Unit 2: Chapter 37

Question 1

Vomiting

Answer 1

Involves 2 functionally distinct medullary centers
1. Vomiting center
2. Chemoreceptors trigger zone
Act is trigger by vomiting center located in dorsal portion of the reticular formation of the medulla near the sensory nuclei of the vagus nerve.
Chemoreceptors is located in small area on the floor of 4th ventricle where it is exposed to both blood and cerebrospinal fluid

Question 2

Act of Vomiting

Answer 2

Consists of taking a deep breath, closing the airway and producing a strong forceful contraction of the diaphragm and abosominal minuscules along with relaxation of the gastroesphageal sphincter
Resp cease during vomiting
Accompanied by dizziness, Leigh head ESR, a decrease of blood pressure and bradycardia

Question 3

Neurotransmitter Involved with Vomiting

Answer 3

Dopamine
Serotonin and opinion receptors are found in the Gi tract and in both vomiting center and chemoreceptors trigger zone

Question 4

Dysphasia

Answer 4

Difficituly swallowing
Results from neuromuscular or structural causes producing narrowing of the esophagus, lack of salivary secretion, weakness of the muscular structures that propel the food bolus toward the stomach, or disruption of the neural networks coordinating the swallowing mechanism.

Question 5

Innervation of Swallowing

Answer 5

depends on the coordinated action of the tongue and pharynx, which are innervated by cranial nerves V, IX, X, and XII.

Question 6

Odynophagia

Answer 6

Painful sallowing

Question 7

Achalasia

Answer 7

Condition, the lower esophageal sphincter fails to relax because of a disruption in the input from the enteric neural plexus and the vagus nerve.
This results in difficulty passing food into the stomach, and the esophagus above the lower esophageal sphincter becomes enlarged.

Question 8

Esopheageal Diverticulum

Answer 8

A diverticulum of the esophagus is a herniation of the esophageal wall caused by a weakness of the muscularis layer
An esophageal diverticulum tends to retain food. Complaints that the food stops before it reaches the stomach, gurgling, belching, coughing, and foul-smelling breath are common.
The trapped food may cause esophagitis and ulceration.

Question 9

Hiatal Hernia

Answer 9

Characterized by a protrusion or herniation of the stomach through the esophageal hiatus of the diaphragm.
There are two anatomic patterns of hiatal herniation: axial, or sliding, and nonaxial, or paraesophageal.

Question 10

Gastroesphageal Reflux Disease (GERD)

Answer 10

Defined as symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus or into the oral cavity (including the larynx) or the lung.

Question 11

GERD Classification

Answer 11

broadly classified into two groups on the basis of endoscopy findings: having esophageal mucosal
damage (erosive esophagitis and Barrett esophagus) and no mucosal damage (endoscopy-negative reflux disease or nonerosive reflux disease).

Question 12

GERD Manifestations

Answer 12

Heartburn and regulation
Sever occurring 30-60 mins after eating
Relieve by sitting upright

Question 13

GERD in Children

Answer 13

occurs in more than two thirds of otherwise healthy infants. GER is considered a normal physiologic process that occurs several times a day in healthy infants, children, and adults.
Less is known about the normal physiology of GER in infants and children, but regurgitation or spitting up, the most visible symptom, is reported to occur daily in 50% of all infants.

Question 14

Cancer of the Esophagus

Answer 14

two types of esophageal cancer
1. Squamous cell carcinoma
Most squamous cell esophageal carcinomas are attributable to alcohol and tobacco use. Most common type of esophageal cancers.
2. Adenocarcinoma
Barrett esophagus and GERD are the two most common risk factors for esophageal adenocarcinoma

Question 15

Progressive Dysphagia

Answer 15

Most frequent complain in people with esophageal cancer

Question 16

Disorders of the Stomach

Answer 16

Gastritis
Peptic ulcers
Gastric carcinoma

Question 17

Gastritis

Answer 17

Refers to inflammation of the gastric mucosa
Either acute or chronic

Question 18

Acute Gastritis

Answer 18

Characterized by an acute mucosal inflammatory process, usually transient in nature.
The inflammation may be accompanied by emesis, pain, and, in severe cases, hemorrhage and ulceration.
Erosive form is an impoartn causeing of bleeding.

