clinical manifestations of gastrointestinal dysfunction
- _____
- -forceful emptying of the stomach and _____ contents from the mouth
- -vomiting center: _____
- -several types of stimuli initiate the vomiting reflex
vomiting
intestinal
medulla onlongata
pathophysiology of vomiting
- serotonin stimulates the vomiting center and appears to be released from enterochomaffin cells in the intestinal wall which activates vagal afferents leading to the chemoreceptors trigger zone
- the activation of this zone, which lies in the medulla leads to vomiting by triggering receptors such as _____
dopamine
clinical manifestations of gastrointestinal dysfunction
vomiting
-_____: for nausea and vomiting
–(_____, _____, and _____ are _____ of _____
antiemetic medications metoclopramide domperidone haloperidol antagonists dopamine
clinical manifestations of GI dysfunction
-_____: directly caused by direct stimulation of the _____ by _____ such as _____, _____, or _____ involving the _____
projectile vomiting vomiting center neurologic lesions intracranial pressure tumors aneurysms brainstem
clinical manifestations of GI dysfunction
- constipation
- -infrequent or difficultly defecation
- normal bowel habits range from _____ evacuations per day or _____ per week
-_____ per _____ are considered the _____ limits of normal
two or three one three stools day upper
secretory and osmotic diarrhea
secretory diarrhea:
-primary causes of secretory diarrhea are _____, particularly those released by _____ or strains of Escherichia coli, and neoplasms, such as gastrinoma or thyroid carcinoma
osmotic diarrhea:
-_____ related to _____ deficiency, pancreatic enzyme or bile salt deficiency, small intestine bacterial overgrowth, and celiac disease cause osmotic diarrhea
bacterial enterotoxins
cholera
malabsorption
lactase
clinical manifestations of GI dysfunction
abdominal pain
-in _____ pain: _____, _____, poorly _____ and _____
visceral diffused vague localized dull
cause of abdominal pain
- chemical mediators such as _____, _____, and _____ produce abdominal pain
- _____ and _____ produce abdominal pain by _____
- _____, caused by distention of _____ or _____, produces abdominal pain
histamine bradykinin serotonin edema vascular congestion stretching ischemia bowel obstruction mesenteric vessel thrombosis
clinical manifestations of GI dysfunction
GI bleeding
-_____: bloody stools- with frank bright red or burgundy blood from the _____
hematochezia
rectum
disorders of motility
- intestinal obstruction and ileus
- clinical manifestations:
- cardinal symptoms of small intestine obstruction: _____ caused by _____ followed by _____
colicky pain
distention
vomiting
disorders of motility
- small intestinal obstruction
- -most common: _____
- large bowel obstruction
- -most common: _____, _____ (twisting), and _____ related to _____
- -_____ (_____): massive dilation of the large bowel; patients who are critically ill and older adults who are immobilized
fibrous adhesions colorectal cancer volvulus strictures diverticulitis acute chronic pseudo-obstruction Ogilvie syndrome
intestinal obstruction at the pylorus or high in the small intestine causes metabolic alkalosis, why?
-if the obstruction is at the pylorus or _____ in the small intestine, then _____ initially develops as a result of excessive _____ of _____ that normally would be reabsorbed from the _____
high metabolic alkalosis loss hydrogen ions gastric juices
the most immediate result of a small intestinal obstruction is _____
- distention begins almost immediately, as _____ and _____ accumulate _____ to the obstruction.
- within _____, up to _____ of fluid and _____ enters the _____ in the form of _____, _____, _____, _____, and _____.
- _____ or _____ of fluids in the intestinal lumen prevents their _____ and produces severe _____ and _____
distention gases fluids proximal 24 hours 8L electrolytes lumen saliva gastric juice bile pancreatic juice intestinal secretions copious vomiting sequestration reabsorption fluid electrolyte disturbances
mechanism of intussusception
-intussusception is the _____ of part of the _____ into another section of intestine, usually causing _____ of the _____ supply
telescoping
intestine
strangulation
blood
acute and chronic gastritis
- acute gastritis
- -_____, _____, _____, _____
- -infections (_____ transient)
- chronic gastritis
- -autoimmune: pernicious anemia (autoantibody)
- -chem: NSAIDs, bile reflux, alcohol
- -bacterial: _____
drugs toxins alcohol ischemia h. pylori helicobacter pylori
chronic gastritis
type A: _____
type B: _____
autoimmune gastritis
antral gastritis
chronic antral gastritis
-associated with _____ and NSAIDs
H. pylori
chronic antral gastritis
- generally involves only the antrum and is more common than fundal gastritis
- it is caused by _____ bacteria or the chronic use of alcohol, tobacco, and nonsteroidal anti-inflammatory drugs
H. pylori
facts about chronic gastritis
- chronic gastritis tends to occur in _____
- chronic gastritis results in _____ and _____
- _____ is a common outcome of chronic gastritis
- _____ is often observed with chronic gastritis
older adults chronic inflammation mucosal atrophy mucosal atrophy epithelial metaplasia
peptic ulcer disease
- peptic ulcer is a _____ or _____ in the protective mucosal lining of the lower _____, _____, or _____
- acute versus chronic ulcers
- superficial (erosions) versus deep
- risk factors:
- -_____ predisposition
- -_____ infection
- -habitual use of _____
- -excessive use of alcohol, smoking, acute pancreatitis, COPD, obesity, cirrhosis, and over 65 years of age
break ulceration esophagus stomach duodenum genetic H. pylori NSAIDs
primary cause of peptic ulcers
_____
H. pylori
clinical manifestations duodenal ulcers
- _____ from duodenal ulcers causes _____ or _____
- the characteristic pain begins _____ to _____ after eating when the stomach is _____
- duodenal ulcers occur with _____ frequency than other types of peptic ulcers
- _____ is relieved by _____
bleeding hematemesis melena 30 mins 2 hours empty greater pain food
ulcerative colitis
-inflammation begins at the _____ of the _____ of _____ in the _____, primarily the _____, with infiltration and release of _____ from _____, _____, _____, _____, _____, and _____
base crypts lieberkuhn large intestine left colon inflammatory cytokines neutrophils lymphocytes plasma cells macrophages eosinophils mast cells
ulcerative colitis
-increased risk for _____ is demonstrated
colon cancer
