Gastrointestinal pathology Flashcards
Upper GI:
mouth, esophagus, and stomach
Ingestion and initial digestion
Middle GI:
SI
Digestion and absorption
Lower GI:
LI
Absorption of water and electrolytes and elimination
Mucosa:
Glandular Tissue
Submucosa:
connective tissue, large blood vessels, lymphatics, nerves, and mucous glands
Muscularis:
2 layers of smooth muscle
Adventitia:
connective tissue, vessels, lymphatics & nerves
GI motility:
propels food and fluid via rhythmic, intermittent peristaltic movement
Neural control:
Autonomic NS via the vagus nerve; SNS & PNS
Right Upper Quadrant (RUQ):
> right lobe of liver
gallbladder
duodenum
head of pancreas
right adrenal gland
right kidney
right of transverse colon
superior part of ascending colon
Right Lower Quadrant (RLQ):
> cecum
appendix
most of ileum
right ovary
ascending colon
right ureter
right spermatic cord
inferior part of right uterine tube
Left Upper Quadrant (LUQ):
> left lobe of liver
spleen
most of stomach
jejunum
proximal ileum
body/tail of pancreas
left adrenal gland
left kidney
superior part of descending colon
left half transverse colon
Left Lower Quadrant (LLQ):
> sigmoid colon
left ovary
left uterine tube
left ureter
left spermatic cord
inferior part of descending colon
Nausea & Vomiting =
prolonged can produce fluid and electrolyte imbalance, pulmonary aspiration, & mucosal/GI damage
due to food, drugs, hypoxic shock, inflammation of abdominal organs, virus, bacteria
Diarrhea =
amount of water lost = severity of illness
dehydration, electrolyte imbalance, dizziness, thirst
weight loss caused by infectious organisms, dysentery, diabetic enteropathy, IBS, hyperthyroidism, neoplasm, diverticulitis, diet, medication
Constipation =
causes increased bowel pressure & lower abdominal discomfort caused by diet, inadequate fluids, sedentary lifestyle, age, and drugs, hypothyroidism, diverticular ds, IBS, Parkinson’s ds, spinal cord injury, tumors
Anorexia =
loss of appetite with inability to eat
associated with anxiety, fear, and depression
causes emaciation, emotional disturbances concerning body image, fear of wt gain
most common in adolescent girls - can result in amenorrhea
Dysphagia =
difficulty swallowing
coughing, or choking caused by lesions of the CNS, esophageal disorders, swelling
Heartburn =
painful burning sensation felt in the esophagus
typically caused by gastric contents in the esophagus
associated with certain foods - citrus, chocolate, coffee, alcohol
triggered by certain positions - bending at the waist, supine after a large meal
Abdominal Pain =
caused by inflammation, ischemia, and mechanical stretching
see referred GI patterns for possible cause
GI Bleeding =
blood in vomit or feces
causes include gastritis, ulcers, prolonged drug or alcohol use
bright red feces consistent with lower GI, tarry black stool consistent with upper GI
Esophagitis =
> Reflux Esophagitis or GERD (gastroesophageal reflux disease)
> Inflammation of the esophageal mucosa as a result of reflux of the stomach contents
Causes: increased gastric volume, decreased anti-reflux, delayed esophageal clearance
Esophagitis
s/sx
Risk factors
Complications
Dx
Tx
s/sx: heartburn, chest pain, difficulty swallowing , regurgitation
Risk factors: obesity, pregnancy, scleroderma, hiatal hernia
Complications: ulcer, Barrett’s esophagus
Dx: Endoscopy, x-ray
Tx: antacids, H-2 receptor blockers, proton pump inhibitors, LINX device
Barrett’s Esophagus =
> usually in long-term GERD pts
> glandular metaplasia in distal esophagus as a result of chronic reflux of gastric acid into the esophagus
> causes: normal squamous cell lining cannot handle gastric acid, thus converts to glandular epithelium
Barrett’s Esophagus
s/sx
Risk factors
Complications
Dx
Tx
s/sx: frequent heartburn, dysphagia
Risk factors: GERD, age, males, white, overweight, smoking
Complications: esophageal cancer
Dx: endoscopy
Tx: treat for GERD, resection, ablation, cryotherapy, surgery
GERD
PT implications:
Exercise & Diet: excess abdominal fat increases abdominal pressure, avoid strenuous exercises & high calorie or fatty food
Supine position: avoid up to 4 hours after a meal
UPPER SPHINCTER DYSFUNCTION:
Shaker head-lifting exercise: strengthen upper esophageal sphincter ms
Hiatal Hernia:
segment of the stomach protrudes through the diaphragm into the mediastinum
cause: age, trauma, congenital, exercising/lifting heavy objects
Hiatal Hernia
s/sx
Risk factors
Complications
Dx
Tx
S/Sx: heartburn, regurgitation, SOB, difficulty, swallowing, acid reflux
Risk factors: obese, >50 years
Complications: GERD, ulcers, obstruction
Dx: x-ray, endoscopy
Tx: antacids, laparoscopic surgery
Hiatal Hernia
PT IMplications:
Flat supine position and exercises that require Valsalva maneuver = AVOID
Before Discharge = pt education regarding activities that increase intra-abdominal pressure & safe lifting
Post-Op = slow return to function (6-8 weeks), chest tubes (caution during repositioning), chest PT
Acute gastritis:
infiltration of edematous gastric mucosa predominantly by neutrophils
causes: aspirin, NSAIDs, smoking, alcohol, uremia, physiologic stress (burn, trauma)
pathogenesis: disruption of mucous layer, direct damage to epithelium (++) and HCO3(–)
Acute gastritis
s/sx
Dx
complications
Tx
s/sx: dyspepsia, mid-epigastric pain, “coffee-ground” emesis, blood in nasogstric tube
Dx: endoscopy
complications: GI bleeding, perforation (stomach wall)
Tx: antibiotics, PPIs, acid blockers, antacids
Morphology active inflammation = acute gastritis
1) gross = diffusely hyperemic gastric mucosa
2) microscopic
a) surface epithelium & glands: in tact with scattered neutrophils among the epithelial cells, “intraepithelial” or within mucosal glands
b) lamina propria: moderate edema & vascular congestion
Chronic gastritis:
infiltration of gastric mucosa with chronic inflammatory cells (lymphocytes), with associated mucosal atrophy and intestinal metaplasia
3 types: type A-fundal (autoimmune), type B-antral (H pylori), type C (NSAIDs, alcohol, bile)
Chronic gastritis
s/sx
Dx
complications
s/sx: upper abdominal pain, indigestion, bloating, nausea, weight loss, loss of appetite, belching
Dx: test for bacteria, stool test, CBC, endoscopy
complications: peptic ulcer, gastric carcinoma, hypochlorydria, achlorhydria, hypergastrinemia
Gastritis
Pt implications:
½ of all patients on long term NSAIDs have acute gastritis = often asymptomatic
Chronic gastritis = pt should seek immediate attention for hematemesis, nausea, vomiting
Pt Ed = medications = steroids should be taken with milk, food, or antacids to reduce gastric irritation
gastritis
RED FLAG:
Patients taking NSAIDs long term should be monitored for stomach pain, bleeding, nausea, or vomiting