Patho Exam 2

Etiology of GERD

Stomach acid regurgitating into the esophagus

manifestations of GERD

heart burn and regurgitation are the characteristic symptoms. heartburn often occurs during the night-antiacids help. other manifestations include belching and chest pain

where is the pain associated with gerd msot felt

epigastric or retrosternal radiating to the throat, shoulder, or back

respiratory manifestations associated with gerd

asthma, chronic cough, and laryngitis

hiatal hernia

protrusion of a part of the stomach upward through the esophageal hiatus opening in the diaphragm

Etiology of Hiatal Hernia

unclear, possibly traumatic or genetic. The exact cause of hiatal hernia is not known. The condition may be due to weakness of the supporting tissue. Your risk for the problem goes up with age, obesity, and smoking.

manifestations of hiatal hernia

Pain areas: in the abdomen or chest
Pain types: can be burning in the chest
Gastrointestinal: belching, hiccup, nausea, regurgitation, or vomiting
Also common: throat irritation

types of hiatal hernias

sliding and paraesophageal (rolling)

GI bleeding

can occur in the upper GI area-esophagus, stomach, and duodenum or the lower GI area-jejunum, ileum, and large intestine

etiology of GI bleeds

ulcers, esophageal varices, hemorrhoids

manifestations of GI bleeding

hematemesis-vomitting of blood, usually described as bright red or coffee ground color, Malena (blood in the stool) with the color ranging from bright to tarry, and occult blood which is blood hidden in the stool

Disorders of the Esophagus

GERD, hiatal hernia

function of esophagus

to carry food, liquids, and saliva from the mouth to the stomach

Gastroesophageal reflux disease

the upward flow of acid from the stomach into the esophagus, a condition that can cause heartbrun or pyrosis (heartburn)

most common disorder originating in the GI tract

GERD

Gastroesopageal reflux symptoms occur when

soon after eating and are short lived

GERD

gastroesophageal reflux disease, defined as symptoms of mucosal damage produced by the abnormal reflux of gastric acid contents into the esophagus or beyond the oral cavity or lung

in GERD what usually allows the reflux to occur

relaxations of weak or incompetent Lower esophageal sphincters , or delayed gastric emptying which can also contirbute by increasing gastric volume and pressure

Most common Hiatal Hernia?

sliding hernia

Sliding hernia

most common, characterized as a bell-shaped protrusion of the stomach above the diaphragm.

paraesophageal hernia

separate portion of the stomach along with the greater portion of the stomach enters the thorax through a widened opening and usually enlarges (may require surgical treatment)

Disorders of the stomach

gastritis and peptic ulcer disease

gastritis

inflammation of gastric mucosa (stomach lining)

etiology

bacterial endotoxins, caffine, alcohol, aspirin, NSAIDS

manifestations of gastritis

Mild - Gastric Distress
Severe - Vomiting and bleeding

Peptic Ulcer Disease

A sore that develops on the lining of the esophagus, stomach, or small intestine. An ulcerative disorder occuring in areas of the upper GI tract that are exposed to acid-pepsin secretions.

Etiology of peptic ulcer disease

alcohol, aspirin(most ulcerogenic of NSAIDS), bile acids, Helicobacter pylori(induces inflammation contributing to rlease of cytokines which causes mucosal damage), exposure to NSAIDS.

most common form of peptic ulcer disease

duodenal ulcer and gastric

mechanism of peptic ulcer disease

decreased mucus production and prostaglandin deficiency

manifestation of peptic ulcer disease

vague abdominal discomfort to life threatening hemorrhage. pain usually burning, cramping rhythmic pain occurs when the stomach is empty between meals, pain located in the mid epigastric area, perforation of gastric ulcer can lead to contents in the peritoneum, decreased hematocrit

when is peptic ulcer disease prevelant

middle aged adults

can peptic ulcer affect one or all layers of the stomach duodenum

yes

Disorders of the intestines

Crohns disease, ulcerative colitis, Diverticular disease and diverticulitis, colon rectal cancer, · Irritable Bowel Syndrome

Crohn's disease

Recurrent, granulomatous type of inflammatory response that can affect any area of the GI tract. Slowly progressive, disabling disease, also relentless.

population characteristics for crohns

Common in people in their 20-30s, and women are slightly more affected than men.

how can the surface of the inflammed bowel in crohns disease be described

as having the characteristic of cobblestone which is a result of the fissures and crevices that develop surrounded by submucosal edema.

