1. True or False. Most viral infections affect superficial epithelium of small intestine & disrupt absorptive function
  2. True or False. Clostridium difficile Colitis is usually acquired in the hospital.
  3. C.difficile is caused by a _____ spore forming bacillus.
    gram positive
  4. What is diverticulitis?
    Inflammation and gross or microscopic perforation of the diverticulum.
  5. How is diverticular disease diagnosed?
    History & clinical manifestations; avoid barium if suspect peritonitis
  6. What are the 3 most common complaints associated with diverticular disease?
    • -pain (lower left quadrant)
    • -nausea, vomiting, slight fever, elevated white count
    • -complications include perforation with peritonitis, abcesses
  7. How is diverticular diseases treated?
    • -treat symptoms
    • -increase bulk in diet which increases colon contents and decreases pressure
  8. _____ is characterized by excessive, frequent passage of stools.
  9. True or False. Diarrhea is the most common cause mortality in children younger than age 5 in developing countries.
  10. What causes acute diarrhea?
    Infectious agents
  11. How long does acute diarrhea last?
    Last less than 4 days
  12. What are 2 types of large volume diarrhea?
    • 1. Osmotic
    • 2. Secretory
  13. What happens in osmotic diarrhea?
    Water is pulled into the bowel by hyperosmotic pressure
  14. Osmotic diarrhea usually disappears with _____.
  15. When does osmotic diarrhea occur?
    When osmotically active particles are not absorbed
  16. When does secretory diarrhea occur?
    • 1.Eenteric organisms secrete toxins that stimulate fluid secretion (v. cholera, e.coli, rotavirus)
    • 2. Organisms destroy epithelial cells which alter fluid transport (halt absorption activity of bowel)
    • 3.Excess bile acids remain in the intestinal contents as they enter the colon
  17. _____ is characterized by the frequent passage of small stools.
    Small volume diarrhea
  18. ______ is characterized by frequency, urgency, colicky abdominal pain, tenesmus, fecal soiling of clothing, awakening at night with urge to defecate.
    Small volume diarrhea
  19. How is diarrhea treated?
    • 1. Replacement of fluid & electrolytes
    • 2. Meds (opiod agonists & adsorbents)
  20. Impairment of movement of intestinal contents in a cephalocaudal direction is referred to as _____.
    Intestinal obstruction
  21. _____ is the twisting of the bowel with possible impairment of blood flow.
  22. _____ is the telescoping of the bowel into adjacent segment (most commonly terminal ileum into right colon).
  23. Neurogenic or muscular impairment of peristalsis is known as _____.
    Paralytic (adynamic) obstruction
  24. Paralytic ileus may also occur secondary to:
    • 1. Ischemia of intestine
    • 2. Pelvic fractures & back injuries
    • 3. Chemical irritation from bile, bacterial toxins, electrolyte imbalances
  25. What are the 2 types of intestinal obstruction?
    Mechanical and paralytic
  26. What are the 4 major effects of both type of intestinal obstructions?
    • 1. Loss of fluid & electrolyte
    • 2. Abdominal distention
    • 3. Possible strangulation, gangrene, and perforation
    • 4. Rapid growth of anaerobes
  27. What are the 6 cardinal symptoms of intestinal obstruction?
    –pain, absolute constipation, abdominal distention, vomiting

    –“Borborygmus”- growling, rumbling (gas propulsion)

    –Visible peristalsis may appear along course of distension

    –Vomiting, fluid & electrolyte imbalances

    –Extreme restlessness, perspiration, anxiety

    –Strangulation –severe, steady pain
  28. _____ inflammation of the serous membrane that lines the abdominal cavity & covers the viscera.
  29. How the bacteria that causes peritonitits enter the body?
    Via a defect in the wall
  30. What are some of the most common causes for peritonitis?
    Perforated peptic ulcer, ruptured appendix, perforated diverticulum, gangrenous bowel, PID, gangrenous gall bladder, trauma, and wounds (stab, gunshot)
  31. Symtoms of malabsorption include:
    Diarrhea, bloating, flatulence, abdominal pain , cramps, steatorrhea (fatty, malodorous, yellow-gray stools)
  32. The ____ and _____ are the site of more primary neoplasms than any other organ in the body.
    Colon & rectum
  33. _____ are mucosal protuberances from the epithelial lining of the lumen of the colon and rectum.
    Adenomatous polyp
  34. True or False. Epithelial cell tumors of intestines are the major cause of mortality & morbidity worldwide.
  35. You have a higher risk for colon cancer if you:
    •Are older than 60

    •Are African American and eastern European descent

    •Eat a diet high in red or processed meat

    •Have cancer elsewhere in the body

    •Have colorectal polyps

    • •Have inflammatory bowel disease (Crohn’s or Ulcerative
    • colitis)

