Unit 11 Flashcards
(166 cards)
1
Q
two distinct medullary centers for vomiting
A
vomiting and chemoreceptor trigger zone
2
Q
emesis
A
vomiting
3
Q
hypoxia exerts direct effect on
A
vomiting center
4
Q
what are some neurotransmitters that work on chemoreceptors for the vomiting
A
dopamine, serotonin, opioid
5
Q
do we want excess or little of dopamine, serotonin, opioids
A
we want little
6
Q
why do we want to attack dopamine, serotonin, opioid
A
to prevent nausea
7
Q
where is the chemoreceptor trigger zone located
A
small area on the floor of the fourth ventricle
8
Q
the chemoreceptor trigger zone is exposed to
A
blood and cerebrospinal fluid
9
Q
the chemoreceptor trigger zone is thought to mediate the emetic effects of
A
blood borne drugs and toxins
10
Q
swallowing depends on the coordinated action of the
A
tongue and pharynx
11
Q
swallowing structures are innervated by cranial nerves
A
V (5), IX (9), X (10), XII, (12)
12
Q
dysphagia
A
difficulty in swallowing
13
Q
Odynophagia
A
painful swallowing
14
Q
achalasia
A
failure of the esophageal sphincter to relax
15
Q
Mallory-Weiss Syndrome
A
non penetrating mucosal tears at gastroesophageal junction
16
Q
Gastroesophageal Reflux Disease (AKA Gerd)
A
heart burn
17
Q
GERD can lead to cancer how?
A
constant inflammation and then healing cycle
18
Q
GERD pain is easily confused with
A
angina
19
Q
Barret esophagus squamous replaced by
A
columnar
20
Q
Barret esophagus can lead to
A
cancer
21
Q
GERD in children commonly will present with
A
evidence of pain when swallowing, irritability, inconsolable crying
22
Q
GERD in children may cause
A
respiratory problems, dental carries or ear pain
23
Q
how do you get dental carries with GERD in children
A
because acid errodes the enamle
24
Q
GERD children are very
A
colicly
25
two types of gastric mucosa
water insoluble and water soluble
26
water insoluble mucus forms
thin, stable gel that adheres to the gastric mucosal surface
27
water soluble mucus is ______ and it is a lubricant that prevents mechanical damage to the mucosal surface
viscid
28
Gastric Mucosal barrier is
impermeable epithelial cell surface
29
Gastric Mucosal Barrier mechanism for selective transport of ________ and ____ ions and characteristics of gastric mucosa
hydrogen, bicarb
30
ASA is non ionized and lipid soluble rapidly diffuses increases
mucosal permeability and damages epithelial cells
31
prostaglandin role
secrete bicarb
32
shock affects the
protaglandin
33
if you are in shock you will have more acid why?
prostaglandins are not working
34
Acute gastritis can or cannot heal its self
can heal itself
35
transient
short term
36
Acute Gastritis is transient inflammation of
gastric mucosa
37
acute gastritis inflammation is caused by
bacterial endotoxins, alcohol or asprin
38
acute gastritis severity ranges from
edema to hemorrhagic erosin
39
acute gastritis is self limiting with complete regeneration and healing within
days
40
Chronic Gastritis is transient or not transient
not transient
41
what is the most common cause of chronic gastritis is
H. Pylori
42
what else could cause chronic gastritis
autoimmune
43
how to get rid of H. Pylori
antibiotics
44
H. Pylori colonizes the
mucus secreting epithelial cells of the stomach
45
H. Pylori bacteria have what that allow them to move through the mucous layer of the stomach
multiple flagella
46
H. Pylori secretes _______ which enables them to produce sufficient ammonia to buffer acidity of their environment
urease
47
H. Pylori produce _______ and ______ that interfere with mucosal protection against injury from gastric acid
enzymes, toxins
48
second most common cause of Chronic Gastritis
NSAIDs
49
H. Pylori causes damages to the stomach lining which could lead to what 2 issues
ulcers or increased risk of gastric cancer
50
When you take Aspirin/NSAIDs those drugs inhibit the synthesis of prostaglandins leading to
increased acid production because acid production is regulated by prostaglandins so when you inhibit them you have unregulated acid production
51
NSAIDs and aspirin contribute to the formation of gastritis by inhibiting the
synthesis of prostaglandins
52
when you take NSAIDs/asprin the synthesis of prostaglandins is decreased due to the __________ action of the drug; there for ____ _________ is unregulated
anti inflammatory, acid production
53
why would the c urea breath test with when testing for H. Pylori
because they released urease
54
ways to test for H. Pylori
