Unit 9 - GI Disorders Flashcards
What is dysphagia?
Difficulty swallowing
- neuromuscular dysfunction
What is achalasia?
Stenosis of the esophagus
- food piles up in the esophagus
- food cannot enter stomach
- patients will be hungry
What are 5 examples of diseases of the esophagus?
- Dysphagia
- Achalasia
- Hernia
- Reflux esophagitis
- Cancer
Where will a LES impairment of the esophagus affect? Why?
Lower Esophageal Sphincter
- lower 2/3 of the esophagus
- because there is only SMOOTH muscle there (not skeletal muscle)
What are the clinical manifestation of oropharyngeal dysphagia?
NASAL REGURGITATION
- coughing when swallowing
- immediate regurgitation
- not able to move the muscles of the jaw properly
What are the clinical manifestations of esophageal dysphagia?
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
What are the reasons for achalasia?
- Spasm of esophagus
- Chronic inflammation of esophagus (usually b/c of acid reflux)
- Reminder: achalasia is the stiffness of the muscle around the esophagus
What is a hiatal hernia?
Protrusion of the stomach into thoracic region
- through the esophageal hiatus
- means that acid will go up into the esophagus
- causes heartburn
What are the two kinds of hiatal hernia?
- Sliding (direct superior displacement)
2. Paraesophageal (side displacement)
What are the clinical manifestations of a hiatal hernia?
- acid reflux into esophagus (GERD)
- heartburn
- erosion/corrosion of esophageal mucosa
- barrett esophagitis
What is Barrett Esophagitis?
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
What is the worst outcome of acid reflux?
Esophageal carinoma
What are some treatments for a hiatal hernia?
- 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
What is esophagitis?
Inflammation of the esophagus
- usually the result of gastric acid reflux
- often associated with hiatal hernia
What is the best treatment for reflux esophagitis?
PPI (proton pump inhibitors)
- decrease acid secretions
What is gastritis?
Inflammation of the stomach mucosa
- acute or chronic form
True or False:
Acute gastritis is a transient inflammation associated with hemorrhage within the stomach mucosa
True
What are the causes of acute gastritis?
- Aspirin
- NSAIDs
- alcohol abuse
- heavy smoking
- stress and shock (seen in patient’s in ICU)
What is acute gastritis characterized by (3)?
- Hyperemia (excess blood)
- Erosions
- Ulcerations
What are the characteristics of acute gastric STRESS ulcers?
- acute
- superficial/shallow
- multiple spots
- associated with trauma, brain injury, and acute alcohol abuse
What is the main form of gastritis?
Chronic atrophic
In > 90% of chronic atrophic gastritis cases, what is it usually related to?
Helicobacter pylori (a bacteria in the stomach) - could be related to autoimmune processes
What does the stomach mucosa look like in cases of chronic atrophic gastritis?
VERY pale
When do chronic peptic ulcers occur? What are chronic peptic ulcers usually caused by?
With chronic gastritis
- usually caused by H. pylori
Describe the characteristics of chronic PEPTIC ulcers
- recurrent
- DEEP
- solitary (not multiple)
- in stomach (20%) AND duodenum (80%)
Where do H. pylori thrive in the body?
In the pylorus region
- transfer area from stomach to small intestine
Explain how ulcers in the stomach can lead to pernicious anemia
Ulceration of mucosa destroys parietal cells (produce intrinsic factor)
- intrinsic factor is involved in absorption of vitamin B12
- not enough B12 = pernicious anemia
Explain how ulcers in the stomach can lead to iron deficient anemia
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
Explain how ulcers in the stomach can lead to hemorrhagic anemia
If ulceration gets down to muscularis layer - blood vessels of the stomach are vulnerable to breech
- could result in a LOT of bleeding
True or False:
Bleeding is a common complication of peptic ulcers
True
What is the most dangerous complication of peptic ulcers?
Perforation of the GI tract
- gastric contents leak into circulation (lots of bacteria) = sepsis
What is enterocolitis?
Inflammation affecting both small and large intestines
What is usually associated with enterocolitis?
An infectious agent
- micro-organism
- introduction of NEW bacteria into the gut
What are some reasons that mutualistic bacteria can become parasitic?
- immuno-deficiency
- change in pH
- overuse of antibiotics (kill off good bacteria)
- introduction of new bacteria into the gut
Describe the pathogensis of enterocolitis
- Infectious agent ingested
- Infection produces inflammation
- Inflammatory exudate is produced to dilute toxins
- Increase in volume causes vomiting or diarrhea
What can happen if there is a lot of undigested material in the GI tract?
Water is drawn into the gut by osmosis
- can cause explosive diarrhea
What are the characteristics of stool, if there is an infection in the small intestine?
Volume = large Appearance = watery Blood = rare Pain = periumbilical region
What are the characteristics of stool, if there is an infection in the large intestine?
