Patho 3 (Connor) > Week 4 GI > Flashcards

Week 4 GI Flashcards

(66 cards)

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1
Q

Pyloric obstruction

A
  • Blocking or narrowing of the opening between the stomach and the duodenum

Manifestations: Epigastric pain and fullness, Nausea and vomiting, Malnutrition, Dehydration

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2
Q

Intestinal obstruction

A

Condition that prevents flow of chyme through the
intestinal lumen

Mechanical: physical block somehow

Functional: condition effects peristalsis

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3
Q

Intestinal obstruction manifestations

A
  • Vomiting and dehydration
  • Electrolyte depletion
  • Constipation
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4
Q
A
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5
Q

Intestinal obstruction treatment

A
  • Remove block
  • decompression
  • fluid/electrolyte replacement

If untreated
- intestinal dilation + edema
- ischemia
- perforation
- gangrene, sepsis, peritonitis, shock

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6
Q

Volvulus

A

Twisting of bowel, causes obstruction and blood vessel compression

Results from rotation, ingested foreign body or adhesion

Common place small bowel, cecum, and sigmoid colon

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7
Q

Intussusception

A
  • Telescoping/invagination of a portion of bowel into
    adjacent (usually distal) bowel, causing intestinal
    obstruction

Bowel folds in on itself :)

Common in kids males

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8
Q

Hirschsprung disease

A
  • Congenital disorder of the large intestine in which
    autonomic ganglia are reduced or absent

Common in kids more males

Manifestations: stasis stool - mega colon
- too much bacteria - enterocolitis
- intentional perforation

Treatment: - colonic lavage (power wash)
- surgery

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9
Q

Paralytic ileus

A
  • Decreased motor activity of the GI tract without physical
    obstruction→ impaired peristalsis → stasis of contents

Ethology: so many all functional obstructions

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10
Q

Paralytic ileus S+S

A

Signs and symptoms:
If complete obstruction:
- Bowel sounds increase
- Obstipation – lack of fecal or gas evacuation
If incomplete obstruction:
- Diarrhea or constipation
- Vomiting → loss of fluids and electrolytes
- Ischemia
- Pressure on diaphragm → respiratory complications
- Colicky abdominal pain

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11
Q

Paralytic ileus treatment

A

-Restriction oral intake
- fluid and electrolyte replacement
- decompression of GI lumen
- surgery

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12
Q

Diverticular disease of the colon

A

Diverticula:
- Herniations of mucosa through the muscle layers of the
colon wall, primarily in the sigmoid colon
Diverticulosis:
- Patient has diverticula and may have bleeding
Diverticulitis:
- Inflammatory stage of diverticulosis

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13
Q

Diverticulosis etiology

A
  • increase pressure
  • weak areas
  • decreased dietary bulk
  • age (old farts)
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14
Q

Diverticulosis patho

A

Decreased fiber → decreased bulk → increased mass of stool
→ decreased motility → increased transit time → increased
absorption of water → exaggerated peristalsis → pushing of
bowel wall into outpouching

Exaggerated peristalsis → smooth muscle hyperplasia that
narrows the lumen → increased pressure exerted on
intestinal wall → inflation of diverticula which can then
rupture in the future

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15
Q

Diverticulosis S+S

A
  • lower GI pain
  • no poop
  • occasional bleeding
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16
Q

Diverticulosis diagnosis

A
  • barium x ray
  • sigmoidoscopy
  • ultrasound or CT
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17
Q

Diverticulosis treatment

A

Increase fibre + laxatives

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18
Q

Diverticulitis

A
  • fecaliths (poop stone) obstruct diverticula = inflammation
  • becomes necrotic and rupture

Complications:
- abscess
- colonic stenosis & occlusion
- fistulae

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19
Q

Diverticulitis S+S

A
  • abdo pain
  • leukocytosis
  • nausea and vomiting
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20
Q

Diverticulitis diagnosis + treatment

A

Diagnosis:
- lower GI x ray
- ct scan
- colonoscopy

Treatment:
- supportive measures
- surgery

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21
Q

Appendicitis

A

Inflammation of the vermiform appendix

Possible causes: obstruction, ischemia, increased pressure, infection, ulceration

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22
Q

Appendicitis patho

A

Obstruction → increased
pressure → decreased blood
flow → hypoxia → ulceration
→ bacterial invasion →
inflammation and edema

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23
Q

Appendicitis S+S

A
  • abrupt onset
  • epigstric and RLQ pain
  • nausea, vomiting
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24
Q

Appendicitis diagnosis + treatment

A

Diagnosis
- rebound tenderness, localized pain
- increased WBC
- CT scan or ultrasound

