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HLSC 222 > MID 2 GI > Flashcards

MID 2 GI Flashcards

1
Q

Anorexia

A
  • Lack of desire to eat with nausea, abdominal pain, diarrhea, psychological stress
  • Side effects of medication and disorders of other organs- cancer, heart disease, kidney disease
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2
Q

Emesis (vomiting)

A
  • Forceful emptying of stomach and intestinal contents
  • Nausea and retching (dry heaves) are distinct events that usually precede vomiting
  • Consequences of nausea and vomiting: fluid and electrolyte imbalances, acid/base disturbance, hyponatremia, hypokalemia, hypochloremia and metabolic alkalosis
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3
Q

Emesis: Caused by

A
  • Extreme pain
  • Distension of the stomach or duodenum
  • Motion sickness
  • Side effects of medications
  • Trauma of ovaries, testes, uterus, bladder or kidney
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4
Q

Nausea

A
  • subjective experience

-associated with conditions like abnormal pain and spinning movements

  • hypersalivation and tachycardia associated symptoms
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5
Q

Projectile vomiting

A
  • Vomiting without nausea
  • Caused by direct stimulation of the vomiting center by neurological lesions (e.g. increased intracranial pressure, tumors, or aneurysms) involving the brainstem or can be a symptom of GI obstruction
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6
Q

Constipation

A
  • Difficult or infrequent defecation/bowel movements
  • Subjective- dependant on normal bowel habits
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7
Q

Primary constipation

A
  • Normal transit (functional)- normal rate, but difficult evacuation: sedentary lifestyle, poor diets- low in fibre, high in refined food, low fluid intake
  • Slow transit- impaired colonic motor activity with infrequent bowel movements, straining, abdominal distension (swollen) and palpable stool in sigmoid colon
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8
Q

Pelvic floor dysfunction

A

difficulty with pelvic floor muscles or anal sphincter e.g. rectal fissures, strictures or hemorrhoids

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9
Q

Secondary constipation

A
  • Caused by medications or neurogenic disorders
  • Opiates, antacids and iron tend to inhibit bowel motility
  • Endocrine or metabolic disorders e.g. hypothyroidism, diabetes mellitus
  • Diverticuli, irritable bowel syndrome and pregnancy are associated with constipation
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10
Q

Constipation: Manifestations

A
  • 25% of the time: straining with defecation Lumpy, hard stools, incomplete emptying sensation, manual maneuvers, <3 bowel movements per week
  • Fecal impaction (hard, dry stool retained in the rectum) → rectal bleeding, abdominal or cramping pain, nausea and vomiting, weight loss and episodes of diarrhea
  • Straining to evacuate stool → engorgement of the hemorrhoidal veins and hemorrhoidal disease or thrombosis with rectal pain, bleeding and itching
  • Passage of hard stools can cause painful anal fissures
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11
Q

Diarrhea

A
  • Presence of frequent loose, watery stools
  • > 3 loose stools within 24 hours lasting less than 14 days
  • very dangerous in children- lower fluid reserves than adults
  • Fluid replacement must be with osmotically balanced products
  • Large volume diarrhea: caused by excessive amounts of water or secretions or both in the intestines
  • Small-volume diarrhea: volume of feces is not increased, usually results from excessive intestinal motility
  • Persistent diarrhea: 14 days-4 weeks
  • Chronic diarrhea: >4 weeks
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12
Q

Osmotic diarrhea

A
  • Excessive fluid drawn into the intestinal lumen by osmosis
  • Caused by: Non-absorbable sugars, full-strength tube feeds, dumping syndrome
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13
Q

Secretory diarrhea

A

Excessive secretion of fluids by the intestinal mucosa

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14
Q

Motility diarrhea

A
  • Excessive GI motility (motility diarrhea)- 80% fluid is reabsorbed in small intestine
  • Caused by: Resection of the small intestine (short bowel syndrome), surgical bypass of an area of the intestine
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15
Q

