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BHSC 2203 - Patho > Unit 9 - GI Disorders > Flashcards

Unit 9 - GI Disorders Flashcards

1
Q

What is dysphagia?

A

Difficulty swallowing

- neuromuscular dysfunction

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2
Q

What is achalasia?

A

Stenosis of the esophagus

  • food piles up in the esophagus
  • food cannot enter stomach
  • patients will be hungry
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3
Q

What are 5 examples of diseases of the esophagus?

A
  1. Dysphagia
  2. Achalasia
  3. Hernia
  4. Reflux esophagitis
  5. Cancer
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4
Q

Where will a LES impairment of the esophagus affect? Why?

A

Lower Esophageal Sphincter

  • lower 2/3 of the esophagus
  • because there is only SMOOTH muscle there (not skeletal muscle)
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5
Q

What are the clinical manifestation of oropharyngeal dysphagia?

A

NASAL REGURGITATION

  • coughing when swallowing
  • immediate regurgitation
  • not able to move the muscles of the jaw properly
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6
Q

What are the clinical manifestations of esophageal dysphagia?

A

LATE regurgitation

  • Chest pain at meals (from bolus putting pressure on muscular wall of esophagus)
  • frequent heartburn (abrasive force of food bolus on esophagus)
  • SWELLING OF LEFT SUPRACLAVICULAR LYMPH NODE
  • food is not going down esophagus
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7
Q

What are the reasons for achalasia?

A
  1. Spasm of esophagus
  2. Chronic inflammation of esophagus (usually b/c of acid reflux)
    - Reminder: achalasia is the stiffness of the muscle around the esophagus
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8
Q

What is a hiatal hernia?

A

Protrusion of the stomach into thoracic region

  • through the esophageal hiatus
  • means that acid will go up into the esophagus
  • causes heartburn
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9
Q

What are the two kinds of hiatal hernia?

A
  1. Sliding (direct superior displacement)

2. Paraesophageal (side displacement)

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10
Q

What are the clinical manifestations of a hiatal hernia?

A
  • acid reflux into esophagus (GERD)
  • heartburn
  • erosion/corrosion of esophageal mucosa
  • barrett esophagitis
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11
Q

What is Barrett Esophagitis?

A

Metaplasia of the cells lining the esophagus

  • stratified squamous epithetial cells are normally in the esophagus
  • Cells change over time becoming columnar cells that produce ACID
  • patient most likely gets esophageal carcinoma
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12
Q

What is the worst outcome of acid reflux?

A

Esophageal carinoma

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13
Q

What are some treatments for a hiatal hernia?

A
  • antacids
  • drink a lot of water in a short period of time (stomach fills with water) - jump down a few stairs, weight pulls stomach back in place
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14
Q

What is esophagitis?

A

Inflammation of the esophagus

  • usually the result of gastric acid reflux
  • often associated with hiatal hernia
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15
Q

What is the best treatment for reflux esophagitis?

A

PPI (proton pump inhibitors)

- decrease acid secretions

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16
Q

What is gastritis?

A

Inflammation of the stomach mucosa

- acute or chronic form

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17
Q

True or False:

Acute gastritis is a transient inflammation associated with hemorrhage within the stomach mucosa

A

True

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18
Q

What are the causes of acute gastritis?

A
  • Aspirin
  • NSAIDs
  • alcohol abuse
  • heavy smoking
  • stress and shock (seen in patient’s in ICU)
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19
Q

What is acute gastritis characterized by (3)?

A
  1. Hyperemia (excess blood)
  2. Erosions
  3. Ulcerations
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20
Q

What are the characteristics of acute gastric STRESS ulcers?

A
  • acute
  • superficial/shallow
  • multiple spots
  • associated with trauma, brain injury, and acute alcohol abuse
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21
Q

What is the main form of gastritis?

A

Chronic atrophic

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22
Q

In > 90% of chronic atrophic gastritis cases, what is it usually related to?

A 
Helicobacter pylori (a bacteria in the stomach)
- could be related to autoimmune processes
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23
Q

What does the stomach mucosa look like in cases of chronic atrophic gastritis?

A

VERY pale

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24
Q

When do chronic peptic ulcers occur? What are chronic peptic ulcers usually caused by?

A

With chronic gastritis

- usually caused by H. pylori

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25
Q

Describe the characteristics of chronic PEPTIC ulcers

A
  • recurrent
  • DEEP
  • solitary (not multiple)
  • in stomach (20%) AND duodenum (80%)
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26
Q

Where do H. pylori thrive in the body?

