PHS 3300 Midterm 1

GI disorders present as one or more of the following symptoms:

dysphagia, esophageal/abdominal pain, vomiting, intestinal gas, diarrhea, constipation

dysphagia

difficulty swallowing

xerostomia

dry mouth due to reduced saliva

stomatitis is an

ulcerative inflammation

stomatitis can be caused by

microorganisms, trauma, chemotherapy, nutritional deficiency, autoimmune disorder

cold sores (herpes simplex) are stomatitis

true

erosive inflammation with cracking at corners or mouth

angular stomatitis

inflammation of parotid glands (myxovirus)

mumps

uncommon disorder of esophageal motility (cause unknown).

achalasia

achalasia: degeneration of esophageal ganglion cells & atrophy of smooth muscle causes:

decreased peristalsis, loss of tone/decreased relaxation of GE sphincter

symptoms of achalasia

dysphagia, vomiting, nausea, weight loss, chest pain & coughing at night

barium swallow and manometry (pressure catheter)

diagnosing achalasia

treatment for achalasia (target is the GE sphincter)

small meals with lots of fluids, sleep with head elevated, pneumatic dilation of GE sphincter or surgery, botox

inflammation of esophageal mucosa

esohagitis

substernal pain, exacerbated by supine position, pulmonary aspiration a risk

symptoms of GERD

diagnosis of GERD

esophageal endoscopy/biopsy, pH measurement

treatment for GERD

antacids, elevation of head, weight reduction, H2-blocker, PPIs

esophagitis can lead to

barrett's esophagus

barrett's esophagus can lead to

cancer

an abnormal change in mucosal cells in the lower esophagus (from stratified squamous epithelium to simple columnar epithelium)

barrett's esophagus

hiatal hernia

part of stomach is located above the diagram

stomach plus GE sphincter slide through esophageal hiatus when supine

sliding hiatal hernia

part of greater curvature of stomach protrudes through 2nd or enlarged opening in diaphragm

rolling hiatal hernia

protrusion of esophageal veins into esophageal lumen

esophageal varices

a consequence of portal hyper tension resulting from cirrhosis due to alcoholism or viral hepatitis

esophageal varices

has a 40% mortality (even with first-time bleed)

esophageal varices

represents 5-10% of GI malignancies

esophagus cancer

age, gender, heavy alcohol/smoke intake, GERD, Barrett's esophagus, obesity, achalasia

risk factors of esophageal cancer

how to diagnose esophageal cancer

endoscopy + biopsy; barium swallow, chest film, blood tests

prognosis of esophageal cancer

poor (16% net survival past 5 years)

caffeine & nicotine influence on stomach

increase amount & acidity of gastric secretions

aspirin, alcohol, and bile salts influence on stomach

alter permeability of epithelial barrier

aspirin decreases output of __________________ in the stomach

mucus by gastric mucosa

prolonged corticosteroids or stress influence on stomach

increase acid/pepsinogen secretion and decrease blood flow to stomach wall

insulin influence on stomach

stimulates vagus nerve and increases gastric secretions

emesis

vomiting

emesis is a complex reflex triggered by

CNS

emetic centre initiates a number of motor responses:

skeletal muscles of abdominal wall/diaphragm contract, GE sphincter relaxes, soft palate rises to close nasal passages

inflammation of gastric mucosa, can be acute of chronic; can affect fundus or antrum or both

gastritis

erosions usually superficial, usually due to injury or protective mucosal barrier by drugs (NSAIDs) or helicobacter pylori

acute gastritis

symptoms of gastritis

vague abdominal discomfort, epigastric tenderness, bleeding

treatment for gastritis

usually spontaneous healing within days aided by antacids, stopping problem drug, reducing acid secretion via a blocker, or antibiotics (if h pylori)

bacterium that can live and multiply in acid environment of stomach

helicobacter pylori

chronic gastritis is usually found in

the elderly

chronic gastritis causes

thinning and degeneration of gastric wall

what are the types of chronic gastritis?

fundal (A) and antral (B)

chronic gastritis: auto-immune in origin, there is impairment of function, most rare but most severe

fundal (A)

chronic gastritis: 4x more common, not associated with function losses, H pylori implicated (persistent inflammation)

antral (B)

treatment for chronic gastritis

small meals, bland diet, avoid alcohol/aspirin, if antral: antibiotics

peptic ulcer disease is found in

lower esophagus, stomach, duodenum

peptic ulcer disease can be acute or chronic, ______________ or ____________

superficial or deep

what is the most common site for peptic ulcer disease?

pyloric region of duodenum (80%)

duodenal ulcers tend to develop in

younger people and people with type O blood

H pylori infection is a major cause of duodenal ulcers but also need another factor to cause the ulcer, what are the possible factors?

