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Pathophysiology - GI Dysfunction

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olanjones's version from 2017-01-29 17:52

M’s GI dysfunction

Question Answer
Anorexialack of desire to eat despite physiologic stimuli
Vomiting integration/activation integrated by medullary vomiting center, activated by:
- direct activation: irritants
-indirect activation: input from GI organs
-vestibular apparatus: motion sickness
-chemoreceptor trigger zone: drugs/toxins
-higher CNS centers that react to sights, sounds or smells
-directly: hypoxia (MI, CVA, ICP)
Projectile vomitingspontaneous vomiting not following nausea or retching
Dysphagia Msdifficulty swallowing, choking, coughing, ABN sensation of food stuck in throat or upper chest when swallow
Dysphagia P-mechanical:narrowing of esophagus ,
-functional: weakness of muscular structures to propel bolus, disruption neural networks coord swallowing mech
Achalasia Definition failure to relax incomplete relaxation of LES after swallowing. Food has difficulty passing into stomach; lower esophagus becomes distended
Achalasia Pdenervation/ABN innervation of LE, functional obstr of LES
Esophageal diverticulumout-pouching of es. Wall d/t weakness of muscularis lay or motility probs
Ms of esophageal diverticulumfood stops before reaches stomach, gurgling, belching, foul-smelling breath
Abdominal pain typesparietal, visceral, referred
Parietal painirritation of the peritoneal lining.
-More severe pain
-Easily localized
-The pain is usually sharp, constant and on one side or the other
Visceral paindirectly related to the organ involved.
-Less severe pain
-Poorly localized
-The pain is usually dull or aching and constant or intermittent
Referred painvisceral pain that is felt in another area of the body and occurs when organs share a common nerve pathway
-More severe pain
-Easily localized
-The pain is usually sharp, constant and on one side or the other
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GI bleeding

Question Answer
Upper GI bleeding-frank hematemesis
-esophageal varices, stomach, duodenum
Lower GI bleedingbelow ligament of Treitz or bleeding from jejunum, ileum, colon, rectum
Hematocheziafresh blood through the anus, usually in or with stools; common with lower GI bleeds. Common w/diverticulosis and hemorrhoids
Melenadark, red tarry stool, large volumes of blood lost
Occult bleedingcan’t see it in stools, bleeds in higher portions of colon and sm ints
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GI disorders

Question Answer
Hiatal hernia typessliding/axial and paraesophageal
Pyloric obstruction defblocking or narrowing of opening betw stomach and duodenum. Acquired or congenital.
Pyloric obstruction M-Epigastric pain and fullness
-Nausea
-Succussion splash
-Vomiting
-With a prolonged obstruction, malnutrition, dehydration, and extreme debilitation
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GERD

Question Answer
GERD def- reflux of chyme from the stomach to the esophagus
- if causes ifmammation of esophagus = reflux esophagitis
GERD PRefluxate → esophageal mucosa injury
GERD Et-mechanical: hiatal hernia, inc abdominal pressure (obesity, pregnancy[relaxin effects also], delayed gastric emptying), inc gastric volume
-agents (decrease tone of LES): ETOH, chocolate, fatty foods, smoking, caffeine, CNS depressants
GERD M- heartburn 30-60min after meal, belching, dysphagia, sore throat, hoarseness, lump in throat
-chest pain, retrosternal and epigastric, may be confused with angina
- exacerbate: bending, reclining; palliate: sit upright
-oft at night
-respiratory symptoms: wheezing, chronic cough
GERD CplxCan lead to Barrett esophagus → adenocarcinoma
GERD Tx-change diet/lifestyle habits – avoid trigger foods/substances
-sleep w/head elevated
-weight loss
-antacids, H2-receptor antagonists, proton pump inhibitors
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Gastritis & Peptic ulcers

