Gastro - part 1 Flashcards
1
Q
What is dumping syndrome?
A
Rapid emptying of hypertonic chyme from the surgically residual stomach
2
Q
What is a simple instetinal obstruction?
A
it is a mechanical blockage via lesion (most common)
- luminal obstruction without impairment of blood supply
3
Q
What is small volume diarrhea caused by?
A
o Ulcerative colitis
o Chron’s disease
o Microscopic colitis
o Colon cancer
o Fecal impaction
4
Q
What symptoms contribute to acid reflex?
A
Vomiting coughing, lifting bending, obesity, or pregnancy increases abdominal pressure, contributing to reflux
5
Q
Signs and symptoms of appendicitis?
A
initially – vague epigastric pain, cramping sensation
Over 24 hours – pain becomes more localized in RLQ
Will also see anorexia, nausea or vomiting, low-grade fever, rebound tenderness on palpation
Following rupture – brief cessation of pain – untreated it is fatal
6
Q
What is secretory diarrhea caused by?
A
Produces large-volume diarrhea caused by:
o Viruses (ie. Rotavirus)
o Bacterial enterotoxins (ie E coli and V coli)
o Exotoxins from C difficile
o Small bowel bacterial overgrowth
7
Q
What is secondary constipation caused by?
A
Diet, medication, or neurological disorders in which neural pathways or neurotransmitters are altered and colon transit is delayed
8
Q
What symptoms accompany chronic diarrhea that’s caused by inflammatory bowel disease or dysentery?
A
- Fever
- Cramps
- Bloody stool
- Steatorrhea (fat in stools)
- Bloating
9
Q
Risk factors for GERD?
A
Risk factors – age, obesity, hiatal hernia (stomach bulges up into your chest through an opening in diaphragm), medications that relax the lower esophageal sphincter
10
Q
What are we going to have with exposure to stomach acid in acid reflex?
A
Metaplasia due to changing cells from exposure to stomach acid
11
Q
What is Emesis?
A
forceful emptying of stomach and intestinal contents
Caused by extreme pain, stomach or duodenum distension, motion sickness, side effects of medications, trauma
Usually preceded by nausea – retching
12
Q
What is slow - transit constipation?
A
It involves impaired colonic motor activity with infrequent bowel movements, staring to deficated, mild abdominal distention, and palpable stool in the sigmoid colon
13
Q
With GERD what may be a precursor to cancer in the esophagus?
A
stomach acid changes the lining of the esophagus – may be precursor to cancer of esophagus
14
Q
What is intussusception? what population is it more common in?
A
Telescoping one part of the intestine into another (this usually causes strangulation of blood supply)
*More common in infant 10-15mon of age rather than adults
15
Q
What is paralytic ileum?
A
(Functional GI obstruction)
failure of intentional motility that is often occurring after intestinal or abdominal surgery, acute pancreatitis, or hypokalemia
16
Q
Signs and Symptoms for acute gastritis?
A
vague abdominal discomfort epigastric tenderness, & bleeding
17
Q
What is GERD?
A
- More serious form of acid reflex (chronic acid reflex)
18
Q
What is appendicitis? What happens if it ruptures?
A
Inflammation of the appendix
If it ruptures you have stool going into tour perineum
19
Q
What is hematochezia?
A
bright red stools, but generally some digested blood components would have occurred producing melena
20
Q
What is Ulcerative Colitis? where do we see it?
A
It is a chronic inflammatory disease that causes ulceration of the colonic mucosa, most commonly in the rectum and sigmoid colon
- Ulcerations of the mucosa in the colon
21
Q
What is secretory diarrhea?
A
Excessive muscosa secretion of fluid and electrolytes produces large volume diarrhea
22
Q
What is anorexia associated with?
A
o Associated with nausea, abdominal pain, diarrhea, and psychological stress
23
Q
What are the structures of lower GI bleeds?
A
jejunum, ileum, colon, rectum
24
Q
What is Nonimmune (astral) gastritis caused by?
A
H.pylori, and is associated with the use of alcohol, tobacco, and NSAIDs
25
How is Diarrhea classified?
More then 14 days to 4 weeks = persistent
more then 3 loose stools within 24 hours lasting less than 14 days
26
How are upper GI tract bleeds characterized?
frank, bright red bleeding or dark grainy digested blood that has been affected by stomach acids
27
What is Steatorrhea?
Fat in stool
28
What are the systematic effects of prolonged diarrhea?
Dehydration
Electrolyte imbalance (hyponatrmia, hypokalemia)
Weight loss
29
What is functional constipation associated with?
o Sedentary lifestyle
o Highly refined foods
o Low fluid intake
30
What is visceral abdominal pain?
