9.1A Pathophysiology - Gastrointestinal Function

Front 1

lack or loss of appetite or hunger

Back 1

Anorexia

Front 2

Difference between appetite & hunger

Back 2

Appetite is psychological, depending on memory and associations.
Hunger is the physiological need for food.

Front 3

The N/V mechanism is part of what nervous system

Back 3

involuntary autonomic nervous system

Front 4

Ice pica

Back 4

Pagophagia

Front 5

Flaking paint, clay, or hair pica

Back 5

Trichophagia

Front 6

Laundry starch pica

Back 6

Amylophagia

Front 7

compulsive eating of nunnutritive substances.

Back 7

Pica

Front 8

Pica occurence common with:

Back 8

- PG women
- some patients with iron or zinc deficiencies
- Children (beginning at age 2 leave by adolescence)

Front 9

Dirt pica

Back 9

Geophagia

Front 10

S&S of ______
- Intense fear of becoming obese that does not diminish as weight loss increases.
- Disturbance of body image - claim to feel fat.
- 25% weight loss or -> Protein, calorie malnutrition
- Refusal to maintain body weight
- NO known physical illness.
- Amenorrhea

Back 10

Anorexia Nervosa

Front 11

Refusal to eat, grossly distorted eating patterns

- loss of 25% of TBW
- Protein/calorie malnutrition

Back 11

Anorexia Nervosa

Front 12

Causes of ______
1) Psychological - rejecting behavior/reinforced by the attention it receives.
20 Endocrine disorder

Back 12

Anorexia Nervosa

Front 13

- Binge eating
- followed by self-induced vomiting or
- abuse of laxatives and/or diuretics

Back 13

Bulimarexia

Front 14

Binge eating without purging

Back 14

Bulimia

Front 15

S&S of ______
- Dental problems
- inflammation of the esophagus & fluid&electrolyte imbalances.

Back 15

Bulimarexia & Bulimia

Front 16

- Most prevalent childhood nutritional disorder
- Predictive of adult obesity
- Dieting is dangerous in children

Back 16

Childhood Obesity

Front 17

These are types of ______

1. Hematemesis
- Bright red
- Coffee ground
2. Melena
- Bright Red
- Tarry black

Back 17

G.I. Bleeding

Front 18

Causes of ______

- Disease, trauma, clotting disorders.

Back 18

G.I. Bleeding

Front 19

Difficulty in swallowing

Back 19

Dysphagia

Front 20

Causes of ______

- Stroke, CA(cancer), stenosis(narrowing), or scarring.

Back 20

Dysphagia

Front 21

Inability of the lower esophageal sphincter (cardiac sphincter) to relax -> foot setting in the esophagus until it slowly passes into the stomach -> potential for aspiration.

Back 21

Achalasia

Front 22

inflammation of the esophagus

Back 22

esophagitis

Front 23

causes of ______

- reflux of gastric contents
- chemical injuries, infection
- irritations from hot/spicy foods

Back 23

esophagitis

Front 24

S&S of _______

- heartburn and pain (similar to cardiac pain)

Back 24

Esophagitis

Front 25

Backward movement of gastric contents into the esophagus -> heartburn
(most common GI disorder)

Back 25

Gastroesophageal Reflux

Front 26

Causes of ______

- Hietal hernia
- Weak or incompetent cardiac sphincter

Back 26

Gastroesophageal Reflux

Front 27

Predisposing factors of ______

- weakness of hiatal muscle
- increased intrabdominal pressure (obesity, PG, ascites)

Back 27

Gastroesophageal Reflux

Front 28

S&S of ______

- Gastric reflux -> heartburn, pain occurring 1/2 - 1 hour following a meal. Heartburn worsens with lying.

