1. clinical manifestations of GI dysfunction
    • anorexia
    • vomiting (projectile)
    • retching
    • constipation 
    • diarrhea
    • abdominal pain
    • GI bleeding
  2. vomiting begins with ____________ and the _________ closes to close airway
    • deep inspiration 
    • glottis
  3. 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
  4. presence of nonabsorbable substances in instestine can cause water to be drawn into lumen by osmosis. Causes large-volume diarrhea
    osmotic diarrhea
  5. most common cause of osmotic diarrhea
    lactase deficiency
  6. caused by excessive mucosal secetion of fluid and electrolytes ( caused by bacterial endotoxins or E. coli)
    secretory diarrhea
  7. decreased transit time, mucosal surface contact and fluid absorbed (caused by resection of small intestine)
    motility diarrhea
  8. Caused by infammatory disorders of small intestine or fecal impaction from sever constipation
    small volume dirrhea
  9. hematochezia
    frank bleeding from rectum
  10. melena
    dark tarry stools
  11. hematemesis
    blood in vomit
  12. slow, chronic blood loss that results in iron deficiency anemia as iron stores in bone marrow slowly deplete
    occult bleeding
  13. caused by esophageal obstruction, impaired esophageal motlity, or achalasia (denervation of smooth muscle in esophagus or muscle cell atrophy)
  14. manifestations of GERD
    regurgitation of chyme within 1 hr of eating
  15. what is caused by increaed abdominal pressure, ulcers, pyloric edema and strictures, hiatal hernia, lower esophageal sphincter incompetent
  16. protrusion upper stomach through diaphragm into thorax
    hiatal hernia
  17. hiatal hernia caused by
    • cogenitally short esophagus
    • trauma
    • weak diaphragmatic muscles at GE junction
    • Increased abdominal pressure
  18. Manifestations of hiatal hernia
    • GE reflux
    • dysphagia
    • epigastric pain
  19. Intestinal obsruction def
    impaired chyme flow through interstinal lumen
  20. What is caused by hernia, telescoping of one part of intestine into another, twisting, inflamed diverticula, tumor growth, loss of peristalic activity
    intstinal obstruction
  21. Manifestations of intestinal obsruction
    • colicky pain to sever constant pain
    • vomiting
    • diarrhea
    • constipation
    • dehydration
    • hypovolemia
    • acidosis
  22. intestinal obstruction causes
    decreased nutrient absorption
  23. antiinflammatory drugs can cause acute _______ by
    • gastritis
    • eroding epithelium by inhibiting prostaglandins that normally stimulate secretion of protective mucus
  24. alcohol, histamine, digitalis are all contributing factors in
    acute gastritis
  25. __________ tends to occure in elderly individuals due to thinning and degeneration of stomach wall
    chronic gastritis
  26. _______ chronic gastritis more severe b/c
    • fundal
    • gastric mucosa degenerates extensively
  27. __________ chronic gastritis more frequent and often due to
    • antral 
    • h. pylori
  28. 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
  29. risk factors of PUD
    • smoking
    • habitiual NSAID or alcohol
    • some chronic diseases (emphysema, RA, cirrhosis)
    • infection of gastric and duedenal mucosa with H. pylori
  30. features of duodenal ulcers
    • 25-40 years
    • men
    • h. pylori usually presnet
    • almost never malignancy
    • increased acid production 
    • pain-food-releif
    • hemmorage common
  31. 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
  32. postgastrectomy syndromes
    • dumping syndrome
    • alkaline reflux
    • afferent loop obstruction
    • diarrhea
    • weight loss
    • anemia
  33. rapid emptying of hypertonix chyme from surgically reduced stomach into small intestine 10-20 min after eating
    dumping syndrome
  34. inflammation caused by reflux of bile and alkaline pancreatic secretions that contain proteolytic enxymes that disrupt mucosal barrier
    alkaline refulx
  35. volvus, hernia, adhesion, stenosis in duodenal stump on proximal side of surgery
    afferent loop obstruction
  36. weight loss after gastrectomy is because
    cant tolerate carbs or normal sized meals
  37. interfere with nutrient absorption in small intestine. failed or faulty digestion because of deficiencies in chemical enzymes
    malaborption syndrome
  38. maldigestion is the result of
    mucosal disruption caused by resection, vascular disorders, or intestinal disease
  39. pancreatic insufficency
    defficent lipase production, amylase, trypsin or chymotrypsin
  40. lactase deficiency inhibits breakdown of lactose into
    monosaccharides in intestinal wall
  41. undigested lactose remains in intestine where
    bacterial fermentation causes flatulence and distention from formed gases
  42. What are two chronic relapsing inflammatory bowel diseases of unknown etiology
    • chrones
    • ulcerative colitis
  43. which disease as lesions on large intestine, mucosal layer involved, with NO skip lesions
    ulcerative colitis
  44. Ulcerative colitis is ________ prone to family history
  45. bloody diarrhea with abdm pain common in
    ulcerative colitis
  46. ulcerative colitis has __________ cancer risk
  47. crohns disease has a common
    positive family history
  48. which disease has lesions in large OR small intestine, with SKIP lesions and the entire intestinal wall is involved
  49. granulomas common in
  50. anal and perianal fistulas and abscesses common in
  51. narrowed lumen and possible obstruction common in
  52. abdominal mass, small intestine malabsorption and steatorrhea common in
  53. what is asymptomatic diverticular disease
  54. ________ is symptomatic inflammation of diverticuli
  55. Most frequent site of diverticulitis
    sigmoid colon at weak pints in colon wall where arteries penetrate muscularis
  56. Wall pressure increases as diameter of lumen decreases from swelling in which disorder
  57. In diverticulitis, prsesure can increase enough to
    rupture diverticula and cause abcess formation or peritonitis
  58. most common cause of appendicitis
    • obstructino of lumen with feces 
    • tumors
    • foreign bodies followed by bacterial infection
  59. Leukoyctosis and low grade fever
  60. Functional disorder
    lower abd pain
    predominant or alternating diarrhea/constipation
    gas bloating
    no cureq
    irritable bowel
  61. What results from dissecting aortic aneurysms or emboli arising form cardiac alterations
    acute occlusion of mesenteric artery
  62. in an acute occlusion of mesenteric artery, ishemic and damaged intestinal mucosa cannot produce enough
    mucus to protect iteslf from digestive enzymes
  63. what causes and who is susceptible for chronic mesenteric insufficency
    from any condition that decreases arterial blood flow