It arises from the stimulus acting on an organ (distension and inflammation)
* Poorly localized, diffuse or radiating
31
What does Chronic immune (fundal) gastritis lead to?
The gastric mucosa degenerates extensively in the body and fungus of the stomach, leading to gastric atrophy
leads to gastric atrophy, which diminishes acid and intrinsic factor, causing pernicious anemia (lack of Vit B12 absorption)
32
Complications of a duodenal ulcer?
What is the most common cause of mortality, particularly among older persons with a duodenal ulcer?
Complications include bleeding, perforation, and obstruction of the duodenum or outlet of the stomach
* most common cause of mortally amount older persons is bleeding
33
what do gastric ulcers cause more of compared to duodenal ulcers?
They cause more anorexia, vomiting, and weight loss than duodenal ulcers
34
What are predisposing factors to diverticulosis?
older age, genetic predisposition, obesity, smoking, diet, sedentary lifestyle, & meds such as aspirin and NSAIDS
35
What is parietal (somatic) abdominal pain? Where does it arise from?
It arises from the parietal peritoneum
****Localized and intense
* Arises from the organs themselves
* Pain lateralizes
36
What can steatorrhea indicate?
Alterations in liver and pancreatic functions
37
What is a Cushing's ulcer? Where are they commonly located?
Stress ulcer that is associated with with severe brain trauma or brain surgery
Most common site os the stomach
38
What is functional constipation?
Involves normal rate of of still passage, but there is difficulty with stool evacuation
39
What is Gastritis?
It is an inflammatory disorder of the gastric mucosa
40
What are some complications of diverticulitis?
abscess, fistula, obstruction, bleeding, or perforation
41
What is alkaline reflux gastritis? Signs and symptoms?
-inflammation caused by reflux of bile and alkene pancreatic secretions
nausea, vomiting bile, epigastric pain
42
What is diverticulitis associated with? how is it idiopathic?
It is associated with increased intracolonic pressure, abnormal neuromuscular function, and alterations in intestinal motility
Idiopathic – related to increased intracolonic pressure, abnormal neuromuscular function, and alterations in intestinal motility
43
What are the 5 indicators of constipation? How long do you need to have them for?
You need to have at least 2 of these indicators for 3 months
1.) Straining with defecation 25% of the time
2.) Lumpy or hard stools 25% of the time
3.) Sensation of incomplete emptying 25% of the time
4.) Manual manoeuvres to facilitate evacuation 25% of the time
5.) Fewer than 3 bowel movements per week
44
What is Chronic immune (funal) gastritis? What is it associated with? what does it lead to?
Rarest from of gastritis and is associated with the loss of T cells tolerance and development of autoantibodies to gastric H+ -K+ ATPase.
45
Diverticulosis Vs Diverticulitis
Textbook: Doverticulosis is an asymptomatic diverticular disease
Diverticulitis represents inflammation - Diverticulitis – inflammation of the outpouching
Diverticulosis occurs when small, bulging pouches (diverticula) develop in your digestive tract. When one or more of these pouches become inflamed or infected, the condition is called diverticulitis
46
What are diverticula?
They are herniations or sacklike outpourings of the mucosa and submucosa through muscle layers, usually in the wall of the sigmoid colon
47
What is motility diarrhea caused by?
o Resection of the small intestine
o Surgery bypass along intestine
o Fistula formation between loops of intestine
o Irritable bowel syndrome – diarrhea prominent
o Diabetic neuropathy
o Hyperthyroidism
o Laxative abuse
48
Signs and symptoms for ileum obstruction?
more pronounced distension – greater length of intestine is proximal to obstruction – vomiting is a late sign – constipation – (rarely diarrhea) – increased bowel sounds
49
Where does ulcerative colitis originate in?
It originates in the rectum and may extend the entire colon
50
Upper GI bleeds is bleeding in what areas of the upper GI tract?
esophagus, stomach, duodenum
51
What is afferent loop obstruction? what is it a result from?
It is intermittent severe pain and epigastric fullness after eating as a result of volvulus, hernia, adhesion, or stenosis of duodenal stump
52
Bleeding from the upper GI can be rapid enough to produce?
hematochezia
53
Signs and symptoms of IBS? What are symptoms usually relieved with?
-There is alternating between consitpation and diarrhea - but one condition can be the dominant or more frequent condition
-Lower abdominal pain or discomfort and bloating
Symptoms are usually relieved with defecation and do not interfere with sleep
54
What is occult bleeding? what is a result of?
o Slow, chronic bleed
o Not obvious
o Results in iron deficiency anemia
o Life threatening
55
What are upper GI bleeds caused by?
