Week 11: GI Flashcards
1
Q
DIGESTIVE SYSTEM
_________ ingested food and fluids
- Breaks them down into their units
- Controlled by enzymes
_______ necessary components
- Membrane transport mechanisms
- Mostly in ______________
A
Processes ingested food and fluids
- Breaks them down into their units
- Controlled by enzymes
Absorbs necessary components
- Membrane transport mechanisms
- Mostly in small intestine
2
Q
Oral cavity
-Initial phase of ___________ breakdown of food
—Mastication by teeth
-Initial chemical digestion
—_________________________ —starts chemical breakdown of carbohydrates
-Formation of bolus
A
-Initial phase of mechanical breakdown of food
—Mastication by teeth
-Initial chemical digestion
—Salivary amylase—starts chemical breakdown of carbohydrates
-Formation of bolus
3
Q
Pharynx
- _____________ (deglutition)
A
Swallowing
4
Q
Esophagus
- Closed except during ____________, skeletal muscle at superior end—
followed by smooth muscle
A
swallowing,
5
Q
STOMACH
Expansible muscular sac—acts as ____________ for food and fluid
_________ smooth muscle layers
Constant mixing and churning of food
A
Expansible muscular sac—acts as reservoir for food and fluid
Three smooth muscle layers
Constant mixing and churning of food
6
Q
STOMACH
Initial digestion of proteins
- By _________
- Formed by combination of pepsinogen and HCl
Production of _________ factor
- Essential for absorption of vitamin B12 in the ileum
Formation of chyme
Absorption of small and lipid-soluble molecules
A
Initial digestion of proteins
- By pepsin
- Formed by combination of pepsinogen and HCl
Production of intrinsic factor
- Essential for absorption of vitamin B12 in the ileum
Formation of chyme
Absorption of small and lipid-soluble molecules
7
Q
LIVER
“_________ factory” of the body
Receives blood from hepatic portal vein
- Transport of nutrients from intestine to liver
Hepatocytes store _________
- Play role in carbohydrate, protein, fat metabolism
Production of plasma proteins and clotting factors
Breakdown of old and damaged _________
_______ production
A
“Metabolic factory” of the body
Receives blood from hepatic portal vein
- Transport of nutrients from intestine to liver
Hepatocytes store nutrients
- Play role in carbohydrate, protein, fat metabolism
Production of plasma proteins and clotting factors
Breakdown of old and damaged erythrocytes
Bile production
8
Q
PANCREAS
Exocrine pancreas arranged in _________
Secretes digestive _________, electrolytes
- Trypsin, Chymotrypsin, Carboxypeptidase, Ribonuclease, Pancreatic amylase, Bicarbonate ions
Pancreatic duct joins bile duct to enter duodenum
A
Exocrine pancreas arranged in lobules
Secretes digestive enzymes, electrolytes
- Trypsin, Chymotrypsin, Carboxypeptidase, Ribonuclease, Pancreatic amylase, Bicarbonate ions
Pancreatic duct joins bile duct to enter duodenum
9
Q
Small intestine
- Duodenum, jejunum, ileum
- Villi (folds of the mucosa) and microvilli (folds of cell membranes)
– Increase surface area for ___________ - Major site for _____________ of nutrients
- Lacteal—lymphatic vessel
- Site of production of:
–_______
– Enterokinase, peptidases, nucleosidases, lipase, sucrase, maltase,
lactase, cholecystokinin (hormone)
A
- Duodenum, jejunum, ileum
- Villi (folds of the mucosa) and microvilli (folds of cell membranes)
– Increase surface area for absorption - Major site for absorption of nutrients
- Lacteal—lymphatic vessel
- Site of production of:
–Mucus
– Enterokinase, peptidases, nucleosidases, lipase, sucrase, maltase,
lactase, cholecystokinin (hormone)
10
Q
Large intestine
- ______ patches (lymphatic tissue)
- Resident normal flora
- Breakdown of certain food materials
-Vitamin ___ synthesis by bacteria - Fluid and electrolyte ______________
- Formation of solid feces
- Mass movements
A
- Peyer patches (lymphatic tissue)
- Resident normal flora
- Breakdown of certain food materials
-Vitamin K synthesis by bacteria - Fluid and electrolyte reabsorption
- Formation of solid feces
- Mass movements
11
Q
NEURAL AND HORMONAL CONTROLS
Parasympathetic nervous system (PNS)
- Primarily through vagus nerve (cranial nerve [CN] X)
- Increased ______________ and ______________
A
- Primarily through vagus nerve (cranial nerve [CN] X)
- Increased motility & secretions
12
Q
NEURAL AND HORMONAL CONTROLS
Sympathetic nervous system (SNS)
-Stimulated by factors such as _______________
- _________ gastrointestinal activity
- Causes vasoconstriction
- _____________ secretions and regeneration of epithelial cells
A
-Stimulated by factors such as fear, anger
- Inhibits gastrointestinal activity
- Causes vasoconstriction
- Reduced secretions and regeneration of epithelial cells
13
Q
Facial (CN VII) and glossopharyngeal (CN IX) nerves
- Maintain continuous flow of _______________
A
saliva in mouth
14
Q
Stomach empties within _______ hours after meal.
A
2 to 6
15
Q
Gastrin
- Secreted by mucosal cells (stomach) in response to ___________ of stomach or partially digested substances
- Increases gastric motility, relaxes pyloric and ileocecal sphincters— promotes _________________________
A
- Secreted by mucosal cells (stomach) in response to distention of stomach or partially digested substances
- Increases gastric motility, relaxes pyloric and ileocecal sphincters— promotes stomach emptying
16
Q
Histamine
- Increased secretion of ____________________
A
hydrochloric acid
17
Q
Secretin
- Decreases ____________ secretions
A
gastric
18
Q
Cholecystokinin
-Inhibits gastric emptying; stimulates contraction of ______________
A
gallbladder
19
Q
Carbohydrates
- Digestion starts in ______
- Followed by digestion in the ______ intestine
A
- Digestion starts in mouth
- Followed by digestion in the small intestine
20
Q
Proteins
- Digestion starts in _________, continues in small intestine
A
stomach,
21
Q
Lipids
- Emulsified by ______ prior to chemical breakdown
-Action of __________ form monoglycerides and free fatty acids
- Formation of chylomicrons
A
- Emulsified by bile prior to chemical breakdown
-Action of enzymes form monoglycerides and free fatty acids - Formation of chylomicrons
22
Q
Fat-soluble vitamins
- Vitamins _______________
- Absorbed with fats
A
A, D, E, K
23
Q
Water-soluble vitamins
- Vitamins B and C—diffuse into:
A
blood
24
Q
Electrolytes
- Absorbed by active transport or ____________
A
diffusion
25
Drugs are primarily absorbed in the _____________
- Various transport mechanisms
- Some (e.g., aspirin) absorbed in the stomach
intestine.
26
Water
- Absorbed primarily by __________
-About 700 mL of water is secreted into the digestive tract each day.
- About 2300 mL is ingested in food and fluids
- Only 50 to 200 mL leaves the body in feces.
-Severe vomiting or diarrhea will interrupt this ___________ mechanism.
- - - Affects fluid and electrolyte balance of body
- Absorbed primarily by osmosis
-About 700 mL of water is secreted into the digestive tract each day.
- About 2300 mL is ingested in food and fluids
- Only 50 to 200 mL leaves the body in feces.
-Severe vomiting or diarrhea will interrupt this recycling mechanism.
