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Clin Med Exam 2 > Gastrointestinal pathology > Flashcards

Gastrointestinal pathology Flashcards

1
Q

Upper GI:

A

mouth, esophagus, and stomach

Ingestion and initial digestion

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2
Q

Middle GI:

A

SI

Digestion and absorption

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3
Q

Lower GI:

A

LI

Absorption of water and electrolytes and elimination

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4
Q

Mucosa:

A

Glandular Tissue

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5
Q

Submucosa:

A

connective tissue, large blood vessels, lymphatics, nerves, and mucous glands

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6
Q

Muscularis:

A

2 layers of smooth muscle

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7
Q

Adventitia:

A

connective tissue, vessels, lymphatics & nerves

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8
Q

GI motility:

A

propels food and fluid via rhythmic, intermittent peristaltic movement

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9
Q

Neural control:

A

Autonomic NS via the vagus nerve; SNS & PNS

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10
Q

Right Upper Quadrant (RUQ):

A

> right lobe of liver
gallbladder
duodenum
head of pancreas
right adrenal gland
right kidney
right of transverse colon
superior part of ascending colon

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11
Q

Right Lower Quadrant (RLQ):

A

> cecum
appendix
most of ileum
right ovary
ascending colon
right ureter
right spermatic cord
inferior part of right uterine tube

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12
Q

Left Upper Quadrant (LUQ):

A

> left lobe of liver
spleen
most of stomach
jejunum
proximal ileum
body/tail of pancreas
left adrenal gland
left kidney
superior part of descending colon
left half transverse colon

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13
Q

Left Lower Quadrant (LLQ):

A

> sigmoid colon
left ovary
left uterine tube
left ureter
left spermatic cord
inferior part of descending colon

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14
Q

Nausea & Vomiting =

A

prolonged can produce fluid and electrolyte imbalance, pulmonary aspiration, & mucosal/GI damage

due to food, drugs, hypoxic shock, inflammation of abdominal organs, virus, bacteria

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15
Q

Diarrhea =

A

amount of water lost = severity of illness

dehydration, electrolyte imbalance, dizziness, thirst

weight loss caused by infectious organisms, dysentery, diabetic enteropathy, IBS, hyperthyroidism, neoplasm, diverticulitis, diet, medication

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16
Q

Constipation =

A

causes increased bowel pressure & lower abdominal discomfort caused by diet, inadequate fluids, sedentary lifestyle, age, and drugs, hypothyroidism, diverticular ds, IBS, Parkinson’s ds, spinal cord injury, tumors

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17
Q

Anorexia =

A

loss of appetite with inability to eat

associated with anxiety, fear, and depression

causes emaciation, emotional disturbances concerning body image, fear of wt gain

most common in adolescent girls - can result in amenorrhea

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18
Q

Dysphagia =

A

difficulty swallowing

coughing, or choking caused by lesions of the CNS, esophageal disorders, swelling

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19
Q

Heartburn =

A

painful burning sensation felt in the esophagus

typically caused by gastric contents in the esophagus

associated with certain foods - citrus, chocolate, coffee, alcohol

triggered by certain positions - bending at the waist, supine after a large meal

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20
Q

Abdominal Pain =

A

caused by inflammation, ischemia, and mechanical stretching

see referred GI patterns for possible cause

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21
Q

GI Bleeding =

A

blood in vomit or feces

causes include gastritis, ulcers, prolonged drug or alcohol use

bright red feces consistent with lower GI, tarry black stool consistent with upper GI

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22
Q

Esophagitis =

A

> Reflux Esophagitis or GERD (gastroesophageal reflux disease)

> Inflammation of the esophageal mucosa as a result of reflux of the stomach contents

Causes: increased gastric volume, decreased anti-reflux, delayed esophageal clearance

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23
Q

Esophagitis
s/sx
Risk factors
Complications
Dx
Tx

A

s/sx: heartburn, chest pain, difficulty swallowing , regurgitation

Risk factors: obesity, pregnancy, scleroderma, hiatal hernia

Complications: ulcer, Barrett’s esophagus

Dx: Endoscopy, x-ray

Tx: antacids, H-2 receptor blockers, proton pump inhibitors, LINX device

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24
Q

Barrett’s Esophagus =

A

> usually in long-term GERD pts

> glandular metaplasia in distal esophagus as a result of chronic reflux of gastric acid into the esophagus

