Pathology: GI System_Exam 2
Small & Large Intestines: Colonic Diverticulitis "___"= out-pouchings bulging weak spots in colon wall ________: condition of having or presence of diverticula ________: inflamed or infected diverticula Pathogenesis: Slow bowel transit time creates ____________ -Low _____ diets & ________ lifestyle slow colonic transit time -High intra-colonic pressures _________ colon wall creating outward protrusion -High pressures also push fecal material outward--obstructing neck of diverticulum. Entrapped bacteria proliferate causing inflammation and erosion. Repeated erosions and micro-perforations heal by scarring. Diverticulum becomes a "_______" out-pouching. -Fecal matter becomes trapped again -->re-obstructing the diverticulum. Bacterial proliferation --> inflammation --> healing & scaring --> cycle repeats -----> slowly enlarging the diverticulum Potential for __________ & ________; spilling fecal material into peritoneum
"Tics" Diverticulosis Diverticulitis high colonic pressures low fiber diets & sedentary lifestyle weakens fixed perforation & rupture
Esophagus: Hiatal Hernia -Upper stomach (cardia portion) herniates up through diaphragmatic hiatus -Affects ~60% by age ______; caused by repeated high intraabdominal pressures (heavy lifting; straining during bowel movements; coughing; vomiting; obesity) Two Main Types: 1)_________: stomach "slides" up through hiatus; gastroesophageal jxn now in chest; associated with reflux esophagitis 2)________: fundus "rolls" up next to esophagus -Gastroesophageal jxn still in ABD; stomach may become ______ & lose blood flow Which one is more common? Clinical Features: heartburn and/or regurgitation; especially when bending over or laying down -_____, ______ pain in chest/epigastrium if hernia becomes trapped -X-rays (Upper GI Series w/contrast) and/or upper endoscopy (EGD) Treatment: Lifestyle/eating changes; acid reducing meds; surgical correction
-60 -Sliding -Rolling -strangulated -Sliding -intense, sharp pain
Esophagus: Esophageal Diverticulum: -Pouch or sac protruding out through weak portion of esophageal lining -Progressive d/o from chronically high pressure within esophagus; usually older over age _______ -Sphincters malfunction (UES or LES); swallowing malfunction; esophageal obstruction Three Primary Types: 1) ________: upper esophagus; located in back of throat 2) _______: traction on esophagus by inflamed or enlarged mediastinal nodes 3) ________: immediately above diaphragm; associated w/esophageal motility disorders Which one is the most common type? Clinical Features: Difficulty ________, Painful ________ (odynophagia), ________ food when bending over/lying down/standing up; chronic cough & bad breath Treatment: Educate patient--thoroughly chew food & drinks lots of water during/after meals; surgical correction
-60 -Zenker's -Midthoracic -Epiphrenic -Zenker's -swallowing (dysphagia) -swallowing -regurgitating
Esophagus: ___________: "failure to relax" -Involuntary nerve dysfunction during swallowing process -disordered _________, incomplete ______ relaxation, ______ sphincter pressures -incomplete relaxation of LES becomes functional obstruction -Esophagus does not empty properly & begins to slowly ____ over years Uncertain Etiology: aside from parasitic _______ disease (Trypanosoma cruzi) in S. America Clinical Features: Dysphagia for ________ and ______ -Atypical central chest pain after eating/drinking -Frank ________ of ________ food; never reached stomach -Recurrent aspiration, lung infection, weight loss -Upper GI X-rays shows classic "_________" appearance Treatment: LES (balloon or bougie) dilation procedure; BoTox injection into LES; surgical revision of LES
-Achalasia -peristalsis -LES -high -dilate -Chagas -solids & liquids -regurgitation of undigested food -birds beak
