GI Pathologies Flashcards
1
Q
PART 1
A
PART 1
2
Q
What is the function of the GI System?
A
Process ingested food by mechanical and chemical means, extract nutrients and excrete the waste products.
3
Q
The GI is divided into an upper and lower GI, what makes up these parts?
A
Upper GI
-mouth, esophagus, stomach (storage function), and duodenum (digestive function)
Lower GI
-small and large intestine
4
Q
- What is the function of the small intestine?
- What is the function of the large intestine?
A
- Digestion and absorption of nutrients.
- Water and electrolyte absorption, stores waste products until elimination.
5
Q
From the mouth to anus, the GI tract has what 4 layers?
A
- Mucosa (epithelial spuamos or columnar)
- Submucosa (accessory glands, lymphoid tissue, blood vessels, nervous tissue)
- Muscularis (longitudinal and circular smooth muscles)
- Serosa (outer most layer)
6
Q
The GI tract is _____ to the external environment (at both ends) and is populated by billions of ________ in a symbiotic state (altered normal flora leads to disease).
A
- open
- bacteria
7
Q
The intestinal tract provides a ___________ barrier for ________ function. Breach of this _________ barrier leaves the host susceptible to disease.
A
- physical
- immune
- mucosal
8
Q
The mouth is involved in what functions?
A
- Mastication
- Initiates Digestion (amylase)
- Mucus Production (moistens food, cleans the mouth, salivary glands)
9
Q
What is located behind the mouth and what are the 3 regions?
A
Pharynx
- nasopharynx
- oropharynx
- laryngopharynx
10
Q
The esophagus is a __________ tube that connects the _______ with the _________. It lies behind the _______ and ______ and in front of the spine.
A
- muscular
- throat (pharynx) with the stomach
- trachea and heart
11
Q
What is peristalsis?
A
Involuntary constriction and relaxation of the muscles of the intestine, creating wave-like movements that push the contents of the canal forward.
12
Q
The stomach is a muscular hollow organ that has what functions?
A
- Storage
- Digestion (mucus, enzymes gastrin and pepsin, hydrochloric acid)
13
Q
- Parietal cells function?
- Chief cells function?
-G cells produce ___________ and chief cells produce _________ which aid in __________ in the stomach.
A
- Produce HCl and intrinsic factor for RBC synthesis.
- Synthesize pepsinogen
-gastrin, pepsinogen (pepsin), digestion
14
Q
The contents of the stomach are called _____ and the __________ sphinicter opens to allow gastric emptying into the ________ intestine.
A
- chyme
- pyloric
- small
15
Q
- What is gastric emptying?
- How long can gastric emptying take?
A
- The time it takes food to empty from the stomach to the small intestine.
- 40 minutes to a few hours.
16
Q
What are the 3 parts of the small intestine?
A
- Duodenum
- Jejunum
- Ileum
17
Q
The small intestine has a ___________ and ____________ function.
A
- Digestive (bile, pancreatic juices, proteins, fats, and carbs)
- Absorption (lacteals, weight loss surgery)
18
Q
Digestion primarily takes place in the ___________. It is facilitated by the presence of ______ which emulsify fats and cause them to be easily digested. It is also facilitated through __________ juices that can help degrade proteins, fats and carbs.
A
- SI
- bile
- pancreatic
19
Q
Absorption takes place in the ______________. It involves _________ which are lymphatic capillaries that absorb dietary fats in the villi of the SI and facilitate the transportation of digested fats from the villi of the SI.
A
- SI
- lacteals
20
Q
PART 2
A
PART 2
21
Q
What is malabsorption syndrome?
A
Group of disorders characterized by reduced intestinal absorption of dietary components and excessive loss of nutrients in the stool.
22
Q
Malabsorption Syndrome is associated with what?
A
- muscle weakness, muscle wasting, paresthesias
- numbness and tingling; neuro damage
- bone pain, fractures, skeletal deformities
- edema (protein deficiency)
23
Q
The ___________ is the last part of the GI tract and functions to absorb _______ and store the remaining waste.
A
- Large Intestine
- water
24
Q
________ Disease is a chronic lifelong inflammatory bowel disease that can affect any segment of the intestinal tract. The current treatment is directed toward symptomatic relief and control of the disease process.