> causes: normal squamous cell lining cannot handle gastric acid, thus converts to glandular epithelium

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25
Q

Barrett’s Esophagus
s/sx
Risk factors
Complications
Dx
Tx

A

s/sx: frequent heartburn, dysphagia

Risk factors: GERD, age, males, white, overweight, smoking

Complications: esophageal cancer

Dx: endoscopy

Tx: treat for GERD, resection, ablation, cryotherapy, surgery

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26
Q

GERD
PT implications:

A

Exercise & Diet: excess abdominal fat increases abdominal pressure, avoid strenuous exercises & high calorie or fatty food

Supine position: avoid up to 4 hours after a meal

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27
Q

UPPER SPHINCTER DYSFUNCTION:

A

Shaker head-lifting exercise: strengthen upper esophageal sphincter ms

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28
Q

Hiatal Hernia:

A

segment of the stomach protrudes through the diaphragm into the mediastinum

cause: age, trauma, congenital, exercising/lifting heavy objects

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29
Q

Hiatal Hernia
s/sx
Risk factors
Complications
Dx
Tx

A

S/Sx: heartburn, regurgitation, SOB, difficulty, swallowing, acid reflux

Risk factors: obese, >50 years

Complications: GERD, ulcers, obstruction

Dx: x-ray, endoscopy

Tx: antacids, laparoscopic surgery

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30
Q

Hiatal Hernia
PT IMplications:

A

Flat supine position and exercises that require Valsalva maneuver = AVOID

Before Discharge = pt education regarding activities that increase intra-abdominal pressure & safe lifting

Post-Op = slow return to function (6-8 weeks), chest tubes (caution during repositioning), chest PT

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31
Q

Acute gastritis:

A

infiltration of edematous gastric mucosa predominantly by neutrophils

causes: aspirin, NSAIDs, smoking, alcohol, uremia, physiologic stress (burn, trauma)

pathogenesis: disruption of mucous layer, direct damage to epithelium (++) and HCO3(–)

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32
Q

Acute gastritis
s/sx
Dx
complications
Tx

A

s/sx: dyspepsia, mid-epigastric pain, “coffee-ground” emesis, blood in nasogstric tube

Dx: endoscopy

complications: GI bleeding, perforation (stomach wall)

Tx: antibiotics, PPIs, acid blockers, antacids

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33
Q

Morphology active inflammation = acute gastritis

A

1) gross = diffusely hyperemic gastric mucosa

2) microscopic
a) surface epithelium & glands: in tact with scattered neutrophils among the epithelial cells, “intraepithelial” or within mucosal glands

b) lamina propria: moderate edema & vascular congestion

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34
Q

Chronic gastritis:

A

infiltration of gastric mucosa with chronic inflammatory cells (lymphocytes), with associated mucosal atrophy and intestinal metaplasia

3 types: type A-fundal (autoimmune), type B-antral (H pylori), type C (NSAIDs, alcohol, bile)

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35
Q

Chronic gastritis
s/sx
Dx
complications

A

s/sx: upper abdominal pain, indigestion, bloating, nausea, weight loss, loss of appetite, belching

Dx: test for bacteria, stool test, CBC, endoscopy

complications: peptic ulcer, gastric carcinoma, hypochlorydria, achlorhydria, hypergastrinemia

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36
Q

Gastritis
Pt implications:

A

½ of all patients on long term NSAIDs have acute gastritis = often asymptomatic

Chronic gastritis = pt should seek immediate attention for hematemesis, nausea, vomiting

Pt Ed = medications = steroids should be taken with milk, food, or antacids to reduce gastric irritation

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37
Q

gastritis
RED FLAG:

A

Patients taking NSAIDs long term should be monitored for stomach pain, bleeding, nausea, or vomiting

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38
Q

Peptic Ulcer:

