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Pathophys Exam I > GI Mod 3B > Flashcards

GI Mod 3B Flashcards

1
Q

two forms of pyloric obstruction

A
  1. infantile hypertrophic pyloric stenosis

2. adult/acquired pyloric obstruction

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2
Q

what is IHPS

A

infantile hypertrophic pyloric stenosis: aka congenital pyloric stenosis

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3
Q

s/s of IHPS

A

infant at 2-3 weeks begins to vomit for no apparent reason

projectile vomiting - several feet

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4
Q

frequency of IHPS

A

infant disorder - 3/1000 births

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5
Q

pathophys of IHPS

A

pyloric sphincter is hypertrophied

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6
Q

etiology of IHPS

A

not fully established

hormones to allergic rxns have been suggested as potential cause

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7
Q

treatment of IHPS

A

surgery - pyloromyotomy

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8
Q

adult/acquired pyloric obstruction

  • cause
  • s/s
  • tx
A

caused by severe peptic ulcer or tumor in area
vague s/s of epigastric discomfort/fullness with eating that progresses to severe epigastric discomfort
gastric distention, nausea, progress to vomit and acute distress as obstruction develops over time
-tx: address cause of obstruction

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9
Q

types of mechanical obstructions

A
  1. adhesions
  2. herniation
  3. intussusception
  4. vulvulus (torsion)
  5. tumor growth
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10
Q

what are adhesions

A

fibrous scar tissue adheres to intestinal loops

common complication of abdominal surgeries

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11
Q

what are herniations

A

intestine protrudes thru abdominal wall

intestine may strangulate thru the opening…inguinal ring, umbilical hernia, hiatal hernia

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12
Q

what is intussusception

A

telescoping of one part of an intestine on another portion

more common in ileocecal area

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13
Q

what is volvulus (torsion)

A

intestine twists upon itself

the mesentary twists around strangulating the blood supply to the intestine

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14
Q

MC cause of LI obstruction d/t tumors

A

colon/rectal cancer is MC cause of LI obstruction

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15
Q

what causes functional obstruction in GI

A

paralytic ileus

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16
Q

what is paralytic ileus

A

obstruction that results when peristalsis stops

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17
Q

possible causes of ileus

A 
certain drugs (narcotics or HTN drugs)
abdominal, spine or joint surgery
injury/trauma
infections/peritonitis
heart attack
imbalance of electrolytes
disorders that affect muscle function
low blood supply to parts of intestine (mesenteric ischemia)
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18
Q

treatment strategies of paralytic ileus

A

NG tube to decompress pressure within GI tract
address the underlying cause
if unsuccessful - surgery may be considered

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19
Q

Hirschsprung’s dz

A

aka congenital aganglionic megacolon

  • birth defect: ganglion nerve cells of the colon fail to develop
  • functional result: impaired motility of colon due to poor coordination/ability to contract intestinal musculature; impacted/trapped stool, infection, inflammation, and constipation
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20
Q

categories/types of Hirschprung’s dz

A

short - segment - rectosigmoid colon

long - segment - regions proximal to rectosigmoid are also involved

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21
Q

treatment strategies of Hirschsprung’s dz

A

decompress the colon (serial rectal irrigation) and surgical removal of involved intestinal segment

  1. mild-mod cases (short seg dz)
  2. severe cases (enterocolitis)
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22
Q

IBD - what is it

A

chronic autoimmune inflammatory dz that damages/ulcerates GI tract

23
Q

two forms of IBD

A
  1. Chrohns dz

2. ulcerative colitis

24
Q

what is Crohn’s dz

A

Crohn’s dz can affect any part of the GI tract, though it commonly occurs at the terminal end of the ileum of the SI and in the cecum of the LI

