Notes from GI Disorder

Question 1

A lot of diseases begin in the gut

Question 2

Nausea and vomiting can be infectious diseases and can be due a number of disorders as well

GI bleeding is due to a GI issue

Question 3

Swallowing takes some pretty coordinated activity of muscles to occur so we need tongue and pharynx to work and you need the muscles to contract and release and to keep food moving down

Question 4

Hema=________

Temesis=__________

Answer 4

Hema=blood

temesis=vomiting

Question 5

Hematemesis=throwing up blood

Question 6

GI system should be a _______ tract and there shouldn’t be bleeding in there and if there is then it means something is a miss and it can be very minor and it can be major and there generally isn’t going to be blood found in the stool

Answer 6

closed

Question 7

Esophageal Diverticulum occurs in the esophagus where you have a bulge almost that it is making the coordinated movement of getting food down the esophagus and into the stomach…not work properly and often is leading to something where something gets stuck…so you have something more like this and whats happening here is food is coming down and its gets trapped there and it can’t get out and it’s a good place to start up and this is where you get foul smelling,breath, gurling,belching and your unnecessarily get that food down and get it out and again there’s coordinated movements here with muscles and this is bulging out and it can’t push nearly as well and it doesn’t work nearly as well and it can’t contract like you would expect it too and its weaker and this leads us to gastroesophageal reflux

Question 8

Common Gastroesophageal reflux and its called heartburn and it occurs 30 to 60 minutes after a meal or though frankly it can occur much later than that and it has an evening onset most of the time and it tends to be with pain in the epigastric area so stomach sometimes radiates to the throat, shoulder, or back and at some point people have experienced GERD at some point and it almost feels like stomach acid is coming up into your throat

Question 9

GERD advice=avoid large meals especially towards dinner or towards the end of the day…if your having a late dinner then you try to lay down and go to bed…turning horizontal can also lead to issues with it…gravity helps keeps things down and if you start laying down you get the reflux coming up

Question 10

Alcohol and smoking also play a role in this and adding alcohol to a meal can increase your risk of having GERD and eat meals sitting up which is important

Question 11

Sometimes sleeping in a chair if someone is having serious GERD issue that day…sleep with the head elevated use two or three pillows so helping gravity work with you as opposed to against you and then losing weight if overweight tends to also be a helpful piece of advice for GERD

Question 12

Stomach is very acidic and has a lining that protects from acid and its important to keep this acid from getting to other layers where it was strong enough to really dissolve the cells and the lining of the stomach

Question 13

Two layers in the stomach water soluble and water insoluble keeps stomach acid from doing its job which is to digest food and things that come in there without damaging the cells that surround it…the epithelial cells

Question 14

Gastritis is when this gastric mucosa gets inflamed and we have seen itis’s all the time and at this time probably pretty comfortable that gastritis is going to be an area of inflammation of this area but its gastric mucosa but it can be transient so acute means that it comes and goes away and its caused by irritants such as endotoxins we talked about some of those with sepsis can be caused by alcohol and its probably a major consideration that you have all heard is aspirin and some NSAIDs can lead to stomach upset and can lead to gastritis if taken too much or too regularly

Chronic is when things become more problematic and so again acute transient is going to come and then its going to go away. Chronic is where its staying around and this damage has become severe enough that we now have visible erosions within the stomach lining and when that happens there’s inflammatory changes and cells are getting damaged that shouldn’t be getting damaged because they are no longer protecting through these erosions and it leads to and it leads to an atrophy of the epithelial cells and epithelial cells are the ones that are lining the stomach so it leads to atrophy of the lining and it can eventually perforate…damaging the surrounding cells as well

Question 15

4 Major Types of Chronic Gastritis but __________ is most common

Answer 15

Helicobacter pylori

Question 16

Helicobacter pylori induces intense response from the body and sometimes its intense inflammation and immune response is actually what can cause some of the damage here but this is one of those bacteria that loves acid and there’s not a lot of things that can live at a pH of two but H.pylori seems to like the mucus secreting cells here and it interferes with their protection against this acid

