Patho Ch 38 - Digestive

Pathophysiology chapter 38 - alterations in digestive function

(canvas quiz) Jaundice is a common manifestation of:

liver disease

(canvas quiz) Hepatic encephalopathy is associated with:

increased blood ammonia levels

(canvas quiz) Ulcerative colitis is commonly associated with:

bloody diarrhea

(canvas quiz) The primary cause of duodenal ulcers includes:

H. pylori infection

bright red bleeding from the rectum is referred to as:

hematochezia

(canvas) regular NSAID use can contribute to the development of which condition?

duodenal ulcers

(canvas) breaks in the mucosa and presence of corrosive secretions can cause the development of which condition?

peptic ulcer disease

(canvas quiz) In alcoholic cirrhosis, the hepatocellular damage is caused by:

acetaldehyde accumulation

most gallstones are composed of:

cholesterol

(canvas quiz) Cholecystitis is inflammation of the gallbladder wall usually caused by:

obstruction of the cystic duct by a gallstone

(canvas quiz) A 50-year-old is diagnosed with gastroesophageal reflux. This condition is caused by:

loss of muscle tone at the lower esophageal sphincter

(canvas quiz) acute pancreatitis often manifests with pain to which of the following regions?

epigastric

“Loose, watery stool occurring three or more times per day” defines:

Diarrhea

“Indigestion” is also termed:

Dispepsia

“Forceful emptying of the stomach” defines:

Vomiting (emesis)

“Difficulty emptying the bowels and associated with hardened feces” defines:

Constipation

What laboratory finding is the primary diagnostic indicator for acute pancreatitis?

Elevated serum lipase

How does iron deficiency anemia frequently develop with ulcerative colitis?

Chronic blood loss in stools

(canvas quiz) A 71-year-old male was diagnosed with colon cancer. He asks: "How did I get this cancer?" The best reply to his question is:

lack of fibers, a history of eating processed food, a high red meat diet

(canvas quiz) The nurse monitors signs of bleeding in his/her patient with cirrhosis because the nurse knows the liver synthesizes which of the following?

Most clotting factors

the term used to describe nonproductive vomiting is:

retching

the presence of blood in the vomit is known as:

hematemesis

which muscle is responsible for supporting the reproductive and digestive organs and functions in continence?

levator anii

diarrhea described as “loose, watery stools” typically implies an _____ cause

infectious

_____ diarrhea is typically associated with an infectious cause

acute

_____ diarrhea is typically due to inflammation

chronic

which mechanism causes diarrhea due to lactose intolerance?

osmotic

which mechanism causes diarrhea associated with an infectious cause?

secretory

which mechanism causes diarrhea due to drugs or hyperthyroidism?

motility

what are the different mechanisms/causes of diarrhea?

osmotic, secretory, motility

what are the signs and symptoms of diarrhea?

dehydration, electrolyte imbalance, rapid weight loss

you would not prescribe _____ drugs to patients experiencing secretory (infectious) diarrhea because excreting is a good way to get the infectious material out of the body.

antimotility

abdominal pain described as dull, colicky, cramping, poorly localized

visceral pain

abdominal pain described as sharp and localized

parietal pain

abdominal pain that is felt in a different area than where the actual problem is (ex: think heart attack - pain is in neck and arm)

referred pain

occult bleeding puts the patient at a higher risk of developing _____

iron deficiency anemia

oral cavity, esophagus, stomach, and duodenum are considered to be anatomically belonging to which section of the GI tract?

upper GI

jejunum, ilium, large intestine, rectum and anus are considered to be anatomically belonging to which section of the GI tract?b

lower GI

visible bright red blood in the stool is defined as:

hematochezia

dark/black, tarry stool is defined as:

melena

bleeding in the GI tract that is not visible to the eye, can cause iron deficiency anemia

occult blood loss

periodic, symptomatic reflux (backflow) of gastric (stomach) contents into the esophagus causing erosion and inflammation - describes what condition?

gastroesophageal reflux disease (GERD)

the resting tone of the lower esophageal sphincter (LES) tends to be lower than normal, it is incompetent. the LES opens more frequently and longer - pathogenesis of which condition?

gastroesophageal reflux disease (GERD)

heartburn, indigestion, chest pain, hoarsness/laryngitis, chronic cough, asthma attacks (microaspirations), globus, and dysphagia are all symptoms of which condition?

gastroesophageal reflux disease (GERD)

burning feeling in the lower chest, along with a sour or bitter taste (acid reflux) in the throat or mouth - describes what?

