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65 Cards in this Set

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Dysphagia:
-difficulty in swallowing
3 types of dysphagia:
1. Problems in delivery of bolus of food into esophagus dt neuromuscular incoordination (pain, neuromuscular disorder, lesion esophagus)
2. Altered peristalsis esophagus
3. LES dysfunction
achalasia:
-failure of a ring of muscle fibers, such as a sphincter of the esophagus, to relax
-needs to be surgically removed
diverticulum:
-disorder where there is a pouch or sac branching out from a hollow organ or structure, such as the intestine
4 Causes of an altered peristalsis esophagus:
1. diverticulae (buldge)
2. achalasia (tight)
3. neoplasms (tumor)
4. strictures (narrowing)
3 Causes of LES dysfunction:
1. GERD
2. neuromuscular disorders
3. any obstruction
Gastrointestinal disorders:
1. Dysphagia
2. Esophogeal pain
3. Abdominal pain
4. Vomiting
5. Intestinal gas
heartburn:
-acid noxious to esophagus
-can cause spasm
2 disorders causing esophageal pain:
1. heartburn (acid noxious, spasm)
2. substernal chest pain (spasm, similar to angina, radiation of the pain)
3 types of abdominal pain:
1. visceral (inflammation, distention of gut)
2. somatic (abdominal wall, diaphragm, peritoneal)
3. referred pain (heart attack has pain in arm)
Which of the 3 types of abdominal pain required surgery to be corrected?
visceral pain
Causes of intestinal gas:
1. swallowed air and bacteria causing digestive action
2. inadequate lactase from bacterial fermentation
3. alterations in motility
List 2 alterations of normal bowel patterns:
constipation and diarrhea
constipation:
=infrequent passage of stools
-caused by diet low in fiber, lack of exercise (stimulates peristalsis), alterations in motility
diarrhea:
-acute or chronic inflammation caused by malabsorption or irritants to GI tract (caffeine)
4 Mechanisms of diarrhea:
1. osmotic (solutes in intestine cause water influx-CHO, epsom salt)
2. secretory (bacteria)
3. exudative
4. motility disturbances
2 types of exudative mechanisms causing diarrhea:
1. increased osmolarity from blood, mucus or protein
2. decreased absorption capacity from damage to epithelium
3 types of motility disturbances causing diarrhea:
1. decreased absorptive time
2. overwhelm capacity of colon
3. disorders such as IBS, Crohn's disease, etc
4 disorders of the mouth/esophagus:
1. Stomatitis
2. Gastroesophageal reflux
3. Hiatal hernia
4. Mallory-Weiss syndrome
Stomatitis:
-inflammation of the mucous tissue of the mouth from various causes, such as mechanical trauma, irritants, allergy, vitamin deficiency, or infection (herpes-simplex)
4 causes of GERD:
1. esophagitis (esophagus inflamm)
2. increased abdominal pressure
3. alteration closure of LES
4. strictures (Tx: surgery to dilate)
LES:
=lower esophageal sphincter
-ring of smooth muscle fibers at the junction of the esophagus and stomach.
-aka cardiac sphincter or gastroesophageal sphincter
3 causes of alteration closure of LES:
1. excess alcohol
2. birth control pills
3. theophylline
Tx for alteration closure of LES:
decrease acidity
increase LES pressure
Hiatal hernia:
-part of the stomach protrudes through the esophageal opening of the diaphragm
-caused by obesity, straining, pregnancy
-NOT a hernia of the abdominal wall
2 types of hiatal hernia:
1. sliding (most common)
2. paraesophageal
Mallory-Weiss Syndrome:
-bleeding due to tear in lower esophagus
-caused by forceful, prolonged vomiting
-common in alcoholics, violent vomiting
-Tx: surgical intervention
7 disorders of GI tract wall:
1. Gastritis
2. Gastroenteritis
3. Peptic ulcer disease
4. Inflammatory bowel disease
5. Enterocolitis
6. Appendicitis
7. Diverticulitis disease
Gastritis:
-chronic or acute inflammation of the mucous membrane of the stomach
-acute caused by alcohol, aspirin, bacterial toxins
-chronic caused by atrophy of epithelium of the stomach
Gastroenteritis:
"Traveler's Diarrhea"
-causes potential fluid and electrolyte loss
-caused by pathogenic organisms (viral, salmonella, campylobacter)
Peptic Ulcer Disease(PUD):
-symptoms of epigastric burning and relief from food
-non-permeable junctions of epithelial cells that usually provide protection barrier
-*causes an increase in vagus activity where gastrin is secreted by the antrum stimulating parietal cells to secrete more HCL
3 Causes of PUD:
1. aspirin & alcohol (bile acids from duodenum which can strip gastric mucus)
2. Helicobacter pylori cause 90% duodenal ulcers and 70% gastric ulcers
3. stress causes an increase in corticosteroids increasing acid
Txs of PUD:
-no apparent effect from diet
-antibiotics
-antacids
-histamine-2 antagonists
Inflammatory Bowel Disease:
-chronic disorder of the gastrointestinal tract
-inflammation of the intestine and resulting in abdominal cramping and persistent diarrhea
-increased risk of cancer
2 types of inflammatory bowel disease:
1. Crohn's disease
2. Ulcerative colitis
Crohn's disease:
aka Regional enteritis and Granulomatous colitis
-a serious chronic and progressive inflammation of the ileum
-more pain, less bleeding
-"skip lesions" found inbtn normal cells
-producing frequent bouts of diarrhea with abdominal pain and nausea and fever and weight loss
-interference with absorption
Tx for Crohn's disease:
sulfas
corticosteroids
nutritious diet
surgical considerations
Ulcerative colitis:
-a nonspecific inflammatory disease of the rectum and colon
-diarrhea with discharge of mucus and blood, cramping abdominal pain
-inflammation and edema of the mucous membrane with patches of ulceration
-inability to absorb H2O and Na
2 Types of Enterocolitis:
1. Pseudomembranous
2. Necrotizing
Pseudomembranous enterocolitis:
p.901
-life-threatening and severe form of colitis
-prompt antibiotic therapy needed to prevent perforation of bowel
Necrotizing enterocolitis:
-more common in premature and small infants
-perforation of bowel causes major complications
What is the most common abdominal emergency surgery?
