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SysPath 400 - Digestive 4
Terms in this set (100)
of entire digestive tract that causes abdominal pain and constipation or diarrhea.
Irritable bowel syndrome (IBS)
What is meant by functional disorder
Although normal functioning is impaired, no structural abnormalities that can be seen with an endoscope (a flexible viewing tube), x-rays, or blood tests. Thus, IBS is identified by the characteristics of the symptoms and, when needed, the results of limited tests.
-sensitive to many stimuli & substances
-emotional factors can trigger ( stress, anxiety, depression, and fear)
-eating too quick, or eating after too long a period w/o food
-occur when awake
but rarely wake up
(peptic ulcer awakens)
-lower abdominal pain, aching, cramps
-sensation of incomplete emptying after poop
-nausea, headaches, fatigue, depression, anxiety, and difficulty concentrating
How common is IBS
women > men (women report more than men)
-usually dx IBS based on typical Sx's but perform tests to rule out other problems
DDx for IBS
-more frequent, smaller meals
-avoid gassy foods
-low fat diet
-if lactose intolerant, avoid dairy
several disorders that compromise blood flow through segments of intestine:
Ischemic Bowel Syndrome
common cause of Ischemic Bowel Syndrome:
Atherosclerosis of intestinal arteries
Risk w/ Ischemic bowel syndrome?
intestinal infarction (tissue death)
is Ischemic Bowel Syndrome acute or chronic condition?
-chronic (produces mild, non-specific symptoms and is often undiagnosed)
-acute (sudden onset and associated with high mortality)
Pathological Classifications of Ischemic Bowel Syndrome
(emboli or thrombi)
(narrowing of arteries-atherosclerotic)
sudden blockage of blood flow to part of intestines, which may lead to gangrene and perforation (puncture).
Acute mesenteric ischemia
-Severe abdominal pain develops suddenly.
-Angiography may be performed.
-Immediate surgery is needed.
Acute mesenteric ischemia
M/C = arterial embolism
-thrombi in BV of intestines
-drug use (cocaine) narrows BV
important Sx's Acute mesenteric ischemia:
-sudden & severe internal abdominal pain
greater than palpation
pain of abdomen
-Later, as the intestine starts to die, the person's abdomen becomes tender on palpation
Dx Acute mesenteric ischemia
Tx Acute mesenteric ischemia:
-surgery to remove or bypass blockage
-remove infected tissue
Px Acute mesenteric ischemia
-early detection = good chance of recovery
-late detection = 70-90% mortality
How long does it take to have permanent damage to intestine from blocked blood flow?
10-12 hours blocked blood flow will kill area intestine
presence of multiple balloon-like sacs in large intestine
-usually 1/10 inch to 1 inch
-sometimes up to 6 inches
M/C location for Diverticulosis
-Spasms of mm layer of intestine (possibly due to
-spasms creates pressure on intestinal wall = bulging at point of weakness
Common finding w/ Diverticulosis:
Increase in thickness mm layer in sigmoid
-bleeding/ blood in stool
-bowel mvmt disturbances
Stool that is trapped in a diverticulum may cause not only bleeding but also inflammation and infection, resulting in:
-barium enema x-ray
-CT (w/ severe abdominal pain to avoid risk of ruptured colon)
-radionuclide scan (determine source of bleeding)
-stool-bulking agents (METAMUCIL)
-water and fiber
-colonoscopy/surgery to repair bleeding
-surgery to remove lg intestine only in severe bleeding situations
Diverticulosis that will usually always require surgery:
-risk of infection/rupture
-2nd M/C cause of sudden severe abdominal pain & abdominal surgery in US
-located beside cecum @ ileocecal sphincter
-may have some immune function
-not an essential organ.
-blockage inside appendix causing inflammation/infections (foreign body, food, worms)
-idiopathic for most part
Why is it so important to treat Appendicitis quickly?
Ruptured appendix spills bacteria-laden intestinal contents into abdominal cavity
due to infection/blockage of fallopian tubes
-shock due to infection
-Pain beginning up abdomen/navel
-nausea, vomiting, fever are common
-after few hours, nausea passes, pain shifts to right lower portion of abdomen
-widespread pain (infants/children)
-less severe pain in older/pregnant
-McBurney's Point REBOUND test positive
-Pressing on right lower portion of abdomen 1/3 from ASIS to umbilicus (McBurney's Point) is tender,
-when pressure is released, pain
-imaging (CT or ultrasonography)
-blood tests (incr white blood cell count)
-surgery (main Tx = appendectomy)
What happens if the Appendix is found to be normal during Appendectomy (happens 15% of the time)?
