Unit 4 - GI pt 1 Flashcards
s/s GI disease
- outcome of underlying disorders
- constitutional symptoms: nausea and vom, diarrhea, malaise, fatigue, fever, dizziness, appetite loss
aging and GI system
Constipation Dehydration Ileus Incontinence Diverticulosis absorption loss
Atrophic Gastritis
- Older age groups
- Atrophy of gastric mucosa
- dec in gastric acidity (HCI secreted by parietal cells)
is reversible
in atrophic gastritis, there is a reduced
intrinsic factor
- Also known as Gastric Intrinsic Factor (GIF)
- Secreted by Parietal Cells
- necessary for the absorption of vitamin B12 (extrinsic factor)
lack of GIF can lead to hematologic disorders such as (4)
- pernicious anemia (macrocytic, normochromic)
- peripheral neuropathy (loss of sensation, weakness, and reduced DTRs)
- subacute combined degeneration (demyelination of lateral white columns causing UMN s/s and dorsal white columns causing loss of fine tactile senses)
- dementia or “megaloblastic madness”
s/s of esophageal disorders (4)
- Dysphagia: difficulty swallowing
- Pyrosis: heartburn
- Odynophagia: pain with swallowing
- Waterbrash: reflex saliva
Esophagitis
acute, non specific
spicy food
resolves in a few days
Gastro-esophageal Reflux (GERD)
Chronic Esophagitis
Acid from the Stomach “splashes” up to the Lower Esophagus
may develop barrett’s esophagus (metaplasia of lower esophagus)
can also be caused by hiatal hernia
scleroderma
(Systemic Sclerosis)
Esophageal Muscle Atrophy
Collagen replaces Muscle
Esophageal Dysmotility and Dysphagia
Esophageal tumor
common location
highest incidence pop
Most (>50%) are in the lower 1/3 of the Esophagus Obstruction Dysphagia & Odynophagia Bleeding water brush, weight loss, cachexia
high incidence among AA on islands
risk factors and survival rate of esophageal cancer
Smoking Alcohol excess GE Reflux Age Being male
5 year relative survival rates is 47%; 25%; 5%
Achalasia (and plexi)
dilation of the lower esophagus due to loss of muscle tone
Loss of myenteric plexus (Auerbach’s)
Loss of submucosal plexus (Meissner’s)
Failure of the LES to relax when swallowing
Accumulation of food causes esophageal dilatation
Mallory-Weiss Syndrome (MWS)
Lower Esophageal Bleeding from Mucosal Tears
Bulimia, alcohol abuse, viruses
Tracheo-esophageal Fistula & 3 C’s
most common congenital disease of the esophagus (infants)
Communication between T&E
3 C’s (Cough, cyanosis, choke)
Aspiration Pneumonia
acute gastritis - stomach/duodenum
Overindulgence in alcohol or eating NSAIDs, ASA (aspirin) GI Viral Infection Some Antibiotics Oral Corticosteroids Diffuse inflammation Epigastric pain Pain - relief food pattern
peptic ulcer etiology
Diet Stress Medications Helicobacter Pylori (H. Pylori) Barriers to Acid (pH=1.5-3.5) -Mucus -Mucosal Epithelium Protective “Barriers” Fail
Back Diffusion of HCl with tissue erosion
-H2 (Histamine) Receptors are stimulated
-Histamine Release from Enterochromaffine-Like Cells (ECL)
Vasodilatation & Bleeding
More Gastric Acid Release-Parietal Cells
incidence of peptic ulcers and locations
- 1:1 Males: Females
- 80% in the duodenal bulb
- 20% pylorus of the stomach (or elsewhere in the stomach)
- Occasionally occur in the esophagus
- Helicobacter pylori (90 - 95%)
clinical features of peptic ulcers
- Nocturnal symptomatic pattern
- Seasonal exacerbations
- Pain - relief food pattern (as opposed to gall bladder disease)
complications of peptic ulcers
- Intractability
- Hemorrhage
- Perforation
- Obstruction
stress ulcers (where most common)
Most form in the fundus of the stomach Generalized GI Ischemia -Major trauma (TBI) -SCI -Serious Illness
risk factors for stress ulcers
- respiratory failure w/ ventilation
- coagulopathy
- shock
- sepsis
- head trauma
- neurosurgery
- severe burns
stomach cancer
- most are adenocarcinomas
- more males and low SES, japan and south korea
- decreasing in frequency
- H. pylori usually present
- 5 yr survival rate
linitis plastica
gastric cancer with poor prognosis
leather bottle stomach
gastric carcinoma - other types
Squamous Cell Carcinoma
Gastric Lymphoma (Mucosa Associated Lymphoid Tumor)
Gastrointestinal Stromal Tumor (GIST)
Gastric Neuroendocrine Tumor (Carcinoid)
Gastric Infiltrative Carcinoma (GIC)
Gastric Squamous Cell carcinoma-Excavated
May form a polyp
Invades the stomach wall
Gastric Lymphoma-Mucosa Associated Lymphoid Tissue (MALT) Lymphoma
Indolent tumor
Usually occurs in the stomach
Originates in B lymphocytes
Associated with chronic gastric inflammation (H. Pylori)
s/s of gastric neoplasia
epigastric pain weight loss bloating dysphagia nausea vom blood black tarry stools
