Gastrointestinal Flashcards
(77 cards)
1
Q
gastroparesis
A
delayed gastric emptying w/o mechanical gastric outlet obstruction
2
Q
melena
A
dark tarry stools
upper GI bleed
3
Q
hematochezia
A
frank blood in stool
lower GI bleed
4
Q
Worldwide, 2nd preventable leading cause of death in children <5
A
diarrhea
5
Q
acute vs persistent diarrhea
A
acute <14 days
persistent >14 days
6
Q
large volume diarrhea
A
excessive water/secretions
7
Q
small volume diarrhea
A
excessive intestinal motility
frequent BMs throughout day
8
Q
4 major mechanisms of diarrhea
A
- Osmotic - extra solutes in LI pull water in - lactose intolerance
- Secretory - electrolytes w/i stool pull water in - cholera; gastroenteritis
- Motility - hypermotility - SI (extra solutes pull water in) or LI (water not absorbed)
- Inflammatory - dysentery; IBD
9
Q
secondary condition constipation caused by…
A
diet (↓ fiber, ↓ water)
meds (opioids)
disorders
aging (↓ peristalsis)
decreased mobility
10
Q
5 malapsorption problems/disorders/diseases
A
bariatric surgery
increased motility
enzyme deficiencies
lactose intolerance
celiac disease
11
Q
CELIAC DISEASE
etiology
explanation
s/s
tx
A
- Genetic, autoimmune
- Gluten ingestion damages villi in SI - ↓ surface area for absorption
- s/s - malabsorption; diarrhea; steatorrhea; growth problems in children; cramping precipitated by eating gluten
- Tx - avoid gluten (wheat)
12
Q
GASTRITIS
explanation
etiology (acute vs chronic)
s/s
A
- Inflammation of stomach lining
- Acute - caused by injury to protective mucosal barrier
- Chronic - H. pylori
- s/s - n/v; indigestion; heartburn; fullness feeling; belching; localized epigastric pain; possibly referred pain to shoulder, abd that worsens with swallowing (how it can be differentiated from cardiac pain)
13
Q
2 types of chronic gastritis
A
- Fundal gastritis - Type A, immune
- Antral gastritis - Type B, nonimmune
14
Q
causes referred pain to shoulder, abdomen that worsens with swallowing
A
gastritis
15
Q
GASTROENTERITIS
explanation
r/f
s/s
A
- Inflammation of stomach & intestines - results from viral or bacterial infection
- “Stomach flu”
- r/f - unclean water
- s/s - watery diarrhea; n/v; stomach pain; cramping; fever; h/a
16
Q
OROPHARYNGEAL CANCER
etiology
r/f
s/s
A
- Etiology - HPV (most common); tobacco
- r/f - white; middle age; male; tobacco use; HPV
- s/s - painless lesions on floor of mouth, side of tongue
17
Q
painless lesions on floor of mouth, side of tongue
A
oropharyngeal cancer
18
Q
GERD
explanation
etiology
r/f
s/s
complications
dx test
A
- Reflux of acid, pepsin into esophagus causing esophagitis - dysfunction of lower esophageal sphincter (LES) - resting tone of LES lower than normal
- Etiology - conditions that ↑ abd pressure; delayed gastric emptying
- r/f - obesity; pregnancy (↑ pressure OR ↑ progesterone in 1st tri); ascites; gastroparesis; hiatal hernia; connective tissue disorders
- s/s - heartburn; acid regurgitation; belching; dysphagia; chronic cough; asthma attacks; laryngitis; upper abd pain w/i 1 hr of eating
- Resp sx caused by inhalation of acid when it gets high enough
- Complications - chronic esophagitis; Barrett’s esophagus (precancer); esophageal cancer (metaplasia caused by acid)
- Test - endoscopy
19
Q
upper abd pain w/i 1 hr of eating
A
GERD
20
Q
HIATAL HERNIA
explanation
etiology
r/f
s/s
complication
dx tests
A
- Upper part of stomach herniates through opening in diaphragm, entering thoracic cavity
- Etiology - consistent, intense pressure on surrounding muscles; congenital (large diaphragm hole)
