Pathophysiology Exam 4

True or false: Stress and psychosomatic disorders can cause an abdominal pain response

True

What defines a loss of appetite, either alone or with nausea and vomiting?

Anorexia

What defines the stimulation of medullary vomiting center, often preceding vomiting and accompanied by autonomic responses such as salivation, pallor, sweating, and tachycardia?

Nausea

What is the forceful oral expulsion of gastric contents?

Vomiting

What defines a hemorrhage above the stomach, presenting with blood in vomit?

Frank hematemesis

What kind of vomit would you expect to see with a hemorrhage into the stomach with partial digestion of blood?

Coffee-ground vomitus

What term defines a hemorrhage in the intestine with blood mixing into stools, that is sometimes not apparent in feces?

Fecal occult blood

What term defines dark black, tarry feces that are associated with upper gastrointestinal bleeding?

Melena

What kind of stools would you expect to see with a hemorrhage in the rectum?

Red, blood-coated stools

True or false: A hemorrhage that goes unnoticed will likely cause anemia

True

What term defines a hole somewhere throughout the GI tract that can allow GI contents to flow into spaces they are not supposed to?

Perforation

What often occurs after perforation of the GI tract?

Peritonitis (inflammation of the peritoneum)

Decreased mucosal function seen with a GI hemorrhage that led to a perforation leads to malabsorption and decreased bacterial containment. If left untreated, what severe complication can occur?

Sepsis

What is a systemic autoimmune disease that affects the entire body along with symptoms of extensive dryness in mouth?

Sjogren’s Syndrome

What is an inflammation of one or both parotid glands that decreases salivary flow?

Parotitis

What term defines difficulty swallowing?

Dysphagia

What term defines the failure of smooth muscle fibers to relax, which can cause a sphincter to remain closed and fail to open when needed?

Achalasia

What is the most common esophageal disease that is the reflux of gastric acid and pepsin through LES into esophagus, often presenting with heartburn or regurgitation?

GERD (Gastroesophageal reflux disease)

What is the outpouching of the esophageal wall that retains food, resulting in weakness of muscle or motility problems that presents with gurgling, belching, coughing, and foul breath?

Esophageal diverticulum

What cancer arises in the distal third of the esophagus and is the consequence of Barret and long-standing GERD?

Adenocarcinomas

What cancer arises in the middle third of the esophagus and is the consequence of alcohol, tobacco, achalasia, or frequent hot beverages?

Squamous cell carcinoma

What term defines metaplastic epithelium in the esophagus presenting with goblet cells that is a complication of chronic GERD, increasing the risk of esophageal cancer?

Barrett’s esophagus

What can esophagitis progress to?

Ulcerations, bleeding, strictures, and Barrett’s esophagus

What is a needed finding to diagnose Barrett’s esophagus?

Goblet cells in the esophageal mucosa

What are the two main symptoms of stomach disease?

Hematemesis and melena

True or false: Melena signifies bleeding distal to duodeno-jejunal junction

False, bleeding is proximal

What is the term for acid output collected via nasogastric tube on an empty stomach, normal <5 mEg/hr?

Basal acid output (BAO)

What is the term for acid output collected 1h after pentagastrin stimulation, normal 5-20 mEg/hr?

Maximal acid output (MAO)

What is the normal BAO:MAO ratio?

0.2:1

What can failure of driving force or obstruction to flow at pylorus result in?

Delayed gastric emptying

What can decreased fundic compliance, loss of pyloric resistance, or failure or duodenal feedback all lead to?

Increased gastric emptying

What can occur from reduced vagal nerve conduction, reduced stomach muscle activity, or compromised myoelectric activity that is a ‘paralysis’ of the stomach?

Gastroparesis

What bacteria produces enzymes and toxins interfering with local protection of gastric mucosa, colonizing the stomach and has been associated with gastric ulcers and cancer?

H. Pylori

What type of Gastritis is usually transient, healing occurring within a few days, caused by NSAIDs, alcohol, stress, toxins, etc.?

Acute

What type of Gastritis presents with absence of visible erosion and inflammatory processes leading to atrophy of glandular epithelium, with changes become dysplastic and possible carcinoma?