excess parietal cells in gastric mucosa, prolonged high serum gastrin, rapid gastric emptying, use of NSAIDs, and cigarette smoke-stimulated secretion of acid

chronic, intermittent epigastric pain (30m-2h after eating), pain relieved by food/antacids, first sign can be hemorrhage or perforation.

symptoms of duodenal ulcer

to differentiate duodenal ulcers from gastric ulcers/carcinoma:

barium x-ray films, flexible endoscopy, gastric biopsy

treatment for duodenal ulcers

antacids, PPIs or H2 blockers, antibiotics, ulcer coating agents for healing

gastric ulcers are typically in

ages 55-65

primary defect of gastric ulcers is

abnormality that increases the permeability of mucosal barrier

gastric ulcers are usually associated with ______________________. secretions are mostly water with a little mucus. __________________ may be lacking

gastric atrophy, intrinsic factor

gastric ulcers are associated with

H pylori and gastritis

gastric ulcers can transform into

malignant tumors

similar pattern of cyclical pain, relief as with duodenal ulcers but pain right after eating. cause more anorexia, vomiting, weight loss

symptoms of gastric ulcers

treatment of gastric ulcers

same as for duodenal ulcers

90-95% of stomach malignancies are ________________

carcinomas

gastric carcinoma usually affects ages

60-65

risk factors of gastric carcinoma

gender, age, smoking, diet (nitrates), positive family history, H pylori

symptoms of gastric carcinoma

vague, nonspecific: early satiety, loss of appetite, weight loss, abdominal pain, vomiting, bleeding

how to diagnose gastric carcinoma?

gastric biopsy

how many canadians have h pylori?

20-30%

supersaturation of bile salts with cholesterol and especially if combined with stasis of bile fluid

gallstones

gallstones obstruct flow of ________________________, pain occurs when it contracts

bile from gallbladder

obstructive jaundice

yellow bile pigments to blood and then to skin

treatments for gallstones

surgical removal of gallbladder, if surgery not an option then oral medication to dissolve gallstones (slow)

chronic liver injury -> extensive fibrosis and regenerative nodules

cirrhosis of liver

cirrhosis of liver ends in ___________________, 10th leading cause of death in canada

liver failure

changes begin during fetal development and are often severe enough by birth to prevent exocrine secretions from reaching duodenum

cystic fibrosis and the exocrine pancreas

intolerance of lactose (not a disease)

deficient lactase enzyme

what are the types of large volume diarrhea

osmotic, secretory, mixed (motility)

diarrhea: non-absorbable substance in intestine draws water into lumen by osmosis

osmotic

diarrhea: due to excessive secretion of fluid & electrolytes into intestinal lumen or inhibition of Na/Cl absorption

secretory

what are the primary causes of secretory diarrhea?

bacterial endotoxins (cholera toxin) and neoplasms

diarrhea: for some reason, rate of transit thru intestine increased so not enough time for water reabsorption

mixed (motility)

small volume diarrhea (exudative)

inflammatory disorders of intestine (ulcerative colitis, crohn disease)

malabsorption can be due to

problems with digestion so that nutrients can be absorbed, difficulty with absorption thru intestinal wall

generalized malabsorption leads to

weight loss and malnutrition

gluten-sensitive enteropathy

celiac disease

celiac disease occurs more often in ___________________________, onset in _____________________

women than in men, young adulthood

frequent, foul-smelling stools containing fats, weight loss, malabsorption of fat-soluble vitamins, muscle wasting, hypo-proteinemia, failure to thrive

clinical signs of celiac disease

diagnosing celiac disease

blood work to look for antibodies, endoscopy and intestinal biopsy

idiopathic, chronic, inflammatory bowel disease that can affect any segment of the GI tract. incidence equal in men and women, occurs in families

crohn's disease

crohn's disease onset

15 and 20 and 55 and 60

crohn's disease and ulcerative colitis are grouped as _____________________________, origins thought to be autoimmune

inflammatory bowel diseases

clinical signs of crohn's disease

irritable bowel for several years, diarrhea, inflamed ileum, malabsorption of vitamin B12, weight loss, blood in feces, nausea, vomiting

skip lesions from crohn's disease

damage to mucosa and deeper, cobblestone appearance, bowel wall becomes thick and rigid

evaluation and treatment of crohn's disease

medical history and clinical signs, radiography showing narrowing

suppress immune response, methotrecate, surgery to manage complications

treatment for crohn's disease

too much water absorbed, stool difficult to pass, lack of fiber, dont heed need to defecate, lack of exercise, emotional upset, laxative abuse

constipation

possible consequence of lack of dietary fiber

diverticulitis

blockage of lumen of bowel by mechanical obstruction

intestinal obstruction