Question Answer
Chronic gastritis def-chronic inflammatory changes of gastric mucosa, no grossly visible lesions, atrophy glandular epithelium
-types: antral and fundal
Chronic Gastritis EtH. pylori most common, autoimmune (10%), chemical gastropathy (reflux duodenal contents)
Acute gastritis defacute, transitory inflammatory process. Usually self-limiting. Regeneration of mucosa with in several days
Acute Gastritis Et- #1 cause ETOH,
-aspirin
-bacterial toxins (staphylococcal enterotoxin
-corticosteroid drugs p.o. (X PG synthesis)
-uremia, CA chemotherapy, gastric radiation
Peptic ulcer def, types-A break or ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum
-types: Gastric ulcers tend to develop in the antral region of the stomach, adjacent to the acid-secreting mucosa of the body
normal or Duodenenum (most common)
- Acute and chronic
-Superficial - Erosions
-Deep – True ulcers
Peptic ulcer P- primary defect is an increased mucosal permeability to hydrogen ions
- Gastric secretion tends to be normal or less than normal
Peptic ulcer Et (6)-#1 H. pylori infection: toxins and enzymes that promote inflammation and ulceration
- Hypersecretion of stomach acid and pepsin
-#2Use of NSAIDs
-High gastrin levels
-Acid production by cigarette smoking
-stress (SNS stimulation)
Peptic ulcer Muncomplicated- burning, gnawing, cramplike pain, rhythmic; occurs when stomach is empty- betw meals or 1am/2am. Midline epigastric – may radiate to back or right shoulder; pain is periodic – occurs daily at intervals of weeks or months with remissions
Peptic ulcer Cplxhemorrhage, perforation, gastric outlet obstruction
Peptic ulcer Tx
Zollinger-Ellison syndrome def, P, Tx, Cmplxgastrin-secreting tumor (Gastrinoma) in small int + pancreas. Increased gastric acid production with ulceration, activation of intestinal lipase with low pH (impaired fat digestion, diarrhea). Tx: resection. Cmplx: CA – 2/3 malignant, 1/3 have metastasized by diagnosis.
Stress ulcer Etlarge surface area burns, trauma, sepsis, ARDS, severe liver failure, major surgery, critically ill w/ decreased GI motility, brain injury/trama
Stress ulcer defn, typespeptic ulcer that is related to severe illness, neural injury, or systemic trauma; often fundus, prox. duodenum
-types: ischemic/Curling, Cushing ulcers
Stress ulcer Pischemis, tissue acidosis, bile salts entering stomach
Stress ulcer Mpainless upper GI bleeding
Stress ulcer RFadmission to ICU
Stress ulcer TxH2 agonist, PPI: prevent and tx
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Inflammatory Bowel Disease

Question Answer
IBS Deffunctional gastrointestinal disorder with no specific structural or biochemical alterations as a cause of disease
IBS Et-Visceral hypersensitivity
-Abnormal intestinal motility and secretion
-Intestinal infection
-Overgrowth of small intestinal flora
-Food allergy/intolerance
Psychosocial factors
IBS M-recurrent abdominal pain and discomfort associated
-Can be diarrhea-predominant or constipation-predominant
-Alternating diarrhea/constipation, gas, bloating, and nausea
- Symptoms relieved with defecation and do not interfere with sleep
IBS RF-anxiety, depression, and chronic fatigue syndrome
-20-30 y/o, lactose intolerance
IBS Txcalm, slow bowel, decrease hypersensitivity, avoid problem foods
UC Def, locationChronic inflammatory disease that causes ulceration of the colonic mucosa; Sigmoid colon and rectum
UC Et-Infectious
-Immunologic (anticolon antibodies)
-Dietary
-Genetic (supported by family studies and identical twin studies)
UC M-Diarrhea (10 to 20/day)
-Bloody stools
-Cramping
-fissures common
-fluid loss
UC CmplxAn increased colon cancer risk demonstrated
UC TxBroad-spectrum antibiotics and steroids, Immunosuppressive agents, Surgery
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Crohn’s disease

