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The GI System Flashcards

1
Q

Functions of the GI system

A

Digest and absorb ingested nutrients
Excrete waste products

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2
Q

GI system and Nutrients

A

Most nutrients are too complex for absorption or completely insoluble so the GI system degrades them enzymatically in the simple molecules sufficiently small in size and in a form that permits absorption across the mucosa epithelia

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3
Q

Upper GI Tract

A

Includes the mouth, esophagus, stomach and duodenum
Aids in the ingestion and digestion of food

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4
Q

Lower GI Tract

A

Includes small and large intestines

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5
Q

Small intestine

A

Accomplishes digestion and absorption of nutrients

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6
Q

Large intestines

A

Absorbs water and electrolytes, storing waste products of digestion until elimination

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7
Q

Integrity of the GI tract immune function and host defense

A

The gut immune system has 70% to 80% of the body’s immune cells, and the protective blocking action of the secretory response in the gut is crucial to the integrity of the GI tract immune function and host defense

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8
Q

What happens with a reduction of normal bacteria in the gut after antibiotic treatment or in the presence of infection?

A

May interfere with the nutrients available for immune functions in the GI system

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9
Q

The GI sytem

A

Harvest the largest micro bio load in the human body
Maintaining balance between immunity against invading pathogens and tolerance to commensal

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10
Q

Commensals

A

Types of micros that reside on either the surface of the body or the mucosa
These micros don’t harm human health, live in harmony with humans mostly consist of bacteria
x10 more of these bacteria than actual cells in the body

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11
Q

Intestinal homeostasis

A

Conducted by a tight regulation by cooperation of different branches of the immunity system that includes the innate and adaptive
If there is any source of disruption in this delicate balance, it is going to lead to GI disorders

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12
Q

Signs and Symptoms of GI Disease

A

Nausea
Vomiting
Diarrhea
Constipation
Dysphagia-difficulty w/swallowing
Achalasia-esophagus muscles don’t contract properly = don’t help propel food down the stomach
Heartburn
Abdominal Pain
GI Bleeding
Fecal incontinence

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13
Q

Most common GI problems in older adults

A

Constipation
Incontinence
Diverticular disease

Each of these disorders has many different underlying causes

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14
Q

What happens to the alimentary organs (esophagus, stomach, small intestine, and colon) with age?

A

Like all muscular structures, lose some tone with age but still manage to perform almost as well in age as in youth

Changes within the alimentary tract include decreases in gastric motility, blood flow, nutrient absorption, and volume and acid content of gastric juice

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15
Q

The Esophagus - Hiatal hernia

A

Upper part of the stomach bulges through the diaphragm
Hernias are either congenital, resulting from a failure of formation or fusion of the multiple developmental components of the diaphragm, or acquired. Acquired hernias can also be categorized as either sliding or paraesophageal

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16
Q

The Esophagus - Hiatal hernia
Incidence

A

Estimated as 5 per 1000 people, increases with age and may be as high as 60% in people older than 60 years of age. Women>men; children may have the sliding type but do not usually exhibit symptoms until they reach middle age.
Age, common on ppl over 50, obesity, smoke

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17
Q

The Esophagus - Hiatal hernia
Risk factors

A

Weakening of the diaphragm muscle or anything that alters the hiatus (the opening in the diaphragm for the passage of the esophagus) and increases intraabdominal pressure can predispose a person to hiatal hernia.
Muscle weakness can be congenital or caused by aging, trauma, surgery, or anything that increases intraabdominal pressure

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18
Q

The Esophagus - Hiatal hernia
Symptoms

A

Heartburn or reflux
Causes of Increased Intraabdominal Pressure:
* Lifting
* Straining
* Bending over
* Prolonged sitting or standing
* Chronic or forceful cough
* Pregnancy
* Ascites
* Obesity
* Congestive heart failure
* Low-fiber diet
* Constipation
* Delayed bowel movement
* Vigorous exercise

