chapter 7 gastrointestinal system

appendicitis

appendix becomes inflamed

inflammation of vermiform appendix

appendicitis causes

obstruction- fecal mass or indigestible material

infection

signs and symptoms of appendicitis

vague epigastric pain

pain moves to right lower abdominal area toward right hip

anorexia

nausea or vomiting

low grade fever

rebound tenderness on palpation

lack of appetite

clinical signs of acute appendicitis

psoas sign is discomfort felt by patient on slow internal movement of hip joint while right knee is flexed

tests for diagnosing appendicitis

wbc count is high

ultrasound of abdomen and pelvis

CT scan

cholecystitis

gallbladder becomes inflamed

gallstone lodged in cystic duct causing painful bladder distention

cholecystitis causes

formation of calculi called gallstones

gallstones

deposits- small stones that form from bile

pigment stones have an excess of unconjugated pigments in bile

cholesterol stones- result from bile supersaturated with cholesterol

risk factors to gallstones

obesity

high-calorie, high cholesterol diet

increased estrogen levels from hormonal contraceptives, hormone therapy, pregnancy

use of clofibrate

diabetes mellitus, ileal disease, blood disorders, liver disease, or pancreatitis

signs and symptoms of acute cholecystitis

acute abdominal pain in RUQ moves to back, between shoulders, and to front of chest

colic due to passage of gallstones along bile duct

pain worsens during deep inspiration

pain more than 6 hours

belching

flatulence

indigestion

nausea

vomiting

low-grade fever

jaundice

tests to diagnose cholecystitis

xrays

ultrasonography

oral cholecystography

technetium-labeled scan

percutaneous transhepatic cholangiography

blood studies

WBC count is elevated

cirrhosis

chronic liver disease

widespread destruction of hepatic cells which are replaced by fibrous cells causing scarring of liver

causes of cirrhosis

alcohol misuse

viral hepatitis

nonalcoholic fatty liver disease

laennec cirrhosis aka portal nutritional or alcoholic cirrhosis

stems from chronic alcohol use disorder and malnutrition

postnecrotic cirrhosis

complication of viral hepatitis or after exposure to liver toxins

biliary cirrhosis

from prolonged bile duct obstruction or inflammation

idiopathic cirrhosis

no known cause

NAFLD

result of fatty deposits in liver over time

nonalcoholic steatohepatitis

from excess fat in liver and poor diet

indicates liver has fatty changes and has undergone inflammation

cirrhosis is characterized by

irreversible chronic injury of liver

extensive fibrosis

nodular tissue growth

early signs and symptoms of cirrhosis

loss of appetite

indigestion

nausea

vomiting

diarrhea

dull abdominal ache

jaundice

bruising easily

bilirubin backs up into blood

later signs and symptoms of cirrhosis

hepatomegaly

esophageal varices

accumulation of ammonia in bloodstream

ascites

bile acids

hormones are not metabolized adequately

renal failure

late-stage signs and symptoms cirrhosis

respiratory effects- fluid in lungs and hypoxia

cns effects- lethargy, mental changes, slurred speech, asterixis, peripheral nerve damage

hematologic effects- nosebleeds, easy bruising, bleeding gums

endocrine effects- testicular atrophy, menstrual irregularities, gynecomastia

skin effects- severe itching and dryness

hepatic effects

renal effects

tests to confirm cirrhosis

liver biopsy

abdominal xray

ct and liver scans

egd

blood studies

urine studies

fecal studies

crohn disease

one of two major types of inflammatory bowel disease

regional enteritis

crohn disease that only affects the small bowel

crohn disease of colon

when it involves colon or only affects colon

granulomatous colitis

crohn disease of colon is sometimes called this

not all patients develop granulomas

crohn disease causes

interplay between genetic susceptibility and environmental factors

smoking

oral contraceptive use

chronic antibiotic use

tests to diagnose crohn disease

fecal occult test

small bowel xray

barium enema

sigmoidoscopy

colonoscopy

biopsy

treatment for crohn disease

drug therapy

stress reduction

reduced physical activity

surgery

celiac disease

aka gluten-sensitive enteropathy

autoimmune disease caused by antibodies that are stimulated by ingestion of gluten

