Week 9 GI/GU

Question 1

Describe causes, pathophys and complications of GERD

Answer 1

• Acid comes up from stomach to esophagus
• Due to LES that doesn’t close right so the acid is able to come up and cause burning sensation
• At risk = being big (pregnancy or obesity), or hiatal hernia (upper part of stomach bulges out of diaphragm which leads to more acid coming up
• chocolate, coffee, soda, dairy, smoking, EtOH
• complications = aspiration pneumonia; the GERD can come up and go into lungs
• complications = esophageal cancer

Question 2

Describe the causes, pathophys, and complications of achalasia

Answer 2

• difficulty pushing food or liquid into the stomach
• involves the smooth muscle layer of the esophagus and the LES
• LES doesn’t fully relax and fails to open during swallowing making it difficult to push food down
• smooth muscle does not contract which allows food to get stuck
• caused is idiopathic but may be autoimmune or genetic
• may lead to esophageal cancer and Chagas disease

Question 3

Explain Mallory Weiss Syndrome

Answer 3

• failure to relax LES timely during retching

- severe retching (etOH; pregnancy)

Question 4

Explain Hiatal hernia

Answer 4

• herniation of stomach through diaphragm
• sliding = most common; when supine; associated with GERD
• paraoesophageal = stomach pouch slides out; can lead to ischemia

Question 5

Explain peptic ulcer disease

Answer 5

• break or ulceration in the protective mucosal lining of the stomach, esophagus, stomach or duodenum

Complication:

• acute hemorrhage
• peritonitis
• obstructions caused by edema, spasms or scar tissue

Question 6

Explain stress ulcer

Answer 6

• peptic ulcer related to severe illness, multisystem organ failure, or major trauma
• curling related to burn injuries
• cushing related to head trauma

Question 7

Explain ulcerative colitis

Answer 7

• colon and rectum; no skip lesions
• colon cancer is common
• bloody, mucousy stools
• peak between 15 to 25 years

Question 8

Explain Crohns

Answer 8

• all of GI tract; mouth to anus; skip lesions
• entire intestinal wall affected
• manifested by >5 stools (not bloody) per day and abdominal pain

Complications:
- perforations, fistulas, abscesses

Question 9

Explain infectious enterocolitis

Answer 9

• there can be viral (rotavirus) or bacterial infections

- bacterial = more severe and the two serious forms are e. coli and c. difficile

Question 10

Explain c. diff

Answer 10

• gram positive
• antibiotics are most common reason in the hospital for this
• muscle tone in colon can be lost at risk for perforation
• pseudomembranous colitis = life threatening form of c. diff

Question 11

Explain e. coli

Answer 11

• found in feces and contaminated milk of healthy dairy/beef cattle
• shigella toxins
• overactivation of platelets and excessive clotting so you’ll lose your clotting factor and spontaneously bleed

Question 12

Explain the three malabsorption syndromes

Answer 12

• Pancreatic insufficiency: sx = fatty stools and weight loss; pancreatic things related to causative factors (pancreatitis, pancreatic cancer, etc)
• Bile salts insufficiency: bile salts normally absorb fats but now they can’t; fatty stools, diarrhea, loss of DAKE (vitamins); caused by liver disease
• lactase insufficiency: can’t break down lactose into monosaccharides; sx = gas and osmotic diarrhea; cause is genetic

Question 13

What is the leading cause of acute liver failure

Answer 13

acetaminophen overdose (hepatotoxicity)

Question 14

Explain the pathophysiologic basis of the major symptoms of liver failure