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NUR 326-Pathopharm > Upper and Lower GI > Flashcards

Upper and Lower GI Flashcards

1
Q

Upper GI structures

A

Esophagus, stomach, beginning of intestines

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2
Q

Upper GI problems

A

Esophageal disorders:
-GERD
-Hiatal Hernia

Inflammatory disorders of the stomach:
-Gastritis
-Acute Gastroenteritis
-PUD

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3
Q

Dysphagia: Definition

A

Defined: Difficulty swallowing
– Begins with solids and progresses to liquids

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4
Q

Dysphagia common causes:

A
  1. Mechanical obstruction
    ■ Stenosis or stricture
    ■ Diverticula
    ■ Tumors
  2. Neuromuscular dysfunction
    ■ CVA
    ■ Achalasia – LES can’t open properly
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5
Q

GERD: definition

A

GASTROESOPHAGEAL REFLUX DISEASE = GERD
– Backflow of gastric acid from the stomach into esophagus
– Occurs via the lower esophageal sphincter (LES)
– Highly ACIDIC material!

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6
Q

GERD: Etiology

A

■ Anything that alters closure strength of LES or increases abdominal pressure
■ Examples:
– Fatty foods
– Spicy foods
– Tomato based foods
– Citrus foods
– Caffeine
– Large amounts of alcohol
– Cigarette smoking
– Sleep position
– Obesity
– Pregnancy
– Pharmacologic agents

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7
Q

GERD: Clinical Manifestations

A

■ Heartburn (pyrosis)
■ Dyspepsia
■ Regurgitation
■ Chest pain
■ Dysphagia
■ Pulmonary symptoms

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8
Q

GERD: Complications

A

Complications:
– ulceration
– scarring
– strictures
– Barrett esophagus (development of
abnormal metaplastic tissue -premalignant)
■ Three-fold increased risk of developing
adenocarcinoma of the esophagus
■ Over all survival only 17%

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9
Q

Hiatal Hernia: Definition

A

■ A defect in the diaphragm that allows part of the STOMACH to pass into the THORAX

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10
Q

Two main types of hiatal hernia

A

■ Two Main Types:
1. Sliding hernia – usually small and often do not need treatment
2. Paraesophageal hernia- part of the
stomach pushes through the diaphragm
and stays there

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11
Q

Hiatal Hernia: Pathophysiology

A

■ Exact cause is unknown
■ Age related
■ Injury or other damage may weaken the diaphragm muscle
■ Repeatedly putting too much pressure on the muscles around the stomach
– Severe coughing
– Vomiting
– Constipation and straining to have a bowel movement

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12
Q

Hiatal Hernia: risk factors

A

Age, obesity, smoking

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13
Q

Hiatal Hernia: Clinical manifestations

A
  • Asymptomatic
  • Belching
  • Dysphagia
  • Chest or epigastric pain

*Common for GERD and Hiatal Hernia to coexist

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14
Q

Hiatal Hernia: Treatment

A

■ Mostly a conservative treatment
– Teaching: small, frequent meals, avoid lying down after eating
– Avoid tight clothing and abdominal supports
– Weight control for obese individuals
– Antacids for the GERD/esophagitis symptoms
■ Surgery if the conservative treatments do not work

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15
Q

Acute Gastritis: Definition

A

■ Defined: TEMPORARY inflammation of the STOMACH lining only (intestines NOT affected)
■ Generally last from 2-10 days

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16
Q

Acute Gastritis: Etiology

A

■ Etiology:
– Irritating substances (alcohol)
– Drugs (NSAIDs)
– Infectious agents

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17
Q

Chronic Gastritis: Definition

A

■ PROGRESSIVE disorder with chronic inflammation in the stomach
– Can last weeks to years

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18
Q

Chronic Gastritis complications

A

PUD, bleeding ulcers, anemia, gastric cancers

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19
Q

Chronic Gastritis: Etiology (2)

A

■ Two main etiologies:
1. Autoimmune: Attacks parietal cells
2. H. pylori infection

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20
Q

What is H. pylori?

A

-Helicobacter pylori bacterium
-Acidic environment
-Destructive pattern of persistent inflammation
- Can cause chronic gastritis, PUD, and
stomach cancer

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21
Q

How is H. pylori transmitted?