celiac disease symptoms

can vary

age exposed to gluten first

diarrhea, abdominal pain, vomiting, anorexia, constipation

extraintestinal symptoms-

fatigue, weight loss, delayed puberty, dermatitis herpetiformis, dental enamel hypoplasia, arthritis, osteoporosis, fractures, neurologic manifestations like ataxia, neuropathy, seizures

celiac disease diagnosis

serologic testing

EGD

celiac disease treatment

strict adherence to a gluten-free diet

diverticular disease

bulging pouches in GI wall push mucosal lining through surrounding muscle

two clinical forms of diverticular disease

diverticulosis - no symptoms

diverticulitis - diverticular are inflamed and may cause obstruction, infection or hemorrhage

diverticular disease causes

high intraluminal pressure on weak area of GI wall

diet

mild diverticulitis signs and symptoms

moderate left lower quadrant pain secondary to inflammation of diverticula

low grade fever and leukocytosis due to trapping of bacteria-rich stool in diverticula

severe diverticulitis signs and symptoms

abdominal rigidity from rupture of diverticular, abscesses, and peritonitis

LLQ pain secondary to rupture of diverticula and subsequent inflammation and infection

high fever, chills, hypotension from sepsis, shock from release of fecal material from rupture site

microscopic or massive hemorrhage from rupture of diverticulum near a vessel

chronic diverticulitis signs and symptoms

constipation, ribbonlike stools, intermittent diarrhea, abdominal distention from intestinal obstruction

abdominal rigidity and pain, diminishing or absent bowel sounds, nausea, and vomiting secondary to intestinal obstruction

tests to diagnose diverticular disease

ct scanning

upper GI series

barium enema

biopsy

blood studies

colonoscopy

gastroesophageal reflux disease

aka heartburn

backflow of gastric or duodenal contents or both into esophagus and past LES

factors to GERD

weakened LES

increased abdominal pressure

hiatial hernia

medications like morphine, diazepam, calcium channel blockers, meperidine and anticholinergic agents

food or alcohol ingestion or cigarette smoking that lowers LES pressure

nasogastric intubation for more than 4 days

diagnostic tests for GERD

esophageal acidity test pH monitoring

acid perfusion test

endoscopy

esophageal manometry

hiatial hernia

defect in diaphragm permits a portion of stomach to pass through diaphragmatic opening into chest cavity

paraesophageal hernia symptoms

none

sliding hernia symptoms

heartburn after eating

retrosternal or substernal chest pain

dysphagia

bleeding from esophagitis

severe pain and shock

tests to diagnose hiatial hernia

chest xrays

barium study

endoscopy

esophageal motility studies

pH studies

acid perfusion test

treating hiatial hernia

drug therapy

dieting

losing weight

elevate head of bed

surgery

irritable bowel syndrome

chronic symptoms of abdominal pain

causes of ibs

GI dysmotility

inflammation

visceral hypersensitivity

altered intestinal microbiome

diet and stress

symptoms of ibs

intermittent crampy lower abdominal pain

constipation

abdominal distension and bloating

tests to diagnose ibs

stool samples

lactose intolerance test

neg fecal calprotectin test

neg celiac disease serology blood test

colonoscopy

treating ibs

medical therapy

counseling

drug therapy

pancreatitis

inflammation of pancreas

acute and chronic forms

pancreatitis causes

male- alcohol use disorder, trauma, peptic ulcer

females- biliary tract disease

gallstone disease

alcohol misuse

hypertriglyceridemia

hypercalcemia

familial pancreatitis

viral infections

pancreatic tumors

other pancreatitis causes

abnormal organ structure

metabolic or endocrine disorders

pancreatic cysts or tumors

penetrating peptic ulcers

blunt trauma or surgical trauma

drugs

kidney failure or transplantation

endoscopic retrograde cholangiopancreatography

heredity

chronic pancreatitis

persistant inflammation that produces irreversible changes in structure and function of pancreas

