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PC705 module 3 FNU GI issues
GERD - define - -Back flow of gastric contents (acid and pepsin) through LES into esophagus. -Inflammation caused by reflux of highly acidic material will cause esophagitis GERD - Cause - -Condition or disease or agent that alters closure strength of LES or increases and pressure. Like V, bending over, coughing, laying down after a meal, and obesity -Foods causing relaxation of LES: fatty foods, caffeine, alcohol, chocolate GERD - CM - -Heartburn w/in 1hr of eating -Wet burp/regurgitation -dysphagia and chest pain -endoscopy shows inflammation in LES and poor closure GERD - complications - -Barrett's esophagus: ulcers form- dysplastic change in distal esophagus...increases risk of esophageal cancer -chronic inflammation leads to metaplasia which leads to cancer -Pulmonary symptoms: chronic cough, asthma, laryngitis Gastritis - define - inflammation of stomach lining Acute gastritis -causes - -Irritating substances: alcohol, tobacco, aspirin, NSAIDs, other drugs -Viral, bacterial, autoimmune -Bacteria H. Pylori Acute gastritis - cm - -Asymptomatic sometimes -Anorexia, vague epigastric discomfort/tenderness, N/V, postprandial discomfort, hemoptysis if stomach lining is damage Chronic gastritis - causes - -Type A: Immune -Type B: non-immune...H. Pylori or NSAIDs H Pylori define - -bacterium transmitted from person to person via fecal-oral route or contaminated water Chronic gastritis - cm - -Anorexia, fullness, N/V, epigastric pain, bleeding Gastritis - complications -
-PUD, atrophic gastritis, adenocarcinoma, decreased intrinsic factor Peptic ulcer disease (PUD)- define - -break or ulcer of mucosal lining of LE, stomach, duodenum -Erosion, slight mucosal injury, very deep ulceration or perforation -Duodenal most common PUD - patho/causes - -H.Pylori (thrives on stomach acid) -H. Pylori increases secretion of acid and pepsin-killing mucosal cells...increases -NSAIDs - inhibit prostaglandins...stimulates bicarbonate/inhibits acid. -genetics, alcohol, smoking, obesity, COPD PUD - cm (duodenal ulcer) - -gnawing burning pain in epigastrium when stomach empty -waking up at 2am in pain -pain relieved by food/antacid but reoccurs -wt gain -GI Bleed w/o warning Gastric ulcers - define (type of pud) - -In antral (upper portion of stomach) -more prevalent in 55-65 range -not as frequently Gastric ulcers -causes - -defect: breakdown of protective mucous layer that normally prevents diffusion of acids into gastric epithelium -Chronic irritants for gastritis: aspirin, NSAIDs, alcohol, occasionally H. Pylori Gastric ulcers - cm - -pain with empty stomach or soon after meal -if pain after meal then is NOT duodenal -GI bleeding w/o warning -anorexia, fill up fast -V, wt loss Gastric ulcers - diagnosis - -Upper GI endoscopy ->50 must have biopsy to r/o malignancy -testing for H. Pylori Gastric ulcers vs PUD - -1st: pain after meal, 55-65y.o. -2nd: no pain after meal Ulcerative colitis - define - -chronic inflammatory ds of mucous of rectum and colon where large ulcers form
Appendicitis - cm - -pain starts in periumbilical area and moves to RLQ with inflammation -RLQ - McBurney's point - classic (but can be anywhere especially if PG) -N/V, fever, diarrhea LLQ tenderness, s/s of inflammation Appendicitis - labs - -CBC: leukocytosis w/elevation of neutrophils and bands Diverticular ds - define - -presence of diverticula or out-pouching herniations of colon (diverticulosis) ->60y.o. -Usually in LEFT descending/sigmoid colon -Hole in lumen diverticular ds - causes - -low intake of fiber causing high intraluminal pressure in bowel diverticular ds - cm - -isis-asymptomatic or constipation, D, or both -itis-fever, acute LL abd pain, leukocytosis IBS - define - -functional bowel syndrome w/no specific structural or biochemical cause ->women -AKA: spastic colitis or irritable colon IBS - diagnostic criteria - -abd pain/discomfort for 3x/month for 3 months -no disease or injury to explain IBS - patho - -pain/discomfort with change in stool frequency/consistency -relieved by BM -never bleeding or waking up at night -3 subtypes IBS - subtypes -
