GI, Hepatic, Biliary

Path

What are the most common GI problems in older adults?

-Constipation
-Incontinence
-Diverticular disease

What are alimentary tract changes during aging?

Decreased:
-gastric motility
-blood flow
-nutrient absorption
-volume and acid content of gastric juice

What is achalasia?

Failure to relax smooth muscle of GI, lower esophageal sphincter can't relax

The gut immune system makes up \____ to \____% of the body's immune cells

70-80%

What is Melena?

-Upper GI bleed proximal to the ileocecal valve
-Pt. will have black, tarry stools

How much blood loss does someone with melena have?

150-200 mL

normal is 0.5-1.5 ml/day

What are signs of GI bleeding?

-coffee-ground emesis (vomit)
-hematemesis
-Melena
-Hematochezia
-pain referral to shoulder or back

What is a hiatal hernia (diaphragmatic hernia)?

Lower esophageal disorder where the esophageal hiatus of the diaphragm becomes enlarged so stomach can slide through diaphragm into thoracic cavity

What are etiologic and risk factors for hiatal hernias?

Weakened diaphragm, altered hiatus, or increase intraabdominal pressure

What is the clinical manifestation of a hiatal hernia?

-asymptomatic
-hear tburn or reflux (esp 30-60 min after meal and lying supine)
-substernal pain
-difficult/painful swallowing

What is gastroesophageal reflux disease (GERD)?

inflammation of esophagus from infectious agents, chemical irritants, physical agents like radiation and nasogastric intubation

What is the principle symptom of GERD?

Heartburn

How is GERD diagnosed?

-barium test
-endoscopy
-H. Pylori
-pH testing

What is some medical management for GERD?

-Proton pump inhibitor
-Antioxidants
-drink fluid btwn meals
-avoid NSAIDS, coffee, ETOH, nicotine

What are the two types of esophageal cancer?

-squamous cell carcinoma (mid-esophagus, most common)
-adenocarcinoma (distal espophagus)

What is the clinical manifestation of esophageal cancer?

-Asymptomatic early
-Dysphagia
-wt. loss
-odynophagia (P! Swallow due to ulcered tumor)
-cough
-hoarseness
-chest pain

What are esophageal varices?

Fragile, dilated veins in lower 1/3 of esophagus immediately beneath mucosa

50% of those with cirrhosis have \____________ due to portal HTN

Esophageal varices

What is the clinical manifestation for esophageal varices?

Variceal blooding is painless but with significant hematemesis

What are pt implications for esophageal varies?

-instruction for proper lfting
-avoiding activities that increase intraabdominal pressure
-Observe for asterixis and behavioral changes

What are the complications for peptic ulcer disease (PUD)?

-bleeding
-perforation
-penetration

What is the etiology for peptic ulcer disease (PUD)?

H. Pylori

What is the 5th most common cancer and 3rd most common cause of cancer death worldwide

Gastric cancer

What is pyloric stenosis?

congenital stomach condition causing hypertrophy of pyloric sphincter that occurs in infants

What are signs and symptoms of pyloric stenosis?

-projectile nonbilious vomiting (can cause metabolic alkalosis)
-palpable mass in area of the pylorus

What are risk factors for celiac disease?

-Other autoimmune diseases
-IgA deficiency
-genetic symdromes
-type 1 diabetes
-thyroiditis

What is the clinical manifestation for celiac diease?

-asymptomatic
-diarrhea, bloating, indigestion, flatulence
-Nutritional deficiencies: folate, iron, fat-sol vit
-Skin- dermatitis herpetiformis
-Long term can cause osteoporosis, infertility, coagulation abnorm, iron deficiency anemia

What is intestinal ischemia?

Vascular diseases with decreased blood supply to bowel categorized as acute mesenteric ischemia, chronic mesenteric ischemia, or colonic ischemia

What are the two conditions under inflammatory bowel disease?

-Chron disease
-Ulcerative colitis

What are clinical manifestations of IBD?

Diarrhea, ab pain, GI bleeding, wt loss

What is the hallmark sign of ulcerative colitis?

Bloody diarrhea

Describe the differences of affected location, appearance of damage, and inflammation between chron disease and ulcerative colitis

-Chron can be any part of GI (mouth —\> anus)
-UC is just lg intestine and rectum

-Chron has patchy damages areas UC is not patchy

-Chron inflammes multiple layers, UC is only innermost

What is toxic megacolon?

Occurs with acute IBD: swelling and inflammation spread into the deeper layers of the colon so it stops working and widens

What are chron disease complications?

-severe bleeding
-abscesses
-bowel obstruction
-fistulas
-impaired growth
-nutrition deficits
-jt inflammation

What is irritable bowel syndrome?

Group of symptoms that has recurring abd pain associated with change in bowl habits without structural changes

What are the etiologic factors is IBS?

Functional disorder or disorder of gut-brain interaction

What is the clinical manisfestation of IBS?

-Manageable to profound symptoms with steady or intermittent pain
-Dull, deep discomfort and sharp cramps in am or after eating
-relief with bowl movement
-lower ab pain with constipation or diarrhea

What is diverticular disease and who is it common in?

Acquired colon deformity due to multiple factors common western countries those 60yo+

What are risk factors for diverticular disease?

-constipation
-inactivity
-red meat
-obesity
-smoking NSAIDs
-CT disorder

What is an intestinal polyps?

