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Flashcards in GI Mod 3B Deck (54):
1

two forms of pyloric obstruction

1. infantile hypertrophic pyloric stenosis
2. adult/acquired pyloric obstruction

2

what is IHPS

infantile hypertrophic pyloric stenosis: aka congenital pyloric stenosis

3

s/s of IHPS

infant at 2-3 weeks begins to vomit for no apparent reason
projectile vomiting - several feet

4

frequency of IHPS

infant disorder - 3/1000 births

5

pathophys of IHPS

pyloric sphincter is hypertrophied

6

etiology of IHPS

not fully established
hormones to allergic rxns have been suggested as potential cause

7

treatment of IHPS

surgery - pyloromyotomy

8

adult/acquired pyloric obstruction
-cause
-s/s
-tx

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

9

types of mechanical obstructions

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

10

what are adhesions

fibrous scar tissue adheres to intestinal loops
common complication of abdominal surgeries

11

what are herniations

intestine protrudes thru abdominal wall
intestine may strangulate thru the opening...inguinal ring, umbilical hernia, hiatal hernia

12

what is intussusception

telescoping of one part of an intestine on another portion
more common in ileocecal area

13

what is volvulus (torsion)

intestine twists upon itself
the mesentary twists around strangulating the blood supply to the intestine

14

MC cause of LI obstruction d/t tumors

colon/rectal cancer is MC cause of LI obstruction

15

what causes functional obstruction in GI

paralytic ileus

16

what is paralytic ileus

obstruction that results when peristalsis stops

17

possible causes of ileus

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)

18

treatment strategies of paralytic ileus

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

19

Hirschsprung's dz

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

20

categories/types of Hirschprung's dz

short - segment - rectosigmoid colon
long - segment - regions proximal to rectosigmoid are also involved

21

treatment strategies of Hirschsprung's dz

decompress the colon (serial rectal irrigation) and surgical removal of involved intestinal segment
1. mild-mod cases (short seg dz)
2. severe cases (enterocolitis)

22

IBD - what is it

chronic autoimmune inflammatory dz that damages/ulcerates GI tract

23

two forms of IBD

1. Chrohns dz
2. ulcerative colitis

24

what is Crohn's dz

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

how many peeps in US have Crohn's

500,000 in US

26

peak onset of Crohn's

15-25 years up to 40

27

women or men are affected more with Crohn's

women

28

is Crohn's genetic

yes

29

what increases risk of Crohn's 2-4x

first degree relative with dz

30

etiology of Crohn's

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

31

pathophys of Crohn's
-what regions can it affect
-types of lesions

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

what are granulomas in Crohn's

cluster of cells that form in area of inflammation

33

Pyloric obstruction

narrowing of pylorus

34

pharmaceutical tx of Crohn's Dz

antiinflammatory drugs - salicylate, corticosteroids, infliximab
immune suppressors
antibiotics

35

surgical tx of Crohns

intestinal resection
colostomy/ileostomy

36

what is ulcerative colitis

chronic inflammatory dz that affects the large intestine

37

pathophys of ulcerative colitis

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

38

what are the different regional patterns in ulcerative colitis in LI

ulcerative proctitis
proctosigmoiditis
pancolitis

39

pharmaceutical interventions of ulcerative colitis

similar to crohn's

40

surgical tx of ulcerative colitis

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

41

what is diverticulosis

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

42

pathophys of diverticulosis

colonic muscle wall weak where vessels penetrate
usually multiple diverticular present (smaller size)

43

distribution of diverticulosis

most commonly found in sigmoid colon

44

tx/management of diverticulosis

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

what is diverticulitis

inflammation of the diverticuli
impacted with fecal material

46

what is most often affect in diverticulitis

sigmoid colon

47

colon perforations due to what in diverticulitis

inflammation

48

two types of perforations in diverticulitis

1. simple diverticulitis
2. complicated diverticulitis

(perforations may or may not penetrate intestinal wall)

49

what % of newly diagnosed cancer in US is colorectal cancer

8.5%

50

pathophys of colorectal cancer

-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

how to prevent colorectal cancer

screening and removal of polyps

52

risk factors for CRC

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

screening for CRC

colonoscopy - considered more thorough screening tool
sigmoidoscopy - limited in ability to screen

54

protocols for screening for CRC

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