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1
Q

Anorexia is characterized as a…

A

loss of appetite

2
Q

What is responsible in the brain for vomiting?

A

medulla oblongata

3
Q

What can committing lead to?

A

fluid, electrolyte, and acid-base disturbances

4
Q

what types of medications can be taken for nausea and vomiting?

A

antiemetic medications

5
Q

What are 5 clinical manifestations of GI dysfunction?

A
  1. nausea
  2. retching
  3. projectile vomiting
  4. constipation
  5. diarrhea
6
Q

What are 2 common symptoms associated with nausea?

A
  1. hypersalivation

2. tachycardia

7
Q

define retching

A

vomiting without the expulsion of vomitus

8
Q

define projectile vomiting

A

spontaneous vomiting that does not follow nausea or retching

9
Q

define constipation

A

infrequent or difficult defecation

10
Q

What kind of constipation is characterized by normal rate of stool passage, but difficulty with stool evacuation from low-residue, low-fluid diet?

A

normal transit constipation

11
Q

What kind of constipation is characterized by impaired colonic motor activity with infrequent bowel movements and straining?

A

slow-transit constipation

12
Q

What is failure of pelvic floor muscles or anal sphincter to relax with defecation:

A

pelvic floor dysfunction

13
Q

what does secondary constipation come from?

A

from an actual disease process or condition

14
Q

what is fecal impaction?

A

hard, dry stool retained in rectum

15
Q

What are some treatments for constipation?

A

bowel retraining, moderate exercise, increased fluid and fiber intake, enemas (should not be habitually used), biofeedback, drugs (stool softeners and laxatives).

16
Q

How many bowel movements do you have a day with diarrhea?

A

three or more per day

17
Q

What are 3 systemic manifestations of diarrhea?

A
  1. acute bacterial or viral infection (fever, with or without vomiting or cramping pain)
  2. inflammatory bowel disease (fever, cramping pain, bloody stools)
  3. malabsorption syndromes (steatorrhea (fat in the stools), bloating, and diarrhea)
18
Q

What kind of diarrhea is characterized by a nonabsorbable substance in the intestine drawing water into the lumen by osmosis, causing large-volume diarrhea?

A

osmotic diarrhea

19
Q

What kind of diarrhea is characterized by large-volume diarrhea caused by excessive mucosal secretion of chloride or bicarbonate-rich fluid or the inhibition of net sodium absorption?

A

secretory

20
Q

What kind of diarrhea is characterized by excessive motility decreases transit time, mucosal surface contact, and opportunities for fluid absorption?

A

motility diarrhea

21
Q

What are 4 clinical manifestations of diarrhea?

A
  1. dehydration
  2. electrolyte imbalance (hyponatremia, hypokalemia)
  3. metabolic acidosis
  4. weight loss
22
Q

What is a symptom of a number of GI disorders?

A

abdominal pain

23
Q

Where does parietal (somatic) pain occur?

A

in the peritoneum

24
Q

Where does visceral pain occur?

A

in the organs themselves

25
Q

Where does referred pain occur?

A

felt in another area, usually the back

26
Q

What are 3 biochemical mediators of the inflammatory response?

A
  1. histamine
  2. bradykinin
  3. serotonin
27
Q

What do biochemical mediators stimulate?

A

organic nerve endings producing abdominal pain

28
Q

Where does upper GI bleeding occur?

A

from the esophagus, stomach, or duodenum

29
Q

What does upper GI bleeding look like?

A

Frank, bright red bleeding in emesis or digested blood (coffee grounds) in stool

30
Q

Where does lower GI bleeding occur?

A

from the jejunum, ileum, color, or rectum

31
Q

define hematemesis:

A

blood vomit

32
Q

define hematochezia:

A

bloody stools

33
Q

define melena:

A

black, tarry stools

34
Q

define occult bleeding:

A

not visible

35
Q

define dysphagia

A

difficult swallowing

36
Q

What are 2 types of dysphagia?

A
  1. mechanical obstructions of esophagus

2. functional obstructions of esophageal motility

37
Q

define achalasia with dysphagia:

A

denervation of smooth muscle in the esophagus and lack of lower esophageal sphincter relaxation

38
Q

What is the treatment of achalasia:

A

dilation or surgical myomotomy of the lower esophageal sphincter

39
Q

define hiatal hernia

A

protrusion of the upper part of the stomach through the diaphragm and into the thorax

40
Q

What kind of hernia is hernia I?

A

sliding

41
Q

What is the most common hernia?

A

hernia I (sliding)

42
Q

What kind of hernia is characterized by the proximal stomach portion moving into the thoracic cavity through an opening in the diaphragm for the esophagus and vagus nerves?

