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SysPath 400 - Digestive 3

Terms in this set (91)

Hernia
a protrusion of a piece of intestine through an abnormal opening.
Diphragmatic Hernia
-hole or weakening in diaphragm
-opening allows some of small intestine to push through opening, creating a bulge
Complications of hernia:
-incarceration: trapped intestine in hernia opening
-strangulation: cut of blood supply to intestine
-perforation: tearing in intestine
-peritonitis: inflammation & infection of abdominal cavity & lining
Pyloric Stenosis
blockage of passage out of stomach due to narrowing of pyloric sphincter
Pathogenesis Pyloric Stenosis
-occurs in early infancy
-causes vomiting after feeding
-may lead to severe dehydration and poor growth.
-commonly occurs in 1st month or 2 of life
-m/c among boys, especially first-born boys
S&S Pyloric Stenosis
-feed well
-projectile vomiting
-severe dehydration (later)
-poor growth, weight loss, jaundice (later)
-palpable lump (olive in abdomen)
What is the difference between regurgitation and vomiting?
Regurgitation: expulsion of material from the pharynx, or esophagus, usually characterized by the presence of undigested food or blood
Vomiting: involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose.
(i.e. no the same thing)
Dx Pyloric Stenosis
results of an abdominal ultrasound.
Tx Pyloric Stenosis
-corrected by fluids given intravenously
-minor surgery.
Acute Gastritis
aka: Erosive Gastritis
-Transient, self-limiting inflammation of the gastric mucosa with neutrophilic infiltration
-Characterized by hemorrhagic defects that extend through the entire thickness of the mucosa w/ sloughing of the superficial mucosa
(-inflammation of stomach lining)
-can be acute (sudden) or chronic (slower onset)
-usually in ppl who are healthy
-self-limiting disease of short duration that usually heals spontaneously
Causes Acute Gastritis (erosive gastritis)
-MC causes: NSAIDs (aspirin), systemic infections (H. pylori), EtOH, cigarettes, and Crohn's disease
-Severe stress to the body
-Illness or injury w/ severe burns or bleeding
-Results in ischemia of mucosal lining
Sx Acute Gastritis (erosive gastritis)
-Often there are no sx, but are variable if they do occur
-Common sx: epigastric pain, indigestion, N/V
Severe sx: overt hemorrhage, massive hematemesis (vomiting blood), melena (blood in stool)
-Anemia w/ fatigue, weakness, and light-headedness
Complications Acute Gastritis (erosive gastritis)
Ulceration w/ significant bleeding
Gastric perforation w/ peritonitis
Chronic Gastritis
Inflammation of the gastric mucosa w/ infiltration of lymphocytes and plasma cells and associated with mucosal atrophy and intestinal metaplasia
Thinning of stomach lining leads to loss of many or all cells that produce acid and digestive enzymes
Chronic Gastritis Causes
MC causes: autoimmune (type A), chronic H. pylori infection (type B)
H. pylori is number one cause
Other causes: EtOH, cigarettes, Crohn dz, radiation, partial gastrectomy
Chronic Gastritis Sx
Often asymptomatic
Common sx, if they occur: vague, mild dyspepsia
Poor digestion and decreased protein breakdown if HCl- secretion is reduced
Pernicious anemia and polyneuropathies
Chronic Gastritis Tx
OTC drugs that neutralize or reduce HCl-
May cause diarrhea or constipation
Discontinue and avoid drugs that can cause gastritis
Chronic Gastritis Complications
Increased risk or peptic and duodenal ulcer
Long term H. pylori infection increases risk of gastric CA
Acute vs. Chronic Gastritis
Define Pernicious Anemia:
Absence of intrinsic factor in stomach causes a decrease in absorption of Vit B12 which enables growing RBCs to divide.
