-
A lack of a desire to eat despite physiologic
stimuli that would normally produce hunger
Anorexia
-
*The forceful emptying of the stomach and intestinal contents through the mouth
Vomitting
(Several types of stimuli initiate the vomiting reflex)
-
*A subjective experience that is associated with a number of conditions...the common symptoms of vomiting are hypersalivation and tachycardia
Nausea
-
Non-productive Vomitting
Retching
-
Spontaneous vomiting that does not follow nausea or retching
Projectile Vomitting
-
*Infrequent or difficult defecation
Constipation
-
Pathophysiology of Constipation
oNeurogenic disorders, functional or mechanical conditions, low-residue diet, sedentary lifestyle, excessive use of antacids, changes in bowel habits
-
*Increased frequency of bowl movements
*Increased volume, fluidity, weight of the feces
Diarrhea
-
Mechanisms of Diarrhea:
- -Osmotic diarrhea
- -Secretory diarrhea
- -Motility diarrhea
-
Motility Diarrhea
*controlled by the parasympathetic nervous system...when the amount of fluid and electrolytes entering the large intestine exceed 8liters of fluid
-
Abdominal Pain
- Abdominal pain is a symptom of a number of gastrointestinal disorders
- Parietal pain
- Visceral pain
- Referred pain
- **when assessing for abdominal pain, always visualize what is underneath the surface
-
Gastrointestinal Bleeding:
- *Upper gastrointestinal bleeding
- Esophagus, stomach, or duodenum
- *Lower gastrointestinal bleeding
- Below the ligament of Treitz, or bleeding from the jejunum, ileum, colon, or rectum...
- Hematemesis
- Hematochezia
- Melena
- Occult bleeding --> blood in the stool
-
Difficulty Swallowing
Dysphagia
-
Types of Dysphagia
- -Mechanical obstructions (something anotomically prohibiting the swallowing of food)
- -Functional obstructions (neurological (ex: stroke) problem that prevents swallowing of food)
-
Denervation of smooth muscle in the esophagus and lower esophageal sphincter relaxation
Achalasia
-
Major Symptom of Achalasia:
Acid Reflux
-
GER (Gastroesophogeal Reflux)
- **GER is the reflux of chyme from the stomach to the esophagus
- **If GER causes inflammation of the esophagus, it is called reflux esophagitis
- **A normal functioning lower esophageal sphincter maintains a zone of high pressure to prevent chyme reflux
-
Major Cause of GER
- *Increased abdominal pressure
- -Pregnancy
- -Ascites
- -Obesity
- -Hernia
-
Manifestations of GER
*Heartburn, regurgitation of chyme, and upper abdominal pain within 1 hour of eating
-
Disorders of Motility
- GER
- Hiatial Hernia
- Pyloric Obstruction
- Internal Obstruction
- Ileus
-
Seen around diaphragm, protruding through a muscle wall (can be pushed back in)
*can cause necrosis and gangrene if it is not treated
Sliding Hiatial Hernia
-
Blocking or narrowing of the opening between the stomach and the duodenum...can be acquired or congenital
Pyloric Obstruction
-
Manifestations of Pyloric Obstruction
*Epigastric pain and fullness, nausea, succussion splash, vomiting, and with a prolonged obstruction, malnutrition, dehydration, and extreme debilitation
-
Any condition that prevents the flow of chyme through the intestinal lumen or failure of normal intestinal motility in the absence of an obstructing lesion
Internal Obstruction
-
Obstruction of the intestines from small bowel obstruction or past surgery ((nothing is moving through))
Ileus
-
Obstruction that requires putting patient on regularized diet plan
Simple Obstruction
-
Removing part of the intestine
Anastomosis
-
Situation in which an anatomical problem is causing the obstruction
Functional Obstruction
-
**Inflammatory disorder of the gastric mucosa (stomach)
GASTRITIS
- Acute gastritis
- Chronic gastritis
- Chronic fundal gastritis
- Chronic antral gastritis
-
Losing of GI mucosa, no bleeding yet, beginning symptoms of heartburn
Erosion
-
Wearing away through the mucosa, muscle, sub-mucosa
**Long term medications and diet alterations
True Ulcer
-
oA break or ulceration in the protective