  • stress may exacerbate s/s but is considered a cause of the dz
  • s/s may be mild to severe
25
Q

how many peeps in US have Crohn’s

A

500,000 in US

26
Q

peak onset of Crohn’s

A

15-25 years up to 40

27
Q

women or men are affected more with Crohn’s

A

women

28
Q

is Crohn’s genetic

A

yes

29
Q

what increases risk of Crohn’s 2-4x

A

first degree relative with dz

30
Q

etiology of Crohn’s

A

cause is poorly understood - classic theories - gentics, autoimmune, environment

31
Q

pathophys of Crohn’s

  • what regions can it affect
  • types of lesions
A

inflammation extends thru all layers of intestinal wall
chronic granulomatous inflammation
may effect entire GI (mouth to anus)
distal ileum and proximal colon most often involved
isolated colonic involvement in 25% of cases
skip lesions - two are more inflamed areas with healthy bowl in bw

32
Q

what are granulomas in Crohn’s

A

cluster of cells that form in area of inflammation

33
Q

Pyloric obstruction

A

narrowing of pylorus

34
Q

pharmaceutical tx of Crohn’s Dz

A

antiinflammatory drugs - salicylate, corticosteroids, infliximab
immune suppressors
antibiotics

35
Q

surgical tx of Crohns

A

intestinal resection

colostomy/ileostomy

36
Q

what is ulcerative colitis

A

chronic inflammatory dz that affects the large intestine

37
Q

pathophys of ulcerative colitis

A

etiology unknown
inflammation extends to mucosa only (does not penetrate deeper layers)
always involves rectum and extends proximally to contiguous secretions of colon

38
Q

what are the different regional patterns in ulcerative colitis in LI

A

ulcerative proctitis
proctosigmoiditis
pancolitis

39
Q

pharmaceutical interventions of ulcerative colitis

A

similar to crohn’s

40
Q

surgical tx of ulcerative colitis

A
  1. total proctocolectomy (brooke ileostomy)
    entire colorectal mucosa excised
  2. ileal pouch anal anastomosis
    pt maintains anal function an continence
41
Q

what is diverticulosis

A

out pockets in intestinal wall
85% of pts are asymptomatic
15% develop colicky symptoms

42
Q

pathophys of diverticulosis

A

colonic muscle wall weak where vessels penetrate

usually multiple diverticular present (smaller size)

43
Q

distribution of diverticulosis

A

most commonly found in sigmoid colon

44
Q

tx/management of diverticulosis

A

high fiber diet
avoid high residue foods (seeds, nuts, corn)
-anecdotal strategy based on theory to prevent from small undigested pieces from getting lodge in diverticula - evidence not fully established

45
Q

what is diverticulitis

A

inflammation of the diverticuli

impacted with fecal material

46
Q

what is most often affect in diverticulitis

A

sigmoid colon

47
Q

colon perforations due to what in diverticulitis

A

inflammation

48
Q

two types of perforations in diverticulitis

A
  1. simple diverticulitis
  2. complicated diverticulitis

(perforations may or may not penetrate intestinal wall)

49
Q

what % of newly diagnosed cancer in US is colorectal cancer

A

8.5%

50
Q

pathophys of colorectal cancer

A
  • most CRC develop from adenomatous polyp
  • initial mutant cancer cell develops in polyp
  • slow growth on polyp as it progresses down the stalk toward the deeper layers of the mucosa
  • if cancer penetrates into sub mucosal it can reach lymphatic/BV pathways and become highly malignant
51
Q

how to prevent colorectal cancer

A

screening and removal of polyps

52
Q

risk factors for CRC

A

age >50
PMH: IBD, adenomatous polyps >5mm, gall bladders urgery, pelvic irradiation
FHx: 1st degree relative with colorectal cancer, familial adenomatous polyposis, hereditary nonpolyposis colorectal cancer
Lifestyle: tobacco and BMI >35-40

53
Q

screening for CRC

A

colonoscopy - considered more thorough screening tool

sigmoidoscopy - limited in ability to screen

54
Q

protocols for screening for CRC

A

average risk pts >50yo

  • colonoscopy every 10years
  • digital rectal exam and fecal occult blood yearly
  • pts with increased risk require more frequent or aggressive monitoring

Pathophys Exam I (9 decks)

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