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60 Cards in this Set

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peptic ulcer etiology
- bacteria: Helicobacter pylori (also major factor in stomach cancer)
- decreases barrier function
- other factors: drugs (NSAIDS)
peptic ulcer disease
- males = females
- 80% in duodenal bulb
- 20% in stomach (pyloric region)
- nocturnal pattern
- pain-relief food pattern, worse at night
- seasonal exacerbations
peptic ulcer treatment
- difficult
- may show little response to interventions
- relaxation technique useful
peptic ulcer pathophysiologoy
- dec. barirer function
- histamine release w/ vasodilation
- gastric acid release
- capillary and venuel destruction
- bleeding alond w/ plasma losss & acid accumulation
peptic ulcer complications
1. gastroduodenal hemorrage
2. perforation: w/ leakage of gastrodueodenal contest intot he peritoneal cavity = peritonitis
3. obstruciton: due to scarring and stricure
4. intractability
acute and chronic petic ulcers
- may penetrate the entire wall of the stomach
- may result in scaring -> contracture -> oclusion of passageway
stress ulcers
- may follow major trauma
- frequently in spinal cord injuries
- secondary to ischemia to GI tract (shunting of blood elsewhere)
- paucity of blood = gastrointestinal infarcts -> ulcerate & bleed
- can occur anywhere in GI tract & usually occur in multiples
stress ulcers healing
- usually heal
- recur from time to time during rehab process
stomach cancer
- most are adenocarcinomas
- males > females
- decreasing freqency in US
stomach cancer etiology
- persone with H. pyloir
- affects lower socioeconomic groups
- chronic gastritis risk factor
stomach cancer prognosis
- high mortality rate; short survival
- 5 year survivla rate only 10%
- aggressive; matastiasis early
(p 642 15-8)
stomach cancer: linitis plastica
leather bottle stomach; replacement of most of stomach tissue
gastrointestinal disease s/s
- outcome of a variety of disorders
- constitutioal symptoms
nausea & vomiting
diarrhea
malaise
fatigue
fever
dizziness
appetite loss
[p629, T 15-1]
aging and the GI system
- constipation
- ilieus (dec. GI motility)
- absorption losos
- incontinence
- diverticular disease
- decreased gastric acidity
atropic gastritis
- prevalent in older
- atrophy of gastic mucosa
- decreased gastric acidity
chronic gastritis
- reduced intrinsic factor (produced by gastric mucosa - necessary for absorption of Vit B12/extrinsic factor
--> extrinsic factor (B12) + intrisic factor -> absorption thru gastic mucosa -> Vit B12 -> hematopoiesis, myelinization
reduced extrinis factor absorption
- impairs ability to produce RBCs and maintenaance of myelin in nervous system
- disorders:
pernicious anemia
peripheral neuropathy
subacute combined
degeneration
dementia
pernicious anemia
macrocytic, normochorimc anemia
peripheral neuropathy
- hypersensitivity (loss of sensation with advanced)
- weakness
- reduced deep tendon reflexes (DTs)
subacute combined degeneration
- results in demyelinization of lateral white columns -> upper motor neuron disease and spasticity
- & of dorsal white column -> loss of fine tactile senses
-- must use vision to know where body/limbs are in space
dementia
- "megaloblastic madness"
- demyelinization of pathways in cerebral cortex
- B12 defiiency
- reversible
symptoms of esphaegeal cancer/disease
- dysphagia
- pyrosis (heartburn due to gastric relfex or acid)
- odynophagia (painful swallowing)
- waterbrash
waterbrash
- relex salivary hypersecreatiion in reponse to peptic esophagitis
- aspirate saliva to lung when lying can result in pneumonia
esphagitis
- non-specific
- produced pyrosis and often reflux
- acute
- due to eathing spicy food
- resolves in a few days
GERD
- gastroesphageal reflux disease
- chronic form of esophagitis
- acid from stomach is regurgitated past the lower esophageal sphincter into lower esophagus
- chronic irritation
Barrett's esphagitis
- metaplasia of lower esophagus due to GERD
- becomes a potential risk for esophageal cancer
[634, B15-3]
hiatial hernia
- herniation of hte esophagus up through the diaphram
- can cause esophagitis
- rolling/direct hiatal hernia & rolling/paraesophageal hiatal hernia
[633, B15-2]
scleroderma
- CVD associated with SLE
- collagen in esophagus & esophageal vessels is affected
- causes esophageal dysmotility & dysphagia
- CT looses elasticity -> rigid
esophageal tumor
- cancer (rarely benign)
- of lower esophagus
- higher incidence in SC coast, especially in AA
- cause unknown
esophageal tumor signs
- obstruction
- bleeding
- difficulty swallowing
- cachexia
- signs of esophageal disease may also be present
achalasia
dilation of lower esophagus
- due to loss of muscle tone & failure of lower esophageal sphincter to relax
- due to loss of muscle innervation (Auerbach's plexus in esophageal wall)
- = stricture
- dilation -> accumulation of food in lower esophagus
Mallory-Weiss Syndrome
- lower esophageal bleeding due to mucosal lesion
- due to alcohol abuse, viral illness, bulimia, or some antibiotics
Tracheoesophageal fistula
- congenital disease of esophagus
- trachea & esophagus communicat with trachea ending ina blind pouch
- infant will cough, choke, & have cyanosis (3 Cs)
- w/out surgery = death
acute gastritis
- sudden onset of diffuse gastic inflammation with epigastric pain
- pain-relief food pattern (pain releived by eathing -> differentiates from gall bladder disease)
- resolves in a few hours to days
- develop subsequent to over-indulgence in eating/drinking, taking NSAIDs or in GI viral infeciton
[p 639, B15-6]
disoreders of the small bowel
(duodemnum, jejunum & ileum -- long for absorption:
-> d & j: iron, Ca, vitamins, fats, sugars, aa's
-> i: vi B12 and bile salts)

