Download Gastrointestinal Disorders: Etiology, Pathogenesis, Clinical Manifestations, and Treatment and more Exams Advanced Education in PDF only on Docsity!
NU 3 2 7 Exam 5 With Complete
Solution
What is dysphagia? - ANSWER difficulty swallowing What are the main clinical consequences of dysphagia? - ANSWER > malnutrition
aspiration Clinical manifestations of dysphagia - ANSWER > Pain with swallowing Choking/aspiration Malnutrition Weight loss Treatments for dysphagia - ANSWER > "Thickener" Aspiration precautions Positioning Surgical correction Esophageal pain etiology - ANSWER Two types: Pyrosis (heartburn) Pain in the middle of the chest Mimics Angina Pectoris May radiate
Pathogenesis of esophageal pain - ANSWER Reflux of gastric contents (acid) into esophagus
Pyrosis Esophageal distention Powerful esophageal muscle contraction Chest pain Clinical manifestations of esophageal pain - ANSWER > Chest pain Shortness of breath Retrosternal burning Water brash (regurgitation of sour fluid or tasteless saliva into the mouth-hypersalivation) Nausea Esophageal pain treatment - ANSWER > prevention causative agent specific Diarrhea etiology - ANSWER Increase in frequency and fluidity of bowel movements Acute Infection Stress Food allergy Leakage of stool around an impaction
Fewer then 3 stools per week Low fiber diet Lack of exercise Slow peristalsis (elderly, postoperatively, narcotics) Can lead to impaction Gastroesophageal Reflux Disease (GERD) etiology - cause - ANSWER > Backward flow of gastric contents into esophagus May or may not produce symptoms Pathogenesis of GERD - ANSWER Incomplete closure of lower esophageal sphincter (LES) May be affected by: Fatty foods Caffeine ETOH Smoking Sleep position Obesity Increased abdominal pressure Pregnancy Hiatal hernias Drugs
Birth control pills Narcotics GERD clinical manifestation - ANSWER > heartburn regurgitation dysphagia chest pain (usually after a meal) Complications of GERD - ANSWER > Esophageal strictures Barrett esophagus-precancerous Pulmonary symptoms (from reflux into breathing passages; cough, asthma, laryngitis) Treatment of GERD - ANSWER Aimed at increasing function of LES Sleep with HOB elevated Sit up during meals Surgical repair Nissen fundoplication Pharmacologic H2 blockers PPI Diet Avoid ETOH
Incarcerated hernia (rare):
Life threatening Portion of stomach caught above the diaphragm and occluded Treatment for hiatal hernia - ANSWER > Same as for GERD Surgery for incarceration and intractable reflux Etiology of gastritis - ANSWER > Inflammation of stomach lining May be acute or chronic Acute Overuse of alcohol Aspirin NSAIDS Tobacco use Chronic Helicobacter pylori
Pathogenesis of gastritis - ANSWER Acute-self limiting (can identify something that causes it) Helicobacter pylori
Causes chronic superficial gastritis in all infected persons Promotes inflammation within the gastric mucosa Interferes with prostaglandin which normally provides protection (see
PUD)
Gastritis clinical manifestations - ANSWER > Anorexia
Nausea Vomiting Postprandial (post-meal) discomfort Chronic gastritis is associated with pernicious anemia due to a loss of
intrinsic factor Treatment for gastritis - ANSWER Removal of causative agent Supportive care
Small meals Lower gastric pH Avoid irritants Etiology of gastroenteritis - ANSWER Irritation of stomach and small intestinal lining Usually self limiting Pathogenesis of gastroenteritis - ANSWER Acute Direct bacterial invasion of GI tract Ingestion of bacteria Imbalance of normal flora may predispose to "travelers" gastroenteritis Chronic
mucosal protective agents In stomach- break in the lining may be exacerbated by medications In duodenum-excessive secretion of acid Main cause of PUD? Why? - ANSWER H.pylori
