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GI Patho Test 5

Terms in this set (96)

Cleft Lip
Results from failure of the maxillary processes and nasal elevations or upper lip to fuse during fetal development
-can be genetic and or chromosomal disorders
-can be bilateral or unilateral;
Cleft Lip Risk Factors
-Native American
-hispanic
-asian
-males

maternal exposure to
-drugs
-toxins
-viruses
-vitamin deficiencies
-cigarettes
-diabetes
Cleft Lip Manifestations
-can be small notch to complete split in upper lip
-may be unilateral or bilateral
Cleft Lip Complications
-feeding difficulties
-speech difficulties
Cleft Palate
failure of the hard and soft palate to fuse during fetal development
-genetic and or chromosomal disorders
Cleft Palate Risk Factors
-Native American
-hispanic
-asian
-females

maternal exposure to
-drugs
-toxins
-virus
-vitamin deficiencies
-cigarettes
-diabetes
Cleft Palate Manifestations
-opening between oral and nasal cavity
-teeth and nasal malformations are often present
-choking or coughing while taking bottle or breast feeding
-can be unilateral or bilateral
Cleft Palate Complications
-high risk for aspiration
-feeding difficulties, nutritional deficits
-speech difficulties
-ear infections
-hearing problems
Pyloric Stenosis
The pyloric sphincter muscle fibers become thick and stiff
-narrowing or blocking of the pyloric sphincter
-difficult for the stomach to empty food into the small intestines
Pyloric Stenosis Risk Factors
-most common cause of GI obstruction in infancy
-can be present at birth but often CMs appear around 3 weeks after birth
-rare after 6 months of age
Pyloric Stenosis Manifestations
-hard olive shaped mass in right upper quadrant (RUQ) of abdomen
-projectile vomiting after feeding
-wave-like stomach contractions
-persistent hunger, failure to gain weight
Pyloric Stenosis Complications
malnutrition
Dysphagia
difficulty swallowing
-mechanical obstructions of esophagus (birth defects, narrowing of esophageal stenosis, esophageal diverticula, tumors in or beside esophagus)
-neurological alterations/diseases affecting esophagus (stroke, brain injury, Parkinson's, Alzheimer's, muscular dystrophy)
Dysphagia Manifestations
-sensation of something stuck in throat
-coughing/choking during/after swallowing
-food pocketing in cheeks
-delayed or painful swallowing
-drooling
-facial paralysis, head control, posture
Dysphagia Complications
-aspiration of food and/or liquids
-aspiration pneumonia
-dehydration and decreased nutritional status/malnutrition
-disability, decreased functional status
-increased mortality
Vomiting
aka emesis
-involuntary or voluntary forceful ejection of chyme from the stomach up through the esophagus and out the mouth
-vomiting center is the brain (medulla coordinates vomiting)
Vomiting Causes
-disease process/treatment
-chemo/radiation
-medications
-postoperative complication
-pregnancy
-can be protective***
-intracranial pressure
-severe pain
-small or large bowel obstruction
Vomiting Complications
-fluid, electrolyte, and pH imbalance
-aspiration, aspiration pneumonia
Vomiting Manifestations
-partially digested food vomitus
-preceded by nausea and or retching but not always
-hematemesis (blood) caused by upper GI bleeding
-yellow/green emesis (bile) caused by GI tract obstruction
-brown emesis (fecal) bowel obstruction
