Patho - Module 13: GI, Hepatic, Biliary

Upper, middle, lower

What are the 3 levels of the GI tract?

Inner mucosal, submucosal, muscularis externa, serosal

What are the 4 layers of the GI wall?

Inner mucosa

What layer of the GI wall produces mucus and provides lubrication?

Submucosal

What layer of the GI wall is composed of fat and secretes digestive enzymes?

Muscularis externis

What layer of the GI wall facilitates movement of content?

Serosal

What layer of the GI wall anchors the organs in place?

CCK

The following is the function of what GI hormone?
- Increase pancreas enzyme flow
- Increases bile secretion in liver

Secretin

The following is the function of what GI hormone?
- Inhibits stomach motility
- Increases bicarbonate secretion in pancreas

Gastrin

The following is the function of what GI hormone?
- Increase stomach motility
- Increase acid production

Anorexia, abdominal pain, n/v

What are the 3 common GI sxs?

Anorexia

Define:
- Condition where a person lacks appetite
- Associated /w nausea, emotional factors, smells, drugs, and disease states

Abdominal Pain

Define:
- Sxs of pain in the abdominal region
> Determine location --> observe for rebound tenderness

Nausea and Vomiting

Define:
- Condition where the vomiting center in the medulla is activated in response to stimuli
> Chemoreceptor center on the floor the 4th ventricle
>> Mediates emetic effects of blood-born drugs/toxins

Vomiting Center

Define:
- Area of the brain involved in the vomiting episode
> Stimulated by bloodborne drugs/toxins
> Located in the medulla

Esophageal atresia, tracheoesophageal fistula

What are the congenital anomalies found in newborns that is made WORSE by feeding?

Oral leukoplakia

Define:
- White plaque on the mucosa of the mouth, precancerous lesion

Tongue, finger

What is the most common site for oral cancer? What do you use to assess it for lesions?

Oral, Head, Neck Cancer Risk Factors

The following are risk factors for what?
- Tobacco --> #1 cause
- Heavy alcohol intake (ETOH) --> #1 cause
- Other chronic irritants

Dysphagia

Define:
- Term that describes difficulty swallowing

Gastroesophageal Reflux Disease (GERD)

Define:
- Condition where backflow of stomach contents into the esophagus occurs

GERD Etio

Etio:
- Weak/incompetent lower esophageal sphincter
- Delayed gastric emptying
- Overweight, tight clothing, laying down after eating, large meals, etc. (Increased pressure in gut)

GERD Sxs

Sxs:
- Heart burn --> Most severe at night
- Reflux into mouth (can be severe)
- Pain/hoarseness after reflux --> Can be mistaken for cardiac pain
- Respiratory symptoms

GERD Patho

Patho:
- Reflux asthma/chronic cough d/t:
> Aspiration
> Laryngeal injury
> Vagal-mediated bronchospasm

GERD Treatment

Treatment:
- Lose weight, sit upright after eating, sleep w/ head elevated
- Small meals, avoid foods that lower esophageal sphincter tone

Incorrect

Correct/Incorrect:
- A nurse is treating a pt. with GERD. After eating, she lays the pt. flat on the bed to let him digest.

GERD Rx

Rx:
- H2 Blockers - Tagamet (cimetidine)
- Proton Pump Inhibitors - Prilosec (omeprazole)

Tagamet (cimetidine)

What GERD medication inhibits gastric acid secretion?
- (Hint: Consider chemical composition of gastric acid)

Prilosec (omeprazole)

What GERD medication inhibits proton pumps that secrete gastric acid

Nexium, Protonix, Prevacid, Prilosec

What are the proton pump inhibitors used to treat GERD?

Pepcid, Zantac, Tagamet, Calcium carbonate

What are the H2 receptor antagonists used to treat GERD?

Mylanta, Maalox, Alka-Seltzer, Rolaids

What are the OTC medications used to treat GERD?

GERD Complications

Complications:
- Scarring
- Strictures
- Barrett's Esophagus (d/t prolonged irritation)

Esophageal-Gastro-Duodenal Endoscopy

What procedure is used to dx GERD?

Esophageal Cancer

Define:
- Malignant tumors of the esophagus; Two types:
> Squamous cell cancers --> MOST COMMON
> Adenocarcinoma --> Barrett's

Squamous cell, adenocarcinoma

What are the two types of esophageal cancer?