A

defect in the mucosal surface of the stomach or duodenum that extends through the muscularis mucosa into the submucosa or into deeper layers

70% (25-64rys)

causes: mucosal exposure to gastric acid, pepsin

H pylori (70% in stomach, 100% in duodenum), NSAIDs

39
Q

Peptic Ulcer
s/sx
risk factors
Dx
complications
Tx

A

s/sx: burning stomach pain, bloating, belching, heartburn, nausea, fatty food intolerance

risk factors: smoking, alcohol, stress, spicy foods

Dx: tests for H. pylori, endoscopy, upper GI x-rays

complications: bleeding, infection, perforation, obstruction

Tx: antibiotics, PPIs, H-2 blockers, antacids

40
Q

Peptic Ulcer Disease

A

Ulcer presentation typically without pain in older adults and in patients who are on NSAIDs

Monitor S/Sx of bleeding, pallor, activity tolerance, fatigue level

Vital signs, positional changes = increase HR may indicate bleeding

41
Q

Peptic Ulcer Disease
Pt implications:

A

Referred pain patterns = back pain radiating to mid-thoracic back & RUQ

Moderate exercise is beneficial = avoid strenuous exercise

Poor nutrition, anxiety, nervousness = negative impact on prognosis

42
Q

Peptic Ulcer
RED FLAG:

A

Pain from peptic ulcers located in the posterior wall of the stomach can present as radiating back pain

Pain can also radiate to the right shoulder

Stress and anxiety can increase gastric secretions and pain

43
Q

Mechanisms of malabsorption:

A

impaired intraluminal digestion

primary mucosal cell abnormality

reduced surface area

obstruction of lymphatics

infections

44
Q

Impaired intraluminal digestion causes:

A

pancreatic insufficiency

defective bile secretion

45
Q

Primary mucosal cell abnormality causes:

A

lactose intolerance

bacterial overgrowth

46
Q

Reduced surface area causes:

A

celiac spure

IBD

47
Q

Obstruct of lymphatics causes:

A

lymphoma

tuberculosis

48
Q

Infestions causes:

A

enterocolitis

parasitic infection

49
Q

malabsorption
S/Sx:

A

bloating

steatorrhea

diarrhea

weight loss

50
Q

Celiac sprue:

A

White»>non-white

Hypersensitivity to gluten

S/Sx: bloating, chronic diarrhea, malabsorption, dermatitis

Complications: diarrhea, increased risk for intestinal lymphoma, small intestinal adenocarcinoma

Tx: avoid gluten

51
Q

disaccharidase deficiency:

A

Sucrose, Maltose & Lactose

S/Sx: bloating, flatus, abd discomfort

Dx: High hydrogen after lactose

Tx: no lactose

52
Q

Stool types:

A

1: separate, hard lumps, hard to pass

2: lumpy-looking with a sausage shape, hard to pass

3: cracked-looking with sausage shape, easy to pass

4: smooth with a sausage shape, easy to pass

5: separate, soft lumps, easy to pass

6: very soft, mushy, very easy to pass

7: entirely liquid, very easy to pass

8: fatty, floating stool, lighter color, foul smell

9: visible, undigested food particles

53
Q

Malabsorptive Disorders
Pt implications:

A

Prolonged unexplained illness = suspect celiac ds or lactose intolerance

Fe (anemia), Vit D, Ca absorption = osteoporosis

S/Sx of malnutrition: ms weakness, ms wasting, fatigue, wt loss, tetany, paresthesia

54
Q

Inflammatory bowel disease:

A

mucosal or deeper damage to GI tract due to dysfunction of immune response towards normal intestinal flora

2 age peaks (2nd-4th decade, 6th decade)

M=F, whites

Ulcerative Colitis
Crohn Disease

55
Q

Crohn’s Disease:

A

region affected: from mouth to colon

location of inflammation: transmural

increased risk of colon cancer: 5-6x

anatomic features: fistula formation, lesions, creeping fat, cobblestoning of mucosa

rectal involvement: no

56
Q

Ulcerative colitis:

A

region affected: colon

location of inflammation: mucosal

increased risk of colon cancer: 10-20x

anatomic features: pseudopolyps, crypt abscesses

rectal involvement: yes

57
Q

Clinical manifestation: Crohn’s

A

S/Sx: abdominal pain, weight loss, and fever; bloody diarrhea; psychiatric symptoms

Dx: Colonoxcopy

58
Q

Clinical manifestation: ulcerative colitis

A

S/Sx: Profuse watery diarrhea with blood, mucus, and pus; abdominal pain; hematochezia

Dx: Barium enema; colonoscopy with biopsy

59
Q

Inflammatory Bowel Disease – CD and UC
Pt implications =

A

Referred pain: low back, peri-umbilical, LRQ pain, antalgic gait

Psoas often first sign: S/Sx = fever, lower abd pain, hip flexion deformity d/t reflex spasm (+psoas sign)

25% patients have migratory arthralgia, monoarthritis, polyarthritis or sacroiliitis

Low bone mineral content & high prevalence of osteoporosis

Hydration & Nutrition

Psychological = anger, anxiety, depression

60
Q

Psoas sign =

A

pain on passive extension of the right thigh

patient lies on left side

examiner extends patient’s right thigh while applying counter resistance to the right hip

61
Q

Irritable Bowel Syndrome (IBS)

A

most common GI disorder (10-15% world-wide)

functional disorder - cause unknown

F>M (2:1) typically between 20-40 years

correlation of IBS with Hx of early adverse life events (abuse-physical, sexual, etc.)

62
Q

Irritable Bowel Syndrome (IBS)
Dx
Tx

A

Dx: based on Rome IV critera

Tx: dietary changes, exercise, stress reduction, CBT

63
Q

CBT =

A

cognitive behavioral therapy

  • thoughts
  • feelings
  • behavior
64
Q

Rome IV =

A

recurrent abdominal pain 1day/week in the last 3 months, associated with 2 or more of the following criteria:

> related to defecation
change in frequency of stool
change in form (appearance) of stool

65
Q

IBD summary

A

classified as a disease

inflammatory condition

can cause hospitalization or need for surgery

can cause permanent damage to intestines

doctors can diagnose with exam and imagine

risk factor for colon cancer

treated with anti-inflammatory drugs or surgery

66
Q

IBS summary

A

classified as a syndrome

non-inflammatory condition

rarely requires hospitalization or surgery

doesn’t cause permanent damage to intestines

exam and imagine don’t show clinical signs of disease

not a risk factor for colon cancer

diet is primary treatment

67
Q

Ischemic bowel disease =

A

damage to the bowel due to decreased blood flow

causes: arterial thrombosis, emboli, venous thrombosis, hypo perfusion, strictures, volvulus

68
Q

Ischemic bowel disease
S/Sx
Dx
Tx

A

S/Sx: abdominal pain, hematochezia, fever, tachycardia

Dx: US, abdominal CT, angiography, stool analysis, colonoscopy

Tx: antibiotics, IV fluids, treat underlying condition, surgery in severe cases

69
Q

Ischemic bowel disease
PT implication:

A

intermittent LBP (thoracolumbar junction)

70
Q

Diverticular disease:

A

diverticulum: pouch in the wall of the GI tract

diverticulosis: many diverticuli

diverticulitis: infection of diverticulum

almost always false diverticula

common in large intestine

71
Q

Diverticular disease
causes
S/Sx
Dx
Tx
Complications

A

causes: high pressure in colon, diet (low fiber/red meat)

S/Sx: none (diverticulitis - lower abdominal pain, fever, rectal bleeding)

Dx: colonoscopy, CT (abdomen/pelvis) to confirm diverticulitis

Tx: antibiotics for diverticulitis, surgery (rupture, abscess, stricture)

Complications: diverticulitis, GI bleeding, perforation, abscess, obstruction, peritonitis

72
Q

Diverticulosis:

A

Characterized by pouch-like herniations (diverticula) of the mucosal layer of the colon

Symptoms: minimal but can include rectal bleeding

73
Q

Diverticulitis:

A

inflammation of one or more diverticula

Symptoms: pain, cramping lower left quadrant, nausea & vomiting, slight fever, elevated WBC

