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Clinical Manifestations of GI dysfunction include:
- anorexia
- vomiting
- nausea
- projectile vomiting
- consstipation
- diarrhea
- abdominal pain
- GI bleeding
- hematemesis
- hematochezia
- melena
- occult bleeding
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Anorexia:
a lack of desire to eat
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Vomiting:
the forceful emptying of the stomach and intestinal contents through the mouth
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Nausea:
- a subjective experience that is associated with a number of conditions
- retching (dry heave)
- nonproductive vomiting
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Projectile vomiting:
spontaneous vomiting
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Constipation:
infrequent or difficult defecation
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Diarrhea:
- increased frequency of bowel movements
- increased volume, fluidity, weight of the feces
- 3 mechanisms of diarrhea=
- --osmotic
- --secretory
- --motility
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Abdominal pain:
- parietal pain
- visceral pain
- referred pain
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Parietal Pain:
localized intense
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Visceral Pain:
poorly localized, diffuse, vague
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Referred Pain:
well localized
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Gastrointestinal Bleeding:
- upper GI or lower GI
- can be LIFE THREATENING
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Upper GI bleeding:
esophagus, stomach, or doudenum
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Lower GI bleeding:
jejunum, ileum, colon, rectum
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Hematemesis:
- bloody vomitus
- (bright red blood or coffee grounds)
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Hematochezia:
bright red stools
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Melena:
blakc or tarry stools
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Occult Bleeding:
trace amounts of blood in stool (detectable only with guaiac test)
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Disorders of Motility include:
- Dysphagia
- Achalasia
- GER
- NERD
- Hiatal Hernia
- Pyloric Obstruction
- Intestinal Obstruction
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Dysphagia:
- difficulty swallowing
- types: mechanical or functional obstructions
- Causes: stroke, esophageal cancer, and scleroderma
- S/S: choking, coughing, c/o food sticking to throat when swallowing
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Achalasia:
- Denervation of smooth muscle in the eesophagus and lower esophageal sphincter relaxation (sphincter fails to relax)
- food has difficulty passing into the stomach; esophagus above sphincter becomes enlarged
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Gastroesophageal Reflux (GER)
- reflux of chyme from stomach to esophagus
- (backward movement of gastric contents into esophagus, causing heartburn)
- the LES relaxes spontaneously after eating and allows gastric contents to regurgitate
- Most common disorder originating in the GI tract
- conditions that increase abdominal pressure can contribute to GER (coughing, vomiting, straining at stool)
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reflux esophagitis:
inflammation of the esophagus cause by GER
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Manifestations of GER
- Heartburn (most frequent) occuring 30-60 minutes after eating; worse by bending over; relieved by sitting straight up
- Acid regurgitation
- upper abdominal pain within 1 hour of eating
- dysphagia
- belching
- wheezing, chronic cough and hoarseness (resp. s/s)
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GER is exacerbated by:
nicotine, caffeine, fatty foods, chocolate, coffee
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Nonerosive Reflux Disease (NERD)
heartburn symptoms without mucosal injury and inflammation
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Hiatal Hernia:
- development of an abnormal gap around the wall of the esophagus
- leads to herniation of stomach into the thoracic cage
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Two Type of Hiatal Hernias:
- Sliding Hiatal Hernia
- Paraesophageal Hiatal Hernia
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Hiatal Hernias often occur with these other diseases:
- reflux esophagitis
- peptic ulcer
- cholecystitis
- cholelithiasis
- chronic pancreatitis
- diverticulosis
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Pyloric Obstruction
- the blocking or narrowing of the opening between the stomach and the duodenum
- can be acquired or congenital
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Manifestations of Pyloric obstruction:
- epigastric pain and fullness
- nausea
- succusion splash (rolling or jarring of abd.)
- vomiting
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Prolonged pyloric obstructions:
malnutrition, dehydration, and extreme debilitation
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Intestinal Obstructions:
- simple obstruction: mechanical blockage
- Functional obstruction: failure of motility
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Paralytic ileus:
failure of motility (often occurs after surgery)
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Manifestations of Intestinal Obstruction:
- abdominal distention
- loss of fluid and electrolytes
- distention
- CARDINAL SX: colicky pain followed by vomiting
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Inssusception
- cause of obstruction
- most common in children under 2; telescoping of the terminal ileum into the right colon most common
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Gastritis:
- inflammatory disorder od the gastric mucosa
- Acute or chronic gastritis
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Acute Gastritis:
- erodes epithelium surface (mucosal barrier)
- superficial erosions
- associated with local irritants
- --bacterial enterotoxins
- --alcohol
- --aspirin
- Aspirin causes heartburn or sour stomach
- Excessive alcohol consumption causes transient gastric distress, vomiting, bleeding and hematemesis
- Staphylococcal enterotoxins manifest with abrupt and violent onset usually 5 hours after ingestion of contaminated food source
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Chronic Gastrits:
- causes thinning and degeneration of stomach wall
- absence of grossly visible erosions
- presence of chronic inflammatory changes
- atrophy of the glandular epithelium of the stomach
- H-pylori gastritis-most common non-erosive gastritis
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Peptic Ulcer Disease:
- a break or ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum
- acute and chronic ulcers
- superficial (erosions)
- deep (true ulcers)
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Peptic Ulcer Disease(cont.):
- duodenal and gastric
- major causes: H. pylori infection
- treated with NSAIDs
- duodenal ulcers occur more frequently and typically seen in early adulthood
- gastric ulcers affect the older older population (55-65)
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Duodenal Ulcers:
- most common of peptic ulcers
- early adulthood
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Developmental Factors of Duodenal Ulcers:
- toxins and enzymes that promote inflammation and ulceration
- hypersecretion of stomach acis and pepsin
- use of NSAIDs
- high gastrin levels
- acid production by cigarette smoking
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Complications of Duodenal Ulcers
- Bleeding
- Perforation (duodenal wall destruction)
- Obstruction (edema, scarring)
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Gastric Ulcers:
- develop in the antral region of the stomach, adjacent to acid-secreting mucosa of body
- Patho:
- primary defect=increased mucosal permeability to hydrogen ions
- gastric secretions=normal or less than normal
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Manifestations of PUD:
- Discomfort and pain(burning, gnawing, or cramp-like) usually rhythmic and frequently occurs when the stomach is empty
- Midline near the xiphoid and may radiate below the costal margins into the back or rarely to the right shoulder
- Pain is relieved by food or antacids (but food may cause pain immediately after eating)
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Gastric Ulcers cause more:
anorexia, vomiting, and weight loss than duodenal ulcers
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Stress Ulcers:
- peptic ulcer related to severe illness, neural injury, or systemic trauma
- -ischemic-burn injury
- -cushing-head trauma or brain injury
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Postgastrectomy Syndromes:
- Dumping Syndrome
- Alkaline reflux gastritis
- afferent loop obstruction
- diarrhea
- weight loss
- anemia
- bone disorders
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Dumping Syndrome:
- the rapid emptying of chyme from a surgically created residual stomach into the small intestine
- a clinical complication of partial gastrectomy or pyloroplasty
- S/S: cramping pain, nausea, vomiting, osmotic diarrhea, weakness, pallor, hypotension
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