Pathophysiology Chapter 36: Gastrointestinal Disorders (Exam 1)

What are the 4 major types of GI tract problems?

Muscle/innervation problems, obstruction, deficient digestion/absorption, and blood supply problems.

What is dysphagia?

Difficulty swallowing.

What are common manifestations of GI disorders?

Dysphagia, heartburn, abdominal pain, vomiting, intestinal gas, and altered bowel movements.

What are the types of abdominal pain?

Visceral, somatic, or referred; acute or chronic.

What are the two major alterations in bowel movements?

Constipation and diarrhea.

What is osmotic diarrhea?

Diarrhea caused by poorly absorbed substances drawing fluid into the intestine.

What is secretory diarrhea?

Diarrhea caused by toxins stimulating intestinal fluid secretion and impairing absorption.

What is exudative diarrhea?

Diarrhea associated with mucus, blood, and protein due to intestinal mucosal damage.

How do motility disturbances cause diarrhea?

Decreased contact time for absorption.

What is an example of diarrhea caused by motility disturbance?

Dumping syndrome.

What is stomatitis?

Inflammation of the oral mucosa.

What can cause stomatitis?

Pathogens, trauma, chemical irritants, chemotherapy, radiation, and nutritional deficiencies.

What causes acute herpetic stomatitis?

Herpes simplex virus.

What are manifestations of acute herpetic stomatitis?

Tingling, itching, and vesicles.

What is a common treatment for herpetic stomatitis?

Acyclovir.

What is GERD?

Backflow of gastric contents into the esophagus through the lower esophageal sphincter (LES).

What causes inflammation in GERD?

Reflux of highly acidic gastric material.

What determines the severity of GERD damage?

Frequency and duration of reflux plus the volume and acidity of gastric contents.

What factors can contribute to GERD?

Anything that weakens LES closure or increases abdominal pressure.

What foods/drugs can contribute to GERD?

Fatty foods, caffeine, alcohol, smoking, certain medications, and other factors affecting the LES.

What are common manifestations of GERD?

Heartburn, regurgitation, chest pain, and dysphagia.

How is GERD commonly treated?

H2 blockers and proton pump inhibitors to suppress gastric acidity.

What is Barrett esophagus?

Intestinal metaplasia of normally squamous esophageal mucosa.

What cells are diagnostic of Barrett esophagus?

Goblet cells in the esophageal mucosa.

Why is Barrett esophagus important?

It is the most common risk factor for esophageal adenocarcinoma.

About what percentage of GERD patients develop Barrett esophagus?

About 10%.

What is a hiatal hernia?

A defect in the diaphragm allowing part of the stomach to pass into the thorax.

Who has increased risk for hiatal hernia?

Risk increases with age; women are affected more than men.

What are manifestations of a hiatal hernia?

Heartburn, chest pain, and dysphagia.

What is a sliding hiatal hernia?

The stomach and gastroesophageal junction slip above the diaphragm; it is the most common type.

What is a paraesophageal hiatal hernia?

Part of the greater curvature of the stomach rolls through the diaphragmatic defect.

What is acute gastritis?

Inflammation of the stomach precipitated by irritating substances.

What commonly causes acute gastritis?

Irritants such as alcohol and aspirin.

What are manifestations of acute gastritis?

Anorexia, nausea, vomiting, postprandial discomfort, and hemorrhage.

What is a major factor in chronic gastritis?

Helicobacter pylori.

What are complications of chronic gastritis?

Peptic ulcer disease, atrophic gastritis, gastric adenocarcinoma, and MALT lymphoma.

What is a key clinical difference between acute and chronic gastritis?

Acute gastritis may have hemorrhage; chronic gastritis generally does not.

What is acute gastroenteritis?

Direct infection of the GI tract by a pathogenic virus or bacterial toxin.

What can contribute to gastroenteritis during travel?

Introduction of unusual bacteria causing imbalance in normal bacterial flora.

What is chronic gastroenteritis usually caused by?

Another GI disorder.

What are manifestations of gastroenteritis?

Diarrhea, abdominal discomfort, nausea, vomiting, fever, and malaise.