Question 19

Chronic Gastritis

Answer 19

Chronic gastritis is characterized by the presence of grossly visible erosions and chronic inflammatory changes, leading eventually to atrophy of the glandular epithelium of the stomach.
3 types chronic gastritis:
1. H. pylori
2. metaplastic atrophic gastritis
3. chemical gastropathy

Question 20

Acute Gastritis Causes

Answer 20

The condition is most commonly associated with local irritants such aspirin or other NSAIDs, alcohol, or bacterial toxins.

Question 21

Helicobacter pylori Gastritis

Answer 21

H. pylori infection is the most common cause of chronic gastritis.
Chronic inflammatory disease of the antrum and body of stomach.
Associated with increased risk of gastric Adenocarcinoma

Question 22

Chronic Atrophic Gastritis

Answer 22

Categorized into multifocal (H. pylori, environmental factors, and specific diet) and corpus predominant (autoimmune).

Question 23

Autoimmune Atrophic Gastritis

Answer 23

Accounts for less than 10% of cases of chronic gastritis, is a diffuse form of gastritis that is limited to the body and fundus of the stomach, with lack or minimal involvement of the antrum.
The disorder results from the presence of autoantibodies to components of gastric gland parietal cells and intrinsic factor.

Question 24

Multi focal Atrophic Gastric

Answer 24

Disorder of uncertain etiology that affects the antrum and adjacent areas of the stomach.
It is more common than autoimmune gastritis and is seen more frequently in whites than in other races.
It is particularly common in Asia, Scandinavia, and parts of Europe and Latin America.

Question 25

Peptic Ulcer Disease

Answer 25

is a term used to describe a group of ulcerative disorders that occur in areas of the upper GI tract that are exposed to acid–pepsin secretions. It is related to a variety of causes, such as medication use and H. pylori infection Peptic ulcer disease, with its remissions and exacerbations, is a chronic health problem.

Question 26

Peptic Ulcers

Answer 26

Ulcers are duodenal and gastric Can affect one or all layers of the stomach or dueodenum. Can penetrate only the mucosal surface or extend into smooth muscle layers

Question 27

Layers of the Small and Large Intestine

Answer 27

1. An inner mucosal layer, which lines the lumen of the intestine 2. A submucosal layer 3. A circular muscularis layer 4. A layer of longitudinal muscle fibers 5. An outer serosal layer

Question 28

Irritable Bowel Syndrome

Answer 28

Characterized by a variable combination of chronic and recurrent intestinal symptoms not explained by structural or biochemical abnormalities. Persistent or recurrent symptoms of abdominal pain; altered bowel function; and varying complaints of flatulence, bloating, nausea and anorexia, constipation or diarrhea, and anxiety or depression. A hallmark: abdominal pain that is relieved by defecation and associated with a change in consistency or frequency of stools.

Question 29

Inflammatory Bowel Disease

Answer 29

Used to designate two related inflammatory intestinal disorders: 1. Crohn disease: distal small intestine and proximal colon 2. ulcerative colitis: colon and rectum Both produce inflammation of the bowel.

Question 31

Chong Disease

Answer 31

Granulomatous Primarily submucosal Skip lesion Diarrhea Fistulas Strictures Perinatal abscesses

Question 32

Ulcerative Colitis

Answer 32

Ulcerative and exudative Primarily mucosal Diarrhea Rectal bleeding Development of cancer

Question 33

Crohn Disease

Answer 33

Recurrent, granulomatous type of inflammatory response that can affect any area of the GI tract. The terminal ileum or cecum is the most common portion of the bowel where inflammation occurs. It is a slowly progressive, relentless, and often disabling disease. The disease usually strikes people in their twenties or thirties, with women being affected slightly more often than men.

Question 34

Crohn Manifestations

Answer 34

Periods of exacerbations and remissions, with symptoms being related to the location of the lesions. The principal symptoms, which are dependent on the area of the GI system that is affected, include diarrhea, abdominal pain, weight loss, fluid and electrolyte disorders, malaise, and low-grade fever.