C urea breath test, stool antigen test
55
C urea breath test using
radioactive carbon isotope
56
Peptic ulcer disease can be caused by
H. Pylori, use of ASA and NSAIDs
57
peptic ulcer you get discomfort and pain when the stomach is empty or full
empty
58
melena
black tarry stool
59
stress curling happens when you have
massive burns
60
cushings is increased
cranial pressire
61
you get cushings after
injury, operation, tumors
62
complications of peptic ulcers
hemorrhage, obstruction, perforation
63
hemorrhage does or does not go through the wall
can happen when the ulcer doesn't go through the wall
64
hemorrhage
caused by bleeding from granulation tissue or from erosion of an ulcer into an artery or vein
65
obstruction caused by
edema, spasm, or contraction of scar tissue and interference with the free passage of gastric contents through the pylorus or adjacent areas
66
perforation occurs when an ulcer erodes
through all the layers
67
perforation looks like a
flower
68
hematemesis and Selena occurs with
hemorrhage
69
hematemsis
blood in vomitus
70
melena
blood in stool
71
occult
hidden
72
cancer of the stomach is often
asymptomatic
73
autoimmune gastritis is chronic
inflammation
74
chrons is
skip lesions of mucosa
75
ulcerative colitis is located just in
colon
76
ulcerative colitis is ___________ of mucosa
continuous
77
Crohn type of inflammation
granulomatous
78
ulcerative colitis type of inflammation
ulcerative/exudative
79
crohns area of involvement
primary ileum, secondary colon
80
ulcerative colitis area of involvement
primarily rectum and left colon
81
Crohn and ulcerative colitis diarrhea
common with both
82
crohn rectal bleeding
rare
83
ulcerative colitis rectal bleeding
common
84
crohns fistulas
common
85
ulcerative colitis fistulas
rare
86
crohns strictures/perianal abcess
common
87
ulcerative colitis strictures/perianal abcess
rare
88
crohns development of cancer
may occur
89
ulcerative colitis development of cancer
high risk
90
clostridium difficile colitis is caused by
a lot of antibiotics
91
clostridium difficile colitis you get _______ with lower abdominal cramping
diarrhea
92
clostridium difficile is caused by disruption to the normal flora which leads to
colonization and release of toxins which cause mucosal damage and inflammation
93
E coli is a ____ borne transmission, person to person
food
94
E. coli may occur in
nursing homes, day care and hospitals
95
e coli may lead to watery
diarrhea
96
e coli may lead to
hemorrhagic colitis, hemolytic uremic syndrome and TTP
97
Appendicitis is
swollen, gangrenous
98
in appendicitis it wil eventually
perforates
99
cause of appendicitis is unknown but may be due to
intraliminal obstruction with fecalith or twisting
100
appendicitis has abrupt or longer onset
abdrupt
101
appendicitis pain is
referred
102
with appendicitis the pain will localize to the ____ in 2-12 hours
RLQ
103
the key factor with appendicitis is
rebound tenderness
104
rebound tenderness
does not hurt when you press down but when you removed pressure
105
peritinoitus has rebound tenderness in
all quadrants
106
2 types of intestinal obstruction
mechanical or paralytic
107
mechanical obstruction can lead to
vomitting
108
why would mechanical obstruction lead to vomiting
because the bolus cannot go thorough the obstruction so it must come up rather than down
109
mechanical obstruction can be caused by
hernia, adhesions, intussusception and volvulus
110
paralytic obstruction is caused by
neurogenic or muscular impairment of peristalsis most commonly after abdominal surgery
111
4 types of mechanical obstructions
adhesions, volvulus, incarcerated inguinal hernia, intuddusception
112
voluvus
twisting
113
adhesions
two portions of the intestine are connected by a scar
114
intussusception
the intention folds in
115
in mechanical you have what type of pain
severe, colicky pain
116
in mechanical you will hear borborygmus which is
rumbling thundery noise of air rushing
117
paralytic will have what type of pain
continous
118
will paralytic have noise or be silent
silent
119
paralytic there is not true blockage but the bowels are
paralyzed
120
results of obstruction
vomiting which leads to fluid and electrolyte loss, distension of bowel, and anaerobic bacteria will produce endotoxin which lead to toxemia
121
with peritonitis where will you get rebound tenderness
all over abdominal
122
peritonitis is well adapted for inflammatory response how?