Back 28

Gastroesophageal Reflux

Front 29

(Not required)
Tx for Gastroesophageal Reflux

Back 29

1. Conservative - lose weight, avoid lying flat, increase HOB(head of bed), frequent small feedings, antacids
2. surgery

Front 30

Outpouching of the esophageal wall caused by a weakness of the muscle layers

Back 30

Esophageal Diverticulum

Front 31

Major complication w/ Esophageal Diverticulum

Back 31

Food can get trapped in pouch

Front 32

S&S of ______

- food gets "stuck"
- gurgling
- coughing
- belching
- bad breath

Back 32

Esophageal Diverticulum

Front 33

(not required)
TX of Esophageal Diverticulum

Back 33

Surgery

Front 34

- Accounts for about 6% of all GI cancers
- Occurs most often in men > 50
- Predisposing factors = alcohol and tobacco, injury to esophagus

Back 34

Cancer of the Esophagus

Front 35

S&S of ______

- dysphagia
- weight loss
- anorexia
- fatigue
- pain or swelling

Back 35

Cancer of the Esophagus

Front 36

A transient irritation of the gastric mucosa.

Back 36

Acute Gastritis

Front 37

Causes of ______

- bacterial endotoxins
- caffeine
- alcohol
- ASA (aspirin)

Back 37

Acute Gastritis

Front 38

Patho of ______

irritant -> inhibit production of prostoglandins (prostoglandins stimulate contraction of uterine and other smooth muscles, decrease B/P, regulate acid secretion of stomach) -> loss of protection of gastric mucosa from normal stomach acids -> disruption of mucosal barrier -> irritation

Back 38

Acute Gastritis

Front 39

S&S of ______

- ASA - asymptomatic of heartburn or sour stomach
- Alcohol - vomiting, GI bleeding, hematemesis(blood vomit)
- Endotoxins - abrupt onset, N/V.

Back 39

Acute Gastritis

Front 40

(not required)
TX of Acute Gastritis

Back 40

Usually gone in a few days
aka "bite the bullet"

Front 41

Progressive and irreversible atrophy of part of the epithelium of the stomach which contains glands (pepsin-producing and acid producing cells) -> lack of hydrochloric acid and vitamin B12 absorption (pernicious anemia)

Back 41

Chronic Gastritis

Front 42

lack of intrinsic factor commonly found in gastric mucosa -> failure to absorb B12

Back 42

Pernicious Anemia

Front 43

S&S of ______

- Pernicious anemia
- impaired O2 transport
- Alterations in RBC structure

Back 43

Chronic Gastritis

Front 44

An ulcer that develops in the upper GI tract which is exposed to acid-pepsin secretions.
- chronic illness with remissions and exacerbations

Back 44

Peptic Ulcers

Front 45

enzyme that breaks down proteins

Back 45

pepsin

Front 46

Causes of ______

- H. pylori infections
- NSAIDs, esp ASA

Back 46

Peptic Ulcers

Front 47

S&S of ______

> Pain - burning, gnawing or cramping
> Pain - between meals (when stomach is empty) or at 1-2 a.m.
> Pain - located near xiphoid, may rotate toward ribs, the back and the right shoulder
> Pain - recurs at intervals of weeks or months
> Pain - is relieved by food or antacids

Back 47

Peptic Ulcers

Front 48

Complications from Peptic Ulcers can include: (3 things)

Back 48

- Hemorrhage
- Obstruction - due to edema
- Perforation - eats through layers of the GI tract -> peritonitis

Front 49

DX for Peptic Ulcers (not required)

Back 49

Endoscopy with biopsy to test for H. Pylori or blood test for titers (measures antibodies to H. Pylori)
History of NSAID use

Front 50

TX for Peptic Ulcers (not required)

Back 50

Kill H. Pylori infection with anitbiotics
Surgery

Front 51

- Rare
- Caused by gastrin-secreting tumor located in pancreas
- Ulcers form from elevated gastrin levels
- Usually malignant

Back 51

Zollinger-Ellison Syndrome

Front 52

- Related to severe stress, trauma, sepsis, head injuries

Back 52

Stress ulcers or Curling's ulcer

Front 53

Patho of ______

Head injuries -> hypersecretion of HCL
Others -> ischemia of the gastric mucosa -> disruption of mucosal barrier -> ulcer from normal acid secretions

Back 53

Stress ulcers or Curling's ulcer

Front 54

Complications of Stress ulcers or Curling's ulcer include: (2)

Back 54

- Hemorrhage
- High mortality

Front 55

TX of Stress ulcers or Curling's ulcer (not required)

Back 55

- antacids, tagamet (acid secretion)