Diarrhea: Manifestations

A
  • Systemic effects: dehydration, electrolyte imbalance, weight loss
  • Infection with diarrhea- fever, with or without vomiting or cramping pain
  • Chronic diarrhea caused by IBD- fever, cramping pain and bloody stools
  • Malabsorption syndromes- fat in stools, bloating, diarrhea
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16
Q

Abdominal pain

A
  • Presenting symptom of a number of GI diseases
  • Caused by stretching (mechanical), inflammation or ischemia
  • Can be acute or chronic
  • Can be parietal (somatic), visceral or referred
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17
Q

Parietal pain

A

from parietal peritoneum, more localized and intense than visceral pain, aggravated by movement

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18
Q

Visceral pain

A

arises from organs themselves, arises from a stimulus (distension, inflammation, ischemia) acting on an abdominal organ, poorly localized, diffuse or vague with a radiating pattern

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19
Q

Referred pain

A

visceral pain felt at some distance from a disease or affected organ

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20
Q

Upper GI bleed: Where is it

A

esophagus, stomach, or duodenum

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21
Q

Upper GI bleed: Caused by

A
  • Bleeding varices
  • Varicose veins of esophagus (most common)
  • Peptic ulcers
  • Tear at the esophageal-gastric junction (Mallory-Weiss syndrome) caused by severe retching
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22
Q

Upper GI bleed: Manifestations

A

hematemesis (vomiting of blood)= emesis of frank, bright red bleeding or dark, grainy digested blood (coffee grounds)

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23
Q

Lower GI bleed: Where is it

A

Jejunum, ileum, colon or rectum

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24
Q

Lower GI bleed: Caused by

A
  • Polyps
  • Diverticulitis
  • Inflammatory disease
  • Cancer
  • Hemorrhoids
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25
Q

Lower GI bleed: Manifestations

A
  • melena= black, tarry, foul-smelling stool- caused by digestion of blood in GI tract
  • hematochezia= bright red blood passed from rectum
  • Occult bleeding= presence of blood in ordinary stool or gastric secretions, no evidence of it until sent to lab
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26
Q

Massive GI bleed

A
  • Blood volume depletion- hypovolemic shock
  • Decreased cardiac output, decreased systolic BP, increased HR
  • Compensatory constriction of peripheral arteries
  • Compensatory failure
  • Decreased blood flow to skin= pallor (pale)
  • Decreased blood flow to kidneys= low urine output
  • Decreased blood flow to GI= abdominal pain, bowel infarction (death of tissue), liver necrosis
  • Decreased blood flow to brain= anxiety, confusion, stupor (numbness), coma
  • Decreased coronary blood flow= angina, myocardial infarct, heart failure
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27
Q

Dysphagia

A

Difficulty swallowing

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28
Q

Achalasia

A

rare form of dysphagia

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29
Q

Dysphagia and Achalasia: Caused by

A
  • Mechanical obstruction of esophagus- tumors, diverticular herniations
  • Functional disorder- neurological or muscular disorders which interfere with voluntary swallowing e.g. cerebrovascular disease, Parkinson’s, MS, muscular dystrophy
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30
Q

Dysphagia and Achalasia: Manifestations

A
  • Stabbing pain at the level of obstruction
  • Discomfort after swallowing
  • Regurgitation of undigested food
  • Unpleasant taste sensation
  • Vomiting
  • Aspiration
  • Anorexia- low weight
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31
Q

Acid reflux (gastroesophageal reflux)

A
  • lower esophageal sphincter (LES) does not properly close, allowing stomach acid to backup, which irritates the lining of the esophagus
  • Intermittent/acute
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32
Q

Acid reflux: Manifestations

A
  • Burning sensation in the center of your chest that lasts from several minutes to an hour or two
  • A feeling of chest pressure or pain that is worse if you bend over or lie down
  • A sour, bitter, or acidic taste in the back of your throat
  • A feeling that food is “stuck” in your throat or the middle of your chest
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33
Q

GERD (gastroesophageal reflux disease)