- Affects fluid and electrolyte balance of body
27
ANOREXIA, NAUSEA, VOMITING, AND BULIMIA
May be signs of digestive disorder or other condition elsewhere in the body
- Systemic infection, Uremia, Emotional responses, Motion sickness, Pressure in the brain, Overindulgence of food, drugs, Pain
-Can cause serious complications: _________________________________
Dehydration, acidosis, malnutrition
28
Nausea
-____________, _____________ feeling
- Simulated by distention, irritation, inflammation of digestive tract
-Also stimulated by smells, visual images, pain, and chemical toxins and/or drugs
-Unpleasant subjective feeling
- Simulated by distention, irritation, inflammation of digestive tract
-Also stimulated by smells, visual images, pain, and chemical toxins and/or drugs
29
Vomiting (emesis)
- Vomiting center located in the ___________
~Coordinates activities involved in vomiting
~Protects airway during vomiting
- Forceful expulsion of __________ from stomach
~Sometimes includes ________ from intestine
- Vomiting center located in the medulla
-Coordinates activities involved in vomiting
-Protects airway during vomiting
- Forceful expulsion of chyme from stomach
-Sometimes includes bile from intestine
30
Bulimia—eating disorder
Damage to structures of the GI tract caused by recurrent vomiting
______________,
____________,
________________
- Oral mucosa
- Teeth
- Esophagus
31
Vomit
Presence of blood—_________________
- Coffee ground vomitus—brown granular material indicates action of HCl on hemoglobin
- Hemorrhage—red blood may be in vomitus
Yellow- or green-stained vomitus
- ______ from the duodenum
Deeper brown color
-May indicate content from _______ intestine
Recurrent vomiting of undigested food
- Problem with gastric ____________ or infection
Presence of blood—hematemesis
- Coffee ground vomitus—brown granular material indicates action of HCl on hemoglobin
- Hemorrhage—red blood may be in vomitus
Yellow- or green-stained vomitus
- Bile from the duodenum
Deeper brown color
-May indicate content from lower intestine
Recurrent vomiting of undigested food
- Problem with gastric emptying or infection
32
DIARRHEA
Excessive ____________ of stools
- Usually of loose or watery consistency
-May be acute or chronic
-Frequently with nausea and vomiting when infection or inflammation develops
-Prolonged diarrhea may lead to dehydration, ____________ imbalance, __________ , malnutrition
Excessive frequency of stools
- Usually of loose or watery consistency
-May be acute or chronic
-Frequently with nausea and vomiting when infection or inflammation develops
-Prolonged diarrhea may lead to dehydration, electrolyte imbalance, acidosis, malnutrition
33
COMMON TYPES OF DIARRHEA
Large-volume diarrhea (secretory or osmotic)
- Watery stool resulting from increased secretions into intestine from the plasma
- Often related to __________
- Limited reabsorption because of reversal of normal carriers for sodium and/or glucose
Small-volume diarrhea
- Often caused by ______________________
-Stool may contain blood, mucus, pus
- May be accompanied by abdominal cramps and tenesmus
Large-volume diarrhea (secretory or osmotic)
- Watery stool resulting from increased secretions into intestine from the plasma
- Often related to infection
- Limited reabsorption because of reversal of normal carriers for sodium and/or glucose
Small-volume diarrhea
- Often caused by inflammatory bowel disease
-Stool may contain blood, mucus, pus
- May be accompanied by abdominal cramps and tenesmus
34
Steatorrhea—“fatty diarrhea”
- Frequent bulky, _________________ stools
- Foul odor
- Characteristic of _________________ syndromes- Celiac disease, cystic fibrosis
- Fat usually the first dietary component affected
- Presence interferes with digestion of other nutrients.
- Abdomen often distended
- Frequent bulky, greasy, loose stools
- Foul odor
- Characteristic of malabsorption syndromes
- Celiac disease, cystic fibrosis
- Fat usually the first dietary component affected
- Presence interferes with digestion of other nutrients.
- Abdomen often distended
35
BLOOD IN STOOL may occur in normal stools with diarrhea, constipation, tumors, or an inflammatory condition.
Frank blood
- _____ blood—usually from lesions in rectum or anal canal
___________ blood
-Small hidden amounts, detectable with stool test
- May be caused by small bleeding ulcers
___________
- Dark-colored, tarry stool
- May result from significant bleeding in upper digestive tract
Frank blood
- Red blood—usually from lesions in rectum or anal canal
Occult blood
-Small hidden amounts, detectable with stool test
- May be caused by small bleeding ulcers
Melena
- Dark-colored, tarry stool
- May result from significant bleeding in upper digestive tract
36
GAS from swallowed air, such as drinking from ___________
-_____________ action on food
-Foods or alterations in motility
Excessive gas causes:
- Eructation
-Borborygmus
-Abdominal distention and pain
- Flatus
GAS from swallowed air, such as drinking from a straw
-Bacterial action on food
-Foods or alterations in motility
Excessive gas causes:
- Eructation
-Borborygmus
-Abdominal distention and pain
- Flatus
37
CAUSES OF CONSTIPATION
Weakness of ____________ muscle because of age or illness
Inadequate dietary _________
Inadequate _________ intake
Failure to respond to defecation reflex
Immobility
Neurological disorders
Drugs (i.e., opiates)
Some antacids, iron medications
Obstructions caused by tumors or strictures
Weakness of smooth muscle because of age or illness
Inadequate dietary fiber
Inadequate fluid intake
Failure to respond to defecation reflex
Immobility
Neurological disorders
Drugs (i.e., opiates)
Some antacids, iron medications
Obstructions caused by tumors or strictures
38
Burning sensation
- Inflammation and __________________ in upper digestive tract
Dull, aching pain
- Typical result of ____________ of liver capsule
_______________ or diffuse pain
- Inflammation, distention, stretching of intestines
Colicky, often severe pain
-Recurrent __________ muscle spasms or contraction
-Response to severe inflammation or obstruction
Burning sensation
- Inflammation and ulceration in upper digestive tract
Dull, aching pain
- Typical result of stretching of liver capsule
Cramping or diffuse pain
- Inflammation, distention, stretching of intestines
Colicky, often severe pain
-Recurrent smooth muscle spasms or contraction
-Response to severe inflammation or obstruction
39
MALNUTRITION May be limited to a specific nutrient or general
Causes of limited malnutrition—specific problem
- Vitamin _____ deficiency
- _____ deficiency
Causes of generalized malnutrition
- Chronic anorexia, vomiting, diarrhea
- Other systemic causes
- Chronic ______________________
- Cancer treatments
- Wasting syndrome
- Lack of available nutrients
Causes of limited malnutrition—specific problem
- Vitamin B12 deficiency
- Iron deficiency
Causes of generalized malnutrition
- Chronic anorexia, vomiting, diarrhea
- Other systemic causes
- Chronic inflammatory bowel disorders
- Cancer treatments
- Wasting syndrome
- Lack of available nutrients
40
Antacids
- To relieve ___________
Antiemetics
- To relieve ____________
Laxatives or enemas
- Treatment of acute _______________
Antidiarrheals
- Reduction of peristalsis
- Relieve __________
Antacids
- To relieve pyrosis
Antiemetics
- To relieve vomiting
Laxatives or enemas
- Treatment of acute constipation
Antidiarrheals
- Reduction of peristalsis
- Relieve cramps
41
Sulfasalazine
- Anti-inflammatory and antibacterial
- Used for acute episodes of ________________________
inflammatory bowel disease
42
Clarithromycin or azithromycin
-Effective against __________________ infection
- Usually combined with a proton pump inhibitor
Helicobacter pylori
43
Sucralfate
-________________
-Enhance gastric mucosal barrier against irritants such as nonsteroidal anti-inflammatory drugs (NSAIDs)
Coating agent
44
Anticholinergic drugs
- Reduce PNS activity
- Reduce ____________________
secretions and motility
45
Histamine 2 antagonists
- Useful for gastric ________
reflux
46
Proton pump inhibitors
- Reduce gastric ___________
secretion
47
Candidiasis
- Candida albicans—causative agent
-Often part of the resident flora
- _____________________
- Oral candidiasis (thrush)
-People receiving broad-spectrum antibiotics
- During and after cancer therapy
-Immunocompromised individuals or those with diabetes
- May appear as red, swollen areas
- May be irregular patches of a white curdlike material
Opportunistic organism
48
Herpes simplex type 1 infection
- Transmitted by _________________
- Virus remains __________ in sensory ganglion
- Activated by stress, trauma, other infection
- Formation of blister, ulcers, clear fluid release—contains virus; can be autoinoculated to other areas
- Lesions heal spontaneously in __________ days.
- Acute stage may be alleviated by antiviral medication.
- May spread to eyes- Conjunctivitis and keratitis
- Transmitted by kissing or close contact
- Virus remains dormant in sensory ganglion
- Activated by stress, trauma, other infection
- Formation of blister, ulcers, clear fluid release—contains virus; can be autoinoculated to other areas
- Lesions heal spontaneously in 7 to 10 days.
- Acute stage may be alleviated by antiviral medication.
- May spread to eyes- Conjunctivitis and keratitis
49
Syphilis
- Caused by Treponema pallidum
-May cause _____ lesions
- Highly contagious during first and second stages
Primary stage
- Chancre, a painless _____ on tongue, lip, palate
-Heals spontaneously (1 or 2 weeks)
Secondary stage
- Red macules or papules on palate—highly infectious
- Heals spontaneously
- Both stages treated with long-acting ___________
- Caused by Treponema pallidum
-May cause oral lesions
- Highly contagious during first and second stages
Primary stage
- Chancre, a painless ulcer on tongue, lip, palate
-Heals spontaneously (1 or 2 weeks)
Secondary stage
- Red macules or papules on palate—highly infectious
- Heals spontaneously
- Both stages treated with long-acting penicillin
50
Caries
-Streptococcus mutans—initiating microbe
- Lactobacillus follows in large numbers.
-Bacteria break down sugars and produce large quantities of lactic acid.
-Lactic acid dissolves mineral in tooth enamel
- Tooth erosion and caries formation
-Caries is promoted by frequent intake of __________________
-__________—anticaries treatment
-Streptococcus mutans—initiating microbe
- Lactobacillus follows in large numbers.
-Bacteria break down sugars and produce large quantities of lactic acid.