Smoking/alcohol abuse, old age, male gender

What are the risk factors for esophageal cancer?

Barrett's Esophagues

Define:
- Adenocarcinoma of the esophagus d/t irritation r/t GERD

Esophageal Cancer Sxs

Sxs:
- Dysphagia --> Hurts to eat
- Severe Weight loss

Gastritis

Define:
- Inflammation of the gastric lining; two types:
> Acute/Chonic --> DIFF. PATHOS

Gastritis Factors

The following are factors r/t what disease?
- #1 cause = H. pylori
- #2 cause = NSAIDs
- Alcohol
- Corticosteroids

Gastritis Patho

Patho:
- Apsirin/NSAIDS inhibit prostaglandin secretion

Prostaglandin function

The following are functions of what chemical compound?
- Improve gastric mucosal blood flow
- Decrease acid secretion
- Increase bicarbonate secretion
- Enhance mucous production

Acute Gastritis

Define:
- Sudden inflammation of the gastric mucosa

Acute Gastritis Etio

Etio:
- H. pylori
- NSAIDS/aspirin
- Alcohol
- Serious illnesses

Acute Gastritis Sxs

Sxs:
- Hemorrhage
- Heartburn
- Hematemesis
- Violent vomiting --> Even after 5 hours after ingestion

Acute Gastritis Treatment

Treatment:
- IV fluid replacement d/t vomiting
- Removal of irritant

No, compensatory mechanism

When treating acute gastritis, should you stop the vomiting? Why?

Chronic Gastritis

Define:
- Long-term inflammation of the gastric mucosa
- Visible erosions --> atrophy of gastric epithelium

Anatomical changes

Fill in the blank:
- Acute and chronic gastritis differ d/t the _____ ______ to the gastric mucosa found in chronic gastritis

Chronic Gastritis Etio

Etio:
- H. pylori
- AID
- Chemical gastropathy

Treatment for H. Pylori

Treatment:
-Two or more antibiotics plus omeprazole for 10-14 days

Dietary, prevent

Fill in the blank:
- Chronic gastritis requires extensive _________ modifications in order to __________ glycemic fluctuations

Peptic Ulcer Disease

Define:
- Condition of open sores that develop on the gastric mucosa of the stomach and upper portion of the small intestine

Elderly, NSAID use, concurrent corticosteroid use

What are the risk factors for peptic ulcer disease?

Peptic Ulcer Disease Patho

Patho:
- H. pylori stimulates release of cytokines which increase mucosal damage

Peptic Ulcer Disease Sxs

Sxs:
- Burning, gnawing, cramping stomach pain --> Especially on empty stomach
- Epigastric pain --> Radiates to costal margins/back

Peptic Ulcer Disease Complications

The following are complications of what disease?
- Sudden severe hemorrhage (life threatening)
- Melena (occult blood)
- Coffee ground emesis

Melena

Define:
- Condition of black, tarry stool d/t partly digested blood

Coffee Ground Emesis

Define:
- Condition where vomit appears like coffee grounds d/t old/coagulated blood in the GI tract

Peptic Ulcer Disease Treatments

Treatment:
- Antacids
- PPI's
- Sucralfate/Misoprostol

Sucralfate

Define:
- Drug used for PUD treatment; acts as a mucous lining and serves as a barrier against acids

Misoprostol

Define:
- Drug used for PUD treatment; Counteracts NSAIDs, reduces gastric acid secretion

Stress Ulcers

Define:
- Ulcers resulting from physiologic stress
- Curling's Ulcer
> Ulceration in response to a major physiologic illness

Stress Ulcer Risk Factors

The following are risk factors for what condition?
- Major burns/trauma
- Sepsis
- Severe liver failure
- Major surgical procedures
- MODS (multi-system organ disease syndrome)
- Pts. admitted to ICU

Cushing Ulcer

Define:
- Type of stress ulcer; occurs w/ intracranial tumors, surgery, or trauma
- Results from hypersecretion of HCl d/t increased ICP stimulating the Vagus Nerve

Stress Ulcer Treatment

Treatment:
- Preventative w/ H2 receptors blockers and PPI's (IV Protonix)

Cholecystitis

Define:
- Inflammation of the gallbladder, usually associated w/ stones

Women, overweight

What are risk factors for cholecystitis?

