Lecture # 11 - Chapter 39 - Alterations In The Gi System

Front 1

Vomiting is caused by

Back 1

gastrointestinal contraction and reverse peristalsis of the esophagus

Front 2

Projectile vomiting

Back 2

is not preceded by nausea and retching - it is associated with direct stimulation of the vomiting center in the brain

Front 3

What causes constipation?

Back 3

Lack of exercise, low fiber diet, poor bowel habits - it can also be caused by a neurogenic disorder, obstruction, or a disorder of intestinal motility

Front 4

What often causes diarrhea?

Back 4

excessive fluid drawn into the intestinal lumen by osmosis, excessive secretion of fluids by the intestinal mucosa, or excessive gastrointestinal motility

Front 5

Visceral pain

Back 5

is abdominal pain that originates in the organs - it is often referred to the back

Front 6

Parietal pain

Back 6

abdomal pain of the peritoneum

Front 7

Upper GI bleed (esophagus, stomach, duodeum)

Back 7

is often caused by bleeding peptic ulcers - they can also be caused by varices, cancer, or a tear from severe retching

Front 8

Lower GI bleeding

Back 8

can be from polyps, inflammatory disease, diverticulitus, hemorrhoids, or cancer

Front 9

What are the manifestations of GI bleeding?

Back 9

hematamesis (vomiting blood), melena (dark, tarry stool), hematochezia (frank blood in stool), or occult blood in stools or vomitus

Front 10

Hematamesis

Back 10

vomiting blood

Front 11

Melena

Back 11

dark, tarry stool

Front 12

Hematochezia

Back 12

frank blood in stool

Front 13

Dysphagia

Back 13

difficulty swallowing (gi - gastrointestinal) - it can be mechanical or functional obstruction of the esophagus

Front 14

Dsyphasia

Back 14

difficulty with speech

Front 15

Achalasia

Back 15

is a functional dysphagia caused by a loss of innervations of the smooth muscles of the mid and lower esophagus and lower esophageal sphincter - the sphincter does not relax with swallowing and this causes esophageal distention

Front 16

GER

Back 16

gastroesophageal reflux - happens when chyme (partially digested food and acid) refluxes into the esophagus

Front 17

GER can cause

Back 17

reflux esophagitis which can lead to esophageal cancer

Front 18

Hiatal hernia

Back 18

is a protrusion of the stomach above the diaphram - it causes increased reflux

Front 19

Pyloric obstruction

Back 19

is a narrowing of the pylorus (opening between stomach and duodenum) - can be caused by a congenital defect, inflammation and scarring, or tumor growth

Front 20

Intestinal obstruction

Back 20

is usually mechanical - caused by torsion, herniation, tumor, or a stricture from scar tissue

Front 21

Paralytic ileus

Back 21

causes functional obstruction (sometimes seen postoperatively)

Front 22

Acute gastritis

Back 22

is an injury of the protective mucosal barrier - can be caused by NSAIDs inhibiting prostaglandin and thereby decreasing production of mucus - other contributing factors are alcohol, histamine, and H. pylori infection.

Front 23

Chronic gastritis

Back 23

is a thining and atrophy of the gastric epithelium - usually in the elderly - it can also be caused by autoimmune factors, diabetes, and thyroid disease

Front 24

Chronic gastritis is a risk factor

Back 24

for gastric carcinoma

Front 25

What are the three types of peptic ulcers?

Back 25

duodenal, gastric, and stress ulcers

Front 26

What are peptic ulcers caused by

Back 26

an inflammation and ulceration caused by excessive secretion of gastric acid, disruption of the protective mucosal barrier or both - usually caused by H. pylori and NSAID use

Front 27

Ischemic stress ulcers

Back 27

develop suddenly after severe illness, trauma, or neural injury

Front 28

Dumping syndrome

Back 28

is the rapid emptying of the chyme (which is hypertonic) into the small intestine - the osmotic shift of fluid from the vascular fluid to the intestine causes a decrease in plasma volume

Front 29

Pancreatic insufficiency

Back 29

results in decreased production of enzymes that digest proteins, carbohydrates, and fats

Front 30

Lactase

Back 30

assists with the breakdown of lactose

Front 31

Difficiency in lactase

Back 31

prevents lactose absorption from the small intestine - the intact sugar moves to the large intestine where it holds on to water resulting in osmotic diarrhea - large intestine bacteria eat some of the sugar, causing gas to form

Front 32

Bile salt deficiency

Back 32

can come from inadequate secretion, bacterial effect on bile, or impaired reabsorption of bile - it causes melabsorption of fat and fat-soluble vitamins

Front 33

What are two types of inflammatory bowel disease?

Back 33

Ulcerative colitis and Crohn's Disease

Front 34

Ulcerative colitis

Back 34

is an inflammatory disease - it causes ulceration, abscess, and necrosis of the colon and rectal mucosa - lesions begin in the rectum and ascend in a continuous pattern

Front 35

What are some of the symptoms of ulcerative colitis?

Back 35

cramping, pain, bleeding, diarrhea, dehydration, and weight loss

Front 36

Crohn's Disease

Back 36

affects both the small and large intestine - ulceration involves all three layers of the lumen - there can be skip lesions separated by segments of normal bowel - fissures and granulomas are common

Front 37

What are some of the symptoms of Crohn's Disease?