- r/f - congenital; obesity; pregnancy; chronic cough
- s/s - asymptomatic; GERD; intense pain with strangulation; constant epigastric/chest pressure
- Complication - strangulation - ischemia, necrosis
- Tests - radiology; endoscopy
21
Q
constant epigastric/chest pressure
A
hiatal hernia
22
Q
PYLORIC STENOSIS
explanation
r/f
s/s
complication
A
- Enlarged pylorus blocks chyme from entering SI - multifactorial genetic condition
- r/f - firstborn; males; first 6 months of life
- s/s - projectile vomiting followed by hunger; FTT (failure to thrive); change in bowel patterns; dehydration; jaundice (not enough feces created to get bilirubin out of body)
- Complications - inability to grow/gain wt
23
Q
projectile vomiting followed by hunger in infants
A
pyloric stenosis
24
Q
PEPTIC ULCER DISEASE
etiology
A
- Etiology - H. pylori - fecal oral, mouth to mouth - requires several medications for extended periods
25
**DUODENAL ULCERS**
etiology
s/s
tx
* Most common
* Etiology - *_H. pylori_*; hypersecretion of stomach acid & pepsin; use of NSAIDs (especially _aspirin_)
* s/s - intermittent epigastric pain, _rapidly relieved by foods or antacids_ (“feed an ulcer” - pyloric sphincer closes, less acid in duodenum); _melena_
* Tx - relieving hyperacidity; preventing complications
26
**GASTRIC ULCERS**
location
etiology
s/s
complication
* Antral region, adjacent to acid-secreting mucosa
* Etiology - _↑ mucosal permeability to H+_ (gastric secretion is normal or less than normal)
* _Pain is worsened by eating_
* Complication - _perforation_ through stomach wall & infection, acid w/i peritoneum
27
2 types of inflammatory bowel disease
Crohn's disease
ulcerative colitis
28
**ULCERATIVE COLITIS**
explanation
r/f
s/s
complications
* _Long-lasting_ inflammation & ulcers in colon
* _Continuous superficial lesions beginning at rectum_ - extent up through colon varies
* r/f - family hx; _teens or twenties_; white
* s/s - _very bloody diarrhea_; abd pain; rectal bleeding; wt loss; fatigue
* Complications - _severe bleeding_; diarrhea; _perforated bowel_; dehydration; _liver disease;_ osteoporosis; _colon cancer_ (especially with 7-8yr hx of UC); _scarring_ (shortens and narrows colon)
29
**CROHN'S DISEASE**
explanation
r/f
s/s
complications
* _Idiopathic_ inflammatory disorder
* Affects _any part of GI tract_, from mouth to anus
* r/f - family hx; _NSAID_ use; _teens or twenties_; white
* s/s - _bloody diarrhea, melena_ (depends on location of lesions); _“skipping” lesions_; lesions on only one side of intestinal wall; _penetration through tract wall (more likely than in UC)_
* Compilations - anemia; _fissures_ that extend into lymphatics; _↑ risk of infection_
30
continuous GI lesions beginning at anus
UC
31
skipping GI lesions anywhere along tract
Crohn's
32
**IRRITABLE BOWEL SYNDROME**
explanation
2 types
r/f
s/s
complications
dx tests
tx
* _Idiopathic_ common disorder of LI - no obvious structutal problem
* IBS-D - _diarrhea_ problems
* IBS-C - _constipation_ problems
* r/f - current smoking; frequent alcohol; _younger age;_ _psych & physical stress_
* s/s - varied; abd pain; gas; _mucus in stool_; bowel sounds; _sx relieved with defecation_
* Associated with _anxiety_, _depression_, reduced quality of life
* Tests - must rule out everything else first
* Tx - _no cure_; individualized
33
GI disease causing anxiety, depression, quality of life problems
IBS
34
**DIVERTICULITIS**
explanation
what is a diverticula?
what is diverticulosis?