Growth or mass protruding into the intestinal lumen from any area of mucous membrane

What is the 4th leading cancer in the US and the 2nd leading cause of CA death?

Colorectal cancer

Who is more prone to getting colorectal cancer?

-those over 40
-men\>womens
-african americans
-smoking history
-positive family history

What are the red flags for colon CA?

-older than 50yrs
-hx of colon ca in 1st degree relative
-bowel disturbances
-unexplained weight loss
-back/pelvic pain unchanged with positions or movement

What are the common metastasis for colon cancer?

-most common: thorax
-other: liver, lungs, bone, brain

What is intussusception?

Telescoping bowel gets trapped and infarcts

What is volvulus?

Torsion of a loop of intestine

What is the most common congenital type of obstructive disease?

Meckel diverticulum (usually dx by 2yo)

What is an appendicitis?

-Vermiform appendix inflammation often with necrosis and perforation with localized or generalized peritonitis
-caused by primary obstruction of lumen or secondary to bacterial infection

True or false

McMurrays point is the spot that is TTP when someone has an appendicitis

FALSE
McBurney's point

What is peritonitis?

Inflammation of serous membrane lining ab cavity walls due to microorganisms, trauma, surgery, or bowel contamination

If pt has decreased intestinal motility and gas distention with vague generalized ab pain to acute severe ab pain and referral to shoulder or thoracic region what might they have?

Peritonitis

What is a rectal or anal fissure?

Ulceration or tear of the anal canal lining usually on posterior wall

What can cause acute anal fissures?

Excessive tissue stretching or tearing like childbirth or passage of a large hard bowel movement

usually heal wihtin 1-2 months

Where are internal hemorrhoids located and how are they notices?

-in lower rectum
-notices when small amount of bleeding occurs during passage of stool esp if straining

Where are external hemorrhoids located and how are they noticed?

-underneath skin around anus
-Blood bright red if inured or ulcerated and can be painful

What are severe complications from damage to the liver?

-Jaudice
-Cirrhosis
-Portal hypertension
-Hepatic encephalopathy
-Ascites
-Hepatorenal syndrome

How does the liver change with age?

-Decrease in size and weight
-Takes longer to process substances, medications, ETOH
-More fibrotic
-Gallbladder releases less bile into liver

What is the major site of production of proteins that are associated with acute inflammatory rxns?

Liver

What can cause jaundice?

-overproduction of bilirubin
-defective bilirubin metabolism
-liver disease
-bile flow obstruction

What are signs of hepatic disease?

-dark urine and light stools
-skin changes
-spider angiomas
-palmar erythema
-hepatic osteodystrophy
-bone pain
-flapping tremor

What are classifications of hepatitis?

-viral
-ETOH
-autoimmune
-toxic/med- induced
-ischema

What is fulminant hepatitis?

Severe, sudden intensity related to hepatic encephalopathy (HE)

True or false

7 different viruses cause more than 95% of all viral cases worldwide

FALSE

6 different

What is cirrhosis?

-Chronic progressive inflammation of the liver when disease or toxins cause liver damage and/or necrosis
-High mortality

What is alcoholic liver disease?

-ETOH consumption causes accumulation of fat around liver
-reversible with abstinence

What is the clinical manifestation for alcoholic liver disease?

Usually asymptomatic but if symptomatic:
-nausea
-vomiting
-ab pain
-jaundice
-anorexia
-fever
-wt. loss
-jaundice

What is the most prevalent chronic liver disease in USA

Nonalcoholic fatty liver disease

What is primary biliary cholangitis (PBC)?

Chronic progressive autoimmune liver disorder with small bile duct destruction (irreversible)

How is primary biliary cholangitis diagnosed?

-elevated antimitochondrial antibodies
-elevated serum levels of ALP for more than 6mo
-Imaging consistent with PBC

What is intrahepatic cholestasis?

-Can occur with pregnancy if pt already had liver disease
-Sluggish or interupted bile flow out of the liver which may present with pruitus and jaundice in last trimester

What are the three groups of hepatic neoplasms?

-benign liver neoplasms
-primary malignant liver neoplasm
-metastatic malignant tumors (20x more often than primary tumor)

What is the most common site for a visceral organ abscess?

Liver

Who is more likely to get pyogenic liver abscess?

Those with...
-hepatobiliary diease
-pancreatic disease
-abdominal infections
-liver transplantation

What are some complications of pyrogenic liver abscess?

-R pleural effusion
-rupture
-spread of infection

What is the primary function of the pancreatic system?

-exocrine secretion of digestive enzymes and pancreatic juices

A defective \___________ characterizes diabetes mellitus

Endocrine gland

What is pancreatitis?

-Potentially serious inflammation of pancreas and surrounding organs
-Can be caused by alcohol abuse and gallstones

What is the third leading cancer mortality cause in the US and has the lowest 5 year survival rate?

Pancreatic cancer

What does the gallbladder do?

Stores and concentrates bile during fasting periods then contracts to expel the bile into the duodenum in response to the arrival of food

What is cholelitheiasis?

Gallstones based on composition of cholesterol and bilirubin salts known as pigmant tones

What is the most common complicationacute cholecystitis?

Inflammation of gall bladder

What is acute cholangitis?

Suppurative infection of lower common bile duct

What are complications of cholelithiasis?

-Fever
-Jaundice
-leukocytosis
-belching
-flatulence