-
Non-absorbable substance in intestine that causes excess fluid shift into intestine, increasing fluidity of stool.
Osmotic Diarrhea
-
Lactose deficiency is an example
Osmotic Diarrhea
-
Due to excessive secretion of fluids by intestinal mucosa secondary to foreign invasion of organisms or toxins.
Secretory Diarrhea
-
E.Coli infections is an example of this type of dirrhea.
Secretory Diarrhea
-
What are the 4 types of diarrhea and what do they run the risk of causing?
- Osmotic, Secretory, Motility, Malabsorption
Consequences: Dehydration, Electrolyte Imbalance, Metabolic Acidosis, Weight Loss
-
Conditions that impair autonomic nervous system innervation of the bowel (ie spinal cord), major cause of which type of diarrhea?
Motility Diarrhea
*Caused by conditions that either increase or decrease bowel motility
-
Conditions that cause chronic inflammation of bowels like ulcerative colitis or Crohn's disease and is a major cause of which type of Diarrhea?
Motility Diarrhea
*Caused by conditions that either increase or decrease bowel motility
-
Upper GI bleeding
-located
- caused by
- - Located in the esophagus, stomach, or duodenum
- - Caused by bleeding varices or uclers
-
Lower GI bleeding
- Location
- Causes
- -Jejunum, ileum, colon, and/or rectum
- - Caused by polyps, inflammatory diseases, cancer or hemorrhoids
-
What are the acute manifestations of GI bleeding?
- Hematemasis
- Melena (dark, tarry stools)
- Hematochezia (frank bleeding from rectum)
- *Blood loss leads to hypovolemia and anemia
-
What are the chronic manifestations of GI bleeding?
Occult bleeding (undetectable by the naked eye)
-
Motility Disorders include:
- 1. Dysphagia
- 2. GERD
- 3. Hiatal hernia
-
Dysphagia
Impaired or difficulty swallowing
-
Etiology and Symptoms of Dysphagia
- Eti= Mechanical obstruciton
- Sx= vary and may be progressive, pain, aspiration
-
How do we diagnose Dysphagia...
- 1. History and Physical
- 2. Barium Swallow
- 3. Manometry
- 4. Endoscopy- visualization, biopsy
-
Treatment of Dysphagia =
- - Slowed eating
- - Postion during eating
- - Enteral nutrition
- - Drugs
- - Mechanical dilation
- - Myotomy
-
What does GERD stand for?
- GastroEsophogeal Reflux Disease
- -reflux of chyme from stomach to esophagus
-
Etiology and Clinical Manifestations of GERD
Etiology: Relaxation of lower esophogeal sphincter, delayed gastric emptying
Clinical Mani: Inflammation of esophagus, Heartburn/pain, Strictures, Spasms, Dysphagia
-
How do we diagnose GERD?
- - symptoms, endoscopy, barium swallow
- - pH monitoring (instead of manometry like dysphagia)
-
Treatment of GERD...
- -Antacid, Proton pump inhibitor (prilosec)
- -Elevate HOB , remain upright 30 minutes after eating
- -Weight reduction
- - Not smoking
- - Fundoplication
-
A protuberance of the upper stomach through the diaphragm, into the thorax.
- Hiatal Hernia
- (a diaphragmatic hernia)
-
GERD and dysphagia are clinical manifestations of this disorder as well as pain although it is often asymptomatic.
Hiatal Hernia
-
Symptoms of Hiatal Hernia are exacerbated by :
- Coughing, belching, tight clothing, ascites, obesity, pregnancy
-
What is the definition of Intestinal Obstruction?
Acute or chronic condition that prevents movement of chyme through the intestinal lumen. Obstruction can be partial or complete.
-
What are the different types of intestinal obstructions?
- -Herniation
- -Intussusception
- -Torsion (volvulus)
- -Paralytic ileus
- -Adhesions
-
What are the consequences of Intestinal Obstruction?
