Pathophysiology Chapter 36 GI Disorders

GI disorder manifestations

dysphagia, heartburn, abdominal pain, vomiting, intestinal gas, alterations in bowel movements

dysphagia causes

obstruction, dysfunction of muscle or innervation, diverticula, inability to prevent stomach contents from reentering

osmotic

increased amount of poorly absorbed fluids in the intestine

secretory

due to toxins that stimulate intestinal fluid secretion and impair absorption

exudative

damage to intestinal mucosa, blood, protein, mucus

diarrhea related to motility distrurbances

decreased contact time, ex. dumping syndrome

stomatitis

inflammation of oral mucosa

stomatitis causes

pathogenic organsisms, trauma, chemical irritants, chemo, radiaition, nutrutional defieciencies

acute herpetic stomatitis

herpes simplex virus, cold sores, tingling, itching, vescicles, remains latent

acute herpetic stomatitis treamtnet

acyclovir, some idiopathic, steroids

gastroesophageal reflux disorder

backflow of gastric contnets into esophagus through LES, inflamamtion cuased by reflux of highly acidic material

extent and severity of damage to esophagus from GERD reflect

frequency and duration of exposure to refulxed material amd volume and acicidity of gastric juices being refluxed

GERD causes

conditions or agents that alter closure strength of LES, increased abdominal pressure, fatty foods, caffeine, alcohol, smoking, sleep position, hpylori

GERD clinical manifestations

heartburn, regurgitation, chest pain, dysphagia

GERD treatment

suppressing gastric acidity, histamine blocers, proton pump inhibitors

barrett esophagus

inttestinal metaplasia of narmal squamous esophageal mucosa, precense of goblet cells in esophageal mucoas is diagnostic, 10% of GERD patients get

most common risk factor for esophageal adenocarcinoma

barrett esophagus

hiatal hernia

defect in diaphragm when a portion of the stomach passes through the diaphragmatic opening to the thorax, risk increases with age, W>M

hiatal hernia clinical manifestatiosn

similar to GERD, heart burn, chest pain, dysphagia

sliding hernia

most common, portion of stomach and gastroesophageal junction slip up into thorax above diaphragm

paraesophageal hernia

rolling, part of greater curvature of stomach rolls through diaphragmatic defect

acute gastritis

precipitated by ingestion of irritating substances like alcohol, results in hemorrhage

acute gastritis clinical manifestations

anorexia, nausea, vomiting, postprandial discomfort

chronic gastritis

hpylori almost always a factor, no hemorrhage present

chronic gastritis complications

peptic ulcer disease, atrophic gastritis, gastric adenocarcinoma, mucosa associated lymphoid tissue lyphoma

gastroenteritis

inflammation of stomach and small intestine

acute gastroeneteritis

direct infection of tract by pathogenic virus or bacteria, may be caused by imbalance of normal bacterial flora

chronic gastroenteritis

Usually a result of another GI disorder

gastroenteritis clinical manifestations

diarrhea, abdominal pain, nasuea, vomiting, fever, malaise

gastroenteritis treatment

fluid and electrolyte replacement

peptic ulcer disease

disorder of upper gastrointestinal tract caused by the action of acid and pepsin, causing injury to mucoasa of espohagus, stomach, or duodenum

peptic ulcer disease causes

H pylori, NDSAIDs, alcohol, spicy food, smoking, genetics

gastrin

acid in gatric motility, stimulates release of HCl by parietal cells, get it out hormone

peptic ulcer clinical manifestations

dull, burning, achin, nausea, vomit coffee ground emesis, melena, epigastric pain in middle of the night, pain food relief(dudenal), perfiration of dudenal or gastric wall is an emergency