Chronic

What are the 3 major causes of chronic gastritis?

• H. pylori (most common)

• Chronic autoimmune disease (T1D, Addison disease)

• Chemical gastropathy (duodenal-gastric reflux)

What occurs in Addison disease?

Adrenal glands don’t produce enough hormones

What are peptic ulcers due to?

Exposure to HCl/pepsin

What are the 2 main causes of peptic ulcers?

NSAIDs/aspirin or H. pylori (main cause)

An uncomplicated ulcer can present with burning pain occurring when stomach is empty or between meals. What can it be relieved by?

Food or antacids

What are GI alterations that occur as a result of physiological stress, thought to result from ischemia, tissue acidosis, and bile salt reflux leading to decreased GI tract motility?

Stress ulcers (Curling ulcer)

What are stress ulcers manifested by, having a high incidence of perforation?

Painless upper GI bleeding

What are esophageal, gastric, and duodenal ulcers following intracranial injury?

Cushing ulcer

What are Cushing ulcers caused by?

HCl hypersecretion following vagal nuclei stimulation due to increased intracranial pressure

What is a rumbling or gurgling sound caused by the movement of gas in the intestines?

Borborygmus

What does mechanical intestinal obstruction present with?

Severe pain coming and going, borborygmus, audible high-pitched peristalsis, and awareness of intestinal movements

What does paralytic intestinal obstruction present with?

Continuous pain with a silent abdomen

What are the results of intestinal obstruction?

Vomiting (fluid and electrolyte loss), accumulation of gas, distension of bowel, compartment syndrome (ischemia, necrosis), anaerobic bacteria producing endotoxins leading to endotoxemia

What is a major cause of work absence, morbidity, and mortality, and is both a sign and symptom?

Diarrhea

What are the 2 pathophysiologic mechanisms of diarrhea?

Decreased absorption (osmotic) / Increased secretion (secretory) of fluids and electrolytes

How does Cholera toxin result in secretory diarrhea?

It increases Cl- secretion into the GI tract, thus increasing Na+ secretion, thus increasing water secretion

What results from stimulated secretion and inhibited absorption, stimulation of enteric nerves causing propulsive contractions and stimulated secretion, mucosal destruction and increased permeability, or nutrient maldigestion and malabsorption?

Inflammation-induced diarrhea

What is described as less than three bowel movements a week?

Constipation

What is an immune disease with gluten intolerance?

Celiac disease

What are symptoms of Celiac disease in infants?

Diarrhea, abdominal distention, and malnutrition

What are symptoms of Celiac disease in older children?

Anemia, short stature, dental enamel defects, constipation

What are symptoms of Celiac disease in adults?

Diarrhea, abdominal pain, bloating, constipation, mouth ulcers, and discomfort

What are fermentable carbohydrates that are poorly absorbed in the small intestine and rapidly fermented by bacteria, producing gas, bloating, abdominal pain, diarrhea, or constipation?

FODMAPs

What are the 5 Rs to help with small intestine bacterial overgrowth?

Remove, replace, reinoculate, repair, and rebalance

What disease has persistent symptoms of abdominal pain, altered bowel function, flatulence, bloating, nausea, and anorexia?

Irritable Bowel Syndrome (IBS)

What does treatment of IBS focus on?

Stress management

What does inflammatory bowel disease include, activating inflammatory cells causing tissue damage?

Crohn’s disease and ulcerative colitis

Which inflammatory bowel disease only affects the large intestine, starting from rectum and going continually upward into colon, only affecting upper layers of intestinal wall (mucosa and submucosa), with no fistula or anal fissure formation, predisposing colon cancer?

Ulcerative colitis

Which inflammatory bowel disease affecting anywhere in the GI tract, with skip lesions, affecting the whole thickness of the intestinal wall, with anal fistula and anal fissure formation?

Crohn’s disease

What are small pouches bulging from the lining of the GI tract, most common in the colon?

Diverticula

Why is diverticular disease almost non-existent in African countries?

Development of disease is due to lack of fiber diet, little physical activity, and poor bowel habits

Where does diverticulitis pain manifest?