-Lactic acid dissolves mineral in tooth enamel
- Tooth erosion and caries formation
-Caries is promoted by frequent intake of sugars and acids.
-Fluoride—anticaries treatment
51
Gingivitis
- Inflammation of the gingiva
--Tissue becomes ____, soft, swollen, bleeds easily
-- May be a result of accumulated _____
- Inadequate oral hygiene
- Toothbrush trauma
--Results from improper or excessive ____________
-- Creates extensive grooving on tooth surface
-- Increase plaque retention and damage to gingivae
- Inflammation of the gingiva
--Tissue becomes red, soft, swollen, bleeds easily
-- May be a result of accumulated plaque
- Inadequate oral hygiene
- Toothbrush trauma
--Results from improper or excessive brushing
-- Creates extensive grooving on tooth surface
-- Increase plaque retention and damage to gingivae
52
Periodontal disease
-Infection and damage to the periodontal ligament and bone
-Predisposing condition is __________
-Caused by ____________ as a result of poor dental hygiene
- Subsequent loss of ________ possible
- Several categories, depending on degree of disease
- May be aggravated by systemic disease and medications that reduce salivary ___________
-Infection and damage to the periodontal ligament and bone
-Predisposing condition is gingivitis
-Caused by microorganisms as a result of poor dental hygiene
- Subsequent loss of teeth possible
- Several categories, depending on degree of disease
- May be aggravated by systemic disease and medications that reduce salivary secretions
53
-Periodontitis occurs when organisms enter the gingival ________________ and travel to the -connective tissues and bone of the dental arch.
-Resorption of bone and loss of ligament fibers result in weakened _____________ of teeth.
-May result in total loss of tooth from socket
-Treated by anti____________, local surgery of gingiva, and improved dental hygiene
-Periodontitis occurs when organisms enter the gingival blood vessels and travel to the -connective tissues and bone of the dental arch.
-Resorption of bone and loss of ligament fibers result in weakened attachment of teeth.
-May result in total loss of tooth from socket
-Treated by antimicrobials, local surgery of gingiva, and improved dental hygiene
54
Hyperkeratosis
-Leukoplakia (example)
- Whitish __________ or epidermal thickening of mucosa
- Occurs on buccal mucosa, palate, lower lip
- May be related to ___________ or chronic irritation
- Lesions require monitoring.
-Epithelial dysplasia beneath plaque may develop into __________________
-Leukoplakia (example)
- Whitish plaque or epidermal thickening of mucosa
- Occurs on buccal mucosa, palate, lower lip
- May be related to smoking or chronic irritation
- Lesions require monitoring.
-Epithelial dysplasia beneath plaque may develop into squamous cell carcinoma.
55
CANCER OF THE ORAL CAVITY
__________________ carcinoma—common type
Often develops in persons older than 40 years
- Smokers, preexisting leukoplakia, alcohol abuse
-Floor of the mouth, lateral borders of the tongue
- Multiple lesions possible
___________ sarcoma in patients with AIDS
Lip cancer has a better prognosis.
- Common in smokers, particularly pipe smokers
Squamous cell carcinoma—common type
Often develops in persons older than 40 years
- Smokers, preexisting leukoplakia, alcohol abuse
-Floor of the mouth, lateral borders of the tongue
- Multiple lesions possible
Kaposi sarcoma in patients with AIDS
Lip cancer has a better prognosis.
- Common in smokers, particularly pipe smokers
56
____________
- Inflammation of the salivary glands
- May be infectious or noninfectious
- Most commonly affected—parotid gland
Sialadenitis
57
Mumps—infectious parotitis
- ________ infection
- Vaccine ___________
- Viral infection
- Vaccine available
58
Noninfectious parotitis
- Often seen in older adults who lack adequate _________________ and mouth care
fluid intake
59
Most malignant tumor of salivary glands is __________________ carcinoma
mucoepidermoid
60
DYSPHAGIA - Difficulty swallowing
Causes
- ___________ deficit [Infection, Stroke, Brain damage, Achalasia]
- ______________ disorder [dystrophy]
- Mechanical obstruction [dystrophy]
Results and presentation
- ______ with swallowing
- Inability to swallow larger pieces of solid material
- Difficulty swallowing liquids
Causes
- Neurological deficit [Infection, Stroke, Brain damage, Achalasia]
- Muscular disorder [dystrophy]
- Mechanical obstruction [dystrophy]
Results and presentation
- Pain with swallowing
- Inability to swallow larger pieces of solid material
- Difficulty swallowing liquids
61
ESOPHAGEAL CANCER
Primarily _________________ carcinoma
Usually in __________ esophagus
Significant dysphagia in later stages
Poor _____________ because of late manifestations
Associated with chronic irritation because of:
- Chronic esophagitis
- Achalasia
- Hiatal hernia
-Alcohol abuse, smoking
Primarily squamous cell carcinoma
Usually in distal esophagus
Significant dysphagia in later stages
Poor prognosis because of late manifestations
Associated with chronic irritation because of:
- Chronic esophagitis
- Achalasia
- Hiatal hernia
-Alcohol abuse, smoking
62
HIATAL HERNIA - Part of the stomach protrudes into the thoracic cavity.
Sliding hernia
- More common type
- Portions of the stomach and gastroesophageal junction slide up above the ____________.
Rolling or paraesophageal hernia
- Part of the fundus of the stomach moves up through an enlarged or weak hiatus in the diaphragm and may become _________.
Sliding hernia
- More common type
- Portions of the stomach and gastroesophageal junction slide up above the diaphragm.
Rolling or paraesophageal hernia
- Part of the fundus of the stomach moves up through an enlarged or weak hiatus in the diaphragm and may become trapped.
63
HIATAL HERNIA (CONT.)
Food may _________ in pouch of the hernia
- Causes inflammation of the mucosa
- Reflux of food up the esophagus
- May cause chronic esophagitis
Signs
- ___________ or pyrosis
- Frequent __________
- Increased discomfort when laying down
- Substernal pain that may radiate to shoulder and jaw
Food may lodge in pouch of the hernia
- Causes inflammation of the mucosa
- Reflux of food up the esophagus
- May cause chronic esophagitis
Signs
- Heartburn or pyrosis
- Frequent belching
- Increased discomfort when laying down
- Substernal pain that may radiate to shoulder and jaw
64
GASTROESOPHAGEAL REFLUX DISEASE AKA GERD
-Periodic reflux of gastric contents into distal esophagus causes _________ and inflammation.
-Often seen in conjunction with ________ hernia
-Severity depends on competence of the lower esophageal sphincter.
-Delayed gastric ___________ may be a factor.
Avoidance of:
-Caffeine, fatty and spicy foods, alcohol, smoking, certain drugs
-Use of medication may reduce reflux and inflammation
-Periodic reflux of gastric contents into distal esophagus causes erosion and inflammation.
-Often seen in conjunction with hiatal hernia
-Severity depends on competence of the lower esophageal sphincter.
-Delayed gastric emptying may be a factor.
Avoidance of:
-Caffeine, fatty and spicy foods, alcohol, smoking, certain drugs
-Use of medication may reduce reflux and inflammation
65
GASTRITIS: ACUTE GASTRITIS
Gastric mucosa is inflamed.; May be ulcerated and bleeding
May result from
- Infection by ________________
- Allergies to foods
-Spicy or irritating foods
-Excessive alcohol intake
- Ingestion of aspirin or other NSAIDs
- Ingestion of corrosive or toxic substances
- Radiation or chemotherapy
Basic signs of gastrointestinal irritation
- Anorexia, nausea, vomiting may develop
- Hematemesis caused by bleeding
- Epigastric pain, cramps or general discomfort
- With infection, diarrhea may develop.
Acute gastritis is usually self-limiting.
-Complete regeneration of gastric mucosa
- Supportive treatment with prolonged vomiting
- May require treatment with ___________ drugs
May result from
- Infection by microorganisms
- Allergies to foods
-Spicy or irritating foods
-Excessive alcohol intake
- Ingestion of aspirin or other NSAIDs
- Ingestion of corrosive or toxic substances
- Radiation or chemotherapy
Basic signs of gastrointestinal irritation
- Anorexia, nausea, vomiting may develop
- Hematemesis caused by bleeding
- Epigastric pain, cramps or general discomfort
- With infection, diarrhea may develop.
Acute gastritis is usually self-limiting.
-Complete regeneration of gastric mucosa
- Supportive treatment with prolonged vomiting
- May require treatment with antimicrobial drugs
66
GASTRITIS: CHRONIC GASTRITIS - Characterized by __________ of stomach mucosa
- Loss of __________ glands
- Reduced production of intrinsic factor
-Helicobacter pylori infection is often present.
Signs may be ________
- Mild epigastric discomfort, anorexia, intolerance for certain foods
-Increased risk of peptic ulcers and gastric carcinoma
-Certain autoimmune disorders are associated with one type of chronic gastric atrophy.