exudes thick, sticky, fibrinous substance that adheres and walls off perforated viscus and aids in localizing process
123
peritonitis uses sympathetic stimulation that limits intestinal activity why?
inhibits movement of contaminants
124
peritonitis translocation of ECF to peritoneal cavity and bowl can cause
nausea, vomiting, hypovolemia and shock
125
what are some things that could lead to peritonitis
perforated peptic ulcer, ruptured appendix, perforated divertivulum, gangrenous bowl, gangrenous gallbladder
126
with colorectal cancers pain is a early or late symptom
late
127
with colorectal cancer _____ side colon could lead to no symptoms until it develops to a mass
right
128
colorectal cancer could be caused by
crohn disease, ulcerative colitis
129
liver function tests
liver enzymes, protein levels, prothrombin time, bilirubin, ultrasound, CT, MRI, angio
130
jaundice in the eye is also called
sclera icterus
131
cause of jaundice
excessive destruction of red blood cells, impaired uptake of bilirubin by the liver cells, decreased conjucation of bilirubin, obstruction of bile flow
132
prehepatic
before liver
133
intrahepatic
in liver
134
posthepatic
after liver
135
prehepatic major cause is
excessive hemolysis of red blood cells
136
intrahepatic causes by disorders that directly affect the ability of the liver to removed
bilirubin
137
posthepatic occurs when bile flow is obstructive between the liver and the
intestine
138
which of the following is not a cause of jaundice?
- excessive destruction of red blood cells
- impaired uptake of bilirubin by the liver cells
- ingestion of iron supplements
- obstruction of bile flow in the canaliculi of the hepatic lobules or in the tntrahepatic or extra hepatic bile ducts
ingestion of iron supplements
139
Tylenol affects the ______
liver
140
cause of hepatitis
autoimmune disorders, reactions to drugs and toxins, infectious disorders, hepatotoxic viruses that primarily affect liver cells or hepatocytes
141
spectrum of alcoholic liver disease includes
fatty liver disease
alcoholic hepatitis
cirrhosis
142
in cirrhosis the ___________ is disrupted
cytoskeleton
143
cirrhosis end state chronic liver disease in which normal architecture of liver is replaced by
fibrous septa
144
portal hypertension ___________ resistance to flow in portal venous system and sustained pressures
resistance
145
portal hypertension causes increased pressure in ___________ capillaries
peritoneal
146
portal hypertension cause portosystemic _________ of blood
shunting
147
portal hypertension
splenomegaly
148
increased pressure in peritoneal capillaries causes
ascites
149
splenomegaly causes
anemia, leukopenia, thromboytopenia, bleeding
150
decreased albumin causes decrease colloidal osmotic pressure which causes
ascites
151
increase bilirubin causes
decrease clotting factors
152
manifestations of cirrhosis
weight loss, portal hypertension, ascites, esophageal varies, splenomegaly
153
cholelithiasis
gallstones
154
cholecystitis
inflammation of gallbladder
155
acute pancreatitis
serve life treating disorder associated with escape of activated pancreatic enzymes into pancreas and surrounding tissue
156
acute pancreatitis: enzymes induce fat necrosis or
autodigestion of pancreas
157
acute pancreatitis: onset of
severe pain abrupt
158
acute pancreatitis: loss of _________ into retroperitoneal and peripancreatic spaces
volume
159
acute pancreatitis: hypocalcemia due to ___________ of calcium in fat necrosis
precipitation
160
acute pancreatitis what is used for diagnosis
serum amylase and lipase
161
acute pancreatitis causes ____ and ____ may result in death
ARDS, ATN
162
common causes acute pancreatitis:
gallstones
163
Cullens sign
test for pancreatitis blood behind belly button
164
chronic pancreatitis
calcifying or obstructive
165
cancer of pancreas: cause
unknown
166
are they pain endings in pancreas
no