Back 37

abdominal pain, non-bloody diarrhea, and weight loss

Front 38

Irritable Bowel Syndrome (IBS)

Back 38

is a chronic funtional gastrointestinal disorder with abdominal pain and altered bowel habits - more common in women - usually youth to middle age

Front 39

What are the symptoms of IBS

Back 39

diarrhea, constipation, and pain

Front 40

Unlike ulcerative colitis and crohn's disease, in irritable bowel syndrome

Back 40

there are no specific structural or biochemical alterations - it may be caused by food allergies or intolerance, changes or overgrowth of intestinal flora, visceral hypersensitivity, or psychosocial factors

Front 41

Diverticula

Back 41

are outpouchings of the colonic mucosa - associated with decreased dietary fiber and increased intracolonic pressure

Front 42

What is the most common site of diverticula

Back 42

the sigmoid colon

Front 43

Diverticulosis

Back 43

is a condition where diverticula are present

Front 44

Diverticulitis

Back 44

is an inflammation of the diverticula - possibly due to obstruction of the opening causing abscess formation

Front 45

What are the symptoms of diverticulitis

Back 45

LLQ pain, fever, leukocytosis, and blood in the stool

Front 46

Appendicitis is caused by

Back 46

an obstruction of the lumen of the appendix leading to ischemia, inflammation, and possibly abscess

Front 47

Untreated appendicitis can lead to

Back 47

perforation of the appendix which can cause gangrene or peritonitis

Front 48

What is the most common surgical emergency of the abdomen?

Back 48

Appendicitis

Front 49

What are the symptoms of appendicitis

Back 49

RLQ pain, fever, leukocytosis, nausea, and diarrhea

Front 50

Celiac disease is also called

Back 50

Sprue

Front 51

Celiac disease

Back 51

is related to gluten intolerance - antibodies are produced which affect the villi in the small intestine and cause them to become flatter - the inflammation and malabsorption cause pain and other systemic problems

Front 52

Where is the gluten protein found

Back 52

mostly in grains such as barley, rye, oats, and wheat (BROW) - some grains do not make gluten and therefore can be substituted

Front 53

Obesity

Back 53

is a BMI greater than 30

Front 54

Obesity is caused

Back 54

by a lack of exercise and proportioanally high coloric intake - genetic disorders, as well as social, cultural, psychogenic, economic, and metabolic factors also contribute

Front 55

Anorexia nervosa

Back 55

is a self-imposed starvation - primarily of adolescent and young women - there is an altered body image - causes medical problems, developmental delays, and can be fatal

Front 56

Bulimia

Back 56

is a binging and purging disorder - involves eating normal amounts but inducing vomiting or taking laxatives to induce diarrhea - fequent vomiting causes tooth decay, pharyngitis and esophagitis

Front 57

Portal hypertension

Back 57

is caused by obstruction or impedance of blood flow through the portal venous system or vena cava

Front 58

What are the intrahepatic causes of portal hypertension

Back 58

thrombosis, inflammation, cirrhosis, viral hepatitis or parasitic infection

Front 59

What are the post-hepatic causes of portal hypertension

Back 59

hepatic vein thrombosis or right sided cardiac failure

Front 60

What are some of the consequences of portal hypertension

Back 60

varices of the esophagus, stomach, and rectum; splenomegally, ascites, hepatoencephalopathy (caused by toxins not metabolized in the liver)

Front 61

Hepatorenal syndrome

Back 61

is kidney failure caused by advanced liver disease - often cirrhosis causing portal hypertension - it is caused by decreased blood flow to the kidneys

Front 62

All hepatitis viruses cause

Back 62

hepatic cell necrosis

Front 63

Hepatitis A

Back 63

is transmitted by fecal-oral route (contaminated food or water) - can also be transmitted by blood - incubation is 4-6 weeks - vaccination is available

Front 64

Hepatits B

Back 64

is transmitted by blood, body fluids, infected needles, and sexual contact - incubation is 6-8 weeks - vaccination is available - chronic infection develops in 15-30% of persons who get active Hep B

Front 65

Hep B is a risk factor

Back 65

for cirrhosis and hepatocellular carcinoma

Front 66

Hepatitis C

Back 66

is transmitted by blood, body fluids, infected needles, and sexual contact - but is mostly obtained by blood transfusion (especially transfusions that took place before Hep C was identified) - incubation is 7-10 weeks - no vaccination - chronic infection develops in 50-80% who are infected with Hep C

Front 67

Hep C can lead to

Back 67

cirrhosis and hepatocellular carcinoma

Front 68

What is Hep C treated with

Back 68

interferon and ribaviron

Front 69

Cirrhosis

Back 69

is an inflammatory disease of the liver that disrupts the lobular structure - damaged liver cells regenerate but if the area of damage is too large the liver cells regenerate in clumps or nodules instead of the plate-like structures of the normal liver - and since there is less surface area in contact with blood the liver function is compromised

Front 70

What causes cirrhosis

Back 70

hepatitis or toxins - this causes irreversible liver damage

Front 71

Alcoholic cirrhosis is caused by

Back 71

an inflammatory response that causes fibrosis

Front 72

Primary biliary cirrhosis

Back 72

is an autoimmune disease

Front 73

Secondary biliary cirrhosis

Back 73

develops from prolonged obstruction of bile flow

Front 74

Post-necrotic cirrhosis

Back 74

comes from liver injury, drugs, toxins, metabolic disorders, and Hep C

Front 75

Cholelithiasis

Back 75

is caused by cholesterol crystals or precipitated unconjugated bilirubin

Front 76

Cholecystitis

Back 76

is an inflammation of the gallbladder caused by obstruction of the bile duct by gall stones

Front 77

Acute pancreatitis

Back 77

is caused by biliary obstruction - leakage of digestive enzymes into the pancreatic tissue or bloodstream can occur - chronic is usually alcohol related