heartburn

discomfort/pain in the upper abdomen or a feeling of fullness soon after eating - describes what? aka dispepsia

indigestion

a sensation of something in the back of the throat when there is not - describes what?

globus

difficulty or pain on swallowing - describes what?

dysphagia

a condition in which metaplastic columnar epithelium replaces the stratified squamous epithelium that normally lines the distal esophagus - common in GERD

barrett esophagus

barrett esophagus due to GERD increases the patients risk of developing what?

esophageal adenocarcinoma

increased abdominal pressure (obesity, pregnancy, hiatal hernia), delayed gastric emptying (gastroparesis), medications (calcium channel blockers), and helicobacter pylori are all risk factors for what condition?

gastroesophageal reflux disease (GERD)

occurs 30-90 minutes after a meal, sleeps with pillows (30-40 degree incline), worsens with reclining, improves with antacids, sitting, or standing - all history that is consistent with what condition?

gastroesophageal reflux disease (GERD)

upper endoscopy with biopsy (test of choice), esophageal manometry, 24-hr pH testing, and barium esophagram are all diagnostic tools for what condition?

gastroesophageal reflux disease (GERD)

weight loss, head elevation, avoidance of meals 2-3 hours before bedtime, elimination of trigger foods, medications (proton pump inhibitors: prilosec, h-2 antagonists: cimetidine), antacids), sugrery: laproscopic fundoplication (treatment of choice for hiatal hernia) - these are treatments for what condition?

gastroesophageal reflux disease (GERD)

a condition that results from the damage to or break in the mucosal barrier of the stomach and duodenom

peptic ulcer disease

inadequate blood supply (caused by vasoconstriction due to shock, smoking, stress, circulatory impairment, scar tissue, anemia) that interferes with the regeneration of epithelium, excessive glucocorticoid secretion or medication, breakdown of mucous layer (can be caused by NSAIDS, aspirin, alcohol), atrophy of gastric mucosa (can be due to chronic gastritis) - pathogenesis of what condition?

peptic ulcer disease

prostaglandin favors the production of what? some medications block prostaglandins, which leads to a decline in production of this.

mucus

_____ is a gram-negative rod bacteria that is a common precursor of gastritis and peptic ulcers. it is also a risk factor for gastric carcinoma.

helicobacter pylori

what are the common complications of peptic ulcer disease?

hemorrhage, perforation, obstruction

fiberoptic endoscopy with barium x-ray are diagnostic tools for which condition?

peptic ulcer disease

epigastric burning or localized pain, usually following stomach emptying - symptoms consistent with which condition?

peptic ulcer disease

determining the cause, reduce exacerbating factors, antimicrobial + proton pump inhibitor for H. pylori infection - treatments for which condition?

peptic ulcer disease

most common of the peptic ulcers, use of NSAIDS is the #1 cause, helicobacter pylori infection, intermittent epigastric pain, relieved rapidly by ingestion of food or antacids, pain 2-3 hours after meals, pain at night - consistent with peptic ulcer disease with what kind of ulcers?

duodenal ulcers

location: antrum of the stomach, increased mucosal permeability to acids, gastric secretion usually normal, food causes pain immediately, antacids provide minimal relief - consistent with peptic ulcer disease with what kind of ulcers?

gastric ulcers

chronic, idiopathic, relapsing inflammatory bowel disorders. Types: ulcerative colitis and Crohn’s disease - defines what?

inflammatory bowel disease (IBD)

alterations of epithelial barrier functions, altered immune reactions to intestinal flora, genetics, and environmental factors - pathogenesis of which condition?

inflammatory bowel disease (IBD)

chronic inflammatory disease that causes ulceration of the colonic mucosa, involves sigmoid colon and rectum. begins in the rectum and extends proximally to the entire colon. intermittent periods of remission and exacerbation. lesions: continuous, limited to the mucosa - describes what condition?

ulcerative colitis

diarrhea (small volume, 10-20 times a day), urgency, bloody diarrhea with mucus, and cramping are symptoms of which condition?

ulcerative colitis

idiopathic, granulomatous, inflammatory disorder; affects any part of the digestive tract from mouth to anus. may also be called regional enteritis or granulomatous colitis. skip lesions. one side of the intestine may be affected but not the other. transmural inflammation. complications include adhesions, fissures or fistulas. interferes with digestion and absorption - describes what condition?