- IBSC: hard lumpy stool. 2. IBSD: loose watery stool. 3. Mixed: both D and C. IBS - causation/theories - -Unclear - maybe slow wave activity of bowel -visceral hypersensitivity/hyperalgesia -abnormal permeability, motility, and secretion -post infection -overgrowth of normal flora -food allergy/intolerance -psychosocial: depression/anxiety/mental issues IBS - CM -
-D, C, alt patterns of both -abd cramping/pain relieved by BM -mucous in stool -N IBS - Diagnosis - -S/S, exclusion of other disorders -absence of alarm symptoms (fever, wt loss, GI bleed, anemia, mass) Post-Gastrectomy syndromes - define - -maldigestion or failure of chemical digestion d/t loss or reduction of chemicals and enzymes that was in removed portion of stomach -Failure to transport nutrients -deficiency of B12, folate, iron, calcium, fat sol-vitamins Dumping syndrome - define - -Loss of normal pyloric emptying of stomach into small bowel -large volume of hyperosmolar food into small intestines cause osmotic shift of water into lumen=diarrhea. -Rapid absorption of excessive glucose=excessive rise in insulin -Followed by rebound hypoglycemia Dumping syndrome - cm - -D, sweating, dizziness, hypotension, increased HR, weakness, pallor, abd pain, rapid hypoclycemia 1-3hr postprandial Dumping Syndrome - patho - -Stomach resected so food goes into intestine undiluted. Fluid shifts from food bolus creating hypovolemia and distends intestine with corresponding s/s. Hyperglycemia then hypoglycemia. Colon polyps - define - -Protrusion into colon lumen -precursor lesion in development of cancer but can be begin. -cancers develop from adenomatous (benign tumor) polyps. -sessile or pedunculated Sessile vs pedunculated -
- raised protuberance w/broad base
- attached to bowel wall by stalk narrower than body colon polyps - cm - -Usually none. -Sometimes gross occult bleeding and abd pain. colon cancer - define - -Malignant tumor in inner wall of large intestines -3rd leading cause of cancer deaths/year separately -2nd leading cause when gender combined -93,000 dx per year
Acute Cholecystitis - risk - -Gallstones and obstruction of bile duct -bacterial infection sometimes Acute Cholecystitis - CM - -Severe RUQ pain, radiates to back -Abd tenderness in RUQ on palpation (Murphy's sign) -Fever, leukocytosis, mild elevation of bilirubin, ALP Acute Cholecystitis - Diagnosis - -Ultrasound. Look for thickened gallbladder wall. Refer to surgeon. Acute Pancreatitis - Define - -Inflammation of ____ -involves exocrine and endocrine portion -digestive enzymes do not move out because of a blocked duct; instead it auto-digests with these enzymes Acute Pancreatitis - Risk factors - -obstruction of duct by gallstone -Aciner cell injury from alcohol, drugs, virus ->males -bilary tract disease, hypertriglyceridemia Acute Pancreatitis (severe) - CM - -Steady, boring pain in epigastrium or LUQ -Severe tenderness on palpation -N/V, abd distention, hypoactive bowel sounds, low-grade fever Acute pancreatitis - Complications - -ARDS (acute respiratory distress), inflammatory response -Shock, auto-digestion, hyperglycemia Acute pancreatitis - diagnosi/lab - -Serum lipase Jaundice - Define - -greenish-yellow staining of tissue sign of impaired bilirubin metabolism -sign of liver disease or hemolysis -Function of liver is to remove bilirubin from bloodstream Jaundice - Prehepatic - -excessive production of bilirubin -Hemolysis, ineffective erythropoiesis, resorption of large hematomas Jaundice - Hepatic - -Dysfunction of hepatic cells and bile canaliculi -increased levels of conducted and unconjucated bilirubin -Immature or muted UDPGT (Gilbert's ds)