Esophagus: Esophagitis Gastroesophageal Reflux Disease (GERD): Peptic Esophagitis -Weak ______ pressure allows stomach contents to reflux up into esophagus -Mucosa becomes irritated from acid, bile, and pepsin ---> inflamed and thickens -LES tone compromised by hiatal hernia, pregnancy (physiologic relaxation) -Tone decreased by : _______, ________, tomatoes, citrus fruits, garlic & onion, chocolate, alcohol, mint Clinical Features: -Recurrent ______; sometimes w/by regurgitation of stomach contents -________: burphing/partial regurgiation of stomach acid; leaves sour taste in mouth -Symptoms usually occur after meals and/or worse at night -Chronic cough; laryngitis; new or worsening asthma Treatment: __________ changes & _______ modification -no eating ___-____ hours before bed; avoid or cut back on triggering _____; raise head of bed -Meds to reduce stomach acid production and/or stimulate gastric emptying -Surgical repair if uncontrolled by meds
-LES -smoking, caffeine -heartburn -water brash -lifestyle changes & dietary modification -2-3 hours -foods
Oral Cavity: Infectious & Inflammatory Lesions Aphthous Ulcers: "Canker Sores" (Aphthous stomatitis) Etiology: unclear w/_________ link; commonly seen under age 20 -Triggers: fever, stress, smoking, hormones, certain foods, malabsorption/bowel disease Clinical Features: small, <5mm, painful, shallow ulcerations on mucosal surfaces -Gray-white center w/erythematous rim; singularly or in clusters Treatment: resolves spontaneously in few weeks; aphthous oral rinse if severe Herpetic Gingivostomatitis: "Cold Sores" -Etiology: HSV 1--virus lays dormant in CN V until reactivated -Triggers: fever, stress, cold, prolonged sun exposure, respiratory tract infection Clinical Features: single or multiple vesicles w/clear fluid typically on ________ surfaces -Outbreak preceded by tingling, itching, or burning sensation Treatment: OTC lip balms; oral antiviral meds
-immune -peri-oral surfaces
Esophagus: Developmental Disorders **Congenital disorders rarely exist along** Esophageal Atresia: congenitally "___________" lumen -Esophagus does not communicate fully with stomach; usually associated w/fistula Tracheo-Esophageal (TE) Fistula: -Abnormal connection between trachea & esophagus; allows liquid/food into lungs -Usually congenital in infants; associated w/erosion from esophageal CA in adults Clinical Features: Presents shortly after birth as infant attempts to feed -Frothy, _______ bubbles in mouth -Coughing or choking when ________ -_________ (not just spitting up) -Aspiration pneumonias Treatment: surgical connection o/w infant death occurs
-incomplete -white -feeding -vomiting
Oral Cavity: Infectious & Inflammatory Lesions Candida albicans: fungal yeast overgrowth--candida is normal flora on skin, mouth, and intestinal tract Thrush: oral candidiasis; common in ________ during breastfeeding stage. -Older children, teens, or adult--associated with ___________ -Broad spectrum antibiotics, steroids (includes inhalers), cancer, immune deficiency (AIDS) Clinical Features: -White, curd-like or "__________" plaque w/underlying erythema -tongue or inner cheeks; may involve roof of mouth, gums, tonsils, and throat -redness, burning, or pain may compromise eating and swallowing Treatment: Antifungal (nystatin) or 1% _________- -Infants and nursing mothers: antifungal dipped swabs to infant's mouth and to nipple/areola -Avoid nursing pads within bra -Clean & dry breasts after feeding
-infants -immune-compromise -cottage cheest -gentian violet
Esophagus: Barrett's Esophagitis -Repeated reflux damages normal squamous epithelium of lower esophagus -Undergoes ________ to columnar glandular epithelium w/ potential progression to CA -Patients typically have an increased risk factor due to _________ & _______ -Metaplasia may resolve if reflux is controlled
-metaplasia -smoking & ETOH
The upper GI (UGI) tract consists of what 4 structures? The Lower GI (LGI) tract starts at the _________ (suspensory muscle/ligament forming duodenal loop), consists of what 5 things?
