2 - gastrointestinal Flashcards
(145 cards)
1
Q
clinical manifestation of GI dysfunction
A
- anorexia
- nausea
- vomiting
- abdominal pain
- changes in bowel sounds
- constipation
- diarrhea
- GI bleeding
2
Q
Diarrhea in children
A
- very dangerous
- have lower fluid reserves than adults
- need to be monitored closely for dehydration
3
Q
diarrhea and fluid replacement
A
must be with osmotically balanced products
4
Q
GI bleeding
A
- hematemesis
- melena
- occult
5
Q
hematemesis
A
- vomiting of blood
- bright red
- dark grainy “coffee grounds”
6
Q
melena
A
dark, sticky, fowl smelling stool
7
Q
occult
A
hidden loss of blood
8
Q
what are the implications of GI bleeding? (slow and rapid)
A
- slow: iron deficient anemia
- rapid: hypovolemic shock
9
Q
congenital structural anomalies
A
- cleft lip and palate
- esophageal & tracheal malformations
10
Q
cleft lip and cleft palate
A
- fetal developmental anomalies
- caused by multifactorial inheritance (maternal alcohol, tobacco use or diabetes)
- failure of fusion between 6 and 12th week of gestation
11
Q
cleft lip
A
- incomplete fusion during 2nd moth of development
- commonly occurs under one nostril
- can be bilateral, symmetric and asymmetric
12
Q
cleft palate
A
- commonly associated with cleft lip but can occur without it
- results from an incomplete fusion of the palate
13
Q
cleft lip and cleft palate - clinical manifestations
A
difficulty feeding
14
Q
cleft lip and cleft palate - complications
A
- sinus infection
- ear infection
- formation of teeth
- speech impediment
15
Q
cleft lip and cleft palate - repair
A
- surgery
- start at 4 months
- could be staged depending on severity
- lip can be repaired earlier than palate
16
Q
esophageal malformations
A
- esophageal atresia
- tracheoesophageal fistula
- can happen together
- below the epiglottis
17
Q
esophageal atresia
A
- condition in which esophagus ends in blind pouch
18
Q
tracheoesophageal fistula (TEF)
A
- abnormal connection between the trachea and the esophagus
- various forms
- allows for food and air to combine
19
Q
esophageal malformations - manifestations
A
- excessive drooling
- cyanosis
- choking and coughing
- milk return through the mouth and nose
- abdominal distention
20
Q
esophageal malformations - complications
A
pneumonia
21
Q
esophageal malformations - repair
A
must be surgically repaired right after birth (usually a few days)
22
Q
functional obstruction
A
function is abnormal
23
Q
mechanical obstruction
A
something is structurally blocking flow
24
Q
intestinal obstruction
A
- regardless of type of obstruction you will eventually end up with an accumulation of fluid and gas
- loss of blood supply to the bowel and eventually loss of function in tissue
25
bowel sound if obstruction is in the area distal (past) to the obstruction
hypoactive
26
bowel sound if obstruction is in the area proximal (before) to the obstruction
hyperactive because it will be trying to squeeze through
27
functional obstruction types
- paralytic ileus
| - hirschsprung disease
28
paralytic ileus
- when your bowel stops working although there might not be anything wrong with it
- mobility helps restore gut function
- common after surgery (more common after bowel surgery)
- usually last from 3-5 days
29
hirschsprung disease
- aganglionic megacolon
- born with lack of bundle of nerve intervation in the colon
- noted by babies not having any bowel movements
- missing a part of the PNS
- surgically repaired
30
mechanical obstructions
- pyloric stenosis
- hernias
- volvulus
- intussusception
- adhesions
- impacted feces
- tumors
31
pyloric stenosis
- narrowing of the pyloric
| - at the end of the stomach is closed
32
hernias
- bowel protrudes through weakening in abdominal wall ligament
- unusual flow and compressed blood flow
- surgical repair
33
volvulus
- kink and twissting of the bowel
| - "our puppy volvy"
34
intussusception
- like a telescope that has collapsed in
| - cannot see through so you must stretch it forward
35
bowel obstruction - manifestations
- nausea and vomiting
- colicky abdominal pain
- distention
- dehydration
- perforation
- necrosis
- sepsis
36
neoplasia of the GI tract
- esophagus
- stomach
- colon and rectum
- gallbladder
- pancreas
- liver
37
cancer of the colon - incidence
remains somewhat high
38
cancer of the colon - mortality rate
decreased
39
cancer of the colon
- one of the leading causes of cancer death in men and women (2nd in men, 3rd in women)
- 5 yr survival is caught early
40
cancer of the colon - risk factors
- age 50+ (rare in children)
- genetic
- low finer diet (because bowel stays in longer)
- smoking
- obesity
- chronic inflammation (ulcerative colitis)
41
cancer of the colon - manifestations
depending on where the disease is located
42
ascending colon
- 25%
| - pain, mass, change in bowel habits, anemia
43
transverse colon
- 15%
| - pain, obstruction, chnage in bowel habits, anemia