A
  • Chronic- acid reflux that does not go away
  • Reflux of acid and pepsin from the stomach to the esophagus that causes esophagitis (inflammation of lining of esophagus)
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34
Q

GERD: Caused by

A
  • Abnormalities in LES function (resting tone lower than normal), esophageal motility, gastric motility or emptying
  • Vomiting, coughing, lifting, bending, obesity or pregnancy increases abdominal pressure contributing to reflux
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35
Q

GERD: Risk factors

A
  • Age
  • Obesity
  • hiatal hernia (stomach bulges up into your chest through an opening in diaphragm)
  • Medications that relax the LES
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36
Q

Intestinal obstruction and paralytic ileus

A
  • Any condition that prevents the flow of chyme through the intestinal lumen
  • Simple obstruction: Mechanical blockage by lesion, most common
  • Functional obstruction or Paralytic ileus: Failure of intestinal motility often occurring after intestinal or abdominal surgery, acute pancreatitis, or hypokalemia , inability of the intestines to conduct peristalsis
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37
Q

Small intestine obstruction: Manifestations

A
  • Colicky pains (pain in abdomen)
  • Nausea and vomiting
  • Pain- severe initially, then diminishes
  • If ischemia occurs: the pain loses its colicky character and becomes more constant and severe, sweating (diaphoresis), tachycardia, fever, leukocytosis, abdominal distension (gas accumulating-swelling), rebound tenderness, progression to necrosis, perforation (hole), peritonitis (redness and swelling) and sepsis
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38
Q

Lower in small intestine obstruction: Manifestations

A
  • More pronounced distension
  • Greater length of intestine is proximal to obstruction
  • Vomiting (late sign)
  • Constipation
  • Rarely diarrhea
  • Increased bowel sounds
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39
Q

Large intestine obstruction: Manifestations

A
  • Hypogastric pain
  • Abdominal distension
  • Pain varies- dependent on ischemia and peritonitis
  • Vomiting (late sign)
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40
Q

Gastritis

A

Inflammation of gastric mucosa

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41
Q

Acute gastritis: Caused by

A

injury of the protective mucosal barrier caused by: Medications (NSAIDs), chemicals, H. pylori infection

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42
Q

Acute gastritis: Manifestations

A
  • vague abdominal discomfort
  • Epigastric tenderness
  • Bleeding
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43
Q

Chronic gastritis

A

Tends to occur in older adults

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44
Q

Chronic gastritis: Caused by

A
  • Chronic inflammation
  • Mucosal atrophy (waste)
  • Epithelial metaplasia (replacement of cells by other kinds of cells)
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45
Q

Peptic ulcer disease

A

Break or ulceration in the protective mucosal lining of the lower esophagus, stomach or duodenum

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46
Q

Peptic ulcer disease: Caused by

A
  • H. pylori bacteria- affects mucous and allows stomach acid to damage lining
  • Medications e.g. NSAIDs- irritate and damage lining
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47
Q

Peptic ulcer disease: Risk factors

A
  • Age> 70 years
  • Alcohol consumption
  • Smoking
  • Injury or trauma
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48
Q

Stress ulcer

A
  • Acute form of peptic ulcer that accompanies physiological stress of severe illness or major trauma
  • Primary sign of a stress ulcer is bleeding
  • Can be classified as ischemic ulcers or Cushing ulcers
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49
Q

Ischemic ulcer

A

Develop within hours of an event such as hemorrhage, multisystem trauma, severe burns (Curling ulcers- most common site is duodenum), heart failure or sepsis

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50
Q

Cushing ulcer

A
  • Stress ulcer associated with severe brain trauma or brain surgery
  • Most common site is stomach
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51
Q

Gastrectomy

A
  • Surgery to remove all or part of the stomach
  • Indication for gastrectomy: recurrent or uncontrolled bleeding- perforation of stomach or duodenum
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52
Q

Gastrectomy: Complications

A
  • Dumping syndrome
  • Alkaline reflux gastritis
  • Diarrhea
  • Weight loss
  • Anemia- iron malabsorption
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53
Q