Volume = small Appearance = mucoid Blood = common Pain = LLQ
If there is blood in the stool that originated in the small intestine, what will the blood look like?
Occult blood
- mixed into stool
If there is blood in the stool that originated in the large intestine, what will the blood look like?
Frank blood
- not much mixing in the large intestine
What are two kinds of inflammatory bowel disease (not irritable bowel syndrome)
- Ulcerative colitis
2. Crohn’s disease
What are BOTH ulcerative colitis and crohn’s disease characterized by?
- Bloody diarrhea
- Autoimmune causes
- genetic predisposition
- involves extraintestinal tissues
- peak onset: 15 - 25 years
True or False:
It is almost impossible to tell Ulcerative colitis and Crohn’s disease apart
True
- they have basically the same symptoms
What layer of the GI tract is affected in ulcerative colitis?
ONLY mucosal (superficial) layer is affected
What are the two hallmark symptoms of ulcerative colitis?
- Bloody diarrhea
2. Lower abdominal cramps
True or False:
In ulcerative colitis, the areas of inflammation are segmental
False!
- they are continuous
What segment of the GI tract is usually affected by ulcerative colitis?
Distal end
- usually just the colon
- in the anus and rectosigmoid area
Why is it, that there is bleeding in ulcerative colitis if just the mucosal layer is damaged? (Mucosa doesn’t have blood vessels)
Just under the epithelium is a layer of connective tissue that DOES contain blood vessels
In what disease can you find polypoid islands of intestinal mucosa?
Ulcerative colitis
- formed by edema fluid collection in the mucosa
True or False:
There is no inflammation in or below GI wall smooth muscle in ulcerative colitis
True
What are the complication of ulcerative colitis?
- red ring around the iris
- inflammation of bile ducts
- jaundice
- fatty tissue close to surface of skin
- toxic megacolon (most serious)
True or False:
Ulcerative colitis has a higher risk of colon cancer than Crohn’s
True
What is Crohn’s disease?
Autoimmune disease causing granulomatous inflammation of the GI tract
What is the most commonly affected portion of the GI tract in Crohn’s disease?
Terminal ileum
True or False:
Crohn’s diease affects the entire (full) thickness of the bowel wall
True
- from mucosa to peritoneal surface
What are fistula?
Two sections of bowel that are connected together
- through a tube-like opening
True or False:
Crohn’s disease affects an entire segment of GI tract
False
- Crohn’s disease is segmental
- skips sections
True or False:
Crohn’s disease only affects the large intestine
False
- affects the small and large intestine
After being affected by Crohn’s disease, what happens to the tissue?
Becomes stiff - like rubber tubes
True or False:
Crohn’s disease is only associated with the presence of frank blood (not occult blood too)
False
- can be associated with both since it can occur anywhere along the intestinal tract
What is a microscopic feature of Crohn’s disease?
Granuloma with central necrosis deep in the bowel wall
What are the clinical features of Crohn’s disease?
- intermittent bouts of fever, diarrhea, and RLQ pain
- ulcerations, strictures, and fistulas
What are the three extraintestinal manifestations of Crohn’s disease?
- Arthritis
- Erthema nodosum (lumps under the skin)
- Sclerosing cholangitis (inflammation of bile ducts)
True or False:
In Ulcerative colitis there is the presence of granulomas
False
True or False:
Fistulas are only seen in Crohn’s disease (not in Ulcerative colitis)
True
- not seen in UC b/c only the mucosal layer is affected
True of False:
Megacolon is only seen in Crohn’s disease (not in ulcerative colitis)
False
- it is only seen in UC, not in Crohn’s
Which has a higher risk for colon cancer, Crohn’s disease or ulcerative colitis?
Ulcerative colitis
What is diverticular disease?
Outpouchings of the colonic wall
- at points where small arteries penetrate from the external surface
Where is diverticulitis typically found in the GI tract?
Sigmoid colon (left lower end)
Where in the world, is diverticulitis commonly found?
In countries with LOW dietary fibre
True or False:
It is easier to expel a larger amount of stool instead of a smaller amount of stool
True
- less muscles are needed less frequently to push out small amounts
What are the two ethological factors for diverticulitis?
- Age
2. Low dietary fibre
What can happen if feces pool in the pouches of the colon?
Cause inflammation (diverticulitis)
- can cause perforation
- allowing bacteria to enter bloodstream = sepsis
How does a patient present if they have diverticulitis?
- LLQ pain
- severe constipation
- nausea
- fever
- usually elderly
What are 7 complications of diverticular disease?
- Fecaliths
- Perforation
- Hemorrhage
- Abscess
- Fistula
- Stenosis
- Colonic masses
What could happen if there is a fistula between the duodenum and the gallbladder?