44
descending colon
- 15%
| - pain, change in bowel habits, bright red, blood in stool, obstruction
45
rectum
- 45%
| - blood in stool, change in bowel habits, rectal discomfort
46
bowel habits
- shape
| - frequency
47
cancer of the colon: stage 0
- carcinoma in situ
| - mucosa
48
cancer of the colon: stage 1
though muscle layer
49
cancer of the colon: stage 2
involves serosa
50
cancer of the colon: stage 3
lymph nodes involved
51
cancer of the colon: stage 4
metastasis
52
cancer of the colon - warning signs
polyp
53
cancer of the pancreas
- incidence increases with age
| - mortality almost 100% due to late diagnosis
54
cancer of the pancreas - risk factors
- smoking
- obesity
- chronic pancreases
- diabetes mellitus
55
cancer of the pancreas - manifestations
- pain (typically late)
| - very vague
56
inflammatory GI disorders
- common
- exposure of unprotected GI mucous membrane to acid
- infection
- autoimmunity
57
inflammatory GI disorders - esophagus
- acid reflux
| - gastroesophageal reflux disease
58
inflammatory GI disorders - stomach and duodenum
- gastritis
| - peptic ulcer disease
59
inflammatory GI disorders - bowel
- diverticulitis
- appendicitis
- inflammatory bowel disease
60
acid reflux
"heart burn"
61
gastroesophageal reflux disease
chronic, ore severe from of reflux
62
gastroesophageal reflux disease - risk factors
- fatty foods
- coffee, chocolate
- obesity
- alcohol
- smoking
- hiatal hernia
63
gastritis
- inflammatory disorder of the mucosa of the stomach
| - acute or chronic
64
stomach - antrum
non-immune
65
stomach - fundus
auto-immune
66
peptic ulcer disease
- a break or ulceration int he protective mucosal lining
- stomach or duodenum
- superficial or deep
67
peptic ulcer disease - superficial
erosions
68
peptic ulcer disease - deep
true ulcers
69
peptic ulcer disease - risk factors
- helicobacter pylori
- NSAIDS
- alcohol
- smoking
- age
- chronic disease
70
stress ulcer
- a tyro of peptic ulcer that is related to severe illness, neural injury or systemic trauma
- stress in internal
71
ischemic ulcers
decrease blood flow
72
crushing ulcers
associated with severe head injury or brain surgery
73
stress ulcers - most at risk
- people who are in critical care units
| - neurological patients
74
diverticulosis
- sigmoid colon
- western society
- low finer diet
- small, bulging pouches (diverticula) develop in your digestive tract
75
diverticulitis
- one or more of these pouches become inflamed or infected
76
appendicitis
- exact mechanism is unclear except for inflammation and infection
77
appendicitis - manifestations
- pain: periumbilical then RQL
- nausea and vomitting
- fever
- elevated WBC
78
appendicitis - treatment
- antibiotics
| - surgery
79
spot where appendicitis pain takes place*****
McBurney's point
80
inflammatory bowel disease (IBD)
- chronic, relapsing inflammatory bowel disorders of unknown origin
- genetics
- alterations of epithelial barrier functions
- immune reaction to intestinal flora
- abnormal T cell response
81
IBD - types
- ulcerative colitis
| - crown's disease
82
IBD - incidence
north american, specifically canada has one of the highest rates
83
remission relapsing
worse better lose better
84
IBD - manifestations
- crampy pain
| - frequent diarrhea
85
crohn's disease
- can occur anywhere in bowel (large and small intestine)
- patchy areas (walls look like stone - cobblestone)
- skipped lesions
86
crohn's disease - fistulas
- connection that shouldn't be there
- due to mal absorption of nutrients
- foods and stress trigger flare ups
- autoimmune therefore more common in females
87
crohn's disease - manifestations
mal absorption/mal nutrition
88
ulcerative colitis
- affects large intestine
| - continuous inflammation with pinpoint hemorrhages
89
ulcerative colitis - manifestations
blood in stool
90
ulcerative colitis - complications
- short term
| - long term
91
ulcerative colitis - treatment
- anti-inflammatory/ anti-immune medications
| - surgery
92
liver dieases
- hepatitis
| - end-stage liver disease
93
end-stage liver disease
- cirrhosis
| - portal hypertension
94
manifestations of liver disease
- jaundice
- ascites
- hepatorenal syndrome
- hepatorenal encephalopathy
95
ascites
- accumulation of fluid in the peritoneal cavity
- reduced albumin levels
- sodium/water retention
- late stage manifestations
96
obstructive jaundice
obstruction of bio flow
97
hemolytic jaundice
break down of a lot of red blood cells and creates an increase in billirubin
98
hepatocellular jaundice
liver isn't working
99
bilirubin
makes skin itchy
100
hepatorenal syndrome
- renal dysfunction secondary to advanced liver disease
- kidney failure that happens with liver failure (if you were to place kidney in someone else w/o liver failure it would work)
- kidney appears to be normal
- ?? changes to blood supply, vessel tone
101
hepatic encephalopathy