A
-Crohn’s Disease
25
___________ _________ Syndrome is a group of symptoms that represent the most common disorder of the GI system. It involves ________ pain/discomfort lasting on average at least one day a week in the last 3 months. What are the 3 types?
- Irritable Bowel Syndrome
- abdominal
- constipation-predominant, diarrhea-predominant, mixed
26
- __________ are small, bulging pouches that can form in the lining of your digestive system.
- What is the difference between diverticulosis and diverticulitis?
-Diverticula
- Diverticulosis- diverticula present but uncomplicated
- Diverticulitis- infected and inflamed divertcula
27
- What is the hallmark of diverticulosis and diverticulitis?
| - How is it treated?
- outpouchings (diverticula) in the wall of the colon or SI
| - treated with antibiotics
28
- What is the first symptom of GI Disease?
| - Is it a disease?
Nausea
-A sensation of unease and discomfort in the upper stomach often accompanied by an involuntary urge to vomit.
NO, it is a symptom.
29
What symptom follows Nausea in regards to GI Disease?
Vomiting (emesis)
| -The involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose.
30
What are the resulting complications of N/V?
Dehydration
- fluid and e- imbalance
- pulmonary aspiration of vomitus
- mucosal tear at the gastroesophageal junction (Mallory-Weiss Syndrome) (can present with hematemesis)
- rupture of the esophagus
- malnutrition
31
GI Disease can also result in Anorexia, what is this?
Diminished appetite or aversion to food.
32
What are some causes of anorexia?
- N/V, diarrhea
- cancer patients may suffer from it
- lack or loss of appetite for food
- voluntary food restriction
- often caused by PSYCHOLOGICAL issues
33
Anorexia can result in _______ disease, ______ disease, hypokalemia, hypotension, and orthostatic hypotension.
- heart
| - renal
34
GI Disease can also result in cachexia, what is this?
Loss of muscle mass and body weight.
35
- Cachexia is associated with ________ metabolic rate, __________ sympathetic drive, and __________ protein degradation.
- Cachexia is __________ weight loss.
- increased, increased, increased
| - involuntary
36
What are some causes of cachexia?
- Cancer
- Chronic HF
- TB
- RA
37
- Anorexia = ___________
| - Cachexia = ___________
- voluntary
| - involuntary
38
Cachexia results in what?
- strength loss
- malnutrition
- weight loss
39
Wasting =/=cachexia =/= anorexia
Wasting =/=cachexia =/= anorexia
40
GI Diseases can also result in constipation, what is this?
Occurs when fecal matter is too hard to pass easily or when bowel movements are so infrequent that discomfort and other symptoms interfere with daily activities.
41
What are some causes of constipation?
- Age
- Diet
- Dehydration
- Side effects of medication
42
Constipation may occur because:
- Inactivity/prolonged ____ ______
- Acute or chronic diseases of the digestive system
- Underlying organic disease
- ______ or _________ abnormalities within the colon that narrow the intestines and/or rectum
- ____-________ alimentary canal
- defactory disorder/defective ________
- bed rest
- lesions or structural
- slow-transit
- reflex
43
GI Diseases can also result in dysphagia, what is this?
Difficulty swallowing
44
How can dysphagia occur?
- Neurological
- Mechanical obstruction
- Trauma
45
GI Diseases can also result in achlasia, what is this?
-Failure of the smooth muscle fibers to relax.
46
Achalasia can result in what?
Lower esophageal sphincter (LES) fails to relax and/or open when needed, can cause accumulation of food in the esophagus.
47
GI Diseases can also result in heartburn and indigestion, which is what?
Burning sensation in the esophagus usually at the midline below the sternum, acid moves into the esophagus.
48
Heartburn, Indigestion:
- The sphincter between the stomach and esophagus (_____) doesn't work as well as it should.
- A painful burning sensation in the middle of the chest [Gastric contents in esophagus]
- Hiatal ______ contributes
- LES
| - hernia
49
Overall, what are the S/Sx of GI Diseases?