A

In the pylorus region

- transfer area from stomach to small intestine

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27
Q

Explain how ulcers in the stomach can lead to pernicious anemia

A

Ulceration of mucosa destroys parietal cells (produce intrinsic factor)

  • intrinsic factor is involved in absorption of vitamin B12
  • not enough B12 = pernicious anemia
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28
Q

Explain how ulcers in the stomach can lead to iron deficient anemia

A

Ulceration of mucosa destroys parietla cells (produce HCl)

  • low acid means that Fe+3 cannot be converted to Fe+2
  • could lead to iron deficient anemia
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29
Q

Explain how ulcers in the stomach can lead to hemorrhagic anemia

A

If ulceration gets down to muscularis layer - blood vessels of the stomach are vulnerable to breech
- could result in a LOT of bleeding

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30
Q

True or False:

Bleeding is a common complication of peptic ulcers

A

True

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31
Q

What is the most dangerous complication of peptic ulcers?

A

Perforation of the GI tract

- gastric contents leak into circulation (lots of bacteria) = sepsis

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32
Q

What is enterocolitis?

A

Inflammation affecting both small and large intestines

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33
Q

What is usually associated with enterocolitis?

A

An infectious agent

  • micro-organism
  • introduction of NEW bacteria into the gut
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34
Q

What are some reasons that mutualistic bacteria can become parasitic?

A
  • immuno-deficiency
  • change in pH
  • overuse of antibiotics (kill off good bacteria)
  • introduction of new bacteria into the gut
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35
Q

Describe the pathogensis of enterocolitis

A
  1. Infectious agent ingested
  2. Infection produces inflammation
  3. Inflammatory exudate is produced to dilute toxins
  4. Increase in volume causes vomiting or diarrhea
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36
Q

What can happen if there is a lot of undigested material in the GI tract?

A

Water is drawn into the gut by osmosis

- can cause explosive diarrhea

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37
Q

What are the characteristics of stool, if there is an infection in the small intestine?

A 
Volume = large
Appearance = watery
Blood = rare
Pain = periumbilical region
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38
Q

What are the characteristics of stool, if there is an infection in the large intestine?

A 
Volume = small
Appearance = mucoid
Blood = common
Pain = LLQ
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39
Q

If there is blood in the stool that originated in the small intestine, what will the blood look like?

A

Occult blood

- mixed into stool

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40
Q

If there is blood in the stool that originated in the large intestine, what will the blood look like?

A

Frank blood

- not much mixing in the large intestine

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41
Q

What are two kinds of inflammatory bowel disease (not irritable bowel syndrome)

A
  1. Ulcerative colitis

2. Crohn’s disease

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42
Q

What are BOTH ulcerative colitis and crohn’s disease characterized by?

A
  • Bloody diarrhea
  • Autoimmune causes
  • genetic predisposition
  • involves extraintestinal tissues
  • peak onset: 15 - 25 years
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43
Q

True or False:

It is almost impossible to tell Ulcerative colitis and Crohn’s disease apart

A

True

- they have basically the same symptoms

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44
Q

What layer of the GI tract is affected in ulcerative colitis?

A

ONLY mucosal (superficial) layer is affected

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45
Q

What are the two hallmark symptoms of ulcerative colitis?

A
  1. Bloody diarrhea

2. Lower abdominal cramps

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46
Q

True or False:

In ulcerative colitis, the areas of inflammation are segmental

A

False!

- they are continuous

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47
Q

What segment of the GI tract is usually affected by ulcerative colitis?

A

Distal end

  • usually just the colon
  • in the anus and rectosigmoid area
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48
Q

Why is it, that there is bleeding in ulcerative colitis if just the mucosal layer is damaged? (Mucosa doesn’t have blood vessels)

A

Just under the epithelium is a layer of connective tissue that DOES contain blood vessels

49
Q

In what disease can you find polypoid islands of intestinal mucosa?

A

Ulcerative colitis

- formed by edema fluid collection in the mucosa

50
Q

True or False:

There is no inflammation in or below GI wall smooth muscle in ulcerative colitis

A

True

51
Q

What are the complication of ulcerative colitis?

A
  • red ring around the iris
  • inflammation of bile ducts
  • jaundice
  • fatty tissue close to surface of skin
  • toxic megacolon (most serious)
52
Q

True or False:

Ulcerative colitis has a higher risk of colon cancer than Crohn’s

A

True

53
Q

What is Crohn’s disease?

A

Autoimmune disease causing granulomatous inflammation of the GI tract

54
Q

What is the most commonly affected portion of the GI tract in Crohn’s disease?