Etiology of Crohn's Disease

unknown, immunologic factors may be triggered by normal intestinal flora. possibly autoimmune problem - Tumor Necrosis Factor

Pathogenesis of Crohn's Disease

lesions develop in the bowel eventually thickening of the bowel and decreased flexibility

manifestations of crohns

usually exacerbations and remissions, oral lesions, abdominal pain, diarrhea, fecal urgency,weight loss - due to malabsorption. Symptoms are usually related to the location of the lesions, ulceration of the perianal skin is common due to severe diarrhea, absorptive surface of the intestine may be disrupted along with nutrtional deficiences

what happens if crohns disease occurs in children

active and severe disease can delay growth, especially in a young child.

Complications of Crohn's Disease

development of fistulas on the skin and vaginal areas, intestinal obstruction, abdominal abscesses

ulcerative colitis

chronic inflammation of the colon with presence of ulcers. This inflammatory response tends to be continuous. the inflammation is usually confined to the rectum, ulcerations are usually superficial and as a result of ulceration the mucosal layer often develops toungelike projections

where is incidence the highest in ulcerative colitis

between the ages of 20 and 30

manifestations of ulcerative colitis

diarrhea, watery stools with blood and mucus, abdominal cramping, nausea and vomiting, weight loss, indications of inflammation. anorexia, fatigue, frequent stoolsstools typically contain mucous and bloodmore severe cases - fever, abdominal pain

complications of ulcerative colitis

arthritis, development of colon cancer

etiology/pathogenesis of ulcerative colitis

only occurs in the rectum and colonlesions are continuous unlike crohnslesions can become necrotic and ulcerate. · The exact etiology is unknown however according to theories it may be due to immune system dysfunction, genetics, changes in normal gut bacteria, and environmental factors

diverticular disease

formation of bulging pouches throughout the colon but most commonly in the lower portion of the colon

etiology of diverticular disease

disease is most prevalent in the developed world due to lack of fiber in the diet, and decreased physical activity, increased intraluminal pressure causes the outpouching

pathogenesis of diverticular disease

mucosal layer herniates through the muscularis layer, often multiple diverticula, most occur in the sigmoid colon

Diverticulitis

inflammation of the diverticula

etiology of diverticulitis

Acute inflammation and infection of abnormal pockets of the large intestine, known as diverticuli. inflammation of the diverticulum with small ulcerations in the diverticulum

manifestations of diverticulitis

nausea, vomiting, fever, increased white blood count. · pain in the lower left quadrant accompanied by nausea and vomiting, tenderness in the lower left quadrant, fever, and elevated white blood cell count

complications of diverticulitis

peritonitis, bowel obstruction, hemorrhage, fistula formation

colorectal cancer

A cancer of the colon or rectum, which may begin as noncancerous polyps.
Colorectal cancer is a growth of cells that forms in the lower end of the digestive tract. Most of these cancers start as noncancerous growths called polyps.

incidence of colorectal cancer

61,000 people die each year, lethal because symptoms do not occur until late into the course of the disease, incidence increases with age, genetic as well as environmental factors are involved, increased risk if hx of ulcerative colitis or polyps in colon

genetic factors of colorectal cancer

familial adenomatous polyposis,
hereditary non-polyposis colon cancer

environmental factors contributing to colorectal cancer

dietary fat intake - increased synthesis of bile acids, fiber intake - removes potential carcinogens

manifestations of colorectal cancer

bleeding - significant early symptom change in bowel habits, diarrhea, constipation, urgency or incomplete emptying of the bowel, pain is a late symptom