- Nausea
- Vomiting
- Anorexia
- Cachexia
- Constipation
- Dysphagia
- Achlasia
- Heartburn, Indigestion
50
PART 3
PART 3
51
_________ pain accompanies large numbers of GI Diseases. What are 4 types?
Abdominal
- Mechanical
- Inflammatory
- Referred
- Ischemic
52
_________ pain is stretching of the wall of a hollow organ or the capsule of a solid organ.
Mechanical
53
___________ pain occurs by the release of prostoglandins, histamine, serotonin, bradykinin, which in turn stimulates sensory nerves.
Inflammatory
54
_______ pain is an unpleasent sensation localized to an area seperate from the site of causative injury or other painful stimulation. It arises when visceral pain fibers and pain fibers from the skin synapse on the same second order pain fibers.
Referred Pain
55
Referred Pain:
- The gall bladder refers pain to where?
- The stomach refers pain to where?
- Intestinal dysfunction may refer pain to where?
- Top of the right shoulder
- Spine between the shoulder blades
- Middle or low back
56
________ pain involves the release of metabolites in the area of ischemia resulting in the generation of pain. This involves abdominal _______ cramps (occuring within 30 minutes of eating and lasting 1-3 hours).
- Ischemic
| - fullness
57
What is hematemesis?
Vomiting of blood
58
- If vomited blood is red, the injury is _____________ in origin.
- If vomit has the appearance of coffee grinds, the injury is in the _________ in origin and indicates ___________ blood.
- esophageal
| - stomach, coagulated
59
- What is hematochezia?
| - It usually indicated lower _______/______ injury and is often secondary to ___________.
- Unaltered red blood passes rectally.
| - colon/rectum, hemorrhoids
60
- What is melena?
| - It is caused by bleeding from any _______ site and results from tumors, ulcers, inflammation, etc.
- Passing of dark, tarry stools.
| - intestinal site
61
Acute GI Bleeds are Potential Emergencies:
- _____ _____ can be large
- _________
- result in hypovolemia
- tissue ________
- blood loss
- anemia
- hypoxia
62
What are the PT implications for GI Diseases?
- body fluid loss (diarrhea, vomiting)
- electrolyte imbalance (decreased K+)
- hypovolemia (orthostatic hypotension, tachycardia, pallor)
63
____________, ____________, and _________ disease are the GI problems most commonly seen in older adults.
-Constipation, Incontinence, Diverticular Disease
64
What is Diverticular Disease?
Formation of small bulges or sacs to form in the wall of the large intestine.
65
What other problems besides constipation, incontinence, and diverticular disease can be seen with aging in the GI tract?
- Decrease in taste bud function
- Decrease in salivary secretions
- Loss of smooth muscle tone
66
What are some diseases of the mouth?
- Aphthous Ulcer (Canker sores)
- Fever Blisters/Cold Sores
- Herpes Simplex Virus Infection
- Fungal Infections
- Cancers of the Oral Cavity
67
-Aphthous Ulcers (Canker sores) are common ______, ________, shallow oral cavity ulcers that are triggered by what?
- small, painful
| - triggered by stress,fever, certain foods
68
- Aphthous Ulcers occur mainly in _____ and __________ and usually disappear within a few weeks.
- What is the etiology?
- Are they contagious?
- children and young adults
- unknown etiology
- not contagious
69
- Fever Blisters/Cold Sores are a result of _______ infection and are often grouped together.
- What causes them?
- Are they contagious?
- viral infection
- herpes simplex virus (HSV-1)
- very contagious
70
- __________ occur inside the mouth and are not contagious.
| - ___________ occur on the lips and outside the mouth and are contagious.
- Canker sores (Aphthous Ulcers)
| - Fever blisters
71
- Herpes Simplex Virus Infection (HSV-1 or HSV-2) are ________ transmitted and the initial infection is __________.
- What certain circumstances can cause a reemergence or HSV-1/2?
- How does it present itself?
- This is a major problem for what patients?
- orally, asymptomatic
- fever, sunlight, cold, trauma, infection
- cold sore or fever blister
- major problem for immune compromised patients
72
- Oropharyngeal Candidiasis is a _______ infection caused by candida ________, which is a normal inhabitant of the mouth.
