PATHO Exam 3 Class Review

PATHO Exam 3 Class Review - GI Disorders

DIARRHEA

• Causes of Diarrhea:

  • Exudative: Due to infection.

  • Associated Conditions: H. Pylori, Crohn’s disease, and any ulcers.

  • Key Point: Always check for H. pylori in patients with ulcers.

    • Definition: H. Pylori is a causative factor and an antigen contributing to exudative diarrhea; associated with ulcerative colitis, Crohn's, and peptic ulcers, where diarrhea is common.

  • Osmotic: Caused by increased amounts of poorly absorbed solutes in the intestine.

  • Secretory: Caused by toxins stimulating intestinal fluid secretion or impairing absorption; can lead to up to 1L/day loss.

  • Definition: Exudate refers to inflammation characterized by mucus, blood, and protein due to infection.

  • Motility Disturbances: Results in decreased transit time of chyme with absorptive surfaces.

CONSTIPATION

• Pathological Causes:

  • Opioids, immobility, dehydration, strictures, low fiber diet, alterations in body systems.

  • Condition Affecting the Intestinal Tract: Diverticulosis, which involves alterations in the intestinal lining leading to fecal material gathering in pouches.

  • Definitions:

  • Constipation: Classified as fewer than 3 stools per week.

  • Diverticulosis: Symptoms include constipation caused by intestinal tract alterations.

STOMATITIS

• Causes: Chemotherapy/radiation, often affecting immunocompromised individuals due to destruction of natural flora.

  • Definition: Stomatitis is characterized by ulcerative inflammation of the oral mucosa.

ESOPHAGEAL VARICES

• Symptoms: Include bleeding and anemia.

  • Definition: Gastroesophageal varices refer to enlarged veins in the esophagus caused by portal hypertension, often a result of alcoholism or post-hepatic cirrhosis.

  • Clinical Manifestations: Hematemesis (vomiting blood), melena (dark tarry stools), and anemia.

PEPTIC ULCER DISEASE (PUD)

• Pathological Process: Breakdown of the mucosal barrier leads to PUD; characterized by sore development on the stomach lining due to acid damage, triggered by factors including ASA, NSAIDS, ETOH, and bile.

  • Involvement of H. Pylori: A key factor in the formation of ulcers.

• Symptom Differences:

  • Duodenal Ulcer: Pain present on an empty stomach.

  • Gastric Ulcer: Pain present with eating.

• Epigastric Pain: Described as burning pain occurring with eating or soon after; lower pain typically arises 2-3 hours after eating for duodenal ulcers.

GASTROESOPHAGEAL REFLUX DISEASE (GERD)

• Avoidance Strategies: Spicy foods, caffeine, alcohol, restrictive clothing, and weight loss to prevent reflux.

• Definition: Any condition altering the closure strength of the lower esophageal sphincter (LES) or increasing intra-abdominal pressure contributes to GERD.

  • Diagnosis Methods: Blood tests, stool specimens, or breath tests for H. Pylori; upper GI endoscopy can also be utilized.

HIATAL HERNIA

• Symptoms: Heartburn, dysphagia, chest discomfort, and anorexia; major symptom include dysphagia.

  • Definition: A condition where the stomach protrudes into the chest through the diaphragm, leading to potential GERD, heartburn, chest pain, and ulcerations.

CELIAC DISEASE

• Statistics: More prevalent in females; allergy to gluten, specifically gliadin, triggering immune responses leading to inflammation and atrophy of intestinal villi.

ULCERATIVE COLITIS (UC)

• Risk: Patients are at risk for developing colon cancer.

  • Pathology: Begins at the rectum and extends upwards; characterized by inflammation at the base of the Lieberkühn crypts leading to abscess formation.

  • Lower Abdominal Pain: Main symptom associated with UC; megacolon is a significant complication.

GASTRITIS & GASTRIC CANCER

• Definition of Gastritis: Inflammation of the stomach lining due to various irritants including alcohol, aspirin, NSAIDS, and H. Pylori infection.

GASTROENTERITIS

• Symptoms: Diarrhea, fever, abdominal pain/discomfort, malaise; often due to imbalance of GI flora from food poisoning or antibiotics.

IRRITABLE BOWEL SYNDROME (IBS)

• Cause: Unknown; characterized by alternating diarrhea and constipation without identifiable pathological processes.