A

hernia I (sliding)

43
Q

Which type of hernia is also called a rolling hiatal hernia?

A

hernia II (paraesophageal)

44
Q

What kind of hernia is characterized by herniation of the greater curvature
of the stomach is through a secondary opening in the diaphragm?

A

hernia II (paraesophageal)

45
Q

What kind of hernia is hernia III?

A

Mixed (a combo of hernia I and II)

46
Q

What is a pyloric obstruction?

A

blocking or narrowing of the opening between the stomach and duodenum

47
Q

What does a pyloric obstruction feel like?

A
  1. epigastric pain and fullness
  2. nausea
  3. succussion splash
  4. vomiting
  5. if prolonged, malnutrition and dehydration
48
Q

What is any condition that prevents the flow of chyme through the intestinal lumen or failure of normal intestinal motility in the absence of an obstructing lesion?

A

intestinal obstruction

49
Q

What is an ileus?

A

an obstruction of the intestines

50
Q

What are symptoms of a small intestine obstruction?

A
  1. colicky pains caused by intestinal distention
  2. nausea
  3. vomiting
51
Q

What are symptoms of a large intestine obstruction

A
  1. hypogastric pain

2. abdominal distention

52
Q

What can type of vomitus indicate in terms of obstruction?

A

location of obstruction

53
Q

What type of vomitus is associated with pylorus obstruction?

A

early, profuse vomiting of clear gastric fluid

54
Q

What type of vomitus is associated with proximal small intestine obstruction?

A

mild distention and vomiting of bile-stained fluid

55
Q

what type of vomitus is associated with lower in small intestine obstruction?

A
  1. more pronounced distention because a greater length of intestine is proximal to the obstruction.
  2. vomiting may not occur or may occur later and contain fecal material.
56
Q

What is the most common cause of small intestine obstructions?

A

fibrous adhesions

57
Q

What are the most common causes of large intestine obstructions?

A
  1. colorectal cancer
  2. volvulus (twisting)
  3. strictures related to diverticulitis
58
Q

What is acute colonic pseudo-obstruction also called?

A

ogilvie syndrome

59
Q

What is acute colonic pseudo-obstruction?

A

massive dilation of the large bowel

60
Q

When does acute colonic pseudo-obstruction occur?

A

in patients who are critically ill and older adults who are immobilized

61
Q

define gastritis

A

inflammatory disorder of the gastric mucosa

62
Q

What is acute gastritis associated with?

A
  1. H. pylori
  2. nonsteroidal antiinflammatory drugs (NSAIDs)
  3. drugs
  4. chemicals
  5. metabolic disorders
63
Q

What is chronic fundal gastritis?

A

Immune Type A

64
Q

What is chronic fundal gastritis associated with?

A

autoantibodies to parietal cells and intrinsic factor

65
Q

What does chronic fundal gastritis result in?

A

gastric atrophy and pernicious anemia

66
Q

What is chronic astral gastritis?

A

Non immune, Type B

67
Q

What is chronic astral gastritis associated with?

A

H. Pylori and NSAIDS

68
Q

Finish the sentence: Signs and symptoms of chronic gastritis often do not what?

A

correlate with the severity of the disease

69
Q

Define peptic ulcer disease:

A

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

70
Q

What is characteristic of peptic ulcer disease?

A

acute and chronic ulcers

71
Q

what are risk factors of peptic ulcer disease?

A
  1. Genetic predisposition
  2. H. pylori infection
  3. habitual use of NSAIDs
  4. excessive alcohol
    smoking
  5. acute pancreatitis
  6. COPD
  7. obesity
  8. cirrhosis
  9. socioeconomic status
  10. over 65 years of age
72
Q

What is superficial in relation to peptic ulcer disease?

A

erosions

73
Q

What is deep in relation to peptic ulcer disease?

A

true ulcers

74
Q

What are the most common peptic ulcers?

A

duodenal ulcers

75
Q

What are stress ulcers?

A

peptic ulcers related to severe illness, multi system organ failure, or major trauma

76
Q

When do ischemic ulcers develop?

A

within hours of an event

77
Q

When do curling ulcers develop?

A

after a burn from ischemia

78
Q

When do cushing ulcers develop as a result of?

A

as a result of head trauma or brain injury from hyper secretion of hydrochloric acid from the vagal nuclei

79
Q

What is the most common clinical manifestation of stress ulcers?

A

bleeding

80
Q

What is a treatment option for stress ulcers?

A

prophylactic therapy

81
Q

What are the 4 pancreatic enzymes associated with pancreatic insufficiency?