Treatment:
- bye bye appendix
- antibiotics

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25
Inflammatory bowel disease
Inflammatory bowel disease (IBD) is a general term to describe to inflammatory intestinal disorders - chronic
26
IBD etiology
1. Failure of immune regulation - Normally, GI immune system recognizes beneficial/harmless intestinal bacteria and destroys pathogenic types 2. Genetic predisposition - Many genes have been linked to IBD, including human leukocyte antigen (HLA) - Ulcerative colitis – HLA-DR2 mutation - Crohn’s disease – HLA-DR1 and HLA-DQw5 mutations 3. Environmental trigger - Microbial flora - Smoking increases risk of Crohn’s disease
27
IBD Patho
- Immune system is abnormally and chronically activated in the absence of any known pathogen - Unregulated, exaggerated immune response against normal intestinal bacteria leading to tissue damage
28
Ulcerative colitis
Chronic inflammatory disease that causes ulceration of the colonic mucosa - Mostly affects the sigmoid colon and rectum
29
Ulcerative colitis etiology
- Immunologic – e.g. anti-colon antibodies - Genetics (family and twin studies) - Infectious agents - Diet
30
Ulcerative colitis characteristic features
- Inflammation - WBC infiltration - Cramps and fever - Large volumes of watery diarrhea - Abscess formation → ulcers and fragile granulation tissue → purulent bloody mucus in stools - Most show relapsing / remitting disorder
31
Ulcerative colitis diagnosis and treatment
Diagnosis: - Colonoscopy - Barium enema - Stool cultures Treatment: - Broad-spectrum antibiotics and steroids - Immunosuppressants and modifiers - Surgery
32
Crohn's disease
Also known as granulomatous colitis, ileocolitis, or regional enteritis Idiopathic, chronic inflammatory disorder that can affect any part of the digestive tract from mouth to anus
33
Crohn's etiology and patho
Etiology: unknown Patho: Lymphatic blockage within submucosa → inflammation Immune factors: - Increased T cell activity - Macrophage activation - Increased IgA production
34
Crohn's diagnosis + treatment
Diagnosis: Lower GI barium X-ray series, Colonoscopy Treatment: - Anti-inflammatory or immunosuppressive drugs - Corticosteroids - Monoclonal antibodies against TNF-α - Balanced, nutritious diet - Anti-diarrheal drugs - Manage complications - Antibiotics - Surgery
35
Crohn's + Ulcerative colitis comparison
see ppt
36
Celiac
Immune-mediated disorder triggered by ingestion of gluten - Gliadin (component of gluten protein) induces intestinal lesions → malabsorption
37
Celiac etiology
- External factor – gliadin - Internal factor(s) – unknown, but genetic factors (e.g. HLA antigens) may be involved
38
Celiac patho
- T cell-mediated immune reaction to gliadin leads to characteristic structural changes in intestinal mucosa - “Flat” mucosa – loss of absorptive cells and mucosal digestive enzymes - Intestinal crypts elongate - Lamina propria infiltrated with inflammatory cells
39
Celiac complications
- Failure to thrive in infants and growth retardation - Possible strictures - High risk of GI lymphoma or adenocarcinoma - Dermatitis herpetiformis
40
Celiac diagnosis + treatment
Diagnosis: - Exclusion of other causes - Reversal of symptoms after exclusion of gluten from diet - Serum anti-gliadin antibody titer - Triple biopsy procedure Treatment Dietary gluten restriction
41
Lactose intolerance
Inability to break down lactose into monosaccharides (galactose and glucose) - Lactose cannot be digested or absorbed - Lactose is fermented by intestinal bacteria → pain, flatulence, osmotic diarrhea
42
Lactose etiology
Primary lactase deficiency: - Genetic deficiency Secondary lactase deficiency: - Lactase-sufficient individual experiences injury to intestinal mucosa (e.g. chemotherapy, celiac disease, Crohn’s disease) leading to malabsorption
43
Lactose patho
- Undigested lactose accumulates in GI lumen → fermentation produces gas - Lactose draws water into lumen → osmotic diarrhea
44
Lactose D+T
Diagnosis: Abnormal lactose-tolerance test - Standard lactose feeding followed by plasma glucose measurement Treatment: - Lactose-free diet - Pre-treatment of milk products with lactase
45
Pancreatic insufficiency
Insufficient pancreatic enzyme production Lipase, amylase, trypsin, chymotrypsin, nuclease Causes include pancreatitis, pancreatic carcinoma, pancreatic resection, and cystic fibrosis Main manifestation is fat maldigestion - Fatty stools - Weight loss
46
Bile salt deficiency