Irritiable bowel syndrome (IBS)

o Used to describe a functional GI disorder.

o Characterized by a variable combination of chronic and recurrent intestinal symptoms which are not explained by structural of biochemical abnormalities.

o Persistent or recurrent symptoms of abdominal pain, altered bowel function, varying complaints of flatulence, bloating, nausea, and anorexia, constipation, diarrhea, nand anxiety and depression

o Abdominal pain is commonly seen along with cramping in the lower abdomen

o believed to be a result of dysregulation of intestinal motor activity and central neural functions associated with the CNS.

o People with this tend to experience increased motility and abnormal intestinal contractions in response to psychological and physiologic stressors

o Women tend to be more effected than men

IBS manifestations

o Diagnosis is usually based upon signs and symptoms of abdominal pain or discomfort, bloating, constipation or diarrhea or alternating bouts of constipation and diarrhea

o Other symptoms includes abnormal stool frequency, abnormal stool form, abnormal stool passage

etiology of IBS

stress - hyperactivity of the bowel

Function of the liver

Helps with clotting factors, protein production, macrophages, metabolism-glycogen formation, glycogenolysis, and gluconeogenesis. Also helps with bile production and aids in the metabolism of drugs

Hepatitis

inflammation of the liver

Hepatitis A

o Caused by hepatitis a virus

o Has an incubation period of 15-45 days

o Transmitted by the fecal oral route

o Hepatocytes (liver cells) are the sole site of replication

o Symptoms include fever, anorexia, and malaise

Hepatitis B

o Caused by hepatitis B virus which is double stranded

o Transmitted by blood, bodily fluids, saliva, and semen

o Prophylaxis-action taken: hepatitis B immune globulin, and hepatitis B vaccine

o Groups at risk include healthcare workers and those who are sexually active

manifestations of hepatitis B

o symptoms do not occur until 2 or 3 months, many of the infections are not apparent, symptoms can be fulminant hepatitis (occurring suddenly)

§ Liver cell necrosis

§ Hepatic failure

§ High mortality

Chronic hepatitis

hepatitis inflammation and necrosis for longer than 6 months

Hepatitis C

§ Associated with blood transfusions

§ There is a greater incidence of carries-80%

· An infection caused by a virus that attacks the liver and leads to inflammation.

· The virus is spread by contact with contaminated blood, for example, from sharing needles or from unsterile tattoo equipment.

· Most people have no symptoms. Those who do develop symptoms may have fatigue, nausea, loss of appetite, and yellowing of the eyes and skin.

Hepatitis C is treated with antiviral medications. In some people, newer medicines can eradicate the virus

Cirrhosis

diffused fibrosis and conversion of normal liver architecture into structurally abnormal nodules, it is a chronic degenerative disease of the liver

Complications of cirrhosis

portal hypertension, splenomegaly, ascitis, hepatorenal syndrome, hepatic encephalopathy.

etiology of cirrhosis

Alcohol, Toxins, Hepatitis, Biliary Obstruction, Alcoholic Cirrhosis

manifestations of cirrhosis

weight loss, weakness, anorexia, hepatomegaly, jaundice,splenomegaly, ascites, esophageal varices

portal hypertension

increased pressure within the portal venous system

splenomegaly

enlargement of the spleen due to the shunting of blood into the splenic vein

ascites

abnormal accumulation of fluid in the peritoneal cavity

hepatorenal syndrome

possibly due to decreased renal blood flow, increased creatine, increased BUN(blood urea nitrogen), decreased urine output.

multiorgan condition affecting the kidneys and the liver

Hepatic encephalopathy

central nervous system manifestations, asterixis - flapping tremor, loss of memory, personality changes, impaired speech, coma

esophageal varices

swollen, varicose veins at the lower end of the esophagus. · They form due to portal hypertension, which commonly is a result of cirrhosis, resistance to portal blood flow, and increased portal venous blood inflow