Dumping syndrome

A
  • Rapid emptying of residual stomach (stomach component remaining after surgical resection)
  • Causes an osmotic shift of fluid from the vascular compartment to the intestinal lumen, which decreases plasma volume → cramping pain, nausea, vomiting, diarrhea, weakness, pallor, hypotension
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54
Q

Alkaline reflux gastritis

A

Inflammation caused by reflux of bile and pancreatic secretions from the duodenum into the stomach → nausea, vomiting bile, epigastric pain

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55
Q

Ulcerative colitis

A
  • Restricted to large intestine - originate in rectum and may extend to entire colon
  • Ulcerations (ulcer=sore) of the mucosa in the colon
  • Chronic condition
  • Peak occurrence 20-40 years of age and then between 50-70
  • Men > women
  • Possible related to abnormal immune response in the GI tract- genetic factors
  • Stress does not cause the disorder but can increase severity
  • Can have remission and exacerbation
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56
Q

Mild ulcerative colitis

A
  • Less mucosal involvement
  • Fewer bowel movement
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57
Q

Severe ulcerative colitis

A
  • Involve entire colon
  • Abdominal pain, fever, tachycardia, frequent diarrhea, bloody stools, continuous cramping pain
58
Q

Crohn’s disease

A
  • Mouth to rectum (anywhere in GI tract- distal small intestine and proximal large intestine most common sites)
  • Idiopathic (no known reason for inflammation) inflammatory disorder
  • Spreads with discontinuous transmural involvement- skips from place to place (patchy lesions), not like colitis which progresses from rectum
59
Q

Crohn’s disease: Manifestations

A
  • Fistulas - abnormal hole between 2 hollow organs, between 2 loops of intestine, between intestine and bladder or vagina
  • Anemia from malabsorption of vitamin B12 and folic acid
  • Asymptomatic for years
  • Diarrhea= major symptom
  • Weight loss
  • Abdominal pain
60
Q

Irritable bowel syndrome

A
  • Recurrent abdominal pain with altered bowel habits
  • Associated with anxiety, depression and reduced quality of life
  • More common in females
61
Q

Irritable bowel syndrome: Manifestations

A
  • Lower abdominal pain or discomfort and bloating
  • Recurrent abdominal pain with altered bowel habits (constipation and diarrhea)
  • Pain- occurs during the day with stress or 1-2 after meals, relieved with defecation
62
Q

Diverticula

A

herniations or saclike outpouchings of the mucosa and submucosa through the muscle layers, usually in the wall of the sigmoid colon

63
Q

Diverticulosis

A

Asymptomatic diverticular disease

64
Q

Diverticulitis

A

Inflammatory stage of diverticulosis

65
Q

Diverticular disease of the colon: Caused by

A
  • unknown- idiopathic
  • associated with increased intracolonic pressure, abnormal neuromuscular function and alterations in intestinal motility
66
Q

Diverticular disease of the colon: Risk factors

A
  • Older age
  • Genetic predisposition
  • Obesity
  • Smoking
  • Diet
  • Lack of physical activity
  • Medication use- NSAIDs and aspirin
67
Q

Diverticular disease of the colon: Manifestations

A
  • Vague or absent (asymptomatic)
  • Cramping in lower abdomen
  • Diarrhea
  • Constipation
  • Distention or flatulence may occur
  • If the diverticula become inflamed or abscesses form (i.e. diverticulitis), the individual develops fever, leukocytosis (increased WBC count), and tenderness in left lower quadrant
68
Q

Appendicitis

A
  • Inflammation of the vermiform appendix- projection from the apex of the cecum
  • Most common emergency surgery of the abdomen
  • 10-19 years of age
69
Q