A

– Person to person via saliva, fecal matter, or vomit
– Contaminated food or water

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22
Q

Acute or Chronic Gastritis:
Clinical Manifestations

A
  • Sometimes none
  • Anorexia
  • N/V
  • Postprandial discomfort
  • Intestinal gas
  • Hematemesis
  • Tarry Stools
  • Anemia
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23
Q

Acute Gastroenteritis:
Definition and Etiology

A

■ Inflammation of stomach &
SMALL INTESTINE
■ Etiology:
– Viral infections: Norovirus
and rotavirus
– Bacterial infections: E. col,
salmonella, campylobacter
– Parasitic infections
■ Usually lasts 1-3 days but may
last as long as 10 days

24
Q

Acute Gastroenteritis:
Clinical manifestations and Complications

A

■ Clinical manifestations
– Watery Diarrhea
-May be bloody if bacterial
– Abdominal pain
– N/V
– Fever, malaise

■ Complication: fluid volume
deficits

25
Q

PEPTIC ULCER DISEASE: Definition

A

■ Ulcerative disorder of the upper GI tract
– Esophageal
– Stomach (gastric ulcers)
– Duodenum (peptic ulcer in the first part of the small intestine)
■ Develops when the GI tract is exposed to acid and h. pylori

26
Q

BALANCING ACT of GI Health:

-Aggressive factors
-Defensive factors

A

Aggressive factors:
-H. pylori
-NSAIDS
-Acid
-Pepsin
-Smoking

Defensive factors:
-Mucus
-Bicarbonate
-Blood flow
-Prostaglandins

27
Q

PUD: Etiology

A
  • H. pylori
  • Injury-causing substances
    -NSAIDs, ASA, alcohol
  • Excess secretion of acid
  • Smoking
  • Family history
  • Stress - remember there is increased gastric acid secreted with the stress
    response
28
Q

Risk factors: NSAID-Induced Peptic Ulcer Disease

A

-Age
-Higher doses of NSAIDs
-History of PUD
-Use of corticosteroids and anticoagulants
-Serious systemic disorders
-H. pylori infection

29
Q

PUD: Pathogenesis

A

-Mucosa is damaged
-Histamine is secreted, resulting in:
-Increase in acid and pepsin secretion–causes further tissue damage
-Vasodilation– causes edema
-If blood vessels are destroyed, this results in BLEEDING

30
Q

PUD: Classification

A

Duodenal ulcer
-Most common type
-Age – any; early adulthood

Gastric/peptic ulcer
-Age – peak 50 - 70
-Why? Increased use of NSAIDS, corticosteroids, anticoagulants and more
likely to have serious systemic illnesses

31
Q

PUD: Clinical Manifestations

A

-Sometimes none
-N/V, anorexia
-Weight loss
-Bleeding
-Burning Pain: in middle of abdomen that is usually worse when the stomach
is empty

32
Q

Timing of PUD symptoms: Gastric vs. Duodenal

A

Gastric: 1-2 hours after eating

Duodenal: 2-4 hours after eating

33
Q

PUD: Complications

A

“HOP” Complications
H – Hemorrhage
O – Obstruction
P - Perforation and Peritonitis

34
Q

LOWER GI DISORDERS

A

Appendicitis
Peritonitis
Irritable bowel disorder
Inflammatory bowel disorder:
-Crohn’s, Ulcerative Colitis
Diverticulosis/Diverticulitis

35
Q

Appendicitis: definition and etiology

A

-Inflammation of the appendix

-Etiology
Appendix is OBSTRUCTED
Leads to INFLAMMATION

36
Q

Appendicitis Pain

A
  • Classic Pain: RLQ in periumbilical area
  • Rebound Pain = Pain is SEVERE
    after release of palpating hand over the RLQ
  • Sudden pain relief may indicate rupture - Peritonitis
37
Q

Peritonitis: Definition

What happens to the peritoneum?

A

■ Inflammation of the PERITONEUM
■ Serous membrane that lines abdominal cavity & covers visceral organs

What happens to the peritoneum?
■ INFLAMMATION
■ Fluid shifts – THIRD SPACING
■ Can lead to hypovolemic shock and
sepsis
■ DECREASED PERISTALSIS
■ Can lead to paralytic ileus and intestinal obstruction

38
Q

Peritonitis: Causes

A

Perforated ulcer
Ruptured gallbladder
Pancreatitis
Ruptured spleen
Ruptured bladder
Ruptured appendix

39
Q

Peritonitis: Clinical Manifestations

A

■ Usually sudden and severe
■ Abdominal pain*
■ Tenderness
■ Rigid “board-like” abdomen
■ N/V
■ Others:
– Fever
– Elevated WBC
– HR: increased
– BP: decreased