-projectile vomiting (often in intracranial pressure)
-presence of fecal odor and bile in emesis indicates back flow of intestinal contents into stomach
Hiatal Hernia
a stomach section protrudes upward through opening in diaphragm toward the lung
causes
-weakness in diaphragm
-increased thoracic or abdominal pressure
-abdominal trauma, congenital defects
Hiatal Hernia Risk Factors
-smoking
-old age
Hiatal Hernia Manifestations
-indigestion, heartburn, belching
-nausea, chest pain, dysphagia
-esophageal strictures
Hiatal Hernia Complications
-reflux of chyme into pouch or esophagus
-may develop GERD
Gastroesophageal Reflux Disease (GERD)
-stomach contents periodically backs up (reflux) into esophagus
-back flow with a malfunctioning lower esophageal sphincter opens and allows reflux
GERD Risk Factors
-alcohol consumption, smoking
-hiatal hernia, obesity, pregnancy
-certain foods and medications
GERD Manifestations
-heart burn, epigastric pain
-dysphagia
-nausea, vomiting
-dry cough
-laryngitis, pharyngitis
-sensation of lump in throat
GERD Complications
-esophagitis
-ulcers, strictures
-esophageal cancer
-chronic pulmonary disease
Gastritis
inflammation with breakdown of protective mucosal lining of the stomach
Gastritis Risk Factors
-long term use of NSAIDS, steroids
-lifestyle behaviors (smoking, alcohol)
-stress from surgery, major burns or infections
-genetic
-large quantities of spicy, irritating foods
Gastritis Manifestations
-indigestion
-heartburn
-nausea
-vomiting
-anorexia
-epigastric pain
-abdominal cramping
Acute Gastritis
mild, transient irritation or severe gastric ulceration with gastrointestinal hemorrhage (GI bleeding)
Chronic Gastritis
onset gradually and last months to years
-H. pylori common cause**
-peptic and gastric ulcers
-anemia
Gastroenteritis
-inflammation of gastric/intestines from contaminated food/water such as E. coli, salmonella, rotavirus, and amoebas
-may be allergic
-fever and chills
-risk for dehydration**
Peptic Ulcer Disease (PUD)
break, or ulceration, in the protective mucosal lining of the lower esophagus, stomach, or duodenum
-usually due to imbalance in excess acid production and/or decreased mucus production
PUD Risk Factors
H pylori: most common factor, aspirin, NSAIDS, corticosteroids, alcohol, smoking, chronic gastritis, hot rough or spicy foods
PUD Manifestations
-decreased gastric motility
-indigestion, heartburn, nausea, vomiting
-epigastric pain, abdominal cramp
-dark, tarry stools, blood in emesis
-local tissue ischemia, tissue acidosis
PUD Complications
-GI hemorrhage
-obstruction
-perforation
-peritonitis
Duodenal PUD
-most common type (80%)
-excessive acid production
-H pylori infection
-epigastric pain (relieved with eating)**
Gastric PUD
-less frequent but more deadly
-associated with malignancy, use of NSAIDS
-epigastric pain worse with eating**
Stress PUD
-develops because of a major physiological stressor on the body
-large burns, trauma, sepsis
-most frequently develop in stomach
-hemorrhage is first indicator
Hepatitis
inflammation of the liver
-infections (viral)
-CDC handout in BB yellow highlighted info will be tested
-alcohol
-medications (Tylenol, anti seizure agents, and antibiotics)
-autoimmune disease (lupus, rheumatoid arthritis)
HAV
-transmitted by fecal-oral caused by Facal contaminated food or drinking water