Appendicitis: Caused by

A
  • Obstruction of the lumen with stool, tumors or foreign bodies → bacterial infection
  • Obstruction does not allow drainage→ intraluminal pressure increases → decreases mucosal blood flow → hypoxia → mucosa ulcerates → increasing bacterial invasion → edema and inflammation → gangrene develops from thrombosis of blood vessels → perforation follows
  • If perforation occurs, contents spill into abdominal cavity → peritonitis → most common and dangerous complication
70
Q

Appendicitis: Manifestations

A
  • Initially- vague epigastric pain, cramping sensation
  • Over 24 hours- pain becomes more localized
  • Anorexia
  • Nausea or vomiting
  • Low-grade fever
  • Rebound tenderness on palpation
  • Following rupture- brief cessation of pain- fatal if it is untreated
71
Q

Obesity

A
  • BMI>30
  • Increases risk for all diseases
72
Q

Obesity: Caused by

A
  • Genetics
  • Sedentary lifestyle
  • Over eating
  • Culture
  • Causes of obesity are complex and involve the interaction of adipokines produced by fat cells and other body weight control signals at the level of the hypothalamus
73
Q

Visceral obesity

A
  • Distribution of body fat is localized around the abdomen and upper body
  • “Apple shape”
74
Q

Peripheral obesity

A
  • Distribution of body fat is extraperitoneal and distributed around the thighs and buttocks
  • “Pear shape”
75
Q

Normal weight obesity (NWO)

A
  • Individuals with normal body weight and BMI with percentage of body fat >30%
  • Risk for metabolic dysregulation, increases in inflammatory cytokines, insulin resistance, increased risk for cardiovascular disease and higher mortality
76
Q

Metabolically healthy obesity (MHO)

A
  • Obese but have no metabolic-obesity associated complications and decreased risk for morbidity and mortality
  • Delays obesity-related complications until an older age
77
Q

Malnutrition

A
  • Lack of nourishment from inadequate amounts of calories, protein, vitamin or minerals
  • Can be consuming calories, but not enough essential vitamins and minerals
78
Q

Starvation

A
  • Decreased energy intake leading to weight loss
  • Extreme state of malnutrition
79
Q

Short-term starvation

A
  • 3-4 days of total dietary abstinence or deprivation
  • Glycogenolysis: glycogen in liver is converted to glucose
  • Gluconeogenesis: formation of glucose from noncarbohydrate molecules
80
Q

Long-term starvation

A
  • Several days of dietary abstinence
  • Breakdown of ketone bodies and fatty acids
  • Eventually, proteolysis (protein breakdown) begins, and death ensues if nutrition is not restored
81
Q

Refeeding syndrome

A
  • Life-threatening
  • Potentially fatal shifts in fluids and electrolytes (hypophosphatemia, hypomagnesemia and hypokalemia) that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally). These shifts result from hormonal (insulin release) and metabolic changes and may cause serious clinical complications
82
Q

Cirrhosis

A
  • Widespread destruction of hepatic cells
  • Inflammatory disease of the liver that causes fibrosis (thickening and scarring of tissue) and nodular regeneration
  • Causes progressive irreversible liver damage, usually over a period of years
83
Q

Cirrhosis: Caused by

A
  • Hepatitis
  • Exposure to toxins e.g. acetaldehyde (product of alcohol metabolism)
84
Q

Alcohol liver disease: Mildest form- alcoholic fatty liver

A
  • Caused by: relatively small amounts of alcohol
  • Reversible with cessation of drinking
  • Characterized by an excessive accumulation of fat inside the liver cells- makes it hard for the liver to function properly
85
Q

Alcohol liver disease: Precursor of cirrhosis- alcoholic hepatitis

A
  • Characterized by the inflammation of the liver leading to the degeneration of liver cells
  • Stage might last for some years but will eventually progress irreversible fibrous if the patient continues to drink
86
Q

Alcohol liver disease: Alcoholic cirrhosis

A
  • Cell damage initiates an inflammatory response that results in excessive collagen formation
  • Permanent fibrosis and scarring alter the structure of the liver and obstruct biliary and vascular channels → jaundice (bile obstruction), portal hypertension/shunting/varices (enlarged veins) (vascular obstruction)
  • Impaired the hepatocytes’ ability to oxidize fatty acids, synthesize enzymes and proteins, degrade hormones, and clear portal blood of ammonia and toxins
87
Q