Removed anyway. Too risky to leave it behind.
inflammation of the peritoneal cavity.
What is the most serious cause of Peritonitis?
-perforation of GI tract
-produces immediate chemical inflammation
-followed shortly by infection from intestinal organisms
Anything that can cuase abdominal inflammation
-perforation of GI tract (infection/inflammation
-strangulation of intestine
-appendicitis, diverticulitis, strangulating intestinal obstruction, pancreatitis, pelvic inflammatory disease, mesenteric ischemia
-Intraperitoneal blood from any source (eg, ruptured aneurysm, trauma, surgery, ectopic pregnancy)
-shunts, drains, dialysis catheters
-ascitic fluid (ascites)
What diagnostic method should
be given to a person suspected of GI tract perforation?
-causes severe peritonitis
Rare version of Peritonitis:
Spontaneous bacterial peritonitis
-peritoneal cavity is infected by blood-borne bacteria
-causes: severe dehydration/electrolyte disturbances, adult respiratory distress syndrome, kidney failure, liver failure, disseminated intravascular coagulation and death may occur within days.
disease in which ≥ 100 adenomatous polyps carpet colon and rectum
-50% Pt have polyps by age 15
-Untreated w/ develop colon carcinoma b/f age 40
Familial Polyposis Coli
Sx Familial Polyposis Coli
-heme-positive stool (blood in bowel mvmts)
What is Gardner's syndrome?
aka: Benign & Malignant
(previously termed Gardner's syndrome),
manifestations = desmoid tumors, osteomas of skull/mandible, sebaceous cysts, misc other adenomas of GI tract.
= cancer in duodenum (5 to 11%), pancreas (2%), thyroid (2%), brain (medulloblastoma in < 1%), and liver (hepatoblastoma in 0.7% of children < 5).
Dx Familial Polyposis Coli
-colonoscopy (> 100 polyps)
-offspring screened for hepatoblastoma
-sigmoidoscopy of family members beginning at 12 yrs
Tx Familial Polyposis Coli
Due to risk of carcinoma, surgery to remove polyp sections of colon is important
-Endoscopic surveillance of remainder of GI tract
-Aspirin (decr polyp growth)
-varying degree of surgery to remove sections of colon followed by monitoring of remaining sections. remove those if necessary
complete obstruction of lumen
, that can occur in any part of intestine
-surgically resected, with end-to-end anastomosis of uninvolved intestinal segments.
What is Atresia of anus:
-prevents defecation but can also be corrected surgically
-section of large intestine is missing nerve network that controls intestine's rhythmic contractions.
-sx's of intestinal obstruction occur
aka: Congenital Megacolon
Common sign in newborns indicating possible Hirschsprung's Disease
-failure to pass meconium
-later in infancy intestinal obstruction sx's
Intestinal blockage Sx's of Hirschsprung's Disease
-bile stained vomit
-refusal to eat
-failure to gain weight
Hirschsprung's disease can also lead to life-threatening:
(sudden fever, swollen abdomen, explosive/bloody diarrhea)
Dx Hirschsprung's disease
-pressure measurement inside rectum (manometry)
Tx Hirschsprung's disease
-surgery to remove abnormal section of intestine and reconnect normal intestine or connect to rectum or anus (colostomy)
congenital outpouchings of intestine:
Best known Congenital Diverticula:
-incomplete apoptosis of embryonic connection b/w intestine & umbilicus
-can fill w/ food & rupture
-cause life-threatening infections in abdomen
Pain symptoms of Mackel's Diverticulum resemble acute Appendicitis w/ an exception:
pain epicenter in
lower quadrant (opposite side of appendicitis)
-M/C cause of intestinal blockage among children between ages of 3 months - 3 years
-boys > girls
-congenital Abnormality where one segment of intestine slides into another (like parts of a collapsing telescope)
-affected segments obstruct bowel & block blood flow
-sudden stomach pain
-pain 15-20 mins leading to continuous if unTx'd
-irritable, listless, apathetic b/w episodes
-currant jelly-like stools
w/ blood and mucus
-Children w/ perforation appear ill w/ pain on palp of abdomen
Dx & Tx
-Air enema + X-ray (may fix)
-Sometimes self correcting
Intussusception reoccurs in what percentage of children?