Question Answer
Crohn’s disease Def, locationGranulomatous colitis, ileocolitis, or regional enteritis
-Idiopathic inflammatory disorder; affects any part of the digestive tract, from mouth to anus. Difficult to differentiate from ulcerative colitis
Crohn’s disease M- “skip lesions”
- Ulcerations can produce longitudinal and transverse inflammatory fissures that extend into the lymphatics
- Anemia may result from malabsorption of vitamin B12 and folic acid
- cobblestone appearance: fissures and crevices dev. Surrounded by areas of sumucosal edema
Crohn's Cmplxfistulas common, abdominal abscess, intestinal obstruction
Crohn’s RFwomen > men, 20-20 y/o
UC/Crohns shared M’sincreased inflammatory cells and release of cytokines:
- remmissions/exacerbations of diarrhea/fecal urgency, wt. loss
- systemic/syndromic M – arthritis of spine/SI, large jts arms+legs, inflam. of eye
- growth retardation peds
- blood disorders –anemia, hypercoaguability
- infl. Of bile duct – schlerosing cholangitis
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Question Answer
Diverticular disease Def- Diverticula - Herniations of mucosa through the muscle layers of the colon wall, especially the sigmoid colon
DiverticulosisAsymptomatic diverticular disease
DiverticulitisThe inflammatory stage of diverticulosis
Diverticular disease M- Diverticulosis oft asymptomatic, ill-defined lower abdominal discomfort, change in bowel habits (diarrhea/constip), bloating, flatulence
- Diverticulitis – LLQ pain, n/v, slight fever, elevated WBC count
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Question Answer
Appendicitis DefInflammation of the vermiform appendix
Appendicitis PObstruction, ischemia, increased intraluminal pressure, infection, ulceration, etc.
Appendicitis M- Epigastric and RLQ pain: vague->increasing, colicky->localized
- McBurney’s point focal pain
- spasm overlying muscle
- Rebound tendernes
- abrupt onse
- n/v 1-2 episodes at onsets
- fever, leukocytosis
Appendicitis RF20-30 y/o
Appendicitis Cmplxperitonitis, abscess, sepsis
Appendicitis Txsurgery
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Question Answer
Enterocolitis Etrotavirus, norovirus, adenoviruses
Enterocolitis DefIntestines attempt to get rid of the infectious agent, Exudate to dilute toxins
Enterocolitis PIntestines attempt to get rid of the infectious agent->
Exudate to dilute toxins->
Hypermotility ->
Vomiting->
Decreased intestinal function->
Food not absorbed->
Osmosis draws water into the bowel->
Osmotic (or explosive) diarrhea
Enterocolitis Mmild-moderate fever + vomiting, diarrhea, dehydration
Enterocolitis Txsupportive
Enterocolitis Vaccinesrotate, rotarix
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Pseudomembranous colitis
Question Answer
Def
P
M
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Bacterial enterocolitis
Question Answer
Def
P
M
RF
Cmplx
Tx
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Dysfunction of motility

 

Diarrhea
Question Answer
Noninflammatory
Inflammatory
Osmotic
Secretory
Motility
Diarrhea associated with what syndromesmalabsorption syndromes
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Question Answer
Constipation Def
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Intestinal obstruction
Question Answer
Def / types
P
M
RF
Cmplx
Tx
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Question Answer
Paralytic ileus
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Peritonitis
Question Answer
Def
P
M
RF
Cmplx
Tx
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Celiac
Question Answer
Def
P
M
RF
Cmplx
Tx
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Malabsorption syndromes

colorectal neoplasms

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Adenoma
Adenocarcinoma
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Hemmorhage Def
P
M
RF
Cmplx
Tx
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Postgastrostomy syndrome Def
P
M
RF
Cmplx
Tx
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Dumping syndrome Def
P
M
RF
Cmplx
Tx
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