Front 56

Causes of ______ & ______

- unknown
- hereditary (esp. Jewish)
- aggravated by psychological stress

Back 56

Chron's Disease/ Ulcerative Colitis

Front 57

DX of Chron's Disease/Ulcerative Colitis

Back 57

- symptoms, x-rays, procto-sigmoidoscopy

Front 58

Recurrent granulomatous type of inflammatory response that affect any area of the GI tract

Back 58

Chron's Disease

Front 59

S&S of ______

- intermittent diarrhea
- colicky pain
- wt. loss & malaise
- low grade fever
- perianal abscesses/fistula

Back 59

Chron's Disease

Front 60

A nonspecific inflammatory condition of the colon
- ulcerative & exudative
- affects colon

Back 60

Ulcerative colitis

Front 61

S&S of ______

- Bloody diarrhea w/ mucous
- Colicky pain
- Anemia
- Hypoproteinemia

Back 61

Ulcerative colitis

Front 62

Bacteria infections of the colon

Back 62

Infectious Colitis

Front 63

Common nosocomial infection resulting from antibiotic tx which leads to disruption of the normal bacterial flora of the colon - difficult to treat - must stop antibiotic therapy.

Back 63

Clostridium difficile Colitis

Front 64

Bacteria found in feces of cattle and milk - contaminated or poorly cooked meat/milk leads to food-borne transmission. Sever infection leads to production of toxins and hemolytic anemia and renal failure. Most common cause of acute renal failure in children.

Back 64

Escherichia coli 0157:H7 Colitis

Front 65

A pouch or sac formed by herniation of intestinal mucous membrane through the muscle layer of the intestine.

Back 65

Diverticular Disease

Front 66

S&S of ______

- Change in bowel habits
- Diarrhea
- Constipation
- Bloating
- Gas

Back 66

Diverticular Disease

Front 67

Causes of ______

- Idiopathic
- lack of dietary fiber
- Aging
- Lack of exercise

Back 67

Diverticular Disease

Front 68

Complications of ______

- Perforation
- Peritonitis
- Hemorrhage
- Bowel obstruction

Back 68

Diverticular Disease

Front 69

- Kills ~ 57,000 each year
- 2nd most common site of fatal CA
- By the time you have symptoms, disease is too far
- Asymptomatic until progressed disease

Back 69

Colorectal Cancer

Front 70

DX for Colorectal Cancer

Back 70

- Hemocult - stool (occult blood)
- Digital rectal exam
- Proto - sigmoidoscopy

Front 71

Inflammation of the peritoneum is a serious complication which commonly results from spread of infection from abdominal organs (appendicitis), rupture in GI tract, or from penetrating wounds to the abdomen

Back 71

Peritonitis

Front 72

Pathophysiology of ______

Initial assault (bacteria/chemical)
-> exudate (sticky, substance) Adhesions -> seals off area -> pockets of puss form and glue the surfaces together -> localizes the infection (however may become generalized) -> adhesions usually disappear when infection disappears but may persist which later -> intestinal obstruction

Back 72

Peritonitis

Front 73

S&S of ______

- N/V
- Pain & abdominal tenderness w/ movement
- Shallow resp. (due to pain)
- Rigid, distended abdomen
- Fever, increase WBC's

Back 73

Peritonitis

Front 74

TX of Peritonitis (not required)

Back 74

- Antibiotics
- NGT - NPO
- Surgery

Front 75

The interference (from whatever cause) with the normal flow of intestinal contents then the intestinal tract

Back 75

Intestinal Obstruction

Front 76

Types of intestinal obstruction (four)

Back 76

- acute
- chronic
- partial
- complete

Front 77

peristalsis halts -> no movement (i.e. obstruction)

Back 77

Paralytic Ileus

Front 78

Causes of ______

- Abdominal surgery
- Trauma
- Peritonitis
- Chemical irritation
- Ischemia
- Electrolyte imbalances

Back 78

Paralytic Ileus

Front 79

Causes of ______

- Adhesions
- Hernias
- Volvulus - twisting of bowel
- Intussusception - telescoping of bowel
- Fecal impaction
- Strictures
- Tumors

Back 79

Mechanical Ileus

Front 80

Effects of Intestinal Obstruction

Back 80

Fluid and electrolyte imbalance

Front 81

S&S of ______

- No bowel sounds or hypoactive
- Continuous pain
- N/V
- Distended abdomen
- lack of BMs

