Week 5: GI Problems Flashcards
What is considered upper GI?
esophagus, stomach and beginning of small intestine
What is considered lower GI?
small intestine, colon, rectum and anus
What are common upper GI problems?
Esophageal = GERD and hiatal hernia
Stomach = gastritis, acute gastroenteritis, and PUD
What is GERD?
backflow of gastric acid from the stomach into the esophagus, occurs at the lower esophageal sphincter
Etiology of GERD
anything that alters closure strength of the lower esophageal sphincter OR increases abdominal pressure
S/S of GERD
heartburn, dyspepsia, regurgitation, chest pain. dysphagia, and pulmonary symptoms
Complications of GERD
ulceration, scarring, strictures, and Barrett esophagus (development of abnormal metaplastic tissue)
What is a hiatal hernia?
a defect in the diaphragm that allows part of the stomach to pass through the thorax
What the two main types of hiatal hernias?
- sliding hernia
- paraoesophageal hernia
Need to know about sliding hernia
usually small and don’t need surgery
What is the patho of a paraoesophageal hernia?
part of the stomach pushes through the diaphragm and stays there
Patho for a hiatal hernia?
exact cause unknown. Can occur from damage to the diaphragm, or by repeatedly putting too much pressure on the muscle around the stomach (severe coughing, vomiting, straining for a BM)
S/S of a hiatal hernia
asymptomatic, belching, dysphagia, chest or epigastric pain
Treatment for hiatal hernia
Mostly a conservative treatment of teaching, but surgery may be necessary
What teachings go along with having hiatal hernias?
small, frequent meals, avoid lying down after eating, avoid tight clothes, weight control, and antacids to alleviate GERD symptoms
What is acute gastritis?
TEMPORARY inflammation of the stomach lining only, lasts 2-10days
Etiology of acute gastritis
irritating substance (alcohol), NSAIDs, and infectious agents
What is chronic gatritis?
Progressive disorder with inflammation that lasts weeks to years
Complications of chronic gastritis
PUD, bleeding, ulcers, anemia, and gastric cancers
What are the 2 main etiologies of chronic gastritis?
autoimmune = attacks parietal cells
H. pylori infection
What is H. pylori?
Helicobacter pylori bacterium, causing destructive pattern of persistent inflammation
How is H. pylori transmitted?
person to person via saliva, fecal or vomit
contaminated food or water
S/S of acute or chronic gastritis
sometimes none, anorexia, V/V, postprandial discomfort, intestinal gas, hematemesis, tarry stools, anemia
What is acute gastroenteritis?
inflammation of stomach AND small intestine
Etiology of gastroenteritis?
Viral infections = norovirus, rotavirus
Bacterial infections= E. col, salmonella, campylobacter
Parasitic infection
S/S of gastroenteritis
watery diarrhea (sometimes bloody) , abdominal pain, N/V, fever, malaise
Complications of gastroenteritis
fluid volume deficits
What is peptic ulcer disease (PUD)
ulcerative disorder that effects the esophagus, stomach, and duodenum
Etiology of PUD
H. pylori, injury causing substances (NSAIDs, ASA, and alcohol), smoking, family hx, and stress (increased stress causing increased gastric juices)
r/f for NSAID induced PUD
age, higher doses of NSAIDs, history of PUD, use of corticosteroids and anticoagulants, serious system disorders, and H. pylori infection
Patho of PUD
-mucosa is damages, histamine is secreted resulting in an increase in acid and pepsin secretion
-vasodilation causing edema
-if blood vessels are destroyed there will be bleeding
what is the most common type of PUD?
duodenal ulcer
S/S of a PUD
sometimes none, N/V, anorexia, weight loss, bleeding, burning pain (in the mid of abdomen usually worse when stomach is empty)
What is the main clinical difference between gastric and duodenal PUDs?
the duration before pain starts after eating.
gastric= 1-2 hrs after eating
duodenal= 2-4 hrs after eating
PUD complications
“HOP” hemorrhage, obstruction, perforation and peritonitis
What are the lower GI disorders?
appendicitis, peritonitis, irritable bowel disorder, Inflammatory bowel disorders (Chron’s UC), diverticulosis/diverticulitis
What is appendicitis?
inflammation of the appendix
Etiology of appendicitis
appendix is obstructed causing inflammation
Complications of appendicitis
gangrene, abscess formation, and peritonitis
What is peritonitis?
inflammation of peritoneum (serous membrane that lines abdominal cavity)
Pain with appendicitis
RLQ in periumbilical area, rebound pain (severe pain after release of palpation), sudden pain relief is NOT good (indicative of rupture)
What happens to the peritoneum during peritonitits?
inflammation, fluid shifts (3rd spacing), decreased peristalsis
Complication of peritonitis
paralytic ileus and intestinal obstruction
What causes peritonitis?
perforated ulcer, ruptured gallbladder, pancreatitis, ruptured spleen, ruptured bladder, and ruptured appendix
S/S of peritonitis
sudden and sever abdominal pain and tenderness, rigid “board-like” abdomen, N/V, fever, increased WBC, tachycardia, and hypotension
What is IBS?
chronic condition characterized by alterations in bowel pattern due to changes in motility
S/S of IBS
vary by individual
-abdominal distension, fullness, flatus, and bloating
-intermittent abdominal pain, relieved after BM
-food intolerance
-non bloody stools that may contain mucous
What exacerbates IBS?
STRESS, food, hormone changes, GI infections, and menstruations
What are the two inflammatory bowel disease
Chron’s disease and ulcerative colitis
R/F for inflammatory bowel disease
women, Caucasians, Jewish descent, and smokers
What is the pathogenesis of Crohn’s disease?
lymph structures of the GI tract are blocked causing tissue to become engorged and inflamed. This leads to deep linear fissures and ulcers developing
Complications of Chron’s disease
malnutrition, anemia, scar tissue, obstruction, fistula, and cancer
S/S of Crohn’s disease
crampy RLQ, watery diarrhea, palpable RLQ mass, mouth ulcers, S/S of fistulas, weight loss, fatigue, anorexia, fever, malabsorption
What is Ulcerative Colitis (UC)?
inflammation of the mucosa of the rectum and colon
R/F for UC
white people, third decade of life (lol), Ashkenazi Jewish decent
Rare in Asians
Pathogenesis of UC
Inflammation begins in the rectum and extends in a continuous segment that may involve the entire colon. The inflammation leads to large ulcerations and necrosis that can lead to abscesses
Colon and rectum try to repair the damage with new granulation tissue
What is crypt abscesses?
abscesses that result from necrosis of epithelial tissue
What is the problem with “new granulation tissue”?
tissue is fragile and bleeds easily
S/S of UC
abdominal pain, bloody diarrhea, weight loss, fatigue, no appetite, fever
Complications of UC
hemorrhage, perforation, cancer, malnutrition, anemia, strictures, fissures, abscesses, toxic mega-colon, colorectal cancer, liver disease, and F&E imbalances
What is diverticulosis’s pathogenesis?
development of diverticula, which are small pouches in lining of the colon that bulge outward though the weak spots
Diverticulosis can be?
congenital or acquired
What is thought to be the cause of diverticulosis?
low fiber diet with resulting chronic constipation
Where does diverticulosis typically occur?
descending colon
S/S of diverticulosis
usually asymptomatic, discovered accidentally or with acute diverticulitis
What is diverticulitis?
inflammation of one or more of the diverticula (pouches)
S/S of diverticulitits
abdominal pain (LLQ), fever, increased WBC, constipation or diarrhea, passing frank blood
Complications of diverticulitis
perforation, peritonitis, and obstruction