-mouth, esophagus, stomach, duodenum -ligament of treitz -small & large intestine, appendix, rectum, anus
Esophageal: Esophageal Bleeding Mallory-Weiss Syndrome (Tear): -Shallow, __________ (longitudinal or lengthwise) tears in mucosa near gastroesophageal jxn -________ (type of people) also from severe retching or "forced" vomiting; usually self-limited Clinical Features: protracted vomiting & retching; then __________ w/blood streaks Boerhaave's Syndrome: ______ esophageal rupture/perforation into mediastinum. -Classically, follows ___________; disordered emesis mechanism w/rapid vomiting pressures -Often spontaneous without a clear vomiting episode; bending forward or during sleep Clinical Features: 30% w/triad of vomiting, chest pain, & _________. Esophageal Varices: -Dilated esophageal veins; associated w/portal hypertension & cirrhosis (alcoholism) Clinical Features: varices rupture & hemorrhage into stomach --> sudden _________. Rarely survivable unless minor bleed; IF pt survives, liver failure death w/in 1 yr
-partial -alcoholics -hematemesis -complete -overindulgence -subcutaneous emphysema -hematemesis
Oral Cavity: Salivary Gland Diseases -Three major paired salivary glands (parotid, submandibular, sublingual) and scattered minor glands _________: inflammation of major salivary glands -Viral: _________; mostly seen in children -Bacterial: Staph/Strep infx; causes supperative discharge from gland=_______ tasting; __________= stone formation in salivary duct often leads to bacterial sialedenitis -Autoimmune: chronic sialadenitis associated w/CT dz (RA, SLE); ________ syndrome (Sicca Syndrome)--dry mouth & eyes (xerostomia & xerophthalmia) Clinical Features: painful swollen salivary glands; sensitive to palpation; Either _________ (overproduction) or xerostomia (under production, dry mouth) Treatment: ABX w/Beta-lactamase inhibitor (Augmentin); Sour products to stimulate salivation; warm compress & cheek massage **Persistent/recurrent sialadenitis=starting thinking about ________**
-sialadenitis -mumps -foul tasting -sialolithiasis -Sjogren's syndrome -sialorrhea -cancer
GI System: Visceral vs. Parietal Pain Visceral ABD Pain is ________, nonspecific, poorly localized pain -crampy, dull, achy: either steady or intermittent; stretching of ________ fibers innervating hollow organ walls or solid organ capsules. As disease progresses, visceral pain may blend with parietal pain. -"_________" spasm pain--patient frequently moves & shifts position; unable to lie still or to find a comfortable position Parietal ABD Pain: ________, well localized pain -Often guarding area; pain may progress to rebound tenderness & rigidity -Irritation of fibers innervating ________ lining above or near the source of pain -Prefer to ________ or move slowly--pain worse with cough or bumpy ride to clinic Referred ABD Pain: pain felt away from where the disease originates -Pain remains on _______ side; may cross midline if dz origin is midline.
-vague -unmyelinated -colicky -point-specific -peritoneal -remain still -ipsilateral (same side)
Small & Large Intestine: Infectious Diseases Viral Gastroenteritis: occurs more frequently than known due to underreporting (disease is usually mild and self-limited) Rotavirus: children ______ months-____ years old; maternal antibodies protect during the first 6 months -_______ diarrhea but immune system easily controls Norwalk virus: highly infectious and spreads well within closed communities Locations: _________, ___________, deployed troops -Short term N/V, watery diarrhea and ABD pain Bacterial Diarrhea (enteritis): Bacterial Toxins (___________): pull fluid into bowel lumen; food poisoning -Staph. Aureus & E. Coli; Vibrio cholera from seafood Bacterial Lytic action (_________): bacteria directly invades & damages mucosa -Yersinia and Campylobacter species most common -Salmonella & Shigella--ulcerations w/entry blood & lymph (typhoid fever)
6 month-2 years old watery cruise ships, nursing homes toxigenic invasive
Small & Large Intestines: IBD (Crohn's Disease & Ulcerative Colitis) In about 20% of cases of Chron's and Ulcerative Colitis symptoms and findings often overlap, which is believed to be variants of the same disease process. What are the similarities between the two disease processes? C PASS Treatment: NO CURE but we can do what two options?
