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difficulty swallowing
dysphagia
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mechanical obstructions causing dysphagia
strictures
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dysorders of skeletal muscle of upper 1/3 of esophogus
functional dysphagia
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neural or muscular disorder that affects the lower 2/3 of esophogus
achalasia
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the reflux of chyme from the stomach to the esophagus
GERD
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2 risk factors of GERD
- hiatal hernia
- delayed gastric emptying
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most common type of hiatal hernia
sliding
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what 2 cells does the fundus contain
- parietal cells
- chief cells
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what are the parietal cells responsible for
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what are the chief cells responsible for
pepsinogens
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4 triggers of GERD
- vomiting
- coughing
- lifting
- bending
-
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dysphagia is associated with
- asthma, laryngitis, and chronic cough
- you are aspirating more
-
etiologies of GERD
- LES relaes 1-2 hr /p meal, permitting gastric contents to regurgitate into the esophagus
- acid is usually neutralized and contents may return to the stomach, sphincter tone restored
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GERD with symptoms of inflammation
reflux esophagitis
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the narrowing or blocking of the opening between the stomach and duodenum
pyloric obstruction
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when is pyloric obstruction more distressing
after eating and later in the day
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initial clinical manifestations of pyloric obstructions
vague epigastric fullnes
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later clinical manifestations of pyloric obstructions
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lack of muscle tone and motility
atony
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stomach sloshing if jarred
succusion splash
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cardinal sign of pyloric obstructions
vomiting
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7 treatments for pyloric obstructions
- drain gastric contents
- PPI
- rehydrate
- correct electrolytes
- surgery
- parenteral hyperalimentation of malnourished
- NOT BARIUM
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mechanical blockage of the lumen by a lesion
simple obstruction
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most common type of simple obstruction
in the small intestine due to adhesions
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obstruction type with a failure of motility (paralytic ileus)
functional obstructions
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7 causes of intestinal obstruction
- herniation
- intussusception
- torsion
- diverticulosis
- tumor
- paralytic ileus
- fibrous adhesions
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main cause of small bowel obstructions
adhesions 2ndary to abdominal surgery
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main cause of large bowel obstructions
colorectal cancer
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second leading cause of small bowel obstructions
hernia's
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ovarian cysts are relatively common and usually disappear without treatment, but can cause what
adhesions
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lower bowel obstructions can lead to
metabolic acidosis, b/c bicarbonate from pancreatic and bile cannot be reabsorbed
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as the condition of distension worsens what happens
hypokalemia becomes severe promoting acidosis and atony of intestinal wall
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cardiac symptoms of intestinal obstructions
- colicky pain (initially)
- followed by vomiting
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autonomic responses of intestinal obstruction
sweating, nausea, hypotension
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S & S of intestinal obstruction if strangulation
pain less colicky, more constant and severe as ischemia progresses to necrosis, or perforation
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if distension pushes up on the diaphragm what can occur
atelactasis and pneumonia
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3 treatments for intestinal obstructions
- decompress lumen with suction
- replace fluids and electrolytes
- surgery if strangulation or complete obstruction
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inflammatory of disorder of the gastric mucosa
gastic ans stress ulcers
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4 risk factors of gastritis and stress ulcers
- drugs (NSAIDS, alcohol, histamine, digitalis)
- chemicals
- metabolic disorders (uremia)
- helicobacter pylori
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erodes the surface epithelium in a diffuse or localized pattern
erosions are usually superficial
can occur as bleeding, stress-related gastritis in seriously ill ICU patients
acute gastritis
-
causes thinning and degeneration of stomach wall
chronic gastritis
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atrophic gastritis
most rare and severe
decrease
chief & parietal cells
pepsinogen
HCl
intrinsic factor --> pernicious anemia-->carcinoma
increase
elevated plasma gastrin
auto immune
fundal chronic gastritis
-
H. pylori is a major causative factor
bile reflux can contribute
antral chronic gastritis
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4 risk factors for peptic ulcer disease
- smoking
- H. pylori infection
- habitual use of NSAIDS or alcohol
- certain chronic diseases
- emphysema
- rhematoid arthritis
- cirrhosis
- stress
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often located in antral area of stomach or duodenum
H. pylori
high prolonged gastrin levels
rapid gastric dumping
peptic ulcer disease
-
occurs in the middle of the night when the stomach is empty
relieved byeating or antacid medications
dull gnawing ache
occurs 2 to 3 hrs after a meal
PUD
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tx of PUD
- antacids
- H2 antagonists
- PPIs
- antibiotics for H. pylori
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acute form of peptic ulcer
multiple sites of injury in stomach or duodenum
superficial lesion of epithelium
stress ulcer
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decreased mucosal blood flow
mucosal lining degenerates
allows stomach acid to diffuse back to mucosa
inflammation, ulceration
stress ulcer
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what is absent from a peptic ulcer that is seen in stress ulcers
scaring and thickening of blood vessels
-
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stress ulcer that has rapid development
ischemic
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stress ulcer associated with severe head injury
high incidence of perforation
cushings
-
ulcer developed of ischemia after a burn
curlings
-
is H. pylori involved with a stress ulcer
no
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the most common surgical emergency of the abdomen and affects 7-12% of the population
most common age 20-30 yo
appendicitis
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localized pain
rebound tenderness RLQ
obstruction with 2ndary distension and bacterial invasion of the wall
1/2 of the cases are not obstructed
appendicitis
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wound infection is the most common post-op complication
surgery and antibiotics
appendicitis
-
mucosal hypoxia
ulcerations
bacterial or other pathogens invade
inflammation and edema
thrombosis of luminal blood vessels
gangrene
perforation
peritonitis
appendicitis
-
S&S
localized pain
increase WBC cound
increase C-reactive protein
appendicitis
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3 arteries supplying the intestines and stomach
- celiac axis
- superior mesenteric artery
- inferior mesenteric artery
-
atherosclerotic lesions
thrombi
emboli
chronic mesenteric insufficiency
vascular insufficiency
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cardinal symptoms of mesenteric insufficiency: colicky abdominal pain after eating
mortality is high in accute occlusion
vascular insufficiency
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bowel ischemia
vascular insufficiency
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complication is abdominal angina
vascular insufficiency
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