Final: Ch 29 Disorders of GI Function Flashcards Preview

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Flashcards in Final: Ch 29 Disorders of GI Function Deck (94):
1

dysphagia definition and causes

difficulty swallowing

narrowing of esophagus (scarring, cancer)

CNS lesions of swallowing nerves

2

Dx of dysphagia

Dx: endoscopy w/ barium

3

3 phases of dysphagia

1: neuromuscular disorder

2: pharyngeal phage/transport phase

3: esophageal phase/peristalsis

4

esophageal diverticula

weaknesses in the wall retain food

inflammation & ulceration result

requires surgery

5

esophageal laceraion

tear in mucosa

caused by severe vomiting

6

hiatal hernia

stomach protrudes through diaphragm

7

sliding HH

herniation at GE junction

8

para-esophageal HH

separate gastric pouch herniated

9

GERD

gastric contents enter esophagus through weak esophageal sphincter

esophageal mucosa injured

10

symptoms of GERD (heartburn)

heartburn 30-60min after eating (severe)

heartburn worse when bending/lying down

can produce chest pain or trigger asthma

11

other symptoms of GERD

mucosal injury can cause erosion or stricture

barrett's esophagus (squamous epithelium replaced by columnar)

12

diagnosis of GERD

history

barium swallow

endoscopy

13

treatment of GERD

avoid large meals, fat, caffeine, and alcohol

antacids, proton pump inhibitors

histamine-2 receptor blockers

14

esophageal cancer

squamous cell or adenocarcinoma

squamous cell from alcohol/smoking

adenocarcinoma starts with barrett's esophagus

15

treatment for esophageal cancer

surgery if early stage

radiation/chemo for late stage

poor prognosis

16

acute gastritis

acute inflammation caused by meds (NSAIDS), alcohol, or bacterial toxins

17

chronic gastritis

chronic inflammation --> atrophy of glandular epithelium

18

most common cause of chronic gastritis

H pylori gastritis

difficult to cure

treat with antibiotics and proton pump inhibitors

19

autoimmune gastritis

Ab vs. parietal cells and IF (intrinsic factor)

accompanies type 1 DM & hashimoto's thyroiditis

lack of IF --> vit b12 deficiency

20

peptic ulcer disease can be ______ or _______

gastric or duodenal

21

peptic ulcer disease can penetrate ______ only or enter the ________ muscle

mucosa, smooth muscle

22

risk factors for peptic ulcer disease

H pylori

NSAIDS

aspirin

23

infection in duodenal disease

bacteria cause inflammation --> cytokines --> damage mucosa

acid production is increased

24

NSAIDS in peptic ulcer disease

inhibit prostaglandins --> mucosal injury

less gastric irritation if use selective COX-2 inhibitors (celebrex)

25

clinical presentation of peptic ulcer disease

pain when the stomach is empty

hemorrhage b/c of erosion of arteries or veins --> tarry stool or coffee grounds emesis

perforation -- peritonitis

26

Dx of peptic ulcer disease

H&P

X-ray w/ contrast

endoscopy

27

treatment of peptic ulcer disease

antacids

proton pump inhibitors

H2 receptor antagonists

surgery for bleeding

28

Zollinger-Ellison syndrome

ulcers from gastrin-secreting tumor

most tumors in the pancreas

29

stress ulcers

seen with burns, sepsis, ARDS

30

stomach cancer is the __ most common worldwide

2nd

31

what increases risk for stomach cancer

eating smoked meat

H pylori infection

32

most stomach cancer is in which regions

pyloric

antrum

irregularly shaped

33

symptoms of stomach cancer

pain

weight loss

N/V

asymptomatic until late stage

34

Dx/Rx of stomach cancer

Dx: x-ray w/ contrast, endoscopy w/ biopsy

Rx: subtotal gastrectomy

35

irritable bowel syndrome symptoms

recurrent abdominal pain

n/v

bloating

farting, altered bowel movements

36

causes of IBS

poor nervous regulation

abnormal contractions due to stress

37

Dx of IBS

based on S&S

continuous or recurrent symptoms for > 12 wks in a year

2/3 of:

relief w/ pooping, onset associated w/ change in frequency, onset w/ change in stool appearance

38

Rx of IBS

reduce stress

avoid fatty foods, alcohol, antispasmotic meds

39

inflammatory bowel disease includes

Crohn's disease

ulcerative colitis

40

common features of inflammatory bowel disease

inflammation of large bowel w/ no cause or family pattern

remissions & exacerbations

41

areas of Crohn's disease

distal SI

proximal colon

42

areas of ulcerative colitis

descending colon

rectum

43

pathogenesis of inflammatory bowel disease

genetics

environment

immune response

microbes

44

Crohn's disease

small/large bowel inflammation

demarcated lesions surrounded by normal mucosa (skip lesions)

submucosa affected

mucosa has cobblestone appearance (fissures surrounded by edema)