Question 17

What chemical do you predict are most likely to be our chemical gastropathy? ________and _____________

Answer 17

Alcohol and aspirin

Question 18

Peptic ulcer is common and its an ulcerative disorder and it occurs in the upper GI tract so again the stomach area and it is dealing with acid and pepsin secretions

Pepsin breaks down peptides and its one of our digestive enzymes and its going to help break down proteins into smaller peptides and it has spontaneous remissions and exacerbations so this means that its getting worse and it gets better and its hard to know why but it does

Question 19

Stress ulcers have to do with physical stress and NOT mental stress

Question 20

The types of foods that one consumes is highly correlative with your risk for gastric cancer

Question 21

Why might gastric cancer be more common in Japan, China, Russia, and South America? More consumption of _________

Answer 21

raw fish

Question 22

Microbiome has a communal relationship with bacteria that live within our body and a lot of it is within the gut…some of it is on the skin

Question 23

There 6 major areas where we have bacteria that are bacteria, fungi, lots of different things…there’s a lot of bacteria that lives in the human body and helps us

Question 24

Major theories that’s out there right now is that some of the large increase we have in autoimmune disorders is because our immune system isn’t being tried enough and we use to have things like rheumatoid fever and some of these disorders,mealses, mumps that have gone away…there’s a much lower incidence of autoimmune disorders and now its increasing and whether that’s due to…it could be due to a lot of things one of the prevailing theories of the microbiome

Question 25

Microbiome

Diseases in many organs are linked to alterations or problems with it and the effects of many drugs is also linked to it as well…warfarin being a major consideration.There’s estimated to be as many as some around 1 to 1.5 bacterial cells every human as there are human cells and some estimate that there are 10 times as many bacteria within your body than there are human cells in your body

Question 26

Has anyone ever taken antibiotic and one of the main side effects is diarrhea and that’s due to killing off some of the bacteria in your gut

Question 27

There’s side effects that come along with drug.

Question 28

Changes that come along with food that will affect and change what we consider to be our microbiome…Decrease in lactic acid in an athlete…anyone who is a runner knows that the buildup of lactic acid is one of the things that really slows down your muscles.

Question 29

Runners with decreased lactic acid your going to have an advantage and that’s what the microbiome is….its talking about the bacteria that lives inside your gut and good bacteria and bad bacteria the ones that make you want to eat more protein versus ones that have you eat more sugar

Question 30

Irritable bowel syndrome: don’t find anything wrong when they look generally so there’s no structural or biochemical abnormalities…there’s no test to say you have IBS (Irritable bowel syndrome) and you have this repeated need to go to the bathroom, manifestations of ________

Answer 30

stress

Question 31

IBS (Irritable bowel syndrome) is frequent diarrhea.

Question 32

Inflammatory Bowel Disease
2 major types
-Chron’s disease
-Ulcerative colitis
Chron’s disease and ulcerative colitis are inflammatory bowel disease
Things beyond the GI system that are associated with Chron’s disease or ulcerative colitis

If one parent has Chron’s disease then the child will have Chron’s disease

Question 33

___________ is defined as having what we are calling skipped lesions within the large intestine…a skipped lesion is what it sounds like…the lesions skip around so there are parts that are okay…parts that are inflamed…parts that are okay…parts that are inflamed…so the skipping of lesions is a major defining factor…

Answer 33

Chron’s disease

Question 34

rectal bleeding with ____________ is rare,development of cancer is lower as well

Answer 34

chron’s disease

Question 35

In ____________, the development of cancer is common and rectal bleeding is common too

Answer 35

Ulcerative colitis

Question 36

Chron’s disease does increase your risk of colorectal cancer but not nearly as much as ulcerative colitis

Question 37

_________ is a continuous lesion that’s at the rectum and goes up so the upper part of the large intestine is probably fine as you get lower and lower depending again on the involvement in the severity it gets worse but it generally starts at the very end and one of the things that can occur here is a colostomy where it gets so bad that they remove the end of the colon and you have a colostomy bag

