Chapter 29_2 flashcards
(23 cards)
Gastroesophageal Reflux Disease (GERD): Pathophysiology
A weak or improperly functioning Lower Esophageal Sphincter (LES) allows stomach acid to reflux into the esophagus, causing irritation and inflammation (esophagitis).
Barrett’s Esophagus: Definition
A complication of chronic GERD where the esophageal epithelial cells undergo metaplasia (transform into stomach-like columnar cells). It is a precancerous condition.
GERD: Symptoms & Treatment
Symptoms: Heartburn, dysphagia, epigastric pain, regurgitation, chronic dry cough, and nocturnal asthma. Treatment: Lifestyle changes (weight loss, avoid trigger foods/smoking/alcohol, don’t lie down after eating), PPIs, H2RAs, and potentially surgery (fundoplication).
Esophagitis: Definition & Common Causes
Inflammation of the esophagus. Causes: Acid reflux (GERD), fungal infection (Candida albicans / thrush), irritating medications (NSAIDs, bisphosphonates), excessive vomiting.
Mallory-Weiss Syndrome: Cause & Symptom
A vertical tear in the mucosal layer at the junction of the esophagus and stomach, caused by forceful or repetitive vomiting. Can cause hematemesis (vomiting blood).
Esophageal Varices: Pathophysiology & Key Risk Factor
Abnormally dilated veins in the lower esophagus caused by portal hypertension, which results from liver cirrhosis. These varices are fragile and prone to rupture, causing a life-threatening UGIB.
Esophageal Varices: Presentation & Treatment
Presentation: Hematemesis, melena, and signs of liver disease (jaundice, ascites). Treatment: Prevent rupture (beta-blockers), or manage acute rupture with emergency surgery, esophageal balloon tamponade, or sclerotherapy.
Pyloric Stenosis: Pathophysiology & Key Signs
Constriction/narrowing of the pyloric sphincter, which obstructs the emptying of stomach contents. Key signs: Projectile vomiting, firm abdomen over the pylorus, visible peristalsis, and potential electrolyte imbalances from fluid loss.
Acute vs. Chronic Gastritis
Acute Gastritis: Inflammation of the stomach lining, often caused by NSAIDs, alcohol, or acute stress. Chronic Gastritis: Causes atrophy of the stomach lining, most commonly caused by H. pylori infection. Can decrease intrinsic factor, leading to vitamin B12 deficiency. It is a precursor to stomach cancer.
Peptic Ulcer Disease (PUD): Definition & Main Causes
An inflammatory erosion in the stomach (gastric ulcer) or duodenal lining (duodenal ulcer is more common). Main causes: H. pylori infection and chronic use of NSAIDs.
PUD: Classic Symptom & Severe Complications
Classic symptom is epigastric, burning pain that occurs between meals and is often relieved by eating. Severe complications include perforation (sudden, severe pain) and bleeding (hematemesis, melena).
PUD: Treatment
Eradication of H. pylori with triple or quadruple antibiotic therapy. Acid suppression with PPIs or H2RAs. In emergencies (severe bleeding/perforation), surgery such as a gastrojejunostomy may be required.
Dumping Syndrome: Cause & Pathophysiology
A common complication after bariatric surgery or partial gastrectomy. Rapid gastric emptying of hypertonic food into the small intestine causes a rapid fluid shift from the bloodstream into the intestinal lumen.
Dumping Syndrome: Symptoms
Early phase (30 min post-meal): Abdominal cramping, diarrhea, tachycardia, dizziness (from fluid shift). Late phase (2-3 hrs post-meal): Symptoms of hypoglycemia (pancreas releases excess insulin).
Hernia: Types & Complications
Protrusion of the small intestine through a weakened abdominal wall muscle (e.g., inguinal, femoral, umbilical). Complications: Incarceration (intestine is trapped), Strangulation (blood supply is cut off, causing ischemia).
Gastroenteritis: Definition & Common Cause
Irritation of the GI lining by a pathogen or toxin, causing vomiting and diarrhea. The most common cause in adults is Norovirus.
C. difficile Infection: Key Risk Factor & Symptom
A patient with a recent history of antibiotic use who develops persistent, watery diarrhea is at high risk for C. diff infection, as antibiotics disrupt normal gut flora.
Celiac Disease: Pathophysiology & Consequence
An autoimmune hypersensitivity to gluten. Ingestion of gluten causes an inflammatory process that destroys the intestinal villi, leading to malabsorption of nutrients, vitamins, and minerals.
Celiac Disease: Symptoms & Diagnosis
Symptoms: Abdominal bloating, diarrhea, and steatorrhea (fat in stools) due to malabsorption. Diagnosis: Serology test for IgA antitissue transglutaminase (IgA TTG) antibodies and intestinal biopsy.
Small Bowel Obstruction (SBO): Most Common Cause
The most common cause of an acute SBO is postsurgical adhesions (bands of connective tissue that form between organs).
Small Bowel Obstruction (SBO): Symptoms & Diagnosis
Symptoms: Abdominal distention, sharp/cramping pain, nausea, vomiting, and hyperactive bowel sounds. Diarrhea may be present in a partial obstruction. Diagnosis: Abdominal x-ray shows excessive intestinal gas proximal to the obstruction.
Peritonitis: Definition & Classic Triad
Inflammation of the peritoneal membrane, often caused by bacterial infection from a ruptured organ (e.g., appendix, diverticula). Classic Triad of Symptoms: Abdominal pain, abdominal rigidity, and rebound tenderness.
Peritonitis: Complication - Paralytic Ileus
A decrease or absence of intestinal motility that occurs during peritonitis as the body shifts blood flow to the area of injury and attempts to wall off the infection.
