Unit 2 Flashcards Preview

PAtho > Unit 2 > Flashcards

Flashcards in Unit 2 Deck (82):
1

hernia

organ protrusion thru retaining str wall

2

where is there inc prevelance of hernias

abdm cavity

3

2 requirments needed for herniation to occur (patho)

weakening of supporting or retaining str
inc intra abdm pressure

4

what etiologies relate to weakening of supporting strs in herniations

acquired (injury, aging)
congenital (baby born w m. weakness)

5

what etiologies relate to inc abdm pressure

acquired (pregnancy, obesity)

6

hiatus

aperture opening in diaphragm for esophagus

7

what is a hiatal hernia

hiatus enlarges dt age(?) and inc P admn -> part of stomach enters TC

8

2 types of hiatal hernia

sliding
rolling

9

percent incidence in sliding hernia

95%

10

percent incidence in rolling hernia

5%

11

what happens in a sliding hiatal hernia

upper stomach and GEJ slide up into TC. stomach is pinched at entry point into TC

12

what percent of pts w sliding hiatal hernias are symptomatic

50%

13

what symptoms are present in pts w sliding hiatal hernias

chest pain, heart burn, reflux

14

what happens in a rolling/paraesophageal hiatal hernia

non upper part of stomach moves above diaphragm while GEJ remains in normal spot

15

mnfts of rolling hiatal hernia

chest pain
dyspnea
feeling full sooner after meals

16

why is there chest pain in a rolling hiatal hernia

rt anatomical repositioning of stomachq

17

why is there dyspnea in a rolling hiatal hernia

stomach takes up part of TC -> dec lung capacity for 02

18

why does the pt feel full sooner if they have a rolling hiatal hernia

dec stomach capacity AND smaller herniated pocket still fx's normally, this mini stomach has stretch receptors so when small pocket fills -> n. sends signal of feeling full

19

tx for hiatal hernias

lifestyle mods
drugs for gastric reflux
sx

20

what lifestyle mods occur when txing hiatal hernias

avoid bending over after eating, avoid heavy meals, sleeping after meals, inc HOB to address reflux -> dec heartburn and pain

21

what drugs are used to treat gastric reflux in hiatal hernias

antacids
H2RA
PPI

22

what sx is used to treat hiatal hernias

fundoplication, reduce hernia while wrapping fundus of stomach around junction to prevent it from moving up while tightening cardiac sphincter

23

inguinal hernia

abdm organs protrude via inguinal ring forming hernial sac

24

what aperture do inguinal hernias exit from

inguinal ring

25

what is the inguinal ring

taught opening allowing passage of spermatic cord to exterior body

26

what is in a hernial sac

peritonium with organ and omentum inside

27

2 types of hernia

direct
indirect

28

direct hernia

herniation via no aperture (hiatal)

29

indirect hernia

herniation via present aperture (inguinal)

30

peptic ulcer disease

ulcerative disorder of upper GI tract (20% stomach, 80% duodenum).

31

why is there higher incidence of peptic ulcer disease in the duodenum

no protective lining here

32

what layers does peptic ulcer disease primarily affect

mucosa, deeper layers if no tx

33

how does peptic ulcer disease progress

with remissions and exacerbations, (acute condition that may become chronic)

34

ET of of peptic ulcer disease

dt inf caused by heliobacter pylori

35

how does heliobacter pylori colonize in the stomach

creates a niche and colonizes within stomach wall

36

how does heliobacter pylori attatch to stomach wall

adhesion proteins allowing attatchment to epithelial tissue

37

how does h pylori survive in acidic environment of the stomach

secrete Urease

38

what is urease

enzyme that breaks down urea

39

what does urease break down urea into

NH3 + CO2 -> carbonic acid buffer -> bicarbonate

40

how does the break down of urea aid in the survival of H pylori

urea breaks into bicarbonate which buffers pH on a small scale allowing H pylori to live

41

what does h pylori induce

inflm of tissue
hypergastrinemia

42

hypergastrinemia

inc sec of gastrin hormone

43

fx of gastrin

inc Hcl prod in host stomach.