A

Terminal ileum

55
Q

True or False:

Crohn’s diease affects the entire (full) thickness of the bowel wall

A

True

- from mucosa to peritoneal surface

56
Q

What are fistula?

A

Two sections of bowel that are connected together

- through a tube-like opening

57
Q

True or False:

Crohn’s disease affects an entire segment of GI tract

A

False

  • Crohn’s disease is segmental
  • skips sections
58
Q

True or False:

Crohn’s disease only affects the large intestine

A

False

- affects the small and large intestine

59
Q

After being affected by Crohn’s disease, what happens to the tissue?

A

Becomes stiff - like rubber tubes

60
Q

True or False:

Crohn’s disease is only associated with the presence of frank blood (not occult blood too)

A

False

- can be associated with both since it can occur anywhere along the intestinal tract

61
Q

What is a microscopic feature of Crohn’s disease?

A

Granuloma with central necrosis deep in the bowel wall

62
Q

What are the clinical features of Crohn’s disease?

A
  • intermittent bouts of fever, diarrhea, and RLQ pain

- ulcerations, strictures, and fistulas

63
Q

What are the three extraintestinal manifestations of Crohn’s disease?

A
  1. Arthritis
  2. Erthema nodosum (lumps under the skin)
  3. Sclerosing cholangitis (inflammation of bile ducts)
64
Q

True or False:

In Ulcerative colitis there is the presence of granulomas

A

False

65
Q

True or False:

Fistulas are only seen in Crohn’s disease (not in Ulcerative colitis)

A

True

- not seen in UC b/c only the mucosal layer is affected

66
Q

True of False:

Megacolon is only seen in Crohn’s disease (not in ulcerative colitis)

A

False

- it is only seen in UC, not in Crohn’s

67
Q

Which has a higher risk for colon cancer, Crohn’s disease or ulcerative colitis?

A

Ulcerative colitis

68
Q

What is diverticular disease?

A

Outpouchings of the colonic wall

- at points where small arteries penetrate from the external surface

69
Q

Where is diverticulitis typically found in the GI tract?

A

Sigmoid colon (left lower end)

70
Q

Where in the world, is diverticulitis commonly found?

A

In countries with LOW dietary fibre

71
Q

True or False:

It is easier to expel a larger amount of stool instead of a smaller amount of stool

A

True

- less muscles are needed less frequently to push out small amounts

72
Q

What are the two ethological factors for diverticulitis?

A
  1. Age

2. Low dietary fibre

73
Q

What can happen if feces pool in the pouches of the colon?

A

Cause inflammation (diverticulitis)

  • can cause perforation
  • allowing bacteria to enter bloodstream = sepsis
74
Q

How does a patient present if they have diverticulitis?

A
  • LLQ pain
  • severe constipation
  • nausea
  • fever
  • usually elderly
75
Q

What are 7 complications of diverticular disease?

A
  1. Fecaliths
  2. Perforation
  3. Hemorrhage
  4. Abscess
  5. Fistula
  6. Stenosis
  7. Colonic masses
76
Q

What could happen if there is a fistula between the duodenum and the gallbladder?

A

Pancreatic enzymes could enter the gallbladder

- and digest the gallbladder!

77
Q

What are fecaliths?

A

Feces trapped in the diverticulum

78
Q

What are abscesses?

A

Areas of large inflammation

79
Q

What is peritonitis?

A

Inflammation of the peritoneum

  • usually acute
  • may be infectious or sterile
80
Q

When does infectious peritonitis occur?

A

When intestinal flora (bacteria) escape the GI tract due to GI wall perforation
- OR due to accumulation of ascitic fluid, ruptured liver abscess or salpingitis

81
Q

When does sterile peritonitis occur?

A

With chemical irritation

- when pancreatic enzymes escape pancreas in acute peritonitis

82
Q

What is the function of the peritoneal fluid?

A

Allows segments of the GI tract to slide

83
Q

What happens to the peritoneal fluid during acute peritonitis?

A

Purulent inflammatory exudate spreads throughout abdomen

  • fluid becomes sticky
  • can develop adhesions
  • could lead to GI obstruction
84
Q

What is appendicitis?

A

Obstruction by fecalith

- inflammation

85
Q

Who is most at risk for appendicitis?

A
  • teenager and young adults

- more common in males than females

86
Q

Describe the pathogenesis of appendicitis

A
  1. A fecalith obstructs the lumen of the appendix (blocking drainage of mucus)
  2. Pressure increases behind obstruction and hinders blood flow
  3. Edema, ischemia, necrosis and bacterial overgrowth result
87
Q

How does appendicitis present?

A

RLQ pain

- nausea, vomiting, fever, diarrhea, tenderness in RLQ

88
Q

How can appendicitis lead to sepsis?