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19
Q

Gastroesophageal Reflux Disease (GERD)

A

Backward flow
Common condition in which the stomach contents move up into the esophagus
Reflux becomes a disease when it causes frequent or severe symptoms or injury, may damage the esophagus, pharynx, or respiratory tract
Primary symptom is heartburn

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20
Q

GERD - Incidence

A

Most common disorders seen in clinics
Approximately 10% to 20% of American adults have this disorder, seen equally in men and women
Older people are more likely to develop severe disease

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21
Q

GERD - Risk Factors

A

Low pressure of the lower esophageal sphincter (LES)
Hiatal hernias
Medications, cigarette smoking, esophageal dysmotility disorders, and xerostomia (dry mouth) all can lead to increased acid exposure

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22
Q

What are the 3 factors involved in aiding the esophagus to remain healthy?

A
  1. anatomic barriers between the stomach and the esophagus,
  2. mechanisms to clear the esophagus of stomach acid,
  3. and maintaining stomach acidity and acid volume
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23
Q

GERD - Symptoms

A

Heartburn is the main; burning sensation at he stomach and raising to up the chest
chest pain, acid regurgitation, belching, dysphagia, nausea, vomiting, early satiety, and painful swallowing

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24
Q

Esophageal Cancer

A

2 types of esophageal cancer exist: squamous cell carcinoma and adenocarcinoma

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25
Squamous cell carcinoma
Typically develops in the middle of the esophagus, 90% of all esophageal cancer
26
Adenocarcinoma
More often located in the distal portion of the esophagus Rise in frequency, 80% in the US
27
Esophageal Cancer - Incidence
Relatively uncommon, only 1% of all cancers diagnosed in the US Cure rate is poor 6th leading cause of cancer deaths worldwide Men>Woman
28
Esophageal Cancer - Risk Factors
Geographic region, ethnic background, and gender Adenocarci. middle-aged white men and often develops from Barrett esophagus Squamous more common in blacks and is associated with alcohol and tobacco use Exposure to nitrosamine, corrosive injury to the esophagus (burning from chemicals), achalasia, vitamin deficiencies (selenium and zinc), and human papillomavirus infection
29
Barret esophagus
Complication of GERD, can lead to adenocarcinoma Occurs when the normal epithelial cells of the lower esophagus are replaced with columnar cells, typically seen in the intestine = Metaplasia 30- to 40-fold increased risk for cancer Pts placed in surveillance program
30
Esophageal Cancer - Symptoms
Dysphagia, initially with solids and progressing to involve liquids Weight loss odynophagia (pain with swallowing), cough, hoarseness, chest pain, anemia, and regurgitation Symptoms associated with progressive disease
31
Esophageal varices
Most serious consequences in people with cirrhosis ~50% Fragile, dilated veins in the lower third of the esophagus immediately beneath the mucosa that occur in the presence of portal hypertension
32
Portal Hypertension
an increase in pressure in the portal veins that return blood to the heart via the liver from the intestines, stomach, spleen, and pancreas
33
Esophageal varices - Incidence
Most common cause of portal hypertension is cirrhosis (90%). This is due to scar tissue and nodule formation in liver tissue (changing the anatomy and making it difficult for blood to pass through the liver), increased blood flow from dilated splanchnic vessels (secondary to an overproduction of nitrous oxide), and an imbalance between intrahepatic vasodilators and vasoconstrictors
34
Esophageal veins - Symptoms
Variceal bleeding (painless but significant hematemesis w/or no melena Mild postural tachycardia to profound shock, depending on the extent of blood loss and degree of hypovolemia
35
Esophageal veins - Management