Characterized by atrophy of stomach mucosa
- Loss of secretory glands
- Reduced production of intrinsic factor
-Helicobacter pylori infection is often present.
Signs may be vague.
- Mild epigastric discomfort, anorexia, intolerance for certain foods
-Increased risk of peptic ulcers and gastric carcinoma
-Certain autoimmune disorders are associated with one type of chronic gastric atrophy.
67
GASTRITIS: GASTROENTERITIS - Inflammation of ______________________
-Usually caused by _____________
-May also be caused by allergic reactions to food or drugs
-Microbes can be transmitted by fecally
-contaminated food, soil, and/or water
- Most infections are self-limiting.
- Serious illness may result in compromised host or virulent organisms.
- May cause epidemic outbreaks in refugee or disaster settings
- Safe sanitation essential for prevention
inflammation of stomach and intestine
-Usually caused by infection
-May also be caused by allergic reactions to food or drugs
-Microbes can be transmitted by fecally
-contaminated food, soil, and/or water
- Most infections are self-limiting.
- Serious illness may result in compromised host or virulent organisms.
- May cause epidemic outbreaks in refugee or disaster settings
- Safe sanitation essential for prevention
68
Although E. coli is usually harmless as a resident in the human intestine, __________________ can cause significant problems.
infective strains
69
PEPTIC ULCER: GASTRIC AND DUODENAL ULCERS
-Most caused by _______________ infection
-Usually occur in the proximal duodenum (duodenal ulcers)
-Also found in the antrum of the stomach (gastric ulcers)
-Development begins with breakdown of mucosal barrier
-Decreased ___________ defense
- More common in gastric ulcer development
- Increased acid secretion predominant factor in duodenal ulcers
-Most caused by H. pylori infection
-Usually occur in the proximal duodenum (duodenal ulcers)
-Also found in the antrum of the stomach (gastric ulcers)
-Development begins with breakdown of mucosal barrier
-Decreased mucosal defense
- More common in gastric ulcer development
- Increased acid secretion predominant factor in duodenal ulcers
70
PEPTIC ULCER: GASTRIC AND DUODENAL ULCERS (CONT.)
Damage to mucosal barrier predisposes to development of ulcers and is associated with:
-Inadequate _______ supply
--Caused by vasoconstriction (e.g., by stress, smoking, shock, circulatory impairment in older adults, scar tissue, anemia)
--Interferes with rapid regeneration of ____________
--Excessive glucocorticoid secretion or medication
-Ulcerogenic substances break down mucous layer.
--Aspirin, NSAIDs, alcohol
-Atrophy of gastric mucosa
--Chronic gastritis
Damage to mucosal barrier predisposes to development of ulcers and is associated with:
-Inadequate blood supply
--Caused by vasoconstriction (e.g., by stress, smoking, shock, circulatory impairment in older adults, scar tissue, anemia)
--Interferes with rapid regeneration of epithelium
--Excessive glucocorticoid secretion or medication
-Ulcerogenic substances break down mucous layer.
--Aspirin, NSAIDs, alcohol
-Atrophy of gastric mucosa
--Chronic gastritis
71
PEPTIC ULCER: GASTRIC AND DUODENAL ULCERS (CONT.)
Increased acid pepsin secretions
- Increased __________ secretion
- Increased _______ stimulation
- Increased sensitivity to vagal stimuli
- Increased number of acid pepsin secretory cells in the stomach (genetic anomaly)
- Increased stimulation of acid pepsin secretion
- Alcohol, caffeine, certain foods
- Interference with normal feedback mechanisms
- Rapid gastric emptying
- Increased gastrin secretion
- Increased vagal stimulation
- Increased sensitivity to vagal stimuli
- Increased number of acid pepsin secretory cells in the stomach (genetic anomaly)
- Increased stimulation of acid pepsin secretion
- Alcohol, caffeine, certain foods
- Interference with normal feedback mechanisms
- Rapid gastric emptying
72
Complications of peptic ulcer
- Hemorrhage
- Caused by __________ of blood vessels
- Common complication
- Perforation
- Ulcer erodes completely through the wall.
- Chyme can enter the peritoneal cavity.
- Results in chemical peritonitis
- ___________ may result later because of the formation of scar tissue
- Hemorrhage
- Caused by erosion of blood vessels
- Common complication
- May be the first sign of a peptic ulcer
- Perforation
- Ulcer erodes completely through the wall.
- Chyme can enter the peritoneal cavity.
- Results in chemical peritonitis
- Obstruction may result later because of the formation of scar tissue
73
PEPTIC ULCER:
Signs and symptoms
- Epigastric ___________ or localized pain, usually following stomach emptying
Diagnostic tests
-Fiberoptic endoscopy
- Barium x-ray
- Endoscopic biopsy
Treatment
- Combination of antimicrobial and ___________________ to eliminate H. pylori
- Reduction of exacerbating factors
Signs and symptoms
- Epigastric burning or localized pain, usually following stomach emptying
Diagnostic tests
-Fiberoptic endoscopy
- Barium x-ray
- Endoscopic biopsy
Treatment
- Combination of antimicrobial and proton pump inhibitor to eliminate H. pylori
- Reduction of exacerbating factors
74
STRESS ULCERS
Associated with severe _______ or systemic problems
- Burns, head injury
- Hemorrhage or sepsis
Rapid onset
- Multiple ulcers (usually gastric) may form within hours of precipitating mevent
- First indicator—______________ and severe pain
Associated with severe trauma or systemic problems
- Burns, head injury
- Hemorrhage or sepsis
Rapid onset
- Multiple ulcers (usually gastric) may form within hours of precipitating mevent
- First indicator—hemorrhage and severe pain
75
GASTRIC CANCER
Arises primarily in _________ glands
Mostly in the antrum or pyloric area
Early carcinoma
- Confined to mucosa and submucosa Later stages
- Involves muscularis
- Eventually invades serosa and spreads to __________________
Asymptomatic in the early stages
- Often, prognosis is poor on diagnosis
Arises primarily in mucous glands
Mostly in the antrum or pyloric area
Early carcinoma
- Confined to mucosa and submucosa Later stages
- Involves muscularis
- Eventually invades serosa and spreads to lymph nodes
Asymptomatic in the early stages
- Often, prognosis is poor on diagnosis
76
GASTRIC CANCER (CONT.)
-_____ seems to be a key factor, particularly smoked foods, nitrites, and nitrates.
-___________influences also play a role.
-Symptoms _________ until cancer is advanced.
- Reason for late diagnosis
- Surgery together with chemotherapy and radiation may relieve symptoms.
- Survival rate less than ____%
-Diet seems to be a key factor, particularly smoked foods, nitrites, and nitrates.
-Genetic influences also play a role.
-Symptoms vague until cancer is advanced.
- Reason for late diagnosis
- Surgery together with chemotherapy and radiation may relieve symptoms.
- Survival rate less than 20%
77
DUMPING SYNDROME
Control of gastric emptying is lost, and gastric contents are “dumped” into the _____________ without complete _____________; May follow gastric resection
Hyperosmolar chyme draws fluid from vascular compartment into intestine
- Intestinal distention
- Increased intestinal motility
- Decreased blood pressure → anxiety and syncope
Control of gastric emptying is lost, and gastric contents are “dumped” into the duodenum without complete digestion; May follow gastric resection
Hyperosmolar chyme draws fluid from vascular compartment into intestine
- Intestinal distention
- Increased intestinal motility
- Decreased blood pressure → anxiety and syncope
78
DUMPING SYNDROME Occurs during or shortly after meals
-Abdominal _________, nausea, diarrhea
-______________ 2 to 3 hours after meal
-High blood glucose levels in chyme stimulate increased insulin secretion → drop in blood glucose levels
-May be resolved by _______ changes; Frequent small meals—high protein, low simple carb
-Often resolves over time
-Abdominal cramps, nausea, diarrhea
-Hypoglycemia 2 to 3 hours after meal
-High blood glucose levels in chyme stimulate increased insulin secretion → drop in blood glucose levels
-May be resolved by dietary changes
-Frequent small meals—high in protein, low in simple carbohydrates
-Often resolves over time
79
PYLORIC STENOSIS
Narrowing and obstruction of ________________
May be developmental anomaly
Signs appear within several weeks after birth.
- Projectile ____________ immediately after feeding
- Firm mass can be palpated at pylorus.
- Infant fails to gain weight, dehydration, persistent hunger
Surgery required to remove obstruction.
May be acquired later in life
- Persistent feeling of _________
- Increased incidence of vomiting
Narrowing and obstruction of pyloric sphincter
May be developmental anomaly
Signs appear within several weeks after birth.
- Projectile vomiting immediately after feeding
- Firm mass can be palpated at pylorus.
- Infant fails to gain weight, dehydration, persistent hunger
Surgery required to remove obstruction.