PUD treatment

antibiotics for h pylori, H2agonstis, proton pump inhibotr, sucrafultate, stop smoking, avoid asprin, NSAIDs, caffeine, alc, irritating foods

ulcer treatment

decrease acid secretion, H2 blcoers, proton pump inhibotr, increase mucosal protection, antibotics for Hpylori, tums to neutralize acid

inflammatory bowel diseases

chronic, relapsing inflammatory bowel disorderes

factors that activate host response

luminal microbs, dietary antigens, endogenous inflammatory stimuli

factors that down regulate

inflammation and maintain mucosa integrity

IBD pathogenesis

genetics: MHC class II allels associated with non HLA genes

failure of immune regulation: CD4 cells

triggering of micorbia flora: microbes provide antigen trigger

Crohns epidemiology

3-5/100,000, age 20-30s, F>M, 3-5X more likely in jews

ulcerative colitis epidemiology

7/100,000, 20-25, 20% familial association

crohns morpholgoy

affect any level of digestive tract, typically transmural involvement of bowel, noncaseating gramulomas, fissuring with formationn of fistulae, demarcation of diseased bowel segments from adjacent uninvolved bowel

chrons early disease

mucosal ulcers, edema, loss of normal texture

chrons progressive disease

ulcer coalesce, oriented along axis of bowel, cobbleston appearance, fissure penetrate to serose, fistula form to adherent viscera outside skin or form abscess

ulcerative colitis

ulcer inflammatory disease affecting the colon, limited to mucosa and submucosa, begins in rectum extends proximally, may involve entire colon, high risk of carcinoma, mucosal inflammation ulceration, and chronic mucosal damage

ulcerative colitis morphology

ongoing inflamamtory destrcution of mucosa, regenerating mucosa will buldge and form psedopolyps, rare cases muscularis propia is comprised when neural plexus exposed to fecal matter

chrons clinical features

highly variable, insidious manifestations, diarrhea, cramps, pain, ffever days to weeks, melena(colon involvement)

ulcerative colitis clinical features

chronic relapsing disorder, insidious manifestations, bloody, mucoid diarrhea days to months, cramps, tenesmus, colicky lower abdominal pain relieved by defecation

inflammatory bowel disease treatment

broad spectrum antibiotics, steroid, immunosuppresive agents, surgery

appendicitis

inflmamtion of vermiform appendix

Appendicitis causes

obstruction of lumen with stool, foreign bodies

appendicits clinical manifestations

periumbilical pain, RLQ pain/tenderness, nausea, vomit, fever, diarrhera, systemic signs of inflammation

appendidicits treatment

immediate surgical removal, antibitoics, fluids/electrolyes, abcesses may be treated with tube drainage

untreated appendicitis

may lead to rupture and susequent peritonitis

irritable bowel syndrome

diarrhea or constupating in alterinating pattern, cramping, pain, mucus in stool, nausea

irritable bowel syndrome treamtment

antidiarrheal agents, antipasmodic medications, high fiber diet

malabsorption disorders

failure of small intestine to absorb or normall digest one or more dietary costiuents

malabsorption disorders causes

enzyme abnormalities, infections, radiation, mucosal dysfunction, chrons, celiac, tropical sprue, surgical alterations

malabsorption disorders clinical manifestations

diarrhea, passage of inappropriately processed intestinal contents, abdominal pain

celiac disease/sprue/non tropical spure

gluten senstiivity, progressive mucosal atrophy relived by gluten withdrawal, familial intolerance, leads to inflamamtion and atrophy of intestingal villi, impaired nutrient absorptions, reduced surface area, decreased brush border enzymes, increase for intestinal malignancy

celiac diagnosis

intestinal biopsy confrims, anti tissue tranglutaminase antibody, IgA antibody

celiac treatment

gluten free diet, supplement iron, folate, vit B12, A, D, E, K, oral corticosteroids, immunocoagulating agents for refractory

warning sigsn for cancer of GI tract

black tarry, bloody, penicl shaped stool, change in bowel habits

risk factors for GI cancer

low fiber, high fat, polyps, chronic irritation or inflmmation

Gi cancer treatment

surgical removal of tumors, chemo/radiation

colon cancer

Cancer of the large intestine, seocnd only to lung cancer in cancer deaths

colon cancer risk factors

>40 years, higgh fat, low fiber diet, polyps, chronic irritation/inflammation, genetics

colon cancer screening

colonoscopy every 10 years

colon cancer treatment

surgical removal, colostomy, chemo/radiation

right side colon cancer manifestations

black tarry stools

left side colon cancer manifestations

intermittent abdominal cramping and fullness, ribbon/penicl shapted sttols, mucus and blood

rectum colon cancer manifestations

cahgen in bowel habits, urgent need to defecate on awkaening, alternate constipation and diarrhea, rectal fullness, dull aches