- a neurologic syndrome of impaired cognitive function, flapping tremor and EEG changes
- develops rapidly during fulminant hepatitis or slowly during chronic liver disease
- shaking hands (tremors)
102
hepatitis
- inflammation caused by exposure to drugs or other chemicals or by viral infections
- acute or chronic
- exposure to drugs, chemicals, viruses
103
viral hepatitis: mild and short-lived infections
A, D, E
104
viral hepatitis: severe and chronic liver function
B, C
105
viral hepatitis: varied mode of transmission
- fecal and oral (A and E)
| - parenteral or sexual blood and body fluids (B, C, D)
106
viral hepatitis: pathophysiology
inflammation and some scaring of the liver
107
viral hepatitis: sequence
- prodromal phase
- icteric phase
- recovery phase
108
prodromal phase
pre jaundice phase
109
icteric phase
jaundice - yellow and itchy
110
recovery phase
some go on to develop chronic active hepatitis
111
viral hepatitis: chronic active hepatitis
increased vulnerability to cirrhosis and cancer
112
cirrhosis of the liver
- chronic, irreversible, inflammation
- scarring of the bile canaliculi
- common causes like hepatitis, ETOH, idiopathic
113
portal hypertension
- abnormally high blood pressure in the portal venous system
- back pressure causes congestion of veins that drain into portal system (esophagus, stomach, spleen and rectum)
114
portal hypertension: consequences
- varicose veins (varices)
- lower esophagus, stomach, rectum
- can rupture and bleed profusely
- splenomegaly
115
gall bladder: cholecystitis
- due to cholelithiasis (gallstones)
- prevalent in developed countries
- caused by abnormalities in bile composition, bile stasis and or inflammation of gallbladder
116
cholecystitis - risk factors
- fat
- female
- fertile
- forty
- first nation
117
pathogenesis of cholecystitis #1
- supersaturated bile
- formation of crystals
- formation of microstones/stones
118
pathogenesis of cholecystitis #2
obstruction of cystic duct
119
pathogenesis of cholecystitis #3
inflammation of gallbladder
120
cholecystitis
- obstruction of cystic duct and inflammation
| - stones in gallbladder
121
cholecystitis - manifestations
- asymptomatic or vague symptoms
- heartburn
- food intolerances
- epigastric pain
- biliary colic
122
cholecystitis and fatty foods
they would have an intolerance to fatty foods because the gallbladder store bile and bile helps us digest fat. So this can trigger pain when digesting fatty foods
123
biliary colic
pain that starts in the upper right quadrant and radiates pain to the shoulder blade
124
cholecystitis - treatment
- prevention
- pain management
- antibiotics
- removal of stone via scope
- cholecystectomy
125
cholecystectomy 2 types
- laparoscopic or open
| - depending on number
126
pancreatitis
- acute or chronic inflammation
127
acute pancreatitis: cause
- associated with several other clinical disorders
- *gallstones
- *alcoholism
128
acute pancreatitis
- blockage of outflow of pancreatic
- enzymes cause autosuggestion of pancreatic tissue
- leak into bloodstream to cause injury to vessels and other organs
- can become extremely sick (nausea, vomitting, fever and elevated WBC)
129
chronic pancreatitis
- related to chronic alcohol abuse as well as smoking
- structural changes
- complications
- scaring narrowing and decreased functions
130
chronic pancreatitis can lead to (2)
- pancreatic cancer
| - diabetes
131
malnutrition
- BMI
| - deficit
132
BMI > 35
- associated with increased risk of morbidity and mortality
133
central obesity
- abdominal/visceral fat
- associated with increased morbidity, mortality
- diabetes, cardiovascular disease, cancer
134
obesity - causes
- imbalances between caloric intake and energy expenditure
- dysregulation of hypothalamus and other hormones that control appetite and weight
- neonatal exposure to calories
135
BMI
also associated with higher mortality
136
normal BMI
30-35
137
deficit
- eating disorder
| - a problem of access to food
138
eating disorders
- characterized by abnormal eating behavior, weight regulation and disturbed attitudes toward body weight, body shape and size
- affect both genders (females more likely)
139
anorexia nervosa
- a person has a disorder of body image
| - may lose 25% - 30% of their ideal body weight as a result of fat and muscle depletion
140
bulimia nervosa
- body weight remains near normal but with aspirations for weight loss
- recurrent cycles of binge eating followed by forced vomiting
141
starvation
- decrease caloric intake leading to weight loss
| - short-term or long term
142
short term starvation
- glycogenolysis
| - glyconeogenesis
143
long-term starvation
- marasmus
- kwashiorkor
- more risk for younger children
144
marasmus
- deficiency of all nutrients
| - younger children
145
kwahiorkor
- severe protein deficiency, related to high CHO intake
- usually after weaning from breast
- presence of subcutaneous fat
ascites