May be acquired later in life
- Persistent feeling of fullness
- Increased incidence of vomiting
80
Cholelithiasis
-Formation of ____________
- Solid material (calculi) that form in bile
-Formation of gallstones
- Solid material (calculi) that form in bile
81
Cholecystitis
- Inflammation of ______________ and cystic duct
gallbladder
82
Cholangitis
- Inflammation related to infection of ____________
bile ducts
83
Choledocholithiasis
- Obstruction of the biliary tract by _______________
gallstones
84
Gallstones vary in size and shape.
Form in bile ducts, gallbladder, or cystic duct
May consist of:
- ____________ or bile pigment
- Mixed content with calcium salts
Small stones
- May be silent and excreted in ______
Larger stones
- Obstruct flow of ______ in cystic or common bile ducts; cause severe pain, which is often referred to subscapular area
May consist of:
- Cholesterol or bile pigment
- Mixed content with calcium salts
Small stones
- May be silent and excreted in bile
Larger stones
- Obstruct flow of bile in cystic or common bile ducts; cause severe pain, which is often referred to subscapular area
85
Risk factors for gallstones
-________ twice as likely to develop stones
-High _____________ in bile
- High _____________ intake
- Obesity
- Multiparity
-Use of __________________ or estrogen supplements
- Hemolytic anemia
- Alcoholic cirrhosis
-Biliary tract infection
- Women twice as likely to develop stones
-High cholesterol in bile
- High cholesterol intake
- Obesity
- Multiparity
-Use of oral contraceptives or estrogen supplements
- Hemolytic anemia
- Alcoholic cirrhosis
-Biliary tract infection
86
Obstruction of a duct by a large calculi
- Sudden severe waves of pain
- Radiating ______
- Nausea and vomiting usually present
- Pain continues, and __________ develops.
- Bile backs up into the liver and blood.
- Risk of ruptured gallbladder if obstruction persists
- Pain decreases if stone moves into duodenum
-____________ intervention may be necessary.
- May be removed using laparoscopic surgery
- Low-fat diet necessary following surgery
- Sudden severe waves of pain
- Radiating pain
- Nausea and vomiting usually present
- Pain continues, and jaundice develops.
- Bile backs up into the liver and blood.
- Risk of ruptured gallbladder if obstruction persists
- Pain decreases if stone moves into duodenum
-Surgical intervention may be necessary.
- May be removed using laparoscopic surgery
- Low-fat diet necessary following surgery
87
JAUNDICE
Prehepatic jaundice
- Result of excessive destruction of __________________
- Characteristic of hemolytic anemias or transfusion reactions
Intrahepatic jaundice
- Occurs with disease or damage to ________________
- Hepatitis or cirrhosis
Posthepatic jaundice
- Caused by obstruction of ________________ into gallbladder or duodenum
- Tumor, cholelithiasis
Prehepatic jaundice
- Result of excessive destruction of red blood cells
- Characteristic of hemolytic anemias or transfusion reactions
Intrahepatic jaundice
- Occurs with disease or damage to hepatocytes
- Hepatitis or cirrhosis
Posthepatic jaundice
- Caused by obstruction of bile flow into gallbladder or duodenum
- Tumor, cholelithiasis
88
Direct or conjugated bilirubin can be measured in the ________
Total bilirubin is measured in blood.
Total bilirubin minus direct bilirubin = indirect or _____________ bilirubin.
Direct or conjugated bilirubin can be measured in the blood.
Total bilirubin is measured in blood.
Total bilirubin minus direct bilirubin = indirect or unconjugated bilirubin.
89
Type of jaundice indicated by increase in serum bilirubin level and changes in stools
Prehepatic jaundice
- Unconjugated bilirubin level __________
Intrahepatic jaundice
- Both unconjugated and conjugated bilirubin levels may be _________
Posthepatic jaundice
- __________ conjugated bilirubin level
- Light-colored stool caused by absence of bile
Prehepatic jaundice
- Unconjugated bilirubin level elevated
Intrahepatic jaundice
- Both unconjugated and conjugated bilirubin levels may be elevated.
Posthepatic jaundice
- Increased conjugated bilirubin level
- Light-colored stool caused by absence of bile
90
HEPATITIS - Inflammation of the liver
Alcoholic
- ______ liver
Idiopathic
- Fatty liver
Viral hepatitis
- Local _____________
Infection elsewhere in body
- Examples—infectious mononucleosis or amebiasis Chemical or drug toxicity
Alcoholic
- Fatty liver
Idiopathic
- Fatty liver
Viral hepatitis
- Local infection
Infection elsewhere in body
- Examples—infectious mononucleosis or amebiasis Chemical or drug toxicity
91
VIRAL HEPATITIS
Cell injury results in inflammation and ____________ in the ________
- Degrees of inflammation and damage vary.
Liver is edematous and tender.
Causative viruses
- Hepatitis A virus (HAV)
- Hepatitis B virus (HBV)
-Hepatitis C virus (HCV)
-Hepatitis D virus (HDV)
- Hepatitis E virus (HEV)
Cell injury results in inflammation and necrosis in the liver.
- Degrees of inflammation and damage vary.
Liver is edematous and tender.
92
Hepatitis A (HAV)
- Small _____ virus
- Infectious hepatitis
- Transmitted by ___________ route in areas of inadequate sanitation or hygiene
-Often from contaminated water or shellfish
- Sexual transmission has occurred during _____ intercourse.
- Acute but self-limiting infection
- No carrier or chronic state
- Fecal shedding of virus before onset of signs
- Vaccine available for travelers, food care workers, and health care workers
- Small RNA virus
- Infectious hepatitis
- Transmitted by fecal-oral route in areas of inadequate sanitation or hygiene
-Often from contaminated water or shellfish
- Sexual transmission has occurred during anal intercourse.
- Acute but self-limiting infection
- No carrier or chronic state
- Fecal shedding of virus before onset of signs
- Vaccine available for travelers, food care workers, and health care workers
93
Hepatitis B (HBV)
- Partially double-stranded ____ virus
- Over 50% of _____-positive patients are positive for HBV.
- 50% of patients are asymptomatic but contagious because of carrier state.
- Chronic inflammation can occur.
- Transmission primarily by infected blood
- Sexual transmission has been noted.
-Tattooing and body piercing may transmit the virus.
- Vaccine available, routinely given to children
- Partially double-stranded DNA virus
- Over 50% of HIV-positive patients are positive for HBV.
- 50% of patients are asymptomatic but contagious because of carrier state.
- Chronic inflammation can occur.
- Transmission primarily by infected blood
- Sexual transmission has been noted.
-Tattooing and body piercing may transmit the virus.
- Vaccine available, routinely given to children
94
Hepatitis C (HCV)
- Single-stranded ___ virus
-Most common type transmitted by ________ transfusion
- May exist in a carrier state
- About ____% of patients enter the chronic state.
-Increases risk of hepatocellular carcinoma
- Treated with interferon injections
- Single-stranded RNA virus
-Most common type transmitted by blood transfusion
- May exist in a carrier state
- About 50% of patients enter the chronic state.
-Increases risk of hepatocellular carcinoma
- Treated with interferon injections
95
Hepatitis D (HDV)
- Also called _______ virus
- Incomplete RNA virus
- Requires ______ to replicate and produce active infection
- HDV infection increases severity of HBV infection
- Transmitted by blood
- Also called delta virus
- Incomplete RNA virus
- Requires HBV to replicate and produce active infection
- HDV infection increases severity of HBV infection
- Transmitted by blood
96
Hepatitis E (HEV)
-single stranded _____ virus
- Transmitted by oral-fecal route
- No chronic or carrier state
-single stranded RNA virus
- Transmitted by oral-fecal route
- No chronic or carrier state
97
VIRAL HEPATITIS: SIGNS AND SYMPTOMS
Preicteric stage
- Fatigue and malaise
- Anorexia and nausea
- General muscle aching
Icteric stage
- Onset of __________
- Stools light in color, urine becomes darker
- ________ tender and enlarged, mild aching pain
Posticteric stage— __________ stage
- Reductions in signs
- Weakness persists for weeks
Preicteric stage
- Fatigue and malaise
- Anorexia and nausea
- General muscle aching
Icteric stage
- Onset of jaundice
- Stools light in color, urine becomes darker
-Liver tender and enlarged, mild aching pain
Posticteric stage—recovery stage
- Reductions in signs
- Weakness persists for weeks
98
VIRAL HEPATITIS (CONT.)
Only body defense is formation of antibodies via vaccination
Supportive measures
- Rest, diet high in __________, carbohydrate, and vitamins
Chronic hepatitis can be treated with ___________
- Decreases viral replication
- Effective in only 30% to 40% of individuals
- Drug combination (slow-acting interferon plus antiviral drug) more effective
Only body defense is formation of antibodies via vaccination
Supportive measures
- Rest, diet high in protein, carbohydrate, and vitamins
Chronic hepatitis can be treated with interferon.
