-
clinical manifestations of GI dysfunction
- anorexia
- vomiting (projectile)
- retching
- constipation
- diarrhea
- abdominal pain
- GI bleeding
-
vomiting begins with ____________ and the _________ closes to close airway
-
What is not preceded by nausea or retching, caused by direct stimulation of vomiting center in brain by neurologic leseions, IICP, tumors or aneurysms
projective vomiting
-
presence of nonabsorbable substances in instestine can cause water to be drawn into lumen by osmosis. Causes large-volume diarrhea
osmotic diarrhea
-
most common cause of osmotic diarrhea
lactase deficiency
-
caused by excessive mucosal secetion of fluid and electrolytes ( caused by bacterial endotoxins or E. coli)
secretory diarrhea
-
decreased transit time, mucosal surface contact and fluid absorbed (caused by resection of small intestine)
motility diarrhea
-
Caused by infammatory disorders of small intestine or fecal impaction from sever constipation
small volume dirrhea
-
hematochezia
frank bleeding from rectum
-
-
hematemesis
blood in vomit
-
slow, chronic blood loss that results in iron deficiency anemia as iron stores in bone marrow slowly deplete
occult bleeding
-
caused by esophageal obstruction, impaired esophageal motlity, or achalasia (denervation of smooth muscle in esophagus or muscle cell atrophy)
dysphagia
-
manifestations of GERD
regurgitation of chyme within 1 hr of eating
-
what is caused by increaed abdominal pressure, ulcers, pyloric edema and strictures, hiatal hernia, lower esophageal sphincter incompetent
GERD
-
protrusion upper stomach through diaphragm into thorax
hiatal hernia
-
hiatal hernia caused by
- cogenitally short esophagus
- trauma
- weak diaphragmatic muscles at GE junction
- Increased abdominal pressure
-
Manifestations of hiatal hernia
- GE reflux
- dysphagia
- epigastric pain
-
Intestinal obsruction def
impaired chyme flow through interstinal lumen
-
What is caused by hernia, telescoping of one part of intestine into another, twisting, inflamed diverticula, tumor growth, loss of peristalic activity
intstinal obstruction
-
Manifestations of intestinal obsruction
- colicky pain to sever constant pain
- vomiting
- diarrhea
- constipation
- dehydration
- hypovolemia
- acidosis
-
intestinal obstruction causes
decreased nutrient absorption
-
antiinflammatory drugs can cause acute _______ by
- gastritis
- eroding epithelium by inhibiting prostaglandins that normally stimulate secretion of protective mucus
-
alcohol, histamine, digitalis are all contributing factors in
acute gastritis
-
__________ tends to occure in elderly individuals due to thinning and degeneration of stomach wall
chronic gastritis
-
_______ chronic gastritis more severe b/c
- fundal
- gastric mucosa degenerates extensively
-
__________ chronic gastritis more frequent and often due to
-
PUD result in
break or ulceration in protective mucosal lining of lower esophagus stomach or duodenum
breaks expose submucosal area to gastic secretions and autodigestion
-
risk factors of PUD
- smoking
- habitiual NSAID or alcohol
- some chronic diseases (emphysema, RA, cirrhosis)
- infection of gastric and duedenal mucosa with H. pylori
-
features of duodenal ulcers
- 25-40 years
- men
- h. pylori usually presnet
- almost never malignancy
- increased acid production
- pain-food-releif
- hemmorage common
-
features for gastric ulcers
- 50-70 years
- no sex difference
- h. pylori may be present
- malignancy possible
- acid normal to low
- pain-food-relief
- uncommon nocturnal pain
- hemmorhage less common
-
postgastrectomy syndromes
- dumping syndrome
- alkaline reflux
- afferent loop obstruction
- diarrhea
- weight loss
- anemia
-
rapid emptying of hypertonix chyme from surgically reduced stomach into small intestine 10-20 min after eating
dumping syndrome
-
inflammation caused by reflux of bile and alkaline pancreatic secretions that contain proteolytic enxymes that disrupt mucosal barrier
alkaline refulx
-
volvus, hernia, adhesion, stenosis in duodenal stump on proximal side of surgery
afferent loop obstruction
-
weight loss after gastrectomy is because
cant tolerate carbs or normal sized meals
-
interfere with nutrient absorption in small intestine. failed or faulty digestion because of deficiencies in chemical enzymes
malaborption syndrome
-
maldigestion is the result of
mucosal disruption caused by resection, vascular disorders, or intestinal disease
-
pancreatic insufficency
defficent lipase production, amylase, trypsin or chymotrypsin
-
lactase deficiency inhibits breakdown of lactose into
monosaccharides in intestinal wall
-
undigested lactose remains in intestine where
bacterial fermentation causes flatulence and distention from formed gases
-
What are two chronic relapsing inflammatory bowel diseases of unknown etiology
- chrones
- ulcerative colitis
-
which disease as lesions on large intestine, mucosal layer involved, with NO skip lesions
ulcerative colitis
-
Ulcerative colitis is ________ prone to family history
less
-
bloody diarrhea with abdm pain common in
ulcerative colitis
-
ulcerative colitis has __________ cancer risk
increased
-
crohns disease has a common
positive family history
-
which disease has lesions in large OR small intestine, with SKIP lesions and the entire intestinal wall is involved