A
  1. lipase
  2. amylase
  3. trypsin
  4. chymotrypsin
82
Q

What is the primary problem with pancreatic insufficiency

A

fat maldigestion

83
Q

what are 2 common signs of pancreatic insufficiency?

A
  1. fatty stools (steatorrhea)

2. weight loss

84
Q

what is the treatment of pancreatic insufficiency?

A

lipase supplements

85
Q

What is the cause of lactase deficiency?

A

congenital defect in the lactase gene

86
Q

Lactase deficiency is associated with an inability to break down what?

A

lactose into monosaccharides and thus prevent lactose digestion and monosaccharide absorption

87
Q

What does lactase deficiency cause?

A
  1. cramping pain, flatulence

2. osmotic diarrhea

88
Q

What are 2 treatments for lactase deficiency?

A
  1. avoid milk products

2. maintenance of adequate calcium intake to decrease risk of osteoporosis

89
Q

What is bile salt deficiency the result of?

A
  1. liver disease

2. bile obstructions

90
Q

What does bile salt deficiency cause?

A
  1. fatty stools
  2. diarrhea
  3. loss of fat-soluble vitamins (A, D, E, K)
91
Q

What are 4 fat-soluble vitamins?

A

A, D, E, K

92
Q

What can a deficiency in vitamin A cause?

A

night blindness

93
Q

What can a deficiency in vitamin D cause?

A

decreased calcium absorption, bone pain, osteoporosis, fractures

94
Q

What can a deficiency in vitamin K cause?

A
  1. prolonged prothrombin time
  2. purpura
  3. petechiae
95
Q

What can a deficiency in vitamin E cause?

A
  1. testicular atrophy

2. neurologic defects in children

96
Q

define ulcerative colitis

A

chronic inflammatory disease that causes ulceration of the colonic mucosa

97
Q

What are suggested cause of ulcerative colitis?

A
  1. infectious
  2. immunologic (anticolon antibodies)
  3. dietary
  4. genetics
98
Q

What is the pathophysiology of ulcerative colitis?

A

lesions are continuous with no skipped lesions, are limited to the mucosa, and are not transmural

99
Q

What are characteristics of ulcerative colitis?

A
  1. large volumes of watery diarrhea
  2. bloody stools
  3. cramps
  4. pain
  5. urge to defecate
100
Q

People who have ulcerative colitis are at an increased risk for what?

A

colon cancer

101
Q

What does crohn disease cause?

A

skip lesions

102
Q

What does crohn disease look like?

A

produces “cobblestone” appearance

103
Q

What does crohn disease feel like?

A

abdominal pain and diarrhea

104
Q

Where is the location of lesions in ulcerative colitis?

A

colon and rectum; no “skip” lesions

105
Q

Where is the location of lesions in crohn’s disease?

A

all of GI tract - mouth to anus; “skip” lesions common

106
Q

What is the area affected in ulcerative colitis?

A

mucosal layer

107
Q

What is the area affected in crohn’s disease?

A

entire intestinal wall

108
Q

What is granuloma with ulcerative colitis?

A

rare

109
Q

What is granuloma with crohn’s disease?

A

common “cobblestone” appearance

110
Q

What is abdominal pain like with ulcerative colitis?

A

occasional

111
Q

What is abdominal pain like with crohn’s disease?

A

common

112
Q

What are bloody stools like with ulcerative colitis?

A

common

113
Q

What are bloody stools like with crohn’s disease?

A

less common

114
Q

What is steatorrhea like with ulcerative colitis?

A

rare

115
Q

What is steatorrhea like with crohn’s disease?

A

common

116
Q

What is antineutrophil cytoplasmic antibody like in ulcerative colitis?

A

common

117
Q

what is antineutrophil cytoplasmic antibody like in crohn’s disease?

A

rare

118
Q

what is antisaccharomyces cerevisiae antibody like in ulcerative colitis?

A

rare

119
Q

What is antisaccharomyces cerevisiae antibody like in crohn’s disease?

A

common

120
Q

define irritable bowel syndrome:

A

functional gastrointestinal disorder with no specific structural or biochemical alterations

121
Q

What are 4 clinical manifestations of IBS?

A
  1. lower abdominal pain
  2. diarrhea-predominant, constipation-predominant, or alternating diarrhea and constipation
  3. gas, bloating
  4. nausea
122
Q

define diverticula

A

herniation of mucosa through the muscle layers of the colon walls

123
Q

define diverticulosis

A

asymptomatic diverticular disease

124
Q

define diverticulitis

A

inflammatory stage of diverticulosis

125
Q

what are possible causes of appendicitis

A
  1. obstruction
  2. ischemia
  3. increased intraluminal pressure
  4. infection
  5. ulceration
126
Q

What are symptoms of appendicitis?