40
Q

LOWER GI PROBLEMS

A

-IRRITABLE BOWEL SYNDROME
-INFLAMMATORY BOWEL DISEASE

41
Q

Irritable Bowel Syndrome : Definition

A

■ Chronic condition characterized by:
alterations in bowel pattern due to changes in intestinal motility
– Chronic and frequent constipation
(IBSC)
– Chronic and frequent diarrhea (IBSD)

42
Q

Irritable Bowel Syndrome: symptoms

A

■ Symptoms: vary by individual
– Abdominal distension, fullness, flatus,
and bloating
– Intermittent abdominal pain
exacerbated by stress and RELIEVED
BY DEFECATION
– Bowel urgency
– Intolerance to certain foods (sorbitol,
lactose, gluten)
– Non-bloody stool that may contain
mucous

43
Q

Inflammatory Bowel Disease (IBD): Definition and Etiology

A

■ A group of life-changing, chronic illnesses
■ TWO SEPARATE DISORDERS:
– Crohn’s disease
– Ulcerative colitis
■ Characterized by:
– Chronic inflammation of the intestines
– Exacerbation and remissions
■ More common in WOMEN, Caucasians, persons of Jewish descent, and smokers
■ Etiology?
■ Genetically AUTOIMMUNE activated by an infection

44
Q

Crohn’s Disease Pathogenesis

A

■ Lymph structures of the GI tract are blocked
■ Tissue becomes engorged and inflamed
■ Deep linear FISSURES and ULCERS develop
in a ”patchy” pattern in the bowel wall
– SKIP LESIONS
– COBBLESTONE APPEARANCE

45
Q

Crohn’s Disease: Complications

A

■ Complications:
– Malnutrition
■ Anemia
– Scar tissue and obstructions
– Fistulas
– Cancer

46
Q

Crohn’s Disease: Clinical Manifestations

A

■ Crampy lower Abdominal pain (RLQ)
■ Watery diarrhea
■ SYSTEMIC:
– Weight loss, fatigue, no appetite, fever,
malabsorption of nutrients
■ Palpable abdominal mass (RLQ)
■ Mouth ulcers
■ S/S of fistulas

46
Q

Ulcerative Colitis: Incidence

A

■ Inflammation of the mucosa of the
RECTUM AND COLON
■ Usually develops in the third decade of
life
■ More common in white people of
European descent, esp. Ashkenazi
Jewish descent
– Occasionally in Black/African
Americans
-Rare in Asians

46
Q

Ulcerative colitis: pathogenesis

A

■ Inflammation begins in the rectum and
extends in a CONTINUOUS segment
that may involve the ENTIRE colon
■ Inflammation leads to large ulcerations
■ Necrosis of the epithelial tissue can result abscesses – CRYPT ABSCESSES
■ Colon and rectum try to repair the
damage with new granulation tissue
– Why is this a problem? Tissue is fragile and bleeds easily

46
Q

Complications of Ulcerative Colitis

A

Complications:
-Hemorrhage
-Perforation
-Cancer
■ Malnutrition
■ Anemia
■ Strictures
■ FISSURES
■ ABSCESSES
■ TOXIC MEGACOLON – a rapid dilation of the large intestine that can be life threatening
■ COLORECTAL CARCINOMA
■ Liver Disease – from inflammation and
scarring of bile ducts
■ Fluid, electrolyte and PH imbalances

46
Q

Diverticulosis: Clinical Manifestations

A

■ Usually asymptomatic
■ Discovered accidently or with
presentation of acute diverticulitis

46
Q

Ulcerative Colitis: Clinical Manifestations

A

-Abdominal pain
-Bloody diarrhea
-Systemic:
-Weight loss, fatigue, no appetite, fever

46
Q

Diverticulosis: Pathogenesis

A
  • Development of diverticula:
  • Small pouches in lining of colon that bulge outward through weak spots
  • May be CONGENITAL or ACQUIRED
  • Thought to be caused by low fiber diet with resulting chronic constipation
  • Usual location: DESCENDING COLON
47
Q

Diverticulitis: Definition

A

INFLAMMATION of one or more of the
pouches (diverticula)
-Usually from retained fecal material

48
Q

Diverticulitis: Clinical Manifestations

A

– Abdominal pain: LLQ
– Fever
– WBC’s: increased
– Constipation or diarrhea
– Acute: passage large quantity of frank blood
– May resolve spontaneously

49
Q

Diverticulitis: Complications

A

Complications
– Perforation
– Peritonitis
– Obstruction

NUR 326-Pathopharm (24 decks)

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