Tx Gastritis (Acute & Chronic):
-Antacids, neutralize acid
-Avoid causative drugs
Peptic Ulcer
Definition
Peptic: of or relating to digestion
Ulcer: a breach in the mucosa that extends through the muscularis mucosa and into the submucosa or deeper
Presentation: sharply demarcated, round or oval defects in the lining of the stomach or duodenum
Acute or chronic
Acute usually shallow gastric lesions w/o mounted immune response and are r/t NSAIDs
Ulcers Anatomic Classification
Duodenal: most common type, occurs in first few inches of unprotected duodenum d/t gastric juice and digestive enzymes
Gastric: typically occur along lesser curvature at the antrum stomach
Marginal: occur where stomach has been surgically removed and anastomosed to intestine
Peptic Ulcer Cause
Imbalance in gastroduodenal mucosal defense mechanisms and damaging forces (HCl- and pepsin)
MC cause: H. pylori --> Present in 90% of people w/ duodenal and 75% of people w/ gastric ulcers
Other common causes: NSAIDs, corticosteroids, and cigarettes
Peptic Ulcer Sx
MC sx: Gnawing, burning, aching epigastric pain that is worse at night
N/V, bloating, belching
May be asymptomatic until iron-deficiency anemia, hemorrhage, or perforation (usually in children and elderly)
Often waxing and waning pain
Gastric vs Duodenal Ulcer Sx
M/C peptic ulcer location:
-Duodenal ulcers
-occur in first few inches of duodenum
Less common peptic ulcer location:
-Gastric Ulcers
-occur along upper curve of stomach (antrum)
Which ulcers follow a pattern and which do not?
Duodenal = Yes patterns
Gastric, Marginal & Stress = No patterns
Complications of Peptic Ulcers
Penetration: into surround vasculature (liver, pancreas)
Perforation: Ulcers go through wall = sudden, intense, steady pain
Bleeding; very common causing hematemesis & melena
Obstruction & Excessive Scarring (Cicatrization): - Swelling, scarring, stenosis of duodenum causing repeated vomiting
Stomach Cancer
What type of ulcer increases risk of stomach cancer 3-6 times:
Ulcers caused by H. Pylori

No incr risk from other ulcer causes
Dx peptic ulceration
-symptoms (stomach pain)
-new symptoms in person over 45
-weight loss
-endoscope
-barium contrast x-rays
-presence of H. Pylori
Tx peptic ulceration:
-M/C = antibiotics for H. Pylori

-antacids (will not heal but reduce symptoms)
-bland diets
-avoid irritants (NSAIDs, alcohol, smoking)
Carcinoma of the stomach
-95% of gastric cancers are primary adenocarcinomas
-Originate from glandular cells
-Most common populations: >50 y.o., marginalized persons, blacks/Hispanics/First Nations, and people in northern climates
M/C cause adenocarcinoma of the stomach:
H. Pylori Bacteria w/ sustained inflammation of gastric lining
Risk factors carcinoma of stomach:
-Risk factors: H. pylori infection, large or multiple gastric polyps, potential dietary link - high salt, carbohydrate, and nitrate intake w/ low fruit and leafy green intake
What do Sx's of carcinoma of stomach mimic?
