chemoreceptor trigger zone located
small area on the floor of the fourth ventricle
the chemoreceptor trigger zone is exposed to
blood and cerebrospinal fluid
the chemoreceptor trigger zone is thought to mediate the emetic effects of
blood borne drugs and toxins
swallowing depends on the coordinated action of the
tongue and pharynx
swallowing structures are innervated by cranial nerves
V (5), IX (9), X (10), XII, (12)
dysphagia
difficulty in swallowing
Odynophagia
painful swallowing
achalasia
failure of the esophageal sphincter to relax
Mallory-Weiss Syndrome
non penetrating mucosal tears at gastroesophageal junction
Gastroesophageal Reflux Disease (AKA Gerd)
heart burn
GERD can lead to cancer how?
constant inflammation and then healing cycle
GERD pain is easily confused with
angina
Barret esophagus squamous replaced by
columnar
Barret esophagus can lead to
cancer
GERD in children commonly will present with
evidence of pain when swallowing, irritability, inconsolable crying
GERD in children may cause
respiratory problems, dental carries or ear pain
how do you get dental carries with GERD in children
because acid errodes the enamle
GERD children are very
colicly
two types of gastric mucosa
water insoluble and water soluble
water insoluble mucus forms
thin, stable gel that adheres to the gastric mucosal surface
water soluble mucus is ______ and it is a lubricant that prevents mechanical damage to the mucosal surface
viscid
Gastric Mucosal barrier is
impermeable epithelial cell surface
Gastric Mucosal Barrier mechanism for selective transport of ________ and ____ ions and characteristics of gastric mucosa
hydrogen, bicarb
ASA is non ionized and lipid soluble rapidly diffuses increases
mucosal permeability and damages epithelial cells
prostaglandin role
secrete bicarb
shock affects the
protaglandin
if you are in shock you will have more acid why?
prostaglandins are not working
Acute gastritis can or cannot heal its self
can heal itself
transient
short term
Acute Gastritis is transient inflammation of
gastric mucosa
acute gastritis inflammation is caused by
bacterial endotoxins, alcohol or asprin
acute gastritis severity ranges from
edema to hemorrhagic erosin
acute gastritis is self limiting with complete regeneration and healing within
days
Chronic Gastritis is transient or not transient
not transient
what is the most common cause of chronic gastritis is
H. Pylori
what else could cause chronic gastritis
autoimmune
how to get rid of H. Pylori
antibiotics
H. Pylori colonizes the
mucus secreting epithelial cells of the stomach
H. Pylori bacteria have what that allow them to move through the mucous layer of the stomach
multiple flagella
H. Pylori secretes _______ which enables them to produce sufficient ammonia to buffer acidity of their environment
urease
H. Pylori produce _______ and ______ that interfere with mucosal protection against injury from gastric acid
enzymes, toxins
second most common cause of Chronic Gastritis
NSAIDs
H. Pylori causes damages to the stomach lining which could lead to what 2 issues
ulcers or increased risk of gastric cancer
When you take Aspirin/NSAIDs those drugs inhibit the synthesis of prostaglandins leading to
increased acid production because acid production is regulated by prostaglandins so when you inhibit them you have unregulated acid production
NSAIDs and aspirin contribute to the formation of gastritis by inhibiting the
synthesis of prostaglandins
when you take NSAIDs/asprin the synthesis of prostaglandins is decreased due to the __________ action of the drug; there for ____ _________ is unregulated
anti inflammatory, acid production
why would the c urea breath test with when testing for H. Pylori
because they released urease
ways to test for H. Pylori
C urea breath test, stool antigen test
C urea breath test using
radioactive carbon isotope
Peptic ulcer disease can be caused by
H. Pylori, use of ASA and NSAIDs
peptic ulcer you get discomfort and pain when the stomach is empty or full
empty
melena
black tarry stool
stress curling happens when you have
massive burns
cushings is increased
cranial pressire
you get cushings after
injury, operation, tumors
complications of peptic ulcers
hemorrhage, obstruction, perforation
hemorrhage does or does not go through the wall
can happen when the ulcer doesn’t go through the wall
hemorrhage
caused by bleeding from granulation tissue or from erosion of an ulcer into an artery or vein
obstruction caused by
edema, spasm, or contraction of scar tissue and interference with the free passage of gastric contents through the pylorus or adjacent areas
perforation occurs when an ulcer erodes
through all the layers
perforation looks like a
flower
hematemesis and Selena occurs with
hemorrhage
hematemsis
blood in vomitus
melena
blood in stool
occult
hidden
cancer of the stomach is often
asymptomatic
autoimmune gastritis is chronic
inflammation
chrons is
skip lesions of mucosa
ulcerative colitis is located just in
colon
ulcerative colitis is ___________ of mucosa
continuous
Crohn type of inflammation
granulomatous
ulcerative colitis type of inflammation
ulcerative/exudative
crohns area of involvement
primary ileum, secondary colon
ulcerative colitis area of involvement
primarily rectum and left colon
Crohn and ulcerative colitis diarrhea
common with both
crohn rectal bleeding
rare
ulcerative colitis rectal bleeding
common
crohns fistulas
common
ulcerative colitis fistulas
rare
crohns strictures/perianal abcess
common
ulcerative colitis strictures/perianal abcess
rare
crohns development of cancer
may occur
ulcerative colitis development of cancer
high risk
clostridium difficile colitis is caused by
a lot of antibiotics
clostridium difficile colitis you get _______ with lower abdominal cramping
diarrhea
clostridium difficile is caused by disruption to the normal flora which leads to