A
  1. epigastric and periumbilical pain
  2. rebound tenderness
  3. nausea, vomiting, fever, anorexia
127
Q

define portal hypertension

A

abnormally high blood pressure in the portal venous system primarily caused by resistance to portal blood flow

128
Q

What are causes of portal hypertension?

A
  1. pre hepatic
  2. intrahepatic
  3. posthepatic
129
Q

What are clinical manifestations of portal hypertension?

A
  1. ascites

2. vomiting blood from bleeding esophageal varices

130
Q

define ascites

A

accumulation of fluid in the peritoneal cavity

131
Q

What are clinical manifestation of ascites?

A
  1. abdominal distention
  2. increased abdominal girth
  3. weight gain
132
Q

define hepatic encephalopathy

A

accumulation of toxins related to liver failure, causing disruption of neurotransmission

133
Q

What are clinical manifestations of hepatic encephalopathy

A
  1. Personality changes
  2. Confusion, irritability, lethargy
  3. Memory loss, sleep disturbances
  4. Flapping tremor (asterixis)
  5. Stupor, coma, death
134
Q

define acute liver failure

A

severe impairment or necrosis of liver cells without preexisting liver disease or cirrhosis

135
Q

What are clinical manifestations of acute liver failure?

A
  1. anorexia
  2. vomiting
  3. abdominal pain
  4. progressive jaundice
136
Q

define viral hepatitis:

A

systemic viral disease that primarily affects the liver

137
Q

What is the sequence of viral hepatitis?

A
  1. incubation phase
  2. prodromal phase
  3. icteric phase
  4. recovery phase
138
Q

Which phase of viral hepatitis varies depending upon the virus?

A

incubation phase

139
Q

When does the prodromal phase begin?

A

2 weeks after exposure

140
Q

During which phase is viral hepatitis is it highly transmittable?

A

prodromal phase

141
Q

What is the actual phase of viral hepatitis?

A

icteric phase

142
Q

What are the clinical manifestations of the icteric phase?

A
  1. jaundice
  2. hyperbilirubinemia
  3. fatigue
  4. abdominal pain
143
Q

What phase of viral hepatitis begins with the end of jaundice?

A

recovery phase

144
Q

Hepatitis A can be found in the what of the infected individual?

A

feces, bile, and sera

145
Q

How is hep A transmitted?

A

by the fecal-oral route

146
Q

What are 2 risk factors of Hep A?

A
  1. crowded, unsanitary conditions

2. food and water contamination

147
Q

How can you prevent hep A?

A
  1. hand washing
  2. administration of immunoglobulin before exposure or early in the incubation period
  3. administration of vaccines
148
Q

How is Hep B transmitted?

A

transmitted through contact with infected blood, body fluids, contaminated needles (parenterally and sexually transmitted)

149
Q

How can Hep B also be transmitted during pregnancy?

A

maternal transmission if the mother is infected during the third trimester

150
Q

What does the Hep B vaccine prevent?

A

transmission and development of Hep B

151
Q

What does Hep B immunoglobulin provide?

A

post-exposure prophylaxis against hep B

152
Q

which Hep is responsible for most cases of post-transfusion hepatitis?

A

Hep C

153
Q

Co-infection of Hep C and what other Hep is common?

A

Hep C

154
Q

Approximately 80% of those with Hep C develop what?

A

chronic liver disease

155
Q

Is there a vaccine available for Hep C?

A

No

156
Q

What is administered with hep C?

A

antiviral meds

157
Q

What is dependent on hep B for replication?

A

hep D

158
Q

What is the treatment for Hep D?

A

pegylated interferon alpha

159
Q

How is Hep E transmitted?

A

fecal-oral transmission

160
Q

what can cause Hep E?

A

contaminated water or uncooked meat

161
Q

Where is Hep E most common?

A

Asian and african countries

162
Q

Where is a vaccine available for Hep E?

A

china, but not other countries

163
Q

define cirrhosis

A

an irreversible inflammatory fibrotic disease that disrupts liver function and even liver structure

164
Q

What are the most common causes of cirrhosis?

A
  1. alcohol abuse

2. HCV

165
Q

What is the 3rd most common cause of cancer death in the US for men and women?

A

cancer of the colon and rectum

166
Q

How does cancer of the colon and recutum develop from?

A

adenomatous polyps - a mass or fingerlike projection arising from the intestinal mucosal epithelium