Peptic ulcer
-in early stages Sx's vague
-burning abdominal pain
-does not resolve w/ ulcer Tx
Sx's carcinoma of stomach:
-Early sx are vague and may mimic burning pain and early satiety of peptic ulcers
R/o gastric CA if tx of peptic ulcers do not resolve sx
-Weight loss or weakness r/t difficulty eating and inability to absorb nutrients
-Anemia w/ fatigue, weakness, and light-headedness
-Hematemesis (vomiting blood) and melena (tarry/bloody stool) are rare
-Possible palpable mass in abdomen (later)
Carcinoma of Stomach Prognosis
Fiver year survival rate is 15%
Late diagnosis w/ metastatic dz
Prognosis is better if CA has not penetrated too deeply
Early metastasis d/t right supply of lymph vessels and nodes
Carcinoma of Stomach Treatment
Surgical excision of large portion of stomach and local lymph nodes
May be palliative to eliminate obstruction and allow food to pass
Chemotherapy and radiation have limited effectiveness beyond palliative care
Dx carcinoma of stomach:
-endoscopy with biopsy
-presence H. Pylori
Celiac Disease
-aka Celiac sprue, non-tropical sprue, gluten enteropathy
-Autoimmune disorder affecting the small intestine in persons who are predisposed to gluten intolerance
-Gluten: a protein found in wheat, barley, and oats
Immune response to gluten ingestion causes inflammation and flattening of villi that results in malabsorption
-Presentation: diarrhea and foul smelling stools, bloating, malnutrition, and weight loss
-Genetic component in 10% of cases
Celiac Disease Sx
-Sx depend on severity of damage to small intestine
-Children: abdominal distention, bloating, FTT
Adults: chronic diarrhea, bloating, malnutrition, and weight loss
-Dermatitis Herpetiformis: itchy, painful, blistering skin rash
-Atopic dermatitis on eyelids and antecubital space less common
-Malabsorption syndromes and resultant symptoms. Common deficiencies include:
Iron: anemia w/ fatigue and weakness
-Calcium: osteoporosis, tooth decay, and higher risk of fracture
-B12: pernicious anemia and nerve damage w/ extremity paresthesia
-Protein: fluid retention and edema
-Estrogen: amenorrhea in women, menopausal sx in adults
Celiac Disease Dx
Symptoms rise suspicion and are followed up with blood or stool Ab-Ag tests
Dx confirmed w/ biopsy
Celiac Disease Tx
Gluten free diet
Celiac Disease Prognosis
-Potential risk for developing intestinal lymphoma (but unknown if GF diet decreases risk)
-Neurologic and psychiatric if gluten is not removed
-Ataxia, peripheral neuropathy, epilepsy, depression, dementia
-Long-standing celiac sprue can be fatal in a small percentage of people d/t incr risk of developing:
-Intestinal Lymphoma
Crohn's Disease
-AKA?
-Def'n
aka regional enteritis, ileocolitis
Hypersensitivity reaction w/ positive feedback loop of inflammation that can affect any part of the digestive tract
Crohn's Disease Presentation
chronic - sometimes bloody - diarrhea, crampy abdominal pain, fever, loss of appetite, loss of weight
MC affected area: ileum and large intestine
Can affect any part of digestive tract from mouth to anus
Skip lesions are common
Full thickness of bowel is affected
Crohn's Disease Cause
Cause: hypersensitivity rxn that may be r/t environmental factors, dietary allergens, or an infections agent
Potential hereditary predisposition
Crohn's Disease Symptoms
MC early sx is diarrhea that can be bloody, crampy abdominal pain, fever, loss of appetite, loss of weight
Crohn's Disease Complications
-Flare-ups
-Can be mild or severe, brief or prolonged
-Tend to reappear in same areas
-Can spread to adjacent area if diseased segment has been removed
-Obstruction d/t scarring
-Rectal bleeding, fissures, and fistulas
-Abscesses and/or fistulas
-Increased risk of colon cancer
-Systemic effects: gallstones, kidney stones, malabsorption, UTI, and amyloidosis
-Inflammatory effects: arthritis, episcleritis, stomatitis, erythema nodosum, pyoderma gangrenosum
-Enteropathic, seronegative spondyloarthritis
-A sacroilitis that can occur w/o presence of sx
Crohn's Disease Diagnosis
GP suspects Crohn's based on hx of crampy abdominal pain and diarrhea and anal issues (bleeding, fissures, etc)
PE may reveal palpable lump or fullness in RLQ
Confirmation: colonoscopy w/ biopsy and/or barium x-ray
Colonoscopy will not be useful if dz is limited to small intestine
Crohn's Disease Treatment
No cure; tx aimed at relieving sx and reducing inflammation
Antidiarrheal, anti-inflammatories, corticosteroids, dietary changes
Sx may resolve w/o any tx
Some require surgical removal of small intestine or colon, to repair fistula, or to remove obstruction
-Chronic inflammation of intestinal wall
-Affects full thickness GI (mucosa, submucosa, muscularis, serosa)
-May affect any part of digestive tract
Crohn's Disease
aka Regional Enteritis, Granulomatous Ileitis, ileocolitis
Etiology/Pathology of Crohn's:
-unknown
-possibly immune mediated
-genetics
-smoking
Is recovery from Crohn's possible?
