Chapter 37: Gastroenterology

acute gastroenteritis

sudden onset of inflammation of the stomach and intestines

adhesions

union of normally separate tissue surfaces by a fibrous band of new tissue

appendicitis

inflammation of the vermiform appendix at the juncture of the large and small intestines

bowel obstruction

blockage of the hollow space within the intestines

cannabinoid hyperemesis syndrome (CHS)

episodic vomiting and abdominal pain, often ameliorated by hot showers or baths

cholecystitis

inflammation of the gallbladder

chronic gastroenteritis

nonacute inflammation of the gastrointestinal mucosa

cirrhosis

degenerative disease of the liver

Common causes of liver cirrhosis

Alcohol abuse and hepatitis

colic

acute pain associated with cramping or spasms in the abdominal organs

Crohn’s disease

idiopathic inflammatory bowel disorder associated with the small intestine

Cullen’s sign

discoloration around the umbilicus suggestive of intraabdominal hemorrhage

cyclical vomiting syndrome (CVS)

disorder of unknown cause characterized by repeated, sudden episodes of severe nausea, vomiting, and physical exhaustion

diverticula

small outpouchings in the mucosal lining of the intestinal tract

diverticulitis

inflammation of diverticula

diverticulosis

presence of diverticula, with or without associated inflammation or bleeding

esophageal varix

swollen vein of the esophagus

Grey Turner’s sign

discoloration over the flanks, suggesting intraabdominal bleedingv

hematemesis

bloody vomitus

hematochezia

bright red blood in the stool

hemorrhoid

small mass of swollen veins in the anus or rectum

hepatitis

inflammation or infection of the liver characterized by diffuse or patchy tissue necrosis

hernia

protrusion of an organ through its protective sheath

infarction

area of dead tissue caused by lack of blood supply

intussusception

condition that occurs when part of an intestine slips into the part just distal to itself

irritable bowel syndrome (IBS)

gastrointestinal system disorder characterized by symptoms that include abdominal pain, cramping, increased gas, altered bowel habits, food intolerance, and bloating

ligament of Treitz

ligament that supports the duodenojejunal junction of the gastrointestinal tract

lower gastrointestinal bleeding

blood loss in the gastrointestinal tract distal to the ligament of Treitz

Mallory-Weiss syndrome

esophageal laceration, usually secondary to vomiting, with resultant bleeding

McBurney’s point

common site of pain from appendicitis, 1 to 2 inches above the anterior iliac crest in a direct line with the umbilicus

melena

dark, tarry stool caused by the presence of “digested” free blood from gastrointestinal bleeding

mesenteric ischemia

death of tissue and in the peritoneal fold that encircles the small intestine

Murphy’s sign

pain caused when an inflamed gallbladder is palpated by pressing under the right costal margin

pancolitis

ulcerative colitis that affects the entire colon

pancreatitis

inflammation of the pancreas

peptic ulcer

erosion in the lining of the digestive tract caused by gastric acid

peritonitis

inflammation of the peritoneum caused by chemical or bacterial irritation

portal

pertaining to the flow of blood into the liver

proctitis

ulcerative colitis limited to the rectum

referred pain

type of pain felt in a location other than that of its origin

somatic pain

sharp pain that travels along clearly defined neural routes, which makes this pain able to be localized to a specific region or area

ulcerative colitis

inflammatory bowel disorder of unknown origin

Two divisions of ulcerative colitis, depending on where the ulcers are

Proctitis and Pancolitis

upper gastrointestinal bleeding

blood loss within the gastrointestinal tract proximal to the ligament of Treitz

visceral pain

dull, poorly localized pain that originates in the walls of hollow organs such as the ureter or bladder

volvulus

twisting of the intestine on itself

Zollinger-Ellison syndrome

condition that causes the stomach to secrete excessive amounts of hydrochloric acid and pepsin due to a tumor

3 mechanisms that cause visceral pain

inflammation, distention, ischemia

main causes of visceral pain

bacterial or chemical irritation

If walking relives the pain, then the cause may be ____

GI or urinary related

If pain lessens when the pt draws their legs up to their chest, then the cause may be ____

peritoneal inflammation

Number of Americans affected by upper gi tract bleeds

300,000

Mortality rate for upper GI bleeds

10%

Six major causes of upper GI bleeds

peptic ulcer, gastritis, variceal rupture, mallory-weiss syndrome, esophagitis, duodenitis

Melena indicates bleeding in ____

Upper GI

Hematochezia indicates bleeding in the ____

Lower GI

Amount of blood needed to be lost for melena to be recognizable

150 ml

Positive tilt test parameters

10 point drop in sys BP or 20 point rise in HR

Mortality rate of esophageal varices

35%

Drug of choice for esophageal varices

Octreotide

general cause of acute gastroenteritis

inflammation with erosion of mucosal lining that protects the stomach

specific causes of acute gastroenteritis

alcohol/tobacco abuse, NSAID abuse, stress, chemo, caustic substance ingestion, infection

Diarrhea can lead to ____

dehydration, hypovolemia, electrolyte imbalances

Most prevalent bacteria causing chronic gastroenteritis

Helicobacter pylori

Gastric ulcers are more common in ___

People older than 50 with physical jobs

Duodenal ulcers are more common in ___

People 25-50 with high stress jobs

What are the 4 phases of cyclical vomiting syndrome?

Prodrome, vomiting, recovery, well

Prodrome Phase

The phase in which the pt begins to feel nauseous and sweaty

Vomiting Phase

The phase in which the pt vomits for 20-30 minutes and experiences severe abdominal pain

Recovery Phase

The phase in which the pt begins to feel better and symptoms subside

Well Phase

The phase in which the pt is asymptomatic

Complications of excessive vomiting?

dehydration, esophagitis, tearing of the upper GI tract, and teeth damage

Long and repetitive hot showers usualy help people with ____

CVS or CHS

Upper GI absorbs ___

nutrients

Lower GI absorbs ___

water

Diverticulitis pain is usually in what quadrant?

Lower left

What can cause diverticula to become inflamed?

Seeds, fecal matter, popcorn fragments

Hemorrhoids commonly occur in the ___ decade of life

Fourth

What’s this?

Inguinal Hernia

What’s this?

Intestinal Volvulus

What’s this?

Intestinal Adhesion

What’s this?

Intestinal Intussusception

Superior Mesenteric Artery

supplies the intestine from the lower part of the duodenum through two-thirds of the transverse colon, as well as the pancreas

Inferior Mesenteric Artery

supplies the intestine from the lower part of the duodenum through two-thirds of the transverse colon, as well as the pancreas

What’s this?

McBurney’s Point

Four Categories of Pancreatitis

Metabolic, Mechanical, Vascular, Infectious

Most common cause of metabolic pancreatitis

alcohol

Common cause of mechanical pancreatitis

gallstone and serum lipid obstructions

Risk factors of hepatitis

Unsanitary living conditions, poor hygiene, bloodborne pathogens, alcoholism

The Six Hepatitis Strains

A, B, C, D, E, G

Symptoms of Hepatitis

Jaundice, swollen liver, photophobia, N/V

What abdominal region is 1?

Right Hypochondriac

What abdominal region is 2?

Epigastric Region

What abdominal region is 3?

Left Hypochondriac

What abdominal region is 4?

Right Lumbar

What abdominal region is 5?

Umbilical Region

What abdominal region is 6?

Left Lumbar

What abdominal region is 7?

Right Iliac

What abdominal region is 8?

Hypogastric Region

What abdominal region is 9?

Left Iliac