Answer 37

Ulcerative colitis

Question 38

________is common with both chron’s disease and ulcerative colitis

Answer 38

Diarrhea

Question 39

Rectal bleeding with ulcerative colitis is common and it can turn to colon rectal cancer due to this kind of intense inflammation

Question 40

C.diff is found in nursing home populations and it can be hard to treat and antibiotic resistant

Question 41

Most e.coli itself is not problematic there…there’s a certain substrain of e.coli that tends to be more pathogenic and O157:H7 infection and that can lead to diarrhea but c.diff is the major one when we think about when we think about bacterial infection

Question 42

Protozoal infection is pretty uncommon

Question 43

Alterations in Motility:Diarrhea and Constipation

Question 44

In constipation,fecal matter doesn’t move as quickly as we hoped and diarrhea is when its moving too fast

Question 45

Types of Diarrhea we have non-inflammatory sometimes its ________ which is due to a mutation in lactate and in case we aren’t have enough lactase and there’s ________which is due to fat malabsorption

Answer 45

osmotic

secretory

Question 46

One of the issues that can’t occur with the GI system is problems with absorption and one of the major signs of that diarrhea wise is ___________ will lead to diarrhea with high levels of fat within it

Answer 46

fat malasborption

Question 47

__________ is usually a smaller volume (IBD, infectious disease or some irritable colon disorder)

Answer 47

Inflammatory disease

Question 48

Common causes of constipation
-Failure to respond to the urge to defecate especially in children who refuse to go and then they can’t constipated and its not only that but it tends to be found in a lot of 3 years old or 2 years old where they just won’t go and they can’t when they actually need too
Pregnancy can push on the colon…make it a little smaller and make it harder
Hemorrhoids can make it painful and more difficult

Question 49

___________ is increased fat in the stool and it’s a sign that its not being absorbed well and usually some malabsorption syndrome

Answer 49

Steatorrhea

Question 50

_________ is immune-mediated disorder to gluten and was considered rare

Answer 50

Celiac disease

Question 51

Classic celiac disease shows up in infancy and now we find people having sensitivity to gluten at older ages

Question 52

Classic celiac disease still shows up at a really young age and the ones that have it the most severe tends to show up at a young age whereas sensitivity there’s a range of gluten sensitivity we find and it use to be very rare now its thought to be more common and that’s a bit of a spectrum where its still kind of rare to have this severe like your going to the hospital if you have a bite versus your stomach gets upset and it just doesn’t feel right but it causes the absorption of the small intestine to be decreased usually what happens is your having some sort of inflammatory reaction in the small intestine and it prevents food,nutrients,fats,proteins,etc from getting across and getting absorbed in the small intestine so they stay in the intestine and then they come out

Question 53

Classic form of celiac disease presents in infancy

-Severe malnutrition…noting can’t get absorbed if the inflammation and the issue is serious enough within the intestine so level of inflammation so the more inflammation the more difficult it is for things to be absorbed and less absorption that is going to occur
-If you have an inflammation within the small intestine it makes the passing and the surface areas…fusion more complicated because of the fluid and inflammation

Question 54

How do you think we find polyps to remove them before they become cancerous? A ___________ can look to see if there are any polyps

Answer 54

colonoscopy

Question 55

Colonoscopy has been a major life saver in decreasing the amount of death from colon cancer

Question 56

Colorectal cancer has decreased death rates because of screenings, colonoscopies

Question 57

Colorectal cancers
-most of these occur after 50…however there has been a significant increase in the development of colon rectal cancer in younger populations and it tends to more aggressive and if is occurring in somebody that is younger in their 40s or 30s it tends to be more aggressive and more advanced

______________: if you have this gene mutation that runs in families you have a ton of polyps that develop early and very likely to turn into colorectal cancer

-Diet (________,__________, high fat foods tends to lead to colonrectal cancer as well

Answer 57

Familial adenomatous polyposis, high sugary,processed foods