r/f
s/s
complications
* _Inflamed diverticula_ - something gets stuck in diverticula
* _Diverticula_ - herniations of mucosa through muscle layers of colon wall - especially in _sigmoid_
* _Diverticulosis_ - _asymptomatic_ diverticular disease
* r/f - aging; obesity; smoking; _standard American diet_; meds that slow motility
* s/s - _vague_ pain; n/v; _LLQ_ tenderness; constipation; _very rigid stomach with peritonitis_
* Complications - abscess; fistula; _obstruction_ (can lead to death due to colon rupture); impaction; bleeding; _perforation_ (can lead to peritonitis)
35
vague LLQ tenderness
diverticulitis
36
**APPENDICITIS**
explanation
etiology
r/f
s/s
what if severe pain is suddenly relieved?
complications
dx tests
* Inflammation of vermiform appendix
* Etiology - obstruction; foreign bodies; infection
* r/f - family hx; younger age; male
* s/s - vague periumbilical pain; migrates to RLQ pain; McBurney’s point between umbilicus and top of hip; fever; n/v
* If severe pain is suddenly relieved, this indicates the appendix has ruptured
* Complications - peritonitis; sepsis
* Tests - rebound (McBurney’s); left side referred rebound (Rovsing’s sign); psoas; obturator signs; CT; barium enema
37
RLQ pain; rebound tenderness
appendicitis
38
**MESENTERIC VASCULAR INSUFFICIENCY**
explanation
complication
etiology
s/s
* Obstruction of _vascular supply to intestines_ (not duodenum; separate supply)
* Dead bowel _impairs functioning of peristalsis_, causing problems for the rest of the bowel
* Etiology - _thrombus_; embolus
* s/s - usually _upper abd pain_
39
what is cirrhosis?
final pathological result of various chronic liver disease - normal hepatocytes replaced with nonfunctional scar tissue
40
5 stages of liver damage
1. Healthy liver
2. Hepatic steatosis
3. Steatohepatitis
4. Liver fibrosis
5. Liver cirrhosis
41
etiology of cirrhosis
* Chemicals
* _Alcohol_ - converted to acetaldehyde causing hepatocellular damage
* Non-alcoholic fatty liver disease
* _Medications_ (acetaminophen; halothane; tetracycline...)
* Infection with _hepatitis_
* Toxic metals
* Excessive iron in liver - _hemochromatosis_
* _Copper hepatotoxicosis_ (Wilson’s disease)
* _Autoimmune_
42
complications of cirrhosis
esophageal varices
hepatic encephalopathy
hepatocarcinoma
kidney failure
43
**ESOPHAGEAL VARICES**
explanation
etiology
r/f
s/s
* _Enlarged veins in esophagus_
* Caused by obstructed blood flow through _hepatic portal vein_
* r/f - portal HTN; alcohol; _cirrhosis_; infection; excessive vomiting
* s/s - _vomiting large amts of blood_; black/tarry stools; lightheadedness; loss of consciousness
44
**HEPATIC ENCEPHALOPATHY**
onset
explanation
s/s
associated with…
* Onset - rapid during fulminant hepatitis, OR slowly during course of liver disease
* _Neurpsychiatric toxicity_ & encephalopathy r/t _liver’s inability to detoxify ammonia_ - unmetabolized ammonia accumulates
* s/s - subtle _personality changes_; memory loss; _irritability_; _disinhibition_; lethargy; sleep disturbances; confusion; _disorientation_; tremors; bradykinesia; stupor; convulsion; _coma_
* Associated with _hepatitis & Reye’s syndrome_
45
neuro sx of cirrhosis
hepatic encephalopathy → peripheral neuropathy; asterixis (liver stops turning ammonia into urea, ammonia accumulates)
46
CV sx of cirrhosis
