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Ch.17 Gastrointestinal System
Terms in this set (171)
Functions of the GI system?
Gastric glands have what types of cells?
-mucous neck cell
what type of gastric cells are involved with Hydrochloric acid and intrinsic factor?
what gastric cell releases Pepsinogen?
what is a hormone that stimulates parietal cells hyperplasia and secretes increased HCl causing PUD?
Gastrin (G cell)
what gastric cell releases histamine?
what type of D cell inhibits secretion of gastrin by unpleasant odors, taste, fear, pain etc.?
what type of D cells secretes mucus , bicarbonate and inhibits secretion of acid. Offer protective function of mucus lining and prevents gastric ulcers?
what gastric cells are the cancer cells of Zollinger-Ellison Syndrom(ZES)?
what is caused by a non-beta islet cell (islet of Langerhans), gastrin-secreting tumor of the pancreas that stimulates the acid-secreting cells of the stomach (parietal cells) to maximal activity, with consequent gastrointestinal mucosal ulceration?
how is ZES treated?
surgically remove tumors or chemotherapy
the stomach secretes large volumes of what gastric juices?
what is an iron-binding protein present in gastric juice?
Part of the stomach protrudes into the thoracic cavity is what condition?
what type of hiatal hernia is the More common type-->
Portions of the stomach and gastroesophageal junction slide up above the diaphragm?
what type of Hiatal hernia is where Part of the fundus of the stomach moves up through an enlarged or weak hiatus in the diaphragm and may become trapped?
Rolling or paraesophageal hernia
in hiatal hernia, _____ may lodge in pouch of the hernia-->Causes ___________ of the mucosa-->
________ of food up the esophagus-->
May cause chronic ________?
what are S/S of hiatal hernia?
-Heartburn or pyrosis
-Increased discomfort when laying down
-Substernal pain that may radiate to shoulder and jaw
Periodic reflux of gastric contents into distal esophagus causes erosion and inflammation-->Often seen in conjunction with hiatal hernia is what condition?
Gastroesophageal Reflux Disease
Severity of Gastroesophageal Reflux Disease depends on competence of what structure?
lower esophageal sphincter
what may be a factor of Gastroesophageal Reflux Disease ?
delayed gastric emptying
what should on avoid with Gastroesophageal Reflux Disease ?
Caffeine, fatty and spicy foods, alcohol, smoking, certain drugs
how can Gastroesophageal reflux disease be treated?
medication to reduce reflux and inflammation:
anihistamines, reglin, etc
Gastric mucosa is inflamed--> May be ulcerated and bleeding is what condition?
what May result from:
Infection by microorganisms,
Allergies to foods,
Spicy or irritating foods,
Excessive alcohol intake,
Ingestion of aspirin or other NSAIDs ,
Ingestion of corrosive or toxic substances,
Radiation or chemotherapy?
Basic signs of gastrointestinal irritation(gastritis)?
-Anorexia, nausea, vomiting may develop
-Hematemesis caused by bleeding
-Epigastric pain, cramps or general discomfort
-With infection, diarrhea may develop
Acute gastritis is usually ________?
how is acute gastritis treated?
supportive treatment with prolonged vomiting-->may require antimicrobial drugs
what condition is Characterized by atrophy of stomach mucosa:
Loss of secretory glands and Reduced production of intrinsic factor?
what infection is often present in chronic gastritis?
what are signs of chronic gastritis?
may be vague:
-Mild epigastric discomfort, -anorexia
-intolerance for certain foods
a pt with chronic gastritis has increased risk of _______ ulcers and gastric ________?
Inflammation of stomach and intestine, Usually caused by infection, May also be caused by allergic reactions to food or drugs;
Microbes can be transmitted by fecally contaminated food, soil, and/or water is what type of gastritis?
most infections in gastroenteritis are _______?
a serious illness may result in _______ host or ______ organisms of a pt with gastroenteritis?
what is essential for prevention of gastroenteritis?
what disorder of the stomach happens in the lower esophagus, stomach and duodenum(upper GI)?
peptic ulcer disease (PUD)
A break or ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum
is what disorder of the stomach?
what ulcers/condition can cause peptic ulcer disease?
what type of ulcers are erosions that do not penetrate the muscularis?
what type of ulcer penetrate through the muscle and damage blood vessels, causing hemorrhage or perforate the GI wall?
Deep or True
Risk factors for a peptic ulcer?
chronic diseases, psychological factors( stress, poor coping skills, persistent anxiety, depression etc).
what are the most common causes of both types of ulcers?
what is rare syndrome; caused due to increased gastrin which is caused by gastrinscreting neuroendocrine tumor or tumor of pancreas or duodenum which causes hyperplasia of parietal cells thus increasing HCl production?
what ulcers are the most common of the peptic ulcers?
what type of peptic ulcer have high risk of cancer and life threatening perforation compared to duodenal?