Caucasians--more common Peak onset between 20-30 y/o Altered intestinal microbiomes Strong familial trends Similar inflammatory mediators and mucosal changes suppression possible w/steroids and immunomodulators surgery to remove involved areas; particularly for Ulcerative Colitis
Small & Large Intestines: Gastrointestinal Neoplasms Esophageal Carcinoma: History of __________ & ________. 10-15x more cases in China, Iran and S. Africa -Often diagnosed late in development; <25% chance of 5yr survival Two Primary types: Upper and middle esophagus: what type of cancer? Lower esophagus: adenocarcinoma (what is a precursor for this?) Clinical Features: _________ (pain with swallowing or obstruction sensation) & Metastasis to _______ is very common.
ETOH & tobacco squamous cell carcinoma Barrett's esophagus dysphagia liver
Small & Large Intestines: Gastrointestinal Neoplasms Cancer of Oral Cavity and Tongue: -Often hx of _________ & _________; increased associated w/____ exposure -Tend to occur later in life, rare before 40 years old -Most are what type of cancer? What are the 3 primary sites? -If not discovered early, up to 80% mortality in 5 years; high metastatic rates Clinical Features: Is this painful or painless? -May cause local pain or difficulty chewing
ETOH and Tobacco HPV Vermillion border of lower lip; floor of the mouth; lateral borders tongue Usually painless
Stomach & Duodenum: Chronic Non-Erosive Gastritis Infectious Gastritis: What pathogen causes this? Most common cause of non-erosive gastritis & PUD -30-40% of US population colonized; half population w/positive antibodies to this pathogen by age _____. Predisposing factors: _________, emotional stress, alcohol, steroids Clinical features: S&S similar to ________ and other gastritis: vague epigastric pain and dyspepsia. There should be clinical suspicion for this disease if patients are unresponsive to standard GERD or ulcer treatments. Diagnosis: Endoscopy with __________ of the ulcer -Blood H. Pylori antibody test--does not R/I or R/O active infection. Why is this the case? -Urea Breath Test: H. Pylori conversion of urea to ammonia and CO2 Treatment: Often treated clinically w/o _____________ -H. Pylori easily treated with _________ and _________ (______ therapy) -Left untreated; chronic ulceration predisposes to ________
H. Pylori 60 years old smoking GERD biopsy of ulcer Once positive for antibody test, test will always be positive confirmatory evaluation antibiotics and PPIs (triple therapy) conversion to gastric cancer
Ulcerative Colitis: Affects what side of the bowels? Where do lesions begin at? ----> then spread proximally ultimately to involve entire colon Inflammation limited to what layers of ABD wall? Mucosa appears "sandpapered"---________ which bleeds easily when touched. Small remnants of normal mucosa remain appearing as _________. Damage to thinner wall of colon makes it prone to dilation --> __________: sudden rapid (few days) dilation w/life-threatening risk for rupture Clinical Features: Intermittent cycles of ______ <--> _________ -Bouts of diarrhea, ________, and ABD pain
Left sided Dz (most often affects large colon and rectum) rectum limited to colonic mucosa (NOT transmural like Crohn's) friable pseudopolyps toxic megacolon symptoms <--> no symptoms rectal bleeding
Crohn's Disease: Affects what side of the bowels? but can involve any part of GI tract from mouth to anus. Chronic inflammation that includes what layers of the intestinal wall? -_________ lesions: patchy inflammation with normal mucosa between patches. Intestinal wall becomes thickened (edema) and rigid (fibrosis) ---> _______ appearance. Edema and fibrosis make bowel prone to strictures and potential obstruction. Inflammation of ________ often creates adhesions and fistulas with adjacent loops. Clinical Features: -Initial symptoms are nonspecific thus delaying diagnosis -__________, ________, weight loss, anemias, malabsorption -Rectal bleeding and/or anal fissures---may be associated with rectoanal manifestations.