Complications: bowel obstruction, perforation & hemorrhage

Preventive treatment: regular exercise

Referred pain: low back

74
Q

Appendicitis

A

Inflammation of the appendix

Usually 10-30 yrs of age due to blockage in lining of appendix

Complication: Rupture = Life-threatening

75
Q

Appendicitis
S/Sx
Dx
Tx

A

S/Sx: sudden pain in R lower abdomen, pain worsens with cough, walk, nausea, vomiting, loss of appetite, low-grade fever, constipation, diarrhea, bloating

Dx: physical exam (Rebound tenderness), Blood Test (high WBC), Urine Test (rule out UTI, Kidney Stone), Imaging (X-Ray, USG, CT)

Tx: Appendectomy

76
Q

peritonitis:

A

Inflammation of the peritoneum = serous membrane lining the walls of the abdominal cavity

77
Q

peritonitis - Caused by bacterial infection:

A

Wounds
Surgery
Perforated peptic ulcer
Ruptured appendix
Perforated diverticulum
Pelvic inflammatory ds

78
Q

peritonitis - Symptoms:

A

Abdominal distension & severe pain

Rigidity & rebound tenderness

Decrease bowel sounds

Nausea & vomiting

tachycardia

79
Q

GI: S/Sx

A

2 main S/Sx: Abdominal Pain & GI Hemorrhage

80
Q

GI: D/Dx Acute:

A

inflammation = appendicitis, cholecystitis, acute pancreatitis

perforation = peptic ulcer

obstruction = volvulus

vascular = acute ischemia, ruptured abdominal aortic aneurysm

81
Q

GI: D/Dx Chronic:

A

inflammation = peptic ulcer, esophagitis, IBD, chronic pancreatitis

vascular = chronic ischemia

metabolic = porphyria

abdominal wall pain

functional = irritable bowel syndrome

82
Q

D/DX of Gi hemorrhage

A

upper GI bleeding = esophageal varices, esophageal neoplasms, Mallory-Weiss laceration, gastritis, peptic ulcer disease

lower GI bleeding = rapid upper GI bleeding, diverticulosis, infectious colitis, angiodysplasia, IBD, neoplasm, anal fissure, hemorrhoids

83
Q

Melena =

A

black/ tarry stool = upper GI bleeding

84
Q

Hematochezia =

A

bright red and bloody stool = lower GI bleeding

85
Q

Hemorrhoids

A

Varicosities in the lower rectum or anus = internal or external

Symptoms = pain, irritation, rectal itching

Straining with defecation, constipation, and prolonged sitting contributes to discomfort

Pregnancy increased risk

Tx: topical medication, dietary changes, sitz bath, local hot/cold compress, surgical

86
Q

Rehabilitation relevance =

A

Pelvic Floor exercises & biopsychosocial approach for defecation & urination problems

Aquatic Therapy = precautions for colostomy bag and stoma

Screening for developmental delays = Down’s Syndrome

Post Surgery = breathing exercises, huffing, coughing abdominal exercises, circulatory exercises, pelvic tilting, knee rolling

Avoid heavy lifting and standing for long periods of time

87
Q

Electrolyte imbalance:

A

orthostatic changes (BP)

88
Q

Close monitoring of CBC and coagulation profiles =

A

determine parameters for physical management

89
Q

Acute GI bleeding =

A

refer to PCP =
watch for tachycardia, hypotension

90
Q

Constipation may be acute or chronic =

A

Acute constipation begins suddenly and noticeably

Chronic constipation may begin gradually and persists for months or years

91
Q

diarrhea =

A

Acute diarrhea = common problem that typically lasts 1 or 2 days and goes away on its own

Persistent diarrhea = longer than 2 weeks and less than 4 weeks

Chronic diarrhea = at least 4 weeks - symptoms may be continual or may come and go

92
Q

diarrhea =

A

common health condition in which a person suffers from watery and loose stool

93
Q

dysentery =

A

infection or inflammation of the intestine that can lead to the presence of blood in the watery stool

also referred to as bloody diarrhoea

Clin Med Exam 2 (10 decks)

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