- Decreases viral replication
- Effective in only 30% to 40% of individuals
- Drug combination (slow-acting interferon plus antiviral drug) more effective
99
TOXIC OR NONVIRAL HEPATITIS
Variety of hepatotoxins can cause inflammation and necrosis of the ______
Drugs include:
- Acetaminophen, halothane, phenothiazines, tetracycline
- Chemicals include: Carbon tetrachloride (not used currently), toluene, ethanol
Direct effect of _______
May result from sudden exposure to large amounts or from lower dose and long-term exposure
Variety of hepatotoxins can cause inflammation and necrosis of the liver.
Drugs include:
- Acetaminophen, halothane, phenothiazines, tetracycline
- Chemicals include: Carbon tetrachloride (not used currently), toluene, ethanol
Direct effect of toxins
May result from sudden exposure to large amounts or from lower dose and long-term exposure
100
CIRRHOSIS - Progressive destruction of the liver
Causes
- _____________ liver disease
- Biliary cirrhosis
- Associated with ___________ disorders
- Postnecrotic cirrhosis
- Linked with chronic hepatitis or long-term exposure to toxic materials
- Metabolic
- Usually caused by ___________ metabolic storage disorders
- Alcoholic liver disease
- Biliary cirrhosis
- Associated with immune disorders
- Postnecrotic cirrhosis
- Linked with chronic hepatitis or long-term exposure to toxic materials
- Metabolic
- Usually caused by genetic metabolic storage disorders
101
CIRRHOSIS (CONT.)
Extensive diffuse fibrosis
- Interferes with _______ supply
- Bile may back up.
Loss of ___________ organization
Degenerative changes may be asymptomatic until disease is well advanced.
Liver biopsy and serologic test to determine cause and extent of damage
Extensive diffuse fibrosis
- Interferes with blood supply
- Bile may back up.
Loss of lobular organization
Degenerative changes may be asymptomatic until disease is well advanced.
Liver biopsy and serologic test to determine cause and extent of damage
102
CIRRHOSIS: ALCOHOLIC LIVER DISEASE
Initial stage—fatty liver
- _____________ of the liver
- Asymptomatic and reversible with reduced alcohol intake
Second stage—alcoholic hepatitis
-Inflammation and cell __________
- Fibrous tissue formation—irreversible change
Third stage—end-stage cirrhosis
-__________ tissue replaces normal tissue.
- Little normal function remains.
Initial stage—fatty liver
- Enlargement of the liver
- Asymptomatic and reversible with reduced alcohol intake
Second stage—alcoholic hepatitis
-Inflammation and cell necrosis
- Fibrous tissue formation—irreversible change
Third stage—end-stage cirrhosis
-Fibrotic tissue replaces normal tissue.
- Little normal function remains.
103
FUNCTIONAL LOSSES WITH CIRRHOSIS
Decreased removal and conjugation of ___________
Decreased production of ______
Impaired digestion and absorption of __________
Decreased production of blood-clotting factors
Impaired glucose and glycogen metabolism
Impaired conversion of ammonia to urea
Decreased removal and conjugation of bilirubin
Decreased production of bile
Impaired digestion and absorption of nutrients
Decreased production of blood-clotting factors
Impaired glucose and glycogen metabolism
Impaired conversion of ammonia to urea
104
FUNCTIONAL LOSSES WITH CIRRHOSIS (CONT.)
Decreased inactivation of ____________and drugs
- Drug dosages must be carefully monitored to avoid toxicity.
Decreased removal of toxic substances
Reduction of bile entering the intestine
- Impairs digestion and absorption
Backup of ______ in the liver
- Leads to obstructive jaundice
Blockage of blood flow through the liver
- Leads to portal hypertension
Congestion in the ________
- Increases hemolysis
Inadequate storage of iron and vitamin B12
Congestion in intestinal walls and stomach
- Impairing digestion and absorption
Development of esophageal varices
- Hemorrhage
Development of ascites, an accumulation of fluid in the peritoneal cavity
- Causes abdominal distention and pressure
Decreased inactivation of hormones and drugs
- Drug dosages must be carefully monitored to avoid toxicity.
Decreased removal of toxic substances
Reduction of bile entering the intestine
- Impairs digestion and absorption
Backup of bile in the liver
- Leads to obstructive jaundice
Blockage of blood flow through the liver
- Leads to portal hypertension
Congestion in the spleen
- Increases hemolysis
Inadequate storage of iron and vitamin B12
Congestion in intestinal walls and stomach
- Impairing digestion and absorption
Development of esophageal varices
- Hemorrhage
Development of ascites, an accumulation of fluid in the peritoneal cavity
- Causes abdominal distention and pressure
105
CIRRHOSIS
Initial manifestations often ________________
- Fatigue, anorexia, weight loss, anemia, diarrhea
- Dull aching pain may be present in upper right abdominal quadrant.
Advanced cirrhosis
- Ascites and peripheral edema
- Increased bruising
- Esophageal varices
- May rupture, leading to ____________, circulatory shock
- Jaundice, encephalopathy
Initial manifestations often mild and vague
- Fatigue, anorexia, weight loss, anemia, diarrhea
- Dull aching pain may be present in upper right abdominal quadrant.
Advanced cirrhosis
- Ascites and peripheral edema
- Increased bruising
- Esophageal varices
- May rupture, leading to hemorrhage, circulatory shock
- Jaundice, encephalopathy
106
CIRRHOSIS: TREATMENT
Avoidance of ________ or specific cause
Supportive or symptomatic treatment
Dietary restrictions
Balancing serum electrolytes
Paracentesis
___________ to reduce intestinal flora
Emergency treatment if esophageal varices rupture
Liver transplantation
Avoidance of alcohol or specific cause
Supportive or symptomatic treatment
Dietary restrictions
Balancing serum electrolytes
Paracentesis
Antibiotics to reduce intestinal flora
Emergency treatment if esophageal varices rupture
Liver transplantation
107
LIVER CANCER
____________ carcinoma
- Most common primary tumor of liver
- More common in cirrhotic livers
Secondary or metastatic cancer
- Arises from areas served by the hepatic vein or spread along the peritoneal membranes
Initial signs are mild and general.
_____________ usually occurs with advanced stages
Chemotherapy, possible lobectomy or radiofrequency ablation
(RFA) procedure
Hepatocellular carcinoma
- Most common primary tumor of liver
- More common in cirrhotic livers
Secondary or metastatic cancer
- Arises from areas served by the hepatic vein or spread along the peritoneal membranes
Initial signs are mild and general.
Diagnosis usually occurs with advanced stages
Chemotherapy, possible lobectomy or radiofrequency ablation
(RFA) procedure
108
ACUTE PANCREATITIS
___________ of the pancreas
- Results in ______________ of the tissue
May be acute or chronic
- Acute form considered a medical emergency
Pancreas lacks a fibrous capsule
- Destruction may progress into tissue surrounding the pancreas
- Substances released by necrotic tissue lead to widespread inflammation
- Hypovolemia and circulatory collapse may follow.
Inflammation of the pancreas
- Results in autodigestion of the tissue
May be acute or chronic
- Acute form considered a medical emergency
Pancreas lacks a fibrous capsule
- Destruction may progress into tissue surrounding the pancreas
- Substances released by necrotic tissue lead to widespread inflammation
- Hypovolemia and circulatory collapse may follow.
109
ACUTE PANCREATITIS (CONT.)
Chemical peritonitis results in ___________ peritonitis.
-Septicemia may result.
- Adult respiratory distress syndrome and acute renal failure are possible complications.
Causes
- Gallstones
- ________ abuse
-Sudden onset may follow intake of large meal or large amount of alcohol
Chemical peritonitis results in bacterial peritonitis.
-Septicemia may result.
- Adult respiratory distress syndrome and acute renal failure are possible complications.
Causes
- Gallstones
-Alcohol abuse
-Sudden onset may follow intake of large meal or large amount of alcohol
110
ACUTE PANCREATITIS: SIGNS AND SYMPTOMS
Severe epigastric or abdominal pain radiating to the back—
primary symptoms
Signs of shock
- Caused by ___________
Low-grade fever until infection develops
-Body temperature may then rise significantly.
Abdominal __________ and decreased bowel sounds
-Decreased peristalsis and paralytic ileus
Severe epigastric or abdominal pain radiating to the back—
primary symptoms
Signs of shock
- Caused by hypovolemia
Low-grade fever until infection develops
-Body temperature may then rise significantly.
Abdominal distention and decreased bowel sounds
-Decreased peristalsis and paralytic ileus
111
ACUTE PANCREATITIS (CONT.)
Diagnostic tests
- Serum ___________ levels—first rise, then fall after 48 hours
-Serum lipid levels are elevated.
- Hypocalcemia
- Leukocytosis
Treatment
-_____________ is stopped.