Alcoholic liver disease: Complications

A
  • portal hypertension
  • varices
  • splenomegaly
  • hematemesis
  • ascites
  • jaundice
  • hepatic encephalopathy
  • hepatorenal syndrome
88
Q

Portal hypertension

A
  • High BP in the portal venous system
  • Disease that obstructs or impedes blood flow in any part of the venous system including the vena cava
89
Q

Varices

A
  • Abnormally dilated vessel with a tortuous course
  • Common in lower esophagus and stomach
  • Rupture can be life threatening
90
Q

Splenomegaly

A
  • Spleen becomes enlarged due to increased pressure in splenic vein
  • Thrombocytopenia- enlarged spleen holds too many platelets
91
Q

Hematemesis

A

Most common sign of portal hypertension due to esophageal varices

92
Q

Ascites

A
  • Abnormal buildup of fluid in the abdomen trapped in peritoneal space- reduces amount of fluid available for normal physiological function
  • Biggest cause= cirrhosis
93
Q

Jaundice

A

Yellow or greenish pigmentation of skin or sclera of the eyes caused by increases in plasma bilirubin concentration (hyperbilirubinemia)

94
Q

Hepatic encephalopathy

A
  • Decline in brain function that occurs as a result of severe liver disease because liver cannot adequately remove toxins from your blood
  • Characterized by impaired behavioral, cognitive and motor function
  • Can develop quickly in hepatitis or slowly in cirrhosis
95
Q

Hepatorenal syndrome

A

Renal failure caused by liver disease

96
Q

Viral hepatitis

A
  • Infection of the liver caused by a strain of hepatitis virus (A, B,C, D and E)
  • All types cause hepatic cell necrosis, Kupffer cell (liver macrophages) hyperplasia, and infiltration of liver tissue by mononuclear phagocytes → obstruct bile flow and impair hepatocyte function
97
Q

Hepatitis A

A
  • transmission: fecal-oral, parenteral, sexual
  • incubation period (days take for symptoms to show): 30 days
  • chronic hepatitis: No
  • Age group: children
  • Prevention: Ig and vaccine
98
Q

Hepatitis B

A
  • transmission: parenteral, sexual, placenta
  • incubation period: 60-180 days
  • chronic hepatitis: Yes
  • Age group: Any age
  • Prevention: Ig and vaccine
99
Q

Hepatitis C

A
  • transmission: parenteral, sexual, placenta
  • incubation period: 35-60 days
  • chronic hepatitis: Yes
  • age group: adults
  • prevention: education, hygiene
100
Q

Viral hepatitis: Manifestations (Stage 1= prodromal phase)

A
  • Fever
  • Malaise
  • Anorexia
  • Liver enlargement and tenderness
101
Q

Viral hepatitis: Manifestations (Stage 2= icteric phase)

A
  • Jaundice
  • Hyperbilirubinemia (build up of bilirubin → pigment → jaundice)
102
Q

Viral hepatitis: Manifestations (Stage 3= recovery phase)

A
  • Symptoms resolve
  • Return of normal liver function 2-12 weeks after jaundice
103
Q

Cholelithiasis

A
  • Gallstone formation
  • As a result of the aggregation of cholesterol crystals (cholesterol stones) or precipitates of unconjugated bilirubin (pigmented stones)
  • Cause abdominal pain and jaundice
104
Q

3 types of cholelithiasis

A
  1. Cholesterol (associated with 70-80% cholesterol)
  2. Pigmented black (rare, associated with chronic liver disease and hemolytic disease) or brown (associated with biliary stasis, bacterial infections, biliary parasites)
  3. Mixed
105
Q

Cholelithiasis: Manifestations

A
  • Asymptomatic
  • Epigastric and right upper quadrant pain/discomfort
  • Intolerance for fatty food
  • Heartburn
  • Flatulence
106
Q

