Comprehensive Study of Digestive Disorders and Their Clinical Manifestations

acute systemic complications

dehydration, sepsis, bleeding, shock

chronic system complications

malabsorption, malnutrition/deficiency

4 classes of S/S associated with GI diseases

altered ingestion of food, altered bowel movements, abdominal or chest pain, GI tract bleeding

altered ingestion of food

anorexia, vomiting, nausea

anorexia

lack of a desire to eat despite physiological triggers that normally cause hunger

vomiting

forceful emptying of the stomach affected by GI contraction and reverse peristalsis of the esophagus

altered bowel movements

constipation and diarrhea

constipation

infrequent or difficult defecation caused by unhealthy diets and lack of exercise or a disorder

diarrhea

3 or more bowel movements per day, associated with malabsorption syndromes

osmotic diarrhea

caused by excessive fluid drawn into the intestinal lumen by osmosis, water is drawn into bowel

secretory diarrhea

excessive secretion of fluids by the intestinal mucosa, seen with a bacterial GI infection like c. diff

motility diarrhea

excessive GI motility, causes abdominal pain

acute diarrhea

less than 4 days

chronic diarrhea

more than 3 weeks

abdominal or chest pain

caused by stretching, inflammation, or ischemia, originates in the organs themselves or in the peritoneum, can be acute or chronic, visceral pain is referred to the back

upper GI tract bleed

vomiting blood (hematemesis), looks like coffee grounds because it's coming from the stomach

lower GI tract bleed

caused by polyps, diverticulitis or hemorrhoids, melena (dark stool), hematochezia (bleeding from rectum), slow bleeding that causes anemia, not obvious

disorders of motility

motility is the result of smooth muscle contraction, controlled by PSNS and enteric nervous system and hormones

dysphagia

difficulty swallowing, can be caused by a mechanical or functional obstruction of the esophagus

GERD

regurgitation of chyme from the stomach into the esophagus, causing an inflammatory response --> erosion of esophageal mucosa, caused by a weak lower sphincter

what can trigger GERD

consuming foods or alcohol that relax the sphincter

predominant presenting symptom of GERD

burning chest pain, usually worse at night

hiatal hernia

protrusion of the upper part of the stomach through the hiatus at the gastroesophageal junction, caused by wearing tight clothes when obese or pregnant

hiatal hernias can be what (2)

sliding (95%) or paraesophageal

S/S of hiatal hernia

heartburn after eating and difficulty swallowing

intestinal obstruction

prevents the normal movement of chyme through the intestinal tract, can be mechanical or functional

mechanical intestinal obstruction

caused by tortion, herniation, or a tumor

functional intestinal obstruction

result of paralytic ileus

most severe consequences of intestinal obstruction

fluid and electrolyte losses, hypovolemia, shock, intestinal necrosis, perforation of intestinal wall

gastric mucosal barrier (stomach lining)

impermeable epithelial cell surface covered with a hydrophobic lipid layer, alcohol and aspirin disrupt it

what thrives in the acidic environment of our stomach lining and disrupts mucus

helicobacter pylori

gastritis

acute or chronic inflammation of the gastric mucosa caused by regurgitation of bile, use of anti inflammatory drugs or alcohol, and systemic diseases

acute gastritis

transient inflammation of the gastric mucosa, usually associated with local irritants like bacterial endotoxins, alcohol, and aspirin

chronic gastritis

irreversible atrophy of the stomach lining, can lead to stomach cancer

chronic gastritis inflammatory changes

eventual atrophy of glandular ET of stomach --> decrease in production of gastric juice and hormones

most severe form of gastritis

chronic gastritis of the fundus and body

most common form of gastritis

chronic gastritis of the antrum

helicobacter pylori gastritis

inflammatory disease of antrum and body of stomach, leads to peptic ulcers

peptic ulcer (singular)

break or ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum

ulcer

circumscribed area of mucosal inflammation and ulceration caused by excessive secretion of gastric acid, disruption of the protective mucosal barrier, or both

peptic ulcers

group of ulcerative disorders in the upper GI tract exposed to acid activated pepsin that eats ET cells of the stomach walls

most peptic ulcers are caused by

helicobacter pylori

3 types of peptic ulcers

duodenal, gastric, stress

duodenal ulcers

most common peptic ulcers, associated with h. pylori that colonize in the mucus lining of the stomach

when does pain occur with duodenal ulcers

when the stomach is empty, relieves with food or antacids

gastric ulcers

develop near parietal cells in the antrum and become chronic, pain occurs after eating, primary defect is an increased mucosa permeability to hydrogen ions

stress ulcers

develop suddenly after severe illness, systemic trauma, or neural injury, follows mucosal damage

primary clinical manifestation of stress related mucosal disease

bleeding

inflammatory bowel disease (IBD)

disorder that causes inflammation of the intestines, are usually familial

ulcerative colitis

chronic nonspecific IBD that causes ulceration, abscess formation, and necrosis of the colonic and rectal mucosa

