GI Disorders Flashcards by Kristin Godsey

hormone that is produced in adipose cells

leptin

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the most common site affected by UC

rectum and sigmoid colon

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client with 5Fs risk factors most likely has…

cholelithiasis

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Mother-infant transmission of Hepatitis B Virus (HBV) will have a high vertical transmission rate when the woman is seropositive for both hepatitis B surface antigen (HBsAg) and _______

HBeAg ( Hep B viral protein)

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Gastric ulcers are more likely to be seen in patients aged ______

55-65

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A colon lesion that may result in obstruction is most likely to be found in the ______

descending colon

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The primary diagnostic marker for acute pancreatitis is…

serum lipase

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Blockage of the bile duct by gallstones or tumor will result in…

obstructive jaundice

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Epigastric pain that is relieved by food is suggestive of…

duodenal ulcer

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hereditary nonpolyposis colorectal cancer is an example of a _________ risk factor

non-modifiable

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condition caused by reflux of acid and pepsin into the esophagus through the lower esophageal sphincter (LES) that causes erosion of esophageal lining (mucosal injury)

GERD

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condition of precancerous lesions in the esophogas which can lead to adenocarcinoma

Barrett’s esophogas

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Risk Factors for ______:
Obesity
Hiatal hernia
Drugs that relax the LES (Ca+ channel blockers, nitrates, nicotine)

GERD

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Causes of ______:
abnormalities in LES
anything that alters closing strength of LES
increased abdominal pressure

GERD

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foods/drink that relax the LES

caffeine
alcohol
fatty foods
chocolate

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severity of esophagitis depends on…

composition of gastric contents

exposure time

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Heartburn (wet burp/regurgitation) is worse with…

within 1 hour of eating
lying down
increased abdominal pressure

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Clinical Manisfestations of \_\_\_\_\_\_:
heartburn
asthma
chronic cough
dysphagia w/ weight loss
sinusitus
laryngitis
chest pain

GERD

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How GERD is diagnosed?

patient history
clinical manifestations
endoscopy

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Findings in endoscopy that confirm \_\_\_\_\_\_:
hyperemia
edema
erosion
strictures
inflammation
poor closure of LES
Barrett's (biopsy)

GERD

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injury to protective mucosal layer of the stomach resulting in inflammation of the lining (deep or superficial) that occurs with or w/o hemorrhage

gastritis

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acute causes of \_\_\_\_\_\_\_:
chemicals
NSAIDS
alcohol
histamine
metabolic disorders (uremia)
h.pylori
shock/hypotension

gastritis

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NSAIDS cause gastritis by…

being COX1 inhibitors- inhibits mucoasal prostaglandins

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prostaglandin action in the stomach

stimulate mucous production

suppress inflammation

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h.pylori action in the stomach

inflammation | increased gastric secretions

symptoms of h.pylori in the stomach

pain | n/v

chronic causes of ______: chronic inflammation mucosal atrophy epithelial metaplasia

gastritis

h.pylori results in _____ gastritis

antral

most rare and most severe type of chronic gastritis that affects the fundus and leads to gastric atrophy

Type A: Fundal/Immune

more common type of chronic gastritis that affects the antral

Type B: Antral/Non-Immune

Type B chronic gastritis causes

chronic alcohol use NSAIDS tobacco use

Type B chronic gastritis can result in high levels of...

hydrochloric acid

increased secretion of hydrochloric acid leads increases risk of _______

duodenal ulcers

condition when Type B gastritis progresses to include Type A and antrum is more severely involved

Type AB: Pan Gastritis

type of gastritis associated with secretion of bile and pancreatic secretions into the stomach causing chemical injury

Type C Gastritis

break or ulcer of the mucosal lining of the lower esophagus, stomach or duodenum

Peptic Ulcer Disease

``` Risk Factors for ______: Genetics H. Pylori ASA & NSAIDS ETOH smoking COPD obesity Stress (unknown why) Age < 65 y.o ```

Peptic Ulcer Disease (PUD)

most common form of ulcer

duodenal

duodenal ulcers are most commonly caused by...

h.pylori and NSAIDS

duodenal ulcers are negatively associated with...

gastric cancer

``` symptoms of _______: chronic/intermittent abdominal pain pain occuring 30 min-2 hrs after eating pain relieved by ingestion of food weight gain ```

duodenal ulcers

PUD is diagnosed with...