Cholecystitis

A
  • Acute or chronic
  • Caused by gallstone lodged in cystic duct
  • Obstruction causes gallbladder to become distended and inflamed
  • Pressure against distended wall of gallbladder can cause decreased blood flow, ischemia, necrosis and perforation
107
Q

Cholecystitis: Risk factors

A
  • Obesity
  • Middle age
  • Female
  • Oral contraceptive use
  • Rapid weight loss
  • First Nations ancestry
  • Gallbladder, pancreas or ileal disease
  • Genetic predisposition
108
Q

Cholecystitis: Manifestations

A
  • Fever
  • Leukocytosis
  • Rebound tenderness
  • Abdominal muscle guarding
109
Q

Pancreatitis: Risk factors

A
  • cholelithiasis
  • Alcoholism
  • Obesity
  • Peptic ulcers
  • Trauma
  • dyslipidemia
  • Hypercalcemia
  • Smoking
  • Some medications
  • Genetics
110
Q

Acute pancreatitis

A
  • Mild
  • Resolves spontaneously
  • Obstruction of the outflow of pancreatic digestive enzymes → accumulation of pancreatic secretions → autodigestion of pancreatic cells and tissues (process whereby pancreatic enzymes destroy its own tissues) → inflammation, vascular damage, coagulation and fat necrosis
  • Can also result from alcohol, medications or viral infection
111
Q

Acute pancreatitis: Manifestations

A
  • Constant mild to severe epigastric pain may radiate to the back
  • Fever
  • Increased WBC count
  • Nausea and vomiting
  • Jaundice
112
Q

Chronic pancreatitis

A
  • Causes progressive fibrotic destruction of pancreas
  • Chronic alcohol abuse is most common cause
  • May also come from gallstones, smoking, genetics
  • Pancreatic parenchyma is destroyed replaced by fibrous tissues, calcification, ductal obstruction and pancreatic cysts
113
Q

Chronic pancreatitis: Manifestations

A
  • intermittent or continuous abdominal pain
  • weight loss
114
Q

Esophagus cancer: Risk factors

A
  • Malnutrition
  • Alcohol
  • Tobacco
115
Q

Esophagus cancer: Manifestations

A
  • Chest pain
  • Dysphagia
116
Q

Stomach cancer: Risk factors

A
  • Salty food
  • Red meat
  • Nitrates- common in processed meats, also in some leafy green vegetables
117
Q

Stomach cancer: Manifestations

A
  • Anorexia
  • Weight loss
  • Vomiting occult blood
  • Right upper quadrant (RUQ) pain
118
Q

Colorectal cancer: Staging

A

Stage 0:
- Carcinoma in situ
- Cancer cells are only in the inner lining of the colon or rectum (mucosa)
- Cancer cells have not grown past the muscle layer of the mucosa

Stage 1:
- Tumor has grown into the layer of connective tissue that surrounds the mucosa (submucosa) or into the thick outer muscle layer of the colon or rectum (muscularis propria)

Stage 2:
- Involves serosa- or into tissues beyond the muscle layer into other organs

Stage 3:
- Cancer cells in lymph does near the colon or rectum

Stage 4:
- Cancer spread to other parts of the body (distant metastasis) such as to the liver or lungs

119
Q

Colorectal cancer: Risk factors

A
  • Polyps - larger polyp the greater the risk
  • IBD
  • Diverticulitis
  • High-fat
  • High refined carbs
  • Low fiber diet
  • Genetics- family history of colorectal cancer puts you at greater risk
120
Q

Colorectal cancer: Manifestations

A
  • Pain
  • Mass
  • Anemia
  • Bloody stool
  • Distension
121
Q

Pancreas cancer: Risk factors

A
  • Chronic pancreatitis
  • Smoking
  • Alcohol
  • Diabetes in women
  • Family history
  • High-fat foods
  • Processed meat
  • Obesity
122
Q