Back 81

Paralytic ileus

Front 82

S&S of ______

- Hyperactive bowel sounds at beginning which later diminish and become absent
- N/V
- Distended abdomen
- lack of BMs

Back 82

Mechanical ileus

Front 83

TX of Intestinal Obstruction

Back 83

- Fluid and electrolytes
- NGT/NPO
- Surgery

Front 84

Inflammation of the liver

Back 84

Hepatitis

Front 85

Causes of ______

- virus
- infections
- drug toxicity (alcohol)

Back 85

Hepatitis

Front 86

Acute inflammatory disease caused by hepatitis virus or other virus (CMV, herpes and measles)

Back 86

Viral hepatitis

Front 87

Fecal, oral route liver inflammation

Back 87

Hepatitis A (HVA)

Front 88

Blood borne liver inflammation

Back 88

Hepatitis B (HVB)

Front 89

Other (Non-A, Non-B) liver inflammation

Back 89

Hepatitis C (HVC)

Front 90

TX of Hepatitis (prevention)

Back 90

- Gamma globulin - HVA
- HVB vaccine/ may prevent HVD
- No vaccine for HBC or HBE

Front 91

S&S of ______

- Prodromal stage - malaise
- Icteric stage - increased bilirubin lvls (jaundice)
- dark urine, pale stools
- increased liver size
- convalescent stage
- presents quickly

Back 91

Hepatitis A

Front 92

S&S of Hepatitis B

Back 92

- carry virus w/out symptoms for long time

Front 93

Fibrosis and "hardening" of the liver

Back 93

Cirrhosis

Front 94

Causes of _____

- Viral hepatitis
- Alcoholism
- Drug toxicity
- Chemical exposures
- Biliary obstructions
- Cardiac disease
- Metabolic disorders
- Others

Back 94

Cirrhosis

Front 95

Types of cirrhosis
1. nodules (fibrous) develop
2. Dmg. to the bile ducts
3. 4th leading cause of death in US adults, most common cause of cirrhosis = alcoholism

Back 95

1. Postnecrotic

2. Biliary

3. Portal of alcoholic

Front 96

Stages of Cirrhosis

Back 96

1. Fatty changes (asymptomatic)
2. liver tenderness, pain, anorexia, fever, jaundice, ascites and liver failure
3. Cirrhosis

Front 97

S&S of _______

- Portal hypertension - fibrous tissue increase portal venous pressure -> dilation of connecting veins (to handle increase pressure) -> venous shunting and congestion -> splenomegaly, Hemorrhoids, esophageal varices, caput medusae (dilated surface veins around the umbilicus), ascites and peripheral edema

Back 97

Portal Cirrhosis

Front 98

Causes of ______ with Cirrhosis

- Impaired protein synthesis in liver -> colloid osmotic pressure

- Obstruction of venous flow through liver -> increase production of lymph -> oozing of serous fluid from liver surface

- increase aldosterone -> NA and H2O retention and K loss

Back 98

Ascites and edema

Front 99

A condition in which acute renal failure occurs with disease of the liver or biliary tract, the cause of which is believed to be either a decrease in renal blood flow or damage to both the liver and the kidneys as from carbon tetrachloride poisoning or leptospirosis.

Back 99

Hepatorenal syndrome

Front 100

Effects of _______

- decreased sex hormones
- decreased synthesis of plasma proteins -> ascites, edema
- synthesis of blood-clotting factors -> bleeding
- failure to remove and conjugate bilirubin -> jaundice
- impaired bile synthesis
- impaired gluconeogenesis
- decreased ability to convert ammonia to urea -> increased blood ammonia levels

Back 100

Hepatocellular dysfunction

Front 101

- common problem esp. for women
- cholesterol and bilirubin "rocks"
- caused by increase in cholesterol in bile

Back 101

Cholelithiasis (gallstones)

Front 102

S&S of _______

- many asymptomatic until obstruction of bile flow
- jaundice (when bile flow obstructed)
- biliary colic = sudden onset of pain which increases in intensity to reach climax in 30-60 minutes
- pain located = upper right quadrant, episgastric area, often radiates to the back, right shoulder and right scapula
- pain rare on left side but possible
- N/V may occur

Back 102

Cholelithiasis (gallstones)

Front 103

DX of gallstones (not required)

Back 103

- oral cholecystogram (x-ray of gb with contrast), ultrasound, gb scan

Front 104

TX of gallstones (not required)

Back 104

- surgery or lithotripsy

Front 105

Inflammation of gallbladder, can be acute or chronic
- associated with gallstones and bile obstruction.

