Gastrointestinal Disorders: Symptoms, Causes, and Treatments, Exams of Pathophysiology

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Pathophysiology: GI system

Acute diarrhea - frequent passage of loose or watery stools more than 3-5 days. Large volume: viral or bacterial infection of large or distal small intestine, can alter volume and electrolyte balance small volume: frequent loss of small amounts of stools, characteristic of ulcerative colitis and crowns disease other symptoms: fever, H/A, vomiting, abd pain, malaise. could have infection, severe dehydration, virus, bad food, need to rule out if there is more going on than just a GI bug. constipation - changes in the frequency, size, consistency. very subjective. individualized...stool less than once every three days. causes: dehydration, delayed GI motility, sedentary lifestyle, low fiber duet, side effect. check for fecal impaction, beware this could lead to an intestinal rupture. need digital disimpaction. lifestyle change: increase fluid and fiber and exercise. or meds, stool softeners, enemas, laxatives, suppositories anorexia - loss of appetite or desire for food. can occur with or without other GI problems. nausea - stimulated by higher brain center or dissension or irritation anywhere in GI tract. may precede vomiting. vomiting - complex reflex mediated by vomiting center in the medulla oblongata of the brain. occurs in response to excessive dissension or irritation of stomach, chemical stimulation, or severe pain. projectile vomiting occurs with direct stim to vomit center meaning increased ICP. preceding symp. nasuea, tachycardia, sweating

types of abdominal pain - -Parietal pain: caused by stimulation of pain receptors in the parietal peritoneum or abdominal wall. the pain is localized, sharp, intense, and one sided (lateralized). -Visceral pain: caused by stimulation of abdominal organs, pain is vague, diffuse, non localized, and dull. -referred pain: is felt at a distance from the affected tissue or organ, is localized at some point along the afferent nerve pathway of the organ or tissue intestinal obstruction - impaired movement of contents. Mechanical obstructions include, tumors, conditions that effect patency, adhesion, severe constipation (impaction). can lead to ABD dissension and altered F&E's. severe:leads to ischemia of bowels. must remove source of obstruction. s&s: pain, distension, N/V, anorexia, diarrhea, reduced or absent bowel sounds (borborygmus), and tenderness, rigidity, fever. ileus - partial or complete non-mechanical blockage or small or large intestine occurs because peristalsis stops, usually temporary. caused by: abd surgery, reduction of abd blood supply, meds symptoms: abd cramp, distension, N/V, failure to pass. stopping of GI motility. what are the 4 quadrants -

1. Right upper quadrant (majority of the liver, right kidney, colon, small portion of pancreas, gallbladder, small intestines.)
2. Left upper quadrant (spleen, left kidney, stomach, colon, pancreas, small intestines, liver)
3. Right lower quadrant (colon, small intestines, right ureter, appendix)
4. Left lower quadrant (colon small intestines, left ureter) peritonitis - inflam of peritoneum causes: perforation of gut or organ into peritoneal cavity (perf ulcer, ruptured appendix, perf diverticulum, PID.)

clin man of PUD - dyspepsia, pain on epmty stomach (duodenal), pain during eating (gastric), hematemesis (vomit w blood), melena (stool mixed with blood that is black and tar like) indicates slow bleed. hematochezia means stool with bright red blood means bleed is faster. chronic pain. diagnosis and treatment of PUD - diagnosis: endoscopy, blood test, upper GI barium studies, occult blood test, urea breath test. treatment: avoid alcohol and caffeine and foods that cause more acid, reduce NSAIDs, stop smoking, reduce stress, check medications studies - barium study (show tumors to rule out gastric cancer) occult blood (test for blood not visible to human eye) urea breath test (elevated CO2 w H-pylori) Gastroesophageal Reflux Disease (GERD) - reflux of gastroduodenal contents into the esophagus incompetent lower esophageal sphincter can have esophageal inflam. causes LES relaxation from narcotics, CCBs, ETOH, nicotine, chocolate, peppermint signs and symptoms of GERD - heartburn (pyrosis) regurgitation retrosternal aching or burning 30-60 min after eating, aggravated by lying down chest heaviness, pressure radiating to jaw neck shoulders (may even think MI) chronic cough hx of gastric cancer (GERD can cause cancer)

barret esophagus (scar tissue formed due to chronic GERD, lower esophageal needs to be removed.) Tests and treatment for GERD - barium radiograph, endoscopy treatment by weight reduction, elevate bed head, avoid large meals and carbonated beverages, avoid stooping, avoid straining at stool. Hiatal Hernia - stomach protrudes through the diaphragm, can herniate to throat, can be asymptomatic or symp of GI reflux. barium swallow or endoscopy treatment same as GERD can stop flow to that tissue and can poke all the way to chest area Diverticulitis - inflam of one or more diverticula in the bowel wall with micro perforation and abscess formation diverticulosis- herniation of mucosa through the muscle wall of the colon punches that occur when patients not eating enough fiber so frequent constipation stretches out the lumen causing little punches on the wall, if these diverticula become inflamed and get stuff in them they get diverticulitis. signs and symptoms of diverticulitis - abd pain most often acute LLQ steady and severe lasting for days abd guarding altered bowel habits pain w defecation low fever N/V/anorexia