    •Have a family history of colon cancer

    •Have a personal history of breast cancer
  36. Congenital narrowing of the external meatus is known as _____.
    Meatal stenosis
  37. The 4 causes of urinary obstruction and stasis are:
    • 1. Meatal stenosis
    • 2. Posterior urethra
    • 3. Damage to sacral
    • 4. Meningomyelocele
  38. What is the cause of spastic bladder?
    • Conditions that produce neural damage above “micturation reflex center” in
    • sacral portion of the spinal cord.
  39. Involuntary loss of urine is known as ______.
    Urinary incontinence
  40. Involuntary loss of urine during laughing, coughing, sneezing, and lifting is _____.
    Stress incontinence
  41. What is the cause of stress incontinence?
    Pelvic floor weakness & poor support of the vesicourethral sphincter
  42. In women, stress incontinence is usually the result of _______.
    Loss of muscle tone associated with normal aging, childbirth, surgical procedures
  43. Involuntary loss of urine with a strong urge to void is known as____.
    Urge incontinence (overactive bladder)
  44. Symptoms of overactive bladder are:
    Urgency, frequency, dysuria, & nocturia
  45. Two causes of urge incontinence (overactive bladder):
    • -Neurogenic (involves CNS control bladder sensation & emptying)
    • - myogenic (spontaneous elevations in bladder pressure)
  46. Loss of urine that occurs when intravesicular pressure exceeds maximal urethral pressure is referred to as ____.
    Overflow incontinence
  47. With this type of incontinence, the bladder is distended and small amts. of urine pass (particularly at night), this is referred to as ______.
    Overflow incontinence
  48. ____ incontinence may occur with retention of secondary to the nervous system lesions or obstruction of bladder neck.
  49. The most frequent form of urinary tract cancer is ______.
    Urinary bladder cancer
  50. Two possible causes for urinary bladder cancer is:
    • 1. Carcinogens, chronic bladder infections, bladder stones
    • 2. Increased incidence in individuals harboring the “Schistoma haematobium” parasite (endemic to Egypt) that excretes a carcinoma
  51. Approx. 90% of urinary bladder cancers are derived from ____ cells that line the bladder.
  52. Manifestations of urinary bladder cancer are:
    Painless hematuria (most common sign), frequency, urgency, and occasional dysuria
  53. True or False. Low grade bladder tumors have an excellent prognosis.
  54. ____ incontinence may occur with retention of urine secondary to nervous system lesions or obstruction of bladder neck, prostate enlargement, & fecal impaction.
  55. Other causes of stress incontinence include:
    • Intrinsic urethral deficiency
    • Congenital sphincter weakness
    • Trauma
    • Irradiation
    • Sacral cord lesion
  56. _____ affects 13 million Americans, 15-35% of the elderly population, & women are twice as more likely to affected than men.
    Urinary incontinence
  57. ____ is caused by an injury to micturation center of sacral cord, cauda equina, or
    sacral roots that supply the bladder.
    Flaccid Bladder Dysfunction
  58. ____ & loss of perception related to bladder fullness permits overstretching of the detrusor muscle that contributes to weak and inneffective bladder contractions.
    Atony of the detrusor muscle
  59. True or False. Voluntary urination will not occur in flaccid bladder dysfunction.
  60. Uninhibited Neurogenic Bladder may develop:
    • 1. After stroke (cva)
    • 2. Early stages of multiple sclerosis
    • 3. Secodary lesions of cortex (inhibitory center) or pyramidal tract
  61. In Autonomic dysreflexia (AD), insertion of catheter (or mild distension of the bladder) may result in:
    • 1. Severe HTN
    • 2. Bradycardia
    • 3. Profuse sweating
  62. True or False. Autonomic dysreflexia (AD) is usually seen in spinal cord injuries to T6 and above.
  63. Dilation of “internal urethral sphincter,” along with spasticity of external sphincter (innervated by upper
    motor neurons) which results in resistance to bladder emptying is seen in _____.
    Bladder dysfunction caused by spinal cord injury
  64. What happens during a state of spinal shock?
    All reflexes (including micturation reflex) become depressed. It may last a few weeks to 6 mos. (usually 2-3 mos).
  65. When the bladder becomes atonic it cannot ____.
  66. Failure to store urine (i.e., results from reflex bladder spasm) is known as ____.
    Spastic bladder
  67. In ____ the bladder function becomes regulated by segmental reflexes, without control from higher brain centers.
    Spastic bladder
  68. The ____ is unique in that it is probably the only ANS visceral organ that is under CNS control.
    Urinary bladder
  69. Neural control of bladder may be interrupted at:
    • 1. Level of peripheral nerves that connect bladder to micturation center in spinal cord
    • 2. Ascending & descending tracts in the spinal cord
    • 3. Pontine micturation center
    • 4. Cortical centers involved with voluntary control of micturation (urination)
  70. _____ are (small pockets) that develop between the trabecular ridges and extend between
    the trabecular fibers and become diverticulae (incapable of contraction).
  71. In ___ incomplete emptying occurs. After a few minutes, voiding can be initiated and completed, accounting for
    the frequency of urination.
    Detrusor muscle fatigue
  72. Continuous urinary obstruction can cause the smooth surface to replaced with coarsely woven structures (hypertrophied smooth muscle fibers) called _____.
  73. Acquired causes of urinary obstruction include:
    • 1. Prostate enlargement
    • 2.Bladder tumors that surround & compress the neck or urethra
    • 3. Constipation & fecal impaction (elderly)
  74. Urinary obstruction can take place in these 3 locations, where are they?
    • 1.Bladder neck
    • 2.Urethra
    • 3.External urethral meatus
  75. What happens when return in bladder dysfunctions related spinal cord injurues?
    They become become “hyperactive” due to the sacral reflex that produces frequent spontaneous contractions secondary to stretch receptor feedback with filling of bladder.
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