PHRM3550 GI

What is gastroparesis?

stomach cannot empty itself

typically because of damage to vagus nerve

can be caused by diabetes

What is hypertrophic pyloric stenosis?

food cant pass freely out of stomach

What is dumping syndrome?

food moves from stomach to intestines too quickly

caused by vagotomy

What does IBS affect?

small intestine

colon

What are the symptoms of IBS?

recurrent bouts of abdominal pain

diarrhea that alters with constipation

What is the pancreas' role in GI secretion disorders?

through secretion of enzymes and bicarb production

What do GI disorders of secretion involve production of?

gastric acid

intrinsic factors

mucus

What is the livers role in GI secretion disorders?

via formation and secretion of bile

What is the role of the small intestine in secretion disorders?

water reabsorption

electrolyte balance

What causes peptic ulcers?

increased acid secretion

decrease in mucosal defense

What do peptic ulcers cause?

discrete areas of erosion

Where is a gastric ulcer?

stomach

Where is a duodenal ulcer?

first part of small intestine

What endocrine disorder can cause peptic ulcers?

pancreatitis

What GI complications can diabetes mellitus cause?

autonomic neuropathy (nerve damage=nerves do wonky shit)

keto acidosis

What types of esophagus disorders are there?

esophageal achalasia (hard to swallow)

reflux esophagitis

increased lower esophageal sphincter tone

What causes esophageal achalasia?

defective innervation in esophageal sphincter

What is the pathology of esophageal achalasia?

esophagus doesn't relax properly in response to swallowing

What are the clinical signs of esophageal achalasia?

enlargement of esophagus

esophagus holds putrid material

infection

esophageal rupture=death

What is a consequence of the esophagus holding putrid material in achalasia?

increase the risk of aspiration pneumonitis

What is reflux esophagitis?

heartburn

inflammation of the esophagus by stomach acid

What are the clinical signs of reflux esophagitis?

burning chest pain

heartburn from recurrent mucosal injury that is often worse after eating or when lying supine or after certain types of food and drugs

dysphagia

hemorrhage

perforation

What causes reflux esophagitis?

any condition that leads to persistent and repetitive acid exposure of esophageal mucosa

alkaline injury

hiatal hernia

What is the pathology of reflux esophagitis?

effectiveness of barrier to reflux of acid from stomach is lost by loss of esophageal sphincter tone

causes recurrent reflux and inflammation

What is chronic recurrent reflex?

change in esophageal epithelium from squamous to columnar

can cause barrett's esophagus

What is Barrett's esophagus?

when lining of esophageal epithelium changes from stomach acid

common in men and smokers

increases risk of adenocarcinoma

What are the typical causes of stomach disorders?

problems with secretion mechanisms

What are the disorders of the stomach?

acid peptic disease

loss of intrinsic factor secretion (inability to absorb vit D and B12)

gastroparesis

What is acid peptic disease?

chronic, mild, gnawing, or burning abdominal pain

can induce GI tract bleeding

What happens as a result of GI bleeding?

hematemesis

melena

perforation

infection

severe abdominal pain

What causes acid peptic disease?

increased acid production

decreased mucosal defense

H. pylori

corrosive agents

What makes H. pylori relevant in GI disorders?

large problem in underdeveloped countries

caused by fecal-oral contamination

causes inflammation

How are gastric ulcers different from erosive gastritis?

penetrate through mucosa

What motility defects can cause gastric ulcers?

tendency if duodenal contents to reflux

incompetent pyloric sphincter

delayed emptying of gastric contents

food retention leads to increase in gastrin and gastric acid secretion

How do NSAIDS cause gastric ulcers?

decrease prostaglandins, which increase blood flow and bicarb

What is acute erosive gastritis?

inflammation of the superficial mucosal lining

causes mucosal erosion and shallow ulcers

What causes acute erosive gastritis?

alcohol

drugs

stress

What causes duodenal ulcers?

sequential H. pylori infections

excessive acid secretion

altered mucosal inflammation repair

What are risk factors for duodenal ulcers?

diet

smoking

excessive alcohol

genetics

stress

What are the clinical signs of peptic acid disease?

acute/chronic GI bleeding

drop in hematocrit

hematemesis

rectal bleeding

melena

hemodynamic changes

What hemodynamic changes occur in peptic acid disease?