Right sided disease (mostly terminal ileum and proximal colon) skip lesions cobblestone appearance outer serosa ABD pain and diarrhea
Stomach & Duodenum: Chronic Non-Erosive Gastritis Auto-immune Gastritis: -Patient's antibodies mistakenly attack gastric parietal cells -Decreased intrinsic factor (IF) production inhibits absorption of vitamin ______ ----> ___________ anemia but ___________ symptoms usually arise before anemia onset. Body has large stores of this vitamin and S&S takes years to manifest. Clinical Features: Vague & Non-specific _________ S&S -numbness, tingling, weakness -decreased coordination & clumsiness CBC will indicate what about RBCs & WBCs? Treatment: Vitamin ________ Injections
Vitamin B12 Pernicious Anemia Neurologic Neurologic Macrocytic RBCs & Hypersegmented WBCs Vitamin B12 injections
Small & Large Intestines: Developmental Disorders Meckel's Diverticulum: -Out-pouching of small bowel--failed _______ causes the remnant from embryonic intestine-umbilicus involution -May become filled with partially digested food and/or bacteria What is the Rule of 2s? Clinical Features: S&S resemble appendicitis Treatment: Surgical removal if inflamed
apoptosis 2% of population within 2 feet of ileocecal valve 2 mucosa: 2 types of ectopic tissue (gastric and pancreatic)
Small & Large Intestines: Developmental Disorders Developmental abnormalities for the intestines are rare ___________: congenitally "incomplete" lumen; may occur anywhere along tract (imperforate anus) _____________ Disease (similar to Achalasia process) -Congenital lack of innervation to part of sigmoid colon or rectum -area without innervation remains in permanent spasm--most commonly _____________ -incomplete relaxation of rectum becomes functional obstruction -Colon does not empty properly & slowly begins to dilate ---> progresses to ________ Clinical Features: discovered early in childhood -Stool & fecal liquid sometimes _____________ as pressure builds OR fecal liquid leaks out ----> _________ -ABD swelling; poor weight gain (failure to thrive) Treatment: surgical resection of __________
atresia Hirschsprung's Disease internal anal sphincter megacolon expelled forcefully overflow diarrhea affected colon
Stomach & Duodenum: Stomach health is a balance between continuous ___________ & _________. -HCL acid & pepsin destroy mucosa <--> mucus & bicarb secretions protect mucosal lining. -___________ increase mucosal blood flow enhancing mucus & bicarb production Gastritis: Acute (erosive) Gastritis: mucosa erosions and shallow ulcers 1) ________________ leads to shock, surgery, illness 2) ______________ is caused by stress 3) ___________ (i.e. drugs, alcohol, chemical irritants, most notable drug= NSAIDs) Chronic (non-erosive) Gastritis: deeper ulcerations -Auto-immune d/o: what two diseases/processes? -Infectious agent: most commonly __________
destruction & protection prostaglandins 1)decreased gastric blood flow 2)increased acid production 3)exogenous irritants pernicious anemia; atrophic patches of gastric mucosa H. pylori
Small & Large Intestines: Vascular Diseases Hemorrhoids "piles": -Varicosities of lower rectum, anal, and perianal region from increased rectal pressure. Chronic constipation, low-fiber diet, ABD straining, prolonged sitting on toilet -If visible, ______ veins or _______ nodules filled with blood and thrombi. Internal or External designation based on location to anal ring (anorectal line) Clinical Features: most are asymptomatic and not protruding -Anal itching or irritation; pain w/BMs; swelling around anus -Bleeding variable and usually ________ -Do NOT assume rectal bleeding is from hemorrhoids alone--evaluate further Treatment: -Eat high _______ foods and plenty of _______; empty bowels when needed -OTC topical creams or cleaning pads; Sitz bath (sit in warm water) -Surgery reserved for persistently painful, bleeding, or thrombosed
dilated veins or blueish nodules painless fiber; fluids
Stomach & Duodenum: PUD What type of ulcer is 4x more common than the other? What is the most common pathogen? Clinical Features and Presentations: _________ ulcers will present with vague epigastric pain and dyspepsia ________ ulcers will erode into capillaries and blood vessels causing melena or hematemesis ___________ will erode completely through all stomach walls ----> gastric secretions & contents will spill into the peritoneum causing _________ ----> gastric air also escapes into peritoneum causing __________ to show up on ABD X-ray. Perforation may directly communicate w/ pancreas causing _________. Treatment: Shallow ulcers treated same as H. Pylori (__________ & __________); ________ is required for deep ulcers, bleeding, or perforations.