crohn’s disease

hypoproteinemia, malnutrition, possibly steatorrhea (fat in stool), anemia: malabsorption of b12 and folic acid - symptoms of which condition?

crohn’s disease

goals: remission/prevention of flares, anti inflammatory medications: sulfasalazine or glucocorticoids, immunotherapeutic agents, antimotility agents, antimicrobials, diet/lifestyle/nutrition supplements, surgic resection (typically ileostomy or colostomy) - treatments for which condition?

crohn’s disease

what is the most common infectious cause of nosocomial diarrhea?

clostridioides difficile

C. diff flourishes within the _____

colon

the normal gut flora is altered by broad-spectrum antibiotics (commonly clindamycin, cephalosporins, ampicillin, amoxicillin, and flouroquinolones), and this allows an overgrowth of _____ - infection.

clostridioides difficile

clostridioides difficile damages the mucosal layer and the epithelial cells of the intestines by releasing _____ that trigger cell death; triggering inflammatory response

a and b toxins

c. diff contains _____ that can survive the acidity of the stomach and reach the large intestine

endospores

colon cancer is the _____ most common cancer diagnosis

third

colon cancer is the _____ most common cause of cancer-related death

third

the risk of colon cancer increases with _____

age

what is the screening tool of choice for colon cancer?

colonoscopy and FIT test

older age, personal or family history of colorectal cancer or polyps, inflammatory bowel disease, hereditary syndrome (ex: lynch syndrome), and type 2 diabetes are all risk factors for the development of what condition?

colon cancer

colonoscopy by age 50, starting at 40 and every 5 years if a family member has it OR every 5 years starting 10 years before their diagnosis (whichever comes first), annual FIT test (colon bleed test) - diagnostic tools for which condition?

colon cancer

treatment of choice for _____ is surgery to remove the affected portion of the intestines. If the affected area is small enough, it may be responsive to treatment with medication instead of surgery.

colorectal cancer

what are the accessory organs to the digestive tract?

liver, gallbladder, pancreas

high blood pressure in the portal venous system caused by resistance to portal blood flow. causes varices, edema (ascites), splenomegaly, vomiting blood - describes which condition?

portal hypertension

vomiting blood from bleeding esophageal varices or esophageal varicose vein rupture is the most common clinical manifestation of what condition?

portal hypertension

“accumulation of fluid in the peritoneal cavity” describes what condition?

ascites

the most common cause of ascites is ______

liver cirrhosis

spectrum of neuropsychiatric abnormalities in patients with liver dysfunction (after exclusion of brain disease). pathogenesis: excess plasma ammonia and astrocyte dysfunction - describes what condition?

hepatic encephalopathy

personality changes, irritability, intellectual impairment, memory loss, depressed level of consciousness (stupor/coma), flapping tremor of the hands (asterixis), and death are all signs and symptoms of which condition?

hepatic encephalopathy

functional renal failure that develops as a complication of advanced liver disease. happens because liver failure increases the work load of the kidneys, causing renal injury/damage. manifestations include oliguria, hypotension, peripheral vasodilation associated with advanced liver disease. may be acute or gradual onset - describes which condition?

hepatorenal syndrome

a condition characterized by the yellowing of the skin and sclera, dark urine, and light-colored stools. caused by hyperbilirubinemia - which condition?

jaundice (aka icterus)

what are the causes/types of jaundice (icterus)?

pre-hepatic, intrahepatic obstruction, post-hepatic obstruction

prehepatic jaundice typically involves the _____. can be caused by a disease such as hemolytic anemia.

blood

intrahepatic jaundice typically involves the _____. can be caused by diseases such as hepatitis or cirrhosis.

liver

post-hepatic jaundice typically involves _____. can be caused by gallstones, inflammation, or pancreatitis for example.

an obstruction

irreversible inflammatory & fibrotic liver disease. biliary channels become obstructed and cause portal hypertension. severity and rate of progression depend on the cause. liver function is permanently decreased. common in alcoholic usage disorder (AUD) due to liver inflam & damage causing scarring - describes what condition?

alcoholic liver cirrhosis

what are the 3 stages of alcoholic liver cirrhosis?

fatty liver (steatosis), alcoholic hepatits, end-stage cirrhosis

enlargement of the liver, asymptomatic and reversible with reduced alcohol intake - which stage of alcoholic liver cirrhosis?

stage 1, fatty liver (steatosis)

inflammation and cell necrosis, fibrous tissue formation, irreversible change - which stage of alcoholic liver cirrhosis?

stage 2, alcoholic hepatitis