- - Inability to move contents through the GI tract (clogged)
- - Pain due to gas or severe distention > Decreased O2 to bowel lumen > Bowel necrosis
- - Electrolyte imbalance (hypokalemia)
- - Dehydration
-
Protrusion of intestine through muscular wall of abdomen or inguinal ring
Herniation
-
Telescoping of one part of the intestine into another part of the intestine, Blood supply is occluded.
Intussusception
-
What is another name for torsion and how would you describe it?
- Volvulus.
- Twisting of the intestine causing occlusion of blood supply to intestine.
(Intestinal Obstruction)
-
Loss of peristalsis associated with surgery, peritonitis, narcotics, hypokalemia, ischemic bowel, spinal trauma, pneumonia.
Paralytic Illeus
-
Scarring within the lumen or structures that attach to the lumen
Adhesion
-
What are the clinical manifestations associated with intestinal obstruction?
i. Intermittent colicky pain and vomiting
ii. Increased pain with peristalsis
iii. When ischemia occurs -> pain becomes constant and severe. Perforation, sepsis, shock more likely
-
What are the inflammatory disorders of the gut?
- 1. Gastritis
- 2. Peptic Ulcer Disease
- 3. Stress Ulcers
- 4. Inflammatory bowel disease- Ulcerative colitis and Crohn's
- 5. Diverticular Disease
- 6. Appendicitis
-
Inflammation of gastric mucosa resulting in edema and possible degenerative changes in the epithelial tissue of the mucosa
Acute and chronic Gastritis
-
What does PUD stand for?
What is the most common type?
Peptic Ulcer Disease
Duodenal and Gastric
-
A break or ulceration in the mucosal lining of the esophagus, stomach, or duodenum resulting in auto-digestion of the stomach.
Peptic Ulcer Disease
-
What are the risk factors associated with PUD?
H. pylori -- Primary cause
Habitual use of NSAIDS
Alcohol
Chronic Illness
-
What is the acute form of PUD?
- Stress ulcers- develop within hours
- 1. Cushings (Vagal nerve stim- neural injury)
- 2. Curlings ( burns)
- 3. Ischemic
formation accompanied by severe illness, systemic trauma, neural injury or burns
-
What is Ulcerative Colitis and who's at risk of this?
Chronic inflammatory disease that causes ulceration of mucosa of large colon (usually sigmoid or rectum)
>Auto-immune disorder<
- - young adults esp women, jewish, caucasion
- - onset btwn 15-30 and again 50-70
-
What is the goal for treatment of ulcerative colitis?
To control the inflammation, replace nutritional losses and blood volume and prevent complications.
-
Idiopathic inflammatory disorder that affects any part of GI tract from mouth to anus, entire thickness of intestinal wall may be affected
Crohn's disease
-
Outpouching of intestinal mucosal through intestinal wall.
Diverticular Disease
-
What are some complications of Diverticular Disease?
- wall thins and can break (perforate)
- Peritonitis - inflam of the peritoneum
-
Inflammatory diverticular disease
Diverticulitis
-
What is the Law of Laplace?
As wall pressure increases, diameter of bowel decreases. Increased pressure forces herniation of mucosa through muscle wall of intestine.
-
What is inflammation of "veriform" appendix called and who is at greatest risk?
- Appendicitis
- - men between puberty-25
-
What is the definition of Hepatitis?
- Acute or Chronic Inflammation or infection of the liver.
- Hepatitis type A, B, or C
-
What are the phases of viral hepatitis?
- 1. Prodromal - flulike Sx
- 2. Icteric - jaundice and itching MOST COMMUNICABLE during this phase
- 3. Recovery "post-icteric"- may take several wks or months to recover
-
What is Fulminating Hepatitis?
- Severe liver impairment, cellular necrosis, and liver failure
- A complication of type B and C
-
What is the yellow pigmentation of skin caused by hyperbilirubinemia?
Jaundice
-
What is the etiology of Jaundice?
- - Liver or bile disease
- - Bile duct obstruction
- - Excessive RBC hemolysis
|
|