colonization and release of toxins which cause mucosal damage and inflammation
E coli is a ____ borne transmission, person to person
food
E. coli may occur in
nursing homes, day care and hospitals
e coli may lead to watery
diarrhea
e coli may lead to
hemorrhagic colitis, hemolytic uremic syndrome and TTP
Appendicitis is
swollen, gangrenous
in appendicitis it wil eventually
perforates
cause of appendicitis is unknown but may be due to
intraliminal obstruction with fecalith or twisting
appendicitis has abrupt or longer onset
abdrupt
appendicitis pain is
referred
with appendicitis the pain will localize to the ____ in 2-12 hours
RLQ
the key factor with appendicitis is
rebound tenderness
rebound tenderness
does not hurt when you press down but when you removed pressure
peritinoitus has rebound tenderness in
all quadrants
2 types of intestinal obstruction
mechanical or paralytic
mechanical obstruction can lead to
vomitting
why would mechanical obstruction lead to vomiting
because the bolus cannot go thorough the obstruction so it must come up rather than down
mechanical obstruction can be caused by
hernia, adhesions, intussusception and volvulus
paralytic obstruction is caused by
neurogenic or muscular impairment of peristalsis most commonly after abdominal surgery
4 types of mechanical obstructions
adhesions, volvulus, incarcerated inguinal hernia, intuddusception
voluvus
twisting
adhesions
two portions of the intestine are connected by a scar
intussusception
the intention folds in
in mechanical you have what type of pain
severe, colicky pain
in mechanical you will hear borborygmus which is
rumbling thundery noise of air rushing
paralytic will have what type of pain
continous
will paralytic have noise or be silent
silent
paralytic there is not true blockage but the bowels are
paralyzed
results of obstruction
vomiting which leads to fluid and electrolyte loss, distension of bowel, and anaerobic bacteria will produce endotoxin which lead to toxemia
with peritonitis where will you get rebound tenderness
all over abdominal
peritonitis is well adapted for inflammatory response how?
exudes thick, sticky, fibrinous substance that adheres and walls off perforated viscus and aids in localizing process
peritonitis uses sympathetic stimulation that limits intestinal activity why?
inhibits movement of contaminants
peritonitis translocation of ECF to peritoneal cavity and bowl can cause
nausea, vomiting, hypovolemia and shock
what are some things that could lead to peritonitis
perforated peptic ulcer, ruptured appendix, perforated divertivulum, gangrenous bowl, gangrenous gallbladder
with colorectal cancers pain is a early or late symptom
late
with colorectal cancer _____ side colon could lead to no symptoms until it develops to a mass
right
colorectal cancer could be caused by
crohn disease, ulcerative colitis
liver function tests
liver enzymes, protein levels, prothrombin time, bilirubin, ultrasound, CT, MRI, angio
jaundice in the eye is also called
sclera icterus
cause of jaundice
excessive destruction of red blood cells, impaired uptake of bilirubin by the liver cells, decreased conjucation of bilirubin, obstruction of bile flow
prehepatic
before liver
intrahepatic
in liver
posthepatic
after liver
prehepatic major cause is
excessive hemolysis of red blood cells
intrahepatic causes by disorders that directly affect the ability of the liver to removed
bilirubin
posthepatic occurs when bile flow is obstructive between the liver and the
intestine
which of the following is not a cause of jaundice?
- excessive destruction of red blood cells
- impaired uptake of bilirubin by the liver cells
- ingestion of iron supplements
- obstruction of bile flow in the canaliculi of the hepatic lobules or in the tntrahepatic or extra hepatic bile ducts
ingestion of iron supplements
Tylenol affects the ______
liver
cause of hepatitis
autoimmune disorders, reactions to drugs and toxins, infectious disorders, hepatotoxic viruses that primarily affect liver cells or hepatocytes
spectrum of alcoholic liver disease includes
fatty liver disease
alcoholic hepatitis
cirrhosis
in cirrhosis the ___________ is disrupted
cytoskeleton
cirrhosis end state chronic liver disease in which normal architecture of liver is replaced by
fibrous septa
portal hypertension ___________ resistance to flow in portal venous system and sustained pressures
resistance
portal hypertension causes increased pressure in ___________ capillaries
peritoneal
portal hypertension cause portosystemic _________ of blood
shunting
portal hypertension
splenomegaly
increased pressure in peritoneal capillaries causes
ascites
splenomegaly causes
anemia, leukopenia, thromboytopenia, bleeding
decreased albumin causes decrease colloidal osmotic pressure which causes
ascites
increase bilirubin causes
decrease clotting factors
manifestations of cirrhosis
weight loss, portal hypertension, ascites, esophageal varies, splenomegaly
cholelithiasis
gallstones
cholecystitis
inflammation of gallbladder
acute pancreatitis
serve life treating disorder associated with escape of activated pancreatic enzymes into pancreas and surrounding tissue
acute pancreatitis: enzymes induce fat necrosis or
autodigestion of pancreas
acute pancreatitis: onset of
severe pain abrupt
acute pancreatitis: loss of _________ into retroperitoneal and peripancreatic spaces
volume
acute pancreatitis: hypocalcemia due to ___________ of calcium in fat necrosis
precipitation
acute pancreatitis what is used for diagnosis
serum amylase and lipase
acute pancreatitis causes ____ and ____ may result in death
ARDS, ATN
common causes acute pancreatitis:
gallstones
Cullens sign
test for pancreatitis blood behind belly button
chronic pancreatitis
calcifying or obstructive
cancer of pancreas: cause
unknown
are they pain endings in pancreas
no