5 to 10%
If recurrence = surgery performed to correct condition & look for a polyp, tumor, or other abnormality that could explain why intussusception recurred
-Congenital Abnormalitiy causing rotation of intestine around its mesenteric attachment site
-leads to twisting of arteries and veins and
of rotated intestinal loop
M/C location for Volvulus:
-Episodic & excessive crying (colic) in children
-term when any obstruction cuts off blood supply to intestine
-occurs in nearly 25% of people with small-intestinal obstruction.
-results when part of intestine becomes trapped in an abnormal opening
Examples of causes of Intestinal Strangulation:
-fever = particularly likely if the intestinal wall ruptures.
Strangulation can cause this in
as short as 6 hours
with blood supply cut off:
-Intestinal wall dies leading to rupture
-Rupture leads to peritonitis, shock, and if untreated, death
What are the causes of Diarrhea:
Accounts in typical food poisoning resulting in Diarrhea:
bacterial toxins from contaminated food/water (unrefrigerated left overs)
What exactly causes Bacterial Diarrhea:
, either preformed in foods or released by bacteria growing outside intestine
of bacteria, colonization by bacteria which invade and destroy intestinal tissue
M/C cause Bacterial toxic food-poisoning causing Diarrhea:
-Botulinum Clostridium (botulism)
Bacterial lysis condition caused by Enterotoxigenic Bacteria which colonize in intestinal lumen:
Common example of Enterocolitis is called
. This is due to which bacteria?
lytic action which produces intestinal ulcerations that are often associated with bleeding, inflammation and even perforation
-can enter blood causing systemic infection:
M/C Viral Gastroenteritis causes:
(common in children under 2 years of age)
(common in adults)
-usually heal w/o consequence
infections are less common
-tend to occur in those travelling to southern countries
-noninvasive protozoan that infest small intestine
-typically acquired by swallowing cysts in contaminated food/water
-presents as diarrhea or malabsorption
aka: Bever Fever
Infection by an Amoebas, especially causing dysentery
-Amoeba widespread in tropics causing dysentary
-tourists affected more than locals due to low tolerance
-most infected persons are asymptomatic
-clinical disease occurs only under exceptional circumstances, which are not fully understood
-2nd M/C cause of cancer death in Western countries
Risk factors of Colorectal Cancer:
-Familial Polyposis Coli
-High-Fat, Low-Fiber Diet
-Risk increases at age 40, peaking 60-75 yrs
What colorectal cancer is m/c in men? women?
Men = Rectal
Women = Colon
Sx Colorectal Cancer:
-M/C 1st symptom = bleeding during bowel mvmt
-blood streaked stool
-feeling that rectum is not fully emptied after mvmt
Unique Sx's with tumor in
Left (descending) colon:
-more likely to cause obstruction at an earlier stage, left colon has smaller diameter and stool is semisolid
-frequent bowel mvmts before obstruction
-crampy abdominal pain
-severe abdominal pain/ constipation
Dx Colorectal Cancer:
-screening tests for people over 50
-testing stool for occult blood
If colorectal cancer is found, what is done?
-further testing for metastasis (CT, chest x-ray, lab tests)
Blood tests are not usually used to Dx colorectal cancer, but what are they used for?
Monitor effectiveness of Tx:
For example, if levels of
carcinoembryonic antigen (CEA)
are high before surgery to remove a known cancer and low after surgery,
monitoring for another increase in CEA
level may help detect an early
Tx ColoRectal cancer:
-surgery is usually performed to remove cancerous section
-removal any nearby lymph nodes
Px Colorectal cancer:
Cancer caught early is most curable
=90% curable when caught in lining only
=70% if extended through bowel wall
=30-50% if spread to lymph nodes in abdomen
Where does colorectal cancer typically metastasize to?
How many stages of colon cancer are there:
Stages 0 - 4
limited to mucosa
of covering polyp.
95%+ survival at least 5 years.
spreads to submucosa
90%+ survival at least 5 years.
invades muscularis & serosa of colon.
55-80% survival at least 5 years.
extends through outer layer into nearby lymph nodes.
20-55% survival at least 5 years.
spreads to other organs (liver, lungs, ovaries, or peritoneum of abdominal cavity.
<1% survival at least 5 years.
THIS SET IS OFTEN IN FOLDERS WITH...
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SysPath 400 - Digestive 3
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