All clients with cirrhosis should be evaluated by EGD or transnasal endoscopy for the presence of esophageal varices Prophylaxis consists of nonselective β-blockers Vasoactive medications A stent may be placed between the hepatic vein and the intrahepatic portion of the portal vein Liver transplantation
36
Stomach - Peptic Ulcer Disease (PUD)
A break in the lining of the stomach or duodenum of 5 mm or more owing to a number of different causes. Gastric ulcer - affects the lining of the stomach Duodenal ulcer - occurs in the duodenum
37
Stomach - Peptic Ulcer Disease (PUD) Incidence
6 million ppl per year in US Men and women equally Decrease in incidence due to Tx of H. pylori
38
Stomach - Peptic Ulcer Disease (PUD) Risk factors
Psychologic stress, diet, caffeine, tobacco use, and alcohol consumption Corticosteroids along with NSAIDs increase risk
39
How does PUD happen?
Ulcers develop if there is change in the balance between mucosal insults and mucosal defenses.
40
Stomach - Peptic Ulcer Disease (PUD) Symptoms
No specific Epigastric pain described as burning, gnawing, or cramping near the xiphoid or radiating to the back
41
Gastric Cancer Definition and Incidence
Malignant neoplasm arising from the gastric mucosa 90% of the malignant tumors of the stomach 5th most common cancer and 3rd most common cause of cancer death in the world
42
Gastric Cancer Tx
The only potentially curative Tx approach for pt w/ gastric cancer is surgical resection with adequate lymphadenectomy
43
Gastric Cancer Risk Factors
Poor diet GERD H. pylori infection Epstein-Barr virus infection Smoking Contaminated water Refrigerated food
44
Intestines - Malabsorption disorders
Celiac Disease- an immune mediated disorder triggered by the exposure of the digestive tract tom gluten in people who are susceptible Damage to the villi inhibits nutrient absorption Symptoms: diarrhea (can be severe), bloating, indigestion, flatulence, weight loss, and abdominal pain/cramping Tx: Strict gluten-free diet
45
Inflammatory Bowel Disease (IBD)
Collectively refers to two inflammatory conditions: Crohn's disease Ulcerative colitis
46
Crohn's disease
Inflammation of the digestive tract Chronic, lifelong inflammatory disorder that can affect any segment of the intestinal tract, although most commonly it affects the ileum and/or colon
47
Ulcerative colitis
Chronic disease of the large intestine, in which the lining of the colon becomes inflamed and develops ulcers Chronic inflammatory disorder of the mucosa of the colon, typically involving the rectum, which can then advance proximally in a continuous manner to involve the entire colon Complication: Cancer common
48
Irritable Bowel Syndrome (IBS)
IBS is a group of symptoms that represent one of the most common disorders of the GI system, with a worldwide prevalence of 11% Recurrent abdominal pain or discomfort (abdominal sensation not described as pain) at least 3 days a month in past 3 months
49
IBS Symptoms
Symptoms include chronically reoccurring abdominal pain associated with altered bowel habits in the absence of structural, inflammatory, or biochemical abnormalities Other: nausea and vomiting, anorexia, sour stomach, bloating, abdominal distention, and flatus
50
IBS Risk Factors
Woman>man Ages 20-40 Other pain syndromes including migraine headaches, fibromyalgia, interstitial cystitis, chronic fatigue syndrome, and chronic pelvic pain
51
Diverticular disease Diverticulosis:
presence of outpouchings (diverticula) in the wall of the colon or small intestine
52
Diverticular disease Diverticulitis:
Inflammation/infection of the diverticula with possible complications such as perforation, abscess formation, obstruction, fistula formation, and bleeding
53
Diverticular disease - Incidence and Risk factors
Western countries Constipation, physical inactivity, eating red meat, obesity, smoking, and NSAID use Ehlers-Danlos syndrome, Marfan syndrome, and scleroderma Genetics Chronic steroids and immunosuppressants
54
Diverticular disease - Manifestation
Symptoms overlap with those of IBS Blocked diverticula, bacteria that are trapped inside begin to proliferate, causing infection and inflammation fever, change in bowel habits (usually diarrhea), nausea, vomiting, and anorexia
55
Neoplasms - Intestinal polyps