* Varicose veins in esophagus
* Peptic ulcers
* Arteriovenous malformations
* Mallory-Weiss tear at esophageal-gastric junction
56
Pain of gastric ulcers occur?
immediately after eating
57
Where can diverticulosis occur in the GI tract?
Anywhere in the GI tract – weak points in the colon wall
58
Maifestations/signs and symptoms of diverticulosis?
vague or absent, cramping in lower abdomen, diarrhea, constipation, distention or flatulence may occur
59
What is projectile vomiting caused by?
It is caused by direct stimulation of the vomiting center by neurological lesions (increased cranial pressure, tumours, or aneurysms) involving the brainstem or can be a symptom of GI obstruction
60
What is jaundice (icterus) caused by?
hyperbilirubinema increased amount of plasma bilirubin concentrations
61
What is anorexia?
– not always the disease, it is lack of a desire to eat - no desire to eat - no craving
Side effects of medications and disorders of other organs (cancer, heart disease, kidney disease)
62
Predisposing factors for diverticulosis?
Predisposing factors – older age, genetic predisposition, obesity, smoking, diet, sedentary lifestyle, & meds such as aspirin and NSAIDS
63
What is Crohn's disease?
It is an idiopathic inflammatory disorder that affects any part of the GI tract from anus to mouth
64
What is Nonimmune chronic gastritis?
Involves the atrium only and is more common than fundal gastritis
– involves the antrum only – follows acute gastritis
65
What are adhesion intestinal obstructions?
excessive scar tissue after surgery – When the wound was healing the wound started to heal with the intestine – bowel isn’t function the way it should because something is mechanically wrong
66
Chronic Gastrits, what does it cause?
Tends to occur in older adults/persons and causes inflammation, mucosal atrophy, and epithelial metaplasia
67
What is a duodenal ulceration?
Ulceration in upper part of the small intestine - will see more a medulla
68
What is IBS?
It is a group of symptoms that occur together
* Currently a symptom based disease that is characterized by recurrent abdominal pain with altered habits
69
What are we seeing in individuals with chronic gastritis?
With chronic inflammation, may see mucosal atrophy, epithelial metaplasia - immune defeicy – long term alcholoics,
We’re changing the cells – has a chance of developing carcinoma of the stomach
70
What are some complications of diverticulitis?
abscess, fistula, obstruction, bleeding, or perforation
71
Mechanism for acid reflux?
the LES is weak or doesn’t properly close, allowing stomach acid to backup, which irritates the lining of the esophagus.
72
What are predisposing factors to diverticulosis?
older age, genetic predisposition, obesity, smoking, diet, sedentary lifestyle, & meds such as aspirin and NSAIDS
73
Where are curling ulcers seen? What is the most common site they are located in?
Stress ulcers that develop as a result of burn injury
Most commonly seen in the duodenum
74
Where is the vomiting center located?
It is located in the medulla oblongata
75
What are lower GI bleeds caused by?
* Polyps
* Diverticulitis
* Inflammatory disease
* Cancer
* Hemorrhoids
76
Risk factors for peptic ulcers?
Alcohol consumption
Smoking
Injury or trauma
Psychological stress
Older than 70
77
What is a Gastric ulceration? What do they tend to be more of?
Ulceration in the stomach lining
They tend to be more chronic rather than alternating between periods of remission and exacerbation
78
What is Pelvic Floor Dysfunction/Outlet dysfunction? Examples?
* Inability to poop due to dysfunction of pelvic floor muscles or anal sphincter
Ex:
o Pelvic floor dyssynergia
o Rectal fissures
o Strictures
o Hemorrhoids
79
What is projectile vomiting?
vomiting not preceded by nausea or retching
80
What precedes vomiting?
o Nausea and retching precede vomiting
Also preceded by hypersalivation and tachycardia
81
Signs + symptoms of chronic gastritis?
Can include vague symptoms of anorexia, fullness, nausea, vomiting, and epigastric pain
82
What is acute gastritis?
injury of mucosal barrier, can be caused by medications (NSAIDS), chemicals, or H. Pylori
83
What are individuals with gastritis at risk for developing?
risk of developing gastric cancer due to changing of the cells
84
What intestine is usually more obstructed? why?
* Small intestine is usually more often obstructed due to small lumen
85
Sings and symptoms of a large intestine obstruction?
hypogastric pain, abdominal distension – pain varies – dependent on ischemia and peritonitis. Vomiting is a late sign – vomiting up food that has gone through the digestive process – bowel obstruction has gone on way to long
86
What is retching?
the music,ar event of vomiting without the expulsion of vomitus (dry heaving)
87
Pathophysiology of osmotic diarrhea?
