Exam 4 GI

Dysphagia.

difficulty swallowing

Odynophagia

painful swallowing

Achalasia

failure of the lower esophagus sphincter muscle to relax

causes of constipation

- Dietary factors

- Fluid intake

- Drugs (i.e. opiods/ narcotics)

- Immobility

Hematemesis

vomiting blood; dark, looks like coffee grounds because blood is old

Melena

dark tarry stools associated with upper GI bleeds

Hematochezia

bright red blood in stool associated with lower bleed, could be mixed with stool or just blood; fresh blood from anus

Upper GI bleeding

- Originates in the esophagus, stomach or duodenum

- Dark tarry stools, coffee ground (hematemesis & melena)

Lower GI bleeding

- Originates in the jejunum, ileum, colon, or rectum

- Bright red blood in stool (hematochezia)

Gastric Esophageal Reflux Disease (GERD)

· Backward movement of gastric contents into the esophagus

· Weak lower esophageal sphincter

Symptoms of GERD

- Heartburn

- Belching

- Chronic cough

- Dysphagia

What is the concern with chronic GERD?

- Esophageal metaplasia- goblet cells (normally line the intestines) are found in the lining of the esophagus

o Barrett esophagus- a condition in which tissue that is similar to the lining of your intestine replaces the tissue lining your esophagus

o Adenocarcinoma- cancer that forms in the glandular epithelial cells

Hiatal Hernia

· sliding of stomach above diaphragm into esophagus

- No specific cause, if asymptomatic usually no concern

- S/S: dysphagia, reflux, chest pain

What occurs with gastritis?

· Inflammation of gastric mucosa

· Result of a breakdown in gastric mucosal barrier Stomach tissue unprotected from autodigestion by HCl acid and pepsin

· Tissue edema results & Disruption of capillary walls

Acute gastritis

- Erosion of the surface epithelium secondary to damage to mucosal barrier

- Often r/t drugs or chemicals (Cigarette smoke, alcohol, NSAIDS)

- Transient & self limiting

- Lasts a few hours to a few days

- Complete healing of mucosa expected

- S/S- Anorexia, nausea, vomiting, epigastric tenderness,

Chronic gastritis

- Thinning and degeneration of the gastric mucosa

- If offending agent not removed

- H.pylori infection

- Loss of intrinsic factor can occur when acid-secreting cells are lost or are nonfunctioning

- Symptoms are similar to acute gastritis. Feeling of fullness. May have hemorrhage

Why are NSAIDs associated with gastritis?

Blocking the development of protective prostaglandins in the stomach

What is the significance of a H pylori infection?

· Leads to ulcers of duodenum and gastric regions

· Secretes toxins that disturb gastric mucosal layer

· Continuous inflammatory response

· Gastric cell atrophy & metaplasia

Which conditions are associated with H. pylori?

- Peptic Ulcer Disease

- stomach cancer

What is peptic ulcer disease (PUD)?

· Ulcer development in the stomach lining or 1st part of small intestines

· ASA (aspirin increases risk!)

Who is more likely to develop PUD?

- Smoking

- Age (55-70 years of age)

- Men \> Women

- Alcohol use

- Anxiety and depression

- Certain chronic diseases

- Infection with H. pylori*

- NSAIDS

How does PUD present?

- Burning, cramping, gnawing pain

- Risk of hemorrhage and possible perforation

- Melena

- Hematemesis

What makes the pain better and worse with PUD?

- Occurs with the stomach empty or 30 min after eating

- Relieved by alkaline foods and made worse by acidic foods

How are Ulcerative Colitis (UC) and Crohn's disease the same?

- Both are associated with activation of the inflammatory response resulting in tissue damage

- Both are IBDs

Appearance of bowel movements with UC

o Watery/bloody diarrhea (hematochezia)

o Passage of blood and purulent mucus

o Crampy pain

o Weight loss

Appearance of bowel movements with Crohn's disease

o Non-bloody diarrhea

o Weight loss, fatigue, fever

o Abdominal pain

o Large joint arthritis

Appearance of disease in the intestines with UC

- an ulceration of the colonic mucosa (rectum and sigmoid colon). More is continuous rather than patchy. Small erosions can cause abscess formation, necrosis, edema.

- limited to the colon

Appearance of disease in the intestines with Crohn's

any area from mouth to anus with granulomatous inflammatory response- Patchy lesions "skip lesions"

- anywhere between the mouth and rectum

What causes both UC and Crohns?

- Both are inflammatory disorders

- Genetic predisposition plus environmental trigger produces an autoimmune response

Diverticulosis

Chronic condition where there are out-pouchings (diverticula) of the sigmoid colon; can be asymptomatic

Diverticulitis

Inflammation of the diverticula and micro-perforation of the intestinal wall

Causes of Diverticulosis

low fiber intake, low physical activity, obesity

Diverticulitis manifestations

- LLQ abdominal pain and tenderness

- Fever and leukocytosis

- N/V

Appendicitis

· Inflammation of appendix with swelling and gangrene (can perforate)

· Appendix becomes obstructed from bacterial infection

Frequently, 20-30 year olds

· rebound tenderness\***

How does appendicitis present?

· vague abdominal pain (frequently starts periumbilical or epigastric), N/V, low grade fever or leukocytosis, pain then intensifies and localizes to RLQ

- Point specific

- Rebound tenderness

Peritonitis

· Inflammation of membrane lining abdominal cavity/peritoneal cavity

· Occurs with infection, irritations, perforations (ulcers), ruptures (appendix), trauma

How does peritonitis present?

· pain, tenderness, N/V, fever & leukocytosis, abdominal rigidity, guarding (shield abdomen to protect from painful palpations)

· May result in paralytic ileus and abdominal distention (progresses to bowel obstruction), sepsis, and hypovolemia

· needs surgery to clean out

Mechanical obstruction

- lumen is blocked; colicky pain, peristaltic rushes, high pitched bowel sounds

Examples of mechanical obstruction

o Hernia

o Intussusception: Telescoping of bowel within itself (distal portion comes back into proximal)