Week 8: GI Flashcards
drugs that control n&v
antimuscarinics (e.g., scopolamine),
antihistamines (e.g., dimenhydrinate [Gravol]), and phenothiazines (e.g.,
chlorpromazine, prochlorperazine [Stemetil]).
foodborne illness
a nonspecific term that describes acute GI
symptoms such as nausea, vomiting, diarrhea, and cramping abdominal pain caused
by the intake of contaminated food or liquids. Bacteria account for most cases of
illness.
Escherichia coli 0157:H7 Poisoning
causes hemorrhagic colitis and kidney failure, and in
young children and older adults, E. coli O157:H7 infection can be life-threatening.
The clinical manifestations of E. coli 0157:H7
mild diarrhea to bloody
diarrhea and systemic complications, including hemolytic uremia and thrombo-
cytopenic purpura and even death.
Management of oral infections and inflammation is focused on
identification of the
cause, elimination of infection, provision of comfort measures, and maintenance of
nutritional intake.
Squamous cell carcinoma is the most common
oral malignant tumour (95% of cases
of oral cancer).
common manifestations of oral cancer
leukoplakia, erythroplakia, ulcerations,
a sore that bleeds easily and does not heal, and a rough area (felt with the tongue).
overall goals for the patient with carcinoma of the oral cavity are to
(1) have a
patent airway, (2) be able to communicate, (3) have adequate nutritional intake to
promote wound healing, and (4) have relief of pain and discomfort.
Gastro-esophageal reflux disease (GERD)
any clinically significant symptomatic condition or histopathological
alteration presumed to be secondary to reflux of gastric contents into the lower
esophagus.
Barrett’s esophagus
considered a precancerous lesion that increases the patient’s risk for
esophageal cancer.
hiatal hernia
is herniation of a portion of the stomach into the esophagus through an
opening (hiatus) in the diaphragm.
Factors that predispose to hiatal hernia
increased intra-
abdominal pressure, including obesity, pregnancy, ascites, tumours, tight corsets,
intense physical exertion, and heavy lifting on a continual basis. Other factors are
increased age, trauma, poor nutrition, and a forced recumbent position (e.g.,
prolonged bed rest).
esophageal cancer
rare malignant neoplasm of the esophagus
Important risk factors for esophageal cancer
smoking and excessive alcohol
intake, chewing betel quid, GERD, tylosis, achalasia, Plummer-Vinson syndrome,
chemical injury to the esophagus, exposure to ionizing radiation, and a personal
history of oral cancer or a family history of esophageal cancer.
gastritis
inflammation of the gastric mucosa that may be acute or chronic, and
may be diffuse or localized.
gastric cancer
adenocarcinoma of the stomach
wall.
Peptic ulcer disease (PUD)
a condition characterized by erosion of the GI mucosa
resulting from the digestive action of HCl and pepsin. Peptic ulcers can be classified
as acute or chronic, depending on the degree and duration of mucosal involvement.
drugs most commonly used to treat PUD
histamine (H2)-receptor blockers,
proton pump inhibitors, antacids, anticholinergics, and cytoprotective therapy.
Antibiotics are employed to eradicate H. pylori infection.
most common causes of appendicitis
occlusion of the appendiceal lumen by a
fecalith (accumulated feces) and intramural thickening caused by hypergrowth of
lymphoid tissue. Obstruction results in edema, venous engorgement, and the invasion
by bacteria, which can lead to gangrene and perforation.
Peritonitis
results from a localized or generalized inflammatory process of the
peritoneum.
gastro enteritis
inflammation of the mucosa of the stomach and small intestine.
Inflammatory bowel disease (IBD)
autoimmune disease that currently refers to
two disorders of the GI tract (Crohn’s disease and ulcerative colitis [UC])
characterized by idiopathic inflammation and ulceration.
Ulcerative colitis (UC)
chronic IBD characterized by inflammation and ulceration
of the rectum and the colon.
Crohn’s disease
a chronic IBD of unknown origin that can affect any part of the GI
tract from the mouth to the anus.