44

risk factors/offensive factors of peptic ulcer disease

Hcl + biliary acid
steroids & NSAIDS
chronic gastritis
smoking, alcohol, caffeine
stress

45

which offensive factor is etiologic

Hcl and biliary acid

46

what is an offensive factor

things that increase aggrevation of peptic ulcer disease

47

which offensive factor is different then the rest? why

chronic gastritis
its presence makes a pt more susceptible to ulcers

48

what are defensive factors

factors that prevent ulcer formation

49

what 4 defensive factors prevent ulcer formation

acid regulation
intact perfusion
mucous presence
ability of mucosa to regenerate new cells

50

what is to be said about the relationship between offensive and defensive factors

normally, defensive factors > then offensive factors

51

what happens if offensive factors > defensive factors

makes pt more susceptible to ulcers if H pylori is present

52

patho of peptic ulcer disease (2)

H pylori infec-> inflm mediator rls -> tissue damage

infc -> inc gastrin prod -> inc acid sec -> tissue damage dt no acid regulation

53

mnfts of peptic ulcer disease

abdm pain
N/V
Fever

54

describe mnft of abdm pain in peptic ulcer disease

burning and cramping dt inflm of tissue and tissue erosion by HCLl. its felt in the chest and may be described as angina pain

55

why does N/V occur in peptic ulcer diesae

GI mnft

56

when does fever occur in peptic ulcer disease

when H pylori is first establishing

57

3 complications of peptic ulcer diseae

perforation of ulcer
hemorrhage
gastric obstr

58

what may perforation of a peptic ulcer ->

peritonitis

59

how does hemmorrhage of a peptic ulcer mnft?

occult blood in stools

60

what may a gastric obstr in peptic ulcer disease be caused by

edema
scar tissue contraction
m. spasm

61

mechanism of scar tissue contraction and gastric obstr

mucosa attempts to come together at points of injury pulling on the tissue around it, making area tight

62

which tests are use to dx PUD

Hx
serology
fecal Ag
UBT
barium swallow
endoscopy

63

fx of serology in PUD

looking for Ab's against H pylori in blood

64

fx of Fecal Ag in blood

testing stool for Ag's related to H pylori / inc protein content

65

what is the number one dx in PUD

UBT

66

fx of UBT

pt ingests soln thats made to mark C14 if present. pt then gives breath sample 2-2.5 h later and if C14 is present h pylori is presnt

67

how does UBT pick up H pylori infc

H pylori breaks down urea using urease, which is normally not present. If urea is being broken down into Co2 and NH3, then the C in CO2 is available to be marked by the test. the marked CO2 is then exhaled

68

fx of barium swallow in PUD

we can do this to visualize extent of ulcerations

69

fx of endoscopy in PUD

may be used instead of ba swallow or with it, we can image ulcers this way

70

Tx for PUD

antacids?
triple regimen
Sx

71

fx of antacids in PUD

for symptom relief and OTC med thats not to be used long term dt inc risk for kidney stones

72

triple regimen

3 drugs used congruiently

73

which drug categories are used in the triple regimen

either H2RA and 2 Abx, or PPI and 2 ABx

74

how does an H2Ra work

block receptor for histamine binding. Normally histamine binding -> facilitates acid sec

75

common H2Ra's

zantac
tagamet

76

how does a PPI work

blocks release of H+ from protein pumps -> dec of HCl prod

77

what are the most common PPIs

Losec
Pariet
Nexium

78

what is the typical 1st line tx in triple regimen

Losec
Amoxicillan
Nexium

79

what is the typical 2nd line tx in triple regimen

Zantac
Amoxicillan
Biaxin

80

what is the normal course of an Abx in triple regmine

week - 10 days

81

what is the normal course of a PPI or H2Ra in triple regmin

weeks - months

82

when is sx used to treat PUD

if complications arise, usually do sx repair during endoscopy