altered gut reactivity in response to luminal factors with stress, visceral hypersensitivity and pain, dysregulation of intestinal motor and sensory functions erratic bowel pattern triggered by stress diagnoses and treatment for IBS - diagnosis is based on symptom based criteria. no definite test. abd bloating, altered stool frequency, form and passage. pain received by defecation treatment is to decrease stress, warmth to abd, diet changes more fiber, possibly one med inflammatory bowel disease - ulcerative colitis is in the colon crowns can be small and large intestine ulcerative colitis - chronic inflammatory bowel disease of the colon manifested by diffuse ulceration of the colonic mucosa especially rectum and sigmoid colon. familial. diffuse ulceration, can have periods of exacerbation and remission. ulcerative colitis - autoimmunity leads to inflam ulceration in large intestine becomes reddened and fragile, top layer of tissue becomes damaged and bleeds, blood in still, more of a surface damage to the colon wall and narrowing HALLMARK: does not skip parts. ulcerative colitis - 10-20 stools per day, cramps pain and dehydration anemia risk for colon cancer diagnoses made by colonoscopy and management includes antiinflam meds. colonic resection may be necessary.

Crohns disease - chronic inflammatory disease of the bowel characterized by patchy inflammation of all layers of the GI tract- submucosal layer, ileum, and colon GI tract has cobblestone appearance remissions and exacerbations causes of crohns disease - unknown- autoimmune theory- infection, allergy, psychosomatic, dietary, hormonal, environmental factors, immune disorder pathophysiology of crohns disease - inability to absorb nutrients with crohns you do have that malabsorption that does with ulcerative colitis...mucous in stool, non- bloody diarrhea, clinical man of crohns disease - N/V, flatulence, colicky pain, malabsorption, 3-5 semisolid foul smelling stools a day, weight loss, fluid imbalance, malaise, low fever, elevated WBC, anemia, diagnosis and treatment of crohns disease - diagnoses: CBC, barium enema, sigmoidoscopy, CT scan, high ESR, electrolyte imbalance treatment: nutritional supplements, diet education, stress management, TPN, antiinflam meds, multi- visceral transplants Hepatobiliary disorders - -cholecystitis -hepatitis -cirrhosis -pancreatitis

treatment of cholecystitis - elective cholecystectomy for asymptomatic: avoid food that irritate, antacids viral hepatitis - malaise, myalgia, fatigue, nausea, anorexia, hepatitis itself is just an acute or chronic inflammation of the liver, inflam of the hepatocytes can be caused by drug and alcohol use, not necessarily the viral origin we associate with it Hepatitis A - fecal-contaminated water, raw shellfish from contaminated areas, self limiting infection, acute only prevent through food and water safety and immunization need it to travel to dirty places...2 injections 6 mo apart Hepatitis B - virus is transmitted through exchange of body fluids like sex, IVDU, hep B can live outside the body and is in SALIVA AND SEMEN acute infection can be mild to life threatening prevent with cleanliness and safety precautions, get vaccinated. rebound tenderness in RUQ, hepatomegaly and splenomegaly, 2-3 weeks Hepatitis C - transmitted through the exchange of blood and bodily fluids. almost always with IVDU but can be sex too. serious acute illness. latency period of many years, kills the liver and requires a transplant. there are new meds that cures the virus. screening is very important. Hepatitis D -

HDV can only occur in those with HBV. co-infection transmitted same as B. hepatitis tests - antibodies to acute infection (anti-hepatitis Immunoglobulin screening) or antibodies to prior infection or vaccination cirrhosis - liver tissue replaced by fibrous tissue (ETOH, viral hep, biliary disease) scarring of channels disrupts flow to the liver leading to portal HTN and further liver failure. portel hypertension - liver receives flow from portal vein and hepatic artery, lots of blood is transferred to liver by portal vein, then liver filters and metabolizes the blood and hepatic artery keeps it perfused. Develop scars to the liver tissue, thin scaring fibrosis backs up flow in the vein because it is a low pressure system (not the artery because artery is a high pressure system) that venous back up is portal hypertension. clinical manifestations of cirrhosis - weight loss, ascites, hepatomegaly, jaundice, abd pain now cannot break down nutrients. because they cannot synthesize albumin you have no colloid pressure which keeps fluid in the vascular space therefore fluid shifts into the belly and you get ascites. cannot break down bilirubin so patient is jaundiced. complications of cirrhosis - spleen becomes congested so lose RBC and WBC and platelets so more prone to infection. Liver is also supposed to clear hormones, so men will have larger breasts, hormones also cause broken blood vessels on the face, also varicose veins on the belly from engorgement. GI bleed because vessels are bulging and cannot synthesize clotting factors and rupture. kidneys may shut down, cannot clear ammonia leading to confusion seizures and AMS Diagnosing Cirrhosis -

tachycardia, hypotension, fever HALLMARK IS INCREASED SERUM LIPASE LEVELS and increased amylase levels decreased calcium (low calcium, high lipase!!) CT abd rest pancreas, NPO, pain relief, IV fluids