Patho 2.2 GI issues

what is pancreatitis?

inflammation of the pancreas

what can cause acute pancreatitis?

cholethiasis, bc gallstones move through common bile duct and block it, leading to pancreatic enzymes backing up

what can cause chronic pancreatitis?

alcohol abuse

so if gallstones block the duct, what happens with pancreatic enzymes?

they activate in the pancreas, digesting itself and leading to inflammation

what is elastase?

necrosis of blood vessels that lead to bleeding

what is lipolysis?

lipids released combine with ionized calcium (causing low calcium)

what happens with proteolysis?

formation of thrombus and gangrene of the pancreas

does the pancreatic enzymes just stay in the pancreas?

no they spread into the peritoneal cavity, burning and damaging other organs

the pancreatic enzymes enter circulation, activating an inflammatory response, leading to…

leaky capillary vessels and hypertensive

what are some complications for pancreatitis?

acute lung injury, acute respiratory distress syndrome, diabetes mellitus (pancreas), septic shock, disseminated intravascular coagulation, renal failure

which respiratory disease is deadly lung disease with high mortality rates?

acute respiratory distress syndrome

what is disseminated intravascular coagulation?

bleeding and clotting at the same time

how does pancreatitis present in a person?

upper quadrant pain, gets worse eating, back pain, jaundice, fever

what are chronic pancreatitis symptoms?

flatulence, less severe pain, steatorrhea, indigestion

what is steatorrhea?

fat in stool

how can you diagnose pancreatitis?

look at the pancreatic enzymes, like amylase and lipase

how can you help pancreatitis?

nil per os, feed the bowel with a tube to where pancreas intersects with small bowel to give nutrition, pain meds, oxygen, IV antibiotics, glucose and hydration levels

what does a person with chronic pancreatitis have to do before eating?

take pancreatic enzymes, stop alcohol, and work with pain and insulin meds

what is the 5 year survival rate for pancreatic cancer?

9%

who is at risk for pancreatic cancer?

genes, pancreatitis, cirrhosis, obesity, African American

how does pancreatic cancer present?

asymptomatic till spread, pain, jaundice, dark urine and clay stool, anorexia/malnutrition/weight loss, clotting and diabetes

how can you diagnose pancreatic cancer?

imaging, CT, MRI, needle biopsy

how can you treat pancreatic cancer?

chemotherapy, radiation, IV, Whipple surgery

what is Whipple surgery for pancreatic cancer?

remove tumor, lots of complications by taking out part of stomach and small bowel

what is an intestinal obstruction?

blockage of intestinal contents in SI or LI, most common in SI

what can cause physical intestinal obstruction?

tumor, adhesions, hernias

what is an adhesion?

bands of scar tissue wrapping around portion of bowel

what is the intestinal blockage made of?

gas, chyme, saliva, bile, gastric juice, pancreatic stuff = dissension and pain

what happens when the intestinal blockage impairs blood flow?

necrosis, and bowel can leak into abdomen causing septic chock

• perforations, pH imbalance, dehydration

how does an intestinal blockage present?

distension, pain, constipation, diarrhea, intestinal rushes, borborygmi

what is borborygmi?

loud bowel sounds

how is intestinal blockage diagnosed?

CT, ultrasound, CBC

how can you treat intestinal blockage?

rest the stomach, NPO, decompress valve and use nasogastric tube to suck up stuck, pain meds, oxygen, fluids

what is appendicitis?

inflammation of the appendix bc of obstruction inside it

why does obstruction cause appendicitis?

it leads to distension and bacterial growth, fluid leads to purulent exudate and pressure

how can appendicitis harm the peritoneum?

ischemia and necrosis get into the peritoneum, causing peritonitis (rigid board abdomen), abscess formation, and ruptured appendix

what are the symptoms for appendicitis?

asymptomatic till lots of pain, lower right quadrant, getting worse over 24 hours, distension, fever and chills from infection, ruptures can lead to peritonitis w

what is peritonitis?

inflammation of the peritoneum

what causes peritonitis?

appendicitis, liver failure, bowel rupture, pelvic inflammatory disease

what is an obvious sign of peritonitis?

abdominal rigidity, low BP but fast HR

how can you diagnose appendicitis?

laparoscopy, holes in the abdomen

what is inflammatory bowel disease?

inflammation disorders of the bowel, immune cells in intestine mucuous release inflammatory mediators

who is at risk for inflammatory bowel disease?

white women, jewish decent, smokers, 30 years

what are the 2 types of inflammatory bowel disease?

Crohn’s disease and ulcerative colitis

T/F, inflammatory bowel disease comes and goes

T

what is Crohn’s disease?

T-cell activation damages intestinal mucosa, common in adolescence

what part of the GI tract does Crohn’s disease affect?

ileum and large intestine

what does Crohn’s disease look like in the intestines?

cobblestones with abscess ulcers, skip lesions with patchy areas of inflammation

what happens when intestines become thick and rigid?

narrowing obstruction, malnutrition

how does Crohn’s disease present?

cramping, diarrhea, steatorrhea, constipation, hematochezia, ulcers

what is hematochezia?

blood in stool

what can Crohn’s disease worsen into?

anemia, fistula formation, adhesions, perforations, anal fissure, pH imbalance, delayed growth and development, intestinal cancer

how is Crohn’s disease diagnosed?

stool analysis, CBC, colonscopy, serum antibodies

how can you treat Crohn’s disease?

you can’t, just reduce flares with IV infusions, nutrition, diet changes, immune modulators

what is ulcerative colitis?

inflammation triggered by T-cell accumulation in colon and rectum

what does ulcerative colitis look like in the GI system?

ulcers, with tons of epithelium loss, erosion, and ulceration, inflammation, edema, tons of bleeding and fistulas

how does ulcerative colitis present?

diarrhea (20.day), tenesmus, practices, cramping, fever

what is tenesmus?

uncontrollable bowel movement

what is practitis?

inflammation of colon

what can ulcerative colitis worsen into?

anemia, perforations, fistulas, strictures, pseudo polyps, toxic megacolon, colorectal carcinoma

how can you diagnose ulcerative colitis?

same as Crohn’s disease + colonoscopy

how can you treat ulcerative colitis?

no cure, remove colon to make an anal pole, bring intestines back to anus, reduce flares, nutrition

what is diverticular disease?

outpouching of the intestinal wall

what causes diverticular disease?

submucosa herniates through layers of intestine, caused by fatty diet, straining

how does diverticular disease present?

asymptomatic till inflammation (retained fecal matter), obstructions, infections, peritonitis, hemorrhage, abscess h

how do you diagnose diverticular disease?

colonoscopy, stool analysis, imaging

how do you treat diverticular disease?

improve stool with high fiber, hydration, stool softeners, colon resection

what is colon cancer?

cancer in the colon or rectum

what is the 3rd most common cancer in US, 3rd most fatal?

colon cancer

what causes colon cancer?

ulcerative colitis or Crohn’s disease

who is at risk for colon cancer?

age > 45, genetics, diseases familial adenomatous polyposis, HPV, NSAIDS use

how does colon cancer present?

asymptomatic till advanced, rectal bleeding (need tests), anemia, fatigue, fullness, pain, distension

how do you test for colon cancer?

colonoscopy, fecal occult blood test

how do you treat colon cancer?

surgery, removal partial (colectomy), complete (colostomy), radiation, chemo