where do ulcerations occur in ulcerative colitis

start in rectum and spread to colon, leads to mucosal hemorrhages

manifestations of ulcerative colitis

cramping pain, fever, elevated pulse, diarrhea, bloody stools, weight loss, dehydration, lesions in the colon

treatment of ulcerative colitis

antibiotics and steroids, possible surgery, ileoanal anastomosis

Crohn's disease

affects both the large and small intestines, usually involves all layers of the lumen, autoimmune disorder that causes chronic malabsorption, genetic mutation

irritable bowel syndrome

no known structural or chemical alterations that can be diarrhea prevalent or constipation prevalent or can alternate between the two

what are associated with the symptoms of IBS (3)

intestinal hypersensitivity, intestinal infection, alterations in motility and secretion

celiac disease

autoimmune disorder that damages the villi of the small intestines --> loss of surface area and decreased absorption

S/S of celiac disease

steatorrhea, malnutrition, anemia, weight loss, abdominal distention, skin rash

treatment of celiac disease

gluten free diet, exclude dairy since lactose intolerance is presumed, corticosteroids

diverticular disease of the colon

occurrence increases with age, usually caused by a lack of fiber in diet, lack of exercise, and neglect in "nature's call" to defecate

diverticula

outpouching of colonic mucosa through the muscle layers of the colon wall, especially the sigmoid colon, happens from bearing down to defecate

diverticulosis

asymptomatic diverticular disease with the presence of outpouchings, mucosa herniates through muscularis of colon, increases intraluminal pressure

diverticulitis

inflammation of the diverticula that is a complication of diverticulosis in which there is inflammation and perforations of the diverticulum, mostly in sigmoid colon, usually asymptomatic

appendicitis

most common surgical emergency of the abdomen, acute inflammation of the vermiform appendix

causes of appendicitis

obstruction of the lumen leads to increased pressure, ischemia, and inflammation of the appendix due to fecalith or by twisting

treatment of appendicitis

surgery

hemorrhoids

abnormal engorgements of vascular mucosal cushions in the anus that assist with anal incontinence, can be internal or external, leads to prolapse of tissue into anal canal

S/S of hemorrhoids

itching, perianal discomfort, soiling, bleeding with defecation

treatment of hemorrhoids

diet modification, topical glucocorticoids, vasoconstrictors, analgesics, surgery

complications of liver disorders

portal hypertension, ascites, hepatic encephalopathy, jaundice, hepatorenal syndrome

portal hypertension

elevation of portal venous pressure to at least 10 mmHg caused by increased resistance to flow

most serious complication of liver disease

portal hypertension

most common clinical manifestation of portal hypertension

vomiting of blood from bleeding esophageal varices

complications of portal hypertension

hepatopulmonary syndrome and portopulmonary hypertension

what occurs secondarily to cirrhosis of the liver

portal hypertension

ascites

accumulation and sequestration of fluid in the peritoneal cavity as a result of portal hypertension and decreased concentrations of plasma proteins

jaundice

yellowish pigmentation of the skin or sclera of the eyes caused by increases in plasma bilirubin concentration --> bile can't leave and enters blood

obstructive jaundice

caused by obstructed bile canaliculi or bile ducts outside the liver --> bilirubin accumulates proximal to sites of obstruction and enters the bloodstream --> carried to skin and deposited

hemolytic jaundice

caused by destruction of RBCs at a rate that exceeds the liver's ability to metabolize unconjugated bilirubin

viral hepatitis

infection of the liver caused by a strain of the hepatitis virus

what can all strains of viral hepatitis cause

hepatic cell necrosis, kupffer cell hyperplasia, infiltration of liver tissue by mononuclear phagocytes

clinical manifestations of viral hepatitis prodromal phase

fever, anorexia, liver enlargement

icteric phase of viral hepatitis

jaundice and hyperbilirubinemia

recovery phase of viral hepatitis

symptoms resolve, takes several weeks

cirrhosis

inflammatory disease of the liver that causes disorganization of lobular structure, fibrosis, and nodular regeneration, can result from hepatitis or exposure to toxins

alcoholic fatty liver and alcoholic steatohepatitis

accumulations of fat in the liver and precursors to alcoholic cirrhosis

nonalcoholic fatty liver disease and nonalcoholic steatohepatitis

accumulation of fat in the liver that isn't associated with alcohol intake, usually associated with obesity

cholelithiasis

formation of gallstones in the bile as a result of the aggregation of cholesterol crystals or precipitates of unconjugated bilirubin

cholecystitis

acute or chronic inflammation of the gallbladder usually associated with obstruction of the cystic duct by gallstones

acute pancreatitis

serious but rare, leakage of digestive enzymes into pancreatic tissue where they become activated and begin the process of autodigestion, inflammation, and destruction of tissues

chronic pancreatitis

results from structural or functional impairment of the pancreas that causes recurrent abdominal pain and digestive disorders