Causes of Duodenal ulcers?
-Hypersecretion of stomach acid and pepsin
-Use of NSAIDs
-High gastrin levels - ZES
-Acid production by cigarette smoking
what type of ulcers from PUD is when pt is well nourished(younger pt), pain happens 2-3 hours after meals, and food/antacids may decrease the pain?
what type of ulcers from PUD happens with weight loss, HCL-normal or hyposecretion, pain 1/2-1 hour after meals, vomiting, and eating may increase the pain?
what type of ulcers from PUD is when there is physiological stress, shock, cushing's ulcer-brain injury, Curling's ulcer-extensive burns?
Gastric ulcers tend to develop in the ______ region of the stomach, adjacent to the acid-secreting mucosa of the body-->
Usually between ages 55-65yrs
The primary defect of a gastric ulcer is an increased mucosal _________ to hydrogen ions and the Gastric secretion tends to be?
-normal or less than normal
in gastric ulcer pain is more _______ and occurs _______ after eating?
what are the major causes of gastric ulcers?
Diagnostic tests for peptic ulcers?
-Detailed history from the patient
-Blood test (CBC) -anemia secondary to ulcer bleeding
-Endoscopy-with or without biopsy
-Fasting gastrin levels for ZES
-Barium Radiography - for those who cant undergo endoscopy
-H Pyloric testing:
--Urea breath test rapid diagnostic test - urea is the byproduct of H pylori and it is tested for presence of H pylori
gastric cancer arises primarily in ______ glands, mostly in the ______ or _______ area?
Confined to mucosa and submucosa is what stage of gastric cancer?
Involves muscularis and
Eventually invades serosa and spreads to lymph nodes is what stage of gastric cancer?
are there any signs of gastric cancer in the early stages?
what are causes of gastric cancer?
-Diet seems to be a key factor, particularly smoked foods, nitrites, and nitrates
does gastric cancer have a good prognosis?
no--symptoms vague at first so late diagnosis
Formation of gallstones-->
Solid material (calculi) that form in bile is what gallbladder disorder?
Inflammation of gallbladder and cystic duct is what type of gallbladder disorder?
Inflammation usually related to infection of bile ducts is what type of gallbladder disorder?
Obstruction of the biliary tract by gallstones is what type of gallbladder disorder?
where do gallstones form?
a gallstone may consist of ______ or bile pigment and mixed content with ______ salts?
what size gallstones may be silent and excreted in bile?
what size gallstones Obstruct flow of bile in cystic or common bile ducts; cause severe pain, which is often referred to subscapular area?
Risk factors for gallstones?
-Women twice as likely to develop stones
-High cholesterol in bile
-High cholesterol intake
-Use of oral contraceptives or estrogen supplements
-Biliary tract infection
when there is an obstruction of a duct by a large calculi: sudden severe waves of ______, N/V present, ______ develops when bile backs up into liver and blood-->risk of _______ gallbladder if obstruction persists--> _______ decreases if stone moves into duodenum?
gallstones may be removed using _______ surgery and a ______ diet is necessary following surgery?
what is measured in jaundice?
bilirubin (in blood)
Total bilirubin minus direct bilirubin =____________
inflammation of the liver is what condition?
causes of hepatitis?
-chemical or drug toxicity
Cell injury results in inflammation and necrosis in the liver and Liver is edematous and tender is what type of hepatitis?
what type of viral hepatitis can be found in the feces, bile, and sera of infected individuals, Usually transmitted by the fecal-oral route;
Crowded, unsanitary conditions
Food and water contamination?
what viral hepatitis is Transmitted through contact with infected blood, body fluids, or contaminated needles; Maternal transmission can occur if the mother is infected during the third trimester?
what viral hepatitis is responsible for most cases of post-transfusion hepatitis, Also implicated in infections related to IV drug use and usually results in chronic hepatitis?
Fatigue and malaise,
Anorexia and nausea,
General muscle aching are S/S of what stage of viral hepatitis?
Onset of jaundice
Stools light in color, urine becomes darker
Liver tender and enlarged, mild aching pain
are S/S of what stage of viral hepatitis?
Reductions in signs
Weakness persists for weeks are S/S of what stage of viral hepatitis?
Posticteric stage-recovery stage
Progressive destruction of the liver is what disorder?
what are the causes of cirrhosis?
-Alcoholic liver disease
what cause of cirrhosis is Associated with immune disorders?
what cause of cirrhosis is Linked with chronic hepatitis or long-term exposure to toxic materials?
in cirrhosis, there is extensive diffuse _______ which interferes with blood supply and _______ may back up; loss of _______ organization, ________ changes may be asymptomatic until disease is well advanced?
what is used to determine cause and extent of damage of cirrhosis?