    elderly with atheriosclerosis particularly susceptbile
  64. leptin and insulin decrease appetite by
    inhibiting neurons that stimulate eating, decrease motabolism and promote catabolism
  65. which hormones control appetite and body weight
    • insulin
    • ghrelin from stomach
    • peptide YY from intestines
    • leptin, adiponectin and resistin from adipocytes of adipose tissue
  66. 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
  67. decreased dependence on gluconeogensis and increased use of products from lipid and pyruvates
    long term starvation
  68. marasmus
    protein energy malnutrition
  69. kwashiorkor
    carb intake w/o protein intake
  70. caused by obstrution or impeded blood flow in portal venous system or vena cava
    portal hypertension
  71. cirrhosis
    viral hepatitis
    parasitic infections
    hepatic vein thrombosis
    right side heart failure
    portal hypertension
  72. manifestations of portal hypertension
    • esophageal and stomach varices with bloody vomit
    • splenomegaly
    • thrombocytopenia
    • ascitis with diaphragm displacement
    • hepatic encephalopathy with cognitive impairment
    • trem
    • or
  73. blood that contains toxins such as ammonia is shunted from GI tract to systemic circulation, toxins reach brain
    hepatic ncephalopathy
  74. manifestations of hep. encephalopathy
    • subtle changes in cerebral function
    • confusion
    • tremor of hands
    • stupor
    • convulsions
    • coma
  75. unconjugated bilirubin
    hemolytic jaundice
  76. conjugated bilirubin
    obstructive jaundice
  77. both unconjugated and conjugated bilirubin
    hepatocelluar and intrahepatic disease, obstruction by bile calculi, genetic enzyme defects or infections
  78. manifestations of jaundice
    • dark urine
    • light-colored stools
    • anorexia
    • malaise
    • fatigue
    • pruritis
  79. hepatic cell necrosis 
    Kupffer's cell hyperplasia
    infiltrations of monocyetes
    viral hep
  80. prodromal phase of viral hep
    begins about 2 weeks after exposure and ends with appearance of jaundice
  81. begins about 1-2 weaks after prodromal phase and lasts 2-6 weeks. Actual phase of illness in viral hep.
    icteric phase
  82. recovery phase viral hep.
    begins with resolution of jaundice at 6-8 weeks after exposure
  83. 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
  84. Fluminant hepatitis can be caused by _______________, is _____________, and requires _______________
    • acetaminophen
    • irreversible
    • liver trans
  85. cirrhosis is
    irreversible inflammation
  86. cause of primary biliary cirrhosis
  87. cause of secondary biliary cirrhosis
    obstrution by neoplasms
  88. postnecrotic cirrhosis
    • viral hep due to hep C, drugs, other toxins. 
    • Consequence of chronic and sever liver disease
  89. Cholelithiasis
    gallstone formation
  90. 2 types of cholelithiasis
    choleterol and pigmented
  91. cholelithiasis and cholecystitis associated with.... perfered treatment
    • epigastric and R hypocondrium pain 
    • Jaundice

    Laproscopic cholystectomy is perfered treatment
  92. choleycytitis is almost always caused by
    lodging of gallstone in cycstic duct
  93. risk factors and symptoms of esophagus cancer
    malnutrition and alcohol 

    CP and dysphagia
  94. risk factors and symptoms of stomach cancer
    dietary salty foods, nitrates, h. pylori

    anorexia, malaise, OB
  95. risk factors and symptoms colorectal cancer
    • chromosomal deletions
    • polyps

    • pain
    • anemia
  96. rsk factors and signs of liver cancer

    pain, anorexia
  97. Rsk factors and signs of gallbladder cancer
    • cholelithiasis
    • cholecystitis

    steady RUQ pain, diarrhea
  98. risk factors and signs and symptoms of pancreatic cancer
    • chronic pancreatitis 
    • cig smoking

    weight loss, weakness
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