chrons
-
granulomas common in
chrons
-
anal and perianal fistulas and abscesses common in
chrons
-
narrowed lumen and possible obstruction common in
chrons
-
abdominal mass, small intestine malabsorption and steatorrhea common in
chrons
-
what is asymptomatic diverticular disease
diverticulosis
-
________ is symptomatic inflammation of diverticuli
diverticulitis
-
Most frequent site of diverticulitis
sigmoid colon at weak pints in colon wall where arteries penetrate muscularis
-
Wall pressure increases as diameter of lumen decreases from swelling in which disorder
diverticulitis
-
In diverticulitis, prsesure can increase enough to
rupture diverticula and cause abcess formation or peritonitis
-
most common cause of appendicitis
- obstructino of lumen with feces
- tumors
- foreign bodies followed by bacterial infection
-
Leukoyctosis and low grade fever
apendecytis
-
Functional disorder
lower abd pain
predominant or alternating diarrhea/constipation
gas bloating
nausea
no cureq
irritable bowel
-
What results from dissecting aortic aneurysms or emboli arising form cardiac alterations
acute occlusion of mesenteric artery
-
in an acute occlusion of mesenteric artery, ishemic and damaged intestinal mucosa cannot produce enough
mucus to protect iteslf from digestive enzymes
-
what causes and who is susceptible for chronic mesenteric insufficency
from any condition that decreases arterial blood flow
elderly with atheriosclerosis particularly susceptbile
-
leptin and insulin decrease appetite by
inhibiting neurons that stimulate eating, decrease motabolism and promote catabolism
-
which hormones control appetite and body weight
- insulin
- ghrelin from stomach
- peptide YY from intestines
- leptin, adiponectin and resistin from adipocytes of adipose tissue
-
several days of total dietary abstinence
glycocen in liver is converted to glucose
peaks 4-8 hr after glycogenolysis and gluconeogenesis in liver begins by formation of glucose from noncarb molecules
short term starvation
-
decreased dependence on gluconeogensis and increased use of products from lipid and pyruvates
long term starvation
-
marasmus
protein energy malnutrition
-
kwashiorkor
carb intake w/o protein intake
-
caused by obstrution or impeded blood flow in portal venous system or vena cava
portal hypertension
-
cirrhosis
viral hepatitis
parasitic infections
hepatic vein thrombosis
right side heart failure
portal hypertension
-
manifestations of portal hypertension
- esophageal and stomach varices with bloody vomit
- splenomegaly
- thrombocytopenia
- ascitis with diaphragm displacement
- hepatic encephalopathy with cognitive impairment
- trem
- or
-
blood that contains toxins such as ammonia is shunted from GI tract to systemic circulation, toxins reach brain
hepatic ncephalopathy
-
manifestations of hep. encephalopathy
- subtle changes in cerebral function
- confusion
- tremor of hands
- stupor
- convulsions
- coma
-
unconjugated bilirubin
hemolytic jaundice
-
conjugated bilirubin
obstructive jaundice
-
both unconjugated and conjugated bilirubin
hepatocelluar and intrahepatic disease, obstruction by bile calculi, genetic enzyme defects or infections
-
manifestations of jaundice
- dark urine
- light-colored stools
- anorexia
- malaise
- fatigue
- pruritis
-
hepatic cell necrosis
scarring
Kupffer's cell hyperplasia
infiltrations of monocyetes
viral hep
-
prodromal phase of viral hep
begins about 2 weeks after exposure and ends with appearance of jaundice
-
begins about 1-2 weaks after prodromal phase and lasts 2-6 weeks. Actual phase of illness in viral hep.
icteric phase
-
recovery phase viral hep.
begins with resolution of jaundice at 6-8 weeks after exposure
-
clinical syndrome resulting in sever impairment or necrosis of liver cells and potential liver failure. May occur as complications of hep C or B and is compounded by infectio with the delta virus
fluminant hepatitis
-
Fluminant hepatitis can be caused by _______________, is _____________, and requires _______________
- acetaminophen
- irreversible
- liver trans
-
cirrhosis is
irreversible inflammation
-
cause of primary biliary cirrhosis
unknown
-
cause of secondary biliary cirrhosis
obstrution by neoplasms
-
postnecrotic cirrhosis
- viral hep due to hep C, drugs, other toxins.
- Consequence of chronic and sever liver disease
-
Cholelithiasis
gallstone formation
-
2 types of cholelithiasis
choleterol and pigmented
-
cholelithiasis and cholecystitis associated with.... perfered treatment
- epigastric and R hypocondrium pain
- Jaundice
Laproscopic cholystectomy is perfered treatment
-
choleycytitis is almost always caused by
lodging of gallstone in cycstic duct
-
risk factors and symptoms of esophagus cancer
malnutrition and alcohol
CP and dysphagia
-
risk factors and symptoms of stomach cancer
dietary salty foods, nitrates, h. pylori
anorexia, malaise, OB
-
risk factors and symptoms colorectal cancer
- chromosomal deletions
- polyps
-
rsk factors and signs of liver cancer
HBV, HCV, HDV
pain, anorexia
-
Rsk factors and signs of gallbladder cancer
- cholelithiasis
- cholecystitis
steady RUQ pain, diarrhea
-
risk factors and signs and symptoms of pancreatic cancer
- chronic pancreatitis
- cig smoking
weight loss, weakness
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