acute pancreatitis in two forms

edematous (interstitial), causing fluid accumulation and swelling

necrotizing, causing cell death and tissue damage

pancreatitis symptoms

steady epigastric pain close to navel

tests to diagnose pancreatitis

dramatically elevated serum amylase and lipase levels

blood and urine glucose tests

WBC count is elevated

serum bilirubin levels are elevated

blood calcium levels may be decreased

stool analysis

abdominal and chest xrays

ct scan and ultrasonography

liver function tests

ERCP

treating pancreatitis

IV replacement of electrolytes and proteins

fluid volume replacement

blood transfusions

drug therapy

surgery

for chronic pancreatitis -

iv opioids

pain medications

antidepressants

peptic ulcer

circumscribed lesion in mucosal membrane of upper GI tract

can develop in lower esophagus, stomach, duodenum, or jejunum

common ulcer types

erosion- penetration of only superficial layer

acute ulcer - penetration into muscle layer

perforating ulcer - penetration of wall

two major forms of peptic ulcer

duodenal

gastric

major causes of peptic ulcers

bacterial infection

use of NSAIDs

penetration in pancreatitis

ulcer crater extends beyond duodenal wall into nearby structures like pancreas or liver

symptoms of gastric ulcer

loss of weight or appetite

pain heartburn or indigestion

feeling of abdominal fullness or distention

pain in ulcer when fasting or in between melas

tests to diagnose peptic ulcer

upper gi endoscopy confirms an ulcer and permits cytologic studies and biopsy

upper gi tract xray

stool analysis

wbc count

serology testing

gastric secretory studies

carbon-13 urea breath test

complete blood count

ulcerative colitis

inflammatory disease causes ulcerations of mucosa in colon and commonly occurs as a chronic condition

lifelong inflammatory disease

cause of ulcerative colitis

unknown

related to abnormal immune response in gi tract

symptoms of ulcerative collitis

irritability

weight loss

weakness

anorexia

anemia

nausea

vomiting

tests to diagnose ulcerative colitis

sigmoidoscopy confirms rectal involvement by showing mucosal friability

colonoscopy

biopsy

barium enema

stool specimen analysis

fecal calprotectin test of stool

stool culture for C difficile

other lab tests

treating ulcerative colitis

drug therapy

diet therapy

surgery

C. difficile infection

bacterium that causes infection in colon associated with antibiotic use

causes colitis throughout large intestine

C difficile causes

overuse of antibiotics

viral hepatitis

common infection of liver

in most patients damaged liver cells eventually regenerate with litle or no permanent damage

liver cell destruction

tissue death

self-destruction of cells

leads to anorexia, nausea, vomiting

hepatitis a virus

transmitted almost exclusively by fecal-oral route

HBV

can be transmitted sexually and also via blood or perinatal transmission

HCV

blood to blood contact or percutaneous exposure to blood

sexual transmission

perinatal transmission

iv drug use

HDV

in us is confined to people frequently exposed to blood and blood products

Hepatitis E virus

mainly occurs in people who live in an endemic area such as india, africa, asia, or central america

signs and symptoms of hepatitis three stages

prodromal

clinical

recovery

prodromal stage n

fatigue

anorexia

mild weight loss

generalized malaise

depression

headache

weakness

joint pain

clinical stage aka icteric stage

itching

abdominal pain or tenderness

indigestion

appetite loss

jaundice

recovery stage

resolution of jaundice

tests to diagnose viral hepatitis

hepatitis profile

liver function studies

pt is prolonged

wbc count is elevated

liver biopsy

fibroscan

salmonellosis

bacterial infection caused by salmonella that manifests with diarrhea, fever, and abdominal cramps

diagnosis of salmonellosis

taking a sample of blood or stool from patient and testing it

treating salmonellosis

most resolve on its own

iv hydration

antibiotics

colorectal cancer

cancer involving large intestine and rectum

CRC tumors

between ileocecal valve and rectum and anus

most often occur in rectosigmoid area of bowel

risk factors for crc

modifiable and nonmodifiable

modifiable-

diet

increased consumption of red meat and other processed meats

large amounts of alcohol intake

cigarette smoking

obesity

sedentary lifestyle

nonmodifiable-

age more than 50

genetics

inflammatory bowel diseases

type 2 diabetes mellitus

symptoms of crc

can have no symptoms

pain

anemia

fatigue

dark red stools

obstruction

narrow ribbonlike stools

vomiting

constipation

blood on stool

screeing options for crc

colonoscopy

flexible sigmoidoscopy

double-contrast barium enema

ct colonography

fecal occult blood testing

fecal immunochemical testing

stool dna and rna testing

treatment of crc

surgical resection of tumor

chemotherapy