Back 105

Cholecystitis

Front 106

S&S of ______

1. acute - symptoms like in gallstones

2. chronic - intolerance to fatty foods
- vague
- belching
- possible colicky pain

3. DX/TX same as gallstones

Back 106

Cholecystitis

Front 107

Severe life threatening disorder due to loss of pancreatic enzymes into surrounding tissues and abdominal cavity. Enzymes begin to autodigest tissues -> necrosis -> hemorrhage

Back 107

Acute hemorrhagic pancreatitis

Front 108

Causes of ______

- Gallbladder disease
- Alcohol abuse

Back 108

Acute hemorrhagic pancreatitis

Front 109

S&S of ______

- abrupt and dramatic
- may follow heavy metal or alcoholic binge
- severe epigastric pain and abdominal pain radiating to back
- pain is worse when person lies flat
- abdominal distension
- hypoactive bowel sounds
- hypovolemia from loss of large volumes of fluid in retroperitoneal and abdominal cavity
- hypovolemic shock
- fever
- elevated serum amylase/lipase after 24 hrs.

Back 109

Acute hemorrhagic pancreatitis

Front 110

Prognosis: Acute hemorrhagic pancreatitis

Back 110

5% die, life-threatening disease

Front 111

TX for Acute hemorrhagic pancreatitis

Back 111

- pain relief
- resting pancreas
- restoring lost plasma volume

Front 112

Progressive destruction of pancreas, two types

Back 112

Chronic Pancreatitis

Front 113

stones form in pancrease, seen most often in alcoholics

Back 113

Chronic calcifying pancreatitis

Front 114

Stenosis of the sphincter of Oddi

Back 114

Chronic obstructive pancreatitis

Front 115

S&S of ______ & ______

- recurring episodes of epigastric and upper left quadrant pain, precipitated by alcohol abuse and overeating
- anorexia
- constipation
- N/V
- flatulence
- finally diabetes mellitus and malabsorption syndrome

Back 115

Chronic calcifying pancreatitis
and Chronic obstructive pancreatitis

Front 116

TX of Chronic calcifying and obstructive pancreatitis

Back 116

low fat diet, alcohol withdrawal, TX biliary disease

Front 117

- 5th leading cause of cancer deaths in US
- occurs mostly after age 50, usually between ages 65 and 79
- prognosis poor and usually not dx until advanced, survival <3%

Back 117

Cancer of Pancreas

Front 118

Cause of ______

- idiopathic, but smoking is major risk factor

Back 118

Cancer of Pancreas

Front 119

S&S of Cancer of Pancreas

Back 119

- pain and jaundice

Front 120

DX for Cancer of Pancreas

Back 120

ulrasound and CT

Front 121

TX for Cancer of Pancreas

Back 121

surgery, radiation, and chemo

Front 122

Hepatitis:
- source is feces
- fecal-oral route of transmission
- no chronic infection
- pre/post-exposure immunization to prevent

Back 122

Hepatitis A

Front 123

Hepatitis:
- source is blood/blood-derived body fluids
- percutaneous/permucosal route of transmission
- chronic infection occurs
- pre/post-exposure immunization to prevent

Back 123

Hepatitis B

Front 124

Hepatitis:
- source is blood/blood-derived body fluids
- percutaneous/permucosal route of transmission
- chronic infection occurs
- blood donor screening; risk behavior modification to prevent

Back 124

Hepatitis C

Front 125

Hepatitis:
- source is blood/blood-derived body fluids
- percutaneous/permucosal route of transmission
- chronic infection occurs
- pre/post-exposure immunization; risk behavior modification to prevent

Back 125

Hepatitis D

Front 126

Hepatitis:
- source is feces
- fecal-oral route of transmission
- no chronic infection
- ensure safe drinking water to prevent

Back 126

Hepatitis E