-Complete/permanent recovery after a single attack extremely rare
-Almost always flares up at irregular intervals throughout life
Sx's Crohn's
-chronic diarrhea
-melena
-crampy abdominal pain
-fever
-loss of appetite
-weight loss
-dehydration (severe)
-intense pain (severe)
-blood loss (severe)
Dx Crohn's
-typical symptoms
-colonoscopy
-biopsy
-barium x-rays
-palp lump in abdomen, most often on rt side
-Barium x-ray
Tx Crohn's
-No cure
-Symptomatic Tx's
-Antidiarrheal drugs
-anti-inflammatory drugs
-corticosteroids
-dietary regimens
-Surgery maybe, but Crohn's can recur in another section
Complications Crohn's
-Obstruction
-Scarring
-Abscesses
-Fistulas
-Rectal bleeding
-Incr risk colon cancer
-1/3 ppl problems w/ Anus
Other complications with Crohn's in other parts of body during a flare up:
-gallstones
-UTI's
-kidney stones
-arthritis
-amyloidosis
-inflammation of whites of the eyes (episcleritis)
-mouth sores (aphthous stomatitis),
-inflamed skin nodules on arms and legs (erythema nodosum)
-blue-red skin sores containing pus (pyoderma gangrenosum).
Even when Crohn's disease is not causing a flare-up of gastrointestinal symptoms, the person still may experience:
-ankylosing spondylitis
-sacroiliitis
-inflammation inside the eye (uveitis)
-inflammation of the bile ducts (primary sclerosing cholangitis)
Crohn's vs UC
refers to a number of disorders in which nutrients from food are not absorbed properly in sm intestine:
Malabsorption Syndrome
Causes Malabsorption Syndrome:
-disorders,
-infections,
-surgical procedures
-insufficient enzymes (pancreas/sm intestine)
-decr bile
-incr stomach acid
-incr wrong bacteria in sm intestine
S&S Malabsorption Syndrome
-Steatorrhea = light coloured stool bulky, extremely foul-smelling, "floating & sticky" stool
-incr passage undigested material
-diarrhea
-abdominal bloating
-flatulence
-nutritional deficiency/weight loss (vary by deficient nutrient)
What do Dr's find in almost all instances of malabsorption Syndrome?
Malabsorption of Fat
Dx Malabsorption Syndrome
-typical symptoms
-testing of stool samples for fat
-biopsy sm intestine
-undigested food fragments in stool
Tx Malabsorption Syndrome
treatment depends on cause.
Symptoms of Nutrient Deficiencies
Calcium- Bone pain/deformities; risk Fx, mm spasms; tooth discoloration/decay
Folate (folic acid)- Fatigue & weakness (anemia)
Iron- Fatigue & weakness (anemia)
Magnesium- Muscle spasms
Niacin- Diarrhea; skin disorders; confusion (pellagra); sore tongue
Protein- Tissue swelling (edema), usually in legs; dry skin; hair loss
Vitamin A- Night blindness
Vitamin B1 - Pins-and-needles sensation, especially in feet; heart failure
Vitamin B2 - Sore tongue; cracks at edge of mouth
Vitamin B12 -Fatigue and weakness (due to anemia); pins-and-needles sensation; confusion
Vitamin C- Weakness; bleeding gums
Vitamin D- Bone thinning; bone pain
Vitamin K- Tendency to bruise & bleed
Ulcerative Colitis Definition
-Chronic, autoimmune disease in which the large intestine becomes inflamed and ulcerated
-Presentation: bloody diarrhea, LLQ abdominal cramps, and fever
-Affected area: rectum and sigmoid colon
-Limited to the large intestine
-Continuous lesions
-Does not affect the full thickness
Ulcerative Colitis Cause
Cause: largely unknown autoimmune reaction
When do UC sx appear? Ulcerative Colitis
Sx usually begin b/t 15 and 30
small number of persons with UC don't have first attack until ages 50-70
Long term Ulcerative Colitis has incr risk for:
Colon Cancer (greater risk with UC than Crohn's)
Does Ulcerative Colitis affect the full thickness of intestinal wall?