A

Fecalith obstuction leading to perforation of appendix

  • loss of bacterial containment
  • leads to sepsis and peritonitis (infectious)
89
Q

Describe the arterial and venous blood flow during acute appendicitis

A

Arterial blood = can still enter appendix due to high blood pressure
Venous flow = cannot escape because of obstruction (lower blood pressure)

90
Q

What are 5 signs of a GI hemorrhage?

A
  1. Frank hematemesis
  2. Coffee-grounds vomitus
  3. Occult blood
  4. Melena
  5. Hematochezia
91
Q

What is frank hematemesis?

A

Blood in vomit

- hemorrhage ABOVE the stomach

92
Q

What is coffee-grounds vomitus?

A

Hemorrhage into the stomach with partial digestion of blood

93
Q

What is occult blood?

A

Hemorrhage into the intestines

  • blood MIXING with stool
  • need a microscope to see it
94
Q

What is melena?

A

Tar-coated stool

- hemorrhage into the intestines with LARGE volumes of blood

95
Q

What is hematochezia?

A

Red blood coated stools

- hemorrhage in the large intestine

96
Q

How does a mechanical obstruction occur in the GI tract?

A

Arises from twisting, compression, or the presence of an object in the GI lumen

97
Q

What are the manifestations of a MECHANICAL intestinal obstruction?

A
  • severe colicky pain
  • audible, high-pitched peristalsis
  • peristaltic rushes
  • patient is AWARE of intestinal movements
98
Q

What are peristaltic rushes?

A

GI wall still contracts rhythmically

  • things will be pushed AROUND the obstruction or through the obstruction
  • colicky pain (comes in waves)
99
Q

What is paralytic obstruction also called?

A

Paralytic ileus

100
Q

What is paralytic obstruction characterized by?

A
  • Absence of peristalsis

- Intestinal contents cannot be propelled down the GI tract

101
Q

What are the manifestations of paralytic obstruction?

A
  • Continuous pain

- Silent abdomen

102
Q

When does paralytic obstruction occur?

A

When the nerves fail

103
Q

What is the treatment for mechanical obstruction?

A

Remove the obstruction

- if you simply stimulate contraction in mechanical obstruction, it will INCREASE the pain

104
Q

What is the treatment for paralytic obstruction?

A

Stimulate contraction

105
Q

What are the three causes of mechanical intestinal obstruction?

A
  1. Hernia
  2. Volvulus
  3. Intussusception
106
Q

What is a hernia?

A

Protrusion of the bowel through a weak portion of the abdominal wall
- external pressure on GI wall can impair venous blood flow, causing edema and entrapment of bowel segment

107
Q

What is an inguinal hernia?

A

Small intestine drops down through the inguinal canal

  • collection of venous blood
  • it will swell and cause the constriction to WORSEN
108
Q

What is a volvulus?

A

Prolapsed (loose) mesentery doesn’t hold the intestines in place properly

  • intestines twist
  • blood flow is restricted, ischemia develops, infarction will occur, tissue dies, inflammation (or perforation)
109
Q

What is the treatment for a volvulus?

A

Surgery!

- that’s it …

110
Q

What is intussusception?

A

Part of the intestine invaginates into another

- mesentery is compressed, leading to engorgement of veins, ischemia, bleeding and pain

111
Q

Where is intussesception most likely to occur?

A

Around the terminal ileum

- cecum is more broad than small intestine

112
Q

If infants have intussesception, how will their stool look?

A

Like currant-jelly

113
Q

If a patient has pain “in the stomach”, where is their pain most likely originating from?

A

Duodenum (mid-epigastric)

114
Q

If a patient has pain that is radiating from the gallbladder, where will it be felt?

A

Mid-epigastric radiates to RUQ or right scapula

115
Q

What is the etiology and clinical findings of esophagitis?

A

Etiology: reflux (GERD)

Clinical finding: pain after meals; “heartburn”

116
Q

What is the etiology and clinical findings of gastritis?

A

Etiology: aspirin, alcohol, H. pylori

Clinical finding: Epigastric pain

117
Q

What is the etiology and clinical findings of diverticulitis?

A

Etiology: low-fiber diet

Clinical findings: low abdominal pain; fever

118
Q

What is the etiology and clinical findings of appendicitis?

A

Etiology: obstruction; “fecalith”

Clinical findings: RLQ pain, fever; rebound pain

119
Q

What is the etiology and clinical findings of peritonitis ileus?

A

Etiology: perforation

Clinical findings: severe pain

BHSC 2203 - Patho (13 decks)

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