What is the main treatment for gastroenteritis?

Fluid and electrolyte replacement.

What does peptic ulcer disease mean?

Upper GI injury caused or aggravated by acid and pepsin.

Where can peptic ulcers occur?

The esophagus, stomach, or duodenum.

What are common causes of peptic ulcer disease?

H. pylori, NSAIDs, stress, alcohol, spicy foods, smoking, and genetic factors.

What does gastrin do?

Aids gastric motility and stimulates HCl release by parietal cells.

What is typical peptic ulcer pain?

Dull, burning, or aching pain.

What other manifestations can occur with peptic ulcers?

Nausea, vomiting, coffee-ground emesis, and melena.

What is characteristic of duodenal ulcer pain?

Pain-food-relief.

Why is ulcer perforation dangerous?

It is a medical emergency.

How is H. pylori-related PUD treated?

Antibiotics.

What medications reduce acid in PUD?

H2 antagonists and proton pump inhibitors.

What does sucralfate do?

Forms a protective coating over injured mucosa.

What lifestyle changes help treat PUD?

Stop smoking and avoid aspirin, NSAIDs, caffeine, alcohol, and irritating foods.

What are the two major inflammatory bowel diseases?

Crohn disease and ulcerative colitis.

What is the general nature of IBD?

Chronic, relapsing inflammatory bowel disorders of unknown origin.

What factors contribute to IBD pathogenesis?

Genetic susceptibility, failure of immune regulation, and microbial antigen triggers.

What part of the GI tract can Crohn disease affect?

Any level of the digestive tract.

What type of inflammation occurs in Crohn disease?

Transmural inflammation.

What type of granulomas are associated with Crohn disease?

Noncaseating granulomas.

What are skip lesions?

Discontinuous areas of diseased bowel separated by normal bowel.

What gives Crohn disease a cobblestone appearance?

Coalescing ulcers and abnormal mucosa.

What complications can occur in Crohn disease?

Fissures, fistulas, and abscesses.

What are common manifestations of Crohn disease?

Diarrhea, crampy abdominal pain, prolonged fever, and melena with colon involvement.

What part of the GI tract does ulcerative colitis affect?

The colon.

What layers are affected in ulcerative colitis?

The mucosa and submucosa.

Where does ulcerative colitis begin?

The rectum.

How does ulcerative colitis spread?

Proximally and continuously.

What are pseudopolyps?

Bulging areas of regenerating mucosa.

What is a major complication of ulcerative colitis?

Markedly increased risk of colon cancer.

What are common manifestations of ulcerative colitis?

Bloody, mucoid diarrhea, cramps, tenesmus, and lower abdominal pain relieved by defecation.

Crohn disease: continuous or discontinuous involvement?

Discontinuous involvement (skip lesions).

Ulcerative colitis: continuous or discontinuous involvement?

Continuous involvement.

Crohn disease: superficial or transmural inflammation?

Transmural.

Ulcerative colitis: superficial or transmural inflammation?

Limited to mucosa and submucosa.

Which IBD commonly forms fistulas and fissures?

Crohn disease.

Which IBD has the greater colon cancer risk?

Ulcerative colitis.

What is the primary treatment approach for IBD in this chapter?

Antibiotics/steroids, immunosuppressive agents, and sometimes surgery.

What is appendicitis?

Inflammation of the vermiform appendix.

What commonly initiates appendicitis?

Obstruction of the appendix lumen by stool, foreign bodies, or other material.

What happens after appendiceal obstruction?

Ischemia, increased intraluminal pressure, infection, and ulceration can occur.

Where is classic appendicitis pain located?

Periumbilical pain that commonly localizes to the RLQ/McBurney's point.

What is rebound tenderness?

Pain that occurs when pressure is released from the abdomen.

What is the most serious complication of appendicitis?

Peritonitis.

What are common manifestations of appendicitis?

RLQ pain/tenderness, nausea, vomiting, fever, diarrhea, and systemic inflammation.

How is acute appendicitis treated?

Immediate surgical removal plus antibiotics and fluid/electrolyte replacement.

What can untreated appendicitis cause?

Appendiceal rupture and peritonitis.