chapter 38

Question 1

what are they clinical manifestation of GI Dysfunction

Answer 1

Anorexia
Nausea
Vomiting (emesis)
Projectile vomiting
constipation
Diarrhea
Upper Gi Bleed
lower GI Bleed

Question 2

Gastroesophageal Reflux Disease ( GERD)

Cause:

Answer 2

Reflux (backward motion) of acid and pepsin from the stomach to the esophagus

Causes:
Resting tone of the LES is decreased or incompetent
 Food: caffeine, chocolate, fatty foods, coffee
 Medications
 Decreased gastric motility or emptying
 Hiatal hernia
 Increases in intra-abdominal pressure

Manifestations
Pyrosis (heartburn)
Dyspepsia (indigestion)
Dysphagia (difficulty swallowing)
Chronic cough
Asthma attacks (acid refluxes up into trachea causing irritation to airways)
Laryngitis
Upper abdominal pain within 1 hour of eating – may radiate
Increased pain with alcohol or highly acidic foods
Symptoms more severe when laying flat

Question 3

gastritis

Types?

Symptoms?

Answer 3

Inflammatory disorder of the gastric mucosa

Types
Acute gastritis
 Caused by injury of the protective mucosal barrier
Chronic gastritis
 Chronic fundal gastritis (type A, immune)
 Chronic antral gastritis (type B, nonimmune)

Symptoms vague
 Anorexia, fullness, nausea, vomiting, epigastric pain

Question 4

Peptic Ulcer Disease

Risk Factors

Types

Answer 4

A break or ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum

Patho: mucosal protective factors become overwhelmed by erosive factors mucosal lesion (“ulcer”) development

Risk factors:
 NSAIDS, steroids
 H. pylori
 Infection
 Alcohol, smoking
 Age
 Stress

Types:
Acute: affects the submucosal later of the muscle

Chronic: ulceration unto the serosa lining of the muscle and it causes scaring

Duodenal Ulcers: Most common of the peptic ulcers
Clinical Manifestations:
Burning, cramping pressure across mid-epigastrium and upper abdomen
Pain occurs 2-3 hours after meals (stomach is empty)
May awaken individual from sleep
Pain relieved by food
Very little risk for malignancy

Gastric Ulcers
Burning and gaseous pressure in high left epigastrium, back, and upper abdomen
Pain immediately after eating
Pain usually does not wake patient
Accentuated by ingestion of food
Risk for malignancy

Question 5

Bowel ( intestinal) Obstruction

Types:

Clinical Manifestation

Answer 5

Any condition that prevents the flow of chyme through the intestinal lumen
Can occur in small or large intestine

Types:
Simple obstruction: mechanical blockage of the lumen by a lesion (most common)
 - caused by Adhesion, hernia, tumor
Functional obstruction (paralytic ileus): failure of intestinal motility
 - Often occurs after intestinal or abdominal surgery, pancreatitis, or hypokalemia

Clinical Manifestation
Signs of small intestine obstruction
 - Colicky pains (abd pain that comes and goes)
 - Early, profuse vomiting
 - Mild to severe abdominal distention
Signs of large intestine obstruction
 - Hypogastric pain and abdominal distention
 - Vomiting occurs late in process


Question 6

inflammatory Bowel Disease

Answer 6

Ulcerative Colitis
Crohn Disease

Question 7

Ulcerative Colitis

Patho

Clinical Manifestations

Answer 7

Involves the sigmoid colon and rectum
Begins in the rectum and may extend proximally

Patho:
Chronic inflammatory disease that causes ulceration of the colonic mucosa
Inflammation leads to mucosal destruction and loss of absorptive mucosal surface
Leads to rapid colonic transit time

Clinical Manifestations:
 Intermittent periods of remission and exacerbation
 Mucosa is hyperemic (increased blood flow)
 Ulcerations
 Diarrhea (10 to 20/day)
 Sometimes bloody
 Urge to defecate
 Abdominal cramping

Question 8

Crohn Disease

Answer 8

Idiopathic inflammatory disorder
Affects any part of the digestive tract from mouth to anus

Patho:
- Inflammation leads to formulation of granuloma lesions surrounded by ulcerations
- Discontinuous involvement leads to “skip lesions” or cobblestone appearance of the GI tract

Crohn Disease
- Clinical Manifestations:
- Diarrhea, occasional bleeding
- Abdominal pain
- Weight loss
- Anemia may result from malabsorption of vitamin B12 and folic acid Crohn Disease


Question 9

Risk factors for Ulcerative Colitis and Crohn Disease

Answer 9

Genetics
Environmental factors
Alterations of epithelial barrier functions
Altered immune reactions to intestinal floral

Question 10

Irritable Bowel Syndrome

Clinical Manifestation

Answer 10

Symptom-based disease characterized by recurrent abdominal pain with altered bowel habits
More common in females
Cause unknown but mechanisms proposed:
 -Visceral hypersensitivity
 -Abnormal intestinal permeability, motility, and secretion
- Post inflammatory reaction (infectious or noninfectious)
- Alteration in gut flora
- Food allergy/intolerance
- Psychosocial factors (abuse, stress)

Clinical Manifestations:
Lower abdominal pain or discomfort and bloating
Diarrhea, constipation, or alternating symptoms of both
Symptoms are usually relieved with defecation and do not interfere with sleep
No cure

Question 11

Diverticular Disease

Types

Clinical Manifestation

Answer 11

Diverticula: Herniations of mucosa through the muscle layers of the colon wall, especially the sigmoid colon
Diverticulosis: Asymptomatic diverticular disease
Diverticulitis: The inflammatory stage of diverticulosis

Clinical Manifestations:
Uncomplicated diverticular disease:
 - may be vague or absent
 - Cramping pain in lower abdomen
- Diarrhea, constipation, flatulence
Diverticulitis:
 - fever, increased WBC, tender abdomen
Complicated diverticulitis can lead to:
 - Abscess formation
 - Obstruction
 - Bleeding
 - Perforation

Question 12

Appendicitis

Answer 12

• Inflammation of the vermiform appendix
• Possible causes:
   Obstruction, foreign bodies, infection
• Epigastric or periumbilical pain
   Rebound tenderness to RLQ
• Perforation, peritonitis, and abscess formation are the most serious
  complications
   Treatment is antibiotics and appendectomy