ANTIBIOTIC ASSOCIATED COLITIS

• Cause: Exposure to bacterial toxins leading to mucosal necrosis, commonly due to antibiotics that destroy normal flora.

PSEUDOMEMBRANOUS COLITIS

• Cause: Clostridium difficile (C. diff) infection, commonly following antibiotic use.

  • Clinical Manifestations: Profuse watery foul-smelling diarrhea, abdominal pain, fever, leukocytosis, and risk of perforation.

DUMPING SYNDROME

• Causes: Often follows bariatric or gastric surgery, leading to rapid gastric emptying into the small intestine.

  • Symptoms: Low blood pressure from hypovolemia after eating (20-30 minutes post-consumption) and rebound hypoglycemia (1-3 hours post-meal).

BOWEL OBSTRUCTION

• Causes:

  • Mechanical Obstruction: Tumors, foreign objects, adhesions, fecal impaction.

  • Functional Obstructions: Caused by surgical interventions inhibiting peristalsis, medications, or neurological disorders.

CROHN’S DISEASE

• Complications: Risk for cancer, fissures, abscesses, fistulas.

  • Characteristics: Affects all layers of the GI tract, starting from the top down, leads to inflammation and ulcers.

APPENDICITIS

• Pain Location: Begins at the periumbilical area and locates to the right lower quadrant (McBurney's point).

  • Symptoms: Generalized periumbilical pain, localized pain in lower right abdomen, fever, nausea, potential diarrhea.

LAB VALUES RELEVANT TO KIDNEY FUNCTION

• Typical values:

  • Triglycerides: Male: 40-160 mg/dL | Female: 35-135 mg/dL

  • Albumin: 3.5 – 5.0 g/dL

  • Creatinine: Male: 0.6-1.2 mg/dL | Female: 0.5-1.1 mg/dL

  • BUN: 10-20 mg/dL

  • Potassium: 3.5 – 5.0 mEq/L

  • Hemoglobin: Male: 14-18 g/dL | Female: 12-16 g/dL

  • Hematocrit: Male: 42-52% | Female: 37-47%

  • GFR: 90-120 mL/min

  • RBC: Male: 4.7-6.1 mm3 | Female: 4.2-5.4 mm3

CHRONIC KIDNEY DISEASE (CKD)

• Complications: Can lead to kidney failure. Stages of CKD includes:

  1. Stage 1: Normal or increased GFR (90-120 mL/min)

  2. Stage 2: Mildly decreased GFR

  3. Stage 3: Moderately decreased GFR

  4. Stage 4: Severely decreased GFR

  5. Stage 5: End-stage renal disease (ESRD)

• Risks: Diabetes and hypertension are the main causes.

ACUTE KIDNEY INJURY (AKI)

• Diagnosis Factors:

  • Increase in creatinine by >0.3 mg/dL within 48 hours.

  • Urine volume <0.5 mL/kg/hr for 6 hours.

  • Classification of phases:

  1. Initiation (normal urine/labs)

  2. Oliguric (decreased urine output)

  3. Diuresis (normal urine output but abnormal labs)

  4. Recovery (normal urine/labs)

ACUTE GLOMERULAR NEPHRITIS

• Cause: Inflammatory response due to antigen-antibody reactions; commonly preceded by Strep A infections.

  • Clinical Manifestations: Generalized edema, hematuria, proteinuria, hypertension.

  • Symptoms Include: Smoky, coffee-colored urine, elevated BUN/creatinine levels.

NEPHROTIC SYNDROME

• Description: A glomerulopathy characterized by urinary loss of >3 to 3.5 grams of protein/day; increased lipid levels due to renal dysfunction.

PYELONEPHRITIS

• Definition: Infection in the kidney, typically ascending from a lower urinary tract infection.

  • Symptoms: Nausea, vomiting, chills, fever, flank pain, dysuria.

URINARY TRACT INFECTION (UTI)

• Infections in Men: Less common, can be linked to STIs or immunosuppression.

• Infections in Women: Mainly caused by E. coli due to hygiene factors and urinary retention.

BODY’S PROTECTION AGAINST BACTERIAL INFECTIONS

• Mechanisms include urine flow, acidic environment, and epithelial mucosal lining as protective barriers.

AGE-RELATED URINARY DYNAMICS

• In older adults, decreased kidney function, weakened pelvic floor, and reduced bladder capacity lead to increased nocturia.

RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM (RAAS)

• Function: Helps prevent acute kidney injury by increasing blood pressure and fluid volume through salt retention.