people at risk: travelers to areas with high rates of HAV, illegal drug users, sex with infected, men who have sex with men with clotting factor disorders
HBV
-transmitted by blood borne route caused by contact with infectious blood, semen, and other body fluids

people at risk: infants with infected mothers, sex with infected, multiple sex partners, people with STDs, men who have sex with men, injection drug, healthcare workers, hemodialysis patrons
HCV
-transmitted similar to HBV caused by IV drug use, sharing needles, blood transfusion before 1992

people at risk: current and former injection drug users, HIV infected, infants born to infected mothers
Hepatitis Manifestations (acute viral)
-asymptomatic incubation period
-prodromal phase: N/V, malaise, anorexia, low fever, H/A starts about 2 weeks after exposure, jaundice onset
-icteric phase: 1-2 weeks after jaundice, dark amber urine (tea color), clay colored stools, hepatomegaly (liver enlargement), and RUQ abdominal pain. lasts 6 weeks
-recovery phase: resolution of jaundice about 6-8 weeks, however hepatomegaly may persist for up to 3 months
Hepatitis Complications (acute viral)
-liver failure, liver cancer, cirrhosis of the liver
Cirrhosis
chronic progressive, irreversible, damage to the liver resulting in decreased liver function
causes:
-hep C 26%
-alcoholic liver disease 21%
-chronic alcohol abuse
-hep and all causes of hep
-diabetes, obesity
-Nsaids, Tylenol
-environmental poisons
Cirrhosis Manifestations
-pressure in hepatic arty and portal vein because scar tissue causes back up of blood into other vessels and organs (portal hypertension)
-high risk for GI bleeding: veins in the esophagus engorge with blood (esophageal varices due to over stretched blood vessels)
-ascites: fluid that accumulates in the peritoneal cavity (portal hypertension pushes fluid back into abdominal cavity). the damaged liver is unable to make enough albumin. this causes a shift of body fluids creating fluid in peritoneal space
Cirrhosis Manifestations pt 2
-respiratory effects: fluid in lungs and weak chest expansion leading to hypoxia
-jaundice** bile accumulates in liver
-skin effects** excessive bile is excreted in sweat which causes intense itching
-CNS effects * numerous toxins and waste products accumulate as liver fails which leads to peripheral nerve damage (neuropathy)
-mental status changes ** excess ammonia leads to confusion, disorientation and excess protein leads to encephalopathy
Pancreatitis
inflammation of pancreas. pancreatic injury causes enzymes to leak into tissue which initiates auto digestion of pancreas
-blockage of enzymes causes them to leak into pancreatic ducts into the pancreatic tissue. leads to edema, vascular damage, hemorrhage and necrosis
-replaced with non functional fibrotic tissue
Pancreatitis Risk Factors
-cholelithiasis
-alcoholism
-certain drugs
-infections
-biliary tract disease
-renal failure
-postoperative GI surgery complications, traumatic injuries damaging the pancreas
Pancreatitis Types
Acute:
-may follow big meal or bing drinking
-occurs suddenly
Chronic:
-persistent inflammation that produces irreversible changes in the structure and function of pancreas
-alcoholics may have chronic with acute episodes
Acute Pancreatitis Manifestations
-left upper to mid epigastric abdominal pain radiates to back
-pain increases as you lean forward or pull knees up to chest and increase after eating or in supine position
-abdominal guarding
-N/V,
-fever
-hypotension
-tachycardia
-shock
Chronic Pancreatitis Manifestations
slow/insidious
-upper abdominal pain
-farts
-indigestion
-weight loss without trying
-steatorrhea (fatty frothy stools with very foul odor)
Pancreatitis Complications
-problems with absorption of vitamin A, D, E > malnutrition
-vitamin K is essential to our clotting system. blood clotting disorders may develop
-DM (damage and loss of islets of langerhans
-shock, acute kidney injury, infection abscess
Constipation
Change in bowel pattern characterized by less frequent passage of stool when compared to the individual's typical bowel pattern
-stool remains in large intestine longer than usual, increasing amount of water removed. stool becomes har, compacted and difficult to pass
Constipation Manifestations
-inability to pass stool after 10 minutes of straining or pushing to expel feces
-no BM for 3 days
-abdominal distention
-pain on defecation
-low back pain
-rectal bleeding/discomfort
-decreased bowel motility
-diarrhea around impacted stool
Constipation Causes
-low fiber diet, inadequate intake of fluids*
-age and decreased tone of the intestinal muscles
-inadequate physical activity*
-delaying urge to defecate
-laxative abuse*
-disease or condition of the bowels
-medications (Fe supplements, narcotics)
-neurologic diseases (stroke, spinal cord injuries)
-colon cancer
Constipation Complications
-hemorrhoids, rectal bleeding **
-anal fissure or fistula
-intestinal obstruction, diverticulitis
Diarrhea
change in bowel pattern characterized by an increased frequency, amount, and water content of stool
Acute Diarrhea
-viral, bacterial, medications
-infectious accompanied by abdominal cramps, nausea, committing, and fever/chills
Chronic Diarrhea
lasts longer than 4 weeks

causes: Crohn's, ulcerative colitis
-malabsorption syndromes (celiac)
-endocrine disorders
-chemo and radiation
Diarrhea Manifestations
-increased bowel motility

small intestine:
-large loose stools
-provoked by eating
-lower right quadrant abdominal pain

large intestine
-small frequent stools
-cramping
-left lower quadrant abdominal pain
Diarrhea Complications
-fluid volume deficit
-alterations in electrolyte
-acid base balance