hypotension

tachycardia

orthostatic bp

dizziness

What is gastroparesis characterized by?

nausea

vomiting

constipation or diarrhea

What is the pathology of gastroparesis?

alteration in enteric nervous system (neuropathy with diabetes)

alteration in gut hormones

pyloric sphincter issues

What are the clinical manifestations of gastroparesis?

development of bezoar's contents (like balls of random material in digestive tract)

bacterial outgrowth

erratic blood glucose control

weight loss

diarrhea

What are the clinical signs of gall bladders disorders?

usually asymptomatic

What are the two pathologies of gall bladders disorders?

bile with cholesterol so concentrated it falls out of solution

decreased gall bladder emptying where bile spends too much time in gall bladder and mixes with cholesterol to make stones

What is cholecystitis?

inflammation of gall bladder

can progress to acute pancreatitis

How does cholecystitis progress to acute pancreatitis?

from stones in common bile duct that can get out

block pancreatic duct

What are the disorders of the small intestine and colon?

diarrhea

IBD

diverticular disease

What can cause diarrhea?

altered motility, secretion, digestion, absorption

disease of stomach, pancreas, and biliary tract

What are the clinical signs of diarrhea?

increased stool frequency and volume

decrease in stool consistency

result of change in water absorption

What causes acute diarrhea?

usually caused by infections or as a side effect of medication

water malabsorption

not enough absorption

too much secretion

What is osmotic diarrhea?

malabsorption in nutrients

pancreatic insufficiency

damaged enterocytes

What is secretory diarrhea?

secreting protein remains elevated

increased rates of fluid out of cells

doesnt stop when patient fasts

What substances are ingested and contribute to excessive osmotic load?

bacterial action

lactose

enzymatic disease

What causes an increase in secretion in diarrhea?

increase in blood borne or intraluminal secretagogue (something that causes secretions) like gastrin, pentagastrin, acetylcholine

exotoxins (food poisoning)

luminal substances (bile acid)

What causes a decrease in absorption in diarrhea?

toxic effect of alcohol

mucosal damage from infectious agents

prokinetic agents make GI tract go too fast

inflammatory disorders that make you lose blood mucus and protein

What are the infectious causes of diarrhea?

toxins that alter small bacterial toxins

invasive organisms localized to colon

What are the clinical manifestations of diarrhea?

dehydration

malnutrition

weight loss

vitamin deficiency

What is inflammatory bowel disease?

function disorder with abdominal pain with diarrhea and/or constipation

chronic autoimmune process

malabsorption is a prominent feature

What is inflammatory bowel disease characterized by?

recurrence

mucopurulent (mucus and pus)

blood diarrhea

lack of positive cultures

failure to respond to antibiotic therapy

exacerbations followed by remission

What is Crohn's disease?

IBD in distal ileum and colon

has areas of ulceration and inflammation that are discontinuous and look cobblestone-y

What is ulcerative colitis?

IBD in mucosa of colon and rectum

similar presentation to Crohn's (symptoms, complications, with acute inflammation)

How is ulcerative colitis different than Crohn's?

limited or no obstructions, perforations, or fistulas

will see pseudopolyps that increase risk of adenocarcinoma

What is diverticular disease?

chronic autoimmune process in small intestine and colon

malabsorption is prominent

How does diverticula in colon appear?

outpockets of colonic mucosa through weakness of muscle layer

What characterizes uncomplicated diverticular disease?

cramping

flatulence

irregular defecation

hard to separate from IBS

What characterizes complicated diverticular disease?

uncommon but highly dangerous

rapid or slow bleeding

diverticula are infected and develop abscesses

What are the symptoms of diverticular disease?

most asymptomatic with the exception being constipation that is intermittent and causes unpredictable gripping lower pain

sometimes bleeding in stool and positive cultures

Where does diverticular disease usually occur?

colon, descending colon and sigmoid colon

What is the cause of diverticular disease?

consumption of highly refined food with less fiber

What is diverticulitis?

development of inflammation of diverticulum

mimics acute appendicitis

What is IBS characterized by?

chronic abdominal pain

discomfort

bloating

alteration in bowel habits (diarrhea, constipation alternate)

How do you diagnose IBS?

by altered bowel habits

in absence of any primary detectable pathology or structural abnormality

What causes IBS?

changes in motility?

increase or decrease

What is the tx for IBS?

diet

trying to increase soluble fiber supplementation