- This causes pathology when there is some impairment in the normal ________ balance of the mouth.
- Oropharyngela Candidiasis may spread in vulnerable patients into the ________.
- What is thrush?
- fungal, candida albicans
- microflora
- esophagus
- White lesions on the tongue due to excess candida albicans.
73
- ________ Cell Carcinomas are cancers of the oral cavity with sites of origin in the vermillion border of the lower lip, floor of the mouth, and lateral border of the tongue.
- Are they painful?
- They are often associated with _____ abuse, _______ use, and poor oral hygeine.
- What is the prognosis of Squamos Cell Carcinomas dependent on?
- Squamos Cell Carcinomas
- Often painless and therefore ignored.
- ETOH abuse, tobacco use
- dependent on early detection
74
- What is dysphagia?
| - Dysphagia involves a lack of __________ sensation and an inadequacy in the ________ mechanism.
- Difficulty in swallowing
| - pharyngeal, swallowing
75
- Esophageal pain is a _______/______ sensation in the center of the chest.
- Esophageal bleeding (__________) is a common sign of esophageal diseases and tends to be ____.
- pressing/burning
| - hematemesis, red
76
PART 4
PART 4
77
______ ________ is a condition in which the upper portion of the stomach protrudes into the chest cavity through an opening of the diaphragm.
-__________ _________ is when the esophagus and stomach stay where they should be, but part of the stomach squeezes through the hiatus to sit next to your esophagus. This is a serious situation and has a risk of ________ insult.
- Hiatal Hernia
| - Paraesophageal Hernia, ischemic
78
Hiatal Hernia:
- __-__% of the adult population
- Largely ___________.
- What are the symptoms of hiatal hernia?
- What should patients avoid?
- Can be managed _________ or via _______ modifications.
- 15-20%
- asymptomatic
- esophageal pain, GERD, dyspnea, may affect cardiac and pulmonary function
- Valsalva, coughing, vomiting, straining, sudden physical exertion
- surgically, dietary
79
- _______________ is inflammation of the esophagus secondary to retrograde flow of gastric juices and involves a defect in the _________ ________ sphincter.
- What are the symptoms of this?
- GERD (Gastroesophageal Reflux Disease), lower esophageal sphincter (LES)
- Heart burn, dysphagia, frequent belching, painful swallowing
80
- GERD involves burning sensation that moves up and down the chest and may radiate to the _____, _____, or _____.
- GERD heartburn most often occurs __-__ minutes after a meal.
- A _______ ______ may weaken the LES and increase the risk for GERD.
- back, neck, or jaw
- 30-60 minutes
- hiatal hernia
81
What are aggravating factors for GERD?
supine position, specific foods
82
GERD Implications for the PT:
- Avoid __________ activity.
- Interventions requiring _______ position should be scheduled before meals.
- For _________ reflux, encourage individual to sleep on the left side with a pillow in place to maintain this position.
- Avoid activities that increase _____-_______ pressure.
- Elevate the head of the bed.
- ________ modifications.
- Patients should wear _________ clothing.
- Patients should remain upright at least __ hours after meals.
- Should avoid meals near _________.
- ______ loss.
- vigorous
- supine position
- nocturnal reflux
- intra-abdominal
- lifestyle
- loose
- 3 hours
- bedtime
- weight
83
What are some symptoms of stomach pathologies?
- Epigastric pain
- Hematemesis (typcally black)
- Melena (black tarry stools)
- Frequent vomiting
84
________ is generalized inflammation of the protective lininig of the stomach mucosa.
-Gastritis
85
- Acute gastritis is _________ or acute erosive.
- Is acute or chronic gastritis more common?
- Gastritis is common in severely ill individuals and can cause a vitamin ___ deficiency.
- It s characterized by _______ irritation.
- hemorrhagic
- acute
- B12
- mucosal
86
What are the causes of Gastritis?
- H pylori (chronic)
- decreased mucous production-decreased protection of the mucosa
- associated with presence of a serious illness
- chemical induced
- stress induced gastritis/physiologic induced
- XRT
- ETOH abuse
87
- Who is at increased risk for Gastritis?
| - What is the treatment for Gastritis?