Cholecystitis Sxs

Sxs:
- Acute onset of RUQ/epigastric pain --> episodes of colicky pain
- Mild fever, anorexia, n/v
- Intolerance to fatty foods

Cholecystitis Labs

The following labs can be found in what condition?
- Increased WBCs
- Elevations in AST, ALT, SGOT, SGPT, and bilirubin --> Liver function tests

Ultrasound

What procedure would you use to dx cholecystitis?

Laparoscopic surgery

What surgery is done to treat cholecystitis?

Cholelithiasis

Define:
- Stone formation in the gallbladder; gallstones

Obesity, female, multiple pregnancies, oral contraceptives

What are risk factors for cholelithiasis?

Jaundice, epigastric/RUQ pain

Cholelithiasis blockage can result in what conditions?

Choledocholithiasis

Define:
- Condition of a stone in the common bile duct
- Characterized by RUQ pain, fever, chills, jaundice
- Bilirubinuria/elevated serum bilirubin levels

Pancreatititis, gallstone

What condition of the pancreas can be caused by choldeocholithiasis? Why?

Acute Pancreatitis

Define:
- Inflammation of the pancreatic acini

Acute Pancreatitis Etio

Etio:
- Choledocholithiasis blockage --> Stasis of exocrine fluid
- Alcohol abuse
- Hyperlipidemia > 1000
- Viral infxn
- Hypercalcemia
- Surgical/abdominal trauma
- Drugs:
> Thiazide diuretics
> T2DM drugs = Byetta (Exenatide)

Thiazide diuretics, byetta (exenatide)

What are two types of drugs that can cause acute pancreatitis?

Acute Pancreatitis Patho

Patho:
- Premature activation of trypsin causes autodigestion of the pancreas
> Can be d/t stasis

Correct

Correct/Incorrect:
- Acute pancreatitis can eventually cause multisystem organ failure/SIRS

Systemic Inflammatory Response Syndrome

What does SIRS stand for?

Acute Pancreatitis Sxs

Sxs:
- Epigastric or periumbilical pain
> Radiates to back, chest or flank
- Severe abdominal tenderness/distention
- Fever

Acute Pancreatitis Labs

Labs:
- Increased serum amylase/lipase
- Increased CRP

Pancreatic Function Test

What diagnostic lab test is used to measure serum amylase/lipase?

Acute Pancreatitis Treatment

Treatment:
- Demerol (meperidine) for pain
- NPO to give pancreas rest
- IV fluids

Morphine

What drug is not given to alleviate pain for pts. w/ acute pancreatitis?
- (Hint: Increases spasms of sphincter of pancreatic duct)

Pancreatic Cancer

Define:
- Malignant tumor of the pancreas; 4th leading cancer COD
> Usually metastasize before dx d/t inability to palpate

Pancreatic Cancer Sxs

Sxs:
- Jaundice
- Pain
- Pruritus
- Multiple thrombi d/t activation of clotting factor by tumor cells

20%

What is the 5 year survival rate for pts. dx w/ pancreatic cancer?

4-6%

What % of pts. dx w/ pancreatic cancer live 18-20 months after dx?

Colonoscopy

Define:
- The #1 method to detect colorectal cancer
- Done every 5 years after age 50 (can start at age 40 if FHx)
- Inspection of large intestines for polyps

Colon Cancer

Define:
- Malignant tumors of the colon
- 3rd most common cancer
- 2nd leading cancer COD

Colon Cancer Risk Factors

Risk Factors:
- Older age (>50)
- Family hx
- Crohn's
- Ulcerative Colitis
- Polyps
- High fat, low fiber diet

Colon Cancer Sxs

Sxs:
- Sxs manifest late and after cancer has spread
- Bleeding
- Change in bowel habits
- Pain = very, very, very late sxs

Colon Cancer Treatment

Treatment:
- Colectomy

Stool test, sigmoidoscopy, colonoscopy

What are the 3 basic tests for colon cancer?

Stage 1

What stage of colon cancer matches the following description?
- 5 year survival of 90 - 100%

Stage 2

What stage of colon cancer matches the following description?
- 5 year survival of 80%