Jaundice - Posthepatic/extrahepatic - -Canalicular bilirubin transport -Conjugated hyperbilirubinemia and mechanical obstruction of bile duct -bilirubin cannot flow to duodenum d/t obstruction -Clay stool -Dark tea colored urine Jaundice - Obstructive - -blockage of bile duct by gallstone or tumor Physiologic jaundice of newborn - cause - -Occurs first or second wk of life -uterine environment low in O2, compensates by creating too many RBC -hepatic system immature -Prehepatic Physiologic jaundice of newborn - breastfeeding - -increased intrahepatic shunting d/t immature BM -lower weight stools, low output Jaundice of newborn - risk factors - -preterm, delayed meconium passage, cephalohemotoma, birth trauma Kernicetrus - Define - -Rare brain injury d/t hyperbilirubinemia -Can cause cerebral palsy, movement disorders, mental retardation -bili serum levels too high, immature blood-brain barrier unconjugated Hepatitis A - Define - -Inflammation of liver parenchyma d/t virus -AKA enteric Hepatitis A - Patho - -Caused by RNA virus -Found in feces, bile, sera -transmitted via fecal-oral route or contaminated water/food Hepatitis A - Incubation and prodromal - -28 days or 15-50 days. Infectious before/during symptomatic period -2 weeks after exposure Hepatitis A - CM - -RUQ pain, malaise, anorexia, N, low grade fever -<6M asymptomatic or jaundice -Older kids - jaundice -Dark urine, light stools, liver tenderness, fatigue -Lasts 6-8 weeks Hepatitis A - Testing - -HBeAg
-transfusion before ' Hepatitis C - CM - -asymptomatic at first -fever, fatigue, dark urine, clay stool, abd pain, anorexia, N/V, joint pain, jaundice -advanced liver ds; cirrhosis, cancer Hepatitis C - Incubation - -4-12 weeks, or 2-24 weeks Ped Pyloric Stenosis - Define - -Obstruction caused by hypertrophy and hyperplasia of sphincter -Overproduction of gastric secretions -Cause unknown -Can be fatal Ped Pyloric Stenosis - risk - -Males, caucasians -Increased gastrin secretion by mom in 3rd trimester -Over production of gastric secretions -Prostaglandin E -Family Hx Ped Pyloric Stenosis - Patho - -muscle is grossly enlarged by hypertrophy and hyperplasia -mucosal lining folded and lumen narrowed Ped Pylori Stenosis - CM - -Projectile vomit, around 2-3 wks age -peristalsis visible on abd. -wt loss, electrolyte imbalance, malnutrition, dehydration, can be fatal, palpable mass in RUQ Ped GERD - Define - -Return of stomach contents to esophagus d/t incompetence of LED -Normal, Outgrow condition -Can cause mucosal erosion, bleeding, dysphagia, failure to thrive -delayed maturation of LES Ped GERD - CM - -excessive vomiting 1st wk of life -By 6th wk, feeding difficulties, refusal to eat, failure to thrive, aspiration pneumonia, esophagitis, iron deficiency anemia Gluten-Sensitivity Enteropathy/Celiac - Define - -Autoimmune ds of small intestine villus epithelium when gluten ingested -Triggered by wheat, rye, barley, oats, malt, flour -Toxin -genetics, immune, environmental factors Celiac - Patho -
-Cell-mediated with T cell mediated autoimmune injury to intestinal epithelial cells. -Results in mucosal cell destruction with inflammation, atrophy, flattening of villi Celiac - CM - -Severe malabsorption -Diarrhea, pale, bulky, greasy, foul-smelling BM, steatorrhea -Malabsorption s/s, Ricketts -Anemia, fat-soluble vitamin deficiency, bruise/bleed easily -Dehydration, protein loss, potassium loss, weakness, calcium caused seizures Celiac - Diagnosis - -Serologic anti-endomysial, anti transglutaminase (IgA antibody) -Intestinal biopsy Obesity - parameters - -Excessive adipose accumulation -BMI≥30 obese -BMI 25-29.9 overweight -BMI ≥40 morbid obese Obesity - related conditions - -heart disease, stroke, DM II, cancer, morbidity, mortality, chronic inflammation -skeletal muscle, vascular and renal systems affected Obesity - causes - -Combination of lifestyle choices environment, genetics, epigenetic -Excessive intake of calories, low expenditure of energy. Metabolic syndrome - Cm - -Abd adiposity (apple shaped) -Increased fatty acid, insulin resistance, low HDL, hypertriglyceridemia, HTN Obesity/metabolic syndrome - hormones - -Resistin, leptin, insulin, gherkin, apelin, adiponectin Lith - -stone/calculus What are the general clinical manifestations of gastrointestinal disorders - -Anorexia, vomiting, nausea, retching, constipation, diarrhea, abdominal pain, gastrointestinal bleeding, dysphagia