- >65 y/o, long-term NSAID use, concurrent corticosteriod treatment
- remove injurious drug
88
Gastritis Symptoms:
- Epigastric pain with sense of abdominal ________/_________.
- Loss of ________.
- _________ pain.
- Heart burn, low grade fever, N/V
- __________ or symptoms associated with eating.
- Hematomesis
- Black tarry stools (__________)
- distension/bloating
- appetite
- abdominal pain
- asymptomatic
- melena
89
Gastritis Implications for the PT:
- Know which patients are on _______ injuring drugs
- Be alert for symptoms (____, ________)
- Encourage patients to only take meds as prescribed/per manufacture recommendations.
- stomach
| - N/V, hematemesis
90
- ______ ______ involve a breach in the protective mucosal lining exposing deeper layer areas to injury by gastric secretions.
- Ulcers reach into the _________ layer damaging blood vessels and causing hemorrhage.
- __% of the american population will develop an ulcer.
- Peptic Ulcers
- muscularis
- 10%
91
What are the two subtypes of peptic ulcers?
- Gastric ulcer
| - Duodenal ulcer
92
Gastric ulcer affects the lining of the _______ and ______/_____ aged individuals are more likely to develop gastric ulcers.
- stomach
| - middle/older
93
Duodenal ulcers are found in the __________, they are __-__x more common than gastric ulcers and are more common in _______ individuals.
- duodenum
- 2-3x
- younger
94
- __% of peptic ulcers represent an infection by _________.
| - Lifestyle and physiological _______ are risk factors.
- 90%, H. Pylori
| - stress
95
Peptic Ulcers:
- Diagnosis is based on ________
- _______ (Hematemesis, Melena)
- Test for _________
- Endoscopic examination of the stomach
- Symptoms include steady midline pain in the ________ spine
- Epigastric pain near the xiphoid
- Pain may accompany consumption of food
- Hemorrhage with resulting _________
- symptoms
- bleeding
- H. pylori
- thoracic
- anemia
96
Ulceration Implications for the PT:
- Monitor ________
- Monitor use of _______
- Pay particular attention in ______ adults
- Signs of bleeding (SP <100mHg, HR >100bpm, >10mmHg drop in DP with a position change)
- symptoms
- NSAIDs
- older, aging adults
97
PART 5
PART 5
98
_______ and ________ are diseases of the intestine resulting in _______ in stool mass, frequency, or fluidity.
-The problem with this is excess loss of ______, severe cases are ___L/day or 1 blood volume.
- Diarrhea and Dysentery, increase
| - water, 14L
99
Therapy implications for Diarrhea and Dysentery?
Be aware of patient excessive fluid loss.
100
What can cause cancers of the stomach?
-Chronic gastritis, H. pylori infection, dietary fibers
101
What are the 4 stages of stomach cancers?
- Stage 1- Mucosa layer
- Stage 2- Submucosal layer
- Stage 3- Muscle layer
- Stage 4- Serosa layer
-Higher stage = more invasive, larger tumor
102
- Colorectal Carcinomas are _________ disorders and are screened using what?
- Colorectal carcinomas are largely ___________ (__%) and are ___________ for years.
- intenstinal, colonoscopy
| - adenocarcinomas (98%), asymptomatic
103
What is a colostomy?
Surgical procedure that brings one end of the large intestine out through the abdominal wall.
104
Colorectal Tumors Implications for the PT:
- Hx of ____________ treatment: bone demineralization, muscle weakness.
- Impaired _________: adaptive shortening of the anterior abs.
- Removal of ________ leading to increased risk of developing lymphedema.
- Can metastasize to the _______, ______, _____
- _________ management
- corticosteroid
- posture
- lymph nodes
- prostate, lungs, liver
- ostomy
105
What is Peritonitis?
Inflammation of the serous membrane liniing the walls of the abdominal cavity.
106
- Peritonitis has multiple causes and tends to be __________.
- Peritonitis creates severe ________ effects such as circulatory alterations, fluid shifts, and respiratory problems leading to fluid/electrolyte imbalance.
- Has a ____ mortality rate, is painful, and the patient is usually hospitalized.
- widespread
- systemic
- high