duodenal 4x more common than gastric ulcers. Duodenal ulcers may occur from teens through adulthood; gastric ulcers more likely in >50 year olds H. Pylori with same predisposing factors shallow deeper perforation peritonitis free air on ABD x-ray antibiotics and PPIs surgery
Ischemic Bowel Disease--Chronic -Associated with atherosclerosis but without an occluding thrombotic event -Chronic hypoperfusion, recurrent ischemia & small infarcts leads to fibrotic changes -Accounts for poor bowel function common in the _____ Clinical Features: often with nonspecific symptoms -_________ Pain (or "intestinal angina"). Dull, cramping ABD pain onset ___-____ min; peaking ___-___ hours after eating -"________ Fear"- postprandial pain becomes severe enough that patient fears eating. Reduces size of meals and/or eats less frequently -Weight loss- slow weight loss as patient eats less and less Treatment: no specific treatment; focused on treating associated diseases
elderly Postprandial pain 10-30 min 1-3 hours "Food Fear"
Small & Large Intestines: Infectious Diseases Peritonitis: Classification: 1)________: rupture of stomach, intestine, abscess, or spread from GYN or liver 2)_____(chemical): pancreatic enzymes, bile from ruptured gallbladder, post-surgical; either source elicits a profound inflammatory response with copious exudates; Healing often results in _______ adhesions (potential for obstruction) Clinical Features: -Sharp, intense ABD pain _________: patient typically wants to remain still -Involuntary guarding (rigidity) Treatment: Surgical exploration to repair rupture and/or wash out exudate; untreated peritonitis has high mortality risk
infectious sterile fibrous rebound tenderness
Small & Large Intestines: Vascular Diseases Ischemic Bowel Disease--Acute (__________ ischemia) -Sudden onset w/________ mortality--typically thrombus occluding mesenteric artery -Normally, collateral flow compensates; elderly w/________ have poor/no compensation -Initial segments infarct --> ________ ensues as intestinal mucosa dies and sloughs --> _______ begins as intestinal bacteria freely cross into ABD Clinical Features: ________ pain--poorly localized Red Flags: -Severe & Refractory pain (even w/narcotics)---How is pain on exam? -No signs of peritonitis initially; after bowel is dead --> rapid peritonitis -Diarrhea turning ________--guaiac negative early then becomes positive (mucosal sloughing) -N/V & Anorexia are common Treatment: Surgical Emergency
mesenteric ischemia high mortality elderly w/atherosclerosis GI bleeding Sepsis Postprandial pain Pain out of proportion on exam bloody
Appendicitis: Class pathogenesis: _________ from fecal material or inflamed tissues blocking the appendix __________ proliferates & appendix distends inflammation & compressive ischemia create _______ through wall; potential for perforation/rupture ----> spilling contents into peritoneum --> peritonitis Incidence: what age range? --mostly school-aged children & young adults (pregnancy); diagnosis often delayed in very young and old; increasing risk for perforation. Clinical Features: Starts as _____________ pain, then localizes to RLQ. -Pain localizes to RLQ @________ as peritoneum becomes irritated (pain localizes over hours to days) -Anorexia, N/V -Variable Fever and variable increased WBCs (leukocytosis) Treatment: appendectomy; some countries use an antibiotic trial first
obstruction bacteria proliferates ulcerations any age vague, peri-umbilical pain McBurney's point
Gastric Neoplasms: Incidence peaks at ________ age: many have an infection from what bacteria? -ETOH & Smoking contribute -Most common in ______ stomach; 95% are adenocarcinoma and is often found when biopsying gastric ulcer Clinical Features: __________: feeling of fullness after eating only a little -occult blood in stool due to slow gastric bleed -tends to metastasize to liver, lung, brain Intestinal Neoplasms: Peak is 50-70 y/o; 80% colon cancer cases have no associated FAMHx -_______ is predominant risk factor; Colon CA 10x more common in Western countries -What type of cancer comprises 95% of all malignant GI tumors? -Starts as adenomatous or villous ________. Any polyp seen during colonoscopy will be removed & biopsied regardless of appearance. Clinical Features: vast majority are asymptomatic until very late __________ is common--may present as an iron deficiency anemia _________--slow unintentional weight loss often goes unnoticed until significant _________ or _________--subtle signal of tumor in elderly
older age H. Pylori distal early satiety diet adenocarcinoma polyps occult bleeding weight loss constipation or change on bowel habits
Small & Large Intestines: Colonic Diverticulitis Treatment: Uncomplicated: isolated inflammation of _______ or more diverticula B A A A F Complicated: perforation, peritonitis, localized abscess, fistula formation -Admission for IV treatment and/or surgery -Surgical _________ to remove involved segment considered: -After one ______ episode..... OR -After multiple _________ episodes.