Cholelithiasis

gallstones in the gallbladder, usually asymptomatic

Cholelithiasis etiology

high cholesterol in bile

Cholelithiasis mechanism

development of cholesterol stones

Adrenal Axis

(CRH is released from the hypothalamus which stimulates ACTH release from the anterior pituitary stimulating cortisol release from the adrenal cortex). involves the central nervous system and the endocrine system adjusting the balance of hormones in response to stress. Stress results in the hypothalamus stimulating the pituitary gland to release hormones that further cause the adrenal glands to release cortisol.

thyroid axis

( TRH is released from the hypothalamus which stimulates TSH release from the anterior pituitary stimulating thyroud hormone release from the thyroid gland) The thyroid axis is comprised of thyrotropin-releasing hormone (TRH) at the level of the hypothalamus which stimulates the pituitary to release thyrotropin (TSH). TSH in turn stimulates the thyroid to secrete the pro-hormone thyroxin (T4) and to a lesser extent the receptor active hormone tri-iodothyronine (T3)

primary disorder

dysfunction caused by the endocrine gland itself. The end organ is not able to put out the hormone- thyroidectomy or adrenalectomy.

secondary disorder

dysfunction caused by abnormal pituitary activity. when hypothalamus or pituitary are unable to put out hormone- removal of pituitary gland

Hypofunction

interruption of blood flow, congenital defect, infection, autoimmune response, inflammation

Hyperfunction

ectopic production- hormones secreted from sites that are not their physiological origin, in amounts sufficient to cause clinical effects

antidiuretic hormone (ADH)

Hormone produced by the neurosecretory cells in the hypothalamus that stimulates water reabsorption from kidney tubule cells into the blood and vasoconstriction of arterioles.causes the kidneys to release less water, decreasing the amount of urine produced. A high ADH level causes the body to produce less urine. A low-level result in greater urine production.

arginine vasopressin

major physiological function is the control of water homeostasis. This is released from the posterior pituitary in response to increased osmolality sensed in the supraoptic nuclei of thehypothalamus.

what stimulates ADH release

low plasma volume

ADH and fluid balance

keeps water in blood; plasma volume decreases causing hemoconcentration (blood becomes more dense) and increase in osmolarity. activates osmoreceptors in hypothalamus, stimulates posterior pituitary and acts on kidney to increase H2O reabsorption. keeps water in blood stream rather than urine

SIADH-syndrome of inappropriate antidiuretic hormone

excessive production of antidiuretic hormone

SIADH etiology

ectopic tumor cells:

-Oat cell adenocarcinoma of the lung

-Carcinoma (cancer of the epithelium) in the duodenum, pancreas, etc.

SIADH mechanism

water retention, expansion of intravascular volume

SIADH signs

hyponatremia, hypoosmolality, urine hyperosmolality

SIADH symptoms

thirst, impaired taste, GI symptoms, vomiting, abdominal cramps, Neuro symptoms like confusion, lethargy, muscle twitching, convulsions

diabetes insipidus

antidiuretic hormone is not secreted adequately, or the kidney is resistant to its effect. insufficiency of ADH

diabetes insipidus etiology

1. Neurogenic (Inadequate production problems with synthesis, transport, release) due to-
-head surgery or brain tumor
-hypophysectomy
- aneurysms
-thrombosis
-infections -
-immunologic disorders
-commonly head injury

2. Nephrogenic (inadequate response due to)
-renal tubular defect
-genetic
-drugs
genetic, some drugs damage the renal tubules pyelonephritis, polycystic disease, general anesthetics, lithium carbonate

manifestations of diabetes insipidus

include low urine specific gravity of 1.000-1.005, Low urine osmolality, polyuria, dehydration unless fluid is replaced, Another symptom is polydipsia (excess thirst)