UGI, endoscopy, and h.pylori tests

______ testing is recommended for any peptic ulcer

h.pylori

90% of DU and 80% of GU are caused by...

h.pylori

bacteria that releases toxins and enzymes that promote inflammation and ulcers

h.pylori

h.pylori infections cause increase of...

acid pepsin gastrin pepsinogen

ulcers in the antral portion of the stomach that are more prevalent in adults 55-65 yo caused by defect that increases permeability of hydrogen ions in the mucosa

gastric ulcers

``` Risk Factors for _______: H. Pylori NSAIDS duodenal reflux Type A: Immune chronic gastritis ```

Gastric Ulcers

Symptoms of _______: pain that occurs immediately after eating then relieved N/V anorexia

Gastric Ulcers

inflammation of the vermiform appendix due to obstruction by fecalith (stone made of feces)

appendicitis

``` Symptoms of ________: epigastric or peri-umbilical pain in 1st 24 hrs increasing in intensity over 3-4 hrs RLQ pain with rebound tenderness at McBurney's point n/v anorexia fever diarrhea (especially in children) sense of constipation LLQ tenderness leukocytosis (on CBC) ```

appendicitis

presence of out-pouching herniations of mucosa through the colon muscular wall

diverticular disease

``` Risk Factors for _________: Older age (>60) Smoking Obesity Genetic predisposition Diet Physical inactivity ASA /NSAIDS ```

diverticular disease

Diverticular Disease is most common in...

left colon (descending and sigmoid colon)

chronic inflammatory disease most commonly of the mucosa of the rectum and sigmoid colon, where large ulcers form

Ulcerative Colitis (UC)

UC starts at the rectum but may extend to...

the entire colon

``` Clinical Manifestations of _____: bloody diarrhea water diarrhea passage of purulent mucous lower abdominal pain rare: shock w/ severe blood loss ```

Ulcerative Colitis (UC)

in acute phase of UC, fever is caused by...

activated macrophages and cytokines

UC for multiple years (7-10) can increase risk of...

colon cancer

``` Risk Factors for _______: 20-40 yo Family Hx Jewish descent Caucasian and northern European ```

Ulcerative Colitis (UC)

UC is limited to _____ and does not involve _____

mucosa, skip lesions

in chronic UC, _______ develops from rapidly regenerating epithelium

inflammatory polyps

an idiopathic, autoimmune, inflammatory disorder that may affect any part of the GI tract from the mouth to the anus (ascending and transverse colon most common sites)

Chron's Disease

inflammatory bowel disorder that results in transmural inflammation and skip lesions (normal areas interspersed with abnormal areas)

Chron's Disease

progression of Chron's causes

abscess formation | crypt destruction

cobblestone projections of inflamed tissue/fissures, surrounded by areas of ulceration

Chron's Disease

Chronic inflammation of all layers of intestinal wall resulting from blockage of lymphoid and lymphatic vessels

Chron's Disease

Clinical Manifestations of _________: only sx may be "irritable bowel" Intermittent bouts of fever, diarrhea (if the diarrhea is bloody, it isn’t as severe or bloody as seen with ulcerative colitis) > 5 stools per day RLQ pain and may have RLQ mass and tenderness. Anemia may occur due to malabsorption of iron, B12 and folic acid Weight loss Anal fissure, perianal abscess and fistulas Steatorrhea (excretion of abnormal amounts of fat with the feces d/t reduced absorption of fat by the intestines)

Chron's Disease

Diverticula form at _____ in the colon wall

weak points where arteries penetrate

lack of fiber and altered intestinal microbe might contribute to...

diverticular disease

_____ and ______ causes intestinal wall thickening and contributes to increased pressure and herniation

increased collagen and elastin deposits

``` Symptoms of _______: may be asymptomatic diarrhea constipation flatulence ```

Diverticulosis

Symptoms of _______: fever acute LLQ pain leukocytosis

Diverticulitis

chronic inflammatory disease most commonly of the mucosa of the rectum and sigmoid colon where large ulcers form

Ulcerative Colitis

UC could be caused by...

dietary habits infection genetics immunology

____ protects against UC

smoking

UC begins as inflammation at the base of _____

the crypts of Lieuberkuhn

Cardinal feature of Chron's Disease

granulomas that form on the intestinal wall

Chron's Disease increases risk of...

intestinal adenocarcinoma

a disorder of brain-gut interaction characterized by abd pain with altered bowel habits

Irritable Bowel Syndrome (IBS)

IBS is more common in _____

women, youth, middle-aged

Hep A is transmitted through...

fecal-oral

enzyme that digests carbs/sugars

amylase

enzyme that digests protein

tripsin

when tripsin regurgitated back to the pancreas

auto digestion

What lab tests do we order for appendicitis?