Pancreatic enzymes could enter the gallbladder
- and digest the gallbladder!
What are fecaliths?
Feces trapped in the diverticulum
What are abscesses?
Areas of large inflammation
What is peritonitis?
Inflammation of the peritoneum
- usually acute
- may be infectious or sterile
When does infectious peritonitis occur?
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
When does sterile peritonitis occur?
With chemical irritation
- when pancreatic enzymes escape pancreas in acute peritonitis
What is the function of the peritoneal fluid?
Allows segments of the GI tract to slide
What happens to the peritoneal fluid during acute peritonitis?
Purulent inflammatory exudate spreads throughout abdomen
- fluid becomes sticky
- can develop adhesions
- could lead to GI obstruction
What is appendicitis?
Obstruction by fecalith
- inflammation
Who is most at risk for appendicitis?
- teenager and young adults
- more common in males than females
Describe the pathogenesis of appendicitis
- A fecalith obstructs the lumen of the appendix (blocking drainage of mucus)
- Pressure increases behind obstruction and hinders blood flow
- Edema, ischemia, necrosis and bacterial overgrowth result
How does appendicitis present?
RLQ pain
- nausea, vomiting, fever, diarrhea, tenderness in RLQ
How can appendicitis lead to sepsis?
Fecalith obstuction leading to perforation of appendix
- loss of bacterial containment
- leads to sepsis and peritonitis (infectious)
Describe the arterial and venous blood flow during acute appendicitis
Arterial blood = can still enter appendix due to high blood pressure
Venous flow = cannot escape because of obstruction (lower blood pressure)
What are 5 signs of a GI hemorrhage?
- Frank hematemesis
- Coffee-grounds vomitus
- Occult blood
- Melena
- Hematochezia
What is frank hematemesis?
Blood in vomit
- hemorrhage ABOVE the stomach
What is coffee-grounds vomitus?
Hemorrhage into the stomach with partial digestion of blood
What is occult blood?
Hemorrhage into the intestines
- blood MIXING with stool
- need a microscope to see it
What is melena?
Tar-coated stool
- hemorrhage into the intestines with LARGE volumes of blood
What is hematochezia?
Red blood coated stools
- hemorrhage in the large intestine
How does a mechanical obstruction occur in the GI tract?
Arises from twisting, compression, or the presence of an object in the GI lumen
What are the manifestations of a MECHANICAL intestinal obstruction?
- severe colicky pain
- audible, high-pitched peristalsis
- peristaltic rushes
- patient is AWARE of intestinal movements
What are peristaltic rushes?
GI wall still contracts rhythmically
- things will be pushed AROUND the obstruction or through the obstruction
- colicky pain (comes in waves)
What is paralytic obstruction also called?
Paralytic ileus
What is paralytic obstruction characterized by?
- Absence of peristalsis
- Intestinal contents cannot be propelled down the GI tract
What are the manifestations of paralytic obstruction?
- Continuous pain
- Silent abdomen
When does paralytic obstruction occur?
When the nerves fail
What is the treatment for mechanical obstruction?
Remove the obstruction
- if you simply stimulate contraction in mechanical obstruction, it will INCREASE the pain
What is the treatment for paralytic obstruction?
Stimulate contraction
What are the three causes of mechanical intestinal obstruction?
- Hernia
- Volvulus
- Intussusception
What is a hernia?
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
What is an inguinal hernia?
Small intestine drops down through the inguinal canal
- collection of venous blood
- it will swell and cause the constriction to WORSEN
What is a volvulus?
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)
What is the treatment for a volvulus?
Surgery!
- that’s it …
What is intussusception?
Part of the intestine invaginates into another
- mesentery is compressed, leading to engorgement of veins, ischemia, bleeding and pain
Where is intussesception most likely to occur?
Around the terminal ileum
- cecum is more broad than small intestine
If infants have intussesception, how will their stool look?
Like currant-jelly
If a patient has pain “in the stomach”, where is their pain most likely originating from?
Duodenum (mid-epigastric)
If a patient has pain that is radiating from the gallbladder, where will it be felt?
Mid-epigastric radiates to RUQ or right scapula
What is the etiology and clinical findings of esophagitis?
Etiology: reflux (GERD)
Clinical finding: pain after meals; “heartburn”
What is the etiology and clinical findings of gastritis?
Etiology: aspirin, alcohol, H. pylori
Clinical finding: Epigastric pain
What is the etiology and clinical findings of diverticulitis?
Etiology: low-fiber diet
Clinical findings: low abdominal pain; fever
What is the etiology and clinical findings of appendicitis?
Etiology: obstruction; “fecalith”
Clinical findings: RLQ pain, fever; rebound pain
What is the etiology and clinical findings of peritonitis ileus?
Etiology: perforation
Clinical findings: severe pain