ascites, peripheral edema (portal vein HTN)
47
GI sx of cirrhosis
anorexia
dyspepsia
n/v
change in bowel habits
_dull abd pain_
_fetor hepaticus_ (liver can no longer remove toxins)
esophageal, umbilical vein, and hemorrhoidal _varices_ leading to bleeding, which may lead to death (portal vein HTN)
_hematemesis_ (esophageal varices)
congestive gastritis
48
integ sx of cirrhosis
intrahepatic jaundice (buildup of bilirubin, byproduct of hemolysis)
palmar erythema, spider angiomas (↑ estrogen)
purpura, petechiae (liver cannot build clotting factors)
caput medusae (umbilical varices)
49
3 types of jaundice
_Prehepatic_ (excessive hemolysis)
_intrahepatic_ (hepatocyte dysfunction)
_posthepatic_ (obstruction of biliary drainage)
50
**JAUNDICE**
r/f
s/s
* r/f - _liver inflammation_; inflammation or destruction of bile duct; _hemolytic_ anemia
* s/s - _yellowing of skin and sclera_; pale skin; _dark urine;_ fatigue; abd pain; n/v; wt loss
51
hematologic sx of cirrhosis
anemia, thrombocytopenia, leukopenia, coagulation disorders (liver cannot supply vitamins, minerals to create blood components)
hepatosplenomegaly developing prior to ascites (portal vein HTN)
52
metabolic cirrhosis sx
hypokalemia
hyponatremia
hypoalbuminemia
53
reproductive sx of cirrhosis
amenorrhea (females)
testicular atrophy, gynecomastia, impotence (males)
(↑ estrogen, liver can no longer break it down)
54
**HAV**
source, route
duration
prevention
* Fecal source; _fecal-oral_ route
* Acute
* Prevented by pre/post exposure _immunization_; early vaccination
55
**HBV**
source, route
duration
complication
prevention
significance
* _Blood & blood-based bodily fluid_ derived; percutaneous and permucosal route
* More _sexually_ transmitted
* Chronic & acute forms
* Chronic form related to _hepatocarcinoma_ in adults & children
* Prevented by pre/post exposure _immunization_; newborn vaccination, 3-shot series
* _Leading cause of liver disease worldwide_
56
**HCV**
source, route
duration
complication
prevention
significance
* _Blood & blood-based bodily fluid_ derived; percutaneous and permucosal route
* More transmission by shared _needles_, tattoos
* Chronic & acute forms
* Pts with mild cases may not realize they have it
* May manifest as GI illness
* Chronic form related to _hepatocarcinoma_
* Prevented by _behavior modification_; blood donor screening; _no vaccine_
* _Leading cause of liver disease in US_
57
**HDV**
source, route
duration
prevention
* _Blood & blood-based bodily fluid_ derived; percutaneous and permucosal route
* Only possible to get Hep D _if you are infected with Hep B_
* Chronic
* Prevented by pre/post exposure _immunization_; behavior modification
58
**HEV**
source, route
duration
prevention
significance
* Fecal source; _fecal-oral_ route
* Acute
* Prevented with _clean drinking water_
* _More common_ in other areas of the world than Hep A
59
causative agents of hepatitis other than the hepatitis viruses
* Canine adenovirus type 1
* *Helicobacter*
* Herpesvirus
* Leptospirosis (*Leptospira*)
60
**PHYSIOLOGIC/INFANT JAUNDICE**
explanation
etiology
* _Lack of maturity_ of bilirubin uptake and conjugation in babies
* Etiology - ↑ breakdown of fetal erythrocytes; low hepatic excretory capacity
61
**CHOLECYSTITIS**
explanation
what is cholelithiasis? caused by?