Bile salts required to emulsify and absorb fats Normally bile salts are synthesized from cholesterol in liver Bile salt deficiency can result from liver disease and bile obstructions Poor intestinal absorption of lipids causes fatty stools, diarrhea, and los of fat-soluble vitamins (A, D, E, and K)
47
Esophageal cancers types
Adenocarcinoma & Squamous cell carcinoma
48
Adenocarcinoma Esophageal
Most arise from Barrett’s esophagus: - Occurs over extended period through stepwise acquisition of genetic and epigenetic changes Additional risk factors: Tobacco use Exposure to radiation
49
Squamous cell carcinoma Esophageal
Adults older than age 45; males 4x more frequently than females - Occurs mainly in upper and middle thirds of the esophagus Risk factors: - Alcohol and tobacco use - Achalasia - Diets deficient in fruits and vegetables - Frequent consumption of very hot beverages
50
Gastric carcinoma
- 50 – 60% occur in pyloric region or adjacent to antrum - Second most common tumour in the world - Most are adenocarcinomas (benign gastric tumours are rare) - Incidence varies widely: High in Japan, Chile, China - Male to female ratio 2:1
51
Gastric carcinoma etiology
Dietary factors - Food high in nitrates and nitrites, smoked foods, heavily salted foods, routine consumption of excessive dietary carbohydrates, lack of fresh fruit and vegetables in diet - Gastric acid suppression (decreased acid leads to increased bacteria) - Chronic gastritis, gastric atrophy, and HCl-suppressing drugs - Post-gastrectomy patients with persistent inflammation - Genetic factors
52
Gastric carcinoma patho
- Nitrates can react with amino acids to form compounds that damage DNA - Reduced HCl production can allow bacteria to colonize → infections, gastritis
53
Gastric carcinoma stages
Early stages – invasion of mucosa and submucosa only Advanced stages – additional invasion of muscularis layers - Usually associated with metastasis Types: - Ulcerating gastric carcinoma - Polypoid gastric carcinoma - Diffuse infiltrative gastric carcinoma
54
Gastric carcinoma S+S initial
- Upper GI discomfort - Nausea, malaise, and anorexia
55
Gastric carcinoma S+S intermediate
- Weight loss - GI bleeding - Dysphagia - Possible obstruction
56
Gastric carcinoma S+S late
- Pallor - Cachexia (wasting) - Evidence of metastasis (e.g. jaundice, ascites)
57
Gastric carcinoma D+T
Diagnosis - Upper GI barium x-rays - Gastric lavage and examination of exfoliated cells - Endoscopic examination Treatment - Prevention is best - Surgery, radiation, chemotherapy - Investigative approaches: immunotherapies, photodynamic therapy, hyperthermia
58
Gastric carcinoma prognosis
10-year survival rate ~10%
59
Colorectal cancer
- 99% of colorectal cancers are adenocarcinomas - Among top three cancers in Canada - 15% of cancer death; 1 in 18 Canadians will be diagnosed - Peak incidence > 60 years of age
60
Colorectal cancer etiology
Environmental risk factors - Diet – high fat, nitrates, nitrites, low calcium, low fiber - Cigarettes Predisposing conditions - Benign colonic adenoma - Ulcerative colitis Genetics - 25% of patients have positive family history - 85% have p53 mutation
61
Colorectal cancer patho
Colorectal cancer usually begins as adenomatous polyps - Usually starts in mucosal glands - Slow growth and spread - Frequently metastasizes
62
Colorectal cancer S+S
Weight loss Abdominal mass Blood in stools Changing bowel habits Possible liver dysfunction Possible hypokalemia and hypoalbuminemia
63
Colorectal cancer manifestations
Tumour location can affect manifestation of the cancer Right-sided lesions (ascending colon): Wider lumen, allowing for increased tumour growth before it causes symptoms (e.g. pain, bleeding) Left-sided lesions (descending colon): Lumen is narrower and more easily obstructed Blood in stools, “ribbon” stools, pain, diarrhea Rectal lesions: Increased feelings of urgency
64
Colorectal cancer diagnosis
Testing for occult blood Protosigmoidoscopy Colonoscopy Barium enema and X-ray Serum carcinoembryonic antigen test (serum CEA) - Not useful for screening - Gives information on efficacy of therapy and possible recurrence
65
Colorectal cancer Treatment
- Resection with end-to-end anastomosis or colostomy - Radiation therapy - Chemotherapy - Immunotherapy Preventative measures: - Consume diet rich in vegetables, fruits, grains, and calcium, but low in animal fats - Use of NSAIDs decreases colorectal cancer risk
66
Colorectal cancer prognosis
10-year survival ~40% with treatment
Patho 3 (Connor)
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