Pancreas cancer: Manifestations

A
  • Weight loss
  • Weakness
  • Nausea and vomiting
  • Abdominal pain
  • Depression
  • Jaundice - due to bile duct obstruction
123
Q

Liver cancer: Risk factors

A
  • Hep B,C,D
  • Cirrhosis
124
Q

Liver cancer: Manifestations

A
  • Pain
  • Anorexia
  • Weight loss
  • Ascites
  • Jaundice
125
Q

Cleft lip and cleft palate

A
  • Caused by the incomplete fusion during the second month of development
  • Syndrome associated with other malformations
  • Nonsyndromic occurs alone
126
Q

Cleft lip and cleft palate: Caused by

A
  • Maternal alcohol and tobacco use
  • Maternal diabetes mellitus
  • Folate deficiency
127
Q

Esophageal atresia

A

esophagus ends in a blind pouch- does not connect properly

128
Q

Tracheoesophageal fistula

A

connection between trachea and esophagus- air enters stomach, regurgitated secretions enter lungs

129
Q

Esophageal atresia and tracheoesophageal fistula: Caused by

A
  • Environmental exposure to Tapazole (medication to treat hyperthyroidism)
  • ½ have one or more other birth defects
  • Infectious disease
  • Alcohol or smoking
  • Maternal diabetes
  • Maternal age
130
Q

Esophageal atresia and tracheoesophageal fistula: Manifestations

A
  • Drooling at birth
  • Inability to swallow secretions
  • Choking with feeding
  • Respiratory distress- abdomen may fill with air becoming distended and interferes with respiration- may show intermittent cyanosis
131
Q

Pyloric stenosis

A
  • Narrowing and distal obstruction of the pylorus
  • Unknown cause- multifactorial- genetic and environmental factors
  • Muscle fibers thicken so the pyloric sphincter becomes enlarged and inflexible
  • Extra effort to force gastric contents may cause muscle layers of stomach to become hypertrophied as well
132
Q

Pyloric stenosis: Manifestations

A
  • 2-8 weeks after birth
  • Forceful, nonbilious vomiting immediately after feeding
  • Constipation due to no fluid reaching intestines
133
Q

Hirschsprung’s disease

A
  • Functional obstruction of colon
  • Absence of nerve cells in part of colon causes decreased peristalsis- distension to proximal colon- causing ‘megacolon’
134
Q

Hirschsprung’s disease: Manifestations

A
  • Delayed passage of meconium (newborn first poop)
  • Mild to moderate constipation
  • Poor feeding
  • Poor weight gain
  • Increasing distension
  • Watery diarrhea as water may pass obstruction
135
Q

Intussusception

A
  • Telescoping of proximal segment of intestine into a distal segment- causing mechanical obstruction
  • Most common cause of small bowel obstruction in children
  • Most occur between 5-7 months of age
136
Q

Intussusception: Manifestations

A
  • Colicky abdominal pain
  • Irritability
  • Knees drawn to chest
  • Abdominal mass
  • Vomiting
  • Bloody stools
137
Q

Hernias

A
  • Bowel protrudes through weakening in abdominal wall ligament- bulge in groin or scrotum (typically comes and goes)- May get bigger if child is straining or crying- Straining makes hernia easier to see
  • Most common in newborns
  • May not be noticeable for several weeks or months after birth
138
Q

Hernias: Caused by

A

Weakness in abdominal muscles

139
Q

Failure to thrive

A
  • Physical sign that a child is receiving inadequate nutrition for optimal growth and development
  • Deceleration in weight gain
  • Usually presents before 18 months
140
Q

Failure to thrive: Caused by

A
  • Multifactorial condition- biological, psychosocial, and environmental contributions
  • 80% will have no underlying medical condition
  • Inadequate intake
  • Inadequate absorption
  • Excessive caloric expenditure
141
Q

Failure to thrive: Manifestations

A
  • Feeding problems
  • delayed growth
  • dry skin
  • sparse hair
  • poorly developed musculature
  • decreased subcutaneous fat

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