Enlargement of the liver-->
Asymptomatic and reversible with reduced alcohol intake is what stage of cirrhosis(Alcoholic liver disease)?
initial stage-fatty liver
Inflammation and cell necrosis--> Fibrous tissue formation—irreversible change is what stage of cirrhosis(alcoholic liver disease)?
second stage-alcoholic hepatitis
Fibrotic tissue replaces normal tissue--> Little normal function remains is what stage of cirrhosis(alcoholic liver disease)?
third stage-end stage cirrhosis
with cirrhosis, there is Decreased removal and conjugation of ________, decreased production of _______, Impaired digestion and absorption of _______, Decreased production of __________ factors, Impaired glucose and glycogen ________, and Impaired conversion of ________ to urea?
in cirrhosis, there is Decreased _______ of hormones and drugs-->monitor to avoid toxicity, decreased removal of _____ substances?
reduction of bile entering the intestine from cirrhosis impairs what?
digestion and absorption
backup of bile in the liver from cirrhosis leads to?
blockage of blood flow thru the liver from cirrhosis leads to what condition?
congestion in the spleen from cirrhosis increases what?
in cirrhosis, there is inadequate storage of ______ and vitamin____?
congestion in intestinal walls and stomach from cirrhosis impairs _______ and _______?
development of esophageal varices from cirrhosis will cause what?
development of ascites, an accumulation of fluid in the peritoneal cavity, from cirrhosis causes _______ distention and ________?
Treatment for cirrhosis?
-Avoidance of alcohol or specific cause
-Supportive or symptomatic treatment
-Balancing serum electrolytes
-Antibiotics to reduce intestinal flora
-Emergency treatment if esophageal varices rupture
Inflammation of the pancreas which Results in autodigestion of the tissue is what condition?
what form of pancreatitis is considered a medical emergency?
the pancreas lacks what?
in acute pancreatitis, Substances released by necrotic tissue lead to widespread inflammation-->
_______ and ________ collapse may follow.
chemical peritonitis results in ______ peritonitis-->_______ may result-->possible complications?
-adult respiratory distress syndrome
-acute renal failure
causes of acute pancreatitis?
-Sudden onset may follow intake of large meal or large amount of alcohol
S/S of acute pancreatitis?
-Severe epigastric or abdominal pain radiating to the back
-Signs of shock
-Low-grade fever until infection develops
-Body temperature may then rise significantly.
-Abdominal distention and decreased bowel sounds
what are the primary symptoms of acute pancreatitis?
severe epigastric or abdominal pain radiating to the back
signs of shock from acute pancreatitis is caused by what?
what does the serum amylase levels do in acute pancreatitis?
first rise, then fall after 48 hours
what does the lipid levels, Ca+ levels, and WBCs do in acute pancreatitis?
-lipid levels elevated
Treatment of acute pancreatitis?
-Oral intake is stopped.
-Treatment of shock and electrolyte imbalances
-Analgesics for pain relief
what condition is a Malabsorption syndrome,
Primarily a childhood disorder--> May occur in adults in middle age-->
Appears to have genetic link-->Defect in intestinal enzyme?
celiac disease prevents further digestion of ______(breakdown product of gluten) and has toxic effect on intestinal _____-->what may result then?
when does first sign of celiac disease appear?
when cereals are added-->4-6 months of age
Steatorrhea, muscle wasting, failure to gain weight, Irritability and malaise common are S/S of what condition?
how is celiac disease diagnosed?
series of blood tests
how is celiac disease treated?
intestinal disorders of the GI system?
-inflammatory bowel disease (IBD)
Chronic, relapsing inflammatory bowel disorders of unknown origin which is caused by either:
Genetics, Alterations of epithelial barrier functions,
Immune reactions to intestinal flora, Abnormal T cell responses?
inflammatory bowel diseases (IBD)
what two disorders increase risk of cancer after 8-10 years in the inflammatory bowel diseases?
what condition is when the colon affected (sigmoid and rectum); nicotine protective in UC; dark, red velvety surface on colon?
what condition happens in Any portion in the entire GIT can be affected; nicotine exacerbates CD; skip lesions or cobble stone appearance?
Chronic inflammatory disease that causes ulceration of the colonic mucosa affecting the
Sigmoid colon and rectum?
Causes of ulcerative colitis?
-Immunologic (anticolon antibodies)
-Genetic (supported by family studies and identical twin studies)
Diarrhea (10 to 20/day when severe) - due to loss of absorptive mucosal area and rapid colonic transit;
Bloody stools, purulent mucus and cramping - due to destruction and inflammation of mucosa are S/S of what condition?
what is used to diagnosed ulcerative colitis?
how is ulcerative colitis treated?