etiology
s/s
r/f
dx test
* Inflammation of gallbladder
* _Cholelithiasis_ - gallstone formation - ↑ elevated cholesterol or bilirubin in the bile
* Etiology - _gallstone_ lodged in cystic duct; bile duct problems; _tumors_; serious illness; certain infections
* s/s - _RUQ pain_; _radiation to rt shoulder_; fever; leukocytosis; _intolerance of fatty food_
* r/f - obesity; middle age; female; American Indian ancestry; gallbladder disease
* Murphy’s sign - patient takes deep breath in, then you push on the RUQ to elicit pain
62
RUQ pain that radiates to the right shoulder
cholelithiasis
63
**PANCREATITIS**
explanation
duration
etiology
s/s
r/f
* Inflammation of pancreas as a result of _autodigestion_ due to obstruction of outflow of pancreatic digestive enzymes
* Acute or chronic
* Acute pancreatitis ↑ risk for chronic
* Etiology - gallstones; alcohol; _hypertriglyceridemia_ (\>500); infections; medications
* s/s - _severe, visceral, gnawing pain in back/epigastric area_ (pancreas sits further back in abd cavity) - pain is better if pt _sits up & leans forward_
* r/f - excessive _alcohol_; smoking; obesity; family hx
64
epigastric/back pain that is relieved when the patient sits up/leans forward
pancreatitis
65
**ILEUS**
explanation
r/f
s/s
tx
* Peristalsis stops in one region of bowel
* r/f - _anesthesia_; open abd surgery
* s/s - _watery stools; hypoactive bowel sounds in one region_; abd distension; pain at site of obstruction
* Tx - none; just wait until peristalsis begins again
66
**OBESITY**
dx criteria
associated with…
etiology
tx
* ↑ body fat mass; _BMI \>30_
* Associated with higher mortality, disease development, hospital costs
* Etiology - _caloric intake \> caloric expenditure_; _genetic_ variations; other causes (peripheral & central pathways; cytokines; hormones; neurotransmitters)
* Tx - _bariatric surgery_ most effective for ↓ morbidity, especially for pts with comorbidities
67
fat localized around abd, upper body
less healthy, risk for heart disease
visceral obesity/central adiposity
68
fat is extraperitoneal, distributed around thighs and buttocks
lower risk
peripheral obesity
69
someone with a normal BMI with \>30% body fat
normal weight obesity
70
high BMI, but no associated complications
↓ risk for mortality & morbidity
metabolically healthy obesity
71
**ESOPHAGEAL CANCER**
prevalence
r/f
s/s
prognosis
* 4.7 cases/100,000
* r/f - _chronic alcohol use_; tobacco; hot & irritant drinks; food containing _nitrosamines_ (beer, bacon, cured meat); _achalasia_ (LES fails to open during swallowing); _Barrett’s esophagus_
* s/s - wt loss; chest pain; dysphagia; feeling like food is getting stuck
* Often leads to metastasis - _poor_ prognosis
72
**STOMACH CANCER**
prevalence
r/f
s/s
* 6.6-20 cases/100,000
* r/f - atrophic _gastritis_; male; *_H. pylori_*; smoking; diet; genetic disorders
* s/s - _chronic n/v_; gastritis; family hx; anorexia; heartburn; wt loss; bloating; pain
73
**COLON CANCER**
prevalence
r/f
s/s
significance
prevention
* 38.6 cases/100,000
* r/f - older age; _IBD_; family hx; obesity; smoking; _DM_; alcohol; diet
* s/s - change of bowel habits; _rectal bleeding_; abd pain; wt loss; fatigue
* After lung cancer, kills more people in US than any other
* At _age 50_, recommend all men & women have colonoscopies
74
**RECTAL CANCER**
etiology
s/s
* Mostly caused by _HPV_
* Not necessary to have receptive anal intercourse - HPV can migrate from genitals
* s/s - _rectal bleeding_, especially painless; _pencil stools_
75
**LIVER CANCER**
prevalence
r/f
s/s
* 5.1-14.3 cases/100,000
* r/f - _HBV (children) or HCV_; alcohol; DM; genetics; fatty liver disease
* s/s - wt loss; abd pain; n/v; fatigue; _jaundice_; _white chalky stools_
76
**GALLBLADDER CANCER**
prevalence
r/f
s/s
* 0.8-1.4 cases/100,000
* r/f - _gallstones_; _female_; older age
* s/s - wt loss; fever; abd pain; jaundice; n/v
77
**PANCREATIC CANCER**
prevalence
r/f
s/s
prognosis
* 4-5.5 cases/100,000
* r/f - smoking; DM; obesity; _pancreatitis_; older age; family hx
* s/s - _vague abd/back pain_; jaundice; _light colored stool_; dark urine; DM; wt loss; blood clots; fatigue
* Very _poor prognosis_ - often advanced at diagnosis
