Upper and Lower GI Flashcards
Upper GI structures
Esophagus, stomach, beginning of intestines
Upper GI problems
Esophageal disorders:
-GERD
-Hiatal Hernia
Inflammatory disorders of the stomach:
-Gastritis
-Acute Gastroenteritis
-PUD
Dysphagia: Definition
Defined: Difficulty swallowing
– Begins with solids and progresses to liquids
Dysphagia common causes:
- Mechanical obstruction
■ Stenosis or stricture
■ Diverticula
■ Tumors - Neuromuscular dysfunction
■ CVA
■ Achalasia – LES can’t open properly
GERD: definition
GASTROESOPHAGEAL REFLUX DISEASE = GERD
– Backflow of gastric acid from the stomach into esophagus
– Occurs via the lower esophageal sphincter (LES)
– Highly ACIDIC material!
GERD: Etiology
■ 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
GERD: Clinical Manifestations
■ Heartburn (pyrosis)
■ Dyspepsia
■ Regurgitation
■ Chest pain
■ Dysphagia
■ Pulmonary symptoms
GERD: Complications
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%
Hiatal Hernia: Definition
■ A defect in the diaphragm that allows part of the STOMACH to pass into the THORAX
Two main types of hiatal hernia
■ 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
Hiatal Hernia: Pathophysiology
■ 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
Hiatal Hernia: risk factors
Age, obesity, smoking
Hiatal Hernia: Clinical manifestations
- Asymptomatic
- Belching
- Dysphagia
- Chest or epigastric pain
*Common for GERD and Hiatal Hernia to coexist
Hiatal Hernia: Treatment
■ 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
Acute Gastritis: Definition
■ Defined: TEMPORARY inflammation of the STOMACH lining only (intestines NOT affected)
■ Generally last from 2-10 days
Acute Gastritis: Etiology
■ Etiology:
– Irritating substances (alcohol)
– Drugs (NSAIDs)
– Infectious agents
Chronic Gastritis: Definition
■ PROGRESSIVE disorder with chronic inflammation in the stomach
– Can last weeks to years
Chronic Gastritis complications
PUD, bleeding ulcers, anemia, gastric cancers
Chronic Gastritis: Etiology (2)
■ Two main etiologies:
1. Autoimmune: Attacks parietal cells
2. H. pylori infection
What is H. pylori?
-Helicobacter pylori bacterium
-Acidic environment
-Destructive pattern of persistent inflammation
- Can cause chronic gastritis, PUD, and
stomach cancer
How is H. pylori transmitted?
– Person to person via saliva, fecal matter, or vomit
– Contaminated food or water
Acute or Chronic Gastritis:
Clinical Manifestations
- Sometimes none
- Anorexia
- N/V
- Postprandial discomfort
- Intestinal gas
- Hematemesis
- Tarry Stools
- Anemia
Acute Gastroenteritis:
Definition and Etiology
■ 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
Acute Gastroenteritis:
Clinical manifestations and Complications
■ Clinical manifestations
– Watery Diarrhea
-May be bloody if bacterial
– Abdominal pain
– N/V
– Fever, malaise
■ Complication: fluid volume
deficits
PEPTIC ULCER DISEASE: Definition
■ 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
BALANCING ACT of GI Health:
-Aggressive factors
-Defensive factors
Aggressive factors:
-H. pylori
-NSAIDS
-Acid
-Pepsin
-Smoking
Defensive factors:
-Mucus
-Bicarbonate
-Blood flow
-Prostaglandins
PUD: Etiology
- 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
Risk factors: NSAID-Induced Peptic Ulcer Disease
-Age
-Higher doses of NSAIDs
-History of PUD
-Use of corticosteroids and anticoagulants
-Serious systemic disorders
-H. pylori infection
PUD: Pathogenesis
-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
PUD: Classification
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
PUD: Clinical Manifestations
-Sometimes none
-N/V, anorexia
-Weight loss
-Bleeding
-Burning Pain: in middle of abdomen that is usually worse when the stomach
is empty
Timing of PUD symptoms: Gastric vs. Duodenal
Gastric: 1-2 hours after eating
Duodenal: 2-4 hours after eating
PUD: Complications
“HOP” Complications
H – Hemorrhage
O – Obstruction
P - Perforation and Peritonitis
LOWER GI DISORDERS
Appendicitis
Peritonitis
Irritable bowel disorder
Inflammatory bowel disorder:
-Crohn’s, Ulcerative Colitis
Diverticulosis/Diverticulitis
Appendicitis: definition and etiology
-Inflammation of the appendix
-Etiology
Appendix is OBSTRUCTED
Leads to INFLAMMATION
Appendicitis Pain
- 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
Peritonitis: Definition
What happens to the peritoneum?
■ 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
Peritonitis: Causes
Perforated ulcer
Ruptured gallbladder
Pancreatitis
Ruptured spleen
Ruptured bladder
Ruptured appendix
Peritonitis: Clinical Manifestations
■ Usually sudden and severe
■ Abdominal pain*
■ Tenderness
■ Rigid “board-like” abdomen
■ N/V
■ Others:
– Fever
– Elevated WBC
– HR: increased
– BP: decreased
LOWER GI PROBLEMS
-IRRITABLE BOWEL SYNDROME
-INFLAMMATORY BOWEL DISEASE
Irritable Bowel Syndrome : Definition
■ Chronic condition characterized by:
alterations in bowel pattern due to changes in intestinal motility
– Chronic and frequent constipation
(IBSC)
– Chronic and frequent diarrhea (IBSD)
Irritable Bowel Syndrome: symptoms
■ 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
Inflammatory Bowel Disease (IBD): Definition and Etiology
■ 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
Crohn’s Disease Pathogenesis
■ 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
Crohn’s Disease: Complications
■ Complications:
– Malnutrition
■ Anemia
– Scar tissue and obstructions
– Fistulas
– Cancer
Crohn’s Disease: Clinical Manifestations
■ 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
Ulcerative Colitis: Incidence
■ 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
Ulcerative colitis: pathogenesis
■ 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
Complications of Ulcerative Colitis
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
Diverticulosis: Clinical Manifestations
■ Usually asymptomatic
■ Discovered accidently or with
presentation of acute diverticulitis
Ulcerative Colitis: Clinical Manifestations
-Abdominal pain
-Bloody diarrhea
-Systemic:
-Weight loss, fatigue, no appetite, fever
Diverticulosis: Pathogenesis
- 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
Diverticulitis: Definition
INFLAMMATION of one or more of the
pouches (diverticula)
-Usually from retained fecal material
Diverticulitis: Clinical Manifestations
– Abdominal pain: LLQ
– Fever
– WBC’s: increased
– Constipation or diarrhea
– Acute: passage large quantity of frank blood
– May resolve spontaneously
Diverticulitis: Complications
Complications
– Perforation
– Peritonitis
– Obstruction