- Treatment of shock and electrolyte imbalances
- Analgesics for pain relief
Diagnostic tests
- Serum amylase levels—first rise, then fall after 48 hours
-Serum lipid levels are elevated.
- Hypocalcemia
- Leukocytosis
Treatment
-Oral intake is stopped.
- Treatment of shock and electrolyte imbalances
- Analgesics for pain relief
112
PANCREATIC CANCER
Risk factors
-Smoking
- Pancreatitis and dietary factors
Adenocarcinoma—most _________ form
- Arises from the epithelial cells in the ducts
-Weight loss and jaundice early manifestations
-Frequently asymptomatic until well advanced
-Metastases occur early.
-Mortality is close to _____%
Risk factors
-Smoking
- Pancreatitis and dietary factors
Adenocarcinoma—most common form
- Arises from the epithelial cells in the ducts
-Weight loss and jaundice early manifestations
-Frequently asymptomatic until well advanced
-Metastases occur early.
-Mortality is close to 95%.
113
CELIAC DISEASE
_______________ syndrome
Primarily a childhood disorder
- May occur in adults in middle age
Appears to have __________ link
Defect in intestinal enzyme
- Prevents further digestion of gliadin (breakdown product of gluten)
- Toxic effect on intestinal villi—atrophy of villi
- Malabsorption and malnutrition result.
Malabsorption syndrome
Primarily a childhood disorder
- May occur in adults in middle age
Appears to have genetic link
Defect in intestinal enzyme
- Prevents further digestion of gliadin (breakdown product of gluten)
- Toxic effect on intestinal villi—atrophy of villi
- Malabsorption and malnutrition result.
114
CELIAC DISEASE (CONT.)
First signs appear when ________ are added.- At about 4 to 6 months of age
Manifestation
- Steatorrhea, muscle wasting, failure to gain weight
- Irritability and malaise common
Diagnosed by a series of blood tests
______________ diet for treatment
- Intestinal mucosa returns to normal after a few weeks without gluten intake.
First signs appear when cereals are added.- At about 4 to 6 months of age
Manifestation
- Steatorrhea, muscle wasting, failure to gain weight
- Irritability and malaise common
Diagnosed by a series of blood tests
Gluten-free diet for treatment
- Intestinal mucosa returns to normal after a few weeks without gluten intake.
115
CHRONIC INFLAMMATORY BOWEL DISEASE
-_______________ & __________________ are chronic inflammatory bowel diseases (IBDs).
-Causes __________
-___________ factor appears to be involved.
-Crohn’s disease—often during adolescence
-Ulcerative colitis—second or third decade
Many similarities between Crohn’s disease and ulcerative colitis
-Crohn’s disease and ulcerative colitis are chronic inflammatory bowel diseases (IBDs).
-Causes unknown
-Genetic factor appears to be involved.
-Crohn’s disease—often during adolescence
-Ulcerative colitis—second or third decade
Many similarities between Crohn’s disease and ulcerative colitis
116
CROHN’S DISEASE
May affect __________ of the digestive tract
- Usually ________ intestine affected
Inflammation occurs in characteristic distribution
- “______ lesions”—affected areas separated by areas of normal tissue
Progressive inflammation and fibrosis may cause obstructed areas.
- Damaged walls impair processing and absorption of food.
- Inflammation stimulates intestinal motility.
May affect any area of the digestive tract
- Usually small intestine affected
Inflammation occurs in characteristic distribution
- “Skip lesions”—affected areas separated by areas of normal tissue
Progressive inflammation and fibrosis may cause obstructed areas.
- Damaged walls impair processing and absorption of food.
- Inflammation stimulates intestinal motility.
117
CROHN’S DISEASE (CONT.)
Interference with digestion and ___________
- Hypoproteinemia, avitaminosis, malnutrition, possibly steatorrhea
Other complications
- Adhesions between loops may form and fistulas may develop.
Children
- Delayed growth and sexual maturation
_____________ used in treatment
Interference with digestion and absorption
- Hypoproteinemia, avitaminosis, malnutrition, possibly steatorrhea
Other complications
- Adhesions between loops may form and fistulas may develop.
Children
- Delayed growth and sexual maturation
Glucocorticoid used in treatment
118
ULCERATIVE COLITIS
Inflammation starts in the _________
Progresses through the _______
Mucosa and submucosa are inflamed.
- Tissue destruction interferes with absorption of fluid and electrolytes in colon.
Severe acute episodes—toxic megacolon may develop.
-Marked diarrhea, with up to ___ stools per day
- Contains blood and mucus; cramping pain
Inflammation starts in the rectum
Progresses through the colon
Mucosa and submucosa are inflamed.
- Tissue destruction interferes with absorption of fluid and electrolytes in colon.
Severe acute episodes—toxic megacolon may develop.
-Marked diarrhea, with up to 12 stools per day
- Contains blood and mucus; cramping pain
119
TREATMENT OF IBD Team approach
_________________ medications
- Sulfasalazine
- Glucocorticoids
-Antimotility agents
-Nutritional supplements
-Antimicrobials
-Immunotherapeutic agents
-Surgical __________ - Usually ileostomy or colostomy
Anti-inflammatory medications
- Sulfasalazine
- Glucocorticoids
-Antimotility agents
-Nutritional supplements
-Antimicrobials
-Immunotherapeutic agents
-Surgical resection - Usually ileostomy or colostomy
120
IRRITABLE BOWEL SYNDROME Types
- Abnormal gastrointestinal mobility and secretion
- Visceral _______________
- Postinfectious IBS
- Overgrowth of ______
- Food allergy or ______________
- Psychosocial factors
- Abnormal gastrointestinal mobility and secretion
- Visceral hypersensitivity
- Postinfectious IBS
- Overgrowth of flora
- Food allergy or intolerance
- Psychosocial factors
121
IRRITABLE BOWEL SYNDROME (IBS): MANIFESTATIONS AND DIAGNOSIS
- Lower abdominal _____
- Diarrhea
-Constipation, alternating with diarrhea
- Bloating, nausea
Diagnosis
- Based on signs and symptoms
- Testing for ______________
- Testing for bacterial or parasitic ___________
- No single cure for IBS
- Lower abdominal pain
- Diarrhea
-Constipation, alternating with diarrhea
- Bloating, nausea
Diagnosis
- Based on signs and symptoms
- Testing for food allergies
- Testing for bacterial or parasitic infections
- No single cure for IBS
122
APPENDICITIS: DEVELOPMENT
Obstruction of the appendiceal lumen
- By a fecalith, gallstone, or foreign material
_______ builds up inside the appendix.
- _______________ proliferate
Appendiceal wall becomes inflamed.
- Purulent exudate forms
- Appendix is ________
- Results in increased permeability
Obstruction of the appendiceal lumen
- By a fecalith, gallstone, or foreign material
Fluid builds up inside the appendix.
- Microorganisms proliferate
Appendiceal wall becomes inflamed.
- Purulent exudate forms
- Appendix is swollen.
- Results in increased permeability
123
APPENDICITIS: DEVELOPMENT (CONT.)
__________________ escape into surroundings.
-Leads to abscess formation or localized bacterial peritonitis
Abscess may develop when inflamed area is walled off.
- Inflammation and pain may temporarily subside.
Localized infection or peritonitis develops around the appendix.
- May spread along the peritoneal membranes
Bacteria and toxins escape into surroundings.
-Leads to abscess formation or localized bacterial peritonitis
Abscess may develop when inflamed area is walled off.
- Inflammation and pain may temporarily subside.
Localized infection or peritonitis develops around the appendix.
- May spread along the peritoneal membranes
124
APPENDICITIS: DEVELOPMENT (CONT.)
Increased necrosis and gangrene in the wall
-Caused by increasing _________ in the appendix
Appendix ruptures or perforates
-Release of _________ into peritoneal cavity
-Generalized peritonitis
- May be life-threatening
Treatment
- _________________ of appendix and antimicrobial drugs
Increased necrosis and gangrene in the wall
-Caused by increasing pressure in the appendix
Appendix ruptures or perforates
-Release of contents into peritoneal cavity
-Generalized peritonitis
- May be life-threatening
Treatment
- Surgical removal of appendix and antimicrobial drugs
125
APPENDICITIS: SIGNS AND SYMPTOMS
General periumbilical pain
- Related to the ______________
Nausea and vomiting common
Pain becomes severe and localized in lower right quadrant (LRQ).
- Involvement of parietal peritoneum over appendix
After rupture
- Pain _________ temporarily.
Pain recurs—severe, generalized abdominal pain and guarding
Low-grade fever and leukocytosis
- Development of inflammation
Boardlike abdomen, tachycardia, hypotension
- As peritonitis develops, abdominal wall muscles spasm.
- Toxins lead to reduced blood pressure.
General periumbilical pain
- Related to the inflammation
Nausea and vomiting common
Pain becomes severe and localized in lower right quadrant (LRQ).
- Involvement of parietal peritoneum over appendix
After rupture
- Pain subsides temporarily.
