Chapter 36: Gastrointestinal Disorders Flashcards Preview

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Flashcards in Chapter 36: Gastrointestinal Disorders Deck (12):
1

Dysphagia

- Difficulty in swallowing

- Inability to initiate swallowing

- Sensation that swallowed solids/liquids “stick” in esophagus

- Pain with swallowing (odynophagia) may occur

2

Esophageal Pain (Heartburn/Pyrosis)

- cause is a reflux of gastric contents into the esophagus (produces high acidic contents that are an irritant to sensory afferent nerve endings in mucosa, and causes spasms of the esophageal muscle)

- Clinical manifestations include substernal burning sensations that may radiate to neck or throat

3

Esophageal Pain (Chest Pain)

- Causes include esophageal distention or powerful esophageal contractions. May also arise from esophageal obstruction or a condition called diffuse esophageal spasm.

- Clinical Manifestations include those similar to angina pectoris (radiates to neck, shoulder, arm, and jaw). Also includes Odynophagia brough on by swallowing

4

Abdominal Pain

- may be the first sign of GI tract disorder or many other disorders

- Visceral Pain (diffuse, poorly localized gnawing, burning, or cramping from inflammation or disteneded abdominal region)

- Somatic Pain (sharp, intense pain; well localized to area of irritation from injury)

- Referred Pain (felt at location distant from the source of the pain, in the same deramtome or neurosegmant; sharp and well localized; may be felt in skin or deeper tissues

5

Ulcerative Colitis

- Chronic inflammatory disease of the mucosa of the rectum and colon

- Large ulcers form in mucosal layer of colon and rectum

- Begins as inflammation at base of crypts of Lieberkühn; damage results; abscess formation in crypts; abscesses begin to coalesce, large ulcerations develop in epithelium

- Associated with increased cancer risk after 7 to 10 years of disease

- Have exacerbations and remissions

- Hallmark clinical manifestations are bloody diarrhea and lower abdominal pain

6

Treatment of Ulcerative Colitis

- Corticosteroids (MAINSTAY for acute)

- Broad spectrum antibiotic

- Salicylate analogs (similar to asprin, decreases inflammation)

- Immunomodulating agents (Azathioprine & Mercaptopurine)

- Intravenous followed by oral cyclosporine for
refractory

- Infliximab (Remicade) for refractory

7

Chron's Disease

- Also called regional enteritis or granulomatous colitis

- Affects proximal portion of the colon or terminal ileum

- Chronic inflammation of all layers of intestinal wall resulting from blockage and inflammation of lymphatic vessels

- Suggestive findings are ulcerations, strictures, fibrosis, and fistulas

8

Clinical Manifestations of Chron's DIsease

Intermittent bouts of fever, diarrhea, if bloody, not as severe as ulcerative colitis; constant, chronic RLQ pain, may have RLQ mass, tenderness

9

Treatment of Chron's Disease

- Alleviating and reducing inflammation

- Smoking cessation

- Drugs similar to ulcerative colitis

- No cure

- Prednisone and sulfasalazine

- Antibiotics: metronidazole

- Azathioprine, 6-mercaptopurine, methotrexate, and biologic therapies (refractory)

- Anti–tumor necrosis factor agents infliximab, adalimulab, and certolizumab (refractory)

10

Antibiotic-Associated Colitis (Pseudomembranous Enterocolitis)

- Acute inflammation and necrosis of large intestine

- Caused by Clostridium difficile (exposure to antibiotics)

- Mediated by bacterial

- Clinical manifestations include Diarrhea (such a distinct and horrible smell that you will know immediately)(often bloody), abdominal pain, fever, leukocytosis, sepsis, colonic perforation (rare)

11

Treatment of Antibiotic-Associated Colitis (Pseudomembranous Enterocolitis)

- Stop current antibiotic (if possible)

- Treat ischemia

- Treat contributing conditions

- Oral antibiotics: metronidazole or vancomycin

- Recurrence common

- Rare: fecal transplant (transfer of fecal material from another healthy person to the source patient via enema or gastric tube) or colectomy

12

Diverticular Disease

- Presence of diverticula (herniations) in the colon: diverticulosis

- Results from low intake of dietary fiber and results in high intraluminal pressure

- Clinical manifestations include Diverticulosis (asymptomatic) and Diverticulitis (inflamed diverticuli) which shows fever, acute lower abdominal pain, leukocytosis

- Treatments include Antibiotics, and surgery for abscess