appendicitis
Diverticulitis:
-found at sites of vessel penetration
-age related
-asymptomatic, fiber extremely important
-Tx ranges from conservative to surgical depending on severity
6 Disorders in motility of the GI tract:
1. IBS
2. Intestinal obstruction
3. Volvulus
4. Intussusception
5. Meckel's diverticulum
6. Hirschsprung's disease
Irritable bowel syndrome:
-disorder of bowel motility involving alterations of diarrhea and constipation of stools
-spastic or mucous colitis, irritable colon
-Tx: increased fiber diet
2 Types of Intestinal obstruction:
1. mechanical -complete or incomplete(adhesions, hernia, tumor, stricture, twisting)
2. paralytic or adynamic(mostly from abdominal surgery, also pelvic fractures)
Intestinal obstruction:
-gas and fluid distention aggravated by increase in secretion into bowel
-no bowel sounds are heard upon auscultation
-impeded absorption function
-causes vomiting, fluid and electrolyte depletion
-incarceration or strangulation can occur causing necrosis
Tx for Intestinal obstruction:
1. xray evaluation
2. decompression
3. fluid-electrolyte replacement
4. surgery
Volvulus:
"Closed-loop obstruction"
-a mechanical bowel obstruction
-twisting of bowel caused by vascular compression
-cecum and sigmoid are the most common sites
-causes impairment of blood leading to gangrene or perforation
Intussusception:
-an infolding (telescoping) of one part of the intestine into another usually causing obstruction
-most common in infants and adults with tumors
Meckel's diverticulum:
-congenital abnormalities
-connection between the intestine and the umbilical cord doesn't completely close off during fetal development
-a small outpouching of the small intestine
-most common symptom is painless bleeding from the rectum
Hirschsprung's disease:
-cogenital obstruction of the large intestine caused by inadequate motility
-enlargement of the colon caused by bowel obstruction resulting from an aganglionic section of bowel (the normal enteric nerves are absent)
-dt absent autonomic nerve ganglia in smooth muscle
-usually segment rectosigmoid
-most common in infants and children
-Tx: surgical intervention
5 Malabsorption disorders:
1. Crohn's disease
2. Celiac disease
3. Tropical sprue
4. Dumping syndrome
5. Short bowel syndrome
Celiac disease:
-intolerance to gluten (protein in wheat)
-immunologic or enzyme defect
-damage to mucosa causing malabsorption
-need to eliminate gluten fro diet
Tropical sprue:
-common in tropical climates
-atrophy of the mucosa causing lack in enzymes
-chronic disorder
-nutrients are not absorbed
-symptoms include foul smelling diarrhea and emaciation
Dumping syndrome:
aka postgastrectomy syndrome
-A condition occurring after eating in patients with shunts of the upper alimentary canal
-bowel motility causes diarrhea
-increase in blood glucose, increasing insulin causing rebound hypoglycemia
-limit CHO intake and more frequent small meals
Short bowel syndrome:
-malabsorption from the small intestine that is marked by diarrhea, malnutrition, and steatorrhea
-results from resection of the small intestine
steatorrhea:
-excessive discharge of fat in the feces
5 Neoplasms of the GI tract:
1. Esophageal
2. Gastric
3. Small intestine
4. Colonic polyps
5. Colon cancer
Esophageal neoplasm:
-chronic inflammation from smoking, alcohol, esophagitis
-poor prognosis, usually infiltrating
-Tx required
Gastric neoplasm:
-10x more common in Japan than USA
-poor prognosis, spreads in lymph and blood
-reduced acid and atrophy predisposing(?)
-Tx: surgery
Small intestinal neoplasm:
-not common
-possible degree of obstruction dt severity
Colonic polyps:
-risk factor for cancer is 20%
-sessile (permanently attached) or pedunculated (stalk-like)
-Dx using endoscopic evaluation
-Tx required
Colon cancer:
-require high fat, low fiber diet
-commonly caused by Crohn's disease, adenomatous polyps, ulcerative colitis
-severity related to location of tumor in large intestine
Tx for colon cancer:
1. Dukes classification
2. resection (surgical removal)
3. colonostomy
4. chemotherapy