Pain recurs—severe, generalized abdominal pain and guarding
Low-grade fever and leukocytosis
- Development of inflammation
Boardlike abdomen, tachycardia, hypotension
- As peritonitis develops, abdominal wall muscles spasm.
- Toxins lead to reduced blood pressure.
126
DIVERTICULAR DISEASE
Development of diverticula
Diverticulum
- Outpouching (herniation) of the mucosa through the muscular layer of the colon
Diverticulosis
- ____________ diverticular disease
Diverticulitis
- ________________ of the diverticula
Diverticulum
- Outpouching (herniation) of the mucosa through the muscular layer of the colon
Diverticulosis
- Asymptomatic diverticular disease
Diverticulitis
- Inflammation of the diverticula
127
DIVERTICULAR DISEASE (CONT.)
Form at gaps between muscle layers
Congenital weakness of wall may be a factor
Weaker areas bulge when pressure increases.
Many cases are asymptomatic.
Diverticulitis stasis of material in diverticula leads to inflammation and infection.
- Cramping, tenderness, nausea, vomiting
- Slight fever and elevated white blood cell count
Treatment of diverticulitis
- _____________ drugs
- ____________ modifications to prevent stasis
Form at gaps between muscle layers
Congenital weakness of wall may be a factor
Weaker areas bulge when pressure increases.
Many cases are asymptomatic.
Diverticulitis stasis of material in diverticula leads to inflammation and infection.
- Cramping, tenderness, nausea, vomiting
- Slight fever and elevated white blood cell count
Treatment of diverticulitis
- Antimicrobial drugs
- Dietary modifications to prevent stasis
128
COLORECTAL CANCER
Most malignancies develop from adenomatous polyps.
Early diagnosis is essential.
Cancer occurs primarily in persons older than ___ years.
Risk factors
- Familial multiple polyposis
- Long-term ________________
- _____________ factors
- Environmental factors
- Diet low in _______
Most malignancies develop from adenomatous polyps.
Early diagnosis is essential.
Cancer occurs primarily in persons older than 50 years.
Risk factors
- Familial multiple polyposis
- Long-term ulcerative colitis
- Genetic factors
- Environmental factors
- Diet low in fiber
129
COLORECTAL CANCER (CONT.)
Initial signs depend largely on the location of the growth.
General signs
- Change in _________ habits
- Alternating diarrhea and constipation
-Bleeding
- Fatigue, weight loss, anemia
Treatment
- __________ removal with radiation and/or chemotherapy
General signs
- Change in bowel habits
- Alternating diarrhea and constipation
-Bleeding
- Fatigue, weight loss, anemia
Treatment
- Surgical removal with radiation and/or chemotherapy
130
INTESTINAL OBSTRUCTION
Lack of movement of intestinal contents through the intestine
- More common in _______intestine
Mechanical obstructions
- Result from tumors, adhesions, hernias, other _____________ obstructions
Functional or adynamic obstructions
- Result from impairment of peristalsis
- __________________ injury
- Paralytic ileus caused by toxins or electrolyte imbalance
Lack of movement of intestinal contents through the intestine
- More common in small intestine
Mechanical obstructions
- Result from tumors, adhesions, hernias, other tangible obstructions
Functional or adynamic obstructions
- Result from impairment of peristalsis
- Spinal cord injury
- Paralytic ileus caused by toxins or electrolyte imbalance
131
INTESTINAL OBSTRUCTION (CONT.)
Gases and fluids accumulate proximal to the blockage, _________ the intestine.
Increasingly strong contractions of proximal intestine
- Effort to move contents along
Pressure increases in _______
- More secretions enter the intestine.
- Compression of veins in wall
- Intestinal wall becomes edematous
- Prevention of absorption
Gases and fluids accumulate proximal to the blockage, distending the intestine.
Increasingly strong contractions of proximal intestine
- Effort to move contents along
Pressure increases in lumen.
- More secretions enter the intestine.
- Compression of veins in wall
- Intestinal wall becomes edematous
- Prevention of absorption
132
INTESTINAL OBSTRUCTION (CONT.)
Intestinal distention leads to persistent ____________
-Additional loss of fluid and electrolytes
- ___________ can result.
Intestinal wall becomes ischemic and necrotic.
- If obstruction is not removed, gangrene ensues.
Ischemia and necrosis → decreased innervation and cessation of
peristalsis
Paralytic ileus occurs if it is not a cause to begin with.
Intestinal distention leads to persistent vomiting.
-Additional loss of fluid and electrolytes
- Hypovolemia can result.
Intestinal wall becomes ischemic and necrotic.
- If obstruction is not removed, gangrene ensues.
Ischemia and necrosis → decreased innervation and cessation of
peristalsis
Paralytic ileus occurs if it is not a cause to begin with.
133
INTESTINAL OBSTRUCTION (CONT.)
Obstruction promotes rapid reproduction of intestinal _____________
- Some produce ____________
-Affected wall becomes necrotic and more permeable
- Bacteria and toxins leak into peritoneal cavity (peritonitis) or into blood (bacteremia and septicemia).
Perforation of the necrotic segment may occur.
- Generalized peritonitis and septic shock
Obstruction promotes rapid reproduction of intestinal bacteria.
- Some produce endotoxins.
-Affected wall becomes necrotic and more permeable
- Bacteria and toxins leak into peritoneal cavity (peritonitis) or into blood (bacteremia and septicemia).
Perforation of the necrotic segment may occur.
- Generalized peritonitis and septic shock
134
INTESTINAL OBSTRUCTION (CONT.)
Mechanical obstruction of small intestine
- __________ colicky abdominal pain
-Intermittent bowel sounds can be heard.
Paralytic ileus
- Pain is steady.
- Bowel sounds decrease or are absent.
Vomiting and abdominal ____________
- Occurs quickly with obstruction of small intestine
- Vomiting is recurrent, eventually with bile-stained content
Obstruction of the small intestine is a medical emergency!
Mechanical obstruction of small intestine
- Severe colicky abdominal pain
-Intermittent bowel sounds can be heard.
Paralytic ileus
- Pain is steady.
- Bowel sounds decrease or are absent.
Vomiting and abdominal distention
- Occurs quickly with obstruction of small intestine
- Vomiting is recurrent, eventually with bile-stained content
Obstruction of the small intestine is a medical emergency!
135
INTESTINAL OBSTRUCTION (CONT.)
Obstruction of large intestine
- Develops ___________ with mild signs
- Constipation
- Mild abdominal pain, followed by abdominal distention
- Anorexia, vomiting, more severe pain
Treatment
-Treatment of ____________________
- Fluid and electrolyte replacement
-Surgery and antimicrobial therapy
Obstruction of large intestine
- Develops slowly, with mild signs
- Constipation
- Mild abdominal pain, followed by abdominal distention
- Anorexia, vomiting, more severe pain
Treatment
-Treatment of underlying cause
- Fluid and electrolyte replacement
-Surgery and antimicrobial therapy
136
PERITONITIS - Inflammation of the peritoneal membranes
Chemical peritonitis may result from:
-___________ released with pancreatitis
- Urine leaking form a ruptured bladder
- Chyme spilled from a perforated ulcer
- ______ escaping from the ruptured gallbladder
- Blood
-Any other foreign material in the cavity
- Enzymes released with pancreatitis
- Urine leaking form a ruptured bladder
- Chyme spilled from a perforated ulcer
- Bile escaping from the ruptured gallbladder
- Blood
-Any other foreign material in the cavity
137
PERITONITIS (CONT.)
Bacterial peritonitis caused by:
- Direct ________ affecting the intestine
- Ruptured appendix
- Intestinal obstruction and gangrene
Any abdominal surgery
- If foreign ___________ is left or infection develops
Pelvic inflammatory disease in women
- When infection reaches the cavity through fallopian tubes
Bacterial peritonitis caused by:
- Direct trauma affecting the intestine
- Ruptured appendix
- Intestinal obstruction and gangrene
Any abdominal surgery
- If foreign material is left or infection develops
Pelvic inflammatory disease in women
- When infection reaches the cavity through fallopian tubes
138
PERITONITIS (CONT.)
Signs and symptoms
- Sudden, severe, generalized ___________ pain
-Localized tenderness at site of underlying problem
- Vomiting common, abdominal distention
- Dehydration, hypovolemia, low blood pressure
- Decreased blood pressure, tachycardia, fever, leukocytosis
Treatment
-Depends on ___________________
- Surgery might be required.
-Massive antimicrobial drugs—specific to causative organism
Signs and symptoms
- Sudden, severe, generalized abdominal pain
-Localized tenderness at site of underlying problem
- Vomiting common, abdominal distention
- Dehydration, hypovolemia, low blood pressure
- Decreased blood pressure, tachycardia, fever, leukocytosis
Treatment
-Depends on primary cause
- Surgery might be required.
-Massive antimicrobial drugs—specific to causative organism
