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Physio II - Exam 2 - Lecture 3 - GI
Terms in this set (58)
What is defined as weak and uncoordinated peristalsis within the body of the esophagus and there is failure of the LES to relax completely during swallowing?
What is the difference between achalasia-A verse B?
A = early stage showing tapering of lower esophagus
B = advanced stage showing dilated tortuous esophagus
What are you most worried about as a provider for a patient with achalasia?
true or false: esophageal achalasia is a hyper motility disorder
false = hypo motility disorder
Esophageal Achalasia is idiopathic and secondary to what?
Where does the degeneration occur?
Is it more common in peds or adults?
Nocturnal regurgitation, pulmonary infections, inflammation, and cancer can all lead to what GI pathology?
what 3 ways can you diagnose a patient for esophageal achalasia?
what 2 options do you have to treat it?
what type of anesthesia will you do?
-history, X-ray, MRI/CT
-endoscopic dilation --> if that doesn't work do the Heller mymyotomy
Inflammation of the esophageal mucosa and decreased resting tone of LES is called what?
What 3 things can cause esophagitis?
1. motility disorders
2. hiatus hernia
3. infection (candida, h pylori, herpes)
true or false: hiatus hernias are associated with chronic reflux esophagitis
what is the pharmaceutical treatment for esophagitis?
what is the surgical treatment?
-Antacids, H2 blockers, antibiotics, PPIS
Which type of hiatal hernia has the LES intact and which type has an impaired LES?
-intact = paraesophaeal
-impaired = direct
A _________ hernia, aka "A = Sliding" is the most common type of hiatal hernia
A ____________ hernia, aka "B = rolling" is less common and has a high risk of strangulation
What are 2 ways you can diagnose a hiatal hernia?
What are the 4 pharmacological treatments?
-radiography or endoscopy
-H2 blockers, antacids, Reglan, omeprazol
What is it called when you ignore GERD treatment and the chronic exposure to acid has now led to cancer (adenocarcinoma) ?
what is the surgical treatment for GERD?
Lap nissen (the wrapping of the proximal stomach)
Which GI disorder shows signs heartburn, regurgitation, GE junction incompetence, and has complications of ulcers, strictures, and esophagitis?
larngyopharngeal reflux from pharyngitis, cough, and laryngitis lead to what?
what lifestyle modifications help to treat GERD?
-avoid fat, alcohol, chocolate, fried foods, acidic foods
What should you give as premeds for a patient with GERD?
what type of anesthetic would you plan for this patient?
-H2 blockers, PPI, Reglan, Bicitra
how can you prevent aspiration pneumonitis for a patient with GERD?
avoid contents > 25cc and pH< 2.5
for PUD, the following levels of damage reach what tissue level?
-reaches mucosa, submucosa, and muscular of soft tissue
-reach muscularis and causes scarring..
What is described as circumscribed breaks in the continuity of mucosa, extending below the epithelium.
peptic ulcer disease
true or false: PUD can be located in any part of the GI tract exposed tot he acid-pepsin gastric juice
PUD generally refers to ulcers located where?
stomach or duodenum
What is an example of how the pathogenesis of PUD is multifactorial?
H pylori is present in 90% of individuals with duodenal ulcers
What 4 complications come from PUD?
hemorrhage occurs in what percentage range of patients with PUD where the symptoms depend on the rapidity of loss?
Perforation occurs in what percentage range of all ulcers?
Obstruction occurs in what percentage of patients with PUD?
true or false: Intractability from PUD has rare and slow recurrences
false = frequent and rapid recurrences
What are you at risk of if a perforation from PUD makes a hold from inside the stomach into the peritoneal cavity?
you develop peritonitis QUICKLY - YIKES!
Obstruction from PUD is typically caused how?
from chronic scarring of the muscularis over time.
A non-mechanical intestinal obstruction is a loss of what?
autonomic motility control
Post abdominal surgery and peritonitis can both cause what type of small intestine disorder?
-non mechanical intestinal obstruction
what is another name for non-mechanical intestinal obstruction?
paralytic ileus or adynamic ileus
what drug do you avoid for a patient with intestinal obstruction?
Reglan (will increase obstruction by dilating the bowel more...)
Mechanical bowel obstructions occur in ___% of adults as a result of ___________ from previous surgery
What are the 3 most common causes of obstruction of large intestine in middle age adults accounting for ____%
What does it mean when there is invagination of one section of the intestine into the next section causing a mechanical bowel obstruction?
intussusesception (due to either narrowing or polyps)
how can an inguinal hernia cause an incarcerated bowel?
strangulation around the bowel can cause bowel to die
If you have intestinal obstruction where intraluminal accumulation of gas and fluid is proximal to the obstruction site... and there is loss of H2O and electrolytes... and ECF volume is decreased.... what condition is the patient in?
During an intestinal obstruction where you notice distention, ischemia of bowel wall, loss of fluid to peritoneal cavity, and there is rapid bacterial proliferation from necrotic bowel into the peritoneum and systemic circulation... what condition is the patient in?
What is a Mallory Weiss tear?
when the patient wretches and causes a tear in the distal esophagus from drinking too much... causing GI hemorrhage
What indicates bleeding has occurred above the cecum?
Melena (black feces)
true or false: melena is a lower GI hemorrhage indication
false = upper
what can be used as a diagnostic and therapeutic tool for an upper GI hemorrhage?
What is a TIPS procedure and what is for?
is this an upper or lower GI hemorrhage concern?
-transjugular intrahepatic prosystemic shunt
-for intractable esophageal bleed from portal hypertension
Which one is more common, upper or lower GI hemorrhage
Lower GI hemorrhage is usually seen in what population of patients?
what does BRBPR stand for?
bright red blood per rectum
seen in lower GI bleeds
What procedure is done as a diagnostic and therapeutic tool to detect lower GI hemorrhage?
colonoscopy (make sure a bowel prep is done before!)
Angiography with embolization or surgical intervention is typically done for upper or lower GI hemorrhages as an alternative therapy
what is the most common cause of a lower GI bleed?
colonic diverticulitis (42% occurrence)
what is the most common cause of an upper GI bleed?
duodenal ulcer (36%) followed by gastric ulcer (24% occurrence)
what are the possible causes for an upper GI bleed?
-mucosal erosive disease
what are the possible causes of lower GI bleeds?
-acute colitis of unknown cause
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