Lower left quadrant

Where does appendicitis pain localize at?

Lower right quadrant

What occurs in Appendicitis?

Appendix becomes inflamed and swollen, can perforate if untreated, abrupt onset with epigastric or periumbilical pain, nausea manifests with onset of pain

What are the functions of the liver?

Remove toxins, metabolize, produce proteins, fight infection, produce substances that regulate blood clotting, produces bile

What is the main manifestation of liver disease?

Portal hypertension

What are the consequences of portal hypertension?

Varices, splenomegaly (spleen enlargement), ascites (fluid buildup in abdomen), and hepatic encephalopathy

What results from liver disease that presents as jaundice?

Excess bilirubin

What is the water insoluble product of heme metabolism?

Unconjugated bilirubin

What is indicated if a patient is vomiting green?

They have a bowel obstruction below the level of the Ampulla of Vater (sphincter of oddi exit)

Prehepatic jaundice is a type of Hemolytic jaundice. What occurs in this type of jaundice?

There is an increase in unconjugated bilirubin due to excessive hemolysis of red blood cells or absorption of a hematoma

What kind of jaundice can be extrahepatic or intrahepatic?

Obstructive jaundice

What are the consequences of liver disease?

Changes in protein synthesis and exocrine gland function

• Bile is only site of cholesterol excretion, excess can lead to gallstones

• Bile acids are markers of liver function

• Bilirubin conjugated/unconjugated ratio in plasma can indicate type of liver malfunction

• Blockage or bile ducts leads to reflux of bile into plasma resulting in jaundice, nausea, and itching

What is the main cause of chronic liver disease, cirrhosis, and hepatocellular cancer?

Chronic hepatitis

What are the causes of Hepatitis?

Viral infections, alcohol use disorder, drug toxicity, autoimmune disorders

What is the highly contagious viral liver infection that is preventable by vaccine and is caused by ingestion of fecal matter, presenting with jaundice, nausea, and abdominal pain?

Hepatitis A

What is the life-threatening liver disease which spreads through exposure to infected body fluids like mother to child birth, exposure to infected blood, and sexual transmission that can be prevented by vaccine and presents with abdominal pain, vomiting, and jaundice?

Hepatitis B

What is a liver disease transmitted through exposure to infected blood, often post transfusion and IV drug administration, that may last up to 6 months and often results in chronic hepatitis?

Hepatitis C

What is the leading cause of acute liver failure?

Hepatotoxicity

What drug has a 50% rate of unintentional overdose leading to hepatotoxicity?

Acetaminophen

How does alcoholic liver disease progress?

Fatty liver disease → alcoholic hepatitis (jaundice presents) → cirrhosis (hepatocyte injury and fibrosis)

Nonalcoholic Fatty Liver disease has a similar progression to ALD. What is this disease associated with?

Obestity, T2D, and hyperlipidemia

How can direct hepatocyte injury cause hepatotoxicity?

Drug metabolism is inhibited therefore toxic metabolites build up in the liver

What is the final, common end-stage for a variety of chronic liver diseases that is an irreversible inflammatory disease that decreases hepatic function due to fibrosis?

Cirrhosis

What is the cause of alcoholic cirrhosis?

Oxidation of alcohol damages hepatocytes

What occurs in biliary cirrhosis?

Cirrhosis begins in the bile canaliculi and ducts leading to cholestasis

What is primary biliary cholangitis due to?

Autoimmune cirrhosis

What is secondary biliary cirrhosis due to?

Obstruction of bile

What is postnecrotic cirrhosis a consequence of?

Chronic diseases (hepatitis B and C / primary biliary cholangitis (PBC))

What presents with hepatic failure?

Jaundice, ascites, fetor hepaticus (sweet breath), hypoalbuminemia, hypoglycemia, palmar erythema, spider angiomas, hepatic encephalopathy

What term defines gallstone formation?

Cholelithiasis

What is the most common cause of gallbladder problems?

Obstruction or inflammation

What are the types of cholelithiases?

Cholesterol (most common) and pigmented (consequence of cirrhosis)

What are the risk factors for gallstones?

Obesity, middle age, female, Native American, gallbladder/pancreas/ileum disease