Class 18/19 - Alterations in GI Flashcards
Manifestations of GI Dysfunction
- Anorexia
- Nausea
- Vomiting
- Abdominal pain (cramping and distension)
- Change in bowel sounds
- Constipation
- Diarrhea
- GI bleeding, upper or lower GI
- Jaundice
Hematemesis
Vomiting of blood
Frank, bright red
- Bleeding is occurring in the esophagus, closer to the exit
Dark, grainy “coffee grounds”
- Deeper in the GI tract
Rectal Bleeding
Frank red bleeding
- Hemorrhoid
- Anal fissure
Occult
- Not visible to the eye, but visible during lab tests
Black, tarry
- Melena
- Typically foul smelling
Jaundice
- Increased amounts of bilirubin
- Yellow discolouration of the skin, mucous membranes and sclera
- Hepatocellular (liver failure)
- Obstructive (gallstones)
- Hemolytic (newborn, sickle cell, transfusion)
Obesity
BMI
- <19 underweight
- 19-24 is healthy
- 25-29 is overweight
- 30-40 is obese
- 40+
- The best is healthy or overweight with regular exercise
Associated with
- Heart and stroke - athersclerosis
- Cancer
- Diabetes - correlated with abdominal fat
Congenital Anomalies in Children
Esophageal atresia
- Condition in which the esophagus ends in a blind pouch
Tracheoesophageal fistula
- Abnormal connection between the trachea and esophagus
- Due to malformations when the esophagus and trachea separate in utero
- Manifestations: stomach fills with air (potential for aspiration), and coughing
Risk factors (maternal)
- Older mother
- Alcohol
- Smoking
- Infections
- Diabetic
Manifestations
- Vomiting
- Drooling
- Milk returns through mouth and nose
- Choking
- Distention
- Cyanosis
- Aspiration of stomach contents
Treatments
- Surgical repair
Functional Obstruction (GI)
There is no movement that pushes anything through, paralyzed
- Loss of function
Paralytic ileus
- Ileum is paralyzed
- Had surgery and the bowel stops moving
- Abdominal trauma
- Anything that irritates the bowel
Hirschsprung disease - congenital ganglionic megacolon
- 1/5000 births, most common in boy babies
- These children lack parasympathetic innervation to the colon
- They end up with a distended and dilated colon (mega colon)
- Nothing can be done to restore innervation, so they have to have their colon removed
Manifestations:
- Nausea and vomiting
- Colicky abdominal pain
- Distension
- Dehydration
- Perforation
- Necrosis
- Sepsis
- Death
Mechanical Obstruction
Something physical is blocking it
- Pyloric stenosis: thick muscle ring around the sphincter
- Volvulus: kinked off like a ballon animal. Needs surgical repair
- Hernias
- Impacted feces
- Tumours
Results
- Compresses blood vessels and blood flow to the bowel through the distention of the bowel
- Will eventually become ischemic and dead
Manifestations
- Nausea and vomiting
- Colicky abdominal pain
- Distension
- Dehydration
- Perforation
- Necrosis
- Sepsis
- Death
Hernia
- Bowel protrudes through weakening in abdominal wall ligament - can be at multiple sites
- Consequences to bowel
- Can be pushed back in, but it can reoccur
- If it isn’t pushed back in, the bowel will become ischemic and die
Colon Cancer
Incidence:
- In men, cancer colon i second leading cause of cancer death
- 3rd in women
Risk factors
- Heredity
- Smoking
- Obesity
- Diet (low fibre)
- High alcohol consumption
- Ulcertive colitis for 10 years or more
Location and manifestations
- Pain
- Change in frequency
- Change in looseness of stool
- Change in shape
Staging 0 - Carcinoma in situ. Has not invaded through the basement membrane. Mucosa 1 - Through the muscle layer 2 - Involves serosa 3 - Lymph nodes involved 4 - Metastasis
Pancreatic Cancer
Incidence
- Increases with age
Mortality is almost 100% due to late diagnosis
Risk factors
- Smoking
- Obesity
- Chronic pancreatitis
- Diabetes
Manifestaions
- Back pain
- Abdominal pain
- Jaundice
Gastroesophageal Reflux Disease
- Chronic, more severe form of reflux/heart burn
Risk factors
- Relaxed lower esophageal spnichter. Occurs with age, drug sue, nicotine, alcohol and hiatal hernia (the stomach is above the diaphragm, causes acid to reflux easily)
- Increased abdominal pressure (obesity, pregnancy)
Gastritis
- Inflammatory disorder of the mucosa of the stomach
Acute
- Occurs in the antrum
- Caused by alcohol, tobacco, NSAID’s,
- Helicobacter pylori
Chronic
- Occurs fundus
- Auto-immune
- Can occur with other auto disorders like Chron’s disease
Manifestations
- Epigastric pain
- Anorexia, fullness
- Nausea, vomiting
- Bleedng
Complications
- Pernicious anemia (becuase parietal cell make intrinsic factor for B12
- Gastric carcinoma (chronic inflammation puts at risk for cancer)
Peptic Ulcer Disease
- A break or ulceration in the protective mucosal
- Risk factors
1. Helicobacter Pylori
2. NSAID’s
3. Alcohol
4. Smoking
5. Age
6. Chronic diseases
i. Emphysema
ii. Diabetes
iii. Rheumatoid Arthritis
Incidence
- 10%
Complications
- Perforations
- Bleeding
Stress Ulcers
- A type of peptics ulcer that is related to severe illness, neural injury or systemic trauma
1. Ischemic ulcers - Decreased blood flow - in hospital
2. Cushing ulcers - Associated with severe head injury or brain injury
3. Curling ulcers - Associated with burn injuries
Diverticululitis
Diverticulae, a pouch due to a weakened part of the bowel
Inflammation of the diverticulae in the sigmoid colon
could form a fistula between the bladder and colon
Incidence
- Western society
- Low fibre diet
Treatment
- Rest of the colon
- If it rupture or forms a fistula, it’ll need surgery