1. malabsorption syndrome
2. obstructive syndrome
malabsorption syndrome
- when nutritional levels fall -> sudden weight loss w/ dec. in body mass
- occur b/c/ red. food intake or the small bowel is unable to adaquately absorb
causes of malabsorption syndrome
- GId surgery (post gastrectomey)
- hepatobiliary/pancreatic disease
- GI lymphoma
- lactase deficiency (lactose irritates the bowel)
- infections (bacterial, parasitic)
- regional enteritis - Crohn's Disease
s/s malabsorption syndrome
- sudden weight loss
- diarrhea
- steatorrhea (fat in stool)
- flatulence
- nocuria
- fatigue
- anemia (lack of Vit B12, folic acid & iron)
- neuropathy (B12 demyelinization)
- easy bruising (subcutaneous tissue loss & capillary fragility)
Crohn's disease
- regional enteritis
- autoimmune disease (ileum)
- chronic inflammation inhibiting absorption
- full thickness of the wall
- enteropathic arthritis
Celiac disease
- Sprue
- gluten sensitivity induced (found in bread)
- intestinal villi lost (gluten shears them off)
- adults and child forms
- can be temporary
- adult form more mild & can be a precursor to intestinal cancer
obstructive syndrome
blockage in the bowel due to:
- loss of peristalsis/motility -> ileus
- presence of tumor
- volvulus (bowel twists upon itself)
- intussuseption (segment of bowel folds up into a proximal segment)
Hirschsprung's Disease
- congenital megacolon
- enlarged bowel becomes static
senile ileus
- dysmotility of bowel due to age
- ileus degeneration in myenteric plexus
- in sedentary individuals
- impaction/organic obstruction is the most immediate concern
Paralytic Ileus
- parasympathetic loss to lower colon (S2-S4)

- with lesion higher than in sc -> parasympathetic still present but have no voluntary control
organic obstruction disease
- dehydration + lazy bowel
- fecal impaction
- post-surgical adhesions
s/s of bowel obstruction
- "crampin" abdominal pain
- abdominal distention & bloating
- vomitting & fever
- alternating constipation/diarrhea
disorders of large bowel
the colon or large intestine
appendicitis
- in all age groups
- unknown etiology or,
- fecalith etiology -> get tiny dried piece of stoll that gets stuck in leumen
- pain in right lower quadrant (belly button or left lower)
McBurney's Point
- line from umbilicus to ASIS
- 1/3 of the was from the ASIS is where the appendix lies
- this is typically where pain presents
s/s of appendicitis
- lekocytosis (normal count is 4000-8000)
- nausea & vomiting
- rebound pain at McBurney's point (Blumbergs' Sign)
- fever

rupture = peritonitis
rebound pain diagnosis of appendicitis
have patient lie supine w/ knees bend to 45
- press on McBurney's point and hold a second then release
- hurts when you get go -> rebound pain
dysfunctional symptoms of appendicitis
- constipation
- diarrhea
- altered stool size/color
- hematochezia (bleeding in the stool)
- "cramping" colicky pain
diverticulosis
- aging-weakness in bowel wall
- past 70 yo, 90%+ have some sort of diverticulosis
- 90% occur in sigmoid colon
diverticulitis
- acute condition
- diverticulum inflammation
-> fever, abdominal pain & hematochezia
diverticulum
- hydrostatic pressure inside bowel causes weakened area of wall to bulge
- an inflamed bout may rupture, causing leakage of intestinal contents into the abdominal cavity -> peritonitis
idiopathic ulcerative colitis
- females > males
- jewish ancestry
- autoimmune disease
- affects mucosa only
- hematochezia
- abdominal cramps, rectal bleeding

regional enteitis & IUC can coexist
ulcerative colitis w/ toxic megacolon
toxic megacolon: large, dilated colon
colorectal carcinoma
- prevalance:
65% rectosignmoid colon
35% ascending or transverse
colon
- worse in ascending/trans. b/c bleeding is harder to detect and this area closer to liver so metastisis dangerous
s/s colorectal carcinoma
- hematochezia (occult)
- colicky pain
- weight loss
- anemia
- alternating diarrhea/constipation
- abdominal distention
irritable bowel syndrome
- most common bowel disorder
- spastic colon

- alternating hyperactivity/sluggishness
- abdominal discomfort
- alternating constipation/diarrhea
- no significant tissue pathology
-> relaxation tech, exercise, counseling are often used to treat