frank blood: bright red on stool surface
occult blood: blood hidden in stool
melena: dark, tarry stool. leading in higher GI tract
Intestinal Obstruction (Mechanical)
interference with normal peristalsis and impairment to forward flow of intestinal contents
-fluid, gas, and intestinal contents accumulate proximal to the obstruction. this causes distention proximal to the obstruction and bowel collapse distal to obstruction
-higher obstruction more rapidly symptoms will occur
-pressure against bowel increases so intestinal contents can seep into peritoneal cavity
-may cause bowel to rupture
-reduces circulating volume due to increased capillary permeability
-impaired intestinal blood flow>ischemia and necrosis
Intestinal Obstruction (Mechanical) Risk Factors
-physical barriers *tumors,
-tumors
-strangulated hernia
-adhesions (fibrous bands between tissues and organs)
-intussusception (telescoping of one portion of intestine into another
-volvulus (twisting of bowel)
Intestinal Obstruction Manifestations
-colicky-type abdominal pain, cramping
-abdominal distention*
-nausea and vomiting (occurs early and is more severe if the obstruction is high*
-diarrhea or constipation*
-restlessness, diaphoresis, tachycardia
Intestinal Obstruction Complications
-bowel perforation
-pH imbalances, fluid and electrolyte disturbance *
-infections in the abdomen
-impairment of blood supply to intestines
Appendicitis
Inflammation of the vermiform appendix often caused by an infection triggered by local tissue edema. microorganisms proliferate and fills appendix with pus and swells leading to compression on the blood vessels leading to ischemia and necrosis
Appendicitis Risk Factors
peak at age 10-12 uncommon in kids under 2
-diet: diet low in fiber and high in sugar/carbs
-obstruction in opening of appendix: hard fecal matter, foreign bodies, microorganisms
Appendicitis Manifestations
-sharp abdominal pain in the umbilicus in first 4-12 hours
-gradually intensifies (12-18 hours)
-becomes localized to lower right quadrant of abdomen (McBurney point)
-fever, leukocytosis, abdominal guarding, nausea/vomiting, anorexia
-pain will subside if appendix ruptures and then returns and escalates
Appendicitis Complications
-abscess
-peritonitis
-gangrene
Peritonitis
-inflammation of the peritoneum (membrane that lines abdominal wall and organs). may occur when abdominal organs perforate or rupture and release their contents into the normal sterile peritoneal cavity. chiefly it is a complication o father abdominal disorders
Peritonitis Risk Factors
-potential complication any time the abdomen is entered either through trauma or for surgery
-perforated organ location in the abdomen (ruptured gall bladder or spleen, ectopic pregnancy with ruptured Fallopian tube, appendicitis, pelvic inflammatory disease, ruptured diverticulum)
-leakage of infected fluid and pathologic organisms (bacteria) into the peritoneal space
-perforation of peptic ulcer
Peritonitis Manifestations
-cardinal sign is abdominal pain with abdominal rigidity (board-like abdomen to touch)**
-sharp or knifelike pain and/or dull and deep-seated pain over involved area; rebound tenderness; pain may radiate to back, shoulder, scapula
-nausea vomiting, anorexia *abdomen distended and rigid
-fever, malaise, leukocytosis
-decreased peristalsis and decreased bowel sounds
Peritonitis Complications
-sepsis and shock, death
Inflammatory Bowel Disease
chronic inflammation of the GI tract, usually the intestines. combination of environmental, immune and genetic predisposition (crohn's disease, ulcerative colitis)
Inflammatory Bowel Disease Manifestations
-possible autoimmune infection may precipitate familial tendency
-periods of exacerbations and remissions, symptoms worsen with exacerbation
-malnutrition, anemia, weight loss
-fluid, electrolyte, and pH imbalances develop
-indications of inflammation (fever, fatigue, arthralgia and malaise)
-painful, debilitating and life threatening
Ulcerative Colitis
occurs in large intestine and rectum
-progressive condition of the rectum and colon mucosa
-continuous superficial inflammation (ulcers) of mucosal layer that begins in the rectum and extends to the whole colon
-generally, only the mucosa layer of the bowel becomes inflamed, edematous, and bleeds easily
Ulcerative Colitis Manifestations
-intermitting cramps abdominal tenderness (left lower quadrant)
-diarrhea, watery stools (20 per day, often bloody with mucus
-number of stools increases with exacerbation of condition; 10 to 20 stools per day in acute exacerbation
-nutritional and fluid deficits and electrolyte and pH disturbances from decreased absorption
-increased systemic symptoms (fever, malaise, anorexia) with exacerbation
-anemia
-minimal small bowel involvement
Ulcerative Colitis Complications
-ulcers combine creating large areas of stripped mucosa that results in an inadequate surface area for absorption (malnutrition, anemia, hemorrhage)
-necrosis, abscesses
-fluid, electrolyte, and pH imbalance
Crohn's disease
can affect any part of GI tract from mouth to anus. most often it affects the portion of the small intestine before the large intestine/colon