The following major classes of medications are used to treat IBD:
o Aminosalicylates o Antimicrobials o Corticosteroids o Immuno-suppressants o Biological drug therapies
Causes of malabsorption
o Biochemical or enzyme deficiencies o Bacterial proliferation o Disruption of small intestine mucosa o Disturbed lymphatic and vascular circulation o Surface area loss
Celiac disease
autoimmune disease characterized by damage to the small
intestinal mucosa from the ingestion of wheat, barley, and rye in genetically
susceptible individuals.
Short bowel syndrome (SBS)
results from extensive resection of the small intestine.
o SBS is characterized by rapid intestinal transit, impaired digestive and absorption
processes, and fluid and electrolyte losses.
o The length and portions of small bowel resected are associated with the number
and severity of symptoms.
Intestinal obstruction
occurs when a partial or complete obstruction of the intestine
prevents intestinal contents from passing through the GI tract. The causes of intestinal
obstruction can be classified as mechanical or nonmechanical.
Hyperplastic polyps
originate from the epithelium and are non-neoplastic
growths. They rarely grow larger than 5 mm and never cause clinical symptoms.
Adenomatous polyps
characterized by neoplastic changes in the epithelium
and are closely linked to colorectal adenocarcinoma.
Colorectal cancer
(a malignant disease of the colon, the rectum, or both) is the
second leading cause of cancer-related deaths in Canada.
ostomy
a surgical procedure in which an opening is made to
allow passage of urine from the bladder, or intestinal contents from the bowel, to an
incision or stoma surgically created in the wall of the abdomen.
diverticulum
outpouching of the mucosa through the circular smooth muscle
of the intestinal wall. Diverticula may occur at any point within the GI tract but are
most commonly found in the sigmoid colon.
Hemorrhoids
dilated hemorrhoidal veins. They may be internal (occurring above
the internal sphincter) or external (occurring outside the external sphincter).
Jaundice,
a yellowish discoloration of body tissues also called hyperbilirubinemia,
results from an alteration in normal bilirubin metabolism or flow of bile into the
hepatic or biliary duct systems.
Prehepatic jaundice
results from an increased breakdown of red blood cells
(RBCs), which produces an increased amount of unconjugated bilirubin in the
blood.
Hepatic jaundice
results from an alteration in the liver’s ability to take up
bilirubin from the blood or to conjugate or excrete it into bile.
Posthepatic (cholestatic) jaundice
due to decreased or obstructed flow of bile
through the liver or biliary duct system.
Hepatitis
broad term meaning inflammation of the liver. Viral hepatitis is the
most common cause of hepatitis. The types of viral hepatitis are A, B, C, D, and E.
Fulminant hepatitis
an acute clinical syndrome that results in severe impairment
or necrosis of liver cells and potential liver failure.
Drug therapy for chronic HBV and HCV is focused on
decreasing the viral load,
aspartate aminotransferase (AST) and aspartate aminotransferase (ALT) levels, and
the rate of disease progression.
Nonalcoholic fatty liver disease (NAFLD)
a spectrum of disease that ranges from simple fatty liver that causes no hepatic inflammation (steatosis) to nonalcoholic steatohepatitis (NASH) to severe liver-scarring (cirrhosis).
Autoimmune hepatitis
chronic inflammatory disorder of unknown cause that
occurs when the body’s immune system attacks its own liver cells. It is characterized
by the presence of autoantibodies, high levels of serum immunoglobulins, and
elevated liver enzymes.
Wilson’s disease
an autosomal recessive gene disorder of copper metabolism that
affects mainly the liver but also the brain, eyes, and kidneys. It is associated with
increased storage of copper.
Hereditary hemochromatosis
a genetic disorder that affects the liver, heart,
pancreas, and endocrine system. It is an inherited condition that is related to the
mutation in the HFE gene, causing an increase and inappropriate absorption of dietary
iron.
Primary biliary cholangitis
a chronic and slowly progressive disease caused by
inflammation and destruction of small bile ducts in the liver.
Cirrhosis
is a diffuse pathological process, characterized by fibrosis (scar tissue)
and conversion of normal liver architecture to abnormal nodules.
