Disorders of Gastrointestinal Function

Question 1

What can cause anorexia?

Answer 1

-loss of appetite
-emotional factors
-drugs
-disease
-precursor to nausea
-can be stimulated or suppressed by smell

Question 2

What is nausea stimulated by?

Answer 2

vomiting center in medulla

Question 3

What can cause nausea?

Answer 3

distention of duodenum

Question 4

What is retching?

Answer 4

spasms of diaphragm, chest, and abdominal muscles

Question 5

What is vomiting?

Answer 5

sudden forceful removal of stomach contents

Question 6

Why does retching and vomiting occur?

Answer 6

protects against ingested toxins

Question 7

What is vomiting and chemoreceptor trigger zone?

Answer 7

medulla (this is why brain injury causes nausea/ vomiting)

Question 8

What can vomiting lead to?

Answer 8

dizziness, hypotension, bradycardia

Question 9

What is hematemesis?

Answer 9

vomiting blood

Question 10

What is melena?

Answer 10

black, tarry stools (blood)

Question 11

What is hematochezia?

Answer 11

bright red blood in stool

Question 12

What is occult bleeding?

Answer 12

small amounts of blood in gastric secretions, vomitus, or stools not apparent by appearance; detectable by guaiac test

Question 13

What happens when RBCs die in GI bleed?

Answer 13

they release protein from hemoglobin

Question 14

What is the end product as protein is metabolized in a GI bleed?

Answer 14

nitrogen

Question 15

This nitrogen resulting from blood cells in the gut leads to increased lab value of blood urea nitrogen

Answer 15

BUN

Question 16

Onset of digestion starts in the stomach but mostly occurs where?

Answer 16

in the small bowel

Question 17

What are enzyme deficiencies?

Answer 17

-lactase
-pancreatic enzymes
-cystic fibrosis

Question 18

What can happen during lactase deficiencies?

Answer 18

undigested lactose leads to lactose intolerance with production of gas, abdominal cramping, and diarrhea

Question 19

What are pancreatic enzymes?

Answer 19

released in inactive form, then activated once in the intestine

Question 20

What can happen in cystic fibrosis?

Answer 20

obstruction and destruction of pancreatic ducts that are blocked by thick mucus in the ducts

Question 21

What is an example of accelerated gastric motility?

Answer 21

dumping syndrome

Question 22

What is dumping syndrome?

Answer 22

-rapid gastric emptying
-to compensate, large bowel brings in lots of fluid
-rapid change of fluid and electrolytes within the bowel

Question 23

What is an examples of delayed or absent gastric motility?

Answer 23

gastroparesis

Question 24

What can cause gastroparesis?

Answer 24

acute illness/ injury, neuropathy of any source

Question 25

Gastrectomy

Answer 25

-loss of food reservoir -loss of intrinsic factor from mucosal parietal cells decreases vitamin b12 absorption from the ileum of the small bowel

Question 26

What is the turnover of GI mucous cells?

Answer 26

72 hours

Question 27

What happens to tissue in GI Translocation?

Answer 27

it erodes from innermost to outermost layer

Question 28

Where do pathogens go during GI translocation?

Answer 28

from inside gut structures into lymph vessels, blood vessels, and abdominal cavity causing peritonitis

Question 29

What is translocation a source of?

Answer 29

multiple organ dysfunction syndrome which is highly fatal

Question 30

What would be a common pathogen involved in bacterial translocation?

Answer 30

E. coli

Question 31

GERD- Etiology

Answer 31

-relaxation of lower esophageal sphincter with back flow of gastric contents into esophagus -acidity of gastric contents irritates esophagus

Question 32

GERD in pediatrics

Answer 32

-resolves by age 6-24 months -spitting up food -bradycardia if aspirating food into lungs

Question 33

GERD in adults

Answer 33

-heartburn after eating with chest pain that can radiate to throat, shoulders, back -can lead to chronic inflammation and esophageal cancer

Question 34

What is Esophagitis?

Answer 34

-irritation by gastric acid -gastro: esophageal reflux -chronic inflammation can lead to Barrett's esophagitis (a precursor to esophageal cancer) -hiatal hernia often present

Question 35

What is gastritis?

Answer 35

acute or chronic disruption of mucosal barrier of stomach allows auto digestion of the mucosa by HCL

Question 36

Gastritis- Etiology

Answer 36

aspirin, NSAIDs, H. pylori, alcohol, smoking, physiologic stress, hypersecretion of HCL

Question 37

What is Peptic Ulcer Disease (PUD)?

Answer 37

ulceration of GI tract due to increased pepsin secretion in the stomach

Question 38

Where does PUD occur?

Answer 38

Can occur in the esophagus, stomach, pylorus, or duodenum

Question 39

What is the leading cause of PUD?

Answer 39

H. pylori infection

Question 40

What leads to bleeding in PUD?

Answer 40

interruption of the stomach mucosal barrier

Question 41

What protects mucosal layer of stomach?

Answer 41

overuse of aspirin, anti inflammatory, action of prostaglandin

Question 42

PUD- Clinical Manifestation

Answer 42

-pain: epigastric region; relieved by food, antacids -occult GI bleeding -dark stools (melena)

Question 43

What are the 2 types of inflammatory bowel disease?

Answer 43

Crohn and ulcerative colitis

Question 44

Crohn disease

Answer 44

-can occur in any site of GI tract -can erode through ALL tissue layers

Question 45

Ulcerative colitis

Answer 45

-occurs only in the colon -erodes only in the innermost layer of colon

Question 46

What happens in Crohn Disease?

Answer 46

-inflammation, swelling, thickening of the involved tissue -etiology often unknown but runs in families and stress

Question 47

Crohn Disease Pathophysiology

Answer 47

-lesions identified by endoscopy -often called skip lesions because they skip around the tissue -areas can perforate and create fissures from the inside of the gut leading into bowel, skin, bladder, vagina

Question 48

Crohn- Clinical Manifestations

Answer 48

-usually non bloody diarrhea -anemia due to blood loss -malabsorption of nutrients when small bowel involved -weight loss -lower abdominal pain -frequent fistula formation -increased risk of colon cancer

Question 49

Ulcerative Colitis

Answer 49

-similar to crohns disease -only involves innermost mucosal layer of colon -inflammation and sloughing of tissue causes bleeding

Question 50

Ulcerative Colitis- Pathophysiology

Answer 50

-rectum and sigmoid often affected -mucosal edema and tissue erosion -mucosal thickening -bleeding -perianal abscess

Question 51

Ulcerative Colitis- Clinical Manifestations

Answer 51

-large volume of watery diarrhea with blood -cramping or abdominal pain -urge to stool -increased risk for colon malignancy after 10 years