A growth or mass protruding into the intestinal lumen from any area of mucous membrane can be termed a polyp Polyps are either neoplastic or nonneoplastic
56
Neoplasms - Benign Tumors
The most common benign tumors of the small intestine are adenomas, leiomyomas, and lipomas. Benign tumors of the small intestine rarely become malignant and may be symptomatic or may be incidental findings at operation or autopsy.
57
Neoplasms - Malignant Tumors
The most common malignant tumors of the small intestine are metastatic through direct extension from adjacent organs (e.g., stomach, pancreas, colon). Adenocarcinoma and primary lymphoma account for the majority of bowel malignancies
58
Colorectal Cancer - Malignant tumor
The fourth leading cause of cancer among American men and women, 2nd leading cause of cancer death in both men and women in the US
59
Colorectal Cancer - Malignant tumor Risk Factors
Increasing age, male gender, a personal history of adenomatous polyps, IBD (UC, CD), family history of colon cancer or FAP, and obesity. Cigarette smoking and excessive alcohol consumption may possibly increase risk
60
Obstructive Disease - Hernia
Abnormal exit of a tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides Muscular weakness (congenital or acquired) ~Obesity, pregnancy, heavy lifting, coughing, surgical incision, or traumatic injuries from blunt pressure, increase the risk of developing a hernia
61
Indirect Inguinal
Location: Sac herniates through internal inguinal ring; can remain in canal or pass into scrotum (men), can extend to the labia (woman) Symptoms: Pain with straining; soft bulge that increases with increased intraabdominal pressure; may decrease when lying down Frequency: Most common, 60%, infant<1yr and males 16-20yr Cause: Congenital or acquired
62
Direct Inguinal
Location: Directly behind and through external inguinal ring, above inguinal ligament; rarely enters scrotum Symptoms: Usually painless; round bulge close to the pubis in area of internal inguinal ring; easily reduced when supine Frequency: 2nd most common, more in men >40yr Cause: Acquired weakness; deficient posterior inguinal wall brought on by heavy lifting, muscle atrophy, obesity, chronic cough, or ascites
63
The Appendix - Appendicitis
Inflammation of the vermiform appendix Appendicitis initially presents with generalized or periumbilical abdominal pain that later localizes to the right lower quadrant
64
Treatment for Appendicitis
The gold-standard treatment for acute appendicitis is an appendectomy ~Laparoscopic appendectomy is preferred over the open approach ~In cases where there is an abscess or advanced infection, the open approach may be needed
65
Appendicitis Risk Factors
Any age Peak btw 15-19 yrs Males>Females Infections causing enlarged lymph nodes CD and UC
66
The Rectum - Rectal Fissure
A rectal or anal fissure is an ulceration or tear of the lining of the anal canal, usually on the posterior wall
67
Acute fissure
Occurs as a result of excessive tissue stretching or tearing, such as childbirth or passage of a large, hard bowel movement through the area
68
Anal fissures
Frequently heal within a month or two when treated with a combination of bran and bulk laxatives or stool softeners, sitz baths, and emollient suppositories
69
Hemorrhoids, or Piles
Varicose veins of a pillow-like cluster of veins that lie just beneath the mucous membranes lining the lowest part of the rectum and anus
70
What are hemorrhoids associated with?
With anything that increases intraabdominal pressure
71
Internal hemorrhoids
Occur in the lower rectum and usually are noticed first when a small amount of bleeding occurs during passage of stool, especially if straining occurs during a bowel movement
72
External hemorrhoids
Located under the skin around the anus bleed (bright red blood) if the hemorrhoid is injured or ulcerated and are very painful because they form in nerve-rich tissue outside the anal canal
73
How are external hemorrhoids treated?
With a local application of topical medications, sitz baths, high-fiber diet, and avoidance of constipation and other causes of increased intraabdominal pressure

Patho (13 decks)

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