CBC w/ diff (WBC >10k w/ left shift)

type of colon polyp that has 100% chance of becoming cancer

familial adenomatous polypopsis

``` These manifestations are indicative of problem with the ________ colon: pedunculated polyps anemia (Fe deficient) fatigue dark red/mahogony stools (melena) unusual to see obstruction ```

ascending

These manifestations are indicative of problem with the ________ colon: small sessile polyp/lesion that can ulcerate grows circumferentially bright red rectal bleeding obstruction (in 8-20% of cases, this is the only sx) progressive abd distention, pain, n/v, constipation

descending

________ is usually asymptomatic until advanced disease

colorectal cancer

higher risk for cancer is associated with _____ ulcers

gastric

alarm signs with IBS

``` pain that awakens the patient at night fever bleeding anemia sudden weight loss ```

type of ulcers seen in patients w/ increased ICP in the esophagus or stomach

Cushing's ulcers

``` Risk Factors for _____: age less than 40 family hx jewish descent slight increase in women more common in smokers ```

Chron's

These GI disorders cause that cause _____: ulcers cancer esophogeal varices

Iron deficient anemia

pre-hepatic or excessive bili production (hemolysis)

unconjugated

pre-hepatic or excessive bili production (hemolysis) results in _____ bilirubin

unconjugated (indirect)

hepatic, post-hepatic or extra-hepatic type of bilirubin

conjugated (direct)

hormones associated with obesity

leptin ghrelin adinopectin

Where is leptin produced?

in adipose cells

What does obesity cause concerning leptin?

increases it

Where is ghrelin produced?

stomach

Ghrelin is produced in response to...

hunger

Adinopectin is produced where?

abdominal (visceral) fat

In obesity, what happens with adinopectin?

decreases it so risk for CV disease is increased

_____ are more often affected by pyloric stenosis

Boys

Which ethnic group is more affected by pyloric stenosis?

White

True celiac Sprue Disease is what type of disease?

autoimmune

Celiac disease affects the _____ of the GI track

small bowel

What triggers gluten sensitivity?

Gliaden

Percentage of people w/ true celiac disease?

The most common site of lesions in Chron's

ascending and transverse colon

If the small intestine is involved in Chron's, the most common site would be...

distal small intestine

endoscopy may show strictures or fistula in patient with...

Chron's

``` tissue sample of small intestine shows atrophy blunting of villi increased intraepithelial lymphocytes & other immune cells normal mucosal thickness in what disease? ```

Celiac

``` Symptoms of _________: tachycardia hypotension pallor weakness sweating dizziness abd pain epigastric fullness n/v diarrhea B12, folate, Ca+, fat-soluble vitamin deficiency ```

Dumping Syndrome

______ bilirubin increases because the body metabolizes the heme component of the red blood cell that was destroyed.

unconjugated (indirect)

Intrahepatic disorders can lead to _________ hyperbilirubinemia

conjugated or unconjugated

What level of serum bilirubin on labs would you expect to see jaundice?

2.5-3 mg/dL

3 phases of bilirubin metabolism

prehepatic intrahepatic posthepatic

prehepatic bilirubin metabolism

hemolytic

intrahepatic bilirubin metabolism

hepatocellular disease

posthepatic bilirubin metabolism

obstructive

posthepatic bilirubin metabolism

obstructive/ extrahepatic

lab findings of acute Hep B

+ HbsAg | +Anti-HBc IgM

lab diagnosis of Hep C

serum HCV RNA anti-HCV IgG elevated alanine aminotransferase

IBS-C

IBS w/ constipation

IBS-D

IBS w/ diarrhea

IBS-M

IBS w/ diarrhea & constipation

symptoms of IBS are relieved by...

defecation

this condition has a 40% chance of developing into colorectal cancer

Hereditary nonpolyposis CRC

signs of colorectal tumor in the ________ colon: melena (dark red/mahogany stools) possible anemia normal shaped stool

ascending

``` signs of colorectal tumor in the ________ colon: intermittent cramping fullness obstruction (due to lumen narrowing) pencil/ribbon-like stool bright red bleeding ```

descending

``` signs of colorectal tumor in the ________ : obstruction bowel habit change constipation diarrhea urgent need to defecate upon awakening dull ache in rectum/sacrum ```

rectum

``` Risk Factors for ______: age > 50 red meat consumption alcohol use smoking African American descent obesity Type II DM ```

Colorectal Cancer

type of polyp that traverses the muscularis mucosae and becomes invasive and highly malignant

adenomatous polyp

criteria for for polyps to have malignant potential:

> 2 cm numerous villous architecture

exogenous chemicals that stimulate adipogenesis and fat storage and interfere with neuroendocrine control of appetite and satiety

obesogens

hormone that promotes insulin resistance and increased blood glucose

resistin

High levels are ineffective at decreasing appetite and energy expenditure

Central Leptin Resistance

Ghrelin enhances...