Portal hypertension
(increased venous pressure in the portal circulation, as well
as splenomegaly, large collateral veins, ascites, systemic hypertension, and
esophageal varices)
Esophageal varices
(complexes of tortuous veins located at the lower end of the
esophagus) and gastric varices
Hepato-renal syndrome (HRS)
serious complication of decompensated
cirrhosis. It is a type of kidney failure with advancing azotemia, oliguria, and
intractable ascites.
transjugular intrahepatic portosystemic shunt
nonsurgical
procedure in which a tract (shunt) between the systemic and portal venous
systems is created to redirect portal blood flow.
Acute liver failure,
clinical condition characterized by rapid deterioration of
liver function resulting in encephalopathy and coagulopathy in persons with no
known history of liver disease. It is a broad term that encompasses fulminant hepatic
failure, which describes development of encephalopathy within 8 weeks of the onset
of the illness. In general, the disease runs its course over 8 weeks, but it can last as
long as 26 weeks. Depending on the cause, survival rates range from 10% to 40%
with intensive support.
Hepatocellular carcinoma (HCC) is the most common type of
primary liver cancer
Acute pancreatitis
an acute inflammatory process of the pancreas. The primary
etiological factors are gallbladder disease (gallstones) and alcohol use disorder.
Chronic pancreatitis
a continuous, prolonged, inflammatory, and fibrosing
process of the pancreas. The pancreas becomes progressively destroyed as it is
replaced with fibrotic tissue. Strictures and calcifications may also occur in the
pancreas.
The most frequent female causes of infertility
factors associated with
ovulation (anovulation or inadequate corpus luteum), tubal obstruction or dysfunction
(endometriosis or damage from pelvic infection), and uterine or cervical factors
(fibroid tumours or structural anomalies). Risk factors for infertility include tobacco
and illicit drug use and being obese or thin.
Primary dysmenorrhea
an excess of prostaglandin F2α (PGF2α)
and/or an increased sensitivity to it.
Secondary dysmenorrhea
acquired usually after adolescence; pelvic causes
include endometriosis, chronic pelvic inflammatory disease (PID), and uterine
fibroids.
ectopic pregnancy
implantation of the fertilized ovum anywhere outside
the uterine cavity.
Pelvic inflammatory disease (PID)
an infectious condition of pelvic cavity that
may involve the fallopian tubes (salpingitis), ovaries (oophoritis), and pelvic
peritoneum (peritonitis).
Immediate complications of PID
include septic shock and Fitz–Hugh–Curtis
syndrome, which occurs when PID spreads to the liver and causes acute perihepatitis.
Long-term complications include ectopic pregnancy, infertility, and chronic pelvic
pain.
Endometriosis
the presence of endometrial epithelial cells in sites outside the
uterine cavity. The most frequent sites are in or near the ovaries, the uterosacral
ligaments, and the utero-vesical peritoneum.
Leiomyomas
benign smooth muscle tumours that occur most
commonly within the uterus.
Cystocele,
or anterior wall prolapse, occurs when support between the vagina and
the bladder is weakened.
Rectocele,
posterior wall prolapse, results from weakening between the vagina
and the rectum.
Transurethral resection of the prostate (TURP)
a surgical procedure involving
the removal of prostate tissue using a resectoscope inserted through the urethra.
Prostate cancer is
a malignant tumour of the prostate gland. It is the most common
cancer among men, excluding skin cancer.
Symptoms of prostate cancer are similar to those for BPH, including
dysuria,
hesitancy, dribbling, frequency, urgency, hematuria, nocturia, retention,
interruption of urinary stream, and inability to urinate.
Hypospadias
a urological abnormality in which the urethral meatus is located on
the ventral surface of the penis anywhere from the corona to the perineum.
Epispadias,
an opening of the urethra on the dorsal surface of the penis, is a complex
birth defect that is usually associated with other genito-urinary tract defects.
Phimosis
is a constriction of the uncircumcised foreskin around the head of the penis,
making retraction over the glans penis difficult.
Paraphimosis
is narrowing or edema of the retracted uncircumcised foreskin,
preventing normal return over the glans and causing strangulation.