-Broad-spectrum antibiotics and steroids
-Surgery - last option
what are some complications that occur from ulcerative colitis?
-Perirectal abscess- late sign
-Edema - early sign
-obstruction from fibrosis
-Anemia - early sign
-Thrombocytopenia - early
risk factors of ulcerative colitis?
-History of the disease
-Age - 20 - 40 yrs
-Prevalent among white populations
Most severe in rectum & sigmoid colon
***Dark, red velvety mucosa
Remission & exacerbation
Pain are S/S of what condition?
what are early signs of ulcerative colitis?
what is a late sign of ulcerative colitis?
Granulomatous colitis, ileocolitis, or regional enteritis; Idiopathic inflammatory disorder; affects any part of the digestive tract, from mouth to anus is what condition?
what condition Causes "skip lesions" because inflammation affect some segments of intestine not others-->Ulcerations can produce longitudinal and transverse inflammatory fissures that extend into the lymphatics-->Anemia may result from malabsorption of vitamin B12 and folic acid?
what is the most common sign of Crohn's disease?
diarrhea--occasionally colonic bleeding
Crohn's disease has what kind of appearance?
Herniations of mucosa through the muscle layers of the colon wall, especially the sigmoid colon is what disorder of the colon?
what is an Asymptomatic diverticular disease called?
The inflammatory stage of diverticulosis is called what?
in diverticular disease, it forms at gaps between ______ layers, congenital weakness of _____ may be a factor, weaker areas _______ when pressure increases, many cases are _______?
Diverticulitis stasis of material in diverticula leads to _______ and ________?
what are S/S of diverticular disease?
-elevated white blood cell count
Treatment for diverticulitis?
-Dietary modifications to prevent stasis
risk factors of cancers of the colon and rectum?
-High alcohol consumption
-High fat, low fiber diet
-Family history of cancer
-Type 2 diabetes mellitus
what is the 3rd most common cancer?
no metastasis is what stage of colon cancer?
local invasion is what stage of colon cancer?
spread to regional structures is what stage of colon cancer?
distant metastasis is what stage of colon cancer?
S/S of colon and rectum cancer?
-Vary by location, size & shape of lesion
-Palpable mass(small to large)
-Blood in stool
-Narrow, pencil shaped stools
Evaluation of colon cancer?
-individuals with hereditary polyps
-Begin screening at age 10-12 yrs.
-Colonoscopy and polyps removal when found
-Dietary modification &Lifestyle changes (to decrease risk)
tests that find polyps and cancer?
-Sigmoidoscopy every 5yrs
-Colonoscopy every 10yrs
-Double-contrast barium enema every 5yrs
-CT every 5yrs
tests that primarily find cancer?
-Yearly fecal occult blood test
-Yearly fecal-immunochemical test
Stool DNA test
Lack of movement of intestinal contents through the intestine-->More common in small intestine?
what type of intestinal obstruction Result from tumors, adhesions, hernias, other tangible obstructions?
what type of intestinal obstruction Result from impairment of peristalsis:
Spinal cord injury or Paralytic ileus caused by toxins or electrolyte imbalance?
functional or adynamic obstructions
intestinal distention leads to persistent ______: additional loss of fluid and electrolytes-->_______ can result?
in intestinal obstruction, the intestinal wall becomes _______ and necrotic-->if obstruction not removed then _______ ensues?
in intestinal obstruction, Ischemia and necrosis → decreased _______ and cessation of ________?
what can occur in intestinal obstruction if not a cause to begin with?
intestinal Obstruction promotes rapid reproduction of intestinal _______-->some produce _____ and affected wall becomes ______ and more permeable-->Bacteria and toxins leak into peritoneal cavity (_________) or into _______ (bacteremia and septicemia).
in intestinal obstruction, Perforation of the necrotic segment may occur causing what?
functional obstructions or paralytic ileus are caused by what?
-Abdominal surgery (follows surgery)
-Spinal shock following spinal cord injuries
-Inflammation related to severe ischemia
-Pancreatitis, peritonitis, infection in the abdominal cavity
Inflammation of the peritoneal membranes
is what condition?
chemical peritonitis may result from: enzymes released with _________, urine leaking from ________ bladder, _________ spilled from a perforated ulcer, _______ escaping from the ruptured gallbladder, blood, and any other _____ material in the cavity/
Sudden, severe, generalized abdominal pain
Localized tenderness at site of underlying problem
Vomiting common, abdominal distention
Dehydration, hypovolemia, low blood pressure
Decreased blood pressure, tachycardia, fever, leukocytosis
are S/S of what condition?
how is peritonitis treated?
-Depends on primary cause
-Surgery might be required.
-Massive antimicrobial drugs—specific to causative organism
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