-skipping ulcerations involving mucosal and submucosal layers along the entire GI tract

-characterized by patchy areas of inflammation are separated by areas of normal tissue (skip lesions)

-the internal intestinal wall has a cobblestone appearance

-the entire wall becomes thick and rigid, and the intestinal lumen becomes narrowed and potentially obstructed
Crohn's disease manifestations
-abdominal cramping and pain (right lower quadrant)
-diarrhea (usually watery), nausea, flatulence
-intermittent fever
-can affect both small and large intestines
-the damaged intestinal wall losses the ability to digest and absorb nutrients
-ongoing inflammation also stimulates intestinal motility, decreasing digestion, and absorption
-weight loss: nutritional deficiencies, impaired absorption of vitamin B12
Crohn's disease complications
-malnutrition anemia (iron deficiency)*
-fluid, electrolyte, and pH imbalance
-fistulas*, adhesions, intestinal obstructions, perforation of the affected area of the intestines
Pancreatic Cancer
aggressive malignancy. often asymptomatic until well advanced and has metastasized
-invades nearby structures (stomach, intestines, spleen, liver, kidneys)
-adenocarcinoma is common
Pancreatic Cancer Risk Factors
-family history, obesity, chronic pancreatitis, long standing DM
-liver cirrhosis, alcohol abuse, and tobacco
Pancreatic Cancer Manifestations
-progressive upper abdominal pain that radiates to back
-jaundice
-dark urine
-itchy skin
-clay colored stools
-indigestion, nausea and vomiting
-anorexxia and weight loss
-new onset of DM 10-20%
Pancreatic Cancer Complications
no reliable screening tool
-5 year survival rate is 7%, related to rapid cancer metastasis
Colorectal Cancer
most often develops from a adenomatous polyp
-common and fatal in US and worldwide
-excessive dietary intake of fat, calories, red meat, processed meat, and decreased fiber
Colorectal Cancer Risk Factors
-family history
-old age
-obesity
-physical inactivity
-tobacco and alcohol
-inflammatory bowel disease
Colorectal Cancer Manifestations
asymptomatic until advanced
-unexplained anemia (iron) and weight loss
-lower abdominal pain
-blood in stool (occur/frank)
-patient noticed change in bowel habits
-intestinal obstruction with narrow stools
Colorectal Cancer Complications
-screening begin at 50 or earlier with risk factors
-overall 5 year survival rate is 90% when localized to large intestine
-5 year survival rate other wise is 65%
Esophageal Cancer
occurs in distal esophagus
-squamous cell carcinoma or adenocarcinoma
Esophageal Cancer Risk Factors
-chronic irration
-GERD
-hiatal hernia
-obesity
-alcohol abuse
-tobacco abuse
-45-70
-men 3 times more likely
Esophageal Cancer Manifestations
-often asymptomatic until advanced
-dysphagia
-chest pain (pressure or burning)
-weight loss
-indigestion or heartburn
-halitosis
-hematemesis
Esophageal Cancer Complications
-tumors grow the circumference of the esophagus creating a stricture
-tumors can grow out into lumen of esophagus creating internal obstruction
-delayed identification and treatment cause asymptomatic
-poor prognosis
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