* Nonabsorbable substance in intestine draws water into intestine
* Increases weight and volume
o Produces large-volume diarrhea
88
Signs and symptoms of dumping syndrome?
cramping pain, nausea, vomiting, diarrhea, weakness, pallor, hypotension
89
What is osmotic diarrhea caused by?
o Lactase and pancreatic enzyme deficiency
o Excessive intake of synthetic (nonabsorbable) sugars
o Full-strength tube feeding formulas
o Dumping syndrome associated with gastric resection
90
What is the most common and dangerous complication of appendicits?
If perforation occurs, contents spill into abdominal cavity – causing peritonitis – most common and dangerous complication
91
What are the most common causes of peptic ulcer disease?
H.pylori bacteria – affects mucous & allows stomach acid to damage lining
Medications – irritate and damage lining
92
What is jaundice?
o Yellow discoloration of skin, mucous membranes, sclerae
93
What is hepatorenal syndrome? What is it caused by?
it is function kidney failure that develops as a complication of advanced liver disease.
The kidney failure is not caused by primary kidney disease of other extrinsic factors by rather by portal hypertension, cardiac impairment, and other circulatory alternations with advanced liver disease.
94
What is referred abdominal pain?
* Visceral pain felt a distance from affected organ
* Well localized
* Felt in skin dermatome or deep tissue
o Ie. Cholecystitis may have pain referred to right shoulder or scapula
95
what is obstructive jaundice?
specific type of jaundice, where symptoms develop due to a narrowed or blocked bile duct or pancreatic duct, preventing the normal drainage of bile from the bloodstream into the intestines.
Caused by:
* Extrahepatic obstruction
o Common bile duce is blocked
Gallstones, tumor, inflammation
o Blocked bilirubin accumulates in liver and enters bloodstream
96
What is short bowel syndrome?
Resection of the small intestine (can lead to motility diarrhea)
97
What is melena?
black or tarry stools that are sticky snd have a characteristic foul odour
* Digestion of blood neon pup GI bleed
98
What is diverticulosis?
It is inflammation of diverticula in the sigmoid colon
99
Food relives what kind of pain and causes what kind of pain in ulcers?
Causes pain: Gastric ulcer
Relives pain: Duodenal ulcer
100
What causes GERD?
abnormalities in lower esophageal sphincter function (resting tone is lower than normal), esophageal motility, gastric motility or emptying
101
Signs and symptoms for small intestine obstruction?
colicky pain, distension, nausea and vomiting, pain – we feel like its cramping up because the intestine is trying to pass something when it can’t
102
Examples of simple intestinal obstructions?
Hernia, adhesions, volvulus, and intussusception
103
What endocrine or metabolic disorders can lead to secondary constipation?
* Hyperthyroidism
* DM
* Hypokalemia
* Hypercalcemia
104
Patho for Ulcerative colitis?
1.) Mucosa is hyperaemic and colon mucosal may appear dark red
2.) Coalesce into ulcers (small erosions form)
3.) Ragged ulceration of mucosa (necrosis of mucosa)
4.) Inner muscle layer scars and thickens (narrowing of intestinal lumen)
5.) Destruction and inflammation (bleeding, cramping)
6.) Loss of absorptive mucosal surface (diarrhea, blood and purulent mucus)
105
What neurological disorders can cause secondary constipation?
* Parkinson’s
* Spinal cord lesions
* MS
* Hirschsprung’s disease
106
Causes of appendicitis?
Obstruction of the lumen with stool, tumours, or foreign bodies – bacterial infection
Obstruction does not allow drainage– perforation follows
*If perforation occurs, contents spill into abdominal cavity – causing peritonitis – most common and dangerous complication
107
What is a hernia?
The protrusion of intestine through the weakness in abdominal muscles through inguinal ring
108
What medications can cause secondary constipation?
* Opiates
* Calcium carbonate
* Aluminum hydroxide
* Anticholinergics
* Bismuth (Peptobismol)
109
Mild Vs severe Ulcerative colitis
Mild: Involves less mucosa so that the frequency of bowel movements, bleeding, and pain is minimal
Severe: May involve the entire colon and are characterized by abdominal pain, fever, elevated pulse rate, frequent diarrhea, urgency, bloody stools, and continuous cramping pain
110
What is peptic ulcer disease?
a break or ulceration in the protective mucosal lining of the lower esophagus