Question 35

Ulcerative Colitis

Answer 35

Nonspecific inflammatory condition of the colon. The incidence and prevalence of ulcerative colitis vary greatly with geographic location. Characteristic of the disease are the lesions that form in the crypts of Lieberkühn in the base of the mucosal layer. The inflammatory process leads to the formation of pinpoint mucosal hemorrhages, which in time suppurate and develop into crypt abscesses.

Question 36

Ulcerative Colitis Manifestations

Answer 36

presents as a relapsing disorder marked by attacks of diarrhea. The diarrhea may persist for days, weeks, or months and then subside, only to recur after an asymptomatic interval of several months to years or even decades. Affects the mucosal layer of the bowel, the stools typically contain blood and mucus.

Question 37

Infectious Enterocolitis

Answer 37

A number of microbial agents, including viruses, bacteria, and protozoa, can infect the GI tract, causing diarrhea and sometimes ulcerative and inflammatory changes in the small or large intestine.

Question 38

Viral Infection

Answer 38

Most viral infections affect the superficial epithelium of the small intestine, destroying these cells and disrupting their absorptive function. Repopulation of the small intestinal villi with immature enterocytes and preservation of crypt secretory cells lead to net secretion of water and electrolytes compounded by incomplete absorption of nutrients and osmotic diarrhea.

Question 39

Rotavirus

Answer 39

Leading cause of severe diarrhea Most fever in children 3 to 24 months begins after an incubation period of 1 to 3 days, with mild to moderate fever and vomiting, followed by the onset of frequent watery stools fever and vomiting usually disappear on or about the second day, diarrhea continues for 5 to 7 days. Dehydration may develop rapidly, particularly in infants. Treatment is largely supportive. Avoiding and treating dehydration are the main goals.

Question 40

Clostridium Difficile Colitis

Answer 40

Associated with antibiotic therapy. is a gram-positive, spore-forming bacillus that is part of the normal flora in 1% to 3% of humans. The spores are resistant to the acid environment of the stomach and convert to vegetative forms in the colon. Treatment with broad-spectrum antibiotics, especially those with activity against gram-negative enteric bacteria, predisposes to disruption of the normal protective bacterial flora of the colon, leading to colonization by C. difficile along with the release of toxins that cause mucosal damage and inflammation.

Question 41

Appendicitis

Answer 41

Extremely common The appendix becomes inflamed, swollen, and gangrenous, and it eventually perforates if not treated. Related to intraluminal obstruction with a fecalith (i.e., hard piece of stool), gallstones, tumors, parasites, or lymphatic tissue.

Question 42

Appendicitis Manifestations

Answer 42

Abrupt onset, with pain referred to the epigastric or periumbilical area caused by stretching of the appendix during the early inflammatory process. Nausea usually accompanies the pain. Initially, the pain is vague, but over a period of 2 to 12 hours, it gradually increases and may become colicky.

Question 43

Diarrhea

Answer 43

excessively frequent passage of loose or unformed stools. Can be acute or chronic and can be caused by infectious organisms, food intolerance, drugs, or intestinal disease.

Question 44

Acute Diarrhea

Answer 44

Diarrhea that is acute in onset and persists for less than 2 weeks is commonly caused by infectious agents. Divided into noninflammatory and inflammatory diarrhea, depending on the characteristics of the diarrheal stool.

Question 45

Noninflammatory Diarrhea

Answer 45

associated with large-volume watery and nonbloody stools, periumbilical cramps, bloating, and nausea or vomiting. It is commonly caused by toxin-producing bacteria (e.g., S. aureus, enterotoxigenic E. coli, Cryptosporidium parvum, Vibrio cholerae) or other agents (e.g., viruses, Giardia) that disrupt the normal absorption or secretory process in the small bowel.

Question 46

Inflammatory Diarrhea

Answer 46

Characterized by the presence of fever and bloody diarrhea (dysentery). It is caused by invasion of intestinal cells (e.g., Shigella, Salmonella, Yersinia, and Campylobacter) or the toxins associated with the previously described C. difficile or E. coli infection.

Question 47

Colorectal Cancer

Answer 47

Cause unknown Risk increases with age, family history, Crohn, ulcerative colitis and adenomatous polyposis opt colon. Diet also is thought to play a role.131 Attention has focused on dietary fat intake, refined sugar intake, fiber intake, and the adequacy of such protective micronutrients as vitamins A, C, and E in the diet.