one bowel rest (NPO or liquid diet) ABX "cool off bowel" Analgesics prn Antiemetics prn Fluid and electrolyte replacement prn colectomy complicated uncomplicated
Small & Large Intestines: Bowel Ileus & Obstruction Ileus AKA "________ Ileus": -neuromusclar paralysis from inflammation or neuro disruption -Associated w/__________ (and it's causes) or spinal injury -Frequently encountered after _______ surgery or trauma---bowel temporarily "stunned" Small bowel contents are mixture of _______, ________, and swallowed _______ -Emulsion is created by peristalsis and forward movement through GI tract -Without ________ or if forward motion is blocked, the emulsion can separate out -Air becomes visible again on X-ray as air/fluid level Obstruction AKA "Obstructive Ileus" Examples: -_________ within lumen---gallstone, fecalith, tumor, foreign body -_________ of lumen--adhesions, scarring, tumor -_________ of lumen--trapped hernia, volvulus, tumor Hernia: protrusion of ABD contents through the ABD wall -_________: small bowel follows inguinal canal towards scrotum -________: small bowel follows femoral canal towards groin -__________: small bowel projects out around umbilicus -_________ (hiatal): stomach projects up into thoracic cavity Recurrent herniation causes inflammation and scarring---tightening the defect. Potential for small bowel to become trapped (incarcerated) & strangled. Obstructing digested food flow through intestine. What is the most common type of hernia?
paralytic ileus peritonitis ABD surgery food, juices, and swallowed air peristalsis obstruction stricture compression inguinal femoral periumbilical diaphragmatic (hiatal) inguinal is the most common
Stomach & Duodenum: Acute Erosive Gastritis NSAID Gastritis -NSAIDs (including ASA) inhibit ___________ synthesis. What class of NSAIDs is this? -Reduced mucosal blood flow and mucous/bicarb production -Leads to patchy necrosis of gastric mucosa and ulcerations Clinical Features: -_________________: gnawing or burning ache -____________: low grade nausea; may be either worse or better with eating -__________: may be blood-tinged or with frank blood Treatment: Stop ______________ and switch to what 2 classes of drugs?
prostaglandin COX 1 NSAIDs vague epigastric pain dyspepsia vomiting stop the offending agent (NSAIDs) switch to H2 blockers (COX 2 NSAIDs) if absolutely needed AND/OR PPI (heals ulcers faster than H2 blockers) i.e. esomeprazole, omeprazole, lansoprazole
Small & Large Intestines: Bowel Ileus & Obstruction Intussusception: -One segment telescopes into adjacent segment (usually ________ into colon). Loss of blood flow to compressed area and constricts lumen -More common in young kids (~____ years old); If adult--secondary to ______ cancers Clinical Features: Intermittent "_______" ABD pain; child writhing in pain for few minutes, then fine for few minutes, then pain Diagnosis & Treatment: _________ enema (or just ______) re-extends intestine Volvulus: -Bowel segment __________; completely obstructing lumen and blood flow -Usually _________-________ population; most often ______ intestine loops or _____ colon. -Bowel ischemia and perforation occur quickly---potentially fatal
small bowel into colon ~2 years old colon cancers "colicky" barium enema (or just air) twists upon itself middle-aged to elderly small intestine loops or sigmoid colon