Thrives in acidic conditions Slows rate of healing High recurrence rate unless H. pylori eradicated PUD clinical manifestations - ANSWER Epigastric pain Gastric-empty stomach Duodenal- 2-3 hours post eating Nausea Abdominal upset Chest pain Life-threatening complication GI bleeding Treatment for PUD - ANSWER PPI (protein pump inhibitor) Eradication of H.pylori "Coating agents" Smoking cessation Avoid Aspirin/NSAIDS
Avoid stress Avoidance of dietary irritants that seem to cause symptoms
ETOH Caffeinated beverages Inflammatory bowel disease - ANSWER
What are the inflammatory bowel diseases? - ANSWER > ulcerative colitis (UC)
Chron disease enterocolitis: pseudomembranous colitis (PC) appendicitis irritable bowel syndrome (IBS)
Etiology of UC - ANSWER > Inflammatory disease of the mucosa of the rectum and colon
Affects the epithelial layer Cause poorly understood (genetic, environmental, immunological) Characterized by remission/exacerbations (chronic) Progression of disease is variable Increased risk for colorectal cancer Stress does NOT cause but can increase severity of attack
Anemia
Anorexia
Treatment of UC - ANSWER Steroids
Side effects limit long term use
Immunosuppressive therapy
Broad spectrum antibiotics
Patients with signs of systemic toxicity Megacolon
Colectomy
Chron Disease etiology - ANSWER > Inflammation of the GI tract that extends through all layers of the intestinal wall
Most commonly effects the proximal colon
Cause is unknown some genetic predisposition
Pathogenesis of Chron disease - ANSWER > Lymph nodes of GI tract enlarge and flow is blocked
Engorgement and inflammation of the surrounding tissue leads to deep linear ulcer development Affected portion becomes thickened with fibrous scarring and fissures Bowel becomes incapable of adequately absorbing the intestinal contents
Clinical manifestations of CD - ANSWER > Constant abdominal pain concentrated in RLQ
Diarrhea Perianal fissures Fistulas Abscesses Weight loss Nutrient deficiencies Fluid imbalances
Treatment for CD - ANSWER > Antitumor necrosis factor (Infliximab)
Corticosteriods
Colon develops "pseudomembrane" composed of leukocytes, mucous, fibrin, and inflammatory cells
Mucosal necrosi
Clinical manifestations of PC - ANSWER Diarrhea (often bloody)
Abdominal pain
Fever
Can lead to perforation
Major cause of fever among hospitalized patients receiving antibiotics
Treatment for PC - ANSWER Stop precipitating antibiotic
Oral Flagyl or Vancomycin
Supportive care
Appendicitis etiology - ANSWER > Most common cause of emergent abdominal surgery
Inflammation of vermiform appendix Twice as common before age 45 as after (peak incidence between 10- years of age) More common in men
Appendicitis pathogenesis - ANSWER > Caused by obstruction
May self limit if obstruction relieved Inflammation can lead to necrosis of appendix Infection Perforation Peritonitis (inflammation of peritoneum produced by bacteria or irritating substances introduced into the abdominal cavity)
Appendicitis clinical manifestations - ANSWER > Generalized periumbilical pain
Nausea Diarrhea
Alternating Diarrhea/Constipation Abdominal pain No other defined pathology identified
IBS pathogenesis - ANSWER > Poorly understood
Disorder of motility Increased wave activity in the colon Heightened sensory response to distention and stimulation
IBS clinical manifestations - ANSWER > Variable (minimal to incapacitating)
Alternating diarrhea/constipation Mucous in stool
IBS Treatment - ANSWER > Anti-diarrheal agents
Antispasmodic agents Increase fiber in diet Hydration Support groups
Colon polyps - ANSWER Polyps: any protrusion into the lumen of the GI tract Refers to a benign or not-yet-malignant lesion
Treatment
Removal upon identification
Etiology of colon cancer - ANSWER Risk factors
Over age 40 High fat, low fiber diet Heredity Medical conditions (Ulcerative colitis, Chron's Disease, Polyps of colon)
Pathogenesis of colon cancer - ANSWER largely unknown
Clinical manifestations of colon cancer - ANSWER Dependent on location/size
Right side of colon
Black, tarry stools
Left side of colon