45

symptoms of Crohn's disease

pain, diarrhea, weight loss, electrolyte imbalances

fistula, abscess, obstruction

46

Dx of Crohn's disease

sigmoidoscopy w/ biopsy

CT

H&P

47

Rx of Crohn's disease

anti-inflammatory meds

immunosuppressant meds

surgical resection

48

ulcerative colitis

inflammation of colon only - begins in rectum and spreads proximally

mostly impacts mucosa - pinpoint hemorrhages

49

symptoms of ulcerative colitits

relapsing attacks of severe diarrhea - bloody stool/mucus

incontinence

anorexia

weakness

50

Dx of ulcerative colitis

sigmoidoscopy

H&P

51

Rx of ulcerative colitis

avoid caffeine, lactose, spicy foods

anti-inflammatory meds

colectomy

52

complications of ulcerative colitis

colon cancer

53

infectious enetocolitis

viral, bacterial, protozoal

spread person to person in food

54

viral infectious enterocolitis

rotavirus

protection from nursing

diarrhea causes dehydration in infants

use supportive management

vaccinate

55

bacterial infectious enterocolitis

clostridium, E. coli, salmonella, C. difficile

some invasive, some non-invasive

2ndary to Antibiotic therapy

severe and life-threatening dehydration

56

diverticular disease

colon mucosa herniates through submucosa in multiple places

lack of fiber and inactivity

57

longitudinal muscle of colon is not continuous... (diverticular disease)

3 bands called teniae coli

places where blood vessels penetrate circular muscle are weak spots for herniations

58

symptoms of diverticular disease

pain, diarrhea, constipation, bloating, farting

59

complications of diverticular disease

perforation

bleeding

obstruction

fistula

60

Dx of diverticular disease

H&P

CT

barium enema

61

Rx of diverticular disease

stop solid food during acute attack

increase bulk in diet

62

appendicitis

inflamed appendix -- possibly gangrenous

abrupt onset of localized pain, signs of infection, rebound tenderness

63

Dx/Rx of appendicitis

H&P, ultrasound, CT

removal

64

complications of appendicitis

peritonitis

abscess

systemic sepsis

65

acute diarrhea

less than 2 wks duration

inflammatory or non-inflammatory

66

non-inflammatory acute diarrhea

large volume of watery stool b/c bacterial toxins

E. coli, S. aureus, vibro cholerae

67

inflammatory acute diarrhea

small volume of bloody stool & fever b/c bacterial infection

salmonella

68

chronic diarrhea

more than 4 wks duration

osmotic - lactose intolerance/excess magnesium salts

secretory - bile salts not reabsorbed in SI

inflammatory - inflammatory bowel disease

treat w/ oral rehydration

69

causes of constipation

neurologic (MS parkinson's)

endocrine (hypothyroidism)

drugs (narcotics, anticholinergics, Ca channel blockers, diuretics)

70

treatment of constipation

treat cause

hydrate

exercise

dont use laxatives/enemas

71

fecal impaction

hard stool in rectum that interferes with pooping

multiple causes that progress from constipation

digital or sigmoidoscopy dis-impaction

72

intussusception

telescoping of bowel

usually terminal ileum enters colon

common in kids > adults

73

volvulus

bowel twists on axis

usually cecum or sigmoid colon

74

inguinal hernia

SI enters defect

may strangulate

75

paralytic ileus

neurological disease or post surgical

76

mass

bowel cancer

77

symptoms of intestinal obstruction

abdominal distention

fluid loss

n/v

severe pain

78

complications of intestinal obstruction

perforation

peritonitis

sepsis

79

treatment of intestinal obstruction

NG suction w/ IV fluids

surgery

80

peritonitis

inflammation of the peritoneum

due to bacteria or chemicals

gut perforation

81

peritonits causes

massive fluid loss --> hypovolemic shock

82

treatment of peitonitis

NPO

NG suction

fluid resuscitation

fix perforation

83

malabsorption syndrome

poor fat absorption --> fat in stool

pancreatic or hepatic insufficiency

mucosal lesions

lymphatic obstruction

84

celiac disease

autoimmune disorder triggered by gluten

inflammation damages villi --> less absorption surface

85

celiac is more common in people with

type 1 DM

other autoimmune disorders

increases risk for cancer

86

symptoms of celiac

infancy w/ diarrhea and FTT

malnutrition

87

diagnosis/treatment of celiac

Dx: biopsy, measure Ab

Rx: don't eat gluten

88

adenomatous polyps

benign growths from intestinal mucosal epithelium

crypt cells proliferate --> abnormal --> adenoma

1/2 in rectum or sigmoid

89

tubular adenoma

some dysplasia only --> unlikely to progress to cancer

90

villous adenoma

broader more diffuse lesion

more likely to progress to cancer

91

colorectal cancer

3rd most common cancer, 2nd leading cause of death

familial risk and high risk for those with inflammatory bowel disease

high fat diet and bacterial infection increases risk

92

familial adenomatous polyposis increases risk for what

colorectal cancer

93

what protects vs. colorectal cancer

aspirin

94

Dx/Rx of colorectal cancer

Dx: screening - DRE, fecal occult blood test, colonoscopy

Rx: surgical removal