appetite

hormone that has has insulin-sensitizing, anti-inflammatory, and antiatherogenic properties until visceral obesity occurs

adiponectin

In _____ obesity, levels of adiponectin decrease, and this contributes to insulin resistant and Type 2 DM, as well as cardiovascular disease.

central (visceral)

produces low grade inflammation of white adipose tissue and lipolysis

obesity

``` Risk Factors for ________: Prolonged fasting or rapid weight loss Pregnancy Oral contraceptives (progesterone slows bile) Obesity 5Fs: female, forty, fat, fertile, fair Diabetes High fat diet Low HDL and hypertriglyceridemia Native Americans – especially Pima Indians ```

Cholelithiasis (Gallstones)

type of gallstones that are associated with hyperbilirubinemia and may be brown or black

pigmented stones

most common type of gallstones that are formed by bile that is saturated in cholesterol

cholesterol stones

``` Symptoms of ________: *often asymptomatic* epigastric and right hypochondrium pain intolerance of fatty foods & cabbage heartburn flatulence pruritus jaundice ```

Cholelithiasis (Gallstones)

acute inflammation of the gallbladder wall usually caused by bile duct obstruction and gallstones

cholecystitis

cholecystitis may be accompanied by...

bacterial infection

Symptoms of _______: fever leukocytosis rebound tenderness and guarding Severe RUQ pain that radiates to the back Murphy’s sign: RUQ tenderness upon palpation of gallbladder

Cholecystitis

lab diagnostics of cholecystitis

maybe... elevated bilirubin elevated alkaline phosphatase

most common diagnostic tool for cholecystitis

Ultrasound

most sensitive diagnostic tool for cholecystitis

HIDA scan

``` epigastric or midabdominal pain that may radiate to the back severe tenderness w/ palpation n/v abd distention hypoactive bowel sounds low fever ```

pancreatitis symptoms

if there is a gallstone obstruction in pancreatitis, labs would show...

increased LFTs

elevated lipase is primary marker for pancreatitis and what other labs will be affected?

leukocytosis hyperlipidemia hypocalcemia elevated amylase

pancreatitis is diagnosed by...

CT scan

``` Complications of ___________ ARDS heart failure renal failure intraabdominal HTN SIRS ```

pancreatitis

``` Symptoms of _____ RUQ pain malaise anorexia nausea low-grade fever jaundice dark urine ```

Hep A

incubation period of Hep A

15-50 days (avg 28)

acute Hep A would have lab results of...

+ Anti-HAV IgM

+ Anti-HAV IgG would indicate...

past infection and immunity to Hep A

incubation period of Hep B

45-160 days (avg 120)

liver cancer risk is greatest with coinfection of...

Hep B and Hep C

``` symptoms of _____ (discrete) jaundice elevated ALT n/v anorexia fever malaise RUQ pain ```

Hep B

``` prodomal stage of _____ could have no sx OR rash arthralgia arthritis angioedema serum sickness glomerulonephritis jaundice ```

Hep B

lab findings of chronic Hep B

+ anti-HBc (total Hep B core antibody)

lab finding of recovery or immunity to Hep B

+ anti-HBs (Hep B surface antibody)

________ provides post-exposure prophylaxis to Hep B

HBV immunoglobulin

Hep C is transmitted via

blood to blood

``` Symptoms of _____ Fever fatigue dark urine clay-colored stool abd pain loss of appetite N/V joint pain jaundice ```

Hep C

Causes of Esophagitis (P.I.E.C.E.)

``` Pills (tetracyclines) Infectious (HSV, Candida) Eosinophils (Inflammatory) Caustic (ingestion of poison) Everything else or gErd ```

incubation period of Hep C

14-180 days (avg 45 days)

type of bilirubin that is water-soluble and appears in urine

unconjugated bili

jaundice caused by excess hemolysis of RBC

hemolytic jaundice

jaundice caused by gallstones, tumor or inflammation of the ducts

obstructive jaundice

jaundice caused by decreased conjugation, cirrhosis or hepatitis

hepatocellular

hemolytic jaundice = _______ bilirubin

unconjugated

obstructive jaundice = _______ bilirubin

conjugated

hepatocellular jaundice = _______ bilirubin

mostly conjugated but can be unconjugated

celiac disease is most often seen in the ______

duodenum

in celiac disease, ______ enzymes and ____ are decreased

pancreatic; bile

leptin sends signals to hypothalamus to _______ appetite but this stops working in obesity

inhibit

GI Disorders Flashcards

(184 cards)