mucosal lining of the lower esophagus, stomach, or duodenum
oAcute and chronic ulcers
oSuperficial
-Erosions
oDeep
-True ulcers
Peptic Ulcer Disease
-
Most common of Peptic Ulcers
Duodenal Ulcers
-
Developmental factors of an Ulcer
- *Helicobacter pylori infection
- -Toxins and enzymes that promote inflammation and ulceration
- oHypersecretion of stomach acid and pepsin
- oUse of NSAIDs (ex: ibruproferens)
- oHigh gastrin levels
- oAcid production by cigarette smoking
-
Gastric ulcers tend to develop in the _____ region of the stomach, adjacent to the acid-secreting mucosa of the body
Antral
-
Pathophysiology of an Ulcer
*The primary defect is an increased mucosal permeability to hydrogen ions
*Gastric secretion tends to be normal or less than normal
-
Peptic ulcer that is related to severe illness, neural injury, or systemic trauma
Stress Ulcer
-
Examples of Stress Ulcers
- Ischemic ulcers
- -problem with the blood flow, necrosis to those areas, requires surgical intervention
- Cushing ulcers
- -Ulcers that develop as a result of a burn injury
-
Post-gastectomy Symptoms
oDumping syndrome
oAlkaline reflux gastritis
oAfferent loop obstruction
oDiarrhea
oWeight loss
oAnemia
-
Type of condition commonly seen in patients with gastectomy:
B12 Anemia (pernicious anemia)
-
The rapid emptying of chyme from a surgically created residual stomach into the small intestine
Clinical complication of partial gastrectomy or pyloroplasty surgery
Dumping Syndrome
-
Developmental Factors of Dumping Syndrome
-Loss of gastric capacity, loss of emptying control, and loss of feedback control by the duodenum when it is removed
-
Failure of the chemical processes of digestion
Maldigestion
-
Failure of the intestinal mucosa to absorb digested nutrients
Malabsorption
-
What is the primary problem with pancreatic disorders?
Fat Malabsorption (steatorrhea)
-
Pancreatic Insufficiency
- -Insufficient pancreatic enzyme production
- oLipase, amylase, trypsin, or chymotrypsin
-Causes include pancreatitis, pancreatic carcinoma, pancreatic resection, and cystic fibrosis
-Fat maldigestion is the main problem, so the patient will exhibit fatty stools and weight loss
-
Lactase Deficiency
-Inability to break down lactose into monosaccharides and therefore prevent lactose digestion and monosaccharide absorption
-Fermentation of lactose by bacteria causes gas (cramping pain, flatulence, etc.) and osmotic diarrhea
-
Bile Salt Deficiency
Conjugated bile salts needed to emulsify and absorb fats
Conjugated bile salts are synthesized from cholesterol in the liver
Can result from liver disease and bile obstructions
Poor intestinal absorption of lipids causes fatty stools, diarrhea, and loss of fat-soluble vitamins (A, D, E, K)
-
Fat Soluble Vitamin Deficiencies
- *Vitamin A
- oNight blindness
- **Vitamin D
- oDecreased calcium absorption, bone pain, osteoporosis, fractures
- ***Vitamin K
- oProlonged prothrombin time, purpura, and petechiae
-
People with vitamin K deficiencies are more prone to.....
Bleeding
***Stop anticoagulants, NO aspirin, limit physical activity, make very cautious judgments because bruises and bumps may lead to bleeding...Monitor patient diet [leafy green vegetables promote bleeding])
-
Inflammatory Bowel Disease
Chronic, relapsing inflammatory bowel disorders of unknown origin
- -Genetics --> family hx
- -Alterations of epithelial barrier functions
- -Immune reactions to intestinal flora
- -Abnormal T cell responses
-
Chronic inflammatory disease that causes ulceration of the colonic mucosa
Sigmoid colon and rectum
Ulcerative colitis
-
Suggested Causes of Ulcerative Colitis
- Infectious, immunologic (anticolon antibodies), dietary, genetic
- (supported by family studies and identical twin studies)
-
Symptoms of Ulcerative Colitis
Diarrhea (10 to 20/day), bloody stools, cramping
-
Treatment of Ulcerative Colitis
Broad-spectrum antibiotics and steroids
-Immunosuppressive agents
-Surgery
-
People with Ulcerative Colitis are at risk for ________?