No
What part of GI is affected by Ulcerative Colitis?
-begins in rectum/sigmoid colon
-spreads along part or all of lg intestine
Can Ulcerative Colitis spread to sm intestine?
Rarely
Seems to decr risk of Ulcerative Colitis:
Smoking
Ulcerative Colitis Sx
Violent, bloody diarrhea, high fever, LLQ abdominal pain, and peritonitis
If disease is limited to the rectum, stool will be dry but will have mucus, WBC, and RBC
If disease extends through the colon, stool is looser and BM are more frequent
Ulcerative Colitis Flare Ups
Often gradual onset w/ defecation urgency, mild cramps, and stools w/ blood and mucus
Some have sudden and severe flare-up of sx w/ profound illness
Can last days or weeks and can recur at any time
Ulcerative Colitis Complications
MC complication: bleeding w/ iron deficiency anemia
Toxic colitis: severe complication that damages entire thickness of colon
Toxic megacolon: massive extension of colon w/ abdominal pain, high fever, and potential of shock
Increased risk of colon cancer
Higher risk when entire colon is affected
Higher risk if dx is >8 years, even if dz is not clinically active
Inflammatory effects: arthritis, episcleritis, stomatitis, erythema nodosum, pyoderma gangrenosum
Enteropathic, seronegative spondyloarthritis
A sacroilitis that can occur w/o presence of sx
Ulcerative Colitis Diagnosis
History, symptoms, and a stool sample are initial indicators
Confirmation: sigmoidoscopy and/or barium studies
Colonoscopy later used to determine extent of damage
Ulcerative Colitis Prognosis
Chronic w/ repeated flare-ups and remissions
Rapidly progressive initial attack w/ serious complications in 10%
Ulcerative Colitis Treatment
Tx aimed at controlling inflammation, reducing sx, and replacing lost fluids and nutrients
Antidiarrheal and anti-inflammatory drugs, corticosteroids
Dietary changes: iron supplements, avoiding raw fruits/vegetables
Surgery: colectomy is curative
Define Toxic Megacolon:
-swelling & inflammation spread into deeper layers of colon
-colon stops working & widens
-severe cases, colon may rupture
2° complications Ulcerative Colitis outside GI tract:
-arthritis (inflamed jt's)
-episcleritis (inflamed sclera)
-erythema nodosum (inflamed skin nodules)
-pyoderma gangrenosum (blue-red skin sores containing pus)
Dx Ulcerative Colitis
-typical symptoms
-sigmoidoscopy
-colonoscopy
-barium enema x-ray
Tx Ulcerative Colitis
-Dietary Restrictions
-Antidiarrheal Drugs
-Anti-inflammatory Drugs
-corticosteroids
-Surgery to remove affected segment (better Px than Crohn's)
Facts regarding surgery w/ Ulcerative Colitis:
-About 30% of people w/ extensive ulcerative colitis require surgery.
-Emergency surgery may be necessary for acute life threatening attacks w/ massive bleeding, perforations, toxic megacolon, or blood clotting
-Surgery more effective with Ulcerative Colitis than Crohn's
Which condition is more painful, Ulcerative Colitis or Crohn's?
Crohn's
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