Cancer
-
Granulomatous colitis, ileocolitis, or regional enteritis
Idiopathic inflammatory disorder; affects any part of the digestive tract, from mouth to anus
Difficult to differentiate from ulcerative colitis
**Similar risk factors and theories of causation as ulcerative colitis
Crohn's Disease
-
Effects of Crohn's Disease
-Ulcerations can produce longitudinal and transverse inflammatory fissures that extend into the lymphatics
- -Anemia may result from malabsorption of vitamin B12 and
- folic acid
**Treatment is similar to ulcerative colitis
-
*Out-pouching of the colon
*Herniations of mucosa through the muscle layers of the colon wall, especially the sigmoid colon
Diverticula
-
*Asymptomatic diverticular disease
Diverticulosis
-
*The inflammatory stage of diverticulosis
Diverticulitis
-
*Inflammation of the vermiform appendix
Appendicitis
-
Possible causes of Appendicitis:
*Obstruction, ischemia, increased intraluminal pressure, infection, ulceration, etc.
-
Pain and Complications associated with appendicitis
- -Epigastric and RLQ pain
- -Rebound tenderness
- **The most serious complication is peritonitis (can quickly turn into sepsis if not found and treated quickly)
-
Vascular Insuffieciency
- -Blood supply to the stomach and intestine
- Celiac axis
- Superior and inferior mesenteric arteries
- Two of three must be compromised to cause ischemia
- -Mesenteric venous thrombosis (blood clot in mesentary)
- -Acute occlusion of mesenteric artery blood flow
- -Chronic mesenteric arterial insufficiency
-
Increase in body fat mass
Body mass index greater than 30
A major cause of morbidity, death, and increased health care costs
Risk factor for many diseases and conditions
Obesity
-
What part of the brain can impact obesity
Hypothalamus
-
Hormones that control appetite and weight:
- *Insulin, ghrelin, peptide YY, leptin, adiponectin, and resistin
- (it takes A LOT of testing to identify hormone related obesity)
-
What factors are associated with Obesity
- Leptin resistance
- Hyperleptinemia
-
Characterized by abnormal eating behavior, weight regulation, and disturbed attitudes toward body weight, body shape, and size
Anorexia & Bulimia nervosa
-
Anorexia facts
-A person has poor body image disorder and refuses to eat
-Anorexic patients can lose 25% to 30% of their ideal body weight as a result of fat and muscle depletion
-Can lead to starvation-induced cardiac failure
-In women and girls, anorexia is characterized by the absence of three consecutive menstrual periods
-Binge eating/purging anorexia nervosa
-
Bulimia Facts
-Body weight remains near normal but with aspirations for weight loss
-Findings
-Recurrent episodes of binge eating
-Self-induced vomiting
- -Two binge-eating episodes per week for at least 3
- months
-Fasting to oppose the effect of binge eating, or excessive exercise
- -Continual vomiting of acidic chyme can cause pitted teeth,
- pharyngeal and esophageal inflammation, and tracheoesophageal fistulas
-Overuse of laxative can cause rectal bleeding
-
-Decreased caloric intake leading to weight loss
Starvation
-
A state of ill health, malnutrition, and wasting that may occur in many chronic diseases, malignancies, and infections
cachexia
-
Short Term Starvation activates:
- Glycogenolysis
- Gluconeogenesis
-
Long term Starvation leads to:
- oMarasmus ---> general wasting and lack of sc fat
- oKwashiorkor ---> protein/albumin deficiency...EDEMA
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